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Renal tumors account for 2 to 3 % of all malignant tumors in adults. Of all patients with renal cell carcinoma, 30 to 40 % have advanced forms of the disease. In the literature, the term "giant renal tumor" is used for tumors larger than 20 cm. In this article, we report a case of surgical treatment for a giant malignant kidney tumor.Patient N., female, 54 years old, referred to an outpatient clinic with complaints of a change in the shape of the abdomen on the left with a palpable large tumor, abdominal pain, shortness of breath, weakness, constipation, episodes of blood in the urine and increased blood pressure. Body mass index 30.2 kg/m2. Ultrasound examination revealed a large tumor in the left retroperitoneal space. Laboratory testing of blood, urine was performed, findings were unremarkable. According to the data of magnetic resonance imaging, the left kidney was transformed into a large cystic solid formation, measuring 30.5 х 17.5 х 17.0 cm, heterogeneously accumulating a contrast agent with a solid component. Patient was admitted to the urology department for surgical treatment. We performed radical nephrectomy on the left with thoracolumbar laparotomy access on the left with resection of the 10th rib, resecting the renal tumor with the adrenal gland, total weight of the complex was 10.7 kg. The histological structure was determined as poorly differentiated renal carcinoma with invasion of the perinephric tissue. In the adrenal gland, fields of fresh erythrocytes with an admixture of tumor tissue were noted. Examined lymph node tissue was completely replaced by tumor cells. Postoperative period was characterized by episodes of dynamic intestinal obstruction. The patient was discharged from the department in a satisfactory condition on the 13th day after the operation, but died 1.5 months after discharge, the cause of death has not been established, as no autopsy was performed. Thus, the size of the tumor is not a contraindication to surgical treatment, which improves the survival rate of patients with malignant renal tumors.

The documents of the League of Nations archive concerning the history of a unique emigrant institution — the Russian Ambulatory in Berlin are introduced into scientific circulation in the article. It is reported that for at least 17 years (since 1920), the clinic had pro-vided free assistance to the poor. The annual reports and correspondence of the clinic make it possible not only to assess the scale of the activities of the philanthropists of Russian Berlin and their humanitarian significance, but also to analyze information about the social and demographic processes in the emigrant community in the 1920s—1930s. It is noted that from 1920 to 1934 the clinic received 171,955 patients (more than one and a half thousand people a year, of all ages and nationalities). Information is given that doctors treated a wide range of diseases: cardiovascular, nervous, venereal, respiratory and digestive system, urogenital system, eye and ear, the consequences of injuries and trauma. It has been established that the outpatient clinic distributed free medicines, food, and basic necessities since the early 1930s and provided lunches and places in the Salvation Army dormitory for the homeless. The statistics of the clinic are presented with data on the ethnic composition of Russian Berlin (the most representative of the known ones), the aging of emigration in Germany, and the low birth rate in the 1930s and the spread of poverty associated with the Great Depression.

We analyzed treatment outcomes in patients with pelvic organ prolapse (POP), some of whom had signs of undifferentiated connective tissue dysplasia (uCTD). Women from subgroup 1 used a pessary, while women from subgroup 2 underwent electromyostimulation in an outpatient department and performed Kegel exercises. After two treatment courses and pharmacotherapy, all patients demonstrated positive dynamics. Electrostimulation in combination with Kegel exercises was more effective than pessary; the effect was more pronounced in women without uCTD than in patients with uCTD. The results of our study were used for the development of a scale to assess POP severity, which enables a tailored approach to the diagnosis and management of such patients depending on the presence of uCTD.

Aim. To determine the presence or absence of specific IgG antibodies against SARS-CoV-2 antigens in outpatient clinic staff and to compare clinical and immunological features from April to August 2020.Materials and Methods. The control group comprised 386 employees of the Novosibirsk City Clinical Polyclinic №13.The determination of IgG antibodies against SARS-CoV-2 antigens in blood serum was performed by using the ELISA method. A real time method of reverse transcription and polymerase chain reaction was used to extract RNA SARS-CoV-2 from nasopharyngeal and oropharyngeal swabs.Results. Specific IgG antibodies against SARS-CoV-2 antigens were detected in 32 (8.42%) employees of the polyclinic. Antibodies were not detected in 91.58% of employees. 9 members (28.12%) had clinical symptoms of varying degrees of disease severity in the group of employees with the presence of antibodies, 4 members of this group (12,51%) had bilateral community-acquired pneumonia with signs of COVID infection, another 5 members (15.61%) with antibodies had signs of ARVI of mild and moderate severity. RNA SARS-CoV-2 in the group of employees with the presence of antibodies and clinical implications was not detected in any case; 23 (71.88%) members with the presence of IgG-antibodies did not have clinical implications of the disease.Conclusion. The presence of specific antibodies against SARS-CoV-2 in employees with clinical implications of COVID-19 without detection of the RNA virus in the biological material is a retrospective confirmation of the etiology of the transferred infection. The detection of specific antibodies in persons who did not have clinical implications can serve as confirmation of the asymptomatic course of the transferred coronavirus infection.

The aim of the study was to assess adherence to breast and cervical cancer screening ensuring compliance with ethical principles.Material and methods. A total of 1,015 women of target age groups, living in Almaty, the Republic of Kazakhstan, participated in breast and cervical cancer screenings. A structured questionnaire was used to collect data from each participant (1,239 questionnaires: 674 for breast cancer screening and 565 for cervical cancer screening). Two hundred and twenty-four women participated in two screenings. The survey was conducted immediately after the respondents had had a mammography and / or Pap test. The questionnaire included the socio-demographic characteristics of women, questions on awareness of screening, level of knowledge before and after screening, sources of information, feelings before screening, after screening and and also after the receipt of test results. Binary logistic regression was used for data analysis.Results. Sixty-one percent (95 % CI 57.7; 63.1) of women participated in screening for the first time, 39 % (95 % CI 36.4; 41.8) of respondents visited outpatient clinic for the second and the third time. Multivariable analysis revealed that the participation in screening was associated with the purpose of visit, awareness and confidentiality. Thus, women, who arrived at the outpatient clinic with purposes other than screening were 2.3 times less (OR=2 95 % CI 1.6; 3.1) likely to participate in next screening compared to those, who came to the clinic with the purpose of screening as well as those, who were referred by employers (OR=2 95 % CI 1.2; 3.2) or friend/family (OR=2 95 % CI 1.0; 4.3). Women, who had little information about screening as a whole and about screening test before it was taken, were 3 and 2 times less likely to come to screening again (OR=3 95 % CI 1.6; 5.9 and OR=2 95 % CI 0.8; 3.7, respectively). The confidentiality violation led to a decrease in chance (OR=3.5 95 % CI 2.2; 4.9) of being screened again for those women, who experienced nervousness and shame during the screening, and also indicated the presence of nonmedical people during the test.Conclusion. Measures aimed to ensure compliance to ethics in screening for breast and cervical cancer will improve the quality of screening programs in accordance with international standards, as well as increase the personal responsibility for active participation in screening.

Aim. To study the opinion of the population about satisfaction with the accessibility and quality of primary health care for diseases of the arteries of the lower extremities in institutions of the Sverdlovsk region, as well as to identify problems in the organization of its provision. Methods. From January to June 2019, an anonymous survey of 384 patients with diseases of the arteries of the lower extremities who applied for a consultative appointment with a cardiovascular surgeon at the clinic of the Sverdlovsk Regional Clinical Hospital No. 1 was carried out. A representative sample was determined by formulae, in which, out of the general population the number of registered cases of arterial disease of the lower limbs in the Sverdlovsk region, was acceptable. The survey involved 301 (78.4%) men and 83 (21.6%) women. Results. More than 90% of respondents were over 50 years old. More than 35% of respondents expected a referral for a consultation with a specialist later than 1 month away. The accessibility and timeliness of obtaining specialized medical care were influenced by the geographical remoteness from the regional center. The presence of queues in outpatient clinics at the place of residence, the difficulty in obtaining a coupon for an appointment with a doctor, the inaccessibility of free research, as well as the inconvenient work schedule of specialist doctors were the main reasons for not obtaining medical care. When examined in the clinic at the place of residence, more than half of the respondents used their own money. Just over a third of patients (35.2%) thought that the level of medical care has improved over the past decade, 19.5% thought that it had become worse, 16.4% that it had not changed, and 28.9% found it difficult to answer. About half of the respondents (48.8%) were satisfied with the result of the medical care provided, 11.2% were not satisfied, and 40% of the patients found it difficult to answer. Conclusion. The shortcomings identified in the organization of outpatient care in medical institutions of the Sverdlovsk region indicate the need to improve primary health care for patients with lower limb arterial disease. Such improvements will achieve the goals and objectives of the National Healthcare project through the development of telemedicine technologies and the development of organizational and functional patient routing models, standard operating procedures for examining more patients with cardiovascular pathology by primary care physicians, and their active introduction into public health practice.

Introduction . One of the most serious periods in the treatment and follow-up of adolescent patients with early debut epilepsy is the transition to a medical center for adults. It is important to carefully watch any possible replacement of antiepileptic drugs (AEDs), which may affect the further course of epilepsy. Aim : to study the algorithms and procedures for bringing patients with epilepsy from a pediatric to adult outpatient practice, and also to evaluate the efficacy of therapy with synonymously replaced AEDs during this period. Materials and methods . A retrospective study involved 218 patients who were transferred from pediatric care to an adult outpatient network. The inclusion criteria were the presence of epilepsy diagnosed in childhood (before age of 18 years), continuous treatment with AEDs, age 18 through 20 years. The exclusion criteria were: irregular observations, failure to comply with medical prescriptions. In case of unplanned pregnancy or failure to take AEDs, the patient was excluded from the ongoing study. History, neurological status, EEG, video EEG monitoring and neuroimaging data were examined. The efficacy of AEDs was graded as “complete remission” (in the absence of epileptic seizures), “incomplete remission” (if the number of seizures dropped by 50% or more), and “without effect” (if the seizures continued). Two groups of patients were analyzed: those receiving original AEDs and those receiving generic AEDs. Results . The study showed that during the transition to an adult outpatient network, the specialized medical care continued: the young patients were monitored by epileptologists; at the same time, we noted a significant increase in the rate of replacement of original AEDs with the respective generics (54 patients). Of these patients, 25 individuals (46.3%) had recurrent seizures. Discussion . Maintaining the continuity of specialized medical care depends on the availability of the city center of epilepsy for children. In addition, the network of outpatient clinics for adult patients with epilepsy and other paroxysmal conditions should be organized in each administrative district. The procedure of synonymous AED replacement is regulated by medical and legal documents; thus, the drugs are prescribed according to their INNs, and pharmacies dispense the medicines under the same INNs but with the trade names that are currently available in the stock. According to reports, the seizures are controlled significantly better under therapy with original AEDs compared to generics. Conclusion . The present study demonstrates the relevance of medical care continuity during transition of young patients with epilepsy from a pediatric to adult outpatient network. However, more extensive comparative studies on the efficacy and safety of synonymous replacement of antiepileptic drugs with the same INNs are needed. All authors contributed equally to this article.

We analyzed more than 30 original articles and reviews to evaluate the current state of the issues of epidemiology, treatment, and prevention of hemorrhagic fever with renal syndrome in the world. A literature search was conducted using the Cochrane Library, PubMed, eLIBRARY databases and official WHO, UR Rospotrebnadzor, Rospotrebnadzor of the Russian Federation, and Center for Disease Control and Prevention data. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease characterized by fever, hemodynamic disorders, hemorrhagic syndrome and kidney damage in the form of acute interstitial nephritis with the development of acute kidney injury. It is caused by RNA-containing viruses of the Hantaan genus, belongs to the group of zoonotic infections, and is transmitted through the air. The Udmurt Republic is one of the regions of the Volga Federal District endemic for HFRS. Annually, from 300 to 2,000 people get sick in the territory of the republic. HFRS affects the most able-bodied part of the population, mainly men aged 20-50. Mortality reaches 20% in certain years of observation. The doctor’s lack of caution regarding HFRS (the initial period of the disease has similar symptoms with acute respiratory diseases) leads to late hospitalization of the patient, often with serious complications that are fatal. The main diagnostic search is carried out by the general practice service of the outpatient clinic. The materials of the article can help to correctly establish a preliminary diagnosis, taking into account clinical and epidemiological data, as well as to prescribe the necessary amount of laboratory and instrumental tests to clarify the diagnosis.

Objective: to analyze whether comorbidity affects the cost of treatment and medical services in elderly patients with atrial fibrillation (AF). Materials and methods. We conducted a retrospective analysis of 98 patients with AF. Comorbidity was evaluated using the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson criterion. The “cost of illness” calculations included direct costs only. Results. In elderly patients with AF (mean age 74.7±8.8 years), high rate of comorbidity was typically found. Charlson comorbidity index amounted to 4.0±1.8, and the CIRS-G score – to 8.0±2.8. AF is often associated with heart diseases such as hypertension – 98.9%, coronary heart disease – 27.6%, and congestive heart failure – 76.5%. A patient with AF received on average 7.5±3.8 medications. Direct costs amounted to 18298.2±9440.4 RUB per patient with AF per year. Of this amount, 78.8% were spent for outpatient treatment, 16.5% for hospitalization and 4.7% for ambulance service. Cardiac medications comprised 66.4% of the total direct costs. In patients with high comorbidity, there are high costs of treatment of concomitant diseases, high secondary costs as well as costs for a doctor visit. Conclusion. An average elderly patient with AF receives 7.5±3.8 permanent medications, which correlates with the severity of comorbidity by the Charlson index (r=0.59; p=0.000) and the CIRS-G score (r=0.29; p=0.004). Management of such patients at the outpatient clinic is by large (66.4%) associated with direct costs of the prescribed medications. However, patients with high comorbidity still need more vital drugs, as the cost of treatment of concomitant diseases increases. Notably, these patients spend 4 times more funds for drugs without proven efficacy.

Objective.To describe the difficulties of diagnosis of Waldenström macroglobulinemia in a patient with atypical clinical picture.Materials and methods.Patient K., 57 years old, came in outpatient department with complaints of unilateral increase in submandibular lymph nodes on the right, discomfort in the nasopharynx, cough without sputum, increased fatigue. During the examination she was consulted by: an infectious disease specialist, otolaryngologist, surgeon, dentist, phthisiologist, hematologist and oncologist consulted her. To confirm the diagnosis conducted diagnostic activities: dynamic assessment of laboratory parameters, examination program cancer search (including multislice computed tomography and magnetic resonance imaging of various areas), with the exception of tuberculosis, monogenically study proteins in the blood and urine tests, biopsy of the ileum, immunohistochemistry trepanobiopsy.Results.During the 4‑year examination in the patient’s blood, an M-gradient in the gamma zone was detected, monoclonal immunoglobulin М-κ 19.3 g / l, Bens-Jones-κ protein in urine (daily proteinuria 0.45 g) was detected during immunofixation. In the myelogram at the light-optical level, the number of cell elements was significantly reduced with a pronounced lymphoid proliferation of 40 %, the granulocytic series and erythropoiesis were relatively narrowed, and plasma cells 6 %. Immunomorphological picture trepanobiopsy our patient based on the data of laboratory methods of research corresponds to the defeat of the bone marrow in Waldenström’s disease-κ, secretion of M-paraprotein. An important feature that allowed to go on the right path of diagnosis was almost pathognomonic for tumor lymphoproliferation, detection of Bens-Jones protein in the urine, which was absent in the onset of the disease.Conclusion.This clinical case is interesting not only by the complexity of the diagnosis of macroglobulinemia of Waldenström in General, but also by the atypical, erased clinical disease in our patient.

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue wounds using modern interactive dressings and conventional wound care dressings. Material and methods. The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September 2018 to January 2019 after an autopsy, necrosectomy and drainage of purulent foci in the surgical hospital. Group I (n = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind® N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing for topical treatment of wounds in the postoperative period. Patients of Group II (n = 78) applied ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing. Patients in both groups received the same broad spectrum antibacterial therapy. In Group I, the dressings were applied once per 2 days, in Group II the dressings were applied on a daily basis. The researchers studied the following indicators: the nature of the wound discharge; the presence of edema and hyperemia of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions of the body; crops on microflora and sensitivity to antibiotic therapy. Results. The study showed more pronounced dynamics of the temperature reaction normalization, reduction of the local inflammatory reaction and the leukocytosis level in patients of Group I. The wound cleansing from pus and fibrin, the development of granulation tissue on Day 5 were reported in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively. Conclusion. The use of Sorbalgon® and Branolind® N dressings improves the results of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.

Aim. To reveal the features of multimorbidity in elderly and senile people with hypertension (HTN).Material and methods. A total of 70 elderly and senile hypertensive patients were examined at one of the Arkhangelsk outpatient clinics (from 60 to 90 years old; mean age — 69,14±1,34 years), including those aged 60-74 years (n=56; (80,0%) and 75 years and older (n=14; 20,0%). We assessed the questionnaire survey data, the outpatient medical records, the clinical status, and the cumulative illness rating scale for geriatrics (CIRS-G).Results. The analysis showed a high prevalence of multimorbidity in elderly and senile people with HTN, which was found in all patients. On average, an elderly patient with HTN has 6 diseases that are pathogenetically interrelated and unrelated, while a senile patient has 8 diseases. The most common comorbidities were gastrointestinal (81,43%), musculoskeletal (77,14%) and endocrine (77,14%) diseases. Among the cardiovascular comorbidities in the elderly with HTN, the following were more common: heart failure (54,29%), coronary artery disease (angina pectoris — 41,43%) and cerebrovascular diseases (28,57%) (stroke/transient ischemic attack, vascular encephalopathy). Patients with HTN took an average of 6 different drugs at the same time. There was moderate comorbidity level in the elderly patients and a high one in those of senile age.Conclusion. In elderly and senile patients with HTN, there is a high prevalence of multimorbidity, which must be taken into account when preventing polypharmacy.

Проанализированы результаты лечения 300 пациентов с грыжами передней брюшной стенки на основе определения качества жизни с помощью специализированных опросников. Проведено сравнение эффективности применения различных методик пластики передней брюшной стенки (открытые методики и с использованием эндовидеоскопической техники). Лучшие показатели качества жизни (КЖ) отмечены после применения лапароскопических технологий. Пациенты этой группы отмечали хорошее течение послеоперационного периода, что позволило им быстро вернуться к выполнению повседневных обязанностей: восстановление работоспособности заняло в среднем 10,2±0,5 (от 7 до 14) суток, в то время как после традиционных вмешательств – в среднем 18,5±1,5 (от 12 до 24) суток (p < 0,05). Концепция исследования КЖ является методом, позволяющим изучать разнообразные субъективные переживания пациента, вызванные болезнью, и становится важным компонентом в оценке эффективности новых методов лечения. Она позволяет осуществлять экспертизу новых методов лечения, опираясь на международные критерии, разрабатывать прогностические модели для многих заболеваний, проводить медико-социальные популяционные исследования с выделением групп риска в отношении различных видов патологии, обеспечить динамическое наблюдение за группами риска и оценить эффективность превентивных программ, изучать и проводить экономическое обоснование методов лечения с учетом фармакоэкономических показателей: стоимость-полезность, стоимость-эффективность., The Authors analyzed the treatment results of 300 patients with abdominal wall hernias on the basis of determining the quality of life using specialized questionnaires. The comparison of the effectiveness of different methods of the anterior abdominal wall plastic surgery (open techniques and endovideoscopic techniques) had been made. The best indicators of quality of life were observed in patients after using the laparoscopic technologies. The patients in this group reported good postoperative period, which allowed them to quickly return to the performance of daily tasks: the restoration of health has taken an average of 10,2 ± 0,5 (7 to 14) days, while after traditional interventions – an average of 18,5 ± 1,5 (12 to 24) days (p < 0,05). The concept of quality of life research is a fundamentally new method that allows to study a variety of subjective experiences of the patient caused by the disease, and becomes an important component in assessing the effectiveness of new treatments. It allows to carry out the examination of new methods of treatment, based on international criteria, to develop prognostic models for many diseases, to carry out socio-medical population studies with the allocation of risk groups for different types of pathology, to provide dynamic monitoring of risk groups and to assess the effectiveness of preventive programs, to study and conduct economic justification of treatment methods taking into account pharmacoeconomical indicators: cost-utility, cost-effectiveness., Вестник Национального медико-хирургического Центра им. Н.И. Пирогова, Выпуск 1 2021, Pages 72-76

Epidemiological studies conducted throughout the world show that the inflammatory diseases of the nasal cavity and paranasal sinuses are the leading cause of otorhinolaryngology (ENT) hospital admissions and outpatient clinic referral. Although the most common cause of acute rhinosinusitis is viral infection, antibiotics are prescribed in more than 80% of cases, which may lead to the development of antimicrobial resistance. The topical inhalation therapy with PARI SINUS device (сompressor Pari Sinus and Pari LC Sinus nebuliser) may provide better treatment options for patients who suffer from the diseases of the nasal cavity and paranasal sinuses. Purpose of the study is to evaluate the efficacy of topical inhalation treatment of acute bacterial rhinosinusitis using pulsating aerosol in comparison with systemic antibiotic therapy. Materials and methods. 60 adult patients at the age from 19 to 62 years with the diagnosis uncomplicated moderate acute bacterial rhinosinusitis has been included in opened randomized controlled trial. 30 patients have been treated with nasal nebulizer inhalation with N-acetyl-cysteine in combination with thiamphenicol on 500 mg once daily for 7 days using pulsating aerosol. Pulsating aerosol was obtained by PARI SINUS device. Controls - 30 patients have been treated with antibiotic therapy of acute bacterial rhinosinusitis using 875/125 mg oral amoxicillin/clavulanate twice daily for 7 days. The result was evaluated by the dynamics of the symptoms of acute bacterial rhinosinusitis (nasal congestion, blockage, facial pain and reduction of smell), active anterior rhinomanometry and nasal endoscopy. Results. For main symptoms of acute bacterial rhinosinusitis was no significant benefit of antibiotic therapy as compared to topical inhalation therapy using pulsating aerosol. Both treatment options were effective against acute bacterial rhinosinusitis, which is confirmed by the improvement of symptoms, active anterior rhinomanometry and nasal endoscopy. Conclusion. The topical nebulizer therapy of acute bacterial rhinosinusitis may provide better treatment options, because systemic antibiotics can be associated with different adverse effects.

Acute respiratory viral infections remain the most common group of diseases causing significant social and economic damage to society. Objective: to study the epidemiological characteristics of respiratory disease influenza and other etiology in the modern period in the Republic of Karelia – one of the most disadvantaged of this group of diseases regions of the country. Materials and methods: On the basis of statistical data and publications is analysed and compared with the performance of the country a long-term dynamics and of etiological structure of acute respiratory viral infections over the years 1980–2016, seasonality of morbidity in separate age and social groups of the population in the years 2013–2016, etiological structure allocated from sore viruses. On the basis of outpatient clinic investigated the clinical characteristics of acute respiratory viral infections in adult outpatients during the period of seasonal rise of morbidity. Results: it was found a marked reduction in the incidence of flu, partly due to clinical underdiagnosis of the infection, its rejuvenation, the prevalence of mild forms of influenza in adults; the increase in the incidence of infections influenza is not the etiology, mainly due to rhinovirus infection, forming a pronounced autumn rises, the lack of differences between the incidence of viral respiratory infections «organized» and «disorganized» children. Conclusions: in the modern period the epidemic process of acute respiratory viral infections has gained some new features, important from the point of view of the organization of preventive and curative interventions.

Pain is one of the most common symptoms in modern clinical practice and one of the most common reasons why patients seek medical care at an outpatient clinic. Traditionally, nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading means of protecting peripheral pain receptors. However, with the intake of NSAIDs, a whole range of different complications is associated. Comorbidity and drug safety are closely related to the use of NSAIDs. In the presented review, domestic and foreign studies of dexketoprofen for the treatment of pain syndrome in the outpatient and polyclinic stage were analyzed. The emergence of the domestic brand-generic dexketoprofen, the drug Flamadex®, in the Russian pharmaceutical market increases the availability of effective and safe therapy of pain syndrome in patients with comorbid pathology at the outpatient and polyclinic stage.

In article we demonstrated the results of the complex assessment of the health status of children during the first year of life with congenital heart defects (CHD). We established a connection between the problems of obstetric history (miscarriage, abortion) and an increased risk of developing severe heart defects. In the group of children with CHD who required surgery for 1 year of life and who have mothers with obstetric history problems, the severity of the CHD in 55% [95% Cl 44,7÷65,0] of children was related to the impact of obstetric history problems on their mothers. We found out that the majority of children with CHD had low body weight by the end of 1 year of life. In the group of operated children, we found a significant increase in the proportion of children with a sharply disharmonious physical development due to a deficit in body weight. We identified that children with CHD requiring surgery for 1 year of life have a high risk of respiratory infections (ОR = 4,67 95% Cl [1,19 ÷ 18,35]). In addition, we found a positive relationship between the respiratory incidence and the degree of heart failure in children with CHD (r = 0,492, p

Purpose. Assessment of the received emergency medical services (EMS) in patients with cardiological profile in the South Kazakhstan region.Materials and methods. A sociological study was carried out among three compared groups: group 1 — patients of the regional cardiological center (312); 2nd — those who applied to rural outpatient clinics, polyclinics, hospitals (244), and the 3rd — who applied to the central district hospital (228).Results. The analysis showed that 65.1% of the respondents applied for EMS over the diseases of the circulatory system, mostly they did it 1–2 times a year (44.9%), less often several times a month (15.1%). Several times a week 5.1% of patients were called to EMS. It was found that in 65.5% of cases there was a rapid arrival of the EMS, less than 20 minutes. It should be noted that a long wait for the arrival of the EMS (45 minutes or more) took place in 10.2% of cases. The waiting time, as the reason for the dissatisfaction of the EMS, was more often called the respondents of the 2 nd and 3 rd groups — 94.1% and 93.9% versus 76.5% in the 1st group (p < 0.05). Inattentive attitude of the staff was more often noted by the patients of the 3rd group, and the low availability of free medication was most often indicated in the 1st group.Conclusion. The received characteristic of the EMS and its assessment by patients with diseases of the circulatory system should be taken into account when developing a package of measures to optimize cardiac care in the region.

The article describes the problems associated with the organization of medical aid to the population in the outpatient setting, particularly in the work of the district services. The causes that produced them, as well as measures to optimize the structure and operation of outpatient clinics. Special attention is paid to the personnel policy and streamline the work of local doctors, which should attract and retain specialists in this service, increase their efficiency, accessibility and quality of medical care.

В статье рассмотрен процесс проектирования подсистемы Ведение электронных амбулаторных карт пациентов для Подгоренской центральной районной больницы, с применением программного продукта IBM Rational Rose Enterprise Edition. Программный продукт Rational Rose Enterprise Edition популярное средство визуального моделирования объектноориентированных информационных систем компании Rational Software Corp. Работа продукта основана на универсальном языке моделирования UML (Universal Modeling Language). Язык UML является языком специфицирования и визуализации, основными единицами его являются диаграммы. Диаграмма в UML это графическое представление набора элементов, изображаемое чаще всего в виде связанного графа с вершинами (сущностями) и ребрами (отношениями). Для проектирования подсистемы МИС были построены: диаграмма прецедентов, на которой показана совокупность прецедентов и актеров, а также отношения между ними диаграмма классов, описывающая структуру системы, демонстрирующая классы системы, их атрибуты, методы и зависимости между классами диаграмма деятельности, на которой показано разложение некоторой деятельности на её составные части и диаграмма компонентов, показывающая разбиение программной системы на структурные компоненты и связи (зависимости) между компонентами. Последовательное создание вышеперечисленных диаграмм позволит получить более полное представление как о проектируемой системе в целом, так и о процессах, протекающих между объектами системы, The article describes the design process of a subsystem Management of electronic patient cards of patients for Podgorenskiy rayon Central hospital, with the use of the software product IBM Rational Rose Enterprise Edition. Rational Rose Enterprise Edition software is a popular tool for visual modeling of objectoriented information systems of Rational Software Corp. The work of the product is based on the universal modeling Language UML (Universal Modeling Language). The UML language is a language of specification and visualization, the main units of it are the diagrams. A chart in UML is a graphical representation of a set of elements, most often depicted as a linked graph with vertices (entities) and edges (relationships). For the design of the MIS subsystem were built: case diagram, which shows the set of precedents and actors, as well as the relationship between them class diagram describing the structure of the system, showing the classes of the system, their attributes, methods and relationships between classes activity diagram showing the decomposition of some activity into its constituent parts and a component diagram showing the breakdown of the software system into structural components and links (dependencies) between the components. Sequential creation of the above diagrams will provide a more complete representation of both the projected system as a whole, and the processes occurring between the objects of the system, №3 (2019)

