The methodological support of rehabilitation based on the achievements of science (development and scientific justification of the concept, approaches and methods) is based on the position that human health is a reflection of the state of adaptation of the organism to various influences, which determines the approaches to rehabilitation based on the principle of optimality.

There are many unresolved scientific problems in rehabilitation – yesterday, today and tomorrow – and those already solved yesterday require a more subtle interpretation today.

Considering the new concepts of rehabilitation and restorative treatment, first of all, it must be indicated that the use of any type of treatment should be based on the evidence of their effectiveness by evidence-based medicine, that is, benign studies. Until now, there are no reliable founda- tions of the theory of physiotherapy, which would lead us out of the field of empiricism at the turn of an accurate calculation of indications, prescriptions and effectiveness. Experimental work (primarily in the field of biophysics, bionics, medical cybernetics) does not sufficiently replenish the theoretical base, leaving, in turn, engineering thought without specific goals.

There is no doubt that there is another problem – the combined use of drugs with non-drug technologies. In this case, many natural or preformed physical factors can significantly reduce the risk of developing drug complications, allow the patient's body to mobilize natural protective resources, and provide them with the necessary metabolic and energy background. In addition, promising areas of scientific research in this area are physiogenetics – the phenomenon of genetic determination of the therapeutic effect of therapeutic physical factors (that is, optimization of adaptation mechanisms), as well as the study and correction of metabolic determinations.

Best regards, Editor-in-Chief, MD, PhD, Prof. V.V. Gladko

¹ Medical Institute of Continuing Education, FGBOU VO MGUPP
² Main Clinical Hospital of the Ministry of Internal Affairs of Russian Federation

Summary

Despite the qualitative improvement of medical care for acute coronary pathology, the level of disability and mortality among the most able-bodied population remains sufficiently significant. The term acute coronary syndrome (ACS), which combined acute myocardial infarction (AMI) and unstable angina (NS), was manifested by the introduction of new approaches to the treatment of patients with AMI and NS, increased interest in the problems of the peculiarities of the occurrence, course of ACS, the effectiveness of invasive and noninvasive methods of treatment, and the reassessment of the medical rehabilitation system (MR). The most important component of the treatment of ACS, especially in employees of the internal affairs bodies, whose activities are associated not only with constant stress factors, but also with a direct risk to life, is MR. The analysis of the ratio of clinical cases of AMI and NS, stages of MR in the Main Clinical Hospital of the Ministry of Internal Affairs (GKG MIA) for a period of 6 years was carried out. There are a total of 805 patients with ACS – 227 employees and 578 pensioners of the Ministry of Internal Affairs. With the development of ACS, employees of the Ministry of Internal Affairs are more often diagnosed with AMI, pensioners are dominated by NS. Despite the timely provision of specialized medical care and MR with AMI by the employees of the Ministry of Internal Affairs, 38% of patients were transferred to a specialized rehabilitation center for the second stage of MR. The presence of a rehabilitation center in the structure of the GKG of the Ministry of Internal Affairs makes it possible to carry out the I and II stages of MR within the framework of one hospitalization.

Key words: acute coronary syndrome, acute myocardial infarction, unstable angina, Interior Ministry employee, Interior Ministry pensioner, medical rehabilitation

For citation: Zolotukhin N.N., Konkov A.V. Treatment and medical rehabilitation for acute coronary syndrome at the inpatient stage. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 8–11.
DOI 10.46393/27821714_2022_3_8

Literature

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10. Золотухин Н.Н., Погонченкова И.В., Рассулова М.А., Фесюн А.Д. Оценка показателей состояния организма у лиц опасных профессий. Вопросы восстановительной и спортивной медицины. Сборник научных трудов. М., 2018: 16–20.
11. Золотухин Н.Н. Острый коронарный синдром: лечение и медицинская реабилитация в главном клиническом госпитале МВД России. Медицинский вестник МВД. 2022; 116 (1): 46–48.

