Background. Despite its proven positive impact on prognosis and quality of life, coronary artery disease (CAD) surgical treatment is accompanied by the development of ischemia-reperfusion injury, a phenomenon underpinned by oxidative stress that mediates the development of the most common postoperative complications.
Materials and methods. The study group consisted of 89 patients with CAD, including 64 patients who underwent coronary artery bypass grafting. The control group consisted of 24 healthy volunteers. Blood oxidation parameters were assessed using a YSI 5300 biological oxygen monitor (Yellow Springs Instrument Co., Inc., USA).
Results. In patients with CAD, compared with the control group, higher values of Vox (2.07 > 1.9; p = 0.049), Vinit (3.29 > 2.11; p = 0.0001), Vmax (3.5 > 2.54; p = 0.001), coefficient of oxidative activity (KA) (40.0 > 5.89, p = 0.0001), and a shorter initiation period (T) (0.97 < 1.91; p = 0.001) were observed. In the comparative aspect, statistically significant differences in the indices of induced blood oxidation depending on the type of cardiac surgery were not observed either 10 days (B2) or 6 months after the operation (B3). In the group of patients who had previously suffered a myocardial infarction, the Vox values were statistically significantly higher in the event of a fatal outcome (2.3 (2.3; 2.5) and 1.9 (1.7; 2.3), respectively (p = 0.04). The results of the logistic regression analysis demonstrated a statistically significant effect of the Vox value on the development of cardiac arrhythmias (p = 0.0001) and cognitive dysfunction (p = 0.004) in the postoperative period.
Conclusions. Patients with CAD had higher blood oxidation parameters. The choice of revascularization technique (cardiopulmonary bypass or off-pump surgery) did not affect these parameters. However, monitoring these parameters during perioperative patient care appears to be useful for predicting the development of complications such as cardiac arrhythmias and postoperative cognitive dysfunction.

Objective. This study aimed to systematize and analyze contemporary data on the evolution of cephalosporin antibiotics from the first to the fifth generation, with a focus on changes in their antimicrobial spectrum, pharmacokinetic properties, and safety profile in the context of rising antibiotic resistance.
Materials and methods. A review of the scientific literature was conducted, sourcing data from PubMed, Google Scholar, CyberLeninka, elibrary.ru, and library resources using keywords such as "cephalosporins", "antibiotic resistance", "MRSA", "Gram-negative bacteria", and "cefiderocol". The analysis included systematic reviews, randomized clinical trials, cohort studies, and meta-analyses published over the last two decades, as well as foundational historical works.
Results. The review demonstrates a clear evolutionary trajectory in the development of cephalosporin. First- and second- generation agents remain relevant for treating infections caused by Gram-positive cocci and some communities of Gram-negative microorganisms. Third- and fourth-generation cephalosporins have become the cornerstone of empirical therapy for nosocomial infections because of their expanded spectrum of activity against Gram-negative flora, including Pseudomonas aeruginosa. Fifth-generation drugs (ceftobiprole and ceftaroline) were developed to overcome MRSA resistance. A separate analysis was dedicated to the innovative agent, cefiderocol — the first siderophore cephalosporin, which possesses a unique transport mechanism into the bacterial cell and demonstrates activity against carbapenem-resistant strains of Enterobacterales, P. aeruginosa, and A. baumannii. Despite its unique properties, cefiderocol resistance is already emerging. The specific pharmacokinetic profiles (administration routes, half-life, and blood-brain barrier penetration) and spectrum of adverse reactions (allergic, hematological, and neurological) of different generations were analyzed.
Conclusion. Cephalosporins remain a cornerstone of modern antimicrobial therapy because of their favorable efficacy and safety profile. The introduction of new generations, particularly cefiderocol, represents a direct response to the global challenge of antibiotic resistance. However, the rapid emergence of resistance mechanisms even to the most advanced agents underscores the critical importance of antimicrobial stewardship programs and strict adherence to the principles of rational antibiotic therapy to preserve the future clinical value of this drug class.

