Gastroesophageal  reflux  disease  is  characterized  by  a  wide  range  of  esophageal  and extraesophageal manifestations, which can be considered as a different disease (the so-called "masks"). Validated questionnaires, such as the Index of Reflux Symptoms and Gerd Q, can be useful in routine practice to objectify the patient's complaints. However, a more reliable diagnostic method for the reflux nature of the patient's symptoms is 24-hour intraesophageal impedance-pH measurement. It can be helpful both in a timely diagnosis and in choosing an adequate therapy. A description of a clinical case is provided as an illustration of the literature data.

One of the urgent problems in neonatology and pediatric surgery is birth trauma, the incidence of which does not tend to decrease. The biomechanics of the birth process is responsible for the highest incidence  of  head  injury  in  a  newborn.  The  main  marker  of  birth  trauma  to  the  head  in  a  child  is cephalohematoma. Despite significant advances in the development of obstetric service, the incidence of subperiosteal  hemorrhage  in  newborns  remains  high.  At  the  moment,  there  is  no  unified  approach  to diagnostic and treatment actions in cases of cephalohematoma in newborns. Lack of tactical consistency at the treatment and diagnosis of subperiosteal hemorrhage children leads to late diagnosis and the formation of complications of long-term existence of cephalohematoma. The purpose of the article is to summarize modern ideas about the particular types of extracranial injuries in newborns, the main differential diagnostic features in the diagnosis are presented. This review examines the main causes and mechanisms of the formation of subperiosteal hemorrhage in newborns. The materials on the features of diagnosis and clinical course of various variants of cephalohematomas in children of the first month of life are presented. Data on the methods of cephalohematoma treatment are generalized, as well as their own clinical observations.

The article presents a literary review devoted to the study of the prognosis of the rehabilitation potential  of  patients  with  cerebral  stroke.  The  information  about  the  relevance  of  neurorehabilitation measures, the conditions of their successful implementation, factors affecting the result of rehabilitation treatment is summarized. Information about modern research in the field of neurogenesis, restoration of lost functions of a patient who has suffered an acute violation of cerebral circulation, innovative technologies of neurorehabilitation  therapy  is  consecrated.  The  importance  of  an  individualized  approach  to  the development of neurorehabilitation programs is emphasized.

The article provides a brief overview of the development of lean management, the prerequisites for its implementation in the Russian healthcare system. The essence of the concept of lean management is reflected. The main directions in health care, in which these technologies are actively used, are presented.

The features of the onset rheumatoid arthritis in old age are discussed in the presented literature. The data of epidemiological studies of the adult population suffering from rheumatoid arthritis, the features of three clinical variants of the onset of rheumatoid arthritis in old age are presented. A comparative characteristic of the course of rheumatoid arthritis in different age groups is given. Immunological and genetic predictors of the onset of rheumatoid arthritis in old age presented. Previously, the debut was registered in mostly middle-aged people. In conclusion, it should be noted that the number of cases of rheumatoid arthritis in old age is increasing, which makes further research in this area relevant.

Lymphotoxin α is a one of the tumor necrosis factor family ligand. For almost forty years its pathophysiologic importance as proliferative and inflammatory cytokine was validated. Correlation between some single nucleotide polymorphism and nosological entity was clarified with lyphotoxin’s gene investigation. In clinic it uses in the treatment protocols of rheumatic diseases especially rheumatoid arthritis. Its role in the oncopathological processes is being studied. Lymphotoxin’s system influenced medicines are being researched. Moreover  the  studying  of  genomic  structure  and  biochemical  aspects  under  normal  and  pathological conditions is in process. There are many points of lymphotoxin’s influence on various metabolic ways. The main research results of this cytokine, its genetic structure and its receptors role in pathological conditions and therapeutic approaches, influencing on its system, were observed in the article.

