The aim of the research: assessment of achievement of the criterion "Provision of outpatient admission of planned patients by district pediatricians strictly on time and by appointment" and to study the reasons for non-fulfillment of this criterion in the Chita polyclinic.

Materials and methods. The study was carried out on the basis of the GUZ "Children's Clinical Medical Center of Chita". The number of observations was 1,158 visits by patients of district pediatricians. Data fixation and study were carried out using a created checklist based on the recommended checklist for evaluating the fulfillment of the criterion. In the future, the data obtained were compared with the target indicators of the criteria of a New model of a medical organization providing primary health care.

Results. The majority of patients (78%) who turned to the district pediatrician made an appointment beforehand (p<0,0001), which indicates that the criterion for this parameter has been reached. 52.2% of patients from the total number of visits by appointment were registered for an appointment by time. At the same time, the recommended figure of 80% has not been reached (p<0,0001). The main reasons for non-compliance with the reception of the district pediatrician strictly on time are: the patient's lateness to the appointment, the queue in front of the doctor's office, an earlier start of the appointment, because the doctor has no patients.

Conclusions. The criterion "Ensuring outpatient admission of planned patients by doctors strictly on time and by appointment" at the Children's Clinical Medical Center of Chita was achieved only within the target values of pre-appointment, which indicates a decrease in the availability of primary health care for the child population.

The objective: was to study the prevalence of risk factors for non-communicable diseases (active and passive smoking, alcohol consumption, physical inactivity, eating disorders) in children of the Trans-Baikal Territory.

Materials and methods. A retrospective analysis of the reports of the Healthcare Centerof Chita Children's Clinical Medical Center was carried out. The data of 69,137 children and adolescents who applied to the Healthcare Center in the period from 2012 to 2021: before the pandemic (2012-2019) and during the pandemic of the new coronavirus infection COVID-19 (2020-2021) were studied. The data obtained were processed using the software package "STATISTICA-10", Microsoft Excel 2010.

Results. The prevalence of passive and active smoking over 10 years was 35,2%, alcohol consumption – 2,75%, physical inactivity – 12,38%, eating disorders – 35,9%. During the pandemic, there was a decrease in the prevalence of smoking (р<0,0001) and eating disorders (р<0,0001). At the same time, an increase in the prevalence of inactivity (р<0,0001), alcohol consumption (р<0,0001) was revealed.

Alcohol consumption by adolescents increased from 1,9% in the period 2012-2019 to 6% in 2020-2021 (р<0,0001). In 2020-2021 inactivity was detected in 15,6% of children, exceeding the before pandemic index (11,6%, р<0,0001). In dynamics a decrease in eating disorders was recorded from 38,1% to 26,4% (р<0,0001).

Conclusion. During the period of restrictive measures related to the new coronavirus infection COVID-19, a decrease in the prevalence of smoking and eating disorders was noted among children and adolescents of the Trans-Baikal Territory. At the same time, an increase in the prevalence of physical inactivity and alcohol consumption was revealed. The data obtained make it necessary to carry out measures to promote a healthy lifestyle both in families and in educational institutions.

Objective: To compare the effectiveness of continuous wound infiltration analgesia with anesthesia using ketoprofen.

Materials and methods. The study included 92 patients aged from 18 to 82 who underwent stoma closure. Patients were randomly divided into two groups. The main group included 48 patients. The basic analgesia was the injection of Ropivacaine 0,2% – 20 ml through the intra-wound catheter 3 times a day. Ketoprofen and tramadol were added on demand depending on the severity of the pain syndrome. The control group included 42 patients. The basic analgesia was the intravenous injection of Ketoprofen – 100 mg 2 times a day, in case of uneffective tramadol 5% – 100 mg was added, up to 3 times a day.

Results. In the main group on the first, second and third days, the maximum dose of ketoprofen was used rarely than in the control group: 21(44%) versus 29(69%), p=0,028; 29(60%) vs 38(90%), p=0,0025; 22(46%) vs 29(69%), p=0,045. On the second day, the frequency of ketoprofen usage was lower in the main group than in control group: 41 (85%) versus 42 (100%), p=0,029. On the first day, tramadol was used less frequently in the main group: 5 (10%) versus 22 (52%), p<0,001. In addition, on the first day, the maximum daily dosage of tramadol was used less frequently in the main group than in control group: 2 patients (4%) versus 10 (24%) in the control group, p=0.0154. The time of activity on the second day was higher in the main group than in control group: 30(20-60) versus 15(10-30), p=0,016. The number of episodes of vomiting on the first day was less in the main group: 4 (8%) versus 12 (29%), p=0,026.

Conclusion. Continuous wound infiltration analgesia reduced the consumption of analgesic drugs, the frequency of vomiting on the first day and increased the time of patients' activity on the second day.

The aim of the research. Was to study of the frequency of variant alleles and genotypes of SNV gene SCNN1G (rs4401050) of the epithelial sodium channel in patients with arterial hypertension and in healthy people in the Trans-Baikal region.

Materials and methods. The research included patients with arterial hypertension (135 people) using a continuous sampling method. The control group consisted of 106 practically healthy donors. Determination of SNV of the SCNN1G gene (rs4401050) was carried out using the real polymerase chain reaction method.

Results. The study of the distribution of SNVs of the SCNN1G gene (rs4401050) in a group of patients with arterial hypertension and in the control group was established that carriage of the C/C genotype in the group of patients with hypertension was more common than in the control group (62% and 38,7%, respectively; χ2 = 7,49, p = 0,006). This way carriage of the C/C genotype of the SCNN1G gene increased the likelihood of hypertension in patients (OR = 2,70, 95% CI 1,60 – 4,55, p = 0,0002). Among patients, allele C was detected 1,2 times more often, with a frequency of 0,79 compared to a group of healthy individuals – 0.68 (χ2 = 7,49, p = 0,006). It was found that the T allele of the SCNN1G gene (rs4401050) in patients with hypertension was 1,5 times less common than in the control group, and its frequency was 0,22 versus 0,33, respectively (χ2 = 7,49, p = 0,006). Carriage of the T allele (genotypes T/T+ C/T) is associated with a lower incidence in patients with hypertension (OR = 0,33, 95% CI 0,20–0.57, p = 0,0002). On the samples we examined, carriage of the T allele reduced the likelihood of hypertension by 1,5 times.

Conclusion. In the studied sample, the carrying of the allele C of the gene SCNN1G (rs4401050) in homozygous form supposedly increases the probability of AG development.

The aim of the research: The goal of the study was to assess the incidence of congestive hepatopathy (CHP) among patients hospitalized with acute decompensation of chronic heart failure (ADHF), to characterize the group with CHP, to identify features and to assess the impact on the patient's prognosis.

Materials and methods. A retrospective assessment of 228 clinical records of patients hospitalized with ADHF was performed. The analysis of the clinic, instrumental and laboratory data was carried out.

Result. Signs of CHP were detected in 92 (41,6%) hospitalized patients. CHP was more common among men than among women. The presence of CHP was associated with a higher frequency of detection of systolic dysfunction. An increase in the concentration of gamma-lutamyltranspeptidase and bilirubin in the blood was more often detected among patients with CHP. There were no significant differences in the semi-annual prognosis.

Conclusion. Hepatomegaly in patients hospitalized with decompensation of chronic heart failure, even in the absence of a vena cava inferiorcollapse on inspiration of more than 50%, cannot be the only criterion for CHP. CHP is characterized by impaired liver function in the form of an increase in the level of bilirubin and gamma-glutamyltranspeptidase. The study did not find the effect of CHP on the prognosis of life. However, the imperfection of the criteria for the diagnosis of CHP probably does not allow accurate diagnosis of CHP. Further studies of the prognostic value of CHP in patients with ADHF should most likely be carried out with an emphasis on the condition of the liver vessels (such as collapse of the hepatic veins on inspiration or ectasia of the veins as a sign of venous congestion or an increase in the diameter of vena cava inferior and hepatic veins - a symptom of Playboy Bunny), which is not determined in routine practice.

Aim of research: to determine the frequency of detection of albuminuria in people of different ages with risk factors for chronic kidney disease identified by a questionnaire.

Materials and methods. A survey of 608 young, middle and older people was conducted. Respondents answered questions from a questionnaire developed by the National Society of Nephrologists of Russia. Albuminuria was determined in all respondents in a semi–quantitative way using Microalbufan test strips.

Results. CKD risk factors were identified in 75.3% of respondents. Albuminuria greater than 30 mg/g was detected in 49% of respondents. The risk factors most associated with albuminuria in the youth group are hyperglycemia, the use of small amounts of water, the use of analgesics several times a month; in the middle–aged group – hyperglycemia, dyslipidemia, arterial hypertension; in the older group, albuminuria is detected equally often.

