Currently, there are many points of view on management of physiological labor, in particular, it concerns the intrapartum position of a woman. Tactics of modern obstetrics should ensure the safety of motherhood, which in future ensures the prosperity of the state. One of the alternative methods of delivery is the vertical position of a woman in the intrapartum period. It is impossible to describe the whole range of possible positions of a woman in the intrapartum period, the common ones being: lying position (lateral, reclining, lithotomy, Trendelenburg’s, etc.) or upright position (sitting, using a chair for childbirth, standing, squatting, standing on the knees, etc.). Opinions about how the vertical position of a mother in the intrapartum period affects the outcome of childbirth are quite ambiguous. The conclusions of various authors on that matter often contradict each other.
The aim of the research was to study the role of vertical delivery in reducing the frequency of obstetric and perinatal complications.
Materials: publications of foreign and domestic authors within the period from 1989 to 2017.
Methods: systematic analysis and synthesis of literature data.
Conclusion: Despite a significant number of studies, it is not possible to determine the universality of the vertical position in childbirth, therefore, the selection of patients for the management of vertical childbirth should be approached carefully. In the presence of pregnancy complications, preference should be given to the classic version of the position in childbirth. In women who have a low risk of perinatal complications, an upright position can be a worthy alternative. To prevent the development of bleeding in the III stage of labor and the early postpartum period, a woman should take a horizontal position after the birth of the fetus. This condition must also be observed when examining the birth canal. Thus, the rational tactics of conducting childbirth is to determine the optimal combination of vertical and horizontal positions at different periods of the childbirth process, taking into account the convenience for the woman in labor. 

Background. At present, the problem of plant colonization by bacteria pathogenic for human is of particular interest. Among the bacteria capable of polyhostality, species of the Enterobacteriaceae family, which includes both phytopathogenic and human pathogens, are of particular interest. Fruits and vegetables contaminated with such pathogens have been shown to be able to cause human intestinal infections. Being one of the ways of communication in the plantmicroorganism system, it is possible that the synthesis of indole acetic acid (IAA) by Enterobacteriaceae determines the growth rate of bacteria, contributing to more rapid colonization of the plant.
Aim: comparative study of the synthesis of IAA by different types of enterobacteria.
Methods. Eight types of enterobacteria were used in the study, seven of which were isolated from sick people, as well as the phytopathogen Pectobacterium carotovorum spp. carotovorum. The work was performed using microbiological and spectrophotometric research methods.
Results. The ability of the synthesis of IAA by opportunistic microorganisms belonging to the Enterobacteriaceae family was studied. We found that the majority of the studied strains synthesize IAA. Studies on the effect on the synthesis of IAA, the introduction into the nutrient medium of tryptophan and its enrichment with glucose, as well as the variation of the temperature regime of the cultivation of bacteria were carried out.

Intaking antithrombotic funds (ATA) and non-steroidal anti-inflammatory drugs (NSAIDs) is one of the most frequent causes of pathology in gastrointestinal (GI) tract.
The purpose of the study: comparison of pathological changes of the mucous membrane in the upper GI tract, that occur against the background of ATA and NSAIDs admission.
Material and methods. Endoscopic data of two groups of patients taking ATA and NSAIDS have been compared. The first group of 448 patients from the 10th Gastrointestinal Department in N.N. Burdenko Main Military Clinical Hospital was on record from 2013 to 2017. The patients had erosive ulcerous changes of gastrointestinal mucosa, occurred against the background of the ATA admission. The second group comprised 6431 patients with rheumatic diseases. They were hospitalized in the clinic of V.A. Nasonova Research Institute of Rheumatology in the period from 2007 to 2016 and took NSAIDs regularly.
Results. Duodenal and gastric ulcer changes in gastric mucosa and duodenal ulcers were identified in 168 (37.5 %) patients taking ATA and in 1691 (26.3 %) patient treated with NSAIDS. Structure of pathology varied. So, against the background of ATA and NSAIDS admission, the number of acute gastric ulceration amounted to 6.5 % and 15.5 % (p < 0.001); acute ulcers duodenal was 2.9 % and 4.9 %; combined ulcerative lesions of gastric and duodenal was 2.9 % and 2.0 %; multiple erosions of gastroduodenal mucosa were 52.4 % and 15.7 % (p < 0.001); single erosion was 35. 1% and 61.6 %. The factor of ulcer history and age ≥ 65 years old increased significantly the risk of duodenal and gastric ulcer changes in patients taking ATA and NSAIDs: OR 5.182 (95% CI 2.701–9.942) and 3.24 (95% CI 2.19–5.34), 4.537 (95% CI 2.036–10.11) and 2.016 (95% CI 1.230–2.917) respectively. Intaking of proton pump inhibitor (PPI) reduced significantly the risk of complications for both ATA and NSAIDs: OR 0.329 (95% CI 0.199–0.546) and 0.317 (95% CI 0.210–0.428) respectively.
Conclusion. The structure of pathology of mucous in the upper gastrointestinal tract that arose against the backdrop of ATA and NSAIDs admission is different. The first is characterized by a multiple erosion, while the second one has single acute distal gastric ulcers. The ulcerative history and advanced age of patients increase significantly the risk of complications concerning the gastroduodenal mucosa when using ATA and NSAIDs. PPI is the effective means of preventing this pathology.

The aim of the research was to analyze the effectiveness of empirical therapy in patients with established complicated upper urinary tract infection (complicated pyelonephritis).
Materials and methods. 51 patients who were treated in 2018 in the urological department of the Irkutsk City Clinical Hospital N 1 were subjected to a retrospective study. The average age of patients was 55.9 ± 16.9 years.
Results. Successful empirical therapy was considered in the absence of correction of the treatment regimen and the normalization of clinical blood and urine tests. Of the patients included in the study, successful empirical therapy was found in 24 (47%) patients, and required correction in 27 (52.9 %) patients. Cephalosporins as monotherapy were ineffective in 24 (57.1 %) patients, carbopenems – in one (25 %), fluoroquinolones – in all (100 %). Aminoglycosides showed the best result as a combination therapy with cephalosporins – 100 % (n = 3) of success. Based on multivariate logistic regression analysis, it was established that the detection of microhematuria and uremia in clinical analyzes upon admission to the hospital increases the likelihood of empirical monotherapy with third-generation cephalosporins by 20 % and 27 %, respectively.
Conclusion. It is advisable to refrain from the use of monotherapy with fluoroquinolones and third-generation cephalosporins until more information is available about the resistance of uropathogens in the population of the Irkutsk region. Patients with impaired renal function require particularly close attention of the clinician when choosing a scheme for the empirical treatment of complicated pyelonephritis.

Background. Plague is an especially dangerous natural focal infectious disease belonging to a group of quarantine infections. There are eleven natural plague foci in Russian Federation. In Republic Tyva plague endemic territories include Ovyur, Mongun-Taigin and Tes-Hem areas where Y. pestis strains are intermittently isolated from Citellus undulates. Population living at the territory of the natural foci get immunoprophylaxis against plague at complication of epizootic and epidemic conditions.
This paper presents the results of monitoring indicators of the immune status of people vaccinated with the plague vaccine living in the territory of the Tuva natural focus.
Materials and methods. The study involved 76 volunteers who had not previously been vaccinated. The study included the determination of production IFN-γ, IL-4, TNF-α by blood cells, titers of specific IgG antibodies to the capsule F1 antigen of the Yersinia pestis, and concentrations of immunoglobulins in serum blood, as well as immunophenotyping of blood lymphocytes.
Results. In the course of a comprehensive immunological study, features of the development of cellular and humoral reactions in people living in the territory of the Tuva natural plague focus were established in the first months after vaccination. Changes in the concentration dynamics of the main classes of immunoglobulins were accompanied by an increase in the level of specific IgGs to the F1 within 6 months after immunization. In the same period, a significant increase in the production of cytokines, as well as significant changes in terms of the subpopulation composition of the vaccinated blood.
Conclusion. It is necessary to note the importance of studying of the human immune status in 1–3 months after plague vaccination as this period coincides with potentially dangerous season from epidemiological point of view. Nevertheless, much important role for improvement of tactics of the specific prevention measures plays the data received after the revaccination.

The causative agents of many infectious diseases can exist in the form of biofilms. The aim of the work is to study of the frequency of occurrence and the degree of activity of biofilm formation of microorganisms isolated from different locus in purulent-septic infections.
Materials and methods. Fifteen strains isolated from patients with purulent-septic infections were examined. Biofilms were determined by the ability to adsorption a crystalviolet to ethanol.
Results. 73,3 ± 11,4 % strains had biofilms (including gram-negative bacteria – 69,2 ± 11,9 %; Staphylococcus – 100,0 %; p < 0,05).The degree of activity of formation of biofilm by gram-negative bacteria was higher than Staphylococcus (0,302 ± 0,04 и 0,134 ± 0,01 units of optical density; p < 0,01). The highest activity of formation of biofilm was detected in K. pneumoniae isolated from patients with sepsis. Strains from clinically important locus (blood, sputum, wound discharge, abdominal fluid) had biofilms in 75,0 %; from locus of monitoring – 66,7 %. The pathogens isolated from locus of the monitoring were characterized by an average degree of activity of biofilm formation (0,180–0,360 units of optical density). Strains from clinically important locus (blood and sputum from patients with sepsis) had a high
degree of biofilm formation (more than 0,360 units of optical density). 
Conclusion. In most cases, strains were characterized by the presence of biofilms and differed in degrees activity of biofilm formation depending on locus.

Today, anthrax is recorded in many countries around the world, in Kazakhstan – in the form of sporadic cases or small outbreaks. Despite the endemicity of anthrax in Kazakhstan, the genetic diversity strains is not well described. At the moment, MLVA-25, which is sufficient for molecular and epidemiological monitoring, is recognized as one of the most discriminatory methods of genotyping.
Objective: to determine the cultural and morphological properties, the genomic characteristics of the strains of the anthrax pathogen, their geographical distribution in the territory of Kazakhstan during the outbreaks in 2016, a comparative analysis with collection strains isolated since 1962.
Methods: microbiological, genetic research methods were used in the work.
Results. We investigated 11 strains of B. anthracis, which were isolated in 2016 in Kazakhstan. For comparison of genotypes, 26 strains were used from the collection of pathogenic microorganisms of the A.M. Aykimbaev’s Kazakh Scientific Center for Quarantine and Zoonotic Diseases. Phylogenetic analysis clustered 37 strains of B. anthracis into three clusters and 23 genotypes.
The results of studying the phenotypic properties of anthrax strains by the main identification tests showed that all the strains studied in the experiment and isolated from 1961 to 2016 had biological properties characteristic of typical of B. anthracis strains.
The anthrax strains isolated in 2016 are characterized as significant variability, as well as the circulation of the same genotypes and clusters in different areas of Kazakhstan. MLVA-profiles of analyzed Kazakhstan strains are unique and do not fully coincide with any studied strain from MLVAbank. On the MST-tree, Kazakhstan’s strains are located in three clusters, as on the phylogenetic tree.
Conclusion: Molecular genetic analysis of B. anthracis strains enhances the ability of epidemiologists to track the sources and pathways of infection.
It is necessary to improve the tracking system for strains of especially dangerous infections in  Kazakhstan using modern molecular genetic methods.

Background. Medicinal plant extracts exhibiting pro- and antioxidant properties may affect antibiotic-induced killing of biofilm-producing bacteria in both synergistic and antagonistic modes. Better understanding of these alternations is required to adjust antibiotic therapy and herbal medicine in order to exclude unwanted losses of antibiotic efficiency.
Aim: to study modulation modes of streptomycin killing rate against mature biofilms of Escherichia coli in the presence of different doses of commonly used medicinal plant extracts.
Materials and methods. Pharmacodynamic parameter killing rate and mass biofilm formation were determined in the presence of streptomycin and medicinal plant extracts.
Results. Synergism was found between 100 mg/ml streptomycin and low doses (0.83 mg of dry herb/ml) of green, black tea, Arctostaphylos uva-ursi, Betula pendula and Laminaria japonica against killing mature biofilms. Alternatively, high doses (6.64 mg of dry herb/ml) of green, black tea and Vaccinium vitis-ideae demonstrated antagonism, decreasing killing rate and enhancing biofilm formation. Presumably, high doses of the extracts were sufficient to enhance biofilm formation blocking penetration of streptomycin through enlarged biofilm matrix and diminishing the killing rate.
Conclusions. Widely consumed as soft beverages or for prophylactic purposes green, black tea and V. vitis-ideae could promote strong antagonistic effects with streptomycin. These extracts can stimulate biofilm production, making benefit for commensal microbiota, but have clinical relevance due to a significant reduction in the lethal efficiency of streptomycin in biofilms of pathogenic strains. This highlights the need of careful antibiotic prescription scheme adjustment when choosing appropriate combinations of plant extracts and antibiotics to achieve a synergistic effect.