Parkinson's disease is a chronic neurodegenerative disease that manifests with motor symptoms such as hypokinesia, muscle rigidity and resting tremors, as well as a wide range of non-motor disorders. It has now been established that non-motor symptoms of the disease contribute significantly to a decrease in the quality of life of patients. The aim of this review is to study the effect of non-motor symptoms on the quality of life of patients with Parkinson's disease and to determine the most valid scales for assessing the quality of life. We searched for scientific articles - the results of clinical studies in the RSCI and PubMed databases using the keywords “Parkinson's disease”, “non-motor symptoms” and “Quality of life”. The study showed that non-motor symptoms have a significant negative impact on the quality of life of patients with Parkinson's disease, in particular depression. To assess the quality of life, the universal scale SF-36 and the specific scale PDQ-39 are mainly used. At the same time, there is insufficient data on the impact of ethnicity and socio-economic status of patients with Parkinson's disease on the quality of life, there is no information on the role of non-drug methods, for example, schools of patients with Parkinson's disease.

In  the  weeks  following  the  outbreak  of  the  new  respiratory  infection  COVID-19,  various laboratories  around  the  world  have  sequenced  the  viral  genome,  as  well  as  provided  structural  and functional information about the basic proteins necessary for the virus to survive, which served as a new stage  in the study of  the immunogenetic aspects  of  the disease.  The article examines the pathogenetic mechanisms of the development and course of a new coronavirus infection. The purpose of the article is to consider the immunological and molecular genetic mechanisms of COVID-19 infection at the present stage. Despite  the  achievements  of  modern  science,  by  now,  comprehensive,  large-scale  and  reproducible immunogenetic studies of a new coronavirus infection are needed, which will allow a more accurate study of its pathogenetic mechanisms, including those leading to pneumonia and the rapid, unfavorable progression of  the  disease,  which  ultimately  will  allow  to  the  necessary  links  of  pathogenesis  and  to  prevent  the development of this socially significant disease.

The aim of the research. To study the clinical features of acute viral bronchiolitis in hospitalized children with predictors of its severe course.

Materials and methods. A retrospective analysis of 124 medical records of children in the first year of life with acute viral bronchiolitis who underwent the stage of inpatient treatment from January 2013 to April 2019 was carried out. The subjects were divided into two groups: the first (n=34) with predictors of the severity of viral bronchiolitis, the second (n=90) without risk factors for the development of a serious illness. The quantitative and qualitative signs in the groups were assessed: the development of severe bronchiolitis, the  formation  of  complications,  the  presence  of  respiratory  failure  and  its  severity,  the  need  for hospitalization in the intensive care unit and oxygen therapy, laboratory markers of bacterial infection.

Results. It was found that in children with severity predictors, viral bronchiolitis in 67.7% proceeds in a severe form, in 32.3% of cases a mild clinical course of the disease develops. Regardless of the presence of risk factors, the severity of the course of bronchiolitis determines the severity of respiratory failure with the predominant registration of severe forms among children with predictors of severity. Children with risk factors for the development of severe bronchiolitis required frequent hospitalization in the intensive care unit (67.7%), non-invasive oxygen therapy (94.1%), the need for mechanical ventilation in the first 6 hours of hospitalization (20.6%) in case of the development of the disease, regardless of the etiological factor of bronchiolitis.

Conclusion. The analysis confirmed the importance of taking into account predictors of the severity of bronchiolitis among young children in connection with the significant risk of developing its severe course, the high need for hospitalization in the intensive care unit, and the development of respiratory failure requiring oxygen therapy. At the same time, the frequency of the formation of severe bronchiolitis among children who do not have traditional predictors of the severity of the disease makes it possible to justify the search for new, including genetic, markers of varying severity of the course of viral bronchiolitis in children.

The aim of the research. Assess the availability of medical care to the population of the Trans-Baikal Territory in the context of the spread of a new coronavirus infection SARS-Cov-2.

Materials and methods. The study was conducted by questionnaires using the Google Forms electronic system to collect and process the collected material. The questionnaire included three blocks of questions: assessing the availability of medical care, the problems of organizing its provision and how to solve them, according to patients. The survey was attended by 1058 residents of the Trans-Baikal Territory.

Results. Most interviewees note reduced accessibility for all group patients. Mostly common problems in receiving medical care are the lack of necessary specialists, insufficient enrollment. Respondents see the solution to the above problems primarily in increasing the number of medical workers.

Conclusion. Residents of the Trans-Baikal Territory note a decrease in the availability of medical care in the context of the spread of a new coronavirus infection.

Obstructive  bronchitis  is  a  common  pathology  among bronchopulmonary  diseases  in  all  age groups, in particular those with weakened immunity, allergic predisposition and in children with recurrent respiratory infections. Аrticle discusses the risk factors that can contribute to the development of obstructive bronchitis in preschool children.

The aim of the research. The study of the content of some molecules of immunological protection in children with recurrent respiratory infections.

Materials and methods. The study involved 103 children, aged 6 ± 1 years (from 3 to 8 years). In order to assess risk factors for recurrent respiratory infections, anamnestic data were studied in all children (the course of the antenatal period, hereditary predisposition to allergic diseases). The frequency and structure of acute respiratory diseases were assessed 12 months before the inclusion of children in the study. Based on the calculation of the resistance index, children were divided into two groups: with recurrent respiratory infections (acute nasopharyngitis, acute simple bronchitis, obstructive bronchitis) - 68 and healthy children - 35. Statistical analysis was carried out using the Statistica 10.0 software package using the criteria: Mann - Whitney, Fisher, Spearman's correlation coefficient.

Results  and  сonclusion.  Factors  for  the  development  of  recurrent  respiratory  infections  have  been established: chronic fetoplacental insufficiency, pathology of the central system in the first year of a child's life, aggravated allergic history, as well as low levels of vitamin D metabolite and surfactant protein. The factors of development of obstructive bronchitis in children were determined, among which there are: low level of 25(OH)D3, α-defensins 1-3, high concentration of IgE in blood serum, as well as low content of SP-D surfactant protein in exhaled air condensate.

The aim of the research. To study the features of cardiac arrhythmias, heart rate variability parameters, QT interval duration and late ventricular potentials in patients with true polycythemia.

Materials and methods. In 63 patients with true polycythemia of stage I-IIB and 52 healthy individuals, cardiac arrhythmias, heart rate variability parameters, QT interval duration and late ventricular potentials were studied by daily ECG monitoring. Statistical data processing was carried out using Statistica 25.0.

Results. In patients with polycythemia vera, against the background of a decrease in overall heart rate variability (22=15.16, df=2, p<0.001) and a decrease in parasympathetic activity (χ²=7.29, df=1, p=0.007), a tendency to lengthen the maximum corrected QT interval (p=0.09), frequent ventricular extrasystoles were recorded 18 times more often (U=364.0, p=0.047), polymorphic extrasystoles (χ²=33.62, df=4, p<0.001). Paired ventricular extrasystoles were detected only in the group of patients (in 4.8%). Late ventricular potentials were 6.6 times more often registered in the group of patients with polycythemia vera compared to the controls (χ²=9.25, df=1, p=0.002).

Conclusion. In patients with polycythemia vera, more severe cardiac arrhythmias were detected. Violations of  the  electrophysiological  parameters  of  the  heart  can  serve  as  markers  of  dangerous  ventricular arrhythmias in patients with true polycythemia.

The purpose of the study. To study the morphological features of changes in the tissues of the demarcation zone during frostbite of the extremities.

Materials and methods. Histological examination of tissues was carried out in 84 patients with frostbite of the II-IV degree of the upper and lower extremities in the area of the hands and feet, on the 30th day from the moment of injury, who were treated at the State Medical Institution "City Clinical Hospital No. 1" in Chita. Fragments of tissue measuring 1x1x0. 5 cm were taken with a scalpel under local anesthesia during surgical treatment in the deep lesion zone at the border of damaged and healthy tissues in the demarcation zone. For the study, the material was fixed in a 10% solution of neutral formalin, followed by pouring into paraffin according to the standard method. Prepared histological sections with a thickness of 4-5 microns were stained with hematoxylin and eosin. A descriptive method of drug research was used.

Results. With frostbite of the extremities, the skin with the underlying tissues, blood vessels, bone, cartilage tissues, in which inflammatory, necrotic processes, sclerosis predominate, are most susceptible to changes. Minimal morphological changes are observed in skin derivatives (sebaceous, sweat glands, epithelium of hair  sheaths),  tendons,  peripheral  nerves  with  a  predominance  of  dystrophic  changes.  The  leading pathomorphological process in the vessels with frostbite of the extremities is sclerosis of the vascular wall, which is caused by the processes of endarteritis, endophlebitis and thrombophlebitis. An important role in the development of destructive changes in tissues during frostbite is played by common thrombosis, which results in tissue hypoxia, secondary morphological changes in tissues that cause the severity of the injury.

Conclusion. The unevenness of tissue damage in the demarcation zone during frostbite was revealed. The most pronounced lesions are skin, muscle, bone, cartilage, blood vessels. The sebaceous, sweat glands, hair follicles and nerves are less susceptible to changes. This is due to the peculiarities of blood circulation in the tissues  and  the  need  for  some  of  them  for  intensive  blood  supply.  In  this  regard,  severe,  irreversible inflammatory and necrotic changes develop in tissues with an abundant blood supply, up to gangrene. And in structures with poor blood supply, focal, dystrophic, reversible processes are noted.

The aim of the research: To study the structure of the outstanding recommendations for the examination of patients with coronavirus infection COVID-19, to identify the causes of their occurrence and to conduct a clinical assessment of the quality of the examination.

Materials and methods. The article presents an analysis of the quality of examination of 55 patients with severe and extremely severe COVID-19 with laboratory-confirmed COVID-19 (the presence of SARS-CoV-2 RNA using nucleic acid amplification methods) who died from the novel coronavirus infection COVID-19 in intensive care units of district hospitals.

The results. A total of 306 outstanding recommendations were identified to screen patients with novel coronavirus infection COVID19 in the ICU in 84% (46/55) of patients. The main reasons for the failure to implement  the  recommendations  for  the  examination  of  patients  with  COVID-19  have  been  identified: shortcomings  of  the  organization,  the  human  factor,  resource  limitations  extremely  severe  course  of coronavirus infection.  The  disadvantages  of the  organization  were  the lack  of  equipment  for  radiation diagnostics and laboratory examination. The limitation of resources was the lack of places in the ICU with a mass  influx  of  patients.  The  extremely  serious  condition  of  the  patients  did  not  allow  for  computed tomography of the lungs with intravenous contrast in order to timely diagnose and treat PE.

Conclusion. The main recommendations for the examination of patients with the new coronavirus infection COVID19 were implemented in 16% of cases, non-compliance with the recommendations did not affect the outcome of the disease in 13%, non-compliance with the recommendations could lead to causing preventable harm to the patient's health in 71%.

One  of  the  mechanisms  of  development  of  heart  failure  in  patients  with  hypertension  with impaired relaxation of the left ventricle is a change in the nitroxide-producing function of the endothelium.

Objective:  to  study  the  global  longitudinal  deformation  of  the  left  ventricle  and  signs  of  endothelial dysfunction in violation of diastolic relaxation of the left ventricle in patients with hypertension.

Materials and methods. 221 patients with stage 1-2 hypertension (103 women and 118 men) were examined, the average age was 42±9.4 years. The control group consisted of 86 healthy individuals. The material for the genetic study was 221 DNA samples. A polymerase chain reaction was performed with the detection of the amplification product. The frequency of genotypes of nitric oxide synthase type 3 in the NOS3 C786E gene was studied. The endothelin content was studied using an ELISA kit from Eagle Biosciences.Inc. The global deformation was determined by the method of non-Doppler mode of gray-scale deformation. 

Results. In patients with hypertension in combination with impaired relaxation of the left ventricle, the genotype of SS nitrogen synthase was 2 times more common than in healthy individuals and 1.5 times more common  than  in  patients  with  hypertension  without  diastolic  dysfunction  (p=0.0076  and  p=0.0042, respectively). The amount of nitrites and nitrates was lower in the group of patients with hypertension in combination with diastolic dysfunction by 52% compared to the control and by 13% compared to the group of  patients  without  DD.  These  changes  are  interrelated  with  a  decrease  in  the  global  longitudinal deformation of the left ventricle. The correlation analysis revealed a moderate negative relationship between the global longitudinal deformation of the left ventricle and the content of NO3 (r=0.64, p=0.004), the presence  of  a  moderate  negative  correlation  between  the  MMLF  index  and  the  concentration  of  NO2 (r=0.54, p=0.047).

Conclusion. In patients with hypertension, in combination with a violation of diastole, a decrease in the function of the endothelium was revealed, which is interrelated with a decrease in the global deformation of the left ventricle.

The aim of the research.  Clarification  of  the  role  of  irisin  in  the  pathogenesis  of  diseases  of  the cardiovascular system. 

