Молодежь и медицинская наука в XXI веке 30 марта 1 апреля 2011 года г. Киров
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Leushina E.A.
EVALUATION AND ESTIMATION OF LIFE QUALITY IN PATIENTS
WITH OSTEOARTHRITIS
Kirov State Medical Academy
Internal Medicine Educational Department
Head of the Department: professor B.F. Nemtsov
Scientific supervisor: professor O.V. Simonova
The purpose of the current study was to evaluate and estimate life quality of patients with osteoarthritis. Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone.
The main targets of the investigation were:
- To study indices of life quality in patients with osteoarthrosis.
- To perform a comparative analysis of indices of life quality of patients with osteoarthrosis and practically healthy individuals.
Materials and methods. 105 patients with reliable osteoarthrosis were studied. Of them, there were 98.1 % of female patients. The average age was 57.817.8 years. 43.8% patients had joint syndrome tor up to 5 years. 40% had it for 5 to 10 years. 16.2% had it for over 10 years. The majority of patients (45.7%) had gonarthrosis. 7.7% of patients had coxarthrosis (arthrosis of the hip). 10% of patients had osteoarthrosis of wrist bones. 27.6% of patients had polyosteoarthrosis. All the patients had either X-ray stage II (64.8%) or X-ray stage III (41.9%). The patients had I (58.1%) or II (41.9%) degrees of functional insufficiency. 28.6% of patients had signs of reactive synovitis.
Life quality was studied according SF-36 scale . The Short Form (36) Health Survey is a survey of patient health. The SF-36 is commonly used in health economics as a variable in the quality-adjusted life year calculation to determine the cost-effectiveness of a health treatment. To evaluate and estimate the influence of the disease on life quality of patients comparative analysis of indices of life quality of patients with osteoarthrosis and indices of population norms was performed. The technique was developed by St. Petersburg International Center for Investigation of Life Quality. Major indices were used. They were: physical functioning; role limitations because of physical problems; role limitations because of emotional problems; vitality; mental health; social functioning; bodily pain; general health.
Results. Investigation of the influence of the disease and treatment on indices of physical, psychological, social functioning of the patients was performed. All the indices of life quality were reliably and significantly worse in patients with osteoarthrosis than in healthy individuals (p<0.05). In patients with osteoarthrosis indices of physical health changes to a greater extent. Those were physical functioning, role limitations because of physical problems, bodily pain, role limitations because of emotional problems. Decrease of role limitations because of physical problems was 35%. As compared with healthy individuals, decrease of bodily was 54%. Decrease of physical functioning was 52 %. Among the indices of life quality that characterized psychological health (vitality, social functioning, role limitations because of emotional problems, mental health), role limitations because of emotional problems decreased to a greater extent (50%). The index of social functioning is the highest among all the parameters of life quality in patients with ostearthrosis (55.5), Nevertheless, it was 12.5% lower than in healthy individuals.
Conclusions. The results and findings show life quality worsens in patients with osteoarthrosis. Physical health, psychological health and social activity worsen.
Mokretsova A.
MERCY FORMULA: THE DOCTOR AND THE DYING MAN
Kirov State Medical Academy,
Department of Foreign Languages, Latin and Russian
Head of the Department: Associate Professor Tatiana B. Agalakova
Scientific Advisers: Associate Professor Tamara L. Moshanova,
Russian Instructor Elena M. Shashkina
The purpose of the investigation is to study and analyze the problem of doctor–patient relationship.
Methods of investigation: personal experience analysis, special literature analysis, doctor–patient relationship observation, doctors’ experience analysis, interviewing, (questionnaire) poll.
Resume. First of all the doctor is supposed to be a competent professional, as he deals with people’s most precious thing – health. And not only that. The doctor must be a highly educated person, a person of culture, kind, merciful, compassionate, sensitive, tactful. The doctor’s mercy is of paramount importance for all his patients and especially for dying people, who already know their terrible diagnosis and their life is going to an end. As life and doctors’ experience show, such patients go through a number of consecutive psychological stages. They are:
1) the stage of patients’ disease negation;
2) the stage of patients’ aggressiveness, depression and even suicidal states;
3) the stage of patients’ understanding of their diseases, the necessity of obeying doctors’ instructions and his methods of treatment.
At each of the above–mentioned stages the qualified doctor must know and be able to apply the corresponding psychotherapeutic tactics. At each of these stages the doctor must skillfully use his main weapon – kind, trustful, merciful, humane words – to support dying people, because the doctor himself, his personality and his words are always their hope for recovery and life – asserting force.
We’d like to conclude with Dr. Daniella Keidar’ s words: “The doctor is in fact the catalyst who effects a change for the better in his patient not only as a result of anatomical knowledge but also by contact with his soul.”
Ogorodnikova N.V.
PSYCHOLOGICAL INSTRUMENTS TO OPTIMIZE THE LANGUAGE LEARNING PROCESS. PSYCHOLOGICAL AND SOCIAL TRAINING. WORKSHOP TECHNOLOGY
Kirov State medical academy
Department of Foreign Languages, Latin and Russian
Head of the Department: associate professor T.B. Agalakova
Recent changes in the education in the Russian Federation have brought about an urgent need to update language teaching methods and to focus on the communication aspect of the language study. This approach treats communication in a foreign language as personal contacts that have creative character. Actually speaking, communication skills are a target in language teaching as well as a matter of social psychology. However we try to combine methods of the above mentioned sciences to optimize the language learning process at Kirov State medical academy. Psychological instruments – trainings- are applied to make language learning process more effective.
