Volume 97, Nº 5 (2018)

The article presents the peculiarities of medical deontology in preventive medicine. The differences between deontological problems in the activity of a Clinician and a Physician in the specialty of medical and preventive medicine are considered. The historical stages of the formation and development of ideas of deontology and medical ethics in Russia are shown. The comparative plan presents an analysis of the main legislative acts in the field of bioethics and deontology of medical and preventive medicine. The world community was noted to show a great interest in topical problems of bioethics: several World Congresses and European Conferences were held, in most countries of Europe and America national bioethics committees were established (in the USA and France they were organized under the Presidents of these States). The main goal of the doctor’s professional activity is to preserve human life, prevent diseases and restore health, as well as reduce suffering from incurable diseases. Much attention is paid to this problem in the Federal law of November 21, 2011. (N 323-FZ) about bases of the protection of the health of citizens in the Russian Federation “which is fundamental in the field of healthcare”. It establishes the obligation of medical and pharmaceutical workers to carry out their activities in accordance with the legislation of the Russian Federation, guided by the principles. The aim of this study was to develop and substantiate the main differences between deontological problems in the activities of clinicians and physicians in the specialty medical and preventive care in the historical aspect. An invaluable role in the development of the principles of deontology was played by outstanding doctors of the past: Hippocrates, Abu-l-Faraj, as well as Russian and Soviet scientists and doctors M.Ya. Mudrov, N.I. Pirogov, V.A. Manassein, V.I. Davydovsky, N.Kh. Petrov, B.V. Petrovsky. Separately, it is noted that the role of medicine can be radically changed, if not exclude the importance of the preventive direction, but, on the contrary, through it to strengthen the ideological and controlling.

There are presented results of the study of the impact of intoxication with nitrogen oxides on to the fatty acids pattern of phosphatidylcholine and phosphatidylethanolamine of erythrocyte membrane in rats. The inhalation exposure with nitrogen oxides was carried out in inoculating chamber with the volume of 100 liters and designed according to the type of chambers by Kurliandsky B.A. with self-cleaning of contained air and regenerating system, specified temperature settings (20-22 °С) and the air humidity (40-60%). Intoxication by nitrogen oxides was performed for 6 minutes with a toxicant concentration of 4.3 mg/cu.m. (MAC in atmospheric air amount to 0.4 mg/m³). Water solutions of dry residue from viburnum extract “Kaliphen” and Eleutherococcus extract (alcohol was anticipatorily removed from preparations by evaporating in a vacuum) were administered daily through the tube intragastrically during 2 weeks in a dosage of 100 mg of total polyphenols per kg of body weight prior to intoxication by nitrogen oxides. The influence of nitrogen oxides was found to be accompanied by the elevation of the level of saturated fatty acids of all kinds and by the decline in unsaturated fatty acids content in the fatty acids pattern of phosphatidylcholine and phosphatidylethanolamine, the main structural phospholipids of biomembranes. The redistribution of fatty acids in erythrocyte membrane supposes the changes of its physicochemical properties, lability, and the complexity of the erythrocyte passage through the microvascular bed. Herbal polyphenol preparations Kaliphen and Eleutherococcus improved the survival rate of animals under the preventive administration before intoxication with nitrogen oxides. The introduction of extracts before intoxication is accompanied by the pronounced trend to the restoration of the ratio of saturated and unsaturated fatty acids in phospholipids of erythrocytes membranes. The preventive administration of Kaliphen before intoxication with nitrogen oxides was supposed to offer more pronounced protection of the fatty acids pattern of phospholipid fractions than those following the introduction of Eleutherococcus. The preventive administration of herbal extracts with polyphenol complexes in its contents under exposure to toxic substances is considered to be a the promising direction for research.

