INTERNAL MEDICINE
What is already known about this topic?
Role of Oxidative Stress in CAD: Oxidative stress—an imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense system—is a key factor in the pathogenesis of coronary artery disease (CAD) and atherosclerosis.
Problem with Revascularization: While surgical treatment for CAD (like coronary artery bypass grafting) improves prognosis, it inevitably triggers ischemia-reperfusion injury and a systemic inflammatory response. This leads to a surge in ROS production and contributes to postoperative complications.
Difficulty of Assessment: Directly measuring oxidative stress in vivo is challenging due to the instability of reactive particles, so indirect methods are typically used.
What is new in this article?
Quantitative Confirmation of Imbalance: The study provides detailed quantitative evidence that patients with CAD have a significant pro-oxidant shift. Compared to healthy individuals, they have statistically higher rates of blood oxidation (Vox), maximum (Vmax) and initial (Vinit) oxidation rates, and a higher oxidative activity coefficient (KA), along with a shorter initiation period (T).
Prognostic Value of Vox:
An increased blood oxidation rate (Vox) was statistically linked to the development of postoperative cardiac arrhythmias (p=0.0001) and postoperative cognitive dysfunction (p=0.004).
In patients with a prior myocardial infarction, high Vox values were associated with fatal outcomes.
Comparison of Surgical Techniques: Contrary to potential expectations, the choice of surgical method (on-pump with cardiopulmonary bypass vs. off-pump on a beating heart) does not affect the long-term parameters of oxidative stress. The changes observed after surgery were temporary (transient) and resolved within 6 months for both techniques.
How can this affect clinical practice in the foreseeable future?
Risk Stratification: Preoperative monitoring of induced blood oxidation parameters, particularly the blood oxidation rate (Vox), could become a practical tool for identifying patients at high risk for complications.
Personalized Management: This would allow clinicians to predict a specific patient's high probability of developing serious complications like atrial fibrillation or cognitive dysfunction following heart surgery.
Targeted Perioperative Care: Identifying patients with elevated Vox values could justify more intensive preoperative preparation (e.g., bolstering antioxidant defenses) and closer postoperative monitoring to enable early prevention or management of these adverse events.
Background. Despite its proven positive impact on prognosis and quality of life, coronary artery disease (CAD) surgical treatment is accompanied by the development of ischemia-reperfusion injury, a phenomenon underpinned by oxidative stress that mediates the development of the most common postoperative complications.
Materials and methods. The study group consisted of 89 patients with CAD, including 64 patients who underwent coronary artery bypass grafting. The control group consisted of 24 healthy volunteers. Blood oxidation parameters were assessed using a YSI 5300 biological oxygen monitor (Yellow Springs Instrument Co., Inc., USA).
Results. In patients with CAD, compared with the control group, higher values of Vox (2.07 > 1.9; p = 0.049), Vinit (3.29 > 2.11; p = 0.0001), Vmax (3.5 > 2.54; p = 0.001), coefficient of oxidative activity (KA) (40.0 > 5.89, p = 0.0001), and a shorter initiation period (T) (0.97 < 1.91; p = 0.001) were observed. In the comparative aspect, statistically significant differences in the indices of induced blood oxidation depending on the type of cardiac surgery were not observed either 10 days (B2) or 6 months after the operation (B3). In the group of patients who had previously suffered a myocardial infarction, the Vox values were statistically significantly higher in the event of a fatal outcome (2.3 (2.3; 2.5) and 1.9 (1.7; 2.3), respectively (p = 0.04). The results of the logistic regression analysis demonstrated a statistically significant effect of the Vox value on the development of cardiac arrhythmias (p = 0.0001) and cognitive dysfunction (p = 0.004) in the postoperative period.
Conclusions. Patients with CAD had higher blood oxidation parameters. The choice of revascularization technique (cardiopulmonary bypass or off-pump surgery) did not affect these parameters. However, monitoring these parameters during perioperative patient care appears to be useful for predicting the development of complications such as cardiac arrhythmias and postoperative cognitive dysfunction.
CLINICAL PHARMACOLOGY
What is already known about this topic?
Evolution of cephalosporins: Cephalosporins are β-lactam antibiotics that have evolved from the first to the fifth generation with expanding spectrum of activity and improved pharmacokinetic properties.
Classification by generation:
Generations I-II: Active primarily against Gram-positive cocci and some Gram-negative bacteria. Cefazolin (generation I) is effective for MSSA infections.
Generation III: Possess expanded spectrum against Gram-negative flora (including Pseudomonas aeruginosa for ceftazidime and cefoperazone), penetrate the blood-brain barrier well, used for meningitis and nosocomial infections.
Generation IV (cefepime, cefpirome): Combine generation III activity against Gram-negative bacteria with improved activity against Gram-positive cocci.
Generation V (ceftobiprole, ceftaroline): Developed specifically to combat MRSA and other multidrug-resistant microorganisms.
Antibiotic resistance problem: Increasing infections caused by multidrug-resistant (MDR) Gram-negative bacteria, including carbapenem-resistant strains of K. pneumoniae, P. aeruginosa, A. baumannii.
Pharmacokinetics and safety: Most cephalosporins have short half-lives (1-2 hours, except ceftriaxone), renal excretion, low toxicity profile, but may cause allergic reactions, coagulopathies (cefamandole, cefoperazone), disulfiram-like reactions, and neurotoxicity (cefepime).
What is new in this article?
Detailed analysis of cefiderocol: Presents the innovative siderophore cephalosporin (FDA-approved 2019-2020) with a unique "Trojan horse" mechanism — transport into bacteria via the iron uptake system.
Cefiderocol spectrum of activity: Describes its high activity against carbapenem-resistant Enterobacterales, P. aeruginosa, A. baumannii, Burkholderia spp., S. maltophilia, including strains producing metallo-β-lactamases.
Resistance mechanisms to newest agents: Shows that despite cefiderocol's unique properties, resistance cases have already been reported (mutations in receptor genes cirA, fiu, piuA, etc., and reduced efficacy against some β-lactamases like NDM, OXA-427).
Updated safety data: Provides contemporary research on cross-allergy (specifically cefazolin safety in penicillin-allergic patients) and cefepime neurotoxicity.
How can this affect clinical practice in the foreseeable future?
Expanding arsenal for difficult infections: Cefiderocol will become an important tool for treating severe nosocomial infections caused by MDR Gram-negative bacteria, especially where carbapenems are ineffective.
Need for antimicrobial stewardship: Rapid emergence of resistance to cefiderocol underscores the critical importance of rational use of new agents and strict adherence to protocols to preserve their effectiveness.
Refining allergy history assessment: Data on cefazolin safety in penicillin-allergic patients may change perioperative prophylaxis approaches, reducing use of less effective alternatives (clindamycin/vancomycin).
Monitoring adverse reactions: Clinicians should maintain increased vigilance for cefepime neurotoxicity and coagulopathies when using cephalosporins with NMTT groups.
Objective. This study aimed to systematize and analyze contemporary data on the evolution of cephalosporin antibiotics from the first to the fifth generation, with a focus on changes in their antimicrobial spectrum, pharmacokinetic properties, and safety profile in the context of rising antibiotic resistance.
Materials and methods. A review of the scientific literature was conducted, sourcing data from PubMed, Google Scholar, CyberLeninka, elibrary.ru, and library resources using keywords such as "cephalosporins", "antibiotic resistance", "MRSA", "Gram-negative bacteria", and "cefiderocol". The analysis included systematic reviews, randomized clinical trials, cohort studies, and meta-analyses published over the last two decades, as well as foundational historical works.
