State Budgetary Healthcare Institution Research Articles

РЕЗУЛЬТАТЫ ОПТИМИЗАЦИИ СЛУЖБЫ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ВЗРОСЛОМУ НАСЕЛЕНИЮ ПЕНЗЕНСКОЙ ОБЛАСТИ ПО ПРОФИЛЮ «ЧЕЛЮСТНО-ЛИЦЕВАЯ ХИРУРГИЯ» В 2021 ГОДУ

The increase in the number of patients with pathology of the maxillofacial region necessitates improving the quality of medical care provided to the population in the field of "Maxillofacial surgery". Anatomical and physiological features of the maxillofacial region, the prevalence of pathology determine the implementation of organizational measures, the involvement of narrow specialists, the need for medical organizations in modern material and technical equipment. The indicators of medical care mainly depend on a full-fledged diagnosis, and are also determined by the availability, quality and speed of specialized medical care. In modern conditions of the development of the health care system, an integrated approach to the organization, the introduction of new methods of providing medical care and rehabilitation of patients is required. Optimization of the maxillofacial surgery service within a multidisciplinary medical organization, the introduction and development of an outpatient polyclinic link, the training of highly qualified personnel contribute to improving the quality of diagnosis, treatment and timely detection of pathology. This article presents the results of optimizing the service for providing medical care to patients with pathology of the maxillofacial region. In the Penza region, the full-fledged, high-quality functioning of the service is realized through the organization of the Center for Maxillofacial Surgery on the basis of the State Budgetary Healthcare Institution «Penza Regional Clinical Hospital named after N.N. Burdenko». The structure of the Center for Maxillofacial Surgery ensures the continuity and complementarity of specialists of a medical organization in the treatment and diagnostic process. Optimal conditions have been created for the diagnosis, treatment and rehabilitation of patients with pathology of the maxillofacial region, in order to provide the population with affordable and high-quality medical care, regardless of the category of citizens. The creation of the Center for Oral and Maxillofacial Surgery contributes to an increase in the structural efficiency and medical efficiency of the health care system of the Penza region. The results of the measures and innovations carried out can be used to eliminate the existing shortcomings in the organization of medical care for patients with pathology of the maxillofacial region in other regions.

НЕДОСТАТКИ В ОРГАНИЗАЦИИ АМБУЛАТОРНО — ПОЛИКЛИНИЧЕСКОЙ СЛУЖБЫ ПО ПРОФИЛЮ ЧЕЛЮСТНО — ЛИЦЕВАЯ ХИРУРГИИ ВЗРОСЛОМУ И ДЕТСКОМУ НАСЕЛЕНИЮ В ГБУЗ ПЕНЗЕНСКОЙ ОБЛАСТНОЙ КЛИНИЧЕСКОЙ БОЛЬНИЦЕ ИМ. Н.Н. БУРДЕНКО ЗА ПЕРИОД 2018 -2020 ГГ.

The availability and quality of medical care is determined by the state of primary health care. Optimization and development of outpatient care is the primary task of healthcare. For the Penza region, according to the resolution of the Government of the Penza region of 02.10.2013 N 743-PP, improving the quality of outpatient care in the field of maxillofacial surgery and increasing its availability is one of the primary tasks for our region. In this regard, the assessment of the work of the outpatient office of the Department of Maxillofacial Surgery of the Consultative Polyclinic of the State Budgetary Healthcare Institution of the Penza Regional Clinical Hospital named after V.I. N.N. Burdenko. Aim: to analyze the work and effectiveness of a dentist - surgeon in the outpatient office of the consultative polyclinic GBUZ Penza Regional Clinical Hospital named after V.I. N.N. Burdenko. Materials and methods. To achieve this goal, a retrospective analysis of the primary accounting and reporting medical documentation for 2018–2020 was carried out, a questionnaire survey of patients hospitalized through an outpatient office in the Department of Maxillofacial Surgery of the N.I. N.N. Burdenko. Statistical data analysis procedures were carried out using MS Office Excel 2010 spreadsheets and PASW Statistics 18 statistical software package. Results. The analyzed accounting and reporting medical documentation for 2018–2020, the results of the questionnaire indicate the ineffective work of the doctor surgeon - dentist in the outpatient office of the consultative polyclinic GBUZ POKB im. NN Burdenko, the workload of the department with non-core hospitalizations, the increased workload on doctors - the department of maxillofacial surgery. The ways of solving the problem of replacing a dentist-surgeon with a doctor-maxillofacial surgeon are proposed; on the organization of a rehabilitation room for patients of the adult and pediatric population with pathology of the maxillofacial region; to create a single case history. Conclusion. Carrying out the above changes will reduce the burden on doctors - maxillofacial surgeons of the Department of Maxillofacial Surgery, transfer some of the manipulations from the inpatient to the outpatient service (inpatient replacement technology), thereby improving the medical care service in the field of maxillofacial surgery in the Penza region.

