[Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19]

Aim to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.17.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography CT-2, 2550% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 5075% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 714 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.

[Functional diseases of the gastrointestinal tract in the context with overlapping functional disorders: current status of the problem]

Functional diseases of the gastrointestinal tract cause significant damage to the health care system. Their frequent combination in the same patient with the migration of clinical symptoms throughout the digestive tube is accompanied by continuous exacerbations, refractory to the therapy and severe psychosocial disorders. This review provides data on the main etiopathogenetic factors, clinical manifestations, course features and management tactics for patients with overlapping for the most common functional diseases of the gastrointestinal tract.

Peculiarities of Pharmacokinetics and Bioavailability of Some Cardiovascular Drugs under Conditions of Antiorthostatic Hypokinesia

We studied pharmacokinetics and bioavailability of verapamil, propranolol, and ethacizine in healthy volunteers after single oral administration under normal conditions and on the second day of simulated antiorthostatic hypokinesia modeling some effects of microgravity. Under conditions of antiorthostatic hypokinesia, a tendency to a decrease in half-elimination period, mean retention time, and volume of distribution and an increase in the rate of absorption, ratio of maximum concentrations, and relative rate of absorption of verapamil and propranolol were revealed. For ethacizine, a statistically significant increase in the time of attaining maximum concentration and volume of distribution and a decrease in the maximum concentration, rate of absorption, ratio of maximum concentrations, and relative rate of absorption under conditions of antiorthostatic hypokinesia were found.

[Diseases of biliary tract in the context of association with oncological diseases of the digestive system]

Cancers of the gastrointestinal tract are widespread among the population and cause significant damage to the health care system. In order to improve the strategy of preventive measures and the detection of oncological diseases at the early stages, it is necessary to provide timely impact on possible risk factors contributing to the onset and progression of malignant neoplasms. This review demonstrates the association between the pathology of the biliary tract and oncological diseases of the digestive system, discusses the possible mechanisms of the influence of cholelithiasis and cholecystectomy on the development of malignant neoplasms of various parts of the gastrointestinal tract.

NSAID-induced enteropathy: the current state of the problem

The review analyzes the main etiological and pathogenetic mechanisms of the development of NSAID-enteropathy. Particular attention is paid to the role of intestinal microbiota in the manifestation and progression of NSAID-enteropathy. The special role of probiotics in the prevention and treatment of NSAIDs enteropathy is considered.

Comparative effectiveness of vitamin-mineral complexes with iron in correcting iron deficiency in women in the outpatient setting

AIM

To compare the efficacy of prophylactic administration of mineral-vitamin complexes "Feroglobin-B12" and "Complivit iron" with different degrees of Fe valence.

MATERIALS AND METHODS

120 female subjects were examined. To determine the quality of life, the SF-36 questionnaire was used. The presence of anxiety was determined on the Spielberger-Khanin Alarm Scale. 30 women with a deficit of Fe were divided into 2 groups of 15 people each. The first group received "Ferroglobin-B12", the second - "Complivit iron" for a month.

RESULTS

In a month after the initiation of preventive therapy in women of the 1 group the content of Fe serum was normalized. In the second group, its concentration approached the control values. The difference in Fe content in the 1 and 2 groups was of a reliable nature.

CONCLUSION

The intake of "Ferroglobin-B12" was not accompanied by side effects, and performance indicators, social activity and mental health reached control values, unlike the group of patients taking Complivit iron.

[The Concept of Patient-Oriented Model of Organization of Medical Care]

The efficient and rational support of quality om medical care rendering is an important aspect of the system of organization of health care functioning. The study considers the development of concept of patient-oriented model of medical care rendering and also system analysis of main parameters of the model. The study was based on the analysis of publications and normative legislative documents of Minzdrav of Russia and the Federal Foundation of mandatory medical insurance, control boards of health care and territorial Foundations of mandatory medical insurance, subjects of the Russian Federation. The comprehensive analysis resulted in formulation of main parameters and propositions of the patient-oriented model. The concept of related model of organization of medical care rendering to population was presented too. The implementation of the proposed concept in case of its appropriate implementation will favor amelioration of clinical outcomes, increasing of satisfaction and compliance of patients, that will permit to optimize organization of medical care rendering.

