Vol 26, No 2 (2020)

Cover Page
Health care organization and public health
Comparative efficiency of various accupucture methods in early rehabilitation of patients after ischemic stroke
Molchanova E.E., Polunina V.V., Plotnikov V.P., Polyaev B.A.

Three hundred and thirty patients aged 35–79 years, who underwent early rehabilitation in the primary vascular department, participated in a randomized controlled trial. In 220 patients (the main group of the study), non-drug rehabilitation (in the form of a combination of physiotherapy and exercise therapy) was optimized using various reflex therapy methods. The effectiveness of including them in rehabilitation schemes was analyzed in seven subgroups. One hundred and ten patients (the comparison group) underwent comprehensive non-drug rehabilitation without the inclusion of reflex therapy. The effectiveness of rehabilitation measures was evaluated by assessing dynamics (on the first day and after two weeks) according to the National Institutes of Health Stroke Scale, Barthel index, Beck questionnaires (level of depression), Spielberger-Hanin (level of reactive anxiety), and the “Motivation for Success and Motivation for Fear of Failure” (level of motivation) questionnaire tests. The best indicators on almost all scales were obtained in groups where patients underwent combined reflex therapy techniques: dynamic electroneurostimulation (DENS) in combination with classical acupuncture, su jok therapy in combination with classical, auricular acupuncture and craniopuncture, and prolonged craniopuncture in combination with corporal and auricular acupuncture. Indicators were slightly lower in the cases when separate methods were applied: DENS or su jok, and in subgroups where corporal and auricular acupuncture were combined with craniopuncture (according to the methodology of Professor Yu Zhi Shun, China), or craniopuncture according to classical methodology. The lowest indicators were in the group of patients who did not use methods of reflex therapy. This study confirmed the need to integrate acupuncture techniques in the schemes of early neurorehabilitation schemes of post-stroke patients for whom combined technologies are most effective.

Medical Journal of the Russian Federation. 2020;26(2):78-84
Results of subjective evaluation of the satisfaction of parents of newborns with the attitude of medical staff
Moiseeva K.E., Alekseeva A.V., Berezkina E.N.

Background. Under current conditions, when a reduction in the birth rate in the Russian Federation becomes a problem of national security of the state, improving the quality of medical care for newborns becomes an important strategic task facing the healthcare service.

AimThis study aimed to assess the satisfaction of parents of newborns with the attitude of medical personnel to children in healthcare facilities in St. Petersburg.

Materials and methods. An anonymous survey of 4467 mothers of newborns, who received medical care within the compulsory medical insurance in healthcare facilities in St. Petersburg in 2019, was conducted using a random sampling technique. The sample’s representativeness was tested by the method of Professor A.M. Merkova, and the error in the study did not exceed 3.5% in obstetric care institutions, 4% in children’s multi-specialty hospitals, and 3% in children’s polyclinics (departments).

Results. In general, 74.1% of mothers were completely satisfied with the attitude of doctors toward newborns in obstetric care organizations, 78.2% of mothers in multi-specialty hospitals, and 70.5% of mothers in children’s polyclinics (departments). The proportion of mothers who were completely satisfied with the attitude of the nursing staff to newborns was 51.7% in obstetric care organizations, 52.4% in multi-specialty hospitals, and 76.0% in children’s polyclinics (departments). When assessing the human and professional qualities of doctors in the obstetric care organizations, the average score was 4.45 ± 0.09, which in children’s multi-specialty hospitals was 4.53 ± 0.10, and that of the doctors of children’s polyclinics (departments) was 4.61 ± 0.08 points. The average score determined by mothers of the human and professional qualities of the nursing staff in obstetric care organizations was 4.22 ± 0.08 that in multi-specialty hospitals was 4.16 ± 0.09, and that of the nursing staff in children’s polyclinics (departments) was 4.63 ± 0.09 points.

Conclusion. The level of satisfaction with the attitude of medical personnel toward newborns was within the target value established by the Territorial program of state guarantees (70%), and the level of satisfaction with the attitude of the nursing staff corresponded to the target value only in children’s polyclinics (departments).

Medical Journal of the Russian Federation. 2020;26(2):85-92
Clinical pharmacology and pharmaceuticals
Use of endogenous cholesterol and its metabolite as markers of cyp450 metabolic activity
Smirnov V.V., Krasnykh L.M., Vasilenko G.F., Ramenskaya G.V., Checha O.A.

This article analyzes the application of the method for determining the activity of CYP3A4 by determining the concentration of endogenous cholesterol and its metabolite/4β-hydroxycholine in blood plasma. It also provides information on the convergence assessment of data obtained using alternative methods for determining the activity of the same CYP450 isoenzyme (CYP3A4) using different substrates: cholesterol and cortisol.

