Introduction. In recent years, the problem of multiple fetuses has become particularly important, which is associated with a steady increase in the frequency of multiple pregnancies worldwide. The feto-fetal transfusion syndrome (FFTS) is a classic example of unbalanced functioning of placental anastomoses, which leads to transfusion between fetuses. The incidence of this syndrome in a group of monochorionic diamniotic twins ranges from 8% to 15% and, in the absence of timely diagnosis and intrauterine correction, leads to death of one or both fetuses in 70-100% of cases. The effect of different methods of intrauterine surgical correction of FFTS in monochorionic diamniotic multiple fetuses on perinatal outcomes is of scientific interest. Purpose of the study — to investigate the effect of different types of laser coagulation of placental anastomosis (LCPA) on perinatal outcomes in intrauterine surgical correction of FFTS. Materials and methods. Depending on the surgical technique used, women were divided into three groups: the total placental anastomosis coagulation method, Group 1 (58 pregnant women); the selective placental anastomosis coagulation method, Group 2 (67 pregnant women); the sequential selective laser coagulation of placental anastomoses, Group 3 (62 pregnant women). Results. We analyzed the results of intrauterine surgical correction of FFTS by different methods of laser coagulation of placental anastomoses in 187 women with monochorionic diamniotic type of placentation of II-IV degrees according to Quintero. We obtained statistically significant differences in many perinatal period indices depending on the LCPA method used. Discussion. Sequential selective LCPA has proven to be the most effective, safe, and promising technique for correction of FFTS. The data obtained indicate possible ways to improve pregnancy prolongation and fetal survival rates after the use of intrauterine surgical correction of placental vascular anastomoses. Conclusion. Sequential selective LCPA has proven to be the best technique to correct FFTS with the least perinatal losses and postoperative complications, as well as the highest efficacy.

Introduction. In modern obstetrics, there are a significant number of diagnostic methods to detect fetal distress, including intrapartum. At the same time, the mechanisms of fetal adaptation to various stressors remain poorly understood. The aim of our study was to provide a clinical assessment of brain and glial neurotrophic factors (NTF) in umbilical cord blood when the fetus is exposed to stressors. Materials and methods. The study included 96 cases, which were divided into five groups depending on the data of retrospective analysis of the history of childbirth, the condition of the newborn. After delivery samples were taken, the level of BDNF (brain-derived neurotrophic factor), GDNF (glial cell-derived neurotrophic factor). Results. The mean NTF level of BDNF in group 1 was 970.3 (60.9) ng/mL, in group 2 was 1499.8 (72.12) ng/mL, in group 3 was 1243.5 (67.49) ng/mL, in group 4 was 1245.5(80.8) ng/mL, in group 5 was 573.5(43.9) ng/mL (p<0.001). Mean GDNF NTF level in group 1 was 35 pg/mL, in group 2 was 41.3 pg/mL, in group 3 was 311.00 pg/mL, in group 4 was 80.00 pg/mL, and in group 5 was 35.6 pg/mL, (p><0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p><0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.><0.001). Mean GDNF NTF level in group 1 was 35 pg/mL, in group 2 was 41.3 pg/mL, in group 3 was 311.00 pg/mL, in group 4 was 80.00 pg/mL, and in group 5 was 35.6 pg/mL, (p<0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p><0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.><0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p<0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.><0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.

Introduction. We studied the quantitative content of brain-derived neurotrophic factor (BDNF) in the serum of pregnant women with hypertensive disorders at 22 to 42 weeks' gestation. A correlation was found between brain plasma neurotrophic factor and the severity of preeclampsia and its complications, such as HELLP syndrome, placental detachment. The increase in BDNF reflects an increase in compensatory restorative functions of the nervous system. Increased brain neurotrophin reserve in severe complications of hypertensive disorders requires further study of the pathogenesis from the standpoint of neuroplasticity, which in turn will improve timely diagnosis and prevention. Purpose of the study — determination of quantitative serum brain-derived neurotrophic factor as a possible predictor of the severity of preeclampsia and its complications. Materials and methods. The study was conducted on the basis of the M.A. Tver'e Maternity Hospital, Perm. Eighty-eight pregnant women at 22 to 42 weeks' gestation were examined, 77 of them with hypertensive disorders as chronic arterial hypertension, gestational arterial hypertension, preeclampsia, and HELLP syndrome. The comparison group consisted of 11 healthy pregnant women. The control group included 11 non-pregnant healthy women. Results. The presence of hypertensive complications in pregnancy and their correlation with the quantitative content of serum BDNF was studied. Discussion. Brain-derived neurotrophic factor determined in peripheral blood serum is one of the laboratory indicators that allow to predict the likely manifestations of preeclampsia and HELLP syndrome and reliably determine the severity of these complications. Conclusion. In severe complications of hypertensive disorders a reliable increase of BDNF in blood serum was revealed, which in turn is a diagnostic marker of these conditions.

