Vol 22, No 1 (2023)

Objective. To assess concordance between blood phosphatidylethanol (PE) concentrations and self-reported alcohol consumption. Methods. The concentration of PE was determined in 480 blood samples of Grodno residents of both sexes aged 18-65 years. The blood was obtained from the laboratory of the medical advisory center, where it was submitted for routine biochemical analysis. Immediately prior to blood sampling, the clients were asked to complete the AUDIT questionnaire. Determination of the concentration of FE was carried out using the method of high performance liquid chromatography - tandem mass spectrometry (HPLC - MS). Statistical data processing was carried out using the Statistica 10.0 program. Results. Discrimination by the level of alcohol consumption using the concentration of PE showed that the proportion of abstinents (practically not drinking alcohol) was 63.51%; the proportion of moderate drinkers was 28.51%; the proportion of those who abuse alcohol was 7.82%. The distribution by level of alcohol consumption according to the total score of the AUDIT test was as follows: abstinents - 23.75%; moderate drinkers - 71.56%; alcohol abusers - 4.69%. Correlation analysis did not reveal any relationship between the concentration of FE and the total score according to the AUDIT test (r=0.07; p<0.734). Conclusion. The data obtained indicate a low concordance between the concentration of PE in the blood and self-reported alcohol consumption. Determining the concentration of PE in the blood is a more reliable way to diagnose alcohol abuse than the use of screening tools.

Objective. To clarify pathological conditions, including nosological forms that contributed to death of patients who had been suffering from bronchial asthma and died from coronavirus infection COVID-19. Methods. A non-randomized, comparative, retrospective study of the materials of 937 protocols of pathoanatomic autopsies of people who died from COVID-19 in the period from May 2019 to April 2022 and were examined in the departments of the Smolensk Regional Institute of Pathology. 53 patients with bronchial asthma were found among them. Then 937 protocols of pathoanatomic autopsies were analyzed, of those who died not from COVID-19 in the period from May 2019 to April 2022 and were examined in the same departments of the Smolensk Regional Institute of Pathology, among which 29 patients with bronchial asthma were found. Results. Among the 937 deaths from COVID-19, the rate of bronchial asthma was 5.42%, with well-controlled bronchial asthma - 3.77%, partially controlled - 69.8% and uncontrolled - 26.43%.Among the 937 deaths without COVID-19, the rate of bronchial asthma was 3.04%. Their bronchial asthma was well-controlled - 6.89 %, partially controlled - 34.49 % and uncontrolled - 58.62 %. In the groups of deaths from COVID-19 and without it, the average age was the same (67.12 + 10.05 and 68.72 + 11.04, respectively). In both groups, women led (64 and 58 %). In the group of deaths from COVID-19 with the presence of bronchial asthma, the most common comorbid diseases were: coronary ischemic heart disease (92.45%), arterial hypertension (77.35%), obesity (66.04%), chronic bronchitis (62.26%), pneumosclerosis (58.49%), emphysema (56.6%). Diabetes of type 2 was reported in 32.07%. Compared with this data, in the group of deaths without COVID-19, the following diseases were less often found: coronary heart disease by 2.3 times, arterial hypertension by 3.7 times, obesity by 3.1 times, Diabetes of type 2 by 3.4 times. In the group of deaths without COVID-19 of people who suffered from bronchial asthma instead of coronavirus infection, the diagnosis "Underlying disease" included the following conditions: in 38% chronic obstructive pulmonary disease; in 20% ischemic heart disease; 16% cerebral infarction; 12% lobar pneumonia; 8% bronchial asthma directly and 6% rheumatoid polyarthritis. At the same time in 34% bronchial asthma was registered in the heading of "concomitant diseases", and in other cases it was in a background or combined pathology. For COVID-19 patients with bronchial asthma, the incidence of chronic obstructive pulmonary disease was by 11.5% higher than in the group of deaths without COVID-19, but the frequency of uncontrolled bronchial asthma, which is accompanied by more pronounced morphological changes in the second group, was 2 times greater than in the first group. Conclusion. Most of the patients in the group with COVID-19, in addition to bronchial asthma, either had several diseases at once, or one, but quite severe pathology. For patients suffering from bronchial asthma who died from coronavirus infection, the most frequent comorbid diseases were coronary heart disease, arterial hypertension, obesity, chronic bronchitis, pneumosclerosis, emphysema. The last three forms were observed mainly for patients with uncontrolled bronchial asthma and most likely were not independent nosological forms, but a consequence in the progression of bronchial asthma. The presence of uncontrolled asthma in the COVID-19-free group confirms the significant impact of COVID-19 on death. Although the incidence of asthma in the COVID-19 group was 2 times higher compared to the group of deaths without COVID-19, the prevalence of bronchial asthma in this group was low (5.42% of cases).

