Vol 30, No 6 (2013)
- Year: 2013
- Articles: 21
- URL: https://journal-vniispk.ru/PMJ/issue/view/184
Articles
TRANSVENTRICULAR SUTURAL SEGMENTAL ANNULOPLASTY OF POSTERIOR MITRAL VALVE SEMI-CIRCUMFERENCE AS A VARIANT OF TRANSGASTRIC CORRECTION OF ISCHEMIC MITRAL REGURGITATION IN PATIENTS WITH POSTINFARCTION LEFT VENTRICULAR ANEURISM
Abstract
Aim. To choose the method of correcting a moderate ischemic mitral regurgitation (IMR) in patients with ischemic cardiomyopathy is an actual task of modern cardiosurgery. Materials and methods. The results of treatment of 75 patients with chronic postinfarction left ventricular aneurysm (CLVA) and moderate annuloectasia-caused ischemic mitral regurgitation operated in 2007–2008 were studied. Results. All patients underwent coronary shunting, left ventricular aneurysm resection with Dor’s remodeling, 26 patients – transventricular sutural segmental annuloplasty of posterior mitral valve semi-circumference, 49 – mitral ring annuloplasty. The obtained results (three-year observation period) prove the comparable efficiency of both mitral reconstruction techniques used for liquidation of a moderate ischemic mitral regurgitation. Conclusion. The procedure of transventricular sutural segmental annuloplasty of posterior semi-circumference of the mitral valve (MV) is easy to perform and provides satisfactory hemodynamic indices.
Perm Medical Journal. 2013;30(6):6-13
6-13
QUALITY OF SLEEP AND COGNITIVE STATUS IN ACUTE PERIOD OF INSULT AMONG PATIENTS WITH MINIMUM MOTOR DEFICIENCY
Abstract
Aim. To assess the correlation between the subjective quality of sleep and the cognitive status in the acute period of insult among patients with minimum motor deficiency. Materials and methods. 67 patients (42 men and 25 women, aged 33–75 years) were examined in the acute period of insult. Neuropsychological study included the following tests: Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), Watch Drawing Test (WDT), Words Test (5) (WT), Schulte Table (ST) and categorical Verbal Fluency Test (VF); the quality of sleep was assessed using Pittsburg Sleep Quality Index (PSQI) determination. Results. Neurodynamic, dysmnestic and mixed types of disorders were singled out on the basis of neuropsychical study. Conclusion. The cognitive status and subjective quality of sleep were assessed in 67 patients in the acute period of insult. After insult, patients had a reduced quality of sleep regarding the time of falling asleep, duration, sleep disturbance and day dysfunction. Low quality of sleep correlated with lower indices of verbal and regulatory processes. The most marked sleep disturbances were detected in patients with mixed and dysmnestic variants of cognitive deficiency.
Perm Medical Journal. 2013;30(6):14-19
14-19
PATIENTS WITH ACUTE CORONARY SYNDROME AND ELEVATED ST SEGMENT AT THE HOSPITAL HAVING NO OPPORTUNITIES TO PERFORM INVASIVE CORONARY INTERVENTIONS: ANALYSIS OF MEDICAL TACTICS AND HOSPITALIZATION OUTCOMES
Abstract
Aim. To give recommendations concerning optimization of treatment at the hospital having no opportunities to perform invasive coronary interventions for patients with acute coronary syndrome and elevated ST segment. Materials and methods. Medical tactics was analyzed in 190 patients with acute coronary syndrome and elevated ST segment at the Unit of Urgent Cardiology of Smolensk Emergency Hospital. Results. Disadvantages in treatment tactics concerning patients with acute coronary syndrome and elevated ST segment were revealed. Thrombolytic therapy was carried out only in 18,42% of patients. Intrahospital mortality was 17,99%, acute heart failure was diagnosed in 19,48% of patients. Conclusion. Patients with acute coronary syndrome and elevated ST segment treated at «invasive» hospitals have a high risk of unfavourable outcomes. It was recommended by the results of this study to follow modern guidelines regarding management of patients with acute coronary syndrome and elevated ST segment, to use widely thrombolytic therapy, low-molecular heparins, up-to-date antiplatelet and hypolipidemic drugs.
