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ORIGINAL ARTICLES
The impact of adjustment disorder on the quality of life of police officers. Shibaev P.V. P.96
REVIEWS
ORGANIZATION OF HEALTHCARE
CLINICAL CASE
THESIS RESEARCHES
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THE 95TH ANNIVERSARY OF INSTITUTIONAL HEALTHCARE OF MINISTRY OF INTERNAL AFFAIRS OF RUSSIA
UDC 614.2:351.74(470+571)(091
DOI: 10.20969/VSKM.2016.9(6).9-12
SIDORENKO VITALY A., C. Med. Sci., associate professor, deputy head of the Department on material and technical
logistics of MIA of Russia, Head of Management of medical support, major general of internal service
UDC 614.2 (470.41):351.74
DOI: 10.20969/VSKM.2016.9(6).13-15
KHISAMIYEV RUSTEM SH., GINJATULLINA LJAYSAN R., AMIROV NAIL B.
Key words: medical service, Ministry of Internal Affairs, MIA pensioners
CLINICAL FEATURES OF ISCHEMIC STROKE COMPLICATED BY NOSOCOMIAL INFECTION
UDC 616.831-005.4-06:616.24-002
DOI: 10.20969/VSKM.2016.9(6).16-20
AGAFONOV KONSTANTIN I., assistant of professor of the Department of neurology and neurosurgery of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaya str., 28, e-mail: agafonov-konstantin@ya.ru
TRIASUNOVA MARINA A., neurologist of Smolensk regional Clinical hospital, assistant of professor of the Department of neurology and neurosurgery of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaya str., 28, e-mail: tryassunowa_marina@mail.ru
ALYOSHINA ELENA N., C. Med. Sci., neurologist, deputy director of Military physician board of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Smolensk region, captain of internal service, Russia, 214000, Smolensk, Oktyabrskaya revolyutsiya str., 14, e-mail: hellen.al@mail.ru
MASLOVA NATALIA N., D. Med. Sci., professor, Head of the Department of neurology and neurosurgery of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaya str., 28, e-mail: maslovasm@yahoo.com
TIMOFEEV SERGEY I., Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Smolensk region, physicion, colonel of internal service, Russia, 214000, Smolensk, Oktyabrskaya revolyutsiya str., 14, e-mail: smol.timofeev@gmail.com
TAGIEVA ELNARA J., 4th year student of the faculty of clinical psychology of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaia str., 28, e-mail: tagievamagda@mail.ru
GAPONOVA VERA N., 4th year student of the faculty of clinical psychology of Smolensk State Medical University, Russia,
214019, Smolensk, Krupskaia str., 28, e-mail: verkagap@gmail.com
Abstract. Aim. Assessment of the prevalence of infectious complications in patients with acute stroke. Establishing correlations between the presence of pneumonia and rehabilitation prognosis. Material and methods.132 hospitalized to Regional Vascular Centre of Smolensk Regional Clinical hospital patient cases were analyzed. Statistical analysis of mortality, incidence of pneumonia (clinical and x-ray features) and number of clinical pharmacologist consultation was performed. Biochemical indicators of nutritional status were also analyzed. Results and discussion. Significant correlations between hypoproteinemia, mobility disorders (according to Rankin scale, Rivermead mobility index and NIHSS) and infectious complications incidence was established (p≤0,05; rs=0,85). These complicated conditions in patients with stroke increase the duration of hospital treatment (for more than 10 days) and worsen recovery prognosis (significant correlation with mortality, p≤0,01, rs=0,67). Conclusion. Hospital patients with severe and moderate mobility disorders (4 points according to Rankin scale) require significant prevention measures for infectious complications. This group of patients needs additional nutritional support to decrease risk of infectious complications and mortality rates.
Key words: stroke, dysphagia, nosocomial infections, pneumonia.
For reference: Agafonov KI, Triasunova MA, Alioshina EN, Maslova NN, Timofeev SI, Tagieva ED, Gaponova VN. Clinical features of ischemic stroke complicated by nosocomial infection. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 16—20.
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ISSUES OF SURGICAL TREATMENT OF LIVER CIRRHOTIC PATIENTS WITH VARICEAL ESOPHAGOGASTRIC BLEEDING
UDC [616.36-004-06:616.329/.33-005.1]-089
DOI: 10.20969/VSKM.2016.9(6).20-27
ANISIMOV ANDREY YU., D. Med. Sci., professor, Head of the Department of еmergency medical care of Kazan State Medical Academy, Chief visiting surgeon of the Ministry of Health of Tatarstan Republic, Russia, 420012, Kazan, Mushtari str., 11, tel. +7-987-297-16-54, e-mail: aanisimovbsmp@yandex.ru
MAMKEEV ELDAR KH., C. Med. Sci., associate professor of the Department of epidemiology and disinfectology of Kazan State Medical Academy, Russia, 420012, Kazan, Mushtari str., 11
AMIROV NAIL B., D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
LOGINOV ALEXANDER V., surgeon of the Department of emergency of Clinical hospital № 7, Russia, 420103, Kazan, Chuikov str., 54
KUZNETSOV MAKSIM V., C. Med. Sci., deputy head physician of Clinic of Medical University, Russia, 420012, Kazan, Tolstoy str., 4
ANISIMOV ANDREY A., pediatric faculty student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49
Abstract. Aim. To improve the results of surgical treatment in patients with liver cirrhosis complicated by bleeding from varicose esophagus and stomach veins using invasive approach. Material and methods. Analysis of the results of treatment of 105 patients with liver cirrhosis with intrahepatic portal hypertension syndrome for the period 2006—2014 was performed. The 1st investigated group consisted of 77 patients with liver cirrhosis complicated by variceal esophagogastric bleeding. They underwent conservative treatment using surgical methods only as «the operation of despair». The 2nd investigated group consisted of 28 patients, whose treatment program included an active surgical approach using M.D. Patsiora surgery. Endoscopic haemostatic self-expanding nitinol Danish stent was placed in 17 patients with portal hypertension with the high risk of rebleeding instead of traditional Sengstaken-Blackmore balloon tamponade. Results and discussion. Conservative treatment does not allow avoiding a large number of complications and significantly reduces mortality rates in patients with liver cirrhosis complicated by esophagogastric bleeding. Surgical approach can reduce the total number of complications from 97,4 to 25,0%, including bleeding relapse — from 12,9 to 7,1%, liver failure — from 16,9 to 14,3%, the median festering wounds — from 6,5 to 3,6%, pneumonia and pleurisy — from 2,3 to 0%, postoperative mortality from 100 to 35,7%, hospital mortality from 76,6 to 35,7%, the time of hospital treatment of patients in class A (18,1±3,0) to (13,0±2,0) days, in class B (22,0±2,0) to (17,25±1,0) days. Conclusion. Invasive approach using M.D. Patsiora surgery helps to achieve sustainable remission of gastroesophageal bleeding as the main symptom of the disease.
Key words: portal hypertension, liver cirrhosis, variceal esophogastrical bleeding, endoscopic hemostasis, surgical treatment.
For reference: Anisimov AY, Mamkeev EH, Amirov NB, Loginov AV, Kuznetsov MV, Anisimov AA. Issues of surgical treatment of liver cirrhotic patients with variceal esophagogastric bleeding. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 20—27.
References
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17. Orloff MJ, Isenberg JI, Wheeler HO, Haynes KS, Jinich–Brook H, Rapier R, Vaida F, Hye RJ, Orloff SL. Liver transplantation in a randomized controlled trial of emergency treatment of acutely bleeding esophageal varices in cirrhosis . Transplant Proc. 2010; 42 (10): 4101–4108.
18. Eramishantsev AK, Shertsinger AG, Kitsenko EA. Portal’naya gipertenziya: klinicheskaya khirurgiya: natsional’noe rukovodstvo [Portal hypertension: clinical surgery: national guidelines]. Moskva [Moscow]: GEOTAR–Media. 2008; 626–665.
UDC 616.321/.322-002-057.36(470.53)
DOI: 10.20969/VSKM.2016.9(6).27-33
BABUSHKIN SERGEY A., Chief of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: permguvdcgsn@mail.ru
IVENSKIKH VIKTOR I., Chief of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: permguvdcgsn@mail.ru
MAMAEV ALEXEY V., deputy chief of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: permguvdcgsn@mail.ru
OZHGIBESOV GEORGY P., chief of the laboratory of bacteriological of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: medmicrobiolog@gmail.com
NIKULINA ELENA A., bacteriologist of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: medmicrobiolog@gmail.com
SHUBINA NADEZHDA V., epidemiologist of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: permguvdcgsn@mail.ru
GODOVALOV ANATOLIY P., C. Med. Sci., bacteriologist of Sanitary-Epidemiological department of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Perm region, Russia, 614000, Perm, Permskaya str., 128, e-mail: AGodovalov@gmail.com
Abstract. Aim. Analysis of characteristics of acute pharyngitis and tonsillitis morbidity among the employees of the Ministry of internal affairs of Russia in the Perm region, as well as the study of the spectrum of pathogens. Material and methods. The study of the epidemic process of acute pharyngitis and tonsillitis manifestations was based on a detailed retrospective analysis of the incidence among employees of the Ministry of internal affairs of Russia in Perm region for the period from 2003 to 2013. Microbiological study of the upper respiratory tract secretion was performed on 841 patient. Results and discussion. The incidence of acute pharyngitis and tonsillitis is a topical issue. The incidence of acute pharyngitis and tonsillitis in law enforcement officers is influenced by the complex and constant cyclic factors and by the impact of irregular accidental causes. Microbiological examination of the upper respiratory tract secretion has showed that pathological process is usually caused by association of several microorganisms. Significant etiologic agents are group A streptococci and yeast-like Candida fungi. Conclusions. The study showed remarkable reduction in the incidence of acute pharyngitis and tonsillitis, including pathogens leading position occupied by gram-positive cocci, and in particular members of the genus Streptococcus, among employees of the Ministry of internal affairs of Russia in the Perm region. Reduction of the incidence is a result of sustained and continuous activity of the sanitary and anti-epidemiological service, affecting all the parts of the epidemic process.
Key words: long-term dynamics of morbidity, pharyngitis, tonsillitis, acute respiratory infections, Streptococcus spp.
For reference: Babushkin SA, Ivenskih VI, Mamaev AV, Ozhgibesov GP, Nikulina EA, Shubina NV, Godovalov AP. Epidemiological and microbiological aspects of the incidence of acute pharyngitis and tonsillitis among employees of the Ministry on internal affairs of Russia in the Perm region. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 27—33.
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UDC 617.586:616.5-002.44-009.85-089.844
DOI: 10.20969/VSKM.2016.9(6).33-38
VALEEV MARAT M., D. Med. Sci., professor of the Department of traumatology and orthopedics of Bashkir State Medical University, Russia, 450000, Ufa, Lenin str., 3, tel. 8-917-463-80-90, e-mail: valeevmm@rambler.ru
BIKTASHEVA ELINA M., postgraduate student of the Department of traumatology and orthopedics of Bashkir State Medical University, Russia, 450000, Ufa, Lenin str., 3
KHALIKOV RUSTAM A., Head of the Department of dispensary № 2 of Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Bashkortostan, Russia, 450015, Ufa, K. Marx str., 59
KHALIKOVA LEYSAN N., transfusiologist of the Department of blood transfusion unit of G.G. Kuvatov Republic Clinical Hospital, Russia, 450005, Ufa, Dostoevsky str., 132
NIGMATULLIN RUSTEM KH., C. Med. Sci., deputy head of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Bashkortostan, Russia, 450015, Ufa, K. Marx str., 59, tel. 8-917-773-81-92, e-mail: nigrustem@yandex.ru
Abstract. Aim. Improvement of results of surgical treatment and postoperative management of patients with neurotrophic ulcers of the load zone of calcaneal region of the foot based on composite perfused skin flaps. Material and methods. Long-term results of surgical treatment of 37 patients with neurotrophic ulcers of the pressed zone of the foot calcaneal area using compound vascularized flaps were presented. All patients had a history of spinal injuries: falls from height, road accident or mine blast injuries. Results and discussion. Assessment of quality of life of the patients treated showed that depression level before and after surgery decreased from 36,5 to 26,5 scores, trait anxiety level — from 45,8 to 19 as well as the rates of general health, physical, role, social and emotional functioning. Auto transplantation turned out to be successful. A five-year follow-up period showed that three patients had flap ulcerations and two — clavus in cicatrix area. Conclusion. Proposed integrated approach using vascularised complex set of patches is optimal. It significantly improves the quality of life of patients with neurotrophic ulcer of the supporting area of calcaneal region of the foot.
