State Budgetary Healthcare Institution Research Articles

The use of argon plasma coagulation in ruptured hemorrhagic syndrome (Mallory-Weiss syndrome) complicated by ongoing bleeding

Objective: to evaluate the efficacy and safety of argon plasma coagulation for endoscopic hemostasis in Mallory-Weiss syndrome. Materials and methods: on the basis of a clinical observation of a patient admitted to the emergency department of the State Budgetary Healthcare Institution of the Moscow Region of the Children’s Central City Hospital with complaints of vomiting of scarlet blood, dark stools, weakness, dizziness. The patient underwent emergency EGDS. Results: According to the EGDS data, a linear mucosal rupture was detected in the lower third of the esophagus along the posterior wall with a transition to the stomach cardia along the lesser curvature, about 8-9 cm long (5 cm in the esophagus, 3-4 cm in the stomach), up to 2 cm deep. -3 mm, from the rupture there is a flow of scarlet blood of medium intensity, in the bottom of the defect, fibers of the submucosal and muscular layers were determined. Endoscopic hemostasis was performed: argon plasma coagulation of the rupture of the mucous membrane of the esophagus and stomach. Against the background of endoscopic treatment by argon plasma coagulation in a patient with a long rupture, hemostasis was achieved and surgical treatment was avoided, which could aggravate the condition and lengthen the treatment time. Conclusions: Argon plasma coagulation as a non-contact method of hemostasis has a limited penetration depth and is safer and more effective than other (contact) electrocoagulation methods, where, as a rule, it is difficult to control the depth of exposure. The use of this method improves the efficiency of endoscopic hemostasis, reduces economic costs, and reduces the patient’s stay in bed.

Анализ динамики заболеваемости туберкулезом в Кабардино-Балкарской Республике в 2020–2023 гг.

According to WHO, tuberculosis remains one of the infectious diseases that kills the largest number of people in the world. Since 2014, there has been an upward trend in the incidence of tuberculosis worldwide, with the exception of 2020, when this figure decreased. In 2022, the number of people newly diagnosed with tuberculosis was 7.5 million. This is the highest rate since WHO began global monitoring of tuberculosis in 1995, which is likely due to limited access to medical services during the COVID‑19 pandemic. In contrast to global trends, the Russian Federation has seen favorable dynamics in the main indicators for tuberculosis since 2009. To assess the real epidemiological situation regarding tuberculosis, it is important to study the incidence of tuberculosis. The purpose of this study was to study the dynamics of the incidence of tuberculosis in the Kabardino-Balkarian republic in 2020–2023 in order to identify the main problems in the epidemiological situation. Materials and methods. A comparative analysis of the incidence of tuberculosis in 2020–2023 was carried out according to statistical materials from the State Budgetary Healthcare Institution of Ministry of Health of the Kabardino-Balkarian Republic “Republican Anti-Tuberculosis Dispensary” for a 4-year period following the results of 2020–2023 after copying information and analyzing time series. Results. In the period from 2020 to 2023, against the backdrop of an improvement in tuberculosis incidence rates among first-time cases, an increase was revealed: the proportion of bacilli excretors with respiratory tuberculosis by 3.9%, including the proportion of patients with multidrug resistance among them by 17.8%; as well as the share of patients with fibrous cavernous tuberculosis of organs of morbidity by 10.4%, the share of cases with a phase of complications with organ tuberculosis by 5%, the share of patients with disseminated tuberculosis by 103.3%, the share of patients with HIV-associated tuberculosis by 25%, the incidence of the child population 0–17 years old – by 60.3%, 0–14 years old – by 54.5%, 15–17 years old – by 108.7%. Conclusions. Against the background of a decrease in the main indicators of tuberculosis incidence among the population of the Kabardino-Balkarian Republic in 2020–2023, significant changes have occurred in the structure of the tuberculosis process. The results of the study require a systematic analysis of the treatment and diagnostic process of the anti-tuberculosis service and other medical organizations with the subsequent development of management decisions to improve the efficiency of the implementation of the regional plan of anti-tuberculosis measures in the Kabardino-Balkarian Republic.

