1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint- Petersburg, Kirochnaya street, 41 2Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing. Russia, 127944, Moscow, Vadkovsky lane, 18, building 5 / 7 3Russian Medical Academy of Continuous Professional Education. Russia, 125993, Moscow, Barrikadnaya street, 2/1, building 4 I.M. Sechenov First Moscow State Medical University (Sechenov University). Russia, 119991, Moscow, Trubetskaya street,8, building 2 Abstract Introduction. The primary goals of Rospotrebnadzor are to achieve the national development goals of the Russian Federation, as well as the goals, objectives and priorities of the Government of the Russian Federation up to 2024. Successful goal achievement, problem solving to ensure the sanitary and epidemiological well-being of the population is impossible without a competent and balanced human resource policy and without employee’s professionalism. The development of staff potential of Rospotrebnadzor is one of the major tasks of the action plan ("road map") for the
strengthening of the Federal system of state sanitary and epidemiological surveillance, approved by the Government of the Russian Federation for 2021-2028. Aim of the study was to analyze the staffing of bodies and institutions of Rospotrebnadzor to develop measures for its improvement. Materials and methods. Regulatory legal, organizational, administrative and methodological documents in the field of ensuring the sanitary and epidemiological welfare of the population and protecting consumer rights were used; state reports "On the sanitary and epidemiological situation in the Russian Federation" (2005-2010); "On sanitary and epidemiological well-being of the population in the Russian Federation" (2011-2019); form of statistical observation No. 19 "Information about the network, structure, staff and personnel ...". The formation of the database, processing of the obtained results, dynamics indicators calculation was carried out using the Microsoft Excel 2010 program. Results and discussion. Network, structure, staffing of bodies and institutions of Rospotrebnadzor have been continuously changing in accordance with tasks in the different periods of time. With the new functions, which were delegated to Rospotrebnadzor in 2004, the human resources policy, as well as the ratio of medical and non-medical workers were reviewed. New challenges and threats, innovations in legislation on control and supervision, the implementation of national projects and etc. set a task to strength and train medical personnel for solving new problems that facing Rospotrebnadzor. Conclusion. The performed study allows to design a list of proposals improving the staffing of bodies and institutions of Rospotrebnadzor within changing health risks conditions Key words: preventive medicine, preventive medicine specialists, personnel training, staff pool, Rospotrebnadzor, Gossanepidnadzor, Federal state sanitary and epidemiological supervision.
WAYS TO REFORM PEDIATRIC REHABILITATION IN SAINT- PETERSBURG
A.S. Simakhodsky1, A.V. Kagan1, N.V. Petrova1, I.A. Leonova2, E.V. Plotnikova1, L.D. Sevostyanova3, O.A. Simakhodsky4 1First Pavlov State Medical University. Russia, 197022, Saint- Petersburg, Leo Tolstoy street, 6-8 2Almazov National Medical Research Centre. Russia, 197341, Saint-Petersburg, Akkuratova street,2. 3Health Committee of Saint -Petersburg. Russia, 191023, Saint -Petersburg, Malaya Sadovaya street, 1 4«Kids» Limited Liability Company. Russia, 192007, Saint -Petersburg, Obvodny Canal embankment, 64, building 1 Abstract Introduction. In Saint- Petersburg, as well as throughout the Russian Federation, it is observed a number of negative health effects associated with fertility decline, high rate of morbidity and childhood disability, being burning issues for healthcare system. Aim of the study was to perform analysis on the use of the available resources based on data from state inpatient and outpatient children's institutions, sanatorium with rehabilitation departments, and specialized rehabilitation centers; to assess the effectiveness in a number of areas and propose ways for implementing existing orders in St. Petersburg. Materials and methods. The study included data of statistical forms of Rosstat No. 14, No. 19, No. 030 / y using the materials of the meeting of the Coordinating Council under the President of the Russian Federation from November 15, 2016, guidelines of the Government of the Russian Federation to the Ministries and Departments from December 21, 2016. Statistical processing was carried out using the methods of variation statistics. Results and discussion. The reduction in infant and child mortality is determined by the use of gentle birth method, the introduction of effective diagnostic protocols, high-tech treatment methods and improved drug supply. However, positive changes in the provision of medical care contributed to the growth of chronic morbidity and disability requiring long-term treatment and rehabilitation. There is a need to study the status and development of this type of medical assistance in Saint- Petersburg. Conclusion. The study revealed the high potential of Saint- Petersburg pediatric care in organizing pediatric rehabilitation. There is observed the slow implementation of the current order, the lack of awareness of medical workers and the public. It is necessary to develop a transition plan to new levels and procedures for the provision of rehabilitation treatment. Key words: perinatal pathology, chronic non-communicable diseases, children's disability, health determinants, rehabilitation (habilitation) of preterm infants, digital technologies.
