Primary Medical Documentation Research Articles

КОМПЛЕКСНЫЙ АНАЛИЗ ПРИЧИН РАЗВИТИЯ НЕЖЕЛАТЕЛЬНЫХ РЕАКЦИЙ НА ОМАЛИЗУМАБ

Currently, there are no comprehensive studies to assess the causes of adverse reactions in terms of the use of omalizumab. The aim of the study was to conduct a comprehensive analysis of the causes of adverse reactions to omalizumab. Materials and methods. Based on these criteria, experts of medical organizations conducted a retrospective assessment of 300 cases of omalizumab use with registration of existing defects based on the data of primary medical documentation (inpatient records, outpatient records). By the method of a sociological survey of 100 doctors, the level of their awareness of the procedure for reporting adverse reactions of drugs and, in particular, omalizumab was studied. The data were processed using applied computer programs. Outcomes. The incidence of medical-organizational defects in safety monitoring of omalizumab was 591 per 100 cases overall. The highest frequency was observed in such defects as: "lack of analysis of identified adverse reactions and cases of ineffectiveness"; "lack of a plan for corrective and preventive measures in connection with the detection of cases of adverse drug reactions"; "violation of the deadlines for the transfer of notices". In the structure of defects in reporting and filling out notifications of adverse reactions of omalizumab by doctors of medical organizations, the leading positions are occupied by: the absence of indications of the presence of bad habits (drug addiction, alcohol abuse, smoking) in the patient; absence of indications of the patient's reaction to the drug; lack of information about the period of time that has elapsed from the administration of the drug to the onset of symptoms of an adverse reaction. The weakest points of professional awareness of doctors about the procedure for reporting adverse reactions of omalizumab are: awareness of the need and content of the analysis of the identified adverse reactions; on regulatory documents on the quality, efficacy and safety of medicines; on the notification scheme of the person responsible for monitoring the safety of the medicinal product.

АНАЛИЗ КАЧЕСТВА ВЕДЕНИЯ МЕДИЦИНСКОЙ ДОКУМЕНТАЦИИ ПРИ ОЦЕНКЕ ДЕЯТЕЛЬНОСТИ СТОМАТОЛОГИЧЕСКОЙ КЛИНИКИ

One of the criteria for assessing the quality of medical care is the complete maintenance of medical records. Defects in the preparation of medical documents lead to serious errors, such as incorrect diagnosis, unreasonable choice of diagnostic methods and treatment. To clarify the causes of their occurrence and adverse consequences, the study and analysis of medical records in dental organizations is of no small importance. Properly completed medical documentation serves as the basis for conducting forensic investigations within the framework of a criminal case in case of defects in the provision of medical dental care. The outpatient card of a dental patient is the object of quality control of medical care in dental organizations in the event of conflict situations. Purpose of the study: To analyze the quality control and safety of medical activities and the examination of the quality of medical dental care carried out in the dental clinic of the Military Medical Academy named after. CM. Kirov. Material and methods. During the study, analytical and statistical methods were used. The collection of primary information was carried out on the basis of data from primary medical documentation - 1067 outpatient records of dental patients. Results and condemnation. A statistically significant influence of a doctor’s work experience on the completeness of providing information about patients’ complaints was revealed. Doctors with less experience provide more complete descriptions of patient complaints. Among all complaints, aesthetic ones were most often described; complaints of a morphological and functional nature were noted quite rarely. In the cards of form No. 043/u, in 46.67% there was no information about the bite, the hygiene index was not determined, treatment plans and visit diaries were not filled out correctly. Conclusions. Internal quality assessment helps to detect defects in filling out dental patient outpatient records. The importance of adequate medical record keeping is beyond doubt; the form of the medical record must meet the needs of dentists and contain information that complies with the legal and regulatory framework.

Drowning and Nonfatal Drowning in Children and Adolescents: A Subsequent Retrospective Data Analysis.

Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994-2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade. We retrospectively investigated data of 47 inpatients aged 0-18 admitted to Leipzig University Department of Pediatrics who matched ICD-10 code T75.1 from 2008 to 2020 and compared them to a preceding study at the same institution. We also examined the prognostic value of parameters regarding the patients' outcomes. There were three median incidents per annum. The median age was 2.75 years; 76% of incidents happened in males. An accumulation was seen during the summer months and weekends. Most drowning incidents occurred in private ponds or pools (48.9%). Thirty-nine children were discharged without resulting morbidity, four showed neurological impairment, and three died. Risk factors concerning age, sex, and incident characteristics were confirmed. Special supervision needs still apply to 1-3-year-old male children or children with pre-existing health conditions around private pools and ponds. Hospitalization duration shortened, and morbidity and lethality decreased since the previous study. There was structural improvement in primary care and medical documentation. Parameters suggesting good outcomes include a submersion time < 5 min, GCS > 3 points, spontaneous movement upon admission, remaining pupillary light response, the absence of cardiovascular arrest, body temperature ≥ 32 °C, pH > 7, blood glucose < 15 mmol/L, lactate < 14 mmol/L, base excess ≥ -15 mmol/L, and the absence of ARDS. Clear legislation can contribute to improved private home water safety. Further studies should include a broad in- and outpatient spectrum and standardized incident documentation presupposing Utstein-style reporting. Regular reinvestigation of consistent geographical regions facilitates process evaluations of drowning epidemiology and therapy evolution.

Complex phenotype of Tourette syndrome in a ten-year-old boy (a clinical case)

Aim. The aim of the work is to draw attention to the symptoms associated with Tourette syndrome and to examine the association with comorbid diseases. Materials and methods. A review of the scientific literature on Tourette syndrome (TS) was conducted using the following Keywords “tics”, “Tourette syndrome”, “Tourette obsessive-compulsive disorder, TOCD”, “obsessive-compulsive disorder, OCD”, “attention deficit hyperactivity disorder, ADHD” using PubMed, MEDLINE, EMBASE as search engines. Taking into account studies conducted in the last 10 years, the abstracts of 275 articles were analyzed. Articles were selected for the study based on the criterion of their close relevance to the topic. The study results covered in 49 articles were examined in more detail. A description of a TOCD clinical case was prepared from primary medical documentation with parental informed consent. Results. The prevalence of TS is quite variable, depends on epidemiological research methods and ranges from 0.3 % to 1.0 % worldwide. Given the methodological limitations of most studies, the actual prevalence may be 10 times higher. TS is a progressive disease and is characterized by regular stages. Tourette syndrome-plus is distinguished, including autoaggressive actions besides the basic symptoms of OCD and ADHD. The etiology of TS is still being studied. In particular, the impact of environmental factors is considered: infection or inflammation, perinatal complications and chronic psychosocial stress in childhood. In 70–80 % of cases, TS is a hereditary disorder, making it one of the most heritable childhood-onset neuropsychiatric diseases. Various approaches have been applied to assess the genetic architecture of TS, including candidate gene studies, segregation analysis, linkage analysis, cytogenetics, copy number variants (CNV), rare variation studies, genome-wide association studies (GWAS), and whole exome sequencing (WES). Currently, there is no specific laboratory or genetic test for TS diagnosis. Pharmacological treatments are available but often ineffective; behavioral and surgical treatments are under development. The clinical case of TS in a 10-year-old boy is described with an onset at the age of 7 years following frequent infections, manifested as cephalocaudal motor tics and several vocal tics (coprolalia, echolalia) with a progression to obsessive-compulsive behavior (mysophobia, compulsive skin picking, self-hitting, self-biting, repetitive compulsions). The presented clinical case is of great interest from the viewpoint of somewhat belated diagnosis of TOCD syndrome, as well as indicates the need to continue the search for effective methods of diagnosis and treatment. Conclusions. The case of comorbid OCD and tic disorder is a unique endophenotype combining externalized disinhibited TS movements in parallel with internalized distress reminiscent of OCD. Clinicians should consider these features when choosing treatment methods.

Основные особенности медицинской эвакуации железнодорожным транспортом раненных в современном вооруженном конфликте

