Hospital In Moscow Research Articles

Occupational Burnout, Psychological Status and Quality of Life in Primary Care Physicians Working in Outpatient Settings.

Aim To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.Material and methods This cross-sectional study was performed at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.Results This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than "good" and 41.6% of physicians evaluated their health condition lower than "good". Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).Conclusion The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.

Background and Expectations for Reorganizing Mental Health Services for Children and Adolescents

Background: сhild psychiatry is essential for preventing adult mental diseases, due to the timely detection of a disease and the initiation of treatment. Thus, the choice of the optimal model of care and the corresponding transformation of the service are important. This work should be preceded by the study of current perceptions of the service and the prospects for its development among specialists and representatives of patients.The purpose: to study representatives’ expectations and fears related to the service, as well as to investigate the current needs of the professionals and their readiness for the service reform in Moscow.Material and methods: 657 district child psychiatrists and employees of clinical departments of children mental hospital in Moscow, and 361 consumers of the service filled in paper questionnaires on October 7–10, 2019.Results: neither the specialists nor the consumers have a general idea for the service development in Moscow. The professionals are more likely to consider their own field of work as a priority for development. The patient representatives expressed a wish for expanding service availability (including its territorial basis), while only 8% advocate the development of outpatient care as a priority. 49% of the specialists see a child as a main recipient of care, and 29% consider a family as a main recipient. 76% of the specialists found it difficult to answer the question about the existence of rules for interaction with a family. The experts consider the main request of a child as “condition stabilization” (85%), while the children themselves do not think in such categories. The myths about the service among the health workers and general population are similar, with the population expressing fears about being “registered” if they seek psychiatric help. At the same time, the loyalty of mental health specialists is comparable to the average in Moscow, primarily due to the high assessment of the staff.Conclusion: the study revealed a number of the related issues which are important to consider when reforming the service.

НАСЛЕДСТВЕННАЯ НЕКОНЪЮГИРОВАННАЯ ГИПЕРБИЛИРУБИНЕМИЯ (СОЧЕТАНИЕ СИНДРОМА КРИГЛЕРА-НАЙЯРА II ТИПА И СИНДРОМА ЖИЛЬБЕРА)

Background. Enzymopathic jaundices are manifested by intermittent hyperbilirubinemia, no changes in the structure of the liver, no hemolysis, Rh-conflict as well as cholestasis being noted. These jaundices include Crigler-Najjar syndrome type I, Crigler-Najjar syndrome type II and Gilbert's syndrome. They are characterized by an autosomal recessive inheritance due to the presence of mutations and polymorphisms in uridine 5'-diphosphate-glucuronosyltransferase gene (UGT1A1) leading to a decrease of the enzyme activity or to its complete loss. Objective. To demonstrate the peculiarities of diagnosis and treatment of a rare case of hereditary unconjugated hyperbilirubinemia - a combination of Crigler-Najjar syndrome type II and Gilbert's syndrome. Material and methods. Clinical observation of a patient G. aged 19, who was examined and treated at the Department of gastroenterology of a multidisciplinary hospital in Moscow in January 2021. Results. The patient G. has had icteric sclerae and skin since birth; he occasionally suffers from easy fatigability and general malaise. Physical examination revealed no changes (except for icteric discoloration). An increase in unconjugated bilirubin up to 270 μmol/L (median - 170 μmol/L) was detected. The molecular genetic study of UGT1A1 gene identified mutations in exon 4 Val378Asp (2002) and Arg108Cys as well as polymorphism 6/7TA in the promoter region, confirming the diagnosis of autosomal recessive inherited disease – a combination of Crigler Najjar syndrome type II and Gilbert's syndrome (heterozygous state), complicated by the development of hepatic encephalopathy stage 2. There was noted a significant decrease in unconjugated bilirubin up to 170.5 μmol/L, as well as improvement in general condition – reduced fatigue and weakness during the treatment with microsomal enzyme inducer (phenobarbital) and hyperammonemia corrector (ornithine aspartate). Conclusions. The use of molecular genetic analysis allows tailoring strategies for patient-specific disease diagnostics, treatment and prevention. The preservation of quality of life within satisfactory level is achieved through elimination of adverse effects provoking the development of this syndrome and through control of risk factors.

