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CONTENTS 2022-1
HYGIENE
Hygienic assessment of complex impact of environmental factors on population health
Makoeva F.K.      5
Characteristics of active and passive smoking behavior among St.-Petersburg population Zaritskaya E.V., Iakubova I.Sh., Kovshov A.A., Shalukho E.S., Suvorova A.V.     11

DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, DISEASE PREVENTION
Surgical treatment of early failure of a critically short bronchial stump by sealing compression with a flap of the latissimus dorsi  Nefedov  A.O., Yablonsky P.K., Arsenyev A.I., Kozak A.R., Mortada M.M.                    20

Periampular zone tumors complicated by mechanical jaundice – commencement of treatment, drainage or resection (review)Sementsov K.V., Boyarinov D.Y., Myanzelin M.N., Alekseev V.V., Koshelev T.E., Goloschapova I.M.          26

Evaluation of the receptor status and proliferative activity of endometrial tumors in patients older than 70 years Gavrish Yu.E., Artemieva A.S., Trifanov Yu.N., Sidoruk A.A., Baltrukova A.N., Ulrikh E.A., Berlev I.V., Urmancheeva A.F.        33

Physical development and prevalence of malnutrition in children with cerebral palsy
 Zavyalova A.N., Novikova V.P., Churakova I.Yu., Chuynyshena S.A., Turun D.P., Luzanova O.A., Efet E.A., Pak A.A.              42

Clinical results of the Bristow-Latarjet procedure for the treatment of anterior shoulder instability with glenoid bone loss Gladkov R.V., Khominets V.V.      53

Sexually transmitted infections and flora alterations in female sex workers in Moscow Makhova T.I., Rumyantseva T.A., Goloveshkina E.N., Akimkin V.G.         64

PUBLIC HEALTH AND HEALTH CARE MANAGEMEMT
Patient flow management strategy in modern medical organizations on the basis of lean production (review) Kurmangulov A.A., Zadorkina T.G., Brynza N.S.    70

Geriatric service contribution to the evolution of traditional technologies in palliative medicine Lapteva E.S., Kulibaba D.M., Tsai A.F., Shubinsky V.D., Cheprakova L.N., Abaidulina T.G., Rizakhanova O.A. 78

School teachers’ mental health during the COVID-19 pandemic Bartosh T.P., Bartosh O.P.           86

CLINICAL LABORATORY DIAGNOSTICS
. Assessment of platelet activation in patients with HIV infection by flow cytometry Ermakov A.I., Vinogradova T.N., Gaikovaya L.B., Sirotkina O.V., Vavilova T.V          94

ANNIVERSARIES
Tutelyan Viktor Alexandrovich
Dedicated to his 80th anniversary     100

INFORMATION           102

TO AUTHORS ATTENTION         103
HYGIENE

HYGIENIC ASSESSMENT OF COMPLEX IMPACT OF ENVIRONMENTAL FACTORS ON POPULATION HEALTH

F.K.Makoeva
Federal State Budgetary Educational Institution of Higher Education "National State University of Physical Culture, Sports and Health named after P.F. Lesgaft, St. Petersburg ", Russiа, 190121, St. Petersburg, st. Decembrists, 35
Abstract
Introduction. Atmospheric air pollution, combined with changing climate parameters, is today considered to be one of the most important factors affecting human health. The high anthropogenic load of environmental factors, unfavorable climatic and geographical conditions, and high incidence rates of the cardiovascular system dictate the need for an epidemiological study using a risk assessment methodology.
Purpose of the study. Ecological and hygienic characteristics of atmospheric air in the urbanized territory of the Caucasian midlands using the methodology for assessing the health risk of the population from the impact of emissions from road transport and meteorological conditions of the area.
Material and research methods. An assessment was made of the quality of atmospheric air and weather conditions in Vladikavkaz for the period from 2012 to 2018. The health of the population of the city was assessed according to the primary documentation of emergency medical care.
Results and its discussion. To assess the risk to public health from road transport emissions, a non-carcinogenic risk from chronic inhalation exposure was considered. The highest values ​​of the hazard index were noted for people suffering from diseases of the cardiovascular system and the blood system with the formation of methemoglobin (HI=5.44), respiratory organs (HI=5.98).
Of the meteorological conditions, the greatest negative effect on the human body is exerted by high air humidity, sharp changes in the average daily temperature and atmospheric pressure. For a more objective assessment of the impact of meteorological factors on the health of the population, the population risk assessment method (Rnon) is used. It has been established that the combination of three unfavorable meteorological factors increases the calls for emergency medical care for cardiovascular pathology by more than 3000 cases.
Conclusion. The non-carcinogenic risk to public health is assessed as high for people suffering from diseases of the cardiovascular system and respiratory organs. The population health risk from adverse weather factors is assessed as high. Proposed measures to reduce the negative impact.
Key words: meteorological factors, vehicles, atmospheric air, air pollution, public health, risk assessment, hazard index, critical organs, cardiovascular pathology.

