Prophylactic Examination Research Articles

Economic analysis of implementing Systemic Coronary Risk Estimation (SCORE2) scale and long-term consequences

Objective: to assess the demand for pharmacotherapy in risk groups on adverse cardiovascular (CV) events identified during prophylactic medical examination of the adult population according to the SCORE2 (Systemic Coronary Risk Estimation) scale, which is being introduced into clinical practice.Material and methods. To analyze the economic consequences of including diagnostic examinations to assess the risk by SCORE and SCORE2 scales, a Markov model was developed, which described the course of lipid metabolism disorders in adult patients aged 40 to 69 years without concomitant diseases identified during prophylactic medical examination. The model cycle was 2 months (the average waiting time for response to therapy); the modeling horizon was 3 years; the calculated values were estimated for the period 2024–2026. The economic analysis of long-term consequences involved calculating the cost of pharmacotherapy and the costs associated with CV events at outpatient and inpatient stages of medical care. The costs of drug therapy were determined based on dosage regimens presented in instructions for medical use in Russia, and clinical guidelines.Results. According to the modeling results, in the period 2024–2026, the administration of pharmacotherapy to reduce the risks of CV events will enable to achieve 23,224 potentially saved lives through exclusively government funding or 23,605 through mixed sources of funding (government and citizens’ own funds). The cost of the analyzed pharmacotherapy upon the introduction of the SCORE2 scale will be from 50.18 billion rubles (with government funding) to 318.14 billion rubles. Concurrently, pharmacocorrection will provide a reduction in the costs of inpatient treatment and outpatient medical services to 4.1 billion rubles due to the achieving of intended low-density lipoprotein level, and 1.6 billion rubles due to the achieving of intended triglyceride levels.Conclusion. Using new SCORE2 scale may lead to changes in the practice of prescribing lipid-lowering prophylaxis of CV diseases, as well as to a sharp increase in the number of patients who may require earlier prescription of pharmacotherapy to prevent CV events.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Prevalence of Age-related Macular Degeneration among Elderly Bulgarian Population

Age-related macular degeneration (AMD) is the leading cause of blindness worldwide in an older patient population with the highest risk of disease development in individuals older than 65 years. This study aims to estimate the prevalence of AMD and its stages among the elderly population of Sofia city. An observational study among elderly Sofia citizens, held as prophylactic ophthalmological examinations was performed. The participants underwent full ophthalmic examination including autorefractometry, noncontact tonometry, best-corrected visual acuity measurement, biomicroscopy, and indirect ophthalmoscopy through a dilated pupil. Optical coherent tomography was performed in cases with difficulties to determine the stage of AMD or when the visual acuity did not correspond to the ophthalmoscopy findings. All participants were asked to fill in informed consent and a specifically structured questionnaire based on the modified Wolffson LVQOL questionnaire that was previously used in the study in Eastern Bulgaria (in 2014 by Nencheva). Overall 700 patients, with a median age of 74 years (69 to 96 years) met the inclusion criteria and were enrolled in the study. The prevalence of AMD, early, intermediate and late AMD was estimated as 26.1%, 14%, 6.6%, and 5.6%, respectively. Age was strongly associated with the prevalence of AMD and its stages. The ageing of the population in Bulgaria and worldwide and the large proportion of elderly persons, affected by AMD, emphasize the necessity of regular ophthalmological examinations of that part of the population. The timely diagnosis and treatment are very important for diminishing of blindness and visual impairment.

Delayed diagnosis, disease and secondary prevention, especially in young patients with colorectal cancer.

