Vol 26, No 6 (2020)

Cover Page

Full Issue

Health care organization and public health

Occupational burnout of healthcare workers: personal deadaptation or system failure in management?

Karsanov A.M., Remizov O.V., Goluchov G.N., Polunina N.V.


The article presents modern data on definitive characteristics, causes of occurrence, phases of development, principles of a systematic approach to prevention, and methods to overcome such a complex concept as occupational burnout of healthcare workers. Occupational burnout has serious negative consequences for not only the health of the health workers themselves but also the effective functioning of the entire healthcare system. In this regard, some discrepancies in the conjugation of internal and external stimulants are considered to improve the efficiency of the work of medical personnel. Lessons learned from the coronavirus 2019 pandemic as a factor of healthcare system overloading and triggering occupational burnout necessitate creation of a multi-stage, systemic mechanism to protect our colleagues as well as patients from the consequences of occupational burnout.

Medical Journal of the Russian Federation. 2020;26(6):334-340
pages 334-340 views

Clinical medicine

Stratification of the risk of postoperative complications in cardiovascular surgery

Kazantsev A.N., Chernykh K.P., Chernyavsky M.A., Zarkua N.E., Shukurov I.K., Lider R.Y., Kubachev K.G., Bagdavadze G.S., Kalinin E.Y., Zaitseva T.E., Chikin A.E., Linets Y.P.


The paper presents a mathematical model function to demonstrate the effectiveness of a new method of preoperative risk stratification of adverse cardiovascular events in patients with atherosclerotic lesions of the coronary and internal carotid arteries. The possibility of choosing the revascularization approach based on the interactive calculation of the mathematical probability of the occurrence of a complication was demonstrated. Conclusions about the effectiveness of the method developed were made.

Medical Journal of the Russian Federation. 2020;26(6):341-350
pages 341-350 views

Difficulties of preventing cardiotoxicity in patients with lymphomas and those receiving anthracyclines treatment

Kulieva A.A., Emelina E.I., Gendlin G.E., Nikitin I.G., Baryakh E.A., Misyurina E.N.


Background. The percentage of short-term and long-term consequences of chemoradiation therapy and their detection increases with the increase in the survival cancer patient rate. Currently, enalapril, carvedilol, and low-dose statins are recognized as drugs that prevent cardiotoxicity from chemoradiation therapy.

The work aimed to study the cardioprotective treatment tolerability in patients with lymphomas receiving chemotherapeutic treatment with the inclusion of anthracycline antibiotics.

Materials and methods. We examined 47 patients with Hodgkin’s and non-Hodgkin’s lymphomas, who received treatment with chemotherapeutic agents, including anthracycline antibiotics (doxorubicin and epirubicin). Study inclusion criteria were anthracycline antibiotic use in specific treatment regimens for the underlying lymphoproliferative disease and signed informed consent. At the start of treatment and after the first cycles of chemotherapy, the indicators of electrocardiography, echocardiography, and blood pressure measurements at home with constant monitoring were assessed. And then, the general condition of the patients, the tolerability of the main and preventive treatments, and adherence to therapy were studied during the preventive treatment with carvedilol and/or enalapril.

Results. Drug titration was difficult because of poor tolerability, asthenia increase, and low blood pressure, and in some cases, it led to self-withdrawal of drugs.

The heart rate during preventive treatment decreased in both groups of patients, but it was statistically insignificant and did not reach the target values. This result was due to the rapid decrease in systolic blood pressure, which prevented the titration of enalapril and carvedilol to the target dosages.

Conclusion. Adherence to preventive therapy throughout chemotherapy remained low. When assessing the tolerability of enalapril and carvedilol at the initial stages of titration, there were difficulties because of the rapid decrease in blood pressure before reaching the target heart rate values.

Medical Journal of the Russian Federation. 2020;26(6):351-358
pages 351-358 views

Experiences of testing immunoglobulins to the SARS-CoV-2 virus in outpatient practice

Minushkina L.O., Grigorieva E.V., Mukhareva A.D., Kuleshova S.V.


