FMBA Of Russia Research Articles

Analysis of practical experience in the development and implementation of standard operating procedures in the activities of nursing medical staff on the base of the FSBHI MRC «Sergievsk mineral waters» FMBA of Russia

The use of innovative technologies in the daily practice of a nurse makes her work more professional, ensures safety and convenience when performing basic professional tasks, reduces labor costs, and allows for the implementation of the diagnostic and treatment process quickly and efficiently. Target. To analyze the experience of developing and implementing standard operating procedures for nurses for 2022–2023. Results. The successful development and further implementation of SOPs for various types of activities of nursing staff was completed; solved problems that arose during the development and implementation of SOPs by creating corrective actions with mutual analysis, taking into account the feedback of the team of specialists; the proposed technologies and standard documents can be used as a model by most medical organizations. Conclusion. In the Federal State Budgetary Healthcare Institution MRC «Sergievsk Mineral Waters» FMBA of Russia, as of January 2024, the following have been developed: 121 SOPs, 30 SOPs have been revised. In 2024, 4 SOPs were introduced in medical organizations and continuous work is underway to further develop them.

Межведомственное взаимодействие при организации телемедицинских консультаций по схеме «врач – врач» с участием медицинских специалистов лечебных медицинских организаций Федерального медико-биологического агентства

Summary. The data are considered on conducting telemedicine consultations in 2021-2022 under “doctor – doctor” scheme with participation of attending physicians and consulting physicians of medical organizations (MO) of the Federal Medical and Biological Agency (FMBA of Russia). The division of telemedicine consultations by medical profiles, forms and types is given. The conclusion is made: ensuring the availability and quality of medical care with the use of telemedicine technologies in remote interaction between medical specialists is directly related to the possibility of conducting telemedicine consultations with the participation of medical specialists of MOs of different departmental affiliation in the presence of common information space, including under the conditions of liquidation of medical and sanitary consequences of emergency situations.

ВЕСТИБУЛЯРНЫЙ НЕЙРОНИТ: КЛИНИЧЕСКИЙ ПРИМЕР ТЕЧЕНИЯ ЗАБОЛЕВАНИЯ С ИСПОЛЬЗОВАНИЕМ БИОЛОГИЧЕСКИ ОБРАТНОЙ СВЯЗИ (БОС)

The examination was conducted with the consent of patient P., born in 1961, who was undergoing treatment in the neurological department of the Federal State Budgetary Health Care Institution "Clinical Hospital No. 8 of the Federal Medical and Biological Agency" (FGBUZ KB No. 8 FMBA of Russia). The patient was examined for viral and bacterial infections: Herpes simplex virus 1,2 IgM, herpes simplex virus 1,2 IgG, cytomegalovirus IgM, Epstein-Barr virus IgM to AG capsid, SARS-CoV-2 coronavirus, IgM antibodies, meningococcus, haemophilus bacillus, streptococcus (Neisseria meningitidis, heamophilus influenzae, streptococcus pneumoniae, PCR), influenza type B virus. It should be noted that all analyses were performed with quantitative evaluation in order to observe the course of the disease in dynamics. This list of analyses was determined not only to monitor the dynamics of the disease, but also to perform differential diagnosis (e.g. with labyrinthitis, as this disease has a similar clinical picture). In the course of the study, as a result of a rational evaluation, it was identified and decided to focus the study on herpes simplex virus 1, 2 IgG analyses in the dynamics - accordingly, the analyses were taken on day 5 of the disease, on day 14, and then on day 21. The patient underwent instrumental diagnostics: audiometry, SCT study, MRI study to exclude other similar pathological phenomena. In addition to laboratory tests, the patient underwent diagnostic and rehabilitation tests on a stabilisation platform with biofeedback based on StabMed 2-"Stabilan-01-2" software, both at the beginning of treatment and at the end (the main diagnostic test performed was a stabilography test. Various variants of the Romberg test are a standard tool in the arsenal of a modern doctor, for example, clinical recommendations on differential diagnosis of peripheral vertigo include it in the list of mandatory procedures during physical examination of a patient with complaints of dysfunction of the vestibular apparatus ).

