Rationale. In the conditions of perinatal centers, the routing of pregnant women with obstetric and somatic pathologies leads to the birth of a significant number of late premature newborns, which make a high contribution to the incidence of respiratory and cerebral pathologies.

Purpose of the study — to analyze respiratory and cerebral morbidity and therapy in late preterm infants.

Materials and methods. А retrospective analysis of a cohort of late preterm infants (GA 34⁰–36⁶ weeks) born within 12 months of 2020. The study involved 508 newborns. Retrospective analysis of the incidence of a cohort of late preterm infants (GA 34⁰–36⁶ weeks) born during the 12 months of 2020. The study involved 508 newborns.

Results. The study showed that late premature infants account for more than 10 % of all newborns and 66 % of the number of premature infants born in the perinatal center and are characterized by high morbidity. The main nosologies were identified: hyperbilirubinemia — up to 67 %; cerebral ischemia — up to 55 %; intraventricular hemorrhage — up to 18 % respiratory distress syndrome and transient tachypnea of newborns — about 46 %; congenital infection — 12 %; congenital heart defects — about 10 %. More than half of the children received of respiratory therapy and a quarter of newborns received antibacterial therapy. About 40 % of patients were hospitalized in the neonatal intensive care unit, and about 80 % in the neonatal pathology unit. The median total duration of hospitalization in the perinatal center was 13 [9.7; 19.0] days.

Conclusion. The study revealed data on the high frequency of respiratory pathology (up to half of the cases) and cerebral pathology (more than 50 %), congenital infection (up to 12 %), the need for respiratory therapy (in more than half of the children) and prolonged hospitalization with a median of 13 days in late premature infants.

Introduction. The issues of managing postpartum women with infectious and inflammatory diseases (IID) are extremely relevant in modern conditions.

The aim of the study is to present the clinical characteristics and features of treatment of women in labor with various forms of postpartum pulmonary dysfunction.

Materials and methods. A retrospective examination of 181 postpartum mothers with IID was carried out, who were divided into 3 groups: A (n = 122) — patients with uncomplicated endometritis; B (n = 43) — with complicated forms (suture failure, metrothrombophlebitis); C (n = 16) — with severe septic complications (parametritis, obstetric peritonitis).

Results. In groups B and C, chorioamnionitis was statistically significantly more often diagnosed during labor compared to uncomplicated endometritis (p_A–B = 0.002, p_A–C < 0.001). In the integrated the number of points on the NEWS2 scale was statistically significantly higher in group B (p = 0.050) and group C (p = 0.007) compared to group A. In 25.42 % of the subjects, there was a discrepancy between the prescribed empirical antibacterial therapy and the pathogen isolated. In group B, organ-preserving surgery was performed in 55.81 % of the mothers on day 6.5 [4.8; 11.0], and hysterectomy was performed on day 9.0 [6.0; 12.0] after delivery.

Conclusion. Chorioamnionitis during childbirth, a score on the NEWS2 scale of 2 or more points suggests the development of complicated forms of postpartum endometritis. When treating, preference should be given to antibiotics of the aminopenicillin group, amoxicillin and beta-lactamase inhibitors, carbapenems and a timely decision should be made on repeated surgical intervention, allowing for organ-preserving surgery.

Introduction. Abdominal adhesions occur in diseases of the abdominal cavity and pelvic organs, reducing the quality of life of patients, leading to severe complications. The mechanisms of formation of adhesions are associated with inflammatory reaction and fibrosis, insufficient phagocytosis.

Materials and methods. In male Wistar rats (n = 20), the formation of adhesions was induced by laparotomy, drying and scarification of the peritoneum. Spontaneous formation of adhesions was researched in on the 7th and 21st days. Rats in group 1 (control), group 2 animals were intraperitoneally injected with aqueous solution of oxidized dextran. Researched the number of macrophages and neutrophils in inflammatory infiltrates, numerical density of cells, expressing TNFa, IL-1, E-cadherin, CK-18, Vimentin.

Results. In rats treated with oxidized dextran (group 2), the content of neutrophils on the 7th and 21st days in infiltrates was lower, and macrophages were greater, the numerical density of cells expressing IL-1 and TNFa was lower, comparatively with control group animals. The expression of Vimentin, E-cadherin, CK-18 was more pronounced in animals of the 1st group on the 7th day of the experiment. On the 21st day there were no differences in the expression of Vimentin, E-cadherin between the groups, and the expression of CK-18 was higher in group 2 rats.

Conclusion. Oxidized dextran affects the functional state of macrophages, prevents the expression of IL-1 and TNFa, promotes more effective phagocytosis, preventing the formation and fibrosis of adhesions, prevents the expression of markers of the mesenchymal to epithelial transition, contributing to the regeneration of the mesothelium.

Introduction. ITGA2 gene C807T and ITGB3 gene T1565C polymorphisms influence the development of cardiovascular conditions and may worsen the condition of patients with COVID-19.

The aim of this study was to evaluate the multimorbidity in COVID-19 patients with ITGA2 gene C807T and ITGB3 gene T1565C polymorphisms.

Materials and methods. The case-control study was conducted: group 1 included 25 patients with COVID-19; group 2 — 25 patients with COVID-19 and acute coronary syndrome. The groups were adjusted by age, volume of lung lesions, body mass index, terms of hospital stay. The genetic study was performed on a DTprime (DT-96) detection amplifier.

Results. In Group 1, chronic heart failure occurred in 6 CC patients of ITGA2 gene, 8 — with T allele; in Group 2 — 12 and 7 patients, respectively (p = 0.036). Previous acute myocardial infarction occurred in 1 CC patient, no persons with T allele; in Group 2 — 2 and 9 cases, respectively (p < 0.001). In Group 1, obesity occurred in 8 CC patients, 1 — with T allele; in Group 2 — 7 and 3 cases, respectively (p = 0.006). The ITGB3 gene polymorphism had no effect on the multimorbidity.

Discussion. There is a close connection between the ITGA2 (C807T) polymorphism and the development of recurrent myocardial infarction and chronic heart failure against the background of the existing systemic inflammatory process, platelet hyperactivation and fibrosis.

Conclusion. The data obtained indicate a significant influence of ITGA2 (C807T) gene polymorphism and the absence of an influence of ITGB3 (T1565C) gene polymorphism on the multimorbidity of patients with COVID-19.

An important area in the work of the TB service is the search for integrated approaches in the treatment of patients with pulmonary tuberculosis. One of these approaches is the widespread use of methods of artificial pneumoperitoneum and endobronchial valvular bronchoblocation. The active use of surgical treatment can also be an effective technique.

The aim of the work is to study the effectiveness of the use of methods of artificial pneumoperitoneum and endobronchial valvular bronchoblocation as preoperative preparation in patients with pulmonary tuberculosis.

Materials and methods. The study included 295 patients: group 1 — patients treated with artificial pneumoperitoneum and endobronchial valvular bronchoblocation (n = 201); group 2 consisted patients who did not use these methods (n = 94).

Results. Operations with the smallest volume were significantly more often performed in patients of group 1a (34.8 %), compared with group 1b and group 2a (p_1a–1b = 0.016, p_1a–2a = 0.014). Large-volume surgery was significantly more often performed in patients of group 2 (41.1 %, p_1a–2a = 0.028).

Discussion. The use of artificial pneumoperitoneum and endobronchial valvular bronchoblocation helps to reduce the volume of surgical intervention. Thus, in the group of patients after effective endobronchial valvular bronchoblocation and artificial pneumoperitoneum, lung resection within 1–2 segments was significantly more often used; whereas in the group of patients who did not use artificial pneumoperitoneum and endobronchial valvular bronchoblocation techniques, large-scale surgical interventions were more often resorted to.

Conclusion. The use of artificial pneumoperitoneum and endobronchial valvular bronchoblocation helps to increase the effectiveness of treatment and reduce the volume of surgery, preventing significant damage to the loss of lung tissue.

Introduction. One of the less common forms of adenomyosis is the nodular type, characterized by localized foci composed of damaged endometrial glands and altered muscle and connective tissue fibers. Diagnosing nodular adenomyosis is oſten challenging, with the diagnosis frequently made intraoperatively or during histological examination.

The purpose of the work. To analyze a clinical case involving a patient with nodular adenomyosis and a prolonged history of pelvic pain syndrome, aiming to identify diagnostic errors associated with this condition.

Materials and methods. A clinical case was reviewed based on the patient’s medical history and treatments conducted prior to admission to the Gynecology Department of the Stavropol State Medical University Medical Center.

Results and discussion. The chronology of diagnosis and treatment, along with an analysis of errors that led to the chronicity of the pathological process and subsequent deterioration in the patient’s quality of life and overall condition, is presented. This clinical case demonstrated that a gynecologist’s primary responsibility when examining patients with pelvic pain syndrome is to conduct detailed diagnostics. The authors re-evaluated the patient’s magnetic resonance imaging scans and suspected the diagnosis of “nodular adenomyosis”, which justified performing laparoscopy to confirm the condition. During the procedure, the diagnosis was confirmed, and the nodular adenomyosis was excised simultaneously. To prevent adhesion formation, an anti-adhesion barrier was applied.

Conclusion. Laparoscopy is one of the most critical methods for diagnosing pelvic pain syndrome, as it enables early diagnosis, detailed examination of pelvic and abdominal organs, and the simultaneous execution of therapeutic interventions.

Introduction. Direct antiviral agents had opened new opportunities of treatment for chronic hepatitis C (HCV) in patients with cirrhosis. However, patients with decompensated liver cirrhosis need special attention and individual approach before antiviral therapy prescription.

The aim of the study — to demonstrate a clinical case probability of developing liver cirrhosis complications aſter effective antiviral therapy.

Materials and methods. Analysis of medical records of 52 уears old male with HCV-associated liver cirrhosis who was treated with direct antiviral agents with achieving of sustained virologic response (SVR). During follow up hepatocellular carcinoma (HCC) was detected. Patient underwent a liver transplantation complicated by primary non function liver graſt in the early postoperative period. Liver retransplantation with necessity of extracorporeal treatment methods and complex immunosuppressive therapy.

Discussion. Antiviral treatment of patients with decompensated liver cirrhosis does not always improve prognosis and sustained SVR does not exclude risk of HCC appearance.

Conclusion. Treated patients should be included in monitoring and HCC surveillance program.

Introduction. According to WHO, nowadays there is a tendency towards an increase in the average age of the population. This creates preconditions for the prevalence of cognitive impairment increase. So, the problem of cognitive disorders early diagnosis is currently relevant.

The aim of the study is to analyze the current state of virtual reality technologies using in the field of neurorehabilitation, and to evaluate the clinical effectiveness of rehabilitation of cognitive abilities in a virtual environment in comparison with traditional methods.

Material and methods. 245 publications were found in the PubMed database using keywords. After selection, 25 publications were included in the final sample.

Results. During the publications analyzing, it was revealed that traditional methods of neurorehabilitation affect only socially significant components. Despite the topic relevance, there are only 6 programs for cognitive abilities rehabilitation. But, existing programs are a computer interpretation of traditional methods. However different studies indicate different clinical effectiveness degrees, which makes it difficult to draw a clear conclusion.

Discussion. The use of virtual reality for the cognitive abilities rehabilitation is a promising direction in modern restorative neurology. Among other things VR opens up opportunities for mount rehabilitation in a remote format. Different clinical efficacy levels in different publications is due to the small number of studies and differences in the research methodology.

Conclusion. It has been revealed that the problem of using virtual reality in the field of neurorehabilitation is currently relevant. However, more studies are needed to assess the clinical effectiveness of such methods.

Introduction. Paracetamol (acetaminophen) is an over-the-counter analgesic and antipyretic drug, available in monoform and included in more than 200 combined drugs. Today, paracetamol is widely used in medicine, and therefore available in different age categories, including children from 0 to 18 years old, adults, the elderly and pregnant women.

The aim is to systematize data on the epidemiology, diagnosis and treatment of paracetamol poisoning based on data from foreign and domestic literature.

Materials and methods. Literary search on the platforms PubMed, Google Scholar, eLibrary.ru, CyberLeninka by keywords “paracetamol, acetaminophen, poisoning, epidemiology, hepatotoxicity, N-acetylcysteine”. Inclusion criteria: original, review articles, randomized and non-randomized clinical trials, meta-analyses and systematic reviews on the topic of paracetamol poisoning.

Results and discussion. The literature review presents data on toxic effects, epidemiology, metabolism, and clinical picture; modern research on methods of diagnosis and treatment of paracetamol poisoning.

Conclusions. Modern methods of diagnosing paracetamol poisoning allow us to focus not only on determining the concentration of the drug in the blood or the dose taken orally, as a decision-making tool. The development of new biomarkers of liver damage is a promising diagnostic tool, suggesting an “early warning” of potential liver damage.

Introduction. Alpha-1 antitrypsin (AAT) deficiency is a deficiency of a protease inhibitor that leads to lung destruction and liver damage. The clinical manifestations of AAT are highly variable and depend on phenotype and environmental factors. The only available treatment for AAT is replacement therapy.

The aim of the study is to systematize current data on the pathogenesis, clinical manifestations and modern methods of treatment of AAT to determine the selectivity of pediatricians according to these manifestations.

Materials and methods. The literature search was carried out in the eLibrary.ru database, PubMed, Russian and foreign specialized medical journals.

Results and discussion. AAT deficiency is caused by mutations in the SERPINA1 gene. In Europe, the prevalence of AAT deficiency varies from 1 : 1 800 to 1 : 2 500 newborns. Mutations in the gene lead to incorrect assembly of the AAT molecule (Z-protein), with their subsequent accumulation and abnormal polymerization in hepatocytes, which leads to hepatitis. As a result of insufficient secretion of AAT into the systemic circulation, antiprotease protection is weakened and inflammatory processes in the lungs intensify. Currently, serum AAT-increasing therapy, which uses protein purified from healthy human plasma, remains the only specific pharmacological intervention available for the treatment of AAT.

Conclusion. AAT deficiency is an autosomal recessive disease that requires knowledge of the characteristics of clinical manifestations. There is great potential in using gene therapy to treat AAT-related diseases.