Results. The review demonstrates a clear evolutionary trajectory in the development of cephalosporin. First- and second- generation agents remain relevant for treating infections caused by Gram-positive cocci and some communities of Gram-negative microorganisms. Third- and fourth-generation cephalosporins have become the cornerstone of empirical therapy for nosocomial infections because of their expanded spectrum of activity against Gram-negative flora, including Pseudomonas aeruginosa. Fifth-generation drugs (ceftobiprole and ceftaroline) were developed to overcome MRSA resistance. A separate analysis was dedicated to the innovative agent, cefiderocol — the first siderophore cephalosporin, which possesses a unique transport mechanism into the bacterial cell and demonstrates activity against carbapenem-resistant strains of Enterobacterales, P. aeruginosa, and A. baumannii. Despite its unique properties, cefiderocol resistance is already emerging. The specific pharmacokinetic profiles (administration routes, half-life, and blood-brain barrier penetration) and spectrum of adverse reactions (allergic, hematological, and neurological) of different generations were analyzed.
Conclusion. Cephalosporins remain a cornerstone of modern antimicrobial therapy because of their favorable efficacy and safety profile. The introduction of new generations, particularly cefiderocol, represents a direct response to the global challenge of antibiotic resistance. However, the rapid emergence of resistance mechanisms even to the most advanced agents underscores the critical importance of antimicrobial stewardship programs and strict adherence to the principles of rational antibiotic therapy to preserve the future clinical value of this drug class.
PEDIATRICS
What is already known about this topic?
Prevalence of the phenomenon: Fever phobia (irrational anxiety of parents about a child's fever) is a global problem, affecting 57–74% of families worldwide (USA, New Zealand, South Korea, etc.).
Depth of misconceptions: Many parents (up to 50–80%) believe that fever can lead to fatal consequences: brain damage, seizures, respiratory arrest, or death.
Scope of the problem in the Russian Federation: In Russia, anxiety about fever is recorded in 80–90% of families, with more than 90% of children with ARVI receiving antipyretics, often unjustifiably (even with subfebrile temperature).
Problem among doctors: The phenomenon is characteristic not only of parents but also of medical staff—65% of pediatricians mistakenly consider elevated temperature an independent risk factor and strive to reduce it by any means.
What is new in the article?
Specific quantitative data (example from Yaroslavl): The study provides fresh figures (2022–2024), detailing maternal behavior:
Frequency of measurements: 40.7% measure temperature 3–5 times a day, and 7.4% do so up to 10–12 times (sometimes every 40 minutes), which objectively confirms a high level of iatrogenic stress for the child.
Unjustified use of medication: 38.9% of mothers give antipyretics for any temperature increase, and 18.5% use them prophylactically, which contradicts clinical guidelines.
Dangerous methods: Widespread use of prohibited and dangerous physical cooling methods was identified (vinegar rubdowns — 25.9%, alcohol rubdowns — 14.8%, ice application — 12.9%).
Self-medication: 74.8% of parents calculate the drug dose only by the package insert, and 9.2% do so independently, creating a high risk of overdose.
Clarification of target indicators: The article records that 64.8% of mothers aim to reduce the temperature to 37.0 °C, and 18.5% to the ideal 36.6 °C, demonstrating a complete misunderstanding of the physiological role of fever as a defense mechanism.
Identification of "blind spots" in education: It confirms that 81% of mothers associate fever with the possible death of their child, indicating a failure of current health education efforts.
How could this affect clinical practice in the foreseeable future?
Revision of educational programs: The obtained data justify the need to implement mandatory structured conversations (scripts) for parents during outpatient visits, focusing on debunking myths (about the dangers of alcohol/vinegar, about "target" 36.6°C).
Training for doctors: The results require strengthening the "Fever" module in postgraduate education programs for pediatricians to eradicate the practice of prescribing unsafe drugs (analgin/dipyrone — 14.8% in the survey) by doctors themselves.
Reducing the burden on emergency services: Correcting parental fears through evidence-based information could reduce the number of unjustified ambulance calls and hospital visits for non-dangerous conditions.
Improved compliance: Parents' understanding of the physiology of fever (rather than fighting the number on the thermometer) will allow for less frequent use of medication, reducing the risk of side effects and toxic reactions from uncontrolled antipyretic use.
Background. Fever phobia — excessive anxiety among parents about fever in children — is a relevant problem in both global and Russian pediatrics. In Russia, up to 80–90 % of families have concerns about fever, the danger of febrile seizures, and even death of a child, which often leads to excessive use of antipyretics, sometimes contrary to clinical recommendations. The phenomenon is typical not only for parents but also for doctors, of whom 65 % of pediatricians consider temperature an independent risk factor and recommend reducing it by all available means.
Objective. This study aimed to assess the attitudes of mothers toward childhood fever and the specifics of providing care when it occurs at the outpatient stage.
Materials and methods. An anonymous survey was conducted between 2022 and 2024 among 54 mothers with children aged 1–15 years who were observed in polyclinics and private medical centers in Yaroslavl. The questionnaire included questions about the frequency of temperature measurements, the criteria for prescribing antipyretics, preferences for medications and their forms, intervals between doses, the presence of allergies, sources of information, the physical treatments used, and the fears associated with fever. The average age of the children was 3.49 years.
Results. Most mothers (40.7 %) measured their child's temperature 3–5 times a day, reflecting a high level of anxiety. Of the respondents, 7.4 % measured their child's temperature 1–2 times a day, while some mothers measured their child’s temperature up to 10–12 times a day, which can lead to measurements every 40 minutes, increasing stress for both the child and the parents. More than 90 % of children with acute respiratory infections receive antipyretics, and in 72 % of cases, antipyretics are administered even when the temperature is below 38°C.
Conclusions. Fever phobia is widespread among parents and is accompanied by high anxiety, frequent temperature measurements, and excessive antipyretic use. Therefore, additional educational measures should be implemented for both parents and healthcare professionals.
ONCOLOGY
What is already known about this topic?
Prevalence: Colorectal cancer (CRC) is one of the most common and deadly oncological diseases in Russia.
Trends: There is a steady increase in CRC incidence, including an alarming rise among individuals under 50 (a 56.3% increase in the Yaroslavl region).
Screening Effectiveness: Two-stage screening (FIT followed by colonoscopy) is a recognized method for early detection of precancerous lesions and reducing mortality.
Risk Factors: High-risk groups include not only older individuals but also workers in hazardous industries (chemical, physical factors).
Quality Indicators: Validated indicators such as ADR (adenoma detection rate), AADR (advanced adenoma detection rate), and PDR (polyp detection rate) are used to assess colonoscopy quality.
What is new in this article?
Confirmation of Effectiveness in a Specific Cohort: It presents the first data on the high effectiveness of two-stage screening (FIT + colonoscopy) specifically among industrial workers with occupational hazards (YANOS) in the Yaroslavl region.
Specific Data in the High-Risk Group:
FIT-positive workers showed significantly higher adenoma (ADR) and polyp (PDR) detection rates compared to the control group (ADR 32.4% vs. 18.1%; PDR 50.7% vs. 37.3%).
Key Finding: CRC was detected in 3.7% of the FIT-positive group, whereas no cancer was diagnosed in the control group (without FIT selection).