Background. Management of the reparative process is an urgent task of modern medicine. In our opinion, the development of pathogenetically grounded approaches to optimizing the repair process for managing the interrelations of stromal cells is promising. One of the promising areas in this regard is the impact on the MAPK-cascades.
Aim: to study the expression of MAP-kinase mechanisms in the regulation of repair by the example of a musculocutaneous wound.
Methods. A linear muscular skin wound was modeled using Wistar rats weighing 220–250 g at the age of 9 months (n = 24). Immunofluorescence staining was performed to detect the activity of p38, JNK, and ERK MAPK cascades from 1 to 30 days.
Results. It was established that specific staining in the area of connective tissue formation during staining with p38 MAPK and its phosphorylated form was first observed on the 3rd day, and its maximum severity occurred at the same time. On the 7th and 14th day, small zones in the area of scar formation were minimally stained. The phosphorylated part of the JNK-cascade in the zone of traumatic injury was detected starting from the 1st day after the injury. Bright color persisted on the 3rd day. On the 7th day, the color was minimal, and by the 14th day a second wave of expression was observed. ERK-staining was observed from the 1st to the 14th day with a peak activity on the 3rd day.
Conclusion. Thus, we revealed the simultaneous involvement of p38, JNK-, and ERK-cascades in the regulation of the reparative process in the conditions of a musculoskeletal wound. At the same time, it is noteworthy that the peak activity of all cascades coincides and falls on the 3rd day.

Currently, the incidence of autism spectrum disorders (ASD) continues to increase in the children’s population. However, the pathogenesis of autism remains controversial.
The purpose of this work is to evaluate the performance of the elimination nutritional approaches to the dynamics of indicators of food hypersensitivity, the balance of interleukins and psychophysiological parameters in children with ASD.
Methods. A prospective cohort study of children aged 7 ± 2 years, healthy and diagnosed with ASD was performed. Determination of specific immunoglobulin concentrations to 111 food antigens and interleukins was measured by ELISA. Psychophysiological indicators of communicative competence in children with ASD were evaluated in the ATEC-test.
Results. It was established that in children with ASD (n = 69), the frequency of occurrence of food hypersensitivity and indicators of specific sIgG concentrations to food antigens of dairy and grain products are higher (р < 0.05). A direct correlation was found between the concentration of INFγ, IgG concentrations to antigens of dairy, grain products and C. albicans. High ratios of the INFγ/IL4 and INFγ/IL10 ratios (p < 0.05) were revealed. As a result of compliance with the elimination diet was noted significant decrease in the concentration of sIgG to food antigens, sIgG to C. albicans, changes indicators following the results of ATEC testing.
The data obtained revealed the unexplored effects the influence of specific food hypersensitivity on the process of initiation and maintenance of immune inflammation, as well as on the communicative competence in pathological conditions. A personalized elimination diet can improve the immunorehabilitation and the quality of life of children with autism.

Background. The progressive increase of the number of schoolchildren with adaptation disorders and low level of health in recent years determines the need to assess the characteristics of the psychosomatic status in children and adolescents with various types of somatic pathology, including diseases of ENT organs, accompanied by nasal breathing disorders and hypoxia. It is also necessary to determine the severity of stress in children, for timely prevention and correction of these disorders.
Aim: to assess the level of stress in schoolchildren with nasal breathing disorders against the background of nasal diseases and concomitant psychosomatic disorders.
Materials and methods. 481 schoolchildren aged 12–17 (boys and girls) were examined. Nasal breathing disorders were assessed by a comprehensive ENT examination, including rhinoscopy, radiography of the sinuses, and olfactometry. The presence and severity of stress were determined by the questionnaire “Social factors and stress”.
Results. We found that the high level of stress in children with nasal breathing disorders on the background of ENT pathology is more often associated with the high frequency and severity of psychosomatic symptoms: the presence of dorsalgia, asthenic syndrome, chronic headache and frequent episodes of abdominal pain. Moderately and significantly increased levels of stress associated with the presence of children with hypertension, asthenic syndrome, frequent abdominal pain, frequent pain in the cervical spine, panic disorders.
Conclusions. Thus, the presence of certain psychosomatic complaints in children with nasal breathing disorders is directly related to the level of stress, which is important to take into account when planning preventive and corrective measures aimed at increasing the adaptive capacity and stress resistance of children. The studies illustrate the need to assess the psychosomatic status and the level of stress in schoolchildren with nasal breathing disorders taking into account their existing comorbid disorders of the psychosomatic spectrum. 

Scales of epidemic process of HIV-associated of tuberculosis are especially noticeable in regions with high prevalence of HIV infection and tuberculosis. A striking example of this situation is the Irkutsk region – the territory with the highest prevalence of HIV infection in the Russian Federation and one of the most unsuccessful one on tuberculosis – in 2010 became Russian “leader” and in prevalence of the HIV-associated tuberculosis, keeping a position “in the first five” so far. It is clear, that all this cannot but imply negative manifestations of two considered epidemic processes at their simultaneous development in one territory. The above-said facts predetermined carrying out the retrospective epidemiological analysis of spread of tuberculosis among the cumulative population in the Irkutsk region, a territory of high risk of HIV infection.
The purpose of the work was to assess features of spread of tuberculosis in the territory of the large center of HIV infection (Irkutsk region).
Results. The expressed negative impact of HIV infection on epidemic process of tuberculosis in the studied region, shown in divergence of trends and higher levels of epidemiological indicators in comparison to the all-Russian data is established.
Conclusion. As a result of a research the trend of regional incidence of tuberculosis, multidirectional with the all-Russian indicators, is established from the moment of epidemic spread of HIV infection that demonstrates integration of epidemic processes of the studied infections. Even on condition of regress of epidemic process of tuberculosis at the end of the analyzed period which is followed by decrease in incidence of all population, HIV infection has a significant impact on his tension that, certainly, demands the strengthened measures of epidemiological control of these socially important infections.

The relevance of cold injury is due to its high specific weight in the structure of injuries, complexities of complex therapy, and unsatisfactory results of treatment. It is known that in the pathogenesis of local cold injury, the leading role belongs to endothelial dysfunction, which secretes a huge amount of biologically active substances, including matrix metalloproteinases.
Aim: to determine the dynamics of the content of matrix metalloproteinases of the second subfamily (MMP-2, MMP-9) in the serum of patients with local cold injury.
Materials and methods. The study included 80 patients (60 men, 20 women) with frostbite of the III–IV degree of the foot to the level of the lower third of the leg in the late reactive period and the period of granulation and epithelization.
Results. In the late reactive period in patients with cryopreservation, the level of MMP-2 was 3.4 times higher relative to the control (p = 0.011), on day 30 MMP-2 values did not differ from the control parameters (p = 0.103). The level of collagenase B (MMP-9) in patients with local cold injury on day 5 was 14.5 times higher than the control parameters (p = 0.002), on day 30 – 12.5 times higher compared to the control group (p = 0.000094).
Conclusion. During the analysis of the data obtained, we can think about the dual nature of collagenases during the processes of inflammation. In a situation of distress, collagenases prevent endothelial dysfunction by eliminating the cellular structures of the endothelium to ensure adequate metabolism in tissues. Their importance as markers of failure of adequate flow of reparative processes is not excluded.

Biological therapy in the treatment of immune-mediated conditions has changed their course, the quality of life of patients and the prognosis of diseases. The accumulated by mankind 20 years of experience with the use of genetically engineered drugs has led to a number of questions regarding, among other issues, safety in the long-term administration of biological therapy. Patients suffering from ulcerative colitis revealed changes in cell membranes, reflecting their structural and energy characteristics. Long-term administration of Infliximab leads to the stabilization of energy processes in the erythrocyte membrane and improves homeostatic function of the kidneys.
The aim of the study was to evaluate the effect of long-term use of TNF-α blockers (Infliximab) on the structural and functional characteristics of cell membranes and the functional state of the kidneys in patients with moderate to severe ulcerative colitis.
Materials and methods. We examined 103 patients with moderate to severe ulcerative colitis during the period of acute attack and remission, of which 28 patients received basic therapy using the drug Infliximab (IFX) for 10 years, 75 patients received standard basic treatment. The patients of the biological therapy group took the original drug Infliximab – Remicade. The comparison group consisted of 30 healthy volunteers, comparable by sex and age. The analysis of the state of erythrocyte membranes was carried out using a set of physicochemical methods: UV spectroscopy (SF-46m spectrophotometer), high-performance thin-layer reaction paper chromatography, membrane ultrafiltration, erythrocyte NMR spectroscopy on phosphoric (31P) and proton (1H) nuclei. The functional state of the kidneys was evaluated using a dynamic scintigraphic study (with the technemage –Tc-99m).
Results. Prolonged use of anticytokine therapy with Infliximab for 10 years in patients with ulcerative colitis, upon reaching deep remission, improves endogenous intoxication, restores the structural and functional characteristics of cell membranes, normalizes cell energy metabolism and does not negatively affect the functional state of the kidneys. 

Background. Perioperative myocardial ischemia often complicates extracardiac surgery. The problems of its prediction, diagnostics, treatment and prevention are not solved. Frequency, structure and clinical features of cardiac ischemic complications of surgical treatment of lung cancer are not well understood.
The aim of the study was to investigate the frequency of postoperative myocardial infarction and myocardial ischemia in the surgical treatment of patients with non-small cell lung cancer.
Methods. The frequency (%) of myocardial infarction (MI) with and without ST segment elevation of electrocardiogram, acute myocardial ischemia in a complete sample of cancer patients (n = 2051) who underwent treatment for non-small cell lung cancer for the last 10 years was calculated. By comparing the relative indicators and calculating the Odds Ratio (OR), we studied the relationship between the cardiac ischemic events with age, type of surgery, prevalence and localization of the tumour. The clinical manifestations and pathomorphology of postoperative myocardial infarction were analysed.
Results. Cardiac ischemic complications of thoracotomy for lung cancer occurred in 2.73 % (95% CI 1.98–3.48) cases. Myocardial infarction with ST segment elevation was recorded in 1.07 % (95% CI 0.58–1.57) patients, MI without ST segment elevation – in 0.54 % (95% CI 0.17–0.9), myocardial ischemia – in 1.12 % (95% CI 0.62–1.63). An increase in the frequency of ischemic events after pneumonectomy was observed compared with lobectomy (OR 6.5, 95% CI 3.5–12.2) and after right-sided pneumonectomy compared with left-sided one (OR 3.2, 95% CI 1.6–6.3), and also the age over 70. Hospital mortality from MI was 39.3 %. According to autopsies of patients who died of МI, coronary atherothrombosis was detected in 2 of 22 cases.
Conclusion. In the surgical treatment of non-small cell lung cancer, cardiac ischemic events develop in 2.73 % of patients. The greatest risk is associated with right-sided pneumonectomy.

Fibroproliferative diseases have been described in the lungs, kidneys, liver, eyes, heart, skin, and abdomen. Each fibrous pathology has causal factors and pathological manifestations characteristic of this organ and this condition. However, there are common mechanisms underlying many fibrous pathologies. This gives potential value to studies focused on specific processes, among which is the adhesive process in the abdominal cavity. The study of growth factors in the formation of connective tissue contributes to a better understanding of the pathogenetic picture in this pathology. It is shown that vascular endothelial growth factor, fibroblast growth factor, transforming growth factor, platelet growth factor, insulin-like growth factor and keratinocyte growth factor participate in the development of abdominal adhesions. Each of these factors contributes significantly to the formation of peritoneal fibrosis.
Thus, damage to any tissue initiates a complex multistage process, which is regulated by a large number of cytokines and growth factors. Growth factors control cell migration, proliferation, differentiation, and survival. In addition, they are able to influence the expression of other factors involved in the regenerative response. Understanding the process that develops during the formation of the adhesive process in the abdominal cavity and the growth factors affecting it is important for their further use in order to prevent the pathological process.

