Aim. To identify changes in cognitive function performance and endogenous oxytocin levels in various brain regions and biological fluids in mice with an experimental model of Alzheimer’s disease, chronic zinc acetate intoxication, and their combined effects. Materials and methods. CD-1 mice (n = 32). Chronic zinc acetate intoxication was modeled by administering Zn(CH3CO2)2 (Zn2+ concentration: 5 mg/L) as drinking water for 3 months; the control group received pure water. Alzheimer’s disease was modeled via intrahippocampal β-amyloid injection; the control group received phosphate-buffered saline. Associative memory was assessed using conditioned freezing testing. Oxytocin levels in brain regions and biological fluids were measured via ELISA. Results. Chronic zinc acetate intoxication and its combined effect with β-amyloid led to increased oxytocin levels in the hippocampus, entorhinal cortex, hypothalamic-pituitary region, and cerebrospinal fluid. β-Amyloid exposure either had no effect on oxytocin levels or caused a decrease (amygdala, blood plasma). Conditioned reflex formation and contextual memory were impaired in all experimental groups. Fear-associated memory in mice with the Alzheimer’s model combined with chronic zinc acetate intoxication did not differ from controls. Exposure to β-amyloid alone worsened fear-associated memory. Oxytocin levels in the amygdala correlated with changes in the mice’s ability to form fear memory. Conclusion. Chronic zinc acetate intoxication and its combination with β-amyloid increase oxytocin levels in nearly all examined brain regions and cerebrospinal fluid, likely as a compensatory response to Zn2+ neurotoxicity. Acute β-amyloid exposure did not cause significant changes. Thus, chronic zinc acetate exposure is the primary factor elevating oxytocin levels in the brain and biofluids. Increased oxytocin levels may contribute to the restoration of cognitive functions.

Aim. The aim of this article is to provide a comprehensive review of the pathogenetic mechanisms underlying the development of acute adrenal crisis (AAC) in children, with an emphasis on recent experimental and clinical findings. Materials and Methods. A comprehensive literature search was conducted using MEDLINE, Embase, Scopus, Cochrane, PubMed, Google Scholar and Elibrary databases, as well as through citation tracking of studies published between 2019 and June 2025. A total of 40 national and international publications were analyzed, including clinical, experimental, and genomic studies, as well as systematic reviews and meta-analyses focused on the pathogenesis of adrenal insufficiency and adrenal crisis in pediatric populations. Results. The classical pathogenesis of AAC is associated with cortisol and aldosterone deficiency, leading to severe metabolic and hemodynamic disturbances. However, in recent years, a new concept of the multifactorial nature of this syndrome has emerged, encompassing systemic, molecular, immune, and microbiota-related components. Key etiological forms have been analyzed, including congenital adrenal hyperplasia, glucocorticoid-induced adrenal insufficiency, and autoimmune adrenalitis. Data are presented on the involvement of pro-inflammatory cytokines (IL-6, TNF-α), mitochondrial dysfunction, altered expression of ACTH receptors (MC2R, MRAP), and epigenetic modifications (NR0B1, CYP21A2). Particular attention is given to sepsis-induced adrenal dysfunction, endothelial impairment, and the influence of the gut–adrenal axis on crisis development. Conclusion. The current understanding of AAC pathogenesis extends beyond the classical hormonal deficiency model and includes complex interactions among inflammatory, mitochondrial, immune, genetic, and microbiota-related mechanisms. The importance of early diagnosis, molecular stratification, and personalized treatment strategies is emphasized. These findings highlight the need to revise current approaches to prevention and management in pediatric practice, with a focus on targeted and multidisciplinary therapeutic interventions.