Age Stratification within the Risk Group: The study shows a clear age dependence even within the FIT-positive group: individuals over 50 have significantly higher ADR (37.0%) and AADR (34.5%) than younger participants (25.0% and 17.3%, respectively).
Early Cancer in Younger Individuals: Cancer was also detected (1.9%) in the <50 age group with a positive FIT, confirming the importance of screening in this age category when additional risk factors are present.
How can this affect clinical practice in the foreseeable future?
Implementation of Targeted Programs: The results justify developing personalized screening programs not only for age groups but also for workers in hazardous industries, including them in priority populations.
Adaptation of Screening Intervals: The critical importance of age stratification is confirmed. Screening intervals could be shortened for individuals over 50 with occupational risks.
Reduction of Unnecessary Invasive Procedures: Using a two-stage approach (FIT as the first step) selects only those with a high probability of pathology (23.3% of the initial group) for colonoscopy, saving resources and reducing the burden on FIT-negative patients.
Regional Healthcare Strategy: This work provides scientific justification for including such targeted programs in regional health systems. This should lead to earlier diagnosis and reduced CRC mortality through timely detection of cancer and precancerous conditions (adenomas) in groups with high (occupational and age-related) risk.
Relevance. Colorectal cancer (CRC) is one of the most common and lethal oncological diseases in Russia. The Yaroslavl region is experiencing a steady increase in incidence, including an alarming trend of rising CRC cases among individuals under 50 years of age (a 56.3 % increase). This underscores the need to develop and implement effective, targeted screening programs, especially for high-risk groups, such as workers in hazardous industries.
Objective. To evaluate the effectiveness of a personalized colorectal cancer screening program based on a two-stage method (faecal immunochemical test (FIT) followed by colonoscopy) among workers at an industrial enterprise with increased occupational hazards in the Yaroslavl region.
Materials and methods. The study cohort included 1,105 employees of the "YANOS" industrial enterprise aged 38 years and older, classified as a high-risk group for CRC development due to exposure to chemical and physical occupational hazards. Screening was conducted in two stages: I stage — Initial testing using FIT; II stage — colonoscopy for individuals with a positive FIT result (n=136). A set of validated colonoscopy quality indicators was used to assess effectiveness: adenoma detection rate (ADR), advanced adenoma detection rate (AADR), serrated lesion detection rate (SSLR), polyp detection rate (PDR), adenomas per colonoscopy (APC), adenomas per positive patient (APPP), and CRC (colorectal cancer detection rate). A control group of 204 patients was included for comparison.
Results. Based on the FIT results, 23.3 % (256 individuals) of all participants tested positive. Overall effectiveness indicators were significantly higher in the FIT-positive group who underwent colonoscopy (n = 136) than in the control group: ADR was 32.4 % vs. 18.1 %, AADR was 27.9 % vs. 18.6 %, and PDR was 50.7 % vs. 37.3 %, respectively. A clear age dependence was identified: in the ≥50 years group, ADR (37.0 %) and AADR (34.5 %) rates were significantly higher than in the <50 years group (25.0 % and 17.3 %, respectively). Key finding: colorectal cancer was diagnosed in 3.7 % of cases in the FIT-positive group (1.9 % in the <50 years group and 4.8 % in the ≥50 years group), whereas no cancer cases were detected in the control group.
Conclusions. The personalized two-stage screening program (FIT + colonoscopy) demonstrated high effectiveness for the early detection of precancerous lesions and CRC among workers with occupational risks. Age is a critically important factor: adenoma and advanced adenoma detection rates (ADR, AADR) significantly increase after age 50, confirming the need for age stratification and adaptation of screening intervals. Implementing such targeted programs in regional healthcare systems, especially for high-risk groups (occupational and age-related), is strategically important for reducing CRC mortality through early diagnosis and prevention.
SURGERY
What is new in the article?
Detailed Pathogenetic Data by Stage: The study provides specific quantitative data on metabolic changes. It details the progression of water-electrolyte disorders (e.g., isotonic dehydration with up to a 20% decrease in circulating blood volume in stage II, and a >30% decrease with hypovolemic shock in stage III). It also presents novel data on the exponential accumulation of specific toxic metabolites (like isovaleric and butyric aldehydes) as the disease progresses.
Conservative Success Rate: It confirms a high success rate (68%) for conservative treatment in adhesive AIO, which accounted for over a third (36.2%) of all cases in the study.
Paradoxical Finding on Hospitalization Timing: A counterintuitive finding was that patients hospitalized within the first 12 hours had a much higher mortality rate (27.8%) than those hospitalized later (6.3%). The authors attribute this to a higher prevalence of strangulation obstruction in the early-presenting group, which requires more extensive resections.
Quantified Risk Factors: The study quantifies the impact of specific risk factors:
Intestinal resection increases mortality to 23.2%.
Tumor-related obstruction has a mortality rate 3.8 times higher than non-tumor causes.
The development of MOF (Stage III) increases the risk of death more than tenfold compared to earlier stages.
Age over 75 is an independent risk factor with a 22.3% mortality rate.
How can this affect clinical practice in the foreseeable future?
Improved Risk Stratification and Prognosis: Clinicians can use the identified factors (age >75, need for resection, disease stage) to more accurately predict outcomes and identify high-risk patients who need more aggressive monitoring and intensive care from the moment of admission.
More Targeted Intensive Care: The detailed data on metabolic changes allows for more pathogenetically based therapy. For example, it emphasizes the critical need to correct circulating blood volume in stage II and to initiate massive detoxification and organ support in stage III.
Emphasis on Organ Preservation: The high mortality associated with intestinal resection (23.2%) strongly reinforces the importance of attempting conservative management, especially in adhesive obstruction, and, when surgery is unavoidable, making every effort to preserve intestinal viability to avoid extensive resections.
Potential for New Diagnostic Markers: The clear correlation between specific toxic metabolites (aldehydes) and the stage of the disease could lead to the development and introduction of new laboratory tests to objectively assess the severity of a patient's condition and guide treatment decisions.
Relevance. Acute intestinal obstruction (AIO) remains the focus of clinicians’ attention. The mortality rate in this pathology is 5.1–8.4 %, occupying one of the leading places among all urgent diseases. The diagnosis and treatment of patients with intestinal obstruction remain relevant.
Objective. Assessment of AIO treatment results based on an improved set of therapeutic measures.
Materials and methods. This study enrolled 1279 patients aged 20–90 years with various AIO course variants. The dynamics of water and electrolyte metabolism, endogenous intoxication, and treatment outcomes in different age groups were studied depending on the etiology, stage of intestinal obstruction, and volume of surgical intervention.
Results. Studies have shown increasing changes in water and electrolyte metabolism during the stage of enteral hypertension, with the most significant changes in the development of peritonitis and multiple organ failure. The progressive accumulation of toxic metabolic intermediates, noted at the very beginning of the disease, also depended on the intestinal obstruction stage. The episode of adhesive intestinal obstruction was conservatively resolved in 68 % of patients. The average mortality rate among all patients was 8.7 %. Intestinal resection was required in 20.1 % of patients, which increased the mortality rate to 23.2 %. The incidence of death in cases of tumor obstruction was 3.8 times higher than that in patients with non-tumor genesis of the disease. The addition of multiple organ failure was accompanied by an increase in mortality by more than 10 times.
Conclusions. In AIO, age >75 years, the need for intestinal resection, and the development of multiple organ failure syndrome are prognostic risk factors for an adverse outcome, regardless of hospitalization duration.
NEUROLOGY
What is already known about this topic?
