The goal of the Federal Project “Development of the export of medical services, approved by the Government of the Russian Federation in 2019 (included in the national project ‘Healthcare’) is to increase the export of Russian medical services by 4 times (in US dollars) by 2025. In this regard, a special role is played by the professional and ethical characteristics of medical personnel, which can have a significant impact on improving the competitiveness of medical organizations. One of these competitive advantages can be the introduction of a special corporate culture of personnel in Russian medical organizations, which includes taking into account the interests of patients belonging to different ethnic and religious groups. The purpose of the study: to determine the competitiveness of Russia in the field of export of medical services and to consider ways to improve it (competitiveness), in particular, through the introduction of a corporate culture aimed at taking into account the interests of various confessional and ethnic groups of the personnel of medical organizations. Methodology: analysis of secondary data and publications on the research topic.
Results: based on the analysis of secondary data, as well as publications on the topic of the study, Russia’s place in the field of medical services export is determined, the competitive advantages and disadvantages of Russian medical services from the point of view of the 5P model of the marketing complex are revealed. It is proposed to improve the corporate culture of the personnel of Russian medical organizations. Discussion: one of the possible ways to improve the basics of corporate culture is to provide additional training for staff on the basics of interaction with patients belonging to different ethnic and religious groups. Conclusion: improving the competitiveness of Russian medical organizations can be achieved by competently promoting the quality characteristics of the staff, such as a tolerant attitude towards patients belonging to different religious and ethnic groups, and taking into account their interests in the process of treatment and interaction.

European-like life expectancy levels in Moscow are attributable to the prevalence of older population and the manifold increase in the working-age population mortality, especially among young people. The goal of the study is to identify the age-specific risk factors for Moscow youth mortality. This analysis is based on the official Russian Statistics Service’ data on mortality in the age groups of 15–24 and 25–34 years between 2000 and 2019. As demonstrated, during the study period, the Moscow youth mortality rates decreased twofold
between both age groups. Starting from 2017, the mortality rate of Moscow youth began to increase, mainly among the 15–24-year-olds. The age vector of the youth mortality structure indicates a change in risk factors associated with age: while adolescents die from external causes, i.e. specific risks directly leading to death, later on youth mortality is more often associated with long-term behavioral factors indirectly resulting in
death (such as sexual conduct as a risk factor for HIV/AIDS mortality, alcohol as the main cause for deaths from digestive system diseases and mental disorders, drugs as a risk factor for deaths from cardiovascular diseases and mental disorders). It is important to take note of the wide age range of the population classified as “young”: while it might be justified in legal and social context, in the demographic context it blurs the differences in mortality among people of different ages. Moreover, the abnormally high level and contribution of mortality from inaccurately described conditions, which the Moscow youth suffered from in the 2000s, calls into question the official rates of mortality due to underlying causes, primarily injuries, poisonings, and circulatory diseases. At the same time, given the increase in the young people’s overall mortality in the recent years, the extremely high mortality rates from inaccurately described conditions make it difficult to identify health priorities for the Moscow youth and, therefore, do not allow determining the reserves for their effective decline.

Purpose. Analysis of the incidence of COVID-19 in patients from the register «Management of chronic patients with multiple diseases» with a previously established CHF diagnosis, depending on the presence or absence of a symptom of bendopnea. Materials and methods. Retrospective analysis of electronic outpatient records of 121 patients with CHF with and without bendopnea symptom, with an assessment of the incidence of COVID-19. For statistical processing of the data obtained, we used the R language and the RStudio software environment. Results. The average age of the patients was 74.38±9.83 years. Bendopnea symptom occurred in 60.3 % (n = 73) of the studied patients. The incidence of COVID-19 was 14 % (n = 17), of which 88 % were patients with the symptom of bendopnea (p-value = 0.023, =2 = 5.17). The chance
of COVID-19 in patients with bendopnea was higher than in patients without symptom of bendopnea (OR 5.8 (1.2; 26.7), p = 0.013). Conclusion. The presence of a symptom of bendopnea in patients with CHF increases the risk of COVID-19. A statistically significant relationship was established between the presence of a symptom of bendopnea, the level of left ventricular ejection fraction and the incidence of COVID-19.

