Kirov State Medical Academy

To scale up PrEP, Indonesia launched a pilot program between 2022 and 2023. This study investigates PrEP providers’ knowledge and attitudes to identify barriers and facilitators for future PrEP scale-up in the country. An online survey with convenience sampling was conducted for healthcare workers and community workers at PrEP-providing facilities between May and June 2023. The survey collected data on participants’ knowledge, attitudes, and experiences in offering PrEP as well as basic demographic information. Logistic regressions were conducted to identify factors associated with support for the PrEP program and comfort offering PrEP. 197 participants were recruited, including 63 healthcare workers and 134 community workers. On knowledge, 84.4% knew the correct definition for PrEP, 62.4% knew all target groups, 51.8% knew all eligibility criteria, and 31.0% knew all initiation procedures. Support for the PrEP program was expressed by 70.1% of participants, and 55.2% of experienced participants were comfortable offering PrEP. Community workers were more likely to express support for the PrEP program (aOR 4.00, 95%CI 1.03–15.54) while participants who supported the program in turn were more likely to be comfortable offering PrEP (aOR 4.06, 95%CI 2.24–7.38). The study highlights the importance of fostering positive attitudes toward PrEP for provider comfort in offering it. It also shows the potential for increased empowerment for community workers as the main drivers of the PrEP program. Targeted training and further research are needed to support providers effectively.

The lifetime risk profile for inguinal hernia is characterised by a profound sexual dimorphism, with males facing an approximate 27% cumulative incidence, ninefold greater than the 3% risk observed in females. This condition exhibits a marked predilection for the elderly, where its incidence peaks at roughly 13 cases per 1,000 individuals. Notably, the global epidemiological burden of inguinal hernia has escalated significantly, demonstrating a 36% surge in occurrence over the preceding three decades. In the spectrum of anterior abdominal wall defects, umbilical hernias rank as the third most prevalent, manifesting in an estimated 5% to 12% of the adult population. Against this clinical backdrop, this case report investigates the procedural viability and outcomes of a single-stage surgical strategy for the concomitant management of inguinal and umbilical hernias. We present a 62-year-old male patient with a 12-month history of a symptomatic, reducible right indirect inguinal hernia (4x2x2 cm) and an incidental, reducible umbilical hernia (3x3x2 cm) with exertion-triggered pain. The patient had no significant comorbidities or history of incarceration. He successfully underwent a unified operative session under spinal anaesthesia, comprising a standard Lichtenstein hernioplasty for the inguinal defect and a modified Mayo repair augmented with polypropylene mesh for the umbilical hernia. The total procedural duration was recorded at 80 minutes. The postoperative convalescence was uncomplicated, facilitating discharge on the sixth day. Critically, at the 36-month long-term follow-up, the patient reported complete resolution of symptoms and exhibited an excellent clinical outcome. There was no radiological or clinical evidence of recurrence at either surgical site, nor were there any sequelae of chronic groin pain, mesh-related complications, or surgical site infection. This successful outcome substantiates the proposition that a single-stage, mesh-reinforced repair under spinal anaesthesia constitutes a clinically feasible and resource-optimised therapeutic pathway. The approach offers distinct advantages by consolidating the surgical intervention into a solitary anaesthetic episode and a unified recovery period, thereby enhancing patient convenience and potentially reducing systemic healthcare costs. Nevertheless, while these preliminary results are highly encouraging, they necessitate rigorous corroboration through prospective, randomised controlled trials with larger cohorts. Such studies are imperative to definitively establish this integrated approach as a superior and standard-of-care alternative to traditional staged repairs for suitable patient candidates.

The aim of the study was to determine the structure and trends of the public-private partnership projects market in the healthcare sector in the Russian Federation. The information and analytical base of the study was data on investment projects implemented on PPP principles and included in the register of the Rosinfra digital platform. Qualitative and quantitative research methods were used. The PPP market in the healthcare sector has been formed and is developing in different areas of industry activity. However, the analysis of the structure and trends showed its imbalance in models, legal forms, and areas of MP. Conditions have not been created for investors in socially significant areas — primary care, medical rehabilitation. The analysis of the structure and trends of the PPP market in the healthcare sector showed that it is necessary to develop mechanisms for attracting investments in the primary care (general therapeutic area) and improve special legislation in terms of PPP agreements in order to replicate infrastructure models in the industry. This will lead to a decrease in the number of low-capital-intensive and short-term projects, which will contribute to more sustainable development of PPP in the healthcare sector.

