State Medical Institute Research Articles

Real-world effectiveness and safety of pan-genotypic antiviral therapy for chronic HCV-infection: data from three clinical centers in St. Petersburg

The aim of the analysis was to describe the results of administration of pan-genotype antiviral therapy (glecaprevir / pibrentasvir, GLE / PIB) in real-world setting in three clinical centers in St. Petersburg within the city program for the treatment of chronic hepatitis C. Materials and methods. A retrospective analysis of the GLE / PIB usage of in the period from 2019 to 2022 within the city program for the treatment of chronic hepatitis C in St. Petersburg was carried out. Results. The analysis included 464 patients treated in three clinical centers of St. Petersburg: St. Petersburg State Medical Institution “Clinical Infectious Diseases Hospital named after S. P. Botkin”, St. Petersburg State Medical Institution “Center for the Prevention and Control of AIDS and Infectious Diseases” and the Clinic of Infectious Diseases of the Military Medical Academy named after S. M.Kirov”. Overall 452 out of 464 patients (97 %) achieved SVR12. According to the duration of treatment, SVR12 rates were the following: 8 weeks – 97.7 % (419 / 429), 12 weeks – 92.9 % (26 / 28) and 16 weeks – 100 % (7 / 7). The effectiveness according to fibrosis stage was as follows: F0 – 97 % (142 / 146), F1 – 100 % (74 / 74), F2 – 100 % (59 / 59), F3 – 98 % (57 / 58), F4 (CP-A, B) – 94 % (118 / 125). SVR12 according to HCV genotypes and subtypes was the following: genotype 1b – 100 % (63 / 63), genotype 1a – 91 % (21 / 23), genotype 1 unspecified – 100 % (23 / 23), genotype 2 – 98 % (50 / 51), genotype 3 – 97 % (292 / 301). In patients with an indeterminate genotype, the efficacy was 100 % (7 / 7). Antiviral therapy was well tolerated, there were no cases of discontinuation of therapy, as well as cases of the development of serious adverse events. Conclusion. GLE / PIB has demonstrated high effectiveness in the real-world setting in patients infected with prevalent genotypes of HCV, including those with genotype 3 and compensated liver cirrhosis. The results of our analysis fully correspond to the data obtained earlier in clinical trials andreal-world setting.

ВОЕННАЯ КАФЕДРА УЧРЕЖДЕНИЯ ОБРАЗОВАНИЯ «ВИТЕБСКИЙ ГОСУДАРСТВЕННЫЙ ОРДЕНА ДРУЖБЫ НАРОДОВ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ», КАК СОСТАВНАЯ ЧАСТЬ СИСТЕМЫ ПОДГОТОВКИ ОФИЦЕРОВ ЗАПАСА МЕДИЦИНСКОЙ СЛУЖБЫ

The article presents the history of the creation and development of the military department of the Vitebsk State Medical Institute (University), the training of medical personnel from the moment of its formation to the present, as well as brief information about the activities of the department staff.

Autofluorescent stomatoscopy and its possibilities to evaluate results of the oral mucosa leukoplakia surgical treatment

Background: Leukoplakia belongs to facultative precancerous diseases. In this regard, the issues of timely diagnosis and treatment of leukoplakia will always be relevant. Autofluorescent stomatoscopy (AFS) is one of the promising methods that allows to detect early signs of malignancy of diseases of the oral mucosa and determine risk zones for pathological processes that are not accompanied by visual clinical manifestations. The aim of the study is to increase the effectiveness of treatment of patients with oral leukoplakia by optimizing the volume of surgical intervention and the timing of postoperative follow–up with the help of AFS. Materials and methods.A survey of 45 patients with oral leukoplakia, who under went conservative and surgical treatment, was conducted. During the clinical examination, the device for autofluorescent stomatoscopy — AFS-400 was used. Surgical treatment of patients was performed at the Department of maxillofacial surgery at St Petersburg State Medical Institution «City Multidisciplinary Hospital No.2». The results of the study. To clarify the area of the pathological process and determine the location for the collection of material for histological examination, it is advisable to use AFS. Histological examination is the main method for confirming the presumed diagnosis and determine the specific nosological form of the disease. After cryodestruction, 7% of patients retained minor foci of hyperkeratosis, however, they had a smaller area compared to the initial examination and during the AFS had a normal green glow of tissues, which made it possible to make a favorable prognosis of the course of the disease. Conclusion: patients who had hyperkeratosis focus smaller than the size of the tissue glow focus in AFS, as well as patients with uneven attenuation of tissue glow in AFS, need a longer period of follow-up and regular check-ups to exclude the processes of malignancy.

