Dmitry A. Nazarov

Background. One of the vulnerable categories of the population during the COVID-19 pandemic has become employees of medical and educational institutions. Timely and properly organized prevention, based on anti-epidemic measures based on vaccination, is necessary not only to reduce the incidence of the disease, but primarily to reduce the severity in case of its occurrence, reduce the risk of hospitalization. Understanding the effectiveness of preventing SARS-CoV-2 infections among healthcare workers is a critical component of occupational health and safety policy and strategy. Aim — analysis of the incidence of COVID-19 after vaccination among medical staff and teaching staff of medical higher educational institutions. Methods. In the period from January to March 2022, a cross-sectional retrospective single-stage online study was conducted (anonymous questionnaires posted on the Anketologist platform). The survey was completed by 6032 respondents (82% efficiency). According to the criteria, 2114 respondents were excluded from the study. The analysis was carried out according to the questionnaires of 3918 respondents, including an assessment of the incidence after vaccination (n = 3668 respondents). Results. Fell ill after a double vaccination for 5 months — 663 (16.9%). Unvaccinated respondents reported that within 5 months. prior to the survey, 116 (46.4%) had a laboratory-confirmed new coronavirus infection. Lack of vaccination increased the risk of SARS-CoV-2 (OR 1.78 ± 0.14; 95% CI: 1.34–2.36). Efficiency within 5 months post-vaccination period was 55.5% (95% CI: 42.2–57.7%) for Sputnik V; 71.9% (95% CI: 68.1–85.4%) — Sputnik Light. It was found that gender and age were not a risk factor for the onset of the disease in the post-vaccination period. The presence of a history of previous COVID-19 increased the risk of disease in the post-vaccination period in individuals under 35 years of age (OR 2.323 ± 0.102; 95% CI: 1.903–2.836), aged 36–64 years (OR 2.547 ± 0.086; 95% CI: 2.150–3.016), older than 65 years (OR 1.323 ± 0.280; 95% CI: 0.764–2.290). Respondents with a history of a combination of chronic cardiovascular pathology and past COVID-19 had a higher risk of getting sick in the post-vaccination period (OR 1.338 ± 0.160; 95% CI: 0.977–1.832). Conclusion. According to the questionnaire, an important factor affecting the risk of COVID-19 in the post-vaccination period is the presence of SARS-CoV-2 before vaccination, which can increase the chance of developing the disease in the presence of other risk factors (chronic pathology, age, smoking, alcohol consumption).

Relevance. Violation of the regulations on the use of personal protective equipment (PPE) by medical workers when providing medical care to patients with COVID-19 (COVID-19) at their workplaces and in other situations requiring PPE is fraught with serious consequences for the health and life of medical personnel and patients. Aims. To assess the impact of violations in the use of PPE on the incidence of COVID-19 of personnel of medical organizations of various profiles, including when providing medical care to patients with COVID-19. Materials and methods. The study used the method of cross-sectional retrospective simultaneous online questionnaire to assess the effectiveness of preventive measures against the spread of COVID-19, conducted from January to March 2022. The results of an anonymous online survey of various categories of personnel of medical, scientific and educational medical organizations of the Russian Federation providing medical care to patients with COVID-19 (n = 6032 people) were analyzed. Results. The study showed the greatest epidemiological significance in the formation of the risk of SARS-COV-2 infection by the irregular use of masks and gloves in the workplace (when providing medical care). The results of the assessment of the strength of the connection of violations in the use of personal protective equipment with infection with SARS-CoV-2 of the studied groups of personnel are presented. It is shown that the irregular wearing of face masks in the workplace when providing medical care has the most pronounced association with the risk of infection of all the factors studied. It is noted that statistically significantly more often the irregular use of masks and gloves in the workplace was allowed by students and nursing staff. Conclusions. The importance of compliance with the regulations for the use of personal protective equipment by medical workers is shown, not only when providing medical care to patients with COVID-19, but also at home, as well as the impact on the incidence of COVID-19 of the irregularity of the use of PPE by medical personnel in various conditions, including when providing medical care to patients with COVID-19.

Medical staff and teachers are at high risk of infection. In this connection, it seems relevant to study the effectiveness of the safety of preventive measures aimed at reducing the incidence. A separate issue of which is the results of vaccination of risk groups for infection with SARS-CоV2. The purpose of the study is to evaluate the frequency of registration of post-vaccination reactions of various vaccines against COVID-19 approved for use in Russia among medical staff and faculty of medical higher educational institutions (HEI). A cross-sectional, retrospective, cross-sectional online study was conducted between January and March 2022. The survey involved the teaching staff and medical workers of medical higher educational institutions (HEI) and their subordinate clinics (n = 6032). The majority of vaccinated employees of medical institutions and medical schools had a good tolerability of immunization.Serious adverse events were not registered. A higher incidence of PE and NE was observed in respondents after the first vaccination (p < 0.05). Most often, respondents reported an increase in body temperature (6.9–21.7 %), myalgia (5.5–21.2 %), general weakness (8.4–23.6 %), arthralgia (1.7–9.7 %), local reactions (0.8–16.7 %). In more than 85 % of cases, the above complaints were detected in the first 3 days from the moment of vaccination. A history of COVID-19 infection increased the risk of local and systemic adverse reactions. Gender characteristics of the post-vaccination reaction were revealed, manifested by more frequent registration of NE and PE in men under 35. An inverse relationship between the frequency of NE and PE with age was determined. The presence of comorbid pathology in two or more systems, regardless of age, increased the risk (OR) of various PE and NE from 1.047 to 1.539. The results can be used as an additional tool when planning a personalized approach to vaccinating healthcare workers against COVID-19.

Aim To improve quality of treatment for senile patients with pronounced aortic stenosis (AS). Material and methods Aortic valve stenosis (AS) is the most common valve pathology in cardiosurgical patients. Surgical correction of aortic valve (AV) stenosis accounts for 10 to 22 % of open-heart operations. 125 patients with pronounced AS were treated in the N. N. Burdenko Main Military Clinical Hospital between 2010 and 2017. This study was based on the implementation of new, minimally invasive methods in our clinic in 2013: balloon aortic valvuloplasty (BAVP) of the aortic valve and transcatheter aortic valve prosthesis (TCAVP). Results In the group of patients receiving the drug therapy alone, the in-hospital mortality was 2 %. At the time of maximum follow-up duration (3 years), the survival rate was 50.5 %. In the group of patients who underwent the AV replacement with extracorporeal circulation, the 3 year postoperative mortality was 16.6 %. There was no 3 year mortality in the group of patients who underwent TCAVP. The short-term beneficial effect of BAVP was confirmed. Conclusion An algorithm was developed for medical care of patients older than 75 with pronounced AS; the place of BAVP in the step-by-step management of these patients was determined. Using the developed approach in the management of these patients provided a 32 % (p<0.05) increase in the number of cases of radical surgical care.