Introduction. Health care workers are at risk of infection with the SARS-CoV-2 virus. However, many aspects of the professionally conditioned COVID-19 are still poorly understood. The aim of study is to conduct a brief review and analysis of scientific data on the prevalence, features of clinical and laboratory COVID-19 syndromes in medical professionals. To evaluate the structure of post-COVID syndrome in health care workers who are observed in a large multidisciplinary medical organization that has a center for occupational pathology. To present the current state of the problem of examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of SARS-CoV-2 infection. Materials and methods. At the first stage, a brief review of the literature on the problem of COVID-19 in health care workers was performed, at the second - a single-center observational prospective study of COVID-19 convalescents. The main group consisted of health care workers (n=203), the comparison group - people who do not have occupational health risks (n=156). The groups were comparable in demographic characteristics. The work experience of the medical staff was 15 (5; 21) years. Of the participants in the main group, 20.2% worked in hospitals, and 79.8% in outpatient institutions. Three of the participants (1.5%) were employees of specialized COVID hospitals. Doctors were 25.6%, secondary medical personnel - 51.7%, junior medical and technical personnel - 22.7%. A severe form of COVID-19 was suffered by 25 (12.3%) people, after the artificial ventilation of the lungs (AVL) - two participants. The observation time is 60 days. Statistical analysis included standard methods of descriptive statistics, determination of relationships by the method of logistic regression. The significance level is p<0.05. Results. Most of the known data on COVID-19 in health care workers is obtained in cross-sectional studies. The possibility of occupational infection has been sufficiently proven. The risk probably depends on the work performed and is higher in conditions of direct contact of medical personnel with adults, potentially infected patients, but not in a specialized hospital. It is possible that the course of COVID-19 in health care workers differs from the general population of patients there is evidence of a greater frequency of weakness and myalgia. Studies of the features of post-COVID syndrome in health care workers in available sources could not be identified. According to the results of their own research, health care workers who had experienced COVID-19 had a higher frequency of central thermoregulation disorders, arrhythmias, heart failure, panic attacks and depression. Conclusions. Health care workers are at risk of COVID-19. Professionally conditioned post-COVID syndrome is characterized by the frequency of violations of the central mechanisms of thermoregulation and arrhythmias. COVID-19 in health care workers meets the definition of occupational disease.
Introduction. Inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (COPD) is not studied enough.The aim was to establish molecular pattern of inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in comparison with bacterial AECOPD and to reveal associations with AECOPD phenotype and subsequent COPD progression.Materials and methods. Subjects hospitalized with acute exacerbations of COPD (AECOPD) of which 60 were viral, 60 were bacterial and 60 were viral-bacterial were recruited to single center prospective (52 weeks) cohort study. Control group – 30 healthy people. COPD were diagnosed previously during stable phase of the disease according to spirographic criteria. Viral AECOPD were confirmed by detection of RNA of influenza A and B, respiratory syncytial virus, rhinovirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in sputum or bronchoalveolar lavage fluid (BALF) using reverse transcription-polymerase chain reaction (RT-PCR). Bacterial AECOPD were confirmed by sputum/BALF neutrophilia or elevated blood procalcitonin levels or by detecting bacteria by standard culture method. Plasma concentrations of cytokines, fibrotic markers, enzymes were measured by enzyme-linked immunosorbent assay, plasma fibrinogen – by Clauss method. Complex lung function investigation, Dopplerechocardiography, subsequent AECOPD assessment were done. Kruskal-Wallis and chi-square test were used to compare groups, Cox regression and linear regression – to explore relationships.Results. Viral AECOPD were characterized by highest plasma concentrations of Eosinophilic cationic protein (62,3 (52,4; 71,0) ng/ml)), interleukin-5 (IL-5) (11,3 (8,4; 15,9) pg/ml), fibroblast growth factor-2 (FGF-2) (10,4 (6,2; 14,9) pg/ml), transforming growth factor-β1 (TGF-β1) (922,4 (875,7; 953,8) pg/ml), hyaluronic acid (185,4 (172,8; 196,3) ng/ml), amino-terminal propeptide of type III procollagen (PIIINP) (249,2 (225,1; 263,7) ng/ml), matrix metalloproteinase-1 (MMP-1) (235,2 (208,6; 254,9) pg/ml). Levels of IL-5 during AE COPD was the predictor of FEV1, bronchodilation coefficient, subsequent exacerbations at remote period, fibrinogen was associated with FEV1, PIIINP and FGF-2 with DLco, PaO2, mean pulmonary artery pressure (mPAP), exacerbations, MMP-1 – with mPAP.Conclusions. In virus-induced AECOPD inflammation pattern differed from those in bacterial one and associated with AECOPD phenotype and COPD phenotype at the stable phase.
