Hospital In Moscow Research Articles

Clinical and economic assessment of nosocomial pneumonia antibacterial therapy in Moscow hospital

Objective: to conduct clinical and economic analysis of nosocomial pneumonia antibacterial therapy in a multidisciplinary hospital in Moscow.Material and methods. The medical records of patients admitted to Yudin City Clinical Hospital in Moscow in 2019–2021 were analyzed retrospectively. Pharmacoepidemiological analysis included the structure of prescriptions of antibacterial drugs (ABDs), features of empirical and etiotropic therapy, duration of using ABDa and other parameters. In total, 110 cases of severe nosocomial pneumonia caused by ESKAPE pathogens were selected for analysis. Direct medical costs and cost-effectiveness coefficients were calculated based on real world data.Results. It was established that nosocomial pneumonia is the most common complication among hospitalized patients in the intensive care unit (ICU). The etiology of nosocomial pneumonia was mostly presented by K. pneumoniae, A. Baumanii, and P. aeruginosa. The administered ABDs included 31 international nonproprietary names of the group J01 Systemic antibacterial drugs. The direct medical costs of empirical antibacterial therapy averaged for 9367 rubles (2118 rubles [1462; 3525]). Comparative cost-effectiveness analysis was performed based on surrogate and endpoints. It was found that direct medical costs associated with ESKAPE pathogens spend about 70% of the budget of established tariff to pay for medical care of the compulsory health insurance program for the patient's stay in the ICU.Conclusion. Antibacterial therapy costs for nosocomial pneumonia significantly increase the total cost of a patient's hospital stay. Сlinical and economic assessment of drug use help optimize therapy costs and develop a hospital formulary of antimicrobial drugs.

The primary hyperparathyroidism and its complications: Substantiation of funding volume for hospital pharmacotherapy

This study investigates factors influencing the cost of pharmacotherapy for primary hyperparathyroidism (PHPT) in a hospital setting to optimize therapeutic strategies and rationalize financing. The study was conducted from 2020 to 2023 and included 200 patients with PHPT from two hospitals in Moscow, Russia. The key aspects for analysis were demographic profiles, treatment methods, complications, and associated costs. The majority of patients (52.1%) were aged 60-74 years, while only 2.0% were aged 75 or older. The most frequently prescribed medications were cardiovascular drugs (33.5%) and vitamin supplements (25.1%). Colecalciferol (13.5%), bisoprolol (6.8%), and cinacalcet (4.9%) were the most common individual medications. The study revealed that the cost of conservative treatment without complications was twice that of surgical treatment. These models can aid in justifying and optimizing PHPT treatment financing in hospital settings. The findings highlight the importance of individualized treatment approaches and cost optimization strategies.

168. Ocrelizumab in Real Clinical Practice of one Municipal Clinical Hospital in Moscow: Experience of Prescription, Safety and Efficacy Problems

168. Ocrelizumab in Real Clinical Practice of one Municipal Clinical Hospital in Moscow: Experience of Prescription, Safety and Efficacy Problems

Two multidrug-resistant Proteus mirabilis clones carrying extended spectrum beta-lactamases revealed in a single hospital department by whole genome sequencing

Proteus mirabilis bacteria is a component of normal intestinal microflora of humans and animals, but can also be found in hospital settings causing urinary tract infections and sepsis. The problem of treating such infections is complicated by multidrug-resistant isolates producing extended spectrum beta-lactamases (ESBL), and the number of ESBL-carrying P. mirabilis strains has significantly increased recently.This study presents a detailed analysis of 12 multidrug-resistant P. mirabilis isolates obtained from the wounds of different patients in one surgical department of a multidisciplinary hospital in Moscow, Russia, using the short- and long-read whole genome sequencing. The isolates under investigation divided into two clusters (clones) C1 and C2 based on their genomic profiles and carried antimicrobial resistance (AMR) genes corresponding well with phenotypic profiles, which was the first case of reporting two different P. mirabilis clones obtained simultaneously from the same specimens at one hospital, to the best of our knowledge. Some genes, including ESBL encoding ones, were specific for either C1 or C2 (aac(6′)-Ib10, ant(2″)-Ia, qnrA1, blaVEB-6 and fosA3, blaCTX -M-65, correspondingly). Additionally, the Salmonella genomic islands 1 were found that differed in composition of multiple antibiotic resistance regions between C1 and C2 groups. CRISPR-Cas system type I-E was revealed only in C2 isolates, while the same set of virulence factors was determined for both P. mirabilis clones.Diversity of all genetic factors found in case of simultaneous existence of two clones collected from the same source at one department indicates high pathogenic potential of P. mirabilis and poses a requirement of proper spreading monitoring. The data obtained will facilitate the understanding of AMR transfer and dynamics within clinical P. mirabilis isolates and contribute to epidemiological surveillance of this pathogen.

