TUBERCULOSIS RISK FACTORS IN EPIDEMIC SITUATIONS IN PRISON FACILITIES

BELOKONOVA LYUDMILA V., C. Med. Sci., associate professor of the Department of infectious diseases and epidemiology of Kursk State Medical University, Russia, 305007, Kursk, Sumskaya str., 45g,
tel. 8(951)339-93-55, e-mail: Ludmila2611@yandex.ru

KOLOMIETS VLADISLAV M., D. Med. Sci., professor of the Department of clinical immunology, allergy and phthisiopulmonology of Kursk State Medical University, 305041, Russia, Kursk, K. Marx str., 3

DEVYANIN PAVEL A., Head of Medical Care unit No 46 of Federal Penitentiary Service, Russia, 305007, Kursk, Pigorev str., 17

Abstract. Aim. The aim of the study was to identify and to assess the risk factors for tuberculosis development thatinfluence the epidemic situation in penitentiary institutions in order to improve anti-tuberculosis measures. Material and methods. The patients with tuberculosis from penitentiary institutions were observed at the Office of the Federal Penitentiary Service of Russia in the Kursk region. Common methods of statistical information processing, including χ2test, were applied in assessment of the influence of risk factors on tuberculosis development. Results and discussion.Persons imprisoned for the first time, having primary or secondary education prevailed among patients with pulmonary tuberculosis. Their duration of stay in places of detention ranged from 2 to 5 years. The main proportion of the people had a history of frequent acute respiratory viral infections, chronic diseases of the upper respiratory tract, comorbidities, smoking, alcohol abuse, drug use, or HIV infection. Practically every second patient with tuberculosis had a history of contact with a bacterium emitter. There were a high proportion of people in extreme situations, and people who have weak social ties with the family. Conclusion. The most significant risk factors for the development of tuberculosis in the penitentiary system include: smoking, upper respiratory tract pathologic conditions, lack of stable social connections, contact with a patient with tuberculosis, HIV infection, stay in extreme situations, and the first time of detention lasting 2 to 5 years.

Key words: prison tuberculosis, incidence of tuberculosis, risk factors.

UDC 616.831-005.4-036.11-037:616.15-078

DOI: 10.20969/VSKM.2018.11(6).11-15

 S-100 PROTEIN AUTOANTIBODY LEVEL AS A POSSIBLE OUTCOME PREDICTOR IN ACUTE STROKE

ЕRMAKOV SERGEY V., neurologist, specialist on X-ray and endovascular methods of diagnosis and treatment of the Department of X-ray surgical methods of diagnosis and treatment of Stavropol Regional Clinical Hospital, Russia, 355000, Stavropol, Semashko str., 1, e-mail: s.v.yermakov@yandex.ru

MOZHEIKO ROSTISLAV A., C. Med. Sci., associate professor of the Department of neurology, neurosurgery and medical genetics of Stavropol State Medical University, Russia, 355000, Stavropol, Mir str., 310, e-mail: rost-m@rambler.ru

BATURIN VLADIMIR A., D. Med. Sci., professor, Head of the Department of clinical pharmacology of Stavropol State Medical University, Russia, 355000, Stavropol, Mir str., 310, e-mail: v_baturin@mail.ru

BELOKON OLEG S., specialist on X-ray and endovascular methods of diagnosis and treatment, Head of the Department of X-ray surgical methods of diagnosis and treatment of Stavropol Territorial Clinical Hospital, Russian, 355000, Stavropol, Semashko str., 1, e-mail: bos-ol@yandex.ru

Abstract. Aim. The aim of the research was to study the variability in blood S-100 protein antibody titer in patients with acute ischemic stroke and to determine their effects on the course of the disease. Material and methods. The patientswith acute cerebrovascular accident and with initial manifestations of degenerative-dystrophic diseases of the spine have been enrolled in the study. ELISA immunoassay was used to determine S-100 protein antibody titer in 84 patients. National Institutes of Health Stroke Scale (NIH SS), and ASPECTS (Alberta stroke program early CT score) scales have been applied. Results and discussion. Direct relationship was established between the severity of ischemic stroke and the S-100 protein antibody titer. The highest S-100 protein antibody titer was seen in patients with NIH rating of SS≥10 points. A similar pattern was revealed in patients with ASPECTS score of 6 points. It was also found that an increase in S-100 protein antibody titer is a predictor of significant brain damage (p<0,05). Conclusion. The threshold S-100 protein antibody titer was experimentally established to predict the course of the disease. An initial value of more than 200 μg/ml is a predictor of severe neurological deficit persistence. At the same time, the values less than 150 μg/ml are predicatively favorable both for the outcome of the disease and for the further rehabilitation.

Key words: S-100 protein, neurospecific proteins, acute stroke, autoantibodies.

For reference: Ermakov SV, Mozheiko RA, Baturin VA, Belokon OS. S100 protein autoantibody level as a possible outcome predictor in acute stroke. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (6): 11–15. DOI: 10.20969/ VSKM.2018.11(6).11-15.

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9. Klimenko LL, Turna AA, Savostina MS, Baskakov IS, Budanova MN, Mazilina AN, Deev AI. Nejrospecificheskie belki kak biomarkery ishemicheskogo insul’ta [Neurospecific proteins as biomarkers of ischemic stroke]. Allergologija i immunologija [Allergology and Immunology]. 2016; 11 (1): 55.