Materials and methods. 41 women aged 32 to 69 years, divided into 2 groups, were studied. The first group consisted of 16 women (49.8 years old (41.0; 59.0)), who did not have pronounced disorders in the activity of the cardiovascular system (control). The second group consisted of 25 patients (mean age 53.4 years (43.0;  62.0))  with  ischemic  heart  disease,  stable  angina  pectoris  I-II  functional  class  and  arterial hypertension grade 2-3. 

Results. Compared with relatively healthy women with a pathology of the cardiovascular system (CVS), the content of irisin was elevated. After a single kinesitherapeutic load in relatively healthy women, the irisin content increased, while in women with CVS damage, it did not change or decrease. In relatively healthy women, both before and after exercise, negative relationships were found between irisin concentration, age, BMI average arterial pressure (ABP) and positive ones with progesterone concentration and dynamometry (after exercise), as well as with heart rate (after exercise). In patients with CVS damage, in contrast to relatively healthy ones, both before and after exercise, no correlation of irisin level with age and ABP is revealed, but in addition to healthy ones, positive correlations with glucose, dynamometry after exercise and negative with the heart rate before the load. 

Conclusion. During exercise in relatively healthy women, the concentration of irisin increases, while in patients  with  cardiovascular  pathology  it  can  either  increase  or  decrease.  The  correlations  found  are consistent with the idea of the appointment of irisin as a fat burner hormone that provides optimal conditions for energy balance during exercise.

Aims. To assess the indices of systemic hemodynamics in patients with severe pneumonia associated with influenza A(H1N1).

Materials and methods. 85 patients with pneumonia associated with influenza А(H1N1) were examined, 30 of them underwent invasive mechanical ventilation (group 1), 55- respiratory support in the form of O2 - therapy (flow 5-15 l/min) (group 2). The control group consisted of 15 healthy volunteers (group 3). The state of central hemodynamics was investigated by the method of volumetric compression oscillometry using the hardware-software complex "Globus".

Results. It was found that in patients with severe pneumonia with influenza A(H1N1), who are on invasive lung  ventilation,  the  indicators  of  systolic,  diastolic,  mean  hemodynamic  and  pulse  arterial  pressure increase. In the study of cardiac activity indicators, it was found that in patients of the 1st group, cardiac output and cardiac index increased, stroke volume and volumetric ejection velocity increased, the power of contractions of the left ventricle and energy consumption per 1 liter of cardiac output increased. In the study of vascular parameters in patients with pneumonia who are on invasive lung ventilation, an increase in pulse wave velocity, a decrease in compliance of the vascular system and a decrease in total peripheral vascular resistance were revealed.

Conclusion. Changes in systemic hemodynamic parameters were revealed in patients with severe pneumonia with  influenza  A(H1N1),  who  were  on  invasive  lung  ventilation,  which  reflects  the  degree  of  acute respiratory failure and is associated with the severity with her level.

The aim of the research is to study the changes of nutritional status in HIV-positive patients with bacterial pneumonia and the estimation of the traditional nutritional support methods effectiveness.

Methods. The research was made on the basis of Perm State Clinical Infectious Diseases Hospital in 2014 – 2018. It included clinical and laboratory data as well as the study of nutritional status in 92 HIV-positive patients with the stage of secondary diseases (4А, 4Б, 4В), progression phase in the absence of ART, with manifestations of pneumonia. Among them the first group were patients hospitalized in the intensive care unit, the second group was treated in a specialized department. On the 1st, 10th and 21st days an evaluation of  the  trophological  status  and  BMI  calculation,  determination  of  the  levels  of  total  protein,  albumin, transferrin  in  the  blood  serum,  the  absolute  number  of  lymphocytes  in  the  peripheral  blood,  basal metabolism (Harris-Benedict formula), and iron indices were made.

Results. In HIV-positive patients with bacterial pneumonia in both groups, the development of the visceral protein  pool  deficiency  was  observed:  serum  albumin  and  transferrin  were  reduced,  their  levels  on  admission corresponded to a moderate degree of protein deficiency. Subsequently, negative dynamics of the nutritional status and the correlation.

Conclusion. It is necessary to introduce methods of nutritional support into routine practice in HIV-positive patients with bacterial pneumonia.