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Vol 76, No 2 (2021)

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OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUES

Healthcare-associated infections (HAI) in maternity hospitals of Russian Federation (the state of the problem at the beginning of the XXI century)

Priputnevich T.V., Lyubasovskaya L.A., Shuvalova M.P., Baibarina E.N., Sukhikh G.T.

Abstract

Over the past decade, the healthcare system of the Russian Federation has undergone progressive changes in the system of maternity care, which relate to the development of infrastructure and the introduction of new organizational models. In particular, a three-level system of providing medical care to mothers and children has been created, including a network of perinatal centers for patients at high perinatal and obstetric risk. Field events of specialists of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation to the medical organizations of maternity care in various regions of Russia revealed “hot spots” that require primary attention: acute shortage of staff for the implementation of diagnostic and therapeutic measures at the modern methodological level, as well as for ensuring epidemiological safety in the medical organizations (medical microbiologists (bacteriologists), clinical pharmacologists and epidemiologists); the lack of registration of healthcare-associated infections, which is associated with the prevailing in the country mainly “punitive” methods of combating hospital infections. In modern conditions of nursing preterm babies, newborns with various severe somatic and surgical pathologies, it is necessary to know the real indicators of morbidity in order to reasonably and promptly carry out therapeutic and preventive measures; the need to organize modern microbiological laboratories in the perinatal centers with the availability of “fast” methods (proteomic and molecular-genetic) diagnostics, allowing for microbiological monitoring in specialized departments of newborns and promptly respond to the changes in the epidemiological situation in the hospital, to prevent the development of clinically pronounced cases of healthcare-associated infections.

Annals of the Russian academy of medical sciences. 2021;76(2):133-141
pages 133-141 views

INTERNAL DISEASES: CURRENT ISSUES

Serum Neutrophil Gelatinase Associated Lipocalin in Patients with Toxic Nephropathies. Prospective Study

Demidchik L.A., Lee V.V., Klyuyev D.A., Bakirova R.Y., Molotov-Luchanskiy V.B., Pozdnyakova Y.V., Beinikova I.V., Bobyrev S.S.

Abstract

Background. Drug induced kidney disorder (DIKD) is a frequent adverse event which contributes to morbidity and even incapacitation. Toxic nephropathy also is one of the pathological syndromes or complications in acute alcohol poisoning (AAP). Recent years experience shows the “insensitivity” of serum creatinine to the early stages of kidney damage. NGAL has been shown as a preferred marker of acute kidney damage in a variety of clinical settings. However, no similar studies of serum NGAL have been performed in patients with toxic nephropathy. The presence of markers discovers the possibility of earlier detection, timely treatment and prevention of disease progression to chronic kidney disease (CKD), which can improve the patient’s prognosis.

Aims — to study serum NGAL levels in patients with AAP and DIKD with clinically diagnosed nephropathy and without signs of kidney damage. The effect of glomerular filtration rate (GFR) on serum NGAL levels was studied.

Materials. This prospective cross-sectional study was conducted on the basis of the biochemical laboratory of the Karaganda Medical University in conjunction with the toxicological department of the Regional Medical Center (from January 2018 to October 2019). The study included 89 patients with AAP and 50 patients with DIKD. 25 healthy donors (control group) and 25 patients with CKD served as comparison groups. Serum NGAL levels were measured using a commercially available ELISA kit.

Results. We detected the increased serum NGAL level in both groups with drug-induced nephropathy and nephropathy, caused by AAP compared with the control group values (p < 0.01). However, there were no significant differences in NGAL level, depending on the type of toxic nephropathy. After ranking the GFR, it was revealed that GFR did not affect the serum NGAL level (F = 2.21; p = 0.12) and its increase was observed both at “reduced” and “increased” GFR relative to the control group values (p < 0.05).

Conclusions. The results of our study showed a multiple increase in the concentration of NGAL in serum not only in patients with toxic nephropathy, but also in patients with “increased” GFR, even in the absence of clinical and laboratory signs of impaired renal function.

Annals of the Russian academy of medical sciences. 2021;76(2):142-148
pages 142-148 views

IMMUNOLOGY: CURRENT ISSUES

Mast Cells Heparin — New Information on the Old Component (Review)

Kondashevskaya M.V.

