Journal «MEDICINA» 4/2024

Background. Healthcare-associated infections are an urgent problem that has a global spread, negative consequences for patients and medical workers, as well as for the state as a whole. The purpose of the study. To identify long-term trends in healthcare-associated infections in the Republic of Tatarstan. Materials and methods. A retrospective analysis of the epidemiological process of ISMP in the Republic of Tatarstan from 2000 to 2023 was carried out. Cases of intrauterine infections were not taken into account when calculating the morbidity rates of ISMP. Statistical processing was performed using the Statistica program version 10.0.1011.0 (StatSoft). The significance of the differences was calculated using the Student's t-criterion with the calculation of a 95% confidence interval by the Wald method. Differences were considered significant at p ≤ 0.05. Trend and approximation coefficient were calculated in Microsoft Excel. Results. There is a downward trend in the registration of ISMP in the Republic of Tatarstan. For many years, the most affected ISMS in the Republic of Tatarstan have been obstetric institutions, the average proportion is 61 ± 0.1%, while surgical hospitals account for only 9.9 ± 0.06%. The annually low incidence of ISMP in the Republic of Tatarstan is due to the underreporting of some nosologic forms: surgical site infections, urinary tract infections, pneumonia, etc. Analysis of Form No. 2 «Information on infectious and parasitic diseases» from 2005 to 2023 revealed that the list of names of nosological forms of ISMP increased by 86%. At the same time, 62.9 ± 16.8%, 95% CI [52.1 – 69.2] of the list of nosological forms according to Form No2 are registered annually in the Republic of Tatarstan. In the Republic of Tatarstan in 2023, the list of prevalent pathogens of ISMP includes bacteria of the genus Klebsiella spp. and Acinetobacter spp. Conclusion. The results of the analysis of the epidemiological situation of ISMP in the Republic of Tatarstan indicate the need for a risk-oriented approach to preventive and anti-epidemic measures. Further work is required to improve the system of epidemiological surveillance and measures to prevent infections associated with the provision of medical care.

Key words: infections related to medical care, Republic of Tatarstan

Background. Harmful alcohol use is associated with increased risk and severity of outcomes in infectious diseases such as HIV/AIDS, tuberculosis, and pneumonia. Alcohol impairs the ability of lung tissue to respond adequately to inflammation, injury, and infection. General hospitals are considered a convenient setting for treating of individuals with alcohol use disorders. Aim of the study. To study the prevalence of alcohol consumption among acutely ill pulmonary patients, not requiring intensive care, hospitalized in a multidisciplinary urban clinical hospital, using screening self-questionnaires (AUDIT-4) and a highly sensitive and specific marker of chronic alcohol intoxication phosphatidylethanol (PEth). Materials and Methods. We studied the prevalence of alcohol use in pulmonary patients with regard to their socio-demographic characteristics. Statistical analysis was performed using IBM SPSS Statistics 25.0 software. We applied descriptive statistics and multivariate logistic regression model to estimate the impact of socio-demographic and diagnostic predictors on the dependent variable and control for confounders. Results. Peripheral blood PEth values of 0.3 μmol/L or more, indicating excessive alcohol consumption during the 2–4 weeks prior to hospitalization, were observed in 8.5% of pulmonary patients. 5.0% of patients admitted drinking alcohol during the day prior to hospitalization. The highest proportion of alcohol abusers (PEth ≥ 0.3 μmol/L) was observed among patients with pneumonia (Influenza and pneumonia (J09–J18)) – 10.7%. The results of the regression analysis showed that women were negatively associated with PEth level ≥ 0.3 μmol/L compared to men (AOR 0.269; CI 95% 0.139-0.519; p<0.001) and patients with diagnoses from the diagnostic rubric «Chronic lower respiratory diseases» (J40-J47) compared to the reference group of the diagnostic rubric «Influenza and pneumonia» (J09-J18) (AOR 0.537; CI 95% 0.296-0.974; p=0.041). There was a positive association with the level of PEth ≥ 0.3 μmol/L in patients who defined their employment status as «Inactive», compared with the reference group «Active» (AOR 2.268; CI 95% 1.191-4.320; p=0.013) and in individuals in psychological distress (SCL-5≥2) compared with those not in distress (SCL-5<2) (AOR 2.892; CI 95% 1.210-6.910; p=0.017). Significant positive association with a PEth level ≥0.3 μmol/L (OR 7.077; 95% CI 3.485–14.371; p <0.001) was observed in those who admitted drinking alcohol during the day prior to hospitalization compared with the reference group of those who answered negatively. Conclusions: Our findings support the need for brief anti-alcohol interventions in multidisciplinary hospital settings.

