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ORIGINAL RESEARCH
ORGANIZATION OF HEALTHCARE
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ORIGINAL RESEARCH
УДК: 616-08-035; 616-08-039.32
DOI: 10.20969/VSKM.2022.15(3). 7-14
ANALYSIS OF THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH COVID-19 AT A TEMPORARY INFECTION HOSPITAL DEPLOYED IN A MULTIDISCIPLINARY CITY HOSPITAL
VIZEL ALEXANDER A.,ORCID: 0000-0001-5028-5276; SPIN code: 5918-5465; Author ID: 195447, Doctor of Medical Sciences, Professor, Head. Phthisiopulmonology Department of the Kazan State Medical University, 420012, Russia, Kazan, Butlerov str., 49, tel.: +7 987 296-25-99, e-mail: lordara@inbox.ru
KHADEEVA VASILY Z., Deputy General Director for medical work of the City Clinical Hospital No 12 Kazan, 420036, Russia, Kazan, Lechebnaya str., 7, tel.: +7 917 263-73-43, e-mail: hadeeva.vasilya@yandex.ru
NURIYEVA LANDYSH F., general practitioner, pulmonologist at the City Clinical Hospital No 12 Kazan, 420036, Russia,Kazan, Lechebnaya str., 7, tel.: +7 927 441-83-68, e-mail: landishnurieva@mail.ru
VIZEL IRINA YU.,ORCID: 0000-0002-8855-8177; SPIN code: 6000-3813, Author ID: 246946, Doctor of Medical Sciences, Professor of the Russian Academy of Natural Sciences, Associate Professor of the Department of Phthisiopulmonology of the Kazan State Medical University, 420012,Russia, Kazan, Butlerov str., 49; researcher of the Central Research Institute of Tuberculosis, 107564, Moscow, Yauzskaya alley, 2, tel.: +7 917 903-91-13, e-mail: tatpulmo@mail.ru
AMIROV NAIL B., ORCID ID:0000-0003-0009-9103; SCOPUS Authоr ID: 7005357664; Doctor of Medical Sciences, Professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
SAUBANOVA KARINA O., clinical resident of the Phthisiopulmonology Department of the Kazan State Medical University, 420012, Russia, Kazan, Butlerov str., 49, tel.: +7 937 152-41-72, e-mail: ksaubanovak@gmail.com
VIZEL LEONID A., student of the Kazan (Volga Region) Federal University, 420008, Russia, Kazan, Kremlin str., 18, tel.: +7 917 279-09-03, e-mail: laskaleo2004@mail.ru
Abstract. Introduction. The novel coronavirus infection COVID-19, caused by SARS-COV-2, has been a global health problem for three years now. A new challenge is virus mutations that change clinical manifestations and response to therapy.Aim. The aim of the workwas to assess the condition of patients with COVID-19 treated in a temporary infectious diseases hospital deployed in a non-infectious multidisciplinary hospital and to identify factors influencing the outcomes of this disease through a retrospective analysis of clinical observations. Material and methods. An analysis of the condition of 92 patients with COVID-19 (ICD-10 codes U07.1 and U07.2) treated in a temporary infectious diseases hospital deployed on the basis of a multidisciplinary hospital is presented. To collect information, the COVIZ program was designed with subsequent export of depersonalized data to the SPSS-18 statistical package. 64 patients recovered and 28 had a fatal outcome. Results and discussion. The work results showed a change in the routing of patients, with a predominance of only patients with a severe course in the hospital. The more frequent prescription of glucocorticosteroids and anti-cytokine drugs also changed the data processing results due to the small number of «control» groups that did not receive these drugs in the hospital. The use of anti-cytokine therapy (levilimab or olokizumab) was more effective in patients younger than 60 years, but in general, 89.1% of those who recovered received these drugs, and 75% of those who died. The data obtained confirmed the high efficiency of early use of subcutaneous anticoagulants and the low efficiency of antibiotic therapy at the stages before the intensive care unit. The frequency of prescribing antibacterial drugs in the dead was 76.8%, and in those who recovered - 57.8%, while later than 8 days from the onset of the disease they were prescribed in 81.8% and 45.9% of cases, respectively (χ2 = 7.357; d.f.=1, p<0.01, TcF=0.006, OR=5.294 CI 1.499-18.695). Conclusion. It was concluded that the clinical picture and the effectiveness of ongoing therapy require constant monitoring and analysis to optimize the updated treatment regimens for COVID-19.
Keywords: COVID-19, diagnosis, treatment, anticoagulants, antibiotics, glucocorticosteroids, anticytokine therapy
For reference. Vizel AA, Khadeeva VZ, Nurieva LF, Vizel IYu, Amirov NB, Saubanova KO, Vizel LA. Analysis of the diagnosis and treatment of patients with COVID-19 at a temporary infection hospital deployed in a multidisciplinary city hospital. The Bulletin of contemporary clinical medicine. 2022; 15(3): 7-14. DOI: 10.20969/VSKM.2022.15(3)7-14.