Summary. The purpose of the study is based on the analysis of medical documentation and the work experience of medical specialists of the Center for Air Ambulance and Emergency Medical Care (CAS and EMS) of the Federal State Budgetary Institution “State Research Center – Federal Medical Biophysical Center named after A.I.Burnazyan” FMBA of Russia for medical evacuation by rail (MEZHT) of the wounded to determine the main features of medical evacuation measures (MEM) and the structure of the contingent evacuated during armed conflicts. Materials and methods of research. Research materials – primary medical documentation of 8 flights of a temporary military medical train (VVSP) of the Russian Ministry of Defense. Study period: July–August 2023. The study used methods of mathematical analysis and direct observation. Research results and their analysis. Currently, temporary military ambulance trains evacuate mainly walking and low-mobility lightly wounded patients, which is due both to the lack of operational need for long-distance MET for this category of patients due to the stable operation of air ambulances, and to the not entirely satisfactory conditions for placing seriously wounded bedridden patients in the air ambulance. Currently, the Air Forces operate in accordance with the scheme of routing the wounded from the zone of armed conflict to medical treatment organizations (HMO) in the rear of the country. At the same time, the existing difficulties in MEVT of bedridden, seriously wounded patients, including those in intensive care, require improvement of railway ambulance transport. In the author’s opinion, the most rational option for such an improvement in modern conditions is the further development of schemes for modifying passenger cars to meet the needs of the MEZhT of the seriously wounded and sick.

Prospects for the application of kuril tea shoots in rehabilitating patients with frequently and long-term respiratory virus diseases

Introduction. Frequently and long-term ill children are an urgent problem in pediatrics. It is of interest to take into account the possibility of rehabilitation of frequently and long-term ill children using the natural resources of the region.Objective. To study the clinical and immunological parameters of children -residents of the Altai Territory, who are often prone to acute respiratory diseases, and the effect on these indicators of herbal tea from the shoots of Pentaphylloides fruticosa, used in complex therapy and rehabilitation of frequently and long-term ill children.Materials and methods. The study involved 49 children aged 3.5 to 7 years of both sexes, who are in the dispensary group of frequently and long-term ill children. During the study, a retrospective analysis of primary medical documentation was carried out, as well as a comprehensive clinical and laboratory, microbiological and parasitological examination, and determination of the immune status. In a prospective cohort study, the effect of the use of herbal tea from the shoots of Pentaphylloides fruticosa on the clinical and immunological parameters of frequently and long-term ill children was evaluated as part of complex therapy with bacterial lysates and endogenous interferon inducers.Results. The age-sex structure of frequently and long-term ill children is dominated by children of preschool age (up to 70%), mostly males (53%), who have a burdened anamnesis (31%). Frequent episodes of respiratory diseases are not a consequence of immune deficiency and develop against the background of an associated, persistent viral and bacterial infection that occurs against the background of transient functional instability of the immune system. The quantitative analysis of immunograms showed a significant immunocorrective role of Pentaphylloides fruticosa extraction preparations in comparison with baseline values.Conclusions. The conducted clinical and immunological study did not reveal any significant clinically significant disorders of the immune system in frequently and long-term ill children -residents of the Altai Territory. At the same time, the use of extractive preparations of Pentaphylloides fruticosa has a significant immunocorrective effect on the parameters of the immune system and can be considered as an important component in the complex rehabilitation of frequently and long-term ill children from the age of 3.5 years.

Optimization of the system for predicting the severity of the course of COVID-19 in hospitalizedpatients based on cardiovascular history, initial clinical status and surface ECG indicators

