CONTENTS 2016-3
MEDICAL SCIENCE PREVENTIVE MEDICINE
Оccupational morbidity of minersin kola polar region: factors of its growthand decline. S. A. Syurin, V. V. Shilov.........................4
Assessment of working conditions exposure and occupational risk among truck drivers S. V. Grebenkov, I. M. Syhova.........................12
Theory and practice of the air microbiota study in closed spaces T. A. Grechaninova, N. S. Grigor’eva,K. G. Kosyakova, O. E. Punchenko.........................18
Antibiotic resistance in community-acquired infections in Saint-Petersburg B. I Aslanov., I. I. Prilutskaya, A. V. Romanov, L. N. Sushkova, Y. S. Svetlichnaya.........................25 Hidemiological and epizootological characteristics of tularemia in the Khanty-Mansiysk autonomous okrug — Ugra. I. I. Kozlova, V. A. Pakhotina, N. G. Kashapov, L. A. Minyailo, N. A. Ostapenko,N. M. Fayzullina, T. F. Fedko.........................33
Organization peculiaritiesof nurses professional activitiesof department of functional diagnostics A. N. Pavlova.........................43
The availability of medical rehabilitationin benign neoplasms of the gynecological field Vishnyakov N. I., Kochorova L. V.,B. L. Tsivyan .........................49 CLINICAL MEDICINE
A rare complication of acute appendicitis V. P. Zemlyanoy, B. V. Sigua,E. L. Latariya, D. S. Semin.........................56
Comparative study of the microvasculature and cell composition of mesenteric and inguinal lymph nodes of rats under the influence of isoprene synthesis by-products E. V. Toropkova, O. S. Kulbakh,I. V. Gayvoronskiy.........................61
Opportunities of surgical treatmentof complicated forms of locally advanced thoracic esophageal cancer L. D. Roman, K. G. Shostka, K. V. Arutyunyan, I. M. Kuznetsov, A. N. Pavlenko, N. A. Mushnikov..........................67
Efficiency of regenerative treatmentof patients with spondylogenic pain syndromeon the background of complex rehabilitation J. A. Kreneva, V. P. Panov, M. V. Avdeeva.........................74 TOAUTHORSATTENTION..........................81
PREVENTIVEMEDICINE
OCCUPATIONAL MORBIDITY OF MINERS IN KOLA POLAR REGION:
FACTORS OF ITS GROWTH AND DECLINE
S. A. Syurin1, V. V. Shilov2 1 Federal Budget institution of science «North Western Public Health Research ; Russia, 191036, SaintPetersburg, 2-aya Sovetskaya st., 4. 2 North-Western State Medical University named after I. I. Mechnikov under the Ministry of public health, 191015, Saint-Petersburg, Kirochnaya str., 41
Absract: Introduction. The working conditions at mining industry, including the Kola Polar region, create an increased risk of developing occupational diseases (OD). The purpose of the studywas to examine the characteristics of OD formation in miners in the Kola Polar region for the past 25 years. Results. We found data on 2264 cases of OD in 1244 Kola Polar region miners. It was found that despite the improvement of working conditions and introduction of modern occupational health care methods, the miners in Kola Polar region showed a steady increase in occupational morbidity. Its structure is dominated (95.2% of all cases) by diseases caused by exposure to harmful factors of physical nature (diseases of the musculoskeletal and nervous systems, vibration disease, hearing loss). The increased incidence was observed in all of the above groups of diseases, especially during the last 10 years (2004-2013). The most significant growth was found in a group of musculoskeletal diseases (by 9.29 times). We revealed an important fact of increased seniority (10.5 years) and age (9.4 years) of miners prior to OD formation. Among all the employees most affected by the development of OD were miners performing tunneling and drilling works. Conclusion. The conclusion was made about the necessity of studying the factors that determine growing rates of occupational morbidity in Kola Polar region miners despite constantly improving working conditions and workers' health protection system. Keywords: occupational morbidity, miners, Kola Polar region.
