Vol 5, No 2 (2020)

ENT Disorders

Issues of personalized treatment of chronic sensorineural hearing loss in the elderly

Vladimirova T.Y., Aizenshtadt L.V.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):76-82
pages 76-82 views

Infectious diseases

Comparative antibiotic resistance of S. aureus strains isolated in surgical and therapeutic departments of hospitals

Zhyltsou I.V.

Abstract

Objectives – 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.

Science and Innovations in Medicine. 2020;5(2):83-87
pages 83-87 views

Cardiology

Indicators of humoral regulation of the circulatory system in obese patients

Zaletova T.S., Derbeneva S.A., Feofanova T.B., Katsuba A.A.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):88-92
pages 88-92 views

Relationship of septal flash with electromechanical dyssynchrony and super-response to cardiac resynchronization therapy

Shirokov N.E., Kuznetsov V.A., Malishevskii L.M., Todosiichuk V.V., Soldatova A.M., Krinochkin D.V.

Abstract

Objectives – to identify a relationship of septal flash (SF) with a super-response to cardiac resynchronization therapy (CRT), apical rocking (AR) and signs of left bundle brunch block (LBBB) in patients with congestive heart failure (CHF).

Material and methods. The study included 38 patients (92.1% men; mean age 54.3±9.4 years) with II-IV NYHA functional class CHF. Left bundle brunch block (LBBB) was diagnosed according to 3 criteria: American Heart Association (AHA) 2009, European Society of Cardiology (ESC) 2013, Strauss. Septal flash (SF, mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). The patients were divided into two groups: with SF (I group, n=8) and without SF (II group, n=30). Mean follow-up was 34.5 [13.8;55.3].

Results. At baseline the groups did not differ in main clinical characteristics including QRS. The left ventricular (LV) ejection fraction (EF) was higher in group I (33.1%±1.7 and 30.0%±4.0; p=0.044). Basal segment of IVS longitudinal strain (LS) delay by STE (258.0 [144.0;294.0] ms vs 323.5 [273.3;385.0] ms; р=0.024) and LS delay by TDI (176.0 [146.8;287.3] ms vs 415.5 [315.8;493.5] ms; р<0.001) were significantly lower in group with SF. There was significant relationship between SF signs and Apical rocking (AR) (r=0.791; p=0.034). According to electrocardiogram (ECG) it was found that the q wave in the I and V5, V6 was absent in all patients with SF. Monophasic R wave was in 62.5% in group I and in 16.7% in group II (p=0.019). All patients in group I had a super-response to CRT (ESV LV decrease ≥30%); 53.1% of patients in group II were super responders (р<0.034).

Conclusion. SF is associated with AR, super-response to CRT, and the change of the direction of interventricular septum depolarization vector. 

Science and Innovations in Medicine. 2020;5(2):93-98
pages 93-98 views

Public health and health service

Characteristics of mortality in the Orenburg region population in 2011–2017

Borschuk E.L., Begun D.N., Begun T.V.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):99-104
pages 99-104 views

Motivation of medical personnel as an important element of personnel management

Petrova N.G., Pogosyan S.G.

Abstract

Objective – to analyze the structure of motivational attitudes of nurse personnel and their career orientations.

Materials and methods. The study was conducted on the basis of three multidisciplinary medical organizations in St. Petersburg. Nurses were asked to complete two questionnaires, including an assessment of motivation and career orientations. The total number of questionnaires processed was 162. The average length of service of the respondents was 10.5 years. According to age, the respondents were distributed as follows: 62.0% were people aged 20-29 years, approximately equal shares were people 30-39 years old (18.6%) and 40 years and older (19.4%). The study of the motivation of professional activity was carried out according to the methodology of K. Zamfir (modified by A. Rean). Also, the methodology used to diagnose the value orientations in the career was ''Career Anchors'' (the method of E. Shein in adaptation by V.A. Chiker and V.E. Vinokurov).

The questionnaires contain certain points and clues, allowing one to evaluate, respectively, the nature of motivation and preferred orientations. The statistical processing of collected data was performed with the Microsoft Оffice 2016 programs: Microsoft Word, Microsoft Excel.

Results. It was established that in the structure of motivation, 40.2% is an external positive motivation (positive incentives in the organization), 30.1% is an internal motivation (satisfaction with work and its results), 19.7% is an external negative motivation (punishment). The main value orientations in a career are as follows. In the first place – the integration of lifestyles (in 73.2% of cases, this orientation scored maximum points); on the second – stability of work (62.0%); in the third place – ministry (52.4%). The ratio of value orientations varies somewhat among people of different ages.

Conclusion. The identified features of motivation and value orientations of nurses should be taken into account both as a whole (to develop a system of motivation in the organization) and personally, taking into account the individual characteristics of each employee. The study of motivation should be carried out by psychologists of medical organizations, and the results should be transmitted to managers to form a reasonable personnel policy.

Science and Innovations in Medicine. 2020;5(2):105-110
pages 105-110 views

Difficulties and limitations of paramedical personnel professional activities: the case of a nurse in the department of oral and maxillofacial surgery

Son I.M., Gazheva A.V., Lebedev M.V., Kerimova K.I., Zakharova I.Y., Bakhturin N.A.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):111-118
pages 111-118 views

Medical and sociological characteristics of planned hospitalization

Suslin S.A., Vavilov A.V., Ginnyatulina R.I., Pavlov V.V., Timyashev P.V.

Abstract

Objectives – to study the patients' opinions on the organization of planned admission to the city multidisciplinary hospital.

Materials and methods. An anonymous survey of 320 inpatients hospitalized on the scheduled basis to Samara City Hospital No. 1 was carried out according to a specially developed program. Statistical, analytical and sociological research methods were used in data collection and processing.

Results. The vast majority of patients (96.0%) expected the inpatient care for two weeks. On average, 55–60% of respondents were fully informed and 25–30% were partially informed about various aspects of their state of health at different stages of planned hospitalization.

Conclusion. The majority of patients (76.3%) were completely satisfied with the inpatient treatment, 21.8% were partially satisfied and less than 2% were not satisfied with the treatment. From the point of view of the respondents, the important parameters of the provision of inpatient care were: staff qualification, anesthesia, absence of complications, recovery, diagnosis accuracy, etc.

Science and Innovations in Medicine. 2020;5(2):119-123
pages 119-123 views

Oncology

Gender specificity in the interpretation of treatment results for patients with colorectal cancer in the Republic of Tatarstan

Gataullin B.I., Khasanov R.S., Savelev A.A., Gataullin I.G.

Abstract

Objective – 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.

Science and Innovations in Medicine. 2020;5(2):124-129
pages 124-129 views

Forensic medicine

New pathomorphological classification of subdural hematomas

Nedugov G.V., Fedorina T.A.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):130-135
pages 130-135 views

Pharmacology

Comparison of pharmacological activity of hawthorn fruits preparations

Kurkin V.A., Zaitceva E.N., Avdeeva E.V., Stenyaeva V.V., Shaikhutdinov I.K., Zhdanova A.V.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):136-139
pages 136-139 views

Phthisiology

Bacteriological indicators in estimating therapy efficiency for newly diagnosed pulmonary tuberculosis

Samsonov K.Y., Mordyk A.V., Aroyan A.R., Batishcheva T.L., Drobinina T.A.

Abstract

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.

Science and Innovations in Medicine. 2020;5(2):140-144
pages 140-144 views

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