Introduction. Health care workers are at risk of infection with the SARS-CoV-2 virus. However, many aspects of the professionally conditioned COVID-19 are still poorly understood. The aim of study is to conduct a brief review and analysis of scientific data on the prevalence, features of clinical and laboratory COVID-19 syndromes in medical professionals. To evaluate the structure of post-COVID syndrome in health care workers who are observed in a large multidisciplinary medical organization that has a center for occupational pathology. To present the current state of the problem of examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of SARS-CoV-2 infection. Materials and methods. At the first stage, a brief review of the literature on the problem of COVID-19 in health care workers was performed, at the second - a single-center observational prospective study of COVID-19 convalescents. The main group consisted of health care workers (n=203), the comparison group - people who do not have occupational health risks (n=156). The groups were comparable in demographic characteristics. The work experience of the medical staff was 15 (5; 21) years. Of the participants in the main group, 20.2% worked in hospitals, and 79.8% in outpatient institutions. Three of the participants (1.5%) were employees of specialized COVID hospitals. Doctors were 25.6%, secondary medical personnel - 51.7%, junior medical and technical personnel - 22.7%. A severe form of COVID-19 was suffered by 25 (12.3%) people, after the artificial ventilation of the lungs (AVL) - two participants. The observation time is 60 days. Statistical analysis included standard methods of descriptive statistics, determination of relationships by the method of logistic regression. The significance level is p<0.05. Results. Most of the known data on COVID-19 in health care workers is obtained in cross-sectional studies. The possibility of occupational infection has been sufficiently proven. The risk probably depends on the work performed and is higher in conditions of direct contact of medical personnel with adults, potentially infected patients, but not in a specialized hospital. It is possible that the course of COVID-19 in health care workers differs from the general population of patients there is evidence of a greater frequency of weakness and myalgia. Studies of the features of post-COVID syndrome in health care workers in available sources could not be identified. According to the results of their own research, health care workers who had experienced COVID-19 had a higher frequency of central thermoregulation disorders, arrhythmias, heart failure, panic attacks and depression. Conclusions. Health care workers are at risk of COVID-19. Professionally conditioned post-COVID syndrome is characterized by the frequency of violations of the central mechanisms of thermoregulation and arrhythmias. COVID-19 in health care workers meets the definition of occupational disease.

Introduction. Heart failure increases the severity of symptoms and worsens the prognosis of chronic obstructive pulmonary disease (COPD) in smokers. Professional COPD is a separate phenotype, which suggests dif erences in the pat ern of comorbidity. Professional COPD in combination with heart failure has not been studied enough. T e aim of the study was to determine the relationship of heart failure c clinical, functional and hygienic characteristics of professional COPD. Materials and methods. T e one-center observational study included 115 patients with occupational chronic obstructive pulmonary disease (OCOPD). T e comparison group of 103 patients with COPD, smokers of tobacco. T e diagnosis of COPD met the criterion of GOLD 2011–2019. OCOPD patients were exposed to aromatic hydrocarbons with an excess of MPC in the air of working zone is 1.5 to 6 times, or of inorganic dust in the range of 2 to 9.5 MPC. Heart failure was diagnosed on the basis of any signs of myocardial dysfunction in echocardiography and/or elevation of the N-terminal precursor of cerebral natriuretic peptide (NT-pro-BNP) serum more than 125 PG/ml. the Groups were comparable in sex, age, durationof COPD, duration of action of exogenous etiological factor, causes of heart failure. Clinical and functional characteristics of COPD and heart failure were evaluated. For comparisons between groups for quantitative parameters used covariance analysis or test Kruskall-Wallis for comparison, the share of χ2 criterion. Relationships were determined by logistic regression. Results. In patients with OCOPD, the heart failure rate was higher — 63 (54.8%) cases compared to 38 (36.9%) in the group of COPD Smoking (p=0.009). Biventricular failure prevailed (44 (38.3%) patients) with preserved ejection fraction(47 (40.9%) cases). Right ventricular failure was detected in 15 (13.0%) of the subjects, lef ventricular failure — in 4 (3.5%), p=0.002. Echocardiography revealed severe pulmonary hypertension and diastolic myocardial dysfunction in the OCOPD group. OCOPD in combination with heart failure was characterized by CAT index values of more than 10 points, low exercise tolerance, a signif cant rate of decline in FEV1, a decrease in the partial tension of arterial blood oxygen, severe exacerbations of COPD. In multivariate analysis of the development of heart failure in patients with OCOPD predicted: length of service, systolic pressure in the pulmonary artery, partial oxygen tension of arterial blood, the test distance of six-minute walk. Conclusions. 1. OCOPD is characterized by a probability of heart failure — 54.8%. Biventricular failure with preserved ejection f action and predominant violation of diastolic myocardial function prevails. 2. T e subphenotype of OCOPD in combination with heart failure is characterized by severe symptoms, hypoxemia of rest, severe exacerbations of COPD.

