SURGICAL TREATMENT OF SECONDARY TRICUSPID REGURGITATION BY THE MODIFIED SUTURE ANNULOPLASTIC

UDC 616.126.46-089

DOI: 10.20969/VSKM.2018.11(2).7-13

ABDULYANOV ILDAR V., cardiovascular surgeon of Interregional Clinical Diagnostic Center, C. Med. Sci., associate professor of the Department of cardiology, interventionional cardiology and cardiovascular surgery of Kazan State Medical Academy — the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Mushtari str., 11, tel. 8-987-421-90-09, e-mail: ildaruna@mail.ru

VAGIZOV ILDAR I., Head of the Department of cardiac surgery No 2 of Interregional Clinical Diagnostic Center, Russia, 420101, Kazan, Karbyshev str., 12a

KAIPOV ARTUR E., cardiovascular surgeon of Interregional Clinical Diagnostic Center, Russia, 420101, Kazan, Karbyshev str., 12a

KHAYRULLIN RUSTEM N., D. Med. Sci., general manager of Interregional Clinical Diagnostic Center, Honored doctor of the Republic of Tatarstan, Russia, 420101, Kazan, Karbyshev str., 12a

Abstract. Aim. Comparative analysis of three different methods of tricuspid valve brous ring correction has been performed in patients with secondary tricuspid regurgitation. The methods of suture annuloplasty and implantation of the supporting ring were compared. Their clinical effect and the features of tricuspid valve closure function regeneration were evaluated. Material and methods. The patients with mitral valve dysfunction of rheumatic origin having signi cant tricuspid regurgitation were enrolled in the study. All patients underwent mitral valve replacement and annuloplasty of tricuspid valve. The patients were divided into three groups, depending on tricuspid regurgitation correction method. Modi ed suture annuloplasty was applied for correction, while in the control group common methods of annuloplasty were applied. Echocardiography has served as a control method. Results and discussion. Good results from allapplied methods were seen in all three groups. The patients with modi ed annuloplasty for tricuspid regurgitation had a greater percentage of satisfactory correction results comparing to control groups. Associated complications were not detected. Mortality was low. Conclusion. Modi ed tricuspid valve brous ring plastic has demonstrated the best long- term results in comparison with other suture and implantation plastics. This plastic is a multipurpose long-term way to prevent recurrence of tricuspid regurgitation without affecting survival or associated complications.

 СOMPARABILITY OF LEFT VENTRICLE FUNCTION EVALUATION BY ECHOCARDIOGRAPHY AND PERFUSION MYOCARDIAL SCINTIGRAPHY

UDC 616.127-073:616.12-005.4

DOI: 10.20969/VSKM.2018.11(2).14-18

AMIROV NAIL B., Resercher ID: E-3177-2016, SCOPUS Author ID: 7005357664, D. Med. Sci., professor of the Department of general medical practice No 1 of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru

TSIBULKIN NIKOLAY A., associate professor of the Department of cardiology, radiologic endovasculular and cardiovascular surgery of Kazan State Medical Academy — the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kldkgma@mail.ru

ABDRAKHMANOVA ALSU I., C. Med. Sci., assistant of professor of the Department of clinical medicine fundamental basis, Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, e-mail: alsuchaa@mail.ru

SAIFULLINA GUSALIA B., physician of the laboratory of radioisotope diagnostics of Interregional Clinical Diagnostic Center, Russia, 420089, Kazan, Karbyshev str., 12а, е-mail: sayfullina_rad@mail.ru

SULTANOVA GUZEL I., 6-year student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: gsultanova101@mail.ru

Abstract. Aim. Comparative analysis of the results of regional and integral contractility assessment in left ventriclemyocardium in patients with chronic coronary heart disease has been performed by echocardiography and perfusionmyocardium scintigraphy. Material and methods. Planned echocardiography and perfusion myocardium scintigraphywithout load results analysis was performed in patients with chronic coronary heart disease undergoing treatmentin cardiologic unit regardless of myocardial infarction. The volume and integral contractility of the left ventricle were assessed by disk method, regional contractility was measured in seventeen segments according to the scheme and central hemodynamic indicators were de ned. Results and discussion. Both methods have shown a high extentof coincidence of the key functional indicator values of the left ventricle. At the same time, regional contractility assessment had a series of divergences: the index of contractility by the results of scintigraphy was higher than that for  echocardiography. Assessment of regional contractility by the results of two methods differed almost in half segments.Conclusion. It is possible to assume that the differences are bound to the methodology of diagnostic tests and to the features of heart diseases. It is necessary to consider the results of all available methods for nal judgment on such a complex functional indicator as the regional contractility.

1. Mark IM. Noble Whatever Happened to Measuring Ventricular Contractility in Heart Failure? Card Fail Rev. 2017; 3 (2): 79–82.

2. Freddy Abi-Samra, David Gutterman. Cardiac contractility modulation: a novel approach for the treatment of heart failure. Heart Fail Rev. 2016; 21 (6): 645–660.

3. Rajding E. Ekhokardiogra ja; Prakticheskoe rukovodstvo [Echocardiography; Practical manual]. MEDpress-inform. 2013; 280 p.

4. McDiarmid Adam K, Pellicori Pierpaolo et al. Taxonomy of segmental myocardial systolic dysfunction. Eur Heart J. 2017; 38 (13): 942–954.

5. Kostakou PM, Kostopoulos VS, Tryfou ES et al. Subclinicalleft ventricular dysfunction and correlation with regionalstrain analysis in myocarditis with normal ejection fraction; A new diagnostic criterion. Int J Cardiol. 2018; 259: 116- 121.

6. Maragiannis D, Alvarez PA, Ghosn MG et al. Left ventricularfunction in patients with hypertrophic cardiomyopathy andits relation to myocardial brosis and exercise tolerance. Int J Cardiovasc Imaging. 2018; 34 (1): 121-129.
7. Iida Y, Inomata T, Kaida T et al. Prognostic Impact of Segmental Wall Motion Abnormality in Patients With Idiopathic Dilated Cardiomyopathy. Int Heart J. 2017; 58 (4): 544-550.
8. Wengenmayer T, Stephan A, Grundmann S et al. Altered Regional Myocardial Mechanics in Transplanted Hearts: In uence of Time and Transplantation. Thorac Cardiovasc Surg. 2017; 65 (5): 415-422.
9. Amzulescu MS, Langet H, Saloux E et al. Head-to-Head Comparison of Global and Regional Two-Dimensional Speckle Tracking Strain Versus Cardiac Magnetic Resonance Tagging in a Multicenter Validation Study. Circ Cardiovasc Imaging. 2017; 10 (11): e006530. doi: 10.1161/ CIRCIMAGING.117.006530.
10. Eitan A, Kehat I, Mutlak D et al. Longitudinal two-dimensional strain for the diagnosis of left ventricular segmental dysfunction in patients with acute myocardialinfarction. Int J Cardiovasc Imaging. 2018; 34 (2): 237-249.
11. Tabassian M, Alessandrini M, Herbots L et al. Machinelearning of the spatio-temporal characteristics of echocardiographic deformation curves for infarctclassi cation. Int J Cardiovasc Imaging. 2017; 33 (8): 1159-1167.
12. Oliveira L, O’Connell J, Carvalho E, et al. Comparison between Radionuclide Ventriculography and Echocardiography for Quanti cation of Left Ventricular Systolic Function in Rats Exposed to Doxorubicin. Arq Bras Cardiol. 2017; 108 (1): 12-20.
13. Sicari R. Stress echocardiography: time for a reassessment? Int J Cardiol. 2018; 259: 47-48.
14. Paz Y, Morgenstern R, Weinberg R et al. Relation of Coronary Flow Reserve to Other Findings on Positron Emission Tomography Myocardial Perfusion Imaging and Left Heart Catheterization in Patients With End-stage Renal Disease Being Evaluated for Kidney Transplant. Am J Cardiol. 2017; 120 (11): 1909-1912.
15. Xie MY, Lv Q, Wang J, Yin JB. Assessment of myocardialsegmental function with coronary artery stenosis in multi-vessel coronary disease patients with normal wall motion. Eur Rev Med Pharmacol Sci. 2016; 20 (8): 1582-1589.
16. Davies R, Liu G, Sciamanna C, Davidson WR et al. Comparison of the Effectiveness of Stress Echocardiography Versus Myocardial Perfusion Imaging in Patients Presenting to the Emergency Department With Low-Risk Chest Pain. Am J Cardiol. 2016; 118 (12): 1786-1791.
17. Al-Makhamreh HK, Al-Sharif AA, Abujbara MA et al. Assessment of segmental left ventricular thickening in diabetic type II obese patients with normal myocardial perfusion scan. Hell J Nucl Med. 2017; 20 (3): 222-226.
18. Abdrahmanova AI, Amirov NB, Sayfullina GB. Bezbolevaya ishemiya miokarda (obzor literaturyi) [Silent myocardial ischemia (literature reeview)]. Vestnik sovremennoy klinicheskoy meditsinyi [The Bulletin of Contemporary Clinical Medicine]. 2015; 8 (6): 103—115.
19. Naya M, Manabe O, Koyanagawa K, Tamaki N. The role of nuclear medicine in assessments of cardiac dyssynchrony. J Nucl Cardiol. 2017; doi: 10.1007/s12350-017-1072-z.
20. Morishita S, Maeba H, Takehana K, Shiojima I. Nicorandil was an Effective Treatment Option for a Patient with Bland-White-Garland Syndrome. Intern Med. 2017; 56 (17): 2295-2299.
21. Niimi T, Nanasato M, Maeda H. Quantification of Contraction Synchronicity and Contraction Work in Coronary Artery Disease. Nucl Med Mol Imaging. 2017; 51 (3): 227-232.