Influence of balneological and mud factors of federal state budgetary institution MRC «Sergievsky mineral waters» FMBA of Russia on the microflora of the vagina

The article discusses the methods of restorative (rehabilitation) medicine, such as balneology and mud therapy, and their effect on the microflora of the women»s vagina. It is emphasized that natural factors have a powerful, versatile biological effect that is incomparable to any existing medical drugs. A study of vaginal smears for microflora was carried out and positive dynamics were revealed in women undergoing treatment at the Sergievsky Mineral Waters Medical Center.

Experience of implementing enhanced recovery program in pancreatic surgery

Aim. To assess the feasibility of enhanced recovery program for patients undergoing pancreatic surgery. Materials and methods. Between January 2019 and May 2022, 47 patients with various pancreatic diseases underwent surgery at the University Clinic of A.I. Evdokimov Moscow State University of Medicine and Dentistry and FMBA of Russia. Male patients comprised 24 (51%), female – 23 (49%); the age of patients was 22 to 78 years (mean age 43.5 years). Pancreaticoduodenal resection was performed in 30 patients, distal pancreatic resection in 17 patients. All patients received some elements of the enhanced recovery program. Results. An uneventful postoperative period was observed in 36 patients (76.6%). Gastric stasis developed in 4 cases (8.5%), pancreatic fistulas in 4 (8.5%), postoperative pancreatitis in 3 (6,4%). A reoperation was performed in 1 case (2.1%) with intra-abdominal bleeding. The average length of stay in the intensive care unit comprised 1.8 days. Conclusion. The use of Fast Track in pancreatic surgery does not significantly increase the incidence of early postoperative complications, meanwhile it reduces the length of hospital stay after surgery and provides more cost- effective results. However, the development of a clear protocol for the management of patients requires further research and accumulation of data.

Радиационная обстановка и дозы облучения в Российской Федерации в 2021 году

The article contains information about the radiation situation and radiation doses of the population, as well as occupational exposure in 2021 in the territories serviced by the FMBA of Russia. The distribution of the number of personnel working with sources of ionizing radiation or exposed to ionizing radiation by dose intervals for taking into account individual doses of radiation at facilities of different departmental affiliation, as well as the values of the collective dose are given. Information is provided on the structure, number of radiological procedures by types and groups of organs, collective and average radiation dose of patients received in 2021 in the territories serviced by the FMBA of Russia. There is a significant increase in the contribution of computed tomography to the collective dose compared to previous years.

СОСТОЯНИЕ ЗДОРОВЬЯ НОВОРОЖДЕННЫХ ДЕТЕЙ В СЕМЬЯХ МУЖЧИН ПЕРСОНАЛА АТОМНЫХ СТАНЦИЙ

Purpose: To give a general description of personnel exposure doses and assess the health status of newborn children in families of male nuclear power plants personnel. Material and methods: The work includes the results of studies of the reproductive health of male personnel of Smolensk, Kursk, Kalinin and Novovoronezh NPPs. The source of information on annual doses of occupational exposure of personnel was the data from the Federal Bank of individual exposure doses of personnel of organizations and the population in the territories served by the FMBA of Russia. The state of newborns was assessed by indicators of physical development and the frequency of birth of a child with pathology. Intrauterine growth retardation, congenital malformations, and other perinatal diseases were noted in the structure of pathological conditions. The source of medical data was information from the individual medical records “History of childbirth” and “History of the development of the newborn” for 2007–2018. Results: The health status of newborn children born in 2007–2018 in the families of male personnel of the considered NPPs and in control groups did not differ significantly in terms of selected indicators characterizing the adaptive capabilities of newborn children to extrauterine life. The proportion of healthy children ranged from 60 to 73 % of their total number. In the structure of pathological conditions, perinatal conditions made the greatest contribution (from 10 to 17 %). The birth rate of children with congenital malformations did not exceed 34,0±8,9 per 1000 newborns and was significantly lower than the level adopted by the ICRP for calculating radiation risk (60 per 1000). There were no differences in the influence of the maternal factor (age and complications during pregnancy) on the development of the fetus and the health of newborns in the families of male staff and control groups. According to calculations, the accumulated individual doses of occupational exposure of male personnel before conception of children did not exceed 30 mSv (on average) and for more than 95 % of the personnel – 100 mSv, which is lower than the exposure doses (above 100 mSv) when the negative consequences of exposure of men were reliably observed in the offspring in radiation-epidemiological studies. Conclusion: No influence of occupational exposure on the health status of newborn children in families of male nuclear power plant personnel has been identified. At the same time, it is proposed to conduct monitoring observations of the state of reproductive health of a small group of male personnel of nuclear power plants, whose accumulated effective doses may exceed 100 mSv.

