Recently, there has been a constant increase in diseases of the gastrointestinal tract, and in particular of the small and large intestines, throughout the country. The number of surgical interventions on the small and large intestine is steadily increasing due to the growth of inflammatory diseases and neoplasms of the gastrointestinal tract that end with the elimination of permanent or temporary intestinal stoma. The basic principle of the removed intestinal stoma is that the passage of intestinal contents is diverted from the site of pathology by removing the end or loop of the intestine through the anterior abdominal wall in the form of a stoma, which is removed on a temporary or permanent basis.

Surgical interventions for diseases of the small and large intestine ending with the removal of the stoma are very diverse. Nosological forms leading to the development of intestinal obstruction most often include both benign and malignant tumors of various parts of the colon, diverticula of the colon, ulcerative colitis, Crohn's disease.

Formed intestinal stomas lead to a decrease in the patient's quality of life and disability. Therefore, the formation of intestinal stomas and reconstructive plastic surgery in patients with various types of stomas are an urgent problem of modern surgery.

Long-term therapy with glucocorticosteroids (GC) is widely used in rheumatic and autoimmune diseases due to their anti-inflammatory and immunosuppressive effects. However, GC therapy can also cause a number of side effects, such as loss of muscle and bone mass, increased blood pressure, metabolic disorders with the development of obesity. This review examines the available literature data in the field of dietetics and nutritionology, which can be recommended to patients who are on long-term therapy with GCS to reduce possible side effects.

The clinical, immunological and endoscopic features of anastomositis were studied in patients after the stomach resection according to Billroth II in various modifications because of peptic ulcer disease. The study revealed the relationship in development of anastomositis with the level of populations T-lymphocytes, immunoregulatory index, circulating immune complexes, R-proteins in the early postoperative period as well as before the operation. Disturbances in the immune system may lead to decrease in stability of mucosa and to the increase of aggressive factors. The severity of disturbances in the functioning of the immune system is interrelated with the presence of Helicobacter pylori infection. The higher the antibody titers to the antigen CagA Helicobacter pylori, the more severe there may be the manifestations of immunopathological reactions and the more severe the clinical signs of anastomositis. Immunological indicators and their dynamics may be used both for the early diagnosis of anastomositis, and for the prognosis and prophylaxis of this postoperative complication.

The article presents the regional experience of organizing immunoprophylaxis of respiratory syncytial viral infection in premature infants, including those with bronchopulmonary dysplasia, with palivizumab is presented on the basis of Regional Children's Clinical Hospital named after. N.N. Silischeva. In the follow-up of children who received this drug for the observation period from 2019 to 2021, the following were noted: the absence of side effects and undesirable effects of the drug, high adherence of parents to treatment with palivizumab, the advantages of a centralized approach to organizing the prevention of RSV infection in premature infants from the high-risk group in the Astrakhan region.

This study was conducted to determine the risk factors and their prognostic significance as predictors of early pregnancy loss.

Materials and methods. Retrospective study examined 214 data patients: social factors, information about obstetric and gynecological history, extragenital diseases, results of clinical and laboratory, instrumental examinations, features and complications of a real pregnancy. To predict we used Bayesian model with A. Wald analysis, calculating prognostic coefficients significant factors identified during the study and their informativeness were assessed by E.V. Gubler and S. Kulbak methods. Predictive coefficients of aggressive and protective factors affecting the peculiarities of the course and termination of pregnancy. Study results. Retrospective review of medical records allowed determine 14 risk factors for early gestational loss: the patient's age is 29 years or more, tobacco smoking, non-developing pregnancy, spontaneous abortions and ectopic pregnancy in history, early loss in the unborn, inflammatory diseases of the genitals, cytomegalovirus infection, one or more C-sections history, organ surgery abdominal cavity, obesity, uterine fibroids, planned in vitro fertilization. With taking into account the identified factors, a prognostic model was compiled, which allows for 95% accurately calculate the prognosis of the course of pregnancy. Based on the obtained values prognostic coefficients formed a table of pre-ravidar assessment of the risk of loss in early dates of gestation.

Conclusion. The study made it possible to identify risk factors and calculate them prognostic significance in the realization of early pregnancy loss. Created the prognostic table allows in the pregravidar period to formulate an accurate forecast in the ratio of early pregnancy losses and, if necessary, a rational pregravidar preparation. 