Moscow and Saint Petersburg General Hospitals as а forerunners of Medical-Surgical Academy (to the 225<sup>th</sup> Anniversary of the Military Medical Academy)

The article represents data on the history of medicine in Russia in the XVIII–XIX centuries. Data on Peter I medical reforms, the foundation of Moscow, St. Petersburg and Kronshtadt land and sea hospitals, Hospital schools are presented. The names of the first teachers of Hospital schools are presented.

The contamination of hospital water supply systems by <i>Legionella pneumophila</i>

The risk of severe infectious complications associated with provision of medical care continues to be a pressing issue in modern surgery. Legionella pneumophila, characterized by its wide distribution in water supply systems and is highly active in film formation, represents a dangerous/important cause of hospital-acquired pneumonia. Patients requiring immunosuppression, including organ transplant recipients, are in the special risk group. Prevention of hospital-acquired legionellosis in patients at risk is essential due to severe clinical manifestations and high mortality. Objective: to summarize the practical experience in detecting contamination of water supply systems by Legionella pneumophila strains in multidisciplinary hospitals in Moscow. Materials and methods. Isolation of Legionella pneumophila strains from water and biofilms of water supply systems in multidisciplinary hospitals in Moscow and serotyping of this pathogen using bacteriological, molecular genetic and enzyme immunoassay methods. Results. Legionella pneumophila content in water reached high levels. The peculiarities of Legionella pneumophila contamination of hot water supply systems included formation of stable biofilms, in which other hospital-acquired pathogens were also identified. The share of Legionella pneumophila «SG 1», which causes up to 80% legionellosis cases in the world, was 13% in the water of the hospitals surveyed. The most effective measures for prevention of legionellosis are actions aimed at ensuring water biosecurity. Conclusion. There are potential risks of disease in the surgical wards of hospitals providing medical care, including in immunocompromised patients. Due to potential risks, prevention of hospital-acquired legionellosis is a necessary component of ensuring the safety of treatment for immunosuppressed patients.

Features of clinical, psychological and socio-demographic characteristics of day hospital patients in the context of psychiatric service reform

IntroductionThe reform of the Moscow psychiatric service began in 2011 and was aimed at its optimization, reducing the inpatient level, actively introducing psychosocial rehabilitation, multidisciplinary teams of specialists and developing community-based forms of care. In 2016, the number of beds in day care hospitals in Moscow had doubled to rich 3500.ObjectivesAnalyze the dynamics of characteristics of day hospital patients and propose measures to improve the quality of medical rehabilitation care provided.MethodsClinical and psychopathological, clinical and statistical, psychological, statistical of 337 schizophrenia patients discharged in 2010 and 2016.ResultsA comparative analysis of the results obtained in 2010 and 2016 indicates a change in the clinical, socio-demographic and psychological characteristics of patients treated in the day hospital. In 2016, the proportion of early stage disease patients with endogenous mental disorders (F20-F29, according to ICD-10) increased; the age of patients and the proportion of patients with disabilities decreased; the proportion of patients with preserved working capacity increased, demonstrating low rates of compliance and motivation for treatment, but higher rates of neuro-cognitive functioning. In 2016, only a fifth of patients received complex psychosocial therapy.ConclusionsThe modernization of the psychiatric service has improved the continuity between its inpatient and out-of-hospital units. To improve the quality of care in the day hospital and to prevent relapses of the disease, it is necessary to combine pharmacotherapy with complex psychosocial treatment followed by a long-term personalized management of patients with the patient’s families involvement.

