A review is done of the latest research on unintentional intraoperative hypothermia (UIH) in oncological surgery, as well as its contribution to cardiac complications. Data are presented on the risk factors for developing UIH, the impact of surgery duration and type, as well as different anesthesia types and methods on the stage of the patient's hypothermia. Data on the relationship between the severity of UIH and the surgical profile of a patient and the patient's comorbidity were studied. It was revealed that cancer patients are at risk of developing UIH in the perioperative period, indicating the importance of preventing hypothermia during the surgery and anesthesia. The results of research on the undesirable effects of UIH, the impact of hypothermia on the development of various events, including cardiac complications, were analyzed. Data on the prevention of UIH and the methods of its prevention were systematized. The potential of maintaining the patient's normothermia for reducing the risk of developing cardiac complications in the immediate postoperative period is shown.

An assessment of the mortality rate of the population of Yakutia as a result of exposure to excessively low natural temperatures in 2011-2019 and the level of disability in 2014-2019 has been given. It was revealed that the impact of excessively low natural temperature (cold injury) ranks third in the structure of external causes of death of the population of Yakutia after suicides and homicides. The death rate of the population due to cold injury exceeds the death rate as a result of road traffic accidents (RTA). At the same time, the level of disability due to severe frostbite, which led to injuries, is relatively low.

In order to study the timeliness of medical evacuation of the patients with severe novel coronavirus from the districts of the Sakha Republic (Yakutia), a retrospective analysis of data from the Republic’s Center for Disaster Medicine (RCDM) for 2019-2022 was carried out. To compare the treatment results of patients living in the city of Yakutsk and patients evacuated from the districts of the republic (“city”, “district”), we conducted a prospective observational case-control study of 600 patients with severe COVID-19 in the specialized anesthesiology, resuscitation and intensive care unit (ARICU) of the Sakha Republic Clinical Hospital in 2020-2022. Lethal outcome (n=397) was chosen as the studied criterion. It was found that the study groups had statistically significant differences in age (p=0.002), body mass index (BMI) (p=0.001), saturation (SaO2) of mixed blood upon admission to the ARICU (p=0.003), oxygenation index (p=0.011), and the severity of the condition according to the SOFA (Sequential Organ Failure Assessment) score. The patients evacuated from the districts were characterized by younger age, higher body mass index, and greater damage to lung tissue. City residents were more prone to experience brain failure, acute kidney injury, and the development of multiple organ dysfunction. The mortality rate for the district patients with severe COVID-associated community-acquired pneumonia was 65.8%; for urban patients it made 66.3%, with no statistically significant differences established (p=0.906). Thus, the arrangement of medical evacuation for COVID-19 patients to a specialized institution during the pandemic ensured the availability and timeliness of specialized care provided to them. Keywords. Novel coronavirus, community-acquired pneumonia, city, district, lethal outcome.

It follows from the classical theorem by Lebesgue (1940) on the structure of minor faces in 3-polytopes that every plane triangulation with minimum degree at least 4 has a 3-face for which the set of degrees of its vertices is majorized by one of the following sequences: ( 4 , 4 , ∞ ), ( 4 , 5 , 19 ), ( 4 , 6 , 11 ), ( 4 , 7 , 9 ), ( 5 , 5 , 9 ), ( 5 , 6 , 7 ). In 1999, Jendrol' gave the following description of faces: ( 4 , 4 , ∞ ), ( 4 , 5 , 13 ), ( 4 , 6 , 17 ), ( 4 , 7 , 8 ), ( 5 , 5 , 7 ), ( 5 , 6 , 6 ). Also, Jendrol' (1999) conjectured that there is a face of one of the types: ( 4 , 4 , ∞ ), ( 4 , 5 , 10 ), ( 4 , 6 , 15 ), ( 4 , 7 , 7 ), ( 5 , 5 , 7 ), ( 5 , 6 , 6 ). In 2002, Lebesgue's description was strengthened by Borodin to ( 4 , 4 , ∞ ), ( 4 , 5 , 17 ), ( 4 , 6 , 11 ), ( 4 , 7 , 8 ), ( 5 , 5 , 8 ), ( 5 , 6 , 6 ). In 2014, we obtained the following tight description, which, in particular, disproves the above mentioned conjecture by Jendrol': ( 4 , 4 , ∞ ), ( 4 , 5 , 11 ), ( 4 , 6 , 10 ), ( 4 , 7 , 7 ), ( 5 , 5 , 7 ), ( 5 , 6 , 6 ). The purpose of this paper is to give another tight description of faces in plane triangulations with minimum degree at least 4: ( 4 , 4 , ∞ ), ( 4 , 6 , 10 ), ( 4 , 7 , 7 ), ( 5 , 5 , 8 ), ( 5 , 6 , 7 ).

Aim of research – the comparative analysis of the frequency and the identification of factors for the development of acute kidney injury (AKI) in patients with myocardial infarction (MI) with and without the formation of pathologic Q-tooth. Material and methods. The total of 134 patients were studied and divided into 2 groups: Group 1 – patients with coronary heart disease (CHD) MI with pathologic Q tooth formation (n = 29); Group 2 – CHD MI patients without Q tooth formation (n = 105). Inclusion criteria are first-ever MI, age older than 18 years, increase in serum creatinine level above 26.5 μmol/l within 48 hours and decrease in diuresis less than 0,5 ml/ kg/h, informed voluntary consent for participation in the study. Exclusion criteria are terminal chronic renal failure, age under 18 years, chronic heart failure with left ventricular ejection fraction (LVEF) below 40%, MI anamnesis, refusal to participate in the study. Results. Among 134 patients with MI, signs of AKI were detected in 40 (29,9%) patients. In group 1, the mean value of glomerular filtration rate (GFR) was 41,0 ± 8,2, in group 2 it was 73,2 ± 13,9 ml/min/1,73m2. Signs of AKI in group 1 were observed in 20 (69,0%) patients, in group 2 in 20 (19,0%) patients. The comparative analysis of the study groups revealed that group 1 patients, compared to group 2 patients, had higher body mass index (BMI)(p < 0,001), more often concomitant chronic kidney disease (CKD) was observed (p < 0,001), lower hemoglobin level was typical (p < 0,001), and arterial hypotension was noted at prehospital stage (p = 0,034). In addition, group 1 patients were more likely to develop complications such as bleeding at the site of arterial puncture during percutaneous coronary intervention (PCI) (p < 0,046), pulmonary edema (p < 0,001) and cardiogenic shock (CS) (p < 0,001). The length of stay of group 1 patients in the Intensive Therapy and Resuscitation Department was 11,5 ± 3,6 bed days, group 2 was 9,6 ± 3,9 bed days (p < 0,019), and 8 (27,6%) patients and 1 (1,1%) died, respectively (p < 0,001). Conclusion. Early signs of AKI were detected in 29,9% of patients with MI; this condition was more frequent in the group of patients with MI who had a formed pathologic Q wave (69%). High BMI (p = 0,02), increased blood levels of HDL (p < 0,006) and total cholesterol (p < 0,001), decreased blood hemoglobin (p = 0,001), arterial hypotension (p = 0,013) and initial CKD (p < 0,001) were the factors contributing to the development of AKI.

