Vol 99, No 10 (2020)

Introduction. Preventive maintenance is of great importance for the prophylaxis of healthcare-associated infection (HAI).

Material and methods. An assessment of the interventional cleaning program of the epidemiologically significant units of a large medical organization was based on the data of marks erasure control, microbiological studies, a survey of employees of the insourcing department.

Results. In 2017, the Center began implementing an intervention program for outsourcing, which began with the creation of the Department of sanitary services (DSS), which took over the functions of cleaning the premises, as well as providing departments with the necessary disinfectants, detergents, and cleaning products. Before the implementation of this intervention program, the staff was trained in the form of theoretical classes (lectures with the display of training videos, presentations). Practical skills were developed directly in the workplace. The interventional insourcing program showed a 1.28-fold decrease in microbial contamination of surfaces in high-epidemiological risk departments. As a result, the consumption of disinfectant was reduced by more than 5 times. The satisfaction of the sanitary service Department operators with the introduction of the new method was more than 90%.

Conclusion. The implemented intervention program allowed not only to improve the quality of cleaning, but also to change the attitude of patients, medical personnel, and the administration to the institution of cleaning by the forces of the medical organization itself.

Introduction. One important aspect of modern research is the study of the role of the phenotypic composition of lymphocytes in the development of a variety of pathological processes.

The aim of the study was to compare the phenotypic composition of lymphocytes and their intercellular cooperation in patients with sensorineural hearing loss (SHL), with vibration disease (VD) from exposure to local vibration, with VD from combined exposure to general and local vibration, chronic mercury intoxication (CMI).

Material and methods. The phenotypical structure of lymphocytes was estimated by the method of indirect immunofluorescence using monoclonal antibodies to molecules CD3⁺, CD4⁺, CD8⁺, CD16⁺, CD20⁺, CD25⁺, CD95⁺.

Results. The general regularity of changes of an immunophenotype of lymphocytes in patients with the occupational pathology induced by the influence of physical and chemical factors was established to be the hyperactivation of immune responses characterized by an increase in the number of lymphocytes (CD3⁺, CD4⁺, CD20⁺) of the various degree of expressiveness. Differences between the compared groups were characterized by an elevation increase in the number of mature T-lymphocytes (CD3⁺) in persons with SHL concerning patients with the VD from the combined impact of the general and local vibration, increase of natural killers (CD16⁺) in comparison with the VD due to a local vibration. The latter showed lower levels of early lymphocyte activation markers (CD25⁺) than BB due to combined exposure to local and general vibration and CMI. Features of pathogenetically significant intercellular interactions, manifested by a difference in number and composition of correlation pairs, are revealed.

Discussion. The results show a different degree of expression of immune responses, which can be due to many factors (severity of the disease course, an initial background of immunoreactivity before starting work in harmful working conditions, work experience, etc.).

Conclusion. The detected changes in the phenotypic composition of lymphocytes and their cooperation in patients with occupational pathology formed under the influence of physical and chemical factors seem to be due to the specificity of the affecting occupational factors and, as a result, the degree of expression of the pathological process.

Introduction. Vibration as a factor of production is one of the leading that influences negatively on workers in various sectors of the economy. In available literature there no adequate information on the comorbid pathology in hand-arm vibration disease (HAVD) patients.

The purpose of the study is to analyze the prevalence of somatic pathology in HAVD patients.

Material and methods. The analysis of comorbidity of HAVD patients according in-depth medical data is carried out. The degree of relationship between work-related health disorders is assessed. The results are presented by average values, intensive and extensive indices, the relationship of work-related health disorders is confirmed by the calculation of the relative risk.

Results. The main syndrome in the clinical picture of HAVD is autonomous-sensory polyneuropathy of the upper extremities, which is recorded in all patients, while some patients have a combination of two or more clinical syndromes of HAVD. A significant prevalence of diseases of the musculoskeletal and circulatory systems, eyes and its adnexa, ear and mastoid process, digestive, genitourinary system, and respiratory systems was revealed. Number of patients who have diseases of endocrine (up to 25.0%, p <0.01), digestive (up to 43.8%, p <0.01), urogenital (up to 37.5%, p <0.01), respiratory (up to 37.5%, p <0.05) and the circulatory (up to 52.9%, p <0.05) systems grows up with an increase of the experience dose of local vibration.

Conclusion. The results of the study can serve as the basis for the implementation of measures for primary and secondary prevention of occupational diseases caused by local vibration, aimed at preventing the development of health disorders.

