No 81 (2020)

Articles
GERIATRIC ASPECTS OF FAMILY MEDICINE DEVELOPMENT IN THE BELGOROD REGION
Nikolaeva I.V., Zubareva N.N., Zhernakova N.I., Babitsyn C.N.
Abstract
The involvement of older people in public social life, the use of their knowledge, experience, and potential, and the improvement of approaches to the organization of medical care for older patients is the most important state task. A regional model for improving the effectiveness of medical care for older people is proposed, based on the revival of the principles of family medicine. As part of the creation of a new paradigm of family medicine, the essence of the family doctor's work has changed, and he has been able to manage the health of the population in practice. Offices of family doctors were created, their material and technical base was modernized, and real conditions were created for walking access to medical (including geriatric) care. Extended functionality of the family doctor in the context of problems and life circumstances of patients. On the basis of OSV and FAP, the issuance of medicines for preferential categories of citizens is organized. Close interaction of family doctors with the regional gerontological center on the basis of the veterans ' hospital was established. The chief freelance geriatric specialist conducts consultations and seminars on VCS every last Wednesday of the month. The reorganisation measures that have been carried out have made it possible to achieve a stable reduction in the death rate of people over the working age.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):3-7
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE: REGIONAL ASPECTS
Prozorova G.G., Kostina N.E., Golysheva I.A., Budnevsky A.V., Burlachuk V.T.
Abstract
The materials of statistical reports on morbidity and mortality due to chronic obstructive pulmonary disease (COPD), primary detection of patients both in the framework of clinical examinations, and in the daily work of a primary care doctor-a General practitioner and a therapist were studied. It is shown that screening spirometric examination during medical examination can serve as an effective tool for early diagnosis of COPD, and the use of new organizational forms of work of the region brings pulmonological care to the population of the districts of the Voronezh region (VO), where there is no pulmonologist. An important role in the management of COPD patients is played by educational pro-grams for primary care physicians, which are a mandatory element of pulmonary health Days.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):8-10
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SCREENING FOR COGNITIVE DISORDERS IS ONE OF THE PRIMARY HEALTH CARE PRIORITIES
Esina E.Y., Pometia O.S., Zuikova A.A., Ostroushko N.I.
Abstract
A screening of cognitive disorders was performed using the Mini-Cog test (Mini-Cog) in outpatient patients who have made an appointment with a General practitioner. The results of the test Mini-Cog, if the cutting point is less than 3 points, all patients were divided into 2 groups: the first, in 17 (42,5%) patients with a high probability of dementia, and the second group of 23 (57,5%) patients with no cognitive disorders. The score on the Mini-Cog test in the first and second groups was: 2.00[1.00;2.00] and 4.00[3.00;5.00], respectively. The groups were comparable in age (p=0.479). The average age of patients in the first and second groups was 78.47 ± 7.59 years and 73.91 ± 8.55 years, respectively. The average values for the MMSE test in groups 1 and 2 were: 20.00[19.00; 24.00] and 24.00[21.00; 26.00] points, respectively, which in the first case reflected the presence of mild dementia, and in the second - pre-dementia cognitive impairment.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):11-13
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CHOICE OF THERAPEUTIC REGIMEN FOR COMORBID CONDITIONS OF DIGESTIVE ORGANS IN GENERAL PRACTITIONER'S PRACTICE)
Kolbasnikov S.V., Kononova A.G., Belova N.O.
Abstract
Despite the widespread prevalence of functional and metabolic diseases of the gastrointestinal tract, primary care doctors do not pay enough attention to this problem. The article discusses the issues of comorbidity of the digestive system, which are most often found in the outpatient practice of general practitioners and the possibility of planning therapeutic and preventive measures
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):14-17
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THE RISK OF SENILE ASTHENIA IN PATIENTS OLDER THAN 75 YEARS WITH DIABETES
Vinogradova I.V., Lugovskaya A.A., Litovkina E.V., Volynkina A.P.