<b>Introduction:</b> Colorectal cancer (CRC) is the third most common cancer worldwide and the second cause of death. Its incidence rate decreased by about 3% per year between 2011 and 2015, and mortality by 35% between 1990 and 2007. This improvement is a result of cancer prevention and early detection strategies through screening. The decline in cancer rates may have been due to a growing awareness of colorectal cancer in the Polish population. There was a discernible improvement in the quality of surgical treatment with time.<b>Aim:</b> The aim of the study was to determine the relationship between colonoscopy and the incidence of CRC, the incidence and family history of cancer and other intestinal diseases, as well as between the stage and time from first symptoms to the start of treatment.<b>Materials and methods:</b> A retrospective analysis of the records of patients with CRC treated surgically between 1995 and 2005 at the Department of General, Oncological, and Gastroenterological Surgery in Krakow and a diagnostic survey method were used.<b>Results:</b> There was a statistically significant relationship between the performance of colonoscopy and the incidence of CRC (P<0.001). There was no correlation between CRC and the incidence of cancer and other bowel diseases in the family, or between the stage and the time from first symptoms to the start of treatment. The length of time was long, usually up to 6 months, 1-3 years, and in some cases longer than 6 years.<b>Discussion:</b> Unfortunately, the incidence of CRC in young people under 50 years (EOCRC) has increased. Screening is of proven importance in reducing the incidence and mortality of CRC and every effort should be made to carry out as many of these screenings as possible. The time between diagnosis and treatment should also be kept as short as possible. Recommendations for the timeframe from diagnosis to treatment of cancer exist in many countries. In Australia, guidelines for an optimal care pathway suggest a timeframe of up to 7-9 weeks, similar to the National Health Service UK guidelines in the UK. Timeliness of treatment is an important factor in cancer care, to assess the consequences of delays and disruptions in oncology care.<b>Conclusions:</b> The incidence of CRC was lowest among those who had prophylactic examinations - colonoscopies. Studies on secondary prevention have confirmed that there was poor diagnosis in this area, even though there were cases of CRC in the immediate family, so it is worth educating the public and encouraging them to have colonoscopies and take care of their health. The long time between the appearance of the first clinical symptoms and the start of treatment, which was presented in the study, is unfortunately associated with a worse prognosis, as any delay in starting treatment for oncology patients is unfavorable.<b>Significance of the research for the development of the field:</b> The role of secondary prevention in the prevention of CRC and the need to educate the public to catch the first worrying signs of cancer and to consult a doctor are emphasized.

Dynamics of Some Medical and Demographic Indicators in St. Petersburg During the Period from 2018 to 2023

Background. There have been negative trends in the birth rate and population growth decline in recent years. Forecasts from demographers are also not so encouraging as the next generation of childbearing age is one from the end of the last century which is characterized by low birth rate. Population mortality exceeded the birth rate during the years of challenging and questionable economic reforms. Moreover, there was a high level of chronic morbidity in child population, and physical development had the trend to retardation. Meanwhile under these circumstances, the President of Russian Federation and the Government adopted regulatory documents (decrees, dedicated programs) that determined the directions of state social policy on improving the situation with children in Russian Federation until 2000.Objective. The aim of the study is to evaluate the dynamics of several medical and social indicators of 2018–2023 characterizing demographic trends direction, with proposals on improving medical care in the maternal and child health care system.Methods. The study has covered reporting form No. 19 of Russian Federal State Statistics Service (Rosstat) for children’s outpatient clinics, form No. 14 for children’s hospitals, form No. 030/у “Check-list of dispensary observation”. The study has used the materials of the Presidential Coordination board meeting from November 15, 2016. Statistical data was obtained from the “Office of the Federal State Statistics Service for St. Petersburg and the Leningrad Region” (Petrostat) and the Center for Analysis and Forecast of Mother and Child Health at Health Committee of St. Petersburg, Medical Information and Analytical Center (“Major results in the field of health care in St. Petersburg”, 2019, 2020, 2021, 2022). Statistical processing was carried out via variational statistics methods (Pearson’s criterion, Fisher’s angular transformation criterion) and data from the automated system of prophylactic medical examination, registration certificate FSR No. 2009/05279, corresponding to the order of the Ministry of Health of Russian Federation No. 514н dated August 10, 2017.Results. The analysis of study results confirms the negative demographic patterns in St. Petersburg like the all-Russian. Increase assisted reproductive technologies was noted alongside with birth rate decrease. There are still high rates of stillbirth and perinatal mortality, as well as increased infant mortality rate. The correlation of depopulation processes with children’s health worsening and increasing disability is emphasized.Conclusion. The problems raised in this paper do not have an straightforward solution and require multimodal approach.