The paper presents the results of the study of routine blood parameters of laboratory rats in the conditions of the Astrakhan region. The aim of the work was to detect possible differences in the blood parameters of rats grown in the Astrakhan region from the values presented by the authors of other regions. As an object of study, 180 outbred rats were used, the blood of which was analyzed by 34 parameters. Small statistically significant differences were found in the blood parameters of rats in the Astrakhan region compared with laboratory animals from other regions. These differences can be associated with a number of environmental factors, namely: climatic differences, differences in atmospheric pressure, peculiarities of the composition of regional raw materials for the food base of laboratory animals.

A personalized approach to providing dental care for patients with background polymorbid pathology has a certain vector, primarily associated with the features of the course of background somatic diseases and the stressful situation that arises during a dental appointment. In this regard, the predictive-preventive paradigm actualizes the problem of specialized psychosomatic pre-medication for dental patients with polymorbid diseases. In the medical protocol for dental patients with background somatic pathology a personalized selection of diagnostic and treatment methods is recorded.

The autonomic nervous system is particularly susceptible to stress. The results of a study of prospective features of heart rate variability in primary school children who have experienced the stress of military operations are presented. 128 children of primary school age who found themselves in the zone of active hostilities were under observation. The assessment of vegetative functions was carried out by analyzing the components of heart rate variability. The younger students of the Io group had a more pronounced sympathicotonia already a year after the start of the stress factor exposure. By the end of the third year, the sympathicotonic orientation of the regulation of the heart rhythm was replaced by vagotonic in children living in the territory of the stressful situation of the war. The peculiarities of vegetative regulation in children who are and have left the combat zone indicate an increase in the costs of the functional reserve to maintain the normal level of functioning of the body.

Fundamental research on human fetal anatomy today has serious applied significance for the implementation of the principles of prediction and prevention of congenital pathology. The aim is to give an anatomical characteristic of the dental alveoli of the mandible of the fetus in the intermediate fetal period of human ontogenesis.

Materials and methods. 110 lower jaws of human fetuses of the second trimester of different sex were studied using ultrasound scanning and morphological techniques.

Results. In the body of the mandible, dental alveoli can be visualized using morphological techniques throughout the intermediate fetal period of ontogenesis and by ultrasound scanning from week 19 of intrauterine development in an amount of 8-10. The average sizes of the dental alveoli are 2.2±0.6 mm for medial incisors, 2.3±0.7 mm for lateral incisors, 2.4± 0.7 mm for canines, and 3.3±1.0 mm for molars. Dental alveoli of the lower jaw in fetuses from 14 to 28 weeks of fetal development grow with a growth intensity range of 57.8-83.3%. The incisors and canines change heterochronously from 14 to 23 weeks of gestation with a growth rate of IR=51-52.6%, from 24 to 27 weeks of pregnancy with a growth rate of 34%-34.5%. The dental alveoli of molars are characterized by uniform growth.

Conclusion. The anatomical features of the structure of dental alveoli have been established, which can be used as additional markers for the detection of congenital pathology of the fetus during a screening study of pregnant women. 

The results of the use of non-invasive lung ventilation (NIV) with the creation of positive airway pressure (Positive Airway Pressure) or PAP-therapy in patients with fibrosing interstitial lung diseases (FILD) are presented. The assessment of the initial functional status and the dynamics of changes was carried out using a cardiopulmonary exercising test (CPET).

Objective: to evaluate the effectiveness of PAP-therapy, as one of the methods of respiratory support, in patients with FILD using CPET.

Materials and Methods: The study included 35 patients with clinically-radiologically or histologically verified FILD, among them, 60% were idiopathic pulmonary fibrosis, 31 % – exogenous fibrosing-type allergic alveolitis, 9 % – pleuroparenchymal fibroelastosis. All patients underwent CPET at baseline, after which they were randomized into 2 groups: the main group A – 18 people who received PAP-therapy for 1 month and the control group B – 17 people who did not receive respiratory therapy. A month later, all patients repeated CPET in dynamics.

Results of the study: after 1 month of PAP-therapy in patients of the study, the main group A, there was a statistically significant change in some indicators of CPET, such as an improvement in the ventilation-perfusion ratio, in the form of a decrease in the VD/VT (p = 0,09), an increase efficiency of the work performed (decrease in VO₂/WR(p=0,02)), increase in the power of the work performed (MET (p=0,02), wt/kg (p=0,03)). In patients of the control group B after 1 month no statistically significant changes in CPET indicators were found. Comparative analysis between groups also confirmed more efficient oxygen delivery in group A.

Conclusion: we can assume a positive effect of a short-term course of NIV respiratory support on the functional status of the respiratory system in FILD patients, in particular, an improvement in the ventilation-perfusion balance at rest and during exercise, as well as an increase in exercise tolerance.

