Susceptibility to thrombosis is a relevant problem of modern medicine and requires development of reliable markers that provide for early
detection of thrombophilic conditions. Th e main purpose of the review is to determine the role of homocysteine as a signifi cant independent factor in
development of thrombophilic conditions and its role in the early diagnosis of thrombophilia based on data obtained in recent studies. To achieve this goal,
a systematic literature search was performed in the PubMed, RSCI, MEDLINE and Cochrane Library online resources. A total of 278 sources published
within the last 5 years were found, of which 74 were selected for further analysis. Th e review considers new data on the role and mechanisms of the eff ect of
hyperhomocysteinaemia on the vascular wall, coagulation factors as the basis for triggering the cascade of coagulation processes. Th e article presents recent
data on the role of homocysteine in deep endothelial dysfunction, induction of the tissue factor, apoptosis induction and the proinfl ammatory eff ect. Based on
the above arguments, we have obtained results indicating the aggressive role of homocysteine in all aspects of thrombus formation: damage and narrowing of
the vessel wall, activation of coagulation factors and inhibition of anticoagulation as well as fi brinolysis. Th e results suggest the importance of homocysteine
as an independent predictor of thrombophilic conditions and the need to develop measures for early diagnosis and prevention of hyperhomocysteinaemia
for the reduction of thrombosis burden.

In foreign literature, identifi cation of children with a positive screening test for cystic fi brosis (CF), but unsuccessful diagnostic testing is interpreted
as a metabolic syndrome associated with a transmembrane conduction regulator (cystic fi brosis transmembrane conduction regulator related metabolic
syndrome, CRMS), or a positive, inconclusive diagnosis of CF (cystic fi brosis screen positive inconclusive diagnosis, CFSPID). Th e purpose of the study is to
analyse the publications of Russian and foreign authors on this topic. Th e analytical method was used to study the literature on the problem of inconclusive
cystic fi brosis published over the past 12 years (2010-2022) in the following databases: PubMed, EMBASE database, Cochrane Library, Wiley, Springer Link, Elsevier and Cyberleninka. Th e article describes algorithms for monitoring patients with inconclusive diagnosis of cystic fi brosis and presents variants of CRMS / CFSPID prognosis

Th e article presents information about the most frequent changes in the cervical spine (CS), preconditioning circulatory failure in the posterior
blood circulation in patients with undiff erentiated connective tissue dysplasia (UCTD). Th e basis for this literature review was the wide prevalence of signs of
UCTD, the severity of some of them is used by many researchers as diagnostic criteria for osteoligamentous dysplasia of the CS. To analyse the literature data, scientific publications over the past 5-10 years from the eLIBRARY and MEDLINE databases were used with keyword search: “undiff erentiated connective tissue dysplasia”, “phenotype”, “extravasal factors”, “cervical spine”, “vertebral arteries” and “vertebrobasilar insuffi ciency”.

Th e aim of the research. Th e aim of the study was to analyse the changes in the parameters of clinical, biochemical and coagulation blood tests in patients
with pulmonary tuberculosis in dynamics upon admission to the clinic, at the time of infection with SARS-COV-2 and before discharge from the hospital.
Material and methods. A retrospective analysis of laboratory parameters was carried out for 23 patients with pulmonary tuberculosis combined with
COVID-19 of mild and moderate severity who were hospitalised at FSBSI Central Research Institute of Tuberculosis.
Results. It has been found that when tuberculosis was associated with COVID-19, the severity of the systemic infl ammatory response increased, as evidenced by
the increase in the incidence and average values of C-reactive protein and fi brinogen aft er infection with SARS-COV-2. At the moment of addition of COVID-19
to tuberculosis, no signifi cant changes in indicators of protein-energy defi ciency, as well as the morphofunctional status of the liver and kidneys were observed.
At the same time, the addition of COVID-19 to tuberculosis causes changes in the functional state of the pancreas, as evidenced by a signifi cantly increased value
of amylase activity. Aft er infection with SARS-COV-2, a hypercoagulable shift is observed, as evidenced by prothrombin time shortening and high content of
fi brinogen and D-dimer. In addition, the presence of thrombocytopenia and prolongation of APTT indicate the development of secondary hypocoagulation.
Conclusion. Development of COVID-19 in addition to tuberculosis intensifi es the severity of systemic infl ammatory response and, at the same time, leads to
the hypercoagulation syndrome with signs of consumption coagulopathy

