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Aim. To review the current progress in the use of remote health monitoring (RHM) technologies for chronic noncommunicable diseases (CNCD).To search for data, we used Web of Science, Scopus, Russian Science Citation Index, Academic Search Complete (EBSCO), Cochrain, and PubMed databases. The date range was 5–10 years. The importance of development of RHM technologies and their further study was shown to confirm the evidence of effect of certain RHM systems.New approaches to the integration of the medical community into the international telemedicine strategy are considered. It was established that RHM can potentially decrease treatment costs and reduce the burden on medical organizations. The review analyzes the experience in using RHM in patients with cardiovascular diseases, as well as respiratory and endocrine disorders. The review also summarizes and systematizes the findings of studies on assessing the effectiveness of RHM technologies in clinical practice, including their use in the COVID-19 pandemic.It is noted that despite high interest of the scientific community in the study of RHM technologies, unambiguous results demonstrating the effectiveness of such developments in clinical practice have not been presented.

Aim. To summarize the experience of organizing and evaluating the efficiency of the Medical Center for Remote Monitoring of patients with COVID-19 and community-acquired pneumonia in Tomsk.Materials and methods. The project of the Medical Center for Remote Monitoring was developed on the basis of data from theoretical and empirical analyses of the current state of the healthcare system in the Tomsk region and the epidemiological situation with regard to COVID-19. The Center efficiency was assessed based on the analysis of quantitative and time indicators of the load on the emergency medical service and outpatient service. Statistical processing of the results was carried out using the Statistica 12.0 software package.Results. On October 20, 2020, in Tomsk, on the premises of the “Emergency medical unit”, a Medical Center for Remote Monitoring was established. It was aimed at providing remote consultations for patients with COVID-19 and community-acquired pneumonia. According to its algorithm, operators of the Center assessed a patient’s condition on a point scale using standardized speech modules to make a decision on the tactics of their support. During the second wave of COVID-19, when the Center operated, a statistically significant decrease in the load on the ambulance service (average number of calls per day, average waiting time for all calls and coronavirusrelated calls) as well as on the outpatient service (average number of house calls per day, including calls for acute respiratory diseases) was registered.Conclusion. The work of the Medical Center for Remote Monitoring based on the described model is associated with a decrease in the load on the healthcare system in an unfavorable epidemiological situation due to high COVID-19 incidence. This experience can be spread to other regions of Russia and adapted for other categories of citizens.

There is an increase in the prevalence of chronic, noncommunicable diseases, including allergic and autoimmune diseases in developed countries. In this regard, the study of factors modifying the population’s immune response is very important.According to the “old friends” hypothesis , insufficiency of infectious stimulation and decrease in prevalence of helminthiasis are associated with development of noncommunicable diseases. Studies revealed that intestinal parasites modulate the host immune response and alter susceptibility to immunological diseases. It is suggested that one of the pathogenetic mechanisms of immune response modulation by parasites is an increase in the content of gastrointestinal bacteria with anti-inflammatory effect. Advanced technologies of microorganism identification provide a deep insight into the microbiota in different pathologies. The study of changes in the intestine and bile microbiota of the host in helminthiases provides new possibilities for prevention, diagnosis and control of such conditions as chronic inflammatory bowel diseases and allergic diseases. The purpose of this review is to analyze current experimental and clinical data on intestinal microbiota in helminth infections and possible association with development of chronic noncommunicable diseases.

The Declaration on Patient-Oriented Healthcare of theTomsk Region was accepted by the medical and patient communities on August 24, 2018. It was the first document of its kind in Russia. It was created based on several elements: modern international experience in the field of protection of patients’ and medical workers’ rights, particular qualities of Russian legislation, principles of humanistic medicine, and broad analysis of specific complaints from patients of regional public health institutions in the Tomsk region. The reason to create the Declaration was the necessity to build a healthcare system in which both medical staff and patients comply with such principles as mutual respect, choice and responsibility, involvement, accessibility, and openness. The document explains the need for constant adherence to these principles for the effectiveness of treatment, the protection of the individual, professional dignity, and equality.

Objectives. Allergic rhinitis (AR) is highly prevalent all around the world. It adversely affects the quality of life of patients and leads to the development of bronchial asthma, which determines its high socioeconomic burden. International and Russian authorities establish control of the disease as a primary efficacy end point of allergic rhinitis treatment. Nevertheless, there is no international, standardized, validated tool to assess control of allergic rhinitis. In this regard, this review aims to analyze research on the development of such tools and to provide their comparative analysis. Review methods. Using PubMed, Web of science and Russian Citation Index database, we searched from 1991 to 2019 with logical combinations of the following key words: “allergic rhinitis control”, “AR control”, “AR questionnaire”. A total of 96 publications were included in the study. Results. All studies were arranged in chronological order and their main results were described. Questionnaires on the quality of life, tools offered by the clinical guidelines, visual analogue scales, and specialized questionnaires for measuring the control of allergic rhinitis were considered separately. The advantages and disadvantages of these instruments are described. Conclusion. The evidence based on the quality of the tool to support the use of specialized questionnaires was shown. Many disease control scales have been validated, but have some practical disadvantages asprimary efficacy criteria in clinical practice.

