Over the past two decades, there has been an increase in the popularity of procedures using hyaluronic acid-based products. In parallel with this, the number of drugs with insufficiently purified hyaluronic acid is growing, in order to reduce the cost of the product, which leads to the development of unwanted adverse reactions (ADRs). The pathogenesis of some reactions is not fully understood, which makes their diagnosis and treatment difficult. The article discusses the types of NPD, factors influencing their development, as well as options for their correction.

Recently, due to the increase in intestinal diseases, there has been a tendency to increase the number of stomatized patients. It has been statistically proven that the elimination of intestinal stomas is fraught with the development of inflammatory phenomena in the area of the removed stoma in the early postoperative period, leading to the development of parastomal abscesses and phlegmon, which in turn are risk factors for the formation of parastomal hernias in the long-term postoperative period. A parastomal hernia makes it difficult to care for the stoma, thereby reducing the quality of life. The presented work provides an overview of the literature data on various methods of preventing the formation of parastomal hernias. In addition, methods for closing a stomal wound during the elimination of intestinal stomas are presented in order to prevent the development of complications after reconstructive operations.

Prognosis of outcome of the burn injury depends on recovery speed of damaged layers of derma, therefore execution of the authodermoplasty stays the main principle of the burn injury treatment. However, local infectious complication retard processes of reparation and epithelization of tissues, hinder the engraftment of the donor skin graft, promote the lasting of healing of the donor wounds. But penetration of pathogenic microflora via damaged skin covers leads to infectious generalization with development of multiple organ failure, sepsis, pneumonia, to the increase of lethal outcome quantity. Considering the role of infection in a structure of mortality of burned patients, the significance to study of its etiology, pathogenesis and treatment does not raise doubts. Opportunistic microflora, causing hospital-acquired, or nosocomial, infections, plays a great role in the development of the similar condition in severely burned patients. Among these representatives are Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii and Enterobacteriaceae spp. The main clinical significant characteristics of such flora are multiresistance to most antimicrobial drugs, high prevalence in hospitals, and the ability to form biofilms on the surface of burn wounds. It should be noted that with every year the trend of antimicrobial resistance is increasing, and the number of resistant strains is also increasing. Therefore, it is getting more difficult to select adequate antibacterial treatment schemes for severe complicated burn injuries. The prescription of empirical therapy for nosocomial infections in burn patients should be based on the results of monitoring the microbial flora and determining its sensitivity to antibacterial drugs. In addition, methods of local treatment of wounds are constantly being improved using special wound dressings with antiseptic solutions and bacteriophage. To improve treatment rates for such patients, it is necessary to evaluate not only the local state of the wound surface, the degree of bacterial contamination of wounds and systemic inflammation during the entire period of hospitalization, but also the state of the epidemiological situation in burn care hospitals.

Hypoxia is a condition that occurs when there is a decrease in the normal level of oxygen due to a decrease in the availability or delivery of this gas to cells and tissues. It is important to note that hypoxic conditions occur in many diseases. With a low oxygen content in tissues and cells, numerous physiological and pathological changes occur. The article summarizes information from the scientific literature on the effect of hypoxia on the immune system. The analysis shows that the lack of oxygen has a significant effect on the regulation of the immune response. This influence is mediated by a family of factors induced by hypoxia. Among them, the most studied is HIF-1α. The action of factors is carried out by various mechanisms. The influence of factors induced by hypoxia was registered in the analysis of the function of all cells of natural and acquired immunity.

Premature birth and premature birth are among the main causes of infant mortality. This article provides an overview of the literature, including scientific studies, meta-analyses and systematic reviews related to preterm birth in the period from 34 to 36 weeks of pregnancy. According to the results of the study, sources in recent years have once again confirmed that understanding risk factors, prognosis and effective management strategies is an important resource for preventing premature birth and improving pregnancy outcomes.

To compare blood creatinine levels in children with constitutionally exogenous obesity and in children without obesity. Materials and methods of research. The analysis of serum creatinine levels (Jaffe colorimetric method) was carried out in 162 children with constitutionally exogenous obesity, including overweight children, grade 1–4 obesity and 178 children of the control group who were treated in the Department of endocrinology of the Regional Children's Clinical Hospital of Astrakhan in the age range from one and a half to 17 years. The study period was more than 10 years. The criterion for exclusion from the study was the absence of concomitant pathology of the urinary system. The results and their discussion. When comparing serum creatinine levels in two groups of children (obese and non-obese), a significant increase was found in the group of children with constitutionally exogenous obesity. Thus, creatinine in the blood ≥ 120.0 mmol/l was recorded in 25 children out of 162 examined with constitutionally exogenous obesity and in 3 children out of 178 without obesity (χ ² = 19.43; p < 0.00001). The highest serum creatinine levels were recorded in children with obesity of 1–2 degrees. Conclusion. Constitutionally exogenous obesity is associated with chronic impairment of nitrogen excretion function of the kidneys.

