Drug-induced dyskinesia is a serious, oft en undesirable, adverse reaction. In clinical practice, it is important to diagnose adverse reactions in time for further correction of patient treatment. Th is article discusses scales and questionnaires for assessing antipsychotic-induced tardive dyskinesia,
parkinsonism and akathisia in dynamics

The aim of the research is to study gender and age characteristics of the main factors of cardiovascular risk and comorbid pathology in patients who
underwent coronary artery bypass grafting.
Material and methods. In order to detect comorbid pathology gender and age analysis was performed in 680 patients (CABG registry of Federal State Budget Scientifi c Institution Research Institute of Complex Problems of Cardiovascular diseases) who were hospitalized for coronary artery bypass graft ing (CABG) during 2011. Modifi ed Charlson Comorbidity Index (1992) was calculated. Statistical analysis was performed by SPSS 20.0.1 program.
Results. In males, comorbid conditions such as chronic cystitis / prostatitis, chronic lower extremities ischemia (CLLI 2B-III stage), myocardial infarction
(MI), and also smoking risk factor are more oft en. Among females’ comorbid pathology are: chronic heart failure (CHF) and high functional class angina
(FC); III stage of obesity, diabetes mellitus of type 2, impaired glucose tolerance, chronic pancreatitis and / or cholecystitis, hyper / hypothyroidism. Charlson index values did not signifi cantly diff er in male and female groups. Th e most adverse in relation to cardiovascular and comorbid pathology is a group of patients aged > 61 ≤ 70 years, both among males and females.
Conclusion. Patients referred to CABG are characterized by high background of cardiovascular comorbidity in both males and females. However, the
structure of comorbidity has gender diff erences.

Th e aim of the research is to determine the relationship of latent infections with each other on the basis of cross-analysis of correlation between infectious agents and antibodies in patients with intermediate left ventricular function.
Material and methods. Exogenous molecular pattern was studied, which included phagocytic indices of 30% and 60%, phagocytic numbers for 30 and
60 minutes, phagocytosis completion index, levels of lipopolysaccharide of gram-negative bacteria wall, antistreptolysin-O, interleukin-6, classes M and
G immunoglobulins to Ebstein-Barr viruse, cytomegalovirus, Candida and Aspergillus fungi, intracellular microorganisms: Toxoplasma gondi, Mycoplasma gondi, Mycoplasma pneumonia, in 195 patients with heart failure on the background of intermediate function of the left ventricle aft er the relief of acute heart failure decompensated. Th e average age of the observed was 65.2 ± 3.6 years. Th ere were 64.3 % of males and 25.7 % of females. In all patients, classes M and G of immunoglobulins to viruses, bacteria and intracellular parasites were determined. Th e results are statistically processed.
Results. Th e article provides cross-analysis between infectious agents and antibodies in patients with intermediate function of the left ventricle, and exogenous molecular pattern is determined in all studied groups for the fi rst time. It was shown that patients with acute heart failure decompensation on the background of intermediate function of the left ventricle had latent infection with a large number of bacterial, viral and fungal agents, as well as intracellular parasites, leading to the development of systemic infl ammatory reaction.
Conclusion.The results of this work allow us to determine several antibodies to pathogens in clinical practice without using entire diagnostic panel in acute
heart failure decompensation.