Experience in the successful application of extracorporeal methods in treatment of tumor lysis syndrome

Introduction. This article, using a clinical case as an example, reflects the problem of the development of tumor lysis syndrome (TLS). The most common cause of SLO development is antitumor treatment: radiation therapy, radiofrequency ablation, vascular embolization, the use of monoclonal antibodies, high-dose chemotherapy with transplantation of stasis from peripheral blood. This disorder leads to the development of metabolic, hemodynamic, respiratory and renal disorders. The TLS distinguished by high mortality rates, from 17% to 70%.Materials and methods. Presented a clinical case of patient, 30 years old - observation of successful treatment of TLS of the III degree of clinical course according to Cairo-Bishop, in the conditions of the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», in the conditions of the intensive care unit and intensive care with the use of renal replacement therapy on the Prismaflex device.Results and discussion. When the patient applied to the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», the diagnosis made — Non-Hodgkin lymphoma with a diffuse type of growth of a high degree of malignancy. Revealed the defeat of the lymph nodes, parietal pleura, right hemithorax, atelectasis of the middle lobe of the right lung with air bronchography, hydrothorax on both sides, hydropericardium, free fluid in the pelvic cavity, phlebolitis of the parametric tissue, degenerative-dystrophic changes in the spine. On the first day of hospitalization, antibacterial and pain relief therapy started, and nutritional disturbances were corrected. After the pre-phase chemotherapy (cyclophosphamide, vincristine), the patient's condition worsened, she was transferred to the intensive care unit. Where was the treatment carried out: convulsive syndrome, respiratory failure, acute renal failure, bilateral pneumonia, PE. Against the background of this therapy, special treatment continued - 2 cycles of chemotherapy. After the patient transferred to spontaneous breathing and the indices of blood slags and potassium were normalized, she was transferred to the antitumor therapy department to continue special treatment. Conclusion. Our algorithm for the treatment of SLO led to positive dynamics and the possibility of carrying out special antitumor therapy for this patient.

Coronavirus infection in patients with HIV infection, features of the course

Purpose. Analyze and identify the features of the course of the new coronavirus infection (COVID-19) in HIV-infected patients.Materials and methods. An analysis of the course of coronavirus infection (COVID-19) was carried out in 16 patients with HIV infection who were hospitalized at the St. Petersburg State Budgetary Healthcare Institution Center for the Prevention and Control of AIDS and Infectious Diseases from April to October 2020. All patients underwent a study of biological material from the oropharynx and nasopharynx for COVID-19 and diagnosed based on a positive PCR result.Results. In HIV-infected patients with diagnosed coronavirus infection caused by COVID-19, signs of progression of HIV infection, clinical, immunological, virological (75%), opportunistic diseases and comorbidities (chronic viral hepatitis in the cirrhotic decompensated stage, cardiovascular diseases and others) (94%). A small sample of patients did not allow to determine with reliable accuracy the mutual influence of existing diseases and pathologies, but, of course, multiple comorbid pathologies play a role in the development of severe conditions and unfavorable outcomes. A clinical case is presented.Conclusion. The provoking factors have been identified that play a role in the development of infection and more severe forms of coronavirus infection caused by COVID-19 in HIV-infected patients (injecting drug use, alcohol abuse, late stage of HIV infection (4B, 4C) and progression of earlier stages (4A ), a low number of CD4 lymphocytes (less than 200 cells / μl), multiple comorbid pathology (HIV infection, opportunistic diseases, comorbidities, especially chronic liver damage in the stage of decompensated cirrhosis), absence, interrupted antiretroviral therapy, multiple changes of regimens, absence prevention of opportunistic diseases). A patient with HIV infection at ART. 4B with multiple comorbidity, the possibility of long-term persistence of the COVID-19 virus coronavirus with positive and negative results for more than 2 months and later development of lung damage caused by COVID-19 was established.