The study aimed to analyze the results of testing the presence of immunoglobulins of severe acute respiratory syndrome coronavirus 2 infection in outpatient clinical practice. The data of all tests of immunoglobulins G and M performed in the laboratory of Polyclinic No. 2 of the Administrative Department of the President of the Russian Federation from June 5 to October 2, 2020, were analyzed. In total, the studies were conducted in 784 applicants (319 [40.7%] men and 465 [59.3%] women), with the average age of 48.46±14.044 years (18 to 89 years). Of patients, 317 were clinically diagnosed with a new coronavirus infection, 64 were examined as having contacted the infected, 83 had bronchopulmonary diseases, and 320 were healthy individuals. A positive test result for the presence of IgG antibodies was obtained in 87.7% of patients with a new coronavirus infection. Of cases, 96.3% had a typical X-ray presentation of viral pneumonia that was confirmed by the polymerase chain reaction method, and also, 5% of cases in the healthy group. The data obtained enabled us to establish high sensitivity of the test systems used.

Medical Journal of the Russian Federation. 2020;26(6):359-363
pages 359-363 views

Laparoscopic cruroraphia and alloloplasty for hiatal hernia of various sizes

Rozenfeld I.I.


The article presents the generalized results of the use of various surgical techniques to remove hiatal hernias of various sizes using posterior cruroraphia, “onlay” alloplasty with a polypropylene implant, and alloplasty with a biocarbon two-layer implant. The results of an experimental randomized retrospective study are presented.

Medical Journal of the Russian Federation. 2020;26(6):364-368
pages 364-368 views

Application of vortioxetine in outpatients with endogenous depression

Krylatykh V.Y.


The study aimed to evaluate the clinical action, safety, and tolerability of vortioxetine in outpatients with depressive conditions.

Material and methods. An open comparative study of patients with various nosological forms of endogenous depressive conditions (depressive episodes, recurrent depressive disorder, and bipolar affective disorder) was conducted. The course of therapy with vortioxetine in a daily dose of 10–20 mg lasted 42 days. Methods of clinical and psychometric evaluation of the results were used as well as correlation analysis using Spearman’s coefficient. The severity and degree of reduction in depressive and anxiety symptoms were recorded using the Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Clinical Global Impression–Disease Severity Scale (CGI-S). To assess the severity of adverse side effects, the side effects rating scale (UKU) was used.

Results. Vortioxetine has been found to be an effective antidepressant. At the end of therapy, a reduction in the mean total score on the HAM-D scale by more than 50% was registered in 92.2% of patients. Furthermore, 76.3% of patients had a therapeutic effect with a reduction in the mean total scores of the HAM-D scale by more than 80%. The reduction in mean scores on the HAM-A scale by day 28 reached 87.25%. According to the CGI-S scale values, 68.4% of patients completed the course of therapy with complete remission. Significant direct correlations were found between the daily drug dose and disease duration and the initial depressive symptom severity. A correlation between the anxiety level and vortioxetine dose was observed in all stages of therapy. The depression level on days 7 and 21 correlated with the dose size, starting from week 3. The adverse event severity detected in most cases ranged from mild to moderate.

Conclusion. Thymoanaleptic and anxiolytic activities provide vortioxetine with efficacy in various nosological forms of endogenous depression. For conditions with a longer duration and severity of the disease, a higher dosage of vortioxetine (20 mg/day) is required. During therapy, vortioxetine has demonstrated a favorable safety and tolerability profile; therefore, it can be used in an outpatient basis.

Medical Journal of the Russian Federation. 2020;26(6):369-377
pages 369-377 views

Clinical pharmacology and pharmaceuticals

Information service “Database OF Clinical Trials of Pharmaceutical Products” in rational use of hepatoprotectors in preferential pharmaceutical provision

Eliseeva E.V., Maneeva E.S., Gribova V.V., Okun D.B.


