ASSESSMENT OF THE COMBINED PROFESSIONAL RISK WORKING IN OPEN TERRITORY IN THE COLD PERIOD OF THE YEAR A.V. Meltser, E.M. Polyakova, V.P. Chashin North-Western State Medical University named after I. I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya Street, 41. Abstract Introduction. The main reasons for classifying oil industry employees as a group with a high risk of general and occupational diseases are the impact of a complex of harmful factors, such as work environment, work process together with adverse climatic conditions. The aim of the study was to assess the combined occupational risk for employees working in the open territory in the cold season by the example of an oil producing company. Materials and methods.The degree of the parameters deviation of the work environment and the labor process from existing hygienic standards was determined due to R 2.2.2006-05. Calculations of occupational risk carried out for individual occupational groups in accordance with R 2.2.1766-03. It was used a developed in 2005 by A.V. Meltzer, A.V. Kisilev combined model of occupational risk assessment. The evaluation of the combined occupational risk of employees was carried out on the basis of joint-stock company “Samotlorneftegaz” using production control protocols for the state of working conditions, protocols of a special assessment of working conditions during 2012 - 2018. The five professional groups of workers were chosen and united by similar work obligations to access the occupational risk. Results. The calculation of occupational risk from exposure to noise, chemicals, microclimate, general vibration during the cold (winter) period of the year when working in the open territory, as well as the total values of the risk to health from their exposure at the workplaces of employees of the corporation “Samotlorneftegaz” with various experience was performed. The number of conditional disorders increases from 3 to 54 cases per 100 employees depending on the level of factors exposure to the workplace, having 10 years of experience. The main factor is noise. The contribution of production factors to the integral risk value is different. The estimated risk indicator for 10 years of experience in the professions is ranged from 12 (operator of the production complex of the oil preparation and pumping workshop No. 1) to 34.5 (electric and gas welder of the oil preparation and pumping workshop No. 2). Conclusion. Using approaches to the assessment of working conditions and employees health based on the occupational risk methodology, significant differences in the probabilistic forecast values of the development of nonspecific and occupational diseases among various groups of employees of the corporation “Samotlorneftegaz” were noted, including the type of work obligations in an open area during the cold period of the year, work experience Key words:occupational risk, work in an open area during the cold period of the year, work load, oil workers, hazardous working conditions.
PREVENTIONOF CARDIORESPIRATORY DISORDERS IN EMPLOYEES OF PRE-RETIREMENT AGE INVOLVING IN CHEMICAL INDUSTRY
E.M.Vlasova, O.Yu.Ustinova, T.A.Ponomareva Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Russia, 614045, Perm, Monastyrskaya str.,82 Abstract Introduction. According to monitoring research the working efficiency of employees under 45 years is lower than optimal by 10 %, in employees aged 46-49 years is lower by 13 %, and in employees aged 50 years and older is lower by 20% or more. One of the main reasons of the decline of the working efficiency in persons above working age is health-related conditions and low adaptive potential, particularly, the decrease of functional reserves of the circulatory and respiratory system. The aim of the study was to scientifically justify the programs forprevention of cardiorespiratory disorders in workers of pre-retirement age employed in hazardous industries. Material and Methods. It was examined 225 employees of the metallurgical plant, the mean age was 49.7 ± 4.7 years, the average experience was 25.4 ± 5.3 years, the main professions were the furnaceman and the casting operator. The comparison group included 97 representatives of the administrative staff of the plant. The mean age was 47.4 ± 5.5 years (p > 0.05), the average experience was 22.8 ± 6.3 years (p > 0.05). Hygienic, clinical, epidemiological and statistical methods were included. Results. According to the results of regular medical examination and conducted examinations of professional suitability in the Center for Occupational Medicine and Occupational Pathology, 1/3 of employees with large working experience suffer from 3 or more chronic diseases, mainly respiratory and circulatory systems diseases. According to the diagnostic results, 47% of employees in the observation group had reduced body adaptive reserves. According to the comprehensive examinations, more than 35% of employees aged 50 years and older after exercise tolerance test were observed with an increase of heart rate up to 100-120 per minute and an increase in systolic blood pressure up to 160 mm Hg, while the muscular endurance decreased by 30-40%. Conclusions. The system of medical examinations does not aim at preserving the health of workers of pre-retirement age. As a result, there is a spread of diseases resulted in pathology and disability to a large extent.