Psychological instruments and those of social training are a set of mechanisms that activate reason, cognition and creativity through communication and socializing. Workshop technology is an example.
Choosing workshop technology we consider the fundamental components of the contents first and foremost – motivation and the so-called ‘value-in-focus’ aspect. These together contribute a lot to learning and person development. The positive effect can be seen in the workshop principles:
- Equal abilities of everyone (including the teacher).
- Empathy-based understanding.
- Cognitive search.
- Choice.
- No marking.
- Non-aggressive involvement in classroom activities.
Workshop technology has been tried out in 1st and 2nd –year student groups. Using pair, group and individual work within the technology has proved its beneficial effect in teaching any type of speech activity.
Psychological and social training in general and workshop technology in particular can boast of the following advantages:
- Developing Student’s emotional self;
- Building Student’s experience in decision-making;
- Forming skills to fix emotional contacts;
- Developing creativity, independence, responsibility, fluency.
However, psychological instruments do make a large contribution into language learning process since they meet the needs of communication as a social, psychological and linguistic phenomenon. Moreover, they play a role of a stimulus - they influence the students to progress.
Petrov M.V.
ALCOHOL DEPENDENCY, DRUG ADDICTION AND TOXICOMANIA
IN KIROV REGION
Kirov Regional Narcology Hospital
Topicality. Kirov region is located 896 km northeast of Moscow. The population of Kirov region is 1,401,200, 1% of Russia’s population (2009 est.) The density is 11.3 per 1 sq km. The urban population accounts for 72.4% (2009 est). The rural population accounts for 27.6%.
The capital of the region is the city of Kirov. Its population is 464,500 inhabitants (2009 est.). Over 150 ethnic groups, nations and nationalities live in the region (2002 est.). The population decrease was 9,000 or 5.2% (2009 est). The life expectancy at birth is 61.3 years in males and 74.2 years in females.
Children and adolescents account for 20%.
The region has low income levels. 18% of the population live at or below the poverty level. 10% of the population have between 2,000 and 4,000 rubles per month per person. 21% of the population have between 10,000 and 15,000 rubles per month per person. 6% of the population have over 25,000 rubles per month per person.
The birth rate is 11.4 per 1,000 population. The birth rate in the Volga Federal District is 11.8 births per 1,000 population. Volga (Privolzhsky) Federal District (Privolzhsky federalny okrug) is one of the eight federal districts of Russia. It forms the southeastern part of European Russia. Its population was 31,154,744 (70.4% urban) according to the 2002 Census, living on an area of 1,038,000 square kilometers (400,774.0 sq mi). It includes 14 federal subjects: Kirov region (oblast), the Republic of Bashkortostan, The Republic of Mari El, Nizhny Novgorod Oblast, Orenburg Oblast, Penza Oblast, Perm Krai, Samara Oblast, Saratov Oblast, the Republic of Tatarstan , the Udmurt Republic, Ulyanovsk Oblast, and the Chuvash Republic.
“Early this year, Russia’s leaders trumpeted demographic success: in 2009, for the first time in 15 years, the country’s population had risen, not fallen. Sure, the scale was insignificant (an increase of 5,300 souls, or 0.004%of the population between January 1 and October 1) ,,,” (“Russian Life”, July – August 2010. – P.4).
The birth rate in the countries of the EU is 10.7 per 1,000 population.
The death rate in Kirov region is 16.5 deaths per 1,000 population, higher than in the Volga Federal District (14.2 deaths per 1,000 population. It is almost twice as high as in the countries of the EU (9.3 deaths per 1,000 population). The death rate in males is almost three times as high as in the countries of the EU.
“By way of comparison, in 2009 the Russian death rate was 14.2 per 1,000 persons, while for the U.S. in 209 it was 8.4 per 1,000” (“Russian Life”, July – August 2010. – P.4).
Thus, The natural decrease results from the above death rate that is 1.4 times higher than the birth rate.
Analysis of the causes of death (as of 2009) shows that the leading causes of death are cardiovascular diseases (60.8%), external causes (13.2%) and cancer (12.2%).
Materials. As far as the external causes of death are concerned alcohol poisoning accounts for 41.5 deaths per 100,000 population ((11.5 deaths per 100,000 population in the Russian Federation). Suicides account for 49.9 deaths per 100,000 population (26.7 deaths per 100,000 population in the Russian Federation). In the structure of the causes of death, homicides (murders) account for 7.4%; deaths caused by traffic (road) accidents account for 10,8%; suicides: 21.2%; alcohol poisoning: 18,6%; deaths caused by other accidents, poisoning and traumas: 42.0%. Deaths from traffic accidents, other accidents, poisoning and traumas are often associated by alcohol consumption. It should be noted that the incidence of suicides at the ages of 10 – 14 also increased.
Of all acute poisonings, 52% resulted from alcohol and illegal alcohol in 2009. The number of poisoning from alcohol increased and was 1,263 cases in 2009 or 5 % higher than in 2008. Acute poisonings from alcohol increased among children and adolescents. Since 2007 the age of children affected by alcohol poisoning has changed from 14.2 to 13 years. There have been alcohol poisonings in children at the age of 8-9 years.
Kirov region takes the 19th place in the deaths that result from external causes rates in the Russian Federation. In 2008, the deaths that resulted from external causes in the Russian Federation were 172.2 per 100,000 population; in the Volga Federal District: 192.2 per 100,000 population; in Kirov region: 244. 8 per 100,000 population.