Perm Medical Journal. 2013;30(6):20-26
20-26
DIAGNOSIS AND NEW TECHNIQUE FOR GASTRIC EROSION AND ULCER TREATMENT
Abstract
Aim. To develop and assess the efficiency and safety of a new technique for treatment of gastric erosions and ulcers by means of combining proton pump inhibitor and probiotics. Materials and methods. The results of treatment using the combination of ezomeprasol and lactobacterin were studied in 102 patients including 51 (50,0%) patients with erosive gastritis detected for the first time, 26 (25,5%) – with erosive gastritis relapse, 15 (14,7%) – with gastric ulcer revealed for the first time, 10 (9,8%) – with combination of gastric ulcer and erosions. The control group consisted of 40 patients who were similar by all the indices and treated using the combination of antisecretory and antibacterial drugs: de-nol + amoxicillin + metronidasol+ omeprasol. Results. The diagnostic program including clinical, endoscopic, morphological and immunological investigations allows to determine the significance of microflora in gastric erosions and ulcers and to assess the indications for antibacterial therapy. Conclusion. The combined treatment using ezomeprasol and antagonistically active culture Lactobacterium plantarum 8P-A3 mixed with almagel is highly effective and nontoxic; it has no contraindications and is significantly cheaper than the analogous by their efficiency methods.
Perm Medical Journal. 2013;30(6):27-31
27-31
COMPLEX SURGICAL TREATMENT OF PATIENTS WITH PURULO-NECROTIC COMPLICATIONS OF REPLANTED EXTREMITIES
Abstract
Aim. To raise the efficiency of treatment in patients with purulo-necrotic complications of replanted extremity segments. Materials and methods. The results of complex treatment of 65 patients with traumatic amputations of the hand and forearm and purulo-necrotic complications are presented in the paper. Treatment of patients of the main group (33 patients) in the postoperative period included, along with traditional, prolonged lymphotropic antibacterial therapy using 1% methylene blue combined with cephtriaxon. The results were estimated by means of standard clinicolaboratory investigations. Quantitative determination of microorganisms in 1 g of the tissue obtained from the wound with calculation of the number of colony-forming units (CFU) in 1 ml of the investigated material was carried out. Results. Clinical analysis of the main group of patients showed decrease in bacterial semination of the postoperative wound from 4,41±1,12×10 5 to 6,4±1,35×10 3 in 1 ml of the investigated material ( p <0,001) by the day 15, fall in initially existing purulo-necrotic complications to 18,2% versus 50% in the comparison group ( p <0,05) beginning from the day 30 and reduced average period of hospitalization from 40,1±3,16 to 33,5±2,76 days ( F =1,1, p =0,03). Conclusion. Lymphotropic therapy in complex treatment of patients with replanted extremities promotes decrease in purulo-necrotic complications by 31,8%, reduces the period of treatment by 16,5% and is an effective method for treatment of patients with purulo-necrotic complications of deep subfascial structures developed after replantation of extremities.
