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Vol 28, No 1 (2022)

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Health care organization and public health

On the need to increase the use of mobile medicine technologies during infectious pandemic

Korkhmazov V.Т., Perkhov V.I.


BACKGROUND: Mobile health units and medical team programs play an important, though underestimated, role in the healthcare system. The coronavirus 2019 (COVID-19) pandemic aggravated the problem of insufficient diagnostic and therapeutic medical care provided by mobile health technologies.

AIM: This study aimed to provide an expert assessment of the prospects for the use of mobile medicine technologies during infectious pandemic in the Russian Federation.

MATERIALS AND METHODS: Methods of content analysis, information, and analytical materials of Russian and international information agencies, statistical materials of the Ministry of Health of Russia, and summary of the Russian federal statistical observation «Information About the Medical Organization» were used.

RESULTS: The COVID-19 pandemic aggravated the problems of regional healthcare systems, which were struggling with an unexpectedly serious viral infection in an environment of weak infrastructure. Thus, mobile health units and teams represent an untapped resource for the Russian healthcare system. In Russia, the number of mobile health units is not growing fast enough, and the volume of their medical activities is not increasing significantly. In 2015, Russia had 1,064 mobile medical teams, and the volume of their work amounted to 2.1 million visits or 0.27% of the total number of outpatient visits. In 2019, 1,529 mobile medical teams were already registered, with a volume of 3.9 million visits (105.0 thousand house calls) or 0.51% of the total number of outpatient visits.

CONCLUSIONS: Mobile clinic programs should be expanded and integrated into the regional healthcare systems and included in emergency preparedness plans to support further development and integration of mobile clinics into the healthcare system.

Medical Journal of the Russian Federation. 2022;28(1):5-10
pages 5-10 views

Prevention of the emotional burnout syndrome in university teachers

Polunina N.V., Soltamakova L.S., Bespalyuk G.N., Polunin V.S., Oprishchenko S.A.


BACKGROUND: Professional burnout in university teachers is an urgent problem. Thus, researchers attempted to determine the dependence of teachers’ health on the peculiarities of their professional activities. Professional burnout of teachers is observed in all countries worldwide. The development of measures to prevent professional burnout is an important task that requires further study.

AIM: This study aimed to scientifically justify measures for the prevention of emotional burnout syndrome in university teachers.

MATERIALS AND METHODS: A total of 2,711 teachers from humanitarian and technical universities in Moscow were surveyed using analytical and socio-hygienic methods. Moreover, extracts from medical, informational, and statistical documents of teachers were analyzed.

RESULTS: On average, one university teacher was found to have 4–5 symptoms characterizing emotional burnout. Two-thirds of the teachers were women, and female morbidity was higher. The high intensity of professional activities, long-lasting forced position, and dissatisfaction with job and remuneration were defined as the most pronounced reasons of psychological burnout.

CONCLUSIONS: Medical and organizational measures are necessary to improve the health and emotional state of teachers.

Medical Journal of the Russian Federation. 2022;28(1):11-16
pages 11-16 views

Current state and prospects for nursing care in the palliative care system

Kasimovskaya N.A., Nevzorova D.V., Geraskina N.S.


BACKGROUND: The demographic trends of the 21st century increase the need for long-term care and challenge the volume and quality of palliative and nursing care. Nursing homes and units are created to increase the availability of palliative care (PC) to patients in need of 24-h nursing care who do not have medical indications for permanent medical supervision. The availability of PC and effectiveness in nursing care beds require further analysis.

AIM: This study aimed to examine the current PC state in nursing care beds and determine the need for further development of this area for patients requiring PC in the Russian Federation.

MATERIALS AND METHODS: Data analysis of PC provision in automated medical statistics monitoring system ( was conducted using descriptive statistics. The sociological method was used to determine the conditions/diseases of patients requiring PC and nursing care.

RESULTS: Patients beyond the working age need PC in nursing care beds. The structural subdivisions of medical organizations and facilities that provide PC in nursing care beds are unevenly distributed throughout the Russian Federation. The availability of nursing care beds and the average bed-days differ among constituent entities of the Russian Federation.

CONCLUSIONS: A positive increase in PC beds has been observed since 2012. For Q1 2021, the average bed-days in a nursing care bed and PC bed were 28.2 and 22.3, respectively. For adult patients receiving PC in inpatient settings, individuals beyond the working age with reduced functional activity, insufficient independent care, and in need of 24-h nursing supervision and care prevailed.

