bluuebunny/crossref_metadata_2025 huggingface dataset:
THE DEFICIENCY OF MEDICAL PERSONNEL: ARE THERE PERSPECTIVES FOR CHANGING?
Authors: Artiukhov I. P , Shulmin A. V , Dobretsova E. A , Arshukova I. L , Titov L. S , Lang A. A
Published: September 2020

The attempts were made to analyze the causes of deficiency of the medical personnel in the Krasnoyarsk kraii and to study possible means of amelioration of situation in the region. The graduates of the Krasnoyarsk state medical university considered as a potential resource for elimination of medical personnel deficiency in regional health care system. The study of opinions of graduates of 2016 on specialty of «Medical business» on the basis of questionnaire survey. The development of questionnaire was implemented on the basis of pilot interviews. The data processing was implemented using licensed statistical software IBM SPSS Statistica 22.0. The methods of cluster analysis were applied alongside with calculations of descriptive statistics. The study was targeted to detecting factors effecting will of young specialists to work in districts of the Krasnoyarsk kraii and also establishing their ideas about further professional activities. All graduates were divided between 5 specific groups depending on their ideas about preferable conditions and place of employment. The respondents wishing to work in polyclinics are the only group where not salary nor conditions of work nor time of working under guidance of tutor are important and it's not easy to motivate them with anything else. More than one third of respondents perceive their own future without the limits of Krasnoyarsk. The key factors effecting wish to work in rural area are housing habitation, salary (higher than 5060 000 rubles), well-developed infrastructure and availability of competent physicians of narrow specialization at the given settlement.
THE QUANTITATIVE ANALYSIS OF SIGNIFICANCE OF SOURCES OF MEDICALIZATION IN SOCIOCULTURAL ENVIRONMENT OF MEGALOPOLIS
Authors: Danilevskaia T. V , Ellansky Yu. G , Khudonogov I. Yu
Published: September 2020

The number of medical information consumed and learned by population of the Russian Federation increased significantly during recent time. The sociological randomized sampled survey was carried out in 2014-2015 in Rostov-on-Don. The sample included 459 adult residents of Rostov-on-Don. The survey established that 65% of respondents never ponder over why they fall ill or they think of their own health only in case of manifestation of certain symptoms. Furthermore, the relationships are analyzed between level of medicalization and status of respondents in gender, educational and self-preserving aspects. Also cumulated morbidity was measured. The parallel application of parametric and non-parametric Student and Pearson criteria permitted to establish absence of a valuable relationship between levels of morbidity and content of medical knowledge obtained within the framework of spontaneous medicalization.
THE MEDICAL SOCIOLOGICAL ASSESSMENT OF SOCIAL EFFICIENCY OF FUNCTIONING OF MEDICAL INSURANCE COMPANY IN THE SYSTEM OF MANDATORY MEDICAL INSURANCE OF RUSSIA
Authors: Juravleva Vera A.
Published: September 2020

The article considers medical sociological study of evaluation of efficiency of functioning of insurance medical organization in the mandatory medical insurance system. The study was carried out on the basis of data survey of insured patients. The analysis established main problems related to financing of medical care within the framework of mandatory medical insurance system of the Russian Federation.
THE OPPORTUNITY OF APPLYING PRINCIPLES OF AUTONOMY OF PATIENT TO POSTMORTEM DONORS OF ORGANS
Authors: Petrov G. S , Krom I. L , Erugina M. V
Published: September 2020

The article is devoted to autonomy of patient as applied to postmortem donors of organs. The conclusion is made on the basis sociological approach and analysis of legal concepts of «medical service», «medical intervention» and «patient» as related to postmortem organ donorship, about priority of assessment of this particular issue. The attempts of applying regulations of the law on funeral business to postmortem organ donors is inadmissible. The suggestion is developed to consider consent presumption of posthumous organ donorship as a form of transition from autonomy of particular patient to autonomy of society given population support.
THE PERCEPTION OF OUTCOMES OF HEALTH CARE MODERNIZATION BY MEDICAL SPECIALISTS
Authors: Prisyazhnaya N. V , Koriagin M. O
Published: September 2020

The social institute of medicine, which has been developing steadily throughout the existence of mankind, covers not only clinical aspects of health, but also socio-economic, cultural, organizational and other components of population health protection. Nowadays, at the "digitalization" stage of society development, health care system is being rebuilt on the basis actual requirements. The condition of the "catching-up" development of industry is implementation of modernization measures targeted to updating material and technical components of health care system, as well as expansion of skills of medical personnel with modern medical equipment and programs. The article presents the results of medical and sociological study (pilot survey) of peculiarities of perception of results of modernization of health care system by medical specialists (as exemplified by the personnel of Krasnogorsk multi-field hospital). The most medical specialists working with equipment received under the state program of modernization of the health care perceived modernization positively (especially personnel working in medicine more than ten years) and believe that measures applied contributed into improving quality of medical care of patients. However, in order to increase efficiency of application of new medical equipment, it is necessary to include into health care modernization program position of mandatory training of medical staff.
The influence of melatonin and dexamethasone instillations on the clinical course of uveitis and the biochemical processes in the aqueous humour of the anterior chamber of the eye (an experimental study)
Authors: Chesnokova N. B , Beznos O. V , Beyshenova Gulmira Alimovna
Published: September 2020