Th e aim of the research. To establish the diagnostic signifi cance of the concentration of soluble receptors of protein glycation end products (sRAGE)
in children with type 1 diabetes mellitus.
Material and methods. A cross-sectional comparative descriptive study was conducted. Th e performance of plasma soluble receptor of advanced glycation
end products of proteins (sRAGE) has been determined and analysed through ELISA in patients with type 1 diabetes of both sexes aged 6 to 17 years with disease duration of 1-10 years. Th e correlation between sRAGE and levels of glycated haemoglobin was studied using multivariate regression analysis in the
group of patients with diabetes mellitus.
Results. Analysis of glycated haemoglobin content in the serum of DM patients has shown unsatisfactory compensation of carbohydrate metabolism (average
HbA1C level: 9.36%, median: 9.32%). A signifi cant decrease in sRAGE concentration in the plasma of patients with diabetes mellitus has been found (p<0.05).
Th e correlation between the level of sRAGE and glycated haemoglobin using multivariate regression analysis revealed the dependence of the sRAGE value on
combined infl uence of several factors. A signifi cant regression model has been presented that predicts sRAGE concentration based on glycated haemoglobin
and puberty. Analysis of the results has shown an inverse correlation and allowed predicting the HbA1C level based on sRAGE concentration, sex and age.
Conclusion. Th e study performed has made it possible to assess the level of plasma sRAGE proteins in type 1 diabetes mellitus, to present the functional
relationships between the HbA1c and sRAGE values, the gender and age-sex factors, to specify the diagnostic signifi cance of sRAGE in concepts of metabolic
compensation and the risk of vascular pathology in childhood

Th e aim of the research. To study the eff ect of insulin resistance on bone mineral density (BMD) and the dynamics of bone remodelling markers in females
with polycystic ovary syndrome (PCOS) in the postmenopausal period. To evaluate the informative value of Anti-Müllerian hormone (AMH) for predicting
bone changes in PCOS.
Material and methods. Th e cross-sectional study included 85 postmenopausal women with PCOS (54.2±2.7 years). Th e control group consisted of 43 women
(54.7±6.4 years). All patients underwent clinical and laboratory examination, which included measurement of fasting glucose, insulin, HOMA-IR index,
AMH, FSH, LH, parathyroid hormone (PTH), vitamin D, free testosterone, serum markers of bone remodelling (P1NP and b-CTx) and lumbar spine BMD
measured using dual energy X-ray absorptiometry.
Results. Th e age of menopause onset in PCOS patients was higher than in the controls (p < 0.01); the PCOS patients were marked with a trend towards AMH
level increase (p < 0.005); AMH negatively correlated with FSH levels (r = -0.389, p = 0.05); a positive correlation was found between the levels of PTH and
testosterone (r = 0.201, p = 0.03), as well as a correlation between PTH and P1NP and b-CTx markers (r = –0.532, p = 0.001 and r = 0.413, p = 0.002); the
relationship between AMH and b-CTx (r = 0.507, p = 0.001); between lumbar spine BMD and insulin levels (r = 0.267, p = 0.04) and negative correlation
between lumbar spine BMD and AMH (r = -0.581; p = 0.03).
Conclusion. PCOS may be considered as an independent risk factor for osteoporosis. Th e associations revealed suggest that hyperinsulinemia directly aff ects
bone structure independently from obesity and may partly explain the higher bone density seen in PCOS. In postmenopausal patients with PCOS, relatively
high AMH levels correlated with bone resorption marker, which attests to the association with processes of adaptive bone remodelling. However, further
studies are needed to elucidate the underlying mechanisms and analyse the prognostic capabilities of AMH in assessing the state of bone tissue in PCOS.

