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Vol 23, No 2 (2020)

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Expertise and rehabilitation

Spinal muscular atrophy type 1: current status of the issue

Bondar V.A., Borisov I.V., Kanarskii M.M., Nekrasova J.Y.


The development of medical technologies has led to an increase in the survival of patients with spinal muscular atrophy (SMA). In turn, these drugs have a high cost, which limits their availability for children with SMA. This fact posed new challenges for the science community. Currently, clinical trials of the effectiveness of drugs for the treatment of various types of spinal muscular atrophy are underway. Clinical forms of SMA are grouped into 5 subtypes depending on the severity of the disease and the age of onset of the disease. Type 1 spinal muscular atrophy, or Werdnig-Hoffmann disease, is the most common, accounting for 60% of all cases of the disease. The first positive results of clinical trials of two potentially new and effective drugs − Zolgensma and Risdiplam were published recently. Despite this, the inaccessibility of treatment of spinal muscular atrophy creates a serious interdisciplinary problem at the state level, including medical and social rehabilitation, which is important to understand when planning medical care.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):4-7
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Medico-social aspects of invalidity and morbidity in children population with endocrine system diseases

Miachina O.V., Puzin S.N., Pashkov A.N., Esaulenko D.I.


Investigation realized in Voronezh found that the level of general disability was 11.09 ± 0.56 per 1000 children, and the level of first-time disability was 1.38 ± 0.18 per 1000 children, which is lower than in Russia as a whole. In the age structure of disability persons from 5 to 9 years old are dominated, and by gender trait — boys. Primary morbidity level in children is higher than in adolescents: 1407.68 ± 86.60 and 1281.33 ± 162.25 per 1000 children, respectively. According to the primary morbidity level, 15 ranking places were allocated. Endocrine system diseases occupy 12 and 9 rank places in children and adolescents, respectively. Prevalence of endocrine system diseases was 4.32 ± 0.78 and 14.94 ± 2.71 per 1000 children in this age group. There is an increase in endocrine pathology by 3.5 times with age. It was investigated that children and adolescents suffering from endocrine system diseases (type 1 diabetes, AIT, obesity) are characterized by adaptation processes decrease, regulatory mechanisms imbalance and energy disorders (p < 0.05 compared to the control group of healthy individuals), which is detected by bioelectrography of exhaled air condensate. The obtained data can be used in preparation of complex programs for prevention of morbidity and disability of children and medical and social rehabilitation of disabled children in Voronezh and in other territories.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):8-11
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Medical and social expertise of patients after amputation of the lower limbs on the background of atherosclerosis

Kugotov A.G.


Rationale. Up to 200 reconstructive operations on the aorta and arteries of the lower extremities are performed annually in the Kabardino-Balkar Republic for obliterating arterial diseases, the main of which is atherosclerosis. After performing reconstructive operations on the arteries of the lower extremities, 40–45% of patients developed a relapse of ischemia during the next 3–5 years due to the progression of the underlying disease, 80% of them undergo high-level amputations of the extremities. Carrying out medical and social expertise in the early stages after amputation is an important link in the rehabilitation of this contingent of patients.

Purpose. assessment of medical and social expertise and quality of life of patients who have undergone amputation of the lower extremities against the background of obliterating arterial diseases.

Materials and methods. The object of the study was 87 patients who had undergone amputation of the lower extremities, who were hospitalized in the vascular department of the Republican Clinical Hospital of Nalchik from 2015 to 2019. Results: The following results were obtained during the examination of patients at the Medical and social expertise bureau in Nalchik: The third group of disability was assigned to 14 patients; The second group of disability was assigned to 68 patients; The first group of disability was assigned to 5 patients. In this case, the objective data of the state of hemodynamics in the lower extremities were assessed. When assessing the quality of life of disabled people using the SF-36 questionnaire, the following results were obtained: after amputation of the lower limb, the indicators of physical health sharply decreased, and the indicator of social role also significantly decreases, not reaching half the value of the scale (38 points).

