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Vol 27, No 5 (2021)

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Health care organization and public health

Risk factors influencing the health of university teachers

Polunina N.V., Soltamakova L.S., Buslaeva G.N., Polunin V.S.


BACKGROUND: Emotional burnout syndrome is described in the historical literature. According to various authors, the syndrome develops on average in 50% of contemporary teachers. However, the influence of the syndrome on the health of university teachers and its risk factors have not been sufficiently investigated.

AIM: This study aimed to identify and analyze the specific of risk factors influencing the health of university teachers.

MATERIALS AND METHODS: An anonymous survey of 1,417 teachers was conducted at humanities institutions of higher education in Moscow, and the results of medical examinations were studied.

RESULTS: The prevalence of health disorders and associated risk factors among teachers were studied. The socio-hygienic characteristics of the surveyed teachers were analyzed based on a comprehensive assessment of their emotional state, according to individual diseases. In addition, the methods of improving their health status were determined.

CONCLUSIONS: More than half of university teachers have health disorders associated with adverse occupational factors and the moral and psychological climate at work and at home, combined with poor health and socio-hygienic activity indicators. Their management should include health-improving technologies and ensure optimal conditions for professional activity.

Medical Journal of the Russian Federation. 2021;27(5):423-432
pages 423-432 views

Primary care physicians: performance indicators in the Russian Federation and federal districts for 2010–2019

Banteva M.N., Manoshkina E.M.


BACKGROUND: The organization of outpatient care has undergone various transformations in the past 20 years, with the main being the development of a new outpatient clinic model and the introduction of a general practitioner in replacement of a primary care physician.

AIM: This study aimed to assess the performance of primary care physicians in the Russian Federation and federal districts (FD) from 2010 to 2019.

MATERIALS AND METHODS: Based on data from the Federal Statistical Observation Form No. 30 “Information on a Medical Institution”, the performance indicators of primary care physicians in the Russian Federation and FDs from 2010 to 2019 were calculated and analyzed.

RESULTS: During the study period, the function of physicians’ position in the Russian Federation remained almost unchanged (−0.2%) and amounted to 5060.4 visits per physician per year in 2019, whereas the FDs showed multidirectional changes ranging from +13.1% in the Southern FD to −9.3% in the Central FD. In the Russian Federation, a decrease in both the total number of visits to primary care physicians per 1000 adults (−16.2%, from 1983 to 1661.9) and outpatient visits (−8.9%, from 1642.7 to 1496.4) and a simultaneous decrease in the share of home visits from 17.2% to 10.0% (−41.9%) were observed. In the structure of outpatient visits, a decrease in visits for diseases (−16.5%, from 84.7% to 70.8%) was registered, whereas the share of preventive visits doubled (from 15.3% to 29.1%). In contrast, regarding the structure of home visits, the share of visits for diseases increased, whereas the share of preventive visits decreased.

CONCLUSIONS: The described processes may be explained by reforming the polyclinic model with an emphasis on strengthening the role of general practitioners and the gradual replacement of primary care physicians.

Medical Journal of the Russian Federation. 2021;27(5):433-443
pages 433-443 views

Clinical medicine

Assessment of the efficiency of arthroscopic laser dual-mode synovectomy in patients with chronic synovitis of the knee joint

Lychagin A.V., Yanbin Y., Ivannikov S.V., Yavlieva R.C., Lipina M.M., Goncharuk Y.R., Vyazankin I.A.


BACKGROUND: Osteoarthritis (OA) of the knee joint is a common disease and a significant medical, social, and economic problem. Synovitis can be revealed at all stages of ОА, contributing to the progression of cartilage damage, increased pain, and impaired joint function. In patients with OA, the morphological pattern of the synovial membrane structure has characteristic features, such as hyperplasia, sublimating fibrosis, and stromal vascularization. Laser radiation is widely used in medicine. Exposure of two working wavelengths (0.97 μm and 1.56 μm) to the synovial membrane may lead to good results in the treatment of synovitis.

AIM: This study aimed to improve treatment outcomes in patients with chronic synovitis of the knee joint by applying radiation of two different wavelengths.