Abstract

Mast cells (MC) are widely distributed throughout the body of animals and humans, mainly in barrier tissues. This review provides new information on the hematopoietic origin of MCs from early erythromyeloid progenitors (EMPs), late EMPs, and definitive hematopoietic stem cells. As well as information on the maturation of MSs and heparin synthesis already in the embryonic period. Many physiological functions of MCs are determined by the properties of heparin, which forms the basis of the matrix of granules, since the heparin molecule is a strong polyanion, capable to forming complexes with many biologically active substances and regulating their properties. In a new hypothesis about the participation of MCs in pathological processes, it is assumed that this is due to the depletion of the heparin pool. In such cases, injections of exogenous heparin can help replenish MCs heparin stores. As a result of the restoration of the physiological functions of MCs and the action of exogenous heparin, the pathological process will be converted into an adaptive one. In clinical practice, unfractionated heparin (UFH) obtained from natural sources and low molecular weight heparin (LMWH) obtained by the biochemical route are used. Most often, UFH and LMWH are used in the clinic only as anticoagulants. The worldwide spread of a disease named COVID-19 in 2020 showed that UFH and LMWH are multifunctional drugs that have saved many people. The pandemic caused by COVID-19 has been an unprecedented social and health emergency worldwide. Depression, anxiety and post-traumatic stress disorder (PTSD) have been reported in populations of many countries. This review provides new information on experimental studies on the successful treatment of pathology with low doses of UFH in modeling PTSD in animals. Consequently, heparin can be considered as a promising multifunctional drug for effective pharmacological correction of comorbid diseases under the influence of extreme factors.

Annals of the Russian academy of medical sciences. 2021;76(2):149-158
pages 149-158 views

CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES

Expression of adipocytokine in heart fat depots depending on the degree of coronary artery atherosclerosis in patients with coronary artery disease

Gruzdeva O.V., Dyleva Y.A., Belik E.V., Akbasheva O.E., Borodkinа D.A., Sinitsky M.Y., Naumov D.Y., Bychkova E.E., Fanaskova E., Palicheva E.I., Kuzmina A.A., Barbarash O.

Abstract

Background. In coronary artery disease, a change in the adipocytokine content of local fat depots of the heart is observed. However, it has not yet been established whether the expression levels of the studied parameters are really related to the degree of atherosclerotic lesion of the spacecraft.

Aims — to identify the features of the expression of adiponectin, leptin and IL-6 by adipocytes of epicardial, perivascular and subcutaneous adipose tissue depending on the degree of atherosclerotic lesion of the coronary channel in coronary heart disease.

Materials and methods. The study conducted at the “Research Institute for Complex Issues of Cardiovascular Disease” in 2017–2020, included 84 patients with coronary heart disease (CAD), of which 39 with a moderate degree of atherosclerotic lesion of the coronary artery (CA) (≤ 22 points on the SYNTAX Score scale), 20 with severe (23–31 points) and 25 with extremely severe (≥ 32 points). Biopsies of subcutaneous (SAT), epicardial (EAT) and perivascular adipose tissue (PVAT) were obtained during elective coronary artery bypass grafting (CABG). The expression of adipocytokine genes was determined using polymerase chain reaction (real-time PCR) using TaqMan probes and the concentration of the studied adipocytokines in adipocyte culture medium by enzyme immunoassay. Statistical analysis was performed using Statistica 9.0, a one-dimensional and multi-dimensional logistic regression analysis.

Results. In CAD in adipocytes of the cardiac fat depot, a shift in the balance of adipocytokines is observed towards increased expression and secretion of leptin, IL-6 and a decrease in adiponectin with maximum manifestation in severe and extremely severe coronary lesions. Adipocytes of EAT were characterized by the minimal expression of the adiponectin gene against the background of the maximum — leptin and IL-6 in comparison with adipocytes SAT and PVAT.

Conclusions. Low expression of the adiponectin in EAT and PVAT against the background of increased expression of leptin and IL-6 is associated with an increase in the degree of atherosclerotic lesion of the coronary channel.

Annals of the Russian academy of medical sciences. 2021;76(2):159-168
pages 159-168 views

PSYCHOLOGY AND PSYCHIATRY: CURRENT ISSUES

Safety of pharmacotherapy in a psychiatric inpatient setting and the QT interval

Kirilochev O.O.

Abstract

Background; Events associated with a risk of death are the most serious complications of pharmacotherapy; One of these complications is prolongation of the QT interval leading to Torsades de Pointes, a life-threatening condition that can result in asystole and sudden death. Factors contributing to the development of the long QT syndrome include heredity, structural abnormalities of the heart, electrolyte disorders, female gender, advanced age, use of drugs with certain electrophysiological properties, and drug-drug interactions. Consideration of all these factors can help achieve the most accurate and objective assessment of the risk of these rhythm disturbances.

Aims — to assess the risk of prolongation of the QT interval and the development of Torsades de Pointes in psychiatric inpatients.

Methods. The study enrolled 500 patients who received medical care in a psychiatric inpatient setting. The risk of QT interval prolongation and development of Torsades de Pointes was assessed using the MedSafety Scan® medical decision support system.

