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MEDICAL SCIENCE

PREVENTIVE MEDICINE

1. Сomparison of micromycetes Сandida albicans contamination in patients and medical items in the hospital for hiv-infected patients with invasive candidiasis and in a welfare period.

I.P. Charushin., I.V. Fel'dbljum, S.Ju. Balandin., G.A. Aleksandrova, L.N. Smirnova, N.I.Markovich

2. Hygienic maintenance of the daily regimen, the educational process in schools.

A.V. Suvorova, I.Sh. Iakubova, A.V. Mel‘tser

3. Planning algorithm for quality audit within risk based model in rospotrebnadzor activities.

E.E. Andreeva

4. Рecularities of dynamic health processes formation within a multicomponent air pollution L.M. Sheuchuk, N.A. Dziarzhynskaya

5. Assessment of the health the urban population following the results of prophylactic medical examination and analysis of its effectiveness.

D.L. Logunov, V.P. Panov., V.S. Luchkevich, M.V. Avdeeva, V.N. Filatov, N.T. Gonchar

CLINICAL MEDICINE

1. Correlation between endothelium-dependent vasodilation and severity of coronary atherosclerosis.

Z.O. Khushvaktova, G.A. Kuкharchik

2. Assessment of functional operability as a key factor for the prevention of complications after esophageal cancer surgery .

К.V. Arutyunyan, I.M. Kuznetsov, K.S. Fedorov, M.D. Ter-Ovanesov, K.G. Shostka, L.D. Roman, N.A. Mushnikov

3. Idiopathic venous thromboembolism events and atherosclerosis.

N.I. Glushkov, M.M. Shilo, M.A. Ivanov, A.S. Artemova, S.A. Vinnichuk

4. Pathogenesis of the local somatic dysfunctions (scientific review ) .

D.E. Mokhov, E.S. Tregubova, Y.P. Potekhina

5. Short-term outcomes after performing gastropancreatoduodenal resections at secondary tumor lesions of the pancreas.

K.S. Ilyin, K. G. Shostka, K. V. Arutyunyan, A. A. Saharov, L.D. Roman

PREVENTIVE MEDICINE

COMPARISON OF MICROMYCETES CANDIDA ALBICANS CONTAMINATION IN PATIENTS AND MEDICAL ITEMS IN THE HOSPITAL FOR HIV-INFECTED PATIENTS WITH INVASIVE CANDIDIASIS AND IN A WELFARE PERIOD

I.P.Charushina¹, I.V.Fel'dbljum¹, S.Ju.Balandina², G.A.Aleksandrova², L.N.Smirnova³ N.I.Markovich⁴

¹State educational institution higher education "Perm state medical University named after academician E. A. Wagner" of Ministry of health of the Russian Federation. Russia, 614000, Perm, Petropavlovskaya Str., 26

²Federal state budgetary educational institution of higher professional education "Perm state national research University". Russia, 614990, Perm, Bukireva Str., 15

³State healthcare institution Perm region "Perm regional center for prevention and control of AIDS and infectious diseases". Russia, 614088, Perm city, Sviyazeva Str., 21

⁴Federal budget institution of science "Federal scientific centre for medical preventive technologies of management of risks of health of the population". Russia, 614045, Perm, Monastyrskaya Str., 82

Abstract.

Materials and methods. Within the study were analyzed 921samples of clinical material taken from "sterile" (blood, cerebrospinal fluid) and "non-sterile" biological substrates (oral fluid, the upper respiratory tract secretion, urine, feces and etc.), and 227 samples from medical items (42 air samples and 185 swabs from surfaces) for the presence of C. albicans. The study shows the enzymatic activity of 64 strains of C. albicans.

Results. It was found out the correlation between level and intensity of colonization of C. albicans in HIV-infected patients and medical items contamination. Cause of C. albicans strains with high enzymatic activity were patients with invasive candidiasis. In epidemic focus of invasive candidiasis colonization indicators of patients and contamination of the external environment by C. albicans is higher than in epidemics welfare period.

Conclusions. In hospital for HIV-infected patients features of an "epidemic outbreak" for invasive candidiasis are the increase of the colonization level both of the "open", "potentially closed" loci and the increase in the number of patients with massive Candida 2 colonization and more more loci.

Key words: HIV infection, C. albicans, hospital environment, invasive candidiasis.

HYGIENIC MAINTENANCE OF THE DAILY REGIMEN, THE EDUCATIONAL PROCESS IN SCHOOLS

A.V. Suvorova, I.Sh. Iakubova, A.V. Mel‘tser

Federal state budget institution of higher education «North - Western State Medical University named after I.I. Mechnikov» of the Ministry of Public Health of the Russian Federation, , Russia, 191015, Saint-Petersburg, Kirochnaya st. 41.