Perm Medical Journal. 2013;30(6):32-36
32-36
RESULTS OF A SINGLE-STAGE REVASCULARIZATION AND SANATION OF PURULO-NECROTIC FOCUS IN PATIENTS WITH CRITICAL LOWER EXTREMITIES ISCHEMIA AGAINST THE BACKGROUND OF DIABETES MELLITUS
Abstract
Aim. To compare the efficiency of a single-stage and staged tactics of surgical treatment in patients with critical ischemia against the background of combined arterial bed lesion. Materials and methods. The results of examination and treatment of 86 patients with critical ischemia caused by combined lesion including type II diabetes mellitus and magistral atherosclerosis were studied. The preoperative diagnosis included ultrasonic dopplerography, duplex arterial scanning, aortoarteriography, estimation of foot and shin microcirculation using transcutaneous measurement of tissue oxygen tension. Critical ischemia corresponded to III–B–IV stage with severe purolo-necrotic process in the foot tissues (stage ID–IIID). According to the order and terms of performing surgical interventions, patients were divided into two groups: Ia (43) – sanation of purulo-necrotic focus was fulfilled simultaneously with revascularization, Ib (43) – inflammatory focus was liquidated either before or after the blood flow correction. Results. In subgroup Ia, the period for healing ulcerous and wound defects on the foot was 42,90±5,70 days; no lethal outcomes, hemorrhages and infection generalization was registered. An effective restoration of blood flow and preservation of extremity was reached in 97,67% of cases. In subgroup Ib, the results were the following: the healing period – 58,72±6,86 days, shunt thromboses – in 20,93% of cases, arrosive hemorrhages – 2,39% and progressive purulent process – 25,58%. An effective restoration of hemorrhage in subgroup Ib was reached in 81,39%, preservation of extremity in 90,69% of observations. Conclusion. A single-stage surgical tactics permitted to significantly decrease the number of vascular and purulent complications ( p =0,0074 and p =0,0008), to reduce the period for healing ulcerous defects ( p =0,040935) and to preserve the support ability of extremity in 97,67% of cases.
Perm Medical Journal. 2013;30(6):37-44
37-44
PROGNOSTICATION OF POST-NATAL PYOSEPTIC COMPLICATIONS IN CONDITIONS OF PERINATAL CENTER
Abstract
Aim. To evaluate the clinical efficiency of a score system for prognostication of the post-natal pyoseptic complications (M. S. Selikhova, 2008) in perinatal center patients. Materials and methods. Peculiarities of anamnesis, pregnancy course, labor and post-natal period were analyzed in 111 patients of the perinatal center depending on the degree of developmental risk of the post-natal pyoseptic complications. Results. Statistically reliable differences by all the analyzed indices were detected in patients of different risk groups. Women in childbirth of high risk groups have more extragenital pathologies, extragenital and gynecological chronic inflammatory diseases prior to and during pregnancy and pregnancy complications caused by them. In the post-natal period, they more often require intrauterine interventions, have more marked local and systemic inflammatory reactions and clinical manifestations of the post-natal endometrites. Conclusion. The score system applied for prognostication of the post-natal pyoseptic complications (M. S. Selikhova, 2008) in patients of the perinatal center permits to prognosticate peculiarities of the post-natal period course and to plan diagnostic and preventive measures depending on difference in the supposed complications.
Perm Medical Journal. 2013;30(6):45-51
45-51
GENDER PECULIARITIES OF EXTERASE BLOOD NEUTROPHILE ACTIVITY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C
Abstract
Aim. To study the changes in functional activity of blood neutrophiles in dynamics of treatment among patients with chronic viral hepatitis C (CVHC) depending on gender peculiarities. Materials and methods. 361 patients with CVHC were examined and treated. The disease had different degrees of activity. Exterase activity of neutrophiles was determined in dynamics – prior to and after treatment. The study was performed using R.P. Nartsissov’s technique. The results were calculated with Kaplow’s semiquantitative method. Results. Among CVHC patients with minimum degree of activity prior to treatment, men and women had tension of alphanaphthylbutyratesterase (BE) activity but alphanaphthylacetatesterase (AE) activity remained within the norm. After the basic therapy, BE activity was significantly inhibited, AE was intact. Against the background of complex therapy, men had inhibition of activity of both esterases. Women had an inhibited BE activity and elevated AE activity. Among CVHC patients with low degree of activity, prior to treatment esterase activity was decreased in men and elevated in women (AE), but BE – on the contrary, increased in men and decreased in women. After the basic therapy, men had an elevated esterase activity, but women – normalization of both esterases. After complex therapy, esterase activity completely normalized in both men and women. Application of basic and complex therapy leads to full normalization of esterases in women and AE in men. Conclusion. In CVHC patients with different degrees of activity there are differences in esterase activity of neutrophiles depending on gender peculiarities.
