Results Of Medical Examinations Research Articles

Clinical Outcomes and Early Postoperative Complications in Boston Type I Keratoprosthesis Implantation: A Retrospective Study

Background/Objectives: The purpose of this study is to evaluate clinical outcomes and early postoperative complications in patients undergoing Boston type I keratoprosthesis (BKPro) implantation, with a specific focus on the onset and nature of ocular surface disorders during the early postoperative period. Methods: This retrospective study included 77 eyes that underwent BKPro implantation between 2019 and March 2022. Patients were treated at the Saint Barbara Hospital, Trauma Centre, Sosnowiec, Poland, and District Railway Hospital, Katowice, Poland. Data were collected from medical records, including patient demographics, medical history, surgical outcomes, postoperative visual acuity, and complications. The analysis incorporated both detailed medical history and direct clinical examination results. Results: The most common early postoperative complication was glaucoma, affecting 32 eyes (42%). Retroprosthetic membrane formation occurred in 20 eyes (26%), while partial extrusion of the BKPro was observed in 10 eyes (13%). Severe corneal surface damage was noted in patients with underlying autoimmune diseases (36%) and after chemical burns (24%). Five patients suffered from transient hypotony resulting from keratoprosthesis extrusion. The results highlight the complex nature of managing ocular surface conditions and the frequent challenges associated with early postoperative complications. Conclusions: BKPro implantation is an effective solution for severe corneal diseases that are resistant to conventional treatments. However, it is associated with a significant risk of early complications, particularly glaucoma and retroprosthetic membrane formation. Early identification and management of these complications are crucial for improving outcomes and maintaining visual function. Further research into optimizing postoperative care is needed to minimize these risks and enhance patient outcomes.

Some features of forensic medical assessment of punch-cut skin injuries caused by a tourist knife

Injuries from tourist and hunting knives are rare in forensic practice. The design of the blades of tourist and hunting knives have a significant impact on the morphological picture of stab wounds, which can cause difficulties to experts in resolving some issues. At the time of the forensic examination of the corpse, the expert established that the man at home had been stabbed twice in the chest and stomach with one knife. Medical and forensic study showed that the wound on the chest was caused by a flat piercing-cutting instrument such as a knife, the blade of which in its mark-forming parts had a tip, one cutting blade, and a U-shaped butt in cross-section with clearly defined ribs, and the wound on the stomach was caused by a flat piercing-cutting weapon, the blade of which in its mark-forming parts had a tip and two cutting blades. Thus, the wounds were caused by different knives. However, after the investigator provided the probable instrument of injury (a tourist knife), it became clear that both injuries may have been caused by the same object. The present case shows that in the absence of information about the traumatic stabbing and cutting object and use of only the data of forensic medical examination of the corpse and results of medical and forensic examination of the morphology of skin wounds, erroneous judgments are possible. Therefore, caution should be exercised when considering the possibility of wounding by one or more knives.

Using mathematical models in the assessment of the circulatory system in employees working under harmful occupational conditions

Introduction. According to the results of medical examinations of metallurgists, in the structure of newly identified somatic morbidity, circulatory system diseases (CSD) are one of the leading pathologies. To assess the prevalence of CSD in workers in harmful working conditions, it is possible to use various mathematical solutions as a tool. The objective of the study was to substantiate the possibility of using variance analysis and classification tree (CT) methods to assess the prevalence of circulatory diseases in industrial workers. Materials and methods. Data of medical examinations and a questionnaire-based survey of three hundred eight workers of steel production were input into a database. The interrelationship between CSD and individual and occupational risk factors was examined using a one- and two-way ANOVA. The classification tree method was used for a multivariate analysis. Results. The one- and two-way ANOVA revealed a statistically significant correlation between the CSD family history (p=0.001) and age, years of occupational exposure, overweight, blood glucose level, total cholesterol (p<0.05) and the CSD prevalence in the steel workers. We applied the classification tree method to make decisions on referring the subjects to potentially “healthy” and “sick” workers by determining the CSD prevalence in relation to various combinations of risk factors. Limitations. This study is limited to the results of medical examinations of the workers collected over a one-year period. Conclusions. Our experience in using the analysis of variance and classification tree to evaluate the CSD prevalence in ferrous industry employees allows recommending them for use in assessing the prevalence of various diseases in workers exposed to occupational hazards.