 GENDER FEATURES OF COMMUNITY ACQUIRED PNEUMONIA AND HIV INFECTION

UDC [616.98:578.828HIV:616.24-002]-055.1/.2 

DOI: 10.20969/VSKM.2018.11(2).19-23

BORODULINA ELENA A., ORCID ID: orcid.org/0000-0002-3063-1538, SCOPUS Author ID:6603123975, D. Med. Sci., professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. 8-846-332-57-35, e-mail: Borodulinbe@ yandex.ru

VDOUSHKINA ELIZAVETA S., ORCID ID: orcid.org/0000-0003-0039-6829, postgraduate student of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. +7-987-945-18-22, e-mail: vdoushkina@rambler.ru

BORODULIN BORIS E., ORCID ID: orcid.org/0000-0002-3063-1538, SCOPUS Author ID: 7801342837, D. Med. Sci., professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. 8-846-332-57-35, e-mail: Borodulinbe@ yandex.ru

SKOPTSOVA NATALIA V., resident of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. +7-927-754-88-23, e-mail: Natali.sckoptsowa@yandex.ruAKHMEROVA TATJANA E., C. Med. Sci., associate professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Chapaevskaya str., 89, e-mail: axmerovate@mail.ru

BORODULINA ELVIRA V., ORCID ID: orcid.org/0000-0002-0687-3473, SCOPUS Author ID: 57189084482, postgraduate student of the Department of public health and health management of Samara State Medical University, Russia, 443099, Samara, Chapaevskaya str., 89, tel. +7-937-649-81-00, e-mail: eljusha@bk.ru

1. Pokrovskij VV, Ladnaja NN, Pokrovskaja AV. VICh/SPID sokrashhaet chislo rossijan i prodolzhitel’nost’ ih zhizni [HIV/AIDS reduces the number of Russians and their life expectancy]. Demogra cheskoe obozrenie [Demographic review]. 2017; 4 (1): 65-82.

2. Ladnaja NN, Pokrovskij VV, Dement’eva LA. Razvitie jepidemii VICh-infekcii v Rossijskoj Federacii v 2015 godu [The development of the HIV epidemic in the Russian Federation in 2015]. Materialy mezhdunarodnoj nauchno-prakticheskoj konferencii «Aktual’nye voprosy VICh-infekcii» [Materials of the international scienti c and practical conference “Actual issues of HIV infection”]. 2016: 4-9.

3. Borisova OV, Agafonova OV, Eremenko EP, Borodulina JeV. Osobennosti jepidemiologii VICh-infekcii v sovremennyh uslovijah na primere goroda Samara [Features of the epidemiology of HIV infection in modern conditions by the example of Samara]. Nauka i innovacii v medicine [Science and innovations in medicine]. 2017; 1 (2): 10-15.

4. Zimina VN, Astaf’ev AV. Vnebol’nichnye pnevmonii u vzroslyh bol’nyh VICh-infekciej: osobennosti techenija i lechenija, pro laktika [Community-acquired pneumonia in adults with HIV infection: features of the course and treatment, prevention]. Pul’monologija [Pulmonology]. 2016; 26 (4): 488-497.

5. Vdoushkina ES. Osobennosti letal’nosti pri vnebol’nichnyh pnevmonijah speci cheskoj i nespeci cheskoj jetiologii bol’nyh VICh-infekciej: obzor literatury. [Features of mortality in community-acquired pneumonia speci c and nonspeci c etiology of patients with HIV infection: review of literature]. Aspirantskij vestnik Povolzh’ja [Postgraduate Bulletin of the Volga Region]. 2016; 5-6: 16-21.

6. Borodulin BE, Borodulina EA, Kozlova OS, Povalieva LV. Differential diagnosis of outpatient pneumonia and in ltrative pulmonary tuberculosis by the Diaskintest®. European Respiratory Journal. 2011; 55: 296.

7. Manno D, Puoti M, Signorini L et al. Risk factors and clinical characteristics associated with hospitalization for community-acquired bacterial pneumonia in HIV-positive patients according to the presence of liver cirrhosis. Infection. 2009; 37 (4): 334-339.

8. Curran A, Falco V, Crespo M et al. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Medicine. 2008; 9: 609-615.

9. Madeddu G, Fiori LM, Mura SM. Bacterial community- acquired pneumonia in HIV-infected patients. Current Opinion in Pulmonary Medicine. 2010; 16 (3): 201-207.

10. Vizel’ AA, Vizel’ AJu, Lysenko GV. Vnebol’nichnaja pnevmonija kak rasprostranennoe ostroe infekcionnoe zabolevanie organov dyhanija [Community-acquiredpneumonia as a common acute infectious disease of therespiratory system]. Medicinskij sovet [Medical Council]. 2014; 16: 44-47.

11. Borodulina EA, Borodulin BE, Povaljaeva LV, Chernogaeva GJu, Vdoushkina ES. Prediktory letal’nosti ot vnebol’nichnoj pnevmonii v sovremennyh uslovijah raboty pul’monologicheskogo centra [Predictors of mortality from community-acquired pneumonia in modern conditions of the pulmonology center]. Vestnik sovremennoj klinicheskoj mediciny [Bulletin of modern clinical medicine]. 2015; 8 (4): 19-22.

