To develop a process model and an algorithm for managing the development of medical organizations. Material and Methods. We enrolled 94 medical organizations of primary healthcare which employed the five key principles of lean technology. Patient satisfaction as well as accessibility and quality of medical care were measured by direct observation and assessing duration of the healthcare procedures. Both patients and medical staff filled a specially designed questionnaire. The study included 610 patients, 460 physicians and 430 paramedical workers. Process model of medical organizations was developed using official records and system analysis. To develop an algorithm for managing medical organizations, we stratifed the priorities and suggested an improvement pipeline. Results. The implementation of the lean technology principles reduced the duration of the pediatric checkup (from 14.1 to 1.0 days, p = 0.001), adult medical checkup (from 8.0 to 3.0 days, p = 0.002), room waiting time for the vaccination procedure (from 117.0 to 45.3 minutes, p = 0.001), and room waiting time for the routine medical procedures (120.5 to 15.5 minutes, p = 0.001). Further, it increased the patient satisfaction rate regarding the register office (from 45.2% to 87.3%, p = 0.001) and decreased the equipment downtime in physiotherapy departments (from 12.5 hours to 2.0 hours, p = 0.001). Conclusion. The development of a process model and an algorithm for managing the development of medical organizations results in a significant reduction in time losses when receiving primary healthcare and increases the efficiency of equipment use.

Aim. To evaluate the efficiency of bone repair on a critical-sized rat calvarial defect model using our original xenogeneic bone mineral, widely established Geistlich Bio-Oss®, and autologous bone graft.

Materials and Methods. We created a critical-sized calvarial defect in Sprague-Dawley rats (n = 48) and then divided them into 4 groups (unfilled defect, autologous bone graft, Geistlich BioOss® and our original xenogeneic bone mineral, 12 rats per group). Rats were sacrificed upon 4 and 12 months (6 rats per time point) with the following excision of the implant and adjacent tissues. 3D structure, extent of mineralisation, and bone volume were measured by means of microcomputed tomography. Microanatomy of the explants and adjacent tissue was investigated by haematoxylin and eosin staining.

Results. The highest and the lowest bone volume was expectedly detected when the defect was filled with the autologous bone graft or remained unfilled, respectively. Replacement of the defect by the original bone mineral entailed better regeneration as compared to Geistlich Bio-Oss. Bone mineral density, bone thickness and the extent of mineralisation did not differ significantly between the experimental groups and were close to the positive control values, indicating efficient bone repair.

Conclusions. Original xenogeneic bone mineral promotes induction of bone regeneration as compared to Geistlich Bio-Oss®, a commercially available bone mineral widely used in the clinical practice.

Aim. To determine the factors contributing to maternal death due to preeclampsia.

Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.

Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).

Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

Aim. Sexual function plays an important role in normal human life, along with sleep and food. As it is behind the main human motivations and can manifest itself in any phase of sexual activity or at any time of sexual life, the sexual function is considered as an important factor in determining the quality of life in adults. Here we aimed to estimate the influence of novel coronavirus disease (COVID-19) on the sexual function of women.

Materials and Methods. Our study enrolled 364 women (17-59 years of age) who admitted to the gynecological units of Kemerovo (Russia). A Female Sexual Function Index (FSFI) questionnaire was used to assess the clinical manifestations of sexual dysfunctions. The key FSFI indicators include desire, arousal, lubrication, orgasm, and satisfaction before and during the COVID-19 pandemic, the number of sexual contacts, the age of the partner, the duration of the relationship and cohabitation, and the assumption to have sexual dysfunction.

Results. The sample was divided into 6 age groups: < 17 years (n = 2), 18-29 years (n = 121), 30-39 years (n = 136), 40-49 years (n = 80), 50- 59 years (n = 25), and ≥ 60 years of age (n = 0). All examined parameters of sexual dysfunction have been impacted by the pandemic. In particular, we documented the reduced sexual arousal, lubrication, and satisfaction as well as increased pain during the sexual intercourse. Risk factors for the development of female sexual dysfunction were age of the sexual partner, the duration of the relationship, the frequency of sexual intercourse, and baseline psychological state.

Conclusion. COVID-19 pandemic has been associated with the considerable impairment of the female sexual function.

Aim. To assess the age-related cancer incidence in Omsk and Orenburg Regions.

Materials and Methods. We analysed the statistical reports (form 7) obtained from the health authorities of Omsk and Orenburg Regions from 2010 to 2019.

Results. Age-specific indicators of cancer incidence in the indicated regions differed significantly (р < 0.001). In the Omsk Region, cancer incidence showed a 65-fold increase with age (from 20 to 79 years), reaching the maximum values at the age of 75-79 years and then decreasing in subjects > 80 years of age (p < 0.05). In the Orenburg region, age-related incidence rates increased 95-fold from 20 to 79 years, reaching a maximum level in the age group of 70-79 years, that was also followed by a decrease in the population over 80 years of age (p < 0.05). Trends in cancer incidence in Omsk and Orenburg Regions were similar to those in Russia, yet the rate was 1.4-1.8-fold lower. Cancer incidence in both regions had a moderate upward trend (increment of 1.2% and 1.5%, respectively; p < 0.001). The highest increase in cancer incidence was detected in subjects between 30 and 39 years and over 80 years of age (Omsk and Orenburg Regions, increment of 1.4% and 2.5%; 1.3% and 1.3%, respectively; p < 0.001).

Conclusions. Cancer incidence in the Orenburg Region significantly exceeds that in the Omsk region, yet both of the regions are characterised by the specific trends. We found the most significant increase in cancer incidence in subjects > 80 years of age over the last decade, which was more pronounced in the Omsk Region in comparison with the Orenburg Region.

Aim. To study the trends in the prevalence of respiratory tract infections in the population of Kemerovo Region and to interrogate the particulate matter as a possible route for the transmission of multidrug-resistant microorganisms into medical organisations.

Materials and Methods. We investigated the prevalence of acute respiratory infections and community-acquired pneumonia among the population of Kuzbass (Kemerovo Region) according to the offcial medical records collected from 2004 to 2020. The study included 10,320,384 cases of acute respiratory infections, 145,357 cases of community-acquired pneumonia, 344,703 hospitalisations of the adults (subjects ≥ 18 years of age) and 75,041 hospitalisations of children (< 18 years of age). Collection of particulate matter samples (n = 97) was performed using sterile gloves and containers from ventilation grilles and adjacent air ducts of the exhaust ventilation systems in various healthcare settings. Bacterial composition of the dust was examined using a VITEK 2 Compact biochemical analyzer. Viral diversity was screened by polymerase chain reaction.

Results. Over the study period, respiratory infections were common in Kemerovo Region (average prevalence 22,155.9 per 100,000 population) and showed an increasing incidence. Frequency of respiratory infections among the hospitalised patients was 207.14 per 1,000, being 1.63-fold higher in children than in adults (304.15 and 186.02, respectively). In 2020, the proportion of cefotaxime-resistant Klebsiella spp. was 26.20% that was strikingly high compared to 2019. Hospital particulate matter frequently (71.13% samples) harboured multidrug-resistant microorganisms.

Conclusions. High prevalence and morbidity from respiratory infections in Kemerovo Region are combined with high prevalence and biodiversity of airborne microorganisms, in particular multidrug-resistant microbes contaminating the hospital particulate matter.

Exopolysaccharide (EPS) production is a widespread phenotypic trait in many commensal and pathogenic microorganisms. In bifidobacteria, the discovery of the eps gene cluster propelled the multiple studies of their EPS, which represent heteropolysaccharides and generally consist of three monosaccharides: D-glucose, D-galactose, and L-rhamnose. EPS of B. animalis subsp. lactis additionally contains mannose while EPS of B. adolescentis and B. longum subsp. longum contains 6-deoxytealose. The number of repeat units in bifidobacterial EPS is a straincharacteristic feature. Precursors of the indicated EPS monomers are glucose-1-phosphate and fructose-6-phosphate, and the synthesis involves nucleotide sugar intermediates. Two molecular systems are implica in polymerisation and polymer secretion in bifidobacteria: ABC transporters and fippase polymerase complex (Wzx/Wzydependent pathway). EPS perform numerous functions. They protect bifidobacteria from aggressive gastrointestinal milieu and reactive oxygen species, provide a scaffold for the bacterial-bacterial interactions, and act as the receptors for phage adsorption. Further, EPS are used by the other members of the gut microbiota as substrates for nutrition, i.e. bifidobacteria regulate the composition and metabolic activity of intestinal microorganisms. Therefore, EPS-producing strains exhibit pronounced antibacterial effects due to the binding of opportunistic and pathogenic microbes. Finally, EPS can act as pathogen-associated molecular patterns. Beneficial effects of bifidobacterial EPS determined the possibility of their use as prebiotics or as a part of symbiotics. The main limitation in this regard is the low yield of the target product when culturing EPS-producing strains. Therefore, current research is aimed at finding novel EPSproducing strains among the bifidobacteria and creating favorable technological conditions that promote EPS production.

