2021, volume 17

Purpose: to clarify and compare the effectiveness of the method of quantitative autonomic testing on the Case-4 apparatus and cardiovascular functional tests performed by pulse oximetry for the early diagnosis of cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus and metabolic syndrome. Material and Methods. The study included 30 patients with type 2 diabetes (average age 56.5±13.5 years), 30 patients with metabolic syndrome (average age61±9 years) and 30 healthy subjects (average age 58±10 years), comparable in gender and age with the study groups. The main cardiovascular reflex tests were performed: subjective sensations were assessed using the NSC questionnaire, the severity of deficient neuropathic disorders was assessed by the NIS-LL scale, and neuropathic pain syndrome was assessed by the TSS scale. Results. In the study group of patients with type 2 diabetes, severe cardiac autonomic neuropathy (CAN) was detected in 13.3% of patients, moderate in 40% of patients, and in 46.6% of patients, signs of CAN were not detected. In the group of patients with metabolic syndrome, 10% of patients had severe CAN, 10% had moderate, and 80% of patients had no signs of CAN. In the group of healthy volunteers, no disorders of the autonomic nervous system were identified. Conclusion. The results of pulse oximetry tests with deep breathing were comparable to the results of quantitative autonomic testing with the Case-4 apparatus (p<0.001). The use of pulse oximetry is most expedient in terms of time and consumables in comparison with hardware quantitative vegetative testing.

The review presents modern data on epidemiology, mechanisms of pathogenesis, clinical picture, diagnostics of chronic pain. A complete system of flags of risk factors for pain chronicity used in Europe and the United States is demonstrated. Criteria for diagnostics, physical and instrumental examination of patients with chronic back pain are presented; the issues of back prevention are considered. Conditions aimed at expanding the range of diagnostic studies and coping strategy are discussed. It is concluded that a multidisciplinary approach to the treatment of patients with back pain is advisable and the use of cognitive behavioral therapy is important. The studies on chronic back pain and coping strategies published in the PubMed and eLibrary databases were examined for the period since 2000. The final analysis of the review included 37 studies.

Objective: to analyze awareness level among Saratov's population about acute cerebrovascular accidents (ACVA) based on the results of an online survey. Material and Methods. An online survey among Saratov's residents was realized using the Google Forms platform. The survey included 809 people. Results. The majority of respondents consider arterial hypertension (94.2%), atherosclerosis (86.2%), obesity (85.7%), smoking (84.1%), alcohol abuse (88.4%), high cholesterol in the blood (85.5%), and emotional stress (88.4%) as risk factors for the development of ACVA. Respondents are not sufficiently informed about the role of diabetes mellitus (75.6%), heart rhythm disorders (76.1%), depression (49.7%), and oral contraceptive usage (22.2%) in the development of ACVA; they also underestimate the transient ischemic attack as a predictor of repeated ACVA (55.0%). High proportion of the population finds it difficult to answer questions concerning the care of patients with ACVA. Conclusion. The data indicate a lack of awareness of Saratov's residents about ACVA. Therefore, it is necessary to form a target audience within the framework of the program to raise public awareness about ACVA and develop strategies for preventive medicine.

Modern therapy for multiple sclerosis (MS) is based on a large selection of disease-modifying treatment (DMT). The appointment of DMT is made taking into account the medium- and long-term prospects of their effectiveness. There is a problem of finding predictors of the effectiveness of therapy. The question of determining the risk factors for the onset of reliable MS after the first attack of demyelination remains not fully understood. The analysis of studies published for the period 2006-2020, available for study according to the main scientific bases, is carried out (46 literary sources). Magnetic resonance imaging (MRI) has shown good results in predicting the effectiveness of interferon DMT therapy. MRI as a reliable criterion for the likelihood of transformation into significant multiple sclerosis after the first attack of demyelination. Multimodal evoked potentials (EP) allow assessing degeneration processes with greater sensitivity than MRI. At the moment, only MRI is the most reliable way to assess the progression of the disease and the risks of its phenoconversion. Multimodal evoked potentials and immunological markers allow more sensitive assessment of degeneration. The integrated use of the results of these methods will make it possible to obtain predictors with greater sensitivity and specificity for predicting the course of MS.

