Medico-social rationale for adaptation of regional drug supply systems to personalized pharmaceutical care for persons of different ages

In this study, we identified indicators of the state of personalized pharmaceutical care for target population groups at the regional level, in a model region, with the aim to develop a differentiated approach to such care. The rationale for the choice of Moscow Region as a model region is based on its specific socioeconomic indicators and a comparison of these with respective average Russian values. A need was shown to modernize patient-oriented pharmaceutical care, especially for certain population groups, such as children, women of working age (mothers), and the elderl

Gender differences in the structure of the cerebrospinal fluid system of pre-school children

Relevance Investigation of the cerebrospinal fluid system of children of different ages, especially pre-school and school periods of childhood, becomes essential, since the further development of the brain and its proper functioning depends on the way it functions. Considering the MRI indications of the elements of the cerebrospinal fluid system of children is important for the development of neurology and neurosurgery, it is necessary to consider gender differences in the brain size and structure.Objective To study the sex differences in the structure of the cerebrospinal fluid system in seven-year-old children.Material and Methods For the study, archival data on the sizes of the lateral ventricles of the brain of 120 children aged 7 (60 boys and 60 girls) were involved, in particular: 1) the length of the anterior horn; 2) the width of the anterior horn; 3) the length of the central part; 4) the width of the central part; 5) the length of the posterior horn; 6) the width of the posterior horn; 7) the length of the lower horn; 8) the anteroposterior size; 9) the distance between the anterior horns; 10) the distance between the posterior horns; 11) the length of the third ventricle; 12) the height of the third ventricle; 13) the length of the aqueduct; 14) the length of the fourth ventricle; 15) the height of the fourth ventricle. The studies were carried out using the method of magnetic resonance imaging. Quantitative indicators were assessed for compliance with the normal distribution using the KolmogorovSmirnov test. The accumulation, correction, systematization of the initial information were carried out in Microsoft Excel 2016. Statistical analysis was carried out using the Statistica 10.0 software (StatSoft Inc., USA). The results were considered statistically significant at p < 0.05.Results The data obtained in the study of the cerebrospinal fluid system in children during their pre-school period of childhood are indicators of the norm and can be used for diagnostic studies in the departments of radiation diagnostics. The bilateral asymmetry of the lateral ventricles of the brain in pre-school children, discovered during the work, is of crucial clinical significance. The morphometric indicators of the elements of the cerebrospinal fluid system should be considered by specialists in the study of brain neuroplasticity.Conclusion Analysis of the obtained in vivo encephalometric data indicates the presence of sexual variability of the brain and parameters of the structures of the cerebrospinal fluid

Change of approach to using intra-aortic balloon counterpulsation in combined cardiac surgery

Perioperative acute myocardial dysfunction is an actual problem of cardiac surgery. Rational use of inotropes and mechanical circulatory support in the postoperative period remains a subject of debate. The outcomes of the combined coronary artery bypass grafting and heart valve prosthesis were analyzed in Irkutsk Cardiac Surgery Center after 80 patients were operated on. As a result of the conducted research, authors proposed a method of differentiated approach to the treatment of acute heart failure in the early postoperative period. Failure to escalate therapy beta agonists in the absence of adequate response hemodynamics and the transition to a mechanical circulatory support improves performance of the cardiovascular system and clinical outcomes, reduces hospitalization duration in the department of intensive therapy. The study showed the superiority of an early beginning of an intra-aortic balloon counterpulsation before traditional inotropic therapy in the treatment of postcardiotomy heartfailure at combined cardiac surgery

The level of Brain natriuretic Peptide as a Predictor of the Postoperative Period at Operations with Artificial Blood circulation

The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass

The market of vocational professional education in Russia in the new economic conditions

Since the end of 2014, the Russian economy has undergone major changes. The crisis continued until 2018, followed by stabilization and short-term growth in 2018-2019. The emerging positive trends were interrupted by the pandemic. All this has had a signifcant impact on the vocational professional eduation market, both in quantitative and structural terms. The modern world is changing too fast, it is necessary to form the creative potential of a person. The article states that specialists’ adaptation mechanisms to new conditions should change with the help of advanced training, obtaining new knowledge and skills in all forms of education, including the system of vocational professional education. This means that the market of educational services formed by state, departmental and corporate educational institutions must respond to the demands of the economy and consumers of these services. Such advanced technologies and methods as online studying should be used along with and in combination with ofine classes. The conducted research has shown that large corporations allocate signifcant funds for the training and retraining of specialists corresponding to the level of technological development, capable of making effective management decisions. The authors of the article note that in the system of vocational professional education consumers of educational services are most interested in training programs related to management, marketing, information and computer technologies, which is quite consistent with the digital economy and the knowledge econom