COVID-19 in children with somatic pathology

The coronavirus infection is a pressing issue in modern healthcare, yet the characteristics of the SARS-CoV-2 infection course in children with comorbidities remain insufficiently studied. The aim of this study was to evaluate the clinical form, severity, and duration of SARS-CoV-2 virus shedding in pediatric patients with somatic diseases, depending on the comorbid pathology. Materials and Methods. A comprehensive single-center retrospective study was conducted, analyzing 314 medical records of patients hospitalized in the infectious diseases department of the Russian Children’s Clinical Hospital in Moscow over 11 months in 2022. The inclusion criterion was the presence of a laboratory-confirmed COVID-19 diagnosis. Results. Children with comorbidities were found to be predisposed to a more severe course of SARS-CoV-2 infection compared to the pediatric population in general. Children with hematological diseases were at the highest risk of adverse outcomes from COVID-19. Patients with oncological and hematological diseases and primary immunodeficiencies shed the SARS-CoV-2 virus significantly longer than patients with other somatic pathologies. The duration of SARS-CoV-2 RNA detection in patients with severe COVID-19 was significantly longer, which also correlated with the severity of the underlying somatic disease. Conclusion. Children with comorbidities are at risk for a more severe and prolonged course of SARS-CoV-2 infection.

Glucosuria as a major mechanism-associated effect of sodium-glucose cotransporter 2 inhibitors: Is there cause for concern?

Introduction. One of the main mechanisms of action of SGLT2 inhibitors is an increase in renal excretion of glucose and sodium, development of glucosuria against the background of decreased levels of daily glycemia. The frequency of glucosuria development in patients without DM/prediabetes, receiving SGLT2 inhibitors for the treatment of CHD or CKD, as a consequence of the mechanism of action of SGLT2 inhibitors inhibitors is poorly studied and seems to be very interesting.Aim. To evaluate in real clinical practice the frequency of the development and severity of glucosuria in patients with CHF treated with inhibitors of SGLT2 inhibitors both on the background of concomitant DM2 and without type 2 DM.Materials and methods. Within the framework of a one-stage, prospective, observational study we evaluated the frequency of development and severity of glucosuria in patients with CHF, receiving SGLT2 inhibitors inhibitors, who were in the cardiology department of V.P. Demikhov State Clinical Hospital of Moscow. A total of 230 patients were included in the analysis.Results. The mean age of the patients was 74 [66; 83] years. Median LVEF was 36 [29; 44] %, NTproBNP 1019 [423; 2355] pg/ml. Heart failure with reduced ejection fraction (HFrEF) was recorded in 64.81% of patients, 17.13% had HF with mildly reduced ejection fraction and 18.06% had a СHF preserved ejection fraction. DM2 was present in 38.7 percent of patients with СHF. Among patients with CHF, the ‘glucosuria phenomenon’ due to the administration of SGLT2 inhibitors was observed in 31.16% of those without DM2, and in 52.27% of СHF patients with concomitant DM2.Conclusion. In patients with CHF receiving SGLT2 inhibitors therapy, the ‘glucosuria phenomenon’ developed in one in three patients without overt carbohydrate metabolism abnormalities and one in two with DM2. The findings suggest that the glucosuria effect of SGLT2 inhibitors is not a required event even in patients with DM2, which may influence the incidence of adverse events in general clinical practice. And the cardioprotective benefits of SGLT2 inhibitors may be due to other mechanisms unrelated to glucose excretion, which, according to recent studies, is considered a surrogate predictor of favorable prognosis concerning CHF and renal outcomes. Nevertheless, additional clinical and experimental studies are required to determine the cardioprotective mechanisms of SGLT2 inhibitors and the predictive value of drug-induced glucosuria.

Orbital injuries: aspects of forensic medical examination in assessing the severity of harm caused to human health

