Vol 34, No 5 (2017)

Aim. To study the parameters of cardiovascular system under physical activity among women with idiopathic arterial hypertension. Materials and methods. The systemic hemodynamics, echographic and sonographic parameters of extracranial, peripheral arteries and veins under physical activity (by J. Ruffier) was analyzed among 73 women diagnosed idiopathic arterial hypertension with SAP 96 (91-98) mm Hg and 37 women having normal arterial pressure with SAP 124 (121-126) mm Hg. Women’s age ranged 18 to 25 years. Results. The results demonstrated that physical activity in case of hypertension causes a reliable increase in SAP, DAP and changes in vascular blood flow (blood velocity and vascular diameter) in a greater number of arteries and veins than in women with normal arterial pressure. Cardial hemodynamics under loading in both groups was identical. Conclusions. The changed response of cardiovascular system in young women with hypertension can be considered as a pathogenetic mechanism of adaptation, so as to preserve an adequate blood flow in the organs and systems.

Aim. To estimate the dynamics of asthenic and anxious-depressive disorders in the early rehabilitation period of ischemic stroke against the background of taking a drug, containing antibodies to brain-specific protein S-100 and endothelial NO-synthase. Materials and methods. Sixty five patients (45 men and 20 women) with a mean age of 63.5 ± 5.3 years were examined in the early rehabilitation period of ischemic stroke. Neuropsychological examination inclu-ded the following tests: subjective multidimentional fatigue inventory (MFI-20), hospital anxiety and depression scale (HADS), National Institute of Health Stroke Scale (NIHSS). Results. After a course of taking a drug, containing antibodies to brain-specific protein S-100 and endothelial NO-synthase, manifestation of asthenia reduced in the main group by 35.48 %, p < 0.05, in the group of compari-son - by 9.57 %; anxious-depressive symptomatology decreased by 26.91 %, p < 0.05 and 5.16 %, respectively. Conclusions. Against the background of taking a brain-specific protein S-100 and endothelial NO-synthase antibodies-containing drug in the dose of 0.036 g, patients of the main group demonstrated faster regression of asthenic, anxious-depressive symptomatology and reduction of neurological deficiency manifestation.

Aim. To study the influence of adamantilbromphenylamine on the degree of postinfectious somatogenic asthenia in tick-borne encephalitis reconvalescents. Materials and methods. Clinical examination of 64 tick-borne encephalitis reconvalescents with postinfectious somatogenic asthenia was performed. Group I - 34 persons received adamantilbromphenylamine in the dose of 100 mg during 25 days. Group II - 30 persons under observation without drug therapy. Before and after treatment all reconvalescents were examined using the following methods: visual analogous asthenia scale, hospital anxiety and depression scale in general somatic practice, questionnaire for revealing vegetative changes, questionnaire for score subjective sleep disturbance estimation. Results. After adamantilbromphenylamine therapy, a reliable fall in scores by visual analogous scale was detected: in group I this index decreased by 2.5 times, in group II - only 1,4 times. Against the background of drug intake there was observed a significant decrease in indices of emotional-personal disorders, reduction in manifestation of vegetative disorders, normalization of sleep indices. Conclusions. Adamantilbromphenylamine can be recommended to patients in rehabilitation period after tick-borne encephalitis with residual effects in the form of postinfectious somatogenic asthenia.

Aim. To study the clinical peculiar features of sleep and its structure by the data of night polysomnographic study and peculiarities of development of higher cortical functions (HCF) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS). Materials and methods. Clinical, neuropsychological and polysomnographic examination of 25 preschool-age children with OSAHS was carried out. The group of сomparison included 10 healthy children. Clinical study of sleep was assessed, using specially developed by the author sleep questionnaire; HCF status was estimated by means of neuropsychological study, adapted for child age (E.G. Simernitskaya). Results. Some peculiar features of organizing sleep in children with obstructive night apnea were detected. There was demonstrated a reduced duration of drowsiness, decreased duration of fast sleep phase, reduced number of sleep cycles and vegetative disorders in the form more frequent episodes of tachycardia, confirming sympathicotonia during night sleep. Kinesthetic dyspraxia was registered in 76 % of observations among apnea children. Differences in anxiety level were registered in extreme values of anxiety index (AI); AI > 50 %, considered as high, was revealed in 72 % of patients with OSAHS. High productivity and stability of attention ( S = 1.00-1.25) was noted in 35 % of control children, in OSAHS group this index was 4 %. Conclusions. Reduced duration of fast sleep phase in children with apnea is a matter of principle. Not only snore is a marker of OSAHS, apnea can occur without marked concomitant snoring. The role of connective tissue dysplasia in OSAHS formation is to be discussed. Muscular hypotonia formed can increase constriction of the upper airways, especially within the fast sleep phase and provoke apnea/hypopnea episodes.