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УДК: 616.314.17-008.1-089.23
DOI: 10.20969/VSK M.2022.15(3).15-20
MICROBIOTA OF THE ROOT CANAL SYSTEM IN PATIENTS WITH DESTRUCTIVE FORMS OF CHRONIC APICAL PERIODONTITIS BEFORE AND AFTER STANDARD ENDODONTIC TREATMENT AND MODERN POSSIBILITIES OF INFLUENCING IT
DEMYANENKO SVETLANA A., ORCID ID:0000-0002-2743-498X; Doctor of Medical Sciences, Professor, Head of the Department of Dentistry and Orthodontics of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, tel.: 8 (978)763-33-01, dc.kvalitet@gmail.com
MOROZOVA MARINA N., ORCID ID:0000-0002-4627-925Х; Doctor of Medical Sciences, Professor of the Department of Dentistry and Orthodontics of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, mmrz58@mail.ru
PAVLOVA NATALIA V., ORCID ID:0000-0002-6173-0619; Candidate of Medical Sciences, Associate Professor of the Department of Microbiology, Virology and Immunology of the: « S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, Natalia_Natalia-1@inbox.ru
MARCHENKO NATALIA V., ORCID ID:0000-0001-8157-5807; Candidate of Medical Sciences, Associate Professor of the Department of Dentistry and Orthodontics of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, marchella1961@mail.ru
SHABLIY DMITRY N., ORCID ID: 0000-0002-2704-8202; Candidate of Medical Sciences, Associate Professor of the Department of Dentistry and Orthodontics of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal UniversityRussia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, shabliy@bk.ru
KAZININA ELENA N., ORCID ID: 0000-0002-1293-4201; Candidate of Medical Sciences, Associate Professor of the Department of Dentistry and Orthodontics of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, kazinina@mail.ru
TOFAN YULIA V., ORCID ID:0000-0002-1190-596X; Assistant Professor of the Department of Dentistry and Orthodontics of «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, julia.tofan@yandex.ru
KIRICHENKO VYACHESLAV N., ORCID ID:0000-0002-2313-3936; Candidate of Medical Sciences, Assistant Professor of the Department of Surgical Dentistry and Maxillofacial Surgery of the «S.I. Georgievsky Medical Academy» Institute, Crimean Federal University, Russia, 295006, Republic of Crimea, Simferopol, Lenin Boulevard, 5/7, kirichenko24_08slava@mail.ru
Abstract. Introduction. Despite the modern achievements of endodontics, it is possible to obtain a positive effect in the treatment of destructive forms of chronic apical periodontitis in 80-85% of cases. In other patients, progressive pathology becomes the main cause of tooth loss with subsequent deformation of the dentition, changes in the temporomandibular joint, the development of purulentinflammatory processes of the maxillofacial region or complicated course of somatic diseases. Aim. The aim of the study was to study the dynamics of microbiological parameters in patients with chronic apical periodontitis before and after standard endodontic treatment, as well as the possibility of exposure to blood autoplasm and hydroxyapatite gel. Material and methods. The study was conducted in 32 patients with destructive forms of chronic apical periodontitis. 82 scraping smears obtained from the apical third of the canal before its primary drug treatment were studied.Results anddiscussion.The study of the microflora of root canals in patients with destructive forms of chronic apical periodontitis after performing the main stages of the standard endodontic protocol showed that by the 10th day of treatment, small associations of microorganisms consisting of gram-positive and gram-negative coccoid, rod-shaped, convoluted forms, as well as fungal microflora, mainly Candida albicans, were found in the area of the root apex. An in vitro study of the antibacterial properties of blood autoplasm and hydroxyapatite gel showed that hydroxyapatite has a pronounced bactericidal effect on international test strains of bacteria Staphylococcus aureus ATCC 25923 and Candida albicans SSM 885, platelet-enriched blood autoplasm has a weak bactericidal effect, and the combined use of these drugs has no antibacterial effect. Conclusion. Taking into account the high osteoinductive properties of these substances, in order to achieve their positive effect on the course of inflammatory and regenerative processes, a scheme of their sequential inclusion in endodontic treatment can be used in order to optimize the existing standard protocol for destructive forms of chronic apical periodontitis, which is the subject of subsequent study.
Keywords: Hydroxyapatite gel, human blood plasma, osteoinductive properties.
For reference: Demyanenko SA, Morozova MN, Pavlova NV, Marchenko NV, Shabliy DN, Kalinina EN, Tofan YuV, Kirichenko VN. Microbiota of the root canal system in patients with destructive forms of chronic apical periodontitis before and after standard endodontic treatment and modern possibilities of influencing it. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 15-20. DOI: 10.20969/VSKM.2022.15(3).15-20.
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УДК: 615.035
DOI: 10.20969/VSKM.2022. 15(3). 21-26
THE INFORMATIONAL-EDUCATIONAL ANALYSIS OF THE PHARMACIST SPECIALISTS NEEDS ON PHARMACIST CONSULTING THE TYPE 2 DIABETES MELLITUS IN THE CRIMEAN REPUBLIC
EGOROVA ELENA A., ORCID ID:0000-0003-4012-2523, PhD, assistant professor of Department of Basic and Clinical Pharmacology Institute «Medical academy named after S. I. Georgievskiy» of Vernadsky Crimean Federal University, 295051, Russia, Simferopol, Lenina blvd., 5/7, e-mail: elena212007@rambler.ru
SHEIKHMAMBETOVA LILYA N., ORCID ID:0000-0002-4481-2225, assistant of Department of Basic and Clinical Pharmacology Institute «Medical academy named after S. I. Georgievskiy» of Vernadsky Crimean Federal University, 295051, Russia, Simferopol, Lenina blvd. 5/7, e-mail: lilya.rojz@mail.ru
EGOROVA SVETLANA N., ORCIDID: 0000-0001-7671-3179; D. Pharm. Sci, professor, Deputy Director for Educational Activities of the Institute of Pharmacy, «Kazan state medical university», 420012 Russia, Kazan, Butlerova Str., 49, e-mail: svetlana.egorova@kazangmu.ru
ONISCHENKO KONSTANTIN N., ORCIDID: 0000-0002-2198-0023, PhD, Professor of the Department of Pharmacy of the Institute of Biochemical technologies, ecology and pharmacy Crimean Federal University named after V.I. Vernadsky, 295007, Russia, Republic of Crimea, Simferopol, prospect Vernadskogo, 4, e-mail: okn1986@gmail.com
USEINOVA ASIE N., ORCIDID: 0000-0003-0725-5455; PhD, assistant professor of Department of Basic and Clinical Pharmacology Institute «Medical academy named after S.I. Georgievskiy» of Vernadsky Crimean Federal University, 295051 Russia, Simferopol, Lenina blvd. 5/7, e-mail: mametova.as@mail.ru
Abstract. Introduction. The quantity of the patients with type II diabetes mellitus is constantly increases, according to the latest 1-st half-year data 2021 it makes 4.5 million people in Russian Federation. Wherein the spread of IItype diabetes mellitus in the majority of countries with developed economics is two times higher than registered. The purpose of the research is to survey the awareness and the informational needs of chemist’s workers consulting the type II diabetes mellitus people in the Crimean Republic. Material and methods. 105 pharmacists of the chemist’s network organizations and the private ones of the Crimean Republic located in Simferopol and resort area took part in the anonymous survey in June-October 2021. 63 pharmacists with the special secondary education and 42 with the higher special education participated in this research.Results and discussion. In the majority of cases patients to treat the type II diabetes mellitus buy medicines, at the same time 34% - over-the-counter drugs, 5%-by the recipe. Besides medicines people buy medical technical things (19%), medicinal raw materials (17%), biologically active additives (16%), care patient items (9%). Test strips are of a great demand (83.7%), insulin syringes (16.3%). In pharmacist’s opinion the majority of the customers (68.8%) use multicomponent medicines to treat the type II diabetes mellitus. The pharmacist survey found out that 95.2% of the patients asked buy the medicine prescribed by the doctors that demonstrates a highly effective pharmacotherapy, doctors trust and patient’s compliance. Conclusions. The pharmacist questionnaire in the Crimean Republic helped to reveal the sufficient knowledge level of the first -line pharmacists to consult the type II diabetes mellitus patients.