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UDC 616.366-089.87-052

DOI: 10.20969/VSKM.2018.11(6).23-28

 PSYCHOLOGICAL CHARACTERISTICS OF PATIENTS WITH CHOLELITHIASIS AFTER CHOLECYSTECTOMY

NIZAMOV RUSLAN A., applicant for a degree of the Department of surgery with the course of endoscopy of Bashkir State Medical University, surgeon, radiologist, Russia, 450000, Ufa, Lenin str., 3, tel/fax 8 (347)223-24-21, e-mail: nizamgik@gmail.com

TIMERBULATOV SHAMIL V., D. Med. Sci., associate professor, professor of the Department of surgery with the course of endoscopy of Bashkir State Medical University, Russia, 450000, Ufa, Lenin str., 3, tel/fax 8 (347)223-24-21, e-mail: timersh@yandex.ru

ISKHAKOV EDUARD R., D. Med. Sci., professor of the Department of criminalistics of Ufa Law Institute, Russia, e-mail: iskhakov1964@mail.ru

KILDIBEKOVA RAUSHANIA N., D. Med. Sci., professor of the Department of mobilization preparation of Bashkir State Medical University, Honored doctor of the Republic of Bashkortostan, Russia, 450000, Ufa, Lenin str., 3, tel/fax 8 (347)223-24-21, e-mail: kildebekova49@mail.ru

Abstract. Aim. The aim of the study was to establish the features of adherence to treatment, the type of attitude towards the disease, and the levels of quality of life indicators in patients with cholelithiasis, depending on the rehabilitation program performed after cholecystectomy. Material and methods. 106 patients of working age, who experienced cholecystectomy via laparoscopic access, have been examined. The examination was carried out before surgical treatment (laparoscopic cholecystectomy) and after 1 month. After the surgery the patients with cholelithiasis were divided into two groups: I – the main group (n=79), unifying patients who continued rehabilitation in a health resort from day 5–6 to enhance the recovery process, and II – comparison group (n=27), where patients were observed in outpatient facilities. Control group included 20 practically healthy individuals matched by gender and age. The patientswere admitted to intensive care unit from the operating room to monitor their general condition after laparoscopiccholecystectomy. After 4–6 hours they were recommended to get up and to take liquid food. The following day after surgery, the patients were able to move around the hospital for 100–150 meters with a daily increase in physical activity. 5–6 days after cholecystectomy the patients were forwarded to health resort for further rehabilitation. The study of thelevel of adherence to medical recommendations was carried out by interviewing patients one month after the operationvia specially designed questionnaire containing questions on following medical recommendations. Quality of life was assessed according to the MOS SF-36 questionnaire. Condition of liver and hepatobiliary system was studied on Siemens acusion ultrasound machine. Magnetic resonance cholangiopacreatography was performed when necessary.Results and discussion. Clinical improvement and improvement of the quality of life was observed after surgicaltreatment. Adherence to treatment, harmonious type of attitude to the disease, and the levels of quality of life indicators related to physical and psychological health were significantly higher in patients in group I, who underwent rehabilitation in health resort, compared with the patients in group II, observed in outpatient facilities. Conclusion. Proportion ofpeople adhering to the prescribed recommendations in patients with cholelithiasis after laparoscopic cholecystectomyand accelerated postoperative rehabilitation was significantly higher in group I with health resort rehabilitation stage compared with those who underwent rehabilitation only in outpatient settings. The number of people having harmonious relationship to the disease significantly increased and the number of people with ergopathic type decreased in patients with gallstone disease after surgery and accelerated rehabilitation in health resort. Quality of life restoration in physicaland psychological spheres was observed as a result of the accelerated postoperative rehabilitation including healthresort stage in patients with gallstone disease after cholecystectomy.

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UDC 616.2-002.282-07:612.2

DOI: 10.20969/VSKM.2018.11(6).28-35

 VENTILATION AND GAS EXCHANGE PARAMETERS AT THE PEAK OF PHYSICAL EXERCISE IN PATIENTS WITH PULMONARY SARCOIDOSIS

POSTNIKOVA LARISA B., D. Med. Sci, associate professor, professor of the Department of internal medicine of Privolzhsky Research Medical University, Russia, 603005, Nizhny Novgorod, Minin i Pozharsky sq., 10/1, e-mail: plbreаth@mail.ru

GUDIM ANDREY L., therapist of City Clinical Hospital No 38, Russia, 603000, Nizhny Novgorod, Chernyshevsky str., 22

BOLDINA MARINA V., C. Med. Sci, assistant of professor of the Department of internal medicine of Privolzhsky Research Medical University, Russia, 603005, Nizhny Novgorod, Minin i Pozharsky sq., 10/1

KOSTROV VLADIMIR A., C. Med. Sci., associate professor, pulmonologist of City Clinical Hospital No 38, Russia, 603000, Nizhny Novgorod, Chernyshevsky str., 22

POGREBETSKAYA VERA A., deputy Head physician of City Clinical Hospital No 38, Russia, 603000, Nizhny Novgorod, Chernyshevsky str., 22

Abstract. Aim. The aim of the study was to analyze the parameters of gas exchange and ventilation based on the results of cardiopulmonary exercise testing with gas analysis in patients with respiratory sarcoidosis. Material and methods.42 patients aged 34,5 (29–41,5) years with stage I–III respiratory sarcoidosis and 21 healthy volunteers were examined. The duration of respiratory sarcoidosis was 3 (1–5) years. Respiratory sarcoidosis was histologically confirmed in 78,6% of cases. Clinical manifestations were assessed in all study participants. Pretest spirometry and cardiopulmonary exercise testing with assessment of ventilation parameters (Rf, Vt, Ve, Vt/FVC, BR) and gas exchange at peak load [PetCO2, Ve/ VCO2 (VT1), Vd/Vt)] were performed. The patients were divided into groups: group 1 (n=20) – oxygen consumption at peak load (VO2 peak pred) ≤ 84% and group 2 (n=22) – VO2 peak pred > 84%. Healthy individuals were placed to the 3rd group. Results and discussion. A decrease in VO2 peak (%) in patients with respiratory sarcoidosis (a criterion for reducing exercise tolerance) did not affect clinical or radiological signs. Minute ventilation (Ve) and tidal volume (Vt) in the group 1 were significantly lower than in the 2nd and control groups. The level of breathing reserve (BR) in all patients with respiratory sarcoidosis exceeded 30%. There were no differences in BR between the groups (p>0,05). Lower PetCO2 value (p<0,001), significant increase in Ve/VCO2 (VT1) (p<0,001) and Vd/W at the peak load (p=0,025) comparing to the group 3 were recorded at all stages of cardiopulmonary stress testing in the group 1. Patients of the group 2 differed in lower PetCO2 at the peak of physical activity compared with the control (p=0,027). Conclusion.Cardiopulmonary stress testing reveals a restriction of exercise tolerance in patients with respiratory sarcoidosis in the absence of functional changes of external respiration at rest. A decrease in exercise tolerance in patients with respiratory sarcoidosis was combined with a decrease in Vt and Ve peak and impaired gas exchange parameters [decrease in PetCO2 at all stages of cardiopulmonary stress testing, an increase in Vd/Vt at the peak exercise and Ve/VCO2 (VT1)].

