Vol 26, No 5 (2020)

Health care organization and public health
Mortality dynamics and scope of high technology medical care availability: regional specificities
Naberezhnaya I.B.
Abstract

In recent years, the demographic situation in Russia has been demonstrating a positive downward trend in the mortality rate. However, this rate is still much higher than in developed European countries. Social policies of the Russian State are increasingly focused on reducing the level of mortality, morbidity, and disability, as well as enhancing the availability and quality of medical care, especially the high-tech medical services. Effective use of the potential availability in the regional medical organizations, as well as building momentum in high-tech medical care, which would be equivalent to services provided in the federal medical centers, will help bring high-tech medical services closer to the population, thereby contributing to the improvement of access to such services. Development of this type of medical care will in the future yield medical and social results enhancing the quality of life, preserving the health of citizens, and consolidating results achieved in demographic policies.

The objective of this study was to explore regional characteristics of the mortality rate dynamics and maturity of high-tech medical care services.

Research methods involved statistical, system, and comparative analyses.

Results of in-depth statistical series analyses of the mortality rate and structure carried out in the Astrakhan region in 2010 through 2017 were correlated with the scope of high-tech medical care provided as a whole and in separate fields of medicine. Correlation analysis of results was carried out, and results revealed a strong inverse correlation between factors under study (rх/y/у=−0.85; mr±0.22) with a significance test value of 3.9 (p>99%).

Diseases of the circulatory system rank first in the list of mortality causes, while in the structure of the high-tech medical care, cardiovascular pathologies account for the greatest proportion of services provided; thus, revealing a strong inverse correlation (rх/y=−0.77; mr±0.26) with the significance test value of 3.0 (p>95%).

Medical Journal of the Russian Federation. 2020;26(5):266-273
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Effects of periodontal diseases in the quality of life associated with oral health
Razboynikova D.A., Solov’eva Y.A.
Abstract

Periodontal diseases are one of the most common oral diseases worldwide. To develop and refine administrative procedures and preventive measures in the field of oral hygiene, assessment of the quality of life in people with periodontal diseases is necessary.

The objective of this study was to determine the effect of periodontal diseases on the quality of life associated with oral health.

Materials and methods. A total of 192 patients receiving dental care participated in this study. Participants were divided into two age groups: 35–44 years old and 65–74 years old. A comprehensive proprietary methodology for analyzing the effect of periodontal diseases on the quality of life associated with oral health was developed, which comprises objective and subjective methods for dental health assessment. In the first stage, the status of the periodontal tissues was assessed using the modified Community Periodontal Index and an indicator of the periodontal tissues attachment loss severity.

In the second stage, the Oral Health Impact Profile-14 dental quality of life questionnaire was used to conduct an anonymous survey among respondents. Thereafter, results of the dental examination and anonymous questionnaire were integrated.

Results. Respondents aged 65–74 years old are prone to a more severe course of periodontal disease and have a significantly lower quality of life. When analyzing the correlation dependence between indicator values of the status of the periodontal tissues and the respondents’ status, a statistically significant positive correlation of various powers was obtained in all age groups, which reliably suggest the existence of close linkage between the severity of periodontal disease and the degradation of the quality of life.

Conclusions. The impact of periodontal diseases on the quality of life associated with oral health has been revealed and reliably established, which proves the need to develop and implement administrative procedures to improve preventive measures and programs designed to provide assistance to such patients at all levels of medical care, with the quality of life indicators to be considered obligatory.

Medical Journal of the Russian Federation. 2020;26(5):274-278
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Multiple sclerosis: analysis of primary disability in St. Petersburg in 2016–2018
Pomnikov V.G., Samsonenko O.O., Sen’kina A.G., Kritskaya L.A., Prokhorov A.A., Delokyan G.A.
Abstract

Multiple sclerosis is the most common cause of disability in young patients with neurological problems, which makes it the most important medical, social, and economic problem. Analysis of the structure and dynamics of primary disability resulted from multiple sclerosis in the city of St. Petersburg was carried out from 2016 through 2018. The proportion of patients with multiple sclerosis, who were for the first time identified as disabled, was 1 in 166 (0.6%) examinations in 2016; 1 in 142 (0.7%) in 2017; and 1 in 135 (0.74%) in 2018. In the course of three years, 74.2% of patients were assigned to the third-degree disability group; 21.2% to the second-degree disability group; 3.2% to the first-degree disability group; and 1.4% of patients were deemed a “disabled child” status. Working age people (26–45 years old) prevailed among those first recognized as disabled, which accounted for 58.6%.