Enhancing the Accuracy of Peripheral Pulmonary Tuberculosis Diagnosis: A Comparative Evaluation of CapitalBioTM Mycobacterium Nucleic Acid Detection Test and Mycobacterium tuberculosis Isothermal RNA Amplification Assay Using Endobronchial Ultrasonography with Guide Sheath.

The diagnosis of tuberculosis located in the peripheral zone remains challenging and requires ultrasound bronchoscopy-guided maneuvers. We assessed the precision of CapitalBioTM Mycobacterium nucleic acid detection test (CapitalBio MTB test) and Mycobacterium tuberculosis isothermal RNA amplification test (MTB-RNA) using endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary tuberculosis (PTB) and compared it with those of acid-fast bacilli (AFB) smear and MTB culture tests. This retrospective analysis included 287 patients suspected of peripheral pulmonary tuberculosis who underwent EBUS-GS examinations, medical examination results of AFB smears, MTB culture, CapitalBio MTB test, and MTB-RNA were analyzed. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC), and its diagnostic accuracy for peripheral PTB was evaluated in comparison with the final clinical diagnosis. The overall sensitivity, specificity, PPV, NPV, and AUC of CapitalBio MTB test were 44.83%, 100.00%, 100.00%, 54.07%, and 0.72, respectively; those of MTB-RNA were 22.99%, 100.00%, 100.00%, 45.75%, and 0.61, respectively, and those for parallel test (CapitalBio MTB test or MTB-RNA) were 46.55%, 100.00%, 100.00%, 54.85%, and 0.73, respectively. These values for AFB smear were 9.2%, 97.35%, 84.21%, 41.04%, and 0.53, respectively, and those of MTB culture were 31.03%, 100.00%, 100.00%, 48.50%, and 0.69, respectively. The CapitalBio MTB test showed the best diagnostic performance compared with AFB smear, MTB culture, and MTB-RNA assays and was similar to the parallel test (CapitalBio MTB test or MTB-RNA). The CapitalBio MTB test combined with EBUS-GS had satisfactory diagnostic accuracy for diagnosing peripheral PTB.

Study on risk factors of impaired fasting glucose and development of a prediction model based on Extreme Gradient Boosting algorithm.

The aim of this study was to develop and validate a machine learning-based model to predict the development of impaired fasting glucose (IFG) in middle-aged and older elderly people over a 5-year period using data from a cohort study. This study was a retrospective cohort study. The study population was 1855 participants who underwent consecutive physical examinations at the First Affiliated Hospital of Soochow University between 2018 and 2022.The dataset included medical history, physical examination, and biochemical index test results. The cohort was randomly divided into a training dataset and a validation dataset in a ratio of 8:2. The machine learning algorithms used in this study include Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), Naive Bayes, Decision Trees (DT), and traditional Logistic Regression (LR). Feature selection, parameter optimization, and model construction were performed in the training set, while the validation set was used to evaluate the predictive performance of the models. The performance of these models is evaluated by an area under the receiver operating characteristic (ROC) curves (AUC), calibration curves and decision curve analysis (DCA). To interpret the best-performing model, the Shapley Additive exPlanation (SHAP) Plots was used in this study. The training/validation dataset consists of 1,855 individuals from the First Affiliated Hospital of Soochow University, yielded significant variables following selection by the Boruta algorithm and logistic multivariate regression analysis. These significant variables included systolic blood pressure (SBP), fatty liver, waist circumference (WC) and serum creatinine (Scr). The XGBoost model outperformed the other models, demonstrating an AUC of 0.7391 in the validation set. The XGBoost model was composed of SBP, fatty liver, WC and Scr may assist doctors with the early identification of IFG in middle-aged and elderly people.

