PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
Primary health care: integrative analysis of the evolution of information and communication technologies in medical organizations of the subjects of the Russian Federation
Voshev D.V., Son I.M., Vosheva N.A. 78
Self-assessment of health and nutritional status of female medical university students
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
PECULIARITIES OF EXTERNAL RESPIRATION IN ADOLESCENTS WITH A LONG HISTORY OF ALLERGIC BRONCHIAL ASTHMA
I.U. Mel`nikova1, V.N. Buryak1, T.A. Kimbiletova1, N.B. Platonova2 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint- Petersburg, Kirochnaya street, 41 2 Children's City Multidisciplinary Clinical Specialized Center for High Medical Technologies. Russia, 198205, Saint- Petersburg, Avangardnaya Street, 14 Abstract Introduction. One of the actual issues of modern allergology and pulmonology is the problem of bronchial asthma, which often begins in children and has a long history to adolescence. The severity of the asthmatic process is most objectively reflected by indices of external respiration. The aim of the study was to analyze the features of external respiration in adolescents with a long history of bronchial asthma. Materials and methods. It was examined 150 adolescents aged from 15 to 18 years, 90 of whom had bronchial asthma from 5 to 16 years (mean 9.32±2.92 years) and constituted the main study group of patients with a long history of the disease. In 30 patients, bronchial asthma lasted from the moment of diagnosis from 1 to 3 years (mean 2.82±0.91 years) and they formed a comparison group with a short history of the asthmatic process. Another 30 patients were practically healthy and comprised the control group. All examined patients underwent spirometry with calculation of external respiration parameters. Results. In both the main group and the comparison group, a significant (p <0.05) decrease in the average values of VC and FVC with an increase in CBD in FEV1 was revealed compared to the control group. In the main group, a significant (p <0.05) increase in MEF25 was established in relation to the comparison group.
In adolescence, the course of bronchial asthma is associated with a decrease in volumetric parameters of the expiratory maneuver. In adolescents with a long history of asthma in comparison with peers with a short history of the disease, there is an increase in forced expiratory flow rate. The revealed regularities reflect the inclusion of compensatory mechanisms associated with the tension of respiratory muscles, aimed at overcoming airway obstruction. Conclusion. The conducted study demonstrates the presence of a decrease in the volume of exhaled air in adolescents with bronchial asthma, with long experience combined with an increase in the rate of expiratory maneuver, associated with compensatory tension of respiratory muscles, aimed at overcoming airway obstruction. Keywords: adolescents, bronchial asthma, long history, external respiration.
PEDIATRIC SARCOPENIA: RISK FACTORS AND DIAGNOSTIC CRITERIA (PILOT STUDY)
A.N. Zavyalova, V.P. Novikova, M.N. Yakovleva Saint Petersburg State Pediatric Medical University. Russia, 194100, Saint Petersburg, Litovskaya street, 2
Abstract Introduction.Sarcopenia is rare in children; there are no consensus documents on its diagnosis. A full analysis of the causes of sarcopenia among children has not previously been carried out. A model for studying sarcopenia could be patients with impaired nutritional status due to cerebral palsy (CP). The aim of the study was to develop diagnostic criteria for sarcopenia in children with cerebral palsy and to identify factors contributing to its development. Materials and methods. Statistical processing (SPSS Statictics 26) and ROC analysis with binary logistic regression of the bioimpedance analysis results of body composition (BCT) were carried out in 809 children with cerebral palsy. Results and conclusions. Two clusters were identified, identical in age (Me = 10.0 years), with a BMI of 11.57 kg/m2 (10.09;12.86) in the first and 12.50 kg/m2 (11.08-13 .98) in the second cluster (p<0.001). 10% (81 people) of children with the proportion of active cell mass %ACM≤43.5 and the proportion of fat mass %FA≤30.5% were identified; these children were diagnosed with sarcopenia- first cluster (p<0.001). At the second stage, significant events affecting CST were identified: dysphagia (p = 0.005), lying feeding (p = 0.046), feeding through a nasogastric tube (p = 0.05), low-calorie pureed food (p = 0.002), formula feeding children under one year old (p<0.001). The sensitivity of the resulting model was 97.5%, specificity – 98.8%. The overall proportion of correct predictions among the subjects studied in this sample was 98.6±0.4%.. Predictors of the sarcopenia development among children with cerebral palsy are the presence of dysphagia, nutrition with low-calorie pureed foods or age-inappropriate low-calorie milk formula. Keywords: bioimpedancemetry; decision tree; children; diagnostics; ROC analysis; sarcopenia.
