[The effect of etiopathogenetic therapy of COVID-19 on the severity of the disease: results of a multicenter double-blind placebo-controlled randomized trial].

AIM: The search for etiopathogenetic agents to prevent the development of severe and extremely severe COVID-19 remains relevant. A placebo-controlled randomized clinical trial was conducted to evaluate the efficacy and safety of the antibody-based biological drug (Raphamin). MATERIALS AND METHODS: 785 outpatients 18-75 y.o. with laboratory confirmed mild COVID-19 were included within 24 hours from the disease onset. 771 patients were randomized to the group Raphamin (n=382) and the Placebo group (n=389). The study drug/placebo was prescribed for 5 days. The rate of progression to a more severe degree of COVID-19 by day 28 as well as the time to sustained clinical recovery and the frequency of hospitalization were evaluated. Safety was assessed taking into account adverse events, vital signs and laboratory parameters. RESULTS: The number of cases of progression to a more severe degree of COVID-19 in participants receiving Raphamin was 59 (15.5%) [52 (14.6%)] versus placebo - 89 (22.9%) [85 (23.7%)], ITT and [PP] analysis data are presented. The odds ratio between groups was OR=0.6157 [OR=0.5494], 95% confidence interval 0.4276-0.8866 [0.3750-0.8048], which meant a reduction in the chance of progression to a more severe degree by 38.4% [45.1%] or 1.48 [1.62] times; p=0.0088 [p=0.0019]. The time to sustained recovery in the Raphamin group was 4.5±2.4 [4.6±2.4] days, versus placebo - 5.8±4.7 [6.0±4.8] days; p=0.0025 [p=0.0036]. No adverse events with a certain relationship were registered. CONCLUSION: Raphamin reduces the risk of progression to a more severe degree of the COVID-19 and significantly shortens the duration of clinical symptoms.

[The effect of characteristics of patient on satisfaction with medical care rendered by general practitioner and district therapist].

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

[The rise of attractiveness of specialty "General Practice" for graduates of medical universities].

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

[The influence of gender, age and length of service on educational preferences of general practitioners in Russia].

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

[Results of simultaneous 24 hour pH and ECG monitoring in patients with cardialgias]. / Rezul'taty odnovremennogo pH i EKG-monitorirovaniia u bol'nykh s kardialgiei.

Simultaneous 24-hour pH and ECG monitoring is suggested as a method for differential diagnosis of cardialgias. Fifty-four patients were examined, complaining of retrosternal and precardial pain, retrosternal burning, heartburn, and belching of unknown origin. Four groups were distinguished. Relationships between gastroesophageal reflux disease (GERD) and coronary disease were evaluated. Reflux in GERD was hypothesized to be the mechanism triggering anginal episodes.

Histamine-dependent changes in free radical processes during coronary heart disease.

Histamine is involved in the pathogenesis of coronary heart disease, intensifies generation of reactive oxygen species by blood leukocytes, and causes mobilization followed by exhaustion of antioxidant reserves. The prooxidant effect of histamine on free radical processes in patients with coronary heart disease determines the rate of recurrences and is associated with poorer prognosis and more severe course of the disease.