Medical Journal of the Russian Federation. 2022;28(1):17-28
pages 17-28 views

Clinical medicine

Left ventricular global function index and peculiarities of daily blood pressure profile in patients with arterial hypertension

Minushkina L.O., Brazhnik V.A., Selezneva N.D., Kapustina A.Y., Alekhin M.N., Zateyshchikov D.A.


BACKGROUND: The left ventricular global function index (LVGFI), determined using transthoracic echocardiography, is a simple clinical marker of left ventricular dysfunction and has superior prognostic value to the standard ejection fraction-based assessment of cardiac pump function. The methodology for calculating this index was proposed in 2019. Currently, the clinical factors that influence the state of left ventricular global functions are not examined.

AIM: This study aimed to assess the association of LVGFI with the peculiarities of daily blood pressure (BP) profile in patients with arterial hypertension (AH).

MATERIALS AND METHODS: A total of 104 patients [51 men (49%) and 53 (51%) women] with AH were examined. The mean age of the patients was 58.7±11.73 years, and disease duration was 6.03±10.93 years. AH corresponded to grades 1, 2, and 3 in 47 (45.2%), 26 (25.0%), and 31 (29.8%) patients, respectively. Patients with myocardial infarction or stroke, cardiomyopathies, heart defects, diabetes mellitus, thyroid dysfunction, or chronic kidney disease were not included in the study. All patients underwent daily BP monitoring, echocardiography, carotid artery examination, and biochemical blood tests.

RESULTS: A significant inverse weak correlation of LVGFI with age (r=−0.215, p=0.028), body mass index (r=−0.378, p=0.001), BP variability (r=−0.307, p=0.002), and daily mean values of systolic (r=−0.223, p=0.026) and diastolic (r=−0.237, p=0.018) BP were observed. In the regression analysis, an increase in body mass index, abnormal diurnal BP with excessive BP reduction at night, and high BP variability demonstrated a significant and independent association with decreased LVGFI.

CONCLUSIONS: The study revealed an independent association of decreased LVGFI with increased body mass index, excessive BP reduction at night, and high systolic BP variability. These factors should be considered in the possible development of a strategy to prevent target organ damage in AH.

Medical Journal of the Russian Federation. 2022;28(1):29-36
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High-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantages

Geyze A.V., Koroleva I.V., Plotnikov G.P., Kovalerova N.B., Manevskiy A.A.


BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.

AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.

MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patient’s tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.

RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.

CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patient’s condition and ventilation requirement.

Medical Journal of the Russian Federation. 2022;28(1):37-45
pages 37-45 views

Dynamics of echocardiographic parameters in patients with severe COVID-19 during hospitalization

Kovtyukh I.V., Gendlin G.E., Nikitin I.G., Dvornikova S.N., Shikhova Y.A.


BACKGROUND: The severe course of a new coronavirus infection may be associated with cardiovascular damage. Thus, there is a need to search for available methods of cardiac status examination to determine management tactics and immediate prognosis in patients with coronavirus disease 2019 (COVID-19).

AIM: This study aimed to assess the dynamics of echocardiographic parameters in patients with severe infection during hospitalization.

MATERIALS AND METHODS: Forty patients hospitalized for COVID-19 were included in the study. All patients underwent echocardiography on admission to the hospital and in dynamics, that is, upon deterioration of the underlying disease. The ultrasound picture of the heart was compared with the severity of parenchymal damage based on computed tomography (CT) and the degree of respiratory failure based on blood oxygen saturation by pulse oximetry. Concomitant nosologies and autopsy findings were also analyzed.

RESULTS: In dynamics, a significant decrease in left ventricular ejection fraction (LVEF) from 47.0% (40.0–56.0) to 43.5% (37.0–49.0; p=0.002) was found in the deceased group, which was not observed in the discharged group. Comparative analysis of this index in the discharged and deceased group in study 2 revealed significantly lower values of LVEF in patients with unfavorable hospital prognosis: 51.0% (44.0–55.0) and 43.5% (37.0–49.0), respectively (p=0.049). Furthermore, a significantly higher level of systolic pulmonary artery pressure was observed in the deceased group in study 1: 54.0 (50.0–59.0) and 60.0 (55.5–70.0) mmHg, respectively (p=0.02), with increasing differences in dynamics, that is, 65.0 (60.0–70.0) and 50.0 (46.0–57.0) mmHg, respectively (p <0.0001). Among the indicators reflecting the state of the right ventricle, right ventricular end-systolic size in study 2 in the deceased group (p=0.062) and more pronounced dilatation by this indicator were noted in the group with unfavorable prognosis compared with the discharged group at re-diagnosis (p=0.071).

