Introduction. The study of the factors associated with the development of postoperative complications in patients with tuberculosis of the respiratory system is a priority and urgent task.

Objective — determination of factors related to the presence of postoperative complications in patients with tuberculosis of the respiratory system.

Materials and methods. A retrospective study of the data of 251 patients with newly diagnosed respiratory tuberculosis and relapse who were treated in the tuberculosis surgical department of the clinic No. 1 of the Moscow Research and Clinical Center for Tuberculosis Control in 2017–2018 was conducted.

Results. In the postoperative period, complications developed in 22/251 (8.76 %) patients. A single-factor analysis revealed that disability (p = 0.013), incomplete education (p = 0.017), potentially ineffective treatment (p = 0.014), and duration of the disease from 6 months to 1 year (p = 0.044) were associated with complications. The coincidence of the specialty obtained during training and further work can contribute to the absence of complications (p = 0.005). The study of the combined effect of risk factors showed that the occurrence of complications may be associated with a potentially ineffective course of treatment (p = 0.006) and the duration of the disease from 6 months to 1 year (p < 0.001).

Conclusion. The factors associated with postoperative complications in patients with respiratory tuberculosis are disability (p = 0.013), incomplete education (p = 0.017), potentially ineffective course of treatment (p = 0.014) and duration of the disease from 6 months to 1 year (p = 0.044).

Introduction. Identification of adverse events in the perioperative and late periods is the main condition for safe surgical care for patients with cerebral palsy.

The aim of the study — based on a retrospective analysis of medical records, to identify triggers and evaluate the frequency of adverse events in the perioperative and late periods in children with severe forms of cerebral palsy combined with epilepsy who received surgical orthopedic treatment for spastic dislocations (subluxations) of the hips.

Materials and methods. The retrospective study included 50 patients with cerebral palsy and epilepsy who underwent hip surgery. Adverse events in the perioperative and late periods were assessed.

Results. After surgery, anemia and hyperfibrinogenemia were diagnosed in both groups. One case of epilepsy relapse and an episode of massive nosebleed were registered. Within a year after the operation, resumption of epileptic seizures was registered in 2 children, the parents (guardians) of 2 patients reported a fatal outcome.

Conclusion. Adverse events of the perioperative period in children with cerebral palsy and epilepsy in 10 % of cases are caused by the effect of anticonvulsants on the hemostasis system, relapse of seizures. The remote postoperative period in children with cerebral palsy and epilepsy in 4 % of cases can be aggravated by the resumption of seizures against the background of the withdrawal or reduction of the dose of anticonvulsants. The combination of somatic pathology, cerebral insufficiency and epilepsy against the background of cerebral palsy can initiate severe adverse events in the remote postoperative period, including death.

Rationale. The development of respiratory function and an increase in the survival rate in children with extremely low and very low body weight with respiratory disorders and morphofunctional immaturity of the respiratory organs determines the frequent development of bronchopulmonary pathology in early childhood. These children are more often at risk for severe respiratory syncytial virus (RSV) bronchiolitis, are hospitalized and undergo intensive therapy. Immunoprophylaxis with monoclonal antibodies is recognized as an effective measure in providing assistance to these children.

Purpose of the study — evaluation of the clinical effectiveness of RSV immunoprophylaxis in reducing respiratory diseases in children aged 1–3 years.

Materials and methods. A retro- and prospective analysis of morbidity in premature infants (gestational age — 240–336 weeks) in the early childhood period was conducted depending on immunization in the 1st year of life. The study included 322 children: 225 children received immunization, 97 did not.

Results. It has been proven that immunoprophylaxis in children at risk in the 1st year reduces the incidence of acute respiratory infections (ARI), the risk of episodes of bronchial obstruction (ВО) and pneumonia at the age of 1–3 years. It has been demonstrated that the absence of immunoprophylaxis in the first year makes a significant contribution to the development of episodes of BO (AР = 81 %), pneumonia (AР = 58 %) at an early age. An inverse relationship has been shown between the frequency of ARI and the number of injections of monoclonal antibodies.

Conclusion. The use of monoclonal antibodies in children at risk reduces the incidence of ARI, episodes of BO and pneumonia in early childhood.

Introduction. Routing patients with large cerebral artery occlusions to specialized centers is a critical aspect of stroke care, improving clinical outcomes after thrombectomy (TE). Clinical scales, such as the Los Angeles Motor Scale (LAMS), are the most accessible prehospital screening tools for patients selection for endovascular centers, but their real-world effectiveness requires validation.

The aim of the study — to evaluate the diagnostic accuracy of the LAMS for detecting acute large cerebral vessels occlusions (LVO) within the Moscow stroke network.

Materials and methods. The study included 336 patients with suspected stroke assessed by emergency medical services (EMS) using LAMS. LVO were confirmed in-hospital via CT angiography. Sensitivity and specificity were calculated for LAMS thresholds of 4–5 points, accompanied by ROC analysis. Retrospective LAMS scoring based on initial neurological examination was also analyzed.

Results. Sensitivity and specificity of LAMS were 50.47 % and 76.86 %, respectively. Performance varied with time since symptoms onset: <2 hours — 41.51 % and 63.53 %; 2–6 hours — 57.14 % and 81.94 %; >6 hours — 61.54 % and 87.50 %. Retrospective LAMS assessment based on in-hospital neurological examination had 72.90 % sensitivity and 77.73 % specificity. ROC analysis revealed higher predictive value for retrospective scoring (AUC = 0.80; 95 % CI — 0.75–0.85) compared to prehospital assessment (AUC = 0.67; 95 % CI — 0.61–0.73).

Conclusion. LAMS can identify patients at high risk of LVO, but its accuracy is limited within the first two hours after symptoms onset. Low early sensitivity necessitates adjustments to routing algorithms. Discrepancies between prehospital and retrospective in-hospital assessments may indicate the advisability of targeted training programs for EMS physicians to optimize LAMS application.

Effective dietary interventions using specialized food products are needed to reduce inflammation in obese children. This study evaluated the safety and effectiveness of a lyophilized colostrum serum product, “Immunocol LP”, in children aged 6–9 years with obesity.

Materials and methods. A prospective single-center study included 80 children (BMI >2.0 SDS by WHO, 2009), divided into a main group and a control group (n = 40 each). The main group received one sachet (3 g) of “Immunocol LP” twice daily, 30 min before meals for 28 days. The following were assessed: serum CRP, LPS, ALT, total cholesterol, CBC, fecal calprotectin, short-chain fatty acids (SCFA), microbiota composition (PCR), anthropometry, and body composition (bioimpedance). Follow-up was performed two weeks after treatment.

Results. “Immunocol LP” intake led to a significant reduction in CRP (p = 0.004), LPS (p = 0.002), ALT (p = 0.040), and cholesterol (p = 0.027). Improvement in CBC and increased fecal SCFAs, including acetic (p = 0.030) and propionic acids (p = 0.037), were observed. Microbiota species composition remained unchanged. BMI, height, and body composition dynamics were similar in both groups.

Conclusion. “Immunocol LP” demonstrated anti-inflammatory effects by reducing systemic markers (CRP, LPS), lowering ALT, and stimulating SCFA production. It was well tolerated, with no adverse effects. These findings support the potential of “Immunocol LP” as an adjunct to dietary therapy in obese young children.

Justification. Mild cognitive impairment in children remains an insufficiently studied problem in terms of etiopathogenetic aspects and the identification of risk factors. This is largely due to the borderline interdisciplinary position of this area of clinical interest. Among other problems, the lack of understanding of the origin of these conditions leads to the stagnation of diagnostic and therapeutic tactics and strategies, in particular, there are no provisions for the early diagnosis of these disorders.

The aim of the study was to identify socio-demographic, ante-, intranatal, and early neonatal predictors of disorders from the group of mild cognitive impairment and attention deficit hyperactivity disorder in children.

Methods. The study included children aged 5–12 years with mild cognitive impairment (MCI), attention deficit hyperactivity disorder (ADHD), as well as neurologically healthy children (control group) living in the Moscow agglomeration, Ekaterinburg, Chelyabinsk and Irkutsk. The criteria for inclusion in the groups were determined based on data from neurological examinations and specialized neuropsychological and speech therapy testing. The parents of the children included in the study filled out a specially designed electronic questionnaire of 47 items, covering socio-demographic characteristics, conditions and circumstances of pregnancy, childbirth and the early neonatal period. The differences in the frequency of distribution of the studied signs between the pathology groups (MCI, ADHD) and the control group (neurologically healthy children) were evaluated, the odds ratio of having MCI depending on the presence of a predictor and the prognostic characteristics of the model of a combination of several predictors were determined.

Results. The study included 344 children, of whom 190 children were in the control group, and 154 children were in the main clinical groups. 120 children were in the LCN group, 72 children in the ADHD group, and 36 more in the comorbid MCI and ADHD group. In MCI, ADHD was observed in 31.7 % of cases. A total of 18 different predictors of LVH were identified, of which the most significant were the need for ventilation (odds ratio OR = 22.59; CI: 2.76–185.06), frequent/copious regurgitation (OR = 9.49; CI: 2.04–44.18) and symptoms of neurological well-being in general (OR = 5.60; CI: 2.91–10.76) in the early neonatal period. The leading predictors were similar for MCI and ADHD. Predictive models of combinations of the most significant predictors are able to correctly predict 92.5 % and 87.5 % of outcomes between MCI and the neurological norm.

Conclusion. There is no doubt that perinatal events affecting the brain, in addition to genetic determinations, should be considered as a risk factor and an etiological factor of MCI and ADHD. This raises the question of the need to identify risk groups for early diagnosis of pathology and the earliest possible treatment of these conditions. The predictors resulting from the results of the study can be used separately and in combination for these purposes. The results of the study are pushing for a revision of the official positions on the management of children with MCI. MCI and ADHD are closely related conditions, which must be taken into account in therapeutic approaches to the management of these disorders.

Introduction. The most common type of injury with a closed chest injury is rib fractures, which are observed in 40–92 % of victims. With a closed chest injury, 82 % of patients with multiple rib fractures have a nature of injury complicated by intrapleural injuries. It seems that the optimal method of osteosynthesis for rib fractures should currently be easily and routinely reproducible, low-traumatic, and implants and related equipment inexpensive and affordable.

Materials and methods. A team of authors has developed a method of minimally invasive osteosynthesis, which is used for stable fixation of rib fracture fragments in order to restore the rib cage framework, early restoration of independent breathing, prevention of complications, increasing comfort and quality of life for the patient in the postoperative period, improving the treatment results for patients with chest injuries.

Results and discussion. A clinical case is presented to detail and describe the advantages of the proposed method of surgical stabilization of the rib cage. A 40-year-old patient with multiple complicated thoracic injury was hospitalized for 11 days after surgical treatment, after which he was discharged for outpatient treatment in satisfactory condition. No complications were received during the treatment.

Conclusion. The presented clinical case clearly confirms the effectiveness of surgical stabilization of the chest skeleton in cases of floating and multiple rib fractures, and also demonstrates the successful introduction into clinical practice of minimally invasive retrograde intramedullary temporary fixation of rib fractures, which has advantages such as minimally invasiveness, reproducibility, relatively low resource consumption and cost-effectiveness.

Introduction. About 25 % of respiratory mycoplasmosis cases involve skin and mucous membrane lesions. The pathogenesis of these lesions is not completely clear. Differences in pathomorphological changes apparently determine the diversity of clinical variants of the disease.

The aim of the work is to present clinical observations of patients with acute respiratory tract infection caused by Mycoplasma pneumoniae, who had lesions of the mucous membranes and skin in accordance with the definition of a typical MIRM (M. pneumoniae-induced rash and mucositis) case.

Materials and methods. Two clinical cases of skin and mucous membrane lesions associated with M. pneumoniae in children treated in an infectious diseases hospital were analyzed.

Discussion. Epidermolytic dermopathies can develop in patients with respiratory tract lesions caused by M. pneumoniae and, as was previously believed, manifest themselves in various variants of mucocutaneous lesions: Stevens — Johnson syndrome, toxic epidermal necrolysis, erythema multiforme exudative. In 2015, a new term MIRM was proposed, which defined a clear connection between skin and mucosal lesions and a specific pathogen. Differential diagnosis of these syndromes is complex, but, according to the definition, MIRM develops against the background of respiratory lesions, mainly in adolescents and has a milder course and a better prognosis.

Conclusion. The list of diagnostic tests for children with pneumonia accompanied by mucocutaneous rashes should include the detection of M. pneumoniae markers to establish a diagnosis of MIRM, since this will determine the necessary range of treatment measures.

Introduction. Bladder injury is one of the most common injuries to the genitourinary tract. Bladder injury is rarely isolated and can often go undetected for long periods of time in combined trauma, due to the greater attention paid to pathologies that lead to the development of life-threatening conditions.

