2024, volume 20

Objective: evaluation of factors affecting hospitalization of children of the first month of life in a multi-disciplinary children's hospital in a metropolitan area. Material and methods. Using the continuous method, data from 267 children in the first month of life in St. Petersburg was copied from the Ariadna medical information system. Re-sults. In 2020-2022 the majority of children were treated through compulsory medical insurance (89.5-93.2%). During the year of the COVID-19 pandemic, 66.7% of patients were admitted as emergencies. More than half of the children were admitted through internal routing. In 2022, the highest hospitalization rate was in patients with certain conditions arising in the perinatal period (452.6%o) and congenital malformations (242.1%o), and the longest average duration of treatment was observed in patients with factors influencing health status population and visits to health care institutions (24.5±7.5 days), respiratory diseases (22.5±21.5 days). Most children were discharged with improvement. Conclusion. The hospitalized morbidity of children in the neonatal period is influenced by a significant number of factors, among the main ones being the location of the medical organization, the presence of a perinatal center in its structure and the COVID-19 pandemic.

Objective: to assess the influence of medical and social risk factors for cardiovascular diseases on outcomes of patients living in rural and remote areas of the Russian Federation. Review writing methodology. A systematic review was carried out according to the PRISMA (The Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology using eLibrary, Google Scholar, and CyberLeninka databases. Search depth — from 2002 to 2022. The review included 19 original studies. It has been established that the prevalence of cardiovascular diseases risk factors in the rural population is not always higher than in the urban population, and the outcomes are worse. Conclusion. It has been shown that among the rural population, social determinants of health come to the fore, determining the ability of patients to follow recommendations for managing risk factors and receive timely and high-quality medical care.

Objective: an integral assessment of the working conditions of doctors of central district hospitals, followed by a quantitative differentiated selection of the totality of the most adverse factors for the health of doctors. Material and methods. A study of the harmful factors of production activities of 80 medical workers (24 surgeons, 16 anesthesiologists, 18 neuropathologists and 22 emergency doctors) of the central district hospital was carried out during 2021-2022 in accordance with the requirements of R 2.2.2006-05, based on the results of a special assessment of working conditions (SOUT). A mathematical model proposed by V. Ivanov (2016) was used to calculate the values of the integral assessment of the working conditions of doctors, expressed in conditional units (UE). Results. The indicators of integral assessment of working conditions calculated as a result of the studies were: for emergency doctors — 5.18 units, surgeons — 3.47 units (were consistent with the dangerous), for anesthesiologists — 2.27 units (met unacceptably harmful conditions), for neuropathologists — 0.13 units (were characterized as harmful). Conclusion. The method of integral assessment of harmful working conditions of medical workers makes it possible to quantitatively carry out a differentiated selection of the totality of the most dangerous industrial factors for the health of doctors.

Objective: to determine the effectiveness of magnetopuncture techniques in the corrective treatment of asthenic syndrome with autonomic manifestations in operators. Material and methods. 66 employees of the operator service aged 24-47 years with asthenia were examined. A survey, a neurological examination, a subjective assessment of fatigue using Fatigue Assessment Scale (FAS) were conducted before and after treatment. Acupuncture treatment included 10 sessions of magnetopuncture. Results. After the course of magnetopuncture, there was an improvement in the condition of the patients, a significant decrease in the subjective assessment of fatigue on the FAS scale from 31.2 (28.6; 34.6) to 17.6 (15.4; 18.8) points (p=0.001). According to the data of the heart rate variability spectrum after corrective treatment, there was a significant increase in the high-frequency component (HF) in absolute values (p<0.001), as well as significant differences in the components of LF (p=0.011) and HF (p=0.027) in normalized units, and the ratio of the low-frequency component to the high-frequency one (LF/HF) (p=0.006). Conclusions. The proposed scheme of magnetopuncture is an effective non-drug technique for the correction of autonomic disorders in asthenic syndrome among operators, and can be used for complex rehabilitation.

In the article is presented clinical case of a patient with late parenchymal neurosyphilis in the form of progressive paralysis. The basis of the clinical manifestations of the disease in the patient was progressive cognitive impairment. The described case demonstrates clinical similarities with chronic cerebral circulatory disorders, multiple sclerosis, neurodegenerative and mental diseases, shows the need to remain vigilant of neurologists and therapists regarding rare but curable diseases of the nervous system due to their polymorphic clinical picture and erased course.

Objective: to assess the concentration of the sST2 biomarker and its relationship with the morphological and functional parameters of the LV myocardium in patients with coronary artery disease and chronic heart failure (CHF) l-lll functional class (FC), who had and did not have COVID-19. Material and methods. We examined 100 patients (66 males), median (Me) age 65 [63; 67] years, with stable coronary artery disease with CHF l-lll FC (New York Heart Association), divided into 2 groups depending on the COVID-19. Along with the conventional clinical examination, the concentration of serum sST2 was determined by enzyme immunoassay Results. It was found that in patients who underwent COVID-19 (group 1), the sST2 level was 38.4 [35.5; 44.8] ng/ml, in the comparison group (group 2) — 29.63 [27.9; 32.7] ng/ml (p<0.001). In group 1, the final diastolic volume and the final systolic volume of LV significantly exceeded those in group 2 (p=0.004 and p=0.02) and amounted to 118.2 [107.5; 166.5] and 44.1 [35.0; 58.1] ml, respectively, for the 1st and 107.5 [92.4; 129.5] and 37.9 [29.5; 47.4] ml for the 2nd group. The number of patients with grade 2 diastolic dysfunction (DD) in group 1 (18-33.9%) significantly exceeded that in the comparison group (7-14.9%). Changes in global longitudinal deformation of LV in COVID-19 group (-15.6 [-20.8; -13.8]%) were more pronounced than in the comparison group (-19.9 [-21.5; -16.3]%)(p=0.018). Conclusion. CHD patients with CHF l-lll FC and previous COVID-19, have significantly higher serum sST2, more pronounced LV DD and greater global longitudinal deformation.