Perm Medical Journal. 2013;30(6):52-58
52-58
PROGNOSTIC VALUE OF TRADITIONAL LABORATORY-INSTRUMENTAL INDICES IN CARDIOVASCULAR DISEASES
Abstract
Aim. To study and determine the prognostic value of screening indices and structure-functional status of myocardium in development of some cardiovascular diseases. Materials and methods. The study as well as correlation and regressive analysis of hemogram, coagulogram, lipidogram and echocardiogram indices was carried out in 249 patients with arterial hypertension (AH) and different forms of ischemic heart diseases IHD and 33 conditionally healthy persons. Results. Intergroup differences by eosinophil, basophile and lymphocyte content were established. The absolute values of LDLP and VLDLP CH grew depending on the severity of coronary pathology, but HDLP CH remained stably low. Hemostatic status was characterized by predominant activation of vasculothrombocyte component and fibrinolysis exhaustion. Unfavourable associations between atherogenic lipid fractions, coagulation component indices, peripheral blood cells and structural myocardial changes were established. Conclusion. The number of leukocytes, granulocytes and monocytes does not yield by its predicting CVD development ability to such traditional factors as sex, age, total cholesterol and fibrinogen level.
Perm Medical Journal. 2013;30(6):59-65
59-65
CARDIOVASCULAR RISK SERUM MARKERS AND QUALITY OF LIFE IN AMBULATORY PATIENTS WITH ISCHEMIC HEART DISEASE AT OUTPATIENT STAGE
Abstract
Aim. To study the correlation between the quality of life (QL) indices and the serum inflammatory marker concentrations in patients with ischemic heart disease (IHD) at the ambulatory stage. Materials and methods. 55 patients aged 44–73 were divided into groups. The main group included 30 IHD patients, the control – 25 practically healthy persons. The following blood serum inflammatory marker concentrations were determined: C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), interferon-γ (INF-γ), tumor necrosis factor-α (TNF-α) as well as lipoprotein (a) (LP(a)), fatty acid binding protein, N-terminal natriuretic propeptide, VII factor of blood coagulation, Willebrand factor (WF). The quality of life indices were estimated using SF-36 survey. Results. Increase in CRP (mean value 3,9±3,20) and IL-8 (20,5±11,96 ) concentrations in IHD patients was revealed. The quality of life indices in IHD patients by most SF-36 scales were lower than in the control group. Negative correlation between QL indices and IL-6, INF-γ, TNF-α, WF concentrations was stated. Conclusion. Negative correlation between QL indices and inflammatory markers indicate a clinical significance of inflammatory process in case of IHD.
Perm Medical Journal. 2013;30(6):66-71
66-71
NEW METHODS FOR DIAGNOSIS AND CORRECTION OF LYMPHODYNAMICS IN CHRONIC LYMPHOVENOUS LOWER EXTREMITY INSUFFICIENCY
Abstract
Aim. To improve the results of treatment of patients with lower extremities CLVI by means of introducing new methods of diagnosis and applying draining thoracal lymphatic duct (TLD) operations. Materials and methods. Lymphodynamic indices were studied in patients with CLVI of lower extremities using US-scaner. 36 patients with CLVI (main group) underwent variants of draining TLD operations but 68 patients (control group) – traditional methods of CLVI therapy. Results. The obtained data prove the presence of lymphatic hypertension in CLVI patients both at peripheral and TLD level and development of dynamic TLD orifice insufficiency. It permitted to use variants of draining cervical TLD surgeries so as to reduce lymphatic hypertension. Surgical technique for treatment of chronic lymphovenous insufficiency of lower extremities was developed (Patent №2466685). Variants of draining TLD surgeries were used for CLVI patients and influence of this intervention on peripheral and central lymphodynamics was studied. Treatment results were compared with those received by traditional techniques. Conclusion. Experience of applying draining TLD surgeries in patients with CLVI of lower extremities and the nearest positive results make it possible to continue our work in this direction.
