Russian Medical Academy Research Articles

A Workshop for Training of Basic Neurosurgical Skills "From Microsurgery to Endoscopy": A Stepping Stone for Young Neurosurgeons.

BackgroundThe aim of the project was to show the peculiarities of manipulations in two-dimensional (2D) visualization and to enlighten young neurosurgical residents for further independent training of their manual skills in the anatomic lab. The course followed a step-by-step training program starting with artificial models in a static 2D exoscopic view field with subsequent transition to cadaveric animal models and the use of dynamic four-hand techniques and endoscopy.Materials and methodsSince 2015, two 2-day workshops and four 1-day workshops have been organized. All courses consisted of short theoretical and prevailing hands-on practical part and were designed mainly for manual skills training. For optimal practical training, each pair of trainees were engaged with a separate working place equipped with a video system, exoscope, drill, suction, and a set of microsurgical and endoscopic instruments. A total of 48 trainees, including residents of the Nikolay Nilovich (NN) Burdenko National Medical Research Center of Neurosurgery (NMRCN), the Russian Medical Academy of Continuous Postgraduate Education, and other institutions from different regions of Russia, completed the program. Analysis of evaluation sheets revealed that over 90% of trainees were under the age of 30.ResultsThe key idea – accommodation to endoscopy through a series of microsurgical exercises in 2D visualization – has been successfully actualized and met with interest. After analyzing the questionnaires, we found that an overall satisfaction rate was high. The vast majority of trainees intended to gain further experience and apply new techniques in their clinical neurosurgical and microsurgical practice. The number of practiced techniques and the quality of the provided equipment were considered by the participants as good or very good. The highly individualized training course with a participant/tutor ratio of 4:1 and the use of tissue models (no sacrifice of living animals) was well appreciated.ConclusionThe demand for a workshop indicates a lack of such training activities for young professionals, such as the one we presented herein. Evaluation of the courses by the trainees showed that the contents of workshops corresponded to their tasks and expectations, regardless of their previous experience. The workshop was not only the 'stepping stone' from which the path of practical self-development should begin but also initiated the development of a whole series of specially focused training workshops on microsurgery and endoscopy for neurosurgeons.

VIOLATIONS OF HOMEOSTASIS PARAMETERS IN ACUTE POISONINGS AND WAYS OF THEIR CORRECTION

N.V. Sklifosovsky Research Institute for Emergency Medicine, Healthcare Department of Moscow|, 129090, Moscow, Russian Federation Research and Applied Toxicology Center of Federal Medical and Biological Agency|, 129090, Moscow, Russian Federation Russian Medical Academy of Continuous Professional Education, RF Ministry of Health|, 125993, Moscow, Russian Federation The problem of correction of disturbed homeostasis parameters in critical conditions, including acute poisoning, has revealed its increasing importance in recent years. In this respect, extracorporeal methods of detoxification (hemosorption, hemodialysis, etc.) and physio- and chemohemotherapy are quite effective. With the help of these methods positive changes in hemorheological, immune and other parameters are achieved, that increase significantly the overall results of treatment of patients. At the same time, targeted correction of disturbed homeostasis outside detoxification activities is still carried out mainly through infusion therapy. Along with this in recent years a growing number of scientific papers devoted to the correction of homeostatic disorders by enteral administration of special solutions in emergency conditions has appeared. However, this approach, although physiological and technically simple, has not yet been studied in clinical toxicology, and this fact encourages further research in this direction.

Pediatrics Department of the Russian Medical Academy of Continuous Professional Education and Moscow Research Clinical Institute of Pediatry and Children Surgery – half century hand in hand

The long-term cooperation of the two scientific institutions contributing to the professional development of pediatricians is based on the long-term scientific relations of the Department of Pediatrics of the Russian Medical Academy of Continuing Professional Education and the Moscow Research Institute of Pediatrics and Pediatric Surgery (now the Research Institute of Pediatrics named after Academician Yu.E.Veltischev). The role of remarkable pediatric scientists – G.N. Speransky, Yu.E. Veltstschev, M.S. Ignatova, N.A. Korovina in the development of these links and pediatric science in Russia.