Working conditions and health status in workers in boiler and welding production in power engineering

Introduction. Preserving the health of qualified workers of older age groups is especially important under conditions of exposure to occupational hazards. The purpose of the study was to assess the influence of occupational hazards on the development of occupational and somatic diseases among workers of various age groups in the main occupations of mechanical engineering. Materials and methods. The study tested the results of hygienic research at workplaces of an enterprise in the power engineering industry in the manufacture of welded metal structures. We assessed the health status in workers based on the results of an in-depth medical examination and ultrasound examination of the vessels of the upper extremities with assessment of blood flow indices. Using a survey method, data were obtained on assessing the influence of production factors on the health status in workers. Results. The working conditions in the main occupational workers groups were assessed as harmful grades 1–3, the priority occupational hazards were: increased noise, and at the workplaces of electric gas workers there were also fibrogenic aerosols, chemical substances, and heavy physical work. Electric and gas welders and boilermakers work in the most unfavourable conditions, about 30% of whom continue to work after reaching retirement age. We have established a significant gain in the incidence of arterial hypertension and sensorineural hearing loss among workers over 40 years of age and an increase in the prevalence of all chronic diseases in the age group over 60 years. Limitations. The study is limited by the number of workers examined and the lack of ability to assess the health status of the studied contingent of workers over time. Conclusion. In conditions of exposure to elevated noise and other occupational hazards, there is an enhancement in the prevalence of work-related and somatic diseases in workers over 40 years of age. With advancing age, the rise in the vascular resistance index is observed, however, the first signs of peripheral blood flow disturbance are often recorded at a young age. In this regard, it is necessary to introduce methods of early diagnosis and prevention of occupational and work-related pathology.

Bilateral internal carotid artery agenesis coexisting with bovine aortic arch: case report and literature review.

This case study aims to elucidate the rare occurrence of bilateral internal carotid artery agenesis combined with a bovine aortic arch. The main objectives are to explore the incidence, embryological origins, clinical manifestations, and associated anomalies of this unique vascular condition. The study involves a detailed investigation of a 55-year-old male with a history of recurrent transient ischemic attacks (TIAs) using MRI and CT scan. The patient's medical history, clinical examination, and imaging results were systematically analyzed to provide a thorough understanding of the anatomical variations. The main findings include the rare coexistence of bilateral ICA agenesis and a bovine aortic arch, making this the 39th documented occurrence of bilateral ICA agenesis and the first recorded instance of its association with a bovine aortic arch. Also, the study highlighted the demographic characteristics, clinical presentations, and associated anomalies observed in the 38 documented cases of bilateral internal carotid artery agenesis. This case report contributes valuable insights into the rarity of bilateral internal carotid artery agenesis and its unprecedented association with a bovine aortic arch. The findings emphasize the importance of heightened anatomical awareness in clinical practice, particularly. Recognizing and understanding such variations is crucial for accurate diagnosis, appropriate management, and improved patient outcomes. Further research in this area is warranted to deepen our understanding of these complex vascular anomalies.

Peculiarities of commissions of forensic medical examinations in criminal cases related to crimes against sexual inviolability

The investigation of criminal cases related to sex crimes determines the range of circumstances to be immediately proved during investigations. Issues arising in the process of conducting such cases must be resolved as part of forensic medical examinations. Illegal acts of a sexual nature generally end in the violation of human health, not only physical with bodily harm but also psychological. During such examinations, specialists of various clinical specialties are included in the composition of expert commissions. These are specialists in the fields of obstetrics-gynecology, venereology, traumatology, psychiatry, and clinical psychology. During investigation and trial, important information can be provided by medical documents on the state of health of the victim, including the testimony of medical workers. Not only forensic medical experts who conducted examinations but also medical workers are called to court hearings as witnesses to incidents. This article analyzed the commissions of forensic medical examinations in a teenager harmed by violent sexual acts. The results of forensic medical examinations were analyzed. This article provides an expert observation of a victim of crimes against sexual inviolability that led to severe complications. During the investigation, the development of a mental disorder in the teenager was examined, and a forensic medical examination was performed. Psychological injuries are no less serious than physical ones. The body’s response to stress causes a pathological state of the psyche. Such a painful reaction can persist for many years. A prolonged depressive reaction due to an adaptation disorder arose in the victim after the unlawful actions committed against her with a direct causal relationship. When conducting forensic medical examinations related to illegal acts of a sexual nature, specialists in the fields of gynecology, traumatology, venereology, psychiatry, and clinical psychology must take part in the examinations.

