Saratov JOURNAL of Medical and Scientific Research

Voronezh State Medical University n.a. N.N. Burdenko

Internal quality control of medical care in scientific publications and regulatory legal acts of the Russian Federation (review)

Year: 2019, volume 15 Issue: №4 Pages: 925-930
Heading: public health Article type: Review
Authors: Chubirko M.I., Chubirko Yu.M., Antonenkov Yu.E.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

The review is devoted to the current state of the problem of activity, which is assigned to each medical organization without taking into account the forms of ownership: the organization of internal quality control and safety of medical activity in medical organizations in Russia. The authors analyzed scientific publications, regulatory legal acts and laws on internal quality control and safety of medical activities at present and made recommendations on the issue under consideration.

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Clinical experience of express repair of ceramics in the oral cavity

Year: 2019, volume 15 Issue: №3 Pages: 623-626
Heading: Stomatology Article type: Case report
Authors: Shumilovich B.R., Vorobyeva Yu.B., Rostovtsev V.V., Kryukova S.N., Malykhin D.V., Akhtanin A.A.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Ceramic cleavage on fixed orthopedic structures is a very common complication of occlusive trauma. Attempts intraoral repair of such defects have been undertaken since the 90s of the last century. The existing technique, including the treatment of the prosthesis with hydrofluoric acid and the subsequent application of silanes, quite successfully coped with the task at the boundary of the chip within the ceramics. When chipping to metal, this technique does not provide adhesion of the composite to the metal. The situation has changed dramatically with the appearance unsilane primers containing MDP monomer and providing reliable chemical adhesion of the metal to the composite. As follows from the presented clinical case, even after 1 year after the repair of the ceramic prosthesis, the anatomical, functional and aesthetic characteristics of the dentition are fully preserved.

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Investigation of abnormalities in buccal epithelial cells in patients with lichen planus of the oral mucosa and lips

Year: 2019, volume 15 Issue: №3 Pages: 611-616
Heading: Stomatology Article type: Original article
Authors: Serikova O.V., Kalaev V.N., Vasilyeva A.Yu., Kalaeva E.A., Filippova Z.A.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Objective: to study the incidence of buccal epithelial cells with nuclear abnormalities in women aged 50- 60 years, suffering from lichen planus; identification of the spectrum of nuclear aberrations and analysis of diagnostic information content of the studied indicators in assessing the risk of complications. Material and Methods. The incidence of nuclear aberrations in buccal epithelial cells was studied in 20 women aged 50 to 60, patients with lichen planus. 10 women of the same age group without the disease were selected for the control group. The use of ROC-analysis allowed to determine the most informative cytogenetic criteria, allowing to establish the diagnosis of «lichen planus», calculating their critical values, sensitivity and specificity for their use as diagnostic tests. Results. A change in the number of cells with micronuclei and signs of destruction of the nucleus, and cells with nuclear aberrations in patients in the area of disease was revealed. Indicators of nuclear destruction in cells outside the affected area in the group of patients differed from those in the control sample. Conclusion. The increase in the number of cells with micronuclei in the area of lesion with lichen planus is a sign of genetic instability, which can start the process of their malignancy. Recognition of nuclear aberrations against the background of nuclear destruction makes it possible to diagnose lichen planus. Determination of the frequencies revealed perinuclear vacuoles and karyopyknosis in the affected cells of the oral mucosa and lips may serve as a confirmation of diagnosis.

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Balloon pulmonary angioplasty — an efective method of treatment for patients with pulmonary arterial hypertension

Year: 2019, volume 15 Issue: №2 Pages: 222-224
Heading: Cardiology Article type: Case report
Authors: Starodubtseva I.A.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

The article presents the clinical case of patient with chronic thromboembolic pulmonary hypertension. It is describes the classical course of the disease with use of full spectrum of diagnostic procedures. Pulmonary endarterectomy (PEA) is a gold standard of treatment. Nevertheless, performance of PEA is possible in only 60 % of patients with chronic thromboembolic pulmonary hypertension. Balloon pulmonary angioplasty and drug therapy with a stimulator of soluble guanylate cyclase are alternative treatment strategy.

