Vol 33, No 4 (2016)
- Year: 2016
- Articles: 20
- URL: https://journal-vniispk.ru/PMJ/issue/view/328
Articles
CLINICOPATHOGENETIC PECULIARITIES AND PREVENTION OF TICK-BORNE BORRELIOSES
Abstract
Aim. The aim of the study was to analyze the clinicopathogenetic peculiarities of tick-borne borrelioses (TBB) course in Perm Krai and their prevention. Materials and methods. During the period from 1991 to 2015, a complex clinicolaboratory and instrumental examination of 1878 patients with borrelioses was carried out at Regional Clinical Infectious Hospital of the city of Perm. Results. The disease is manifested in two forms: erythemal (77,5 %) and erythema-free (22,5 %). The organ pathology includes the damage of nervous and cardiovascular systems, locomotor system and liver. Reliable increase in the total peripheral resistance was detected while studying the hemodynamic structure. Decrease in tissue oxygenation, capillary-tissue oxygen diffusion, tissue metabolism and blood flow was revealed when determining the state of tissue gaseous metabolism. While studying the parameters of hemostasis, changes in the form of raised SFMC level, fall in Pt and APTT were found ( p < 0,05). Platelet serotonin neuromediator level analyzed in borrelioses patients indicated significant reduction in this index versus the control values. Conclusions. The peculiar feature of acute borreliosis course consists in the damage of different organs and systems that should be taken into consideration in diagnosis of this disease. New pathogenetic mechanisms in the form of structural and functional vascular changes, disturbed hemostasis in the form of development of latent syndrome of disseminated intravascular clotting were stated. Decrease in activity of cerebral serotoninergic structures in case of acute borreliosis course was established and need for correction of this status was shown. To prevent TBB development, it is necessary to carry out an antibacterial preventive course, which is of great efficiency, and results in a 10-12 fold reduction of morbidity.
Perm Medical Journal. 2016;33(4):6-11
6-11
ENDOSURGICAL INTERVENTIONS FOR ADRENAL TUMORS
Abstract
Aim. The aim of the study was to analyze the peculiarities of intraoperative and early postoperative periods in patients with adrenal lesions and chromaffin tissue tumors (CTT), who were operated with endovideosurgical techniques. Materials and methods. The results of surgical treatment performed in 82 patients with tumors of adrenal glands were analyzed depending on the size of lesion, morphological structure and technique of adrenalectomy; 22 patients underwent «open» operations, 60 - laparoscopic ones. Results. Endosurgical adrenalectomy for tumors larger than 5 cm was established to increase the duration of surgical intervention by 32 minutes and does not influence the number of intraoperative and postoperative complications ( r = 0,09, p = 0,70). Conclusions. Duration of surgical intervention and development of complications do not depend on morphological structure of the tumor. Simultaneous surgeries performed from the laparoscopic approach insignificantly increase the duration of surgery without elevating the number of the postoperative complications and time of hospitalization.
Perm Medical Journal. 2016;33(4):12-16
12-16
PATHOGENETIC AND CLINICAL PECULIARITIES OF DISSEMINATED SCLEROSIS
Abstract
Aim. The aim of the study was to investigate the gender structure, peculiarities of fatigue syndrome and depressive disorders in patients with disseminated sclerosis (DS); to determine the cytokine status and neurotrophic mechanism, serotoninergic, semaphorin Sema4 (CD100) statuses of the above mentioned disease. Materials and methods. Patients with a reliable diagnosis of disseminated sclerosis were examined according to McDonald 2010 criteria with remittent type of disease course. Clinical method, psychometric testing, immune-enzyme analysis, immunological methods were used. Results. In process of disseminated sclerosis, patients' gender shifts to femininity. Fatigue and emotional disorders are inseparable symptoms of this disease. Neurochemistry of disseminated sclerosis is characterized by serotoninergic insufficiency and deficiency of neurotrophic mechanisms; inflammatory process does not stop in the phase of clinical remission, but semaphorin system is participating in formation of immunopathological reactions. Conclusions. Clinical and pathogenetic characteristics of disseminated sclerosis are supplemented by new data, which can be the targets of new therapeutic strategies.
