The data about the use of external ECG event recorders are few and contradictory, which makes it relevant to the present study. We evaluated the clinical efficacy of fragmentary ECG monitoring in patients with palpitation and/or dizziness. The study involved 83 patients, mean age 46,5±13,6 years, with complaints of palpitation (group 1, n=65) and dizziness/syncope (group 2, n=18). All patients underwent 24-h holter monitoring and event recording. Comparative analysis showed that the diagnostic value of event recording was higher: 50,6% versus 24.1%. Therefore, the fragmentary ECG monitoring is an effective method to detect arrhythmic events and its diagnostic value 2 times higher than the traditional Holter monitoring.

A special role in the formation of atrial fibrillation in patients with arterial hypertension is played by diseases of the thyroid gland. In any form of hypothyroidism, vascular tone increases, hypervolemia is formed, which leads to changes in blood pressure, myocardial dystrophy and the development of AF. The development and progression of AF affects the lack of thyroid hormones: TH suppresses aldosterone synthesis and stimulates the secretion of atrial and cerebral natriuretic peptide. Therefore, hypothyroidism develops hyperaldosteronism and decreases the content of natriuretic hormone in the blood, which leads to hypervolemia. Atrophic processes in cardiomyocytes are exacerbated by intracellular potassium deficiency, which is caused by hyper aldosteronism characteristic of all types of hypothyroidism. TG plays the role of physiological antagonists of antidiuretic hormone, and their deficiency leads to increased water reabsorption and increases the likelihood of the formation of a volume-dependent form of hypertension, the effect on the endothelium of the cell, releasing vasoactive substances and reducing the sensitivity of adrenoreceptors to the action of catecholamines. In hypothyroidism, almost all soft tissues, including the vascular wall, accumulate in an excessive amount of glycosaminoglycans, which " ' " ions and water, which leads to swelling of the vascular wall, reduction of nitric oxide production and narrowing of the lumen of arteries and veins. Hyperproduction of thyroliberin, which leads to a decrease in dopaminergic activity of the brain. In addition, hypothyroidism causes thickening of the basement membrane of capillaries and the diffusion of oxygen through their wall is disturbed. The effect of hypothyroidism and drugs used in its treatment on AF is ambiguous. The authors disagree about the course of AF and the frequency of relapse, the risk of complications of AF. All this indicates the need to continue research in this direction.

The connection of the normal human anatomy theoretical material with practical skills in the professional activity of a doctor is presented in this article. This relationship is shown by the example of the bone : ' : of the human skeleton when setting up the electrodes for the ECG machine installation. The authors substantiated the need to organize educational research works among students of I-II courses of a medical university in order to better understand students of the fundamental nature of the material being studied for subsequent clinical disciplines

Detailed study of risk factors for the development of acute cerebral disorders blood circulation in young people and a description of the clinical case of cerebral venous thrombosis with the occurrence of ischemic stroke in both hemispheres of the brain in a woman of childbearing age while taking the drug combined oral contraceptives. An analysis of one clinical case, which was carried out on the basis of a thorough and painstaking identification of anamnestic data and interpretation of the results of a comprehensive clinical, laboratory and instrumental examination conducted by different specialists - obstetrician / gynecologist, neurologist and therapist. A clinical case of cerebral venous thrombosis is presented in a 31-year-old patient who developed on the background of hormonal contraception, and then entailed the occurrence of an acute ischemic stroke. In women of childbearing age, an increased risk of stroke as a result of cerebral venous thrombosis is associated with the development of prothrombotic conditions caused by the use of combined oral contraceptive pills. Maintaining patients of fertile age by an obstetrician / gynecologist requires interdisciplinary counseling, as well as the selection of alternative methods of contraception.