POSSIBILITIES OF INFORMATION TECHNOLOGY FOR MANAGING LABORATORY TESTS IN HOSPITAL
A.S. Fedorenko 1, A.T. Burbello 1, L.B. Gaykovaya 1, E.L. Lataria 1, O.V. Granatovich 1,2, A.I. Ermakov 1, M.V.Pokladova 1 1North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya str., 41 2Health Committee of St. Petersburg,Russia, 191023,Saint-Petersburg, M.Sadovaya str., 1 Abstract. Introduction. Digitalization in the field of healthcare causes the necessity to use various information means. For instance, the integration of the laboratory and medical information systems allows to develop the automatic decision-making systems for various levels. The implementation of a laboratory management system reduces the number of repeated tests and correspondently has an additional economic expediency. The aim of the study was to determine the possibilities to use the information technology to reduce the number of unreasonable appointments for laboratory tests as an example of the integrated information hospital systems. Materials andmethods. The study was carried out on the basis of medical and laboratory information systems of the North-Western State Medical University named after I.I. Mechnikov by implementation of integrative networks and the development of an automated appointment management system. Results. It was developed the automated appointment management system: repeated tests for planned patients, and a warning / prohibition system for prescribing examinations exceeding the minimum intervals for prescribing an appropriate laboratory test. Conclusion. The implementation of automated appointment management system allows to reduce a number of unjustified laboratory tests, resulted in a reduction of financial costs without loss of heath care quality. Key words: management of laboratory prescriptions; laboratory information system, medical information system
MEDICAL AND SOCIAL ASPECTS OF DISABILTY DEVELOPMENT IN CHILDREN OF YONGER AGE GROUPS IN SAINT PETERSBURG DURING 2008-2017.
Рavlov First Saint Petersburg State Medical University, Russia, 197022, Saint Petersburg , Leo Tolstoy str., 6-8
Children’s Health Analysis and Prognosis center of Health Committee, Russia,191023, Saint-Petersburg
Children’s City Hospital N1, Russia, 198205, Saint Petersburg, Avangardnaya str.,14
Children's Multidisciplinary Clinical Center of High Medical Technologies. K.A. Rauhfusa, Russia, 191000, Saint Petersburg, Ligovsky pr., 8
Abstract Introduction. The problem of childhood disability has increased over the past years not only worldwide, but in Russia either. The article presents the issues concerning the disability development in children aged 0-4 during 2008-2017. Aim of the study was to examine the reports of children clinics and the city’s bureau of medical and social expertise. It was revealed as a different approach to the age groups formation, as a change in the disability structure. Materials and methods. It was used the reports of Russian Federal State Statistics Service (Rosstat) No. 19 for children's clinics and for sociomedical examination of Rosstat 7-D during 2008-2017, as well as: meeting materials of the Coordinating Council under the President of the Russian Federation from November 15, 2016, government instructions to ministries and departments from December 21, 2016; information from the cancer registry of Saint-Petersburg and the data bank of children with diabetes. Statistical analysis was carried out using methods of variation statistics (Pearson criterion, angular transformation criterion). Results. The absolute number of disabled children in the city increased by 2 thousand people over the 10 years of research. It was identified the disagreements between medical and social services on the age groups formation, multiple repeated examinations, the impact of perinatal factors on the disability structure in the group of deeply premature babies.
The positive dynamics of the relative prevalence rates per 10,000 children is associated with the birth rate. Conclusion.This research was conducted be the initiative group in response to the increase of childhood disability. The children aged 0-4 years were chosen as a result of multi-factorial risks and disability. These trends prevail not only in the Russian Federation and this article is relevant to other countries. The article focuses on dynamics of the level and structure of disability during 2008-2017. The research materials are reports from child clinics and city level expert on medico-social issues. The changes of disability structure throughout this period were found. From 2008 the total number of disabled children increased by 2000 people. In conclusion, the authors suggest to classify growing disability issues in children as a priority. Key words: younger age group, children with disabilities, changes in the structure of disability, mental illness and behavioral disorders.
