In 2016, the 120th birth anniversary of Ilya Yakovlev is celebrated. The article is devoted to Yakovlev’s biography and describes his research path, pointing out the main achievements in obstetrics and gynecology. The characteristic of its clinical work is provided. In addition, the article tells about his teaching activity.

Currently the problem of preventing cerebrovascular disorders, in which antiplatelet therapy takes one of the leading places, remains relevant. The efficiency of the therapy depends on a large number of modifiable and non-modifiable factors. There are many methods to assess the severity of the response to antiplatelet therapy, but there is no common approach to the assessment of the results and their prognostic significance. Further studies of this issue are essential with the aim of individualization of antiplatelet therapy thereby increasing its efficiency and safety.

The most essential data, predisposing to onset and recurrence of urinary tract infection in children are included in the review. Mineral, carbohydrate and purin metabolism monitoring both in active stage and remission of pyelonephritis is necessary for elaboration individual schemes of primary and secondary prophylaxis of chronic renal disease in children.

Relevance. Benign neoplasms of the gynecological field have a significant impact on reproductive health of the population. The efforts of the state authorities aimed at overcoming the demographic crisis; therefore, the questions of organization of medical care for women require special consideration.

Goal of research – todevelop a system of measures to optimize the arrangement of medical care for women with benign neoplasms of the gynecological sphere and to evaluate its effectiveness.

Materials  and methods. In 2015-2016, the study of delivery of medical care of patients with benign neoplasms of the gynecological field was undertakenon the basis of the antenatal clinics of St. Petersburg. 2500 cases of treatment were analyzed with the involvement of experts. Completeness and validity of diagnostic and treatment activities, the degree of continuity in the work of health care organizations, the need of patients in treatment at different stages were estimated. Taking into account the obtained results on the basis of one of the districts organizational experiment to optimize the provision of health care to women was carried out, and further its effectiveness was evaluated: an opinion poll of 2190 patients was held, 3334 cases were analyzed according to the database of issued and paid bills and ambulatory medical records.

Results.  Optimization of delivery of outpatient medical care to patients with benign tumors of female genital sphere is possible by increasing the activity of their dynamic monitoring: information on the characteristics of the disease, monitoring of compliance with the schedule of doctor visits, which can increase the frequency of prophylactic visits from 1.2 to 1.8 per year (optimal frequency – no less than 1.56 visits per year). Increase of treatment efficiency is achieved by early medical rehabilitation – professional psychological support of patients. Adjusted volume of psychological problems of patients in connection with the identified benign neoplasm: consultation of psychotherapist is indicated to 67.0% of the patients, specialized treatment is prescribed to one third of them. The introduction of a two-level system of internal quality control of medical care, allows to perform the prescribed amount of medical care, to ensure continuity of outpatient and inpatient stages of its delivery and to reduce the frequency of emergency hospitalization from 11.6 to 9.0 per 100 thousand of the adult population.

Conclusions. The experiment showed that the effective observation of patients is possible only under condition of close cooperation of medical organizations at all levels and building of a trusting relationship of the physician with his patient.

The paper is devoted to the study of little-known and previously unknown bacteria isolated from patients with various diseases. Here we present the data on 22 strains that are little-known or previously unknown as human pathogens and isolated from patients with various diseases. Most of the isolates were found to have multiple antibiotic resistances. Moreover, in many conditions potentially pathogenic spore-forming bacteria were identified. Spore formation provides bacteria for survival in the environment and promotes high resistance to antiseptics and disinfectants. Spore-forming bacteria are high survival and especially dangerous as potential hospital-acquired infections because of its antibiotic resistance but the activity of this antibiotic therapy doesn’t concern microbial spores.

 Relevance. Hematopoietic stem cell transplantation (HSCT) is one of methods to care patients with malignancy, hematologic and hereditary diseases; in most cases, it requires prolonged and massive substitutionary transfusion therapy. Analysis of effectiveness, cost and need for blood components in different types of HSCT would allow blood transfusion department for more accurate planning in blood output.

Objective  – to determine the need for blood components in different types of HSCT.

Material and methods. From December 2000 to December 2015, 851 patients with malignancies, hematologic and hereditary diseases who underwent 915 HSCT (54repeatedly) were included into the study.