 CORONARY STENT THROMBOSIS PREDICTION IN THE EARLY POSTOPERATIVE PERIOD

UDC 616.132.2-089.819.5-06:616-005.6-037

DOI: 10.20969/VSKM.2018.11(2).24-28

PLECHEV VLADIMIR V., D. Med. Sci., corresponding member of the Academy of Sciences of the Republic of Bashkortostan, professor, Head of the Department of advanced surgery of Bashkir State Medical University, Russia, 450008, Ufa, Lenin str., 3, tel/fax: 8 (347)255-19-84

RISBERG ROMAN YU., C. Med. Sci., associate professor of the Department of advanced surgery of Bashkir State Medical University, Russia, 450008, Ufa, Lenin str., 3, tel/fax: 8 (347)255-19-84, e-mail: risbergu@mail.ru

BUZAEV IGOR V., C. Med. Sci., associate professor of the Department of advance surgery of Bashkir State Medical University, Head of the Department of radiologic surgical methods of diagnosis and treatment No 1 of Republican Cardiology Center, Russia, 450008, Ufa, Lenin str., 3, tel/fax: 8 (347)255-19-84

OLEINIK BOGDAN A., associate professor of the Department of advanced surgery of Bashkir State Medical University, deputy chief physician for surgery of Republican Cardiology Center, Russia, 450008, Ufa, Lenin str., 3, tel/fax: 8 (347)255-19-84

NIGMATULLIN MARSEL R., 2nd year resident of the Department of advanced surgery of Bashkir State Medical University, Russia, 450008, Ufa, Lenin str., 3, tel/fax: 8 (347)255-19-84

Abstract. Aim. The forecast of coronary stent thrombosis development in the early postoperative period was determinedon the basis of instrumental and laboratory methods. Material and methods. The patients with functional class 2 coronary heart disease, who underwent coronary artery stenting in a planned manner (2610 patients) were enrolled in the study. Postoperative complications occurred in 443 (17%) of 2610 patients, who had undergone percutaneous coronary stenting, including 18 cases (4,1%) of coronary stent thrombosis in the early postoperative period and 425 cases (95,9%) of coronary stent restenosis during late postoperative period. Results and discussion. Postoperative complications develop somewhat less frequently comparing to intraoperative ones (17% against 24,6%), including 4,1% of cases with early postoperative complications such as coronary stent thrombosis and 95,9% of late postoperative complications, such as restenosed coronary stent. Conclusion. The risk of coronary stent thrombosis increases in patients who have narrow implanted coronary stents. Coagulation correlates with the coronary stent thrombosis. The model of prediction of the risk of coronary stent thrombosis based on the PTI, CPK and a-v oxygen content difference values assures the accuracy of predictions in 99,1% of cases.

1. Mikhalina EV et al. Faktory riska ishemicheskoj bolezni serdca sredi gorodskogo i sel’skogo naselenija Gornoj Shorii [Risk factors for coronary heart disease among ur-ban and rural population of mountain shoria]. Kompleksnye problemy serdechno-sosudistyh zabolevanij [Complex problems of cardiovascular diseases]. 2017; VI (2): 79-86.

2. Epstein AJ et al. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011; 305: 1769-1776.

3. Barbaraš LS, Ganyukov VI. Organizacija i taktika prove-denija chreskozhnogo koronarnogo vmeshatel’stva pri infarkte miokarda s pod#emom segmenta ST [Organiza- tion and tactics of percutaneous coronary intervention inmyocardial infarction with ST segment elevation]. Kem-erovo. 2012; 230 p. https://docslide.com.br/documents/556e5db1d8b42a6a248b47f4.html

4. Protopopov AV. Uvelichenie kolichestva pervichnyh chreskozhnyh koronarnyh vmeshatel’stv. Kak jetogo dobit’sja? [Increase in the number of primary percutaneous coronary interventions. How to achieve this?]. Kompeksnye prob-lemy serdechno-sosudistyh zabolevanij [Complementary problems of cardiovascular diseases]. 2013; 1: 40-43.

5. Ganyukov V.I. Dokazatel’naja baza prioritetnoj roli per-vichnogo chreskozhnogo koronarnogo vmeshatel’stva v revaskuljarizacii bol’nyh infarktom miokarda s pod#jomom segmenta ST [Evidence base for the primary role of pri- mary percutaneous coronary intervention in revascular-ization of myocardial infarction patients with ST segment elevation]. Kompeksnye problemy serdechno-sosudistyh zabolevani [Complex problems of cardiovascular dis-eases]. 2013; 1: 24-34.

6. Bokeria LA, Gudkova RG. Serdechno-sosudistaja hirur-gija. 2010 god. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija [Cardiovascular surgery. 2010 year. Diseases and congenital anomalies of the circulatory sys-tem]. Moskva: NCSSH im. A.N. Bakuleva RAMN [Moscow: NTSSSH AN Bakulev RAMS]. 2011; 162 p.

7. Shalnova SA, Konradi AO, Karpov YuA et al. Analiz smertnosti ot serdechno-sosudistyh zabolevanij v 12 regionah rossijskoj federacii, uchastvujushhih v issledo-vanii «Jepidemiologija serdechno-sosudistyh zabolevanij v razlichnyh regionah Rossii» [Analysis of mortality from cardiovascular diseases in 12 regions of the Russian Federation participating in the study “Epidemiology of cardiovascular diseases in various regions of Russia”]. Rossijskij kardiologicheskij zhurnal [Russian Cardiology Journal]. 2012; 97 (5): 6-11.

 ZHUKOVSKIY BALLOON TAMPONADE USAGE EXPERIENCE DURING CAESAREAN SECTION IN PATIENTS WITH PLACENTA PREVIA

DOI: 10.20969/VSKM.2018.11(2).28-33

SEROVA OLGA F., D. Med. Sci., professor, Head of the Department of obstetrics, gynecology and perinatology of State Scientific Center of Russian Federation — Federal Medical Biophysical Center named after A.I. Burnasyan, Russia, 143900, Balashikha, Entuziast highway, 12, tel. +7(495)529-44-74 (add. 236), e-mail: omo_2012@mail.ru

SEDAYA LUYDMILA V., C. Med. Sci., associate professor of the Department of obstetrics, gynecology and perinatology of State Scientific Center of Russian Federation — Federal Medical Biophysical Center named after A.I. Burnasyan, Russia, 143900, Balashikha, Entuziast highway, 12, tel. +7(495)529-44-74 (add. 236), e-mail: omo_2012@mail.ru

SHUTIKOVA NATALIYA V., C. Med. Sci., associate professor of the Department of obstetrics, gynecology and perinatology of State Scientific Center of Russian Federation — Federal Medical Biophysical Center named after A.I. Burnasyan, Russia, 143900, Balashikha, Entuziast highway, 12, tel. +7(495)529-44-74 (add. 236), e-mail: omo_2012@mail.ru

KLIMOV SERGEY V., postgraduate student of the Department of obstetrics, gynecology and perinatology of State Scientific Center of Russian Federation — Federal Medical Biophysical Center named after A.I. Burnasyan, Russia, 143900, Balashikha, Entuziast highway, 12, tel. +7(496)514-23-47, +7(965) 401-01-00, e-mail: mail@zdravnoginsk.ru

Abstract. Aim. Ef ciency of Zhukovskiy balloon tamponade as a component of hemorrhage treatment during caesarean section has been studied in patients with placenta previa. Material and methods.72 puerperants with indicated cae-sarean section for placenta previa were enrolled in the study. The pregnant women enrolled in the study were divided into 2 groups. The main group included 48 puerperants after cesarean section for placenta previa with Zhukovskiy balloon catheter applied as a component of combined hemorrhage treatment in postpartum period. The control group consisted of 24 patients, who received uterotonic drugs as a component of combined hemorrhage treatment. The age of the patients ranged from 22 to 45 years, the mean age was (29,3±6,2) years. Common and special study tools such as ultrasound, histological and statistical methods were applied in order to evaluate the ef ciency of postoperative hemorrhage treatment. Results and discussion. When estimating the location of placenta in relation to the internal os via ultrasonography it was revealed that 64,6% of puerperants in the main group and 66,7% — in the control group had total placenta previa. 35,4% and 33,3% of puerperants, respectively were diagnosed with marginal (incomplete) placenta previa (p>0,05). Blood loss measurement in the group of patients after Zhukovskiy balloon tamponade has shown that the volume of blood loss was one third less [(293±96) ml] than in ones after traditional methods of prevention and bleeding arrest [(436±113) ml]. It has indicated the difference in total volumes of blood loss in the studied groups (p<0,05). Taking into account the total volume of blood loss in the main group of puerperants, it was (1080±198) ml, while in the control group — (1214±219) ml (p<0,05). Consequently infusion therapy in control group of puerperants more often included fresh frozen plasma and packed red cells. In order to assess the ef ciency of Zhukovskiy balloon tamponade hemoglobin levels have been assessed after operative delivery. The difference between the initial and posthemorrhagic values in the control group was 1,5 times higher than in the main group (23,4 g/l in the main group and 34,8 g/l in the control group) (p<0,05). Mean hematocrit level assessment after hemorrhage and after treatmentprocedures has showed that after the bleeding arrest these indicators in the compared groups of puerperants were(29,5±2,8)% and (25,6±2,3)%, respectively (p<0,05). Сonclusion. Implementation of the discussed method contributes to improvement of abdominal birth index as well as to suppurative, septic and haemorrhagic complication reduction.Key words: caesarean section, hemorrhage, Zhukovskiy balloon tamponade, placenta previa.