The study examines the risk factors for mortality in patients across various age groups through a retrospective analysis of 591 medical records of patients with severe COVID-19-associated pneumonia treated in the intensive care unit (ICU). Univariate and multivariate analyses were conducted to identify risk factors for mortality in two distinct groups: patients under the age of 60 (group 1) and those aged 60 years and older (group 2), and comparative analysis between these two groups was performed. Mortality in group 1 was observed to be 46.9%, whereas in group 2 it was 73.3%. Patients in group 2 exhibited a comparatively lower weight and body mass index (BMI), a higher number of concomitant diseases, and more severe assessments according to the APACHE II and SOFA scales. The clinical presentation on day 1 did not differ between the groups based on the following criteria: hypercoagulation (93.1% in group 1 and 93.3% in group 2, p=0.950), septic shock (11.9% in group 1 and 18.1% in group 2, p=0.080), acute kidney injury (AKI) (12.5% in group 1 and 16.7% in group 2, p=0.206), and multiple organ failure syndrome (MODS) (55% in group 1 and 52.2% in group 2, p=0.236). In group 1, a higher prevalence of acute liver failure was observed (25% vs. 5.1%, p<0.001), whereas group 2 exhibited a greater incidence of acute cerebral failure (ACF) (13.8% vs. 34.8%, p=0.001). Group 1 also demonstrated significantly elevated leukocytosis (p<0.001) and alanine aminotransferase (ALT) levels (p<0.001). Conversely, group 2 showed lower levels of lymphopenia (p<0.001), hypoalbuminemia (p<0.001), and platelet count (p<0.001), in addition to higher levels of blood urea nitrogen (p<0.001), creatinine (p<0.001), and brain natriuretic hormone (NTproBNP) (p=0.003). In patients under 60 years old with severe COVID-19-associated pneumonia, the independent risk factor for death was the development of MODS on the first day of admission in the ICU. For patients over 60 years old, independent risk factors for death were age, the presence of chronic kidney disease (CKD), the severity of hypoxia as determined by the PaO2/FiO2 ratio upon admission to the ICU, the development of MODS, septic shock, and acute cerebral disorder. Keywords: coronavirus disease 2019, COVID-19, predictors, age, risk factors

ОЦЕНКА ВЗАИМОСВЯЗИ КЛИНИКО-ЛАБОРАТОРНЫХ ПОКАЗАТЕЛЕЙ С ИСХОДОМ ЛЕЧЕНИЯ У ПАЦИЕНТОВ С ТЯЖЕЛОЙ COVID-19-АССОЦИИРОВАННОЙ ПНЕВМОНИЕЙЧулакова Н.А. 1,2, Потапов А.Ф. 1 , Иванова А

A review is done of the latest research on unintentional intraoperative hypothermia (UIH) in oncological surgery, as well as its contribution to cardiac complications. Data are presented on the risk factors for developing UIH, the impact of surgery duration and type, as well as different anesthesia types and methods on the stage of the patient's hypothermia. Data on the relationship between the severity of UIH and the surgical profile of a patient and the patient's comorbidity were studied. It was revealed that cancer patients are at risk of developing UIH in the perioperative period, indicating the importance of preventing hypothermia during the surgery and anesthesia. The results of research on the undesirable effects of UIH, the impact of hypothermia on the development of various events, including cardiac complications, were analyzed. Data on the prevention of UIH and the methods of its prevention were systematized. The potential of maintaining the patient's normothermia for reducing the risk of developing cardiac complications in the immediate postoperative period is shown.