Key words: sarcoidosis, cardiopulmonary exercise test, peak oxygen consumption, exercise capacity.

For reference: Postnikova LB, Gudim AL, Boldina MV, Kostrov VA, Pogrebetskaya VA. Ventilation and gas exchange parameters at the peak of physical exercise in patients with pulmonary sarcoidosis. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (6): 28–35. DOI: 10.20969/VSKM.2018.11(6).28-35.

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 EXPERT EVALUATION OF DRUGS USED FOR DETOXIFICATION THERAPY AT REHABILITATION DEPARTMENT AT ADDICTION CLINIC

SIDULLIN ANTON YU., senior laboratory assistant of the Institute of pharmacy of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

AKHMETZYANOV ILGIZ I., Head physician of Republican Narcological Dispensary of Republic of Tatarstan, Russia, 420061, Kazan, Sechenov str., 6

EGOROVA SVETLANA N., D. Pharm. Sci., professor, deputy Director for education of the Institute of pharmacy of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

SIDULLINA SVETLANA A., C. Pharm. Sci., associate professor of the Institute of pharmacy of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

Abstract. Aim. Evaluation of consumer properties of the drugs used in detoxification therapy in psychoactive substance poisoning at the intensive care unit at addiction clinic was the aim of the study. Material and methods. Expert evaluation of the range of drugs used for detoxification therapy, registered in the State Registry of Medicinal Products of Russia, present on the regional pharmaceutical market and in addiction clinics of the Republic of Tatarstan, was conducted in the course of the study. Results and discussion. Comprehensive assessment of consumer properties of detoxification treatment drugs was carried out by expert doctors working in addiction clinics of the Republic of Tatarstan. 33 expert doctors were surveyed (total population was 36), which ensures the representativeness of the sample with 95% accuracy. As a result of the analysis of data on competence assessment in narcologists who participated in the expert assessment of consumer properties of the drugs for detoxification therapy, it was found that 52% of the experts had an average level of competence and 48% had a high level. Factors that influenced the choice of drugs were therapeutic efficacy (43,2%), safety (22,1%), contraindications (8,3%), rationality of the dosage form and the dosage itself (21,1%), and price availability (5,3%). Using an average weighted score the drugs tested were ranked for all of the analyzed parameters (top 10). The coefficient of concordance of expert opinions during the ranking of the drugs was in the range of 0,72–0,88, which suggests that the experts slightly differ in their opinions regarding the consumer properties of the studied drugs. The coefficients of variation of expert opinions during the ranking of the drugs ranged from 10 to 20%, i.e. the total data presented is homogeneous. The results of the evaluation of consumer properties of the drugs for detoxification therapy were systematized by pharmacotherapeutic groups. The study allowed identifying the leaders of medical preferences in each group. Conclusion. The medical preferences of drugs for detoxification therapy at the intensive care unit of the addiction clinic were revealed.

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8. Poryadok okazaniya meditsinskoy pomoshchi po profilyu «psikhiatriya-narkologiya»: Prikaz MZ RF ot 30/12/2015 No1034n [The procedure for rendering medical assistance in the «psychiatry-narcology» profile: Order of the Ministry of Health of the Russian Federation of 30/12/2015 No 1034n]. www.base.garant.ru

9. Dremova NB, Kobzar’ LV, Korzhavykh EA. Metodologiya otechestvennykh issledovaniy potrebnosti v lekarstven- nykh sredstvakh i ikh potrebleniya [Methodology of domestic research on drug demand and consumption]. Farmatsiya i farmakologiya [Pharmacy and pharmacology]. 2015; 3: 4-9.

10. Sidullin AYu, Sidullina SA, Bariyev MF. Lekarstvennyye sredstva, primenyayemyye pri infuzionno-dezintoksi- katsionnoy terapii [Drugs used in infusion-detoxification therapy]. Kazan’: Aktual’nyye voprosy povysheniyakachestva poslediplomnoy podgotovki farmatsevticheskikhkadrov: sbornik nauchnykh statey rossiyskoy nauchno- prakticheskoy konferentsii KazGMU [Kazan: Actualissues of improving the quality of postgraduate training ofpharmaceutical personnel: a collection of scientific articles of the Russian scientific-practical conference, KazSMU]. 2012; 4: 79-89.

11. Tarychev VV. Legitimnost’ standartov okazaniya skoroy meditsinskoy pomoshchi [Legitimacy of ambulance standards]. Meditsinskoye parvo [Medical Law]. 2014; 1: 49-50.

1. Savel’eva GM, Shalina RI, Smirnova AA, Kunyah ZhYu, Evstratova OP, Simuhina MA. Asfiksiya donoshennyh novorozhdennyh. kompleksnaya terapiya s ispol’zovaniem kraniocerebral’noj gipotermii [Asphyxia in full-term newborn infants: combination therapy using craniocerebral hypothermia]. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2015; 4: 19-24.

2. Starodubov VI, Suhanova LP, Sychenkov YuG. Repro- duktivnye poteri kak mediko-social’naya problema demograficheskogo razvitiya Rossii [Reproductive lossesas medical social problem in demographic development ofRussia]. Social’nye aspekty zdorov’ya naseleniya [Social aspects of population health]. 2011; 22 (6): 1.

3. Kogan YaE. Patologiya pupoviny i ee rol’ v perinatal’nyh oslozhneniyah [Umbilical cord pathology and its role in perinatal complications]. Prakticheskaya medicina [Practical medicine]. 2016; 1 (93): 22-25.

