Vol 2, No 1 (2017)

Aim - the purpose of the study is the development of a method for prevention of pathological pregnancy syndrome from the perspective of integral genesis, determined by morphological and functional abnormalities in the fetoplacental system, assessing the effectiveness of methodological standards of evidence-based medicine. Materials and methods. Prospective study of 435 women with high risk of decompensation of placental insufficiency was conducted. Depending on the method of prevention of gestational complications 4 groups were formed: 1st group included 145 pregnant women, who were prescribed dydrogesterone on the 6-20 weeks of gestation, and starting with the 21st week - highly-purified diosmin 600 mg as vasoprotective; in the 2nd group 118 women received a course of preventive treatment with low doses of acetylsalicylic acid; 3rd group included 102 patients who underwent a course of preventive monotherapy with magnesium; 4th group comprised 70 pregnant women who refused preventive treatment. A control group encompassed 30 healthy pregnant women. Dynamic survey included definition of markers of endothelial and hemostasiological dysfunction, vascular-platelet dysfunction elements, apoptosis, inflammatory response, total reactive capacity of the organism, magnesium and carbon dioxide concentrations; a hystostereometric study of placenta was conducted. Standards of evidence-based medicine were applied for the objectification of the effectiveness of the developed method. Results. Method of preventing great obstetric syndromes by successive appointment of progestogen dydrogesterone on the early stage of pregnancy followed by vasoprotective diosmin 600 mg in the 2nd half of pregnancy showed high efficiency (NNT 1.4 (95% CI 1.1 -1.7); OSH 5.3 (95% CI 4.7 -5.8), namely reducing pre-eclampsia by 93%, placental insufficiency with intrauterine growth restriction and/or chronic fetal hypoxia - 95%, preterm birth - 86%, and no premature abruption of normally situated placenta, severe forms of pre-eclampsia and placental insufficiency. Higher clinical effectiveness of the proposed method of prophylaxis of pathological pregnancy syndrome, compared to the use of low-dose acetylsalicylic acid and preparation of magnesium, can be explained by the normalizing effect of dydrogesterone and highly-purified diosmin 600 mg on the immune and biochemical homeostasis, apoptosis and angiogenesis, activation of endothelial and hemostasiological system, adaptive compensatory reactions in the placenta. Conclusion. The method of choice for the prevention of pathological pregnancy syndrome at high risk of fetoplacental system decompensation is the application of progestogen dydrogesterone and vasoprotective diosmin according to the developed method. The study revealed the potential of targeted selection of preventive methods depending on special needs of pregnant women.

Aim - to develop an automated program for the evaluation of physiological adaptation of the cardiovascular system for combat veterans. Materials and methods. The study included 60 male patients, average age 53.13 ± 2.9 years, who participated in combat operations in Afghanistan (1979 - 1989) and Chechnya (1994 - 2002). The study of adaptive homeostasis of the cardiovascular system is made on cellular, microvascular, cardiovascular and organ levels. Results. The veterans of combat operations are characterized by disturbances in the psychological, physiological and social adaptation, which leads to premature aging. The cardiovascular system is highly reactive and plays a major role in the adaptive changes of the functional state of the organism. Based on the model of canonical correlation with step-by-step inclusion and exclusion of predictors, parameters of the cardiovascular system, a computer system for assessment of the degree of adaptation was developed. Conclusion. The developed automated system can be used in treatment, prophylactic and rehabilitation institutions, as well as in research and education centers for the diagnosis and monitoring of the effectiveness of therapeutic and rehabilitation measures.

This article presents innovative techniques for diagnostics, risk stratification and treatment of patients with hypertriglyceridemia. Hypertriglyceridemia is not only known as an independent risk factor of cardiovascular diseases, but also its high level can become a cause of acute pancreatitis.

Aim - analysis of the incidence of musculoskeletal system diseases and comorbid pathology in children; development of an algorithm for the rehabilitation of young children with congenital foot deformities for their parents and primary care professionals. Materials and methods. 244 cards of complex rehabilitation in rehabilitation centers of the Samara region for the period from January 2013 to August 2016 were studied. The children were divided into two groups: I group - the core group - included children of senior preschool age who were born between 22-37 weeks of gestation with birth weight of 500-2499 g; group II - control group - included children of preschool age who were born at 38-41 weeks of gestation with birth weight 2500-4500 g. Results. The study revealed the incidence of diseases of the musculoskeletal system in children in rehabilitation centers of the Samara region. The number of children with congenital deformities of the foot was 49.7% in the group of prematurely born children; flatfoot composed 42.3%, which proves the importance of the background condition (prematurity) in the development of congenital diseases of the foot. Multivariate analysis showed that the following factors are statistically significant: infantile cerebral palsy (p = 0.004), varus and valgus foot deformity (p<0.001) and hypotension (p<0.001). According to the results of the study a program was established that enables to determine the tactics of the follow-up of children, including prematurely born ones, depending on the type of congenital foot deformities. Conclusion. Therefore, the pediatrician should take into account the presence of background diseases in children with congenital deformities of the foot and carry out primary preventive activities in cooperation with parents.

Background. The terms for application of video-assisted endosurgical interventions appear rather often in the surgery of chest trauma. There is a certain need for clear selection and differentiation of indications and contraindications for performing thoracoscopy and other operations. Materials and methods. The 3-years’ experience of treatment of patients with blunt chest trauma and penetrating wounds is described in the article. There was prevalence of patients with isolated blunt chest trauma (35.1%) and penetrating thoracic wounds (29.0%). We have performed thoracoscopy for 107 patients. Emergency thoracoscopy had been done in 38 cases (35.5%), urgent thoracoscopy in 27 (25.2%) and delayed thoracoscopy - in 42 patients (39.3%). The rate of thoracotomy was 14.9%. Results and discussion. The indications for thoracoscopy at chest trauma were defined. The analysis of treatment results depending on the kind of traumatic lesion and operation method was carried out. The best results were obtained in patients with isolated blunt chest trauma and those who underwent thoracoscopy. The role of thoracoscopy in case of urgent and delayed indications for surgery was emphasized. We registered complications in 13.5% of patients with blunt chest trauma and 6.1% of patients with penetrating wounds. The general mortality was 3.8%. Conclusion. We can conclude that the results of treatment of patients with blunt chest trauma and penetrating wounds depend on the severity of the trauma, terms and quality of special medical management and wide application of thoracoscopy.