Over the past few decades, various applications of the metabolic drugs have been extensively tested. Most of them affect oxygen-dependent processes, improving cellular metabolism and increasing tissue resistance to hypoxia and ischemia. The most promising candidates include components of the respiratory chain, purine nucleosides, and creatine phosphate which affect glucose oxidation and fatty acid metabolism in the Krebs cycle. This review critically evaluates the most popular drugs of this group (adenosine triphosphate, adenosine-5-monophosphate, creatine phosphate, coenzyme Q10, cytochrome C, adenosine, glucose-insulin-potassium solution, L-carnitine, mildronate, and trimetazidine), which are widely represented on the pharmaceutical market. Of all metabolic drugs, only trimetazidine was included in the European and Russian recommendations for the second-line treatment of stable angina. In most clinical studies, the therapeutic efficacy of metabolic drugs has been evaluated using the surrogate endpoints. Despite being actively advertised and widely used in the clinical practice, metabolic drugs currently do not have a convincing evidence base for affecting prognosis (mortality and/or major adverse cardiovascular events). Further studies in large-scale randomised trials are needed to confirm the beneficial effects of the metabolic drugs in cardiovascular medicine.

Here we analysed rare and acute complications of endometriosis in pregnant women by searching Cochrane, HINARY, and PubMed databases. Keywords were “rare”, “causes”, “acute”, “complications”, “endometriosis”, and “pregnancy”. The search depth was 10 years (2011−2021). In total, we found 126 publications, 41 of which met the selection criteria. The course of pregnancy and childbirth in patients with endometriosis is insufficiently studied. Yet, it is characterised by a higher risk of complications including those rarely occurring: haemoperitoneum, intestinal perforation, appendicitis, torsion and rupture of the endometrioid cyst, and thoracic endometriosis. Because of major hormonal changes occurring during the pregnancy, endometriosis undergoes a significant progression or decidualisation. As endometrioid tissue is characterised by a resistance to progesterone, its defciency during the pregnancy can lead to necrosis, perforation of decidualised foci, and severe bleeding. Progesterone deficiency provokes hypervascularisation of the endometrioid tissue, which is the most common cause of spontaneous haemoperitoneum and most frequently occurs in the third trimester of pregnancy and after in vitro fertilisation. Pregnancy increases the risk of endometriosis-related intestinal perforation of different localisation: small intestine, caecum, appendix, and rectosigmoid colon. Limited information about the pregnancy-related complications of endometriosis leads to their underestimation, albeit they can be life-threatening and significantly impact the health of the mother and fetus. The results of this review indicate the need for the further studies of the pregnancy course in patients with endometriosis, especially after the use of assisted reproductive technology. Development of specific clinical guidelines would contribute to the efficient prevention of obstetric and perinatal complications in patients with endometriosis.

Polymerase chain reaction (PCR)-based diagnostics is currently established as a gold standard for the detection of microorganisms. The features of PCR include rapid amplification of DNA and RNA as well as high sensitivity and specificity. In contrast to diagnostic microbiology, PCR diagnostics does not require preliminary culture of the microorganisms for their identification, reducing both time and costs of the diagnostic procedure. The lecture discusses the molecular basis behind the modern technical solutions for the PCR diagnostics of human infectious diseases including multiplex and reverse transcription PCR. We describe the principles of qualitative and quantitative PCR-based detection of pathogens in biological samples and provide the examples of PCR application for solving specific diagnostic scenarios. The lecture is primarily designed for students of biomedical specialties and healthcare professionals using molecular genetic techniques in their practice.