[Possibilities of effective interaction in the system pharmacovigilance at registration of medicinal undesirable reactions at patients of the senior age groups.]

In recent years, complications of drug therapy are an important medical problem. Data on adverse drug reactions (ADR) in patients of older age groups were analyzed. The object of the study was notification cards for unwanted reactions received from medical organizations of the Irkutsk region for period 2009-2020 years. The Narangio scale was used to assess the causality between ADR and medicines. Of the 1021 ADR notifications in patients over 65 years of age, 2/3 (668) are presented with ADR notifications in women, 353 (34,6%) in men. The presence of background diseases was registered in 915 notifications (89,6%). There were no gender differences except for a higher incidence of chronic obstructive pulmonary disease in men (7,2 and 3,5% respectively, p<0,05) and diabetes mellitus in women (14 and 3,5% respectively, p<0,05). ADRs for antibacterial agents amounted to 31,8%, drugs for the treatment of cardiovascular diseases - 10,5%, cases of therapeutic inefficiency - 5,1%. The ADR data statement was in line with the recommended form of 76%. The most common filling defect was incomplete patient information. The validity of the Narango causation was high. The deadlines for reporting data were observed in 89,1%. For effective interaction in the pharmacovigilance system, it is necessary in each medical organization to constantly inform about the procedure for pharmacovigilance, types of ADRs, the rules for their detection and the timing of data reporting. The work should be supervised by a trained specialist.

[Comparative characteristic of cognitive impairment at alcoholic and discirculatory encephalopathy]. / Kharakteristika kognitivnykh narushenii pri alkogol'noi i distsirkulyatornoi entsefalopatii.

OBJECTIVE: Identification of features of cognitive impairment at patients with alcoholic and discirculatory encephalopathy. MATERIAL AND METHODS: 30 patients with the alcoholic encephalopathy (AE) and 32 - with discirculatory encephalopathy (DE) participated in research. To patients conducted clinical examination, a computer electroencephalography with determination of cognitive evoked potentials, neuropsychological testing. RESULTS: General and distinguishing characters of a clinical picture, cognitive deficiency, disturbances in the emotional and personal sphere at patients with encephalopathies alcoholic and vascular genesis are established. CONCLUSION: It is established that a basis of a clinical picture of encephalopathy of various genesis are the cognitive disturbances (CD) and an asthenic syndrome, of AE it is characteristic hyposthenic, and at DE - hyper - and hyposthenic syndromes. Changes of bioelectric activity of a brain at DE had primary localization in occipitoparietal departments of a brain, at AE - in temporal and occipitoparietal assignments. Disorder of categorial thinking, the long-term memory, reciprocal coordination, manual gnosis indicating dysfunction by a frontal, parietal lobe of the left hemisphere, a hippocampus, a corpus collosum are provided to CD in DE and AE patients. It is established that distinguishing characters of CD in AE and DE patients are values of indexes Δ-, ß1-, ß2-rhythms, the indicators characterizing the impressive speech, volume of visual figurative memory, level of severity of hypochondria.

[The case of the fulminant course of amyotrophic lateral sclerosis]. / Sluchai molnienosnogo techeniia bokovogo amiotroficheskogo skleroza.

The authors report the case of a lightning-fast course of amyotrophic lateral sclerosis (ALS) in a 49-year female patient. The diagnosis was based on complaints, clinical picture, electroneuromyography and tomography of the cervical spine. The nature of the course of the disease was fulminant, since 6 months passed from the onset of the first symptoms to the pronounced process, and then to the fatal outcome.

[Emotional and physiologic features of civil aviation pilots with neurosensory deafness].

The article presents results of evaluation concerning neurophysiologic and psychoemotional state of pilots with occupational neurosensory deafness. Findings are that pilots with occupational neurosensory deafness demonstrate disorganized type of EEG, supported by fading alpha-rhythm, increased slow wave activity in delta range. Other changes are decreased conduction velocity in distal part of median and ulnar nerves - that indicates development of demyelination processes. Psychologic studies proved that personality structure in pilots with occupational neurosensory deafness has dominant traits of balanced emotional reactions, constructive ways to overcome difficulties.

[Dynamic follow-up of health state in workers of railway tunnel].

The article covers results of examination in workers engaged into railway tunnel exploitation, for health state features, in dependence on occupational factors, character and intensity of somatic diseases. The authors evaluated frequency of instrumental parameters change, analyzed clinical symptoms at manifestation and advanced disease, and its dynamics.

[The impact of the long-term exposure of industrial aerosols on clinical and functional indices of the broncho-pulmonary system in aluminum smelter workers].