The Experience of Observational Departments’ Functioning for Treatment of Patients with Tuberculosis from COVID-19 Contact and Convalescents after COVID-19

Relevance. To control COVID-19, a net of special infection hospitals and departments was created, a system of medicaments and protective means’ supply was set up, necessary normative and regulatory documentation was developed and overall vaccination of population was performed in Moscow. Within frames of work for prophylaxis of COVID-19 spread in patients with tuberculosis at in-patient units of the State Budgetary Healthcare Institution of Moscow city «The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health” (hereinafter referred as the Center), observational departments for treatment of patients with tuberculosis from COVID-19 contact and convalescents after COVID-19. Aims. To evaluate specialized observational departments’ work as part of general anti-epidemic control measure system for COVID- 19 at tuberculosis hospitals. Materials and methods. The observational departments’ work within the period of 2020–2022 with 1075 patients treated including 400 patients from COVID-19 contact areas (37.2%) and 675 convalescent patients after COVID-19 (62.8%), was analyzed. The results obtained during the study were statistically treated by means of application program package Microsoft Office 2007. The quantitative parameters with presumably normal distribution were described with mean arithmetic values (M) and standard deviations (SD), and 95% confidence interval (CI 95%). The estimation of significance of differences between outcomes was evaluated with the Pearson χ2 test. The differences were considered to be statistically significant with p < 0,05. Results and discussion. The evaluation data on functioning efficacy of observational departments for patients with tuberculosis from COVID-19 contact and convalescent patients with tuberculosis after COVID-19 within the large medical institution hospital of physiatry profile. Among all patients, 153 of patients who fell ill with COVID-19 (14.2%; 95% CI [12.21–16.38%]) were determined, which lowered the number of COVID-19 areas at in-patient departments of the Center by 11.8%. The mean timeframes of COVID- 19 determination in general were 8.0 days: 5.4 days among contacts from new coronavirus infection areas and 12.4 days among convalescents at the department for the treatment of patients with tuberculosis and new coronavirus infection. The comparative analysis showed that COVID-19 was more frequently determined in tuberculosis patients from the contact with those who fell ill with COVID-19 (p < 0.001) than in convalescents. Conclusions. During medical care for patients of physiatry profile in Moscow city, a wide range of management decisions consisting in the change of routing system in specialized medical care, was taken. Among them, creation and functioning of observational departments for contact persons from COVID-19 areas and convalescents after COVID-19 play a particular role.Creation of such departments within a large medical institution enabled the contemporary isolation of contact persons from COVID- 19 areas and convalescents after COVID-19 and allowed the additional control of nosocomial infection spread

Venous thromboembolic complications in stroke and their prevention

The senior nurse of the State Budgetary Healthcare Institution «Samara Regional Clinical Hospital named after V. D. Seredavin» spoke about the possibilities of using intermittent pneumatic compression in patients with neurological disorders.

Facial changes in individuals deceased from ethanol poisoning

BACKGROUND: Changes in the facial area (facial edema, its purplish or bluish color, drooling, tearing, and a sign described by A.P. Kurdyumov) are among the most commonly observed signs of ethanol poisoning. However, their diagnostic capabilities are not investigated, and the mechanisms of development are not described. AIM: To study the occurrence of changes in the facial area in individuals who died from ethanol poisoning. From a modern perspective, the mechanism of their development, characteristics, and specificity were assessed. MATERIALS AND METHODS: A single-center retrospective observational cross-sectional study was conducted based on the archive of the State Budgetary Healthcare Institution of Moscow Region “Bureau of Forensic Medical Examination,” including cases of death from January 1, 2020, to December 31, 2020. Cases were grouped into five categories: ethanol poisoning, poisoning with other alcohols, asphyxia, other violent causes of death, and natural death. RESULTS: The study included 1,181 cases, with a median age of 52 (range, 19–95) years. Women were older, with no significant difference in blood ethanol concentration. Facial puffiness was observed in 53.1% of ethanol poisoning cases and bluish discoloration in 59.5%. The sign described by A.P. Kurdyumov was less frequently observed. Facial puffiness (p=0.002) and the sign described by A.P. Kurdyumov (p=0.014) were more common in poisoning with other alcohols than in deaths from asphyxia. However, no such differences were observed for facial bluish discoloration (p=0.176). Facial bluish discoloration had the highest sensitivity in both alcohol and other alcohol poisoning cases (59.53% and 40.74%, respectively) but had the lowest specificity in the same groups among the examined signs. The sign described by A.P. Kurdyumov had the highest specificity among those examined for both ethanol poisoning and poisoning with other alcohols. CONCLUSION: In ethanol poisoning, facial bluish discoloration was the most sensitive sign, and the sign described by A.P. Kurdyumov was the most specific among the analyzed signs. The examined signs were observed in both ethanol and other alcohol poisoning but less frequently. The forensic medical signs considered are largely similar to the clinical signs observed in flush syndrome.

