Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.

The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.

Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO₂).

Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.

Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.

Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

Introduction. Improving the disease severity scoring systems at the stages of inter-hospital transportation remains an actual in neonatal intensive care. Therapeutic scales remain poorly studied and their predictive value and practical applicability. The aim of the work is to determine the predictive value of the NTISS scale at the stage of pre-transport preparation in relation to the treatment outcomes of newborns.

Materials and methods. The cohort study included data from 604 visits of the resuscitation and consultation center transport team. The evaluation was performed on the NTISS scale, and the outcomes were studied. The AUC ROC curve of the NTISS scale was calculated in relation to the binary outcomes. The correlation analysis of the quantitative data was performed by Spearman's criterion.

Results. AUC greater than 0.8 was observed for the risk of death (AUC=0,823 (0,758-0,888)), 7-day mortality (AUC=0,827 (0,752-0,901)), late onset sepsis (AUC=0,808 (0,737-0,879)), bronchopulmonary dysplasia (AUC=0,810 (0,763-0,856)), severe intraventricular hemorrhage (AUC=0,847 (0,804-0,889)) иocclusivehydrocephalus(AUC=0,830 (0,757-0,904)). Similarresultswereobtained analyzing the outcomes among the surviving patients. For other binary outcomes, the scale shows an AUC of less than 0.8. The analysis of outcomes among the surviving patients showed a weak correlation between the NTISS score and the duration of intensive care, r=0.492, p<0.0001, and the duration of hospitalization, r=0.498, p<0.0001.

Discussion. The NTISS scale demonstrated an acceptable level of accuracy (AUC>0.8) in predicting hospital mortality, late neonatal sepsis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and the formation of occlusive hydrocephalus, among both surviving patients and general sample. The observed results are comparable with the information content of other neonatal scales of various types.

Conclusion. The predictive value of NTISS in relation to the outcomes of the hospital stage is comparable to the physiological scales described in the literature.

Introduction. The greatest difficulties arise in the differential diagnosis of hypovolemic or distributive (septic) shock. The aim of this study was to critically analyze the information value of the blood plasma content of lactate and procalcitonin (PCT) in patients with septic and hypovolemic shock.

Materials and methods. The diagnosis of «Sepsis» and «Septic shock» in the study was established according to the criteria of «Sepsis-3». 143 IRCs were filled, 34 of them with septic shock, 44 IRCs with hypovolemic, 65 IRCs with sepsis and organ dysfunction (OD).

Results. When determining the content of PCT in the blood plasma in patients with septic and hypovolemic shock, we found a statistically significant difference. The level of PKT in infectious shock —

33.3 (95% CI 7.9 — 58.0) ng / ml was higher than hypovolemic-0.9 (95% CI 0.43 — 6.45) ng/ml on average more than 30 times. In contrast to PCT, the content of lactate in the blood plasma did not carry a differential diagnostic value. Once measured at admission to the ICU, the level of PCT has no informational significance and does not indicate a likely outcome of the disease, complicated by the development of septic and hemorrhagic shock. Together with the low predictive ability of the nature of shock, lactate was highly informative in relation to the outcome of the disease, complicated by the development of shock syndrome.

Discussion. In our analysis, it is obvious that there were observations when the PCT level during hypovolemia was noticeably higher than normal, reaching a maximum of 6.4 ng / ml. Apparently, there was a combination of factors with an obvious activation of a trigger that affects its libration or the presence of endotoxinemia in hypovolemic shock in these specific patients. The informational value of PCT is not absolute and, according to meta-analyzes, is about 80%.

Conclusion. The blood content of procalcitonin in shock of an infectious nature was more than 30 times higher than the hypovolemic level on average. The informational value of procalcitonin in terms of predicting the course of the disease in septic and hypovolemic shock is absent. In the absence of predicting the nature of the shock, lactate is informative about the outcome of the shock. The possibility of increasing the blood lactate content in severe hemorrhagic shock with renal damage was noted.

Introduction. To analyze the efficacy and safety of treatment tactics for term patients diagnosed with TTN in an ICU without venous access and parenteral nutrition.

Materials and methods. The study gives a retrospective analysis of the medical records of 241 ICU patients from January 2020 to March 2021. 83 children meet general criteria for inclusion in the study.