A systematic analysis of data available in modern literature that affect the etiology, pathogenesis of connective tissue dysplasia in children and adolescents, and the results of studying the clinical efficacy and safety of the use of complex and combination therapy in patients with this pathology. The paper presents research data on the search for effective methods of treatment of connective tissue dysplasia in children and adolescents aimed at finding the optimal treatment regimens, including the use of modern pharmaceuticals, non-drug effects, therapeutic and rehabilitative nature, including exercise therapy, physiotherapy, diet therapy. As a result of the research, it was found out that the treatment of children and adolescents with connective tissue dysplasia requires various approaches based on a number of criteria: approach to treatment, method of medical care, scientific soundness, degree of innovation. Early treatment and rehabilitation can reduce or avoid complications.

The article defines a high level of sexual activity and assesses the standard of reproductive behavior of adolescents in modern society. The low level of awareness of 15-17-year-old boys in the field of reproductive health and the correlation between the levels of awareness of reproductive health and motivation for its preservation were revealed. The necessity of development of new forms and methods of health education in the formation of motivation for health-saving behavior in the field of reproductive health in adolescent boys.

The aim is to demonstrate the pharmacoeconomical feasibility of using inhaled glucocorticosteroids in high doses in the provision of medical care to patients with acute stenosing laryngotracheitis at the prehospital stage. Materials and methods. For the period from 2011 to 2016 were reviewed 46 discharge instructions discharge summaries of children and 221 card call to patients with syndrome of croup from January to September 2015. Results and discussion. It was found that mild forms of syndrome of croup prevailed among the hospitalized patients, while the average duration of inpatient treatment was 6.2 days. Most of the drugs, prevailed at all stages appointed, pathogenetically unreasonable in the provision of emergency care for mild forms of syndrome of croup. Only 78.7% of patients received nebulizer therapy with budesonide, mainly in low doses. The use of high doses of budesonide had a more pronounced clinical effect on reducing the severity of respiratory failure. Conclusions. The use of high-dose inhalation corticosteroids, allows you to quickly stop respiratory failure at home and avoid hospitalization, which has significant pharmacoeconomical advantages compared to inpatient treatment.

Revascularisation plays an important role in treatment of acute coronary syndrome for increased population of type 2 diabetic patients. The set of anatomical and pathophysiological peculiarities of atherosclerotic injury of coronary arteries in patients with type 2 diabetes causes the worst prognosis and response after revascularization. Modification of this factors is really difficult. The most promising approaches are the choice of optimal method of revascularization, timely diagnostics of diabetes, determination of the degree of compensation, correction of glycemic changers, and the definition of further algorithm of treatment.

Introduction: the question of the nosological affiliation of vegetative dystonia (VD) remains controversial. According to the literature, the VD has an adverse effect on the course of pregnancy and childbirth, despite the lack of clear criteria for diagnosis. Aim: to determine the frequency of occurrence of the VD in pregnant women, the relationship with complicated pregnancy and childbirth. Materials and methods: analyzed 178 exchange cards and birth histories. Results: The diagnosis of the VD was made by therapists in 47 cases (26%): in 21 - according to the hypotonic type (according to the criteria in 17), in 9 - according to the hypertonic type (in 5 there were various options for arterial hypertension requiring additional examination), in 6 - by mixed type and in 11, the type of VVD is not specified. Conclusions: there is no evidence that the VD has a significant effect on the course of pregnancy and childbirth. The absence of criteria for making this diagnosis allows us to talk about the need to exclude this term (diagnosis) from the practice of the general practitioner and obstetrician-gynecologist.

Hysteroscopic metroplasty is very important for the restoration of the normal anatomy of the uterus, creation of the conditions for favorable obstetric outcomes. This review of the current scientific papers on the topic summarizes the data on the indications, preoperative preparation, and techniques of hysteroscopic metroplasty. It also presents the information on the approaches to the evaluation of the effectiveness of this kind of surgery, peculiarities of the postoperative care, preventive treatment of the intra- and postoperative complications. The paper provides state-of-the art information on the importance of the hysteroscopic metroplasty for the reproductive health of a woman and peculiarities of the gestation course after the dissection of the intrauterine septum.