The degree d(x) of a vertex or face x in a graph G is the number of incident edges. A face f = v(1) center dot center dot center dot v(d(f)) in a graph G on the plane or other orientable surface is of type (k(1), k(2), ...) if d(vi) <= k(i) for each i. By delta we denote the minimum vertex-degree of G.It follows from the classical theorem by Lebesgue (1940) that every plane triangulation with delta >= 4 has a 3-face of types (4, 4, infinity), (4, 5, 19), (4, 6, 11), (4, 7, 9), (5, 5, 9), or (5, 6, 7). In 1999, Jendrol' gave a similar description: "(4, 4, infinity), (4, 5,13), (4, 6,17), (4, 7, 8), (5, 5, 7), (5, 6, 6)" and conjectured that "(4, 4, infinity), (4, 5,10), (4, 6,15), (4, 7, 7), (5, 5, 7), (5, 6, 6)" holds. In 2002, Lebesgue's description was strengthened by Borodin to "(4, 4, infinity), (4, 5, 17), (4, 6, 11), (4, 7, 8), (5, 5, 8), (5, 6, 6)". In 2014, we obtained the following tight description, which, in particular, disproves the above mentioned conjecture by Jendrol': "(4, 4, infinity), (4, 5,11), (4, 6,10), (4, 7, 7), (5, 5, 7), (5, 6, 6)", and recently proved another tight description of faces in plane triangulations with delta >= 4: "(4, 4, infinity), (4, 6,10), (4, 7, 7), (5, 5, 8), (5, 6, 7)".It follows from Lebesgue's theorem of 1940 that every plane 3-connected quadrangulation has a face of one of the types (3, 3, 3, infinity), (3, 3, 4, 11), (3, 3, 5, 7), (3, 4, 4, 5).Recently, we improved this description to "(3, 3, 3, infinity), (3, 3, 4, 9), (3, 3, 5, 6), (3, 4, 4, 5)", where all parameters except possibly 9 are best possible and 9 cannot go down below 8.In 1995, Avgustinovich and Borodin proved the following tight description of the faces of torus quadrangulations with delta >= 3: "(3, 3, 3, infinity), (3, 3, 4,10), (3,3,5,7), (3,3,6,6), (3,4,4,6), (4, 4, 4, 4)".Recently, we proved that every triangulation with delta >= 4 of the torus has a face of one of the types (4, 4, infinity), (4, 6,12), (4, 8, 8), (5, 5, 8), (5, 6, 7), or (6, 6, 6), which description is tight.The purpose of this paper is to prove that every graph with delta >= 4 that admits a closed 2-cell embedding on the torus has a face of one of the types (4, 4, 4, 4), (4, 4,infinity), (4, 5,16), (4, 6,12), (4, 8, 8), (5, 5, 8), (5, 6, 7), or (6, 6, 6), where all parameters are best possible.

An analysis of the Yakutsk Emergency Department documentation for 2018–2022 was carried out in order to assess the effectiveness of prehospital cardiopulmonary resuscitation. It was revealed that over a number of years, the Department has maintained a fairly high level of successful resuscitation with restored cardiac activity (increased from 0 % in 2005 to 44.7 % in 2022). The result was achieved through continuous managerial efforts (training of mobile team personnel, increasing readiness for extended resuscitation in all mobile teams, gradual acquisition of technical equipment for providing comprehensive emergency services, daily quality control of medical services provided to patients, effective functioning of the operational department). A high-quality resuscitation performed by the teams contributes to the reduced mortality from preventable causes.

Aim. To explore the etiological structure of wound microflora and its antimicrobial susceptibility in burn patients treated in hospital burn departments. Materials and methods. The authors analyzed the microbiology testing results of 2354 wound exudates in samples of 1581 patients with severe burns who underwent treatment in the Burn Unit and Department of Anesthesiology, Resuscitation and Intensive Care of the Center for Emergency Medical Care of the Republic of Sakha (Yakutia) in the period from 2016 to 2020. Data processing and antibiotic resistance analysis were performed via AMRcloud online platform (Beta version, 05.07.2022). Results. Of the pathogens isolated in the burn wounds, Staphylococcus aureus accounted for 26.1%, Enterococcus faecalis – 24.5%, Pseudomonas aeruginosa – 11.9%, Klebsiella pneumonia – 9.4%, Acinetobacter baumannii – 7.9% and Escherichia coli – 6.0%. The susceptibility of isolated microbial strains to carbapenems and high resistance to cephalosporins and fluoroquinolones were established. Conclusion. Microbial strains detected in burn patients indicate infection of wounds with representatives of nosocomial flora and their high resistance to commonly used antibiotics.