CHARACTERISTICS OF ACTIVE AND PASSIVE SMOKING BEHAVIOUR AMONG SAINT-PETERSBURG POPULATION

E.V. Zaritskaya¹,², I.Sh. Iakubova², A.A. Kovshov¹,², E.S. Shalukho¹, A.V. Suvorova²
¹North-West Public Health Research Center, Rospotrebnadzor, Russia,191036, Saint-Petersburg, 2-ya Sovetskaya street, 4
²North-Western State Medical University named after I.I. Mechnikov, Russia,191015, Saint-Petersburg Kirochnaya street, 41
Abstract
Introduction. Observational studies enabling to characterize active and passive smoking behavior in Saint- Petersburg population were carried out.
Aim of the study was to analyze the major characteristics of active and passive smoking behavior, to study preferences in nicotine-containing product use among Saint-Petersburg population.
 Materials and methods. Random sampling among adults was used to conduct a personal formalized questionnaire study of 1198 respondents aged 18-92 years, concerning their smoking behavior.
Results and discussion. The study group included 38.0% of nicotine-containing product consumers, 24.0% of former smokers, 38.0% of never smokers; 54.5% of smokers were males and 45.5% females. Among nicotine-containing product users of all ages about 70% preferred tobacco cigarettes, and 30% gave priority to alternative types of products. The highest percent of smokers was reported among 30-55 aged persons, and 17-30-year-old respondents were major consumers of electronic nicotine-delivery systems. Percentage of passive smokers in the studied sample was 91.1%, about a half of the respondents (45.1%) daily becoming passive smokers. Almost half of the interviewees (49.8%) had negative attitude towards smoking and almost everyone considered smoking to be harmful to health, and 55.2% of respondents were concerned that smoking, including passive one, resulted in adverse health effect. About 30% of the respondents believe that use of alternative types of nicotine-containing products is less harmful to health than tobacco cigarette smoking.
Conclusions. Prevalence of active and passive smoking in Saint-Petersburg population is very high -38.0% and 91.1%, respectively, especially among middle-aged people.
Key words: smoking, questionnaire survey, cigarettes, nicotine-containing products, electronic nicotine delivery systems, electronic tobacco heating systems, passive smoking, smoking behavior.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, DISEASE PREVENTION

Surgical treatment of early failure of a critically short bronchial stump by sealing compression with a flap of THE LATISSIMUS DORSI 

A.O. Nefedov ¹, P.K. Yablonsky ¹, A.I. Arsenyev ^2,3, A.R. Kozak ¹,
M.M. Mortada ^1
1 Saint-Petersburg Scientific Research Institute of Phthisiopulmonology, Russia, 191036, Saint Petersburg, Ligovsky avenue,2-4
² N.N. Petrov National Medicine Research Center of oncology, Russia,197758, Saint Petersburg, Leningradskaya street, 68
³ North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
Abstract
Introduction. The failure of the bronchial stump after thoracic surgery is a frequent (3-20%), severe complication, the treatment algorithms of which require further study.
The aim of the study was to optimize the surgical treatment of the failure of the short bronchial stump, prevention of its recurrence during thoracic operations.
Materials and methods. It was performed a literature review on the use of various treatment methods of this complication. It was described a method being developed be the authors of the article, which was successfully used in three patients.
Results and discussion. After the diagnosis of bronchopleural fistula, retoracotomy is performed as soon as possible. A flap of the latissimus dorsi on the feeding leg is mobilized and a part of the rib is resected for its conduction. The sealing of the bronchial defect is achieved by squeezing the bronchial stump from the outside by a muscle flap folded in the form of a "sandwich" and they’re through with U-shaped stitch; after applying 3-4 stitches through the bronchus stump, additional fixation of the muscle flap to the trachea sidewall, to the main bronchus, to the lobar bronchus, to the prevertebral fascia, to the mediastinal pleura is performed. Thus, the reduction of the edges of the bronchus is achieved by tightly enveloping the muscle flap, resulted in complete sealing.
Conclusion. The result of the described technique of suturing a critically short bronchial stump is the reliable elimination of bronchopleural fistula, prevention of its recurrence, reduction of the volume of the residual pleural cavity, prevention of the development of pleural empyema and do not imply the conduction of thoracostomy.
Key words: lung cancer, bronchial stump failure, bronchial fistula, bronchoplasty, pleural empyema.

