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Vol 28, No 4 (2022)

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Original Research Articles

Study of the quality of life of patients with proliferative diabetic retinopathy and end-stage chronic renal failure requiring hemodialysis: prospective cross-sectional study

Belikova E.I., Golovin A.S., Yudin V.E.


At present, a sufficiently high efficiency of including the assessment of the quality of life (QOL) of patients in the complex of standard clinical and functional methods for examining the organ of vision of patients with various types of vitreoretinal pathology has been determined. The occurrence and/or progression of proliferative diabetic retinopathy (PDR) is accompanied by an increase in the prevalence of chronic kidney disease because of similar pathogenetic mechanisms associated with pathological abnormalities in the microvascular bed. However, the analysis of the literature indicates the special practical importance of the end-stage chronic renal failure (CRF), which requires continuous hemodialysis.

AIM: This study aimed to investigate the patient’s QOL with PDR and end-stage CRF requiring hemodialysis.

MATERIALS AND METHODS: A prospective cross-sectional study was conducted from November 2020 to March 2022. Two groups of equal age, gender, and severity of PDR («Severe», «Severe risks I and II») were under observation: the main group (MG, n=36, mean age 60.4±2.1 yr), in which the hemodialysis procedure and the control procedure (CG, n=32, mean age 61.8±2.2 yr) were regularly performed, in which stage IV CRF was diagnosed. The study of QOL was performed according to two questionnaires, tested in patients with vitreoretinal pathology: «general» («VFQ-25») and «special» («QOL-20»).

RESULTS: The results obtained indicate a pronounced, statistically significant increase in the level of QOL in the CG compared with the MG. In quantitative terms, the conducted comparative assessment is 12.7 (p <0.05) and 26.1% (p <0.01) for the «QOL-20» and «VFQ-25» questionnaires, respectively. According to the «VFQ-25» questionnaire, the most pronounced differences between the QОL of patients in the MG and the CG were noted on the scales of near visual function, distant visual function, social functioning, and mental health. It is especially important to note that in accordance with the methodological foundations of the «QOL-20» questionnaire, patients in the CG (according to the total scores) were diagnosed with the 3rd degree of severity of visual impairment, whereas in patients of the MG, it was already the 4th degree.

CONCLUSION: In practical terms, the results presented reflect the improvement of the technology of surgical intervention in patients with PDR who are on hemodialysis. The level of QОL in patients with PDR who are on hemodialysis is significantly lower than in patients with PDR with stage IV CRF.

Medical Journal of the Russian Federation. 2022;28(4):265-272
pages 265-272 views

Expert (medical) evaluation of the main complaints of a patient after cataract phacoemulsiification from the position of a medical and social approach to the study of quality of life: prospective cross-sectional study

Ovechkin N.I., Ovechkin I.G., Pokrovsky D.F., Pavlov A.I., Shakula A.V.


BACKGROUND: At present, the study of the quality of life (QOL) of a patient is becoming increasingly important in the practice of cataract surgery, which is associated with the presence of statistically significant correlations between QOL and objective indicators of the visual system. The developed QOL questionnaires for patients with cataracts are based on the medical model of health.

AIM: This study aimed to assess the main complaints of the patient after cataract phacoemulsification (CP) from the standpoint of a medical and social approach to the study of QOL.

MATERIALS AND METHODS: A prospective cross-sectional study was conducted between April 2021 and February 2022. The initial volume of questions (complaints) of the patient was performed in the following areas: before and 3 months after the CP (50 patients with binocular cataract, «visual» manifestations); analysis of the domains of the International Classification of Functioning (ICF, «domestic» manifestations); literary analysis of patient complaints in asthenopic conditions («professional» and «medical-psychological» manifestations); and analysis of the classification structure of the ICF («functional» manifestations). The obtained data were transformed into questions with subsequent analysis by 47 expert ophthalmologists (19.2±1.4 yr of professional experience, including 11.9±1.7 yr of experience in performing CP) from the standpoint of the impact on the patient’s QOL. At the same time, the assessment was carried out on a 10-point scale, according to which of the following: 0 points — the question is irrelevant, 10 points — the question is very relevant. The mathematical analysis of the results was based on the calculation of the basic parameters of descriptive statistics for all 52 questions — the arithmetic mean (AC, as the «weight» coefficient of the question) and the standard deviation (SD, as an indicator of the consistency of the position of the respondents). As a result, the indicator of adjusted relevance (IAR) was calculated according to the formula: IAR = AC/CO. The IAR indicator of at least 2.3 determined the choice of the most relevant responses.