High Prevalence: Headache (HA) is an extremely common problem among students, occurring significantly more often than in the general population (rates vary from 26% to 95%).
Dominant Types: Among primary headaches in students, two types predominate: tension-type headache (TTH) and migraine. In most studies, TTH is more common.
Main Triggering Factors: Key triggers for HA in students are psycho-emotional stress (related to studies), lack of sleep, overwork, and anxiety.
Gender Differences: Nearly all studies confirm that women suffer from headaches, especially migraines, significantly more often than men.
Negative Consequences: HA leads to reduced academic performance, lower quality of life, sleep disturbances, and can contribute to the development of anxiety and depressive disorders.
Low Healthcare Seeking: The majority of students prefer self-medication with over-the-counter analgesics and very rarely consult specialists.
What is new in the article?
Updated Data in Modern Context: The article summarizes recent data (2020–2024), allowing for an assessment of the situation considering current changes in education (digitalization, growth of distance learning) and social factors.
Identification of New Risk Factors: Data on the impact of modern digital technologies are systematized. Long-term smartphone use (>5-7 hours a day) and internet addiction are highlighted as important provocateurs of HA.
Demonstration of Data Heterogeneity: The review clearly shows a wide variation in epidemiological indicators across different studies. This points to the lack of a unified methodology and emphasizes the need for standardized approaches to studying the problem.
Focus on Medical Students: It confirms that medical students are in a special risk group due to the high intensity of their academic workload, requiring special attention to prevention and therapy in this population.
Synthesis of Trigger Factors: The work presents a summary table of potential HA provocateurs, providing a comprehensive view of the multifactorial nature of the problem in students.
How can this affect clinical practice in the foreseeable future?
Enhanced Preventive Work: Understanding the role of "digital" factors will allow doctors to give students more specific recommendations on study and rest hygiene, and gadget use.
Personalized Approach for Medical Students: Recognizing that future doctors are at a high risk of pain chronification should lead to earlier identification of their problems and timely selection of preventive therapy to avoid medication-overuse headache.
Focus on Psycho-emotional State: Confirmation of the strong link between HA and anxiety, stress, and depression will encourage doctors to more thoroughly assess a student's psychological status and, if necessary, collaborate with psychologists or psychiatrists.
Increased Awareness: Data on the low rate of students seeking specialized care highlight the need for educational activities (lectures, brochures) in universities about the dangers of self-medication and the importance of timely diagnosis.
Justification for Administrative Measures: The review's findings can serve as an argument for university administrations when planning the educational process to reduce stress loads (e.g., optimizing schedules, creating relaxation rooms).
Modern medicine is facing a serious problem — the consequences of cephalgic disorders, which, despite the relatively low mortality rate, significantly affect society. Patients suffering from regular migraine attacks and other types of headaches often find themselves unable to fully study and work, which significantly reduces their life potential. In the most difficult situations, hospitalization is the only way out. The inability of people with cephalgia to function effectively in everyday life creates large-scale economic and social problems for the whole society. This situation requires the health care system to develop comprehensive and effective solutions, as it affects many aspects of public life. The main objectives of the literature review are to determine the prevalence of migraine and tension headache among groups of students divided according to a number of criteria, to identify key factors predisposing to headache, as well as comorbid disorders, anamnesis features associated with its manifestations.
INFECTIOUS DISEASES
What is already known about this topic?
Combination of Pathologies: Chronic Hepatitis C (CHC) and Metabolic Syndrome (MS) often coexist and aggravate each other, accelerating liver fibrosis and potentially reducing the effectiveness of antiviral therapy. CHC itself can contribute to liver steatosis, a manifestation of MS.
Assessment Tools:
Bioimpedance Analysis is a known method for assessing nutritional status and body composition.
The Phase Angle (PhA) derived from bioimpedance is a recognized marker of metabolic intensity and cell health. A low PhA (<5°) correlates with a poor prognosis in various chronic diseases (cancer, cirrhosis, HIV).
Quality of Life (QoL) is known to be reduced in patients with chronic viral hepatitis, affecting both physical and psychological components.
Clinical Debate: The use of hepatoprotectors in viral hepatitis remains a topic of discussion, creating a need for comparative studies of their clinical and metabolic effects.
What is new in the article?
Comparative Design: This study provides a direct, prospective comparison of three different hepatoprotective regimens (glycyrrhizic acid + essential phospholipids, ademetionine, and ursodeoxycholic acid) specifically in patients with the combined pathology of CHC and MS.
Comprehensive Evaluation: It is novel in its combined assessment of standard biochemical markers (ALT, AST, ALP, GGT) alongside quality of life (SF-36) and bioimpedance parameters (phase angle, fat mass, waist-to-hip ratio) to evaluate treatment effects.
Identified Frontrunner:
Ademetionine showed the most pronounced biochemical improvement (ALT ↓65%, AST ↓50%, cholestasis markers ↓70%).
It was the only group showing a positive trend (though not statistically significant) in body composition parameters (phase angle), suggesting a potential metabolic benefit.
Quality of Life Dynamics: Statistically significant improvements in QoL (vitality, emotional and social functioning) were observed only in the ademetionine and glycyrrhizic acid + phospholipids groups, but not in the UDCA group.
Phase Angle Reactivity: The study demonstrates for the first time that a 4-week course of hepatoprotective therapy can lead to a statistically significant increase in the phase angle in this patient population, indicating improved metabolic activity.
How can this affect clinical practice in the foreseeable future?
Informed Drug Selection: The findings support a differentiated approach. In patients with CHC and concurrent MS (especially with cholestasis), ademetionine may be the preferred choice due to its broader positive impact on liver enzymes, patient well-being, and potential metabolic effects.
Expanded Monitoring Criteria:
Bioimpedance analysis (specifically phase angle) and QoL questionnaires (SF-36) could be recommended for routine use in monitoring patients with chronic liver disease and metabolic issues.
These tools provide a more holistic view of treatment effectiveness, capturing not just lab results but also the patient's functional status and well-being, which is valuable for long-term outpatient care.
Direction for Future Research: The observed trend of improved body composition with ademetionine warrants further investigation with larger patient groups and longer follow-up periods to confirm its role in correcting metabolic disorders associated with CHC.
Relevance. The combination of chronic hepatitis C (CHC) and metabolic syndrome (MS) represents a mutually aggravating condition that contributes to the progression of liver fibrosis and reduces the effectiveness of therapy. Investigating the influence of hepatoprotective therapy on metabolic parameters and quality of life in this patient category is a clinically significant task.
Objective. To evaluate the impact of different hepatoprotective therapy regimens on bioimpedance body composition analysis indicators and quality of life in patients with CHC and MS.
Materials and methods. A prospective randomized study included 120 patients with CHC, randomized into 4 groups: 1 — glycyrrhizic acid + essential phospholipids (n=30); 2 — ademetionine (n=30); 3 — ursodeoxycholic acid (n=30); 4 — comparison group (n=30). Therapy was administered for 4 weeks. Biochemical parameters (ALT, AST, ALP, GGT), bioimpedance analysis parameters (phase angle, fat mass percentage, waist-to-hip ratio), and quality of life using the SF-36 questionnaire were assessed before and after treatment. Statistical analysis was performed using Student's t-test, Mann-Whitney U test, and Wilcoxon test.