Keywords: diabetes mellitus, oral hypoglycemic agents, questionnaire.
For reference: Egorova EA, Sheikhmambetova LN, Egorova SN, Onishenko KN, Useinova AN. The informational-educational analysis of the pharmacist specialists needs on pharmacist consulting the type 2 diabetes mellitus in the Crimean Republic. The Bulletinof Contemporary Clinical Medicine. 2022; 15(3): 21–26. DOI:10/20969/VSKM. 2022.15(3).21-26.
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УДК: 616.31-085
DOI: 10.20969/VSKM.2022.15 (3). 27-32
MANIFESTATIONS OF METABOLIC SYNDROME IN ORAL CAVITY IN MENTALLY ILL PATIENTS
ILYINA ROZA J., ORCID ID: 0000-0001-8534-1282, Scopus ID: 56053199600, C. Med. Sci., Associate Professor of Department Maxillofacial and Surgical Stomatology, Kazan State Medical Academy – filiation of Russian Medical Academy of Continued Medical Education, Russia, 420012, Kazan, Mushtary St., 11, e-mail: ilroza@yandex.ru
MUCHAMEDZHANOVA LUBOV R., ORCID ID: 0000-0003-0752-6497, D. Med. Sci., Professor of Department Dentistry and New Technology, Chuvash State University, Russia, 428015, Moscow p-t, 15, Cheboksary, e-mail: lr71@bk.ru
AKHMEDOVA GUZEL M., ORCID ID: 0000-0003-0857-8934, Scopus ID: 55674079300, C. Med. Sci., Deputy Director of Science and Development, Associate Professor of Neurology Department, Kazan State Medical Academy – filiation of Russian Medical Academy of Continued Medical Education, Russia, 420012, Kazan, Mushtary St., 11, e-mail: guzel29@mail.ru
GURJANOVA TATJANA V., C. Med. Sci., Deputy Chief Physician for Medical Operations, Republic Clinical Psychiatric Hospital named akad. V.M. Bekhterev, Russia, 420061, Kazan, Jershova St., 49, e-mail: goortv@mail.ru
Abstract. Introduction. The article considers the study results of the metabolic syndrome effect on the state of periodontal tissues in persons with mental disorders depending on the duration of the disease and the use of antipsychotics. Material and methods. In the Republic Clinical Psychiatric Hospital named V.M. Bekhterev of the Ministry of Health of Tatarstan Republic (Kazan) 206 patients who were treated for schizophrenia were examined. Depending on duration of disease, all patients were divided into three groups: 1 group with less than 5 years - (88 people), 2 group - from 5 to 10 years (73 people) and 3 group - more than 10 years (45 people). According to the analysis of medical records of inpatients, comorbidities were studied, the study included patients with cardiovascular diseases and diabetes mellitus. Recent indicators of systolic blood pressure, diastolic blood pressure, body mass index, fasting blood glucose index, low-density lipids, high-density lipids were recorded, a dental history and complaints were collected, and oral examination according to generally accepted criteria. For statistical results, a package of statistical programs SPSS 13.0. Results and discussion. It was revealed that diseases incidence of cardiovascular system, diabetes mellitus, systolic and diastolic blood pressure, glucose in the blood and low-density lipids significantly increased and positively correlated, depending on length of the patient's illness. The level of high-density lipids, while, on the contrary, decreased. Body mass index was the highest in the group of patients with 5 to 10 years of age experience and then tended to decline. The study identified a high prevalence of severe periodontitis in persons with mental disorders with 5 to 10 years of disease experience. With a severe degree of periodontitis, bleeding of the gums increased, these pathological changes were noted when the patient had a history of cardiovascular pathology and directly correlated with the level of systolic blood pressure, blood glucose and low-density lipids. Conclusion. The close association of periodontal conditions and manifestations of metabolic syndrome in persons with mental disorders suggests the need for an integrated approach to the treatment of oral diseases and a wide interdisciplinary interaction.
Keywords: metabolic syndrome, chronic generalized periodontitis, persons with mental disorders, antipsychotics.
For reference: Ilyina RJu, Muchamedzhanova LR, Akhmedova GM, Gurjanova TV. Manifestations of metabolic syndrome in oral cavity in mentally ill patients. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 27–32. DOI: 10/20969/ VSKM.2022(3).27–32.