75 years in the service of Karelia: to the anniversary of the State Medical Institution of the Republic of Karelia Bureau of Forensic Medical Examination

The article is dedicated to the 75th anniversary of the State Budgetary Healthcare Institution of the Republic of Karelia «Bureau of Forensic Medical Examination». The history of the formation of the forensic medicine service in the Republic of Karelia is briefly described. The data on the heads of the service and well-known forensic experts, the organizers of the forensic medical examination in Karelia, the course of forensic medicine of Petrozavodsk State University, the role of its employees in the work of the State Medical Institution of the Republic of Karelia «Bureau of Forensic Medical Examination» are presented. In addition to available literature sources, archival materials of employees and veterans of the forensic medical service of Karelia were used.

Medical and economic analysis of the effectiveness of the structural units of a medical organization

Medico-economic analysis in a medical organization is a set of techniques and methods for assessing the indicators of medical, industrial and financial activities, the purpose of which is to choose ways to rationally use internal resources. The main objectives of medical and economic analysis is to determine the reserves for the use of the organization's resources; introduction of effective technologies of the treatment process; assessment of the effectiveness of medical care, assessment of the effectiveness of management decisions. The combination of types of analysis, their subordination to management goals can improve the efficiency of the medical organization and its structural divisions. In the context of increasing competition in the medical services market, the importance of medical and economic analysis in medical organizations of various forms of ownership is growing. State medical institutions are no exception. Modern autonomous and budgetary healthcare institutions operate in the status of independent economic entities, while the role of the chief physician as the organizer of the medical and economic process, as well as the role of the head of the structural unit, who must analyze the results and costs, calculate the need for material and financial resources, determine efficiency of medical activity. The subject of the analysis of this article is to determine the optimal algorithm for conducting a medical and economic analysis in the context of the functioning of the structural units of a medical organization.

History of the Kazan School of Dermatovenereology

The Department of Skin and Venereal Diseases is one of the oldest departments of Kazan State Medical University. It originates in the bowels of the medical faculty of the Kazan Imperial University. The founder and first head of the Department of Skin and Syphilitic Diseases was Professor A.G. Ge. There are three periods in the development of the scientific school, which differ in research issues and teaching methods. The first period from the birth of the school of A.G. Ge until the end of the 1920s, it is characterized by the fight against syphilis, which is reflected in the name of the department of skin and syphilitic diseases. The starting point of the second period in the history of the Kazan school of Dermatovenereology can be considered 1930, when the medical faculty of the university formed an independent institute the Kazan State Medical Institute. At this stage, it is difficult to identify the main scientific direction, the research was carried out based on the urgent tasks of the time. The third stage (from the 1970s to the present) is characterized by research into issues of allergy and its skin manifestations. Employees of the Department of Dermatovenerology of the Kazan State Medical University are currently continuing the main traditions of the Kazan dermatovenerological school.