Key words: neurotrophic ulcer, foot, calcaneal area, skin grafting, compound flaps, plastic surgery, microsurgery.
For reference: Valeyev MM, Biktasheva EM, Khalikov RA, Khalikovа LN, Nigmatullin RCh. Surgical treatment and postoperative management of patients with neurotrophic ulcers of the pressed zone of the foot calcaneal region using compound flaps. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 33—38.
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12. Biktasheva EhM, Minasov BSh, Valeev ММ. Mikrohirurgicheskie tekh–nologii pri lechenii bol’nyh s obshirnymi defektami myagkih tkanej pro–ksimal’nyh otdelov stopy [Microsurgical technologies in the treatment of patients with extensive soft tissue defects of the proximal foot]. Prakticheskaya medicina [Practical medicine]. 2015; 6 (91): 90–93.
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15. Shaw WW, Hidalgo DA. Anatomic basis of plantar flap design: clinical applications. Plast Reconstr Surg. 1986; 78: 637.
CHARACTERISTICS AND PREDICTORS OF SLEEP DISTURBANCES IN LAW-ENFORCEMENT OFFICERS
UDC 616.8-009.836-057.36(571.56)
DOI: 10.20969/VSKM.2016.9(6).39-43
GOLOKOV VLADISLAV A., C. Med. Sci., internal services major, Head of the Department of neurology of the Medical Care unit of the Ministry of Internal Affairs of Russia in Yakutia region, Russia, 677005, Yakutsk, Sverdlov str., 1/2, e-mail: yamchik@inbox.ru
SHNAYDER NATALIA A., D. Med. Sci., professor, Head of the Department of medical genetics and clinical neurophysiology of V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Russia, 660022, Krasnoyarsk, Partisan Zheleznyak str., 1, e-mail:naschnaider@yandex.ru
NIKOLAEVA TATJANA YA., D. Med. Sci., professor, Head of the Department of neurology and psychiatry of M.K. Ammosov Nord-East Federal University, Russia, 677000, Yakutsk, Petr Alekseev str., 83а, e-mail: tyanic@mail.ru
DOLINSKAYA ELVIRA A., colonel of internal service, Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in Yakutia region, Russia, 677005, Yakutsk, Sverdlov str., 1/2, e-mail: mshmvdrsy@mail.ru
SOLOVYEVA SARDANA F., lieutenant colonel of internal service, Head of the Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in Yakutia region, Russia, 677005, Yakutsk, Sverdlov str., 1/2, e-mail: mshmvdrsy@mail.ru
GOLOKOVA ELENA A., neurologist of the Department of functional diagnostics of Republic Hospital № 2, Russia, 677005, Yakutsk, Petr Alekseev str., 83а, e-mail: ele-stars@mail.ru
KANTIMIROVA ELENA A., C. Med. Sci., assistant of professor of the Department of medical genetics and clinical neurophysiology of V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Russia, 660022, Krasnoyarsk, Partisan Zheleznyak str., 1, e-mail: kantilea@mail.ru
Abstract. Aim. Assessment of sleep disturbances in law-enforcement officers. Material and methods. 120 Internal Affairs service employees were examined. All patients have taken sleep-screening questionnaire including information on the lifestyle and occupation, complaints, health risks, related illnesses and assessment according to Epworth Sleepiness Scale. Results and discussion. The analysis of the results showed that the most prevalent predictors of sleep disturbances in police officers are tea and coffee consumption and smoking without statistically significant gender differences. Men compared to women significantly more often state mixed schedule, 1st degree obesity, complaints on snoring as well as they indicate longer duration and frequency of daytime sleep in a week, while women present significantly higher figures of the total duration of awakenings during the night sleep and the average amount of time required to sleep. Conclusion. The prevalence of major significant risk factors in men may cause a more pronounced negative effect on the function of sleep.
Key words: sleep disturbances, predictors, police staff, Epworth Sleepiness Scale.
For reference: Golokov VA, Shnayder NA, Nikolaeva TY, Dolinskaya EA, Solovyeva SF, Golokova EA, Kantimirova EA. Characteristics and predictors of sleep disturbances in law-enforcement officers. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 39—43.
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9. Shnayder NA, Demko IA, Alekseeva OI, Petrova MM, Kantimirova EA, Strockaja IG, Djuzhakov SK. Fenotipicheskie i genotipicheskie faktory riska sindroma obstruktivnogo apnoje / gipopnoje sna [Phenotypic and genotypic risk factors for obstructive sleep apnea / hypopnea]. Problemy zhenskogo zdorov’ja [Women’s Health Issues]. 2015; 10 (2): 55–64.
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13. Polujektov MG, Levin JaI. Narushenija sna v obshhej medicinskoj praktike [Sleep disorders in common medical practice]. Doktor RU [Doctor RU]. 2012; 5 (73): 34–39.
14. Kalinkin AL. Kardiovaskuljarnye oslozhnenija i prognosticheskoe znachenie obstruktivnogo apnoje sna [Cardiovascular complications and prognostic significance of obstructive sleep apnea]. Doktor RU [Doctor RU]. 2014; 2 (90): 72–75.
PSYCHOSOCIAL ADAPTATION OF POLICE OFFICERS WITH A HISTORY OF BORDERLINE MENTAL DISORDERS
UDC 616.89-057.36(470.342)
DOI: 10.20969/VSKM.2016.9(6).43-47
ZLOKAZOVA MARINA V., D. Med. Sci., professor, Head of the Department of psychiatry and addiction medicine of V.A. Bagaev Kirov State Medical Academy, Russia, 610998, Kirov, K. Marx str., 112
ICHETOVKINA ELENA G., C. Med. Sci., Head of the Centre of psychophysiological diagnostics of the Medical Care unit of the Ministry of Internal Affairs, lieutenant colonel of internal service, Russia, 610000, Kirov, Talitsa, Prokhladnaya str., 6в, e-mail: elena.ichitovckina@yandex.ru
EPSHTEIN ANDREY M., C. Med. Sci., Honored doctor of the Russian Federation, Head of the Medical Care unit of the Ministry of Internal Affairs, retired colonel of internal service, Russia, 610000, Kirov, Talitsa, Prokhladnaya str., 6в, e-mail: ame1957@yandex.ru
Abstract. Aim. To analyze psychosocial adaptation of police combatants with transient affective reactions and borderline mental disorders four years after the execution of operational tasks in particular conditions. Material and methods. 954 police officers of the Ministry of internal Affairs were surveyed across the Kirov region. The officers were divided into three groups according to the level of mental health: I gr. — 338 healthy employees; II gr. — 311 people who had shown transient affective behavioral reactions (educational staff); III gr. — 305 people with a history of borderline mental disorders treated in a period between the travel orders. The protocols of psycho physiological examination of police officers were analyzed in dynamics (after a travel order and in four years). Results and discussion. The results of the follow-up study showed that social adaptation of ex-combatants, police officers treated for the border psychic disorders in history in majority of cases are positive. Successful maintenance of the service with a low number of disciplinary violations, more stable family relationships and low risk of destructive aggressive actions was seen. The combatants with a history of educational staff not receiving care timely present with a lower level of social adaptation, combatant accentuation are being formed. Conclusion. Creation of fundamentally new diagnostic and treatment structure in mental health centers on the basis of existing centers of psycho physiological diagnostics at Medical units of the Ministry of internal Affairs in the regions of the Russian Federation is required in order to improve the quality of medico-psychological support of combatants.
Key words: combatants, rehabilitation, borderline mental disorders, transient affective-behavioral responses.
For reference: Zlokazova MV, Ichetovkina EG, Epstein AM. Psychosocial adaptation of police officers with a history of borderline mental disorders. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 43—47.
References
1. Ichitovkina EG, Zlokazova МV, Soloviev AG. Vlijanie lichnostnyh i psihosocial’nyh harakteristik na razvitie pogranichnyh psihicheskih rasstrojstv u kombatantov ministerstva vnutrennih del [Effects of personal and psychosocial characteristics on a progress of borderline mental disorders in combatants of the Ministry of Internal Affairs]. Vestnik psikhoterapii [The Bulletin of Psychotherapy]. 2011; 37 (42): 56–68.
2. Myagkikh NI, Krylova NI. Teorija i praktika psihologii krizisnyh situacij [Theory and practice of psychology crisis]. Meditsinskii vestnik MVD [Medical messenger of the Ministry of Internal Affairs]. 2010; 5: 5–8.
3. Permogorskaya EМ, Padun MA. Posttravmaticheskij stress i semejnye otnoshenija u sotrudnikov OVD — uchastnikov kontrterroristicheskih operacij na Severnom Kavkaze [Post–traumatic stress and family relationships in Police Officers — Members of counterterrorism operations in the Northern Caucasus]. Psikhologicheskie issledovaniya: elektronnyi nauchnyi zhurnal [Psychological researches: electronic scientific magazine]. 2011; 3 (17): Available at: URL: http:// psystudy. ru. 0421 100116\0031
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5. Prikaz MVD Rossii ot 12.01.2012 № 5 «O provedenii medico-psihologicheskoj reabilitacii sotrudnikam organov vnutrennih del Rossijskoj Federacii» [The Ministry of internal Affairs order dated 12.01.2012 № 5 «About carrying out medico-psychological rehabilitation of employees of internal Affairs bodies of the Russian Federation»].
UDC 616.127-005.8-053.9-085
DOI: 10.20969/VSKM.2016.9(6).47-51
ISAKOV LEONID K., C. Med. Sci, assistant of professor of the Department of primary health sector physician training of Kemerovo State Medical University, Russia, 650029, Kemerovo, Voroshilov str., 22a, doctor of ultrasonic diagnosis of the Medical Care unit of the Ministry of Internal Affairs of Russia in Kemerovo region, Russia, 650000, Kemerovo, Kuzbasskaya str., 10a, tel. +7-904-376-04-95, e-mail: isakovy@inbox.ru
SINKOVA MARGARITA N., C. Med. Sci., assistant of professor of the Department of primary health sector physician training of Kemerovo State Medical University, Russia, 650029, Kemerovo, Voroshilov str., 22a, tel. +7-903-048-73-31, e-mail: margov@inbox.ru
LEBEDEVA NATALIA B., D. Med. Sci., professor of the Department ofprimary health sector physician training of Kemerovo State Medical University, Russia, 650029, Kemerovo, Voroshilov str., 22a, tel. +7-903-993-10-26, e-mail: lebenb@mail.ru
TARASOV NIKOLAY I., D. Med. Sci., professor, Head of the Department of primary health sector physician training of Kemerovo State Medical University, Russia, 650029, Kemerovo, Voroshilov str., 22a, tel. +7-905-900-46-33, e-mail: tarassov53@mail.ru
VATUTIN MAXIM K., C. Med. Sci., Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in Kemerovo region, Russia, 650000, Kemerovo, Kuzbasskaya str., 10a, tel. +7-906-933-96-07, e-mail: maksimvatutin@yandex.ru
MESYATS LUDMILA A., Head of the Department of functional diagnostics of the Medical Care unit of the Ministry of Internal Affairs of Russia in Kemerovo region, Russia, 650000, Kemerovo, Kuzbasskaya str., 10a, tel. +7-906-923-11-32, e-mail: mesiats@inbox.ru
Abstract. Aim. Investigation of efficacy and safety of supplemental myotropic cytoprotecton with meldonium dihydrate and of inotropic stimulation with levosimendan comparing to standard treatment of elderly patients with myocardial infarction complicated by heart failure stage II—III (Killip classification). Material and methods. 70 patients were randomized into two groups, both groups received standard therapy for complicated myocardial infarction including percutaneous transluminal coronary angioplasty. Patients at the second group additionally received meldonium and levisimendan. Results and discussion. Safety and efficiency of the therapy in treatment of complicated infarction was demonstrated. The result is due to the mutually reinforcing effects of these two drugs when administered together. Conclusions. An additional administration of Meldonium dihydrate and levosimendan in combined therapy of elderly patients with complicated myocardial infarction is safe. It leads to decrease in mortality rates as well as the frequency of relapses and severity of arrhythmic complications during hospital treatment.