Objective. To evaluate the effects of L-tryptophan and zinc aspartate on the antibacterial activity of doxycycline in relation to clinical strains of S. aureus and S. haemolyticus in the state of plankton and in biofilms. Methods. During the study, the minimum inhibitory concentration (MIC90) of doxycycline and its combinations with tryptophan and zinc aspartate were determined in relation to the planktonic forms of the studied strains S. aureus 2738 and S. haemolyticus 2642 on the turbidity detector of suspensions DEN-1 Biosap. Microbial biofilms were cultured in immunological tablets under static conditions. The MIC of drugs in relation to microorganisms was determined by the reduction of XT based on 1% resazurin. The biofilms were visualized using transmission electron microscopy JEM 1011 (JEOL, Japan). The research data were processed by means of MS Excel 2010, as well as a package for statistical data processing Statisticf 10, using multivariate analysis of variance. Results. The addition of tryptophan and zinc aspartate to the culture medium at concentrations of 0.2-2000 mcg/ml increases the antibacterial activity of doxycycline against planktonic forms of S. aureus and S. haemolyticus p<0.05. The addition of tryptophan and zinc aspartate to the medium at a working concentration of 1000 mcg/ml increases the antibacterial activity of doxycycline against S. aureus and S. haemolyticus biofilms in vitro by 2 times. Conclusions. The addition of tryptophan and zinc aspartate increases the antibacterial and antibiotic film effect of doxycycline, which allows them to be considered as modulators of antibacterial activity.

Objective. The review material analyzes on the significance of peptide signaling systems in teleost fish as a new molecular model for experimental neuropharmacology. Results. In recent decades, due to the development of phylogenomics, new ideas about the evolution of vertebrates and about the homology of peptide signaling systems within vertebrates, about the similarities and differences in molecular structure within vertebrates, have developed. Comparative sequencing of signal peptides and the genes encoding them made it possible to draw conclusions about the relationship of peptide systems and their evolutionary origin from the same ancestral molecular systems within vertebrates. Conclusion. A high level of similarity in the molecular structure of signal peptides and corresponding receptors is noted, which leads to the conclusion that the use of bony fish representatives as model organisms for studying peptide signal systems as pharmacological targets is promising. In this case, one should take into account the differences in the physiological effects of signal peptides in fish, on the one hand, and in humans and higher mammals, on the other.