Dynamic Electroneurostimulation in Rehabilitation: a Prospective Randomized Study of 60 Patients after Surgical Treatment of Colorectal Malignancies

INTRODUCTION. Surgical treatment of colorectal malignancies, while increasing overall survival often determines the persistence ofthe pain syndrome, causing a decrease in the quality of life of patients. Pain-relieving medicines have side-effects and complications,which determines the search for and introduction of non-medicinal technologies. AIM. To evaluate the effectiveness of incorporating dynamic electroneurostimulation in the rehabilitation of patients after surgicaltreatment for colorectal cancer to correct pain syndrome, autonomic dysfunction and quality of life indices. MATERIAL AND METHODS. 60 male and female patients aged between 35 and 65 with a verified diagnosis of the colon and rectummalignant neoplasms after surgical treatment were examined in the conditions of the outpatient oncological care center at the StateMedical Institution “City Clinical Hospital No. 2” (Novosibirsk). They were divided into 2 groups: the 1st group (the main group, n=40)in addition to standard therapy received a 15-day course of dynamic electroneurostimulation (DENS) performed with «NEURODENSPCM» device, the 2nd group (the comparison group, n=32) received a standard treatment including chemotherapy, symptomaticpharmacotherapy and exercise therapy. The examination included assessment of pain syndrome using validated pain scales, thevegetative status, anxiety and depression, quality of life parameters. RESULTS AND DISCUSSION. The patients of the 1st group showed 1.2- and 2.4 times reduction of algias by the 5th and 15th day ofrehabilitation respectively. Upon completion of the rehabilitation the autonomic nervous system balance index (LF/HF) was adjustedby 4.8 and the centralization index by 6.0 times against the baseline, the anxiety and depression index on the HADS scale was reducedby 1.5 times, the quality of life on the SF-36 scale improved: physical functioning by 1.5 times, pain by 1.2 times, general health by 1.5times, which differed from the similar indicators in the 2nd group.Dynamic electroneurostimulation using NEURODENS-PCM device can have pain-relieving and vegetative-regulating effects due toactivation of antinociceptive brain structures and influence on suprasegmental parts of the autonomic nervous system. CONCLUSION. The inclusion of dynamic electroneurostimulation using «NEURODENS-PCM» device in the rehabilitation of patientsafter surgical treatment of malignant neoplasms in the colorectal region enables a faster relief of pain syndrome, adjustment of theneurovegetative regulation and the anxiety level, which contributes to improvement of the ' quality of life of patients.

Combination of type I diabetes mellitus and diabetes associated with GCK gene mutation: features of the clinical course in puberty

This article discusses a clinical case of the manifestation of MODY2 diabetes, which complicated the course of type I diabetes mellitus in a patient of puberty. For 9 months, the dynamics of the patient’s condition was monitored, who was on inpatient treatment in the endocrinology department of the State Medical Institution of the Tambov City Hospital for the entire period of observation. The criteria for daily monitoring of the patient’s clinical condition were: blood glucose and glycated hemoglobin, the level of glucosuria, the concentration of ketone bodies in the blood and acetone in the urine. The patient underwent insulin therapy and infusion therapy. Despite the ongoing treatment, including, among other things, the treatment of complications of the underlying disease, by the 6th month the patient’s condition worsened to an extremely severe degree. Additional laboratory and instrumental diagnostic studies were conducted, including a molecular genetic study for diabetes typing, the results of which made it possible to determine the cause of the progressive course of type I diabetes mellitus, which was the clinical manifestation of MODY2 diabetes with the development of insulin tolerance against the background of hormonal adjustment of puberty. The problem of timely and accurate diagnosis, and, accordingly, correct treatment, of type I diabetes mellitus combined with MODY2 diabetes, remains urgent and serious, due to the difficulty of interpreting differential diagnostic criteria with progressive type I diabetes mellitus of childhood and adolescence, which in turn can lead to multiple complications, including fatal exodus.

