Осведомленность врачей-терапевтов и врачей общей практики о гепатите С. Результаты опроса
Осведомленность врачей-терапевтов и врачей общей практики о гепатите С. Результаты опроса
Сагалова О.И., Синеглазова А.В. Осведомленность врачей-терапевтов и врачей общей практики о гепатите С. Результаты опроса. Терапевтический архив. 2020; 92 (11): 5–12. DOI: 10.26442/00403660.2020.11.000664
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Аннотация
Цель. Для потенциального совершенствования диагностики и терапии хронического гепатита С в рамках настоящего исследования проведена оценка информированности врачей-терапевтов и врачей общей практики Челябинска и Челябинской области о проблеме гепатита С.
Материалы и методы. В рамках областной научно-практической конференции «Мультидисциплинарные вопросы семейной медицины» 19 мая 2018 г. проведено одномоментное сплошное исследование осведомленности врачей-терапевтов и врачей общей практики о вирусе гепатита С (ВГС)-инфекции. Для опроса использована анкета, состоявшая из 12 вопросов, разработанная О.И. Сагаловой. Опрошены 78 врачей Челябинска и Челябинской области, в том числе 20,52% (n=16) опрошенных представляли медицинские организации городских округов Челябинской области, 39,74% (n=31) – медицинские организации муниципальных районов Челябинской области, 39,74% (n=31) – медицинские организации Челябинска.
Результаты. Проведенный опрос выявил пробелы в знаниях врачей первичного звена по вопросам естественного течения, диагностики, внепеченочных проявлений ВГС-инфекции и современной противовирусной терапии. Результаты исследования свидетельствуют о недостаточном понимании врачами тактики ведения пациентов с ВГС-инфекцией и подчеркивают необходимость совершенствования междисциплинарного взаимодействия между инфекционистами, врачами первичного звена, врачами других специальностей, в том числе разработки и внедрения образовательных мероприятий для врачей-неинфекционистов.
Заключение. Результаты свидетельствуют о необходимости повышения образованности врачей в вопросах диагностики и ведения пациентов с ВГС и включения вопросов скрининга на наличие ВГС-инфекции в клинические рекомендации отдельных хронических неинфекционных заболеваний в рамках первичного обследования.
Ключевые слова: гепатит С, терапевты, врачи общей практики, диагностика, терапия, мультидисциплинарность.
Materials and methods. A continuous study of hepatitis C virus (HCV) awareness among therapists and GPs was conducted within the framework of the regional research-to-practice conference Multidisciplinary Issues of Family Medicine on May 19, 2018. 78 questionnaires have been distributed. Thus, 78 therapists from different districts of Chelyabinsk Oblast took part in the study. For these purposes, a questionnaire of 12 questions developed by Olga I. Sagalova was used. The study involved 78 therapists from different districts of Chelyabinsk Oblast. 20.52% (n=16) of respondents were from the healthcare institutions (HCI) of urban districts of Chelyabinsk Oblast, 39.74% (n=31) were from the HCIs of municipal districts of Chelyabinsk Oblast, and 39.74% (n=31) from the HCIs of the city of Chelyabinsk.
Results. The survey revealed certain gaps in therapists’ awareness of the natural course of the disease, diagnosis, routing, the natural course of HCV infection, as well as its extrahepatic manifestations. The survey results indicate a lack of understanding among physicians and therapists of tactics for managing patients with HCV infection and emphasize the need to improve interdisciplinary interaction between infectious disease specialists, primary care doctors and doctors of other specialties including the development and implementation of an educational strategy for non-infectious disease doctors.
Conclusion. The results indicate the needs to increase the level of education among doctors in the diagnosis and management of patients with HCV in accordance with guidelines and to include screening for HCV infection in the guidelines for selected chronic non-communicable diseases as part of the initial examination.
Keywords: hepatitis C, therapists, general practitioners (GP), diagnosis, treatment, multidisciplinary approach.
Материалы и методы. В рамках областной научно-практической конференции «Мультидисциплинарные вопросы семейной медицины» 19 мая 2018 г. проведено одномоментное сплошное исследование осведомленности врачей-терапевтов и врачей общей практики о вирусе гепатита С (ВГС)-инфекции. Для опроса использована анкета, состоявшая из 12 вопросов, разработанная О.И. Сагаловой. Опрошены 78 врачей Челябинска и Челябинской области, в том числе 20,52% (n=16) опрошенных представляли медицинские организации городских округов Челябинской области, 39,74% (n=31) – медицинские организации муниципальных районов Челябинской области, 39,74% (n=31) – медицинские организации Челябинска.
Результаты. Проведенный опрос выявил пробелы в знаниях врачей первичного звена по вопросам естественного течения, диагностики, внепеченочных проявлений ВГС-инфекции и современной противовирусной терапии. Результаты исследования свидетельствуют о недостаточном понимании врачами тактики ведения пациентов с ВГС-инфекцией и подчеркивают необходимость совершенствования междисциплинарного взаимодействия между инфекционистами, врачами первичного звена, врачами других специальностей, в том числе разработки и внедрения образовательных мероприятий для врачей-неинфекционистов.
Заключение. Результаты свидетельствуют о необходимости повышения образованности врачей в вопросах диагностики и ведения пациентов с ВГС и включения вопросов скрининга на наличие ВГС-инфекции в клинические рекомендации отдельных хронических неинфекционных заболеваний в рамках первичного обследования.
Ключевые слова: гепатит С, терапевты, врачи общей практики, диагностика, терапия, мультидисциплинарность.
________________________________________________
Materials and methods. A continuous study of hepatitis C virus (HCV) awareness among therapists and GPs was conducted within the framework of the regional research-to-practice conference Multidisciplinary Issues of Family Medicine on May 19, 2018. 78 questionnaires have been distributed. Thus, 78 therapists from different districts of Chelyabinsk Oblast took part in the study. For these purposes, a questionnaire of 12 questions developed by Olga I. Sagalova was used. The study involved 78 therapists from different districts of Chelyabinsk Oblast. 20.52% (n=16) of respondents were from the healthcare institutions (HCI) of urban districts of Chelyabinsk Oblast, 39.74% (n=31) were from the HCIs of municipal districts of Chelyabinsk Oblast, and 39.74% (n=31) from the HCIs of the city of Chelyabinsk.
Results. The survey revealed certain gaps in therapists’ awareness of the natural course of the disease, diagnosis, routing, the natural course of HCV infection, as well as its extrahepatic manifestations. The survey results indicate a lack of understanding among physicians and therapists of tactics for managing patients with HCV infection and emphasize the need to improve interdisciplinary interaction between infectious disease specialists, primary care doctors and doctors of other specialties including the development and implementation of an educational strategy for non-infectious disease doctors.
Conclusion. The results indicate the needs to increase the level of education among doctors in the diagnosis and management of patients with HCV in accordance with guidelines and to include screening for HCV infection in the guidelines for selected chronic non-communicable diseases as part of the initial examination.
Keywords: hepatitis C, therapists, general practitioners (GP), diagnosis, treatment, multidisciplinary approach.
Список литературы
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J Nurse Pract. 2019;15(6):415-9. doi: 10.1016/j.nurpra.2018.12.009
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6. Thrift AP, El-Serag HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol. 2017;14(2):122-32. doi: 10.1038/nrgastro.2016.176
7. Cacoub P, Comarmond C, Domont F, et al. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016;3(1):3-14. doi: 10.1177/2049936115585942
8. Ferri C, Ramos-Casals M, Zignego AL, et al., ISG-EHCV coathours. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev. 2016;15(12):114-60. doi: 10.1016/j.autrev.2016.09.006
9. Санитарно-эпидемиологические правила. СП 3.1.3112-13. Профилактика вирусного гепатита С. 2014 [Sanitary and epidemiological rules. SP 3.1.3112-13. Prevention of viral hepatitis C. 2014 (In Russ.)].
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13. McGowan CE, Monis A, Bacon BR, et al. Fried. A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care. Hepatology. 2013;57(4):1325-32. doi: 10.1002/hep.26246
14. Shiffman ML, Stewart CA, Hofmann CM, et al. Chronic Infection with Hepatitis C Virus in Patients with Elevated or Persistently Normal Serum Alanine Aminotransferase Levels: Comparison of Hepatic Histology and Response to Interferon Therapy. J Infect Dis. 2000;182(6):1595-601.
15. Inglesby TV, Rai R, Astemborski J, et al. A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use. Hepatology. 1999;29(2):590-6.
16. ФБУЗ «Центр гигиены и эпидемиологии в Челябинской области». Анализ динамики наркомании, хронического алкоголизма и алкогольных психозов по показателям социально-гигиенического мониторинга в Челябинской области за 2014 г. 2014 [Federal Budgetary Healthcare Institution "Center for Hygiene and Epidemiology in Chelyabinsk Oblast". Analysis of the dynamics of drug addiction, chronic alcoholism and alcoholic psychoses by indicators of social and hygienic monitoring in Chelyabinsk Oblast' for 2014. 2014 (In Russ.)].