HYGIENE
INFLUENCE OF CONDITIONS AND ORGANIZATION OF DISTANCE LEARNING ON THE FUNCTIONAL STATE OF THE BODY OF YOUNG SCHOOL CHILDREN
N.A. Petrova, O.I. Yanushanetc, E.A. Adamova North-Western State Medical University named after I.I. Mechnikov. Russia, 195015, Saint-Petersburg, Kirochnaya street, 41 Abstract Introduction. The forced transition of schoolchildren's education in connection with the 2020 pandemic to a distance format was implemented in the absence of health-safe online learning technologies in modern schools. The organization of hygienically rational conditions of the educational process in the distance format for younger schoolchildren is of particular relevance due to the anatomical and physiological characteristics of children of this age, whose musculoskeletal system and visual analyzer are forming, and the nervous system is being improved. The aim of the studywas to analyze the functional state of the body of younger schoolchildren in the conditions of distance learning. Materials and methods. The study involved 276 junior schoolchildren. Hygienic assessment of the conditions and organization of distance learning, on-screen visual materials supplied to technical teaching aids, was carried out according to protocols developed on the basis of regulatory documentation and methodological recommendations. Timing observations during the lessons were carried out online by a connected researcher. The assessment of the functional state of the body of schoolchildren was performed in the dynamics of lessons using two diagnostic tests: a correction test and a simple sensorimotor reaction with a red color signal. Parametric and non-parametric methods of statistics were used for statistical analysis. Results and discussion. The study allows to establish that 84.8% of primary school students study distantly in hygienically non-rational conditions. The changes in well-being is significantly influenced by: the organization of the workplace, the type of Internet connection, the type of lighting. It is shown that the combined influence of the demonstration of non-ergonomic screen material and the difficulty of the lesson affects the decrease in mental performance in 51.1% and the development of nervous fatigue in 39.9% of schoolchildren. Conclusion. The results obtained allow to develop recommendations that were implemented in the St. Petersburg State Healthcare Center "City Center for Medical Prevention" and a number of schools in the training of teachers and parents of primary school students in organizing distance learning. Key words: distance learning, younger school children, functional state of the body.
DETERMINATION RESULTS OF SELENIUM CONCENTRATION IN BIOASSAYS OF RESIDENTS OF THE NORTH-WESTERN REGION
I.I. Shantyr, M.V. Yakovleva, M.A. Vlasenko, N.V. Makarova
Nikiforov’s All-Russian Center for Emergency and Radiation Medicine (ARCERM). Russia, 194044, Saint- Petersburg, Akademika Lebedeva street, 4/2 Abstract
Introduction. Selenium is an essential component affecting a number of biological processes in human body. The lack of this component resulted in the development of many pathological processes. The aim of the study was to analyze the parameters of selenium supply to the body of the residents of the North-West region in order to identify the prevalence of selenium deficiency. Materials and Methods. Using screening 17,555 residents of Saint-Petersburg and Leningrad region aged from 18 to 85 underwent outpatient examination during 2010-2021.
The selenium content in the internal environment of the body was assessed by analyzing the chemical composition of hair or blood serum samples by inductively coupled plasma mass spectrometry. Result.The performed study allows to determine gender and age parameters of selenium deficiency among residents of the North-West region, which should be taken into account when developing preventive and individual treatment programs for health improvement. Keywords: selenium, trace element, bioelemental status, inductively coupled plasma mass spectrometry method.