Radiation exposure of personnel and public of radiation control areas of radiation hazardous facilities in the Russian Federation in 2021

The article presents analysis of exposure doses to the population of observation zones and personnel of radiation facilities of the Russian Federation in 2021. For the analysis , we used data received by the Federal Data Bank on Personnel Exposure Doses , which operates as part of the Unified System of Individual Dose Control of the Russian Federation citizens . Data received from 20 359 radiation facilities were used . Among them , there are 19 743 radiation hazardous facilities supervised by Rospotrebnadzor and 616 supervised by the FMBA of Russia. 15 883 (78%) radiation hazardous facilities are medical institutions . In total , in 2021, the Federal Data Bank on Personnel Exposure Doses received the results of measuring the annual individual effective doses of technogenic industrial exposure of 239 743 persons of group A personnel and 22 490 persons of group B personnel . 12 095 people of group A personnel who worked part-time at several radiation facilities were identified The average annual effective dose of technogenic occupational exposure of group A personnel in 2021 was 1.12 mSv , and for group B personnel , whose exposure doses were obtained according to instrumental control data – 0.61 mSv . The maximum values of the average annual effective dose of technogenic occupational exposure for group A personnel in 2021 took place in the Zabaykalsky Krai (2.81 mSv ), Perm Krai (2.60 mSv ), the Ulyanovsk region (2.03 mSv ), the Yamalo-Nenets Autonomous Okrug (1.93 mSv ) and the Republic of Buryatia (1.91 mSv ). The average individual annual effective dose of technogenic occupational exposure for part-time workers in 2021 was 1.92 mSv / year . It’s in 1.7 times higher compared to personnel A group . In 2021, two cases of exceeding the annual individual dose of 20 mSv and one case of exceeding the annual individual dose of 50 mSv for group A personnel and 12 cases of exceeding the annual individual dose of 5 mSv for group B personnel were identified . The annual individual dose of technogenic occupational exposure of 51.0 mSv ( exceeding the dose limit for group A personnel ) was registered in the Production association “ Sevmash ” in the Arkhangelsk region . In 2021, 1.54 million people lived in the radiation control areas of category I of potential hazard radiation facilities . The average annual effective dose of technogenic exposure to this category of the population due to the operation of radiation facilities was 0.018 mSv , which is only 1.8 times higher than the annual effective dose of 0.01 mSv , corresponding to a negligible radiation risk and 55 times less than the average annual dose limit for the population , equal to 1.0 mSv . In general , the radiation situation at the radiation facilities of the Russian Federation is quite stable and complies with safety requirements . Technogenic exposure of the population and personnel due to the normal operation of technogenic sources of ionizing radiation is the least significant radiation factor , both for individual exposure doses and for the collective exposure dose to the population of the Russian Federation. In 2021, only less than 24 thousand persons of group A personnel received annual effective dose of technogenic occupational exposure exceeding 2.0 mSv , which is comparable to the average annual effective dose of natural exposure (3.36 mSv ) received by the entire population of Russia. The collective annual effective dose to the population of the Russian Federation due to the operation of radiation facilities in 2021 was less than 0.1% of the dose from all sources .

