Эпидемиологические аспекты повреждения магистральных сосудов

А.Н. Журкин, Р.Н. Ищенко Д.С., Комарова

Научный руководитель: доцент, к.м.н. А.Г. Макеев, доцент, к.м.н. О.П. Галеева

Кафедра оперативной хирургии и топографической анатомии Иркутский государственный медицинский университет, г. Иркутск, Россия

Цель: Провести эпидемиологический анализ повреждений магистральных сосудов.

Материал и методы: Проведен анализ результатов хирургического лечения 117 пострадавших с травмой магистральных сосудов. Из них 108 (92,3%) мужчины и 9 (7,7%) женщины (pF<0,000). Возраст соста­вил от 15 до 70 лет (средний 32±5,7). 97 (83,0%) составили лица трудоспособного возраста. У большинства больных имели место явления геморрагического шока различной степени тяжести - 105 (90,0%). По типу ранения колото-резанные встречались у 108 (93%), огнестрельные у 3 (2,4)% и закрытые повреждения у 4 (3,6)%. Изолированные сосудистые повреждения встречались у 92 (78,6%), сочетанные – у 24 (20,5%), комбинированные – у 1 (0,9%) пострадавших. По типу повреждённого сосуда изолированное повреждение артерии либо вены наблюдалось у 41 (35,4%) и 59 (50,1%), сочетанное повреждение артерии и вены, либо артерии, вены и нерва у 12 (10,3%) и 5 (4,3%) больных соответственно. По областям тела травма сосудов шеи диагностирована у 26 (22,2%), грудной клетки у – 1 (0,9%), живота и таза у – 33 (28,2%), верхней конечности у – 21 (17,9%), нижней конечности у 36 (30,8%). Среди сосудов шеи общая сонная артерия – 4 (15,4%), наружная сонная артерия – 2 (7,7%), внутренняя ярёмная вена – 12 (46,1%), наружная ярёмная вена у 2 (7,7%). Из сосудов живота и таза повреждения аорты были у 2 (6,25%), верхней брыжеечной артерии 2 (6,25%), почечной артерии у 1 (3,0), подвздошной артерии у 2 (6,25%), нижней полой вены у 7 (21,9%), верхней брыжеечной вены 2 (6,25%), воротной вены у 2 (6,25%), почечной вены у 1 (3,0%), подвздошной вены у 10 (31,3%). На верхней конечности: травма подключичной артерии было в 4 (19,0%), плечевой артерии в 12 (57,2%), локтевой артерии в 4 (19,0%), плечевой вены в 1 (4,8%) случаях. На нижней конечности: бедренной артерии в 20 (50,7%), подколенной артерии в 1 (2,9%), бедренной вены в 13 (37,1%), подколенной вены в 1(2,9%) случаях. Всем пациентам выполнено экстренное хирургическое вмешательство: лигирование сосуда как окончательная операция – 25 (21,4%), наложение бокового сосудистого шва – 54 (46,2%), наложение циркулярного сосудистого шва – 13 (11,0%), реконструктивно-восстановительная операция с применением сосудистых протезов – 25 (21,4%). Статистическая обработка результатов произведена с помощью пакета программ Statistica 7.0 for Windows. Определение значимости различий полученных данных (p) в сравниваемых группах проведено с помощью точного метода Фишера. Критический уровень значимости при проверке статистических гипотез в данном исследовании принимался равным 0,05.

Результаты: Ампутация конечности в раннем послеоперационном периоде выполнена 2 (2,0%) пациентам. Летальный исход был у 4 (3,2%) пострадавших на фоне декомпенсированного геморрагического шока.

Выводы:

1. Травма магистральных сосудов мирного времени чаще наблюдается у лиц молодого, трудоспособного возраста (pF<0,000).

2. Преобладают в структуре травматизма колото-резанные изолированные повреждения сосудов (pF<0,000).

3. Чаще наблюдается изолированное повреждение вены либо артерии в сравнении с сочетанными повреждениями артерии и вены, или артерии, вены и нерва (pF<0,000).

4. Наиболее часто имеет место травма внутренней ярёмной вены на шее, нижней полой вены в животе, плечевой артерии на верхней конечности и бедренных сосудов на нижней конечности.

______________________________

СЕКЦИЯ МЕДИЦИНЫ НА ИНОСТРАННОМ ЯЗЫКЕ

BIOINFORMATIC ANALYSIS OF YERSINIA SIMILIS STRAIN 228 CRISPR/CAS SYSTEM

I. A. Portnaya, N. P. Peretolchina, A. Y. Borisenko

Research advisors:

V. I. Zlobin, Member of the Academy of Sciences, Doctor of Medical Science;

Irkutsk State Medical University, Irkutsk, Russia

Y. P. Dzhioev, Leading researcher, Candidate of biological sciences

Scientific Center of Addressing Family Health and Human Reproduction Problems

S. A. Khakhalova, Doctor of Philology, habil., Professor

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Introduction. CRISPR/Cas system refers to clustered regularly interspaced short palindromic repeats/CRISPR-associated proteins, or short palindromic repeats. These repeats are located regularly in groups with CRISPR-associated proteins, they stand for a specific adaptive protective system in order to protect prokaryotes against phages and plasmids. CRISPR-cartridges represent short palindromic repeats with 21-47 polinucleotides length. These repeats are spaced by unique spacer sites. Presumably, the spacers along with Cas-genes are responsible for bacteria resistance against bacteriophages and plasmids.

The aim of this research is to study the features of CRISPR/Cas system of Yersinia similis strain 228 as well as the features of bioinformational phages and plasmids screening through decoded spacer sites.

Materials and methods. The object of the study is Yersinia similis strain 228 genome which belongs to GenBank (NZ_CP007230) database. We have used online-apps like CRISPRone, CRISPRFinder and CRISPRDetect in order to find CRISPR/Cas systems. We have done the phages and plasmids screening through spacers using online-app CRISPRTarget which is a tool to explore targets of CRISPR RNAs, BLASTn and ACLAME database. We have used online-app PHAST (PHAge Search Tool) to find prophages in the strain genome sequences.

Results. CRISPR/Cas system of Yersinia similis strain 228 refers to IF type and consists of 2 loci. These loci are located at a distance from each other. They both have essential for performance Cas genes. The amount of spacers in the cartridges is nearly the same: 30 and 11 spacers for YP1 and YP3 cartridges respectively. The homology search by BLAST algorithm showed that spacers are found only among representatives of this species. However Yersinia pseudotuberculosis str.PA3606 and Yersinia pseudotuberculosis IP31758 account for 98% of similarity. Phages’ screening through spacer sequences shows that DNA sites of bacteria (which correspond to included in bacteria genome prophages) possibly give rise to some spacers.

Conclusion. CRISPR/Cas system of Yersinia similis strain 228 is active towards phages and plasmids. Cas genes service equally both loci. Spacers aren’t specific only for one strain and can be transferred among strains. Geographic location of the spacers varies.

______________________________

THE PROBLEM OF OBESITY IN CHILDREN AND TEENAGERS

A.A. Vedernikov, E. A. Uvarova, A.A. Barkhatova

Research advisors:

O.I. Ptichkina, Doctor of Medical Science, Assistant Professor

Chair of children’s diseases Yu.V. Vinogradova

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Considering that recently the problem of excess weight and obesity in many countries of the world assumes more and more menacing scale, it is one of urgent in modern health care. It was decided to carry out the analysis of prevalence of overweigh and obesity, to detect risk factors among children from 0 to 17 years in one of children's out-patient departments of the city.

Aim. To study prevalence of overweight among children and teenagers on the example of Irkutsk city children's out-patient department No. 10, to identify the risk factors provoking development of excessive weight and obesity.

Materials and methods. Statistical analysis of primary medical documentation, out-patient cards, data of medical examination of schoolchildren. The analysis of forms 112/y – history of development of children with overweight by continuous sampling method of was carried out.

