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Contents 2021-2 MEDICAL SCIENCE
PREVENTIVE MEDICINE
CLINICAL MEDICINE
OBITUARY In memory of Lyudmila Pavlovna Zueva 109 TO AUTHORS ATTENTION 111 PREVENTIVE MEDICINE
BASE STAFFING ANALYSIS OF REGIONAL HEALTHCARE SYSTEMS BY DOCTORS OF DIFFERENT SPECIALTIES IN WHICH ARE REGISTERED THE MAIN CAUSES OF DEATH AMONG POPULATION, INCLUDING THE WORKING-AGE POPULATION A.V. Meltser, N.V. Erastova, V.N. Filatov, T.V. Kolomenskaya North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41 Abstract Introduction. The achievement of national objectives and the solution of the strategic tasks of the development of the Russian Federation, stipulated by the Presidential Decree No. 204 dated by May 7, 2018, is ensured by the implementation of the State Program " Health Care Development " aimed atreducing of mortality rate of the working-age population by 2024; reducing mortality rate from circulatory system disease and neoplasms; infant mortality rate. The achievement of strategic tasks is possible by the availability of affordable and high-quality primary health care services, which is largely due to the elimination of staff shortages. Sufficient base staffing of medical personnel would ensure high-quality and timely provision of medical care to the population of the Russian Federation. Aim of the study was to evaluate the base staffing of medical personnel of different specialties in which are registered the main causes of death among population , including working-age population, in Vologda Oblast, Kaliningrad Oblast, Pskov Oblast and the Republic of Karelia (2017-2019). Materials and methods. In accordance with the classes of causes of death specified in the objectives of the State Program "Healthcare Development" and federal projects of the national project "Healthcare", the base staffing indicators of medical personnel and part-time work coefficient of cardiologists and oncologists in Vologda Oblast, Kaliningrad Oblast, Pskov Oblast and the Republic of Karelia were calculated (2017–2019) using data from federal statistical observation form No. 30 "Information about a medical organization" (2017 - 2019). Data from the Federal State Statistics Service was used to assess the mortality rates. It was calculated the increase (decrease) rate of base staffing indicators in medical personnel and population mortality rate(2017–2019). Results and discussion. The performed analysis of health care system in Vologda Oblast, Kaliningrad Oblast, Pskov Oblast and the Republic of Karelia indicated a decrease of the base staffing indicators of medical personnel, including cardiologists and oncologists during 2017-2019. The total mortality rate and mortality rate form circulatory system disease of the population included in the analysis of the constituent entities of the Russian Federation also decreased. However, the mortality rate from neoplasms increased (except for the Republic of Karelia). Conclusion. In order to achieve the strategic tasks of the State Program of the Russian Federation " Health Care Development", federal projects of the national project "Healthcare" by 2024, it is necessary to develop management decisions by the he state authorities of the constituent entities of the Russian Federation in the field of health care to ensure the base staffing of medical personnel considering medical and demographic indicators, comprehensive assessment of the volume of provided medical care by its types, morbidity rate and etc. Key words: base staffing of medical personnel, part-time work ratio, decrease (increase) rate of base staffing of medical personnel, mortality rate of working-age population, mortality rate of the population from circulatory system disease, mortality rate of the population from neoplasms.