¹ Medical Institute of Continuing Education, FGBOU VO MGUPP
² Dagestan State Medical University

Summary

The paper presents the results of the use of hydrogen sulfide baths of the Talgi resort (Republic of Dagestan) in a comprehensive program of medical rehabilitation of patients with rheumatoid arthritis with impaired lipid metabolism. The study included 80 patients with rheumatoid arthritis and hypertension. The average age of the subjects was 62.4 ± 7.5 years (from 53 to 70 years). All the subjects had a low and moderate degree of disease activity according to DAS28 (2.64 ± 1.21). The patients were divided into 2 groups of 40 people each: the main group received statin therapy and hydrogen sulfide baths. The control group received statin therapy only. The course of balneotherapy consisted of 12 baths, the procedures were carried out every other day or two days in a row with a break on the third day, lasting 2 minutes and gradually increasing by 2 minutes, bringing to a maximum duration of 6 minutes. At the same time, a statin group drug, pitavastatin 2–4 mg/day, was used for a year.

The inclusion of balneotherapy in the treatment program of this category made it possible to obtain a more pronounced and persistent anti-inflammatory effect, improve microcirculation, and improve the clinical and functional condition of patients. All patients had favorable dynamics of subjective symptoms of the disease: irritability, headaches and dizziness decreased, the state of the emotional and mental sphere stabilized.

Statin therapy, in addition to the main lipid-lowering effect, contributed to a decrease in the number of joints involved, had an activating effect on

Key words: medical rehabilitation, hydrogen sulfide baths, rheumatoid arthritis, statins

For citation: Klimko V.V., Dzhalilova R.A., Yudin V.E. et al. A comprehensive program of medical rehabilitation of patients with rheumatoid arthritis using hydrogen sulfide baths. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 12–17.
DOI 10.46393/27821714_2022_3_12

Literature

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3. Babaeva A.R., Tarasov A.A., Davidov S.I., Reznikova E.A. The prognostic value of anti-connective tissue antibodies in coronary heart disease and asymptomatic atherosclerosis. Cardiovasc. Res. 2016; 111 (Suppl. 1): S56–S81. Abstract 314.
4. Земляничкина Н.В., Храмцова Н.А., Дзизинский А.А. и др. Частота артериальной гипертензии при ревматоидном артрите. Сибирский медицинский журнал. 2009; 7: 43–46.
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6. Попкова Т.В., Новикова Д.С., Насонов Л.Е. Интерлейкин 6 и сердечно-сосудистая патология при ревматоидном артрите. Научно-практическая ревматология. 2011; 49 (4): 64–72.
7. Ревматология: клинические рекомендации. Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2010.
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10. Тортов И.Н., Улубиева Е.А., Амбалова С.А. и др. Риск кардиоваскулярных осложнений у больных ревматоидным артритом. Sciences оf Europe. 2016; 7–1 (7): 78–83.
11. Тутунов В.С., Зубарева М.Ю., Малышев П.П., Кухарчук В.В. Cтатины в ревматологии. Атеросклероз и дислипидемии. 2011; 2 (3): 43–48.
12. Насонов Е.Л. Проблема атеротромбоза в ревматологии. Вестник Российской академии медицинских наук. 2003; 7: 6–10.
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21. Бобровницкий И.П., Фесюн А.Д., Яковлев М.Ю. Восстановительная медицина как научное направление системы санаторно-курортного лечения. Вестник Медицинского института непрерывного образования. 2022; 2: 28–33.

¹ National Medical Research Center for High Medical Technologies – A.A. Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of Russia
² Medical Institute of Continuing Education, FGBOU VO MGUPP
³ Biomedical University of Innovations and Continuing Education, A.I. Burnazyan Federal Medical and Biological Center
⁴ Medical Research and Education Center, M.V. Lomonosov Moscow State University
⁵ D.D. Pletnev City Clinical Hospital, Moscow
⁶ A.V. Vishnevsky National Medical Research Center for Surgery
⁷ RUDN University

Summary

The article represents three complex clinical cases describing the use of flexible ureteroscopes in patients with urolithiasis. The features of the use of flexible single-use ureteroscopes for percutaneous nephrolithotripsy, retrograde intrarenal surgery and antegrade ureterolithotripsy are demonstrated. The treatment of urolithiasis using flexible ureteroscopes is feasible and effective method. The need of further research and development of this technique is warranted.