“These high death rates have many causes: abnormally high levels of alcoholism; disproportionately high levels of mortality from heart disease and infectious diseases; one of the world’s highest level of death from external causes (injury or poisoning)” (“Russian Life”, July – August 2010. – P.4).
In 2009, 38,324 people or 2,791.4 per 100,000 population were registered to have narcological disorders. Of them, 1,394 were under the age of 18 years. In the Russian Federation, the narcological disorder rate is 2,336 individuals per 100,000 population; in the Volga Federal District: 2,596.6 per 100,000 population.
In 2009, alcohol psychosis was registered in 1,335 patients or 97.2 per 100,000 population. Of them, there were 2 adolescents. In the Russian Federation alcohol psychosis was registered in 80.32 patients per 100,000 population; in the Volga Federal District: 81,04 patients per 100,000 population.
In 2009, alcoholism was diagnosed in 30,080 individuals or 2,190 individuals per 100,000 population. In the Russian Federation, alcoholism was diagnosed in 1,486 individuals per 100,000 population; in the Volga Federal District: 1,636,9 patients per 100,000 population.
In Kirov region, drug addiction was registered in 568 individuals or 41.3 people per 100,000 population (as of 2009); in the Russian Federation: 252.18 patients per 100,000 population; in the Volga Federal District: 234.01 patients per 100,000 population. Drug addicts are mostly individuals who use illegal drugs made of codeine containing medications (opiates).
In Kirov region, toxicomania was registered in 74 individuals or 5.39 individuals per 100,000 population; in the Russian Federation: 10.67 patients per 100,000 population; in the Volga Federal District: 11.42 patients per 100,000 population.
In order to provide specialized health services there are 225 beds in inpatient health care institutions:
- 145 beds in Kirov regional narcology hospital;
- 25 beds in the narcology department of Omutninsk central district hospital;
- 20 beds in the narcology department of Vyatskiye Polyany central district hospital;
- 10 beds in the narcology department of Urzhum central district hospital.
In Sovietsk and Kotelnich districts narcological health services are provided in mental hospitals:
- 10 beds in Kotelnich psychiatry hospital;
- 15 beds in Sovietsk psychiatry hospital.
Kirov regional narcology hospital includes the following subdivisions:
- the resuscitation and intensive care department (6 beds);
- the inpatient narcological department for female (34 beds);
- the inpatient narcological department with 95 beds including 40 beds for emergency narcological health care for patients with combined pathologies and 6 beds for children) ;
- the inpatient department for services for payment (10 beds);
- the department of narcological expertise:отделение наркологических экспертиз;
- the dispensary department for adult population (the dispensary department for adult population also includes a medical room for anonymous narcological assistance for payment);
- the dispensary department for children and adolescents;
- the chemical toxicological laboratory;
- the clinical diagnostic laboratory;
- the physical therapy department.
Thus, the demographic and narcological situations in Kirov region require improvement of the system of narcological services, improvement of accessibility and quality of health care narcological assistance that should result in in-time treatment and medical rehabilitation of alcoholism, drug addiction and psychoactive substance abuse.
Conclusion. Priorities of narcological assistance for the population of Kirov region include:
1) Improvement of the organizational structure of narcological assistance due to current standards and development of new forms of assistance and their components (including organization of inter-municipal narcological centers).
2) Further development of the system of medical prophylaxis: early discovery, treatment and rehabilitation oriented first of all toward children, adolescents and young adults.
3) Organization of the system of medical psychological and medical social rehabilitation oriented toward reduction of medical and social consequences of disease, increase of duration of remission, prophylaxis of disability and increase of life quality of rehabilitated individuals and their close environment. Active introduction of team technologies of rehabilitation, improvement of interrelations between inpatient and outpatient stages of rehabilitation measures, development of therapeutic community.
4) Development of outpatient services that may contribute to full and in-time discovery of individuals affected by dependency diseases, their treatment and medical social rehabilitation as well as development of the system of registration and dynamic follow-up.
5) Development of anti-narcotic ideology.
6) Research in the above fields due to cooperation with specialized research institutes and educational departments of higher educational institutions.
Kirov region has problems common to the Russian Federation: moderate and low levels of life and economic development, large area of the region, insufficiency of the transportation network, high levels of alcoholism, high levels of complications of alcoholism (alcoholic psychoses), high death rates caused by external causes, inadequate accessibility to narcological services.
The regional high top authorities are very much concerned by the problems of alcoholic and illegal drug dependency. Conditions for cooperation are being created.
To sum up, in Kirov region, there are all conditions to develop wide epidemiological investigations, to practice organizational models of narcological services for the population of the Russian Federation and to created algorithms of narcological services.
In addition to the above, of interest is investigation of home made illegal drugs and illegal drug dependency. Due to low level living standards in Kirov region consumption of home made illegal drugs made from codeine containing medications is more or less common. Consumption of home made opiates is also common to the majority of Russian areas with low economic development.
Plyasunova M., Khlybova S.V.
SOCIAL AND BIOLOGICAL CHARACTERISTICS AND PECULUARITIES OF HISTORY CASES OF WOMEN FACING HABITUAL MISCARRIAGE
Kirov State Medical Academy
Scientific supervisor: S.V. Khlybova
Currently, habitual miscarriage is an urgent problem of practical obstetrics. According to the World Health Organization, 15% of all registered pregnancies result in spontaneous abortions. Of them, habitual miscarriages account for 3%.