AGE-RELATED FEATURES OF THERAPY ADHERENCE AMONG PATIENTS WITH BRONCHIAL ASTHMA(REVIEW)
S.I. Melnik 1,2, I.Yu. Melnikova 1, K.K. Bagomedova 2 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 2St. Petersburg Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky Prospekt. 2-4
Abstract
The prevalence of bronchial asthma has been steadily increasing worldwide for several decades, some patients fail to achieve disease control even with multidrug therapy, and fatalities continue to be reported despite medical advances. Adherence to treatment of bronchial asthma in children and adults is an important aspect of effective disease control and includes various strategies. The article is devoted to a literature review on the problem of adherence of pediatric, adolescent and adult patients to long-term treatment of bronchial asthma. The main reasons for non-compliance with medical recommendations and factors influencing the duration and refusal of therapy are considered. Methods of measurement and evaluation of patients' adherence to treatment are analyzed, as well as the main reasons for decreased adherence to therapy in different age groups of patients. Keywords: bronchial asthma, treatment adherence, adherence assessment, questionnaire, non-adherence to treatment.
LEAKY GUT SYNDROME IN CHILDREN WITH ATOPIC DERMATITIS AND CHRONIC GASTRODUODENITIS
A.P. Listopadova, V.P. Novikova, Yu.E. Zamyatina, A.E. Blinov, O.P. Gurina, O.N. Varlamova Saint -Petersburg State Pediatric Medical University. Russia, 194100 Saint-Petersburg, Litovskaya street, 2
Abstract Introduction. Increased intestinal permeability is supposed to underlie allergic, autoimmune and metabolic diseases. Aim of the study was to evaluate the level of fecal biomarker of intestinal wall permeability (zonulin) in children with atopic dermatitis on the background of chronic gastroduodenitis. Materials and methods.The study included 78 children with morphologically verified chronic gastroduodenitis. The main group included 52 patients with atopic dermatitis and chronic gastroduodenitis, the comparison group comprised 16 children with chronic gastroduodenitis without atopic dermatitis. All patients underwent a stool examination for zonulin by enzyme immunoassay using the IDK Zonulin test system ELISA (“Immundiagnostik AG”, Germany) to assess intestinal permeability. Statistical processing of the material was carried out using the IBM SPSS Statictics 26 software package. Results.According to the research results it was revealed that the average content of zonulin in the stool among both examined groups did not have significant differences (99.9 (77.3; 133 ng/ml) and 73.5 (51.8; 99.6 ng/ml), p 0.05). However, children with atopic dermatitis and chronic gastroduodenitis more often had increased (53.8% and 25%, p 0.05) and high (26.9% and 0%, p 0.01) zonulin levels, which indicates the increased intestinal permeability in children of this group. A significant positive relationship was observed between the level of zonulin in feces and the presence of food allergies. Conclusions. Children with atopic dermatitis and chronic gastroduodenitis have increased intestinal permeability compared to children with chronic gastroduodenitis only. The correlation between the presence of food allergies and intestinal permeability disorders has been identified. Keywords: children, zonulin, atopic dermatitis, chronic gastroduodenitis.
ENDOBRONCHIAL AND INTERSTITIAL BRACHYTHERAPY IN THE TREATMENT OF NON-SMALL CELL LUNG CANCER (REVIEW)
A.I. Arseniev 1,2, K.E. Gagua 1, S.N. Novikov 1, A.A. Barchuk1, A.O. Nefedov 3, E.A. Arseniev1, S.A. Tarkov 1, R.V. Novikov 1, A.Yu. Zozulya1, F.E. Antipov 1 1N.N. Petrov National Medical Research Center of Oncology. Russia, 197758, Saint Petersburg, Pesochny, Leningradskaya str, 68 2 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 3 Saint-Petersburg State Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky av., д.2-4
Abstract
In the review article, based on the analysis of literature data related to topical problems of radiotherapy, the place of intraluminal and interstitial brachytherapy in the treatment of lung cancer is determined, its capabilities, effectiveness, technological aspects and safety of use are evaluated. The small number of publications covering this topic in recent years draws attention. It is shown that the method could be implemented with different radiation sources and dose rate options. In the treatment of lung cancer, three main approaches to brachytherapy are used: intraoperative, intracranial and intraluminal. A number of clinical studies, including randomized and meta-analyses, have shown that the method allows for a significant improvement in immediate and long-term results, both in localized and locally widespread and generalized processes with acceptable side effects.