The problem of rational hepatoprotector use in patients in the system of preferential pharmaceutical provision has become significantly relevant recently because of the increase in hepatobiliary system diseases, namely, hepatitis, nonalcoholic fatty liver disease, and cirrhotic lesions. Appropriate pharmacotherapy with this drug class can be prescribed only when healthcare professionals receive evidence-based information obtained from medical electronic databases. The work aimed to fill the information service “Database of Clinical Trials of Pharmaceutical Products” with the results of randomized clinical trials, systematic reviews, and meta-analysis for the most frequently purchased and prescribed drugs from the hepatoprotector group (phospholipids + glycyrrhizinic acid and ademetionine) in the preferential segment, as well as the development of recommendations for the rational use of these drugs. The study used official data of the state portals “State Register of Pharmaceutical Products” (www.grls.rosminzdrav.ru) and “Unified Information System in Procurement” (http://zakupki.gov.ru) on medicinal products with hepatoprotective action, namely, phospholipids in combination with glycyrrhizinic acid and ademetionine, which were purchased for the “Program for the provision of necessary drugs to certain categories of citizens” in 2014–2020. The study results were searched in MEDLINE (PubMed) websites (https://www.ncbi.nlm.nih.gov/pubmed/), EMBASE (https://www.elsevier.com/), COCHRANE (https://www.cochrane.org/), eLibrary, and CyberLeninka (https://cyberleninka.ru/). The data obtained were entered into the information service “Database of Clinical Trials of Pharmaceutical Products,” which is based on the ontological principle. It was developed by the specialists from the Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences. The effectiveness of the hepatoprotectors being studied in relation to “surrogate” endpoints in the form of a significant reduction in clinical symptoms, improvement in biochemical parameters, and decrease in viral load in liver pathology limits their use and inclusion in the lists for preferential provision. The presented information resource and recommendations developed by the authors can be used for the rational prescription of hepatoprotectors.

Medical Journal of the Russian Federation. 2020;26(6):378-385
pages 378-385 views

Influence of ABCB1 gene polymorphism on rivaroxaban pharmacokinetics

Kazakov R.E., Rodina T.A., Melnikov E.S., Danko A.A., Muslimova O.V., Demchenkova E.Y., Checha O.A., Mazerkina I.A., Belkov S.A., Prokofev A.B.


This article presents the comparison of the pharmacogenetic and pharmacokinetic testing results in patients with atrial fibrillation taking rivaroxaban. The role of ABCB1 gene polymorphism in the variability of the pharmacological response was assessed, and the possibility of personalized treatment using therapeutic drug monitoring was discussed.

Medical Journal of the Russian Federation. 2020;26(6):386-393
pages 386-393 views

Clinical application of interferon gamma in comprehensive therapy of patients with coronavirus infection

Myasnikov A.L., Berns S.A., Ershov F.I.


Background. The problem of effective therapy of coronavirus disease 2019 (COVID-19) at the hospital stage requires urgent resolution. Studies on the role of interferons in the immune response finding showed that interferon gamma is a potent endogenous regulatory cytokine that activates an antiviral immune response while simultaneously exerting its intrinsic antiviral activity, which promises new horizons for effective therapeutic care of patients with COVID-19.

The present study aimed to evaluate the efficacy and safety of complex therapy using interferon gamma 500,000 IU when administered subcutaneously to patients with viral pneumonia.

Material and methods. This prospective, open-labeled, randomized-controlled, single-center, investigator-initiated study included patients aged >18 years with mild COVID-19. The study agent interferon gamma was prescribed for therapeutic purposes at a dose of 500,000 IU subcutaneously once daily for 5 days.

Results. A superior efficacy of therapy with the study agent was noted. A statistically significant difference was observed with reference to the World Health Organization scale for Clinical Improvement when assessed 14 days after the therapy (p=0.024), with a higher patient survival rate (p=0.039). A comparative analysis of the changes showed a statistically significant difference between the groups with respect to the change in the levels of laboratory parameters of lactate dehydrogenase and C-reactive protein, which reflected the degree of damage and inflammation of the lung tissues.

Discussion. Past studies demonstrated the therapeutic efficacy of interferon gamma for coronavirus infection and community-acquired pneumonia. The present clinical experience confirms the past data on the positive effect of interferon gamma on the rate of clinical stabilization and recovery of patients.