АSSESSMENT OF WORKING CONDITIONS EXPOSURE AND OCCUPATIONAL RISK AMONG TRUCK DRIVERS
S.V. Grebenkov, I.M. Syhova North-Western State Medical University named after I.I. Mechnikov under the Ministry of Public health, 191015, Saint-Petersburg, Kirochnaya str., 41 Abstract Introduction. Occupational risk assessment is an important issue around the world, and therefore a differentiated risk assessment seems to be actual, depending on the profession, in this case - the drivers . Purpose. To assess the working conditions exposure and occupational risk among truck drivers. Materials and methods. In 2011-2014 was conducted a research among drivers of specialized trucks (1050 people). An analysis of worker exposure impact on health was based on the methodology of risk assessment according to the "Guidelines for the assessment of occupational risk for workers' health. Organizational-methodical bases, principles and evaluation criteria. R.2.2.1766-03", the main of which were relative risk (RR), the etiological fraction (EF), the index of occupational diseases (IPD). Results. The study of working conditions of drivers showed the suspect risk is evaluated from "medium" to "high" depending on the timetable and the type of work.
Occupational risk assessment based on the results of the periodic medical examination showed a high risk of diseases such as hypertension 1, hyperopia, dorsopathies lumbosacral level, encephalopathy. It is also identified a discrepancy between the levels of relative risk of successive stages in the of hypertension associated with the screening-out of drivers with contraindications to driving. These data indicate a low risk of occupational diseases among modern drivers. Conclusions. The research allowed to make conclusions about occupational risk among drivers in modern conditions and also showed a high dependency of their health from their profession. In addition, it is revealed the need for differentiated risk assessment in occupational groups with contraindications to certain activities (in this case - driving), which is important for organization of preventive measures. Key words: drivers, transport, working conditions, medical examination, health, occupational risk.
THEORY AND PRACTICE OF THE AIR MICROBIOTA STUDY IN CLOSED SPACES
T.A. Grechaninova1, N.S. Grigor’eva1, K.G. Kosyakova2 , O.E. Punchenko2 1Federal Budget Health Care Institution «Centre of Hygiene and Epidemiology in Saint-Petersburg», Russia, 192103, Saint-Petersburg, Malaya Sadovaya str., 1. 2 Federal state budget institution of higher education “North-Western State Medical University named after I.I Mechnikov” under the Ministry of Public Health of the Russian Federation, 195067, Saint-Petersburg, Piskarevsky pr., 47
Abstract Purpose. To analyze different methods of selection of indoor air samples and evaluate the results of their application in practice. Materials and methods. The methodological basis of the study was an analysis of the scientific literature about the methods of indoor air samples selection, as well as own data of the air microbiota study. All studies on the detection of microorganisms in the air of closed spaces were carried out according to current regulations. Results. In assessing the quality and air pollution biosafety, depending on the objectives of the study different groups of microorganisms were defined. Methods of air sampling for counting the number of microorganisms are classified into four groups: natural sedimentation, incentive sedimentation, aspiration through the liquid, filtration through membrane filters.
In addition to the direct determination of micro-organisms in closed spaces to which the special requirements of air purity it is used a method of counting the number of suspended particles. Selection of acceptable air sampling method is based on predicted concentration of microorganisms and sensitivity of the method, microbial resistance to the sampling procedure, duration and conditions of sampling, design peculiarities of devices for air intake. The use of a new method or design of the air sampler requires a series of comparative tests. Conclusion. The choice of sampling method of indoor air is determined by techniques and devices listed in regulatory documents.
Technical characteristics of a particular model, as well as expected concentration of microorganisms in air must be taken into consideration during selection of sampler. Key words: indoor air, microorganisms, air sampling.
