Medical Academy Research Articles

Exploring the characteristics of successful prehospital trauma care teams: Insights from military trauma care simulations.

Trauma care teams play a crucial role in determining the outcomes of trauma victims. The composition and training of these teams can vary. Our study seeks to examine the characteristics of successful military Advanced Life Support (ALS) teams and the factors that affect them. A retrospective study was conducted at the Israel Defense Force (IDF) Military Medical Academy throughout 2021, where prehospital medical teams were observed in trauma care simulations. Teams were led by ALS providers (military physicians or paramedics) trained in IDF Military Trauma Life Support. Demographic and training data were collected. Teams were categorized into high or subpar performance groups based on simulation scores. Specific skills were assessed by trauma instructors using a points system. Scores were compared between the groups and analyzed for correlations with demographic and training data. Overall, 63 team simulations were analyzed, with teams led by a military paramedic in 78% of simulations. The mean overall simulation performance was 81% ±6.2, and there were no differences in scores of single or multicasualty simulations. A total 3% of the teams achieved successful results and were more likely to have a paramedic as the ALS provider ( p = 0.028). A sensitivity analysis excluding physicians was conducted and showed that high-performance teams had significantly higher skill assessments for primary survey ( p = 0.004), injury recognition ( p = 0.002), exposure ( p = 0.006), adherence to clinical practice guidelines ( p = 0.032), and medical device use ( p = 0.002). Our study found that ALS provider is associated with overall simulation performance in prehospital ALS teams, with military paramedics more likely to be successful. These findings have implications for the training and staffing of prehospital ALS teams, suggesting that teams should be composed accordingly and that training should focus on skills affected by the ALS provider type. Prognostic and Epidemiological; Level IV.

Comparative Analysis on Clinical Characteristics Among Patients with Acute Hepatitis A Virus (HAV) and Patients with Acute Hepatitis E Virus (HEV): A Single-Center Retrospective Study from Bulgaria.

The acute viral hepatitis was one of the most common conditions in daily clinical practice varying in different parts of the world. The aim of the present study was to perform a comparative analysis on clinical characteristics among patients with acute hepatitis A virus (HAV) infection and patients with acute hepatitis E virus (HEV) infection admitted to the Military Medical Academy (MMA), Sofia, Bulgaria. A retrospective study was performed at MMA, between 1 January 2016 and 31 December 2021. The etiological diagnosis was confirmed by enzyme-linked immunosorbent assay (ELISA) HAV/HEV IgM serology assays. The current survey included 231 patients with mean age 45.11 ± 16.08 years (95% confidence interval: 43.04-47.19). According to the case definition, inclusion and exclusion criteria, persons were divided into two groups: patients with acute HAV infection (68.4%; 158/231) and patients with acute HEV infection (31.6%; 73/231). Males with HEV had 3.091 times the odds of comorbidity "hypertension" than males with HAV (p = 0.032). There were almost equal odds of increased ALT (odds ratio = 0.999; p = 0.003) in men with HEV and men with HAV. Females with HEV had 5.161 times the odds of comorbidity "hypertension" compared with females with HAV (p = 0.049). We found almost equal odds for elevated ALT in women with HEV and women with HAV (OR = 0.999; p = 0.025). In the non-elderly group (<60-year-old), HEV individuals had 4.544 and 10.560 times the odds of comorbidities "hypertension" and "cardiovascular diseases" compared with HAV patients (p < 0.05). We found almost equal odds for elevated ALT in HEV patients and HAV participants (OR = 0.998; p = 0.002). The results from the current study may support the physicians daily care for patients with acute HAV and acute HEV.