Results. All active therapy groups showed positive dynamics in biochemical parameters. The most pronounced reduction in ALT (65 %), AST (50 %), and cholestasis markers (70 %) was recorded in the ademetionine group. Statistically significant improvement in quality of life on the scales of vitality, emotional and social functioning was noted in groups 1 and 2. Bioimpedance analysis parameters demonstrated a significant increase in phase angle after treatment; however, no significant changes in fat mass percentage or waist-to-hip ratio were found. In the control group, the dynamics of the indicators were not significant.
Conclusions. The use of hepatoprotectors (glycyrrhizic acid + essential phospholipids, ademetionine, ursodeoxycholic acid) in patients with CHC and MS for 4 weeks leads to an improvement in biochemical parameters and quality of life. The most comprehensive positive effect, including a trend towards improved body composition parameters, was observed with the use of ademetionine. Bioimpedance analysis and quality of life assessment are promising screening tools for monitoring therapy effectiveness in this patient category.
What is already known about this topic?
Prevalence: Post-COVID syndrome (PCS) is a significant global health issue, affecting an estimated 6% to 45% of those infected, with symptoms potentially lasting for years.
Core Symptoms: International research has established that dominant Long COVID symptoms include debilitating fatigue, cognitive impairments ("brain fog"), shortness of breath, sleep disturbances, and psycho-emotional disorders.
Risk Factors: Well-known risk groups include women, the elderly, individuals with obesity or chronic diseases, and those who experienced a severe acute infection.
Nature of the Condition: PCS is recognized as a multisystem condition that can develop regardless of the severity of the acute phase, even after asymptomatic infections.
What is new in the article?
Novel Sensory and Food-Related Phenomena:
The study documents cases of selective food aversion (e.g., to meat, chicken, sweets) that are not necessarily linked to distorted smell or taste, potentially impacting nutritional status.
It reports the emergence of new food allergies (4%) to previously well-tolerated items.
Unusual Drug Reactions: A significant finding is that 13.6% of respondents experienced new, unusual side effects (nausea, altered taste) to familiar medications post-COVID, suggesting possible virus-induced changes in drug metabolism (e.g., liver function).
Atypical Skin Manifestations: The research describes cases of vasculitis-like rashes (livedo reticularis, petechiae) that were statistically more frequent in patients with pre-existing autoimmune or metabolic conditions.
Specific Relapse Triggers: It identifies and quantifies factors that provoke the wave-like return of symptoms: stress (31.8%), weather changes (22.7%), and changes in daily routine (18.2%).
Paradoxical Reactions: It notes not only loss of smell but also heightened sensitivity to odors (7%), accompanied by headaches and nausea.
How can this affect clinical practice in the foreseeable future?
Individualized Dietary Guidance: Clinicians will need to screen for selective food aversions and new allergies to provide tailored nutritional advice and prevent unintended weight loss or deficiencies in PCS patients.
Caution in Pharmacotherapy: Prescribing any medication to post-COVID patients will require increased vigilance for unexpected side effects and closer monitoring of liver function, as tolerance to familiar drugs may have changed.
Need for Interdisciplinary Care: The link between skin manifestations and autoimmune issues reinforces the need to involve dermatologists and rheumatologists in managing complex PCS cases.
Targeted Rehabilitation Strategies: Understanding that stress and weather changes act as triggers will allow for the development of more effective rehab programs that include psycho-emotional support and patient education on managing these factors.
Refining Diagnostic Criteria: These findings can help update clinical guidelines by adding new sensory, skin, and drug-reaction phenomena to the list of recognized post-COVID symptoms, improving diagnosis and patient recognition of their condition.
Background. Post-covid syndrome (Long COVID) remains a serious medical and social problem, as its symptoms can persist for months or even years after the acute phase of COVID-19. According to the WHO, up to 6 % of those who have been ill experience Long COVID, and according to meta-analyses, up to 45 %. This creates a significant burden on the healthcare system and requires new approaches to the diagnosis and rehabilitation of patients, especially among the able-bodied population. Objective. To analyze the features of long-term symptoms in patients who have had COVID-19, based on survey data, in order to identify new clinical phenomena, determine the frequency and duration of their manifestations, as well as to study the influence of demographic and clinical factors on the formation of post-covid syndrome.
Materials and methods. The study was conducted among 220 residents of Yaroslavl in 2024 (82.7 % women, average age 33.8 years) using an electronic questionnaire. The presence of chronic diseases, vaccination status, course and duration of symptoms were assessed. Methods of descriptive statistics, correlation analysis, and significance level p <0.05 were used.
Results. The majority of participants retained various symptoms: fatigue (83.8 %), cognitive impairment (85 %), insomnia (35 %), depressive states (52.4 %), hair loss (52.1 %). Sensory disturbances were often noted (85 % — loss/distortion of sense of smell and taste), selective aversion to foods, new food allergies (4 %), atypical skin manifestations (6.8–11.4 %), unusual drug reactions (13.6 %). The symptoms were often wave-like (65 %) and persisted for more than three months. Vaccination reduced the severity of the acute phase, but did not always prevent Long COVID. The risk factors were chronic diseases, female sex, autoimmune and metabolic disorders.
Conclusions. Long COVID is a multisystem condition that requires an individual approach to diagnosis and rehabilitation. It is recommended to pay special attention to sensory, nutritional and skin disorders, as well as psychoemotional support for patients. The data obtained can serve as a basis for the development of new clinical guidelines for the management of patients after COVID-19.
What is already known about this topic?
Prevalence: Ixodes tick-borne borreliosis (ITBB) is the most common tick-borne infection in Russia, with a clear spring-autumn seasonality and high prevalence, especially in the Central Federal District.
Classic Presentation: Diagnosing the erythematous form of ITBB is usually straightforward when there is a known history of a tick bite and the presence of classic erythema migrans (EM) — a patch larger than 5 cm that expands centrifugally.
Rare Symptoms: Atypical skin manifestations within the erythema (such as papules, vesicles, and hemorrhages) have been described in the literature but are considered rare, occurring in an estimated 1-4.8% of patients.
Laboratory Challenges: Serological confirmation (ELISA) in the early stages can be difficult due to a delayed immune response, with IgM antibodies typically appearing only 1-1.5 months after infection.
What is new in the article?
Demonstrates Diagnostic Difficulty: This clinical case vividly shows how the absence of a remembered tick bite, combined with atypical skin lesions (papules, vesicles, hemorrhages, a cyanotic hue), can lead to misdiagnosis (e.g., dermatitis, local infection) and a delay in specific treatment.
Describes Unusual Clinical Course: It details the evolution of the rash during doxycycline treatment, which did not regress immediately but temporarily worsened. The authors link this to modifying factors: the patient's continued use of a topical glucocorticosteroid cream and sun exposure (photosensitization, a side effect of doxycycline).
Analyzes Co-infection: The case describes the concurrent infection with ITBB and COVID-19, which likely influenced the systemic symptoms (fever, cough) and complicated the clinical picture.
Documents Long-term Outcome: It shows that in this atypical form, the resolution of EM was followed by significant scaling and pigmentation, which eventually resolved completely.
How can this affect clinical practice in the foreseeable future?
Increase Clinical Suspicion: Physicians (infectious disease specialists, dermatologists, therapists) should maintain a high index of suspicion for ITBB even without a reported tick bite, especially if the patient was in an endemic area during tick season.
Broaden Differential Diagnosis: When encountering a large (>5 cm) expanding skin lesion, even with unusual features like papules or vesicles, ITBB should be included in the differential diagnosis alongside dermatitis and allergic reactions.