Analysis of types of multiple sclerosis course carried out for the year 2017 showed the prevalence of relapsing-remitting multiple sclerosis accounting for 86% of cases. Main indicators associated with the disability were as follows: work-related limitations (98.7%), limited ability to move independently (93.4%), and limited ability to perform activities of daily living (19.9%). This study showed an increase in the number of people first recognized as disabled among patients with multiple sclerosis during this period, which probably results from multiple sclerosis incidence and prevalence growth. Patients of working age with third-degree disability, predominantly women with relapsing-remitting multiple sclerosis, prevail among patients with multiple sclerosis who were first recognized as disabled, which corresponds to the literature data. Leading indicators of disability are: work-related limitations, limited ability to move independently, and limited ability to perform activities of daily living. Data obtained indicated a high medical, social, and economical significance of multiple sclerosis, which confirm the need for earliest diagnosis and timely initiation of therapy in order to slow down the disability progression in patients of working age.

Medical Journal of the Russian Federation. 2020;26(5):279-282
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Medical care provided for the river fleet shipboard crews
Barankina T.A., Fetisov A.O., Valeeva R.M., Kurbanova S.N., Yakimenko O.N.
Abstract

Relevance: The problem in assessing the health status of employees exposed to certain harmful occupational factors is always a paramount challenge. Professional activities of water-borne transportation workers are associated with the impact of wide range occupational hazards as follows: noise, vibration, electromagnetic fields, ship rocking, and frequent change of time and climatic zones, etc. The work of rivermen under conditions of long voyages and intensive occupational loads, with schedule rotation, inevitably build up a significant physical and psychoemotional strain. The multifactorial complex resulted from these negative health effects inevitably leads to a breakdown of the compensatory and adaptive responses in humans.

Objective: This study aimed to assess the periodic medical examinations results of employees of companies assigned to Medical Care and Preventive Unit at the Federal Medical and Biological Agency of Russia including the quantity and structure of diseases, while identifying challenges associated with the healthcare system tasks implementation.

Materials and methods: This study was carried out based on results of the periodic medical examinations of employees of water-borne transportation companies assigned for getting medical services to Medical Care and Preventive Unit of the Federal Siberian Scientific and Clinical Center at the Federal Medical and Biological Agency of Russia in the city of Krasnoyarsk. Federal and industry-wide regulations, as well as local medical regulations were utilized.

Medical Journal of the Russian Federation. 2020;26(5):283-291
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Clinical medicine
Uric acid as a prognostic marker in elderly patients with an exacerbation of coronary artery disease
Zubova E.A., Brazhnik V.A., Minushkina L.O., Averkova A.О., Zateyshchikov D.A.
Abstract

The search for causal factors that can influence the prognosis after an acute coronary syndrome in elderly patients is a critical task. This study aimed to assess the correlation between increased uric acid levels with the incidence of adverse outcomes in patients over 75 years of age with history of acute coronary syndrome. Medical Records of 343 patients over 75 years old with history of acute coronary syndrome were retrospectively reviewed. Clinical characteristics and laboratory data upon admission, whether deceased or survived, were also analyzed. When carrying out multivariate analysis, following factors independently associated with total mortality were analyzed: aortic stenosis, atrial fibrillation, hyperglycemia, and acute heart failure at the moment of the index event, hyperuricemia, and percutaneous coronary intervention at the time of hospitalization caused by the index event. Thus, an increase in the level of uric acid is an independent predictor of lethality in the senior age group patients.

Medical Journal of the Russian Federation. 2020;26(5):292-297
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Application of stabilometric diagnostics in the “conscious correction of scoliosis and posture disorders” comprehensive program
Levkov V.Y., Kiselev D.A., Shavyrin I.A., Panyukov M.V., Andronova L.B., Polyaev B.A., Lobov A.N., Butorina A.V., Plotnikov V.P., Tsoy S.V.
Abstract

Objective: to prove the effectiveness of stabilometry in the early diagnosis of posture disorders and scoliosis in children.

Materials and methods: Participants include patients diagnosed with scoliosis and impaired posture. In addition to standard examination methods, such as in-depth history taking, clinical examination, scoliometry, anthropometric parameters measurement, strength of main muscle group’s measurement, and X-ray diagnostics, computer stabilometry was used.

Conclusions: In patients diagnosed with scoliosis and postural disorders, lower leading limb support is impaired in ˃81% of cases. Transfer of support to the contralateral lower limb and/or a pronounced displacement of the support in the frontal plane took place. In most cases, computer stabilometry allows diagnosing such pathological changes earlier than the establishment of the other signs from the above mentioned diagnoses.

