Background. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5-10 % of reproductive-aged women. The dermatologic manifestations of PCOS play a significant role in diagnosis. The purpose of the present study was to examine the impact of androgenic alopecia among patients with PCOS and to define their most significant trkhological features. Because the data on dermatologic changes associated with PCOS are rather scarce, the present study was designed to determine the incidence and prevalence of androgenic alopecia. Materials and methods. We conducted a prospective observational study of patients with PCOS. The diagnosis of PCOS was made according to the consensus criteria adopted in May2003 in Rotterdam. Each patient signed informed consent, and then a general physical examination, systemic examination, breast and pelvic examination, as well as a detailed trichological examination were carried out. Results. Twenty women with PCOS participated in the study. The median age was28.7± 6.2years. Oligo/anovulation frequency was 63.2 %, hirsutism frequency - 68.4 %. In our study, the prevalence of androgenic alopecia was found to be 30 %, telogenic hair loss - 55 %, absence of alopecia signs in І5 % of cases. Conclusions. Androgenic alopecia is a prevalent but unreliable marker of biochemical hyperandrogenism. It is therefore imperative for the treating physicians to understand the adverse effects associated with PCOS, recognize these potential health risks in patients, and treat them accordingly.

Background. Microbiological disorders in the genital tract predispose to the development of chronic pelvic diseases and subsequently worsen the prognosis for reproductive function, causing infertility, miscarriage. Aims: study of the microbiocenosis of the vaginal tract and its role in initiating inflammatory process in endometrium in women with reproductive disorders. Materials and methods. The study included 50 patients with reproductive disorders with histological confirmation of the diagnosis of chronic endometritis and 50 patients with reproductive disorders without chronic endometritis. Microbiological studies of the biotope of the vagina were carried out according to the guidelines. The counting of immune cells was carried out in peripheral blood with flow cytofluorimeter. Methods of mathematical statistics implemented in the application package Statistica 6.1 (StatSoft Inc., USA) were used in the study. Used criteria were Student's t-test and Fisher criterion with a significance level less than 5 % (p < 0.05). Results and conclusions. Conditionally pathogenic microflora in women with chronic endometritis in the cervical canal is represented by candidiasis, herpesviruses, ureaplasma and facultative-anaerobically positive microorganisms. Candida, obligate-anaerobic gram-negative, and facultative anaerobic gram-positive microorganisms predominated in the endometrium. The secondary immunodeficiency state is characterized by suppressor activity of T-lymphocytes; the decrease in microbicide activity of blood, pronounced inhibition of the humoral link of the immune system. Violations of the balance of the indigenous and conditionally pathogenic microflora accompanied by a secondary immunodeficiency may be the initiator of chronic inflammation in the endometrium.

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women and has a significant impact on various aspects of their health and the quality of life. The epidemiology of PCOS is well understood, while the prevalence of this syndrome depends on diagnostic criteria used, the characteristics of the population sample, and vary from 6-10 % to 15 % and higher. A number of studies suggest that the endometrium in women with PCOS differs from the normal endometrium morphologically and functionally. PCOS is associated with infertility problems, higher incidence of pregnancy complications and with increased risk of endometrial cancer, especially when obesity is present. The purpose of this review was to systematize the available data on molecular markers of endometrial pathology associated with PCOS. The information search was conducted using Internet resources (PubMed, EMBASE); literature sources for the period 1992-2016 were analyzed. Although the available information on the pathology of the endometrium is inconsistent, as a result of the analysis of published data, several mechanisms of endometrial disorders characteristic of PCOS have been identified: changes of hormonal effects (changes in hormone receptor expression, HOXA gene expression, changes in the synthesis of sex hormone binding globulin, enzymes involved in the metabolism of sex hormones in situ in the endometrium), hyperinsulinemia and disturbance of the glucose transport system, ratio of proinflammatory and antiinflammatory factors. Authors conclude that the majority of analyzed studies report an increased prevalence of histologically confirmed hyperplasia or endometrial cancer in women with PCOS. However, there are no clinical guidelines and approaches to prognosis of endometrial changes women with PCOS. It is still unclear if endometrial biopsy is necessary for all women with PCOS. The clinical significance of endometrial markers requires further investigation.

The problem of obesity is extremely relevant for modern medical science and healthcare, and child and adolescent obesity deserves special attention. It seems to be interesting to trace the interrelation of pathological processes in obesity in the form of metabolic disorders at the level of the organism and at the cell level - disorders in the system of lipid peroxidation. Studies in adolescent boys are relevant, as there has been a general increase in the incidence in this age category. The purpose of the research was to study the state of the system "lipid peroxidation - antioxidant protection" in adolescent boys with exogenous-constitutional obesity. 19 adolescent boys with obesity were examined in comparison with the control group. Spectrophotometric and fluorometric methods of examination were used. An increase in the level of secondary lipid peroxidation products - ketodienes and conjugated trienes (1.65 times) - was revealed in adolescent boys with obesity. In the antioxidant defense system, differences in this group included reduced values of α-tocopherol (1.42 times), retinol (1.51 times) and superoxide dismutase activity (1.19 times), in the absence of statistically significant changes in the total antioxidant activity (AOA) in blood and components of glutathione status. The revealed disorders allow to recommend the complex therapy including prescription of antioxidants and medicines directed on normalization of lipid exchange at the given category of patients.