Objective. To investigate the peculiarities of cardiovascular drugs prescription for patients with sarcopenia, comorbidity and multifocal atherosclerosis. Methods. 139 patients form the cardiology hospital were divided into groups: with sarcopenia "S+" and without it "S-". The diagnosis of arterial hypertension (AH), ischemic heart disease (IHD) and chronic heart failure (CHF) was carried out according to the recommendations of the European and Russian Cardiological Society. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People 2010 and 2018; The presence of atherosclerotic plaques (ASP) - according to the Criteria of the International Consensus 2006-2010. Results. Patients with "S+" significantly more commonly had: stage 2-3 AH, IHD (II-IV functional class), postinfarction cardiosclerosis, stoke in the anamnesis, CHF, diseases of peripheral vessels, chronic cerebral ischemia, atrial fibrillation (p<0.05). Patients "S+" were older (p<0.05). Patients with "S+" were characterized by the presence of prolonged, concentric, with an uneven surface, heterogeneous hypoechoic and unclassifiable due to severe calcification of ASP (p<0.05), and for patients with "S-" - local, with a flat surface ASP (p<0.05) was characterisric. Patients with "S+" more commonly intake beta-blockers, i-ACE, antiplatelet agents, anticoagulants, nitrates and statins for a long time - more than 3 years (p<0.05). In patients with severe sarcopenia there was no significant difference in the doses and duration of statin administration for patients with unstable and stable ASP (p<0.05). The level of total cholesterol did not differ in patients with stable and unstable ASP (p>0.05. Conclusion. In patients from cardiological hospital "S+" is associated with a severe comorbid background and the presence of unstable (potentially thrombogenic) ASP, that’s why they have a very high risk of cardiovascular complications. The prescription of statins is carried out in accordance with clinical recommendations. Identification of unstable ASP simultaneously with sarcopenia requires a personalized approach to the management of geriatric patients.

Objective. To study the effect of therapy on the clinical course of chronic lymphocytic leukemia. Methods. The study group included 39 patients with CLL, aged 51 to 88 years, who were treated in the fourth therapeutic department at the Republican Clinical Hospital. Statistical significance of differences was determined using the nonparametric χ2 test - Pearson's chi-square test, Fisher's test, chi-square test with Yates correction. Differences were considered statistically significant at p<0.05. Results. Of all the treatment regimens, the RFC protocol was used most frequently in 34 patients. Complete response was achieved in 18 patients, partial response - in 10 patients; disease progression was detected in 6 patients. At the initial admission, all patients with CLL showed only hematological changes, after the therapy, hematological complications expanded, hemorrhagic, infectious, cerebral, gastrointestinal disorders, and cell decay syndrome were added. A high comorbidity of CLL with cardiovascular diseases and diseases of the gastrointestinal tract was revealed. Conclusion. The RFC protocol was most often used in the treatment of patients with chronic lymphocytic leukemia. The combination of RFC allows obtaining an overall response in 82% of primary CLL patients, while 53% of patients have a complete remission. The effectiveness of cytostatic therapy in patients with CLL is higher with standard RFC therapy relative to all other programs, and the use of the RFC protocol significantly increases the likelihood of achieving complete remission. When using various chemotherapy regimens for CLL, both non-hematological and hematological complications occurred. The greatest number of adverse events from chemotherapy occurred with the FCR treatment regimen, the smallest - with rituximab monotherapy. An unfavorable prognostic factor is the presence of additional oncological diseases and kidney diseases; we consider it appropriate to determine creatinine clearance in all patients with CLL before starting chemotherapy. Acute vascular pathology significantly limits the possibilities of chemotherapy in patients with CLL.

Objective. To present a clinical case of diagnosis and treatment of a patient with chronic heart failure with reduced ejection fraction, who was implanted with a new type of device that optimized his heart contractions. Methods. Data of an out-patient survey card and case report form of a patient with chronic heart failure observed in an out-patient department after his hospitalization in a cardiology clinic for implantation of a heart rate modulator are presented. The authors analyzed Russian and foreign literature on the diagnosis and innovative high-tech treatment methods of chronic heart failure with reduced ejection fraction and permanent atrial fibrillation. Results. The male 75 years old patient has been observed in an out-patient department at the place of his residence for 15 years. In 2018, after suffering a lower lateral myocardial infarction and with permanent atrial fibrillation, the patient’s chronic heart failure with reduced left ventricular ejection fraction (23-25%) deteriorated. In August 2022 at the FSBI "National Medical Research Center of Cardiology named after Academician E.I. Chazov" of the Ministry of Health of Russian Federation he was implanted with a cardiac contractility modulator. In the postoperative period, during four months of out-patient follow-up and optimal drug treatment his left ventricular ejection fraction increased from 25% up to 37%. Conclusion. Up to date, in patients with atrial fibrillation and chronic heart failure (CHF), who despite optimal drug treatment retain symptoms of CHF with reduced left ventricular ejection fraction and who have no indications for cardiac resynchronization therapy and catheter ablation, implantation of a new generation cardiac contractility modulator may be recommended.