Retrospective analysis of the incidence of chronic periodontitis and gingival recession in patients in Ufa

Abstract Background. Inflammatory periodontal diseases are one of the most pressing problems in modern dentistry and rank second in frequency and prevalence among all dental diseases. The aim of the study is to determine the outcomes of chronic periodontitis treatment, the percentage of relapses and complications based on a comparative retrospective analysis of the incidence of chronic periodontitis for the period 2017 to 2022. Material and methods. To assess the prevalence of inflammatory periodontal diseases, we conducted a retrospective analysis of 1,500 medical records of patients diagnosed with periodontitis who received treatment at Dental Clinic No. 4 in Ufa for the period 2017–2022. Results. As a result of a retrospective analysis of medical records of 1,500 patients with periodontal diseases in the State Budgetary Healthcare Institution of the Republic of Bashkortostan, Dental Clinic No. 4, Ufa, in the period from 2017 to 2022, it was revealed that patients with chronic gingivitis prevailed in the age group of 20-29 years - 90 people (6.01%), CGP LS was detected mainly in the group of 30-39 years - 267 people (17.8%), CGP SS in the group of 40-49 years - 528 people (35.2%), and CGP TS from 50 years and older - 615 people (40.99%). Discussion. Comparative retrospective analysis of outpatient records of patients with periodontal diseases showed low efficiency of the methods used to treat patients with periodontitis, accompanied by a high percentage of relapses and complications, namely: transition from mild to moderate - in 37.2 ± 0.3%; moderate to severe in 28.7 ± 0.1% of cases; exacerbation of periodontitis - in 21.9 ± 0.1%.; tooth extraction in patients with CP LS severity - 1.2 ± 0. %, with CP SS severity - 13.3 ± 0.1%, with CP TS severity - 22.1 ± 0.1%. Conclusion. According to the retrospective analysis, it was found that the need for treatment of inflammatory periodontal diseases is 93% in different age groups. Data analysis states a high (up to 88.6%) prevalence of periodontal diseases in patients seeking dental care.

Retrospective analysis of surgical treatment of adult patients with trauma and posttraumatic deformities of the middle zone of the facial skeleton

The issues of diagnosis, planning, timing and tactics of surgical treatment, possible risks of postoperative complications in patients with trauma of the middle zone of the facial skeleton have remained relevant for many years. Due to the prevalence and complexity of solving a number of problems facing specialists arising from post-traumatic deformities (PTD) in this area, the problem of treating this category of patients is not only medical, but also socio-economic. Purpose. To carry out a retrospective analysis of the data of medical documentation of adult patients with trauma and PTD of the middle zone of the facial skeleton. Material and methods. We analyzed statistical data on the provision of specialized medical care to patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. A sample of 32 495 medical records of patients who were hospitalized at the State Budgetary Healthcare Institution of the Department of Healthcare of the Moscow “Maxillofacial Hospital for War Veterans” was conducted from March 2015 to December 2023. Statistical processing of the obtained data from the study group of patients was carried out. Results. Information is presented on the specialized care provided to adult patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. Our study included 233 patients with trauma and PTD of the midfacial skeleton who underwent surgical treatment. Of these, 84.12% (n=196) were men and 15.88% (n=37) women. The average age of the patients was 35.74±11.11 years. The study group was divided into two subgroups: the 1st – patients with injuries to the bones of the midface (n=157, 67.38%), the 2nd – with PTD of the bones of the midface (n=76, 32.62%). The article presents the main characteristics of these patients. The methods of their examination at the prehospital stage are analyzed in detail; the time from the moment of injury to the moment of seeking specialized medical care; channels of hospitalization; causes of injuries; aesthetic and functional disorders as a result of injuries; types of injuries; applied methods and tactics of surgical treatment. Conclusions. The results of the study present a modern characterization of adult patients with trauma and PD of the middle zone of the facial skeleton. Recommendations are given on the use of four main fixation points during operations of metallosteosynthesis of the bones of the zygomatic complex, the need to reduce the time from the moment of injury to the moment of specialized medical care, the need for an integrated approach and treatment of patients with injuries and PTD of the bones of the middle zone of the face in specialized centers of maxillofacial-facial surgery.

