In the final issue of the Acta biomedica scientifica in 2021, the main attention is drawn to the series of articles devoted to infectious diseases. 

Diabetes mellitus is one of the most serious medical, social, and economic health problems in all countries of the world. The incidence of diabetes mellitus in the world doubles every 10–15 years, acquiring the character of a non-infectious epidemic. Therefore, it is extremely important to search for new drugs that help normalize glycemia, prevent complications of diabetes mellitus, and improve the quality of life of patients. These drugs include “Neo inulin”, which has a hypoglycemic, antioxidant, hepatoprotective and angioprotective effect.
The aim: to evaluate the effectiveness of “Neo inulin” in the complex treatment of patients with type 2 diabetes mellitus.
Materials and methods. The study involved 18 women (average age – 64.5 ± 8.7 years, average weight – 77.8 ± 11.4 kg) and 3 men (average age – 54.6 ± 12.4 years, average weight – 114 ± 40.2 kg). The average duration of type 2 diabetes was 11.0 (7.0–12.0) years. “Neo inulin” was prescribed as 2 capsules per day for 12 weeks in the complex of basic diabetes therapy To assess the effectiveness of therapy, a study of the quality of life related to health, a biochemical blood test (glycated hemoglobin), a clinical minimum (CBC, OAM, ECG, blood glucose) was carried out, the functional characteristics of tissue blood flow were investigated, and the ankle-brachial index (ABI) was determined. Statistical processing of the results was carried out using the Statistica 6.0 software package (StatSoft Inc., USA). Differences were considered statistically significant at p < 0.05.
Results. Statistically significant differences were revealed in the values of all scales of health-related quality of life in patients in the groups before and after treatment with “Neo Inulin”, including the total physical and mental components. An improvement in the functioning of microcirculatory regulation mechanisms was noted, which is confirmed by a statistically significant increase in ABI (1.0 and 0.8 on the right; 0.9 and 0.8 on the left, respectively; p < 0.05) and the coefficient of microcirculation variation (9.2 and 8.3, respectively; p < 0.05). In 57,1 % of cases (12 people), the level of glycated hemoglobin was normalized.
Conclusion. The use of a treatment regimen that includes “Neo Inulin” improves the effectiveness of treatment and improves the quality of life of patients with type 2 diabetes mellitus.

Background. The use of antiviral agents can shorten the duration of the viral infection.
The aim: to study the clinical and epidemiological features and the effectiveness of antiviral therapy for new coronavirus infection (COVID-19) in outpatient children.
Materials and methods. From April 2020 to March 2021, 9334 outpatient children aged from 0 months to 17 years were randomly tested for new coronavirus infection. SARS-CoV-2 RNA was detected in oropharyngeal and nasal material by PCR. Patients with confirmed new coronavirus infection were prescribed interferon-alpha (IFN-α) intranasally, antiviral agents of systemic action. The control group consisted of children with COVID-19 who did not receive treatment.
Results. When examining clinically healthy contact children, SARS-CoV-2 RNA was detected in 7.4 % of cases. In the structure of ARI, the specific weight of COVID-19 was 12.3 % with the peak incidence in April-May (up to 22.8 %) and NovemberDecember (up to 30.0 %). In half of the cases, children became infected in the family, and usually adults were the index patient. In 47.7 % of cases, an asymptomatic form of COVID-19 was registered without significant differences in patients of different ages. In one third of children with concomitant pathology, the disease was asymptomatic, in half it was mild, in other cases moderate severity was diagnosed. The clinical picture of COVID-19 did not differ from other ARIs. Anosmia (9.4 %) in half of the cases was combined with ageusia (4.4 %) and was significantly more common in boys. The duration of clinical manifestations in children of the control group and those who received antiviral therapy did not statistically significantly differ in mild and severity of the disease. Also, various antiviral therapy options did not significantly affect the duration of SARS-CoV-2 detection in children with various forms of COVID-19.
Conclusion. In the first year of the pandemic, the novel coronavirus infection did not dominate the pattern of respiratory diseases in outpatient children. Further research is required to develop pediatric guidelines for the treatment of COVID-19 at the outpatient stage.

Background. The COVID-19 pandemic has raised the importance of this problem to the first stage and has affected healthcare system around the world. Despite the more favorable COVID-19 course, the child population should be at focus of special attention, due to the active participation in its distribution. The course of COVID-19 includes a cascade of pathological processes accompanied by the generation of reactive oxygen species, which can have extremely negative consequences for the developing organism. The research of these processes in children is vital and will improve the effectiveness of preventive and therapeutic measures.
The aim: to analyze changes in enzymatic and non-enzymatic links in the antioxidant defense in children and adolescents with diagnosed COVID-19 infection.
Materials and methods. 17 children and adolescents (average age – 12.35 ± 4.01 years) were examined, including 8 boys (47 %) and 9 girls (53 %) with COVID-19 infection. The control group of children and adolescents (practically healthy) according to the «copy-pair» principle was selected. We used spectrophotometric methods.
Results. In the group of children and adolescents with diagnosed COVID-19 infection, there were lower levels of total antioxidant activity (p < 0.0001), superoxide dismutase activity (p < 0.0001), content of reduced glutathione (p = 0.048) and retinol (p = 0.015), increase in glutathione reductase activity (p = 0.015) relative to the control.
Conclusion. The obtained data indicate the insufficiency of antioxidant system components number in children and adolescents with diagnosed COVID-19 infection and indicate the advisability of antioxidant therapy using to stabilize these indicators.

The spread of strains of microorganisms that are multidrug resistant to modern antimicrobial drugs is still an urgent problem in the treatment and prevention of infectious diseases and public health in general.
Currently, the possibility of using metal nanopreparations in various fields of medicine is being actively studied. Nanoparticles of metals and metal oxides are promising antimicrobial agents and are attracting growing interest due to their effectiveness. Nanoscale copper metal particles have shown high antimicrobial activity against
various types of gram-positive and gram-negative bacteria, as well as fungi. Taking into account the potential of copper nanoparticles in antimicrobial therapy, we present an overview of the current state of research related to their antimicrobial properties, consideration of the mechanisms of action, key factors affecting antimicrobial activity, including the polymer matrix. The issues of toxicity and resistance to copper are considered. The advantage of copper nanoparticles over other metal nanoparticles is shown.
The studies summarized in this review have shown the promise of copper nanoparticles in the creation of new antimicrobial drugs that can be used in the future to control, prevent, and treat various diseases.

Background. Various methods of respiratory support in combination with prone positioning have been used during the COVID-19 pandemic. The effects of combination of these two factors on hemodynamics are of interest for clinical practitioners.
The aim: to evaluate the effect of prone positioning on hemodynamics in COVID-19 patients depending on the method of respiratory support.
Materials and methods. The study included 17 patients of both sexes diagnosed with COVID-19-associated community-acquired polysegmental viral and bacterial pneumonia with progressive respiratory failure. The study consisted of two stages. During the first stage, the patients were receiving respiratory support with humidified oxygen (3–7 liters per minute). The second stage was initiated after switching to noninvasive ventilation (NIV). The measurements were performed using a technique of volumetric compression oscillometry on a non-invasive hemodynamic monitoring system KAP CGosm-Globus (Russia).
Results. The study showed that prone positioning in patients with severe COVID-19 when switching from oxygen therapy to NIV resulted in a change in the diastolic blood pressure difference module from 2.5 (1.0; 8.2) to 8.0 (5.7; 14.0) (p = 0.016). Escalation of respiratory support led to the changes in the left ventricular outflow tract velocity difference module from 11.5 (9.5; 34.2) to 31.0 (15.7; 42.0) (p = 0.049).
Conclusions. Patients with community-acquired polysegmental viral and bacterial pneumonia associated with COVID-19 demonstrated changes in diastolic blood pressure and left ventricular outflow tract velocity as a result of prone positioning following switching from oxygen therapy to NIV.

New data have been obtained for assessing the expression of genes of metalloproteinases and their tissue inhibitors (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2) in the Ligamentum flavum in patients with lumbar stenosis of spinal canal and dural sac. The features of the metabolism of the extracellular matrix (ECM) were revealed, the data obtained were compared with those for previously studied candidate genes. The search for relationships with the features of the ECM metabolic characteristics was carried out.
The aim. To study the expression of genes of metalloproteinases and their tissue inhibitors in intraoperative biopsies of the Ligamentum flavum of patients with lumbar stenosis of the spinal canal and dural sac.
Materials and methods. A group of 33 people (17 women, 16 men) with lumbar stenosis of the spinal canal and dural sac was studied; the average age is 45.73 ± 1.95 years. RNA was isolated from intraoperative biopsies of the Ligamentum flavum, reverse transcription was performed, and PCR using specific primers was performed.
Results. In Ligamentum flavum of patients with stenosing processes of the spinal canal and dural sac, an increased activity of MMP-1 and insufficient response of TIMP-1 and TIMP-2 were found; the expression of MMP-1 increased synchronously with Dio2, and both genes decreased their activity with increasing age of the patient. In patients with Ligamentum flavum ossification, the MMR-8 gene was more actively expressed, and the synthesis of the mRNA of the MMR-9 gene decreased compared to the subgroup without ossification.

Background. Obesity is a multifactorial disease that is one of the important public health problems in the 21st century. Functional bowel disorders in obese children and adolescents are one of the most common pathologies of the digestive tract.
The aim: to characterize the bacteriological composition of the colon microbiota in obese adolescents and identify its associations with the clinical manifestations of functional bowel disorders.
Materials and methods. The study included 20 adolescents aged 11–17 years. Stool consistency was assessed using the Bristol Stool Scale. The study of biological material was carried out using standard bacteriological methods. To assess the strength of the relationship between the nominal variables, Cramer’s V test was used.
Results. It has been shown that in adolescents with obesity and functional bowel disorders, there is a decrease in the number of representatives of bifidoflora, an increase in the microbial density of Escherichia coli with altered enzymatic properties and an excessive growth of potentially pathogenic enterobacteria. In obese adolescents with functional bowel disorders, abdominal pain associated with the act of defecation is associated with the presence of enterobacteria and E. coli with altered enzymatic properties. Rare bowel movements are associated with an increased abundance of Enterococcus spp. and the presence of opportunistic Enterobacteriaceae microorganisms. Frequent bowel movements are associated with the presence of E. coli with altered enzymatic properties and Clostridium spp. In the presence of loose stool, Clostridium spp. is present; unstable stool (alternation of hard and liquid stools in one patient) is associated with a decrease in the number of lactobacilli and E. coli with normal enzymatic properties, the appearance of E. coli with altered enzymatic properties, opportunistic microorganisms of Enterobacteriaceae family and Clostridium spp.
Conclusion. The relationship between the clinical symptoms of functional bowel disorders and changes in the composition of the gut microbiota in obese adolescents may be a justification for conducting in-depth studies aimed at finding early predictors of functional bowel diseases associated with obesity in the adult cohort.

Until now, there is no radical method of treating children with cerebral palsy, which allows us to consider scientific research in this direction reasonable and promising.
The aim of the research: to study the effect of exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback on the indicators of motor skills in children with spastic cerebral palsy.
Materials and methods. We conducted an open, non-randomized, prospective, comparative, controlled study in pairs (each participant in the main group corresponds to a participant in the control group). The study involved 53 patients aged 4–12 years with cerebral palsy: the intervention group (group 1: n = 27 (13 boys, 14 girls)) and the control group (group 2: n = 26 (11 boys, 15 girls)), comparable in terms of gender, age and severity of movement disorders. Characteristics of the medical intervention: group 1 – botulinum toxin type A (BTA, for exercising against the background of relative muscular normotonus) + exercise therapy + exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback (BFB); group 2 – BTA + exercise therapy. Duration of the study: 2019–2020. The difference between groups in terms of motor skills on the day of hospitalization and after completion of the training program (10 sessions each) was determined. Motor skills were assessed according to the GMFM-66/88 (Gross Motor Function Measure) table using the “Scales for measuring global motor functions”.
Results. The inclusion of additional exercises on the mini-simulator “Kinesioplatformswing” with biofeedback in the rehabilitation of patients with movement disorders with spastic cerebral palsy (BTA + exercise therapy) in comparison with the control group. However, the question of the long-term effects of such training remains open and requires further study.

The aim. To study the features of the course of the neonatal period in children, perinatally exposed to HIV, who receive an enhanced regimen of chemoprophylaxis of HIV mother-to-child transmission.
Patients and methods. A retrospective longitudinal cohort study of mother – child pairs for the period from 2017 to 2019 was carried out. The clinical observation group included HIV-positive women with a high risk of vertical transmission of the immunodeficiency virus (n = 213) and their newborn children (n = 214), who were prescribed an enhanced chemoprophylaxis regimen of HIV transmission from mother to child. Results. According to the results of the study of HIV-positive mothers we revealed a high prevalence of secondary diseases and a high per partum viremia – 1700 (222–18342) copies/ml. 35.9 % of children were born prematurely, 27.5 % – had low birth weight by gestational age. In newborns, diseases of the respiratory (24.3 %) and nervous (17.2 %) systems prevailed. 17.2 % of children developed intrauterine infection; HIV RNA was detected in 3.7 %. Congenital malformations were observed in 7.4 % of children. Symptoms of enteropathy were noted in 24.7 % of newborns. A decrease in red blood counts was found in all children by the 28th day of life (pw < 0.001).
Conclusion. The study confirms the need for increased attention and improvement of approaches to medical support of children who were perinatally exposed to high risk of vertical HIV infection.

Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.
The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.
Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.
Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.

Antiretroviral therapy has markedly reduced morbidity and mortality for persons living with human immunodeficiency virus (HIV). HIV can now be classified as a chronic disease; until a cure is found, patients are likely to require life-long therapy. However, despite these undoubted advances, there are many issues that need to be resolved, including the problems associated with long-term efficacy and toxicity. Moreover, pharmacotherapy of patients infected with HIV is challenging because a great number of comorbidities increase polypharmacy and the risk for drug-drug interactions. There is considerable interindividual variability in patient outcomes in terms of drug disposition, drug efficacy and adverse events. The basis of these differences is multifactorial, but host genetics are believed to play a significant part. HIV-infected population consists of ethnically diverse individuals on complex and potentially toxic antiretroviral regimens on a long-term basis. These individuals would benefit greatly from predictive tests that identify the most durable regimens. Pharmacogenetics holds that promise. Thus, detailed understanding of the metabolism and transport of antiretrovirals and the influence of genetics on these pathways is important. To this end, this review provides an up-to-date overview of the metabolism of antiHIV therapeutics of the protease inhibitors Lopinavir and Ritonavir and the impact of genetic variation in drug metabolism and transport on the treatment of HIV.

The article is devoted to the problem of prevention of adhesions in cardiac surgery. It was determined that the problem is urgent due to the increase in the number of heart surgeries. The formation of adhesions is a reaction of the body after surgery, which is a stage of healing and partly performs a protective function. Nevertheless, the presence of adhesions violates the mechanical properties of the heart, negatively affects central hemodynamics, complicates the surgeon’s task during repeated surgical interventions and increases the risk of repeated operations.
It has been shown that at present, for the prevention of adhesions, researchers tend to use biodegradable barrier materials with biocompatibility and the ability to dissolve after performing the barrier function. The main anti-adhesion agents used in cardiac surgery are membranes and gels. The requirements for an “ideal” agent for the prevention of adhesion were determined: biocompatibility, no irritating effect, no effect on wound healing, suppression of the growth of connective tissue in the pericardium.
Conclusions. Until now, none of the funds has all the necessary qualities to prevent adhesion in the pericardium. Therefore, the search for effective methods for the prevention of postoperative adhesions remains relevant for cardiac surgery.

The interrelation of the severity of the epidemiological situation in a particular country and its institutional characteristics (including the level of health care, quality of management, the level of public trust, cultural characteristics, etc.) is considered. As a result, using the developed index of the severity of the epidemiological situation, the institutional characteristics that most affect the effectiveness of the measures applied were determined. It was figured out that of the 16 characteristics considered, only two (the level of employment and trust in the government) have a medium statistical correlation with the severity of the pandemic. Three more characteristics (prevalence of secular-rational values, degree of urbanization, GDP PPP per capita) have a correlation close to the medium. The remaining characteristics (including health care costs, government efficiency, etc.) have either a weak correlation wiыth severity, or actually do not have it. The results obtained indicate insufficient use and reassessment of existing institutional capacities at the initial stage of the pandemic, as well as insufficient reliability of morbidity and mortality statistics in a number of countries. In conclusion, based on the analysis of statistical indicators, recommendations are given to improve the effectiveness of the use of institutional capacity to counter epidemiological threats, improve this potential, increase the effectiveness of protective and restrictive measures that reduce the severity of the epidemiological situation.

Background. Improving organizational technologies for early detection of cancer using targeted programs for large-scale cancer screening is a priority task of primary health care.
The aim: to assess the potential of lean technologies to optimize cancer screening during periodic health examination of the adult population.
Materials and methods. To develop an optimal organizational and functional model of cancer screening, a working group was created; information about the current state of the process was collected.
Results. A comprehensive analysis of the state of the process revealed the following problems: violation of the algorithms of oncological screening at stage 1 of periodic health examination (13.8 %); cases of non-completion of stage 2 of periodic health examination by patients with suspected colon cancer (20.4 %); queues for endoscopic examinations (14 days) and, as a consequence, not a quick visit to the oncologist of the primary oncology department (17–18 days). After optimization of the periodic health examination: there is no queue for endoscopy for patients with suspected oncopathology; accelerated access of patients with suspected oncopathology to the oncologist of the primary oncology department (from 17–18 to 5 days; p < 0.01). Increased awareness of patients about the rules for preparing for endoscopic examination and a reminder of the date and time of the upcoming endoscopy, there was an increase in the number of patients who completed stage 2 of health examination to exclude/confirm oncopathology (from 79.6 to 90 %; p < 0.05). The frequency of violations by doctors of the oncological screening algorithm decreased from 13.8 to 2.3 % (p < 0.01).
Conclusion. The use of lean manufacturing marketing strategies in primary health care has helped to identify, eliminate and control the causes of problems during the first and second stages of clinical examination of patients with suspected oncopathology.

Background. Currently, the multichannel nature of financial flows determines the multivariate methods of payment for medical services, which are also influenced by the type of medical care, conditions, form of its provision, and type of institution. As a result, the cost of a medical service can vary significantly not only in different, but even in one medical organization. The lack of a unified methodological approach puts healthcare organizations in unequal conditions, as a result, public sector medical organizations are forced to seek additional resources to provide medical care to the population that meets the standards. None of the current methods for determining the cost of a medical service reflects its actual cost, since it does not take into account the structure of production costs.
The aim. To improve the methodology for the formation of the cost of public services in the health care system, taking into account their resource intensity.
Materials and methods. The study included the analysis of the forms of state statistical observation of medical organizations of the Irkutsk region, reports of the federal and regional accounting chambers, industry regulations, materials of scientific periodicals, conferences, monographic studies, including on the Internet; comparison of the cost of medical services in various medical organizations of the Irkutsk region; modeling methods for calculating the cost of medical services using the Cobb – Douglas production function.
Results. A unified classification of medical services based on their resource intensity and an improved method of forming the cost of medical services based on the Cobb – Douglas production function are proposed, revealing the dependence of the volume of production on two factors of production – capital and labor; the cost of medical services was calculated using the example of real services provided in one of the medical organizations of the public health sector of the Irkutsk region.
Conclusions. The proposed method for determining the cost of a medical service based on its resource intensity makes it possible to determine the real cost of a medical service, the full reimbursement of which will increase the financial stability of medical organizations in the public sector, which will be reflected in the improvement of their material and technical base and, as a result, will increase the quality of medical services.