Th e most common clinical manifestation of new coronavirus infection is bilateral pneumonia. At the same time, COVID-19 has a wide range
of cardiovascular complications, with the development of acute heart failure, arrhythmias, acute coronary syndrome, and myocarditis. Myocardial injury
is relatively common in COVID-19, accounting 7-23 % of cases. The presented clinical case describes a 56-year-old patient with a confi rmed coronavirus infection. Th e peculiarity of this clinical case is that it is the first report on COVID-19 with systemic manifestations: lungs, heart, kidneys and skin lesions. It should be noted that despite viral pneumonia typical for COVID-19, clinical picture and severity of the patient’s condition were determined by the developed myocardial injury. Th e presented clinical case is specific due to skin lesions.

This review highlights fundamental knowledge about the processes within a damaged liver cell, mechanisms of fi bro- and angiogenesis, as well
as hypoxia and hypoxemia. Th e causes and consequences of endothelial dysfunction, the role of cytokines in vascular remodeling and the formation of
hemodynamic disorders are described. Th ese changes lead to disorder of local and systemic hemodynamics in case of liver cirrhosis. Such complications
as: hepatopulmonary syndrome and portopulmonary hypertension are also described.

The term "idiopathic hydrocephalus" in adults is a broader concept that includes larger spectrum of patients compared to "idiopathic normotensive
hydrocephalus". It includes both young and elderly patients with various forms of the disease, patients with various levels of obstruction. Th ere is no general classifi cation and general approach to treat patients with such a pathology. Endoscopic triventriculostomy in idiopathic aqueductal stenosis and cerebrospinal fluid shunting aft er a positive test of cerebrospinal fl uid (tap test) evacuation in idiopathic normotensive hydrocephalus are proved to be eff ective. In patients with other forms of cerebrospinal fluid pathway obstruction, treatment approach is represented by the opinions of some surgeons. At the same time, most surgeons consider the use of cerebrospinal fl uid shunting operations to be eff ective and justified, and they use endoscopic techniques as an option for examining ventricular system and for performing auxiliary manipulations. The high frequency of various complications of bypass surgery and slightly lower efficiency of endoscopic operations indicates the need to systematize patients; to improve selection criteria and to expand the indications for the use of endoscopic surgical techniques.

Th e present scientifi c review of medical and technical literature presents the attempt to assess modern technological stage of spine biomechanical
hardware diagnostics in terms of its objectivity, as well as diagnostic and prognostic value on the example of etiopathogenesis analysis of spine degenerative-dystrophic diseases. A set of structural and extra vertebral factors contributing to the onset and progression of spine degenerative-dystrophic diseases was identifi ed to determine diagnostic and prognostic value studying particular literature sources, which use empirical and mathematical research methods. Central indicator value of intersegmental compression-distractive kinetics and loads shift s related to these factors was also determined. When considering the objectivity of spine biomechanics video analysis, the reliability of kinetics and spinal motion segments kinematics was separately assessed. Furthermore, impropriety of the latter was established in terms of reliability and repeatability of diagnostic results. Only vertical force indicator is valid in kinetics, reflecting intersegmental compression load, due to the suffi cient objectivity and weak dependence of its values on the type of computer mathematical models used by commercial systems of video motion analysis. Walking is optimal motional act for calculating vertical force by modern optoelectronic soft ware and hardware
systems.

The aim of the research. To evaluate the eff ect of sarcopenia on the incidence of postoperative complications in patients who underwent resection interventions on the pancreas, as well as the development of a simple clinical diagnosis of sarcopenia.
Material and methods. Th e study included 109 patients, including 59 (54.1 %) men and 50 (45.9 %) women. All patients included in the study were operated on with subsequent morphological examination of the removed preparations. Diagnosis of the presence of sarcopenia in a patient was carried out using computed tomography (CT) and calculating the musculoskeletal index. Also, all patients underwent calculation of the psoas major muscle index (IBPM) equal to the ratio of the area of the psoas major muscle on one side to the square of the patient’s height. Th e patients were divided into two groups. The control group (68 patients) included patients without sarcopenia. The main group consisted of 41 patients who were diagnosed with sarcopenia.
Results. Among patients in the compared groups, there were no statistically signifi cant diff erences in age, sex, ASA score and body mass index. Th ere was no statistically signifi cant diff erence in the incidence of major complications (Clavien-Dindo III / IV) (p = 0.2), however, the incidence of postoperative infectious complications was signifi cantly higher in patients from the study group compared to the control group (63.4 % versus 39.7 %, respectively, p = 0.01), as well as the incidence of postoperative clinically signifi cant pancreatic fi stulas (36.6 % versus 17.6 %, respectively, p = 0.02), as well as mortality (9.8 % versus 1.5 %, respectively, p = 0.04). The average postoperative bed-day was 19.9±7.8 days in the main group, 14.2±5.1 days in the control group (p = 0.03). According to the study, the value of IBP in the diagnosis of sarcopenia is < 3,5 сm2 /м2 (AUC – 0,83) for men and < 2,7 сm2 /м2 (AUC – 0,87) for women.
Conclusion. Sarcopenia is associated with a higher incidence of postoperative infectious complications, clinically signifi cant pancreatic fi stulas, mortality,
as well as with a longer postoperative bed-day in patients who underwent resection of the pancreas

The aim of the research. The work considers the results of posterior cruraraphy along with hernioplasty, using polypropylene and biocarbon implant in surgical treatment of diaphragmatic hernias of various sizes.
Material and methods. Totally 716 patients were divided into 3 study groups, based on the size of esophageal hernia defect: group I (314 people) – with small and medium size of hiatal hernias, who underwent posterior cruraphy; group II (323 patients) – with large hernias: subgroup 1 (92 patients) underwent posterior cruraphy, subgroup 2 (231 patients) – underwent hernioplasty. Subgroup 2 was divided into: subgroup A (89 people) – plastic surgery with polypropylene implant and subgroup B (142 people) – plastic surgery with biocarbon implant. Group III (79 patients) – patients with giant hiatal hernias: subgroup A (29 people) – plastic surgery with polypropylene implant and subgroup B (50 patients) – biocarbon construction.
Results. While comparing group Ӏ with group II, subgroup 1 signifi cant diff erences were found in the degrees and types of hernias. Th e age of patients was not statistically important. While comparing subgroup 1 with subgroup 2 of group II, statistically insignifi cant diff erences were revealed in degrees and types of hernias. Th e age of patients was also statistically insignifi cant. While comparing subgroup A with subgroup B of group II, insignifi cant diff erences were revealed in degrees and types of hernias. While comparing subgroup 2, group II with group III, the diff erence turned out to be signifi cant in types and degrees of hernias. While comparing subgroup A with subgroup B, group III, statistically insignifi cant diff erences were revealed in the degrees and types of hiatal hernias.
Conclusion. Posterior cruraphy in small and medium diaphragmatic hernias differed in types, degrees and size of hernia defect in comparison to the one in large hernias. Posterior cruraphy with plasty for large hernias did not diff er signifi cantly according to any of the criteria. Plastic surgery by polypropylene
implant with biocarbon in case of large hernias did not diff er signifi cantly by any criteria. Plastic surgery for large hernias compared to giant ones, diff ered only in the degree and types, as well as in hernia defect size. Plastic surgery by polypropylene implant with biocarbon in giant hernias did not diff er in any
criteria, except for gender distribution, which was not signifi cant, that made it possible to compare treatment results in these subgroups more correctly.