HEALTH RISK ASSESSMENT OF POPULATION UNDER CHRONIC INHALATION EXPOSURE OF AUTOMOTIVE TRANSPORT EMISSIONS R.B.Tsallagova 1, O.I. Kopytenkova2, F.K.Makoeva 1 1 Lesgaft National State University of Physical Education, Sport and Health, Russia, 190121, Saint-Petersburg, Dekabristov street, 35 2 Saint-Petersburg State University, Russia, 191036, Saint-Petersburg, University embankment, 7/9 Abstract Introduction. Currently, the risk assessment method is a generally recognized tool for assessing the impact of environmental factors on the human body. This method is used by leading scientists in the field of hygiene and epidemiology in the study and assessment of chemicals effect of various etiologies on human health. The health risk assessment method was applied within chronic inhalation exposure to vehicle emissions on the population of Vladikavkaz city and Republic of North Ossetia-Alania. Aim of the study was to assess non-carcinogenic risk and to calculate the health hazard index for the population in case of chronic inhalation exposure to road transport emissions. Materials and methods. The state of the city's atmospheric air was assessed according to the priority pollutants in the atmospheric surface layers - sulfur dioxide, nitrogen oxides, carbon monoxide, particulate matter, and lead compounds. The non-carcinogenic health risk was assessed in chronic inhalation exposure to vehicle emissions. Results and discussion. A hygienic assessment of the quality of atmospheric air indicates the formation of an acceptable and high level of pollution in the atmospheric surface layers. The indicators of public health risk on the roads with traffic intensity over k≥1500 vehicles / hour are assessed as "extremely high" and "high". Risk indicators equal to "average" were observed at traffic intensity 500<k<1500 vehicles / hour, at a distance of over 50 meters from the edge of the road and beyond. The intensity of traffic flows k≤500 auto / hour determines the average health risk, contributing to an increase in the background level of morbidity. The total hazard index is considered as a "high" with increased values of the hazard index for people suffering from cardiovascular diseases (HI = 6,7), respiratory disease (HI = 7,54) and blood system disease (HI = 8,42). Conclusion. The present study proves the high anthropogenic load on the population of the city determining the high incidence rates of cardiovascular pathology development. Epidemiological studies using risk assessment methods are relevant in areas with a high anthropogenic load of environmental factors. Keywords: atmospheric air, vehicles, vehicle missions, public health, risk assessment, hazard index, critical organs, cardiovascular pathology.
SUBSTANCE ABUSE SYNDROME, VIOLENCE AND HIV-INFECTION/AIDS (SAVA) AND RISK FACTORS OF HIV INFECTION AMONG INJECTING DRUG USERS IN SIX CITIES OF THE RUSSIAN FEDERATION A. N. Barinova 1, A.A. Lebedeva 1, N.N. Ladnaya 2, Tayts B.M.1, E.E. Zaytseva 3, S.L. Plavinskii 1 1North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 2Central Research Institute of Epidemiology, Russia, 111123, Moscow, Novogireevskaya street, 3А 3Open Health Institute Foundation, Russia, 117461, Moscow, Kachovka street, 25 Abstract Introduction. Substance abuse syndrome (syndemics) described in 1990th, violence and HIV/AIDS (SAVA), typical for the USA inner cities, demonstrated importance of considering the combination of social, behavioral and biological factors. There is a lack of information on the SAVA role in HIV-infection epidemics development in the Russian Federation. The aim of the study was to analyze, based on study results of injecting drug users in six cities of the Russian Federation, factors that are associated with SAVA presence and how the syndemics associates with HIV-infection risk factors and IDU-related stigma. Materials and methods. The study was carried out in the form of survey and testing of 2109 injecting drug users in six Russian cities. Results. It was found that full SAVA associated with age (р=0,029), joint use of needles and syringes (р=0,022) and length of drug use (p<0.001), but do not associated with gender or education. Respondents with SAVA more frequently reported about sex related work(р=0,014), overdose (р=0,029), and participation in rehabilitation and harm reduction programs (р<0,001 for both parameter). The same results were obtained for incomplete SAVA. Presence of SAVA also was associated with stigma indicators. Conclusion. SAVA in Russian IDU associated with risky behaviors leading to HIV acquisition and transmission. Keywords: syndemics, SAVA syndrome, injecting drug users, violence, HIV-infection, stigmatization.