Epidemiological analysis of the main indicators of HIV infection in the Primorsky Region

Currently, HIV infection continues to be one of the main socially significant problems in the field of human health. Despite all the efforts aimed at fighting the epidemic, the number of HIV-infected patients worldwide is growing every year. HIV infection is a disease that is not only a medical problem. Its distribution affects all spheres of society and affects everyone. HIV affects the most working-age population, affecting demographic indicators. Every year there are about 1000 cases of infection on the territory of the Primorsky Territory. The article presents an epidemiological analysis of the main indicators of HIV infection in the Primorsky Territory. The analyzed data are taken from the accounting and reporting forms of the State Budgetary Healthcare Institution «Regional Clinical Hospital No. 2» Center for the Prevention and Control of AIDS and Infectious Diseases for the period 2016–2020. According to the results of the analysis, at the moment there is some stabilization of the situation with regard to HIV infection in the Primorsky Territory, since there are years without dynamics or with a decrease in the incidence rate. The number of administrative territories of the region has increased, where there was a decrease in the incidence rate relative to last year. An increase in the prevalence of HIV infection is recorded annually, while the rate of growth of the indicator is decreasing. The disease has spread beyond vulnerable groups of the population and is actively spreading in the general population. In recent years, there has been a steady tendency in the region to increase the coverage of the population with screening tests for HIV infection. Since 2015, there has been a downward trend in the detection of HIV-positive persons in the total mass of the surveyed in the territory of the region.

Diseases of the Endocrine System in the Population of the Orenburg Region

Introduction. The increase in the rates of diseases of the endocrine system has been observed in the Russian Federation for many years. Unfavorable trends, including increasing growth rates and rising incidence and prevalence, are also registered in the Orenburg Region. The prevalence and structure of endocrine disorders in children and adolescents differ significantly from those in adults. The objective of our study was to establish regional features of the structure, dynamics and rates of endocrine morbidity in the population of the Orenburg Region. Materials and methods. We conducted correlation and regression analyses of data extracted from summary statistical reports for 2006–2019 issued by the State Budgetary Health Care Institution for the Orenburg Region “Medical Information and Analytical Center”. Results. In 2006–2019, the incidence rate of diseases of the endocrine system increased by 1.6 and 1.7 times in the Russian Federation and the Orenburg Region, respectively. In 2019, the growth rate in the Orenburg Region was 2.6 %. We observed age-specific differences in disease growth rates: the prevalence in the adult population increased by 1.7 times while in children aged 0–14 years this increase was already by 2.4 times. The incidence rate of endocrine disorders in the population of the Russian Federation and the Volga Federal District increased by 1.2 times, and in the Orenburg Region – by 1.5 times. By 2024, there is a 95 % probability that the prevalence of diseases of the endocrine system will range from 124.3 to 143.3 % while the incidence rates might range from 20.6 to 38.6 % with the same confidence level. Conclusions. Our findings indicate unfavorable trends in the rates of diseases of the endocrine system among both adults and children.