The predictive capability of several anthropometric indices for identifying the risk of metabolic syndrome and its components among industrial workers

Metabolic syndrome (MetS) is closely associated with adverse cardiometabolic outcomes. The objective of this study was to identify practical methods that could enable the effective identification of MetS based on anthropometric indices. The basis of our study involved retrospective database obtained from routine medical prophylactic examinations. This was a cross-sectional study on the health status of male workers employed in hazardous working conditions at industrial enterprises in the Ural region conducted in 2019. A total of 347 male workers employed under hazardous working conditions were investigated. The presence of MetS was established by a healthcare professional in accordance with the guidelines of the International Diabetes Federation (IDF). Simple linear regression was used to evaluate the associations between anthropometric indices and MetS incidence. Logistic regression was used to determine the odds ratios of MetS in relation to increases in anthropometric indices. ROC curves were calculated to compare the ability of each anthropometric index to predict MetS and to determine the diagnostic thresholds of the indicators considered. According to the IDF criteria, 36.3% of the workers had MetS. A direct relationship was found between the individual components of MetS and the anthropometric indices studied. The highest OR was shown by the Body Roundness Index (BRI) of 2.235 (95% CI 1.796–2.781). For different age quartiles, the optimal cut-off values for predicting MetS were as follows: BRI, 4.1–4.4 r.u.; body shape index (ABSI), 0.080–0.083 m11/6 kg−2/3; and lipid accumulation product (LAP), 49.7–70.5 cm mmol/l. The most significant associations with MetS were observed where the values were greater than these cut-off points (Se = 97.4%). The results of this study demonstrated the rapid use of new anthropometric indicators, which have shown good predictive ability and are quite easy to use.

HUMAN CYSTIC ECHINOCOCCOSIS IN ENDEMIC REGIONS IN BULGARIA - ULTRASOUND SURVEILLANCE, TREATMENT AND FOLLOW-UP OF PATIENTS

Introduction: Cystic echinococcosis (CE) is a chronic disease in humans, usually asymptomatic, but in some cases could be very severe with fatal outcomes. This parasitosis is a health and economic problem in many areas of the world. The actual spread among people with CE in endemic regions is not known. The purpose of prophylactic ultrasound examinations of people in some areas was to clarify the real prevalence of CE and to detect undiagnosed asymptomatic cases and recurrences. Materials and methods: An abdominal ultrasound survey in four endemic regions in Bulgaria with the highest rate of registered patients with CE in Bulgaria for the last five years was conducted. For every patient with CE an epidemiological and clinical history, abdominal ultrasound examination, blood tests and ELISA IgG test for CE were performed. Results: From all 8602 people examined, in seventeen persons (0.2%), liver hydatid cysts were found for the first time. Ssixty five (0.8%) reported a history of previous surgical treatment for CE, of which 54 (83.1%) had passed surgery because of liver CE and 11 (16.9%) had extrahepatic CE (pulmonary, cardiac, bone, spleen). In three (5.6%) patients, who were operated years before for liver CE, recurrences were discovered. In 11 (64.7%) patients devitalized CE4 cysts were observed without any data for previous treatment. Three of the discovered patients with CE were treated with surgery, one with puncture-aspiration-injection-reaspiration, four only with Albendazole. The patients were successfully treated and followed for a period of five years. Conclusions: During the prophylactic ultrasound examinations, a higher percentage of people infected with liver cystic echinococcosis was found compared to the official information. It should be noted that these results are found in areas with the highest incidence of this disease in the country. US screenings give the opportunity for early detection, timely treatment of infected people and to prevent severe complications in patient with CE disease.

Cardiotoxic Drugs Used in the Treatment of COVID-19

Background. The COVID-19 pandemic is caused by the SARS-CoV-2 virus. Insufficient attention is paid to the cardiotoxic potential of the drugs used in the treatment of COVID-19.Aim. A brief report on the effect of the drugs commonly used in the treatment of COVID-19 on the cardiovascular system.Discussion. Various medications have been used to treat COVID-19. Some of the most common drugs include hydroxychloroquine, remdesvir, favipiravir, fluoroquinolones, interferon-α2b, glucocorticoids, molnupiravir, and ritonavir/nirmatrelvir. Most medications can cause changes in the cardiovascular system, especially in the QT interval.Conclusions. Physicians should take into account the cardiotoxic potential of all medications used in the treatment of COVID-19. Therapists and general practitioners should be aware of cardiovascular risks in the management of patients with COVID-19, as well as the prophylactic medical examinations of the population.