PHYSICAL DEVELOPMENT OF CHILDREN WITH ATOPIC DERMATITIS AT DIFFERENT AGE PERIODS A.N. Zavyalova, O.A. Matalygina, A.P. Listopadova, D.V. Buzina, E.A. Rusinova, M.N.Yakovleva, M.P. Slobodchikova Saint-Petersburg State Pediatric Medical University, Russia, 194100, Saint-Petersburg, Litovskaya street,2 Abstract Introduction. Atopic dermatitis is chronic inflammatory skin disorder, resulting from genetic predisposition, dysfunction of immune and epidermal barrier. A long-lasting elimination diet affects physical development of children. The aim of the study was toassess and identify patterns in the physical development of children with atopic dermatitis. Materials and methods. The objective is to evaluate physical development of children with atopic dermatitis. Study included 78 children (49% boys and 51% girls), from 3 months to 17.11 years (average age 7.9). All children were divided into groups according to their age. Physical development (height, weight, body mass index (BMI)was assessed by WHO Anthro and WHO AnthroPlus. The somatic protein pool was evaluated according to body weight and BMI, and in children over 4 years according to bioimpedance data. The visceral protein pool was assessed by certain blood parameters due to biochemical and clinical analysis. Results. For infants and children of early childhood a lag in physical development is distinctive feature. For children of the period of the first childhood, approximation to normal values is typical. Children of the second childhood, adolescence and juvenile age are characterized by a sharp predominance of high values. In the nutritional status of children with atopic dermatitis in the acute stage, only the somatic protein pool suffers, and the visceral pool remains within the age norms. Conclusion. The visceral pool within the age range is a favorable sign for recovery. The most vulnerable group in terms of nutritional deficiency is infants and early childhood. For children of older age groups, it is imperative to adjust the carbohydrate component of the diet due to the development of overweight and obesity. Evaluation of food diaries in these age groups is needed. Research is ongoing. Key words: atopic dermatitis; nutrition status; physical development; children
CLINICAL MEDICINE MODERN TECHNOLOGIES IN DIAGNOSTICS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH COMPLICATED FORMS OF COLON CANCER N. I. Glushkov, T.L. Gorshenin, M.Ya. Belikova, S.K. Dulaeva North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint- Petersburg, Kirochnaya Street, 41 Abstract Introduction. The article presents the treatment results of elderly and senile patients with complicated forms of colon cancer, who, along with traditional methods, have been applied modern methods of diagnosis and treatment. The urgency of the treatment of complicated colon cancer is due to its high incidence. The traditional approach to the diagnosis and treatment of this pathology in elderly and senile patients is accompanied by negative outcomes. Aim of the study was to improve the treatment results of elderly and senile patients with complications of colon cancer by introducing modern methods of diagnosis and treatment. Materials and methods. A comparative analysis of the treatment results of elderly and senile patients with colon cancer complications by the traditional method and using modern techniques of diagnosis and treatment was performed. In the complication’s diagnosis the study of intra-abdominal pressure, hemodynamic parameters in the unpaired arteries of the abdominal aorta, and perfusion spiral computed tomography were used. According to the developed algorithm, patients of the main group were performed surgery using endovideosurgical technologies. Results. In the group of patients where additional diagnostic methods and minimally invasive methods of treatment were used, a more favorable course of the postoperative period was marked with a decrease in postoperative complications (from 44.9% to 27.8%) and mortality (from 8.9% to 5.3%). Conclusion. Implementation of the developed algorithm with the use of modern methods of diagnostics and treatment of patients of older age groups with colon cancer complications in the perioperative period allow to reduce the number of complications and mortality. Keywords: colon cancer, surgical treatment, old and senile age.
THE INFLUENCE OF THE CONSTRUCTIVE POSITION OF THE LOWER JAW ON THE TREATMENT RESULTS OF PATIENTS WITH TEMPOROMANDIBULAR JOINT DISFUNCTION
E.V. Basieva, A.V. Silin, D.E. Mokhov North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41 Abstract Introduction. Occlusion violation is one of the most important etiological factors of the temporomandibular joint dysfunction (TMD). Splint therapy is considered as the main treatment method. In modern literature, the question of the constructive position of the lower jaw remains controversial. Aim of the study was to compare the effectiveness of two different methods for determining the constructive position of the lower jaw in the treatment of patients with temporomandibular disorders. Materials and methods. The study included 32 patients with signs of the TMD. All patients underwent occlusion therapy along with drug treatment and myogymnastics. Depending on the determination method of the constructive position of the lower jaw, the patients were divided into 2 groups. For the first group of patients, the central ratio of the jaws was determined by using a registration wax according to the method described by R. Slavicek. For the second group of patients, the constructive position of the lower jaw was determined by the anatomical and topographic method using the virtual articulator of the Avantis 3D program. Results. The use of the proposed methods for determining the constructive position of the lower jaw allow to quickly and effectively eliminate the symptoms of this complex pathology. According to the obtained results, 12 weeks after the start of treatment, in 82% of the second group of patients, all clinical signs of TMJ MSD were eliminated, while in the first group of patients occurred only 20% of cases. After 20 weeks from the start of treatment, in 14% of cases in the first group of patients and in 6% of cases in the second group of patients was not observed the complete elimination of the signs of the TMJ MSD. Conclusion. The parameters of the constructive position of the lower jaw are of a high importance in the treatment of musculo-articular dysfunction of the temporomandibular joint. Isolated dental treatment is quite effective in eliminating of the TMD. However, in 14% of cases in the first group of patients and in 6% in the second group of patients, it was not possible to achieve complete elimination of the TMD signs. In order to obtain stable results, it is necessary to receive as dental therapy as well as treatment from related specialists. Key words: temporomandibular disorders, splint, constructive position of the lower jaw, computer modelling.
