Kuban State Medical University Research Articles

Alcohol consumption among medical students

Introduction. Medical students constitute a special social group differing a lot from the other studentship. First, they are professionally aware of the risks associated with bad habits. Second, they will be doctors soon and one of their future functions is to prevent bad habits (both current and potential) among their patients. The purpose of the study was to analyze alcohol consumption among medical students of different gender depending on socio-psychological factors. Materials and methods. The analysis was based on the student survey data of the Kuban State Medical University (Krasnodar). The survey used an electronic anonymous questionnaire. A total of one thousand seven hundred thirty two questionnaires have been analyzed (questionnaires completed by males accounted for 24.1% of the total number of questionnaires). Comparisons of shares of individual responses in different groups of respondents have been conducted on the basis of four-field tables using Chi-square criterion, significance level p < 0.05. The relative risk and its confidence interval have been determined. Results. 37.6% of respondents have not consumed alcohol in the last 12 months. 45.0% of students consume alcohol once per month or less frequently. Every 7th student (14.6%) drinks alcohol 2–3 times a month, and only 1.1% indulge more often (2–3 times a week). The relationship between frequency of alcohol consumption and characteristic features differed by gender. Research limitations. The analysis was based on the student survey data of the Kuban State Medical University (Krasnodar). Conclusions. The situation among young students — students of the Medical University, is rather favourable. As the number of years in training increases the share of students who consume alcohol decreases. However, the level of general anxiety is on the rise coupled development of episodes of behaviour in some respondents that raise concern.

Vaccination in latent papillomavirus infections: An experimental randomized, prospective, open-label, controlled trial

Background. Human papillomavirus refers to one of the most common sexually transmitted infections with the majority of viruses in the host being transient carriers, the so-called latent forms of papillomavirus infection. Persistence of cancer-associated human papillomavirus is fraught with cervical intraepithelial neoplasia, and subsequent cervical cancer. Measures for secondary prevention of cervical cancer in latent forms of papillomavirus infection are yet to be developed, which predetermined the present study.Objectives. To increase the effectiveness of secondary prevention of cervical cancer by improving the algorithm for managing latent forms of papillomavirus infection in women. Methods. A randomized controlled trial enrolled 152 patients diagnosed with a latent papillomavirus infection. Patient examination and data analysis were carried out at clinical trial centers of the Department of Obstetrics, Gynecology and Perinatology of Kuban State Medical University (Russia) in 2020–2024. The trial involved patients aged 18 to 35 years. Patients were divided into 2 groups using the sealed code envelope method: Group I (comparison group) (n = 74) — microbiological sanitation of the cervicovaginal zone (as indicated) and observation for 36 months with annual control of viral load, colposcopy and oncocytology; Group II (study group) (n = 78) — microbiological sanitation of the cervicovaginal zone (as indicated) and administration of quadrivalent recombinant human papillomavirus vaccine (types 6, 11, 16, 18) (3 doses intramuscularly: second and third doses were administered 1 and 3 months after the first one). Each patient was analyzed for the effectiveness of preventive therapy according to the dynamics of indicators: colposcopy, cytology (Papanicolau staining), and molecular biological analysis (polymerase chain reaction). The indicators were evaluated after 12, 24, and 36 months. Statistical analysis of the results was carried out using IBM SPSS Statistics 26 (IBM, USA) variation statistics programs.Results. Vaccination with a quadrivalent recombinant vaccine against human papillomavirus of types 6, 11, 16, 18 against the background of correction of dysbiotic vaginal and cervical disorders in latent forms of papillomavirus infection in women was revealed to cause a 9.3-fold decrease (compared to the study group) in realization of latent persistence of viruses into subclinical (25.7 % in group I vs. 9.0 % in group II) and clinical forms of papillomavirus infection (cervical intraepithelial neoplasia) — 12.1 % in group I vs. 1.3 % in group II, to reduce the persistence of human papillomavirus and the appearance of their new genotypes, the viral load of highly oncogenic types of human papillomavirus (1.9 times —3.2 ± 2.4 geq/ml in group I versus 1.7 ± 2.1 geq/ml in group II).Conclusion. The trial has shown that human papillomavirus vaccination is associated with a reduced risk of realization of latent forms of papillomavirus infection into clinical forms as cervical intraepithelial neoplasia and, consequently, cervical cancer, thereby being considered promising for secondary prevention of this pathology.

Experience of strategic sessions to improve the quality of lean technology implementation in medical organizations in Krasnodar Krai: a one-stage observational study