Results. In total 205 histories were analyzed that made 100%, 181 people of them were diagnosed alimentary excess weight (88%), 20 people were diagnosed hypothalamic syndrome of puberty period (HSPP) -10%. There were more boys - 98 (54%) than girls – 83(46%) among children with alimentary excess, mainly they were children of 11-15 years of age old – 101 (48%). Girls prevailed among children with HSPP – 14 (70) in comparison with boys – 6 (30%). Most children 161 (79%) were born in term, from the 1^st pregnancy – 125 (61%), independent labors without complications – 163 (80%). Overweight was observed in the majority of children – 96 cases (47%) – since preschool age. Burdened family history was in 117 children (57%). According to objective status data, overweight 5-10 kg was in 82 children, physical development was on middle level in 122 cases (65%), and fat deposition was irregular in 82 children (40%). Puberty corresponded to age – 196 people (96%), it was precocious in 9 (4%). Such diseases as hypothyroidism – 24 (76%), single cases of gastritis, infantile cerebral paralysis, epilepsy and electric injury were diagnosed among all the comorbidities in patients with alimentary obesity – 28 (88%). Hypothyroidism - 4 (67%) was revealed in six patients (30%) with HSPP, the Verge cyst, the increase in size of thyroid gland were diagnosed in the rest. Therapy was prescribed in 97 cases (54%) for treatment of patients with alimentary excess weight: lipid-lowering diet for 90 children (93%), physical activity for 89 (92%), metabolic therapy for 72 (74%), vitamin therapy for 71 (73%), Thyrozol for one (1%), antihypertensive agents in two cases (2%). Lipid lowering diet, physical activity - 17 (85%), metabolic therapy - 13 (65%), vitamin therapy - 16 (80%), Phenotropil - 1 (5%) were administered in the treatment of all 20 patients with HSPP (100%). After treatment, improvement occurred in 20 patients (17%) with alimentary obesity, weight gain occurred in 71 patients (59%) with alimentary obesity, 16 (13%) with HSPP. Only 11 (5%) children ate properly. There were errors in nutrition: eating sausages, bakery products, sweet, etc. 173 (85%) have physical training in school, 32 (19%) of them go for sport.

Conclusions.  Children with alimentary excess weight-181 (88%) predominated among all detected cases of obesity 205 (100%). Hereditary factor plays a significant role in the development of obesity in children and adolescents: family anamnesis of obesity - 98 cases (56%); alimentary factor: unbalanced and improper nutrition – 194 (95%).

______________________________

HYGIENE OF STUDIES IN secondary EDUCATIONAL institutions of irkutsk

T. P. Kuskova, T. K. Nikolaeva

Research advisors:

R. S. Manueva, Doctor of Medical Science, Assistant Professor

Chair of General Hygiene

O. V. Antipina, Doctor of Philology, Assistant Professor Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The main important hygienic principle of planning the daily regimen of learners is rational organization of the educational process. There should be a combination of getting a wide range of knowledge and fortifying schoolchildren's health, since such an approach fosters the process of formation of the integral, socially demanded personality. The current state of the educational system reveals negative trends for schoolchildren's health. It can be explained by serious changes in redistribution of study load in different types of schools. The entire period of the school stage education shows a steady growth in a number of individual pathologies. That is why the problem of studying life quality indicators of schoolchildren of different age groups is more than relevant.

Aim. The aim of the research is to give analysis of educational and extra-curricular activities in educational institutions of various types in Irkutsk, at children of the primary and secondary school age.

Materials and methods. The research was carried out in Irkutsk in the MBEI SE of School No. 30 and the MBEI of Gymnasium No. 3. The schedules of 88 classes were examined for compliance with hygienic requirements. The rank scale of difficulty introduced by I. G. Sivkov was the main method for the results’ estimation. The survey of 446 schoolchildren was conducted. The comparative and statistical methods were used.

Results. The school schedule can be estimated positively only when the graph shows a two-rise curve on Tuesday and Thursday for primary and secondary schoolchildren. According to the results of the study, most of the schedule in School No. 30 (except for Forms 1E, 1G, and 2F), and none in Gymnasium No. 3 shows such a rise, which means that the schedules do not meet the hygienic requirements. In addition, the school week in these secondary educational institutions was 3-4 hours overloaded, and difficult subjects (Russian, English, Maths) were the first lessons while this period must be intended for the preparatory stage. The survey involved schoolchildren aged 6 to 16 years. Primary school children actively attend clubs and sections, have tutors and spend on average 2 hours a day doing homework. Besides, children find spare time for reading fiction and playing computer games. For sleep they have on average 8.5 hours a day, which is certainly a good indicator. Junior schoolchildren spend about 1 hour a day playing the computer and watching TV. It should be mentioned that both in the gymnasium and in the school the tendency to attend extra classes during the off-hour time was almost the same: 95.7% and 94.2%, respectively.

Conclusions. The study of the daily and weekly dynamics of working capacity makes it possible to assert that in the conditions of the current study regime and at a low motor activity, total study load in educational institutions is excessive for schoolchildren. As for the rest regime, it has been revealed that, in general, the quality of schoolchildren’s life can be assessed positively.

______________________________

PREVENTION OF PNEUMOCOCCAL INFECTION

C. A. Abdusamatova, A. V. Yuschchenko

Research advisors:

R. S. Manueva, Doctor of Medical Science, Assistant Professor

Chair of General Hygiene

O. V. Antipina, Doctor of Philology, Assistant Professor

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. To date, respiratory diseases in the Russian Federation continue to occupy the first place in the general structure of morbidity. There is a tendency for epidemic spread in military troops because of newly arriving conscript servicemen. Since 1998, Pneumo-23 vaccine has been used in Russia. It protects against 23 most common types of pneumococci and diseases they cause.

Aim. The aim of the research is to conduct comparative analysis of morbidity with acute respiratory diseases in a group of servicemen who were vaccinated with Pneumo-23 and in a group of servicemen who were not vaccinated with it.

Materials and methods. To accomplish the tasks of the research, during the autumn draft of 2014, 600 servicemen were examined and vaccinated. For comparison, the data on respiratory diseases among servicemen in 2013 were analyzed. The morbidity rate in people on conscription was calculated in ppm. Besides, the total morbidity indicator, the indicator of infectious morbidity, the morbidity rate of respiratory diseases, the morbidity rate of acute respiratory diseases and pneumonia were calculated.

Results. According to the morbidity rate data, in the group of people on conscription the total morbidity in 2014 was 183.67 ppm (in 2013 it was 476.99 ppm), the average indicator in the Central Military District was 1268.9 ppm (1325.2 ppm, respectively). The infectious morbidity rate in the group of people on conscription in 2014 was 11.66 ppm (in 2013 it was 25.10 ppm), the indicator in the Central Military District was 72.25 (81.8 ppm, respectively). The morbidity rate of respiratory diseases in the group of people on conscription in 2014 was 172.01 ppm (in 2013 it was 451.88 ppm), the average indicator in the Central Military District was 756.31 (812.5 ppm, respectively). The morbidity rate of acute respiratory diseases in the group of people on conscription in 2014 was 183.12 ppm (in 2013 it was 246.86 ppm), the average indicator in the Central Military District was 760.77 ppm (427.07 ppm, respectively). The morbidity rate of pneumonia in the group of people on conscription in 2014 was 20.41 ppm (in 2013 it was 58.58 ppm), the average indicator in the Central Military District was 22.9 ppm (46.37 ppm, respectively).

Conclusions. In comparison with 2013, the morbidity rate of respiratory diseases in conscript servicemen in 2014 decreased by 2.6 times, including acute respiratory infections – by 1.3 times, and pneumonia – by 3 times. The current state of conscript servicemen’s health allows them to undergo military training successfully. Thus, the pneumococcal vaccine (Pneumo-23) has proved to be effective.

______________________________

IRON-DEFICIENCY ANEMIA IN CHILDREN IN TULUN

A. V. Vladykina

Research advisors:

O. I. Ptichkina, Doctor of Medical Science, Assistant Professor

Chair of children's diseases

M.O.Naymushina

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. From the first days of child’s life the quality of nutrition determines the development and functionality of the most of organs and systems. Deficiency, including iron deficiency anemia (IDA) might affect the speed of natural dynamic development of a child. Iron deficiency in human body causes increasing fatigue, neurological disorders, the suppression of cellular and humoral immunity, cognitive decline. The outcomes of iron deficiency may remain during several months, years, or even be irreversible. The incidence of IDA in children is a significant medical and social problem. According to published data, the prevalence of IDA in children in Russia and developed European countries is about 50% in young children and 20% in older children.

Aim. The purpose of our research was to study the prevalence of IDA in children in Tulun, Irkutsk Region, and the importance of on time diagnostics and the effecacy of treatment.

Materials and methods. 760 medical records (112 Form) of children 0 – 17 years old were randomly chosen and analyzed. The number of girls and boys in each age group was approximately equal. The diagnosis of IDA was made in all cases of hypochromic anemia with positive dynamics from treatment with iron supplements for 1 month.

Results. Research showed that the greatest prevalence of IDA falls on the first year of life – 62.5%. In children of the second year of life anemia was detected in 21.2% of cases, the third year of life - in 11.7% of cases, in the fourth year - in 4.6% of children. In the age groups from 4 to 17 years, no cases of IDA have been identified. The following iron supplements were used for treatment of IDA: FerrumLek (74.6% of patients with IDA), Aktiferrin (9.5%), Maltofer (3%), Haemophore (7.9%). In all cases, IDA was treated to normalize the level of hemoglobin. Research of reserved and transport resources of iron was made neither before, nor after the treatment of IDA.