17. Sturm D, Gurevitz SL, Davidson C, et al. Bane of Baby Boomers. Clin Rev. 2014;24(11):24-32.
18. Southern WN, Drainoni ML, Smith BD, et al. Physician nonadherence with a hepatitis C screening program. Qual Manag Health Care. 2014;23(1):1-9. doi: 10.1097/QMH.0000000000000007
19. Министерство здравоохранения Челябинской области. О маршрутизации взрослых пациентов с парентеральными вирусными гепатитами в Челябинской области. 2016 [Ministry of Health of Chelyabinsk Oblast'. On routing of adult patients with parentetal viral hepatitis in Chelyabinsk Oblast'. 2016 (In Russ.)].
20. Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3(2):47-52.
21. The International Liver Congress 2018 Abstract Book – EASL – The Home of Hepatology. European Association for the Study of the Liver. https://easl.eu/publication/the-international-liver-congress-2018-abstract-book/
22. Hepatitis C. Questions and Answers. CDC. https://www.cdc.gov/hepatitis/hcv/cfaq.htm
23. Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2017 году. 2018 [Kaprin AD, Starinskii VV, Petrova GV. Malignant neoplasms in Russia in 2017. 2018 (In Russ.)].
24. Axley P, Ahmed Z, Ravi S, Singal AK. Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review. J Clin Transl Hepatol. 2018;6(1):79-84. doi: 10.14218/JCTH.2017.00067
25. Mahale P, Sturgis EM, Tweardy DJ, et al. Torres. Association Between Hepatitis C Virus and Head and Neck Cancers. J Natl Cancer Inst. 2016;108(8):djw035. doi: 10.1093/jnci/djw035
26. Adinolfi LE, Nevola R, Rinaldi L, et al. Chronic Hepatitis C Virus Infection and Depression. Clin Liver Dis. 2017;21(3):517-34. doi: 10.1016/j.cld.2017.03.007
27. Drazilova S, Gazda J, Janicko M, Jarcuska P. Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy. Can J Gastroenterol Hepatol. 2018;2018:6150861. doi: 10.1155/2018/6150861
28. Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology. 2010;51(3):729-33. doi: 10.1002/hep.23561
29. Hepatitis C: Common, Deadly, and Curable. https://www.bcg.com/publications/2017/health-care-payers-providers-hepatitis-c-common-deadly-curable...
2. Gardenier D, Olson MC. Hepatitis C in 2019: Are We There Yet?
J Nurse Pract. 2019;15(6):415-9. doi: 10.1016/j.nurpra.2018.12.009
3. The Viral Hepatitis Prevention Board. Viral Hepatitis. 2011;19(1). https://www.vhpb.org/files/html/Meetings_and_publications/Viral_Hepatitis_Newsletters/vhv19n2.pdf
4. Pimenov NN, Vdovin AV, Komarova SV, et al. The relevance and prospects of introducing a uniform federal register of patients with viral hepatitis B and C in Russia. Therapeutic Archive. 2013;85(11):4-9 (In Russ.)
5. ITPCru. Long farewell. Results of monitoring the procurement of drugs for the treatment of hepatitis C in Russia in 2017. St Petersburg: Treatment Preparedness Coalition, 2018 (In Russ.)
6. Thrift AP, El-Serag HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol. 2017;14(2):122-32. doi: 10.1038/nrgastro.2016.176
7. Cacoub P, Comarmond C, Domont F, et al. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016;3(1):3-14. doi: 10.1177/2049936115585942
8. Ferri C, Ramos-Casals M, Zignego AL, et al., ISG-EHCV coathours. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev. 2016;15(12):114-60. doi: 10.1016/j.autrev.2016.09.006
9. Sanitary and epidemiological rules. SP 3.1.3112-13. Prevention of viral hepatitis C. 2014 (In Russ.)
10. Ministry of Health of the Russian Federation. Clinical guidelines. Chronic viral hepatitis C (HVHS) in adults. 2016 (In Russ.)
11. European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018;69(2):461-511. doi: 10.1016/j.jhep.2018.03.026
12. The Boston Consulting Group. Road to elimination: barriers and best practices in hepatitis C management. 2017.
13. McGowan CE, Monis A, Bacon BR, et al. Fried. A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care. Hepatology. 2013;57(4):1325-32. doi: 10.1002/hep.26246
14. Shiffman ML, Stewart CA, Hofmann CM, et al. Chronic Infection with Hepatitis C Virus in Patients with Elevated or Persistently Normal Serum Alanine Aminotransferase Levels: Comparison of Hepatic Histology and Response to Interferon Therapy. J Infect Dis. 2000;182(6):1595-601.