Objective. To study the efficacy and safety of immunomodulatory drugs in the complex therapy of acute respiratory viral infections (ARVI) complicated by pneumonia in children aged 2 to 6 years who were hospitalized in the infectious diseases department of Smolensk in 2019. Methods. A retrospective analysis of 60 case histories of children aged 2 to 6 years, with confirmed acute respiratory viral infections, complicated by pneumonia, who were hospitalized in the infectious diseases department of Smolensk in 2019 was perfomed. The patients were divided into 2 groups: Group 1 (main) - 30 patients who received interferon alpha-2b (rectal suppositories) 150,000 IU 2 times a day after 12 hours daily for 10 days; Group 2 (comparison) - 30 patients who received the drug umifenovir 50 mg 4 times a day orally for 5 days. Standard therapy included symptomatic agents (nasal drops, inhalations with saline solution), antipyretic drugs (according to indications), antibacterial therapy (according to indications). Results. The evaluation of the effectiveness of immunomodulating drugs was carried out on the basis of clinical, laboratory and instrumental examination data with dynamic observation of patients at different stages of the disease. The duration of intoxication, catarrhal and bronchopulmonary syndromes, the duration of hospitalization were evaluated. The safety (tolerability) of the use of immunomodulatory drugs was assessed by comparing the frequency of adverse events. Retrospective analysis showed that the duration of elevated body temperature in patients was the same and amounted to 5.4±0.49 days in the group of children receiving interferon alpha-2b and 5.5±0.36 days in the group of children receiving umifenovir.Significant differences in the duration of intoxication syndrome were revealed: in group 1 it lasted 6.6±0.59 days, while in group 2 it was longer - 8.4±0.54 days (p<0.05). There were no significant differences in the duration of catarrhal syndrome: 9.3±0.66 versus 8.93± 0.56 days, respectively, in group 1 and 2 (p>0.05). The duration of cough was also comparable and amounted to 10.9±0.69 days in the main group and 10.97±0.53 days in the comparison group. The improvement in the general condition of patients, which was assessed based on the positive dynamics of the main clinical symptoms of the disease against the background of therapy, was 5.4 ±0.49 days in group 1, 5.7±0.35 days in group 2 (p>0.05). There were also no significant differences in the number of bed days: 7.2±0.35 versus 6.5±0.31, respectively, in group 1 and 2 (p>0.05). Conclusion. As a result of the study, the effectiveness and safety of the use of immunomodulatory drugs in the complex therapy of acute respiratory viral infections complicated by pneumonia in children 2-6 years old has been proven. The clinical efficacy of interferon alpha-2b, rectal suppositories is due to a faster relief of intoxication syndrome in patients (p<0.05). According to the duration of catarrhal and bronchopulmonary syndromes, the timing of the onset of improvement, the results of laboratory and instrumental examination methods, there were no significant differences in the main group and the comparison group (using the drug umifenovir) (p>0.05). After the 5-day course of immunomodulatory therapy, the children of the main group for health reasons reasonably needed to increase the duration of the course of therapy, which was increased to 10 days. When assessing the safety of immunomodulating drugs, their good tolerability was noted in the first and second observation groups.