COMPARATIVE ANALYSIS OF THE EFFICIENCY OF OSTEOSYNTHESIS FOR LONG-BONES DIAPHYSEAL FRACTURES WITH TRADITIONAL LOCKING COMPRESSION PLATES WITH ORIGINAL DOUBLE-ROW LOCKING COMPRESSION PLATES L.K. Brizhan 1, D.V. Davudov 1, I.V. Khominets1, V.I. Kotov2, M.V. Rezvantsev 2 1 Main military clinical hospital named after academician N. N. Burdenko, Russia, 105094, Moscow, Gospital’naya square, 3 2 S.M. Kirov Military Medical Academy, Russia, 194044, Saint-Petersburg, Akademika Lebedeva street, 6 Abstract Introduction. Plate osteosynthesis of the long-bones fractures is widely used in clinical practice. However, the design of implants, their installation options, the working length of the plates and the number of locked screws is still to be scientifically discussed. Aim of the study was to test and prove the effectiveness of the use of the original double-row plate in clinical practice in the treatment of patients with long-bones diaphyseal fractures of the extremities. Materials and methods. The material for the study was an original double-row locking compression plate with polyaxially-inserted screws designed for osteosynthesis of long bones fractures (RU 2476180C2). It was performed a comparative study of the features and results of surgical treatment of 125 patients with diaphyseal fractures of the humerus, femur, and tibia, who were divided into two group. Validated questionnaires (NRS, DASH, KSS, AOFAS, SF-36) were used to evaluate the functional results of treatment. The results. The analysis of the data obtained from the validated questionnaires of patients with diaphyseal fractures of the humerus and femur did not reveal statistically significant differences (p>0.05) indicating comparability of the functional outcomes achieved during osteosynthesis with the developed double-row plate with similar results of osteosynthesis with standard locking compression plates. The results of the data validated analysis between the patients samples with diaphyseal tibial fractures according to the SF-36 questionnaire "physical health scores", allow to identify statistically significant differences (p=0.023), indicating the best results achieved in the osteosynthesis of diaphyseal tibial fractures in patients of the main sample. Conclusions. The obtained data indicate that the original implant under study is not inferior, but in several parameters exceeds the standard locking compression plates, which allows to recommend it for further use in clinical practice. Key words: bone, plate, fracture, diaphysis, osteosynthesis, angular stability, screw, implant.