The aim – to optimize the system of early assessment of the tendency to a more severe subsequent course of COVID-19, based on initial clinical, anamnestic and electrocardiographic markers.Materials and methods. Data from primary medical documentation on 104 patients with moderate severity of COVID-19 (50 men and 54 women, aged 24 to 84 years) who were treated (at least 16 days) in clinics of Ukraine during 2020–2021 were analyzed on the study of the effectiveness of the treatment of COVID-19. Risk factors (advanced age, inflammatory diseases, cardiovascular pathology: the presence of hypertension, obesity, diabetes, coronary artery disease, heart failure (HF), persistent or permanent atrial fibrillation (AF)), dynamics of the clinical state (HR, to body, blood pressure, SpO2, respiratory rate (HR), clinical symptoms and signs from all body systems), as well as surface ECG data in 12 leads were studied. Based on the dynamics of the clinical condition (according to a specially developed scale), all patients were divided into group A (66 pts, a more severe hospital course of COVID-19) and group B (38 pts, a milder variant of the course of COVID-19).Results and discussion. Among the electrocardiographic risk factors (RF) of a more severe hospital course of moderate-severe COVID-19, the following were more informative than others: a decrease in the amplitude of the Q wave in lead V5 (HR = 1.96 (95 % CI 1.29–2.96)) and an increase in the amplitude of the S wave in lead V4 (HR = 1.57 (95 % CI 1.18–2.08)), an increase in the duration of the QR interval in lead V1 (HR = 1.49 (95 % CI 1.11–2.0)) and its decrease – in leads V5–V6 (HR = 1.64 (95 % CI 1.3–2.1)), ST segment elevation in lead V4 (HR = 1.69 (95 % CI 1.43–2.00)), a low-amplitude T wave in lead I (HR = 1.60 (95 % CI 1.15–2.23)) and the appearance of abnormal TU complexes in leads V2–V6 (HR = 1.37 (95 % CI 1.04–1.80)), as well as a model built taking into account 8 ECG criteria (duration of the QR interval in lead V1 &gt; 20 ms and in lead V5 &lt; 24 ms, SI wave amplitude ratio to QII wave amplitude ratio &gt; 4, R wave amplitude ratio in avL to QV5 wave amplitude ratio &gt; 16, QR interval duration ratio in V1 to QR interval duration in V5 &gt; 1, the ratio of ST elevation in V4 to the amplitude of the TI wave &gt; 1), evaluated according to their significance (area under the ROC curve (ROC) 0.88, for values &gt; 35 points HR = 2.43 (1.73–3.39)). When the 8-component ECG scale was combined with the components of the previously created clinical and anamnestic scales, the ROC increased to 0.93, the value &gt; 48 points on the first day of COVID-19 with a sensitivity of 86 % and a specificity of 87 % (HR = 4.29 (2,4–7,69)) predicted a more severe variant of the hospital course of COVID-19 of moderate severity.Conclusions. The developed and optimized risk assessment system, based on clinical, anamnestic and electrocardiographic data, allows to accurately predict the subsequent more severe course of the disease on the first day of treatment for COVID-19. These results are promising from a practical point of view and require further study in a prospective study.

Влияние патологии мочевыделительной системы на развитие эндометрита после кесарева сечения.

Introduction. Pregnant women with pathology of the urinary system are at high risk of complications. The aim of the study was to assess the prevalence and structure of diseases of the urinary system in maternity women with endometritis after cesarean section, to determine their prognostic value as independent predictors of the development of postoperative infectious and inflammatory complications. Materials and methods. A retrospective multicenter statistical analysis of the medical histories and primary medical documentation data of 648 women delivered by caesarean section, 406 of them with a diagnosis of "endometritis after cesarean section" (main group) and 242 with the physiological course of the postoperative period (control group). Results and discussion. The prevalence of diseases of the urinary system in puerperant with endometritis was 56.5% and is mainly represented by urinary tract infection. Asymptomatic bacteriuria complicates the course of pregnancy 3.3 times more often in women with endometritis after cesarean section compared with the corresponding indicator in women with uncomplicated course of the postoperative period (20.9% vs. 6.3%), which makes it possible to attribute it to significant predictors of the development of postoperative infectious and inflammatory complications in obstetrics. Conclusion. According to the results of multivariate regression analysis, chronic and gestational pyelonephritis had less pronounced associations with the prediction of endometritis development after cesarean section.

Assessment of the Formation of Professional Vocabulary as a Component of the Doctor’s Competence

The formation of a professional vocabulary is important in the education of doctors for understanding colleagues and patients and is associated with teaching communication skills. The study examined graduate students' knowledge of communication skills when taking anamnesis, as well as knowledge of differential diagnosis when conducting an initial examination of a patient, and the requirements for preparing primary medical documentation.

Probability of change in diagnosis among adult patients diagnosed with childhood mental disorders

BACKGROUND. The problem of changing a psychiatric diagnosis is a reality.&#x0D; AIM. To study the frequency and probability of changing the exposed patient at the age of psychiatric illness when moving under the supervision of a psychiatrist served by a large population.&#x0D; MATERIAL AND METHODS. We analyzed 246 cases of patients who first applied to a psychiatrist in childhood (adolescence), then taken for consultative or dispensary registration. The study was follow-up in nature, was carried out with the help of the analysis of electronic databases of the RCPB. acad. V.M. Bekhterev of the Ministry of Health of the Republic of Tatarstan (Kazan), as well as by studying primary medical documentation (outpatient cards and case histories). The results of the study were processed on the basis of Statistica 6.0 and MS Excel 2020.&#x0D; RESULTS. The main variants of the outcomes of mental disorders diagnosed in childhood of patients are described. It is shown that in more than half of clinical cases the confirmation of a psychiatric diagnosis at an early age is not final, and the issue of further diagnostic search remains unresolved and requires revision. Using the methods of multifactorial statistics, the main transnosological (dimensional) models of algorithms for the development of mental disorders are modeled.