Objective. To optimize the technique of inframammary suture in patients during their augmentation mammoplasty. Material and methods. The study included 171 patients who applied to the Department of reconstructive Surgery of the Republican Scientific Center for Cardiovascular Surgery in the period from 2005 to 2022. The age of the patients ranged from 19 to 45 years, the average age of the patients was 28.5±3.1 years. Congenital glandular tissue deficiency was observed in 96 (56.1%) cases, in 75 (43.9%) cases, the deficiency occurred after childbirth and lactation. Results. All patients were divided into two clinical groups. The first group included 82 patients who received a standard intradermal Halsted suture. The second clinical group included 89 patients who had a three-layer suture, upgraded by specialists of the Center. The age and other characteristics of the women were comparable in both clinical groups. As for long-term complications, they were estimated in terms of up to one year and above. During the survey in clinical group I, 32 patients called the cosmetic result in the suture area good, 27 women called them satisfactory, and 23 - unsatisfactory. At the same time, 46 patients in the II clinical group called the results of scar healing good, 31 patients - satisfactory, and only 12 patients classified them as unsatisfactory. Conclusion. Thus, the technique of applying a three-layer suture can significantly improve the cosmetic results in the area of implant insertion, which in turn improves the psychological state of patients in the postoperative period. Although current clinical research considers suturing in augmentation mammoplasty to be of minor importance, the findings show that this is far from the case.

Objective. To evaluate the clinical and diagnostic value of contrast-free Arterial spin labeling Magnetic Resonance perfusion of the kidneys for patients passing hemodialysis treatment. Methods. In the course of the work, patients with chronic kidney disease, acute renal impairment and a group of healthy volunteers were examined. The results of a laboratory test, ultrasound examination of the kidneys with duplex scanning of the arteries of the kidneys and MRI with ASL-perfusion of the kidneys were used for the analysis. Results. The values of ASL-perfusion of the kidneys in healthy volunteers and in patients for each stage of chronic kidney disease were found in comparison with data from other studies. Conclusion. The use of ASL-perfusion in patients with CKD makes it possible to evaluate the effectiveness of hemodialysis and predict an unfavorable outcome.

Objective. To study the pathogenetic mechanisms of SARS-CoV-2 heart disease, the pathogenesis of arrhythmic complications in postcovid syndrome (long COVID), statistical data on the forms of cardiac arrhythmias in long COVID and their clinical manifestations. Methods. A literary review of domestic and foreign scientific sources on this problem. Results. As a result of the analysis of literature sources, the pathogenetic mechanisms of arrhythmias in long COVID were clarified (direct myocardial damage, acute systemic inflammatory response and cytokine storm, mismatch between myocardial oxygen demand and its consumption, ischemia due to atherosclerotic changes in coronary arteries, electrolyte imbalance). The most common arrhythmias in long COVID are sinus tachycardia, atrial fibrillation. Less often, malignant cardiac arrhythmias occur (ventricular tachycardia, ventricular fibrillation). Conclusions. It is concluded that there is a direct connection between COVID-19 and arrhythmic complications, which are a rather formidable manifestation of long COVID.

Objective To demonstrate the basic principles and further directions of the study of first-line systemic therapy in patients with metastatic renal cell carcinoma. Methods. The work is based on materials of full-text articles available on Pub Med. Results. The analysis of introduction into clinical practice of the targeted drugs blocking angiogenesis, inhibiting targets of rapamycin, as well as immunotherapy drugsis performed. The principles of studying the effects of their combinations and the directions of further research are outlined. Conclusion. Understanding the molecular profile of tumor cells led to the development of systemic treatment methods, and the study of antitumor immunity changed the clinical picture of the disease. The paradigm has changed twice in the last decade, improving patient outcomes through the use of combined regimens using checkpoint inhibitors and VEGF inhibitors (axitinib plus pembrolizumab or avelumab). Currently, such combinations of drugs are approved and are part of an ever-expanding arsenal for therapy. Nevertheless, this raises the need for the detection of predictors and prognostic biomarkers capable of personalizing the treatment of patients in order to increase the effectiveness and reduce the toxicity of therapy.