It was found that the appearance of respiratory diseases among workers was established to be associated with the impact of aerosols with the complex chemical composition, exceeding corresponding MAC. Among respiratory diseases in workers there were detected predominantly chronic non-obstructive bronchitis - 59.15%, and chronic obstructive pulmonary disease (COPD) - in 35.2% of cases. In the analysis of spirometric indices of examined patients the vast majority (76.3%) of them showed disturbances of the bronchial patency of mild to moderate degree of the pronouncement. As a result of the implementation offlexible bronchoscopy there was established the presence of a diffuse lesion of bronchi with a predominance of subatrophic and atrophic processes in the mucosa. It was found that under the increase of the concentration of HF in the air of industrial premises the probability of bronchial obstruction and deterioration of the tracheobronchial patency in aluminum smelter workers was established to elevate.

[Clinical and neurophysiological peculiarities of health disorders in workers in dependence on the vinyl chloride exposure load].

Results of the clinical and neurophysiological examinations of 42 workers with operating history at the chemical plant exposed to vinyl chloride (VC) are presented. The purpose of research was the identification ofpeculiarities of clinical manifestations and disorders of the functional activity of the brain in workers at the vinyl chloride production, with taking into account the exposure toxic load (ETL). There were made clinical and electroencephalographic examinations with the detection of cognitive evoked potentials (CEP) and statistical analysis of results with the use of the Mann-Whitney U-test, Fisher's F-test, calculation of Spearman's correlation coefficient. The features in clinical picture of the pathology of the nervous system were detected in the form of asthenic disorders with cognitive impairment and autonomic dysfunction syndrome. There was established the increase in the cognitive impairment rate (p = 0.03), the decline in a-EEG activity (p = 0.01) and the worsening of indices of the amplitude (p = 0.011) and latency (p = 0,05) of CEP in extremely high level of ETL in comparison with same indices in the group with moderately high ETL. In the first group there was revealed a statistically significant exceedance of the frequency of hypertension - by 1.6 times, skin diseases - by 9 times, chronic subatrophic rhino-pharyngitis by 1.4 times in comparison with cases from the second group. In the group with moderately high level of ETL there was established the statistically significant inverse correlationship between the ETL and the index of P300 amplitude from the left side (r = -0.38, p = 0.019) and in the group with extremely high level ETL - between ETL and index of the ß2 - rhythm (r = - 0.73, p = 0.0008).

[Vibration disease: hygienic and medical aspects].

The hygienic assessment of working conditions of employees exposed to local vibration established that working conditions for employees ofvibration dangerous occupations at the aircraft plant according to the degree from a health standpoint and hazard are referred to the fourth (dangerous) class of the degree of danger that stipulates stable high levels of the morbidity rate. The leading factor is a local vibration that results in the consistently high levels of occupational morbidity rate. There was shown the efficiency of the use of the pulsed magnetic stimulation in the treatment ofpatients with vibration disease associated with the exposure to local vibration. For the evaluation of the effectiveness of treatment in patients the condition of the central nervous system was determined with the use of computer electroencephalography with the registration of visual and auditory evoked potentials and somatosensory evoked potentials; there was studied the state of the peripheral nerves in arms and legs relying upom electromyographic data; there was performed psychological study. After the performance of pulse magnetic stimulation in patients diagnosed to have the vibration diseases there were observed the improvement in the interaction of cortical-subcortical structures and associative areas of the frontal and temporal lobes of the brain. After treatment there was noted the shortening of the time of the conduction of the afferent wave of the excitation at the level of the cervical spinal cord, subcortical structures and the central conduction time. There was restored previously reduced the speed of the conduction of the impulse via the distal parts of the tibial and median nerve, through the ulnar nerve in the area of the elbow joint. There was noted the rise in the average temperature on the hands; the decline of thresholds of vibration and pain sensitivity; the improvement of indices characterizing of the state of mnestic- attentional and psycho-emotional scope of activity.

[Differential diagnostic method of initial implications and degree I of the chronic mercury intoxication].