Key words: myocardial infarction, elderly patient, acute heart failure, myocardial cytoprotection, inotropic stimulation.
For reference: Isakov LK, Sinkova MN, Lebedev NB, Tarasov NI, Vatutin MK, Mesyats LA. An elderly patient with complicated myocardial infarction: focus on inotropic stimulation and cytoprotection. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 47—51.
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2. Syrkin AL. Infarct miokarda [Myocardial infarction]. M: Medicinskoe Informatisionnoe Agenstvo. 2006; 464 p.
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ATOPIC ECZEMA TREATMENT IN ADOLESCENTS AND ADULTS: PROBLEMS AND SOLUTIONS
UDC 616.516.5-085.276
DOI: 10.20969/VSKM.2016.9(6).52-57
KAMASHEVA GULNARA R., C. Med. Sci., associate professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail:kamasheva73@rambler.ru
NADEEVA ROZALIYA А., C. Med. Sci., associate professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: rosa.nadeeva@gmail.com
AMIROV NAIL B., D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, deputy director of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Kazan, Orenburgsky trakt str., 132, tel. 8-843-291-26-76, e-mail: namirov@mail.ru
Abstract. Aim. Analysis of the antecedent treatment and evaluation of effectiveness of «proactive» external treatment of atopic eczema in adolescents and adults. Material and methods. 20 patients with exacerbation of atopic eczema aged 15 to 30 [mean age (18,1±3,7)], including 13 women and 7 men were being observed. Moderate variant was seen in 85%, severe — in 15% of patients. Antecedent treatment was evaluated according to the results of survey data and medical documentations. Topical therapy consisted of daily application of 0,1% methylprednisolone aceponate until complete relief of signs of allergic skin inflammation with subsequent transition to «proactive» therapy, which consisted of intermittent application of the medication on previously affected areas of skin 2—3 times a week. Clinical efficacy was determined using SCORAD index on 2-nd, 4-th and 8-th week of treatment. Results and discussion. In 60% of patients antecedent treatment did not meet national guidelines or medical standards of care for patients with atopic eczema. Steroidophobia was detected in 60% of patients. Significant reduction of SCORAD index as well as the lesion size and intensity of pruritus compared to antecedent treatment (p<0,001) and reduced frequency of exacerbations of atopic eczema appeared as a result of therapy on 2-nd, 4-th and 8-th weeks. Conclusion. High frequency of steroidophobia and maladjustment of atopic eczema treatment to the national guidelines and standards significantly reduce the quality of treatment. «Proactive» external therapy with topical corticosteroids is effective and safe. It reduces the frequency of early relapse and extends clinical remission of the disease.
Key words: atopic eczema, adolescents, adults, «proactive» therapy, topical corticosteroids.
For reference: Kamasheva GR, Nadeeva RА, Amirov NB. Atopic eczema treatment in adolescents and adults: problems and solutions. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 52—57.
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1. Haitov PM, Il’ina NI. Allergologija i immunologija. Nacional’noe rukovodstvo [Allergology and immunology. National guideline]. Moskva: «GJeOTAR–Media» [Moscow: «GEOTAR–Media»]. 2009; 656 p.
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3. Akdis CA, Akdis M, Bieber T et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Aca-
demy of Allergology and Clinical Immunology, American Academy of Allergy, Asthma and Immunology. PRACTALL Consensus Report. Allergy. 2006; 61: 969–987.
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MEDICAL, SOCIAL AND CLINICAL CHARACTERISTICS OF ELDERLY GLAUCOMA PATIENTS
UDC 617.7-007.681-053.9(571.150)
DOI: 10.20969/VSKM.2016.9(6).58-61
MAKOGON ALEXANDER S., C. Med. Sci., associate professor, Head of the Course of eye diseases supervisor of Altay State Medical University, Russia, 656038, Barnaul, Lenin ave., 40, tel. 8-913-210-26-21, e-mail: mas65@mail.ru
MAKOGON SVETLANA I., C. Med. Sci., internal service major, ophthalmologist of the Medical Care unit of the Ministry of Internal Affairs of Russia in Altai territory, Russia, 656056, Barnaul, Anatolia str., 66, tel. 8-913-096-58-00, e-mail: vvk_msi@mail.ru
Abstract. Aim. The study of medical, social and clinical characteristics of elderly patients with glaucoma. Material and methods. The questionnaire including medical and social aspects of patients with primary open angle glaucoma was created. The survey was taken by 366 patients with glaucoma of I, II, III and IV stages living in the Altai territory and being treated at the Regional ophthalmologic Hospital. 3 groups were formed: group 1 — 104 patients of middle age (45—59 years), 42,3% (44) males and 57,7% (60) females, group 2 — 164 advanced people (60—74 years) — 40,2% (66) males and 59,8% (98) females, group 3 — 98 senile patients (75 years and older) — 36,7% (36) men and 63,3% (62) women. Results and discussion. The sociological study of glaucoma patients of different age groups showed that the patients in older age groups are characterized by higher index of comorbidity (5,4±0,3) rather than middle-aged patients (2,3±0,2). Psychological status of elderly patients was characterized by significantly lower parameters compared to those of middle aged ones. Conclusion. More than the half of senile patients rated their health as poor (62,2%), advanced persons (59,1%) and middle-aged group (70,2%) as satisfactory.
Key words: glaucoma, age groups, health and social characteristics.
For reference: Makogon AS, Makogon SI. Medical, social and clinical characteristics of elderly glaucoma patients. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 58—61.
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13. Rusina EV. Problemy glaukomnoi sluzhby v Kaliningradskoi oblasti [Problems of cataractogenesis in the Kaliningrad region]. Glaukoma: teorii, tendentsii, tekhnologii. [Glaucoma: theory, trends, technologies]. 2010; 327-332.
14. Dmitrieva TV. Povtornaya invalidnost’ vsledstvie miopii v Belgorodskoi oblasti v dinamike za 2006-2010 gody [Repeated disability due to myopia in the Belgorod region for 2006-2010 years]. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta; Meditsina; Farmatsiya [Scientific statements, Belgorod State University; Medicine; Pharmacy]. 2012; 10 (18/1): 148-153.
THE FEATURES OF COMORBIDITY IN PRIMARY OPEN-ANGLE GLAUCOMA PATIENTS IN DIFFERENT AGE GROUPS
UDC 617.7-007.681-053.9(571.150)
DOI: 10.20969/VSKM.2016.9(6).61-66
MAKOGON SVETLANA I., C. Med. Sci., major of internal service, ophthalmologist of the Medical Care unit of the Ministry of Internal Affairs of Russia in Altai territory, Russia, 656056, Barnaul, Anatolia str., 66, tel. 8-913-096-58-00, e-mail: vvk_msi@mail.ru
MAKOGON ALEXANDER S., C. Med. Sci., associate professor, Head of the Course of eye diseases supervisor of Altay State Medical University, Russia, 656038, Barnaul, Lenin ave., 40, tel. 8-913-210-26-21, e-mail: mas65@mail.ru
Abstract. Aim. Analysis of comorbidity in patients with primary open-angle glaucoma in different age groups. Material and methods. Analysis of 1098 patients’ data with a diagnosis of primary open-angle glaucoma of I, II, III and IV stages, who received treatment for glaucoma in Altai Regional Eye Hospital from 2013 to 2015. 3 groups were formed: group 1 — 312 middle-aged patients (45—59 years), group 2 — 492 people of advanced age (60—74 years), group 3 — 294 senile patients (75 years and older). Results and discussion. Analysis of comorbidities helps to create the conditional «portrait» of a patient with glaucoma. Thus, middle-aged patient has an index of comorbidity of 1,5 in ophthalmic pathology, cataract was seen in 37,5%, 18,0% presented with the «dry eye» syndrome and in 11,2% were diabetic changes on the fundus. The index of comorbidity on the somatic pathology is 1,7. 36,9% patients suffer from hypertension, 16,3% of thyroid disease; diseases of the digestive system are seen in 14,1% of patients. Senile patients with comorbidity index of 1,9 for eye diseases and 2,3 for somatic pathology presented with cataract in 48,0%, in 28,75% with «dry eye» syndrome, 26,8% got operated for cataract, 17,9% have senile macular degeneration; among somatic diseases: 53,9% have hypertension, 28,0% — coronary disease, COPD is seen in 21,1%, 17,3% present with encephalopathy. Senile patients with comorbidity index of 2,4 and 3,4 for ophthalmic and somatic pathology, have cataract in 62,9%, 48,0% suffer from «dry eye» syndrome, 37,4% — senile macular degeneration, 36,7% — pseudophakia. Among the somatic diseases the most prevalent are hypertension (34,7%), COPD (24,5%) and encephalopathy (25,9%). Conclusion. Comorbidity index by the ophthalmic and somatic pathology significantly increases with the age. Cataract, senile macular degeneration, hypertension, coronary heart disease and encephalopathy can be considered as syntropic for glaucoma.
Key words: comorbidity, comorbidity index, glaucoma.
For reference: Makogon SI, Makogon AS. The features of comorbidity in primary open-angle glaucoma patients in different age groups. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 61—66.
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UDC 616.12-008.331.1-037:616.133-073.432.19
DOI: 10.20969/VSKM.2016.9(6).67-72
MAYANSKAYA SVETLANA D., D. Med. Sci., professor of the Department of hospital terapy of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. (843)236-09-22, e-mail: smayanskaya@mail.ru
GREBYONKINA IRINA A., C. Med. Sci., associate professor of the Department of outpatient medicine and general practice (family medicine) of Novosibirsk State Medical University, Russia, 630092, Novosibirsk, Кrasniy ave., 52, tel. 8-913-928-41-16, e-mail: iren-quaf@yandex.ru
OSHCHEPKOVA OLGA B., Head of the Department of cardiology of Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. 8-905-039-43-55, e-mail: oschepkova.kazan@mail.ru
MIKHOPAROVA OLGA YU., Head of the Department of functional diagnostics of Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. 8-937-525-53-61, e-mail: Olga-mihoparova@rambler.ru
Abstract. Aim. Evaluation of the intima-media thickness of the common carotid artery in young individuals with family history of hypertension. Material and methods. The study included 104 individuals [62 women and 42 men, mean age (23,9±2,7) years] with family history of hypertension. Control group consisted of 36 persons of the same age and gender, but without hypertension in family history. All of them have undergone outpatient blood pressure monitoring, ultrasound of the carotid arteries as well as they had blood lipids test. Results and discussion. According to the blood pressure monitoring results all patients were divided into 3 groups: 1 — hypertensive patients; 2 — persons with high normal blood pressure; 3 — persons with normal blood pressure. Statistically significant increase of common carotid artery intima-media thickness and common carotid artery diameter in systole in groups 1 and 2 compared to patients of 3-d and the control group (p<0,001; p<0,01; p<0,05) was revealed. In addition, patients with hypertension presented with association of common carotid artery intima-media thickness with age, the average daily level of systolic blood pressure, diastolic blood pressure and pulse pressure as well as the degree of reduction in diastolic blood pressure and night level of total serum cholesterol. Conclusion. The results of evaluation of common carotid artery intima-media thickness in patients with family history of hypertension may have a prognostic value in the development of hypertension and atherosclerosis. Revealed increase of common carotid artery intima-media thickness in patients with high normal blood pressure even before the development of hypertension proposes its primary nature.
Key words: hypertension, hereditary load, common carotid artery, the thickness of the intima-media complex.
For reference: Mayanskaya SD, Grebenkina IA, Oshchepkova OB, Mihoparova OJ. Intima-media thickness of common carotid artery as an early predictor of arterial hypertension in patients with hereditary load. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 67—72.