Introduction. When pregnancy failure occurs, not only the woman should be examined, but also her partner. Purpose of the study — to evaluate the significance of spermogram values in the partners of patients with an uncompleted pregnancy. Materials and methods. A retrospective comparative cohort study was conducted. A total of 197 married couples were ncluded in the study. Group 1 consisted of 71 couples with a history of miscarriag. Chromosomal abnormalities (CA) were detected during embryo cytogenetic examination in 45 cases; these patients were included in subgroup 1a; the rest constituted subgroup 1b. The control group (group 2) consisted of 126 couples without a history of pregnancy loss. A detailed anamnesis and general clinical examinations were performed in all the couples. Spouses of the patients underwent spermogram analysis. Results. The proportion of men who abused alcohol was higher in group 1 than in group 2 — 40.8% vs. 19% (p<0.01). In subgroup 1b chronic diseases were noted in 61.5% of men, in group 2 — only 28.6% (p<0.001). Differences in the number of men with normal spermogram were found between group 2 and subgroup 1b, 65.1% and 35.3%, respectively (p=0.036). In group 1, 45% of men had teratozospermia (43.5% in subgroup 1a, 47.1 in subgroup 1b) and in group 2, only 16.3% (p=0.004). Discussion. In most cases, the leading etiological factor in pregnancy failure is a chromosomal abnormality n the embryo (fetus). The role of the "male" factor is increasing in the genesis of pregnancy failure. Examination of thspouse should be an integral component of pre-conceptional preparation. Conclusion. Spousal alcohol abusrisk factor for CA in the embryo and for pregnancy failure. The presence of chronic diseases in the spouse is also a risk factor for pregnancy failure. Among the spermogram parameters, the number of spermatozoa with normal morphology is the most significant in assessing the ririsk of pregnancy failure in a married couple, teratozoospermia significantly increases the risk of non-pregnancy.

Introduction. The high frequency of inflammatory changin the placenta in isthmic-cervical insufficiency may be primarily associated with an ascending infection as a result of a violation of the barrier function of the cervix, however, premature remodeling of the cervix may also be secondary due to an already existing process. The study of the features of the spread of the infectious process and thnature of the inflammatory reaction in various structures of the placenta and fetal membranes can contribute to the understanding of pathogenetic mechanisms of preterm birth in isthmic-crvical insufficiency. Aim of the study — to evaluate the frequency and structure of inflammatory changes in the placenta in women with isthmic-cervical insufficiency. Materials and methods. A prospective cohort study was conduct, which included 154 pregnant women taken by the continuous sampling method. All patients were divided into two groups: group 1 consisted of 100 pregnant women with isthmic-cervical insufficiency, group 2 — pregnant women without isthmic-cervical insufficiency. All women after childbirth underwent a pathomorphological examination of the afterbirth. Results and discussion. In women with isthmic-cervical insufficiency, inflamatory changes in the placenta were detected in 71% (71) of cases, which was significantly more frequent compared to group 2 — 38.9% (21). Membranitis was significantly more frequent in isthmic-cervical insufficiency, amounting to 16% (16) versus 3.7% (2) comparison group (OR=4.32, 95% СI=1.03-18.09, p=0.023). Chorioamnionitis was 6 times more common in the afterbirth in women of group 1, accounting for 12% (12), versus 1.9% (1) in group 2 (OR=6.48, 95% CI=0.87-48.51, p=0.031). Involvement of the umbilical cord in the inflammatory process occurred only in pregnant women with isthmic-cervical insufficiency: funiculitis was combined with membranitis in 4% (4) of cases (p=0.137), the combination of funiculitis with choriomnionitis was detcted in 7% (7) of women p=0.047). Conclusion. The frequencof detection of inflammatory changes in the placenta in ICN was 71% (71). In the structure of inflammatory changes of the afterbirth in patients with ICN, the defeat of the fetal membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage to the umbilical cord in ICN can occur both wth total inflammation of all structures of the placenta, and directly through the fetal membranes, without involving the chorion in the process.