Влияние методики анестезии на течение послеоперационного периода у детей, оперированных с искусственным кровообращением

Objective: to show that patients’ accelerated activation in the use of combined anesthesia with sevoflurane and fentanyl reduces the incidence of pulmonary complications in young age children after surgery under extracorporeal circulation. Subjects and methods. A randomized controlled study covering 127 patients aged 10 months to 3 years was performed. The study included the patients who had undergone surgery for congenital heart diseases. The patients were found to have atrial and ventricular septal defects and arteriovenous communication. The patients were divided into groups in the operating suite just before anesthesia. After standard premedication-preinduction, a child was taken to the operating room. Group 1 patients were given intubation anesthesia with a combination of the inhalation anesthetic halothane and intravenously infused fentanyl. In Group 2 (a study group), anesthesia was made via continuous fentanyl infusion and sevoflurane inhalation. The authors studied the duration of artificial ventilation, postanesthesia sleep, and antibacterial therapy, the frequency of antibiotic switching, as well as sudden sputum mobilization episodes, the duration and intensity of inotropic support, the rapidity of gastrointestinal passage recovery, and the length of intensive care unit stay. Results. Analysis of the findings showed that in Group 2 (a study group), the time of emergence from anesthesia was significantly shorter than that in Group 1 (a control group). The time of postoperative mechanical ventilation was shorter than that in the group of patients receiving the inhalation anesthetic sevoflurane. Anesthesia with the latter reduced the intraoperative dose of fentanyl when clinically adequate anesthesia was applied. There were no differences in the protocol of inotropic agents immediately after surgery, but the patients receiving sevoflurane as an inhalation component needed no inotropic agents 3 hours after surgery while in the controls the infusion of inotropic agents lasted as long as 6 hours postoperatively. After extubation, the number of sputum mobilization cases requiring additional medical measures substantially reduced in children given the inhalation anesthetic sevoflurane. There was a more need for antibiotic substitution due to the presumed clinical inefficiency of the conventional antibiotic prophylaxis, adopted by the protocol in the cardiology center, in the control group. Additional efforts for tracheobronchial tree sanitation broke a schedule of the children’s feeding and rehabilitation in the intensive care unit. In the study group, intestinal performance normalized more promptly. Conclusion. Early spontaneous breathing and extubation make it possible to activate and rehabilitate a child as soon as possible, to reduce a risk for respiratory complications and treatment costs in the postoperative period, which provides an economic gain.Цель исследования — показать, что ускоренная активизация пациентов при использовании комбинированной анестезии се-вофлураном и фентанилом снижает частоту легочных осложнений у детей младшего возраста после операций с искусственным кровообращением. Материал и методы. Проведено рандомизированное контролируемое исследование, в которое включено 127 пациентов в возрасте от 10 мес до 3-х лет. В группы вошли пациенты, перенесшие операции по поводу врожденных пороков сердца. У пациентов были выявлены: дефекты межпредсердной и межжелудочковой перегородки, арте-рио-венозная коммуникация (АВК). Пациенты распределены по группам в операционной, непосредственно перед началом анестезии. После стандартной в обеих группах премедикации-преиндукции, ребенка доставляли в операционную. Пациентам 1-й (сравнения) группы проводили интубационный наркоз с помощью комбинации ингаляционного анестетика галотана и внутривенной инфузии фентанила. Во 2-й (основной) группе анестезию проводили постоянной инфузией фентанила и ингаляцией севофлурана. Исследовали: длительность искусственной вентиляции легких, длительность постнаркозного сна, продолжительность антибактериальной терапии, частоту смены антибиотиков, эпизоды внезапной мобилизации мокроты, длительность и интенсивность инотропной поддержки, быстроту восстановления пассажа по желудочно-кишечному тракту (ЖКТ), длительность нахождения в палате интенсивной терапии. Результаты. Анализ результатов исследования показал, что во второй группе (основной) время пробуждения было значимо короче, чем в первой (сравнения). Время проведения механической вентиляции легких в послеоперационном периоде было короче в группе с использованием ингаляционного анестетика севофлурана. Наркоз с использованием севофлурана позволил снизить дозу расходуемого за операцию фента-нила, при клинически адекватной анестезии. В протоколе инотропных препаратов сразу после операции различий не было, но у пациентов, где применялся в качестве ингаляционного компонента наркоза анестетик севофлуран, через три часа после операции не было необходимости в применении инотропных препаратов, в то время, как у ряда пациентов из группы клинического сравнения, инфузия инотропных препаратов продолжалась до 6 часов послеоперационного периода. После эксту-бации у детей с использованием ингаляционного анестетика севофлурана значимо сокращалось число случаев мобилизации мокроты, требующих дополнительных лечебных мероприятий. Необходимость в замене антибактериального препарата по причине предполагаемой клинической неэффективности стандартной, принятой протоколом в кардиоцентре, антибиотико-профилактики, возникала чаще в группе сравнения. Дополнительные мероприятия по санации трахеобронхиального дерева (ТБД), нарушали график кормления и реабилитации детей в палате интенсивной терапии. В основной группе быстрее восстанавливалась нормальная работа кишечника. Заключение. Ранний перевод на самостоятельное дыхание и экстубация позволяют активизировать и провести реабилитацию ребенка в короткие сроки, снизить риск развития респираторных осложнений и сократить расходы на лечение в послеоперационном периоде, что приносит экономическую выгоду. Ключевые слова: ингаляционный наркоз, севофлуран, галотан, дыхательная недостаточность