Results and Discussion. While comparing the study group and the control group, no significant difference was detected in the incidence of risk factors during pregnancy and childbirth, such as gestational diabetes, ARVI during pregnancy, chorioamnionitis, preeclampsia, and the frequency of a prolonged anhydrous period, the frequency of induced labor, delivery by caesarean section, fetal distress and the use of vacuum extraction. Despite the same initial level of severity of respiratory disorders, when the child was admitted to the ICU, the duration of CPAP therapy was significantly higher in the control group: 7.5 (5.5-12) versus 5 (4-6) hours p = 5×10-5. The average length of hospital stay in the ICU and the total length of hospital stay was significantly higher in the control group (p = 4×10-11 and p = 0.006, respectively), as well as the need for treatment in the Neonatal Pathology unit conditions (p = 0.001).

Conclusion. Analyzing the tactics of treating term patients diagnosed with TTN, the study proved that children without venous access require less time for respiratory therapy with CPAP in the NICU, the total duration of hospitalization in the NICU is significantly lower, as well as the need for additional treatment in the Neonatal Pathology unit. The study revealed that the early onset of enteral nutrition and the rapid expansion of the feeding portion, provided with child’s stable health condition, enable to avoid the installation of venous access and the prescription of parenteral nutrition at the ICU stage.

Introduction. The metabolic activity of the intestinal microbiota is an important indicator of the functioning of the digestive tract, one of the main functions of which is the absorption of nutrients.

The aim of the study was to analyze the content of short chain fatty acids in feces and assess their relationship with the indicators of physical development in children 3 years of age.

Materials and methods. A prospective cohort study was conducted in 89 children 3rd year of life. The 1st observation group included children of the I and II health groups, the children of the 2nd group underwent surgical treatment on the intestine in the first months of life, the children of the3rd group are with atopic dermatitis. FD assessment was carried out in accordance with WHO recommendations (2017) the spectrum of FGC in feces was determined by gas-liquid chromatography.

Results. It was determined the features of the rates of FD in healthy children, children with a history of intestinal resection and children with atopy in relation to the indicators of metabolic activity of the intestinal microbiota. The percentile distribution of the values of FGC in feces and their comparative assessment in the observation groups are given.

Discussion. The content of FGM in feces has differences depending on the health status of children of the 3rd year of life. Different level of FGC shows a close relationship with the indicators of FD. Conclusions. A decrease in growth rates (body length SD: from -1 to -2) was revealed at low values (<25%) of the amount of acids, with an increase in propionate (25%) in feces. Reduced nutrition (body weight SD: from -1 to -2) it was associated with low values of the sum of isoacids and AI(-) (<25%); by 3rd year of life, the risk of low nutrition decreased in 4 times with high values (75%) of the sum of acids in feces (OR=4.33[1.09-17.71]). The multidirectionality of the content of fecal matter in young children and their influence on the indicators of FD emphasizes the versatility of the functions of the intestinal microbiota, which has a local and systemic effect on the human body.

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.

The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.

Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.

Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p<0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.

Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.

Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.

Introduction. The syndrome of posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological condition caused by vasogenic brain edema due to elevated blood pressure. The development of this syndrome is associated with the toxic effect of drugs in the treatment of oncological diseases. In most cases, timely diagnosis and therapy of PRES determine the complete reversibility of symptoms. However, a poor prognosis is possible with the development of severe disabling consequences or death. In practice, there are difficulties in the diagnosis of PRES due to the lack of specificity of clinical manifestations and awareness of many doctors about the existence of this syndrome.

The aim of the study was to present the clinical-radiological aspect of the syndrome of posterior reversible encephalopathy in children with oncological diseases.

Materials and methods. The analysis of 8 medical histories of children with oncological pathology complicated by the syndrome of posterior reversible encephalopathy was carried out.

Results. The study group was dominated by patients with hemato-oncological diseases. The development of PRES occurred during chemotherapy and in most cases was not associated with arterial hypertension. The clinical picture was dominated by such symptoms as impairment of consciousness, seizures and movement disorders in the form of paresis. When carrying out magnetic resonance imaging (MRI), the lesion of the white matter of the brain was determined, mainly in the projection of the parieto-occipital regions. During treatment, all patients showed reversibility of neurological symptoms with leveling of radiological signs.

