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Vol 27, No 3 (2021)

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Health care organization and public health

Occupational burnout of doctors: characteristics of generations

Kobyakova O.S., Levko A.N., Bakhteeva A.V., Chernov D.Y., Malkova A.A., Chigrina V.P., Tyufilin D.S., Kulikov E.S.


BACKGROUND: Medical care quality improvement is one of the relevant aspects of healthcare development in the Russian Federation. However, healthcare workers are susceptible to occupational burnout syndrome due to the nature of their activities, which prevents care quality improvement. The literature indicated that the level of professional burnout varies among the representatives of different generations.

AIM: This study aimed to compare the level of occupational burnout, the factors of its development, and the relationship with labor parameters among doctors of different generations in the Tomsk region.

MATERIALS AND METHODS: The study used the Maslach Burnout Inventory (MBI) questionnaire as well as several additional questions.

RESULTS: The study involved 1669 physicians representing all generations. Due to the small number of individual generation representatives, they were distributed into three main groups: generation 3 represented by millennials and generation Z (n = 630), generation 2 included generation X (n = 783), and generation 1 included silent generation and boomers (n = 256). Doctors of generation 1 have the lowest workload. Generation 3 representatives have, on average, a higher level of depersonalization and reduction in professional achievements. Generation 2 doctors showed the highest level of emotional exhaustion compared to other generations. The lowest scores for all subscales of the MBI questionnaire were registered among the generation 1 doctors. Significant factors in the development of professional burnout in the younger generation include workplace dissatisfaction, lack of sleep, and the rare use of whole annual leave, which was most common in generation 3.

CONCLUSIONS: Based on the study results, we can conclude that measures to prevent professional burnout should be separately selected for each generation.

Medical Journal of the Russian Federation. 2021;27(3):205-216
pages 205-216 views

Epidemiology of macular holes in the Republic of Bashkortostan (according to the Ural Eye and Medical Study)

Bikbov M.M., Zinnatullin A.A., Gilmanshin T.R., Zainullin R.M.


BACKGROUND: Macular holes are among the common causes of irreversible visual impairment. At an early stage macular holes may be asymptomatic which is a pressing problem in the diagnosis of this pathology.

AIM: This work analyzes the prevalence of non-full-thickness and full-thickness macular holes in the population of the Republic of Bashkortostan, depending on the age, gender, and nature of the respondent’s settlement.

MATERIALS AND METHODS: The Ural Eye and Medical Study was conducted and included 5899 people.

RESULTS: In the study population, macular holes were detected in 64 patients (1.1%, 71 eyes), including non-full-thickness macular holes revealed in 46 (0.8%) cases, and full-thickness macular holes found in 18 (0.3%) cases. The average age of patients with macular holes was 67.80±9.34 years, which significantly exceeded the average age of individuals in the study population (59.0±10.7 years; p <0.001). The incidence of macular holes among women was 1.35%, and that of men was 0.81%. In contrast, it was 0.96% among urban residents and 1.34% among rural residents. In the patient population with macular holes, and especially in the subpopulation with non-full-thickness macular holes, a significant predominance of this pathology was registered in female patients and urban residents.

CONCLUSIONS: The incidence of macular holes in the Republic of Bashkortostan was 1.1%, in line with the average global level. Non-full-thickness macular hole predominance among urban residents in the absence of a significant difference in gender characteristics and the prevalence of full-thickness macular holes is a distinguishing feature in the epidemiology of macular holes for the region under study.

Medical Journal of the Russian Federation. 2021;27(3):217-225
pages 217-225 views

Evaluation of the efficiency of preventive examinations of the adult population, aimed at early tuberculosis diagnosis

Rubis L.V., Markelov Y.M.


BACKGROUND: In Russia, compared with other countries, at least 65% of the population must undergo an annual fluorographic examination for early tuberculosis detection.

AIM: This study aimed to assess the impact of mass fluorographic examinations of the adult population on the main epidemiological factors and indicators of prompt tuberculosis detection.

MATERIALS AND METHODS: The morbidity and mortality from tuberculosis have been analyzed along with the efficiency of its detection during preventive examinations, the proportion of destructive forms of the disease, and the 1-year mortality rate in four federal districts from 2014 to 2019.

RESULTS: For all districts, low efficiency of preventive examinations was registered (1 patient per 2,000–5,000 people examined), as well as its strong correlation with morbidity and, in case of its absence, with the coverage of examinations. The change in morbidity and mortality rates over time was independent of the mass screening volume of the adult population. The relative risk indicators of increased morbidity and mortality with a decreased number of examinations were 0.4 and 0.3, respectively. The increased coverage of the population with examinations was not accompanied by an improved indicator of detection timeliness, namely a decreased incidence of destructive forms and 1-year mortality rate. The incidence of tuberculosis is determined by socioeconomic factors, which influence the level and living conditions of the population.

