Introduction. The relevance of the study is due to the need to conduct a scientific analysis of the quality of the country’s population life, improve the standard of citizens living through the implementation of medical measures, including medical and preventive work.
The purpose of the work is to conduct a comparative analysis of the quality of life of urban and rural residents of the Yaroslavl Region based on physical and psychological well-being, determine the level of general health indicators of the working-age population, and analyze the role of organizational and preventive measures in improving the quality of life.
Materials and methods. The SF‑36 questionnaire was used in the study to assess the quality of life. 600 residents (age (25.1±0.8) years) of Yaroslavl and the Yaroslavl Region took part in the survey. The ratio of men and women was 50 % and 50 %, respectively.
Results. It was revealed that the quality of life of rural residents has lower values compared to city residents. This difference is especially noticeable in indicators that are directly dependent on the emotional and physical state of a person.
Discussion. The conducted comprehensive analysis shows that as a result, the assessment of the quality of life of the population of the respondents was based on their subjective understanding and perception of their own situation in life, which is also typical for studies in other regions of the country. The indicators of the general health of the rural population of working age indicated insufficient access to medical care and a low level of literacy of the population in matters of maintaining and strengthening their own health, as well as medical activity.
Conclusion. Hygienic assessment of the quality of the population life in terms of physical and psychological well-being made it possible to identify a number of differences in the assessment of the quality of urban and rural areas residents life at Yaroslavl and the Yaroslavl Region. Most of the considered characteristics of the quality of rural residents life had reliably significant low values in comparison with city residents.

Introduction. Septic complications after critical obstetric conditions (COC) are a pressing problem in obstetrics. The aim of the study is to conduct an integral assessment of the severity of postpartum women with septic complications after COC.
Materials and methods. We examined 39 postpartum women after COC (massive obstetric hemorrhage, severe preeclampsia). All patients were divided into 2 groups: the main group (n = 18) — with associated septic complications, the comparison group (n = 21) — without septic complications. The average age of the subjects was (29.80±6.48) years.
Results. Obstetric bleeding was complicated by hemorrhagic shock in more than 75 % of patients in both groups. Premature detachment of a normally located placenta (PDNLP) was statistically significantly more often recorded in the main group (p = 0.04). All patients underwent total hysterectomy during childbirth or in the early postpartum period. Multiple organ failure syndrome (MODS) occurred in all women of the main group and in 17/21 (80.95 %) in the comparison group (p = 0.05). When assessing the condition of maternity hospitals using integral scales, a higher number of points were noted in the main group on the APACHE II scale (p = 0.02), SOFA (p = 0.001), NEWS2 (p < 0.001). In the main group, septic complications developed on the 9 [4; 9] day after delivery.
Conclusion. Risk factors for septic complications after COC are: MODS, renal failure, acute kidney injury, heart failure, respiratory distress syndrome, pneumonia. Maternity hospitals at risk of septic complications after COC initially show an increase in the number of points according to APACHE II, SOFA, NEWS2.

Introduction. Among hand injuries, the proportion of metacarpal fractures is 9.6–40.0 %. Currently, there is no single approach to the treatment of children with such injuries.
The aim is to determine the optimal method of surgical treatment of metacarpal fractures in children by comparative analysis of the results of antegrade and retrograde osteosynthesis with Kirchner spokes.
Materials and methods. A prospective cohort study included 186 children with closed head fractures of the II–V metacarpal bones. The main group consisted of 103 children (55.38 %) who underwent antegrade osteosynthesis; the control group consisted of 83 children (44.62 %) who had needles retrograde. Local inflammatory changes were assessed on the 3rd and 7th days after surgery. The volume of active movements in the metacarpophalangeal joints was measured after 3, 6 and 12 weeks.
Results. At week 3 of follow-up, the median amplitude of movements in the metacarpophalangeal joints in patients of the main group was 18 [13; 26] degrees, in the control group — 7 [4; 9] (p < 0.001); at week 6–59 [49; 72] and 35 [32; 54] (p < 0.001) At week 12–89 [84; 90] and 82 [74; 86], respectively (p < 0.001). Macroscopic assessment of the needle insertion area on the 3rd day after surgery showed the absence of local inflammatory changes in 92 (89.3 %) and 73 patients (88.0 %) of the main and control groups (p = 0.953); on day 7, in 100 (97.1 %) and 76 (92.5 %), respectively (p = 0.497), however, the differences were not statistically significant.
Discussion. The optimal way to treat metacarpal fractures in children should be technically simple and low-traumatic. The importance of early rehabilitation for restoring the volume of movement in the joints of the hand is confirmed by many studies.
Conclusion. Due to the minimization of damage to the articular surfaces and the early start of rehabilitation, the best functional results were achieved in the antegrade osteosynthesis group.

