Recommendations for the management of familial Mediterranean fever are reflected in presented translation of new international guidelines (EULAR, 2016)

The article describes the problems associated with the organization of medical aid to the population in the outpatient setting, particularly in the work of the district services. The causes that produced them, as well as measures to optimize the structure and operation of outpatient clinics. Special attention is paid to the personnel policy and streamline the work of local doctors, which should attract and retain specialists in this service, increase their efficiency, accessibility and quality of medical care.

Despite general availability, safety, modern computer equipment and also despite increase in quantity of respiratory organ’s diseases, the spirometry is applied more rarely than other diagnostic techniques that used in practice of the doctor. One of the reasons of the current situation is underestimation of spirometry opportunities in medical practice. It is shown that in case of the correct accomplishment and interpretation of spirometric data is possible to diagnose violations of pulmonary ventilation at the initial stages. The spirometric research is an important method of functional diagnostics for assessment of durability and a risk level, for effective maintaining and dynamic observation of patients with diseases of lungs.

The goal of this research was to value of primary prevention of myocardial infarction using clinico-economical indices and to find a way of raising efficiency of its. The costs of treatment 17 378 patients up to 70 years old with stenocardia and expense amount of treatment in out-patient, inpatient departments and ambulance were estimated on the basis of compulsory medical insurance rates. Probability of myocardial infarction in patients with stenocardia was evaluated in relation to medical aid appealability to medical organizations. It was found 31% patients with stenocardia do not seek medical advice in out-patients. Meanwhile probability of myocardial infarction in those patients in 2.3 times higher than in patients received treatment in out-patients. It was found also that 1.0 ruble investment to prophylactic medical examination for patients with stenocardia gives profit 8.5 rubles in view of saved person-years and reducing of treatment expense. That profit can be raised twice by the using of “recipientoriented” primary prevention of myocardial infarction. “Recipient-oriented” primary prevention of myocardial infarction is realized in cooperation of medical organizations, health insurance companies and compulsory medical insurance fund.

Research is devoted to the design of a quantitative approach to the assessment of therapeutic response to therapy of patients with ulcerative colitis in the first 5 days of treatment. The study included 48 patients with ulcerative colitis with mild and moderate-severe current disease. Quantitative changes in the severity of the condition of the patient were analyzed using a specially designed questionnaire, including laboratory values and clinical symptoms. It was found that the standard qualitative approach to evaluating the effectiveness of the therapy in patients with ulcerative colitis with multidirectional dynamics of individual clinical symptoms and laboratory parameters in the first 5 days of treatment in most cases does not allow to give an integral characteristic of the general condition of the patient changes. Designed quantitative approach to evaluating therapeutic response to the treatment allow not only identify the minimal changes in patient condition in the first 5 days, but also to predict the effect obtained by the treatment of two weeks.

Introduction. Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal tract. The difficulty of its diagnosis related to the lack of specific markers of the disease. This article describes the visual changes of the mucosa of the colon in irritable bowel syndrome in the dynamics of medical and physiotherapy treatment. Materials and methods. Examined and treated 100 patients with endoscopically confirmed diagnosis of IBS. Of which 50 people were receiving pharmacotherapy and 50 –sinusoidal modulated currents — phoresis natural brine. Given the morphological evaluation of the mucosa of the intestine in the dynamics of treatment. Results. In IBS morpho-endoscopically detected dyskinetic disorders, minimal signs of nonspecific inflammation of the mucosa of the colon and primary degenerative manifestations. These changes are reversible and can be used to assess the quality of treatment. The high efficiency of SMC-phoresis natural brine in IBS.

The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

Combined liver damage in patients with chronic heart failure and non-alcoholic fatty liver disease leads to the formation of pathological hemodynamic types of microcirculation with prevalence of shunt blood flow, nutritional deficiency, that correlated with changes in the functional state of the liver. Using cytoprotector mexicor for 16 weeks as part of the basic treatment of patients with chronic heart failure and non-alcoholic fatty liver disease can correct these microcirculatory disorders, has a beneficial effect on endothelial function, autonomic tone of microvessels, which is accompanied by the positive dynamics of indicators of cytolysis and cholestasis.