Introduction. Influence of incidental nanoparticles of industrial aerosols on occupational lung diseases development is not studied enough. As nanoparticles has properties to induce inflammation and fibrosis, it is hypothesized that they affect occupational chronic obstructive pulmonary disease (COPD) phenotype. The aim was to establish monocyte subsets, airway inflammation, clinical and functional features in occupational COPD due to aerosols containing nanoparticles exposure. Materials and methods. Study design was a single center prospective cohort observational. Subjects with occupational COPD (GOLD 2011-2021 criteria) exposed to aerosols containing nanoparticles (n=50) enrolled. Comparison group - COPD in tobacco smokers (n=50), control group - healthy people (n=50). Groups were matched by demographics and COPD duration. Nanoparticles at workplaces air were measured by inductively coupled plasma atomic emission spectrometry and by scanning electron microscopy. Of participants 26 were exposed to maximal concentrations of metal nanoparticles and 24 - of silica nanoparticles. Spirography, body pletysmography, lung diffusing capacity (DLco/Va), Doppler-ehocardiography, induced sputum cytology, COPD exacerbations assessment were done. Monocyte subsets were determined by flow cytometry. Linear regression model was used to explore relationships. Results. COPD due to aerosols containing metal nanoparticles was characterized by most severe airflow limitation, lung hyperinflation, pulmonary hypertension, most prominent decrease in DLco/Va, frequent and severe COPD exacerbations, eosinophilic inflammation. The largest proportion of «classical» CD14+CD16- monocytes subset, 96,4% (90,3%; 97,2%), high level of CCR5 expression were seen in this group. The features of COPD due to aerosols containing silica nanoparticles were substantial decrease in DLco/Va, the least airflow limitation, mild lung hyperinflation, rare COPD exacerbations, paucigranulocytic inflammation. The largest proportion of «non-classical» CD14DimCD16+ monocytes with high level of CCR2 expression revealed. Mass concentration of metal nanoparticles was associated with «classical» monocytes, (B=1,5), silica nanoparticles - with «non-classical» monocytes (B=1,4). On their turn, «classical» monocytes were associated with DLco (B=-1,6), functional residual volume (B=1,2), mean pulmonary artery pressure (B=-1,4), eosinophilic inflammation. «Non-classical» monocytes were associated with DLco (B=-1,5) and paucigranulocytic inflammation (B=1,2), p<0,015. Conclusions. Exposure of incidental nanoparticles was associated with circulated monocyte subsets, airway inflammation and occupaitonal CODP phenotype.

Aim. To establish symptoms, lung function and to evaluate subsequent exacerbations of chronic obstructive pulmonary disease (COPD) during a year after virus-induced COPD exacerbations. Materials and methods. Patients hospitalized with viral (n=60), bacterial (n=60) and viral-bacterial (n=60) COPD exacerbations were enrolled to single-center prospective observational study. COPD was diagnosed according spirography criteria. Viral infection was established in bronchoalveolar lavage fluid or sputum by real-time reverse transcription-polymerase chain reaction for RNA of influenza A and B virus, rhinovirus, respiratory syncytial virus and SARS-CoV-2. Symptoms, lung function, COPD exacerbations were assessed. Patients were investigated at the hospitalization onset and then 4 and 52 weeks following the discharge from the hospital. Results. After 52 weeks in viral and viral-bacterial COPD exacerbations groups the rate of forced expiratory volume in one second (FEV1) decline were maximal 71 (68; 73) ml/year and 69 (67; 72) ml/year versus 59 (55; 62) ml/year after bacterial exacerbations. Low levels of diffusion lung capacity for carbon monoxide (DLco/Va) 52.5% (45.1%; 55.8%), 50.2% (44.9%; 56.0%) and 75.3% (72.2%; 80.1%) respectively, of 6-minute walk distance; p0.001 in relation to bacterial exacerbations. In Cox proportional hazards regression analyses viral and viral-bacterial exacerbations were associated with increased risk of subsequent COPD exacerbations by 2.4 times independent of exacerbations rate before index event and FEV1. In linear regression models the relationships between airflow limitation and respiratory syncytial virus, rhinovirus and influenza virus infection, between low DLco/Va and rhinovirus, influenza virus and SARS-CoV-2 infection. Conclusion. COPD after virus-induced exacerbations were characterized by progression of airflow limitation, low DLco/Va, low 6-minute walking test distance, subsequent COPD exacerbations risk.