Кафере педиатрии ЦИУв - ЦОЛИУВ - РМАПО - РМАНПО – 85 лет: от прошлого к будущему

Кафере педиатрии ЦИУв - ЦОЛИУВ - РМАПО - РМАНПО – 85 лет: от прошлого к будущему

DOPAMINE DYSREGULATION SYNDROME IN PARKINSON’S DISEASE AND APPROACHES TO ITS CORRECTION WITH DRUGS

The objective is to describe a clinical case of dopamine dysregulation syndrome (DDS) with compulsive intake of large doses of levodopa in a patient with Parkinson’s disease (PD). Materials and methods. Male patient R., born in 1956, has had PD since 2004 when he noticed changes in his handwriting, difficulties to perform small movements with the right hand. Therapy with levodopa/benserazide was started at 300 mg/day. With time symptoms of the disease escalated: gait impairment and motor fluctuations started. Action duration after administration of levodopa/benserazide sin gle dose shortened to 2 hours, peak dose dyskinesia developed, as well as instability with frequent falls. In 2012, clinical picture of the disease included symptoms of DDS. The patient independently increased the drug dose, decreased time between doses, didn’t follow the doctor’s recommendations. Relatives noticed a state of euphoria in the patient after taking a dose of levodopa/benserazide. At the time of visiting the Department of Neurology of the Russian Medical Academy of Continuous Professional Education in the beginning of 2016, the daily equivalent levodopa dose was 2000 mg, and 800 mg of it were taken at night. Results. The patient was transferred to a three-component modern levodopa drug Stalevo (levodopa + carbidopa + entacapone) 150 mg + levodopa/benserazide 50 mg 6 times a day (daily dose 1200 mg). Decreased levodopa daily dose achieved by transferring the patient to a three-component drug with better bioavailability lead to significant reduction of motor and non-motor symptoms, significant increase in effect duration after a single dose of levodopa. In a year of follow-up, DDS symptoms gradually regressed, time between drug administration increased, the patient stopped taking the drug at night, fluctuations and drug-induced dyskinesias significantly decreased. Conclusion. In this clinical case, manifestations of DDS caused by long-term compulsive levodopa intake at doses significantly exceeding daily dose (necessary for control of motor symptoms) are described. One of the approaches to reduction of high doses of levodopa and control of motor fluctuations is prescription of Stalevo which stabilizes levodopa level in plasma and provides a more continuous stimulation of dopamine receptors in the striatum.

The 85th Anniversary of the Department of Pediatrics of the Russian Medical Academy of Continuous Professional Education: From Past to Future

The 85th Anniversary of the Department of Pediatrics of the Russian Medical Academy of Continuous Professional Education: From Past to Future

NS-24CURRENT TREATMENT APPROACHES FOR INFANTS WITH BRAIN TUMORS AND LONG-TERM OUTCOMES

NS-24. CURRENT TREATMENT APPROACHES FOR INFANTS WITH BRAIN TUMORS AND LONG-TERM OUTCOMES Kaspot Matuev1,2, Sergey Gorelyshev1,2, and Andrey Lubnin1; Burdenko Neurosurgical Institute, Moscow, Russia; Russian Medical Academy of Postgraduate Education, Moscow, Russia The long-termresults strictlydependon radicalityof tumor removalandhistology of the tumor. Most of brain tumors in infants shoud be radically removed. We aimed to analyse of the long-term results of comprehensive treatment of brain tumors in infants, according to radicality of surgery, tumor location and degree of malignancy. We analised the long-term results in 80 infants (1 to 12 months) with brain tumors, that were operated on from 2000 to 2010 in the Burdenko Neurosurgical Institute, Moscow, Russia. Total removal was achieved in 85% cases of the lateral and third ventricle tumors; tumors of large hemispheres 82%; posterior fossa tumors 83%. Total removal in cases of chiasmatic region tumors was possible in the minority of patients 15%. Five-year overall survival rates depended on the malignancy of tumor: GrI-II 92%, GrIII-IV 48%. The best long-term outcomes were obtained after total removal of astrocytomas GrI, GrIII and plexus papilloma. Total removal malignant gliomas, plexus carcinoma, ependymoma increases the efficiency of adjuvant therapy and progression free survival.

Differential diagnosis of breast tumors on the basis of radiothermometric findings

The paper presents a method for the differential diagnosis of breast tumors in accordance with radiothermometric findings, which is based on the authors’ developed diagnostic technique (Patent No. 2532372 dated 5 September 2014). The radiometric method was used to examine 119 patients with malignant breast tumors, 53 patients with benign breast tumors, and 60 women without breast involvement. The data were obtained in 3 institutions: the Russian Medical Academy of Postgraduate Education, the N.N. Blokhin Russian Cancer Research Center, and Moscow Oncology Dispensary Five. A microwave radiothermometer was used to measure core and skin temperatures in 9 symmetrical points of each breast. Using the findings as a basis, the authors proposed quantitative criteria that ensured that breast tumors should be differentially diagnosed with high specificity.