The aim of the study is to describe non-traumatic (spontaneous) bladder rupture using a clinical case as an example.

Materials and methods. The patient’s complaints, clinical picture, life history, diagnostic measures and treatment tactics of nontraumatic (spontaneous) bladder rupture were analyzed.

Results and discussions. In the present study, a detailed analysis of a clinical case of bladder rupture was performed. The patient’s subjective complaints, objective symptoms, diagnostic methods and surgical treatment were studied. The obtained clinical data were subjected to comparative analysis with modern scientific publications on this pathology.

Conclusions. Based on clinical observation, it can be concluded that the history of nontraumatic bladder rupture is traceable to symptoms such as anterior abdominal wall pain, bloating, and impaired act of urination, but difficulties in making the diagnosis may also arise during the clinical evaluation phase, due to the mimicry of bladder rupture and acute surgical pathology.

Every year, 20 % of all ischemic strokes are recurrent, characterized by severe course and high mortality and disability rates. Secondary prevention measures are aimed at preventing repeated brain catastrophes, which leads to a 20–30 % reduction in the risk of recurrent stroke. One of the directions of therapy is the appointment of antiplatelet drugs. Currently, acetylsalicylic acid and clopidogrel are widely used in the Russia. Effective platelet inhibition by prescribing these antiplatelet agents is one of the priorities in the treatment of atherothrombotic ischemic stroke. At the same time, a number of patients develop resistance to antiplatelet agents, which is associated with a variety of factors, such as drug interactions, concomitant diseases, and genetic predisposition. In order to control the formation of laboratory resistance, several methods for assessing platelet function have been developed. For example, optical Born aggregatometry, thromboelastogram, flow cytometry. Currently, there is no “golden method” for determining the high residual activity of platelets, since none of them has achieved a significant advantage. This article discusses methods for detecting laboratory resistance and factors influencing its development, depending on the prescribed antiplatelet drug.

Introduction. The relevance of the problem of infertility in the modern world is beyond doubt, which is the basis for the active development and introduction of new surgical methods for the treatment of this disease.

Objective — to show the method of in vitro activation (IVA) of autotransplanted ovarian follicular tissue as a potentially promising infertility therapy for patients with premature ovarian insufficiency with partially preserved ovarian reserve.

Materials and methods. The materials contain 67 analyzed literature sources, of which 10 are Russian-language sources and 57 are English-language sources.

Results and discussions. The analysis of scientific and practical research data will allow evaluating the success of single-stage surgical activation of the ovaries and IVA of the latter using an automaterial, the cortical layer of the ovaries, in women who had previously been diagnosed with infertility on the background of primary ovarian insufficiency (ICD-10 — E28.3/9. Ovarian dysfunction). This literature review examines and analyzes the role of the effect of anti-muller hormone on the effectiveness and effectiveness of assisted reproductive technology treatment, as well as on the formation of premature ovarian insufficiency in women of reproductive age. Against the background of premature ovarian insufficiency, a detailed examination of endometriosis of various localization is relevant (ICD-10 — N80.0–80.9).

Conclusion. Thus, IVA treatment of autotransplanted ovarian follicular tissue is a potentially promising infertility therapy for patients with premature ovarian insufficiency with partially preserved ovarian reserve.

Introduction. An increase in the level of placental factors in pregnant women with preeclampsia is the cause of hypertension and endothelial dysfunction. These phenomena often progress in the early postoperative period of cesarean section. Severe complications and an increased risk of developing diseases of the cardiovascular system are possible.

The aim — to analyze the available literature on the study of the effect of postoperative pain on the progression of endothelial dysfunction and hypertension in women with preeclampsia after cesarean section.

Materials and methods. A search was conducted for publications from the PubMed/MEDLINE and eLibrary.ru databases over the past 5 years

Results and discussion. In pregnant women with preeclampsia and patients with postoperative pain syndrome, the mechanisms of vascular endothelial damage and the development of hypertension are the same: inflammation, oxidative stress, changes in the response of immune cells, activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system. The progression of endothelial dysfunction and hypertension in the early postoperative period of cesarean section in women with preeclampsia may depend on the pain syndrome.

Conclusion. Pain syndrome activates inflammation, oxidative stress and changes in the response of immune cells in the early postoperative period of cesarean section. This may be the cause of the progression of endothelial dysfunction and hypertension in women with preeclampsia. Regional analgesia can reduce these phenomena.