Key words: urolithiasis, minimally invasive endourological technologies, percutaneous nephrolithotripsy, retrograde intrarenal surgery, patients with pathologies of the bones of the skeleton, joints of the lower extremities, contact ureterolithotripsy

For citation: Kochetov A.G., Martov A.G., Sidorov O.V. et al. The possibilities of modern flexible ureteroscopes in the treatment of complex forms of urolithiasis and the achievement of "stone free". Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 18–22.
DOI 10.46393/27821714_2022_3_18

Literature

1. Мартов А.Г., Ергаков Д.В. Достижения современной эндоурологии: материалы XII Съезда Российского общества урологов. М., 2012: 417–426.
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¹ Medical Institute of Continuing Education, FGBOU VO MGUPP
² Main Clinical Hospital of the Ministry of Internal Affairs of Russian Federation

Summary

The literature provides many ways to close perforations of the nasal septum (NS), there is no differential approach to the choice of technique depending on the etiological factor.

Objective: to study the clinical and morphological features of tissues at the edges of postoperative nasal septum perforations (PNSP) to substantiate the choice of the optimal surgical technique.

Material and methods. 52 patients are divided into 3 groups in accordance with the area (S) of PNSP: group 1 – S < 1 cm2 (10%); group 2 – S = 1–2 cm2 (75%), group 3 – S > 2 cm2 (15%). In group 2, the subgroups are: 2A – PNSP without curvature of the NS (CNS) (52%); 2B – PNSP with CNS (48%). The state of the mucous membrane (MM) and supporting tissues at the edges of the PNSP, the results of a cytological study from the edges of the PNSP, and specific complaints of the patients were evaluated.

Results. In group 1 and 2 at the edges of the PNSP, a significant decrease in tissue elasticity compared with group 3, indicating a deficit in supporting tissues (p < 0.05). The ratio of the area of the defect of supporting tissues and PNSP in group 1 – 1 to 3.5, in group 2 – 1 to 1.5, in group 3 – 1 to 1.1. A high degree of elasticity of the posterior margin of PNSP is accompanied by pronounced clinical manifestations, regardless of the size of PNSP, and is confirmed by the cytological picture of inflammation (p < 0.01). The presence of CNS enhances the clinical manifestations of PNSP (p < 0.05).

Conclusion. The structure of the edges of PNSP forms a clinical picture of the disease. When choosing a closure method for PNSP, the surgeon must solve the following problems: the size of the NS defect required for replacement is determined not so much by the dimensions of the PNSP as the area of the defect in the supporting tissues of the NS; with a deficit of local tissues, it is advisable to additionally use grafts; MM in the area of the posterior and lower edges has pronounced signs of inflammation, these tissues should be removed during the operation.

Key words: nasal septum perforation, complication of nasal septum surgery

For citation: Morozov I.I., Grachev N.S., Gorbunova N.V. et al. Study of clinical and morphological features of nasal septum perforations. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 24–27.
DOI 10.46393/27821714_2022_3_24

Literature

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¹ Medical Institute of Continuing Education, FGBOU VO MGUPP
² Main Military Clinical Hospital of the National Guard Troops of the Russian Federation

Summary

The new coronavirus infection COVID-19 is a potentially dangerous respiratory infection caused by the SARS-CoV-2 coronavirus, which has several variants of the course with a high risk of death. In addition to the main damage to the respiratory tract, lungs, other organs and systems also suffer, most often the heart, liver, kidneys, nervous system.
The main complication of coronavirus infection, which causes the development of a lethal outcome, is respiratory and multiple organ failure, the development of distress syndrome. Currently, antiviral and anti-inflammatory drugs are used to treat COVID-19. Given the possibility of developing hypercoagulable syndrome, hypocoagulant therapy is widely prescribed. In this case, it is necessary to take into account the risk of developing hemorrhagic complications.

Key words: new coronavirus infection, hemorrhagic complications, bleeding, hematoma

For citation: Obelchak I.S., Kukushkina E.A., Zherebtsov A.I. et al. Radiation diagnosis of hemorrhagic complications in patients treated for a new coronavirus infection: clinical observations (MSCT, MRI). Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 28–31.
DOI 10.46393/27821714_2022_3_28

Literature

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¹ Burdenko Main Military Clinical Hospital
² RUDN University
³ Medical Institute of Continuing Education, FGBOU VO MGUPP

Summary

Chondroblastoma of the bones of the base of the skull is extremely rare, with the most typical site of its occurrence being the temporal bone. In cases where the base of the skull and adjacent structures are involved in the pathological process, the use of hightech techniques is required to fully restore function and aesthetics. The article describes a clinical observation of chondroblastoma of the temporal bone at the base of the skull, the surgical treatment of which required the use of virtual surgical planning and 3D printing.