The remote post-graduate education in otorhinolaryngology: the first results and further prospects

The objective of the present work was the retrospective analysis of the efficiency of two courses of remote education of otorhinolaryngologists in the real-time mode based on the results of the on-line questionnaire study. We analyzed the data obtained during the implementation of the pilot project of the remote post-graduate education at the Department of Otorhinolaryngology,Russian Medical Academy of Post-Graduate Education making use of the independent Internet resource for the professional training of otorhinolaryngologists. The two programs of remote education realized in 2012 and 2013 involved 7.9% of all otorhinolaryngologists practicing in the Russian Federation. The fraction of those who passed through all stages of the learning process increased almost two-fold, that is from 10% in 2012 up to 19% in 2013. About 14% of the participants made themselves familiar with all program modules; this result is in agreement with the data obtained in mass on-line remote teaching of the non-medical audience. It is concluded that the results of the present study provide a basis for the elaboration of the remote education programs for the training of specialists not only in otorhinolaryngology but also in other fields of medicine.

The Department of children neurology of the Russian Medical Academy for Postgraduate Education (the 50 anniversary)

The Department of children neurology of the Russian Medical Academy for Postgraduate Education (the 50 anniversary)

USE OF THREE-COMPONENT LEVODOPA (LEVODOPA/CARBIDOPA/ENTACAPONE) TO CORRECT NOCTURNAL SYMPTOMS OF PARKINSON,S DISEASE

Objective: to describe a clinical case of late-stage Parkinson’s disease (PD) with nocturnal symptoms and fluctuations and to present successful experience in using the three-component drug Stalevo (levodopa/carbidopa/entacapone) as a single dose prior to sleep. Patient V. aged 72 years took medical advice at the Department of Neurology, Russian Medical Academy of Postgraduate Education, for complaints of constrained movements, inability to turn in bed independently, painful muscle cramps, light sleep with nocturnal awakenings, and frequent (5–6 times) urinations at night. The first symptoms of the disease appeared 12 years ago when the patient began to notice sluggishness, altered handwriting, and clumsiness during small movements of the right hand. By taking into account symptoms (obvious nocturnal akinesia, overactive bladder, sleep disorders, and cramps) and the results of his examination, the patient was diagnosed with the akinetic-rigid form of PD (4 Hoehn-Yarh scores). Therapy was corrected as follows: the dose of amantadine remained the same (300 mg); its last administration is recommended to be at 16:00; the daily dose of levodopa was 700 mg; that of levodopa/benserazide was 550 mg/day (1 tablet × 3/4 tablet × 1 tablet). The evening intake of levodopa was changed for that of the three-component drug Stalevo (levodopa 150 mg/ carbidopa 37.5 mg/entacapone 200 mg). Results. After 3 months, the patient was observed to have significant health improvement: reduced nocturnal and morning akinesia, better gait, a considerably smaller number of nocturnal urinations (less than once per night), regression of painful calf muscle cramps, and improved sleep. Conclusion. The three-component drug Stalevo (levodopa/carbidopa/entacapone) is effective in treating late-stage PD. Its use as a single dose before going to bed has led to regressive nocturnal symptoms, better sleep, and lower motor fluctuations.

The Frequency of Cyp2c19 Genetic Polymorphisms In Russian Patients With Peptic Ulcer Treated With Proton Pump Inhibitors

The Frequency oF cyP2c19 GeneTic PolymorPhisms in russiAn PATienTs WiTh PePTic ulcer TreATed WiTh ProTon PumP inhibiTors N.P. Denisenko; D.A. Sychev; Zh.M. Sizova; A.V. Grachev; and K.A. Velikolug Russian Medical Academy of Post-Graduate Education, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia; SM-Clinic, Moscow, Russia; and Out-patient department No. 51 branch 3, Moscow, Russia Introduction: Proton pump inhibitors, which are widely used as acid-inhibitory agents for the treatment of peptic ulcer, are mainly metabolized by 2C19 isoenzyme of cytochrome P450 (CYP2C19). CYP2C19 has genetic polymorphisms, associated with extensive, poor, intermediate or ultrarapid metabolism of proton pump inhibitors. Genetic polymorphism of CYP2C19 could be of clinical concern in the treatment of peptic ulcer with proton pump inhibitors. The aim of the study – to investigate the frequencies of CYP2C19*2, CYP2C19*3 and CYP2C19*17 alleles and genotypes in Russian patients with peptic ulcer. Materials and Methods: The study involved 971 patients with peptic ulcer from the European part of Russia (Moscow), 428 male (44%) and 543 female (56%). The mean age was 44.6 ± 11.9 years (range 15–88 y). DNA isolated from blood samples was used for the analysis of CYP2C19 genetic polymorphisms (CYP2C19*2, *3, *17 alleles) by real-time polymerase chain reaction. Results: Regarding CYP2C19 genotype, 317 patients (32.65%) out of 971 were CYP2C19*1/*1 carriers classified as extensive metabolizers. Three hundred eighty-six (39.75%) with CYP2C19*1/*17 or CYP2C19*17/*17 genotype were ultrarapid metabolizers. Two hundred fifty-one people (25.85%) were intermediate metabolizers with CYP2C19*1/*2, CYP2C19*2/*17, CYP2C19*1/*3, CYP2C19*3/*17 genotypes. Seventeen patients (1.75%) with CYP2C19*2/*2, CYP2C19*3/*3, CYP2C19*2/*3 genotypes were poor metabolizers. The allele frequencies were the following: CYP2C19*2 – 0.140, CYP2C19*3 – 0.006, CYP2C19*17 – 0.274. Conclusion: There is a high frequency of CYP2C19 genotypes associated with modified response on proton pump inhibitors in Russian patients with peptic ulcer. Genotyping for CYP2C19 polymorphisms is suggested to be a useful tool for personalized dosing of proton pump inhibitors.

Russian Medical Academy for Postgraduate Education of the Ministry of Health of the Russian Federation. 1§125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1

Despite the urgency of the problem, the impact of uterine fibroids on the effectiveness of programs assisted reproductive technology (ART) remains open. The data indicate that the induction of superovulation in vitro fertilization (IVF) increases the production of factors that contribute to the proliferation of fibroids. These data may explain the link between uterine myoma and effectiveness of ART programs, as expression of the same genes associated with implantation and post-implantation embryo development. Surgical removal of large knots prior to the IVF program in most cases, is regarded as a positive prognostic factor. However, surgical treatment, in turn, has a negative impact on the fallopian tubes and peritoneal and also leads to the appearance of the scar on the uterus. This review gives an idea of the current state of the problem and can help in the development of individual approaches in patients with infertility and uterine myoma.

THE DEVELOPMENT OF PROFESSIONAL COMPETENCIES IN THE MANAGEMENT TRAINING OF HEALTH

The article considers modern problems of management training of health described the long experience of the Department of international health, Russian medical Academy of postgraduate education in the field of additional professional education of managers of medical organizations using methods of activating the learning process. The basis of realization of programs of management training was competencybased approach, involving the assessment and development of professional competencies of heads of health organizations on a modern methodological basis, aimed at improving the efficient use of labor and human resources of the organization.

WOQ-19 improves satisfaction of patients with Parkinson's disease

WOQ-19 improves satisfaction of patients with Parkinson's disease

History of pediatric chair of the State-Financed Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation

History of pediatric chair of the State-Financed Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation

Diabetic polyneuropathy in children and adolescents: clinical picture and diagnosis

The Department of Childhood and Adolescence Endocrinology, Russian Medical Academy of Postgraduate Training, Ministry of Health of the Russian Federation, examined 529 patients with type 1 diabetes mellitus (DM) whose age was 5 to 22 years. The study was undertaken to examine the prevalence and severity of diabetic peripheral polyneuropathy (DPN) in children, adolescents, and young individuals who fell ill with DM in childhood, to characterize the symptoms and neurological manifestations of this complication, and to choose adequate studies for their examination. DPN is most common in adolescents and young individuals having a longer history of the disease and worse values of compensation of carbohydrate metabolism. The specific feature of DPN in these age groups are the absence of severe forms of the disease and the presence of mainly the sensory pattern of disorders. The study defined the required scope of a neurological examination for early diagnosis of DPN in children and adolescents, which should include a thorough analysis of a patient’s complaints and a test by the Total Symptoms Score, a neurological examination by the modified Neuropathy Impairment Score for the Lower Extremities, stimulation electromyography of the sensory and motor nerves of the leg. By taking into account a poor DM compensation in the absolute majority of children and adolescents, the neurological examination should be regular at least once a year.

Spotlight – Thinking in the old way and trying to live in the new

Professor Viatcheslav Alexeev offers freelance journalist Sarah Powell his views of the state of the Russian national health system and the challenges faced as Russia moves from a socialist to a capitalist economy. Viatcheslav Alexeev is Professor of International Health and Management at the Department of International Health of the Russian Medical Academy of Advanced Medical Studies in Moscow. His wide-ranging experience includes teaching management and health administration, health manpower development, and interpersonal relationships at the Central Institute for Advanced Medical Studies. Following this, for over 20 years he was Assistant Professor and Director of the WHO International Courses for Health Administrators. From 1981 to 1987, he worked on the staff of the Health Manpower Development Division of the WHO in Geneva, in which capacity he gained extensive experience of training, research and organization in over 30 countries.