卷 2, 编号 1 (2022)

On the materials of official statistics and data of FGBU "CNIIOIZ" of the Ministry of Health of Russia the comparative analysis of mortality, treatment, general, primary and hospitalized morbidity of the whole population with peptic ulcer disease (PUD) of the stomach and duodenum mortality on the territory of the Russian Federation, Siberian Federal District and Omsk region for the period of 2007-2019 has been carried out. The characteristic feature of the observed period is the increase in mortality and lethality from the disease on the background of the decrease in the state-funded morbidity, the decrease in the general and primary morbidity of the whole population. That can speak both about insufficient diagnostics at the out-patient stage of patients' management and increase in the number of comorbid persons.

Kosyuga S.Y. et al, (2015) in the structure of general systemic pathology of patients with CPAC out of 37 people with GI pathology (100%) in 17 (45.9%) notes chronic cholecystitis [1,5]. The authors note that the disease is characterized by inflammatory reaction of the POPR, development of painful aphthae and erosions, polymorphism of the clinical picture and resistance to treatment. [4]. The location of aphthae in CPAC is observed on the cheek mucosa (45.6%), transitional fold (45%), tip and lateral surface of the tongue (6.1%-14%), hyoid region (4%-7%), upper and lower lip (41.2%), soft palate (2%) [2,3,6,7].

The article considers the possibilities of application of competence approach in higher school, which in its basis does not contradict the traditional educational paradigm and, to a certain extent, expands it. Attention is emphasized on the personal aspect of educational activity of both teacher and student. The special importance of problematization of methods and techniques of educational activity for the realization of the goals of the new educational model is noted. The choice of the latter will help to solve one of the most important tasks of modern education - the formation of skills to comprehend, analyze and evaluate information. Humanities disciplines are "responsible" for the development of these skills, which means that it is impossible to neglect their participation in the training of a specialist capable of independent activity and independent decision-making. It is noted that in practice, in the process of implementation of the competence-based approach, a number of difficulties of objective nature that a teacher of non-core disciplines in a specialized university has to face. These difficulties require resolution at the managerial level.

Euthanasia is not a new phenomenon in our world, since ancient times since primitive times it was used, but only in the 16th century Bacon gave a definition of this procedure, which we know now.

There are two forms: active, which includes the introduction of the patient increased dose of drugs that will ensure painless, lethal outcome, and passive, implying inaction of medical personnel (for example, disconnecting the ventilator).

A distinction is also made between voluntary euthanasia, which is performed with a deliberate, conscious decision, and the opposite of involuntary euthanasia, when the decision is made by relatives or caregivers.

Proponents of euthanasia make strong arguments. The person is given the choice to carry out the procedure. Relief of relatives and preservation of the family budget. Preservation of the state budget and forces of medical workers.

Opponents of this phenomenon counterargue that euthanasia takes life, breaking its natural course. The possibility of making an erroneous diagnosis, the emergence of new drugs and methods of treatment.

Euthanasia is subjective, each person should determine for himself how to treat it.

Dental caries is one of the most widespread dental diseases among children, especially early childhood caries is becoming more and more widespread. For this reason, one of the most important and urgent problems in modern pediatric dentistry is to find the most effective methods of preventing dental caries among children.  Currently, the methods of primary pathogenetic prophylaxis aimed, first of all, at preventing the development of focal enamel demineralization (initial caries) and based on the fundamental knowledge of the etiology and pathogenesis of this disease show considerable success in this matter. Although the record efficiency in theoretical and clinical aspects of pathogenetic prophylaxis is shown by the experience of application of remineralizing agents, no less significant, especially in children, is a complex approach with the use of endogenous methods. On the one hand, this is due to the high need of growing children's organism in vitamins (in particular, in ergocalciferol) and minerals. On the other hand, the high relevance of endogenous methods is explained by the more prolonged effect of systemic preparations compared to topical agents. This feature contributes to the successful implementation of mineralization and creates the conditions for good maturation of enamel. Not only vitamin and mineral complexes, but also systemic fluorides and probiotics are widely used in endogenous prophylaxis. The action of the former is based on the diffusion of fluoride into enamel with further formation of highly caries-resistant compounds in its structure. The use of probiotic preparations is based on the ability of some strains of microorganisms to inhibit the activity and reduce the number of representatives of pathogenic microflora in the dental plaque. In addition, probiotics used for prophylactic purposes increase local immunity of the oral cavity. In connection with the above, this literature review provides relevant information on methods of modern endogenous caries prophylaxis in childhood with the description of clinical cases of vitamin-mineral complexes, systemic fluorides and probiotics.