Background. Lean production is mainly focused on increasing value in processes and improving the quality of services provided. These principles are implemented in medical organizations within the framework of the national project “Healthcare” and the federal project “Development of the Primary Healthcare System”. Introduction of lean technologies at all levels of the organization can serve as a highly effective method of positive changes. In 2023, Kuban State Medical University, together with the Ministry of Health of Krasnodar Krai and the Regional Center for Primary Healthcare, held a strategic session aimed at identifying problematic processes in medical organizations of the region and jointly searching for ways to solve them. The session involved 73 primary healthcare organizations. Its results formed the basis for a study of the project activity of medical organizations. Objective. To analyze the current state of project activities of medical organizations in Krasnodar Krai to achieve a “new model” through the introduction of lean technologies.Methods. A one-stage observational study was carried out in two steps. The first step involved participant observation. Its results determined a set of tools to be compiled. The second step of the study included a questionnaire survey and analysis of information. The data obtained from the questionnaire survey and observation were coded, the distribution and frequency were identified using frequency analysis and calculation of mean values. The qualitative analysis of open-ended questions was additionally applied.Results. The analysis showed that the prevailing number of projects are aimed at forming and developing the availability of medical care for the population (50.6 %), including projects focused on inclusiveness and provision of medical care to low-mobility patients at home. It was also revealed that 42 projects in four areas are planned for implementation in 47 organizations using lean technology tools in 2024. The study showed that 91.49 % of projects failed to calculate financial efficiency and evaluate project results in monetary terms. Meanwhile, 8.51 % of those who carried out the efficiency calculations lacked an analysis methodology and revealed the superficiality of the calculations. Of all the participants, 53.19 % reported the need for help in organizing and implementing project activities, and 36.17 % of the participants had enough resources to cope on their own. The three most problematic processes requiring joint work with colleagues included “Reducing the wait times for healthcare in regional medical organizations,” “Registration of discounted prescriptions” and “Preventive medical examination and dispensary.”Conclusion. The experience of a strategic session at Kuban State Medical University proved to be effective in improving the quality of implementation of lean technologies in medical organizations of Krasnodar Krai. The study was instrumental in assessing the current state of the project activities of medical organizations to achieve a “new model” through the introduction of lean technologies, as well as in identifying the most common areas of project activities and the main problems. The performed analysis revealed a positive trend in improving the quality of work of medical organizations in Krasnodar Krai and disseminating the lean technologies in primary healthcare.

Microbial landscape of periodontal pockets against local antibacterial therapy of chronic generalized periodontitis: a multicenter clinical trial

Background. A microbial nature of periodontitis requires an accurate analysis of the pathogenic potential of the periodontal pocket microflora thereby enabling correct diagnosis to be made and the most effective pharmacological agent to be selected for treating chronic periodontitis. Metronidazole demonstrates excellent results for anaerobic microorganisms in the periodontal pocket, whereas minocycline hydrochloride, moxifloxacin and amoxicillin/clavulanate are efficient for aerobic microorganisms. However, specialists find considerably relevant to analyze the correlations between specific bacterial associations in the periodontal pocket against local antibacterial therapy, as well as to track the contents of periodontal pockets long after antibacterial therapy. Therefore, a microbiological analysis of periodontal pocket contents is considered necessary in order to select and monitor the effectiveness of local antibacterial therapy.Objective. To evaluate the effectiveness of local antibacterial therapy for chronic generalized periodontitis by means of analysis of changes in the microbiological composition of periodontal pockets.Methods. The clinical trial involved 144 patients with chronic generalized periodontitis. The study included examination of patients and analysis of clinical data bases of the Department for General Practice Dentistry, Kuban State Medical University and the Dentistry Department, Stavropol State Medical University of the Ministry of Health of the Russian Federation. The trial included patients aged 30 to 60 with a diagnosis of chronic generalized periodontitis of different severity. All periodontitis patients were divided into 2 groups depending on the therapy: main and control groups. Each group had three subgroups depending on the severity of the pathologic process. The first subgroup of the control group (chronic generalized periodontitis of mild degree) consisted of 16 people (11.1%), the second subgroup (chronic generalized periodontitis of moderate degree) — 31 people (21.5%), the third subgroup (chronic generalized periodontitis of severe degree) — 7 people (4.9%). The first, second and third subgroups of the main group consisted of 28 (19.4%), 48 (33.3%) and 14 persons (9.7%) respectively. The severity of periodontitis was determined by the depth of the periodontal pocket, degree of bone resorption (according to x-ray examination), and pathologic tooth mobility. A local anti-inflammatory therapy for the patients of the control group included oral baths with propolis (15–20 drops of 10% propolis tincture diluted in 100 ml of warm water) 3 times a day for 7 days starting from the first visit. At the final stage of treatment after preliminary scaling and rootplaning, patients of the control group received antiseptic gel with 10% metronidazole and 2% chlorhexidine bigluconate to be injected into periodontal pockets with over 4 mm depth. Additionally, applications of adhesive dental films Diplene Denta L (with lincomycin) and Diplene Denta M (with metronidazole) were prescribed to be done in the home. In addition to the above-mentioned comprehensive therapy, patients of the main group received a single insufflation of minocycline hydrochloride microspheres into each periodontal pocket. The tools for the patients of the main group included plastic cannulas with minocycline hydrochloride microspheres in the form of powder in the tip of the cartridge, and a special syringe-insufflator. The technique of antibiotic insufflation into the periodontal pocket was preliminary trained on the model of jaws with the studied pathology. Statistical analysis of the results was performed using variance analysis in the Excel Microsoft Office 2016 (Microsoft, USA).Results. According to the systematic observation of the patients from the control group, periodic fluctuations in microbial population in the majority of pathologic pockets obtained a specific regularity: a decrease in the number of microorganisms on day 21 was followed by its increase in the subsequent period of observation after 30 and especially 60 days. According to the ongoing follow-up of the patients of the main group, fluctuations of microbial population in the majority of pathologic pockets obtained a certain regularity: a significant reduction in the number of microorganisms on day 21 was followed by its slight rise in the subsequent period of observation after 30 and a slight increase again in 60 days. Fluctuations in the number of microorganisms of periodontal pockets in the main group reveal their specific character: their number remained invariably lower than that of the control group throughout the observation period, while the total number of detected periodontopathogens decreased.Conclusion. The established correlations between the main indicators of microbiological status of periodontal pockets and the severity of chronic generalized periodontitis within different periods after the local therapy confirm the positive dynamics of treatment in the main group, where patients were insufflated with minocycline hydrochloride microspheres, proved by a change in the typology of microbial status of periodontal pockets and a number of periodontopathogenic microorganisms.