Key words: chondroblastoma, skull base, reconstructive surgery, individual implant, temporomandibular joint

For citation: Tereshchuk S.V., Sukharev V.A., Vasilyev E.A. Chondroblastoma of the base of the skull: a clinical observation. Bulletin of the Medical Institute of Сontinuing Education. 2022; (2): 32–36.
DOI 10.46393/27821714_2022_3_32

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¹ National Medical Research Radiological Center
² Medical Institute of Continuing Education, FGBOU VO MGUPP

Summary

Kidney cancer is one of the most significant problems in oncourology. Over the past 10 years, there has been an increase in the incidence of kidney cancer, while the introduction of modern methods of radiation diagnostics makes it possible to more often detect the disease at an early stage. The method of choice for this pathology at stage T1a is kidney resection. It should be noted that this surgical intervention requires careful hemostasis, since it is performed on an organ with intensive blood circulation. To ensure adequate hemostasis during kidney resection, mechanical, physical and chemical methods are used. This review highlights the various methods and techniques used to stop bleeding when performing a kidney resection. It presents the results of large studies that have evaluated various methods of hemostasis and reduce the risk of complications associated with bleeding.

Key words: renal cell carcinoma, kidney resection, organ-preserving operations, hemostasis, bleeding, hemostatics, glue, ischemia, anoxia

For citation: Alekseev B.Ya., Nyushko K.M., Shevchuk I.M. et al. Surgical approaches to organ-preserving operations in patients with kidney cancer. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 38–43.
DOI 10.46393/27821714_2022_3_38

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Medical Institute of Continuing Education, FGBOU VO MGUPP

Summary

The article discusses the pathogenetic relationship of neurogenic and immune inflammation in rosacea and the most likely causes of dermatosis.

Key words: rosacea, etiology, pathogenesis, patient profile, melatonin, neurogenic inflammation, immune inflammation

For citation: Gorbakova E.V., Masyukova S.A., Ilyina I.V. et al. Pathophysiology of inflammation and directions of therapy in rosacea. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 44–47.
DOI 10.46393/27821714_2022_3_44

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¹ Medical Institute of Continuing Education, FGBOU VO MGUPP
² Federal Center for Cardiovascular Surgery, Penza

Summary

The purpose of the study: to determine the rate of pacemaker implantation after Cox-Maze IV surgery and to identify predictors that affect the neсessity of a pacemaker.

Results. In the group of patients with implanted pacemakers, perioperative complications were similar to those in the group without pacemakers. In the group with pacing, the aorta was clamped for a longer time. Patients with implanted pacemakers spent a longer time in the hospital. According to multiple regression data, the only predictor of pacemaker implantation is the age of the patient. For every year of the patient's age, the chance that a pacemaker will need to be implanted after the Cox-Maze procedure increases by 4%.

Conclusions

1. The rate of pacemaker implantation after simultaneous heart surgery is 4%, but increases with the age of the patient.
2. Long aortic cross-clamp time and cardiopulmonary bypass time increase the risk of pacemaker implantation.
3. Artificial neural networks have an advantage in finding leading predictors compared to logistic regression.

Key words: Cox-Maze IV procedure, pacemaker implantation, atrial fibrillation

For citation: Bazylev V.V., Karnakhin V.A., Kuznetsova A.A. Predictors of pacemaker implantation after the Cox-Maze IV procedure in open heart surgery. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 48–53.
DOI 10.46393/27821714_2022_3_48

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¹ Infectious Clinical Hospital No. 2, Moscow
² Evdokimov Moscow State Medical University of Medicine аnd Dentistry
³ Medical Institute of Continuing Education, FGBOU VO MGUPP

Summary

The article is devoted to the study of the features of surgical interventions in emergency gynecological diseases in women with COVID-19. The study included 218 women aged 36 to 53 years. Most often, the reason for the treatment of patients is abnormal uterine bleeding. Approaches to conservative and surgical methods of treatment have been studied and formulated. Surgical interventions do not adversely affect the course and outcome of coronavirus infection.