Traumatic brain injury (TBI) is the main cause of unnatural death and disability in the child population, ranking first among all injuries requiring hospitalization. The lack of full and detailed medical and social statistics on the prevalence of TBI and its consequences impedes their reasonable assessment and reduces the possibility of prevention. The aim is to study and assess the current epidemiological situation of TBI in children in Moscow. Materials and methods. Comparative study of main trends in the incidence and mortality of TBI in children in Moscow in 2003–2018 with the average Russian indicators based on state statistical data. Results and conclusions. Megacities are a high risk area for TBI in
children, therefore policies require additional prevention strategies. Limitations in the existing forms for state statistics impede an objective assessment and establishment of true levels of morbidity and mortality in children from TBI, as well as identification of its causes. Increased hospitalization rate of children with TBI in Moscow at high morbidity levels contributes to low mortality and lethality rates in children from this type of injury.

In order to improve the clinical use of antibiotics in surgical departments of Morozovskaya Children City Clinical Hospital of Moscow Healthcare Department authors prepared, discussed and agreed upon a protocol for perioperative and post-exposure antimicrobial prophylaxis. The choice of antibiotics for systemic use was made according to the Antimicrobial Stewardship Program (ASP) stratification both for patients of type I (community-acquired infection without risk for shedding of polyresistant infectious agents) and type II (community-acquired infections with risk factors for shedding of polyresistant infectious agents). Study determined indications for post-exposure antimicrobial prophylaxis within the approved protocol.
Following that the Chief Physician issued an Order On Division of Responsibility of all Members of the Operating Team and On Approval of the Protocol for Conducting Perioperative and Post-Exposure Antimicrobial Prophylaxis. As a result of the implementation of the protocol, by the end of 2020 clinical use of antibiotics in surgical departments has improved.

Background and purpose. The aim of this work is to evaluate the efficacy of treatment patients with moderate left-sided and total ulcerative colitis (UC) with prolonged-release ethylcellulose-coated mesalazine. Materials and methods. The clinical analyses of results of treatment UC patients with prolonged-release ethylcellulose-coated mesalazine was performed. Eighty-seven patients with UC, treated with ethylcellulosecoated microgranules of mesalazine, were examined: 38 (43,7 %) men and 49 (56,3 %) women. The age of patients was from 26 to 49 years, median age 38,3±12,6 year. Results. After 2 weeks prolonged-release ethylcellulosecoated mesalazine treatment the response to therapy was demonstrated in majority of UC patients -71 (81,6%). After 12 weeks treatment prolonged remission persisted in 71 (81,6 %) UC patients. Mayo score decreased from 7,6±0,99 to 2,6±0,25 points. Significant decrease of inflammation markers (CRP, ESR, leukocytosis, fecal calprotectin etc) was determined. After 26 weeks of treatment Mayo score was 2,2-2,3 points. Thirty-two (36,8 %) UC patients showed healing of colon mucosa. After 1 year of prolonged-release ethylcellulose-coated mesalazine treatment clinical remission was determined in 69 (79,3%) UC patients with response to therapy, clinical-endoscopic remission- in 32 (36,8 %) patients. During 1 year follow-up no cases of surgical procedure and readmission because of UC reccurence were noted. Conclusion. Treatment of moderate active UC should be started with oral mesalazine ≥3 gr per day and rectal mesalazine. The most appropriate effective and highcompliance forms of mesalazine are prolonged-release forms of meselazine.

Introduction. The article presents an analysis of the use of non-invasive prenatal testing for chromosomal abnormalities in the fetal extracellular DNA in the blood of pregnant women in Moscow. Materials and methods. When processing materials and research results, authors considered all available clinical data: findings of an ultrasound examination, medical history and results of additional laboratory tests. Results. The article presents results of invasive prenatal diagnostics and pregnancy outcomes in patients with high NIPT risks. Discussion. Authors analyzed diagnostic capabilities of NIPT, its limitations, false-positive and false-negative results, and described 3 cases of prenatal diagnosis of fetal aneuploidy identified in patients who are in the «gray zone» of risk based on the results of combined screening of the first trimester of pregnancy. Conclusion. Prenatal diagnosis of the described aneuploidy is difficult due to individual risk of developing chromosomal abnormalities of the fetus based on the results of combined first-trimester screening in the range of 1:101‒1: 2500 and lack of indications for invasive prenatal diagnostics.