ALGORITHMS OF NON-INVASIVE, MINIMALLY-INVASIVE AND INVASIVE DIAGNOSTICS FOR LUNG CANCER (REVIEW) A.I. Arseniev 1,2, A.O. Nefedov 3, S.N. Novikov 1, A.A. Barchuk 1, S.A. Tarkov 1, K.A. Kostitsin 1, A.V. Nefedova 1, N.Yu. Aristidov 1, Yu.V. Semiletova 1,2, A.A. Ryazankina 1,2 1. N.N. Petrov National Medicine Research Center of oncology, Russia, 197758, Saint Petersburg, Leningradskaya street,68 2. North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 3. Saint-Petersburg Scientific Research Institute of Phthisiopulmonology, Russia, 191036, Saint Petersburg, Ligovsky avenue, 2-4 Abstract The scientific review presents publications analysis on modern diagnostic algorithms for lung cancer. Diagnostic methods are non-invasive, minimally invasive and invasive. Non-invasive methods include general clinical examination; radiological methods for anatomical, functional, and multimodal imaging; cytology and biomarkers in sputum and blood, analysis of exhaled air. Endoscopic examinations, percutaneous fine-needle aspiration and lung biopsy are considered as minimally invasive methods. Invasive methods include diagnostic video thoracoscopy, laparoscopy, mediastinoscopy, parasternal mediastinotomy and diagnostic thoracotomy. While forming an individual diagnostic plan for each patient, it is necessary to carefully analyze the safety, sensitivity, specificity, accuracy and appropriateness of using specific methods available in a vast arsenal of modern diagnostic tools. Optimization of methods for lung cancer diagnostics, including early detection methods, is one of the priorities in contemporary oncology. Many aspects of the rational approaches to solving this urgent problem remain unresolved and require further research. Key words: lung cancer; non-invasive diagnostics; minimally invasive methods, transthoracic core-needle biopsy, mediastinoscopy.
THE REALITIES OF PREDICTING THE DEVELOPMENT OF COVID-19 COMPLICATIONS M.A. Ivanov,A.N. Agurbash North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41 Abstruct Introduction. Preventing the complications development is especially important among patients from the risk groups. The aim of this study was to study the reasons of the risk of COVID-19 complications development. Materials and methods. The work was based on observations of 148 patients with COVID-19, where 60 people had a severe course of the disease, while in 88 patients weren’t found any complications. Results. Acute course of COVID-19 was observed in patients with stage II-III arterial hypertension, chronic kidney disease, obstructive pulmonary disease and post-infarction cardiosclerosis (p < 0.05). High CRP levels, D-dimer, and ferritin were observed in individuals with a complicated course of disease. Conclusions. The development of COVID-19 complications is predisposed to uncontrolled arterial hypertension, a previous myocardial infarction, chronic lung and kidney pathology, as well as an increase in the level of inflammatorymarkers and thrombosis. Keywords: COVID-19, complications, risk factors.
PECULARITIES OF SURGICAL TREATMENT OF PATIENTS WITH NON-INFECTIOUS COMPLICATIONS OF THE MALLEOLAR SEGMENT FRACTURES (REVIEW)
V.V. Khominets, S.V. Mikhailov, A.V. Shchukin, D.A. Shakun, S.E. Zhumagaziev S.M. Kirov Military Medical Academy, Russia, 194044, Saint-Petersburg, Akademika Lebedeva Street, 6 Abstract Introduction. Due to a high incidence of non-infectious complications of malleolar segment fractures, the number of methods aimed to restore function (reconstructive and joint replacement procedures), or aimed to limit function (arthrodesis) of the ankle joint are developed. Many aspects of choosing the proper surgical tactic generally and in every particular case are still disputable. The aim of the study is to present a short historical review and current state of the issue of treating patients with non-infectious complications of malleolar segment fractures. Material and methods. The review included 62 papers of domestic and foreign authors published during 1970- 2021 indexed by PubMed and eLIBRARY databases. Results. Reconstructive procedures are indicated for treatment of non-infectious complications of malleolar fractures in patients having no signs or suffering the early stages of deforming arthrosis. These procedures are aimed to restore the articular surfaces congruency, as well as the axis and stability of the ankle joint. Currently, the ankle joint arthroscopy in cases of old injuries is the effective way to find the cause of the chronic pain syndrome and to treat it. The distraction arthroplasty technique becomes more and more widely used and promising method, especially for treatment of young patients. Nevertheless, the clinical results of using this technique is not thoroughly studied yet. For treatment of a terminal stage of the ankle joint deforming arthrosis several tactics of surgical treatment are developed. The most widely used treatment method is the arthrodesis which allows patients to restore limb support and relieve pain. Conclusion. Despite the continuous improvement of surgical treatment techniques using for treatment of patients with infectious complications of malleolar segment fractures and elaboration of new implants and methods, this problem still remains urgent. Key words: ankles, ankle joint, malunion ankle fractures, deforming arthrosis, arthrodesis, arthroscopy.