Perception of stress by medical staff during the first wave of the COVID-19 pandemic in russia

IntroductionAssessment of mental health in medical staff during the COVID-19 pandemic helps to prevent the delayed negative consequences of work under high risk.ObjectivesThe study compares the perceived stress and coping ability in medical staff caring for patients diagnosed with COVID-19 and in professionals, working with other patients.Methods Online survey involved 249 doctors and medical staff of a Moscow hospital aged 19 to 60 (80 men and 169 women). 135 people worked directly with COVID-19 patients and 114 specialists did not. The study was conducted with the Perceived Stress Scale (10-items) amidst the first wave of COVID-19 in Russia, in May 2020.ResultsNo significant differences were found in the stress levels between the two groups of healthcare providers. On average, the sample revealed an increased level of stress (15.4 with standard values of 12-13). The general indicator of perceived stress (F = 13.471; p <0.001), stress level (F = 12.333; p = 0.001) and stress resistance (F = 6.003; p = 0.015) in women is significantly higher than in men. In addition, women working with COVID-19 patients have a higher level of stress resistance than women working with other patients (F = 3.432; p = 0.045).Conclusions The perception of stress by healthcare staff during the COVID-19 pandemic increases independently on whether or not they work with infected patients. Although stress is higher in women, they are better at coping, especially in extreme situations. The reported study was funded by RFBR, project number 20-04-60174.

Monitoring Methicillin-Resistant Staphylococcus Strains in the Moscow Medical and Surgical Center using Molecular-Biological Methods

Relevance. Staphylococci are one of the most common pathogens in the etiological structure of nosocomial infections. Methicillinresistant staphylococci are resistant to the main groups of antibiotics and are one of bacteria that pose the greatest threat to human health according to the World Health Organization. The introduction of modern molecular biological methods in the monitoring of methicillin-resistant staphylococci is necessary for the rapid and accurate identification of microorganisms, monitoring the epidemiological situation and studying the need for anti-epidemic measures. Aims. Аnalysis of the results of monitoring methicillinresistant staphylococcus strains using molecular biological methods in a multidisciplinary hospital in Moscow for one year. Materials and methods. Single-center observational study with a one-year follow-up period (December 2016 to December 2017). The research included a molecular-biological analysis of biological material from 240 patients with signs of infection and washings samples (n=250) from the objects of the hospital environment. The whole genome sequencing was carried out for 24 samples, isolated from patients with different forms of staphylococcal infection and washings from a hospital environment. DNA detection of methicillin-resistant strains was performed using the «AmpliSens®MRSA-screen-titer-FL» reagent kit. Sequencing was performed on an Illumina HiSeq1500 instrument using the IlluminaHiSeq PE RapidClusterKit v2 and IlluminaHiSeqRapid SBS Kit v2. Results. DNA of methicillin-resistant staphylococci were detected in 6.3% of blood samples from patients with signs of infection and in 42.4% of washings from the objects of the hospital environment. The results of PCR of washing samples showed that DNA of methicillin-resistant coagulase-negative staphylococci were detected much more often than MRSA (p <0.001). DNA of methicillin-resistant staphylococci were detected more often in the intensive care and intensive care units compared with the hematology and surgical departments (p <0.001). The examine samples of Staphylococcus aureus belonged to 6 different sequence types (ST-5, ST-7, ST-8, ST-22, ST-30 and ST-5555) and 8 spatypes (t008, t021, t091, t1062, t12437, t1544, t223, t4573). As a result of monitoring, an isolate with a new allelic profile was found. Today it has been assigned the number ST5555. The predominant type of staphylococcal mec cassette was the type IV SCCmec cassette. Conclusion. Due to the widespread distribution of methicillin-resistant strains and the identification of epidemiologically significant genetic lines of staphylococci, it is necessary to conduct regular monitoring, take measures to limit the spread of such strains and introduce modern molecular biological methods for quick and accurate identification.