Alexander Artemyevich Matchin - Professor, Honored Maxillofacial Surgeon. To the 80th of birthday

It is the 80th anniversary of the birth of the head of the Department of Dentistry and Maxillofacial Surgery of the Orenburg State Medical University, Doctor of Medical Sciences, Professor Matchin Alexander Artemievich. Alexander Artemievich was born on January 1, 1942 in the village of Alekseevka, Orenburg Region, in the family of a teacher. After completing his studies at the Faculty of Medicine at the Orenburg State Medical Institute, he was enrolled in the clinical residency of the Department of General Surgery. At the end of his residency, he continued his postgraduate studies at the Department of Hospital Surgery and in 1971 successfully defended his thesis. All further scientific and practical activities of A.A. Matchin - a talented surgeon, scientist, skillful organizer - were associated with the Orenburg State Medical Institute (since 1994 - the Academy, and since 2014 - the University), where he worked as an assistant, and then an assistant professor of the Department of Hospital Surgery in the course of dentistry. After the opening of the Faculty of Dentistry, the course was reorganized into the Department of Dentistry and Maxillofacial Surgery, and Associate Professor A.A. Matchin became the head of this department. As the head of the department, A.A. Matchin organized and supervised the educational process for the study of dentistry and maxillofacial surgery at all faculties of the university, gave the main course of lectures, supervised the training of students and clinical residents of the department. He not only supervised the medical work of the clinic of maxillofacial surgery, but also performed the most complex surgical interventions. Under the scientific advice of the Honored Scientist, member of the RAMS correspondent, Doctor of Medical Sciences Professor V.A. Kozlov in 2007, Alexander Artemievich successfully defended his doctoral dissertation and received the title of professor. For a series of scientific works on the use of new medical technologies in maxillofacial surgery and dentistry, Professor A.A. Matchin was twice (2011, 2017) awarded the title of laureate of the Governor of the Orenburg Region Prize in the field of science and technology. Professor A.A. Matchin wrote three chapters for the textbook "Topographic Anatomy and Operative Surgery," published in 2009 by the GEOTAR-Media publishing house, which was reprinted several times. He is also a co-author of a textbook on operative maxillofacial surgery and dentistry edited by V.A. Kozlov and I.I. Kagan, released in 2014 and with an additional circulation in 2019. The main areas of multifaceted medical and scientific activity of Professor A.A. Matchin are such undoubtedly important problems as restorative surgery of the maxillofacial region, treatment of inflammatory diseases and injuries, issues of oncological dentistry and organization of care for specialized patients. He embodied his knowledge and invaluable practical experience in publications of more than 350 scientific and educational works, seven copyright certificates and patents for inventions, prepared five candidates of medical sciences. For many years, Professor A.A. Matchin headed the Dental Association of the Orenburg Region, was a member of the Council of the Dental Association of Russia. Currently, he is a member of the dissertation council D 208.066.04 at the Orenburg State Medical University, a member of the profile commission for maxillofacial surgery of the Ministry of Health of the Russian Federation. For merits in the field of health care and many years of conscientious work, by Decree of the President of the Russian Federation V.V. Putin No. 824 of May 6, 2000, Professor A.A. Matchin was awarded the honorary title "Honored Doctor of the Russian Federation." By a resolution of the StAR Council of 23.04.19, he was awarded the honorary title "Honored Maxillofacial Surgeon." Among colleagues A.A. Matchin is known not only as a high-class specialist, but also as a person of a big soul and a good heart. Happy anniversary, dear friend and reliable comrade!

A clinical case of the debut of pemphigus foliaceus against the background of vaccination against coronavirus infection (COVID-19)

The article describes the onset of pemphigus foliaceus against the background of vaccination with the combined vector vaccine "Gam-COVID-Vac" ("Sputnik V"). A feature of this clinical case is the duration of the period from the moment of development of the first symptoms of the disease to clinical and immunohistochemical confirmation of the diagnosis, which, in fact, indicates a low availability of specialized medical care for rare dermatoses. In particular, the waiting period for taking material for histological examination lasted for several months, which, in fact, is not an isolated case. At the same time, against the background of an increase in clinical symptoms, this became an additional factor in the patient's self-referral to a specialized federal state medical institution, where, within two weeks, the diagnosis was confirmed by immunohistochemical analysis methods and inpatient treatment was carried out with a pronounced positive effect. In addition, the analysis of the medical care provided to the patient showed insufficient alertness and the level of training of dermatovenereologists in diagnosing rare dermatoses accompanied by blistering rashes. In particular, the patient initially underwent several courses of antifungal therapy in combination with intravenous infusion of systemic glucocorticosteroids. The article also presents an analysis of the frequency of occurrence of this disease in different countries for more than 100 years.