Development of the undifferentiated connective tissue dysplasia (UCTD) is influenced by various adverse factors to the fetus during intrauterine growth. There is not a clear linkage to the contribution of the separate factors to the development of the UCTD.Aims of the study are to determine the risk factors associated with the development of the UCTD of the adolescents and to appreciate the predictive value of the examined factors related to UCTD to form the dispensary groups of the children with UCTD.Materials and methods. During the first stage of the study there was an examination of 110 adolescents at the age of 10–14 years old, the UCTD presence was established according to the scale proposed by T.I. Kadurina and V.N. Gorbunova (2009). During the second stage the data of the prenatal casework and maternity hospital records attached to the out-patient medical records were examined to detect the specialties of the antenatal life course. During the third stage 2 groups were formed: with the presence of UCTD (n = 81) and without UCTD (n = 29). The mother groups were formed accordingly with the adolescents groups.Results. The pregnancy of the mothers of the adolescents with UCTD proceeded against the anemia, threatening miscarriage, chronic fetal hypoxia, chronic fetoplacental insufficiency, toxicosis, gestosis, and concomitant chronic conditions (thyroid, kidneys, digestive apparatus, aspiration pathology) more common than the pregnancy of the mothers of the adolescents without UCTD. The binary logistic regression method allowed the predictors of the UCTD’s formation to be determined, there were: toxicosis during the gestation course (OR = 10.9; CI 95% 2.94–40.49), anemia of pregnancy (OR = 8.6; CI 95%: 2.42–30.81), gestosis (OR = 6.53; CI 95%: 1.27–33.71), chronic fetal hypoxia (OR = 4.4; CI 95%: 1.09–17.83) and pre-existing chronic conditions of the mothers (OR = 3.6; CI 95%: 0.86–15.48). Different factor combination enhances the likelihood of the delivery of a child with UCTD more than 6.5-fold: chronic conditions of the mothers and chronic fetal hypoxia (OR = 6.8; CI 95%: 1.95–48.57); anemia of pregnancy and chronic fetal hypoxia (OR = 7.2; CI 95%: 1.01–50.99), and toxicosis (OR = 10.4; CI 95%: 1.48–72.82).Conclusion. The risk factors associated to the development of UCTD in adolescents are: toxicosis during the gestation course, anemia of pregnancy, gestosis, chronic fetal hypoxia and pre-existing chronic conditions of the mothers. The use of the equation of the binary logistic regression allows the prediction of the possibility of the development of UCTD in adolescents at the level of 80.9% and to form the dispensary groups of children in order to prevent the development of dysplastic-dependent pathology

The severity of the disease is the main factor for further treatment. Bronchoobstructive syndrome of children is widespread. Early detection of the disease severity and correct treatment eliminate the clinical manifestation of the syndrome and improve the quality of patients life. Criteria of severity, as a rule, serve a certain set of clinical and paraclinical parameters used for different nosological forms. In particular, the decrease in parameters of the function of external respiration is the “gold standard” for assessing the severity. Lung function tests for preschoolers are limited. Clinical respiratory scales may be useful in the evaluation of preschooler. Alternative assessment respiratory function is sometimes used as clinical scale. Numerous studies devoted to the objective assessment of bronchial obstruction syndrome severity. A scientific literature review is dedicated to the analysis to the assessment of the bronchoobstructive syndrome severity degree and the effectiveness of therapy at preschool-aged children.

Patients’ evaluation of medical care is becoming more and more important due to expanding patient-centered care. For this purpose a complex index of patient satisfaction with healthcare is used. This parameter reflects the correspondence of actual healthcare services to patient’s expectations that were formed under the influence of cultural, social, economic factors, and personal experience of each patient. Satisfaction is a subjective parameter, thus, a grade of satisfaction is barely connected with quality of healthcare services itself. Moreover, medical organizations should always take into account specific features of each patient, since they can have an influence on customer attitude to medical services.This article comprises the review of publications studying determinants of patient satisfaction. In the course of the study, we analyzed data received by research teams from different countries.According to the review, we made some conclusions. First, determinants of patient satisfaction with healthcare can be divided in two groups. The first group of factors includes patients’ characteristics such as age, gender, ethnical and cultural features. However, researches from different countries revealed that there is a difference in the importance of factors belonging to this group and their influence on satisfaction of certain patient cohorts. The second group includes factors that belong to the process of healthcare services delivery and its organization. Moreover, it was found that patient satisfaction level is changing in a waveform. Thus, medical organization should not only try to increase patient satisfaction level but also maintain it. AS a result, it necessary to monitor patient satisfaction with healthcare services. That is why there is a distinct need for the development of a new tool or adaptation of existing instrument of satisfaction measurement, which would be unitized for all medical organizations in the Russian Federation