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UDC 616-057.36-084(470.64)
DOI:10.20969/VSKM.2016.9(6).72-76
MURTAZOV ALBERT M., C. Med. Sci., Head of the Center of psychophysiological diagnostics of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, the colonel of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8-928-711-44-10
SHOGENOV AKHMED G., C. Med. Sci., Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, the colonel of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8 (8662) 44-28-11, e-mail: mdo.kbr@list.ru
ELGAROV ANATOLY A., D. Med. Sci., professor, general practitioner of Clinic outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8-928-589-58-58
KRAVTSOV ALEXANDER V., С. Psych. Sci., deputy head of the Center of psychophysiological diagnostics of the Medical Care unit of the Ministry of Internal Affairs of Russia in Kabardino-Balkar Republic, major of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8-928-913-57-82
MAKITOVA MARIANNA P., doctor-supervisor of the Department of organizational methodical medical and preventive provision of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, senior lieutenant of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8 (8662) 49-44-63
ASHKHOTOV ELBERD R., C. Med. Sci., Head of the Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in Kabardino-Balkar Republic, major of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8 (8662) 49-49-05
ZHIRIKOV ALIM YU., Head of Clinic outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, senior lieutenant of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. 8 (8662) 49-45-88
Abstract. Current issues of medical and psychological support of activities of internal affairs bodies’ employees are being discussed. Aim. Assessment of effectiveness of comprehensive medical and psychological support of employees of Internal Affairs bodies taking into account specifics of professional activities in North Caucasus region. Material and methods. Epidemiological survey of 390 1st and 2nd intent group employees of internal Affairs bodies aged 30—55 years with 10 year duration of service before and after preventative and individual rehabilitation measures was carried out. Results and discussion. Due to gradual implementation in the Federal state healthcare institution «Medical unit of the Ministry of internal affairs of Russia in the Kabardino-Balkar Republic» departmental profile, «Center for restorative medicine and rehabilitation of the Ministry of internal affairs of Russia» a positive dynamics of important physiological parameters and clinical-dynamic indicators of health was seen in police officers with stress-induced adjustment disorder and hypertensive reactions. The possibility of increasing levels of adoption and active use of modern technologies in the Center for psychophysiological diagnostics was seen in assessment of the effectiveness of diagnostic, therapeutic and rehabilitation activities in departmental health on the basis of analysis of the results. Conclusion. Systematic set of measures aiming for implementation of medical and psychological rehabilitation should be considered as effective rehabilitation program in the framework of medical and psychological support organization ensuring professional longevity of Internal Affairs bodies’ employees.
Key words: medical and psychological support, monitoring, prevention, professional longevity, police.
For reference: Murtazov AM, Shogenov AG, Elgarov AA. Kravtsov AV, Makitova MP, Ashkhotov ER. Twenty year experience of the medical and psychological support of activities of employees of internal affairs bodies. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 72—76.
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UDC 616.34-009-052
DOI: 10.20969/VSKM.2016.9(6).76-81
SPIRIDONOV ALBERT V., C. Med. Sci., deputy chief of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, tel. +7(843) 291-86-94, e-mail: 89046668452@bk.ru
ABSALJAMOVA LEJLE R., Head of the Department of gastroenterology of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, tel. +7(843) 291-86-8, e-mail: 89046668452@bk.ru
GIMALETDINOVA IRINA A., gastroenterologist of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, tel. +7(843) 291-86-85, e-mail: 89046668452@bk.ru
Abstract. Aim. Quality of life assessment in persons with irritable bowel syndrome among the office workers. Material and Methods. 32 patients with irritable bowel syndrome aged 19—46 years were examined. Statistical processing was performed using Statistica 7 software. Statistical methods such as comparison of relative values and variation series methods of nonparametric statistics were applied. The level of significance was estimated as p˂0,05. Results and discussion. The category of office workers were classified as persons who take sitting position with low physical activity 60% or more working time. The diagnosis of irritable bowel syndrome and the disease form were set according to the Rome criteria III. Depending on the form of irritable bowel syndrome the patients were divided into groups: irritable bowel syndrome with constipation, irritable bowel syndrome with diarrhea, mixed irritable bowel syndrome and undifferentiated irritable bowel syndrome. The patients having the symptoms of anxiety were excluded from the study. Conclusion. The quality of life assessment according to the simplified (short) questionnaire on the outpatient treatment by the World Health Organization allows the doctor to evaluate the internal condition of the patient reasonably prior to the medical treatment, to assess effectiveness of the therapy at the follow-up control, to identify the worsening of quality of life indicators timely as well as to carry out the diagnosis of possible functional abnormalities.
Key words: irritable bowel syndrome, quality of life, diagnostics, clinic.
For reference: Spiridonov AV, Absaljamova LR, Gimaletdinova IA. Appliance of the short questionnaire of WHOQOL-BREF by the WHO for quality of life assessment in irritable bowel syndrome patients. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 76—81.
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11. Nemcov VI. Sindrom razdrazhennogo kishechnika: novye predstavlenija ob jetiopatogeneze i lechenii [Syndrome of the angry intestines: new ideas of an etiopatogeneza and treatment]. Lechashhij vrach [Attending physician]. 2015; 6: http: //www.lvrach.ru/ 2015/06/15436246/
12. Spiridonov AV. Rol’ fitoterapii pri sindrome razdrazhennogo kishechnika [A phytotherapy role in case of a syndrome of the angry intestines]. Nauchnyj al’manah [The Scientific almanac]. 2015; 8 (10): 989-1001.
13. Jakovenko AV, Ivanov AN, Prjanishnikova AS, Agafonova NA, Jakovenko JeP. Patogeneticheskie podhody v lechenii sindroma razdarzhennogo kishechnika [Pathogenetic approaches in treatment of a syndrome of razdarzhenny intestines]. Lechashhij vrach [The attending physician]. 2011; 7: http://www.lvrach.ru/2011/07/15435230
UDC 613.81-057.36(470.332)
DOI: 10.20969/VSKM.2016.9(6).82-84
TIMOFEEV SERGEY I., Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in Smolensk region, colonel of internal service, Russia, 214000, Smolensk, Oktiaborskaya revolutsiya str., 14, tel. (4812) 65-31-51
SERGEENKO ZHANNETA I., Head of the Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in Smolensk region, lieutenant colonel of internal service, Russia, 214000, Smolensk, Oktiaborskaya revolutsiya str., 14, tel. (4812) 40-50-97
LISTOPADOVA MARIA V., C. Med. Sci., physician of the Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Smolensk region, Russia, 214000, Smolensk, Oktiaborskaya revolutsiya str., 14, tel. 8-950-705-26-76, e-mail: listopadovamasha@mail.ru
GUBANKOVA GALINA V., functional diagnostics physician of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Smolensk region, Russia, 214000, Smolensk, Oktiaborskaya revolutsya str., 14, tel. (4812) 77-38-97
LITVINOVA EKATERINA S., student of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaya str., 28, tel. 8-961-138-34-40
SHPAKOV ALEXANDER V., resident of the Department of general practice with a course of outpatient medicine of Smolensk State Medical University, Russia, 214019, Smolensk, Krupskaya str., 28, tel. 8-910-767-76-28
Abstract. Aim. To assess effectiveness of monitoring management as well as the outpatient medical care provided for smoking certified employees on the basis of Medical Unit of the Ministry of Internal Affairs of Russia in Smolensk region. Material and methods. The study included certified employees with the history of smoking at the time of the clinical examination in 2015. The basis of the monitoring organization was the letter of the Ministry of Health and Social Development of the Russian Federation from May 5, 2012 № 14-3/10/1-2817 «Providing healthcare to adults for the smoking prevention and cessation». Results and discussion. 39,9% (n=46) of respondents had high level of nicotine dependence, 27,6% and 21,5% of smokers had average and low degree of dependence respectively. 29,4% of the employees had high motivation to give up smoking initially. Taking smoking status in consideration differential approach of medical care was applied. During individual monitoring 41,4% (n=48) certified employees gave up smoking; 50,8% (n=59) of smokers reduced the number of cigarettes per day and decided to complete smoking cessation. Conclusion. Results of this study confirm the effectiveness of individual monitoring of assistance in smoking cessation. Necessity of comprehensive approach in organization of individual consultations, education and training of smoking employees is verified.
Key words: smoking, smoking cessation.
For reference: Timofeev SI, Sergeenko JI, Listopadova MV, Gubankova GV, Litvinova ES, Shpakov AV. Organization of monitoring of smoking in certified employees on the basis of medical unit of the Ministry of Internal Affairs of Russia in Smolensk region. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 82—84.
References
1. Zaridze DG, Karpov RS, Kiseleva SM. Kurenie — osnovnaja prichina vysokoj smertnosti rossijan [Smoking –– the main reason for the high death rate of Russians]. Vestnik RAMN [Herald RAMN]. 2002; 9: 40–45.
2. Global’nyj opros vzroslogo naselenija o potreblenii tabaka (GATS), stranovoj otchet [The global survey of adults about tobacco use (GATS)]. Rossijskaja Federacija [Russian Federation]. 2010; 172 p.
3. Amirov NB, Andreeva TI. Tabachnaja jepidemija: Farmakologicheskie vozmozhnosti bor’by [The tobacco epidemic: The pharmacological possibilities of struggle]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2011; 4 (3): 28––33.
4. Krivonos OV, Bojcov SA, Gambarjan MG, Kalinina AM. Okazanie medicinskoj pomoshhi po profilaktike i otkazu ot kurenija: metodicheskie rekomendacii Minzdrava Rossii [Providing medical care for the smoking prevention and cessation: Russian Ministry of Healthcare guidelines]. Moskva: «Gosudarstvennyj nauchno––issledovatel’skij centr profilakticheskoj mediciny» Minzdravsocrazvitija Rossii [Moscow: «State Research Center for Preventive Medicine,» Health Ministry of Russia]. 2012; 42 p.
5. Najdenova NE, Dmitrieva EE, Zubareva NN. Opyt okazanija medicinskoj pomoshhi po otkazu ot kurenija v uslovijah centra zdorov’ja [The experience of medical care for smoking cessation in a health center]. Zamestitel’ glavnogo vracha [Deputy vracha]. 2014; 10 (101): 23–32.
UDC 616.12-008.331.1-057.36(470.41)
DOI: 10.20969/VSKM.2016.9(6).85-89
FROLOVA ELVIRA B., C. Med. Sci., deputy head of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, e-mail: frolova.67@mail.ru
SAFARGALIYEVA LILIYA KH., Head of the Department of internal medicine of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, e-mail: safargalieva.lilia@mail.ru
YAGFAROVA RITA R., physician of the Department of internal medicine of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132
MIKHOPAROVA OLGA YU., Head of the Department of functional diagnostics of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, e-mail: olga-mihoparova@rambler.ru
SHARIPOVA ROZALIA R., physician of the Department of internal medicine of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky trakt str., 132, e-mail sharipova.7@mail.ru
URGADULOVA KSENIYA V., resident of the Department of cardiology, roentgen-endovascular and cardiovascular surgery of Kazan State Medical Academy, Russia, 420012, Kazan, Mushtari str., 11
ULANOVA ALEXANDRA D., resident of the Department of cardiology, roentgen-endovascular and cardiovascular surgery of Kazan State Medical Academy, Russia, 420012, Kazan, Mushtari str., 11
Abstract. Aim. To perform retrospective comparative study of 235 patients with arterial hypertension. Material and methods. We included in the study the patients with arterial hypertension with the absence of co-morbidities for the period from 2011 to 2015. Chi-square nonparametric method was used to identify the frequency of outcomes depending on the factor. Results and discussion. The results demonstrate that on average patients had hypertension stage I or II and the second group of risk with normal and subnormal echocardiographic parameters of cardiac function. Thus, the indicators of daily blood pressure monitoring showed no or insufficient pressure decrease at night in half of the patients. Conclusion. 5 year comparative analysis has demonstrated that the clinical profile of the patients with arterial hypertension has not changed. The most important tool for the diagnosis of arterial hypertension on the early stages is 24-hour blood pressure monitoring.
Key words: arterial hypertension, 24-hour blood pressure monitoring.
For reference: Frolova EB, Safargaliyeva LH, Yagfarova RR, Mihoparova OY, Sharipova RR, Urgadulova KV, Ulanova AD. Comparative analysis of clinical and functional indicators of the patients with arterial hypertension and no comorbidity in 5 years. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 85—89.
References
1. Shal’nova SA, Kukushkin SK, Manoshkina EM, Timofeeva TN. Arterial’naja gipertenzija i priverzhennost’ terapii [Arterial hypertension and compliance]. Vrach [Doctor]. 2009; 12: 39—42.
