Dispensary Supervision Research Articles

The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID-19 pandemic. Temporary guidelines. Version 2

Guidelines were approved at the meeting of the academic council of the National Medical Research Center for Therapy and Preventive Medicine, Moscow (Protocol No. 10 of 19.10.2021).The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic non-communicable diseases in the conditions of the new coronavirus infection (COVID-19) pandemic, including the use of telemedicine technologies.The organization and conduct of high-quality medical follow-up are the most important tasks aimed at both reducing the risks of developing complications of chronic non-communicable diseases and reducing overall mortality, especially in the current conditions of the COVID-19 pandemic. The guidelines contain clinical aspects of dispensary follow-up, general principles of tactics for managing patients with various chronic non-communicable diseases in COVID-19 conditions, in addition, brief checklists with options for interviewing patients with various chronic non-communicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic non-communicable diseases with antiviral drugs are considered.The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care.

Respiratory viral infections including caused by coronaviruses in oncological and oncohematological patients

BACKGROUND: Patients with cancer are prone to developing infectious complications. They significantly aggravate the course of the underlying disease and worsen the quality of life of patients. The emergence of infections is largely promoted by immunosuppression associated with the use of cytostatic drugs, high-dose chemotherapy and hematopoietic stem cell transplantation in hematological cancer patients. Among infectious agents, respiratory viruses, especially influenza viruses, play an important role. The urgency of this problem has increased many times in connection with the development of the COVID-19 pandemic.
 AIM: To study the features of the course of respiratory infections, including coronavirus (seasonal and COVID-19), infections in cancer and oncohematological patients during hospitalization and in outpatient settings.
 MATERIALS AND METHODS: The study of the frequency and course of infectious complications in cohorts of patients with oncological diseases, who were under dispensary supervision in the polyclinic in Kirovsk, Leningrad region. Retrospective analysis of the frequency and characteristics of the course of coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1) in patients treated at the clinics of the Russian research institute of Hematology and Transfusionology. Prospective study of the coronavirus COVID-19 of patients hospitalized at the Russian research institute of Hematology and Transfusionology and at the Kirov interdistrict hospital in Leningrad Region during the period of its conversion to specialized infection diseases hospital.
 RESULTS: Coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1), occurs in hematological cancer patients more often in association with other respiratory viruses. In the cases of detection of the SARS-CoV-2 in hospitalized patients, they need to be transferred to specialized infectious hospitals.
 CONCLUSIONS: Respiratory viral infections are risk factors in cancer and oncohematological patients. Outpatient oncological and oncohematological patients require constant dispensary observation and special attention during the COVID-19 pandemic, outbreaks of influenza and other viral infections.

Features of the course of gastric ulcer in different age groups

Introduction. The problem of gastric ulcer is of particular socio-economic importance and has a tremendous impact on the quality of life of people. The relevance of our study is due to an increase in the incidence of peptic ulcer in the population, the variability of the clinical picture depending on the age category of patients, and the peculiarities of the treatment of this gastrointestinal pathology.The aim of the study is to study the features of the course of gastric ulcer in different age groups of patients under dispensary supervision in the outpatient department of the State Budgetary Healthcare Institution of the Republic of Moldova “Republican Clinical Hospital No. 5” in the period from 2017 to 2020.Materials and methods. A retrospective analysis of outpatient records of 100 patients of different age groups with gastric ulcer who were under dispensary observation at the outpatient clinic of the Republican Clinical Hospital No. 5 in Saransk in 2017– 2020 was carried out. Statistical analysis of the data obtained was carried out using the Microsoft Office Excel program.Results and discussion. It was found that gastric ulcer is more often observed in middle-aged and elderly patients and is accompanied by blurring of the clinical picture of the disease, in contrast to young people, who have vivid clinical manifestations of this disease. Ulcerative defects in young and middle-aged patients are more often small in size and are located mainly in the area of the stomach angle, and in elderly and senile patients, ulcers are localized mainly in the cardiac region, can be gigantic and often lead to the development of complications (primarily gastrointestinal intestinal bleeding).Conclusions. The blurring of the clinical picture, the absence of pathognomonic symptoms in elderly patients determine the late diagnosis of gastric ulcer, which ultimately leads to a high incidence of complications requiring surgical intervention. In clinical practice, it is necessary to take into account these features of the course of peptic ulcer disease in elderly patients and to prescribe the necessary complex of laboratory and instrumental studies and preventive therapy in a timely manner.