USe of ASSESSMENT METHODOLOGY OF OCCUPATIONAL RISK AND HACCP Principles IN DEVELOPMENT OF OPERATIONAL CONTROL PROGRAM AT LARGE INDUSTRIAL ENTERPRISE
I.G.Eliovich 1,2 , A.V. Meltser 2
¹ Territorial St. Petersburg and Leningrad Region Health Workers Union of the Russian Federation, Russia, 190098, Saint-Petersburg, Truda sq., 4, room 503 2 North-Western State Medical University named after I.I Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya str.,41 Abstract. Introduction.There are no studies on the planning of methodological approaches for the development of operational control programs using the methodology for assessing occupational risk and the quality system principles to reasonable selection of critical control points for research and measurement of working environment factors, the development of operational control programs at industrial enterprises depending on the type of economic activity. The aim of the study was to justify the principles for the development of operational control programs for large refinery using the system of critical control points and risk assessment methodology. Materials and methods. The study was conducted at a large refinery in the Leningrad Region - Limited Liability Company “Production Association“Kirishinefteorgsintez ”(LLC“ PA “KINEF”) with more than 6,000 employees. When calculating a priori occupational risk, it was used the methodology presented in the “Methodological recommendations for justifying the risk to the employees’ health depending on indicators of working conditions” (A.V. Meltser, A.V. Kiselev. - St. Petersburg: RNII "Electronstandart", 1999.– 34 p.). Results. According to the study results, it was recommended to add the list of the controlled substances from 24 to 36 in all critical control points, to reduce the frequency of studies in 172 control points (the main manufacturing are workshops No. 1-5), and to maintain the existing frequency of studies at 66 control points (welding stations and repair units), increase the frequency of research in 13 control points (research center, main production of workshop No. 9). The development of the operational control programs of working conditions based on the results of laboratory monitoring of the working environment factors and the working process based on critical control points, the justification of which was carried out using the methodology for assessing occupational risk, allows to increase the preventive focus and economic effect from the planned laboratory and instrumental studies by eliminating uninformative, but at the same time resource-consuming studies and apply mechanism for managing the risk to the health of employees. Key words: priori risk, a posteriori occupational risk, operating control program, quality system, critical control points, employees of the fuel and petrochemical complex
CLINICAL MEDICINE
CHRONIC GASTRITIS IN CHILDREN WITH CELIAC DISEASE
V.P.Novikova1,2, N.S Shapovalova1, S.V. Lapin2, E.Yu. Kalinina3, M.O.Revnova1, S.V.Azanchevskaya3, E.A.Dementieva 1,K.A. Klikunova 1 1Saint-Petersburg State Pediatric Medical University, Russia, 194100,Saint Petersburg, Litovskay str., 2 2Pavlov First Saint- Petersburg State Medical University, Russia, 197022, Saint Petersburg, Leo Tolstoy str., 6-8. 3City Hospital of St. George the Great Martyr, Russia, 194354, Saint- Petersburg, Northern Avenue 1. Abstract Introduction:According to morphological data chronic gastritis in patients with celiac disease is observed in 80 -96% of cases, but morphological and immunological features are still unstudied. The aim of the study was to study the features of chronic gastritis in children with celiac disease. Materials and methods: It were examined 176 children with chronic gastritis. The first group comprises 58 children with chronic gastritis and newly diagnosed celiac disease, who didn’t follow a gluten-free diet, the second group comprises 49 children with chronic gastritis and celiac disease, who was on gluten-free diet. The comparison group (third group) comprises 69 children with chronic gastritis and without celiac disease. All patients underwent a morphological analysis of biopsy specimens of the gastric and duodenal mucosa, serological examination: determination of tissue transglutaminase antibodies (tTG), deamidated gliadin peptides. Anti-parietal cell antibodies (APCA) were also determined: in 140 children to antibodies to Castle’s intrinsic factor and in 58 to H + / K + ATPase of parietal cells were determined by ELISA; in 45 children the determination of antiparietal antibodies PCA IgG was carried out by indirect immunofluorescence test (iIFR). Results: According to a morphological study, the pathological process in the mucous membrane of the body of stomach prevails in the first and second groups with celiac disease, and antral gastritis was observed in the third group. The atrophy was found out in the gastric mucosa without a statistically significant difference in the groups, and stromal fibrosis was observed in the third group. The number of parietal cells wasn’t statistically different in the examined patients. Dystrophic morphometric changes were typical for patients with celiac disease, mainly in the first group. The frequency of detection of an increased level of antiparietal cell autoantibodies in the studied groups was different. PCA IgG(iIFR) was found only in the first group, which is statistically significant in comparison with the second and the third groups. In the second group weren’t found autoantibodies, which is statistically significant in comparison with the second and the third groups for antibodies to H + / K + ATPase and PCA, and not significant for Castle’s intrinsic factor antibodies. Analysis didn’t reveal a correlation between the level of antibodies to tTG and the level of APCA in the first group. Conclusion: According to the iIFR the preatrophic stage of autoimmune type gastritis was oftener (10%) diagnosed in children with celiac disease than in chronic gastritis without celiac disease. Keywords: children, celiac disease, gastritis, autoimmune gastritis, antiparietal autoantibodies, antibodies to tissue transglutaminase
TACTICAL APPROACHES IN SIMULTANEOUS ATHEROSCLEROTIC LESION OF CORONARY AND CAROTID ARTERIES
N.I.Glushkov, M.A. Ivanov, A.A. Zagorulko, Y.A.Blaidel, K.D. Khokhlova, P.D. Puzdriak, D.A.Yakovlev, A.S. Artemova, North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya st., 41 Abstract. Introduction. Currently, tactics for the combined lesions of the carotid and coronary territory are not determined. The aimof the study was to evaluate the impact of tactical approaches in patients with coronary and cerebrovascular disease on the development of postoperative complications. Materials and methods. It was examined 107 patients with critical carotid stenosis and coronary arterial disease dividing into 3 groups: 61 patients underwent carotid endarterectomy, 28 patients underwent coronary artery bypass surgery, and 18 patients underwent simultaneous revascularization of both arterial territories during one hospitalization. The number of complications in the early postoperative period was considered. Univariate and multivariate analysis was performed to determine the indications for the simultaneous revascularization of coronary and carotid lesion. Results. According to the study results, it was proposed an algorithm for selecting individual tactical approaches in the discussed patients’ cohort. Simultaneous surgical interventions are characterized by a minimal number of complications; they are shown in the normal course of the coronary arterial disease and the absence of an increased risk of carotid endarterectomy.
