The COVID-19 (coronavirus disease 2019) pandemic has spurred the development of highly effective quantitative methods for assessing the adaptive immune response to the SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) virus. In order to assess the humoral component of the immune response, various methods for detecting immunoglobulins A, M, G are widely used. ELISPOT seems to be the most accessible and effective method to assess the level of T cells that specifically respond to the SARS-CoV-2 virus antigens.

The aim. To assess cell-mediated and humoral immunity in COVID-19 in residents of the Republic of Crimea.

Methods. The study was performed on 24 volunteers: the presence of coronavirus antibodies was determined by ELISA method, and the presence of contact with coronavirus proteins – by the ELISPOT “TigraTest®  SARS-CoV-2” method (Generium, Russia). For retrospective study of  humoral immunity in the population, we assessed 10 000 ELISA tests (ECOlab IgM and IgG, Russia) performed in our laboratory for the period from July 2020 to January 2022.

Results. The results show the effectiveness of using the ELISPOT method to detect latent forms of coronavirus infection. It is important to note that there is statistically significant relationship between the timing of the disease and the number of spots in  both antigen panels. After vaccination against SARS-CoV-2, cell-mediated immunity lasts up to 6 months or more.

Conclusions. As a result of the study, it was found that during 2021, the level of  immunization of the population of the Republic of Crimea against COVID-19 has significantly increased; the proportion of residents who have positive IgG test has increased from 27 % to 87 %. The results of ELISPOT studies using a set of reagents for in vitro detection of blood T-lymphocytes that specifically respond to SARS-COV-2 virus antigens (“TigraTest® SARS-CoV-2”) showed that this method is more sensitive than ELISA in detecting latent diseases. 

Background. Eating disorders are an urgent public health problem due to their high prevalence and mortality. The disease prognosis depends on timely diagnosis; however, these conditions are sure to be underestimated.

The aim. To study the prevalence, features of clinical manifestations and psychosomatic comorbidity of eating disorder (ED) and subthreshold eating disorder (SED) in schoolgirls aged 11–17 years.

Materials and methods. We examined 917 schoolgirls aged 11–17 years. The screening questionnaire including 11questions combined into three pools named “Thoughts about one’s own body” was used. The first pool (A) – assessed body dissatisfaction, the second one (B) – eating disorders, the third one (C) – food intake disorders. The answers were encoded as “1”, “2”, “3” (“false”, “rather true”, “true”). Schoolgirls who scored the maximum number of points (12) in the pool A were regarded as dissatisfied with their body and were further divided into two groups: the first group (ED) included girls who scored more than 10 points in the pool B; girls who scored less than 10 points were in the second group (SED), respectively. Body mass index (BMI) was determined by the weight-height coefficient correlated with centile tables. Psychosomatic comorbidity was assessed by the presence of recurrent headache and abdominal pain in the last six months.

Results. The overall prevalence of eating disorders was 11.7 %, where ED made 2.1 %, SED – 9.6 %. All schoolgirls had abnormal eating behavior; however, those with SED used less aggressive weight-loss methods. BMI ˂ 5th percentile was observed in 10 % of girls with ED and 4.5 % – with SED. 60 % of girls with ED and 40.9 % with SED complained about frequent headaches; 30 % of girls with ED and 20.4 % with SED were suffering from frequent abdominal pain.

Conclusion. In schoolgirls, subthreshold eating disorder is 4.6 times more common than threshold eating disorder. Characteristics of clinical manifestations are the absence of underweight for most schoolgirls and comorbidity with pain syndrome. 

Background. Worldwide, there is a rapid increase in the number of people suffering from various forms of carbohydrate and lipid metabolism disorders. Modern studies show that the transport, distribution, excretion and accumulation of chemical elements in these types of metabolic disorders change in different ways and affect the further functional state of the body differently.

The aim. To evaluate the level of macro- and microelements in the blood serum and liver, as well as the content of metal-ligand forms of zinc in the blood serum of a Wistar rat in a high-calorie diet.

Materials and methods. Thirty male rats were selected for the experiment, from which two groups were formed: control (n = 15) and experimental (n = 15). The animals of the control group received the basic diet (270 kcal/100 g), and the animals of  the experimental group received a high-calorie diet. During the  experiment, the caloric content of the diet of the experimental group gradually increased from the caloric content of the total diet. During the study, body weight, biochemical parameters of blood and urine were evaluated. The analysis of macro- and microelements in the samples was carried out using inductively coupled plasma mass spectrometry. Determination of the content of individual zinc compounds in blood serum was carried out using a combination of a chromatograph and a mass spectrometer.