Background. Fever phobia — excessive anxiety among parents about fever in children — is a relevant problem in both global and Russian pediatrics. In Russia, up to 80–90 % of families have concerns about fever, the danger of febrile seizures, and even death of a child, which often leads to excessive use of antipyretics, sometimes contrary to clinical recommendations. The phenomenon is typical not only for parents but also for doctors, of whom 65 % of pediatricians consider temperature an independent risk factor and recommend reducing it by all available means.
Objective. This study aimed to assess the attitudes of mothers toward childhood fever and the specifics of providing care when it occurs at the outpatient stage.
Materials and methods. An anonymous survey was conducted between 2022 and 2024 among 54 mothers with children aged 1–15 years who were observed in polyclinics and private medical centers in Yaroslavl. The questionnaire included questions about the frequency of temperature measurements, the criteria for prescribing antipyretics, preferences for medications and their forms, intervals between doses, the presence of allergies, sources of information, the physical treatments used, and the fears associated with fever. The average age of the children was 3.49 years.
Results. Most mothers (40.7 %) measured their child's temperature 3–5 times a day, reflecting a high level of anxiety. Of the respondents, 7.4 % measured their child's temperature 1–2 times a day, while some mothers measured their child’s temperature up to 10–12 times a day, which can lead to measurements every 40 minutes, increasing stress for both the child and the parents. More than 90 % of children with acute respiratory infections receive antipyretics, and in 72 % of cases, antipyretics are administered even when the temperature is below 38°C.
Conclusions. Fever phobia is widespread among parents and is accompanied by high anxiety, frequent temperature measurements, and excessive antipyretic use. Therefore, additional educational measures should be implemented for both parents and healthcare professionals.

Relevance. Colorectal cancer (CRC) is one of the most common and lethal oncological diseases in Russia. The Yaroslavl region is experiencing a steady increase in incidence, including an alarming trend of rising CRC cases among individuals under 50 years of age (a 56.3 % increase). This underscores the need to develop and implement effective, targeted screening programs, especially for high-risk groups, such as workers in hazardous industries.
Objective. To evaluate the effectiveness of a personalized colorectal cancer screening program based on a two-stage method (faecal immunochemical test (FIT) followed by colonoscopy) among workers at an industrial enterprise with increased occupational hazards in the Yaroslavl region.
Materials and methods. The study cohort included 1,105 employees of the "YANOS" industrial enterprise aged 38 years and older, classified as a high-risk group for CRC development due to exposure to chemical and physical occupational hazards. Screening was conducted in two stages: I stage — Initial testing using FIT; II stage — colonoscopy for individuals with a positive FIT result (n=136). A set of validated colonoscopy quality indicators was used to assess effectiveness: adenoma detection rate (ADR), advanced adenoma detection rate (AADR), serrated lesion detection rate (SSLR), polyp detection rate (PDR), adenomas per colonoscopy (APC), adenomas per positive patient (APPP), and CRC (colorectal cancer detection rate). A control group of 204 patients was included for comparison.
Results. Based on the FIT results, 23.3 % (256 individuals) of all participants tested positive. Overall effectiveness indicators were significantly higher in the FIT-positive group who underwent colonoscopy (n = 136) than in the control group: ADR was 32.4 % vs. 18.1 %, AADR was 27.9 % vs. 18.6 %, and PDR was 50.7 % vs. 37.3 %, respectively. A clear age dependence was identified: in the ≥50 years group, ADR (37.0 %) and AADR (34.5 %) rates were significantly higher than in the <50 years group (25.0 % and 17.3 %, respectively). Key finding: colorectal cancer was diagnosed in 3.7 % of cases in the FIT-positive group (1.9 % in the <50 years group and 4.8 % in the ≥50 years group), whereas no cancer cases were detected in the control group.
Conclusions. The personalized two-stage screening program (FIT + colonoscopy) demonstrated high effectiveness for the early detection of precancerous lesions and CRC among workers with occupational risks. Age is a critically important factor: adenoma and advanced adenoma detection rates (ADR, AADR) significantly increase after age 50, confirming the need for age stratification and adaptation of screening intervals. Implementing such targeted programs in regional healthcare systems, especially for high-risk groups (occupational and age-related), is strategically important for reducing CRC mortality through early diagnosis and prevention.