4. Ignatko IV, Kardanova MA, Miryushchenko MM, Bajbulato- va ShchSh. Patogenez, diagnostika, perinatal’nye iskhody pri kriticheskom sostoyanii ploda [Pathogenesis, diagnosis, perinatal outcomes in the critical state of the fetus]. Arhiv akusherstva i ginekologii imeni VF Snegireva [Archive of Obstetrics and Gynecology named after VF Snegireva]. 2015; 2 (4): 43-44.

5. Strizhakov AN, Ignatko IV, Kardanova M. Kriticheskoe sostoyanie ploda: opredelenie, diagnosticheskie kriterii, akusherskaya taktika, perinatal’nye iskhody [A critical state of the foetus: definition, diagnostic criteria, obstetric tactics, perinatal outcomes]. Voprosy ginekologii, akusherstva i perinatologii [Gynecology, Obstetrics and Perinatology]. 2015; 14 (4): 5-14.

6. Unterscheider J, O’Donoghue K, Malone FD. Guidelines on fetal growth restriction: a comparison of recent national publications. Am J Perinatol. 2015; 32 (4): 307-316. doi: 10.1055/s-0034-1387927.

7. Kamalyan SA, Hvorostuhina NF, Bebeshko OI, Novichkov DA, Naumova EV, Plekhanov AA. Analiz faktorov riska razvitiya ugrozhayushchej asfiksii ploda pri beremennosti i v rodah [Analysis of risk factors threatening asphyxia of the fetus during pregnancy and childbirth]. Vrach-aspirant [Postgraduate Doctor]. 2017; 82 (3.1): 144-151.

8. Hvorostuhina NF, Kamalyan SA, Bebeshko OI, Artemenko KV. Prichiny kriticheskogo sostoyaniya ploda v rodah [The reasons for the critical status of the fetus during labor]. Mezhdunarodnyj zhurnal eksperimental’nogo obrazovaniya. 2016; 9-1: 77-78.

9. Gagaev ChG, Radzinskij VE, ed. Patologiya pupoviny [Pathology of the umbilical cord]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2011; 96 p.

10. Buyukkayaci Duman N, Topuz S, Bostanci MO, Gorkem U, Yuksel Kocak D, Togrul C, Gungor T. The effects ofumbilical cord entanglement upon labor managementand fetal health: retrospective case control study. J Matern Fetal Neonatal Med. 2018; 31 (5): 656-660. doi: 10.1080/14767058.2017.1293033.

11. Nkwabong E, Ndoumbe Mballo J, Dohbit JS. Risk factors for nuchal cord entanglement at delivery. Int J Gynaecol Obstet. 2018; 141 (1): 108-112. doi: 10.1002/ijgo.12421.

12. Walla T, Rothschild MA, Schmolling JC, Banaschak S. Umbilical cord entanglement’s frequency and its impact on the newborn. Int J Legal Med. 2018; 132 (3): 747-752. doi: 10.1007/s00414-017-1746-8.

13. Prohorov VN, Prohorova OV, Medvedeva SYu. Morfologiya tkanej pupoviny cheloveka pri nekotoryh patologicheskih sostoyaniyah beremennyh [The morphology of human umbilical cord tissues in some pregnant morbid conditions]. Ural’skij medicinskij zhurnal [Ural Medical Journal]. 2014; 4 (118): 30-33.

14. Sozonova NS, Lazarev IP, Chernova AL, Ivanova EN, Chernov IA, Makarevich SL. Klinicheskij sluchaj antenatal’noj gibeli ploda vsledstvie razryva anevrizmy veny pupoviny [Clinical case of the fetus antenatal death due to the umbilical cord vein aneurysm rupture]. Medicinskaya nauka i obrazovanie Urala [Medical science and education of the Ural]. 2017; 4(92): 102-105.

15. Belozerceva EP, Belokrinickaya TE, Iozefson SA, Salimova MDK, Fyodorova EA. Faktory riska antenatal’noj gibeli ploda: retrospektivnoe kogortnoe issledovanie [Risk- factors of the antepartum fetal death: retrospective cohort study]. Mat’ i ditya v Kuzbasse [Mother and Baby in Kuzbass]. 2015; 2: 86-90.

16. Peesay M. Nuchal cord and its implications. Matern Health Neonatol Perinatol. 2017; 3: 28. doi: 10.1186/s40748- 017-0068-7.

17. Balkawade NU, Shinde MA. Study of length of umbilical cord and fetal outcome: a study of 1,000 deliveries. J Obstet Gynaecol India. 2012; 62 (5): 520-525.

18. Proctor LK, Fitzgerald B, Whittle WL, Mokhtari N, Lee E, Machin G. et al. Umbilical cord diameter percentilecurves and their correlation to birth weight and placentalpathology. Placenta. 2013; 34 (1): 62-66.

19. Bohîlțea RE, Turcan N, Cîrstoiu M. Prenatal ultrasounddiagnosis and pregnancy outcome of umbilical cord knot – debate regarding ethical aspects of a series of cases. J Med Life. 2016; 9 (3): 297-301.

20. Veropotvelyan NP, Rusak NS. Prenatal’naya diagnostika istinnogo uzla pupoviny s primeneniem ob»emnoj ehkhografii [Prenatal diagnosis of umbilical cord true knot using volume ultrasound]. Prenatal’naya diagnostika. 2014; 13 (2): 149-153.

21. Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, Mazor M. Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol. 2001; 98 (1): 36-39.

22. East CE, Leader LR, Sheehan P et al. Intrapartum fetal scalp lactate sam-pling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev. 2010; 17 (3): CD006174.

23. Ramanah R, Martin A. Fetal scalp lactate microsampling for nonreassuring fetal status during labor: a prospective observational study. Fetal Diagn Ther. 2010; 27 (1): 14-19.

24. Eremina OV, Shifman EM, Baev OR, Aleksandrova NV. Issledovanie krovi iz predlezhashchej chasti ploda v ocenke ego sostoyaniya v rodah [Test of blood from thepresenting part of the fetus in the evaluation of its statusduring labor]. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2011; 8: 16-20.

25. Gunin AG, Milovanov MM, Denisova TG. Metody ocenki sostoyaniya ploda v rodah [Methods of fetal assessment in labors]. Zdravoohranenie Chuvashii [HealthCare of Chuvashia]. 2014; 3 (39): 39-48.