Background. 1t is known that the type 2 diabetes mellitus (DM) and osteoporosis are more often diagnosed in senior women. The condition of a bone tissue is accompanied by the metabolic violations that are typical for DM. The recent researches established the multidirectional changes of bone remodeling markers in women with type 2 DM at different age periods. Aims: to study the condition of bone remodeling in women with type 2 DM at different age periods. Materials and methods. We examined 27 women with type 2 DM, among them 15 were in the post-menopausal period and 12 with preserved menstrual function. Levels of osteocalcin, N-terminal propeptide of type 1 collagen (P1NP), C-terminal telopeptide of type 1 collagen (β-Crosslaps), 25-OH vitamin D, the ionized calcium were researched. Results. The analysis showed that increase in β-Crosslaps levels, P1NP, levels of osteocaltcin were observed in women with type 2 DM in the post-menopausal period, compared to parameters of women with type 2 DM with preserved menstrual function. Inverse correlation relation of osteocaltcin and 25-OH vitamin D was revealed in women with type 2 DM. Conclusion. Significant increase in markers of osteosynthesis and osteoresorption in women with type 2 DM was shown in the post-menopausal period compared with indicators of women with type 2 DM with preserved menstrual function.

Aim: to establish a link between the level of folic acid, vitamin D and iodine consumption, and infant and perinatal mortality, morbidity of childhood tuberculosis in the Irkutsk region. Consumption of folate in the form of a single-agent preparation increased 3 times in 5 years. Consumption of folic acid in women at the stage of preconception and pregnancy affected the reduction of perinatal (R = -0.9; p = 0.016) and infant (R = -0.89; p = 0.04) mortality, including neonatal (R = -0.89; p = 0.039). Preventive supplementation of vitamin D of people in the region over the past 5years has increased by 70 %, and infant mortality fell by 35.5 %. Infant (R = -0.94; p = 0.01) and especially post-neonatal (R = -0.97; p = 0.004) mortality are controllable and depend on the prevention of hypovitaminosis D. The understanding of the role of vitamin D in triggering the synthesis of the antimicrobial peptide cathelicidin opens prospects for using it as a medicine for prevention and treatment of childhood tuberculosis. The incidence of pediatric tuberculosis in the region during this period decreased by 46 % (R = -0.95; p = 0.01). Correction of iodine deficiency in pregnant women and children caused the reduction of perinatal (R = -0.99; p = 0.07), early neonatal (R = -0.99; p = 0.05), neonatal (R = -0.98; p = 0.06) and post-neonatal (R = -0.99; p = 0.002) infant mortality.

Purpose of the study. To determine the influence of climatic and geographical factors of the Irkutsk region on the risk of hypovitaminosis D in children and adults. Patients and methods. The contents of 25(OH)D-3 in the blood of children and adults (3261 samples) were evaluated. The materials were obtained in the Diagnostic Center of the region and the InVitro laboratory. Results of monitoring of ultraviolet radiation and precipitation in the Irkutsk region for 2014-2015 were analyzed according to ground and satellite measurements. Results. The Irkutsk region is in the zone of ultraviolet insufficiency during the period from September-October to March-May. The status of the metabolite of vitamin D - 25(oH)D3 in the population of the region is low, especially in adolescents and people older than 70 years. 68 % of children have vitamin D deficiency. Activity of 25(oH)D3 depends on meteorological factors, especially the level of precipitation and the intake of vitamin D. For each geographical area of the region, time intervals were calculated for the formation of vitamin D in the skin under the influence of ultraviolet radiation and time intervals for the intake of vitamin D preparations. The exposure time in the sun was calculated for the formation of vitamin D for individuals with different skin phototypes, depending on the degree of its openness.

Evidential base for diagnosis and treatment of myocardial infarction is based on the results of randomized clinical studies that included mostly male patients. Objective: to determine gender specifics in development, progression, methods of treatment, diagnostics, outcomes of myocardial infarction for defining customized approaches to its treatment. Study material and methods: 84 medical records of patients with myocardial infarction - 50 male and 54 female patients admitted in the emergency cardiac care department. Statistical data is processed in Microsoft Excel and Statistica v. 10.0. Results. Female patients suffer myocardial infarction late in life; they display higher obesity rate, renal dysfunction, type 2 diabetes as compared to male patients. At the time of admission to hospital the risk of hemorrhage is higher among female patients, which is related to the higher rate of renal disfunction and age. Average CRUSADE score for female patients is 39.14 ± 2.5, for male patients - 22.7 ± 1.4 points. Female patients demonstrate higher frequency of atypical symptoms for myocardial infarction - 18 %, compared to 8 % for males (р = 0.05), that leads to prolongated period of symptom-hospitalization. Thus, there are less women who are hospitalized within first 3 hours - 6 % against 28 % men (р = 0.01). Women display tendency to a higher frequency of Q-negative and recurrent myocardial infarctions, men - to first-time and Q-positive infarctions. As for the frequency of CAG, TLT and PCI, as well as mortality rate due to MI there is no difference between the groups.

