Vol 23, No 6 (2017)

The photo time-keeping monitoring of working of 50 physicians of ultrasound diagnostic was carried out in 20 pilot territories with consideration for modern technical possibilities. The substantiation of the study was based on point 3 of the regulations of development and authorization of type labor standards, approved by enactment of the Government of the Russian Federation of November 11 2002 № 804 (legislation corpus of the Russian Federation, 2002, № 46, article 4583) and point 19 of the plan of actions («road map») «The alterations in sectors of social sphere directed to increasing of efficiency of health care», approved by the enactment of the government of the Russian Federation of December 28 2012 № 2599-p (legislation corpus of the Russian Federation, 2013, № 2, article 130; № 45, article 5863; 2014, № 19, article 2468). The results of study testify the necessity of development of normative documentation related to establishment of standards of load of endoscopy physicians concerning increasing of time spend to implementation of curative diagnostic examinations.

The article presents the results of delivery in women older than 34 years. The obtained data testifies that on the whole in the Republic of Azerbaydzhan percentage of delivery in women older than 34 years factually has no difference with such in similar countries and amounts to 5-6 cases per 100 deliveries correspondingly. The analysis of perinatal losses during deliveries in women older than 34 years demonstrated that only in every second region of the Republic of Azerbaydzhan there is a statistical confirmation of correlation dependence between percentage of deliveries in women older than 34 years and perinatal losses. The significant differences are established depending on regions both in prevalence of deliveries in women older than 34 years and availability of perinatal losses. This occurrence requires further investigation of causes and development of measures of their elimination.The purpose. To evaluate significance of inter-regional differences of prevalence of deliveries in women older than 34 years among cases of terminated pregnancy in period of gestation after 22 weeks for health of mother and child.Materials and methods. The study was carried out using retrospective algorithm in obstetric institutions of cities of republican subordination. The object of observation was formed using complete inclusion of all cases of termination of pregnancy in of gestation after 22 full weeks during 2012-2014. The percentage of delivery in the age older than 34 years was determined. The results. In totality, 5.8±0.07 cases of delivery at 35 ages and older go to 100 terminated cases of pregnancy in period of gestation after 22 full weeks. In district and municipal obstetric institutions, a value of this indicator varied in the range from 0.3±0.06% to 18.5±0.53%. In totality, level of perinatal losses made up to 1.8±0.04%. In regional obstetric institutions, the level of perinatal losses varied in the range from 0,1±0.04% to 3.7±0.16% (p < 0,01).Conclusions. In Azerbaydzhan, the inter-regional differences in prevalence of delivery at the age 44 years and older are significant (percentage of deliveries at the age 34 years and older varies in the range from 0,3 to 18,5%). The increasing of risk of perinatal losses under delivery at the age 34 years and older has no unequivocal confirmation. In Azerbaydzhan, in most of the municipal and district obstetric institutions (8 out of 15) deliveries in women older than 34 years have no association with increased level of perinatal losses.