RESPIRATORY SYSTEM DISORDERS IN ANTIPHOSPHOLIPID SYNDROME (CLINICAL CASE)

The article discusses a clinical case of diagnosing secondary antiphospholipid syndrome (APS) in a young patient. The multiple organ symptoms and the need for additional special laboratory research methods make it difficult to make this diagnosis. APS is diagnosed with one clinical (thrombosis or pregnancy complication) and one serological criterion (lupus anticoagulant, antibodies to cardiolipin or p2-glycoprotein I). Patients with APS should be under long-term dispensary supervision to prevent recurrence of thrombosis and their prevention., it is necessary to control the activity of the underlying disease, timely detection and treatment of concomitant pathology, and the impact on corrected risk factors for thrombosis with secondary APS.

Indicators of dental incidence in older populations

BACKGROUND: The study of dental problems characteristic of geriatric patients is becoming increasingly relevant. As a person ages, the entire dental system undergoes physiological and functional changes. To eliminate the adverse effects of oral diseases, prolong the period of remission, preventive measures, constant monitoring of the level of hygiene, dispensary supervision of elderly and senile persons are necessary.
 AIM: This study aimed to determine the prevalence and intensity of dental diseases in the following older age groups: young elderly (6574 years old), old elderly (7584 years old), and very old elderly (85 years old and older).
 MATERIALS AND METHODS: A dental examination of 183 patients was carried out using a modified card for assessing the state of the dental status, according to guidelines of the World Health Organization.
 RESULTS: Analysis of dental morbidity in the older age group showed that the most common dental diseases in this group were extractions of lossened teeth caused by caries and periodontal diseases. Following a comprehensive dental examination of elderly patients and people with senility, the intensity of KPU and OHI-S was 19.760.52 and 2.710.12, respec-tively, and this indicates the poor hygienic state of the oral cavity of this population.
 CONCLUSION: Data support the untimeliness and inadequacy of dental care in elderly patients and people with senility. This necessitates the development of special treatment and prophylactic programs for this population, aimed at reducing dental morbidity.

Циркулирующие опухолевые клетки: мониторинг течения рака молочной железы в реальном времени

The aim of the research. Th is study aims to determine the content of circulating tumor cells (CTCs) in the peripheral blood using the MDA 231 aptamer in the dynamics of the disease. Material and methods. Th e study included 6 patients with breast cancer, who have been under dispensary supervision since 2017. Detection of CTCs was carried out in 3.5 ml of the blood of BC patients with the help of the MDA 231 aptamer which is affi ne for breast cancer cells, labeled with the fl uorescent Cy-5 dye. Th e count of CTCs in the blood samples was performed using fl uorescent and laser scanning microscopy. Results. Using the MDA231 aptamer, the content of CTCs in the peripheral blood of patients with breast cancer in the dynamics of the disease was analyzed. CTCs were detected in 1 patient, who was subsequently diagnosed with metastatic liver damage. Conclusion. Th e study demonstrates the possibility of using aptamers to determine the risk of relapse and to evaluate the eff ectiveness of antitumor therapy in patients with breast cancer.

Состояние твердых тканей зуба у лиц, переболевших COVID-19

Relevance. It is believed that the main cause of carious demineralization is microorganisms. However, the deterioration of the process is facilitated by the disruption of mineral metabolism in the oral cavity and, primarily, due to the insufficient supply of minerals naturally, from saliva. Aim: to study the effect of reduced functional activity of salivary glands on the intensity of the carious process and the sensitivity of teeth to stimuli in persons who have undergone COVID-19. Materials and methods. The studies involved 27 patients aged 18–42 years, 17 of them suffered from COVID-19. To compare the results, a group of individuals in the same age range who did not have COVID-19 was selected. All studied salivation rate, caries intensity, Green-Vermillon oral hygiene index (G-V), enamel solubility by TER test scale and the sensitivity of teeth to stimul. Results. In patients with COVID-19, immediately after recovery, pronounced hyposalivation (0.27±0.04 ml/min) was observed. After 1 year, this figure has not changed significantly; the intensity of caries increased by 35 %; the G-V index was at the middle level; the TER test had high rates and most of the patients with COVID-19 developed tooth hyperesthesia, which indicated that demineralization prevailed over remineralization. Conclusions. 1. In patients who have undergone COVID-19, enamel resistance decreases and the risk of developing a carious process increases and the appearance of hypersensitivity of teeth due to insufficient natural mineralization due to a decrease in the amount of saliva released – the main source of minerals entering the tooth enamel. 2. The microbial cantamination factor of demineralized enamel exacerbating the process is also not excluded. However, with good oral hygiene, the role of this factor is significantly reduced. 3. Persons who have undergone COVID-19 need dispensary supervision by a dentist, as well as medical and preventive measures that reduce the risk of developing a carious process. Key words: Patients who were sick with COVID-19; salivary gland function; enamel demineralization; caries intensity; tooth hypersensitivity.