Th e aim of the research. To study variants of the passage of thoracodorsal nerve bundles through all elements of the brachial plexus.
Material and methods. Macro-microscopic intra-trunk dissection of 121 brachial plexus preparations from 105 corpses of males and females aged 40-100
years was performed. A database was formed from the obtained indicators in MS Excel 12 and their processing was carried out using Statistica for Windows
12. All indicators were checked for distribution normality using the Shapiro-Wilk test. When describing the studied indicators, the median Me [Q1, Q3] was
determined, the conjugacy between the parameters was estimated using Spearman’s rank correlation coeffi cient.
Results. Th e macro-microscopic dissection revealed that the thoracodorsal nerve has a distinct intra-trunk structure and consists of a diff erent number of bundles: 76 % consist of two bundles, 21.5 % of three, 1.7 % of one and 0.8 % of four. It has been established that the farther away from the spinal cord and closer to the thoracodorsal nerve, the fewer variants of intra-trunk pathways in its bundles are: 5 in the spinal nerves, 7 in the trunks,
always the same in their posterior divisions and the posterior bundle. Only in 43 % of the cases, the bundles of the thoracodorsal nerve pass through
the spinal nerve C7, the middle trunk, its posterior division and the posterior bundle, and in other cases (57 %) they are duplicated or pass through
other paths.
Conclusion. Th e data obtained on the variants of the intra-trunk pathways of the thoracodorsal nerve bundles justify the more frequent use of the spinal nerve
C7, the middle trunk and its posterior division as a transfer nerve in contralateral transpositions with paralysis of the upper limb.

Th e aim of the research. To study the dynamics of changes in blood fl ow parameters of the hepatopancreaticoduodenal area in patients with post-hepatectomy
liver failure.
Material and methods. Th e results of operative treatment of 54 patients with focal liver diseases of various etiologies operated thorough laparotomy and
liver resection were studied. Th e patients were divided into 2 clinical groups: Group I: patients with a favorable course of the postoperative period (n = 44
(81 %)), Group II: patients with PHLF diagnosed in the postoperative period (n = 10 (19 %)). All patients underwent an ultrasound duplex scan (UDS) in the
preoperative period and on the third day aft er surgery, with an assessment of the linear blood fl ow velocity (LBFV) of the portal vein, LBFV and the resistance
index (RI) of the hepatic artery, diameter of the portal vein, inferior vena cava, aorta and splenic vein.
Results. Analysis of UDS parameters of the hepatobiliary area in patients aft er liver resection and with PHLF developing in the postoperative period revealed
signifi cant diff erences from the parameters of the group of patients with a favourable postoperative period both prior to and aft er the surgery.
Conclusion. Th us, preoperative evaluation of the volume and rate of linear liver blood fl ow makes it possible to establish the expected liver residue function
and is a necessary test before hepatectomy. Ultrasound duplex scan, in turn, allows assessment of blood fl ow in the hepatobiliary area, is a publicly available,
screening, non-invasive and safe method of examination

Th e aim of the research. To develop a method for prevention of clinically signifi cant postoperative pancreatic fi stula (CS-POPF) during resection interventions
on the pancreas (P) and evaluate its effi cacy in clinical practice.
Material and methods. Th e study included 96 patients, including 57 (59 %) males and 49 (41 %) females. Th e patients underwent standard volumes of
surgical interventions: pancreaticoduodenal resection, distal and central resection of the pancreas. Th e patients were divided into two groups. Th e control
group (46 patients) included patients who received standard preventive procedures against postoperative pancreatic fi stula (POPF), including octreotide. Th e
main group consisted of 50 patients who underwent complex medical perioperative POPF prevention, including preoperative enzyme replacement therapy
as well as perioperative administration of prednisolone, octreotide, drotaverine and aprotex.
Results. Among patients in the compared groups, there were no statistically signifi cant diff erences in age, gender, ASA score and body mass index. When
assessing postoperative complications, a statistically signifi cant decrease in “major” complications (Clavien-Dindo III-IV) was revealed in the main group of
patients compared with the control group (8 cases (16 %) versus 16 cases (34.8 %), respectively, p = 0.03). Th ere was a decrease in the incidence of CS-POPF in patients from the main group with “soft ” pancreatic parenchyma (7.4 % vs 29.6 %, p = 0.03), as well as in patients with intermediate and high risk stratifi ed
by the Fistula risk score (6.1 % vs 26.7 %, p=0.02).
Conclusion. Th e proposed method for POPF prevention makes it possible to reduce the incidence of CS-POPF, as well as “major” postoperative complications
in high-risk patients with “soft ” pancreatic parenchyma.

Th e aim of the research. To study the specifi cs in nutrition of multiple sclerosis patients in the Chelyabinsk region, to compare the data obtained with the
data of scientifi c studies.
Material and methods. Th is research is a cross-sectional study of 77 patients in the Chelyabinsk region with a diagnosis of multiple sclerosis supplemented
with a literature review. A structured questionnaire was used including the diet composition, dietary regimen and personal attitude to keeping a dietary
record upon the admission with multiple sclerosis.
Results. Th e nutrition of the majority of MS patients included in the study is represented by the Western model. At the same time, 80.5 % of them consider
their diet to be traditional and diverse and do not change their dietary habits. None of the respondents followed any general or specifi c diets. Vegetarian, vegan
or plant-based diets were also not common among our patients. MS patients are not suffi ciently informed about the possible infl uence of nutrition quality on
the severity, burden of the disease, and do not consider diet as a possible component of treatment.
Conclusion. Th e medical community and MS patients need accessible and reliable information about the eff ectiveness of dietary interventions as part of the complex treatment of the disease. Further research on the role of nutrition and individual nutrients in the development and progression of multiple sclerosis in large scientific studies is required.

Data on the prevalence of Helicobacter pylori (HP) infection among children and adolescents vary widely. Th e dispersion of this value ranges from 3 % to
38 %. However, the prevalence among children whose parents are in constant contact with HP-positive patients has not been studied. Th is justifi ed our study.
Th e aim of the research. To study the prevalence of HP infection and symptoms of functional dyspepsia in children of gastroenterologists.
Materials and methods. A cross-sectional study was carried out. A total of 29 children aged 1 to 17 years whose parents work as gastroenterologists were
examined. In total, 23 families were surveyed, among which 17 had 1 child, 6 had two brothers/sisters. Th ere were 3 children aged up to 3 years old, 6 children
aged 3-6 years, 6 children aged 7-11 years and 14 children aged 12-17. Th e study included 19 male and 10 female children. Th e survey was conducted in 2
stages. At the fi rst stage, a survey of parents was carried out using a questionnaire we had developed, the questions in which the parents of the 29 children
answered. Th e second stage included analysis of faeces for HP antigen using a one-stage immunochromatographic assay that 21 children and 19 parents
working as gastroenterologists took part in. Statistical processing of the results obtained was carried out using Microsoft Excel 2010 and STATISTICA 8.0
soft ware packages (StatSoft Inc., USA).
Results. Symptoms of postprandial distress have been registered in 23.8 % of the children. Abdominal pain syndrome was detected in 19.0 % of the children.
Th e time of symptoms onset varied from 3 months to 2 years ago and from 1 to 2 years ago for the majority (6 children). Th e HP antigen in faeces was found
in 28.6 % of the children. For 5 HP(+) children, HP(+) antigen has been detected in one of the parents.
Conclusion. HP antigen in faeces has been detected in 28.6% of children of gastroenterologists. Th e symptoms of functional dyspepsia faeces have been
detected in 42.8 % of children of gastroenterologists. Postprandial distress syndrome predominates. Functional dyspepsia associated with Helicobacter pylori was found in 9.5 % of the children