For reference: Serova OF, Sedaya LV, Shutikova NV, Klimov SV. Zhukovskiy balloon tamponade usage experience during caesarean section in patients with placenta previa. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 28-33. DOI: 10.20969/VSKM.2018.11(2).28-33.

1. Radzinskiy VE. Krovotechenija v akusherstve; Perspektivy sovremennyh tehnologij [Obstetrics bleedings; Perspec-tives of modern technologies]. Moskva [Moscow]: Mat’ i ditja: tezisy VIII Rossijskogo foruma [Mother and child: theses VIII Russian forum]. 2006: 214-215.

2. Savelieva GМ. Kesarevo sechenie i ego rol’ v sovremen-nom akusherstve [Cesarean section and his role in modern obstetrics]. Akusherstvo i ginekologija [Obstetrics and gynecology]. 2008; 3: 10-15.

3. Strizhakov АN. Sovremennaja hirurgicheskaja taktika pri akusherskih krovotechenijah [Modern surgical tactics in ob-stetric haemorhage]. Moskva [Moscow]: Novye tehnologii v diagnostike i lechenii ginekologicheskih zabolevanij: tezisy nauchnaja konferencija [New technologies in diagnostic and treatment gynecological diseases: theses of scienti c conferences]. 2010: 276-277.

4. Curtser МА. Istinnoe vrastanie placenty. Novye podhody k terapii [True placenta previa; New traetment to therapy]. Saratov [Saratov]: Mat’ i ditja: tezisy III regional’nyj nauch-nyj forum [Mother and child: theses III regional scienti c forum]. 2009; 155-156.

5. Serov VN. Pro laktika materinskoj smertnosti [Prevention of maternal mortality]. Russkij medicinskij zhurnal «Mat’ i ditja (Akusherstvo i ginekologija)» [Russian Medical Journal «Mother and child (Obstetrics and gynecology)»]. 2008; 1: 1-5.

6. Sukhih GТ et al. Pro laktika i terapija massivnoj krovo-poteri v akusherstve [Prevention and therapy of massive obstetrics haemorhages]. Moskva [Moscow]: Medicinskaja tehnologija [Medical technology]. 2010; P: 4-18.

7. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during Caesarean delivery. Obstetrics & Gynecology. 2008; 96: 129-131.

8. Belotserkotseva LD et al. Upravljaemaja ballonnaja tam-ponada matki pri poslerodovyh krovotechenijah [Controlled balloon tamponade of postpartum haemorhages]. Voprosy ginekologii, akusherstva i perinatologii [Questions of gynecology, obstetrics and perinatology]. 2011; 5: 36-41.

9. Zharkin NA. Jeffektivnost’ ballonnoj tamponady pri akusherskih krovotechenijah. Mnogocentrovoe issledo-vanie [Perfomance of balloon tamponade of obstetrical haemorhages: Multicentre study]. Moskva [Moscow]: Mat’ i ditja: tezisy doklada X jubilejnogo Vserossiiskogo nauchnogo foruma [Mother and child: theses X Anniversary All-Russian science forum]. 2009; 66-67.

10. Hackethal A, Tcharchian G, Ionesi-Pasacica J, Muenstedt K, Tinneberg HR, Oehmke F. Uterine surgery in postpartum hemorrhage. Minerva Ginecol. 2009; 61 (3): 201-213.

11. Olenev AS. Ballonnaja tamponada matki kak metod lech-enija gipotonicheskih akusherskih krovotechenij [Uterusballon tamponade was method treatment hypotonic obstetrical haemorhages: Synopsis]. Moskva [Moscow]. 2008; 18 p.

 THE ROLE OF EXTRAINTESTINAL MANIFESTATIONS IN THE EARLY INFLAMATORY BOWEL DISEASE DIAGNOSIS IN THE UDMURT REPUBLIC

UDC 616.34-002.44-06:616.1/.9(470.51)

DOI: 10.20969/VSKM.2018.11(2).33-36

STYAZHKINA SVETLANA N., D. Med. Sci., corresponding member of the Russian Academy of Natural Science, professor of the Department of surgery of Izhevsk State Medical Academy, Russia, 426039, Izhevsk, Votkinsk highway, 57, e-mail:asu@rkb1.udm.ru

VOLKOVA ANASTASIA G., student of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281KAVUNENKO ANDREY A., student of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281

Abstract. Aim. Extraintestinal manifestations in patients with Crohn’s disease and ulcerative colitis in the territory of the Udmurt Republic have been characterized. Material and methods. Coloproctology department case reports (1,266 in total) at the 1 Republican Clinical Hospital of the Udmurt Republic in Izhevsk for 2017—2018 were studied. Results and discussion. The group of 25 patients with Crohn’s disease, 11 of them were men aged 17 to 59 years old [mean age was (30,7±4,45) years] and 14 were women 19 to 68 years old [mean age was (35,3±4,54) years]. Anterior uveitis was seen in 4% of the patients, hyperplastic mucous membrane lesion («cobblestone pavement» lay) was seen in 56% of the patients in the group. Sacroiliitis was seen in 12% of cases. In all cases saсroilitis was revealed in women, the «cobblestone pavement» lay was present in patients in equal proportion regardless of the gender. In the group of 54 patients with nonspeci c ulcerative colitis there were 24 men aged 22 to 76 years [mean age was (47,8±3,26) years] and 20 women aged 18 to 66 [mean age was (43,5±3,27) years]. In this group we revealed spondylitis (1,9% of cases) and primary sclerosing cholangitis (9,3% of cases), which is somewhat more than of cial statistics data. Сonclusion. The data obtained suggests that there are speci c features of the course of ulcerative colitis in the residents of Udmurtia.

Key words: in ammatory bowel disease, Crohn’s disease, ulcerative colitis, extraintestinal manifestations.

For reference: Styazhkina SN, Volkova AG, Kavunenko AA. The role of extraintestinal manifestations in the early in ammatory bowel disease diagnosis in the Udmurt Republic. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 33-36. DOI: 10.20969/VSKM.2018.11(2).33-36.

1. Zimmerman YS, Zimmerman IY, Tretyakova YuI. Yazvennyj kolit i bolezn’ Krona: sovremennye predstavleniya chast’ 1: De niciya, terminologiya, rasprostranennost’, etiologiya i patogenez, klinika, oslozhneniya, klassi kaciya [Ulcerative colitis and Crohn’s disease: modern views part 1: De nition, terminology, prevalence, etiology and pathogenesis, clinic, complications, classi cation]. Klinicheskaya medicina [Clinical medicine]. 2013; 11: 27-33.
2. Nazarenko LI, Baranovskiy AYu. Pitanie i vospalitel’nye zabolevaniya kishechnika [Nutrition and in ammatory bowel diseases]. Medical academic journal [Medicinskij akademicheskij zhurnal]. 2012; 12 (2): 28-34.
3. Adler G. Bolezn’ Krona i yazvennyj kolit [Crohn’s disease and ulcerative colitis]. Moskva: Geotar-Med [Moscow: Geotar-Med]. 2001; 83-115.
4. Zhilin SA, Radchenko VG, Dobritsa VP. Vnekishechnye proyavleniya vospalitel’nyh zabolevanij kishechnika [Extraintestinal manifestations of inflammatory bowel diseases]. Vestnik Severo-Zapadnogo gosudarstvennogo medicinskogo universiteta imeni II Mechnikova [Vestnik of the North-West State Medical University named after AI Mechnikov]. 2013; 5 (2): 111-117.
5. Podymova SD. Pervichnyj skleroziruyushchij holangit [Primary sclerosing cholangitis]. Medicinskij vestnik Severnogo Kavkaza [The medical bulletin of the North Caucasus]. 2009; 2: 75-82.
6. Shevtsov VD, Dmitrieva OA. K voprosu o vrachebnoj oshibke kak odnomu iz vidov defektov medicinskoj pomoshchi pri hirurgicheskih vmeshatel’stvah [On the issue of medical error, as one of the types of medical care defects in surgical competitions]. Problemy ekspertizy v medicine [Problems of expertise in medicine]. 2007; 27 (3): 4-7.