Adjust Management Strategy: In complex or atypical cases, it is prudent to order laboratory confirmation (ELISA for Borrelia IgM) early and not delay empiric antibiotic therapy (doxycycline) if clinical suspicion is high.
Consider Modifying Factors: Clinicians should be aware that topical corticosteroid use or sun exposure can alter the typical presentation of ITBB and the initial response to antibiotics. This should not rule out the diagnosis.
The clinical and epidemiological diagnosis of the erythematous form of Ixodes tick-borne borreliosis (Lyme disease) typically poses no difficulties for an infectious disease specialist. Diagnostic challenges arise when there is no history of a tick bite and when the presentation of erythema migrans is atypical. This skin manifestation must be differentiated from various dermatological, allergic, and other inflammatory conditions. In such complex cases, laboratory confirmation is required. With appropriate antibiotic therapy, erythema migrans typically resolves rapidly.
The present case report illustrates these diagnostic difficulties due to the absence of a reported tick bite and the atypical presentation of the erythema, which included papules, vesicles, and hemorrhagic components.
For a correct and timely diagnosis of Lyme borreliosis, even in the absence of a known tick bite, a detailed exposure history is essential. This includes assessing the patient's residence in or travel to an endemic area and any outdoor activities (e. g., walking in forested or park areas) during the tick season. The classic clinical picture is characterized by a red patch or spot, typically exceeding 5 cm in diameter, that expands centrifugally. In rare cases (reported in 1–4.8 % of patients), the erythema migrans lesion may be accompanied by atypical features such as papules, vesicles, pustules, or hemorrhages.
MEDICAL CYBERNETICS
What is already known about this topic?
The Problem of Centralization: Traditional Medical Information Systems (MIS) are centralized, fragmented, and vulnerable to cyberattacks and data falsification. This makes unified access difficult and removes control from the patient.
Basic Types of Blockchain: There are public (open but slow), private (managed by one organization), and consortium (managed by a group) blockchains. Private and consortium models are best suited for medicine due to confidentiality requirements.
Hybrid Architecture: Storing large medical files (like MRI scans) directly on a blockchain is impractical. The known solution is a hybrid model where data is stored off-chain (e.g., in IPFS), and only the cryptographic hashes are stored on-chain to verify integrity.
Basic Functions of Smart Contracts: Smart contracts can automate simple processes like payments for consultations or sending alerts to doctors based on data from patient-worn sensors.
What is new in the article?
Focus on the Russian Context and "Masterchain": The article highlights the "Masterchain" platform, which is based on Hyperledger Fabric and complies with Russian cryptographic standards (GOST) and data privacy laws (FZ-152). This is crucial for implementation in Russia.
A Solution for the "Right to be Forgotten": It proposes a specific architectural solution to the conflict between blockchain's immutability and the "right to be forgotten." By deleting the cryptographic key that decrypts off-chain data, the data becomes unreadable. The blockchain retains an immutable audit trail of the data's existence and its deletion, satisfying both requirements.
Post-Quantum Security: The article raises the issue of long-term data security against future quantum computing attacks. It advocates for a preventive transition to post-quantum cryptography (like CRYSTALS-Kyber), which is a forward-looking step beyond current security standards.
The Concept of "Prosent" (Proactive Consent): It expands the idea of dynamic consent to a "proactive" or "predictive" mode. Using smart contracts, a patient could predefine complex rules for the future use of their data, even for research purposes not yet imagined at the time of giving consent.
Detailed Analysis of the Consortium Model: The article thoroughly explains why the consortium model is the optimal balance for healthcare. It combines decentralization, control, high transaction speed, and confidentiality, which is necessary for data exchange between hospitals, insurers, and regulators.
How can this affect clinical practice in the foreseeable future?
Realistic Dynamic Consent: User-friendly digital interfaces will allow patients to give or revoke a doctor's access to their medical history in real-time (e.g., during a telemedicine consultation) or permit the use of anonymized data for research. This empowers the patient.
Trust in Telemedicine and IoT Data: Doctors will be able to use data from wearable devices more confidently for clinical decisions because blockchain can guarantee the data came directly from the device and hasn't been altered.
Transparency for Clinical Trials: Patients in clinical studies will be able to see exactly who used their data and when, thanks to an immutable audit log. For researchers, obtaining and updating patient consent will be simplified and automated.
A New Standard for Data Protection: Medical institutions will gradually move toward hybrid systems where data integrity is guaranteed and access is tightly controlled. The adoption of post-quantum cryptography will become a standard for systems that must protect patient data for decades.
Gradual Integration: Blockchain won't replace existing systems overnight. Its impact will be felt through integration layers and new solutions (especially those based on "Masterchain") that connect different clinics and systems into a unified, decentralized, and patient-oriented network, improving interoperability.
This article analyzes the prospects and challenges of integrating blockchain technologies into medical data management systems within the context of digital healthcare transformation. The study's relevance stems from the growing need to establish secure, transparent, and patient-centric infrastructures for handling medical information. The paper provides a comparative analysis of public, private, and consortium blockchain platforms, identifying the consortium model as the most promising for creating data exchange ecosystems among various healthcare stakeholders. Technological aspects are examined in detail, including a hybrid storage architecture (combining blockchain with distributed file systems like InterPlanetary File System), models for dynamic and predictive informed patient consent based on smart contracts, and the application of blockchain in telemedicine and next-generation electronic health record (EHR) management. The article also systematizes key implementation challenges: the need to reconcile blockchain immutability with the right to be forgotten, the imperative for a transition to post-quantum cryptography, as well as issues of scalability, energy efficiency, legal regulation, and integration with existing medical information systems. The conclusion emphasizes that the successful implementation of blockchain solutions in Russian healthcare requires coordinated development of technological infrastructure (focusing on domestic platforms like "Masterchain"), adaptation of the regulatory framework, and targeted training of medical professionals with competencies in digital technologies.
PHARMACY BUSINESS ORGANIZATION
What is already known about this topic?
Historical Significance: Vitamin K antagonists (VKAs), particularly warfarin, have been the "gold standard" for thrombosis prevention and treatment for decades.
Therapeutic Drawbacks: The main limitations of VKAs are well-documented: a narrow therapeutic window, significant drug and food interactions, the need for constant laboratory monitoring (INR), and difficult dose titration due to genetic factors.
Market Shift: The emergence of Direct Oral Anticoagulants (DOACs) is known to be changing clinical practice, as they offer fixed dosing, require no routine monitoring, and have a better safety profile regarding intracranial hemorrhages.
What is new in the article?
Current Market Data (2025): It provides up-to-date quantitative data on which VKAs are actually available in the EAEU. Of the 10 existing INNs globally, only 3 are registered in the EAEU (Warfarin, Acenocoumarol, Phenindione). In Russia, only Warfarin and Acenocoumarol remain (Phenindione was removed in 2023).
Negative Market Trend: It clearly identifies a trend of assortment reduction in Russia. The peak number of registered trade names (8) was in 2010-2016; by 2025, this number has shrunk to 5.
Comparative EAEU Analysis: It provides a unique comparison of VKA availability across the union:
Kazakhstan, Armenia, and Kyrgyzstan have only warfarin.
Belarus still has phenindione (unlike Russia).
Dosage availability varies (e.g., Russia and Kyrgyzstan only have 2.5 mg warfarin, while others have 3 mg and 5 mg).
Production Localization Data: It quantifies import dependence. The production of active pharmaceutical ingredients (APIs) for warfarin in Russia is completely absent (sourced from India, China, etc.), though 50% of finished dosage forms are packaged/produced locally.