15. Inglesby TV, Rai R, Astemborski J, et al. A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use. Hepatology. 1999;29(2):590-6.
16. Federal Budgetary Healthcare Institution "Center for Hygiene and Epidemiology in Chelyabinsk Oblast". Analysis of the dynamics of drug addiction, chronic alcoholism and alcoholic psychoses by indicators of social and hygienic monitoring in Chelyabinsk Oblast' for 2014. 2014 (In Russ.)
17. Sturm D, Gurevitz SL, Davidson C, et al. Bane of Baby Boomers. Clin Rev. 2014;24(11):24-32.
18. Southern WN, Drainoni ML, Smith BD, et al. Physician nonadherence with a hepatitis C screening program. Qual Manag Health Care. 2014;23(1):1-9. doi: 10.1097/QMH.0000000000000007
19. Ministry of Health of Chelyabinsk Oblast'. On routing of adult patients with parentetal viral hepatitis in Chelyabinsk Oblast'. 2016 (In Russ.)
20. Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3(2):47-52.
21. The International Liver Congress 2018 Abstract Book – EASL – The Home of Hepatology. European Association for the Study of the Liver. https://easl.eu/publication/the-international-liver-congress-2018-abstract-book/
22. Hepatitis C. Questions and Answers. CDC. https://www.cdc.gov/hepatitis/hcv/cfaq.htm
23. Kaprin AD, Starinskii VV, Petrova GV. Malignant neoplasms in Russia in 2017. 2018 (In Russ.)
24. Axley P, Ahmed Z, Ravi S, Singal AK. Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review. J Clin Transl Hepatol. 2018;6(1):79-84. doi: 10.14218/JCTH.2017.00067
25. Mahale P, Sturgis EM, Tweardy DJ, et al. Torres. Association Between Hepatitis C Virus and Head and Neck Cancers. J Natl Cancer Inst. 2016;108(8):djw035. doi: 10.1093/jnci/djw035
26. Adinolfi LE, Nevola R, Rinaldi L, et al. Chronic Hepatitis C Virus Infection and Depression. Clin Liver Dis. 2017;21(3):517-34. doi: 10.1016/j.cld.2017.03.007
27. Drazilova S, Gazda J, Janicko M, Jarcuska P. Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy. Can J Gastroenterol Hepatol. 2018;2018:6150861. doi: 10.1155/2018/6150861
28. Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology. 2010;51(3):729-33. doi: 10.1002/hep.23561
29. Hepatitis C: Common, Deadly, and Curable. https://www.bcg.com/publications/2017/health-care-payers-providers-hepatitis-c-common-deadly-curable...
2. Gardenier D, Olson MC. Hepatitis C in 2019: Are We There Yet?
J Nurse Pract. 2019;15(6):415-9. doi: 10.1016/j.nurpra.2018.12.009
3. The Viral Hepatitis Prevention Board. Viral Hepatitis. 2011;19(1). https://www.vhpb.org/files/html/Meetings_and_publications/Viral_Hepatitis_Newsletters/vhv19n2.pdf
4. Пименов Н.Н., Вдовин А.В., Комарова С.В. и др. Актуальность и перспективы внедрения в России единого федерального регистра больных вирусными гепатитами В и С. Терапевтический архив. 2013;85(11):4-9 [Pimenov NN, Vdovin AV, Komarova SV, et al. The relevance and prospects of introducing a uniform federal register of patients with viral hepatitis B and C in Russia. Therapeutic Archive. 2013;85(11):4-9 (In Russ.)].
5. ITPCru. Долгие проводы. Результаты мониторинга закупок препаратов для лечения гепатита С в России в 2017 году. Санкт-Петербург: Коалиция по готовности к лечению, 2018 [ITPCru. Long farewell. Results of monitoring the procurement of drugs for the treatment of hepatitis C in Russia in 2017. St Petersburg: Treatment Preparedness Coalition, 2018 (In Russ.)]
6. Thrift AP, El-Serag HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol. 2017;14(2):122-32. doi: 10.1038/nrgastro.2016.176
7. Cacoub P, Comarmond C, Domont F, et al. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016;3(1):3-14. doi: 10.1177/2049936115585942
8. Ferri C, Ramos-Casals M, Zignego AL, et al., ISG-EHCV coathours. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev. 2016;15(12):114-60. doi: 10.1016/j.autrev.2016.09.006
9. Санитарно-эпидемиологические правила. СП 3.1.3112-13. Профилактика вирусного гепатита С. 2014 [Sanitary and epidemiological rules. SP 3.1.3112-13. Prevention of viral hepatitis C. 2014 (In Russ.)].