The purpose of the current study was to investigate social and biological factors and gynecological histories in females during the first trimester of pregnancy, facing the threat of miscarriage. 105 history cases were studied. They underwent treatment at the gynecology department and were followed up at the female consultation facility of Northern City Teaching Hospital in 2008.
Group I (main, n=58) included females facing the threat of miscarriages. The threat of miscarriages was characterized by long-term pains in the lower during the first trimester (from 4 to 15 weeks).
Group 2 (control, n=47) included females who were followed up at the female consultation facility. These pregnancies did not face any threat of miscarriages.
The average age of Group I was older as compared with Group II (27.7±0.6 and 25.9±0.6 years relatively, р<0,05 ). According to the results of the current investigation, there were no differences between Group I and Group II in the following history characteristics: height, weight, gonadarche age, age of the beginning of sexual life, frequency of the registered marriage at the moment of pregnancy, the number of deliveries, the number of abortions, the number of scraping of the uterus cavity, vaginitis, salpingitis, and mycoplasmosis, and others.
Females of Group I were more frequently single (17.5±4.3% vs 6±3.4%, р<0,05) and more rarely were in civic marriages (44±7.0% vs. 7.5±2.9%, р<0,001). Females of Group I had longer menstruations (5.47±0,1 vs. 5.04±0.2, р<0.05) and longer menstrual cycles (29.51±0.5 vs 27.9±0,3, р<0.05). Females of Group I had more pregnancies (2.47±0,2 vs.1.80±0.2, р<0,05) and a history of more miscarriages or spontaneous abortions (0.34±0,1 vs. 0.02±0,02, р< 0,05). They more often suffered from infertility (13.75±3.9 vs 2±1.98, р<0.05). They more often had surgery on the epoophorons (11.3±3.5% vs. 2±1.98%, р<0,05) but they had more rarely cervical ectropion (32.5±5.2% vs. 62±6.9%, р<0.001). Females with habitual miscarriages more rarely used barrier birth control (26.3±4.9% vs. 54±7.1%, р<0.05). They more often had chronic urogenital infections (45±5.6% vs. 18±5.4%, р<0.05). Ureaplasmosis prevailed in the above infections (33.8±5.3% vs. 16±5.2%, р<0.05). Females of Group I had more erythrocytes (4.15±0.04 vs. 3.94±0.05, р<0.05) and more leucocytes (8.1±0.22 vs. 5.13±0.17, р<0.05). Urinalysis of Group I females showed more leucocytes (3.72±0.8 vs. 0.76±0.1, р<0.05). But these data do not violate the required norm.
Thus, habitual miscarriages may be influenced by absence of family well-being, more rare use of barrier birth control as well as primary disorders of menstrual functions that may show possible disorders of hormonal functions. The consequence is infertility and miscarriage prior the current pregnancy. The threat of miscarriage is associated with ureaplasma urealyticum that may result from disorders of biocoenosis of the vagina. Infections may be traced in leucocytic reactions in the blood and urine. All this can be evaluated as a pre-morbid background of the threat of miscarriage.
Rossikhina E.V.
EVALUATION OF LACTOBACILLI ADHESIVE ACTIVITY IN MICROBIOCENOSIS
Kirov State Medical Academy
Department of Microbiology with Virology and Immunology
Head of the Department: PhD, associate professor E.P. Kolevatykh
Scientific supervisor: PhD, associate professor E.P. Kolevatykh
Due to the development and application of new microbiological and molecular- biological methods, the fact that 99% of bacteria exist in natural ecosystems as specifically organized, relatively stable communities was determined. Microorganisms in the mucin gel form biofilms on mucosal surfaces, which are essential for the macroorganism. Lactobacilli, involved in the immunoregulatory mechanisms of the homeostasis maintaining, underlie the biolayer. There are parietal and a free (translucent, planktonic) microflora types in biotopes.
The purpose: to assess adhesive activity of parietal and luminal located lactobacilli in the oral cavity and vagina of experimental animals.
The investigation included 25 outbred female rats. The samples of the oral cavity and vaginal contents and the isolates of the walls from these biotopes were taken at postmortem autopsy under aseptic and antiseptic rules. The seeding was carried out on nutrient medium - laktobakagar, cultured in microaerophilic conditions ( using Oxoid apparatus for anaerobic culturing with a gas-generating packages AnaeroGas Pack, HIMEDIA production) at 37o C, 48 hours. Lactobacilli were identified by biochemical plates and microbial suspension was prepared. To assess the results of ligand - receptor interaction of microbial cells with sheep erythrocytes we applied photocolorimeterig method (Oborin V.A., et al, 2009). Index of bacterial adhesion (IA) was calculated using the appropriate formula. If the value of IA was less than 5%- we considered the degree of bacterial adhesion as zero, with the IA from 5 to 15% - low, from 15 to 40% - the average and over 40% - high.
The research work found that parietal strains of lactobacilli of the oral cavity and vagina demonstrated a high adhesive activity with IA = 37.5%, translucent microflora – had low adhesion (IA = 12%).
Therefore, an important role in the formation of microbiocenoses on mucous membranes belongs to the bacteria with significant adhesive activity.
Solomina Kh.V.