УСКОРЕННОЕ ФОРМИРОВАНИЕ ПРОДУКЦИОННЫХ СТАД СТЕРЛЯДИ

The paper declares that effectiveness of building productional breeding flock depends mainly on the quality of feeds applied. Development of valuable feeds requires knowledge about fish food spectrum in natural conditions. The data analysis about sterlet’s food preferences allowed developing the special combined feed for replacement stock and its producers. New special feeds allow accelerating of starlet replacement breeding flock building from the natural population. The authors recommend controlling physiology of sturgeons population when keeping them. The blood characteristics of fish allows making conclusion about growing conditions and energy value of feeds. Appropriate and correct applying of valuable combined feeds balanced on essential aminoacids, fatty acids and vitamins influences sturgeons population of replacement breeding flock blood composition and their physiology. The authors developed a test-diet for starlet, which has similar composition of nutrients to the natural feeds. The research results of growing starlet replacement flock by means of applying new combined feed demonstrated positive influence on fish physiology and their productional properties.Эффективность формирования продуктивных маточных стад зависит, прежде всего, от качества используемых кормов. Для разработки полноценных комбикормов необходимы знания о спектре питания рыб в естественных условиях. Анализ сведений о пищевом предпочтении стерляди в различном возрасте позволил разработать специальный комбикорм для ремонтного стада, а также для производителей. Новые специализированные комбикорма дают возможность ускоренного формирования ремонтно-маточного стада стерляди из особей природной популяции. При содержании коллекционных стад осетровых рыб рекомендуется проводить регулярный контроль их физиологического состояния. На основании характеристики состава крови рыб можно судить об условиях выращивания, а также о полноценности пищевого рациона. Правильное применение полноценных комбикормов, сбалансированных по незаменимым аминокислотам, жирным кислотам и витаминам, при выращивании и содержании ремонтно-маточного стада осетровых рыб на рыбоводных предприятиях положительно отражается на составе крови и их общем физиологическом состоянии. Разработанная тест-диета для стерляди приближена по составу питательных веществ к естественной пище рыб. Результаты выращивания ремонтной группы стерляди с использованием нового комбикорма показали его положительное влияние на физиологическое состояние рыб и ее продукционные свойства

Опыт применения комбинированной сочетанной терапии Амелотексом®и Комплигамом В® у больных с проявлениями синовита на фоне остеоартроза коленных суставов