RESULTS: According to expert ophthalmologists, in total (n=52), 21 most pressing issues were identified, mainly «visual» (n=7), «functional» (n=6), and «everyday» (n=5). With regard to the average score of IAR on all the most pressing issues, the leading positions are occupied by «everyday» (average score is 3.20), «visual» (average score is 3.07), and «functional» (average score is 2.63). Thus, the number of «visual» complaints, according to experts, is only one-third of the total relevance, while there is a comparability of the average score of IAR on «visual», «functional», and «everyday» issues.

CONCLUSION: The use of the medico-social model of health provides an increase in the clinical and diagnostic efficiency of assessing the patient’s QOL in cataract surgery. The presented results are basic in the development of an original method for assessing QOL, as they fully comply with the generally accepted requirements for the content and constructive validity of the questionnaire.

Medical Journal of the Russian Federation. 2022;28(4):273-280
pages 273-280 views

Improvement of primary medical care for preschoolers: medical and social research

Kravchenko I.A., Oprischenko S.A., Polunin V.S., Buslaeva G.N.


AIM: The purpose of the study was to conduct a medical and social study of preschool children and scientifically substantiate measures to improve the preventive work of children's polyclinics.

MATERIALS AND METHODS: A study was conducted on 6,458 children aged from 3 to 6 yr, 11 months, and 29 days, and their families permanently reside in the city of Moscow and observed in children's city polyclinics of Moscow Department of Health.

RESULTS: The maximum incidence rate of preschoolers at 4 yr old is 4,221.6‰. Among them are also more frequently ill, with age the proportion of children with chronic pathology increases from 12.3% at 3 yr to 32.1% at 6 yr, by the age of 6, every 4th child has disharmonious physical development, and every 3rd has a «bad» state of health. With chronic diseases, 64.2% of children are covered by preventive examination. Parents with a high level of medical activity have healthier children. Filters operate only in 29.3% of children’s polyclinics.

CONCLUSION: To improve the preventive work of the children’s polyclinic, it is necessary to actively conduct sanitary and educational work with parents of preschoolers to increase their medical activity and ensure the full functioning of the filter in the children's polyclinic.

Medical Journal of the Russian Federation. 2022;28(4):281-290
pages 281-290 views


Interleukin-13 and cardiovascular diseases: literature review

Alieva A.M., Reznik E.V., Teplova N.V., Sarakaeva L.R., Surskaya E.V., Elmurzaeva D.A., Shavaeva M.Y., Rakhaev A.M., Kotikova I.A., Nikitin I.G.


Cardiovascular diseases remain the leading cause of death worldwide despite significant advances in medicine and increased life expectancy. It is very important to search for and study new cardiovascular biological markers that can help the early diagnosis of cardiovascular diseases, serve as a laboratory tool for assessing the effectiveness of treatment, be a predictive marker of possible adverse clinical outcomes, and be a significant criterion for risk stratification. This review aims to consider interleukin-13 (IL-13) as a diagnostic and prognostic biomarker in cardiovascular pathology. IL-13 is involved in the development of many cardiovascular diseases, according to various in vitro and in vivo studies, but its role remains unclear until the end. IL-13 has a positive effect, promoting the development of the heart at an early stage and facilitating the recovery of the heart after a myocardial infarction. Due to the induction of fibrosis and adverse cardiac remodeling, long-term IL-13 synthesis appears to be a risk factor for adverse outcomes in chronic cardiovascular diseases, such as heart failure. Understanding the effect of IL-13 on cardiac metabolism will shed light on possible new pathogenetic mechanisms for the development of heart disease. As a rule, an increase in the level of IL-13 in the blood serum goes in parallel with its expression in the tissues of the heart. However, the dissociation of systemic inflammatory reactions and local expression is not excluded. The introduction of IL-13 can restore the regenerative capacity of cardiomyocytes and reduce cardiac dysfunction. IL-13 deficiency limits the proliferation of cardiomyocytes, induces compensatory hypertrophy of cardiomyocytes in vitro and deletion of IL-13, leads to cardiac dysplasia, and impairs recovery processes in vivo. Although IL-13 is associated with cardiac fibrosis, cardiomyocyte proliferation, myocardial hypertrophy, immune cell recruitment and differentiation, and chemokine secretion in the heart, it is precise signaling pathways and underlying mechanisms of action remain poorly understood.