Introduction. Diagnostics of congestive events in chronic heart failure (CHF) in elderly people is increasingly relevant due to the general aging of the population, which determines the search for new research methods. The aim is to evaluate the diagnostic capabilities of bioimpedance method in determining the severity of congestion in elderly patients with CHF. Materials and methods. 86 elderly patients with CHF of different clinical stages were examined, 36.0% of them were burdened with varicose vein disease of the lower limbs. Total body water content was assessed by active impedance at 50 kHz, extracellular fluid content — at 5 kHz. Results. Active resistance at 50 kHz in patients with CHF II B was 473.92±29.39, with CHF II A - 569.24±58.97, with CHF I — 601.33±24.64 ohms, respectively, at 5 kHz — 555.52±27.44, 633.50±51.32 and 722.50±15.85 ohms respectively. No total and/or extracellular fluid retention was detected in CHF II A without lower limb varicosity, and in 10 (58.8%) patients — in cases of its presence. Retention of total and/or extracellular fluid was detected in 74.4% of CHF stage II B patients, and 48.3% of them had varicose vein disease of the lower limbs. Discussion. Patients with CHF stage II B have the highest amount of total and extracellular fluid in the body compared to patients with CHF stage II A and CHF stage I, but the method is insensitive for diagnosis of fluid retention in the small circle of the circulation and differential diagnosis of the genesis of edema in varicose vein disease of the lower limbs. Conclusion. Bioimpedance imaging can be used for additional diagnostics of CHF in elderly patients in order to estimate the amount of total/extracellular fluid in the body to build personalized treatment and prevention programs.

Introduction. The aim of the study was to detect the dependence of the composition of the parietal microflora of the colon on the activity of Helicobacter pylori-associated chronic gastritis and the degree of Helicobacter pylori contamination of the gastric mucosa. Materials and methods. The study was carried out on 50 patients aged 24 to 72 years, who were diagnosed with HP-associated chronic gastritis in the phase of exacerbation based on the results of FEGDS and histological examination of biopsies of the mucous membrane of the antrum of the stomach in combination with a rapid urease test. A series of dilutions 10¹-10⁹ was prepared from a homogenized biopsy specimen of the mucous membrane of the sigmoid colon in 0.1 ml of isotonic sodium chloride solution, and 0.1 ml of a solution of the corresponding dilution was inoculated onto the surface of the nutrient medium. The study of mucosal microflora was carried out by means of bacteriological examination of biopsies of the mucous membrane of the sigmoid and cecum. The degree of H. pylori contamination of the gastric mucosa was assessed in the course of histological examination by a semi-quantitative method: low degree of contamination — up to 20 microbial bodies, average — 20-50 microbial bodies, strong — over 50 microbial bodies in the field of view. Results. The study demonstrated that the indicators of the average concentrations of bifidobacteria, lactobacilli and typical strains of E. coli progressively decreased with the transition to a higher degree of HP infection. This tendency was maximum in relation to bifidobacteria — 6.1-1.57-1.09 x 10⁸ CFU/g, with a difference between the maximum (I degree) and minimum (III degree) 5.59 times. A similar relationship, but much less pronounced, was observed for Lactobacterium spp. and E. coli. As the severity of HP infiltration of the gastric mucosa increases, there is a decrease in the concentration of the above microorganisms in the parietal mucin - the correlation coefficient is r = -0.74. Discussion. Since the mucous microflora is more stable and functionally significant than the cavity microflora, the data obtained allow us to consider Helicobacter pylori as an etiological factor of colonic dysbiosis. Conclusion. The probability of excessive growth of conditionally pathogenic fraction of intestinal parietal microflora has a direct dependence on the severity of Helicobacter pylori infestation, being maximum at degree III contamination. Content of bifidobacteria, lactobacilli and typical E. coli strains in the intestinal biotope of the large intestine is inversely related to the degree of histological activity of HP-associated gastritis.