Abstract

Purpose: It was developed preventive measures on negative impact minimization of education process and daily regimen on the schoolchildren health based on risk assessment methodology.

Material and methods: The study included 360 senior high school students aged 15-17 years (168 male, 192 female) from 5 magnet schools of Saint- Petersburg. The level of hygienic maintenance of educational institutions was assessed by 44 parameters of school environment with further calculation of the integral criteria [3]. Student’s daily regime was studied by questionnaire. More than 6 thousand units of information were analyzed. Schoolchildren health’s state was assessed according to medical examination data. For the assessment of the schoolchildren’s health risk caused by factors of daily regime, educational process were estimated parameters of relative risk (RR), odds ratio (OR), etiological fraction (EF) using contingency tables [4].

Results and conclusions. Medical examination results revealed a low level of schoolchildren’s health of magnet school. The majority of high school students had irrational daily regime: deficit of sleep and walk, prevalence of passive leisure activities, malnutrition, and high study load. Schoolchildren health risk caused by irrational daily regime and educational process was proved as well as risk of visual organ pathologies from deficit of sleep (RR = 1,32) and walk (RR = 1,57), high study load (RR = 1,79); risk of cardiovascular pathologies from deficit of walk (RR = 2,08), malnutrition (RR = 2,08);

The risk of vision pathological deviations was installed due to insufficient duration of nocturnal sleep (RR = 1,32), of walking (RR = 1,57), high educational load (RR = 1,79); the risk of cardiovascular pathological deviations - from the insufficient duration of walking (RR = 2,08), violations of the diet regime (RR = 2,08); the risk of musculoskeletal system disorders from prolonged computer work (RR = 1,31), high educational load (RR = 1,25); nervous system diseases from prolonged computer work (RR = 1,31), malnutrition (RR = 1,28); digestive systems disorders from prolonged computer work in educational institution with extended activities (RR=2,56).The obtained results were used to prepare a guideline on negative impact minimization on the schoolchildren health and to make changes in sanitary regulations.

Keywords: health status, schoolchildren, hygienic maintenance, educational process, daily regimen, health risk assessment, optimization of the daily regimen.

PLANNING ALGORITHM FOR QUALITY AUDIT WITHIN RISK BASED MODEL IN ROSPOTREBNADZOR ACTIVITIES

E.E. Andreeva

Administration of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in Moscow, Russian Federation, 129626, Moscow, Grafsky lane, 4/9,

Abstract.

Risk-based model used by Rospotrebnadzor for the improving of the quality audit were effective in minimization of potential harm to health by the classification according to hazard rate.

The final quality audit revealed 13,2 % of economic entities (2016) that have to be under control for sanitary and hygienic control the facilities contributing about 95 % to potential health risk.

Keywords: sanitary-epidemiological well-being, control and surveillance activities, sanitary-epidemiological service, risk management.

PECULARITIES OF DYNAMIC HEALTH PROCESSES FORMATION WITHIN A MULTICOMPONENT AIR POLLUTION

L.M. Sheuchuk¹, N.A. Dziarzhynskaya²

¹ Republican unitary enterprise «Scientific practical centre of hygiene», Belarus, 220012, Minsk, Akademicheskaya st., 8.

² Educational Establishment «Belarusian state medical university», Belarus, 220116, Minsk, Dzerzhinski av., 83.

Abstract

Purpose. The present study is aimed to analyze peculiarities of dynamic health processes formation within multicomponent air pollution.

Methods and materials. Materials: urban planning materials on justifying placement and technological parameters of 466 enterprises; chemical substances content in the atmosphere - 2495 samples, background pollution - 14162 samples. The total children morbidity was 1516 people. Methods: analytical laboratory, statistical, mathematical model, epidemiological.

Conclusion. Air pollution in the study area presented as multicomponent pollutant with concentration levels not exceeding hygiene standards; with the summation effect for certain group of chemicals is exceeded the total permissible content. Air pollution degree corresponds to the «acceptable» and «low» levels of index of air pollution. The impact of the studied pollution has damaging effect, resulted in increase of children morbidity and in potentially combined health risks.

Kеy words: multicomponent air pollution, index of air pollution, index of atmospheric purity, summation effect, combined health risk, children's health.