Investigation of a focus of brucellosis among animals and people in the Republic of Tatarstan

Over the past 3 years, the number of new cases of brucellosis has increased in the Russian Federation. Brucellosis remains an important problem in regions with developed livestock farming; however, cases of diseases in animals and humans can also be recorded in other regions. The article describes an outbreak of brucellosis in a peasant farm affecting 148 heads of cattle and 4 farm employees in the Novosheshminsky municipal district of the Republic of Tatarstan. The disease was caused by Brucella abortus. Epizootic and epidemiological maps of the outbreak, sanitary and epidemiological survey activities, and sanitary and hygienic characteristics of the working conditions were analyzed. Data from the case histories of four peasant farm workers with brucellosis are also presented. The most likely cause of the epizootic was the unauthorized import of cattle, and infections in humans were caused by noncompliance with working conditions and personal-protective measures by farm workers. Brucellosis cases are more often recorded in endemic areas. However, with poor veterinary and sanitary control in any territory, epizootics are possible, which pose a danger in terms of damage to the national economy and possible infection in humans, primarily the professional risk groups. The disease does not have pathognomonic symptoms and can be suspected only if doctors are aware of them, evaluate the results of preliminary and periodic medical examinations with laboratory examinations of “at-risk” populations, and subject them to a thorough collection of epidemiological history.

Clinical Characteristics of Patients with Cryptococcal Meningitis in Hokkaido: A Case Series.

We retrospectively reviewed the medical histories, examination results, treatments, and prognoses of nine patients with cryptococcal meningitis who were diagnosed and treated at Hokkaido University Hospital and its affiliated hospitals over the past 10 years. Cryptococcal meningitis can develop even in immunocompetent hosts, and its prognosis is poor owing to diagnostic difficulties and delayed treatment. Although liposomal amphotericin B and oral 5-fluorocytosine are standard therapies, voriconazole or intraventricular administration of amphotericin B may also be considered treatment options for refractory patients. Some patients develop delayed exacerbations owing to immunological mechanisms that require steroid therapy.

On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma

Introduction According to domestic and foreign authors, the leading cause of death in victims with polytrauma is blood loss. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the new promising ways to manage bleeding in patients in a state of traumatic shock. There are a large number of publications in the world scientific literature indicating the high effectiveness of this technology in the treatment of bleeding. However, in the Russian Federation, this method has not yet entered into everyday practice, and scientific research on this matter is scarce. AIM Based on literature data and analysis of our own sample, to justify the need to use REBOA technology for the treatment of victims with polytrauma.Material and methods A retrospective analysis of the medical records of patients with polytrauma admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021 was carried out. Data from medical records and the Results of forensic medical examinations were studied. The main sample included victims with polytrauma (Injury Severity Score, ISS, of more than 17 points) delivered from the scene of the incident in a state of traumatic shock (systolic blood pressure, SBP, of less than 90 mm Hg) and a verified source of bleeding. To assess the potential survival of victims, we used the Trauma Score and Injury Severity Score (TRISS) scale.Results Of the 92 patients with polytrauma, 19 patients (20.6%) had indications for REBOA. The most common sources of bleeding were injuries to the pelvic ring, 14 (73.7%), abdomen, 11 (57.9%), and chest, 7 (36.8%). In 6 victims (31.5%), there were combined abdomen and pelvic injuries as the area of blood loss. The mean age of the victims was 48.8±19.9 years, the mean ISS value was 39.4±20.1. On admission, the mean SBP was 62.4±31.5 mm Hg, and heart rate — 91.8±43.3 beats/min. In 8 victims (42.1%), norepinephrine was administered immediately upon hospitalization at an average dose of 837.5±537.0 ng/kg/min. As a result of their injuries, 15 patients (78.9%) died, and 4 were discharged from the hospital. According to the Conclusions of forensic experts, the leading cause of death was blood loss in 11 (61.1%), severe traumatic brain injury (TBI) in 4 (22.2%), and infectious complications in 3 cases (16.7%).The TRISS was calculated for each patient. In order to identify the most potentially viable patients with indications for REBOA, we excluded 5 patients with severe TBI (the mean TRISS was 20.9±11.1%), and 5 patients with the TRISS of less than 50% (the mean TRISS was 10.0±14.1%), the latter died from hemorrhagic shock. Among the remaining 9 patients with higher TRISS values, 5 (26.3%) who died had the mean TRISS of 80.5±15.8%, comparable to the mean TRISS of 83.3±2.4% in the 4 survivors.Conclusion 1. According to foreign and domestic publications, the technology of resuscitation endovascular balloon occlusion of the aorta (REBOA) is effective for stopping internal bleeding in patients with polytrauma. 2. When analyzing our own sample of patients, it was proven that 20.6% of patients with polytrauma had indications for the use of REBOA. Most of them (78.9%) died. The main cause of death was hemorrhagic shock. 3. About a quarter of patients (26.3%) with indications for REBOA had a potentially high chance of survival. In the future, the use of this technology may reduce the number of deaths.