PERIAMPULAR ZONE TUMORS COMPLICATED BY MECHANICAL JAUNDICE – COMMENCEMENT OF TREATMENT, DRAINAGE OR RESECTION (REVIEW)

K.V. Sementsov ^1,2, D.Yu. Boyarinov ^1,2, M.N. Mianzelin ¹, V.V. Alekseev ^1,2,
T.E. Koshelev ¹, I.M. Goloshchapova ^1
1North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
²Hospital for War Veterans". Russia, 193079, Saint-Petersburg, Narodnaya street, 21, building 2
Abstract
Periampular zone tumors comprise 5-9% of all forms of malignant formations, while the incidence continues to grow, and mortality ranked 8th in the world.
The main, and sometimes one of the first clinical manifestations of neoplasms of this localization is mechanical jaundice. If the tumor of this localization is resectable, but complicated by jaundice, the resection is the most effective treatment method. However, these very patients are often emaciated, have severe liver dysfunction and are at high risk of perioperative complications. An important treatment aspect is to improve the tolerability of surgical interventions by reducing the cholestasis before surgery. One of the ways to solve this problem is preoperative drainage of the biliary tract. At the same time, this issue is still disputable. The present review analyzes modern approaches to the preoperative drainage of the biliary tract in patients with resectable tumors of the periampular zone complicated by mechanical jaundice.
Keywords: periampular zone tumors, surgical treatment, mechanical jaundice, drainage of the biliary tract, review.

EVALUATION OF THE RECEPTOR STATUS AND PROLIFERATIVE ACTIVITY OF ENDOMETRIAL TUMORS IN PATIENTS OLDER THAN 70 YEARS

Yu.E. Gavrish^1,2, A.S. Artemieva¹, Yu.N. Trifanov¹, A.A. Sidoruk^2,4,
A.N. Baltrukova², E.A. Ulrikh^1,2,3, I.V. Berlev^1,2, A.F. Urmancheeva^1,2
1National Medical Research Center of Oncology named after N.N. Petrov, Russia, 197758, Saint-Petersburg, Leningradskaya street, 68
²North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
³Almazov National Medical Research Centre, Russia, 197341, Saint-Petersburg, Akkuratova street, 2
⁴Leningrad Regional Clinical Oncological Dispensary named after L. D. Roman, Russia, 191014, Saint-Petersburg, Liteiny prospect, 37-39
Abstract
Introduction: Endometrial cancer is a heterogeneous process not only from the standpoint of histological characteristics, but also tumor biology, affecting the course of the disease and long-term results. The article presents the immunohistochemical characteristics of endometrial tumors, a comparative assessment of the age-related characteristics of the expression of steroid receptors and the proliferative activity of endometrioid adenocarcinomas.
The aim of the study was to evaluate the receptor characteristics and proliferative activity of endometrial tumors by the expression of the Ki-67 antigen in patients older than 70 years old in comparison with younger patients.
Materials and methods: The study included 309 patients diagnosed with endometrial cancer, who were treated at the National Medical Research Center of Oncology named after N.N. Petrov, from 2009 to 2016, divided into two groups: group 1 - from 50 to 69 years old (n = 150), group 2 - 70 years old and older (n = 159). Immunohistochemical analysis included an assessment of the expression level of estrogen and progesterone receptors and proliferative activity of endometrial tumors by expression of the Ki-67 antigen.
Results: The expression levels of steroid receptors in endometrioid adenocarcinoma exceeded those in clear cell (p = 0.002) and serous tumor histotypes (p <0.001), in comparison to the Ki-67 antigen, where an inverse relationship was observed. A direct dependence of the expression of estrogen and progesterone receptors on the histological grade of endometrioid adenocarcinoma was established: a decrease in the histological grade resulted in a decrease in the expression of steroid receptors (p <0.001), in addition, with the same degree of tumor differentiation, the expression values of the studied immunohistochemical markers are statistically lower in the group of patients ≥ 70 years old. Evaluation of the proliferative activity of endometrioid carcinomas revealed an inverse relationship: G1 tumors were characterized by the lowest Ki-67 antigen values compared to G2 and G3 carcinomas (p <0.001). The expression level of Ki-67 did not depend on age.
Conclusions: The expression level of steroid receptors and Ki-67 antigen depends on the histological type of tumor. In endometrioid adenocarcinomas, the expression of steroid receptors depends on histological grade of the tumor and the age of the patients. The proliferative activity of endometrioid adenocarcinomas is determined by the histological   grade of tumor differentiation and does not depend on age.
Key words: endometrial cancer, morphology, elderly, immunohistochemistry, estrogen receptors, progesterone receptors, Ki-67 antigen.