Conclusions. Research showed that: the greatest prevalence of IDA in children falls on the first and second years of life (62.5% and 21.2% respectively); in all studied cases the duration of treatment was insufficient: drug treatment of iron deficiency ceased after the normalization of hemoglobin level; no child with IDA has been examined for a reserved and transport resources of iron. Thus, the identified shortcomings in diagnostics and treatment of IDA in children show the necessity and importance of outreach lectures about diagnostics and treatment among pediatricians in Tulun.

______________________________

INTERGENETIC INTERVAL IN IRKUTSK REGION

A. V. Enikeeva, M. N. Khatyleva, L. A. Delina

Research advisors:

D. A. Stupin Chair of obstetrics and gynecology with the course of parthenology and adolescent gynaecology

M. O. Naymushina Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The postpartum period is the one of the most important periods of a woman's life, when all changed conditions caused by pregnancy are recovering. It is very important to wait the intergenetic interval because the unwanted pregnancy soon after childbirth is very unpleasant which can cause severe anemia, progression or the beginning of lower extremity varicose vein disease and the threat of abortion and decompensation of existing somatic diseases. From 10 to 25 women in every 100 visit abortion clinics during the first year after childbirth, and only about 36% of women are ready for a second pregnancy in the near future [Vikhlyaeva E.M.]. Therefore, it is recommended to consider the postpartum period "as a critical" period in a woman's life and using of contraception is an important way to support her reproductive health.

Aim. To identify the intergenetic interval of women after natural and operative labour, the rest period after miscarriage, and also to estimate the condition of woman pregnancy with different intergenetic intervals and contraceptive methods used by respondents.

Materials and methods. 327 woman of Irkutsk and Irkutsk region were surveyed and 150 outpatient cards of pregnant women were processed in antenatal clinic in Irkutsk State Perinatal Center

Results. According to the survey, the intergenetic interval should be more than 3 years (42%), but this interval among respondents was up to 2 years - 21%, 3-4 years - 28%, 5-6 years - 16%, 7-10 years - 21%, more than 10 years 14%. The intergenetic interval after operative labour was more than 2 years, the average was 7 years. According to the data of the processed outpatient cards we formed 3 groups of woman: Women with intergenetic interval 24 + 9 months(3 years) are 28%, with intergenetic interval from 24 + 9 months (3 years) - up to 5 years - 28% and women with itergenetic interval over 5 years - 44%. Among women with a short period between births, the chance of abortion and anemia of pregnant women are more often, but women with a long intergenetic interval are more likely to have placental diseases and low birth-weight babies. According to the survey, the rest period after miscarriage was more than 9 months, for an average 3 years. The most popular methods of contraception among respondents are barrier methods (54.2%). Betweenthe women who used the method of lactational amenorrhea there are not all who followed the requirements (61.3%), some of them (31.5% ) got pregnant in a year after previous pregnancy.

Conclusions. During the survey it was found out that almost half of the women (42%) were aware of the length of the optimal intergenetic interval. But the majority of respondents do not wait for this period, which leads to a complicated course of pregnancy. More than half of the surveyed women (54%) consider the most convenient contraceptive method in the postpartum period is the barrier methods of contraception. Not all women who used the method of lactational amenorrhea followed with the neededrequirements, as a result every third of them had a repeated pregnancy after the first year after childbirth.

______________________________

LATENT IRON DEFICIENCY AND IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN

F. S. Rakhmonova, K. A. Murunova

Research advisors:

D. A. Stupin

Chair of obstetrics and gynecology with the course of child and adolescent gynecology

I.M. Semenova Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance.  Iron-deficiency condition in pregnant women is known to develop at any stage of gestation due to an increased consumption and/or insufficient ingestion of iron, iron balance being close to deficit. Different factors reducing iron ingestion or increasing its consumption may lead to the development of the symptomatic iron deficiency. This disease is a serious problem of an extragenital obstetric pathology since it complicates the course of pregnancy, childbirth and the postpartum period.

Aim. To study the dynamics of changes in the parameters responsible for iron metabolism in trimesters, to identify the specific changes, to analyze the urgency and effectiveness of the administration of iron-containing medicines.

Materials and methods. A retrospective descriptive study was conducted. The database of the Medical Unit of the Irkutsk Aviation Production Association was used. The analyzed data were taken from the form 096 / u (n = 250). The personal data of the female patients were not disclosed. In all patients, the parameters of peripheral blood and iron metabolism were determined. Statistical processing was carried out by means of Microsoft Excel.

Results. In the first trimester, anemia was diagnosed for the first time in 40 (16%) of 250 examined pregnant women, 5 (12.5%) of them had anemia associated with the iron deficiency. In the second trimester, 30 (12%) of 250 pregnant women suffered from anemia, 21 of them (70%) were diagnosed it for the first time, of which 15 (71%) had iron deficiency anemia (IDA). In the third trimester, anemia was diagnosed in 180 (72%) female patients, and in 53 cases (29%) it was diagnosed for the first time. Pregnant women suffering from IDA were given iron preparations (Maltofer, Ferrum-Lek) until the blood and iron metabolism returned to normal, a significant clinical result being noted.

Conclusions. 1) Every second woman has an IDA at the end of pregnancy, the effectiveness of iron-containing medicines was 65%; 2) it's better to prescribe iron-containing medicines before pregnancy, as a pregraviated preparation and prevention of IDA.

______________________________

DIAGNOSTIC DIFFICULTIES AND ON-TIME SURGICAL TREATMENT OF PRIMARY HYPERPARATHYOROSIS

V. E. Sekretarev

Research advisors: V. A. Beloborodov, Doctor of Medical Science, habil., Professor

Chair of General Surgery

I.M. Semenova Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkusk State Medical University, Irkutsk, Russia

Relevance. Over the past ten years, there has been an increase in the number of patients with primary hyperparathyroidism (PHPT). Due to the constant increase in revealing PHPT, this problem has become one of the most urgent in clinical endocrinology. PHPT is the third most common after the pathology of the thyroid gland and diabetes mellitus.

Aim. The purpose of the study was a retrospective analysis of the survey results and the causes of diagnostic errors in patients with different forms of CGTP.

Materials and methods. The results of examination and treatment of 49 patients with PHPT treated at the General Surgery Clinic of Irkutsk State Medical University are presented. The complex of diagnostic investigations included laboratory methods, puncture biopsy, ultrasound, scintigraphy, CT scan, osteodensitometry and morphological investigations.

Results. There were 14 patients with a bone graft type, 21 patients had a mixed type, 14 patients had a visceral type. Errors in the interpretation and verification of the nature of bone pathology in 5 patients led to the unjustified traumatic interventions for "tumor" formations of bone structures, recurrent organ failure and progression of the underlying disease. In the largest (21 patients) group with a mixed type of the disease, 8 patients had a combination of renal, bone and cholangastral lesions. 6 patients were operated due to urolithiasis (one of them was operated twice), cholecystectomy was performed in 3 patients, gastrectomy was performed in 2 patients. Hypercalcemia was revealed in 14 (100%) patients with the bone disease. Hypercalcemia was diagnosed in 19 patients who had a mixed type. We believe that monitoring the level of calcium and parathyroid hormone, along with the clinical picture is important for determination of hyperparathyroid activity. In order to improve the diagnostics of PHPT based on the multivariate analysis (multiple regression), a model describing the predictors of complicated forms of PHPT was created. There are seven factors that significantly impact the outcome (Spearmen R): x1-age, x2-alkaline phosphatase of blood, x3-duration of the disease, x4-size of the PTG, x5-blood phosphorus, x6-parathyroid hormone, x7-blood calcium. The model was found to show the determination coefficient (RI = 0.63), and the significant (p <0.0000) - Y = - 0.27 - 0.11 × X1 - 0.11 × X2 + 0.30 × X3 - 0, 05 × X4 + 0.09 × X5 + 0.36 × X6 + 0.44 × X7. The most significant are the coefficients of the model x3 - duration of the disease, x6 - blood parathyroid hormone x7 - blood calcium.

Conclusions. Long-term and ineffective symptomatic treatment of patients with PHPT by doctors of diverse medical specialties, late ascertainment of the fact of the disease, and as a result the invalidization of patients emphasize the obvious interdisciplinary and social nature of this problem.

Taking into account the transient nature of normocalcemia in some patients at the initial stages of the disease, it is extremely important to evaluate this index in dynamics in comparison with the clinic and other laboratory data.

______________________________

THE PROBLEM OF IODINE DEFICIENCY IN THE REPUBLIC OF BURYATIA

N. A. Alekseeva

Research advisors:

I. F. Zolnikova, Ph.D, Biology, Assistant Professor

L. A. Nikolaeva

Chair of laboratory diagnostics

A.S. Dadueva Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Iodine refers to vitally important elements, it is not formed in the organism and is essential in forming thyroid hormones. These hormones serve asa “power station” that adjusts the work of the whole organism. On average, we need 150 mcg iodine every day. Iodine deficiency is responsible not only for goiter but formany other conditions. In pregnant womenit is associated with miscarriage, still birth, congenital anomalies, perinatal and child mortality, in children - with physical and mental disability, in newborns –with multiple malformations including mental retardation, deaf-mutism, strabismus, etc., and in all ages – with thyroid enlargement and dysfunctions such as hypothyroidism and nodular goiter. The problem of iodine deficiency has been receiving an increased attention in the Baikal region recently. Buryatia is one of the areas of Russia where natural iodine deficiency is well represented, largely forming population pathology.