Structure of circulatory system diseases and their genetic predictors in athletes with high intensity of training and competitive load

Introduction: Morphofunctional changes of the circulatory system organs detected in athletes may remain without due attention, as clinical (phenotypic) signs of pathological abnormalities are very similar to manifestations of cardiovascular system adaptation to intensive physical loads. The aim of the study is to propose a personalized algorithm for biomedical support of professional athletes with abnormalities and diseases of the circulatory organs based on clinical and genomic data.Materials and methods: The results of in-depth medical examination (2021-2023) of 15,464 athletes who are members of Russian sports teams were analyzed. The structure of circulatory system diseases according to the codes of the International Classification of Diseases, 10th revision (ICD-10), which were included in the summary report of the last examination, was analyzed. Fifty athletes with abnormalities and diseases of the circulatory system organs, experiencing different degrees of intensity of dynamic and static loads in accordance with the Mitchell classification, were selected from the study sample for full genome sequencing and subsequent clinical interpretation of the obtained data.Results: In the study sample the number of people with pathologic conditions of the circulatory system organs amounted to 6 946 people (45 %). Mitchell classification groups had statistically significant differences with respect to the prevalence of 10 diseases of the circulatory system organs. In 50 DNA samples of professional athletes, 5 probably pathogenic variants (10%), 19 variants with uncertain clinical significance (38%), relevant to the phenotype of a monogenic disease with circulatory system organ damage, were detected.Conclusion: Molecular genetic testing is an effective tool for differential diagnostics of pathologic and adaptive changes in the organs of the circulatory system. Carrying causative genes in combination with clinical signs allows to change the tactics of medical and biological support of an athlete according to the proposed algorithm.

Health Symptoms Affecting the Marriage Contract Between Pay and Lift

The research, titled (Health symptoms affecting the marriage contract between payment and withdrawal), aims to participate in developing appropriate solutions to reduce the rates of divorce and annulments that are growing day after day. The research relied on the inductive and analytical approach to the texts of jurists and examined their meanings and objectives. To achieve the objectives of this study. The research included an introduction, two sections, and a conclusion. The first section, Pictures of jurists’ attention to health symptoms affecting the marriage contract, contains two requirements. The second topic is the guardian’s right to organize a healthy marriage contract and its legal and theoretical supports, and it contains three demands. The researcher concluded that the health symptoms that require annulment between spouses are not limited to specific descriptions but rather everything that prevents enjoyment, causes alienation, reduces it, or affects the regularity of marital life, such as psychological illnesses, which are left to the discretion of the judge. He also concluded that a legal document was drawn up that gives the guardian the right to expand the conduct of medical examinations as needed and for the benefit of the public, provided that the contracting parties are not obligated to perform the results of the examinations and that they are left free to sign the marriage contract or withdraw from it. Thus, it is known that the medical examination before marriage is not a condition for the validity of the marriage contract but rather a condition for its legal documentation. Among the most important recommendations were health authorities continuing to raise awareness and educate the community about the necessity of adhering to the results of medical examinations that have health consequences for the individual, the family, and society, and the attention of the media and mosque preachers to spread awareness among people by disclosing the spouses’ faults before the marriage contract; To avoid or reduce division after the contract, and to urge universities to conduct studies to evaluate the results of the medical examination system, its positive or negative effects, and the means of treating them, through scientific dissertations, or scientific promotion research for faculty members.