Th e aim of the research is to analyze the incidence of diabetic nephropathy (DN), chronic kidney disease (CKD) in patients having treatment at endocrinology department of NIH RWCH, the causes of CKD and ongoing glucose-lowering, nephroprotective therapy in this category of patients.
Material and methods. While analyzing histories of 1476 patients with type 2 diabetes, DN and CKD were diagnosed in 283 patients (19.2 %) who were
admitted to NIH RWCH for the period from 01.01.2014 to 09.01.2017. Th e average age of patients was 66.7 ± 9.9 years, the debut age of type 2 diabetes was 53.2 ± 9.9 years, and the duration of type 2 diabetes was 13.5 ± 7.1 years. The average age of DN debut is 64.7 ± 9.2 years. When assessing the stages of CKD due to GFR, stages 2 and 3a prevailed in 45 % and 21.2 % of cases, respectively, due to albuminuria of the 2nd and 3rd category, in 75.3 % and 13.4 %, respectively.
Results. Correlation analysis showed an inverse correlation of GFR with the age of patients, duration of type 2 diabetes, level of albuminuria, total cholesterol and uric acid; correlation of albuminuria with the duration of type 2 diabetes, with the level of HBA1c and uric acid. As a result of causes analysis, formulated diagnosis in the medical history, DN was determined in 60.4 % of patients, from non-diabetic causes, chronic pyelonephritis – 25.1 % comes fi rst, then goes urolithiasis – 12 %, arterial hypertension – 1.8 %, acquired kidney cysts – 0.7 %. But hypertension rate in this group of patients was 97.8 %, the debut of hypertension was recorded at 50.4 years, i.e. 2.8 years earlier than the debut of type 2 diabetes, this confi rms the role of hypertension in the development of CKD in the analyzed group of patients. When GFR decreases, the incidence of coronary heart disease, MI, and stroke increased.
Conclusion. Most of the patients did not reach the target indicators of carbohydrate and lipid metabolism, and they needed therapy correction. Nephroprotective therapy was not carried out in full.

Th e aim of the research is identifi cation of nutrition patterns and eating behavior in patients with metabolic syndrome from the Republic of Khakassia.
Material and methods. 2 groups – the Khakass and the Caucasians of Khakassia (n = 100) were examined. Verifi cation of the metabolic syndrome was carried out taking into account the criteria of JIS (2009). Nutrition assessment was carried out on the basis of 24-hour registration of food consumption and frequency of meals. Analysis of dietary intake and eating behavior was carried out using Nutrition Analytics program and the DEBQ questionnaire. Statistical processing of the results of the study was carried out using BioStat package.
Results. Regardless of ethnicity, nutritional structure of patients with metabolic syndrome is characterized by insuffi cient consumption of dairy products, fish and seafood, vegetables and fruits amid excessive consumption of sugar, confectionery, fat and bakery products. Th ere is an unbalanced diet with violation of proteins, fats, carbohydrates ratio: regardless of gender and ethnicity. The most characteristic violations of chemical composition of the diet are excessive calorie and fat intake, insuffi cient intake of protein, complex carbohydrates and dietary fiber, signifi cantly higher consumption of sodium, potassium, phosphorus. All these is amid a defi ciency of magnesium intake. Diet imbalance for the consumption of certain groups of macronutrients had ethnic differences. The leading type of food addiction in the Khakases with metabolic syndrome was restrictive eating behavior, while in the Caucasians – emotional one.
Conclusion. The analysis of nutritional structure of patients with metabolic syndrome indicates pronounced deviations in the consumption of individual
nutrients from the recommended values, as well as eating disorder

Th e aim of the research is to assess the possibility of using integrated scales in predicting infectious complications in victims with thoracoabdominal
injuries.
Material and methods. Based on the study of data from 244 medical records of inpatients with thoracoabdominal injuries, the effi cacy and possibility of using generally accepted ISS, TRISS, RAPS, APACHE II scales, as well as the developed and proposed SHORI and SHORI 2 scales, were evaluated.
Results. Evaluation due to ISS and TRISS scales did not have a reliable correlation with the development of infectious complications. When examining RTS scale, its eff ectiveness was revealed at the stages of admitting department and on the fi rst day of inpatient treatment, since the value less than 7.84 was combined with an increased chance of developing infectious complications. RAPS scale showed positive results in predicting infectious complications, starting from the first day of inpatient treatment. Value which is higher than 10, due to APACHE II scale, also increases the chances of infectious complications development. The assessment of the areas under ROC-curves revealed the fact that in admitting department SHORI scale is the most eff ective one; and on the first day
of inpatient treatment – SHORI 2 scale.
Conclusion. SHORI and SHORI 2 scales can be used in admitting department and on the fi rst day of inpatient treatment to predict infectious complications
in patients with thoracoabdominal injuries. Th ese scales can be used in practical health care system and their eff ectiveness is highly competitive with generally accepted scales.