Aim. To study the problem of iodine deficiency in the Republic of Buryatia

Materials and methods. To estimate iodine intake intothe organism at the population level we studied ioduriaindicators in 398 children aged 1–18. We estimated iodine deficiency severity level by the WHO (World Health Organization) criteria: iodine level in urine below 20 mcg/lindicates well expressed (severe) deficiency, from 20 to 49 mcg/l - moderate (moderately severe) deficiency, from 50 to 99 mcg/l -mild deficiency, iodine levelover 99 mcg/l is considered normal (WHO Guidelines, 2001). The spectrophotometric ceric-arsenic method was used.

Results. Insufficient iodine intake causes 65% thyroid diseases among adults and 95% among children. In all examined population the iodine excretion median is 75 mcg/l that shows weakly expressed iodine deficiency. However, mode calculation (mode is the most common ioduria index) showed the prevalence of urinary iodine index of 35 mcg/l, i.e. moderate forms of iodine deficiency.

Conclusions. Buryatia is an endemic region where water, soil and air containonly 10-30% required iodine. Iodine deficiency is first of all a decrease of intellectual potential. Children and teenagers not taking iodine preparations not only study worse but more often suffer from colds, digestive disorders, physical retardation. In the Republic a national programfor combating iodine deficiency disorders among populationhas been adopted and is being realized. The work is carried out at the up-to-date level, systematically, for a long time with an ultimate goal of elimination of iodine deficiency disorders.

______________________________

THE PROBLEM OF IODINE DEFICIENCY ON THE TERRITORY OF IRKUTSK

A. A. Pecherina, N. A. Alexeeva

Research advisors:

I. F. Zolnikova, Ph.D, Biology, Assistant Professor

L. A. Nikolaeva Chair of laboratory diagnostics

A.S. Dadueva Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Iodine deficiency includes a variety of human health disorders provoked by lack of iodine as a result of inadequate intake with food, malabsorption or active process of excretion. Iodine deficiency among children of cities of the Irkutsk region has the prevalence of 60 - 87% of the children surveyed.

Aim. To study the problem of iodine deficiency in children living in the city of Irkutsk.

Materials and methods. The study involved 472 children aged 1 to 12 years. The degree of iodine deficiency was assessed by the WHO criteria: the level of iodine in urine below 20 mg / l indicates pronounced (severe) deficiency, 20-49 g / l - moderate (moderately severe) deficiency, 50-99 g / l - mild iodine deficiency, level over 99 mg / l is considered normal (WHO guidelines to eliminate .., 2001). To determine urinary iodine the ceric arsenic spectrophotometric method was used.

Results. In Irkutsk, iodine deficiency was found in 86.9% of cases, in 55.5% severe and moderately severe forms of iodine deficiency were revealed. The urinary iodine excretion median was 5 mg%, the most frequently encountered iodine value (mode) was 3.5 mg%. District differences were revealed.Many locally produced food stuffs are characterized by low iodine content. Drinking water contains trace amounts of iodine, which is consistent with the published data on weak mineralization of Baikal and Angara water.

Conclusions. Thus, iodine is the most important trace element essential for normal development and functioning of the organism. In the regions endemic for iodine content in foods it is necessary to take special measures for the prevention of iodine deficiency disorders that manifest themselves in the form of violations on the part of almost all organs and systems. Food rich in iodine (seaweed, sea fish, etc.), products enriched with iodine, iodized salt and iodine preparations should be taken for prophylaxis.

______________________________

DIAGNOSTIC FEATURES OF ACUTE MESENTERIC ISCHEMIA IN URGENT SURGERY

S. O. Nepomnyashchikh

Research advisors:

A.P. Frolov, Doctor of Medical Science, Assistant Professor

Chair of General Surgery

Z.K. Poselova

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. An acute mesenteric ischemia (AMI) is a serious surgical problem that requires urgent medical and diagnostic measures. The lack of a clear clinical picture of the disease, difficulties in the early diagnosis of occlusion of mesenteric vessels leads to a high lethality (50-100%).

Aim. Evaluate the results of clinical and instrumental diagnostic methods of AMI.

Materials and methods. The retrospective analysis of 218 observations of AMI in patients who were treated in the clinic of the general surgery of the Irkutsk state medical university from 2009 to 2013 was performed. Patients were at the age of 74.90±0.74 years. There were 83 men and 135 women on admission.

Results. Diagnosis of AMI when entering the clinic presented certain difficulties. The correct provisional diagnosis was established in 69 patients. To diagnosethe disease, instrumental methods were used. Survey radiography (SR) of the abdominal cavity was performed in 131 cases. Pathology of the abdominal cavity was revealed in 84 cases. Of these, 60 cases showed signs of acute intestinal obstruction, 8 cases showed the presence of free gas in the abdominal cavity, in 1 case there was a combination of signs of acute intestinal obstruction and free gas in the abdominal cavity, in 15 cases there were intestinal pneumatosis. 47 cases showed no abnormalities in the abdominal cavity. In 88 cases, the SR was not performed. The ultrasound imaging of the cavity was performed in 178 cases. Changes in the abdominal cavity were detected in 100 cases. Of these, free fluid in the abdominal cavity was detected in 28 cases, in 15 cases, signs of acute intestinal obstruction, a combination of hydroperitoneum and signs of acute intestinal obstruction were detected in 3 cases, in 15 cases there were intestinal pneumatosis, in 40 cases another pathology of the abdominal cavity not related to the AMIwas detected. In 78 cases, pathology of the abdominal cavity was not revealed. Ultrasound imaging of the mesenteric vessels did not reveal any changes. In 78 cases, ultrasound imaging of the abdominal cavity was not performed. To specify the diagnosis, more targeted instrumental methods were used: computed tomography (CT) and laparoscopy. CT of the abdominal cavity was performed in 29 cases. Pathology of the abdominal cavity organs and retroperitoneal space was revealed in 26 cases. Of these, signs of AMI were detected in 8 cases, the other 18 cases showed another pathology. Laparoscopy was performed in 30 cases. In all observations, AMI was diagnosed.

Conclusions. In urgent surgery, AMI was diagnosed in 31.7% of cases in the presence of classic symptoms of the disease. In other cases, diagnoses of other acute surgical pathology, which requires instrumental research methods are made. Screening instrumental methods: SV and ultrasound imaging of the abdominal cavity are ineffective methods for AMI diagnosis. CT does not prove high expectations in making right AMI diagnosis. The most effective method of diagnosing AMI is laparoscopy.

______________________________

PREVALENCE AND CAUSES, EXAMINATION, CORRECTION OF ANATOMICAL DISORDERS OF FEMALE REPRODUCTIVE ORGANS AMONG WOMEN WITH HABITUAL MISCARRIAGE.OVERVIEW OF THE CLINICAL CASE

I. A. Letiagina, V. V. Lunkova

Research advisor:

D. A. Stupin Chair of obstetrics and gynecology with the course of child and adolescent gynecology

Z.K. Poselova Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. According to WHO, for several years, evidence of habitual miscarriage has comprised 20% out of all pregnancies and had no tendency to decline, despite numerous effective methods of diagnosis and treatment developed in recent years.

Aim. To determine the prevalence and causes, methods of diagnosis and treatment methods for patients with anatomical disorders of female reproductive organs, which lead to the habitual miscarriage of pregnancy.To analyze the policy of treatment of patients with doubling of uterus, cervix and vagina.

Materials and methods. Review of the current scientific articles. A study of the clinical case of a patient with a diagnosis: Pregnancy 38 weeks, cephalic presentation, urgent operative delivery. Compromised obstetrical medical history.Uterine scar after the delivery through cesarean section.Doubling of uterus, cervix and vagina.Chronic fetoplacental insufficiency.Pfannenstiel incision.Cesarean section.Statistical data analysis.

Results. Habitual miscarriage comprised 2% of the total number of pregnancies among women. The incidence of anatomical disorders in the structure of habitual miscarriages varies from 10 to 16%. In the structure of congenital anatomical anomalies, a bicornic uterus occupies the leading position - 37%, followed by an intrauterine septum - 22%, an arcuate uterus - 15%, a total doubling of the uterus - 11%, a unicornuate uterus - 4.4%. Acquired anatomical defects: ischemic-cervical insufficiency - 40%, uterine myoma - 5-6%.

