Results Of Medical Examinations Research Articles

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.

Research of the application of elements of sports games in the process of therapeutic physical education activities

Recent studies have shown that the use of elements of team sports in physical education classes in a special medical group “B” (therapeutic physical education) remains one of the promising areas and, at the same time, a rather complex methodological problem, caused in many cases by concomitant diseases of students. When discussing the features and advantages of various team sports in the mode of practical exercises in therapeutic physical culture in universities, it is necessary to pay attention to the differentiated use of elements of sports games in accordance with the existing pathology.Purpose. Determine the most effective complexes of physical activity using elements of team sports.Materials and methods. The material for the work was the results of a current medical examination, motor tasks that make it possible to determine the level of development of physical qualities, and data from a functional test. The research was conducted at the departments of physical education of Astrakhan State Medical University and Kuban State Medical University and Astrakhan State University in the 2021/22 academic year. Based on functional tests, the level of physical fitness of those involved was analyzed, and hemodynamics were determined during physical activity classes using elements of team sports. The work used standard methods of mathematical analysis.Results. A reliable correlation was revealed between the use of elements of team sports and the level of increase in the regulatoryadaptive potential of the cardiovascular system, reduction of BMI, elements of team sports were identified that are advisable to recommend for the appropriate medical group. During the work, data were obtained on the effectiveness of using elements of sports games for students assigned to medical group “B”.Conclusions. It is advisable to use elements of basketball in the form of developing coordination abilities, mastering techniques of ball possession with changing parameters in space and time interval. In our opinion, this format allows you to vary the intensity of physical activity in accordance with the level of functional and physical fitness of students. In the same group, it is possible to use elements of volleyball and the game of volleyball itself according to simplified rules. The individual duration of rest breaks should allow the cardiorespiratory system to be restored to background levels.

Overtime work is related to nonrestorative sleep independently of short sleep time among a Japanese occupational population.

The symptoms of insomnia are defined as difficulty falling asleep, difficulty staying asleep, and early awakening. Although also a symptom of insomnia, nonrestorative sleep (NRS) is clearly more associated with objective indices than other insomnia symptoms. However, the link between NRS and overtime work duration is poorly understood. The results of a single year's medical examinations were investigated for 26,144 Japanese office workers who were 30 to 59years old. NRS status and lifestyle were collected through a computer-assisted medical interview. The subjects were asked about the presence or absence of NRS and their lifestyles in the most recent two to three months. The subjects were asked about their sleep times and average overtime durations per month (< 20h/month, ≥ 20 but < 40h/month, ≥ 40 but < 60h/month, and ≥ 60h/month). The relationships between NRS and overtime work duration adjusted for sleep time were also analyzed. The proportion of subjects with NRS showed a stepwise increase as overtime work hours increased. A logistic regression analysis was performed using NRS as an objective variable. The multivariate analysis demonstrated that overtime work duration (OR, 1.13; 95% CI 1.10-1.17; P < 0.001; per one-category increase) was an independent determinant of NRS. For office workers, long hours of overtime work increased the NRS prevalence at any sleep duration.

Results of preventive medical examinations of children in Donetsk People’s Republic, Luhansk People’s Republic, and Zaporizhzhya and Kherson regions

BACKGROUND: The preventive direction of medicine has become increasingly popular in recent years. The government has paid much attention to the health of the population and preventive examinations. Among the main priorities of the state, the health of the pediatric population remains a guarantee of a healthy nation.&#x0D; AIM: To assess the health status of the pediatric population of the new territories of the Russian Federation and develop measures to further improve medical care at the regional level.&#x0D; MATERIAL AND METHODS: The study enrolled children aged 017 years living in the new territories of the Russian Federation, namely, the Donetsk Peoples Republic, Luhansk Peoples Republic, Zaporozhye oblast, and Kherson oblast. A total of 32 teams of specialists from 30 territories of the Federation have been formed to conduct in-depth preventive medical examinations of the pediatric population of these new territories.&#x0D; RESULTS: The study participants were predominantly children aged 014 years. The overall morbidity in all regions was dominated by diseases from the five classes according to ICD-10, namely, diseases of the musculoskeletal system and connective tissue; endocrine, nutritional, and metabolic diseases; of the eye and adnexa; and disorders of the nervous system, respiratory system, and psychological development. Half of the study participants were diagnosed with a disease for the first time in their lives.&#x0D; In the Russian Federation, the high proportion of healthy children is due to the contingent of the child population, and the third group of health with better detection of diseases due to the in-depth nature of preventive medical examinations. The distribution into groups for physical education corresponded to health groups. According to the preventive medical examinations results, more than a third of the total number of examined children was transferred to dispensary supervision. Emergent and urgent cases and mental disorders require measures under stable conditions.&#x0D; CONCLUSION: The results of the preventive medical examinations can be the basis for subsequent therapeutic, diagnostic, and rehabilitation work by medical organizations and preventive and health-improving activities by educational institutions.

What do we Know about Flat Feet?