Objective. The aim of the study is to study the accumulation of the most significant artificial and natural radionuclides in medicinal plant raw materials the example of five-bladed dummy grass. Methods. On the basis of 10 plant objects used for the preparation of medicinal raw materials, selected from 36 points of the Voronezh region, studies were carried out on the content and storage capacity of plant objects from strontium-90, cesium-137, thorium-232, potassium-40, radium-226 soils. Results. Based on the grass of five-bladed dummy, harvested from 36 points of the Voronezh region, studies were carried out on the accumulation of the most significant artificial and natural radionuclides by plant objects from soils. Analysis of soil and grass samples of five-lobed motherwort was carried out on the gamma-beta-alpha-spectrometer-radiometer of the RADEK MKGB-01 with determination of the specific activity of basic (long-lived) artificial radionuclides (strontium-90, cesium-137) and natural radionuclides (potassium-40, thorium-232, radium-226), which are often found in nature. Conclusion. It was revealed that with an increase in the specific activity of strontium-90, cesium-137, thorium-232, potassium-40, radium-226 in the soil, their specific activity in the of five-bladed dummy grass. The transition patterns are described by mathematical dependencies with the maximum approximation validity factor.

Objective. To identify patterns in the distribution of elements by organs of C. cyanus (leaves, stems, baskets, edge flowers, grass) depending on their concentration and atomic order number. Methods. The elemental composition of the C. cyanus specimens has been investigated using inductively bound plasma mass spectrometer ELAN DRC-e ICP-MS and the Agilent 715 ICP-OES optical emission spectrometer. Sample preparation for element analysis included attachment treatment of plant material with nitric acid followed by microwave decomposition systems Speedwave TM MWS-3+ and BERGHOF. Statistical processing of the obtained chemical analysis results was carried out in Microsoft ® Excel 2010 with calculation of errors of indirect measurements, on the basis of reference values of element concentrations and their errors. Concentrations of 60 elements were compared using the least squares method. Results. 66 elements were found in the studied herbal specimens and morphological parts of C. cyanus . The specimens are identical in composition but differ in content. Accumulative series of elements with decreasing concentrations for each object of study have been compiled. A comparison of 60 element concentrations (according to a logarithmic scale) showed high correlation (R2 = 0.99) in the study subjects. For grass and morphological parts of C. cyanus , geometric mean values of 60 chemical elements, their logarithms have been calculated. It reveals a similar pattern, deposited in the logarithmic scale, in the distribution of elements depending on their concentration and atomic sequence number in the grass and morphological parts of C. cyanus . Conclusions. A same type of regularityin the distribution of chemical elements in the grass and morphological organs (edge flowers, stems, leaves, baskets) of C. cyanus has been identified, depending on the concentration and atomic sequence number of the element.

Objective. Assessment of the degree of import dependence of the Russian market of gynecological drugs and development of a set of measures to help overcome it. Methods. The study was based on data from an audit of retail sales and hospital purchases, as well as an audit of preferential medication supply in the segment of the Russian pharmaceutical market, including medicines for the treatment of gynecological diseases, between 2012-2021. Data are provided by the research team DSM Group. Results. It is shown that the Russian market of gynecological drugs is highly dependent on imports, the share of foreign drugs in its individual segments reaches 90%. The highest share of imports is observed in the retail segment, among the original gynecological drugs and medicines not included in the Vital and Essential Drugs List, and in terms of ATC classification - in subgroup G03 [Sex hormones and modulators of the reproductive system]. Among the leading gynecological medicines in terms of sales both in kind and in value terms, as well as manufacturing companies, mainly foreign ones predominate. Conclusion. A set of measures aimed at activating the process of import substitution in the Russian market of gynecological drugs is proposed. The practical implementation of all planned activities should contribute not only to overcoming import dependence, but also to the development of the production of new domestic gynecological drugs, which will increase their availability for the population and healthcare institutions and, in general, increase the level of drug safety in our country.