The primary and main method of treating ACS with ST elevation is timely restoration of coronary vessel patency. Material and methods. 273 medical records of patients admitted with provisional diagnosis of ACS with ST elevation were studied. Statistical data were processed in Microsoft Excel and Statistica 10 (StatSoft Inc., USA). Results. One third of patients with ACS with ST elevation were admitted at «the golden hour» since symptoms onset. 234 (86 %) patients underwent coronary angiography. Primary percutaneous intervention (PCI), coronary stenting were performed for 117 patients, thrombolysis - for 23 and thrombolysis with subsequent PCI was carried out in 34 cases. Assessment of RCI efficiency, invasive revascularization in terms of IM frequency and mortality showed the following: the incidence of myocardial infarction in the group with PCI and without PCI was the same - 94 % against 98 % respectively; however the mortality in patients with STEMI was lower in the group with performed invasive revascularization - 4 % against 12 % (р = 0.04). Decrease is observed in both total mortality and mortality in the first 24 hours for STEMI patients - 3 % in the PCI group, compared to 9 % in the other group (р = 0.04). The suvival rate for STEMI patients was better for first time PCI - mortality 2.7 % against 12 % in the group without revascularization (р = 0.01).

In connection with the increased interest in the use of auto-erythrocytes for directional drug transport, the study of the ability of erythrocytes to sorb an antioxidant drug is becoming topical. The article considers the method of spectrophotometry developed for evaluating the ability of erythrocytes to load with a mexidol preparation under conditions of natural sorption and a method created for determining the drug concentration in erythrocyte biological medias. Materials and methods. The peripheral blood of 15 clinically healthy males aged 20 to 45 years was used as an object of the study. A pharmaceutical preparation of oxymethylethylpyridine succinate-mexidol (ZAO «Pharmasoft», Russia) was used for clinical studies. The drug belongs to the group of 3-hydroxypyridines. The inclusion of mexidol was carried out by direct incubation of erythrocytes in a medium containing this preparation. The concentrations of the preparation were 1.25,2.5 and 5 ßg/ml and the incubation time was 15,20 and 3o minutes. The supernatant was obtained by centrifugation for 10 minutes at 3000 rpm on a SF-2000 spectrophotometer at a wavelength of 630 nm. In addition to the pharmacopoeial method, the oxidation-reduction reaction of the supernatant with methylene blue was used. Results. When measuring the spectra of the supernatant with different concentration of the preparation and using methylene blue, a regression relationship between mexidol and optical density was established, and the optimal exposure time of red blood cells and the drug was determined. These data can be used to control the directional transport of the drug to target organs. A model of the equation for determination of the mexidol content in biomedids is proposed.

Dysbiotic disorders of the oropharynx takes one of the first places in the structure of morbidity worldwide. The aim of the study was to determine the peculiarities of microbiocenosis of the oropharynx in children at different ages and to assess the level of sensitivity of S. aureus strains to specific bacteriophages. Material for the study consisted of 84 smears from the oropharynx of children with inflammatory diseases of the upper respiratory tract (nasopharyngitis, pharyngitis, tonsillitis, laryngitis (J00, J02, J03, J04 according to 1CD-10). The biological material was distributed depending on the age of the surveyed: the first group - children 3-6 years (n = 61) and the second age group - children 7-12 years (n = 23). Studies of the microflora of the oropharynx were performed according to standard methods. Isolated microorganisms were identified by morphological, tinctorial, cultural and biochemical properties. The results were evaluated in accordance with the Order of USSR Ministry of Health N 535 as of April 22,1985. Specific lytic activity of bacteriophages against S. aureus was determined using preparations of staphylococcal bacteriophage and polyvalent pyobacteriophage Sexta. The sensitivity of strains of S. aureus to specific bacteriophages was assessed by the method of «crosses», according to the guidelines. Statistical analysis was performed with the use of licensed applications Offiœ Ms Excel 2007for Windows 7 BioStat v. 5.0.1.2008. Correlation analysis (Pearson method) was used. 1t has been shown that with increasing age children in the oropharynx microbial density is increasing for indicators of both normoflora (S. oralis), and of opportunistic microflora (S. β-hemolytic, S. pyogenes, S. pneumoniae, bacteria Enterobacteriaceae), especially of S. aureus (up to 74 %). Registration of sensitive strains of S. aureus in more than 70 % of cases in preschool and school-aged children is evidence of the correctness of correction of the dysbiotic disorders of the oropharynx with the use of bacteriophages of staphylococcus and Sexta.

The article represents a description for microbiocenosis of isolated prostate secret. The initial samples were taken on the territory of the Irkutsk region from men diagnosed with chronic bacterial prostatitis in the acute stage. 90 % of samples of isolated prostate secret were tested by cultural method revealed 4l representatives of opportunistic pathogenic microflora. Gram-positive microorganisms were found in most samples (86.7 %). Staphylococcus genus representatives formed the majority in isolated samples of conditionally pathogenic microflora (66.7 %). As for gram-negative representatives (which role in chronic bacterial prostatitis is proven by multiple research), E. coli and K. pneumoniae were isolated. In the half of samples, we revealed bacterial associations consisting mostly of two kinds of microorganisms. Staphylococcus epidermidis was isolated in 70 % of such associations.

The review is devoted to the problem of diagnostics and differential diagnostics of chronic appendicitis. As it is commonly known, the very existence of chronic appendicitis is still considered controversial. The article describes the current ideas on chronic appendicitis (primary, secondary, residual and recurrent), presents the list of morphological manifestations in the vermiform appendix at chronic inflammation, discovered at routine histological examination: dystrophic changes in the form of atrophy of all layers of appendix with sclerosis or hypotrophy of various degree, up to appendiclausis and disappearance of mucous membrane, and lipomatosis of submucosa. The authors discuss the complexity of diagnostics predetermined by lack of precise criteria of the disease; show the possibility of evaluation of the expression of cytoadherence molecules for diagnostics of the disease, in particular of VCAM-1 and ICAM-1 for differential diagnostics of chronic appendicitis. The role of suppressor of signal cytokine proteins SOCS3 in chronic inflammation is discussed. The data demonstrate the increase of T-lymphocytes and neurons in chronic appendicitis as an increase of PGP 9.5 (panneuronal marker protein gene product 9.5) level. It has been shown, that immunohistochemical staining on p44 MAPK has an advantage in differential diagnostics of chronic appendicitis - specific staining of subserous and muscle layer of the wall is observed only at the discussed pathology of the appendix. In spite of multiple studies and acknowledgment of the fact that chronic form of appendicitis is a separate disease, the diagnostics of this pathology still presents quite a problem especially when only routine methods of examination are used. Thus, we found it necessary to introduce additional immunomorphologic methods into the clinical practice.

The purpose of the research is substantiation of the choice of optimal surgical treatment for intervertebral disc hernias basing on the complex examination of patients. The authors worked out and introduced into practical healthcare the diagnostic algorithm for intervertebral disc raptures and constrictive processes of the spinal canal and dural sack. The algorithm includes clinical neurologic examination, complete blood count and biochemical blood test, electroneuromyography, densitometry, standard and functional spinal radiography, weight-bearing radiography, MSCT, MR1, and multisection CT myelography. The analysis of the obtained data has given the authors the opportunity to establish precise indications for surgical treatment of intervertebral hernias depending on the localization of the rupture, its size, degree of compression of neural structures, and the volume of osteo-neural involvement. The work presents three methods of surgical treatment of intervertebral hernias, optimizing the outcomes of surgical interventions based on the conducted diagnostic algorithm. 425 patients with intervertebral hernias were operated in different ways: 149 people - by laser-mediated vaporization; 131 people - with the use of video-assisted endoneurosurgery; and 145 patients were treated by surgical decompression with minimally invasive reconstruction of spinal canal and dural sack. The suggested methods of surgical treatment of intervertebral raptures are substantiated and confirmed by the patents, innovative surgical techniques and proved to be highly efficient. The use of said methods allowed to achieve good and satisfactory outcomes in 89.5 % of cases.

In the structure of diseases of the urinary system in children, microbial-inflammatory lesions of the kidneys and urinary tract are 70-80 %. The prevalence of infections of urinary system in children in the Russian Federation is on average 18-22 per 1000 children's population. The aim of the study was to analyze the spectrum of infectious agents of urinary infection in children and to determine the dynamics of bacterial resistance. We analyzed 330 cases of urinary system infection in children aged from 2 months up to 18 years in two time periods - 2002-2004 and 2014-2016 (n = 114 and n = 216, respectively). Patients of both periods were divided into three groups: the first one - cystitis, the second one - pyelonephritis and the third group - a combination of pyelonephritis and cystitis. An obligatory criterion for including the patient in the study was the presence of a pathogmonic combination of leukocyturia and bacteriuria, 10⁵ KOE/ml, for the infection of the urinary system. The main causative agent of urinary infection in children remains E. coli. An increase is marked in the specific gravity of E. coli, Enterococcus spp. and Klebsiella spp., Pr. vulgaris. The study revealed the growth of E. coli resistance to cephalosporins of 11, HI, IV generations; decreased resistance of Enterococcus spp. to ampicillin and gentamicin. In the study of the sensitivity of Klebsiella spp. an increase was detected in resistance to cephalosporins of the III generation. We identified the main pathogens of infections of the urinary system and determined bacterial resistance.