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УДК: 617-089
DOI: 10.20969/VSKM.2022.15(3). 33-39
THE INFLUENCE OF THE COVID-19 PANDEMIC ON THE DIVERTICULAR DISEASE COMPLICATIONS TREATMENT
KARPUKHIN OLEG Yu., ORCID ID: 0000-0002-7479-4945; Doctor of Medical Sciences, Professor of the Department of surgical diseases, Kazan State Medical University, 420012, Russia, Kazan, Butlerova Str., 49, e-mail: oleg_karpukhin@mail.ru
PANKRATOVA YULIA S., ORCID ID: 0000-0001-7498-2412; Postgraduate student of the Department of Surgical Diseases, Kazan State Medical University, 420012, Russia, Kazan, Butlerova Str., 49, e-mail: iuliiaps@gmail.com
SHAKIROV RAIS R., ORCID ID: 0000-0001-8344-2696; doctor of Coloproctology Department, Republican Clinical Hospital, 420140, Russia, Kazan, Orenburg tract Str. 138, e-mail: raiskazan2@mail.ru
CHERKASHINA MALIKA I., ORCID ID: 0000-0002-7871-042X; doctor -radiologist of the Computed Tomography Department, Republican Clinical Hospital, 420140, Russia, Kazan, Orenburg tract Str. 138, e-mail: garifulina@bk.ru
Abstract. Introduction. The COVID-19 pandemic affected not only the organization of the entire healthcare system, but also made adjustments to the diagnosis and treatment of a wide range of diseases, including diverticular disease. Aim. Analysis of the results of inpatient care for patients with acute diverticulitis during the COVID-2019 pandemic. Material and methods: From 2017 to January 2022, 244 patients with diverticular disease were treated in coloproctology clinic. During the pandemic period (March 2020 – December 2021) there were 15 patients with COVID-2019 associated pneumonia who developed complications of diverticular disease. Results and discussion. An increase of hospitalizations of patients with complicated forms of the disease was established, while patients with uncomplicated diverticular disease were hospitalized less frequently. There was also a decrease in the number of reconstructive surgeries in 2020. The most informative diagnostic tool that allows to verify complicated forms of diverticular disease and determines further treatment tactics, especially in the COVID -19 pandemic, is X-ray computed tomography with intravenous contrast, which was performed in 53.3% of patients. The number of urgent surgical interventions increased, including in patients with COVID -2019. During the pandemic, minimally invasive interventions began to be performed more often, allowing the patient to be treated as gently as possible. Moreover, drainage of abscess under ultrasound guidance is currently becoming a popular procedure even with large abscesses (>3 cm). This technology should be considered as bridge operation before a radical intervention, which implementation should be carried out after the stabilization of the general condition of the patient. Diffuse peritonitis in COVID-positive patients continues to be considered as an indication for emergency laparotomy. At the same time, Hartmann-type operations should be performed, refusing the extended intestinal resection and primary anastomosis. Conclusion. The COVID -19 pandemic has made adjustments to the organization of medical care for patients with diverticular disease. In this regard, it is advisable to conduct interdisciplinary multicenter research in order to study the influence of the pandemic on the course of the disease and take early measures to minimize the negative consequences of the pandemic.
Key words: diverticular disease, complicated diverticulitis, diagnosis and treatment, COVID-19 pandemic.
For reference: Karpukhin OYu, Pankratova YuS, Shakirov RR, Cherkashina MI. The influence of the COVID-19 pandemic on the diverticular disease complications treatment. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 33–39. DOI:10.20969/VSKM.2022.15(3).33–39.
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УДК: 616.72-002.772
DOI: 10.20969/VSKM.2022.15(3).40-44
METABOLIC SYNDROME IN RHEUMATOID ARTHRITIS AS A CRITERION FOR CARDIOVASCULAR RISK
LAPSHINA SVETLANA А., ORCID ID: 0000-0001-5474-8565; PhD, associate professor of the Department of hospital therapy of «Kazan state medical university», 420012 Russia, Kazan, Butlerova Str., 49, e-mail: svetlanalapshina@mail.ru
FEYSKHANOVA LYUTCIYA I., ORCID ID: 0000-0001-7830-5283; PhD, associate professor of the Department of hospital therapy of «Kazan state medical university», 420012 Russia, Kazan, Butlerova Str., 49, e-mail: ljuts@rambler.ru
GARAEVA ALINA R., ORCID ID: 0000-0002-8254-652X; resident physician of the Department of hospital therapy of «Kazan state medical university», 420012 Russia, Kazan, Butlerova Str., 49, e-mail: alina-garaeva97@mail.ru
KURBANOV ALBERT R., ORCID ID: 0000-0002-4748-6840; resident physician of the Department of Clinical Pharmacology and Pharmacotherapy of «Kazan state medical academy», 420012, Russia, Kazan, Mushtari Str., 11, e-mail: al.ku2100@ yandex.ru
Abstract. Introduction. Rheumatoid arthritis and metabolic syndrome have common pathogenic mechanisms, thus mutually reinforcing each other, creating a higher risk of cardiovascular disease. Objectives: study the effect of metabolic syndrome on the course of rheumatoid arthritis and the formation of cardiovascular risk. Material and methods. The study included a clinical evaluation of 100 patients with rheumatoid arthritis (average age 55±12,4 years). The patients were divided into 2 groups depending on the presence of metabolic syndrome: 1st group – persons with metabolic syndrome (59 people, 59%) and 2nd group - persons without metabolic syndrome (41 patients, 41%). The received data were processed using the program STATISTICA 10. The differences in the indicators were considered statistically significant at p<0,05. Results. In 1st group, the activity of rheumatoid arthritis was higher (DAS-28 was 5.58±0.9) than in 2nd group (DAS-28 was 5.23±0.85) (p=0.02). The daily dose of steroids was higher in the group with metabolic syndrome: in terms of prednisone 7.5 [5; 10] mg versus 5 [5; 10] mg in the group without metabolic syndrome (p=0.013). Verified arterial hypertension was 3.8 times more common in the presence of metabolic syndrome. Left ventricular myocardial hypertrophy was 1.5 times more common in patients in the group with metabolic syndrome (35.9%), and it was noted both in combination with arterial hypertension and without it. In 1st group, left ventricular myocardial hypertrophy, unrelated to hypertension, was found in 9 people (9.78%). In 2nd group, myocardial hypertrophy was associated with arterial hypertension in all patients. Conclusion. The presence of metabolic syndrome in rheumatoid arthritis is associated with a higher activity of rheumatic disease. In patients with rheumatoid arthritis, it contributes to an increase in cardiovascular risk, characterized by a higher incidence of hypertension (3.8 times), an increase in total cholesterol and an increase in left ventricular myocardial mass. In patients with a combination of rheumatoid arthritis and metabolic syndrome, myocardial hypertrophy was detected even in the absence of an increase in blood pressure, which dictates the need for echocardiography in this group of patients.
Key words: rheumatoid arthritis, metabolic syndrome, cardiovascular risk.