The occurrence of allergic diseases in children with normal weight, excess body weight and obesity: a comparative analysis

Aim to study the prevalence of allergic diseases (AD), excess body weight and obesity in school children and to analyze the correlations between the AD diagnosis and body weight.&#x0D; Material and methods. During the single-stage observational study, 1503 children aged from 7 to 14 years received medical checkup. In all children, we measured anthropometric data, calculated body mass index and standard sigma deviation with the following assessment. The information about the presence of AD was obtained from the primary medical documentation of schoolchildren. Then, we conducted a telephone survey of the parents of the examined children to clarify the data on the presence of allergopathology in them.&#x0D; Results. The prevalence of excess body weight in school-children was 20.9%, obesity 13.5%. The prevalence of atopic dermatitis (AtD) according to the medical record was 6.72%, allergic rhinitis (AR) 6.65%, bronchial asthma (BA) 1.86%. The statistical analysis of mentioned diseases revealed no correlation between the increased body weight and the prevalence of AD both in the general cohort of children, and when stratified by age and gender. The comparative analysis of the telephone survey data on the prevalence of allergopathology in overweight and obese children provided statistically significant results: with the weight gain, the prevalence of the studied allergic diseases was increasing.&#x0D; Conclusion. The results of the study did not reveal a statistically significant positive association between excess body weight, obesity and the presence of AD in the children of the examined group. However, the differences in the prevalence of allergopathology in schoolchildren according to primary medical documentation and the results of a telephone survey of parents indicate the need for a deeper study of the problem and an epidemiological study of the true prevalence of AD in children, followed by an analysis of the association between these conditions.

Women's sexual abuse: forensic-gynecologic expertise experiences.

Women sexual violence as a gynecological, social-criminological and gynecological problem has no declining trend in developing and developed countries, including in Croatia. From my own 23-year forensic-gynecological expertises practice, along with the results of legally completed examples of sexual abuses, as a contribution to this problem, which is also read from other works. Of the cases of sexual abuses (n= 31) with a median age of 37 years, gynecological-forensic expertise proved and confirmed 67.7% of sexual abuses criminal cases with a significant problem of inadequate primary gynecological procedure, most often due to insufficient gynecological examination and medical documentation in high 64.5%, as well as late sexual abuses report in 51.6%. Of all cases of sexual abuses, 6 (19.4%) required primary surgical care due to bleeding and lacerations of the genitals, there were no reported cases of sexual abuses in pregnancy, and no deaths related to sexual abuses. The problems that can affect the forensic-gynecological evaluation of sexual abuses victims are: inadequate and insufficient primary medical documentation immediately after sexual abuses, late reports of sexual abuses, after several days, months and years in the reproductive age of women, with a late primary examination and an almost difficult to prove objective gynecological examination and inadequate education of gynecologists in primary examination. In conclusion, it should be mentioned that the mentioned medical problems can be solved by constant education of all professional medical participants, permanent court experts with experience, coordination and subordination of expert gynecological and forensic societies in cooperation with the state attorney's office, courts and police, and social service.