Key words: harmful alcohol use, AUDIT-4, phosphatidylethanol, community-acquired pneumonia, alcohol-related disease, pulmonary pathology, brief intervention

Background. The article presents the results of microbiological monitoring of microorganisms of the respiratory tract of patients with cystic fibrosis (CF), changes in the spectrum, palette, and antibacterial resistance during repeated hospitalizations in a specialized hospital. Purpose of the study. To analyze the results of microbiological examination of respiratory tract biomaterial of children with CF hospitalized in a multidisciplinary pediatric hospital to optimize epidemiological surveillance at the local level. Materials and methods. The material for the study was the results of a microbiological study of smears from the pharynx, nose, or induced sputum of patients with cystic fibrosis observed at the Children's Center for Cystic Fibrosis (CF). Identification of isolated cultures was carried out by classical bacteriological methods. Subsequently, the isolated microorganisms were systematized to species. The analysis was carried out for 2019-2023. Determination of sensitivity to antibacterial drugs was carried out using the disk diffusion method. Indicators of the frequency (%) of isolation of various microorganisms and the frequency (%) of resistant microorganisms to the antimicrobial drugs used in a medical organization (MO) were calculated. A comparison was made of the frequency (%) and spectrum of isolated cultures during initial and subsequent hospitalizations at the Children's Cystic Fibrosis Center. Confidence intervals CI (95%) were calculated for relative values. Calculations were carried out using the epidemiological calculator Confidence Interval Calculator. Results. In the structure of isolated cultures from the biomaterial of the respiratory tract of children with cystic fibrosis, 45.4% were gram-negative microorganisms. During initial and subsequent hospitalizations, the highest frequency of isolation were Pseudomonas aeruginosa, Klebsiella pneumoniae, Stenotrophomonas maltophilia. Gram-positive microorganisms in the spectrum of isolated cultures amounted to 37.9%. The majority of the isolated gram-positive microorganisms are represented by Staphylococcus aureus (75.7%). During repeated hospitalizations to the Children's CF Center, based on the monitoring results, changes in the spectrum, frequency of isolation, and spectrum of resistance to antimicrobial drugs were determined. An increase in the frequency (p<0.05) of the isolation of Pseudomonas aeruginosa and Staphylococcus aureus was determined. During repeated hospitalizations, the frequency of isolation of associations of microorganisms increased from 50.5% CI [55.7; 45.3] to 81.4% CI [83.8; 79.0] (p<0.05). An increase in the frequency (p<0.05) of isolation of Pseudomonas aeruginosa strains resistant to reserve antibacterial drugs was determined by 3.2 times during subsequent hospitalizations. Conclusion. The revealed changes in the spectrum, frequency, palette and antibiotic resistance of microorganisms of the respiratory tract of CF patients at the local level of epidemiological surveillance indicate the need to develop algorithms of action in outpatient and inpatient management of CF patients to ensure epidemiologic safety of medical activity and improve the quality of medical care.