Introduction. Vibration disease (VD) is associated with an imbalance of endocrine regulation, the development of metabolic syndrome (MS), which leads to the development of neurological complications. One of the reasons is microcirculation disorders that involve the CNS and peripheral nerves in the pathological process.

The aim of the study is to provide a comprehensive assessment of the state of peripheral nerves and afferent pathways in workers with VD, and patients with VD, burdened with MS.

Material and methods. We examined: 41 patients with VD associated with combined local and general vibration (group 1), group 2 - patients with VD burdened with MS (29 people), control (group 3) - 33 people. Check somatosensory evoked potentials (SSEP) and electroneuromyography was performed on the NCS system «Neuro-EMG-Micro», «Neurosoft».

Results. In group 2, violations of the central afferent pathways at the level of the cervical spine and the somatosensory cortex were detected, expressed in an increase in the latency period of components P25 and N30 and the duration of the interval N11-N13. When testing the motor and sensory components of peripheral nerves, patients with VD, burdened with MS, were found to have a more pronounced decrease in SPI for the sensory and motor components of the tibial nerve, and increased residual latency.

Discussion. Changes in the central nervous system and peripheral nerves in MS are aggravated by the impact of vibration - changes in carbohydrate, protein, and enzymatic metabolism, triggering processes that lead to polyneuropathy. Exposure to vibration generates chronic stress (external factor MS) associated with activation of the hypothalamic-pituitary-adrenal system and the development of insulin resistance.

Conclusion. In group 2, there was an increase in moderate autonomous-sensory polyneuropathy of the hands and feet and peripheral angio-dystonic syndrome of the hands. Violations in the state of the central afferent pathways at the level of the cervical spine and cortical structures of the somatosensory cortex were detected. Exposure to vibration and MS leads to an aggravation of demyelination of sensory and motor axons of peripheral nerves, expressed in the legs.

Introduction. The Russian aluminum industry is one of the world’s leading producers of aluminum. At the same time, the features of aluminum production technology contribute to the formation of unfavorable working conditions and increased risk to the health of workers. In this regard, an urgent but insufficiently studied issue in the production of aluminum is the assessment of occupational risks that establish the likelihood of health disorders in workers.

Material and methods. The basis of the assessment of occupational risks was the existing regulatory documents (Guidelines) issued by the Federal Center for Hygiene and Epidemiology of Russian Consumer Health and Epidemiology. Existing methodical recommendations and medical technologies were used to calculate occupational risks and allowable working time (experience) under the chemical factor. The values of the annual volume of the air inhaled by the individual of the production environment and the average annual concentrations of toxicants, determined in the air of the working zone of the employees of the main occupational groups, were used. Occupational risk calculations were carried out over a period of 25 years. The total risk assessment for individual occupational groups was conducted under the probability (risk) rule calculated for individual chemicals.

Results. Studies have found the average annual concentrations of harmful substances in the air of the working area over the past 5 years to be significantly lower when using the upgraded electrolysis technology (UET) compared to the traditional technology of self-burning anodes (SBA). The exception was hydrofluoride, whose concentrations did not depend on the technologies used, exceeding the MPC by 1.7 - 3.0 times. The total health risk for employees of the main occupations over a period of 25 years was in the range of 7.2 to 22.1% when using SBA, which is almost 2 times higher than when using UET (from 3.7 to 11.6 %). The highest levels of risk were observed in the group of workers using SBA and operators of electrolysis baths with UET, and the lowest - in the crane operators using both technologies.

Conclusion. The use of indices of occupational risk and acceptable working hours under the influence of adverse production factors allows identifying a contingent of employees with an increased level of exposure to occupational hazards. Based on the obtained data, it is possible to predict the levels of occupational morbidity and evaluate the effectiveness of measures to improve working conditions, which plays an important role in managing occupational risk.

Introduction. Exposure to mercury and its compounds can be a risk factor for the development of cardiovascular diseases.

The aim of the study is to investigate the levels of antibodies to oxidized LDL, intercellular adhesion molecules sICAM-1, sVCAM-1, and VEGF in individuals exposed to mercury.

Material and Methods. A cross-sectional examination was carried out using biochemical methods in persons who have come into contact with metallic mercury with a work experience of more than five years, persons with a first established diagnosis of chronic mercury intoxication, and patients with chronic mercury intoxication in the long-term postexposure period.