Laparoscopic umbilical appendicostomy in children (Malone surgery): experience in treating 3 patients

Introduction. Fecal incontinence of various origins still remains a complex medical and social problem that reduces both the quality of life and the chance of child’s full integration into the modern society. Antegrade enema, originally described by Malone, consists of creating an appendicostomy or neoappendicostomy of the ileum, which allows to irrigate the entire colon in order to empty the colon and rectum. As a result, children stay clean from 24 to 72 hours. Thus, surgical intervention can significantly improve the quality of life of children suffering of incontinence. Laparoscopic access minimizes surgical trauma and shortens rehabilitation period.Purpose. To analyze the obtained outcomes after treating children with laparoscopic umbilical appendicostomy.Material and methods. We report our own results obtained after performing laparoscopic umbilical appendicostomy in 3 children at the Federal Scientific and Clinical Center for Children and Adolescents, FMBA of Russia. Two children had neurological disorders of the pelvic organ; the third child suffered a severe combined injury, which led to the development of gross scarring changes in the sphincter area with a complete loss of its contractility. All children underwent laparoscopic umbilical appendicostomy. The article describes in detail all the stages of preoperative preparation and surgical intervention.Results. The duration of surgery ranged from 60 to 80 minutes. An appendicostomy intubator was left for 1 month in all cases. Hospital stay ranged from 8 to 11 days. The catamnesis was traced for 3–7 months. Therapeutic effect was assessed by children’s parents as satisfactory; the child remained clean for 12–18 hours, which contributed to socialization and significantly improved the quality of life. Conclusion. Performing laparoscopic umbilical appendicostomy is a relatively affordable technique. Our own experience has proven its effectiveness. Laparoscopic access minimizes surgical trauma, reduces rehabilitation time, and brings excellent cosmetic results. Malone surgery in children should be considered as a method of choice.

The current state and problematic issues of medical care in the waters of the Northern Sea Route

Introduction. The solution of state issues for the development of the Arctic zone of the Russian Federation involves the active use of the Northern Sea Route as the main strategic highway. In order to preserve the life and health of ship crews in conditions of climatic and geographical and industrial risks, a smoothly functioning national system of medical care, harmonized with international requirements, is of great importance. The study aims to assess the state of the medical care system for ship crews on the Northern Sea Route, identify regulatory and organizational problems, and substantiate proposals for their elimination. Materials and methods. The researchers conducted an expert and analytical study, as well as analyzed and compared data during search and rescue operations in the waters of the Northern Sea Route (2010-2020), statistical data on medical examinations of ship crews conducted in 2020 in the organizations of the FMBA of Russia. The authors also have studied the main stages and forms of medical care in the waters of the Northern Sea Route. Scientists have conducted the analysis of scientific publications for the period from 2000 to 2021, contained in scientific electronic libraries, current international and Russian regulatory legal acts, information from official websites of executive authorities and organizations. Results. The system of medical care involves the implementation of measures for several interrelated elements: the provision of medical care on a ship, consultation by a medical professional using communication means, search and rescue operations, medical evacuation, medical care in the conditions of a coastal medical organization. International and Russian regulatory legal acts regulate the implementation of measures to provide medical care on board the vessel, the work of a wide range of participants from among federal executive authorities, executive authorities of subjects, institutions and organizations, officials and employees. In the course of the study, we found that there are concretized schemes of medical care, name lists and coordinates of participants. Specialists update all this in the Basin Plans for each territory of the Northern Sea Route. Despite the established rules of interaction of participants and conditions of medical care, the gaps identified by the researchers in administrative and legal regulation significantly affect the quality of medical care to members of the crews of ships, violate the constitutional rights of citizens to health protection. Conclusions. Experts have substantiated the proposals for improving the system of medical care in the waters of the Northern Sea Route when applying an integrated approach to the development of the coastal infrastructure of medical organizations, staffing ships with medical workers and providing medicines. Ethics. Scientists conducted the study in compliance with Ethical standards. This study did not require the conclusion of the Ethics committee.