Perioperative nutritional support is one of the important components of complex surgical treatment of the esophagus and stomach. According to various authors, protein-energy deficiency in cancer patients in 20–80 % of cases with cancer reduces body weight – an independent predictor of permanent continuation of the disease. Surgery, as one of the treatment methods, which is the strongest stressor, causes catabolic reactions, significantly increasing the loss of protein and energy in patients. However, at present, the need to prescribe artificial nutrition in the perioperative period is questioned and there is no consensus on artificial nutrition in the perioperative period. Numerous comparative studies and recommendations for its implementation are very diverse. Given the widespread use of nutritional mixtures, a thorough study of the effect of nutritional support on the dynamics of hematological and biochemical parameters in this pathology is required.

The aim of the study was to develop methodological approaches for the production of heterogeneous antigens common to humans, animals (guinea pig) and microorganisms (pathogens of plague and brucellosis), and antibodies to them using magnetic affinity sorbents. Materials and methods: isolation of tissue (parenchymal organs) and bacterial water-soluble antigens, preparation of immune rabbit sera, creation of antigenic and antibody affinity sorbents, creation of immunofluorescence and immunoenzyme antigens for control reactions, purification of antigens and antibodies using magnoimmunosorption methods, developed by us. Results and conclusion. Mimicry antigens common in humans and guinea pig with pathogens of plague and brucellosis and antibodies to them were determined and isolated. The control immunochemical reactions at the stage of isolation of purified tissue heterogeneous antigens, the test samples exceeded the control by 2–3 times using immunosorbents prepared from commercial brucellosis and plague antisera, and by 3–5 times – from experimental brucellosis antisera.

Fetal distress is a combination of clinical and/or laboratory-instrumental indicators suggestive of an abnormal fetal state, often attributed to either temporary or permanent oxygen deficiency, potentially resulting in hypoxia [1]. Fetal hypoxia occurs in 5–10 % of all pregnancies, which confirms the significance of the research. The objective: Of this study is to identify risk factors associated with the occurrence of fetal distress in women depending on the method of surgical delivery. Throughout the research, we carried out a prospective analysis of 90 birth records featuring the clinical diagnosis of “Labor and delivery complicated by fetal stress [distress],” all obtained from the maternity ward No. 21 of the Samara City Clinical Hospital №1 named after. N.I. Pirogov. In all cases, indications for emergency delivery were signs of fetal distress based on cardiotocography data. Patients in the primary group were categorized based on their delivery method. Group I consisted of 30 women who underwent retrovesical C-section, while group II comprised 30 women who had vacuum extraction of the fetus, and group III encompassed 30 women whose second stage of labor was expedited through episiotomy. Conclusion. The main risk factors for intrapartum fetal distress are: late gestational age with a tendency toward post-term pregnancy, short stature with a high body mass index (BMI), complicated somatic and obstetric-gynecological history, duration of labor more than 8 hours, premature rupture of amniotic fluid mixed with meconium, increased anhydrous period, changes in motor activity and fetal heart rate.

Clinical and instrumental data of patients with acute myocardial infarction are of little informative value for COVID-19 identification. The aim is to study the significance of myocardial injury markers on admission in patients with acute myocardial infarction on COVID-19 background. At admission to the hospital in 20 patients with acute myocardial infarction and COVID-19 in blood markers of myocardial damage (highly sensitive troponin T, myoglobin and creatine kinase MB fraction) were studied using immunochemiluminescent method on immunoenzyme analyzer “Cobas e 411” (“Roche Diagnostics”, Germany). The values of highly sensitive troponin T in patients with acute myocardial infarction and COVID-19 were significantly lower than in patients with acute myocardial infarction without COVID-19 (94.8 vs. 171.8 pg/ml). There were no statistically significant differences in the values of myoglobin and the MB creatine kinase fraction in the study groups. Thus, markers of myocardial damage in patients with acute myocardial infarction have no predictive value in relation to COVID-19.

