The purpose of the study. To evaluate the diagnostic significance of cytokines IL-1β, IL-6, TNF-α, INF-γ, IL- 4, IL-10 and TGF-β in children with rotavirus infection.

Materials and methods. The study analyzed 46 cases of hospitalized rotavirus infection in children aged 6 to 59 months (average age 23 months [16; 34]) in the early period of the disease. Serum cytokine levels (IL-1β, IL-6, TNF-α, INF-γ, IL-4, IL-10 and TGF-β1) were measured in all children using flow fluorimeter. The results were processed using software IBM SPSS Statistics 26.

Results. In the group of children with rotavirus infection, a statistically significant increase in the level of the studied cytokines IL-4, IL-1β, IL-6, IFN-γ, and TGF-β1 was detected compared to the control group. According to the results, the cytokines IL-1β and IL-6 turned out to be the most informative for the diagnosis of rotavirus infection.

Conclusions. It has been established that the determination of serum levels of IL-1β, IL-6 and IFN-γ can be used as an additional diagnostic criterion for rotavirus gastroenteritis.

Introduction. The appearance of the SARS-CoV-2 virus has led to a change in a number of manifestations of the epidemiological process for a group of acute respiratory virus infections, including respiratory syncytial virus infection. However, there is insufficient data on a possible change in the nature of the clinical course of respiratory syncytial virus infection during the period of COVID-19 circulation.

The aim of the research: to study the clinical and epidemiological features of the course of bronchiolitis of respiratory syncytial virus etiology in children in the pre-pandemic period and during the decline of COVID-19 incidence.

Materials and methods. A study of 332 cards of children hospitalized in the Regional Clinical Infectious Diseases Hospital (Chita, Zabaikalsky Krai) with a diagnosis of Acute bronchiolitis of respiratory syncytial virus etiology was conducted. 2 observation groups were identified: the first group of the pre–pandemic period – 207 patients (2013 to 2017), the second group during the period of decrease in COVID-19 incidence (2021–2023), n=125. Statistical data processing was carried out by the STATISTICA 6.1 software package.

Results. The epidemic season of respiratory syncytial infection (RSVI) 2021–2022 was characterized by an early onset with peaks in incidence in December and February. The epidemic season of 2022-2023 was accompanied by a late start of hospitalization for RSVI in January 2023, with the maximum number of cases in March and April. Severe forms of bronchiolitis developed in 15,5% of cases in the first group and in 8,8% in the second. Patients who received treatment in the period 2013–2017 more often needed hospitalization in the intensive care unit and artificial lung ventilation, which may be explained by the more frequent development of complications (pneumonia) detected in this group.

Conclusion. The circulation of the respiratory syncytial virus during the extinction of the COVID-19 pandemic remains almost at the inter-pandemic level. Regardless of the circulation of the SARS-CoV-2 virus among the population, the clinical picture of respiratory syncytial virus associated bronchiolitis in children has not changed. With a decrease in the incidence of bacterial complications (pneumonia) and the need for intensive care in the 2021–2023 season.

The aim of the research: to assess the achievement of the criteria of the first level of a New model of a medical organization providing primary health care, using the example of medical organizations in the Trans- Baikal Territory.

Materials and methods. The basis of the study was the state medical organizations providing primary health care in the Trans-Baikal Territory (n = 4). Using the Methodology for assessing the achievement of the target values of the criteria of the first level of the "New model of a medical organization providing primary health care", an assessment of medical organizations was carried out according to 9 criteria. Research materials: local regulations of medical organizations, the form of federal statistical observation, floor plans of polyclinics, doctors' work schedules, information from medical information systems.

Results. When evaluating the first criterion of the new model in medical organizations, violations were identified related to the intersection of patient flows, during preventive medical examination, with the flows of patients who applied for the disease, the reason for which was the lack of separation of the admission of specialist doctors in time and space. When analyzing the criterion related to the assessment of navigation, the optimal level of this system in polyclinics was noted. The criterion related to the system of informing visitors about the organization of medical activities of the polyclinic was fulfilled by only one medical organization. When evaluating the criteria from the block "accessibility of medical care", the studied medical organizations did not demonstrate a high level of achievement of the target values of the indicators.

Conclusions. The introduction of a new model of a medical organization providing primary health care is necessary to set up processes aimed at improving the availability and quality of medical care, focusing on values for the patient. According to the results of the study, it was revealed that none of the studied medical organizations achieved all the criteria of the first level of the new model of a medical organization providing primary health care. The current situation requires management decisions aimed at transforming the processes of providing medical care in the clinic.

Objective – to study the subpopulation composition of T-helpers in the tumor microenvironment of patients with colon cancer.

Materials and methods. The relative content of T-helpers in the tumor microenvironment, the subpopulation composition of T-helpers, and the expression of co-inhibitory proteins (CTLA-4, PD-1, TIM-3) by CD4-positive cells were determined by flow cytofluorimetry in 105 patients with stage III colorectal cancer. The control group consisted of 75 patients who underwent colon surgery for non-neoplastic diseases.

Results. In patients with colorectal cancer (CRC), the relative content of T-helpers in the tumor microenvironment increases by 1,4, the proportion of naive cells (CD3⁺CD4⁺CD45RA⁺CCR7⁺) decreases by 1,8 times, the relative content of central memory T-helpers (CD3⁺CD4⁺CD45RA^-CCR7+) increases, the number of CD4-positive effector memory cells (CD3⁺CD4⁺CD45RA^-ССR7^-) and terminally differentiated T-helpers (CD3⁺CD4⁺CD45RA⁺ССR7^-) decreases. In patients with CRC, on the surface of CD3⁺CD4⁺ lymphocytes in the tumor microenvironment, the expression of CD57 increases by 4,1 times, the co-inhibitory molecule CTLA-4 by 5,5 times, and the PD-1 protein by 1,8 times.

Conclusion. In patients with colorectal cancer, the subpopulation composition of T-helpers in the tumor microenvironment changes, which is expressed in a decrease in the proportion of naive cells and the most differentiated effector cells with a simultaneous increase in the percentage of central memory cells.

Background. There are now a sufficient number of published papers devoted to the study of various factors influencing theoutcomeofthe disease. The significance of these predictors in thenewcoronavirus infection varies depending on various anthropological factors: including regional, age, gender and medical characteristics.

The objective. To assess the significance of defects in the provision of intensive care to patients with a new coronavirus infection, presented on the basis of expert opinions, and to determine their impact on the outcome of the disease.

Materials and methods. An analysis of 93 inpatient records with the primary diagnosis of "Community- acquired bilateral polysegmental viral pneumonia, ARDS" was conducted. A simple blind sampling method was used of the medical records of patients who were treated in the intensive care unit from 01.04.2021 to 31.10.2021. A power analysis showed that a minimum sample size of 15 patients per group is sufficient to detect significant differences between the groups of survivors and deceased (power 95% and α = 0.05). The presented study was carried out as a cohort retrospective single-center study stratified into groups by the following criterion: survivors and deceased. Statistical data processing was performed using STATISTICA 10.0 and MedCalc programs. The following statistical analysis methods were used: odds ratio method, Kaplan-Meier survival analysis, log-rank test, ROC analysis.

Results. The study did not reveal any effect on the timing of death of the area of lung tissue damage upon admission. The most significant defects of intensive care affecting the chance of death in patients with a new coronavirus infection were identified. Untimely testing of a number of laboratory parameters leads to late administration of the necessary corrective therapy. The chance of an unfavorable outcome increases with a late test for ferritin, d-dimer, and procalcitonin levels. The ROC analysis showed that increased mortality is affected by: irrational and untimely antibacterial therapy – AUC equal to 0,7 with a sensitivity of 45,83% and a specificity of 94,2%, as well as untimely targeted therapy, AUC was 0.967, with a sensitivity of 100% and a specificity of 92,75%.

Conclusion. The development of an unfavorable outcome during intensive care is influenced by factors such as the untimely prescription of targeted and antibacterial therapy to patients with COVID-19 and untimely diagnostic measures, which occurred due to the incomplete material and technical equipment of medical organizations.

Background. The quality of prolonged epidural analgesia depends not only on the pain level, but also on the patient`s complacency with the methods by which the fixation of the epidural catheter (EC) was performed, as well as on its efficiency. Despite the wide distribution of epidural anesthesia/analgesia by staff carrying out the operation of the EC, little attention has been paid to these factors so far.

Aim. To determine the optimal the EC fixation method by the level of comfort and efficiency during the prolonged epidural analgesia based on questionnaires of patients and doctors.

Materials and methods. The comparative research of three methods of the EC fixation in patients during the conducting of prolonged epidural anesthesia after the surgery treatment of fractures of the lower limb bones was carried out. Patients were splited into three groups: group 1 (n = 20) with the EC fixation in the site of epidural access by the fixing device Lockit; group 2 (n = 20) with the EC fixation by the methods of the tunneling under the skin with the formation of a subcutaneous catheter loop; group 3 (n = 20) with the EC fixation in the site of epidural access by the fixing device Epi-Fix. We have developed two questionnaires to choose the optimal method of the EC fixation. The first questionnaire is intended for a patient, in which he assessed the level of comfort when fixing the EC during the change of the patch or fixing device, as well as comfort during mobilization activities. The second questionnaire is intended for to assess the efficiency of EC fixation in various methods, which was filled out by the doctor who installed the EC and operated it. After that, the scores were summed and the total scores in the three study groups were compared. Informed consent was obtained from all patients to conduct a survey for the purpose of the research work.

Results. The total score in the 1st group is 200, in the 2nd group – 294, in the 3rd group – 209. Statistically significant differences were found when comparing group 3 (Epi-Fix) and group 2 (tunneling) and when comparing group 1 (Lockit) and group 2 (tunneling), where p < 0,05. No statistically significant differences were found when comparing group 1 (Lockit) and group 3 (Epi-Fix).

Conclusion. When comparing three methods of EC fixation using questionnaires for patients and doctors, the method of tunneling under the skin with the formation of a subcutaneous catheter loop was determined as optimal in terms of comfort and efficiency.

The literature review presents an analysis of the current state of the existing system for monitoring congenital malformations in children and fetuses. The birth rate of children with developmental defects in different countries and on the territory of the Russian Federation varies over a wide range, both over time and across observation areas. Using the example of defects and anomalies of the urinary system organs, the issues of defining the terms “congenital defect” and «developmental anomaly» are discussed. The problem remains that researchers have used various classifications over the years to systematize birth defects. To ensure a unified approach to the registration of developmental defects, it is advisable to take into account all their forms according to the International Classification of Diseases, separating defects from congenital anomalies, and also to single out defects from the entire spectrum for mandatory recording, which is important for comparing regional indicators with the results of individual researchers and with the data of the International register. A prerequisite for organizing the work of registers is the existence of uniform definitions, classifications, and coding of registered congenital malformations.

The article presents data from scientific publications indexed in the PubMed and Web of Science databases reflecting the pathophysiological and clinical features of chronic kidney disease (CKD) in children suffering from type 1 diabetes mellitus, which is increasingly common in real clinical practice, has a stable upward trend in parallel with an increase in the number of patients with diabetes, the appearance of its new aggressive phenotypes, an increase in the number of risk factors for CKD, such as obesity, low birth weight, hyperlipidemia etc.. The level of early diagnosis of nephropathy remains an unresolved issue, primarily due to the imperfection of diagnostic criteria, which subsequently leads to progressive loss of renal functions. The solution to the problem lies in the interdisciplinary activity of specialists, the search for new optimal and effective models for the diagnosis and management of patients with diabetes mellitus.

Children have thrombosis in the presence of thrombophilia genes. A trigger mechanism is needed for the thrombotic process. Triggers are known in adult patients, but there is little information in children. The article contains a scientific review on thrombophilia. The general provisions and data from some studies by Russian and foreign authors are described. The article focuses on thrombotic conditions and triggers in children.

Despite the high prevalence of calcium (Ca²⁺) and phosphate (P) imbalance in pediatric intensive care practice, this electrolyte disturbance is often overlooked because of its non-specific symptoms and the higher prevalence of imbalances involving other electrolytes (potassium, sodium, magnesium). The physiological role of Ca²⁺ and P makes them extremely important for supporting the body's major systems, and a significant fall or rise of the levels of these electrolytes can lead to decompensation of vital systems, increasing the risk of death in critically ill children. Many urgent conditions call for constant monitoring of Ca and P levels in blood serum for early detection of hypo- and hypercalcemia, as well as hypo- and hyperphosphatemia, because often no specific symptoms are present in these conditions. The amount of intensive therapy measures required in a child or adolescent with such an electrolyte imbalance is determined primarily by severity of the Ca²⁺ and P deficiency or toxicity, and by the presence of any background discase that triggers this electrolyte disorder. In an intensive care unit, the treatments of choice for severe hypocalcemia and hypophosphatemia are parenteral preparations of Ca²⁺ and P.

Helicobacter pylori (HP) is one of the most common infections and is recognized as a gastric pathogen in humans, leading to the development of gastritis in all infected individuals. The etiological role of HP in the formation of peptic ulcer (PU) and gastric cancer (GC) has been noted. The prevalence of HP differs in different regions, in different ethnic, social and age groups. The article summarizes publications on the frequency of HP infection in different countries, changes in the epidemiological situation in the world in recent years, and noted a decrease in HP positivity in Japan, Korea, China, and Australia. Risk factors for infection were analyzed depending on gender, age, place of residence, ethnicity, educational status and profession. Data are presented on the more frequent infection of medical personnel with HP. Identification of an occupational risk group for medical workers is an important fact, as it can contribute to the early detection and treatment of Helicobacter pylori infection and associated diseases (chronic gastritis, ulcers, gastric cancer), the prevention and control of the transmission of HP in the workplace, as well as a better understanding of the problem and proper treatment of their patients.

Corrected transposition of the great vessels is a rare congenital heart defect characterized by atrioventricular and ventricular-arterial discordance. The article describes a clinical case of this defect in an elderly patient, the feature of which was a long-term asymptomatic course of the defect due to the absence of hemodynamic disorders. Echocardiographic examination in this case had a leading role in the diagnosis.

Chronic obstructive pulmonary disease (COPD) and endocrinological conditions, such as thyroid dysfunction, are both associated with chronic inflammation. Epidemiological studies have shown that patients with COPD have a higher risk for developing thyroid dysfunction compared to the general population. This comorbidity has not been well studied, and its diagnosis can be difficult due to the combined burden and layering of clinical symptoms, while this combination of the disease can seriously worsen the quality of life of patients. Understanding the relationship between thyroid dysfunction and COPD can help improve the clinical prognosis in these patients. The review examines the existing links between COPD and thyroid diseases, their mechanisms and clinical features.

Over the past couple of decades, it has become apparent that skeletal muscles work as an endocrine organ that can produce and secrete myokines that exert their effects in an endocrine, paracrine, or autocrine manner. Modern research shows that physical exertion induces the synthesis of molecules involved in the transmission of signals between skeletal muscle cells and other organs, in particular the brain, adipose tissue, organs of the gastrointestinal tract, as well as skin and vascular cells. This review examines the myokines that cause communication with the brain, neuroprotection in response to physical activity and related processes. Unlike exercise-induced protective myokines and related signaling pathways, physical inactivity and muscle wasting can disrupt the expression and secretion of myokines and, in turn, disrupt the function of the central nervous system. It is assumed that adapting the transmission of signals from muscles to the brain by modulating myokines will help combat age-related neurodegeneration and brain diseases affected by systemic signals.

The authors searched, analyzed and systematized the results of domestic and foreign studies of SSRI-induced QT prolongation and the risk of Torsades de Pointes (full-text versions of original articles, clinical cases, systemic reviews, meta-analyses, Cochrane reviews) in Russian and English languages available in bibliographic databases (e-LIBRARY, PubMed, Scopus, Springer, ClinicalKeys, OxfordPress, Google Scholar, MedCredit, DrugBank, PharmGKB) to update the knowledge of practicing neurologists, cardiologists, clinical pharmacologists and general practitioners (physicians, pediatricians) about the possibility of predicting and preventing life-threatening cardiac adverse reactions. From the obtained results it can be judged that escitalopram and citalopram have a potentially high risk. Also, some studies show significantly affects the QT interval at therapeutic and toxic doses of sertraline. The safety was demonstrated by fluvoxamine and fluoxetine. Studies of these SSRIs didn’t show a statistically significant increase the QT interval.

Demyelinating diseases of the central nervous system are a group of autoimmune inflammatory diseases of the central nervous system (CNS) characterized by the formation of multiple foci of demyelination in the white matter of the brain and spinal cord. The clinic is quite polymorphic and may include various isolated and combined neurological syndromes. The commonality of pathogenetic reactions that underlie this nosological group determines their rather similar clinical picture, which can lead to difficulties in diagnosis. This article presents an analysis of a clinical case of demyelinating disease in a young 18-year-old patient. The peculiarity was that the disease arose at a fairly early age, was accompanied by severe rapidly progressive neurological symptoms due to the simultaneous involvement of the white matter of the brain and spinal cord in the pathological process.

Immunodeficiency in the neonatal period is often recorded. Neutro- and lymphopenia of secondary genesis are detected in various infectious diseases of the ante-, intra- and postnatal period of infection. Primary immunodeficiency occurs due to genetic breakdown of the immune system and is included in the syndrome complexes of hereditary and chromosomal diseases. The clinic of immunodeficiency conditions does not have a specific picture, and is realized as a sluggish infectious disease, often leading to sepsis. Newborn children, especially premature infants, have a functionally immature immune system, do not form an adequate immune response when exposed to pathogens, which leads to rapid generalization of infectious diseases. An infectious process against the background of congenital immunodeficiency can lead to death. A clinical example of the development of a generalized infectious process with secondary immunodeficiency clearly shows the difficulty of curating patients with a fatal outcome.