The aim of this study was to analyse and summarise all researches about proadrenomedullin (pro-ADM) prognostic value as covid-19 severity and mortality early predictor. After a literature search and selection, we found 19 articles eligible to inclusion in a meta-analysis. We found pro-ADM had significantly high values in patients both admitted to the general department and ICU-patients with unfavourable outcomes. The Pro-ADM measurement in the admission or early stages of the hospitalisation can be used for the patient's risk stratification, to making a decision and a differential treatment approach.

Summary. The aim of the study is to investigate the peculiarities of sanitary aviation work in the Republic of Sakha (Yakutia) during the COVID-19 pandemic. Materials and research methods. The subject of the study is the work of the Disaster Medicine Service of the Republic of Sakha (Yakutia); the object of the study is the volume and structure of sanitary tasks performed during the spread of the new coronavirus infection COVID-19. Research methods were analytical methods, methods of expert evaluation and mathematical analysis. Results of the study and their analysis. A comparative analysis of the main performance indicators of the Republican Center for Disaster Medicine of the Republic of Sakha (Yakutia) in 2020-2022 is presented. The results of the study indicate that during the spread of a new coronavirus infection COVID-19 the air ambulance service of the Republic worked with increased workload. Under the conditions of COVID-19 pandemic, emergency medical care and medical evacuation of not only patients with severe form of new coronavirus infection, but also of patients with other nosologic forms of diseases requiring emergency medical intervention were provided. The conclusion about the acute urgency of using sanitary aviation in vast sparsely populated areas of other regions is made.

To study the functioning of emergency medical services in the city of Yakutsk during the new coronavirus infection, a retrospective comparative analysis of main performance indicators of the Yakutsk Ambulance Service in the period 2017–2021 was conducted. It was revealed that the number of calls in Yakutsk City and its suburbs had been growing annually. However, compared to 2019, the end of 2021 saw a decreased number of total visits by 1.2.%; of efficient visits — by 1.5%; of patients having received aid — by 1.1.%. At the same time, in 2020–2021, in order to ensure timely and quality response to all the calls, the Service had to tackle a range of managerial challenges (deficit of ambulance teams, 32% incidence in doctors and assistants, difficulties with admitting the patients with pathologies other than the COVID-19).

Ultraviolet radiation is known as one of the major contributors to skin malignancies, including basal cell carcinoma (BCC), which is the most common type of skin cancer. It is a heterogeneous tumor, which presents with various types that are stratified into low- and high-risk tumors. Sunlight is important for overall health and vitamin D synthesis in the skin, whereas deviations from the optimal level of vitamin D are shown to be associated with the risk of the development of BCC. The accumulating evidence suggests the ability of vitamin D to antagonize the Sonic Hedgehog (SHH) signaling, the key tumor pathway, and play a protective role in the development of BCC. Additionally, a vitamin D binding protein (DBP) is shown to be implicated in the complex regulation of vitamin D. Here, we aimed to explore serum vitamin D in patients with different primary and recurrent BCC of the head and neck and investigate cutaneous DBP and SHH indices, confirmed immunohistochemically in these subjects. According to the results, 94.9% of the Latvian cohort of BCC patients were found to be deficient in vitamin D. No significant differences in serum vitamin D levels were found between genders, primary and recurrent tumors, and different types of BCC. Serum vitamin D was inversely associated with tumor size. Susceptible male individuals with low blood vitamin D levels were recognized at risk of developing aggressive and recurrent BCC confirmed by the use of hierarchical clustering analysis. In smaller tumors with a favorable course, such as superficial and nodular BCC, the association between high DBP and low SHH tissue expression was found, providing supportive evidence of the existence of a link between vitamin D, proteins involved in its metabolism, as exemplified by the DBP and SHH signaling pathway. The assumption of a deficiency in the protective effect of vitamin D in patients with high-risk BCCs was proposed in low DBP and high SHH tissue indices. New extensions to existing knowledge and characterization of the BCC signaling pathways and their cross-talk with vitamin D are warranted when searching for a preferential effect of vitamin D on skin cancer.

