Iliopsoas muscle abscess is a rare surgical pathology that, in the beginning with the main location of the muscles, determines the diagnosis of this disease. A timely diagnosis will determine a favorable prognosis for the patient. The article describes the case of an elderly patient with fever and intoxication syndrome against the background of chronic pain syndrome. The long course of the pain syndrome complicated the diagnostic search and forced diagnosis. The iliopsoas abscess includes a differential range of disorders in patients, detection of fever, pain in the legs, antalgic gait with closure of the thigh muscles, and a positive psoas symptom. Informing doctors about the manifestations of iliopsoas muscle abscess, the importance of diagnosing this life-threatening condition.

After infection of the new coronavirus infection (NCI) COVID-19 of the patients, the development of long-term consequences can not be excluded and it is correlated not only with severe forms of the disease NCI COVID-19, but also with moderate and mild forms of th is pathology. Patients with rheumatic diseases that suffered from new coronavirus infection (NCI) COVID-19 are often encountered in doctors’ outpatient and inpatient practice. NCI can lead to an exacerbation of an existing rheumatic disease and can also be a trigger factor for autoimmune changes and the debut of a rheumatic disease. Th is article presents a clinical case of granulomatos is with polyangiitis (Wegener’s) of a patient after suffering from NCI COVID-19. The diversity of th is pathology makes its timely diagnostics quite a difficult task, oncological and septic processes, tuberculos is and rheumatological disease were excluded for a long time. Th is article reviews a long period of observation of the patient – the use of various diagnostic methods to verify the diagnosis, consultations with various specialists for differential diagnosis, and repeated changes in treatment due to periodic deterioration of the patient’s condition. Th is clinical case is a reminder to doctors, that it is extremely important to fully examine the patient and analyze the dynamics of symptoms during the therapy in details, that can highly increase the chances of earlier diagnos is of such diseases. In addition, a significant factor of improving the quality of provided medical care is the continuous education of each attending physician in order to develop interdisciplinary competencies.

New coronavirus disease (COVID-19) caused by SARS-CoV-2 is associated with a high mortality rate and is a major public health problem worldwide. In publications from the early months of the COVID-19 pandemic, the authors reported that hypertension (HTN) is associated with higher susceptibility to SARS-CoV-2 infection, severe disease, and increased mortality associated with COVID-19. The risk of more severe clinical manifestations of COVID-19 is higher in men and increases dramatically with age. However, according to the results of multivariate analyses with the inclusion of data on age, risk factors (RF) of cardiovascular diseases (CVD), diabetes mellitus, the independent role of HTN in the development and outcome of COVID-19 was not confirmed, while age turned out to be the most significant factor. The authors made the conclusion that HTN may not play an independent role in SARS-CoV-2 infection and the course of COVID-19, and the formation of adverse outcomes is influenced by old age. However, age-related changes include accumulated chronic diseases, their RF, target organ damage etc. Morphofunctional changes caused by a long course of HTN, the development of associated clinical conditions can increase the susceptibility of the cardiovascular system to the damaging effects of SARS-CoV-2, as well as contribute to the formation of adverse outcomes of COVID-19. In addition, diabetes mellitus, obesity, and other metabolic disorders associated with HTN negatively contribute to the course of COVID-19 and the risk of mortality. A more severe course of COVID-19 in HTN patients, especially the elderly, may be facilitated by the mechanisms of cellular and immune inflammation common in these diseases. The endothelial monolayer plays an important role. Endothelial injury and endothelial dysfunction in HTN and endothelitis in COVID-19 may reinforce each other, increasing the likelihood of cardiovascular events in patients with COVID-19. An important pathogenetic mechanism of HTN — the renin-angiotensin- aldosterone system (RAAS) activation — plays a significant role in the genesis of COVID-19. Angiotensin-converting enzyme 2 (ACE) is a key receptor for SARS-CoV-2 entry into human cells, providing a link between COVID-19 and RAAS. In this regard, it was expected that ACE inhibitors and angiotensin II receptor blockers (ARB), which modulate the RAAS, may increase the risk of SARS-CoV-2 infection and worsen outcomes in COVID-19. However, in further experimental and clinical studies, these assumptions were not confirmed. Moreover, currently international experts strongly recommend that ACE inhibitors or ARB be continued in HTN patients with COVID-19, as they protect against cardiovascular complications and improve prognosis. Observations have shown that COVID-19 significantly increases the likelihood of developing HTN, acute coronary syndrome, cardiac arrhythmias, right ventricular dysfunction, myocardial fibrosis, heart failure, and also increases the risk of death from CVD. Further clinical and long-term prospective studies are needed to evaluate the role of past COVID-19 as a RF for CVD and mortality.

