The aim of the study is to analyze the outcome of vaginal delivery after cesarean section. Material and methods. Retrospective analysis of vaginal delivery cases in women with the uterine scar was made. Patients were divided into 2 groups: with and without manual examination of the uterus after delivery. Results. Blood loss is increased by an average of 79 ml. during the manual examination. The need for episiotomy after a manual examination is two times high. Vaginal delivery in women with uterine scar does not affect a newborn and patients are discharged on the 4th day on average

The aim of the study is to assess the influence of changes in arterial inflow during exercise on quantitative parameters of reflux. Material and methods. The study included 61 patients with primary incompetence of the great saphenous vein. The diameter, cross-sectional area, average velocity, reflux time in seconds, were measured by duplex ultrasound. Reflux volume flow and reflux volume were calculated. The measurements were performed on standing patients at rest before physical exercise and 60 seconds after physical exercise (30 rising on toes at a frequency of 1 time per second). A decrease in the volume of reflux after exercise was calculated (DRV = RV (after) – RV (before)/RV (before)*100 %.). Automatic distal compression-decompression (120 mm Hg) was used as a provocation maneuver. The median and interquartile range were used for describing quantity parameters. Results. Before exercise, reflux parameters were: RT = 4.85 (3.71–6.00) sec; Q = 3.89 (2.03–5.81) ml/s; RV = 17.05 (10.32–25.34) ml. After physical exercise parameters change to RT = 2.86 (2.14–3.33) sec (p < 0,0001); Q = 3.61 (2.06–6.37) ml/s (p = 0,9981); RV = 10.07 (6.08–16.48) ml (p = 0,0007). By comparison of “before” and “after” parameters the reflux volume after the exercise was -40,9 %. Correlation analysis identified statistically significant inverse correlation between the diameter of the great saphenous vein and reflux volume after the exercise (-0,56 (p < 0,05)), as well as an inverse correlation between DRV and disease severity (VCSS) (r = -0.41 (p < 0.0001)).

The aim of the study is to analyze the clinical picture of bronchitis in children of different age groups in conjunction with the influence of exogenous and endogenous factors on the severity of the disease. Materialand methods. The 110 children with the established diagnosis of bronchitis were examined in the Children’s City Hospital No. 2 of Rostov-on-Don. The patients were divided into 5 groups: I group included 54 patients aged from
1 month to 1 year (49.1 %); II group had 43 children from 1 year to 3 years (39.1 %); III group consisted of 7 children from 4 to 7 years (6.4 %); IV group included 4 children from 8 to 12 years (3.6 %); V group had 2 children older than 12 years (1.8 %). Results. The study of the clinical picture of bronchitis in children showed that inflammatory diseases of the bronchi most often occured in patients of the I and II age groups. Obstructive variants of the disease with the development of respiratory failure are also more common within patients of the I and II groups. The burdened allergic history and premorbid background contribute to the severe course of the disease.

The aim of the study is to describe a clinical case of a hemophagocytic syndrome associated with the Epstein-Barr virus infection in view of clinical-radiological symptomatology. Material and methods. Presents a clinical observation of the development of haemophagocytic syndrome, which complicated the infectious process caused by the Epstein-Barr virus with an unusual development of the clinical picture. Results. Due to the complexity of verifying the syndrome, a patient with such a diagnosis often remains without the proper level of therapy, which very often leads to death. This indicates the need for a timely differential diagnostics, which, if the syndrome is confirmed, gives the patient a chance for recovery.

The aim of the study is to describe epidemiologic features and clinical signs in adults and children from the same site of trichinosis. Material and methods. Study materials were statistical data from the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being in the Russian Federation, the Department of Rospotrebnadzor in the KhMAO – Ugra, results of a retrospective analysis of 6 inpatient cases treated in medical
organizations of levels 1 and 3. Results. The conducted analysis of 6 cases of illness allows suggesting that the source of infection was the meat of the wolf. The laboratory diagnosis was confirmed in 5 people and one patient was diagnosed on the basis of clinical and epidemiological data.