This question may seem strange to physicians, but how will they explain that in the forties of the last century, flat feet were tested only in 4-6% of the population, and in 2000, according to the results of a general medical examination conducted in Russia, deformities of the feet and spine were already noted in 85-95 % of the population.

Forensic medical cytological examination of the trace evidence on the knife’s blade in the case of multiple penetrating stab/cut wounds in the chest with lung damage: a case report

Various trace evidence are often found on the instruments of mechanical injury, including microparticles of humans damaged organs and tissues. The detection of cells and microparticles of organs and tissues on the instrument of injury confirms its contact with the human body, which is of great evidentiary value.&#x0D; The article presents the results of forensic medical cytological examination of biological evidence taken from the knifes blade in the case of multiple penetrating stab/cut wounds in the chest that result in lung damage. Microscopic preparations were made from the traces on knifes blade, which were stained with fluorochrome solutions (0.0005% aqueous solution of atebrine and 0.01% solution of acridine orange). The study was performed using the luminescent microscope Leica DM2500 (20 and 60 lenses, 10 eyepiece). The examination of microparticles of the striated skeletal muscle revealed areolar connective and fat tissues with capillary and arteriole fragments. The isolated mesothelial cells and type II pneumonocytes were also detected. Fibers of the striated skeletal muscle tissue looked like long multinucleated cells with distinguishing cross-striation. The areolar connective tissue was represented by loosely arranged fibers embedded in the ground substance. Fragments of the fat tissue looked like the clusters of round and oval large cells, tightly pressed together, with capillaries, and arterioles in between. Y-chromatin was detected in the nuclei of most cells. In addition, human blood was found on the knifes blade.&#x0D; Thus, the study revealed that tiny particles of tissues and isolated human cells of the male genetic sex were detected, their organtissue affiliation was established, which is a valuable diagnostic finding, because it confirms the contact of the trauma instrument with the human body.

Типизация фиксаций глазодвигательных реакций при восприятии аддиктивно значимых стимулов пациентами с алкогольной зависимостью

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;The relevance&lt;/strong&gt; of the study is due to the need to search for objectivizing methods for identifying signs and manifestations of dependence, both for diagnostic purposes and for the purpose of assessing the effectiveness of the rehabilitation process at its various stages. &lt;strong&gt;Purpose:&lt;/strong&gt; to identify typical strategies for the distribution of fixations of oculomotor reactions during the perception of addictively significant stimuli by patients with alcohol dependence. &lt;strong&gt;Materials and Methods: &lt;/strong&gt;The total sample size was 73 people. The experimental group included 37 subjects (23 men and 14 women) with alcohol dependence (diagnosed as F10.2 according to ICD 10 &amp;ndash; Alcohol dependence). The control group consisted of 36 subjects (22 men and 14 women) with a &amp;ldquo;healthy&amp;rdquo; conclusion based on the results of periodic medical examinations. The study was carried out on the basis of written informed consent from the subjects. The study included two stages: an assessment of the neurocognitive status of the subjects (Montreal Cognitive Function Assessment (MoCA) and an experimental study of fixations of oculomotor reactions during the perception of addictively significant stimuli (the hardware complex for assessing oculomotor reactions Tobii EyeX and the GazeControll software). &lt;strong&gt;Results.&lt;/strong&gt; Specific features of fixations of oculomotor reactions during the perception of addictively significant stimuli by patients with alcohol dependence make it possible to typify the strategies of oculomotor reactions. on an empty background field outside the depicted objects) may be due to the actualization of a pathological craving for alcohol caused by the demonstration of addictively significant stimuli.&lt;/p&gt;

Study on risk factors of diabetic peripheral neuropathy and establishment of a prediction model by machine learning

BackgroundDiabetic peripheral neuropathy (DPN) is a common complication of diabetes. Predicting the risk of developing DPN is important for clinical decision-making and designing clinical trials.MethodsWe retrospectively reviewed the data of 1278 patients with diabetes treated in two central hospitals from 2020 to 2022. The data included medical history, physical examination, and biochemical index test results. After feature selection and data balancing, the cohort was divided into training and internal validation datasets at a 7:3 ratio. Training was made in logistic regression, k-nearest neighbor, decision tree, naive bayes, random forest, and extreme gradient boosting (XGBoost) based on machine learning. The k-fold cross-validation was used for model assessment, and the accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC) were adopted to validate the models’ discrimination and clinical practicality. The SHapley Additive exPlanation (SHAP) was used to interpret the best-performing model.ResultsThe XGBoost model outperformed other models, which had an accuracy of 0·746, precision of 0·765, recall of 0·711, F1-score of 0·736, and AUC of 0·813. The SHAP results indicated that age, disease duration, glycated hemoglobin, insulin resistance index, 24-h urine protein quantification, and urine protein concentration were risk factors for DPN, while the ratio between 2-h postprandial C-peptide and fasting C-peptide(C2/C0), total cholesterol, activated partial thromboplastin time, and creatinine were protective factors.ConclusionsThe machine learning approach helped established a DPN risk prediction model with good performance. The model identified the factors most closely related to DPN.