Abstract
The assessment of signs of senile asthenia in persons 75 years and older was examined. Risk groups with a high probability of having senile asthenia for referral to geriatric counseling have been identified. The percentage of the development of senile asthenia in men and women was established.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):18-20
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CHANGES IN THE BRACHIOCEPHALIC ARTERIES IN PATIENTS OF MATURE, ELDERLY AND SENILE AGE WITH SARCOPENIA
Erokhina A.S., Golovanova E.D., Miloserdov M.A.
Abstract
Goal. To study the incidence of atherosclerotic changes in the brachiocephalic arteries (BCA) in patients of various age groups with cardiovascular disease, depending on the presence or absence of sarcopenia. Materials and methods. 57 patients (30 men, 26 women), aged from 45 to 89 years old, who were hospitalized in the Department of Emergency Cardiology of KBSMP, were examined. For the diagnosis of sarcopenia, the recommendations of EWGSOP 2010 were used.Atherosclerotic changes in BCA were studied by ultrasound dopplerography (Doppler ultrasound) on an Philips HD11XE ultrasound scanner, an L9-3 linear sensor, with an assessment of the quantitative and qualitative characteristics of atherosclerotic plaques (ASB). Results. In mature patients, sarcopenia was not diagnosed, in elderly patients it occurred in 59.1% of cases, and in the group of patients older than 75 years with CVD, sarcopenia was diagnosed in 95.7% of cases. The frequency of occurrence of post-infarction cardiosclerosis in patients with sarcopenia was significantly higher than in its absence (37.0% versus 18.2%, p <0.05). The degree of ACS stenosis in patients with sarcopenia was statistically significant: in bifurcation of the left common carotid artery (CCA), bifurcation of the right CCA and right CCA. In elderly patients with sarcopenia, prolonged ASB were more common (45.2% versus 15.0%, p <0.05). Conclusion The presence of multifocal atherosclerosis (MFA) of coronary and brachiocephalic vessels (ASB) in older patients, which affects the risk of general and cardiovascular mortality, is closely associated with the development of sarcopenia, which should be taken into account when planning treatment and rehabilitation measures in patients with MPA and the presence of geriatric syndromes
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):21-24
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FEATURES OF THE COURSE OF COMORBID PATHOLOGY IN PATIENTS WITH DIABETES MELLITUS AND ARTERIAL HYPERTENSION WITH SUBCLINICAL HYPOTHYROIDISM
Volynkina A.P., Raskina E.A., Perfileva M.V.
Abstract
The issues of peculiarities of the course of arterial hypertension and other indicators of metabolic processes in patients with type 2 diabetes mellitus against the background of subclinical hypothyroidism in stationary conditions of medical care were studied. The analysis of the duration of diabetes mellitus and arterial hypertension in patients was performed. It was found that patients with type 2 diabetes mellitus in combination with arterial hypertension on the background of subclinical hypothyroidism were more often registered with the 3rd degree of severity of arterial hypertension, and more pronounced disorders of carbohydrate and lipid metabolism were noted. The adverse effect of reduced thyroid function on the course of arterial hypertension in patients with type 2 diabetes mellitus in the form of a violation of the normal daily profile and circadian rhythm of blood pressure was revealed.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):25-27
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HYPERTENSION AND SLEEP DISORDERS: FROM FEATURES TO RELATIONSHIPS
Rezova N.V., Budnevsky A.V.
Abstract
The article presents the results of a clinical study devoted to the study of the features of arterial hypertension in patients with sleep disorders. In addition, the study analyzed the relationship between sleep disorders and the course of arterial hypertension in the subjects. It was found that in patients, the sleep quality index, determined using the Pittsburgh questionnaire (the Pittsburgh Sleep Quality Index (PSQI)), is significantly associated with the number of patient visits to a specialist, calls to emergency medical teams, the degree of hypertension and its duration. Based on the results obtained, it was concluded that arterial hypertension can have a pronounced negative impact on the quality of patients ' sleep.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):28-30
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CLINICAL AND PATHOGENETIC VALUE OF NEUROPEPTIDE Y IN PATIENTS WITH BRONCHIAL ASTHMA
Shkatova Y.S., Budnevsky A.V., Tribuntseva L.V., Prozorova G.G.