Ex vivo STUDY OF THE ACTION OF INTEGRIN RECEPTORS ANTAGONIST FROM ECHIS MULTISQUAMATIS SNAKE VENOM ON PLATELETS OF PREGNANT WOMEN WITH COMPICATIONS DURING GESTATION

Aim. In our work, we studied platelet aggregation in blood plasma of pregnant women and estimated the possibility of ex vivo normalization of aggregation rate using a polypeptide from the Echis multisquamatus snake venom. Previous reports demonstrated that it directly interacts with glycoprotein IIb/IIIa receptors on the surface of platelets, preventing their adhesion, thereby affecting the degree of aggregation. Methods. chromatography followed by size-exclusion chromatography on Superdex 75 using the FPLC system (ӒKTA, GE Healthcare, USA). Analysis of molecular weight of protein components was performed using SDS-PAGE. The concentration of protein was measured using spectrophotometer Optizen POP (Korea) at 280 nm. The ability of obtained protein to inhibit platelet aggregation was measured directly by aggregometry. Blood samples of women with placental disfunction during pregnancy (n = 28) were kindly provided by “Perinatal Center of Kyiv”. This study was approved by the Ethics Commission of the Shupyk National Medical Academy of Postgraduate Education and the Ethics Commission of the Kyiv Perinatal Center (# 3 from 05/05/2020). Aggregation of platelet-rich plasma (PRP) induced by ADP was investigated using aggregometry on the AP 2110 (Solar, Belarus). We compared the rate of platelet aggregation in the presence vs absence of platelet aggregation inhibitor. Results. Two-step chromatography protocol allowed us to obtain the polypeptide from the venom of Echis multisquamatus that possessed the anti-aggregatory action. SDS-PAGE analysis confirmed the homogeneity of obtained polypeptide with apparent molecular weight 14 kDa that corresponds to the platelet aggregation inhibitor reported earlier. Initial studies of ADPinduced platelet aggregation allowed selecting active concentration for the effective inhibitory action as 0.02 mg/ml. Conclusions. Platelet aggregation inhibitor from Echis multisquamatis snake venom of can be assumed as the effective agent that reduce the rate of platelet aggregation. We demonstrated it efficacy in platelet rich plasma of pregnant women that had placenta dysfunction. The use of direct antagonist of platelet integrin receptors was assumed as the prospective approach for suppressing of platelet reactivity in particular during complicated pregnancy.

Academician Vladimir Ivanovich Burakovsky (1922–1994) (on the 100&lt;sup&gt;th&lt;/sup&gt; anniversary of his birth)

Professor Vladimir Ivanovich Burakovsky was born on August 20, 1922 in Tiflis (Tbilisi). In 1940, Vladimir entered the Tbilisi Medical Institute. In 1947, V. I. Burakovsky was enrolled in a clinical residency at the Department of Faculty Surgery № 2 (since 1955 – Department of Surgery for Advanced Doctors № 1) Military Medical Academy named after S. M. Kirov in Leningrad. In the spring of 1960, Vladimir Ivanovich was accepted as a senior researcher at this Institute and appointed the head of the Department of Surgery of the heart and blood vessels in children. Vladimir Ivanovich was the author and co-author of more than 500 scientific papers, including 15 monographs: on the issues of pathophysiology, clinic, diagnosis and surgical treatment of congenital and acquired heart defects and major vessels, heart diseases in young children, complications after open heart surgery, surgery of complex congenital defects and coronary heart disease, heart defects with pulmonary hypertension, the use of hyperbaric oxygenation in cardiac surgery, surgical treatment of coronary disease, heart transplantation in experiment, history and philosophy of cardiac surgery. In 1970, «for the best scientific work on thoracic surgery», Vladimir Ivanovich was awarded the title of laureate of the S. I. Spasokukotsky Prize of the USSR Academy of Medical Sciences (together with B. A. Konstantinov). Academician Vladimir Ivanovich Burakovsky died on September 22, 1994 in Moscow and was buried at the Kuntsevo cemetery. The Institute of cardiac Surgery of the Federal State Budgetary Institution «A.N. Bakulev National Medical Research center of cardiovascular Surgery» (A. N. Bakulev NMRcVS) of the Ministry of Health of the Russian Federation bears his name, in which a bust of his creator is installed.