The dynamics of the incidence of breast cancer in the Moscow region (2011–2018)

Introduction. Breast cancer is a serious medical and social challenge and the statistics around the world look daunting.Relevance. The incidence of breast cancer is increasing in most countries and this may be due to a number of reasons. First of all, it should be noted the improvement of diagnostic methods, in particular, mass mammographic screening, which allows detecting neoplasms at early stages, before the onset of clinical symptoms. As for mortality rates, in recent years, world statistics show a downward trend in rates.Goal. To analyze the incidence and mortality rates of breast cancer (BC) in the Moscow Region (MO) for the period from 2011 to 2018. The study of indicators in one of the regions of Russia – MO – is of great importance for determining and predicting the true needs of the population in specialized medical care.The purpose of the study was to analyze the incidence of breast cancer (breast cancer) in the Moscow Region (MO) for a period of time from 2011 to 2018.Materials and methods. Some data of the territorial cancer registry of the Ministry of Defense of the Russian Federation on the diagnosis and treatment of patients with breast cancer were used, which will make it possible to determine the needs of this cohort of patients in specialized care.Results. From 2011 to 2018, 26755 new cases of breast cancer were diagnosed in the Moscow Region. The analysis of the comparative stratification in breast cancer in the medical district made it possible to obtain statistically significant differences indicating an increase in the incidence in the period from 2015–2018 in comparison with the period of 2011–2014. The presented data also indicate a trend towards a decrease in the one-year mortality rate over 8 years: from 6.33% in 2011 to 5.32% in 2018. For the period from 2011 to 2018 (8 years) there is an increase in the number of patients with breast cancer who have been in the medical center under dispensary supervision for 5 years or more.Conclusions. Analysis of the data obtained on the indicators of morbidity and mortality from malignant neoplasms is of great importance for determining the needs of the population in specialized medical care.

The role of primary health care in preparing young men for military service

The basis of the system for providing medical care to the population is primary health care, which includes a number of measures: prevention, diagnosis, treatment of various diseases, medical rehabilitation, the formation of a healthy lifestyle and sanitary and hygienic education. When providing primary health care to young men 15-16 years of age, scheduled preventive medical examinations are carried out annually. The local pediatrician or general practitioner coordinates the work and is responsible for the timeliness of its implementation. Based on the results of the examination, a comprehensive assessment of the state of health of young men is given, physical fitness and neuropsychic health is assessed, a health group and a medical group for physical education are determined, a final diagnosis is made, recommendations on health improvement, treatment, regimen and nutrition are provided, and data on the level of training of young men to serve in the army are analyzed. From 2002 to 2019, the number of boys aged 15-16 declined from 39,113 in 2002 to 18,935 in 2019. The coverage of their preventive examinations was at a high level and averaged 94.27%. During preventive examinations, for the first time a significant number of young men in need of dispensary registration, medical and recreational activities were identified. The total number of young men 15-16 years old, who are annually under dispensary supervision, changed, and during the study period this indicator was 60.6%. The effectiveness of the work was assessed based on the results of the transfer from the third health group to the second health group and removal from the dispensary register. The long-term average rate of transfer of young men from the third health group to the second health group was 26.9%, and the removal from dispensary registration was 7.0%. The leading role in the preparation of young men for military service belongs to outpatient-polyclinic medical organizations. It is necessary to strive to further improve the quality of dispensary observation, to provide all the young men with full-fledged treatment, health improvement and rehabilitation, when it is necessary.