We present a clinical case of a fatal thrombotic complication in a patient with coronavirus disease 2019 (COVID-19) in the recuperative period. A retrospective analysis of the patient's medical records with the chronology of laboratory and instrumental examinations, clinical course and intensive therapy was performed. The algorithm of pulmonary embolism (PE) diagnosis, validity and decision-making concerning thrombolytic therapy and extracorporeal membrane oxygenation are shown. The results of autopsy are also presented, which confirmed the diagnosis of PE and the appropriateness of medical interventions.

ДИНАМИКА ЦЕНТРАЛЬНОЙ ТЕМПЕРАТУРЫ ТЕЛА ПРИ ПРИМЕНЕНИИ АКТИВНОГО МЕТОДА ИНТРАОПЕРАЦИОННОГО СОГРЕВАНИЯ ПРИ ЛАПАРОСКОПИЧЕСКИХ И ЛАПАРОТОМИЧЕСКИХ ОПЕРАЦИЯХ У ПАЦИЕНТОВ С АБДОМИНАЛЬНОЙ ОНКОЛОГИЧЕСКОЙ ПАТОЛОГИЕЙНусугуров С.Д. 1,2, Потапов А

The paper deals with selected aspects of the studies of Orientalism, as it was introduced by E. W. Said in his monograph Orientalism, in the context of Russian colonial experience, with specific features of Russian “internal” and “outer” colonization, as well as with elements of Orientalism reflected in Russian literature. The applicability of E. Said’ theory is demonstrated through an analysis of the poetic works of one of the founders of the Eurasian movement, P. N. Savickij.

Aim: To analyze the work in the specialized anesthesiology and intensive care unit in the Republic of Sakha (Yakutia) for patients with COVID-19 in the context of the pandemic. Materials and methods: A retrospective observational study was conducted based on work perfomed by anesthesiology and intensive care unit (AICU) in the State Budgetary Institution of the Republic of Sakha (Yakutia) "Yakut Republican Clinical Hospital" (YRCH) for the period since March, 2020, to December, 2021. Results and discussion: YRCH have repurposed the hospital beds and enhanced the material and technical equipment supply of the AICU. Given the epidemiological situation, the bed capacity and the staff schedule of the unit were in the scope of regulation. The medical staff level was 76.5 % in 2020 and 80 % in 2021. The level of nursing and medical attendant staff for the entire period was 100 %. During the study period 1,796 patients were admitted (488 patients in 2020, 1,308 patients in 2021). The bed turnover was 24.4 and 28.2 patients per bed, the average rate of bed occupancy was 136 and 244.6 days, the average length of stay of patients was 5.5 and 6.0 days in 2020 and 2021, respectively. In total, 1,015 patients have died (mortality rate - 56.5 %), with 281 patients to have died in 2020 (mortality rate - 58.0 %) and 734 in 2021 (mortality rate - 56.2 %). The mortality rate of patients significantly increases with age and amounted to 71.2 % in patients older than 81 years. The main cause for admission in AICU was acute respiratory failure (ARF), the treatment has used is stepwise respiratory therapy. Standard oxygen therapy (15-20 l/min) was effective in 64 (3.6 %) patients, high-flow oxygen therapy (HFOT) was used in 1,732 (96.4 %) patients, non-invasive mechanical ventilation (NIV) was used in 717 (39.9 %), invasive mechanical ventilation was used in 1,015 (56.5 %) patients. Conclusion: The complex of measures for the deployment of specialized anesthesiology and intensive care for adults with COVID-19 in the YRCH has allowed to succeed with an overflow of patients suffering a severe course of the disease. The characteristics of the unit indicated the difficulties in managing patients with COVID-19 complicated by viral pneumonia with severe ARF.