Aim. To estimate the influence of prenatal introduction of polyvitamin complexes to experimental animals on the development of allergic reactions in their posterity. Materials and methods. Sexually mature female rats were placed with males 1:3 and during all the period of pregnancy they received vitamin complexes in the therapeutic dose (1TD) ( n = 8) and a five-fold greater dose (5TD) ( n = 8). The control female rats received treated water. By the age of 1 month, the posterity underwent blood sampling and allergic tests. For this purpose, the group of posterity from females, receiving therapeutic dose of vitamins was divided into 2 groups: the group, sensitized with vitamins during 7 days and the group without vitamins. Similarly was divided the posterity from females, receiving a five-fold dose of vitamins, and the posterity from control animals. Manifestation of allergic reactions was assessed in hypersensibility test of delayed type using a full Freund’s adjuvant and mast cell degranulation test. Besides, leukogram in peripheral blood smears was calculated and mass coefficients of immunocompetent organs after euthanasia of a part of animals from all the groups were estimated. Results. In the posterity from female rats, receiving a five-fold dose of vitamins during pregnancy, strengthening of a delayed type allergic reaction by 1.7-3 times compared to the control groups was stated. At the same time, peroral sensibilization of this posterity with vitamins during 7 days reduced the manifestation of this reaction, though, statistically significantly exceeding the indices of control groups and animal groups from females, taking during pregnancy therapeutic doses of vitamins, with practically comparable manifestations of delayed type hypersensibility reactions. In the reaction of immediate type, a statistically significant 2-2.5 times excess of mast cell degranulation index in all experimental groups compared to the control groups was established. At the same time, mast cell degranulation indices in the animal groups, perorally sensibilized during 7 days,was reliably higher (by 1.4 times) than in the groups of posterity without vitamin intake. In both groups of nonsensibilized posterity decrease in mass coefficient of the spleen was noted. No influence on the posterity peripheral blood leukogram in all experimental groups was detected. Conclusions. Prenatal introduction of vitamin complexes to female rats alters manifestations of allergic reactions of both immediate and delayed type in the posterity; introduction of vitamins to the posterity from the above mentioned female rats during 7 days also ambiguously influences the course of allergic reactions.

Aim. To analyze the modern system of public health in the Russian Federation and Perm Krai, to determine the problems of this system and ways of their solution. Materials and methods. The results of literature analysis on the problems, revealed in public health system, history of medicine, normative legal documents, regulating medical activity, programs, determining development of health care service at the modern stage are presented in the paper. Results. Health care service remains an object of experiments in the country and Perm Krai. Reforms of public health system are directed to solution of three basic problems: overcoming of problems inherited from the USSR, optimization of legislative base of health care service, growth of professional level and quality of training of medical and pharmaceutical staff, as the main resource of public health service. Conclusions. Public health system is now at the stage of its formation and there is still no universal way for its development. Health care reforms are not supported by material and normative-legal basis. A negative balance in dynamics of the quantity of medical workers is being preserved.

Aim. To analyze the organization of dispensary observation on the basis of detected tendencies and structure of noninfectious diseases sickness rate over the period from 2012 to 2016. Materials and methods. A comparative analysis of chronic diseases sickness rate among dispensary patients and registered adult population was conducted; statistical processing of data was performed using Microsoft Excel 2010 “Analysis package”. To predict the changes in indices, a polynominal trend line for the future 5 years with approximation reliability value ( R 2) not less than 0.85 was developed. Reliability of difference between relative indices was proved by Student’s test ( p < 0.05). Results. It was established that general sickness rate for all diseases and separate classes indicated prognostic growth up to 2012, even with negative tendencies for indices in 2012-2016. General sickness rate structure in the dispensary group somewhat changed during the studied period: positions 1 and 2 are held by circulatory and endocrine system diseases, position 3 (by the year 2016) - by eye and supplementary organs diseases, moving aside digestive diseases, respiratory diseases, urinary diseases. General noninfectious chronic diseases sickness rate, as a whole, and by most separate classes of diseases is higher among the registered population. Annual fluctuations of sickness rate by the analogous classes of diseases in the dispensary group and in the registered population are not identical. Conclusions. In conditions of the existing order of dispensary observation, it is necessary to study thoroughly its organization, so as to explain the above phenomenon.

The article presents an analysis of regulatory documents governing the training and continuous professional development of plastic surgeons. We revealed the lack of integrity of the educational programs of the specialty and residency, the failure of the Federal state educational standards to ensuring high and uniform quality of training in residency, the lack of occupational standard for a specialist in plastic surgery