26. Petruhin VA, Ahvlediani KN, Logutova LS, Ivankova NM, Mel’nikov AP, Chechneva MA et al. Vakuum-ehkstrakciya ploda v sovremennom akusherstve [Fetal vacuum extraction in modern obstetrics]. Rossijskij vestnik akushera-ginekologa [Russian Bulletin of Obstetrician- Gynecologist]. 2013; 13 (6): 53-59.

27. Hvorostuhina NF, Kozlova TU, Novichkov DA, Bebeshko OI. Analiz ehffektivnosti i bezopasnosti rodorazreshayushchih operacij [Analysis of effectiveness and safety of assisted]. Saratovskij nauchno-medicinskij zhurnal [Saratov Journal of Medical Scientific Research]. 2014; 10 (2): 346-349.

28. Linde LE, Rasmussen S, Kessler J, Ebbing C. Extreme umbilical cord lengths, cord knot and entanglement: Risk factors and risk of adverse outcomes, a population-based study. PLoS One. 2018; 13 (3): e0194814. doi: 10.1371/ journal.pone.0194814.

UDC 614.881-053.2(470.56-25)

 TWENTY YEARS OF EXPERIENCE OF EMERGENCY MEDICAL SERVICE AT THE CITY CHILD HOSPITAL

CHOLOYAN SALIM B., D. Med. Sci., Head physician of Child City Clinical Hospital of Orenburg; professor of the Department of public health and health management No 1 of Orenburg State Medical University, Russia, 460014, Orenburg, Kobozev str., 25a, e-mail: sb433@mail.ru

PAVLOVSKAYA OLGA G., C. Med. Sci., associate professor of the Department of forensic medicine and law science of Orenburg State Medical University, Russia, 460000, Orenburg, Sovetskaya str., 6,
e-mail: pavlovskaya-o@mail.ru

SHEENKOVA MARINA V., C. Med. Sci., General manager, Head physician of «Medgard-Orenburg», e-mail: ms_1301@mail.ru

PAVLENKO LYUDMILA I., pediatrician of emergency medical care of Child City Clinical Hospital of Orenburg, Russia, 460014, Orenburg, Kobozev str., 25a

Abstract. Aim. The aim of the study is assessment of effectiveness of the emergency medical service at the children’s hospital. The demand for services was assessed depending on the day of the week, time of the day, age of the patients, and type of syndrome or disease. Material and methods. The patients who received emergency care in 2017 were enrolled in the study, according to the data from medical information system of the organization. Applied static and analytical research methods have been used. Results and discussion. In 2017 emergency service operated 10,368 calls for 43,397 assigned child populations. The maximum number of calls was being answered from 13.00 to 16.00, and the minimum – from 11.00 to 13.00. In terms of the frequency of requests for emergency care, children of 3–7 years old take the first place. The second is the age group of children of 1–3 years old. Third place belongs to children under 1 year. The rarest appeal for emergency care was seen in adolescents of 14–18 years old. The greatest share of submissions was dedicated to the hyperthermic syndrome. On the second place there was dyspeptic syndrome. Bronchial obstruction occupied the third place. There was a predominance of respiratory diseases in the nosological structure of the calls. The second place was occupied by diseases of the digestive system, the third – by infectious and parasitic diseases. Conclusion. It was estimated that for one child there are 0,24 emergency visits to the outpatient clinic, which shows the unselected volumes by the medical organization. This indicates the need to develop their own round-the-clock emergency care, dental and trauma services in the hospital.

Key words: organization of medical care for children, emergency medical care for children, medical information system.

For reference: Choloyan SB, Pavlovskaya OG, Sheenkova MV, Pavlenko LI. Twenty years of experience of emergency medical service at the city child hospital. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (6): 52-56. DOI:10.20969/VSKM.2018.11(6).52-56.

1. Federal’nyy zakon ot 21/11/2011 N 323-FZ «Ob osnovakh okhrany zdorov’ya grazhdan v Rossiyskoy Federatsii» [Federal Law of 21/11/2011 N 323-FZ «On the basis of the protection of public health in the Russian Federation»]. 2011.

2. Prikaz Ministerstva zdravookhraneniya RF ot 7 marta 2018 goda No 92n «Ob utverzhdenii Polozheniya ob organizatsii okazaniya pervichnoy mediko-sanitarnoy pomoshchi detyam» [Order of the Ministry of Health of the Russian Federation of March 7, 2018 No 92n «On approval of the Regulations on the organization of the provision of primary health care for children»]. 2018.

3. Poryadok okazaniya meditsinskoy pomoshchi i standarty meditsinskoy pomoshchi [Procedures for the provision of medical care and standards of medical care]. http://www. consultant.ru/cons/cgi/online.cgi?req=doc&base

4. Postanovleniye Pravitel’stva Orenburgskoy oblasti ot 29/12/2017 goda No 992-p «Ob utverzhdenii territorial’noyprogrammy gosudarstvennykh garantiy besplatnogookazaniya grazhdanam na territorii Orenburgskoy oblasti meditsinskoy pomoshchi na 2018 god i na planovyy period 2019 i 2020 godov» [Decree of the Government of the Orenburg region dated December 29, 2017 No 992-p «Onapproval of the territorial program of state guarantees offree medical care to citizens in the Orenburg region for 2018 and for the planned period of 2019 and 2020»]. 2017.

