The concept of chronic obstructive pulmonary disease has undergone significant changes in recent years, which is associated with the emergence of a new classification and the distinguishing of various phenotypes of the disease. The purpose of the study is to analyse the papers on this topic by Russian and foreign authors published over the past decade. The study employed the method of analysis of literature devoted to the problem of COPD published in PubMed, Medscape, Clinical Evidence, Annals of Internal Medicine, MedLine databases over the past 10 years (2011-2020). The article presents information on the definition, prevalence, risk factors, recent updates in the classification of chronic obstructive pulmonary disease and describes the main phenotypes of the disease (emphysematous, bronchitic and others). Their distinguishing helps both to choose the most appropriate therapy for patients and to assess the prognosis of the disease. The main approaches to treatment of the disease defined by the standards, clinical guidelines and GOLD documents have been
considered.

The aim of the research. To study the influence of empathic care level provided by the attending physician on the level of chronic gastritis patients’ adherence to treatment and on therapy effectiveness.
Material and methods. A total of 302 patients with chronic gastritis were examined. Depending on the level of patients’ adherence to treatment, the patients were divided into 4 groups. Group 1: 96 patients with chronic gastritis associated with H. pylori; group 2: 110 patients with chronic gastritis not associated with H. pylori. Patients in these groups had a high level of adherence. Group 3 was formed from 36 patients with chronic gastritis associated with H. pylori who rejected treatment; group 4 included 60 patients with chronic gastritis associated with H. pylori who partially adhered to the physician’s recommendations. The “Consultation and Relational Empathy Measure” (CARE Measure) questionnaire was used to assess the degree of empathy that arose between the physician and the patient during examination.
Results. The maximum degree of eradication of the causative agent of chronic gastritis was over 80% and the minimum frequency of clinical manifestations
and complications of the disease was observed in group 1. Patients of this group fully adhered to the physician’s recommendations and had high scores on the CARE Measure questionnaire at the beginning of the study (44 points), as well as the maximum number of visits to the physician in the observation period (9.0 [7.0; 10.0]) in comparison to groups 2 and 3 (8.0 [6.0; 9.0] and 5.0 [3.0; 6.0], respectively; p=0.012). The minimum result was noted in group 3, which was due to the extremely low adherence of these patients. At the same time, these patients noted a low level of empathy on the part of the doctor, which made a significant contribution to the decrease in the level of their adherence to treatment.
Conclusion. The CARE score may be used as a criterion of chronic gastritis patients’ adherence to treatment and as a predictor of therapy effectiveness .

The aim of the research. To study the role of menopause, glucocorticoids (GCs) intake and characteristics of rheumatoid arthritis (RA) in development of
osteoporosis (OP) and osteoporotic fractures.
Material and methods. A total of 73 female RA patients in menopause were examined. The control group included 29 female RA patients in premenopause. In addition to standard clinical and laboratory examinations, P1NP, 25(OH)D, CTX-1 were measured, dual-energy x-ray absorptiometry and x-ray of the thoracic and lumbar spine were performed. Statistical analysis was performed using the “Statistica 12.0” software package.
Results. Premenopausal patients had lower BMI. Patients in postmenopause had higher rate of OP (42 patients) than the controls (8 patients) (57.5% vs
27.6%, respectively). Among patients in postmenopause, OP was associated with lower BMI (27.6 vs 30.5 kg/m2), higher cumulative dose of GCs (6.9 vs 1.65g), higher duration of GCs intake (32 vs 18 months), lower RA activity (3.37 vs 3.9 according to DAS28-CRP) and lower CTX-1 level (0.52 vs 0.7 ng/ml). In the same group, osteoporotic fractures were only associated with longer GCs intake (32 vs 24 months). In premenopause patients, OP was associated with longer RA duration (21 vs 6 months), cumulative dose of GCs (13.9 vs 0.45 g), duration of GCs intake (48 vs 3 months), higher level of hs-CRP (46 vs 8 mg/l) and lower P1NP level (51.8 vs 43.8 ng/ml). Osteoporotic fractures in premenopause were associated with RA duration (28 vs 6 months), cumulative dose of GCs (12.5 vs 1.2 g) and lower BMD in all examined areas.
Conclusion. The OP rate was higher in postmenopause patients. In both groups, the duration of GCs intake and accumulated dose of GCs were associated with OP. In postmenopause, OP was also associated with lower BMI. In premenopause, OP and osteoporotic fractures were associated with longer RA duration, cumulative dose of GCs and lower BMD in all studied areas.