USE OF EVAPORATED MILK FORMULA “PRE NAN” FOR FEEDING PREMATURE INFANTS
Kirov State Medical Academy
Department of Propedeutics of Children’s Diseases
Head of the Department: Associate Professor V.A. Belyakov
Department of Foreign Languages, Latin and Russian
Head of the Department: associate professor T.B. Agalakova
Scientific Supervisor: associate professor I.V. Popova
The purpose of the investigation is to study therapeutic effectiveness of the use of evaporated milk formula “Pre NAN” for feeding premature infants.
Material and methods. 63 premature newborns took part in the research. One group of infants had breast milk and evaporated milk formula “Pre NAN”; the other group had only “Pre NAN”; the third – only breast milk. Anamnestic and clinicophysiologic parameters of infants of all the three groups were compared. Gestational age of the newborns varied from 27 to 36 weeks. Body weight and gestational age of the infants in group one varied from 1090 to 2480 gm (1876±277 gm; 27-35 weeks; 32,7±1,9); in group two - from 980 to 2680 gm (1893±348 gm; 29-36 weeks; 32,9±1,7); in group three - from 1080 to 2900 gm (2065±402 gm; 29-36 weeks; 33,8±1,4). Infants in groups one and two had “Pre NAN” beginning from the seventh day of their life. “Pre NAN” made up 10 % of overall daily food intake at the beginning and then in the next 2-3 days its intake grew up to 50 % or 100 % in accordance with the groups of observation. The evaporated milk formula was administered only after mothers’ personal consent. Calculation of daily food intake was done regularly. Therapeutic effectiveness and evaporated milk formula tolerance were evaluated every day. Allergy and side effects the evaporated milk formula weren’t noticed.
Results and conclusion. The research didn’t show any significant differences in the average daily increase of body weight in different groups. However the average daily increase per a kilogram of body weight in infants of groups one and two was really higher than that in group three (p < 0,05) and than it is recommended for premature newborns (15g/kg per day). This fact indicates adequate digestion of the evaporated milk formula ingredients and its high food value. Including the evaporated milk formula “Pre NAN” into premature infants’ food intake made average daily increase of body weight per one kilogram higher. The results received in the course of the investigation prove the necessity of further development of differential approaches to feeding premature infants according to their body weight, morphofunctional maturity, level of health, nature of pathology. The evaporated milk formula “Pre NAN” may be recommended for efficient feeding of premature infants during the second stage of management in the hospital. Lower increase of premature infants’ body weight per a kilogram needs further investigation and improvement.
Solovieva N.V., Zhizhov R.E., Borisova A.A.
PERMANENT ATRIAL FIBRILLATION AND RIGHT VENTRICULAR APICAL PACING
Kirov state medical academy, the department of internal medicine
The aim of this study was to asses the effects of right ventricular apical pacing (RVAP) in patients with normal left ventricular (LV) function and permanent atrial fibrillation.
Methods. Twenty seven patients [9 (33, 3%) male, mean age 74 years] with standard indication for permanent single-chamber pacemaker in case of permanent atrial fibrillation underwent a permanent single-chamber apical pacing. Detailed echocardiography studies were performed at baseline (no RV apical pacing) and after 6-12 month to evaluate systolic and diastolic function. Post-implantation patients were divided in two groups. 14 patients had LV ejection fraction >50% (60, 71±4, 54%).They were first group. The other 13 patients had ejection fraction ≤ 55% (51, 23±3, 87%, p=0,001).
Results. After 6-12 month there were no differences in functional status. Patients in both groups were paced more than 72%.
Conclusion. Permanent RV apical pacing in patients with permanent atrial fibrillation and LV EF>40% has no deleterious effects on left ventricular function and can be used as base treatment for patients with permanent atrial fibrillation.
Troylova M.E., Akhmetzyanova R.R., Zaitseva E.A.
CLINICAL AND EPIDEMIOLOGICAL HIGHLIGHTS ROTAVIRUS INFECTION IN CHILDREN IN THE KIROV REGION
Kirov State Medical Academy,
Department of infectious diseases, with rates of epidemiology,
childhood infections and infectious diseases IPO
Head of the Department: professor A.L. Bondarenko
Scientific supervisor: N.V. Klebnikova
Rotavirus infection (RVI) in recent years out on top in the etiological structure of acute intestinal infections (AII) in infants.
Objective: analysis of clinical and epidemiological features of RVI in the structure of the OCI for the year 2010 in the Kirov region.
Metods: an analysis of the clinical course of RVI 832 children treated at the Kirov Clinical Infectious Diseases Hospital. Diagnosed based on clinical and epidemiological data and detection in feces by direct immunofluorescence rotavirus antigen.
Results: in 2010 the share of RVI in the structure of the OCI was 11.5%. When studying the age structure of children aged 0 to 1 year were 25.5%, from 1 to 3 years, -55.86%, from 3 to 7 years - 17.24%, over 7 years - 0,01%. Thus, the most vulnerable RVI were children under three years, was dominated by boys. The vast majority were bottle-fed (60%). Children under the age of moderate forms predominated (80%, p <0,05), less often lungs – 1 %, heavy forms – 19 %. At children of advanced age easy forms prevailed (67 %, р <0,05), in 22 % disease proceeded in average heavy to the form. Complaints to weakness, immovability showed 92,3 % of children, decrease or a total absence of appetite – 81,3 % hospitalized. Crying, concern it is noted at 93.7 % of children, the expressed pallor of a leather – at 67,5 % of children.