Th e aim of the research. To study the features of quality of life in patients with acute and chronic forms of coronary heart disease at the moment of inpatient
hospitalisation.
Material and methods. Th e study included 140 patients on inpatient treatment. All patients were asked to fi ll in the Minnesota and Seattle questionnaires as
well as the analogue-visual scale. Th e examined patients were divided into 2 groups: Group 1 included patients with diagnosed acute myocardial infarction
with ST segment elevation, Group 2 consisted of patients with decompensation of chronic coronary heart disease. Th e assessment of quality of life in both
groups was carried out at the time of hospitalisation in the cardiology department of the multi-profi le hospital.
Results. According to the Minnesota questionnaire, the worst quality of life was found among patients with decompensation of the chronic form of coronary
heart disease, where high values of the sum of points on the Likert scale were observed: 23 (17; 33) compared with patients in Group 1 – 11 (6; 20). Analysis of the Seattle questionnaire revealed signifi cant physical limitations (PL) in Group 2, where the PL index reached the value of 76 (62.2; 84), in contrast to patients with MI, whose PL value was 81 (69; 88.9). Th e severity of anginal pain (AS) prevailed in Group 2: 50 (0; 100) compared with Group 1 – 100 (50; 125). Th e
incidence of angina pectoris (AF) in patients with the chronic form of coronary heart disease was 60 (20; 90), which was more common than in the MI group,
where the AF index was 90 (60; 100) (p=0.009), while the level of quality of life (DP) in this group was lower as compared to Group 1: 39.5±9.4 and 49±10.2
points, respectively. Th e treatment satisfaction index (TS) in both groups was comparable at 95 (89; 95) and 95 (88.8; 95). According the analogue-visual scale
results, the quality of life in Group 2 was signifi cantly lower than in Group 1: 60 (50; 75) versus 70 (60; 80).
Conclusion. Reduced quality of life was revealed in patients with chronic coronary heart disease compared with patients with MI at the stage of inpatient
treatment. Th e worse quality of life indices in patients in the chronic coronary heart disease group are partly because patients in the MI group had no previous
history of coronary heart disease. In addition, in the last month before hospitalisation, they led a usual lifestyle and did not observe deterioration in their
condition. It is also likely that higher QL values in the MI group may be due to the diff erence in the method of therapy, and more specifi cally, the performance
of percutaneous transluminal coronary angioplasty (PTCA). In patients with decompensation of stable angina pectoris, compared with the MI group, there
were worse indicators of QL on the AS, AF, DP scales, which is most likely due to PTCA in the MI group. Patients with decompensation of postinfarction
cardiosclerosis compared with the MI group had worse QL scores on the PL, AS, DP scales, which is probably due to the PTCA in the MI group: the AS scale,
a long history of CHF and lower left ventricular ejection fraction scores on the PL and DP scales. When comparing a subgroup of patients with stable angina
pectoris and the subgroup of postinfarction cardiosclerosis, patients with postinfarction cardiosclerosis had worse QL scores on the PL and DP scales, the
reason for which was most likely a long history of CHF and lower left ventricular ejection fraction scores, whereas patients with decompensation of stable angina pectoris had worse QL scores on the AS and AF scales, due to the presence of stable angina pectoris and the corresponding symptoms in their medical history.

Currently, infl ammatory bowel diseases (IBD) occupy a leading position in the structure of diseases of the gastrointestinal tract (GIT). Changes
in the genus and species composition of the intestinal microbiota can refl ect the severity of the pathological process and serve as a new diagnostic sign,
contribute to the timely correction of treatment regimens. Th is clinical case is indicative of the change of intestinal microbiome species in a patient with
a severe form of Crohn’s disease, which promotes modifi cation of medicinal treatment regimens and makes it possible to achieve stable remission.

A clinical case of observation of a patient with Ormond’s disease is presented. At the beginning of the disease, the clinical picture was represented
by nonspecifi c symptoms. Diff erential diagnosis was performed between retroperitoneal fi brosis and lymphoma, hematoma. Th e stages of diagnostic search are described, the results of clinical observation, laboratory and instrumental examination methods are analysed. Th e article presents successful experience
of glucocorticoid therapy (prednisone at a dose of 30 mg per day), against the background of which retroperitoneal fibrosis regressed, clinical symptoms and laboratory blood parameters normalised. Within the 5-year follow-up period, complete remission of the disease was noted. Dynamic ultrasound examination, MSCT of the abdominal cavity, retroperitoneal space did not detect relapse of the disease.

At 25 weeks of gestation, the patient suff ered mild SARS-CoV-2 COVID-19 NCI. At 30+5 weeks of pregnancy, there was a signifi cant increase in
the echogenicity of the walls of the lesions in arteries and veins of the umbilical cord against the background of a pronounced oedema of Wharton’s jelly.
Th e pregnancy concluded at 34+2 weeks with the birth of a live premature male infant with an Apgar score of 7-7 points, weighing 2450g. Histological
examination of the umbilical cord revealed sclerosis of the walls and ectasia of the lumen of veins and arteries, calcium salt deposits around the vascular
adventitia. Th is feature of the umbilical cord is considered to be a sign of postcovid necrotic funisitis

Given the high occurrence of caesarean section deliveries worldwide, the problem of uterine scar pregnancy is of high relevance. Th is is due to the
diffi culty of diagnosis and the severity of complications of this pathology. Th is article summarises specifi c features of the clinical picture and gives modern
approaches to diagnosis, treatment and other aspects of management of female patients with this pathology