Results. It was found that a high-calorie diet led to a decrease in the level of iron, chromium, iodine, zinc, potassium, calcium, and an increase in vanadium in blood serum. In the liver, there was a decrease in the level of lithium and an increase in  the  level of calcium, vanadium, chromium, iron, zinc, cobalt. When assessing the chemical forms of zinc in the blood serum, a percentage increase in the albumin fraction was recorded against the background of a decrease in amino acid complexes and low-molecular-weight forms of zinc.

Conclusion. The data obtained suggest that a high-calorie diet leads to an imbalance of chemical elements, which can serve as one of the triggers for dysregulation of a number of physiological functions of the body. 

The aim. To analyze the possibility of using the genetic mechanisms of CRISPR-Cas9 technology in the prevention and treatment of certain viral diseases.

Materials and methods. The search for publications was carried out in Russian and foreign literature using the following search engines: RSCI, Cyberleninka, eLibrary, PubMed, Cochrane Library, etc. A review of domestic and international scientific papers on the research topic was carried out using search keywords: CRISPR, genetic engineering, genome editing, Cas9, sgRNA.

Results. A review of using CRISPR-Cas9 method (“genetic scissors”) as a gene therapy for some viral diseases was carried out, and its main advantages and disadvantages were revealed. An analysis of the data of scientific studies on genetic research methods over the past decade discovers the main aspects of CRISPR-Cas9 technology, modern classification and prospects for using this technology in clinical practice for the treatment and prevention of human viral diseases. The possibilities of creating a more versatile and stable version of the CRISPR-Cas9 technology are considered. Particular attention is paid to the technological difficulties and obstacles that scientists face when implementing this system for targeted use in clinical medicine.

Conclusion. One of the rapidly developing areas in science giving promising prospects for modern healthcare is genetic engineering, especially in cases where scientific developments are applied in clinical practice. The discovery of “genetic scissors” technology has revolutionized all medicine. Wide opportunities for developing new treatment methods for many viral diseases and creating conditions for their early prevention opened up for the medical community. In the future, with the introduction of this technology into clinical practice, it will become possible to treat diseases that have not previously responded to ongoing therapy and were considered incurable. 

Background. Pseudotuberculosis remains a serious healthcare problem, which determines the expediency of developing the express methods for its early diagnosis. To detect the pathogen, we designed test system for dot-immunoassay (DIA) based on antibodies labeled with silver nanoparticles (SNPs) isolated from hyperimmune rabbit serum obtained against killed cells of  Yersinia pseudotuberculosis of O:1b serovariant.

The aim. To assess the possibility of using dot-immunoassay for express identification of Y. pseudotuberculosis cultures isolated from clinical material and environmental objects at the initial stage of bacteriological study during laboratory diagnosis of the disease.

Methods. We used the materials from the outbreak of pseudotuberculosis in the Krylovskaya Boarding School of the Bakcharsky district of the Tomsk region in 2021. Specific antibodies from hyperimmune rabbit sera obtained against Y. pseudotuberculosis 3704 particulate antigen of O:1b serotype were labeled with SNPs and used in DIA on nitrocellulose membranes with visualization of reaction results with a solution of a physical developer. The presence of the causative agent of pseudotuberculosis in the test material was inferred by the formation of gray spots of different intensity (from 4+ to 1+).

Results. All Y.  pseudotuberculosis strains isolated using bacteriological method on  the second day of the study from clinical material obtained from sick people and environmental objects were detected in DIA at concentrations ≥ 3.1 × 104 microbial cells per milliliter (m.c./ml).

Conclusion. The designed test system for dot-immunoassay using SNPs as a marker of specific antibodies for the detection of Y.  pseudotuberculosis in cultures isolated from swabs from vegetables and clinical material from patients, including those  with  mixed infection, allows us to  detect a specific corpuscular antigen with a high sensitivity (≥ 3.1 × 10⁴ m.c./ml), providing express identification of isolated cultures at the initial stage of bacteriological study. 

Background. The main method of screening of patients with HIV infection to detect pulmonary tuberculosis is X-ray diagnostics. A comparative assessment of changes in lung tissue in different methods of X-ray diagnostics and at different levels of CD4⁺ cells seems relevant.

The aim of the study. To compare plain radiography and computed tomography of the lungs as screening methods for detecting tuberculosis in patients with HIV infection at various stages of immunosuppression.

Materials and methods. 396  patients with HIV registered at the AIDS Center were  examined using plain lung radiography (PLR) and computed tomography (CT). To search for mycobacterium tuberculosis, we used bacterioscopy of a smear with Ziehl – Neelsen staining; HAIN-GenoType MTBDRplus technique; inoculation of BACTEC MGIT 960 liquid media; inoculation of Löwenstein – Jensen dense medium. Statistical processing of numerical material was carried out using the Statistica 5.5 program with a significance level p ≤ 0.05; Pearson χ² criterion was used for the analysis of qualitative features

Results. When comparing the results of PLR and CT, the differences were found. When  using PLR, the focal lung lesions were described more often (χ²  =  40.79; p = 0.00001), according to CT data, they turned out to be fibrosis (χ² = 2.33; p = 0.1269). When comparing the PLR and CT data, the differences were obtained in the description of pulmonary fibrosis (χ² = 20.78; p = 0.00001), focal lung lesions (χ² = 40.79; p = 0.00001), dissemination (χ² = 9.16; p=0.0025).