The purpose of this study is to evaluate the ability of systemic glucocorticosteroids administered during the exacerbation of the disease to have a modifying effect on the qualitative and quantitative composition of the oropharyngeal microbiota.Material and methods. The study included 88 patients with COPD and 50 patients with stable asthma. The patients have had a history of observation for twelve months or more; they are characterized by the absence of exacerbations and systemic antibiotic therapy for four weeks or more prior to inclusion in the study. Also, all patients participating in the study were taken samples of oropharyngeal microbiota for isolating bacterial DNA and sequencing 16S rRNA gene sequences followed by the analysis of the taxonomic composition of the microbiota. Generalized linear model implemented in the R programming language version 3.1.0, glm2 package was used to identify the relationship between taxonomic composition of metagenomes and metadata.Results. The study suggests that the use of systemic glucocorticosteroids administered during the exacerbation of asthma and COPD modifies the composition of the respiratory microbiome in the period of stability increasing the oropharyngeal representation of non-pathogenic bacteria such as Bacteroidetes (including members of the genus Prevotella) and reducing bacterial contamination of oropharyngeal swabs by proteobacteria especially Streptococcus, and Haemophilus, which includes pathogens.

The purpose of this paper is to perform the pilot review of the official medical statistics on reported Opisthorchis felineus (O. felineus) infection and liver and intrahepatic bile duct cancer in Russian Federation, covering the period 2011–2013.Materials and methods. Statistical data collected from 81 regions of Russia, reflecting the incidence of opisthorchiasis over a period from the 1st of January 2011 to the 31st of December 2013 was analyzed. The analysis of official health statistics of malignant hepatic lesions and intrahepatic bile duct was conducted in 82 regions of Russia over the same period. The data was obtained from the annual reports of the Russian center of information technologies and epidemiological studies in the field of oncology.Results. The average annual incidence of O. felineus was 24,7 ± 9,0 cases per 100,000 population. The highest incidence was observed in Khanty-Mansiysk Autonomous Okrug, Yamalo-Nenets Autonomous Okrug, Tyumen Oblast, Tomsk Oblast, Omsk Oblast and Novosibirsk Oblast. We did not observe any significant change in O. felineus infection rates within last 20 years. However, we found that infection incidence had increased in some geographical units of Western Siberia. The incidence of liver and intrahepatic bile duct cancers was 4,8 ± 0,2 cases per 100,000 population; the highest rate was reported in Far East regions, Siberia and Volgograd Oblast. This study documents the importance of opisthorchiasis in certain endemic areas and presents the best available data on associations between O. felineus infection and liver/intrahepatic bile duct cancers in endemic areas of Russian Federation.

Introduction. Currently, clinical trials (CT) remain the only technology, which provides proof of efficacy and safety of new drugs and their subsequent release to the market. Medical researcher and informed consent (IC) are the main (and often the only) source of information for the patient about the upcoming clinical trials, and thus have a direct impact on the perception of clinical trials, and on the patient’s decision about participation. However, the degree of influence of these factors on the clinical trials participants still remains unclear.Materials and methods. A multicenter cross-sectional study was conducted in different cities of the Russian Federation. Patients who had previous experience in CTs (or were enrolled in a CT at the time of this study) were asked to complete a questionnaire.Results. To assess the impact of researcher, all respondents were divided into 2 groups: patients that acquainted with IC in collaboration with the researcher, and the other group, which reviewed IC form independently. We evaluated the importance of the factors influencing the decision-making process on participation in clinical trials. According to our data, the most important factors were professional monitoring services (3,72 ± 1,00), regular condition monitoring (3,66 ± 0,98), and better medical care (3,62 ± 1,00). These factors were evaluated at significantly lower score by group of patients that acquainted with IC together with the researcher (3,55 ±0,94, vs 4,01 ± 0,90, p = 0,002; 3,52 ± 1,01 vs 3,87 ± 0,90, p = 0,040; 3,49 ± 0,94, vs 3,83 ± 1,06, p = 0,020 respectively). In assessing the factors that had negative impact on the interest in participating in a clinical trial, the most significant were risk of side effects (3,01 ± 1,27), study of new medication (2,68 ± 1,21), and the risk of getting into the placebo group (2,64 ± 1,34) (so-called “objective” risk factors). At the same time, risk of side effects and risk of getting into the placebo group were also assessed at significantly lower score by group of patients that acquainted with IC together with the researcher (2,87 ± 1,28, vs 3,33 ± 1,17, p = 0,024; 2,51 ±1,25, vs 3,03 ± 1,34, p = 0,022 respectively). Furthermore, it was found that in the case of the researcher’s assistance acquaintance time with IC reduced threefold. We also evaluated the effect of the complexity of IC text on the decision-making process on participation in clinical trials. The group of respondents, who rated the IC as easy, appeared to be more interested in the final results of the study.Conclusion. Thus, when assessing the impact of the researcher on the review process of informed consent with the decision to participate in clinical trials, we found that in the case of assistance of the researcher, the acquaintance time with IC is reduced three times. In addition, this group of patients during the conversation with the researcher shows better and more clear understanding of the nature and general methodology of clinical trials, resulting in an adequate assessment “objective” risk factors for participation in clinical trials. Thus, this group of patients is more informed, compared with an “independent” group. According to the study “Face to Face”, we can recommend mandatory participation of a researcher during review process of the IC.