Conclusion. Interferon gamma can be recommended for medical use in the complex therapy of patients with moderate COVID-19.

Medical Journal of the Russian Federation. 2020;26(6):394-401
pages 394-401 views

Efficiency and safety of direct oral anticoagulants in onco-associated venous thromboembolic complications: meta-analysis

Petrov V.I., Akinchits A.N., Shatalova O.V., Gorbatenko V.S., Gerasimenko A.S.


The work aimed to analyze the efficiency and safety of direct oral anticoagulants in treating onco-associated venous thromboembolic complications.

Materials and methods. A meta-analysis of randomized controlled trials was performed in accordance with the guidelines “Preferred reporting parameters for systematic reviews and meta-analyses.”

Results. Data from four randomized controlled trials were used to perform the meta-analysis. Direct oral anticoagulants reduce the relative risk of recurrent venous thromboembolic complications compared with dalteparin by 38% (relative ratio [RR]=0.62; 95% confidence interval [CI] [0.43–0.91]; p=0.01) and reduce statistically significantly the risk of deep vein thrombosis by 40% (RR=0.60; 95% CI [0.40–0.90]; p=0.01). In the effectiveness of prevention of repeated pulmonary embolism, the compared technologies are comparable (RR=0.89; 95% CI [0.52–1.51]; p=0.66). A safety meta-analysis suggests that direct oral anticoagulants are comparable in safety compared with dalteparin, in terms of major bleeding incidences (RR=1.33; 95% CI [0.84–2.11]; p=0.23) and in relation to gastrointestinal bleeding development (RR=1.91; 95% CI [0.96–3.82]; p=0.07). Direct oral anticoagulants increased the incidence of clinically significant minor bleeding (RR=1.58; 95% CI [1.11–2.24]; p=0.01).

Medical Journal of the Russian Federation. 2020;26(6):402-411
pages 402-411 views


Etiology of enterococcal bacteria: literature review and own data

Gabrielyan N.I., Kormilitsina V.G., Drabkina I.V., Saitgareev R.S., Zakharevich V.M., Kisil O.V., Maleev V.V.


The relevance of the work is due to the worldwide increase in the number of hospital bloodstream infections associated with bacteria of the genus Enterococcus spp. The ability to acquire and distribute antibiotic resistance determinants contributed to the transformation of enterococci from opportunistic pathogens to a significant problem in medical institutions.

This review aimed to analyze the materials published in 2015–2020 on epidemiological risk factors for enterococcal bacteremia and microbial enterococci resistance. The clinical difference between Enterococcus faecalis and Enterococcus faecium was discussed as well as the virulence factors and antibiotic tolerance of enterococci. The study presented own data on enterococcal bacteremia in the early period in vital organs in recipients.

Medical Journal of the Russian Federation. 2020;26(6):412-420
pages 412-420 views

Essential criteria for assessing the quality of cancer care: international experience

Andreev D.A., Zavyalov A.A., Kashurnikov A.Y., Dobrodeev A.Y.


Background. To retain guarantees for the provision of quality medical services in oncology, optimal tools of the system for monitoring medical activities are required to be further introduced in real practice. Analysis of the results of the selection of the most valid criteria for assessing the quality of medical activity is of significant scientific interest and contributes to the improvement of the organization of medical care.

The work aimed to review the international literature on the identification of control criteria for the quality of cancer care.

Materials and methods. The international experience is analyzed based on reliable sources of information obtained through the application of queries on the topic under study in the PubMed (Medline) database and Google search engine. Additional key phrases were used as and when required. About 45 of the most relevant information sources were selected.

Results. Various criteria for the quality and safety of medical activity in oncology are presented. Some general (universal) criteria for assessing the quality of medical activity, specific to individual nosologies, have been identified. The advanced international experience in the classification and identification of key quality criteria used in oncology in patients with the most frequently diagnosed cancer types in Russia has been generalized. The standardization and validation of new quality assessment criteria are priorities for subsequent scientific development.

