Modern strategy of drug treatment of patients with myocardial infarction without ST segment elevation

The modern approach to the treatment of patients with acute coronary syndrome without ST segment elevation on electrocardiogram (NSTEMI) involves the implementation of invasive interventions and the appointment of drug therapy. This literature review presents data on the features of drug treatment of patients with NSTEMI.

Effect of lisinopril on indicators of electrocardiographic and echocardiographic studies in patients with liver cirrosis

Chronic diffuse liver diseases (CDLD) of various etiologies remain a serious socio-economic and clinical-epidemiological health problem. Every year more than 1 million people die from cirrhosis of the liver of various etiology all over the world. According to the results of a study by a group of authors, it was found that in the Siberian Federal District there is an unfavorable situation in terms of gastroenterological mortality, in particular, hepatological mortality. CCM is characterized by lengthening of the QT interval, electromechanical dyssynchronization, and chronotropic insufficiency. The duration of the QTc interval in the subgroup of patients with liver cirrhosis who received basic therapy and the drug lisinopril (Diroton) was (418.21 ± 2.74 ms) and was significantly lower than in the subgroup of patients receiving only basic therapy. Evaluating the parameters of transthoracic echocardiography among patients with liver cirrhosis, it was noted that during treatment with basic drugs in combination with lisinopril (Diroton), the volume of LV EDV significantly decreased (p < 0.05). The appointment of an ACE inhibitor lisinopril to patients with cirrhosis of the liver as part of complex therapy leads to an improvement in general well-being, a decrease in shortness of breath, an increase in exercise tolerance, an improvement in basic laboratory parameters, as well as an improvement in some morphometric parameters (EDV) and cardiac electrical systole.

Specific features of fat-soluble vitamins in the indigenous and administrative population of the Far North

In recent decades, interest in the study of the content of fat-soluble antioxidant vitamins among residents of the northern territories of Russia has not weakened, which is associated with the transformation of the diet in a harsh climate, a negative ecological situation resulting from the technogenic pollution of the biosphere with various toxicants, and urbanization of the environment. In recent decades, interest in the study of fat-soluble antioxidant vitamins among residents of the northern territories of Russia has not weakened, which is due to the transformation of the diet in a harsh climate, a negative environmental situation that arose as a result of technogenic pollution of the biosphere with various toxicants. Аim. Conduct a comparative analysis of the content vitamins A, D, E in indigenous and alien populations, living on the territory of the Yamalo-Nenets Autonomous Okrug. Material and methods. The study involved 185 males of working age (31.3 ± 12.2 years), permanently residing in the territory of the Yamalo-Nenets Autonomous Okrug. The study participants were divided into 2 groups: the control group (97 representatives of the newcomer population) and the main group (88 people from the ethnic population: Nenets, Khanty). In all examined individuals, vitamins A and E were determined in the blood by the fluorometric method, and the concentration of hydroxyvitamin D – 25 (OH) D3 was determined using the chemiluminescent method. Results. In the course of a comparative analysis of the content of the studied vitamins in the blood, it was found that the average values of vitamin A in the newcomer population were in the range of optimal values, while the provision with vitamins D and E was 1.4 and 1.1 times lower than the minimum. permissible physiological values, respectively. The opposite picture was observed in the aboriginal population, who had a pronounced deficiency of only vitamin A. Conclusion. The results obtained indicate the presence of intergroup features in the content of fat-soluble vitamins in the body of the population of the Far North, which requires a corresponding correction of the diet and the development of a set of preventive measures aimed at improving the ecology of the environment.

Telemedicine in obstetrics in areas with low population density: legal framework and practical results of integration

The purpose of the study is to characterize the legal framework for integrating telemedicine into the obstetric service in the light of the new Order of the Ministry of Health of the Russian Federation of 2010.2020 No. 1130n, to establish aspects of the use of telemedicine in obstetrics, and to show the practical results of its implementation. Material and methods. A scientific and analytical, retrospective study of all cases of the use of telemedicine technologies in the obstetric service of the Perinatal Center of Noyabrsk (Yamalo-Nenets Autonomous Okrug) in 2020 was carried out. Results. The main aspects of the use of telemedicine in obstetrics in areas with a low population density have been established, namely: selection of pregnant women requiring a high level of attention, routing of high-risk pregnant women in health care facilities of levels II and III, extreme conditions of pregnant women and newborns, pregnancy complications and negative medical and genetic prognosis of offspring, high-tech remote medical care for pregnant women, women in labor and newborns in federal healthcare facilities of III B level. The capabilities of patient-centered telemedicine technologies in the context of the COVID-19 pandemic have been determined. The clinical experience of the Noyabrsk Perinatal Center has proved that telemedicine counseling for pregnant women located in areas remote from the PC, prescribed by Order No. 1130n, significantly improves the quality of the regional obstetric care system. Conclusion. The Order of the Ministry of Health of the Russian Federation No. 1130 n ensures the effective integration of telemedicine technologies into the obstetric service, laying the foundation for the formation of a regional regulatory framework for obstetric telemedicine. Thanks to the new Order, the planned development of telemedicine obstetric networks and the organization of remote consulting centers in level III A health facilities have become mandatory. The Order gave impetus to the formation of electronic databases of high-risk pregnant women in each region. It provides for remote provision of both routine and emergency obstetric care. All this allows the obstetric service of the regions with the use of telemedicine to provide high-quality medical care to pregnant women, women in labor and parturient women, even in extreme conditions of epidemics and emergencies.