Perm Medical Journal. 2013;30(6):72-76
72-76
MODERN ASPECTS OF IMPROVING HEALTH IN CHILDREN FROM RISK GROUP OF PERSISTENTLY AND FREQUENTLY FALLING ILL
Abstract
Aim. To estimate the efficiency of rehabilitation measures by means of using homeopathic remedies for children from the risk group of persistently and frequently falling ill (RGPFFI). Materials and methods. A cohort, prospective, open study was carried out in children from the risk group of persistently and frequently falling ill (RGPFFI). The developed program included observation of five year-old children from the risk group of persistently and frequently falling ill and children who had acute respiratory infection (ARI) during the study. The study involved 222 children. They were divided into 3 groups; rehabilitation measures were presented by antiviral homeopathic drug ocillococcinum combined with vitamins. Children with ARI were administered the drugs corisalium and ocillococcinum. All children underwent clinical screening investigation of skin carotinoid index (SCI). Results. During six months, the number of sick children in first three groups reliably ( p <0,1) reduced as compared to the forth group (the control). While performing rehabilitation measures with homeopathic drug ocillococcinum and vitamins (Multi-tabs Immuno-kids, Vetaron-E, Multi-tabs Intello-kids with Omega 3), percentage of sick children with ARI significantly decreased for 6 months and one year. The efficiency of combined use of ocillococcinum and vitamins is reliably higher ( p <0,02) than their separate application. The obtained data on children’s skin carotinoid content showed that the lowest indices were detected in group 4 (the control) 22,03±1,15 ( p <0,03) where children did not receive antirecurrent therapy (vitamins, antioxidants and homeopathic drug ocillococcinum). At the end of the study, high SCI content in comparison with the first month was noted. Conclusion. The efficiency of rehabilitation measures contributed to decrease in ARI morbidity among children from the risk group of persistently and frequently falling ill when they were administered antiviral homeopathic drugs ocillococcinum and corisalium combined with vitamins. Antioxidant activity was higher in groups 2 and 3 and was preserved till the end of the study. Good tolerance of homeopathic drugs, absence of allergic reactions in pre-school children was detected.
Perm Medical Journal. 2013;30(6):77-81
77-81
ASSESSMENT OF BUFFERED FORMALIN EFFECT ON ALKALINE PHOSPHATASE ACTIVITY BY MEANS OF ELECTROCHEMICAL METHOD
Abstract
Aim. To assess the effect of formalin on the activity of alkaline phosphatase in vitro using electrochemical method. Materials and methods. The method based on assessment of alkaline phosphatase activity by its substrate decay products (1-naphthyl phosphate) possessing electrochemical activity was developed. Alkaline phosphatase solution samples were mixed with buffered formalin (10% concentration) in the ratio of 50:50 and stored during 10–240 minutes at the room temperature. Alkaline phosphatase samples free of formalin served as the control. Then, chronoamperometric measurement of enzyme activity after addition of substrate (1-naphthyl phosphate) was performed. Results. It was established that alkaline phosphatase activity is significantly reduced already in 2 hours after its contact with buffered formalin. Conclusion. It is recommended to determine AP activity in nonfixed biological tissues or in 10% neutral formalin fixed tissues for not more than two hours.
Perm Medical Journal. 2013;30(6):82-86
82-86
COMBINED PRESERVATIVE PROPERTIES USED TO FREEZE PLATELET PRESERVATIVES
Abstract
Aim. To determine the properties of a new cryopreservative based on hexamethylentetraoxyethylurea (HMBTOEU) and dimethylacetamide (DMAC) and its effect on functional platelet ability. Materials and methods. The effect of different variants of cryopreservative on the platelet function was analyzed. Results. Osmolarity of the studied solutions was from 184 to 750 mosm/l. When the solution components’ concentration increased their osmolarity grew. The acidity index (pH) of the prepared forms of cryopreservative was 5,6–6,0, pH of native platelet preservatives (PP) – 7,32±0,12 and their osmolarity – 309±13,0 mosm/l. After cell suspension was mixed with cryophylactic solutions, pH of platelet preservatives decreased from 7,0 to 6,2, osmolarity ranged from 246,2±8,62 to 541,0±23,0 mosm/l; 92,9–96,2% of the basic amount of cells was preserved and their functional activity was registered at the level of 61,5–84% (of the corresponding native PP indices) Conclusion. The composition of cold-protective solution determines physic-chemical properties of cryopreservative itself (pH, osmolarity) as well as the degree of changes in morphofunctional activity at the stage of PP exposition with cryopreservative.