The article contains the results of a study of the ecological hazards of long-term consequences (XVII-XXI centuries) of human activities on the shores and waters of the South-Eastern Baltic Sea. The following issues have been considered: 1) territorial losses and the destruction of man-made objects; 2) natural radioactivity of the potential source of mineral raw materials — titanium-zirconium concentrates in beach sands and their content of ¹³⁷Cs (the “Chernobyl trace”); 3) echoes of the Great Patriotic War (WWII) — ammunition on the shore and dumping on the seabed of captured chemical warfare agents from the arsenal of Nazi Germany. The study has determined the following. Coast in Courland, after Peter the Great built the port of Libava (the end of XVII century) and after malls were extended in the nineteenth century, had been stable. Modernization of the military avantport of Emperor Alexander III at the beginning of the XX century with the removal of the sea piers on 2123 m caused the obstruction of sands along the coast and its grassroots catastrophic erosion to the North of the port. By the 1930s, the bottom sands have been eroded to Cape Akmenrags (along with the coast to ~40 km, the volume of >70 million m³). By the 1990s, at 4-6 km closest to port, the shore has receded up to 200 meters. Houses, landfills, fragments of the sewer were destroyed. There was a threat of collapse of toxic objects of municipal wastewater treatment facilities into the sea (sludge beds, chlorination station, town Schedes). An environmental disaster was prevented by the timely constructed shore protection facilities (1988-1991). The erosion of the shore caused the accumulations on the beach of industrially important titanium-zirconium concentrates (>1,5 t/m³). Heavy minerals (zircon, monazite, etc.) contain natural radionuclides (thorium, uranium etc.), their activity (5668,6 Bq/kg) exceeded the hygienic standard (1500 Bq/kg) by ~4 times. Mineral raw materials of this quality refer to the IV class of hazard. As for ¹³⁷Cs, considering the period from the Chernobyl disaster (April 1986) to the analysis of the specimens (spring 2015 ~the half-life of the isotope), the concentration could reach,: in sands — 110 Bq/kg, in organic soils and peatlands — up to 500 Bq/kg. The contamination was consistent with the radiation condition of the several territories of the USSR, which have experienced the impact of the disaster, but was higher than in the Altai (“Semipalatinsk trace”, 41-43 Bq/kg). Echoes of the War resulted in storms bringing ashore ammunition, which caused injuries and deaths of adolescents, who found such “waste” of World War II (the town Schedes, the elimination of the Nazis in “Liepaja port”, 1945). In the deep (92-208 m) basins (Bornholm, Gotland) and in other areas of the Baltic Sea there are about 60 underwater dumpings of chemical warfare agents. The threat of environmental disaster may appear in the case of their large-scale mechanical damage (trawling, drilling, pipelines, etc.). The uncertainty of the information about the number of dumpings of chemical warfare agents keeps a danger of their location on the coast and bringing by waves to the beach. Further exploration and monitoring of dumpings are particularly relevant in connection with the laying of the gas pipeline “Nord stream – 2”.

The analysis of personal data (characterizing a way of life, area of residence, food ration, an available disease, symptoms) of patients with the established diagnosis of colorectal cancer (CRC) and persons of the comparison group without this diagnosis was carried out. The factors (signs) associated with the risk of the development of colorectal cancer were determined, the probability of their detection in patients and healthy, their diagnostic value (informative value) was estimated. The most informative factors associated with the risk of the development of CRC were found for residents of the Omsk region: changing the region of residence, addiction to fatty food, passing the last prophylactic medical examination more than 4 years ago, having relatives of the first line with colorectal cancer, information on the state of health (positive the result of examination of feces for latent blood, symptoms of the presence of admixture of blood in the stool, false desires for stool presence of polyps, hemorrhoids, cracks in the rectum).