МЕЖДИСЦИПЛИНАРНЫЙ ПОДХОД В ОКАЗАНИИ ПОМОЩИ ПАЦИЕНТАМ С ПАТОЛОГИЕЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ В УСЛОВИЯХ ЦЕНТРА ЧЕЛЮСТНО-ЛИЦЕВОЙ ХИРУРГИИ

Every year there is a significant increase in combined anomalies and deformities of the maxillofacial region, congenital pathologies, malignant tumors, severe inflammatory diseases of the face and neck. Almost every patient who underwent surgery on the maxillofacial region develops secondary deformities of the maxillofacial region, adentia of the teeth of the jaws, impaired occlusion and speech, skeletal anomalies, which requires a comprehensive interdisciplinary approach of doctors of different profiles. The aim of the work was to improve the provision of specialized care to patients with pathology of the maxillofacial region through the introduction of an interdisciplinary approach in the treatment of patients in the center of maxillofacial surgery at the N.N. Burdenko Penza Regional Clinical Hospital (N.N. Burdenko ). Material and methods. The study was carried out on the basis of the Center for Maxillofacial Surgery of the State Budgetary Healthcare Institution "Penza Regional Clinical Hospital named after V.I. NN Burdenko ". A retrospective analysis of outpatient patient records, case histories, electronic databases, regulatory and legal documentation from 2010-2020 was carried out. Results and its discussion. Until November 2020, in the Penza region, medical care for patients with diseases of the maxillofacial region was provided in the department of maxillofacial surgery of the N.N. Burdenko State Budgetary Clinical Hospital. When analyzing the reporting and regulatory documents, it was concluded that it is necessary to improve the quality of specialized care in the field of maxillofacial surgery. We propose to employ the following specialists on the staff of the department: dentist-therapist for adults and children, gnathologist, dentist-orthodontist, otorhinolaryngologist, speech therapist. Conclusion. The materials presented in the article reflect the need for an integrated approach and close interaction between the doctors of the center. This stage begins during the preoperative preparation and planning of the operation. Rehabilitation of patients with pathology of the maxillofacial region is aimed at maximum aesthetic and anatomical recovery and requires an individual approach. To solve this problem, it is necessary to introduce interdisciplinary interaction of specialists in the center of maxillofacial surgery.

Частота развития и особенности клинического течения герпесвирусных менингитов у детей и взрослых по данным областной инфекционной клинической больницы города Тюмени

Aim. The objective is to explore the incidence rate and the specifics of the clinical course of herpesviral meningitis in children and adults. Materials and methods. The post-hoc analysis of 23 patients’ records has been carried out. The patients were admitted to State Budgetary Healthcare Institution of the Tyumen Region, Clinical Hospital for Infectious Diseases, City of Tyumen, during the period of 2018-2019 diagnosed with meningitis of herpesviral etiology. When analysing the data the following aspects were taken into account: age, sex, etiological agent, complaints at admission, results of clinical examination and laboratory findings. Results. Twenty-three (23) cases of herpesviral meningitis were registered during the period of two (2) years; mixed infection was detected in every fifth patient. Epstein Barr viral meningitis was diagnosed in most cases and was detected 3.5 times oftener in adults than in children. Herpes Simplex Virus meningitis was the second one in terms of detection rate and it affected only adults. Varicella Zoster Virus meningitis was detected two times rarer than Herpes Simplex Virus and only in adults. The herpesviral meningitis caused by human herpes virus type 6 was detected with the same rate as Varicella Zoster meningitis but was registered among children only. Cytomegaloviral meningitis was detected in one adult who was affected by severe immune deficiency. Conclusion. The detected specifics of the incidence of the herpesviral meningitis with respect to a patient’s age will enable a practitioner to suggest the possible meningitis etiology and to prescribe appropriate treatment thus improving the prognosis for the disease.

Assessment of the conditions for the introduction of modern nursing technologies on the example of the surgical department of the state budgetary healthcare institution of Samara region «Togliatti city clinical hospital NO. 1»