Delivery and organ-preserving surgery in a woman with high-risk uterine myoma

This article presents a clinical case from the practice of the State Budgetary Healthcare Institution of the Republic of Belarus "GKPTs" in Ufa regarding organ-conserving surgery in a woman with high-risk uterine fibroids of isthmus localization with transition to the posterior wall of the uterus. In May 2023, at 39 weeks of pregnancy, patient T. was scheduled for planned surgical delivery by cesarean section, with subsequent expansion of the scope of the operation to conservative myomectomy. The indication for surgery was uterine fibroids of gigantic size and isthmus localization with transition to the posterior wall of the uterus, as a result of which delivery through the natural birth canal is impossible. Uterine fibroids in this patient were discovered during pregnancy. Instrumental research methods used during the examination: ultrasound, magnetic resonance imaging (MRI). During routine ultrasound screenings, uterine fibroids of isthmus localization measuring 123x99x112 mm without disruption of the node's nutrition were diagnosed. According to MRI, the diagnosis of large uterine fibroids was confirmed. A transverse suprapubic laparotomy was performed. The first stage of the combined operation was a cesarean section in the lower segment. As a result, a live full-term boy weighing 3480 g, 53 cm, with 7-8-9 points on the Apgar scale was recovered. Then, during an inspection of the pelvic organs, a myomatous node was discovered in the isthmus area with a transition to the posterior wall of the uterus measuring 10x12 cm, without signs of necrosis. A conservative myomectomy was performed without penetration into the uterine cavity. The bed is sutured with separate sutures. Hemostasis has been achieved. The weight of the myomatous node will be 570 grams. Our clinical case shows that a favorable full-term pregnancy with high-risk, large size, atypical localization uterine fibroids is possible. Also, organ-preserving, combined operations are currently being carried out, which enable a woman to preserve the organ and further realize her reproductive potential.

First results of the work of the department of palliative medical care for children

This article describes the experience of the department of palliative medical care for children, opened on the basis of the State Budgetary Healthcare Institution «Samara Regional Clinical Hospital named after. V. D. Seredavin» Samara.

Analysis of the quality of surgical care for patients with consequences of gunshot combat wounds of the maxillofacial area