MATERIALS AND METHODS: Treatment outcomes of 50 patients with chronic synovitis of the knee joint, aged 23 to 67 years, with stages II–IV gonarthrosis according to the Kellgren–Lawrence classification, were prospectively analyzed. All patients underwent arthroscopic sanation and laser partial synovectomy using LSP-IRE-Polus apparatus (OOO NTO “IRE-Polus,” Russia), with a wavelength of 0.97 μm (pulse 100 ms, pause 50 ms) in a pulsed-periodic mode and 1.56 μm with a power of 5 W in a continuous mode. Surveys were conducted preoperatively and at 3, 6, and 12 months postoperatively using the following scales and questionnaires: Visual Analog Pain Scale (VAS), Lequesne index, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS).

RESULTS: The mean age (M±s) of the study subjects, body mass index, and the duration of synovitis were 45.32±13.1, 28.63±4.72 kg/m2, and 2.26±1.91 years, respectively. Statistically significant improvements in the VAS, WOMAC, Lequesne, and KOOS scales were observed three months after surgery, whereas much more better results were obtained at six months and remained the same within 12 months after surgery (p <0.05).

CONCLUSIONS: The results suggest that the proposed technique could be introduced into clinical practice.

Medical Journal of the Russian Federation. 2021;27(5):445-453
pages 445-453 views

Choice of the method for eliminating postburn shoulder joint contractures

Sarygin P.V., Stepanova Y.A., Gushchina N.V.


BACKGROUND: In the Russian Federation, over 400,000 patients with thermal injuries are registered yearly, with approximately 30% of them requiring hospitalization. Physicians pay special attention to the rehabilitation of patients with complications of deep burns. According to several authors, deep burns occur in 47% of cases. The most common complications of deep burns are contractures and limb deformities. Shoulder contractures occur in over 50% of patients. The outcomes and terms of a patient’s return to active social and working life depend on the timeliness and selection of an optimal surgical intervention from a wide range of reconstructive and plastic techniques.

AIM: This study aimed to improve the functional and esthetic results of surgical treatment in patients with postburn shoulder joint contractures.

MATERIALS AND METHODS: From 2011 to 2020, 198 patients underwent surgery, including 59% women and 41% men. Right shoulder, left shoulder, and right and left shoulder simultaneous joint contractures occurred in 54.5%, 38.5%, and 7% of cases, respectively. The patients’ age ranged from 18 to 72 years, and 99% of them were of working age. The scope of preoperative examination included clinical data, photographic documentation, duplex vascular scanning, and determination of the degree of contracture using a mechanical goniometer. Patients with grade I, II, and III shoulder joint lesions accounted for 29%, 60%, and 11% of the total number of cases, respectively. Early surgical rehabilitation prevents the development of secondary myogenic and arthrogenic contractures and accelerates the patient’s social reintegration. Local tissue plasty using the armpit adipodermal tongue-shaped flap, a nonperforated full-layer or split skin graft, a rotated flap based on perforating vessels, and the expander stretching method were used to eliminate contractures.

RESULTS: Bacterial infection, total and marginal necrosis, hematomas, and seromas were not observed in the immediate postoperative period. Complete elimination of the shoulder joint contracture was achieved in 63% of cases, whereas joint mobility increased by over 60° in 30% of patients.

CONCLUSIONS: The algorithm presented for choosing a method of surgical rehabilitation for patients with shoulder joint contractures leads to an increase in the efficiency of reconstructive surgery after burn injuries.

Medical Journal of the Russian Federation. 2021;27(5):455-463
pages 455-463 views

Analysis of morphological changes in gallbladder walls after endoscopic bile duct decompression

Shabunin A.V., Tavobilov M.M., Karpov A.A., Ozerova D.S.


BACKGROUND: In patients who have undergone retrograde endoscopic choledocholithoextraction, technical difficulties are frequently encountered when performing laparoscopic cholecystectomy, which is associated with the development of destructive changes in the gallbladder wall. However, no studies on the assessment of morphological changes occurring in the gallbladder wall at different terms after endoscopic retrograde bile duct interventions are currently available in the literature. The relevance and insufficient knowledge of the research area prompted this study.

AIM: This study aimed to determine the optimal terms of laparoscopic cholecystectomy after endoscopic bile duct decompression performed for cholelithiasis complicated by choledocholithiasis based on morphological changes in the gallbladder wall.