Of particular interest is the use of intraluminal endobronchial brachytherapy for central lung cancer according to radical, palliative and symptomatic programs. It is proved that it is preferable to perform it on devices with high-dose sources of radiation to shorten the duration of procedures, reduce painful sensations in patients and optimize the positioning of applicators. The method is a reasonable option when the possibilities of remote irradiation and systemic treatment are exhausted. Indications for endobronchial brachytherapy are determined individually. Own data indicate that the median survival in the endobronchial brachytherapy group reached 19 months versus 8 months in the group without it, 1-year overall survival was 68% versus 33%, 2-year survival was 37% versus 8%. One of the indications for palliative use of the method is recurrent endobronchial obstruction. It is recommended to conduct new RCTs to evaluate the effectiveness and safety of the method. Keywords: review; non-small cell lung cancer; central lung cancer; radiation therapy; intracranial brachytherapy, endobronchial brachytherapy.
PRINCIPLES OF MULTIDISCIPLINARY APPROACH TO TREATMEANT GERIATRICPATIENTS WITH COMPLICATIONS OF COLON CANCER (REVIEW)
N.I. Glushkov1,2, T.L.Gorshenin1,2, К.V. Sementsov2, М.B. Kvetniy, А.V. Andrusenko1, T.S. Zelenina1 1North-Western State Medical University named after I.I. Mechnikov. Russia, 195067, Saint-Petersburg, Piskarevsky prospect, 47 2 Hospital for War Veterans. Russia, 193079, Saint-Petersburg, Narodnaya street, 21, building 2
Abstract
Surgical treatment of geriatric patients with complicated forms of colon cancer presents significant challenges due to polymorbidity and phenomenon of mutual aggravation. This requires a special multidisciplinary approach, involving specialist of various profiles in the perioperative period, which helps to improve the results of diagnosis and treatment of this complex category of patients. The review analyzes modern principles of a multidisciplinary approach in the treatment of elderly and senile patients with complicated forms of colon cancer. Keywords: colon cancer, surgical treatment, multidisciplinary approach, elder and senile age.
MODERN ASPECTS OF INCIDENCE, CLINICAL PICTURE AND DIAGNOSIS OF COLON CANCER COMPLICATIONS IN ELDERLY AND SENILE PATIENTS (REVIEW)
T.L.Gorshenin1,2, N.I. Glushkov1,2, М.Ya. Belikova2, М.B. Kvetniy1, А.V. Andrusenko1, D.А. Galitskiy1 1North-Western State Medical University named after I.I. Mechnikov. Russia, 195067, Saint-Petersburg, Piskarevsky prospect, 47 2 Hospital for War Veterans. Russia, 193079, Saint-Petersburg, Narodnaya street, 21, building 2
Abstract
In recent years, there has been a significant increase in the incidence of colon cancer (CC), especially in elderly and senile patients. One of the features of the course of this pathology in gerontological patients is a long-term asymptomatic nature: in 66.3% of cases, the disease manifests itself as complications requiring urgent surgical intervention. In this regard, timely diagnosis of СС and its complications is of paramount importance in improving surgical outcomes. The presented literature review discusses modern aspects of the incidence, features of clinical picture of CC complications in gerontological patients in conditions of polymorbidity, as well as the most effective methods of their diagnosis. Key words: colon cancer, elder and senile age, incidence, diagnosis of complications of colon cancer.
IDENTIFICATION OF BIOFILMS ON INVASIVE DEVICES USED IN UROLOGICAL PRACTICE
S.D. Konev 1,2, B.I. Aslanov 1, N.K. Gadzhiev 2, I.A. Gorgotsky 2, A.G. Kulyash 2, K.V. Rozhkovan 2 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 2Clinic of High Medical Techonologies n.a. N.I. Pirogov, Saint-Petersburg State University. Russia, 190020, Saint-Petersburg, Fontanka River Embankment, 154
Abstract Introduction. The issue of biofilm formation by infectious agents associated with the use of invasive medical devices in healthcare currently becomes highly relevant. Studying the epidemiology of healthcare-associated infections and developing measures for their prevention couldn’t be comprehensive without investigating the properties of biofilms formed by the causative agents of these infections. The scientific literature provides information on a large number of methods for detecting biofilms; however, in practice, several issues related to this problem require further resolution. The aim of the study was to identify the formation of biofilms on invasive devices used in urological practice associated with the risk of developing healthcare-associated infections. Material and methods. A retrospective analysis of 129 patient medical records from the urology department, focusing on those with urinary stone disease, was conducted at the St. Petersburg State University, Clinic of High Medical Techonologies n.a. N.I. Pirogov. Biofilm detection on fragments of urinary catheters in vitro was performed using the O'Toole and Kolter method (1998).
