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A Community Pharmacy

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					                                      A Community Pharmacy

        A pharmacy is a place where medicines are compounded and dispensed. There are
different terms applied to this place: in the UK, for example, people call it a chemist's shop, in
the USA - a drugstore. Nowadays a pharmacy has become a multi-functional institution where
one can buy not only various medications, but also medical devices and appliances, cosmetics,
candies, troches and even bath accessories.
        In every city, there are two types of pharmacies: an average pharmacy and one, which is
open after normal closing hours or on holidays (the so called ―Pharmacy on duty‖).
        In an average community pharmacy, there are two departments: a non-prescription
department with a self-service form of catering, where one can have some medicines right away,
and a prescription department, where medicaments such as ointments, tinctures, and lotions must
be ordered beforehand. All the pharmaceuticals can be divided into prescription and over-the-
counter (OTC) ones. A prescription pharmaceutical can be dispensed only with a prescription or
an order for medication.
        A working day at a state pharmacy usually starts at 8 a.m. and lasts until 7 or 8 p.m.
Several consultant pharmacists work here. Every pharmacist has a number of professional
responsibilities such as patient education and counseling, recognition, prevention and
management of drug interactions, dosage adjustment, preventive services, etc. Therefore, a
registered pharmacist must possess skills, knowledge and understanding of basic principles,
which allow him to dispense safe, accurate and appropriate drugs for the customers.
        Nowadays, prescription medications may be dispensed to customers only by a registered
pharmacist. Usually, the procedure of dispensing is the following:
        -   a patient presents the prescription to a pharmacist or a technician;
        -   if the drug is available at the moment, the pharmacist consults the patient on its
            directions for use, dosage, contraindications and side effects.
In case a customer presents a prescription for compounding a medication, the technician makes
sure if all the ingredients are available.
       For compounding medications, a community pharmacy must have proper equipment such
as a hot plate, a sink, an autoclave, electric mixers, special containers for packaging, funnels and
beakers of various sizes, filter paper, etc.
Compounding of any prescription medicament and dispensing of drugs is controlled by the state
board of pharmacy.
    Essential vocabulary to the text:
1. to compound – готовить по прописи
2. to dispense – отпускать (товар)
3. a multifunctional institution – многофункциональное заведение
4. medical devices and appliances – медицинские приборы и оборудование
5. troches – леденцы
6. average – обычный, стандартный
7. catering – обслуживание
8. right away – сразу
9. ointment – мазь
10. tincture – настойка
11. lotion – лосьон
12. beforehand – заранее
13. a pharmaceutical – фармацевтический препарат
14. over-the-counter (OTC)– безрецептурный
15. patient education and counseling – обучение пациентов и предоставление
    консультаций
16. recognition, prevention and management of drug interactions – распознавание,
    предотвращение и лечение последствий лекарственных взаимодействий
17. dosage adjustment – установление дозировки
18. preventive service – профилактическая служба
19. a registered pharmacist – лицензированный фармацевт
20. a technician – техник, младший персонал в аптеке
21. be available- иметься в наличии
22. directions for use, dosage, contraindications and side effects – указания по
    применению, дозировка, противопоказания и побочные эффекты
23. proper equipment – надлежащее оборудование
24. a hot plate – нагревательная плита
25. a sink – раковина
26. an autoclave – автоклав
27. funnels – воронки
28. beakers –мензурки
29. filter paper – фильтровальная бумага
30. compounding – изготовление лекарства
31. the state board of pharmacy – государственный совет по вопросам фармации
                             «Chelyabinsk state medical academy»

                    Эта тема составляется студентами самостоятельно
                          с использованием следующей лексики:

1.    Academy: to enter the Academy; to be admitted to the Ac;
2.    to study at the Academy; to graduate from the Ac.
3.    to be founded (on the 1st of July 1944)
4.    The Medical Faculty; the Pediatric Faculty (1970);
5.    The Nurse's Faculty (1996); stomatologic F; medico-prophylactic F.
6.    Department (49); the Head of the Department; Anatomy Department;
      Department of Foreign Languages; Surgery Department etc.
7.    to be located (the main building of the Academy; the Morphological
      building)
8.    Central Research Laboratory (1978)
9.    The staff of the Institute includes teachers, clinicians and scientific
      investigators.
10.   Subjects: general, clinical, pre-clinical, theoretical.
11.    A first-year curriculum includes.
12.    to attend post-graduate courses
13.    a first (second, third) year student, a Junior student, a senior student, a post-graduite
      student, a fellow-student.
14.    Higher School; to get a higher education
15.    to complete subinternship
16.    a general practitioner
17.    to work in the field of
18.    to be a member of students Scientific Society