For reference: Lapshina SA, Feyskhanova LI, Garaeva AR, Kurbanov AR. Metabolic syndrome in rheumatoid arthritis as a criterion for cardiovascular risk. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 40–44. DOI: 10.20969/VSKM.202(3).40–44.
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УДК:615.28
DOI:10.20969/VSKM.2022.15(3).45–53
THE PROBLEM OF CHOOSING STARTING ETHIOTROPIC THERAPY IN SURGICAL PRACTICE
MOROZOV ARTEM M., ORCID ID: 0000-0003-4213-5379; Candidate of Medical Sciences, Associate Professor of the Department of General Surgery, Tver State Medical University, Russia, 170100, Tver, Sovetskaya str., 4, e-mail: ammorozovv@gmail.com
SERGEYEV ALEKSEY N., ORCID ID: 0000-0002-9657-8063; Doctor of Medical Sciences, Associate Professor, Head of the Department of General Surgery, Tver State Medical University, Russia, 170100, Tver, Sovetskaya str., 4
ZHUKOV SERGEY V., ORCID ID: 0000-0002-3145-9776; Doctor of Medical Sciences, Head of the Department of Emergency Medicine and Disaster Medicine, Tver State Medical University, 170100, Russia, Tver, Sovetskaya str., 4
EPIFANOV NIKOLAY Y., ORCID ID: 0000-0002-0079-9057; surgeon, GBUZ GKB im. S.S. Yudina, Russia, 115446, Moscow, Kolomensky proezd, 4
MURAVLJANCEVA MARIJA M., ORCID ID: 0000-0002-0942-4614; 5th year student of the Faculty of General Medicine, Tver State Medical University, Russia, 170100, Tver, Sovetskaya str., 4
RYZHOVA TAISIJA S., ORCID ID: 0000-0002-8572-4862; 5th year student of the Faculty of General Medicine, Tver State Medical University, Russia, 170100, Tver, Sovetskaya str., 4
POTOCKAJA LIDIJA A., ORCID ID: 0000-0001-6283-2310; 5th year student of the Faculty of General Medicine, Tver State Medical University, Russia, 170100, Tver, st. Sovetskaya str., 4
Abstract. Introduction. The choice of an effective starting antibiotic therapy is a key problem at the stage of treatment of purulent-infectious diseases in a surgical hospital. Justified prescription of certain pharmacological groups of drugs with a certain duration of the course in accordance with the sensitivity of the pathogen prevents the development of antibiotic resistance, which has now acquired a global character. The aim of the study identification of the most common causative agents purulent-septic diseases in patients of a surgical hospital and monitoring of their sensitivity to antibacterial drugs in order to select the optimal empirical starting therapy.Materials and methods. A statistical analysis of the results of bacteriological examination of purulent discharge from foci of surgical infection of 285 patients of the surgical department of the City Clinical Hospital 7 in Tver is presented. Results and its discussion. The analysis of the results of bacteriological research revealed a wide range of microorganisms in a surgical hospital, such as Escherichia coli, Klebsiella oxytoca, Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and a number of microorganisms from the category «other» with less frequency of occurrence sensitivity to antibacterial drugs. The results obtained were compared with the data for the Russian Federation and global statistics. Conclusions. The dominant gram-negative microorganisms were Escherichia coli and gram-positive ones - Staphylococcus aureus. Local sensitivity assessment showed that the predominant percentage of microorganisms is sensitive to gentamicin, chloramphenicol and ciprofloxacin. The data obtained simplifies the selection of an effective starting antibiotic therapy, which reduces the rate of formation of multidrug resistance. However, taking into account the rate of development of antibiotic resistance, at the moment, there remains a need for constant monitoring of the sensitivity of pathogens to antibacterial drugs within each specific department of a medical and prophylactic institution.
Key words: antibiotics, antibiotic therapy, surgical infection, sensitivity, resistance.
For reference: Morozov AM, Sergeev AN, Zhukov SV, Epifanov NY, Muravljanceva MM, Ryzhova TS, Potockaja LA. The problem of choosing starting ethiotropic therapy in surgical practice. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 45–53. DOI: 10.20969/VSKM.2022.15(3).45–53.
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УДК.616-08-039.57:616-01/-099
DOI:10.20969/VSKM.2022.15(3).54-59
TREATMENT OF PATIENTS WITH CORONAVIRUS INFECTION COVID-19 AT THE POST-HOSPITAL STAGE USING HYPERBARIC OXYGENATION
PRASKURNICHY EVGENII A. ORCID ID: 0000-0002-9523-5966; D. Med. Sci., professor of the Department of aviation, Russian Medical Academy of continues education, 123242, Russia, Moscow, Barrikadnaya, 2/1, Head of the Department of Internal medicine, A.I. Burnazyan State Scientific Center of the «Russian Federation – Federal Medical Biophysical Center, Federal Medical and Biological Agency of Russia», 123098, Russia, Moscow, Zhivopisnaya str., 46, 8-916-524-84-81, e-mail: praskurnichey@mail.ru
AGAPOV KONSTANTIN V. ORCID ID: 0000-0003-0951-1360; D. Med. Sci., Surgeon, Chief Executive Officer of the Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 141435, Russia, Himki, st. Ivanovskai 15a, e-mail: info@kb119.ru
PAVLOV NIKOLAY B. ORCID ID: 0000-0002-0540-1095; C. Med. Sci., Anesthesiologist, the Head of the Outpatient Clinic, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency No2, 121309, Russia, Moscow, Novozavodskay 14a, 8-910-426-38-62, e-mail: bobvodolaz@yandex.ru
ORLOVA OLGA S. ORCID ID: 0000-0002-7222-9731; postgraduate student of the Department of internal medicine of State Research Center Federal Medical Biophysical Center named after A.I. Burnazyan, 123098, Russia, Moscow, Zhivopisnaya str., 46, 8-926-461-10-19, e-mail: orlova.os@mail.ru
KUZNECOVA ТATYANA E. ORCID ID: 0000-0002-8945-2059, D. Med. Sci., professor, Pirogov Russian National Research Medical University, 117513, Russia, Moscow, Ostrovitianiva 1, 8-910-414-96-07, e-mail: kuztek@rambler.ru
GROMAKOV VLADIMIR A. ORCID ID: 0000-0003-4376-2673, Cardiologist, the Head of the Hyperbaric Oxygenation Department, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency No2, 121309, Russia, Moscow, Novozavodskay 14a, 8-916-592-55-90, e-mail: gromakov_va@mail.ru
SHUTOV ALEXEY A. ORCID ID: 0000-0002-3588-8957; the Head of the Scientific Research Institute of Pulmonology Russia, 105077, Russia, Moscow, 11 Parkovai 32/4, e-mail: dr.shutov@gmail.com
Abstract. Introduction. It is commonly known that patients who have been exposed to the coronavirus in the past and are in the recovery stage now, experience deterioration of health-related quality of life, decreased productivity and decrease in cognitive functions, energy and breathing discomfort. Aim. Efficiency analysis of hyperbaric oxygenation therapy for patients with syndrome on outpatient treatment stage of rehabilitation. This article also gives consideration to the management problems of patients who have been exposed to COVID-19 in the outpatient treatment stage. We consider disease process and theoretical determinants for the progress of pathological conditions as the result of earlier disease. Material and methods.110 outpatients who have been exposed to the coronavirus in the past and treated with hyperbaric oxygenation therapy are included in the research. Results estimation was based on a patient-reported outcomes questionnaire and simple, noninvasive methods, including remote thermography. Results and discussion. The hyperbaric oxygenation method has shown us high efficiency for reducing residual symptoms of COVID-19. Conclusion. Inclusion of hyperbaric oxygenation into Post-COVID-19 rehabilitation program leads to immediate treatment effects, decreasing faintness and fatigability, increasing exercise tolerance, decreasing breathing discomfort, and, as a consequence helping to speed up recovery and getting back to social life and work-related activities.
