Vol 33, No 7 (2022)

The pandemic of the novel coronavirus infection (NCI) has favored the development of economic, educational, political, and health crises. Healthcare workers turned out to be the most vulnerable population in terms of the risk of developing professional burnout. The additional challenges faced by healthcare staff have contributed to a multifold increase in the workload of healthcare professionals and increased susceptibility to stress and burnout. Objective. To identify the main occupational risk factors and to study the dimensions of professional burnout among the healthcare personnel of various facilities (COVID hospitals, outpatient clinics, and multidisciplinary hospitals) during the COVID-19 pandemic. Subjects and methods. A survey was conducted among the healthcare staff of COVID hospitals (n=201), outpatient clinics (n=186), and multidisciplinary hospitals (n=195), as well as in the control group (n=190). The Maslach Burnout Inventory and a questionnaire survey that assesses healthcare workers’ attitude to the current situation during the spread of the COVID-19 pandemic were used to study the professional burnout syndrome. Results. The Maslach Burnout Inventory demonstrated higher professional burnout rates in the healthcare workers, regardless of the place of employment. During which, there were significantly higher rates of professional exhaustion and depersonalization in the healthcare staff of COVID hospitals than in those of multidisciplinary hospitals (p≤0.001) and outpatient clinics (p≤0.001). At the same time, the healthcare staff of COVID hospitals had a significantly lower rate of reduced personal accomplishment than in those of the other facilities. In addition, the authors identified the main occupational risk factors (an organizational factor; a threat and risk of infection; stigma and social isolation) that influence the psychological health and professional burnout of healthcare workers during the spread of the COVID-19 pandemic. Conclusion. A comparative analysis showed that all the examined groups of healthcare workers had higher professional burnout rates, as evidenced by the Maslach Burnout Inventory. At the same time, the healthcare personnel of COVID hospitals had significantly higher rates of professional exhaustion and depersonalization and lower rates of reduced personal accomplishment than those of the other facilities. The treatment of patients with NCI exposes the staff to a number of specific risk factors related to the care of infected patients, as well as to considerable work changes associated with the organization and safety of a medical process during the pandemic, which contribute to increased stress and burnout.

Late admission to the intensive care unit is associated with increased mortality in severe community-acquired pneumonia (CAP). The purpose of the study was to summarize current data on the possibilities of assessing and predicting the severity of CAP. The effectiveness of predicting the severity of CAP was evaluated using the most popular scales. The current procedures for assessment and prediction are focused on the early detection of respiratory and cardiovascular insufficiency and other types of internal organ dysfunctions. The inclusion of various biomarkers substantially increases the informative values of the scales. However, none of the scales can be an absolutely accurate tool and they should be considered as an additional aid in clinical practice.

Tobacco smoking (TS) during pregnancy and secondhand smoke to the fetus may cause numerous and serious adverse health effects. Healthcare costs associated with labor complications are much higher for women who smoke during pregnancy than for non-smokers. The paper presents the results of a motivational smoking cessation program in pregnant women with nicotine addiction. Objective. To study regional experience and global trends in risk management of TS during pregnancy. Subjects and methods. The data of the WHO pilot project in the Slobozia District, Transdniestria (as of December 31, 2017), were used as material for prospective cohort and retrospective comparative studies. Exhaled carbon monoxide (CO) concentration was measured using the EC50 Smokerlyser in 276 pregnant women; 320 childbirth and newborn histories were analyzed. The investigators examined health and demographic characteristics, social status, frequency of somatic diseases and pregnancy complications in women with nicotine addiction, and newborn physical development indicators. Studies in Russian, English, and French were comparatively analyzed using the Medline and Cochrane databases and the recommendations of international societies. Results. Active psychosocial intervention of healthcare personnel contributed to smoking cessation in the first weeks of pregnancy in 22.1% of pregnant women with a mean TS duration of 7.14±1.31 years who smoked <10 cigarettes per day before pregnancy. The frequency of somatic diseases and pregnancy complications, and newborn physical development indicators did not differ from those in never smokers. Exhaled CO measurement is the tobacco intoxication marker with a high correlation, which makes it possible to assess the degree of adherence of pregnant women to TS. The method is easy to use and non-invasive and can therefore be useful in everyday practice. Conclusion. Emphasis should be placed on the integration of services for TS cessation with other healthcare services, for the training of healthcare professionals and for the elaboration of guidelines.

In Russia, decreased kidney function was diagnosed in 16% of able-bodied people and in 36% of people over 60 years of age. It is necessary to develop additional algorithms for diagnosing this disease for its early detection at the stage of screening, monitoring the development of pathology, and preventing complications. Objective. To evaluate the effectiveness of co-use of high-frequency skin ultrasound and contrast-enhanced renal ultrasound in the diagnosis of chronic kidney disease (CKD). Subjects and methods. The investigation enrolled 34 patients with a documented CKD diagnosis. The patients were divided into groups according to the glomerular filtration rate (GFR): Group 1 consisted of 17 patients with normal or slightly reduced GFR (>60 ml/min/1.73m2); Group 2 included 17 patients with significantly reduced GFR (30-44 ml/min/1.73 m2). The patients were examined according to the unified diagnostic algorithm: B-mode multiparametric renal ultrasound, contrast-enhanced renal ultrasound with the co-application of high-frequency skin ultrasound. Results. The proposed method for determining the severity of CKD, by assessing peripheral microcirculatory abnormalities using contrast-enhanced renal ultrasound and high-frequency skin ultrasound before and during intravenous contrast enhancement, by determining the difference between the values of ratio of acoustic scan lines, showed a high sensitivity (89.5%) and specificity (90.6%). Conclusion. The co-use of high-frequency skin ultrasound and contrast-enhanced renal ultrasound is effective in detecting and monitoring CKD.