Early diagnostics of prostate cancer based on a comprehensive analysis of risk factors

BACKGROUND: There is a trend of increasing incidence and mortality from prostate cancer. Existing methods for early diagnosis and screening of prostate cancer did not demonstrate enough efficiency.
 AIM: To improve the quality and efficiency of diagnostic measures for prostate cancer through a personalized approach to patients based on an analysis of a set of risk factors.
 MATERIALS AND METHODS: The methodology was developed using the data from the population-based Cancer Registry of the Altai Territory, created at the Altai Regional Oncology Center in Barnaul, Russia. At the moment the Cancer Registry included information on 308 550 patients with malignant neoplasms, including 15 167 males with prostate cancer. On the basis of the method of prostate cancer risk assessment proposed by Lazarev AF an automated program for early diagnosis of prostate cancer has been developed. Testing of this technique included assessment of 532 patients (aged between 23 and 82).
 RESULTS: 128 patients were determined to belong to the high risk pre-cancer group. A high-risk precancer registry was created, which included the patients having individual risk of developing prostate cancer either increased or high or absolute. Upon a set of in-depth examinations, 7 of 128 patients (9.3%) were diagnosed with prostate cancer, all at early stages (I or II). Thus, the incidence of prostate cancer among the patients from the high risk pre-cancer registry was significantly higher than the average observed during prophylactic examinations (0.01%).
 CONCLUSION: The automated program for early diagnosis of prostate cancer could be implemented with the aim to assign in-depth examination in more targeted manner to patients at high risk of prostate cancer and to contribute to detection the cancer in the early stages.

Cardiovascular complications in the context of COVID-19: arrhythmias

The COVID-19 pandemic has become a global crisis of unprecedented level for all mankind. The whole process of studying the disease (etiopathogenesis, diagnosis, treatment, prevention, prognosis) was not easy, because COVID-19 is a relatively new nosology that the world has never encountered. Cardiovascular complications in COVID-19 play an important role in the prognosis of morbidity and mortality. As the COVID-19 pandemic spreads, more and more patients with cardiac arrhythmias, arterial hypertension and other cardiovascular complications appear. This may be due to the impact of the SARS-CoV-2 virus on the respiratory, cardiovascular and other systems, as well as the development of inflammation. During the COVID-19 pandemic, there were more patients with arrhythmias. According to some data, the risk of arrhythmias in COVID-19 in hospitalized patients varies from 7.57% to 17.97%. The main causes of arrhythmia in the context of COVID-19 are hypoxia (acute respiratory distress syndrome, pulmonary embolism, the effect of SARS-CoV-2 on chemoreceptors), myocarditis (direct and indirect effects of SARS-CoV-2 on the myocardium), electrolyte imbalance, autonomic dysfunction, cardiotoxic drugs used in COVID-19. There can often be several reasons, and it is quite difficult to figure out which one has become the main one for each patient. This review focuses on the potential mechanisms for the development of cardiac arrhythmias in patients with COVID-19. Cardiologists, therapists and family medicine physicians should be aware of cardiovascular complications in the management of patients with COVID-19, and the prophylactic medical examination of the population.

Coverage by examinations associated with early detection of colorectal neoplasia in the Czech Republic.

Coverage by examinations is a crucial indicator of the future impact on the burden of colorectal cancer (CRC). The study aimed to evaluate coverage by examinations associated with CRC screening and early cancer detection of CRC in the Czech Republic. The burden of CRC was also assessed. The novel nationwide administrative registry with individual data (period 2010-19) was used to evaluate coverage by examinations for screening faecal occult blood test and colonoscopy. In the second step, additional examinations for early CRC detection were included in the coverage calculation (complete coverage). Age-specific trends in CRC incidence (period 1977-2018) were investigated using Joinpoint regression. Coverage by screening examinations within recommended interval was around 30%. Complete coverage reached >37% and >50% at the 3-year interval. The coverage by examinations for the non-screening population aged 40-49 years was almost 4% and 5% (most of them were colonoscopies) at the 3-year interval. In age groups aged ≥50 years, we observed a significant annual decline, especially in the 50-69 age group, with recent annual decreases reaching up to 5-7%. The change in trend and the recent decline were also observed in the age group 40-49. More than half of the target screening population was covered by examinations potentially associated with early detection and subsequent treatment of colorectal neoplasms. The substantial coverage by potentially prophylactic examinations might be an explanation for the considerable decrease in CRC incidence.

