2024, volume 20

Objective: hygienic assessment of working conditions and health status of surgeons based on the rates of morbidity with temporary disability. Material and methods. Assessment of working environment was done in accordance with the Guideline R 2.2.2006-05. Assessment of occupational risk was done in accordance with Guideline R 2.2.1766-03. The incidence of temporary disability was studied on the basis of sick leave certificates. Observation group — 493 surgeons. The comparison group was 353 men. The observation and comparison groups were divided into those with up to 10 years of experience and those with more than 10 years of experience. Results. According to the cause of morbidity the 1st places were occupied by acute respiratory viral infections (J00-J06), hypertension (110-115), dorsopathies (M40-M43). The increase in somatic morbidity due to hypertension by 5.4%; dorsopathies by 5.8%; varicose veins by 1.3% was revealed in workers with length of service. The analysis of morbidity with temporary disability in the comparison group showed significant differences in the proportion of incapacity for work due to early pregnancy in both seniority groups (15.9 and 7.8%, at p=0.025; 21.7 and 13.6%, at p=0.042, respectively), as well as varicose veins in the first stage group (8.5 and 2.9%, atp=0.019), and hypertension in the second stage group (24 and 16.6%, atp=0.048). Conclusion. The working conditions of surgeons corresponded to harmful 3-4 degrees (cl. 3.3-3.4). Statistically significant differences in the character of disability cases depending on the length of service were revealed. Diseases of the musculoskeletal system and diseases of the circulatory system were more frequently observed in workers with more than 10 years of service, which may indicate the industrial causation of these pathologies.

Objective: to study the quality of life (QoL) of children born prematurely with extremely low (ELBW) and very low body weight (VLBW), in the age aspect. Material and methods. In the stage 1 of the study, the QoL of 50 (Qualite de vie du Nourisson questionnaire) preterm infants (PI) (18 children with ELBW at birth, 32 with VLBW) and 20 full-term peers (control group) were studied at 3, 6, 9 months (corrected age for PI), 1 year (corrected age for PI), 2 and 3 years of life. In stage 2, the QoL (Pediatric Quality of Life Inventory questionnaire) examined of 40 PI aged 9-12 years compared to 20 full-term infants of the control group. The main group consisted of 14 children with ELBW and 26 children with VLBW at birth. Results. In the first three years of life, the QoL of PI is significantly lower than that of full-term, while in children with a birth weight of less than 1000 g at 2 and 3 years of life, it is significantly lower than in PI born with VLBW. Positive age-related dynamics of QoL was demonstrated. Disagreements between pediatricians and parents in the allocation of leading aspects of QoL in PI were revealed. At 9-12 years of age, the effect of body weight on QoL remained relevant for children with ELBW at birth, as assessed by the children themselves, and as assessed by parents for the entire PI group. Conclusion. The results obtained indicate a significant effect of birth weight on the quality of life of children born prematurely with VLBW and ELBW, in infancy, early and school age, which dictates the need to introduce this indicator as an integral criterion for monitoring their health status.

Objective: to compare the features of autonomic regulation of blood circulation in newborns of different gestational ages on the basis of heart rate variability (HRV) and photoplethysmographic waveform (PPWF). Material and methods. Fifty neonates were included in the study: group 1 (n=20; gestational age 37-42 weeks) — with physiological course of early neonatal adaptation period; group 2 (n=30; 34-42 weeks) with pathological course of early neonatal adaptation period: 2a (n=15; 37-42 weeks) — infants with birth weight >2500, and 2b (n=15; 34-36.6 weeks) — infants with birth weight <2500 g. All infants underwent synchronous recording of electrocardiography, pho-toplethysmography, and respiration signals using a Reacor-T multichannel biological signal recorder. Spectral analysis of HRV and PPWF was performed, and the strength of synchronization between low-frequency oscillations in HRV and PPWF (S-index) was assessed. Results. Infants in subgroup 2b had higher values of HR (p=0.004) and two HRV indices in the time domain: RMSSD — 26.6 (p=0.005) and PNN50 — 7.65 (p=0.002), relative to infants in the other groups. S-index was low in all infants (14.4-18.5). Conclusion. Newborns are characterized by functional immaturity of sympathetic autonomic regulation of blood circulation and predominance of sympathetic and baroreflex influences on cardiac function. In the regulation of peripheral blood flow in newborns of group 1, respiratory influences over sympathetic influences prevail, and in infants of group 2 — sympathetic influences.