MATERIALS AND METHODS: A comparative analysis of the pathological examination of 198 gallbladders removed surgically on different days after endoscopic bile duct decompression performed for cholelithiasis complicated by choledocholithiasis is presented.

RESULTS: In group 1, cholecystectomy after endoscopic bile duct decompression was performed on days 1–3. Gallbladder wall changes were observed in 10 (12.8%) patients. In group 2, cholecystectomy was performed on days 4–7. Inflammatory changes were revealed in 13 (37.1%) preparations. Pathological examination of the surgical specimens of the patients in group 3 who underwent cholecystectomy on days 14–30 revealed changes in the gallbladder wall in 48 (56.4%) cases.

CONCLUSIONS: Laparoscopic cholecystectomy after endoscopic bile duct decompression within the first 72 h is the most optimal.

Medical Journal of the Russian Federation. 2021;27(5):465-472
pages 465-472 views

Comprehensive rehabilitation for injuries to the medial collateral ligament of the knee in skiers and snowkiters

Levkov V.Y., Ikonnikova M.S., Andronova L.B., Remizov A.N., Panyukov M.V., Butorina A.V., Polyaev B.A., Lobov A.N., Plotnikov V.P., Platonova A.V.


BACKGROUND: The main function of the medial collateral ligament is static stabilization when the tibia is deviated outward. Medial collateral ligament damage may result from the application of a sharp force to the tibia and knee joint in a valgus position, often leading to knee instability, recurrent synovitis and posttraumatic osteoarthritis. This often results in the development of functional disorders that sharply limit the motor abilities of patients, thereby affecting the performance (support ability) of the injured limb.

AIM: The study aimed to conduct a comparative analysis of the efficiency of various current rehabilitation techniques providing a more patient-oriented approach in the conservative treatment of various degrees of medial collateral ligament injuries based on the assessment of the capabilities of magnetic resonance imaging in 38 patients.

MATERIALS AND METHODS: Thirty-eight patients (27 men and 11 women, 71.05% and 28.95%, respectively) with partial medial collateral ligament injuries were followed up. The mean age was 28.5 years (19–38 years). All subjects were involved in skiing and snowkiting in the “alpine skiing” discipline. The diagnosis was made based on clinical examination, patient’s complaints, and magnetic resonance imaging (MRI) of the knee joint. The examination was performed on a Vestra-2 magnetic resonance tomograph with a superconducting magnet and a magnetic field induction of 0.5 Tesla. Optimal for knee joint examination was a quadrature Surf-76 receiving and transmitting coil, which allowed the selection of a small field of view without artifacts or spatial distortion and increased the signal/noise ratio. The knee joints were examined twice: on the day of admission (maximum 1.5 days after injury) and at the end of the week 6 of conservative treatment.

RESULTS: Using the rehabilitation treatment program proposed by the authors in patients with medial collateral ligament injuries, a decrease in the severity of clinical symptoms and an improvement of functional characteristics were observed. Inclusion of the kinesiotaping technique led to a reduction of the treatment recovery period.

CONCLUSIONS: Current noninvasive diagnostic techniques (in particular, MRI) for bone tissues, articular cartilages, and periarticular soft tissues allow to determine the degree of damage to anatomical structures, choose the optimal conservative treatment method , and set the duration and extent of artificial immobilization and the terms of the onset of rehabilitation procedures for patients with partial injuries of the medial collateral ligaments. The results of the proposed rehabilitation treatment program for injuries of the medial knee ligament include a reduction of pain, synovitis and limping, and an improvement of muscle strength and elasticity and knee stability.

Medical Journal of the Russian Federation. 2021;27(5):473-480
pages 473-480 views

Is the С-reactive protein/albumin ratio a prognostic factor in children with peripheral facial paralysis?

Ayral M., Toprak S.F., Samanci S., Dedeoglu S.


BACKGROUND: Bell’s Palsy (BP), accepted as an idiopathic condition and for which inflammation is believed to have a role in the pathogenesis, is a disease characterized by acute unilateral weakness in facial muscles innervated by the facial nerve.

AIM: This study aimed to examine the relationship between the C-reactive protein/albumin ratio (CAR) and hematological parameters including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) in children with BP.