Results. Of the 500 patients treated in the psychiatric inpatient setting, 224 had a risk of QT interval prolongation and developing Torsades de Pointes; the incidence was highest in the group of elderly patients. The mean risk score was 7.59 ± 3.29 in general, 6.02 ± 3.14 in patients aged under 65 years, and 9.16 ± 2.62 in subjects over 65 years of age. An analysis of the frequencies of risk factors for prolongation of the QT interval and Torsades de Pointes revealed that patients aged over 65 years most commonly had atrial fibrillation, chronic heart failure, heart valve disorders, hypertension, and a history of myocardial infarction. Patients under 65 years of age more commonly received medicinal products prolonging the QT interval and drug combinations that can lead to potential drug-drug interactions of relevant clinical significance.

Conclusion. The obtained results indicate the importance of assessing the risk of QT interval prolongation and development of Torsades de Pointes in psychiatric inpatients as an affordable preventive tool that can increase the safety of drug therapy.

Annals of the Russian academy of medical sciences. 2021;76(2):169-176
pages 169-176 views

HEALTH CARE MANAGEMENT: CURRENT ISSUES

What Are Patient Registries and Why Are They Needed (Through a Number of Examples of Psoriasis Registries)

Kubanov A.A., Bogdanova E.V.

Abstract

The article substantiates the relevance of registries of patients as illustrated by registries of patients with psoriasis, gives a comparative characteristic and description of the advantages and disadvantages of randomized controlled and observational registry studies, considers the main goals of patient registers. The importance of patient registers as sources of additional knowledge about diseases is described. Review of the existing dermatological patient registers is given. The paper provides the detailed description of the most significant registries of patients with psoriasis: PSOLAR, Badbir, Corrona, BIOBADADERM and others. An overview of publications and main results of the research based on registries of psoriasis patients is presented. A description of the register of patients with psoriasis as part of the Database of patients with chronic diseases of the skin and subcutaneous tissue, maintained by the Russian Society of Dermatovenereologists and Cosmetologists since 2018 is given. The article substantiates the relevance of patient registries as illustrated by registries of patients with psoriasis, gives a comparative characteristic and description of the advantages and disadvantages of randomized controlled studies and observational registry studies, argues in favor of complementarity of data from randomized controlled trials and registry-based studies. Consideration of the main goals of patient registers is given. The importance of patient registers as sources of additional knowledge about diseases and quality of medical care is described. Review of the existing dermatological patient registers is given. The paper provides the detailed description of the most significant registries of patients with psoriasis: PSOLAR, Badbir, Corrona, BIOBADADERM and others. An overview of publications and main results of the research based on registries of patients with psoriasis is presented. A description of the register of patients with psoriasis as part of the Database of patients with chronic diseases of the skin and subcutaneous tissue, maintained by the Russian Society of Dermatovenereologists and Cosmetologists since 2018 is given, as are inclusion criteria. In addition, the main federal registries of patients that are maintained in the Russian Federation are listed, the goals of their maintenance are indicated.

Annals of the Russian academy of medical sciences. 2021;76(2):177-186
pages 177-186 views

Risk management for healthcare organizations

Nikolaeva N.G., Priimak E.V., Razina I.S., Kazanceva M.A.

Abstract

It is believed that more than 70% of errors in a medical organization can be prevented, in particular, by using risk management methods and implementing risk management tools in the practice of their activities. To this end, the authors conducted a study based on data from the analysis of scientific papers and regulatory documents regulating quality management and risk management in healthcare. The study summarizes the main approaches to implementing risk management methods in healthcare and suggests an algorithm for analyzing the types and consequences of potential failures in healthcare (HFMEA). As the analyzed process, the process of performing doctor’s appointments by medical nurses for drug therapy was chosen, which refers to the main medical events, and drug error is a serious problem in drug therapy. The results of the study revealed possible risks associated with each step. The study is appropriate due to the fact that many healthcare institutions are currently implementing a quality management system to improve their processes.

Annals of the Russian academy of medical sciences. 2021;76(2):187-195
pages 187-195 views

Complex Analysis of Information Technologies Integration and Adoption into Medical Organizations

Mikailova A.A., Efimova A.K., Shestakov A.V., Bobrysheva A.A., Motlokhova E.A., Zvonareva O.I.