Ways to solve the problem of training highly qualified internists

Training a highly qualified internist in residency is a multifaceted task facing the teaching staff of the Kuban State Medical University.The aim of the study was to analyze the long-term experience of training internal medicine physicians (from 2019 to 2022) at the Kuban State Medical University.Conclusion. A developed methodological system for personalized preparation of internists, the integration of theoretical and practical training, the individual work of students with ongoing progress monitoring of each resident, the mentor system, as well as the active use of modern technical equipment, novel methodological techniques, digital and simulation technologies, introduced organizational measures and material incentives for students have made it possible to achieve 100% employment of General Medicine residency graduates of the Kuban State Medical University in recent years.

Research of the application of elements of sports games in the process of therapeutic physical education activities

Recent studies have shown that the use of elements of team sports in physical education classes in a special medical group “B” (therapeutic physical education) remains one of the promising areas and, at the same time, a rather complex methodological problem, caused in many cases by concomitant diseases of students. When discussing the features and advantages of various team sports in the mode of practical exercises in therapeutic physical culture in universities, it is necessary to pay attention to the differentiated use of elements of sports games in accordance with the existing pathology.Purpose. Determine the most effective complexes of physical activity using elements of team sports.Materials and methods. The material for the work was the results of a current medical examination, motor tasks that make it possible to determine the level of development of physical qualities, and data from a functional test. The research was conducted at the departments of physical education of Astrakhan State Medical University and Kuban State Medical University and Astrakhan State University in the 2021/22 academic year. Based on functional tests, the level of physical fitness of those involved was analyzed, and hemodynamics were determined during physical activity classes using elements of team sports. The work used standard methods of mathematical analysis.Results. A reliable correlation was revealed between the use of elements of team sports and the level of increase in the regulatoryadaptive potential of the cardiovascular system, reduction of BMI, elements of team sports were identified that are advisable to recommend for the appropriate medical group. During the work, data were obtained on the effectiveness of using elements of sports games for students assigned to medical group “B”.Conclusions. It is advisable to use elements of basketball in the form of developing coordination abilities, mastering techniques of ball possession with changing parameters in space and time interval. In our opinion, this format allows you to vary the intensity of physical activity in accordance with the level of functional and physical fitness of students. In the same group, it is possible to use elements of volleyball and the game of volleyball itself according to simplified rules. The individual duration of rest breaks should allow the cardiorespiratory system to be restored to background levels.

Efficacy Evaluation of Combination Therapy in Patients with Generalized Periodontitis According to the Index Estimation of Periodontal Status: Experimental Randomized Single-Arm Study

Background. Treatment and prevention of inflammatory periodontal diseases represent a serious general medical and social problem, which remains relevant due to the significant prevalence of periodontitis among the population, as well as the associated loss of teeth and the negative impact of periodontal foci of infection on the body as a whole. Chronic generalized periodontitis is difficult to treat: it is only possible to achieve periods of remission. Therefore, it is of great theoretical and practical importance to develop further ways to improve methods for treating inflammatory-dystrophic damage of periodontal tissues in chronic generalized periodontitis.Objective. To perform an index estimation of treatment efficacy in patients with moderately severe chronic generalized periodontitis.Methods. An experimental randomized single-arm study was conducted examining 204 patients diagnosed with moderately severe chronic generalized periodontitis. Patient examination and data analysis were carried out at the Dentistry Department of the Stavropol State Medical University and the Department for General Practice Dentistry of the Kuban State Medical University in 2021–2022. The study included patients aged 35 to 65 years diagnosed with moderately severe chronic generalized periodontitis. Patients with somatic diseases in the decompensation stage were not eligible for the study. The patients were randomly divided into three groups (closed-envelope method). Group 1 was treated using conventional methods. As well as conventional therapy, Group 2 was prescribed vitamin D (Aquadetrim® at a dose of 5000 IU once per day while monitoring vitamin D blood level). The third group of patients was prescribed conventional therapy along with the developed pharmacotherapy, which included vitamin D (Aquadetrim® at a dose of 5000 IU once per day), vitamin A (3.44% oil solution of retinol acetate at a dose of 50 000 IU, 15 min after a morning meal), and 2-ethyl-6-methyl-3-hydroxypyridine (Mexidol® at a dose of 125 mg twice a day). In each patient, the treatment efficacy was analyzed in adjacent oral cavity segments (split-mouth design) according to clinical pocket depth, attachment loss, and bleeding on probing. Also, the authors used the X-ray index to assess the condition of osseous structures and the simplified oral hygiene index. The specified indices were estimated prior to treatment and at one and 12 months following treatment. The statistical analysis of study results was performed using Excel Microsoft Office 2016 (Microsoft, USA).Results. The obtained data indicate that the immediate clinical outcomes (after one month) of combination therapy in patients from all three groups were approximately the same. However, the efficacy of treatment measures in the long-term period (12 months) was different, as evidenced by the dynamics of index values. Only in Group 3 patients, the full implementation of pharmacotherapeutic measures as part of the combination therapy of periodontitis ensured a stable therapeutic effect throughout the entire period of observation.Conclusion. The data obtained 12 months following treatment indicate that the additional prescription of the developed pharmacotherapy contributed to prompt inflammation relief in periodontal tissues, providing a stable treatment outcome and long-term remission.

