[The comparative evaluation of level of security culture in medical organizations].

The study was carried out on the basis of clinic "Medicine" in 2014-2015 concerning security culture. The sampling included 465 filled HSPSC questionnaires. The comparative analysis of received was implemented. The "Zubovskaia district hospital" Having no accreditation according security standards and group of clinics from USA functioning for many years in the system of patient security support were selected as objects for comparison. The evaluation was implemented concerning dynamics of security culture in organization at implementation of strategies of security of patients during 5 years and comparison of obtained results with USA clinics was made. The study results demonstrated that in conditions of absence of implemented standards of security in medical organization total evaluation of security remains extremely low. The study of security culture using HSPSC questionnaire is an effective tool for evaluating implementation of various strategies of security ofpatient. The functioning in the system of international standards of quality, primarily JCI standards, permits during several years to achieve high indices of security culture.

A new method for screening diagnosis of insulin resistance.

A simple method for the diagnosis of insulin resistance, easily realized in clinical practice, is developed in order to detect patients at a high risk of diseases associated with this condition. The metabolic index is estimated as the proportion of triglycerides and glucose values to quadratic HDL cholesterol value (in mmol/liter). The specific feature of this method for detection of insulin resistance in comparison with the known indirect methods is the use of routine biochemical values, evaluated in venous serum, for estimations. Estimation of this metabolic index is an economic and effective indirect method for evaluating the homeostasis system without additional evaluation of blood hormones.

[New metabolic index in the diagnosis of insulin resistance in patients with nonalcoholic fatty liver disease].

UNLABELLED: Early diagnosis of insulin resistance (IR) in patients with non-alcoholic fatty liver disease (NAFLD) is relevant in connection with the possibility of timely correction and the primary prevention of cardiovascular disease. OBJECTIVE: To evaluate the diagnostic significance of the new metabolic index (MI) in the early diagnosis of IR in patients with NAFLD. MATERIALS AND METHODS: In 494 patients with ultrasonographic evidence of NAFLD have been studied lipid and carbohydrate metabolism. Indirect methods of assessment of IR were analyzed and we proposed a new MI. RESULTS AND DISCUSSION: NAFLD is accompanied by a progression of metabolic disorders and atherogenic dyslipidemia, disorders of carbohydrate metabolism, changes in the functional state of the liver. In the early stages of IR for the initial isolate changes of carbohydrates and lipid metabolism MI index is more sensitive to the existing violations, and with the progression of changes in laboratory parameters observed its gradual increase. CONCLUSIONS: MI can be recommended in clinical practice for screening IR in NAFLD patients for further in-depth examination.

[Hybrid revascularization: a combined approach to multivessel coronary artery lesions].

Analysis of effectiveness and feasibility of hybrid approach to multivessel coronary artery disease and problems of interaction between cardiac surgeons and interventional cardiologists in deciding on the choice of revascularization method is performed in the article. Hybrid approach to multivessel disease defined as sternal sparing, off-pump, minimally invasive, hand sewn left internal mammary - left anterior descending (LAD) arteries by-pass graft with percutaneous coronary revascularization of non-LAD lesions to achieve functionally complete revascularization is described in detail. Data of multicenter studies and clinical recommendations for myocardial revascularization is discussed.

[Non-invasive techniques in diagnosis of steatosis and fibrosis in nonalcoholic fatty liver disease].

UNLABELLED: Diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD) is one of the most actual problems of modern hepatology. Ultrasound elastometry is alternative method to determine the density of the liver tissue. The efficiency of the method was confirmed by a large amount of data in patients with viral hepatitis. However, the diagnostic value of elastometry was not studied enough in patients with NAFLD. THE AIM OF THE RESEARCH: to study the possibility of non-invasive diagnostic methods of examination in a complex assessment of the liver in patients with NAFLD. MATERIALS AND METHODS: We studied 24 patients with signs of NAFLD and a long persistent elevation of liver enzymes. All patients underwent a needle biopsy of the liver. We conducted a comparative analysis of the results of the morphological study of the liver tissue with ultrasound elastometry, computed tomography of the liver, biochemical blood tests. RESULTS AND DISCUSSION: Among biochemical liver enzymes ALT was a marker of NAFLD which characterized the transformation of steatosis to steatohepatitis. The combined ALT and GGT increase reflected the high activity of inflammation in the liver tissue. Elastometry results were comparable to the histological features in all liver fibrosis stages, but the maximum diagnostic accuracy was observed at the late stages. The area under the ROC-curves showed the highest precision in the F2-F3 stages, the lowest value - in the F1 stage. Imprecision of the method in the early stages of fibrosis may be due to the hepatic steatosis in NAFLD and high biochemical activity with cholestasis signs. Patients with early-stage liver fibrosis diagnosed with elastometry need additional examination using other methods of noninvasive diagnostic tools.

[The integrated approach to diagnostics of metabolic syndrome in clinical practice].

Basic criteria of diagnostics and definitions of metabolic syndrome recommended by various international associations and expert groups are discussed. Permanent changes of criteria and usage of various approaches to diagnostics influence prevalence of metabolic syndrome among populations and estimation of its association with unfavorable outcomes. Some definitions of metabolic syndrome are more sensitive in detection of risk groups for cardiovascular diseases, and others in - detection of persons with high risk of type 2 diabetes mellitus. New integrated definition of metabolic syndrome which unites pathophysiological and clinical epidemiological approaches for assessment of metabolic disorders and detection of high risk groups of patients applicable for use in everyday clinical practice is presented.

[Non-alcoholic fatty liver disease as an atherosclerosis risk factor].

Currently, along with cardiovascular disease, changes in lipid and carbohydrate metabolism in the syndrome of insulin resistance seen pathology of the liver. The aim of our study was to determine the prognostic significance of nonalcoholic fatty liver disease (NAFLD) to assess the risk of early manifestations of atherosclerotic disease of carotid arteries. The correlation between the presence of NAFLD and signs of early atherosclerosis in the insulin resistance syndrome. The resulting ranked a number of prognostic factors influencing the degree of change in the walls of the carotid arteries, making it possible to construct estimates of individual risk of atherosclerosis development in clinically healthy patients. The clinical significance of the results is the need for more thorough examination of patients with NAFLD to assess risk factors for progression of pathology not only the liver, and cardiovascular disease.

[State of the brachial artery wall in patients with and without metabolic syndrome].

The purpose of this study was to investigate the condition of endothelium-dependent vasodilatation of the brachial artery in patients with metabolic syndrome, as well as to determine the clinical and laboratory factors associated with disordered macrovascular reactivity. The study comprised one hundred and thirty-two 35-to-50-year-old somatically healthy men. The diagnosis of metabolic syndrome was made in accordance with the WHO criteria. Insulin resistance was assessed according to the HOMA-IR index. To evaluate the interrelationships between the risk factors of atherosclerosis and the pattern of peripheral vascular reactions, the study was carried out in two groups of patients: one comprising patients with metabolic syndrome, and the control group. The increment of the brachial artery's diameter after decompression in the control group turned out reliably more pronounced as compared with that in the study group patients (averagely 11.9+/-0.44 % for the control group subjects vs. 9.0+/-0.37% for the study group patients, p=0.047). In the group of the patients with metabolic syndrome, the diameter of the brachial artery after the test with reactive hyperaemia varied in inverse proportion with the degree of insulin resistance in accordance with the HOMA index (p=0.04, r=-0.25). Also an inverse correlation was observed with the body mass index (r=-0.43, p<0.001), the duration of arterial hypertension (r=-0.29, p=0.014), and the level of triglycerides and very low density lipoproteins (r=-0.28, p=0.02).

[Predictive significance of insulin resistance and metabolic syndrome for assessment of the degree of endothelium disfunction and early signs of atherosclerotic lesion].

The contribution of the clinical or laboratory risk factors associated with the metabolic syndrome to the changes in peripheral vascular reactions and to the natural history of atherosclerosis has not been established until now. The aim of the work was to study interrelations between the risk factors entering the symptom complex of the metabolic syndrome, to assess their impact on endothelium-dependent vasodilatation and constrictor component of vascular reactivity as well as on the change in the thickness of the intima-media complex (TIMC) of the common carotid artery (CCA). The study accrued 122 practically normal men aged 35 to 50 years. Stepwise multiple regression analysis has established interrelations between the disorder of vasoregulating endothelium function and the intensity of atherosclerotic lesion according to the maximal value of the TIMC of the CCA, glucose concentration 120 min after glucose load, IMT, the signs of arterial hypertension. The data have been obtained that confirmed the hypothesis of the role played by endothelium dysfunction manifesting by the disturbance of vasoregulating function, as an early marker of atherosclerosis. Carbohydrate metabolism, tissue sensitivity to insulin and the presence of arterial hypertension were most significant predictive factors of the TIMC of the CCA and disorder of arterial wall function.

[Clinical experience with the use of nitroglycerin in the acute period of myocardial infarct]. / Klinicheskii opyt primeneniia nitroglitserina v ostrom periode infarkta miokarda.

The authors summarize the results of treating 1284 patients with macrofocal acute myocardial infarction. In 1097 of these patients the treatment consisted of the intravenous administration of the alcohol solution of nitroglycerin. The control group was comprised of 184 patients whose treatment scheme included no nitroglycerin. The group of nitroglycerin-treated patients showed a decrease in the mortality rate as compared to control, 18.1% and 24.1%, respectively. The drug studied was also found to have an anti-arrhythmic effect. The most optimal timing of nitroglycerin use to limit the area of myocardial ischemia is the first six hours of infarction, later on in the presence of heart failure it is advisable to use this drug in combination with cardiac glycosides. There were practically no complications following the intravenous administration of nitroglycerin.