90 women of reproductive age, including 70 women with pain syndrome of varying severity in external genital endometriosis, were examined to identify the features of pain symptoms. Studied socio-demographic indicators, developed a questionnaire of pain, depending on the nature of pain and the severity of associated symptoms. The results of the study revealed that the intensity of the pain syndrome had no correlation with the localization of the process, the presence or absence of infiltrative growth of endometriosis, the number of endometrioid lesions, and the intensity of the pain syndrome is not related to the duration of the pain. But the duration of the pain syndrome is associated with the degree of prevalence of medium-strength external genital endometriosis correlation significant relationship (r=0.33; p<0.001). Conclusion: Pain syndrome in external genital endometriosis is associated not only with the pathological process itself, but also with morphological changes in structures, the degree of prevalence of the focal process, forming directly the substrate of pain.

Purpose of research. To study the relationship of nonalcoholic fatty liver disease (NAFLD) in patients with hypertension (AH) with cardiometabolic risk factors (FR) of cardiovascular disease (CVD) and the effect of NAFLD on their development. 71 patients with stage I-III hypertension were randomly selected for this purpose. Two groups were identified - 37 patients with NAFLD and 34 patients without NAFLD, mainly elderly and senile age. The results of the study can be concluded. The presence of NAFLD in patients with hypertension in the elderly and senile age is not sufficient for patients to be considered as patients with a higher risk of cardiovascular disease. The main reason is the presence of metabolic syndrome and its components, which increase the risk of CVD in the study group, rather than NAFLD itself. Metabolic syndrome, in our opinion, is a common denominator, the Foundation for all risk factors. The level of transaminases in the group of patients with hypertension and NAFLD decreases with age, so it is inappropriate to use ALT as a NAFLD surrogate in elderly and senile patients. The level of transaminases in patients with steatosis and steatohepatitis is not associated with the risk of cardiovascular disease. With the combination of AH and NAFLD there is no connection of NAFLD with ischemic heart disease, AF, LVH and stroke. The presence of hypertension in a patient with NAFLD and without NAFLD, in our opinion, levels the impact of NAFLD on the risk of CVD, as the hypertension itself is a powerful risk factor for cardiovascular disease. There are no differences in the frequency of LVH and in the type of LV remodeling in patients with and without NAFLD.

Currently, there has been a steady increase in chronic diffuse liver diseases and a constant search is underway for new methods for diagnosing liver diseases and their complications. The most frequent and prognostically significant complication of chronic liver disease is hepatic encephalopathy. The incidence and prevalence of hepatic encephalopathy are associated with the severity of hepatic failure and portosystemic shunting of blood. It has been established that of all the complications of cirrhosis, it is the hepatic encephalopathy that limits the working capacity of patients and their social adaptation. The review of the literature presents the current provisions on the pathogenesis and methods of diagnosis of hepatic encephalopathy.

The purpose of the work is to compare the effectiveness of anesthesia with the use of a highly specific blocker COX-2 and a dedicated cyclo-oxygenase blocker COX-1 and COX-2 lornoxicam as part of multimodal analgesia in patients after primary knee replacement. The material was the cases of knee prosthesis (N=196) using multimodal analgesia; patients were divided into two groups, depending on the type of anesthesia, in accordance with the developed scheme of pharmacotherapy: I - receiving celecoxib (n=98) and II - lornoxicam (n=98). Methods for evaluating the effectiveness of anesthesia were the visual analogue scale (VAS), the KSS knee joint function evaluation scale before surgery and on the 5th day after it; analysis of the features of early verticalization, the patient's need for additional pain relief after surgery; costs of drug therapy are calculated. Results. Patients of both groups were comparable in age and average duration of hospitalization. The pain syndrome assessment on the VAS scale showed a higher efficacy of pain relief on days 1 and 5 in group II (4.1 ± 0.1 versus 3.5 ± 0.1 and 1.9 ± 0.04 versus 1.6 ± 0.1 points respectively) (p<0.05). Evaluation of the functional activity of the prosthetic knee joint on the KSS scale did not reveal any differences between the groups. Of the features of early verticalization on the first day after surgery, a higher percentage of weakness in the legs (79.6%) and nausea (70.4%) was noted in group I, and a higher percentage of dizziness (15.3%) and hemodynamic disorders ( 6.1% of cases). The cost of providing basic pain therapy in group I was 2.4 times higher than in group II, with the same costs for additional anesthesia with solutions of paracetamol and narcotic analgesics. Conclusions. As part of multimodal analgesia, Lornoxicam showed a higher efficacy in relieving pain syndrome at a low cost of a course of treatment compared with celecoxib.