MEDICAL AND SOCIAL CHARACTERISTICS OF WOMEN WHO CONTRACTED COVID-19 DURING PREGNANCY

Introduction. Pregnant women are at a higher risk of a severe course of the coronavirus infection, including severe acute respiratory syndrome. They were identified as vulnerable groups with recommendations to take additional precautions since the onset of the COVID-19 pandemic.&#x0D; The aim of the study is to investigate the frequency and structure of risk factors for perinatal complications in women who contracted COVID-19 during pregnancy.&#x0D; Materials and methods. Analysis of clinical epidemiological and medical statistical data of the primary medical documentation (390 medical records) was carried out. The findings of 190 women who contracted COVID-19 during pregnancy (main group) were studied. We compared parameters of the test group with respective parameters of 200 women of the control group who did not contract COVID-19 during pregnancy. Age parameters, social status, somatic, reproductive and anamnesis data were investigated. Statistical processing of the results obtained was carried out using the package of application programs "Statistica 7.0" using the Excel 2013 standard package of statistical analysis. Credibility between different groups was examined based on the Pearson χ² test. Differences were considered plausible at a significance level of p&lt;0.05.&#x0D; Results. The findings from the primary medical records of 190 women who contracted COVID-19 during pregnancy in 2021 were analyzed. The study has demonstrated that these women were significantly more often older than 36 years of age compared to the control group, they were significantly more likely to have complicated reproductive anamnesis: 28.4% vs. 10.5%, mainly based on all the parameters studied: spontaneous miscarriages, infertility and stillbirth (р&lt;0.05). Somatic anamnesis in women of the main group was significantly more often burdened: 70.0% vs. 35.5%, p&lt;0.05), due to the significant prevalence of endocrine pathology (14.2% vs. 5.0% in the control group), the cardiovascular disorders (10.0% vs. 4.0%, respectively), the urinary disorders (8.4% vs. 3.0%), and diseases of the respiratory system (18.0% vs. 1.5%) in women of the control group (р&lt;0.05). Conclusion. The results obtained have shown that the risk factors for possible perinatal complications in women who contracted COVID-19 during pregnancy the most likely include the age over 36 years (13.5%), complicated reproductive anamnesis (28.4%), and the presence of somatic diseases (70.0%). Women who have contracted COVID-19 during pregnancy are at risk for obstetric complications.

Вивчення особливостей структури хвороб системи кровообігу, травм і бойових поранень грудної клітки під час воєнного стану

The purpose of the work was to study the frequency of diseases of the cardiovascular system, the frequency and nature of received injuries and combat wounds of the chest in order to ensure the proper quality of the provision of highly qualified medical care of the cardiosurgical profile. Materials and methods. The study included military personnel who took part in combat operations and received injuries and combat wounds of the chest, as well as requiring surgical treatment for diseases of the cardiovascular system. The study was carried out on the basis of the State Institute “Amosov National Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine”. Results and discussion. The article presents the results of the analysis of the primary accounting medical documentation, clinical data, research on the evacuation routes of servicemen with diseases of the cardiovascular system, injuries and combat chest wounds received during hostilities. According to the basics of medical care, all military personnel must be knowledgeable about cardiopulmonary resuscitation, bleeding control, immobilization, dressings, transportation of the wounded and evacuation, communication with other levels of medical care, and be able to fill out reports on accounting for combat wounds and injuries that will accompany soldiers during evacuation to medical facilities. After analyzing in more detail the mechanism of damage/injury to the chest according to the primary medical record documentation, as well as according to the medical card of the outpatient/inpatient patient, it was found that during the provision of specialized cardiosurgical care in 3 cases out of 7, there was a need for the involvement of specialists from other medical specialties. Having specified the clinical cases of combat injuries and wounds of the chest, it was established in which specialists there was a need for consultation and joint surgical intervention: a thoracic surgeon, an orthopedic trauma surgeon, a neurosurgeon, and others. The above determines the expediency of creating multidisciplinary medical teams, approving their work schedule/shifts during martial law. Conclusion. The study has begun on creating a clinical registry of diseases of the circulatory system, injuries and combat wounds of the chest in military personnel and civilians. The main types of injuries and combat wounds of the chest were established, nosological forms of diseases of the circulatory system were clarified. When analyzing the clinical forms of injuries and combat wounds of the chest, the feasibility of creating multidisciplinary medical teams to ensure the proper quality of medical care and increase its efficiency was substantiated