During the last 20 years, the penetrating keratoplasty gave in its leading place to selective lamellar keratoplasty when pathologically altered layers of cornea are selectively replaced, including endothelium. The main technical task of all procedures of endothelial keratoplasty is an obligatory complete or almost complete post-operative adjacency of endothelial transplant to stroma of recipient. However, there are publications concerning resorption of edema in case of separation of endothelial transplant and even at its absence. The purpose of study. To analyze, on the basis of limited clinical observations, the results of partial discemetorexis (5.25 mm) without transplantation in patients with endothelial dystrophy of cornea (Fuchs).The materials and methods. The study was implemented concerning maximal correcting visual acuity, central thickness of cornea, density of endothelial cells and optical density of cornea, before, in one day, in one week, in 1, 3 and every 6 months after operation. The study covered 6 patients with Fuchs dystrophy (average age 63 ± 6,5 years) operated in 2015-2016 with period of observation neither less than 6 months. The visual acuity before operation in average made up to 0,32 ± 017 mkm, average central thickness of cornea - 677 ± 76 mkm. The native crystalline lens was present in 2 patients. The study was supported by ethical committee of the Helmholtz Moscow research institute of eyes diseases. The results. The resorption of edema of cornea occurred in 2 patients (33%), visual acuity increased from 0.45 to 0.6. In different periods density of endothelial cells varied from 549 to 689 kl/mm2. The central thickness of cornea decreased from 613 ± 33 mkm to 553 ± 15 mkm in 12 months after operation. Conclusion. The discemetorexis (5.25 mm) is more often efficient in case of availability of native crystalline lens, at earlier stages of dystrophy independently of patient's age. The discemetorexis ensures lower indices of maximal correcting visual acuity and density of endothelial cells and higher values of central thickness of cornea in comparison with DMEK. The indices of central thickness of cornea and optical density of cornea are exposed to fluctuations in different periods after discemetorexis (5.25 mm).

The sampling consisted of 79 examined males of able-bodied age. The arterial hypertension stage I and II was established in 58% of them; obesity of various degree of severity was diagnosed in 63% of them; metabolic syndrome according criteria ATP-III was noted in 46.8% of examined patients. The general clinical and anthropometric examination was carried out. The laboratory analyses included estimation of lipidogram, fasting glycaemia and also hormones adiponectin and insulin with following calculation of index of insulin resistance HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). The study was organized to investigate effecting of obesity on secretion of adiponectin and its relationship with indices of lipidogram and level of insulin resistance. The comparative analysis of groups with and absence of obesity established no significant difference in level of adiponectin and indices of lipidogram. the significant differences were established in the levels of basal insulin hence in value of index NOMA-IR that points to hyperinsulinemia and expressed insulin resistance in patients with obesity. The patients were separated in two groups depending on presence of manifestations of metabolic syndrome: with metabolically healthy obesity and metabolically complicated obesity. The analysis established a significant decreasing of level of adiponectin in the group of metabolically complicated obesity accompanied by insulin resistance, dyslipidemia and increased level of glycaemia. The study established no effect of degree of obesity on decreasing of level of adiponectin. The significant differences between levels of adiponectin in comparison between group without obesity and group of metabolically healthy obesity. The correlation analysis in group with obesity demonstrated back-coupling between level of adiponectin and content of total cholesterol, low density lipoproteins and coefficient of atherogenicity. The comparison of groups according median of adiponectin established significant differences in rate of development of metabolic syndrome and value of coefficient of atherogenicity.

The article considers issues of mental health of patients with oncologic pathology from position of bio-psychosocial approach and in the context of psycho-oncology, an actual direction of practical medicine. The prevalence of marginal mental disorders in this contingent of female patients is demonstrated on the example of women with oncologic diseases of reproductive system. The psychotherapeutic approaches to their correction are outlined. The original view on ratio of pathogenic factors effecting mental health of patients with oncologic pathology at various stages of medical care support. The genuine point of view on functional diagnosis of patient with oncologic disorder including somatic, clinical psychological and social components. The conclusions are made concerning necessity in timely modern psychosocial and psychotherapeutic care of the given contingent of patients.

In case of poly-trauma the early operations of osteosynthesis under fractures of long bones, unstable fractures of pelvis and backbone bones being an operational trauma, can provoke progression of inflammatory reaction, development of systemic complications and poly-organ inadequacy i.e. causing a «second hit» effect. The pathophysiologic mechanisms of «second hit» phenomenon are complicated and they are implementing by means of modulation of immune response. The risk of development of the given phenomenon depends on period of implementation and method of osteosynthesis, severity of injuries and condition, age, concomitant pathology of patient, presence of chest trauma and craniocerebral trauma. The study of pathophysiology of «second hit» phenomenon is perspective for development and optimization of clinical concepts of treatment of patients with poly-trauma and skeletal damages.