Total hip arthroplasty is an effective method of treatment of diseases and injuries of the hip joint. However, after hip replacement complications develop. The most dangerous are purulent-inflammatory processes. The literature review presents the main causes, risk factors, clinical features, diagnosis, prognosis and prevention of purulent-inflammatory complications after total hip arthroplasty. Surgical treatment in the development of infectious complications is reduced to the verification of periprosthetic altered tissues, their radical removal together with the components of the endoprosthesis.

The increase in interest in amateur sport for psychoemotional unloading and restoration of forces and also ensuring satisfactory physical training and working capacity for the last 15 years, it is resolutely truly possible to consider a revolution in daily activity. Article is devoted to a traumatism problem in fitness. The general algorithm of complex rehabilitation of patients after a sports injury, exacerbation of chronic diseases of a backbone including medicamentous therapy, targetny therapy (medical blockade), physiotherapy exercises, physical therapy, a dietotherapy, manual therapy, acupuncture, massage, psychotherapy is provided. Specialists in physiotherapy exercises and rehabilitation should pay attention to increase in number of damages, to the prevention of traumatism, to the development of modern diagnostic methods and treatments, to promote development of rehabilitation on base fitness of the center. The fitness brings to thousands of Russians pleasure and considerable benefit, but in the meantime will unreasonably neglect important adverse factors of sharp increase in physical activity as damages, injuries or exacerbation of chronic diseases. The most part of doctors the centers employed in fitness - young specialists without due experience with patients after sports injuries, exacerbation of chronic diseases of a backbone therefore each doctor who is engaged in rehabilitation of patients with this type of pathology is obliged to gain the system impression allowing to avoid harming health of the patient and to gain the maximum effect in treatment.

Bisphosphonate osteonecrosis of the jaw is a severe complication that can occur in patients receiving bisphosphonate therapy due to bone metastases. The relevance of research is conditioned by spread use of bisphosphonates in patients with proved bone metastases in myeloma. Despite the active study of the problem, a high percentage of relapses of the disease remains, the direct criteria of sequestrectomy determination lines during surgical treatment. The study was conducted on the basis of the Department of maxillofacial surgery MAI "CCCH №23”, where patients with the diagnosis of "Bisphosphonate osteonecrosis of the jaw" in the period from December 2017 to December 2018 were treated.

Phlegmon of the maxillofacial region in the Khanty - Mansiysk Autonomous Region is one of the main pathologies of the oral and maxillofacial surgery, accounting for 4.3% of the hospitalized in the Department of oral and maxillofacial surgery (maxillofacial surgery). On the basis of a complete retrospective examination, the results of treatment of 171 patients were analyzed, it was found that the age group of 21-40 years (58.5 0%), male (67.8%) prevails. The main etiological factor is odontogenic causes (76.6%). Among the diseases that form the premorbid background, the presence of HIV infection (4.7%) and diabetes mellitus (4.1%) was noted. Surgical intervention in combination with antibacterial therapy and complex postoperative management of purulent wound allows to achieve satisfactory immediate results of treatment, to exclude lethal outcomes and to reduce the average duration of hospital treatment to 9,0 + 1,3 days.