Arterial hypertension in COVID-19

Background. The SARS-CoV-2 virus caused the COVID-19 pandemic. Arterial hypertension in COVID-19 plays an important role in the prognosis of morbidity and mortality. Objective. A brief report on the effect of COVID-19 on arterial hypertension. Discussion. COVID-19 is often accompanied by changes in the cardiovascular system. Arterial hypertension is one of the most common comorbid conditions. A lot of studies have proved the connection of hypertension with COVID-19. The main mechanisms for increasing blood pressure indicators may be: an increase in the concentration of angiotensin II in the blood, the interaction of SARS-CoV-2 with the APF2 receptors of the infected cell membrane, direct and indirect effects on the endothelium, a decrease in the level of vasodilating factors (nitric oxide (NO) and prostacyclin), psychological pressure by the COVID-19 pandemic. Conclusions. Physicians and general practitioners should be aware of hypertension in the management of patients with COVID-19, and the prophylactic medical examination of the population.

Manifestations of uveitis of toxoplasmosis etiology after vaccination: clinical cases

Inflammatory diseases of the retina and choroid (chorioretinitis), including those of toxoplasmosis etiology usually occur against a background of decrease in immunity. We present two clinical cases of ocular inflammation at different times after the vaccination with Sputnik V. An analysis of the occurrence of ocular pathologic condition after vaccination to prevent coronavirus infection caused by the SARS-CoV-2 virus will help determine the criteria for prophylactic ophthalmological examination of patients before vaccination.

ДОНОЗОЛОГИЧЕСКАЯ ДИАГНОСТИКА КАК МЕТОДОЛОГИЯ ОЦЕНКИ ФУНКЦИОНАЛЬНЫХ СОСТОЯНИЙ ОРГАНИЗМА, ПОГРАНИЧНЫХ МЕЖДУ НОРМОЙ И ПАТОЛОГИЕЙ, И ЕЕ МЕСТО В КОСМИЧЕСКОЙ И ЗЕМНОЙ МЕДИЦИНЕ

A new concept of the health doctrine – prenosology – was conceived in space medicine. Roman M. Baevsky was one of the founders. The concept was built not on diagnostics of diseases but assessment of health quality by assigning to one of 4 adaptation states: good, strained, bad, and failure. Mass prenosological examinations of more than 25 thousand people in the period between 1975 and 2005 showed a high effectiveness of this approach in assessment of both personal and group health. It was found that about 20–30 % of people required medical care. In recent decades, the stress level and development of de-adaptation transiting to pathologies within six months have been growing catastrophically. Automated prenosological diagnostics system approved by the Russian Ministry of Health can be instrumental in prophylactic examination to triage the stream of people by the level of adaptation and need of medical care. In future, medicine will certainly be focused on the health of healthy people and prenosology will gain acceptance and progress.

The Sanitary Service of the 431st Tikhvin Infantry Regiment during World War I

The article analyzes the formation and development of the sanitary service in one particular regiment in the period from August 1914 to December 1916. The main body of sources con- sists of archival files of the respective military unit. The novelty of the present paper is seen in the fact that it is the first study devoted to the formation of the medical service of the regiment, starting with the militia squads. It is proved that in the squads the sanitary unit was not independent but relied on the zemstvo medical system of the cities and on the infirmaries of the garrisons. A focus is on the work of doctors in the 431st Tikhvin Regiment during their stay in Livonia from June 1915 to May 1916. Various areas of medical care of the regiment before participating in hostilities are studied in detail: the treatment of soldiers and prophylactic examinations, sanitary education, supervision of places of residence, as well as the prevention of infectious diseases. It is established that during the guard service of the regiment, the sanitary unit worked satisfactorily. The article zooms in on the expansion of the duties of the regiment's sanitary service at the front starting in the summer of 1916, and identifies how the medical personnel of the regiment was replenished. Special attention is paid to the difficult sanitary and hygienic situation at the front in Austria-Hungary, and the measures that were taken to combat the main epidemics that arose at the front, namely typhus, cholera, and dysentery. Equally discussed are the consequences of unsettled life and malnutrition.