CONCLUSIONS: This study established the low efficiency of mass fluorographic examinations of the population, lack of influence of coverage with examinations on the epidemiological situation, and the timeliness of tuberculosis detection.

Medical Journal of the Russian Federation. 2021;27(3):227-235
pages 227-235 views

Clinical medicine

Laboratory markers of toxoplasmosis in heart recipients

Abbazova E.V., Goncharov D.B., Domonova E.A., Silveystrova O.Y., Kovaleva V.A., Titova I.V., Zakharevich V.M., Kormilitsyna V.G., Muminov I.I., Koloskova N.N., Khalilulin T.A., Gabrielyan N.I.


BACKGROUND. The number of organ transplantation surgeries is growing every year, including heart transplantion. The full spectrum of infections in heart transplant recipients is not well understood. One of the infectious agents that is particularly difficult to recognize is Toxoplasma gondii (T. gondii).

AIM: This work determines the informative value of detecting laboratory markers of toxoplasmosis in patients after heart transplantation to identify active forms of invasion.

MATERIALS AND METHODS: This investigation studied 121 heart recipients (95 men and 26 women) at different times after transplantation (several days to 12 years). Markers of Toxoplasma invasion were determined in blood sera, namely antibodies of the IgG, IgM, and IgA classes to T. gondii, avidity index of IgG antibodies to T. gondii, and DNA of the pathogen.

RESULTS: In 60 patients (49.6±4.5%) after heart transplantation, markers of Toxoplasma invasion were identified. In 20 (16.5±3.6%) cases, markers of active invasion were revealed, namely IgM and IgA antibodies to T. gondii in six and 11 patients, respectively, low-grade IgG antibodies to T. gondii in three patients, and DNA of the pathogen in two cases. Based on the totality of studies, it was determined that the disease activity in 75% of cases was due to its reactivation, whereas in the other cases, it was a recent infection. Laboratory signs of toxoplasmosis reactivation occurred mainly during the first year after transplantation, which was probably associated with the intensity of immunosuppressive therapy.

CONCLUSIONS: It was revealed that the most compelling studies indicating early signs of toxoplasmosis reactivation include detection of IgA antibodies to T. gondii and DNA of the pathogen. Further joint research is required by clinicians, epidemiologists, and laboratory diagnostics specialists to study the aspects of toxoplasmosis and disease diagnostics and preventionin patients after heart transplantation.

Medical Journal of the Russian Federation. 2021;27(3):237-245
pages 237-245 views

Polyacrylamide mammary syndrome — specificity of the histological pattern of the focus before and after air-plasma treatment

Osmanov E.G., Shulutko A.M., Krylov A.Y., Gandybina E.G., Malyugina A.Y.


BACKGROUND: At the end of the twentieth century, mammary gland contour correction using polyacrylamide gel (PAAG) became widely popular. The surgical approach must be improved because of the negative consequences associated with this technique.

AIM: This study aimed to evaluate the possibilities of air-plasma technology in the treatment of long-term septic manifestations of polyacrylamide mammary syndrome as well as the prevention of its recurrence based on the analysis of histological examination findings.

MATERIALS AND METHODS: Biopsy samples of eight women aged 38 to 59 years, who had undergone gel augmentation of the mammary glands six to 20 years ago, were studied. The complex treatment included air-plasma flow in cutting coagulation modes and nitric oxide therapy. A morphological study of the focus was performed before and after exposure to the plasma flow.

RESULTS: Before treatment, chronic granulomatous inflammation and helioma were revealed in six cases; and acute phlegmonous-necrotic soft tissue inflammation in two cases. On the fifth day after combined necrectomy, single loci of the gel were visualized, the majority of which was vaporized. Chronic inflammation was less pronounced than the original histograms. During the sanitation with nitric oxide, the early appearance of foci of fibroblastic proliferation and marginal epithelialization was registered.

CONCLUSIONS: Exposure to the air-plasma flow contributes to effective sanitation of purulent focus and gel total elimination Nitric oxide therapy (NO-therapy) accelerates the development of granulation tissue.

Medical Journal of the Russian Federation. 2021;27(3):247-255
pages 247-255 views

Relationship of potential biomarkers of interstitial cystitis/painful bladder syndrome

Sholan R.F.


BACKGROUND: Biomarker identification fulfills the need for simple, accurate, and non-invasive diagnostic methods for interstitial cystitis/painful bladder syndrome (IC/PBS). The simultaneous study of cytokines and growth factors is essential for understanding the role of biomarkers.