ANTIBIOTIC RESISTANCE IN COMMUNITY-ACQUIRED INFECTIONS IN SAINT-PETERSBURG
1State budget institution of higher education “North-Western State Medical University named after I.I Mechnikov” under the Ministry of Public Health of the Russian Federation. Russia, 191015, Saint-Petersburg, Kirochnaya st., 41 2State budget institution of Public Health “City Polyclinic №17”. Russia, 195273, Saint-Petersburg, Metallistov pr., 56. 3Federal budget institution of Public Health “ of Hygiene and Epidemiology in Saint-Petersburg” in Nevskiy and Krasnogvardeysky districts. Russia, 192012, Saint-Petersburg, Novo-Aleksandrovskaya st., 12 4Saint-Petersburg State budget institution of Public Health “Medical Information and Analytical ”. Russia, 198095, Saint-Petersburg, Shkapina st., 30
Abstract Purpose. This study aimed to evaluate the levels of antibiotics resistance in infectious diseases pathogens in the outpatient population of St. Petersburg in 2014-2015. Methods. Over a 2-year period, clinical specimens were obtained in a large polyclinic from outpatients with community acquired infections and were cultured. Isolated bacteria underwent disk diffusion test for different antibiotics. WHONET software has been used to analyse the levels of antimicrobial resistance in 1649 strains isolated during 2014-2015. Results. The microorganisms isolated from outpatiens were distributed as follows: E.coli – 42%, S.aureus – 27%, S.epidermidis – 12%; K.pneumoniae, E.faecalis, E.cloacae – 4% each; C.koseri – 3%; all other pathogens – 4%.
High levels of resistance were observed only for certain antibiotics. E.coli strains were resistant to ceftriaxone (40.0% of the strains) and ampicillin (39.8%). S.aureus showed the greatest resistance to penicillin – 83.5% of the strains. The majority of K.pneumoniae strains were resistant to ampicillin (81.5%); 60% of K.pneumoniae were resistant to nitrofurantoin. Almost 100% of strains of E.faecalis were resistant to amikacin and 66.7% to amoxicillin. All P.aeruginosa strains were resistant to trimethoprim and nitrofurantoin.
With regard to other tested antibiotics, studied microorganisms were characterized by a fairly high levels of susceptibility. Conclusion. Overall, community-acquired strains isolated from outpatient population characterized by relatively low levels of resistance to the most tested antibiotic. At the same time, it has been observed high prevalence of resistance to defined antimicrobials. Keywords: antibiotic resistance, outpatients, community-acquired infection.
PIDEMIOLOGICAL AND EPIZOOTOLOGICAL CHARACTERISTICS OF TULAREMIA IN THE KHANTY-MANSIYSK AUTONOMOUS OKRUG – UGRA I.I.Kozlova2, V.A.Pakhotina1, N.G.Kashapov2, L.A.Minyailo2, N.A.Ostapenko2, N.M.Fayzullina2, T.F.Fedko1
Budgetary Institutions of Higher Education of the Khanty-Mansiysk Autonomous Okrug - Ugra "Khanty-Mansiysk State Medical Academy", Russia, 628011, Khanty-Mansiysk, Mira str., 40.
Federal Budgetary Healthcare Institution " of Hygiene and Epidemiology in the Khanty-Mansiysk Autonomous Okrug - Ugra", Russia, 628011, Khanty-Mansiysk, Roznin str., 72.
Abstract Introduction: The natural foci of tularemia in the Khanty-Mansiysk Autonomous Okrug - Ugra retains its activity and vitality. The natural and climatic conditions of Ugra, as well as the factors of anthropogenic influence, contribute to the formation of the ecological environment favorable for carriers and vectors of tularemia. Purpose: The study of the current state of tularemia foci to optimize preventive and anti-epidemic measures. Materials and methods: During research complex expertize of the disease incidence, disease producing factor, pathogen activity, transmission of infection and ways of human being contacts with the nature, is carried out. 310 cards of epidemiological survey of the foci of tularemia and clinical records of patients with tularemia, are analyzed. The laboratory studies (the bacteriological, immuno-serological and molecular genetic ones) of small mammals, ticks, mosquitoes, as well as water samples taken in the natural foci of tularemia, are carried out. Results: It was stated as follows: Current epidemiological situation with tularemia in the Khanty-Mansiysk Autonomous Okrug - Ugra is characterized by an expansion of highly enzootic areas towards city areas with the prevalence of urban population incidence, as well as an increase of epizootic and epidemic manifestations in some landscape and epidemiological areas of KhMAO with 5/6-year cyclicity of the deterioration of the situation with tularemia. The highest adverse epidemiological impact of rodents and bloodsucking arthropods requires continuous improvement tactics of epizootic and epidemiological surveillance and sanitary-epidemiological measures. The promising directions to reduce the incidence of tularemia are as follows:
- specific prevention;
- abatement of number of carriers as well as factors and ways of non-specific disease vectors transmission;
- up-to-date personal protection measures that can prevent a human being from biting arthropods, and therefore, from any infection transmitted by them. Keywords:Tularemia, natural foci, urban foci, small mammals, epidemiological and ehpizootological monitoring, prevention.