Cataral the syndrome was registered at 62 % of children with laboratory confirmed RVI. Dullness of cordial tones, systolitical noise diagnosed in 9,2 % average heavyforms RVI. Duration of displays of the general intoxication has made 2-3 days. The most frequent initial symptom was vomiting (89 %). At 48 % of children vomiting was 4-5 multiple, at 52 % - 1-2 multiple in current of 1-2 days. At the majority of children infringement of a chair appeared for the first day of illness. Frequency of a chair has made 4-6 times (73 %), more than 10 times – at 23 % of children.
In 56 % of cases the chair was aqueous, in 44 % - foamy with lumps of not digested food. Normalization of a chair is registered for 2-5 day at 41 %, for 5-7 day at 50 %, and for 10 day at 9 %. The intestinal syndrome was shown gastroenteritis (81 %), enteritis (16 %), at children older three years – gastroenterocolitis (3 %), that, possibly, are connected with mixed reason sharp intestinal infections.
Isolated colitis the syndrome was not marked. According to coprological researches it is revealed: steatorea (52 %), amilorea (75 %), kreatorea (13 %). Lack of water of an organism: 1 degrees it is registered at 5 % of children, 2 degrees – 8 %. At 39 % of children weight of a condition has been caused acetonemia by a condition.
Such in the image, RVI is one of the leading reasons infectious gastroenteritis in reason to structure SII. RVI keeps typical clinical and epidemiological features, it is registered more often at children of early age, it is characterized by predominance average heavy forms, progress gastroenteritis.
Vorovchenko Tatiana
THE PLANNING OF DENTAL IMPLANTATION USING COMPUTER TECHNOLOGIES
Samara State Medical University,
Kirov State Medical Academy
Chair of maxillofacial surgery and dentistry
Coordinator: DDS, MD, Ph.D. Nikolsky V.Yu.
Proper dental implantation planning is the keystone to success of an implantation treatment. An electronic program was created during our work with which the doctor can be guided at all stages of data collection and analysis. For revealing of all patient’s individual conditions which can influence a course of dental implantation, it is necessary for the doctor to make the general and local examination. The program offers to estimate the general condition of the patient, patient's readiness for operation, etiology of teeth absence, an objective examination of an oral cavity, a functional estimation, radiological inspection (for definition of quality and quantity of a bone tissue), it also defines the regenerative potential of a bone and the parodonthological status of the patient.
The next step is choosing the appropriate prosthodontic construction. For its realisation the doctor should specify the localisation and extent of the defect. Then the program offers various variants of possible schemes of constructions. According to the received information, the doctor will be given the quantity and prospective places of implants statement. After choosing a type, form, and the appropriate size of established constructions, the doctor must then specify the accessible length of an alveolar crest, the thickness of a bone in a defect place, its vertical size and quality.
For optimization of a treatment plan, the doctor should estimate the influence of biomechanical factors using the offered table including geometrical and occlusive technological conditions as well as risk factors of a bone or tissue implant. If the degree of risk is high, the doctor always has the option to modify the treatment plan by changing design of a prosthodontic construction or the scheme of occlusion.
The aforementioned program with the algorithm of the doctor's actions at the planning stage of dental implantation and the table of biomechanical risk factors are applicable in clinical practice for the purpose of achievement of dental implantation positive results.
Yakovleva I.A., Kazarinova T.Y.
MISDIAGNOSING IN DIARRHEAL DISEASES
Kirov State Medical Academy, Kirov
Department of infectious diseases
Head of Department: Professor A.L. Bondarenko
Scientific supervisor: Associate professor O.N. Lyubeznova
Many surgical diseases, gynecopathy, cardiovascular diseases proceed under the guise of diarrheal diseases (DD), especially in their prime. That is why any doctor can misdiagnose. We can find in the literature that about 2.5-15% of DD are misdiagnosed. There are only few publications concerning DD differential exclusion with surgical, therapeutic and other pathologies.
The objective of the present research was the analysis of DD misdiagnosing as exemplified by the Gastroenteric unit of Kirov hospital of infectious diseases (KHID).
Goals: marking of nosological groups that cause problems in diagnosing, defining lost diagnostic criteria and reasons of misdiagnosing.
Data and methods: there were analyzed 75 cases of DD misdiagnosing of KHID patients, observed in KHID during 2008-2009. During 2 years Gastroenteric unit admitted 2517 patients of ages 17 to 85 years old, therefrom 37 men and 38 women. The patients with the diagnosis changed in the reception ward and sent to the specific hospital are not included to the research. We analyzed the spectrum of nosology proceeding under DD cover, causes of medical errors and also the period of the correct diagnosis establishing.
Results: the rate of misdiagnoses accounts for 3 % of all the patients of the Gastroenteric unit during the reviewed period. The most numerous groups among them are groups with acute surgical pathology (33,3%), acute pneumonia (22,7%), exacerbations of chronic gastrointestinal issues (18,7%), kidney diseases (8%). In most cases little attention was paid to history taking, the development of disease; manifestation degree of clinical and laboratory implications was not taken into consideration. In the group with acute pneumonia the diagnosing was hampered by the disease pathomorphism of socially disadvantaged patients with grave associated conditions.
Conclusions:
In conclusion it should be taken into consideration that doctors often review symptoms and syndroms apart from each other and do not pay due attention to their unity, intensity and sequence of onset of a certain patient. Also it should be noted that early and qualified diagnosing can be achieved by qualitative accumulation of epidemiological anamnesis, the anamnesis of current disease and patient’s life.
The main reasons of misdiagnosing were:
- Pain syndrome underestimation and domination of pain syndrome over the others;
- Underestimation of evidence, course of main symptoms and disease symptoms during the first hours of the case;
- Underestimation of anamnestic data (patient’s age, chronic gastroenteric or cardiovascular pathology in anamnesis).
Zakharova N.
ANAMNESTIC FEATURES IN WOMEN WITH POLYCYSTIC OVARY
SYNDROME WITHOUT METABOLIC ABNORMALITIES
Kirov State Medical Academy,
Department of Obstetrics and Gynecology
Head of the Department: professor S.A. Dvoryansky
Scientific supervisor: professor S.A. Dvoryansky
А polycystic ovary syndrome (POS) is a multifactorial heterogeneous disease and also socially significant hormonal pathology which reduces quality of life in women.
The purpose of the research is to study peculiarities of the medical history in women-patients with polycystic ovary syndrome without metabolic abnormalities.
Material and research methods. Prospective analysis of a group of patients (n=42) with polycystic ovary syndrome without metabolic abnormalities has been done.
Results. Young women of 25,31 ± 2,79 years old took part in the research. Among them 71,4 % of women (n=30) are married, 21, 4 % (n=9) are in civil marriage, 7,1 % (n=3) live alone. 52, 4 % (n=22) of women have university-level education, 16, 7 % (n=7) have incomplete higher education and 30, 9 % (n=13) of women have specialized secondary education. 83,3 % (n=35) of women work, 7,1 % (n=3) work and study at the same time and 9,5 % (n=4) are students. All the patients live in Kirov. Extragenital pathology has been revealed in all the patients: respiratory infections in 100 % (n=42), chronic throat diseases in 45,2 % (n=19), old children's infectious diseases in 80,9 % (n=34), diffuse hyperthyroidism of the 0-1 degrees in a normal function in 19,0 % (n=8), diseases of the urinary system in 11,9 % (n=5), gastrointestinal tract pathology in 21,4 % (n=9), muscular-skeletal system pathology in 9,5 % (n=4), vascular dystonia in 7,1 % (n=3), myopia in 7,1 % (n=3), mammary gland mastopathy in 4,8 % (n=2), anemia in 2,4 % (n=1) of cases. The following gynecological diseases have been revealed in patients: chronic urogenital infections in 42, 9 % (n=18), acute calpitis and vaginitis in 69,1 % (n=29), chronic salpingo-oophoritis and endometritis in 26,2 % (n=11), ectopia of the neck of uterus in 78,6 % (n=33), condyloma of vulva in 4,8 % (n=2) of cases. 21, 4 % (n=9) of women have a medical history of surgery. Pathologic pregnancy and/or labour in mothers of the women-patients take place in 11, 9 % (n=5) of cases. To hereditary factor there can be added menstrual irregularities, hirsutism, POS and problems concerned reproductive property in 33,3 % (n=14) of patients.
19,1 % of women have medical history of allergy. Only 4,8 % (n=2) of all patients have bad habits of smoking up to 5 cigarettes a day. Menarche begins approximately at the age of 13,74±1,31 years old; the beginning of sexual life is noticed at the age of 18,0±2,15 years old; the number of sexual partners is 2,48±1,27. Contraception is always used in 14,3 % (n=6) of cases, while 28,6 % (n=12) of women don’t always use it. 23,8 % (n=10) of patients have medical history of pregnancy: childbirth in 16,7 % (n=7), therapeutic abortion in 11,9 % (n=5), spontaneous abortion in 4,8 % (2). These women became pregnant approximately in 14,18±16,59 months of sexual life without contraception.
Conclusion. The research shows that the following factors are the most significant in the etiology of POS:
1. Pathologic current pregnancy and / or labour in mothers of the women-patients.
2. Acute or chronic infections a girl had in various periods of her life, especially in pubertal period; diseases of the upper respiratory tract take the leading place among them.
3. Neurosis, stress, psychic traumas, increased educational load and chronic information stress.
4. Recurrent chronic inflammatory diseases of internal female genital organs.
5. Hereditary factor.
Zaytseva E.A.
CHANGE TITERS OF ANTIBODIES TO HARIENTAL CELLS - A MARKER OF LONG NOT CICATRIZING ULCER
Kirov State Medical Academy
Department of Microbiology of virology and immunology
Head of the Department: associate professor E.P. Kolevatyh
Scientific supervisor : associate professor E.P. Kolevatyh
Autoantitela to the parietal cells (anti-PC) are antibodies to microsomes and the cell surface of parietal cells. Binding to microvilli of parietal cells, anti-PC hurt them.
Known that antibody titers correlated with the degree of severity of atrophy of the gastric mucosa. Autoimmunity developing in diseases of the digestive system, significantly alter their course and outcome.
Target: assessment of changes in titer of anti-PC in the development of long- not cicatrizing stomach ulcers (DNYAZH). In the blood serum of 25 patients with gastric ulcer was determined by the content of autologous antibodies to parietal cells (antibodies to the H + / K + - ATPase in gastric parietal cells) by ELISA using a test - of DRG - Diagnostics (Germany). The comparison group included 10 clinically healthy individuals. When aggravation of gastric ulcer concentration of anti-PC was 217 IU / ml, slowly decreased during remission up to 30 U / ml. Established that the development DNYAZH titer of anti-PC sharply decreased to 14 U / ml. In the controls the circulation of anti-PC was detected in 17% of cases within 6 - 10 U / ml.