Optimizing therapy of liver diseases not associated with viral infection

The review demonstrated results and prospects of non-pharmacological and drug therapy patients with liver disease, not associated with a viral infection. The presented data emphasize the relevance of studying the problem of effective therapy of diseases of the liver and its role in improving the course and outcomes of liver disease.

[The new 2017 European society of cardiology (ESC) guidelines: important changes for introduction into clinical practice]

The paper gives an overview of the European Society of Cardiology (ESC) guidelines updated in 2017. The revised and amended guidelines for areas, such as dual antiplatelet therapy (DAT), treatment of patients with ST-segment elevation myocardial infarction (STEMI), and management of patients with valvular heart disease and peripheral artery disease, were presented in late summer of this year. The authors of this paper present an independent analysis and discussion of new data on the key issues of diagnosis and treatment in patients in the above areas. The recommendations on DAT pay special attention to the timing of the therapy and to the choice of its drugs. The updated data on the treatment of patients with STEMI accurately determine the time to percutaneous coronary interventions, approaches to revascularization; the updates touch upon fibrinolytic therapy and new approaches to lipid-lowering therapy too. Recommendations for the management of patients with peripheral artery atherosclerosis propose for the first time a section devoted to the choice of antiplatelet therapy (an antiaggregant and/or an anticoagulant) depending on the clinical situation.

[Place of vitamin D in the prevention of premature aging and the development of age-associated diseases]

There is an ongoing search for the molecular and biochemical mechanisms underlying the development of aging and age-associated diseases. At the same time there is growing evidence geroprotective properties of vitamin D.In this review, described in detail the possible mechanisms by which vitamin D affects differentiation, cell proliferation and apoptosis, and describes the potential benefits of this vitamin in the fight against aging and age-related diseases.

[Direct oral anticoagulants in atrial fibrillation patients aged 75 years or older: Efficacy and safety balance]

Atrial fibrillation (AF) is one of the most common heart rhythm disorders in the population. Researchers revealed a direct relationship between their incidence and a patient's age long ago. One of the most challenging issues of clinical practice in patients with AF is anticoagulant therapy used in the so-called very elderly patients aged 75 years and older when age itself is a risk factor for developing both thromboembolic and hemorrhagic events due to anticoagulants, regardless of the mechanism of action of the latter. However, scientific data regarding the treatment and prevention of thromboembolic events in elderly and senile patients with AF are very scarce and often uninformative. The data from the EURObservational Research Programme-Atrial Fibrillation Registry Pilot Phase (EORP-AF Pilot) and the randomized clinical studies RELY, ROCKET AF, ARISTOTLE, and AVERROES were analyzed to identify the most safe and most effective anticoagulant for elderly patients (over 75 years). Relying on the analyses of literature data, the authors propose an algorithm based on clinical characteristics for choosing the anticoagulant for patients older than 75 years.

[Chronic constipation in the practice of a therapist: Features of therapy for comorbidity]

AIM

To evaluate the clinical efficacy of laxatives with different pharmacological effects in the combination therapy in patients with chronic constipation (CC) concurrent with obesity, hypertensive disease, and type 2 diabetes mellitus (DM).

SUBJECTS AND METHODS

A total of 110 people (45 men, 65 women) aged 45 to 72 years with CC in the presence of concomitant diseases: grade 1 or 2 hypertensive disease + obesity + type 2 DM. The investigators determined the severity of abdominal pain syndrome and flatulence, by indicating the mean frequency of defecations per week and fecal consistency according to the Bristol stool scale; anthropometric parameters; serum biochemistry tests; and serum lipoprotein phenotyping. Quality of life was assessed by the SF-36 questionnaire. The patients were divided into 3 groups according their use of agents: 1) dietary fiber (psyllium); 2) osmotic laxatives (disaccharides); 3) osmotic laxatives (polyethylene glycol).

RESULTS

The patients taking psyllium to treat constipation showed an increasing frequency of defecations and normalization of stool consistency. Incorporating psyllium into combination therapy was accompanied by a significant decrease in the levels of total cholesterol and low-density lipoprotein cholesterol. A similar trend was observed for serum triglycerides. The patients receiving combination therapy including other laxatives displayed no significant differences between lipid metabolic parameters at the beginning and after the end of treatment.