Medical Journal of the Russian Federation. 2020;26(2):93-97
Falls in the elderly due to vestibular dysfunction: clinical and pathogenetic aspects
Damulin I.V., Tardov M.V.

This article discusses the clinical features and causes of falls in the elderly due to vestibular dysfunction. The sociomedical significance of this problem is emphasized. Almost 50% of older people who have suffered repeated falls have a restriction of physical activity because of psychological reasons (fear of repeated falls). The most common cause of falls is balance disorders, and the corresponding complaint in patients with falls is vertigo. The description of peripheral and central forms of vertigo is provided. The clinical and pathogenetic aspects of these disorders are considered. It emphasizes that research conducted in recent years using methods of functional neuroimaging has significantly advanced our understanding of the mechanisms of functioning of the vestibular system, especially its central parts. Based on the results of studies aimed at studying the human connectome in patients with cochleovestibular disorders, the significance of multimodal sensory integration disorders with this pathology is shown.

Medical Journal of the Russian Federation. 2020;26(2):98-103
Assessment of persistent digestive system dysfunctions in sociomedical examination
Stolov S.V., Ugleva E.M., Yamshchikova T.Y., Makarova O.V.

Based on data in the literature, this article provides criteria for assessing persistent digestive system dysfunction. This issue must be considered when referring or conducting a sociomedical examination of patients with gastrointestinal tract pathology to establish a disability group, taking into account the aspects of the existing Order No. 585 of the Ministry of Labor of Russia, “On classifications and criteria used in the implementation of sociomedical examination of citizens by federal state institutions of sociomedical examination.”

Medical Journal of the Russian Federation. 2020;26(2):104-113
Periodontal biotype: anatomic features and association with surrounding tissue
Kopetskiy I.S., Pobozhieva L.V., Shevelyuk Y.V., Kopetskaya A.I.

The high prevalence of periodontal diseases, up to 90%, is an important issue in medicine. The periodontal biotype is one of the most important parameters that determine the course and prognosis of periodontal diseases. Gingival thickness, keratinized tissue, and bone morphology are the main characteristics of the periodontal biotype. This article presents a review of the literature on the characteristics of periodontal biotypes, their response to treatment, and treatment prognosis. A search of electronic databases (Medline, EMBASE, CyberLeninka, Elibrary, and RINC) was performed for the literature review. The article also presents studies about relationships among periodontal biotype, recession, and malocclusion. The thin biotype is a predictive factor of gingival recession. Recessions are characterized by apical migration of marginal gingiva and defects in root coverage. Gingival recession may result from orthodontic movement of teeth, particularly among patients with the thin gingival biotype. The thin and thick biotypes respond differently to inflammation, restorative and surgical effects, and parafunctional habits. A gingival thickness greater than 2 mm can be categorized as the thick biotype and less than 1,5 mm as the thin biotype. Gingival thickness can affect the results of restorative therapy and root coverage procedures. It is necessary to determine the gingival biotype before initiating treatment. Special care must be taken when planning treatment for cases with a thin biotype.

Medical Journal of the Russian Federation. 2020;26(2):114-118
Practice case
Surgical treatment of severe posttraumatic foot deformity
Leonchuk S.S., Chibirov G.M.

The surgical treatment of a 17-year-old patient with posttraumatic complex and rigid foot deformity by the transosseous osteosynthesis method by Ilizarov (original frame) is presented in the article. Previously, the patient incurred a fracture of the left tibia. He was treated by open reduction and internal fixation with a plate in the private clinic. Within four years, an equinovarus adductus foot deformity had developed. During our treatment, the deformity of the foot was eliminated without resection of the bones of this segment. After one year of treatment, the patient was satisfied with the functional condition of the foot, its cosmetic appearance, and the absence of pain in the foot. The American Orthopedic Foot and Ankle Society scale score increased significantly from 30 points preoperatively to 82 postoperatively, whereas the visual analog scale (VAS)-pain scale score decreased from 7 to 1. His ankle motion increased from 10° preoperatively to 29° postoperatively. This case demonstrates the possibilities of the Ilizarov method and our approach in the treatment of severe rigid foot deformities by the Ilizarov technique.

Medical Journal of the Russian Federation. 2020;26(2):119-124
Fulminant diabetes mellitus and concomitant enterovirus infection: a clinical case
Saprina T.V., Musina N.N., Vtorushin S.V., Krakhmal’ N.V., Rogovskaya Y.V.

Fulminant type 1 diabetes mellitus is a subtype of diabetes mellitus. It is characterized by the extremely rapid development of hyperglycemia and ketoacidosis because of the near-total destruction of pancreatic β-cells. A clinical case of lethal, type 1, fulminant diabetes mellitus is presented. The patient management strategy and possible causes of the adverse course and outcome of the disease are analyzed.

Medical Journal of the Russian Federation. 2020;26(2):125-132

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