EFFICACY OF FIXED COMBINATION OF VALSARTAN, AMLODIPINE AND HYDROCHLOROTHIAZIDE IN COMPLEX THERAPY OF THE PATIENT OF VERY HIGH CARDIOVASCULAR RISK

The high prevalence of arterial hypertension in association with high and very high cardiovascular risk requires widespread use of combined therapy. Current approaches to selection of combination components of antihypertensive drugs are based the efficacy of these drugs proven in multicenter randomized clinical trials. The triple combination of calcium antagonist, angiotensin II receptor blocker and thiazide diuretic is regarded as the best option for combined therapy in patients with arterial hypertension and ischemic heart disease to reduce cardiovascular risk

Персонифицированный учет затрат в управленческом учете медицинских организаций

In the modern economic conditions, the rational planning of costs and the complex process optimization are essential requirements to all organizations. Knowledge of costs is needed to correctly assess the economic performance of an organization. Competent and timely correction of tariffs for the obligatory medical insurance and rationalization of the requested financing of the medical organization depends on this assessment. In the present study, we analyze various methods of personalized cost accounting: the ratio of costs to charges (RCC); relative value unit (RVU); time-driven activity-based costing (TDABC), and the possibility of their adaptation to the specific needs of medical organizations. The personalized cost accounting incorporated into a medical information system allows for controlling, planning and carrying out a close internal management of financial activity. This function helps decision-makers: control the use of funds for medical care provision; increase the efficiency of management decisions; justify the prices of paid medical services; define the deficit and surplus work units; analyze the treatment cost for each patient, considering the diagnosis, method of treatment, age and other classification signs, including the reference to specialized departments; reduce the unnecessary “paper” work load on the medical personnel; model the future needs of the organization in accordance with the planned changes in the hospitalization policy; optimize, control and plan the budget with regard to the established standards of financial expenses. Implementation of this approach is expected to increase the work efficiency in most medical organizations and the entire healthcare system.В современных экономических условиях характерной чертой для всех организаций является рациональное планирование расходов и комплексная оптимизация процессов. Изучение затрат позволяет выработать правильную оценку уровня экономических показателей организации. От данной оценки зависит грамотная и своевременная корректировка тарифов обязательного медицинского страхования и обоснованность необходимого финансирования медицинской организации. В статье приводится анализ различных методов персонифицированного учета затрат: метода соотношения затрат к прибыли, метода единицы относительной стоимости, система учета затрат по видам деятельности и ее модификации Time-driven ABC (TDABS), а также возможность их адаптации для различных целей медицинских организаций. Система персонифицированного учета затрат, включенная в медицинскую информационную систему, позволяет оперативно контролировать, планировать и проводить внутренний финансовый контроль деятельности организации. Эта функция помогает лицам, принимающим решения в медицинской организации, в решении следующих задач: контроль использования средств на оказание медицинской помощи; усиление действенности и оперативности управленческих решений; обоснование цены платных медицинских услуг; определение дефицитных и профицитных отделений; анализ данных о стоимости случая лечения каждого пациента с учетом диагноза, метода лечения, возраста и других классификационных признаков, в т.ч. в разрезе профильных отделений; снижение «бумажной» нагрузки на медицинский персонал; моделирование будущих потребностей организации в соответствии с планируемыми изменениями структуры госпитализации; оптимизация расходов, контроль и планирование с учетом установленных нормативов финансовых затрат. Реализация данного процесса является актуальным и необходимым инструментом повышения эффективности деятельности, как самой медицинской организации, так и всей системы здравоохранения в целом

High level of glycated hemoglobin (HbA_1c) in patients with COVID-19 is a marker of the severity of the infection but not an indicator of previous diabetes mellitus