The article is dedicated to the analysis of features of somatic pathology in children with low, very low and extremely low body weight at birth at different ages of life, according to foreign cohort studies of newborns with different gestational age and weight into electronic databases PubMed, Medscape. The results of the study demonstrated the fact that the vast majority of children in the study population are have impaired the physical and neuropsychological development, and associated with prematurity, respiratory, cardiovascular and hematopoietic diseases in older age. In this connection, currently there is a need not only use latest technology of nursing of newborns with a gestational age less than 37 weeks, which increases the survival of low-birth-weight cohort of patients, but also provide full preventive care in women with high perinatal risk and threat of preterm labor, that will prevent in the future the development and progression of disabling diseases in the population of premature infants.

ABSTRACT Aim of the study is to develop the diagnostic checklist based on the incidence and significance analysis of the external features of the dysplasia of the connective tissue (DCT) for its screening and assessment of its prevalence in the adolescents’ population.Materials and methods.110 adolescents (aged from 10 to 14 years) were examined, 81 of them had the dysplasia of the connective tissue (the first group). The second group was presented by 29 adolescents without DCT. The presence and degree of manifestation of DCT were established according to the criterions of Kadurina T. I., Gorbunova V.N. (2009), Т. Milkovska–Dimitrova (1987). There were the physical, laboratory and instrumental examination. Statistical processing of the results was carried out using Statistica 6.0 program and IBM SPSS Statistics 20.0. The diagnostic efficiency of the developed checklist was appreciated by means of the receiver operating characteristic curve (ROC curve). Results. The frequent occurrence of the DCT’s external features in adolescents was identified. The diagnostic checklist was developed. It was consisted of 12 items with illustrations, allowing readily identification of the dysplastic phenotype presence with diagnostic sensitivity 81.5% and specificity 79.3%. This checklist can be recommended as for the population studies, as for screening about DCT in adolescents during the primary outpatient pediatrician attendance. In the positive result of the screening it is necessary the further checkup to detect the organ changes and diagnosis updating.

Aim. To identify oropharyngeal Streptococcus species and to analyze the genetic determinants of antibiotic resistance in patients with asthma and in those with chronic obstructive pulmonary disease (COPD). Materials and methods. An experimental diagnostic Streptopol+ (Lytech Co. LTD) panel based on a multiplex real-time PCR was applied to investigate the representation of antimicrobial resistance genes (mef and ermB) and the species composition of streptococci isolated from oropharyngeal swab samples from 89 patients with stable COPD and from 51 patients with asthma. Results. In the stable disease period, the oropharyngeal swabs were found to contain Streptococcus pneumoniae in 7.8% of the patients with asthma and in 6.74% of those with COPD; the common feature of these groups was a tendency towards a severe disease course and recurrent exacerbations requiring antibiotics. S. pyogenus was detected in 42.9% of the oropharyngeal swabs from COPD and asthma patients without exacerbations. The oropharyngeal swabs showed the mef gene in 100% of the patients with asthma and in 100% of those with COPD; the ermB gene was encountered in 91% of the patients with COPD and in 82.4% of those with asthma. The COPD patients displayed a direct correlation between the representation of the ermB gene and sputum production and smoking index. The mef and ermB genes were directly correlated with the frequency of exacerbations in patients with COPD. Conclusion. The identified streptococci are a reservoir of antimicrobial resistance genetic determinants – the mef and ermB genes encoding the mechanisms of streptococcal macrolide resistance. The representation of the above genes directly correlates with the frequency of exacerbations and the number of antimicrobial drug uses.