The aim of the study is to evaluate the interaction of children’s incidence and weather-climate conditions in Surgut according to the analysis of primary medical aid appealability. Material and methods. Climate conditions for the period of 2011 through 2016, the number of visits to the child’s clinic concerning diseases and the number of doctor home visits are analyzed. Correlation analysis and descriptive statistics method are used for data processing. Results. The analysis showed that according to the number of sick children, February is in the first place, March is on the second and December is on the third. According to the temperature intervals, the least incidence of disease in children coincides with the air temperature below -30 °С.

The aim of the study is to define regional features of comorbid pathology prevalence in patients with arterial hypertension and to examine its effect on chronic heart failure outcome on the example of the Chuvash Republic residents. Material and methods. The study was conducted in the framework of the multicenter, epidemiological program for the investigation of arterial hypertension and heart failure prevalence rate. First, random 3,090 people over the age of 15 years living in the Chuvash Republic were examined. According to the results, 231 patients with clinical signs of chronic heart failure were selected. Results. Persons with arterial hypertension suffer from comorbid pathology 8.7 times more often than people without hypertension (44.3 % versus 5.7 %). In patients with arterial hypertension, signs of chronic heart failure were detected in 5.7 ± 0.4 %.

The aim of the study is to assess the reasons for relaparotomy after a cesarean section in order to improve medical care during operative delivery. Material and methods. Retrospective analysis of 27 cases resulting in relaparotomy after cesarean section in Surgut Regional Clinical Prenatal Centre is made. The analysis period is from January 2014 to June 2018. Results. The key reason for relaparotomy after the cesarean section was hypotonic postpartum hemorrhage (85.2 %). In 75 % of cases, hemorrhage began less than 6 hours after cesarean section, including 25 % within the first hour after the end of the operation. Plan of actions for medical staff at all stages of operative delivery is developed according to the analysis results. The effectiveness of these actions will be evaluated at the following stage of the research.

The aim of the study is to evaluate the dynamics of the quality of life parameters of patients who underwent inguinal herniorrhaphy using totally extraperitoneal repair and trans abdominal preperitoneal hernia repair methods. Material and methods. A comparative analysis of the indicators of quality of life was carried out using the EQ-5D questionnaire on the 1st day, in 1 month and in 12 months after totally extraperitoneal repair (20
patients) and transabdominal preperitoneal repair (33 patients). Results. Maximum differences in the analyzed parameters appeared on the first-day post-surgery. Largely the presence of problems during this period, patients associated with pain or discomfort in the area of operation. The latter, first of all, manifested itself in the majority of those who underwent transabdominal preperitoneal hernia repair (64 %) and caused their lower health rating. The revealed differences abated within a month after the intervention and were absent in 12 months after surgery.

The aim of the study is to analyze the influence of mastectomy type on thе level of stress and anxiety in women of reproductive age with breast cancer in an early and long period. Material and methods. Prospective analysis of 274 cases is made, including women in the I group that underwent radical mastectomy (n = 141); women that underwent radical mastectomy with single-step breast reconstruction in the II group (n = 133); and healthy women in the III group with breast reconstruction (n = 40). The levels of cortisol and vanillylmandelic acid, stress according to Hospital Anxiety and Depression Scale before surgery were defined, as well as in 6 months, in 1 year and in 5 years after surgery. Results. Patients of the I group with breast cancer developed clinically apparent depression and clinically significant anxiety. The contents of cortisol in the blood serum and vanillylmandelic acid in the urine before the operation was increased in all patients, and after 1 year and 5 years, the levels of both cortisol and vanillylmandelic acid decreased. Single-step breast reconstruction in cases of oncopathology in women of reproductive age improves the psycho-emotional state.