Key words: gynecology, COVID-19, abnormal uterine bleeding

For citation: Gafurov Yu.T., Faller A.P., Sundukov A.V. Acute surgical pathology in gynecological patients with new coronavirus infection. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 54–57.
DOI 10.46393/27821714_2022_3_54

Literature

1. Umakanthan S., Sahu P., Ranade A.V. et al. Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Postgrad. Med. J. 2020; 96 (1142): 753–758.
2. Alabi O.C., Okohue J.E., Adewole A.A., Ikechebelu J.I. Association of gynecological endoscopy surgeons of Nigeria (AGES) advisory on laparoscopic and hysteroscopic procedures during the COVID-19 pandemic. Niger. J. Clin. Pract. 2020; 23 (5): 747–749.
3. Zizzo M., Bollino R., Ruiz C.C. et al. Surgical management of suspected or confirmed SARS-CoV-2 (COVID-19)-positive patients: a model stemming from the experience at level III hospital in Emilia-Romagna, Italy. Eur. J. Trauma Emerg. Surg. 2020; 46 (3): 513–517.
4. De Simone В., Chouillard E., Di Saverio S. et al. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann. R. Coll. Surg. Engl. 2020; 102 (5): 323–332.
5. Gupta N., Agrawal H. COVID-19 and laparoscopic surgeons, the Indian scenario – perspective. Int. J. Surg. 2020; 79: 165–167.
6. Chadi S.A., Keegan G., Caycedo-Marulanda A. et al. More current evidence for minimally invasive surgery during the COVID-19 pandemic and risk mitigation strategies: a narrative review. Ann. Surg. 2020; 272 (2): e118–e124.
7. Thomas V., Maillard C., Barnard A. et al. International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 253: 133–140.

Medical University "Reaviz"

Summary

In a pandemic, medical workers were faced with a choice between working as usual, or working in the COVID zone. What is the specificity of the personality of a medical worker who is ready to be exposed to the risk of a disease on a daily basis, to work in a situation of uncertainty in treatment methods, patient routing, and control difficulties. The aim of the study was to study the specifics of personal characteristics in health workers working with COVID patients by comparing with health workers working with ordinary patients.

Key words: personality traits, pandemic, COVID patients, healthcare workers

For citation: Abdullaev A.M., Mosolov O.A. Specifics of personal characteristics of medical workers working with COVID-patients. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 58–60.
DOI 10.46393/27821714_2022_3_58

Literature

1. Безносов С.П. Профессиональная деформация личности. СПб.: Речь, 2010. 272 с.
2. Пшеничная Н.Ю., Веселова Е.И., Семенова Д.А. и др. COVID-19 – новая глобальная угроза человечеству. Эпидемиология и инфекционные болезни. Aктуальные вопросы. 2020; 10 (1): 6–13.
3. Царанов К.Н., Жильцов В.А., Климова Е.М., Тарбастаев А.Г. Восприятие угрозы личной безопасности специалистов-медиков в условиях пандемии COVID-19. Менеджер здравоохранения. 2020; 4: 15–19.
4. Говорин Н.В., Бодагова Е.А. Психическое здоровье и качество жизни врачей. Томск, Чита: Иван Федоров, 2013.

Institute of Food Systems and Health Technologies, FGBOU VO MGUPP

Summary

The main issues of ensuring the quality and safety of food products by microbiological indicators are considered. Various groups of microorganisms (saprophytic, pathogenic and conditionally pathogenic), the ways of their entry into production and the influence of technological factors on their survival are described. The main microbiological criteria for the quality and safety of food products, established in regulatory documents, are given.

Key words: microbiological safety, quality, microorganisms-contaminants, sources of entry of microorganisms-contaminants into production

For citation: Moiseyak M.B., Ilyashenko N.G., Grishin A.G. Microbiological safety in food production. Bulletin of the Medical Institute of Сontinuing Education. 2022; (3): 64–67.
DOI 10.46393/27821714_2022_3_64

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