The aim of the research. Development of an additional diagnostic criterion for the early detection of CIRCI accompanied by vascular insufficiency in critically ill patients using ECMO.

Materials and methods. A prospective cohort study was performed in the intensive care unit (29 patients on ECMO). Patients with CIRCI were divided into: Ia (with vascular insufficiency and hyponatremia) and Ib (vascular insufficiency without hyponatremia). Both groups were treated with hydrocortisone when vasopressor requirements were ≥0,2 mcg/kg/min. Corticoresistance index CRI = 536 (nmol/l) / patient’s total cortisol value (nmol/l).

Results. According to the results of a comparative analysis, in group Ia the CRI compared to group Ib on the day of initiation of ECMO was higher Me 2,2-1,2, p = 0,03; in the last day ECMO was lower – 0,2-0,8 p = 0,003. Patients in group Ia were older in age (Me 58 vs. 33 years). On the day of ECMO initiation, patients did not differ significantly on the SOFA. Mortality in group Ia is 90,9%, in group Ib – 50%, p <0,05.

Conclusions. A prognostically high risk of developing corticoresistance and high mortality was observed in patients of the older age group with vascular insufficiency and hyponatremia when connected to ECMO with a corticoresistance index ≥2,2. Patients in the older age group (Me 58 years old) need to be prescribed hydrocortisone before the development of hyponatremia, an increase in the corticoresistance index ≥ 2,2, and therefore, it is not recommended to focus on the need for vasopressors ≥0,2 mcg/kg/min.

The aim of the research. Assessment of the influence of social factors on the course and outcome of a new coronavirus infection COVID-19 in patients with tuberculosis and HIV-associated tuberculosis.

Materials and methods. A retrospective analysis of 103 case histories of patients in 2 study groups: HIVassociated TB/COVID-19 (n=45) and TB/COVID-19 (n=58) is presented.

Results. The mean age of patients with a combination of HIV-associated tuberculosis and COVID-19 infection (42,8 ± 7,2 years) is significantly lower than patients with tuberculosis and COVID-19 infection (51,3 ± 13 years). Bad habits, including drug addiction (62,2% and 3,4% in the groups, respectively) and alcoholism (93,3% and 67,2% in the groups, respectively) were associated with HIV infection. Hepatitis C (77,8% and 15,5% in the groups, respectively), refusal of further inpatient treatment (84,4% and 25,9% in the groups, respectively), stay in correctional labor institutions (ITU) (53,3% and 27,6% in the groups, respectively) were significantly more common in HIV-infected patients. Such social factors as disability, lack of work, place of residence, degree of education, living with or without relatives, marital status, housing characteristics did not affect the dynamics and outcome of the disease in general. The form and phase of the course of tuberculosis were associated with HIV infection. Type 2 diabetes mellitus was associated with the absence of HIV infection (0% and 17.2% in the groups, respectively). The severity of the course of COVID-19, the outcome of the disease at the end of inpatient treatment did not depend on the presence of HIV infection.

Conclusion. No direct relationship between HIV infection and social factors associated with it with the severity of tuberculosis and the new coronavirus infection COVID-19 has been established.

The aim of the research. To study the aggregation function of platelets in the blood of patients with type 1 diabetes mellitus complicated by ketoacidosis, depending on the severity of ketoacidosis in the dynamics of the disease.

Materials and methods. 135 patients with type 1 diabetes mellitus complicated by mild and moderate ketoacidosis were examined, respectively, on the 1st, 5th and 10th days of the disease. The average age of the patients was 29,2±8,9 years. Platelet aggregation was studied using a Biola two-channel laser platelet aggregation analyzer (model LA230, Russia).

Results. It was found that in patients with type 1 diabetes mellitus complicated by moderate and severe ketoacidosis, spontaneous platelet aggregation was sharply increased compared with patients with type 1 diabetes mellitus complicated by mild ketoacidosis. The most pronounced changes were registered on the 1st and 5th days of the disease in patients with type 1 diabetes mellitus complicated by moderate and severe ketoacidosis, and on the 5th day in the same cohort of patients complicated by mild ketoacidosis.

Conclusion. Clinically significant laboratory parameters in patients with type 1 diabetes mellitus complicated by ketoacidosis, indirectly indicating hypercoagulation, require drug correction.