CONCLUSIONS: Dynamic reduction of baseline low LVEF and progression of pulmonary hypertension are the main echocardiographic predictors of hospital mortality in patients with COVID-19. Increased volume of pulmonary parenchyma lesions on CT determines unfavorable hospital prognosis.

Medical Journal of the Russian Federation. 2022;28(1):47-55
pages 47-55 views

Assessment of the comparative efficiency of treatment with angiotensin-converting enzyme inhibitor and angiotensin II receptor blockers in patients who are old and senile with stage 3, grade 2–3 hypertension

Zaslavskaya R.M., Krivchikova L.V., Teyblyum M.M.


BACKGROUND: The problem of sex differences in the treatment of hypertension is currently relevant because of the different disease course in men and women. Particular attention should be paid to the age aspect of the problem, since the clinical and hemodynamic parameters of arterial hypertension (AH) in patients who are old and senile have their specifics.

AIM: This study aimed to assess the sex aspect of the comparative efficiency of the angiotensin-converting enzyme inhibitor (ACEI) perindopril and angiotensin II receptor blockers (ARB) losap, losartan, and lorista patients who are old and senile with stage 3, grade 2–3 hypertension.

MATERIALS AND METHODS: A total of 185 patients with stage 3, grade 2–3 hypertension were examined. Two randomized groups of patients were formed depending on the therapy received. Group 1 received ACEI (perindopril), and group 2 patients received ARBs (lozap, losartan, and lorista). Patients kept a diary in which the amount and types of pain, dizziness, and heart palpitations were noted. In addition, the Health, Activity, and Mood Questionnaire and daily self-monitoring of blood pressure every 3 h during the hospital stay and for 2–3 months after discharge were used. The obtained information was processed using variation statistics and the difference method.

RESULTS: The analysis of the comparative efficiency of ARBs and ACEIs revealed significant sex differences in hemodynamic parameters. The ARB group of drugs showed a more pronounced decrease in 24-h blood pressure monitoring (24-h BPM) and the number of pain episodes in the heart area in women compared with men. When using ACEI, no sex difference in the decrease in 24-h BPM indicators was observed. However, significant differences in clinical symptoms of both men and women were found. In women, compared with men, ACEIs had a greater positive effect on the subjective state in points (according to the Health, Activity, and Mood Questionnaire).

CONCLUSIONS: The results suggest that ARB therapy for women who are old and senile with stage 3, grade 2–3 hypertension. For men of a similar age with this pathology, therapy with both ACEIs and ARBs may be recommended.

Medical Journal of the Russian Federation. 2022;28(1):57-63
pages 57-63 views

Clinical dynamics of affective episodes in bipolar disorder

Osipova N.N., Beglyankin N.I., Roganov D.A., Klyachin V.A., Bardenshteyn L.M.


BACKGROUND: Diagnosing bipolar disorder (BD) is a major clinical challenge during the disease course. Diagnostic uncertainty is probable in the early disease stages, particularly those associated with heterogeneity of clinical manifestations and concomitant psychiatric and somatic disorders. Delayed diagnosis of BD leads to the chronicity of the disease process, disability, and premature mortality from suicide and concomitant somatic pathology. The study of clinical dynamics and diagnosis of affective episodes in patients with bipolar affective disorder may contribute to the timely and adequate treatment and prevention of complications.

AIM: This study aimed to assess features of clinical dynamics and diagnosis of affective episodes in BD.

MATERIALS AND METHODS: Eighty-two patients diagnosed with bipolar affective disorder (F31) who were hospitalized in a psychiatric hospital (mean age 48.3±13.5 years) were examined. The study used clinical and psychopathological and statistical methods.

RESULTS: In 51.2% (n=42) of the patients, the diagnosis of BD was made at the first hospital admission and did not change at subsequent admissions. Depressive and manic episodes without psychotic symptoms predominated in this group. In 36.6% (n=30) of the patients, the diagnosis of BD was preceded by neurotic, stress-related, and somatoform disorders (F41.1–2) and recurrent depressive disorder (F33.2,9) for 2 or more hospitalizations. Moreover, in 12.2% (n=10) of patients on repeated hospitalizations, the diagnosis of BD was changed to others, that is, schizoaffective disorder (F25.1–2) and paranoid schizophrenia (F20.01). On average, 6.4±1.4 years elapsed from the first hospitalization to the development of disability (mean age of disability, 39.5±9.8 years).

