Differentiated approach to correcting low vitamin D status in adolescent girls in Moscow

Introduction. The work is devoted to the study of vitamin D status in adolescent girls and the selection of adequate doses for its correction.Study objective. To study the dynamics of calcidiol concentration in the blood serum against vitamin D3 intake and evaluate the effectiveness of correcting doses of vitamin in adolescent girls from Moscow.Study design. A double-blind, placebo-controlled, prospective, randomized clinical study.Materials and methods. The study involved adolescent girls aged from 11 to 17 years (n = 218) from I-II health groups, with determined serum level of 25(OH)D. Participants were randomly assigned to the main and control groups. The adolescent girls in the study group received vitamin D3 tablets, and the control group received a placebo. Study duration was 6 months. The dose of vitamin D3 was dependent on baseline serum caLcidioL levels and ranged from 800 IU to 2000 IU. Vitamin D status was redetermined in the girls who completed the treatment (n = 192).Results. Initially, 96.4% of girls had a low vitamin D status, while vitamin D insufficiency was observed in 26.6%, deficiency in 57.8%, deep deficiency in 12%. The median level of 25(OH)D in the main group before taking the vitamin was 16.25 ng/ml, after taking - 24.1            ng/ml, in the control group - 17.9 and 11.4 ng/ml, respectively (p < 0.001). In the main group, an increase in the content of the metabolite was observed in 94.9% of the subjects, the initially identified pronounced deficit was completely absent.Conclusions. A differentiated approach to prescribing different doses of cholecalciferon, depending on the baseline level of 25(OH)D, BMI and age, is an effective method for replenishing vitamin D deficiency in adolescents. The high probability of normalization of vitamin D status in certain age groups, mainly with the appointment of low corrective doses of cholecalciferol justifies the possibility of their use for 6 months or more in adolescents during puberty period

Digital Transformation of Russia’s Agricultural Sector

The paper presents a methodical approach to the assessment of agricultural sector transformation in the conditions of intensive penetration of digital technologies into the economy sector. The authors offer a schematic diagram of data collecting and processing in the start-to-finish automated production-and-marketing chain of activity within the agricultural secto

DEVELOPMENT OF A PROTOTYPE MODEL OF BLOOD FLOW IN THE LIVER

This paper discusses the prerequisites for the creation, as well as the main stages for the development of a prototype model of normal liver blood flow

Magnetic materials based on layered double hydroxides

Composite materials that contain tetracationic hydrotalcite-like layered double hydroxide and a cobalt-iron spinel phase were prepared by coprecipitation from a solution of a mixture of magnesium, aluminum, cobalt(II), and iron(III) salts followed by hydrothermal treatment. The iron and cobalt contents in the samples were varied within a broad rang

Features of cellular structure of the induced sputum and profile of cytokines at sintropiya of bronchial asthma and obesity at young patients

Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events

Prevalence of professional burnout among practicing cardiologists in the constituent entities of the Russian Federation

The burnout syndrome among healthcare professionals is a headline problem in the world, as it leads to poor health of medical workers, affects patient satisfaction with health care and the healthcare system as a whole. At the same time, existing preventive measures can improve the well-being of staff.Aim. To study the prevalence of professional burnout syndrome among practicing cardiologists in the Russian Federation (RF).Material and methods. This cross-sectional study was carried out using the method of online anonymous surveying. The inclusion criterion was the current practical activity in the RF. The study involved 452 cardiologists from 8 federal districts (women; n=377, 83,4%), 48,2% of which worked in a hospital. Occupational burnout was assessed using the Maslach Burnout Inventory (MBI) questionnaire in the Russian language adaptation for healthcare workers by N. E. Vodopyanova and E. S. Starchenkova. The score was calculated on three subscales (emotional exhaustion, depersonalization, personal accomplishment), the maximum score for the subscales was 54, 30 and 48, respectively. The personal accomplishment subscale is the opposite as follows: the higher the score, the less the symptom severity. Additionally, demographic parameters, working conditions, the desire to change job and field of activity were taken into account. Regression analysis was used to establish associations of burnout with factors.Results. The median score of the emotional exhaustion subscale was 29,5 (23,0; 35,0) points, depersonalization — 12,0 (8,0; 16,0) and personal accomplishment — 32,0 (28,0; 37,0). Men had higher depersonalization score than women as follows: 15,0 (10,0; 18,0) vs 11,0 (8,0; 15,0), p=0,001. High degrees of emotional exhaustion and depersonalization (burnout) were found in 235 (52%) cardiologists, while all three symptoms simultaneously — in 132 (29,2%) doctors. There were no symptoms of burnout in 84 (18,6%) cardiologists. A high degree of burnout was associated with a desire to change job (p<0,001).Conclusion. A high prevalence of professional burnout among practicing cardiologists in the RF was revealed, which, in turn, is associated with the desire to change job or occupation

Frequency of hemodynamic response to orthostatic stress in heart failure with reduced ejection fraction, associations with clinical blood pressure

Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented  left ventricular ejection  fraction <40%, followed   up in a HF center  and receiving optimal medical therapy, underwent AST with beat-to-beat  non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed  in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%).  Classical OH was detected  in 4 (4,6%)  patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed  in office  SBP >140 mm Hg compared  to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248  for delayed  BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented  by initial OH and delayed BP recovery associated  with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress

Common variable immunodeficiency disorder: a clinical case

Primary immunodeficiency is a rare congenital pathology associated with failure of immune system, manifested by disturbances of its functions. These defects lead to increased susceptibility of patients to various infectious agents, as well as the development of autoimmune, malignant and other diseases. Primary immunodeficiency is classified as a rare disease, which was previously associated with a poor prognosis with a high risk of mortality in childhood. To date, the emergence of highly effective treatment methods has changed the course and prognosis of these diseases. Clinicians of various specialties increasingly meet with this pathology in everyday practice, including adult age cohorts. In this regard, early diagnosis of primary immunodeficiency in adults becomes relevant, being associated with choosing optimal therapy, prevention of severe internal organ damage, determination of management strategy for the patient, as well as the need to identify inherited disorders and provide information to the patient’s family. Delayed verification of the diagnosis may cause disability of the patient and development of irreversible, often fatal complications. This article presents our own clinical case with a newly diagnosed clinical condition: Common variable immunodeficiency disorder (CVID), the most common form of primary immunodeficiency in adults. The symptoms of common variable immunodeficiency disorder appear in these patients in adulthood, but a high-quality collected history of the disease will allow you to trace symptoms in the patients even since early childhood. There is a common gap for several years between the onset of the disease and clinical diagnosis, since erroneous diagnosis is often made due to non-specific clinical symptoms that resemble other, more frequent diseases. The prognosis of patients with CVID depends on several factors: frequency of infections, structural disorders in the lungs, the occurrence of autoimmune diseases and the success of infection prevention. Thus, a variety of clinical forms of primary immunodeficiency, lack of awareness of doctors about this pathology, complexity of immunological examination in the general medical network lead to the fact that CVID is not diagnosed for long terms, and patients do not receive the necessary pathogenetic therapy. There is a need for drawing attention of doctors of various disciplines to the fact that the recurrent inflammatory processes of various localization, which are difficult to respond to adequate traditional therapy, may be caused by changes in the immune system, including congenital, genetically determined immunodeficiency