Aim. To analyze current scientific publications addressing the impact of urbanization-related factors on the dietary patterns and eating behaviors of school-aged children, in order to identify key nutritional risks, regional disparities, and justify directions for future interdisciplinary research aimed at optimizing child nutrition in urban environments. Materials and Methods. A systematic review of scientific literature published between 2020 and 2025 was conducted using databases of peer-reviewed publications, including eLIBRARY.ru, CyberLeninka, PubMed, Google Scholar, Scopus, and Web of Science. Search terms and their combinations included: «school-aged children», «eating behavior», «dietary habits», «sugar-sweetened beverages», «nutrition hygiene», «urban environment», «urbanization», «ultraprocessed foods», «fast food», and «nutritional assessment». The search was limited to sources from peer-reviewed journals, including those officially recommended by national scientific accreditation bodies, as well as internationally indexed journals. Results. The review revealed that urbanization exerts a multifaceted and predominantly adverse influence on children's eating behavior. There is a consistent trend toward reduced intake of fresh vegetables, fruits, whole grains, and dairy products, accompanied by increased consumption of fast food, sugar-sweetened beverages, and ultra-processed foods. Numerous studies highlight widespread micronutrient deficiencies among children living in urban settings, which negatively affect their health status. A significant association was established between a family’s socioeconomic status and the quality of children’s diets. Conclusion. The findings underscore the relevance of a comprehensive hygienic assessment of schoolchildren’s nutrition in urban settings. Educational institutions and the broader social environment can serve as key platforms for implementing preventive and educational interventions aimed at promoting sustainable healthy eating habits among children.

Aim. To develop and describe a functional model of the activity of a doctor of a multidisciplinary polyclinic in the provision of specialized medical and sanitary care. Materials and methods. The work is based on an integrated approach. The analysis of the works of foreign and domestic authors of the scientific electronic library elibrary for the period 2005-2025; data from the reference information resource "Register of medical organizations of the Russian Federation"; procedures for the formation of primary accounting medical documents in the digital environment. The study involved surgical specialists from 6 multidisciplinary polyclinics in Volgograd. 20020 pieces of information about the specifics of providing specialized medical care to patients under different conditions of visitor flows were analyzed. The organizational and functional process modeling of the medical and diagnostic activity of a doctor was carried out using SADT technology using the service Draw. io; used the IDEF0 functional modeling methodology. Mathematical and statistical data processing was carried out using an Excel spreadsheet processor and the statistical package «Statistica 6.0». Results. The accounting documentation and the actual content of the work of medical workers have been studied; the main processes ensuring the provision of specialized medical care in outpatient settings have been identified; a model of the doctor's activity has been built based on the IDEF0 functional modeling methodology using SADT modeling technology using the service Draw.io. Conclusion. The digital transformation of primary healthcare is a complex multicomponent process of transforming the medical care system through the use of new digital technologies, the use and implementation of digital medical documents and digital diagnostic equipment. A functional model of the polyclinic doctor's activity in providing primary specialized medical care has been developed. Its application will make it possible to identify problematic actions in a timely manner, eliminate unnecessary steps, distribute functional responsibilities between the doctor and the secondary medical staff, extend the concept of a «lean polyclinic» not only to the patient, but also to the doctor, minimize the risks of medical errors based on the identification of redundant processes of activity, increase the validity of decisions, the effectiveness of sanitary and hygienic measures for the prevention of non-communicable diseases. diseases of medical workers. It is necessary to develop modern methods based on
digital data.

Aim. To evaluate the attitude of medical personnel to vaccinations in conditions of high biological risks associated with the new coronavirus infection in order to develop effective technologies for correcting their adherence to vaccination in other emergency situations of an epidemic nature. Materials and methods. The study was conducted in several stages corresponding to the 8 epidemic outbreaks of COVID-19 in 2020−2023. According to multicenter anonymous online surveys of medical staff, their commitment to vaccine prevention has been studied, taking into account strategies for perceiving and overcoming stress. The total number of respondents is 7,800. The study used a set of epidemiological, sociological and statistical methods. Results. The gradual changes in the attitude towards vaccination of medical personnel at different stages of the COVID-19 pandemic are demonstrated, with a dynamic increase in vaccination adherence. The occupational risk category with a negative attitude towards vaccinations was the average medical staff and employees of non-medical specialties, mostly female, who had up to 10 years of work experience. Among the main motives for negative attitudes towards vaccinations, the most common were concerns about possible side effects after vaccination, especially in the long term, skepticism about new immunobiological drugs, insufficient time elapsed since the start of clinical trials of new vaccines, and a lack of information. A study of the psycho-emotional state of workers showed that destructive perception of stress factors increased the risk of not receiving vaccination by 1.6 times, and destructive stress management programs by 2.6 times. Conclusion. The results obtained expand the understanding of the mechanisms of forming the attitude of medical personnel to vaccinations against new infectious diseases and provide a basis for developing programs to increase their commitment to vaccination in conditions of high biological risks, based on a competence-based approach that includes the formation and development of professional and supra-professional competencies in immunoprophylaxis.