CONCLUSION

The whole complex of properties of psyllium (Mucofalk) can be fully realized in patients with comorbidity and chronic constipation, which is accompanied not only by the normalization of bowel emptying, but also by marked positive changes in the main lipid metabolic parameters and by a reduction in overweight.

[ACCREDITATION OF THE HEALTH PROFESSIONAL AS A LAUNCH PAD FOR CONTINUING MEDICAL EDUCATION.]

The rapid development of medical science and health care practice, the need to improve the quality of health care, the ongoing modernization of education was the basis for scientfic rationale and implementation of the system of continuous medical education, which will be gradually expanded to cover individuals who have undergone 2016 accredited specialist.

[PROSPECTS FOR CLINICAL APPLICATION OF STATINS IN GASTROENTEROLOGY]

We present the analytical review of non-cardial effects of statins used in gastroenterology with the data illustrating their high antibacterial activity as exemplified by combined therapy of conditions associated with Helicobacter pylori infection. Special emphasis is laid on anti-inflammatory and oncoprotective mechanisms of statin action that are successfully made use of for the treatment of liver, pancreas, gallbladder, and biliary system diseases. Prophylactic aspects of statin application to overcome an addiction to fast food are discussed.

[Acute glomerulonephritis in the 21-st century]

The paper discusses the specific features of the current course of acute glomerulonephritis, the spectrum of its etiological factors, and clinical manifestations. The factors influencing the course and outcomes of acute glomerulonephritis, including the risk of its progression to chronic kidney disease, are specially depicted.

[Role of the morphogenetic proteins FGF-23 and Klotho and the glycoprotein sclerostin in the assessment of the risk of cardiovascular diseases and the prognosis of chronic kidney disease]

AIM. To analyze changes in the serum concentrations of the morphogenetic proteins fibroblast growth factor 23 (FGF-23) and Klotho, as well as sclerostin, an osteocyte-secreted glycoprotein, in relation to the degree of hypertension, left ventricular (LV) hypertrophy, and arterial stiffness in patients with chronic kidney disease (CKD) at its different stages.

SUBJECTS AND METHODS

Sixty-five patients (33 men and 32 women) aged 20-65 years, including 25 with chronic glomerulonephritis, 15 with tubulointerstitial nephritis, and 25 with hypertensive nephrosclerosis, were examined. A control group consisted of 15 healthy volunteers matched to the study group patients for age and gender. Serum FGF-23 concentrations and blood pressure (BP) were measured in the all subjects. Patients with BPs > 140/80 mm Hg underwent echocardiography, followed by determination of LV mass (LVM) and calculation of LVM index. Vascular circulation, pulse wave velocity, cardiac and vascular calcifications, and vascular functional properties were estimated.

RESULTS

There was a strong direct Correlation between the serum concentration of FGF-23 and the stage of CKD and an inverse correlation between the levels of Klotho and sclerostin and the stage of CKD. As the glomerular filtration rate became lower, the concentration of FGF-23 increased and that of Klotho and sclerostin decreased just in Stage III CKD while hyperphosphatemia and elevated parathyroid hormone levels were noted in Stages IV-V CKD. As CKD progressed, the serum concentrations of Klotho and sclerostin were inversely correlated with the levels of phosphorus and parathyroid hormone. The degree of blood pressure elevation correlated positively with serum FGF-23 concentrations and inversely with Klotho levels. There was no significant correlation of the level of sclerostin with the degree of BP increase. The direct correlation between higher FGF-23 level and higher VLM is most pronounced in hypertensive patients. There was a strong direct relationship between FGF-23 and Klotho levels and a strong inverse relationship between sclerostin levels and pulse wave velocity. Lower Klotho concentrations were associated with the detection rate of calcifications in the heart valves and large arteries (the abdominal aorta). The reduced serum levels of Klotho and sclerostin were also correlated with concentric LV remodeling.

CONCLUSION

It was demonstrated that there was a clear link between increased serum FGF-23 and decreased Klotho concentration as CKD progressed, and that between arterial stiffness and calcification and myocardial remodelling regardless of traditional risk factors. More experimental and clinical studies are required to clarify the role of sclerostin in CKD.