Medical Journal of the Russian Federation. 2022;28(4):291-304
pages 291-304 views

Organization of accelerated recovery and early rehabilitation of surgical patients within the framework of the service of anesthesiology and resuscitation: literature review

Manevskiy A.A., Sviridov S.V., Oprishchenko S.A., Polunina N.V., Polunin V.S.


Accelerated recovery after surgery, according to publications, has been developed since 1980 and is a multimodal strategy aimed at reducing the physiological response to surgical trauma, rapid recovery and early discharge of the patient. This study aimed to analyze the feasibility of introducing a methodology for accelerated recovery of the patient after surgery and early discharge from the surgical hospital. A study of the literature and formulation of a theoretical algorithm for the implementation of the process of accelerated recovery after surgery or fast track. According to publications, accelerated recovery from surgery has been developed since 1980 and is a multimodal strategy intended to reduce the physiological response to surgical trauma and accelerating recovery and early discharge of the patient. This concept consists of scientifically based approaches to the perioperative and postoperative management of surgical patients and represents a radical revision of the established traditional approach. Solving organizational issues of implementing the fast track concept in multidisciplinary hospitals in our country is a key factor toward wider dissemination and implementation of accelerated recovery after surgery.

Medical Journal of the Russian Federation. 2022;28(4):305-314
pages 305-314 views

Prevention of complications after the surgical treatment of the facial fractures

Demyanova A.V., Amkhadova M.A., Ivanova E., Demyanov V.I., Amkhadov I.S.


In modern society, with a high rate of industrialization and, at the same time, a decrease in the standard of living, an increase in maxillofacial injury (MFI) has been noted, ranging from 6 to 16% of the total number of injuries. In addition, MFI is a public health problem due to its high prevalence and the need for resources to treat it, as well as the financial and social impact of MFI victims on the health care system. Osteosynthesis of the bones of the facial skeleton with titanium miniplates and screws is an effective way to treat fractures of the bones of the facial skull. According to the studied literature sources, researchers continue to search for the most inert materials for surgical otheosynthesis. Samples of various materials are examined for the adhesive ability of the main pathogens of purulent-inflammatory diseases, inertness, toxicity and other indicators. But studies are few and there is no conclusive evidence in favor of either material. However, the use of titanium miniplates and screws coated with silicon carbide is advisable for the prevention of postoperative complications. The use of titanium miniplates and screws coated with silicon carbide is the method of choice in the treatment of infected fractures of the bones of the facial skeleton.

Medical Journal of the Russian Federation. 2022;28(4):315-320
pages 315-320 views

Technical Report

Features of the organization of medical care for patients with skin cancer using radiation therapy

Vinogradova L.V., Polunin V.S., Polunina N.V.


BACKGROUND: Malignant skin diseases occupy the 2nd place in the frequency of prevalence after breast cancer. Basal cell carcinoma of the skin (basal cell carcinoma of the skin) is most often diagnosed, its share is 60–80% of all malignant skin diseases. Squamous cell skin cancer is much less common and accounts for 18–25%. The annual increase in cancer incidence with localization of the process on the skin is from 3 to 10%.

AIM: This study aimed to investigate the features of the organization of medical care for patients with skin cancer using radiation therapy in Moscow and to develop recommendations for its improvement.

MATERIALS AND METHODS: Analysis of the results of treatment with short-focus radiation therapy of 461 patients with skin cancer in a large multidisciplinary hospital was carried out.

RESULTS: The health status of patients with skin cancer was studied, in which 88.0% of cases had basal cell skin cancer, and 12.0% had squamous cell skin cancer; 90.1% of these patients were over 50 yr old. Medical care was provided in the radiotherapy department. The condition of patients after a course of short-focus radiation therapy allowed to obtain a positive cosmetic effect, and relapses occurred in 3.0% of patients. Measures have been identified to improve the organization of medical care for patients with skin cancer and to improve the quality of treatment results.

CONCLUSION: The most effective strategy for the treatment of skin cancer with the best cosmetic result is to accelerate the process of determining treatment methods before the start of radiation therapy and conducting short-focus radiation therapy four times a week.

Medical Journal of the Russian Federation. 2022;28(4):321-328
pages 321-328 views

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