Socio-psychological prerequisites and the age of the beginning of the use of narcotic substances by adolescents

The article is devoted to the analysis of social and psychological factors that can directly or indirectly act as prerequisites for the beginning of the use of psychoactive substances (surfactants) by adolescents. The results of the study of the first episode of anesthesia are presented, the characteristics of relationships in the family, educational institution and in society, before the start of drug use, are given. It is concluded that the earlier start of alcohol consumption is a risk of starting anesthesia in the future. The concept of “social idol” and its role in the emergence of addictive behavior of adolescents is described. Measures for the prevention of anesthesia are proposed. A clinical example is described.

The effect of melatonin on the activity of nucleolar organizer districts in women with ovarian endometriosis

Aim. To study the activity of ribosomal synthesis in women with ovarian endometriosis and its relationship with melatonin levels. Materials and methods. The study included 52 women with ovarian endometriosis. All patients were admitted to the gynecological department of the Clinic of the Southern State Medical University of the Russian Federation for surgical treatment. The paper uses the classification of ovarian endometriosis L. V. Adamyan (1998). During the study, 3 groups were formed: 1 group-stage 1 (n = 8), 2 group – stage 2 (n = 29), 3 group- stage 3 (n = 15).There were no patients with stage 4 ovarian endometriosis. Anamnesis was collected in all women, therapeutic and diagnostic laparoscopy, 6-SOMT was determined in the morning portion of urine, the activity of nucleolar organizer areas in the tissue of endometrioid foci of the ovaries was determined. Statistical data processing was performed using the IBM SPSS Statistics 19 software package. Results. In women with ovarian endometriosis, the lowest level of melatonin in the urine is observed at 1 and 3 stages. In patients with 1 stage ovarian endometriosis, its level was 41.14 ± 1.80 ng / ml; in group 2 – 71.16 ± 2.19 ng/ml, in group 3 – 54.01 ± 1.33 ng / ml (p = 0.048, p1-2 < 0.001, p2-3 = 0.046, p1-3 = 0.062). The main complaint in patients with stage 1 endometriosis was infertility – 8 (100%). The level of melatonin in the urine was significantly reduced in all groups of patients with ovarian endometriosis and infertility, independently of the stage. In patients with 1 stage ovarian endometriosis with low melatonin levels, proliferative diseases of the uterus (uterine fibroids, endometrial polyps, endometrial hyperplasia) are more common in the anamnesis. The number of intranuclear and extranuclear argentaffin inclusions, as well as their combination (INC + ENC) was significantly higher in stage 3 of ovarian endometriosis than in 1 and 2 stages. In endometriosis of the ovaries, a decrease in the level of melatonin in the urine correlates with an increase in the number of cells with a high degree of ribosomal synthesis activity. Conclusion. In women with endometriosis, the lowest values of melatonin were found at stage 1, especially in the presence of infertility, as well as in the common process. The activity of nucleolar organizers, which characterizes the intensity of ribosomal synthesis and the severity of proliferation, was significantly increased in the epithelial cells of ovarian endometriomas at stage 3, while an inverse relationship was revealed between the level of melatonin and the activity of nucleolar organizers.

Morphological changes in the ampula of the uterine tubes in different periods of life of giving women

The aim of the study is to determine the dynamics of morphological changes in the ampullae of the fallopian tubes at different age periods of life using autopsy material from women giving birth. Materials and research methods. The analysis of the results of a complex morphological study of the ampullae of the fallopian tubes of 150 corpses of giving birth women of adolescence, the first and second periods of adulthood, elderly and old age was carried out. Results. The histological picture revealed regular atrophic changes in all layers of the wall of the ampulla of the fallopian tube. When comparing the mean values in five age groups according to the Kruskell-Wallis test, statistically significant differences in the length of the epithelial lining in the transverse section of the ampulla of the right and left fallopian tubes (p < 0,001), as well as the wall thickness of the ampulla of the right and left fallopian tubes (p < 0,001) have been identified. Conclusion. The results of the study supplement the literature data on morphological changes in the fallopian tube and can be used as a standard reference.