Diseases of the arteries of the lower extremities are extremely widespread in patients with diabetes mellitus. Patients with multilevel atherosclerotic lesion of the arteries of the lower extremities on the background of diabetes mellitus have a high risk of critical ischemia, and in accordance with this, the number of amputations and the number of deaths increases. Our clinical case describes the importance of timely revascularization of the arteries of the lower extremities in patients with diabetes mellitus. The possibility of simultaneous surgery in such patients, including endovascular recanalization with balloon angioplasty and distal amputation, which allows to preserve the supporting function of the lower limb. Our article presents a clinical case of successful repeated retrograde endovascular treatment followed by amputation of the middle and distal phalanx of the little digit of the right lower limb in a patient with a lesion of the arteries of the tibia on the background of diabetes mellitus.

Acne conglobata and acne fulminans are severe forms of acne requiring a special approach to both diagnosis and treatment. The combination of genetic predisposition, features of the innate and adaptive immune responses, presence of comorbid pathologies in patient, skin reaction to stress are currently considered to be the pathogenetic mechanisms, which form the basis of developing severe forms of acne. The main factors provoking the development of severe forms of acne have been described, the correlation between acne conglobata, acne fulminans and metabolic syndrome has been demonstrated, the main diagnostic criteria of severe forms of acne and characteristics of therapeutic tactics in these forms of the disease have been formulated, the algorithmic approach of managing patients with acne fulminans has been provided. Alternative methods of managing patients with acne fulminans resistant to performed therapy have been presented. Acne conglobate and acne fulminans require timely and accurate diagnosis, as well as personalized approach to treatment. A differentiated approach, preciseness and patient’s adherence to therapy effectively help to prevent the complications of severe forms of acne and to minimize the post-acne manifestations, primarily in the form of severe cicatricial changes.

Objective: to evaluate the correlation between psychoacoustic hearing thresholds and ASSR (Auditory Steady-State Response) thresholds in patients with sensorineural hearing loss (SNHL) and in otologically healthy subjects. Material and methods. Auditory function was studied in 130 people grouped into 3 groups: group 1 consisted of patients with chronic SNHL (n=50), group 2 - patients with acute SNHL (n=50), group 3 - otologically healthy subjects (n=30). Thresholds were compared when registering tonal threshold audiometry and when registering auditory stationary evoked potentials. Results. The average difference between psychoacoustic hearing thresholds and ASSR thresholds at 4 speech frequencies in patients with SNHL in the right ear was 15 dB normal hearing threshold (NHT; p=0.005), in the left ear- 14.4 dB NHT (p=0.005), with a minimum difference of 12.3±5.9 dB NHT at 4000 Hz in patients with chronic SNHL in the right ear (p<0.001), with a maximum difference of 18.4±8.2 dB NHT at a frequency of 2000 Hz in patients with acute SNHL in the left ear (p=0.005). In otologically healthy subjects, the average difference between psychoacoustic hearing thresholds and ASR thresholds at 4 speech frequencies in the right ear was 10 dB NHT, in the left ear- 11.2 dB NHT. The minimum threshold difference was detected at a frequency of 4000 Hz in the right ear (6.5±1.6dB NHT; p<0.001), the maximum at a frequency of 500 Hz in the right ear (14.8±5.8 dB NHT). In patients with SNHL, the correlation coefficient ranged from 0.81 to 0.94 (p<0.001) when registering the tonal threshold audiometry and ASSR test. In otologically healthy subjects, the correlation closeness on the Chaddock scale ranged from 0.76 to 0.96 (p<0.001). Conclusion. The obtained values demonstrate a significant strong correlation between psychoacoustic hearing thresholds and ASSR thresholds.

Neuromyelitis optica spectrum disorders (NMOSD, formerly known as opticoneuromyelitis or Devic's disease) are severe chronic autoimmune inflammatory diseases of the central nervous system (CNS) associated with high disability in the absence of adequate treatment. In Russia, no assessment of the medical and social characteristics of this disease and the quality of life of patients has been conducted, which complicates the assessment of the prognosis and the development of medical and social management strategies for these patients.Objective: to analyse the medical and social characteristics and quality of life of patients diagnosed with NMOSD (opticoneuromyelitis).Material and methods. The condition of patients with a confirmed diagnosis of NMOSD or opticoneuromyelitis was assessed using a specially designed questionnaire, which also included questions about patients' attitudes towards their health. The SF-36 international quality of life questionnaire was used to score quality of life. Based on the results of the study, 280 patients diagnosed with NMOSD were surveyed in 21 regions of the Russian Federation.Results. Most patients with NMOSD who are observed by neurologists receive specialised treatment, but half of all patients with NMOSD currently experience some difficulties in obtaining drug therapy. Over the past year, 28.6% of respondents reported an improvement in their health, 39.6% reported no change, and 31.8% reported a deterioration. Self-assessment of health status declines sharply in patients over 55 years of age. The majority (74%) of patients report a decline in vision. Every second patient noted a decrease in vision at the onset of the disease. Severe movement disorders are characteristic, and for the majority (91%) of patients with NMOSD, strenuous physical activities such as running and weight training are not possible. Patients with disability groups I or II are more limited in their physical and mental resources. Patients receiving treatment significantly better assess changes in their health over the past year, both physical and psychological. Those who receive specialized drug therapy have a much better perception of their own health and its prospects. The SF-36 quality of life indices for NMOSD are significantly lower than normal, primarily in terms of physical condition, but also in terms of psychological well-being.Conclusion. In NMOSD, there are pronounced changes in the quality of life of patients, both according to the original questionnaire and according to the SF-36 scale. Receiving timely and adequate treatment significantly improves these indicators and the prognosis.