Background: Forensic examination plays a key role in establishing the severity of injuries, especially of orbital trauma, which can lead to serious consequences, including vision loss. Examination of forensic reports associated with orbital trauma provides valuable information about the nature of the injuries, their prevalence, and factors influencing the severity of the injury. Aim: Analysis of the possibilities of an interdisciplinary approach based on the presence of a full ophthalmological status and computed tomography data of the skull in conducting a forensic medical examination of living persons and in the final qualification of the degree of harm to health in orbital injuries. Materials and methods: An analysis of 37 completed forensic medical examinations of living persons with orbital injuries who were treated in multidisciplinary hospitals in Moscow was carried out. The forensic medical examination was carried out in the Bureau of Forensic Medical Examination of the Moscow Health Department. In 23 cases, the ophthalmological status was assessed at periods from 1 week to 6 months after the injury. In all cases (n = 37; 100%), computed tomography of the facial and cerebral skull was performed. The age of the victims at the time of injury ranged from 12 to 82 years (average 39.7 ± 9.2 years). There were 29 adults among the victims (78.3%), 8 children (21.6%). In terms of gender distribution, there was a significant male predominance — 27 men (73%) versus 10 women (27%). Results: According to the results of the analysis of forensic medical reports, polytrauma with the simultaneous presence of several severe injuries to various organs and systems, combined with orbital trauma, was recorded in 12 victims (32.4%). A combination of traumatic brain injury and orbital injury without involvement of other organs and systems was detected in 9 victims (24.3%), isolated orbital trauma — in 13 people (35.1%), isolated injury of two orbits simultaneously — in 3 victims (8.1%). From the conclusions of forensic experts, it follows that in 89% of cases, the bone walls of the orbits, formed by the frontal, ethmoid and sphenoid bones, as well as the upper jaw, were damaged, which could subsequently lead to damage to the globe, optic nerve and other orbital structures. Damage to the soft tissue of the orbits with globe contusion was noted in 11% of cases. In 3 cases (n = 3; 8.1%), moderate harm to health was determined based on significant persistent loss of general ability to work. In 14 cases (n = 14; 37.8%), it was not possible to focus on the acuteness of the injured globe before the traumatic episode, due to the fact that the victims had no documented visits to an ophthalmologist before the injury. Conclusions: To objectively assess of the orbital trauma and determine the degree of harm to human health, it is necessary to have a full ophthalmological status, including such clinical and instrumental criteria as visual acuteness, presence or absence of ophthalmoplegia and globe dystopia, as well as computed tomography data of the skull, which must be presented in the primary medical documentation.

Опыт лечения пораженных при аварии на Чернобыльской АЭС в условиях специализированного стационара

Summary. The purpose of the study is to analyze and summarize the experience of treating those affected by a radiation accident at the Chernobyl nuclear power plant (Chernobyl nuclear power plant) in a specialized hospital. Materials and research methods. The research materials are documented experience in organizing treatment and treating those injured in the Chernobyl accident with acute radiation injury. Research methods – analytical method and method of generalization. The results of the study and their analysis. 129 patients were sent to a specialized hospital in Moscow in the first two days, 84 of which were diagnosed with acute radiation disease (OLB) II-IV Art. severity. As the main diagnostic criteria for the early diagnosis of patients used: the timing and severity of the primary general and local (leather) reaction, the severity of lymphopenia and neutrophilic leukocytosis and other criteria. The main directions of early treatment of the affected were: – prevention and treatment of infectious complications; – detoxification therapy; – correction of water-electrolyte metabolism, parenteral nutrition in connection with common burns, oropharyngeal syndrome, intestinal syndrome, etc.; – pre-transplantation: HLA-typification of patients, the selection of donors, the actual transplantation of bone marrow from the donors of relatives and cells of the embryonic human liver (in the absence of donors) affected with irreversible damage to the bone marrow; – replacing therapy with blood cells. Based on the results of the study, the following conclusions were made: – the complex of medical measures was highly effective; – there were practically no fatal outcomes due only to infection in patients with bone marrow, even severe and extremely severe, form of OLB, not complicated by burns, radial enteritis or acute secondary disease due to bone marrow transplantation; – none of the patients died from hemorrhagic syndrome, most had no signs of bleeding even with deep and prolonged thrombocytopenia (> 2–4 weeks); – the successful treatment of those affected in the Chernobyl accident was prepared by many years of experience in the work of the Clinical Division of Radiation Medicine of the Institute of Biophysics of the USSR Ministry of Health – State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency for the treatment of those affected in other radiation accidents.

Clinical manifestations of scarlet fever in children in the megalopolis at the present stage.