The incidence of the adult population living in the "uranium legacy" area in conditions of radon exposure

Introduction. The purpose of the study is to assess the health status of the adult population of the Lermontov city, Stavropol Territory, living in the “uranium legacy” area in conditions of increased exposure to radon in residential premises has been investigated. Materials and methods. The material of the study was the medical statistics data for the period 2009-2018 reported by Clinical Hospital No. 101 under FMBA of Russia, presented in forms No. 7 (information on malignant diseases) and No. 12 (information on the number of diseases in adults). The frequency, structure and dynamics of primary morbidity and incidence of malignant neoplasms were evaluated. Results. During the period under review, a high primary incidence in the adult population was revealed (average: 748.2 ± 111.4 per 1000 persons) to increase and significantly exceeded the same indicator in the Stavropol Territory (390.3 ± 20.3 per 1000 persons) The incidence of four classes of diseases: diseases of the musculoskeletal system and connective tissue, diseases of the genitourinary system, diseases of the skin and subcutaneous tissue, diseases of the eye and adnexa was significantly higher than the regional average value. The incidence of respiratory diseases (lungs - a critical organ to the action of radon) did not significantly differ from the average regional indicators. On the contrary, the incidence of malignant neoplasms decreased (330.6 ± 1.1 per 100.0 persons) and on average approached that in the region (320.5 ± 11.4 per 100.0 persons). At the same time, the incidence of lung cancers was significantly lower than the regional average (22.6 ± 3.0 and 33.5 ± 0.3 per 100.0 persons, respectively). Limitations. The study is limited to studying the state of incidence (primary, cancer) of Lermontov adult population. The estimation of the relative number of excess lung cancers is based on the expert assessment of the ICRP of the corresponding coefficient. Conclusion. According to medical statistics for 2009-2018, the population of Lermontov had a relatively low incidence of malignant neoplasms, including lung cancers, of which, according to theoretical estimates, no more than 15-20% of cases can be conditionally associated with radon exposure. The revealed relatively high primary incidence of the adult population seems to be associated with the adverse impact on health of numerous factors of the human environment. Presumably, this situation also reflects the availability of quality medical care for the population.

ВЦМК «Защита» ФГБУ «ГНЦ – Федеральный медицинский биофизический центр им. А.И.Бурназяна» ФМБА России: итоги работы в 2021 г. и задачи на 2022 г.

The need to protect the population of the territories and personnel of the facilities serviced by the Federal Medical and Biological Agency in emergency situations by medical treatment organizations and mobile medical formations sets them an important task — to provide timely emergency and urgent medical care to victims in an emergency in accordance with modern principles of medical evacuation routing. The aim of the study is to analyze and to evaluate the main results of the activities of the All-Russian Center for Disaster Medicine “Zaschita” as a part of Federal Medical and Biophysical Center named after A.I. Burnazyan of the Federal Medical and Biological Agency of the Russian Federation, to develop proposals and to define objectives for further development and improvement of the system to organize medical care and medical evacuation in emergencies at facilities and territories served by FMBA of Russia. Materials and research methods. Materials: regulatory, legal and methodological documents governing the procedure for providing medical aid to the victims of emergencies; reports of the structural units of the All-Russian Center for Disaster Medicine “Zaschita”, including special exercises held in 2021; scientific papers on topical issues of medical support to the population in emergencies. Research methods: analytical, statistical, method of direct observation. Results of the study and their analysis. The results of the first year of operation of the the All-Russian Center for Disaster Medicine “Zaschita” as a part of Federal Medical and Biophysical Center named after A.I. Burnazyan of the Federal Medical and Biological Agency of the Russian Federation in 2021are presented. The following results are considered and analyzed: special trainings of the Field Multidisciplinary Hospital and Consolidated medical detachment; work on medical support of mass events — “Tavrida” Forum of Young Culture and Arts Workers and “Silk Road” international rally. The work of the laboratory of scientific and methodical problems of medical support in emergency situations established in the All-Russian Center for Disaster Medicine “Zaschita” within the past year was characterized. Decrease of the Center of sanitary aviation and ambulance services abroad activities due to borders closing, caused by COVID-19 pandemic, is highlighted. The activities of the All-Russian Center for Disaster Medicine “Zaschita” in the field of civil defense in the interests of FMBA of Russia, are listed. The main tasks for the All-Russian Center for Disaster Medicine “Zaschita” for 2022 are formulated.