Population immunity in residents of the Kaliningrad region to current antigenic variants of influenza viruses over 2018-2021

The article presents the results of population immunity assessment in residents of the Kaliningrad region to current antigenic variants of influenza viruses over the period of 2018 to 2021. To assess spectrum of influenza types circulating in Kaliningrad region, the real-time PCR method was used using AmpliSense reagent kits. The biological material for the study was obtained from oropharyngeal swabs from the persons who applied to polyclinics with inflammatory diseases of upper respiratory tract, or underwent treatment at the out- or inpatient basis in a healthcare facilities of Kaliningrad region. Humoral immunity was assessed by testing blood sera obtained from healthy residents of Kaliningrad region during periodic prophylactic examinations at the city and regional polyclinics. The study of residents covered all age groups. For the period of 2018-2021, more than 14,000 studies have been carried out. Determination of specific serum antibody titers was carried out by staging the hemagglutination suppression reaction using local influenza antigens (LLC PPDP, St. Petersburg). Antibody titers of 1/40 and higher were considered sufficient to reduce the risk of disease by 50%. During the study period, 2165 cases of influenza were confirmed in the region by laboratory tests. Over the study period, the A(H1N1) pdm serotype proved to be the major strain causing influenza, its proportion reached 57.5%. However, along with A(H1N1) pdm, a significant contribution was also made the A(H3N2) strain to the epidemic process, being the etiological cause of influenza infection in 2019 (42.2%), type B influenza strains being actual in 2020 (42.5%). Over the period of 2018-2021, 420 samples of blood sera from vaccinated and non-vaccinated individuals were tested for specific antibodies. The sera were taken 1-2 months after vaccination and between epidemic rises of influenza (April-May). In vaccinated individuals, the antibody titer was protective in 58.3-64.5%. In this group of persons, the titer sufficient to produce immunity was maintained over the spring/summer period. Among those persons who refused vaccination, a protective antibody titer in the pre-epidemic period was noted in 41.2% of the examined, and during the off-season it was detected in 37.4% of the volunteers. Thus, the A(H1N1) pdm strain was the main etiological factor of influenza in Kaliningrad Region in 2018-2021. The protective level of antibodies in vaccinated population over the period preceding the epidemic peak, was observed 30% more often than in unvaccinated individuals. High incidence of influenza B strains noted in 2020 appears to require a change of specific vaccine preparation.

Эффективность ранней диагностики и приверженности к медикаментозной профилактике развития и прогрессии ДГПЖ.

Introduction. Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system in men. Severe symptoms of lower urinary tract dysfunction (LUTS), which develop with BPH, worsen the quality of life. Prophylactic examinations, dynamic monitoring and necessary treatment: conservative (nonpharmacological and pharmacological treatment) or surgical treatment are necessary to control the course of the disease. Bioregulatory peptides can be used for early control of LUTS. The aim of the work was to assess the efficacy of early diagnosis and adherence to drug prophylaxis of BPH development and progression using different methods including bioregulatory peptides. Materials and methods. Data of the clinical examination and periodic medical examinations of 1675 men who were enrolled in the program «Complex of measures to increase the efficiency of early diagnostics of BPH and increase adherence to medical prophylaxis of BPH development and progression» were analyzed. After full clinical examination, depending on indications, patients were recommended surgical or conservative treatment – non-medication (behavioral) or medication (α1-adrenoblockers + muscarinic receptor antagonists, 5α-reductase inhibitors or Vitaprost preparations). The patients were observed for 4 years. Efficacy and safety of the use of bioregulatory peptides (Vitaprost®) in patients with BPH and LUTS were compared with the results of treatment in patients who chose behavioral therapy (active observation). Results. Behavioral therapy was used in 221 patients with mild to moderate symptoms, 312 patients were prescribed Vitaprost® Forte and Vitaprost® tablets. Active observation was more often chosen by patients of the youngest group (40-44 years). During Vitaprost® application there were improved IPSS questionnaire indexes, maximal urination rate increased, residual urine volume and prostate volume decreased. Worsening and increase of severity of complaints, according to IPSS questionnaire, decrease of maximum urinary flow rate and increase of residual urine volume and prostate volume were registered in actively observed group of patients. Conclusions. Timely initiation of therapy with Vitaprost® Forte and Vitaprost® tablets in patients with BPH has a favorable efficacy and safety profile. Further analysis of the data received as a result of the regional program is supposed to be carried out to evaluate its results.