Results. In persons exposed to mercury with concomitant cardiovascular diseases, the level of sVCAM-1 differed depending on the presence/absence of intoxication and acquired maximum values in its long-term period, while the concentrations of sICAM-1 and antibodies to oxidized LDL did not differ significantly. In the groups without cardiovascular pathology exposed to mercury, the concentration of sVCAM-1 was higher in patients with intoxication, and sICAM-1 was 1.5-2 times lower when compared with experienced individuals, the level of antibodies to oxidized LDL was maximum in the presence of intoxication in its initial period.

Discussion. The progression of chronic mercury intoxication is accompanied by an increase in the level of sVCAM-1, and a gradual decrease in the content of sICAM-1 to reference values. Trained workers were found to have elevated sICAM-1 levels.

Conclusion. The role of antibodies to oxidized LDL, intercellular adhesion molecules is their multidirectional participation in the mechanisms that inhibit or contribute to the formation of cardiovascular pathology in individuals exposed to mercury.

Introduction. Among occupational poisoning, chronic mercury intoxication (CMI) in the Irkutsk region occupies a leading position.

Objective. To give a comparative analysis of the methods of pharmacotherapy of sleep disorders in patients in the long-term CRI.

Material and methods. The study included 60 patients with long-term CRI, divided into two equal groups of 30 cases: in the first, the average age was 56.0 ± 0.7, in the second, the average age was 57.1 ± 3.0. Questionnaires were conducted using the hospital scale of anxiety and depression, electroencephalographic, polysomnographic studies before and after treatment. During the study, two treatment regimens for sleep disorders were implemented: the first regimen included the administration of an antidepressant (trazodone) and the chemical analog of melatonin (melaxen), and the second regimen was zolpidem. Statistical processing of the research results was carried out using the software package “Statistica 6.0”.

Results. After treatment, in the first group there was an increase in the duration of the total sleep time (p = 0.0008), a decrease in the time of falling asleep (p = 0.004), a decrease in the total number of activations (p = 0.00005), and the time of wakefulness in bed (p = 0.0018), an increase in the representation of delta sleep (p = 0.03), and REM sleep (p = 0.004), an increase in the sleep efficiency index (p = 0.0008), and a decrease in the integrative sleep quality index (p = 0.001). In the second group, only a decrease in the latent period of stage 1 (time of falling asleep) was established (p = 0.05).

Discussion. After treatment with trazodone in combination with melaxen, a decrease in the severity of presomnic and intrasomnic disorders was found, and in patients taking zolpidem, only the severity of presomnic disorders was reduced. The results confirm the hypothesized cause of dissominal disorders in CRI (changes in the activity of the limbic-reticular complex).

Conclusion. The use of trazodone in combination with melaxen proves the improvement of the qualitative and quantitative indices of the structure of night sleep in patients in the long-term postexposure period of CRI.

Aim of the study. Analysis of the dynamics of the alimentary-dependent prevalence in children from various age groups in the industrial center.

Materials and methods. The study was conducted retrospectively according to official statistical reporting. The total and primary incidence in children and adolescents in the city of Angarsk was estimated for 6 years (2013-2018). Age-specific features of the incidence in children were analyzed over 3 years (2016-2018). Relative indices of the incidence were calculated (per 1000 population of the corresponding age), characteristics of the time series: the average annual absolute increment; the rate of average annual growth (decrease); linear regression models were built using the Excel software module.

Results. An analysis of the primary morbidity of alimentary-dependent pathology in children of different ages showed that its structure is characterized by a predominance of diseases of the digestive, endocrine systems, and blood. Moreover, in young children, blood diseases are most pronounced. Assessment of the dynamics of alimentary-dependent diseases in children aged 0-14 and 15-17 years revealed multidirectional trends. In children aged 0-14 and 15-17 years, the presence of pronounced trends to a decrease in the incidence of the pathology of the digestive system was revealed. The differences are that pronounced trends in the increase in the incidence are observed in children aged 0-14 years - in the frequency of obesity, in children 15-17 years old - in the frequency of endemic goiter.

Discussion. The obtained values of the regression analysis allow predicting an increase in the frequency of diseases of the thyroid gland associated with iodine deficiency in children aged 0-14 years, obesity - in 15-17 year adolescents. Differences in the frequency of these nosological forms depending on the age of the children can be presumably due to changes in eating behavior, the influence of heredity, and the adaptive capabilities of the body. The incidence rates of alimentary-dependent pathology depend on the quality of medical care and the geochemical characteristics of the territory of residence.

Conclusion. The study revealed the age-related characteristics of alimentary-dependent pathology and concretized the directions for improving medical and preventive activities.

Introduction. Based on arabinogalactan, a complex of hybrid nanobiocomposites has been created, which carry a balanced amount of macro- and microelements necessary for the body. A feature of the action of nanoparticles on the body is their ability to easily penetrate all organs and tissues.

