Vol 26, No 5 (2020)

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.

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.

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.

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.

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 (r_х/y/у=−0.85; m_r±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 (r_х/y=−0.77; m_r±0.26) with the significance test value of 3.0 (p>95%).

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.