Vol 101, No 6 (2020)

Aim. To assess the effectiveness of the screening approach by prescribing a streptotest to verify the etiological cause of tonsillopharyngitis in children.

Methods. We observed 67 patients aged 7 to 11 with a history of recurrent respiratory infections. The incidence of acute respiratory infections varied from 8 to 12 times during the year preceding the examination. The main group consisted of 36 children who had tonsillopharyngitis with severe inflammation of the tonsils and plaque on the tonsils. The control group included 31 patients with acute tonsillopharyngitis with inflammatory changes in the tonsils and the absence of plaque. The observation and control groups were comparable and did not have statistically significant differences in gender and age. All patients underwent a common clinical, laboratory, and instrumental exa­mination. Along with microbial culture, the special examinations included an express test (Dectra Pharm, France) for the presence of group A β-hemolytic streptococcus.

Results. All children underwent an etiological examination. The presence of a viral antigen was confirmed in 71.64% of children. 27.49% of patients in the control group and 30.72% of patients in the main group had positive results of the express test for group A β-hemolytic streptococcus, taking into account the requirements for asses­sing this reaction. It was revealed a reliable direct relationship between the detected viral infection and the negative results of the streptatest test (r=0.86; p=0.03) for the control group, and a positive correlation of the confirmed pre­sence of group A β-hemolytic streptococcus in the main group as with both C-reactive protein (r=0.78; p=0.04) and with inflammatory markers in the general blood test. A combination of positive fluorescence of viral antigens based on the results of immunofluorescence and a positive enzyme-linked immunosorbent assay (ELISA) for group A β-hemolytic streptococcus was recorded in 7.46% of all patients. Clinical examples are given the justification of practical implementation of the express test for the quick diagnostic information.

Conclusion. Differentiated etiological diagnosis of acute tonsillopharyngitis based on clinical symptoms and the levels of markers of bacterial inflammation is extremely difficult therefore laboratory criteria should be the justification for prescribing antibiotic therapy; currently, the most accessible is the streptatest for the detection of group A β-hemolytic streptococcus, which allows confirming or denying the presence of group A β-hemolytic streptococcus within a few minutes, which means that it is correct to prescribe antibacterial drugs to patients.

Aim. To assess the anatomical possibility of the use of the thoracodorsal nerve as a donor for nerve transfer to the musculocutaneous nerve.

Methods. Anatomical dissection of the brachial plexus with layer-by-layer dissection of secondary bundles, short and long branches was performed in 121 male and female corpses. The localization of the origin of thoracodorsal and musculocutaneous nerves relative to the clavicle, the takeoff angle (degrees) from the secondary bundle, the length (in centimeters) of the nerves from the site of origin to the latissimus dorsi muscle entry point and the perforation of the coracobrachialis muscle, respectively, were investigated. The length of the thoracodorsal nerve with and without extramuscular branches was studied separately.

Results. It was revealed that, in 58.7% of cases, the thoracodorsal nerve has the optimal length required for transposition to the musculocutaneous nerve. The excess length of the thoracodorsal nerve was between 0.1 and 9.1 cm. In 41.3% of cases, the length of the thoracodorsal nerve is not enough for transposition. Of these, in 17.4% of cases, the shortage of the length of the thoracodorsal nerve was –2 cm or less, which categorically does not allow its transfer to the musculocutaneous nerve. Only in 5% of cases, the length of the nerve was not enough for transposition in the use of the thoracodorsal nerve with extramuscular branches.

Conclusion. Due to tension in many cases, the thoracodorsal nerve transfer to the musculocutaneous nerve can be performed with difficulty, and in some cases it is impossible, solving the problem in this category of people dictates the deve­lopment of new surgical techniques with the thoracodorsal nerve or the use of another nerve as a donor.