Biofilm modeling and detection on fragments of urinary catheters were carried out using five clinical isolates. The formation of biofilms was assessed by measuring their optical density. Results. The study revealed the formation of biofilms on fragments of urinary catheters associated with the risk of urinary tract infections. Bacteriological analysis of long-standing (more than 7 days) urinary catheters with microbial growth exceeding 105 CFU/ml and characteristic changes in optical density values indicated the formation of microbial biofilms on the investigated medical devices. Patients with developed urinary tract infections showed biofilm forms of microorganisms, among which E. coli, P. aeruginosa and E. faecalis. were predominant. Conclusion. Research in the field of epidemiology of healthcare-care associated infections is closely linked to studying biofilm forms of microorganisms and their biological properties. The applied method could be used to identify biofilms of infectious agents associated with the provision of medical care, in particular, in modeling and in studying long-standing urinary catheters removed from patients. Keywords: biofilm, urinary tract infection, healthcare associated infection, optical density, urinary catheter, invasive devices, indication.
EPIDEMIOLOGICAL ASSESSMENT OF THE ROLE OF VARIOUS FACTORS OF MISCARRIAGE
O.V. Shirai 1,2, B.I. Aslanov 1, S.V. Rishchuk1, N.Y. Gladynuk2 ,V.I. Knysh2 , E.A. Orishak 1, L.Y. Nilova 1 1 North West State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41 2St. Elizabeth City Hospital, Russia, 195257, Saint Petersburg, Vavilov street, 14
Abstract Introduction. The demographic situation in the Russian Federation in recent years continues to cause serious concerns. According to the Federal State Statistics Service, there has been a steady decrease in the birth rate coefficient over the past 5 years. In 2018, it was 10.9, in 2019 - 10.1, in 2020 - 9.8, in 2021 - 9.6, and in 2022 - 8.8 per 1000 population. Therefore, the assessment of risk factors for miscarriage is a relevant task for healthcare in the context of improving the demographic situation. Materials and Methods. An in-depth survey of the main and control groups of patients was conducted using special survey questionnaires. Clinical material (swab from the cervical canal and vagina, stool, throat swab, blood from a vein) was examined using serological, coagulographic, cultural, bacterioscopic, and molecular biological methods. Results. The prevalence of certain non-infectious risk factors is significantly higher in the group of women with miscarriage. The frequency of detection of specific anti-chlamydial Ig G was significantly higher in the miscarriage group (p<0.001). In this group of patients abundant growth of S. pneumoniae (p=0.020) and E. faecalis (p<0.001) in the throat was significantly more common. The study revealed that the incidence of severe intestinal and vaginal dysbiosis in the group with miscarriage was higher. A higher frequency of active forms of chronic viral herpes infection types 1 and 2, new coronavirus infection in the medical history was revealed in the control group (p<0.001). Conclusion. Timely identification and prevention of risks of miscarriage are priority tasks for improving the maternal health, safe childbearing, and, consequently, the demographic situation in the country. Keywords: miscarriage, risk factors, reproductive losses, demographic situation, missed abortion, reproductive health, pregnancy loss.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
PRIMARY HEALTH CARE: INTEGRATIVE ANALYSIS OF THE EVOLUTION OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN MEDICAL ORGANIZATIONS OF THE SUBJECTS OF THE RUSSIAN FEDERATION
D.V. Voshev1, I.M. Son 2,3, N.A. Vosheva4
1National Medical Research Centre for Therapy and Preventive Medicine. Russia, 101990, Moscow, Petroverigsky lane, 10, building 3 2PIFYPh – Branch Campus of FSBEI FPE RMACPE MOH Russia. Russia, 440060, Penza, Stasov street, 8A 3FSBEI FPE RMACPE MOH Russia, Russia, 125993, Moscow, Barrikadnaya street, 2/1, p. 1 4LLC «Data storage center». Russia, 125284, Moscow, Leningradsky avenue, 35, p. 1
Abstract Introduction. The article presents the importance of information and communication technologies in the modern world, especially in the healthcare system. It is described both the direct and indirect impact of information and communication technologies on the standard of living and well-being of the population, including through remote consultations and electronic medical records. It is pointed out that considerable attention is paid to the development and implementation of information and communication technologies in the Russian healthcare system, which is a key component in achieving digital maturity and creating a single digital circuit. The aim of the study was to analyze the availability of information and communication technologies in medical organizations in the Russian Federation during 2018-2022 with a focus on primary health care. Material and methods. The study was conducted in the Russian Federation in accordance with the official data of the Federal statistical observation form No. 30 «Information about a medical organization». As part of the study, the parameters for medical personnel (for automating the treatment process) in departments providing outpatient medical care were performed. Results and discussion. The article presents data demonstrating a significant increase in the number of personal computers for medical personnel in outpatient departments – from 1 072 573 in 2018 up to 1 527 765 in 2022, which is an increase of 42.4%. The indicator of the number of PCs per medical worker was also analyzed, which increased from 0,5 PC in 2018 up to 0,8 PC in 2022. Conclusion. The analysis results revealed a positive trend in the development of digital infrastructure in medical organizations providing primary health care. The study highlights significant progress in equipping Russian medical organizations with ICT, which contributes to improving the quality and accessibility of medical care. Keywords: primary health care, digitalization of primary health care, information and communication technologies, digitalization of healthcare.