Thyroid gland (ThG) diseases lead at structure of the endocrine diseases. At the same time ThG-diseases frequency are age-associated and depend from influence of combination of negative external risk factors (Iodine deficiency, Selenium deficiency, technogenic stress rising, environmental pollution, high level of urbanization). Iodine prophylaxis is necessary at the all age groups and requires for pregnant woman. The legislative Iodine prophylaxis predetermines primarily the reduction of the frequency of occurrence such ThG-diseases as diffuse euthyroid goiter and nodule goiter. The appearance and progression of diffuse euthyroid goiter are more typical for rural. The adequate (without overdosing) correction of Iodine deficiency is necessary in order to avoid the hypothyroidism, what is especially important for coastal urban and rural. It is noted the rising of the frequency of occurrence of autoimmune ThG-diseases and ThGantibodies carrying, including autoimmune polyendocrine syndromes. Selenium deficiency and Vitamin D deficiency must be adjusted along with Iodine deficiency. The natural and the technogenic strumogenes negatively effluenced to ThG are considered. It was proposed to consider the frequency of occurrence of ThG-cancer as the marker of ecological pollution. It was observed the connection of depression and ThG-function. The rural inhabitation affected to the severity of depression that is more actually for postmenopausal women. At the same time the correct formation of the urban landscape (in reorganization context) promotes the maintainance of ThG’s metabolic health.

This article discusses various issues of organizing and conducting emergency evacuation of medical organizations in case of emergencies in the city of Moscow. The problematic moments and possible ways of their solution are reflected.

Purpose. To evaluate clinical trials data since January 2021 till March 2021. Materials and methods. The information about clinical trial’s approvals from the state register of medicines of Russian Federation ministry of health website was used as the main source of the original data concerning clinical trials. The register contains all the information relating to clinical trials in Russian Federation. Results. Clinical trials data was analyzed by its type (international, local, bioequivalence), sponsorship (foreign, local), phases and disease areas. Separately COVID-19 clinical trials were considered. Conclusion. During the 2021 Q1 we can mark a clinical trail's quantity growth (started ones) both in Russia and in Moscow in comparison with 2018-2020 similar periods, that is definitely a positive trend especially in COVID-19 pandemic circumstances. There  is a significant growth of bioequivalence share in 2021 versus 2019-2020 in Moscow. Due to SARS-CoV-2 ongoing pandemic lots of related to SARS-CоV-2 treatment clinical trials started, which considerably increased the contagious diseases pool in clinical trials market structure. Totally 14 related to SARS-CоV-2 treatment trials started in Russia, including 5 ones held in Moscow Healthcare Department medical organizations.

Introduction: Artificial intelligence, which is a set of algorithms, currently does an impressive amount of work related to its analysis and processing. The use of the computing power of a large number of simple processors, as well as the compilation of a mathematical model for their joint operation based on the principle of organizing neural networks of cells of living organisms, constitutes an artificial neural network. Such a system is not programmed at the development stage into a final consumer product (as is usually the case, for example, with the software of a device), but “teaches” throughout its entire operation. “Teaching” is about finding the percentage relationship between neurons and input data, which ultimately leads to the identification of complex relationships between the provided data. These properties of training neural networks are already helping doctors in their work, making it easier and providing more readable data. Purpose of the study: to update information about the use of modern technologies for teaching neural networks in the healthcare sector. Tasks: to consider the terminology and designate technologies in Data Science used in healthcare; to find on peer-reviewed resources information about modern approaches to the analysis of accumulated information and present it in a public language; to demonstrate the advantages and disadvantages of using deep teaching of neural networks; detail the “future” of deep teaching of neural networks in healthcare. Results: a complex system of interconnection between neurons of a neural network with a correctly written program code, together with relevant and verified information, makes it possible to accurately find correlations of many statistical indicators in the field of healthcare. This fact will ultimately lead to improved medical care. A neural network can handle large amounts of information much faster and more accurately, which is a huge step towards personalized medicine. This became possible due to the accumulation of a sufficient amount of data in digital form, as well as the achievement of sufficient technical progress in the field of deep teaching of neural networks.

Bulletin about results of Applied Research Conference dedicated to development of socio-psychological assistance to adolescents and their social environment in modern megacities. It targets practitioners and specialists involved in topical research in adolescence: psychologists, teachers, doctors, anthropologists, culturologists and sociologists.