2016, volume 12

The article discusses the succession of teaching of basic and clinical (therapeutic) disciplines in higher medical school: the urgency and necessity of interdisciplinary cooperation, its form, expected results, existing obstacles and ways to overcome them. The experience cathedral groups in the implementation of the process and prospects of further interdisciplinary cooperation in teaching basic science education and internal medicine.

The article presents the author's analysis of modern interpretations of palliative care. Transformation of palliative care conceptualization during the last decade has led to the appearance of a palliative approach to treatment of patients with chronic diseases; quality feature of this approach is possibility to render a palliative care along with treatment of underlying disease and syndrome treatment of a patient. The authors note that due to increasing number of patients requiring renal replacement therapy, organization of palliative care is relevant in the group of patients with chronic kidney diseases. According to the authors' viewpoint, palliative approach to aging and fast-growing cohort of dialysis patients, many of which are in the period of living out, suggests implementation of individual program of dialysis therapy, in domestic literature there are only a few works devoted to palliative approach to patients with terminal chronic renal failure that suggests prospects of research in this direction.

The aim is to study reasons for repeated fundoplication and possible variants of cardia correction in patients suffering from hiatal hernia and reflux esophagitis. Material and methods. Results of antireflux correction in 118 patients suffering from hiatal hernia have been studied, such results have been observed for the period of up to 36 months. Results. Most recurrent cases have been characterized by anatomical background for repeat hernia development, such as migration of fundoplication cuff, inconsistency, extreme traction of tissues that form gastric cuff or derived technique of fundoplication during previous operation. It has been found out that the subjective assessment of patients' condition after fundoplication is one of the most important criteria in deciding whether the repeated intervention is needed. Conclusion. Analysis of long-term results of the repeated antireflux surgery has revealed that quality-of-life index of patients having undergone repeated surgery may be compared to that of a healthy person. Traditional fundoplication of Nissen with non-tractional surgical intervention should be the method of choice for treatment of recurrent hiatal hernias.

Purpose: to study the effect of vitamin D3 on cytokine activity of macrophages and monocytes of gingival fluid. Material and methods. The examination and treatment of 42 patients with chronic generalized periodontitis at the age of 45-50 years were conducted. Gingival fluid was obtained from the periodontal pockets of patients. Material processed statistically. Results. Colecalciferol efficacy in inflammation and processes of destruction of periodontal tissue was twice higher than using traditional therapy. Resistance anti-inflammatory effect of the drug was maintained for 6 months, which had been confirmed by clinical and laboratory investigations. Conclusion. The use of applications of vitamin D in the treatment of periodontitis may achieve compensatory restoration of immune protection of the oral cavity.

The article is devoted to the methods of orthopedic treatment of dentition defects. To restore the functionality and individual aesthetic standards of dental system, with different types of partial loss of teeth, depending on the anatomical and topographical conditions, various kinds of dental prosthesis designs are used in the oral cavity: non-removable (bridges, cantilever, adhesive) dentures and removable (laminar and clasp dental) prostheses, as well as their combinations.

The aim: to study the frequency of birth defects in Perinatal Center of the Saratov region from 2014 till 2015, the possibility of prognosing, early diagnosis and optimization of programs for the prevention and correction of congenital malformations, the evaluation of treatment outcomes. Materials and Methods. The study included newborn babies and fetuses with birth defects for the period 2014-2015 according to data received from Perinatal Center. The data on ultrasound examination of pregnant women and about 149 fetuses with malformations in case of early terminated pregnancies were analyzed. Results. In 2014 Perinatal Center of the Saratov region found 77 newborns with congenital malformations, in 2015-72; 24 children (16.1%) required early surgical intervention. The comprehensive assessment of the health status of women and their children, the assessment of placental blood flow and fetal development, the identification of chromosomal and genetic abnormalities were conducted. 5 children of 149 children with congenital malformations died at the stage of the maternity hospital where average mortality accounted for 3.3%. Congenital malformations of central nervous system and sense organs accounted for 13.4%, malformations of the face and neck — 5.4%, malformations of the cardiovascular system — 28.8%, malformations of the respiratory system — 2.7%, malformations of the gastrointestinal tract — 4%, malformations of the musculoskeletal system — 9.4%, malformations of the urinary system — 27.5%, genital malformations — 4%, defects of the skin and its appendages — 1.3%, other malformations — 2.7%. Multiple malformations accounted for 4.7%. During 2014-2015 due to congenital malformations 311 births (4.4%) were interrupted, the main cause was determined as chromosomal abnormalities. Training, diagnosis, management of pregnant women and their delivery is carried out in Perinatal Center of the Saratov region in accordance with the complex program and algorithm methods for the prevention and correction of congenital malformations. Conclusion: This study has shown that there is a growth of small anomalies and reduction of frequency of multiple malformations. Comprehensive preventative program is possible to reduce the number of infants with untreated birth defects (13,5%), increase the percentage of defects detected by ultrasound from 51.7 to 66.7%.