Objective: to study the efficiency of combination therapy with Amelotex®and Compligam B®in patients with osteoarthrosis with the signs of knee joint synovitis. Subjects and methods. The efficiency of combination therapy with Amelotex®and Compligam B®was studied in 40 patients. During a Phase I trial, Amelotex®was administered in a dose of 1,5 ml (15 mg) as periarticular blocks, by alternating intramuscular Compligam B®in a dose of 2,0 ml. In a Phase II trial, the intramuscular injection of these drugs was alternated. Electroneuromyography (ENMG) was performed and the levels of proinflammatory cytokine interleukin-1β (IL-1β) and IL-8 were determined over time (before and on 10 and 20 days of therapy). Quality of life was assessed by a 100-mm visual analog scale before and after therapy. Results. The early sign of therapeutic efficiency was a significant reduction in the magnitude of knee joint pain, which was observed just after completion of the Phase I trial. Diminished limb cacesthesia and crepitation were most important after the end of Phase II. Synovitis cases significantly reduced in number. Recovered peripheral nerve function was objectively supported by an increase in ENMG parameters, such as the amplitude of M responses in the peroneal nerve and sensor fiber action potential in the sural nerve. After termination of the therapy, IL-1β levels became significantly lower. Quality of life improved, as shown by VAS scores. Conclusion. The findings suggest that combination therapy with Amelotex® and Compligam B® shows clinical effectiveneЦель исследования - изучить эффективность комбинированной терапии препаратами Амелотекс® и Комплигам В® у больных ОА с явлениями синовита коленных суставов Материал и методы. Эффективность комбинированной терапии препаратами Амелотекс® и Комплигам В® изучали у 40 больных. В 1-ю фазу исследования Амелотекс® вводили в дозе 1,5 мл (15 мг) в виде периартикулярных блокад, чередуя его с внутримышечным введением 2,0 мл Комплигама В®. Во 2-ю фазу исследования чередовали внутримышечное введение этих препаратов. В динамике (до лечения, на 10-й и 20-й день терапии) пациентам проводили электронейромиографию (ЭНМГ) и определение уровня провоспалительных интерлейкинов (ИЛ) 1β, 8. Качество жизни оценивали по 100-миллиметровой ВАШ до и после лечения. Результаты исследования. Ранним признаком эффективности терапии явилось достоверное уменьшение выраженности боли в коленных суставах, что наблюдалось уже после завершения 1-й фазы исследования. После окончания 2-й фазы наиболее значимыми были уменьшение расстройств чувствительности в конечностях и крепитации. Достоверно уменьшилось количество случаев синовита. Объективным подтверждением восстановления функции периферических нервов служило увеличение таких параметров ЭНМГ, как амплитута М-ответа малоберцового нерва и потенциала действия по сенсорным волокнам икроножного нерва. После окончания лечения достоверно снизился уровень ИЛ 1β. Достоверно улучшилось качество жизни пациентов по данным шкалы ВАШ. Заключение. Полученные результаты свидетельствуют о клинической эффективности комбинированной терапии препаратами Амелотекс® и Комплигам

Features of the brainstem and its cavities in three-year-old children

Background: Little is known about the brainstem in healthy three-year-old children; yet there is a need for further studies because children at this age are growing and developing rapidly.Objective: To study differences in the brainstem and its cavities in healthy three-year-old children, considering the sex and bilateral asymmetry.Materials and methods: We retrospectively analyzed 120 MRI scans of healthy three-year-old children (60 boys and 60 girls) to study the brainstem features. The following parameters of the brain stem structures were assessed: 1) the length of the pons (mm), 2) the height of the pons (mm), 3) the length of the medulla oblongata (mm), 4) the height of the medulla oblongata at the upper and lower borders (mm), 5) the length and height of the vermis (mm), 6) the width of the cerebellum (mm), 7) the length, width, height of the cerebellar hemispheres (mm), 8) the length and height of the third ventricle, 9) the length of the cerebral aqueduct (mm), 10) the length and height of the fourth ventricle (mm). We assessed the compliance of quantitative parameters with the normal distribution according to the Kolmogorov-Smirnov criterion. We used Microsoft Excel 2016 tables to accumulate, correct and systemize the raw data. Statistica 10.0 software (StatSoft. Inc., USA) along with the corresponding statistical method provided the digital data. The differences were considered significant at P < .05.Results: We aimed to study sex-related differences in the basic sizes of the brainstem. The length and height of the pons, the length of the third and the fourth ventricles, and the size of the cerebellar hemispheres were greater in boys. We found a bilateral asymmetry in cerebellar hemispheres (length, width, and height).Conclusions: The changes in the complex brainstem of three-year-old children are sex-dependent and consist in active transformations of its structures