CORRELATIONS OF PARAMETERS OF ACTIVE ANTERIOR RHINOMANOMETRY WITH ANTHROPOMETRIC PARAMETERS, AGE AND GENDER IN CHILDREN AGED 4 TO 14
I.E. Shtina, S.L. Valina, O.Yu. Ustinova Federal Scientific Center for Medical and Preventive Health Risk Management Technologies. Russia, 614000, Perm, Monastyrskaya street, 82 Abstract Introduction.Activeanterior rhinomanometry is an objective assessment method of the state of nasal breathing. The aim of the study was to identify the correlation of the parameters of active anterior rhinomanometry with anthropometric data: age and gender in children aged 4 to 14. Materials methods. The study included 407 children of both sexes aged 4 to 14. The average age of children was 8.45±3.04, the proportion of boys - 52.3%, girls -47.7% (p=0.372). All children underwent anthropometry (height, weight, BMI) and active anterior rhinomanometry (RMM). Statistical analysis was carried out using the package of functions of the Jamovi 1.6.23.0 statistical application. Results. As a result of statistical analysis, significant direct relationships of the velocity parameters of the RMM with growth (r=0.18–0.32, p<0.001), age (r=0.15–0.28, p<0.001–0.002) and feedback of the nasal resistance parameters with growth (r=-0.3–(-0.2), p<0.001) and age (r=-0.28–(-0.18), p<0.001) were established. Conclusion. The obtained correlations indicate that for the correct interpretation of the results of active anterior rhinomanometry in children and adolescents, it is necessary to take into account the height and age of the subject. Key words: children; active anterior rhinomanometry; height; age; sex; correlations.
STRUCTURAL RESULTS OF THE BRISTOW-LATARJET PROCEDURE FOR THE TREATMENT OF ANTERIOR INSTABILITY OF THE SHOULDER 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. The high efficiency of the Bristow-Latarjet procedure is often associated with the development of osteoarthritis, limitation of motion, subluxations or apprehension. Most of the complications of coracoplasty are graft- or implant-associated, therefore, the study of the structural outcomes is necessary to improve the surgical algorithm and technique of the operation. The aim of the study: To investigate the structural results of Bristow-Latarjet procedure in patients with bipolar bone loss of the shoulder. Materials and methods: A prospective observational cohort transverse study of the localization, degree of resorption and consolidation of the graft, the direction of the screw and fatty infiltration of the subscapularis muscle on computed and magnetic resonance imaging in 262 patients. Statistical analysis of the collected information in order to determine the significance of the patient's characteristics and injuries of the shoulder joint as risk factors for the deterioration of the structural results of the operation. Results: In 42 (16.0%) patients, graft medialization of more than 5 mm was revealed, and in 20 (7.6%) - lateralization of more than 3 mm. From 25% to 50% of the bone block was located above the equator of the glenoid in 31 (11.8%) patients and in 7 (2.7%) - more than 50%. The upper border of the graft, on average, was localized at 03:07 [02:35; 03:17] hours of the conventional dial (from 01:15 to 04:15 o'clock, Me 02:53 o'clock), the lower limit - at 04:51 o'clock [04:05; 05:07] (from 02:50 to 05:35 hours, Me 04:37 hours). In 43 (16.4%) observations, the α-angle exceeded 30° and, on average, was 15° [6; 28] (from 2° to 43°, Me 17°). Resorption of the graft led to a decrease in its area, on average, by 38% [24; 55] (from 6 to 84%, Me 41%). The nonunion was observed in 24 (9.2%) patients over 50 years old, fracture - in 6 (2.3%). Fatty infiltration, mainly of the lower portion of the subscapularis muscle, was recorded in the mid-term in the absence at the beginning of the observation. A strong direct correlation (rs = 0.715, P<0.001) was found between the severity of resorption and the age of the patients. A strong inverse relationship (rs = -0.819, P<0.001) was observed between resorption and the size of the glenoid defect. Significantly more often (P<0.001) nonunion and all cases of graft fracture were observed in smoking patients with significantly higher resorption (P = 0.031). Conclusion: A relationship was found between the severity of graft resorption and fatty infiltration of the subscapularis muscle, as well as the frequency of graft nonunions on smoking, the patient's age and sex, and the presence of grade II preoperative omarthrosis and the size of the glenoid defect. In the future, it is necessary to assess the effect of structural outcomes on the functional results of treatment and the development of complications in order to improve the algorithm of surgical treatment of such patients. Keywords: shoulder joint instability, bipolar bone loss, Bristow, Latarjet, coracoplasty.
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.