An important feature of the modern life is a significant environmental pollution, which creates the danger of simultaneous effects of carcinogenic and toxic compounds on the human organism. The combined effect of such ubiquitously common compounds as benzo(a)pyrene (BP) and nitrites (NI) was studied in the experiment, on 320 female mice F1 (CBAxC57BL/6). The mice (6 groups of 50 animals) received BP application on the skin at a dose of 6 or 9 µg/mouse (two cycles for 12 weeks each) or BP in the same doses in combination with sodium nitrite (SN) was administered to animals with water at a concentration of 50 mg/l or 500 mg/l throughout the entire experiment. The study revealed SN to have moderate potent effects on carcinogenesis induced by cutaneous application of BP, increasing tumor multiplicity index by 1.4–1.6 times (p < 0,05), as well as the prevalence rate of skin tumors and hormone-dependent tumors. Under the action of the maximum doses of BP + SN (9 µg + 500 mg/l), the number of animals with skin tumors increased by 2.4 times (p < 0.01). The number of animals with hormone-dependent tumors (total: breast, ovary, and uterus) increased by 2.8–3.5 times (p < 0.01) under the combined effect on BP+SN compared with that of BP alone. There is discussed a possible mechanism of the stimulation the carcinogenic process due to the increased appearance of reactive oxygen species, nitric oxide metabolites, as well as the suppression of the phagocytic function of blood neutrophils.

The article shows the classification of the supervised objects of the Office of Service for Supervision of Consumer Rights Protection and Human Welfare in the city of Moscow depending on the index of the potential risk for harm to public health in the conditions of the application of the risk-oriented approach. There is considered the possibility of the control and surveillance activities with the redistribution of human resources of the Office of Service for Supervision of Consumer Rights Protection and Human Welfare in the city of Moscow with respect to supervised objects 1 and 2 classes of the potential risk for harm to the health of the population on the risk-oriented approach.

Introduction. Phthalates are substances widely used as plasticizers for the production of various industrial, domestic, food and medical polymer materials. Possessing high volatility, solubility, a wide range of toxic effects, phthalates represent a serious danger to human health. Goal. Identify the characteristics of donosological forms of impaired health.

Material and methods. A special clinical and functional examination of the aparatics for the first time started their work in the production of terephthalic acid (TPA), purified terephthalic acid (oTPA) and polyethylene terephthalate (PET) in the dynamics of 5 years of operation of the enterprise POLYEF. Hygienic, hematological, cytochemical and biochemical studies were performed for workers with a primary 5-year experience in this industry.

Results. It is established that the chemical factor is represented by a complex of harmful substances of 1 to 4 hazard classes, among which there are substances of irritating, general toxic, allergenic action. The production of phthalates is characterized by an increased content of TPA from 1.5 to 2.8 MPC.

Discussion. The working conditions of the apparatchiks in all industries are estimated as harmful to the third degree — 3.3. Among those who have worked for 5 years, about a third of workers are recognized with clinical and functional disorders. For 5 years of work, two of the first three come into contact with phthalates revealed changes in the blood system that go beyond physiological fluctuations. Most workers have anemia, reticulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, decreased activity of enzymes.

Conclusions. The introduction of a differentiated approach, taking into account the results of the clinical, hygienic and laboratory-diagnostic studies carried out, will allow monitoring of the health status of workers in the production of TFA and PET, identify early donosological signs of health disorders, and adequately form high-risk groups for conducting therapeutic and preventive measures.

There was executed the study including the examination of 833 students of 2-6 courses of the medical University concerning their subjective rating of the stress level on exams, its causes and the measures they used to reduce stress. 26.7% of students noted the high level of stress on examination, there was significantly increased the number of students with low-stress levels in students оf 3-4 courses, boys, and students with good and excellent grades note significantly less a high level of examination stress. The most common manifestations of stress are changes in the cardiovascular system (62% of the students) and autonomic nervous systems (48.6%), these manifestations were significantly less noted in students with good and excellent grades. In the course of training, there was discovered the increase in complaints of the frequent urination, loose stools and discomfort or pain in the abdomen. The main causes of stress at exams, according to students, there are a large amount and difficulty of exam material and the insufficient addressing of examination tasks in the classroom. In the dynamics of training, there is a significant reduction in the number of students who believe early acquaintance with the exam questions to be important, the sufficiency of the time devoted to self-education and an increase in the number of students recognizing it is necessary to reduce the waiting time of the call to the exam. Most popular methods of the reducing examination stress on younger courses are the use of rites, superstitions, and drugs, in the senior years. A growing number of individuals using the techniques of autogenic training was discovered. 49.9% of students do not fight with stress. 63.9% of students consider the introduction of elective subjects of “Prevention and correction of examination stress in students” to be necessary.