Conclusion. It is necessary to carry out a medical and social examination of patients after amputation of the lower limbs by the visiting commission of the Main Bureau of Medical and Social Expertise in the postoperative period in the hospital, while up to a period of 6 months (before hip prosthetics) for group 1 of disability patients , considering that these patients during this period need constant outside care. It is necessary to create, on the basis of rehabilitation centers, orthopedic workshops for the manufacture of good quality limb prostheses, and train patients in the use of prostheses by specialists of rehabilitation centers. After teaching the patient to use a prosthesis in a rehabilitation center, undergo a medical and social examination to obtain an appropriate group of disabilities.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):12-14
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Quality of life assessment in patients with acute limb ishemia

Sinyavin G.V., Kosenkov A.N., Vinоkurоv I.A., Mnatsakanjan G.V., Odinokova S.N., Meshherjakov A.F., Belov J.V.


Background. In conditions of permanent progress in the quality of surgical care in various areas of surgery, it is very important to allow patients themselves to evaluate provided treatment.

Aims: this paper analyzes the quality of life in individuals with acute lower limb ischemia who have undergone lower limb revascularization surgery.

Materials and methods. An assessment of the quality of life of 122 patients with acute lower limb ischemia (ALI) of II degree who were treated at the Moscow Сity Сlinical Hospital оf S.S. Yudin from 2016 to 2018 (average age 72.1 ± 14.7 years) was performed. The quality of life was assessed using the medical Outcomes Study-Short Form (MOS SF-36) quality of life assessment methodology.

Results. When assessing the quality of life of patients, it was found that the psychological and physical components of patients’ health are significantly affected by the angiotropic effect of the affecting factor associated with the presence of diabetes mellitus. 1 month after surgical restoration of blood flow against the background of the initial embolism, 83.6% of the respondents who did not suffer from diabetes noted a persistent improvement in their General condition and quality of life.

Conclusion. This method of assessing the quality of life after surgical restoration of blood flow in patients with acute lower limb ischemia can be used in angiosurgical practice and clearly reflects of patient satisfaction with the treatment.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):15-18
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Legal aspects of forensic medico-social expertise assignment

Paikov A.Y., Samoilova Y.B.


The topic presented in the title of the article has been the matter of numerous studies. In spite of this, it remains relevant these days. This is because in practice there arise controversies related to the procedural issues of forensic medico-social expertise assignment and conducting. The authors have attempted to conduct a comprehensive study of the legal issues of the assignment and production of forensic socio-medical expertise, both in civil cases related to appeal against decisions of medico-social assessment services, and in criminal cases, in particular, with regard to fraud in receiving payments. The article analyzes the practice of appealing against decisions of medical and social assessment services. This practice reveals the lack of uniformity in the assignment of forensic medical and social expertise. Based on previous studies in this area, as well as the provisions of regulatory legal acts, the authors distinguish medico-social expertise from other types of medical and forensic examinations. Due to the limited space of the paper, not all relevant aspects on this issue are considered. The paper concentrates on the issues of determining the institution and persons who have special knowledge sufficient to produce medico-social expertise. The authors have developed recommendations on the assignment of forensic medico-social expertise, emphasizing that the production of medico-social expertise requires special knowledge and should be carried out by specialists who have received special training in the specialty of medical and social expertise. In this connection, the production of forensic medico-social expertise cannot be entrusted to forensic medical establishments and business organizations. The authors emphasize that such an expertise should be entrusted to highly qualified employees with specialized training in medical and social expertise and working for medical and social expertise services.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):19-26
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Current problems of medical and social expertise

Epidemiological aspects of the incidence of thyroid cancer in the Russian Federation

Shurgaya M.A., Pogosyan G.E., Puzin S.N., Achkasov E.E., Memetov S.S.


The results of an analysis of the incidence of thyroid cancer (thyroid cancer) in the Russian Federation (2008−2018) are presented. With increasing age, the incidence of thyroid cancer increases. Dominated by people aged 55 years and above (52.9%). Over the 10-year period (2008−2018), the increase in the “rough” indicator of the incidence of thyroid cancer was 49.03%, the standardized − 43.5%. The prevalence of thyroid cancer among the population of the Russian Federation in 2018 amounted to 114.1 per 100,000 population, which is 52.5% higher than in 2008 (74.8). This is due to several reasons: the demographic aging of the population, an increase in the incidence rate, and an improvement in the detection of the disease among the population (from 17.4% in 2008 to 34.3% in 2018). There was an increase in the share of thyroid cancer patients registered in oncological institutions of the Russian Federation for 5 years or more from the moment of diagnosis (from 61.6% to 68.8%, respectively), and the index of accumulation of patients with thyroid cancer (from 12.4 to 13.9 respectively). In the cohort of thyroid cancer patients, identified actively, the proportion of patients with a tumor process of stage I−II was 77.7%, and with a running tumor process (stage III−IV) — 21%. There is a differentiation of the territories of the Russian Federation both in terms of early detection and morphological verification of thyroid cancer, and the volume of radical treatment and the use of various methods for its implementation.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):27-32
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Disability as a result of craniocerebral trauma in Russia: actuality and forecasts