Application of cytological research methods to solve the question of the organic origin of animal horns

Conducting forensic examinations is the leading evidentiary mechanism in the investigation and disclosure of poaching cases. During the investigation, animal derivatives (horns, hooves, and feathers) are found and seized from poachers in addition to clothing, crime instruments, and animal carcasses. Currently, the expensive horns of artiodactyls are of the greatest value for extraction, and their quality is largely determined by the correctness of processing from the remnants of blood, skin, and hair. Such processing precludes the use of biological methods of analysis to determine the organic origin of the seized derivatives, and genetic examination is complicated by the lack of proper laboratory equipment, appropriate reagents, and the high cost of analysis.
 The expert of the forensic biological department of the State Medical Institution of the Penza region should have established the organic origin of animal horns, presumably saiga, based on the decision on the examination appointment. The study included14 pieces of animal horns seized from persons suspected of poaching.
 Microparticles were obtained from the peripheral and central parts of the horns, from which pressed preparations were prepared, followed by their staining and microscopy during the study. Luminescent microscopy of preparations from solid plates of the central part of the horn stained with fluorochromes revealed osteocytes, which are cellular characteristics of bone tissue. Epithelial cells that form the basis of the horn cover were detected when azur-eosin stained small particles from the peripheral part of the horn.
 The identification of these cell types provides sufficient grounds to conclude the organic origin of the horns presented for research.

Surgical treatment of liver echinococcosis

This article is based on the treatment results of primary and recurrent epidural infection among 1230 patients treated at three medical institutions: Khorezm Regional Multidisciplinary Medical Center, Clinic of Andijan State Medical Institute, Republican Specialized Scientific and Practical Medical Center for Surgery, between 2015-2020. The comparison group included 621 patients (from 2015 to 2017) who underwent a retrospective analysis. In comparison, the main group of the study included 609 patients (from 2018 to 2020). In the main group of patients, traditional echinococcectomy (EE) was performed in 80.1% of cases, LapEE in 12.3%, and PAIR and PEVAC techniques in 7.6%. The overall incidence of complications from the residual cavity in the comparison group was 36.4% after the PAIR technique, 39.1% after the PEVAC technique, 21.7% after LapEE, and 6.9% (37 out of 503) after traditional and resection EE. The proposed algorithm for selecting a method for treating exocrine pancreatic insufficiency (EPI) made it feasible to optimize tactical approaches to perform traditional and minimally invasive interventions, which ensured a decrease in the incidence of complications from the residual cavity and, accordingly, the need for repeated minimally invasive and open interventions and conservative therapy.

Improving the quality of diagnosis and verification of peripheral lung neoplasms by using a modified biopsy technique for ultrasonic bronchoscopy (EBUS)