[Pulmonary paecilomycosis: Diagnosis and treatment]

AIM

To represent the advances of Russia and Uzbekistan in studying the problem of paecilomycosis. The goal of the investigation was to develop the diagnosis and treatment of pulmonary paecilomycosis (PP).

SUBJECTS AND METHODS

Two hundred and twenty-five people, including 200 patients with bronchopulmonary infection with fungi of the Paecilomyces genus and 25 clinically healthy individuals (a control group), were examined. Clinico-anamnestic, laboratory diagnostic, mycological, and immunological studies were conducted; a lymphocyte antigen-binding test was used for differential diagnosis. Paecilomyces infection was diagnosed by microscopically examining the morphology of the fungi in the pathological material (blood, sputum) and by isolating the cultured fungi in the media (Sabouraud's and Czapek's ones). The severe complication of PP - atypical paecilomycosis-associated myocarditis (APAM) - was studied in 112 patients with helminthiasis-complicated paecilomycosis. These patients underwent using the conventional echocardiography.

RESULTS

Bronchopulmonary paecilomycosis resulting from primary and secondary infection with fungi of the Paecilomyces genus was clinically manifested as chronic obstructive bronchitis (11.5%), recurrent pneumonia (13.5%), exogenous allergic alveolitis (37%), and asthma (26%) complicated by helminthiasis (12%). Iodine deficiency promotes the prevalence of paecilomycosis and echinococcosis favors Paecilomycosis infection; moreover, the helminth capsule itself serves as a nutrient medium for the development of the mycelial form of the fungus. APAM is a severe complication of PP. Almost 50% of the patients with PP presented with carditis. The patients with APAM occasionally experienced fear and the most severe intermittent pain. The latter first occurred in the chest.and irradiated to the axilla, left hand, and its fingertips, paralyzing the arm. In some patients, the pain manifested itself in both arms with abdominal irradiation, by being accompanied by faints. Current analgesics (meloxicam, tizanidine, nimesulide, morphine, promedole) in combination with fluconazole provided a temporary positive effect.

CONCLUSION

Further investigations that must also include neurologists and anesthetists are required to work out effective pain relief regimens for APAM in patients with PP.

[Better diagnosis is an obligatory condition for improving medical care quality]

The paper discusses current approaches to organizing a diagnostic process in health care facilities. It describes approaches to improving patient examinations in multidisciplinary hospitals.

[Clinical value of surfactant protein D as a biomarker of pulmonary fibrosis in patients with scleroderma systematica in relation to the presence of gastroesophageal reflux]

AIM

To study the role of serum surfactant protein D (SP-D) as a biomarker of lung injury in scleroderma systematica (SDS) in relation to the presence of gastroesophageal reflux (GER).

SUBJECTS AND METHODS

Fifty-six patients (mean age 46±14 years) with diffuse and circumscribed SDS were examined and underwent pulmonary functional tests, X-ray and, if lung injury was present, high-resolution computed tomography of the lung, echocardiography, gastroduodenoscopy, and barium X-ray of the esophagus; an enzyme-linked immunosorbent assay was used to determine serum SP-D levels.

RESULTS

SP-D concentrations significantly correlate with the presence of lung injury in SDS and are significantly higher in the presence of pulmonary fibrosis and the signs of frosted glass and honeycomb lung patterns. SP-D levels were higher in the patients with lung injury and SDS in the group of those with pulmonary fibrosis and GER than in the group of pulmonary fibrosis patients without the latter.

CONCLUSION

Serum SP-D may be considered in a number of biomarkers for the severity of lung injury in SDS, including GER-associated lung injury.

[DIFFUSE NEUROENDOCRINE SYSTEM OF THE STOMACH AND CHARACTERISTICS OF PROLIFERATION IN REALIZATION OF CORREA'S CASCADE IN DISEASES ASSOCIATED WITH HELICOBACTER PYLORI]

AIM

To study the role of the vascular endothelial growth factor (VEGF), Ki-67, BCL-2, and endocrine cells (EC) of gastric mucosa producing somatostatin (SS), glucagon (GL), and pancreatic polypeptide (PP) in diseases associated with Helicobacter pylori. To use the data obtained to develop early diagnostic criteria for the progress of structural changes in gastric mucosa of the patients with stomach ulcer disease [SUD), chronic atrophic gastritis (CAG), gastric adenomatous polyps (GAP), and gastric cancer (GC) before and after surgical intervention and eradication of H. pylori.