Nurses' Attitude Towards Various Hand Hygiene Products. Soap vs Antiseptics.

According to the latest recommendations of WHO, in most situations requiring hands treatment, alcohol-based skin antiseptics should be used. This study is aimed to determine the awareness and preferences of nurses in the city of Moscow regarding the choice of methods regarding hand hygiene treatment and the factors influencing this choice. Using the specially designed questionnaire, 184 nurses working in Moscow hospitals were interviewed to find out the attitude of nurses to various methods of hand hygiene. The questionnaire was developed on the basis of WHO Recommendations and Russian Recommendations. The survey was conducted from May 2017 to July 2017. To confirm the statistical significance of the identified associations a chi-square test was used. To find the 95% confidence interval to the relative values the Clopper-Pearson method was used. Only 3 (1.63%) of respondents indicated that they use antiseptic as the most frequently used hand hygiene product, 27 (14.67%) use liquid soap more often, 153 (83.15%) indicated that they use soap and antiseptic with equal frequency. In none of the standard situations we examined the use of antiseptic was the most frequent choice. Only in three cases antiseptic was chosen more often than soap - before and after manipulations with wounds and catheters (36.96%) or before performing invasive procedures (36.41%) and after contact with biological material (29.35%). At the same time nurses with more than 15 years of experience have preferred antiseptic. Based on the study it can be assumed that despite the implementation of the Russian guidelines on hand hygiene developed according to WHO recommendations, nurses prefer the traditional method of washing hands with soap. This suggests that in the current conditions additional measures are needed to train nurses and to monitor their work.

Analysis of sporadic cases of invasive listeriosis in a metropolis

Introduction. Listeriosis is a foodborne infection, especially dangerous for people in at-risk groups. Susceptibility to listeria infection is determined by a complex of reasons: environmental factors, host immune status, and pathogen virulence. The susceptibility to listeriosis can also be aggravated by previous infections, especially viral infections, which demonstrate a steadily increasing number of identified pathogens.The aim of our study was to present molecular and genetic characterization of pathogens causing sporadic invasive listeriosis in a megalopolis, primarily during the peak of influenza and ARVI incidence.Materials and methods. Listeria monocytogenes isolates were collected from 18 hospitalized patients at hospitals in Moscow, from November 2018 to October 2019. The first comparison group was represented by isolates from food products and fish preserves. The second comparison group included previously examined environmental isolates. The clinical isolates were examined by using multilocus sequence typing techniques, including the standard MLST scheme extended by loci of internalin genes. Isolates of the autochthonous genotype (ST7) were compared through whole-genome sequencing and subsequent analysis of the core genome (cgMLST).Results. In cases of invasive listeriosis, 44% of isolates were isolated from patients with listeriosis; 27% of isolates were obtained from patients with meningitis. L. monocytogenes of phylogenetic lineage II prevailed in these groups of cases that occurred when the epidemic threshold for influenza was crossed during the 2018/2019 season. Listeria pneumonia identified in the senior age group occurred during the season of autumn ARVI and was primarily caused by L. monocytogenes of phylogenetic lineage I. The examination of genomes of ST7 isolates demonstrated identity between the core genomes of bacteria isolated from the mother-infant pair. Out of ST7 food isolates most closely related to the clinical ones was the isolate from meat (23 locus differences, the common deletion in the MFS transporter locus). Analyzing invasive listeriosis, the comparison between the list of the identified genotypes and the data from European countries showed that each country had its own specific range of genotypes, though ST7 was detected in all the examined samples.Conclusions. Along with the monitoring of food manufacturing and storage, timely vaccination against seasonal respiratory infections and use of personal protective equipment in public spaces can reduce the risk of listeriosis incidence in at-risk groups.