Simulation training in the tashkent medical academy

Doctors should acquire practical skills before applying clinical situation on patients in simulation departments equipped with high-tech simulators and computerized mannequins, computer games and programs that allow simulating clinical and organizational situations. One of the prerequisites for the implementation of this invention is the creation of modern simulation centers. The article deals with the problems that need to be solved for the successful and effective use of simulation training in vocational education. The chronology of medical modeling is given, in which there are many thousands and inextricably dangers with the possible development of knowledge, the progress of scientific and technological progress and military orders.

Professor Anatoly Alekseevich Kurygin (1932–2011) (to the 90th anniversary of the birth)

Anatoly Alekseevich Kurygin was born on September 10, 1932 in the village of Zaborye, Solotchinsky District (now Ryazansky District), Ryazan Region, into a peasant family. In 1950, Anatoly Kurygin graduated from the Solotchinsk complete secondary school with excellent and good marks and applied for admission to the Ryazan Medical Institute. A. Kurygin decided to become a surgeon already at the beginning of his studies at the Institute and persistently went to achieve this goal. After graduating from the 4th year, Anatoly Alekseevich, along with other most successful students, received an offer to continue the study at the Military Medical Faculty at the Kuibyshev Medical Institute named after D. I. Ulyanov, agreed and joined the ranks of the Soviet Army. In July 1956, having received a diploma with honors, lieutenant of the medical service A. A. Kurygin, together with his wife Lyudmila Nikiforovna, departed for the Belarusian Military District. In April 1961, having got the highest grades (five) in the entrance exams, Anatoly Alekseevich was enrolled in the postgraduate course at the Department of Faculty Surgery named after S. P. Fedorov. As a dissertation research, Anatoly Alekseevich was instructed to study the state of lavsan prostheses and a new vascular bed at different times after arterial alloplasty. Soon after defending his dissertation, V. M. Sitenko suggested Anatoly Alekseevich to take up the issue of chronic pancreatitis, which was little studied at that time. During the year, A. A. Kurygin studied the literature on this topic and came to the convincing conclusion that it was impossible as a doctoral dissertation. Anatoly Alekseevich reported his thoughts to the head of the department, substantiated the futility of this topic and expressed a desire to study the physiological and surgical aspects of vagotomy as a new and alternative method of gastric resection for the treatment of chronic duodenal ulcers and its complications. In June 1978, the deputy head of the department, associate professor A. A. Kurygin, successfully defended the first doctoral dissertation in the USSR on the treatment of duodenal ulcers by vagotomy in combination with pyloroplasty. Five years later, in November 1987, professors of the Military Medical Academy V. M. Sitenko, A. A. Kurygin and A. I. Nechay, as part of a group of surgeons from Moscow, Kyiv and Tallinn, were awarded the title of Laureate of the USSR State Prize «For the development and implementation of new methods of treatment of peptic ulcer». In 1985, Professor A. A. Kurygin was appointed head of the Department of Surgery № 2 (for advanced medical training) of the Military Medical Academy. Anatoly Alekseevich was the author and co-author of more than 300 scientific papers, including 39 monographs and manuals, more than 25 teaching aids, 14 inventions, as well as the editor of the Abdominal Surgery section of the Small Medical Encyclopedia. Also, A.A. Kurygin published three collections of poetry. On November 12, 2011, after a severe and prolonged illness, the doctor Anatoly Alekseevich Kurygin was no longer with us. Major-General of the Medical Service A. A. Kurygin was buried on November 15 at the Serafimovsky cemetery in St. Petersburg.