First-round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap.

Although the accreditation approach is widely used to ensure the quality of medical education in many countries, there is scant empirical evidence on whether and how it improves actual medical school performance. We focused on conditions in China, which introduced an accreditation system during the 2010s. Specifically, we examined the relationship between first-round accreditation and actual performance based on the results of medical licensing examinations. Referring to organisation theory, we hypothesised that the impacts of accreditation would depend on existing performance gaps. In 2022, we analysed panel data from 105 Chinese medical schools during accreditation (2012 to 2021) and pass rates on medical licensing examinations (2011 to 2019), as matched into 834 school-year records in a window of years before and after accreditation. We employed fixed-effects regression models with a comparison group to exclude factors that may have confounded the impacts of accreditation time. We also demonstrated the heterogeneous effects of accreditation by tier and performance gap of medical schools. The conservative estimates showed a substantial cumulative improvement (over 15 percentage points) in pass rates during the years before accreditation, with no clear trend indicating performance drops in the years after accreditation. Lower-tiered medical schools gained greater benefits from accreditation. Medical schools with a larger prior performance gap achieved a greater percentage point increase in pass rates with the passage of time in pre-accreditation years. This is the first empirical study to investigate whether accreditation has bridged performance gaps among medical schools. The results support the value of accreditation in China, a country that recently established the system, and might work as a substitute for missing information on early accreditation history in countries with long-established accreditation systems. We encourage more studies in countries that have recently introduced accreditation systems.

Purpose, subject matter and objectives of forensic medicine

It has been established that forensic medicine is a branch of medicine that deals with the application of medical knowledge and methods to resolve legal issues, in particular those related to death, injury and other types of violence. The main purpose of forensic medicine is to examine the bodies of the dead or injured in order to determine the cause of death or injury, as well as to determine the possible criminal element in the act. To do this, forensic physicians use methods of body examination, evidence collection and expert analysis.&#x0D; It has been generalised that forensic medical examination as a subject of forensic medicine is a scientific and practical research carried out by specially trained specialists with the aim of providing an objective assessment of medical issues in cases brought before a court. This examination may include determining the causes and circumstances of death, assessing injuries, determining the severity and possible consequences of injuries, examining the patient's medical history, and other medical issues that may be relevant to the resolution of court cases. The results of a forensic medical examination may be used as evidence in a court of law.&#x0D; It has been stated that the main tasks of forensic medicine as a branch of science are: study of human physiology and pathology, as well as the relationship of these processes with the knowledge of the cause of death and other traumatic injuries; development and improvement of methods for detection and assessment of traumatic injuries and their consequences, as well as establishment of the relationship between trauma and health consequences; detection of the impact of physical and chemical factors on human health, as well as establishment of the causes and consequences of the impact of these factors; determining the state of human health in the context of criminal investigation, including assessment of the state of alcohol or drug intoxication and its impact on human behaviour and actions; studying the relationship between the state of health and the crime committed, as well as establishing the facts of the presence and nature of injuries of victims.

Occupational health issues and respiratory toxicity of a complex of harmful factors in electrolytic and hydrometallurgical copper production

Introduction. In recent decades, there has been a decrease in occupational morbidity at enterprises producing rough and refined copper, in the structure of which, nevertheless, bronchopulmonary pathology retains a leading position.The aim is to study the occupational risk of developing respiratory pathology in workers engaged in obtaining cathode copper by electrolysis and electorowinning methods, based on the study of working conditions of workplaces and clinical observation.Materials and methods. The object of the study were: Uralelectromed, V. Pyshma (UEM); Uralhydromed, Polevskoy (RMK). The subject of the study were 100 employees of the electrolysis shop of UEM – the 1st observation group; 102 people of the auxiliary workshops of UEM – the 2nd observation group; 92 workers of the extraction and electorowinning department of UGM – the 3rd observation group.Results. During electrolytic refining of copper, the leading harmful factors with respiratory toxicity are sulfuric acid aerosol, selenium dioxide, nickel, arsenic, and during electrovinig – sulfuric acid aerosol. Violations of ventilation function and pulmonary gas exchange were observed in 21.0 % of cases in persons of the 1st and in 15.7% of cases in patients of the 3rd observation group).Discussion. Changes in the function of external respiration (FVD) were established mainly by the obstructive type, namely, an increase in RV, FRC and RV/TLC and a decrease in FEV1, VC, FEV1/VC, FEV25-75 of mild and moderate severity were noted. The bronchodilation test revealed the reversibility of bronchial obstruction in both groups 1 and 3. Obstructive disorders and dynamic hyperventilation of the lungs in copper refining workers are probably a consequence of hyperreactivity of the bronchi in response to the irritating properties of sulfur-containing gases, arsenic and nickel compounds.Conclusion. The results of the study indicate respiratory toxicity of harmful factors in workers of electrolysis and electrovining, which corresponds to a high and average occupational risk of class 3.3 and class 3.2 assessment of working conditions and the results of mandatory periodic medical examinations.