Objective . To evaluate the effectiveness and prospects of modern medical and pharmaceutical care for persons with alcohol-induced liver disease on the basis of official sources of information, analysis of scientific literature and the results of our own research. Methods . Collection and analysis of the results of modern experimental and clinical scientific research on the problem. Results. The problem of lesions of internal organs and systems associated with excessive alcohol consumption has an important medical and social significance. It is widely known that one of the target organs in this case is the liver, and its lesion - alcoholic liver disease is the most frequent cause of disability and mortality in this category of patients. According to V.S. Moiseev et al. (2009) the alcohol intake leads to hospitalization in 20-35% of in-patients, to referral to outpatient clinic in 10-20% of outpatients, to referral to a psychiatrist for consultation in more than 40% of patients with psychiatric diseases. Pathogenetic mechanisms of liver damage are manifold and lead to the development of cytolysis, inflammatory reaction with subsequent progression of fibrosis. It is known that one of the leading mechanisms of disturbance of structural and functional integrity of cell membranes is the activation of free radical lipid peroxidation and violation of antioxidant protection. Generally accepted drug therapy, including inflammatory-destructive diseases, in some cases does not give the desired result, or the clinical efficacy of treatment remains quite low, given the patient population. Conclusions. Anti-alcohol policy in the Russian Federation in recent decades has been aimed at reducing the number of persons with alcohol addiction. Nevertheless, in Russia the number of alcoholics reaches 5 million, which accounts for 68% of deaths from liver cirrhosis, 60% from pancreatitis, and 23% from cardiovascular pathologies. Since the highest mortality rate is characteristic of alcoholic cirrhosis of the liver, this indicator serves as a kind of indicator of alcohol consumption in each specific country. The mortality rate from alcoholic cirrhosis in Russia has been and remains substantially higher than in the European countries: in 2010, it reached 50 per 100,000 people in large cities. Traditional domestic treatment of alcohol-induced liver disease is primarily reduced to abstinence from alcohol, a rich protein diet, and intake of hepatoprotectors. Undoubtedly, the most effective treatment for alcohol-induced liver disease is refusal to take ethanol in any form.

Objective. To evaluate the effectiveness of distance and traditional learning formats based on the results of a survey of students of 3-5 courses of the Faculty of Dentistry and teachers of specialized departments of SSMU. Methods. The study analyzed 378 questionnaires of dental students and 45 medical school teachers of SSMU. Questions about the feasibility of the distance format in clinical classes and lectures suggested two options ("yes" and "no"). When answering the questions about the real need for online training, the respondents chose a number from 1 to 10, where 1 is not needed, 10 is needed. Results. Most students surveyed find the distance learning format demanded within the dental disciplines, while lecturers consider face-to-face classes to be an essential part of the learning process. Conclusion. Nowadays medical school education is undergoing significant changes. Despite the fact that there is a number of advantages of distance learning, teaching medical students clinical disciplines is impossible without communication between teachers, students and patients in face-to-face learning format.

Objective. To analyze the results of modern research on the influence of chemical substances in drinking water on public health. Methods. Collection, systematization and analysis of theoretical, experimental and clinical data of modern scientific research of domestic and foreign scientists on the effect of chemical substances in drinking water on public health, presented in leading scientific publications over the past 15 years. Results. The article shows the effect of inorganic and organic chemical substances on public health. The influence of transformation products formed during chlorination, ketones and aldehydes - during ozonation is noted. The article pays attention to the problem of the physiological usefulness of drinking water, reflects the relationship between the ions present in drinking water and the ratio of structural fractions of water that affect its quality. Conclusions. As a result of the analysis of scientific works on the influence of the chemical composition of drinking water on public health over the past 15 years, generalized data on the effect of the organic and inorganic substances amount in drinking water on water quality and the development of certain diseases of the population are presented. The analysis of the data indicates a number of methodological and organizational problems related to providing the population with safe drinking water in terms of chemical composition: the problems of monitoring new or previously undetectable substances, the problems of water treatment safety, which allows to avoid the appearance of dangerous transformation products, the problems of supplying the population not only with purified drinking water, but also with water, which physiologically completes in chemical and fractional composition.

The article is devoted to the 100th anniversary of the foundation of the Department of Children's Diseases at Smolensk State Medical University. The rich history of the department in the temporal aspect is described, the achievements of today and the prospects for the development of the department are presented.