Medical education in Syria at a time of crisis: Analysis of the results of the knowledge-based National Medical Examination.

This study explored how the Syrian crisis, training conditions, and relocation influenced the National Medical Examination (NME) scores of final-year medical students. Results of the NME were used to denote the performance of final-year medical students between 2014 and 2021. The NME is a mandatory standardised test that measures the knowledge and competence of students in various clinical subjects. We categorised the data into two periods: period-I (2014-2018) and period-II (2019-2021). Period-I represents students who trained under hostile circumstances, which refer to the devastating effects of a decade-long Syrian crisis. Period-II represents post-hostilities phase, which is marked by a deepening economic crisis. Collected data included test scores for a total of 18 312 final-year medical students from nine medical schools (from six public and three private universities). NME scores improved significantly in period-II compared with period-I tests (p< 0.0001). Campus location or relocation during the crisis affected the results significantly, with higher scores from students of medical schools located in lower-risk regions compared with those from medical schools located in high-risk regions (p< 0.0001), both during and in the post-hostilities phases. Also, students of medical schools re-located to lesser-risk regions scored significantly less than those of medical schools located in high-risk regions (p< 0.0001), but their scores remained inferior to that of students of medical schools that were originally located in lower-risk regions (p< 0.0001). Academic performance of final year medical students can be adversely affected by crises and conflicts, with a clear tendency to recovery upon crises resolution. The study underscores the importance of maintaining and safeguarding the infrastructure of educational institutions, especially during times of crisis. Governments and educational authorities should prioritise resource allocation to ensure that medical schools have access to essential services, learning resources, and teaching personnel.

The influence of production factors on the formation of the health of workers in the production of synthetic rubbers, preventive measures

The petrochemical industry, which includes, along with the production of basic chemicals for the production of rubber, occupies one of the leading places in terms of potential chemical hazards to the health of workers. The high prevalence of CNID among workers of petrochemical industries is an important socio-economic problem. The issues of reducing the incidence of chronic non-communicable diseases, including those related to working conditions, the protection and preservation of the health of workers in petrochemical industries dictate the need to develop preventive measures. The aim of the study was to study the prevalence of chronic non-communicable diseases in synthetic rubber production workers. Clinical and hygienic studies have been carried out in the production of synthetic rubber. Harmful production factors were assessed at 80 workplaces based on the materials of a special assessment of working conditions and production control data. The health status of 674 employees was studied according to the results of periodic medical examinations. The surveyed workers were represented by apparatchiks (33.2 %), locksmiths for the repair of technological equipment (12.8 %), machinists of pumping and compressor units (10.7 %), locksmiths of KIP and A (9.1 %). A number of clinical and laboratory, functional research methods have been used to assess the state of health. At the workplaces of the production of synthetic rubber, an adverse effect of chemicals on the worker’s body in combination with industrial noise, the severity of labor and microclimate in certain working areas has been established. The working conditions of employees of the main professions are assigned to the third class of the first-second degrees of harmfulness (classes 3.1–3.2). It was found that there were 17.3 % of practically healthy individuals. Among the identified chronic non-communicable diseases, the leading place was occupied by diseases of the musculoskeletal system (31.1 %), disorders of the autonomic nervous system (28.7 %), myopia (22.0 %), hypertension (12.2 %) hearing impairment (10.3 %). When evaluating the results of biochemical blood tests, the most pronounced changes were found in the indicators of lipid metabolism. Excess values of total cholesterol were detected in 40.9 % of employees. A complex of therapeutic and preventive measures has been developed aimed at reducing the risk of the formation of chronic non-communicable diseases, including measures of primary and secondary prevention.