Th e aim of the research is to analyze the results of laminectomy with lateral masses fi xation in treatment of patients with multilevel cervical spine degenerative
diseases.
Material and methods. A prospective study included 57 patients who underwent decompression-stabilizing neurosurgical interventions in CIII-CVII segments in the period from 2013 to 2016. Gender characteristics, anthropometric data, technical parameters of intervention, specifi city of postoperative management, presence of perioperative complications were analyzed. Furthermore, pain level in cervical spine and in upper extremities according to visual analogue scale (VAS), functional status according to Neck disability index (NDI), result of surgical treatment according to subjective Macnab scale were studied before surgery, at the discharge from hospital, in 12 and 24 months.
Results. A signifi cant decrease in pain intensity was observed both in cervical spine from 71 (67; 78) mm to 23 (21; 33) mm (p < 0.001) and in the upper
extremities from 84 (80; 87) mm to 18 (10 ; 29) mm (p > < 0.001); positive dynamics of functional status from 47 (42; 48) to 21 (18; 26) (p > < 0.001) was revealed. Due to subjective Macnab scale, excellent and good outcomes of 75.4% were obtained in the long-term period. Th e total number of perioperative complications was 10.5 %.
Conclusion. Performing cervical vertebrae laminectomy with lateral masses screw fixation according to Anderson – Sekhon method has high clinical effi cacy and a low risk of adverse eff ects development when performing multilevel decompression-stabilizing interventions in patients with cervical spine degenerative diseases.

Th e aim of the research is to compare the results of surgical treatment of patients with auditory nerve neurinomas, operated in diff erent positions on the operating table, «sitting» and «lying» to be exact.
Material and methods. In the period from 2015 to 2016 200 patients were operated on, there were 107 females (69 %) and 93 males (31 %) aged 15-75 years (average age is 46 years). Patients were divided into 2 groups («sitting» and «lying» positions), each group included 100 people. Retrosigmoid suboccipital access was performed in all operations. Average size of the extrameatal tumor part was 30 mm and it was the same in both groups.
Results. The function of trigeminal and abducent nerves, as well as the severity of nystagmus in the early postoperative period, is worse in case of patient’s lying position (p < 0.05). In the late postoperative period, this dependence is lost. Th e function of facial, auditory, bulbar group of nerves and the severity of ataxia in the early and late postoperative periods does not depend on patient’s position on the operating table (p > 0.05). Surgery nature does not depend on patient’s position on the operating table (p < 0.05). Th e frequency of venous air embolism, orthostatic hemodynamic disorders and postoperative pneumocephalus is significantly lower in case of patient’s lying position (p < 0.05).
Conclusion. Operations on posterior cranial fossa on removal of the auditory nerve neurinoma, in particular, are more appropriate if a patient is lying, as far
as this eliminates the risks of venous air embolism and hemodynamic disturbances and does not worsen neurological function aft er surgery

The aim of the research is to study the dynamics of morphological changes in spinal cord in the fi rst day aft er complicated spine fracture.
Material and methods. In experiments, a complete transverse LIV osteotomy of vertebra was performed in 6 dogs with the displacement of its fragments in sagittal and frontal planes and a decrease of spinal canal diameter by 50-70%. For histological examination of spinal cord, the animals were withdrawn from the experiment in 2, 4, and 24 hours aft er the injury. Serial paraffi n cross sections of spinal cord at LIV-LVII level were stained by hematoxylin and eosin, thionine and by Masson’s three-color method.
Results. In 2 hours aft er injury, hemorrhages in central channel were detected mainly at LVII level, intramedullary hemorrhages, reactive changes in neurons (nucleoli fuchsinophilia, nucleus edema, cytoplasm vacuolization), appearance of amoeboid gliocytes, signs of neuronophagy of small neurons. In 4 hours aft er the injury, edema and reactive changes in vessels of spinal cord are pronounced. By the end of the fi rst day, destructive processes and neurons death prevail over vascular disorders.
Conclusion. Interaction of vascular disorders and infl ammatory response start the mechanism of secondary damage of spinal cord tissues, leading to rapid
irreversible changes.

