№3, 2014, volume 10

The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007) were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.

Objective: research is devoted to the development of criteria and methods for prognosis of the next recurrence of exacerbation of ulcerative colitis (UC) after the patient discharged from hospital. Material and Methods: During a period of a year 38 patients with UC were supervised. The criteria used in the prognosis of recurrence included results of the evaluation of quality of life (SF-36 questionnaire), the analysis of the autonomic nervous system (coefficient Hildebrant and Kerdo index) and the level of stressful load procedure Holmes-Rage. Results. It has been established that the risk factors for recurrence include low quality of life on the scale of RP, SF and MH SF-36, the coefficient Hildebrant >5.6 units, Kerdo index <16.2 units and stress load >314 points. Conclusion: The obtained data have been processed by multivariate mathematical statistics and the obtained analytical expression allows to prognose the time of recurrence of ulcerative colitis.

Functional systemic approach to the resuscitation and intensive care may be considered as a direct correlation between analysis and synthesis, induction and deduction, and, in general, between the formal and dialectical categories. The realization of this system should be started with the interaction and formation of the final beneficial result. Therefore the experience assessment on the basis of functional systematic approach will enable us to formulate more precisely the subject and methods of resuscitation from the philosophical point of view taking into consideration the interaction of the human life integrity with death phenomenon as fixed in ontogenesis and will allow to methodically justify the distinguishing of functional systems and standard processes both in sanogenesis and thanatogenesis.

The aim of the study is to evaluate influence of estrogen deficiency on lipid profile in women of different age. Material and Methods. 189 women with normal body weight: 44 women with premature menopause (aged <40 years), 69 women with early menopause (aged 40-45 years), and 76 women with natural menopause (aged 46-55 years) have been studied. In all women identification of clinical status has been performed during clinical examination. Results. It is shown that increasing age associated with increasing total cholesterol, triglycerides, low-density lipoprotein (LDL), very low density lipoproteins (VLDL) (p<0.05). We have not observed a significant association between age and level of high-density lipoprotein (HDL) (p=0.117). According with increased age, atherogenic index of plasma (AIP) increases from initial -0.17±0.09 (M±o) to 0.09±0.47 (p<0.05) in women with premature menopause, and to 0.14±0.21 (p<0.05) in other women. Final level of AIP was similar between women aged 40-45 years and women aged 46-55 years (p=0.084). Conclusion. Lipid metabolism disorders were assessed in 73.5% of women with estrogen deficiency. According to the age factor the rate of women with normal lipid metabolism decreases (x2=10,165, p=0.026).

A method is proposed for quantitative assessment of the phase synchronization of 0.1 Hz oscillations in autonomic cardiovascular control by photoplethysmogram analysis in real time. The efficiency of the method is shown in the comparison with the results obtained by the previously developed method.

anesthesia. Material and Methods. Decahydroquinolinyl derivative under laboratory code PAS-68 synthesized in the A. B. Bekturov Institute of Chemical Sciences under the guidance of K. D. Praliev has been studied. Benzocaine, lido-caine and tetracaine were used as the comparison drugs. Male rabbits of 2,0-3,5 kg weight were used as experimental animals. A threshold of corneal sensitivity to tactile effects (Rainier index) was determined by the standard method. Computer prognosis of PAS-68 acute toxicity also was made. Results. The local anesthetic activity of 1 %, 0,5% and 0,25% solutions of PAS-68 were identified as higher than that for lidocaine and benzocaine in similar concentrations (p <0,05) but lower than that for tetracaine (p<0,05). PAS-68 has no local irritating action. The duration of anesthesia, 0,5% and 1 % PAS 68 exceeds that for benzocaine and lidocaine at equivalent concentrations (p<0,05). By this kind of activity PAS-68 is a second to the duration of anesthesia by tetracaine (p<0,05). The latent period of anesthesia induced by PAS-68 is shorter than the latent periods induced by benzocaine, lidocaine and tetracaine. On the base of predictive analysis it was concluded that PAS-68 is of low toxicity. Conclusion. PAS-68 exceeds benzocaine and lidocaine by the local anesthetic activity and duration of anesthesia and is second only to tetracaine. The latent period of anesthesia PAC-68 is shorter than the latent period of benzocaine, lidocaine and tetracaine respectively.

Objective: analysis of autopsy material of the patients who died with clinical diagnosis of stroke. Material and Methods. The protocols of postmortem investigations of 172 patients have been studied. The interested information were added to the questionnaire. Material was processed statistically. Results. It has been determined that 51,74% of dead patients were men and 48,26% were women. 96,9% of dead patients were from age group of 41-50 and 81-90 years respectively. The causes of death of the patients were edema of brain and pneumonia, which developed within 24 hours to 7 days. In 16,28% and 11.05% the death was fixed from 7 to 14 and from 14 to 28 days, respectively. The conclusive clinical diagnosis more commonly consisted of two basic diseases. Conclusion. There is a positive trend for improvement of the quality of diagnosis of stroke, to reduce the number of mistakes in conclusive clinical diagnosis.

The review of literature concerns the questions of development, structure, function, blood supply and innervation of structures of hip joint. The characteristics of changes of these structures in dysplastic coxarthrosis of various degree of expressiveness has been presented. Radiological and biomechanical features of hip joint have been described in various types of dysplastic coxarthrosis.

Aim: To define the most informative indicators of the water resources quality, which reflect the increased risk for the infectious diseases occurrence due to water. Material and Method: The water collection was performed from the rivers of the Saratov region. The retrospective analysis of indicators of the water quality and the morbidity level associated with water among the population has been performed. The statistical analysis has been performed by means of dispersion, regression and discrimination methods. Results: The rivers in this study belong to the water sources of the 2nd grade. We have identified the most polluted rivers with chemicals: Maly Usen, Medveditsa, Atkara; with microorganisms: Choper, Big Ysen, Big Irgis. The two statistic correlations have been found for the right bank of the Volga region; the three statistic correlations have been found for the left bank of the Volga region. Conclusions: The indicators of the chemical consumption of oxygen and of general coliform bacteria have been determined to be the most significant for the risk assessment of morbidity of acute intestinal infections.