The Use of Digital Personal Health Records (PHR) in Occupational Health.

The exact definition of a personal health record (PHR) is not clear, but it is generally defined as an electronic record of an individual's medical examination results and medication history that can be accurately tracked by the individual and family members. There are many opportunities to obtain personal PHR data in the field of occupational health, and the amount of information in a worker's PHR is enormous. It is necessary in this field to comprehensively integrate and accumulate not only information from medical examinations, but also records of the work environment and work records as personal health information.

УЧАСТИЕ СПЕЦИАЛИСТА ПО ОКАЗАНИЮ МЕДИЦИНСКОЙ ПОМОЩИ НЕСОВЕРШЕННОЛЕТНИМ ОБУЧАЮЩИМСЯ В ФОРМИРОВАНИИ ЗДОРОВЬЕСБЕРЕГАЮЩЕЙ СРЕДЫ ОБЩЕОБРАЗОВАТЕЛЬНОЙ ОРГАНИЗАЦИИ (НА ПРИМЕРЕ СКРИНИНГА И ПРОФИЛАКТИКИ ПЛОСКОСТОПИЯ)

One of the important tasks of medicine, education, state and municipal authorities is to protect the health of children and adolescents - students of general education institutions. The deterioration of indicators characterizing the health status of schoolchildren requires improving the organization of medical and preventive care for students, creating a favorable and safe environment for their harmonious growth and development. The results of ongoing preventive medical examinations show that functional deviations and chronic diseases of the musculoskeletal system (impaired posture, flat feet) have moved to the first ranking place. The purpose of this study was to improve the work on creating a health-preserving environment with the participation of a specialist in providing medical care to minor students (using the example of screening and prevention of flat feet) in a general education organization. To conduct the study, theoretical (analysis of reporting documentation) and experimental (observation, plantography) methods were used. The study was approved by the local ethics committee of the Kazan State Medical University (protocol №8 of October 18, 2022) and was conducted on the basis of two schools in Kazan in November-December 2023. The survey involved 383 children (whose parents signed voluntary informed consent) aged 8-12 years, of which: 257 girls and 126 boys. Statistical processing was carried out in the Microsoft Excel application package. Processing of the results included the calculation of average values and the proportion of the characteristic (%). When comparing the reliability of differences in proportions (p) of signs, Fisher's test with φ-transformation was used. The results obtained showed a high prevalence of morphofunctional foot disorders in first-graders. To improve the work of a general education organization in creating a health-preserving environment and preventing diseases (using the example of preventing flat feet), a work scheme for a specialist in providing medical care to minor students is proposed.

Assessment of specificity of immunologic tests for detection of tuberculosis infection in children with juvenile idiopathic arthritis

Introduction. The use of genetic engineering biological agents (GEBA) in the treatment of rheumatic diseases over the past decades has led to a significant improvement in the prognosis in this group of patients. However, against the background of anti-tumor necrosis factor α therapy (anti TNF-α), the risk of developing tuberculosis increases tenfold.Aim. To evaluate the specificity and safety of Mantoux test, recombinant tuberculosis allergen (RTA) test, IGRA tests: TB-Feron IGRA, T-SPOT.TB, QuantiFERON-TB GIT in patients from 5 to 18 years of age, who are at risk for the development of tuberculosis, due to the use of immunosuppressive therapy, including GEBP.Materials and methods. This clinical trial is a prospective single-center open-label study with 120 patients under observation. Girls predominated among the patients – 71 (59.2%), the average age was 12 years (95% CI [5.2–17.4]). As part of the treatment of the underlying disease, patients in the vast majority of cases (78.3%) received iFNO-α drugs: etanercept (67 people), adalimumab (25 people), golimumab (2 people).Results and discussion. According to the results of a comprehensive medical examination, including CT scan of the chest organs, the presence of active tuberculosis was not established in any of the patients. A positive result of the RTA sample was registered in 0.8% of the subjects, Mantoux test in 46.6%, T-SPOT.TB – 1.7%, TB-Feron IGRA and QuantiFERON-TB GIT – 0.8% each. During the safety assessment, it was noted that within 28 days after the study, none of the 120 patients had any adverse events. Patients need appropriate screening before starting treatment and regular follow-up examinations.Conclusions. The Mantoux test with 2 TE has low specificity (0.49), and the sample with RTA (0.99), TB-Feron IGRA (0.99), T-SPOT.TB (0.98) and QuantiFERON-TB GIT (0.99) are highly specific and safe as tests for detecting tuberculosis infection in children with juvenile idiopathic arthritis.