Perm Medical Journal. 2016;33(4):17-22
17-22
RISK FACTORS FOR ESOPHAGOGASTRIC ANASTOMOSIS FAILURE DEPENDING ON TYPE OF ESOPHAGEAL PLASTY
Abstract
Aim. The aim of the study was to improve the results of treatment of esophageal anastomosis failure in esophagoplasty. Materials and methods. During 20 years, 262 esophageal resections with different variants of plasty for cancer and benign esophageal diseases were fulfilled. Anastomosis failure was developing in 65 % of cases (24,8 %). Results. More frequently anastomosis failure was developing after the posteromediastinal esophagogastroplasty - in 43 patients (38,4 %). Following the proximal gastric resections with esophageal resection from laparotomy approach, complications were diagnosed 11 patients (24,3 %), gastrectomy with esophageal resection - in 6 persons (16,2 %). Anastomosis failure occurred after Lewis surgeries - in 5 cases (7,7 %). Twenty three (35,4 %) patients underwent the repeated surgeries. Thirty one patients died (11,4 %). Death caused by purulent complications following anastomosis failure was registered in 58,1 % of patients. Surgical circular stapling instruments CDH and CEEA used for the formation of anastomosis permitted to reduce its failure rate from 34,1 to 15,4 %, and experience of esophageal surgery - to decrease lethality from 19,1 to 6,8 % for 20 years. Conclusions. Esophageal anastomosis failure more often occurs after the posteromediastinal esophagogastroplasty, rarely - after Lewis surgery that is connected with peculiar features of transplant blood supply. Machine suture raises reliability of anastomosis.
Perm Medical Journal. 2016;33(4):23-27
23-27
EXPERIENCE OF TREATMENT OF INFECTIOUS COMPLICATIONS AFTER PRIMARY HIP JOINT ENDOPROSTHESIS REPLACEMENT
Abstract
Aim. The aim of the study was to analyze the results of treatment of infectious complications after primary hip joint endoprosthesis replacement. Materials and methods. The results of treatment conducted in 735 patients after primary hip joint endoprosthesis replacement were analyzed. Clinical, roentgenological, laboratory and bacteriological methods of study were used. Results. Development of paraprosthetic infection is a severe complication after primary hip joint endoprosthesis replacement. Complications connected with paraprosthetic infection were found in 8 (1 %) patients. The early postoperative infectious complications developed in the terms up to 4 weeks - in 3 patients, from 4 weeks to 6 months - in 2 patients. The late postoperative infectious complications (more than 1 year) were stated in 3 patients. In 6 patients the infectious agent was revealed - it was St. Aureus ; in 1 patient it was Ps. Aeruginosa ; in 1 patient infectious agent was not identified. Three patients with developing paraprosthetic infection in the early postoperative period (up to 4 weeks) underwent debridment (sanation) of the joint using washing system and antibacterial therapy course. Conclusions. 1. The paraprosthetic infection development rate in primary hip joint endoprosthesis replacement is 1 %. 2. Efficiency of surgical treatment of paraprosthetic infection is determined by the quality of joint debridment performed, irrespective of the terms of development of this infection.
Perm Medical Journal. 2016;33(4):28-32
28-32
ASPECTS OF DIAGNOSIS AND RECONSTRUCTIVE-RESTORATIVE SURGERY IN FUNCTIONAL DISORDERS OF DIGESTIVE SYSTEM
Abstract
Aim. The aim of the study was to improve the outcomes and functional results of gastric and duodenal surgeries and as well as those of associated organs at the expense of perfection of diagnosis, surgical correction and prevention of motor-evacuatory and secretory disorders. Materials and methods. For diagnosis, the following special as well as original methods of study were used: intragastric pH-metry, balloonometric method, radiotelemetric and tensometric methods for assessment of gastric motor activity and intestinal motility; radioisotopic methods for estimation of functional status of hepatobiliary and gastrointestinal systems; roentgenological methods of double contrast study of the stomach and duodenum, endoscopic methods, pathomorphological studies, statistical processing of results with “Biostatic” program. Results. One thousand two hundred and forty eight (1248) patients underwent selective proximal vagotomy; 2199 patients - gastric resection with formation of artificial pyloric canal in different volumes (from antrumectomy to subtotal); 190 patients - gastrectomy with formation of oesophageal-intestinal reservoir, 403 patients - reconstructive-restorative surgeries for postoperative functional disorders. Conclusions. In most patients it is possible to reach good operative results and prevent development of postoperative complications at the expense of purposeful diagnosis of initial disorders, differentiated choice of surgical technique depending on the degree of severity of the diagnosed pathology and observation of certain techniques, providing optimal conditions for restoration and preservation of the most important functions of digestive system.