2. Global Health Observatory (GHO) data. Raised blood pressure. Situation and trends. url=http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
3. Amirov NB, Vizel’ AA, Potapova MV, Ishkineev FI, Frolova JeB, Merikova EF, Iskandarova VV, Afanas’eva JuA, Sokolova OR, Husnutdinova RG. Chastota i osobennosti formirovanija gipertenzivnogo sindroma i faktorov riska CCP u rabotnikov MVD i MChS, rabotajushhih v avtoinspekcii i v pozharnoj sluzhbe [Frequency and characteristics of hypertensive syndrome and cardiovascular risk factors of Ministry of Interior and Ministry of Emergency Situations officers working in the traffic police and the fire service]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2008; 1: 93—95.
4. Davhale R, Potapova MV, Amirov NB. Rasprostranennost’ arterial’noj gipertenzii sredi sotrudnikov pravoohranitel’nyh organov (obzor literatury) [Prevalence of аrtеrial hipertension among the employees of law—enforcement bodies: a review]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2013; 6 (2): 66—72.
5. Amirov NB, Andreeva TI. Tabachnaja jepidemija: farmakologicheskie vozmozhnosti bor’by [The tobacco epidemic: pharmacological control features]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2011; 4 (3): 28—33.
6. Amirov NB. Profilaktika, diagnostika i lechenie arterial’noj gipertenzii; osnovnye polozhenija, tablicy, shemy i kommentarii k rossijskim rekomendacijam 2008 goda (v pomoshh’ prakticheskomu vrachu) [Prevention, diagnosis and treatment of hypertension; the main provisions, tables, charts and comments on the recommendations of the Russian 2008 (to assist the practitioner)]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2009; 2 (1): 49—65.
7. Amirov NB ed. Voprosy kliniki, diagnostiki, differencial’noj diagnostiki, lechenija i profilaktiki arterial’nyh gipertenzij (Uchebno metodicheskoe posobie dlja slushatelej poslevuzovskogo i dopolnitel’nogo professional’nogo obrazovanija [Clinic, diagnosis, differential diagnosis, treatment and prevention of arterial hypertension (Study guideline for students of postgraduate and additional professional education)]. Kazanskij gosudarstvennyj medicinskij universitet [Kazan State Medical University]. 2010; 127 p.
8. Amirov NB, Chuhnin EV. Risk vnezapnoj smerti i chastota serdechnyh sokrashhenij [The risk of sudden death and heart beats frequency]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2010; 4: 47—48.
9. Potapova MV, Mihoparova OJu, Amirov NB, Sabirov LF, Frolova JeB. Analiz dinamiki dejatel’nosti sluzhby funkcional’noj diagnostiki Klinicheskogo gospitalja MSCh MVD Rossii po Respublike Tatarstan [Analysis of the dynamics of service of functional diagnostics of Clinical hospital of medical unit of MIA of Rrussia in RT]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2012; 5 (3): 19—25.
10. Hisamiev RSh, Ginjatullina LR, Amirov NB. Vedomstvennoe zdravoohranenie MVD po Respublike Tatarstan: realii i perspektivy [Departmental health care of ministry of the interior in the Tatarstan Repablic: reality and perspectives]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2014; 7 (suppl. 1): 11—15.
UDC 616.12-008.331.1-057.36(470.41-25)
DOI: 10.20969/VSKM.2016.9(6).89-95
KHISAMIEV RUSTEM SH., major of internal service, Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Lobachevsky str., 13, e-mail: khisamru@mail.ru
AMIROV NAIL B., D. Med. Sci., professor of the Department of general practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, deputy head of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Orenburgsky trakt str., 132, e-mail: namirov@mail.ru
GINJATULLINA LAJSAN R., lieutenant colonel of internal service, deputy head of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Lobachevsky str., 13, e-mail: 1610med@mail.ru
FATYKHOV NIJAZ SH., senior lieutenant of internal service, Head of the Clinic of the outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Lobachevsky str., 13, e-mail: niaz81@mail.ru
MERIKOVA ELENA F., major of internal service, deputy head of Clinic of the outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Lobachevsky str., 13, e-mail: elenamerikova@gmail.com
JAKIMETS SVETLANA A., Head of the Department of internal medicine № 2 of Clinic of the outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, Lobachevsky str., 13, e-mail: lanastar2011@mail.ru
Abstract. Aim. To study the influence of modifiable and non-modifiable risk factors on the development of hypertension in police officers as well as the possible ways of cardiovascular disease prevention, taking into account the specifics of the work during annual clinical examination. Material and methods. As a part of the annual medical examination 9 616 employees of internal service were recruited to the study. Dynamics of the data on the state of health from annual medical examination for the period 2011—2015 were studied. The work has been carried out according to the regulatory documents of the Ministry of internal and of the Ministry of health affairs of the Russian Federation. Results and discussion. It was found that out of 9289 employees of internal service of Kazan garrison, who had undergone clinical examination in 2015, only 1 061 (11,4%) are registered at the general practitioners. Among those there are 242 persons with hypertension (2,6% of the total number of internal service officers, and 22,8% of all the dispensary accounting). Among the 22,8% of patients with hypertension the proportion of females was 9,7% (23 women). The number of men with hypertension is 213 (90,2%). It was found that all patients with hypertension are characterized by the modifiable risk factors for cardiovascular disease (smoking, excess weight gain, dyslipidemia), target organs affected (left ventricular hypertrophy, peripheral arterial disease), non-modifiable risk factors (family history) and by comorbidities including type 2 diabetes. Conclusion. The prevalence of hypertension among police officers is lower than in the general population. The incidence of risk factors for cardiovascular diseases in individuals diagnosed with hypertension does not differ from the average population. In order to prevent development of hypertension and its complications among police officers it is necessary to strengthen all measures aiming to prevent cardiovascular disease, to promote healthy lifestyle and to improve rehabilitation.
Key words: hypertension, police officers, medical examination.
For reference: Hisamiev RSh, Amirov NB, Ginjatullina LR, Fatyhov NSh, Merikova EF, Jakimec SA. Comparative analysis of the incidence of hypertension and of the prevalence of risk factors among internal affairs bodies of Kazan garrison. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 89—95.
References
1. Abdrakhmanova AI, Amirov NB, Cibul’kin NA. Medikamentoznoe lechenie arterial’noj gipertenzii i ego pobochnye jeffekty u pacientov starshego vozrasta [Drug treatment of hypertension and its side effekty older patients]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of contemporary clinical medicine]. 2016; 9 (2): 110-116.
2. Davhale R, Potapova MV, Amirov NB. Rasprostranennost’ arterial’noj gipertenzii sredi sotrudnikov pravoohranitel’nyh organov (obzor literatury) [The prevalence of hypertension among law enforcement officers (literature review)]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of contemporary clinical medicine]. 2013; 6 (2): 66-73.
3. Amirov NB, Andreeva TI. Tabachnaja jepidemija: farmakologicheskie vozmozhnosti bor’by [The tobacco epidemic: the pharmacological possibilities of struggle]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of contemporary clinical medicine]. 2011; 4 (3): 28-33.
4. Jablonskij PK, Suhovskaja OA. Jelektronnye sigarety — «sposob kurenija» ili sredstvo otkaza ot kurenija? Kommentarij k stat’e V.D. Mendelevicha [Electronic cigarettes — «method of smoking» or means of giving up smoking? Comment to Article VD Mendelevich]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of contemporary clinical medicine]. 2015; 8 (3): 72-75.
5. Klinicheskie rekomendacii po lecheniju arterial’noj gipertonii ESH / ESC 2013 [Clinical guidelines for the treatment of hypertension, ESH / ESC 2013, Collection, 1st edition]. Moskva: Izdatel’stvo «Siliceja-Poligraf» [Moscow: Publishing house «Silitseya-Polygraph»]. 2014; 488 p.
6. Amirov NB, Galeeva ZM, Gornaeva LI, et al. Voprosy kliniki, diagnostiki, differencial’noj diagnostiki, lechenija i profilaktiki arterial’nyh gipertenzij [Questions clinic, diagnosis, differential diagnosis, treatment and prevention of arterial hypertension]. Kazan’: Medicina [Kazan: Medicine]. 2010; 128 p.
7. Prikaz № 104 MVD RT ot 19/02/2004 goda «O provedenii ezhegodnyh medicinskih osmotrov rukovodjashhih rabotnikov MVD, lichnogo sostava organov vnutrennih del, uchastnikov Velikoj Otechestvennoj Vojny i veteranov MVD» [Order № 104 of the Ministry of Internal Affairs 19/02/2004 «On holding of annual medical examinations of senior Interior Ministry employees, the personnel of the internal affairs bodies, participants of the Great Patriotic War and veterans of the Ministry of Interior»].
8. Prikaz № 895 MVD Rossii ot 30/11.2006 goda «Polozhenie ob organizacii medicinskogo obsluzhivanija i sanatorno-kurortnogo lechenija v medicinskih uchrezhdenijah sistemy MVD» [Order № 895 Russian Ministry of Internal Affairs of 30.11.2006 «Regulations on the organization of medical care and spa treatment in health facilities Ministry of Internal Affairs»].
9. Diagnostika i lechenie arterial’noj gipertonii: klinicheskie rekomendacii MZ RF [The diagnosis and treatment of hypertension: clinical guidelines MoH RF]. Moskva [Moscow]. 2013; URL: http://cardioweb.ru/klinicheskie-rekomendatsii
10. Diagnostika i lechenie arterial’noj gipertenzii: rossijskie rekomendacii (4 peresmotr) [Diagnosis and treatment of hypertension. Russian recommendations (revision 4)]. Moskva ]Moscow]. 2010; http://scardio.ru/content/Guidelines/recommendation-ag-2010.pdf
11. ESH/ESC. Rekomendacii po lecheniju arterial’noj gipertonii [Guidelines for the management of arterial hypertension]. 2013; http://www.scardio.ru/content/Guidelines/ESChypertension2013.pdf
THE IMPACT OF ADJUSTMENT DISORDER ON THE QUALITY OF LIFE OF POLICE OFFICERS
UDC 616.89-057.36(470.323)
DOI: 10.20969/VSKM.2016.9(6).95-99
SHIBAEV PAVEL V., psychiatrist, supervisor physician of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kursk region, Russia, 305029, Kursk, Krasnyi Oktyabr str., 4, tel. 8-950-878-41-56, e-mail: schibaev.pavel@yandex.ru
Abstract. Aim. Clinical features of adjustment disorders and their impact on the quality of life of police officers returned from detached service in the North Caucasus region were studied. Material and methods. The study involved the officers of police department
of Kursk region. Patients were examined using clinical psychopathological method and psychometric tests before and after detached service. Results and discussion. Prolonged detached service was proved to be a stressful situation and a cause for adjustment disorders. It was found that the quality of life indicators of the patients with adjustment disorders are lower than in general population. Conclusion. It was shown that the negative effects of adjustment disorders on physical health, mental condition and social activity can be measured by the quality of life test. Changing the parameters of quality of life of patients with adjustment disorder is an essential part of the dynamics of their condition that must be considered when carrying out rehabilitation.
Key words: adjustment disorder, quality of life.
For reference: Shibaev PV. The impact of adjustment disorder on the quality of life of police officers. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 95—99.