Keywords: COVID-19, long-covid, pathogenesis, treatment, hyperbaric oxygenation, rehabilitation.
For reference: Praskurnichy EA, Agapov KV, Pavlov NB, Orlova OS, Kuznecova TE, Gromakov VA, Shutov AA . Treatment of patients with coronavirus infection covid-19 at the post-hospital stage using hyperbaric oxygenation. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 54–59. DOI: 10.20969/VSKM.2022.15(3).54-59.
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УДК:616.12-009.7-055.1:616.681-008.64:616.43
DOI:10.20969/VSKM.2022.15(3).60–67
THE SEVERITY OF DEPRESSION AND ANDROGEN DEFICIENCY IN YOUNG MALES WITH STEMI, CORRESPONDING TO ANGIOGRAPHIC FINDINGS
TKACHENKO VYACHESLAV V., researcher, Department of Advanced Internal medicine and Cardiology, Perm State Medical University named after Academician E. A. Wagner, 614990, Perm, Petropavlovskaya street, 26, phone: +7-909-109-36-32, e-mail: vvtkachenko@heart-perm.ru
KARPUNINA NATALYA S., ORCID ID: 0000-0003-3127-1797, Scopus Author ID: 55943730200, Researcher ID: ААС-3786-2022, RSCI Author ID: 339179, Associate Professor, Professor of the Department of Advanced Internal medicine and Cardiology, Perm State Medical University named after Academician E. A. Wagner, 614990, Perm, Petropavlovskaya street, 26, phone: +7-909-109-36-32, e-mail: karpuninapsma@mail.ru
KHLYNOVA OLGA V., ORCID ID: 0000-0003-4860-0112, Scopus Author ID: 6507749784, Researcher ID: Y-6422-2018, RSCI Author ID: 466698, D. Med. Sci, Professor, corresponding member of RAS, the Head of the Department of Advanced Internal medicine and Cardiology, Perm State Medical University named after Academician E. A. Wagner, 614990, Perm, Petropavlovskaya street, 26, phone: +7-902-478-34-82, e-mail: olgakhlynova@mail.ru
Abstract. Introduction. In young age, due to low evidence and gender inequality, non-obstructive acute coronary syndrome including slow blood flow is in priority. Aim. The aim was to evaluate severity of depression and androgen deficiency in young men with ST segment elevation myocardial infarction due to atherothrombosis and slow flow phenomenon. Material and methods. 99 men aged 25 to 44 years, were observed: 60 patients with ST segment elevation myocardial infarction and slow flow phenomenon, 39 patients with infarction due to coronary artery occlusion. The study did not include patients with body mass index more than 35 kg/m2, diabetes, valve diseases, arrhythmias, conductive disorders, previous history of acute coronary syndrome and pre-hospital fibrinolysis, surgery on pelvic organs and scrotum, prostate cancer, congenital hypogonadism, taking steroids, chronic kidney and liver diseases with impaired function, refusal to participate. Subjective signs of androgen deficiency and erectile dysfunction were analyzed, as well as presence and severity of depression according to Beck's Depression Inventory. Serum levels of prolactin, testosterone, luteinizing hormone, cortisol, sex steroid-binding globulin and free testosterone were measured. Results and discussion. Slow flow phenomenon patients had higher free testosterone and lower serum cortisol concentrations (p=0.04 and p=0.02). In the first group, mild erectile disfunction prevailed (35%), it was absent in 23.3% of respondents, severe disorders were noted in 13.3% of cases. In the second group, erectile disfunction was absent in 23.3%, and 36.7% of respondents had mild symptoms. 23.3% had moderate erectile disfunction. Males with severe and moderate symptoms of androgen deficiency prevailed in the second group. The absence of depression was found in 18.3% and 23.3% in both groups. Conclusion. High prevalence of depression in young men with type 1 myocardial infarction and with slow coronary blood flow has been established. Differences were found in levels of cortisol and free testosterone in groups, which did not correlate with subjective severity of erectile dysfunction symptoms. The results suggest that there is a relationship between estimated parameters, angiogram, and severity of myocardial damage in case of myocardial infarction in young men. To confirm this hypothesis, a prospective follow-up with assessment of one-year survival is required.
Key words: indices of depression and androgen deficiency, myocardial infarction, young males, slow flow phenomenon.
For reference: Tkachenko VV, Karpunina NS, Khlynova OV. The severity of depression and androgen deficiency in young males with STEMI, corresponding to angiographic findings. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 60–67. DOI:10/20969/VSKM.2022.15(3).60–67.