Perm Medical Journal. 2016;33(4):33-42
33-42
PERFECTION OF SECONDARY SINGLE-STAGE TENDOPLASTY IN MEDICAL REHABILITATION OF CONSEQUENCES AFTER INJURIES OF FLEXOR MUSCLE TENDONS OF FINGERS
Abstract
Aim. The aim of the study was to improve the results of medical rehabilitation after injuries of flexor muscle tendons of fingers in the second zone. Materials and methods. Treatment of 90 patients with consequence of injuries of flexor muscle tendons of fingers in the second zone, who underwent medical rehabilitation using the secondary single-stage tendoplasty was analyzed. Two groups of patients were formed: the group of comparison ( n = 50) with traditional operative tactics used and the main group ( n = 40) with the developed complex of measures (preoperative adaptive preparation, new technique for fixation of tendinous transplant, modified protocol of functional rehabilitation). Results. Comparative analysis of efficiency reached during treatment of patients from different groups was conducted. It was established that the developed complex of medical rehabilitation applied gave positive long-term results in 93,7 % of follow-up observation. Efficiency of treatment versus the comparison group was 9,5 %. Conclusions. The offered complex of reconstructive medical rehabilitation of patients with consequences of injuries of flexor muscle tendons of fingers including preoperative preparation, surgical aids with new technical solution and rational rehabilitation permitted to improve the results of treatment in patients with this pathology.
Perm Medical Journal. 2016;33(4):43-48
43-48
DIAGNOSTIC VALUE OF TUMOR NECROSIS FACTOR ALPHA AND POLYMORPHYSM OF ITS GENE (G4682A) IN HEPATIC CIRRHOSIS PROGRESSION
Abstract
Aim. The aim of the study was to assess the diagnostic value of tumor necrosis factor alpha (TNF-α) and polymorphysm of its gene TNF-A (G4682A) in hepatic cirrhosis (HC) progression. Materials and methods. Eighty one persons with HC and 81 healthy donors were examined. Blood TNF-α concentration and polymorphism of gene TNF-A (G4682A) were estimated. Results. Serum TNF-α level was increased in 99 % of HC patients as compared with the control group ( p < 0,001), it directly correlated with the degree of severity gj by Child-Pugh grading scale ( r = 0,31; p = 0,004) and inversely - with albumin level ( r = -0,24; p = 0,03). In case of compensated stage of HC ( n = 23), TNF-α was 2,7 (2,5-3,3) pg/ml, in subcompensated ( n = 26) - 3,6 (3,0-4,9) ( p = 0,01), in decompensated ( n = 32) - 3,9 (2,9-9,8) pg/ml ( p = 0,34). The threshold value of TNF-α for differentiation of compensated stage from subcompensated and decompensated HC stages was 3 pg/ml with sensibility 65,0 % and specificity 76,9 %. Occurrence of allel variations of gene TNF-A (G4682A) as well as association of the studied gene with the tempos of disease progression were compared in donors and HC patients. Conclusions. Determination of TNF-α level permits to assess the degree of HC severity. When serum concentration of TNF-α is lower or equal to 3 pg/ml, the compensated HC form is diagnosed, with TNF-α level higher than 3 pg/ml - the subcompensated HC is diagnosed.
Perm Medical Journal. 2016;33(4):49-54
49-54
INFLUENCE OF ALDOSTERONE LEVEL ON SYNOVIAL MEMBRANE MORPHOSTRUCTURE IN RHEUMATOID ARTHRITIS PATIENTS
Abstract
Aim. The aim of the study was to state the peculiarities of changes in patients with rheumatoid arthritis (RA) depending on blood ALD. Materials and methods. Thirty four patients with diagnosed RA were divided into two groups depending on blood aldosterone (ALD) level (determined with IEA method): group I included 16 patients with ALD level ≤ 130 pg/ml, group II - 18 patients with ALD level > 130 pg/ml. To carry out semiquantitative microdetermination of synovial membrane (SM), patients underwent knee joint arthroscopy followed by biopsy. Results. In patients of group II, it was stated as a result of morphological study that SM tectorial cells proliferation > 6 rows occurred by 35 % more often, villous hyperplasia and SM edema - by two times more often versus group I ( p < 0,05). Direct correlation between blood ALD level and the following microdetermination indices in RA patients was established: villous hyperplasia with tectorial cells proliferation, formation of lymphoid follicles, mycoid swelling and fibrinoid changes. Conclusions. High ALD level can be considered as proliferative-destructive activity marker in patients with rheumatoid arthritis.