Currently available methods for diagnosis of chronic mercury intoxication (CMI) are applied at the any stage of the disease. Changes in these indices sometimes have no the specificity for any CMI stage, and a conclusion on them has the descriptive character. In addition, the above mentioned methods possess not sufficiently high accuracy in the diagnosis of intoxication at early stages of the development of the disease. The purpose of the research is the development of the method permitting to make the differential diagnosis between the initial symptoms of mercury poisoning and its first degree. 118 men who work/worked in the contact with mercury vapor were examined. There were evaluated electroencephalogram, long-latency auditory and cognitive evoked potentials, cerebral hemodynamics, noradrenaline (NA)content in the blood plasma. Statistical processing was performed with the use of «Statistica 6.0¼ software. The levels of NA in the development of CMI were shown to increase, by the time of the shaping of this disease the noted change was decompensated in the nature. The study of reactivity of cerebral vessels revealed the presence of abnormal responses during hypercapnic load in 14 - 24% of examined cases. In the analysis of auditory evoked potentials there was established the change in indices of latency and amplitude of the V- wave, which pronounced in the prolong response time, significant elongation in the P1 peak latency and the gain in the latency of N1 peak. There was established the presence of the wave-like change in the index of the latency of P300. In workers without an occupational disease, there was noted the marked elongation of the latent period of cognitive potential, while in patients with the newly made diagnosis the latency of P300 corresponded to standard values, and in the long term there was observed a sharp deterioration in this index. With the aid of the discriminant analysis with the calculation of canonical value there were revealed the most informative neurobiochemical indices, reoencephalogric ones and evoked potentials. The developed method of diagnosis allows to distinguish between the initial symptoms of mercury intoxication and the first stage of the disease.

[On theory of sensory conflict under exposure to physical factors: main principles and concepts of formation].

The article presents results of longstanding studies on influence of occupational physical factors on workers health. Experimental and nature studies helped to justify basic concepts of sensory conflict theory, a trigger of occupational disease formation. Patients having occupational disease present disorders of cortex-subcortex relationships on diencephal level, central and peripheral regulatory mechanisms, central sensory mechanisms participation in pathologic processes development, changes in vegetative regulation on cerebral level, demyelination and axon demyelination changes in peripheral nerves of upper and lower limbs. Findings are also changes in central nervous, peripheral nervous systems, endocrine, immune systems, severe emotional negative strain and high level of nervous system excitation, perivascular edema in brain cortex of experimental animals. Based on key principles of the theory, the authors specified and tested new methods of treatment and prevention of occupational diseases caused by physical factors, aimed to unblock the sensory conflict.

[Cognitive disorders in toxic (mercurial) and alcohol encephalopathy].

To differentiate cognitive disorders in toxic (mercurial) and alcohol encephalopathy, the authors determined peculiarity of mental disorders in patients with toxic encephalopathie of various origins. Discriminant analysis helped to evaluate totality of informative neurophysiologic and psychologic parameters to assign patients to a group with cognitive disorders due to mercurial toxic encephalopathy or to a group with that due to alcohol encephalopathy.

[Cognitive impairment in a toxic lesion of the brain].

OBJECTIVE: To identify features of cognitive impairment in patients with toxic (mercury or alcohol) encephalopathy. MATERIAL AND METHODS: The study involved 36 patients with chronic mercury intoxication and 30 people with chronic alcoholism. A control group included 30 age-matched healthy men who were not exposed to toxic substances and alcohol abuse. All patients underwent neuropsychological examination, which involved a set of neuropsychological Luria rated memory status, praxis, gnosis and speeches. MMSE and FAB were used for the diagnosis of moderate cognitive impairment. Computer electroencephalography and cognitive evoked potentials method were used as well. RESULTS AND CONCLUSION: The diffuse brain injury in toxic encephalopathy (alcohol and mercury) on EEG, and according to the results of neuropsychological testing was identified. Changes in analytical and synthetic thinking, audio-verbal, long-term, visual memory, reciprocal coordination, finger gnosis, impressive speech were observed in mercury encephalopathy. Functional failure of the frontal lobe and the premotor area of the left hemisphere were revealed in alcoholic encephalopathy.

[CLINICAL AND BIOCHEMICAL CHARACTERISTICS OF DISORDERS OF THE NERVOUS SYSTEM AND THE RISKS OF COMMON PATHOLOGICAL SYNDROMES IN MERCURY PRODUCTION WORKERS].

The occupational factors are assigned one out of main parts to the development of occupational and comorbid pathology. At the same time the social aspects of labor relations act as the most important factors influencing on the workers' self-assessment of health status. Quantitative risk assessment of the common pathological syndromes has identified the excess of share of persons with a minimum level of risk over the medium and high. In the structure of risks of common pathological syndromes there are prevailed risks for disorders of the cardiovascular and nervous systems and borderline mental disorders, which is a response to the impact of not only industrial, but also psychosocial factors. The results of self-assessment of health status and clinical examination of employees in conditions of mercury exposure show the similarity of the structure of diseases in these cases. In either event there are dominated diseases of the nervous and mental sphere, and from the comorbid pathology disorders of the cardiovascular system are prove to be important. Clinical manifestations of the mercury exposure, ranging from pre-clinical manifestations to marked changes from the side of the nervous system in toxic encephalopathy, are characterized by the presence of hyperkinetic syndrome. For pre-clinical and early forms of mercury poisoning there is also typical the presence of asthenic (emotional lability) disorders with autonomic dysfunction. Comorbidities in an internship working was manifested primarily by diseases of visual organs, cardiovascular system and diseases of the musculoskeletal system. Observed disorders of the nervous system and psycho-emotional sphere are caused, inter alia disturbances of the balance of catecholamines (the rise of norepinephrine in dynamics with a concomitant increase in the coefficient reflecting the degree of its metabolism: norepinephrine/epinephrine and norepinephrine/(adrenaline + Normetanephrine)) in the body.