Occupational incidence in the modern socio-economic conditions of Donbass

An analysis of the current state of occupational pathological assistance to the working contingent of industrial enterprises of the Donetsk People's Republic is presented. When analyzing the dynamics of occupational morbidity for the period 2017-2021, it shows a significant increase from 12.3 cases in 2017 to 30.5 cases in 2021 (per 10,000 workers), mainly due to workers in coal mines. Most of all occupational diseases were registered among workers of the main underground professions - miners of a stope (37.5%) and sinkers (23.3%). The observed increase in occupational morbidity is considered from the standpoint of today's specifics of the working conditions of coal mining enterprises in Donbass. First of all, the absence of a leading occupational hazard with simultaneous multifactorial industrial exposure, often exceeding the threshold values of limit values, as well as a change in operating factors and the intensity of their impact during the length of service. Most cases of occupational diseases identified when workers applied for medical help to the Republican Center for Occupational Pathology had pronounced chronic forms of diseases in workers with work experience in harmful production factors of 20-39 years (up to 75%) and over 50 years of age - more than half of all cases (2020 - 52.7%, 2019 - 51.2%, 2018 - 53%, 2017 - 51.8%). At the same time, when analyzing primary medical documentation (originals of outpatient cards, professional examination cards) working in hazardous conditions, it is noted that more than 80% are «healthy». One of the main reasons for the growth of occupational morbidity is the poor quality of medical examinations carried out by general medical institutions, which causes late detection of occupational and work-related pathologies, the development of advanced forms of general somatic diseases that prevent employees from fulfilling their job duties. In the structure of occupational pathology in the DPR, the largest share falls on diseases caused by physical overload - 44.3%; industrial aerosols - 37.1%; physical factors: vibration - 17.2%, noise - 0.7%. It is concluded that all of the above processes are due to a number of interrelated reasons - a change in the socio-economic situation caused the economic instability of coal enterprises, which led to worsening working conditions, a reduction in the number of employees, an increase in intensive appeals to the Republican Center for Occupational Pathology in order to resolve the issue of the relationship of morbidity with the profession, and , consequently, the solution of social problems through compensation for damage to health.

Механическая травма почки – что упускают урологи в медицинской документации

The article provides a brief description of the main terms and concepts of kidney damage used in forensic medicine and urology, with a list of requirements for the description and formation of a clinical diagnosis when maintaining primary medical documentation. The importance of a unified approach in objective interpretation in the expert assessment of kidney injuries is substantiated.

The role and place of the FRAX calculator in initiation osteoporosis treatment: an analysis of the osteoporosis center registry

Background:The growing frequency of fractures associated with osteoporosis, the significant costs of their treatment, disability and increased mortality make it an important and urgent task to optimize the diagnosis and treatment of osteoporosis in the Russian Federation.Aim: The aim of this study was analyzed of using modern diagnostic criteria for osteoporosis by specialists when they making a clinical decision to initiate treatment for osteoporosis, including an estimate of the 10-year probability of fractures according to FRAX.Materials and methods: The study was conducted in the city consultative and diagnostic center for the prevention of osteoporosis, St. Petersburg. The register of the osteoporosis center for 2018–2021 was used to select patients for the study. Based on the analysis of registry data, a sample of 362 patients with newly diagnosed osteoporosis was obtained. In the resulting sample, the existing FRAX value was assessed on the therapeutic intervention threshold graph, all of them analyzed the primary medical documentation, as well as the available DXA densitometry data.Results: In this study, we assessed the place of FRAX 10-year risk of major osteoporotic fractures in the clinical decision of an osteoporosis specialist to start anti-osteoporosis therapy, in this case taken as the «gold standard». The study found that a positive FRAX score had a high predictive value of 100%. In contrast, the negative predictive value was very low (19.5%): a FRAX value below the intervention threshold did not guarantee a truly low fracture risk and no need to start osteoporosis treatment.Conclusion: Despite the fact that both densitometry and FRAX have significant limitations in use, and cannot identify all patients with a high risk of fractures, their combined use increases the prognostic value of the methods. FRAX technology in routine practice allows, in addition to clinical and instrumental methods for diagnosing high-risk fractures, to identify candidates for the treatment of osteoporosis, and should be used in accordance with clinical recommendations.

Analysis of long-term results of operative treatment of pathologically thickened mediopathellar synovial knee fold

BACKGROUND: The mediopatellar synovial fold (MPSF) of the knee joint is normally a thin and elastic structure, but under the influence of various factors, the MPSF thickens and turns into a fibrous cord, which injures nearby structures and clinically manifests with pain. One of the effective methods of treating MPSF in pediatric patients is an arthroscopic excision of the fold. AIM: Evaluation of long-term results of arthroscopic treatment of patients with pathologically thickened MPSF of the knee joint. MATERIALS AND METHODS: There was conducted an analysis of primary medical documentation, which included the study of hospital records and case histories of 73 patients. The survey questionnaires (based on VAS and WOMAC scales) were sent to these patients. Responses were received from 35 patients who were included in the study. RESULTS: When evaluating the long-term results of surgical intervention in 35 operated patients in 29 (82.1%) patients, it was found out that there were no exacerbations in postoperative period and, at the time of the data collecting, there weer no complaints for the pain syndrome. Dysplasia of the femoral condyle of type A and B was diagnosed in these patients. At the time of the evaluation, 6 (18.9%) patients had pain syndrome with decreased function of the knee joint. In these patients, dysplasia of the femoral condyle corresponded to type C in 4 cases, types D and B in 1 case. CONCLUSION: At the early stages of the disease, it is necessary to carry out a detailed differential diagnosis to identify the pathology of the knee joint. Attention should be paid to the combination of a pathologically thickened MPSS with dysplasia of the femoral condyle, which can lead not only to complications of conservative therapy and ineffectiveness of surgery, but also to the development of patellofemoral arthrosis.