ORGANIZATION PECULIARITIES OF NURSES PROFESSIONAL ACTIVITIES OF DEPARTMENT OF FUNCTIONAL DIAGNOSTICS
N. Pavlova
Federal state budget institution of higher education “North-Western State Medical University named after I.I Mechnikov” under the Ministry of Public Health of the Russian Federation, Russia, 195067, Saint- Petersburg, Piskarevsky prospect, 47.
Abstract Purpose: To study professional activities of the nurses of functional diagnosis department in order to optimize the work process to improve the quality of diagnostic and the health maintaining of the staff. Materials and methods: During the research the activities from 2010 to 2015 of the functional diagnostics service in St. Petersburg were analyzed. On the basis of an expert assessment which was performed on a special designed program (n = 35) the peculiarities of work organization of nurses in the functional diagnostics department were studied. Assessment of working conditions and the nurses state health of functional diagnostics department due to using of medical-sociological research program (n = 237) were performed. Results: It was stated that the number of performed diagnostic studies in the functional diagnostics departments is being increased annually. Despite of it there is a shortage of staff nurses. Imbalance of diagnostic necessity and staff nurses results in significant increasing of work amount among the nurses of the functional diagnostics departments. Besides that, an inadequate organization of nurses’ work negatively influencing on the nurses’ state health is marked. Conclusions: Complex approach is necessary for the organization of professional activities of functional diagnostics departments nurses for their health maintaining, labor potential, as well as to ensure the effectiveness and quality of diagnostic care. Key words: nurses, functional diagnostics, professional activity, health maintaining.
THE AVAILABILITY OF MEDICAL REHABILITATION IN BENIGN NEOPLASMS OF THE GYNECOLOGICAL FIELD
Vishnyakov N.I., Kochorova L.V., Tsivyan B.L.
State educational establishment of higher professional education " Pavlov First Saint Petersburg State Medical University " of Russian Ministry of Health, Saint-Petersburg, Russia, 197022, St. Petersburg, St. Leo Tolstoy, 6-8
Abstract Introduction. Restrictions of access to medical care remains one of the leading problems of modern health and lead to untimely implementation of the medical-diagnostic, rehabilitation and preventive measures. The article discusses the results of a study conducted in St. Petersburg, by examining the opinions of patients with benign tumors of the female reproductive organs and gynecologists on issues of accessibility of medical rehabilitation programs. Purpose: analysis of accessibility for patients with benign tumors of the female reproductive organs medical rehabilitation at various stages of medical care. Methods. The analysis was carried out using the sociological method in antenatal clinics, hospitals and sanatorium. To explore the views of patients with benign tumors of the female reproductive organs and the doctors participating in rendering of medical aid at different stages, and developed special questionnaires for each group of respondents. All the studied opinion of the 10 502 patients and 750 gynecologists. Results. The study showed that two-thirds of women with benign neoplasms, experiencing significant psychological distress, a feeling of insecurity in his "women's health", anxiety about the ambiguities of prognosis, the need for surgical treatment in the future. Women appreciate the possibility of medical rehabilitation after undergoing primary treatment, however, due to the low availability of this type of assistance, have virtually no possibility of receiving it at the stage of antenatal clinics. More than 80% of the surveyed physicians also consider the application of medical rehabilitation in the treatment of benign neoplasms of the gynecological system effective at different stages of treatment. The most effective methods of medical rehabilitation of women consider physiotherapy and exercise therapy (63%), chiropractic (56%) and psychotherapy (37%). Conclusion. The study showed that women with benign gynaecological tumors, in need of rehabilitation activities, the availability of which currently remains very low. Application of methods of medical rehabilitation is important at every stage of medical care. One of the ways to increase the availability of rehabilitation assistance might be the development of programs of medical rehabilitation in a day hospital. Keywords: benign tumors of the female genital sphere, the availability of medical care, medical rehabilitation. CLINICAL MEDICINE