Conclusions. A thorough medical history needs to be taken during the treatment and diagnosis of a group of patients with anatomical disorders. If a possible anatomical defect is suspected, a thorough diagnosis should be made. The decision about surgical correction and the correction method is determined strictly individually. It is possible to plan pregnancy without surgical correction of the anatomical defect, with the correct assessment of possible risks for the expectant mother and fetus.

______________________________

ALCOHOL-ASSOCIATED MORTALITY: THE GENDER AND AGE CHARACTERISTICS, THE ANALYSIS OF ECONOMIC LOSSES IN IRKUTSK REGION

Y. G. Dareeva

Research advisors:

T. I. Alekseevskaya, Doctor of Medical Science, habil.

Chair of Public Health

Z. K. Poselova Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The premature mortality due to alcohol consumption is one of the most significant medical and social problems. It leads to great problems for public health, economic and moral damages in Irkutsk region.

Aim. To study the dynamics of alcohol-associated mortality among the population, its social and economic consequences in Irkutsk region.

Materials and methods. Statistic method, content analysis, the PYLL method (Potential Years of Life), monographeses, accounting and reporting documents.

Results. The PYLL indicator for the urban male population constituted 5,865.9 lost years in 2011, and 5924 lost years in 2013. There were 97.2 and 98.2 people who could have lived 60.3 years (average life expectancy in Irkutsk region). For the female populations there were 1183.8 and 1198.6 constituting 16.2 and 16.4 people aged under 73.3 (average life expectancy). The analysis showed 1539.8 and 1565.8 for the male population at rural area that comprised 25.5 and 25.9 people. It was 312.3 and 309.7 for female constituting 4.3 and 4.2 person, respectively. The non-violent death research revealedamong the male population there were 3535.5 lost years in 2011 and 4031.1 in 2013 constituting 58.6 and 66.9 people. For the female population - 941.1 and 1068.4 lost years that equal 12.8 and 14.6 persons respectively. The violent death analysis revealed 3870.2 and 3464.8 lost lives for males equal 64.2 and 57.5 persons. It was 1035.5 and 935 lost years comprising 14.1 and 12.8 person for the female population. The economic loss was increased from 26.9 to 34.1 billion rubles during the period of 2011-2013 in Irkutsk region.

Conclusions. A considerable loss is formed in the most productive age group among the male and female population. Economic losses increase owing to premature mortality of active population as well. It’s necessary to control production and circulation of alcohol, to carry out prevention of alcoholism and to contribute to a healthy lifestyle.

______________________________

THE INFLUENZA, ACUTE RESPIRATORY VIRAL INFECTION AND PROPHYLACTIC MEASURES IN REPUBLIC OF BURYATIA

K. S. Khankhareev

Research advisors:

M. V. Lemeshevskaya, Doctor of Medical Science

Chair of infectious diseases

Z. K. Poselova, A.A. Sazonova

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The incidence of influenza and acute respiratory viral infections is one of the most urgent health and socio-economic problems. According to the analysis of infectious and parasitic diseases, the prevalence of SARS and flu is about 70% every year. In the period from 2006 to 2009 the increase of influenza and acute respiratory viral infections by 22, 8% in the Russian Federation and by 56.1% in the Republic of Buryatiawas registered. The main method of specific prevention of influenza is annual vaccination of the population that can prevent the occurrence of the disease by 80-90% in children and adults.

Aim. The evaluation of the incidence of SARS and influenza in Republic of Buryatia and the vaccination of population.

Materials and methods. The information was taken from the state reports "About the sanitary-epidemiological situation in the Republic of Buryatia for 2015-2016." then the results were selected, analyzed and systematized.

Results. Monitoring of immunization against influenza in the Republic of Buryatia has shown that from 35 to 43% of the population had been vaccinated in recent years annually. In

autumn 2016, 140,800 children and 197,200 adults were vaccinated against influenza according to the National calendar of preventive vaccinations. In the epidemic season 2016-2017 the seasonal increase of SARS and influenza was noted, but the incidence didn’t exceed the epidemic threshold in Republic of Buryatia. The influenza was registered in 78 people, while during the epidemic period in 2009 722 patients fell ill with highly pathogenic avian influenza during 2 months (November - December), the index of the diseases was 142.3 per 100 thousand of population.

Conclusions. 1. The annual vaccination of the population is the main factor in the prevention of influenza. 2. The prolonged analysis of the diseases showed that a high level of immunization against flu in the population reduces the incidence and severity of the course not only of influenza but also of ARVI too. 3. The use of nonspecific preventive measures against influenza and ARVI is less expensive and hasa significant effect on reducing the incidence of the diseases.

______________________________

NON-ALCOHOLIC FATTY LIVER DISEASE AS A RISK FACTOR FOR ATHEROSCLEROSIS IN YOUNG ADULT

I. A. Letiagina, A. A. Kratova

Research advisors:

O. V. Tirikova

Therapeutical Chair by University’s clinics

E.A. Fedina Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Current data confirms that non-alcoholic fatty liver disease (NAFLD) increases the risk of cardiogenic events and reduces lifespan.

Aim. To determine early atherosclerosis signs in young patients with NAFLD.

Materials and methods.  47 patients aged 25-44 yearswere examinedon the basis of the therapeutic Department of ISMU Faculty Clinics.The core group included 27 patients with NAFLD: the average age is 36.5 years [me 37, min25, max44]10men and17women, and control group consisting of 20 healthy volunteers: man age of 35.2 [me34,5, min25, max44] 7men and 13 women. General clinical examination included: lipid profile, duplex scanning of the carotid arteries, evaluation of endothelial dysfunction (reactive hyperemia test).

Results. In patients with NAFLD (n=27) non-alcoholic steatosis was detected in 52% (14), and steatohepatitis in 48% (13) of all cases. In the core group 56% (15) of patients exhibited concomitant diagnosis of hypertension; at 3.7% (1) coronary heart disease and 3.7% (1) diabetes mellitus. Anthropometric study of the core group showed that excess body weight was identified in 41% (11) of the cases,1 degree obesity had 33% (9), 19% (5) had 2 degree obesity, 7% (2) had 3 degree obesity. The study of lipid metabolism in two groups revealed that patients in the core group were sufferingfrom hyperlipidemia and dyslipidemia (in comparison with the control group).Endothelial dysfunctionwas not revealed neither in the control group, nor inthe coregroup. ED was detected in 70% (19) of patients and in 30% (8) ED was not detected.Vasodilation of brachial artery options while conducting the test with reactive hyperemia in patients of core and control groups found out the following results: increase of brachial artery diameter in-phase reactive giperemiaof core group showed 7.5 %, whereas in the control group it was 17.1%, which is greater than the 2.3 times (r < 0.001). Examination of the carotid arteries showed significant enlargement of the thickness of the intima-media and tunica of arteries, in the core group compared with the control group it was 0.92 and 0.62 respectively (p<0.001), which is an early manifestation of subclinical atherosclerosis.

Conclusions. Obtained results reveal the relationship between NAFL Dand cardiovascular disease. Thus the topical question is the necessity of introduction vessels analysis of NAFLD patients for early diagnosis of atherosclerotic changes. It is necessary to develop preventive measures against developing of circulatory system diseases.

______________________________

EVALUATION OF CLINICAL EFFECTIVENESS OF PREGRAVID PREPARATION WOMEN WITH THIN ENDOMETRY, INSUFFICIENCY OF LUTEIN PHASE, SYNDROME OF POLYCYSTIC OVARIES

E. V. Pyatko

Research advisor:

V. V. Florensov, Doctor of Medical Science, habil., Professor

D. A. Stupin

Chair of Obstetrics and Gynecology with a course of children and adolescents gynecology

E.A.Fedina Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The periconceptional and pregravid preparation (PP) of women with gynecological diseases is subject of numerous discussion. It is known that the reproductive health of women with disorders of receptor apparatus and the functional activity of the endometrium need restorative treatment, including complex therapy of chronic endometritis. The early diagnosis of luteal phase defect and other abnormalities of the menstrual cycle is necessary for prevention primary placental insufficiency and recurrent pregnancy loss. Due to the fact that about 40% of pregnancies in patients with polycystic ovary syndrome end in spontaneous termination, it is interesting to study the pathogenetic features of pregravid preparation in this pathology.

Aim.To  evaluate the clinical benefit of pregravid preparation of women with a history of violations of the functional activity of the endometrium, luteal phase deficiency, polycystic ovary syndrome.

Materials and methods. The analysis of 193 "Medical cards of the pregnant and puerperas" in “IPC” during the period of 2014-2016 was made using the method of continuous random sampling. During the study the patients were divided into 3 groups depending on the identified pathology: A (patient with infringement of functional activity of the endometrium), B (violation of the luteal phase - LPI), C (polycystic ovary syndrome - PCOS).