Abstract

Nowadays Information Technologies (IT) are taking more and more stable position in the process of work organization in various companies, and particularly among medical organizations. Present-day scientific society has already begun to research the topic of IT integration particularities into the Health organizations. Current article is focused on this issue. Our team has planned and provided a systematic review to understand which barriers can appear in different medical centers during implementation of the innovative IT into working process. The review has been fulfilled according to the designed protocol based on the actual recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. In the course of the workflow we have explored 2050 articles complied with the requirements. As a result, 23 key publications have been chosen and analyzed in detail. After considering the list of issues and barriers associated with the IT Implementation into hospitals and medical centers have been highlighted and described. We have classified them to notional clusters depending on the reasons of their appearance as well. In addition our team has defined the list of practical recommendations following which the result of the IT integration will be improved, but the risk of a negative outcome in the future can be eliminated.

Annals of the Russian academy of medical sciences. 2021;76(2):196-209
pages 196-209 views

PHARMACOLOGY: CURRENT ISSUES

The Continuity of Chronic Medications in Multimorbid Patients during Perioperative Period: Retrospective Analysis

Nigmatkulova M.D., Kleymenova E.B., Yashina L.P., Sychev D.A.

Abstract

Background. Failure of continuity at care transitions results in 50% of all medication errors and up to 20% of adverse drug events (ADEs). In surgical patients medication errors occur more often than in medical patients due to perioperative corrections of medications and greater number of in-hospital transitions. The frequency of ADE in surgical patients varies from 2.3 to 27.7%.

Aims — to determine the prevalence and structure of unintentional discrepancies (UDs) in medications at admission to and discharge from surgery departments, report their potential clinical impact and analyse possible risk factors.

Methods. Retrospective observational study was conducted in a general hospital in Russia. The study included patients hospitalized for elective surgery in Surgical Departments from January to June 2019. The pre-admission Best Possible Medication History (BPMH) for every patient was obtained. The BPMHs were compared with admission medication orders and hospital discharge prescriptions to identify UDs. Detected UDs were analysed for potential ADE with severity evaluation.

Results. 206 patients were included, 55.83% were female, mean age 63.85 (±9.38), median of chronic medications was 3 drugs. At least one UD was detected in 70.87% of patients at admission and in 92.72% at discharge, respectively, with averages of 1.30 and 2.81 discrepancies per patient. Cardiovascular drugs were the most frequent class involved at both admission (72.2%) and discharge (68.05%) in UDs. The most often UDs at both admission (51.68%) and discharge (94.65%) were omissions, incorrect dose (22.47% and 2.25%), and additional medications (11.6% and 1.55%). UDs had the potential to cause significant ADEs in 81.27%, serious ADEs in 18.35% of cases. Only 0.37% of UDs could contribute to life-threatening ADEs. The relative risk of discrepancies in patients of 60 years and older was 1.292-fold higher; three and more chronic medications increase risk 1.565-fold; diabetic or thyroid medications increase risk 1.932-fold.

Conclusions. We reported on the first study of medication discrepancies conducted in Russian hospital. Estimated frequency, structure and risk factors of UDs in medications at admission to and discharge from surgery departments are similar to those from other countries. To decrease UDs in medications, implementation of medication reconciliation is needed.

Annals of the Russian academy of medical sciences. 2021;76(2):210-220
pages 210-220 views

EPIDEMIOLOGY: CURRENT ISSUES

Modern view of the evolution of the concept of "epidemiology". Analytical overview

Briko N.I., Shkarin V.V.

Abstract

The article analyzes the evolution of views on the concept of “epidemiology” in various phrases, provides a critical rationale and assessment of individual groups of definitions of “epidemiology”, presents a substantiated description of new scientific directions in epidemiology. Additions and changes to the existing structure of epidemiology have been developed and proposed, taking into account modern scientific data on infectious and somatic pathology. The formation of new directions in epidemiology has significantly enriched it not only in scientific but also in applied terms. The section “epidemiology of infectious diseases forms” the fundamentality of the science of epidemiology, which is constantly developing, which cannot be said about non-infectious epidemiology. Taking into account current trends, the author proposes his own vision of the modern structure of epidemiology as a science. The epidemiology of noncommunicable diseases is still at a lower stage of development than the epidemiology of infectious diseases. It lacks a full-fledged theoretical basis, both in general and in individual sections. There is no epidemiological terminology generally accepted in world medical science.

Annals of the Russian academy of medical sciences. 2021;76(2):221-230
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ANNIVERSARIES, CONGRATULATIONS

To the 70th anniversary of the birth of Sergei Lvovich Kuznetsov

Abstract

May 6, 2021 marks the 70th anniversary of the birth of a Corresponding Member of the Russian Academy of Sciences, Head of the Department of Histology, Cytology and Embryology of I.M. Sechenov, Doctor of Medical Sciences, Professor Sergei Lvovich Kuznetsov.

Annals of the Russian academy of medical sciences. 2021;76(2):231-232
pages 231-232 views

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