Medical Journal of the Russian Federation. 2020;26(5):298-301
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Patients with postnatal manifestation of congenital diaphragmatic hernia: management specificities
Zheleznov A.S., Ermolaeva N.S., Parshikov V.V., Teplov V.O.
Abstract

Treatment of congenital diaphragmatic hernia is one of the most critical neonatal surgery challenges, which is associated with high mortality rate. Despite the progress achieved in the treatment of congenital diaphragmatic hernia, the choice of surgical approach and time of hernial correction remains controversial.

Material and methods: From 2000 to 2018, 39 children with congenital false diaphragmatic hernia were hospitalized in the department of surgery of the Nizhny Novgorod Regional Children's Clinical Hospital. Of these, 26 (66.7%) were boys and 13 (33.3%) were girls. Cases of successful treatment of bilateral diaphragmatic hernia and correction of persistent right Bochdalek defect with underlying right tension pneumothorax with “late manifestation” of diaphragmatic hernia deserve a special presentation.

Results: Most typical set of symptoms includes respiratory failure, cardiovascular disorders, and intestinal pseudo-obstruction syndrome. Left-sided hernia was detected in 35 children (89.7%), while right-sided hernia was detected in 3 (7.7%), and a bilateral hernia was detected in one child. The mortality rate accounted for 25.6% (10 children) of children due to progression of cardiopulmonary complications.

Conclusions: Despite the extensive clinical experience in the management of children with diaphragmatic hernias, of the prenatal diagnostics potential and technical capacities of modern medicine, individual cases of diaphragmatic hernias are associated with challenges regarding timely detection of malformation in the postnatal period, since the diaphragmatic hernia with persistent diaphragmatic defect tend to demonstrate a late pattern of manifestation. Diaphragmatic hernia can develop at a later time—age 4–6 months, which could be explained by an intra-abdominal pressure increase when the child is becoming more active, while underlying Bochdalek defect is persisting.

Medical Journal of the Russian Federation. 2020;26(5):302-310
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Reviews
Specificities of septic complications prevention in elderly patients with concomitant diabetes mellitus undergoing major joint arthroplasty
Sirotin I.V., Dudinskaya E.N., Brailova N.V., Milto A.S., Kotovskaya Y.V., Lazishvili G.D., Ratyev A.P., But-Gusaim A.B., Egiazaryan K.A., Tkacheva O.N.
Abstract

This article discusses the specificity of the perioperative period in patients with diabetes mellitus after major joint arthroplasty, and causes of an increased risk of septic complications development. The data on the criteria for compensating the course of diabetes mellitus when performing this operation were presented. Recommendations were given for the perioperative management of this category of patients in order to reduce the chance of developing wound and periprosthetic infections.

Medical Journal of the Russian Federation. 2020;26(5):311-316
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Current potential and opportunities for improvement of hearing screening in newborns and infants: literature review and own observations
Toropchina L.V., Mironova A.K.
Abstract

This article deals with challenges of hearing screening in newborns and infants (children in the first year of life). Data on the current opportunities of hearing screening in newborns are presented, and specificities of hearing abilities diagnostics in premature infants born with a very low and extremely low body weight are discussed. Emphasis is made on prospects for improving the audiological screening system.

Medical Journal of the Russian Federation. 2020;26(5):317-325
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Calcification of the basal ganglia: ethiopathogenetic, clinical, and therapeutic aspects
Damulin I.V., Andreev A.D.
Abstract

This article discusses the clinical manifestations, etiology, and pathogenesis of Fahr disease, as well as causes of Fahr syndrome. This condition is characterized by abnormal calcium deposition, most commonly in the basal ganglia. Calcifications are composed not only of calcium, but also of iron, zinc, and aluminum. At present, several basic concepts of Fahr disease etiology have been put forward, and concepts considering genetic mutations have been studied most profoundly. Both Fahr syndrome and Fahr disease demonstrate a very similar clinical picture. Clinical manifestations in patients with this pathology are marked by significant polymorphism; however, the most typical variation of Fahr disease is the association of motor functions and mental disorders. As for motor functions disorders, Parkinsonism accounts for more than half of the cases. With regards to this pathology, this article considers the key diagnostic criteria and potential of brain computed tomography and magnetic resonance tomography. At present, pathogenetic treatment of Fahr disease does not exist, while Fahr syndrome therapy is focused on diagnostics and treatment of the underlying disease. Pharmacotherapy treatment for Fahr disease is targeted at anxiety and depression relief, as well as reduction of motor functions disorder manifestation.

Medical Journal of the Russian Federation. 2020;26(5):326-330
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