MODERN APPROACHES TO PREVENTION, DIAGNOSTICS AND TREATMENT OF PANCREATIC FISTULA AFTER PROXIMAL PANCREAS RESECTION (REVIEW) M.Yu. Kabanov1,2, N.I. Glushkov1, K.V. Sementsov1,2, A.V. Skorodumov1, D.M. Yakovleva2,3, B.B. Bromberg3, T.E. Koshelev1, V.V. Alekseev1,2, D.K. Savchenkov1,2, A.Yu. Navmatulya3,4, M. Ya. Belikova2 1North-Western State Medical University named after I.I. Mechnikov, 191015, Russia F, Saint-Petersburg, Kirochnaya street, 41 2 St Petersburg State Budgetary Institution of Health Hospital for War Veterans, Russia, 193079, Saint-Petersburg, Narodnaya street, 21, building 2. 3 S. M. Kirov Military Medical Academy, Russia, 194044, St. Petersburg, Academician Lebedev street, building 6. 4St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncological), Russia, 197758, Saint-Petersburg, Leningradskaya street, 68, lit. A. Abstract About 10% of all malignant neoplasms of the digestive system are pancreatic cancer. Within 30 years, the diagnosis of new disease cases in Russia has increased by 30%. Currently, pancreatic cancer comprises 50-60% of all malignant tumors of the pancreatoduodenal zone. Surgical interventions are still the main treatment method for this category of patients. At the same time, it is remained a high incidence of postoperative complications, including the formation of a pancreatic fistula. This complication occupies one of the leading positions with an incidence rate up to 22%. The review presents an analysis of current approaches of the prevention and treatment of postoperative pancreatic fistula after proximal pancreatic resection and presents modern criteria for its diagnosis. Key words: surgical treatment of the pancreas, pancreatic neoplasms, complications, pancreatic fistula, pancreatic resection, review.
IODINE DEFICIENCY DISORDERS AND AUTOIMMUNE THYROIDITIS IN CHILDREN: CONTROVERSIAL AND UNRESOLVED ISSUES IN THYROIDOLOGY (REVIEW) O.V. Lagno, K.A. Kravtsova, G.S. Artemenko, I.E. Chernykh Saint-Petersburg State Pediatric Medical University, Russia, 194100, Saint-Petersburg, Litovskaya street, 2 Abstract Iodine deficiency disorders and autoimmune thyroiditis are traditionally considered as the most common thyroid pathology in children and teenagers. The problem of iodine deficiency in Russian medical literature was disseminated widely after has gained wide interest after the discontinuation of mass iodine prophylaxis in the USSR. In the 90’s an increase in thyroid pathology among children was observed. Extensive research was carried out to monitor iodine deficiency conditions in different regions of the country. During 2005 - 2010 research of iodine deficiency diseases was carried out, revealed that among the population the iodine supply indicators improved against the group iodine prophylaxis, but 100% iodine provision of the regions was not achieved. Since 2000 a large number of publications were devoted to the problem of autoimmune diseases of the thyroid gland, especially to the autoimmune thyroiditis. A number of social and economic factors could predispose to this: industrial growth, air pollution, population migration, increased information load, as a possible stress factor. This article presents a review of publications on the problem of iodine deficiency disorders and autoimmune thyroiditis in children and teenagers. Factors predisposing to this pathology development in childhood are considered. Pediatricians and therapists are interested in the clinical manifestations of autoimmune thyroiditis and iodine deficiency conditions in children and teenagers in terms of the early primary diagnosis of this pathology. World Health Organization main criteria for assessing the iodine supply of regions are described. Excerpts from Russian national recommendations on micronutrient iodine supply of the population, in particular iodine, are given. The possible pathogenesis of the development of autoimmune thyroid pathology is briefly described. The article also presents the views of various authors on reducing the main thyroid pathology among the child population, and examines the problems of insufficient effectiveness of preventive measures aimed at reducing thyroid pathology and the risks of its development in childhood. Key words: iodine deficiency disorders, autoimmune thyroiditis in children and teenagers, iodine prophylaxis, iodine deficiency, thyroid pathology in childhood, monitoring of iodine deficiency.
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