Influenza and acute viral respiratory infections have a great social significance during epidemic rise of morbidity and demand differential diagnosis of pneumonia with bacterial etiology and consultation with an infectious disease doctor in case of seeing patients in non-core hospitals. This article highlights the problem of influenza and acute respiratory viral infections’ early diagnosis. Clinical manifestations of influenza and other respiratory extremely similar. The differential diagnosis must take into account the presence of mixed infection in the same patient. According to the results of consultative infectious ambulance teams in 2014-2016, quality of diagnostics of this infectious pathology was examined. Observed deaths in persons later seeking medical treatment, not receiving timely antiviral therapy and related to high-risk groups: patients with obesity, chronic alcohol intoxication, diabetes, pregnant women. Influenza and acute viral respiratory infections, more complicated by pneumonia, people in the older age group, indicating the need for timely medical evacuation of patients older than 60 years. In some cases, in the diagnosis of influenza was helped by the results of laboratory studies (especially the trend to leukopenia) and a positive rapid test. It should be noted that a negative rapid test for influenza was not a reason for exclusion of the diagnosis “influenza”.

Thrombotic complications are a common problem in clinical practice. The most important are coronary thrombosis with myocardial infarction, ischemic cerebral infarcts in patients with atrial fibrillation, venous thrombosis complicated by pulmonary embolism. The use of oral antiplatelet therapy significantly reduced the incidence of fatal thrombotic complications. However, use of this group of drugs is associated with an increased risk of bleeding, which often turn out to be fatal for the patient. In the article presented the modern tactics of treatment of patients receiving a variety of oral antithrombotic agents, described a typical example of clinical complications.

The goal is to determine the possibilities of treatment of reperfusion myocardial injury in patient with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Methods. Clinical observation. Results and discussion. After percutaneous coronary intervention the return of blood flow can result in reperfusion myocardial ischemia, «no-reflow» phenomenon, which is manifested with recurrent angina, disturbances of rhythm and conduction, worsening of ECG, decrease in local and global contractility of the left ventricular myocardium. Conclusion. The addition of calcium channel blockers to standard therapy can stabilize the patients condition, relief angina.

Close clinical and phylogenetic relationship of skin conditions, mental health and disorders of the hepatobiliary system was established. The aim of the study was to evaluate the efficacy of systemic antifungal monotherapy (terbinafine) plus S-adenosylmethionine (AdoMet, SAMe), as compared to terbinafine alone, in patients (n=108) with onychomycosis and different chronic itching dermatoses. Management with terbinafine plus hepatoprotective agent was associated with better therapy response, SAMe supplementation seem to be effective in the prevention of liver injury, normalization of biochemical parameters and neuropsychological evaluation of patients.

Cameron syndrome is the ulcerative or erosive lesions of mucosal layer at the sac of hiatal hernia which can cause chronic occult or overt bleeding and iron-deficiency anemia. Hiatal hernia is a relatively frequent finding, which is in most cases asymptomatic or manifested by dyspeptic symptoms of varying severity. Despite of being a very important association of hiatal hernia Cameron syndrome is not widely represented in medical literature. That`s the reason of a lack of awareness among physicians, surgeons and endoscopists about that pathology. Cameron lesions are significant pathology because they can become a source of chronic occult as well as an acute life-threatening bleeding. Those lesions of upper gastrointestinal tract are often misinterpreted or overlooked during standard diagnostic procedures. It can lead to the misdiagnosis and false ways of treatment. The review focuses on the pathogenesis, main diagnostic problems and treatment options of that pathology. The diagnostics of the Cameron syndrome is difficult because sometimes the lesions can`t be seen on upper gastrointestinal tract endoscopy. The review describes the criteria by which the physician may suspect Cameron syndrome when endoscopy results are not certain. Clinical case represents an important problem which is often faced by the doctors — the severe iron-deficiency anemia refractory to the medication and blood transfusions in the patients with Cameron lesions. It`s very important for doctor to be aware of that complication to include Cameron syndrome into the diagnostic search for the sources of persistent blood loss. Cameron lesions can be asymptomatic as well as be manifested in the form of severe chronic anemia. And that`s the reason why there are an important issue about the proper treatment which have to be provided in each case. The review describes the effectiveness of different treatment options and makes the conclusion about the principles on which doctor can rely in giving favor to a conservative or surgical treatment.