PHYSICAL DEVELOPMENT AND PREVALENCE OF MALNUTRITION IN CHILDREN WITH CEREBRAL PALSY

A.N. Zavyalova¹, V.P. Novikova¹, I.Yu. Churakovа², S.A. Chuynyshenа¹,
 D.P. Turun¹, O.A. Luzanova¹, E.A. Efet¹, A.A. Pak³
¹ St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia. 194100, St. Petersburg, Litovskaya, 2, Russian Federation
² St. Petersburg School of Economics and Management, Higher School of Economics, National Research Institute, 190121, St Petersburg, Souza Pechatnikov,16, Russian Federation
³ St. Petersburg State Budgetary Inpatient Social Service Institution for Children with Mental Disabilities No. 4. 196620, St. Petersburg, Elizavetinskaya,11, Russian Federation
Abstract
Introduction: A high degree of disability among children with cerebral palsy is associated with low motor activity.
Objective: to assess physical development and the degree of malnutrition in children with cerebral palsy.
Materials and Methods: Physical development was assessed in 1420 children according to centile tables depending on motor activity, age and social conditions. Statistical program IBM Stata 12. For binary features, the odds ratio and 95% confidence interval were calculated.
Results: In the №1 group 199 toddlers (1.9-3 g), first childhood № 2 - 387; second childhood № 3 -397; adolescents № 4 - 302 and youth № 5 - 135 patients. Severe malnutrition was detected among children in groups 4 and 5 (p <0.001). Malnutrition was detected in 67.5% of children from group 1 to 85.2% in group 5. Confidence intervals of the average underweight in each group were calculated for all groups (bootstrap analysis). In the group of patients №4 and №5, the percentage of children with severe deficiency and the degree of deficiency increase. Mean % underweight in children №1 -21.959 [CI-23.649:-20.269], №2 -24.872 [CI-26.007:-23.737], №3 - 26.097 [CI -72.208:-24.986], №4 -28.269 [CI -29.505:-27.034], №5 - 31.839 [CI-33.656:-30.021] (F-test 19.5 and p-value<0.001).
Conclusions: Conclusions: Growth retardation and malnutrition worsening with age. Body weight deficiency was found in all age groups, but in adolescence and youth, the percentage of severe malnutrition is higher. Gender differences and dependence on social conditions were not revealed.
Key words: Malnutrition, Children, Physical development, Cerebral palsy, GMFCS IV-

CLINICAL RESULTS OF THE BRISTOW-LATARJET PROCEDURE FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY WITH GLENOID BONE LOSS

R.V. Gladkov, V.V. Khominets

S.M. Kirov Military Medical Academy, Russia, 194044, Saint-Petersburg, Akademika Lebedeva Street, 6