Для того чтобы составить тему, вы можете опираться на следующие вопросы:

1. Where do you study at?
2. Where is it located? How many buildings does your Academy occupy?
3. How many faculties are there in your Academy? What faculty are you
    in?
4. Who         is     the     Head     of    Anatomy    (Chemistry,   Physics, Biochemistry)
    Department?
5. Who is the Rector of the Academy?
6. What can you say about the Staff of the Academy?
7. How many departments has the Academy?
8. When did you enter the Medical Academy?
9. When will you graduate from the Academy?
10. Is it difficult to get a higher medical education?
11. What subjects does a first-year curriculum include?
12. In what 3 main clinical subjects do students get more experience?
13. Haw many years does the course of studies last?
                               DIAGNOSTIC PROCEDURES

Throughout the 20th century the quality of medical care has been transformed. Diagnosis of
medical conditions has been enhanced by ultrasound, computerized axial tomography (CAT,
or CT), magnetic resonance imaging (MRI), and the endoscope. Nuclear Medicine is a
medical specialty that uses radioactive substances combined with imaging techniques.

Nuclear medicine is considered pain-free, safer and more cost-effective than many other
treatments, such as surgery or chemotherapy. It is used to diagnose and treat injury or disease,
such as sports injuries, heart disease, cancer, and other diseases.

In the 1970s magnetic resonance imaging (MRI) technology transformed the field of nuclear
medicine. In current medical practice, MRI is preferred for detecting the narrowing of blood
vessels. It can show the spread of cancer cells to bone and a degenerative brain disorder.

To produce an image, a patient is given (by mouth or injection) a radioactive substance that is
chemically drawn to the site of the problem—a specific organ, bony structure, or tissue. MRI is
risk free except for patients with cardiac pacemakers or patients with inner ear transplants.

Computed Tomography (CT) is a medical technology that uses X- rays and computers to
produce three-dimensional images of the human body. Doctors analyze the detailed views of
the body's soft tissues, such as blood vessels, muscle tissue, organs, the brain. CT is also
commonly used to diagnose disorders involving the chest, abdomen, spine, and pelvis. CT
may be used to determine the location and size of a cancerous tumor. The patient may be
asked to drink a liquid that makes internal organs more clearly visible in the CT scan.

Another medical diagnostic technique is Ultrasound Imaging, in which very high
frequency sound is directed into the body. Ultrasound can be used to examine many parts
of the body, the best application is in obstetrics. It is used to diagnose both the age and health
of the developing fetus. It is used to detect tumors, damage, or abnormalities in the liver,
kidney, ovaries, eyes, and other organs.

Ultrasound examination of the heart is known as echocardiography. Echocardiography is used
to study congenital heart disease, coronary artery disease, tumors of the heart and other
cardiac disorders. Doppler ultrasound is used to measure the flow of a liquid, for example
blood flow.
Vocabulary:

  1. To be enhanced by ... - улучшаться . . . .
  2. Ultrasound - ультразвук
  3. computerized axial tomography (CAT, or CT) - компьютерная томография
  4. magnetic resonance imaging (MRI) - ядерно-магнитно-резонансная томография
(магнитный резонанс, ядерный магнитный резонанс, магнитная резонансная [магнитно-
резонансная] томография, ядерно-спиновая томография, ЯМР-интроскопия, ЯМР-
томография)
  5. nuclear medicine - ядерная медицина
  6. to be considered pain-free - считаться безболезненным
  7. cost-effective – недорогостоящий, экономный
  8. to produce an image - чтобы сделать снимок, изображение
  9. to draw to the site of the problem— вводить в проблемное место
  10. except for - за исключением
  11. cardiac pacemaker - электронный стимулятор сердца, водитель ритма
  12. Х- rays - рентгеновские лучи
  13. three-dimensional images - трѐхмерные изображения
  14. to determine a cancerous tumor - выявить раковую опухоль
  15. more clearly visible in ...- более четко видны при...
  16. high frequency sound - звук высокой частоты
  17. fetus – плод
  18. to study congenital disease - изучить врожденное заболевание
                                    Environmental Medicine.



   A man can live without food for weeks and without water for days, but he can live without
air for only a few minutes. Accordingly, air is the most vital resource. In the last few decades
contamination is producing concentrations that are harmful to men, animals and plants.
   Besides man's activities are reducing the world supply of green plants which are the only
sources of oxygen.
   The problem of air pollution is of great social importance. Russia scientists have established
that there is a definite correlation between the degree of air pollution and rates of incidence and
death from bronchitis, pneumonia and lung cancer.
   Water pollution is considered to be perhaps an ever greater hazard to health than air pollution.
Water pollution means contamination of surface or ground water supplies by sewage industrial
wastes or garbage and other refuse. Water pollution becomes not only an esthetic problem for
men but an economic and medical one as well. Bacterial and viral contamination is a threat for
the spread of waterborne diseases such as typhoid, shigellosis or bacillary dysentery, amoebic
dysentery, cholera and hepatitis.
   One of the more recently "discovered" pollutants in the modern environment is noise. For the
city dweller noise may be the most significant environmental pollutant. He is constantly buffeted
by the noise of aircrafts, trains, motorcycles, buses, machinery when he is at home and at work.
Noise can cause the heart to beat rapidly, the blood vessels to constrict, the pupils to dilate, and
the stomach, esophagus, and intestines to be seized by spasm. Noise puts our nerves "on edge" so
that our personal relationships are strained and often explosive, it interferes with our
concentration and impairs the efficient functioning of our minds.
   Vast radioactive contamination has become a global ecological problem. During four decades
of nuclear materials production and processing in the Mayak nuclear plant millions of tons of
radioactive wastes were discharged into local rivers and lakes/ In 1957 after a nuclear accident in
Kyshtym radioactive substances were emitted into the atmosphere. In 1967 there was an accident
at the same nuclear plant and it means that the same areas suffered from contamination once
again. Epidemiological studies of the exposed population showed increased morbidity rate in
leukemia and other oncologic conditions as well as other communicable and non-communicable
diseases.
                                  Vocabulary:

1. the most vital resource – главный жизненный источник
2. contamination – загрязнение
3. man's activities – деятельность человека
4. the only source - единственный источник
5. correlation – взаимосвязь, соотношение
6. surface or ground water – поверхностные и грунтовые воды
7. sewage – сточные воды
8. industrial wastes – отходы промышленного производства
9. garbage – отбросы, гниющий мусор
10. refuse – отбросы, остатки, мусор
11. waterborne diseases – заболевание, передающиеся через воду
12. dweller – житель, обитатель
13. buffet – удар, наносить удары, ударять
14. pupil- зрачок
15. dilate- расширяться
16. strain – натяжение, распад, раскол
17. explosive – взрывчатый, вспыльчивый
18. interfere – вмешиваться, мешать чему-либо
19. nuclear - ядерный
20. accident – авария
21. emit – выбрасывать
22. exposed pollution – (здесь облученное население)
23. morbidity rate – заболеваемость (уровень)
24. communicable disease – инфекционное заболевание
                          International cooperation in medicine


International cooperation in medicine is very important because there are medical problems
that individual countries cannot solve by themselves. For example, control of such
communicable diseases as hepatitis, ТВ, influenza or AIDS, or development of methods to
eradicate some non-communicable diseases, which are considered killers number I
nowadays. They are cardiovascular diseases, oncological conditions, chronic respiratory
diseases, diabetes and so on.

To coordinate all these issues World Health Organization (WHO) was founded in 1948. Now
about 180 countries are the members of WHO. The Headquarters is located in Geneva
(Switzerland) and the European Office of WHO is in Copenhagen (Denmark). WHO is
responsible for the world health problems.

This international organization has a number of objectives:
   • To assist government to strengthen health services
   • To provide information in the field of health
   • To promote research in the field of medicine
   • To stimulate the eradication of epidemic, endemic and other
       diseases
   • To promote improved nutrition, housing, sanitation, working
       conditions and other aspects of environmental hygiene
   • To develop international standards for biological and
       pharmaceutical products

One of the main services carried out by WHO is the service of epidemic warnings. Such
epidemic diseases as cholera and yellow fever are still a great danger in our time. WHO
informs the national health services about the outbreaks of viral diseases (for example,
SARS -sudden acute respiratory syndrome or bird flu) so that the nations could take
measures to prevent the spread of these often deadly viruses.

The responsibility for the world's health goes beyond specific disease control. It ranges from
maternal and child health care and prevention of injuries to improved financing of health
services and provision of essential drugs.

Thanks to the achievements of WHO the health status and life span of the world population
have improved.
                              United Kingdom Medical Education

        Medical education in the UK includes educational activities in training of medical
doctors, from entry-level training to continuing education of qualified specialists. Medical school
in the UK generally refers to a department within a university involved in the education of future
medical practitioners.
        Admissions:
        In the UK students usually begin their medical studies without any preliminary higher
education typically at the age of 18 or 19. Entry to British medical schools is very competitive.
The medical education takes five years which consist of 2 years of preclinical training in an
academic environment and 3 years of clinical training at a teaching hospital. Medical schools and
teaching hospitals are closely integrated.
Applications for entry into medical school are made through the Universities and Colleges
Admissions Service. Applicants are allowed to apply for four places for medical courses at
different universities. Most UK medical schools also require applicants to sit additional entrance
tests such as the United Kingdom Clinical Aptitude Test.
        Curriculum:
        Traditionally the delivery of medical education has been divided into two types: problem-
based learning (PBL) and lecture based teaching. PBL encourages the students to work in groups
(10 students) on solving clinical and ethical cases with little input from tutors in the form of
lectures. PBL was introduced into the UK medical school curriculum because medical students
were required to learn unnecessary scientific subjects instead of clinical practical ones. But there
is an opinion that PBL is more suitable for teaching graduate students as they can benefit from it
due to basic knowledge of academic subjects (Anatomy, Physiology), and unsuitable for less
able students and undergraduates.
        Traditional or Lecture-based Learning (LBL):
        More traditional courses are conducted in the form of lectures, which are divided into
preclinical or theoretical teaching (Anatomy, Physiology, and Microbiology) and clinical
teaching (communication, diagnosis, etc.). There is the need for balance between PBL and LBL.
        Graduation:
        Graduating from the medical school all students receive the Bachelor of Science Degree.
If they spend an additional year studying clinical subjects they are offered Masters Degree. After
graduation they work for another year under high supervision and cannot legally practice
independently. A doctor’s further training may include such fields as Pediatrics, Obstetrics or
General practice, etc.

Vocabulary:
   1. educational activities – образовательная деятельность
   2. entry-level training – подготовительный уровень
   3. continuing education – дополнительное образование
   4. preliminary higher education – предварительное высшее образование
   5. competitive – конкурсный
   6. academic environment – аудиторные занятия
   7. applications for entry – заявления на поступление
   8. applicant – кандидат
   9. to sit entrance tests – проходить вступительные экзамены
   10. Clinical Aptitude Test – тест на пригодность к медицинской профессии
   11. delivery of medical education – проведение обучения медицинским предметам
   12. with little input from tutors – без особой помощи со стороны преподавателей
   13. graduate students – студенты старшего курса
   14. undergraduate students – студенты
   15. Bachelor of science degree – степень Бакалавра естественных наук
   16. Masters degree – степень Магистра
   17. under high supervision – под пристальным наблюдением
                                  Medical Education in the USA


        The United States has 144 medical schools. Of those, 125 award a Doctor of Medicine
(MD) degree and 19 award a Doctor of Osteopathy (DO).
        Preparation for a career as a physician in the USA is long and demanding. It usually takes
11 years of study after high school to become a physician. The training typically includes four
years of premedical study at a college or university; four years of medical school; and three years
of advanced training in a residency. The exact length of study varies. Acceptance into a medical
school requires excellent college grades, high scores on the Medical College Admission Test
(MCAT), good letters of recommendation, and a personal interview with school officials.
        Premedical students usually take some courses in biology, chemistry, biochemistry,
mathematics and physics. Many premedical students gain practical experience by taking summer
jobs or volunteer positions in hospitals, clinics, or research laboratories.
        Education of a physician does not end with medical school graduation. New physicians
must pass an examination for a state license to practice. Many then go into postgraduate
education. MDs take a residency that lasts from one to seven years. DOs take an internship,
which may be followed by a residency. During postgraduate education, physicians treat patients
under the supervision of more experienced doctors. This postgraduate training usually takes
place in a hospital or clinic.
        To be recognized as a specialist in a particular field, a physician must pass a special
examination and become board-certified. Physicians earn a certificate from the American Board
of Medical Specialties. This organization in Atlanta, Georgia, oversees the certification process.