One of the most pressing problems of maxillofacial surgery (MFS) is the provision of specialized medical care to the wounded and injured in combat conditions. Even more complex tasks are reconstructive surgical treatment at the stages of evacuation and the most complete rehabilitation of patients with the consequences of combat injuries to the maxillofacial area (MFA). Gunshot combat wounds of the MFA are characterized by severe anatomical and functional disorders, they can manifest themselves as significant defects and severe deformations, which in turn leads to an increase in sanitary losses of army personnel, disability of young and middle (working) age patients, a decrease in the quality of their life, long-term and expensive treatment that requires special knowledge and manual skills from specialists. All this determines not only the medical, but also the socio-economic significance of the topic of this study.Objective. Present an analysis of the quality of surgical care provided to patients with consequences of gunshot combat wounds of the MFA.Methods. The study was carried out by specialists from the State Budgetary Healthcare Institution «Maxillofacial Hospital for War Veterans» of the Moscow Department of Health, under the guidance of the chief, PhD, professor, main specialist in MFS – V.A. Belchenko, for the period from October 2022 to July 2023. Diagnosis, planning and surgical treatment of adult patients with the consequences of gunshot combat wounds of the MFA were carried out at the stages of treatment and evacuation measures. A sample of medical documentation was made, the data obtained was processed by the generally accepted statistical method. The results were analyzed and compared with data from similar studies.Results. The study group included 55 males, aged from 23 to 56 years, the average age of the patients was 36.16±7.79 years. We divided the studied patients into subgroups according to the conditional zones of damage to the MFA: 1st – upper zone of the face (n=3, 5.45%), 2nd – middle zone of the face (n=28; 50.91%), 3rd – lower zone of the face ( n=32; 58.18%). The number of patients with isolated injuries is 18.18% (n=10); with multiple – 81.81% (n=45); with combined – 72.72% (n=40). The article presents the characteristics of patients with the pathology under study, discusses some features of diagnosis and planning, discusses tactics and problems associated with the surgical stage of treatment, as well as further rehabilitation measures.Conclusion. Despite the emergence of new medical equipment, equipment for diagnostics, planning and solving complex problems of surgical intervention, there is a clear need for training specialists, developing and improving the applied medical recommendations, with a clear indication of the method of choosing tactics and methods of surgical treatment. Medical care for adult patients with the consequences of gunshot combat wounds of the MFA must be comprehensive and carried out on the basis of specialized centers, and must include both surgical and orthopedic components, which will minimize the number of errors and complications, increase the effectiveness of treatment and, as a result, make rehabilitation as complete as possible.

Predictive models of high risk of heart failure, atherosclerotic diseases and CKD in patients with type 2 diabetes mellitus

Due to the high prevalence of complications from the cardiovascular system and kidneys in patients with type 2 diabetes mellitus (DM) already in the early stages of the disease, it is interesting to identify predictors that could be used for early diagnosis and prevention of cardio-renal complications in patients with type 2 diabetes.Objective: to develop prognostic models for the development of ASCVD, CHF, and CKD in patients with type 2 diabetes, identifying predictors and determining the contribution of each factor in the development of these diseases.Material and methods: A one-time observational study was conducted on a sample of patients hospitalized in the endocrinology department of the State Budgetary Healthcare Institution of the City Clinical Hospital named after V.P. Demikhov. Statistical analysis was carried out using Jamovi and IBM SPSS Statistics 23 (IBM. USA). Differences were considered statistically significant at p <0.05. The construction of a prognostic model of the probability of a certain outcome was carried out using the logistic regression method with reverse stepwise exclusion of collinear factors, calculation of the odds ratio (OR) and 95% confidence interval (CI).Results: The study included 1150 patients with type 2 diabetes, whose median age was 65 [57;74] years, median BMI - 31.2 [26.3; 35.8] kg/m2. According to logistic regression analysis, the most significant factors associated with the development of ASCVD in the population of patients with type 2 diabetes were: duration of diabetes more than 10 years (OR 4.16 (95% CI: 3.01-5.76) (p>0.001) ) and hypertension (OR 3.92 (95% CI: 2.17-7.08). Age over 60 years (OR 2.12 (95% CI: 1.46-3.06) (p>0.001), male gender (OR 1.61 95% CI: 1.14-2.26) (p>0.006)). Predictors increasing the likelihood of CHF were: patient age over 60 years (OR 4.05 (95% CI: 2). .70-6.06), (p>0.001)), previous MI (OR 3.71 (95%(2.58-5.33), p<0.001), presence of AF 2.93 (OR 2.93 (95 % CI: 1.79-4.78), p<0.001), hypertension (OR 2.45 (95% CI: 1.29-4.65), p<0.006) and female gender (OR 1.58 ( 95% 1.09-2.28), p<0.014). Factors increasing the odds of CKD were: age over 60 years (OR 2.36 (95% CI: 1.61-3.47), p <0.001), the presence of CHF was associated with an increase in the odds of CKD by 1.86 times (p <0.001), previous MI by 1.55 times (p<0.008), female gender by 1.62 times (p<0.004) and diabetes duration of more than 10 years by 1.44 times (p>0.037).Conclusion: The universal predictors of the development of cardiorenal complications in patients with type 2 diabetes were: age over 60 years and hypertension. Predictors of the development of ASCVD, in addition to universal ones, were: duration of diabetes and male gender; the likelihood of developing CHF increased in patients with a history of myocardial infarction, the presence of AF, and in females. The presence of obesity increased the chances of developing CHF, but was not associated with ASCVD and CKD. The odds of developing HF were similar regardless of the duration of diabetes, while the duration of diabetes was closely associated with the development of ASCVD and renal dysfunction. The following factors were associated with the development of CKD: duration of diabetes, female gender, history of CVD and female gender.