Exploring medical students’ perceptions of family medicine in Kyrgyzstan: a mixed method study

BackgroundDespite knowing that health systems with strong primary care improve overall health outcomes within a population, many countries are facing a global trend of declining interest and shortage of family doctors. This is the case of the Kyrgyz Republic, in which rural areas are struggling to attract and retain family medicine (FM) doctors. This study aims to explore how Kyrgyz medical students perceive FM and the factors that influence their specialty choice.MethodsThis study used a cross-sectional explanatory sequential design, including quantitative survey and focus group discussions that were carried out at the Kyrgyz State Medical Academy (KSMA) in Bishkek in 2017. Overall, 66% (953 out of 1449) of medical undergraduate students registered in year 1, 4 and 6 completed the survey, and 42 participated in the focus groups. The results were organized around 7 factors influencing perceptions and attitudes towards FM identified through a qualitative systematic review.ResultsThe interest of Kyrgyz students for FM was the lowest of all specialties. Access to high medical technologies, career opportunities, salary, patient interaction and possibility to work abroad were the five most important factors influencing specialty choice. FM was perceived as a difficult profession, yet with poor prestige, insufficient remuneration, limited career possibilities and poor working conditions, especially in rural areas. The academic discourse, which disregards FM specialty had a negative influence on student’s perceptions and prevented students’ ability to identify with the practice of family medicine. However, students’ awareness of their social accountability arose as a positive leverage to increase the choice of FM, provided other problems were solved.ConclusionThis study highlighted key factors responsible for the low number of students choosing to become FM in Kyrgyzstan. The first major factor, presumably specific to many low- and lower-middle- income countries was the poor working conditions in remote areas. The second factor, common to many countries, was the distorted image of FM and its specialty transmitted through the medical schools’ institutional culture which does not value FM through positive role models. This study served as a basis to establish a strategy to promote FM within the KSMA and potentially at National level.

Biological and functional properties of human umbilical cord-derived lyophilized tissue-engineered matrices

The use of tissue-engineered products (TEP) from decellularized extracellular matrix (dECM) to treat deep skin lesions is a tissue engineering method that promotes regenerative healing. Cell-free preparations reproduce the hierarchical complexity of tissues, mimic structural, biochemical and mechanical signals that are necessary to attract cells, and are a source of bioactive molecules. The human umbilical cord biomaterial has a fetal phenotype with extra-embryonic origin, and therefore is available and has no ethical limitations in its use. The tissue engineering laboratory at Kirov Military Medical Academy developed and patented a TEP from the highly regenerative human umbilical cord in the form of matrix and hydrogel matrix. To study its regenerative potential, lyophilisates of tissue-engineered solid-state and hydrogel matrices were implanted around mini pig fullthickness wounds in vivo. The external signs of inflammatory response and the histological images of biopsy specimens from the lyophilizate implantation areas were analyzed. The effect of nutrient media, «conditioned» with lyophilizates of both matrices, on the viability and migration activity of fibroblast-like cells, isolated from mini pig skin, was investigated. The matrix lyophilisates showed good biocompatibility and bioactivity in in vitro and in vivo experiments. Implantation of the samples promoted faster formation of mature epidermis compared to the control.

OUR EXPERIENCE IN SURGICAL TREATMENT OF PATIENTS WITH INJURIES OF THE ORBITAL FLOOR WITH COMBINED INJURIES OF THE FACIAL SKELETON

Under our supervision there were 117 patients with fractures of the inferior wall of the orbit on the basis of the department of plastic surgery and the department of neurosurgery of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2019 to 2022. Surgical treatment of zygomatic-orbital complex injuries and isolated injuries of the lower wall of the orbit was performed according to the technique developed by us, observing a number of features depending on the severity and localization of injuries, as well as the timing of the surgical intervention using modern information technologies. A method for eliminating post-traumatic defects in the walls of the orbit, including performing computer preoperative planning, manufacturing an implant, determines the indications and contraindications for surgery, low-traumatic access to the damaged area, in addition, it also helps to reduce postoperative complications by 2.4 times, resulting in a reduction in the period of functional adaptation of patients in 1.6 times.