Научно-методические подходы к оценке противоаварийной готовности медицинских организаций ФМБА России в случае радиационной аварии

The purpose of the study is to develop approaches to the substantiation of criteria and methods for quantitative assessment of the preparedness of medical organizations of FMBA of Russia to work in case of radiation emergency situations. Materials and research methods. Expert (analytical) and computer-based methods were used to estimate preparedness indices for medical organizations of FMBA of Russia on the basis of consensus ideas about possible medical and sanitary consequences of radiation accidents. Research results and their analysis. A general approach to the quantitative evaluation of emergency preparedness of medical organizations of FMBA of Russia in case of radiation accidents at the enterprises and territories they serve is formulated. The peculiarity of the approach under consideration in determining the proper (baseline) level of readiness for emergency response is the identification of the scale (magnitude) of medical and sanitary consequences based on the gradation of exposure doses and the number of victims. Approaches to substantiation of federal, regional and territorial (local) levels of emergency response of medical organizations of FMBA of Russia are proposed.

The role of pomalidomide in treatment of relapse and refractory multiple myeloma

Background. Over the past 15 years, the therapeutic breakthrough in the treatment of multiple myeloma observed primarily due to the emergence of new drugs. Since the characteristic of the disease is a chronic course with consecutive periods of remissions and relapses, the search for new effective treatment options with each subsequent relapse/progression is critical to increasing the survival of patients.Objective: to evaluate the role of pomalidomide in the treatment of relapsed/refractory multiple myeloma.Materials and methods. The results’ analysis of using pomalidomide-based treatment (Pd (pomalidomide/dexamethasone), PVd (pomalidomide/bortezomib/dexamethasone), KPd (carfilzomib/pomalidomide/dexamethasone), IxaPd (ixazomib/pomalidomide/dexamethasone), DaraPd (daratumumab/pomalidomide/dexamethasone), IsaPd (isatuximab/ pomalidomide/dexamethasone), EloPd (elotuzumab/pomalidomide/dexamethasone)) in pretreated patients, including own data, was done. Based on the RosNIIGT FMBA of Russia, 17 patients with relapsed/refractory multiple myeloma were treated; the frequency of achieving a response and the development of adverse events was estimated; the possibility of pomalidomide dose reducing with the development of adverse events was described without an apparent decrease of effectiveness.Results. The frequency of the overall response in using pomalidomide-based programs was 53 % (according to the world data, from 38 to 82 %). This drug is recommended for patients with multiple myeloma, even accompanied by the final stages of renal failure. The most frequent adverse event was grade III–IV neutropenia (30 % of patients). In 3 patients, the dosage of pomalidomide was adjusted with a decrease to 2 mg per day. In 2 patients, therapy was discontinued due to pulmonary embolism and bilateral pneumonia. After three courses of DaraPd, one patient achieved a complete response and underwent autologous hematopoietic stem cell transplantation.Conclusion. Pomalidomide-based programs in patients with relapsed/refractory multiple myeloma are an effective treatment option. Using dose-adjusted pomalidomide after the occurrence of neutropenia makes it possible to normalize the neutrophils level (more than 1 × 109/l) and continue anti-myeloma therapy, preserving the therapeutic effect and in individual patients with unfavorable prognosis factors to conduct high-dose therapy followed by autologous hematopoietic stem cell transplantation.

The Assessment of Morphological and Functional Changes in the Detection of the Initial Stage of Primary Glaucoma

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.

