The formation of the oncology service in the USSR became a logical step in the development of healthcare and responded to a new challenge in the era following the discovery of antibiotics - an increase in mortality from malignant neoplasms. The process launched in the scientific centers of the country was continued in the regions, where both an independent oncology service and a scientific and educational base for training oncologists, as well as specialists in the general medical network, were being formed. Oncology service in Astrakhan region has come a long way thanks to the efforts of many outstanding doctors and health care organizers.

The prevalence and risk factors associated with acute and chronic urticaria in children were analyzed for the period 2015–2025. Based on literature review, there was an increase in the incidence of urticaria to 2.1–6.7 %, especially in chronic forms among adolescents. A clear distinction was made between the etiopathogenesis of acute and chronic urticaria. The study showed that the reaction of a sensitized child's body to exogenous triggers is predominantly of allergic origin in case of acute urticaria, while in case of chronic urticaria, it is endogenous mechanisms, including comorbid pathology. A clear association between chronic urticaria and autoimmune diseases (including autoimmune thyroiditis), chronic inflammatory processes, parasitic infections, and anxiety disorders has been identified. The study concluded that an interdisciplinary approach to the management of such patients is necessary, with mandatory screening for concomitant pathology, which is essential for achieving stable remission and improving the quality of life for patients with acute and chronic urticaria.

The article presents the results of research by foreign and domestic authors on the role of melatonin in women's reproductive health. Melatonin (N-acetyl-5-methoxytryptamine) is the main hormone of the pineal gland and has a wide range of biological effects, including antioxidant, immunomodulatory, cancer-protective, antidepressant, anticonvulsant, hypocholesterolemic, and hypoglycemic effects. In the reproductive system, it promotes follicular maturation, gametogenesis, fertilization, and embryo implantation, protecting reproductive cells and chorionic tissue from free radicals. By systematizing existing knowledge, it will be possible to justify the need for research on biomarkers in reproductive system dysfunction, particularly in secondary functional oligomenorrhea.

The serous cavities fluids examination, in particular, peritoneal fluid, has diagnostic importance. Biocrystallomics studies the dried droplets dry residue (facies) of biological fluids in normal conditions and in various diseases. The aim of the research was to study the peritoneal fluid solid phase structure in normal and peritonitis of various origins in an experiment on laboratory rats. Material and methods. The experiment was conducted on 125 rats, which were divided into four groups. The first group included intact animals, the second group consisted of individuals with experimental fecal peritonitis, divided into three subgroups (10, 15, and 20 % fecal suspension), the third group included urinary peritonitis, and the fourth group included chemical peritonitis. The peritoneal exudate solid phase structure was studied by wedge-shaped dehydration. Results. The facies of the peritoneal fluid of healthy animals were similar in structure, related to the conditionally radial type, and there were no pathological markers. Facies of abdominal effusion in animals with fecal and chemical peritonitis had a similar specific structure, which we called "craquelure"- facies – of the irradiated type with a multitude of three-ray, Y-shaped, cruciform cracks passing into one another. In the exudate facies structure of rats with urinary peritonitis, both common markers of intoxication processes and congestion phenomena in the form of toxic plaques, separated three-ray cracks, and special oval and rhomb-shaped inclusions were distinguished. Conclusions. The facies of the peritoneal fluid of intact animals corresponded to the facies pattern of a fluid with a small amount of protein and salts. The peritoneal fluid facies in fecal peritonitis were characterized by a "craquelure" structure consisting of three-ray cracks, contained Y-shaped cracks, and toxic plaques. The solid phase structure characteristic features of the peritoneal fluid of rats with urinary peritonitis were the irradial type of facies, the presence of separated three-ray cracks, streak cracks, rhomb-shaped and oval inclusions. The chemical peritonitis animal’s peritoneal fluid facies were similar to those of rats with fecal peritonitis.

