No abstract

Fractional myocardial extraction/release of glutamate, glutamine, alanine, ammonia, asparagine, glucose and lactate was studied in 12 subjects with normal coronary anatomy (controls) and 28 patients with coronary artery disease (CAD) during rest and atrial pacing. At rest patients with CAD showed an increased myocardial extraction of glutamate, glucose and lactate and an augmented glutamine and alanine release compared with controls. In all CAD patients myocardial ammonia and asparagine release was found at rest, while all controls showed myocardial extraction of these compounds. Myocardial glutamate extraction correlated positively with glucose and lactate extraction, glutamine and alanine release and inversely with ammonia release in CAD patients at rest. In patients with two- and three-vessel disease pacing-induced ischaemia resulted in a pronounced decrease in myocardial glutamate extraction and glutamine release, augmented myocardial production of ammonia and asparagine and a conversion of lactate extraction into lactate release. During pacing myocardial glutamate extraction was related to alanine and glutamine release and correlated inversely with ammonia and lactate release in these patients. The results indicate that glutamate extraction is closely connected with glucose and lactate extraction and ammonia binding via glutamine formation in the hearts of CAD patients and, thus, with the energy supply of ischaemic myocardium. An assessment of myocardial exchange of the nitrogenous compounds we have studied, complimentary to lactate, is a promising biochemical test for the identification of ischaemic heart disease in man.

The review of domestic and foreign research on leveling problematic of medical and sanitary consequences of traffic accidents has been carried out. Scientific articles were extracted from specialized scientific search systems (eLibrary.ru, PubMed.gov, Scopus Database) using keywords: emergency medical care, prehospital phase, road traffic injuries and road traffic accidents. Increase in the frequency of road traffic accidents (RTA) in absolute number of injured persons, mainly with polytrauma, caused by high-energy collisions of motor vehicles on highways require the development of new methods and forms of providing medical care. The aim of the study was to identify and analyze the ways of improvement of emergency medical care system for victims of RTA at the pre-hospital phase of medical evacuation. New methods in this sphere have been suggested. The most relevant ways to improve the system of emergency medical care to the RTA victims are the following: improvement of professional competence of specialists providing first aid to RTA victims; cooperation optimization of Emergency Medicine Service with similar forces of departmental healthcare and other regional emergency services; creation conditions for immediate movement of emergency teams to the scene of a traffic accident for provision victims medical care; standards optimization on providing medical care to the victims of traffic accidents at the pre-hospital phase of medical evacuation; increase of personnel training, working in the regional operations control centers of emergency medicine; emergency wards and leading municipal hospitals by means of conducting incident command team exercise; renovation of vehicle fleet for aerovac of RTA victims to widen opportunities to provide specialized medical care. These proposals, in our opinion, are the most important ways for development of emergency system provision to RTA victims. Its implementation will allow to reduce mortality in prehospital phase.

The purpose of the study is to evaluate the inter-hospital medical evacuation of victims of road accidents on the Federal highway M-8 "Kholmogory" in the Arkhangelsk region to determine ways of further improvement. Materials and methods of research: a retrospective study is carried out of 112 medical records of victims of accidents on the FAD M-8 "Kholmogory" in the Arkhangelsk region, evacuated for urgent reasons in the period from 01.01.2012 to 31.12.2018 from the Central district hospitals (CRH) to the Arkhangelsk regional clinical hospital – trauma center level I. Research results and their analysis. There was an increase in the number of cases of inter-hospital medical evacuation of victims of accidents on the FAD M-8 "Kholmogory", especially its sanitary aviation component-by 2018; all evacuees had severe polytrauma, the vast majority of them were evacuated from the CRH to the level I trauma center within the first day. The need is substantiated to equip a helipad, purchase a helicopter, create full-fledged emergency response teams, and organize routing of victims of accidents on the FAD M-8 Kholmogory in the Shenkursky and Velsky districts of the Arkhangelsk region to the Velsky CRH-level II trauma center.