Aim. To study the manifestations of the epidemic process of healthcare-associated infections in patients with acute cerebrovascular accident. Materials and methods. A descriptive, continuous, retrospective, single-center analytical study was performed to assess the frequency and intensity of the HAI epidemic process in patients with ACA (n = 1015) For the period from 2019 to 2025, in order to establish the dominant microflora and analyze the resistance of pathogens of HAIs of different localization to antibiotics, microbiological studies were carried out using the classical bacteriological method of more than 1300 isolates of microorganisms isolated from different biological materials (sputum, blood, urine, cerebrospinal fluid, etc.) of patients receiving inpatient treatment. For 21 Klebsiella pneumoniae isolates, hypervirulence marker genes were analyzed: the aerobactin gene − iucA, the mucoid phenotype regulator gene − rmpA2, as well as resistance genes − the main carbapenemases (OXA-48). All HAI cases are classified according to standard epidemiological case definitions. Results. The incidence density of HAI averaged 20,52 [20,40−20,64] cases and 29,89 [29,86−29,92] episodes per 1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP) 52,53 [52,52−52,54] per 1,000 days of mechanical ventilation, central line bloodstream infection (CLABSI) 2,55 [2,52−2,58] per 1,000 days of catheterization, catheter-associated urinary tract infections (CAUTI) 18,84 [18,81−18,87] per 1,000 days of cathetero-infections, incidence of surgical site infection (SSI) was 87,92 [87,79−88,05] per 1000 operations. The structure of HAI pathogens was dominated by Klebsiella pneumoniae, Acinetobacter baumannii, Candida albicans, whose specific gravity was 28,15 %, 20,08 % and 13.81 %, respectively. Extensively drug-resistant (XDR) was exhibited by 82,09 % of Klebsiella pneumoniae isolates and 52,67 % of Acinetobacter baumannii strains. There are data on a high prevalence of hypervirulence marker genes of Klebsiella pneumoniae (HvKp) isolates, namely, the aerobactin iucA gene (95.24 %), the mucoid phenotype regulator gene rmpA2 (100 %), isolates having a hypermucoid (positive stringing test) Hm phenotype (38.09 %) and carbapenem antibiotic resistance gene − carbapenemase OXA-48 gene (80.95 %). Conclusion. The epidemic process of HAI in patients with ACA is characterized by a high frequency and intensity of manifestations. In the etiological structure, Klebsiella pneumoniae, Acinetobacter baumannii and Candida albicans were of maximum importance. 82,09 % of Klebsiella pneumoniae and 52,67 % of Acinetobacter baumannii strains had extreme resistance properties (XDR). Isolates of Klebsiella pneumoniae simultaneously carrying hypervirulence marker genes and carbapenemase genes exhibiting a hypermucoid phenotype are described.

Aim. Analysis of infectious disease incidence among physicians and nursing staff in Moscow during 2018−2023. Materials and Methods. Data on infectious diseases among physicians and nursing staff (2018−2023) in Moscow were obtained from the automated information system «ORUIB» and Federal Statistical Monitoring Form No. 2 («Information on Infectious and Parasitic Diseases»). The study included a total of 25,125 cases of infectious diseases among physicians and nursing staff using a complete sampling method, including 652 cases of tuberculosis, 733 cases of pneumonia, and 14,720 cases of novel coronavirus infection (COVID-19). Results. Tuberculosis incidence among physicians and nursing staff during 2018−2023 exceeded the tuberculosis incidence of the adult population of Moscow. An increase in tuberculosis incidence was observed among physicians from 51.98 (95 % CI [36.96–66.99]) in 2018 to 107.34 (95 % CI [85.77–128.91]) per 100,000 physicians in Moscow, and among nursing staff from 19.26 (95 % CI [11.21–27.30]) in 2018 to 181.18 (95 % CI [156.52–205.85]) per 100,000 nursing staff in Moscow. With the onset of the COVID-19 pandemic in 2020, pneumonia incidence among the adult population of Moscow increased sharply from 371.32 (95 % CI [367.49–375.15]) in 2019 to 2,558.47 (95 % CI [2,5418.52–2,568.42]) per 100,000 adult population in Moscow. Conclusion. Tuberculosis, pneumonia, and COVID-19 continue to remain significant problems for physicians and nursing staff.

Postpartum hemorrhage (PPH) remains a significant factor in maternal mortality and morbidity worldwide. Fatal outcomes associated with PPH can be potentially prevented through effective prediction and prevention. Methods for PPH prevention have been developed, regulated by clinical guidelines and have found wide application in most countries of the world. However, to date, there is no effective system for identifying patients with a high risk of PPH who require more stringent and scientifically based preventive measures. Aim. To develop and evaluate the informativeness of a computer program (CP) for predicting the risk of refractory PPH based on anamnestic, clinical and laboratory parameters. Materials and methods. Data processing and model building were performed using Python 3.12 and pandas, shap, xgboost, sklearn and mlxtend libraries. Ensemble extreme gradient boosting (XGBoost) models were trained on the selected features. The SHAP method was used to estimate the contribution of each feature to the predictive ability of the models, visualized in bar charts and bee swarm graphs. The developed models were tested on an independent sample of 556 women (the study design was a continuous cross-sectional onetime study). Results. As a result of the conducted study using the available databases, 9 clinical and anamnestic (patient age, age at menarche, parity of delivery, uterine scar, emergency cesarean section, one paraclinical (placenta localization on the anterior wall of the uterus according to ultrasound examination data) and four laboratory (HB, Ht, APTT, fibrinogen levels) parameters were selected from 178 parameters. They were used as the basis for two automated models of the CP for the computer "Prediction of the risk of postpartum hemorrhage". In the model based on the assessment of clinical and anamnestic parameters, the most significant were the presence of a scar on the uterus and the localization of the placenta on the anterior wall of the uterus. In the model based on the assessment of clinical and laboratory parameters, the most important were the levels of Hb and Ht. Conclusion. Two sufficiently informative models of the program "Prediction of the risk of refractory postpartum hemorrhage" have been developed, based on the assessment of clinical and anamnestic (AUC – 0.69) and clinical and laboratory data (AUC – 0.74), the use of which can contribute to the correct stratification of patients in the high-risk group for PPH for the purpose of a more differentiated approach to preventive measures.

Aim. To present a clinical case of myocardial hypertrophy with intracavitary left ventricular obstruction in a premature newborn. Materials and Methods. The article describes a clinical case of myocardial hypertrophy with left intraventricular cardiac obstruction. Myocardial hypertrophy with left intraventricular cardiac obstruction in newborns is a life-threatening condition requiring timely diagnosis and therapy. Results. One of the means of diagnosing and monitoring this condition is target echocardiography, which allows it to be diagnosed, to correct hemodynamic components and to evaluate the effectiveness of therapy, including the use of beta-blockers. Myocardial hypertrophy with left intraventricular cardiac obstruction was diagnosed based on an ultrasound picture of thickening of the myocardial walls and the presence of an intraventricular gradient of 11 mmHg. The hemodynamic profile of this condition was characterized by a decrease in preload and postload, as well as an increase in myocardial contractility. Treatment included increased liquid load, the use of the vasopressor norepinephrine, and the administration of the beta-blocker atenolol. Against the background of the therapy, regression of the obstruction of the excretory tract of the left ventricle and clinical stabilization of the child were achieved. Conclusion. Target echocardiography has demonstrated its clinical effectiveness in the detection and control of therapy for myocardial hypertrophy with left intraventricular cardiac obstruction.