Predictive value of the clinical scale for assessment of premature newborns during pre-transport preparation of newborns

Purpose. This study is aimed at determining the predictive value of the clinical assessment scale for premature newborns during pre-transport preparation in relation to the outcomes of treatment of newborns.Materials and methods. The cohort study included data from 604 visits of the neonatal transport team to the newborn children hospitalized in the medical centers of the Sverdlovsk region from August 1, 2017, to December 31, 2018. Median birth weight [IQR] 2515 [1600; 3275] grams, median gestational age [IQR] 36 [32; 38] weeks. Primary medical documentation was used for scale assessment. Descriptive statistics tools: median and interquartile range, fraction, 95% CI for the proportion, error of the proportion, calculation of the area under the ROC curve, calculation of sensitivity, specificity, cut-off level, positive (PPV) and negative predictive value (NPV). The correlation analysis of quantitative data with an abnormal distribution is performed by Spearman’s test.Results. The scale demonstrated a high predictive value for lethal outcome (AUC = 0.803 (0.734–0.872)), 7-day mortality (AUC = 0.821 (0.743–0.899)), late neonatal sepsis (AUC = 0.763 (0.697–0.830)), severe intraventricular hemorrhage (AUC = 0.784 (0.729–0.838)), and occlusive hydrocephalus (AUC = 0.802 (0.725–0.878)) in the total sample of newborns (fullterm and premature). The negative predictive value significantly prevails over the positive predictive value. Weak correlations were found between the score and the duration of intensive care (r = 0.305, p &lt; 0.0001), duration of ventilation (r = 0.221, p &gt;&lt; 0.0001), duration of nCPAP (r = 0.214, p = 0.001), and hospitalization (r = 0.214, p &gt;&lt; 0.0001), both in the general sample and among the survivors. Conclusion. The scale has a high predictive value in relation to the outcomes of the hospital stage in newborns, but a weak correlation with quantitative outcomes. Key words: Newborns, interhospital transportation of newborns, neonatal transfer, severity assessment, tactical decision.&gt;˂ 0.0001), duration of ventilation (r = 0.221, p ˂ 0.0001), duration of nCPAP (r = 0.214, p = 0.001), and hospitalization (r = 0.214, p ˂ 0.0001), both in the general sample and among the survivors.Conclusion. The scale has a high predictive value in relation to the outcomes of the hospital stage in newborns, but a weak correlation with quantitative outcomes.

Клинический случай развития стероидной офтальмогипертензии на фоне перорального приема метилпреднизолона у пациента с системной красной волчанкой

The purpose of the work is to evaluate the dynamics of development and clinical course of secondary steroid ophthalmohypertension in a patient with systemic lupus erythematosus. Material and methods. We analyzed the primary medical documentation. In the following, we described this clinical case. Results and conclusions. The patient did not notice any positive dynamics during 2 months of conservative treatment of chronic blepharitis against the background of instillations of Dexamethasone 0.1% in both eyes. In addition, the patient was taking oral methylprednisolone for the treatment of systemic lupus erythematosus. At the initial appointment with an ophthalmologist, an increase in IOP was detected, and the diagnosis was made: allergic blepharitis, chalazions of the upper eyelid of both eyes, steroid ophthalmohypertension. Blepharitis treatment was prescribed, as well as hypotensive drops in both eyes. The patient came to our clinic 1.5 months after the start of treatment, without positive dynamics and with a persistently high level of IOP. Appropriate treatment was prescribed and all necessary methods of additional diagnostics were carried out. Conclusions. This clinical case is of interest to practitioners, as it reflects a multidisciplinary approach to the treatment and management of patients with rheumatological pathology requiring steroid medications. Keywords: steroid ophthalmohypertension, glaucoma, steroid glaucoma, systemic lupus erythematosus, glucocorticosteroids