UDC 616.132.2-02:616.127-005.4-039.56(048.8)

DOI: 10.20969/VSKM.2018.11(6).57-62

 THE QUESTION OF CORONARY ARTERY DAMAGE IN SILENT MYOCARDIAL ISCHEMIA

ABDRAKHMANOVA ALSU I., C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74; physician of the Department of cardiology, of Interregional Clinical Diagnostic Center, Russia, 420089, Kazan, Karbyshev str., 12а, tel. 8-917-922-66-29, e-mail: alsuchaa@mail.ru

AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Authоr 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

ABDULYIANOV ILDAR V., ORCID ID: orcid.org/0000-0003-2892-2827; C. Med. Sci., associate professor of the Department of cardiology, roentgen-endovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Mushtari str., 11; physician of the Department cardiosurgery Interregional Clinical Diagnostic Center, 420089, Russia, Kazan, Karbyshev str., 12а, tel. 8-987-421-90-09, e-mail: ildaruna@mail.ru

GAIFULLINA RAUSHANIA F., C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74

OSLOPOVA JULIYA V., C. Med. Sci., associate professor, Head of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74

Abstract. Aim. The aim of the study was analysis of recent publications on the features of coronary lesions in patients with silent myocardial ischemia according to coronary angiography and comparison of literature data with personalfindings. Material and methods. Review of recent publications on the features of coronary artery disease in patients with silent myocardial ischemia according to coronary angiography has been conducted. The data of selective coronary angiography from 84 patients examined in the period from January 2011 to December 2015 at Interregional Clinical Diagnostic Center was analyzed retrospectively. Results and discussion. In 7 (8,3%) patients, there were slightly altered coronary arteries, 16 (19%) – single-vessel, 24 (28,6%) – double-vessel, 37 (47,4%) – multiple lesions of the coronary arteries. Anterior interventricular arteries were most often affected [in 69 (89,6%) patients; р˃0,005]. Middle and proximal segments of anterior interventricular artery (44,5 and 36,6%), right coronary artery (40,8 and 20%), and circumflex artery (34,4 and 40,9%) prevailed when analyzing the level of the lesion. Hemodynamically significant stenoses were found in anterior interventricular artery (33%), in right coronary artery (24%), in circumflex artery (41,3%), and in brachial coronary artery (63,7%). The most frequently affected coronary artery of the second order was a branch of the blunt edge (32,5%). Hemodynamically significant stenosis was seen in 48,6% of cases. Conclusion. Available data onthe severity of atherosclerotic changes according to coronary angiography in patients with silent myocardial ischemiaare controversial. Personal data confirms the concept of a multi-vascular lesion of the coronary arteries in patients with silent myocardial ischemia, with a predominance of lesions of the anterior interventricular artery with a high level of critical stenosis. The inconsistency of the available data on the severity of coronary artery disease in patients with silent ischemia according to the modern papers requires further study, which indicates the need in further research.

Key words: coronary heart disease, silent myocardial ischemia, coronary arteries, сoronary angiography, ischemic pain.

For reference: Abdrahmanova AI, Amirov NB, Abdulyanov IV, Gaifullina RF, Oslopova JV. The question of coronary artery damage in silent myocardial ischemia. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (6): 57-62. DOI:10.20969/VSKM.2018.11(6).57-62.

UDC 617.71-007.234-053.9(048.8)

 QUALITY OF LIFE AND THE MAIN ASPECTS OF REHABILITATION IN PATIENTS OF ADVANCED AGE WITH OSTEOPOROSIS

DYMNOVA SVETLANA E., endocrinologist of Hospital for veterans of war; postgraduate student of the Department of internal medicine, medical and social expertise and rehabilitation No 2 of Saint Petersburg Institute of doctor-expert advanced training, Russia, 194044, St. Petersburg, Bolshoy Sampsonievsky ave., 11/12, tel. 8-921-558-23-77, e-mail: svetadymnova@rambler.ru

SERGEEVA VERA V., D. Med. Sci., professor, Head of the Department of internal medicine, medical and social expertise and rehabilitation No 2 of Saint Petersburg Institute of doctor-expert advanced training, Russia, 194044, St. Petersburg, Bolshoy Sampsonievsky ave., 11/12

RODIONOVA ANNA YU., C. Med. Sci., associate professor of the Department of internal medicine, medical and social expertise and rehabilitation No 2 of Saint Petersburg Institute of doctor-expert advanced training, Russia, 194044, St. Petersburg, Bolshoy Sampsonievsky ave., 11/12

1. Korobkova MV, Pomnikova VG. Spravochnik po mediko- sotsial’noy ekspertize i reabilitatsii [Handbook of medical and social expertise and rehabilitation]. SPb: Izdatel’stvo «Gippokrat» [SPb: Publishing House «Hippocrates»]. 2010; 337-385.

2. Kosul’nikova YeN, Pushkova YeS. Vliyaniye oslozhnenno- go senil’nogo osteoporoza na kachestvo zhizni pozhilykh lyudey [The impact of complicated senile osteoporosis on the quality of life of the elderly]. Osteoporoz i osteopatii [Osteoporosis and osteopathy]. 2010; 1: 5-7.

3. Novik AA, Ionova TI, Tsygan YeN. Metodologiya izucheniya kachestva zhizni patsiyentov s osteoporozom [Methodology for studying the quality of life of patients with osteoporosis]. Nauchno-prakticheskaya revmatologiya [Scientific and practical rheumatology]. 2001; 80.

4. Novik AA, Tsygan YeN, Ionova TI. Osteoporoz i kachestvo zhizni [Osteoporosis and quality of life]. Obzory po klinicheskoy farmakologii i lekarstvennoy terapii [Reviews on clinical pharmacology and drug therapy]. 2004; 3 (4): 20–26.

5. Lesnyak OM. Audit sostoyaniya problemy osteoporoza v Rossiyskoy Federatsii [Audit of the state of the problem of osteoporosis in the Russian Federation]. Profilaktiches- kaya meditsina [Preventive medicine]. 2011; 14 (2): 7-10.

6. Burge R, Dawson-Hughes B, Solomon DH et al. Incidenceand economic burden of osteoporosis related fractures inthe United States 2005-2025. J Bone Miner Res. 2007; 22: 465–475.

7. Benevol’skaya LI, Lesnyak OM. Osteoporoz: dia- gnostika, profilaktika i lecheniye; Klinicheskiye rekomendatsii Rossiyskoy assotsiatsii po osteoporozu [Osteoporosis: diagnosis, prevention and treatment; Clinical recommendations of the Russian Association for Osteoporosis]. Moskva: «GEOTAR-Media» [Moscow: «GEOTAR-Media]. 2010; 272 p.

