ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers.Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation.Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol.Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression

Appointment of lipid-lowering therapy in the Russian population: comparison of SCORE and SCORE2 (according to the ESSE-RF study)

Aim. In 2021, the European Society of Cardiology (ESC) guidelines for the prevention of cardiovascular diseases (CVDs) were published, where a new SCORE2 CVD risk assessment model was introduced. In our work, we compared approaches to determine the indications for initiating lipid-lowering therapy in the Russian population aged 25-64 years according to the guidelines for the diagnosis and treatment of lipid metabolism disorders of the Russian National Atherosclerosis Society (2020) and ESC guidelines for CVD prevention (2021).Material and methods. The ESSE-RF epidemiological study was conducted in 12 Russian regions. All participants signed informed consent and completed approved questionnaires. We performed anthropometric and blood pressure (BP) measurements, as well as fasting blood sampling. In total, 20665 people aged 25-64 years were examined. The analysis included data from 19546 respondents (women, 12325 (63,1%)).Results. Of the 19546 participants, 3828 (19,6%) were classified as high or very high CV risk based on the 9 criteria: BP ≥180/110 mm Hg, total cholesterol >8,0 mmol/l, low-density lipoprotein (LDL) >4,9 mmol/l, lipid-lowering therapy, chronic kidney disease (CKD) with glomerular filtration rate <60 ml/min/1,73 m2, type 2 diabetes, previous stroke and/or myocardial infarction. Of 3828 people, lipidlowering therapy was indicated in 3758 (98%) (criteria for LDL ≥1,8 mmol/l and LDL ≥1,4 mmol/l, respectively, high and very high risk). In addition, 5519 individuals aged <40 years were excluded from further analysis due to the lower age threshold of models. For 10199 participants aged >40 years without established CVD, diabetes, CKD, cardiovascular risk stratification was performed according to the SCORE and SCORE2. Of them, according to the Russian National Atherosclerosis Society (2020) and ESC 2021 guidelines, lipid-lowering therapy was indicated for 701 and 9487 participants, respectively.Conclusion. Using the new approach proposed by the ESC in 2021, the number of patients aged 40-64 years without CVD, diabetes and CKD with indications for lipidlowering therapy for primary prevention in Russia increases by 14 times compared with the 2020 Russian National Atherosclerosis Society guidelines

INSTABILITY AT CHRONIC DAMAGES OF A BACKBONE AND SPINAL CORD

By means of mathematical modeling studying influence of angular deformation of a body on development of a spinal stenosis was performed. It is proved, that the increase in a corner of deformation promotes development of narrowing of the channel. The given law on an example of treatment of 10 patients with chronic damages of a backbone and a spinal cord is studied. At all patients the progression of deformation that has demanded surgical treatment was observed. The lead treatment has reduced a painful syndrome, has improved social adaptation, but has not affected a level of neurologic deficiency

Features of vertebral arteries pathology at trauma

OBJECTIVE. The authors compared results of changes in clinical and radial studies of vertebral arteries in case of trauma of cervical spine. MATERIAL AND METHODS. An analysis of data of complex examination and treatment was made in 157 victims aged 38,5 ± 1,5 years old. RESULTS. Pathology of vertebral arteries was detected in 68,8 % cases. The main ultrasound syndromes were deformations of speed with local hemodynamic significance, compression with systemic deficiency of blood flow, irritative effects, extravasal changes on the level of V-3 segment, thrombosis and dissection. CONCLUSIONS. The development of hemodynamically significant local effects on the vertebral artery depended on degree of stenosis and cross-section area of its canal

FEATURES OF MEDICAL AID FOR NEUROTRAUMA IN REGION WITH LOW POPULATION DENSITY

The system of medical aid for neurotrauma in the region with low population density in the case of the Komi Republic was studied. Neurosurgical care to the population of the republic last decade had an intense focus of development. Currently, neurosurgical service is based entirely in Syktyvkar, and is represented by three neurosurgical departments. Due to the low population density (2.3 people 1 km2), the centralization of specialized medical care and inadequate equipment of district and regional hospitals, special significance remote consultation, as well as adequate ways of evacuation with neurotrauma

ASSESSMENT OF MEDICAL CARE QUALITY IN CRANIOCEREBRAL TRAUMA ON THE BASE OF DATA ANALYSIS

An analysis of 658 medical records of inpatient treatment from 15 hospitals of St. Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52,9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1,0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1,0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma

THE RESULTS OF EXAMINATION OF MEDICAL CARE QUALITY FOR ASSOCIATED VERTEBRO-SPINAL-CORD INJURY

Medical care quality assessment for patients with vertebro-spinal-cord injury at different stages in St.-Petersburg during year was performed. The first aid in the most cases (74,8%) was rendered by emergency service. A vertebro-spinal-cord injuries were not diagnosed by a staff of line and special medical aid brigades in 31,6-51,9%. The causes of incorrect diagnostics at hospital stage: insufficient and delayed patient examination, underestimation of injury severity in consequence of delayed use of neuro-imaging methods. Surgical operations for vertebro-spinal-cord injuries were performed in 59 (8%) cases. 43 (73%) patients needed in vertebral fixation

CHANGES FACETS JOINTS IN TRAUMA AND DEGENERATIVE DISEASES OF THE LUMBAR SPINE

Produced spondilometric measurements of the lumbosacral spine is normal (20 cases) and in patients with spinal cord injury and degenerative-dystrophic diseases of the spine (43 cases). The width of the facet joint space joints on both sides, its relation to the longitudinal axis of the body in degrees and another on the same level were studied. The width of the facet joint space at the lumbosacral level of 3.5–4.0 mm, the area of the intervertebral foramen varies from 96–132 mm2. Among the changes in the parameters of the vertebral-motor segment can distinguish moderate, marked and significant extent that is important in determining the amount of the alleged operation

ALGORITHM OF DIAGNOSTICS AND SURGERY OF TRAUMA AND DEGENERATIVE DISEASES OF CERVICAL SPINE

A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31±5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52±7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed

VALUE OF ANATOMICAL INTRACRANIAL RESERVE IN SURGICAL TREATMENT OF INJURIES AND DISEASES OF THE BRAIN

The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation