Introduction. Obstructive sleep apnea (osa) and concomitant comorbid pathology cause dysregulation of the autonomic nervous system (ans). For the primary prevention of osa complications, the most prognostically significant indices of heart rate variability (hrv) should be further studied. The aim of the study was to reveal hrv peculiarities in patients with aos and comorbid pathology. Material and methods. The study included 113 patients who underwent anthropometric measurements, polysomnography, hrv recording, and questionnaires (beck scale, hads, holmes-reay stress scale, spielberger-hanin questionnaire). On the basis of polysomnography results 2 groups of subjects were formed: with osa (n = 61) and without apnea (n = 52). Results. Hypertension occurred in 86.9 % of osa patients (p = 0.000), acute cerebral circulation disorder in 8.2 % (p = 0.035), and chronic cerebral ischemia in 82 % of patients (p = 0.000). Emotional changes in patients with osa were due to depression (p = 0,000). Representative hrv indices in patients with orthostasis apnea were low values of cr (%), sdnn (ms), rmssd (ms), dx (ms), cv (%) and ic (arb. Units), fr (ms²), hf (ms²), lf (ms², %), vlf (ms²), and at rest – ic (arb. Units), vpp (arb. Units), hf (%) and vlf (%), which were higher than in the comparison group. Discussion. Low values of hrv temporal and spectral analyses in patients with osa are probably caused by desaturation. Hypoxemia affects changes in the work of segmental-adrenergic mechanisms, hypothalamic-limbic brain structures, leads to dysfunction of cardiac 2-adrenergic receptors and promotes activation of sympathetic department (sd) of ans. Conclusion. In patients with moderate and severe osa, the influence of the central circuit of autonomic regulation on the heart rhythm increases, the total power of hrv decreases due to the parasympathetic division and the activity of sd prevails, which can lead to exhaustion of regulatory systems of the body, decrease in the adaptation reserve and increase the risk of vascular complications.

Introduction The only remaining kidney after nephrectomy for cancer requires increased attention due to partial loss of functioning tissue (kidney death). The outcome of surgical treatment of kidney cancer depends not only on cancerspecific survival, but also on the degree of loss of renal function, which often develops after surgery, especially in the amount of nephrectomy. The aim of the investigation was to study early functional changes of the single kidney as a mechanism of compensation after nephrectomy for kidney cancer. Materials and methods To study functional state of the single kidney in 36 patients after nephrectomy for contralateral organ cancer, the peripheral blood pressure was measured with the calculation of mean dynamic pressure, renal ultrasound investigation, renal vessels Doppler study, GFR calculation, bulbar conjunctiva biomicroscopy. Results By the 2nd day after surgery, tendency to increase mean dynamic BP to 105,3 ± 2,5 mm Hg was registered in 61,1 % of patients with a single kidney in comparison with initial values (p < 0,05), and kidney volume increased on the average by 16 % (from 110,4 ± 11,2 cm³ to 132,4 ± 4,8 cm3, p < 0,05). There was a decrease in GFR to 58.4 ± 5.4 ml/min/1.73 m² (p < 0.05). Doppler sonography of the vessels of the single kidney showed a moderate increase in linear blood flow, increased resistance index in the main trunk, decreased pulsation index in the segmental and interlobular arteries. Bulbar conjunctival biomicroscopy revealed the changes in the microcirculatory bloodstream in 83.3 % of patients – narrowing of arterioles, dilation of venules, deceleration of venular and capillary blood flow, stasis of blood-forming elements in the capillaries. Discussion. Early signs of dysfunction of the single kidney in patients after nephrectomy are: the organ volume increases, its function decreases and blood flow worsens, arterial pressure increases and microcirculatory changes. Considering the prognostic significance of early changes in the sole kidney it is necessary to control the functional parameters of the organ and substantiate pathogenetic complex medical rehabilitation. Conclusion. In patients with the only kidney special attention should be paid to early changes of the kidney and prevent development of hypertensive nephropathy and CKD, the organ is considered incomplete in the conditions of increased functional load.

Introduction. Perinatal routing ensures increased survival among preterm infants. Early admission to a highlevel neonatal care facility is also associated with lower morbidity in this patient population. A significant number of scales have been proposed to assess neonatal severity, predicting morbidity and risk of death. However, the comparison of the decision of the transport team with the recommendations of the scales is poorly understood. Materials and methods. The cohort study included data from 604 resuscitation team visits. The CASPN (clinical assessment scale for the premature newborn) was assessed, and a subgroup of patients with a CASPN score of 6-8 (n = 98) was taken for further analysis: 73.47 % of neonates (n = 72) were rated as transportable, 22.45 % of patients (n = 22) were considered nontransportable, and 4 patients (4.08 %) were left due to lack of indications for evacuation. The parameters and type of respiratory and hemodynamic support, monitoring data, volume of pre-transport preparation were studied. Results. Analysis of intensive care revealed significant differences in the frequency of high-frequency ventilation (2.78 % [0.34–9.68] and 22.73 % [7.82–45.37] among the transportable and nontransportable, respectively, p = 0.007), the frequency of adrenaline infusion (1.39 % [0.04–7.50] and 27.27 % [10.73–50.22] among the transportable and nontransportable, respectively, p = 0.0005). There was a higher requirement for supplemental oxygen, a higher mean airway pressure value, and a higher value of the oxygenation index in the nontransportable subgroup. Patients who were considered untransportable were significantly more likely to require prescription or adjustment of catecholamine dose (1.39 % [0.04–7.50] and 22.73 % [7.82–45.37], p = 0.002) and correction of respiratory support parameters (23.61 % [14.40–35.09] and 54.55 % [32.21–75.61], p = 0.009). Discussion. The results of the study indicate significant internal heterogeneity of the group with a score of 6–8 on the CASPN by the severity of respiratory and hemodynamic disorders. With a similar structure by weight and gestational age, there is a significant difference in the need for respiratory function replacement and medication management of hemodynamics. Conclusion. The CASPN score does not allow a detailed description of the severity of a newborn patient by the severity of respiratory and circulatory insufficiency in the pre-transport preparation phase and cannot be applied as a tool for assessing transportability.

Introduction. Cerebral palsy is a group of disorders of movement and body position development that are caused by non-progressive damage to the developing brain of the fetus or child. Modern scales and questionnaires help to objectify the problems and assess the result of rehabilitation measures. The purpose of the study. was to assess the quality of life of children with cerebral palsy depending on the level of the GMFCS scale and the surgical treatment performed from the point of view of patients and their parents. Materials and methods. The study group included 48 patients (24 boys and 24 girls) of both sexes aged from 2 to 17 years diagnosed with infantile cerebral palsy and their parents. Surgical treatment was performed in 18 children, 8 of them were operated on using SEMLS technique. Quality of life was assessed using the PedsQL 3.0 questionnaire, Cerebral Palsy module. Results. Assessment of daily activities, school activities, movement and balance, pain, fatigue, eating, speech and communication by parents was directly related to patients' level of mobility on GMFCS scale. No such correlation was found on the part of the patients themselves. Surgical treatment, according to the parents, resulted in improvement of such statodynamic indicators as moving and balance retention. The patients themselves did not report any changes in their quality of life after the surgical treatment. The presence of pain was reported by 91.6 % of patients. Discussion. Differences in the characterization of the quality of life of children with cerebral palsy by their parents depending on the GMFCS scale appear in the evaluation of all indicators of the PedsQL questionnaire. The surgical treatment performed leads to improvement of these indicators. The results obtained confirm the data of a number of publications on the effectiveness of operative tactics for improving motor activity in children with cerebral palsy. Conclusion. Reduced quality of life in patients with cerebral palsy depends on the severity of the disease according to the GMFCS scale. Surgical treatment, according to parents, improves the quality of life by increasing the physical functioning of the child.

Introduction In scientific and regulatory sources the issues of evaluation of medical care with the use of telemedicine technologies are reflected in the system «patient-doctor» in the form of quantitative indicators of medical council. There are no solutions for the processing information data in the provision of medical care with the use of telemedicine technologies in the "doctor – doctor" system. The objective was to develop a system of indicators of telemedicine services in the "doctor – doctor" system in order to improve the quality of the organization of remote interaction between medical organizations in providing medical care using telemedical technologies. Material and methods. An analysis of 18 scientific and 15 regulatory sources for the existing methods of development and types of indicators of the quality of medical care was performed. The depth of the search was 15 years. The information-analytical method was used to determine the types and ways of forming the quality indicators of telemedical services in the "doctor – physician" system. Results. The indicators of telemedicine services in the system "doctor – physician", reflecting the volume of medical care provided by the consulting medical organization using telemedicine technologies, the expert and consultative work of the doctor, and seasonality of load on the consulting organization have been developed. Discussion. The proposed system of indicators should help the consulting medical organization to use its forces and means as rationally as possible, to manage the distribution of reference flows of medical organizations, to form an optimal algorithm of each specialist's work and to plan his expert load. The creation of this system of indicators is an attempt to summarize the available experience on the use of telemedical technologies in the provision of medical care using remote interaction between medical organizations. Conclusion. It is planned to evaluate the effectiveness of applying the system of indicators to a larger volume of studies in the framework of the pilot project.

