THE STRUCTURE OF PATIENTS REFERRED TO THE DIFFERENTIAL DIAGNOSTIC DEPARTMENT OF TB DISPENSARY

Goal of the study: to investigate the structure of patients referred with the suspicion of tuberculosis to the differential diagnostics department of TB dispensary.Materials and methods. The analysis included investigation of medical documents of 990 patients admitted to the hospital in 2012-2014 with the suspicion of tuberculosis to the diagnostic department of TB dispensary.Results. No active tuberculosis had been confirmed in 506 (51.1%) patients out of 990. Out of those patients 29.4% of cases had pneumonia or other inflammatory disease, in 18.9% – post-tuberculous changes, 12.7% – lung cancer, 6.5% – respiratory tuberculosis. The time of diagnosis for each nosology without invasive methods of sample obtaining was analyzed

Restorative minimally invasive interventions in patients with colostomy

Aim. To show the benefits of performing mini-access restorative phase on the colon in patients with colostomy. Methods. A retrospective analysis of the results of closure stomy operations in 2011-2017 in two emergency cancer departments of Republican Clinical Oncology Center MH RT was conducted. The inclusion criteria of the study were: 1) surgical intervention for acute intestinal obstruction in colorectal cancer performed in RCOC; 2) mandatory removal of the primary tumor during the first surgery; 3) the presence of a functioning intestinal stoma formed during the first surgery; 4) fixation of both stumps in one stoma. The exclusion criteria were refusal to restore the continuity of the colon for medical indications and the patient's refusal to undergo the surgery. Results. The study included 11 males (44 %) and 14 females (56 %). The age interval was 49 to 81 years, of which 12 patients were over 70 years old (48 %), the average age was 67.7 ± 5.4 years. The tumor removed at the first stage was localized in the right parts of the colon in 5 patients (20 %), and in the left in 20 patients (80 %). By the stages of the malignant process, the patients were distributed as follows: stage B - 14 cases (56 %), stage C - 10 (40 %), stage D - 1 (4 %). The average duration of the surgery was 53 ± 14.38 minutes (40 to 123). The postoperative period was 10.8 ± 1.92 days on average (5 to 18). Conclusion. Restoration of intestinal continuity through mini-paracolostomy access is technically rational, as due to the mini-access the patient undergoes minor surgical trauma; the anatomical proximity of the anastomosed bowel stumps excludes the difficulties associated with the search for the distal stump in the traditional method of recovery; the duration of the postoperative hospital stay decreases significantly

Состав больных, направляемых в дифференциально-диагностическое отделение противотуберкулезного диспансера

Goal of the study: to investigate the structure of patients referred with the suspicion of tuberculosis to the differential diagnostics department of TB dispensary.Materials and methods. The analysis included investigation of medical documents of 990 patients admitted to the hospital in 2012-2014 with the suspicion of tuberculosis to the diagnostic department of TB dispensary.Results. No active tuberculosis had been confirmed in 506 (51.1%) patients out of 990. Out of those patients 29.4% of cases had pneumonia or other inflammatory disease, in 18.9% – post-tuberculous changes, 12.7% – lung cancer, 6.5% – respiratory tuberculosis. The time of diagnosis for each nosology without invasive methods of sample obtaining was analyzed. Цель исследования: изучить состав больных, направляемых с подозрением на туберкулез в дифференциально-диагностическое отделение противотуберкулезного диспансера.Материалы и методы. Проанализированы медицинские документы 990 больных, госпитализированных в 2012-2014 гг. с подозрением на туберкулез в диагностическое отделение противотуберкулезного диспансера.Результаты. У 506 (51,1%) больных из 990 диагноз активного туберкулеза был исключен. Среди этих больных в 29,4% случаев была пневмония или другие воспалительные заболевания, в 18,9% - посттуберкулезные изменения, в 12,7% - рак легких, в 6,5% - саркоидоз органов дыхания. Проанализированы сроки диагностики для каждой нозологии без применения инвазивных методов получения диагностического материала