Introduction. Skin cancer is one of the most common types of malignant neoplasms in Russia. Radiation therapy, surgical intervention, and combined treatment are usually used for skin cancer. Unfortunately, the above methods are not always successful. The reason for the incomplete effect of surgical treatment may be insufficient radicalism of the intervention due to the doctor's desire to cause the least trauma to the surrounding healthy tissues in order to obtain a good cosmetic result. Selective destruction of tumor tissue in cryogenic exposure with minimal damage to surrounding healthy tissues is accompanied by a hemostatic effect, which is especially important in the treatment of both primary and recurrent decaying tumor ulcers. Aim — to evaluate the effectiveness of cryodestruction as the method of choice in the outpatient treatment of recurrent skin cancer. Materials and methods. The study was controlled, non-randomized. The criterion for inclusion in the study was the establishment of the diagnosis of recurrent skin cancer at the application and subsequent treatment in the outpatient clinic of the State Budgetary Institution "Oncologic Dispensary" in Novocherkassk from 2016 to 2020. A total of 532 patients were studied. Patients were planned to undergo tumor cryodestruction with several freeze-thaw cycles, lasting 2-5 minutes. Results. The results of the study indicate high efficiency of cryodestruction. Complete recovery in the treatment of recurrent skin cancer was observed in 446 (83.4%) patients. Repeated cryodestruction was performed in 86 (16.6%) patients, who experienced continued growth and recurrence after cryodestruction within 1 to 18 months. Subsequently, 38 of 86 patients (7.2%) did not experience continuation of growth and new recurrences. Discussion. Based on the literature data and our treatment results it was determined that cryodestruction is the most acceptable and simple method of treatment for this category of patients. Conclusion. In the presence of limited recurrences of skin cancer of various localizations, cryogenic exposure is effective (in 90.6% of the outcome — recovery) in patients of different sex and age, regardless of the location and prevalence of the tumor process and is the method of choice of treatment in an outpatient setting.

Introduction. The complex of transcriptional proteins of NF-kB (Nuclear Factor kappa-light-chain-enhancer of activated B cells) family deservedly attracts attention as a factor capable of determining the course of malignant disease. Its promising study in combination with the expression of proinflammatory gene IL6 in patients with parotid cancer (PSG) is associated with the development of modulation of malignant disease treatment and risk assessment of the disease course. Aims — to determine the effect of the expression activity of the proinflammatory interleukin-6 gene and the NFKB1 transcriptional gene on the survival rate of patients with parotid cancer. Materials and methods. A cohort retrospective study was conducted in two groups. The epidemiological group of patients included 140 people from the cancer registry of Rostov region. The clinical part of the work was carried out on 25 patients with PSG cancer of both sexes aged 50 to 80 years. Followup period of the patients after radical surgery was 18 years. Expression activity of NFKB1 and IL6 genes was estimated by real-time PCR in tumor and conditionally healthy tissue. Patient survival rate was analyzed using Kaplan-Meier method. Results. According to the results of the survival analysis in the epidemiological group, the probability that an PSG cancer patient would survive the first year after diagnosis was 95.7%, three years — 82.4%, five years — 70.9% and 10 years — 31.2%. A comparative study of gene expression levels in tumor tissue samples compared to conditionally healthy tissue revealed an increase (p<0.001) in the relative index for both the IL6 gene (5.7 times) and the NFKB1 gene (7.9 times).><0.001) in the relative index for both the IL6 gene (5.7 times) and the NFKB1 gene (7.9 times). Discussion. Analysis of our data showed the possibility of using the complex evaluation of NFKB1 and IL6 gene expression in the cells of tumor samples of PSG cancer tissue obtained during surgery to predict the long-term survival of patients after surgical treatment. Conclusions. The expression profile of NFKB1 gene in tumor tissue was a proven prognostic factor determining the course of the disease in patients with PSG cancer, which should be taken into account when forming the prognosis of the disease. The expression of IL6 gene expression in tumor cells had no independent effect on the survival rate of PSG cancer patients, but contributed to the functional activation of NFKB1 transcription gene.