Clinical Justification for Preliminary Thermal Exposure to Composite in the Treatment of Caries: Randomized Clinical Trial

Background. Polymer composites have good aesthetic characteristics and pronounced physicochemical properties, as compared to traditional restorative materials such as amalgam. However, the polymerization reaction of composite material containing bismethacrylate group commonly used in clinical practice is always accompanied by a different degree of volumetric shrinkage (2.7%~7.1%). The resulting stress can lead to adhesion failure and some other unfavorable clinical consequences, such as enamel destruction, microcracking of composite material and formation of microleakage between composite and tooth cavity wall, which can result in recurrent caries and postoperative sensitivity, thereby affecting the long-term effect of restoration. Therefore, studying the effect of preheating on composite restoration is important for its clinical application. Objective. To improve the effectiveness of treatment of patients with dental caries by improving the physicochemical properties of composite restorations.Methods. A randomized clinical trial enrolled 180 patients aged 18 to 45 years, diagnosed with dentin caries class I, according to Black (K02.1 in ICD). The study was conducted in the Dental Clinic of Kuban State Medical University, Russia. 180 composite restorations were performed in the treatment of dentin caries of molars. Patients were randomized into 2 groups): the control group — 90 patients and the main group — 90 patients. The control and main groups, in turn, were divided into three subgroups, depending on the composite used — Estelite Sigma Quick (Tokuyama Dental, Japan), Filtek Bulk Fill Posterior Restorative (3M Espe, USA) and DentLight (VladMiVa, Russia). Each subgroup consisted of 30 patients. In the control group, the classical method of filling with a composite material at “room temperature” was applied. In the main group, a composite heating conditioner “Ena Heat” (Micerium, Italy) was used to heat the composite to 55 °C before adapting the material in the formed cavity with subsequent photopolymerization. The quality of composite restorations within the clinical study was evaluated using the modified Ryge criterion immediately after treatment and after 6, 12, 18, 24 months. Statistical processing of the obtained data was carried out by means of one-factor analysis of variance using the GraphPadPrism 9 program (GraphPad Software, USA).Results. The duration of the clinical study comprised 24 months. The study revealed a statistically significant decrease in the quality of marginal fit of composite restorations (according to the Ryge score) by 20.1% (p = 0.0001) in the control group and by 5.7% (p = 0.0328) in the main group. At the same time, no statistically significant changes in Ryge scores were reported in the subgroups of composite materials of the main group (pF = 0.9480, pE = 0.1837, pD = 0.2529). As a result of the study, an optimal time algorithm (7 seconds) for using a special furnace for preheating the composite before sealing with subsequent photopolymerization was obtained.Conclusion. The study revealed a statistically significant positive effect of the proposed algorithm for working with a heated composite on the quality of marginal fit in the long term after treatment in comparison with the classical method of working with a composite at “room temperature”.

Antiatherogenic Potential of Transcranial Electrical Stimulation in a High-Fructose/High-Fat Diet: Experimental Randomized Trial