The purpose of the study was to substantiate a model for assessing the conditions for the introduction of modern nursing technologies in a medical organization. Results. It has been established that the criteria for assessing the conditions can be the theoretical and practical preparedness of the medical staff of the department, the presence of a system and the results of continuous professional development of specialists, the motivation of specialists to innovate. Mathematical modeling was used as a method for assessing conditions. Conclusion. A comprehensive assessment of the conditions, expressed as an integral value, made it possible to identify the strengths and weaknesses of the most important driving force behind the introduction of innovations — the staff of a medical organization. The developed model made it possible, at the stage of making a decision on the introduction of an innovation, to determine the level of knowledge and practical skills of working specialists, evaluate this component using relative values, and identify a shortcoming in the practical training of a specialist. To study the level of professional development of a specialist using the developed model for assessing CPD. Assess, using psychological techniques, the readiness of the team to innovate. As part of our study, it was revealed that the individual integral indicators of three specialists are above the boundary value and are the driving force, the indicators of ten people are within the limits between the boundary values. These specialists are almost ready to innovate. The values of the integral indicators of 6 specialists are in the negative zone, the indicators of three people from the entire group are located below the boundary values. Thus, in this team, 18 % of specialists can slow down the process of introducing innovations.

Solitary mastocytoma in children: a retrospective analysis of the clinical course and timing of regression

Introduction. Solitary mastocytoma is a rare clinical variant of cutaneous mastocytosis that makes its debut in infancy and early childhood. Сhanges in clinical manifestations at different ages and the rate of regression of the disease are insufficiently covered in the literature.Aim. To study the clinical manifestations and timing of regression of solitary mastocytoma in children, through retrospective analysis.Materials and methods. We retrospectively reviewed data from 32 children aged 3 months to 9 years who were on outpatient treatment and observation at the State Budgetary Healthcare Institution “Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department” in the period from 2016 to 2020 inclusive. Diagnosis information obtained from medical records.Results and discussion. The average age of disease onset was 2.5 ± 0.7 months. Solitary mastocytoma was observed more often in boys than in girls (1.4:1). In 81.2% of children, solitary mastocytoma clinically regressed before the age of 6 years. Delayed regression of rashes in the age range from 6 to 9 years was observed in 18.8% of children. Late correct diagnosis, lack of timely recommendations for care and treatment, traumatization of elements are factors that slow down the regression of the disease. Dermatoscopic examination can be used for dynamic observation of mastocytoma, since the patterns in the foci of regression differ from mature mastocytomas in the absence of yellow-orange areas. A pronounced brown pigment network on a yellow background can be a sign of the activity of the process and a reason for the appointment of symptomatic therapy.Conclusion. The clinical features of the modern course of solitary mastocytoma are the tendency to multiple rashes, the variety of localization and the long-lasting positivity of the Darier sign. Obviously, clinical monitoring using dermatoscopy and laboratory research methods allows to follow-up the activity of the process and promptly adjust drug treatment. To prevent delayed regression of solitary mastocytoma, traumatization of rashes of any localization should be excluded.

Features of the course of gastric ulcer in different age groups

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

Characteristics of cerebrospinal fluid under tuberculosis in patients with HIV-infection

Purpose. To carry out an analysis of characteristics and to reveal the peculiarities of laboratory changes of cerebrospinal fluid (CSF) in patients with tuberculosis of central nervous system associated with HIV-infection.Materials and methods. Analysis of 206 patients with CNS tuberculosis associated with HIV-infection who were treated in State Budgetary Healthcare Institution «City tuberculosis hospital No. 2» of Saint Petersburg during the period from 2006 to 2018 was conducted.Results and discussion. It was concluded that a mean protein level in CSF was 1,6±0,1 g/l and was significantly increased in patients with tubercular meningoencephalomyelitis. When decreasing the amount of CD4-lymphocytes, increasing of protein level in cerebrospinal fluid is observed. As cytosis increases, the amount of neutrophils increases too. Patients with tuberculous meningitis showed remarkable pleocytosis in comparison with patients with meningocephalitis. In 47% of cases, neutrophilic cell composition of CSF was registered. Therewith, the rate of neutrophils in CSF increased as the rate of lymphocytes decreased. Reducing of glucose in CSF was observed in the majority of patients with CNS tuberculosis independently of severity of immunosuppression and extent of brain injury.