According to statistics, an acute violation of cerebral circulation takes the second place among the causes of mortality, disability, and a reduction in the quality of life of patients who have endured it [1]. Atherosclerotic lesion of the brachiocephalic vessels in 50 - 60% of cases leads to the development of ischemic stroke [2]. As a rule, carotid endarterectomy is performed for patients suffering from stenosing and deforming lesions of the brachiocephalic vessels to prevent primary and secondary ischemic stroke. However, at the main stage of the implementation of this surgery (clamping of the carotid arteries) there is an increased risk of developing critical brain ischemia. It is during this period, even in the absence of signs of critical cerebral ischemia, that the products of metabolism under-oxidize, which aggravate ischemic damage to brain cells, especially during the reperfusion period [3, 4]. One of the possible ways to ensure adequate brain oxygenation requirements, cerebral circulation adequacy and metabolism optimization can be the selection of the most appropriate method of general anesthesia [5, 6, 7, 8]. The analysis of the scientific literature of domestic and foreign authors presents information that confirms and consolidates the results of a large number of scientific works and demonstrates changes that have occurred in recent years and affected various aspects of surgical treatment and anesthesiology of patients with atherosclerosis of the brachiocephalic vessels, concerning its epidemiology, prevention, treatment and prediction of outcomes. In this review article, we sought to provide new knowledge about the significance of atherosclerotic lesions of the carotid arteries, comparing types of anesthesiological support in carotid endarterectomy, the inappropriateness of neuromonitoring methods and changes in brain metabolism with this surgical procedure, as well as the effect of anesthesia on postoperative cognitive function after carotid endarterectomy.

One of problem in prophylactic medical care - it is insufficiency of capability to provision assistance in phase of realization recommendation. It decreases of compliance and commitment of long term action. One of effective method of realization prophylactic medical care is a modern medical organization, such as fitness centers. We define characteristic of centers, which can be classify as medical organization. The article presents fitness centers as medical prophylactic organization. There are results of observation of 11246 patients. The proportion of people with risk factors among those who had first visited the fitness centers was 76,2%; cardiovascular risks - 32%; overweight and obesity - 43,4%, hypercholesterolemia - 32%; hyperglycemia - 11,2%. Behavioral factors (physical inactivity, smoking, irrational diet) was in 74,1%. In comparients organization of the possibility of implementation of recommendations on physical activity, education of patients, food rational nutrition balanced diet. The average number of visits per person is 49.2 per year. This confirms the fact that the studied fitness centers create favorable conditions for the primary and secondary prevention of non-communicable diseases.

The results of the analysis of medical staff, especially of physicians, are highly relevant for the decision-making process by the health organizers and the administration of municipalities, are in demand by graduates of medical universities and young specialists coming to the medicine, and are of interest to scientists in the field of public health. In this regard, the indicators characteristic of medical institutions of state medical organizations of the Irkutsk region in the context of municipalities and the most important special areas in the dynamics are analyzed. The study was conducted using the method of continuous statistical analysis using specially developed statistical data sheets, where data was entered from the official primary statistical documentation of state medical organizations of Irkutsk region. Over the eleven years, the coverage of the population of the region by doctors fell by almost 10%, however, during the same period, the reduction in the number of physicians' persons reached almost 15%. Only every fifteenth doctor works in the rural territories. The proportion of physicians who don’t have a qualification category continues to increase. In-depth analysis made it possible to identify leading and lagging territories in terms of the most important indicators characterizing the staff potential, including in the context of individual medical specialties. The revealed decrease in the level of provision of the population of the region by doctors became a consequence of an even more significant reduction in the number of physicians' persons, but was masked by a decrease the population of the region.