Pathological menopause in 26-48% of women is accompanied by vascular, endocrine-metabolic, and neuropsychiatric disorders, which favors the development of somatic disease and substantially reduces quality of life. It is considered as a multifactorial disease, in the development of which the leading role is played by impaired autonomic and hormonal regulation, the decreased adaptive reserves of the hypothalamus and its insufficient adaptability to the changed conditions for the functioning of the hypothalamic-pituitary-ovarian axis. It is always impossible to prescribe menopausal hormone therapy, so a search for alternative therapy for menopausal syndrome remains extremely relevant. In this area, Femoklim (Parafarm, Russia) is one of the promising herbal remedies, an agent that simultaneously affects both triggers of menopausal symptoms, such as estrogen and testosterone deficiency. The authors give the results of their own study assessing cognitive function changes and quality of life indicators in postmenopausal women using the natural non-hormonal agent Femoklim.

The indicators of clinical and biochemical blood tests were analyzed in 54 patients with the extremely severe course of the novel coronavirus infection (NCI) COVID-19 who had died in the intensive care unit. It was established that >50% of the patients with the extremely severe NCI COVID-19 had anemia, as suggested by the significantly low levels of hemoglobin and hematocrit than in healthy people. The mean values of mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell distribution width did not differ substantially from those in healthy people. The study of the indicators of biochemical blood tests showed that the patients with the extremely severe course of NCI had a pronounced systemic inflammatory response. This was evidenced by higher C-reactive protein (CRP) and procalcitonin (PCT) levels in all the patients than in healthy people (a maximum of CRP was 478.7 mg/l, that of PCT was 22.7 ng/ml). The presence of a pronounced systemic inflammatory reaction was also suggested by a lower albumin level in the majority (88.9%) of patients (the minimum value was 17.3 g/l). The enhanced activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in >50% of the patients indicated impairments in the morphofunctional state of the liver (the maximum value of ALT was as much as 2608 U/l; that of AST was 5653 U/l). The majority (74.1%) of patients without concomitant diabetes mellitus in their history were observed to have an increase in glucose levels compared with healthy people (a maximum ranged up to 21.8 mmol/l). Most patients were found to have elevated levels of creatinine and urea in 68.5% and 88.9% of cases, respectively. At the same time, the maximum value of creatinine was 514 pmol/l; that of urea was 50.1 mmol/l. Impaired electrolyte metabolism was observed only in one-fourth of patients.

The purpose of this study was to determine the reliability of the use of shaving, haircut or depilation with cream at the site of surgery as a prevention of infection of the surgical intervention area. The statistical analysis of the data of modern Russian and foreign literary sources, as well as the latest scientific works in the field of preoperative preparation of the patient and prevention of infections in the field of surgical intervention was carried out. The development of such infections is a rather complex process that depends on several indicators directly related to patients and the operating environment. One of the most important factors is preparation. Preoperative preparation depends on the type of operation, the individual reaction of the patients skin, as well as on the preferences of the patient himself. Based on the results obtained during the study, it can be concluded that the use of a haircut or depilation cream is the best way of preoperative preparation than standard shaving with a blade.

The paper describes a rare clinical case of maxillary sinus adenoma. The tumor was removed using video-assisted endoscopy.

Objective. To evaluate the therapeutic efficacy of Floema® Complex in correcting androgenetic alopecia in women Subject and methods. The investigation involved 30 female patients diagnosed with androgenetic alopecia, who were divided into 2 groups according to therapy: 1) a control group of 15 patients who received mesoscooter therapy; 2) a study group of 15 patients who had topical treatment with Floema® Complex-based lotion applied to the scalp with one 1-ml pipette per night, as well as mesoscooter therapy. Therapy in both groups was performed for 3 months. Before and after treatment, all the patients underwent trichoscopy and phototrichogram using a special software and hardware FotoFinder system. To assess clinical presentations over time, survey scalp photography was done before and 3 months after therapy. Results. The study group patients were observed to have a more pronounced effect of treatment according to the following indicators: an increase in hair density in the parietal region from 191.0 (181.0-201.0) to 221.0 (207.0-228.0) (p=0.009), a decrease in the percent of telogen hair from 22.0 (16.0-33.0) to 14.0 (9.0-19.0) (p=0.116), and that in the percent of vellus hair from 23.0 (16.0 28.0) to 13.0 (11.0-16.0) (p=0.081); the control group had no significant positive changes in the condition of hair, as shown by the results of phototrichograms. Conclusion. A clinical study showed that Floema® Complex was highly effective in treating androgenetic alopecia in women.

AL amyloidosis (AL-A) is an extremely heterogeneous disease in clinical manifestations with no pathognomonic symptoms. Early diagnosis and cytoreductive therapy allow most cases to achieve a positive effect and to stop the progression of organ dysfunction. There is a literature review of scientific information on modern methods for the diagnosis of systemic AL-A. Attention is drawn to the difficulties in diagnosis, as well as to the main clinical signs that make it possible to suspect this disease. Consideration is given to the international criteria confirming the diagnosis and prevalence of the process, as well as prognostic staging systems. The timely diagnosis of AL-A is the most important task for physicians of various specialties, who see these patients at the first stages