BACKGROUND: Less than a year has passed since the start of the new coronavirus infection COVID-19 pandemic caused by SARS-CoV-2. First published research results demonstrate a frequent increase in glycemia in patients without previously diagnosed carbohydrate metabolism disorders. A possible relationship between the carbohydrate metabolism state and the course of COVID-19 is considered.AIM: To identify the incidence of known and newly diagnosed diabetes mellitus (DM) in hospitalized patients with COVID-19 and evaluate the relationship between glycated hemoglobin (HbA1c), inflammation markers and infectious disease severity.METHODS: A single-center, cross-sectional, retrospective study included 155 patients with confirmed COVID-19 and bi- lateral polysegmental viral pneumonia hospitalized in the Endocrinology Research Centre, Russian Federation. Diagnosis of carbohydrate metabolism disorders was based on the HbA1c level, blood glucose level at admission (BGA) and fasting plasma glucose (FPG). Patients were divided into 2 groups: without the previously diagnosed DM (n=129, 83.3%) and with known history of DM (n=26, 16,7%). Patients without previously diagnosed DM were divided into subgroups according to HbA1c levels: ≤6,0% (Group A), >6,0% HbA1c, <6.5% (Group B), ≥6,5% (Group C). Additionally, insulin, interleukin 6 (IL-6) and D-dimer levels were measured in all patients. Blood oxygen saturation (SpO2) was measured by pulsoximetry, computerized tomography of lungs with calculation of lung parenchyma damage percentage.RESULTS: Type 2 DM was previously established in 16.7% of all included patients. Among patients without DM history, DM was revealed in 8 patients (5.2%), based on HbA1c, FPG and BGA. In 66 patients (42.6%) we observed no changes in carbohydrate metabolism. In 55 patients, the interpretation of carbohydrate metabolism state was difficult due to inconsistency of HbA1c level with FPG and BGA: in particular, the level of HbA1c ≥ 6.5% (which corresponds to the diagnostic threshold of the DM) was detected in 19 patients (12,2%) with normal FPG and BGA. No true stress hyperglycemia on admission and according to FPG was reported. Despite the presence of confirmed DM, HbA1c levels positively correlated with inflammatory markers (erythro- cyte sedimentation rate, C-reactive protein, IL-6) and SpO2. Patients with a HbA1c ≥6.5% without DM history had the most severe course of the disease: longest duration of hospitalization, largest damage of the pulmonary tissue, and high lethality.CONCLUSION: The incidence of DM among patients hospitalized with COVID-19 was 21.9% (16.7% had previous diagnosis of DM, 5.2% — newly diagnosed), which is 1.5 times higher than in general population in a comparable age category. It is difficult to assess the carbohydrate metabolism disorders in patients in acute infectious period. An increased level of HbA1c (≥6.5%), first detected in the acute period of infection, in combination with normal FPG and BGA parameters, cannot be a diagnostic criterion and requires dynamic monitoring. HbA1c level can be considered as a predictive factor of COVID-19 severity, independent of DM

Time-related OCT-A changes in preclinical retinopathy and their association with systemic factors

Background. Optical coherence tomography angiography (OCT-A) is a promising tool for the detection of microvascular impairment at the preclinical stage of diabetic retinopathy (DR). Evaluation of dynamic OCT-A changes and their association with systemic factors can help to reveal early biomarkers of DR progression.Aim: to evaluate time-related OCT-A changes and their association with systemic factors in type 1 diabetes mellitus (DM1) patients with no apparent DRMaterials and methods. 38 DM1 patients with no apparent DR and 39 healthy volunteers were included in the study. All participants underwent 7-fi eld fundus photography, OCT and OCT-A. We analyzed OCT-A parameters (foveal avascular zone (FAZ) area (mm2), acircularity index (AI), vessel density (VD), skeletonized density (SD)) as well as the results of blood and urea tests.Results. After one year of observation, AI was significantly higher (р = 0.005) and VD0–300 was signifi cantly lower in superfi cial vascular plexus (SVP, p < 0.0001) and deep capillary plexus (DCP, р = 0.032) in DM1 patients. We have also registered a positive correlation between AI and triglycerides (TG) level (r = 0.627, p = 0.007) as well as a negative correlation between ketones and VD (SVP VD0–300: r = –0.695, p = 0.030; intermediate capillary plexus (ICP, VD0–300: r = –0.551, p = 0.041; DCP, VD0–300: r = –0.704, p = 0.003; SVP, VD300–600: r = –0.853, p = 0.001).Conclusions. After one year of observation, we have registered an increase in AI level and a decline in VD in SVP and DCP which can be the earliest signs of DR progression. A signifi cant correlation between these parameters and systemic factors indicates their role as potential DR biomarkers