Results. Substitutionary transfusion therapy was required in 849 HSCT (92.8% of cases Red blood cell-containing blood components were used in 842 HSCT (92%), platelet containing – in 795 HSCT (86.8%), fresh frozen plasma – in 228 HSCT (24.9%). The total number of blood transfusion in 1 case of autologous HSCT was 14.7 doses, in allogeneic HSCT – 18.5 (p=0,01). On average, transfusion therapy for one recipient of autologous HSCT cost – 57 817.4 RUB, for recipient of allogeneic HSCT – 181 710.3 RUB. The need for blood components was increased in the presence of progression/relapse of the underlying disease (p=0.0001), allogeneic HSCT compared to autologous HSCT (p=0.0001), in patients with a long history of transfusion (more than 30 blood transfusions).

Conclusion. Substitutionary transfusion therapy is a key factor increasing the effectiveness of treatment with the help of HSCT by prevention and treatment of anemic syndrome and hemorrhagic complications. Allogeneic HSCT compared to autologous HSCT was associated with significantly higher financial expenditure for providing substitutionary transfusion therapy.

Introduction. This article is devoted to the comparative analysis of the Russian and British approaches to restoration of the highest mental functions in patients with neurological disorders.

The applicability of development of effective programs for neuropsychological rehabilitation of neurological patients is represented, where one of the main directions is the reconstruction of higher mental functions.

Results. This article shows the importance of cooperation and understanding of specialists among the multidisciplinary team in medical rehabilitation system. The history of origin of the concept «multidisciplinary approach» is cited, it was spoken about by V. M. Bekhterev for the first time, emphasizing the necessity of multidisciplinary study of neuropsychic system of a healthy and ill person. Special aspects of rehabilitation process in Russia and in England were considered. Results of the comparison of neuropsychological rehabilitation models of two countries were presented.

Conclusions. Further guidelines of cooperation between Russian and foreign neuropsychologists were identified. The attention is focused on determination of rehabilitation potential and inclusion of the patient and his family in rehabilitation process as it allows to solve problems of insufficiency of motivation, a self-assessment and to prevent emotional violations, increasing quality of life of patients. 

Studies have shown that exposure to organophosphates (OPs) is associated with increased frequency of gastrointestinal diseases. In order to evaluate the effect of dysfunction of detoxification system on the development of gastrointestinal pathology, we studied «esterase status» (activity of acetylcholinesterase, butyrylcholinesterase and paraoxonase 1 (PON1)) among workers at the plants providing storage and disposal of OPs. The enzymatic activity of PON1 was significantly increased in individuals who had prolonged direct contact with the OPs. It was shown that among all gastrointestinal diseases included in this study PON1 activity was increased in patients with chronic esophagitis and chronic gastritis as compared to workers without gastrointestinal diseases (p<0.05), so and with diseased workers who had no direct contact with OPs (p<0.05). Thus, changes in PON1 activity may contribute to development of the gastrointestinal pathology among persons having direct contact with OPs. 

Importance. The study of psychological characteristics of patients is important for the creation and planning of psychological correction and improve the efficiency of the treatment of coronary heart disease.

Тhe purpose. This research is devoted to the study of the psychological features in patients with coronary artery disease (CHD) in the preoperative period, depending on their involvement in psycho-correction program.

Material and methods. We observed 30 patients with coronary heart disease before coronary bypass surgery. Clinical-psychological method (observation, conversation) and psychological testing were used.

Results  and conclusions. We found that patients who participated in psycho-correction program had lower values of «anxiety», «phobic anxiety» and «obsessive-compulsive» symptoms. In both groups of patients, on average, we identified the prevalence  of the coping-strategies «self-control» and «planning solution». Furthermore, on average, the «self-awareness» and «extraversion» were more manifested features in the structure of the personality traits of the surveyed patients. The revealed features should be taken into account in planning the programs of psycho-correction for patients with CHD prior to CABG surgery.

The psychological peculiarities of dental patients with periodontal disease are summarized here. Also, the article presents the description of patients with positive and negative dynamics of treatment.

Objective  – to identify relationships between the characteristics of the patient’s personality and their implementation to the recommendations of dentist.