        New vocabulary:
  1.    to award a Doctor of Medicine (MD) degree - присуждать степень Доктора медицины
  2.    Doctor of Osteopathy (DO) degree – степень Доктора остеопатии
  3.    high school – средняя школа
  4.    premedical study – домедицинское обучение
  5.    a residency - ординатура
  6.    acceptance into a school – принятие (поступление) в школу
  7.    to require excellent grades – требовать отличных оценок
  8.    high scores – высокие баллы
  9.    to gain experience – приобретать опыт
  10.   a state license – государственная лицензия
  11.   an internship - интернатура
  12.   treat under the supervision –лечить под наблюдением
  13.   to be recognized as a specialist – быть признанным в качестве специалиста
  14.   to become board-certified – стать сертифицированным специалистом
  15.   American Board – Американский комитет
  16.   to oversee the certification process – надзирать за процессом сертифицирования
                           The National Health Service (NHS) in England



         The NHS came into being on July 5, 1948. It was designed to improve mental and
 physical health and to provide prevention, diagnosis and treatment of illnesses. Similar services
 operate in England, Scotland, Wales and Northern Ireland. Everybody in Great Britain can use the
 NHS because roost of the cost of health care is paid through general taxation and National Insurance
 system. About 97% of the whole population in G. В is using the system.

          The majority of General practitioners and specialists take part in the service. There are also
 certain hospitals which take private patients who pay the full cost of their- accommodation and
 treatment. Many overseas patients come to Britain for treatment in private hospitals, clinics and
 internationally recognized centres of medical consultancy.

        The public is free to use the NHS or private sector of the service. Professional attention of a
family doctor is available to everyone in G R Patients .may choose the doctor they wish, they may
change him Doctors have the same freedom to accept or refuse patients

          If a serious illness develops or diagnosis is difficult a doctor may call in a consultant or get
hospital treatment for his patients. Distinct general hospitals provide treatment and diagnostic
facilities for in-patients, day-patients and outpatients. 'There, are maternity departments, infectious
diseases units, psychiatric and geriatric units, intensive care units with all kinds of specialized treatment.

  There is growing interest in alternative therapies such as homeopathy, osteopathy and acupuncture,
but they are mostly practiced outside the NHS.

         Central Government is directly responsible for the NHS - planning and management of all
health services, training of medical professionals, pharmaceutical and dental services. The Government's
aim is to raise the standards of health care in Great Britain.
                              HEALTH CARE IN THE USA



       Nowadays the health care system in the USA is a complex mechanism of arrangement and
financing. Its most prominent feature is vast development of commercial health insurance. The
insurance market of the USA includes a great number of private insurance companies.

       According to some data about 76% of Americans participate in commercial health
insurance. Another 14% (they are elderly patients) are provided health care by the program
called «Medicare». About 10% of Americans (the poorest part of the population) come under
protection of «Medicaid» program. These are national programs and they are financed from the
Federal budget.

       Within the structure of American Health care system private sector plays a prominent role.
There are private insurance companies, hospitals and health practitioners.

       Average Americans can make use of this system. Most of them can afford buying health
insurance for themselves and their families. But if they lose jobs, eventually they may lose
health insurance. It sounds paradoxical, the richest and economically advanced country cannot
guarantee health care to the disabled and disadvantaged patients. Insurance companies are
unwilling to provide care to people who run great risk of developing some serious conditions.

American Health Care system is a living organism; it has its good and bad sides,
Among the advantages one may mention:
■ high-tech equipment
■ qualified medical staff
■comfortable hospitals
■ a great number of people who make use of the system

Its drawbacks include:
■ about 10-15% of Americans cannot afford buying health insurance
■ growing expenditure on hospital administration
■ a great amount of documentation
■ overuse of technical devices .

       Nowadays growing understanding that healthy lifestyle will result in social well-being on
the one hand and high cost of medical care on the other make many Americans use creative
medicine methods, such as meditation and hypnosis, acupuncture and Chinese medicine,
nutritional therapy and osteopathy and art therapy.