Conclusion. For step-by-step operations, the off-pump technique has certain advantages. Consistently performed carotid endarterectomy and coronary artery bypass surgery reduces the risk of perioperative stroke and does not increase the total number of dangerous outcomes. Keywords: carotid stenosis, coronary arterial disease, staged reconstructions
MODERN APPROACHES TO THE PREDICTION AND PREVENTION OF NON-SPECIFIC COMPLICATIONS OF INFECTIOUS HEMOCOLITES IN CHILDREN
O.I. Klimova1, N.V. Gonchar1,2, N.V. Skripchenko1,3, Yu.V. Lobzin1,2, S.G. Grigor`ev1 1Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, 197022, Saint -Peterburg, Professora Popova street, 9 2North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia, 195015, Saint-Petersburg, Kirochnaya Street, 41. 3St. Petersburg state medical pediatric University, Saint-Petersburg, Russia, 194100, Saint-Peterburg, Litovskaya street,2 Abstract Introduction. Non-specific complications of infectious hemocolitis in children increase the duration of treatment and its cost. A modern approach to prevent the complications of infectious hemocolitis is their prediction. The aim of the study is to develop a multiple-factor mathematical and statistical model of the individual prediction of development of non-specific complications of infectious hemocolitis in children. Materials and methods. It was examined 57 children aged from 3 months up to 16 years with infectious hemocolitis, considering the development of non-specific complications. The method of discriminant analysis was used to individually predict the development of non-specific complications of infectious hemocolitis in children. Results. Within the study the patients were divided into two groups: without complications (n = 46; 80.7%) and with complications (n = 11; 19.3%). An informative prediction model was created (p <0.0001), including anamnesis of illness and current living conditions, severity of intestinal infection according to the Clarke index, hemogram features, and alanine aminotransferase level in blood serum. Conclusion. Prediction of the development of non-specific complications of infectious hemocolitis is aimed at improving the outcomes in children. Key words: acute intestinal infections, bacterial hemocolitis, children, prognosis, non-specific complications.
ASSOCIATION OF TUMOR NECROSIS FACTOR -ALPHA AND INTERLEUKIN-10 WITH THE PRESENCE OF CAROTID ATHEROSCLEROSIS IN PATIENTS WITH ESSENTIAL HYPERTENSION
A.K. Baatyrbekova1, T.B. Zalova2, A.K.Turusbekova1, N.S.Satieva1, A.G.Polupanov1, T.A. Romanova 1 1National Center of cardiology and Internal Medicine, Bishkek, Kyrgyz Republic, 720040, Togolok Moldo street,3 2Kyrgyz Russian Slavic University, Bishkek, Kyrgyz Republic, 720000, Kievskaya street, 44 Abstract Introduction:Currently, atherosclerosis is considered as a chronic progressive disease based on subclinical inflammation of the vessel wall. However, the study results on the correlation between the concentrations of pro- and anti-inflammatory cytokines with the atherosclerosis development of different localization are rather controversial. The aim of the study wasto analyze the association of tumor necrosis factor-alpha and interleukin-10 concentrations with the presence of carotid atherosclerosis in patients with essential hypertension. Material and methods: It were examined 156 patients with essential hypertension aged 40 -75 years (mean age-55.8 ± 7.5 years), including 57 female patients and 99 male patients divided into 2 groups: the first group comprises 39 patients without atherosclerotic lesions of the carotid arteries, the second group comprises 115 patients with atherosclerotic lesions of the carotid arteries. All patients underwent clinical studies, measurement of blood biochemical parameters, instrumental examinations, determination of the concentration of tumor necrosis factor-alpha and interleukin-10 serum. Results: In patients with essential hypertension and atherosclerotic lesions of the carotid arteries, the concentration of tumor necrosis factor-alpha and interleukin-10 was not significantly different from the values of similar indicators in patients without carotid atherosclerosis (p> 0.05). At the same time, it was observed a correlation between the concentration of interleukin-10 and the severity of carotid atherosclerosis. Conclusions: A correlation between the concentrations of interleukin-10 with the severity of carotid atherosclerosis in patients with essential hypertension was revealed. Key words: tumor necrosis factor-alpha, interleukin-10, atherosclerosis, essential hypertension.