Background. Transcranial electrical stimulation is a promising method for correction of malnutrition-induced hyperlipidemia, in the absence of indications for drug hypolipidemic therapy in young and middle-aged patients with low and moderate cardiovascular risk. Objectives — to study the effect of transcranial electrical stimulation on lipid metabolism in a high-fructose/high-fat (HFHF) diet in rats.Methods. An experimental randomized trial was performed to study the effect of transcranial electrical stimulation on lipid metabolism in a high-calorie diet enriched with fructose and saturated animal fat in rats. The experiments involved 180 outbred male rats and were carried out on the basis of the vivarium of Kuban State Medical University. The animals were divided into three groups: group 1 (control group, n = 60) — followed a standard diet; group 2 (comparison group, n = 60) — followed a HFHF diet; group 3 (experimental group, n = 60) — underwent transcranial electrical stimulation against the background of a HFHF diet. According to the target reference point of the study, the groups were divided into three equal subgroups of 20 rats each: subgroup A — day 30, subgroup B — day 60, and subgroup C — day 90 (biomaterial sampling and euthanasia were carried out on those days). In the obtained blood samples, the following lipid metabolism parameters were evaluated: total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and atherogenic index. Statistical analysis was performed using Microsoft Office Excel 2021 (Microsoft, USA), GraphPadPrism 9 (GraphPad Software, USA) and Statistica 13.3 (StatSoft, USA).Results. On the 30th day of the study, it was noted that in group 3, the concentration of low-density lipoprotein cholesterol was 14.9% lower and the atherogenic index was 30.8% lower (p < 0.05) than in group 2, while total cholesterol concentration, triglycerides, and high-density lipoprotein cholesterol had no statistically significant differences (p > 0.05). On the 60th day of the study, in group 3, when compared to group 2, the concentration of total cholesterol was 18.7% lower, low-density lipoprotein cholesterol was 42.9% lower, high-density lipoprotein cholesterol was 16.7% higher, and the atherogenic index was 56.3% lower (p < 0.05), while triglycerides had no statistically significant differences (p > 0.05). On the 90th day of the study, in group 3, when compared to group 2, the concentration of total cholesterol was 29.2% lower, the concentration of triglycerides was 36.0% lower, low-density lipoprotein cholesterol was 42.8% lower, and the atherogenic index was 57.0% lower (p < 0.05), while the concentration of high-density lipoprotein cholesterol had no statistically significant differences (p > 0.05).Conclusion. High-fructose/high-fat diet leads to a progressive increase in the serum concentration of low-density lipoprotein cholesterol, total cholesterol, triglycerides, as well as to a moderate decrease in high-density lipoprotein cholesterol and a growth in the atherogenic index. Transcranial electrical stimulation has a moderate lipid-lowering effect, manifested in the form of a decrease in the serum concentration of low-density lipoprotein cholesterol, total cholesterol and atherogenic index, while the effect on the concentration of triglycerides and high-density lipoprotein cholesterol is insignificant.

Роль генов серотонинергической медиаторной системы в формировании регуляторно-адаптивных возможностей человека

The purpose of this article was to establish the role of polymorphisms of genes regulating serotonin metabolism in the formation of human regulatory and adaptive capabilities. Materials and methods. The research involved 89 students of Kuban State Medical University. Their adaptation level was assessed at the end of the academic year according to the index of regulatory and adaptive status (IRAS) using the cardiorespiratory synchronism test (V.M. Pokrovskiy) on the VNS-Mikro device (Neurosoft, Russia). In addition, a molecular genetic analysis was performed (by DNA isolation from the peripheral blood using the standard phenol–chloroform extraction method) to identify polymorphisms of genes involved in serotonin biosynthesis (tryptophan hydroxylase genes TPH1 and TPH2) and genes encoding serotonin receptors (HTR2C and HTR2A). Results. The subjects were divided into three groups: with high (52.8 % of students), satisfactory (34.8 %) and low (12.4 %) regulatory and adaptive capabilities. In the group with high regulatory and adaptive capabilities, the most common alleles and genotypes were the following: *C allele for the ТРН1 gene; *G allele and *G/*T genotype for the ТРН2 gene, *G allele and *G/*G genotype for the HTR2С gene, and *A/*G genotype for the HTR2A gene. Statistically significant differences in the frequency of the *A/*G heterozygous genotype for the G1438A marker of the HTR2А gene were found between the groups with high and satisfactory regulatory and adaptive capabilities as well as in the groups with high and low regulatory and adaptive capabilities. In both cases, the *A/*G heterozygous genotype prevailed in individuals with high regulatory and adaptive capabilities, whereas the *G/*G heterozygous genotype was only identified in the group with low regulatory and adaptive capabilities. Thus, medical students with high regulatory and adaptive capabilities had alleles and genotypes that provide high sensitivity of serotonin receptors and sufficient activity of its biosynthesis enzymes. The obtained data revealed a dependence between the regulatory and adaptive capabilities and the polymorphisms of genes involved in both biosynthesis and reception of serotonin in humans.

Iron deficiency anemia in reproductive-aged women: options for treatment and prevention

Objective. To assess the frequency of iron deficiency states among reproductive-aged women and to consider the features of their prevention. Subjects and methods. The investigation enrolled 2401 reproductive-aged patients who came first to the Clinic of the Kuban State Medical University in 2019. The patients’ mean age was 36.71±6.32 years; the follow-up period was 36 months. Results. Iron deficiency and iron deficiency anemia (IDA) were detected in 518 (21.6%) and 591 (15.9%) patients, respectively. At the same time, IDA was mild, moderate, and severe in 383 (15.9%); 202 (8.2%), and 6 (0.5%) patients, respectively. New-onset anemia was recorded in 70.3% of patients. A re-examination was carried out after 36 months, which involved 1917 patients (79.8% of the baseline patients). A total of 156 (8.1%) patients were diagnosed with mild and moderate (in 149 (7.7%) and 7 (0.3%) patients, respectively; latent iron deficiency was identified in 518 (21.6%) patients. At the same time, IDA was undetected in the patients who had followed the recommendations for prophylactic iron supplementation after reaching the target levels of serum hemoglobin and ferritin. Conclusion. An integrated approach that includes the informing of a patient about iron deficiency consequences, etiotropic and pathogenetic treatment, preventive drug use recommendations, and dynamic monitoring, assist in overcoming iron deficiency in reproductive-aged women.