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Торопцова НВ, Алексеева ЛИ, Бирюкова ЕВ, Гребенникова ТА, Дзеранова ЛК, Древаль АВ, Загородний
НВ, Ильин АВ, Крюкова ИВ, Лесняк ОМ, Мамедова
ЕО, Никитинская ОА, Пигарова ЕА, Родионова СС,
Скрипникова ИА, Тарбаева НВ, Фарба ЛЯ, Цориев ТТ,
Чернова ТО, Юренева СВ, Якушевская ОВ, Дедов ИИ.
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The aim of the research. To study the biomarkers of inflammation in acute ST-elevation myocardial infarction (STEMI) in patients of the Buryat ethnic group
in comparison with Russian patients.
Material and methods. In 109 patients with acute STEMI of Buryat (n = 43) and Russian (n = 66) nationalities, as well as in 42 healthy donors (20 Buryats
and 22 Russians), serum levels of high-sensitivity C-reactive protein, interleukin-1β (IL-1β ), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), as well as IL-6/IL-10 and IL-8/IL-10 ratios were evaluated and compared between the ethnic groups with consideration for the clinical data and STEMI severity, as well as in the groups of healthy patients and those with STEMI.
Results. The study groups did not differ in gender and age. Compared to healthy subjects in the STEMI group, the concentration of all inflammation
biomarkers was higher regardless of ethnicity, with the exception of IL-1β, which significantly increased in Caucasians only. According to the results of
comparative analysis, patients with STEMI of the Russian group matched to that of the Buryat, had higher levels of IL-1β (1.46 [0.41-3.67] and 0.02 [0.01-
1.12] pg/ml, respectively), TNF-α (2.1 [1.4-3.0] and 0.9 [0.4-2.2] pg/ml), IL-6/IL-10 ratios (4.9 [3.5-7.8] and 3.4 [1.7-6.7]) and IL-8/IL-10 (37.6 [8.1-63.4]
and 11.9 [5.8-30.7]), troponin T (2.5 [0.19-15.5] and 0.38 [0.11-2.7] ng/ml), creatine phosphokinase-MB (29.4 [17.3-89] and 19.0 [12-26] IU/l), and lower body mass index (24.9 [22.5-28.4] and 27.3 [25.1-31.0] kg/m2 ) and left ventricular ejection fraction (51.5% [44-57] and 55.0% [50-58]). After adjustment for gender, age, and body mass index, the association with ethnicity remained significant for IL-1β (F for the general regression model was 5.28; p = 0.024) and the IL-6/IL-10 ratio (F = 4.43; p = 0.037).
Conclusion. The pro-inflammatory response against the background of STEMI in the Buryat ethnic group as compared to the Russian one is characterised
by lower levels of IL-1β, TNF-α as well as lower IL-6/IL-10 and IL-8/IL-10 ratios. After adjustment for gender, age, and body mass index, differences in
ethnic groups remained significant for IL-1β and IL-6/IL-10, which indicates a less pronounced proinflammatory response in STEMI patients of the Buryat
nationality.

СереброваЕВ. Влияние синдрома апноэ сна на когнитивные функции у пациентов с инфарктом мозга. Сибирское медицинское обозрение. 2022;(3):34-39.