Discussion. When analyzing the clinical and radiological characteristics of PRES in children, a comparison of the data with clinical observations presented in the literature was noted. The role of chemotherapy as a triggering factor in the development of posterior reversible encephalopathy syndrome has been determined.

Conclusion. The necessity of including the syndrome of posterior reversible encephalopathy in the list of differential diagnoses in patients receiving chemotherapy is shown.

Introduction. The experience of organization of medical activity in the medical institutions subordinate to the FMBA of Russia in the Siberian Federal District during the I-III epidemic waves of COVID-19, the procedure for making and implementing organization and managerial decisions on building the health care system; the analysis of the experience gained in the formation and operation of consolidated mobile emergency response teams was made.

Materials and methods. The study was performed on the basis of the statistical data, regulations on the organization of medical care for patients diagnosed with COVID-19, including medical care provision in the extreme conditions.

Results and Discussion. The rational distribution of infectious diseases hospitals, human resources and equipment made it possible to create bed capacity reserve, as a result of which, even during the peak episodes of the pandemic process, the average occupancy of beds in the serviced area was no more than 92-93% and there was always the possibility to receive new patients in hospitals; the capacity of the laboratory was gradually increased 25 times: from 200 tests per day in the pre-pandemic period to 5,000 tests per day. Thanks to the introduction of the new management solutions, digitalization of medical processes has been ensured: accounting of results in the medical information system, transmission of results directly to medical institutions within 12-14 hours, which is 4 times faster than the standard time. The legal regulations of interaction with the rescue centres of the Ministry of Emergency Situations of Russia, the Ministry of Defense and other power structures, the improvement of the material and technical equipment of basic mobile hospitals and emergency medical teams were proposed for discussion.

Conclusion. A scheme has been worked out for the involvement of the MOF of the Federal Medical and Biological Agency of Russia in the timely organizational measures for mobilization of forces and means in order to ensure the re-profiling of medical activities to work on providing medical care in the COVID-19 pandemic conditions.

Introduction. Anaphylaxis is a systemic potentially life-threatening hypersensitivity reaction featuring the rapid onset, manifestations of the respiratory tract and/or hemodynamics and usually, but not always, accompanied by changes in the skin and mucous membranes [1]. The cause of developing an acute generalized reaction in food anaphylaxis may be the minimum culprit product amount that has entered the patient's body through the mouth or through the skin/mucous membranes. Patients like these are, as a rule, first seen by a paediatrician, a related specialist, or a paramedic. Since the doctors often consider the symptoms of foodborne anaphylaxis separately, the latter does not cause proper suspicion: angioedema and/or acute urticaria accompanying rhinorrhea, acute bronchospasm or laryngitis developed extremely quickly or immediately after contact with an allergen.

The aim of the work was to acquaint paediatricians and doctors of related specialties with the food anaphylaxis symptoms, to justify the need for an allergologist-immunologist to consult these patients in order to resolve the issue of required component-resolved diagnosis of allergy and development of an individual elimination diet, taking into account the patient's sensitization profile.

Materials and methods. Clinical observation of a child (boy, age — 12 months) with symptoms of atopic dermatitis and episodes of food anaphylaxis in the anamnesis; general clinical examination and allergological examination of the patient by component allergodiagnostics were performed.

Results. Sensitization to ovalbumin (Gald 2 -16.60 kU/l) and ovomucoid (Gald 1-9.01 kU/l) was established. The detected sensitization is a predictor of severe systemic allergic reactions to eggs.

Discussion. Component diagnostics performed as prescribed by an allergologist not only confirms the causative allergen, but also evaluates the risks of developing acute reactions if the allergen is accidentally introduced to the child and the timing of the patient's tolerance formation. This sensitization will cause sudden systemic allergic reactions for years to come.

Conclusion. It is important for a specialist to timely suspect food anaphylaxis, differentiate it from other emergency and urgent conditions, and give the patient the correct recommendations on the need for consultation with an allergologist-immunologist. Only a thoughtful, comprehensive medical approach to each acute condition in a child will significantly reduce the risk of repeated episodes of food anaphylaxis.

