[The characteristics and problems of professional activity of medical workers in conditions of COVID-19 pandemic].

The article is based on the results of sociological survey of medical workers of the Republic of Bashkortostan in 2021. The approaches to issues of their professional activities are analyzed. It is argued that the COVID-19 pandemic has aggravated a number of systemic problems accumulated in health care system in last years. The main difficulties are associated with shortage of medical personnel, increased workload, low remuneration of labor of medical workers, unpractical work organization decreasing quality of medical care, etc. The majority of respondents (68.4%) are not satisfied with their salaries. The highest percentage of negative assessments is fixed among physicians and paramedical personnel. The amount of average monthly salary of junior medical personnel is so low that it does not correlate with the minimum wage accepted in the Republic. The study discovered sufficiently high occupational risk, determined by biological production factor related to possibility COVID-19 contamination. The assessment of occupational morbidity demonstrated that at present the most widely-spread occupational pathologies in medical workers are infection with COVID-19 (70.2%) and emotional burnout syndrome (67.2%). Such measures as annual dispensarization, provision of medical workers with sanatorium-and-spa vouchers are obviously insufficient. Only 14.1% of respondents could underwent annual medical examination. Only 13.8% of respondents had opportunity to take advantage of sanatorium-and-spa vouchers. The study revealed deficiency of personnel in medical organizations among paramedical and junior medical personnel and physicians as well.

[Experience of using rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinotherapy in individual motor recovery programs in patients with spastic paresis of the lower limb]. / Opyt ispol'zovaniya v individual'nykh programmakh dvigatel'nogo vosstanovleniya ritmicheskoi transkranial'noi magnitnoi stimulyatsii, ekstrakorporal'noi udarno-volnovoi terapii i botulinoterapii u patsientov so spasticheskim parezom nizhnei konechnosti.

Walking disorder is one of the most frequent consequences of stroke and traumatic brain injury, occurring in 80% of cases. Spastic paresis of the muscles of the lower extremity is the cause formed in 20-40% of patients within a few weeks after brain damage. In this case, a complex of symptoms occurs: motor deficiency (muscle paresis), increased muscle tone (spasticity), biomechanical changes in muscles, joints and surrounding tissues, contractures. Recovery of walking is a difficult task due to the peculiarities of its organization in the norm. At the same time, changes occurring in the muscles of the lower limb after a stroke, their modular reorganization, the formation of various pathological patterns, violation of the regulation of movements by the central nervous system, rapidly occurring changes in muscles, ligaments, complicate this process. Improving walking is one of the most important priorities of rehabilitation. Already at the second (stationary) stage of rehabilitation, patients have a lack of proper support on the lower limb, which inevitably leads to excessive load on the second limb, a change in the body scheme, incorrect foot placement, violation of the mechanics of walking (moving from heel to toe) due to plantar flexion / turn of the foot, etc. All this makes patients dependent on outside help, and walking unsafe, increases the risk of falls and complications (arthropathy, contracture, etc.). In this regard, it is important to timely diagnose the totality of changes in the lower limb and create optimal comprehensive rehabilitation programs using highly effective treatment methods aimed at reducing the severity of the motor defect, reducing spasticity and preventing complications. The article discusses the place of rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinum therapy during rehabilitation in patients with spastic paresis of the lower limb after a stroke. The results of the protocol of clinical approbation «Complex rehabilitation of patients with lower limb spasticity after focal brain damage at the second stage of medical rehabilitation¼ are presented.

[Comparison of the final clinical and autopsy detected diagnoses in sepsis]. / Sopostavlenie zaklyuchitel'nogo klinicheskogo i patologo-anatomicheskogo diagnozov pri sepsise.

With sepsis, more than a third of patients die, while the immediate causes of death may remain unknown. Autopsy largely helps to establish them. OBJECTIVE: Identification of discrepancies in the final clinical and autopsy detected diagnoses in patients with sepsis who died in the surgical intensive care unit. MATERIAL AND METHODS: 107 cases of patients with sepsis who died in the Department of Surgical Resuscitation of the Republican Scientific Center for Emergency Medical Care in 2020-2021 were studied. Autopsy was performed in 60 (56%) of the deceased. The autopsy was performed within 24 hours after the death was pronounced. The final clinical and pathoanatomic diagnoses were compared in accordance with the International Goldman System and the Russian Classification of categories of diagnosis discrepancies. RESULTS: As a result of autopsies, 3 (5%) of the deceased had a discrepancy in the diagnoses of class I and 14 (23%) - class II according to the International Goldman System. During his lifetime, diseases or their complications were not recognized in 17 (28%) cases, mainly acute myocardial infarction of type 2 (3 cases) and liver abscesses (3 cases). CONCLUSION: A pathoanatomic autopsy is a modern and important diagnostic tool that can clarify the causes of death.

Beclin-1-Dependent Autophagy of Left Ventricular Cardiomyocytes in SHR and Wistar-Kyoto Rats with Type 1 Diabetes Mellitus.

Autophagy is considered as a mechanism of progression of heart failure, but under certain conditions, it can also act as an adaptation mechanism. Beclin-1 plays the key role in autophagy. We studied the features of Beclin-1 expression in cardiomyocytes of the left ventricle in arterial hypertension, type 1 diabetes mellitus, and their combination. The experiment was performed on male 38-week-old Wistar Kyoto rats and SHR rats aged 38 and 57 weeks. Type 1 diabetes mellitus was modeled by a single parenteral administration of streptozotocin. Expression of Beclin-1 in cardiomyocytes of the left ventricle was evaluated by immunohistochemical analysis. In arterial hypertension, a decrease in the intensity of Beclin-1-dependent autophagy of cardiomyocytes was seen, while in combined pathology, we observed an opposite effect manifested as a significant increase in the expression of protein Beclin-1.