The aim of the research is correlation study of peritoneum viscera-parietal adhesions with laparotomy wound purulence.
Material and methods. 149 patients with purulent peritonitis were operated and studied. In the observation check group, laparotomy wound was closed
with a traditional layer-by-layer suture in 99 patients. In 50 patients from the main group, laparotomy wound was closed with a removable draining muscle-aponeurotic suture. In 19 patients, separate cytological analysis of subcutaneous and preperitoneal cellular spaces healing process was performed.
Results. In the check group, laparotomic wounds purulence occurred in 34 (34,7 %) patients. In 19 (19,4 %) patients among the mentioned group, adhesive disease developed in the long-term, in this connection four patients underwent surgery. In the main group of the observed, purulence occurred in two patients (4,0 %), and infl ammatory infi ltrate appeared in one patient. These three patients in the long term got peritoneal adhesion disease that was treated conservatively. Cytologically parallel one-way dynamics of both infl ammatory-regenerative and degenerative-necrotic processes that occur simultaneously in subcutaneous and in peritoneal cellular space of laparotomy wound was revealed.
Conclusion. Laparotomic wound purulence is the cause of viscera-parietal adhesions, which are formed as abdominal cavity protection from purulent
preperitoneal tissue infection. At the same time, such planar viscera-parietal adhesions most oft en cause peritoneum adhesive disease. Removable drainage muscle-aponeurotic suture for peritonitis reduces the risk of purulent complications and the development of adhesive disease signifi cantly. Purulence or «smooth» laparotomy wound healing for peritonitis proceeds one-way, and simultaneously in both preperitoneal and subcutaneous tissue, regardless of apparent of infectious lesion depth.

The aim of the research is the assessment of initial immune system state in patients with generalized purulent peritonitis (GPP) according to hemogram.
Material and methods. A retrospective analysis of the results of 109 patients with GPP examination and treatment was carried out. The main causes of
peritonitis were acute appendicitis, intestinal perforations, perforated gastroduodenal ulcers and postoperative peritonitis. Immune system reaction types and their characteristics were determined with the help of computer program “RAKI” (“complete blood count, immunology”) according to the complete blood count. Statistical analysis of the data was carried out by methods of variation statistics
Results. Initially, before the fi rst operation four types of immune system reactions, from fi ve possible, were identifi ed in patients with GPP; the main of which were «activation of innate immunity” and “immune system suppression”. It was established that “immune system areactivity” as a type of reaction is one of the factors of unfavorable outcome. A signifi cant correlation was found between some ratios of immune system reaction types and their characteristics with patient’s gender. In postoperative peritonitis, such reaction as “immune system suppression” is more common than other causes of peritonitis. Correlation analysis revealed a signifi cant relationship between the initial immune system reaction type and pathological process phase with peritonitis and the severity of multiple organ failure (MOF).
Conclusion. Th e proposed method of GPP patients’ stratifi cation, depending on initial immune system state, based on interpretation of complete blood count indicators, can be used as a simple routine method for predicting the disease, planning the volume of surgical intervention, further surgical tactics, deep immunological examination and personifi ed immune-correction.

Th e aim of the research is improving short- and long-term results of patients with pancreatic cysts treatment.
Material and methods. Analysis of treatment results of 79 patients with pancreatic cysts is presented, among them there were 38 (48.1 %) males and 41 (51.9 %) females aged 26 to 76 years. Th e average age of patients was 48.9 ± 1.9 years. Th e criteria for exclusion from the study were verifi ed solid pancreatic formations (cancer, pseudotumor pancreatitis, neuroendocrine tumors), parasitic cysts, congenital polycystic pancreas, post-necrotic cysts developed less than 3 months ago, complications of acute pancreatitis (sequestration, abscess). Cysts associated with chronic pancreatitis occurred in 58 (73.4 %) patients, in the outcome of acute pancreatitis – 12 (15.2 %) and in 9 (11.4 %) patients’ treatment was carried out for cystic tumors. Short- and long-term results of conservative, minimally invasive (puncture) and surgical methods of treatment are compared.
Results. It was shown that long term results of surgical treatment were the best (there was no relapse in 80.6 %), however, the number of complications in this group of patients was maximum. Th e eff ectiveness of puncture treatment depended directly on the connection of cyst with Wirsung duct (positive eff ect was obtained in 43.8 %). Finally, long-term results of conservative therapy were the least favorable, the eff ectiveness was 37.5 %.
Conclusion. According to the study results, algorithm for cystic formations of the pancreas diagnosis and treatment based on etiology of the disease, cyst
connection with the ductal system of pancreas, formation, as well as the previous treatment, is proposed.

The aim of the research is analysis of methodological changes in the operation for parotid salivary gland removal with benign neoplasms and chronic parotitis with preservation of facial nerve branches.
Material and methods. Th e features of tumors clinical course and frequency of patients’ hospitalization with parotid salivary glands tumors in three separate periods from 1966 to 2016 were evaluated. Methodological approaches to the technology of patients’ surgical treatment and treatment results in three separate periods from 1966 to 2016 are described. A total of 261 medical records were subjected to expert evaluation. Th e technology of parotid salivary gland extirpation in a single unit with preparation and preservation of facial nerve branches is presented. Methodological approaches and patients with parotid gland neoplasms surgical treatment results were evaluated.
Results. Removal of pleomorphic adenomas with partial and even subtotal resection of parotid salivary glands is not always a radical operation that relieves relapses. The operation of complete parotid salivary gland removal contributes to the prevention of recurrence of parotid salivary glands pleomorphic adenomas, but the operation requires certain technological approaches related to the preparation of the main trunk and facial nerve branches as well as elimination of postoperative complications, deformations and defects of soft tissues. This technique has been successfully applied for extirpation of parotid salivary glands in chronic parotitis with severe damage to the parenchyma and frequent exacerbations of the purulent infl ammatory process.
Conclusion. Th e proposed additions and technical methods to previously developed ones provide a stably positive result of operation for complete removal (extirpate) of parotid salivary gland both in tumors and in chronic infl ammatory processes that are not amenable to conservative treatment

Acute heart failure leads to signifi cant damage of target organs and brings unfavorable outcome, but the medications used till present day (diuretics, vasodilators, etc.) have not reduced mortality during hospitalization and in long term period. Serelaxin is a recombinant form of the human hormone
relaxin-2, produced in female body in the fi rst trimester of pregnancy. For the first time in RELAX-AHF study the drug showed a decrease in cardiovascular
and overall mortality in 180 days aft er infusion and a positive trend in symptoms of heart failure in patients with acute heart failure, compared with standard therapy. Th is article describes a clinical case of treating a patient with myocarditis and heart failure decompensation by serelaxin

Acute appendicitis (AA) is one of the most common surgical diseases. Mortality is 0.1-0.3%, while complications occur in 5-9% of cases. Th e
most common cause of AA is enterogenic pathway of infection; certain role in genesis belongs to hematogenous and lymphogenous pathways. Diagnosis
of typical AA forms is of no diffi culty. Th ere are various vermiform appendix (VA) locations, that infl uence clinical picture of the disease. Subherpatic
location of VA complicates the diagnosis of AA signifi cantly. Tenderness, muscle tension in the right hypochondrium, positive Shchotkin-Blumberg
symptom makes it possible to exclude acute cholecystitis (AC). Th erapeutic tactics in AA is early removal of VA. Among acute diseases of the abdominal organs, acute cholecystitis takes the second place aft er AA. Timely diagnosis of AC, eff ective treatment, in compliance with active surgical tactics
principle, allowed to reduce mortality rate to 2-5 %. VA infl ammation in acute diseases of abdominal cavity is sometimes secondary problem. Among
the etiological factors of AC occurrence, the leading role is taken by cholestasis and infection. AC occurs suddenly with intense abdominal pains that are of permanent nature, their intensity increases while the disease is in progress. Th e symptoms of AC are nausea, repeated vomiting, which does not bring relief to a patient, fever, chills. Specifi c symptoms are: Ortner, Murphy, Kera, Mussi-Georgievsky, Shchetkin-Blumberg if peritoneum is involved in the infl ammatory process. Th e frequency and dependence of these symptoms depends on morphological changes in the gallbladder. In typical cases, it is not diffi cult to diagnose AC. Timely surgical intervention, rational intensive care in postoperative period lead to a favorable surgical treatment outcome of patients with acute appendicitis and acute cholecystitis. Th e article presents clinical observation of simultaneous acute appendicitis and acute
cholecystitis.

Rehabilitation measures were carried out for children with secondary defects of the upper lip and the palate aft er repeated surgical treatment.
Obturator prostheses were made using Titanide dental casting alloy. Adaptation to obturator prostheses lasted in average 10-30 days, aft er which satisfactory functional state of dentoalveolar apparatus was observed, the patients used prostheses constantly. Intelligibility and level of speech disturbance depended on topography of the defect, nasal anastomosis size, ranged from 31.68% to 60.74%.