МЕДИЦИНСКИЕ РАДИОЛОГИЧЕСКИЕ ПОСЛЕДСТВИЯ СПУСТЯ 35 ЛЕТ ПОСЛЕ АВАРИИ НА ЧЕРНОБЫЛЬСКОЙ АЭС

Purpose: In an article prepared on the basis of the conclusion of the Russian Scientific Commission on Radiological Protection (RSCRP) at the Department of Medical Sciences of the Russian Academy of Sciences "Assessment of the radiological consequences of the Chernobyl accident after 35 years according to the National Radiation and Epidemiological Register" (NRER), the main conclusions of the large-scale radiation-epidemiological studies carried out.
 Material and methods: The work uses information NRER – liquidators of the consequences of the Chernobyl accident and the Branch Register of FMBA of Russia – liquidators. When assessing the excess relative risk of malignant neoplasms, the EPICURE.
 Results: The current status of the National Radiation and Epidemiological Register, which is currently functioning within the framework of the Law of the Russian Federation of 30.12.2012 No. 329-FZ “On Amendments to Certain Legislative Acts of the Russian Federation in terms of ensuring that changes in the health status of certain categories of citizens are taken into account exposed to radiation". For the first time in an integral form, the article presents the medical radiological consequences of the accident at the Chernobyl nuclear power plant for the population of Russia. It was found that an increase in the incidence of thyroid cancer due to incorporated exposure to 131I was found in a cohort of children and adolescents (28 856 people) who received radiation doses of more than 200 mGy in 1986. There was no increase in the incidence of thyroid cancer among the adult population. Analysis of the incidence of solid cancers in the territories of the Bryansk, Kaluga, Tula and Oryol regions contaminated with radionuclides did not reveal an increase in the frequency of this pathology for children and adults. It is shown that in the cohort of liquidators of the Chernobyl accident, who received radiation doses of more than 150 mGy (35 303 people), an increase in the incidence of leukemia during the first 11 years after the accident at the Chernobyl nuclear power plant and solid cancers was revealed in comparison with the spontaneous level.
 Conclusions: The article points out serious limitations associated with a high degree of uncertainty in the received personal dosimetric data on liquidators in 1986–1987. and the need to use the total dose from all types of radiation (professional, emergency, medical, natural) to calculate the radiation risk. RSCRP emphasizes the high urgency of continuing work on reducing the uncertainty of dosimetry data and assessing the radiological consequences of the Chernobyl accident based on a comprehensive analysis of the NRER data.

ИССЛЕДОВАНИЯ ИНКОРПОРИРОВАННОГО В ОРГАНИЗМ ЧЕЛОВЕКА РАДИОНУКЛИДА АМЕРИЦИЯ-241 С ПОМОЩЬЮ РАНЕВОГО ДЕТЕКТОРА

Purpose: to develop a method for experimental study of the distribution of radionuclide 241Am in human organs and tissues during wound admission to clarify the process of formation of doses of alpha radiation.
 Material and methods: in clinical practice of Burnazyan FMBC of the FMBA of Russia To improve the method of determination, an experiment was performed to determine the depth of radionuclide on pigskin with the location of 241Am point sources behind different thicknesses. 
 Results: the used methods of measurement, tested on pigskin, allowed to obtain the dependence of the localization depth of radionuclide 241Am on the measured on the surface of the tissue ratios of photons with different energies.
 Conclusion: Set the ratio of photons with different energies on the thickness of the barrier (depth), and proven methodology allow you to go directly to the planning of experimental studies on the barrier effect created in the bone material, and including a radionuclide, the formation of doses of alpha radiation on the bone marrow.

The achievements of pulmonology and the main directions of further improvement of medical care in the Russian Federation

The development of pulmonology in Russia is linked with the creative activity of the Scientific Research Institute of Pulmonology of the Federal Medico-Biological Agency (Research Institute of Pulmonology of the FMBA) and its scientific school.The aim of the analytical review was to assess the role and contribution of the research team of the Research Institute of Pulmonology in improving the quality of medical care to the population of Russia.Methods. The data of medical statistics of the Ministry of Health of the Russian Federation on morbidity and mortality of the population due to respiratory diseases (RD) from 2004 - 2018 are analyzed. The publications on scientific research conducted with the participation of employees of the Research Institute of Pulmonology for the period from 2005 to 2020 were studied.Results. Over the past 30 years in Russia, with the participation of the staff of the Research Institute of Pulmonology, the state task of creating a system for organizing medical care for the population with RD has been successfully solved. The study and implementation of modern innovative approaches in the diagnosis, treatment and prevention of RD, the training of primary care physicians allowed to improve the quality of medical care to patients to the level of world standards. For the period from 2004 - 2018 the mortality of the population from RD 35.6% decrease was registered. During the pandemic of a new coronavirus infection, the use of pulmonology achievements in clinical practice contributed to a decrease in the frequency of deaths in people with COVID-19.Conclusion. Currently, the Research Institute of Pulmonology of the FMBA of Russia retains a leading position in the country in the field of fundamental scientific research, innovative methods of diagnosis and treatment of RD, educational activities and training of specialists in the field of pulmonology.