Objective: to assess the presence of cardiometabolic risk factors in women who have suffered arterial or venous thrombosis at a young age. Material and methods. The type of study is a "cross-section" based on a prospective observational study. The main group included 49 women aged 18-44 who had undergone instrumental^ verified arterial or venous thrombosis at least 1 year ago. The median follow-up was 80.3 months [50.1; 96.2] months. The control group included 24 practically healthy female volunteers in the same age range. All patients underwent a comprehensive laboratory examination, bioimpedance measurement and oscillographic sphygmography Results. Women with a history of thrombosis had higher levels of LDL cholesterol (3.4±0.8 vs 2.6±0.6 mmol/L); lipoprotein (a) (90.6±7.4 vs56.9±6.5 mg/dl) and adiponectin (10.4±4.3 vs 8.2±3.6 mcg/ml); lower levels of cholesterol HDL(1.5±0.4 vs 1.8±0.4 mmol/l) (0.049>p>0.001). The incidence of visceral obesity in this group was 76.2% vs 37.5% in the control group (p<0.001). The total number of cardiovascular risk factors in these patients averaged 2.7±0.1 vs 1.4±0.2 in the control group (p=0.0001). In the main group, an increase in the cardio-ankle vascular index was revealed 6.85±0.95 vs 6.20±0.51 (p=0.044) in women without thrombosis. Only in the group with thrombosis patients have a decrease in LPK0.9 and an increase in the CAVI index>8 (18,5 vs 0% in the control; p=0.025). Conclusion. Young women with a history of thrombosis are characterized by a more burdened profile of cardiometabolic risk factors, a higher incidence of visceral obesity and increased vascular wall stiffness compared with women without thrombosis of the same age group.

Objective: clinical characteristics of patients with carbohydrate metabolism disorders (CDM) in the post-COVID period. Material and methods. 72 people with CDM in the post-COVID period were examined. Results. When detailing complaints, the incidence of respiratory symptoms in patients with impaired glucose tolerance (IGT) and diabetes mellitus (DM) was comparable. In both groups, nonspecific (general weakness) and neurological (memory deterioration, sleep disturbances, decreased vital activity) symptoms predominated. The development of NUD in the post-COVID period was facilitated by such risk factors as age >45 years, body mass index >25 kg/m2, family history of type 2 diabetes, hypertension. The most common concomitant diseases were overweight and obesity — in 64 (88.9%) patients, dyslipidemia — in 44 (61.1%), hypertension — in 32 (44.4%). In the group of patients with IGT, the frequency of re-infection with SARS-CoV-2 was higher compared to the group of patients with diabetes, and there was a tendency for the course to become more severe with re-infection. Conclusion. In the post-COVID period, patients with IGT and diabetes are more likely to have nonspecific and neurological complaints, while identified NDEs can aggravate the course of concomitant diseases and lead to re-infection with SARS-CoV-2.

Objective: to determine the potential prognostic value of serum biomarkers in relation to the development of adverse cardiovascular events in patients who have undergone COVID-19. Material and methods. The prospective study involved 114 patients hospitalized with confirmed COVID-19. In addition to standard examinations, blood samples were taken from patients on the day of hospitalization to determine the level of serum cardiovascular biomarkers, including pentaxin-3 (РТХЗ). The patients were monitored for 366 [365; 380] days after discharge from the COVID hospital with registration of major adverse cardiovascular events (MACE) developed in patients. Results. During follow-up, MACE was noted in 19 patients (16.7%), including 2 deaths (1.8%) from cardiovascular causes. The incidence of MACE was higher in patients with higher concentrations of РТХЗ (odds ratio — OR 1.28, 95% confidence interval — Cl 1.13-1.45; p<0,001), interleukin 6 (OR 1.01, 95% Cl 1.0-1.02; p=0.048), D-dimer (OR 2.05, 95% Cl 1.16-3.6; p=0.019), lactate dehydrogenase (OR 1.08, 95% Cl 1.03-1.13; p<0.001), creatine phosphokinase-MB (OR 1.19, 95% Cl 1.02-1.39; p=0.001). The concentration of PTX3>3.1 ng/ml predicted the development of MACE with a sensitivity of 94.0% and a specificity of 82.1% (AUC 0.885; p<0.001). Conclusion. Serum biomarkers, in particular РТХЗ, may be used to predict the development of MACE in the long-term follow-up of patients who have undergone COVID-19.

Lumbar fractures are an urgent medical problem. They are often feature the compression of dural sac and roots followed by neurological deficit. This case study presents the anterior approach surgery as the method of choice for the management of multiple fractures with damage to the A and В columns ensuring optimal decompression of the spinal canal and deformity correction and avoiding multi-stage interventions.