Key words: Cystic fibrosis, microbiological monitoring, chronic lung infection, antibiotic resistance, epidemiological risk, epidemiological surveillance

Introduction. Young shoots of raspberry vulgaris contain a variety of biologically active substances with pronounced antiradical activity. The aim: Determination of the content of the main groups of biologically active substances and the antiradical activity of leaves and leafless parts of raspberry shoots. Materials and methods of research. Raw material for the study was harvested on the territory of the Ilyinsky district of the Perm Territory in June 2023. Raw material was collected only from well-developed specimens not damaged by pests. Harvested shoots were air-shade dried. Determination of the content of water-soluble polysaccharides was carried out spectrophotometrically using the modified Draywood antron-sulfur method. The determination of the amount of flavonoids in raspberry shoots was carried out by spectrophotometry, by complexation reaction with 2% solution of aluminum chloride. To determine the antiradical activity, a reaction with the stable free radical 2,2-diphenyl-1-picrylhydrazyl was used. Results of research and their discussion. The content of extractive substances extracted by water was found to be higher in raspberry leaves. It was found that the content of water-soluble polysaccharides, tannins and flavonoids is higher in the leaves of ordinary raspberries, compared with the leafless part. Infusion of raspberry ordinary shoots has a pronounced antiradical activity. The antiradical activity of the infusion of raspberry shoots turned out to be higher, compared with the decoction of rosehip fruits which acted as a comparison drug. Conclusion. In the study of biologically active substances, it was found that ordinary raspberry leaves accumulate higher BAS major groups. However, the level of antiradical activity of raspberry infusions of ordinary leaves and leafless parts does not differ significantly.

Key words: raspberry, shoots of the first year, biologically active substances, antiradical activity

The work is devoted to the analysis of scientific literature data on the consequences of vaccination with foreign mRNA vaccines against COVID-19. Evidence is presented for the presence of delayed, not immediately apparent clinically serious consequences. Particular attention is paid to the theory of «spikeopathy» – the pathogenetic effect of vaccines caused by the SARS-CoV-2 spike protein. Three potential pathogenetic mechanisms are considered that could explain the toxicity observed with the use of mRNA vaccines against COVID-19: 1) chemical toxicity of lipid nanoparticles, 2) direct toxicity of the spike protein, the expression of which is induced by vaccines, 3) destructive effects of the immune response to the protein spike. Evidence is provided of contamination of mRNA vaccines with plasmid DNA, which includes the promoters of the simian virus (SV40), associated with cancer in humans, and metal particles. It has been shown that booster doses of mRNA vaccines may worsen the immune system in immunocompromised individuals. It was noted that after the peaks of increased mortality in 2020 and 2021 due to COVID-19 disease in Russia, no further peaks of increased mortality were observed, while in Europe there was a high mortality rate in 2022 and 2023. The situation was assessed and a conclusion was made about the need for assessments of the possible consequences of vaccination, taking into account delayed consequences.

Key words: mRNA vaccines, recombinant vaccines, gene therapy, lipid nanoparticles, side effects

Aim of the study. To study the importance of anatomical and structural parameters of the eye in the effectiveness of treatment with orthokeratological lenses in myopia. 200 eyes (100 patients) were examined, including 160 eyes (80 patients) with myopia – 60 eyes (30 patients) with a mild degree and 100 eyes (50 patients) with an average degree; mean age 12.0± 0.38 years, control group – 40 eyes (20 people) – healthy individuals with emmetropia. Research methods. Along with the generally accepted methods, autorefractometry (Grand Seiko VR-2100), ophthalmometry (Topcon KR-7309), biometry (Zeiss IOLMaster 500), keratotopography (root otopographic system SW-600), accommodation study – AKA-01 device, and Shapovalov S.L. method, skiascopy against the background of cycloplegia, ultrasound of the eye, ultrasound of the retinal vessels, OST-angiography, study of the hydrodynamics of the eye (Glau Test 60). Follow-up in 1-3-6-12-24 Months. Results. With the formation of induced myopia against the background of the use of orthokeratological lenses in mild and moderate myopia, an increase in the difference in corneal curvature between the central and peripheral zones was revealed – the coefficient «Q» is equal to (-) 0,56±0,05 mm and (-) 0,57 ±0,054 mm (Р <0,001), in CG (-) 0,26±0,03 mm; increase in the index (asymmetry) «I-S» – before 2,78±0,18D and 3,22 0,12D (Р <0,001), in CG –>1,2±0,18D (Р <0,01); increase in the frequency of refractive power amplification along the vertical and horizontal meridians (SimK1, Sim K2) by 37% and 44%; Normalization of hydrodynamic parameters: «Po» is normal in в 30%; increase «C» – up to 0,22 мм³/min (Р<0,05); increase in AAA to 7,6 D±0,23  and 8,5D±0,01 (Р <0,05)  and 1,5 times – ZOA; increase in LSC in CAC to 15.0±0.64 cm/sec and in CVD – up to 5.5±0,59 cm/sec (Р <0,05) with choroidal thickening to 301±1,9 мкм (Р <0,05). Effectiveness of treatment with orthokeratological lenses: increase in NCOZ to 0.9-1.0 in 100%; reduction of the degree of myopia to (-) 0.55D±0.21 (P <0.01); lack of reliable stretching of the AXL. Conclusion: One of the additional factors contributing to the effectiveness of the use of orthokeratological lenses in mild and moderate myopia are: activation of accommodation, normalization of hydrodynamics and hemodynamics of the eye.