Abstract
Bronchial asthma is a widespread disease that leads to poor quality of life and disability; this disease affects 300 million people worldwide. In recent years, interest has arisen in the nature of the relationship between neuropeptide Y (NPY) and asthma, since certain NPY genotypes are associated with asthma, NPY Y1 receptors are likely to play an important role in allergic airway inflammation, and during exacerbations of asthma, NPY levels can rise. Thus, the aim of the study was to identify the relationship between the level of neuropeptide Y and the features of the clinical course of asthma.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):31-33
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PECULIARITIES OF THE QUALITY OF LIFE IN PATIENTS WITH BRONCHIAL ASTHMA AND OSTEOARTHRITIS
Ivanchuk Y.S., Budnevsky A.V., Tribuntseva L.V., Prozorova G.G.
Abstract
Osteoarthritis is a severe chronic disease that can lead to disability. It is assumed that osteoarthritis occurs in patients with bronchial asthma more often than in chronic obstructive pulmonary disease and in the general population. The aim of the study was to analyze the effect of osteoarthritis on the quality of life of patients with bronchial asthma using the SF-36 questionnaire.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):34-36
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ANALYSIS OF ARTERIAL HYPERTENSION IN PATIENTS AT THE OUTPATIENT STAGE
Grevtseva T.V., Khanina E.A., Dobrynina I.S., Zuikova A.A.
Abstract
The analysis of outpatient records of patients with high blood pressure was carried out.it was found that 144 patients had an increase in blood pressure, and later they were divided into two equal groups by gender. As a result, it was determined that persons with high blood pressure prevailed in the 1st group of 98 people, among whom hypertension of the 1st degree was more common - 73 patients than other degrees, the leading risk factor among people with arterial hypertension of 1 and 2 degrees in both groups was abdominal obesity, although other risk factors were present in both groups, women are more committed to the treatment of their disease than men, 44 people among men know that they have high blood pressure, but only 12 people take drugs, and women 18 people know about high blood pressure, take drugs - 14 people.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):37-39
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MODERN ALGORITHMS FOR TREATMENT OF COPD IN THE GENERAL PRACTITIONER
Prozorova G.G., Fateeva O.V., Kozhevnikova S.A., Budnevsky A.V., Yuryeva M.Y.
Abstract
We studied the issues of modifying the treatment of patients with chronic obstructive disease (COPD) in order to achieve disease control, prevention of exacerbations, taking into account the concomitant pathology. It is shown that the use of algorithms for starting therapy and its modification in accordance with the Federal recommendations for COPD, depending on the phenotype, serves as an effective tool for controlling symptoms and provides prevention of exacerbations of the disease. The optimal effect was obtained by using a complex personalized approach with the definition of COPD phenotype, vaccination and rehabilitation.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):40-42
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MIKOGENNY SENSITIZATION IN PATIENTS WITH BRONCHIAL ASTHMA
Pozdnyakova O.Y., Baida A.P.
Abstract
Complex laboratory examination of 96 patients with bronchial asthma is conducted. At patients, determined very high and high levels of specific IgE and IgG to various fungoid allergens are defined. Most clinically, the significant fungoid sensitization was noted at patients with heavy bronchial asthma.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):43-46
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INFLUENCE OF TEMPORARY DISABILITY ON THE FORMATION OF ANXIETY AND DEPRESSIVE DISORDERS
Popova I.A., Khanina E.A., Dobrynina I.S., Zuikova A.A.
Abstract
In this research paper, the relationship of loss of temporary working capacity to the formation of anxiety and depressive disorders at the outpatient level was determined. The analysis revealed that cases of temporary disability in the exacerbation of chronic diseases are common, among them diseases of the gastrointestinal tract and musculoskeletal system took the leading position, it was determined that the average level of personal anxiety (36.25 points) and reactive (situational) anxiety (34.0 points) prevailed in the subjects, 10 patients had a high level of reactive anxiety and 3 patients had personal anxiety, which indicates anxiety and discomfort, which occurs in patients when they are on a temporary disability sheet, with the average age of patients with a high level of reactive anxiety being 40 years.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):47-49
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NON-DRUG TREATMENT OF OBESITY BASED ON THE TYPE OF EATING BEHAVIOR
Esina M.V., Esina E.Y., Zuikova A.A.