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УДК: 616.24-002.52
COMPLETE BLOOD COUNT IN THE DIFFERENTIAL DIAGNOSIS OF PULMONARY TUBERCULOSIS AND PNEUMONIA IN PATIENTS WITH HIV INFECTION
SHUBINA ANASTASIA T., ORCID ID 0000-0002-8096-7611, AuthorID: 1009823, SPIN-код: 2706-7833, Postgraduate Student of the Department of Phthisiology and Pulmonology, Samara State Medical University, Pionerskaya Street, 48, Samara, 443020, Russia, tel.: +7-927-7377308, e-mail: doc.inkova@gmail.com
BORODULINA ELENA A., ORCID ID: 0000-0002-3063-1538, AuthorID: 651365, SPIN-код: 9770-5890, Dr. Med. Sci, Professor, Head of the Department of Phthisiology and Pulmonology, Samara State Medical University, Pionerskaya Street, 48, Samara, 443020, Russia, tel.: +7-917-9583482, e-mail: borodulinbe@yandex.ru
KUDLAY DMITRY A., ORCID ID: 0000-0003-1878-4467, Dr. Med. Sci, Leading Researcher of Laboratory of Personalized Medicine and Molecular Immunology, Institute of Immunology, Prof. of Pharmacology Department, Institute of Pharmacy, First Moscow State Medical University named after I.M. Sechenov, Bol'shaya Pirogovskaya Ulitsa, 2, Moscow, 119435, Russia, е-mail: D624254@gmail.com
GERASIMOV ANDREY N., ORCID: 0000-0003-4549-7172, AuthorID: 141741, SPIN-код: 4742-1459, Doctor of Physical and Mathematical Sciences, Professor, Head of the Department of Medical Informatics and Statistics, First Moscow State Medical University named after I.M. Sechenov, Bol'shaya Pirogovskaya Ulitsa, 2, Moscow, 119435, Russia, tel.: +7-905-5505084, e-mail: andr-gerasim@yandex.ru
YAKOVLEVA ELENA V., ORCID ID 0000-0003-1858-5206, Postgraduate Student, Department of Phthisiology and Pulmonology, Samara State Medical University, Pionerskaya Street, 48, Samara, 443020, Russia, e-mail: elena130894@mail.ru
Abstract. Introduction. Nowadays, methods for detecting Mycobacterium tuberculosis are being improved, but at the same time, general clinical methods of laboratory diagnostics, which include a complete blood count, included in the diagnostic minimum of tuberculosis screening, do not lose their significance. Aim. The aim of the study is to evaluate the value of a complete blood count in the differential diagnosis of pulmonary tuberculosis and pneumonia in patients with HIV infection. Material and methods. The parameters of the complete blood count were studied in 159 patients in the pulmonology department who were at the stage of differential diagnosis with tuberculosis. For analysis, indicators of erythrocyte sedimentation rate, leukocytes, lymphocytes and hemoglobin were selected. According to the diagnostic results, the diagnoses of pulmonary tuberculosis (n=119) and pneumonia (n=40) were verified. Statistical processing was carried out using the statistical software package IBM SPSS Statistics 22.0. Results and discussion. In a comparative analysis of the complete blood count parameters of a group of patients with a confirmed diagnosis of tuberculosis and pneumonia, statistically significant differences were found in the average hemoglobin level (by 13.25 g/l more in tuberculosis, p<0.001) and the average level of leukocytes (by 4.44*109/l less with tuberculosis, p<0.001). When studying the dependence of changes in the main indicators of a clinical blood test in HIV-infected patients on the level of CD4+ T-lymphocytes, a direct correlation (r=0.451) between the number of CD4+ T-lymphocytes and the level of hemoglobin (p<0.001) was established, the lower the number of CD4+ T-lymphocytes the lower the hemoglobin level.Conclusion. A complete blood count does not differentiate between pneumonia and tuberculosis in patients with HIV infection, but can be used in the algorithm for forming a risk group for tuberculosis in a pulmonology department. Being the most important laboratory test, it can evaluate the changes characteristic of inflammatory (infectious) lung diseases.
Keywords: complete blood count; pulmonary tuberculosis; pneumonia; HIV infection.
For reference: Shubina AT, Borodulina EA, Kudlay DA, Gerasimov AN, Yakovleva EV. Complete blood count in the differential diagnosis of pulmonary tuberculosis and pneumonia in patients with HIV infection. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 66–71. DOI: 10.20969/VSKM.2022.15(3).66-71.