BACKGROUND: according to the literature, an increase in severe forms of scarlet fever among children was noted in a number of foreign countries in 2022-2023. AIMS: to identify the current clinical features of scarlet fever in children in a large metropolis of Russia. MATERIALS AND METHODS: an observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted according to 295 case histories of patients diagnosed with Scarlet fever from 2020 to 2022 on the basis of the GBUZ "DGKB named after Z.A. Bashlyaeva DZM", GBUZ "DGKB No. 9 named after G.N. Speransky DZM" in Moscow. The statistical processing of the material uses traditional methods for calculating extensive and intensive indicators (p1 and p2), errors of extensive indicators (m1 and m2) and standard deviations (rmax↔rmip), taking into account the confidence interval (t) and confidence probability (P=95%), a method for comparing indicators using a well-known formula, where at t ≥ 2.0 P ≥ 95% p ≤ 0.05, the definition of standard deviations, taking into account the confidence interval (t) and the confidence probability P = 95%. The comparison of percentages in the analysis of four-field conjugacy tables was performed using the exact Fisher criterion. The differences were considered statistically significant at p 0.05. RESULTS: as a result of the study, it was revealed that the abolition of strict anti-epidemic restrictions on COVID-19 in 2022 led not only to an increase in the incidence of scarlet fever among children from 0 to 18 years of age by 3.6 times in 2022 compared with 2021, but, as a result, to an increase in hospitalization of children in hospitals in Moscow. Thus, the number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to 2020. The majority of those hospitalized (83.4%) were children from organized groups, including those aged 3 to 7 years (52.9%) and from 7 to 14 years (39.3%), with an average severity of the disease (93.6%). It was noted that that among the examined children, 53 children (18%) had a history of COVID-19, and among this group of children, one in five children had severe scarlet fever, while among children who did not have a history of COVID-19, these were significantly (p 0.001) 8.4 times less (respectively, 20.7% versus 2.5%). It was revealed that every 8-9 patients (12.2%) had various complications, mainly of a septic nature and those that arose in the first week of the disease, including otitis media, sinusitis, community-acquired pneumonia, parathonsillar and lateral pharyngeal abscesses and toxic shock syndrome. In the second week and later, complications of an infectious and allergic nature were reported, including tubulointerstitial nephritis, acute renal injury, post-infectious cardiomyopathy, acute post-streptococcal glomerulonephritis, toxic allergic vasculitis, post-streptococcal arthritis. Beta-lactam antibiotics remain the etiotropic drugs of choice. Antibiotics of the cephalosporin 53.6% and penicillin 46.4% series were used to treat scarlet fever. CONCLUSIONS: in modern conditions of the megalopolis, scarlet fever occurs with a typical clinical picture. The majority of those hospitalized were children of preschool and school age, only 12.2% of children were diagnosed with various complications of scarlet fever and the vast majority of children (93.6%) had a moderate severity of scarlet fever. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases, while the incidence of complications in patients does not change (12.3% - 12.8%). It was shown that among patients who had suffered from COVID-19, scarlet fever was 8.3 times more likely to occur in severe form compared with children who had no history of COVID-19 disease (respectively, 20.7% vs. 2.5, p 0.0001).

Humoral immune response to shiga toxin 2 (Stx2) in children with escherichiosis with hemolytic-uremic syndrome

Shiga toxin-producing Escherichia coli (STEC) causes acute intestinal infections and also causes acute renal failure, especially in children. Shiga toxins (Stx) occupy a central place in the pathogenesis of hemolytic uremic syndrome (HUS) in Escherichiosis. The presented work analyzes the effectiveness of laboratory diagnostics of enterohemorrhagic escherichiosis in patients at the stage of manifestation of HUS and/or acute renal failure using microbiological, immunological research methods and PCR analysis. The study used clinical material from 30 patients in the pediatric intensive care unit of the St. Vladimir Children’s City Clinical Hospital in Moscow with symptoms of HUS aged from 8 months to 5 years. Blood sera from 20 healthy donors were used as control. As a result of PCR analysis, stx2 DNA was detected in 23.3% of cases. Bacteriological research made it possible to sow a pure culture of Escherichia coli O157:H7 in only 3.3% of cases. Since the development of HUS begins in patients with acute intestinal infection caused by Shiga toxin-producing microorganisms starting from the 5th day of the disease, when antibiotic therapy is already carried out, the bacteria can be completely destroyed, which makes it difficult to identify them by bacteriological methods, as well as to detect genes encoding Shiga toxin in PCR analysis. Typically, patients with HUS are admitted to the intensive care unit 5–7 days after the onset of the disease, when class G immunoglobulins specific to the pathogen are already beginning to circulate in the blood. In this regard, the use of immunological tests can be effective to confirm the diagnosis of STEC infection. In our studies, enzyme immunoassay allowed us to detect antibodies to Stx2A in 63.3% and to Stx2B in 43.3% of patients. Using immunoblotting, antibodies to Stx2A were detected in all sera obtained from patients and in 66.7% of cases to Stx2B. Immunoblot analysis was characterized by higher sensitivity for detecting antibodies to Stx2, however, due to the presence of an immunological layer among healthy people, it is preferable to use ELISA analysis. In healthy donors with antibodies to Stx2, the antibody titer was significantly lower than in patients. Laboratory confirmation of the diagnosis of STEC infection is difficult when conducting microbiological and molecular genetic studies, which is confirmed in this work. The effectiveness of laboratory diagnostics can be expanded by performing an ELISA aimed at detecting antibodies to Stx2A.

Meteoropathy: myth or reality? Assessment of the relationship between cardiovascular diseases and weather conditions according to data from a Moscow hospital

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p<0,001): with day- and nighttime air temperature ≥0о C, the number of admissions was less compared to sub-zero temperatures. Significant inverse correlations were established between the number of patients hospitalized with symptomatic BP increase, AF and HF per day, with air temperature at night (correlation coefficient r=-0,339; p<0,001), air t during the day (r=-0,316; p<0,001), temperature difference over 48 hours (r=-0,205; p<0,001); direct correlations with atmospheric pressure (r=0,106; p=0,044) and its changes (r=0,115; p=0,028) were identified. All identified relationships were of moderate strength. According to prognostic model, only nighttime air temperature turned out to be a significant indicator associated with the hospitalization rate per day. With a decrease in air temperature at night for every 7,5о C <0, one more patient is expected to be hospitalized with a symptomatic BP increase, decompensated HF, or paroxysmal AF.Conclusion. Negative air temperature in a metropolis is associated with an increase in hospitalizations for symptomatic BP increase, AF or decompensated HF. Atmospheric pressure and precipitation do not affect these conditions.