Results. Among analyzed cards the cards of group A patients predominated (40.3 per cent).Anamnestic confirmed ILP was detected in 15.3%, PCOS in 12.5% of cases. It was noted that among A group patients the second pregnancy women prevailed (65.7%). In C group the first pregnancy women predominated(78%). In group A the previous pregnancies(more than half of the cases 72,4%) ended with miscarriage and only 27.6% with births. In group B, 82% of patients were hospitalized with the threat of interruption of pregnancy (UPB), receiving micronized progesterone at prescribed doses, as a result 71% of cases resulted in delivery. In group C, while preparing for pregnancy, 89% of women took COC, metformin. Almost half of the patients of this group (46%) had a history of ovulation stimulation with the use of progestogens in the 2nd phase of the cycle, which ended in pregnancy in 75% of cases. There were also those who had laparoscopic interventions (54%), however, only 30% of women result in a pregnancy.

Conclusions. The study showed that in a group of patients with a violation of the functional activity of the endometrium, whose pregnancies ended in miscarriage, after the preparation with progesterone therapy, a second pregnancy occurred in 89.5% of cases. Due to the conducted hospital therapy with micronized progesterone the pregnancies of the group of patients with insufficiency of luteal phase in 71% of cases ended with childbirth. The use of COC in combination with gestagens in the second phase of the cycle in women with PCOS with ovulation induction improved the prediction of pregnancy (75%).

______________________________

CLINICAL AND FUNCTIONAL FEATURES OF MYOCARDIAL INFARCTION ACCORDING TO THE PRESENCE OF ATRIAL FIBRILLATION

O. B. Zabadaeva, I. O. Abramenko, E. A. Vyatkina

Research advisor:

N. M. Kozlova, Professor

Therapeutical Chair by University’s clinics

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice.

Aim. The purpose of this manual is to evaluate functional laboratory features of Clinical characteristics and Quality of life in myocardial infarction (MI) , depending on the AА.

Materials and methods. Overall, 42 patients with MI who have the concomitant atrial fibrillation (AF) were included in this prospective study. The clinical diagnosis of myocardial infarction is verified by ESC. In this study we used the ESC criteria for the diagnosis of myocardial infarction. The patients were divided into three groups depending on concomitant AF: Group 1 - 13 myocardial infarction patients (MI) with chronic AF; Group 2 - 15 MI patients with persistent AF and Group 3 – MI with paroxysmal AF (14 patients).We have conducted a large-scale comparative evaluation of levels fasting of blood glucose, glycated hemoglobin (in HbAlc), total cholesterol (TC) and serum creatinine.Quality of life was assessed using the "SF-36 Health Status Survey" (SF-36) questionnaires. The results were reported as a mean (M) ± standard deviation (SD). The one-way analysis of variance (ANOVA) was used to determine statistically significant differences. Types of relationships were conducted with the Pearson correlation. Statistical hypothesis testing shows the level of critical significance at р<0.05.

Results. The First group of patients with BMI 25,08 ± 2,7, the second group - 27,59 ± 4,8 and the third group- 28,14 ± 3,5 (p = 0.02). Three groups of patients were comparable for age: 70 ± 3, 65 ± 3 and 63 ± 4 years, respectively (p = 0.1). Significant differences were observed in the biochemical parameters between the first and the third groups (4.9 ± 0.5 and 5.4 ± 0.7 mmol / l , p = 0.04), and (between group 2 and group 3) between the second and the third groups ( 4.8 ± 0.5 and 5.4 ± 0.7 mmol / l, p = 0.027) HbA1c (%) levels were significantly higher in group 3 compared with group 1 (5.68 ± 4.86 and 0.4 ± 0.7 mmol / l , p = 0.002), and also with group 2 ( 5,68 ± 0,4 and 4,91 ± 0,5 mmol / l, p = 0.0008). An ejection fraction (EF) levels were -31±2 9, - 43±2,3, -52±4,1 (р=0,0001) in groups 1 ,2 and 3 , respectively. Significant differences were observed in Physical Functioning — PF between the first and second groups( 27 ± 3,3 and 24,26 ± 3,1 points, respectively , p = 0.0096); between the 1st and the 3rd groups of 27,69 ± 3,3 and 34 ± 5,9, respectively (p = 0.0025). Role Emotional (RE) level was significantly higher in group 1 compared with group 3 (34,92 ± 4,2 and 33,85 ± 3 points , p = 0.0026). Significant differences were observed in the level of Physical Functioning (PF ) between the first and the 3rd groups ( 34,46 ± 2,3 and 31,57 ± 4,9 points, p = 0.04). Significant correlations were found between group 2 and group3 in the level of self-esteem(9,26 ± 8,6 and 61,14 ± 3,5 points, p = 0.0001.

Conclusions. Patients with permanent AF and MI had ejection fraction less than patients with persistent and paroxysmal AF. Levels of cholesterol and HbAlc were higher in patients with MI and paroxysmal AF compared to MI patients with permanent and paroxysmal AF.

______________________________

RESULTS OF URGENT SURGERY TREATMENT OF ABDOMINAL TUBERCULOSIS inHIV-positive PATIENTS

A. V. Shevchenko, А. A. Potapov

Research advisors:

D. B. Soktoev, Doctor of Medical Science Chair of General Surgery

Ju.N. Timofeeva

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk state medical University, Irkutsk, Russia

Relevance. Irkutsk region has one of the most unfavorable epidemiological tuberculosis (TB) situation in Russian Federation. The majority of TB patientshave HIV-Infection.Due to these facts the number of HIV-positive TB patients is growing steadily. The abdominal tuberculosis (AT) is still quite rare pathologyamong extrapulmonaryTB cases. But the overall growth of TB in HIV-positive patients leads to increasing incidence of these diagnoses in urgent surgery.

Aim. To study the effectiveness of diagnosis and treatment of HIV-positive AT patients in urgent surgery.

Materials and methods. A retrospective analysis was conducted based on the observation of 21HIV-positive AT patientsbeing on treatment during 2013-2015 at the General surgery clinic of the Purulent Surgery Department of Irkutsk City clinical hospital №1.The age of HIV-positive AT patients was from 21 to 44 years old, average agewas 33.0 (31.1-36.5), 18 of them were men and 4 women.

Results. 6 HIV-positive patients had AIDS. 16 patients, in addition to specific lesions of the abdominal organs, had tuberculous lesions of the lungs. Some patients had serious concomitant tuberculous pathology.2 patients had pneumonia, 1 had exudative pleuritis and 1 had thrombocytopenia which was complicated by the intestinal bleeding. 16 patients hadabdominal X-ray examination,the radiograph of 8 of themrevealed free gas in the abdominal cavity, 2 of the 16 patients had signs of acute intestinal obstruction. Abdominal ultrasound was carried out at 14 patients. 12 patientshad free liquid in the abdomen, 2 patients had lymphadenopathy in the portahepatis. All the patients were operated on.During surgery in all cases diffuse purulent peritonitis was detected, the main causes of this condition were perforation of tuberculous intestinalulcer(13) and abscessing mesenteric lymphadenitis. 9 operated patients received the programmed relaparotomy. During the operation the sampling of abdominalexudate was taken from all the patients for subsequent bacteriological studies of nonspecific microflora and its sensitivity to major antibiotics. During bacteriological examination of the abdominal exudatestaphylococcus aureus (9), citrobacterfreundii (6), escherichia coli (5)were mostly isolated. Sensitivity of selected bacterial cultures was quite high (from one to eight antibiotics), among which the prevalent areimipenem, Meropenem, Cefepime.AT diagnosis was confirmed by histological methods.Only one complication was noted in the postoperative period, it wassuture failure after perforated ileum ulcer excision.

Conclusion. The main cause of peritonitis is perforation of tuberculous ulcers of the intestine and abscessed mezadenitis.The lack of early AT diagnosis, its combination with lung TBand septic complications together withsevere immunodeficiency lead to complicated methods of treatment and high mortality rate (47.6%or 10 patients).

______________________________

CLINICAL CHARACTERISTICS OF COMPLICATIONS OF DIABETIC FOOT SYNDROME PATIENTS

IN GENERAL SURGICAL HOSPITAL

I. F. Bokovikov, S. O. Nepomnyashchikh

Research advisors:

A. P. Frolov, Doctor of Medical Science, Assistant Professor

Chair of General Surgery,

V.V. Litvinenko, Doctor of Philology, Assistant Professor

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. In the last decade the problems associated with various complications of diabetes mellitus (DM), are attracting increasing interest. This is due to the annual increase in the detection of 5-7% of cases of DM, and their doubling every 10 years. Currently, diabetes affects at least 4-5% of the world population. In Russia in 2000, there were about 3 million. In 20-80% of cases diabetes leads to the development of specific complications – the diabetic foot syndrome (DFS), which in 50-75% of cases leads to amputation of the limb.

Aim. To analyze the clinical manifestations of the complications of DFS patients, who were treated in General surgical hospital.