Organization of medical care in FMBA institutions of the siberian federal district during the pandemic of new coronavirus infection (COVID-19): challenges and solutions

Introduction. The experience of organization of medical activity in the medical institutions subordinate to the FMBA of Russia in the Siberian Federal District during the I-III epidemic waves of COVID-19, the procedure for making and implementing organization and managerial decisions on building the health care system; the analysis of the experience gained in the formation and operation of consolidated mobile emergency response teams was made.Materials and methods. The study was performed on the basis of the statistical data, regulations on the organization of medical care for patients diagnosed with COVID-19, including medical care provision in the extreme conditions.Results and Discussion. The rational distribution of infectious diseases hospitals, human resources and equipment made it possible to create bed capacity reserve, as a result of which, even during the peak episodes of the pandemic process, the average occupancy of beds in the serviced area was no more than 92-93% and there was always the possibility to receive new patients in hospitals; the capacity of the laboratory was gradually increased 25 times: from 200 tests per day in the pre-pandemic period to 5,000 tests per day. Thanks to the introduction of the new management solutions, digitalization of medical processes has been ensured: accounting of results in the medical information system, transmission of results directly to medical institutions within 12-14 hours, which is 4 times faster than the standard time. The legal regulations of interaction with the rescue centres of the Ministry of Emergency Situations of Russia, the Ministry of Defense and other power structures, the improvement of the material and technical equipment of basic mobile hospitals and emergency medical teams were proposed for discussion.Conclusion. A scheme has been worked out for the involvement of the MOF of the Federal Medical and Biological Agency of Russia in the timely organizational measures for mobilization of forces and means in order to ensure the re-profiling of medical activities to work on providing medical care in the COVID-19 pandemic conditions.

ЗАБОЛЕВАЕМОСТЬ ДЕТСКОГО НАСЕЛЕНИЯ Г. ЛЕРМОНТОВА, РАСПОЛОЖЕННОГО В РАЙОНЕ «УРАНОВОГО НАСЛЕДИЯ»

Purpose: To carry out assessment the health status of the child population of the Lermontov city. This child population living in the area, of uranium legacy, and they are critical group of the population in terms of sensitivity to adverse environmental factors.
 Materials and methods: The object of the study was the morbidity of children 0–14 years old (primary, chronic, oncological). The research material was the data of reporting forms of medical statistics, presented in the following forms: 7 – information on malignant neoplasms and 12 - information on the number of diseases in children. The development included data from Clinical hospital # 101 of the FMBA of Russia for 2014–2018. Statistical data processing was carried out using standard methods used for the analysis of biomedical data.
 Results: The morbidity of children 0–14 years old in Lermontov in 2014–2018 averaged 2310.9 ± 115.7 per 1000. In the structure of morbidity, the leading places were occupied by diseases of the respiratory system – 59.2 %, the digestive system – 8.8 %, skin and subcutaneous tissue 5.5 %, trauma and poisoning – 4, 8 % and infectious and parasitic diseases. The frequency of chronic morbidity does not exceed the population estimates – 73.0 ± 4.1 per 1000. The peculiarity of chronic morbidity is the relatively high incidence of skin diseases – 25.3 % and the musculoskeletal system – 20.4 %. The morbidity of children in the first year of life is 2348.0 ± 135.1 per 1000. A feature of the morbidity structure is the high incidence of respiratory diseases, which makes up 66.3 % of the total morbidity, with population estimates – 20–30 %.
 Conclusion: The increased radiation background can be considered as one of the possible negative environmental factors affecting the health of the population.