ВОЗМОЖНАЯ ОРГАНИЗАЦИЯ ДОПОЛНИТЕЛЬНОГО ОБУЧЕНИЯ БАЗОВЫМ ХИРУРГИЧЕСКИМ НАВЫКАМ

Significance. Within the educational process in medical universities, one of the important aspects is the development of basic surgical skills. During the educational process this helps to decide on your specialty in general, and also improves the quality of training of future doctors. At present, there is no well-established structure for conducting courses in basic surgical skills. The purpose of the study was to evaluate the demand for an additional course in basic surgical skills among 1-6-year students of the Kuban State Medical University. Material and methods. To identify feasibility of an additional training in basic surgical skills, a survey was conducted covering 2190 students of the Kuban State Medical University in a remote format based on the GoogleScholar platform in September-October 2022. The questionnaire included the choice of the most optimal, from the point of view of the student, schedule, the number of students in the group and materials used. Results. Out of the students surveyed, the majority support the idea of ​​introducing additional training in small groups using biomaterials or artificial materials with the predominance of practicing surgical skills. Conclusion. According to the survey results, introducing an additional course to train students in basic surgical skills will be relevant and help to improve manual skills during the educational process, as well as to decide on specialty in the future. Scope of application. The aspects of the possible organization of additional training in basic surgical skills presented in the article will contribute to better training of medical university students.

Роль руководителя научного кружка в формировании мотивации студента к углубленному освоению будущей профессии

One of the important components in teaching students of medical universities is assistance in choosing a future specialty, the area that will need to be studied in depth, constantly updating knowledge for most of life. The sooner this happens, the sooner the doctor will reach a high level of knowledge and skills in the chosen field. In this regard, the role of the discussion group in shaping the student’s motivation to master the future profession can become decisive, and the most important role in it belongs to the correct selection of the scientific adviser. In connection with the foregoing, the purpose of this study was to evaluate the effectiveness of the discussion group at the Department of Otorhinolaryngology, depending on the individual characteristics of the scientific adviser, as well as the development and implementation of modern approaches to the formation of student motivation for in-depth development of the future profession. Annual reports on the work of the discussion group of the Department of ENT Diseases of the Kuban State Medical University from 2005 to 2022 were taken as a material for the study. We have identified three periods of 5 years in the work of the discussion group: 2005–2009, 2010–2014, 2018–2022, in each of which the role of scientific adviser was performed by different teachers. Evaluation of the effectiveness of the work of the discussion group was carried out by counting the number of students who visited the group, conducting a test control among former members of the group and residents who are not involved in the work of the discussion group, and determining the external activity of students. Also, in the article, we analyzed all the types of interaction we use with students. Our analysis showed that the effectiveness of the discussion group depends on the educational technologies used, and the role of the scientific adviser of the discussion group in shaping the student’s motivation for in-depth development of the future profession is decisive.

АКТУАЛЬНЫЕ ВОПРОСЫ РАЗРАБОТКИ ДОПОЛНИТЕЛЬНЫХ ПРОФЕССИОНАЛЬНЫХ ПРОГРАММ ДЛЯ СПЕЦИАЛИСТОВ С ФАРМАЦЕВТИЧЕСКИМ И МЕДИЦИНСКИМ ОБРАЗОВАНИЕМ

The paper deals with topical issues of developing additional professional advanced training programs for specialists in several specialties with a secondary pharmaceutical and medical education. For many years, postgraduate medical and pharmaceutical education provided for a one-time advanced training of specialists over a five-year period. At the same time, such a training format lasting, as a rule, 144 hours, hardly allowed the student to master a significant amount of relevant professional information accumulated by science and practice over the past five years. It is obvious that the current pace of development of domestic healthcare in general and pharmacy, in particular, the emergence and active use of innovative educational technologies, the existing need for pharmaceutical personnel to regularly receive updated and systematized professional knowledge could not but lead to the transformation of the previously existing model of postgraduate education. However, to date, two inextricably linked components of this process have been clearly defined: the introduction of continuing medical and pharmaceutical education and the accreditation of specialists. Moreover, in the current conditions, continuous education is becoming a necessary condition for the formation of a portfolio and admission to the accreditation procedure for a specialist, while accreditation serves as a fundamental licensing tool for professional activities. An active participant in the continuing medical and pharmaceutical education system are educational organizations that have been delegated the functions of developing and implementing additional professional advanced training programs. The purpose of this work was to popularize the experience of the Department of Pharmacy of the Kuban State Medical University of the Ministry of Health of Russia in the development of additional educational programs for specialists with medical and pharmaceutical education. The methodological basis for the process of developing a development of additional educational programs for specialists with medical and pharmaceutical education was the professional competencies presented in the Federal State Educational Standards in the specialty "Pharmacy", Nursing, Federal State Educational Standards "General Medicine", Federal State Educational Standards "Obstetrics" and labor functions given in the relevant professional standards. On the example of additional professional advanced training programs developed at the Department of Pharmacy of the Kuban State Medical University of the Ministry of Health of Russia, modern approaches are shown that allow harmonizing their content with the requirements of the Federal State Educational Standards for medical and pharmaceutical specialties with professional standards "Pharmacist", "Nursing Organization Specialist", "Nurse/Nurse Brother", "Midwife", "Nurse Anesthetist", "Paramedic".