Introduction. There is evidence that smoking affects the course and effectiveness of treatment of patients with pulmonary tuberculosis. At the same time, tobacco smoking and pulmonary tuberculosis are significant risk factors in the development of functional lung disorders.
The purpose of the study to study the nature of changes in spirometry parameters and the peculiarities of the course of the tuberculosis process in smoking patients.
Materials and methods. A retrospective cohort study, which included 102 patients with pulmonary tuberculosis. The patients were divided into two groups: 1 — smoking patients (47 people), 2 — non-smoking patients (55 people).
Results. It is shown that men are significantly more common among the former, while women are more common among the latter (p = 0.001). Bilateral lung tissue lesions are more common among smokers compared to non-smokers. It is shown that a decrease in the volume of forced exhalation in the first second (OFV1) of an extremely severe degree is significantly more often observed among smokers (p = 0.028). At the same time, a mild degree is more common among non-smokers (p = 0.039).
Discussion. Thus, the most important problem among smokers and non-smokers is a violation of the functional parameters of the lungs. Currently, there is a need to find optimal approaches to prevent a decrease in lung function. Conclusion. It has been shown that a decrease in lung function is observed more often among smoking patients. Also, respiratory symptoms and infiltrative pulmonary tuberculosis are more common among smokers compared to non-smokers.

Relevance. Chronic abacterial prostatitis (CAP) of a non-inflammatory nature remains a complex disease in terms of proven etiological factors and pathogenetic mechanisms. Recent studies define it as a nosology based on homeostasis disorders with damaging effects directed towards the prostate. Pathogenetically, this is cytokine aseptic inflammation and lipid peroxidation, which occurs under conditions of compromised antioxidant protection. Objective — to study the cytokine status in the experimental reproduction of non-inflammatory CAP models.
Materials and methods. 100 male white rats were studied, 25 formed a control group, and the remaining ones were divided into 3 equal groups for experiments on creating various models of CAP and systemic chronic stress. At the end of the experiment, blood was taken and the prostate was removed to obtain a homogenate. The substrates were used to determine pro- and anti-inflammatory cytokines.
Results. In the isolated CAP model of category IIIB, cytokine disorders were detected in prostate tissue (to a greater extent), and at the systemic level (to a lesser extent). The model of systemic immobilization stress proved the possibility of triggering cytokine disorders in prostate tissue characteristic of CAP IIIB. Severe homeostasis disorders at the systemic and local levels were observed in experiments where both systemic stress and the local CAP model were modeled.
Conclusion. Cytokine imbalance plays a key role in the pathogenesis of СAP IIIB. At the same time, systemic and organ cytokine disorders interact with each other and, under certain circumstances, aggravate the damaging effect of each other.

Introduction. The question of the possibility of predicting the severity of multiple organ failure that developed in the postoperative period in cardiac surgery patients is not sufficiently covered in the literature.
The aim of the study is determine the prospects of studying the relationship between the level of biomarkers and the severity of multiple organ failure in patients undergoing cardiac surgery.
Materials and methods. A series of seven observations was carried out on the clinical course of the immediate postoperative period in patients who underwent elective cardiac surgery. In the preoperative period, the risk of in-hospital mortality was assessed using the EuroSCORE II scale and the presence of multiple organ failure using the SOFA scale. Before surgery and at the beginning of the first postoperative day, the plasma level of presepsin was studied. Also, at the beginning of the first postoperative day, plasma levels of transferases and troponia T were studied, and the severity of multiple organ failure was analyzed using the SOFA scale. The length of stay of patients in the ICU was assessed. The results of the study are presented in the form of tables and graphs and subjected to visual analysis.
Results. The obtained data do not allow us to accurately link the level of tissue damage markers (aspartate aminotransferase, alanine aminotransferase, troponin T) and the marker of the systemic inflammatory reaction presepsin with the severity of multiple organ failure in patients after cardiac surgery. At the same time, they do not exclude the existence of such a connection.

Introduction. Infant mortality is a universally recognized indicator for social well-being of the population. There is a need for an in-depth analysis of the causes and factors leading to the death of infants at home, including determining the etiology of infectious diseases potentially causing death.
The purpose of the study — to determine the implication of herpesviruses in infant out-of-hospital death.
Materials and methods. Samples from autopsy material of 23 infants (blood, small intestine, heart, lungs, liver, brain), who died at home from various causes, were analyzed by PCR for the presence of viral DNA and RNA from herpesviruses, orthomyxoviruses, paramyxoviruses, picornaviruses, adenoviruses, coronaviruses, parvoviruses, as well as intestinal viruses.
Results and discussion. Positive PCR results were found in 11 cases (43.5 %), of which herpesviruses DNA was detected in 10 cases. In these samples, cytomegalovirus predominated, in association with Epstein — Barr virus and human herpesvirus type 6. This association was detected in blood and internal organs samples from four infants diagnosed with generalized viral infection, and from two infants with acute respiratory viral infection. This suggests the presence of a causal relationship between the lethal outcome and the detection of these viruses. Not all infants showed clinical signs characteristic of generalized herpes infection. In one infant with hypertrophic cardiomyopathy, coronavirus, enterovirus and rotavirus DNA was found in samples of internal organs.
Conclusion. Results showed the dominant role of the herpesviruses in out-of-hospital infant death cases.

Purpose — to investigate the dynamics of the content of antioxidant enzymes superoxide dismutase 1 (SOD1), glutathione peroxidase 1 (GPO1), glutathione reductase (GR) and lipid peroxidation products diene conjugates (DC), malondialdehyde (MDA) in the spleen and liver during the latent period of growth and metastasis of experimental tumor.
Materials and methods. Using 28 white male rats, a model of hematogenous liver metastasis was created by transplanting sarcoma 45 cells (S45) into the spleen, previously lead out under the skin 3 weeks before. Previously, was determined that a tumor visualized in the spleen at 5 weeks, and liver metastases at 7 weeks after transplantation S45. Levels of SOD1, GPO1, GR and MDA were determined using ELISA and DC by biochemical method in spleen and liver homogenates during the latent period of tumor growth and metastasis (1–2 weeks post-transplantation).
Results. Significant changes (1.5–5.2 times, р < 0.050–0.001) in studied factors levels were observed compared to intact rats and rats with the spleen lead out. Activation of lipid peroxidation and antioxidant system was noted in the spleen (tumor-carrying organ) during tumor growth and metastasis. At the same time, in the liver (the target organ of metastasis) observed also increased lipid peroxidation but simultaneously a pronounced decreased GR levels (5 times, p < 0.001) without affecting SOD1 levels.
Conclusion. Liver tissue exhibited the inferiority of antioxidant protection and the formation of pro-oxidant condition during the latent period of tumor growth, which may prepare the soil for metastasis.

Developmental and epileptic encephalopathies (DEE) are the most difficult problem in epileptology. Lennox — Gastaut syndrome (LGS) is a developmental and epileptic encephalopathy with onset in childhood, manifested by: frequent polymorphic seizures, including tonic axial ones; severe cognitive impairment; slow activity (with a frequency of <2.5–3.0 Hz) sharp-slow wave in the interictal period on the electroencephalogram, as well as runs of fast activity with a frequency of 10–20 Hz, often associated with tonic seizures; and resistance to therapy. Presumably genetic or forms with an unknown cause account for 20–30 % of cases of LGS, but a family history of epilepsy among patients with LGS is observed in only 2.5 %.
The purpose of this work was to describe a familial case of LGS in two siblings.
Materials and methods. A retrospective description of the medical history of 3 siblings born in a consanguineous marriage was performed.
Results and discussion. There was a similarity in the course of the disease in the two brothers, absolute resistance to drug antiepileptic therapy and temporary effectiveness of hormonal therapy for LGS with a decrease in the duration of the effect from course to course. In addition, the rare parallel existence in this family of another autosomal dominant disease — neurofibromatosis type 1 — is shown.
Conclusion. A detailed description of LGS within one family will not only expand doctors’ knowledge of this disease and the difficulties of its treatment, but also improve understanding of the genetic mechanisms of the development of DEE.