Chronic kidney disease and its complications are one of the leading causes of morbidity, disability and mortality in the world population, due to both the widespread prevalence of arterial hypertension, diabetes mellitus and co¬ronary heart disease, and the increase in life expectancy. In the terminal stage of chronic kidney disease, mortality from cardiovascular events increases significantly. This review examines the most common risk factors for stroke in end-stage kidney disease. The role of arterial hypertension, diabetes mellitus, chronic heart failure is discussed, taking into account common risk factors, hyperactivation of the renin-angiotensin-aldosterone system, the deve¬lopment of oxidative stress, volume overload with an increase in the size of the left atrium and a subsequent increase in the risk of thrombosis and stroke in patients with end-stage kidney disease on programmed hemodialysis. In addition, data are presented in the study of the contribution of bone mineral disorders to the occurrence of cerebral complications in this category of patients. Timely diagnosis of cardiovascular diseases and secondary prevention of stroke, including adequate antihypertensive, hypoglycemic therapy and correction of heart failure with blockers of the renin-angiotensin-aldosterone system, as well as the elimination of bone mineral disorders are currently a very popular approach to improving the quality of life and increased survival in the discussed category of patients. Understanding the pathogenetic mechanism of stroke in patients with end-stage kidney disease on programmed hemodialysis, with the study of risk factors in the development of an acute cerebrovascular accident, will help to develop a strategy for their management.

The recent pandemic caused by the novel coronavirus strain (COVID-19) has suddenly and radically shattered all ideas about the norm, not only in medical practice but also in society. This has particularly affected the healthcare system, physicians, and the distribution of life-sustaining therapy in the context of limited resources and the absence of a known treatment protocol. One of the main ethical dilemmas of the coronavirus epidemic has been the confrontation between public health ethics, reflected in the fair distribution of limited resources and a focus on public safety, and patient-centred clinical ethics. Ultimately, the COVID-19 pandemic is putting medical staff in tragic situations that they have never faced. And in the case of a shortage of medical staff — doctors and nurses, ventilators and other life-supporting devices for patients or even just beds in hospitals, it frequently becomes necessary to classify patients and decide an order to determine who, where and what kind of help will receive (or not receive) and in what queue to provide it. Another important problem was the problem of digital control of citizens, who must limit their freedoms for preserving the health of other citizens. The fear is widely shared that the situation will allow manipulation citizens in the future when there is no epidemiological need. Also, the problem of the responsibi-lity of politicians and authorized organizations for the health not only its people but all over the world arises. These and other questions today require bioethical expertise.

The publication presents an analysis of the modern regulatory framework for labor, shows controversial positions on each component of the labor rationing system in healthcare. The amount of normative time spent on visits to outpatient doctors, established by orders of the Ministry of Health of Russia, in the main medical specialties: doctors-the¬rapists district, pediatricians district and general practitioners (family doctors), does not coincide with the data of the territorial program. Approved more than 20 years ago and currently in force standards for laboratory and instrumental examinations do not correspond to the modern equipment of medical organizations. The numbers of health workers providing primary health care to the population, established by the orders on Procedures and Regulations, for the majority of medical personnel have different meanings in the simultaneously valid regulatory documents for the provision of medical care to both adults and children. The planned and normative volume of work on outpatient care has not been reported since 2013, either in visits or in appeals about diseases. The planned and normative indicators for the amount of hospital care are characterized by sharp annual changes that are not justified ¬either by the morbidity of the population or by the technologies of the medical process, do not correspond to the actual development of the bed stock and are not reflected by healthcare practice. Based on the analysis of time standards, norms of number and planned volume of work, the authors make a reasonable conclusion about serious problems in the system of labor rationing in healthcare. The authors identified the necessary measures for its restoration and revision of the entire labor regulatory framework, which are the need to include labor rationing issues in the program of diploma and postgraduate training of doctors in a healthcare organization; advanced training of developers of staff standards and specialists approving these documents; mandatory expert assessment of documents on labor standards prior to their approval by qualified specialists on labor standardization in health care.

Aim. To compare the results of using traditional and distance education technologies in the training of obstetricians and gynecologists in the continuing medical education cycles.