Problems of Organization of Radiation Diagnostics to Dispensary Cancer Patients

Currently, the Russian Federation pays unprecedented attention to the prevention, early diagnosis and treatment of cancer. In this regard, the identification of problems at the stage of dispensary observation of patients with cancer is extremely important, and their solution will ensure the proper level of quality and availability of medical care provided to them. A sociological survey of 1230 patients under dispensary supervision of oncologists of regional oncology offices in St. Petersburg was conducted. Identified limitations to the availability of radiation diagnostic techniques for cancer patients observed in the primary cancer office under dispensary observation: the waiting time needed for patients diagnostic tests often exceed the standard (8,9% during ultrasound examination, 25,8% - computed tomography, 28,8% - ultrasound, 34,6% - magnetic resonance imaging, in some cases, patients have to pay for designated health services, all of which is guaranteed free of charge (advice of a specialist - 36,7 per 100 respondents, laboratory diagnostic tests - 35,4 per 100 respondents). When conducting diagnostics using radiation methods, patients were most often forced to pay for ultrasound (43,3 per 100 respondents). The identified problems affected patient’s perception of medical care: only 79,5% were satisfied with the organization of dispensary observation in the primary oncology office. Direct dependence of the low level of patients satisfaction with the organization of follow-up in primary cancer study on long waiting diagnostic studies, inability to get directions for the study directly from the oncologist, restrictions in its timely implementation is free, the lack of explanation from the treating oncologist on an order and conditions of granting of medical aid (p=0,05; r=0,7-1).

Untapped Possibilities of Antiischemic Therapy after Acute Myocardial Infarction: Data from the PROFILE-IM Register

Aim. To evaluate the practice of prescribing antianginal/antiischemic therapy in patients who, after acute myocardial infarction (AMI), retained typical clinical manifestations of stable angina.Material and methods. The registry includes 160 patients who applied to the polyclinic from March 01, 2014 to June 30, 2015 after suffering an AMI. Anti-ischemic therapy was evaluated in patients with typical angina pectoris.Results. Based on the survey, typical angina attacks were detected in almost a quarter of patients (38 patients – 23.8%). According to the main indicators, patients with typical angina pectoris practically did not differ from the rest of the group of patients, with the exception of a significantly larger proportion of patients with diagnosed ischemic heart disease before AMI and patients under dispensary supervision. Almost all patients received beta-blockers (97.4%), about a third of patients received calcium antagonists (28.9%) or long-acting nitrates (34,2%). During the first year after AMI, second-line drugs were practically not prescribed to enhance antianginal therapy. According to international non-proprietary names, the choice of doctors tended to prescribe bisoprolol, amlodipine, and isosorbide dinitrate. Exacerbation of the disease course with hospitalization for unstable angina pectoris was recorded in 9 (23.7%) patients from the group with typical angina pectoris and in 5 (4.1%) patients in the rest of the group (p<0.001).Conclusion. In real clinical practice, only a small part of patients with typical angina pectoris receive drug therapy that corresponds to evidence-based medicine; therefore, the unique possibilities of antianginal (anti-ischemic) therapy often remain unrealized.

ЗНАЧЕНИЕ ОТДЕЛЬНЫХ КЛИНИКО-ДИНАМИЧЕСКИХ ХАРАКТЕРИСТИК ГЕРОИНОВОЙ НАРКОМАНИИ В ОЦЕНКЕ ПРОГНОЗА ЗАБОЛЕВАНИЯ

Objective: To study and provide the clinical and dynamic characteristics of heroin addiction and their impact on the prognosis of the disease and formulate the recommendations to improve the narcological care. Methods: The values of some clinical and dynamic factors in the assessment of the prognosis of heroin addiction in 170 patients were investigated. Results: It has been established that the combination of such clinical and dynamic factors of heroin addiction as the early onset of familiarization the use of narcotic substance in the age of 20 years, the use of heroin as a first sample of the narcotic substance, the duration of the disease more than ten years, a highly progressive rate of the course, the presence of concomitant viral hepatitis or positive HIV status may determine an unfavorable prognosis of the disease. Clinical and dynamic factors of favorable prognosis are: the late start of drug use – over the age of 40 years; the first test drug is different from heroin; duration of drug use up to 5 years; the low-progressive rate of the disease, the absence of concomitant diseases associated with injecting drug use in the form of viral hepatitis and HIV. Conclusions: The highlighted prognostic criteria for heroin addiction and the offered to their base prognostic «risk group» of patients will optimize clinical and organizational approaches in fulfillment of complex measures aimed at the treatment and rehabilitation of patients with heroin addiction. Presented characteristics can be taken into account in the formation of preventive measures, a differentiated approach to dispensary supervision of persons suffering heroin addiction. Keywords: Opioids, narcomania, heroin, prognosis, addiction, narcological care