Conclusion. The albuminuria was detected in 49% of respondents with risk factors for chronic kidney disease in the Baikal region. The largest proportion of respondents with risk factors for chronic kidney disease and albuminuria is determined among older people. The questionnaire and the albuminuria test effectively identify individuals at high risk of developing chronic kidney disease.

The aim of the research. We aimed to study clinical, laboratory and instrumental characteristics of patients with asthma and diabetes type 2.

Materials and methods. The study includes patients with asthma and diabetes type 2, they divide into 3 groups for comparative analysis, 100 people in each group. A general clinical examination, laboratory testing, and instrumental examination were performed. Nonparametric statistical methods were used to analyze the data.

Results. We revealed a more severe course of asthma in patients with concomitant diabetes type 2, lower control of asthma, lower indicators of respiratory function and we found that the target blood glucose level was not reached.

Conclusion. The revealed characteristics of asthma and diabetes type 2 in patients should be taken into account. These patients have a higher risk of exacerbation of asthma and decompensation of diabetes and they require active monitoring of medical examinations.

Diabetes mellitus (DM) is one of the most common metabolic diseases with a large number of complications. Disorders of the nervous system (NS) are the main complication of DM, the pathophysiology of which is not fully understood. The dysfunction of the central nervous system against the background of DM primarily includes diabetic encephalopathy (DE) and peripheral polyneuropathy (PP). Oxidative stress (OS) is considered one of the leading hypotheses leading to NS disorders in DM. In addition, OS is discussed as one of the pathophysiological links in the development of type 1 and type 2 DM. OS causes mitochondrial dysfunction, neuroinflammation, with a parallel decrease of the antioxidant system, having a negative effect on the brain. The important role of the OS in the occurrence of PP is discussed. Antioxidants (AO) have direct indications for the correction of central nervous system disorders in DM. Preclinical studies have shown the preventive role of various AO in DE and PP. Further clinical studies are needed to substantiate the appointment of AO in the prevention of NS disorders in DM.

Over the past decades, the incidence of diabetes has increased. Type 1 diabetes mellitus (Dm1), like any chronic disease, affects the quality of life of patients. Today it is important not only to develop new high-tech methods of examination and therapy, but also to study the quality of life of the patient in order to obtain information about the psychological state, to take into account the data obtained in the correction of the treatment. This review presents up-to-date information on the study of quality of life (QOL) in Russia, examines the problem in the historical aspect of the formation of the concept, research methodology. Emphasis is placed on improving tools for studying the quality of life in pediatrics, including in patients suffering from DM1t.

The review is based on relevant publications obtained by selective literature search in eLibrary.

Summary. The review summarizes literature data about role of immune control points to the development of immunosuppression in patients with cancer. The molecular characteristics of immune control points are described, and special attention is paid to the cancer immunotherapy based on blocking immune control points.

The article provides a review of scientific literature data on the application of one of the main methods of lean production – Total Productive Maintenance (TPM). The review is based on the results of experimental and theoretical work by domestic and foreign authors over the past 20 years. Possible problems and risks of introducing universal equipment maintenance into the healthcare system have been identified, and the possibilities of the method in improving the efficiency of the functioning of medical organizations of various forms of ownership have been identified.

Hemorrhagic stroke is a severe and disabling disease. The use of therapeutic hypothermia 35 °С reduced perifocal edema and intracranial pressure.

The aim of the research. Timely detection and adequate correction of endocrinopathy of critical conditions of patients in the acute period of hemorrhagic stroke against the background of moderate therapeutic hypothermia with a target temperature regime of 35 °C.

Materials and methods. Clinical observation of a 57-year-old patient with a diagnosis of "Hemorrhagic stroke with extravasation in the brain stem, volume 7 cm3"

Results. In the phase of maintaining therapeutic hypothermia, a decrease in the level of cortisol and adrenocorticotropic hormone was observed, and in the warming phase, an increase in these indicators was noted. The development of adrenal dysfunction caused by a critical condition and the addition of hydrocortisone to therapy was considered based on the need for vasopressors. The level of thyrotropin (TSH) in the phase of maintaining hypothermia decreased, while in the last day of observation, TSH increased to the middle of the reference values. The level of free triiodothyronine in the maintenance phase decreased below normal, and in the last days increased to reference values. Thyroid dysfunction caused by a critical condition was considered with a decrease in the level of TSH and free triiodothyronine in blood plasma against the background of therapeutic moderate hypothermia, the development of intestinal dysfunction and sinus bradycardia. With this clinical and laboratory picture, levothyroxine sodium was added to therapy.

Conclusion. Against the background of the introduction of hydrocortisone at an initial dose of 300 mg, the addition of norepinephrine was discontinued on the fourth day, after which the dose of hydrocortisone was reduced to complete withdrawal. When levothyroxine sodium was added to therapy 300 mcg / day, intestinal dysfunction was resolved, normosystole was achieved. The patient's quality of life on the Glasgow outcome scale was 5 points.

Tuberous sclerosis is a multisystem lesion of the human body, consisting in the formation of benign neoplasms in various organs and systems. The specificity of the disease is associated with genetic mutations in the TSC – 1 and TSC – 2 genes, which are suppressors of tumor growth. Diagnosis of tuberous sclerosis in early childhood is extremely difficult and often these patients are observed and treated with a diagnosis of epilepsy, mental retardation and numerous neoplasms of various tissues of organs and systems.

The presented article shows two clinical cases of tuberous sclerosis with ophthalmological manifestations of this pathology. The presence of astrocytic hamartomas, which are the primary diagnostic criterion of the disease, makes it necessary to conduct full ophthalmic examination in time in order to identify the disease.

Abstract. This article presents data on methods of invasive detection of myocardial ischemia based on the assessment of the functional significance of coronary artery stenoses. The scope of application of fractional flow reserve and instantaneous flow reserve according to the clinical guidelines is considered, limitations and difficulties of their use are given, the technique of their application is described. A clinical example of determining the instantaneous flow reserve in a patient with "borderline" coronary artery stenoses is presented.

Abstract. This article presents data on methods of invasive detection of myocardial ischemia based on the assessment of the functional significance of coronary artery stenoses. The scope of application of fractional flow reserve and instantaneous flow reserve according to the clinical guidelines is considered, limitations and difficulties of their use are given, the technique of their application is described. A clinical example of determining the instantaneous flow reserve in a patient with "borderline" coronary artery stenoses is presented.

Drug-induced osteonecrosis of the jaw (DONJ) is a rare complication of antiresorptive therapy, which in oncology is used in the treatment of bone metastases to prevent the occurrence and treatment of adverse bone events (pain syndrome, pathological fractures, compression syndrome). The article presents a clinical case of the occurrence of DOC in a patient with progression of kidney cancer with the presence of bone metastases, who received long-term targeted therapy in combination with Denosumab (an antibody that inhibits bone tissue resorption). A review of the literature on the incidence, risk factors and treatment methods of LONJ is provided. The need to carefully collect anamnesis, including oncological history, the presence of a connection with the use of antiresorptive drugs, and identification of clinical and instrumental signs of LOC will allow a diagnosis to be made. It is necessary to remember the possibility of the occurrence of LOC in cancer patients receiving antiresorptive therapy, both oncologists and dentists, general practitioners in order to prevent the development of LOC, timely diagnosis and treatment, taking into account the possibility of a fatal outcome due to the development of sepsis.

The quality of the prolonged epidural analgesia depends on a lot of factors, one of which is what method and what conditions the attachment of epidural catheter (EC) on the skin is performed. Despite the presence of a large selection seemingly reliable fixing devices, the anatomical features of surface shape in the site of the epidural approach can prevent solid and long the EC fixation on the skin.

Aim: to show on clinical cases the possibility of using a differentiated approach to the choice of the EC fixation method, taking into account the anatomical features of the surface shape of the epidural access site during prolonged postoperative epidural analgesia.

Results. This article describes three clinical observations of carrying out prolonged epidural analgesia during surgical treatment of fractures of the lower limb, where the epidural catheter (EC) fixation was carried out in the first and third observations depending on anatomical features of the surface shape of the epidural approach site.

Conclusions. In the first and third clinical observation when choosing the method of EC fixation, the anatomical features of the surface shape of the epidural site approach were taken into account, which allowed to perform the prolonged and high-quality epidural analgesia. In the second observation EC fixation was performed excluding the anatomical features, which led to a disorder of the adhesion of the device to the skin, clinically significant EC dislocation, and premature termination of epidural analgesia.