Cardiovascular disease is the most common cause of death worldwide. In this regard, there is a need to find and implement effective methods for the prevention and treatment of such diseases. Lifestyle modification is an important component of a complex of preventive and therapeutic measures, including nutrition optimization, increased physical activity, and breaking bad habits. Currently, an actively developing area is the use of biologically active additives to food, in order to replenish the missing nutrients in the diet and maintain health. In the course of the present review, an analysis was made of randomized clinical trials performed over the past 5 years. The studies investigated both the short-term effects of taking omega-3 polyunsaturated fatty acids (effect on the blood lipid spectrum, blood pressure levels) and longterm results (development of myocardial infarction, stroke, cardiovascular mortality). This supplement has demonstrated a positive effect on immediate outcomes, namely the reduction of total cholesterol, low-density lipoprotein, triglycerides (lipid-lowering effect). However, there was no significant effect on long-term results. It also provides information on studies that have examined the cardioprotective effects of supplements such as resveratrol, red yeast rice, L-arginine, and curcumin. An analysis of publications has shown that these supplements have the potential to reduce the risk of development and progression of cardiovascular diseases due to possible hypolipidemic, endothelial protective, and antihypertensive effects. Nutraceutical support can be an effective addition to the basic treatment and help reduce morbidity and mortality due to cardiovascular disease.

The purpose of the study was to compare the efficacy of regular prolonged inhalation therapy with tiotropium bromide delivered via the Respimat inhaler and short-acting bronchodilator (SAB) therapy with ipratropium bromide/fenoterol in the perioperative period in patients with non-small cell lung cancer (NSCLC) combined with chronic obstructive pulmonary disease (copd). Material and Methods . The study included 66 patients with Nsclc and copd. The patients received tiotropium bromide, 5 mcg/day (TB group) or a combination of ipratropium bromide/fenoterol 20/50 mcg/dose, 2 doses 4 times a day (SAB group) for 6 weeks before and 6 weeks after surgery. The control group consisted of patients who did not receive bronchodilators before surgery, but they received a combination of ipratropium bromide/fenoterol in the postoperative period. All patients underwent tests of pulmonary function (spirometry, body plethysmography), measurement of lung parenchyma density and emphysematous lung areas (high-resolution computed tomography). Results. After preoperative preparation with use of tB or saB, there was a significant improvement in FEV1, FVC, VC, RV, ITGV, and. RV/TLC ratio relative to baseline. In the tB and sad groups, a significant reduction in the severity of total respiratory resistance (Rtot) compared to that in the control group was observed. According to the assessment of lung density and the volume of emphysematous areas on expiration, the results in the TB group were significantly better than those in the sad and control groups. six weeks after surgery, all patients showed a significant decrease in post-FeV1, post-FVC, and post-VC relative to the preoperative values. Bronchodilator therapy resulted in the reduction in Rtot in all groups; however, better results were achieved in the TB group (86 %) compared to sad group (93 %, p=0.03) and control (101.5 %, p=0.02). After surgical treatment, a decrease in the volume of emphysematous areas on inspiration was observed: the parameters were better in the TB group than in the sad and control groups (220 cm3 versus 1025 cm 3 and 1002 cm 3 , p<0.001 and p=0.002, respectively). Conclusion. In patients with Nsclc and copd, longterm inhaled bronchodilator therapy can significantly improve respiratory function. more beneficial results are achieved after using long-acting drugs (tiotropium bromide).

Introduction. Isthmic-cervical insufficiency (ICI) continues to be one of the main causes of miscarriage and premature birth (PB), contributing to the growth of reproductive losses and directly affecting the indicators of perinatal morbidity and mortality.Objectiveof the study – to study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.Material and methods.A retrospective analysis of birth histories (n = 144) with a diagnosis of Isthmic-cervical insufficiency was carried out, for the period from 2015 to 2020. 102 pregnant women who delivered through the natural birth canal (70.8%) made up group 1, and 42 women whose births ended with cesarean section (29.2%) made up group 2. The control groups included patients with a singleton uncomplicated pregnancy, which ended with an emergency delivery through the natural birth canal (group 3 – n = 96) and by caesarean section (group 4 – n = 58). Anamnestic data, peculiarities of the course of pregnancy, childbirth and perinatal outcomes were studied in detail. Statistical analysis was carried out using the programs Excel MS Office Professional and STATISTICA 7.0.Results and discussion. ICI is more common in repeat-bearing women with a male fetus (p < 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p >< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes. >< 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p < 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p < 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p < 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001).Conclusion.The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.

В Российской Федерации недостаточно изучены ассоциации отдельных параметров трудовой деятельности с возникновением факторов риска хронических неинфекционных заболеваний (ХНИЗ) у медицинских работников. ЦЕЛЬ ИССЛЕДОВАНИЯ Определение ассоциаций отдельных параметров трудовой деятельности с развитием факторов риска ХНИЗ у врачей и среднего медицинского персонала в Томской области. МАТЕРИАЛ И МЕТОДЫ Использовали опросник, связанный с трудовой деятельностью респондента, а также вопросник, составленный на основании методических рекомендаций «Мониторинг факторов риска хронических неинфекционных заболеваний в практическом здравоохранении», рекомендованных к применению Минздравом России. РЕЗУЛЬТАТЫ Полученные результаты позволяют констатировать, что факторами трудовой деятельности, ассоциированными с риском возникновения факторов риска ХНИЗ, являются: чрезмерная нагрузка, возраст респондента и др. ЗАКЛЮЧЕНИЕ Проведенное исследование у медицинских работников Томской области продемонстрировало, что основными факторами трудовой деятельности, ассоциированными с возникновением факторов риска ХНИЗ, являются: чрезмерная нагрузка и стресс работников медицинских организаций. Именно на ликвидацию этих причин должны быть направлены мероприятия по снижению частоты факторов риска ХНИЗ среди работников здравоохранения.

The problem of the widespread prevalence of noncommunicable diseases (NCDs) and their risk factors (RF) has not lost its relevance already for many years. In 2017, World Health Organization (WHO) published cost-effective solutions and other recommended interventions for the prevention and control of NCDs. For each behavioral RF and category of disease, measures are listed with an assessment of their cost-effectiveness. In this review, the measures presented by WHO are analyzed in terms of their application at three out of the six levels identified by the authors: community, family, medical specialist. Human health is known to be only 1015 % dependent on medical support. However, medical specialists are completely responsible for some types of prevention, as well as the management of NCDs. At the same time, only a small number of novel studies on the prevention and management of NCDs are devoted to activities carried out at the level of communities or families. To date, it is necessary to take these levels into account when developing comprehensive preventive measures of the “life-long cycle”. The review provides examples of preventive programs aimed at combating unhealthy diet and lack of physical activity, consumption of alcohol and salt. It also examines the relationship of infectious and non-communicable diseases by the example of human papillomavirus infection. Possible criteria that increase the effectiveness of modern preventive measures have been identified.

Achievements of modern medicine and a number of other factors have led to an increase in the life expectancy and aging of the population. Together with an unhealthy lifestyle it has contributed to the growth in the number of noncommunicable diseases (NCDs). The priority area is the reduction of the burden of NCDs on a global scale and for each individual country in order to improve the quality of life and the welfare of the population. However, various programs for the prevention and management of NCDs make an unequal contribution to their effectiveness and cost. In 2017, World Нealth Оrganization (WHO) published cost-effective solutions and other recommended interventions for the prevention and control of noncommunicable diseases. For each behavioral risk factor and disease category, measures were listed with an assessment of their cost-effectiveness. In this review, the cost-effective and other measures presented by WHO are analyzed in terms of their application at three out of the six levels identified by the authors: legislation, the media, and the environment. In addition, examples of preventive programs aimed at combating smoking and drinking sugar-sweetened beverages, as well as increasing the physical activity of the population are given.

