The importance of postgraduate training of doctors on pharmaceutical supply of the population

As the use of medicines in the provision of medical services is an important component, it is advisable to constantly update the knowledge of doctors and monitor regulatory and market changes in the field of pharmaceutical supply. The purpose of this work is to identify educational and practical issues in the pharmaceutical field, knowledge of which contributes to the proper management of the provision of drugs to the medical organizations, motivated choice, appointment, rational therapy of diseased – patients of the doctor. General information on providing relevant knowledge to physicians in the cycles of thematic improvement in health management and economics on a number of issues are presented, including: legal and marketing regulation of health care organizations and the population with medicines; state regulation of drug prices; determining the need for drugs and purchasing for budget funds; regulatory requirements for prescriptions; features of use, storage and accounting in inpatient and outpatient settings of narcotic, psychotropic drugs and precursors, etc. Given that the development of the pharmaceutical healthcare sector is influenced by the market mechanism, it is advisable to familiarize yourself with the marketing management of its subjects. It is shown that knowledge of the main issues of medical care of health care institutions and the population contributes to the quality of professional duties of organizers and specialists on the basis of legal regulation, rational use of drugs, compliance with existing restrictions and standards, and forms the principles of professional interaction and ethical communication between health professionals.

Therapeutic Potential of α-Synuclein Evolvability for Autosomal Recessive Parkinson’s Disease

The majority of Parkinson’s disease (PD) is sporadic in elderly and is characterized by α-synuclein (αS) aggregation and other alterations involving mitochondria, ubiquitin-proteasome, and autophagy. The remaining are familial PD associated with gene mutations of either autosomal dominant or recessive inheritances. However, the former ones are similar to sporadic PD, and the latter ones are accompanied by impaired mitophagy during the reproductive stage. Since no radical therapies are available for PD, the objective of this paper is to discuss a mechanistic role for amyloidogenic evolvability, a putative physiological function of αS, among PD subtypes, and the potential relevance to therapy. Presumably, αS evolvability might benefit familial PD due to autosomal dominant genes and also sporadic PD during reproduction, which may manifest as neurodegenerative diseases through antagonistic pleiotropy mechanism in aging. Indeed, there are some reports describing that αS prevents apoptosis and mitochondrial alteration under the oxidative stress conditions, notwithstanding myriads of papers on the neuropathology of αS. Importantly, β-synuclein (βS), the nonamyloidogenic homologue of αS, might buffer against evolvability of αS protofibrils associated with neurotoxicity. Finally, it is intriguing to predict that increased αS evolvability through suppression of βS expression might protect against autosomal recessive PD. Collectively, further studies are warranted to better understand αS evolvability in PD pathogenesis, leading to rational therapy development.

About lesions of the peripheral nervous system after influenza in the winter of 1931-1932. in Kazan

Since 1916-1917, the period of the last pandemic of epidemic encephalitis, infectious diseases of the nervous system have become common and fairly frequent in medical practice. Covering in some places large groups of the population and taking away a large number of working hours from socialist construction, these diseases should be the object of serious study by practically working doctors for their rational therapy and prevention.

IN INTRA-ABDOMINAL INFECTIONS AND PERITONITIS

Summary. Purpose of the reserche. To study changes in microflora and sensitivity of isolated strains to antibiotics using bacteriological research methods for intra-abdominal infections and peritonitis to determine their resistance when planning antibiotic therapy. Results and discussion. The paper presents data from a retrospective analysis of the results of studies of microflora and its resistance in intra-abdominal infections (IAI) and peritonitis for 2 periods: I period — from january 2007 to december 2008, II period — from january 2018 to december 2019. The difference between period II and I was in the increase in the number of individual pathogenic strains of microorganisms. Thus, the number of Klebsiella spp. increased from 13.8 % to 23.8 %, which in absolute number of their total number amounted to a 73.5 %, ranking second in the overall structure among pathogens sown in IAI and peritonitis. The number of strains of Staphylococcus spp., Enterobacter spp., Acinetobacter spp. has also increased by 2.4–5.8 % respectively. Among the strains Klebsiella spp., E. coli and Staphylococcus spp. the number of poly- and multi-polyresistant forms has increased. Thus, the number of such forms among Klebsiella spp. increased from 19.2 to 44.5 %, Staphylococcus spp. — from 43.8 to 67.1 % and E. coli from 18.2 to 23.5 %, respectively. Conclusions. Over the past 10 years, with IAI and peritonitis, the most significant changes were revealed on the part of pathogenic strains of Klebsiella spp., Staphylococcus spp. and Acinetobacter spp. Multidrug resistant strains were predominantly susceptible to carbapenems, semisynthetic ureidopenicillins, aminoglycosides, glycopeptides, oxazalidinones, phosphonoic acid derivatives. In the context of changes in the microbial landscape observed over the past decade, an increase in the number of poly- and multi-resistant forms of pathogenic microorganisms in IAI and peritonitis, the choice of antibiotics for rational therapy should be based solely on bacterioscopy and antibiograms.

