Vol 67, No 2 (2023)

Introduction. The outpatient stage of management of patients with malignant neoplasms does not have additional funding. Availability of patients to prescribed drugs on outpatient review of funds allocated by the Russian Federation for the purchase of drugs based upon budgets providing for benefits. In connection with the study of the problem of procurement of drugs for the treatment of patients with malignant neoplasms in outpatient treatment, an urgent task arises, the solution of which is the essence of the development of a study on the planning of drug treatment of patients.

Purpose is to study the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment in the Federal Districts of the Russian Federation.

Material and methods. To study the availability of patients with malignant neoplasms, the supply of medicines for the treatment of patients with malignant neoplasms in 2019 and 2020 to hospitals purchased at the expense of the constituent entities of the Russian Federation and the federal budget in the Federal Districts was analyzed. We compared the funds spent between the subjects of the Russian Federation in terms of patients with a first diagnosis. To compare the provision of patients with drugs, we recalculated the amount of funds spent on the purchase of drugs per patient with a newly diagnosed oncological disease living in the Federal District.

Results. Significant differences were found in the provision between the Federal Districts, reaching almost four times the size.

Limitations. When studying the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment, purchases of all Federal Districts of the Russian Federation at the expense of both the subjects of the Russian Federation and the federal budget were analyzed, which is a sufficient reference sample.

Conclusion. A significant difference in the amount allocated per patient both from the funds of the regional and federal budgets, with the newly diagnosed malignant neoplasm in the Federal Districts creates unequal conditions for treating patients on an outpatient basis.

Compliance with ethical standards. The study does not require the submission of the opinion of the biomedical ethics committee or other documents.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The author declares no conflict of interest. 

Received: April 21, 2022
Accepted: June 30, 2022
Published: April 28, 2023

The article describes the module “Medical certificate of death” of the medical information system of the Orenburg region. The article describes the results of operational monitoring of mortality in the Orenburg region.

The purpose is to analyze the results of monitoring mortality from all causes in the Orenburg region.

Materials and methods. A comprehensive analysis of the deaths registered in the Orenburg region in 2019 and 2020 was made. For this purpose, the depersonalized database of medical death certificates of the mortality monitoring system of the MIAC of the Orenburg region was used. The results were evaluated using parametric and nonparametric methods.

Results and discussions. The absolute number of deaths increased by 26% in 2020 compared to 2019. The maximum increase in mortality occurred in the class of “Respiratory diseases”. The leader in the absolute number of deaths with an increase of 40.5% was “Diseases of the circulatory system”. In general, the database does not trace the existence of a logical chain between the initial and immediate causes of death. In 78.67% of all causes of death according to medical certificates, the class of the original cause is not established.

Limitations. The research materials are limited by the capabilities and completeness of the database of medical death certificates of the MIAC mortality monitoring system.

Conclusions. The main part of the indicators in the structure due to the initial cause of death is associated with unspecified and unassigned conditions. A large proportion of causes of death where the class is not established are due to non-compliance with the ICD-10 coding rules for coding causes of death and choosing the original cause of death. There is no clear expert system of immediate and initial causes of death.

Compliance with ethical standards. Research does not require the submission of a biomedical ethics committee opinion or other documents.

Contribution of the authors:
Borshchuk E.L. — concept and design of the study, writing the text, editing;
Begun D.N. — concept and design of the study, collection and processing of the material, writing the text, statistical data processing;
Duisembaeva A.N. — compilation of the list of references.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: June 30, 2021
Accepted: October 14, 2021
Published: April 28, 2023

The problem of obtaining high-quality, affordable, effective medical care for the population in developing countries, especially the African continent, is urgent.

The purpose of the study is an assessment of Ethiopian health care system based on various health indicators of the country’s population.

The following indicators characterizing the health care system were used: health care financing, life expectancy, indicators of medical care, human resources capacity of health care institutions, population morbidity, crude mortality rate, maternal mortality rate, infant and child mortality rate, vaccine prevention. There were analyzed the scientific literature reviews, obtained from the incidence databases of the World Bank, the World Health Organization, the Ethiopian Ministry of Health and other sources. The search for scientific literature was carried out using the Scopus, Web of Science, MedLine, Global Health databases.

The review presents an assessment of the health care delivery system in Ethiopia, which identified a number of problems regarding the underfunding of the health care system. Maternal and child mortality rates were noted to be significantly reduced owing to the implementation of programs for prenatal care and vaccination of children. The distribution of highly qualified employees is biased towards private and non-governmental organizations. Statistical data showed an increase in the coverage of routine vaccination of children in recent years.

The analysis made it possible to determine the main directions of medical and preventive work and can fully serve as the base for the development of programs for the improvement of the population of Ethiopia.

Contribution of the authors:
Molla I.B. — writing of the text, responsibility for the integrity of all parts of the article, work with literature;
Kiku P.F. — the concept and design of the study, writing of the text;
Rasskazova V.N. — editing, writing of the text;
Bogdanova V.D. — writing of the text, work with literature.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version. 

Acknowledgment. The study had no sponsorship. 

Conflict of interest. The authors declare no conflict of interest.

Received: September 07, 2020
Accepted: January 14, 2021
Published: April 28, 2023

Introduction. The problem of palliative care developing is actual due to the increasing the proportion of older people and the number of patients with incurable diseases. The task of palliative care is to improve the quality of life in the incurable patient. To choose the best ways for solving this problem it is important to analyze all components of QL and it’s important for the evaluating the effectiveness of the measures taken.

The aim of this study was to assess the quality of life in patients in the palliative care unit and its trend.

Material and methods. The base of study — palliative care department. The EORTIC — QLQ30 and MSAS — SF questionnaires were used. The sample of patients included 82 people. The share of people with non-oncological diseases was 54.9%, with cancer — 45.1%. The study was conducted with an interval of one month.

Results. The analysis of the trend in the quality of life showed unreliable (p > 0.05) decrease in the QL: 31.5 — 25.4 points (the maximum is 100 points). The trend in the partial components were multidirectional. The indicators of the functional scale and the symptom scale decreased from 34.7 to 29.8 points and from 30.3 to 29.9 points. The indicator of financial well-being increased: 35.0 and 38.6 points, social well–being — from 14.0 to 17.1. According to the scales characterizing the psycho-emotional status of patients, there is a positive trend: the average score of emotional well-being increased from 68.1 to 74.4; cognitive — from 44.7 to 53.2. The overall GDI distress index on the MSAS-SF scale increased from 2.3 to 2.4 points (with a maximum of 4 points).

Limitations. Patients receiving palliative care; satisfactory condition; follow-up interval — at least a month.

Conclusion. Trend assessment in the quality of life in patients receiving palliative care should be carried out to obtain a comprehensive understanding of the urgent problems of the patient treatment, correction of therapeutic and care measures and may indicate their effectiveness.

Compliance with ethical standards. The study was approved by the Ethics Committee of I.P. Pavlov St. Petersburg State Medical University (Protocol No. 3 of 13.09.2019).

Patient consent. All patients signed an informed consent to participate in the study.

Contribution of the authors:
Petrova N.G. — concept and design of the study, writing the text, editing;
Yarovaya V.A. — collection and processing of the material, statistical processing, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: May 07, 2021
Accepted: May 26, 2021
Published: April 28, 2023

Metabolic syndrome among different age groups is one of the priority problems of modern health care in many countries. Currently, the medical and social significance of the metabolic syndrome is related o the high specific weight among the causes of disability and mortality, which, along with this, is the leading risk factor for cardiovascular, cerebrovascular, diseases, diabetes mellitus and their complications. The high prevalence of metabolic syndrome in the world ranges from 44.9% in Japan to 50.9% in Spain. Due to the continued increase in the proportion of the elderly and senile population, a further increase in the incidence of metabolic syndrome is predicted, and a pronounced gain in health care costs for outpatient and inpatient medical care.

The purpose of the study is to analyze the prevalence of the metabolic syndrome and its components according to the data of domestic and foreign reports.

Russian and foreign scientific reports, monographs, and collections of articles for 2003–2019 were retrospectively studied using computer search engines and peer-reviewed journals in international databases (Scopus, Web of Sciences). As a result of the search, 164 articles were selected for analysis, from which 128 works and materials were excluded due to incomplete information, unrepresentative sampling, and other reasons.36 publications served as the basis for this study.

An enlargement in the prevalence of metabolic syndrome in various countries, including Russia, with an increase in the age of the population in combination with arterial hypertension, diabetes mellitus, in the risk of developing cardiovascular complications by 2–3 times in the combination of metabolic syndrome with arterial hypertension and by 5 times-with diabetes mellitus.

Data on the prevalence of the metabolic syndrome will allow health care managers implementing preventive measures and, above all, to correct modifiable risk factors for the metabolic syndrome, such as obesity and hypertension, which are the most common components of the metabolic syndrome.

Contribution of the authors:
Agarkov N.M. — research concept and design, the collection and processing of the material, writing the text, editing;
Titov A.A. — the collection and processing of the material;
Korneeva S.I. — drawing up bibliography;
Kolomiets V.I. — drawing up bibliography;
Aksenov V.V. — statistical data processing, editing;
Kolpina L.V. — statistical data processing, editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article. 

Acknowledgement. The study had no sponsorship. 

Conflict of interest. The authors declare no conflict of interest. 

Received: July 21,2021 
Accepted: October 14, 2021 
Published: April 28, 2023

The emergence of COVID-19 almost coincided with the beginning of an active phase of the digitalization process in all areas, including the healthcare system. Moreover, COVID-19 unwittingly became the impetus that accelerated the adoption of digital technologies, and initiated new, often innovative solutions to combat both the virus and its devastating social and economic consequences.

The purpose of the study: the current study conducts a literature review of existing scientific reports in the field of digital contact-tracing COVID-19 using artificial intelligence (AI) technologies, to discuss issues related to the security of personal data when using official mobile applications, to draw conclusions and make recommendations in the field of effective and ethical management of digital contact-tracing as one of the main tools for preventing the spread of the pandemic.

Scientific reports contained in the scientific research databases of Ebsco Publishing and SpringerLink for the period March 2020 — April 2021 were analyzed.

Digital contact-tracing solutions have found their important place among other anti-epidemic measures in many countries around the world. However, the same solutions, but already using AI, are still gaining popularity. National governments in numerous developed and developing countries understand the importance of national contact-tracing systems, which in turn has introduced such approaches in national pandemic response strategies.

Conclusion. Digital contact-tracing technologies using AI can be an effective tool in the fight against COVID-19 and similar pandemics. However, such digital systems are still at a preliminary stage of their development and implementation, and it will take time before the results will be visible. Very few of the considered examples and models of digital tracing solutions using AI technologies have operational maturity at this stage.

Contribution of the authors:
Daminov B.T. — research concept and design, writing of the text, editing;
Ashirbaev Sh.P. — collection and processing of material, writing of the text, statistical data processing;
Vikhrov I.P. — research concept and design, collection and processing of material, writing of the text, compilation of the list of literature, statistical data processing, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: May 26, 2021
Accepted: October 10, 2021
Published: April 28, 2023

Purpose is to identify the features of the clinical picture, course and outcomes of Haff disease in the Tyumen region.

Materials and methods. A retrospective study was conducted. There were included nine patients (7 men and 2 women) with a diagnosis of “Alimentary-toxic paroxysmal myoglobinuria (Haff disease) (T62.8)”. Were collected original demographics (age, gender), symptoms, time to onset of initial symptoms, time to hospitalization, and laboratory tests (general blood analysis, biochemical analysis of blood, analysis of blood coagulation functions and of arterial blood gases).

Results. 4 (44.4%) patients had stage 3 severity, in 3 (33.3%) — stage 2 severity and in 2 (22.3%) — stage 1 severity of alimentary-toxic paroxysmal myoglobinuria. The main complaints presented by patients at the moment admissions were pain in the leg muscles (n = 6; 66.7%) and lower back (n = 6; 66.7%), dark urine (n = 5; 55.5%) and weakness (n = 4; 44.4%). Myoglobin, ALT, AST, LDH, CPK and CPK-MB were increased in all patients, the average level of these indicators was 4691.4 ± 2831.5 ng/ml, 1572.0 ± 547.5 U/L, 547.3 ± 158.2 U/L, 1555.7 ± 420.6 U/L, 33662.4 ± 15195.7 U/L and 1848.8 ± 692.6 U/L, respectively. The main complications developed in patients with stage 3 severity include acute renal and hepatic insufficiency and cardiomyopathy. Milder degrees of the disease (1–2 stages) were characterized by such complications as hepatitis and myocarditis. Also 1 death was observed, the analysis of this clinical case is analyzed in detail.

Limitations. The main limitation of the study is the small group of patients due to the rare occurrence of Huff disease. In addition, there are no data on the amount of eaten fish, while there is evidence of a direct relationship between the severity of the disease and the amount of eaten food. The results are obtained in this region, and may differ from the results of other territories.

Conclusion. with the development of myalgia or weakness of unknown etiology, it is necessary to ask patients if they have eaten fish in the previous 24 hours.

Compliance with ethical standards. The study was approved at a meeting of the Ethics Committee of the Tyumen State Medical University (protocol No. 112, February 13, 2023). All patients signed an informed consent to participate in the study. All methods used in the study were carried out in accordance with the legislation of the Russian Federation.

Contribution of the authors:
Lebedeva D.I. — research concept and design, writing the text, compilation of the list of literature, statistical data processing;
Marchenko A.N. — writing the text, statistical data processing, editing;
Sharuho G.V. — collection and processing of material;
Raspopova Yu.I. — collection and processing of material;
Turovinina E.F. — writing the text, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: February 28, 2023
Accepted: March 30, 2023
Published: April 28, 2023

Following the special attention of foreign colleagues to appoint doctors as hospital managers, the issue of appointing specialists without medical education to the management of medical institutions in Russia is increasingly being looked at and discussed.

The purpose of the study is to analyze historical and modern literary sources that highlight the experience of domestic and foreign healthcare by appointing specialists without medical education to the head positions of treatment and preventive medical institutions.

The analysis of literary sources from 1940 to 2021 was carried out in electronic scientific libraries: Scopus, Web of Science, MedLine, eLibrary, CyberLeninka, Central scientific medical library and the Russian State Library by keywords: manager, physician, physician leadership, hospital CEO.

The article presents historical data on the formation in Russia since the beginning of the 18^th century of the first medical institutions for the needs of the army and navy and the appointment of doctors to senior positions in them. From 1755 to 1908, the management of military hospitals was temporarily transferred to specialists without medical education, which led to numerous conflicts and a decrease in the efficiency of hospitals. Currently, in a number of foreign countries, in order to improve the quality of medical care, the issue of transferring managerial functions to doctors in hospitals is being actively discussed.

The main reasons for the discussion about the expediency of appointing specialists to senior positions in medical institutions without medical education are: shorter terms of their training; health care activities in market conditions; the need for modern managers to possess leadership, managerial, economic and legal competencies.

Conclusion. The work experience of domestic and foreign health care indicates the expediency of appointing doctors with leadership qualities and special training in the field of healthcare institutions and public health to senior positions in medical institutions. This contributes to the formation of a corporate culture in medical teams and improving the quality of medical care for the population.

Contribution of the authors:
Khoroshaev O.E. — collection and processing of material, writing text, compiling a list of references;
Tregubov V.N. — concept and design of research, writing text, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: February 10, 2022
Accepted: March 11, 2022
Published: April 28, 2023

Introduction. Data were obtained on the difference in the quantitative and specific composition of intestinal microbiota bacteria in practically healthy individuals with subclinical invasions by pathogenic intestinal protozoa Lamblia intestinalis, Blastocystis hominis. Сhanges in bacterial composition were shown to have characterological features and species-specific «targets» of intestinal microbiota destruction.

Material and methods. Bacteriological and parasitological research methods were used. For a comparative analysis of quantitative and specific changes in the symbiotic microflora, there were formed two groups: “Yes” and “No” for each type of pathogenic protozoa, bacteriological indicators were ranked by quantitative content — CFU “0–10³”, CFU “10³–10^max”, CFU “10^max”. Statistical differences in research results were determined by the Chi-square calculation method.

Results. Antagonistic activity of unicellular protozoa in relation to the symbiotic bacterial intestinal microflora in the examined population groups has a different degree of severity depending on the type of invasion. Parasitic pathogens were shown to inhibit up to 40% of the quantitative and 50% of the species composition of the intestinal microflora and are an aggressive biogenic factor in the destruction of biota. There are no limitations of the study.

Limitations. The studies had no methodological or administrative restrictions.

Conclusion. For the first time, significant statistical material has confirmed that asymptomatic parasitosis is a strong biogenic determinant of the development of destructive changes in the integral structure of the symbiotic microflora and the formation of a subclinical form of dysbiosis in an “almost healthy contingent” of the population. The asymptomatic carriage of Blastocysts spp. was found to have a more pronounced antagonistic effect on the bacterial composition of the intestinal microbiota than the presence of L. intestinalis, Blastocysts spp., form intestinal dysbiosis more aggressively, which indicates a greater pathogenic potential of B. hominis in the formation of intestinal pathology in humans.

Compliance with ethical standards. The studies were approved by the decision of the local ethical commission to use anonymized, de-identified, non-re-identifiable samples (protocol of the Federal State Budgetary Institution “CSP” of the FMBA of Russia No. 3 of 2013).

Contribution of the authors:
Kuznetsova K.Yu. — concept and design of the study, writing the text;
Sergiev V.P. — research concept and design, editing;
Kuznetsova M.A. — collection and processing of material, statistical processing;
Aslanova M.M. — collection and processing of material, writing text;
Zagaynova A.V. — collection and processing of material;
Fedets Z.E. — collection and processing of material;
Kovalchuk M.V. — statistical processing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version. 

Acknowledgment. The research was carried out within the framework of the research work “Development of technologies for cryopreservation and archiving of biological samples of human microecological resources (code“Cryobank”)”. 

Conflict of interest. The authors declare no conflict of interest.Received: May 19, 2021

Accepted: July 27, 2021
Published: April 28, 2023