Risks of legionella pneumonia in patients receiving immunosuppressive therapy

The legionellosis infection associated with medical care is usually registered for patients with reduced immunity, including those receiving immunosuppressive therapy. Prevention of nosocomial legionellosis in patients is essential due to high mortality. The aim . Analyze of the potential risks of legionellosis infection in patients of surgical departments. Materials and methods . Isolation of Legionella pneumophila from water supply systems in Moscow hospitals and serotyping of the isolated microorganism was performed using bacteriological, molecular genetic and enzyme immunoassay methods. Results and discussion . The study showed that there are potential risks of disease in surgical departments of hospitals that provide medical care, including immunocompromised patients. The content of Legionella pneumophila in water reached 10 5 CFU/l. The share of Legionella pneumophila SG 1, which causes up to 80 % of cases of legionellosis in the world, is 13 % in the water of the surveyed hospitals. The only action prevention of legionellosis is the biological safety of water. Conclusion . Due to the presence of potential risks, prevention of legionellosis is a necessary component of ensuring the safety of the treatment process for patients with immunosuppression.

Разрыв матки после миомэктомии, произведенной вне беременности

Objective. To study the incidence and risk factors of uterine rupture (UR) in a scarred uterus after myomectomy during pregnancy and childbirth. Patients and methods. A retrospective analysis of UR after myomectomy during pregnancy and childbirth was carried out according to the study of 43 labor and delivery medical records of patients from various maternity hospitals in Moscow. Results. Uterine scar after myomectomy, especially when performed laparoscopically, in the presence of pronounced interstitial changes poses a significant threat to both the mother and the fetus. In 27 (62.8%) cases, UR occurred before childbirth in a full-term pregnancy. UR in a scarred uterus after myomectomy was characterized by untimely diagnosis and laparotomy in 8 (21.6%) patients, resulted in blood loss of 1,000-5,000 mL in 32 (74.4%) patients; adverse perinatal outcomes: out of 45 children (2 cases of twins), 11 (24.4%) died (2 with extremely low body weight), 4 (8.9%) born with severe asphyxia, 6 (13.3%) with moderate asphyxia, 10 (22.2%) with mild asphyxia. In 5 (11.6%) cases, UR was detected in the early postpartum period. Conclusion. UR in a scarred uterus after myomectomy is characterized by delayed diagnosis and underestimation of early symptoms. Laparotomy was performed when a rupture occurred, both for complete 32 (74.4%) and incomplete 11 (25.6%). Careful choice of surgical approach for myomectomy in patients planning pregnancy and timely assessment of the state of the uterine scar are recommended. In case of UR, organ preservation surgery is performed. Key words: myomectomy, uterine rupture, uterine scar after myomectomy

Typology and Factorial Conditioning of Suicidal Behavior of Adolescents

The problem of suicidal behavior of an individual continues to remain relevant, due to the increase in the number of suicides among people of different ages, on the one hand, and insufficient information about the factors of suicidal behavior of an individual. The purpose of the study is to identify the factors that determine the formation of a certain type of personality who committed suicidal attempts in adolescence. In order to identify the types of adolescent suicides, there was conducted a survey of 20 doctors in psychiatric clinical hospitals in Moscow. The survey results were processed using cluster analysis. To identify the factorial conditioning of suicidal behavior of each personality type, a complex of psychodiagnostic techniques was used, focused on the study of the characteristics of the emotional, value-semantic and behavioral spheres of the personality. The obtained empirical data were processed with the help of factor analysis. Three clusters have been identified that combine similar personality characteristics of suicides. It was specified that among adolescents there are the following personality types: “militant” (22%), “sacrifice” (54%) and “self-deprecating” (24%). Each type of adolescent suicide is due to the characteristics of the emotional, value-semantic and behavioral spheres of their personality. To develop targeted programs for the prevention of suicidal behavior among adolescents, it is necessary to take into account the results of the study, since such programs should be aimed at blocking the factors that form a certain type of suicide.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КТ-АНГИОГРАФИИ БРАХИОЦЕФАЛЬНЫХ АРТЕРИЙ У ПАЦИЕНТОВ С ОНМК ПО ИШЕМИЧЕСКОМУ ТИПУ И ИХ СВЯЗЬ С ТЯЖЕСТЬЮ НЕВРОЛОГИЧЕСКОЙ СИМПТОМАТИКИ ПО ШКАЛЕ NIHSS

