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.
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. For patients with the consequences of COVID-19 it seems relevant to undergo a rehabilitation program to restore the respiratory function, oxygen uptake by tissues, increase exercise tolerance, etc. Rehabilitation includes aerobic-based exercises adequate to the patient’s state and physical capabilities, breathing exercises and physiotherapy modalities. Aim. To evaluate the effectiveness of the third stage rehabilitation in patients aged 18–45 years with the consequences of COVID-19 (U07.1) in a day hospital of multispecialty hospital. Materials and methods. One hundred and thirty-nine patients aged 18–45 years with a verified diagnosis of pneumonia associated with COVID-19 (U07.1) were examined in a day hospital of multispecialty hospital. The patients were divided into 2 groups: 107 patients of the 1st group underwent the third stage rehabilitation; 32 people from who made up the 2nd group refused rehabilitation. The severity of dyspnea was assessed using the Medical Research Council (MRC) Dyspnea Scale; functional impairment in the performance of activities of daily living – according to the Baseline Dyspnea Index and Transitional Dyspnea Index scales; exercise tolerance – according to the 6-minute walk test and the modified Borg Scale; the severity of anxiety and depression – according to the Hospital Anxiety and Depression Scale (HADS); pain intensity – according to the Visual Analogue Scale (VAS); quality of life – according to the EuroQoL Five-Dimension Questionnaire (EQ-5D). Statistical processing of the obtained results was carried out. Results. In the group of patients who completed rehabilitation, upon follow-up examination, there was a significant decrease in complaints, normalization of a number of hemodynamic parameters, an improvement in the 6-minute walk test scores, a decrease in the severity of dyspnea according to the MRC Dyspnea Scale by 1.8 times, a decrease in anxiety according to the HADS by 2.1 times, a decrease in pain according to the VAS by 3.2 times, an improvement in exercise tolerance according to the modified Borg Scale by 1.8 times and quality of life – according to the EQ-5D by 1.4 times. In the group of patients who refused rehabilitation, the change in these indicators was not significant. Conclusion. For patients who have had pneumonia associated with SARS-CoV-2, it is advisable to go through the third stage rehabilitation in a day hospital in order to restore the respiratory functions, increase exercise tolerance, reduce anxiety and improve quality of life.
Инновационные технологии полного объемного промывания полости носа в лечении аллергического и вазомоторного ринитов Д.м.н., проф. В.А. ДРОБЫШЕВ 1 , д.м.н., проф. Л.А. ШПАГИНА 2 , д.м.н. С.А. КАРМАНОВСКАЯ 2 , И.Г. ЗАЙЦЕВА 2 1 Кафедра госпитальной терапии и медицинской реабилитации (зав. кафедрой-д.м.н., проф. Л.А. Шпагина) Федерального государственного бюджетного образовательного учреждения высшего образования «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Красный проспект, 52, Россия; 2 Государственное бюджетное учреждение здравоохранения Новосибирской области «Городская клиническая больница №2» (главный врач-Л.А. Шпагина), Новосибирск, ул. Ползунова, 21, Россия Обследованы 60 мужчин и женщин (средний возраст 26,2±2,4 года) с ринитами, в том числе 30 человек (18 женщин и 12 мужчин) 20-45 лет с верифицированным диагнозом персистирующего аллергического ринита и 30 пациентов (16 мужчин и 14 женщин) 18-35 лет (средний возраст 22,5±1,7 года)-с нейровегетативной формой хронического вазомоторного ринита в фазе обострения, получавших базисную терапию антигистаминными препаратами II поколения, стабилизаторами мембран тучных клеток и деконгестантами, разделенных методом случайной выборки на 4 группы: 1А (20 пациентов с аллергическим ринитом) и 2А (20 пациентов с вазомоторным ринитом) получали в течение 30 дней в дополнение к базисной терапии процедуры промывания полости носа устройством Долфин; в группах 1В (10 пациентов с аллергическим ринитом) и 2В (10 пациентов с вазомоторным ринитом) проводилось только базовое лечение. К окончанию лечебного курса выраженность симптома «затруднение носового дыхания» у пациентов в группах 1А и 2А уменьшилась в 2,6 раза и соответствовала критерию «незначительное нарушение», тогда как в группе 1В снизилась только в 1,3 раза, а в 2В-изменения не были значимы и соответствовали «умеренно выраженному нарушению». Проявления ринореи после терапии снизились в группе 1А в 2,0 раза, а в группе 2А-в 1,7 раза, что расценивалось как «незначительная выраженность симптома», тогда как в группах 1В и 2В выявлялась лишь тенденция к улучшению. По завершении периода наблюдения выраженность симптома «чиханье» сократилась у пациентов в группе 1А в 4,0 раза, в группе 2Ав 3,3 раза и соответствовала «отсутствию нарушения», в то время как в группах 1В и 2В изменения оказались меньшими в 3,0 и 2,7 раза соответственно. По окончании лечебного курса у пациентов в группе 1А обоняние восстановилось, в группе 2А степень выраженности нарушений обоняния сократилась в 3,0 раза, тогда как в группе 1В-только в 1,2 раза, а в группе 2В-не изменилась. Согласно визуальной аналоговой шкале (ВАШ), на фоне лечения, оптимизированного промыванием носа устройством Долфин, наибольшее снижение нарушений бытовой жизнедеятельности было выявлено у пациентов с аллергическим ринитом-в 2,9 раза. После лечения влияние симптомов ринита на нарушение ночного сна снизилось в группах 1А и 2А в 1,9 раза, в то время как в группах 1В и 2В-только в 1,3 раза. Применение процедуры промывания носа устройством Долфин ...
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