Perm Medical Journal. 2016;33(4):55-60
55-60
BIOCHEMICAL INDICES OF VITREOUS HUMOR IN DIAGNOSIS OF DISEASES
Abstract
Aim. The aim of the study was to carry out the biochemical analysis of vitreous humor for the development of the methods of postmortal differential diagnosis of diabetes mellitus comas. Materials and methods. In the vitreous humor of 378 patients suffering in the life time from diabetes mellitus, the following indices were determined: glucose, lactate, ketone bodies, «average molecular weight» peptides content. Results. Vitreous humor glucose content higher than 17 mmol/l proves hyperglycemic coma; at the same time, glucose content higher than 9,0 mmol/l and lower than 17 mmol/l is typical for precomatose status. In case of ketoacidotic coma, vitreous humor ketonic content is higher than 4,0 mmol/l, but in case of hyperosmolar ketoacidotic coma (hyperglycemia + ketoacidosis) ketonic bodies content is higher than 2,5 mmol/l and glucose content exceeds 7,0 mmol/l. Absence of glucose and vitreous humor lactate content lower than 10 mmol/l testifies the presence of hypoglycemic coma. Conclusions. The methods for postmortal differential diagnosis of diabetic comas and endogenous intoxication syndrome were developed.
Perm Medical Journal. 2016;33(4):61-64
61-64
GENETIC CONTROL PECULIARITIES OF BIOFILM FORMATION IN ACINETOBACTER GENUS BACTERIA
Abstract
Aim. The aim of the study was to detect the degree of polymorphism of the operon pgaABCD , critically significant in the process of biofilm formation in bacteria of Acinetobacter genus , so as to assess the possible horizontal gene transfer from the other pathogens. Materials and methods. The operon pgaABCD was studied using molecular-genetic methods in clinical and natural Acinetobacter spp, belonging to different species including A. baumannii resistant to carbapenems - pathogens of ESCAPE list. The choice of strains was also conditioned by their experimentally proved ability to form biofilms. To compare, the strain Escherichia coli O157:H7 Sakai, the representative of pathogenetic subgroup EHEC, was used. Results. The G+C nucleotide content index in operon sequence of the studied strains reliably corresponds to the characteristic specific criterion. Polymorphism of amino acid (translated) sequences in the form of dissimilar amino acid substitutions (acid amino acids for neutral nonpolar ones; neutral - for basic and acid - different by hydrophobicity index) was revealed. While comparing clinical isolates A. baumannii 60perm and biofilm hyperproducer MAR002 there were shown amino acid substitutions including dissimilar ones, in pgaAB sequence. Mapping of the operon A. baumannii 60perm (Russia) and MAR002 (Spain) demonstrated an identical order of its location on the chromosome. Conclusions. The order and location of the genes, G+C nucleotide content index, mol.%, availability of dissimilar amino acid substitutions do not support the assumption on horizontal transfer of the operon pgaABCD out of Acinetobacter genus. Polymorphism of amino acid sequences in the operon of poly-beta -(1-6)- N -acetylglucosamine (PNAG) synthesis is typical for A. baumannii/A.nosocomialis group. The obtained material can be used for the development of computer (in silico) models of the most active biofilm-forming structures.
Perm Medical Journal. 2016;33(4):65-72
65-72
GLUTATHIONE SYSTEM INDICES AND CHOLESTASIS ENZYMES IN ACUTE ALCOHOLIC INTOXICATION
Abstract
Aim. The aim of the study was to assess in experiment the changes in glutathione system and activity of cholestasis system in acute alcoholic intoxication against the background of preliminary alcoholization. Materials and methods. The study was performed on 64 white rats. Acute ethanol intoxication was modeled on intact animals against the background of preliminary alcoholization. Acute poisoning was caused by intragastric introduction of 40 % ethanol solution in the dose of 0,5 LD50. Gamma-glutamiltranspeptidase and leucinaminopeptidase activity was determined spectrophotometrically in blood plasma, reduced glutathione content and glutathionreductase activity were assessed in blood erythrocytes. Results. In case of acute ethanol poisoning, blood plasma leucinaminopeptidase and gamma-glutamiltranspeptidase activity was raised, erythrocyte gluthatione content was increased. In case of acute ethanol intoxication against the background of preliminary alcoholization, erythrocyte glutathione content is decreased, gamma-glutamiltranspeptidase activity remained elevated, but leucinaminopeptidase and glutathionreductase activity did not significantly differ from the control. Conclusions. Determination of reduced glutathione content in peripheral blood erythrocytes and cholestasis enzymes activity in blood plasma is significant for the assessment of severity of cytotoxic hepatic lesion and development of cholestasis in acute alcoholic intoxication.