One of the most significant and urgent targets of modern healthcare is an effective control of chronic non-communicable diseases. These diseases lead not only to premature death, but also to permanent incapacitation and worsening of life quality. Prophylactic measures have proven to be the most effective method for control of chronic non-communicable diseases. However, in addition to well-known prevention tactics: population, high-risk and secondary prevention strategies, there are currently other approaches. The presented review provides a brief comparison of two “classical” prevention strategies. We analyzed the contribution of each of them to world healthcare, and justified the need for a complex approach to prevention. We studied possible transformation of present strategies and considered other promising approaches developed by some authors. Particular attention is paid to assessing the possibilities and feasibility of genetic information using to define the disease risks and personalize medical prevention.

Objectives. Allergic rhinitis (AR) is highly prevalent all around the world. It adversely affects the quality of life of patients and leads to the development of bronchial asthma, which determines its high socio-economic burden. International and Russian authorities establish control of the disease as a primary efficacy end point of allergic rhinitis treatment. Nevertheless, there is no international, standardized, validated tool to assess control of allergic rhinitis. In this regard, this review aims to analyze research on the development of such tools and to provide their comparative analysis. Review methods. Using PubMed, Web of science and Russian Citation Index database, we searched from 1991 to 2019 with logical combinations of the following key words: "allergic rhinitis control", "AR control", "AR questionnaire". A total of 96 publications were included in the study. Results. All studies were arranged in chronological order and their main results were described. Questionnaires on the quality of life, tools offered by the clinical guidelines, visual analogue scales, and specialized questionnaires for measuring the control of allergic rhinitis were considered separately. The advantages and disadvantages of these instruments are described. Conclusion. The evidence based on the quality of the tool to support the use of specialized questionnaires was shown. Many disease control scales have been validated, but have some practical disadvantages as primary efficacy criteria in clinical practice.

Aim. To determine the prevalence and structure of risk factors (RF) for chronic noncommunicable diseases (CNCD) medical specialists in the Tomsk Region depending on labor parameters, gender, residence and specialty.Material and methods. As part of the study, specialists filled out questionnaires that included questions related to their labor activity, as well as a questionnaire made up on basis of methodological recommendations “Monitoring of risk factors for chronic noncommunicable diseases in practical healthcare”. The questionnaire was submitted in electronic form and posted on the website http://www.golosaonline.ru/medto.Results. Medical specialists in the Tomsk region revealed a high prevalence of such RFs of CNCD as improper feeding and sedentary lifestyle, as well as overweight. We recorded that these RFs are most common among surgical specialties.Conclusion. The study showed that there is a need for practical recommendations for medical specialists on leveling the individual RFs of CNCD.

Background. According to the World Health Organization, chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. COPD with frequent exacerbations is a most challenging variant of the disease. Currently it is not clear how respiratory microbiota can modify the immune response in this disease. Aim. To establish the role of bacterial oligonucleotides in modification of the immune response in patients with COPD. Materials and м ethods. In accordance with the protocol of the study, 10 patients with stable COPD with frequent exacerbations and 10 patients without frequent exacerbations were included. Immature dendritic cells were obtained by culturing the monocyte fraction of the peripheral blood of patients with COPD. The cells were stimulated by addition of bacterial lipopolysaccharide and small oligodeoxynucleotides (CpG-ODN) of A or B classes. Then the immunophenotypical profile of the obtained cells was determined by flow-cytometry with the use of monoclonal antibodies to antigens CD40, CD83, CD86. To determine the antigen-presenting properties, these dendritic cells were cultivated with CD4+, and then the phenotypic profile of the obtained T-lymphocytes was evaluated by using antibodies to CD4, CD25, CD127, and CD45RO. Results. Cultivation of stimulated dendritic cells by СpG-ODN of A class with T-cells in COPD patients without exacerbations leads to an increase of the amount of lymphocytes of CD25+CD45RO phenotype (15% increase after stimulation), in contrast to the group of patients with frequent exacerbations of COPD (p = 0,018). It may indicate inadequate control of persistent inflammation, mediated by CD25+CD45RO pool of cells in the group of COPD patients with frequent exacerbations. Conclusion. This study demonstrated the presence of discoordination of the immune response of a bidirectional nature in patients with COPD with frequent and infrequent exacerbations.