[Occupational neurointoxications: patterns and mechanisms of formation].

The article covers results of long-standing study of clinical features of occupational neurointoxications in late period, and mechanisms underlying nervous system disorders in individuals working under long exposure to neurotoxic chemicals and in late period of occupational intoxications. With modern neurophysiologic, neuropsychologic, immunologic and biochemical diagnostic methods, the authors specified early manifestations of occupational disorders. Translation patterns of neurointoxications are specified.

[Cognitive disorders in patients with chronic mercury intoxication].

To assess severity of cognitive disorders in chronic mercury intoxication, the authors performed claster and discrimination analysis of neuropsychologic and neurophysiologic research data from workers exposed to mercury during long length of service, from patients with early and marked stages of chronic mercurial intoxication. Cognitive disorders in chronic mercurial intoxication have three severity degrees, in the light degree disorders patients demonstrate lower amplitude of cognitive evoked potentials, poor long-term memory and associative thinking. Moderate cognitive disorders are characterized by decreased visual, long-term memory, concentration of attention, poor optic and spatial gnosis. Marked cognitive disorders with chronic mercurial intoxication present with more decreased long-term, short-term, picturesque memory, poor intellect, optic and spatial gnosis and associative thinking.

[Dynamics of morphofunctional state of central nervous system in white rates exposed to vibration].

The authors presented results of experimental studies assessing influence of vibration on white rats. Dynamics of morphologic changes development in brain of experimental animals exposed to vibration were shown. Exposure to vibration in white rats daily during 4 hours over 15 days causes astrogliosis--compensation process in response to brain injury; over 1 month--causes morphologic brain changes (vacuoles formation in neuropile, decrease in astroglia cells number); over 2 months--causes lower plasticity of brain neurons, preserved astrogliosis; over 4 months--causes perivascular edema. Changes in brain bioelectric activity indicate stages of pathologic process in central nervous system. Increase in vibration exposure duration leads to more severe diffuse pathologic changes in brain and local cortical and diencephalic disorders. Exposure to vibration in white rats causes increase in general mobility, nonspecific activation of behaviour, intense emotional exertion, negative emotional state, but less severe effects of vibration were seen in orientative-trying reactions that are inborn, inherited forms of behaviour.

[Quantitative estimation of the health status dynamics of persons occupationally exposed to mercury vapor: a remote period of intoxication].

The article presents the results of the dynamic clinical observation for persons suffered from occupational chronic mercury intoxication in the remote post-exposure period of the disease. The estimation of the dynamics of syndrome manifestations of chronic mercury intoxication and co-morbidity are presented. The important role of mercury exposure load as a predictor of deterioration of actual health of the patients in the remote period of intoxication is demonstrated.

[Neuropsychologic traits in individuals with chronic exposure to mercury at work].

The article deals with diagnostic peculiarities of neuropsychologic traits in individuals with previous exposure to industrial neurotoxic chemicals. Pilot studies demonstrated brain disorders characteristic for toxic (mercurial) and vascular (discirculatory) encephalopathies, justified necessity of neuropsychologic approach in occupational therapeutic diagnosis. The authors presented results of suggested scheme of neuropsychologic prompt screening aimed to reveal higher psychic functional disorders in individuals with occupational neurointoxications.

[Main aspects of classification and course of occupational neurointoxication with toxic chemical complex in firemen].

The article covers results of long-standing research of peculiarities of psychoneurologic syndromes formation in firemen during distant period after intoxication with toxic chemical complex. The authors studied course, peculiarities of early manifestations of neurointoxication. Analysis of the data obtained helped to classify occupational intoxication with toxic chemical complex, considering the clinical peculiarities.

[Toxic encephalopathies in distant post-contact period of occupational neurointoxications (clinical and experimental studies)].

The article covers results of long-standing research on clinical peculiarities and course of toxic encephalopathy in distant period of occupational neurointoxications, on main concepts and pathogenetic steps of formation and progress of toxic encephalopathy. Through investigation covered firemen after exposure to complex of toxic chemicals and patients in post-contact period of chronic mercury intoxication. Modelling of chronic inhalation of metallic mercury vapors was performed.