       American medical practitioners are hard working and very proficient. They are ambitious
to introduce advanced technology into medical practice, develop medical science and reach the
highest standards of care for the benefit of their patients.
                                     My Future Profession

       I began to consider medicine as a career from school. I am a son/ daughter of a physician.
I decided to follow in my mother’s steps. She is a cardiologist in our district hospital. I have
always understood about my mother’s work. She took me to her in-patient department from a
very young age. I am convinced that I was born with the need to treat people. I like to help
people. Moreover at school I was good at Biology, Chemistry and Physics.
       My parents tried to dissuade me telling me what a hard life it can be. But I think I must
reveal good and bad sides of this profession myself. This job requires good professional
knowledge. I must be quiet, understanding and friendly with my patients. I know that preparation
for a career of a physician is long and demanding. This year I have entered Chelyabinsk Medical
Academy. I am sure I will be well qualified.
       As a physician I will diagnose diseases and injuries. I’ll ask a patient some questions
about his medical history and his health in general. I will administer drugs and different
procedures. I will advise patients to keep to a diet and to follow a healthy lifestyle. Perhaps in
future I will found and run my own medical clinic.


       New Vocabulary:
   1. to consider smth. as a career - рассматривать ч-л как карьеру
   2. to follow in smb’s steps – следовать по чьим-либо стопам
   3. an in –patient department - стационар
   4. to be convinced – быть убежденным
   5. to be good at – иметь хорошие знания по…
   6. to dissuade - разубеждать
   7. to reveal - выявить
   8. to require - требовать
   9. demanding - требовательный
   10. to enter Academy – поступить в Академию
   11. to administer - назначить
   12. to keep to a diet – придерживаться диеты
   13. to follow a lifestyle –вести образ жизни
   14. to found - основывать
   15. to run a clinic – иметь клинику ( как бизнес)
                  Outstanding Scientists of Chelyabinsk Medical Academy

      The scientific school of Chelyabinsk Medical Academy was founded by L.Y. Ebert. He
was the first in the world to work out the drug stimulation method of the human body immune
status. His investigations were continued by his pupils Yu. Zakharov, S.N. Teplova, I.I.
Dolgushin – the scientists with international reputation in the field of immunology. Now prof.
E.L. Kurenkov holds the post of vice-rector responsible for scientific orientation. He contributed
much to the field of Pathologic Anatomy, being one of the youngest professors.

      There are some academicians in our Academy. Y.M. Zakharov, Corresponding Member of
Natural Sciences Academy has founded Haematologic Center which has been working out new
approaches in management of haemopoesis impairments. He is the head of the Ural department
of International programme aimed at investigation of ecologic monitoring.

      S.N. Teplova guides the scientific investigations connected with the problems of acquired
immune deficiency syndrome (AIDS). She is the author of the monograph "Immunology and
HIV Infection" (human immune deficiency virus). Academician A.V. Vazhenin being the Head
of the Regional Oncologic Dispancery and Department of X-ray diagnosis and treatment with his
colleagues introduces the latest achievements in the fields of oncology, radiology into practical
medicine. He holds many honorary degrees and membership in numerous scientific academies
all over the world. Among the names of the theoreticians contributing much to medical science
are the names of Y.V. Bryukhin, I. Volchegorsky, V.L. Kovalenko.

      The scientific school of surgeons was founded by P.M. Tarasov. The original operation
performed by prof. L.V. Novokreshchenov on siamese twins received international appraise.
Y.I. Malyshev founded the Cardiologic Center in the Urals. V.V. Privalov, V.A. Bordunovsky,
I.V. Andrievskikh contribute much to surgery developing new techniques of operating and
teaching students and post-graduate students.

      The list of prominent scientists in the field of therapy includes the names of D.A.Glubokov,
S.P. Sinitsin, A.S. Prazdnov, I.I. Shaposhnik. They deal with one of the most pressing problems
of nowadays – management of cardiovascular diseases.

     Pediatric Scientific School was founded by N.S. Turina. The main scientific orientation of
pediatric research is nonspecific respiratory and allergic diseases in children, taking into
consideration severe ecological situation in our region.

      The scientists of our Academy take part in international programmes and exchange
knowledge and experience with their colleagues from Canada, USA, Great Britain, Japan taking
part in international conferences and symposia.

				
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