Туберкулез у работников здравоохранения

Tuberculosis constitutes an occupational risk for healthcare workers. We studied tuberculosis morbidity in healthcare workers in 1996-2000. For this period tuberculosis was diagnosed in 266 healthcare workers (220 females and 46 males), among them 239 (89.8%) became ill with lung tuberculosis.We divided all the healthcare workers into 4 groups according to their contacts with tuberculosis patients: 1) medical staff of tuberculosis settings who are in direct touch with tuberculosis patients; 2) workers of tuber­culosis settings who do not render medical services for tuberculosis patients; 3) medical staff of general med­ical settings who diagnose and treat diseases disguising tuberculosis; morbid anatomic and forensic medical staff; 4) the rest healthcare workers not getting a direct contact with tuberculosis patients.Туберкулез представляет профессиональный риск для работников здравоохранения. Нами изучена заболеваемость туберкулезом среди работников здравоохранения (РЗ) за период с 1996 по 2000 г. За это время заболело туберкулезом 266 РЗ (220 женщин и 46 мужчин), из них туберкулез органов дыхания выявлен у 239 (89,8%) человек.По степени контакта с туберкулезными больными всех РЗ мы разделили на 4 категории: 1) медицинские работники противотуберкулезных учреждений, непосредственно контактирующие с больными; 2) работники противотуберкулезных учреждений, не оказывающие непосредственно медицинские услуги больным туберкулезом; 3) медицинские работники ЛПУ, участвующие в диагностике и лечении заболеваний, под маской которых может протекать туберкулез; работники патолого­ анатомической и судебно-медицинской служб; 4) остальные работники системы здравоохранения, не контактирующие непосредственно с больными туберкулезом

Peculiar properties of prophylactic medical care in organizations of various organizational and legal orientation

One of problem in prophylactic medical care – it is insufficiency of capability to provision assistance in phase of realization recommendation. It decreases of compliance and commitment of long term action.One of effective method of realization prophylactic medical care is a modern medical organization, such as fitness centers. We define characteristic of centers, which can be classify as medical organization. The article presents fitness centers as medical prophylactic organization. There are results of observation of 11246 patients. The proportion of people with risk factors among those who had first visited the fitness centers was 76,2%; cardiovascular risks – 32%; overweight and obesity – 43,4%, hypercholesterolemia – 32%; hyperglycemia – 11,2%. Behavioral factors (physical inactivity, smoking, irrational diet) was in 74,1%. In comparients organization of the possibility of implementation of recommendations on physical activity, education of patients, food rational nutrition balanced diet. The average number of visits per person is 49.2 per year. This confirms the fact that the studied fitness centers create favorable conditions for the primary and secondary prevention of non-communicable diseases.Недостаток мощностей медицинских организаций на этапе реализации профилактических рекомендаций существенно влияет на комплаенс и приверженность к долгосрочным профилактическим действиям. Одним из эффективных способов реализации профилактической помощи являются такие современные профилактические медицинские организации, как фитнес центр. Определены критерии фитнес центров, которые можно отнести к организациям, оказывающим профилактическую помощь. Приведены результаты обследования 11246 пациентов. Наличие факторов риска неинфекционных заболеваний среди занимающихся выявлено в 76,2%, кардиоваскулярных факторов риска - в 32,3%, повышенная масса тела и ожирение - в 43,4%, гиперхолистеринемия в 32%, гипергликемией в 11,2%. Поведенческие (гиподинамия, курение, нерациональное питание) встречались в 74.1%. Значимым отличием является организация возможности реализации рекомендаций по двигательной активности, образованию пациентов, пищевому режиму. Среднее количество посещений на одного человека 49,2 в год, что подтверждает наличие благоприятных условия для проведения первичной и вторичной профилактики неинфекционных заболеваний, а также возможность для фитнес центров быть высокоэффективным дополнением к уже существующим способам профилактической помощи, а также являться ее этапом в сочетании с другими медицинскими организациями

Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria

Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR). Materials and methods. This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle. Results. There was no statistically significant difference in the age, Anti-Müllerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028). Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial

ASPIRATING DRAINAGE OF THE CAVITY OF THE LESSER PELVIS AS A WAY OF CONSERVATIVE TREATMENT OF LOW-LYING COLORECTAL ANASTOMOTIC LEAK

Aim. Examination of efficacy of the double-lumen “pipe in pipe” drainage set mounted in the cavity of the lesser pelvis by the method developed by the authors for conservative treatment of colorectal anastomotic leak.Material and methods. Data have been analyzed for 124 patients operated in two surgeries of the base No.2 of the Republican Clinical Onco- logic Dispensary of the Ministry of Health of the Republic of Tatarstan, whose surgery was completed with formation of colorectal anastomo- sis; aspirating drainage of the cavity of the lesser pelvis was performed with double-lumen drainage of the authors’ design, mounted in the retroperitoneal part of the cavity of the lesser pelvis through a puncture in the anterior abdominal wall. No patient was applied a preventive intestinal stoma.Results. 4 (3.2 %) out of 124 patients died after surgeries. 21 (16.9 %) patients experienced colorectal anastomotic leak, which was resolved in a conservative manner in all patients.Conclusion. Our data allow us to speak about the efficacy of this technique of drainage of the cavity of the lesser pelvis in colorectal anastomotic leak