Conclusion. When screening HIV-infected patients (at the standard of using plain radiography twice a year) it should be taken into account that CT provides more precise differentiation of focal lung lesions and pulmonary fibrosis, earlier detection of dissemination syndrome and ground-glass, especially at severe immunodeficiency with a decrease in CD4+ T lymphocytes down to 200 cells and less. Timely appointment of CT study will improve the effectiveness of tuberculosis detection at the stage of screening in AIDS centers. 

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.

Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.

Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.

Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.

Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications.

The aim of the study. To identify the frequency of occurrence of TLR4 Asp299Gly (rs4986790) gene polymorphism and to establish its contribution to the development of organ dysfunction in patients with severe pneumonia associated with A/H1N1 influenza.

Materials and methods. The study included 55 patients with severe pneumonia associated with A/H1N1 influenza. Inclusion criteria: severe pneumonia; consolidation/ground-glass syndrome according to chest X-ray/CT. Exclusion criteria: unstable hemodynamics; body mass index > 30; diabetes mellitus; HIV; tuberculosis, oncopathology. Verification of the pathogen in the respiratory swab was carried out using PCR method: A/H1N1  influenza virus RNA was identified. The age of  the  patients was 47 [38; 62] years. Among all the patients the proportion of men was 47.8 %, of women – 52.2 %. Patients were divided into 2 groups: group 1 included patients with SOFA scale (Sequential Organ Failure Assessment) score ≥ 2 points; group 2 – patients with SOFA scale score ˂ 2 points. Gene SNPs were determined by PCR method using standard kits developed by Research and Production Company “Litekh” (Moscow). Amplification of the TLR4 gene fragments was carried out in a thermocycler Bis-M111 (Bis-N LLC, Novosibirsk). Genomic DNA isolated from whole blood leukocytes using the “DNA Express Blood” reagent was analyzed followed by an amplification reaction. The amplification product was detected in a 3% agarose gel.

Results. Multiple organ dysfunction (SOFA scale score ≥ 2 points) in patients with severe pneumonia associated with A/H1N1 influenza was registered in 24 (43.6 %) cases. When analyzing the frequency of occurrence of the minor Gly allele, according to genetic models, the differences were established between patients of the groups 1 and 2 in codominant (p = 0.023; odds ratio (OR) – 8.82 (0.95–81.89)) and dominant (p = 0.005; OR = 12.35 (1.40–109.07)) models.

Conclusion. Severe pneumonia associated with A/H1N1 influenza is accompanied by a high incidence of  organ dysfunction. The risk of organ failure development is  2.1  times increased in patients with severe pneumonia with identified TLR4 Asp299Gly gene polymorphism, which probably requires further study. 

The aim. To assess the effect of glucose-electrolyte composition with plant extracts having antioxidant activity on the hemodynamic parameters of vertebrobasilar system during the incrementally increasing submaximal exercise test.

Materials and methods. The study included 12 athletes (6 candidates for master of sports and 6 masters of sports) aged 18–22, who have been engaged in orienteering for 10 years and more. Time of aerobic exercise – 2 hours a day, five days a week. The study subjects performed an incrementally increasing submaximal exercise test and also submaximal exercise test with the preventive intake of a glucose-electrolyte composition with plant extracts having antioxidant properties. To assess the hemodynamic parameters in all study subjects we used Doppler ultrasound of the cerebral vessels, evaluating vertebrobasilar system blood flow, exercise gas test in the modification of hypo- and hyperventilation, and also positional test.

Results. A single intake of glucose-electrolyte drink under conditions of incrementally increasing exercise test contributed to the manifestation of a homeostatic effect in hemodynamic parameters of the vertebrobasilar arteries. It is evidenced by the approximation to the pre-exercise level of maximum systolic velocity and average blood velocity in the breath-holding test, of the diastolic blood velocity in the hyperventilation test, and of the pulsatility index in the torsion test, as compared to the isolated submaximal exercise test which caused the change in both velocity indicators and calculated indices during the functional tests.

The article considers the main mechanisms underlying the change in arterial hemodynamic parameters caused by incrementally increasing load, as well as describes the proposed mechanisms arising from the combined effect of an incrementally increasing load and the intake of a glucose-electrolyte composition with plant extracts having antioxidant activity.

Conclusion. It was shown that using glucose-electrolyte drink contributed to the restoration of hemodynamic parameters of the vertebrobasilar arteries after an incrementally increasing submaximal exercise test. 