The aim of the study is to determine the pathogenesis of microcirculatory disorder in the intestine during various stages of intra-abdominal hypertension secondary to peritonitis. Material and methods. Collection and analysis of literature are made in Russian and international electronic systems such as the Digital Dissertation Library of the Russian State Library, eLIBRARY.RU, Springer, Web of Science, MEDLINE. The analysis is performed
within the 2014-2019. The used keywords are intra-abdominal hypertension, peritonitis, adhesion molecule, enteral insufficiency, microcirculatory disorder. Results. Biologically active substances, proinflammatory mediators and cytokines are main factors in microcirculatory disorder development. Features of microcirculatory disorders during various stages of intra-abdominal hypertension are compared with the clinical picture, pathomorphological changes, and progression of enteral insufficiency. The role of PECAM-Flk-1 endothelial mechanosensory complex as the early marker of endothelial dysfunction by nitric oxide activation is identified.

The aim of the study is to analyze scientific data on diagnosis and glycemic control of gestational diabetes mellitus. Material and methods. Foreign and domestic publications, randomized controlled trials, clinical guidelines over the past 16 years from various sources, including PubMed, ClinicalTrials.gov and Cochrane Database of Systematic Reviews are studied. Results. The review presents the current state of various approaches to diagnostic criteria for gestational diabetes mellitus. The study data is intended to assess the objective difficulties and obstacles in finding a universal solution for making screening and methods of glycemic control during pregnancy easier and more effective. The proposed set of criteria for the diagnosis of gestational diabetes mellitus will require a consensus approach based on a balance between risks and benefits in specific social, economic and clinical conditions.

The aim of the study is to determine the etiological role of intestinal dysbiosis in the occurrence of bacteriuria in children. Material and methods. The study included children aged from 1 year to 15 years with decompensated intestinal dysbiosis. All patients underwent the examination of urine for bacteriuria and feces for dysbiosis. In isolated Enterobacteriaceae from the urinary tract and intestines the anti-lysozyme activity, the ability of bacteria to inactivate the antibacterial agent of the human leukocyte interferon preparation, and the anticomplementary activity are studied. Copro and uro-isolates are compared according to biological properties. Results. Studies have shown that intestinal dysbiosis is a factor determining the development of urinary tract infection in children. Copro and uro-isolates of colon bacillus have the same biological properties

The aim of the study is to evaluate the state of bone mineral density in postmenopausal women of the Northern Region and compare the data obtained with the results of studies in other cities of Russia. Material and methods. The areas of the femur neck and lumbar vertebrae are examined using Dual-energy X-ray absorptiometry. Results. Analysis of the results revealed normal bone mineral density in 20.5 % of the examined, osteoporosis was detected in 33.0 % of cases, 46.4 % of women had osteopenia. An increase in the prevalence of osteopenia and osteoporosis was revealed in the cities lying to the North. Obtained results can be used as a preventive measure to fractures in postmenopausal women.

The aim of the study is to determine the activity of antioxidant enzymes of blood before and after contact with granulated modified carbonaceous sorbents to assess their possible effectiveness in the complex treatment of patients with acute pancreatitis. Material and methods. Sorption methods of treatment with the use of granulated carbonaceous molded sorbent are carried out in 10 men with acute pancreatitis who were admitted to the hospital of Omsk in an emergency. Results. It is established that the granulated carbonaceous sorbents treated with various modifiers enhance the activity of the main antioxidant enzymes of the first and second protective lines, the antioxidant system in patients with acute oedematous pancreatitis. The results of these studies allow stating that investigated sorbents are of considerable interest for sorption treatments and can be recommended for the prevention and correction of oxidative stress that occurs in inflammatory processes.

The aim of the study is to present the scientific literature analysis based relevance of determining levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) as a marker of hyperlipidemia and to describe its structure and role in cardiovascular diseases pathogenesis. Material and methods. The literature sources published for the past 10 years are observed. The CyberLeninka, PubMed, PMC, PLOS ONE, eLIBRARY.RU are used. The used
keywords are proprotein convertase subtilisin/kexin type 9, hypercholesterolemia. Results. Proprotein convertase subtilisin/kexin type 9 is a new marker reflecting the degree of lipid metabolism imbalance. The PCSK9 structure, its participation in lipid metabolism, factors affecting PCSK9 level and its role in coronary vascular disease progression are described