Objective: to identify the association of congenital heart defects in children with maternal factors. Material and methods. This retrospective study reviewed the medical records of 109 children who were treated in the cardio-rheumatology department of Chelyabinsk Regional Children's Clinical Hospital between January 2016 and December 2018. All children underwent two-dimensional echocardiography with Dopplerography Results. The average age of the children was 9.48 years, 62% were boys. When analyzing the structure of congenital malformations, almost half of the children (47%) had defects with left-to-right discharge, 13% had defects from right to left, every 5th (19%) child had defects with cross-discharge, 4.5% of children had defects with blood flow obstruction, 5.5% had defects of the valvular apparatus, and 1.9% had defects of the coronary arteries of the heart. 14% of children were born with low birth weight, including 7% of children with left-to-right shunt heart defects. 67% of children with congenital malformations were born from repeated pregnancies. 59% of women had somatic pathology. In 17% of cases, the course of pregnancy was complicated by threatened miscarriage/threat of termination of pregnancy and/or chronic placental insufficiency. Infectious diseases during pregnancy were noted in 21 % of cases. In 10% of cases, pregnancy was complicated by premature birth. In 31 % of cases, delivery was performed by cesarean section for obstetric indications.

Using the example of a case of diffuse large B-cell lymphoma 4A with cardiac involvement, which occurred under the guise of myopericarditis with rhythm and conduction disturbances, the difficulties of diagnosis and treatment that affect the outcome of the disease are presented. The clinical case demonstrates the need for an expanded diagnostic search in unclear situations using telemedicine technologies, modern instrumental and immunohis-tochemical studies.

Objective: To develop a system of quality measures for monitoring the process and outcome of medical care in patients with chronic heart failure (CHF) in real clinical practice. Review methodology. The procedure for selecting indicators to monitor the treatment of cardiological patients proposed by О M. Posnenkova (2013) was applied. An analysis of the Russian Ministry of Health's clinical guidelines on CHF (2024) was conducted to determine the characteristics of the planned treatment outcomes and key measures with proven impact on outcomes. A systematic literature review using the PRISMA methodology was performed to identify therapeutic interventions that determine the achievement of results in real-world clinical practice. The PubMed and eLibrary databases were used. The search depth was from 2020 to 2024. Twenty-five sources were selected. Conclusion. In real clinical practice it is advisable to assess: 1) the proportion of patients with HF with reduced ejection fraction (EF) who have been prescribed quad-riple therapy (angiotensin-converting enzyme inhibitor/angiotensin receptor/angiotensin receptor neprilysin inhibitors + beta-blockers + aldosterone receptor antagonists + sodium/glucose cotransporter 2 inhibitors); 2) the proportion of patients with HF with preserved EF and HF with mildly reduced EF who have been prescribed sodium/glucose cotransporter 2 inhibitors; 3) the proportion of HF patients without adverse events (hospitalizations due to HF or death) over the past 12 months.