Relevance. Acute intestinal obstruction (AIO) remains the focus of clinicians’ attention. The mortality rate in this pathology is 5.1–8.4 %, occupying one of the leading places among all urgent diseases. The diagnosis and treatment of patients with intestinal obstruction remain relevant.
Objective. Assessment of AIO treatment results based on an improved set of therapeutic measures.
Materials and methods. This study enrolled 1279 patients aged 20–90 years with various AIO course variants. The dynamics of water and electrolyte metabolism, endogenous intoxication, and treatment outcomes in different age groups were studied depending on the etiology, stage of intestinal obstruction, and volume of surgical intervention.
Results. Studies have shown increasing changes in water and electrolyte metabolism during the stage of enteral hypertension, with the most significant changes in the development of peritonitis and multiple organ failure. The progressive accumulation of toxic metabolic intermediates, noted at the very beginning of the disease, also depended on the intestinal obstruction stage. The episode of adhesive intestinal obstruction was conservatively resolved in 68 % of patients. The average mortality rate among all patients was 8.7 %. Intestinal resection was required in 20.1 % of patients, which increased the mortality rate to 23.2 %. The incidence of death in cases of tumor obstruction was 3.8 times higher than that in patients with non-tumor genesis of the disease. The addition of multiple organ failure was accompanied by an increase in mortality by more than 10 times.
Conclusions. In AIO, age >75 years, the need for intestinal resection, and the development of multiple organ failure syndrome are prognostic risk factors for an adverse outcome, regardless of hospitalization duration.

Modern medicine is facing a serious problem — the consequences of cephalgic disorders, which, despite the relatively low mortality rate, significantly affect society. Patients suffering from regular migraine attacks and other types of headaches often find themselves unable to fully study and work, which significantly reduces their life potential. In the most difficult situations, hospitalization is the only way out. The inability of people with cephalgia to function effectively in everyday life creates large-scale economic and social problems for the whole society. This situation requires the health care system to develop comprehensive and effective solutions, as it affects many aspects of public life. The main objectives of the literature review are to determine the prevalence of migraine and tension headache among groups of students divided according to a number of criteria, to identify key factors predisposing to headache, as well as comorbid disorders, anamnesis features associated with its manifestations.

Relevance. The combination of chronic hepatitis C (CHC) and metabolic syndrome (MS) represents a mutually aggravating condition that contributes to the progression of liver fibrosis and reduces the effectiveness of therapy. Investigating the influence of hepatoprotective therapy on metabolic parameters and quality of life in this patient category is a clinically significant task.
Objective. To evaluate the impact of different hepatoprotective therapy regimens on bioimpedance body composition analysis indicators and quality of life in patients with CHC and MS.
Materials and methods. A prospective randomized study included 120 patients with CHC, randomized into 4 groups: 1 — glycyrrhizic acid + essential phospholipids (n=30); 2 — ademetionine (n=30); 3 — ursodeoxycholic acid (n=30); 4 — comparison group (n=30). Therapy was administered for 4 weeks. Biochemical parameters (ALT, AST, ALP, GGT), bioimpedance analysis parameters (phase angle, fat mass percentage, waist-to-hip ratio), and quality of life using the SF-36 questionnaire were assessed before and after treatment. Statistical analysis was performed using Student's t-test, Mann-Whitney U test, and Wilcoxon test.
Results. All active therapy groups showed positive dynamics in biochemical parameters. The most pronounced reduction in ALT (65 %), AST (50 %), and cholestasis markers (70 %) was recorded in the ademetionine group. Statistically significant improvement in quality of life on the scales of vitality, emotional and social functioning was noted in groups 1 and 2. Bioimpedance analysis parameters demonstrated a significant increase in phase angle after treatment; however, no significant changes in fat mass percentage or waist-to-hip ratio were found. In the control group, the dynamics of the indicators were not significant.
Conclusions. The use of hepatoprotectors (glycyrrhizic acid + essential phospholipids, ademetionine, ursodeoxycholic acid) in patients with CHC and MS for 4 weeks leads to an improvement in biochemical parameters and quality of life. The most comprehensive positive effect, including a trend towards improved body composition parameters, was observed with the use of ademetionine. Bioimpedance analysis and quality of life assessment are promising screening tools for monitoring therapy effectiveness in this patient category.