Aim. Assessment of the influence of medical and social factors on the duration of treatment of newly diagnosed patients with pulmonary tuberculosis. Materials and methods. a retrospective longitudinal study was conducted with a survival analysis, taking into account the influence of medical (excluding factors related to the characteristics of the tuberculosis process) and social factors, based on data from patients over the age of 18 who were treated in the Kemerovo Region in 2014−2022. The sample included 6,889 patients who completed effective chemotherapy courses according to regimens I, II, and III. Patients with resistance to rifampicin were excluded. A Cox regression model was used to assess the impact of medical and social factors on the duration of treatment. The analysis was conducted in two stages, including and excluding patients with HIV infection. Results. Treatment duration increased with HIV infection (HR = 0.77; p < 0.001), PAF use (HR = 0.84; p < 0.001), male gender (HR = 0.92; p < 0.002), and rural residence (HR = 0.92; p < 0.017). A shorter duration of treatment was associated with active tuberculosis detection (HR = 1.32; p < 0.001), working patients (HR = 1.22; p < 0.001), older age (HR = 1.005; p < 0.001), and the presence of mental disorders (HR = 1.55; p < 0.001). Conclusion. The results obtained highlight the importance of early diagnosis and socio-organizational support in reducing the duration of treatment for tuberculosis patients. Given the impact of the identified factors, it is necessary to adapt organizational approaches to treatment and increase attention to patient adherence, especially in rural areas and among socially vulnerable groups.

Nowadays, antimicrobial resistance is one of the most important threats to public health. Inappropriate use of antibiotics is a primary driver of antibiotic resistance. The aim of the study to assess the level of knowledge and the appropriateness of antibiotic use among students from Kazan universities and to determine the factors associated with nonprescription antibiotic consumption. Materials and methods. A cross-sectional analytical study was conducted, based on an anonymous survey of students from various universities in Kazan. Data are presented as proportions (%). Binary logistic regression was applied to identify factors associated with nonprescription antibiotic use. Adjusted odds ratios (aOR) with 95 % confidence intervals (95 % CI) were calculated. Results. A total of 260 students participated in the survey (45,4 % of men and 54.6 % of women). Students from Russia accounted for 65,8 %, 34,2 % were from other countries (India, Algeria, Jordan, Bangladesh, Egypt, Iran, Kuwait, Lebanon, Pakistan, Saudi Arabia, Kazakhstan, Ukraine, Israel). 83,1 % of students were from medical and pharmaceutical faculties. The proportion of respondents from medical and pharmaceutical faculties who answered all knowledge-assessment questions correctly was significantly higher compared with students from nonmedical faculties (60,6 % vs. 20,5 %, p < 0.001). Overall, 54,6 % of participants reported using antibiotics without a doctor’s prescription. Male gender was associated with non-prescription antibiotic use (aOR 1,824; 95 % CI: 1,060–3,139; p = 0.030). International students were also more likely to use antibiotics without a prescription compared with Russian students (aOR 1,921; 95 % CI: 1,009–3,658; p = 0.047). Only 81.5 % of students take antibiotics strictly according to the doctor's prescription or instructions for use, following the dosage and interval. 49,2 % of students stated that prescriptions were not required when purchasing these medicines. Furthermore, 12,3 % of respondents reported that if a pharmacy refused to sell antibiotics without a prescription, they were able to obtain them from another pharmacy. Conclusion. The obtained results highlight the need to strengthen educational work in the field of rational use of antibiotics, alongside improving the legal regulation of antibiotic supply.

Aim. Description of a clinical case of congenital fourday malaria. Case study. Patient: Female, 56 days old, with thrombocytopenia and anaemia. Due to abnormal changes in the blood tests, a blood smear was prepared for microscopic examination. The digital CellaVision system detected giant platelets. Imaging revealed malaria Quartana: Plasmodium malariae. The CellaVision system did not detect gametocytes and schizonts and mistakenly classified them as platelets. of African descent and previously ill with unknown malaria, underwent treatment, showed no clinical symptoms. During pregnancy, there were no typical symptoms of malaria. After the birth of the child, jaundice was detected and a complete blood test was performed. Results were normal, but jaundice persisted and fever subsequently developed. A second blood test was carried out. After microscopic examination, the causative agent of Quartana malaria, Plasmodium malariae, was found. The diagnosis was confirmed by a positive PCR test. Conclusion. In epidemiologically malaria-friendly regions, caution should be exercised about the possibility of the disease and testing of pregnant women arriving from an area with a high risk of malaria transmission should be mandatory.