Effectiveness of virtual technologies in relieving pain in patients with rheumatoid arthritis

Purpose: tto assess the possibility and feasibility of using virtual technologies to reduce the intensity of pain in patients with rheumatoid arthritis in real clinical practice.Materials and methods: we observed for 2 weeks 48 women with rheumatoid arthritis verified by modern methods during inpatient treatment at the State Budgetary Healthcare Institution of the Research Institute-KKB No. 1 n.a. prof. S.V. Ochapovsky. The patients were divided into two groups according to the case-control principle, of which 1 out of 28 patients constituted the intervention group, and 2 out of 20 patients were observed as controls. The study included only women from 20 to 75 years old, signed informed consent. According to clinical data and indicators of the course of rheumatoid arthritis, the groups were comparable. The severity of pain manifestations of the articular syndrome, quality of life, and duration of pain during the day were analyzed. All patients received comparable standard basic therapy. Patients of the 1st group were additionally conducted daily 20-minute lessons according to the method of "distracted involvement" using virtual games through VR-glasses.Results: the using of computer games with VR glasses led to a decrease in the severity of pain by 29,62% in patients of group 1 versus 18,97% in the comparison group. They had a significant decrease in intense pain 3 days earlier and by the end of the course of virtual therapy they recorded a significant (by 37.5%) reduction in the duration of pain during the day (with a 26% effect in the comparison group). A positive aspect of the use of virtual technologies was the reduction in the total dose of non-steroidal anti-inflammatory drugs taken in the observation group by 48% (versus 26% in group II). This fact creates conditions for reducing the drug load in the total volume of therapy and prevents the development of side and unwanted iatrogenic reactions.Conclusion: the application of the method of "distracted involvement" with the use of games through VR-glasses in patients with rheumatoid arthritis is an effective method of analgesic non-drug action in complex therapy. The low cost and high analgesic efficacy of the method makes it possible to recommend its use in the inpatient treatment of patients with rheumatoid arthritis. At the same time, a number of issues of safety and effective duration of course use of virtual games in order to reduce the severity of pain syndromes require further study.

Comorbidity in children with gallstone disease

According to the WHO report, in 44.0% of cases of the adult population, comorbidity is formed, which increases with the age of the patients. Meanwhile, early detection and impact on a single etiopathogenetic mechanism of comorbid diseases will not only reduce the number of diseases in one and the same patient, but also help solve the problem of polyprogmasia and disability of patients. In pediatric practice, there are isolated works devoted to the problem of comorbidity, in connection with which our studies on the study of comorbid conditions in children with cholelithiasis (cholelithiasis) are of particular interest.Purpose. The aim of this study was to improve the early diagnosis of comorbid diseases in children with cholelithiasis for the development of therapeutic and prophylactic measures and rehabilitation of patients with cholelithiasis.Material and methods. This study involved 146 children with cholelithiasis (GSD), selected based on the results of appeals to the consultative-polyclinic and inpatient departments of the State Budgetary Healthcare Institution of the Children’s Regional Clinical Hospital of Krasnodar. Children were divided into three groups according to the number of comorbid diseases. Group I consisted of 59 children, including 38 girls (26.0%) and 21 boys (14.4%), whose average age was 8.6 ± 4.5 years, with 3 comorbid diseases. Group II — 57 children, (29–19.7% girls and 28–19.2% boys, average age was 9.1 ± 4.4 years, with 5 comorbid diseases. Group III — 30 children (14–9.6% of girls and 16–11.0% of boys), the average age was 10.3 ± 4.7 years with 6 or more comorbid diseases.The clinical trial protocol was approved at a meeting of the ethnic committee of the KubSMU, Krasnodar.Conclusion. Comorbidity in children with gallstone disease is common. Among them, functional disorders of the biliary tract are in the lead. Among chronic diseases of the digestive tract, diseases of the upper sections of the digestive tract are significantly more common, and somewhat less often of the liver and pancreas. More than half of children with gallstones have comorbidity of other organs and systems, in particular, diseases of the upper respiratory tract and urinary system are more often determined. Comorbid diseases increase the severity of the condition and worsen the prognosis of the disease. Diagnosis of comorbid conditions should be thorough in order to select adequate therapy, taking into account the combination of drugs. At the same time, the environment is one of the risk factors for the development of children with gallstone disease.

