Vol 6, No 3 (2021)

The review presents the analysis of domestic and foreign literature, selecting the available scientific data on the features of constitutional and X-ray anatomy of the chest in adolescents and adults. The size and shape of the chest depends on age, sex and anthropometric parameters: height, body mass index, and also the presence of concomitant pathology. These patterns are characteristic of individual anatomical structures of the chest: sternum, ribs, spine and diaphragm. The study of constitutional anatomy is necessary for the development of morphological foundations for the interpretation of the results of intravital imaging of the chest and organs, justification of various methods of surgical access to the organ and structures of the chest and chest cavity.

Objectives – to study the effect of ACE and CIS sound coding strategies on sound perception in patients with the cochlear implants system produced by Cochlear Limited.

Material and methods. The study included 50 patients taking the rehabilitation course in the Astrakhan branch of the National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency over the past 5 years (from 2014 to 2019). The group of subjects included children over 7 years old and adults, whose success in rehabilitation made it possible to perform a full range of tests. The patients underwent tonal threshold audiometry and speech audiometry in a free sound field; the results obtained were registered in special MS Excel tables and further analysed using statistical methods.

Results. There were no statistically significant differences in hearing thresholds on tonal audiometry when using the coding strategies ACE and CIS, however, differences in speech perception were observed on average by 4.2%. The patients experienced in using hearing aids reported improved speech recognition, with scores varying within 5%.

Conclusion. Using a higher-resolution coding strategy can significantly improve speech recognition, while lower-resolution coding is beneficial for patients with digital hearing aid experience.

According to the literature, such dentition anomaly as supernumerary teeth is more common in the practice of a dentist than of an otorhinolaryngologist. Clinical manifestations of this pathology in adults are less frequent than in children. Periodically, there appear descriptions of individual cases of hyperdentia, in which the tooth is located in the nasal cavity, paranasal sinuses, orbit. It is not always possible to find such a tooth on examination, therefore, additional research methods help to determine the location and pathological process in more detail. We present our clinical observation of tooth retention and ectopia in the nasal cavity and upper jaw. The diagnosis was confirmed by the data of endoscopic examination and computed tomography of the paranasal sinuses. The ectopic tooth was found before the development of pronounced local inflammation. The tooth was removed from the nasal cavity using endoscopic techniques, no communication between the nasal cavity and the oral cavity was found. The postoperative period was uneventful. On examination two weeks after the operation, no pathological changes in the nasal cavity, paranasal sinuses were found, as well as defects in the mucous membrane and bone part of the nasal cavity floor.

Objectives – to study the frequency of impairments of the ability to move in elderly patients – care recipients of a social inpatient institution of the Kyrgyz Republic.

Material and methods. We examined 88 inmates of a social inpatient institution, among them there were 47 (53,4%) men and 41 (46,6%) women aged 65 to 74 years. The average age was 71,9±6,4 years.

Results. Disorders of general motor activity were observed in 62 (70,5±5,31%) patients. The violations of stability and walking parameters were more pronounced, they were found in 70 (79,5±5,04%) and 71 (80,7±6,31%) patients respectively. When assessing the parameters of stability, the disturbances were observed in all positions; mostly they manifested themselves during the tests for standing with closed eyes (46,6±4,27; р<0,05) and when leaning back (44,3±3,83; р<0,05).

Conclusion. A comprehensive geriatric assessment to identify the main geriatric syndromes in elderly patients of residential social institution should become an integral part of the organization of medical care aimed at solving these problems and the subsequent mandatory correction of these disorders.

Objectives – to identify the correlations between the Charlson comorbidity index and the results of functional activity tests as predictors of sarcopenia among elderly and senile women with polymorbidity.

Material and methods. The study included 269 elderly and senile women aged from 65 to 84 years, having polypathology.

Results. Sarcopenia was detected in 14.63% of the elderly, and in 27.40% of senile women. The Charlson comorbidity index was associated with the risk of progression of frailty, a decrease in basic functional activity, increased muscle weakness and impaired function of skeletal muscles.

Conclusion. Dynamometry and functional activity tests can be used in clinical practice to diagnose sarcopenia syndrome in elderly and senile women.

Objective – to assess the risk of developing the burnout syndrome in medical workers under the influence of working conditions and psychological environment in the team.

Material and methods. To evaluate the level of emotional burnout, 134 medical workers of medical institutions of the Saratov region were tested according to Viktor Boiko methodology, based on the study of the working environment and the labor process, as well as according to Fiedler’s methodology of assessing the psychological climate in the team.

Results. The study results testified the direct influence of the factors of the labor process that determine the class of working conditions on the risks of developing emotional burnout in medical workers. The 2.0 class of working conditions implies the risk of occupational burnout in 30.7% of doctors after five years of work. The 3.2 class of working conditions leads to burnout in 46.7% of doctors after five years of work.