Adolescence is a time of important physical, cognitive, emotional, and social changes. Sleep is a primary aspect of adolescent development. Its disorders critically influence adolescents' ability to think, behave, and feel during daytime hours. Daytime activities, changes in the environment, and individual factors can have significant effects on adolescents' sleeping patterns. It is known, that a significant change of the sleep-wake cycle across adolescent development is a tendency to stay up later at night and to sleep in later in the morning. The peculiarity of this period of life is called a sleep delayed phase phenomenon, which can play the important role in the development of eating disorders and cause risk of obesity. The epidemic of childhood obesity presents a major public health problem. Many authors consider that obesity is a multisystem disease with potentially devastating consequences for physical and emotional health across the lifespan. Obesity may cause obstructive sleep apnea syndrome that can result in excessive daytime sleepiness in adolescents and have a negative effect on learning, school performance, and behavior. Early detection of risk factors, screening for metabolic and sleep disturbances in adolescents are major aims in reducing risk of cognitive and behavioral disorders. We assume that further studies of the psycho-cognitive impairments in adolescents with obesity in the sleep-wake continuum are necessary for the development of new approaches to forecasting, early diagnosis and pathogenically therapies of emotional and cognitive changes at the stage of personality formation as well as potentially reversible sleep and metabolic disorders.

Urticaria is a frequent disease in childhood, which almost every child had. Usually, the presence of distinct urticaria does not present difficulties in nosological diagnosis, but many factors in account for its development cause challenge for doctors in choosing tactics for therapy. Traditionally the triggers of urticaria in children are food allergens and drugs, and that is why pediatricians unreasonably eliminate many foods from the baby's nutrition for a long time. We analyzed the causes of acute and chronic urticaria in children hospitalized in the department of pediatrics over the ten-year period. In acute urticaria, in most cases, triggers were food (46.7 % children) and drugs (22.5 % children), in children with chronic urticaria, food was the cause of rashes only in 20 % of cases, and the infectious etiology of the disease was confirmed in 8 children. In almost a half of children with chronic urticaria the cause of the rash was not established. Based on the research, recommendations for the examination of patients with this pathology are suggested. Except for testing for food allergens and drugs, the diagnostic protocol of a patient with chronic urticaria should include the laboratory tests for infectious agents, as well as conducting fibrogastroduodenoscopy with biopsy of the gastric mucosa according to indications.

Background. Juvenile idiopathic arthritis is accompanied by severe functional disabilities refractory to standard treatment with methotrexate. Recently introduced genetic engineering has significantly improved the functional state of the patients with persistent disease and stopped the progressive destruction of joints. However, the risk of adverse reactions against the background of this type of therapy requires further study. Aims: to analyze the efficiency of the genetically engineered drugs applied at juvenile arthritis and undesirable effects of this treatment. Materials and methods. Long-term (7 years) observations of 141 patients aged from 8 months to 18 with juvenile idiopathic arthritis. Results. The article summarizes the experience of successful application of genetically engineered biological preparations (tocilizumab, abatacept, etanercept, adalimumab) in 33 patients out of 141 patients with juvenile arthritis observed in Irkutsk. Serious infections were not registered, but we detected cases of managed neutropenia in 2 out of 12 patients receiving tocilizumab. In one case (3 %) out of 33 patients receiving genetically engineered drugs, the drug was withdrawn because of the risk of tuberculosis. Rare cases of secondary inefficiency of such drugs as abatacept, etanercept, adalimumab have been revealed. The tactics of treating children with undesirable reactions to genetically engineered drugs is described. Conclusions. Genetic engineering therapy has shown a good effect in improving clinical and functional indices and stopping joint destructive damage. However, when using genetically engineered drugs in treatment, the safety issues should be evaluated. Nevertheless, in our study there were no serious adverse events.

The aim of the study was to evaluate the role of psychological and somaticfactors in the development of left ventricular hypertrophy in the cohort of persons without arterial hypertension and to give a quantitative evaluation to the effect of these factors on this phenomenon. Materials and methods. The study included 107 practically healthy people of working age from an organized population, including 46 men (mean age of 43.7 ± 11.5 years; M ± s) and 61 women (mean age 43.1 ± 10.1 years; M ± s). All the subjects underwent measurement of blood pressure according to the standard procedure, questionnaire survey using validated psychological questionnaires, the study of structural changes of the myocardium with echocardiography, the tests for metabolic indices in venous blood on an empty stomach (hormonal, immunological, biochemical). Results. Individuals with left ventricular hypertrophy were characterized by a significantly greater level of depression, accumulated stress, social frustration, decreased self-evaluation of health state and vitality. The value of the left ventricle mass index in practically healthy individuals without arterial hypertension is determined by 4 factors: the level of apolipoproteins B, the ratio of waist circumference / hip circumference, the level of the end products of free radical lipid oxidation, and smoking duration. Conclusion. Hypertrophy of the left ventricle in people without arterial hypertension is associated with personality characteristics that determine the nature of a multilevel response (somatic, hormonal, biochemical).

Differential diagnosis of somatic and somatoform pathology is a pressing issue in general practice. The aim of this study was to develop an algorithm for identification of the patients with indications for psychiatrist's consultation and possible psychotropic therapy at the stage of admission to multi-disciplinary hospital. Material and methods. Regression analysis of data of 1031 patient hospitalized in the cardiology department of a multiprofile hospital was done with the aim of identifying factors determining the recommendation for receiving psychotropic therapy at discharge. Results. An algorithm for allocation among patients of cardiological profile individuals that require a multidisciplinary approach to treatment involving experts in the field of mental health is proposed. Factors included in the formula were labile or paroxysmal hypertension, the number of associated (non-cardiological) diagnosis, female gender and heart rate or heart rhythm disorders with the debut at the age below 55 or 50 years: I = 8 х L + D + 3 х F + 3 (6) х H. Conclusion. The revealed pattern may be useful in the clinic of internal diseases for screening of patients with a high contribution of the emotional state the severity of the condition. The doctors of the hospitals of somatic (therapeutic) profile should pay more attention to the psycho-emotional condition of patients with labile hypertension, early onset of cardiac arrhythmias, and large number of comorbidities. Patients that meet the criteria are likely to need a consultation of a psychotherapist or psychiatrist because of the presence of psychosomatic or other mental disorders.