 PERSPECTIVES OF GENETICALLY ENGINEERED THERAPY IN SEVERE SEASONAL ALLERGIC RHINITIS

UDC 616.211-002.193-056.3-085.37

DOI: 10.20969/VSKM.2018.11(2).36-40

UKHANOVA OLGA P., D. Med. Sci., professor of the Department of immunology with advanced professional training course of Stavropol State Medical University, Russia, 355017, Stavropol, Mir str., 310; Head of allergy and immunology office of Stavropol Regional Clinical Hospital, 355030, Stavropol, Semashko str., 1, tel. +7(8652)71-71-66, e-mail: uhanova_1976@mail.ru

DZHABAROVA ALEKSANDRA A., master level nurse of office of allergy and immunology of Stavropol Regional Clinical Hospital, Russia, 355030, Stavropol, Semashko str., 1

SIVUN INNA V., C. Biol. Sci., associate professor, North-Caucasus Federal University, Russia, 355009, Stavropol, Pushkin str., 1

BURINDINA ELENA I., laboratory technician of the laboratory of immunology of Stavropol Regional Clinical Hospital, Russia, 355030, Stavropol, Semashko str., 1

Abstract. Revolutionary breakthrough in immunology has happened due to active development and implementation of genetically engineered medications for severe chronic disease treatment. Serum IgE monoclonal antibodies (omalizumab) are successfully used in allergology since 2007 for atopic bronchial asthma treatment. General IgE-dependent seasonalallergic rhinitis and atopic bronchial asthma development mechanism implies possible extension of indications for thistherapy. Omalizumab was rst used as an additional or alternative method of uncontrolled severe seasonal allergic rhinitis treatment. Aim. The ef cacy of severe allergic rhinitis treatment with IgE monoclonal antibodies (omalizumab) has been evaluated. Material and methods. A personal experience of omalizumab administration in routine practice in patients with severe seasonal allergic rhinitis, associated with weeds owering, is presented. Standard methods of speci c allergic patient examination (skin allergen tests, ELISA test for serum IgE level) were applied. Statistical processing of acquired data and individual titration of omalizumab dose was performed according to the manual. Results and discussion. The dynamics of IgE level in exacerbation, remission and after administering medication are presented during several seasons of weed owering. Prominent positive dynamics were noted. Duration and severity of seasonal allergic rhinitis symptoms as well as the volume of symptomatic drug therapy has decreased. A high commitment to biological therapy for seasonal allergic rhinitis was demonstrated. Conclusion. Omalizumab treatment inclusion is promising both in severe and comorbid seasonal allergic rhinitis.

Key words: omalizumab, IgE, seasonal allergic rhinitis, genetically engineered therapy.

For reference: Ukhanova AP, Dzhabarova AA, Sivun VI, Burindina EI. Perspectives of genetically engineered therapy in severe seasonal allergic rhinitis. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 36-40. DOI: 10.20969/ VSKM.2018.11(2).36-40.

 ADAPTATION OF THE MEDICAL ACHIEVEMENT SELF-EFFICACY SCALE (MASS) INTO TURKISH

UDC 61.378.4(560).091.212:303.62

DOI: 10.20969/VSKM.2018.11(2).41-45

TURAN SEVGI, MSc, PhD, associate professor of the Department of medical education and informatics Hacettepe University, faculty of medicine, Sihhiye campus, Turkey, 06100, Ankara, e-mail: sturan@hacettepe.edu.tr

ELCIN MELIH, MD, MSc, CHSE, professor of the Department of medical education and informatics Hacettepe University, faculty of medicine, Sihhiye campus, Turkey, 06100, Ankara

DERESE ANSELME, MD, PhD, associate professor of the Department of family medicine and medical education, Ghent University Faculty of Medicine, Department of Family Medicine and Primary Health Care, De Pintelaan 185, 6K3, 9000, Ghent, Belgium

Abstract. Aim. Curriculum innovators are eager to evaluate the overall effects of curriculum changes. In a Belgian-Turkish collaboration we developed a scale, for content validity based on the competency frameworks of CanMEDs and the Five Star Doctor, to measure self-ef cacy changes in undergraduate medical students. In this study, the reliability and construct validity of Medical Achievement Self-ef cacy Scale (MASS) among Turkish medical students were examined.Material and methods. The MASS contains 18 items, to be rated on a ve-point Likert scale. The study was conducted with undergraduate medical students at Hacettepe University (n=547). The Turkish form of the scale was examined for content validity by ve experts. Cronbach’s alpha was calculated for reliability of the scale. Item-total correlation was calculated and the scores of lowly and highly performing groups were compared by means of a t-test. Exploratory factor analysis was conducted to determine the construct validity. Results and discussion. The content validity ofthe Turkish MASS was considered appropriate. The reliability of the scale was high (Cronbach’s a= 0,89). Item-total correlation coef cients of the Turkish MASS ranged from 0,53 to 0,70. Lower and upper score groups were compared as an indicator of the discriminant validity. All items discriminated signi cantly between lowly and highly performing students. Factor analysis showed that the scale has a one factor structure which explains 37,89% of the variance. Factor loadings ranged from 0,56 to 0,73. Conclusions. The study showed the reliability and delivered evidence about theconstruct validity of the Turkish adaptation of the MASS.

Key words: academic self-ef cacy, medical students, scale development.

For reference: Turan S, Elcin M, Derese A. Adaptation of the Medical Achievement Self-ef cacy Scale (MASS) into Turkish. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 41-45. DOI: 10.20969/VSKM.2018.11(2).41-45.

REFERENCES

 PLACE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS IN THE THERAPY OF NICOTINE DEPENDENCE: A MODERN LOOK AT THE PROBLEM

UDC 613.84(048.8)

DOI: 10.20969/VSKM.2018.11(2).46-50

OSIPOV DMITRY A., resident of the Department of family medicine of Samara State Medical University, Russia, 443099, Samara, Leningradskaya str., 45, tel. 8-987-915-36-41, e-mail: dmitriylapka@gmail.com

Abstract. Aim. Analysis of the latest publications on electronic nicotine delivery systems safety evaluation and on their place in the modern tobacco addiction treatment setting was performed. Material and methods. Review of scienti c and medical publications devoted to electronic nicotine delivery system has been carried out. Results and discus-sion. It was concluded that electronic nicotine delivery systems are not the option for nicotine replacement therapy in tobacco addiction treatment. This opinion is based on a variety of publications in foreign and domestic sources devotedto analysis of the aerosol produced by electronic nicotine delivery systems and electronic cigarette as a therapeutic toolin general. It was proved that the aerosol produced by electronic nicotine delivery systems causes harm not only to the smoker, but also to the people around him. Because of the opportunity of using electronic nicotine delivery systems in places where a person would refrain from using conventional cigarettes, the frequency of inhalations increases as well as the daily dose of nicotine. Conclusion. The use of electronic nicotine delivery systems as the means of nicotinereplacement therapy is associated with a risk of complications, primarily affecting respiratory tract, and has no advan-tages over classical nicotine replacement therapy facilities.However, the use of an electronic cigarette is fraught with danger not only for the users, but also for the people around them, which is an additional limit to the use of electronic cigarettes as a therapeutic tool.

Key words: electronic nicotine delivery systems,electronic cigarette, tobacco smoking, nicotine addiction, nicotine replacement therapy.