Discussion. The high degree of emotional burnout registered in medical workers in the course of this study was naturally determined by both the level of the class of working conditions and the level of the psychological tension in the team. The prognosis of burnout syndrome development in the teams with positive psychological climate is 20.0%, while in the teams with unfavourable psychological situation the risk of occupational burnout reaches 46.6%.

Conclusion. The results obtained in the course of this study were used as the basis for the development of a method for predicting the risk of developing burnout syndrome in medical professionals.

The clinical case presents a young patient with antiphospholipid syndrome, which was the cause of recurrent acute ischemic cerebrovascular accidents and pathology of pregnancy.

During the clinical and laboratory examination, the patient was diagnosed with systemic lupus erythematosus. To determine the etiology of ischemic strokes and recurrent pregnancy loss, the patient underwent an immunological blood test which led to diagnosing the antiphospholipid syndrome. The patient failed to comply with the doctor's recommendations for taking an anticoagulant in the early postpartum period that resulted in the development of multifocal ischemic stroke.

After treatment, the patient's condition improved, focal neurological symptoms partially regressed, and laboratory parameters returned to normal. As a secondary prevention of thrombosis, the patient was prescribed anticoagulant therapy.

Objectives – to substantiate and define the main directions of the development of public-private cooperation in the provision of specialized oncological care to patients.

Material and methods.The research was based on the data of official statistics, scientific and methodological literature presented in the eLibrary, Publons, Scopus, the Cochrane Library databases. Research methods included bibliographic, descriptive and analytical, content analysis method, mathematical and statistical (calculation of relative indicators, mean values, methods of aligning the interval time series).

Results. Reducing morbidity and mortality from oncopathology is a state-scale problem that can only be solved comprehensively by attracting private investors when implementing innovative public-private partnership projects in healthcare. One of the modern models of interaction between state and business is the construction of public-private partnerships for new medical infrastructure.

Conclusion. The Center for Nuclear Medicine for the treatment of cancer is an innovative project, the implementation of which will help to reduce mortality from malignant neoplasms, increase the availability of specialized care and the quality of life of patients.

Objectives – assessment of structural changes in the calcaneal tendon tissue in experimental tendinopathy under autologous platelet-rich plasma.

Material and methods. Twenty mature Wistar rats, selected for the study, were divided into 5 groups. Rats of all groups received intra- and peritendinous injections of 0.5 ml of 10% sterile talc suspension to provide the experimental modeling of tendinopathy of the calcaneal tendon. Then the tendinopathy area was treated by injections of autologous platelet-rich plasma (PRP), a hyaluronic acid preparation "Rusvisk" (Rusvisk, Russia) and their sequential combination. The results were evaluated after 10 weeks in the autopsy preparations using a light microscopy method and morphometry.

Results. The histological signs characteristic of tendinopathy were revealed, such as the disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid and histiocytic infiltration. The injection of PRP, hyaluronic acid, or their sequential combination in the area of simulated tendinopathy led to changes in the histological presentation of the tissue. As a result, the collagen matrix had less signs of disorganization and less pronounced degenerative changes, as well as manifestations of the inflammatory process in the peritenon and the soft tissues surrounding the tendon, in comparison with the histological profile, which was observed in micropreparations in animals with tendinopathy who had no treatment.

Conclusion. The introduction of PRP into the area of the calcaneal tendon has reduced the manifestations of the inflammatory process, disorganization of the collagen matrix, promoted the enhancement of collagen synthesis by cells and, ultimately, the processes of tissue remodeling.

Objectives – to evaluate the effectivenes of platelet-rich plasma preparations in the treatment of chronic inflammatory diseases of lower extremities.

Material and methods. The study involved patients hospitalized in the Research Institute – S. V. Ochapovsky Regional Clinic Hospital No.1, Krasnodar, with trophic ulcers and chronic osteomyelitis. The patients received injections of platelet-rich plasma as platelet lysate and/or platelet gel.

Results. The study involved 19 patients with trophic ulcers of the lower extremities with a duration of more than 2 months. Previously, the patients had underwent therapy without effect. In all cases, the patients received a complex of therapeutic measures, including debridement, dressing, conservative treatment, physiotherapy, antibiotic therapy. In the presence of large ulcers, 8 patients underwent autodermoplasty with complete engraftment. It has been noted that during platelet-rich plasma use the average healing time was 6-7 weeks.

Four patients were observed with chronic osteomyelitis. During operation, the bone cavity was filled with platelet gel. The postoperative period was uneventful in all cases. The maximum observation period was 1.5 years. No recurrence of osteomyelitis was detected.

Conclusion. The results of the study demonstrate the positive effects of platelet-rich plasma products use.