Background. Post-covid syndrome (Long COVID) remains a serious medical and social problem, as its symptoms can persist for months or even years after the acute phase of COVID-19. According to the WHO, up to 6 % of those who have been ill experience Long COVID, and according to meta-analyses, up to 45 %. This creates a significant burden on the healthcare system and requires new approaches to the diagnosis and rehabilitation of patients, especially among the able-bodied population. Objective. To analyze the features of long-term symptoms in patients who have had COVID-19, based on survey data, in order to identify new clinical phenomena, determine the frequency and duration of their manifestations, as well as to study the influence of demographic and clinical factors on the formation of post-covid syndrome.
Materials and methods. The study was conducted among 220 residents of Yaroslavl in 2024 (82.7 % women, average age 33.8 years) using an electronic questionnaire. The presence of chronic diseases, vaccination status, course and duration of symptoms were assessed. Methods of descriptive statistics, correlation analysis, and significance level p <0.05 were used.
Results. The majority of participants retained various symptoms: fatigue (83.8 %), cognitive impairment (85 %), insomnia (35 %), depressive states (52.4 %), hair loss (52.1 %). Sensory disturbances were often noted (85 % — loss/distortion of sense of smell and taste), selective aversion to foods, new food allergies (4 %), atypical skin manifestations (6.8–11.4 %), unusual drug reactions (13.6 %). The symptoms were often wave-like (65 %) and persisted for more than three months. Vaccination reduced the severity of the acute phase, but did not always prevent Long COVID. The risk factors were chronic diseases, female sex, autoimmune and metabolic disorders.
Conclusions. Long COVID is a multisystem condition that requires an individual approach to diagnosis and rehabilitation. It is recommended to pay special attention to sensory, nutritional and skin disorders, as well as psychoemotional support for patients. The data obtained can serve as a basis for the development of new clinical guidelines for the management of patients after COVID-19.

The clinical and epidemiological diagnosis of the erythematous form of Ixodes tick-borne borreliosis (Lyme disease) typically poses no difficulties for an infectious disease specialist. Diagnostic challenges arise when there is no history of a tick bite and when the presentation of erythema migrans is atypical. This skin manifestation must be differentiated from various dermatological, allergic, and other inflammatory conditions. In such complex cases, laboratory confirmation is required. With appropriate antibiotic therapy, erythema migrans typically resolves rapidly.
The present case report illustrates these diagnostic difficulties due to the absence of a reported tick bite and the atypical presentation of the erythema, which included papules, vesicles, and hemorrhagic components.
For a correct and timely diagnosis of Lyme borreliosis, even in the absence of a known tick bite, a detailed exposure history is essential. This includes assessing the patient's residence in or travel to an endemic area and any outdoor activities (e. g., walking in forested or park areas) during the tick season. The classic clinical picture is characterized by a red patch or spot, typically exceeding 5 cm in diameter, that expands centrifugally. In rare cases (reported in 1–4.8 % of patients), the erythema migrans lesion may be accompanied by atypical features such as papules, vesicles, pustules, or hemorrhages.

This article analyzes the prospects and challenges of integrating blockchain technologies into medical data management systems within the context of digital healthcare transformation. The study's relevance stems from the growing need to establish secure, transparent, and patient-centric infrastructures for handling medical information. The paper provides a comparative analysis of public, private, and consortium blockchain platforms, identifying the consortium model as the most promising for creating data exchange ecosystems among various healthcare stakeholders. Technological aspects are examined in detail, including a hybrid storage architecture (combining blockchain with distributed file systems like InterPlanetary File System), models for dynamic and predictive informed patient consent based on smart contracts, and the application of blockchain in telemedicine and next-generation electronic health record (EHR) management. The article also systematizes key implementation challenges: the need to reconcile blockchain immutability with the right to be forgotten, the imperative for a transition to post-quantum cryptography, as well as issues of scalability, energy efficiency, legal regulation, and integration with existing medical information systems. The conclusion emphasizes that the successful implementation of blockchain solutions in Russian healthcare requires coordinated development of technological infrastructure (focusing on domestic platforms like "Masterchain"), adaptation of the regulatory framework, and targeted training of medical professionals with competencies in digital technologies.