8. Benevolenskaya LI. Problema osteoporoza v sovremennoy meditsine [The problem of osteoporosis in modern medicine]. Consilium medicum. 2014; 6 (2): 26-29.

9. Zotkin YeG, Kosul’nikova YeN. Osteoporoz: ot organizatsii pomoshchi bol’nym k lecheniyu [Osteoporosis: from organizing care to treatment]. Medlayn ekspress [Medline Express]. 2007; 1 (190): 56–59.

10. Zubkova II. Mediko-sotsial’nyye i ekonomicheskiyeposledstviya osteoporoticheskikh perelomov sredivzroslogo nacheleniya Sankt-Peterburga [Medical-socialand economic consequences of osteoporotic fracturesamong the adult population of St Petersburg]. Sankt- Peterburg: Voyenno-meditsinskaya akademiya [St. Petersburg: Military Medical Academy]. 2013; 22 p.

11. Lesnyak OM, Toroptsova NV, Yevstigneyeva LP. Osteo- poroz: profilaktika i ambulatornoye vedeniye patsiyentov [Osteoporosis: prevention and outpatient case mana- gement]. Moskva [ Moscow]. 2013; 44 p.

12. Zotkin YeG, Khurtsilava OG, Zubkova II, Safonova YUA. Vertebral’nyye i perifericheskiye osteoporoticheskiye perelomy: diagnostika i mediko-sotsial’naya znachimost’ [Vertebral and peripheral osteoporotic fractures: diagnosis and medical and social significance]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2010; 2 (56): 106–109.

13. Kanis JA, Burlet N, Cooper C et al. European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women. Osteoporos Int. 2008; 19: 399-428.

14. Toropovtsova NV, Nikitinskaya OA, Benevolenskaya LI. Osteoporoz sotsial’naya problema XXI veka [Osteoporosis social problem of the XXI century]. Rossiyskiy meditsinskiy zhurnal [Russian Medical Journal]. 2007; 4: 315-318.

15. Ivanov SN, Kochish AYU, Sannikova YeV. Opyt sozdaniya sluzhby vtorichnoy profilaktiki osteoporoticheskikh perelomov kostey v RNIITO imeni RR Vredena [The experience of creating a service for the secondary prevention of osteoporotic bone fractures in the NIITO them RR Vreden]. Farmateka [Farmateka]. 2015: 4 (15): 27–33.

16. Alekseyeva LI, Baranov IA et al. Klinicheskiye rekomen- datsii po profilaktike i vedeniyu bol’nykh s osteoporozom: Izdaniye 2-oye, dopolnennoye [Clinical guidelines for the prevention and management of patients with osteoporosis: 2nd edition, supplemented]. Yaroslavl’: IPK «Litera» [Yaroslavl: IPK Litera]. 2014; 24 p.

17. Gardner D, Shobek D. Bazisnaya i klinicheskaya endokrinologiya [Basic and clinical endocrinology]. Moskva: Izdatel’stvo BINOM [Moscow: Publishing house BINOM]. 2011; 2: 424-435.

18. Yershova OB. Kommentarii k prakticheskomu ispol’- zovaniyu rossiyskikh klinicheskikh rekomendatsiy po osteoporozu [Comments on the practical use of Russian clinical guidelines for osteoporosis]. Osteoporoz i osteopatii [Osteoporosis and osteopathy]. 2010; 1: 34-47.

19. Mikhaylov YeYe, Men’shikova LV, Yershova OB. Epide- miologiya osteoporoza i perelomov v Rossii [Epidemiology of osteoporosis and fractures in Russia]. Moskva: Materialy Rossiyskogo kongressa po osteoporozu [Moscow: Proceedings of the Russian Congress on Osteoporosis]. 2003; 44.

20. Novik AA, Matveyev SA, Ionova TI. Otsenka kachestva zhizni bol’nogo v meditsine [Assessment of the quality of life of the patient in medicine]. Klinicheskaya meditsina [Clinical medicine]. 2000; 78: 10-13.

21. Dedov II, Mel’nichenko GA. Endokrinologiya: natsional’- noye rukovodstvo [Endocrinology: national leadership]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2009: 757-817.

 MEDICAL AND SOCIAL ASPECTS OF REHABILITATION FOR CORONARY HEART DISEASE AFTER CORONARY ARTERY BYPASS GRAFTING

POLONSKAYA IRINA I., postgraduate student, assistant of professor of the Department of internal medicine, medical and social expertise and rehabilitation No 2 of Saint Petersburg Institute of doctor-expert advanced training, Russia, 194044, St. Petersburg, Bolshoy Sampsonievsky ave., 11/12, tel. +7-921-785-59-32, e-mail: pol-lonskay@mail.ru

SERGEYEVA VERA V., D. Med. Sci., professor, Head of the Department of internal medicine, medical and social expertise and rehabilitation No 2 of Saint Petersburg Institute of doctor-expert advanced training, Russia, 194044, St. Petersburg, Bolshoy Sampsonievsky ave., 11/12

Abstract. The paper is devoted to medical and social aspects of rehabilitation in patients with coronary heart diseaseafter coronary artery bypass grafting. Aim. The aim of the study was to analyze the publications on the effectivenessof rehabilitation in patients with coronary heart disease after coronary artery bypass grafting in terms of their returnto work. Material and methods. Review of publications in scientific and medical literature on rehabilitation after coronary artery bypass grafting has been carried out. The methods of myocardial revascularization allow restoring blood flow in coronary arteries affected by atherosclerotic process. Functional class of angina is being reduced and the functional capacity of the heart is being improved after coronary artery bypass surgery. Results and discussion. It was concluded that the goal of cardiac rehabilitation is to improve and maintain a certain level of physical, psychological and social function in a patient with coronary heart disease. It consists of physical rehabilitation, drug treatment, psycho-physiological rehabilitation, social and labor rehabilitation. Timely comprehensive cardiac rehabilitation has a positive effect on health of patients with cardiovascular diseases, as well as on return of disabled people or people who have temporarily lost ability to work, to normal personal and social life. Returning to work after surgical treatment is an independent objective of rehabilitation, the solution of which affects somatic and mental state of a patient with coronary heart disease. Implementation of comprehensive rehabilitation programs improves not only immediate but long-term prognosis of the course of coronary artery disease, and improves the quality of life in patients. Conclusion.Successful rehabilitation, retraining and reemployment can facilitate the return to work of patients with coronary heart disease after coronary artery bypass grafting.