For reference: Osipov DA. Place of electronic nicotine delivery systems in the therapy of nicotine dependence: a modern look at the problem. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 46-50. DOI: 10.20969/ VSKM.2018.11(2).46-50.

1. Quirmbach D, Gerry CJ. Gender. Education and Russia’s tobacco epidemic: a life-course approach. Social Science & Medicine. 2016; 160: 54-66.

2. Elektronnyie sistemyi dostavki nikotina: doklad VOZ [Electronic nicotine delivery systems: report by WHO]. Moskva: Konferencija Storon Ramochnoj konvencii VOZ po bor’be protiv tabaka [Moscow: Conference of the Parties to the WHO Framework Convention on Tobacco Control]. 2014; 20 p. URL: http://apps.who.int/gb/fctc/ PDF/cop6/ FCTC_COP6_10-ru.pdf

3. Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General’s report: “The Health Consequences of Smoking–50 Years of Progress”: A paradigm shift in cancer care. Cancer. 2014; 120: 1914-1916. doi:10.1002/ cncr.28695

4. Amirov NB i dr. Tabachnaya epidemiya: farmako-logicheskie vozmozhnosti borbyi [The tobacco epidemic: pharmacological control features]. Vestnik sovremennoy klinicheskoy meditsinyi [The Bulletin of Contemporary Clinical Medicine]. 2011; 4 (3): 28—33.

5. Martsevich SYu, Lukina JuV. Problema tabakokureniya v Rossii. Medikamentoznaya terapiya nikotinovoy zavisi-mosti: novyie i staryie preparatyi s pozitsiy dokazatelnoy meditsinyi [The problem of tobacco smoking in Russia. Drug therapy for nicotine dependence: new and old drugs in the context of evidence-based medicine]. Pro-lakticheskaya meditsina [Preventive medicine]. 2010; 6: 24—28.

6. Speranskaya OI, Smirnov VK, Bogdanov KA. Pervich-naya i vtorichnaya terapevticheskaya rezistentnost k nikotinzamestitelnoy terapii u lits s tabachnoy zavisi-mostyu [Primary and secondary resistance to nicotine replacement therapy in tobacco dependent patients]. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [Jour-nal of Neurology and Psychiatry. SS Korsakov]. 2013; 9. 59—62.

7. Fiore MC, Baker TB. Treating Smokers in the Health Care Setting. N Engl J Med. 2011; 365: 1222—1231.

8. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews. 2013; 6: CD006103. DOI: 10.1002/14651858.CD006103. pub6.

9. Cahill K, Stevens S, Perera R et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews. 2013; 5: CD009329. DOI: 10.1002/14651858. CD009329. pub2

10. Drummond MB, Upson D. Electronic cigarettes. Potential harms and bene ts. Ann Am Thorac Soc. 2014; 11 (2): 236—242.

11. McNeill A, Munafo MR. Reducing harm from tobacco use. J Psychopharmacol. 2013; 27 (1): 13-18.

12. Pearson JL. E-Cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012; 102: 1758—1766.

13. Rodu B. The scienti c foundation for tobacco harm reduc-tion, 2006—2011. Harm Reduct J. 2011; 8 (1): 19.

14. Morgan CJ et al. Harms and bene ts associated with psychoactive drugs: ndings of an international survey of active drug users. J Psychopharmacol. 2013; 27 (6): 497—506.

15. Department of Mental Health, International Narcotics Control Board, United Nations Of ce on Drugs and Crime.Guidelines for the psychosocially assisted pharmacologicaltreatment of opioid dependence. World Health Organiza-tion. 2009; 111 p.

16. Dutra LM, Glantz SA. Electronic cigarettes and convention-al cigarette use among US adolescents: a cross-sectional study. JAMA pediatrics. 2014; 168 (7): 610-617.

17. International Union Against Tuberculosis and Lung Disease. Position Statement on Electronic Cigarettes [ECs] or Electronic Nicotine Delivery Systems [ENDS]. Paris : 44th Union World Conference on Lung Health. 2013: 29 p. https://www.theunion.org/what-we-do/pub-lications/of cial/body/E-cigarette_statement_FULL.pdf

18. Adkison SE, O’Connor RJ, Bansal-Travers M et al. Elec-tronic nicotine delivery systems: international tobacco control. American journal of preventive medicine. 2013; 44 (3): 207-215.

19. Talbot P. Potential health effects of electronic cigarettes: a systematic review of case reports. Preventive medicine reports. 2016; 4: 169-178.

20. McRobbie H et al. Electronic cigarettes for smoking cessa-tion. The Cochrane Library. 2012; 12: СD004705.

21. Stead LF. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews. 2012; 11: CD000146. DOI: 10.1002/14651858. CD000146.pub4.

22. Adriaens K et al. Effectiveness of the electronic cigarette: an eight-week Flemish study with six-month follow-up on smoking reduction, craving and experienced bene ts and complaints. International journal of environmental research and public health. 2014; 11 (11): 11220-11248.

23. Hajek P, Etter JF, Benowitz N et al. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014; 109: 1801–1810.

24. Zhang Y, Sumner W, Chen DR. In vitro particle size distri- butions in electronic and conventional cigarette aerosolssuggest comparable deposition patterns. Nicotine Tob Res. 2013; 15: 501–508.

25. Reidel B, Radicioni G, Clapp P et al. E-cigarette use causes a unique innate immune response in the lunginvolving increased neutrophilic activation and alteredmucin secretion. American Journal of Respiratory and Critical Care Medicine. 2018; 4: 492-501.

26. Flouris AD, Chorti MS, Poulianiti KP et al. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol. 2013; 25: 91–101.

27. Schripp T, Markewitz D, Uhde E, Salthammer T. Does e- cigarette consumption cause passive vaping? Indoor Air. 2013; 23: 25–31.

28. Czogala J, Goniewicz ML, Fidelus B et al. Secondhand exposure to vapors from electronic cigarettes. Nicotine Tob Res. 2014; 16 (6): 655-662. doi: 10.1093/ntr/ntt203. http://ntr.oxfordjournals.org/ content/early/2013/12/10/ntr. ntt203.long.

29. Soneji S, Barrington-Trimis JL, Wills TA et al. Associa-tion Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017; 171 (8): 788-797.

30. Goniewicz ML, Hajek P, McRobbie H. Nicotine content of electronic cigarettes, its release in vapour and its consis-tency across batches: egulatory implications. Addiction. 2014; 109: 500–507.

31. Weaver M, Breland A, Spindle T, Eissenberg T. Electronic cigarettes: a review of safety and clinical issues. J Addict Med. 2014; 8 (4): 234–240.

32. Antonov NS et al. Elektronnyie sigaretyi: otsenka bezopasnosti i riskov dlya zdorovya [Electronic cigarettes: safety assessment and health risks]. Pulmonologiya [Pulmonology]. 2014; 3: 122-127.

 SURGICAL TACTICS AND TRANSFUSIONAL COMPONENT INFLUENCE ON THE EARLY PERIOD OF TRAUMATIC DISEASE

UDC 616.001.085.38 

DOI: 10.20969/VSKM.2018.11(2).51-54

PELINA NATALIA A., part-time postgraduate student of the Department of surgical diseases with a course of anesthesiology and resuscitation of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Repin str., 1, tel. 8-912-851-32-47, e-mail: pelina.nata@yandex.ru

STYAZHKINA SVETLANA N., D. Med. Sci., professor of the Department of surgery of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, tel. 8-912-855-34-36

PRONICHEV VYACHESLAV V., D. Med. Sci., professor of the Department of surgery of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, tel. 8-912-850-19-57

NEGANOVA OLGA A., therapist, Сhief physician of the City Clinical Hospital No 9, Russia, 426000, Izhevsk, Promyshlennaya str., 52

Abstract. Aim. The aim of the study was to evaluate the effectiveness of transfusion therapy in the early period of traumatic disease in providing emergency surgical care to the victims with cavity trauma in the dynamics for 2005—2017 due to the change of surgical tactics. Material and methods. The study is a retrospective analysis of medical records (case reports) of the patients with cavity trauma (abdominal or thoracic) for 2005—2007 in comparison with a prospective set of similar patients 10 years later in 2015—2017. The stage of patient delivery to the operating room, the severity of the lesion and the volume of incoming blood loss, the initiation of transfusion therapy as a part of comprehensive emergency response, the change in its effectiveness depending on the change in the tactics of surgical patient management were evaluated. Results and discussion. The change of the surgical concept has led to a change in the pro le of transfusion therapy at the stages of traumatic disease and to the improvement of clinical and laboratory indicators. An increase of transfused FFP dose has resulted in hemostasis stabilization at earlier periods from the moment of injury and in reduction of its transfusion at long-term treatment. Red blood cell transfusion peak change for 12—48 hours from the time of injury has led to more stable early hemoglobin level normalization. The results con rm the validity of the transfusion component pro le change in the complex therapy in the early trauma period. Conclusion. It was established that the change of the surgical concept has led to a change in transfusion therapy pro le in posttraumatic period, to a quicker acute blood loss manifestations reduction and to stabilization of the body functions.