Objective. To identify trends in the development of the pharmaceutical market for vitamin K antagonists in the member states of the Eurasian Economic Union (EAEU), focusing on the rates of drug registration and the localization of production for active pharmaceutical ingredients (APIs) and finished dosage forms.
Materials and methods. A search for drug registration certificates was conducted in the state registries of medicines of the Russian Federation, the Republic of Belarus, the Republic of Kazakhstan, the Republic of Armenia, and the Kyrgyz Republic. A database on the state registration and production of vitamin K antagonists was developed in Microsoft Excel. The methods of content analysis, critical analysis, and classification were used.
Results. According to the 2025 ATC Index, code B01AA (vitamin K antagonists) includes 10 active substance names (10 INNs). In the EAEU territories, only 3 INNs have been registered (warfarin, acenocoumarol, and phenindione). In Kazakhstan, Armenia, and the Kyrgyz Republic, only warfarin preparations are registered under the B01AA code. In Russia, the largest number of drugs were approved between 2010 and 2016 (8 trade names). Since 2017, there has been a negative registration trend, and currently only 5 trade names of drugs are available. The production of the warfarin API is not localized in Russia (manufacturing countries include India, China, the Republic of Belarus, the Czech Republic, and others). The production of finished dosage forms is localized in Russia for 50 % of the approved medicines.
Conclusions. A trend towards a narrowing range of vitamin K antagonists and negative registration dynamics in Russia have been identified, including the cancellation of the state registration of the only phenindione drug since 2023. Warfarin and acenocoumarol are available in Russia, while warfarin and phenindione are available in Belarus. In other EAEU member states, only warfarin is used among vitamin K antagonists. This negative trend can be explained by the inconvenience of warfarin use, the need for careful laboratory monitoring of therapy, and the introduction of direct oral anticoagulants to the pharmaceutical market. The production of the warfarin API is not localized in Russia. The finished dosage form production for every second warfarin drug registered in the Russian Federation is localized domestically.

Relevance. The modern retail pharmaceutical market provides accessibility and personalization of medical care. Its development is accompanied by the growth of pharmacy organizations, the introduction of innovations, and digitalization, which requires a certain level of readiness of pharmaceutical workers for managerial activities. Regulatory documents, professional standards, and employers place high requirements on potential managers of pharmacy organizations.
Methodology. The study was based on a systematic analysis of scientific publications, regulatory documents, and data from job websites (SuperJob.ru, HeadHunter, and Rabota Rossii) in 2025 in the Russian Federation and the Yaroslavl Region. A total of 511 vacancies for managerial positions in pharmacy organizations were analyzed. The information was grouped based on the positions, educational requirements for pharmaceutical workers, and work experience or seniority. The study of the requirements for personal qualities, knowledge, skills, and work actions was based on the authors' developed model of readiness for managerial activities among pharmaceutical workers (GUD FR). The analysis of the region's retail pharmaceutical market included an assessment of the number, ownership forms, and network affiliation of pharmacy organizations for the period 2015–2025. The study used a combination of scientific methods, including logical, structural, comparative, content analysis, and mathematical and statistical analysis.
Results. Regulatory documents regulate the labor functions of specialists in the field of pharmaceutical management, the nomenclature of positions for managers of pharmaceutical organizations, taking into account the management functions and levels of management in accordance with the theory of management. The application of the GUD FR model in the study of employers' requirements for candidates for managerial positions has contributed to the systematization of personal and motivational characteristics, theoretical knowledge, and labor duties for the corresponding levels of management. Over the period from 2015 to 2025, the number of pharmacy organizations in the Yaroslavl Region has almost doubled, with a predominance of private ownership and large pharmacy chains. The pharmaceutical market requires managers of pharmacy organizations with various levels of management training, adapted to regional specifics
Conclusion. The development of the retail pharmaceutical market justifies the need for a differentiated approach to the selection of management personnel in pharmaceutical organizations according to the levels of management. A model of readiness for managerial activities by pharmaceutical workers has been proposed and confirmed. The results contribute to training and professional development programs that focus on the tasks of each management level, thereby improving the quality of personalized medical care in modern conditions.

