Journal «MEDICINA» 2/2016

Оver half of a century neuroprotective drugs are widely used in treating various neurological diseases. However, with the implantation of the principles of evidence-based medicine is still no clear answer how effective each of these drugs. In this work we are using statistical methods to collate the published data on the efficacy of the three drugs – cerebrolysin,cortexin and сellex. During the work we are faced with significant challenges in conducting the statistical data for all these drugs. The main obstacle for combining data for meta-analysis are marked differences in the design of clinical trials. We were able to find meta-analytic studies or combine data from clinical trials and conduct own statistical analysis only for cerebrolysin. Published data for cortexin and cellex are extremely heterogeneous and do not allow them to evaluate. Thus, as a result of this work we can conclude that the only evidence of the efficacy cerebrolysin has the highest level (1A) in vascular dementia and Alzheimer's disease. Unambiguous conclusion about the effectiveness ofneuroprotectivedrugsin treatment of ischemic stroke on the basis of published data can not be done, further study are needed.

Key words: cerebrolysin, cortexin, сellex, meta-analysis

The article deals with the problems of anesthesia in operations of gynecologic oncology. 421 patients were included in this study with simple hysterectomy. Divided into 3 groups, the division into groups was carried out in accordance with the applicable methods of intraoperative analgesia. In all study groups the method of multimodal balanced analgesia was used. In group 1 additionally used epidural analgesia, Group 2 was the control, without epidural analgesia. In group 3 was used adjuvant analgesic gabapentin before surgery at a dose of 600 mg. In operation, a significant difference was detected between groups by the presence of intensity of pain in the postoperative period for the 72 hours after awakening. The study confirms the efficacy of patient-controlled epidural analgesia by calculating the profile of pain intensity on a visual analog scale at rest and when coughing. It is proven to reduce the need for opioid analgesics in the stages of surgery and in the postoperative period, and also decrease the risk of postoperative nausea and vomiting after surgery in the gabapentin group with laparoscopic access.

Key words: postoperative pain, balanced multimodal analgesia, epidural analgesia, gabapintin

Objective: The aim of the current study was to make an attempt to generalize the available data related to quality of life among the critically ill patients. Methods: Literature review using Russian Science Citation Index platform and PubMed search. Results: It is shown that quality of life is the dynamic indicator changing in time together with human society. In recent years in spite of improving outcomes of critical illness, practitioners and researchers started to move away from the developed «survived/died» approach in terms of evaluation the patient’s outcome. On discharging from critical care unit to general ward, the patient very often retains numerous problems: organ dysfunctions, neuro-cognitive impairment. It was shown that estimated quality of life of the patient’s relatives could serve as the indirect indicator of the patient’s quality of life. Conclusions: Now there are a lack of convincing data for introduction any of the programs directed on improvement of the patients’ quality of life. To achieve the most possible quality of life, change of the «classical» medical approach is needed. Healthcare workers should be focused not on the nosology-related intervention, but on the problems of the patient and his family (so-called «patent centered care» and «family centered care» approach).

Key words: critically ill, quality of life, post-intensive care syndrome

Purpose. To study the retinal and vitreous body status in the central and peripheral compartments of the eye fundus and to evaluate the vitreoretinal interface dynamics followed phacoemulsification in patients with high and extremely high myopia. Material and methods. 73 patients (85 eyes) with high and extremely high myopia whom cataract phacoemulsification was performed, underwent the complete ophthalmic examination including ultrasound biomicroscopy of the peripheral retina, ultrasound B-scanning of the vitreous body, optical coherence tomography of the central retinal zone preoperatively, in the first postoperative days, in 1 and 6 months. Results. Within the postoperative follow-up, we observed the increase in the altitude of the posterior hyaloid detachment and fluctuation amplitude of the detached vitreous body, progression of the acoustic alterations of the peripheral retina and OCT-alterations of the central retinal zone that became statistically significant by the 6th month of the follow-up. Conclusion. Owing to the use of such highly informative methods of diagnosis as UBM and OCT we manage to receive the complete information about the status of vitreoretinal interface in the eyes with high and extremely high myopia followed cataract surgery.

Key words: high myopia, cataract, vitreoretinal interface, ultrasound biomicroscopy, optical coherence tomography

Results of the effect of simvastatin, as part of the complex therapy of patients with metabolic syndrome and chronic generalized periodontitis of moderate severity in the microcirculation of periodontal tissues during the 30-day study are presented. The inclusion of simvastatin in the complex therapy of these patients normalize lipid metabolism, possessing gipoholisterinemicheskim effect and has a positive effect on the blood vessels of the microvasculature of periodontal tissues, increasing the efficiency index of microcirculation.

Key words: metabolic syndrome, chronic generalized periodontitis, microcirculation, statins

The article presents the results of experimental studies on the development of optimal composition and technology of complex suppositories for chronic prostatitis' treatment, which contain crystalline bear's bile and dry extract derived from dead bee bodies. Standartization of the developed drugs was established. It is found that obtained suppositories accord to organoleptic, physical, chemical and technological characteristics meet the requirements of the normative documentation.

Key words: suppositories, technology, chronic prostatitis, bear's bile, extract derived from dead bee bodies

By a method of a cytophotometry on 3 pilot models of swellings of a solid type is shown that tumor`s influence to the organism includes 2 stages: 1stage – tumor`s direct influence to the target-organ; 2 stage – indirect tumor`s influence, which consists in the change of functional relations between other organs cells populations under the influence of transformed cells of the damaged target-organ.

Key words: tumor, target, transformed cell

The question of the optimal quantity of staff and rational structure is a common problem for all the world's health systems. The share of employed in the health systems of developed countries is much higher than in Russia. At the same time in the Western countries, compared with Russia, there is almost half the number of doctors per capita, a similar number of nurses, and a much larger number of employees of other categories, the so-called related personnel. Despite the constant optimization of the personnel policy in countries with medium to high levels of economic development there are no common approaches to the formation of the structure of health care professionals.

Key words: health care system, medical personnel, medical specialty, personnel structure, wage-rates