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ORGANIZATION OF HEALTHCARE
УДК: 614.2
DOI: 10.20969/VSKM.2022.15(3).72–79
ASSESSMENT OF THE EFFECTIVENESS OF THE DEVELOPMENT OF LEAN COMPETENCIES IN COMPLETING THE BASIC PROFESSIONAL EDUCATIONAL PROGRAM «NURSING»
PCHELINA NADEZHDA V., ORCID ID: 0000-0003-2766-9890; postgraduate student of the Department of Economics, Management and Medical Law, Privolzhsky Research Medical University, pl. Minin and Pozharsky, 10/1; Deputy Director for Educational and Methodological work, Arzamas Medical College, 607220, Russia, Arzamas, pl. Cathedral, 7, e-mail: nad707@yandex.ru
POZDEEVA TATYANA V., ORCID ID: 0000-0001-5853-859X; Doctor of Medical Sciences, Associate Professor, Head of the Department of Economics, Management and Medical Law, Dean of the Faculty of Preventive Medicine and Faculty of Higher Education, Privolzhsky Research Medical University, pl. Minin and Pozharsky, 10/1; 603950, Russia, Nizhny Novgorod, pl. Minin and Pozharsky, 10/1, e-mail: pozdeevatv@inbox.ru
NOSKOVA VERA A., ORCID ID: 0000-0001-8253-6121; C. Med. Sci., Privolzhsky Research Medical University, 603950, Russia, Nizhny Novgorod, pl. Minin and Pozharsky, 10/1, e-mail: jeslaver@mail.ru
Abstract. Introduction. The use of lean technologies in the activities of nursing staff has indicated the need for the formation of core competence among nurses already at the level of basic education. Building the trajectory of training innovative nursing personnel contributed to the development of a model for the formation of innovative competence of nursing specialists in the application of the concept of core making in their professional activities, its integration into the educational process and the transformation of the content of the basic level of education of nurses. Aim.The purpose of the study is to determine the effectiveness of the implementation of an educational model for the formation of lean competencies among medical college students studying in the speciality 34.02.01 «Nursing». Material and methods. The study was conducted in two stages: the first (October 2019) - before the introduction of the educational model; the second (May 2021) - evaluation of the results of model integration). The respondents were students of SBPEI NO «Arzamas Medical College», studying in the speciality 34.02.01 «Nursing»: in 2019 - the second and third year of study (312 persons), in 2021 - the fourth year of study (141 persons). To achieve the purpose of the study, a special questionnaire was developed. Future nurses' personal and professional development was also assessed, and their professional portrait was formed. The results were analyzed using Microsoft Office Excel and Statistica 5.0. Relative values and their errors were calculated, and Student's coefficient (t) was used to assess the significance of differences. When statistical testing hypotheses, the critical significance level was taken equal to 0.05. Results and discussion. Revealed significant positive dynamics of several indicators: the proportion of persons who are aware of the use of lean technologies in the professional activities of a nurse; the proportion of persons who are regularly interested in innovations in the healthcare sector; the proportion of those wishing to master the skills of using digital technologies in their professional activities; the share of those wishing to participate in innovative projects, as well as the attitude of respondents to maintaining order in personal belongings, is considered as a result of integration into the main professional educational program in the speciality 34.02.01 Nursing Models for the formation of lean-competence among students. Conclusion. The high efficiency of introducing the Model of the creation of innovative competence of nurses into the educational process in applying the concept of lean manufacturing in their professional activities has been proven. The professional portrait of future nurses lies in their professional orientation (desire to get a medical education and find a job in their speciality), possession of professionally important qualities, and active participation in volunteer activities.
Key words: «lean technologies» in health care; future nurses; professional training of nurses; medical college students; modernization of the educational process; educational model.
For reference: Pchelina NV, Pozdeeva TV, Noskova VA. Assessment of the effectiveness of the development of lean competencies in completing the basic professional educational program «Nursing». The Bulletin of Contemporary Clinical Medicine. 2022; 15(3): 72–79. DOI: 10.20969/VSKM.2022.15(3).72–79.
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УДК: 616-037: 616-053.5: 616.3-008.1
DOI: 10.20969/VSKM.2022.15(3).80–86
SCIENTIFIC SUBSTANTIATION OF MEDICO- HYGIENIC MEASURES TO REDUCE THE INCIDENCE OF DIGESTIVE DISEASES IN ADOLESCENTS
RADCHENKO OLGA R., ORCID ID: 0000-0002-0616-2620; Scopus Author ID: 53364221600; RSCI Author ID 579507; SPIN code: 1234-5286; D. Med. Sci, Associate Professor, Professor of the Department of General Hygiene, Professor of the Department of Preventive Medicine and Human Ecology, Kazan State Medical, Russia, 420012, Kazan, Butlerova St., 49, radch.olga@gmail.com
URAZMANOV ARTHUR R., ORCID ID: 0000-0002-1186-0386; RSCI Author ID: 988624; SPIN code: 8610-6748; C. Med. Sci, Associate Professor, Associate Professor of the Department of Public Health and Organization of Healthcare, Kazan State Medical University, Russia, 420012, Kazan, Butlerova St., 49, director@starclinic.ru
VALIEV RUSHAN I., ORCID ID: 0000-0003-0799-1698; ResearcherID: A-4780-2019; SPIN code: 8891-1181; RSCI AuthorID: 797794, Senior Lecturer, Department of Public Health and Organization of Healthcare, Kazan State Medical University, Russia, 420012, Kazan, Butlerova st., 49, rushan.valiev@kazangmu.ru
Abstract. Introduction. In recent years, the fact that the health of children and adolescents is of great medical and social importance has become more and more obvious. The size of economic losses of a society in the future depends on it. Therefore, at present, a search is underway for effective ways to identify risk factors and develop preventive measures to reduce the incidence. Aim. Based on the analysis of morbidity and pathological lesion rates in children and adolescents of the Republic of Tatarstan, to propose evidence-based preventive measures to reduce the incidence of diseases of the digestive system. Material and methods. At the first stage, the structure of primary, general morbidity, pathological susceptibility (the share of diseases detected during preventive medical examinations) of children and adolescents in Kazan and the Republic of Tatarstan was studied, the most vulnerable age groups were identified and classes of diseases with the highest growth rate were identified. At the second stage, we studied the dynamics and prognosis of primary and general morbidity among adolescents in Kazan and the Republic of Tatarstan with diseases of the digestive system as one of the rapidly progressing diseases and proposed measures to reduce the incidence of digestive diseases. Results and discussion. In the structure of primary, general morbidity, pathological affection of children and adolescents in Kazan and the Republic of Tatarstan, the share of diseases of the digestive system occupies a leading position. The most vulnerable age group are teenagers. The dynamics and forecast of indicators of primary and general morbidity among adolescents in Kazan and the Republic of Tatarstan with diseases of the gastrointestinal tract shows that the situation will worsen towards an increase in the number of diseases if no measures are taken. Methods and ways for searching for risk factors for the most common diseases of the gastrointestinal tract in the adolescent population are proposed. A number of proposals were made to improve primary and secondary prevention, a concept was formulated for medical and hygienic monitoring of adolescents with the digestive system diseases for further diagnosis, treatment and prevention of this pathology. Conclusion. The results of the study made it possible to determine priorities in the development of preventive and therapeutic technologies and programs when working with adolescents with diseases of the digestive system.
Keywords: morbidity, digestive organs, adolescents, preventive measures.
For references. Radchenko OR, Urazmanov AR, Valiev RI. Scientific substantiation of medico-hygienic measures to reduce the incidence of digestive system diseases in adolescents. The Bulletin of Contemporary Clinical Medicine. 2022; 15(3):80–86. DOI: 10.20969/VSKM.2022.15(3).80-86.
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