Vol 5, No 2 (2020)

Objectives – to analyse the age-related features of chronic sensorineural hearing loss (SNHL) in elderly patients in regards to the course of the disease and treatment.

Material and methods. We reviewed the articles on the problem, published in the recent 5 years, presented in the international databases PubMed, Scopus and E-library.

Results. Considering the difficulty of decision-making on the diagnosis and rehabilitation of patients with chronic SNHL, the development of automated computer programs combining the relevant information on the personification of diagnostic and treatment algorithms is relevant.

According to scientific data, the rehabilitation procedure for chronic SNHL should take into account the patient's comorbid conditions, the use of pharmacological preparations with a possible ototoxic effect.

Aim – to identify the characteristics of resistance of clinical isolates of S. aureus, obtained in hospitals of various specialization, to beta-lactam antibiotics, and to improve recommendations for empirical etiotropic therapy prescribed to patients with staphylococcal infections.

Materials and methods. The subject of the study is the clinical isolates of S. aureus received from patients hospitalized to Vitebsk Regional Clinical Infectious Diseases Hospital "therapeutic" isolates, n=117) and purulent surgery departments and intensive care units of Vitebsk Regional Clinical Hospital ("surgical" isolates, n=111) in 2016–2017 years. Methods for the study of antibiotic resistance of clinical isolates of S. aureus: disk diffusion method, method for determining the beta-lactamase activity of bacterial suspension using the "BioLactam" test system.

Results. It was found, that 80.6% of the therapeutic isolates and 73.2% of the surgical isolates were resistant to the 1st generation penicillins. 5.4% of therapeutic isolates and 34% of surgical isolates were resistant to inhibitor-protected beta-lactams. 36.8% of surgical isolates and no therapeutic isolates were resistant to cephalosporins of the 3rd generation. No MRSA were detected among the therapeutic isolates, and among the surgical isolates the prevalence of MRSA was 30.5%. 93.3% of therapeutic isolates of S. aureus did not show any beta-lactamase activity. Among surgical isolates there were only 34.4% of such isolates. Direct Spearman’s correlations of moderate strength were revealed between the levels of beta-lactamase activity of S. aureus isolates, the duration of hospitalization and febrile period, as well as between the isolation of MRSA and the duration of hospitalization, fever and diarrheal syndrome.

Conclusion. The use of inhibitor-protected penicillins and 3rd generation cephalosporins is recommended for empirical antibiotic therapy of "therapeutic" infections caused by S. aureus. Reserve antibiotics with selective antistaphylococcal activity (such as glycopeptides or oxazolidinones) are required for empirical antibacterial therapy of staphylococcal infections in surgical departments and resuscitation units

Objectives – to study the indicators of humoral regulation of circulatory system in obese patients as the predictors of CHF development.

Materials and methods. Two groups of 40 patients were formed: the first group consisted of patients with I or II grades obesity with BMI of up to 40 kg/m², the second group included patients with grade III obesity with BMI of over 40 kg/m². None of the selected patients had a history of cardiovascular events. The concentration value of renin-angiotensin-aldosterone system components and level of N-terminal pro B-type natriuretic peptide (NT-pro-BNP) was determined.

Results. Aldosterone level in grade I–II obese patients was close to normal upper border: 58.9 [54.9; 73.8] pg/ml (normal range is 10–60 pg/ml), while in patients with grade III obesity it was 79.5 [64.5; 90.1], which is 25.9% higher than in patients of the first group and 24.5% higher above the normal level (p < 0.05). These two groups was significantly different not only in average plasma aldosterone level, but in absolute number of patients with hyperaldosteronism, whose number accounted for 46.2% in grades I or II obese patients and 85.7% among patients with grade III obesity. Plasma renin level and angiotensin II levels in both groups was within the normal range. NT-proBNP level in the first group was 23.7 [10.6; 23.6] pg/ml, in the second group – 138.0 [121.5; 145.9] pg/ml, which is 5.8 times higher (p = 0.001). In both groups of patients, the correlation analysis showed that aldosterone and NT-proBNP levels are closely related (r = 0.74, p < 0.05).

Conclusion. This study suggests that aldosterone level can be used as a predictor of HF.

Objectives – to study the mortality indicators, their dynamics and structure, in the population of the Orenburg region in the period of 2011–2017.

Material and methods. The study was conducted using the data from the territorial authority of statistics in the Orenburg region in the period from 2011 to 2017. The analytical, demographic and statistical methods were implemented for the study of the demographic indicators.

Results. Cities and municipal settlements of the Orenburg region with high mortality indicators were included in the second and fourth clusters during the cluster analysis. The first and third clusters included cities and municipal settlements with an average mortality. The most favorable position has the Orenburg area with the lowest mortality rate in the region in 2017 – 8.4‰.

The dynamics of mortality rates among the male and female population tends to decrease, more pronounced dynamics is in men. Though, the male population is characterized by higher mortality rates in all age groups.

The leading position among the causes of death is taken by diseases of the circulatory system (46.3% of the total mortality). The second position is occupied by tumors (17.2%), the third – by external causes (8.4%). Mortality from circulatory system diseases and from external causes has reduced. The dynamics of mortality from tumors does not change significantly.

The rank of leading causes of death is not identical in the clusters: in the third and fourth clusters, the other causes occupy the second place in the structure of mortality, while tumors occupy the third.

Conclusion. In the Orenburg region, the mortality rate is higher than overage in the Russian Federation by 0.9 per 1000 people. The study revealed significant territorial differences in the mortality rates. In general, the mortality among men in all age groups is higher than the mortality of women. The mortality rate from diseases of the circulatory system plays the leading role in the structure of mortality, but has the tendency for decline. Until 2006, the mortality from external causes ranked the second place, now the second place is taken by death from tumors The mortality from external causes is decreasing; mortality from tumors does not change significantly.