Сardiorespiratory relationships in people of young age depending on the composite composition of the body

BACKGROUND: The decisive importance of the sympathetic and parasympathetic nervous system in maintaining vegetative homeostasis requires the determination of sensitive non-invasive parameters of multidimensional outpatient monitoring of cardiorespiratory adaptation under various physiological and clinical conditions, taking into account the function of external respiration (FER), compound body composition and heart rate variability (HRV).AIM: To identify concomitant changes in HRV, HR and compound body composition in young people as markers of cardiorespiratory adaptation and rehabilitation.MATERIALS AND METHODS: On the basis of the Kuban State Medical University, a single-centre, interventional, cross-sectional, single-sample, comparative, uncontrolled study of a general group of young people in which respiratory parameters and parameters of the compound body composition were determined. Some individuals in this group additionally underwent Holter monitoring of the electrocardiogram (ECG) at short intervals.RESULTS: In young people, a change in the compound body composition with an increase in total fat mass, visceral and body fat is associated with a decrease in respiratory function (a decrease in the Tiffno index, a decrease in the maximum middle-expiratory flow — MMEF), manifested by a decrease in HRV (according to the TI indicator), the absence of an increase in the autonomic regulation circuit (according to SDNN indicator), a decrease in parasympathetic activity (in terms of rMSSD) and the absence of sympathetic activation (in terms of SDANN). Positive shifts in the form of an increase in trunk muscles, the total amount of water and a decrease in the total fat mass are accompanied by an increase in lung capacity, forced expiratory volume in the first second and a change in HRV with sympathetic (in terms of LF / HF, SDANN) and parasympathetic activation (in terms of rMSSD), an increase in HRV (in terms of TI) and an increase in the autonomic regulation circuit of the vegetative nervous system (in terms of SDNN).CONCLUSION: Accurate and rapid diagnostics of vegetative homeostasis requires a comprehensive correlative analysis of the parameters characterizing HRV in short recordings, the compound composition of the human body and respiratory function.

Influence of immunity intensity to opportunistic infections on in vitro fertilization efficiency

BACKGROUND: The number of infertile couples and women seeking in vitro fertilization is on the rise worldwide. At the same time, the probability of pregnancy after one in vitro fertilization attempt is 2540%. Among the various causes of in vitro fertilization failure, the impact of opportunistic infections remains underestimated.
 AIMS: retrospective assessment of the dependence of the number of successful in vitro fertilization attempts on the intensity of immunity to opportunistic infections.
 MATERIALS AND METHODS: On the basis of the Clinic of the Kuban State Medical University, from January 2020 to March 2021, 865 women aged 26 to 48 years with infertility, included in the assisted reproductive technology program, were observed. Before the in vitro fertilization procedure, all patients were examined by enzyme immunoassay (ELISA) and polymerase chain reaction for the presence of herpesvirus infections (herpes infection, cytomegalovirus infection) and toxoplasmosis. The study included 79 people with unexplained infertility with a history of one to four in vitro fertilization cycles and positive antibody titers [IgG (+), IgM ()] to herpes simplex virus, cytomegalovirus, and toxoplasmosis. During the study, groups were formed depending on the presence of opportunistic infections and the number of unsuccessful in vitro fertilization attempts.
 RESULTS: During the study, a dependense was established between the number of in vitro fertilization attempts and the level of the initial (before pregnancy) IgG to toxoplasma. A negative prognosis for the effectiveness of in vitro fertilization is most likely in the presence of high titers of IgG to toxoplasma (370.057.0 U/ml). In the case of herpes infection, there was a tendency to increase the number of necessary in vitro fertilization attempts to 34 in the group with higher herpes simplex virus IgG levels. The baseline IgG cytomegalovirus level was not directly related to the effectiveness of the in vitro fertilization procedure.
 CONCLUSION: The study demonstrates the importance of determining the intensity of immunity to toxoplasma and herpes infection in preparation for in vitro fertilization, especially if there is a history of unsuccessful in vitro fertilization attempts or spontaneous abortion.

Influence of thermal vibration impact on the strength characteristics of composite materials used in dentistry

The article discusses the evaluation of the effectiveness of the influence of thermal vibration effects on the bending strength and surface hardness of composite filling materials.The study was conducted on the basis of the Department of Therapeutic Dentistry of the Kuban State Medical University, as well as at the Krasnodar Instrument Plant “Cascade”. The samples under study were made according to the group affiliation from three different composite materials: Estelite Sigma Quick, Filtek Bulk Fill Posterior Restorative and DentLight. The bending strength was evaluated on the “MIP-10” testing machine of the company “NPK TECHMASH”. Determination of the surface hardness according to Vickers was carried out on the device PMT-3 of the company “LOMO”.According to laboratory studies, a statistically significant increase in flexural strength and surface hardness according to Vickers was determined for all samples of composite materials subjected to thermal vibration before polymerization.The data obtained indicate an increase in the strength characteristics of composite filling materials as a result of thermal vibration exposure before their polymerization, which increases the service life of composite fillings and reduces the risks of secondary caries formation after filling.