Relevance. Road traffic injuries, having the nature of a global epidemic, pose an urgent medical and social problem. Among victims of road traffic accidents, mortality is many times higher than that of victims who were injured under other circumstances. The survival of victims in road accidents depends on the timeliness, quality and capacity of emergency medical care, on the competence of care providers and on the effectiveness of the organization of this type of medical care at the prehospital stage.Intention – to estimate the time of providing emergency medical care for victims on the federal highway M-8 “Kholmogory” on the territory of the Arkhangelsk region.Methodology. The material of the study was a sample of 906 medical records (form 003/y) for victims of the road accidents, who were admitted to hospitals of Arkhangelsk region in the period from 01.01.2012 to 31.12.2018. Registered forms were selected according to the criteria of retrospective full-design documentary observation. Differences between the observation groups were considered statistically significant at level of p < 0.05 as adjusted for multiple comparisons (Bonferroni correction).Results and Discussion. Time factor of emergency medical care on the federal highway M-8 “Kholmogory” in 3 medical districts of the Arkhangelsk region was characterized. The ambulance teams arrived at the place of accident within 20 minutes in 30 (3.3 %) cases, from 21 to 40 minutes – in 345 (38.1 %) cases, from 41 to 60 minutes – in 299 (33 %) cases and over a period of more than 1 hour – in 232 (25.6 %) cases. There was no statistically significant difference in time of providing emergency medical care for victims with isolated, multiple and concomitant traumas.Conclusion. It was shown that in 74.4 % of cases (p < 0.001) ambulance arrived at the site of a road accident earlier than 60 minutes. The largest number of cases of providing emergency medical care exceeding 60 minutes was noted in the Arkhangelsk Medical District – 28.4 % (p < 0.013), and the lowest –in the Severodvinsk Medical District – 18.3 %. In more than a quarter (26 %) of cases the emergency medical care was provided for victims with polytrauma beyond the 60 minutes period, with most of them in the Arkhangelsk Medical District (p = 0.004).

■ Keywords: pregnancy and parturition in minors; pregnant adolescent; young mothers.

The purpose of the study is to use the example of the Arkhangelsk region to identify conditions affecting the organization of medical care for victims of road accidents on the federal highway in a region with a low population density, and to determine the main directions of its improvement. Materials and research methods. Using the method of comparative analysis, the following review was carried out: review of the authors’ studies, the subject of which was the features of road traffic injuries on the federal highway M-8 «Kholmogory» within the Arkhangelsk region; review of domestic and foreign scientific research, review of regulatory documents on the provision of medical assistance to victims of road accidents. Scientific literature search was performed in eLibrary, PubMed, Scopus systems by keywords. Scientific articles published in 1990–2020 were selected for analysis. Using the method of an organizational experiment, a scientific substantiation of a set of measures to improve the efficiency of the provision of medical care in prehospital and hospital periods to victims of road traffic accidents at federal highway in regions of the Russian Federation with a low population density was carried out. Applying the method of system analysis, on the basis of the results of this study, conceptual provisions for a systemic register of health consequences of road accidents in the Russian Federation have been developed and scientifically substantiated. Research results and their analysis. The article describes road traffic injuries on the federal highway M-8 «Kholmogory» in the Arkhangelsk region. The factors that determine the effectiveness of the provision of medical care in prehospital and hospital periods to victims of road traffic accidents are considered. The ways of improving the provision of medical care to victims of road traffic accidents at federal highway in a region with a low population density are formulated and substantiated.

Aim. To present data of Russian and foreign studies on the prevalence, pathogenesis and clinical picture of gastrointestinal tract (GIT) pathology in patients with primary hyperparathyroidism (PHPT).Key point. At the beginning of the 20th century PHPT was considered a severe endocrine disease with specific bone and kidney complications, however in 1957 W.T. St Goar proposed a mnemonic triad to recognize this pathology as “diseases of stones, bones and abdominal groans”. A high frequency of gastrointestinal complaints, peptic ulcer, pancreatitis, cholelithiasis in patients with PHPT has been reported. Hyperparathyroidism has been shown to cause smooth muscle atony with specific upper and lower GI symptoms such as nausea, heartburn and constipation. The prevalence of peptic ulcer in patients with PHPT, according to studies of the 50s–60s of the last century, ranged from 10 to 25 %. However, studies linking PHPT to peptic ulcer development were performed before the advent of proton 1). On the other hand, the development of pancreatitis in PHPT is one of the most studied pathologies. In developing countries its frequency can reach 10–20 % due to the absence of routine screening for blood calcium. Some authors report the impact of elevated parathyroid hormone levels on the formation of gallbladder stones by inhibiting of gallbladder emptying, hepatic bile secretion and mobility of the sphincter Oddi, and changing of the bile composition. A number of studies have found an increased risk of developing malignant neoplasms of the intestine, especially the colon, in patients with PHPT.Conclusion. The digestive manifestations of parathyroid dysfunction in patients can often be overlooked, and serum calcium levels should be included in the routine examination in the presence of abdominal symptoms.