Background. Community-acquired pneumonia (CAP) remains one of the most common diseases requiring urgent hospitalization, with a significant part of patients already receiving antibiotics before admission to the hospital. Aim. To assess the relationship between outpatient antibacterial therapy and in-hospital mortality and the severity of the CAP. Materials and methods. The retrospective study included the data of adult patients with CAP who were hospitalized in Tomsk from January 1 to December 31, 2017. Results. Among 1412 patients, 22.2% received antibiotics before admission to the hospital, the proportion of deaths in this group was significantly lower – 3.8% compared with 10.6% among patients without antibiotic therapy (p0.001). Subjects who received antibiotics on outpatient basis were less likely to require being in the intensive care unit and administering vasopressors, in contrast to patients without prior antibiotic therapy: 5.1 and 10.6% (p=0.003); 7.1 and 4.7% (p=0.018) respectively. In patients with severe CAP on a scale IDSA/ATS, only 11.8% of cases were detected with antibiotics before hospitalization, while in mild CAP the frequency of administration was 16.6% (p0.001). Conclusion. Ambulatory antibacterial therapy had a positive effect on the subsequent course and outcomes of CAP in a hospital setting. Patients had a predominantly mild course of the disease, needing for vasopressors, and being in the intensive care unit, but was not consistent with the need for invasive mechanical ventilation.

Relevance. Among the studies during the COVID-19 pandemic, a special role is played by studies examining the prognostic value of clinical, laboratory and instrumental markers in patients. Biomarkers with absolute sensitivity and specificity for predicting the outcome of a new coronavirus infection have not been identified yet.Aim: To identify early clinical and laboratory predictors of severity and mortality in hospitalized patients with COVID-19 and to evaluate the effectiveness of the pharmacotherapy in outpatient and early hospital settings.Methodology and research methods. A retrospective, comparative study was carried out. Medical data from 745 adult patients with COVID-19, hospitalized in the respiratory hospital of the Siberian State Medical University (Tomsk) from 05/16/2020 to 09/30/2020 were included. The main group consists of patients who were discharged from the hospital. The comparison group included patients with a fatal outcome of the disease.Results. The group of deceased patients was characterized by older age and a greater number of comorbid diseases (р < 0.0001), the presence of pneumonia during the year preceding COVID-19 (р < 0.0001) and risk factors for the development of Pseudomonas aeruginosa infection (р < 0.005). Early admission to the hospital (р = 0.0110), severe dyspnea (р < 0.0001) with a decrease in oxygen saturation below reference values (р < 0.0001) are also associated with the risk of a fatal outcome. Anosmia was significantly more common in the group of surviving patients.The number of platelets, the absolute number of lymphocytes, amounts of total protein, albumin (р < 0.0001), sodium (р = 0.0013) in the first 48 hours of hospitalization in the main group were significantly higher. The number of leukocytes (p = 0.0078), neutrophils (p < 0.0001), neutrophil-lymphocyte ratio (p < 0.0001), concentrations of glucose, aspartate aminotransferase, urea, creatinine, C-reactive protein and lactate dehydrogenase were significantly lower in the main group. Serum procalcitonin levels > 0.5 ng/ml were 5 times higher in deceased patients during early period of hospitalization.Conclusion. Clinical, anamnestic and laboratory factors were identified through this study. These factors may be useful in the early period of hospitalization for accurate assessment of risks of severe ill, effective disease management and reduction of mortality in hospitalized patients with COVID-19.

The article presents theses of the resolution of the Interdisciplinary Council of Experts in Psychiatry and Neurology (Moscow, 2024) on the issue of comorbid anxiety disorders (AD) in patients with neurological pathologies. The authors highlight the high prevalence of comorbid ADs and their significant negative impact on the course of underlying diseases, such as epilepsy, pain syndromes and post-stroke conditions. Modern approaches to the diagnosis and treatment of ADs in this group of patients are discussed. Special attention is given to the role of etifoxine as an effective anxiolytic in the comprehensive therapy of ADs. Etifoxine, due to its dual mechanism of action on GABA receptors, demonstrates high efficacy in reducing anxiety and has neuroprotective, neurotrophic, neuroplastic, analgesic, and anti-inflammatory properties, making it an important tool in the treatment of comorbid ADs in patients with neurological pathologies. The article also reviews recently published data confirming its efficacy and favourable safety profile compared to traditional benzodiazepines and other anxiolytic drugs.

This article describes two clinical observations of the use of mepolizumab in patients with severe uncontrolled asthma with a mixed granulocytic pattern of inflammation in the bronchi and comorbid pathology. The mixed granulocytic form of severe asthma is characterized by a combination of T2 endotype and non-T2 endotype. The most common mixed granulocytic pattern of severe asthma occurs in comorbid pathology, in particular, when it is combined with chronic obstructive pulmonary disease (COPD) or bronchiectasis.In the presented observations, both patients had an experience of smoking, a late manifestation of bronchial asthma with the development of centrilobular emphysema and an irreversible decrease in the FEV/FVC ratio as part of the development of COPD. A feature of one of the cases was the presence of cylindrical bronchiectasis in both lungs. The choice of mepolizumab as an additional maintenance agent at GINA stage 5 in both cases was justified by the uncontrolled course of asthma despite the use of a high dose of glucocorticosteroids in combination with other basic drugs and the need for the use of systemic corticosteroids > 50 % of the time per year, a history of recurrent exacerbations in previous 12 months, the presence of persistent blood eosinophilia (>150 cells/μl), as well as a combination of asthma with polypous rhinosinusitis in one of the patients.Overall, the use of mepolizumab 100 mg subcutaneously every four weeks in addition to regular maximum optimized maintenance therapy was characterized by rapid, signifi cant and sustained effi cacy, which was expressed in early achievement of asthma control within the fi rst 16 weeks of therapy.

After infection of the new coronavirus infection (NCI) COVID-19 of the patients, the development of long-term consequences can not be excluded and it is correlated not only with severe forms of the disease NCI COVID-19, but also with moderate and mild forms of th is pathology. Patients with rheumatic diseases that suffered from new coronavirus infection (NCI) COVID-19 are often encountered in doctors’ outpatient and inpatient practice. NCI can lead to an exacerbation of an existing rheumatic disease and can also be a trigger factor for autoimmune changes and the debut of a rheumatic disease. Th is article presents a clinical case of granulomatos is with polyangiitis (Wegener’s) of a patient after suffering from NCI COVID-19. The diversity of th is pathology makes its timely diagnostics quite a difficult task, oncological and septic processes, tuberculos is and rheumatological disease were excluded for a long time. Th is article reviews a long period of observation of the patient – the use of various diagnostic methods to verify the diagnosis, consultations with various specialists for differential diagnosis, and repeated changes in treatment due to periodic deterioration of the patient’s condition. Th is clinical case is a reminder to doctors, that it is extremely important to fully examine the patient and analyze the dynamics of symptoms during the therapy in details, that can highly increase the chances of earlier diagnos is of such diseases. In addition, a significant factor of improving the quality of provided medical care is the continuous education of each attending physician in order to develop interdisciplinary competencies.

Aim. To assess clinical and demographic characteristics of severe asthma (SA) patients and their management in Russian Federation. Materials and methods. This publication provides data for Russian part of population of the international observational study. In Phase I, retrospective analysis of medical records of patients with SA was performed with assessment of clinical and demographic data, medical history, comorbidities, treatment approaches and healthcare utilization. Phase II was a cross-sectional collection of patient-reported outcomes: level of asthma control assessed by ACT (Asthma Control Test) and health-related quality of life (HRQoL) measured using the EQ-5D-5L questionnaire. Phase I patients were enrolled into Phase II if they signed a written consent form. Results. A total of 315 patients were included in Phase I of the study, 106 (33.6%) of them entered Phase II. Majority of study participants were either obese (n=103; 39.8%) or overweight (n=94; 36.3%). The most common comorbidities were cardiovascular diseases (n=217; 71.4%), followed by chronic respiratory diseases (n=198; 68.8%). There were 268 (85.1%) patients who had at least one exacerbation during last 12 months. Data for blood eosinophil count were available in 176 patients; 81.3% of them (n=143) had only one test in the last 12 months. The mean (SD) last available blood eosinophil count was 161.2 (181.2) cells/mm3. Serum Immunoglobulin E (IgE) value was known for 88 patients, and the mean (SD) last measured IgE value was 254.3 (249.7) ng/mL. Only 4.7% of Phase II participants had ACT scores indicative of controlled asthma (20). As much as 74.5% had scores ≤15 suggesting uncontrolled disease. Most patients also had impaired HRQoL. Conclusion. Most SA patients had poor disease control with frequent exacerbations and high number of comorbidities. Blood eosinophils and IgE level measurements were not evaluated routinely which might be a barrier for appropriate phenotyping and treatment selection.

Aim. To determine clinical and laboratory factors associated with a severe course and lethality in hospitalized patients with COVID-19.Materials and methods. A retrospective comparative study included data of 745 adult patients hospitalized with COVID-19 from 16.05.2020 to 30.09.2020 (Tomsk, Russia). The intergroup comparison of indices, ROC analysis, and determination of odds ratio to assess the association between risk factors and the outcome were performed.Results. Age > 62 years, pneumonia within a year before COVID-19, and the presence of ≥3 comorbidities were associated with a fatal outcome (FO). Negative predictors of the outcome at the time of hospitalization included dyspnea, diastolic blood pressure ≤ 80 and pulse pressure > 48 mmHg, SpO2 < 94% (and/or a decrease to ≤ 89% throughout hospitalization). Laboratory predictors of FO at admission were platelets ≤ 183 × 109 / l, neutrophils > 4.57 × 109 / l, lymphocytes ≤ 1.08 × 109 / l, neutrophil-to-lymphocyte ratio > 4.8, aspartate aminotransferase > 39 U / l, urea > 6.75 mmol / l, lactate dehydrogenase > 219 U / l, blood albumin ≤ 38 g / l, C-reactive protein (CRP) > 47 mg / l. When threshold values were reached during any of the hospitalization periods, FO was associated with CRP > 38 mg / l, ferritin > 648.6 µg / l, D-dimer > 731.11 ng / ml, white blood cells > 14.27 × 109 / l, lymphocytes ≤ 0.73× 109 / l, duration of oxygen therapy > 3 days, need for non-invasive and invasive ventilation ≥ 1 day, need for glucocorticoid administration > 1 day, reaching a total course dose > 6 mg for dexamethasone.Conclusion. The factors associated with FO in hospitalized patients with COVID-19 were identified.

Despite significant progress in the field of prevention, early diagnosis and antibacterial therapy, community-acquired pneumonia still retains the status of not only the most common among acute infectious diseases, but is also a frequent source of sepsis, which greatly increases the likelihood of death in this group of patients. The purpose of the study was to perform a comparative analysis of clinical and laboratory parameters and assess the nature of their changes in the first 48 hours from the moment of verification of sepsis that developed against the background of pneumonia in patients of the therapeutic department, depending on the outcome of hospitalization.Clinical groups and research methods. A retrospective comparative study was carried out, which included, using a continuous sampling method, patients with sepsis that developed against the background of pneumonia in patients hospitalized in therapeutic clinics of the Federal State Budgetary Educational Institution of Higher Education Siberian State Medical University of the Ministry of Health of Russia in the period from 01/01/2019 to 04/30/2023. In total, the study included 40 patients of both gender, followed by division into two comparison groups depending on the outcome of hospitalization (discharge from hospital or death) for the dynamic assessment of clinical, anamnestic and laboratory parameters in the early stages of the development of a septic condition (the first 48 hours) in order to determine their relationship with the outcome of hospitalization.Results. All patients were divided into 2 groups. The first group (n=17, 42.5 %) consisted of patients with a favorable outcome of hospitalization (recovery), the second group (n=23, 57.5 %) consisted of patients with a fatal outcome. At the time of verification of sepsis, patients with a favorable outcome had a significantly lower SOFA score (3 (2; 6) points) than patients with a fatal outcome (6 (5; 7) points), p = 0.037. The change in urea concentration in the first 48 hours from the moment of verification of sepsis, which in the group of survivors was -1.3 (-4.4; 1.99) mmol/l, and in the group of deceased 5.5 (-1.5; 12. 2) mmol/l, p=0.020. In the group of deceased patients, 8 people (34 %) at the time of verification of sepsis had a combination of hypotension (<90/60 mm Hg) and serum lactate >5 mmol/l. In the survivor group, hypotension was observed in only 2 people (11 %), and lactate levels in these patients were in the range of 4.5- 4.6 mmol/l. At point 1, the indicators of immature granulocytes were not statistically significantly different between surviving and deceased patients (1.2 (0.7; 2.1)% vs 0.8 (0.6; 1.5)%, respectively, p>0. 05). After 48 hours, the level of immature granulocytes increased in surviving patients to 1.5 (1; 3.2)% and, conversely, decreased to 0.65 (0.45; 1.45)% in the group of deceased patients, and the difference in these indicators between groups became statistically significant, p <0.05.Conclusion. Thus, in patients with sepsis against the background of severe pneumonia, the mortality rate was 57.5 %. In order to identify groups at high risk of death due to sepsis due to pneumonia, in addition to the SOFA scale, dynamic monitoring of biomarkers such as urea, lactate, immature granulocytes and reticulocytes should be carried out in the first 48 hours from the moment of verification of the septic state.

New coronavirus disease (COVID-19) caused by SARS-CoV-2 is associated with a high mortality rate and is a major public health problem worldwide. In publications from the early months of the COVID-19 pandemic, the authors reported that hypertension (HTN) is associated with higher susceptibility to SARS-CoV-2 infection, severe disease, and increased mortality associated with COVID-19. The risk of more severe clinical manifestations of COVID-19 is higher in men and increases dramatically with age. However, according to the results of multivariate analyses with the inclusion of data on age, risk factors (RF) of cardiovascular diseases (CVD), diabetes mellitus, the independent role of HTN in the development and outcome of COVID-19 was not confirmed, while age turned out to be the most significant factor. The authors made the conclusion that HTN may not play an independent role in SARS-CoV-2 infection and the course of COVID-19, and the formation of adverse outcomes is influenced by old age. However, age-related changes include accumulated chronic diseases, their RF, target organ damage etc. Morphofunctional changes caused by a long course of HTN, the development of associated clinical conditions can increase the susceptibility of the cardiovascular system to the damaging effects of SARS-CoV-2, as well as contribute to the formation of adverse outcomes of COVID-19. In addition, diabetes mellitus, obesity, and other metabolic disorders associated with HTN negatively contribute to the course of COVID-19 and the risk of mortality. A more severe course of COVID-19 in HTN patients, especially the elderly, may be facilitated by the mechanisms of cellular and immune inflammation common in these diseases. The endothelial monolayer plays an important role. Endothelial injury and endothelial dysfunction in HTN and endothelitis in COVID-19 may reinforce each other, increasing the likelihood of cardiovascular events in patients with COVID-19. An important pathogenetic mechanism of HTN — the renin-angiotensin- aldosterone system (RAAS) activation — plays a significant role in the genesis of COVID-19. Angiotensin-converting enzyme 2 (ACE) is a key receptor for SARS-CoV-2 entry into human cells, providing a link between COVID-19 and RAAS. In this regard, it was expected that ACE inhibitors and angiotensin II receptor blockers (ARB), which modulate the RAAS, may increase the risk of SARS-CoV-2 infection and worsen outcomes in COVID-19. However, in further experimental and clinical studies, these assumptions were not confirmed. Moreover, currently international experts strongly recommend that ACE inhibitors or ARB be continued in HTN patients with COVID-19, as they protect against cardiovascular complications and improve prognosis. Observations have shown that COVID-19 significantly increases the likelihood of developing HTN, acute coronary syndrome, cardiac arrhythmias, right ventricular dysfunction, myocardial fibrosis, heart failure, and also increases the risk of death from CVD. Further clinical and long-term prospective studies are needed to evaluate the role of past COVID-19 as a RF for CVD and mortality.

Background. Dupilumab, a fully human monoclonal antibody directed against the common -subunit of interleukin (IL)-4 receptors and blocking signaling from both IL-4 and IL-13, may be recommended for the treatment of moderate to severe atopic dermatitis (AD) and bronchial asthma (BA). Aim. To perform a comparative assessment of the effectiveness of maintenance therapy with dupilumab in patients with severe BA as the main indication for genetically engineered biological drugs and in patients with severe asthma with concomitant severe AD as the indication for targeted therapy. Materials and methods. A 6-month retrospective comparative study was performed at the specialized reference center for allergology and immunology. The study included 115 adult patients of both sexes treated with dupilumab for uncontrolled severe asthma as the main indication for targeted therapy (BA group; n=65) or for a combination of severe uncontrolled asthma and severe AD (BAAD; n=50). Dupilumab was administered subcutaneously for 6 months. The first dose was 600 mg once and then 300 mg Q2W. Evaluation of the effectiveness of dupilumab therapy at 6 months of treatment in both groups included achieving asthma control (ACT, ACQ5), improving pulmonary function test, reducing the risk of exacerbations and the need for systemic glucocorticosteroids (SGCS), improving quality of life (AQLQ), change of biomarkers (FeNO, eosinophil count) and the course of comorbid diseases, including improvement in the AD (SCORAD, EASI) and rhinosinusitis polyposa (SNOT-22). Results and conclusion. During dupilumab therapy, in a significant proportion of patients, regardless of the presence or absence of other T2-associated diseases (e.g., AD or rhinosinusitis polyposa), an improvement in asthma was demonstrated as early as in the first 6 months of treatment with dupilumab in all recommended domains for assessing the response to targeted therapy: improving asthma control and respiratory function, reducing the frequency of moderate and severe exacerbations associated with the use of SGCS and/or hospitalization, a positive effect on the quality of life and the comorbid diseases, as well as a cumulative reduction in the need for SGCS.

Objectives: Antimicrobial resistance (AMR) is a growing global health threat. The misuse of antibiotics is the main factor contributing to the development of AMR. Healthcare practitioners (HCPs) play a crucial role in the use of antibiotics. There are limited data available on antibiotic prescribing patterns among physicians in Russia. The aim of this study was to explore antibiotic prescribing practices and perceptions of AMR among HCPs in the Russian Federation.Study design: A cross-sectional, multi-centre study was used. Methods: A survey using an online questionnaire was conducted among HCPs. A qualitative study was conducted before the questionnaire was developed. The online questionnaire was distributed via email addresses obtained from the Consilium Medicum database, a specialised educational resource for healthcare professionals in Russia.Results: In total, 746 HCPs from 74 regions of the Russian Federation were included in the study. Physicians who participated in this study did not frequently prescribe antibiotic drugs: 40.6% of participants recommended antibiotics less than five times per week. Gynaecologists, paediatricians, family doctors, and surgeons were the least likely study participants to prescribe antibiotics, whereas clinical pharmacologists, otolaryngologists, urologists, and infectious disease specialists prescribed antibiotics more often. Amoxicillin and amoxicillin/clavulanic acid were the most frequently prescribed antimicrobials. The majority of HCPs in Russia who took part in this survey reported relying on national guidelines for information on antibiotic prescribing. Only 67.8% of study participants perceived AMR as a challenge for their practice. Conclusions: Health authorities should regularly provide up-to-date reliable information on AMR in the region. Antimicrobial stewardship programmes are important for specialised medical professionals, such as urologists, gynaecologists, and otolaryngologists, since they are responsible for prescribing secondline antibiotics, which carries with it a greater responsibility.(c) 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Cardiovascular disease is the most common cause of death worldwide. In this regard, there is a need to find and implement effective methods for the prevention and treatment of such diseases. Lifestyle modification is an important component of a complex of preventive and therapeutic measures, including nutrition optimization, increased physical activity, and breaking bad habits. Currently, an actively developing area is the use of biologically active additives to food, in order to replenish the missing nutrients in the diet and maintain health. In the course of the present review, an analysis was made of randomized clinical trials performed over the past 5 years. The studies investigated both the short-term effects of taking omega-3 polyunsaturated fatty acids (effect on the blood lipid spectrum, blood pressure levels) and longterm results (development of myocardial infarction, stroke, cardiovascular mortality). This supplement has demonstrated a positive effect on immediate outcomes, namely the reduction of total cholesterol, low-density lipoprotein, triglycerides (lipid-lowering effect). However, there was no significant effect on long-term results. It also provides information on studies that have examined the cardioprotective effects of supplements such as resveratrol, red yeast rice, L-arginine, and curcumin. An analysis of publications has shown that these supplements have the potential to reduce the risk of development and progression of cardiovascular diseases due to possible hypolipidemic, endothelial protective, and antihypertensive effects. Nutraceutical support can be an effective addition to the basic treatment and help reduce morbidity and mortality due to cardiovascular disease.

The purpose of the study was to compare the efficacy of regular prolonged inhalation therapy with tiotropium bromide delivered via the Respimat inhaler and short-acting bronchodilator (SAB) therapy with ipratropium bromide/fenoterol in the perioperative period in patients with non-small cell lung cancer (NSCLC) combined with chronic obstructive pulmonary disease (copd). Material and Methods . The study included 66 patients with Nsclc and copd. The patients received tiotropium bromide, 5 mcg/day (TB group) or a combination of ipratropium bromide/fenoterol 20/50 mcg/dose, 2 doses 4 times a day (SAB group) for 6 weeks before and 6 weeks after surgery. The control group consisted of patients who did not receive bronchodilators before surgery, but they received a combination of ipratropium bromide/fenoterol in the postoperative period. All patients underwent tests of pulmonary function (spirometry, body plethysmography), measurement of lung parenchyma density and emphysematous lung areas (high-resolution computed tomography). Results. After preoperative preparation with use of tB or saB, there was a significant improvement in FEV1, FVC, VC, RV, ITGV, and. RV/TLC ratio relative to baseline. In the tB and sad groups, a significant reduction in the severity of total respiratory resistance (Rtot) compared to that in the control group was observed. According to the assessment of lung density and the volume of emphysematous areas on expiration, the results in the TB group were significantly better than those in the sad and control groups. six weeks after surgery, all patients showed a significant decrease in post-FeV1, post-FVC, and post-VC relative to the preoperative values. Bronchodilator therapy resulted in the reduction in Rtot in all groups; however, better results were achieved in the TB group (86 %) compared to sad group (93 %, p=0.03) and control (101.5 %, p=0.02). After surgical treatment, a decrease in the volume of emphysematous areas on inspiration was observed: the parameters were better in the TB group than in the sad and control groups (220 cm3 versus 1025 cm 3 and 1002 cm 3 , p<0.001 and p=0.002, respectively). Conclusion. In patients with Nsclc and copd, longterm inhaled bronchodilator therapy can significantly improve respiratory function. more beneficial results are achieved after using long-acting drugs (tiotropium bromide).

Background. A combination of different types of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. COPD, accompanied by ventilation disorders and, often, respiratory failure, is a significant additional risk factor for mortality in these patients. Identification of risk factors for mortality in patients with lung cancer and COPD can potentially be associated with better long-term outcomes.Materials and methods. Using a Cox regression model based on information about the outcome of the disease and life expectancy after treatment initiation, a survival analysis was performed with an assessment of the contribution of various clinical and anamnestic factors for a group of 118 COPD patients with primary diagnosed lung cancer. These patients received treatment at the Cancer Research Institute in Tomsk in 2013–2019.Results. The study included 118 patients (87.3% men and 12.7% women). Among them, 77.97% of patients were active or former smokers with smoking index (SI) ≥ 10 pack-years, and 22% of patients had never smoked or had SI < 10 pack-years but had other risk factors for COPD. Peripheral lung cancer was detected in 45.8% of cases. Squamous cell carcinoma was noted in 54.2% of cases, adenocarcinoma – in 34.7%, large cell carcinoma – in 1.7%, small cell carcinoma – in 5.9%, and carcinoid tumors – in 2.5% of cases. Patients were characterized by varying degrees of severity of ventilation disorders in accordance with the GOLD classification: stage 1 was observed in 44% of patients, stage 2 – in 38.1 % of patients, stage 3 – in 16.9 % of patients, and stage 4 – in one patient. Threeyear mortality was 28.12%.Conclusion. According to the results of the Cox regression analysis, factors that significantly reduced the survival rate of patients with lung cancer in combination with COPD were more severe stages in terms of the size of the primary tumor and its localization, the prevalence of metastasis (according to TNM classification), more severe dyspnea (mMRC scale), lower oxygen saturation values, atelectasis, and episodes of pneumonia, including paracancrotic pneumonia, over the previous 12 months. The presence of certain types of metastases, such as metastatic lesions of the pleura, adrenal glands, distant non-regional lymph nodes, and bones should also be noted as negative factors for survival. It is worth noting that surgical treatment of the primary tumor was associated with an increase in the survival rate in patients with lung cancer in combination with COPD.

Background. The growth of antibiotic resistance is an urgent problem of modern medicine associated with the irrational use of antibacterial drugs. The solution to this problem requires a comprehensive analysis of the situation not only from the patients’ standpoint, but also from that of medical specialists. Aim. To establish the level of awareness about the problem of antibiotic resistance and to study the practice of antibacterial drug use among senior students of a medical university. Material and methods. A one-time sociological study was conducted in the format of an online survey of the 5th–6th year students of the medical and pediatric faculties of the Siberian State Medical University of the Ministry of Health of the Russian Federation. Results. An invitation to the survey was sent to 406 5th–6th year students of the pediatric and medical faculties; 334 students voluntarily completed the questionnaire (return rate — 82.3%). Most students are aware of the problem of antibiotic resistance. 58.8% of the students took drugs as prescribed by a doctor, adhering to the prescribed duration of treatment. The most commonly used antibiotics were: amoxicillin/clavulanic acid — 57.6%, amoxicillin — 29%, azithromycin — 19.4%, ciprofloxacin — 13.4%, 3rd generation cephalosporins — 8.1%. It was found that 45.4% of students used antibiotics parenterally, of which half (50.4%) performed injections at home or in the dormitory. Up to 89.2% of respondents consider it necessary to use medications to restore the intestinal microflora against the back-ground of antibiotic therapy. Conclusions. Despite the high awareness of the problem of antibiotic resistance and adherence to medical recommendations regarding the use of antibiotics, it is necessary to increase the competence in the field of rational antibiotic therapy for both students and practitioners.

In 2020 treating patients with Coronavirus Disease 2019 (COVID-19) has become a global problem. Early recognition of unfavorable forms is absolutely essential for timely triage of patients. Peripheral oxygen saturation (SpO2) level is one of the affordable key parameters in assessing the severity of the disease. Materials and Methods: The study included 286 patients with COVID-19 moderate severity, hospitalized in SibMed clinics (Tomsk) from May to October 2020 (133 (46.5%) men and 153 (53.5%) women). Tab 1. The association of the saturation level at the time of hospitalization with concomitant pathology and subsequent changes in blood biomarkers during hospitalization in patients with COVID-19 *р<0,05 – statistically significant result The results of this study showed that the decrease of saturation at the time of hospitalization is associated with the diseases of the cardiovascular system and an increase of C-reactive protein, ferritin and the development of lymphopenia during hospitalization

Background Severe asthma is a poorly controlled disease in Russia which leads to significant healthcare resource use and costs. However, little is known about its burden and management in a real clinical practice in Russia. Here we report the results obtained in the Russian population during an international cross-sectional study. Methods The study comprised two phases: in Phase I data were collected retrospectively from medical records, while Phase II was a cross-sectional collection of patient-reported outcomes and up-to-date data. For Phase I, adult patients with severe asthma according to ERS/ATS criteria were enrolled. Phase I patients were enrolled into Phase II if they signed a written consent form. Data on demographics, history of asthma and comorbidities, treatment approach, and healthcare resource utilization were obtained in both phases. In Phase II, asthma control and health-related quality of life (HRQoL) were also evaluated. Results A total of 315 patients were included in Phase I of the study, 106 (33.6%) of them entered Phase II of the study. The study population included more female (n=211, 67.0%) than male patients (n=104, 33.0%). Majority of subjects were either obese (n=103, 39.8%) or overweight (n=94, 36.3%). The most common comorbidity was cardiovascular disease (n=217, 71.4%), followed by chronic respiratory disease (n=198, 68.8%), including COPD and allergies. Mean (SD) age at diagnosis of asthma and severe asthma were 42.9 (16.0) and 53.1 (13.2) years, respectively. There were 268 (85.1%) patients who had at least one exacerbation during last 12 months. Most subjects had only one blood eosinophil count in the last 12 months (n=143, 81.3%). Mean (SD) FEV1 was 56.9 (20.4) % predicted. The mean (SD) last serum IgE/(RAST) value was 254.3 (249.7) ng/mL. Asthma management was generally in line with guidelines. Most patients had poorly controlled asthma according to the ACT and impaired HRQoL. Conclusions In Russia, severe asthma patients had poor disease control, high hospital admission rates and multiple comorbidities. Eosinophil and IgE level measurements are not considered routine tests which might be a barrier for appropriate phenotyping and treatment selection, including prescription of biologics in course of disease management.

Antimicrobial resistance control programmes often aim to "fix" the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health-care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self-treatment and over-the-counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem.