The study of the adaptation of first-year students to the university system of education

The purpose of the study is an assessment of adaptation to the university system of education and identification of its links with various factors in first-year students of the Ural state medical university.Цель исследования – оценка адаптации к вузовской системе обучения и выявление ее связей с различными факторами у студентов первого курса Уральского государственного медицинского университет

PATHOGENIC POTENTIAL AND MUTUAL INTERACTION OF MICROFLORA OF MUCOUS MEMBRANES OF OPEN CAVITIES OF DIFFERENT BIOTOPES IN WOMEN AS IMPORTANT FACTORS OF THEIR REPRODUCTIVE HEALTH

Micro-ecological interrelation between intestinal, vaginal and nasopharyngeal biocoenoses as parts of microbiome of a macroorganism was determined by the latest researches. The research included 44 women with inflammatory diseases of genital tract and reproductive disorders and 28 healthy women. Genospecies structure of enterococcus for each biotope (intestinal, vaginal and nasopharyngeal) had original differences with the most full spectrum of species in intestinal biotope. The contract between the groups is evident at the conclusion of the pathogenicity genes tests

VAGINAL MICROECOLOGY IN WOMEN WITH THE NON-SPECIFIC GENITAL INFLAMMATORY DISEASES AND REPRODUCTIVE FUNCTION DISORDERS

We conducted the microbiological examination of vaginal microbiota in 324 women with non-specific inflammatory diseases of the genital tract and with reproductive dysfunction. According the condition of microecological balance of indigenous microflora (lactobacilli concentration) of women we have identified three types of vaginal microbiota: "normocenosis", " dysbiosis", "deep dysbiosis" We marked deficiency oflactobacilli in every fourth women (28%) with infertility and miscarriage, and deep deficit in every second (53% in the third group) - sharp depression of the indigenous microbiota and its replacement by opportunistic (facultative anaerobic and obligate anaerobic), what indicates microecological trouble in the vaginal biotope and can be one of the causes of infectious and inflammatory diseases of genitals and other reproductive disorders. It was shown that the dominant microorganisms of pathogenic microbiota (UPM) of inflammatory diseases in women are coagulase-negative staphylococci (CNS), fungi of genus Candida, Escherihia coli and Enterococcus spp. During the analysis of UPM representatives material of groups with "normocenosis", "dysbiosis" and "deep dysbiosis" an important microecological indicator was calculated which characterizing microbiocaenosis as a whole - index of species richness (ISR) - the average number of species in the composition

Epidemiological characteristics nosological forms of sexually transmitted infections among the population of the Sverdlovsk region in the period from 2011 to 2020

The aim of the study - to study the incidence of STI among the population of Sverdlovsk region for the period from 2011 to 2020 and to identify the main trends of the epidemic process of the most prevalent nosological forms.Цель исследования – изучить заболеваемость ИППП среди населения Свердловской области за период с 2011 по 2020 гг. и выявить основные тенденции развития эпидемического процесса наиболее распространенных нозологических форм

An evidence - based apporoachto the treatment of advanced – stage Parkinson’s disease. clinical case

Parkinson's disease is one of the most common age-related diseases, most often developing between the ages of 65 and 70. But, earlier debuts of the disease are also possible - in young or adult age. Due to the progressive neurodegenerative process, mainly in the dopaminergic neurons of the substantia nigra, patients need constant symptomatic therapy aimed at maintaining dopamine in sufficient concentration to correct neurological deficits. According to the accepted clinical guidelines for Parkinson's disease, at the onset of the disease at the age of 65- 70 years, the preparation of choice for starting therapy should be dopamine receptor agonists, and only with the progression of the disease, severe neurological deficit, therapy is supplemented with Levodopa. The article considers a clinical case of Parkinson's disease in a patient who had an incorrect treatment strategy.Болезнь Паркинсона – одно из самых распространенных возраст-зависимых заболеваний, чаще развивающееся в возрасте старше 65-70 лет. Но, возможны и более ранние дебюты болезни – в юношеском, молодом или зрелом возрасте. В связи с прогрессирующим нейродегенеративным процессом, преимущественно в дофаминергических нейронах черной субстанции, пациенты нуждаются в постоянной симптоматической терапии, направленной на поддержание дофамина в достаточной концентрации для коррекции неврологического дефицита. Согласно принятым клиническим рекомендациям по болезни Паркинсона, при дебюте болезни в возрасте до 65-70 лет препаратами выбора для старта терапии должны применяться агонисты дофаминовых рецепторов и только при прогрессировании болезни, выраженном неврологическом дефиците терапия дополняется препаратами Леводопа. В статье представлен обзор клинического случая болезни Паркинсона у пациента, которому была неправильно выстроена тактика лечения

Response sensitivity to bacteriophages of Staphylococcus aureus strains isolated from the microbiota of the oropharynx in children of Irkutsk

Dysbiotic disorders of the oropharynx takes one of the first places in the structure of morbidity worldwide. The aim of the study was to determine the peculiarities of microbiocenosis of the oropharynx in children at different ages and to assess the level of sensitivity of S. aureus strains to specific bacteriophages. Material for the study consisted of 84 smears from the oropharynx of children with inflammatory diseases of the upper respiratory tract (nasopharyngitis, pharyngitis, tonsillitis, laryngitis (J00, J02, J03, J04 according to 1CD-10). The biological material was distributed depending on the age of the surveyed: the first group - children 3-6 years (n = 61) and the second age group - children 7-12 years (n = 23). Studies of the microflora of the oropharynx were performed according to standard methods. Isolated microorganisms were identified by morphological, tinctorial, cultural and biochemical properties. The results were evaluated in accordance with the Order of USSR Ministry of Health N 535 as of April 22,1985. Specific lytic activity of bacteriophages against S. aureus was determined using preparations of staphylococcal bacteriophage and polyvalent pyobacteriophage Sexta. The sensitivity of strains of S. aureus to specific bacteriophages was assessed by the method of «crosses», according to the guidelines. Statistical analysis was performed with the use of licensed applications Offiœ Ms Excel 2007for Windows 7 BioStat v. 5.0.1.2008. Correlation analysis (Pearson method) was used. 1t has been shown that with increasing age children in the oropharynx microbial density is increasing for indicators of both normoflora (S. oralis), and of opportunistic microflora (S. β-hemolytic, S. pyogenes, S. pneumoniae, bacteria Enterobacteriaceae), especially of S. aureus (up to 74 %). Registration of sensitive strains of S. aureus in more than 70 % of cases in preschool and school-aged children is evidence of the correctness of correction of the dysbiotic disorders of the oropharynx with the use of bacteriophages of staphylococcus and Sexta

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362