I.P. Pavlov as an experimental pharmacologist (to the 275th anniversary of the Department of Pharmacology of the Military Medical Academy)

The work is devoted to the formation of pharmacology as a science within the walls of the Medico-Surgical Academy, founded in 1798. The main purpose of the work is to sanctify the activities of the famous Russian physiologist and naturalist I.P. Pavlov in the field of experimental and clinical pharmacology, performed mainly in the early period of his work at the Medico-Surgical (Military Medical) Academy (1879-1895). The scientific publications of I.P. Pavlov in this area, mainly works on the use of bitterness as appetite stimulants, herbal preparations of cardiotonic action obtained from Adonis vernalis, lily of the valley, hellebore, the use of caffeine and bromine preparations for the treatment of neuroses were analyzed. In addition to scientific activity, the formation of I.P. Pavlov as a lecturer, his features of teaching, the introduction of demonstrations of experiments on animals during lectures, explanation of the mechanisms of reproducible physiological and pharmacological phenomena were described. The implementation aspect of the theoretical developments of I.P. Pavlov in practical medicine was revealed as well.

Effects of fullerene C60 with antihypoxants

BACKGROUND: Drug improvement is often carried out with the help of chemical modifications that improve the receptor action or transport of drugs to their target tissues.&#x0D; AIM: The aim of this study was to investigate the effect of combinations of C60 fullerene with amtizol, 2-amino-4-acetylthiazolo[5,4-b]indole, metaprot, metaprot base, and rutin on antihypoxic activities in a model of acute hypoxia with hypercapnia.&#x0D; MATERIALS AND METHODS: Several compounds with mono-, bi-, and tricyclic structures were examined separately or combined with C60 fullerene. All compounds, except for rutin, were synthesized at the Department of Pharmacology of the S.M. Kirov Military Medical Academy and contain active amino groups, nitrogen, and sulfur atoms in the cycles: amtizol (3,5-diamino-1,2,4-thiadiazole), VM-606 (2-amino-4-acetylthiazolo[5,4-b]indole), Metaprot (2-ethylthiobenzimidazole hydrobromide monohydrate), and Metaprot base. All compounds demonstrated antihypoxic activity. Hypobaric hypoxia was simulated in a flow pressure chamber by lifting animals to a height of 10,000 m at a speed of 50 m/s and exposure for 60 min. The preparations were administered intraperitoneally 60 min before the experiment. The protective effect was evaluated by the average life expectancy at altitude. Hypoxia with hypercapnia was assessed on male white mice weighing 2022 g, which were placed in 200 mL glass jars with hermetic lids, which were lowered under water to prevent air leakage. The studied preparations and their complexes with fullerene in the form of a thin suspension with Tween-80 were administered intraperitoneally min before hypoxia. The lifespan of the animals was recorded.&#x0D; RESULTS: The formation of the complex and its properties depend on the development of a donoracceptor bond between the drug and fullerene. An increase in the bioavailability of amtizol in the form of a complex with C60 fullerene increased the antihypoxic activity of the mixture by 40%. For the first time, dynamic curves of the activities of amtizol and 2-amino-4-acetylthiazolo[5,4-b]indole depending on time were obtained in a model of hypercapnic hypoxia.&#x0D; CONCLUSION: Fullerene C60 enhances the antihypoxic activity of the studied compounds due to an increase in the bioavailability of the antihypoxant caused by the microporation of tissue membranes due to the action of fullerene C60.

Olympiad movement as a method of training high-level professional competencies

This paper shows the influence of students’ participation in the Olympiad movement in internal medicine on the development of their competencies. On the basis of the Department of Hospital Therapy and Endocrinology of the Chita State Medical Academy, an intra-university Olympiad in internal medicine was held for sixth-year students. We assessed the level of effectiveness of the competence-based approach as part of the active implementation of the Olympiad movement. This paper shows that participation in the Olympiad movement allows students to master a high level of competencies, form a clearer idea of the profession, which in the future makes it possible to prevent professional incompetence.