The aim of the research is the assessment of cognitive status dynamics during levodopa pharmacotherapy.
Material and methods. A new approach was created to assess cognitive status in patients with PD. It allows diagnosing cognitive fl uctuations at an early stage at the highest quality level as well as to correct the disorders rationally and timely. Th e patients were randomized into two groups. In group 1 (n = 25), the assessment of cognitive status was carried out at the “peak” dose of levodopa and in 6 months at the state of levodopa dose “outcome”. In group 2 (n = 25), respectively, on the contrary, the initial assessment of cognitive status was carried out at the “outcome” of levodopa dose and in 6 months later at the “peak”. The study groups were comparable in terms of such parameters as: age, gender, average duration and stage of disease. On average, all the participants by the study time were at 2.5 stage of the disease according to Hoehn and Yahr scale; and the average length of the disease was 5 years.
Results. Th e following statistically signifi cant results were obtained: in the fi rst group (peak–outcome) the average values on MMSE scale at the “peak” were 27 points; at the “outcome” they were – 25; MOCA values were 25 and 22 points, respectively; on FAB scale the values were – 16 and 14.5 points, SCOPA-Cog values were 33 and 28 points. In the second group (outcome – peak), the average values on MMSE scale at the “outcome” were 27, at the “peak” – 28, on MOCA scale – 23 and 25.5, respectively, on FAB scale – 16 and 17.5, SCOPA–Cog – 30 and 33.
Conclusion. The present study confi rms that cognitive status of patient associated with antiparkinsonian therapy changes depending on the peak of levodopa and its outcome. At the peak of levodopa action, patients show signifi cantly better results on scaling, and at the end of the day, they demonstrate more significant cognitive impairments. A new two-stage method for assessing CF allows diagnosing cognitive impairments at a better level. Such method is necessary for timely initiation of therapy and rational correction of antiparkinsonian treatment.

The aim of the research is to assess the epidemiology of premature birth and measures for organizing medical evacuation of patients from agricultural regions in vast territory of the Tyva Republic and Altay Territory for the period 2015-2019.
Material and methods. Th e statistical reports data on the work of obstetric service in the Tyva Republic and Altay Territory for the period 2015-2019 are
analyzed. Th e frequency, structure, dynamics of premature birth, features of organizing medical evacuation have been studied. Th e analysis of the information received was carried out using absolute, relative and intensive fi gures. Th e statistical signifi cance of the temporal dynamics of data was assessed using regression analysis with calculation of determination coeffi cient.
Results. The analysis showed that premature birth frequency in two agricultural regions with a vast territory and diff erent nationalities in the Tyva Republic and Altay Territory over the past 5 years has no tendency to decrease (2019 – 6.2 % and 7.1 %, respectively) and the data are comparable with an average Russian indicator (2018 - 6.0 %). Distribution of PB by clinical phenotype and gestational age in the studied territories does not diff er and correspond to global indicators. Th e share of very early premature births (22-27 weeks of gestation) is not more than 7 %. A distinctive feature of Altai Territory in comparison with the Tyva Republic is a rarer (p <0.001) obstetric delivery of patients with PB in obstetric hospitals, level III (63.3 % and 96.8 %, respectively), which is associated with high frequency of late PB (53.1 %) and suffi cient capacity of medical organizations, level II. During medical evacuation in the regions, beta-adrenergic agonist ginipral (95 %) was used for acute tocolysis.
Conclusion. Organization of medical evacuation in the Tyva Republic is characterized by more frequent use of air ambulance for patient transportation to obstetric hospital, level III, which is explainable by 7 times lower population density compared to Altay Territory with the same schemes of acute tocolysis.

Features of pregnancy and childbirth course, as well as perinatal outcomes in women with tuberculosis and viral hepatitis B and / or C were studied.
Th e research showed a high level of other concomitant somatic, gynecological diseases in such women, as well as high level of sexually transmitted infections compared to women without tuberculosis and viral hepatitis. Fetal growth retardation in pregnant women with tuberculosis was noted in 49.2 %, and if tuberculosis is combined with viral hepatitis it is noted in 53.3 %, while fetal growth retardation of III degree was observed only in combination of tuberculosis and viral hepatitis