ASSESSMENT OF THE HEALTH THE URBAN POPULATION FOLLOWING THE RESULTS OF PROPHYLACTIC MEDICAL EXAMINATION AND ANALYSIS OF ITS EFFECTIVENESS

D.L. Logunov, V.P. Panov, V.S. Luchkevich, M.V. Avdeeva, V.N. Filatov , N.T. Gonchar

Federal State Budgetary Educational Institution for Higher Training «North-Western State Medical University named after I.I. Mechnikov» of the Ministry of Health of the Russian Federation. Russia, 195067, Saint-Petersburg, Piskarevsky pr., 47.

Abstract.

Introduction. Monitoring of the prophylactic medical examination is vital due to the necessity of identification of the most problematic issues of its practical implementation and improvement of primary health care.

Material and methods. During 2015 were analyzed 22924 registered forms №131/y «Prophylactic medical check-up card » and report form № 131 «Data on clinical examination of certain groups of adults» in one of the clinics of St. Petersburg. Efficiency of prophylactic medical examination was assessed by criteria of Ministry of Health of the Russian Federation; integral efficiency coefficient of early (prenosological) identification of risk factors of non-communicable diseases; population satisfaction with prophylactic medical examination.

Results. The study has shown that there is 21% of patients from district covered by physician were undergone prophylactic medical examination. It is also marked a lack of prophylactic medical examination coverage of patients with increased cardiovascular risks needing preventive counselling (2,5 times below the target value), and the lack of directed activities for prophylactic medical examination counseling among patients having medical ground (0%). Integral efficiency coefficient of early (prenosological) identification of risk factors of non-communicable diseases was on the average rate (0,6±0,2) substantially ranging from low to high rates due to patients age undergoing prophylactic medical examination. Population satisfaction with prophylactic medical examination was 35, 1%.

Conclusion. The obtained data show the necessity of the population in preventive measures and insufficient efficiency of prophylactic medical examination.

Keywords: prophylactic medical examination, public health, the efficiency of the prophylactic medical examination, the effectiveness of primary health care, disease risk factors.

CLINICAL MEDICINE

CORRELATION BETWEEN ENDOTHELIUM-DEPENDENT VASODILATION AND SEVERITY OF CORONARY ATHEROSCLEROSIS

Z.O. Khushvaktova, G.A. Kuкharchik

State Budget Institution of Higher Education «North-Western State Medical University named after I.I. Mechnikov» under the Ministry of Public Health of the Russian Federation, Russia, 191015, Sankt-Petersburg, Kirochnaya str., 41.

Abstract

Purpose: The study was aimed to evaluate endothelium-dependent vasodilation, depending on the severity of coronary arteries lesions in patients suffered myocardial infarction.

Materials and methods: The study involved 98 patients suffered myocardial infarction. Patients were examined the levels of severity of coronary atherosclerosis by Modified Gensini score and endothelium-dependent vasodilation assessed by peripheral arterial tonometry.

Results: It was found that patients suffered myocardial infarction accompanied with severe coronary artery lesion, marked endothelial dysfunction remaining within a year of observation, while patient with mild coronary artery during treatment were marked with normalized endothelial function a year after.

Conclusions: Impairment of endothelium-dependent vasodilation was revealed in patients suffered myocardial infarction wherein the severity of endothelial dysfunction depends on the severity of coronary atherosclerosis.

Key words: endothelial dysfunction, atherosclerosis, endothelium-dependent vasodilation, peripheral arterial tonometry, myocardial infarction.

ASSESSMENT OF FUNCTIONAL OPERABILITY AS A KEY FACTOR FOR THE PREVENTION OF COMPLICATIONS AFTER ESOPHAGEAL CANCER SURGERY.

Arutyunyan ¹, I.M. Kuznetsov ², Fedorov K.S.², Ter-Ovanesov M.D.³,K.G. Shostka ¹,

L.D. Roman ¹, N.A. Mushnikov ²

¹State budget health institution “Leningrad Regional Oncologic Dispensary”, Russia, 191014, St Petersburg, Liteyny Prospect 37.

² Federal State Budget military educational institution of higher professional education "Military Medical Academy named after S.M. Kirov» under the of Ministry of Defense of the Russian Federation. Russia, 194044, St. Petersburg, Akademika Lebedeva St., 6, Lit. J.

³ Federal State Institution Russian National Research Medical University named after N.I. Pirogov, Deputy chief Surgeon and Oncologist of the medical unit City clinical oncological hospital №40, chief scientific officer of Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Russia, 129301, Moscow, Kasatkina Str., 7

Abstract

Purpose. A research on the treatment improvement of patients with esophageal cancer by reducing the number of postoperative complications and postoperative mortality.