1. Tulupov AN. Tjazhelaja sochetannaja travma [Severe combined trauma]. SPb: Izdatel’stvo OOO «RA «Russkij Juvelir» [SPb: Publishing house of the LLC “RA” Russian Jeweler “]. 2015; 314 p.

2. Potapnev MP, Leshhuk SP. Transfuzionno-obuslovlennaja immunomoduljacija. Klinicheskoe znachenie i mehanizmy dejstvija [Transfusion-mediated immunomodulation. Clinical significance and mechanisms of action]. Transfuziologija [Transfusiology]. 2013; 14 (2): 27–48.

3. Carson JL, Terrin ML, Noveck H et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011; 365 (26): 2453-2462.

4. Lamb CM, MacGoey P, Navarro AP, Brooks AJ. Damage Control Surgery in the Era of Damage Control Resuscitation. Br J Anaesth. 2014; 113 (2): 242-249. doi: 10.1093/bja/aeu233

5. Feinmana M et al. Optimal uid resuscitation in trauma: type, timing, andtotal. Curr Opin Crit Care. 2014; 20: 366–372.

6. John B Holcomb, Philip C Spinella. Optimal use of blood in trauma patients. Biologicals. 2010; 38 (1): 72–77.

7. Ob utverzhdenii pravil klinicheskogo ispol’zovanija donorskoj krovi i (ili) ee komponentov: Prikaz Ministerstva zdravoohranenija Rossijskoj Federacii ot 2 aprelja 2013 g. N 183n, Moskva [On the approval of the rules for the clinical use of donor blood and (or) its components: Order of the Ministry of Health of the Russian Federation of April 2, 2013 N 183n Moscow]. Rossiisksya gazeta [Russian Newspaper]. 2013; 6166 (190).

8. Zhiburt EB. Menedzhment krovi pacienta pri kriticheskom krovotechenii i massivnoj transfuzii [Blood management of the patient with critical bleeding and massive transfusion]. Vestnik Nacional’nogo mediko-hirurgicheskogo centra imeni NI Pirogova [Bulletin of the National Medical-Surgical Center named after NI Pirogov]. 2013; 8 (4): 71-77.

9. Zhiburt EB, Madzaev SR, Shestakov EA, Fajbushevich AG et al. Medicinskaja i jekonomicheskaja jeffektivnost’ ogranichitel’noj strategii perelivanija krovi [Medicaland economic effectiveness of the restrictive strategyof blood transfusion]. Vestnik Nacional’nogo mediko- hirurgicheskogo centra imeni NI Pirogova [Bulletin of the National Medical-Surgical Center named after NI Pirogov]. 2015; 10 (1): 100-102.

10. Zhiburt EB, Kozhemjako OV, Shihmirzaev TA, Zarubin MV. Prioritety razvitija transfuziologii [Priorities for the development of transfusiology]. Zdravoohranenie Dal’nego Vostoka [Public Health of the Far East]. 2016; 1: 64.

 TREATMENT FEATURES IN PATIENT WITH DIABETIC FOOT SYNDROME TAKING INTO ACCOUNT SOFT TISSUE CHANGES

UDC 617.586-002.44-06:616.379-008.64 

DOI: 10.20969/VSKM.2018.11(2).55-58

STYAZHKINA SVETLANA N., D. Med. Sci., professor of the Department of surgery of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, e-mail: asu@rkb1.udm.ru

KIRYANOV NIKOLAY A., D. Med. Sci., professor, Head of the Department of pathological anatomy of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, e-mail: kirnik@list.ru

BAYRAMKULOV ENVAR D., postgraduate student of the Department of surgery of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, tel. 8-912-442-14-42

AKHMATDINOVA ELVINA N., 5th year student of general medicine faculty of department of evening studies of Izhevsk State Medical Academy, Russia, 426034, Izhevsk, Kommunar str., 281, e-mail: elvina_akhmatdinova@mail.ru

1. Gal IG, Slepnev SYu. Organizacija pomoshhi pacientam s sindromom diabeticheskoj stopy [Organization of the help to patients with a syndrome of diabetic foot]. Materialy Mezhdunarodnogo nauchno-prakticheskogo kongressa «Saharnyj diabet i hirurgicheskie infekcii» [Materials of the International scienti c and practical congress “Diabetes and Surgical Infections”]. 2013; 15-26.

2. Girsh YaV, Davidenko OP. Sindrom diabeticheskoj stopy; Ego rol’ i mesto v sovremennoj diabetologii [Syndrome of diabetic foot; His role and the place in modern diabetology]. Nauchno-prakticheskij zhurnal «Vestnik SurGU; Medicina» [Messenger of SURGU; Medicine]. 2013; 15 (1): 10-31.

3. Belozertseva YuP, Kurlayev PP, Yesipov VK, Gritsenko VA. Opyt lechenija gnojno-nekroticheskih oslozhnenij sindroma diabeticheskoj stopy s primeneniem original’noj hirurgicheskoj metodiki na fone celenapravlennoj antibiotikoterapii [Experience of treatment it is purulent —necrotic complications of a syndrome of diabetic foot withapplication of an original surgical technique against the background of purposeful antibiotic treatment]. Kreativnaja hirurgija i onkologija [Creative surgery and oncology]. 2014; 3: 61-68.

4. Mitish VA, Makhkamova FT, Paskhalova YuS, Gruzman VA, Margolina II, Sokov SL. Fakticheskaja stoimost’ kompleksnogo hirurgicheskogo lechenija bol’nyh nejroishemicheskoj formoj sindroma diabeticheskoj stopy [Actual cost of complex surgical treatment of patientswith a neuroischemic form of a syndrome of diabeticfoot]. Hirurgija: Zhurnal imeni NI Pirogova [Surgery: The magazine of NI Pirogov]. 2015; 4: 35-43.

5. Galstyan GR, Tokmakova AYu, Egorova DN, Mitish VA, Paskhalova YuS, Antsiferov MB, Komelyagina EYu, Udovichenko OV, Guryeva IV, Beregovsky VB, Eroshkin IA, Eroshenko AV, Eroshenko AV. Klinicheskie rekomendacii po diagnostike i lecheniju sindroma diabeticheskoj stopy [Clinical recommendations about diagnostics and treatment of a syndrome of diabetic foot]. Rany i ranevye infekcii [Wound and wound infections]. 2015; 3: 60-81.