Introduction. The problem of the treatment of uveitis has the important socio-medical implications bearing in mind the high prevalence of this pathological condition frequently affecting the subjects of the employable age. Uveitis is characterized by the enhanced production of free radicals in the eye tissues and marked activation of oxidative reactions that gradually aggravate the pronounced changes in the immune system that, in their turn, promote the development of oxidative stress. Aim. This study was designed to evaluate and compare the influence of melatonin and dexamethasone or their combination on the clinical symptoms and local metabolic processes in the aqueous humour of the anterior chamber of the rabbit eyes. Materials and methods. The present study was based on the rabbit model of immunogenic anterior uveitis developed by the subcutaneous injections of the normal equine serum followed by its intravitreal administration. We investigated the influence of instillations of a 0.1% melatonin solution and a 0.4% dexamethasone solution or their combinations on the clinical course of uveitis and the biochemical processes in the aqueous humour of the anterior chamber of the eye including the anti-oxidative activity, total protein and alpha-2 macroglobulin contents as well as the leukocyte count. Results. It was shown that instillation of melatonin either alone or in a combination with the dexamethasone solution reduced the severity of the inflammatory processes associated with uveitis. Melatonin, similar to dexamethasone, decreased palpebral oedema and iridial swelling. The two medication instilled successively produced a synergic effect on palpebral oedema, conjunctival hyperemia, corneal and iridial oedema. A significant decrease of protein and alpha-2 macroglobulin levels in comparison with the same values in the aqueous humour of the anterior chamber of the eye of the untreated animals was documented within 8 days after the induction of experimental uveitis. The similar effects of dexamethasone was even more pronounced. At the same time, the instillation of melatonin more significantly than that of dexamethasone reduced the number of leukocytes in the aqueous humour of the anterior chamber. It is worthwhile to note that instillations of melatonin, unlike those of dexamethasone, caused a significant increase in the anti-oxidative activity in the aqueous humour of the anterior chamber. Discussion. The instillations of melatonin make it possible to reduce the intensity of the inflammatory processes associated with experimental uveitis, enhance the anti-oxidative potential in the eye tissues, and decrease the permeability of the blood-ocular barrier. Conclusion. It is concluded that the introduction of melatonin instillations in the combined treatment of uveitis may improve the effectiveness of therapy of this condition.
The federal clinical guidelines on “The diagnostics and treatment of uveitis associated with juvenile idiopathic arthritis”
Authors: Katargina Lyudmila Anatol'evna , Brzheskiy Vladimir Vsevolodovich , Guseva Marina Raul'evna , Denisova Ekaterina Valer'evna , Drozdova Elena Aleksandrovna , Zhukova Ol'ga Vladimirovna , Nikishina Irina Petrovna , Starikova Aleksandra Viktorovna
Published: September 2020

Federal clinical recommendations were approved at the presidium meeting of the All Russian Organization “Association of ophthalmologists” 24.09.2015
The factors responsible for impairment of vision and the algorithm for the regular medical check-up of the patients following retinopathy of prematurity
Authors: Kogoleva Lyudmila Viktorovna , Katargina L. A
Published: September 2020

Objective. To develop the algorithm for the regular medical check-up of the patients following retinopathy of prematurity based on the investigation of the main factors responsible for the impairment of vision in the patients presenting with this pathology. Material and methods. A total of 655 patients (1307 eyes) at the age varying from 4 to 18 years with cicatrical retinopathy of prematurity were available for the examination, The standard methods employed for the ophthalmological examination were supplemented by optical coherent tomography, retinal tomography, registration of different kinds of electroretinograms, multichannel visual evoked potentials, computed perimetry, evaluation of spatial contrast sensitivity. Results. It was shown that the main factors responsible for the impairment of vision in the patients presenting with retinopathy of prematurity are the following ones: (1) the degree of residual changes in the fundus at the cicatrical stage of retinopathy of prematurity, (2) late complications, (3) the concomitant pathology of the conduction pathways and higher portions of the visual analyzer, (4) concomitant eye pathology, (5) refractive and oculomotor disorders, (6) functional incompetence of the retina due to prematurity and/or the consequences of retinopathy of prematurity suffered in the past. Conclusion. The organization of the regular medical check-up of the patients following retinopathy of prematurity implies the necessity of the comprehensive clinical and functional examination throughout the entire lifespan of the subjects with this pathology for the purpose of timely identification and correction of the revealed disorders.
The new method for the treatment of relative amblyopia in the patients presenting with optical nystagmus
Authors: Gubkina G. L , Apaev Aleksandr Vyacheslavovich , Tarutta E. P
Published: September 2020