MATERIALS AND METHODS

We examined 104 patients with gastric pathology associated with Helicobacter pylori including 30 with SUD, 30 with CAG, 20 with GAP and CAG, 24 with stage II noncardia GC. The effectiveness of the treatment was evaluated 2 months after alleviation of inflammation in the stomachfollowing polypectomy in case of GAP or gastrectomy in case of GC. Material for immunohistochemical studies was taken from the fundus. Monoclonal antibodies against VEGF SS, GL, PP Ki-67, BCL-2 (1:100, Novocastra) were used. Histobacterioscopy was conducted using antral mucosal smears stained by the Romanowsky-Giemsa procedure.

RESULTS

Exacerbation of SUD was accompanied by a decrease in the number of epithelial cells and EC producing VEGF glucagon (GL), and pancreatic polypeptide (PP) with the increase in the number of SS-secreting EC along with intensification of proliferative processes determined from the number of Ki-67 and BCL-2 immunopositive epithelial cells. CAG and GC were associated with persistence of H. pylori, hyperplasia of EC producing VEGF glucagon (GL), pancreatic polypeptide (PP) and hypoplasia of SS-secreting EC along with high proliferative activity of epitheliocytes expressed via Ki-67 and BCL-2.

CONCLUSION

Endothelial growth factor (VEGF), somatostatin (SS), glucagon (GL), and pancreatic polypeptide (PP) are of importance for the prognostication of development and clinical course of diseases associated with Helicobacter pylori since their pathological properties are realized either directly or indirectly through H. pylori, Ki-67 and BCL-2. Eradication of H. pylori does not result in the disappearance of intestinal metaplasia.

[MICROSCOPIC COLITIS: CURRENT STATE-OF-THE-ART]

The aim of the study was to analyse publications on practical aspects of the management of microscopic colitis (MC) as a common manifestation of diarrheic syndrome in aged subjects. Many etiopathogenetic issues remain debatable. Major difficulties are encountered in differential diagnostics. Of special importance is the relationship between MC, autoimmune and inflammatory intestinal diseases. Approaches to MC therapy vary from the use of antidiarrheal agents to comprehensive immunosuppressive treatment.

[Morphological verification of renal lesion as a compulsory stage in the diagnosis of Fabry disease]

The paper describes a case of Fabry disease in a patient in whom kidney biopsy enabled the renal lesion be characterized in detail. Fabry nephropathy-associated kidney tissue changes, including renal lesion, have been verified using electron microscopy of renal tissue.

[Full-dose combinations of antihypertensive drugs: what has changed in experts' guidelines?]

The 2013 European Society of Hypertension guidelines, including treatment policy changes presupposing that one two-component combination of antihypertensive agents may be substituted for another and their full-dose combinations may be prescribed if monotherapy is ineffective, are discussed. A rationale is provided for the most effective two-component full-dose combinations of antihypertensive drugs.

[Clinical diagnosis progress and continuing medical education]

The paper discusses current approaches to diagnosing in an internal medicine clinic and to improving diagnostic tactics. It gives prospects for training physicians in current diagnostic approaches in the framework of the continuing medical education system.

[Phosphate binders in chronic kidney disease: the positions of sevelamer]

The paper shows the role of phosphate binders in the correction of phosphorus and calcium metabolic disturbances in chronic kidney disease. The results of clinical trials demonstrating the efficacy and safety of sevelamer are discussed.

[Teaching therapeutic disciplines: vectors of modernization]

The paper discusses approaches to improving educational technologies in therapeutic disciplines taught at higher medical education institutes according to the basic curricula in Therapeutics (060101).

[The training concept of laparoscopic surgery in post-graduate education of doctors]

The active use of virtual devices and laparoscopic boxes for the control of the achieved skills level are the general idea of the suggested concept of the laparoscopic surgical training. The in vivo training make sense only after finishing the "virtual" course. The complete realization of these new concept of laparoscopic surgery training is possible only in frames of the endoscopic surgery department of the mighty hospital center. The organization of such center promise to rise the level of doctors' training.