 RESULTS OF PATIENT SURVEY ON THE SUBJECT OF PROCESS ORGANIZATION EVALUATION IN MEDICAL SETTING

UDC 614.253.8:303.62 

DOI: 10.20969/VSKM.2018.11(2).59-65

BERSENEVA EVGENIA A., ID: orcid.org/0000-0003-3481-6190, SCOPUS Author ID 55554758300, D. Med. Sci., Head of the Center of the higher and additional professional education of N.A. Semashko National Research Institute of Public Health, Russia, Moscow, Vorontsovo Pole str., 12/1, tel. +7-916-216-84-59, e-mail: eaberseneva@gmail.com

MENDEL SERGEY A., ID: orcid.org/ 0000-0001-7679-7106, researcher ID: D-2425-2018, C. Med. Sci., Head of Clinical Hospital of Ministry of Internal Affairs of the Russian Federation for Moscow, high level certified physician, Russia, Moscow, Novaya Ipatovka str., 3a, tel. +7-916-076-46-41, e-mail: 89160764641@mail.ru

SAVOSTINA ELENA A., ID: orcid.org/0000-0002-2039-4639, researcher ID: D-3882-2018, D. Med. Sci., associate professor of the Department of medical statistics and informatics of Russian Medical Academy of Postgraduate Education, Russia, Moscow, Barrikadnaya str., 12/1, bld. 1, tel. +7-916-486-50-50, e-mail: eas-m@mail.ru

TAIROVA RAISA T., ID: orcid.org/0000-0002-4174-7114, C. Med. Sci., senior researcher of Research institute of cerebrovascular diseases and stroke of N.I. Pirogov Russian National Research Medical University, Russia, 117997, Moscow, Ostrovitianov str. 1, tel. +7-926-226-59-88, e-mail: tairova-r@mail.ru

1. Kakorin VG, Kukovyakin SA, Sheshunov IV, Kukovyakina ND. Udovletvorennost’ medicinskoj pomoshch’yu (obzor literatury) [Satisfaction with medical aid (review of literature)]. Vyatskij medicinskij vestnik [Vyatsky medical bulletin]. 2009; 2-4: 69-77: https://cyberleninka.ru/article/v/ udovletvorennost-meditsinskoy-pomoschyu-obzor-literatury

 DRUG THERAPY OPTIMIZATION IN THERAPEUTIC DEPARTMENTS AT MULTISPECIALTY HOSPITAL BASED ON THE IMPLEMENTATION OF THE ORDERS AND STANDARDS OF MEDICAL CARE

UDC 616.1-085.22-07

DOI: 10.20969/VSKM.2018.11(2).65-70

SHKITIN SERGEY O., external postgraduate student of N.A. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12, bld. 1, tel. 8-903-963-39-32, e-mail: ishkitin@gmail.com

BERSENEVA EUGENIA A., D. Med. Sci., professor, Head of the Center for higher and additional professional education of N.A. Semashko National Research Institute of Public Health, Russia,105064, Moscow, Vorontsovo Pole str., 12, bld. 1, tel. 8-916-216-84-59, e-mail: eaberseneva@gmail.com

BEREZNIKOV ALEXEY V., D. Med. Sci., professor of Scientific and educational center for applied medicine and food safety of M.V. Lomonosov Moscow State University, Russia, 119991, Moscow, Leninsky gory, 1, tel. 8-964-799-10-22, e-mail: avbereznikov@mail.ru

TAIROVA RAISA T., C. Med. Sci., senior researcher of National research institute of cerebrovascular diseases and stroke of N.I. Pirogov Russian State Medical University, Russia, 109074, Moscow, Slavyanskaya square, 4, bld. 1

ONUFRIYCHUK JULIA O., C. Med. Sci., associate professor of the Department of medical rehabilitation and physical methods of treatment of the Institute of Medical and Social Technologies, Russia, 125080, Moscow, Volokolamsk highway, 11

Abstract. Aim. A methodology aiming to ensure the implementation of medical services according to the order and standards of medical care in the departments of the therapeutic pro le of a multi-specialty hospital was developed.Material and methods. An expert assessment of medical care delivered for patients with acute and chronic types of coronary heart disease, atrial brillation, and decompensated chronic heart failure was performed with involvement of experts in the quality of care. Then, the quality of medical care provided for patients in medical organizations was assessed with different approaches to the organization of its delivery. After determining the most effective methods for organizing the provision of medical care, effectiveness of introduction of internal quality and safety control of medical activities has been assessed. Results and discussion. When organizing the provision of medical care using the treatment regimens developed on the basis of the orders and standards of medical care, the smallest number of violations was reached. With the further introduction of internal control system based on monitoring compliance of medical care with treatment regimens, the violations were detected in even fewer cases. Conclusion. Introduction of internal quality control andthe practical treatment schemes developed on the basis of the orders and standards of care into clinical practice inmedical institutions helps to reduce the proportion of violations in health care.

Key words: quality of medical care, treatment regimen.

For reference: Shkitin SO, Berseneva EA, Bereznikov AV, Tairova RT, Onufriychyuk JuO. Drug therapy optimization intherapeutic departments at multispecialty hospital based on the implementation of the orders and standards of medicalcare. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (2): 65-70. DOI: 10.20969/VSKM.2018.11(2).65-70.

1. Bereznikov AV, Konev VP, Onufriychuk YuO et al. Jekspertnaja dejatel’nost’ v objazatel’nom medicinskom strahovanii: prakticheskoe posobie [Expert activity in compulsory medical insurance: practical manual]. Moskva [Moscow]: Infra-M. 2016; 184 p.

2. Predlozhenija (prakticheskie rekomendacii) po organizacii vnutrennego kontrolja kachestva i bezopasnosti medicinskoj dejatel’nosti v medicinskoj organizacii (stacionare) Federal’noj sluzhby po nadzoru v sfere zdravoohranenija [Suggestions (practical recommendations) on the organization of internal quality control and safety of medical activities in the medical organization (hospital) of the Federal Service for Supervision of Health]. Moskva: FGBU CMIKJeJe [Moscow].

3. Porjadok organizacii i provedenija kontrolja ob#emov, srokov, kachestva i uslovij predostavlenija medicinskoj pomoshhi po objazatel’nomu medicinskomu strahovaniju, utverzhdennomu prikazom Federal’nogo fonda objazatel’nogo medicinskogo strahovanija ot 01.12.2010 No 230 [The procedure for the organization and monitoring of volumes, terms, quality and conditions for the provision of medical assistance for compulsory health insurance, approved by the Order of the Federal Fund of Mandatory Medical Insurance No 230 of December 1, 2010].

4. Standart specializirovannoj medicinskoj pomoshhi pri nestabil’noj stenokardii, ostrom i povtornom infarkte miokarda (bez pod’ema segmenta ST jelektrokardiogrammy), utverzhdennyj prikazom Ministerstva zdravoohranenija RF ot 01.07.2015 No 405an [Standard of specialized medical care for unstable angina pectoral, acute and repeated myocardial infarction (without the elevation of the ST segment of the electrocardiogram) approved by the Order of the Ministry of Health of the Russian Federation of July 1, 2015, No 405an].

5. Standart specializirovannoj medicinskoj pomoshhi pri ostrom infarkte miokarda (s pod’emom segmenta ST jelektrokardiogrammy), utverzhdennyj prikazom Ministerstva zdravoohranenija RF ot 01.07.2015 No 404an [Standard of specialized medical care for acute myocardial infarction (with the rise of the ST segment of the electrocardiogram), approved by the Order of the Ministry of Health of the Russian Federation of July 1, 2015, No 404an].

6. Standart specializirovannoj medicinskoj pomoshhi pri serdechnoj nedostatochnosti, utverzhdennyj prikazom Ministerstva zdravoohranenija RF ot 24.12.2012 No 1554n. [Standard of specialized medical care for heart failure, approved by Order of the Ministry of Health of the Russian Federation of December 24, 2012 No 1554n].

7. Standart specializirovannoj medicinskoj pomoshhi pri brilljacii i trepetanii predserdij, utverzhdennyj prikazom Ministerstva zdravoohranenija RF ot 28.12.2012 No 1622n [Standard of specialized medical care for atrial brillation and fluttering, approved by Order of the Ministry of Health of the Russian Federation of December 28, 2012 No 1622n.].

8. Shkitin SO, Nechaeva GI, Bereznikov AV et al. Dekompensirovannaja hronicheskaja serdechnaja nedostatochnost’ [Decompensated chronic heart failure]. Vestnik Roszdravnadzora [Bulletin of Roszdravnadzor]. 2017; 2: 53-60.