Abstract

Introduction. Despite the popularity, wide range of indications and long-term evolution of the Bristow-Latarjet procedure, due to its high efficiency, there is no consensus on the importance of factors determining the treatment result. The frequency of complications and consequences of both instability and the procedure itself remains high.
The aim of the study was to analyze the mid-term functional results of the Bristow-Latarjet procedure, as well as risk the factors for their deterioration in patients with anterior shoulder instability and bipolar bone loss.
Materials and methods. It was carried out a prospective observational cohort cross-sectional study of the functional state of 262 patients using the Rowe and Walch-Duplay scales, measuring the range of motion, assessing joint stability and subscapularis muscle strength. The obtained data were analyzed considering the patient's characteristics, shoulder joint injuries assessed by CT and MRI, as well as the selected Bristow-Latarjet procedure technique.
Results. The scale scores increased significantly, reaching 86.4 points according to Rowe scale and 85.3 according to Walch-Duplay. Residual instability was observed in 12.6% of patients and reccurent shoulder dislocation in 2.3%. Persistent contracture greater than 20° and signs of omarthrosis of the III stage observed in 1.9% of patients. Patients with signs of residual instability had so much worse values ​​on the scales and the stress test results of the subscapularis muscle. The size of articular surface defects and the ISIS index did not significantly affect the residual instability development. Poor and satisfactory outcomes were oftenly observed in older patients with initial stage II arthrosis. (P<0.001) and PT-RCT) (P = 0.024). Omarthrosis was accompanied by a decrease in the strength of the subscapularis muscle. Injuries of the superior and posterior labrum tear, as well as the size of the bone defects, did not affect the functional outcome. The use of arthroscopy, ligament refixation after coracoplasty (P=0.018) and suture of PT-RCT (P=0.037) were accompanied by the achievement of better outcomes.
Conclusion. Shoulder stabilization by Bristow-Latarjet procedure allow to achieve excellent and good outcomes in 91.6% of patients according to Rowe scale and in 90.8% according to Walch-Duplay scale. The age over 30 years, preoperative stage II osteoarthritis and PT-RCT that wasn’t restored along with coracoplasty, have a negative impact on the functional outcomes
Incomplete recovery of function in 12.6% of patients was associated with residual instability of the shoulder joint and the subscapularis muscle dysfunction.
Keywords: shoulder joint instability, bipolar bone loss, Bristow, Latarjet, coracoplasty.

SEXUALLY TRANSMITTED INFECTIONS AND FLORA ALTERATIONS IN FEMALE SEX WORKERS IN MOSCOW

T.I. Makhova ¹, T.A. Rumyantseva ², E.N. Goloveshkina ¹, V.G. Akimkin ^1
1Central Research Institute of Epidemiology of Rospotrebnadzor, Russia, 111123, Moscow, Novogireevskaya street, 3A
²Fomin Clinic, Russia, 127006, Moscow, Dolgorukovskaya street, 17 b.1
Abstract
Introduction. Sex workers make a significant contribution to the spread of various sexually transmitted infections among the population, however, there is insufficient data on the prevalence of infections of the reproductive organs in this group, which makes the issue of their study relevant.
The aim of the study was to evaluate the prevalence of sexually transmitted infections and flora alterations in female sex workers in Moscow and their correlation.
Materials and Methods. The study included 180 female sex workers, who were taken a vaginal swab. The samples were tested by real-time PCR using reagent kits to detect bacterial vaginosis, aerobic vaginitis and sexually transmitted infections (Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium).
Results. Sexually transmitted infections were detected in 45 (22.8%) women. M.genitalium was detected in 19 (10.6%) patients, T.vaginalis in 19 (10.6%), C.trachomatis in 13 (7.2%). N.gonorrhoeae was not detected. Bacterial vaginosis was identified in 41.7% of women, aerobic vaginitis in 2.2%, and the intermediate flora in 13.9%. Sexually transmitted infections were 2.2 times significantly more common in the group of patients with bacterial vaginosis. Among sex workers, sexually transmitted infections were 7.1 times more common, and the flora alterations were 1.9 times more common than in the main population group.
Conclusions. Sexually transmitted infections and flora alterations in the sex workers are at a high level. Bacterial vaginosis increases the risk of detecting sexually transmitted infections. Monitoring and prevention of vaginal microbiota disorders could reduce the incidence of sexually transmitted infections.
Keywords: sexually transmitted infections, bacterial vaginosis, aerobic vaginitis, female sex workers.