PHYSIOLOGICAL TEMPERATURE OF NUTRIENT MIXTURE THROUGH GASTROSTOMY DRIP FEEDING
M.V. Gavshchuk1, K.A. Klikunova1, A.N. Zavyalova1, O.V. Lisovskii1, A.V. Gostimskii2, I.A. Lisitsa1, A.S. Gavrilova1 1Saint Petersburg State Pediatric Medical University. Russia, 194100, Saint Petersburg, Litovskaya street, 2 2Saint-Petersburg hospital №26. Russia, 196247, SaintPetersburg, Kosctiusko street, 2 3 Saint-Petersburg сhildren ‘s City Multidisciplinary Clinical Center of High Medical Technologies. Russia, 198205, Saint -Petersburg, Avangardnaya street, 14
Abstract Introduction. Enteral feeding through a gastrostomy or jejunostomy is the main component of palliative care for patients with long-term dysphagia. Wherein, food enters the digestive tract bypassing the upper sections and should have an appropriate consistency, composition and temperature. Deviation of enteral food temperature from the physiological one (37°C) leads to the inhibition of digestive enzymes activity, affects peristalsis and may cause digestive disorders. The aim of the study was to analyze the changes in enteral feeding temperature during drip infusion of the nutrient mixture. Materials and Methods. A model of enteral drip nutrition administration through a specialized gravity system at room temperature of +20°C was developed. About 300 ml of the nutrient mixture was heated up to 37 ° C, placed in the gravity system bag for the introduction of enteral mixture. Then the nutrition was drip-fed through the system for 30 minutes at a rate of 3 drops per second with recording the temperature of the mixture in the reservoir and at the system outlet at intervals of 5 minutes. Results and discussion. Already after the overflow of the nutrient mixture into the drip system tank was observed a decrease in temperature to 34-35 ° C, and at system outlet the temperature was 30-32 ° C. After 15 minutes, the temperature of the nutrient mixture at the end of the system was close to the ambient temperature (20-21°C). Feeding through the feeding fistula excludes physiological mechanisms of feeding temperature regulation. Introducing room-temperature food into the gastrointestinal tract through the fistula could reduce the activity of digestive enzymes, stimulate peristalsis and require additional energy expenditure for heating the food. Conclusion. Introducing room-temperature food into the gastrointestinal tract through the fistula may reduce the activity of digestive enzymes, stimulate peristalsis and require additional energy expenditure for heating the food. In the case of bolus feeding through the gastrostomy, it is necessary to heat the enteral food to physiological temperature. In the case of drip feeding through a nutrient fistula the temperature of the food is reduced to the ambient temperature, so additional devices should be used to maintain its physiological temperature. Keywords: enteral nutrition, gastrostomy, jejunostomy, nutritional fistula, gravity system, drip administration, palliative care, enzyme activity.
DIFFICULT CHOICE BETWEEN CAROTID ENDARTERECTOMY AND STENTING
N.I. Glushkov, D.V. Kornievich, P.D. Puzdriak, E.A. Vasenina, M.A.Ivanov North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint- Petersburg, Kirochnaya street, 41 Abstract Introduction.The issues on the ways of the carotid artery stenosis elimination are still unsolved. The aimof the study was to determine the indications for carotid endarterectomy and stenting in patients with carotid artery stenosis. Materials and methods. The study included 130 patients: 55 patients underwent carotid endarterectomy; 75 patients were performed carotid angioplasty and stenting.
Early (first 30 days) and long-term (up to one year) outcomes were analyzed. The correlation between comorbid pathology, atherosclerotic plaque characteristic and the interventions outcomes were analyzed. Results. Carotid angioplasty more often performed if there is a severe course of comorbidities, while, the carotid endarterectomy was carried out in case of atherosclerotic plaque instability and
severe calcined carotid stenosis. Key words: carotid endarterectomy, carotid angioplasty, carotid stenting, carotid stenosis, cerebrovascular disease.