AIM: This work determines the concentration of interleukins (IL) 6 and 8, nerve growth factor (NGF), heparin-binding epidermal growth factor (HB-EGF), and their relationship in patients with IC/PBS.

MATERIALS AND METHODS: This study examined 126 female patients with IC/PBS, with a mean age of 46.7±14.0 years. The disease duration averaged 6.0±2.8 years. The control group consisted of 20 women without IC/PBS, with a mean age of 35.3±9.7 years. The level of IL-6 and IL-8 in blood serum and urine was determined by ELISA. The NGF and HB-EGF levels were determined by ELISA using the appropriate test kits. Statistical analysis was performed using SPSS software version 15.0. The Student’s t-test and Spearman’s correlation coefficient were calculated.

RESULTS: In patients with IC/PBS, blood levels of IL-6 and IL-8 exceeded the control indicator by 65.99% (t=4.62, p=0.000) and by 67.14% (t=2.81, p=0.006), respectively, the NGF level exceeded it by 8.82% (t=0.10, p=0.920), and the HB-EGF level decreased by 30.84% (t=0.62, p=0.537). In urine, the level of IL-6 in IC/PBS was increased by 52.94% (t=7.62, p=0.000), IL-8 level was increased by 57.53% (t=2.01, p=0.049), NGF was increased by 50.44% (t=2.06, p=0.043), and HB-EGF level was increased by 56.44% (t=2.01, p=0.049). Cytokines correlated with growth factors with weakly bound in blood and urine (p >0.05). A strong, direct relationship was registered between the urine levels of NGF and HB-EGF (r=+0.987, p <0.05).

CONCLUSIONS: Correlations between IL-6 and IL-8 with NGF and HB-EGF in urine indicate an increased risk of damage to the bladder epithelium. The increase in urinary HB-EGF is a response to a significant increase in urinary NGF and may be a bladder epithelial defense mechanism.

Medical Journal of the Russian Federation. 2021;27(3):257-264
pages 257-264 views

Aspects of the formation of an individual rehabilitation program in multiple sclerosis

Kritskaya L.A., Pomnikov V.G., Sen’kina A.G.


BACKGROUND: Multiple sclerosis (MS) is a progressive nervous system disease that results in the early limitation of life activities and disability in young patients of working age (in 30% of cases, within the first two years of disease onset). Clinical symptoms in the advanced stage of the disease are very polymorphic and become sufficiently persistent and pronounced depending on the course options. The disease progresses to a disorder of the main functions and categories of vital activity, which necessitates socially protecting patients with MS. The primary rehabilitation aim of patients with MS is the maximum prolongation of their socially meaningful life and activities. The successful implementation of rehabilitation activities is determined by assessing the patient’s rehabilitation potential. The integrative concept of rehabilitation potential includes the rehabilitation potential of the body, the rehabilitation potential of the individual (an active member of microsocial groups), and the rehabilitation potential of the personality. Achievement of rehabilitation aims is based on the emotional-volitional, intellectual, and motivational rehabilitation potential of the individual.

AIM: This study aimed to demonstrate the importance of a systematic integrative approach toward all aspects of rehabilitation in MS, as well as the need to assess the rehabilitation potential in forming an individual rehabilitation program that determines the successful implementation of goals at various rehabilitation stages.

MATERIALS AND METHODS: This article analyzes more than 500 certificates of examining patients with MS at the sociomedical expertise (SME) bureau to clarify the clinical and functional criteria leading to social maladjustment. Rehabilitation potential was assessed, and its significance was established in the form of an individual rehabilitation program. All aspects of the individual rehabilitation program for patients with MS (medical, social, and psychological) were analyzed in detail.

RESULTS: The analysis of the examination certificates of patients with MS at the SME bureau and our clinical material (>500 patients) revealed that during the initial examination at the SME bureau, groups with severe disability were most often identified (groups I and II amounted to 61%). An individual rehabilitation program was developed for the disabled with MS, considering all its aspects. The rehabilitation potential assessments in patients with MS, which is only the basis and prerequisite for the formation and implementation of an individual rehabilitation program, established that the rehabilitation potential has certain characteristics due to the variants of the disease course and prognosis, opportunities for such patients to work in social groups, and their psychological attitude toward life in illness situation. As a rule, the individual rehabilitation potential in patients with MS is quite high despite the disease severity and the guarded prognosis.

CONCLUSION: A clear, coordinated system of medical, social, and professional measures of the rehabilitation process is required to achieve the maximum possible success in providing medical and social assistance to patients with MS.

Medical Journal of the Russian Federation. 2021;27(3):265-271
pages 265-271 views

Clinical pharmacology and pharmaceuticals

Vaccine safety for COVID-19 prevention

Romanov B.K., Alpatov S.P., Bogush N.V., Borozdenko D.A., Buyanova N.M., Ganshina I.V., Dibirova G.O., Dmitrieva N.B., Kalinina E.V., Kirillova A.V., Kiseleva N.M., Kukushkin G.V., Leonteva T.I., Maximov M.L., Markina E.V., Mileshina S.E., Tsitsuashvili M.D., Yurov D.E.


BACKGROUND: In 2021, the Uppsala Monitoring Center of the World Health Organization included 52 vaccines for coronavirus disease-2019 (COVID-19) prevention in the international database, VigiBase, and almost immediately, this group of medicines (drugs) took the lead in the increased rate of reported adverse reactions (ARs).

AIM: This study aimed to review the case reports of ARs from COVID-19 vaccines in the VigiBase database.

MATERIALS AND METHODS: Statistical analysis of cases that describe ARs in the international pharmacovigilance VigiBase database was performed.

RESULTS: On May 12, 2021, the VigiBase database included 26,099,906 reports that describe AR cases on drugs, including 585,744 reports of AR on vaccines for COVID-19 prevention. Serious ARs after immunization with these vaccines were registered in 31.5% of reports, including 0.9% fatal and 1.3% life-threatening. Headache (37.1% of reports), pyrexia (31.1%), chills (23.2%), and fatigue (22.7%) were most frequently recorded.

CONCLUSIONS: More data are required to confirm the association between the COVID-19 vaccines and the increased risk of ARs following their use.

Medical Journal of the Russian Federation. 2021;27(3):273-280
pages 273-280 views

Original Research Articles

Prevalence of hereditary factors in different age groups in patients with acute coronary syndrome

Brazhnik V.A., Minushkina L.O., Zubova E.A., Averkova A.O., Chumakova O.S., Koroleva O.S., Dankovtseva E.N., Evdokimova M.A., Zateyshchikov D.A.


BACKGROUND: Genetic factors are essential for the pathogenesis of coronary heart disease (CHD). This study presents the role of genetic factors in a prematurely developing disease in males under 55 years old and females under 60 years old. Additionally, genetic risk factors may also be significant for CHD development in other age groups although specific genetic factors may differ.

AIM: The work aimed to analyze the prevalence of hereditary genetic factors in different age groups in patients with coronary heart disease.

MATERIALS AND METHODS: The study was conducted as part of the analysis of data from two observational multicenter Russian studies of acute coronary syndrome (ACS) ORACUL I (1193 patients) and ORACUL II (1803 patients) (the study was registered on with an ID number NCT04068909). The average age of patients was 63.5±12.45 years (1875 men and 1121 women). The study of a panel of candidate genes was performed using the polymerase chain reaction method.

RESULTS: In order to analyze the significance of hereditary factors in patients of different ages, groups of patients with “early” development of CHD (men under 55 years old, women under 60 years old) were formed (n=828). The middle-aged group included men aged 55–74 years and women aged 60–74 years (n=1410). The older age group consisted of patients aged 75 years and older (n=602). In the group of patients with early onset coronary heart disease, the proportion of patients with aggravated heredity was higher. In the older age group, the proportion of patients with non-burdened or unknown heredity was higher. Significant differences in the frequencies of alleles and genotypes of the polymorphic variants studied by us were revealed only for the G-2667C variant of the CRP gene (the frequency of the GG genotype was 87.3% in young patients and 77.2% in the elderly and old patients (p=0.007) and for the C804A variant of the LTA gene (frequency of the CC genotype was 52 0% in young patients, 49.4% in middle-aged patients, and 34.2% in elderly and old patients, p=0.026).

CONCLUSIONS: A burdened family history is more common among patients with early onset coronary artery disease. The differences revealed in the frequencies of genetic variants of genes encoding anti-inflammatory cytokines may indicate their role in the pathogenesis of coronary heart disease in older individuals.

Medical Journal of the Russian Federation. 2021;27(3):281-290
pages 281-290 views


Current issues of surgical treatment of large and giant hiatal hernias

Rozenfel'd I.I.