Abstract
In the conditions of outpatient practice, the study of types of eating behavior in obese patients was carried out. The study included 53 out-patient patients aged 18 to 59 years, 24 (45%) men and 29 (55%) women. The division into three groups was carried out taking into account the values of the body mass index (BMI). The first group was formed from respondents with normal BMI values-22.5 [21.9; 23.3] kg / m2, aged 36.2±15.7 years. Patients with overweight and grade I obesity left the second and third groups, respectively. BMI in the second (mean age 36.75±12.66 years) and third (mean age 43.40±10.27 years) groups reached: 27.42 [26.15; 28.50] kg / m2 and 32.20 [30.50; 56.10] kg/m2, respectively. The DEBQ score (restrictive type) in patients of the third group was 2.10 [1.60; 2.40], reflecting their uncontrolled food consumption and lack of food restrictions. Thus, to improve the effectiveness of treatment of obesity, it is necessary to take into account and correct the type of eating behavior of the patient.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):50-52
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PATHOLOGICAL CHARACTERISTICS OF SEASONAL MORTALITY RATES OF PATIENTS IN THE CITY MULTIDISCIPLINARY HOSPITAL
Malykhin F.T.
Abstract
Seasonal aspects of mortality from the main types of diseases in urban multi-specialty hospitals were studied. The study was conducted on the basis of data on the results of 2 345 pathoanatomic autopsies on the basis of the specialized Department of the emergency hospital in the period from 2012 to 2016. the distribution of autopsies by season, age groups, prevalence of pathology of the main organs and body systems, and gender factor was Analyzed. The presence of seasonal rhythms of total mortality with a maximum in the summer-autumn period, and a minimum in the spring period was established. The most common cause of death in hospital was cardiovascular disease. Patients and clinicians should be aware of the increased risks of seasonal exacerbations and deaths to enable appropriate disease management strategies to be implemented.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):53-55
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THE QUESTIONS OF PSYCHOLOGY AND PSYCHOSOMATICS IN THE TRAINING OF GENERAL PRACTITIONERS (FAMILY DOCTORS) IN POSTGRADUATE AND ADDITIONAL PROFESSIONAL EDUCATION
Baranov A.A., Aksenfeld R.G., Kolinko A.A., Savelyeva L.A.
Abstract
The methodological issues of training of general practitioners (family doctors) are considered in the article in the order to prevent emotional burnout syndrome. Professional activity involves a high percentage of factors causing stress. The result is burnout syndrome. Psychological mental overwork, dissatisfaction with the profession, low level of financial and social well-being, accumulated negative emotions require the prevention of burnout and neurotic and psychosomatic disorders in doctors. In addition, without obtaining professional communicative, mediative, psychosomatic and psychotherapeutic competencies, our graduate will not become a professional and will acquire burnout. Timely identification of the initial signs of burnout syndrome helps to maintain the personal and professional potential of physicians. Burnout syndrome prevention involves reinforcing professional skills and right responding to emotional stress. We have proposed conducting the Balint groups as a method for the burnout syndrome prevention. We recommend to include Balint groups in the residency programm.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):56-59
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DYNAMICS OF KNOWLEDGE OF SURGICAL DOCTORS IN THE FIELD OF NOSOCOMIAL INFECTIONS ON THE BACKGROUND OF TRAINING EVENTS AND THEIR IMPACT ON MORBIDITY
Bontsevich R.A., Adonina A.V.
Abstract
Тhe article presents the results of two stages of a survey of surgical doctors on the management of patients with nosocomial infections (NI), conducted in 2001-2003 during the work of one of the authors in the city of Dnepropetrovsk [1]. Between the stages of the survey, educational activities were carried out for 1.5 years to improve the level of knowledge of respondents, which led to a significant increase in the competence of doctors and a decrease in the incidence of nosocomial pneumonia (NP).