Prospective Use of Brown Spider Venom Toxins as Therapeutic and Biotechnological Inputs

Brown spider (genus Loxosceles) venoms are mainly composed of protein toxins used for predation and defense. Bites of these spiders most commonly produce a local dermonecrotic lesion with gravitational spread, edema and hemorrhage, which together are defined as cutaneous loxoscelism. Systemic loxoscelism, such as hematological abnormalities and renal injury, are less frequent but more lethal. Some Loxosceles venom toxins have already been isolated and extensively studied, such as phospholipases D (PLDs), which have been recombinantly expressed and were proven to reproduce toxic activities associated to the whole venom. PLDs have a notable potential to be engineered and converted in non-toxic antigens to produce a new generation of antivenoms or vaccines. PLDs also can serve as tools to discover inhibitors to be used as therapeutic agents. Other Loxosceles toxins have been identified and functionally characterized, such as hyaluronidases, allergen factor, serpin, TCTP and knottins (ICK peptides). All these toxins were produced as recombinant molecules and are biologically active molecules that can be used as tools for the potential development of chemical candidates to tackle many medical and biological threats, acting, for instance, as antitumoral, insecticides, analgesic, antigens for allergy tests and biochemical reagents for cell studies. In addition, these recombinant toxins may be useful to develop a rational therapy for loxoscelism. This review summarizes the main candidates for the development of drugs and biotechnological inputs that have been described in Brown spider venoms.

Early arthritis and digestive diseases. A rheumatologist’s view

Peripheral arthritis is one of the most common manifestations of articular syndrome, not always associated with rheumatic diseases. Determination of its nosological affiliation and rational therapy at an early stage (early arthritis) present a complex clinical and diagnostic problem requiring an interdisciplinary approach. The review presents the differential diagnosis of early arthritis in diseases of the gastrointestinal tract such as inflammatory bowel disease, celiac disease, PPP syndrome (Pancreatitis, panniculitis and polyarthritis (PPP-) syndrome), etc., manifested by similar clinical symptoms with rheumatic diseases such as early rheumatoid arthritis and spondylitis. Most of the immuno-inflammatory diseases presented in the review are multisystemic and heterogeneous in clinical symptoms, course and outcomes. Therefore, the diagnostic process, especially in case of early arthritis with typical multisystem involvement, is comprehensive and cognitive in nature and requires the synthesis of many data that are usually not taken into account in a simple algorithm based on a set of classification criteria.

IRRATIONAL USE OF MEDICINES IN MEDICAL ORGANIZATIONS OF THE VOLGA FEDERAL DISTRICT. (ON THE EXAMPLE OF THE PENZA REGIONAL CLINICAL HOSPITAL NAMED AFTER N. N. BURDENKO, WHEN PROVIDING SPECIALIZED CARE TO CHILDREN IN THE CONDITIONS OF THE ADULT DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY)

The issues of financing in a medical organization are one of the most relevant areas of healthcare in the Russian Federation. Providing departments with the necessary financial resources to provide effective and accessible medical care to the population is important for both the administration and doctors and nurses. In some regions of the Volga Federal District, the departments are combined (Penza, Saransk), that is, all types of medical care are provided to both adults and children in one place, which leads to a number of problems associated with the irrational use of medicines. One of these is the department of Maxillofacial Surgery of the N.N. Burdenko National Clinical Hospital, on the basis of which the disadvantages of using drugs for parenteral use are considered. The purpose of this work is an economic analysis of the effectiveness of the use of solutions for parenteral use in children on the basis of an adult medical organization. The materials of the study were data from patients ' medical histories, prescribing lists, invoices from the pharmacy organization, and data on the cost of medicines. The results of the work are an analysis of the existing problems of combined type departments related to drug provision, a number of medicines for parenteral use that are not available to order, but are included in the standards of treatment of children with injuries of the maxillofacial region. The ABC - analysis of expenses under the item "medicines" is calculated, the data of the VEN – analysis is presented, which includes vital, necessary and secondary medicines for the treatment of children with injuries of the maxillofacial region. An algorithm for the selection of effective and rational therapy has been developed, using the example of antibacterial agents for parenteral administration.

Allergic rhinitis from the otorhinolaryngologist’s perspective

Allergic rhinitis remains one of the most pressing problems of modern otorhinolaryngology. Allergic rhinitis is an allergic inflammation of the nasal mucosa characterised by the following symptoms (one or more): stuffiness, rhinorrhoea, nasal itching, sneezing. In recent years the incidence of allergic rhinitis in the economically developed countries has been shown to be close to 40–50%. Allergic rhinitis is now characterised by an early onset, often continuously relapsing course and resistance to antiallergic therapy. Allergic rhinitis has a negative impact on a person’s social and daily activities, mental well-being and general health, regardless of age. Allergic rhinitis significantly reduces job performance, physical and mental activity, communication skills, causes snoring, anxiety, depression, sleep disorders and erectile dysfunction. Studying the mechanisms of the disease provides the basis for a rational therapy that addresses the complex inflammatory response rather than just the symptoms of allergy. Treatment is either in outpatient settings or inpatient – in specialised departments. A recent priority of pharmacotherapy is the use of intranasal corticosteroids, both as basic therapy for allergic rhinitis and as part of a combined regimen. The use of intranasal corticosteroids is considered to be the therapy of choice in allergic rhinitis. The paper demonstrates the efficacy and safety of topical corticosteroids for use in clinical practice. Intranasal corticosteroids have a wide range of reported indications, an extensive evidence base and can be recommended for the treatment of allergic rhinitis. For best result intranasal corticosteroids should be used at first signs of allergic rhinitis onset.