Objective: to analyse the measure of EEG connectivity in patients with cardiovascular diseases and obstructive sleep apnea. Material and methods. The patients (n=133) underwent polysomnography and were divided into 4 groups depending on the apnea-hypopnea index (AHI). Wavelet bicoherence method were used to assess the level of EEG connectivity for the whole duration of night sleep. Results. The mean value of interhemispheric connectivity decreases significantly with increasing severity of apnea syndrome almost at all frequency ranges. The mean values of occipital interhemispheric connectivity show an inversely proportional trend as AHI increases in Af6 [4.0-8.0 Hz]: 0.472 [0.391; 0.585], 0.439 [0.402; 0.509], 0.418 [0.384; 0.483], 0.395 [0.359; 0.433] (p=0.012). Intrahemispheric connectivity, both in the left and right hemispheres, is higher to interhemispheric connectivity and demonstrates heterogeneous dynamics. Conclusions. With increasing AHI, interhemispheric connectivity decreases and intrahemispheric connectivity increases selectively. At the same time, in the group of patients with AHK10 ep/h, this pattern is broken, and their measures of EEG connectivity correspond to the most severe cases of apnea.

Objective: to evaluate the role of soluble fms-like thyroxine kinase-1 and endothelial factor in patients with acute coronary syndrome in the post-COVID period. Material and methods. The study included 118 patients (including 57 women and 61 men) with acute coronary syndrome and COVID-19 history. Soluble fms-like thyroxine kinase-1 and endothelial factor were determined in all patients. The comparison group consisted of 121 patients with acute coronary syndrome without COVID-19. Results. High levels of soluble fms-like thyroxine kinase-1 and antibodies to endothe-lium were more often detected in the ACS and previous COVID-19 group than in the comparison group (risk ratio — RR=2.768 [95% confidence interval — Cl: 2.0810-3.681]; p<0.001) and (RR=1,554 [95% Cl: 1.216-1.987]; p=0.002), respectively. In the group of patients with ACS and COVID-19, a more severe course of ACS was also observed: rhythm disturbances were recorded more often (RR=1.372 [95% Cl: 1.005-1.784]; p=0.032), rehospitalization in the first 14 days for cardiovascular diseases (RR=1.475 [95% Cl: 1.100-1.977]; p=0.032) and hospital mortality (RR=1.610 [95% Cl: 1.160-2.233]; p=0.042). Conclusion. The obtained data allow us to say that anti-endothelial antibodies and soluble fms-like thyroxine kinase-1 are associated with the risk of developing severe ACS in patients with COVID-19 history.

Objective: to determine the prevalence of gastroesophageal reflux disease (GERD) and possible risk factors for its development among residents of the Republic of Dagestan. Material and methods. A survey of 496 residents of the republic (308 and 188 men) was conducted using the "Epidemiology and risk factors for the development of gastroesophageal reflux disease in Dagestan" questionnaire. Results. GERD was detected in 26.2% of respondents. GERD symptoms caused discomfort in 50% of respondents, forced 30.7% to give up their favorite foods, reduced productivity in 16.9%, and disrupted sleep in 27.7%. It was also found that GERD occurs significantly more often in people with a low level of education, low wages, with neurotic and anxiety-depressive disorders, leading a sedentary lifestyle, lonely people, obese people, smokers and frequent alcohol consumers, and those with bad eating habits (night snacks, overeating, eating in a hurry, eating dry food, abuse of spicy, sweet, fried and hot food). Conclusion. The prevalence of GERD in residents of the Republic of Dagestan is 26,2%. Reliable risk factors for the development of GERD are: low socioeconomic status and level of education, psychoemotional disorders, physical inactivity, alcohol abuse, smoking, loneliness (more common in single people, divorced people and widowers), overeating, night snacks, obesity, eating in a hurry and on the go, abuse of spicy, sweet, fried and hot foods.

This clinical case reflects the successful application of videothoracoscopic technologies in the surgical treatment of relaxation of the diaphragm with displacement of the abdominal organs into the thoracic cavity, with compression of the lung and mediastinum. A distinctive feature is the large volume of displaced organs into the thoracic cavity, which implies a significant increase in intra-abdominal pressure in the postoperative period, increased pressure on the operated area of the diaphragm, and a high risk of complications, and requires a combined approach to the treatment of an anesthesiologist and a surgeon in a specialized department.