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):60-62
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PHYSICIANS’ KNOWLEDGE ON TREATMENT OF ARTERIAL HYPERTENSION IN THE BELGOROD REGION
Vovk Y.R., Gavrilova A.A., Osipova O.A., Pokrovskaia T.G.
Abstract
Arterial hypertension (AH) is one of the most common chronic non-infectious diseases. The speed of this pathology’s progression, as well as the patient’s quality of life depends on the correct actions of the doctor. This article presents the results of an anonymous survey in the framework of the multicenter study PHYSTARH for 2017-2019. The questionnaire dealt with different aspects of hypertension, but in this article we analyzed questions about the 5 main classes of antihypertensive drugs and the benefits of combination therapy. The results of our study showed an insufficient level of physicians’ knowledge in Belgorod region on the treatment of arterial hypertension. Therefore, there is a need for additional educational activities to improve the knowledge of doctors in the treatment of this pathology.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):63-65
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TEACHING TEMPORARY DISABILITY EXAMINATION AS A FORM OF MEDICAL EXPERTISE TO ATTENDING PHYSICIANS
Ivanova G.N., Burlachuk V.T., Tribuntseva L.V., Kozhevnikova S.A.
Abstract
The article focuses on the relevance of including temporary disability examination when teaching attending physicians, who carry out expertise of temporary disability. The conclusion of the article is based on the results of the questionnaires filled by attending physicians who took a retraining course at the Department of internal medicine .
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):66-69
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KNOWLEDGE OF PHYSICIANS OF THERAPEUTIC PROFILE ON ISSUES OF DIAGNOSTIC SIGNIFICANCE OF ADMINISTRATION OF SAT AND mMRC SCALES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Shershneva A.S., Prozorova G.G., Osipova O.A., Pokrovskaia T.G.
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading respiratory diseases. The speed of its progression, as well as the quality of life of patients, depends on the correct actions of the doctor. The article analyzes the results of an anonymous survey of doctors of the Voronezh and Belgorod regions in the framework of the 2nd phase of the multicenter study ASCO (project-Assessment of Senior Medical Students (Physicians) in the Field of COPD) for 2017-2019. In the application of modern CAT and mMRC scales in working with patients with COPD. The results of the study showed an insufficient level of knowledge of therapists on the diagnosis of COPD.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):70-72
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COMMUNITY-ACQUIRED PNEUMONIA: ASSESSMENT OF THE KNOWLEDGE OF DOCTORS
Prozorova G.G., Budnevsky A.V., Tribuntseva L.V., Kozhevnikova S.A., Yurieva M.Y.
Abstract
Within the framework of the multi - center study "KNOCAP" (full name of the project "The assessment of physicians' knowledge ofcommunity- acquired pneumonia basics"), an anonymous survey was conducted to assess the knowledge of doctors of the therapeutic profile of the Voronezh region in the pharmacotherapy of community-acquired pneumonia (VP), for which an original questionnaire was developed based on clinical recommendations. To help doctors, a remote training program “community-Acquired pneumonia” was developed on the Moodle platform. The results of the survey before and after the training of doctors for this program are presented.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):73-75
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ANALYSIS OF THE KNOWLEDGE OF PRIMARY DOCTORS DOCTORS FOR MANAGEMENT OF PATIENTS WITH HOSPITAL PNEUMONIA
Prozorova G.G., Budnevsky A.V., Olysheva I.A., Burlachuk V.T.
Abstract
An anonymous survey of physicians in the Tambov region was conducted using a questionnaire based on guidelines, which evaluated knowledge of managing patients with pneumonia as part of the multicenter study “KNOCAP” (“The assessment of physicians' knowledge of community- acquired pneumonia basics”) . To study the issues of prevention, diagnosis and treatment of pneumonia, the distance course “Review of guidelines “Pneumonia” was developed and posted on the Moodle. The results of the survey were analyzed before and after distance training.
Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2020;(81):76-78
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