Background. Dysphagia is a problematic field in the clinical work of neurologists, resuscitation experts and therapists due to the high percentage of secondary complications caused by aspiration pneumonia, nutritional deficiency, which affect the recovery process. This ultimately affects the main socio-medical indicators such as mortality, lethality, disability in structure of cerebrovascular diseases. Neurogenic dysphagia occurs in 25–65 % of patients with stroke, while mortality among patients with post-stroke dysphagia receiving tube feeding varies from 20 to 24 %.

The aim. To evaluate the impact of reflexology in the treatment of post-stroke dysphagia in comparison with the methods of physical impact. Materials and methods. An open clinical comparative study was conducted in two clinical bases: Republican Hospital named after N.A. Semashko (Ulan-Ude) and Bokhan District Hospital.

In this clinical trial, 53 patients with swallowing disorders during the acute period of ischemic stroke were tested. When diagnosing dysphagia, a point scale of the Clinic of the Institute of the Brain was used, which assesses the degree of swallowing disorders before and after treatment. The comparative group receiving standard therapy in combination with physiotherapy (VOCASTIM) included 27 patients, the study group was comprised of 26 patients, who underwent basic therapy in combination with acupuncture (1 course – 10 sessions). In the course of the comparative clinical trial, statistical data were obtained that indicate the positive role of acupuncture in restoring the function of swallowing in patients with acute impairment of cerebral circulation.

Results. During the current clinical study, on the background of a 10-day course of reflexology with an exposure of 10–15 minutes and VOCASTIM physiotherapy for 10–15 minutes, the majority of patients experienced regression of post-stroke dysphagia.

Conclusion. According to the results of this study, the method of reflexology as a result of physiotherapy showed a faster recovery of swallowing function in the correction of neurogenic swallowing diseases, which causes cerebral infarction. 

The aim. To analyze the role of the spine adipose index (SAI) in predicting the risk of septic spondylodiscitis after lumbar percutaneous laser disk decompression (PLDD).

Material and methods. A retrospective observational single-center study was performed. Various clinical and instrumental parameters have been studied, including the spine adipose index, which are potential risk factors for the development of postprocedural septic spondylodiscitis.

Results. The study included 219  patients who underwent PLDD for degenerative lumbar disk disease. The average period of postoperative observation was  30.8  ±  13.3  months. Signs of septic spondylodiscitis were detected in 5 (2.28%) cases. Multivariate analysis showed that III degree of anesthesiological risk by the American Society of Anesthesiologists (ASA) scale (p = 0.021), a high value of body mass index (more than 25 kg/m²) (p = 0.043) and a high value of SAI (over 0.7) (p = 0.037) are statistically significantly associated with the development of septic spondylodiscitis in patients who underwent lumbar PLDD.

Conclusion. The value of SAI is statistically significantly associated with the development of spondylodiscitis in patients who underwent PLDD for degenerative lumbar disk disease. 

The review analyzes and summarizes the results of the studies on the pathogenesis of  vulvar squamous cell carcinoma and its diagnostic features, reviews precursors and  molecular subtypes of carcinomas. Despite the relatively low incidence of this tumor, over the past few decades, there has been an upward trend in its incidence, including the incidence among young women. According to the latest World Health Organization classification of lower genital tumors from 2020, vulvar squamous cell carcinoma is divided into human papillomavirus (HPV) associated and HPV-independent. While these carcinomas are often morphologically similar, their mechanisms of carcinogenesis, precursors, and clinical outcomes are different. Just the detection of virus DNA in a tumor is not enough to establish HPV status. Meanwhile immunohistochemical detection of the expression of p16 and p53 proteins allows not only to separate two pathogenetic pathways of carcinogenesis, but also to identify its molecular subtypes. The data on the possible use of p16 and p53 expression as the disease prognosis molecular markers have been obtained. Currently, the tactics of treatment and monitoring patients does not depend on the HPV status of carcinoma; however, the results of recent studies suggest that women with HPV positive vulvar cancer have significantly higher survival rates and a lower risk of recurrence. Understanding the mechanisms of carcinogenesis and improving its diagnosis will advance the assessment of the individual risk of the progression of precancerous lesions, as well as the outcome and the occurrence of tumor recurrence. 

Background. Today we have active development of ophthalmic surgery, but the role of cytokines in the pathogenesis of bullous keratopathy of the cornea remains insufficiently studied at present.

The aim. To study the dynamics of the local cytokine profile in bullous keratopathy by using personalized treatment with suspension of autologous blood mononuclears.

Material and methods. Two groups of patients with bullous keratopathy were formed: the main group (30 people, 30 eyes), who received an intrastromal injection of a suspension of autologous blood mononuclears and comparison (28 people, 28 eyes), who received a course of pharmacotherapy. The level of interleukins (IL) – IL-10, IL-4, IL-6, IL-1ß, transforming growth factor beta-2 (TGF-β2), tumor necrosis factor alpha (TNF-α) was determined in the lacrimal fluid of the patient’s eye by enzyme immunoassay.

Results. All patients before treatment showed an increase of IL-1ß in the lacrimal fluid by 3.3 times, IL-6 – by 4.2 times, TNF-α – by 2.0 times (p < 0.05); an increase in the level of IL-4, IL-10 and TGF-β2 by 1.1 times (p > ˂ 0.05). In the main group, after treatment, there was a decrease in IL-1ß by 2.0 times, IL-6 – by 2.1 times and TNF-α – by 1.8 times, and an increase in IL-10 by 1.5 times, IL-4 – by 1.9 times, TGF-β2 – by 1.4 times (p < 0.05), persisting for 12 months. There was a short-term decrease of IL-1ß by 1.7 times, IL-6 and TNF-α – by 1.2 times and an increase of IL-10, IL-4, TGF-β2 by 1.2 times (p >< 0.05) in the comparison group which then reached the initial values. Conclusion. There is an imbalance in the system of pro- and anti-inflammatory cytokines in bullous keratopathy in the lacrimal fluid. Injection of autologous mononuclear cells in the stroma of the cornea reduces the severity of the imbalance of the local cytokine system compared to the course of pharmacotherapy. Key words: bullous keratopathy, cellular technologies, autologous mononuclear leukocytes, cytokines>˂ 0.05), persisting for 12 months. There was a short-term decrease of IL-1ß by 1.7 times, IL-6 and TNF-α – by 1.2 times and an increase of IL-10, IL-4, TGF-β2 by 1.2 times (p ˂ 0.05) in the comparison group which then reached the initial values.

Conclusion. There is an imbalance in the system of pro- and anti-inflammatory cytokines in bullous keratopathy in the lacrimal fluid. Injection of autologous mononuclear cells in the stroma of the cornea reduces the severity of the imbalance of the local cytokine system compared to the course of pharmacotherapy. 

Blepharoptosis is an abnormally low position of the upper eyelid in relation to the eyeball due to its omission. The method of surgical treatment of blepharoptosis depends on the function of the levator.

The aim. To analyze the results of surgical treatment of partial blepharoptosis of various etiology by the dosed muscle-conjunctival resection of the upper eyelid cartilage.

Material and methods. We operated 78 patients (82 eyes) with blepharoptosis, among them with congenital blepharoptosis – 34 people (36 eyes), with acquired – 44 (46 eyes). The patients’ age was from 6 to 82 years.

Inclusion criteria: the function of the upper eyelid levator – more than 5 mm, the width of the palpebral fissure – 3 mm or more.

The patients underwent a dosed muscle-conjunctival resection of the upper eyelid cartilage in the period from 2018 to 2021. The follow-up period ranged from 2 months to 2 years.

Results. Elimination of blepharoptosis was achieved in all patients. With congenital blepharoptosis, a good result was obtained in 33  people (91.7  %), satisfactory – in three patients (8.3 %), which was associated with the asymmetry of the palpebral fissure, for the correction of which these patients underwent additional intervention. In patients with acquired ptosis of the upper eyelid, a good result was achieved in 91.3 % of cases (42 eyes). One patient underwent repeated surgery due to hypocorrection and asymmetry of the palpebral fissure width after the first surgery.

In all patients, the result remained stable throughout the observation period.

Conclusion. The use of the method of dosed muscle-conjunctival resection of the upper eyelid cartilage in patients with partial ptosis of the upper eyelid and intact levator function made it possible to obtain a good cosmetic and functional result: with congenital blepharoptosis – in 91.7 % of cases, acquired ptosis of the upper eyelid – in 91.3 % patients. 

Background. Alexithymia is traditionally regarded as a factor which influences the development of psychosomatic diseases and contribute to a more severe and prolonged course of somatic diseases the high level of alexithymia indicates the deficit in  cognitive processes associated with awareness, exteriorization and regulation of feelings and emotions. In recent years, a lot of research has been conducted on the comorbidity of alexithymia and psychosomatic diseases in adults, but there are very few studies in relation to children and adolescents.

The aim. To analyze psychosomatic diseases associated with the high level of alexithymia in adolescents, to study the correspondence of alexithymia and central sensitization (CS) in adolescents with primary headaches (migraine and tension-type headache).

Methods. The diagnosis of headache was based on the criteria for the International Classification of Headache, 3rd edition. The study group included 84 adolescents, average age – 14 [13; 16] (51 females, 33 males). CS was assessed using the Russian version of “Central Sensitization Inventory” (2020) for adolescents. Alexithymia was  assessed using the Russian version of “Alexithymia questionnaire for children” (2019). Headache intensity was measured using the Visual Analogue Scale. There were also assessed the number of months and days per month with headaches; duration of night sleep; age of phrasal speech start.