The results of the literature analysis with the description of oral lesions in COVID-19 have shown the variability of the clinical picture. Oral manifestations were characterized by polymorphism. The most frequently described were erosions, aphthae, ulcers, vesicles, petechiae. The anatomical localization of the lesion elements were tongue, lips and palate. Poor oral hygiene and diseases of pa-rodontal tissues had a negative impact on the severity of the inflammatory process in the oral cavity.

Despite the fact that the SARS- CoV-2 virus uses the oral mucosa as an "entrance gate", the oral mucosal manifestations are not manifesting specific signs due to direct SARS-CoV-2 infection, but are caused by the systemic nature of the lesion, severity of the course and its progression due to the possible presence of concomitant infection, against the background of weakened immune response. Oral manifestations may be the result of anticoagulant therapy or an unfavorable reaction to combined drug treatment.

The period of appearance of oral mucosal lesions ranged from 4-90 days. However, those who required treatment and hospitalization developed lesions in about 7-24 days. The earliest symptom noted by many authors was impaired taste and smell. Disturbance of olfactory function and/or impaired taste was observed in patients according to different sources from 18.6% to 91%. Postcovoid manifestations may occur in different periods and may be a consequence of prolonged immunosuppression, imbalance of microflora, the effect of drugs. At the moment in the domestic sources, which describe changes in the oral cavity in the remote postcovoid period, it is noted that 100% of patients after the infection diagnosed exacerbation of chronic generalized periodontitis, chronic gingivitis. Oral candidiasis was combined with xerostomia, in patients after COVID-19 the most widespread was candidal pseudomembranous glossitis - 77,4%. Further observations and studies are needed to determine the diagnostic and pathologic significance of oral manifestations of COVID-19. And also for designation of the role and tactics of the dentist during rehabilitation measures.

The pandemic of a new coronavirus infection has swept the world. Scientists and physicians of all countries are making maximum efforts to contain the growth of morbidity. And in this, of course, the key role should play a large-scale vaccination against the new coronavirus infection. There are 4 main vaccines on the Russian market, which are officially registered and authorized for use in our country: "Gam-KOVID-Vac" ("Sputnik V"), "Sputnik Lite", "CoviVac". "EpiVac-Corona". Citizens of the Russian Federation are given a choice of which vaccine to be immunized with. Many people wonder which vaccine to choose. In our work we tried to demonstrate the current situation of vaccines used in Russia, and also tried to answer the question "Which vaccine to choose against coronavirus infection?".

The review provides information on the history of development of domestic vaccines "Gam-KOVID-Vac" ("Sputnik V"), "Sputnik Lite", "CoviVac", "EpiVacCorona", analyzed their composition, vaccination schemes, determined the stages of testing and efficacy. Based on the available data in domestic and foreign literature, the advantages and disadvantages of vector, peptide and whole-virion vaccines against the new coronavirus infection were identified. The list of indications and contraindications for vaccination of "Gam-KOVID-Vac" ("Sputnik V"), "Sputnik Lite", "CoviVac" was analyzed. "EpiVacCorona", the possibility of vaccination during pregnancy, as well as reactions and complications during the use of these vaccines.

Based on the analysis, we can conclude that the most optimal choice for primary vaccination of people who have not had a new coronavirus infection will be the vaccine "Gam-KOVID-Vac" ("Sputnik V"), as it has successfully passed all clinical trials and has an efficacy of 91.6%. This vaccine is the safest for the human body and has a minimum number of absolute and relative contraindications than other vaccines. The Sputnik V vaccine is authorized for use during pregnancy and breastfeeding. For people who have had a new coronavirus infection or have been previously vaccinated, the Sputnik Lite vaccine is the best option. Its safety profile is similar to Sputnik V and efficacy is 79.4%. To date, there is no unequivocal evidence base for the efficacy of the CoviVac and EpiVacCorona vaccines. But clinical trials are not finished and, perhaps, in time these vaccines will take the leading positions in vaccination against the new coronavirus infection.