Determination of indications for the treatment of temporary teeth in conditions of general anesthesia in preschool children by equipping the study of indicators of oxygen saturation of the brain using the method of cerebral oximetry

Annotation. A common problem at the dental appointment with different treatment methods (without general anesthesia and general anesthesia) is the risk of cognitive dysfunctions against the background of hypoxic brain damage in children: in the first case, against the background of stress, in the other, against the background of general anesthesia. The purpose of the study — to determine indications for the treatment of temporary teeth at the stages of growth and stabilization in conditions of general anesthesia in preschool children based on the study of oxygen saturation indicators of the brain using the cerebral oximetry method. Dental examination and dental procedures of varying severity were performed for 100 children under the age 3–7 years (545 teeth were treated) at the Dental Medical Center at the Bogomolets National Medical University. The method of cerebral oximetry was applied (the permissible reduction of cerebral oximetry was not more than 20%). The results of treatment of medium and deep caries showed a reliably low percentage of complications at different stages of tooth development that occur during rehabilitation of the oral cavity under general anesthesia (12.83% and 15%, respectively) than during rehabilitation of the oral cavity on an outpatient basis (23.5 % and 28.87%, respectively) (p≤0.01)). The results of the treatment of chronic fibrous pulpitis showed a reliably low percentage of complications that occur during oral rehabilitation in conditions of general anesthesia (15%) than during oral rehabilitation in outpatient settings (28.87%) (p<0.01). In the treatment of chronic forms of periodontitis at the stage of root stabilization on an outpatient basis, 59% have complications that cause tooth extraction. Of these, 38% have complications in the form of an exacerbation of the process with a violation of the cortical plate, the rudiment of permanent teeth, 62% — pathological resorption of the roots of temporary teeth. In the treatment of chronic forms of periodontitis at the stage of root resorption on an outpatient basis, 73% have complications, including local enamel hypoplasia of permanent teeth. The treatment of this diagnosis involves several visits, which is technically impossible to perform under general anesthesia. Therefore, in order to preserve the rudiments of permanent teeth, teeth with chronic granulating periodontitis at the aggravation stage were subject to lengthening, at the stage of remission, at the stage of the formed root, instrumental and drug treatment of the channels and root canal filling with iodine paste (according to indications, removal) were performed, in the remission stage at the stage of root resorption, tooth extraction was performed. Dentistry with such a diagnosis involves several visits, which is technically impossible to perform under general anesthesia. The poem, in order to preserve the rudiments of permanent teeth, teeth with chronic granulating periodontitis at the exacerbation stage were subject to extension, at the stage of remission — at the stage of the formed root, instrumental and drug treatment of the channels and root canal filling with iodoform paste (according to indications - removal) were performed, in the remission stage at the stage of root resorption, tooth extraction was performed. Thus, in children aged 3–7 years: the choice of the method of dental treatment depends on the temperament and type of phobias, which determine the nature of the behavior at the dental appointment. Dispensary supervision of children ensures their habituation to the dental chair and, as a consequence, prevents the development of cryptogenic phobias in them.

Analysis of indicators of public health in the Kamensko-Dneprovskyi rural region.

Purpose of the research performed by the cohort method is to study the levels of public health among children and adults living in the rural industrial area of the Zaporizhzhia region. In order to estimate primary and overall disease incidence by the separate nosological forms in children and adult population: (C00-C97), (E10-E14), (I10-I15), (I20-I25), (J95- J99), (K20-K31) retrospective research was carried out according to the ICD-10. Scientific substantiation of the research in the rural district was based on the following categories: choosing category of the adult population and children aged 0-14 years to 15-17 years, social-hygienic parameters, types of water supply systems. Investigation of the incidence was carried out according to the report of Information Health Department Centre for the period of 2008-2016 years. The main factors which influence the formation of public health are demographic indicators of different age groups, as well as indicators of dispensary supervision (the composition of health groups, the proportion of frequently ill children) on the territory of experimental observation area. In our research we tried to study these two groups of medical and social factors to understand the conditions under which health of the rural population in this industrially developed region of Ukraine is being formed. The percent of organized groups of frequently ill childrenl in the Kamensko-Dniprovskyi rural district during 2008-2016 observation period increased from 53.3% in 2008 to 68.2% in 2016, which also testifies to a negative tendency to increase in the rate of children falling ill more than 4 times during 1 year, and the low resistance of the body to acute viral infections.