Previously we elaborated software for analysis of diabetic foot outpatient clinic (DFOC) performance parameters. In this study we tested this software in 4 DFOCs in several cities. As a result, we obtained main parameters of treatment efficacy which can be base for elaboration of benchmarks for quality management in this field. This software can be helpful for administrators of the healthcare system in planning of measures for treatment results improvement and in assessment of these efforts efficacy.

Diabetic foot ulcer (DFU) is not only type of ulcers which can affect lower extremities of patients with diabetes mellitus (DM). The second common type is leg ulcer (LU). These ulcers may appear not only as classic ones – a result of venous diseases, but also result of some degree of leg ischemia in combination with several additional factors. Some diabetic foot outpatient clinics (DFOC) have experience with treatment of such ulcers. Aim of our study was to analyze main characteristics of patients with diabetes and LU treated in DFOC, results of their treatment and possible reasons for treatment of this group in the DFOCs. Object and methods All patients with diabetes and LU of any etiology (venous, posttraumatic, mixed) treated in our DFOC from July 2007 to June 2012 were included in our study (n = 101, main group). All patients with DFU treated in the same DFOC in this time frame (n = 721) formed the control group. Follow-up data was observed from medical records or by phone calls. Follow-up time was between 6 mo and 2.5 yrs. Results Most of patients with LU were females (71%) and had type 2 DM. More frequent wound infection, higher median wound surface, lower depth and very rare involvement of deep tissues (phlegmone and osteomyelitis) were characteristic for LU group. There were not significant difference (p > 0.05) between groups in terms of diabetes duration, type 2 DM treatment methods, rate of DM complications and concomitant diseases and HbA1c level. At follow-up contact time ulcers healed in 64% in LU group and 65% of DFU group (р > 0.05). More LUs stayed unhealed at this time than DFUs (13% vs 5%, р = 0.013). Minor amputations were made in 0% in LU group and in 5% in DFU group (p = 0.039), but major amputations rate was not significantly different between groups (4% vs 6%, p > 0.05). Mortality was not also significantly different between groups (p > 0.05). Conclusions Leg ulcer population of the DFOC is mainly female and has type 2 DM; LUs healed during follow-up in 64% patients but stayed unhealed in 13% and leaded to major amputation in 4%; Amputation prevention programs in patients with diabetes should take into account that at least 10% of major amputations in these patients are a result of LU; Epidemiological studies are necessary to assess prevalence of LU and LU-related amputations in whole diabetic population; Treatment of LU in patients with diabetes should be as careful as of DFU and DFOC is optimal setting for it.

The aim of the investigation was development of science-based recommendations for increasing efficiency of operative treatment of adult patients with shin fractures in multiprofile city hospital. Investigation was made in Saint-Petersburg Alexandrovskiy City Hospital. Clinical material was presented by official hospital reports, individual medical documentation and results of direct survey of patients treated in this hospital in period 1999-2010 years. All patients had follow up treatment in outpatient department of this hospital. Information was completed following federal and local laws. Recommendations for standardization of modern specialized medical care of patients with shin fractures, based on methods of internal fixation, were performed. We took into consideration possibilities of conventional and minimally invasive fixation of closed and open fractures including politrauma injuries. Models of patients with shin fractures depending on method of internal fixation and list of basic diagnostic procedures and treatment were formed. Operations classifier of internal shin fractures fixation was developed. This classifier includes calculation of hospital costs in process of specialized medical care considering actual correction coefficients. Calculation of each surgical procedure component was performed. List and composition of instrument sets and expense materials for such operations were formed. Analisis of organizational, medico-technological, economica aspect and expert evaluation of clinical results of different methods of long bones fractures fixation have provided conceptual approach to treatment standardization. On this base we have developed medico-economical standards of long bones fractures treatment in city multiprofile hospital.