Methods. The effectiveness of the use of traditional and distance learning technologies in the training of obstetrician-gynecologists on the continuing medical education cycles was assessed based on Bashkir State Medical University. The study included an assessment of the knowledge of obstetricians and gynaecologists trained in the 36-hour program. Two study groups were selected. The group I included 28 doctors, whose training and knowledge assessment was carried out mainly using traditional education technologies. The group II consisted of 30 doctors, whose training and knowledge assessment was carried out using distance education technologies. The final effectiveness of the use of the studied technologies was evaluated based on the analysis of the final test results and the solution of situational clinical tasks as a General interview. The research results processing was performed by IBM SPSS Statistics Version 25.0.

Results. The study revealed that the use of distance learning technologies does not lead to a decrease in the physician's level of training: 70.0% in group I, 60.7% in group II (χ2=0.11, df=1, p=0.74). Meanwhile, the distance lear­ning format causes difficulties for doctors of the older age group: in group I, there is a direct moderate correlation between age and performance (r=0.497, p=0.007), in group II — a noticeable inverse correlation (r=–0.689, p <0.001).

Conclusion. Based on the results of the study, it is necessary to take a differentiated approach to the formation of groups for distance learning in the future.

Aim. To assess the territorial accessibility of primary health care (PHC) to the rural population in the Orenburg ¬region.

Methods. Statistical, monographic, organizational experiment research methods were applied. Statistical proces¬sing was carried out by using the Statistica 10.0 software. Basic statistics were calculated (arithmetic mean, weighted arithmetic mean). All parameters were checked by using Shapiro–Wilk, Kolmogorov–Smirnov and Lilliefors tests for normal distribution. The parametric method of statistics (Student's t-test) was used.

Results. The assessment of the territorial accessibility of primary medical health care to the population of the Orenburg region was carried out using the methodology developed by us for calculating the criteria for the accessibility of primary medical health care to the rural population “Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population”. The use the methodology allows ¬making management decisions regarding the territorial planning of primary health care for the rural population in the selection of problem areas with low accessibility of primary medical care. In the Orenburg region, there are the following problems: different levels of accessibility of primary health care with a variety of distance up to 30 km and different population sizes in settlements create difficulties in organizing the provision of primary health care; remoteness from the regional center up to 300 km forms a personnel deficit.

Conclusion. Application of the methodology “Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population” in the Orenburg region has allowed the development of the following recommendations for making management decisions at the regional level: (1) prioritization of territories for priority measures to ensure the availability help; (2) selection of the form of primary health care organization for the timely medical care provision to the population; (3) the formation of competition among medical organizations in the ranking of the availability of primary health care.

Lead fracture is a serious complication of a pacemaker; its prevalence is 0.1–4.2%. The common site of lead fracture is at the space between the clavicle and the first rib. The causes are intense physical activity, which approximates the clavicle to the rib and compression of the lead, chest trauma, anatomical features, twiddler’s syndrome. Diagnosis of lead fracture is can be made by electrocardiography — there is a transient or permanent stimulation/sensitivity disturbance. When the programmer interrogates the pacemaker, a significant sign is an abrupt rise in the lead impedance, although cases of fracture with normal impedance values have been reported. The article presents an extremely rare clinical case of an intracardiac lead fracture in a 28-year-old patient. At the initial implantation, leads were passed through the accessory left superior vena cava, resulting in a loop in the right ventricle. The patient himself was subjected to increased physical activity. The question of the need to remove such leads remains open. Some authors note that the distal end is firmly fixed to the heart wall, and therefore does not expose the patient to a vital risk. Others consider that the lead can become a source of thrombus formation, or fragmentation with embolism in the pulmonary circulation can occur. In our case, the causes of the fracture were probably an intense physical activity and bending of the lead inside the right ventricle. The clinical situation was discussed with cardiac surgeons of the federal centers of cardiovascular surgery. Given the high risks of open-heart surgery, it was deci¬ded to refrain from removing the broken lead, and the patient was provided with atrial pacing.

Aim. To create a new prognostic index that allows screening and predicting the development of tuberculosis in persons infected with human immunodeficiency virus (HIV), from among the suspects, accused, convicts, and assessment of how an additional diagnostic criterion can become a justification for additional preventive and anti-¬epidemic measures.