Hyperparathyroidism is a clinical and laboratory syndrome characterized by high production of the chief cells of the parathyroid hormone, a calcium-phosphorus metabolism disorder and the organ failure (kidneys, bone tissue).There are primary, secondary and tertiary hyperparathyroidism.
This literature review is focused on tertiary hyperparathyroidism and includes the following sections: definition of different forms of hyperparathyroidism, the role of vitamin D in the tertiary hyperparathyroidism development, the development of tertiary hyperparathyroidism in chronic kidney disease patients, the development of tertiary hyperparathyroidism in patients after kidney transplantation, differential diagnosis various forms of hyperparathyroidism, indications for surgical tertiary hyperparathyroidism treatment in patients with kidney disease, in patients with normal kidney function.
Objective. The objective of this literature review is to study the current information about this definition, pathogenesis, diagnosis and treatment of tertiary hyperparathyroidism.
Methodology. The literature review was taken in English data bases MEDLINE (Pubmed), Scopus, Cochlear library, using following keywords: “secondary hyperparathyroidism pathogenesis diagnosis treatment”, “tertiary hyperparathyroidism pathogenesis diagnosis treatment”, “development of tertiary hyperparathyroidism from secondary hyperparathyroidism”, “chronic vitamin D deficiency, hyperparathyroidism”, “early stages of chronic renal failure, hyperparathyroidism”. Also, search for the same keywords was completed in Russian data base Elibrary.
Discussion. Both the lack of a common understanding of this problem, and the presence of diverse and contradictory data of the etiology and pathogenesis indicate the need for further study of tertiary hyperparathyroidism.

Background. The specific detection of genomic/template +RNA and replicative –RNA of tick-born encephalitis virus (TBEV) is necessary to study the mechanisms of viral replication in the cells of reservoir and accidental hosts. However, the current approaches of quantitative reverse transcription – polymerase chain reaction (qRT-PCR) are rather focused on the detection of total viral RNA load in the sample. Thus, the significant optimization is necessary both for RT-PCR and for RNA copy number standard preparation.
Aims. To develop the set of standard samples of synthetic +RNA of TBEV and to optimize qRT-PCR for quantification of genomic +RNA of the virus.
Materials and methods. Fragment of the genomic +RNA of TBEV was synthesized using pTZ57R-T\A plasmid vector with embedded T7 promoter and T7 RNA polymerase. The DNA contamination was removed using RNase-free DNase I treatment followed by additional RNA purification step. Reverse transcription was performed using specific antisense primer 11154R 5`- AGCGGGTGTTTTTCCG-3` and qPCR detection was used according to the modified procedure of M. Schwaiger and P. Cassinotti (2003).
Results. As a result of the amplification of standard samples, the concentration of positive polarity ТBEV RNA, carried out in five independent repetitions on different days, the correlation coefficient R2 between the quantification cycle and the concentration of the standard sample was 0.99, and the efficiency of PCR was 100 %. The coefficient of variation in assessing the inter-test accuracy of determination averaged 2.8 %.
Conclusions. Optimized qRT-PCR procedure and set of +RNA standards allow to determine the concentration of genomic +RNA of TBEV in routine laboratory practice.

The purpose of the research was to study epidemiological manifestations and etiological structure of sepsis in a multidisciplinary hospital for children.
Materials and methods. An analysis of cases of 85 patients with a diagnosis of sepsis hospitalized in a multidisciplinary hospital at the regional level (Irkutsk) for the period 2013–2018 was carried out.
Results and discussion. The most affected age groups are children under one year old (23.5 %) and from one year to two years (29.4 %). During the study period, 572 bacterial and fungal cultures, represented by 19 types of microorganisms, playing a leading role in the formation of the microbial ecology of the hospital, were isolated from patients with GPSI. In the structure of the GPSI microflora, gram-negative microorganisms are found in 49.8 % of cases, grampositive microbiota – in 30.1 %, fungi account for one fifth of all positive findings. A. baumannii and P. aeruginosa were sown more often from blood, sputum and abdominal cavity, and S. aureus and A. baumannii were the most frequent pathogens from wounds. The largest number of enterococci is isolated from urine.
Conclusions. The etiological factor in the development of nosocomial GPSI in most cases is gram-negative microorganisms – A. baumanii (39.9 %), P. aeruginosa (20.7 %), K. pneumoniae (23.1 %). At the same time, in recent years, fungi have become increasingly important in the etiology of septic conditions.

Almost every year in Kazakhstan, cases of diseases of animals and people with anthrax are recorded. The incidence rate of people with anthrax in the period from 2000 to 2018 ranged from 0.01 to 0.24 per 100 thousand people. In the territory of the East Kazakhstan region, the incidence rate is higher than in the republic.
Objective: a retrospective analysis of anthrax outbreaks in the East Kazakhstan region from 2000 to 2018.
Methods: a retrospective analysis using statistical, cadastral data, archival funds, the results of participation in the investigation of outbreaks of infection.
Results. Since 1938, cases of animal and human disease of anthrax have been recorded in East Kazakhstan. Infection of humans occurs during the slaughter of animals. In Zharma, Urjar, and Ayagozskiy areas most of all are anthrax foci of soil. In 67 % of cases, outbreaks of anthrax were recorded in these areas.
Conclusion. The relative incidence rate of anthrax in people in East Kazakhstan is from 0.07 to 0.27, since 2001 it is higher than the republican indicator.
In the East Kazakhstan region from 1997 to 2018, 37 people fell ill with anthrax. The form of the disease is skin, in 8.1 % secondary sepsis. In the remaining patients, the diseases were mild (70.3 %), ended in recovery. The source of human infection is mainly cattle. The isolated strains of B. anthracis have typical properties, they are included in cluster A1a, A3b (MLVA-8). The strains isolated in 2016 are similar to the strains isolated in the Almaty region (MLVA-25). Grouped with a number of European, Asian and African strains from France, Germany, Italy, Tajikistan, Pakistan, Korea and Namibia. The presence of a significant number of soil foci of anthrax in the territory of the East Kazakhstan region, not fully the implementation of veterinary and sanitary preventive measures leads to an exacerbation of the situation for anthrax. 

Case of somatoform algic disorder with pain in maxillofacial region is described on a 58 years old patient. The patient have been observed by different specialists and underwent numerous medical examinations which led as a result to groundless medical manipulations such as several teeth extirpation, removal of previously mounted metalloceramic constructions.
Latest observations show that there is a link between age and pain localization rate at mouth area as well as changes in hypochondriac experience to the increase of supervaluable generations. Thus condition described becomes a disorder which is hard to diagnose and a social problem concerning early diagnostics and treatment. With time and increase of life expectancy as well as increase of assortment and affordability of dental procedures problem of somatoform algic disorder diagnostics in late age becomes more urgent. Clinical case illustrates accumulated practical experience of late age somatoform disorders treatment by combinations of antidepressants and small doses of antipsychotics. Ethiopathogenesis of this condition assessed as nociceptive, neuropathologic and then as psychogenic pain is still to be investigated. Late diagnostics in this case points to a necessity of multidisciplinary approach to such patients’ treatment in order to develop criteria to apply in practice for diagnostic mechanisms optimization and pharmacologic effect on early disorder stages.

Revealed by morphological characters, physiological status, and genetic diversity of populations of the main plague host Rhombomys opimus Licht., 1823 in Central Asia desert natural focus is described.
Differences in the skull parameters of R. opimus from different populations were revealed. It’s shown that gerbils from Moyunkum are separate autonomous populations group. Samples from Moyunkum and Mangyshlak differed from other samples. In Balkhash-Alakol depression found two regional complexes: Pre-Balkhash and Dzungarian.
Study results of free amino acids level in R. opimus blood serum obtained by gas-liquid chromatography of blood sera from animals captured in different zones of Central Asian focus gave statistically significant differences. To determine genetic variability in ecological and geographical isolation of R. opimus populations the DNA was genotyped.
DNA samples analysis combined the studied gerbil from the desert focus into four clusters with eighteen haplotypes. R. opimus sequence analysis taking into account data from territories of Iran, Kazakhstan and China, clustered into three large clusters. First cluster combined the sequences of Kazakhstan and China samples, while great gerbil captured in Kazakhstan is located in a separate treasure. Second and third clusters include sequences of a great gerbil captured in Iran.