The purpose of the study: to study the features of the organization of the work of the TB hospital in the city of Kemerovo during the COVID-19 pandemic.

Materials and methods. The analysis of the work of inpatient departments of the Kuzbass Clinical Phthisiopulmonological Medical Center named after V.I. I.F. Kopylova in 2020.

Research results. Regional regulatory documents on the organization of anti-tuberculosis activities from March 2020 to December 2020 were analyzed. A continuous observation of 81 cases of co-infection with COVID-19/tuberculosis was carried out. Despite the difficulties in the new conditions in the course of the administrative management of the activities of the phthisiopulmonological center, the effectiveness of the use of anti-epidemic measures was noted.

Conclusion. The rapid deployment of a system of administrative and organizational measures made it possible to prevent the massive spread of COVID-19 among patients in the TB hospital.

The aim of the study: to assess the significance of the study of the state of the pelvic floor in women of reproductive age who have risk factors for the development of pelvic organ plolapse; to evaluate the effectiveness of an electric exercise machine in combination with Kegel exercises in the prevention of pelvic organ prolapse.

Matherial and methods: 363 women with a history of vaginal childbirth were examined, which, depending on parity and body mass index, were divided into 4 groups. Ultrasound measurement of the height of the tendon center of the perineum, the width of the muscle bundles of the levator legs (m. bulbospongiosus, m. bulbocavernosus), the angle of urethral incline (alpha angle), vesico-urethral angle (betta angle), the length of the urethra was performed.

The results of the study: obtained indicate the expediency of performing ultrasound scans with study of the muscles that form the pelvic floor in women who gave birth with perineal trauma, for early detection of pelvic floor insolvency. The effectiveness of using electric exercise machines in combination with a set of physical exercises to strengthen the pelvic floor muscles in women with preclinical manifestations of pelvic floor muscle failure has been proven.

In recent years, the role of microcenosis in the occurrence and progression of the pathology of various organs, including cervical cancer, has been actively discussed.

Purpose: to study the cervical microflora in a patient with moderate cervical dysplasia.

Material and research methods. An extended microbiological study of cervical mucosal cultures and cervical biopsy was performed in a patient with moderate cervical dysplasia. Cervical biopsy microcenosis was studied using a MALDI-ToF mass spectrometer (Bruker). The biocenosis of the cervical canal was studied on the basis of the polymerase chain reaction method, the Digene HPV test system test and bacteriological examination.

Research results. In the biopsy specimen of the cervix, a microflora not typical for the cervical biotope was found. In particular, microorganisms were found in the tissue of the cervix, which can cause the development of pathology of the oral cavity (Streptococcus oralis, Streptococcus mitis, Streptococcus anginosus, Streptococcus sanguinis) or intestinal dysbiosis (Alloscardovia omnicolens). At the same time, these bacteria were not found in the mucous membrane of the cervical canal.

Conclusion. Further research is needed to understand the causes and consequences of biocenosis differences in the altered tissue of the cervix and cervical canal.

The relevance of the topic is caused by the insufficient acquaintance of Klatskin's tumor, or the portal cholangiocarcinoma, among the general practitioners, because of the evident rarity of the disease and poor information available for the practical doctors, especially internists, upon the modern opportunities of its clinical manifestations, differential diagnosis and methods of treatment of this pathology. Clinical observation of the portal cholangiocarcinoma at the man of 66 years old is described from the moment of the first complaints/ The difficulties at establishment of the final diagnosis, with the description of modern laboratory toolinstrumental methods of medical visualization, the technics of medical interventions and chemotherapy are represented. A clinical case of this disease is presented.

Aortic thrombosis is a rare, but severe and dangerous manifestation of increased thrombosis in the neonatal period. The presented clinical case demonstrates the features of the clinical course of infrarenal abdominal aortic thrombosis in a full-term newborn. Laboratory and instrumental data are described, as well as the methods of treatment used. Despite the therapy, a fatal outcome occurred on the 26th day of life. The described clinical case expands the understanding of the possible causes, clinic, diagnosis and choice of therapies for this condition in newborns.

The localization of the ovum in the postoperative scar on the uterus is considered as a variant of ectopic pregnancy with a high risk of maternal morbidity and mortality. A clinical case of diagnosis and treatment of a patient with ectopic pregnancy in the uterine scar after caesarean section, complicated by uterine bleeding, is described in the article. The clinical features and ultrasound diagnostic criteria are provided. Justification of the treatment tactics with hysterectomy is provided, taking into account the status of the patient, changes in the postoperative uterine scar, concomitant gynecological pathology and willingness of the patient to accomplish the childbearing function.