Materials and methods. From 2005 to 2012 were performed 196 dilated near-total resections of the esophagus for malignant tumors in State budgetary healthcare institution “Leningrad Regional Oncological Dispensary”. Due to the reduction of the number of postoperative complications and mortality were conducted a more detailed assessment respiratory and circulation systems in our clinic since 2009.

Analyzing postoperative complications and mortality we divided patient into two groups: the first group included 93 patients after near-total esophagus resections with one-stage intrathoracic esophagogastroplastics in 2005-2008; the second group of patients included 103 patients after esophagus resection (57,9% of the total number of patients with esophageal cancer for the mentioned period) who undergone scrutinize examination of respiratory and circulation systems as well as malignant tumors resection of esophagus.

Depending on the necessity of correction of particular disorders of the circulatory and respiratory systems was conducted intensive preoperative preparation, arterial hypertension correction, anti-arrhythmic and anticoagulant therapy, protein-energy deficiency correction, therapy aimed at increasing of the compensatory capabilities of the respiratory system.

Results. In the second group the postoperative complications were 41% (43 cases), among them were 48.8% of «non-surgical» complications (21 cases). The obtained data were not allowed to reveal significant differences in comparison with the first group of patients; however, analyzing "non-surgical" complications in both groups were revealed statistically significant differences. Postoperative mortality was completely different with 7.5 % (7 cases) in the first group and 4.8% (5 cases) in the second group correspondingly.

Conclusions.

1. Modern assessment of the patients’ functional operability with esophagus cancer allows obtaining more reliable information about the severity of the main and concomitant diseases.

2. Directed preoperative preparation of patients with esophageal cancer based on a deep understanding of patient clinical status allows reducing a number of postoperative complications and mortality by 12.8% and 2.7 % respectively.

3. Prevention of disorders caused by chronic obstructive pulmonary disease, ischemic heart disease and hypertension is vital for the prevention of postoperative complications in patients with esophageal cancer, which allows to reduce the number of "pulmonary" (respiratory failure and pneumonia after prolonged mechanical ventilation) and "vascular" (myocardial infarction, acute violation of cerebral circulation) complications in the postoperative period.

Keywords: esophageal cancer, resection of the esophagus, functional operability, prevention of complications after esophagus resection.

IDIOPATHIC VENOUS THROMBOEMBOLISM EVENTS AND ATHEROSCLEROSIS

N. I. Glushkov, M. M. Shilo, M. A. Ivanov, A. S. Artemova, S. A. Vinnichuk

Federal state budget institution of higher education «North - Western State Medical University named after I.I. Mechnikov» of the Ministry of Public Health of the Russian Federation, Russia, 191015, Saint-Petersburg, Kirochnaya st. 41.

Abstract

Introduction: There is very little agreement about the nature of idiopathic venous thromboembolism (VTE). They might be connected with metabolic disorders and atherosclerosis, which can be proved by results of postmortem examination.

Purpose: To provide more precise data on the frequency of artherial thrombotic events for patients with venous thromboembolism.

Results: Out of 1,150 postmortem examinations between 2010 and 2014, a connection between idiopathic VTE and artherial thrombotic events (ATE) has been detected in 49 cases, while isolated idiopathic VTE has been found in 4 cases. Presence of corоnary and cervico-cranial thrombosis increased the probability of idiopathic VTE 3.24 and 1.9 times respectively.

Conclusion: Idiopathic VTE is detected truly more often for patients with metabolic disorders associated with atherosclerotic disease of coronary and brachiocephalic vascular pools, which determines the kind of corrective measures for controllable risks of metabolic syndrome.

Keywords: venous thromboembolism, arterial thrombosis

PATHOGENESIS OF THE LOCAL SOMATIC DYSFUNCTIONS

(SCIENTIFIC REVIEW)

D.Е. Mokhov ^{1, 2}, Е.S. Tregubova^1,2, Y.P.Potekhina³

¹Federal State Funded Educational Institution of Higher Education “North-Western State Medical University n. a. I. I. Mechnikov” of the Ministry of Health of the Russian Federation, 41, Kirochnaya street, Saint Petersburg, 191015, Russia.

²Federal state Funded Educational Institution of Higher Education of Higher Education "Saint-Petersburg State University”, Russia, 199034, Saint-Petersburg, Universitetskaya embankment, 7-9.

³ Federal State Funded Educational Institution of Higher Education “Nizhny Novgorod State Medical Academy” of the Ministry of Health of the Russian Federation, 10/1, Minina and Pazharskogo square, Nizhny Novgorod, 603005, Russia

Abstract

In the article presents the definition of the somatic dysfunction being the specific object of osteopathic treatment and types of pathogenesis of acute and chronic somatic dysfunctions locally. Somatic dysfunction is a reversible alteration of the body tissues functions manifesting by three components: biomechanical (mobility impairment, compliance and tissues stability); hydrodynamic/ rhythmogenic (disturbance of production, sending and acceptance of cardiac, respiratory and cranial rhythms); and neurodynamic (alteration of nervous regulation). Herewith the connective tissue is vital due to the presence in all organs performing biomechanical (supporting), trophic (metabolic), protective (barrier) and structure-forming (plastic, reparative) functions. For that reason pathogenesis of somatic dysfunction is considered from processes and structural changes of connective tissue.

Systematic mechanical effects on the connective-tissue structures can lead to their reorganization. The lowering of the pressure on the tissue or the reduction of its tension lead to blood and intertissue liquid flow, and consequently, to the improvement of mobility and trophism, and in the course of time, to the reorganization (remodeling) of the architectonics. As a result, the structure of the connective tissue becomes more ordered and more functional. The earlier the osteopathic treatment starts, the higher is the possibility of restoration not only of the function but also of the structure of the organ.

Key words: Somatic dysfunction, pathogenesis, connective tissue, inflammation, fibrosis, collagen, fibroblast.

SHORT-TERM OUTCOMES AFTER PERFORMING GASTROPANCREATODUODENAL RESECTIONS AT SECONDARY TUMOR LESIONS OF THE PANCREAS

К. S. Ilyin, К.G. Shostka, К.V. Arutyunyan, А.А. Saharov, L.D. Roman

State budget health institution “Leningrad Regional Oncologic Dispensary”, Russia, 191014, St Petersburg, Liteyny Prospect 37

Abstract.

Purpose. The study purpose is to analyze and to improve the results of the gastropancreatoduodenal resections performance at secondary pancreatic tumors.

Materials and methods. From 2004 to 2016 20 patients underwent gastropancreatoduodenal resections. There were 14 newly admitted patients (70%), 3 patients (15%) were diagnosed with local recurrence after prior surgical treatment, and 2 patients (10%) were diagnosed with progression of the main disease - metastatic renal cell carcinoma in head of pancreas, one patient (5%) was diagnosed with both local recurrence and disease progression, accompanied by the liver metastatic. All patients had undergone extensive gastropancreatoduodenal resections. Patients with locally advanced tumors of the stomach were performed subtotal resections while 2 patients were conducted full gastrectomy. Patients with locally advanced tumor of large intestine were performed extensive gastropancreatoduodenal resection combined with extended right hemicolectomy, and 3 patients were additionally operated for atypical resection of the liver (1 patient with liver tumor, 2 patients with locally advanced tumors, including one patient with recurrent tumor). Other patients were conducted extended gastropancreatoduodenal resection.

Results. The average duration of the postoperative was 17.25±5, 80 days (12-34 days). Postoperative complications developed in 9 patients (45%), 1 patient with IIIa-(11%), 4 patients with IIIb-(44%) degree according to the Clavien-Dindo score. The most common complication was the development of pancreatic fistula (5 patients), pancreatic fistula type A was diagnosed in 3 patients, type B – 2 patients. In 5 (25%) patients were diagnosed purulent-septic complications (4 - intra-abdominal abscesses, 1 - suppuration of postoperative wounds). One patient had decompensation of diabetes with further progression of encephalopathy the other had respiratory failure. Erosive bleeding from the gastric stump was observed in one patient when hemostasis was obtained by endoscopic methods. Relaparotomy was performed in 4 (20%) patients diagnosed with intra-abdominal abscesses. Almost 14 patients were required packed red cell transfusion with the average volume of 730 ml (323-1825 ml), 15 patients were transfused with the average volume of 786 ml (310-2098 ml) of fresh frozen plasma. Postoperative mortality was not marked.

Conclusions.

1. Involvement of parenchyma of the pancreatic health in the tumor by absence of unresectable signs should not be considered as a contraindication to combined surgery including gastropancreatoduodenal resection.

2. Performance of combined operations increases the risk of postoperative complications, however, is not accompanied by an increased risk of postoperative mortality.

3. The most widespread postoperative complication is the pancreatic fistula formation requiring specially-formed technic for pancreatojejunal anastomosis formation.

Keywords: locally advanced cancer, combined resections, gastropancreatoduodenal resection, secondary tumors.

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