BACKGROUND: The problem of diagnosis and treatment of malignant neoplasms of the lungs is extremely relevant. Verification of the malignant process in the case of peripheral localization of the neoplasm in the lung when using ultrasound bronchoscopy does not exceed 70.6%.
 AIMS: This study aimed to improve the effectiveness of ultrasound bronchoscopy in the State Medical Institution Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine by introducing into clinical practice a modified biopsy technique for ultrasound bronchoscopy. The technique is patented, patent for invention no. RU2719666 C1.
 MATERIALS AND METHODS: From 2019 to 2021, a study was conducted based on the endoscopic department of the State Medical Institution Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine, which included 137 patients. The patients were divided into two groups: the main group included 66 patients in whose examination FBS with endoussis with biopsy by a modified technique was used; the comparison group included 71 patients who underwent ultrasound bronchoscopy with biopsy by a standard technique. The time of biopsy manipulation according to the standard procedure ranged from 14 to 41 min, averaging 305 min. Ultrasound bronchoscopy with biopsy by a modified technique lasted from 16 to 45 minutes, on average 315 min.
 RESULTS: In the main group, where FBS with ENDOUSSI with biopsy was used in the diagnosis of patients using a modified technique with endosonographic control of the position of the endoscopic instrument in the pathological focus, the diagnosis of malignant neoplasm was verified in 52 patients (in 78.8% of cases). In the comparison group, where the standard biopsy technique was used in patients with ultrasound bronchoscopy, the diagnosis of malignant neoplasm was verified in 41 patients (in 57.7% of cases). Thus, the verification of peripheral lung malignancies when using a modified biopsy technique increases by 21.1% (p 0.05). FBS with endoussis with biopsy using a modified technique is satisfactorily tolerated by patients and is a relatively safe manipulation.
 CONCLUSION: modified biopsy technique developed by us with endosonographic control of the position of the endoscopic instrument in the pathological focus during ultrasound bronchoscopy makes it possible to increase the percentage of verification of peripheral lung malignancies by 21.1% (p 0.05). The introduction and widespread use of the modified biopsy technique for ultrasound bronchoscopy in the diagnosis of peripheral lung malignancies will reduce the time of examination of patients and prescribe antitumor treatment earlier.

Features of eating behavior in women: experience of observation with an assessment of the risk of predicted complications

Introduction. Studies show that up to 8 % of pregnant women suffer from eating disorders. Such problems are found everywhere, most often women do not even realize that this may be related to problems. And for pregnant women, this issue is most relevant, since there is a risk of complications of the gestation period, after which it is necessary to prevent unfavorable variants of the course of pregnancy and childbirth. Aim. To study the variants of eating disorders in pregnant women to assess the prognosis of pregnancy. Materials and methods. We conducted a retrospective analysis of clinical case histories of pregnant women (n = 267), followed by a survey of women on the basis of the State Medical Institution “Maternity Hospital No. 2” in Tyumen. The study period is from 2019–2022. Two groups were identified for the analysis: 1st – BMI of 18.5–24.9 kg/m2 : 2nd – BMI of 25 kg/m2 or more. In order to determine the type of eating disorder, we used various versions of questionnaires. Results. Of the total number of women surveyed, overweight (BMI) was determined in 149/267 (55.9 %, 2 group), in 118/267 (44.1 %, 1 group), BMI was within normal values. Risk factors were identified for the groups that could affect the course of the gestational process in the case of an identified eating disorder. When assessing comorbidity, gynecological diseases were detected, pathologies were significantly more common for group 2 62/149 (41.6 %). The dependence of the presence of a violation of any type of eating behavior and the risk of possible complications of pregnancy is not statistically significant. Conclusions. To maximize the favorable course of pregnancy and reduce the risk of possible complications, it is necessary to prepare a plan of preventive measures, which will include nutrition planning with a detailed description of solutions for a certain type of eating disorder.

Development of local infiltration anesthesia by Kazan obstetricians and gynecologists (dedicated to the 125th anniversary of the birth of professor P.V. Manenkov)

The purpose of the article is to highlight the achievements of Kazan obstetricians and gynecologists in replacing general anesthesia with local infiltration anesthesia during obstetric and gynecological surgeries. In the period before the formation of anesthesiology and resuscitation into a separate branch of medicine with its equipment and medicines, local infiltration anesthesia with a tight creeping infiltrate, according to A.V. Vishnevsky, occupied a dominant position in surgery in the first half of the 20th century. In 1925 in Kazan, a student of Professor V.S. Gruzdev, Professor A.I. Timofeev, began to introduce it into the obstetric clinic and developed the technique of this type of anesthesia for gynecological abdominal surgeries. His work was continued by his colleagues, among whom was Professor P.V. Manenkov. He and the staff of the Department and Clinic of Obstetrics and Gynecology of the Kazan State Medical Institute performed more than 5,000 operations in obstetrics and gynecology, refined the technique of local anesthesia, improved technical equipment, expanded the range of indications for surgery under this type of anesthesia. Many years of clinical and laboratory developments, widely covered in the press, made it possible to perform up to 97% of operations in obstetrics and gynecology clinics in Kazan under local infiltration anesthesia.