The aim of the research is to determine frequency of atrial fi brillation; factors that lead to the formation of atrial fi brillation and the development of cardiovascular complications in dialysis patients.
Material and methods. Analysis of current clinical practice in one out-patient hemodialysis center.
Results. The incidence of atrial fi brillation in dialysis patients is 10.5 %. Most patients (72.4 %) had a paroxysmal form of atrial fi brillation. Th ere is clinical and laboratory characteristics of patients with atrial fi brillation. Atrial fi brillation occurred in 58.6 % of dialysis patients in average in 45 [15.4; 70.5] months after the beginning of regular hemodialysis, the rest got it in pre-dialysis period. Th e main factor associated with the development of atrial fi brillation on dialysis is the duration of dialysis therapy. Dialysis patients with atrial fi brillation are characterized by more pronounced systemic infl ammation and a higher incidence of hyperparathyroidism compared with patients without atrial fi brillation. Cardiovascular complications developed in 41.4 % dialysis patients with atrial fibrillation. Anuria is a factor associated with the development of myocardial infarction and stroke.
Conclusion. Atrial fibrillation is found in every tenth dialysis patient. An increase in atrial fi brillation was noted along with an increase in hemodialysis duration. To optimize dialysis treatment of patients with atrial fi brillation further research is needed

The purpose of the study. Th e aim of this study was to study the polymorphism of the ADRB2 gene, as well as the frequency and nature of cardiovascular complications in its presence in patients with severe pneumonia with infl uenza A/H1N1/09.
Material and methods. Th e study included 100 patients with pneumonia with infl uenza A/H1N1 / 09 in 2019 in the Trans-Baikal Territory. All patients
were treated in the intensive care unit. In patients, the causative agent-infl uenza virus A/H1N1 / 09 was verifi ed by PCR-detection of the pathogen in nasopharyngeal smears or hemagglutination inhibition test (HIT) with an increase in the antibody titer in paired sera. DNA was isolated from peripheral blood leukocytes; fragments were amplifi ed by polymerase reaction and genotyped by short fragment length polymorphism for Gln27Glu and Arg16Gly ADRB2.
Results. The patients were divided into 2 groups: Group I (n=41) – patients with cardiovascular complications; group II (n=59) – patients without cardiovascular complications. Th e groups were comparable in gender and age. Among the cardiovascular complications prevailed: arrhythmias (n=13); decompensation of chronic heart failure (n=13); acute myocardial infarction (n=7); pulmonary embolism (n=5); myocarditis/pericarditis (n=3). When studying the ADRB2 polymorphism, it was found that the most unfavorable variant is the homozygous mutation Arg16Gly (Gly/Gly). Th is mutation was detected in 6 (14.6 %) patients in group I, but was not detected in group II (P=0.003). In the presence of this mutation in patients with severe secondary viral-bacterial pneumonia with infl uenza A/H1N1 / 09, the risk of developing cardiovascular complications increases (HR=2.6; CI 2.06; 3.49).
Conclusion. Patients with severe pneumonia during the A/H1N1/09 infl uenza epidemic in 2019 had a high incidence of cardiovascular complications (41 %). The presence of the homozygous Arg16Gly mutation (Gly/Gly) increases the risk of cardiovascular complications by 2.06 times, and the presence of the heterozygous Arg16Gly mutation (Arg/Gly) reduces this risk by 0.5 times

The aim of the research is to optimize the assessment of collagen volumetric fraction in patients with stage 1 and 2 hypertensions.
Material and methods. In total 39 patients with arterial hypertension took part in the study. Group 1 included patients (n = 13) with stage 1 hypertension,
the second group included patients with stage 2 hypertension (n = 26). To verify structural changes in the left ventricle, all subjects underwent comprehensive examination, including history taking, anthropometric data taking, ECG study with the calculation of general QRS (mm) as a total indicator of R wave amplitude in 12 electrocardiographic leads, and echocardiography according to standard technique. Statistical analysis, based on the data obtained, was carried out using SPSS soft ware package. Furthermore, there was comparison of collagen volumetric fraction calculation (СVFC) according to the method of J. Shirani et al. (1992), and by our own formula based on nonlinear regression equation.
Results. When calculating СVFC in accordance with the formula of J. Shirani et al. (1992), СVFC values (%) in the 1st group of subjects were 8.48 [5.5; 9.7];
in the 2nd group they were 11.16 [0.5; 1.7], (U = 51.0, p = 0.45). When studying groups СVFC in accordance with the alternative formula, more statistically signifi cant diff erences were observed: СVFC values in the 1st group were 23.5 [21.4; 30.4], in the 2nd group - 29.5 [25.5; 35.7] (U = 105.0, p = 0.049).
Conclusion. The developed method for calculating collagen volumetric fraction is more pathogenetically suffi cient. Th is makes it possible to determine this
indicator more accurately for identifying a group of patients suff ering from stage 1 and 2 hypertension, with a high risk of heart failure development for its wide use in clinical practice to monitor them more frequent and to correct their therapy.