Introduction. At the end of 2019, the world faced a pandemic of infection caused by the SARS-CoV-2 coronavirus. The disease caused by this virus is referred to as COVID-19, and is characterized by multiorgan lesion. The leading syndrome is the syndrome of immune response disregulation or the «cytokine storm». According to the studies, which were used as the basis of patient management clinical protocols, antiinterleukin-6 agents, and glucocorticosteroids, are the most effective in stopping the «cytokine storm». At the same time, the use of immunosuppressive drugs increases the risk of secondary infectious complications not associated with the COVID-19 viral infection.

The aim of the study was to present a successful case of treating a secondary bacterial infection in a patient with a severe new coronavirus infection in the context of a limited choice of antimicrobial therapy.

Materials and methods. The report presents a clinical case of a complicated urinary tract infection associated with an extremely resistant Kl.pneumoniae strain in a 58-year-old patient hospitalized with severe COVID-19. Due to comorbidity, combined with long-term hospitalization, the need in immunosuppressive therapy, and long-term catheterization of the urinary tract, the patient got affected by Kl.pneumoniae. This pathogen demonstrated microbiological and clinical resistance to all studied classes of antibiotics, including carbapenems, aminoglycosides and polymyxins. The patient developed an abscess of the prostate, and orchiepididymitis, which required repeated surgical interventions.

Results and Discussion. The multidisciplinary approach to patient treatment, as well as the use of local and regional epidemiological data made it possible to choose the most effective drug therapy. The combination of adequate surgical debridement and combined antibiotic therapy (ceftazidime/avibactam and aztreonam) led to regression of the complicated urinary tract infection manifestations and clinical recovery.

Conclusions. The use of ceftazidime/avibactam and aztreonam combination is a promising therapeutic option for the treatment of infections caused by extremely resistant strains of Enterobacterales, in which the combined production of serine proteases and metallobetalactamases is expected.

Introduction. Despite significant advances in the creation of stable cell lines, the focus of research has recently shifted toward the creation of primary cell cultures derived directly from patient tumor samples, which include both tumor cells and microenvironmental cells.

The aim of the study was to compare the morphological characteristics of the cells of a breast carcinoma sample when cultured over three passages.

Materials and methods. Material for the study was obtained during surgical intervention in a patient diagnosed with breast carcinoma. Slices were prepared from the tumor sample according to the standard histological protocol and stained with monoclonal antibodies to estrogen, progesterone, Ki-67, Her2/neu receptors. Cell nuclei were stained with hematoxylin. Immunohistochemical reaction was performed in DAKO autostainer (Denmark). Part of the material was placed in Hanks' solution with 5% antibiotic antimycotics and delivered to the Cell Culture Laboratory, where after performing the standard protocol for obtaining cell culture, tumor cells were diluted in Mammocult nutrient medium and placed in culture vials. For morphological evaluation, cells were stained by Pappenheim. For immunocytochemical analysis in determining the belonging of cells to epithelial cells using anti-Pan Keratin Primary Antibody antibody. The number of cells was counted in an automatic TC20 counter, and culture growth was monitored using an Eclipse TS100 microscope, Nikon (Japan).

Results and Discussion. On the basis of immunohistochemical study, the tumor sample was classified as Luminal-A subtype. During the study several groups of cells were isolated and cytologically evaluated. The results of immunocytochemical analysis of the cultured cells confirm that the tumor cells retained their epithelial phenotype during culturing. In spite of the manifestation of cell polymorphism in BML cell culture, during three passages the cultured tumor cells retained their epithelial nature and showed a tendency to form a monolayer.

Conclusion. A detailed study of cytomorphology and immunocytological characteristics of cultured cells of different immunohistochemical PBMC subtypes will help to evaluate the main regularities of tumor cell vital functions in vitro and allow a more differentiated approach to the creation of personalized cell cultures in order to develop a targeted chemotherapeutic effect on tumors of specific patients.

