Frequency and risk factors of fractures in adolescents and young ADULTS in the population of Irkutsk

The aim of the study was to examine frequency and risk factors of fractures among adolescents and young adults of Irkutsk aged 14 to 24. The results of the study showed that the frequency of fractures was 23.8 %; and boys have fractures significantly more often than girls (p = 0.01). Risk factors for fractures are: male gender (OR = 1.25); body height (> 174 cm for girls (OR = 3.9), > 177 cm for males (OR = 3.5)); body weight (> 60 kg for girls (OR = 2.5), > 66 kg for boys (OR = 2.1)); tenderness to palpation of spinous processes of vertebra (OR = 3.1 for girls, and OR = 2.4 for boys); dietary calcium intake < 500 mg/day (OR = 1.5 for girls, and OR = 2.3 for boys). In addition, back pain (OR = 1.9) and joint hypermobility syndrome (Or = 1.4) were significantly more often found in girls with fractures. There was no statistically significant connection between fractures in adolescents and young adults and hypodynamia, bone mineral density, social factors (single-parent or multi-child family), and parental history of fractures

PREVALENCE OF THE DISEASES OF OSTEOMUSCULAR SYSTEM AND FRACTURES AMONG THE PERSONS OF YOUNG AGE IN IRKUTSK

The purpose of a research was the study of the frequency of arthralgia, prevalence of the diseases of osteomuscular system, and fractures among the persons from 14 to 24 years in Irkutsk. The frequency of arthralgia composed. 22,4 %. The prevalence of the diseases of osteomuscular system composed. 36561 to 100000. Fractures occurred in 23,8 % people at the age of up to 24 years

Mechanisms of angiotensin-converting enzyme nhibitors side effects development

The article presents the results of the review of literature devoted to angiotensin-converting enzyme inhibitors. The study aimed at searching for molecular mechanisms underlying the key side effects of drugs use and becoming the reason for the drug withdrawal.В статье изложены результаты обзора литературы, посвященной ингибиторам ангиотензин-превращающего фермента. В работе был сделан упор на поиск молекулярных механизмов, лежащих в основе ключевых побочных эффектов действия, возникающих при применении препаратов и служащих причиной для их отмены

Ace inhibitors pharmacodynamics aspects

The article presents the literature review results on drugs belonging to the group of antihypertensive drugs - angiotensin-converting enzyme inhibitors. The work focused on the search for molecular action mechanisms that provide clinically significant effects.В статье изложены результаты обзора литературы, посвященной препаратам, относящимся к группе антигипертензивных средств – ингибиторам ангиотензинпревращающего фермента. В работе был сделан упор на поиск молекулярных механизмов действия, обеспечивающих клинически значимые эффекты

Влияние ранней диагностики травматических повреждений на развитие легочных осложнений у пострадавших с сочетанной травмой

Despite the existing progress in providing care to patients with severe multisystem chest injury using advanced diagnostic methods, a high mortality rate still reaches 20–30%.Aim of study. To assess the impact of early diagnosis and correction of chest injuries on the development of complications in patients with multisystem trauma.Material and methods. The results of diagnosis and treatment of 89 patients with severe multisystem closed chest injury were studied. According to the time of admission to the Institute, the patients were divided into two groups: Group I, who were admitted to the Institute within the first hours after the injury (51 patients), and Group II, who were transferred from other medical institutions on the 3rd–7th day (38). CT was performed as a standard method of diagnosis and monitoring the dynamics of the process. With the development of purulent-inflammatory pulmonary complications, the bacteriological test of bronchoalveolar lavage was performed. Treatment included complex intensive therapy, drainage of the pleural cavity and emergency surgical interventions, if necessary.Results. In Group I, lung contusion occurred in 43 (84%) patients, and after 7-10 days, the contusion foci partially regressed in 20 (46.5%) patients. In 8 (16%) patients with lung rupture, infiltrative changes in the lung were resolved on the 18th-30th day, while 4 (50%) of them had pneumonia outside the contusion zones. In Group II, patients were put on a ventilator and inflammatory changes in the lungs were revealed in 30 patients (79%). Lung rupture associated with the contusion was revealed in 2 (5.2%). When comparing the groups by the composition of the isolated microflora, it was found that in patients of group II, Acinetobacter spp was more often found (46.7% vs. 17.1% in group I patients, p=0.021) and Enterococcus spp. (30.0% and 8.6%, respectively, p=0.058), as well as Klebsiella pneumoniae (46.7% and 37.1%, p=0.6). At the same time, Staphylococcus aureus was not found in these patients, while it was detected in 14.3% of patients from Group I (p=0.09). Medical care in Group I was carried out according to the principles of the “golden hour”: within the first hour from the moment of admission to the patients with the presence of pneumothorax and hemothorax, the pleural cavity was drained. In Group II, this procedure was performed in other medical institutions and in 5 additional patients at the Institute.Conclusions. Early computed tomography diagnosis of multisystem trauma makes it possible to assess the severity of injuries to the chest organs and other areas of the body and determine the treatment tactics. A comprehensive approach to the management of patients, including early diagnosis of trauma, drainage of the pleural cavity, determination of management tactics, bacterial test of the lower respiratory tract discharge, helps reduce infectious complications by an average of 45.46%. Актуальность. Несмотря на имеющийся прогресс в оказании помощи пострадавшим с тяжелой сочетанной травмой с использованием передовых методов диагностики, сохраняется высокий уровень летальности, достигающий 20–30%.Цель исследования. Оценить влияние ранней диагностики и коррекции повреждений груди на развитие осложнений у пострадавших с сочетанной травмой.Материал и методы. Изучены результаты диагностики и лечения 89 пострадавших с тяжелой сочетанной травмой. В соответствии со временем поступления в институт пациенты разделены на две группы: I группа — поступили в институт в первые 3 часа после травмы (51 больной), II — переведены из других лечебных учреждений на 3-и–7-е сутки (38). Компьютерную томографию выполняли как стандартный метод диагностики и контроля за динамикой процесса. При развитии гнойно-воспалительных легочных осложнений проводили бактериологическое исследование бронхоальвеолярного лаважа. Лечебные мероприятия включали в себя комплексную интенсивную терапию, дренирование плевральной полости и при необходимости проведение неотложных хирургических вмешательств.Результаты. В I группе ушиб легких был у 43 пациентов (84%), через 7–10 дней очаги ушиба частично регрессировали у 20 пострадавших (46,5%). При разрыве легкого у 8 (16%) инфильтративные изменения легкого разрешались на 18–30-е сутки, при этом у 4 (50%) из них было присоединение пневмонии вне зон контузии. Во II группе пострадавшие поступали на искусственной вентиляции легких, и воспалительные изменения в легких были у 30 больных (79%). Разрыв легкого на фоне ушиба был у 2 (5,2%). При сравнении групп по составу выделенной микрофлоры обнаружено, что у пациентов II группы чаще выделяли Acinetobacter spp. (46,7% против 17,1% у пациентов I группы, p=0,021) и Enterococcus spp. (30,0% и 8,6% соответственно, p=0,058), а также Klebsiella pneumoniae (46,7% и 37,1%, p=0,6). При этом Staphylococcus aureus у данных пациентов не встречался, тогда как его обнаруживали у 14,3% больных из I группы (p=0,09). Медицинскую помощь в I группе осуществляли по принципам «золотого часа»: в течение первого часа от момента поступления пострадавшим с наличием пневмо- и гемоторакса выполняли дренирование плевральной полости. Во II группе этот прием проводили в других лечебных учреждениях и у 5 пострадавших дополнительно в институте.Выводы. Ранняя компьютерно-томографическая диагностика сочетанной травмы дает возможность оценить тяжесть повреждений органов груди, других областей тела и определить тактику лечения. Комплексный подход к ведению пострадавших, включающий раннюю диагностику травмы, дренирование плевральной полости, определение тактики ведения, бактериальную оценку отделяемого нижних дыхательных путей, способствует снижению инфекционных осложнений в среднем на 45,46%.