A RARE COMPLICATION OF ACUTE APPENDICITIS
V.P. Zemlyanoy, B.V. Sigua, E.L. Latariya, D.S. Semin. Federal state budget institution of higher education “North-Western State Medical University named after I.I Mechnikov” under the Ministry of Public Health of the Russian Federation, 193015, St. Petersburg, Kirochnaya st. 41 Abstract. Purpose: Demonstration of a rare form of the destructive appendicitis occurred without apparent clinical inflammation in the abdomen. Methods: The article presents a retrospective analysis of clinical case of atypical latent course of acute appendicitis with formation a fistula of the sigmoid colon. Results: The disease occurs under the guise of colon pathology. Modern research methods gave contradictory information and did not allow to make a definitive diagnosis. Intraoperative revealed the signs of acute destructive appendicitis (two months old), complicated of an appendicular abscess formation, and the presence of an additional loop of the sigmoid colon facilitated drainage of an abscess formed by intestinal fistula.The patient was successfully surgically operated - dissection and sanitation of an appendicular abscess, appendectomy, resection part of the sigmoid colon with fistula and formation of sigmosigmo-anastomosis, sanitation and drainage of the abdominal cavity. Conclusion: Were showed significant diagnostic difficulties arising from atypical for one of the most common surgical diseases in the practice of the surgeon even though the use of a wide range of modern diagnostic methods. Kеy words: acute appendicitis, complication, fistula, surgical treatment.
COMPARATIVE STUDY OF THE MICROVASCULATURE AND CELL COMPOSITION OF MESENTERIC AND INGUINAL LYMPH NODES OF RATS UNDER THE INFLUENCE OF ISOPRENE SYNTHESIS BY-PRODUCTS
E.V. Toropkova1, O.S.Kulbakh2, I.V. Gayvoronskiy1
1 Federal State military educational institution of higher professional education "Military Medical Academy named after S.M. Kirov» of the Russian Federation Ministry of Defense. Russia, 194044, St. Petersburg, ul. Akademika Lebedeva, 6, Lit. J. 2 Federal State Educational Institution of Higher Professional Education "Saint Petersburg State Pediatric Medical University" of the Russian Federation Ministry of Health. Russia, 194100, St. Petersburg, ul. Lithuanian, House 2.
Abstract
This article describes the structural changes of the microvasculature and cellular composition of mesenteric and inguinal lymph nodes of rats after intragastric administration of the by-products of synthesis of isoprene, which can enter the natural water bodies with effluents of the enterprises for manufacture of synthetic rubber. Prolonged exposure to toxic products in the mesenteric lymph nodes that are regional to the gastrointestinal tract, on the 45th day of the experiment the observed initial signs of functional exhaustion of the organs, whereas changes in inguinal lymph nodes remote from the injection site toxicants, indicate the development of protective and compensatory-adaptive reactions. Key words: mesenteric lymph node, inguinal lymph node, microvasculature, cellular composition, by-products of synthesis of isoprene.
OPPORTUNITIES OF SURGICAL TREATMENT OF COMPLICATED FORMS OF LOCALLY ADVANCED THORACIC ESOPHAGEAL CANCER.
L.D. Roman 1, K.G. Shostka 1, K.V. Arutyunyan 1, I.M. Kuznetsov 2, A.N. Pavlenko 1, N.A. Mushnikov 2 1State budget health institution “Leningrad Regional Oncologic Dispensary”, Russia, 191014, St Petersburg, Liteyny Prospect 37. 2 Federal State Budget military educational institution of higher professional education "Military Medical Academy named after S.M. Kirov» under the of Ministry of Defense of the Russian Federation. Russia, 194044, St. Petersburg, Akademika Lebedeva St., 6, Lit. J.
Abstract
Purpose. The aim of the study is to improve treatment outcomes for patients with complicated forms of locally advanced thoracic esophagus cancer.
Materials and methods. During the period from 2005 to 2012, 306 patients with thoracic esophagus cancer underwent surgery at Leningrad Regional Oncologic Dispensary. 123 (40%) patients of them had complicated forms of locally advanced thoracic esophagus cancer (CLATEC). 76 patients (60%) of the study group with CLATEC had combined resections of esophagus with the resection of adjacent organs and structures.
The post-operative mortality and complications were compared with the same data in the control group of patients who had standard surgery for ‘uncomplicated” esophageal cancer.