Perm Medical Journal. 2013;30(6):87-92
87-92
EARLY DIFFERENTIAL DIAGNOSIS PRINCIPLES OF LOCAL AND GENERALIZED FORMS OF SURGICAL SOFT TISSUE INFECTION
Abstract
Aim. To determine the occurrence rate and to search the methods of early clinicolaboratory diagnosis of different variants of generalized form of surgical soft tissue infection. Materials and methods. Prospective study of the results of treatment of 2350 patients with different purolo-necrotic diseases of the soft tissues was carried out. Results. The results of dynamic blood TNF, IL-1RA, CRP, oligopeptides and lactoferrin investigation in local and generalized forms of soft tissue infection detected direct correlation between CRP, oligopeptide, lactoferrin and TNF levels that allowed to use these markers in diagnosis of generalized forms of infection. Taking into account the results of analysis, diagnostic criteria of compensated systemic inflammatory response syndrome and sepsis were determined. Sepsis is characterized by increase in CRP>30 mg/l, oligopeptides>0,34 un, lactoferrin>1900 ng/ml, TNF>6 pg/ml and decrease in IL-1RA<1500 pg/ml with systemic inflammatory response syndrome preserved for more than 72 hours from the initiation of an adequate therapy. Lower blood TNF, CRP, oligopeptide and lactoferrin concentrations and IL-1RA level exceeding 1500 pg/ml accompany the compensated systemic inflammatory response syndrome. Conclusion. A new approach used for early diagnosis of generalized infection makes it possible to optimize and raise the efficiency of its treatment.
Perm Medical Journal. 2013;30(6):93-98
93-98
QUALITY OF LIFE AS EFFICIENCY CRITERION OF INTERACTIVE PROGRAM FOR TRAINING PREGNANT WOMEN WITH CHRONIC URINARY INFECTIONS
Abstract
Aim. To estimate the level and indices of the quality of life (QL) in pregnant women with chronic urinary infections (CUI). Materials and methods. The efficiency of the developed training interactive program was estimated in dynamics by QL level, medical activity and hygienic literacy of 102 pregnant women. The universal international Russian-language health status survey SF-36 was used as an instrument. Mathematical apparatus included parametric (calculation of relative and mean values with estimation of their reliability) and nonparametric methods (χ2). Results. Training at «Health School for Pregnant Women with Urinary Infections» was conducted by means of interactive and informative programs based on the nursing technology «nursing process». It was shown that introduction of this method leads not only to raising the level of patients’ hygienic literacy (HL) and medical activity (MA) by 51,0%, but also the QL level at the expense of role emotional and role physical functioning indices (42,9% each). Conclusion. The QL level and its indices, variability of their contribution to QL are important efficiency criteria of innovation forms of training. Training of pregnant women with CUI promotes not only elevation of QL, HL and MA levels, but smoothes women’s role crisis during pregnancy.