Materials  and Methods. 45 people were examined, an average age of 43 years. The following psychodiagnostic methods were used: 1) the multidimensional questionnaire on health; 2) the test «Diagnosis of interpersonal relationships»; 3) characterological questionnaire by K. Leonhard&T. Shmishek; 4) individually-typological questionnaire by Sobchik L.N.; 5) the questionnaire of self-evaluation status;  6) personality Inventory of Bekhterev Institute. These dental indexes of oral health were measured: 1) CPITN; 2) PMA; 3) Saxer & Muhlemann; 4) Silness & Loe; 5) OHI-S.

Results.  According to the results of two measurements of dental indexes, 3 groups of patients were identified: 1) with good oral hygiene; 2) with poor hygiene and positive dynamics (improving dental health index); 3) with poor hygiene and negative dynamics (deterioration indexes). The interrelation of the recommendations  of a dentist with the personal characteristics of patients was found.

Summary.  Most patients have tried to follow the dentist’s recommendations for oral care, as evidenced by the decline in dental health indexes in the second survey. Differences in personal characteristics of patients, following and not following the recommendations were revealed, also, the gender differences in the groups with improvement and deterioration indexes were found.

The work is devoted to study of features of the status of smoking in patients with the chronic obstructive pulmonary disease (COPD). Degree of nicotine addiction, types of smoking behavior in various age groups of patients are determined. The interrelation at sick HOBL between motivation to refusal of smoking and the attitude towards health is analyzed. The directions of psychotherapeutic impacts for increase in efficiency of the techniques directed to refusal of smoking are offered.

Objective  – to study the motivation to quit smoking and attitudes towards health in patients with COPD.

Materials  and  methods. A questionnaire by D. Horney for determining the type of smoking behavior; Fagerstrem test for the determination of nicotine dependence; the questionnaire for determining the motivation to refuse to smoke; the questionnaire of N.E. Vodopyanova «Assessment of the level of satisfaction with the quality of life» (2005) and the methodology «Attitude to health» by R. A. Berezovsky.

Results.  The average age for the entire sample of respondents was 65.3±7.6 years, the length of smoking in smokers was 33.5±14.3 years. The predominant type of smoking behavior in the survey sample was «Support». In patients with high motivation, the assessment of the level of satisfaction with the overall «quality of life index» (ICI) was 26 points. In patients with low motivation to quit smoking, the mean value (ICR) was 21.

Conclusion. Patients with high motivation to quit smoking were older than patients with low motivation. A group of patients with COPD with high motivation to quit smoking was characterized mainly by low or medium degree of nicotine dependence; the dominant type of smoking behavior of them was «Support.» On the contrary, in the group of patients with low motivation, physical dependence on nicotine prevailed; the «thirst» was the dominant type of smoking behavior.

Relevance. Kidney transplantation is the method of choice for women of reproductive age with late stage of chronic kidney disease, who want to realize their  childbearing function. Pregnancy and childbirth in patients with renal  allografts are classified as an increased risk due to the more frequent complications compared to the general population. Progressive pregnancy is observed in 5–12 % of patients with renal  allograft, the frequency of favorable outcomes in such  cases  is 65–92 %.

Objective. To identify the most common complications in pregnancy in women with a transplanted kidney, to review the algorithms for maintaining this category of patients

Material and methods. In the  clinic  of obstetrics and  gynecology two patients with a renal  allograft were examined and  delivered, observed in common with specialists from the Research Institute of Surgery and Urgent Medicine.

Results. Both patients were delivered by a cesarean section, the postoperative period proceeded without complications in both cases.

Conclusions. This  category of patients needs to be  closely monitored throughout the  pregnancy by a multidisciplinary team  of specialists. This article describes the clinical cases  of pregnancy in patients with a transplanted kidney.

Hirayama disease is a rare neurological disease with unilateral or asymmetric bilateral distal upper limb paresis and muscle atrophy. Here  the authors report a clinical case of patient with weakness of cluster muscles and distal asymmetric upper paraparesis. Taking into consideration complaints, clinical presentation and performed follow-up examination (bloodwork, cervical MRI in neutral position and with flexion, MRI of lower limb muscles and electroneuromyography) the patient was diagnosed with Hirayama disease with asymmetric upper extremities. Also, there is a review of literature with pathogenesis, clinical presentation, diagnostic and treatment approaches to this disease.