SELF-ASSESSMENT OF HEALTH AND NUTRITIONAL STATUS OF FEMALE STUDENTS OF MEDICAL UNIVERSITY
D.O. Ivanov, O.V. Lisovskii, V.L. Gritsinskaya, K.E. Moiseeva, I.A. Lisitsa St.Petersburg State Pediatric Medical University, Russia, 194100, St. Petersburg, Litovskaya street, 2 Abstract Introduction. Education at a university is associated with increased academic and psycho-emotional stress, which could have a negative impact on the body.
The aim of the study was to determine the components of the health and nutritional status of female students at different stages of education. Materials and methods. An anonymous interview was conducted with 1332 female students of medical university. The questionnaire included questions about height and body weight; frequency of acute and chronic diseases, and items from the SF-36 questionnaire for self-assessment of health status.
Results. Body mass index was within the normal range in 70% of female students; 21% were underweight, and 8.9% were overweight. In the group of first-year students was the largest number of girls with malnutrition (28%), and with overweight in the sixth year (14.2%). The group of female students who experienced acute respiratory infections more than 4 times a year was three times larger in the sixth year (8.3%) compared to first and fourth-year students (2.6%).). Self-assessment of the state of health as “excellent” and “very good” was more often given by fourth-year students (49%), less often by students in the first (35%) and sixth (28%) years. Subjective assessment of health as “poor” was more common among sixth-year female students, which corresponds to a higher level of acute morbidity and the presence of chronic pathology (42.5%) among them. Conclusion. Considering the decrease in the level of students’ health by the end of their study at the university, it is necessary to conduct additional study to identify possible factors negatively affecting the body. Keywords: students, women, morbidity, nutritional status, physical development, self-assessment of health.
CLINICAL LABORATORY DIAGNOSTICS
EVALUATION OF SYNOVIAL FLUID ON NEW GENERATION HEMATOLOGICAL ANALYZERS
S.A.Guzyukina1, A.A. Moskalenko2, A.V. Ovsyankin1 1 Federal Center of Traumatology, Orthopedics and Endoprosthetics. Russia, 214031, Smolensk, Stroiteley avenue, 29 2 Institute of Laboratory Medicine. Russia, 127015, Moscow, Leningradsky prospekt, 80G, office 911A
Abstract Introduction. Measurements techniques for a number of joint aspirate cells continue to be a relevant issue in the practice of a clinical laboratory diagnostics doctor due to the complexity of this biomaterial, which is associated with a high content of hyaluronic acid. Based on the experience of foreign colleagues and our own observations, it was assumed that by eliminating interference from hyaluronan with the enzyme hyaluronidase, it is possible to obtain correct results of synovial fluid examination using the flow cytofluorometry method. The aim of the study was to evaluate the correlation of the results of leukocyte counting in native joint aspirate diluted with hyaluronidase solution on a phosphate-buffered saline using a new generation hematology analyzer Sysmex XN-550 with manual cell counting using a Goryaev chamber. Materials and methods. It was analyzed 177 samples of synovial fluid by three-fold manual counting using the Goryaev 's chamber, three-fold examination on the hematology analyzer Sysmex XN-550 of diluted articular aspirate 1:10 and single-native synovial fluid. Results. According to the study results, the number of cell elements in diluted joint aspirate correlated with manual counting in 100% of cases, while automatic counting without dilution was correct in only 53% of cases. Therefore, by diluting synovial fluid 1:9 with hyaluronidase solution in a phosphate-buffered saline on the hematological autoanalyzer, it is possible to obtain the results comparable with the results of manual cell counting in the Goryaev chamber, saving time and ensuring accuracy in research Conclusions. Adding hyaluronidase to synovial fluid resolves the interference of hyaluronan during cell counting on automatic analyzers. This method allows not only cell count but also differential analysis within two minutes. This technique could be recommended for routine clinical practice. Key words: synovial fluid, hyaluronidase, hematological analyzer.
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