To determine the detection of large intracranial artery thrombosis by CT angiography (CTA) in patients with acute ischemic stroke, depending on the severity of neurological symptoms at the international NIHSS score. Materials and methods. Study population are patients, hospitalized to the M.P. Konchalovsky City clinical hospital in Moscow during 2019 with ischemic stroke and underwent CTA scans of extra-and intracranial arteries: total 173 patients (94 women (54.3%), man 79 (45,7 %), average age – 70 years) with a diagnosis of acute ischemic stroke, who were in all cases, NIHSS scale was used to assess the severity of neurological symptoms. Intravenous fibrinolytic therapy (FT) or intra-arterial mechanical thrombectomy (TE) was performed in all cases. The Spearman rank correlation was used to measure the correlation. Results. In 63 of 173 patients (36%) NIHSS score was 6 points or less. Occlusions of large intracranial arteries were detected in 27.7% (n=46) of cases, of which only 61% (n=28) patients reached the stage of TE. FT was performed in 54% of cases (n=94). Of 46 cases with occlusion of large intracranial arteries only 2 patients (4%) had NIHSS score 6 or less. Of all patients, who underwent the CTA, only 2 (1.2%) had NIHSS score 6 or less. There was a significant positive correlation between NIHSS score and the detection of intracranial artery thrombosis. Spearman's rank correlation coefficient Rs is 0.55 (p<0.0001). For one patient brought to the TE stage, there were 6 CTA of extra-and intracranial arteries. Conclusion. There is a strong relationship between NIHSS score and the detection of intracranial artery thrombosis by CTA. With the low values of the NIHSS score (less than 6), the probability of detection of thrombosis is extremely small. It is advisable to prescribe CTA for patients with NIHSS score of 7 or more only.

Особенности диагностики новой коронавирусной инфекции у детей, госпитализированных в многопрофильный стационар

The second decade of the 21st century started with the emergence of a new coronavirus SARS-CoV-2, affecting humans and causing COVID-19 infection. Children usually have mild disease with one-third of them being asymptomatic, which hinders diagnostics of this infection and does not prevent hospitalization of infected children with non-respiratory disorders to hospitals. Objective. To assess the incidence and specific characteristics of COVID-19 among children emergently admitted to a multidisciplinary hospital not intended for hospitalization of patients with COVID-19. Patients and methods. We performed retrospective analysis of medical records of children admitted to different departments of a multidisciplinary hospital in Moscow between 20.03.2020 and 20.07.2020 (9,779 were discharged during this period). Results. A total of 64 children aged 1 month to 17 years admitted to 10 different departments had positive PCR results for COVID-19 (nasal/oropharyngeal swabs) upon admission to hospital. Fifteen patients (23.4%) had asymptomatic coronavirus infection. These were primarily children of school age and less often of preschool age admitted to the Departments of Traumatology, Surgery with injuries, fractures, exacerbation of chronic nephrological or abdominal disorders. Twenty-four participants (37.5%) presented with mild or none catarrhal symptoms, whereas 12 children were diagnosed with pneumonia. The highest number of SARS-CoV-2-positive children (n = 30; 46.9%) were admitted to the Department of Infectious Diseases, as could be expected. Conclusion. Our findings suggest that, in general, the current situation reflects our knowledge about COVID-19. Children usually have mild or asymptomatic COVID-19 and play a significant role in virus transmission, contributing to the continuation of the pandemic. Our results have high clinical and epidemiological significance and require further investigations among children of different ages to accumulate the data. Key words: children, SARS-CoV-2