Proinflammatory cytokines IL-6, IL-1β, TNF-α in infective endocarditis

Aim. To study the features of macrophages in the tissues of resected valves in operated patients with infective endocarditis (IE), their significance and interaction with inflammatory markers to improve the effectiveness of IE diagnosis. Materials and methods. Prospectively the research included 25 adult patients with active IE (Duke criteria 2015) and 24 patients with heart defects without IE, hospitalized in a cardiosurgical hospital in Moscow (2021–2022). A standard laboratory and instrumental examination was carried out for the diagnosis of IE, including etiological diagnosis with microbiological and molecular biological methods, and echocardiographic examination of heart. Additionally, the neutrophil-to-lymphocyte ratio (NLR) was calculated. The study of macrophages was carried out in the tissues of resected valves with the determination of the expression of pro- and anti-inflammatory cytokine genes, macrophage markers (CD 68+) using real-time PCR. Results. Increased expression of proinflammatory cytokines IL-1β, TNF-α and IL-6 was revealed in the group of operated patients with IE with significant differences in IL-1β (CI [IQR] 0.00367 [0.00047–0.01553] vs 0.00018 [0.00012–0.00262]; p0.05) and IL-6 (CI [IQR] 0.00367 [0.00047–0.01553] vs 0.00018 [0.00012–0.00262]; p0.05) and IL-6 (CI [IQR] 0.00338 [0.00066–0.01674] vs 0.00054 [0.00044–0.00378]; p0.05). The expression of anti-inflammatory cytokines in valve tissues prevailed in the control group without significant differences from patients with IE. The macrophage marker CD 68+ was revealed in all examined patients with a significant quantitative predominance in the group of patients with IE. There were no differences in the expression of pro- and anti-inflammatory cytokines depending on the presence of embolic events, intracardiac complications, etiological affiliation to S. aureus, as well as hospital mortality and combined endpoint (death from all causes or recurrence of IE 6 months after surgery) in patients with IE with or without events. Cytokines IL-1β and IL-6 positively correlated with each other, with leukocytes and NLR. ROC analysis determined that IL-1β and NLR had the most favorable features for the diagnosis of IE [IL-1β AUC 0.816 (p=0.02), NLR AUC 0.807 (p=0.03)]. IL-6 did not show a diagnostic value in IE. The threshold value for IL-1β was 0.00029 (sensitivity 86.4%, specificity 60.0%, prognostic value of negative result 75.0% and positive 76.0%, AUC 0.761; p=0.008). Conclusion. The valve macrophages of patients with IE express elevated levels of proinflammatory cytokines IL-1β and IL-6, regardless of etiological affiliation or complicated course of IE. IL-1β has a high diagnostic value for determining the inflammatory activity in IE.

Possible causes of morbidity and adverse outcomes of COVID-19 in vaccinated elderly patients

A prospective randomized observational study was conducted in cohorts of vaccinated and unvaccinated patients hospitalized in one of the Moscow hospitals and diagnozed with COVID-19 in the period from 06.23.2021 to 01.05.2022.The purpose of the study was to identify the epidemiological features of COVID-19 in vaccinated people and to present scientifically based data on the need for vaccination and its importance in stopping the epidemic process.Materials and Methods. The samples were studied in comparison for a number of indicators: age, clinical condition at admission, the presence and number of concomitant systemic chronic diseases as well as disease outcomes.Results. It was proven that the risk of COVID-19 morbidity in vaccinated people decreased by 1.5 times, mortality by 1.5 times, and hospitalization due to the severity of the condition by 3.1 times. The mortality risk among vaccinated patients shifted to older age (76.9 years), while among unvaccinated patients, the mortality risk was higher for older people (73.7 years), which indicates an increase in life expectancy of vaccinated people.

Compliance and adherence to hand hygiene practices for effective infection control.