Methods. A mathematical model was developed by using expert opinions and applying the logical-mathematical approach of hierarchical analysis. It includes characteristics and criteria described in the modern scientific literature that does not exclude the presence of active tuberculosis or cause its unfavorable course in HIV-infected patients. The research was carried out in two stages. At the first stage, the weighting coefficients of the predictors used were calculated, and a prognostic index was created. At the second stage, the technique was applied in practice. As a result of the study in the observation group, which consisted of 157 clinical cases, the probability of tuberculosis was calculated by using the statistical grouping method.

Results. A model for calculating the prognostic index of the development of tuberculosis in patients with HIV infection has been developed. Based on the example of patients held in prisons, a graphical method is proposed for assessing the possibility of development/absence of tuberculosis in HIV-infected individuals, depending on the value of the prognostic index. In the practical application of the developed prognostic index, tuberculosis was diagnosed in 37 patients, and plans of preventive measures were developed in 120 patients.

Conclusion. The developed method of screening and predicting the development of tuberculosis in patients with HIV infection makes it possible to improve the timeliness of diagnosis of tuberculosis in the early stages and to determine the need for additional preventive or anti-epidemic measures during the work to counter the spread of this disease in the institutions of the Federal Penitentiary Service.

The article provides information about the organizational activities and role of S.V. Kurashov in establishing and developing of national medicine and health care in the USSR and his contribution to the organization of health resorts, medical industry, pharmacy. The data on the improvement of outpatient specialized medical care for the population, the dynamics of health care in the USSR in 1950–1965, and the implementation of national programs to eliminate especially dangerous infections in the country are detailed. The paper shows the role of S.V. Kurashov in the training of medical personnel, the construction of multi-specialty hospitals in rural areas, allowing to provide specialized outpatient and inpatient medical care, in the country's accession to the World Health Organization in Geneva, which increased the importance of the USSR health care in the international arena.

This article was prepared for the 120th anniversary of the Kazan Scientific Research Institute of Epidemiology and Microbiology. The paper describes the main stages of the institute’s development since its founding as the Kazan Bacteriological Institute at Kazan University in 1900. Until 2005, the institute belonged to the system of the Mi¬nistry of Health, and later, among 28 Federal State Institutions of Science, it entered the Rospotrebnadzor system. The information on priority research and the contribution of the institute to the achievements of domestic health care and the federal service for supervision in the field of consumer protection over the 120-year history of its activity are presented. The data on ongoing research and development, development prospects also are presented. The article was prepared using documents from the archives of Kazan Scientific Research Institute of Epidemiology and Microbiology, Kazan Medical University and Kazan Federal University, the National Archives of the Republic of Tatarstan, and the memoirs of employees of the Kazan Research Institute of Epidemiology and Microbiology.

20 октября 2020 г. исполнилось 75 лет профессору кафедры пропедевтики внутренних болезней имени профессора С.С. Зимницкого Казанского государственного медицинского университета (КГМУ), известному врачу, педагогу, учёному Владимиру Николаевичу ­Ослопову.

Что мы хотели узнать? Мы хотели узнать, уменьшает ли профилактическое применение «разжижителей» крови у людей, госпитализированных с COVID-19, число смертельных случаев по сравнению с людьми, которые их не получали или получали плацебо. Мы также хотели узнать, нуждаются ли эти люди в меньшей поддержке дыхания, образовались ли у них всё-таки тромбы, были ли у них кровотечения и были ли у них другие нежелательные явления (например, тошнота, рвота, проблемы с почками и ампутации).

Плазма выздоровевших и гипериммунный иммуноглобулин успешно применялись для лечения других респираторных вирусных инфекций. Эти методы лечения (при капельном или инъекционном введении), как правило, хорошо переносятся, но могут иметь нежелательные эффекты. Мы хотели узнать, является ли плазма от людей, перенёсших COVID-19, эффективным лечением для людей с COVID-19, и не вызывает ли это лечение какие-либо нежелательные эффекты.