PERSONAL ASPECT OF MEDICAL STUDENTS’ TRAINING BASED ON UNDERSTANDING OF PSYCHOLOGICAL DIFFICULTIES OF THE PROFESSION

The article investigates the issues of psychological difficulties prevention in the medical profession in the training of medical students. The paper substantiates the arguments for strengthening the personal aspect of medical students’ training based on understanding the ideas about difficulties in the work of a doctor. The authors reveal the interrelation between personal characteristics of students (conscientiousness, understanding of emotions, benevolence, etc.) and their ideas about the nature of difficulties in the chosen specialty at the stage of training. The study presents the main directions of students’ understanding of such difficulties. The article describes strategies for supporting students based on the correlations of personal characteristics and the above-mentioned ideas, aimed at mastering a confident behavior by students. The proposed strategies can be of interest to teachers of courses related to ethical issues of the profession, as well as in individual work with medical students

Development of a New Dosage Form of Herbal Medicinal Products

The «cut-and-pressed granules» dosage form was developed to improve the technological properties of cut and powdered herbal substances in order to compensate for their insufficient flowability, as well as to facilitate dosing, reduce the contamination of the production equipment with dust and contamination of water extracts with dietary fibers. Based on the results of the information research the authors chose an optimal technology for the production of cut-and-pressed granules from some types of herbal substances (Rose hips, Bearberry leaf, Thyme herb, Melissa herb, Oregano herb, Motherwort grass, Matricaria flower). The authors standardised the new dosage form, developed the list of test parameters, test methods, and regulatory requirements for the quality of medicinal products based on the technological features of the new dosage form. Cut-and-pressed granules should not be produced from herbal substances that contain essential oils and coumarins, as it was demonstrated that the content of these compounds may decrease in the process of wet granulation. To determine whether it is possible to produce cut-and-pressed granules from a particular type of raw material, it is necessary to conduct comparative experimental studies confirming that the quality of aqueous extracts obtained from powdered herbal substances in sachets is comparable to that of tinctures or decoctions obtained from cut-and-pressed granules packed in sachets. The materials of the study were used to draft the general chapter OFS.1.4.1.0022.15 «Cut-and-pressed granules». This dosage form is not described in any foreign pharmacopoeias

Statin-induced rhabdomyolysis in a 60-year-old woman with decompensated type 2 diabetes: a case report

Rhabdomyolysis is a very rare and most severe form of statin-induced muscle adverse event characterized by muscle pain, muscle necrosis with myoglobinemia and/or myoglobinuria with a very high risk of acute kidney injury and death. The article presents a case report of developing rhabdomyolysis in a middleaged female patient with hypertension, decompensated type 2 diabetes and albuminuria. A 60-year-old woman was admitted to the hospital for emergency indications with complaints of severe muscle weakness that began in the neck, which spread over several days to the upper and lower extremities, with a symptoms progression up to paresis. According to the appointment of a primary care physician, three months before hospitalization, the patient was switched from therapy with European generic brand-name rosuvastatin 20 mg to the Russian generic unbranded atorvastatin in the same dose (20 mg), which is not comparable in lipid-lowering effect. In a laboratory study, an increase in creatine phosphokinase level by 348 times (50462 U/L) of upper normal limit in combination with severe hypokalemia 1б7 mmol/L in the absence of renal dysfunction was recorded. Cancellation of statin, metformin and empagliflozin, intensive infusion therapy and treating electrolyte imbalance made it possible to prevent the development of acute renal damage, life-threatening arrhythmias and completely stop muscle complaints within a few days. The patient was discharged from the hospital on the 23rd day with reference clinical and laboratory values, including creatine phosphokinase.This case emphasizes the importance of maintaining clinical suspicion regarding rhabdomyolysis in patients receiving statin therapy in the presence of risk factors (in this case, female sex, hyperglycemia, chronic kidney disease, concomitant therapy), as well as the relevance of timely diagnosis and treatment of this condition

Insulin resistance and heart failure with preserved ejection fraction. Pathogenetic and therapeutic crossroads

Insulin resistance, which is a fundamental pathogenetic factor of prediabetes, is closely associated with abdominal obesity on the one hand and the development of cardiovascular diseases, heart failure (HF), on the other. The pathogenetic role of insulin resistance is multifaceted and consists in the acceleration of atherosclerosis, the formation of left ventricular myocardial hypertrophy, including through mechanisms that do not depend on blood pressure, as well as the development of its diastolic dysfunction. The latter is the starting point for starting HF with preserved ejection fraction (HFpEF).Compared with patients with HF with reduced ejection fraction, the presence of HFpEF determines a higher frequency of hospitalizations not due to decompensation of heart failure, but due to concomitant diseases, such as destabilization of the course of arterial hypertension, decompensation of type 2 diabetes mellitus, curation of which, in general, has a greater impact in terms of improving prognosis. Thus, in patients with prediabetes and HFpEF, the correction of insulin resistance as the underlying cause and trigger of cardiometabolic disorders can potentially improve not only insulin-glucose homeostasis, but also the parameters of myocardial diastolic function. This literature review is devoted to the accumulated experience of using metformin as a «strategic» antidiabetic drug in HFpEF and considering potential new points of its application as a protector of the cardiovascular system

THE STUDY OF DIAGNOSTIC POTENTIAL OF MONOCLONAL ANTIBODIES SPECIFIC TO THE MEMBRANE PROTEIN OF CHOLERA AGENT IN ENZYME-LINKED IMMUNOASSAY

Objective of the study was to develop peroxidase conjugate on the base of monoclonal antibodies (MCA) H2F6 and to study the possibility of its application for the detection of tcp+ Vibrio cholerae O1/O139 strains using direct ELISA methods.Materials and methods. Utilized for the investigation was the hybrid H2F6 clone, which synthesized monoclonal antibodies specific to the outer membrane protein of cholera vibrio into culture medium.Results and conclusions. Peroxidase conjugate was designed on the base of MCA which allows for the detection of tcp+ V. cholerae O1 and O139 strains in direct solid-phase enzyme-linked immunosorbent assay and dot-ELISA. The preparation was tested on a group of strains of V. cholerae and heterologous microorganisms and showed specificity in relation to V. cholerae O1 and O139. Monoclonal peroxidase conjugate H2F6 can be used for the detection of epidemically significant V. cholerae O1/O139 strains by means of immune-enzyme methods

The "Resonant Space" of the Russian Classic Novel: N. S. Leskov's "Neglected People" and F. M. Dostoevsky's "The Idiot"

В статье впервые рассматриваются поэтико-типологические соответствия между романом Н. С. Лескова "Обойденные" и романом Ф. М. Достоевского "Идиот".The article establishes poetic-typological correspondences between N. S. Leskov's novel "Neglected People" and F. M. Dostoevsky's novel "The Idiot"

Non-alcoholic fatty liver disease and metabolic liver dysfunction in the new coronavirus infection COVID-19

Our study aimed to explore associated non-alcoholic fatty liver disease (NAFLD) and metabolic liver dysfunction influence on the severity of the new coronavirus infection COVID-19. Material and methods. The study design was a cross-sectional study. The research included 215 patients (39.50 % of men) aged 26–60 years who had undergone a new coronavirus infection COVID-19 at least two months ago. Participants were divided into three groups by severity of infection: mild (n = 99), moderate and severe (n = 116) by anamnesis. Hepatic steatosis index (HIS), body mass index (BMI), waist circumference, alanine aminotransferase and gamma-glutamyl transpeptidase activity, glucose and triglyceride content, systolic and diastolic pressure were calculated and abdominal ultrasound examination was done. Results. In the group with moderate and severe course of COVID-19, the proportion of patients diagnosed with NAFLDaccording to the HSI index was significantly higher compared to patients with mild coronavirus infection. Patients with mild COVID-19, who were diagnosed with NAFLD, had higher alanine aminotransferase and gamma-glutamyl transpeptidase activity, glucose and triglyceride content, BMI, systolic and diastolic pressure, waist circumference compared to patients without NAFLD. Similar differences persisted for patients with moderate and severe course. With the step-by-step exclusion of cardiometabolic parameters from the logistic regression model, the triglyceride content and BMI retained association with steatohepatosis according to ultrasound data, regardless of severity. When creating a similar model for the HSI index, significant correlation was shown for alanine aminotransferase activity in patients with mild COVID-19, for alanine aminotransferase activity and BMI – in patients with moderate and severe COVID-19. Conclusions. Patients with NAFLD have a more severe course of COVID-19. In addition, associations of the severity of COVID-19 with a combination of NAFLD and other cardiometabolic changes in the body, such as arterial hypertension, obesity, dyslipidemia, were revealed