References
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CARDIOVASCULAR DESIESES IN INTERNAL AFFAIRS BODIES: FREQUENCY, JOB PERFORMANCE
UDC 616.12-057.36-036.22
DOI: 10.20969/VSKM.2016.9(6).99–103
SHOGENOV AKHMED G., C. Med. Sci., Head of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, colonel of internal service, Russia, 360000, Nalchik, M. Gorky str., 7, tel. (8662)44-28-11, e-mail: mdo.kbr@list.ru
ELGAROV ANATOLY A., D. Med. Sci., professor, therapist of Clinic of the outpatient of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, Russia, 360000, Nalchik, M. Gorky str., 7
MURTAZOV ALBERT M., C. Med. Sci., Head of the Center for psychophysiological diagnostics of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Kabardino-Balkar Republic, colonel of internal service, Russia, 360000, Nalchik, M. Gorky str., 7
Abstract. Aim. To establish the frequency of common cardiovascular diseases among internal affairs bodies as well as their job performance. Material and methods. Standardized epidemiological (n=1847) and clinical instrumental assessment of a 10% sample of random employees of internal service aged 25—53 years were recruited with the following daily monitoring of blood pressure (n=106) and electrocardiograms (n=75). Physiological testing was performed using chronoreflexometry complex apparatus — 01 (n=96). Results and discussion. Relatively high levels of the common risk factors (60–90%) and significant prevalence of arterial hypertension (39,3%), ischemic heart disease (18,8%) and heart rhythm disorders (17,9%), with a natural tendency to increase with age as well as the low awareness of the presence of predictors of acute cardiovascular disease and arterial hypertension (40,0%), ischemic heart disease (or 1,9%), cardiac arrhythmias (19,8 per cent) were found in police officers. Among persons with hypertension only 9,7% were on medication; constant rational antihypertensive therapy was rarely administered. Daily blood pressure monitoring in 70,5% of persons with stage I arterial hypertension demonstrated various deviations of the blood pressure profile: usually (67—72%) — in the evening/night and morning, rarely (28—33%) — day/evening or undifferentiated variants of hypertensive reactions. Morning rises in blood pressure were found in 79,1% of police officers with hypertension; significant deviations of basic parameters of professional performance in individuals with ischemic heart disease, arterial hypertension along with coronary disease Cerda with hypertension were defined via psycho-physiological testing. Conclusion. The frequency of arterial hypertension, coronary heart disease and heart rhythm disorders among police officers is high; thus the quality of their professional performance decreases. It requires early diagnosis and adequate correction. Presented results were the basis for creation of a data Bank Register of cardiovascular diseases, the use of which will enhance the management of psychosomatic status of internal Affairs bodies.
Key words: common cardiovascular diseases, epidemiology, policemen, professional workability.
For reference: Shogenov AG, Elgarov AA, Murtazov AM. Cardiovascular diseases in internal affairs bodies: frequency, job performance. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 99—103.
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9. Elgarov AA, Kalmykova MA, Elgarov MA. Arterial’naja gipertonija i aritmija serdca [Arterial hypertension and cardiac arrhythmias]. Nal’chik: OOO «Tetragraf» [Nalchik: Tetragraph]. 2011; 250 p.
10. Elgarov AA, Kalmykova MA, Elgarov AA. Otdel’nye neinfekcionnye zabolevanija sredi voditelej avtotransporta, bezopasnost’ dorozhnogo dvizhenija [Individual non–infectional diseases among vehicle drivers and road safety]. Nal’chik: Tetragraf [Nalchik: Tetragraph]. 2014; 232 p.
11. Amirov NB, Vizel AA, Potapova MV Ishkineev FI, Frolova EB, Merikova EF, Iskandarov VV, Afanasyev YA, Sokolov OR, Khusnutdinova RG. Chastota i osobennosti formirovanija gipertenzivnogo sindroma i faktorov riska SSZ u rabotnikov MVD i MChS, rabotajushhih v avtoinspekcii i pozharnoj sluzhbe [Frequency and characteristics of the formation of hypertensive syndrome and CVD risk factors among employees of the Interior Ministry and the Emergencies Ministry, working in the traffic police and the fire service]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2008; 1 (1): 93–95.
PNEUMOCOCCAL DISEASE PREVENTATIVE VACCINATION EXPERIENCE IN ORGANIZED GROUPS OF MILITARY OFFICERS
UDC [616.98:579.862.1]-057.36-084.47
DOI: 10.20969/VSKM.2016.9(6).103-108
SHUBIN IGOR V., C. Med. Sci., Honored doctor of the Russian Federation, Head of Clinical vaccinology laboratory of Scientific Research Institute of pulmonology, 105077, Moscow, 11th Parkovaya str., 32, build. 4, Chief therapist of Army medical department of Chief Command of interior troops of the Ministry of Internal Affairs of Russia, Russia, 111250, Moscow, Krasnokazarmennaya str., 9a, e-mail: shubin-igor@mail.ru
Abstract. The problem of pneumococcal disease is relevant not only in Russia but also worldwide. It acquires special relevance in organized groups of servicemen due to the impact of a number of adverse factors that accompany military service as well as the high density of people and therefore a high concentration of healthy individuals with nasopharyngeal carriage of pneumococcus in the group. Complex of these factors leads to an increase in the incidence of both non-invasive and invasive pneumococcal infections. Aim. Assessment of the effect of vaccination against respiratory infections in conscripts. Material and methods. Since 2002 in terms of medical protection against pneumococcal disease vaccination of conscripts using «Pnevmo-23» vaccine was performed. Results and discussion. Vaccination of the conscripts using «Pnevmo-23» vaccine has led to significant reduction of the incidence of community-acquired pneumonia as well as of severe and complicated forms of the disease. The greatest effect of the vaccination against respiratory infections has been achieved with simultaneous vaccination against influenza and pneumococcal disease providing high coverage. Conclusion. Preventative vaccination against pneumococcal disease in young people a few months prior military service can significantly reduce the number of military personnel suffering from pneumonia, which contributes to the preservation of their lives and health.
Key words: pneumococcus, pneumonia, vaccine, vaccination, military personnel.
For reference: Shubin IV. Pneumococcal disease preventative vaccination experience in organized groups of military officers. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 103—108.
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12. Chuchalin AG, Shubin IV, Bashtovoj MA et al. Aktual’nye voprosy diagnostiki i lechenija grippa v pandemicheskij period (po materialam XIX-XX Nacional’nyh kongressov po boleznjam organov dyhanija) [ Current problems in the diagnosis and treatment of influenza in the pandemic period (based on xux-XX National Congress on respiratory diseases)]. Medicinskii vestnik MVD [Medical Bulletin MIA]. 2011; L (1): 13-17.
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15. Rajcheva MV, Shubin IV, Marsova LA [et al]. Jetiologicheskaja diagnostika vnebol’nichnoj pnevmonii u molodyh muzhchin v organizovannyh kollektivah s ispol’zovaniem testa «BinaxNOW®» [The etiological diagnosis of community-acquired pneumonia in young men in organized groups using a test “BinahNOSch®”]. Medicinskii vestnik MVD [Medical Bulletin MIA]. 2011; LI (2): 61.
16. Shubin IV, Budul JuI, Rajcheva MV et al. Metodicheskie ukazanija «Diagnostika, lechenie i profilaktika vnebol’nichnoj pnevmonii vo vnutrennih vojskah MVD Rossii » [Methodical guidelines “Diagnosis, treatment and prevention of community-acquired pneumonia in the Interior Troops of Russia]. Moskva: GKVV MVD Rossii [Moscow: Russian Ministry of Internal Affairs GKVV]. 2013; 2: 74 p.
URINARY TRACT INFECTIONS IN PREGNANCY: CURRENT RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT
UDC 618.3-06:616.6-022
DOI: 10.20969/VSKM.2016.9(6).109-114
ARKHIPOV EVGENY V., C. Med. Sci., assistant of professor of the Department of general practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-843-231-21-39, e-mail: jekaland@mail.ru
SIGITOVA OLGA N., D. Med. Sci., professor, Head of the Department of general practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-843-231-21-39, e-mail: osigit@rambler.ru
Abstract. Aim. To analyze the current data on the issue of diagnosis, classification and treatment of urinary tract infections in pregnancy. Material and methods. The publications of native and foreign authors as well as the data from randomized clinical and epidemiological studies were reviewed. Results and discussion. Modern classification, approaches to diagnosis and tactics of antimicrobial therapy of urinary tract infections in pregnancy are present in the article from the position of evidence based medicine, which should be the guide for practitioners engaged in management and treatment of these patients. Conclusion. The use of modern methods of diagnosis and rational therapy of urinary tract infections in pregnancy can significantly reduce the risk of one’s recurrence as well as the complications of pregnancy, with a real ability to fully achieve both clinical and microbiological convalescence.
Key words: pyelonephritis, urinary tract infection, diagnosis, pregnancy, antibacterial therapy.
For reference: Arkhipov EV, Sigitova ON. Urinary tract infections in pregnancy: current recommendations for diagnosis and treatment. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 109—114.
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GAIT DISORDERS IN THE ELDERLY: DIAGNOSIS AND COMPLEX REHABILITATION
UDC 616.8-009.18-053.9(048.8)
DOI: 10.20969/VSKM.2016.9(6).115-119
BAYBULATOVA LILIYA F., Head of the Department of rehabilitationof of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, 420048, Orenburgsky trakt str., 132, tel. +7-917-286-80-31, e-mail: liliya-bajbulatova@yandex.ru
ZAKIROVA DILYRA R., Head of the Department of neurology of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, Kazan, 420048, Orenburgsky trakt str., 132, tel. +7-987-066-73-08, e-mail: dilyara.zakirova555@yandex.ru
MAMEDOV KHALIT I., Head of the Department of stroke unit of Republic Clinical Hospital, Russia, Kazan, 420048, Orenburgsky trakt str., 138, tel. +7-905-314-35-66, e-mail: mamedov1961@yandex.ru
KHUZINA GULNARA R., C. Med. Sci., associate professor of the Department of neurology and rehabilitation of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-987-296-43-86, e-mail: gkhuzina@yandex.ru
Abstract. Gait disorders and postural instability is observed in 80—90% of the elderly population. It is one of the most important factors that determine the quality of life deterioration as well as increased morbidity and mortality. Aim. To analyze the modern principles of complex rehabilitation of gait disorders. Material and methods. Analysis of native and foreign literature was performed. Results and discussion. Dangerous consequences of movement disorders in the elderly are falls, tending to end up with fractures in 5—10% of cases, as well as the head injuries, soft tissue injuries and avulsed wounds in up to 36% of cases. Falls are on the sixth place among the mortality causes in older people. They are the reason for 40% of nursing homes assignments. Very often falls turn into phobias — «a fear of falling syndrome». Patients having these phobias stop moving or getting out of the bed. The fear of recurrent falls significantly limits potential social life. Conclusion. Movement and balance disorders in the elderly are a complex and important problem. The solution is the complex medical and social support measures starting from diagnostic and therapeutic expertise ending with rehabilitation and adaptation.
Key words: gait disorders, ataxia, coordination disorders, abnormal walking patterns, rehabilitation, postural control.
For reference: Baybulatova LF, Zakirova DR, Mamedov HI, Huzina GR. Gait disorders in the elderly: diagnosis and complex rehabilitation. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 115—119.
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PAROXYSMAL MOVEMENT DISORDERS AS AN INTERDISCIPLINARY PROBLEM: PRINCIPLES OF DIAGNOSIS AND THERAPY
UDC 616.831-009-039.31(048.8)
DOI: 10.20969/VSKM.2016.9(6).119-124
ZAKIROVA DILYARA R., Head of the Department of neurology of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420048, Kazan, Orenburgsky trakt str., 132, tel. +7-987-066-73-08, e-mail: dilyara.zakirova555@yandex.ru
SITDIKOVA ALINA I., physician of Military physician board of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420048, Kazan, Orenburgsky trakt str., 132, tel. +7-965-582-57-17, e-mail: alinochka_636@mail.ru
IKSANOVA EKATERINA N., neurologist of the Department of neurology of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420048, Kazan, Orenburgsky trakt str., 132, tel. +7-906-116-24-21, e-mail: iksanova_en@mail.ru
KHUZINA GULNARA R., C. Med. Sci., associate professor of the Department of neurology and rehabilitation of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-987-296-43-86, e-mail: gkhuzina@yandex.ru
Abstract. Aim. This paper illustrates the current state of the problem and the principles of differential diagnosis of paroxysmal movement disorders. Material and methods. Paroxysmal movement disorders are one of the most important problems of modern clinical medicine characterized by steady increase of these conditions in young and middle-aged people as well as by diagnostic complexity of majority of conditions. Analysis of the current and relevant publications, data and personal observations on this issue were taken in consideration. Results and discussion. About 30% of the adult population has experienced at least one cerebral paroxysm (CPU). Approximately 42—57% of all traffic accidents were caused by impaired consciousness of various origins in drivers. In children CPU occurs 5—10 times more often than in adults, coming to 60% during the first 3 years of life (Aslanov, L.M., 1990). In general the frequency of convulsive seizures in children reaches 14% of the total number in the population (Kreindler A. et al., 2003). Conclusion.Тhe etiology of paroxysmal disorders is very diverse. The origin of the attacks can be either primary cerebral or secondary due to a number of somatic and metabolic diseases. Multiple etiologies are often the reason for the difficult differential diagnosis as well as for error-prone management of patients. Diagnosis of paroxysmal disorders is a complex and urgent problem where solution comes after the set of clinical diagnostic activities of interdisciplinary character.
