Journal «MEDICINA» 3/2025

The identification of a patient as a subject of medical-legal relations is a mandatory condition for the implementation of the state-guaranteed program of free medical care for citizens and for the legitimacy of medical activities within the territory of the Russian Federation. Identification allows for the full realization of citizens' rights to quality care under the compulsory health insurance (CHI) system and ensures the protection of medical workers from negative legal consequences in cases of patient rights violations. The failure to provide medical care due to the inability to identify a patient entails liability for the specific employee or medical organization.

Key words: patient identification, patient’s rights, medical workers' duties, failure to provide medical care, liability for failing to provide medical care

Background. The dopamine transporter gene SLC6A3 (DAT1) regulates synaptic dopamine levels by directly interacting with the opioid system in the mesolimbic reward pathway. Its VNTR polymorphism may modulate the response to the μ-opioid receptor antagonist naltrexone. Purpose of the study. To evaluate the effect of VNTR SLC6A3 on the efficacy of extended-release naltrexone (ER-N) in alcohol dependence (AD), with a focus on opioid-dopamine interaction as a key mechanism of action of the drug. Material and methods. In a 180-day prospective study, 100 Russian-speaking patients of Slavic origin with AD received monthly injections of PN. Genotyping of VNTR SLC6A3 was performed by PCR with electrophoretic detection of fragments. Validation of 20% of samples by sequencing (ABI 3500xl) confirmed 100% accuracy. The distribution of genotypes corresponded to Hardy-Weinberg equilibrium (χ²=1.32, p=0.25): 10R/10R (n=63), 9R/10R (n=33), 9R/9R (n=4). The duration of remission, adherence to therapy, frequency of relapses, dynamics of pathological craving (PACS scale), as well as phenotypic characteristics (craving structure and type of motivation) were assessed. Results. Carriers of the 9R/10R genotype had the most favourable clinical outcomes: 153.7±33.1 days (p=0.047), completion of therapy – 81.8% (p=0.048), decrease in craving according to PACS =-7.3±2.1 (p<0.001). The 9R/9R group (n=4) was not included in statistical comparisons due to its small size. The risk of relapse in carriers of ≥1 9R allele: OR=0.49 (95% CI: 0.24–0.99; p=0.048). Conclusion: VNTR SLC6A3 may modulate the efficacy of PN by influencing dopaminergic tone, which determines the sensitivity of the opioid system to blockade. Intermediate DAT expression in 9R/10R heterozygotes likely optimises naltrexone's ability to suppress opioid-induced dopamine release in the nucleus accumbens. The data obtained highlight the need to study the polygenic background (including OPRM1) for personalising therapy.

Key words: SLC6A3, DAT1, alcohol dependence, extended-release naltrexone, pharmacogenetics, dopamine, relapse

Relevance. Obesity and related metabolic disorders represent a global contemporary issue. From 1975 to 2016, the number of obese people worldwide more than tripled, reaching 13% of the global adult population (11% of men and 15% of women). In Russia, the number of individuals with excess body weight has remained high over the past 30 years, with a pronounced upward trend. There is a rapid increase in the number of registered cases of obesity-associated diseases. Nutritional correction is a key strategy for the prevention and treatment of obesity and its related comorbidities. Objective. To provide a concise review of diets used for weight loss purposes. Materials and Methods. An initial keyword search in the Pubmed, Google Scholar, Cochrane Library, and e-library databases yielded 34,227 references. The inclusion criteria for the review were full-text articles or monographs in English or Russian, comprising original observational and experimental studies, as well as meta-analyses and systematic reviews. Results and Discussion. Overweight and obesity are the result of abnormal or excessive fat accumulation that may impair health. The excessive functional activity of visceral adipose tissue drives the development of a wide range of complications. The analysis of a patient's health status and the determination of indications for pharmacotherapy or bariatric surgery, using cognitive-behavioral psychotherapy techniques, should involve physicians of various specialties experienced in this field. In the treatment of obesity, measures aimed at normalizing metabolic disturbances are of primary and pathogenetic importance. The pathogenesis of metabolic syndrome is significantly influenced by nutrient deficiencies, particularly of vitamins, macro- and micronutrients, polyunsaturated fatty acids, and other biologically active substances. Therefore, the diet must ensure a high-quality composition of consumed foods (proteins, fats, carbohydrates, vitamins, and minerals) to maintain the necessary level of metabolism. A crucial condition for achieving these goals is dietary diversity. Conclusion. Lifestyle modification recommendations and rational, personalized nutritional correction can help patients achieve positive outcomes in many aspects of their health.

Key words: obesity, treatment, diet

Introduction: in 2022, against the backdrop of the escalation of the military conflict in Donbass, the adaptive resources of the personality of many people were on the verge of maladjustment. According to the director of the Scientific Research Center for Humanitarian Problems Agaev N., psychogenic losses among the personnel of the Armed Forces of Ukraine are about 80%. The increase in this indicator is due to the fact that modern armed conflicts differ in nature from traditional local wars. Thus, it is necessary to search for new approaches to the diagnosis, prevention and treatment of mental disorders in military personnel. Objective of the study. Aim. To study the structure and clinical and psychopathological features of mental disorders in persons serving in the military under the conditions of a special military operation (SMO). Materials and methods. The study group included military personnel participating in the SMO who underwent emergency treatment in the 24-hour inpatient department of the State Novosibirsk Clinical Psychiatric Hospital №3 in Novosibirsk from 2022-2024. The sample included 133 men. The study used clinical-psychopathological, psychodiagnostic methods and the method of mathematical processing of the results using the computer programs Microsoft Excel and Statistica10. Results and discussion. The analysis of the obtained results showed that in the sample we studied, mental disorders and behavioral disorders caused by the use of psychoactive substances (PAS) (61%), as well as stress-associated (18%) and organic mental disorders (9%) prevail. According to the nosological affiliation, the most common mental disorder in the study group was psychosis against the background of alcohol withdrawal, mainly hallucinatory (26.1%, n = 35), with delirium (22.4%, n = 30). The clinical picture of alcoholic psychosis is classical, not causing difficulties in diagnosis. However, the presence of a military theme in the hallucinatory symptoms attracts attention. In second place in terms of detection frequency, non-psychotic stress reactions prevail in the form of PTSD (13.5%, n=18), disorders of adjustment reactions (3.7%, n=5). Of the 18 subjects in this subgroup, eight attempted suicide. In third place in terms of occurrence frequency is organic personality disorder (5.3%, n=7). The clinical picture of the disorder developed after receiving a combat wound, head injury, concussion, shell shock. Patients with behavioral disorders were hospitalized in a psychiatric hospital for further examination and treatment. Conclusions. The problem presented in the study requires further in-depth and multifaceted study on larger samples, and monitoring of the condition of the SVO participants before and after the end of the conflict is required. This will help to develop more relevant and effective recommendations in the field of mental health of military personnel. In the future, we plan to conduct a detailed analysis of suicidal behavior in the studied group of patients.

Key words: combat stress, military personnel, special military forces, combatants, mental disorders, PTSD

Relevance. The provision of the population with effective and safe medicines has always been a top priority, making the search for new promising molecules a relevant task. A research group led by Professor I.A. Volchegorsky at the South Ural State Medical University has synthesized «Thioxipine» (TOP) – a new complex ester exhibiting antihypoxic activity (Russian Patent No. 2797949, dated June 13, 2023). Aim. To study the possibility of using ultraviolet spectrophotometry (UV spectrophotometry) for the analysis of 2-ethyl-6-methylpyridinol-3-yl thiooctanoate and to develop methods for its quantitative determination. Materials and methods. The test substance is an intense yellow oily liquid; it is insoluble in water but soluble in 95% ethyl alcohol, which was used as the solvent. Samples were weighed on an OHAUS EX224/AD analytical balance (USA). Measurements were performed using an SF-56 spectrophotometer («LOMOSPEKTR», Russia) equipped with quartz cuvettes (l = 1.00 cm) at room temperature. Pure solvent was used as the reference solution. Class A volumetric glassware was used at all stages of the study. Results. Two methods for the quantitative determination of the new ester using ultraviolet spectrophotometry are proposed. The first method involves direct spectrophotometric determination of the test substance at λ=269 nm. The method demonstrates linearity in the concentration range of 0-200 µM (r=0.9999), and the recovery rate falls within 98.14–101.41%. The repeatability of the determination is indicated by an RSD value of 1.41%. The probability of an erroneous result is p<0.05, indicating the absence of significant systematic error in the determination. The second method is a variant of differential spectrophotometry and allows for avoiding errors in the quantitative determination of Thioxipine in the presence of its hydrolysis products. The optical density of model solutions containing Thioxipine and its hydrolysis products was measured at λ=269 nm and λ=287 nm against the pure solvent. The value ΔD = D₂₆₉ – D₂₈₇ was used to calculate the ester content in the sample. A linear dependence of ΔD on the Thioxipine concentration is observed in the range from 0 to 300 µM (r=0.9997), and the recovery rate for Thioxipine remains within 100.8–101.4%. The maximum value of the relative error in a series of determinations using the differential spectrophotometry method was 1.45%, which is lower than the value of 2.02% obtained with the first method. Conclusions. The preferred applications of the developed methods are indicated. Their metrological assessment demonstrates the feasibility of using the UV spectrophotometry method for the analysis of 2-ethyl-6-methylpyridinol-3-yl thiooctanoate (Thioxipine).

Key words: thioctic (lipoic) acid, 2-ethyl-6-methyl-3-hydroxypyridine (emoxypine), 2-ethyl-6-methylpyridinol-3-yl-thiooctanoate (Thioxypine), spectrophotometry, quantitative determination

Infectious diseases in children, despite the successes of vaccination programs, continue to pose a significant problem for global public health, leading to the development of serious long-term consequences. This article reviews the general mechanisms behind such complications, including immune dysregulation, neurocognitive and mental disorders, metabolic and endocrine disturbances. It also provides a detailed analysis of the long-term sequelae of measles, polio, Epstein-Barr virus (EBV), and COVID-19 (SARS-CoV-2). Special attention is paid to the phenomena of immunological amnesia, molecular mimicry, and chronic inflammation as key links in the pathogenesis. The significant disparities in infection rates and outcomes between countries with different income levels are highlighted, along with the socioeconomic factors that exacerbate the situation in resource-limited regions. The article reviews modern approaches to mitigating the chronic consequences of past infections, including expanding vaccination coverage, early diagnosis, telemedicine technologies, and comprehensive rehabilitation measures. Promising research directions are identified, such as the development of predictive biomarkers and the integration of international efforts to address existing global inequities in pediatric healthcare. The authors emphasize the need to shift from simply preventing acute infections to forming a systemic approach aimed at preserving children's health in the long term. It is underscored that insufficient attention to the long-term complications of infectious diseases in children significantly increases the medical, social, and economic costs to society. Evidence is also presented that adequate preventive and therapeutic measures can substantially reduce the risk of chronic complications and improve the quality of life for patients who suffered from infectious diseases in early childhood.

Key words: infectious diseases, child, vaccination, autoimmune diseases, neurocognitive disorders, Epstein-Barr virus infections, COVID-19

The Professor Rozanov V.N. Pushkino Clinical Hospital plays a significant role in providing High-Tech Medical Care (HTMC) to the population of the Moscow Region. HTMC is the most costly component of specialized medical care, yet the demand for it is constantly growing. This study describes the organization of HTMC at the Pushkino Clinical Hospital. Statistical data are analyzed, and an assessment is provided of the application of the main methods and tools used for organizing HTMC delivery. Project management methods are employed to optimize workflow processes. An aspect model is used to determine cause-and-effect relationships in HTMC organization. The cost-utility analysis method is applied to evaluate treatment outcomes, with an example of calculating this coefficient for the «Traumatology and Orthopedics» profile provided. The use of relevant project management methods and tools is recommended for healthcare institution administrators to ensure a high standard of HTMC organization.

Key words: high-tech medical care, HTMC, project management, aspects model

Ocular blood flow can be used as a «diagnostic window» in the surgical treatment of primary open-angle glaucoma. The aim of this study is to investigate the parameters of retrobulbar blood flow in patients with POAG after trabeculectomy. The retrobulbar blood flow of 50 patients with an advanced stage of POAG was examined using a VOLUSON E8 device. The values of the peak systolic velocity, end-diastolic velocity, and resistive index in the retrobulbar vessels were analyzed one week before surgical treatment and 1.5 months after trabeculectomy. The study revealed statistically significant (p≤0.05) changes in retrobulbar blood flow parameters: an increase in the peak systolic velocity and end-diastolic velocity in the central retinal artery (CRA) and short posterior ciliary arteries (SPCA), and a decrease in the resistive index in the CRA and SPCA.The results of the study showed that trabeculectomy statistically significantly reduces intraocular pressure in patients with primary open-angle glaucoma. Concurrently, a significant improvement in retrobulbar blood flow parameters was recorded.

Key words: primary open-angle glaucoma, intraocular pressure, retrobulbar blood flow, ocular blood flow, trabeculectomy

Introduction. Healthcare-associated infections (HAIs) are one of the global challenges in modern medicine. Anesthesia and intensive care units pose the highest risk of patient infection due to the high number of invasive procedures, their prolonged duration, and the irrational use of antibiotics. Aim of the Study. To analyze the prevalence, etiological structure, and antibiotic resistance of HAI pathogens in the intensive care unit of the Belgorod Regional Clinical Hospital for the period 2022-2023. Materials and Methods. Active surveillance methods were used for an objective assessment of the epidemiological situation. Microorganisms were isolated from diagnostic samples using standard microbiological techniques. The results of microbiological studies were analyzed using the qLIS laboratory information system and the WEB-hospital electronic medical record system. Results. Eighty-seven HAI cases were registered in the intensive care unit during the study period. The dominant pathogens were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Most Klebsiella pneumonia strains were producers of extended-spectrum beta-lactamases (ESBLs) and carbapenemases. Acinetobacter baumannii and Pseudomonas aeruginosa strains were resistant to cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides. Conclusions. During 2022-2023, the leading etiological agents of HAIs in the intensive care unit were Gram-negative bacteria (Klebsiella, Acinetobacter, Pseudomonas) and Gram-positive bacteria (Staphylococcus). The isolated microbial strains exhibited antibiotic resistance to most antimicrobial drugs used in the hospital. Therefore, one of the key factors for HAI control should be the continuous monitoring of the species composition and resistance patterns of dominant pathogens. This allows for the timely adjustment of antimicrobial therapy and anti-epidemic measures, thereby minimizing HAI cases.

Key words: infections related to medical care, epidemiologic monitoring, antibiotic resistance, Belgorod