The significant prevalence of industrial aerosols with unintentional nanoparticles and the increasing use of engineering nanoparticles in modern production determine the relevance of research on the patterns of interaction with the human bronchopulmonary system. Unintentional nanoparticles are formed during various production processes: melting and welding of metals, combustion, crushing, grinding of minerals, plasma processing of materials. Engineering nanoparticles are released into the air of the work area during their production or use in any technological processes. The respiratory system, as a barrier organ, is most vulnerable to the effects of adverse environmental factors. At the same time, nanoparticles are the least studied component of industrial aerosols. In order to systematize data on the role of nanoparticles in the development of occupational bronchopulmonary pathology, the authors conducted a literature review. The size determines the features of the physical, chemical and biological properties of nanoparticles. They have high values of the ratio of surface area to volume, total surface area, which leads to an increase in reactogenicity and penetrating power. The pathogenic properties of nanoparticles depend on the chemical composition, shape, curvature of the surface, structure, charge, mass concentration, total surface area of the particles, and exposure time. The multidimensionality of hygienic characteristics determines the complexity of hygienic rationing and monitoring of nanoparticles. To date, safe exposure levels have not been established. When interacting with cells of the respiratory tract, nanoparticles induce the following cellular and molecular mechanisms: oxidative stress, inflammation, violation of the epithelial barrier, autophagy and dysfunction of lysosomes, stress of the endoplasmic reticulum, apoptosis, senescence, fibrosis, endothelial dysfunction, DNA damage. This leads to the development of interstitial pneumonitis, pulmonary fibrosis and obstructive disorders, and an increase in the activity of allergic inflammation. All these mechanisms are present in the pathogenesis of occupational lung diseases. Under the influence of nanoparticles of various chemical compositions, separate phenotypes of occupational chronic obstructive pulmonary disease are formed. There is a lack of epidemiological studies of the possible etiological role of nanoparticles. Nanoparticles of industrial aerosols are a significant factor in the development of occupational diseases of the bronchopulmonary system and have a significant impact on the formation of phenotypes.

Introduction. The interrelationships of vibration sickness (VS) and prognostically unfavorable acute cardiovascular events have not been studied sufficiently. The study aims to determine the frequency and phenotype of adverse cardiovascular events in patients with vibration disease in comparison with people working in vibration conditions, without occupational diseases and in dynamics over 10 years. Materials and methods. Study design: a retrospective, observational, single-center study. Vibration induced disease patients (n=1505) and workers exposed to vibration above occupational exposure limits without occupational diseases (n=1505) were included. The authors have obtained the data from the registry of the Center for Occupational Pathology and the medical information system. The endpoints were cases of myocardial infarction and unstable angina. Using the pseudorandomization method, the scientists compared the groups by gender, age, and type of production vibration. They determined the relative risk (RR) and 95% confidence interval (CI) of the event under study. To assess the 10-year dynamics of adverse cardiovascular events in the main group, the experts calculated moving averages of morbidity with an interval of two years. The significance level is p<0.05. Results. Patients with vibration sickness had a higher incidence of all endpoints, relative risk (95% CI) 2.18 (1.79–2.65), acute myocardial infarction, RR 3.00 (2.13–4.22), with ST segment elevation, RR 4.73 (2.72–8.22) and without ST segment elevation, RR 2.04 (1.29–3.21), unstable angina, RR 1.78 (1.38–2.29). In the subgroups of myocardial infarction in patients with vibration disease, scientists noted an increase in the proportion of multivessel damage, RR 1.63 (1.09–2.43), as well as myocardial infarction without coronary artery obstruction (MICAO), RR 2.67 (1.002–7.10), MICAO and unstable angina in combination with signs of ischemia according to the results of stress tests or myocardial scintigraphy. The authors observed the maximum increase in the relative risk and the number of associated acute forms of coronary heart disease in patients with vibration syndrome from exposure to local or combined vibration. The relative risk increased with the second degree of severity of the disease. During the 10-year follow-up period, the incidence of acute forms of coronary heart disease in the VS group increased: 1.6 times regardless of the nosological form, 1.9 times — acute myocardial infarction with ST segment elevation, 1.6 times — without ST segment elevation, and 1.5 times — unstable angina. Conclusion. Vibration sickness is associated with an increased frequency of adverse cardiovascular events and is a promising risk factor. Ethics. The study was conducted in compliance with the ethical principles set out in the Helsinki Declaration of the World Medical Association and in accordance with the Ethical standards and regulations stipulated in the Bulletin of the Higher Attestation Commission of the Ministry of Education, Russian Federation, No. 3 of 2002. The study was approved by the Ethics Committee of the Federal State Budgetary Educational Institution of Higher Medical Education of the Ministry of Health, Russian Federation, Protocol No. 161 dated 10/14/2024.