Materials and methods. A retrospective analysis of 151 cases of DFS patients who were treated in the General Surgery General Clinic of Irkutsk State Medical University in 2013. The average age of the patients was 63.6±1.0,among them men were 87 (57.6%) persons, women were 64 (42.4%) persons.

Results. Among 151 patients with complications of diabetic foot, 12persons (7.9%) had diabetes oftype 1, 139 persons (92.1%) had type 2. During hospitalization of patients with average level ofglucosein blood was 10.6±0.4 mmol/l, the level of glycerinogenes hemoglobin is 8.9±0.2 at the proper 7.6±0.2. All 151 patients had diabetic angiopathy including: microangiopathy in combination with macroangiopathia in 133 patients, macroangiopathia in 5 patients, microangiopathy in 13 patients. Diabetic neuropathy was 140 observations that determined the neuroischemic form of DFS. 11 patientshad ischemic form of DFS, neuropathic form was absent. Retinopathy was noted in 6 observations,arthropathy in 30 cases, nephropathy in 27 cases. In accordance with the classification of DFS F. Wagner (1981) stage 0, which is manifested by cellule, was in 7 cases, stage 1 in 19 cases, stage 2 in 11 cases, stage 3 in 32 cases, stage 4 in 45 cases, stage 5 in 37 cases. The defeat of both feet occurred in 32 cases, right foot in 62 cases, left foot in 51 cases. The average duration of purulent-inflammatory complications amounted to 31.4±3.3 day. The vast majority of patients (140) had comorbidities: CHD in 106 cases, arterial hypertension in 129 cases, and obesity in 28 cases. In 119 cases patients took simple insulin at a dose of 23.8±0.5 UA/day, of which 109 cases were combined with the intake extended insulin at a dose of 27.2±1.3 UA/day. In 14 cases, the insulin was combined with the intake of tableted hypoglycemic drugs. In 12 cases the level of glucose was corrected just by tableted drugs, in 6 cases correction by medical drugs was not conducted.

Conclusions. In the Department of purulent surgery, patients with stage 3-5 of DFS at Wagner are 75.5%. In the majority of cases (92.7%) patients reported the presence of neuroischemic form of DFS. Patients arehospitalizedafter 1 month from the beginning of the development of septic complications, with a high level of glycerinogenes hemoglobin and blood glucose on the background of continuous use of relatively high doses of simple and prolonged insulin.

______________________________

PREVALENCE OF BREASTFEEDING of Infants OF THE CITY OF IRKUTSK

E.V. Pyatko, R.О. Hamitova, N.N. Arsentieva, G.М. Kodzoeva, V. V. Slepchenko

Research advisors:

O. I. Ptichkina, Doctor of Medical Science, Assistant Professor

Chair of children diseases

V.V. Litvinenko, Doctor of Philology, Assistant Professor

Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Full and well-adjusted nutrition plays an extremely important role in the life of the child. It is well-known that breastfeeding has no equivalent among all other methods of feeding the baby and "is the gold standard of optimal nutrition which is proven by millennial evolution." The nature of feeding largely determines the health of the child not only at an early age, but also in subsequent periods of his life. Proper nutrition of children ensures their normal growth and development, contributes to the prevention of most diseases and prevents the possibility oftheir chronization.

Aim. To study the prevalence of breastfeeding ofinfants.

Materials and methods. Study design: by using the method of total sampling the analysis of 751 "Histories of the development of the child" (112) was conducted in the "CKH №10" during the period 2013-2015. The study identified 3 groups of infants depending on the method of feeding: N (natural), A (artificial), M(mixed).

Results. A total of 751 cards were included to the study among which 91,1% (684) children were born full-term, and 8,9% (67) were premature. Group N included 92.1% (691) children, in group A- 34.3% (250). During the analysis it became known that 17.2% of children were on artificial feeding since birth. In the course of statistical treatment, 94.3% (707) of children were breastfed until 1 month, 86% (645) to 2 months, 79,4% (595) to 3 months, 74% to 4 months (554), to 5 months - 69.4% (520), up to 6 months - 66.2% (496), up to 7 months - 62.3% (467), up to 8 months - 60.4% (453), up to 9 months - 58% (435), up to 10 months - 55.1% (413), up to 11 months - 52.3% (392). Up to a year only 46.7% (350) of children were breastfed. Of the 751 studies, complementary feeding was introduced: from 4 months in 12.1% (91), from 4.5 mon. - 0,8% (6), from 5 mon -32,3% (242), from 5,5 mon - 1,1% (8), from 6 mon - 31,1% (233), from 7 mon. - 6% (45), from 8 mon - 0.8% (6), from 9 mon. - 2,1% (16), from 10 mon. - 0,7% (5), from 11 mon. - 0,4% (3), from 12 months. - 0.1% (1). In case of artificial feeding, the following mixtures are used mainly: Similak in 31.2% of cases (78), Nestozhen in 16.4% (41), Malyutka - 11.6% (29), NAS - 37.6%. As a complementary food, most of the children had purees and juices.

Conclusions. Thestudies have shown that natural feeding is a common method of breasteeding children in the first year of life. Its level in Irkutsk remains quite high (92.1%). It was noted that the rates of breastfeeding of children under 3 months (79.4%) are higher than those in Russia - 40% according to I.N. Zakharova, E.V. Lykina. The age of the first introduction of complementary foods in most cases corresponds to the standards of the national program for the optimization of feeding children of the first year of life in the Russian Federation.

______________________________

PROBLEMS OF NUTRITION OF PUPILS IN IRKUTSK

E. Danilova, T. Manuev

Research advisors:

R. S. Manueva, Doctor of Medical Science, Assistant Professor

Department of General Hygiene

A.A. Sazonova Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. The proper organization of children’s and adolescent’s healthy nutrition is very important both as a factor maintaining health and a factor determining the health of future generations.

The research results showed that over the past few yearsstudents’ health deterioration had beensignificantly increased.The adverse dynamics of youthhealth is getting worse as they are learning at school.Increasing the incidence of school-related diseases is marked.

Aim. To assess the nutritional quality in different schools as well as the content of basic nutrients, vitamins and minerals in school diet.

Materials and methods. The study was carried out among children and adolescents of high schools and secondary schools in Irkutsk (School №49, Gymnasium №3). The evaluation of the school actual nutrition was conducted by a questionnaire survey and the method of analyzing the menu caloric record from January to December 2015-2016. The chemical composition of the food included in the students’ menuwas estimated by the calculation method according to the reference book "Tables of the chemical composition of Russian food products" (2007). The obtaineddata was compared with the norms of MP 2.3.1.2432-08 "Norms of Physiological Needs for Energy and Food Substances for Different Populations".

Results. Theanalysis of dietary chemical composition madeat schools in Irkutsk showed their nutritional disbalance, insufficient intake of vitamins, macro- and micronutrients.It was done on the basis of the menu caloric recordscomparingthem with the recommended consumption norms.

Thus, there has been an increased intake of all nutrients with a predominantly carbohydrate component both in students of high schools and secondary schools in the younger age group and girls older than 11 years. The conservativevolume of high-quality animal proteins and fats was identified instudents ofsecondary schools.Identified negative outcomes affected the energy value of food and were expressed asa disbalance.

The reduced content of vitamin A, vitamins B, E, C, PP, as well as mineral elements (Calcium, Phosphorus, Magnesium, Iron and Iodine) has been marked in all the diet. Only 15% of learners constantly follow their meal plan; 46% break it systematically, 39% follow it, but not always. An assessment of the learner’sactual nutrition in Irkutsk was made. It was done on the basis of a questionnaire survey of the consumedfood amount. Thefrequency analysis method aimed at collecting and processing of data on food consumption was used. The prepared questionnaire made it possible to obtain data on nutrition peculiarities.

Conclusions. Nutrition that students get in all types of schools in Irkutskis not balanced inessential nutrients. The insufficient intake of vitamins, macro- and micronutrients has been identified. The provided food did not match the menu caloric record and its volume.

______________________________

CONTENT OF VITAMIN C IN VEGETABLES REALIZED

IN IRKUTSK TOWN

N. A. Tarmaeva

Research advisors:

V. I. Bakhtairova, Doctor of Medical Science

Chair of Biochemistry and Chemistry

I. N. Kukushkina, Doctor of Philology, Assistant Professor Chair of Foreign Languages with Latin and “Russian for Foreigners” Programs

Irkutsk State Medical University, Irkutsk, Russia

Relevance. Micronutrients are related to irreplaceable food substances and necessary for the normal implementation of all biochemical processes in the body: metabolism, growth and development, protection from diseases and environmental hazards. Ascorbic acid is involved in many important fermentative reactions associated with redox reactions of tryptophan, corticosteroids, etc., has a beneficial effect on the functions of the central nervous system, stimulates the activity of the endocrine glands, promotes better absorption of iron and normal hematopoiesis, increases a person's resistance to extreme effects, prevents the formation of nitrosamines which are strong carcinogens.