Perm Medical Journal. 2016;33(4):73-77
73-77
PATHOMORPHOLOGICAL CHANGES IN RAT PANCREATIC TISSUES CAUSED BY LONG ADMINISTRATION OF NIMESULIDE
Abstract
Aim. The aim of the study was to assess the character of pancreatic tissue lesion in experimental animals when modeling NSAIDs-pancreatopathy using the generally accepted methods. Materials and methods. Modeling of NSAIDs-induced lesion of pancreatic gland in nonlinear white rats was performed by means of per oral introduction of nimesulide (Nise®) during 21 days in the following doses: 0,5 mg/kg (therapeutic dose), 2,5 and 5,0 mg/g. The results were compared with the control group. By the end of experiment, histological material was taken (tissue samples) with observation of ephthanasia rules. Histological methods were used by standard protocols. Results. When using nimesulide (per orally) during 21 days, histopathological changes typical for toxic pancreatitis (vacuolar degeneration, necroses, acinus structure impairment) with marked dose-dependent effect were detected in animal pancreatic parenchyma. In animals with NSAIDs-induced lesion of the pancreas, mast cell were revealed, the number of which visually increased with growth of the dose of this drug.
Perm Medical Journal. 2016;33(4):78-81
78-81
ORGANIZATIONAL ASPECTS OF SUBLINGUAL ALLERGEN-SPECIFIC IMMUNOTHERAPY
Abstract
Aim. The aim of the study was to analyze the organizational aspects of allergen-specific immunotherapy (ASIT) including peculiarities of choosing patients for treatment, choice of drug and method of allergen introduction, time of onset and duration of therapy. Materials and methods. Patients, who in 2015 addressed to one of commercial allergic centers of Perm on account of respiratory allergic disease, were under observation. The condition for patients to be chosen for ASIT was availability of clinically significant allergic rhinitis and rhinoconjunctivivtis, elevated IgE level. Results. One hundred thirty seven patients received ASIT (102 children and 35 adults; age - from 3 to 57 years) with allergic rhinoconjunctivivtis and mild bronchial asthma. In etiological structure, there predominated pollinoses - 90,5 %, including 72,5 % - early spring trees, 9,4 % - house allergy. Duration of treatment was 88,6 ± 3,89 days. Conclusions. When choosing ASIT method, in particular, therapy with commercial allergens, the most popular method among patients is sublingual. The time to start therapy for the early spring pollinosis is not later than the beginning of February, for cereals and meadow plants - the beginning of March, for weed - the beginning of April - depending on regional peculiarities of pollination. Sublingual ASIT is characterized by good tolerance; local temporary allergic reactions are observed at the stage of choosing the dose in 11 % of patients, who do not keep to hypoallergenic diet.
Perm Medical Journal. 2016;33(4):82-86
82-86
PECULIARITIES OF MOTIVATION AND PROFESSIONAL TRAINING OF EXODONTISTS FOR MAXILLARY OSTEOPLASTIC SURGERIES AT AMBULATORY-POLYCLINIC INSTITUTIONS OF VARIOUS FORMS OF PROPERTY
Abstract
Aim. The aim was to study the exodontists’ motivation component for fulfillment of maxillary osteoplastic surgeries at ambulatory treatment-and-prophylactic institutions of various forms of property. Materials and methods. The results of clinical study based on sociological survey of 100 exodontists (76 men and 24 women) aged 29-45 years, whose length of professional service was not less than 3 years after graduating from intership or clinical residency, and who work at municipal (30 persons), departmental (24 persons) and private dental clinics and rooms (46 persons) are presented in the paper. Results. Motivational component for fulfillment of maxillary osteoplasty was studied; factors restraining introduction of osteoplastic techniques at municipal and departmental dental ambulatory-polyclinic institutions were determined. Conclusions. Academic programs and plans, worked out at the chairs conducting professional retraining, advanced training and (or) training of exodontists at clinical residency regarding operative dentistry and maxillofacial surgery need correction.