The aim of the research. We aimed to study the prevalence of genetic variants in the NOS3 gene (G894T) related to nitric oxide production in individuals with both asthma and type 2 diabetes.

Materials and methods. The study was carried out among 240 patients suffering from asthma and diabetes type 2, dividing them into three groups for comparative analysis, each of which had 80 people. Clinical examination and molecular genetic analysis of the polymorphism of nitric oxide synthase NOS3 (G894T) was performed by PCR in all groups.

Results. Patients suffering from type 2 diabetes and asthma have a high frequency of G-allele polymorphism NOS3 894G/T compared with those who have only type 2 diabetes or asthma. The G-allele of the NOS3 894G/T polymorphism contributes to an increased risk of developing diabetes type 2 in patients with asthma.

Conclusion. The study of NOS3 polymorphism (G894T) may be useful to identify a group of patients with asthma who are at increased risk of diabetes type 2.

The aim of the research was to study the frequency of occurrence of anxiety and depression in first-year medical university students in the post-holiday period.

Materials and methods. The study involved 70 first-year medical university students (average age 17,9 ± 1,31 years). The study was conducted as part of a periodic medical examination of participants during the first semester (in the early post-holiday period). The Hospital Anxiety and Depression Scale (HADS) was used.

Results. The analysis of the answers to the questions of the HADS anxiety subscale showed that more than a third of the survey participants (38,6%) had anxiety disorders, of which more than half of the participants (51,9%) needed the advice of a clinical psychologist or psychotherapist. 21,4% of participants had a feeling of tension, 27,2% - fear, 24,3% - restless thoughts, 17,1% - inability to relax, 22,8% - internal tension or trembling, 40% - restlessness, 31,4% - panic. Analysis of answers to questions on the HADS depression subscale indicated that 22,9% of students had depressive disorders, of which more than a third (37,5%) needed the advice of a clinical psychologist or psychotherapist. 27,1% of participants had a decrease/lack of pleasure from something that used to bring positive emotions, 10% - inability to laugh, 15,7% - lack of a sense of cheerfulness, 20% - slowness, 15,7% - unwillingness to monitor their appearance, 18,6% - decreased sense of satisfaction from hobbies, 20% - decreased feelings of pleasure from a good book, radio or TV program.

Conclusion. The expansion of the standard scope of periodic medical examination made it possible to screen the psycho-emotional state of students in the post-holiday period of the autumn semester and identify a risk group for the development and increase of existing anxiety-depressive disorders during the educational process, which can have an adverse effect on both the quality of life of students and the effectiveness and success of training.

The aim of the research. Examine the features of prevalence of asthenia in patients with chronic noncommunicable diseases in real clinical practice.

Materials and methods. Research includes 2 373 patients, who are under the general practitioner’s care for chronic noncommunicable diseases. These patients are 1 337 (56,3%) women and 1 036 (43,7%) men. The average age of them is 56,3±15,0 year. We asked about complains, took anamnesis, examined the organs’ systems, and reviewed patients’ cards. According these data we confirmed the diagnosis of chronic noncommunicable disease. We diagnosed asthenia thanks to Multidimensional Fatigue Inventory – 20, MFI-20 and Fatigue Severity Scale, FSS. Statistic data processing was made with applying of Mann–Whitney U test

Results. The largest amount of patients, who we examined, have cardiovascular diseases (1 474 patients, 62,1%). More than one half of all examined patients are from 18 to 60 years (1349 patients). According MFI-20, 847 patients have asthenia (35,7%). According FSS, 701 patients have it (29,5%). 57,1% patients with asthenia are people elder 61 year (484 patients). Moreover, 334 citizens among elderly patients have polymorbidity (69,1%). The level of severity of asthenia is utterly higher in patients who elder 61 year (p < 0,001). Patients with multimorbidity have more sever asthenia that patients who have only one disease (p < 0,001).

Conclusion. Results of large spread of asthenia in patients with chronic noncommunicable diseases underline the necessity of awareness of general practitioners about right assessment of asthenia in real clinical practice, especially in elderly patients with multimorbidity.

The aim of the research. To study prognostically unfavorable risk factors of the occurrence osteoporotic fractures in women over 50 years old in Trans-Baikal Region.

Materials and methods. 121 women with OP (67 Russian and 54 Buryat nationalities, average age 63.5 years) and 145 healthy women of the same age were examined. The genetic polymorphisms VDR, LCT and COL1A1 were studied by PCR. The concentrations of bone tissue metabolism markers in the blood serum of 80 women were studied.

Results. Homozygous TT of LCT 13910 C>T and recessive allele A VDR - Bsm1 c.IVS7 G>A were associated with increased risk of osteoporosis in women over 50 years of age living in the Trans-Baikal Territory. Heterozygous GА of VDR Bsm1 c.IVS7G>A, homozygous TT of LCT 13910 C>T were associated with increased risk of osteoporosis in Russian women. Homozygous АА of VDR Bsm1 c.IVS7G>A were associated with osteoporosis risk in Buryat women. The content of pyridinoline is increased in the blood serum of Russian women compared to Buryats. Independent predictors of the development of fractures were established: the TT genotype of the LCT and a high concentration of the ß-CrossLaps in Russian women, an increase in the level of pyridinoline and ß-CrossLaps in the blood serum of Buryats.

Conclusion. The study of genetic polymorphism of bone tissue metabolite genes and markers of bone resorption in blood serum can be used as an early preclinical diagnosis of low-energy fractures in women over 50 years old living in the Trans-Baikal region.

With retrograde ejaculation, the ejaculation mechanism changes: the expulsion of the seed fluid occurs in the proximal direction into the bladder.

The aim of the research. Identification of the value of determining the concentration of prostate specific antigen (PSA) in post-orgasmic urine (POM) for the diagnosis of retrograde ejaculation.

Materials and methods. 59 men (age 34,1 ± 8,9 years) were examined. The main group (n=27) consisted of men suffering from retrograde ejaculation. The comparison group (n=32) included men whose ejaculation was physiologically antegrade and who had no coitus during the previous 2 days. The concentration of total PSA in blood serum and urine was determined by solid-phase enzyme immunoassay (ELISA) using the test system "total PSA-ELISA-BEST" (T-8458) (Vector–Best LLC, Russia).

Results. The median concentration of total PSA in urine in the comparison group was 9,52 times higher than the same indicator in blood serum. When comparing the content of total PSA in the main group of patients in the morning urine, in the 1st (at the beginning of the act of urination) and 2nd (at the end of the act of urination) portions of POM, we found comparable indicators of the concentration of total PSA, no significant differences were found (the Kraskel–Wallis criterion H=0,4914, p=0,9208, with a pairwise comparison between all the studied groups of urine samples, p = 1,000000).

Conclusion. The level of PSA in the urine of men of fertile age is almost 10 times higher than that in blood serum. The presence of PSA in high concentration in the bladder urine may indicate various ways of getting this substance into the urine: retrograde casting of sperm during ejaculation and free filtration of this protein in the glomeruli of the kidney. The PSA total urine test is not suitable for laboratory diagnosis of retrograde ejaculation.

The purpose of the study is to establish the significance of the MMP12-82A>G gene SNP in the pathogenesis of community-acquired pneumonia in patients of military age.

Materials and methods. A survey of 160 unrelated patients of military age (18-20 years) living in the TransBaikal Territory was carried out. The first group (n=80) - patients with COVID-19 infection complicated by mild pneumonia (n=40) and severe pneumonia (n=40). Group 2 – clinical comparison (n=80) – patients with acute respiratory infection (ARI) of non-influenza etiology, complicated by mild pneumonia (n=40) and severe pneumonia (n=40). The control group consisted of 86 practically healthy men of the same age. Exclusion criteria: presence of family ties; patients with acute and/or chronic concomitant pathology. Research methods: clinical; laboratory (immunological - determination of metalloproteinase-12; genetic - polymorphism of the MMP12-82A>G gene); instrumental (computed tomography). The studies were carried out upon admission to the hospital. Statistical processing of the study results was carried out using the IBM SPSS Statistics Version 25.0 software package (IBM, USA).

Results. A predominance of the -82A- allele of the MMP12-82(A>G) gene was recorded in the group with ARI and -82A/G genotype in patients with community-acquired pneumonia against the background of COVID-19 infection, while in severe cases a predominance of the -82A- allele and - was noted 82A/A genotype. An increase in the concentration of MMP-12 in the main group was found to be 3.6 times compared to the same value in the control group and 1.7 times compared to the group of community-acquired pneumonia against the background of ARI. Studying the effect of SNP MMP12-82A>G on the expression of MMP-12, a tendency was noted for its content to decrease in carriers of the -82G/G genotype.

Conclusion. The -82A- allele and the -82A/A genotype of the MMP12 gene are associated with a severe course of community-acquired pneumonia (COVID-19, ARI) in patients of military age, while carriage of the -82Gallele and -82G/G genotype can be considered as a protective effect of a favorable course pathological process in the lungs. In patients of military age with community-acquired pneumonia, an increase in the concentration of MMP-12 is recorded, with the highest values in the group with severe pneumonia due to COVID-19 infection. When carrying the -82G/G genotype of the MMP12 gene, a decrease in the concentration of MMP-12 in the blood serum is recorded.

The aim of the research. To identify the relationship between the serum content of MPP-9 and the polymorphism of the MPP-9 gene (A8202G) with the severity of the course of COVID-19-associated lung damage.

Materials and methods. The paper presents the results of a survey of 200 people 1 month after suffering COVID-associated lung damage in the period from June 01 to October 31, 2020. The patients were divided into groups of 50 people depending on the degree of lung damage according to the results of computed tomography: 1st group (CT-1), 2nd group (CT-2), 3rd group (CT-3), 4th group (CT-4). The following diseases were registered in the structure of background pathology: arterial hypertension (AH), coronary heart disease (CHD), obesity, type 2 diabetes mellitus (type 2 diabetes), chronic kidney disease (CKD), COPD and bronchial asthma. The control group included 56 relatively healthy individuals who did not suffer from coronavirus infection, the median age was 55.0 [51.1; 55.0]. All groups were comparable in age and gender. The content of MMP-9 in the blood serum was studied. A molecular genetic study of the MMP-9 (A8202G) gene was also conducted.

Results. As a result of the work, a lower content of MPP-9 was revealed in the control group compared to the study groups. A higher level of matrix metalloproteinase 9 was also revealed in patients with more severe COVID-19-associated lung damage (CT-4), compared to less severe patients (CT-1).

Conclusion. Thus, taking into account the data obtained in patients after coronavirus infection with COVID19-associated lung damage, it can be assumed that an increased concentration of MPP-9 is one of the factors contributing to both lung damage against the background of infection and a factor in the severe course of this complication.

Introduction. BIRADS 3 tumors are an area of interest for the oncologist and the gynecologist considering likelihood of cancer less than or equal to 2%.

Aim. To analyze the frequency of diagnoses in BIRADS 3 of ultrasound, to determine the risk of breast cancer in women with BIRADS 3 after the first ultrasound.

Materials and methods. A prospective study was carried out, the participants of were women from the TransBaikal Regional Oncology Center with BIRADS 3 after the first ultrasound.expert-class ultrasound examination of the breast was carried out for all patients using a General Electric Voluson E6 device (Austria, 2011).The fine-needle aspiration biopsy (FNA) with cytological examination, core tumor biopsy (Biopsy needle, Italy, 14 G / 2.00 mm) with histological examination were performed according to indications.Statistical analysis was carried out using the IBM SPSS Statistics Version 25.0 program"

Results. Almost every third of the woman referred to an oncologist does not have a BIRADS gradation in the ultrasound report. Changing the BIRADS category was performed in 22.4% of cases after expert ultrasound Biopsy of tumors with the BIRADS 3 was performed in 31% cases, among them breast cancer was detected in 3,4% of cases, intraductal papilloma with atypia – 1,7%.

Conclusion. The use of BIRADS grading is necessary for the breast ultrasound, which affects the routing and examination. The management for patients with BIRADS 3 ultrasound should be individualized, considering clinical, radiological features.

The literature review examines the composition and properties of maternal breast milk and its impact on the complex process of human body development from the standpoint of modern pediatric science and practice. Various artificial feeding mixtures have a lot in common with breast milk for a number of nutrients, but there is no ideal replacement. The composition of breast milk can vary significantly depending on the lactation period, the effects of environmental factors, including the diet and lifestyle of the mother. It is noted that vitamins D and K may not be enough to ensure the normal growth of the child, therefore their additional subsidy is recommended. Previously, it was believed that breast milk of a healthy woman is sterile. However, several subsequent studies have found the presence of a diverse microflora in breast milk. Finally, mother's milk contains microRNA, which plays a role in various functions, such as immunoprotection and programming of further human development. Thus, from the perspective of rational feeding, maternal breast milk is the best possible source of nutrition for the baby.

The article presents the results of the analysis of regulatory and legal regulation and empirical research on the issues of visualization in the organization of an accessible environment of medical organizations. It has been established that the possibilities of visualization when creating an accessible environment for low-mobility groups of the population in state medical organizations are not used to their full extent, both quantitatively and qualitatively. As a methodological support for the active implementation of lean methods in the management of medical organizations, further systematization and stratification of examples of the use of visualization in the creation and improvement of an accessible environment of health care facilities is necessary.

Тhe scientific review of the historical development of reproductive health care for children and adolescents from the 19th century to the present reflects the evolution of approaches and the significance of research in modern healthcare.

The aim of the study was to study the history of the formation of the reproductive health system for children and adolescents.

Materials and methods: The study used information bases: PubMed, PubMed Central, Scopus, MEDLINE, ScienceDirect, Cochrane Library, eLibrary for the period from 1954 to February 2024. For the specified keywords: “protection of reproductive health of adolescents”, “reproductive health of adolescent girls”, “organization of adolescent health”, “reproductive health”, “preventive work”, 40 publications were found in search engines that fully correspond to the stated problem. The formation of the adolescent health care system in Russia since the early Soviet period is examined, highlighting the features of organizing preventive and medical services. The development of medical care in the post-war period is analyzed, particularly in the context of reproductive health, including the establishment of specialized clinics for children and adolescents, and strengths and weaknesses of healthcare organization are described. Additionally, the current influence of global reproductive health strategies on medical service policy in Russia is discussed. The role of outpatient and obstetric-gynecological care in providing medical-preventive assistance is emphasized, highlighting the importance of preventive work and information-educational activities. A comprehensive approach to reproductive health, including social and psychological aspects, and the significance of scientific research and initiatives in this area are examined.

Ischemic stroke is an acute, severe vascular pathology of the brain, accompanied by general cerebral and focal neurological symptoms. The occurrence of the disease is based on arterial thrombosis, leading to the formation of a focus of infarction of brain tissue. In most cases, after an acute cerebral accident, persistent neurological deficits persist in the form of motor, cognitive and other disorders. Cerebral infarction is a multifactorial disease with a complex multicascade pathogenesis. The severity of the disease, the speed of patient recovery and outcome do not always correlate with their age and the presence of underlying pathology. Therefore, at the moment, there is a certain interest in an in-depth study of the pathological processes that occur directly at the site of cerebral infarction and in the penumbra zone (ischemic penumbra). It is possible that a more detailed understanding of the ongoing pathological processes will allow us to further achieve better results in the process of treatment and recovery of patients.

The presented literature review highlights current data on the main pathological processes that occur during ischemic stroke. The role of microglia as the main regulator of the processes of inflammation, immunosuppression, degeneration and repair of nervous tissue is considered.

Chronic polypous rhinosinusitis is a multifactorial disease that is accompanied by chronic inflammation of the nasal mucosa and paranasal sinuses with its remodeling, formation and recurrent growth of polyps. Given the unfavorable epidemiological data, as well as frequent relapses of the disease, despite the use of conservative therapy and repeated surgical interventions, this disease significantly reduces the quality of life of patients. This article presents generalized literature data on the clinical phenotypes and endotypes of polyposis rhinosinusitis.

The epidemic of a new coronavirus infection provoked a second pandemic, “post-Covid”, among convalescents with a long-lasting clinical condition. Most patients who have had COVID-19 recover completely after two weeks from the onset of the disease. At the same time, every tenth person faces long-term manifestations from a number of body systems. Symptoms of post-Covid syndrome are numerous, heterogeneous and difficult to interpret. The review examines the development mechanisms and main manifestations of long-term COVID-19. Particular attention is paid to the causes and clinical variants of damage to the cardiovascular system, including endothelial dysfunction.

Bronchial asthma is a chronic disease of the respiratory tract, which is formed by the action of endogenous factors and environmental influences. At the same time, T-helpers of the second type play a major role in the development of bronchial asthma, causing hyperreactivity and inflammation of the respiratory tract. However, the data that bronchial asthma in most cases is an allergic, eosinophilic, T-helper-mediated disease of the second type is insufficient to establish complete control over the course of disease. This is probably due to the fact that endogenous factors play an important role in the pathogenesis of asthma, knowledge of which is currently limited. Toll-like receptors are an established element of the development of bronchial asthma. Their insufficient function or, conversely, the launch of an excessive immune response is associated with the initiation of the disease or its exacerbations. Expanding the understanding of Toll-like receptors leads not only to a more detailed understanding of the pathogenesis of bronchial asthma, but also to the application of this knowledge in practice.

Hereditary angioedema refers to life-threatening, orphan diseases and is characterized by recurrent edema in deep dermis of various localization. It is associated with a deficiency or decrease in C1-inhibitor function or does not depend on it. Genetic variants in the SERPING1, FXII, PLG, ANGPT1, KNG1, MYOF, and HS3ST6 genes lead to hereditary angioedema. Some of these genes are involved in the metabolism of bradykinin, others influence the permeability of the endothelium. In total, we identified 1078 articles, 40 of which are included in the review. This review emphasizes the importance of further research of the molecular features of these diseases and, treatment.

The article presents a review of literature sources highlighting the issues of clinical and laboratory diagnosis of hemophagocytic lymphohistiocytosis in children. The authors of various observations have repeatedly emphasized hemophagocytic lymphohistiocytosis continues to be a life-threatening disease despite modern implementations in diagnosis and treatment. At the same time, the prognosis and outcome are largely determined by the timeliness of diagnosis and the right tactic. The review is illustrated by a clinical example of a fatally ended case of an infant, he was diagnosed posthumously based on the results of a molecular genetic tests.

Kawasaki syndrome is characterized by damage to the coronary arteries with the formation of aneurysms, which persist and progress after the completion of the acute stage of the process and cause hemodynamically significant stenoses and thrombosis. The literature research data on cardiac pathology in patients with Kawasaki syndrome are presented. A clinical case of a young non-mongoloid patient with a high probability of Kawasaki syndrome suffered in childhood is described. Repeated myocardial infarctions, multiple aneurysms of characteristic shapes and sizes in the coronary arteries are confirmation of this disease. With the development of coronary pathology in young people, when conducting a diagnostic search, it is necessary to remember about the Kawasaki syndrome.

The aim of the research is to assess stress levels and stress resistance in anesthesiologists and intensive care physicians.

Materials and methods. The study includes 149 anesthesiologists and intensive care physicians working in the Russian Federation. The average age of respondents was 37,2 ± 12,1 years. Depending on age, all participants were divided into groups III: group I (under 29 years old) – 45 (30,2%) people, group II (30- 49 years old) – 77 (51,7%) and group III (over 50 years old) – 27 (18,1%) people, the sex distribution was approximately the same: 77 women and 72 men, among them 82 doctors had a family and 67 people were single. The average work experience in the specialty was 11,2 ± 11,0 years. The average diploma score of the university was 4,21 ± 0,39.

Study results. It was revealed that 35% of respondents are introverts and 58% showed themselves as emotionally stable extroverts. When analyzing the results of testing according to Lusher, it was found that the majority of respondents at the first presentation of eight cards chose blue as the main color, which indicates the need for calm and peace. The maximum level of neuropsychiatric tension was characteristic of doctors working for days: 42,5 ± 9,3 points, with a minimum score of 30 points and a maximum score of 71 points. Women were characterized by higher rates, but this was not statistically significant. There was a strong statistically significant negative correlation between the level of NSP and age r = - 0,80, p < 0,05) and a direct correlation with health status (r = 0,83, p < 0,05). There was also a statistically significant direct correlation between neuropsychiatric tension level and stress resistance (r = 0,36, p < 0,05).

Conclusion. The majority of anesthesiologists and intensive care physicians are characterized by extraversion, a high level of internality and sensitivity, the need for calm and peace, while the main priority in the practical activities of anesthesiologists-resuscitators is situational orientation.