Perm Medical Journal. 2013;30(6):99-106
99-106
BIOLOGICAL AGE DETERMINATION IN PATIENTS WITH CHRONIC HEART FAILURE
Abstract
Aim. To determine the biological age of patients of senior age groups with chronic heart failure (CHF) of different functional classes treated at the hospital for war veterans so as to establish their individual rate of ageing. Materials and methods. 86 male patients aged 72–96 (82,436±4,624) hospitalized to Geriatric Unit of Perm Regional Hospital for War Veterans who against the background of ischemic heart disease and arterial hypertension had functional classes I–IV CHF were examined. CHF severity was assessed by NYHA classification functional classes. The comparison group included 10 men aged 80,88±1,902 without clinical cardiovascular system (CVS) manifestations. Out of all standard protocol indices of echocardiogram characterizing morphofunctional CVS status, the most changeable while ageing (correlation coefficient 0,8 and more) and minimally correlating between each other parameters were chosen using the method of discriminant analysis. So, we took into consideration the following echocardiographical indices: AOd – aortal orifice diameter; LA – left atrium size, mm; VST – vetntricular septum thickness, mm. Besides, biological age (BA), due biological age (DBA) and individual BA and DBA difference index (∆T) were determined. Statistical processing of the obtained results was performed using t-Student’s test. Results. For the group of comparison, the delayed rate of aging and for CHF patients the accelerated aging with ∆T>0 (or BA/DBA>1) was established. At the same time, in patients with FCII, the degree of aging was not significantly increased, but in patients with FC III–IV CHF it was accelerated. (comparison group – FC III–IV, p 0 – III–IV£0,005). Conclusion. Biological age of the examined patients without clinically marked CVS pathology is significantly lower than the population standard that reflects the delayed rate of aging. Functional class II–IV CHF negatively influences the rate of aging and viability, raises the rate of patients’ aging, thus, significantly reducing the adaptive patency of the body and increasing the probability of death. The method of BA determination is easy-to-use in conditions of functional polyclinic and hospital units. Consequently, BA determination can be used for annual deepened medical examinations. Knowledge of age standards for patient’s circulation system and BA is to be taken into account while choosing medical tactics and giving recommendations regarding the mode of life.
Perm Medical Journal. 2013;30(6):107-111
107-111
EXTERNAL CAUSES OF DEATH IN RUSSIAN REGIONS
Abstract
Aim. Decrease in the population in the Russian Federation is determined, first of all, by a high level of mortality (annually nearly 2 mln people die in the country). But how these, exceeding the maximum values, mortality levels are distributed among different regions of Russia? The objective of the present study was to reveal the regularities of territorial dynamics of the mortality rate indices. Materials and methods. Since 1992 the author has been carrying out field studies in the villages of Tver region using the methods of oral history and inclusive observation by his own programs. Demographic indices for Tver region and other regions of the Russian Federation presented in official documents of Federal State Statistics Service of RF, the data enumeration census (October 2010) are analyzed in the paper. Results. From 1980 to 1991 mortality indices are constant for each subject and for Russia as a whole. Minimum mortality values (nearly 6%) are registered in Dagestan, maximum (nearly 15%) – in Tver region. Mortality in Bashkortostan (nearly 10%) during these years approaches the mean values for Russia. Beginning from 1991 there is a significant growth of mortality in all the regions of RF reaching the peak by the middle of the nineties. After default of 1998 mortality grows again and in 2002–2003 in some regions it is raised to maximum values of 1993–1994. Dagestan showed the highest rates of growth of the population among the Russian regions. According to the data of enumeration census of 2010, the population of Dagestan in comparison with 2002 increased by 15,6%. Conclusion. After the Soviet Union was disintegrated in 1991, there began the growth of mortality and reduction of birth rate in Russia. Since the end of the nineties, smooth growth of birth rate began in the country being equal to mortality indices by 2013. In different regions of this country the level of natural movement indices of the population differs rather significantly. There is a need in urgent measures of the government directed to family and childhood support so as to stop the process of depopulation and stable growth of the population. Dynamics of natural movement of the population in different regions of the Russian Federation essentially differs and can be one of the basic indices while assessing the rate of this or that territory and estimating the efficiency of the managing structures of different levels.