Th e aim of the research is to analyze indicators and structure of infant mortality in Krasnoyarsk Territory for the period from 2014 to 2018.
Material and methods. Th e article studies indicators of population mortality and fertility, infant mortality in Krasnoyarsk Territory for fi ve-year period from 2014 to 2018. Th e analysis of the results obtained is carried out in comparison with other constituent entities of the Russian Federation and with the country in general. Newborns morbidity rates in Krasnoyarsk Territory over a five-year period were studied in comparison with the data for the Russian Federation during 2017 and 2018.
Results. The study revealed the excess of mortality over births in the region by 2018, with the coeffi cient 0.7 for 1000 population. It was found that in the period from 2014 to 2018 there is a decrease in infant mortality rate in the Russian Federation by 31.1 %; by 21.8 % in the Siberian Federal District; by 33.7 % (from 8.8 to 5.5 for 1000 alive births) in Krasnoyarsk Territory. The main causes of infant mortality in the territory are: conditions occurring in perinatal period, external causes and congenital anomalies (malformations). Decrease of infant mortality in the territory is primarily determined by the decrease in the number of deaths among children under 1 year of age due to the above-mentioned causes. Despite the annual decrease in infant mortality rate, on average, every third death occurs in the first 28 days of a child’s life. When studying the morbidity of newborns, one can mark a steady decline of the indicator both in the Russian Federation and in Krasnoyarsk Territory. At the same time, every year more than 80 % of absolute number of sick newborns falls on full-term babies.
Conclusion. Th e results obtained during the study indicate a decrease in infant mortality rate over the study period. Th e study of indicators of infant mortality and morbidity in newborn children is fundamental in the fi eld of maternal and child health. Pediatricians need to pay special attention when examining newborns and children of the first year of life; they should timely identify pathological conditions and diseases, which will help reduce the risk of complications, chronic diseases, and, deaths.

Th e aim of the research is to study the results of minimally invasive surgery for the treatment of nonspecifi c infectious spine lesions, and to present personal experience.
Material and methods. Th ree patients with purulent nonspecifi c spondylodiscitis of lumbar spine got minimally invasive surgical treatment. The essence of surgical intervention included X-ray-assisted placement of tubular retractors in the area of intervertebral disc aff ected by purulent process; debridement and irrigation with antiseptic solution of interbody space, and setting a drain tube. All patients were treated during the period from December 2016 to February 2019. They were examined before surgery and in 3 months aft er the discharge. Laboratory parameters (CBT, C-reactive protein, bacteriological analysis of intervertebral disc contents) and instrumental research methods (computer tomography, magnetic resonance imaging) were evaluated. ODI, VAS, SF-36 questionnaires helped to assess pain syndrome and life quality of patients.
Results. In 100 % of studied cases infection was caused by Staphylococcus aureus. The result of treatment in all cases was assessed as good, because pain syndrome, neurological disorders and infl ammatory process were arrested; there were no signs of disease progression. In all cases, life quality of patients was restored. In one case, additional surgical intervention was required (posterior instrumental fi xation of spine) because of instability signs.
Conclusion. Minimally invasive surgical treatment of purulent single-level spondylodiscites can be recommended for practical use. The use of such approache allows to verify purulent infection agent, to damage soft tissues less getting proper sanitation of interbody space. It also allows to stop the infection and restore life quality of a patient

Currently, myocardial infarction diagnostics has no diffi culties. Type 2 myocardial infarction is an exception, as it occurs due to a mismatch with
oxygen delivery along coronary arteries and myocardial demand for it. Th e disease is secondary and this is the main diffi culty for its diagnostics. The article described a case of a young man having Wolff -Parkinson-White syndrome with type 2 myocardial infarction development. The main cause of myocardial necrosis is a prolonged paroxysm of reciprocal atrioventricular antidromic tachycardia.