Today, the contribution of the microbiota to the genesis of many diseases, including endometriosis, is widely discussed. However, the literature data on the microbiological composition of endometriosis are contradictory. In addition, data indicating the effect of conservative therapy on the microbiological composition are limited only to estrogen-containing drugs, while there is no data on the effect of progestogens. Objective: to evaluate the composition of the intestinal microbiota of patients with external genital endometriosis on oral progestogen therapy. A single-stage pilot study was conducted, which included 17 patients with external genital endometriosis (average age 30.9 (7.8) years, average body mass index 20.2 (2.0) kg/m² ). The women received oral progestogen therapy (dienogest at a dose of 2 mg per day in a continuous mode). Microbiological examination of faecal samples by culturomics methods with inoculation on selective and non-selective nutrient media, followed by species identification of microorganisms, was carried out using time-of-flight mass spectrometry (MALDI-TOF MS) at two points: initially and after 6 months of taking dienogest. Dienogest therapy showed an improvement in a number of microbiological indicators of the intestinal microbiota in the form of a tendency to increase species and taxonomic diversity, a decrease in the Bacillota / Bacteroidota index, and a decrease in the titer of conditionally pathogenic microorganisms Staphylococcus spp. and increased colonization of symbiotic bacteria of the Collinsella aerofaciens and Lactobacillus spp. Thus, dienogest therapy can have both a direct and indirect effect on the composition of the intestinal microbiota of patients with external genital endometriosis, which was demonstrated by the results of the study.

The study of genes regulating the function of cytokines is an important aspect in the pathogenesis of bronchial asthma, predicting its severity and control. And also, as a result, the implementation of therapeutic approaches for this disease. Interleukin genes have a high degree of polymorphism. The aim of the work was to establish the significance of the effect of polymorphisms of the interleukin genes IL-4 590TC (rs2243250), IL-4RA I50V (rs2243250), TNF-alpha 308AG (rs1800629) on the phenotypic manifestations of the disease. a control group of children consisting of 90 people, patients with bronchial asthma of varying severity – 86 children. The identification of genetic polymorphisms was carried out by PCR. Statistical processing was carried out using the nonparametric chi-square criterion method with the analysis of conjugacy tables. The predictor significance of the homozygous variant of GG and the TNF-alpha allele G rs1800629 in severe disease, as well as the homozygous AG genotype with moderate severity of the disease. Studies of cytokine gene polymorphism in AD contribute to the study of the molecular genetic basis of AD formation and can be used to personalize therapy.

Introduction: a significant group of patients undergoing cardiac surgery develop postoperative atrial fibrillation. 40 % after coronary artery bypass grafting alone, 49 % after coronary artery bypass surgery plus aortic valve replacement, and 64 % after coronary artery bypass surgery plus mitral valve replacement. Determine the frequency of postoperative complications in the development of atrial fibrillation. The study included patients operated on at the Cardiac Surgery Department of the State Budgetary Healthcare Institution of Research Institute-KKB No. 1 of Krasnodar in the period from January 1, 2020 to January 1, 2021. During the analysed period of time, open-heart surgery was performed in 1503 patients, 158 of whom had newly diagnosed postoperative atrial fibrillation (10.5 %). Patients with postoperative atrial fibrillation were more likely to have ischaemic stroke, haemorrhagic complications, ventricular arrhythmias (ventricular fibrillation or flutter), and clinically significant atrioventricular block II and / or III degree, in addition, they had higher mortality in the early postoperative period (with index hospitalization), while acute myocardial infarction occurred with the same frequency in the compared groups. Thus, the relationship between postoperative atrial fibrillation and unfavourable early outcomes is significant, and therefore timely verification of arrhythmia and effective treatment of arrhythmia become relevant. Postoperative atrial fibrillationis a frequent complication of cardiac surgery, which worsens the short-term prognosis, and therefore it is necessary to identify patients at high risk of developing AFP. The appointment of anticoagulant therapy in patients with AFP remains a controversial issue and requires further study in a larger group of patients. It is important to note that AF after cardiac surgery increases the risk of intrahospital mortality, which requires an active search for predictors of this arrhythmia and the development of effective preventive strategies.