Optimization of prevention of dental diseases in pregnant women

Effective prevention of dental diseases during pregnancy, as well as the correct tactics of a dentist and obstetrician-gynecologist is important factors in improving the level of dental health in pregnant women. The aim of research was to increase the effectiveness of the prevention of dental caries and periodontal diseases by introducing a complex of prophylactic and therapeutic measures in pregnant women. The implementation of the prophylaxis scheme is performed in 136 women aged 18-35 years. In the main group (70 women) prophylaxis was carried out using the complex of prophylactic and therapeutic measures developed by us, which includes: professional oral hygiene, oral health treatment, nutrition correction, prescribing the medicines of systemic and local action, training in proper teeth brushing, active sanitary and educational work. In the control group (66 women), the generally accepted prophylaxis scheme was used. Evaluation of the effectiveness of prophylactic and therapeutic measures was determined by indicators of caries incidence during pregnancy, reduction of caries, the dynamics of Papillary-Marginal-Attached Index and Papillary Bleeding Index. The effectiveness of the proposed algorithm of dental diseases prevention for pregnant women was confirmed by 3.45 times lower incidence of dental caries in women of the main group compared to the control group (0.44±0.06 versus 1.52±0.13 tooth, respectively); significant decrease (p<0.001) of Papillary-Marginal-Attached Index values (14.01±1.17 versus 49.25±1.86%), as well as bleeding indices (0.32±0.08 versus 1.82±0.13) and Green-Vermilion (0.89±0.08 versus 1.71±0.12 scores). Regular prophylactic and therapeutic examinations of pregnant women by a dentist, hygienic education and training of expectant mothers, active motivation of women to carry out individual oral hygiene with a constant monitoring of its implementation, correction of nutrition and mineral metabolism, influence on cariogenic and periodontal microbiota of the oral cavity, improvement of physiological enamel mineralization and increasing of hard tooth tissues resistance contributed to the reduction of caries incidence by 71.05±5.42% and the effectiveness of periodontal diseases treatment by 88.46±3.81% in the main group versus 36.84±5.94% in the control group (p<0.001).

Estimation of the feasibility of using empirical models for prediction of the second metachronous tumor after chemotherapy of the first tumor to improve cancer surveillance

Aim. To assess the possibility of using empirical models for predicting a second metachronous tumor after chemotherapy of the first one to improve the efficiency of prophylactic medical examination of cancer patients.Material and Мethods. The objects of the study are electronic databases on the chemotherapy treatment of cancer patients, extracts from the database on the treatment of patients with PM oncology for the period 1990–2015, case histories and medical records of 796 patients with metachronous PM oncology: experimental group – 496 patients after chemotherapy, control group – 300 patients after surgical treatment of the first tumor, the sample size was not previously calculated.Results. Empirical models for predicting a second metachronous tumor after chemotherapy of the first one showed the highest probability of a second metachronous tumor in three time intervals: 1256.00–1884.00 days (3.44–5.16 years; HR=2.25; tumor is 69.2 %), 3768.00–4396.00 days (10.32–12.04 years; HR=3.86; chance 79.4 %), 6280.00–6908.00 days (17, 21–18.93 years; HR=2.00; 66.7 % chance.Conclusion. Based on the results of the analysis of empirical risk models for a second metachronous tumor after chemotherapy of the first one, amendments were developed to the timing of dispensary observation of patients with primary multiple metachronous malignant neoplasms after chemotherapy of the first tumor. Knowledge of the most probable timing of the occurrence of a second metachronous tumor after chemotherapy of the first one makes it possible to more accurately draw up and, if necessary, adjust the plan for dispensary observation after chemotherapy treatment of the first tumor.

On the question of legal provision of dispenserization of adolescents, including in current conditions of increased infectious risks of COVID-19

The article presents the results of the analysis of regulatory legal documents that ensure the organization and conduct of prophylactic medical examination of adolescent children in the Russian Federation in modern conditions of increased infectious risks of COVID-19. As a result of the analysis undertaken, a variety of forms, legal force of documents, dynamics and practical justification of their adoption were identified, as well as tasks were identified: by submitting an array of regulatory legal documents regulating the conduct of medical examination of adolescents into a single internally agreed system that excludes duplication of norms, powers and responsibilities; on the normative consolidation of clearly and in detail defined rights, duties and responsibilities of all subjects of relations arising in the course of organizing and conducting medical examination of adolescents, primarily authorized representatives of medical and educational organizations, adolescent children themselves and their legal representatives; on regulatory support and methodological support for the implementation of the requirements of the updated standard for equipping a specialized unit for organizing medical care for minors in educational institutions. The conclusion is made about the progressive development of the regulatory framework for medical examination, about the absence of legal conflicts between documents of different legal force, about their complementarity to each other. The guidelines voiced by the President of the Federal Assembly (April 2021) to expand measures within the framework of clinical examination of the population and to pay special attention to the health of children are a logical justification for improving the regulatory and legal support in protecting the health of children and adolescents.