Aim. The objective of the present study was to develop the method for the pleoptical treatment of relative amblyopia in the children presenting with optical nystagmus with the use of sinoptophore under conditions of nystagmus blockade. The secondary objective was to evaluate the effectiveness of the proposed method. Materials and methods. The newly developed technique for the pleoptical treatment of relative amblyopia consisted of the blockade of nystagmus by conversion effort and the application of the light pulses to the central fovea of the retina under control of bifoveal fusion. Results. The proposed method was employed to treat 21 patients presenting with optical nystagmus and relative amblyopia at the age varying from 5 to 10 years. In 18 children, the changes in the parameters of nystagmus were evaluated from its amplitude and fixation area density on the retina by means of microperimetry using the NIDEK Microperimeter-MP1 apparatus. The study revealed the tendency toward the improvement of binocular visual acuity, both corrected and uncorrected (by 0.14±0.09 and 0.12±0.07 on the average, respectively), and of the absolute accommodation volume (by 2.88±1.9 diopters). The inverse relationship between the motor parameters of nystagmus and visual acuity was documented. Conclusion. The proposed new method for the pleoptical treatment of relative amblyopia consists of blockade of nystagmus by conversion effort and the delivery of the light pulses to the central fovea of the retina in both eyes under control of bifoveal fusion on sinoptofphore. The method allowed to improve both the functional (enhanced visual acuity) and motor (amplitude and fixation area density) characteristics of nystagmus.
Early vitrectomy in the case of stage IVA retinopathy of prematurity: pro and contra
Authors: Diskalenko O. V , Konikova Ol’ga Aleksandrovna
Published: September 2020

Objective. To evaluate the effectiveness and safety of early lens-sparing vitrectomy for the treatment of the children presenting with stage IVa retinopathy of prematurity during the early and late periods after the surgical intervention. Material and methods. We analyzed the results of the early surgical intervention for vitrectomy with synechiae removal in 83children (116 eyes) at the mean age of 40.0 ± 1.8 weeks with stage IVa retinopathy of prematurity with the use of modern methods including electrophysiological techniques. Results. Stabilization of stage retinopathy of prematurity with the complete reattachment of the retina and the elimination of the vascular activity in the fundus have been achieved in 97.4% of the cases (113 eyes). Thirteen patients (15 eyes or 13.3%) turned out to have glaucoma within the first 3 months after the onset of observations. The maximum corrected visual acuity after vitrectomy in the children at the age of 4.0 ± 0.6 averaged 0.34 ± 0.07, the spherical equivalent of myopic refraction was estimated at 9.8 ± 1,5 D. The electrophysiological study has demonstrated the well apparent reduction of electrogenesis in the central portion of the retina especially in the cone cells and the bipolar nuclear cell layer despite the absence of the noticeable ophthalmological changes in the posterior pole of the fundus in the children treated by lens-sparing vitrectomy as well as in the patients presenting with stage IVa retinopathy of prematurity managed given no vitreoretinal surgery. Conclusion. Urgent vitrectomy with synechiae removal durng the acute period of stage IVa of retinopathy of prematurity is an efficacious and pathogenetically substantiated method for the stabilization of this pathology provided the surgical intervention is performed upon the appearance of the very first signs of retinal detachment. However, the increased risk of glaucoma formation after minimally invasive lens-sparing vitrectomy should be taken into consideration. Moreover, the visual acuity remains impaired due to the inhibition of maturation of the retina at stage IVa of retinopathy of prematurity both after vitrectomy with synechiae removal and in the absence of such intervention.
The experience with the application of multimodal anesthesia in pediatric ophthalmology for the treatment of the children presenting with retinopathy of prematurity
Authors: Korobova Lyudmila Sergeevna , Balashova L. M , Poduskov E. V , Kuznetsova Yu. D , Milashchenko T. A , Ovchar R. A
Published: September 2020

Purpose. The objective of the present study was the comparative evaluation of the effectiveness and adequacy of the regional anesthetic medication as a component of multimodal anesthesia applied in ophthalmological surgery for the treatment of the children presenting with retinopathy of prematurity. Materials and methods. The study included the comparative analysis of anesthetic support in 120 cases of the surgical intervention for the treatment of retinopathy of prematurity in the children at the age varying from 1 month to 1 year. The comparison involved three groups of the patients. The main group was comprised of the children treated with the non-steroidal anti-inflammatory agent paracetamol in the combination with retrobulbar (peribulbar) or infraocular anesthesia and the peripheral van Lint block (14 anesthesias). The control group 1 consisted of the children treated with the narcotic analgesic fentanyl (46 anesthesias) while the control group 2 was composed of the children (n = 60) given inhalation anesthesia with the use of oxygen, nitrous oxide, and sevorane). The principal hemodynamic characteristics including the heart rate, mean, systemic, systolic, and diastolic arterial pressure as well as electrocardiogram, concentration of inhalation anesthetics, capnometry, and the blood oxygenation level were monitored. In addition, the severity of pain and the frequency of apnoea during the postoperative period were evaluated. Results. The application of regional anesthesia with the use of a 0.2% solution of naropin in ophthalmological surgery for the treatment of retinopathy of prematurity in the children ensures strong enough anesthetic effect in the absence of the additional therapeutic interventions that might influence the hemodynamic characteristics and allows to refuse to use narcotic preparations as well as reduce the concentration of inhalation anesthetics. This method improves the course of the postoperative period by virtue of the long-standing anesthetic effect, rapid restoration of consciousness, the absence of postoperative apnoea, reduction of the postoperative starvation time, and the promotion of accelerated rehabilitation of the patients.
THE DIAGNOSTIC SIGNIFICANCE OF FLUORESCENCE ANGIOGRAPHY FOR THE EARLY DETECTION AND PROGNOSTICATION OF THE DEVELOPMENT OF ACTIVE RETINOPATHY OF PREMATURITY IN THE INFANTS BORN ON THE DEADLINES OF GESTATION
Authors: Saidasheva E. I , Lyubimenko V. A , Buyanovskaya S. V , Kovshov F. V
Published: September 2020