Sputnik V Protection from COVID-19 of HIV-Infected Individuals Under Art

Background: HIV infection is a known factor that aggravates the clinical course of many infectious diseases including COVID-19. The international guidance suggests that benefits from preventive SARS-CoV-2 vaccination using products with proven efficacy overweigh potential risks for HIV-infected people. However, there is little data on epidemiological assessment of COVID-19 vaccines efficacy among HIV-infected people. This paper provides preliminary assessment of Sputnik V (Gam-COVID-Vac) vaccine effectiveness in HIV-infected patients under antiretroviral therapy (ART) in Moscow.Methods: We performed a retrospective cohort study to assess the effectiveness of Sputnik V standard vaccination regimen in HIV-infected patients during spring-summer 2021, comparing SARS-CoV-2 PCR-positivity, hospitalization, and severe illness rates in vaccinated and unvaccinated subjects. The study included HIV-positive subjects on ART from Moscow City Center for AIDS Prevention and Control, using data from the Moscow COVID-19 Vaccination and COVID-19 incidence Registries. Vaccine effectiveness was calculated as (1-RR)*100%, where RR – is a risk ratio to contract SARS-CoV-2 in both unvaccinated and vaccinated individuals. 2021 spring data shows Sputnik V effectiveness against initial SARS-CoV-2 variant, while summer data are indicative of vaccine effectiveness against the Delta and its descendant lines.Results: The data obtained indicate that Sputnik V epidemiological effectiveness in the entire cohort of HIV-infected people on ART in Moscow was 76·33% (95% CI 69·84% – 81·43%). In the subgroup of HIV-infected patients with CD4+ T-cell count ≥ 350 cells/μl vaccine effectiveness was 79·42% (95% CI 72·54 – 84·57), preventing hospital admissions in 90·12% (95% CI 77·70 – 95·62) and protecting from the development of moderate-to-severe and severe disease in 97·06% (95% CI 78·93 – 99·59). During predominant circulation of the delta variant Sputnik V epidemiological effectiveness in subjects with CD4+ T-cells count ≥ 350 cells/μl was 65·35% (52·61% – 74·66%), preventing hospital admissions in 75·77% (95% CI 44·25 – 89·47) and protecting from the development of moderate-to-severe and severe disease in 93·05% (95% CI 49·51 – 99·04).Conclusion: The study demonstrated high epidemiological effectiveness of full immunization with Sputnik V in HIV-infected ART-treated patients with CD4 + T-cell counts ≥ 350 cells/μl. Moreover, the epidemiological effectiveness of vaccination was documented for both – the original and the delta SARS-CoV-2 variants, with the latter predominating in the Moscow region since June 2021. Although the efficiency of the vaccine declined in immunocompromised individuals (T-cell count Funding: Ministry of Health of Russia and Moscow Healthcare Department.Declaration of Interest: DVS, DYL and ALG report patents for a Sputnik V immunobiological expression vector, pharmaceutical agent, and its method of use to prevent COVID-19. All other authors declare no competing interests.Ethics Approval Statement: All information from the databases was anonymized before it was received by the research team. The study was submitted to the Local Ethics Committee of State Budgetary Healthcare Institution Infectious Diseases Hospital № 2 Moscow Health Department. The Committee concluded (Protocol № 11 of 04/10/2021) that the study does not use identifiable biological specimens and does not provide any confidential patient data. Therefore, according to the rules of the Local Ethics Committee and National standards, this project does not require ethical approval.

Method of endonasal endoscopic dacryocystorhinostomy with plastic stoma formation

The article presents modern methods of surgical treatment of chronic dacryocystitis, a brief historical review of various options for endonasal endoscopic dacryocystorhinostomy is carried out. The method of plastic seamless formation of dacryocystostomy, which does not require intubation of the lacrimal passages and/or using of silicone stoma dilators, is described. Between 2010 and 2019 at The State Budgetary Healthcare Institution of Moscow Area Moscow regional research clinical institute n.a. M.F. Vladimirskiy, according to the developed technique, 32 patients (32 eyes) with chronic dacryocystitis were operated on. According to the results of observation 1 year after surgical treatment, all 100% of patients recorded a positive result (absence or significant decrease in lacrimation, good anatomical visualization of dacryocystostomy with a good tear passage, both passive and during washing the lacrimal passages).