The problem of open and tension pneumothorax at the prehospital stage of emergency care and prospects for its solution

The purpose of the study is experimental testing of Russian medical devices for the elimination of tension and open pneumothorax.Objectives of the research. Perform an analysis of the volume of therapeutic measures in the wounded and injured with open and tension pneumothorax. Conduct experimental testing of Russian samples to eliminate tension and open pneumothorax.Materials and methods. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the war surgery department of the Kirov Military Medical Academy in the period from 2015 to 2019. An experimental study was carried out on large biological objects (pigs) to evaluate the effectiveness of eliminating open and tension pneumothorax using products from the UD-02f (paramedic) kit.Results. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the clinic in the period from 2015 to 2019 was carried out. The incidence of tension pneumothorax was 11.6%. In 44.4% of cases, it was eliminated; in 55.6% of the ambulance teams, tension pneumothorax was not eliminated. Open pneumothorax was diagnosed in 21.1% of those admitted at the prehospital stage. In all cases, the elimination of open pneumothorax was carried out by applying an improvised sealing bandage to the chest. An experimental study of the effectiveness of the UD-02f set showed that the use of products included in this set allows to effectively eliminate the life-threatening consequences of wounds and chest injuries.Conclusion. Open and tension pneumothorax are severe life-threatening consequences of chest injuries with a development rate of up to 12.1% and 11.6%, respectively. The inclusion of a set for eliminating tension and open pneumothorax disposable, sterile (paramedical) UD-02f, in the complete equipment and training of medical personnel in the procedure for its use, will allow timely and effective elimination of tension or open pneumothorax at the prehospital stage of emergency medical care.

Analysis of the factors which may have influenced the incidence of congenital malformations in children born in the province of Warmia and Mazury between 1999 and 2000

&lt;b&gt;Introduction.&lt;/b&gt; Congenital malformations have been known about for ages, but the reasons for their development have always been shrouded in mystery. All efforts to explain such reasons as to relating to the natural forces of God’s revenge have not stood the test of time. Still, the knowledge concerning the aetiology of malformations is not complete; we know, however, about many factors which may contribute to their development during various stages of embryogenesis. &lt;b&gt;Aim.&lt;/b&gt; The aim of this paper is the analysis of specific factors which may have contributed to the development of congenital malformations in children born in the Province of Warmia and Mazury between the years 1999 and 2000. &lt;b&gt;Materials and methods.&lt;/b&gt; The author of this paper, who is involved in the creation of the Polish Register of Congenital Malformations (PRCM), evaluated case records of newborns who had been reported to have been born with congenital malformations. The data recorded in this Register, maintained by the Chair and Department of Medical Genetics at the Medical Academy (at present Medical University) in Poznań, was verified by specialists, and later analysed according to the methodological principles of this work. The analysis included: fetal age and birth weight, mother’s age and education, as well as mother’s place of residence. Statistical analysis was carried out by means of Statistica v.6.1 software. &lt;b&gt;Results and discussion.&lt;/b&gt; Congenital malformations were found in 276 boys, with a malformations incidence factor of 166.8/10000 for boys, and in 212 girls, the malformations incidence factor being 136.2/10000 for girls. The higher incidence of congenital malformations in boys was caused by a nearly 10 times higher incidence of urinary system defects. The incidence of congenital malformations in newborns whose mothers resided in cities amounted to 132.9/10000 of newborns born in cities. The incidence of congenital malformations in newborns of mothers residing in the country was 141.9/10 000 of newborns born in the country. It was also noted that the incidence of congenital malformations was 2–3 times higher in children with low birth weight in comparison to the general population. The highest incidence of congenital malformations was found in those children whose mothers were 35 years of age or older at the time of giving birth. Advanced maternal age was the most significant factor in the development of malformations caused by chromosome aberrations. Creating a district map presenting the incidence of malformations may be the first step to further research concerning those specific geographical regions at high risk of congenital malformations. The highest incidence, irrespective of the type of malformation, was observed in the districts of: Mrągowo, Ostróda and Braniewo, whereas the lowest was found in the districts of: Ełk, Olecko and Gołdap, and Giżycko. &lt;b&gt;Conclusions.&lt;/b&gt; Having analysed all pertinent data, it was then concluded that: 1. Male sex correlates with the incidence of congenital malformations of the genitals. 2. Low birth weight correlates with an increased incidence of congenital malformations. 3. The incidence of congenital malformations in particular districts is diversified, pointing to the significance of necessary further research in order to identify those specific geographical locations having the highest malformations incidence factors.