Dentist’s work time expenditures while providing dental care to patients with infectious diseases

The aim of the study is to analyze the working process of dentists providing medical care to patients with infectious diseases in a multidisciplinary hospital. Materials and methods. Chronometry has been carried out, the time standards have been established for the provision of dental care by the doctors of the dental office of a large multidisciplinary clinical hospital in Moscow, which provides medical services to the adult population, including patients with infectious diseases. There were used analytical method, timing, descriptive statistics. Results. It was found that the investigated types of activities of a dentist, while visiting one infectious patient, were distributed in decreasing order as follows: main activity — 32.34 (50.4%) minutes, work with documentation — 16.03 (24.98%) minutes, auxiliary activities — 8.65 (13.5%) minutes, official — 3.51 (5.47%) minutes, other activities — 2.30 (3.6%) minutes, personal required time — 1.35 (2.1%) minutes. Labor time of the specialist was completely occupied. Conclusion. The workflow of a doctor in a dental office of a multidisciplinary hospital, while providing medical care to infectious patients, is organized in the optimal way.

Клинико-микробиологические особенности менингококковой инфекции у детей

The threat of a pandemic of meningococcal infection, the severity of the disease and the unpredictability of outcomes necessitate monitoring of the characteristics of the disease course and the circulating serotypes of meningococcus. The purpose — to study the features of the clinical manifestations of meningococcal infection in children depending on the serogroup of N. meningitidis, as well as the phenotypic and genotypic characteristics of the pathogen. Material and methods. 97 children with invasive meningococcal infection with the established serogroup N. meningitidis, hospitalized in 2014–2020, were under observation at PRCCID. We also analyzed 15 discharge epicrises of children with invasive meningococcal infection caused by N. meningitidis W, hospitalized in hospitals in Moscow (Infectious Diseases Hospital No. 2 and Children’s City Clinical Hospital named after Z.A. Bashlyaeva) in 2017–2019. The study of the phenotypic and genotypic characteristics of the pathogen was carried out by the analysis of 34 strains of meningococcus isolated at PRCCID. Results. It was found that in the disease caused by NmW, in 29% of cases (n = 9), there was a subacute onset of the disease with a delayed appearance of an abundant hemorrhagic rash with a predominant localization on the distal extremities (p < 0,01). Also, with NmW in 22,6% (n = 7) cases, the development of convulsive syndrome is noted in 22,6% (n = 7) cases (p < 0,01). NmB is characterized (65,3%, n = 34) by multiple elements of hemorrhagic rash and the formation of soft tissue neuroses (46,2%, n = 24). Focal neurological symptoms were predominantly observed in children with HFMI caused by NmC (23,5%, n = 4) and NmW (13,3%, n = 4). It is noteworthy that among the atypical manifestations of meningococcal infection in NmW, diarrhea, pain in the abdomen and joints, myalgia were most often noted, and conjunctivitis in NmC. Intracranial complications are observed mainly in children with the disease caused by NmB (36,0%, n = 9) and NmC (24%, n = 6), extracranial — by NmB (50%, n = 5), and intracranial + extracranial — by NmW (26,8%, n = 11) and NmB (51,2%, n = 21). Analysis of the phenotypic and genotypic features of invasive meningococcal infection, depending on the pathogen, revealed meningococcal strains (54,1%, n = 20) with reduced sensitivity to antibacterial drugs, as well as 12 NmW strains (ST-11, cc11), closely located to Anglo-French and Swedish subgroup of the Hajj cluster. Conclusion. The features of the clinical manifestations of meningococcal infection in children largely depend on the serotype of the causally significant meningococcus, the timely diagnosis of which makes it possible to predict the course of the disease. It has been established that currently among circulating meningococci there are meningococcal strains with reduced sensitivity to antibacterial drugs (54,1%, n = 20), as well as NmW strains (ST-11, cc11), close to Anglo-French and Swedish subgroups of the Hajj cluster (35,3%, n = 12). This situation requires continuous monitoring of the phenotypic and genotypic characteristics of the microorganism to optimize management tactics.