Chronic heart failure (CHF) remains one of the leading causes of morbidity, disability, and mortality worldwide. The primary clinical manifestations of CHF—dyspnea, fatigue, and exercise intolerance—significantly impair patients’ quality of life. Cardiac rehabilitation (CR) effectively improves physical performance, functional status, and compliance in patients with CHF. Conventional CR programs include moderate-intensity aerobic exercise, resistance training, respiratory muscle training, risk factor modification, and patient education. However, engagement in CR remains extremely low. Major barriers include insufficient referrals from healthcare providers, financial constraints, transportation difficulties, and limitations related to social, cognitive, and digital accessibility. This article discusses new strategies for expanding cardiac rehabilitation coverage, including the development of hybrid and home-based programs, the use of digital technology for remote monitoring, and the potential integration of artificial intelligence to personalize treatment approaches. Special attention is given to addressing digital inequality and ensuring broader access to CR programs for vulnerable populations. Innovative cardiac rehabilitation models have the potential to transform the care paradigm for patients with heart failure by increasing access to rehabilitation services and improving clinical outcomes.

Ophthalmictoxicity has become increasingly relevant upon introduction of novel anticancer agents – targeted therapies, immunotherapies, and endocrine treatments. Women with malignancies of the reproductive system, including ovarian, endometrial, and cervical cancers have been receiving treatments associated with potential visual impairments more frequently. This review consolidates the data on ocular adverse events associated with key drug classes used in gynecologic oncology: BRAF (B-Raf proto-oncogene, serine/threonine kinase) inhibitors, MEK inhibitors (mitogen-activated protein kinase kinase) inhibitors, immune checkpoint inhibitors (ICIs), including PD-1 (programmed cell death protein 1), PD-L1 (programmed cell death-ligand 1), and CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), antiangiogenic agents targeting VEGF (vascular endothelial growth factor) and VEGFR (vascular endothelial growth factor receptor), as well as selective estrogen receptor modulators (SERMs), aromatase inhibitors, and PARP (poly(ADP-ribose) polymerase) inhibitors. Particular attention is paid to the most common and clinically significant toxicities, including uveitis, keratitis, dry eye syndrome, macular edema, retinopathy, optic neuritis, and rarer but severe complications such as retinal vein occlusion and retinal detachment. In addition, it also presents differentiated approaches to diagnosing and managing ophthalmic toxicity related to the specific drug class. The importance of multidisciplinary collaboration between oncologists, gynecologists, and ophthalmologists is emphasized to ensure timely identification and management of visual impairments. Practical recommendations are provided for screening, monitoring, and managing patients at risk of ocular complications, including referral algorithms and treatment modification strategies. The article aims to increase awareness among gynecologic oncologists regarding ocular toxicity and optimize the clinical management of affected patients.

The aim is to assess the diagnostic value of applying regional ultrasound fetometry standards for verifying intrauterine growth restriction (IUGR) in the pregnant population of the Kirov region. Material and methods. The analysis included data from 320 full-term newborns diagnosed with IUGR, delivered at the Kirov Regional Clinical Perinatal Center between 2021 and 2023. Three IUGR subtypes were distinguished among the newborns: hypotrophic, hypoplastic, and dysplastic. The hypotrophic subtype is characterized by low birth weight with normal body length and head circumference, which corresponds to asymmetric fetal growth restriction on prenatal ultrasound fetometry. The hypoplastic subtype, consistent with symmetric fetal growth restriction on prenatal ultrasound, demonstrates proportionate deficits in birth weight, length, and head circumference compared to expected gestational age standards. The dysplastic subtype combines growth restriction with fetal malformations. We also performed a retrospective analysis of 374 maternal ultrasound scans, applying both national reference standards and our institutionally developed regional fetal growth parameters. Results. The sensitivity of ultrasound fetometry using regional norms reached 82.3% (asymmetric form) and 88.2% (symmetric form), substantially exceeding the sensitivity achieved with federal standards (30.9% and 71.1%, respectively). Meanwhile, the specificity of the method demonstrated a modest reduction with regional standards yet maintained high diagnostic performance. Conclusion. Regional ultrasound biometry standards significantly increase IUGR detection sensitivity by incorporating local population characteristics. Their clinical adoption in the Kirov region is recommended for improved fetal growth restriction diagnosis.