Introduction. Pharmaceutical market and clinical trials (CTs) industry are growing rapidly in Russia, but little is known about perceptions of patients involved in medical experimentation, about their expectations regarding trial participation, and associated fears and reservations. Material and methods. A multicenter cross-sectional study was conducted in different cities of the Russian Federation. Patients who had previous experience in CTs (or were enrolled in a CT at the time of this study) were asked to complete a questionnaire. Results. Likert-style questions were used to evaluate factors influencing the perception of CTs by the patients. The most important factors to decide whether to participate in the clinical trial or not for the patients included professional monitoring services, regular condition monitoring, better medical care, and free treatment. Three most significant factors that have adverse effect on the interest to participate in the study were: the risk of side effects, study of new medication and the risk of getting into the placebo group. The most important motivating factors to continue CTs for the patients were as follows permanent monitoring of condition, personal relationships with medical researchers, improvement of physical condition, as well as free medical examinations and medical assistance. Conclusion. Results of the study showed that expectations, motivations and experiences of patients participating in clinical trials in Russia are comparable with the world's data. The findings suggest more significant role of the researcher in almost all aspects of patient participation. After the end of the study the majority of respondents were still in contact with doctors.

Introduction. Currently, clinical trials (CT) remain the only technology, which provides proof of efficacy and safety of new drugs and their subsequent release to the market. Medical researcher and informed consent (IC) are the main (and often the only) source of information for the patient about the upcoming clinical trials, and thus have a direct impact on the perception of clinical trials, and on the patient’s decision about participation. However, the degree of influence of these factors on the clinical trials participants still remains unclear.Materials and methods. A multicenter cross-sectional study was conducted in different cities of the Russian Federation. Patients who had previous experience in CTs (or were enrolled in a CT at the time of this study) were asked to complete a questionnaire.Results. To assess the impact of researcher, all respondents were divided into 2 groups: patients that acquainted with IC in collaboration with the researcher, and the other group, which reviewed IC form independently. We evaluated the importance of the factors influencing the decision-making process on participation in clinical trials. According to our data, the most important factors were professional monitoring services (3,72 ± 1,00), regular condition monitoring (3,66 ± 0,98), and better medical care (3,62 ± 1,00). These factors were evaluated at significantly lower score by group of patients that acquainted with IC together with the researcher (3,55 ±0,94, vs 4,01 ± 0,90, p = 0,002; 3,52 ± 1,01 vs 3,87 ± 0,90, p = 0,040; 3,49 ± 0,94, vs 3,83 ± 1,06, p = 0,020 respectively). In assessing the factors that had negative impact on the interest in participating in a clinical trial, the most significant were risk of side effects (3,01 ± 1,27), study of new medication (2,68 ± 1,21), and the risk of getting into the placebo group (2,64 ± 1,34) (so-called “objective” risk factors). At the same time, risk of side effects and risk of getting into the placebo group were also assessed at significantly lower score by group of patients that acquainted with IC together with the researcher (2,87 ± 1,28, vs 3,33 ± 1,17, p = 0,024; 2,51 ±1,25, vs 3,03 ± 1,34, p = 0,022 respectively). Furthermore, it was found that in the case of the researcher’s assistance acquaintance time with IC reduced threefold. We also evaluated the effect of the complexity of IC text on the decision-making process on participation in clinical trials. The group of respondents, who rated the IC as easy, appeared to be more interested in the final results of the study.Conclusion. Thus, when assessing the impact of the researcher on the review process of informed consent with the decision to participate in clinical trials, we found that in the case of assistance of the researcher, the acquaintance time with IC is reduced three times. In addition, this group of patients during the conversation with the researcher shows better and more clear understanding of the nature and general methodology of clinical trials, resulting in an adequate assessment “objective” risk factors for participation in clinical trials. Thus, this group of patients is more informed, compared with an “independent” group. According to the study “Face to Face”, we can recommend mandatory participation of a researcher during review process of the IC.

Background: Severe persistent asthma is associated with high morbidity, among patients with severe asthma, higher risks can be expected in patients with refractory asthma, but little is known about clinical factors which associated with refractory (therapy-resistant) asthma. Aims and objectives: To compare prevalence and clinical characteristics of refractory asthma in severe asthma population. Methods: Prospective, interventional, controlled study in parallel groups with 6 month treatment period was performed. Patients with severe uncontrolled disease and appropriate (GINA) treatment administered were included in the study. According to treatment response patients were aposterior divided according to ATS 200 criteria into groups of severe or refractory asthma. Results and conclusion: Initially, in the group of refractory asthma worse clinical and functional parameters of asthma course were registered compared with severe asthma. According to our data the prevalence of refractory asthma in population with severe asthma is more than 50%.