This article presents a rare case of isolated parotid sialadenitis at a newborn. Possible etiology, classification, frequency, diagnosis and management of the disease are described in orderto determine this pathology. The paper gives the data on observation of a newborn with sialadenitis, the results of examination and treatment.

Objective: to estimate the structure and frequency of detection of secondary diseases in patients with neurological manifestations of HIV infection. Materials and methods. The study involved 304 patients infected with HIV. Results. The defeat of the nervous system in HIV infection occur encephalopathy, cerebral vascular lesions, meningitis, subacute encephalitis, secondary CNS lesions. The number of CD4-lymphocytes in HIV-infected patients with neurological disorders was significantly lower. Most of them have comorbid diseases. The most commonly diagnosed hepatitis С and B, herpes, cytomegalovirus infection, chlamydia, Candida, toxoplasmosis and tuberculosis, mixed infection. Hepatitis В and С and herpes are the most widely represented in patients with HIV-induced encephalopathy and cerebrovascular form of HIV. The presence of cytomegalovirus infection is correlated with the development of subacute encephalitis. Conclusion. Manifestations of nervous system pathology in HIV polymorphic and correlated with the presence of secondary comorbid pathology. Such conditions are due to underlying disease immunological parameters.

Aim: to determine the role of brain-derived neurotrophic factor in the formation and forecasting of psycho-vegetative syndrome in patients with cerebral mild to moderate injury. Material and Methods. There have been 150 patients with contusion of the brain, examined. Indicators of neurological, psycho-vegetative status, quantitative content of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the serum were studied. Results. At patients with brain contusion neurological, psycho-vegetative disturbances and decrease neurotrophic factors are determined. It was found to depend of the content of BDNF and psycho-vegetative indicators. Conclusion. The level of brain-derived neurotrophic factor serum (less than 300 pg/ml) is a predictor of psycho-vegetative syndrome in the long term of the brain injury.

The results of the regional studies on the frequency of Parkinson's disease (PD) and the incidence of it in Russia have been generalized, the main factors that determine the quality of the estimates of this disease epidemiological indicators have been identifyd. The article summarizes data from 19 original studies on the epidemiology of parkinsonism and Parkinson's disease in Russia published between 2005-2015. Due to the statistical heterogeneity of the primary results computational analytics was not applied to the data; however, data consolidation allowed to perform a trend analysis of epidemiological indicators. The methodological basis of the majority of studies was medical aid appealabil-ity; two of the studies used door-to-door surveys. One of the studies returned questionably low epidemiological indicators obtained from the medical records, and the rest showed the standardized prevalence of 30.0-139.9/100,000 and incidence of 7.63-21.8/100,000 per year. Contribution of Parkinson's disease to the nosological structure of parkinsonism was >61.3%. Estimate of the number of patients with PD in Russia is approximately 210,000 people. Conclusions are made regarding the prevalence of PD in Russia according to the cross-cutting research on the level of indicators in the Western countries. The prevalence of PD by appealability is 2-3 times less than the prevalence in continuous research, both national and foreign. The incidence of PD, demonstrated in half of the studies, is stable from region to region and is comparable with the universally recognized values.