Aim. The objective of the present study was to elucidate the fluorescent angiographic characteristics, such as the features of retinal and choroidal microcirculation, depending on the duration of the active course of retinopathy of prematurity in the infants born on the deadlines of gestation (the gestational age of 21-26 weeks). Materials and methods. The study included 65 patients presenting with retinopathy of prematurity. A total of 102 sessions of fluorescence angiography (FA) of the retina were carried out, with 40% of the sessions being performed in duplicate. The gestational age of the infants ranged from 22 to 26 (mean 24.9+-1.0) weeks, their body weight at birth varied from 490 to 1,400 (mean BW 774.8+-152.6) g. All the patients were subdivided into 4 groups. Group 1 was comprised of 8 (12.3%) children at the initial stages of retinopathy of prematurity, group 2 consisted of 28 (43.1%) children presenting with threshold retinopathy of prematurity, group 3 was composed of 20 (30.8%) children with the recurring disorder, and group 4 involved 9 (13.8%) children experiencing induced regression of this pathology. The photographs of the fundus and digital video FA images were obtained with the use of the RetCam3 pediatric retinal camera (“Clarity”, USA). The 10% fluorescein solution was administered intravenously in the form of bolus injections at a dose of 7.5 mg/kg. Results. The present study has revealed some characteristic fluorescent and angiographic features of active retinopathy of prematurity in the extremely preterm born infants including instability of the retinal blood flow, variability in the filling of the choroid, various types of pathological branching of the blood vessels at the boundary between vascularized and avascular retina, etc. The comparative analysis of the angiograms and colour images of the fundus obtained with the use of the RetCam3 camera gave evidence of the high diagnostic value of the fluorescence angiography technique that provides the possibility for the early objective visualization and registration of the pathological changes in the retinal vasculature characteristic of the initial and threshold stages of the disease as well as for the reliable detection of the signs of its relapse (the local sites of re-proliferation) and regression of the pathology being considered. Conclusion. The application of the fluorescence angiography technique for the examination of the markedly prematurely born infants provides a safe and efficient tool allowing to greatly optimize both the early detection and prognostication of the development of active retinopathy of prematurity in the infants born on the deadlines of gestation.
THE EXPERIENCE WITH THE COMBINED TREATMENT OF KERATOCONUS (FEMTOLASER IMPLANTATION OF INTRASTROMAL SEGMENTS WITH THE SUBSEQUENT CROSS-LINKING OF CORNEAL COLLAGEN) IN THE CHILDREN
Authors: Pershin K. B , Gurmizov Evgeny Petrovich , Pashinova N. F , Burenina E. V , Semenova L. A , Tsygankov A. Yu
Published: September 2020

Aim. The objective of the present study was the analysis of the results of the combined treatment of keratoconus in the adolescent patients (2 clinical cases). Results. In both cases, the combined treatment was carried out with the use of femtolaser implantation of intrastromal segments with the subsequent cross-linking of corneal collagen. Conclusion. The described combined treatment resulted in the significant improvement of the functional indicators of both patients/ It is concluded that the proposed method can be used to treat the children and adolescents presenting with keratoconus.
MANIFESTATIONS OF IHTIOSIS IN THE EYE IN CHILD (CLINICAL CASE)
Authors: Khamraeva Lola Salimovna , Bobokha L. Yu , Abdurakhmanova Ch. K , Kalankhodzhaeva D. B. , Makhmudova Z. A
Published: September 2020

A clinical case of observation of patient B-go K., was presented, 9 years old with the main diagnosis: OU-spastic eversion of the eyelids. OS-purulent corneal ulcer. Shortening ofthe upper eyelid and upper arch of the conjunctival cavity; concomitant diagnosis: vulgar ichthyosis. From the side of theeye changes were associated with hyperkeratosis,which led to the contraction of the facial skin resulting in cicatrical eversion of eyelids, xerosis, leading to abscess and ulcer of the cornea. As a result of the complex treatment (antibacterial, trophic therapy, plastic surgery of the eyelids) it was possible to achieve a positive result.
DIAGNOSTICS OF STRABISMUS INCOMMITANT
Authors: Aklaeva Nailya Anvarovna
Published: September 2020

Strabismus incommitant-complicated kind of oculomotor pathology. Timely detection of signs of strabismus incommitant contributes the choice of the correct optimal treatment tactics, achievement of high functional results and restoration of the lost visual functions. On the ground of long-term working experience in the department of pathology of refraction and binocular vision of The Helmholtz Moscow Research Institute of Eye Diseases were elaborated general diagnostic schemes of the strabismus incommitant for children and for adults, which help to identify features of strabismus and binocular diplopia and also to reveal the affected oculomotor muscle (muscles).
Comparative analysis of visual analogue scale and the new scale of efficacy and safety of postoperative analgesia for orediction of pain during the early postoperative period
Authors: Zabolotskikh Igor Borisovich , Durleshter V. M , Musaeva T. S , Trembach N. V , Makarenko V. A , Skraastad E. , Dybvik L. , Eltaeva A. , Konkaev A. K , Kuklin V. N
Published: September 2020