A standard preoperative workup, included esophagogastroduodenoscopy, roentgenoscopy of the esophagus and stomach; contrast- enhanced CT of the chest and abdomen, EUS (endoscopic Ultrasound of the esophagus (with the technical possibility of the manipulation), bronchoscopy, pulmonary function tests, echocardiography, Holter monitoring. The Karnofsky Performance Scale Index and the ECOG Scale of Performance Status were used to quantify the functional status of the patients. The ASA score was used to assess anesteriological risks. Results. Postoperative complication rate did not differ significantly between the groups (36% in the standard surgery group vs. 50% in the combined resection group). However, postoperative mortality rate in the group of patients with CLATEC twise as much as the group of patients who underwent standard esophageal resection (15.8% vs. 8.5%). After the postoperative morphological assessment we selected a group of patients with locally advanced tumor that was allegedly associated with paracancerous inflammation; the group required a T- criterion ‘restaging’.
Long-term outcomes for patients with CLATEC who underwent combined resections remain unsatisfactory: the three-year survival rate is less than 18%. However, in the absence of regional lymph nodes involvement, the three-year survival rate is over 60%. Conclusions.
1. All patients with complicated forms of locally advanced thoracic esophageal cancer, who have contraindications to chemoradiotherapy, should be considered as surgical candidates for combined resections.
2. Combined resections are expedient for surgical treatment of the patients with complicated forms of locally advanced thoracic esophageal cancer, provided reliable tumor growth assessment in cases when the patients are fit for surgery.
3. Short-term outcomes of combined resections in CLATEC are comparable with that of standard esophageal resections, but postoperative mortality in the group of CLATEC patients is much higher.
4. Absence of metastatic involvement of regional lymph nodes is an apparent favorable prognostic factor for patients with complicated forms in locally advanced thoracic esophageal cancer. Keywords: esophageal cancer, complicated locally advanced cancer, combined resections, esophageal cancer surgery.
EFFICIENCY OF REGENERATIVE TREATMENT OF PATIENTS WITH SPONDYLOGENIC PAIN SYNDROME ON THE BACKGROUND OF COMPLEX REHABILITATION J.A. Kreneva 2, V.P. Panov 1,2, M.V. Avdeeva 1 1 Federal state budget institution of higher education “North-Western State Medical University named after I.I Mechnikov” under the Ministry of Public Health of the Russian Federation, 195067, Saint-Petersburg, Piskarevsky pr., 47. 2 St. Petersburg state budget health care institution «Municipal polyclinic №14». Russia, 194021, Saint-Petersburg, 2-oj Murinskij pr., 35 Abstract. Introduction. The problem of the treatment effectiveness of chronic back pain is extremely important, since the lack of clinical benefit from the use of different methods of treatment leads to tangible social and economic consequences due to lower life quality, disability of patients and growth of expenses on their medical and social care. Materials and Methods. The study involved 90 outpatients aged 18-75 years with pain in the lower back, who took a rehabilitation course, 60 of them used phonophoresis with the medical cream and 30 patients – used phonophoresis, but without medicine. The reason for choosing the medical cream is a complex mechanism of its therapeutic action with a combination of anti-inflammatory, analgesic and antiedematous effect. The efficiency was assessed by expressiveness of a pain syndrome, degree of physical activity, mental condition and life quality of patients who were determined by using standardized questionnaires in dynamics before and after a course of rehabilitation. Results. Against the background of rehabilitation treatment there was a reduction of pain, what showed results of evaluation of the visual-analogue scale, questionnaire about pain by Mc Gill, the ranking index of questionnaire about pain by Mc Gil and Roland-Morris questionnaire in both groups of patients. However, a positive trend was more pronounced in the study group than in the control group (р<0,01-0,05). Conclusion. Using phonophoresis with the medical cream with complex mechanism of its therapeutic action within the standard of care for rehabilitative treatment of patients with pain in the lower back contributes to a more rapid relief of pain, reduction of drug loading, restoration of physical and daily activity and improvement of quality of life in comparison with the patients accepting treatment according to other scheme. Keywords: treatment of back pain, pain in the lower back, physiotherapy, the effectiveness of physiotherapy, phonophoresis.
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