Thus, the change in the concentration of anti-PC in the peripheral blood of patients with gastric ulcer disease suggests the development of autoimmune reactions, complicating the course of the underlying disease.
Zaytseva E.A., Dvoeglazov P.D., Sakulyan A.A., Zhdanov D.K.
HELIOBIOLOGY CHRONOMEDICINE AND IN THE ASPECT
OF HUMAN BODY PATOLOGICAL PROCESSES
Kirov State Medical Academy
Department of Microbiology of virology and immunology
Head of the Department: E.P. Kolevatyh
Scientific supervisor: Professor N.F. Kamakin
The influence of solar activity and magnetic fields on the development of human diseases is a debated issue of science and today. But with the development heliobiology - Section of Biophysics, studying the effects of changes of solar activity on terrestrial organisms, and chronomedicine - medicine, which uses the idea of biological rhythms, all the more important in the development of pathological processes of the body given to the imbalance in the system "man - the physical fields" .
Adaptation to changing conditions of existence involves a biological rhythm, which is one of the mechanisms of adaptation to periodic processes of extreme nature. In addition, a person has its own physical fields: acoustic, electric and magnetic fields, the study of which allows a deeper understanding of the processes occurring in the body, and use these fields for diagnostic purposes.
Produced an analysis of the published data on environmental influences on human biological rhythms has shown that, despite the broad and in-depth research scientists patterns chronobiology is not fully disclosed. In particular, it is not thoroughly studied the patterns of influence of cosmic events, changes in solar activity and disturbances of the magnetosphere and ionosphere on life processes of all biological objects on our planet. However, the ancient scientists found that each organ has its specific culminating point - especially during strenuous activity. At this time the body is most vulnerable to pathological effects and the most malleable to curative effects. In other words, doctors know that for each body there is his "healing time."
Scientifically proved link frequency changes of solar activity with cardiovascular disease remains one of the first places in the list of causes of premature death. Perturbed Earth's magnetic field significantly affects the human body, especially on the patient and her child. The impact of magnetic storms is very diverse: many changes blood pressure, electrical activity of brain electrographic characteristics of sleep (rhythm, duration of the phases), amplified the inhibitory processes in the central nervous system, slowed reflexes. During magnetic storms increase in the number of accidents, due to the weakening of the attention, the delayed reaction to the signal. Even a healthy person, it could get worse by 3-4 times. Often the symptoms of heaviness in the legs, tachycardia, weakens eyesight, a sense of anxiety. To solar activity responds blood (NA Schultz): change parameters of blood clotting, white blood cells and platelets, decreased erythrocyte count and hemoglobin.
Thus way biorhythmological knowledge of the laws of the human body should be considered by physicians during periods of changes in solar and magnetic activity, when the treatment policy is necessary to introduce amendments, without which the interpretation of the results of laboratory and instrumental investigations can cause medical errors.
Zaytseva E.A., Prudnikovа Z.P., Kormschikova N.S., Shubina O.I.
PRINCIPLES, POSSIBILITIES AND PROSPECTS SALIVADIAGNOSTICS
Kirov State Medical Academy
Department of Microbiology of virology and immunology
Head of the Department: E.P. Kolevatyh
Scientific supervisor: professor N.F. Kamakin
Until recently salivadiagnostika remained almost exotic medical research. At the present time salivadiagnosticheskoy orientation introduced this technique in a number of recognized diagnostic technologies. Saliva examined to establish the body of alcohol, drugs and many pharmacological substances, nicotine in tobacco, many hormones, antibodies and immunoglobulins, DNA, tumor markers, a number of enzymes, exotoxins.
Salivadiagnostika increasingly incorporated in various medical specialties, but especially in endocrinology as a noninvasive alternative method for indirect determination of hormones in the blood (serum, plasma). Salivadiagnostiki advantage, primarily, is an exception venipuncture as a fairly risky in the current manipulation of the HIV and hepatitis considerable number of subjects on different occasions persons. Manipulation of the collection of saliva and oral fluid is devoid of the pain of stress, which changes the homeostasis of the body, including hormonal (Korotko G.F., 2006). Especially these benefits are valuable for studies in children with clinically healthy individuals (eg athletes), if necessary, multiple studies (for tracking the dynamics of the process), for collecting material (saliva and oral fluid) or by the non-specialist instructed surveyed in the home. Certainly to be preferred method in childhood and old age, is transformed from the first procedure of taking the material in the game, the second eliminates the complicated age-related changes taking venous blood vessels. Third, saliva, or oral liquid, unlike blood, does not require pre-treatment undertaken at the research material (Korotko G.F., 2006). It is difficult to overestimate the benefits salivadiagnostiki for population screening.
There are reasons that are alarming experts in the application salivadiagnostiki. Among them include variability salivation, different transport mechanisms of interest to researchers of substances from the blood into the saliva and the lack of scrutiny of these mechanisms. This explains the absence of market analysis at the laboratory kits for many kinds of salivadiagnostiki. In addition, saliva are among the most reactive of the physiological processes that react on virtually any exogenous and endogenous effects are not only highly labile amount of salivation, but gematosaliva permeability barrier (Komarova L.G., 2006).
Of course, the main advantage is its non-invasive salivadiagnostiki that opens up the possibility of multiple studies, painless, safe infection, the ability to study people of all ages to obtain reliable data on their health status. Therefore the main task of modern medicine, in our opinion, is the introduction of salivadiagnostiki a list of recommended standards for mass screening of the population.