Monitoring of indications for hospitalization of patients in round-the-clock hospitals of anti-tuberculosis facilities of the Department of Health of the city of Moscow

The article presents the results of five-year (2014–2019) monitoring data analysis of indications for hospitalization of adult patients to in-patients’ tuberculosis hospitals in Moscow. The structure of the collected information, created on the basis of the developed guidelines, is presented. From 1 to 15 indications were notified for each hospitalization. It has been shown that the majority of patients were hospitalized on the basis of groups of indications associated with the tuberculosis process and / or the need for a diagnostic examination (91.2%). These groups of indications were registered in 73.7% and 28,0% respectively. Also, 48.2% of hospitalizations were associated with the presence of concomitant diseases and conditions requiring hospital treatment and / or seriously aggravating the course of tuberculosis, and 32.8% – with epidemiological and social factors. These four groups were analyzed for their various indications, such as the presence of bacterial excretion and lung cavern, a widespread tuberculosis process, the need to use special treatment methods or individual selection of chemotherapy regimens, the presence of different concomitant diseases and various social factors, such as living with children under 14 years of age, old age, etc. Separately, a comparative analysis of indications was carried out depending on the presence of HIV coinfection, which showed that these patients more often have indications associated with a widespread tuberculosis process, the need for individual selection of therapy, drug addiction, bad treatment adherence, and belonging to homeless people. Periodic monitoring of indications for hospitalization is a necessary measure that allows you to obtain information necessary to optimize the quantitative and qualitative structure of the bed fund of antituberculosis medical organizations.

Echinococcosis of the liver: evolution of surgical treatment

To analyze the development of surgical approaches for hepatic echinococcosis. We have analyzed diagnosis and treatment of 349 patients with liver echinococcosis; 97 patients were treated at the Botkin Clinical Hospital for the period from 2009 to 2019 and 252 patients were treated in surgical hospitals of Moscow city for the period from 2014 to 2019. General and specific postoperative complications, relapses and surgical approaches were assessed. The number of echinococcectomies performed in surgical hospitals of Moscow is 3 times higher compared to the Botkin Hospital. The number of liver resections is comparable in both groups. The number of pericystectomies is more than 2 times higher in the Botkin Hospital. PAIR technique was more common in surgical hospitals of Moscow. Evolution of surgical treatment from open echinococcectomy to anatomical liver resections and subsequent pericystectomy with PAIR technique becomes another round of evolutionary spiral in the development of surgical treatment of liver echinococcosis.

Рефлексия жизненного сценария и связанных с ним бессознательных убеждений и проекций будущего как фактор длительности ремиссии при синдроме зависимости от алкоголя у мужчин

A cross-sectional study performed in a Moscow hospital for addiction treatment (2019—2020) tested a hypothesis that the capacity to reflect on a life script exert¬ed a positive effect on alcohol dependence (AD) remission duration. The sample included 61 males with AD and without dual diagnosis; the mean age was 44.1 (SD = 10.1) years. Methods. (1) Socio-demographic and clinical data was collected using a semi-structured therapeutic interview. (2) Explicit representations of one’s future were evaluated using a Self-defining Future Projections task; “Life Line”, and a “Cultural script” task. (3) Data on life script characteristics was gathered using the semi-structured “Script Questionnaire”. Qualitative data was processed by means of quantitative content analysis performed by experts based on relevant guidelines. Effects of verbalized life script characteristics on several remission parameters were assessed using multiple linear regression. Results and Conclusions. People with AD who were capable of verbalizing and reflecting on long-term, self-relevant repre¬sentations of the future related to the basic beliefs about their own life course, were capable of maintaining longer remissions in contrast to those who failed to reflect on these topics and limited their memories and future projections by overgeneral cultural script events.