Modern postoperative analgesia - is an individual selection of optimal doses of analgesics in order to obtain high efficiency of analgesia with minimal side effects. The quality and safety of postoperative pain is largely dependent on the severity of pain immediately after the operation. The aim of the study was to compare the efficacy of visual analogue scale (VAS) and the new scale of efficiency and safety (ESS) of postoperative analgesia in predicting of the severity of pain and postoperative complications. The study was conducted in 209 patients (mean age (66-77) years), in which a major surgery on the abdominal organs were routinely performed. Patients were randomized into two groups, depending on the method of evaluating of the quality of analgesia: in group 1 is controlled via ESS (n = 102), the 2nd group - by VAS (n = 105). Postoperative complications were recorded: nausea and vomiting, respiratory failure (need for noninvasive or invasive ventilation), delirium, cardiac arrhythmias, ileus. ESS and VAS demonstrated good prediction of the effectiveness of pain relief (AUROC 0,973, [0,913-0,996] and 0.976 [0,913-0,997], respectively). ESS showed a good prediction of the complicated postoperative period (AUROC = 0,924, [0,856-0,967]), as opposed to the VAS (AUROC = 0,649, [0,548-0,741]). Baseline ESS and VAS score equally effective in predicting the intensity of pain in the early postoperative period. ESS advantage, compared to VAS, is the ability to predict complicated postoperative period and postoperative complications. ESS score for more than 17 is a risk factor for postoperative complications associated with inadequate analgesia.
Anesthesia method for toe-to-hand transfer in children
Authors: Zabolotskii Dmitrii V. , Koryachkin V. A , Ivanov M. D , Zaytseva N. V , Malashenko N. S
Published: September 2020

Background: toe-to-hand transfer - an effective method of surgical reconstructive restoration of hand function in children, which is highly traumatic and characterized by complexity, duration and multiple stages. These aspects determine the importance and relevance of the choice of anesthesia method is not only in the perioperative period, but at the stage of rehabilitation in this group of the patients. Aim of the study: To evaluate the efficacy of the continuous regional blocks in pediatric toe-to-hand transfer. A total of 136 children had toe-to-hand transfer, and received general anesthesia with regional anesthesia (study group n = 84) and general anesthesia alone (control group n = 52). In the first group regional blockade was used on foot / feet, and continuous regional block of the brachial plexus. We studied the temperature and Doppler on the limbs at different accesses to the brachial plexus, the effect of regional anesthesia on hemostasis, compared intraoperative drug load in the groups, the level of awakening, the quality of early postoperative analgesia and the final outcome of the surgical treatment. The data of thermometry and Doppler showed increase in microcirculation in blocked limbs. Data from thromboelastography showed a tendency to hypocoagulation, due to the influence of regional blocks on the platelet aggregation. The effectiveness of regional block has reduced drug load in the perioperative period. The therapeutic effect of continuous regional blocks helped to reduce the number of surgical complications in 1.9 times.
POSTOPERATIVE ANALGESIA IN CHILDREN. ARE THERE ANY METHODS AVAILABLE TODAY?
Authors: Zabolotski Dmitriy V. , Koriachkin V. A , Ulrikh G. E
Published: September 2020

This review presents the current state of postoperative pain in children. Based on the fundamental studies that have shown the presence of a newborn neurophysiological and neurochemical nociceptive information transmission mechanisms, provides information about the negative impact of pain on the body of the child. Presented neurophysiological aspects of pain perception in children, pain assessment methods, the basic principles of modern post-operative analgesia. Particular attention is given to drugs permitted for use in the Russian Federation. in children
LABOUR PAIN RELIEF. THE MODERN APPROACH
Authors: Neimark M. I , Ivanova Olga S.
Published: September 2020

Women have an intense pain in the labor. Amount of pain varies greatly and it depends on the emotional, mental, physical status of women and environmental factors. The pain is caused by various physiological factors and triggers a cascade of biochemical reactions in the woman’s body. Intense pain brings suffering to women and can do damage to the fetus. Effective and safe anesthesia delivery is extremely important task for modern medicine. The article describes the essence of the most popular methods of pain relief during labor, discussed their positive and negative properties. Search literature for the review of various special medical and general Internet search engines. There are medication and non-medication methods of pain relief in labor. Non-medication method is non-invasive and healthier for a maternity patient and a child but their effectiveness is disputable. Medication methods of pain relief are presented injection of opioid analgesics and non-opioid analgesics, inhalation and neuroaxial anesthesia methods. Every method has advantages and disadvantages. Opioid analgesics reduce the pain for a few hours however cause a large number of undesirable effects such as nauseaand sleepiness of maternity patient, respiratory distress and depression of consciousness of newborn. Study of non-opioid analgesics showed a high analgesic activity but it was not study enough to use for pain relief in labor. Today the most common method is neuroaxial analgesia. It relieves the pain effectively and has no effect on the fetus but it has some disadvantages.The question of the influence of the neuroaxial methods of anesthesia on the duration of the labor is controversial. Promising is the use of inhaled anesthetics in particular xenon. But these methods are not study enough. All currently used labor pain relief methods are not ideal as far as each method has its own characteristics and bad effects. In each particular case the method of labor pain relief must be selected individually, it’s necessary to take into consideration the psychological and physical condition of the woman and obstetric situation.
EPIDURAL ANALGESIA DURING VAGINAL DELIVERY AT THE WOMEN WITH THE UTERINE SCAR. IS IT RISKY? POSSIBLE? NECESSARY?
Authors: Bozhenkov K. A , Gustovarova T. A , Ivanyan A. N , Vinogradov V. L , Shifman E. M
Published: September 2020