Tracking the adoption of bread wheat varieties in Afghanistan using DNA fingerprinting.

BACKGROUND: Wheat is the most important staple crop in Afghanistan and accounts for the main part of cereal production. However, wheat production has been unstable during the last decades and the country depends on seed imports. Wheat research in Afghanistan has emphasized releases of new, high-yielding and disease resistant varieties but rates of adoption of improved varieties are uncertain. We applied DNA fingerprinting to assess wheat varieties grown in farmers' fields in four Afghan provinces. RESULTS: Of 560 samples collected from farmers' fields during the 2015-16 cropping season, 74% were identified as varieties released after 2000, which was more than the number reported by farmers and indicates the general prevalence of use of improved varieties, albeit unknowingly. At the same time, we found that local varieties and landraces have been replaced and were grown by 4% fewer farmers than previously reported. In 309 cases (58.5%), farmers correctly identified the variety they were growing, while in 219 cases (41.5%) farmers did not. We also established a reference library of released varieties, elite breeding lines, and Afghan landraces, which confirms the greater genetic diversity of the landraces and their potential importance as a genetic resource. CONCLUSIONS: Our study is the first in wheat to apply DNA fingerprinting at scale for an accurate assessment of wheat varietal adoption and our findings point up the importance of DNA fingerprinting for accuracy in varietal adoption studies.

[Mapping of motor-points in the flexor muscles of the arm for the optimization of botulinum toxin injections in treatment of spasticity]. / Kartirovanie motornykh tochek myshts-sgibatelei ruki dlia optimizatsii vvedeniia botulinicheskogo toksina pri lechenii spastichnosti.

AIM: To study the location and verification of motor points (MP) of the upper limbs for targeting botulinum toxin (BT) type A injections in the treatment of spasticity. MATERIAL AND METHODS: Twenty healthy people were examined. Using electromyography a complete study of the muscles of the upper limbs was conducted. RESULTS: Anatomical localization of MP was performed. The location of MP is identical and does not depend on sex, age and the dominant limb. Tables and maps of MP locations are presented. CONCLUSION: MP in the flexor muscles of the arm were identified. A surface map with MP location was created. This data may improve the clinical efficacy and feasibility of MP targeting, when injecting BT in spasticity.

[Clinical studies of transpedicular system using TiNi rod with functionally optimal rigidity].

Transpedicular metal systems are very widely applied in surgical treatment of spinal pathology. Recently TiNi constructions were introduced into practice. This material is characterized by shape memory, superior elasticity and cyclic durability. Adequacy of mechanical interactions of tissues and TiNi-based alloys allows to suggest that TiNi systems are more physiological and functional in comparison with steel and titanium alloys. This enabled development of transpedicular TiNi system with good safety and stability properties in combination with physiologic compatibility and high functional value of TiNi connections. We performed computer modeling of different spine lesions treated by transpedicular systems using ANSYS program kit. Statistic and cyclic tests of transpedicular systems were made using test machine 'Terotest' according to international standards. Results of studies allowed to formulate guidelines for application of transpedicular systems with different level of rigidity in treatment of injuries and degenerative lesions of the spine. The authors performed 53 operations in patients with lesions of lower-thoracic and lumbar spine using TiNi rod with functionally optimal rigidity and obtined good postoperative results.

[Correction of neurological complications after transpedicular stabilization of the spine].

Nowadays transpedicular fixation systems have gained great priority in stabilization of thoracic and lumbar spine. But implantation of the system may cause iatrogenic complications due to extrapedicular insertion (malposition) of screws. Present work is devoted to analysis of neurologic disturbances of screw malposition in the prospective study of 44 consecutive patients. Patients had complains which could be attributed to mistakes in implantation of TPF system. After detailed examination we created a group of 8 patients who had compression of spinal cord and radices due to inadequately implanted TPF system (5 male and 3 female patients, age range 27-63 (median 42)). According to malposition of screws we divided patients into 3 groups: medial malposition (3 patients); lateral (2 patients); and 2 patients with inferior-lateral malposition. 1 patient had both medial and lateral malposition of screws. On the basis of results of treatment we suggested management protocol for complications due to mistakes in implantation of TPF.

[Validation and approaches to correction of hemorheologic disorders in patients with gastrointestinal cancer]. / Obosnovanie i puti korrektsii gemoreologicheskikh rasstroistv u bol'nykh rakom zheludochno-kishechnogo trakta.

A total of 237 patients were examined: 127 with gastric cancer and 110 with colonic cancer, 99 women and 138 men, mean age 57.5 years. Erythrocyte deformability and aggregation were studied by original methods. Red blood, protein metabolism, and endogenous intoxication parameters were evaluated by routine laboratory tests. Increased aggregation and volume of erythrocytes and decrease of their deformability and hemoglobin content in parallel with hypo- and dysproteinemia and increased level of endogenous intoxication were observed in all patients with gastrointestinal cancer. Correction of these disorders by intravenous laser exposure of the blood essentially improved the erythron status and protein metabolism and decreased endotoxicosis. Infusion/transfusion therapy also notably improved the erythron function and decreased endogenous intoxication. Analysis of the results of surgery showed decreased incidence of complications and lethal outcomes, which was due to methods of corrective therapy.