The impact of the competence-based approach to training on the results of intermediate certification of students at the Department of General Hygiene of Voronezh State Medical University

Year: 2019, volume 15 Issue: №1 Pages: 114-119
Heading: Pedagogics and Education Article type: Original article
Authors: Popov V.I., Fertikova Т.Е.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Purpose: analysis of the level of competence formation on the basis of the results of intermediate certification of students at the Department of General Hygiene of Voronezh Medical University. Material and Methods. The article describes the dynamics of the results of intermediate certification of students enrolled in the Department of General Hygiene of Voronezh Medical University, in connection with the implementation of the competence approach. Results. A conclusion about stable results of examinations of students of all faculties for the last years is made. The highest proportion of excellent and good grades was noted among students of the medical faculty. The share of excellent marks received by students of the medical faculty was 17.4-20.7%, by students of the pediatric and medical preventive faculties — 9.6-17.8 and 1.9-17.1%, respectively. The proportion of satisfactory marks among students of the medical faculty — 31.2-37.2%. Most of all the proportion of satisfactory assessments among students of the medical preventive faculty — 51.2-69.7%. The directions of activity of the teaching staff of the department have been proposed, they will allow to increase the level of development of competencies, especially professional ones. These include the widespread use of innovative educational technologies, such as problem- oriented and design-organized learning technologies. Examples of new approaches to teaching in a

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The use of original device for positioning tools during the installation of femoral component of hip joint

Year: 2019, volume 15 Issue: №1 Pages: 57-61
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Varfolomeev D.l., Samoday V.G.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Objective: to assess the accuracy of the femoral neck resection using the developed "Device for positioning tools for the installation of the femoral component of the hip prosthesis". Material and Methods. On the basis of the Department of traumatology and orthopedics of Voronezh state medical University n.a. N.N. Burdenko conducted experimental studies on 40 models of plastic bones. In the comparison group resection was performed using the proposed device, in the control group — using a standard guide. Results. Experimental studies have demonstrated higher accuracy of femoral neck osteotomy in the comparison group. The average value of the neck filing angle in the frontal plane in the comparison group was 3.2° higher than in the control group (p<0.05), and in the sagittal difference was 3.1°. The average distance from the line of the osteotomy to the apex of the greater trochanter in both groups was not significantly different (p=0.62). Conclusion. The use of the developed device allows to perform osteotomy of the femoral neck with high accuracy, as well as to control the position of the leg endoprosthesis, which helps to reduce the number of complications and improve the quality of life of patients.

On the clinical picture and diagnosis of rare neurological diseases

Year: 2018, volume 14 Issue: №1 Pages: 174-177
Heading: Neurology Article type: Case report
Authors: Ulyanova O.V., Kutashov V.A., Brezhneva N.V.
Organization: Regional Children's Clinical Hospital No. 1 (Voronezh), Voronezh State Medical University n.a. N.N. Burdenko
Summary:

 The article presents clinical observation of patient H, 2007 year of birth., with X-linked adrenoleukodystrophy (X-ALD). This is a rare hereditary metabolic disease, not only in Russia but also worldwide. It belongs to the group of peroxisomal diseases, is associated with the accumulation of fatty acids with a very long chain and is characterized by a combined lesion of the nervous system and adrenal glands. X-ALD in neurology and Pediatrics require a targeted individual approach to each patient, genetic tests in relatives and prenatal diagnosis among patients at risk.