How can this affect clinical practice in the foreseeable future?
Limited Choice for Physicians: Doctors in Russia and most EAEU countries will have a narrower range of options. The loss of phenindione and 3 mg/5 mg warfarin dosages reduces flexibility in titrating doses for complex patients.
Drug Security Risks: The complete lack of localized API production creates a potential supply chain risk (logistics, currency, politics), which could affect the availability of therapy for patients who cannot take DOACs (e.g., those with mechanical heart valves).
Shift to DOACs: The confirmed trend away from "inconvenient" VKAs will accelerate. This solidifies DOACs as the first-line treatment for most indications (like atrial fibrillation) where warfarin was previously used.
Challenges for Specific Patient Groups: Warfarin/acenocoumarol remain essential for niche but critical groups (mechanical valves, antiphospholipid syndrome, DOAC intolerance). The reduction in dosages and available brands may complicate the management of these specific patients.
Objective. To identify trends in the development of the pharmaceutical market for vitamin K antagonists in the member states of the Eurasian Economic Union (EAEU), focusing on the rates of drug registration and the localization of production for active pharmaceutical ingredients (APIs) and finished dosage forms.
Materials and methods. A search for drug registration certificates was conducted in the state registries of medicines of the Russian Federation, the Republic of Belarus, the Republic of Kazakhstan, the Republic of Armenia, and the Kyrgyz Republic. A database on the state registration and production of vitamin K antagonists was developed in Microsoft Excel. The methods of content analysis, critical analysis, and classification were used.
Results. According to the 2025 ATC Index, code B01AA (vitamin K antagonists) includes 10 active substance names (10 INNs). In the EAEU territories, only 3 INNs have been registered (warfarin, acenocoumarol, and phenindione). In Kazakhstan, Armenia, and the Kyrgyz Republic, only warfarin preparations are registered under the B01AA code. In Russia, the largest number of drugs were approved between 2010 and 2016 (8 trade names). Since 2017, there has been a negative registration trend, and currently only 5 trade names of drugs are available. The production of the warfarin API is not localized in Russia (manufacturing countries include India, China, the Republic of Belarus, the Czech Republic, and others). The production of finished dosage forms is localized in Russia for 50 % of the approved medicines.
Conclusions. A trend towards a narrowing range of vitamin K antagonists and negative registration dynamics in Russia have been identified, including the cancellation of the state registration of the only phenindione drug since 2023. Warfarin and acenocoumarol are available in Russia, while warfarin and phenindione are available in Belarus. In other EAEU member states, only warfarin is used among vitamin K antagonists. This negative trend can be explained by the inconvenience of warfarin use, the need for careful laboratory monitoring of therapy, and the introduction of direct oral anticoagulants to the pharmaceutical market. The production of the warfarin API is not localized in Russia. The finished dosage form production for every second warfarin drug registered in the Russian Federation is localized domestically.
MANAGEMENT AND ECONOMICS OF PHARMACY
What is already known about this topic?
Management Theory: It is well-established that management is divided into three classic levels: top (strategic), middle (tactical), and lower (operational). Each level requires distinct competencies, ranging from strategic thinking to functional, hands-on skills.
Regulatory Framework: Current professional standards and regulatory orders (e.g., Order of the Ministry of Health No. 205n) define the labor functions and the nomenclature for heads of pharmacy organizations. However, these documents are unified and do not differentiate requirements based on specific management levels.
Market Trends: The pharmaceutical market is growing rapidly, undergoing digitalization, and shifting in ownership structure (with a rise in private pharmacies and large chains). This evolution increases the demands on the qualifications and readiness of managerial personnel.
What is new in this article?
Application of the RMA PW Model: The authors systematically applied their original three-component model of Readiness for Managerial Activities among Pharmaceutical Workers (RMA PW)—which includes personal-motivational, theoretical, and activity-based components—to analyze real-world employer requirements.
Differentiation of Requirements by Level: The article provides a novel, clear mapping of the three management levels to specific employer demands (see Table 3).
Top Level: Strategy, business process management, network development.
Middle Level: Operational management of pharmacy groups, mentoring, KPI control.
Lower Level: Achieving sales plans, inventory management, digital labeling (MDLP/Chestny ZNAK).
Regional Data and Analysis: It presents a detailed ten-year (2015–2025) analysis of the Yaroslavl Region's pharmaceutical market. The findings—a near-doubling of pharmacies, a dominance of the private sector (94%), and the prevalence of large chains (69%)—provide empirical evidence for adapting management strategies to regional specifics.
How can this affect clinical practice in the foreseeable future?
Improved Quality of Medicinal Care: More competent management at all levels of a pharmacy (from procurement and logistics to patient counseling) directly enhances the accessibility, safety, and personalization of the medicinal care provided to patients.
Optimized Personnel Training: The research results enable universities and continuing education programs to move beyond training "generalist" pharmacists. Instead, they can prepare specialists tailored for specific managerial roles (e.g., training heads of single pharmacies separately from territorial directors of large networks).
Standardized Recruitment: Employers can use these findings to formulate clearer, more precise job requirements for candidates. This can help reduce staff shortages and accelerate hiring, ensuring greater stability in pharmacy operations.
Adaptation to Digitalization: By highlighting the specific digital skills required at different levels (working with 1C, MDLP, GRLS), the article supports the faster and more effective integration of modern technologies into daily pharmacy practice, ultimately improving the efficiency and safety of drug dispensing.
Relevance. The modern retail pharmaceutical market provides accessibility and personalization of medical care. Its development is accompanied by the growth of pharmacy organizations, the introduction of innovations, and digitalization, which requires a certain level of readiness of pharmaceutical workers for managerial activities. Regulatory documents, professional standards, and employers place high requirements on potential managers of pharmacy organizations.
Methodology. The study was based on a systematic analysis of scientific publications, regulatory documents, and data from job websites (SuperJob.ru, HeadHunter, and Rabota Rossii) in 2025 in the Russian Federation and the Yaroslavl Region. A total of 511 vacancies for managerial positions in pharmacy organizations were analyzed. The information was grouped based on the positions, educational requirements for pharmaceutical workers, and work experience or seniority. The study of the requirements for personal qualities, knowledge, skills, and work actions was based on the authors' developed model of readiness for managerial activities among pharmaceutical workers (GUD FR). The analysis of the region's retail pharmaceutical market included an assessment of the number, ownership forms, and network affiliation of pharmacy organizations for the period 2015–2025. The study used a combination of scientific methods, including logical, structural, comparative, content analysis, and mathematical and statistical analysis.
Results. Regulatory documents regulate the labor functions of specialists in the field of pharmaceutical management, the nomenclature of positions for managers of pharmaceutical organizations, taking into account the management functions and levels of management in accordance with the theory of management. The application of the GUD FR model in the study of employers' requirements for candidates for managerial positions has contributed to the systematization of personal and motivational characteristics, theoretical knowledge, and labor duties for the corresponding levels of management. Over the period from 2015 to 2025, the number of pharmacy organizations in the Yaroslavl Region has almost doubled, with a predominance of private ownership and large pharmacy chains. The pharmaceutical market requires managers of pharmacy organizations with various levels of management training, adapted to regional specifics
Conclusion. The development of the retail pharmaceutical market justifies the need for a differentiated approach to the selection of management personnel in pharmaceutical organizations according to the levels of management. A model of readiness for managerial activities by pharmaceutical workers has been proposed and confirmed. The results contribute to training and professional development programs that focus on the tasks of each management level, thereby improving the quality of personalized medical care in modern conditions.