Key aspects of developing standard operating procedures

In modern medical practice, standard operating procedures play a crucial role in ensuring quality medical care. The development and implementation of effective SOPs require a systematic approach and active participation of medical personnel. This article discusses the stages of developing standard operating procedures and outlines the fundamental principles of developing SOPs in healthcare institutions. Drawing on the successful experience of a State Budgetary Healthcare Institution «City Clinical Hospital №52 of the Moscow City Health Department», the authors highlight key aspects and provide recommendations based on practical experience for the implementation of standard procedures to enhance the efficiency and safety of medical care. The authors analyze the importance of standardizing processes in healthcare and discuss the key stages of creating and implementing SOPs, including forming professional teams, engaging experts, and justifying the legislative framework. The research findings can be valuable for methodologists, senior nurses, and healthcare institution leaders seeking to improve the quality of medical care through the systematization and standardization of operating procedures.

РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ ОЖОГОВОЙ ТРАВМЫ ПО МАТЕРИАЛАМ РАБОТЫ АСТРАХАНСКОГО ОЖОГОВОГО ЦЕНТРА

The relevance of burn traumatism on the territory of the Russian Federation is shown up on the example of the performed analysis of the burn department work of the State Budgetary Healthcare Institution of Alexandr-Mariinskiy Regional Clinical Hospital of the Astrakhan region. With the aid of such data, it is feasible to contemplate the accessibility of high-tech medical care delivery in this direction, as well as to devise additional initiatives for the advancement of the department.

The feasibility of pathogenetic therapy for chronic viral hepatitis C in adult HIV-infected patients

In the third decade of the XXI century, HIV infection and viral hepatitis C remain urgent problems of modern medicine. Only in the Russian Federation in 2023, more than 1.6 million HIV-infected people and about 2 million patients with chronic viral hepatitis C are registered. Patients with a combined course of these diseases are of particular concern. However, insufficient coverage of etiotropic therapy for patients with chronic viral hepatitis C due to its high cost leaves pathogenetic therapy as the only available method of treatment for many of them. Material and Methods. Clinical data of patients hospitalized in the day hospital of the state budgetary health care institution "Samara Regional Clinical Center for AIDS Prevention and Control" were used. Physical, virological, immunological, biochemical and general clinical methods, elastometry of liver tissue were used for examination of hospitalized patients. Statistical processing of the results was performed using the application program "Statgrarhics Plus for Windows". Pathogenetic therapy was carried out in a two-week course in accordance with the "Recommendations for the diagnosis and treatment of adult patients with hepatitis C" (2013) and included (along with protective regime and therapeutic nutrition) the use of detoxification and metabolic therapy. Antiretroviral therapy with 3–4 drugs was carried out in 68% of the patients. Results. It was shown that the prescribed course of pathogenetic therapy of chronic viral hepatitis C did not have the expected effectiveness in the majority of patients referred for treatment according to the dynamics of changes in the values of "liver tests", despite the fact that the "right subcostal syndrome" was eliminated in 75.7% of persons with stage 3 and 66.7% with stages 4A and 4B of HIV infection. Statistical studies of the relationship (linear, rank and canonical) did not reveal its presence between the results of the conducted treatment and the complex of initial clinical and clinicallaboratory data obtained during hospitalization of the examined persons. Discussion. The presence of cytolysis syndrome and "right subcostal syndrome" is not a valid criterion for referral to a two-week course of pathogenetic therapy of chronic viral hepatitis C in order to obtain a positive result in the majority of patients with stages 3, 4A and 4B of HIV infection. Other baseline data (virologic and immunologic indices, degree of liver tissue fibrosis, indices of general and biochemical blood analysis) had no reliable correlation with the results of treatment, which did not allow their use for predicting the effectiveness of the prescribed treatment. Antiretroviral therapy was not associated with the results of pathogenetic therapy of chronic viral hepatitis C according to the indicators of cytolysis syndrome and "right subcostal syndrome", despite the fact that most of the prescribed drugs had a hepatotoxic effect.

Analysis of practical experience in the development and implementation of standard operating procedures in the activities of nursing medical staff on the base of the FSBHI MRC «Sergievsk mineral waters» FMBA of Russia

The use of innovative technologies in the daily practice of a nurse makes her work more professional, ensures safety and convenience when performing basic professional tasks, reduces labor costs, and allows for the implementation of the diagnostic and treatment process quickly and efficiently. Target. To analyze the experience of developing and implementing standard operating procedures for nurses for 2022–2023. Results. The successful development and further implementation of SOPs for various types of activities of nursing staff was completed; solved problems that arose during the development and implementation of SOPs by creating corrective actions with mutual analysis, taking into account the feedback of the team of specialists; the proposed technologies and standard documents can be used as a model by most medical organizations. Conclusion. In the Federal State Budgetary Healthcare Institution MRC «Sergievsk Mineral Waters» FMBA of Russia, as of January 2024, the following have been developed: 121 SOPs, 30 SOPs have been revised. In 2024, 4 SOPs were introduced in medical organizations and continuous work is underway to further develop them.

Риск распространения COVID-19 среди медицинских работников Самарской области в стационарах различного типа

The purpose of this study was to assess the epidemiological risk for medical workers in the pandemic spread of a new coronavirus infection in various types of medical organizations. Materials and methods. The results of epidemiological surveillance of the staff of the State Budgetary Healthcare Institution of the Samara region «Samara City Clinical Hospital № 2 named after N.A. Semashko» in the number of 631 people, according to the protocols of 132 commissions for the prevention of infections related to the provision of medical care for the period from January 2021 to December 2022. Information from 1318 reports No. 1035 «Monitoring on the number of cases of coronavirus infection, including community-acquired pneumonia, and deaths» in the Samara region from the Rospotrebnadzor information system from April 22, 2020 to December 31, 2022 in terms of the total number of COVID-19 patients per day, the number of infected medical workers per day, the number of infected people in medical organizations. The results of the analysis of 11 scientific articles on the topic of the characteristics of epidemic foci in the teams of medical workers. Results and discussions. The COVID-19 pandemic has demonstrated the importance of developing national bed resources and the human resources of medical workers, taking into account the need for rapid conversion of somatic hospitals. Doctors, mid-level and junior medical personnel are at higher risk of infection both through contact with patients if they do not follow the rules for using PPE, and when interacting with each other. Repurposed somatic hospitals (GBUZ SB «SOKB named after V.D. Seredavina», FGBI VO «Clinics of SamSMU»), in comparison with a specialized infectious diseases hospital (GBUZ SB «GBS № 6»), due to the peculiarities of construction and planning solutions, represent an environment with a higher risk of infection of medical personnel, which requires additional organizational preventive measures. In addition to the general requirements of biological safety in the repurposed red zone, a comprehensive formation of a safe working environment is required, including such components as: organization of rest rooms for staff separately from the residents, development and observance of a meal schedule to eliminate the intersection of personnel flows as much as possible, digitalization of medical documentation, time-limited reception of biomaterial in the laboratory, issuance of the results of research through an electronic information system. Keywords: COVID-19, nosocomial component, epidemic outbreak, medical personnel, PPE, risk of infection, organization of the working environment.

Клиническая картина вторичного периода сифилиса у ВИЧ-инфицированных больных

Predominantly sexually transmitted infections (STIs) continue to be of concern to physicians. Particularly interesting are cases of combined STIs. Patients infected with human immunodeficiency virus (HIV) and other diseases pose the most challenging diagnostic and treatment scenarios. Venereologists observe severe manifestations of chronic dermatoses in individuals with HIV infection, atypical courses of other infections, and lack of response to conventional treatment methods. This study focuses on monitoring HIV-infected patients with syphilis during their hospitalization in the venereology department of the V.G. Korolenko Clinic, a branch of the State Budgetary Healthcare Institution Moscow Research and Practical Center for Dermatovenerology and Cosmetology. The study presents a differential diagnosis of secondary syphilis manifestations in these patients and discusses the peculiarities of the disease course.

Inflammatory complications due to mandibular body fractures. Analysis of the causes

The aim of this research was to identify the factors that can further the development of infectious and inflammatory complications of a fractured mandible and search for ways to eliminate them. 643 medical histories of patients with mandibular fractures that received inpatient treatment in the maxillofacial surgery department in the State Budgetary Healthcare Institution of the Volgograd region «The Regional Clinical Hospital №1» between January 2019 and December 2021 were studied. The results of retrospective analysis of the frequency rate and nature of inflammatory complications from 2019 to 2021 were presented. The relation was revealed between the frequency rate of inflammatory complications, the quality of medical services, the time people wait until seeking medical help, and also whether patients have chronic diseases, which could lead to metabolism disruptions, that can cause chronic endogenous intoxication, secondary immune deficiency and reparative regenerations disruptions. Recommendations were proposed about a more reasonable treatment plan and elimination of common mistakes during the stages of medical care, which could reduce the risk of inflammatory complications.

Broncho-obstructive syndrome in pediatrician’s practice (clinical cases)

Background. With the development of broncho-obstructive syndrome (BOS), spasm, edema, hypercrinia and bronchial dyscrinia occur. Increasing airflow resistance can complicate the course of diseases of the respiratory system. Broncho-obstructive syndrome coexists many pathologies, including cardiovascular diseases, gastrointestinal diseases and other abnormal developments of internal organs. The causes of this syndrome are diverse, including bronchial asthma, abnormal developments of the bronchopulmonary system, gastroesophageal reflux, cystic fibrosis and congenital heart diseases. The purpose of this study was to analyze and describe clinical cases of pediatric patients with BOS.Clinical cases description. The article presents clinical cases of patients who were treated at the State Budgetary Healthcare Institution of Republic of Crimea “Republic Children’s Clinical Hospital” at different times, who developed BOS against the background of Nijmegen Breakage Syndrome and aspiration of a foreign body (feather from a pillow) into the bronchi. Both clinical cases show the importance of comprehensive, and most importantly, timely diagnostic procedure. In clinical case No. 1, the medical history of patient N. with Nijmegen Breakage Syndrome is described. The pathology was revealed owing to a comprehensive diagnostic procedure. Representatives of patient N. appealed to the State Budgetary Healthcare Institution of Republic of Crimea “Republic Children’s Clinical Hospital” in connection with the development of symptoms of bronchial obstruction. Clinical case No. 2 describes the untimely diagnosis of a radiolucent bronchial foreign body. In this situation, the ambiguity of the clinical picture and, as a result, the search for other pathologies cost the child his life.Conclusion. Broncho-obstructive syndrome is associated with a variety of pathologies that are not limited to problems with the respiratory system. It is important to be able to identify symptoms in patients that will indicate the cause of the developed BOS.

ПРИМЕНЕНИЕ НОВЫХ МЕТОДИК ЛУЧЕВОЙ ТЕРАПИИ В ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ И РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ В РАМКАХ РЕАЛИЗАЦИИ НАЦИОНАЛЬНОГО ПРОЕКТА «ЗДРАВООХРАНЕНИЕ» В НОВОСИБИРСКОЙ ОБЛАСТИ

In 2023, within the framework of the national project “Healthcare”, two state of the art linear accelerators for radiation therapy were put into operation at the State Budgetary Healthcare Institution of the Novosibirsk Region “Novosibirsk Regional Clinical Oncology Dispensary”: Elekta Versa HD and Elekta Infinity. Thanks to the new equipment and the new dosimetric planning system, it became possible to use modern radiation therapy technologies in the Novosibirsk Region. The use of the new equipment is becoming especially relevant for the treatment of leading tumor diseases – breast cancer in women and prostate cancer in men.