Vol 27, No 3 (2021)

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.

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.

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.

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.

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.

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 ClinicalTrials.gov 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.

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.

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.