10. Министерство здравоохранения РФ. Клинические рекомендации. Хронический вирусный гепатит С (ХВГС) у взрослых. 2016 [Ministry of Health of the Russian Federation. Clinical guidelines. Chronic viral hepatitis C (HVHS) in adults. 2016 (In Russ.)].
11. European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018;69(2):461-511. doi: 10.1016/j.jhep.2018.03.026
12. The Boston Consulting Group. Road to elimination: barriers and best practices in hepatitis C management. 2017.
13. McGowan CE, Monis A, Bacon BR, et al. Fried. A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care. Hepatology. 2013;57(4):1325-32. doi: 10.1002/hep.26246
14. Shiffman ML, Stewart CA, Hofmann CM, et al. Chronic Infection with Hepatitis C Virus in Patients with Elevated or Persistently Normal Serum Alanine Aminotransferase Levels: Comparison of Hepatic Histology and Response to Interferon Therapy. J Infect Dis. 2000;182(6):1595-601.
15. Inglesby TV, Rai R, Astemborski J, et al. A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use. Hepatology. 1999;29(2):590-6.
16. ФБУЗ «Центр гигиены и эпидемиологии в Челябинской области». Анализ динамики наркомании, хронического алкоголизма и алкогольных психозов по показателям социально-гигиенического мониторинга в Челябинской области за 2014 г. 2014 [Federal Budgetary Healthcare Institution "Center for Hygiene and Epidemiology in Chelyabinsk Oblast". Analysis of the dynamics of drug addiction, chronic alcoholism and alcoholic psychoses by indicators of social and hygienic monitoring in Chelyabinsk Oblast' for 2014. 2014 (In Russ.)].
17. Sturm D, Gurevitz SL, Davidson C, et al. Bane of Baby Boomers. Clin Rev. 2014;24(11):24-32.
18. Southern WN, Drainoni ML, Smith BD, et al. Physician nonadherence with a hepatitis C screening program. Qual Manag Health Care. 2014;23(1):1-9. doi: 10.1097/QMH.0000000000000007
19. Министерство здравоохранения Челябинской области. О маршрутизации взрослых пациентов с парентеральными вирусными гепатитами в Челябинской области. 2016 [Ministry of Health of Chelyabinsk Oblast'. On routing of adult patients with parentetal viral hepatitis in Chelyabinsk Oblast'. 2016 (In Russ.)].
20. Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3(2):47-52.
21. The International Liver Congress 2018 Abstract Book – EASL – The Home of Hepatology. European Association for the Study of the Liver. https://easl.eu/publication/the-international-liver-congress-2018-abstract-book/
22. Hepatitis C. Questions and Answers. CDC. https://www.cdc.gov/hepatitis/hcv/cfaq.htm
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24. Axley P, Ahmed Z, Ravi S, Singal AK. Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review. J Clin Transl Hepatol. 2018;6(1):79-84. doi: 10.14218/JCTH.2017.00067
25. Mahale P, Sturgis EM, Tweardy DJ, et al. Torres. Association Between Hepatitis C Virus and Head and Neck Cancers. J Natl Cancer Inst. 2016;108(8):djw035. doi: 10.1093/jnci/djw035
26. Adinolfi LE, Nevola R, Rinaldi L, et al. Chronic Hepatitis C Virus Infection and Depression. Clin Liver Dis. 2017;21(3):517-34. doi: 10.1016/j.cld.2017.03.007
27. Drazilova S, Gazda J, Janicko M, Jarcuska P. Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy. Can J Gastroenterol Hepatol. 2018;2018:6150861. doi: 10.1155/2018/6150861
28. Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology. 2010;51(3):729-33. doi: 10.1002/hep.23561
29. Hepatitis C: Common, Deadly, and Curable. https://www.bcg.com/publications/2017/health-care-payers-providers-hepatitis-c-common-deadly-curable...
Авторы
О.И. Сагалова1, А.В. Синеглазова2
1 ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск, Россия;
2 ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия
1 South Ural State Medical University, Chelyabinsk, Russia;
2 Kazan State Medical University, Kazan, Russia
1 ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск, Россия;
2 ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия
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1 South Ural State Medical University, Chelyabinsk, Russia;
2 Kazan State Medical University, Kazan, Russia
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