Клиническая характеристика острых средних отитов и мастоидитов у детей

Objectves. To study the prevalence of acuta otitis media and mastoiditis in children according to data from the pediatric otolaryngology department of state budgetary health care institution “Regional Clinical Hospital No 2”. Tyumen city. Materials and methods. A retrospective analysis of the case histories of children who were hospitalized in the period from 2009 to 2017, the prevalence of various forms of otitis media and mastoiditis was studied. Results and discussion. The article analyzes the prevalence of clinical forms of otitis and mastoiditis in children. The number of children with otitis was 33% (4984 /15,087), of wich 68% with nonperforated form, 32% with perforated form, 6% complicated forms. Boys are more often sick, the younger and preschool age groups of children is the main risk group (85%) for the development of otitis media and mastoiditis. Conclusions. The high prevalence of otitis media and mastoiditis, their steady growth testifies to the urgency of the problem in pediatric practice.

Therapeutic physical exercises as an adjuvant method of rehabilitation for conservative therapy in the acute period of the disease of the new coronavirus infection SARS Covid-19

In order to provide rehabilitation with conservative therapy in the acute period of the disease of the new coronavirus infection SARS Covid-19, methods of physiotherapy exercises have been developed. The data of the medical rehabilitation specialist of the State Budgetary Healthcare Institution Regional Clinical Hospital №. 3 are presented, indicating the importance of physiotherapy exercises at the stage of rehabilitation during conservative therapy in the acute period of the disease of the new coronavirus infection SARS Covid-19.

Innovative project «Vector of Professional Movement» for acquisition of competencies by the middle medical personnel in the conditions of the medical department

The goal is to develop and study an experimental method for acquiring competencies by middle medical personnel and to prove its effectiveness in an inpatient Medical Department. Material and methods: analysis of the data obtained during the implementation of this method in the work of employees from among the middle medical personnel of Psychiatric Phthisiology Department No. 14 of the State Budgetary Healthcare Institution Samara Regional Clinical Psychiatric Hospital. Results: an innovative method of acquiring competencies by middle medical personnel has been developed and introduced into the practice of Psychiatric Phthisiology Department No. 14 of the SBHI SRCPH. The positive influence of the method on the medical activity of nurses of the Medical Department has been proven.

Routine correction disadvantages of iron deficiency anemia in pregnant women, women in labor and puerperas (a retrospective study based at the State Budgetary Healthcare Institution of Nizhny Novgorod Region “Dzerzhinsk Perinatal Center”)

Introduction. Iron deficiency (ID) is in almost 90% of pregnant woman by the third trimester, persisting in 55% of cases after childbirth. This study aims identification of deficiencies in the routine diagnostics and correction of iron deficiency anemia (IDA) in pregnant women, women in labor and postpartum. Methods . the study included 150 pregnant women from 18 to 43 years old, in whom iron therapy during pregnancy and the postpartum period analyzed in a complex of blood-saving technologies. Results. Serum ferritin (SF) detected only in 45% of pregnant women with anemia. In the first trimester, mild anemia diagnosed in 10% of women, moderate - in 0.6%; in the second trimester - in 47.3% and 1.2%, respectively. In the third trimester, mild anemia was in 94% of patients, moderate - in 4%. Correction of IDA in 94% of cases carried out with oral iron. In the postpartum period, all women have IDA: mild anemia in 82.7%, moderate in 15.3%, severe in 2% of cases. Mild anemia treated with oral iron, moderate - with intravenous iron in 61%, in other cases used oral iron. Conclusion. An increased severity of IDA before childbirth, in spite of it’s correction during pregnancy; it is necessary to diagnose anemia by SF in all pregnant women, with an assessment of the oral iron therapy response by hemoglobin and tolerance; in the absence of a result, intravenous non-dextran iron is indicated in the required calculated dose. Complex correction of obstetric blood loss and postpartum anemia by autoerythrocytes, blood coagulation factors and rational IDA therapy with non-dextran high-dose intravenous iron will allow us to implement restricting approach of the use of donor blood components.