The aim is to reveal the psychological characteristics of elderly patients of the neurological hospital with multisensory insufficiency and statodynamic disorders. Material and Methods. The study included data on 100 patients (mean age 67.6±7.7 years), each of whom was tested twice: on admission to a neurological hospital and on the day of discharge. We used the Luscher color test modified by L. N. Sobchik. Results. The level of performance of patients is assessed as average, but the indicators of the stressful state reflect the presence of moderate stress, unproductive tension, instability, fatigue, and the prevalence of negative thoughts and regrets. More than 30% of elderly patients experienced severe anxiety, a tendency to depressive feelings, about 11 % of patients had strong psychological stress. Conclusion. The revealed characteristics "heteronomy" and "concentricity" can be attributed to the "portrait of an average elderly patient" of the neurological hospital with balance disorders. However, given the wide range of fluctuations in the values in this sample, it will be advisable to use psycho-diagnostics, in particular, with the help of time-consuming projective techniques, for each patient of the older age group in the selection of individual approaches to the provision of medical care.

The article presents the scientific and practical contribution of the doctor of medicine E. K. Rosenthal in the organization and development of surgery and oncology in the Saratov and Penza provinces in the Zemsky period (in the 60-90s of the nineteenth century). Rosenthal's active work in "Conversations of Saratov Doctors Society" was shown to expand the provision of medical care, the fight and the prevention of infectious diseases among the population of the region.

The research follows the career of Igor I. Zhadyonov, a prominent administrator of the Russian science, who managed Saratov Scientific Research Institute of Traumatology and Orthopedics for 30 years. Igor I. Zhadyonov founded and headed the Republican Arthrology Center (RAC) for 28 years, the only facility in the Russian Federation focused on rheumaorthopedic science. RAC scientists led by Igor I. Zhadyonov were the pioneers of arranging the Soviet rheu-maorthopedic service. It was Igor I. Zhadyonov who performed first total joint replacements in Saratov. He made a great contribution to the design of the Russian hip implants. The prosthesis created by Zhadyonov and his colleagues was one of the first Soviet medical devices of this kind, and unlike the analogues it was a dismantling one.

The article is devoted to the bibliographic data of Professor N. P. Chesnokova. The aim of the article is to underline professor's contribution into the development of pathophysiology as a science and to the training of both medical students and teaching staff at Saratov State Medical University n. a. V. I. Razumovsky.

The aim is to identify the features of quantitative and qualitative changes in the humoral and cellular components of the immune defense in patients with primary multiple synchronous breast cancer (PMSC) and thyroid cancer and solitary thyroid cancer (STC). Material and Methods. The indicators of humoral and cellular components of immunity were analyzed in comparison in 34 patients with breast and thyroid multiple primary synchronous cancer, in 36 patients with STC and 36 women of the control group. Results. Significant quantitative and qualitative changes in cellular and humoral immunity in patients with PMSC and thyroid glands in comparison with corresponding indicators of women of the control group in declining more than 30% of the level of CD3-, CD16-, CD4-T-lymphocytes, all classes of immuno-globulins, against virtually unchanged indicators CD19-b cells. When comparing the indicators of immunity in patients with STC and control groups showed a reduction of approximately 34% in CD4-T-lymphocyt.es, 20% CD16-T cells, in the absence of significant changes of the studied parameters. Conclusion. In the course of the study more expressed changes of disorders of cellular and humoral immune protection in patients with PMSC breast and thyroid glands in comparison with the indicators at patients with STC and control group in the form of lower total number of lymphocytes, CD3-T-lymphocytes, CD4-T-lymphocyt.es, CD16-T-lymphocytes, immunoregulatory index, as well as lower level of im-munoglobulins of main classes were identified.

The goal of the article is to determine social determinants of a physician's professional reputation. Materials and methods. The results of the semi-structured expert interview (Л/=12; 7 men, 5 women) are analyzed, the group of respondents consists of professors of Saratov SMU n. a. Razumovsky; respondents' general experience in practical medicine and education is more than 20 years; experts' age is 54-69 years. The interviewed experts specialize in surgery, traumatology and orthopedics, therapy, endocrinology, cardiology, gastroenterology. Results. The key social determinants of a physician's reputation are highlighted on the basis of the analyzed contradictions between organization and control over everyday medical practice, values and meanings of medical education. The authors explain the origin of negative "markers" of social value of a physician's profession and significance of higher medical school to overcome them. Conclusion. It was revealed that there is a negative connotation and inconsistency between formed in the period of study and real ideas about physician's professional role, as well as requirements for a modern specialist in the field of medicine. The decrease in importance of empathy and prestige of a medical profession among young generation of doctors is marked.