Анализ изменений структуры насильственной смерти детей и подростков в Саратовской области за период 2018–2022 гг.

Abstract. The analysis of violent child mortality is important in developing preventive measures to reduce this indicator. Aims and Tasks. The research purpose is to analyze the structure of violent death among children in the Saratov Region in 2018–2022. Materials and Methods. The research materials include the results of forensic medical examinations of the corpses of 314 children under the age of 18 who died from external causes. Results/Discussion. We establish decrease in the rate of violent death among children from 17.7 to 12.2 per 100 thousand of the population. There is a prevalence of blunt trauma (35.7 %), asphyxia (34.7 %) and poisoning (22 %) in violent death causes among children. The dynamics showed a tendency towards an increase in the proportion of blunt trauma. We note the peak of deaths from asphyxia in 2020 (45.8 %), reveal an increase in the proportion of hangings. Asphyxia is the leading cause of death in children under 1 year old, asphyxia and blunt trauma with a high percentage of falls from high altitude (40 %) – in the 1–3 year old group. In the 4–6 years old group the main types of death are blunt trauma (38.6 %) and poisoning (36.4 %). In the 7–11 years old group asphyxia is in the lead (40.4 %), followed by blunt trauma (36.5 %) with a high percentage of traffic accidents. In 12–17 years old group blunt trauma is in the first place (38.5 %), asphyxia with a predominance of hangings is in the second place. Conclusions. As we note a decrease in the violent death of children in general, we establish a tendency of increasing the proportion of blunt trauma and a change in the structure of asphyxia with a significant increase in the proportion of hangings. Differences in the structure of causes of death in different age groups were revealed.

ПРОФИЛАКТИЧЕСКИЕ МЕРОПРИЯТИЯ НА ОСНОВЕ ОЦЕНКИ РИСКА РАЗВИТИЯ ЗАБОЛЕВАНИЙ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У РАБОТНИКОВ МЕТАЛЛУРГИЧЕСКОГО ПРОИЗВОДСТВА

Significance. The conducted studies are devoted to the analysis of the factors of disease development and prevention of major non-communicable diseases, the most common of which are cardiovascular diseases. The relevance of this work is determined by the possibility and need for timely identification of pre-pathological and pathological conditions, in order to develop optimal schemes of preventive measures to preserve professional longevity of workers. The purpose of the study was to develop a program of preventive measures based on the risk assessment of cardiovascular diseases in workers of metallurgical production, exposed to a complex of occupational risk factors. Material and methods. Results of periodic medical examination of workers of certain professional groups of a metallurgical enterprise have been analyzed. To determine the total fatal cardiovascular risk among workers, the SCORE (Systematic Coronary Risk Evaluation) was used. Results. A general sanitary audit of the working conditions of the metallurgical plant workers corresponds to hazardous class 3, degree 2-3 (3.2-3.3). According to the survey results, tobacco smoking is common among more than half of the surveyed workers - 56.8%. Among the professional group of temperers, tobacco smoking is more common (67.0%) compared to the professional group of wire-drawers (50.0%) and the control group (25.6%). The average body mass index among workers was 26.1±1.7 kg/m², and 27.8±1.5 kg/m² in the control group. Analysis of the average cholesterol group level was within the reference values of 4.8±0.1 mmol/l. 31.6% of the workers had high and very high levels of fatal cardiovascular risk, and 14.1% - a low one. Conclusion. Preventive measures to preserve professional longevity of metallurgical production workers should be carried out based on the cardiovascular risk assessment using the developed programs. Scope of application. The developed algorithm for selecting medical measures with due regard to cardiovascular risk assessment can be used as a corporate program for preserving health of the working population.