ЛАБОРАТОРИЯ КЛИНИЧЕСКОЙ БИОХИМИИ КАФЕДРЫ ГОСПИТАЛЬНОЙ ТЕРАПИИ ГРОДНЕНСКОГО ГОСУДАРСТВЕННОГО МЕДИЦИНСКОГО ИНСТИТУТА – МЕЖВЕДОМСТВЕННЫЙ И МЕЖКАФЕДРАЛЬНЫЙ ОПЫТ ПЛОДОТВОРНОГО СОТРУДНИЧЕСТВА

The article considers the background for the establishment in the year 1968 and the activities of the joint laboratory of clinical biochemistry of Grodno State Medical Institute and Grodno Regional Clinical Hospital that formed a basis for multi-disciplinary clinical and biochemical studies for research projects and solving problems in practical health care. The laboratory served as a basis for preparation of more than 10 candidate and doctoral dissertations, which allowed to achieve a high level of biochemical research in hospital patients and to obtain new findings in the fields of coagulogy and vitaminology.

Abstract 29 Unprecedented Experience of Cord Blood Banking in Ukraine During Russian Invasion in 2022

IntroductionOn February 24, 2022, Russia started the unprovoked and unjustified attack on the entire territory of Ukraine. Besides tremendous human losses, the war caused the biggest refugee crisis in Europe since World War II. Approximately 7 million people fled the country; women, some pregnant, and children made 90% of them. Cord blood (CB) banking appeared to be an industry especially sensitive to these unprecedented conditions.ObjectiveThe objective of this study was to analyze the experience of CB banking in Ukraine during the Russia-Ukraine war in 2022.MethodsThematic analysis was performed.ResultsDespite the scarce number of hematopoietic stem cell (SC) transplants for blood malignancies performed there, Ukraine has been a country with a developed regenerative medicine program, with dozens of clinical trials applying perinatal tissues SC. Access to SC therapy was one of the main purposes of medical tourists in Ukraine. The Ukraine’s first CB bank launched in 2003 at the Institute of Cell Therapy LLC and was the main supplier of cell and tissue products to state medical institutions in the country. Thus, the consequences of war, such as disrupted logistics (24,000 km of roads and 300 bridges were destroyed during the first 100 days), ruination of hospitals including maternity clinics (almost 700 health facilities were damaged as of June 9, 2022), lack of human staff (men were mobilized for army and women fled the country), and lack of petroleum, made the successful implementation of contracts on CB storage and SC therapy for both Ukrainian and foreign patients sometimes impossible. The lack of liquid nitrogen experienced during the beginning of the war endangered at least 40,000 CB samples stored at Ukrainian CB banks, as well as biological material at fertility clinics.DiscussionThe unprecedented experience of CB bank operation during the war showed that, for safety reasons, CB banking facilities should be located distantly from strategic objects (eg, railways, airports, and military bases), and should have significant reserve storages of liquid nitrogen, generation reserves, bomb shelter. However, having dedicated personnel was the most important factor allowing for the enterprise functioning in force-majeure events.

Challenges of developing a new model of a medical institution providing primary health care in conditions of optimizing the health system

Introduction. Measures implemented in the form of a project to change the activities of medical instituions are recognized as successful if, on the basis of intensive diagnostic and treatment methods, the maximum possible amount of medical care is provided in compliance with licensing requirements. The purpose of the study was, taking into account the trends in the attitude of the population towards the activities of private medical institutions, to conduct not only an analysis of the activities carried out by the authorities and management to improve the model of the state medical institution, but also to identify possible problems that, against the background of optimizing the health system, can impede the successful implementation of appropriate management decisions. Materials and methods. The material for the comparative analysis was the normative legal acts of state authorities and management bodies, as well as the results of measures taken in the Kemerovo region to optimize the regional health care system and the information obtained by questionnaire of patients of a private medical institution. The analysis database was created in the IBM SPSS Statistics 22 license statistical package. Statistical comparison of ordinal and qualitative traits in independent groups was carried out using the chi-square test (χ2) and the Z-test. Differences are statistically significant at the difference level p < 0.05. Results. Patients who took part in the survey as respondents gave a higher rating to a private medical institution on the following indicators: management of work, quality of prescribed treatment, staff attitude to patients, waiting time for admission, sanitary condition of the institution, satisfaction with the quality of services. Differences are statistically significant. Limitations. As part of the study of the results of the implementation of a new model of a medical institution providing primary health care in the context of optimizing the healthcare system, an analysis of regulatory documents on the problem under consideration and a survey of two hundred nineteen residents of Novokuznetsk who sought medical help at the clinic of Grand Medica LLC were carried out. Conclusions. The conclusions contain not only an assessment of the declared level of the priority project being implemented, but also possible management decisions, the implementation of which will contribute to a positive change in the health system.

Professional Profile of Communication Experts in the Public Administration in Bulgaria

This paper presents the results of a study of the professional profile of communication experts in the public administration in Bulgaria. It is part of a project focused on public communications in the public administration in the country. A review of previous local studies of the public communications of the state administration was carried out. The research was conducted in 2021 in a survey filled out by 182 respondents who work as communication experts in state structures such as the Council of Ministers, ministries, state agencies, state commissions, regional administration, municipal administration, and state medical institutions, state universities, etc. The results summarize the skills of PR experts in the state administration in the following main directions: strategic competencies, narrative competencies, and technological competencies.

НОВЫЕ ПОДХОДЫ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ОСЛОЖНЕННЫМ ДЕСТРУКТИВНЫМ АППЕНДИЦИТОМ

Abstract. Introduction. The treatment of complicated forms of acute destructive appendicitis remains an urgent problem of urgent abdominal surgery. Aim. The aim of our investigation was to substantiate the use of VAC-therapy to improve the results of surgical treatment of patients with acute destructive appendicitis complicated by typhlitis and periappendicular abscess. Material and methods. The present investigation is based on the results analysis of 84 patients aged from 17 to 78 years with acute destructive appendicitis, complicated by typhlitis and periappendicular abscess, being treated at the department of surgery 2 of the State Medical Institution City Clinical Hospital 7 of Kazan. Open ligature appendectomy was performed in all cases due to pronounced infiltration of the cecum dome. Two groups of patients were singled out according to the method of ОБМЕН ОПЫТОМ ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 15, вып. 2ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2022 Том 15, вып. 4110 surgical intervention completion. In 54 patients of the comparison group the surgical intervention was terminated by gauze- gingival drainage of the appendix bed, since there was a high probability of appendix residual limb failure and necessity of purulent process isolation from the free abdominal cavity. Penrose drainage was removed through the surgical wound. In addition, the pelvis was drained through the contraperitoneum with a tubular drain. In 30 patients of the main group after appendectomy for abdominal cavity drainage we connected a Vacuum–assisted closure-system using Vivano apparatus and consumables of Hartman, Germany. Statistical processing of the results was carried out using Statistiсa 10 software package and Miсrosoft Exсel 2010. The differences were considered statistically significant at p<0.05. Results and discussion. Analysis of the used surgical techniques showed that in the main group the wound postoperative complications decreased by 3 times and were 23,3%; formation of the abdominal cavity infiltrates was 2 times less; period of hospitalization decreased by 1,8 times. Conclusion. Ease of implementation of VAC-therapy method, therapeutic and economic feasibility allow us to recommend it as the final stage of treatment of acute destructive appendicitis complicated by typhlitis and periappendicular abscess