Journal «MEDICINA» 3/2023

The article analyses the dynamics of the incidence of chronic bronchitis (CB), bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) among the population of the Russian Federation in 2010-2022, both adults aged 15 and over and children aged 0-14 years. Despite the fact that the increase in the incidence of respiratory diseases (RD) in 2000-2021 was not the highest, compared with other classes of diseases, respiratory diseases currently remain the most common in the Russian Federation. In recent decades, the country has carried effective tobacco control measures, taking into account that tobacco is the leading risk factor for many RD, and adopted clinical guidelines for asthma and COPD. On the other hand, the pandemic of a new coronovirus infection COVID-19 in 2010-2021 significantly influenced the registration of newly diagnosed cases of COPD and BA, marking a sharp decrease in the incidence of registered COPD and BA. In general, for the period 2010-2022 there was a decrease in the incidence of chronic bronchitis and an increase in the incidence of asthma in the adult population. The incidence of CB and BA in the children's population has been steadily declining every year. Dynamics of COPD incidence in 2010-2022 adult population showed no significant trend. However, due to significant fluctuations in the incidence of COPD caused by the change in the statistical accounting of the nosology «other chronic obstructive pulmonary disease» in 2014 and the COVID-19 pandemic in 2020-2021, it is impossible to analyze the dynamics of the true incidence of COPD and BA in the study period.

Key words: morbidity, respiratory diseases, COPD, bronchial asthma, chronic bronchitis, morbidity dynamics

The Constitution of the Russian Federation enshrines the rights of citizens to healthcare and medical care. In the paper, we study the prevalence of problems in the implementation of the rights of citizens insured in the system of compulsory medical insurance among patients of Orenburg branch of the S. Fyodorov Eye Microsurgery Federal State Institution by conducting a survey of patients in 2022. Assessing the results of the study, it should be noted that the issues of medical and legal literacy of the population are an urgent problem of modern society.

Key words: medical and legal literacy of the population, compulsory health insurance, ophthalmological medical center

The article discusses the trends in the use of antipsychotic drugs in the treatment of patients with schizophrenic spectrum disorders (RSHS) in the context of the reorganization of the psychiatric service on the example of Moscow. The reform of the psychiatric service (2012-2020) has radically changed the structure of psychiatric care, the system for evaluating its effectiveness and the economic basis. While the number of inpatient beds decreased by more than 3 times, the number of places in day hospitals increased by more than 2 times, the number of visits to a psychiatrist in the outpatient network increased by 2.5 times during the year. During the period under review, the number of repeated hospitalizations of patients with RS in psychiatric hospitals has also significantly decreased. At the same time, stable indicators of the incidence of RS during the considered period of time remain. Simultaneously with the reform of the psychiatric service, there was an increase in the consumption of antipsychotics from 7.6 million Defined Daily Dose (DDD) in 2013 to 12.3 million DDD in 2021, including conventional (KA) and atypical antipsychotics (AA) from 17% to 30% with an outstripping increase in the use of prolonged injectable antipsychotics (primarily AA). If in 2013-2016 AA of prolonged action made up an insignificant part of the total array of prolonged drugs (5-9%), then there was a consistent increase in their use. In 2021 they accounted for 36% of the total volume of prolonged-acting drugs (an increase of 400%), with a general increase in the use of prolonged forms by about 3 times. There was a sevenfold increase in the proportion of injectable forms from the total volume of AA – from 3% (2016) to 23%, and a twofold overall increase in the volume of AA use from 2.5 million DDD (2013) to 5.8 million DDD (2021). It is stated that there has been a stabilization of the system of providing psychiatric care to patients with RSHS with a shift of emphasis to the outpatient link and the widespread introduction of prolonged AA. To the greatest extent, these trends are found in the increasing use of risperidone-const and prolonged forms of paliperidone. It is concluded that the psychiatric service is on the threshold of a new stage of development, which represents a way of personalizing psychiatric care based on an individual approach to the patient.

Key words: psychiatric service, reorganization, antipsychotics, atypical antipsychotics of prolonged action, personalization of psychiatric care

Introduction. The coronavirus disease pandemic (COVID-19) is a leading global health and economic concern. The danger to the mother and fetus during pregnancy from infection with SARS-CoV2 is still being studied. New evidence suggests that SARS-CoV-2 infection causes oxidative stress during pregnancy and immune system activation, leading to cytokine storm and subsequent tissue damage. Objective. To establish the pathogenetic role of oxidative stress in the occurrence and severity of COVID-19 and, more importantly, pregnancy outcomes in female patients. Results. A systematic review of the scientific literature in the following databases was performed: PubMed, ResearchGate, Medscape, Cochrane Library. Key searches included the words: pregnancy, oxidative stress, placenta, cytokine storm. Based on a review of the literature, the following conclusion was reached: morphofunctional placental changes resulting from oxidative stress in SARS-CoV-2-infected mothers may result from disorders of the mother-placenta-fetal system caused by systemic viral exposure, resulting in a pathogenetic vicious circle involving systemic inflammation that exacerbates oxidative stress in both the placenta and systemically in the woman. Conclusion. This review highlights the general characteristics of oxidative stress in pregnant women with COVID-19. A better understanding of the mechanisms of SARS-CoV-2 infection and its impact on placental function is critical because the association of pregnancy complications and COVID-19 can lead to potential risk of intrauterine fetal development.

Key words: COVID-19, placenta, pregnancy, oxidative stress, inflammation

Background: Logging results in big amount of wood waste, including Siberian fir cones, which can be used in medicine. Aim of the study: Determination of the content and component composition of the essential oil of Siberian fir cones, as well as acute toxicity and antiradical activity of their aqueous extract. Materials and methods: As the object of exploration was used Siberian fir cones, procured in August 2022. Content study of essential oil was carried out by Clevenger apparatus. Study of the component composition was carried out with gas chromatograph Agilent 7890A with mass spectrometer Agilent 5975C. The infusion was prepared from cones, acute toxicity was determined by oral administration of an infusion to mice. For determination of the antiradical activity, we used reaction with the stable free radical 2,2-diphenyl-1-picrylhydrazyl. Results and discussion: The study revealed that the dominant constituents of the essential oil of Siberian fir cones are monoterpenes. The main component of essential oil is bornyl acetate. Optimal conditions have been developed for assessing the quality of cones according to the content of essential oil. The content of essential oil of Siberian fir is 1,16±0,02%. Next, the infusion of Siberian fir cones was prepared and it was found that oral administration of the infusion at a dose of 2000 mg/kg and 2500 mg/kg did not lead to the death of rodents during two weeks of observation. The infusion has a pronounced antiradical activity, which was proved by comparing the activity with the action of well-known antioxidants – rutin and hyperoside. Conclusion: The research resulted in the establishment of component composition and optimal conditions for determination of content of essential oil in Siberian fir. It has been established that an infusion of Siberian fir cones does not cause death of rodents when administered in large doses and has a pronounced antiradical activity. The data obtained allow us to consider Siberian cone fir as a promising type of medicinal plant material.

Key words: Siberian fir, cones, essential oil, infusion, acute toxicity, antiradical toxicity

The level of population awareness and alertness in the prevention of rabies, as well as the organization of anti-rabies prevention for the population, is an important factor that plays a role in the development of the epidemic process of this disease. Therefore, we conducted a study to assess the awareness of the population in the Tatarstan Republic on the rabies epidemiology and prevention. Materials and methods. An anonymous online survey of the population permanently residing in the Tatarstan Republic (n=105) was conducted. Categorical data is presented as percentages (%) and absolute values. Results. 32 men (30.5%) and 73 women (69.5%) took part in the survey. The age of the respondents was 18-66 years, the median age was 26 years [Q1-Q3=23-30 years]. 88.6% of respondents live in the city (93/105), 11.4% (12/105) – in the rural area. 91.4% of respondents (96/105) believe that rabies can be infected through bites, scratches, and salivation by animals; only 59.0% (62/105) know that infection can occur when animal saliva gets on wounds. Only 66.7% of respondents (70/105) know about the existence of an anti-rabies vaccine. 60.0% (63/105) of respondents have pets, but among them only two thirds (65.1%, 41/63) have vaccinated their pets against rabies. A third of the respondents (35.2%, 37/105) experienced contact with an animal (bite or salvation of a wound). Among those who had contact with animals, more than half (54.1%, 20/37) did not seek medical help after the injury. Among the respondents who did not apply to a medical organization for help after the injury (n=20), only 45.0% of people suffered from vaccinated animals. 10.0% of respondents suffered from unvaccinated animals. In other cases, the vaccination status of the animal was unknown (45.0%). Conclusion. The study demonstrated an insufficient awareness in the rabies prevention and a low rate of seeking medical help in population after injury received from animals.

Key words: rabies, awareness, epidemiology, prevention

Background. The problem of the prevalence of HIV infection is a topical problem not only in the Russian Federation, but also in global healthcare. HIV infection and the consequences of HIV prevalence threaten the health of the working-age population and cause significant damage to the country’s economy. The article presents some epidemiological features of HIV infection in the Russian Federation at the present stage. Materials and methods. We used data from English and Russian literary sources. The research method is analytical (theoretical analysis and synthesis of scientific literature data). Results and conclusion. During the study period, the proportion of contingents of different age groups in the structure of the overall incidence of HIV infection changed: in 1987, the largest prevailing group was from 20 to 30 years old (more than 60% of all newly diagnosed cases of HIV infection). Every year there was an increase in the share of other age groups – in 2021 the prevailing group was from 30 to 40 years old, as well as a group from 40 to 50 years old, i.e. population of working and reproductive age, which affected the change in the structure of routes of transmission of HIV infection, where sexual intercourse through heterosexual contact became predominant, while the contribution of the artificial route of transmission has decreased. Currently, the Russian Federation is in the concentrated stage of the HIV epidemic.

Key words: epidemiological features, HIV infection, literature review

Drink-driving remains one of the leading causes of road accidents with a high level of injury and mortality. In most high- and middle-income countries (according to the World Bank classification), the completion of drink-driving rehabilitation course is provided at the legislative level as a prerequisite for reinstatement of the license. Over the past decade in the Russian Federation, one observes the growth in the proportion of alcohol-related road injuries in the overall structure of road injuries. Despite that, the abovementioned approach to reinstatement of the driving license for drink-driving offenders remains insufficiently studied. Accordingly, the results of the review of foreign rehabilitation programs for drink-drivers will allow us to identify effective strategies, making it possible to develop a pilot project adapted for use in the activities of the narcological service of the Russian Federation. Of particular interest is the study of the experience of rehabilitation programs for drink-drivers in New Zealand and the UK, that started with initially identical approaches to the appointment of rehabilitation programs in these countries and their subsequent development. The obtained results of the review of foreign experience in the rehabilitation of drink-drivers indicate the need to use not only an integrated approach including various stages (educational, if necessary – therapeutic, preventive in order to prevent cases of repeated driving of vehicles in a state of intoxication), but also to provide an approach designed to stimulate the involvement of drivers-offenders in rehabilitation programs. The use of such an approach in most high- and middle-income countries makes it possible to carry out both effective re-admission of offending drivers to driving vehicles and to reduce the frequency of cases of repeated driving while intoxicated.

Key words: driver, driver intoxication, alcohol intoxication, prevention of intoxication, vehicle, preventive program, rehabilitation program, driver rehabilitation, admission to management