Efficacy of hyperbaric oxygenation in the complex treatment of new coronavirus infection COVID-19

Purpose of the study: evaluation of the therapeutic effectiveness of hyperbaric oxygenation in the complex treatment of a new coronavirus infection – COVID-19. Materials and Methods: we studied 190 patients with COVID-19-induced pneumonia (mean age 52.2 ± 2.3 years), the study group (95 patients; 41 women, 54 men) received against the background of complex treatment courses of hyperbaric oxygenation № 3-5; at pressure 1.3-1.4 ATA for 40-60 minutes; comparison group (n = 95; 42 women; 53 men) received standard complex treatment. The concomitant diseases in most patients were: arterial hypertension (stage I-II), obesity (stage II-IV) and type 2 diabetes mellitus. Results: a more pronounced therapeutic effect was noted in the main group of patients: only 3 patients were admitted to the intensive care unit, while in the comparison group – 10 patients, 2 of whom died. The presented data suggest that the use of HBO can quickly achieve correction of hypoxia in patients with new coronavirus infection, improve lung function, as well as improve the course of related diseases, including symptoms related to gastrointestinal pathology, cardiovascular disease, mental conditions, etc., affecting the body as a biostimulant. Conclusion: hyperbaric oxygenation in patients with new coronavirus infection caused by SARS-CoV-2 virus is an effective method and has a multifactorial effect leading both to improvement of subjective state parameters of the examined patients and to increase of hemoglobin oxygen saturation, decrease of lipid peroxidation processes intensity, activation of antioxidant system of the body, restoration of pro- and antioxidants balance, normalization of apoptosis processes.

Indicators of hemostasis in non-alcoholic liver steatosis (experimental and clinical study)

Aim. Assessment of the morphological changes of the liver on the model of non-alcoholic steatosis in laboratory animals and hemostasis parameters in animals and patients with steatosis. Materials and methods. The experimental part of the study was conducted on 18 white rats divided into 2 groups: control (intact animals) and “Steatosis” (animals with liver steatosis modeled in laboratory conditions). The clinical part was performed on 52 patients with non-alcoholic fatty liver disease (the clinical form is non-alcoholic liver steatosis), with an average age of 43.0 ± 11.1 years and a body mass index of 37.2 ± 2.6. The control group consisted of 20 practically healthy individuals. At the end of the experiment, on the 30th day, the animals were removed from the experiment, direct blood sampling was performed from the right atrium, the liver mass and mass coefficient were determined, and a histological examination of the liver was performed. Laboratory tests included the determination of the following indicators of hemostasis in blood plasma: activity of the von Willebrand factor, platelet aggregation with ADP, collagen and ristocetin; prothrombin time, Quick prothrombin, international normalized ratio, thrombin time, activated partial thromboplastin time (APTT), fibrinogen and Hageman-dependent fibrinolysis. Results. In the experiment, the mass coefficient of the liver was significantly higher in the “Steatosis” group compared to the control group (3.75 (3.38-3.99) and 3.5 (3.3-3.6), respectively) (p = 0.009). Structural reorganization of the liver confirms the development of steatosis in animals. In animals with steatosis, a change in indicators reflecting the activity of the plasma link according to the external mechanism of coagulation was found: an elongation of the prothrombin time (p = 0.034), a decrease in the prothrombin index according to Quick (p = 0.018), an increase in INR (p = 0.027). APTT and thrombin time in animals with steatosis are higher than in the control, but these changes are not statistically significant (p = 0.181 and p = 0.364, respectively). The concentration of fibrinogen, Hageman-dependent fibrinolysis, platelet aggregation with ADP and the activity of the von Willebrand factor did not have statistically significant differences when comparing the two groups. In patients with steatosis, the number of platelets did not significantly differ from the control (p = 0.082). However, there was a decrease in aggregation with collagen (p = 0.002) and with ADP (p = 0.02). Platelet aggregation with ristocetin and the activity of the von Willebrand factor was higher than in the control (p = 0.001 and p = 0.01, respectively). In patients with steatosis, there was an extension of the APTT and an increase in the concentration of fibrinogen in comparison with the control, but these indicators did not go beyond the reference values of the set. The thrombin time was significantly prolonged in patients with steatosis in comparison with practically healthy individuals (p < 0.001). Conclusion. Non-alcoholic fatty liver disease is accompanied by a violation of the functioning of both vascular-platelet and coagulation hemostasis. There is a violation of the aggregation properties of platelets, signs of endothelial damage, hepatic coagulopathy.

Visual prognosis and sleep quality in patients with chronic kidney disease

Goal. To analyze the effect on the visual prognosis of panretinal laser coagulation, sleep quality, and the severity of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus. Materials and methods. 56 patients (112 eyes) with a history of panretinal laser coagulation were examined. The patients were divided into two groups: group 1 included 32 patients (64 eyes) with CKD of the 1st degree, group 2 included 24 patients (48 eyes) with CKD of the 3rd degree with the same ratio of women and men of 62.5% and 37.5%, respectively. Results. Comparative characteristics of clinical and laboratory parameters revealed significant differences in the groups by age (p = 0.000557), duration of the disease (p = 0.009507) and GFR (p = 0.000000). A significant increase in visual acuity with correction after panretinal laser coagulation (t = -5.31394; p = 0.000009) was observed only in patients of group 1. The correlation dependence of sleep quality on the stage of CKD was revealed (t = -2,647; p = 0,01). In patients of group 2, 100% of the lens pathology and a complication of diabetic retinopathy – diabetic macular edema-were detected. Conclusion. Further prospective study of the effectiveness of laser coagulation in patients with type 2 diabetes mellitus and its effect on sleep quality and visual prognosis in patients with varying degrees of severity of CKD is required.