Key words: Myopia, orthokeratological lenses, myopic defocus, accommodation, hydrodynamics and hemodynamics of the eye

Introduction. The review is devoted to epidemiologic aspects of community-acquired pneumonia. The incidence of community-acquired pneumonia remains high both in the world and in the Russian Federation (RF). The economic burden of this infection shows the need for the development of new methods to combat community-acquired pneumonia. Purpose of the study. To study the epidemiologic features of community-acquired pneumonia at the present stage. Materials and methods. We analyzed original articles on the topic of community-acquired pneumonia published in the databases PubMed, VINITI, electronic scientific library cyberleninka.ru. The most important articles in English and Russian, investigating issues related to etiology, epidemiology, diagnostics and treatment of out-of-hospital pneumonia, were selected. Results. Statistical data on the incidence of out-of-hospital pneumonia in the Russian Federation for 2019-2023 are presented. The etiology, main risk factors, risk groups and methods of prevention of this infection are studied. The etiologic significance of Streptococcus pneumoniae and Staphylococcus aureus in the development of community-acquired pneumonia is considered. Antibiotic resistance of clinical isolates of Streptococcus pneumoniae occurring in the Russian Federation is presented. The importance of vaccine prophylaxis of community-acquired pneumonia to prevent its spread in organized collectives is noted. Conclusion. The analysis of the literature has shown that the study of epidemiology of community-acquired pneumonia is an urgent task at the present stage. Interest in this infection is constantly maintained at a high level. In 2019, since the advent of the COVID-19 pandemic, the publication activity on this topic has significantly increased. The issues of studying new etiologic agents of community-acquired pneumonia, search for modern drugs and diagnostic methods, development of regulatory documentation for the purpose of timely epidemiologic monitoring and prevention of community-acquired pneumonia remain relevant.

Key words: community-acquired pneumonia, epidemiology, Streptococcus pneumoniae, Staphylococcus aureus, virulence factors, vaccines

Introduction section shows the relevance of the problem of female alcoholism. An overview of the main causes of alcohol dependence in women is given. Among the main factors of female alcoholism, researchers distinguish heredity, biological and psychogenic-stress factors, the peculiarities of the metabolism of the female body, as well as the degree of socialization of women in society. The purpose of the study is to investigate the clinical manifestations and reasons of alcohol dependence in women and their impact on socio-demographic indicators. In the Methods section the use of statistical and analytical methods in the study is described. Results present the characteristics of socio-demographic indicators characterizing the alcohol situation in the region and the state of the narcological service: the level of general incidence of alcoholism and alcoholic psychosis, the level of alcohol consumption, the share of women among all patients who turn to psychiatrists-narcologists. The Findings present the analysis of the alcohol situation in the Sverdlovsk region, considering positive and negative factors, characterizing the activities of the regional narcological service.

Key words: alcoholism, women, features, factors