Borisov I.V., Bondar V.A., Kanarskiy M.M., Nekrasova J.Y., Yankevich D.S., Lebedev A.S., Brodnikov M.Y., Miroshnichenko M.V.


According to the World Health Organization, injuries take first place among the causes of death among the population under 40 years of age. In the Russian Federation, in 2019, death from external causes, including injuries, was in third place in all deaths. Among the causes of disability — first place. Mortality from severe traumatic brain injury is over 70%. The most common cause of disability and mortality is head injuries. Annually, 1.5 million people die from traumatic brain injury (TBI) in the world, and 2.4 million are disabled. According to the Federal State Budgetary Scientific Institution National ”Institute of Public Health named after N.A. Semashko”, the annual damage from the head injury is estimated at 500 billion rubles. This is a serious socio-economic and state problem requiring complex and multidisciplinary intervention.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):33-41
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Assessment of disability in patients with alkaptonuria

Kuzin A.V., Zaytseva E.M., Amirdzhanova V.N., Makarov S.A., Agzamov J.S., Ismailov K.G., Zar V.V., Dolzhenkova E.A., Politova N.N.


Background. Alkaptonuria is an orphan, autosomal recessive disease in which clinical symptoms debut in adulthood and are characterized by progressive degenerative changes in large joints (knee, hip, shoulder) and the spine, often leading to the need for joint replacement. Developing changes often lead to persistent disability.

The purpose of this study was to evaluate disability among adult patients with alkaptonuria.

Materials and methods. The study included 46 adult patients (31 m − 67.4% and 15 w − 32.6%) with a reliable diagnosis of alkaptonuria at the age of 20 to 76 years (avg age 56.83 ± 10.52). The assessment of the presence of a disability group at the time of patients’ treatment to a rheumatologist was carried out.

Results. It turned out that disability was determined in 34 (75.6%) patients, there were no signs of persistent disability in 11 patients (24.4%). Among the patients who had signs of persistent disability, most often during the survey period, group 2 disability was established (61.8%), the differences between this and other groups were statistically significant (p < 0.05). For the first time, disability in the study cohort of patients was established at the age of 31 to 59 years (the average age was 50.83 ± 5.5 years).

Conclusions. It is important to note that in the vast majority of cases, persistent disability occurs in patients who were of working age, which underscores the importance of alkaptonuria as a medical and social problem.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):42-45
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Original study

Features of the structure of adult disability due to hypertension

Odebaeva R., Achkasov E.E., Shurgaya M.А.


A retrospective statistical analysis of primary, repeated and General disability of the adult population in Moscow and in the Russian Federation was carried out. The observation period 2011−2017. Scope of the study: 31 373 disabled people (primary 11 069 and repeated 20 304), recognized as disabled due to hypertension during examination in the BMSE. The analysis of the dynamics of disability due to all classes of diseases in the Russian Federation is carried out. The total population was 324 832 people (90 808 primary and 234 024 repeated), who were recognized as disabled due to hypertension during examination in the BMSE. The observation period 2011−2017. The features of clinical and functional disorders and limitations of life activity in disabled people due to essential arterial hypertension (hypertension) were studied. A sample study was conducted in a cohort of disabled people (271 people due to hypertension).

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):46-51
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Health education is the foundation of a healthy society. Need to inform disabled people

Mironova-Hodorovich A.Y., Kiseleva E.V.


It is impossible to change people’s attitude to their health without the help of the most powerful tool for forming public opinion — the media. Television, radio and the press, performing educational, informational, cultural and spiritual functions, can increase the interest of the population in maintaining a high level of their own health.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(2):52-56
pages 52-56 views

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