Introduction. Statistical indicators and dissatisfaction of recipients of medical services indicate the low quality of mental health care for children. The provision of medical care to children with psychiatric disorders is an area with few regulatory documents, which, inter alia, could be used to organize and conduct internal quality control of specialized care at the level of the medical organization working on the profile "psychiatry". Materials and methods. The article describes the first steps in the implementation of an internal quality control system using the principles laid out in the practical recommendations of the Roszdravnadzor National Institute for Quality Control. In order to develop a separate version of the practice guidelines, sensitive to the specifics of child psychiatry, an expert review was performed by a multidisciplinary group of specialists. The experts were asked to conduct an informational analysis of the documents, to evaluate the data characterizing the state of child psychiatric care and the system of internal quality control in the medical organization, and to propose a vector for the development of the quality service. The "Ishikawa diagram" method was used to visualize and organize the data. Results. The group of experts identified 12 main directions in which the organization of internal quality control in child psychiatry was required, including "psychiatric safety", determined the stages of further implementation, the need to delegate the development of algorithms, procedures, and checklists to the teams of units. Discussion. An original solution with the allocation of four categories of subjects, to which the criteria of medical care quality should be applied in all 12 main directions: employees, patients (children), parents (legal representatives) and property (provision) was proposed. The focus on parents (legal representatives) corresponds to the chosen strategy of development of the medical organization of the G.E. Sukhareva Center, as focused on the family of a mentally ill child. Conclusions. When implementing the system of internal quality control it is necessary to take into account the specificity of activity and development strategy of the medical organization, it requires the participation of the management and a significant part of the staff, which allows to involve employees in the policy of quality.

Introduction. The changes of organizational, legal and methodological nature occurring in the system of quality and safety management of medical activity in the Russian Federation require a scientific assessment of the role of the medical commission (MC), as a formed subject of control and support for management decisions. The objective of the study is to determine the role and place of the MC in the management of quality and safety of medical activity in the regional segment of healthcare based on the analysis of the reported data. Materials and methods. The materials of the reporting data of the regional medical information system were used to analyze the activities of MCs of medical organizations in the Chelyabinsk region. Calculations of average values, calculations of intensive and extensive indicators, construction of series of dynamics were performed. Results. It was established that consideration of issues of clinical-expert decision support occupied 74.6 % of the total MC load, and from 2015 to 2021 their number increased from 792.1 to 815.4 per 1000 MC meetings per year. MC involvement in internal quality control issues occupied 11.3 % of the total workload and tended to decrease from 239.4 to 75.7 per 1,000 MC meetings per year. Discussion. The obtained data, together with the requirements of the current legislation, confirm the need to revise the role of MCs in the organization and conduct of internal control. Changes in the normative base laid down the basis for transformation of the MCs activity as an internal control subject. Conclusion. Consideration of clinical and expert issues by the MC is the leading direction of its activity, the role of which in 2015–2021 was increasing. The number and proportion of internal quality control issues considered by the MC in 2016–2021 tended to decrease. Conditions of high clinical uncertainty of pandemic COVID-19 led to additional intensification of the work of the MC in clinical-expert direction and caused the reduction of the role of the MC in internal quality control.

Introduction. The question of management tactics of comorbid patients remains the most difficult task in clinical practice. Combined cardiac and renal disorders (cardiorenal syndrome) are widespread in this category of patients and require close attention of the practitioner due to the emerging difficulties of drug therapy selection, in particular related to the limitations of prognostic-modifying drugs prescription. The aim of the study was to demonstrate on clinical example the peculiarities of comorbid patient management with combined cardiovascular and renal pathology. Materials and methods. Clinical case of patient R. with chronic heart failure and chronic disease of the only right kidney, the description of which highlights the key aspects that require attention in determining the tactics of comorbid patient management. Results. As a result of multicomponent personalized conservative therapy, the severity of dyspnea decreased, edema of the lower extremities was eliminated, regression of pleural effusion was achieved. Intensification of treatment was necessary during hospitalization due to exacerbation of chronic pyelonephritis of the right sole kidney, which helped improve the patient's condition. Conclusion. The most effective correction of each pathology improve the quality and life expectancy of a comorbid patient. Difficulties in achieving the target treatment results due to the interaction of several pathogenetic links potentiating each other should be overcome by selecting personalized therapy, as well as by searching for new therapeutic targets.

Introduction. Men who have sex with men (MSM) are a vulnerable social group in terms of sexually transmitted infections (STI) risks. Given the increase in STI incidence among MSM over the last decade in many countries, as well as the lack of coverage of this topic in the domestic literature, the study of this problem is relevant for the development of preventive measures. Objective of the study was to reveal main clinical and epidemiological peculiarities of various STIs course in MSM group on the basis of foreign scientific literature data. Materials and methods. A 40-year search in the PubMed and Scopus bibliographic databases, and the Elibrary electronic scientific library was conducted; 32 sources were selected for the scientific review. Nosologies analyzed: gonorrhea, chlamydia, mycoplasmosis, papillomavirus infection, syphilis, venereal lymphogranuloma, and anogenital herpes. Results and discussion. The presence of extragenital foci of STI lesions in MSM, which may not be detected during clinical examination of a patient, the occurrence of mixtures and co-infections were noted. Modern preventive programs should be envisaged. Conclusion. Owing to a number of clinical and epidemiological specific features of STI among MSM, including the formation of extragenital foci of lesions, mixt and co-infection, as well as predominantly asymptomatic course of diseases, more than half of cases remain undetected. This leads to increased morbidity and poses a danger to the heterosexual population.

Introduction. The ongoing pandemic caused by the new coronavirus infection SARS-CoV-2 requires the development of effective methods of diagnosis, treatment and prevention of the disease. The problem is particularly urgent in obstetric practice. Currently, the effect of SARS-CoV-2 on the course of pregnancy, delivery and the condition of newborns is poorly studied. The aim of the investigation was to review the foreign and domestic literature data on the immune system status of novel coronavirus infection COVID-19 during pregnancy, its effect on perinatal outcomes. Materials and methods. Scientific publications were searched by keywords in Web of Science, Scopus, and Medline (2020–2021) and Russian specialized journals in obstetrics and gynecology (2019–2021) science databases. Particular attention was paid to the effect of COVID-19 infection caused by SARSCoV-2 on the formation of the immune response in pregnant women, in particular pro- and anti-inflammatory cytokines. Results and discussion. Immunological interactions in the maternal-placental-fetal system are quite complex and cannot be considered fully understood to date. Infectious diseases during gestation, due to the immune tolerance of the body, are often more severe than outside pregnancy, and the presence of associated somatic diseases only aggravates the clinical picture. The analysis showed the importance of the role of local protective factors in the new SARS-CoV-2 coronavirus infection, and especially of the cytokine profile system, one of the leading factors of immunopathogenesis. In the initial stages of the infectious process, there is an increase in the production of pro-inflammatory cytokines in the formation of the body's defense in adverse infectious genesis, which may contribute to the kipping of inflammation in SARS-CoV-2. In the majority of cases, the occurrence of severe infection complications is accompanied by a systemic anti-inflammatory response syndrome; therefore, the evaluation of cytokine regulation during pregnancy is an important task. Conclusion. A detailed study of the cytokine profile will reveal an imbalance in the functional activity of immunocompetent cells and help to formulate predictive criteria affecting the resolution of inflammation in SARS-CoV-2, depending on the severity of the disease and gestational age, as well as predict the duration of immune response maintenance.

Introduction. Women during pregnancy may be particularly susceptible to SARS-CoV-2 infection as physiological changes affect the cardiovascular, respiratory and immune systems. Several studies suggest that pregnant women who have had COVID-19 are not only at high risk for developing a severe infection, they also have an increased incidence of placental-associated pregnancy complications. The objective of this literature review was to establish pathogenetic relationships between COVID-19 and placenta-associated pregnancy complications. Materials and methods. International and Russian scientometric databases Google Sholar, ResearchGate, Pubmed, and Elibrary were used to analyze the scientific literature. Results and discussion. Severe COVID-19 is closely associated with preeclampsia, preterm birth, and other adverse perinatal outcomes. Pregnant women with SARS-CoV-2 infection are at higher risk of: maternal death, intensive care unit hospitalization, preterm birth and stillbirth. However, in some cases, the increased incidence of preeclampsia observed in mothers with SARS-CoV-2 may be related to misdiagnosis and iatrogenic preterm birth, as preeclampsia and COVID-19 may have similar symptoms. COVID-19 vaccination is recommended during pregnancy in high-risk groups to prevent severe maternal morbidity and adverse pregnancy and childbirth outcomes. Conclusion. COVID-19 increases the risk of placental-associated pregnancy complications. In some cases, COVID-19 mimics the clinical picture of preeclampsia, so careful differential diagnosis is required to reduce the incidence of iatrogenic preterm labor. Vaccination in pregnant women is a preventive measure against COVID-19 infection and its severe forms and may indirectly reduce in the incidence of major obstetric syndromes.

Introduction. Rehabilitation of patients after pulmonary tuberculosis treatment is a separate area of research in the field of phthisiology and pulmonology. The accumulation of data on the condition of patients after treatment in the near and distant period makes it possible to identify the factors of disease recurrence. Statistical estimation of pulmonary tuberculosis treatment outcomes provides the accumulation of parametric data on the results of therapeutic and rehabilitation measures. Purpose of the work was to analyze respiratory function of patients after treatment of pulmonary tuberculosis and possible causes of relapses of the disease by defining the dynamics of functional reserves depending on the form of the disease and methods of its treatment. Materials and methods. Scientific Russian and English literature was searched for the last five years. The literature search was performed in the PubMed, ResearchGate, Cyberlenica, and eLibrary databases. Results and discussion. It was established that respiratory function of patients after treatment of pulmonary tuberculosis depends on the form of the disease and methods of invasive intervention, as well as the algorithm of their choice in a particular case. Due to the variety of forms of pulmonary tuberculosis, the effects on respiratory function of such surgical methods of treatment as thoracoplasty, valve bronchoblocations, cavernotomy, resection continue to be studied. Studies of respiratory function have focused on patients with complicated, drug-resistant forms of tuberculosis. Causes and risk factors for tuberculosis recurrence have been found to include an increasing proportion of multidrug-resistant pathogens and comorbidities. The place of residence and social behavior of an individual are also singled out as risk factors. Conclusion. Current studies of respiratory function in patients after tuberculosis treatment have raised the question of the increase in the proportion of multidrug-resistant mycobacteria, and there are proposals for prevention of pulmonary tuberculosis recurrence by screening the treated patient and developing contra-cycling rehabilitation programs. Prognostic value of respiratory parameters after surgical treatment of pulmonary tuberculosis is insufficiently studied. At the same time the dynamics of functional reserves of the respiratory system allows to estimate the efficacy of surgical intervention.

The aim of the investigation was to evaluate the efficacy and safety of the treatment of arterial hypertension syndrome in patients with peripheral arterial disease of the lower and upper extremities and to analyze the efficiency of the effect of operative revascularization of the limb arteries on the course of arterial hypertension. Materials and methods. Literature sources were searched for 15 years in electronic resources of Pubmed. com, Sciencedirect.com, eLibrary.ru. Results and discussion. Hypotensive therapy, in patients with peripheral arterial disease and local "atherothrombotic" mechanisms of acute thrombotic occlusion, the main groups of drugs providing metabolic safety of long-term treatment can significantly affect the risk of repeated arterial thrombosis and critical ischemia, including, after reconstructive vascular surgery. International methodological materials and recommendations practically do not cover the issues of perspective hypotensive therapy of patients with embolic character of acute arterial occlusion in chronic lower limb ischemia. These categories of patients were not singled out separately in the controlled prospective studies, therefore, planning of additional works on the study of the issue is required. Conclusion. Adequately selected hypotensive therapy and blood pressure control in patients with lower limb peripheral atherosclerosis allows not only to provide the target level of blood pressure reduction, but also to reduce the risk of thrombotic complications, including those leading to critical limb ischemia and gangrene.