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Features of the medical and social characteristics and anxiodepressive disorders in patients with little brain insult in the early recovery period

Year: 2018, volume 14 Issue: №1 Pages: 141-144
Heading: Neurology Article type: Original article
Authors: Kutashov V.A., Ulyanova O.V., Zakharov O.P.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

The aim of the study was to study medical and social and anxiodepressive disorders (ADR) in patients with little brain insult (LBI) in the early recovery period. Materials and Methods. 140 patients were examined, the mean age of which was 57.2±2.2 years. The patients were examined in the early recovery period. Among the 140 patients with LBI, 62% were men and 38% women. The level of anxiety and depression was assessed using the Hamilton psychometric scales (HPMS). Results. In 6% of patients there are relatives who have undergone an acute cerebrovascular acident. 50% of patients live with their families, 27.2% lived with relatives and 22.8% lived alone. Only 25.5% of patients had a daily monitor blood pressure (BP), 17.8% of patients — several times a week and 17.8% of people — several times a month. In addition, 16.4% of patients are forced to measure BP in the health facility, since they do not have a personal tonometer. 26.4% of patients did not measure their BP. 16.4% measure blood pressure once a year. A high level of depression occurred in 3.57% of patients, an average level in 27.86% of patients, mild depression in 33.57% of patients and absence of depressive symptoms in 35% of patients. A high level of anxiety was found in 17.50% of patients with Ml, moderate anxiety level in47.86% of patients, low anxiety level in 45.00%, no anxiety in 1.43% of patients. Conclusion. In patients with LBI in the early recovery period a rather high level of ADR severity was revealed. That causes as early as possible the identification and administration of specific therapy for ADR with LBI.

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Cardioembolic stroke: risk factors, forecast, secondary prevention

Year: 2017, volume 13 Issue: №1 Pages: 187-192
Heading: Neurology Article type: Original article
Authors: Khakhanova O.N., Skorokhodov А.Р., Kutashov V.A., Ulyanova O.V.
Organization: Voronezh Emergency City Hospital №1, Voronezh State Medical University n.a. N.N. Burdenko
Summary:

The goal of the study is to evaluate the effectiveness of warfarin and the new direct anticoagulants (xarelto and pradaxa) in the secondary prevention of re-occurrence of cardioembolic stroke (CES). Material and methods. Inclusion criteria of patients in the study: migrated CES, confirmed the presence of a pathology of heart; reception of indirect anticoagulant (warfarin) or direct inhibitors of factor Xa (xarelto, pradaxa) to prevent re-CES. Exclusion criteria from the study: patients with other subtypes of ischemic stroke (IS), hemorrhagic stroke (HS), patients receiving aspirin, diseased patients with CES. The severity of neurological deficit was assessed according to the NIHSS, Rivermead, Rankine and Barthel scales. Results. By the end of the second year of monitoring after suffering CES number of patients with full recovery a self-service increased by 3% and decreased by the same number of patients with moderate and severe dependence on assistance in everyday life. More efficient and faster neurological function was restored in patients taking warfarin is worse in the group of patients receiving pradaxa. However, a second stroke in the first year after suffering several CES were more frequent in the group of patients receiving pradaxa, and usually fatal. Conclusion. Change of medications in the group of patients receiving xarelto and warfarin, other anticoagulants have not led to the emergence of recurrent stroke.

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Revisiting of etiology, clinical picture and diagnosis of the Kleine-Levin syndrome.

Year: 2017, volume 13 Issue: №1 Pages: 181-187
Heading: Neurology Article type: Case report
Authors: Ulyanova О.V., Kutashov V.A.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Objective: to draw the attention to the Kleine - Levin syndrome (SKL), a rare, poorly understood disease, not only in Russia but throughout the world. We analyzed the case of the 23-year old patient M, with the Kleine — Levin syndrome. SKL belongs to the group of recurrent hypersomnia and is characterized by long bouts of sleep lasting an average of 10-14 days, beginning with the imperative and difficulty awakening. During bouts of sleep observed unusual behavior of patients: hyperphagia; hypersexuality in males; irritability, restlessness, impaired mental activity; aggression; feeling of unreality of it all; confusion, hallucinatory episodes and depression in females. During wakefulness, marked dyspho-ria, emotional stupefaction, loss of memory. The syndrome develops in 4 times more often in men than in women, aged 12-25 years. Etiological factors: brain tumor, head trauma, metabolic disorders, acute infectious diseases with fever. Often the development of the syndrome is preceded by hyperemia and hypothalamic-pituitary dysfunction. The article discussed the etiology, diagnosis, and possible combinations of clinical manifestations in SKL.

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