Key words: coronary heart disease, coronary artery bypass grafting, rehabilitation, ability to work, disability.

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 «ARTRAKAM» MEDICATION APPLICATION EXPERIENCE IN PATIENTS WITH ARTHROSIS

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

FATYKHOV RUSLAN I., C. Med. Sci., assistant of professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: 74ruslan@rambler.ru

KLUSHKINA MARIA S., 6th year student of the pediatric faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

Abstract. Aim. The aim of the study was to evaluate the possibility of using 1,884 g glucosamine sodium sulfate chloride drug «Artrakam» in terms of 100% substance, including glucosamine sulfate – 1,5 g and excipients, such as sorbitol and citric acid added to obtain 2,2 g mass content in one sachet. Taking into account the anti-inflammatory and analgesic action that occurs during the stimulation and synthesis of proteoglycans and hyaluronic acid, leading to inhibition of degenerative processes in the joints. Material and methods. 30 patients with chronic arthrosis have been enrolled in the study. WOMAC survey was conducted during the first visit. The patients were examined by an orthopedic surgeon, followed by radiographs of the affected joints. Quite often, this method competes with ultrasound examination of the joints. Magnetic resonance tomography was performed in certain patients. Additional examination methods were used for clinical and radiological assessment of the joint process stage according to N.S. Kosinskaya scale (1961). Results and discussion. Pain relief with its gradual regression from the second day occurred after 4–5 days of using «Artrakam» drug. Detoxification was performed before treatment in combination with forced diuresis. Analgesic and anti-inflammatory effect lasted up to 70 days. Сonclusion. The use of «Artrakam» drug in patients with chronic arthrosis of the knee joint has shown its effectiveness. The use of the powder dosage form to be dissolved in water did not adversely affect gastric mucosa in supervised patients. There were no complaints on pain in the gastrointestinal tract. The use of «Artrakam» drug had a long-lasting analgesic, anti-inflammatory, and anti-catalytic effect not only in diseases of the knee joint, but also in other large joints. The recommended frequency for taking «Artrakam» drug is at least half of the dose 2 times a day, which contributes to adequate absorption of the drug in the ileum. It allows obtaining a more pronounced effect, and to maintain the concentration.

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UDC [616-005.1-02:617-089]-082

DOI: 10.20969/VSKM.2018.11(6).77-82

 METHODS AND INSTRUMENTS IN PROJECT MANAGEMENT IN ACUTE INTRAOPERATIVE BLOOD LOSS DOCUMENTATION PROCESS

KHACHATURYAN VICTORIA A., Head of the Department of development of Republican Clinical Oncological Dispensary, Russia, 420019, Kazan, Sibirskiy trakt, 29, e-mail: torya9578@mail.ru

KHAFIZOVA EKATERINA E., transfusiologist of the Department of transfusiology of Republican Clinical Oncological Dispensary, Russia, 420019, Kazan, Sibirskiy trakt, 31

AKSENOVA NATALYA N., C. Med. Sci., Head of the Department of transfusion of Republican Clinical Oncological Dispensary, Russia, 420019, Kazan, Sibirskiy trakt, 29

BARYEV NAIL I., Head of the Department of anesthesiology, resuscitation and intensive care of Republican Clinical Oncological Dispensary, Russia, 420019, Kazan, Sibirskiy trakt, 29

SHAYMARDANOV ILSUR V., C. Med. Sci., Honored Doctor of the Republic of Tatarstan, part-time specialist for palliative care of Ministry of Health of the Republic of Tatarstan, deputy Head physician of Republican Clinical Oncological Dispensary, Russia, 420019, Kazan, Sibirskiy trakt, 29

Abstract. Aim. The aim of the study is to improve the processes of documenting information on acute intraoperativeblood loss using project management methodology and tools. Material and methods. Literature sources, containing description of methods for calculating the volume of blood lost during surgery have been studied. The information was structured in the original document, which is a «Card of acute intraoperative blood loss». Retrospective and prospectiveanalysis of the medical records of a hospital patient having or not having a card for acute intraoperative blood losswas carried out. The documenting processes in the protocols of operation and anesthesia, an anesthetic map, the protocol and the journal of reinfusion in case of using hardware reinfusion, were studied in 228 documents in total. The introduction of the original document into the existing documenting process of acute intraoperative blood loss was launched within the project, using project management methodology and tools. Results and discussion. Coordinationof specialists’ efforts at the initial stage: analysis of risk events, independent planning of activities to achieve project goals, creation of a temporary organizational and role structure that provides a balance of responsibility and authority, distinguishes project management from the legislative and administrative one. It also ensures the introduction of the original document into the existing processes of documenting acute intraoperative blood loss, which includes the name of the events, the deadlines for their execution, the planned result and the responsible executives. The implementation of the original document within the project using project management methodology and tools has increased consistency of the information on acute intraoperative blood loss from 9 to 72%. Conclusion. The process of documentation ofacute intraoperative blood loss has been improved. «Card for acute intraoperative blood loss» was first applied; a new process of documenting acute intraoperative blood loss was launched within the framework of the project «Introduction of a card for acute intraoperative blood loss». The original document «Card of acute intraoperative blood loss» with instructions for filling it out is an algorithm that allows estimating the volume and severity of blood loss and referencematerial allowing working out a common strategy for the specialists in replenishment of intraoperative blood loss duringsurgical treatment of the patient. The use of project management methodology and tools improves existing process in medical institutions, allows implementing original ideas, performing tasks set by management and implementing health priorities.

Key words: project management, medical organization, acute intraoperative blood loss.

For reference: Khachaturyan VA, Khafizova EE, Aksenova NN, Bariev NI, Shaimardanov IV. Methods and instruments in project management in acute intraoperative blood loss documentation process. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (6): 77-82. DOI: 10.20969/VSKM.2018.11(6).77-82.

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