Perm Medical Journal. 2013;30(6):112-118
112-118
RISK FACTORS FOR CIRCULATORY DISEASES IN DIFFERENT GROUPS OF POPULATION OF PERM TERRITORY
Abstract
Aim. To analyze the circulatory diseases morbidity (CDM) in the group of the population of Perm Territory (PT) taking into account the possible effect of ethnic belonging, urbanization degree and allele carriage APOE* ε 4 . Materials and methods. The averaged for the period of 2001–2011 annual CDM indices (per 1000 persons, further ‰) for the cities and regions of Perm Territory were analyzed. In the sample of Russian people of Priuralie ( n =164), the following allele frequencies APOE* ε 3, ε 2 ε 4 were stated. The corresponding data were obtained earlier for Komi-permyak sampling. Results. CDM in the rural regions with the Russian population prevailing was 26,2%, in Perm and other cities of PT – 17,3 and 19,6% in (difference between urban and rural population p <0,05). Maximum CDM was registered in the regions with prevalence of Komi-permyak population (villages 27,3%, Kudymkar 31,1 %). The share of allele carriages APOE* ε 4 associated with increased cholesterol content in Russian people of Perm Territory was 0,170, in Komi-permyaks – n 0,144. These frequencies are relatively high in comparison with the other groups of Russian people and European populations. Elements of self-preservation behavior are weaker expressed in the population of Perm Territory with a relatively low educational status and in rural population. Conclusion. The population of Perm Territory has a comparatively high share of allele carriages APOE* ε 4 being a risk factor for cardiovascular pathology. The contribution of medicogenetic, cultural and economic factors into CDM of the population of Perm Territory needs special study.
Perm Medical Journal. 2013;30(6):119-127
119-127
DYNAMICS OF PSYCHOPATHOLOGICAL SYMPTOMS IN PATIENTS WITH DISTURBANCES OF SСHIZOPHRENIC SPECTRUM UNDERGOING COMPULSORY TREATMENT AT GENERAL TYPE MENTAL HOSPITAL
Abstract
Aim. To assess the manifestation and dynamics of psychopathological symptoms by positive and negative symptoms scale (PANSS) in 82 patients with schizophrenia and disturbances of schizophrenic spectrum undergoing a course of compulsory treatment at the mental hospital of general type taking into account gender peculiarities. Materials and methods. The results of observation of 62 patients undergoing a course of treatment at the mental hospital of general type were studied. Paranoid form of schizophrenia prevailed irrespective of a gender composition. Manifestation and dynamics of psychopathological symptomatology was assessed using PANSS. To register the data, PANSS signs reflected in three subscales (positive, negative and general pathological) as well as total summary score were applied. The data were estimated at the beginning of hospitalization and at the moment of discharge from hospital. Results. Manifestation of psychopathological symptoms at admission to hospital was significantly higher ( p <0,001) in female patients (69,2±12,9 in women and 58,8±10,0 in men), predominantly at the expense of positive and general pathological symptoms. At the moment of discharge form hospital, women had a reduced manifestation of positive and general pathological symptoms with a reliable difference ( p <0,001) as compared to the admission symptoms. Among men, in spite of decreased PANSS values, this dynamics was less evident. By the moment of discharge from hospital, manifestation of general pathological symptoms in women (29,5±3,9) was higher than the analogous indices in men (25,6±5,3) with a reliable difference ( p <0,001). Conclusion. The reached relapse of mental disorders is one of the necessary conditions for assessment of the efficiency of compulsory treatment, however, it is not the only efficiency criterion. Individual-psychological peculiar features and social setting taken into account are not less important.
Perm Medical Journal. 2013;30(6):128-132
128-132
DEVELOPMENT OF RUSSIAN MEDICAL LEGISLATION IN SOVIET AND MODERN PERIOD
Abstract
M State Academy of Medicine named after Academician E. A. Wagner, Perm, Russian Federation The present paper is devoted to the study of formation and development of Soviet and modern legislation. Legal acts regulating relations in the sphere of rendering medical care are considered in the context of forming a state system of public health and subsequent transformation of the state to market economy. It was concluded that the Soviet period (1917–1991) is characterized by presence of the system of state public health in the country – a net of state medical institutions, prohibited private medical practice, heightened responsibility of medical staff for the quality of medical care including a criminal one. The post-soviet period (1991 to present days) is notable for variety of types of both state and private medical institutions functioning in the framework of one legal field.
Perm Medical Journal. 2013;30(6):133-139
133-139