Results and discussion. The results showed the direct correlation between levels of alexithymia and central sensitization (rS = 0.49; p = 0.00001), the number of days with headaches per month and central sensitization severity (rS = 0.24; p = 0.027). There was no significant correlation between alexithymia severity and headaches duration (rS= 0.06; p = 0.5), no reliable results on the correspondence of alexithymia severity, age of phrasal speech start and nocturnal sleep.

Conclusion. A high level of alexithymia is observed in adolescents with various somatic diseases. Primary headaches are associated with a high level of alexithymia and the severity of central sensitization. Pediatricians and neurologists should be advised to assess the level of alexithymia and central sensitization in adolescents with headaches. 

Psychogenic gait is common in patients with medically unexplained neurological symptoms and provides significant challenges to healthcare providers. Clinicians may arrive at a correct diagnosis earlier if distinctive positive signs are identified and acknowledged. Psychogenic disorders of posture and gait are common and are the major manifestation in 8–10 % of patients with psychogenic movement disorders. Psychogenic movement disorders can present with varied phenomenology that may resemble organic movement disorders. The diagnosis is based on clinical evaluation with a supporting history and classic features on neurologic examination. In functional gait disorders, walking is often bizarre and does not conform to any of the usual patterns observed with neurologic gait disorders. Astasia-abasia, an inability to stand (astasia) or walk (abasia) in the absence of other neurologic abnormalities, was the term applied by investigators in the mid to late 19thcentury to describe certain patients with a frankly functional gait. Other descriptive terms include gaits that resemble walking on ice, walking a sticky surface, walking through water (bringing to mind excessive slowness), tightrope walking, habitual limping, and bizarre, robotic, knock-kneed, trepidant, anxious, and cautious gaits. Ancillary testing, such as imaging and neurophysiologic studies, can provide supplementary information but is not necessary for diagnosis. 

The pathogenesis of malocclusions, which are common among the population of  all  countries, is  well represented in the professional literature. The occurrence of  malocclusions is associated with genetic and various environmental factors. Among the latter, fluorides which affect the prevalence of some dental diseases are of particular interest. However, there are few publications reflecting the frequency of malocclusion among the population in the regions with different levels of fluoride in drinking water. This problem seems to be significant in the context of the increasing impact of fluorine compounds on human health, including dental health.

The aim of the study. To analyze the literature on the frequency of malocclusion among the population living in conditions of variable fluoride content in drinking water. A manual search of domestic and foreign literature was performed in the search databases PubMed, Medline and Google Scholar. From the initial list of publications, eighteen articles that met the inclusion criteria for the study were selected for analysis. We revealed significant variability of the research results. Some authors note a higher prevalence of malocclusions among the population under conditions of increased fluoride intake, others note a lower one, and still others did not reveal any differences between the values obtained in both samples. Most of the assessed publications did not methodologically meet modern international standards, and therefore were of little evidence.

The literature data do not provide grounds for an unambiguous assessment of fluorine compounds as an environmental factor that indirectly affects the process of occlusion formation in humans and animals.

The review did not allow to make a definitive conclusion on the possible impact of  systemic fluorides on the prevalence and pattern of malocclusion in humans and animals. It requires the implementation of studies that comply with the principles of evidence-based medicine. 

Background. The concept of multistage surgical treatment of patients has been established in surgery rather recently and therefore the discussions on the expediency of using a particular surgical technique in a specific situation still continue. Vacuum-assisted laparostomy is being widely implemented into clinical practice for the treatment of abdominal compartment syndrome, severe peritonitis and abdominal trauma, but the indications and advantages of this method are not clearly defined yet.

The aim of the study. To conduct a systematic review and meta-analysis on the comparison of the effectiveness of vacuum-assisted laparostomy with various variants of relaparotomy and laparostomy without negative pressure therapy in  the  treatment of patients with urgent abdominal pathology and abdominal trauma complicated by widespread peritonitis, sepsis or compartment syndrome.

Material and methods. A systematic literature search was conducted in accordance with the recommendations of “Preferred Reporting Items for Systematic Reviews and Meta-Analyses”. We carried out the analysis of non-randomized (since January 2007 until August 6, 2022) and randomized (without time limits for the start of the study and until August 6, 2022) studies from the electronic databases eLibrary, PubMed, Cochrane Library, Science Direct, Google Scholar Search, Mendeley.

Results. Vacuum-assisted laparostomy causes statistically significant shortening of the time of treatment of patients in the ICU and in hospital and a decrease in  postoperative mortality compared to other variants of laparostomy without vacuum assistance.

Conclusion. To obtain data of a higher level of evidence and higher grade of recommendations, it is necessary to further conduct systematic reviews and meta-analyses based on randomized clinical studies. 