Introduction. Total hip arthroplasty (THA) is one of the most commonly used surgical interventions among patients with diseases of the hip joint. Despite the high frequency and effectiveness of THA, instability is the main reason for repeated surgical interventions, which have a significant impact on the quality of life of patients.
Purpose. Analysis of literature data on spinal-pelvic interactions, development of recommendations for eliminating pathologies of the spine and pelvis based on the analyzed data.
Materials and methods. The author searched for publications in the electronic databases PubMed and eLibrary. ru using the following search terms: “spinopelvic mobility, total hip replacement, hip arthroplasty, vertebral-pelvic mobility, total hip replacement, hip arthroplasty”.
Results and discussion. The orientation of the pelvic component should be planned according to hip motion assessment to position the pelvic portion of the endoprosthesis according to the new safe zone and combined sagittal index. However, the surgeon must take into account that postoperative mobility of the pelvis and spine may differ from preoperative mobility due to joint contracture or physiological aging of the spine. To date, it has not yet been determined how often these changes lead to the pelvic component of the endoprosthesis moving beyond its position and spatial location, increasing the risk of dislocation.
Conclusion. A proper understanding of the relationship between the hip joint and the spine, and the impact of their interactions on the positioning of the acetabular component, is critical to reducing the risk of dislocation.

Introduction. Acute adrenal insufficiency (AAI) is a severe endocrinopathy whose victims include children and adolescents and which can be life-threatening despite its low incidence. Analysis of issues associated with intensive care of children with this pathology is of vital interest for pediatric anesthesiology and critical care medicine. 
The aim of this work was to assess current views on the etiopathogenesis, clinical pathology and intensive treatment of pediatric AAI.
Materials and methods. The topic was researched by analyzing publications found in the Cochrane Library, PubMed and Medscape using the following search terms: “acute adrenal insufficiency, children and adolescents, intensive therapy, fluid management”, with 65 published sources chosen.
Results and discussion. In AAI, caused by a sharp deficiency of cortisol (and mineralocorticoids), which triggers an inflammatory reaction, electrolyte imbalance and hemodynamic disorders. AAI presents with dehydration, nausea and vomiting, feelings of pain, hypotension, tachycardia, seizures and impaired consciousness up to coma. Laboratory tests in children often reveal hyperkalemia, hyponatremia, hypoglycemia and hypercalcemia. Intensive management of AAI in the ICU relies on parenteral corticosteroids (preferably intravenous hydrocortisone). Two or three days later, when the child is stable, they are switched to oral hormones. Meanwhile, fluid management is performed over 2 to 3 days to increase the circulating blood volume and relieve dehydration with crystalloid fluids.
Conclusion. A clearer understanding of the etiopathogenesis, clinical manifestations and diagnostic features of AAI, along with knowledge of emergency care algorithms, will improve the quality of intensive therapy of pediatric patients with this condition.

Introduction. Bronchopulmonary dysplasia (BPD) is a chronic neonatal lung disease, with oxygen dependence by 36 weeks post conceptual age (PCA). Over the past decade, the frequency of the disease has increased. More and more modern scientific data are published that BPD has an adverse effect not just the development of the lungs, but also on the cardiovascular system. There is a large amount of information in the literature about the outcomes of BPD, but there is not enough information about the consequences of cardiovascular disorders in children with a history of BPD. Lack of clear criteria to predict and prevent to demonstrate cardiovascular disorders, were the basis for a detailed study of the literature concerning this issue.
Purpose of the study based on study of the results of studies by local and foreign authors, to analyze the nature of cardiovascular disorders in children with a history of BPD, and to determine directions for more detailed scientific and practical search for a solution to this problem.
Materials and methods. Research articles were searched for keywords “bronchopulmonary dysplasia” and “сardiovascular disorders” in the PubMed, UpToDate, Google Scholar databases, eLibrary.ru. At least 80 publications have been extracted from search results for simplification. Analyses of the results of studies by local and foreign authors on outcomes, BPD, including cardiovascular disorders, was carried out.
Results and discussion. At the moment, the outcomes of BPD are well understood, while few information on cardiovascular disorders and possible prognosis for children who have undergone BPD.
Conclusion. Cardiovascular disorders in children with a history of BPD are a pressing problem in pediatric practice. The presented literature review summarizes the information accumulated over several years on the outcomes of cardiovascular changes and determines the direction for further study of the problem, involving pediatricians and doctors of other specialties in order to identify groups at increased risk for the development of these diseases in children.