Community-acquired pneumonia is one of the most common acute infectious diseases, especially in organized groups. Community-acquired pneumonia in military personnel is a serious problem of the medical service and is diagnosed 2–3 times more often than among civilians. The purpose of the study. To study the clinical features of the action of “Immunovac-VP-4 ®” in the complex treatment of community-acquired pneumonia in new recruits. Materials and methods. The study group included 88 conscripted military personnel from among the new recruits who were hospitalized with a diagnosis of mild community-acquired pneumonia. The main group of the study included 35 patients receiving basic antibacterial therapy in combination with the therapeutic vaccine “Immunovak-VP-4 ®”. The control group included 53 patients who received only standard basic antibacterial therapy. Results. In the main study group, the frequency of repeated respiratory infections in all nosologies was lower than in the control group, statistically significant differences were noted in relation to pneumonia and acute rhinosinusitis. A decrease in the level of IL-1β in blood serum was revealed after 15 days (p = 0.05) and 6 months after discharge from the hospital (p = 0.002) in the main group compared with the control group. After 15 days, in the group of patients receiving “Immunovak-VP-4 ®”, there was a decrease in IL-6 levels relative to the baseline (p = 0.04) and it became lower than the control group (p = 0.04). Conclusion. The use of the “Immunovak-VP-4 ®” vaccine can be considered as a way to improve the treatment of community-acquired pneumonia: it can be a drug for treatment, prevention of complications, and an instrument in immunorehabilitation. The use of “Immunovak-VP-4 ®” in the complex treatment of community-acquired pneumonia of mild course is accompanied by a decrease in the activity of systemic inflammation: a decrease in serum levels of IL-1β, IL-6.

The purpose of the study: was to compare the concentrations of bacterial infection indicators lactoferrin (LF) and lactoferricin (LFC) in the blood serum and peritoneal exudate of patients with destructive forms of acute appendicitis after laparoscopic and laparotomic appendectomy. The concentrations of LF protein and LFC peptide were studied in blood and peritoneal exudate samples of 45 patients with destructive forms of acute appendicitis of varying severity after laparoscopic or laparotomic appendectomy. When studying the levels of LF and LFC in patients with acute destructive appendicitis, it was found that their levels differ from the donors' figures by 3 times for both LF and LFC. It was found that the concentrations of LF and LFC in patients with acute destructive appendicitis and appendicular peritonitis are 3 times higher than the donors' figures for both LF and LFC. As for the peritoneal exudate of patients with destructive forms of acute appendicitis, they were compared with the results of the same patients in the blood serum. In this case, a statistically significant excess of peritoneal concentrations over serum levels in patients with acute destructive appendicitis and appendicular peritonitis is characteristic only for LF (by 3–4 times), but not for LFC. Comparison of the levels of the two studied biochemical indicators in the blood serum and peritoneal exudate in patients with destructive forms of acute appendicitis after laparoscopic and laparotomic appendectomy options did not reveal a reliable relationship between LF and LFC and the type of appendectomy. Thus, tests for LF and LFC in patients with destructive forms of acute appendicitis are primarily closely related to the severity of patients with acute destructive appendicitis and appendicular peritonitis. The antibacterial properties of LF and LFC have been actively studied in recent years in emergency medicine for abdominal surgical infection. The fact is that a serious problem in antibacterial therapy of abdominal infection is the rapid development of resistance to known antibiotics, which requires the use of increasingly new classes of antibiotics and antiseptics and the development of new classes of antibacterial agents, including lactoferrin and its derivative lactoferricin. We have found that, despite the common nature of these substances, the mechanisms of action of the LF protein and LFC peptide on bacteria differ significantly, which is confirmed in our study using the example of studying both tests in destructive forms of acute appendicitis. LF in surgical abdominal infection primarily reflects various bactericidal and bacteriostatic effects of iron in the blood, intestines and abdominal cavity. The short peptide LFC is not associated with iron metabolism, which does not prevent this peptide, due to its unique amino acid composition, from exhibiting in the experiment even higher antimicrobial activity than LF.

Among all benign formations, lipomas are the most common and are located on any part of the body. However, they are rare in the oropharynx and oral cavity and account for 1-4% of cases. The tongue is devoid of fat cells, but there have been cases of patients with formations on the walls of the tongue, which, after morphological verification, were recognized as lipomas. The priority direction of treatment of these formations is surgical. The presented clinical cases confirm the importance of timely diagnosis of formations and the need for their removal.

Triploidy is a rare lethal chromosomal anomaly characterized by the presence of an additional set of chromosomes in the cell. The presented clinical observation demonstrates a rare case of the birth of a child with a complete form of triploidy. The features of the clinic, the data of laboratory and instrumental research methods, as well as the methods of treatment used are described. The baby was born prematurely with signs of intrauterine hypotrophy, respiratory failure and multiple stigmas of dysembriogenesis. In dynamics, the child's condition was aggravated by the development of sepsis, which subsequently led to a fatal outcome.