The most privy of all privy councilors in the Russian Empire: To the biography of Vyacheslav Avksentievich Manassein (1841-1901)

The article, on the basis of archival documents introduced into scientific circulation, considers personality of prominent Russian physician Vyacheslav Avksentievich Manassein (1841-1901), who held the position of professor of the therapeutic Chairs of the Medical Surgical Academy in 1875-1892. The Manassein's public activity had special character, reaching All-Russian scale owing to the weekly "The Physician" published by him in 1880-1901. The article considers various aspects related to the scientific school of S. P. Botkin. For the first time, it is reported about the facts shedding light on complicated relationship of S. P. Botkin with his student V. A. Manassein.

The Centenary of the Birth of Professor Georgy I. Dorofeev

The article is devoted to one of the leaders of the Leningrad school of gastroenterologists of the second half of the last century. For almost two decades, he headed the oldest department of the Military Medical Academy — the Department of Hospital Therapy, turning it into one of the famous gastroenterological centers of the country of that period. The author offers the reader the complete biography of this famous scientist. One of the most important scientific merits of G.I. Dorofeev is the creation of an original scientific internist school. Many followers of it headed and continue to head the leading scientific centers of the country.

Predictive modeling of adverse events of tamoxifen therapy for breast cancer (results of a cohort study)

Relevance. Endocrine therapy is the standard treatment for women with ER-positive breast cancer. The clinical response to Tamoxifen is variable. Approximately 30 % of patients with breast cancer will have a recurrence of the disease within 15 years after treatment, despite ongoing endocrine therapy. This article presents the results of a prospective pharmacogenetic cohort study. The study was conducted in 2018–2019. Aim. To analyze adverse drug reactions to Tamoxifen in the adjuvant regimen in breast cancer patients in relation to the carriage of genetic polymorphisms of genes encoding cytochrome P450 enzymes and drug transporter proteins and to build predictive models based on them. A comparative analysis of the relationship between genetic and non-genetic determinants with adverse events on tamoxifen therapy allowed us to build predictive models of their development. Materials and Methods. The study involved 120 women with pre- and postmenopausal breast cancer who underwent genetic testing for CYP and Pg enzyme gene polymorphisms. Entry criteria: a histologically confirmed diagnosis of breast cancer, taking Tamoxifen at the recommended doses, establishing a diagnosis not earlier than 2007, and obtaining informed voluntary consent to participate in the study. Allelic variants were determined using real-time polymerase chain reaction in the Research Institute for Molecular and Personalized Medicine of the Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation. Results. An associative analysis showed their association with the development of adverse drug reactions (ADR) to Tamoxifen, indicating the clinical significance of different genetic polymorphisms of CYP2D6, CYP3A5, CYP2C9 and ABCB1. The complex associative analysis performed using mathematical modeling made it possible to build predictive risk models for the development of such ADR, such as hot flashes, dyspepsia, bone pain, and asthenia. The resulting regression models were statistically significant (p &lt; 0,001) and demonstrated high diagnostic efficiency. This allows them to be implemented in clinical practice. Conclusion. Thus, models that include both genetic and non-genetic determinants of response may further improve the prediction of individual response to tamoxifen