The analysis of data on alimentary-dependent diseases among persons of the working age in the Republic of Tatarstan testifies to their steady growth. The proportion of deaths from diseases in the etiology of which nutrition plays a significant role over the period 2005-2015 was 77.9%. We have identified the main trend of eating behavior in each age group: high protein intake (in 75% of men and 81% of women) and fat (in 59% of women and 67% of men). A normal range of the body mass index (20.0-24.9), was noted in 44.3% of women and 44.7% of men. About 38% of the surveyed men and more than 2/3 of women (63.2%) do not have additional physical activity. As a result of the irrational eating behavior and low physical activity, the number of overweight men increased by 17.5% during the studied period. Only 20% of residents of the Republic of Tatarstan can be considered rational.

Introduction. The purpose of the study was to determine the characteristics of the biological effect of diisononyl phthalate, a new plasticizer for polymer products.

Material and methods. Toxic properties of the compound have been studied in various ways of its entering in the organism of laboratory animals, local irritating, cumulative and skin-resorptive actions have been established, the potential ability of the compound to induce remote effects in experimental models in vivo/in vitro has been revealed.

Results and discussion. The obtained data show diisononyl phthalate do not pose a risk of the acute poisoning under intragastric, intraperitoneal, epicutaneous and inhalation modes of exposure, being incapable of inducing signs of the irritation of the skin and mucous membranes, is not allergic. With subchronic intragastric administration of diisononyl phthalate in doses from 10,000 to 100 mg/kg, the dose dependence of toxic effect and its ability to cause chronic polytropic poisoning of the action in the form of disturbance of the pattern of peripheral blood, calcium and phosphorus metabolism and changes in the functional state of internal organs are revealed. In the study of the reproductive toxicity against the background of the administration of the drug at a dose of 10,000 mg/kg, an increase in total postimplantation, embryonic and the postnatal mortality rate was established. Intragastric administration of diisononyl phthalate at the mentioned dose to female animals during pregnancy triggered the formation of multiple (combined), external and internal malformations of embryos that were single in response to a reduced dose of up to 100 mg/kg. Changes in the state of the reproductive function of males have not been established. In the study of mutagenic toxicity in the Ames test, the effect of the compound has not been established to lead to an increase in the number of revertant colonies, which indicates the lack of ability of diisononyl phthalate to induce point mutations.

Conclusion. The results of the studies showed that further study of the toxic effect of diisononylphthalate in chronic exposure and in vitro tests is necessary.

The article presents the historical medical and historical legal aspects of the development of sanitary care in the domestic penitentiary system; the role of the outstanding Russian scientist, the founder and the first professor of the Department of Hygiene of the Medical-Surgical Academy, a doctor, and scientist, public figure, Professor — Aleksey Petrovich Dobroslavin. For ten years he headed the health care department of the Main Prison Administration of the Russian Empire. November 18, 1871, Aleksey Petrovich Dobroslavin read the first lecture on the course of hygiene for listeners of the 4th year of the Medico-Surgical Academy. That day, according to the authors, can be considered the day of the founding of the national hygiene science. In September 1879, the scientist headed the Health care Department of the Main Prison Administration of Russia. At this position, Aleksey Petrovich combined all his knowledge, obtained earlier - hygiene and public knowledge, medicine and law. He served science and law, the people and the State. In 80 years of the XIX century, A.P. Dobroslavin played a decisive role in the development of domestic penitentiary hygiene. He received a real opportunity not only to develop theoretical provisions of hygiene but also the possibility to implement them by his orders binding on the staff of the penitentiary system of the Russian Empire. The scientist observed the implementation of his scientific provisions, generalized the experience of practical application of his research in various geoclimatic and other environmental conditions. Each of his commanding decisions is a separate, completed scientific work. He introduced the penitentiary science, which he actively developed as a scientist hygienist. Theoretical heritage of A.P. Dobroslavin for many decades determined the ways of the Russian penitentiary hygienic science.