Vol 27, No 6 (2021)

BACKGROUND: Over the past 20 years in the Russian Federation, general practitioners have been increasingly introduced into the structure of primary health care, which naturally affects the work and number of district general practitioners as the main representatives providing this type of care.

AIM: The study aimed to assess the indicators of the availability of district general practitioners in the Russian Federation and federal districts in the period from 2010 to 2019.

MATERIALS AND METHODS: The indicators of the availability of local general practitioners in the Russian Federation and federal districts in 2010–2019 were analyzed using the data of the form of federal statistical monitoring No. 30 “Information about the medical institution.”

RESULTS: During the monitoring period in the Russian Federation, both the absolute number and provision of the population with district general practitioners per 10,000 population decreased (regular positions from 4.2 to 3.88, assumed positions from 3.91 to 3.28, and individuals of the main workers in assumed positions from 3.25 to 3.11 (−7.6%, −16.1%, and −4.3%, respectively), and the staffing level of these doctors decreased by 9.1% (from 92.9% to 84.5%). A similar trend can be traced in most federal districts, except for the North Caucasus, where the number and availability of district general practitioners and their staffing increase. Moreover, the secondary employment ratio of these doctors decreased positively in both the Russian Federation (by 12.3%, from 1.2 to 1.06) and all federal districts.

CONCLUSIONS: The process described can be due to the reformation of the polyclinic model with an emphasis on strengthening the role of general practitioners and their gradual replacement of district general practitioners in most regions of the country. This process is intensive in the Central Federal District. On the contrary, in the North Caucasian Federal District, the role of district general practitioners is increasing.

BACKGROUND: Every modern person, especially residents of cities and metropolitan areas, is exposed daily to numerous negative factors. One of the most significant factors is noise and loud sounds. In addition to industrial noise, many people voluntarily increase the noise load through headphones, which affects negatively not only the auditory function but also the psycho-emotional and psycho-physiological state while listening to loud music. In addition to a direct effect on the ears, loud sounds affect the central nervous system, various parts of the brain, change the normal processes of higher nervous activities, and lead to impaired cognitive functions.

AIM: The study aimed to examine the effect of using various portable electronic devices equipped with headphones on the psycho-physiological state of young people.

MATERIALS AND METHODS: The study was conducted in 2018–2019 at the Department of Hygiene of the Izhevsk State Medical Academy. The survey involved 440 school and university students aged 10–22 years. All respondents were distributed into two groups depending on the use of headphones. The survey was conducted using a developed questionnaire consisting of 24 questions with pre-formulated answers.

RESULTS: Adverse psycho-physiological manifestations, as well as impaired cognitive functions of the brain, are registered among people who regularly use headphones 2.6 and 3.8 times more often, respectively, than those students who do not use audio headphones in everyday life. The high level of negative psycho-physiological manifestations and impairments of cognitive functions is due to the use of audio headphones at a volume significantly higher than normal values.

CONCLUSIONS: Daily uncontrolled use of portable electronic devices equipped with headphones has a negative effect not only on the psycho-physiological state but also on the cognitive functions of the brain of young people.

BACKGROUND: The search for available predictors of hospital survival and mortality rates during the COVID-19 pandemic is an urgent problem.

AIM: The study aimed to determine the role of troponin in the immediate prognosis of patients with COVID-19.

MATERIALS AND METHODS: The study included 85 patients with a new coronavirus infection upon admission, who underwent a blood test for troponin. All patients underwent an echocardiographic study according to a standard protocol, and the effect of troponin levels on nosocomial survival and mortality rates, correlation of this indicator with the left ventricular ejection fraction, degree of pulmonary hypertension, laboratory parameters, and degree of respiratory failure determined by computed tomography of the lungs and oxygen saturation indicators were analyzed. Correlation analysis with autopsy parameters was performed.

RESULTS: A high level of troponin indicated the worst prognosis of patients during hospitalization. The laboratory marker level correlated significantly with the parameters of the left ventricular ejection fraction. Its highest level was determined in patients with type 1 myocardial infarction. Troponin was not correlated with the degree of respiratory failure, as well as the state of the myocardium in the autopsy material.

CONCLUSIONS: Determining the troponin levels as a routine laboratory marker can be recommended for stratifying the risk of myocardial damage in patients with COVID-19 during hospitalization.

Cardiovascular diseases remain a heavy socioeconomic burden in the modern world, claiming up to four million lives annually, including one million of the Russian population. Most often, cardiovascular mortality is associated with chronic coronary heart disease and its complications. Despite the progress in the treatment of acute coronary syndrome in the acute disease phase, the problem of recurrent coronary events and associated adequate rehabilitation remains unresolved. Modern Russian and European recommendations for cardiovascular rehabilitation present the main directions of secondary prevention of myocardial infarction, which summarize the global and Russian evidence-based medicine data on the problem and are based on the principles of phasing, continuity, succession, and multidisciplinary approach to the patient management. This review focuses on the problems and shortcomings of secondary prevention and cardiac rehabilitation at the patient, doctor, and healthcare system levels. In addition, contemporary approaches to their elimination are described. The necessity and importance of individual training and informing patients and the formation of their sustainable commitment to a healthy lifestyle and therapeutic and preventive measures prescribed by modern guidelines on this issue are emphasized.

The review raised current problems arising from the use of various surgical methods for the treatment of gastroesophageal reflux disease and small diaphragmatic hernias. The literature search aimed to identify the main indications, criteria for choosing methods for laparoscopic antireflux surgeries, and compare the results on the frequency of relapses and complications of posterior cruroraphia and Nissen fundoplication. Various surgical techniques for fundoplication were compared, and the most optimal one, which improves the quality of life of patients, was determined. The advantages of laparoscopic antireflux surgeries over conservative treatment and open techniques were determined.

Despite the current development of cardiology, postinfarction rupture of the interventricular septum (IVS) is one of the most hazardous, life-threatening complications of acute myocardial infarction. The paper describes a clinical case of a 63-year-old female patient with a history of an acute ST-elevation myocardial infarction complicated by IVS rupture. The difficulties in the management of this patient and a comparative analysis of our treatment strategy with the available modern literature data on this issue are also presented.