This paper will be concerned with the results of a prospective controlled longitudinal study which has involved 132 secundiparae (among them 69 patients are with the uterine scar after cesarean section). The parturient women have been divided into 3 groups. Group “A” includes 38 women with the uterine scar after cesarean section, in this group epidural analgesia was administered during vaginal delivery. Group “B” includes 32 secundiparae without uterine scar, in this group epidural analgesia was administered during vaginal delivery. Group “C” - 31 women with the uterine scar, no epidural analgesia was administered during vaginal delivery. Based on a comparative assessment of the pain syndrome intensity in labor according to the visual analogue scale, the research has proved that delivery at the women with the uterine scar is accompanied by statistically more significant pain than at the women without uterine scar. The necessity of analgesia during vaginal delivery at the women with the uterine scar has been proved. The effectiveness and safety of epidural analgesia at patients with the uterine scar have been analyzed. It has been proved that epidural analgesia provides anesthesia during vaginal delivery at the women with the uterine scar, while it does not affect the total duration and course of labor, maternal and perinatal outcomes, and does not mask the clinical picture of the uterine rupture threat.
SALIVARY ALPHA-AMYLASE AS A PREDICTOR OF ARTERIAL HYPOTENSION DURING CESARESN SECTION UNDER SPINAL ANESTHESIA IN PRIMIPAROUS OF YOUNGER AGE
Authors: Degtyarev Evgeniy N. , Shifman Y. M , Tikhova G. P
Published: September 2020

Arterial hypotension refers to the frequent complications of spinal anesthesia during cesarean delivery. Expressed anxiety before the operation of caesarean section, can contribute to the occurrence of arterial hypotension during CA. Juvenile pregnant women are characterized by a high level of anxiety. Determination of the level of α-amylase of saliva is a simple and non-invasive way of an objective assessment of the intensity of stress. Objective: To develop an algorithm for predicting arterial hypotension in spinal anesthesia during cesarean section in young primiparas. Materials and methods of research. After the approval of the ethical committee of the FSBU VO “Amurskaya GMA” of September 21, 2016. Clinical research on the topic “Anesthesia of delivery of young patients” conducted a prospective observational study of 43 pregnant women aged 14 to 18 years, on the basis of the regional perinatal center of GAUZ JSC “AOKB” in the period from 2016 to 2017. Primary endpoints of the study included a level of salivary α-amylase (AAS) recorded at resting patients (baseline level) and on the operating table immediately before anesthesia, as well as an assessment of anxiety and depression on the HADS scale performed on the eve of delivery. The parameters of hemodynamics (blood pressure and heart rate) were recorded on the eve of delivery, before performing spinal anesthesia, and the lowest level of blood pressure during the operation was noted. The level of α-amylase was determined by a Labio 200 (Mindray), using the “alfa-AMY” reagent, kinetic method on photometric systems. Results. In the presence of clinically significant anxiety on the HADS scale in the patient, the level of AAS before the operation increases by almost a quarter of the initial level, whereas in patients with anxiety scores less than 11 points, the percentage increase in AAS is 2 times less. The maximum decrease in blood pressure and blood pressure in patients during the operation of a cesarean section with an anxiety score above 11 points is on average 37-38% of the initial, while in patients with no clinically significant anxiety, the blood pressure increase is on average 17.5%. The difference between the mean absolute values of AAS levels at rest and before the operation in patients of the above 2 subgroups was also expressed. Сonclusion. The level of amylase has a strong associative relationship with the scale of anxiety and depression of HADS. The algorithm developed by us, which includes preoperative levels of salivary α-amylase and systolic blood pressure, allows us to predict the likelihood of intraoperative hypotension in a particular patient.
ANALYSIS OF MRI DATA ON THE LOCATION AND SIZE OF SPINAL NERVES IN THE PARAVERTEBRAL SPACE OF HIGH THORACIC LEVEL
Authors: Yaskevich Valery Victorovich , Busel A. V , Marochkov A. V.
Published: September 2020

А retrospective study of T2-weighted MRI images of the thoracic spine at the levels of Th1 to Th6, which was performed in 30 women. 956 MRI images were studied. Reduction of distances from the skin surface to the dorsal surface of the transverse process of the vertebrae to the nerve and the pleura was in the caudal direction. The distance from the surface of the skin to the dorsal surface of the transverse processes of the vertebrae was, the level of Th1 - 50,8 mm (43,8; 57,4) mm on the left and 53,6 (45,7; 59,8) mm on the right; at the level of Th6 - 30,8 (25,4; 35,2) and 29.1 mm on the left (25,1; 36,7) mm on the right. The largest diameter of the nerve was at the level of Th1 - 1,96±0,17 mm. the smallest diameter of the nerve was at the level of Th3 - of 1,52±0,20 mm. Reducing of the distance from skin to nerve and pleura from Th1 to Th6 is due to the decrease in the distance from skin to transverse process. Distance from the dorsal surface of the transverse process of the vertebrae to nerve and from nerve to the pleura is constant on the levels of Th1 to Th6. Clinical and anatomical characteristics and dimensions of spinal nerves in high thoracic level spine should be considered when performing thoracic PVB.
CAUDAL ANESTHESIA IN SURGICAL INTERVENTIONS ON THE LOWER EXTREMITIES IN CHILDREN
Authors: Nasibova Esmira M. , Ismailov I. S , Nasibov F. G , Sattarov N. S
Published: September 2020