CLINICAL PSYCHOLOGY
What is already known about this topic?
Professional self-efficacy acts as a psychological buffer, protecting medical staff from stress and reducing the risk of burnout
Intrinsic motivation (achievements, responsibility, job content) is associated with higher quality of medical care
Pediatric nurses are at high risk for professional burnout due to the emotional demands of working with children and families
Patient-centered care improves both patient outcomes and healthcare professionals' job satisfaction when organizational support is present
Self-efficacy is linked to better emotional regulation, empathy, and ability to manage chronic diseases
What is new in the article?
Differentiated motivational profiles: Physicians value achievements more, while nurses prioritize career growth opportunities
Experience-related shifts: For experienced staff, external recognition becomes significantly more important (p=0.04)
Age-specific patterns in physicians: Older physicians value money and relationships with management more, but job content and responsibility become less important
Strong career motivation in nurses: Career growth motivation strongly increases with age (r=0.735) and experience (r=0.779) among nurses
Young specialist characteristics: Younger staff have higher interpersonal self-efficacy, but this correlates with lower teamwork orientation and higher financial motivation
Stability of self-efficacy: Self-efficacy levels did not differ significantly by position or experience, suggesting it develops early and remains stable
How can this affect clinical practice in the foreseeable future?
Differentiated management programs: Hospitals should develop separate motivation strategies for physicians vs. nurses, and for young vs. experienced staff
Career pathways for nurses: Create clear professional advancement opportunities to address nurses' strong career motivation, especially among experienced nurses
Recognition systems: Implement formal recognition programs for experienced staff who increasingly need external validation
Burnout prevention: Target experienced physicians showing declining interest in job content and responsibility with reinvigoration programs
Team-building for young staff: Address the tendency of young, confident specialists to undervalue teamwork through structured collaboration initiatives
Patient-centered care enhancement: Use these motivational insights to better align staff incentives with patient-centered care principles, ultimately improving quality of pediatric care
Relevance. The transition of the healthcare system to a patient-centered model, especially in pediatric practice, places increased demands on the psychological resources of medical staff. Studying the relationship between professional self-efficacy and the motivational structure of personnel in this context is of significant scientific and practical interest for improving the quality of medical care and preventing professional burnout.
Objective. To investigate the specifics of professional self-efficacy and the motivational structure among physicians and nurses of a pediatric hospital depending on work experience in the context of implementing a patient-centered approach.
Materials and methods. A pilot study involved 33 medical workers from pediatric hospitals in Yaroslavl: 17 physicians and 16 nurses. A set of psychodiagnostics methods was used: the "Self-Efficacy Test" (Maddux, Scheer modified by Boyarintseva), the "Motivational Structure Test" by F. Herzberg, and an author's questionnaire to assess the level of patient-centeredness. Statistical data processing was performed using the Mann-Whitney U-test for group comparisons and Spearman's rank correlation coefficient for relationship analysis (p < 0.05).
Results. Significant differences in motivational structure were identified: physicians were more oriented towards achievements (p = 0.02), while nurses were more oriented towards career growth (p = 0.004). For specialists with longer work experience, the importance of external recognition increased (p = 0.04). The level of professional self-efficacy did not depend on experience or position. Correlation analysis showed that with age, physicians attach greater importance to material rewards (r = 0.521) and relationships with management (r = 0.539), but the importance of job content decreases (r = –0.613). For nurses, motivation for career growth significantly increases with longer work experience (r = 0.779). Young professionals demonstrate higher confidence in interpersonal communication, which correlates with increased importance of financial factors (r = 0.527) and lower orientation towards teamwork (r = –0.476).
Conclusions. The study revealed a complex and differentiated structure of motivation and the role of self-efficacy among medical personnel in a pediatric hospital. The obtained data emphasize the need to develop differentiated personnel management programs that consider position, age, and experience characteristics to enhance intrinsic motivation, prevent burnout, and successfully implement a patient-centered approach in pediatric practice.
EDUCATION
What is already known about this topic?
Prevalence of risk factors: Unhealthy diets, low physical activity, smoking, and alcohol consumption are widespread in Russia and are major contributors to the rise of chronic noncommunicable diseases (NCDs).
Effectiveness of prevention: Preventive measures account for at least 50% of the success in reducing NCD mortality. Modern prevention programs are proven to be cost-effective, with investments yielding returns within 5-10 years.
Challenges among youth: The university period (including residency) is inherently a risk factor. Students often face stress, irregular eating, reduced physical activity, and academic burnout, which worsen their health habits.
What is new in this article?
The theory-practice gap in future doctors: The study uniquely focuses on the lifestyle of clinical residents—almost qualified doctors. It reveals a critical gap: while 96% of residents acknowledge the importance of a healthy lifestyle (HLS), only 31% regularly follow its principles, and 29% have a low level of adherence.
Specific "blind spots" in resident training:
Low physical activity (only 19% exercise regularly).
Neglect of body hardening (only 26% practice it).
Superficial knowledge about substance abuse (only 53.7% feel fully informed).
Underestimation of early pregnancy risks (34% don't see it as a serious issue).
New assessment tool: The authors propose and test a quantitative scoring system (0-14 points) to measure residents' adherence to HLS principles, based on clinical guidelines.
How could this affect clinical practice in the foreseeable future?
A shift in educational priorities: The results highlight the need to move beyond simply informing future doctors about HLS. Universities must actively integrate programs that help residents incorporate these principles into their own daily lives.
Improved quality of preventive care: If residents don't follow HLS principles themselves and have superficial knowledge on related issues (like addiction), their future preventive work with patients will likely be ineffective. Correcting their own behavior will directly improve the quality of primary prevention in the general population.
The power of personal example: The study emphasizes the importance of young specialists being convinced through personal experience. By integrating HLS into their own routine, residents become more credible and effective advocates for health with their future patients.
Background. The increasing prevalence of modifiable risk factors associated with an unhealthy lifestyle, combined with the influence of biological, social, and anthropogenic environmental factors, negatively affects health status and is a significant cause of chronic noncommunicable diseases (NCDs). Population-based and personalized preventive measures contribute to at least half of the success in reducing NCD incidence and mortality. It has been proven that modern, effective prevention programs yield tangible and intangible returns on investment within 5–10 years.
Objective. To assess the adherence to healthy lifestyle (HLS) principles among residents at Yaroslavl State Medical University.
Materials and methods. Between 2023 and 2024, a survey was conducted among 82 clinical residents, aged 25–35, in their first or second year of study across various medical specialties at Yaroslavl State Medical University. The «Structure of a Healthy Lifestyle for Students» questionnaire was used, which included sections on communication skills, physical activity, attitudes towards bad habits and sexual activity, hardening practices, vaccination, and dietary habits.
Results. The importance of adhering to HLS principles was acknowledged by the overwhelming majority of respondents (96 %). However, the study revealed that in daily practice, 56 % of residents demonstrated a moderate level of adherence, while 29 % showed a low level. Specific areas with low adherence included: regular exercise (only 19 %), periodic hardening practices (26 %), insufficient knowledge of substance abuse issues (46.3 %), and inadequate understanding of the risks associated with early pregnancy (34 %).
Conclusions. While the importance of core healthy lifestyle principles is recognized by most medical residents, their awareness and practices are insufficient for healthcare professionals who have graduated from a medical university. These findings highlight the need for active integration of comprehensive HLS programs into the daily training and education of medical residents.
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