Hand hygiene (HH) is the most effective way to curb the spread of healthcare-associated infections. Nonetheless, healthcare personnel encounter difficulties in adhering to WHO HH recommendations. This study aimed to investigate HH compliance and adherence after the implementation of an action plan in a municipal hospital in Moscow. An initial evaluation of HH compliance among clinical health workers was carried out in June 2022 according to the WHO HH guidelines followed by a 3-month re-audit of HH practices. The results were compared to the baseline to evaluate compliance and adherence to HH among healthcare personnel. From June to September 2022, there were 2,732 moments of contact with patients or their immediate surroundings. The HH total compliance rate significantly (p < 0.05) increased from 52.3% in June 2022 to 83.3% in September 2022 with a 75% overall total compliance rate. The profession-specific total compliance rate was highest among nurses (79.6%) and lowest among ancillary staff (69.7%). Staff were also more adherent to the before-moments compared to the after-moments of the HH guidelines. Monthly re-audits and providing feedback resulted in a significant improvement in compliance and adherence with HH guidelines after implementation of the action plan.

Prevalence of heart failure among hospitalized patient with T2D: results of a prospective observational multicenter study (CREDO)

BACKROUND: Heart failure (HF) is in the first place in the structure of cardiovascular death in patients with type 2 diabetes mellitus (T2D). One of the factors determining the prognosis of patients with this pathology is hospitalization. The difficulties of managing patients are related to the heterogeneity of the population. In some cases, HF in patients with T2D remains undiagnosed, and data on the true frequency of HF in patients with T2D and their clinical and laboratory characteristics in real clinical practice remain limited.AIM: To assess the prevalence of HF, clinical and demographic characteristics and therapy profile in patients with T2D admitted to multidisciplinary hospitals.MATERIALS AND METHODS: A prospective observational multicenter study was conducted at the city clinical hospitals of the Moscow. For the period from August 2022 to April 2023, data from patients with T2D were analyzed. Data collection was carried out at one visit. The study design did not involve any intervention in routine clinical practice, including the choice of diagnostic method or treatment.RESULTS: The study included 445 patients in accordance with the main inclusion criteria - T2D, age over 50 years, duration of T2D more than 3 years. The incidence of HF in patients with type 2 diabetes at discharge was 76.6%. The diagnosis of HF was confirmed in 48.7% (n=217), newly diagnosed HF occurred in 27.9% (n=124) of cases, in 12.6% of patients (n=56) the diagnosis of HF was withdrawn, in 10.8% (n=48) of cases the diagnosis of HF was not established. The frequency of prescribing drugs at discharge was iSGLT-2 — 77.3% (n=344), statins — 86.7% (n= 386), MRAs — 23.1% (n=103), diure­tics — 46.1% (n=205).CONCLUSION: 76.6% of patients with T2D admitted to multidisciplinary Moscow hospitals were diagnosed with HF at discharge. The results obtained confirm the possibility of detecting HF and initiating cardioprotective therapy at the hospital stage, using inpatient clinical diagnostic examination, and patients with type 2 diabetes lasting more than 3 years and aged over 50 years can be classified as a high risk group for developing HF.

Predicting COVID-19 outcomes in patients at advanced stages of HIV infection: a model-based approach

BACKGROUND: Today, clinicians and their decisions extensively rely on specific treatment algorithms. These algorithms include prognostic models to identify high risk patients requiring hospital admission and clinical monitoring. This study suggests a prognostic model for forecasting COVID-19 outcomes in patients with advanced HIV infection, considering the high risk of unfavorable outcomes and the need for a specialized approach.&#x0D; AIM: To develop a prognostic model that combines predictors of unfavorable COVID-19 outcomes in patients with advanced HIV infection.&#x0D; MATERIALS AND METHODS: The study was based on 500 medical records of patients with advanced HIV infection admitted for confirmed COVID-19 between March 1, 2020, and December 31, 2022, and inpatient treatment at the Infectious Diseases Hospital in Moscow.&#x0D; RESULTS: All 500 patients were evaluated for 167 predictive markers for unfavorable COVID-19 outcomes, outlining 50 indicators that significantly varied across the subgroups of patients with both advanced HIV infection and COVID-19 depending on the presence of favorable or poor outcomes. Oxygen therapy was the most significant factor showing a strong correlation with poor outcomes in patients with advanced HIV infection and COVID-19. Subsequently, predictors were selected stepwise to enhance the predictive accuracy of the resulting model by adding more factors.&#x0D; The resulting model included seven factors: oxygen therapy requirements, CD4+ count under 50 cells/μL; manifested CMV infection with lung damage; elevated levels of lactate dehydrogenase, urea, and fibrinogen; and the presence of unspecified encephalitis. Using the available data in the calculations, a prognostic scenario and a receiver operating characteristic (ROC) curve were created to assess the practical significance of the proposed prognostic model. The area under the ROC curve was 90.9%, confirming the prediction accuracy and overall practical significance of the model.&#x0D; CONCLUSIONS: The proposed prognostic model enables the assessment of potential outcomes and planning of adequate therapies in patients with HIV and COVID-19 co-infection admitted to hospitals at advanced stages of the disease.

The effect of vaccination against the COVID-19 on the course and outcomes of a new coronavirus infection: a retrospective analysis of laboratory and clinical indicators of hospitalized patients

BACKGROUND: The Gam-COVID-Vac vaccine was proven effective in preventing the severe course and adverse outcomes of COVID-19 during different periods of the pandemic. However, the effect of vaccination on laboratory marker levels in hospitalized patients during the spread of the omicron variant of SARS-CoV-2 has not been sufficiently studied.&#x0D; AIM: To assess the effect of vaccination on the severity and outcomes of COVID-19 in hospitalized patients during the dominance of the SARS-CoV-2 omicron variant in Russia.&#x0D; MATERIALS AND METHODS: This case–control study included adult patients diagnosed with COVID-19 (U07.1) and hospitalized in infectious hospitals in Moscow between February 1, 2022, and July 31, 2022 (n=119). The main group included individuals vaccinated with two doses of Sputnik V vaccine (n=59). The control group included individuals who were not vaccinated (n=60). The median patient age was 66 [interquartile range, 41–66] years, and 58.8% were female. The chi-square test for categorical variables and the Mann–Whitney test for continuous variables were used for the analysis. P-values 0.05 were considered statistically significant.&#x0D; RESULTS: Viral pneumonia was less likely to develop in the vaccinated group than in the unvaccinated group (46.7% and 18.6%, respectively, p = 0.007). The proportion of patients without lung damage (0 CT-severity scores) in the vaccinated group (72.0%) was significantly higher than that in the unvaccinated group (42.9%) (p=0.003). In the vaccinated group, the levels of C-reactive protein on admission were lower (29.1 [7.4–68.6] mg/L and 75.1 [32.4–104.0] mg/L, p 0.001), and the highest level was recorded during hospitalization (38.2 [12.0–84.0] mg/L and 92.2 [45.3–137.4] mg/L, p 0.001). The D-dimer levels before discharge were lower in the group of patients vaccinated 6 months ago than in the unvaccinated group (157.0 [107.0–297.0] ng/mL and 316.0 [125.0–556.0] ng/mL, respectively, p = 0.014). The frequency of deaths in the control group (11.7%) was 6.9 times higher than that in the main group (1.7%) (p = 0.030).&#x0D; CONCLUSIONS: Completion of the primary vaccination course of Sputnik V vaccine resulted in lower levels of prognostic markers of severe COVID-19 (C-reactive protein and D-dimer) and a decrease in the frequency of pulmonary and fatal outcomes than in the unvaccinated group during the dominance of the omicron variant of SARS-CoV-2.

Effect of Lactobacillus reuteri NCIMB 30351 drops on symptoms of infantile functional gastrointestinal disorders and gut microbiota in early infants: Results from a randomized, placebo-controlled clinical trial.

Infantile functional gastrointestinal disorders, such as colic, constipation, diarrhea, and gastroesophageal reflux (regurgitation), often occur in early infancy and, representing one of the causes of significant parental anxiety, lead to a significant strain on the healthcare resources. In this study, we aimed to evaluate the effects of Lactobacillus reuteri drops (L. reuteri NCIMB 30351) on the symptoms of infantile colic, constipation, diarrhea, and gastroesophageal reflux, as well as on the levels of intestinal microbiota in full-term newborns during the first months of life. A randomized, placebo-controlled, single-masked (blinded), post-marketing clinical study was conducted in two clinical units-Children's City Clinical Hospital of Moscow and Medical Center "St. Andrew's Hospitals-NEBOLIT" from March 2020 to May 2022 in 90 infants aged from 1 to 4months (mean age (± SD) 12.3 ± 5.09weeks; 53.3% females, 46.7% males). Patients with colic, regurgitation (single symptom or combination of several symptoms), and constipation or diarrhea were randomly allocated in two parallel arms to receive either 5 drops (2 × 108 colony forming unit) of L. reuteri NCIMB 30351 (n = 60) or masked placebo (n = 30) for 25 consecutive days. Two treatment arms had equal numbers of patients with constipation and diarrhea (n = 30 each). Daily crying times and their duration, evacuations, and regurgitations were recorded in a structured diary. The levels of gut microbiota were analyzed by deep sequencing of bacterial 16S rRNA gene. Infants with colic receiving supplementary L. reuteri NCIMB 30351 for 25days had significant reduction in the numbers of colic (change from baseline - 6.3 (7.34) vs - 3.0 (7.29) in placebo, P < 0.05) and numbers of crying cases and mean duration of crying (decrease from baseline - 144 (70.7) minutes, lower in the diarrhea subgroup than in constipation infants, compared with - 80 (58.9) in placebo, P < 0.0001), as well as regurgitation numbers (decreased by - 4.8 (2.49) with L. reuteri vs - 3 (7.74) with placebo). We also observed increased numbers of evacuations in infants with constipation (L. reuteri 2.2 (2.4) vs 0.9 (1.06) in placebo, P < 0.05). There was a remarkable reduction of evacuations in infants with diarrhea, while not statistically significant. The analysis of bacterial 16S rRNA gene in the collected samples showed that L. reuteri positively influences the proportions of prevalent species, while it negatively affects both conditionally pathogenic and commensal microbes. Additional in vitro test for formation of Clostridium colonies in the presence of the probiotic demonstrated that L. reuteri effectively inhibits the growth of pathogenic Clostridium species. No adverse events were reported in this study. Conclusion:The uptake of L. reuteri NCIMB 30351 leads to a significant reduction in the number of regurgitations, feeding-induced constipations, and diarrhea as well as mean daily numbers of crying and crying duration in infants during the first months of life. Our results suggest that L. reuteri NCIMB 30351 represents a safe and effective treatment for colic in newborns. Trial registration: ClinicalTrials.gov : NCT04262648. What is Known: • Infantile functional gastrointestinal disorders, such as colic, constipation, diarrhea, and gastroesophageal reflux (regurgitation), often occur in early infancy and, represent one of the causes of significant parental anxiety. • A number of studies have shown that both the composition and diversity of the intestinal microbiota play important roles in the development and function of the gastrointestinal tract. What is New: • The uptake of L. reuteri NCIMB 30351 leads to a significant reduction in the number of regurgitations, feeding-induced constipations, and diarrhea as well as mean daily numbers of crying and crying duration in infants during the first months of life. • L. reuteri positively influences the proportions of prevalent species, while it negatively affects both conditionally pathogenic and commensal microbes in gut microbiota.

Forensic psychiatric examination of terrorist-related criminal cases: clinical and social characteristics of the sub-experts, analysis of the expert case

In recent years, due to changes in the socio-political situation, including at the international level, the number of terrorism-related criminal cases has increased, and, therefore, the number of forensic psychiatric examinations conducted in this category of cases has risen. To date, there is a lack of any scientific studies or analytical reviews devoted to the problem of forensic examination of suspects and the accused involved in such criminal cases. The article presents the results of a review of cases of outpatient complex forensic psychological and psychiatric examinations in terrorism-related criminal cases conducted on the basis of the Department of Forensic Psychiatric Examination, Psychiatric Clinical Hospital in Moscow, from 2020 to 2023. In total, 25 cases were described and analyzed, clinical and social characteristics were studied, and an overview of expert solutions was given. An analysis of one expert case was carried out. During the examinations, 56 % of the examinees did not show symptoms of mental illness when committing the incriminated criminal act, while 36 % of the examinees in the sample were diagnosed with a mental disorder. The diagnoses included mild cognitive disorder, various types of personality disorders (emotionally unstable, schizoid, with mixed features), alcohol abuse, as well as paranoid and undifferentiated forms of schizophrenia. Based on the conducted research, it is concluded that no confessional model of religious or other consciousness in itself is a source of terrorism, including its political form. Predisposition to terrorist manifestations is a multi-level phenomenon and enters an active phase due to certain «triggers» that operate at the individual, group or mass level, which depends, among other things, on psychopathological factors.

Doctors' Choice of Rehabilitation Measures for Patients Who Have Suffered Covid-19

Relevance. According to WHO, the number of patients with a new coronavirus infection amounted to more than 676 million people for the period from January 2020 to January 2023. It is obvious that the consequences of COVID-19 will prevail in medical practice in the coming years, so medical rehabilitation should be the focus of attention when providing medical care to patients with coronavirus infection.Aims. To investigate the approach to physicians' selection of rehabilitation interventions for patients who have undergone Covid-19.Materials and methods. The analysis of 1832 case histories of patients of one of the temporary covid hospitals in Moscow, who are being treated in the hospital in 2020–2022, was carried out. Statistical analysis was carried out using the StatTech v. 3.1.3 program (developed by Stattech LLC, Russia). Predictive models characterizing adherence to rehabilitation measures were developed using the logistic regression method.Results and discussions. The analysis of predictors of statistically significant regression models showed that when deciding on the appointment of rehabilitation measures or additional consultation when a patient is discharged from the hospital, doctors rely on pathologies already present in patients before COVID-19 disease, without taking into account the occurrence of possible pathology after a new coronavirus infection in any organ system. For example, the appointment of a cardiologist's consultation increases 6 times in the presence of a history of cardiovascular diseases or atherosclerosis and 10 times in the presence of cardiovascular diseases and atherosclerosis at the same time. The presence of bronchial asthma increased the probability of consulting a pulmonologist by almost 3 times, and in the absence of diabetes mellitus, the probability of getting additional advice from an endocrinologist decreased by 11 times.Conclusions. An individual rehabilitation plan should take into account the severity of the COVID-19 disease, the degree of damage to the lung tissue, heart, blood vessels and other organs. The regression models can be used for economic analysis in order to identify the need for working hours and the number of medical workers necessary to ensure the optimal volume and effectiveness of rehabilitation measures for patients who have suffered a new coronavirus infection.