Introduction. A review of the literature considering the problem of reproductive health against the background of chronic endometritis is presented. According to the literature, in the etiology and pathogenesis of infertility and habitual miscarriage, the main cause is the «uterine factor» (24-62%). Chronic inflammation in the uterine mucosa can lead to infertility, which increases the significance of this pathology. It is proved that most often the causative agents of this disease are representatives of conditionally pathogenic microflora. Chronic endometritis is an unexplored pathology associated with unfavorable reproductive outcomes, such as unsuccessful implantation and repeated miscarriage. Most scientists assume that inflammation develops against the background of a long-term persistence of an infectious agent. According to other scientists, the cause of the occurrence and development of chronic endometritis is an autoimmune process that contributes to the progression of inflammation. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system. In this article, we aim to give an overview of the diagnosis, etiology, pathophysiology and treatment of chronic endometritis, its effect on endometrial receptivity and its relationship with reproductive dysfunction.

The aim of the study is to identify the main discussed aspects of the management of patients with chronic endometritis, to determine promising diagnostic methods.

Materials and methods. The analysis and systematization of the data were carried out on the basis of scientific publications in the common database of Cyberleninka and PubMed.

Results and Discussions. The article discusses the methods of laboratory, ultrasound and instrumental diagnostics used in Russia and abroad. The» gold standard « of diagnostics is a histological examination of the endometrial tissue material on the 7th10th day of the menstrual cycle. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system.

Conclusion. Chronic endometritis remains an important problem in modern society, as it has a social significance: the frequency of reproductive losses is at a high level. There is a need to further study the features of the etiology and pathogenesis of chronic endometritis in order to improve the presentation of the course of the inflammatory process and improve the methods of therapy and prevention of this disease for the realization of reproductive function.

Introduction. The literature review deals with the effects of ionizing radiation and radiation on the body of medical personnel.

Materials and methods. 50 actual sources were analyzed. The relevance of the study of the constant, long-term influence of low doses of radiation is shown, in view of the increasing use of sources of ionizing radiation in various fields of scientific and practical human activity, including medicine.

Results. Thanks to the analysis of numerous literature data, it was revealed that operating doctors, who are faced in their work with sources of ionizing radiation, often do not have a sufficient level of protection of the thyroid tissue from radiation. It was revealed that the overwhelming majority of studies highlighting thyroid pathology in medical personnel working with X-rays are aimed at identifying the risks of thyroid cancer and does not take into account the pathology of non-tumor genesis. Analyzed the data of scientific publications, allowing to draw a conclusion about the effects of chronic exposure to ionizing radiation, namely X-rays, in low doses on the thyroid tissue from a morphological and functional point of view.

Discussion. It was established on the basis of the analysis of experimental data that under the influence of low-dose X-ray radiation, the intercellular contacts of thyrocytes are disconnected, which can lead to a decrease in the synthesis of thyroid hormones and, as a consequence, to the development of hypothyroidism.

Conclusion. Based on the analysis of the experimental data, it has been established that under the influence of low-dose X-rays there is a disconnection of intercellular contacts of thyrocytes, which may lead to a decrease in the synthesis of thyroid hormones and, consequently, to the development of hypothyroidism.

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.

Materials and methods. Scientific publications search was carried out in PubMed, Google Scholar databases for the period from December 2019 to September 2021.

Results and Discussion. Cardiospecific troponin I increase beyond reference limits is reported to occur in at least every tenth patient with identified SARS-CoV-2, the elevated troponin detection rate increasing among persons with moderate to severe course of the infection. The mechanisms of acute myocardial injury in patients with COVID-19 are poorly understood. By September 2021, there are several pathogenesis theories. A high frequency viral myocarditis direct cardiomyocytes damage is explained by the high SARS-CoV-2 affinity to ACE2 expressed in the myocardium. The cytokine storm related myocardial damage is reported a multiple organ failure consequence. Coagulopathy may also trigger myocardial microvessels damage. Up to every third death of SARS-CoV-2 infected persons is related to the acute myocardial injury. At the same time, due to the high incidence of the acute myocardial injury, it is rather difficult to assess the true incidence of acute myocardial infarction in patients with COVID-19. In the pandemic setting, the waiting time for medical care increases, the population, trying to reduce social contacts, is less likely to seek medical help. In this regard, in order to provide effective medical care to patients with acute myocardial infarction, it is necessary to develop algorithms for providing care adapted to the current epidemiological situation.

Conclusion. The treatment of patients with probable development of acute myocardial damage against the background of new coronavirus infection should be performed in accordance with the current clinical guidelines. Anticoagulant therapy should be administered in a prophylactic dose under control of hemostasis parameters and a wide range of biochemical parameters.