ИЗМЕНЕНИЕ МОЩНОСТИ СВЕТОВЫХ ПУЧКОВ РАЗЛИЧНЫХ ТИПОВ ПРИ ПРОХОЖДЕНИИ СЛОЕВ РАССЕИВАЮЩЕЙ СРЕДЫ

Laser radiation is extensively used for optical diagnostics of various scattering media. In most cases, laser beams having a Gaussian profile are applied for this task. At the same time, other-type light beams have some features that can be used to obtain additional information about investigated objects. In this context, a relevant task is to reveal the penetrability of different-type light beams in a scattering medium with their subsequent application for the nondestructive testing of various objects, including biological tissues. In this article, a comparative analysis is carried out for four different configurations of laser light beams (Gaussian, Laguerre-Gaussian, and zero- and first-order Bessel light beams) in relation to the power stored by them after passing through a scattering medium layer. To form the light beams we used helium-neon laser emitting at a wavelength of 0.633 micrometers, and a modular optical system. This system makes it possible to change the light beam profile by the inclusion / exclusion of the corresponding modules from the light path. As the scattering medium we used plane-parallel layers of semi-transparent silastic with the thickness ranging from 0.17 to 6.61 mm. It is investigated experimentally how the power of the light beam passing through the scattering medium layer depends on the layer thickness. According to the obtained results, the approximating curves are plotted in the form I = exp (–Dx) where D is the attenuation coefficient, I is the total power of the beam, x is the layer thickness. The values of the coefficient D for different-type beams are calculated. The D values for different-type beams scarcely differ (within the standard error) from each other. It means that the beam type in the optical system configuration has almost no effect on the penetration properties of the light beam, and on the total energy of the light passing through the scattering medium layer.Лазерное излучение широко используется для оптической диагностики различных рассеивающих сред. В подавляющем большинстве случаев для этих целей применяются лазерные пучки, имеющие гауссов профиль. В то же время световые пучки других типов имеют ряд особенностей, с помощью которых можно получить дополнительную информацию об исследуемых объектах. В данном контексте актуальной является задача выявления проникающей способности световых пучков различных типов в рассеивающей среде c целью их последующего применения для неразрушающего контроля различных объектов, в том числе биотканей. В настоящей работе проведен сравнительный анализ четырех различных конфигураций лазерных световых пучков: гауссова, лагерр-гауссова и бесселевых световых пучков нулевого и первого порядков в отношении сохраненной ими мощности после прохождения слоя рассеивающей среды. Для формирования световых пучков применялся гелий-неоновый лазер, излучающий на длине волны 0,633 мкм, и модульная оптическая схема, позволяющая изменять профиль светового пучка путем включения/исключения из светового тракта соответствующих модулей. В качестве рассеивающей среды использовались плоскопараллельные слои полупрозрачной силиконовой резины различных толщин в диапазоне от 0,17 до 6,61 мм. По результатам экспериментальных измерений построены аппроксимирующие кривые для зависимости мощности прошедших через слой рассеивающей среды световых пучков четырех типов от толщины слоя вида I = exp (–Dx), где D – показатель ослабления, I – суммарная мощность пучка, x – толщина слоя. Рассчитаны значения коэффициента D для разных типов пучков. Значения D мало (в пределах стандартной ошибки) отличаются для разных типов пучков, из чего следует, что тип пучка в данной конфигурации оптической схемы практически не влияет на его проникающие свойства и суммарную энергию света, прошедшего через слой рассеивающего материала.

КОНЦЕПЦИЯ УСТРОЙСТВА ДЛЯ ПРОВЕДЕНИЯ ПРИПОВЕРХНОСТНОГО ЛАЗЕРОФОРЕЗА

We developed a conception of the electronic-optical device for carrying out of the nearsurface laser phoresis procedure using the dynamical gradient light field (DGLF) of the interference type. To select an optimal construction we considered some variants of devices for formation of the such DGLFs. In the framework of a model of biological tissues with nonequilibrium radiation absorption by its microstructures we calculated the general form of the temperature response dependence on the coherence ratio of the affecting DGLF. We proposed a criterion for choice of a laser source on the coherence ratio of its radiation for near-surface laser phoresis with DGLF.Выработана концепция электронно-оптического устройства для проведения процедуры приповерхностного лазерофореза с применением динамических градиентных световых полей (ДГСП) интерференционного типа. С целью  выбора оптимальной конструкции рассмотрены несколько вариантов устройств, позволяющих формировать такие ДГСП. В рамках модели биоткани с неравновесным поглощением излучения микроструктурными  элементами рассчитана  аналитически  в  общем  виде  зависимость коэффициента температурного реагирования биоткани от степени когерентности воздействующего на нее ДГСП. Предложен критерий выбора лазерного источника по степени когерентности  его  излучения  для  проведения  приповерхностного  лазерофореза  посредством ДГСП

Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021

BACKGROUND. One of the priority directions in the development of the health care system is to reduce the medical and social damage caused by the increase in the prevalence of diabetes mellitus (DM). From this point of view, the development of a diabetes register is very important as the main information and analytical platform for clinical and epidemiological monitoring of diabetes in the Russian Federation (RF).AIMS. The aim of our study was to analyze a dynamic (2016–2020) of the epidemiological characteristics of diabetes mellitus in the Russian Federation (prevalence, morbidity, mortality), the prevalence of complications, the level of HbA1c and the dynamics of the structure of glucose-lowering therapy (GLT) according to the Federal Diabetes Register (FDR).MATERIALS AND METHODs. The database of FRD (http://diaregistry.ru) 84 regions of the RF. The data are presented in dynamics 2016→2020.RESULTS. The total number of DM patients in the RF as of 01.01.2021 was 4,799,552 (3.23% of the population), including: Type 1 (T1) — 5.5% (265.4 ths) , T2 — 92.5% (4.43 million), other DM types — 2.0% (99.3 ths). The dynamics of prevalence was 168.7→180.9/100 ths people with T1, and 2709 → 3022/100 ths people with T2; morbidity in T1 10.5→7.7/100 ths population, in T2 219.6→154.2/100 ths population. Age and sex characteristics: the proportion of men in T1 — 54%, in T2 — 30%; the max proportion of patients with T1 at the age of 30–39 years, T2 65–69 years. Mortality: T1 3.0 → 2.7/100 ths population, T2 87.7→93.9/100 ths of the population, the main cause of death was cardiovascular: in T1 38,1% cases, in T2 — 52,0%. Life expectancy (average age of death of patients): T1 was 53.2years, the dynamics in males 50.7 → 50.5years, ­females 58.7→55.2years; in T2 — 73.5 years, males 70.2→70.1years, females 75.7→75.4 years. The dynamic of DM duration until the death: in T1 17.4→19.0 years; in T2 11→11.4 years. The incidence of diabetic complications in T1 and T2 patients: neuropathy 43.3% and 24.4%, nephropathy (CKD) 25.9% and 18.4%, retinopathy 31.7% and 13.5%, respectively. The ­proportion of ­patients with HbA1c <7%: in T1 32.3%→36.9%, in T2 51.9%→52.1%, with HbA1c ≥ 9.0% in T1 23.1%→18.7% , in T2 8.9%→8.0%. The structure GLT in T2 patients: glucose lowering medications (GLM) — 76.2% (monotherapy — 44.1%; ­combination of  2 GLM — 28.9%, 3 GLM — 3.2%), insulin therapy in 18,8%, without drug therapy in 4.9%.CONCLUSIONS. The performed analysis demonstrates the importance of dynamic assessment of epidemiological characteristics and monitoring of clinical data on patients with diabetes through a registry for assessing the quality of diabetes care and the prospects for its development

Регистры пациентов и реестры счетов по ОМС: вопросы интеграции и взаимозаменяемости

Patient registers are an effective tool for monitoring the disease incidence in the population and the effectiveness of medical care provided to patients. The registers also represent a source of information for making organizational decisions on the healthcare system. The aim of this study is to review the regulatory and legal acts governing the patient registers, and compare them with the registers of compulsory medical insurance (CMI) accounts to assess the possibility of integrating the data into a unified registry based on the CMI accounts.Регистры пациентов являются действенным инструментом наблюдения за заболеваемостью населения, оказываемой пациентам медицинской помощью и степенью ее эффективности, а также представляют собой источник значимых сведений при принятии некоторых организационных и управленческих решений в сфере здравоохранения. Целью настоящего исследования является рассмотрение нормативно-правовых актов, регламентирующих ведение регистров пациентов, и сравнение регистров с реестрами счетов по ОМС для оценки возможности ведения регистров, основываясь на данных реестров счетов по ОМС

Early functional and microcirculatory changes in patients with type 1 diabetes mellitus and no apparent diabetic retinopathy

BACKGROUND: Diabetic retinopathy (DR) is the leading complication of diabetes mellitus (DM) which is reported to affect more than one-third of the global diabetic population. Optical coherence tomography angiography (OCT-A) can help to reveal early biomarkers of DR to improve current diagnostic approach.AIMS: To evaluate early visual functions deficiency and OCT-A changes in patients with type 1 DM (T1DM) without clinical signs of DR.MATERIALS AND METHODS. 74 eyes of 40 T1DM patients with no apparent DR and 49 eyes of 28 healthy volunteers were included in the study. The mean duration of DM was 11,7 ± 6,1 years. All participants underwent standard ophthalmological examination, low-luminance visual acuity (LLVA) assessment, 7-field fundus photography, OCT and OCT-A. We analyzed LLVA deficit as a marker of visual function. For OCT-A scans we evaluated foveal avascular zone (FAZ) area (mm2), acircularity index (AI), vessel density (VD), skeletonized density (SD) and vessel diameter index (VDI) in superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP).RESULTS: LLVA deficit was significantly higher in T1DM patients (0,16±0,05 vs 0,10±0,04, p<0,0001). We also detected a significant difference in AI level (11,47 ± 0,24 vs 1,31 ± 0,15, p<0,0001). VD was significantly lower in T1DM patients in SVP (25,37 ± 2,24%, vs 26,67 ± 1,81%, p=0,028) and DCP (17,22 ± 3,10 % vs 18,29 ± 1,95%, p=0,015)CONCLUSIONS: Our results demonstrate early visual functions deficiency and OCT-A changes at the preclinical stage of DR. The prognostic value of these findings will be studied during longitudinal observation