Viktor Kosenko

The reform of the postgraduate medical education system in the Russian Federation has significantly impacted the quality of professional knowledge acquired by specialists and has also revealed several problems in medical education. The transition from the traditional system of advanced training, coupled with the introduction of periodic accreditation, has created additional challenges for specialists in gaining access to professional practice. The Department of Psychiatry No. 2 of the Kuban State Medical University of the Russian Ministry of Health (Kuban State Medical University) conducted an anonymous survey of 212 psychiatric specialists and clinical psychologists at specialized institutions in the Krasnodar Territory, representing 30.0% of the total. Respondents expressed a number of preferences for optimizing existing postgraduate training. The transition to periodic accreditation and its practical significance in line with current requirements dominated the negative responses, accounting for 24.1% of cases, which is a worrying signal.

Background: the problem of studying certain aspects of the quality of life of patients with mental disorders, including the neurotic spectrum, remains insufficiently disclosed. The level of quality of life is influenced by various factors, one of which is the nature of intra-family relationships, which largely depends on the indicators of social functioning. The aim was to identify and analyze indicators of social functioning that undergo changes against the background of the development of neurotic spectrum disorders and have an impact on intra-family relationships. Patients and Methods : a simultaneous prospective comparative study of individual aspects of social functioning affecting family relationships of patients with neurotic spectrum disorders before and after the development of neurotic pathology was conducted. The research material was data from an anonymous voluntary survey of 500 patients with diagnoses according to the International Classification of Diseases 10th revision (ICD-10) — F40–F48; F32; F06. A specially designed questionnaire was used, which included blocks for assessing family status, work, financial situation, fear of stigmatization, and the specifics of seeking specialized help. Results : against the background of the development of a neurotic mental disorder, the divorce rate increased 3-fold, and the level of conflict in families increased significantly. The deterioration of the financial situation due to the forced transition to a job with a lower salary was subjectively associated with an increase in the number of family conflicts in 69.4% of cases. A pronounced fear of intra-family stigmatization was noted by 31.2% of patients, while external stigmatization was noted by 39.6%. More than a third of patients (36%) first sought specialized psychiatric help only 2 years or more after the onset of the disease. One of the main reasons of late referral was the fear of stigmatization due to their disorder. Conclusion : indicators of social functioning such as marital status, financial status, and fear of stigmatization of an existing neurotic disorder show significant dynamics and are closely related to the nature of intra-family relationships in patients with neurotic spectrum disorders. Studying the specific effects of neurotic spectrum disorders is important for developing an integrated approach to therapy and rehabilitation.

A pathological process in the nasal cavity and paranasal sinuses in chronic rhinosinusitis with nasal polyps (CRSwNP) is not limited by nasal obstruction and has a complex impact on the patient’s central regulatory mechanisms manifesting in cognitive and mnestic functions impairment. Objective. To conduct a comprehensive comparative analysis of clinical and functional indicators characterizing nasal manifestations in patients with CRSwNP, as well as the results of cognitive tests in the pre- and postoperative periods. Patients and methods. A number of patients equal 45 with a long medical history of CRSwNP (M=117 months) without concomitant chronic pathology were examined. The age of patients was between 22 and 65 years (M=48.964 years). Clinical testing was carried out using the Sinonasal Outcome Test (SNOT-22), Lund—Mackey tests and active anterior rhinomanometry (ml/s). The changes in the X-ray examination (computed tomography of paranasal sinuses) were evaluated on the Lund—Kennedy scale. Cognitive abilities were assessed based on the MoCA test (in scores) with subsequent interpretation by a psychiatrist. The evaluation of indicators was carried out before the surgical treatment, after 1 and 6 months. Results. There has been a decrease in sinonasal symptoms on the SNOT-22 scale (from M=31.42 scores before surgery and to M=4.04 scores after 6 months); the Lund—Kennedy scales (from M=7.87 to M=0.38 respectively); the Lund—Mackey scales (from M=15.49 to M=0.47 scores respectively). The active anterior rhinomanometry indicators had a tendency to mean values increase from 399.04 ml/s to 856.60 ml/s after 6 months. Assessment of neurocognitive disorders on MoCA in patients preoperatively demonstrated mean values of 21.49 scores, which indicated the presence of disorders of mild severity. Mean values of 25.38 scores were obtained at further testing after 1 month, which were fixed after 6 months. Conclusion. An interdisciplinary approach to the evaluation of clinical manifestations in patients with CRSwNP, based on the inclusion of neurocognitive disorders testing in the study, allows to more fully evaluate the impact of the pathological process on the patient’s body. The inclusion of the MoCA test in the complex of intra- and postoperative researches allows to form an individualized approach in the implementation of therapeutic and rehabilitation activities in this category of patients.

The purpose of the study: to review the results of scientific research on combined etiopathogenetic, clinical, and functional manifestations of chronic rhinosinusitis and a number of neurological diseases classified as neurocognitive disorders (NCDs). The interdisciplinary approach in the analysis was based on the modern understanding of neurocognitive disorders and induced neuroinflammatory reactions, the commonality between the infectious agents in the pathogenesis of chronic rhinosinusitis and diseases characterized by NCDs, and the validity of the involvement of central brain structures in the process of chronic inflammation of the nasal cavity and paranasal sinuses. The analogy of the formation of such manifestations as nasal obstruction, changes in the olfactory tract and visual function, and disorders of the microbiota of the upper respiratory tract, and their impact on brain structures with impaired neurocognitive functions was drawn. The systematization of scientific research data characterizing various chronic forms of rhinosinusitis and NCDs was a confirmation of the regulatory role of the autonomic nervous system and the hypothalamic-limbic-reticular complex in understanding the common pathophysiological mechanisms occurring in these nosologies.

The article examines in detail the historical process of organization and subsequent development of the first psychiatric hospital in Kuban - the State Budgetary Healthcare Institution "Specialized Clinical Psychiatric Hospital No. 1" of the Ministry of Health of the Krasnodar Territory, covering a period of 120 years. The authors conducted a historiographical study based on materials from departmental, private and state archives, memories of hospital employees, as well as specialized literature. The results of the work done are presented in detail in chronological order. For the first time, data has been established and systematized, reflecting the sequence of transformations of the psychiatric department, opened by the Cossack military administration of the Kuban region, into an independent institution, acting as the flagship of the system of providing psychiatric care to the population of the Krasnodar region. Data are provided on changes in the hospital's bed capacity, the composition of inpatient and outpatient departments, chief physicians, as well as features that influenced its development in various years.

The use of the method of expert assessments is an indispensable element of the search for reserves to improve the quality and safety of medical activities for the realization of strategic tasks in the field of population conservation and improvement of health indicators of the Russian population.The purpose of the studywas to assess the factors influencing the appeal for drug treatment of alcohol–associated diseases in state medical organizations on the model of a large agro-industrial region.Materials and methods.Anonymous sociological survey was conducted in 2022. 135 doctorsspecialist in the field of “Psychiatry-narcology” working in outpatient or inpatient units of the public health system of the Krasnodar region. The following methods were applied in this study: sociological, statistical, content analysis, expert assessments.Results.The representative group of experts was characterized by a predominance of female doctors (57,0 %), persons aged 40–49 years (25.2 %) with a qualification category (76.3 %), with more than 15 years of work experience in the specialty “Psychiatry-narcology” (58.5 %). The organization of drug treatment in outpatient settings was rated “good” and “excellent” by 54.8 % of respondents, in inpatient – 71.1 %. According to experts, the factors of legal restrictions, public censure, as well as defects in the self-assessment of the nosological status of patients and the lack of general medical literacy of the population had the greatest impact on the decrease in the incidence of drug treatment for alcohol-related pathology.Conclusion.The potential aspects of possible directions for selective influence in order to increase the appeal of the population with addictive alcohol disorders to specialized professionals and the preservation of human resources were identified.

Архив медицинского научно-практического журнала «Российская оториноларингология»

Study purpose. Study of the system-wide magnetic therapy efficacy in major depressive disorder treatment. Materials and methods. Depression patients were assigned to two groups: the control group and the main one. The control group underwent conventional antidepressant treatment while for the main group conventional treatment was combined with system-wide magnetic therapy. In the course of treatment, patients were exposed to a variable-amplitude rotating magnetic field with 2,2 MT induction and 100 Hz current frequency for 30 minutes. The treatment efficacy was evaluated on the Hamilton scale after 4 weeks of treatment. Results and Conclusion. The number of patients (responders) in remission,  7 points on the Hamilton scale, was significantly greater in the main group than it was in the control one: 18 and 28 in the control group and the main group, respectively (p < 0,01). Significant (by over 50 %) reduction in six symptoms was achieved in the main group: suicidal thoughts (80,65 %), critical attitude to the disease (75,0 %), late insomnia (72,5 %), early insomnia (70,91 %), agitation (53,16 %). Symptoms decreased by 35,84 % and 50,91 % in the control group and the main group, respectively (p < 0,05), by total scores on the Hamilton scale. The treatment efficacy under CNE was 0,643 and 0,491 in the control group and the main group, respectively, and as 0,491 < 0,643, we proved statistically that treatment in the main group is significantly more effective (p = 0,000021). With the procedure being well tolerated and causing no adverse effects during treatment, this depression treatment method can be recommended for clinical practice.

Mexidol has been used in combination with basic therapy in 65 patients with mental disorders of organic genesis. The patients were treated during 56 days in accordance with a special scheme including the drug intake and intramuscular and intravenous injections. Mexidol exerted a positive effect on affective sphere, normalized the sleep-wake cycle, promoted rehabilitation of cognitive function thus improving the global clinical state of patients. Marked and significant improvement was found in 40,0% and 33,8% of cases, respectively. No severe side-effects were noticed.