Aim. Taking into account the high importance of vitamin C in nutrition, we conducted research on the content of vitamin C in vegetables coming for sale to the population of Irkutsk.

Materials and methods. The method is based on extraction of ascorbic acid, reduction of 2,6dichlorophenolindophenolate sodium ascorbic acid, followed by extraction with an organic solvent (xylene or butyl acetate) of excess 2,6 dichlorophenolindophenolate sodium and photometry of this extract at 490 nm.

Results. The results of laboratory studies show that in vegetables, the amount of vitamin C in comparison with the data specified in the "Handbook of the Chemical Composition of Russian Food Products" is insufficient in both the autumn and the spring periods. The amount of ascorbic acid in cabbage decreased on average to 16.2 mg%, in potatoes to 4.0 mg%, in carrots to 2.4 mg%, onion 6.3 mg%, beet 2.6 mg%. Low content of ascorbic acid in vegetables due to improper and long-term storage, improper culinary processing: non-observance of optimal cooking times, long storage in water, cooking in open dishes - all this is the cause of widespread C-hypovitaminosis in winter-spring period.

Conclusions. In this situation, the most effective and, at the same time, economical means of cardinally improving the vitamin status and preventing polyhypovitaminosis are the regular intake of multivitamin preparations for preventive purposes, the choice of enriched foods.

______________________________

RESEARCH STUDY OF APOE GENE, APOLIPOPROTEIN E

U. Battulga Uyanga

Research advisor:

B. Biziya Baasanjargal, Doctor of Medical Science Department of physiology

Mongolian National University of Medical Sciences, Ulan Bator, Mongolia

Relevance. Currently from the following apolipoproteins were identified in the lipoprotein particle fractions: ApoA1, ApoA2, ApoA4, ApoB, ApoC1, ApoC2, ApoC3, ApoC4, ApoD, ApoE, ApoF, ApoL, ApoM, and lipoprotein(a). The gene APOE we stress in our study is one of the genes that increases the incidence of ischemic heart disease. The APOE gene mutation becomes the cause of is an abnormal amount of lipids in the blood (Dyslipidemia), obesity, coronary heart disease, diabetes, stroke, metabolic syndrome, and Alzheimer's disease. APOE gene is located in the q13.2 of 19th chromosome and its function: The APOE gene provides instructions for making a protein called apolipoprotein E. This protein combines with fats (lipids) in the body to form molecules called lipoproteins. Lipoproteins are responsible for packaging cholesterol and other fats and carrying them through the bloodstream. There are at least three slightly different versions (alleles) of the APOE gene. The major alleles are called e2, e3, and e4. The most common allele is e3, which is found in more than half of the general population. There are three types of the APOE gene, called alleles: APOE2, E3 and E4. Everyone has two copies of the gene and the combination determines your APOE "genotype"—E2/E2, E2/E3, E2/E4, E3/E3, E3/E4, or E4/E4. The E2 allele is the rarest form of APOE and carrying even one copy appears to reduce the risk of developing Alzheimer's by up to 40%. APOE3 is the most common allele and doesn't seem to influence risk. The APOE4 allele, present in approximately 20% of people, increases the risk for Alzheimer's and lowers the age of onset. Having one copy of E4 (E3/E4) can increase your risk by 2 to 3 times while two copies (E4/E4) can increase the risk by 12 times [2].

Aim. Our research aims to study RS429358 and RS7412 polymorphism and identify which genotype of APOE gene dominates in Mongolian people

Materials and methods. APOE gene rs429358 and rs7412 variants were genotyped for ϵ2, ϵ3, ϵ4 alleles using ischemic heart disease in 96 subjects.

Results. Furthermore, people who contains any of E2 type of genotypes are less risky to have cardiovascular diseases. Although the E2/E2 genotype carriers incur the third type of hyperlipoproteinimia. But E4 carriers have more high risks to increase holesterine and lipoprotein of low density and to have heart attacks, atherosclerosis and Alzheimer’s diseases. In addition, overweight people have different ways to lose weight because of genotype distinction. It is more effective to recommend the diet to use more foods that contain carbohydrates to the people of E2 and E4 type from who have obesity due to the increasing level of holesterine in blood.

Conclusions. Isoforms are distinguished according to amino acid as Apo-E2-112cys- 158cys, Apo-E3-112cys- 158arg, Apo-E4- 112arg- 158arg and it is different in every nations.

______________________________

STREPTOCOCCUS MUTANS EFFECTED IN HGF CELLS BY ALTERING INTRACELLULAR CA2+ SIGNALING

M.Erkhembaatar Munkhsoyol, D. Boldbaatar Damdindorjyt

Research advisor:

M. W. Kim Min Seuk, Doctor of Medical Science, habil. Department of physiology

Wonkwang university, Korea Mongolian National University of Medical Sciences, Ulan Bator, Mongolia

Relevance. Streptococcus mutans (S. mutans) is a facultative anaerobic bacterium mainly found in the oral cavity and is known to contribute to tooth decay and gingivitis. Recent studies on intestinal microbiota have revealed that microorganisms forming a biofilm play important roles in maintaining tissue homeostasis through their own metabolism.

Aim. However, the physiological roles of oral microorganisms such as S. mutans are still unclear.

Materials and methods. In our current study, we identified that constituents released from S. mutans (CR) reduce arecoline mediated cytotoxicity without producing toxic effects themselves. Arecoline, as a major alkaloid of areca nut, is known to mediate cytotoxicity on oral epithelial cells and induces a sustained intracellular Ca2+ ([Ca2+]i) increase that is cytotoxic.

Results. The exposure of human gingival fibroblast (HGF) cells to CR not only inhibited the sustained [Ca2+]i increase but also the initial [Ca2+]i elevation. In contrast, CR had no effects on the gene regulation mediated by arecoline.

Conclusions. These results demonstrate that S. mutans has physiological role in reducing cytotoxicity in HGF cells and may be considered a novel pharmaceutical candidate.

______________________________

CARDIOVASCULAR ADAPTATION MONGOLIAN CHILDREN’S

B. Saikhanbayar, G. Achsaikhan, B. Batkhishig

Research advisors:

M. Otgon Galsanjav, Doctor of Medical Science, habil., Professor

G. Zandarmaa Zunduidavaa Chair of Physiology Mongolian National University of Medical Sciences, Ulan Bator, Mongolia Songdo clinic, Ulan Bator, Mongolia

Relevance. Mongolia is a landlocked country. The total land area of Mongolia is 1,564,116 square kilometres. The territory contains very little arable land and forest, as much of its area is covered by steppes, with mountains to the north and west and the Gobi Desert to the south. The remarkable feature of Mongolia's climate is extremely cold winter, shiny summer and more than 250 cloudless days a year. Average temperature in January is - 300C and in July more than 300C. The country has unpredictable weather and average of 10-35 cm precipitation per year depending on region. Some regions of Gobi receive no precipitation the whole year. Above factors influenced on health peoples. Also, air pollution has major health impacts on people living in Mongolia, in particularly in Ulaanbaatar. The excessively high particulate matter concentrations, especially in the winter and in the ger areas, increase the incidence of heart and lung diseases, and lead to premature deaths.

Aim. The aim our study was to detection air pollution of capital city Mongolia- Ulaanbaatar and regions and influence its on cardiovascular(CV) adaptation children’s.

Materials and methods. We did retrospective analyses of data between 1989 - 2011 of air pollution of the Ulaanbaatar and 4 regions of Mongolia. We are used average of air pollutants during 24 hours, the toxicity by maximum allowable concentration. Also used AQI, that showed effect concentration of one elements and effect on health. For revealing toxicity effects on human health we are studying blood pressure and arterial pulse, adaptation index(AI), that showed CV function.

Results. Concentration SO2 in air of the studying regions and Ulaanbaatar has tendency to increasing, NO2 - from 1993 years. In particularly, average years of concentration SO2- in air of Ulaanbaatar strongly increased at 2010, 2011 year, NO2 – in 2007, 2011 year. Air pollution of Ulaanbaatar determined by AQI as, “danger”. We revealed that boy and girl, aged 8-17 year in Ulaanbaatar had percent of normal AI (69.2-95.6%, for boys - 78,8%, for girls - 84,4%) and low level CV adaptation had child Ulaanbaatar, than other region. Determined negative correlation between arterial pressure boys of Ulaanbaatar and SO2 (r=-0.4), NO2 (r=-0.9), between arterial pulse girls Ulaanbaatar’s and atmosphere pressure (r=-0.6), air temperature (r=0.7), SO2 (r=0.8).

Conclusions. The data showed, that percent of children Ulaanbaatar’s with bad CV adaptation was higher, than other region’s (р≤0.001).

______________________________