Key words: paroxysmal disorders, cerebral paroxysm, syncope, paroxysmal movement disorders.
For reference: Zakirova DR, Sitdicova AI, Iksanova EN, Huzina GR. Paroxysmal movement disorders as an interdisciplinary problem: principles of diagnosis and therapy. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 119—124.
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THE FEATURES OF CRITICAL CONDITION POLINEUROMYOPATHY TREATMENT
UDC [616.74+616.833]-039.31-08(048.8)
DOI: 10.20969/VSKM.2016.9(6).124-130
SAKOVETS TATIANA G., C. Med. Sci., assistant of professor of the Department of neurology and rehabilitation of Kazan
State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: tsakovets@yandex.ru
SITDIKOVA ALINA I., physician of Military physician board of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420111, Kazan, Lobachevsky str., 9, tel. +7-965-582-57-17, e-mail: alinochka_636@mail.ru
BOGDANOV ENVER I., D. Med. Sci., Head of the Department of neurology and rehabilitation of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-843-237-34-72, e-mail: enver_bogdanov@mail.ru.
KHUZINA GULNARA R., C. Med. Sci., associate professor of the Department of neurology and rehabilitation of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: gkhuzina@yandex.ru
Abstract. Aim. This paper presents the current state of the problem and the principles of critical condition мyopathy/polyneuropathy differential diagnosis. Critical condition myopathy/polyneuropathy is a syndrome characterized by neuromuscular disorders in intensive care unit patients presenting myopathy and/or sensory-motor neuropathy of progressive nature, following sepsis, multiple organ failure, acute distress syndrome or heart or urinary-genital system пациsurgery. Material and methods. Analysis of the current and relevant publications, data and personal observations on this topic was performed. Results and discussion. Classification of neuro-muscular disorders in intensive care units includes critical condition polyneuropathy, prolonged neuromuscular block and critical condition myopathy. In terms of risk factor development in critical condition myopathy/polyneuropathy older age, female gender, hypoxia and hypotension, hyperthermia, hyperglycemia, hypoalbuminemia, treatment with corticosteroids or aminoglycosides should be considered. Critical condition myopathy/polyneuropathy affects every day household activity and reduces the quality of life. It determines the need for early rehabilitation. Conclusion. In order to maximize effectiveness of rehabilitative treatment it requires continuity in rehabilitation process organization. The patient needs to continue rehabilitation in outpatient clinic. In order to avoid polyneuromyopathy it is necessary to provide adequate treatment to prevent sepsis, systemic inflammation or multiple organ failure. Effective treatment for critical condition myopathy/polyneuropathy requires multidisciplinary approach.
Key words: critical condition polyneuropathy, intensive care, rehabilitation treatment for critical condition polyneuropathy.
For reference: Sakovets TG, Sitdikova AI, Bogdanov EI, Huzina GR. The features of critical condition polineuromyopathy treatment. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 124—130.
References
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42. Van den Berghe G, Wilmer A, Hermans G et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354 (5): 449-461.
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45. Mohr M, Englisch L, Roth A et al. Effects of early treatment with immunoglobulin on critical illness polyneuropathy following multiple organ failure and gram-negative sepsis. Intensive Care Med. 1997; 23: 1144–1149.
46. Brunner R, Rinner W, Haberler C et al. Еarly treatment with IgM-enriched intravenous immunoglobulin does not mitigate critical illness polyneuropathy and/or myopathy in patients with multiple organ failure and SIRS/sepsis: a prospective, randomized, placebo-controlled, double-blinded trial. 2013; 17 (5): 213.
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UDC 616.611-002(048.8)
DOI: 10.20969/VSKM.2016.9(6).130-137
SIGITOVA OLGA N., D. Med. Sci., professor, Head of the Department of general practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. (843) 231-21-39, e-mail: osigit@rambler.ru
KIM TAISYA YU., postgraduate student of the Department of general practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. (843) 231-21-39, e-mail: tais_ariana@mail.ru
Abstract. Aim. Analysis and presentation of the current guidelines for diagnosis, immunosuppressive and syndrome treatment, prevention of relapse of glomerulonephritis both at outpatient and hospital stage, the use of which would improve disease prognosis and delay its progression. Material and methods. Clinical review of scientific publications, results of native and foreign basic and clinical research relying on evidence-based medicine. Results and discussion. The recommendations allow estimating diagnosis timely, differentiating active and supportive immunosuppressive therapy and syndrome treatment as well as developing individual tactics of treatment of glomerulonephritis at outpatient and hospital stage. They allow to achieve clinical and laboratory remission and to reduce the frequency of relapses of glomerulonephritis. Conclusion. Application of the guidelines in clinical practice will contribute to the early diagnosis of glomerulonephritis and to increase the efficiency of treatment and prevention, which will delay the progression of the disease and improve the prognosis. Key words: glomerulonephritis, diagnosis, treatment, relapse prevention, evidence-based medicine.
For reference: Sigitova ON, Kim TYu. Guidelines for diagnosis, treatment and prevention of recurrence of glomerulonephritis at the outpatient and hospital stage. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 130—137.
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14. Auwardt R, Savige J, Wilson D. A comparison of the clinical and laboratory features of thin basement membrane disease (TBMD) and IgA glomerulonephritis. Clin Nephrol. 1999; 52 (1): 1–4.
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32. Cameron JS, Turner DR, Heaton J, Williams DG, Ogg CS, Chantler C, Haycock GB, Hicks J. Idiopathic mesangiocapillary glomerulonephritis. Comparison of types I and II in children and adults and long-term prognosis. Am J Med. 1983; 74: 175–192.
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34. Donadio JV Jr, Offord KP. Reassessment of treatment results in membranoproliferative glomerulonephritis, with emphasis on life-table analysis. Am J Kidney Dis. 1989; 14: 445-451.
UDC 340.6:005.6(470.41)
DOI: 10.20969/VSKM.2016.9(6).138-143
GAZIZYANOVA ROZALIYA M., C. Med. Sci., deputy chief for organizational and methodical work of Republican bureau of forensic medicine of the Ministry of Health of the Republic of Tatarstan, Russia, 420029, Kazan, Sibirsky trakt str., 31a, e-mail: Rozaliya.Gazizyanova@tatar.ru
NIZAMOV ALMAZ KH., Head of quality control office of Republican bureau of forensic medicine of the Ministry of Health of Republic of Tatarstan, Russia, 420029, Kazan, Sibirsky trakt str., 31a
TIMERZYANOV MARAT I., C. Med. Sci., Head of Republican bureau of forensic medicine of the Ministry of Health of the Republic of Tatarstan, Russia, 420029, Kazan, Sibirsky trakt str., 31a
SAFINA JULIYA G., C. Chem. Sci., associate professor of the Department of analytical chemistry, certification and quality management of Kazan National Research Technological University, Russia, 420015, Kazan, K. Marx str., 68
GINYATULLINA LYAISAN R., lieutenant colonel of internal service, deputy chief of the Medical Care unit of the Ministry of Internal Affairs of Russia in Tatarstan Republic, Russia, 420111, Kazan, Lobachevsky str., 13
Abstract. Aim. Assessment of the work activity management of forensic medicine specialists on emergency site from perspective of the quality management system. Normative documents regulating this activity were analyzed; the duties of forensic pathologist were discussed in detail as well as their functional relationships. Material and methods. The study was aiming to investigate the experience of forensic institutions for inspections on the emergency site. The authors have used business process modeling method (Business Process Management) and process approach to the work activity management. Results and discussion. Analysis of the work of forensic pathologist at emergency site from perspective of the process approach has shown that the inspections of the site and of the dead body requires intra- and inter- departmental regulations. The model (algorithm) identifies the most important aspects of the work at the site that does not have a legislative framework. The risks were identified in organization of this activity. Conclusion. The authors propose to implement the algorithm developed from perspective of the process approach for the work activity management at the site in the whole territory of Tatarstan. The model is a good reminder to forensic pathologists, for newly hired employees as well, which allows organizing and providing high quality of work at the site as well as the transparency of proceedings for relatives and friends of the dead person.
Key words: inspection of the emergency site, process approach, forensic expert.
For reference: Gazizyanova RM, Nizamov AKh, Timerzyanov MI, Safina YuG, Ginyatullina LR. Operating procedures of a forensic pathologist on emergency site and their improvement on the basis of quality management approaches in Tatarstan Republic. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 138—143.
References
1. Evgen’ev-Tish EM. Ustanovlenie davnosti smerti v sudebno-medicinskoj praktike (posobie dlja vrachej i studentov) [The establishment of prescription of death in forensic practice: Reference book on forensic medicine]. Kazan’: Kazanskij gosudarstvennyj medicinskij institut [Kazan: Kazan state medical Institute]. 1963; 183 p.
2. Matysheva AA ed. Osmotr trupa na meste ego obnaruzhenija: rukovodstvo [Inspection of corpse in place of its discovery: reference book on forensic medicine]. SPb: Izdatel’stvo «Lan’» [SPb: Publishing House «LAN»]. 1997; 299 p.
3. Prozorovskij VI. Pravila raboty vracha-specialista v oblasti sudebnoj mediciny pri naruzhnom osmotre trupa na meste ego obnaruzhenija (proisshestvija) [Rules of the doctor-expert in forensic medicine at external examination of a corpse to the place of its finding (scene)]. M: Mir. 1978; 55 p.
4. Cipkovskij VP. Osmotr mesta proisshestvija i trupa na meste ego obnaruzhenija. [Examination of the scene and the corpse to the place of its finding]. Kiev: GMI USSR [Kiev: Museum of the USSR]. 1960; 320 p.
5. Sarkisjan BA, Jankovskij VJe. Ustanovlenie davnosti smerti [Establishment of prescription of death]. Barnaul: Altajskij gosudarstvennyj medicinskij universitet [Barnaul: Altai state medical university]. 2008; 39 p.
6. Sadovoj MA, Bedoreva IJu. Sistema menedzhmenta kachestva v uchrezhdenii zdravoohranenija [Quality management System in healthcare institution]. Novosibirsk: ANO «Klinika NIITO» [Novosibirsk: ANO «Clinic of the Institute»]. 2007; 320 p.
7. Rumjanceva ZP. Obshhee upravlenie organizaciej: principy i processy [General management: principles and processes]. M: Infra-M. 2000; 315 p.
UDC 614.21(470.57):351.74
DOI: 10.20969/VSKM.2016.9(6).143-148
NAUSHIRVANOV OLEG R., Head of the Medical Care unit of the Ministry of Internal Affairs in Bashkortostan Republic, Russia, 450015, Ufa, K.Marx str., 59
NIGMATULLIN RUSTEM KH., C. Med. Sci., deputy head of Medical Care unit of the Ministry of Internal Affairs in Bashkortostan Republic, Russia, 450015, Ufa, K.Marx str., 59, e-mail: nigrustem@yandex.ru
FAZLYEV MARAT M., D. Med. Sci., professor, Head of the Hospital of Medical Care unit of the Ministry of Internal Affairs
in Bashkortostan Republic, Russia, 450015, Ufa, K.Marx str., 59
KUTUEV ZEMFIR Z., C. Med. Sci., deputy head of the Hospital of Medical Care unit of the Ministry of Internal Affairs in Bashkortostan Republic, Russia, 450015, Ufa, K.Marx str., 59, e-mail: doczem@mail.ru
Abstract. Aim. Analysis of activity in the system of compulsory health insurance of Medical unit of the Ministry of internal affairs in Bashkortostan Republic in dynamics for the 2012—2016 period. Material and methods. Analysis of work was conducted over a five-year period. It was based on annual reports applying the methods of statistical processing of the material. Patient appealability using compulsory health insurance was studied in detail depending on the type of medical service. The legal base for medical care provision to certain categories of citizens was reflected. Results and discussion. The paper summarizes a five-year experience of interaction of the medical unit of the Ministry of internal Affairs of Russia in Republic of Bashkortostan with the territorial compulsory health insurance Fund and the Ministry of health of the Republic of Bashkortostan, allowing to expand annually allocated planned amount of medical care rendering using compulsory health insurance for the attached contingent. The basic indicators of the hospital in terms of funding for the types of services rendered during the studied period are reflected. The problems encountered during provision of medical care to this category of citizens were considered. Conclusion. Working for 20 years in the system of compulsory health insurance Medical unit of the Ministry of internal affairs of Russia in Republic of Bashkortostan remains effective to fulfill the requirements of Russian legislation and it is able to obtain additional financing for the Unit in providing target social support for this category of citizens.