Relevance. The transition of the healthcare system to a patient-centered model, especially in pediatric practice, places increased demands on the psychological resources of medical staff. Studying the relationship between professional self-efficacy and the motivational structure of personnel in this context is of significant scientific and practical interest for improving the quality of medical care and preventing professional burnout.
Objective. To investigate the specifics of professional self-efficacy and the motivational structure among physicians and nurses of a pediatric hospital depending on work experience in the context of implementing a patient-centered approach.
Materials and methods. A pilot study involved 33 medical workers from pediatric hospitals in Yaroslavl: 17 physicians and 16 nurses. A set of psychodiagnostics methods was used: the "Self-Efficacy Test" (Maddux, Scheer modified by Boyarintseva), the "Motivational Structure Test" by F. Herzberg, and an author's questionnaire to assess the level of patient-centeredness. Statistical data processing was performed using the Mann-Whitney U-test for group comparisons and Spearman's rank correlation coefficient for relationship analysis (p < 0.05).
Results. Significant differences in motivational structure were identified: physicians were more oriented towards achievements (p = 0.02), while nurses were more oriented towards career growth (p = 0.004). For specialists with longer work experience, the importance of external recognition increased (p = 0.04). The level of professional self-efficacy did not depend on experience or position. Correlation analysis showed that with age, physicians attach greater importance to material rewards (r = 0.521) and relationships with management (r = 0.539), but the importance of job content decreases (r = –0.613). For nurses, motivation for career growth significantly increases with longer work experience (r = 0.779). Young professionals demonstrate higher confidence in interpersonal communication, which correlates with increased importance of financial factors (r = 0.527) and lower orientation towards teamwork (r = –0.476).
Conclusions. The study revealed a complex and differentiated structure of motivation and the role of self-efficacy among medical personnel in a pediatric hospital. The obtained data emphasize the need to develop differentiated personnel management programs that consider position, age, and experience characteristics to enhance intrinsic motivation, prevent burnout, and successfully implement a patient-centered approach in pediatric practice.

Background. The increasing prevalence of modifiable risk factors associated with an unhealthy lifestyle, combined with the influence of biological, social, and anthropogenic environmental factors, negatively affects health status and is a significant cause of chronic noncommunicable diseases (NCDs). Population-based and personalized preventive measures contribute to at least half of the success in reducing NCD incidence and mortality. It has been proven that modern, effective prevention programs yield tangible and intangible returns on investment within 5–10 years.
Objective. To assess the adherence to healthy lifestyle (HLS) principles among residents at Yaroslavl State Medical University.
Materials and methods. Between 2023 and 2024, a survey was conducted among 82 clinical residents, aged 25–35, in their first or second year of study across various medical specialties at Yaroslavl State Medical University. The «Structure of a Healthy Lifestyle for Students» questionnaire was used, which included sections on communication skills, physical activity, attitudes towards bad habits and sexual activity, hardening practices, vaccination, and dietary habits.
Results. The importance of adhering to HLS principles was acknowledged by the overwhelming majority of respondents (96 %). However, the study revealed that in daily practice, 56 % of residents demonstrated a moderate level of adherence, while 29 % showed a low level. Specific areas with low adherence included: regular exercise (only 19 %), periodic hardening practices (26 %), insufficient knowledge of substance abuse issues (46.3 %), and inadequate understanding of the risks associated with early pregnancy (34 %).
Conclusions. While the importance of core healthy lifestyle principles is recognized by most medical residents, their awareness and practices are insufficient for healthcare professionals who have graduated from a medical university. These findings highlight the need for active integration of comprehensive HLS programs into the daily training and education of medical residents.