PUBLIC HEALTH AND HEALTH CARE MANAGEMEMT

PATIENT FLOW MANAGEMENT STRATEGY IN MODERN MEDICAL ORGANIZATIONS ON THE BASIS OF LEAN PRODUCTION (REVIEW)

A.A. Kurmangulov¹, T.G. Zadorkina², N.S. Brynza^1
1 Tyumen State Medical University, Russia, 625023, Tyumen, Odessa street, 54
² Central science-research institution of organization of healthcare, Russia, 127254, Moscow, Dobrolubova, 11
Abstract
The article provides an overview of literary sources and regulatory legal documents dedicated to the regulation of patient flow management in medical organizations. The management concept of lean production, which has been actively introduced into the healthcare system of the Russian Federation since 2016, was taken as a qualimetric characteristic of patient flow management. Patient flow management is one of the blocks of criteria considered when assessing a medical organization providing primary health care for compliance with the new model within the framework of the federal project "Development of primary health care". At the heart of the flow control strategy in the lean methodology are three interrelated principles: the organization of space, the organization of visualization and the organization of routing. With the correct planning of the adjacent territory and internal spaces with communication rooms, the installation of navigation and information elements at the branch points of the routes and the construction of a rational and understandable route, the main and additional losses considered in the concept of lean production could be significantly reduced, not only from patients, but also from the side of the personnel of the medical organization.
Key words: visualization, navigation, routing, lean manufacturing, federal project.

GERIATRIC SERVICE CONTRIBUTION TO THE EVOLUTION OF TRADITIONAL TECHNIQUES IN PALLIATIVE MEDICINE

E.S. Lapteva¹, D.M. Kulibaba¹, A.F. Tsai², V.D. Shubinsky², L.N. Cheprakova², T.G. Abaydulina², O.A. Rizakhanova^1
1North-Western State Medical University named after I.I.  Mechnikov. Russia, 191015, Saint -Petersburg, Kirochnaya street, 41
² City Geriatric Medical and Social Center. Russia, 190103, Saint- Petersburg, Fontanka River Embankment, 148
Abstract
Introduction. Recently, there has been a tendency in the use of high-tech diagnostic and therapeutic techniques in provision of palliative care to improve the quality of life of the incurable patients.
Аim of the study was to evaluate the effectiveness of the use of diagnostic and therapeutic technologies used in the Saint-Petersburg City Geriatric Medical and Social Center for the improvement of incurable patients conditions in the provision of palliative care.
Materials and methods. An observational retrospective cohort study based on archival medical records of patients hospitalized in the department of palliative care during 2015-2020 was conducted on the basis of the City Geriatric Medical and Social Center (Saint- Petersburg).
Results and discussion. The most frequently used methods of laboratory diagnostics were clinical blood analysis, biochemical blood analysis, coagulogram, study of the electrolytes’ composition and blood gases.  The most common imaging diagnostic methods was chest X-ray, the use of which was considered as an obligatory anti-epidemic measure within the COVID-19 pandemic in 2019-2020, as well as the frequency of pulmonary complications in bedridden patients,
the number of which in the palliative care department ranged from 70–80%.
The dynamics and nature of percutaneous endoscopic gastrostomy and endoscopically assisted percutaneous dilational tracheostomy were developed when the department started providing palliative care to patients with neurodegenerative diseases.
Conclusions. The evolution of palliative care methods corresponds to the general trend in the development of medicine and aim for high-tech, highly informative methods of diagnosis and treatment.
The use of new methods of laboratory, instrumental diagnostics and specialized treatment reduces the number of failures in clinical practice and increases the competence of the medical staff of the palliative care department.
The transition to high-tech ways of providing palliative medical care using modern instrumental techniques requires both legislative and timely budget support.
Keywords: palliative care, high-tech diagnostic and therapeutic techniques, geriatric service.

School teachers’ mental health during the COVID-19 pandemic

T.P. Bartosh, O.P. Bartosh
Scientific  Research Center “Arktika”, Fareastern Branch of the Russian Academy of Sciences, Russia, 685000, Magadan, Karl Marks avenue, 24