Assessment of the quality of providing medical care using auxiliary reproductive technologies in the Russian Federation in the period from 2015 to 2019

The article presents the results of assessing the quality of medical care with the use of assisted reproductive technologies (ART) in Russia in the period from 2015 to 2019. Were considered such quality criteria as: availability, effectiveness, satisfaction, safety and cost-effectiveness.В статье изложены результаты оценки качества оказания медицинской помощи с применением вспомогательных репродуктивных технологий (ВРТ) в Российской Федерации (РФ) в период с 2015 по 2019 гг. Были рассмотрены такие критерии качества, как доступность, эффективность, удовлетворенность, безопасность и экономическая эффективность

Остеоартрит – аспекты фармакотерапии

The main goal of management of patients with osteoarthritis (OA) is analgesic and anti-inflammatory therapy, deceleration of the progression of the disease, and improvement of quality of life. Fast-acting symptomatic drugs (analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs)) and sustained-release structure-modifying drugs (chondroitin sulfate, glucosamine sulfate, their combination, piascledine, diacerein) are used to treat OA. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)) has analyzed the proposals of a number of expert groups and elaborated a consensus on the management of patients with OA: it has recommended the use of sustained-release drugs just in early OA.The article gives the data of comparative studies of a new Russian chondroprotector, the active ingredient of which is a bioactive extract from small sea fish, which contains alflutop. It evaluates the analgesic and anti-inflammatory effects and acute and chronic toxicity on experimental animal models and the preliminary results of therapy with the new drug in patients with OA in the large and small joints. Основная цель ведения пациентов с остеоартритом (ОА) – обезболивающая и противовоспалительная терапия, замедление прогрессирования болезни и улучшение качества жизни. Для лечения ОА используются симптоматические средства быстрого действия (анальгетики и нестероидные противовоспалительные препараты, НПВП) и структурно-модифицирующие препараты замедленного действия (хондроитина сульфат, глюкозамина сульфат, их комбинация, пиаскледин, диацереин). Европейское общество по клиническим и экономическим аспектам остеопороза и остеоартрита (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, ESCEO) проанализировало предложения ряда экспертных групп и выработало консенсус по ведению больных ОА: рекомендовано назначать медленнодействующие препараты уже на ранних стадиях ОА.В статье приведены данные сравнительных исследований нового отечественного «хондропротектора», активным компонентом которого является биоактивный экстракт из мелкой морской рыбы, с препаратом алфлутоп. Оценивали анальгетический, противовоспалительный эффект, острую и хроническую токсичность на экспериментальных моделях животных, а также предварительные результаты терапии новым препаратом у больных ОА крупных и мелких суставов.

Analysis of karyotypes of abortive fetuses in non-developing pregnancy

The aim of the study - to analyze the frequency of chromosomal abnormalities in non-developing pregnancy, 77 depending on the method of its onsetЦель исследования - проанализировать частоту хромосомных нарушений при неразвивающейся беременности в зависимости от способа ее наступления

Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy)

Non-steroidal anti-inflammatory drugs (NSAIDs) are most popular medications for the treatment of pain in common musculoskeletal diseases such as osteoarthritis (OA) and non-specific low back pain (LBP). However, the factors affecting the effectiveness of these drugs have not been determined fully. Aim: to identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. Materials and methods. An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). Results and discussion. Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (