The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Background: to achieve control of asthma and reduce mortality, as well as improve the patients' quality of life, it requires not only the new drugs development and improvement of stepwise therapy regimens but also new approaches to comprehensive individual rehabilitation programs for patient management. Aim: to assess the impact of comprehensive rehabilitation programs on asthma control, pulmonary function, motor activity, and quality of life (QOL) in multimorbid patients with asthma and obesity. Patients and Methods: 70 patients with asthma and obesity were divided into 2 groups of 35 subjects: group 1, in which patients underwent a rehabilitation program, and group 2, patients who were only under the outpatient supervision of a pulmonologist.The following tests were conducted twice: Asthma Control Questionnaire (ACQ-5), Cumulative Illness Rating Scale (CIRS) for assessing the multimorbid profile, 6-minute walk test for identifying the functional capacity, ODA23+ for motor activity assessment, QOL according to Asthma Quality of Life Questionnaire (AQLQ), pulmonary function test. Results: the patients were comparable in all assessed parameters. Functional capacity in both groups corresponded to the class I. The motor activity level according to ODA23+ was low to moderate. In group 1, the CIRS index was 10.0±1.1, in group 2 – 9.2±1.1 (p>0.005). After rehabilitation actions in group 1, the BMI decreased by 0.7 kg/m2 and waist circumference by 3.3 cm (p<0.05), motor activity increased from 63.8±4.9 to 70.4±4.5 (p<0.0001). In group 2, motor activity increased unreliably: the number of patients with low motor activity increased by 11.4%. The level of asthma control according to ACQ-5 in group 1 was 1.2±0.1, in group 2 — 1.58±0.1 (p<0.05). QOL in group 1 increased from 3.8±0.4 to 4.5±0.3 (p<0.0001) in all major domains except the emotional function, which increased unreliably (p>0.05). In group 2, QOL did not change significantly (p>0.05). Conclusion: to increase the level of asthma control, multimorbid patients with preserved rehabilitation potential should be offered multicomponent rehabilitation programs that affect both asthma and concomitant diseases. The use of rehabilitation programs improves the asthma control, increases the QOL of obese patients, promotes weight loss, increases motor activity level and functional capacity.

В статье представлен способ определения степени бронхиальной обструкции у больных бронхиальной астмой (БА), который позволяет определить степень бронхиальной обструкции по значению объема форсированного выдоха (ОФВ1) за счет одномоментного учета совокупности диагностически значимых для данного определения степени обструкции показателей. Исследование включало 237 больных БА в возрасте от 18 до 78 лет: мужчин – 51 (21,5%), женщин – 186 (78,5%), средний возраст 52,6±1,3 лет. Клиническое и лабораторное обследование пациентов проводили на этапе включения в исследование. Диагноз БА установлен в соответствии с критериями GINA 2022. Все пациенты прошли комплексное обследование, включавшее сбор жалоб и анамнеза, оценку объективного статуса, лабораторное исследование. У пациентов определяли уровень двигательной активности по опроснику ОДА23+, уровня активности пациентов по шкале Лекена и уровень общей антиоксидантной способности ImAnOx. Затем на основании полученных данных, вычисляли ОФВ1 по заданной формуле. При значении ОФВ1 «от 80,0% до 100,0%» определяется легкая степень бронхиальной обструкции, при значении ОФВ1 «от 60,0% до 79,9%» – бронхиальная обструкция средней тяжести, при значении ОФВ1«от 59,9% и менее» – тяжелая степень бронхиальной обструкции. Разработанный способ относится к медицине, а именно к терапии и пульмонологии, и может быть использован для индивидуального определения степени бронхиальной обструкции у больных БА с целью повышения эффективности профилактических мер, учитывая предикторы прогрессирования, недостаточного контроля БА, патогенетические механизмы БА, особенно у пациентов с низкой физической активностью The article presents a method for determining the bronchial obstruction degree in patients with asthma, which allows determining the bronchial obstruction degree by FEV1 due to simultaneous accounting of a set of indicators that are diagnostically significant for the given determination of the obstruction degree. The study included 237 patients with asthma aged 18 to 78 years: men – 51 (21.5%), women – 186 (78.5%), the average age is 52.6±1.3 years. Complete physical examination and lab test values were on baseline visit. The diagnosis of asthma was established according to the GINA 2022 criteria. All patients underwent complete physical examination: symptoms/signs, present history, lab test values. In patients with asthma, the ODA23+, Leken activity level, ImAnOx were determined. Based on the received data, FEV1was calculated using the formula. If FEV1 is 80.0% to 100.0%, mild bronchial obstruction is determined, if FEV1 is 60.0% to 79.9%, moderate bronchial obstruction is determined, if FEV1 is 59.9% or less, severe bronchial obstruction is determined. The developed method relates to medicine, namely to therapy and pulmonology. It could be used for individual determination of bronchial obstruction degree in patients with asthma in order to increase efficiency of preventive measures, taking into account predictors of progression, insufficient asthma control, pathogenetic mechanisms of asthma, especially in patients with low physical activity

В статье представлен способ достоверного прогнозирования развития обострений бронхиальной астмы (БА) у больных с сопутствующей мультиморбидной патологией. Исследование включало 237 больных БА в возрасте от 18 до 78 лет: мужчин – 51 (21,5%), женщин – 186 (78,5%), средний возраст 52,6±1,3 лет. Пациенты находились под наблюдением в течение 12 месяцев, комплексное обследование проводили на этапе включения в исследование и через 12 месяцев. Диагноз БА установлен в соответствии с критериями GINA 2022. Все пациенты прошли комплексное обследование, включавшее сбор жалоб и анамнеза, оценку объективного статуса, определение лабораторных показателей венозной крови. У пациентов с БА с сопутствующей мультиморбидной патологией определяли уровень двигательной активности по опроснику ОДА23+, объем форсированного выдоха за 1-ю секунду (ОФВ1), уровень перекисей сыворотки крови, уровень активности пациентов по шкале Лекена, уровень лептина венозной крови, индекс массы тела, уровень интерлейкина-6, кумулятивный индекс заболеваний CIRS. На основании полученных данных вычисляли индекс вероятности частоты обострения БА в течение ближайшего года (ExacBA) по заданной формуле. При значении ExacBA менее 2 прогнозируют низкий риск развития обострений БА, с количеством обострений – 1 раз в год. При значении ExacBA 2 и более прогнозируют высокий риск обострений, с количеством обострений в год 2 и более раз. Разработанный способ относится к медицине, а именно к терапии и пульмонологии, и может быть использован для персонифицированной программы ведения пациентов с БА с сопутствующей мультиморбидной патологией с учетом индивидуального риска обострений заболевания в течение ближайшего года наблюдения The article presents a method for reliable prediction of asthma exacerbations development in patients with multimorbid pathology. The study included 237 patients with asthma aged 18 to 78 years: men – 51 (21.5%), women – 186 (78.5%), the average age is 52.6±1.3 years. Patients were kept for observation during 12 months. Complete physical examination was on baseline visit and at 12 months. The diagnosis of asthma was established according to the GINA 2022 criteria. All patients underwent complete physical examination: symptoms/signs, present history, lab test values. In patients with asthma and multimorbid pathology, the ODA23+, FEV1, PerOx, Leken activity level, leptin level, body mass index, interleukin-6 level, CIRS index were determined. Based on the received data, the probability index of asthma exacerbation frequency over the next year (ExacBA) was calculated using the formula. If ExacBA is less two, low risk of asthma exacerbations is predicted, with number of exacerbations – 1 times a year. If ExacBA is two and more, high risk of asthma exacerbations is predicted, with number of exacerbations per year two or more times. The developed method relates to medicine, namely to therapy and pulmonology. It could be used for a personalized program of management of patients with asthma and multimorbid pathology taking into account individual risk of disease exacerbations during the next year of observation

One of the most important areas of modern medicine is the search for molecular biomarkers that open up new possibilities in fundamental research of pathological processes, allowing to diagnose human diseases with high accuracy and to implement a personalized approach to prescribe effective therapy. Currently, one of the promising molecular biomarkers in respiratory medicine is club cell protein (CC16, or secretory globulin SCGB1A1). Club-shaped cells are known to be involved in pulmonary homeostasis and regulate the progression of acute and chronic inflammatory processes in the bronchopulmonary system. Immunomodulation and regulation of inflammation by club-shaped cells is mediated by secretion of CC16 protein, which has pronounced anti-inflammatory, anti-allergic, and anti-tumor properties. The aim of the review is to collect and analyze data from recent domestic and foreign studies on the role of club-shaped cells and their CC16 protein in physiological and pathological processes in the airways. Conclusion. Based on the data of domestic and foreign studies presented in the review, it can be concluded that club-shaped cells and their secretory globulin SCGB1A1 play an important role in the physiological and pathological processes in the respiratory tract. Thus, club cell protein may serve as a molecular biomarker for diagnosing and monitoring the progression of certain bronchopulmonary diseases, for individual assessment of the treatment efficacy, and as a basis for the development of new therapies in respiratory medicine.

The article contains a literature review that presents the results of studies of the prevalence of comorbidy in patients with bronchial asthma (BA), as well as the gender- and age-related characteristics of comorbidity in such patients. More than half of asthma patients suffer from the comorbid pathology, which negatively affects the clinical course of asthma, as well as the quality of life. The number of chronic comorbid diseases increases with age, on average to 5 comorbid conditions in BA patients aged 75 years and older. The most common diseases, the prevalence of which increases with age, are cardiovascular, ophthalmological and otolaryngological diseases and diseases of the musculoskeletal system. Female patients with BA, as a rule, are more likely to suffer from comorbid diseases, and on average have more comorbid pathologies than men. The comorbid diseases with the largest gender difference in prevalence are recurrent urinary tract infection, thyroid diseases, migraine and osteoporosis, which are prevalent in women. Among the factors and mechanisms influencing the presence and course of comorbid pathology in asthma patients, there are factors that have an effect before birth and during early childhood, systemic inflammation, hyperinsulinemia, leukotrienes and mitochondrial dysfunction. Despite the vast amount of data, research results are often quite contradictory; further investigations of the mechanisms underlying the relationship between comorbid pathology and asthma are necessary.

В последнее время все чаще изучается влияние неправильного питания на возникновение и прогрессирование бронхиальной астмы (БА) и ожирения. Ожирение представляет собой пандемию XXI века. В настоящий момент имеются данные о влиянии ожирения на риск развития БА. Повышенное потребление насыщенных жиров приводит к увеличению содержания циркулирующих свободных жирных кислот в организме. Это индуцирует провоспалительные процессы в том числе в дыхательных путях, что приводит к ухудшению функционирования легких, утяжелению протекания БА, учащению обострений данного заболевания, увеличению числа госпитализаций по поводу тяжести течения астмы. Кроме того, учеными выявлено, что диета с низким содержанием пищевых волокон также способствует развитию системного воспаления, тем самым ухудшая течение БА. Имеются данные о влиянии дефицита витамина D на развитие, прогрессирование и ухудшение контроля хронических и аутоиммунных заболеваний, к которым также относится БА, на ухудшение состояния липидного обмена исследуемых. Повышение уровня витамина D в организме пациентов приводит к улучшению отдельных характеристик течения и проявления данных заболеваний. Использование средиземноморской диеты уменьшает вероятность возникновения и прогрессирования БА, бронхиальной обструкции, аллергических реакций. Достаточное употребление витаминов А, С, Е приводит к снижению воспалительных реакций в бронхиальном дереве, улучшению показателей функции легких, уменьшению обострений БА и частоты госпитализаций, связанных с ухудшением контроля заболевания. Таким образом, актуально и целесообразно проводить научную и клиническую работу по определению и более глубокому изучению влияния питания на развитие и течение БА и ожирения, выявлению взаимосвязи между данными заболеваниями. Recently, the influence of malnutrition on the occurrence and progression of bronchial asthma and obesityhas been increasingly studied. Obesity is a 21st century pandemic. Now, there is evidence of the effect of obesity on the risk of developing bronchial asthma. An increased intake of saturated fat leads to an increase in circulating free fatty acids in the body. This induces pro-inflammatory processes, including in the respiratory tract, which leads to a deterioration in the functioning of the lungs, an aggravation of the course of bronchial asthma, an increase in exacerbations of this disease, an increase in the number of hospitalizations due to the severity of the course of asthma. In addition, scientists have found that a diet low in dietary fiber also contributes to the development of systemic inflammation, thereby worsening the course of bronchial asthma. There is evidence of the effect of vitamin D deficiency on the development, progression and deterioration of control of chronic and autoimmune diseases, which also include bronchial asthma, on the deterioration of the state of lipid metabolism in the subjects. An increase in the level of vitamin D in the body of patients leads to an improvement in certain characteristics of the course and manifestation of these diseases. The use of a Mediterranean diet reduces the likelihood and progression of bronchial asthma, bronchial obstruction, and allergic reactions. Adequate intake of vitamins A, C, E leads to a decrease in inflammatory reactions in the bronchial tree, an improvement in lung function indicators, a decrease in exacerbations of bronchial asthma and the frequency of hospitalizations associated with a deterioration in the control of this pathology. Thus, it is relevant and expedient to carry out scientific and clinical work to determine and in-depth study of the influence of nutrition on the development and course of obesity and bronchial asthma, and to identify the relationship between these diseases.

Ожирение является распространенной проблемой во всем мире; ожидается, что количество пациентов с ожирением будет продолжать увеличиваться. Особое значение ожирение имеет для пациентов страдающих бронхиальной астмой, так каку астматиков с ожирением было выявлено большее количество симптомов астмы, отмечались более частые и тяжелые обострения, а также снижение ответа на лечение глюкокортикостероидами и снижение качества жизни. В свою очередь ожирение отрицательно влияет на качество жизни пациентов. Целью исследования было изучить особенности качества жизни у пациентов с бронхиальной астмой и ожирением в сравнении с пациентами с нормальной и избыточной массой тела на основании специфического опросника «Качество жизни больных бронхиальной астмой».

Osteoarthritis is a severe chronic disease that can lead to disability. It is assumed that osteoarthritis occurs in patients with bronchial asthma more often than in chronic obstructive pulmonary disease and in the general population. The aim of the study was to analyze the effect of osteoarthritis on the quality of life of patients with bronchial asthma using the SF-36 questionnaire.

Chronic obstructive pulmonary disease (COPD) is characterized by comorbidity. Obesity is one of the comorbidity in COPD. Obesity, in turn, causes the liver metabolic damage, such us non-alcoholic fatty liver disease (NAFLD) with a decrease of detoxification function, the conversion of toxic ammonia to urea and the development of hyperammonemia. The aim of the study is to identify hyperammonemia in patients with COPD and obesity, to analyze the degree of its effect on disease course and the quality of life.

Within the framework of the multi - center study KNOCAP (full name of the project assessment of physicians' knowledge ofcommunity- acquired pneumonia basics), an anonymous survey was conducted to assess the knowledge of doctors of the therapeutic profile of the Voronezh region in the pharmacotherapy of community-acquired pneumonia (VP), for which an original questionnaire was developed based on clinical recommendations. To help doctors, a remote training program “community-Acquired pneumonia” was developed on the Moodle platform. The results of the survey before and after the training of doctors for this program are presented.

It is known that iron deficiency is a negative factor for the onset of pregnancy. It aggravates its course, increasing the risk of preeclampsia, placental insufficiency, uterine inertia, premature birth, bleeding and hypogalactia. This condition increases the risk of unfavorable outcomes, iron deficiency anemia and cognitive delay in a child. Raising the awareness of women of reproductive age and the clinical suspicion of physicians regarding the iron deficiency anemia and latent iron deficiency can facilitate timely visit a doctor. At the expert council “Relevant issues of iron deficiency in the Russian Federation” held in June 2020, aspects of the epidemiology, diagnosis and treatment of this condition were discussed, and promising directions for improving the situation were proposed.

Изучены вопросы актуальности включения вопросов экспертизы временной нетрудоспособности при проведении обучения лечащих врачей, как непосредственных исполнителей этой функции на сертификационных и аккредитационных циклах. Выводы основаны на результатах анкетирования врачей, проходящих переподготовку на кафедре терапевтических дисциплин.

Aim: The research prevalence of familial hypercholesterolemia (FH) among hospitilized patients with cerebrovascular diseases (CVD).

Objectives: The aim of the investigation was determination of the prevalence of non-coronary atherosclerosis among the adult population using the method of multi-channel volume sphygmography (MCVS).