A review of literature devoted to the methods for surgical safety provision based on standardisation of processes and procedures in a medical
organisation was performed. The review was conducted for publications in PubMed and Scopus databases dated 2003 to 2021 using the following keywords:
surgery, postoperative complications, surgical safety, checklist, surgical service. Today, more than 234 million operations a year are carried out globally for
various surgical pathologies and one of the objective parameters for assessment of treatment effectiveness is development of postoperative complications.
Implementation of the surgical safety concept is the checklist developed by the WHO in 2008. The surgical safety checklist has become the standard for
surgical care in some countries at the national policy level. Compliance with the checklist standards shows an 8% reduction in the incidence of surgical
complications compared to the control group, with a 0.42% reduction in the relative risk. The decrease in total hospital mortality was 1%. The average bed-day
decreased from 7.8 days to 7.0 days, the patient’s stay in the intensive care unit also shortened. Significant experience has been gained in applying the checklist
or surgical standards proving the validity and necessity of its application in surgical practice.

Abstract. Currently, massive postpartum haemorrhage remains the main cause of maternal death. Knowledge of the pathogenesis of its development determines the quality of medical care. The aim of the research was to perform analysis of pathogenetic links of postpartum haemorrhage. A systematic analysis of
modern literature on the pathogenesis of postpartum haemorrhage was carried out. The study used such databases as e-library, Scopus, PubMed and Medline
for search for publications dated from January 2016 to July 2022. The main and possible links in the pathogenesis of postpartum haemorrhage have been
considered. Postpartum haemorrhage is a multifactorial and urgent situation, the pathogenesis of which includes many inextricable links.

Anti-tuberculosis therapy and HIV infection often lead to dysbiosis and dyspepsia, which have a variety of causes. The purpose is to review information
about the dyspeptic syndrome in patients with tuberculosis, the causes of its development and the possibilities of correction. A review was carried out for 60
literature sources published in the PubMed and E-library databases within the period from 2005 to 2021 and covering the problems of dyspepsia in tuberculosis patients. Dyspepsia develops in 90% of anti-tuberculosis therapy cases and is more often conditioned by dysbiosis. The risk factors for these disorders are
anti-tuberculosis drugs and HIV infection. Timely probiotic therapy reduces the duration of dyspepsia and symptoms of tuberculosis-associated intoxication.

The aim of the research. To develop an algorithm for assessing risk factors for bone mineral density disorders in patients with Hodgkin's lymphoma after
pathogenetic therapy.
Material and methods. A retrospective single-stage study was conducted enrolling 118 subjects, of which 30 constituted the control group and 88 were patients
with a confirmed diagnosis of LH. Demographic and anthropometric data, measurements of densitometry and pathogenetic therapy results (polychemotherapy
courses) were used to build a model for predicting a decrease in BMD. The need to prevent a decrease in BMD in patients with LH was the final parameter of this
study assuming either the value of 0 (preventive measures are not indicated) or 1 (preventive measures are indicated) at the output of the model.
Results. The decision tree makes it possible to build a fairly simple prognostic model that suggests the need for prevention of osteopenia/osteoporosis in
patients with HL after pathogenetic therapy. The constructed prognostic model can be applied in clinical practice to diagnose the need for prophylaxis in
patients with HL who have received pathogenetic therapy.
Conclusion. Application of the developed algorithm in patients with HL after pathogenetic therapy allows calculating the likelihood of bone complications
development and the need for preventive measures against osteoporosis/osteopenia. This method contributes to the optimisation of decision-making in the field of taking preventive measures

The aim of the research. To study the antimicrobial activity duration and mechanical properties of bone cement based on polymethylmethacrylate filed with
a combination of antibiotic agent and finely dispersed silver in vitro.
Material and methods. The specimens were prepared from bone cement containing 4.22% gentamicin. Test specimens were obtained through addition of
vancomycin and/or poviargol. Changes in the stress-strain properties of bone cement with additional components were evaluated using a tensile testing machine 1958U-10-1 for deformation, compression and bending. The study of antimicrobial activity duration against strains was performed by applying a daily
incubation solution with the specimens to the bacterial lawn surface.
Results. Tensile strength analysis of the specimens has shown a consistent decrease in mechanical characteristics of the bone cement as 10 wt.% vancomycin,
2.5 wt.%, and then 10 wt.% of the silver were added. Impregnation with vancomycin or its combination with 2.5 wt.% silver did not lead to significant violation of mechanical properties in bending and compression. An increase in silver to 10 wt.% statistically significantly worsened tensile strength and flexural
modulus in bending. However, it did not significantly affect mechanical characteristics in compression. The maximum duration of antimicrobial activity
was recorded for specimens with silver agent. With addition of 2.5 wt.% silver, the duration was 21 days against MSSA and MRSA, with an increase in the
proportion of silver to 10 wt.%: 35 and 34 days, respectively. A similar pattern was also found for Gram-negative pathogens. The tested specimens were not
effective against panresistant isolates, regardless of their composition Conclusion. The combination of the silver agent with vancomycin in the composition of bone cement has a pronounced antimicrobial activity for a significant
period of time. The results obtained indicate the possibility of using the tested antibacterial compositions in clinical practice. However, further research is
required to develop methods to control gram-negative bacteria with a high level of antibiotic resistance

The aim of the research. The aim is to evaluate the metabolic profile and viability of human dermal fibroblasts under the influence of malate and oxaloacetate in vitro.
Material and methods. Fibroblasts grown by the method of primary explants were incubated with solutions of malate and oxaloacetate. After that, the biochemical profile and enzyme activity relative to intact fibroblasts in the cell culture supernatant and lysate were determined. Cell viability was determined
using an methyltetrazolium test (MTT-test). Statistical processing of the obtained research results was carried out in the environment of IBM SPSS Statistics
21 application programs.
Results. After incubation of fibroblasts with malate solution, the level of glucose, pyruvate and cholesterol in the supravascular fluid; pyruvate, glycerophosphate dehydrogenase and gamma-glutamyltranspeptidase in the cell lysate significantly changed. The effect of oxaloacetate is confirmed by a significant
change in the content of pyruvate and cholesterol in the cell culture supernatant; pyruvate, glycerophosphate dehydrogenase and gamma-glutamyltranspeptidase in fibroblast lysate. The use of the MTT-test revealed an increase in the viability of fibroblasts by 27,31% (p=0,019) and 33,83% (p=0,028) when growing
in an environment with malate and oxaloacetate, respectively.
Conclusion. The data obtained by us indicate that the components of the malate dehydrogenase shuttle can play a regulatory role, rearrange the metabolomics
of fibroblasts and have a protective effect on cell viability.

The aim of the research. To study antibacterial properties and technical characteristics of the developed modified suture material with antimicrobial effect.
Material and methods. Studying of technical characteristics employed evaluation of the distribution of particles of calcium hydroxyapatite (HA) (a sorbent
component of the composition for modification, replaced by metal ions to impart antibacterial properties), the breaking load in a simple knot and the elongation at break of the suture material. To study the antibacterial properties against S. aureus and E. coli, a bacteriological study of experimental threads was carried out. The test specimens were divided into 5 groups: the first included suture material modified with HA with argovit, the second included Zn-substituted
HA with argovit, the third included Ag-substituted HA with argovit, the fourth included Cu-substituted HA with argovit, the fifth group was unmodified
suture material (control).
Results. The data obtained on the breaking load and on the elongation at rupture are within the permissible limits and comply with the GOST 31620-2012
National Standard. As a result of studies of antibacterial properties of the modified suture material against cultures of microorganisms S. aureus and E. coli,
it has been found that the highest values of the diameter of the growth retardation zone were registered in threads modified with Zn-substituted calcium
hydroxyapatite 22.42 ±0.2718 mm (р<0.05) (for S. aureus). Therewith, a statistically significant increase in the antibacterial potential of the threads was registered in all experimental groups compared with the control.
Conclusion. The developed technology of suture material modification makes it possible to preserve the technical properties of the threads and provide
antibacterial effect. In this regard, it is important to study the effectiveness of filaments in vivo and conduct further studies of antibacterial suture material.

The aim of the research. The study aimed to identify the characteristics of the psychological well-being of student youth with different somatic health in the
pre-pandemic and pandemic periods associated with COVID-19. Pandemic periods associated with COVID-19 have been seen as periods of social isolation.
Material and methods. The presented results of an empirical study were obtained on a sample of students of a Medical University. Study design: • group
1 - conditionally healthy (100 people); • group 2 - persons with a history of an acute or chronic disease that does not affect their ability to work (110 people);
• group 3 - patients with chronic diseases with rare and short-term disability (101 people). The study was carried out in 2 stages: stage 1 - in the pre-pandemic
period, stage 2 - in the pandemic period (lockdown, social isolation). The study involved 311 students at each stage of the study. The method was used «The
scales of psychological well-being» (C. Riff). The study was carried out using a specially developed module of psychological diagnostics https://krasgmu.
ru/index.php?page [common ]=psy, which allows collecting data, automatic processing, and obtaining statistical data on a specific set of respondents.
Results. Significant differences on the scales «Autonomy» (p=0,046) and «Environment Management» (p=0,015) were found in the second
group. This indicates insignificant shifts in the direction of worsening psychological well-being. Also, significant differences were found on all
scales of psychological well-being in the third group. The scores on the «Autonomy» (p=0,015), «Environment Management» (p=0,046) and
«Personal Growth» (p=0,009 & p=0,003) scales for the third group dropped sharply. This indicates a total decline in psychological well-being.
Conclusion. It is concluded that it is the respondents with chronic somatic diseases that experience the pandemic period more difficulty. General isolation
mode significantly affected the psycho-emotional condition of students in the third group. The data obtained indicate the relevance of the development of
special programs of psychological support during the period of the epidemiological regime (social isolation conditions, lockdown).

The aim of the research. To investigate the clinical and epidemiological features of patients hospitalised with community-acquired pneumonia (CAP) in
Tomsk, Russian Federation.
Material and methods. As part of a continuous retrospective study, a comprehensive analysis of the data of all patients with CAP hospitalised in on-duty
hospitals in Tomsk in 2017 was carried out.
Results. Anamneses of 1344 subjects (mean age 61 [40; 76] years), including 756 male [56.3%] and 588 female patients (43.7%), were analysed. The males were
significantly younger (57 [38; 69]) than the females (66 [45; 79]), p<0.001. A total of 595 (44.6%) patients were retired and 284 (21.3%) patients of working age were unemployed. The male patients were more likely to come from care homes, to be homeless and lived in student residences. The females were overweight
compared to the males (26.7 [22.2; 31.3] kg/m2
 vs 23.9 [21.5; 27.4] kg/m2
 (p<0.001). A total of 1314 (97.8%) patients fell ill with CAP for the first time that year.
Male subjects significantly predominated among those who fell ill with CAP again during the year. The acute onset of the disease was found in 635 (47.1%)
patients. The time of treatment before admission to the hospital in different groups was similar and amounted to 5 [3; 7] days. The most common complaint
was cough. The second most common symptom was fever, followed by general weakness, shortness of breath, purulent sputum and chest pain. Every fifth
patient took antibiotics on an outpatient basis, the female patients women used antibiotics significantly more often than the male patients (160 [27.0%] and
140 [18.4%] cases, respectively). Patients who used antibiotics were hospitalised a day later (on 6 [3; 9] day). In 943 (70.2%) patients, concomitant diseases
were detected, while in 661 (49.2%), their number was two or more.
Conclusion. The results of the study indicate the relevance of the problem of CAP for the population of Tomsk. Comorbidities and lifestyle are factors that
increase the risk of pneumonia, and achieving control over them in the population may be one way to reduce the prevalence of CAP. At the same time, the
data obtained may be used in practical healthcare and help physicians in collecting information from the patient and making tactical decisions.

The aim of the research. Studying body composition features in patients with obstructive sleep apnoea (OSA) and comorbid pathology.
Material and methods. A total 102 patients (56.25±8.75 years) were examined. All subjects underwent polysomnography, assessment of body composition
by bioimpedance analysis using the «Neuron-Spectrum NET» and «Diamant Complex V.11.06.2018» software, measurements of anthropometric indicators.
Results. Two groups of patients were formed. The main group consisted of OSA patients (n=56) and the control group included subjects without apnoea
(n=46). For OSA patients, there were higher rates of desaturation index per hour (32.71 [16.39; 52.28]), BMI (37.02±5.04), incidence of AH (92.90%) and
CCI (72.20%) than in the control group (1.30 [0.20; 2.39], 32.04±4.82, 47.80% and 39.10% respectively). CVA was only detected in the main group in 10.7%
of the cases. The average values of the subjects’ body sizes were higher in subjects with apnoea. Patients with moderate and severe OSA were characterised by
high rates of BMR (kcal) and ACM (kg) (1978.50 [1686.00; 2266.25] and 46.75 [42.33; 51.46] respectively). With increasing desaturation index, the severity
of OSA, the amount of fat mass, total fluid and water increases (39.21 [28.04; 45.58], 42.29±6.41 and 53.05±9.08, respectively).
Conclusion. As a result of the study, it has been found that the most common comorbid pathologies in OSA patients are AH, II-III degree obesity, CCI
and CVA. It has been determined that with rising severity of apnoea, the desaturation index and BMI (kg/m2
) increase, the significance of anthropometric
parameters of the body grows, which should be taken into account in clinical practice. For the first time, features of the body composition have been revealed
in patients with moderate and severe OSA, which are characterised by high rates of BMR (kcal) and ACM (kg). It has been determined that with an increase
in the desaturation index and the severity of apnoea, the amount of fat mass as well as total fluid and water increase.

The aim of the research. To define peculiarities of pulmonary artery hemodynamics in virus-associated exacerbations of chronic obstructive pulmonary
disease (COPD) and within the following year.
Material and methods. Patients with COPD (the spirometry criterion) exacerbations were enrolled into an observational prospective cohort study. They were
hospitalised with virus-associated (n=60), bacterial (n=60) and viral-bacterial (n=60) exacerbations. The control group was constituted by subjects with no
corresponding pathology (n=30). Virus-associated exacerbations were diagnosed according to sputum or bronchoalveolar lavage fluid investigation by the
real time PCR method. During the index exacerbation and after 12 months of follow up, Doppler echocardiography was done for all patients. Additionally,
arterial blood gases, D-dimer assessment and serum protein measurement by enzyme-linked immunosorbent assay were performed during the exacerbation.
The relationships were explored using logistic regression.
Results. The rate of pulmonary hypertension during exacerbation was 82% in virus-associated, 78% in viral-bacterial and 52% in bacterial COPD exacerbations groups. After 12 months of follow-up, pulmonary hypertension was noted in 62%, 57% and 38% of patients respectively. The odds of pulmonary
hypertension in the long term after virus-associated COPD exacerbations were 2.6-fold higher after viral-bacterial and 2.1-fold higher in comparison to the
bacterial one. COPD exacerbations of viral aetiology were characterised by diastolic dysfunction of the right ventricle during exacerbation and in the long
term. Independent predictors of pulmonary hypertension 12 months after virus-associated or viral-bacterial COPD exacerbations were N-terminal propeptide of type-III procollagen (OR 1.54), fibroblast growth factor 2 (OR 1.45), matrix metalloproteinase-1 (OR 1.32), partial oxygen tension in arterial blood
(OR 1.18) and D-dimer (OR 1.62).
Conclusion. Exacerbations of COPD associated with virus or viral-bacterial respiratory infection are distinguishable by more prominent pulmonary hypertension, right ventricle dysfunction and interconnected with development of pulmonary hypertension in the long term.

Trigeminal schwannoma is a benign neoplasm growing from Schwann cells of the sheath of the trigeminal nerve. It is the second most occurring
cranial neurinoma type after vestibular schwannoma, ranging from 0.8% to 8.0%. The behavioural biology of all intracranial neuromas is considered to be
similar. The frequency of hydrocephalus in acoustic neuromas ranges from 3.7% to 42%. Most often, hydrocephalus in trigeminal neuromas develops in the
postoperative period and after radiation treatment. Sometimes it occurs before treatment due to compression of cerebrospinal fluid pathways at the level of
the posterior cranial fossa. This paper describes a rare case of observing the development of communicating hydrocephalus with trigeminal neuroma, which
required initial CSF shunting surgery with subsequent tumour removal and radiation therapy. We only found one analogical case in the literature

Diverticular disease of the colon is a widespread disease. In Russia, it occurs in 17-28% of gastroenterological patients. Ultrasound is the first step in
the algorithm for suspected abdominal pathology, including acute diverticulitis. The method is non-invasive, without radiation exposure of the patient. The
article presents a case of echography for a rare complication of diverticular disease: covered diverticular perforation. Based on the combination of clinical and laboratory data, the patient underwent timely operative treatment, which prevented development of peritonitis.

The authors present a case report of obstetric-gynaecologic sepsis and septic shock, which developed after delivery of a dead fetus against the
background of panmetritis. The course of the disease was complicated by multiple organ dysfunction (intestinal failure in particular) histologically reported
perforation of acute ulcers of the small intestine, diffuse peritonitis and phlegmon of the anterior abdominal wall. It is worth noting that different treatment
tactics exist for unformed enteric fistulae with purulent abdominal complications. In particular, there is no uniform opinion on the time of anastomosis
formation against the background of intestinal failure and diffuse peritonitis. The lethality of intestinal perforation against intestinal failure remains high:
74.2-86.2%. In the discussed case, obstructive resection of the fistula-bearing segment of the small intestine, naso-intestinal intubation to the proximal stump,
three sanation relaparotomies were performed and followed by formation of an entero-enteric anastomosis through single-row interrupted extra-mucosal
suturing. In the postoperative period, a laparotomy incision was made due to phlegmon of the anterior abdominal cavity and compartment syndrome.
Abscess sanation involved application of an improvised vacuum pack system. At the final stage, the laparotomy incision was closed by stitching of the
mobilised skin flaps. The patient was discharged on the 77th day after hospitalisation. The presented case demonstrates successful treatment of gynaecological sepsis, septic shock and perforated digestive stress ulcers that conditioned development of diffuse peritonitis and phlegmon of the anterior abdominal wall.

The analysis of modern literature data on the methods of diagnosis and treatment of polycystic ovary syndrome (PCOS) was carried out. The article
considers the issues of surgical and medical treatment, with paramount importance given to medical therapy. We emphasize that the treatment of patients
with PCOS should be individualized, taking into account the characteristics of the clinical picture, laboratory and instrumental examination methods, as
well as reproductive plans. The presented schemes and principles for the treatment of patients with PCOS are based on international clinical guidelines and consensuses adopted by leading experts.