In the structure and content of the elemental composition of the pharmacy organization distinguish the external and internal environment, which in various ways, through numerous factors, affect the work of this organization in the present and future time. In the internal environment there are two components: resource, thanks to which the internal organizational activities are carried out and operational, which serves to transform the resources available in the pharmacy organization into something material. Considering the external environment of the pharmacy organization, we can distinguish factors of direct and indirect impact, which in turn make up the macro-environment and micro-environment of the organization.  The factors of indirect impact include factors that are outside the organization and do not have a direct impact (political, economic, technological). Direct impact factors, in turn, have a direct impact on the work of the organizational process in the pharmacy (suppliers, competitors, consumers). One of the most important factors of indirect impact is state regulation, which is responsible for regulating the activities of the pharmacy organization at the state level and the level of the subject of the Russian Federation. The tasks of state regulation include constant control over compliance of pharmacies with the current legislation in the territory of the Russian Federation, control over licensing of pharmaceutical activities, tracking and control of financial and tax reporting and other types of control and regulation of pharma-ceutical activities. In order for the organization to work in a profitable mode for itself, the manager and his subordinates need to be able to cope with the influence of emerging factors inside and outside the pharmacy organization, using in their work rational and optimal strategies, for the development of which it is necessary to apply various methods of strategic analysis, such as: SWOT-analysis, PEST-analysis, Porter's five forces analysis, scenario planning, value chain analysis. To choose an effective method of strategic analysis, the manager and staff need to be able to make strategies and understand what exactly the organization should achieve during its time-consuming activities.

Road traffic traumatism in Russia today has acquired the scale and character of a national catastrophe due to the high severity of injuries and the frequency of lethality of victims. The federal target programs being implemented in the Russian Federation have shown high efficiency in the fight against child mortality, social and transport risk in road traffic accidents. The authors of this literature review have considered the main causes of road traffic injuries, which remain high both in Russia and in the world as a whole. The level of development of road infra-structure directly affects the number of road accidents on the roadway. Under-recording of casualties and fatalities due to organizational shortcomings of emergency services hinders quality forecasting of injuries and effective training of medical personnel, but the creation of a unified information registry can solve this problem. Low medical literacy of the population, as well as insufficient knowledge of traffic rules has a direct impact on the number of road accidents and the level of injuries. More careful control over the admission of drivers to driving vehicles and the technical condition of the vehicle itself will also increase road safety. The authors also outline the basic principles of medical care for victims of road accidents. Lack of medical personnel, ambulances, air ambulance units and their insufficient equipment makes it difficult to diagnose injuries and evacuate victims from the scene of an accident. The fastest diagnosis of craniocerebral injuries is of great importance, which is possible only if the emergency response team is equipped with a mobile computerized tomography machine. Lack of necessary specialists in central district hospitals, which often turn out to be the nearest point for hospitalization of victims, and poorly equipped diagnostic departments of central district hospitals do not allow to provide the necessary assistance in full. In addition to diagnosis and therapy of somatic pathologies, the role of psychological rehabilitation of victims at all stages of medical care was highlighted.

The development of neuropsychiatric disorders in conditions of COVID-19 pandemic becomes a problem of international scale and affects both persons who have suffered COVID-19 and those who have not been ill. There has been a significant increase in the prevalence of psychiatric disorders, often more severe than respiratory symptoms and somatic pathologies. The impact on the human psyche is not only caused by the SARS-CoV-2 coronavirus itself, which has tropism to the nervous tissue, but also by public prophylaxis measures, which significantly limit interpersonal contacts and disrupt the usual social environment. As a consequence, many people face asthenia, cognitive disorders, depression, insomnia and stress disorders, up to the formation of post-traumatic stress disorder. The emergence of neuropsychiatric disorders contributes to the spread of viral infection, which is associated with more frequent development of complications and unfavorable dynamics of existing somatic diseases. The most vulnerable groups in this situation are medical workers who work directly in infection foci, the elderly, people who have been in self-isolation or quarantine for a long time, those who have mental disorders and those who have tested positive for coronavirus infection. Underestimation by physicians and patients of the significance of developing neuropsychiatric disorders leads to late diagnosis and delay of qualified treatment, which in turn leads to a worsening of the prognosis of mental disorders, a decrease in the level of social functioning and quality of life of patients, as well as possible significant socio-economic consequences and additional burden on the health care budget. The magnitude of the problem dictates the need to develop evidence-based recommendations, psychological support programs, psychological counseling and self-help training as a set of organized public health actions. This literature review was prepared to systematize and analyze data on the mechanisms of neuropsychiatric disorders in an international public health emergency caused by COVID-19. The literature search was conducted in Embase, PubMed and Google Scholar.