MATERIALS AND METHODS: The study included 65 children diagnosed with idiopathic peripheral facial paralysis and a control group of 49 healthy children. The patients were classified into two groups according to the House-Brackmann (HB) grade at the time of diagnosis, as mild (HB grade 2–3) and severe (HB grade 4–5). Patients evaluated as HB grade 1 with normal, healthy, and symmetrical muscle function were not included in the study. The children in the patient group were classified into three groups at the end of a six-month follow-up period as full recovery, partial recovery, and no recovery. The patient and control groups were compared according to the CAR, NLR, PLR, MPV, and RDW values. After treatment, the full recovery and no recovery groups were compared based on the CAR, NLR, PLR, MPV, and RDW values.

RESULTS: The NLR was found to be significantly higher in the BP patient group than in the control group (p <0.001). There was also a significant difference in the NLR value between the full recovery and no recovery groups. No statistically significant difference was found between the patient and control groups or between the full recovery and no recovery groups in terms of the CAR, PLR, MPV and RDW values.

CONCLUSIONS: NLR, an easily accessed hematological parameter, may be used as a marker of poor prognosis in pediatric patients with BP. CAR was of no prognostic value in pediatric BP patients.

Medical Journal of the Russian Federation. 2021;27(5):481-490
pages 481-490 views


Listeria monocytogenes today

Gruzdeva O.A., Tartakovsky I.S., Maleev V.V., Saitgareev R.S., Kormilitsina V.G., Sharapchenko S.O., Kisil O.V., Gabrielyan N.I.


The epidemiological surveillance of listeriosis remains an urgent problem for Russia, especially in the metropolitan areas. The Gram-positive bacterium Listeria monocytogenes, which causes the infectious disease listeriosis, is a foodborne pathogen and widespread in nature. Ready-to-eat foods are particularly dangerous because no heat treatment or other antimicrobial action is performed between their production and consumption. Newborns, pregnant women, the elderly, and immunocompromised people are highly susceptible to listeriosis. The timely detection of L. monocytogenes in foodstuffs during the manufacturing and storage phases is important both for food processing and catering companies and for public health.

Medical Journal of the Russian Federation. 2021;27(5):491-500
pages 491-500 views

Current views on the diagnosis and treatment of spleen injuries in children

Rozenfel'd I.I., Chilikina D.L., Varpetyan A.M., Kakhlerova T.A.


The study highlights current problems arising from the use of various surgical techniques for the treatment of spleen injuries and their consequences. Through a literature review, we aimed to determine the structure of spleen injuries and peculiarities of their diagnosis and treatment in children and identify the main indications, consequences, and selection criteria for spleen surgery techniques. A comparison of different assessment methods and surgical techniques and determination of the most optimal method that improves patients’ quality of life are presented. An algorithm of procedures for closed abdominal trauma in children is specified.

Medical Journal of the Russian Federation. 2021;27(5):501-516
pages 501-516 views

Inhumane medicine: imperial japan’s development and the use of biological weapons during World War II

Damulin I.V., Strutzenko A.A.


There is currently an acute lack of information on the activities of Japanese doctors during World War II. Being a country with limited natural, financial, and human resources, Imperial Japan considered biological and chemical weapons one of the most promising and effective means of warfare in its quest to dominate Southeast Asia. In the mid 1920s, the Japanese leadership approved biological and chemical warfare research. The implementation of the biological weapons project, including human testing, was entrusted to Shiro Ishii and a group of Japanese scientists under his leadership, as well as to military and civilian experts. These studies examined the effectiveness of plague, gas gangrene, cholera, anthrax, and other pathogens. Experiments, including detailed descriptions of the subjects’ suffering and the results of autopsies/vivisections, were carefully documented. Field tests involved the distribution of contaminated food and crops to the Chinese population, as well as the contamination of water supplies. Similarly, in keeping with military interests, the effectiveness of munitions and the effects of decompression, hypothermia, and electric current were investigated on prisoners. After the end of World War II and the surrender of Imperial Japan, large-scale buried victims of experiments were found on the territory of the People’s Republic of China, including the borders of the USSR. The paper focuses on the ethical component of the studies conducted, based on the dominant view in the Japanese society that all actions for the glory of the country and the emperor are justified and the absence of any ethical considerations due to the prejudice of the Japanese against foreigners in general and the Chinese in particular.

Medical Journal of the Russian Federation. 2021;27(5):517-526
pages 517-526 views

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