STEREOTACTIC RADIOTHERAPY IN THE TREATMENT OF PRIMARY AND METASTATIC SPINE TUMORS (REVIEW)
A.I. Arseniev 1,2, S.N. Novikov 1, S.V. Kanaev 1, A.A. Barchuk 1, O.I. Ponomareva 1, A.O. Nefedov 3, F.E. Antipov 1, Yu.O. Merezhko 1, A.Yu. Zozulya1, K.E. Gagua 1, S.A. Tarkov 1, N.Y. Aristidov 1 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 Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky Avenue,2-4, , Russia. Abstract The literature review analyzes the scientific data and outlines the main aspects of the problem of the possibility, safety and effectiveness of stereotactic radiation therapy in patients with primary and metastatic spine tumors, considering the nature and extent of the spread of the process, general somatic and functional status. It is shown that careful selection of patients and the use of modern, high-tech planning techniques play a crucial role for the successful treatment. The possibility of the use of stereotactic radiotherapy is of a particular importance for patients who have been previously irradiated. This method significantly expands the range of specialized care for cancer patients, allows increasing the life expectancy and improving the quality of life. The study of the advantages of various fractionation modes, dose values per fraction continues. The technique requires high qualifications and sufficient experience from medical personnel, as well as full-fledged equipment of the clinic with diagnostic and radiotherapy equipment. Optimization of methods of spine tumors treatment is one of the priorities of modern oncology, and many aspects of a rational approach to solving this urgent problem remain unresolved and require further study. Key words: primary and metastatic spine tumors, stereotactic radiation therapy, prescribed doses, radiation reactions and complications, local control, local progression, dose restrictions.
COMPARATIVE CHARACTERISTICS OF PATIENTS WITH COVID-19 WITH COMORBIDITY
A.V. Rogozhkina1, E.S. Romanova1, G.Yu. Startseva1, O.M. Filipovich1,2, M.N. Pogromskaya1,2, I.P. Fedunyak1,2 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint- Petersburg. Kirochnaya street, 41 2Clinical Infectious Diseases Hospital named after S.P. Botkin. Russia, 191167, Saint-Petersburg, Mirgorodskaya street, 3
Abstract Introduction. Diabetes aggravates the course of COVID-19; however, numerous publications indicate that patients with diabetes have other somatic diseases. Currently, predicting the severity of novel coronavirus infection within the polymorbidity of patients is extremely difficult. The aim of the study was to evaluate the clinical and laboratory characteristics of patients hospitalized with COVID-19, depending on the presence or absence of diabetes mellitus, in a burdened comorbid background. Materials and methods. The study included two groups :56 patients with type 2 diabetes mellitus and other concomitant diseases in history; 41 patients with comorbidities, without diabetes mellitus. The age and sex structure, the number of bed days, the timing of admission to the intensive care unit, the timing of artificial ventilation, and the results of laboratory tests were studied. Results. The study and control groups significantly differed in age (P = 0.001), patients with diabetes mellitus more often had progressive anemia that could not be corrected, the absolute number of leukocytes was significantly lower (P = 0.41), there was a tendency to more frequent development of progressive thrombocytopenia (P = 0.022). In both groups, there was a significant increase in acute phase proteins, hypercoagulability. Conclusion. Laboratory parameters such as hemoglobin, platelet count, lactate dehydrogenase, C-reactive protein, ferritin could be used as biomarkers to assess the severity of COVID-19. There were no differences in the duration of hospitalization, the timing of the start of intensive care and respiratory support between patients with and without diabetes mellitus, which may be due to the fact that the study included patients with an initially aggravated comorbid background. Thus, the assessment of the presence of one risk factor (for example, diabetes mellitus) in patients with polymorbidity is not very informative. Keywords: COVID-19, diabetes mellitus, risk factors, comorbid background, polymorbidity, concomitant diseases, course severity, duration of hospitalization.
CLINICAL LABORATORY DIAGNOSTICS
CELIAC DISEASE: FROM METABOLIC DISORDERS TO GENETICS AND EPIGENETICS (REVIEW)
N.V. Vokhmyanina, L.B. Gaikovaya, R.N. Pavlova North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
Abstract
The article presents novel promising ways for the celiac disease detection. Metabolomic and epigenetic studies are given as the examples. The significance of one-carbon metabolism for DNA methylation is considered as an important component of gene expression modification affecting the phenotypic manifestations of celiac disease. The information content of the DNA modified methylation profiles, as well as significant metabolites involved in the formation and donation of methyl groups, is shown. The article focuses on the possibility of using such a new biological material as saliva to determine the methylated profile, the results of which correlate with the data obtained in biopsy specimens.
Based on the performed analysis, it was made the conclusions helping doctors to correctly navigate within the proposed new opportunities for detecting celiac disease. Key words: one-carbon metabolism, S-adenosylmethionine, choline, betaine, DNA methylation, genetics, epigenetics.
(с) 2020 North-Western State Medical University named after I.I.Mechnikov