SURGICAL TREATMENT OF LONG HEAD OF THE BICEPS TENDON INSTABILITY
O.A. Danilenko1, E.R. Makarevich2, S.A. Linnik3 1Minsk City Clinical Hospital No. 6, Republic of Belarus, 220037, Minsk, Ural street, 5. 2Belarusian State Medical University, Republic of Belarus, 220116, Minsk, Dzerzhinsky Ave, 83. 3North-West State Medical University named after II. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41. Abstract: Introduction: Pain in the anterior part of the shoulder is one of the most common reasons to make an appointment at orthopedic surgeon. Aim of the studywas toimprove the treatment results of patients with long head of the biceps tendon instability as an element of the rotary-bicipital complex using differentiated therapeutic tactics developed by the authors. Materials and methods. Within the study were analyzed the treatment results of 66 patients with long head of the biceps tendon instability undergone treatment during 2004-2017. Patients were divided into 5 groups depending on the type of long head of the biceps tendon instability according to Bennet classification (2003). The aim was to develop tactical approaches for treatment the patients due to the level of rotatory-bicipital complex damages for various types of long head of the biceps tendon instability. For treatment of 1 and 2 groups of patients was assigned a conservative treatment. Patients of 3, 4, 5 groups were recommended surgical treatment using arthroscopy and methods developed by the authors. Results.According to Rowe score were observed 40 cases of excellent outcomes (60,6%), 11 (16,7%) good, 11 (16,7%) satisfactory and 4 (6,1%) unsatisfactory from treatment. The result of evaluation is presented in the form of median [Q25; Q75] comprising before treatment 55 [15; 75], and after - 90 [75; 100]. Conclusions.With the use of tactical approaches and methods developed by the authors it was possible to improve objective indicators of joint function and subjective sensations of patients. Key words: biceps instability, biceps injury, biceps dislocation, rotator cuff of the shoulder.
USE OF SPACER TO TREAT THE LATE PERIPROSTHETIC INFECTION OF HIP JOINT
S.A. Linnik1, G.E. Kvinikadze1, D.V. Kravcov1, G.E. Afinogenov2, A.G. Afinogenova2,3, A.A. Spiridonova3, I.O. Kucheev4, P.P. Romashov1, D.A. Sabaev1 1 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya str., 41 2Saint-Petersburg State University, Russia,199034, Saint-Petersburg, Universitetskaya Embankment, 7–9 3 Saint-Petersburg Pasteur Institute, Russia,197101, Saint-Petersburg, Mira str., 14. 4 Saint-Petersburg city Hospital for War Veterans, Russia, 193079, Saint-Petersburg, Narodnaya str., 21/2.
Abstract: Introduction. Deep periprosthetic infection of the hip joint comprises 0.3-2.22%. The treatment of the periprosthetic infection of the hip joint includes two stages: the first one is a sanitizing operation with a spacer implantation; the second one is a re-endoprosthetic replacement. The aim of the study was to analyze the treatment outcomes in patients with deep periprosthetic infection of the hip joint to choice a spacer when performing a sanitizing operation (the first stage of re-endoprosthesis replacement). Materials and methods. It was performed an analysis of the treatment outcomes in 78 patients with deep periprosthetic infection of the hip joint. After the sanitizing operation and the type of the used spacer the patients were divided into two groups. Results. The immediate (100%) and long-term (78%) treatment results were studied using the Harris hip scores and WHO assessment of quality of life. Conclusion. The use of the developed total hip spacers including the antimicrobial composition with a prolonged action, allows to obtain a disease remission, reduces the treatment period and achieve positive outcomes in 88.5% of cases. Key words: periprosthetic infection, hip joint, spacer.
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