Introduction. The problem of hearing loss and deafness, due to the general prevalence of hearing loss in different age groups, is significant not only for medicine, but also for the social sphere of society. Nowadays, just as 40 years ago, preventive medical examinations and initial examinations by an otorhinolaryngologist use methods of testing hearing by means of whispered speech, which has its own characteristics for everyone. This leads to diagnostic errors and does not allow to detect hearing loss in its early stages. Purpose of the study—development of a whispered-speech apparatus for early express diagnosis of hearing loss, and study of the effectiveness of the developed apparatus. Materials and methods. The Department of Hygiene at the Izhevsk State Medical Academy, as part of the program "Umnic-2018" a whispered hearing analyzer — a device for early express diagnosis of hearing loss was developed. The device was tested on the basis of otorhinolaryngologist offices in Izhevsk and Tchaikovsky. The study group included 53 patients aged 19 to 76. As part of the testing of the device, the subjects underwent whispered speech hearing tests using acumetric Voyacek word tables; express diagnostics of the hearing level with the whispered hearing analyzer and tonal threshold audiometry using the ITERA II diagnostic audiometer (Otometrics, Denmark). Results. As a result of the testing of the developed device, we found that the use of the whispered hearing analyzer allows you to reduce the time of examination and increase its diagnostic efficiency compared to conventional methods of hearing level examination at medical check-ups. Discussion. The Whispering Hearing Analyzer is designed to quickly and accurately detect hearing loss during medical examinations. The results obtained with this instrument can only tell you that you have a hearing loss, but it is not possible to make a diagnosis. Conclusion. The problem of disabling hearing loss can be solved through preventive measures, one of which is the developed device for early express diagnosis of hearing loss. The use of this device eliminates the occurrence of diagnostic errors associated with the researcher's speech characteristics, thereby making it possible to detect hearing loss at an early stage.

Introduction. Atrophic postacne scars are a persistent cosmetic defect, cause psychological discomfort, and significantly reduce patients' quality of life. Laser technologies are effectively used for their treatment. The aim of the study was to investigate the quality of life in patients with atrophic post-cancerous scars before and after the use of laser methods of scar correction. Materials and methods. A randomized comparative clinical trial included 120 patients with atrophic postacne scars divided into two comparable groups of 60 patients each. Patients received laser ablation procedures with an Erbium laser (2940 nm). The Dermatological Quality of Life Index (DQLI) questionnaire was used to assess the quality of life before and after the laser procedures. Results. The DICG of patients before treatment ranged from 8 to 17 points and averaged 12.962.05 points. In women the mean value of DICG was 14.221.34 points and was higher compared to men (11.141.45 points) (p0.05). After fractional laser ablation procedures and the procedures of its combination with the treatment of the scar edge with a solid stain, improvement of the DICG scores was observed; intergroup differences were found in self-esteem, in the choice of clothing, in personal and intimate relationships, and in the assessment of daily routine. Discussion. The pre-treatment DICG scores of patients with postacne scars indicate a strong impact of the disease on quality of life. The DICG in women was higher than in men, which may be associated with a greater degree of women's anxiety about the aesthetic condition of the skin and appearance. After treatment, the degree of impact of the disease on patients' quality of life decreased to moderate in both groups. Conclusion. The combined method of treatment contributes to the reduction of DICG compared to fractional ablation procedures, which indicates greater patient satisfaction with the result of these procedures.

The aim of the study was to evaluate the safety of the use of organotin compounds containing a fragment of 2,6-di-tert-butylphenol as pharmaceutical substances when administered intragastrically to Wistar outbred rats (females). Material and methods. The objects of the study were three organotin compounds: ((3,5-di-tertbutyl-4-hydroxyphenylthiolate) triphenyltin (Me-5), (3,5-di-tert-butyl-4-hydroxyphenylthiolate)trimethyltin (Me-4), bis(3,5-di-tert-butyl-4-hydroxyphenylthiolate) dimethyltin (Me-3). Acute toxicity study were performed on 106 Wistar rats (female) weighing 190-210 g by "fixed dose" and "up and down" methods according to the OECD protocols. Results. According to the harmonized system of hazard classification and labeling of chemical products (GHS) the studied organotin compounds should be assigned to the following toxicity classes: Me-5 — IV, Me-3 — V, Me-4 — II. Average lethal dose in intragastric administration for Me-5 is LD50 = 955.0 ± 58.3 mg/kg, the value of LD50 for Me-3 is conventionally assumed to be much more than 2000 mg/kg, for Me-4 is in the range of 5 to 50 mg/kg. Discussion. The modification of tin-organic molecules in the course of directed synthesis opens broad prospects for the creation of a new class of anticancer drugs. In the course of the experimental study, the regularities of the "structure-toxicity" relationship of organic tin derivatives were revealed: the introduction of the 2,6-di-tert-butylphenol group significantly reduces toxicity compared to the corresponding initial substances; methyl derivatives are more toxic than their phenyl analogues. Compounds of GHS toxicity classes IV and V can be considered as leading candidates for promising preclinical studies in the field of experimental oncology. Conclusion. Substances of Me-3 and Me-5, which have the highest safety for intragastric use, were recommended for further study as antitumor drug agents.