Introduction. The high risk of infection of healthcare workers dictates the need to study their working conditions during the COVID-19 pandemic. The study aims to research the working conditions of medical workers during the COVID–19 pandemic in multidisciplinary medical and preventive organizations. Materials and methods. Analysis of working conditions of medical workers of medical and preventive organizations. The study design is a closed population (four medical institutions were randomly selected), a target group (doctors and nurses). The authors analyzed the staffing table and 16 reports on a special assessment of working conditions at 1,251 workplaces (1,845 medical workers, of which 787 doctors, 1,058 nurses). Statistical analysis included: standard methods of descriptive statistics, determination of relationships by logistic regression (odds ratios (OR) and 95% confidence intervals (OR CI)). p<0.05 was taken as the critical level of significance. Results. The largest number of ill medical workers provided assistance to patients without signs of COVID-19 both in hospitals (86.06% of doctors, 85.85% of nurses) and in outpatient polyclinic treatment and prevention organizations (90.31% of doctors, 92.05% of nurses). The probability of getting sick COVID-19 was maximum in an infectious diseases hospital (compared with emergency departments OR 2.049; 95% OR CI 1.194–4.608 and diagnostic and treatment units of medical institutions OR 3,057; 95% OR CI 1,876–4,98). The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized teams are classified as harmful class 1–3 degrees, and workers are classified as high occupational risk groups according to SARS-CoV-2. The probability of getting sick with COVID-19 is significantly higher when in contact with pathogens of infectious diseases (class of working conditions 3.3 compared to 3.1 or 3.2). Conclusion. The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized brigades are classified as harmful class of the first to third degree, and workers are classified as high occupational risk groups for COVID–19. Ethics. Scientists have conducted the study in compliance with the Ethical principles set out in the Helsinki Declaration of 1975 with amendments of 1983 and obtaining the informed consent of patients.
Both in Russia and worldwide, morbidity and mortality from acute coronary syndrome (ACS) remain high. The emergence of a new coronavirus infection, the active participation of medical workers in its elimination, determined a new phenotype of patients, which determines the relevance of the problem and of a more detailed assessment of this cohort of patients. Aim of the study was to identify and determine the clinical and functional features, phenotype and endotype of the course of ACS in medical workers who have had a new coronavirus infection. Material and methods. An open cohort comparative study was conducted. It included 60 healthcare workers with ACS and a previous novel coronavirus infection, who were selected based on the identification of SARS-CoV-2 and/or its antibodies (positive PCR test) in anamnesis. All patients were admitted to the regional vascular center № 7 of the City Clinical Hospital № 2, Novosibirsk. The comparison group consisted of 60 healthcare workers with ACS without positive PCR test in anamnesis. General clinical and instrumental, coronary angiography with possible stenting. Results. Of the 60 medical workers with ACS after a new coronavirus infection, myocardial infarction with ST segment elevation was detected in 21 people, myocardial infarction without ST segment elevation – in 31, unstable angina pectoris – in 8 people. Within 6 months of undergoing COVID-19, they developed complex rhythm disorders, such as paroxysm of fibrillation or atrial flutter, more frequently than in the comparison group, as well as a full AV-blockade (n = 25, 41.6 %, p = 0.020), bradyarrhythmias and conductivity disturbances (n = 8, 13.3 %, p = 0.045), revealed a more than 2-fold increase in the pro-brain natriuretic peptide (proBNP) (n = 21, 35 %, p = 0.033), observed myocardial dysfunction (ejection fraction less than 50 %) (n = 6, 10 %, p = 041). Conclusions. The data obtained indicate the formation of a new ACS phenotype in medical workers who have undergone a new coronavirus infection.
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