Discussion and conclusions. During standardization, there has been a tendency to determine comprehensive parametric criteria for assessing quality and covering the entire scope of interdisciplinary medical care. To further improve the scientific and methodological support of control, it is advisable to develop medical methodologies for conducting clinical audits for various types of malignant neoplasms (ICD10: S00–96), considering specific indicators and requirements of regional healthcare system. The selection of the optimal, most valid, and informative indicators of the quality of medical activity and the establishment of digital standards for the quality of services are becoming an integral aspect of the general processes of improving clinical audit tools in oncological institutions.

Medical Journal of the Russian Federation. 2020;26(6):421-430
pages 421-430 views

Classification criteria for primary diagnosis of chronic suppurative otitis media

Dubinets I.D.


The work aimed to analyze the available literature in the international and Russian databases to identify the classification criteria for determining the timing of the primary diagnosis of chronic suppurative otitis media.

Materials and methods. A review of the literature on the diagnostic criteria of chronic suppurative otitis media, pathomorphological mechanisms of osteolysis, and factors predicting the chronicity were emphasized, as well as aggressiveness and recurrence of the inflammatory process of the mucous membrane of the middle ear cavity and bone tissue of the petrous pyramid. Based on the literature analyzed, the transition time from acute state to chronic mucous membrane inflammation of the middle ear cavity and persistent perforation formation of the tympanic membrane has not yet been documented, and therefore, the timing of the operation, as a favorable outcome for recovery, is delayed.

Results. An analysis of the literature showed that to date, enough classifications, or rather, groups of chronic diseases of the middle ear and its consequences have been published, which indicates the imperfection of the classification criteria for diagnosing chronic suppurative otitis media. Severe pathological changes in the mucous membrane of the middle ear cavities, with purulent fusion, replacement with granulation tissue, and transition of inflammation to the underlying bone tissue with the development of irreversible morphological processes of the temporal bone structures by the type of osteonecrosis, osteoproliferation, and osteosclerosis, which determines the course of chronic purulent otitis media, its outcome, and the risk of complications.

Conclusion. Through a combination of the results of literature reviews on the study of clinical experience data from international and Russian specialists, we present the definition of chronic suppurative otitis media as a chronic disease of the middle ear cavity with the formation of a persistent perforation or retraction pockets of the tympanic membrane for a period of 1 month after an episode of acute otitis media with radiographic-tomographic confirmation of latent otoantritis/mastoiditis. Consequently, the diagnosis established enables us to regulate the approach of managing a patient with chronic suppurative otitis media.

Medical Journal of the Russian Federation. 2020;26(6):431-438
pages 431-438 views

Practice case

Combination of the spinal hernia, sprengel’s deformity, and situs viscerum inversus

Ivanov S.V., Zharkov D.S.


Background. The combination of Sprengel’s deformity with various types of spinal hernias and internal organ development anomalies, such as situs viscerum inversus (inverse or mirror location of internal organs), is a rare case. The etiology of these malformations is unknown, but their combination may suggest a common pathogenesis and cause.

The work aimed to review the literature and describe a clinical case of a patient with multiple malformations of the spine and spinal cord along with unilateral Sprengel’s deformity and situs viscerum inversus.

Materials and methods. A 4-year-old patient was diagnosed with myelomeningoradiculocele of the lumbosacral spine, malformation of the spine by the segmentation impairment type of C7–Th1, Th1–Th2, and Th2–Th3 vertebrae, non-closure of the arches of the С5–Т2 and Т12–S5 vertebrae, S-shaped congenital scoliosis, condition after surgical removal of myelomeningocele of the lumbosacral spine, concrescence and hypoplasia of ribs 1, 2, and 3 on the right, severe right-sided Sprengel’s deformity, and situs viscerum inversus.

Conclusions. The case description of concomitant malformations contributes to clinical material accumulation and further research in determining the factors of etiopathogenesis. Understanding the processes of pathoembryogenesis in combined malformations of the musculoskeletal system allows early suspicion and identification of latent deformities.

Medical Journal of the Russian Federation. 2020;26(6):439-445
pages 439-445 views

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