The aim of the work is to study the effect of copper arabinogalactan on the content of copper in the main tissues and organs of rats.

Material and methods. The content of copper in organs and tissues of rats after a 10-day intragastric administration of a solution of copper arabinogalactan in a dose of 500 μg per kg of weight was studied by the atomic absorption method.

Results. A high level of copper (above 2 μg/g) was found in wool, kidneys, liver, and heart. The brain and testes contain from 1 to 2 μg/g of copper. In the tissues of the stomach, small and large intestines, thymus, pancreas, blood, eyes, spleen, lungs, and skeletal muscles - less than 1 μg/g.

Conclusion. The study of the distribution of copper in the organs of rats after oral administration of the nanocomposite of copper oxide with arabinogalactan demonstrated the main target organs for the accumulation of the element to be the kidneys, liver, brain, and stomach. The different character of the accumulation of copper in the tissues of the body of the rats received arabinogalactan of copper in the form of a nanocomposite, may indicate the selective ability of tissues and organs to accumulate this element. For further work on the possible use of the drug for medicinal purposes, it is necessary to take into account the peculiarities of biodistribution and bioaccumulation in various organs.

Introduction. Biological monitoring of 1-hydroxypyrene is the most widely used method for evaluating the effects of PAHs on humans. The determination of 1-hydroxypyrene in urine is performed using gas chromatography-mass spectrometry (GC-MS).

Material and methods. Sample preparation consists of extracting the analyte from the biological matrix by 2-fold liquid extraction with hexane, evaporation the extract to the dry residue in the nitrogen current, and re-dissolution of the dry residue in the silylating agent BSTFA. We used gas chromatograph Agilent 7890A with an HP-5MS capillary column and a mass-selective detector. 1-hydroxypyrene was identified as trimethyl silane on a mass chromatogram based on the retention time and intensity ratio of the registered ions.

Results. Optimization of the conditions for liquid extraction of 1-hydroxypyrene was performed using mathematical planning, varying the mass of magnesium sulfate, the extraction time, and the extraction multiplicity. The planning matrix included eight experiments, and the degree extraction of 1-hydroxypyrene was used as an optimization parameter. Interpretation of the model showed the multiplicity of extraction to contribute more to the formation of the degree of extraction than the mass of magnesium sulfate and the extraction time.

Discussion. The proposed method foк the sample preparation, based on the extraction of 1-hydroxypyrene by 2-fold liquid extraction with hexane for 2 min with the addition of 0.5 g of magnesium sulfate to the biological sample, allowed reaching the detection limit of 0.1 ng/ml. The evaluation of metrological characteristics showed RSD of the reproducibility to do not exceed 6.4%, the systematic error is not significant, and the accuracy index in the form of a total error is not higher than 15%. Levels of 1-hydroxypyrene in the urine of aluminum production workers are 53 - 414 times higher than in the control group.

Conclusion. The choice of optimal conditions for liquid extraction of 1-hydroxypyrene by mathematical planning allowed developing a method for the determination this analyte in urine by GC-MS for biological monitoring.

Aim of the study. Justification of the relevance of the study of the metabolic syndrome in terms of the view of the theory of health risk analysis.

Material and methods. The expert-analytical method analyzes the literature on the problem, collected by searching the databases Scopus, Web of Science, RSCI, PubMed, MedLine for the period 2014-2020 on the prevalence, diagnostic criteria, and risk factors for the development of the metabolic syndrome.

Results. Data from numerous studies indicate the influence of the occurrence of the metabolic syndrome of various risk factors: gender, age, genetic predisposition, ethnicity, traditions, lifestyle, physical activity, diet, ecology, the diagnostic criteria used, etc. Currently, a combination of metabolic syndrome with a twofold increase in the risk of cardiovascular disease and a fivefold - type 2 diabetes.

Discussion. In recent years, under the influence of ubiquitously increasing urbanization, a person’s lifestyle has undergone profound changes. Mechanized transport, information technology have made a certain contribution to reducing motor activity, changing the nature of nutrition, reducing the duration of sleep, the intensity of occupational activity, etc. Various components of children’s nutrition form eating habits and preferences, subsequently determine the nature of the individual’s diet, modeling further effects associated with risk the development of many diseases, including obesity.

Conclusion. The combination of adverse risk factors leads to the development of metabolic syndrome. The data obtained confirm the relevance of developing the optimal complex of medical and preventive measures aimed at preventing the development of MS and its components in the modern population.