Anxiety disorders among general practice patients are the most common. We examined the efficacy and safety of Buspirone in patients with anxiety disorders in outpatient practice. In accordance with lCD-10, the patients were distributed as follows: generalized anxiety disorder - 38.7 %, panic disorder - 29 %, adjustment disorder in the form of mixed depressive and anxiety reaction - 32.3 %. In order to evaluate the impact of therapy the following research methods were used: clinical, clinical-psychopathological, psychometric (Hamilton anxiety scale (HaM-А), Spielberger-Hanin anxiety level self-evaluation scale, Shihan anxiety self-evaluation scale, Clinical Global lmpression-Severity Scale (CGl-S), and Clinical Global Impression of Improvement (CGl-l) Scale. Among patients with anxiety disorders 28 people (90.3 %) have finished the study, three persons (9.7 %) dropped out of the study with regard to the ineffectiveness of Buspirone therapy. Analysis of the values on the HAM-А scale revealed statistically significant reduction in composite score by the end of day 14 (by 23.4 %, p < 0.05) and a statistically significant increase in differences by day 35 of therapy and reduction of scores by 51.5 % (p < 0.01). A statistically significant reduction (by 21.9 %, p < 0.05) of points on the Shihan anxiety scale was revealed by day 21 of therapy. Reduction of the mean values of the total score of reactive and personal anxiety by the Spielberger - Hanin scale was recorded from day 21 of therapy (p < 0.05). CGl-S scale statistically reliable reduction of patients with moderate degree of severity to 26.6 % (p < 0.05) and a statistically significant increase in the number of patients with mild degrees of severity by 20 % (p < 0.05) were revealed on day 14 of therapy. On the CGl-l scale, a marked improvement (26.7 %, p < 0.05) and a slight improvement (33.3 %, p < 0.05) is achieved by day 14 of therapy. Undesirable effects in the form of motor coordination disturbance, drowsiness, dizziness leveled during the therapy and did not require additional prescriptions for their correction. Buspirone can be recommended as an effective anxiolytic drug with safe portability profile for the treatment of anxiety disorders.

Alcohol dependence syndrome is the important modern medico-social issues. ln recent years, the problem of achieving remission with alcohol dependence has been given great attention, both in Russia and abroad. The duration, persistence and quality of remission are the indicators of effectiveness of alcohol dependence therapy. The possibility of an objective prediction of the outcome of ongoing therapy, the duration of remissions and the likelihood of relapses of alcohol dependence are urgent needs. Despite a large number of scientific studies, there is no single idea of the factors influencing the formation of remissions in patients with alcoholic dependence syndrome. The article presents the modern view on the terms and stages of the remissions formation in alcohol dependence syndrome, clinical-psychopathologic structure of remissions. Diagnostic assessment of the remissions is examined according to the current classifications of lCD-10 and DSM-V Biological, personal, social and therapeutic factors of the formation of long-term remissions in patients with alcohol dependence are analyzed. Comorbid affective disorders, in particular, depressive and anxiety-phobic disorders, cerebral pathology (traumatic, hypertonic, vertebrogenic genesis), nicotine dependence, are attributed to factors influencing the stability of the clinical picture of remission and causing a high risk of recurrence. Modern approaches to the prognosis of remission in alcohol dependence on the basis of a complex biopsychosocial approach are presented.

The article presents the comparative analysis of application of terpene-containing medicine Antiran (1:3 solution) and 0.06% chlorhexidine bigluconate solution in a complex therapy of patients with chronic generalized parodontitis. According to the curative effect, these drugs are comparable with antibacterial and antiseptic agents, but they act more gently and, as a rule, do not cause side effects. Currently, as a etiotropic therapy of periodontitis, a wide range of drugs affecting the parodontal pathogenic microflora, irrational use of antibacterial agents has acquired the status of a global problem of modern medicine, since it leads to the emergence of resistant strains of microorganisms that are poorly sensitive or resistant to treatment. The medicaments were used in ultrasonic scaling and for passive ultrasonic irrigation of periodontal pockets during curettage process. The results were evaluated according to the PMA, SBI, PI indexes, an extravazation time formation and periodontal pockets depth. The first total time period of clinical observation established that inflammation process was eliminated earlier when Antiran was used. Thus our study demonstrated and substantiated the successful experience of Antiran application in periodontal practice.

The review considers the problem of connection the polycystic ovarian syndrome and periodontal disorders of the fertile women. The authors marked that this problem is not virtually touched upon in Russian science. In the foreign literature this issue is discussed in connection with studying the micro-biome and oxidative stress. The authors refer to some articles showing that the quantity of pathogenic microorganisms responsible for periodontal disorders and the level of specific antibodies in blood serum are increased in women with polycystic ovarian syndrome, especially in the cases of gum inflammation. Also the article gives the data where the results show the wider spreading of periodontal disorders in women with polycystic ovarian syndrome in comparison with the healthy ones where controls were matched by age and BMI. The authors think that studies on oral microbiocenose disorders and tissue quality of periodontium of the fertile women with polycystic ovarian syndrome are quite important. The further studying of connection of polycystic ovarian syndrome and oral mucous membrane inflammation could reveal definite periodontal pathogens, which can influence systematic inflammation processes in polycystic ovarian syndrome.

Teeth discoloration is a rare orthodontic complication during orthodontic treatment. We present 6-year clinical observation conducted from January 2010 till December 2016. The eighteen orthodontic patients with teeth discoloration took part in this observation. Four patients were excluded from the observation as their teeth discoloration were under orthodontic treatment. During clinical observation period, discovered discoloration was evaluated as «improved» in 4 out of 14 teeth (28.5 %), as «maintained» in 10 teeth (71.4 %). Electroodontodiagnosis conducted during the initial detection period of discoloration showed 14.3 % positivity, which improved to 21.4 % at the final follow-up. The radiological pictures of the teeth showed no abnormalities. Thus, we can assume that teeth with one wide long root canal are more prone to damage to the pulp blood supply. Discoloration is also more frequent in the maxillary teeth, possibly due to the overjet relationship, which may increase susceptibility to trauma in the maxillary teeth. We should keep dynamical observation in the orthodontic practice as teeth color could reverse to the initial without additional interference. 1f discoloration does not improve even after sufficient observation, it is necessary to start orthodontic treatment (endodontic, prosthetic) or bleaching. A patient should be informed that discoloration does not always indicate devitalization or pulp necrosis. Instead of "devitalization" or "pulp necrosis" we recommend to use the term "discoloration".

Background. In cases of tuberculosis in children, contacts with patients with drug-resistant forms are often detected. Treatment and prevention of the disease is based on these data and adherence to treatment. Aims. To analyze the social status of the family of children with tuberculosis, clinical forms and drug resistance of MBT in patients who are sources of infection in the outbreak for adequate planning of preventive treatment of contact and treatment of children with tuberculosis. Materials and methods. The study involved 150 children with tuberculosis treated in a hospital in 2009-2012 and 142 children - in 2015-2017. We studied social factors and drug resistance of Mycobacterium tuberculosis in adult patients - sources to child transmission. Drug resistance of MBT cultures was determined by Löwenstein - Jensen medium and automated system BACTEC MGIT 960. Results. 50.0 % of children with tuberculosis are patients of preschool age, 33.0 % of children aged under 3 years. From 2009-2012 to 2015-2017 the proportion of socially disadvantaged families fell from 68.0 % to 45.1 %. At the same time the proportion of children with tuberculosis, contracted from a known contact decreased from 70.0 % to 57.0 %. Often children get infected from mother or from several close relatives (mother, father, grandfather, grandmother), TB patients source of infection of children are often diagnosed with infiltrative (21.9-38.3 %) and fibro-cavernous tuberculosis (17.0-21.0 %). To 2015-2017 multi-drug resistance in the nidi was recorded at 52.2 %. The development of tuberculosis in children was facilitated by the defects of preventative measures: absence of BCG vaccination (from 9.0 to 14.0 % of children), the absence of preventive treatment (55.3-67.5 %).

This article is devoted to experience of endoscopic ligation of varices in N.A. Semashko Republic Clinical Hospital. We analyzed the results of ligation in 28 patients treated since February 2013 to March 2016. Selected patients had diagnoses of liver cirrhosis, syndrome of portal hypertension of different origin, 10 (35.5 %) had the history of one or more episodes of bleeding from varicose veins of the esophagus. Endoscopic ligation was performed for patients with varices of grade 3-4 according to J. Paquet classification, grade 3 according to N. Soehendra, K. Binmoeller classification improving primary and secondary prevention of bleeding. The effectiveness of endoscopic ligation as a method of primary and secondary prevention of bleeding from the varices, with subsequent transfer to oral administration of non-selective β-adrenoblockers was evaluated. In the result of the study throughout the entire period of observation we indicated no episodes of esophageal bleeding and established a low rate of recurrence of varices. Those patients who, after the first endoscopic ligation session, followed the recommendations for taking beta-blockers, have a better prognosis and the outcome in relation to patients who have neglected the recommendations. During the first year of follow-up there was one fatal outcome - a man with VHC died as a result of hepatocellular insufficiency.

One of the most serious complications of modern anesthesia is malignant hyperthermia, which is a pharmacogenetic disease phenotype manifested by skeletal muscle hypermetabolism and rhabdomyolysis during or after general anesthesia with the use of inhaled anesthetics and succinylcholine. In Russia, the problem of malignant hyperthermia remains unresolved. This is mainly due to the fact that the only specific drug dantrolene created for the effective treatment of malignant hyperthermia is still not legalized and thus formally prohibited to import, disseminate and apply on the domestic pharmaceutical market. This article deals with the regulatory framework of specific treatment of malignant hyperthermia in Russia, allowing the possibility to legally import to the territory of the Russian Federation dantrolene as an unregistered drug, if it is a question of rendering medical assistance on vital indications to a particular patient, or its unauthorized use for vital indications in a situation of extreme necessity. The article presents the recommendations of domestic experts on the treatment of malignant hyperthermia. In this case, as a possible alternative to dantrolene, magnesium preparations are considered, whose role in the treatment of the crisis of malignant hyperthermia continues to be specified. Thus, given the increasing use of inhalation anesthesia by Russian anesthetists, to ensure the safety of patients with regard to the development of malignant hyperthermia, it is possible only in the case of official registration in the domestic dantrolene market. Also, in the territory of Russia, a network of relevant consultative and diagnostic centers should be established. These measures will undoubtedly increase the effectiveness of treatment and prevention of severe consequences of this disease in our country.

The article describes the observation of a child with a very rare combination of noncompact left ventricular myocardium and coronary dilatation in type 1 neurofibromatosis (NF1). The first of these complications, undifferentiated cardiomyopathy, also known as noncompact myocardium, is not described in combination with nF 1 in available literature, although cases of hypertrophic cardiomyopathy in patients with NF 1 have been previously reported. Dilatation of the coronary arteries also refers to infrequent manifestations of vascular pathology against the background of neurofibromatosis, and the combination of all three signs (NF 1, noncompact myocardium and coronary dilatation) has not yet been reported by other authors. When examining the patient, we found the characteristic signs of NF 1 (foci of "coffee" pigmentation on the skin, multiple nevuses, fibroids of the forearm, cognitive disorders), electrocardiogram features of left ventricular hypertrophy, negative T-tooth and ST-segment displacement 1 mm below the isoline in Leads V4-6, in echocardiography - pronounced trabecularity, thinning of the compact myocardium layer and a "spongy myocardium" in the region of the left ventricle apex, dilatation of the coronary arteries. With magnetic resonance imaging, signs of noncompact myocardium of the left ventricle were found, with selective coronary angiography - slowing of the coronary blood flow. The patient receives the permanent treatment for heart failure and aspirin, his condition remains stable for 4 years of follow-up

Incidence rate of primary synovial chondromatosis of the shoulder joint makes 15-28 %. It is a rare benign lesion of synovial membrane of the joint featured by multiple foci of cartilaginous metaplasia in tissues of the membrane. Differential diagnostics should be conducted with the diseases, accompanied by formation of intra-articular loose bodies (secondary chondromatosis) at osteochondritis dissecans, osteochondral fracture of the humeral head, and tuberculous rheumatism. But the critical role belongs to histopathology report and molecular genetic analysis. Synovial chondromatosis most frequently afflicts one of the major joints (knee, hip, elbow, or shoulder). The pathology develops mainly in young men. Published descriptions of the development of this shoulderjoint lesion are very sparse. Diagnostics becomes possible only on the grounds of histological examination of cartilage flaps removed from the joint. Present treatment of synovial chondromatosis includes removal of intra-articular cartilage bodies, either with open surgery or by arthroscopic approach. The authors of the article present the clinical example of diagnostics and surgical treatment of the patient with primary synovial chondromatosis. The disease, aged more than 4years, was accompanied with limited movements in the shoulder joint. Postoperative check-up examination established restored volume of movements and no pain syndrome in the joint. The patient came back to everyday routine and amateur sport. Therefore, adequate volume of surgical intervention excludes the recurrence of the disease in early and remote postoperative period. The patient is able to work and participate in routine physical activity.

The paper presents a clinical case of the Patient T., 34years old, who underwent the treatment in the Department of ART of the Regional Perinatal Center for tubal peritoneal infertility for seven years. In the anamnesis: one spontaneous uterine pregnancy, culminating in medical abortion for up to 12 weeks, treatment for chronic salpingo-oophoritis, tubectomy on the right side for a progressing ectopic pregnancy. The patient denied the presence of Chlamydia infection in the anamnesis. Studies on sexually transmitted infections before the 1VF program were negative. During laparoscopic tubectomy, no endometriotic foci were found. There were four programs of ART in anamnesis: in 2009, 2012, 2014,2016. During the fourth ART program in 2016, two embryos were transferred to the uterine cavity, resulting in a uterine pregnancy in combination with an ectopic pregnancy diagnosed in the ultrasound study at 4 to 5 weeks of gestation, in the absence of clinical symptoms. The patient underwent emergency laparoscopic tubectomy on the left, the course of the postoperative period proceeded without complications. Later, in the period of uterine pregnancy of 7-8 weeks, with a clinical picture of acute appendicitis, the woman was hospitalized in the surgical department where she underwent laparoscopic appendectomy. Later the pregnancy proceeded without complications, at 39 weeks the planned cesarean section was performed, a girl weighing 3480 grams, 51 cm long with an Apgar score of 9-10 points was extracted on the operation. The course of the early postoperative period without complications, the patient was discharged with the child on the 4th day.