Peculiarities of manifestations of chronic diseases after a Covid-19 coronavirus infection

The aim of the work was to study specific features of manifestations of chronic noninfectious diseases in persons after COVID-19 coronavirus infection to substantiate preventive and rehabilitative measures.Цель работы – изучить особенности проявлений хронических неинфекционных заболеваний у лиц после перенесенной коронавирусной инфекции COVID-19 для обоснования профилактических и реабилитационных мероприятий

Ассоциация полиморфных вариантов генов ферментов биотрансформации ксенобиотиков и цитокинов с деструкцией легочной ткани у больных туберкулезом

The objective: to investigate the association of polymorphic gene variants of xenobiotic biotransformation enzymes (NAT2, CYP2E1, ABCB1, GSTM1, GSTT1) and cytokines (IL1B, IL-4, IL-10, TNF) with lung tissue destruction in pulmonary tuberculosis patients.Subjects and Methods. An ethnically homogeneous population sample of unrelated individuals of Slavic nationalities (mainly Russians) living in Kursk Oblast suffering from new pulmonary tuberculosis was examined.Results. New pulmonary tuberculosis with no destructive changes in the lungs was associated with the EE genotype of the GSTM1 gene (p &lt; 0.0001) in 89.5%, while the DD genotype of the GSTM1 gene (p &lt; 0.0001) was associated with the presence of destructive changes in the lungs in 56.1% of cases; the dominant GG genotype of the TNF-α gene was associated with destructive changes in the lungs in 93.3% (p = 0.027), and the recessive GA genotype of the TNF-α gene was associated with no destructive changes in the lungs in 71.9% (p = 0.027).Цель исследования: исследовать взаимосвязь полиморфных вариантов генов ферментов метаболизма ксенобиотиков (NAT2, CYP2E1, ABCB1, GSTM1, GSTT1) и цитокинов (IL1B, IL-4, IL-10, TNF) с развитием деструкции легочной ткани у больных туберкулезом легких.Материал и методы. Обследована гомогенная по этническому составу популяционная выборка неродственных индивидов славянских национальностей (преимущественно русских), проживающих на территории Курской области, с впервые выявленным туберкулезом легких.Результаты. Впервые выявленный туберкулез легких с отсутствием деструктивных изменений в легких в 89,5% ассоциировался с генотипом ЕЕ гена GSTM1 (p &lt; 0,0001), в то время как генотип DD гена GSTM1 в 56,1% случаев (p &lt; 0,0001) ассоциировался с наличием деструктивных изменений в легких; доминантный генотип GG гена TNF-α в 93,3% (p = 0,027) ассоциировался с формированием деструктивных изменений в легких, рецессивный генотип GA гена TNF-α в 71,9% ассоциировался с отсутствием деструктивных изменений в легочной ткани (p = 0,027)

The rs11385942 and rs657152 variants are not associated with COVID-19 severity and outcomes in patients treated with favipiravir and remdesivir

Background. There is a mounting evidence in the scientific literature that susceptibility to SARS-CoV-2 infection could vary. The severity of COVID-19 symptoms can  range from asymptomatic to severe respiratory failure, requiring prolonged artificial ventilation. The underlying causes of this range of clinical manifestations remain unclear. Identification of the risk factors that may cause this variation in clinical symptoms is important for identifying the most susceptible populations at highest risk. This should help improve prevention measures, reduce hospitalizations, and decrease the mortality rate of the disease. Previously, an association has been found between the severity of COVID-19 and the genetic markers rs11385942 G&gt;GA and rs657152 A&gt;C.The aim. To assess the impact of carrying polymorphic markers rs11385942 G&gt;GA and rs657152 A&gt;C on the severity of COVID-19 in patients undergoing specific therapy. Materials and methods. A total of 240 patients hospitalized with a coronavirus infection were included in the study. All patients received therapy with favipiravir or remdesivir. The presence of the rs11385942 G&gt;GA and rs657152 A&gt;C variants was determined in all patients. The study compared the length of hospital stays, frequency of patient transfers to the intensive care unit (ICU), and frequency of clinical outcomes (recovery or death) among carriers of allelic variants of the markers under investigation.Results. There were no significant associations between the carriage of variants rs11385942 G&gt;GA and rs657152 A&gt;C and the duration of patients’ hospitalization, frequency of patient transfers to the ICU, and patient outcomes.Conclusion. The carriage of rs11385942 G&gt;GA and rs657152 A&gt;C variants did not affect the severity or type of clinical outcomes in patients with COVID-19