The obtained results could be used by local authorities in developing the program of public health protection and assessing its effectiveness.

The literature review focuses on the problems of the professional activities of paramedical personnel. The attention is given to the specific features of the nursing staff work.

The review is based on scientific papers published on the relevant topic and regulatory documents of medical organizations.

Aim – to identify the gender-specific features of modeling the prognosis of treatment outcomes for patients with colorectal cancer (CRC).

Materials and methods. The study included 654 patients with colorectal cancer (CRC) who were treated from 2013 to 2015, of which 434 were men, 220 were women. The average age of the patients was 64.1±10.2 years. All patients underwent genetic analysis for the presence of a mutation in the KRAS gene from the primary tumor.

Results. The gender approach to assessing the long-term results of treatment of patients with CRC showed that in men with colorectal cancer, the most favorable treatment results were observed in patients with tumors in stage T 1-2 N0 M0, regardless of the differentiation of the tumor and its mutational status. In men, poorly differentiated tumors with any T, with the presence of regional metastases and a mutation of the KRAS gene, even in the absence of distant metastases, should be considered prognostically unfavorable: not a single patient lived for 5 years. In women, based on the decision tree analysis, the most favorable treatment results were observed in patients with tumors in the stage T 1-2-3 N0 M0 under the age of 70 years (five-year survival rate of 90%), with tumors T 1-2 N0 M0 – over the age of 70 years (five-year survival of 81.8%), regardless of the differentiation of the tumor and its mutational status. Tumors of any differentiation of the T3-4 N0 stage with the presence of distant metastases (5% of patients lived for 5 years) and poorly differentiated T4N0M0 tumors (five-year survival of 8%) are prognostically unfavorable for women.

Conclusion. The study of gender and age-related features of the development and course of CRC is relevant for oncologists to select effective diagnostic, therapeutic and rehabilitation measures.

Objective – to develop a pathomorphological classification of subdural hematomas, which reflects the aspects of their pathogenesis and time of occurrence that are important for forensic analysis.

Materials and methods. The study is based on a prospective pathomorphological analysis of the qualitative evolution of 200 of subdural hematomas in closed and open non-penetrating craniocerebral trauma.

Results. The new pathomorphological classification of subdural hematomas is developed. It takes into account a hierarchical sequence of hematoma characteristics: the presence and severity of organization; the genesis of encapsulation and resorption, and the mechanism of organization.

Conclusion. The developed pathomorphological classification is recommended for use in the course of forensic or medical expert analysis of subdural hematomas.

Objectives – a comparative study of antidepressant activity and diuretic action of water and water-alcohol preparations of the fruits of Crataegus sanguinea Pall. and Crataegus submollis Sarg.

Materials and methods. The study covers the water and alcohol-water extracts from the fruits of hawthorn blood-red (Crataegus sanguinea Pall.) and Quebec hawthorn (Crataegus submollis Sarg.). The comparative study of the antidepressant activity and the diuretic action of the preparations was carried out on white mongrel rats of both sexes.

Results. The liquid extracts of fruits Crataegus sanguinea Pall. and Crataegus submollis Sarg. at a dose of 100 µl/kg revealed an antidepressant activity. Decoctions of Crataegus sanguinea Pall. and Crataegus submollis Sarg. at a dose of 100 µl/kg had a pronounced diuretic and saluretic activity. Pharmacotherapeutic effects of the studied preparations can be explained by the presence of flavonoids in them.

Conclusion. The preparations of the fruits of Crataegus sanguinea Pall. and Crataegus submollis Sarg. can be recommended as antidepressant and diuretic agents. The fruits of Crataegus submollis Sarg. are the promising medicinal plant raw materials.

Objectives – to evaluate the main bacteriological indicators for newly diagnosed pulmonary tuberculosis and to compare them with the timing of sputum smear negative reaction and abacillation.

Materials and methods. The study included 127 people with newly diagnosed pulmonary tuberculosis. Bacteriological and radiological data were evaluated at 2, 4 and 6 months of the study. The patients were divided into 2 groups: patients with an ineffective course of chemotherapy (1st group, n = 67) and an effective chemotherapy (2d group, n = 60).

Results. In the 1st group, the patients with the following processes prevailed over the 2nd group: destructive (86.4% vs 40.0%; р < 0.001), generalized (76.1% vs 50.0%; р = 0.003), bilateral (62.7% vs 36.7%; р = 0.004), with bacterial excretion (68.7% vs 33.3%; р < 0.001). The difference in mass of bacterial excretion in the compared groups was insignificant (p > 0.050). The Mtb growth in solid medium was absent within 90 days in patients with effective chemotherapy (28.3% vs 1.5% in the 1st group, р < 0.001). The low intensity of Mtb growth was also observed in the 2nd group (46.5% vs 21.2%; р = 0.006). XDR of Mtb was registered in 16.4% of patients in the 1st group, versus 5% in the 2nd group (p = 0.04). In the 1st group, the sputum smear microscopy was revealing bacteria discharge in 29.8% of patients during 12 months. In the 2nd group, the abacillation was registered in all the patients after 6 months of treatment. During the 6–8 months of chemotherapy, the abacillation was registered in 41.9% of patients in the 2nd group, and in 13.6% of patients in the 1st group (р = 0.020). After 12 months of treatment, the Mtb growth in solid medium was present in 57.6% of patients in the 1st group, compared to the 20.9% in the 2nd group (p < 0.001).

Conclusion. The results of our study indicate the relationship of Mtb drug resistance, XDR in particular, and the rate of Mtb division to the generalization of the process, the tendency for destruction of lung tissue, as well as the early appearance of bacterial excretion and, accordingly, the longer periods for sputum negative reaction and abacillation.