Relevance. Paraesophageal hiatal hernias are much less common than other types of diaphragmatic hernias. The risk of strangulation in this pathology is about 21 %. It is often very difficult to establish the correct diagnosis in time, because patients are admitted with an atypical clinic of acute cardiological or pulmonary pathology. Usually, the correct diagnosis is established only on the 4th day. Due to late diagnosis, necrosis and perforation of the strangulated organ occur, which causes high mortality; sometimes the correct diagnosis is established only at autopsy.

Clinical observation. The patient was admitted to the surgical department on an emergency basis with complaints of intense pain in the lower chest and epigastric region, vomiting of eaten food. From the anamnesis it is known that about a year ago, periodic nausea and vomiting of food eaten began to bother. The last 12 hours before admission to the hospital, pain in the chest and epigastrium intensified, all eaten food came out with vomiting. X-ray diagnosed strangulated paraesophageal hernia of the esophageal opening of the diaphragm. During esophagogastroduodenoscopy it was impossible to pass into the distal parts of the stomach; hyperemia and petechial hemorrhages were detected in the zone of strangulation. Video-laparoscopic reduction of the hernial contents, resection of the hernial sac and anterior diaphragm crurorrhaphy were urgently performed. The early postoperative period was uneventful. The presented clinical observation indicates the promise of using video-endoscopic technologies for diagnosis and treatment of strangulated diaphragmatic hernias. The key to success is the timely establishment of the correct diagnosis. We consider it impractical to perform an antireflux intervention simultaneously in conditions of an acute inflammatory process. 

Background. In the available literature, the data on the positive effects of sleeve gastrectomy in treatment of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) become more common, however, they are heterogeneous and not always unambiguous.

The aim. To analyze our own results of treatment of patients with type 2 diabetes mellitus and impaired glucose tolerance, who underwent sleeve gastrectomy.

Materials and methods. Retrospective cohort registry-based study was carried out. From 2016 to April 2021, 29 (19 %) and 7 (4.6 %) patients with diagnosed T2DM and IGT respectively underwent surgery. Of these, sleeve gastrectomy was performed in 13  (44.8  %)  patients with type  2 diabetes mellitus and in 5  (71.4  %)  patients with IGT. The mean duration of follow-up for T2DM and IGT patients was 14.2 ± 12.3 and 11.2 ± 9.0 months respectively.

Results. The mean %EWL (% excess weight loss) in patients with T2DM and IGT was 44.1 ± 17.3 and 51.5 ± 16.9 respectively, and the mean %TWL (% total weight loss) was 25.0 ± 8.0 and 27.8 ± 6.0 respectively. At the moment of observation, all patients had normal level of fasting blood glucose. The level of HbA1c in patients with type 2 diabetes before the surgery was 8.2 ± 1.6, after surgery, at the time of observation – 5.8 ± 0.5 (U = 4; p ≤ 0.01). Targeted HbA1c values was recorded in all 13 patients with type 2 diabetes.

Conclusion. Our study shows the efficiency of sleeve gastrectomy both in terms of weight loss and of the remission for patients with T2DM and IGT. 

In accordance with the current legislation a healthcare organization shall be obliged to provide conditions for safe delivery of healthcare to patients and medical personnel performance.

Implementation of effective model of medical activities quality and safety internal control producing meaningful result is a current license requirement to a healthcare organization.

Implementation of risk-oriented approach to medical activities quality and safety management is an important constituent of modern stage of the Russian Federation healthcare functioning.

It is necessary to understand sources of potential hazard within an organization, consider and analyze all undesired events and incidents arising in the process of a healthcare organization functioning and their reasons, take preventive measures to avoid them.

The tasks of digital transformation in the Russian Federation healthcare are development of integrated digital contour, transition to electronic document flow, reduction of medical personnel’s time expenditure not involving delivery of healthcare.

Implementation of customer centricity and digitalization principles is an absolute trend of modern stage of development of the Russian Federation healthcare. It determines necessity of development of present-day accounting and analyzing data system on undesired events in a healthcare organization.

The article presents the experiment of Federal Center for Traumatology, Orthopedics and Endoprosthetics (Barnaul, Russian Federation) in establishing system of work with undesired events and managerial decision-making on their avoidance and prevention with the use of present-day digital technology resulting in credible frequency reduction of undesired events in the space of 2.5 years. 

Background. It is well known that viral infections are able to cause an imbalance of the interferon system and inhibition of cellular and phagocytic reactions of the body. One of the possible solutions of the flu treatment problem may be the application of immunomodulators of native plant origin since the influenza virus possesses a suppressive effect on cellular immunity and the interferon system.

The aim. To evaluate the effect of saponin tauroside Sx1 obtained from Crimean ivy leaves on histological changes in the spleen of mice infected with influenza A/WSN/1/33(H1N1) virus.