The goal of the study: Comparative study of the effects of bupivacin and ropivacaine in caudal anesthesia in surgical interventions on the lower extremities in children. Material and methods. 59 children operated under caudal anesthesia for congenital dislocation of the thigh, deformities of pelvic bones, clubfoot, etc. were included in the study. The patients were divided into 2 groups depending on the type of local anesthetic used: in group I (n = 39) caudal anesthesia was performed with a 0.75% solution of ropivacaine with intravenous sedation with propofol; in the second group (n = 20), the caudal block was administered with a 0.5% solution of bupivacaine. During the operation and in the postoperative period, the indices of central hemodynamics, the concentration of cortisol and blood plasma glucose were studied, the intensity of postoperative pain syndrome was assessed. Results. Serious complications of anesthesia were not recorded. The indices of central hemodynamics remained stable during anesthesia, the indices of stress markers decreased somewhat, which indicates the adequacy of both variants of anesthesia. Twelve hours after the operation, a significant increase in the cardiac index, heart rate and blood pressure, as well as an increase in the concentration of cortisol and glucose, was noted in Group II patients who had anesthesia with bupivacaine. This was accompanied by an intensive pain syndrome, which required an additional appointment of tramadol. In group I patients (caustic anesthesia with ropivacaine), the indices of central hemodynamics and stress markers remained stable after the operation, and the intensity of the pain syndrome was significantly lower. Conclusions. Caudal anesthesia with 0.75% ropivacaine is a highly effective, reliable and safe method of anesthesia in traumatological operations on the lower extremities in children. Caudal administration of a 0.75% ropivacaine provides a longer sensory and motor block compared with a 0.5% bupivacaine. The superiority of caudal anesthesia with ropivacaine is due to the more potent and prolonged action of the drug, as evidenced by the wider spread of the sensory block, deeper motor blockade, stability of hemodynamic parameters and stress markers.
COMPARISON OF LEVOBUPIVACAIN AND ROPIVAKAIN IN COMBINED ANESTHESIA IN ONCOGNECOLOGICAL INTERVENTIONS
Authors: Tsygankov Kirill A. , Lakhin R. E , Schegolev A. V , Khalikov A. D , Mordovin V. V , Averyanov D. A , Andreenko A. A
Published: September 2020

The aim of the study was to evaluate the nature of the development of the sensory block and the frequency of occurrence of critical incidents during anesthesia, in the immediate postoperative period using levobupivacaine and ropivacaine in patients with an oncogynecological profile. Materials and methods. The study included 48 women who were randomized into two groups of 24 patients each, depending on the anesthetic used: group 1 - ropivacaine, group 2 - levobupivacaine. The latent period of the sensory block, the motor block, the maximum level of development of the sensory block after 15 minutes, critical incidents at the stages of anesthesia, the level of the pain syndrome after extubation and coughing were analyzed in the groups. Results. The sensory response to the cold sample, after the administration of local anesthetics in the groups, differed: in the first group, 300 (241.25, 314.75) s, in the second group 54.5 (45.75, 60.25) s. The maximum level of the sensory block in the groups was different. During the induction and maintenance of anesthesia, the most common critical incident was hypotension. Reduction of systolic blood pressure for the induction of anesthesia in group 1 was detected in 6 (25%) cases, in group 2 in 7 (29%). After extubation, the pain syndrome in the first group was 1.7 (1; 6), in the second group 1.7 (1; 4). With a cough, the assessment of the pain syndrome had the same intensity of pain, both in the first and in the second group 2 (1; 3). Conclusions. Levobupivacaine with epidural anesthesia accelerates the development of the sensory block. The maximum level of the sensory block does not differ with the use of levobupivacaine and ropivacaine. Hypotension in the stages of anesthesia is a frequent critical incident in epidural anesthesia. The severity of the pain syndrome during extubation and in the immediate postoperative period does not depend on the selected anesthetic.
Advantages of regional anesthesia for carotid endarterectomy
Authors: Shmelyov Vadim V. , Neimark M. I
Published: September 2020

At 190 patients with carotid endarterectomy the relative assessment of total intravenous anaesthesia with use propofol, penetrating blockage of a cervical plexus and inhalation sevofluran is made. Cerebral circulation parametres, markers of cerebral damage, a state of the highest mental functions were investigated. It is shown that for each kind of anaesthesia specific changes of parametres of the cerebral blood-groove, defining level neuronal damages that affects on a state of number and character of postoperative complications are characteristic.
Regional obstetric monitoring in the Sverdlovsk region. Innovative tools for reduction of maternal and perinatal mortality rate
Authors: Ankudinov Nikolay O. , Ababkov S. G , Zil’ber N. A , Zhilin A. V , Kulikov A. V
Published: September 2020