[The role of insulin resistance in diagnosis of metabolic syndrome]. / Rol' insulinorezistentnosti v diagnostike metabolicheskogo sindroma.

Early diagnosis of metabolic syndrome is based on detection of insulin resistance, hyperinsulinemia, and clinical presentations of this syndrome. Differences in approaches to diagnosis of metabolic syndrome and its multi component nature hamper comparison of results of different studies and elaboration of generalized guidelines for selection of high risk groups and prevention of cardiovascular diseases and type 2 diabetes. Until present there are no common criteria of the syndrome and this makes difficult standardization of methodology of its investigation. Several organizations (WHO, National Cholesterol Education Program, European Group for the Study of Insulin Resistance) issued documents in which diagnostic approaches to detection of metabolic syndrome and its separate components have been formulated. These approaches as well as comparative analysis of direct and calculated methods of assessment of insulin resistance are presented in this review.

[Central hemodynamic characteristics of patients with acute myocardial infarct of the right ventricle]. / Osobennosti tsentral'noi gemodinamiki u bol'nykh ostrym infarktom miokarda pravogo zheludochka.

A study of central hemodynamic parameters and clinical patterns of acute right-ventricular myocardial infarction (ARVMI) is reported. Thirty-nine patients with acute inferior left-ventricular myocardial infarction were divided into 2 groups: 28 patients with electrocardiographic signs of ARVMI (group 1) and 11 patients showing no such signs (group 2). All patients were subjected to catheterization of the heart's right compartments, and their minute blood volumes were measured by thermodilution. Three patterns of ARVMI were identified on the basis of the mean pulmonary arterial blood pressure: hypo-normo- and hypertensive ones. All the three were associated with the development of prevailing right-ventricular insufficiency in group 1.

[Effect of different diets on quality of life in patients with metabolic syndrome]. / Vliianie razlichnykh diet na kachestvo zhizni patsientov s metabolicheskim sindromom.

The purpose of the research was to study influence of diets with a various ratio of carbohydrates and fatty components on modification of metabolic risk factors due to decrease of weight and abdominal adiposity, and also on quality of life of the patient. 49 males were included in the study the age 30-65 years with metabolic syndrome X. All patients had increased body mass or obesity. Hypertension of I and II stages was observed in 49.0% of cases. The estimation of results was carried out in three months after assignment of one of investigated diets. Effective reduction of body mass parameters was achieved at use of all diets within three months. Nutritional counseling was based on dietary preferences and habits of the patient to improve quality of life at observance of a diet. Common negative feature of investigated diets was occurrence of feeling of hunger that caused infringement of accuracy of observance of recommendations.

[Influence of various diets on lipid exchange in patients with obesity and metabolic syndrome]. / Vliianie razlichnykh lechebnykh diet na obmen lipidov u patsientov s ozhireniem i metabolicheskim sindromom.

The investigation of influence the diets with different rations carbohydrate and lipid components on the status of lipid spectrum of patients, suffering of metabolic syndrome, these were be used during 4 mounts, was the aim of present researches. The 84 male in the age of 30-65 years were examination Effective decrease body mass, atherogenic parameters of lipid metabolism (hypertrigleciridemia, LDL) and also the levels of arterial hypertension were founded in patients? Using low carbohydrate and low fatty diets.

[Drug lesions of the gastroduodenal zone]. / Lekarstvennye porazheniia gastroduodenal'noi zony.

Many new high effective preparations, acting on cellular and molecular levels, now have appeared. They have rendered more penetrating influences on the various aspects of the organism activity and causing thus the side effects. They are the following: medicine-induced disorders of stomach and duodenum at treatment by nonsteroid anti-inflammation preparations accompanying by development of erosions, ulcers and bleeding, exacerbations of chronic ulcers and etc. The medicine-induced disorders of the digestive organs recently began to determine as the nosologic forms with possible acute and chronic current. Even lethal cases are observed at using medicines in medical doses. Till now there are no legible criteria of clinical-laboratory and morphological diagnostics of medicine-induced disorders of the digestive organs. The problems of their pathogenesis are studied insufficiently. There is no united classification. In this connection, the purpose of the given article is the study of epidemiology, pathogenesis, features of diagnostics and clinical current of medicinal gastropathies.

[Atherosclerotic lesions of the coronary arteries in acute myocardial infarction: effects on myocardial contraction, disease course and prognosis]. / Ateroskleroticheskoe porazhenie koronarnykh arterii pri ostrom infarkte miokarda: vliianie na sokratitel'nuiu funktsiiu serdtsa, techenie i prognoz zabolevaniia.

Coronary arterial affection (CAA) is an objective indicator, closely related to cardiac contractility as well as clinical severity and immediate prognosis of myocardial infarction. The progress of CAA is associated with more pronounced disorders of cardiac contractility, higher rates of severe complications and less optimistic immediate prognosis. Long-term prognosis is not affected by the magnitude of CAA in postmyocardial-infarction patients.