Purpose of work — analysis of modern scientific literature on the resource approach to the definition of personnel policy in medical organizations, analysis of personnel management system, personnel policy in a particular medical organization, justification of definition: "Personnel policy is personnel management, which is carried out taking into account the levels of organizational and economic, socio-psychological (huemonizing), legal, technical (5S, lean production, medical organization of a new type), training and pedagogical (mentoring) in combination and interrelation with the determining role of socioeconomic factors of the surrounding society". Materials and methods. The subject of the study — personnel policy in a medical institution on the example of the State Autonomous Institution «Serov City Hospital», using certain resources for the formation of its levels. The following methods were used in the study: analysis, classification, synthesis of scientific theoretical literature on the problem of research; analysis of documents related to the activities of a medical institution, comparison, socio-psychological testing of a number of mental and psychophysiological functions of medical workers in the professional environment. Results and discussion. The definition of "personnel policy" in a medical organization is clarified, taking into account the systematic and resource-based approach. Recommendations on the implementation of personnel policy in Serov City Hospital during the period of organizational changes and preventive measures to prevent the spread of COVID-19 were developed. Conclusion. The use of a systematic approach in the formation of personnel policy, taking into account the organizational and economic, sociopsychological, legal, technical, training and educational levels proposed by us in the aggregate and interrelation, with the determining role of socio-economic factors, allows to solve the most important issues of sustainable functioning of the medical institution in the period of organizational changes and preventive measures to prevent the spread of COVID-19.

Introduction. Forensic workers are at high risk of contracting Koch's bacillus infection. Significant risk factors for infections are a high microbial load, increased traumatism, and the absence of lifetime medical records of tuberculosis in cadavers admitted for examination. In addition, sporadic cases of infection continue to be reported, necessitating measures to improve the prevention of personnel infection. In view of the above, there is a great need for research into the awareness of bureau personnel, on the basis of which preventive measures will be developed. Purpose of the study — to examine the awareness of bureau personnel about the main issues of tuberculosis infection, its prevention, ways of infection, diagnosis, and clinical manifestations. Materials and methods. The main method of research was an anonymous questionnaire survey of 262 employees of the Kazan bureau of the Republic of Tatarstan. The obtained data were counted on the service onlinetestpad, where the questionnaire was posted. Results. According to the results of the study, 12 employees (4.6%) out of those interviewed in the bureau had tuberculosis. Forty-three employees (16.4%) reported contact with a sick person at their place of work (training). A total of 147 respondents (56.1%) think that it is possible to get infected by a sick person; 39 respondents (14.9%) think that it is possible to get infected while doing professional duties. Some respondents did not consider important aspects in preventing the formation and spread of TB: a significant part of workers (96 workers, 36.6%) wash dirty work clothes at home by themselves and about the same number of respondents (95 workers, 36.3%) do not consider it important to change work clothes when moving from a "dirty" zone to a "clean" one and vice versa. Discussion. Positive results of the questionnaire were associated with a high degree of competence of the staff, dissemination of TB guidelines, training, and supervision by supervisory authorities. Conclusion. Based on the results, it was found that staff at the Bureau of Forensic Medicine are sufficiently informed about methods of specific and non-specific prevention of tuberculosis and have information about the modes of transmission. However, there is a lack of awareness among certain staff members on how to prevent the spread of tuberculosis infection.

Introduction. In recent years, the issue of informative value of lung ultrasound for diagnosis, differential diagnosis and prognosis determination in cardiac patients, especially in decompensated heart failure, has been actively discussed. The relevance of this method lies in the absence of invasiveness, radiation exposure and the possibility to perform lung sonography at the patient's bedside. The purpose of this review was to assess and analyze the available literature on this issue. Materials and methods. Scientific publications were searched and selected from PubMed and Google Scholar from 1982 to 2020. Results and Discussion. Pulmonary ultrasound can be used as an accurate tool for detection and differential diagnosis of extravascular fluid in patients with heart failure. Literature analysis indicates high prognostic value of the method, as well as its possible use for dynamic monitoring in real time. Lung sonography shows higher sensitivity and specificity of the method than chest radiography, physical examination, natriuretic peptide level. In isolation, this method has lower specificity than sensitivity, but when complemented by natriuretic peptide levels and echocardiography, it increases accuracy and speed of diagnosis. Conclusion. Lung ultrasound has a sufficient evidence base and good potential for use in clinical practice as a complementary component to traditional methods of determining congestion in heart failure.