The leading reason of early social orphanage is the mother’s rejection from her newborn child directly in the maternity facilities. Taking into consideration this acute problem, the Russian State Universities and social organizations are actively trying to solve it only after the fact of abandonment of the newborn in maternity facilities. The aim of this study is the revelation of features of reproductive anamnesis and medical activity during pregnancy of future mothers that are going to abandon their newborn child. Materials and methods of the research. The primary material was formed using the method of copying data from the accounting form 96 "History of childbirth”. The total number of observation units was 1429 mothers. Results and discussion. The large amount of pregnancies, starting with third, were generally due to increase of amount of aborts at the request of women. The further increase in the number of pregnancies of mothers that are going to abandon their child is only due to the increase in the number of abortions at the request of women. In general, during 9 years of the research Their number can reach nine cases in one or three births. On average, less than a third of expectant mothers, who have abandoned their children, have been admitted to obstetricians-gynecologists for nine years of study in all three groups of territories. Conclusion. In 81,1% mothers that are going to abandon their child of Chelyabinsk region the rejection from child is a regular result due to the features of their reproductive behavior, full neglect to contraception and their own health that is indicated be their multiple pregnancies that end by abort operations. The traditional prophylactic work to prevent early social orphanage with modern society of mothers that are going to abandon their child is possible with 16,5% of pregnant women that registered timely in female consultation. With 69.7% of mothers the work to prevent abandonment of the newborn can be carried out only by the staff of the maternity hospital and in a short time-in the first 3-5 days from the date of birth.

The article presents the results of the study of the degree of influence of diabetes on the patient's lifestyle by the method of Serdyuk. In the examination of 72 patients with type 2 diabetes aged 54 from 82 years and the disease duration of 11.8 years, a quantitative assessment of the causes and regularity of treatment for dental orthopedic care was carried out. It was found that the greatest impact of diabetes had on the change of the material component of the lifestyle of patients, in the second place in social significance was the inability to make a career, which also affected the material well - being, in the third was the feeling of loss of strength and energy. The combination of these factors does not allow patients with diabetes to seek timely orthopedic dental care.

As shown by the results of the analysis of the activities of the existing regional trauma centers, their formation did not take into account the need to increase the state assignment by optimizing the trauma, orthopedic and surgical hospital funds. This is due, primarily, to the fact that the primary idea of organizing trauma centers was to provide specialized, including high-tech medical care to victims of accidents. New trends in injuries and modern models of organization of medical care require the formation of a system of trauma centers for all victims with multiple, combined and shock injuries. In this regard, there is a serious question about the need for substantive calculation of state tasks of medical organizations in modern conditions, taking into account the approval of routing schemes and a significant increase in the flow of patients from municipalities within the coverage of trauma centers. The calculations presented in the work on the formation and optimization of bed funds should be used first of all, as well as planning the location of trauma centers with effective attachment of service areas taking into account the climatogeographic and economic features of the region, the number of residents of municipalities and the capacity of medical organizations on the basis of which trauma centers.

The article substantiates the relevance of the revision of the state regulation of the industry in the form of legal, economic intervention of the state in the sphere of health care. The activity of medical organizations of state and non-state ownership, their interaction is considered. The medical organizations participating in implementation of the territorial program of compulsory medical insurance of Sverdlovsk region for the period 2013-2017, forms of ownership of organizations are considered. The problems of the lack of clear criteria for the distribution of medical care between organizations of different legal forms, the interaction of medical organizations of different forms of ownership, the level of income of the population of the region and the structure of consumer spending of households of the Sverdlovsk region in the dynamics for seven years are identified and analyzed. The result of the study was formulated by authors criteria for the distribution of medical care between public and private medical institutions operating in the system of compulsory medical insurance.

Clinical and morphological features of cardiovascular system at aging were presented in the article. The reliable data of correlation between ET-1, the value of intima-media complex and expression of NO-synthase in patients of middle and old age were received in result of research. The ratio of thickness of intima-media complex thickness in patients of middle age was reliably higher than in patients of old age. The same dynamics was observed between ET-1 level and expression of proapoptotic factor p53 in myocardium of patients of middle and old age.