Gender and age-specific eating behaviour in urban populations at risk of chronic noncommunicable diseases: an observational cohort study

Background. Nonrational nutrition is among main risk factors of chronic noncommunicable diseases (CNCDs) that can be contained via adopting and motivating population to a healthy diet by clarifying territorial, gender and age-specific eating behaviours.Objectives. A study of urban gender and age-specific eating behaviours associated with universal and metabolic CNCD risk factors.Methods. An observational cohort study has been conducted with 1,317 urban residents (657 men and 660 women) aged 18–74 years at Kuban State Medical University, Ministry of Health of the Russian Federation, using anonymous surveys on food preferences, tobacco and alcohol consumption, physical activity (PA), as well as physical examination, anthropometry, electrocardiography (ECG) and biochemical blood tests.Results. Urban residents revealed low-physical activity (PA) (88%), overweight and obesity (33%), high tobacco (65%) and alcohol use (39%) in men, high metabolic risk by waist/hip circumference (33.7%) and significant polymorbidity in hypertension (3 to 8 diseases per person). The urban dietary pattern can be described “intermediate” by the co-presence of rational and nonrational ingredients in diet. Rational ingredients prevailed in women and elderly people. Elevated total cholesterol, low-density lipoproteins, triglycerides, gamma-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, bilirubin, uric acid, urea, creatinine and ultra-sensitive C-reactive protein in blood were associated with foods intake like chips and breadsticks, potatoes, sweet drinks, confectionery and borscht.Conclusion. Adopting measures to rational nutrition in population may comprise a clear declaration of dysmetabolic nature of specific foods, eating behaviour monitoring and motivated self-control of body mass index and waist girth beyond medical check-ups.

National multicenter prospective observational study “The role of concomitant diseases in poSTOPerative complications RISK stratification — STOPRISK”: study protocol

INTRODUCTION: Advances in modern anesthesiology have significantly reduced the risk of anesthesia compared to the last century, however, the level of perioperative in-hospital mortality after elective major abdominal surgery is still high at the moment. Poor outcome prediction is the cornerstone of individualized perioperative management of high-risk patients aimed at preventing complications. Despite the fact that a large number of risk assessment tools have been developed over the past decades, the accuracy of the forecast is still far from required. According to the literature data, models based on the study of risk factors in the national population of patients, of which comorbidities make the greatest contribution, have the greatest accuracy. MATERIALS AND METHODS: Design: prospective observational study. Setting: National multicenter study of patients in surgical hospitals. Patients: Patients undergoing abdominal surgery. Interventions: Not provided. RESULTS: The developed design was registered in the ClinicalTrials.gov database, a study organized by the Federation of Anesthesiologists and Resuscitators of Russia in cooperation with the Kuban State Medical University has now begun, 38 centers are participating in it, two papers have been published based on the results of an interim analysis. CONCLUSIONS: The study is of great scientific and medical and social importance, as a result of the analysis of the data obtained, the role of concomitant diseases in the development of an adverse outcome will be studied and a national risk assessment model will be developed.

ПРИВЕРЖЕННОСТЬ СТУДЕНТОВ С РАЗНОЙ САМООЦЕНКОЙ СОСТОЯНИЯ ЗДОРОВЬЯ К ЗАНЯТИЯМ ФИЗИЧЕСКИМИ УПРАЖНЕНИЯМИ

Significance. Regular physical activity strengthens health and improves well-being, therefore, increasing commitment to physical activity among population is rather relevant. Students of medical universities will become guides to a healthy lifestyle for their future patients, which implies their commitment to regular physical activity. Personal interest in promoting health through physical exercises presumably depends upon the health status of students. Purpose: to analyze commitment to physical exercises among students with different self-assessment of health. Material and Methods. The analysis of 1732 questionnaires collected during the survey of students of the Kuban State Medical University was carried out. Responders included 25.7% of young males, 35.0% of the first-year students and 11.9% of the sixth-year students. The average age of males and females is the same (21.9 years). The analysis of commitment to physical exercises was carried out among all respondents in general and with a breakdown on gender, year in the University (first and sixth year students), health self-assessment (“good health and very good” and “bad health and very bad”), self-assessment of the concern for health (“I care a lot” and “I care little or not at all”), and presence of chronic diseases (yes/no). The Chi-square test was used to compare distribution of different opinions. Conclusion. Commitment to physical exercises among students is associated with health self-estimation rather than the state of health. The state of health increases motivation to exercise only among a small share of students with poor health. Awareness of the impact of physical activity on the risk of chronic diseases is not sufficient to increase commitment of the young people to exercise, sports or fitness. The highest impact on the commitment is made by the "fashion trend" for a healthy lifestyle. Students who define their state of health as good are more concerned about their health and significantly more often practice regular physical activity of high intensity. For young males with good health social contacts are more significant in physical exercises both in comparison with females who define their state of health as good and in comparison with young men with lower self-estimation of health. For students with low health self-estimation, the main incentive for physical activities, sports or fitness is the desire to look better. Doctor's recommendations are a twice more effective incentive for females compared to males.