ВЛИЯНИЕ САРКОПЕНИИ НА ТЕЧЕНИЕ И ПРОГНОЗ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Purpose of the study: to evaluate and compare the main anthropometric, echocardiographic parameters and survival between a group of patients with chronic heart failure (CHF) and sarcopenia and a group of patients with CHF without sarcopenia. Materials and methods: 69 patients with chronic heart failure were examined, who were divided into two groups during the examination. The main group (n=36) is represented by patients with chronic heart failure (CHF) and sarcopenia. Patients with CHF without sarcopenia (n=33) were studied as a control group. The study was conducted on the basis of the Department and Clinic of Hospital Therapy of the Military Medical Academy named after S.M. Kirov. (St. Petersburg). The indicators were re-evaluated after 12 months. Evaluation of indicators in dynamics after 12 months was carried out taking into account the withdrawn patients. Results and Discussion: During the study, a statistically significant intergroup difference was demonstrated. Thus, patients in the CHF and sarcopenia group significantly differ in lower anthropometric parameters such as height, weight, muscle mass and strength compared to the control group. At the same time, analyzing the indicators of the morphofunctional state of the heart according to echocardiography data, it was demonstrated that there was a statistical decrease in the ejection fraction in dynamics after 12 months in the main group compared to the control group. However, no differences were found at baseline. Survival of patients in the CHF group without sarcopenia is higher than in the group of patients with CHF and sarcopenia. There were no intergroup differences in the causes of death. Conclusion: As a result of the assessment and intergroup comparison, data were obtained indicating a statistically significant effect of sarcopenia on such anthropometric indicators as height, weight, muscle mass and strength. In addition, in the main group there was a statistically significant decrease in the ejection fraction in dynamics after 12 months compared with the control group. The survival rate of patients with CHF and sarcopenia is lower than in the group of patients with CHF without sarcopenia.

Обізнаність законних представників пацієнтів із дитячим церебральним паралічем про е-інструменти щодо контролю та моніторингу доступності лікарських засобів

In October 2020, the Association of palliative and hospice care together with the Department of Organization and Economics of Pharmacy of Shupyk National medical academy of postgraduate education have conducted a survey on awareness of parents and relatives of seriously ill children with cerebral palsy (CP) about online tools for control and monitoring availability of drugs. The study found that the vast majority of parents and relatives of seriously ill children with cerebral palsy are unaware of this resource and do not use it to check the availability of drugs. The level of ignorance of parents in Kyiv and other regions is generally the same (around 95%). The survey of the administration of NGOs (8 respondents), which on the basis of their Statute provide activities to protect the rights and interests of children with cerebral palsy in these areas, have shown that most of them (6 respondents) also do not use e-tools in their activities. The Association of palliative and hospice care is planning educational work in this direction. The purpose of such activities should be capacity building and social mobilization of citizens. No conflict of interests was declared by the authors.

Historical aspects of water quality control in Russia. To the 150th anniversary of the first Zemstvo sanitary station and the 100th anniversary of the establisment of the State sanitary epidemiological service (literature review)

The purpose of this study was to investigate the history of water quality control in Russia in connection with the 150th anniversary of the establishment of the first Zemstvo sanitary station and the 100th anniversary of the publication of the Decree of the Council of People’s Commissars “On sanitary authorities of the Republic”. A historical retrospective analysis of publications was carried out using the database of the Russian Scientific Electronic Library eLibrary.Ru, integrated with the Russian Science Citation Index (RSCI), and reports from the collections of the scientific library of the Military Medical Academy named after S.M. Kirov. The data on the creation of the first Perm Zemstvo sanitary station in Russia and the conduct of original scientific research on the use of chemical and bacteriological methods of water quality control in it are presented. The achievements of Russian scientists in the field of establishing sanitary protection zones of water sources and the role of oil pollution of rivers are shown. The significance of the Decree of the Council of People’s Commissars “On sanitary bodies of the Republic” issued in 1922 in the legislative regulation of drinking water quality is determined. The activity of the bodies of the sanitary service of the Red Army to ensure adequate water supply in order to preserve the combat capability of the troops during the Great Patriotic War has been studied. A list of regulatory documents determining the quality of drinking water from 1945 to 2021 is presented, an analysis of new modern methods of quality control is carried out, the main requirements for which are expressiveness, reproducibility, accessibility. Conclusion. The creation of the first Zemstvo sanitary station and the State Sanitary Service in Russia served as the basis for the development of methods for monitoring the quality of drinking water, which went from the initial methods of assessing organoleptic indicators to the use of quantitative standards and the creation of innovative high-tech methods for studying it.