Perm Medical Journal. 2016;33(4):87-93
87-93
ANALYSIS OF RESULTS OF STUDYING HEMOMICROCIRCULATION IN SUBJECTS EXPOSED TO DIFFERENT INDUSTRIAL FACTORS
Abstract
Aim. The aim of the study was to investigate the peculiarities of blood flow in eye microvessels among workers, exposed to a complex of harmful industrial factors of different productions, so as to reveal the earliest and the most typical changes. Materials and methods. Hemomicrocirculation was studied in workers of different industries using the method of conjunctival biomicroscope in the red-free light with a 60-fold enlargement and assessment in scores. Results. Conjunctival index appeared to be the highest in workers of gold-mining industries (23,16), the lowest - in workers of gas-compressor stations of main gas pipe lines (12,85) that is a direct reflection of intensity of harmful industrial factors exposure on the human body. Conclusions. The study of conjunctiva hemomicrocirculation permits to detect the changes conditioned by the exposure of harmful industrial factors of environment and working process. Changes in eye conjunctival and retinal vessels have the same character. The results of microcirculation study allowed to develop the methods for early diagnosis of health abnormalities among workers of different industries.
Perm Medical Journal. 2016;33(4):94-101
94-101
COMPARATIVE ASSESSMENT OF LEVELS OF ANTIBODIES TO ANTIGENS USED TO VACCINATE PLASMA DONORS FOR FRACTIONATING
Abstract
Aim. The aim of the study was to compare the level of antibodies to antigens, which were used for vaccination, and those to foreign vaccine antigens among donors immunized with different vaccines. Materials and methods. The prevaccinal examination of 9459 plasma donors for fractionating during the period from 2008 to 2011 (donors aged18-60) included determination of blood serum AB to tetanus anatoxin (TA). The level of specific antibodies to tetanus anatoxin was assessed using assay kit for detection of antitoxic diphtheria and tetanic antibodies “IFA anti DS” (SPA “Microgen”, Perm). To carry out donors’ immunization, tetanus anatoxin - refined, adsorbed, liquid for donors (NPU “Microgen”, Perm) was used. Results. Changes in immune response of donors (who had in anamnesis immunizations with vaccines against TBE) were found in case of subsequent immunizations with TA for donors, that is, increase in AB production not only with TA for donors, but as a whole. A high degree of linear correlation between increase in production of AB to tetanus toxin and tick-borne encephalitis vaccine ( r = 0,73) was revealed. Conclusions. It is recommended to carry out tetanus anatoxin immunization of donors, earlier immunized with tick-borne encephalitis vaccine, in the intervals between remote revaccinations that will permit to use immune donor plasma more rationally, and if necessary, to use it for production of the other types of directed immunoglobulins.
Perm Medical Journal. 2016;33(4):102-106
102-106
MYCOLOGICAL CONTAMINATION OF AIR ASSESSED AT MEDICAL INSTITUTIONS
Abstract
Aim. The aim of the study was to investigate the epidemiological peculiarities of mycological contamination of air at medical institutions. Materials and methods. Microbiological study was carried out in different rooms of medical institutions ( n = 454) using methodical guide MUK 4.2.2942-11 «Methods of sanitary-bacteriological studies of environment, air and control of sterility at medical institutions». Results. On the basis of the obtained data, epidemiological characteristic of dynamics of detecting the samples not corresponding to sanitary and hygienic standards was presented. It was established that during the whole period of studies, growth of fungi of different types was found in 35,9 ± 2,3 % of cases. Conclusions. These studies testify the necessity of developing additional measures for reduction of mycological contamination of air at medical institutions during the periods of maximum risk for occurrence of health care-associated infections.
Perm Medical Journal. 2016;33(4):107-112
107-112
MANAGEMENT TACTICS FOR PATIENTS WITH URINARY INFECTION
Abstract
Modern approaches to diagnosis, management and prevention of complicated urinary infections are presented in the paper. The clinical example was used to describe the main principles of management in patients with pyelonephritis in conditions of polyclinic, aimed at timely diagnosis of disease and reduction of risk for development of possible complications.
Perm Medical Journal. 2016;33(4):113-124
113-124
CONTRIBUTION OF SCIENTISTS OF PERM STATE MEDICAL UNIVERSITY NAMED AFTER E.A. WAGNER TO HEALTH PROTECTION OF THE POPULATION
Abstract
Documents containing short information on the foundation and development of higher school - beginning from medical faculty to medical university, achievements of scientists reached at each historical stage, relationship with practical health service are presented in the paper. The role of scientists of different spheres of medicine, their scientific development, ideas and directions in therapeutic, diagnostic, preventive and organizational activity aimed at the struggle with prevailing diseases and perfection of medical and sanitary provision, development of medical science and health protection of the population as a whole is shown.
Perm Medical Journal. 2016;33(4):125-134
125-134