CONCLUSIONS: BD is characterized by significant polymorphism of clinical manifestations during the disease course, which significantly complicates timely diagnosis. During the first hospitalization, symptoms were significantly severe, which may indicate a lack of adequate treatment at the pre-hospital stage. The presence of psychotic symptoms during affective episodes limited BD identification and led to difficulties in differential diagnosis with schizophrenia–spectrum disorders. Further study of the clinical dynamics of BD should include a thorough clinical analysis of affective episodes, clinical and dynamic follow-up, and the development of additional diagnostic criteria.

Medical Journal of the Russian Federation. 2022;28(1):65-74
pages 65-74 views


Fibroblast growth factor 21 as a new tool in the multicomponent assessment of cardiovascular diseases

Alieva A.M., Baikova I.E., Reznik E.V., Valiev R.K., Akhmatov I.Z., Arakelyan R.A., Saryev M.N., Nikitin I.G.


Currently, the search and study of new biological markers that can assist in the early diagnosis of cardiovascular diseases, serving as a laboratory tool for assessing the efficiency of ongoing therapy and being a prognostic criterion of possible clinical outcomes and a significant indicator in risk stratification, remain relevant. Two decades have passed since fibroblast growth factor 21 (FGF21), the 21st member of the FGF family, was identified and cloned. FGF21 is a secreted protein that acts as a metabolic regulator and participates in glucose homeostasis, ketogenesis, and regulation of insulin sensitivity. FGF21 expression is controlled by PPAR alpha receptor, which activates peroxisome proliferation. The liver is the main site of FGF21 production. Extrahepatic tissues such as white adipose tissue, brown adipose tissue, and skeletal muscle also express FGF21. Human FGF21 contains 209 amino acids, whereas the mouse counterpart has 210. Mouse and human FGF21 have 75% homology. Endocrine actions of FGF21 include enhancing glucose uptake by adipocytes of white adipose tissue via a unidirectional glucose transporter protein and activating the thermogenic function of brown adipose tissue. Furthermore, FGF21 has autocrine/paracrine effects, such as the induction of hepatic ketogenesis. FGF21 affects target cells with the participation of FGFR1 and FGFR4 receptors and beta-Klotho, a single-pass transmembrane protein that functions as an obligate cofactor of FGF21 signaling. Animal studies have clearly demonstrated that FGF21 acts directly on cardiac tissue, preventing the development of cardiac hypertrophy and reducing post-infarction damage and diabetic cardiomyopathy. Accumulating data emphasize the value of FGF21 as a new biological marker for diagnosis and prognosis assessment in patients with cardiac issues. Moreover, the role of FGF21 in heart diseases is very interesting because of its cardioprotective effects. Future large-scale prospective studies are necessary to confirm of the diagnostic, predictive, and possibly therapeutic role of this marker.

Medical Journal of the Russian Federation. 2022;28(1):75-88
pages 75-88 views

Safety of omalizumab in the treatment of moderate-to-severe bronchial asthma

Shnaider K.O., Maksimov M.L., Romanov B.K.


This review aimed to analyze national and international literature on the safety of omalizumab in the treatment of moderate-to-severe bronchial asthma. Omalizumab is one of the longest-standing monoclonal antibodies and the first available treatment option for severe allergic asthma in patients aged ≥6 years. Several randomized controlled studies have established its efficiency and safety, leading to its final registration more than 15 years ago. In most cases, long-term treatment with omalizumab is safe without increasing the risk of adverse reactions. However, over the years, a growing trend has been observed in several registrations of adverse events associated with the use of omalizumab. A review of the literature revealed a lack of long-term clinical monitoring data (over 2 years) in both patients aged >18 years and children. Long-term adverse reactions during omalizumab therapy are insufficiently examined and require more detailed analysis, despite reports of an association between omalizumab and some adverse events. Moreover, extremely few cases of adverse reactions to omalizumab were reported in the Russian Federation. Thus, further investigations of the safety profile of omalizumab and monitoring of its delayed adverse reactions are required.

Medical Journal of the Russian Federation. 2022;28(1):89-98
pages 89-98 views

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