Material and methods. We used 78 male BALB/c mice weighing 16–18 g which were divided into the groups: control (K; n = 12); healthy animals treated with saponin (KS; n = 22); animals infected with influenza virus A/WSN/1/33(H1N1) (V; n = 22); infected animals treated with saponin tauroside Sx1 twice a day for 3 days (SV; n = 22). Histological studies of the spleen were performed on the 4th (subgroups V, SV, KS) and 14th day (2V, 2SV, 2KS).

Results. The spleen tissue of the KS subgroup demonstrated hyperplasia of the white pulp in the form of lymphoid nodules expansion. On the 4th day in the KS subgroup a statistically significant increase in the total area of the lymphoid nodules by 3.9 times compared to the K subgroup was observed. In subgroup V, there was a sharp decrease in the area of white pulp and in 2V the lymphoid nodules zones were practically indistinguishable. Applied correction in the SV and 2SV subgroups significantly ceased the damaging effect of the virus: the lymphoid nodules area increased by 2.7 times in the 2SV subgroup compared to 2V.

Conclusion. Infection with the H1N1 influenza virus leads to compensatory activation of the immune response, however, on the 14th day, a pronounced depletion of the splenic white pulp occurred. The introduction of saponin tauroside Sx1 enhanced the functional activity of the spleen due to an increase of the white pulp area. 

Background. There are many aspects of the development of immunity to the SARSCoV-2 virus, that remain poorly understood, like the influence of age-related characteristics on the intensity of immunity and the course of the disease. Studies of the state of immunity are widely used, mainly in the adults. But questions of the patho- and immunogenesis in children remain unsolved. Determining the nature of seroconversion of antibodies to SARS-CoV-2 in this age group is important information for serological monitoring for targeted immunoprophylaxis of the population and forecasting the epidemic situation in the region.

The aim. Evaluation of the dynamics of seroprevalence of specific antibodies to SARS-CoV-2 in children of the Irkutsk region during the pandemic of a new coronavirus infection.

Materials and methods. Study was conducted among the child population of the Irkutsk region in the period June 2020 – December 2021 as part of the Rospotrebnadzor project to assess population immunity to SARS-CoV-2 in the population of the Russian Federation. The content of antibodies to SARS-CoV-2 was determined by ELISA using native commercial test systems.

Results. Population immunity among the child population of the Irkutsk region was characterized by an upward trend from 7.8 % at stage 1 to 98.4 % at stage 6 of the study. IgG to SARS-CoV-2 remained in 72.8 % and formed in 25.6 % of previously seronegative children. Antibodies were detected in 66.1 % of cases and persisted for up to 10–15 months after COVID-19 infection. The proportion of asymptomatic forms of infection among seropositive volunteers was 69.5 %, which determines the high intensity of the latent epidemic process.

Conclusion. The level of seroprevalence was 98.4%. The current results of serological monitoring serve as a scientific basis for adjusting the list and scope of management decisions on the organization of preventive anti-epidemic measures, including vaccination. 

Background. Biomechanical studies of both the Ilizarov apparatus itself and the physiological system “apparatus – limb” occupy a significant place in the history of the formation and elaboration of the Ilizarov method, developed in the middle of the last century at the Kurgan Research Institute of Experimental Traumatology and Orthopaedics (nowadays – the world-famous Centre named after its creator). The analysis of the history of biomechanical research in the formation of Ilizarov method is not without interest.

The aim. To analyze the history and stages of development of biomechanical research in order to substantiate the effectiveness of the Ilizarov method of transosseous osteosynthesis.

Results. The national medical industry did not produce the appropriate equipment for biomechanical research in the early 1970s. That is why a group of engineers was included into the Laboratory of Clinical Physiology and Biomechanics (established in 1971) of the Ilizarov Centre, which created equipment for studying the processes in the tissues of the limbs and in the structure of the Ilizarov apparatus itself during its traction and compression impact on biological structures. The community of physicians, scientists and engineers made it possible to overcome a number of difficulties and problems. In their scientific publications and dissertations, the laboratory staff paid great attention to biomechanical research during transosseous osteosynthesis with the Ilizarov apparatus. At present, the staff of the Ilizarov Centre continues the traditions established by G.A. Ilizarov. For the first time in our country, a computer 3D video analysis of the kinematics and kinetics of orthopedic patients gait was introduced; it was supplemented with embedded software for the preparation of a clinical report of human gait biomechanics.

Conclusions. The initial stage of the biomechanical research at the Ilizarov Centre included the creation of the research equipment. Subsequently, the biomechanical studies carried out by the staff of the Centre for almost half a century have shown an applied and functional result of the realization of general biological regularities of the Ilizarov’s discovery. At present, the biomechanical research continues at a higher level with the use of modern high-tech equipment.