Abstract
Introduction. Under the COVID-19 pandemic, new working conditions make it relevant to study school teachers’ mental health, including occupational burnout.
The aim of the study was to examine the emotional exhaustion and neuropsychiatric adaptation as indicators of mental health in school teachers after the COVID-19 outbreak.
Materials and methods. The study focused on the Magadan region teachers, the first group comprises 78 teachers, who were examined within the first wave of COVID-19 pandemic using online survey. Comparison group comprises 95 teachers from several Magadan schools, who were examined before pandemic. The questionnaire by V.V. Boyko was used to assess the risk of occupational burnout, where the neuropsychiatric adaptation was assessed by I.N. Gurvich scale. Processing of obtained data was carried out by the Statistica-10.0 program.
Results. A third of the studied teachers from both groups developed a Resistance phase. Those who were examined in first wave of pandemic exhibited some indices of the burnout syndrome to be significantly (p<0.05) less pronounced than in comparison group. Those indices were resistance phase, symptoms of experiencing traumatic circumstances, inadequate selective emotional response, psychosomatic and psycho-autonomic disorders, and the overall score for the emotional burnout. Both groups showed equal values for neuropsychiatric adaptation, with 35-38% of the examinees being diagnosed with probability of borderline and severe mental pathology and neuroticism.
Conclusion. School teachers’ mental state continues to be a major concern. The long-term exposure to negative factors associated with the pandemic could reduce the psychophysiological resources. Teachers with neuropsychiatric instability and borderline mental pathology could develop painful neuropsychiatric states and asthenic syndromes that may result in worsening of mental and physical performance, intensifying symptoms of emotional burnout.
Keywords: teachers, mental health, neuropsychiatric adaptation, emotional burnout, COVID-19 pandemic.

CLINICAL LABORATORY DIAGNOSTICS

ASSESSMENT OF PLATELET ACTIVATION IN PATIENTS WITH HIV INFECTION BY FLOW CYTOMETRY

A.I. Ermakov¹, T.N. Vinogradova¹, L.B. Gaikovaya²,
O.V. Sirotkina^3,4, T.V. Vavilova^3
1St. Petersburg City AIDS Center; Russia, 190103, Saint-Petersburg, Obvodnyi channel, 179
²North-Western State Medical University named after I.I. Mechnikov; Russia, 191015, Saint-Petersburg, Kirochnaya st., 41
³Almazov National Medical Research Centre, 197341, Russia, Saint-Petersburg, Akkuratova str., 2
⁴Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre «Kurchatov Institute», Russia,188350, Saint-Petersburg, Gatchina, Orlova Rostcha, 1
Abstract
Introduction. Combined antiretroviral therapy has dramatically reduced the number and mortality of HIV-related diseases. The use of highly active antiretroviral therapy causes many atherogenic metabolic disorders, which increases the risk of developing cardiovascular disease in HIV-infected patients. This requires an extension of the individual approach when using laboratory markers to detect atherosclerosis progression and thrombotic conditions against the background of antiretroviral therapy. The current cell-associated model of hemostasis in providing blood coagulation pays particular attention to platelets. High platelet functional activity is a powerful risk factor for acute cardiovascular conditions. Cytometric analysis of whole blood without preliminary sample preparation allows assessing the number of activated receptors on the surface of platelets, which allows measuring the basic state of circulating cells without the influence of artifact activation "in vitro".
The aim of this study was to determine the spontaneous platelet activation by flow cytometry in patients with HIV infection against the background of antiretroviral therapy.
Materials and methods. The study included 24 patients with HIV infection aged 44 ± 6 years; 13 women and 12 men. The total length of therapy was 6.7 years. The control group included healthy volunteers (13 women and 12 men) aged 35 to 55 years. A monoclonal antibody to the platelet marker (CD61) labeled with fluorescein isothiocyanate (FITC) was selected to identify platelets in the cytometric assay. As a platelet activation marker, P-selectin expression on the platelet surface was measured using a phycoerythrin (PE) labeled monoclonal antibody CD62P.
Results and discussion. A comparative evaluation of spontaneous platelet activation by flow cytometry revealed a higher (12.6% [IQR 8.3-13.5], p < 0.001) platelet content of P-selectin positive compared to that of healthy individuals (1.4% [IQR 0.5-3.7]). High levels of spontaneous platelet activation in HIV-infected patients enhances hypercoagulation and contributes to increased risk of thrombotic complications.
Conclusion. Evaluation of spontaneous platelet activation by flow cytometry in HIV-infected patients can be an additional laboratory tool for assessing the risk of developing cardiovascular complications, including fatal outcomes.
Keywords: HIV-infection, platelets, P-selectin, flow cytometry.

(с) 2020 North-Western State Medical University named after I.I.Mechnikov