The aim of the research. To study clinical and laboratory features of the new coronavirus infection (COVID-19) in order to develop a model that would allow,
taking the publicly available research methods into account, to carry out early diagnosis of severe community-acquired pneumonia against the background
of the new coronavirus infection.
Material and methods. A total of 82 COVID-19 patients who complied with inclusion and exclusion criteria were enrolled. Depending on the clinical
severity, three study groups were formed: group 1 included 13 patients with uncomplicated COVID-19, group 2 consisted of 39 patients with non-severe
forms of pneumonia that developed against COVID-19 and group 3 was comprised of 30 patients with COVID-19 complicated by severe pneumonia. The groups were comparable in age and gender. All patients underwent general clinical examination, laboratory tests, including general and biochemical blood analysis, as well as chest computed tomography.
Results. The clinical picture in COVID-19 patients differed depending on the disease severity. Coughing and shortness of breath were more often observed in patients with severe pneumonia; sore throat, on the contrary, was more often noted in patients with uncomplicated COVID-19. On admission to the inpatient facility, patients with severe pneumonia had higher body temperature and respiratory rate, with simultaneous decrease in blood oxygen saturation. One half of the patients with severe pneumonia had hypertensive disease in medical history, and one third had ischaemic heart disease. As a rule, uncomplicated COVID-19 patients did not have ischaemic heart disease. It was found through laboratory analysis of blood that groups of patients significantly differed in the levels of neutrophils, lymphocytes, monocytes, basophils and eosinophils.
Conclusion. The use of such clinical and laboratory data as acute respiratory failure, fever, the levels of neutrophils, monocytes, lymphocytes, eosinophils and basophils makes it possible to identify patients with more severe pneumonia against the background of COVID-19 even before chest computed tomography.

The aim of the research. To develop a means that would optimise the method of delivery for women with development of abnormalities of labour.
Material and methods. Retrospective analysis of 186 cases of labour was carried out at the premises of the perinatal centre of the Regional Clinical Hospital in Chita in 2018-2021. The total sample was divided into 5 study groups: group 1 included 33 women with primary uterine inertia; group 2 included 16 women with secondary uterine inertia, group 3 included 32 women with discoordinated labour activity, group 4 included 55 women with excessive uterine activity, group 5 included 50 women with abnormal uterine contractile activity which arose against the background of the clinical narrow pelvis. All women on the eve of labour (1-2 days) underwent general and special obstetric examination. The groups were comparable in nationality, age, financial and social conditions of the women, their gestational age, frequency of genital and extragenital pathology as well as the main pathology of pregnancy. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program.
Results. Optimisation of the delivery method for patients with abnormal labour was implemented on the basis of multilayer perceptron, the percentage of
incorrect predictions in the learning process of which was 2.4%. The structure of the trained neural network included 14 input neurons: gestational age,
labour parity, the woman’s height, uterine fundus height, presence / absence of fetal growth retardation or macrosomia, oligohydramnios, prelabour rupture
of amniotic membranes and the posterior view of the foetus’s occipital presentation.
Conclusion. An integrated approach based on implementation of universally available methods of objective and instrumental research on the eve of labour
makes it possible to choose the correct method of delivery for patients with abnormalities of labour with an accuracy of 96.2%.

The aim of the research. To assess the role of a-1-3-defensins (HNP1-3) and H. pylori in development of chronic gastroduodenitis (CGD) in children; to study the level of a-1-3-defensin (HNP 1-3) dynamics in children with H. pylori after standard eradication therapy.
Material and methods. We examined 102 children aged 8 to 14, including 70 patients with chronic gastroduodenitis in the exacerbation phase. A total of
32 children belonged to health groups I-IIa. All patients underwent FEGD with targeted gastric mucosal biopsy and subsequent morphological assessment
of gastro-biopsy specimens. Diagnosis of H. pylori was carried out using bacterioscopy and PCR of gastro-biopsy specimens. The level of a-1-3-defensins in blood serum was measured via ELISA.
Results. A significant increase in the level of α-defensins in patients with helicobacter pylori-associated gastritis in comparison with both healthy children (p <0.005) and patients with chronic gastritis not associated with the microorganism (p = 0.004) has been shown. Therewith, it should be noted that among patients with helicobacteriosis, the concentration of α1-3-defensins was of higher statistical significance in patients with severe gastric mucosal inflammation (p = 0.0004).
Conclusion. The significant role of α-1-3-defensin in development of CHD in children, including the H. pylori-associated variant, has been determined. In
addition, HNP1-3 can be used as a predictor of the severity of gastric mucosal lesions in H. pylori infection, which is necessary for identification of the risk
groups of children with severe forms of chronic gastritis.

The aim of the research. To study self-perceived dental health of adolescents and to determine its association with socio-demographic factors and objective
data on the condition of teeth. Moreover, we assessed the prognostic value of models based on the studied indicators as tools for caries prognosis in 15-years old teenagers.
Material and methods. A total of 1143 15-years old adolescents from 7 urban and 5 rural settings took part in a cross-sectional study. Questionnaire
surveying and objective assessment of dental health was performed using the standardised and validated WHO methodology. The decayed (D), missing (M)
and filled (F) teeth (T) counts were combined in the DMFT index and presented with 95% confidence intervals (CI). Bivariate analysis of categorical variables was performed using the chi-squared test. Numeric variables were compared using the Kruskal-Wallis test. The association between socio-demographic factors and self-perceived dental health independently from caries experience was evaluated using multivariate ordinal regression. The prediction of caries based on the studied factors was performed using logistic regression models.
Results. Only 14.4% of the adolescents characterised their dental health as excellent or very good while 10.7% reported having bad or very bad teeth. The
mean DMFT index in the abovementioned groups varied between 2.9 (95% CI: 2.5-3.3) and 6.5 (95% CI: 5.8-7.3). Significant linear trends between selfperceived health and objectively measured caries experience was observed (p < 0.001) and explained by the difference in the number of decayed teeth (p < 0.001). The place of residence and parents’ education were significantly associated with self-perceived health both in bivariate analysis and after adjustment for caries experience. In the multivariate logistic model, self-perceived dental health was the most significant factor in prognostic models contributing with 7.8% out of 8.5% of the total variance.
Conclusion. Self-perceived dental health in adolescents is significantly associated with objectively assessed caries experience. Social factors are significantly associated with self-perception of dental health even after adjustment for objective data. However, the coefficients of determination of the prognostic models are too small, which precludes their application for prognosis of caries development based on self-reported data in the studied population.

The aim of the research. To reveal the influence of the patch material for aortic arch reconstruction in treatment of aortic coarctation in newborn patients.
Material and methods. Within the framework of this retrospective study, a total of 89 medical records of newborn patients with coarctation of the aorta
were analysed. The patients were divided into six groups in accordance with the surgical correction method chosen and the patch material. The following
control points of the study were chosen: intraoperatively-measured gradient at aortic isthmus and the gradient measured when transferring the patient to
the intensive care unit; the need for reoperation as well as death in the late postoperative period. Intergroup comparison of baseline characteristics was made using the Kolmogorov-Smirnov, Kruskal-Wallis and Kaplan-Meier tests.
Results. The patients were evenly distributed into the study groups by baseline characteristics (p>0.05). The results of the Kruskal-Wallis test showed no statistically significant differences between the groups by the aortic isthmus gradient at each time period (p>0.05). There were also no intergroup differences in Kaplan-Meier survival analysis (p>0.05).
Conclusion. When performing the aortic arch reconstruction in newborn patients with coarctation of the aorta, the surgeon may choose the patch material that they are most experienced with or of their preference, since the patch material does not have significant influence on the surgical outcome.

The aim of the research. To evaluate the dynamics of contraction of the pelvicalyceal system in patients operated with congenital hydronephrosis at different periods of the disease.
Material and methods. The archival medical records of 350 patients operated on for congenital hydronephrosis within the period of 1990-2020 were
processed. The age of patients at the time of surgery varied from two months to 18 years. Based on the protocols of ultrasound examination of kidneys before and after surgery, the dynamics of contraction of the cavitary system of the operated kidney was evaluated.
Results. As a result of surgical intervention, all patients showed reduction in the pelvicalyceal system. The most favourable result of cavitary system reduction after surgery was obtained in the 1st age group: 75.24% of the pelvis and 77.76% of the calyx; a low percentage was diagnosed in the 7th age group with 41.39% and 43.38%, respectively.
Conclusion. In patients operated under the age of six months, a statistically significant better result regarding the contractility of the renal cavity system was obtained. With increasing age at the time of surgery, the elasticity of the pelvicalyceal system gradually decreases.

The aim of the research. According to the WHO, the prevalence of respiratory tuberculosis in the world tends to decrease, while the rate of extrapulmonary
tuberculosis remains stable: in 2019, approximately 1,050,000 new cases were registered and every sixth of them featured the clinical form of peritonitis. The unsatisfactory results of detection and treatment of tuberculous peritonitis as well as the high frequency of disability and mortality in this disease require
a further comprehensive approach to its non-invasive diagnosis including the use of CT. The aim of this study was to evaluate the radiological features of
tuberculous peritonitis compared with the data of endoscopic and morphological studies, as well as to develop an optimal integral scale for diagnosis of peritoneal tuberculosis.
Material and methods. A retrospective analysis of invasive and CT diagnosis in 25 patients with confirmed tuberculous peritonitis within the period from
2014 to 2020 was performed. The same indicators were used in the comparison group consisting of 28 patients with diseases that often mimic tuberculous peritonitis (by carcinomatosis and sarcoidosis of the peritoneum, non-specific ascites).
Results. The main signs of peritoneal lesion in tuberculosis have been revealed. Based on this, an integral scale for assessment of the significance of individual CT symptoms in combination with clinical and anamnestic data has been developed. The statistical data obtained suggest the following pattern: the probability of tuberculous peritonitis upon evaluation of all the described parameters is low with the score of up to 5, and high with 6 or more points.
Conclusion. The developed integral scheme for assessment of CT signs allows the clinician to assume the presence of tuberculous peritonitis based on CT scans of the abdominal cavity and chest, anamnesis, as well as the results of laboratory findings, and to choose further tactics in diagnostic search.

The aim of the research. To identify clinical phenotypes of sarcoidosis using cluster analysis based on clinical and demographic characteristics and the results of laboratory and instrumental analysis of patients in real clinical practice.
Material and methods. We retrospectively studied the data of outpatient records of 276 sarcoidosis patients (107 males, 169 females) aged 20-68 years (41 (30; 55) years), who had been observed for more than 2 years. We analysed the gender characteristics of the patients, the forms of sarcoidosis, clinical symptoms, laboratory and functional parameters, X-ray stages, extrapulmonary lesions, and comorbid conditions.
Results. A total of 5 clusters were identified using two-step cluster analysis. Cluster 1: female and male patients with acute or chronic form of pulmonary
sarcoidosis (PS) and extrapulmonary manifestations; cluster 2: women with chronic asymptomatic PS; cluster 3: females with the chronic form of clinically
relevant PS; cluster 4: male patients with the chronic form of asymptomatic PS; cluster 5: men with the chronic form of clinically associated PS. In contrast to cluster 4 patients with the criteria of favorable PS course, the risk of sarcoidosis progression was 7 times higher for cluster 1 patients (OR=7.01; 95% CI 2.53- 22.95; p<0.001), and 5.7-fold higher for cluster 3 patients (OR=5.73; 95% CI 2.25–17.73; p<0.001). Patients of clusters 2 and 5 had no significant differences in laboratory and instrumental parameters compared to cluster 4 patients (p>0.05).
Conclusion. Identification of clinical phenotypes of sarcoidosis in patients in clinical practice based on clinical, demographic, laboratory, functional and
radiological characteristics, makes it possible to optimise the therapy choice and predict the course of the disease.

The aim of the study. To study the regeneration processes in infected wounds against the background of long-standing diabetes mellitus with topical ozone
therapy and ultrasound.
Material and methods. The experimental study included 35 animals (rats of the Wistar population). Among them, a total of 30 had long-standing diabetes
mellitus and 5 were healthy rats modelled with an infected wound. The animals were divided into groups depending on the chosen treatment method. The first group was comprised of 10 rats treated with daily topical ozone therapy and low-frequency ultrasound. The rats from the second group only received topical ozone therapy and the wound was treated with “Autry 6000”. The rats of the third group received standard daily treatment with 1% dioxidin solution. In group IV rats (n=5) without DM, the simulated infected wound was treated daily with 1% dioxidin solution. Evaluation of treatment effectiveness was performed based on the results of wound planimetry, measurement of blood flow rate at the border between healthy tissue and the wound as well as
histological examination data.
Results. Based on the research conducted, the effectiveness of combined treatment using topical ozone therapy and low-frequency ultrasound has been
proved. This method of treatment normalises blood flow rate at the border between healthy tissue and the infected wound, reduces wound healing time
and accelerates the processes of wound cleansing from purulent exudate, filling of the wound with granulation tissue as well as formation of marginal
epithelisation.
Conclusion. In connection with the same pathogenetic pattern of the infected wound in both rats with long-standing diabetes mellitus and that in a diabetes
mellitus patient, it is advisable to use the new topical wound treatment methods including ozone therapy and ultrasound.

The aim of the research. To determine the possibilities and describe the features of parallel mastering of residency programmes and additional professional programmes to develop a technology for training of a competitive graduate sought for on the labour market.
Material and methods. The study was conducted at the premises of the KrasSMU. The study group was formed by students in the 1st year of residency programmes, 270 subjects in total. The survey was conducted online with open-ended, closed-ended and menu questions to determine the focus group. Processing of the survey results was performed using the quantitative method. For segmentation of the respondents according to certain characteristics depending on the answers, the «decision tree» method was used.
Results. The results of the study indicate the interest of the respondents in parallel mastering of residency programmes and additional professional
programmes: 54.4% of the respondents showed the willingness to learn. Based on the results of the interviews in the focus group, 45 (30.4%) respondents were included in the educational project of parallel learning.
Conclusion. The technology of parallel learning is described as a tool for personalised education for obtaining qualifications in the framework of higher
education, and improving the obtained qualifications in the framework of additional professional education. The measures for implementation of the
educational project and the expected effects for students, employers and educational organisations have been developed.

In this paper, the main epidemiological indicators of primary immunodeficiency disorders (PIDDs) in the Irkutsk region based on analysis of data
from 66 patients registered in the PIDDs database from 2010 to November 2021 were studied. The prevalence of primary immunodeficiencies in the Irkutsk region totals 2.75:100,000 of the population. The cohort of living patients is dominated by children (74%). A total of 22 nosological forms were verified in the registry of primary immunodeficiencies. Molecular genetic diagnosis was confirmed in 26% of the patients. Hematopoietic cell transplantation was performed in 21.2% of the patients. Intravenous immunoglobulin preparations are received by 19.7% of patients. The main purpose of the registry is to systematise patients with primary immunodeficiencies, provide them with the necessary treatment in a timely manner and improve their quality of life.

The aim of the research. To evaluate the results of treatment of patients with cicatricial tracheal stenosis after laryngectomy.
Material and methods. A total of 15 patients with cicatricial tracheal stenosis (CTS) and persistent tracheostomy after laryngectomy for laryngeal cancer
were treated. The treatment employed an algorithm including bougienage, cryodestruction and stenting, as well as complex bronchodilator therapy aimed
at restoring bronchial patency. Cryotherapy of CTS was performed through a tracheostomy with a developed cryoapplicator made of titanium nickelide.
Results. The duration of cannula-bearing period after tracheal stenosis was from six months to three years. The length of cicatricial changes ranged from
10 to 55 mm. Tracheal stenosis was detected in the area of the end tracheostomy in 10 patients, at the level of the thoracic trachea in 4 patients, subtotal tracheal injury after laryngectomy in 1 patient. Subcompensated tracheal stenosis was detected in 10 patients, decompensated – in 5, of which 2 patients had this condition combined with tracheomalacia. In case of decompensated stenosis, emergency bougienage of the trachea was performed. Recanalisation and maintenance of the tracheal lumen was carried out according to the proposed treatment regimen. No fatal outcomes were registered during the hospitalisation period. All patients managed to restore adequate breathing and tracheal lumen. Within 6-8 months, 12 patients were decannulated, the rest continued cannula-bearing and free breathing was supported by stenting. The failure of their decannulation was associated with the presence of tracheomalacia and subtotal tracheal stenosis.
Conclusion. Surgical correction of CTS in patients after laryngectomy requires an alternative therapeutic approach and differs from those prescribed in
the classical version of stenosis. The proposed CTS treatment after extirpation of the larynx is an effective method for restoring the patency of the airways,
allowing 80% of patients to restore free breathing without a tracheostomy cannula. The use of the adapted cryoapplicator made of titanium nickelide expands the possibilities of cryosurgery, and the developed method of CTS treatment may be recommended for wide practical application.