This work analyzes Russian and international literature sources that discuss the surgical intervention results for large and giant hiatal hernias. To date, there is no uniform classification of hiatal hernias by the size of the hernial defect. The classifications and algorithms for choosing the plastic method proposed by various authors provide no convincing evidence base. Although there are many methods for surgically correcting hiatal hernia, clear indications for their implementation have not been developed. The postoperative complications and relapses of the disease after surgery represent an unresolved issue. The laparoscopic approach for large and giant hiatal hernias is preferable to open surgery. However, it can lead to serious intra- and postoperative complications, especially in emergency cases. Alloplasty provides clinical improvement and an increase in the quality of life of patients, but has a relatively high risk of recurrence. To date, the treatment of hiatal hernias involves using various prosthetic materials, and their advantages and disadvantages are described in this article. Thus, the search for optimal surgical techniques to treat large and giant hiatal hernias continues.

Medical Journal of the Russian Federation. 2021;27(3):291-298
pages 291-298 views

Efficiency of using the technology of functional electrical stimulation in gait disorder in patients with cerebral palsy

Guryanova E.A., Chebanenko N.V., Litvak F.G., Zykov V.P.


Cerebral palsy is a group of developmental disorders affecting motor skills and postural maintenance, leading to motion defects due to non-progressive damage and/or a developing brain anomaly in the fetus or the newborn child. Leg muscle weakness and spasticity associated with cerebral palsy limit the range of motion in the ankle joint and negatively affect the child’s motor ability. This article reviews scientific studies on an innovative method of functional electrical stimulation of walking in children with cerebral palsy. We searched for information in the Scopus, Web of Science, Medline, The Cochrane Library, PubMed, Pedro, Scholar, eLibrary, and CyberLeninka databases. The efficiency of remedial treatment of motion using functional electrical stimulators was assessed using biomechanical and neurophysiological methods of evidence-based medicine. When children are rehabilitated using electrical stimulation techniques such as functional electrical stimulation, the gait is restored significantly, dorsiflexion is improved, the gait pattern is normalized, stability when walking is increased, the number of falls is decreased, and the need for additional support is reduced. The effect of functional electrical stimulation on the normalization of walking speed, gait kinematics and symmetry, the ability to overcome obstacles, and the range of motion of the ankle joint and foot clearance during walking are discussed. In addition, the work analyzes the effect of functional electrical stimulation on reducing the patient’s energy consumption when walking, normalizing muscle tone, decreasing the risk of falls, and increasing confidence and comfort when walking. As part of this analysis, the speed of adaptation and patient tolerance of the devices for functional electrical stimulation are also discussed. A comparative characteristic of functional electrical stimulation using ankle joint orthoses is provided.

CONCLUSIONS: For many years, movement dynamics have used functional electrical stimulation technologies to rehabilitate neurological patients after stroke and multiple sclerosis. It is only a matter of time before these technologies also become the standard treatment for children with cerebral palsy in rehabilitation programs.

Medical Journal of the Russian Federation. 2021;27(3):299-312
pages 299-312 views

Case reports

A сomplication of COVID-19 in the maxillofacial region. Сlinical cases

Khelminskaya N.M., Posadskaya A.V., Kravets V.I., Pavlova I.A.


This study focuses on the clinical symptoms of inflammatory and destructive lesions of the facial skeletal bones as a long-term complication of coronavirus disease-2019 (COVID-19). The most common symptom of COVID-19 is thrombosis. Many scientists have noted that the main target of COVID-19 is the lungs with varying damage severity in the form of pneumonia. Acute cerebrovascular accidents and coronary pathology have become the most common causes of lethal outcomes in young people. Clinically, in patients with COVID-19, both obvious thrombotic complications were recorded with large thrombi detection (not only in the veins and pulmonary arteries, but also in the heart and vessels of the brain, kidneys, and liver), as well as signs of thrombosis at the microcirculatory level, which is quite difficult to establish in vivo. The diagnostics, treatment, and follow-up of a patient with COVID-19 history and complications that arose in the maxillofacial region were conducted in the Department of Maxillofacial Surgery of Clinical Hospital. Upon admission, the patient was diagnosed with chronic osteomyelitis of the upper jaw on the right, chronic right-sided maxilloethmoidal sinusitis, mucous membrane defect on the right hard palate, oroantral fistula on the right, and keratitis of the right eye. During the inpatient treatment, multicomponent therapy was performed. During the therapy, a general condition and local status improvement of the patient was noted.

CONCLUSIONS: The clinical cases indicate that the course of COVID-19 is characterized by late complications in the maxillofacial region in the form of damaged vessels that extend from the а. maxillaris trunk in the pterygopalatine fossa region.

The trophic disorder was slowly progressive and irreversible. The clinical and radiological presentation showed no clearly defined boundaries of bone necrosis of the facial middle zone. Low tissue regeneration was noteworthy.

Medical Journal of the Russian Federation. 2021;27(3):313-320
pages 313-320 views

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