Currently, the worldwide increase in the spread of myopia in children and youth is a serious problem. With the progression of myopia, there is a possibility of complications that lead to decreased vision. That is why it is important to develop models for predicting the occurrence of myopia in order to identify risk groups. The purpose of the study is to develop predictive mathematical models of classification trees for calculating the probability of myopia in children and youth. Material and research methods. 3,599 schoolchildren and students of the city of Krasnoyarsk were studied, of which 2,038 were female from 6 to 20 years old and 1,561 were male from 6 to 21 years old. All respondents were divided into two groups – patients with myopia and a control group with emmetropia. All subjects underwent comprehensive measurement of somatometric, cephalometric and ophthalmological parameters. Research results. Two decision trees have been developed to predict the likelihood of myopia. According to the first classification tree, the highest probability (83.9 %) of developing myopia was observed in males when identifying such characteristics as: the age groups of adolescence and adolescence, the values of the Rees-Eysenck index less than 103.7 and the facial index lower than 89.9. Female individuals are at the highest risk of developing myopia, equal to 83.9 % if they match There are three conditions: being in the age categories of adolescence or adolescence, a body mass index below 20.2 and a head index less than 75.9. When studying ophthalmological parameters, it was revealed that the probability of developing myopia reaches the highest probability (93.4 %) in subjects with an eyeball length greater than or equal to 24.3 mm, a radius of curvature of the corneal plane meridian less than 8.1 mm and an accommodation volume less than 8.0 dpt. Conclusion. The use of mathematical classification models "decision trees" makes it possible to identify risk groups for predicting the occurrence of myopia and carrying out preventive measures.

Transient ischemic attacks are short-term disturbances of cerebral circulation, often preceding the development of ischemic stroke. One of the key causes of transient ischemic attacks is increased blood clotting associated with atherosclerosis and arterial hypertension. Objective. To evaluate the parameters of the blood coagulation system in patients with transient ischemic attack, to identify the risks of thrombus formation and complications. Material and methods. The study included 160 patients with transient ischemic attack, divided into groups depending on the affected area (carotid and vertebrobasilar basins). A study of the parameters of the coagulation system was carried out: activated partial thromboplastin time, prothrombin time, fibrinogen concentration and antithrombin III activity. Results. Patients with transient ischemic attack had a significant increase in fibrinogen levels and a decrease in antithrombin III activity, indicating hypercoagulation. The most pronounced changes were found in lesions of the vertebrobasilar basin. A correlation was also found between blood pressure and the severity of changes in the hemostasis system. Conclusion. The data obtained emphasize the importance of monitoring blood coagulation parameters in patients with transient ischemic attack to reduce the risk of stroke. An individual approach to treatment, including correction of hypercoagulation, is necessary.

Tuberculosis is one of the most serious global medical problems today. Since 2009, the Russian Federation has seen a positive trend in the main epidemiological indicators for tuberculosis, such as incidence and mortality. The detection and successful treatment of tuberculosis patients are essential for achieving epidemiological well-being in this disease. Objective: to study the genetic polymorphism of HLA system genes in the DQA 1* locus in patients with pulmonary tuberculosis in the Astrakhan region. Materials and methods. The polymorphism of HLA system genes in the DQA1* locus was studied in 34 patients who received inpatient treatment. The study included an analysis of the age and sex composition of the patients, clinical and radiological data, the frequency of occurrence of various DQA1* alleles, and the drug resistance of the pathogen. Results. It was found that the HLA-DQA1-0501* allele is significantly more common in patients with tuberculosis, especially in those with recurrent disease. Carriage of this allele was associated with a more severe course of tuberculosis, including extensive damage to the lung tissue, frequent formation of cavities, and bacterial excretion. In contrast, patients with alleles 0103* and 0301* did not exhibit bacterial excretion. Conclusion. It has been established that the DQA1 0501* allele can be a prognostic marker for progressive tuberculosis.

The relevance of measures to ensure immunological safety of transfusion therapy in a medical organization is demonstrated. The main purpose of the study was to analyze the results of establishing the specificity of alloimmune anti-erythrocyte antibodies in recipients, as well as to compile a priority scale for transfusion-dangerous antigens in the Perm region. The materials for the study were the results of the determination and identification of alloimmune anti-erythrocyte antibodies in recipients of the Perm region for the period 2022–2024. Research results. The study made it possible to establish a priority scale for transfusion-dangerous antigens in the Perm region. It was shown that some of the erythrocyte antigens that are not included in the mandatory list of studies in the recipient are highly immunogenic and can cause the development of post-transfusion hemolytic complications. Attention should be paid to the validity of transfusion of erythrocyte-containing blood components, repeated screening of alloimmune antibodies in recipients, as well as training of doctors involved in the clinical use of donor blood components on issues of transfusiology and immunohematology. The case of the development of a hemolytic post-transfusion complication is considered, the probable causes of its occurrence are proposed, attention is drawn to the data of immunohematological studies and the necessary preventive measures.

Chronic lymphocytic leukemia is the most common form of leukemia and is usually, diagnosed in older patients. Objective. To evaluate the impact of therapy on the overall comorbidity of patients with chronic lymphocytic leukemia. To analyze the effectiveness of using the CCI and CIRS-G scales to assess comorbidity in patients with chronic lymphocytic leukemia. Materials and methods. The medical histories of 67 patients with chronic lymphocytic leukemia were analyzed, and the comorbid status was assessed both at the time of diagnosis and after specific therapy. Out of the total number of patients, 53 were men (79 %) and 14 were women (21 %), with a median age of 64 [54; 71] years. Two scales were used to objectively assess the level of comorbidity: the Charlson Comorbidity Index (CCI) and the Comorbidity Index for the Elderly (CIRS-G). Results. During the study, a subgroup of 9 patients was identified who did not require specific therapy. As a result, of the therapy, 42 (72 %) patients experienced complications, while 16 (28 %) patients tolerated the therapy without complications. When calculating comorbidity using the CCI scale, there was an increase in the number of patients with high levels of comorbidity from 22 to 28, and using the CIRS-G scale, there was an increase from 43 to 45, highlighting the negative impact of the therapy on patient outcomes. Conclusion. The CCI and CIRS-G scales allow only an approximate assessment of the comorbidity of treated patients, as the CCI does not include conditions such as polyneuropathies, immunodeficiency conditions, thrombosis, arrhythmias, gastritis, and the CIRS-G scale does not include conditions such as thrombosis and immunodeficiency conditions. This indicates the need for a more comprehensive comorbidity assessment scale.

The article examines the legal aspects of innovative non-pharmacological intervention for a broad range of patients, involving remote interaction through gamified approaches. The key legislative acts regulating this methodology are outlined and described in detail. A generalized framework of laws and regulations governing this practice is presented. Special emphasis is placed on the protection and processing of patients' personal data. Examples of gamified interventions are provided. The moral, ethical, and deontological principles of patient gamification are discussed. The feasibility of implementing this methodology in real-world clinical practice, considering the specifics of the Russian healthcare system, is assessed.

Among the complications of tracheostomy, massive bleeding from large vessels of the neck is recognized as the most severe and often becomes fatal. The objective is to present a case of successful stopping of arterial bleeding from the brachiocephalic trunk in a patient with a persistent lower tracheostomy. The technical aspects of the performed surgical intervention are described - access, features of manipulations with a large arterial vessel.

The treatment of giant incisional ventral hernias with significant loss of domain is a major surgical challenge associated with a high risk of abdominal compartment syndrome and recurrence. Aim. To demonstrate the effectiveness of the combined use of preoperative injection of botulinum toxin A into the broad muscles of the anterior abdominal wall and intraoperative fascial traction in the complex treatment of postoperative ventral hernia W3 with a pronounced domain loss of 53 % based on a detailed analysis of the clinical case and current literature data. Materials and methods. A detailed analysis of the clinical case of a 55-year-old patient with incisional ventral hernia W3 (large) M3 (midline) R0 (primary), characterised by a significant loss of the abdominal domain (more than 30 % of the contents in the hernial sac) and multiple concomitant pathology is presented. The uniqueness of the case is the combination of a pronounced domain loss (53 %) with a narrow hernia gate (11 centimeter), which in typical situations is associated with moderate domain loss (10–25 %) and a lower risk of complications. Here, narrow gates and domain loss increase the risk of abdominal compartment syndrome during reduction without preparation, requiring a combined approach with botulinum toxin A and fascial traction. 4 weeks before the operation, 300 International Units Botulinum toxin A was administered to relax the muscles of the abdominal wall. Intraoperatively, fascial traction was applied to restore the volume of the abdominal cavity. Intra-abdominal pressure was controlled through a catheter in the bladder. Postoperative management included monitoring of vital functions and prevention of complications. Results. Injection of Botulinum toxin A into the broad muscles of the abdominal wall during the pre-rehabilitation period provided lengthening of the broad muscles of the abdominal wall by 3-5 centimeter on each side. Intraoperative application of intraoperative fascial traction (30 minutes of vertical diagonal traction) allowed to achieve adequate comparison of the edges of the defect measuring 20×10 centimeter without performing traumatic component separation. The intraabdominal pressure after reconstruction was 12 centimeter of water (initially 8.5 centimeter of water), which prevented the development of abdominal compartment syndrome. The patient was discharged on the 12th day in a satisfactory condition with wound healing by primary tension. Conclusion. The combined use of Botulinum toxin A and intraoperative fascial traction is a pathogenetically sound and clinically effective strategy for the treatment of complex incisional ventral hernias with domain loss. This approach allows you to minimise surgical trauma, reduce the risk of postoperative complications and improve functional results.

There is strong evidence in the literature on the effect of multiple antimicrobial resistances on the course of the disease. There is also evidence that coronavirus disease 2019 affects the development of antibiotic resistance. The aim. To evaluate the course and outcome of the postoperative period in patients with infectious endocarditis against the background of coronavirus disease 2019, depending on the indicators of antibiotics. Materials and methods. A retrospective analysis of the case histories of 10 patients (men, aged 47 to 70 years) with infective endocarditis, who were treated at the Federal State Budgetary Institution Federal Center for Cardiovascular Surgery (Astrakhan) from 2020 to 2023, was carried out. Patients in the presence of coronavirus disease 2019 were divided into 2 groups: group 1 (n = 5) – patients with infectious endocarditis and coronavirus disease 2019; group 2 (n = 5) - patients with infectious endocarditis without coronavirus disease 2019. Diagnosis of infective endocarditis upon admission to the hospital and assessment of antimicrobial therapy was carried out using microbiological studies in accordance with the requirements of the legislation of the Russian Federation. Patients in the groups were comparable in gender, age and severity of cardiovascular pathology. The results. In patients of the 1st group, antimicrobial resistance at admission to the hospital averaged 97.33 %, in patients of the 2^nd – 40.81 %, which is 56.52 % lower than in the 1st group. This indicated the role of coronavirus disease 2019 in the development of resistance in patients with infectious endocarditis. Group 1 with multiple and choice drug resistance had an unfavorable outcome. The performed study revealed multiple antibiotic resistance of bacterial hemoculture in patients with infectious endocarditis and coronavirus disease 2019 associated with a severe course, which gives reason to consider it a risk factor for an unfavorable outcome of the disease. Since the treatment of patients with multiple resistance is problematic, it is possible to recommend the results of the analysis of accumulated observations to improve the existing clinical recommendations for the treatment of infectious endocarditis in patients with coronavirus disease 2019.