[Lerkanidipin: evolution of dihydropyridine calcium antagonists continues]

We discuss the clinical studies on the efficacy and tolerability of lerkanidipine in arterial hypertension.

[The use of laser Doppler flowmetry for the estimation of the influence of intranasal medications on microcirculation in nasal cavity mucosa]

AIM OF THE STUDY

to investigate the influence of various intranasal medications on the microcirculatory bed in nasal cavity mucosa using the original method of laser Doppler flowmetry.

METHODS

this comprehensive study of the influence of intranasal medicines on nasal cavity mucosa using laser Doppler flowmetry was designed to evaluate the mucociliary clearance, breathing efficiency of the nose, and subjective symptoms of its impairment. The outcomes of a single application of intranasal medications were estimated in 90 rhinologically healthy subjects; in 15 of them, the micrcirculatory blood flow in the nasal cavity was investigated in the early postoperative period with the use of intranasal decongestants and irrigation products.

RESULTS

this study has demonstrated the relationship between the changes in the microcirculatory bed and the application of intranasal medications acting on nasal mucosa. Moreover, these agents were shown to affect intranasal mucosa and its microcirculatory bed following rhinological surgical interventions. Tachyphylaxis of the microcirculatory bed after the administration of the decongestants developed earlier than previously thought. At the came time, irrigation therapy exerted the beneficial effect on the state of the intranasal microcirculatory bed in the postoperative period.

[Pharmacological correction of Th1 and Th2 lymphocyte activity and cytokine profile in ethanol intoxicated rats]

It was established in experiments on noninbred rats that their ethanol intoxication (13 days; total dose, 2.6 LD50) significantly reduces the concentration of blood cytokines IFNgamma, IL-2, IL-4, IL-10, increases the concentration of IL-6, suppresses the immune responses, and reduces the interrelation IFNgamma/IL-4 in comparison to the control, which testifies to the greater damage of Th1 cells in comparison to Th2 lymphocytes. The immunomodulator polyoxidonium administered for four days at a daily dose of 700 microg/kg fully restores the cellular and humoral immune responses and the synthesis of cytokines IFNgamma, IL-2, and IL-4 and partly restores the production of IL-10.

[Endothelial dysfunction in urolithiasis patients]

To characterize endothelial dysfunction in operated nephrolithiasis patients, we studied NO, VEGF, ET-1, IL-6 concentration in the blood serum and NO in the urine of nephrolithiasis patients divided into three groups by the type of surgical treatment before operation, 7-10 days and 1 month after it. We used beta-2 microglobulin as an indicator of tubular dysfunction. We found a significant rise of a concentration of the endothelial dysfunction markers ET-1, IL-6 and VEGF in the blood serum (p < 0.05), showing endothelial dysfunction in nephrolithiasis patients, especially in early postoperative period after multiple exposure to short-wave lithotripsy. One month after open surgery or lithotripsy a complete recovery of endothelial function was not recorded.

[Management as a key professional competence of preventive medicine specialists]

The paper deals with the strategy of training specialists in preventive medicine and improvement of their professional skills for the management of activities aimed at the maintenance of adequate population health status and prevention of adverse effects of environmental factors. Integration of managerial issues into curricula and teaching courses for preventive medicine specialists may be instrumental in upgrading their professional level.

[Reduction of the immune responses and synthesis of cytokines associated with Th1 and Th2 lymphocyte function and their correction by polyoxidonium under conditions of subacute intoxication by organophosphorus compounds]

Experiments on Wistar rats showed that subacute poisoning by organophosphorus compounds dimethyldichlorovinyl phosphate (DDVF), malation, and dimethylparation (total dose, 1.0 LD50) suppresses both cell and humoral immune responses and significantly decreases the level of blood cytokines (IFNg, IL-4) and the IFNg/IL-4 ratio in comparison to the control, which is evidence for a greater lesion of Th1 cells in comparison to Th2 cells. The immunomodulator polyoxidonium administered for four days in a daily dose of 700 microg/kg under conditions of subacute intoxication with organophosphorus compounds restores the cell and humoral immune responses and the synthesis of cytokines.