THE IMPORTANCE OF SOCIAL FACTORS IN OUT-THE HOSPITAL SUDDEN DEATH OF INFANTS OF THE FIRST YEAR OF LIFE

The importance of social factors in sudden infant death syndrome (SIDS) has been proved, but their contribution to the unexpected out-of-hospital sudden infant death (OSID) has not yet been executed. There is presented the importance of social risk factors for OSID in 336 babies suddenly died beyond the hospital (1st group) in comparison with the 350 babies died in the hospital (2nd group). In 85.7%, several adverse factors were revealed, in 27.4% - in the 2nd group. Low socio-economic status of the family in the 1st group was observed in 34% of cases, and in the 2nd group - in 8% of cases. In the first group the number of antisocial families with the mother or both parents being alcohol or drug abuse appeared by 5 times more. In the 1st group the number of families with unregistered marriage and single mothers were 3.1 times more than in the 2nd group. 20.8% of women in Group 1 were not observed in antenatal clinics during pregnancy, and 12% of persons in this group and children remained without medical and dispensary supervision. Thus, families with a low socioeconomic level and antisocial families are a group of high-risk OSID infants of the first year of life, which determines the need for the active preventive work of health authorities and guardianship, the migration service and law enforcement agencies.

SPECIES OF YEAST-LIKE FUNGI OF THE GENUS CANDIDA IN ISOLATES FROM THE ORAL CAVITY IN HIV-INFECTED PATIENTS OF THE BRYANSK REGION

We examined of the oral cavity of 174 HIV-infected patients who are on dispensary supervision and treatment in the Bryansk Center for the prevention and control of AIDS and infectious diseases with the implementation of a complex of bacteriological and parasitological studies. The predominance of non-albican species, as well as mixed infections with two or more species of fungi of the genus Candida were shown.

СТРУКТУРА ЗАБОЛЕВАНИЙ, ОБУСЛОВИВШИХ ИНВАЛИДНОСТЬ СРЕДИ ДЕТЕЙ ГОРОДА ДУШАНБЕ

Objective: To analyze the dynamics and structure of the morbidity that caused disability in children living in Dushanbe. Methods: Summary reports provided by the City’s Informational Department and Medical Statistics of Dushanbe (medical form № 31) for 2014-2018 were retrospectively analyzed. Results: The analysis showed that there is a tendency to increase from year to year those who are on the dispensary account. There is a close correlation (r=0.95; p<0.005) between children under observation and children taken on dispensary records with the first established disability. The largest number (more than a third) of children with disabilities falls on the third age corridor (age 5-9 years) with a tendency to increase. The first place in the structure of diseases of children aged 1-4, 5-9 and 10-14 years, which caused the occurrence of disability, are occupied by diseases of the nervous system, then there are mental disorders, the third congenital anomalies and chromosomal abnormalities. In the structure of congenital anomalies (malformations) and chromosomal disorders are dominated by congenital heart defects, much less – Down’s syndrome. The study found that less than half of children with disabilities (41.6%) were disabled who received inpatient treatment, most of them under the dispensary supervision of narrow specialists of Urban Health Centers, i.e. received outpatient treatment. The hospital was arranged at home for 12.3% of immobile children. Rehabilitation centers for rehabilitation treatment were used by 9.7% of children. Conclusion: A study of the dynamics of age disability revealed the largest number of children of preschool age, namely 5-9 years, a little less – children aged 10-14 years. Disability by adolescence, in the fifth group, decreases slightly. The importance of diseases of the nervous system increases in the third age group (5-9 years) and has some tendency to decline by adolescence (15-17 years). The incidence of mental disorders, congenital abnormalities (developmental malformations) and chromosomal disorders also increases with age and is approximately the same quantitative expressions until adolescence. Keywords: Child disability, child morbidity, morbidity structure, age groups, age dynamics.

The skin test with tuberculous recombinant allergen AT successful treated patients with lung tuberculosis

38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p0,05). Other factors differed unreliably.