Key words: compulsory health insurance, territorial fund of compulsory health insurance, organization of medical maintenance, scheduled volume.
For reference: Nauchirvanov OR, Nigmatullin RCh, Fasliev MM, Kutuev ZZ. Organization of work of the medical unit of the Ministry of internal affairs of Russia in the Republic of Bashkortostan in compulsory health insurance system. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 143—148.
References
1. Federal’nyj zakon ot 19/11/2010 №326-FZ «Ob obyazatel’nom medicinskom strahovanii v Rossijskoj Federacii» [On compulsory medical insurance in the Russian Federation]. Sobranie zakonodatel’stva Rossijskoj Federacii [Meeting of the legislation of the Russian Federation]. 2010; 49: 6422.
2. Federal’nyj zakon ot 21/11/2011 №323-FZ «Ob osnovah ohrany zdorov’ya grazhdan Rossijskoj Federacii» [About bases of health protection of citizens of the Russian Federation]. Sobranie zakonodatel’stva Rossijskoj Federacii [Meeting of the legislation of the Russian Federation]. 2011; 48: 6724.
3. Postanovlenie Pravitel’stva Rossijskoj Federacii ot 31 dekabrya 2004 goda № 911 «O poryadke okazaniya medicinskoj pomoshchi, sanatorno-kurortnogo obespecheniya i osushchestvlenie otdel’nyh vyplat nekotorym kategoriyam voennosluzhashchih, sotrudnikov pravoohranitel’nyh organov i chlenam ih semej, a tak zhe otdel’nym kategoriyam grazhdan, uvolennyh s voennoj sluzhby» [About an order of rendering of medical aid, sanatorium and resort support and individual payments to some categories of servicemen, law enforcement officers and their families and separate categories of citizens, dismissed from military service]. Sobranie zakonodatel’stva Rossijskoj Federacii [Meeting of the legislation of the Russian Federation]. 2005; 2: 166.
4. Postanovlenie Pravitel’stva Rossijskoj Federacii ot 30/12/2011 № 1232 «O poryadke okazaniya sotrudnikam organov vnutrennih del Rossijskoj Federacii, otdel’nym kategoriyam grazhdan Rossijskoj Federacii, uvolennyh so sluzhby v organah vnutrennih del, i chlenam ih semej medicinskoj pomoshchi i ih sanatorno-kurortnogo obespecheniya» [On the procedure of providing officers of the internal Affairs of the Russian Federation separate categories of citizens of the Russian Federation dismissed from service in bodies of internal Affairs, and members of their families medical care and sanatorium-resort support]. Sobranie zakonodatel’stva Rossijskoj Federacii [Meeting of the legislation of the Russian Federation]. 2012; 3: 432.
5. Gurov SP, Vasilevskaya SB, Sidorov AG. Opyt vzaimodejstviya FKUZ «MSCH MVD Rossii po Orlovskoj oblasti» s departamentom zdravoohraneniya, territorial’nym fondom obyazatel’nogo medicinskogo strahovaniya i medicinskimi strahovymi kompaniyami v usloviyah «odnokanal’nogo» finansirovaniya [Experience of interaction of Federal state healthcare institution «Medical sanitary unit of Ministry of internal Affairs of Russia across the Oryol region» with the Department of health, territorial Fund of obligatory medical insurance and medical insurance companies in a «single-channel» funding]. Medicinskij vestnik MVD [Medical Bulletin of the Ministry of internal Affairs]. 2016; 2: 14-17.
APPROACHES TO THE METHODOLOGY OF MULTIDISCIPLINARY HOSPITAL PERFORMANCE ASSESSMENT
UDC 614.21:351.74(470.41)
DOI: 10.20969/VSKM.2016.9(6).148-156
SABIROV LENAR F., C. Med. Sci., Head of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, associate professor of the Department of public health, economics and health vanagement of Kazan State Medical Academy, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. 8 (843) 277-88-84, e-mail: hospitalmvdrt1@rambler.ru
SPIRIDONOV ALBERT V., C. Med. Sci., deputy head of Clinical hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, associate professor of the Department of public health, economics and health management of Kazan State Medical Academy, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. 8 (843) 291-26-94
Abstract. Aim. Evaluation of effectiveness of activities of the clinical hospital of medical unit of the Ministry of Internal affairs of Russia in the Republic of Tatarstan on the basis of the implemented quality management system. Material and methods. The study was performed on the basis of dynamics of the main indicators of the institution taking into account the data obtained in the course of internal quality management system audits, performance assessment, customer, staff and other interested parties satisfaction monitoring. Results and discussion. There has been a pronounced interest in the development and implementation of adequate health system performance into practice. The impact is assessed according to key indicators taking into account the requirements of international standards and specific field characteristics of the Clinical Hospital. According to the results of the II level internal quality examination the quality factor for the 2011—2015 is steadily high (on the basis of expert maps) (0,89). According to the results of internal expertise quality factor remains stable for 5 years as 1,0. Integrated customer satisfaction (internal and external) tends to increase. It reached 91% in 2015. Conclusion. Assessment of key performance indicators allows timely identification of problematic criteria, correction of which is an effective mechanism for improving quality of care.
Key words: effectiveness, management, quality, auditing, monitoring, process.
For reference: Sabirov LF, Spiridonov AV. Approaches to the methodology of multidisciplinary hospital performance assessment. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 148—156.
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UDC 614.29:351.74:004
DOI: 10.20969/VSKM.2016.9(6).156-162
SIDORENKO VITALY A., C. Med. Sci., Honored doctor of the Russian Federation, deputy head of the Department of material and technical logistic of the Ministry of Internal Affairs of the Russian Federation, Chief of Administration of civilian health and medical program, major general of internal service, Russia, 123060, Moscow, Raspletin str., 26, tel. 8-495-214-03-01, e-mail: sidorenko@mail.ru
Abstract. Aim. The mail goal was to evaluate implementation of automated work stations aiming for medical specialists at military physician boards of the Ministry of Internal Affairs of Russia as a part of unified information service that provides conduction of military medical expertise via department’s unified information space. Material and methods. «Medicine» is the original software — the information service that provides operation of government military physician boards. «Medicine» was being implemented stepwise all across 80 Russian regions at the medical facilities during 2015—2016. The system was introduced through remote connection of the facilities via secure channels to the main center that was processing data needed to interact with the service. Results and discussion. Introduction of the «Medicine» has made it possible to create digital entries to form medical database, to automate compilation of all outgoing expert documents, to store information on every patient visit to military physicians all across Russian Federation, to exchange information between the boards regarding the state of health of examined contingent, to exclude the possibility of presenting inaccurate or false information to the examinees and to keep track of non-effective individuals, to enable responsible officials to control all stages of medical examination, to automate the creation of statistical reports, to provide a complete data protection and to exclude unauthorized access to personal and medical data or expert reports. Conclusion. The «Medicine» information service is a qualitatively new stage of automation of military physician boards of the Ministry of internal affairs of Russia. The opportunities offered with the introduction of the service are not limited only by saving time spent on a purely mechanical document issue, but also allow to design and develop the algorithms and mechanisms aiming to create a unified architecture to process expert solutions and avoid errors on adjudication procedure.
Key words: military medical expertise, military physician board, medical examination, automated management systems, information technologies.
For reference: Sidorenko VA. Trial implementation of automated management systems supporting military physician boards of the Ministry of internal affairs of Russia. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 156—162.
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HYPERPARATHYROIDISM AND UROLITHIASIS: DIAGNOSTICS ERRORS (clinical case)
UDC 616.447-008.6:616.62-003.7-035.7
DOI: 10.20969/VSKM.2016.9(6).163-168
NADEEVA ROZALIYA A., C. Med. Sci., associate professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: rosa.nadeeva@gmail.com
KAMASHEVA GULNARA R., C. Med. Sci., associate professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: kamasheva73@rambler.ru
AMIROV NAIL B., D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
Abstract. Aim. To invite attention of professionals to hyperparathyroidism in order to assure its early diagnostics in patients with bone and nephrological masks of the disease. Material and methods. The incidence of primary hyperparathyroidism among patients with urolithiasis is 8%. Visceral form with predominant renal damage occurs in over 60% of cases of primary hyperparathyroidism manifest. Kidney damage may be the only manifestation of primary hyperparathyroidism. Often it occurs in the form of urolithiasis. The surgical intervention in primary hyperparathyroidism is not a method of urolithiasis treatment, but just a way to get rid of the patient concretions. Results and discussion. The case is a patient with recurrent kidney stones, over which the surgery was performed twice. Unfortunately, the removal of calculus does not cure the patient if the cause of the changes that led to the development of urolithiasis is not known. Besides complaints of the patient and the clinical manifestations of hyperparathyroidism screening test for blood calcium level was not carried out on time, which has led to the renal damage with the development of urolithiasis and osteoporosis with pathologic fractures. Adenoma of the parathyroid gland and primary hyperparathyroidism were detected during occasional visit to endocrinologist followed by successful parathyroidectomy. Conclusion. The clinical case demonstrates errors and late diagnostics of primary hyperparathyroidism, which is related to poor knowledge of the manifestations of hyperparathyroidism, its bone and nephrology masks as well as the necessity to introduce the serum calcium level measurement in routine biochemical practice.
Key words: primary hyperparathyroidism, urolithiasis disease, hypercalcemia, osteoporosis.
For reference: Nadeeva RA, Kamasheva GR, Amirov NB. Hyperparathyroidism and urolithiasis: diagnostics errors (clinical case). The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 163—168.
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SELECTED ASPECTS OF THE NEED IN INCREASED GLUTAMIC ACID CORRECTION IN SEPTIC PATIENTS
UDC 616.94-07:616.153.466.64-074
DOI: 10.20969/VSKM.2016.9(6).169-178
ALEKSEEVA ELENA V., С. Мed. Sci., anesthesiologist of the Department of intensive care of Central Clinical Hospital and Clinic of the outpatient, Russia, 121359, Moscow, Marshal Timoshenko str., 15, tel. 8-910-442-11-37, e-mail: aev_69@mail.ru
Abstract. Aim. Sepsis is associated with an increased level of kynurenic acid, which contributes to hypofunction of 3 neurotransmitter systems and to the decrease of survival function. A number of amino acids inhibit the formation of kynurenic acid. The trial was performed on septic patients with deterioration of their condition. Plasma levels of amino acids that reduce the formation of kynurenic acids were identified in order to determine an optimal way of correction. Material and methods. We analyzed data from 2 groups of resuscitated patients. Group I (n=43) — septic patients, group II (n=19) — patients without sepsis. Group 1 consisted of subgroup 1 (n=24) — «severe sepsis», subgroup 2 (n=19) — «septic shock». Groups and subgroups were compatible by the content of phenylalanine, leucine, isoleucine, glutamic acid, alanine, methionine, aspartic acid, glutamine, tyrosine. Amino acid concentrations in plasma were determined by high performance liquid chromatography — mass spectrometry. Statistical data processing was carried out by using Statistica 12 software. Results and discussion. There were significant differences between groups and sub-groups only in decreased content of glutamic acid rates. In group I it was higher (9,8-fold), p=0,00028; more in subgroup 1 (2-fold) p=0,0208. 28-day survival rate was higher in patients without reduced level of glutamic acid, relative to the reference parameters, p=0,00074. Conclusion. Administration of amino acids inhibits production of kynurenic acid that significantly changes glutamic acid level in septic patients with deterioration of their condition. Reduced level of glutamic acid in the blood plasma is an unfavorable factor for the course of pathological process in critical patients.
Key words: glutamic acid, kynurenic acid, sepsis, critical patients.
For reference: Alekseeva EV. Selected aspects of the need in increased glutamic acid correction in septic patients. The Bulletin of Contemporary Clinical Medicine. 2016; 9 (6): 169—178.
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