According to the State program of the Russian Federation «Health care development» till 2020 approved by the decree of the Russian Federation government dated 24.12.2012 N 2511-p, the principle of the cluster approach became the one of the directions of informatization of healthcare. Subsystem perinatal cluster is the continuous monitoring of pregnant women. Its main advantage is the formation of a unified information space of the hospitals in the region that allows you to reliably group out pregnant females according to the risk of complications of pregnancy and childbirth, to determine the routing for all the patients. The goal of the system is a significant improvement of the assistance within a cluster (group), the formation of a standardized approach to the medical care, management of emergency situations in the occurrence of life-threatening conditions, the reduction of maternal and perinatal mortality rate. Computerization of medical care in obstetrics was implemented in the automated system «Program monitoring for pregnant females».
Fetal growth retardation syndrome and adaptation of the placenta
Authors: Goryunova Aleksandra G. , Simonova M. S , Murashko A. V
Published: September 2020

There are considered modern data on etiology, pathogenesis, course of the pregnancy, methods of diagnosing of the fetal growth retardation syndrome. There is presented information about the role of growth factors and their receptors, as well as modern views on the problem of placental insufficiency as a major cause of fetal growth retardation syndrome.
To the memory of Andrew E. Czeizel
Authors: Donnikov Andrey E.
Published: September 2020

The article is devoted to the outstanding Hungarian doctor - Andrew Czeizel, his biography and achievements in the Enforcement Network for the improvement of the Health of Children - the future of humanity.
Polycystic ovary syndrome
Authors: Sosnova Elena A.
Published: September 2020

In the clinical lecture the polycystic ovary syndrome (PCOS) is considered as the multiple endocrine disease associated with the disturbed function of ovaries, pancreas, adrenalcortex, the hypothalamus and the pituitarygland. The attention is drawn at the modern look at PCOS as a “diagnosis of exclusion”. There is presented information on basic theories of pathogenesis and differential diagnosis of PCOS from other hyperandrogenic conditions. The ultrasound semiotics of polycystic ovaries is reported in details. There are considered opportunities and perspectives of various modalities of therapies of PCOS.
The course of pregnancy and blood coagulation system
Authors: Murashko A. V , Drapkina Yuliya S. , Koroleva N. S
Published: September 2020

Pregnancy represents the procoagulant state, giving rise in the high prevalence rate of thrombotic complications. An imbalance between coagulation and anticoagulation systems of blood during pregnancy can lead to the development of pre-eclampsia, intrauterine growth retardation, preterm labor, premature rupture offetal membranes and fetal death. These complications are mostly caused by the impaired generation of thrombin as well as changes in the concentration and activity of tissue factor TFPI (tissue factor pathway inhibitor), TAT III complex and protein Z. Nevertheless, it should be noted that the thrombotic complications during pregnancy depend not on the elevation of the concentrations of specific coagulation factors or lack of the activity of anticoagulant proteins, but on the shift in the whole system toward the procoagulant state. These disorders most of all lead to thromboses ofplacental vessels, causing disorders ofperfusion of the affected area. Placental pathology can develop as from the maternal as from the fetal side. Despite the fact that changes in the blood coagulation system occur from the very beginning of pregnancy, and often are adaptive in nature, i.e., do not require special medical intervention, the prompt diagnosis and treatment of hemostatic disorders as main pathogenetic link in the development of thrombosis is extremely important.
HORMONAL CONTRACEPTION IN AUTOIMMUNITY THYROIDITIS FEMALE PATIENTS OF THE REPRODUCTIVE AGE
Authors: Klyukina L. A
Published: September 2020

At present, the problem of hormonal contraception in women with autoimmune thyroiditis is quite relevant and poorly understood. There is a few works devoted to the study of the effectiveness and acceptability of hormonal contraceptives in this group of women. This review considers characteristics of the reproductive health of autoimmune thyroiditis female patients and assesses the effect of hormonal contraceptives on the course of the underlying disease and the indices of the immune system in autoimmune thyroiditis female patients of the reproductive age.
SYSTEM OF REPRODUCTION IN HYPOTHYREOSIS
Authors: Esina M. M
Published: September 2020

Hypothyreosis is one of the most common endocrine pathologies closely related with the reproductive system. In female patients with hypofunction of the thyroid gland, various disorders occur in the reproductive system: menstrual cycle deteriorations, miscarriage, infertility. Therefore, the study of thyroid function should be carried out as a screening in women planning pregnancy, as well as in infertile couples in the treatment of the infertility. When hypothyreosis is detected, L-thyroxine replacement therapy is necessary.
CONGENITAL DYSFUNCTION OF ADRENAL CORTEX AND PREGNANCY (SYSTEMATIC REVIEW)
Authors: Davtyan D. A , Kovaleva A. A
Published: September 2020

Fertility in women with congenital dysfunction of the adrenal cortex (CDAC) due to the insufficiency of 21-hydroxylase (n21-OH) is presumed to decrease, especially in women with classic salt-losing type. Several factors contribute to the development of subfertility: an excess of androgens, adrenal hypersecretion of progesterone, the consequences of the reconstructive genital surgery, a syndrome of secondary polycystic ovaries and psychosexual factors. Adequate glucocorticoid therapy and the improvement of surgical and psychological care can contribute to the optimization of infertility in CDAC patients, even in classical variant women. This review contains up-to-date information on reproductive outcomes in CDAC women due to n21-OH, infertility and pregnancy problems.