Improving the automation of information support for medical rehabilitation and dynamic monitoring of the health of participants in wars and armed conflicts

An analysis of the experience of medical support of troops in the wars and military conflicts shows that their characteristic feature was and remains the constant improvement of the organizational forms of medical support for the troops aimed at optimizing the medical rehabilitation of the wounded and sick. The results of the analysis of medical support of troops during the Great Patriotic War showed that the composition and content of the sanitary minimum level for servicemen should be in constant accordance with the requirements for the level of professional training of servicemen. Organization of medical care for participants of the Great Patriotic War of 1941-1945 and the Afghan conflict of 1979-1989 in the postwar period shows that the basis of all measures to monitor the health of war participants must be a system of active personal dynamic observation. Active dynamic monitoring of the state of health using automated information systems allows to solve the problem of restoring health among participants in wars and military conflicts at the optimal level, provides medical information necessary for assessing the health status of participants in wars, determining the scope and composition of medical and recreational activities. Active invitation of the patient, who is on dispensary supervision, makes it possible to conduct a comprehensive assessment of his health status. However, the effectiveness of the system of medical control over the health of war participants largely depends on the high degree of automation of information processes in the system of dynamic control over the health of a workable and efficient resource on a national scale. The implementation of the principles of dynamic monitoring of the health of participants in wars can be carried out through the practical implementation of Decision 36 of the Plenum of the Academic Medical Council with the Chief of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation (1996). Special attention was paid to the necessity and urgency of the development and operation of an automated information system on the wounded and sick on the basis of the Military Medical Museum. At the same time, it is necessary that its electronic information module is located in the institution where the wounded and sick war veterans are kept in the hospital. At present, such an institution in the Armed Forces of the Russian Federation is an archive of military medical documents of the Russian Military Medical Museum.

КОМПЛЕКСНЕ ЛІКУВАННЯ ГЕНЕРАЛІЗОВАНОГО ПАРОДОНТИТУ В НАРКОЗАЛЕЖНИХ, ХВОРИХ НА ТОКСИЧНИЙ ГЕПАТИТ

Generalized parodontitis (GP ) occurs and proceeds against a background of violations of the indices of local immunity of the oral cavity of patients. Modern ideas about the causes of inflammatory parodontal diseases are based on the violation of local and general immune mechanisms, sensitization of the organism to antigens produced by pathogenic microorganisms, the presence of somatic pathology. The use of narcotic drugs causes disturbances in the functioning of the immune system. For the complex treatment of inflammatory parodontal diseases, the use of a drug with immunomodulating activity - nuklex and agents, which reduces the amount of oxidized stress products and has a hepatoprotective effect – mexidol is suggested.The aim of the study – to learn the dynamics of general and local immunity indices (for the concentration of cytokines) in patients with generalized parodontitis with toxic hepatitis in opioid dependence during complex treatment.Materials and Methods. 65 patients with GP were examined in the stage of unstable remission: 19 women (29.2 %) aged 20 to 45 years and 46 men (70.8 %) aged 19 to 47 years. All patients are on dispensary supervision with an expert in narcology about opioid addiction. At the stomatologic examination, GP of the second degree, toxic hepatitis is established. To determine the cytokine profile, samples of blood serum and mixed saliva were used in drug addicts, patients with Hepatitis B with toxic hepatitis, and healthy donors (reference norm).Results and Discussion. Development of GP , especially in persons with toxic lesions (drug addiction), is accompanied by significant changes in the state of immune mechanisms of oral protection, which are manifested in local changes in the composition of gum cells, as well as the content of immunoglobulins and cytokines in the saliva. As a result of the conducted studies, before the beginning of preventive treatment, an increase in the level of IL-6, IL-8 and IL-10 was observed against the background of a decrease in γ-IFN. After finishing the treatment in patients with GP with opioid dependence with toxic hepatitis, there was an improvement in the indices of the studied cytokines (IL-6, IL-8, γ-IFN and IL-10). At the same time, a more pronounced positive dynamics of these indices was manifested in patients, an additional combination of nucleax and mexidol was taken.Conclusions. To study the activity of local immunity in drug-dependent patients with toxic hepatitis, it is expedient to determine the level of cytokines by a non-invasive method. Imbalance of pro-inflammatory and anti-inflammatory cytokines is considered as a reflection of the inflammatory and autoimmune process. In the treatment of generalized parodontitis with the inclusion of a combination of nucleic acid and mexidol, the production of cytokines is restored. The use of this combination reduces the destructive-inflammatory process in the parodontium and the severity of immunodeficiency.