As of the first quarter of 2021, more than 133,796,059 confirmed cases and 2,903,696 deaths were reported worldwide due to the emergence of infection caused by the new coronavirus, COVID-19 («Coronavirus disease 2019») [1]. Due to the emergence of infection caused by the new  coronavirus COVID-19, and the difficulties in diagnosing and treating this  disease, with an ever-increasing cases, the study and description of this infection is important for scientists and medical professionals around the  world. Due to the lack of clarity of the symptoms of COVID-19, we conducted an observational study aimed at identifying the prevalence and  severity of gastrointestinal symptoms with an e-survey platform named «Survio: Online Survey Software» using the Internet. 

 Summary. Relevance of the topic: most of the world is obese and there are enough cases of the impact of this pathology on the development of a complicated and severe course of novel coronavirus (COVID-19)
infection.

Purpose of the study: to study literature data on the effect of obesity on the course of novel coronavirus infection.

Objectives: 1. To consider obesity as a factor contributing to the intensification of inflammatory reactions. 2. To study the etiology and pathogenesis of COVID-19 infection. 3. To establish the relationship  between obesity and complications arising from coronavirus infection. 

Results. The most common feature of COVID-19 is severe acute respiratory syndrome caused by progressive lung consolidation. There is a positive correlation between the duration of COVID-19 infection and the degree of  interstitial fibrosis. Extensive pulmonary fibrosis is one of the main causes of  pulmonary consolidation due to the excessive extracellular matrix component produced by activated myofibroblasts [7]. Pulmonary  lipofibroblasts are a special type of adipocytes that contain typical lipid droplets and are close to the second type of alveolar epithelial cells of the pulmonary interstitium. Lipofibroblasts may result from ectopic fat deposition, which plays a vital role in the progression of COVID-19 in these patients. When exposed to various stimulants, such as hyperoxia and  infection of lung lipofibroblasts, a transdifferentiated myogenic phenotype  called myofibroblasts occurs, which causes pulmonary fibrosis [10]. A  significant number of obese patients have impaired glucose metabolism,  which is considered a risk factor and leads to death. SARS infection has been found to cause hyperglycemia in some patients due to dysfunction of the islets of the pancreas as a result of a viral attack. A similar effect occurs after infection with SARS-COV-2. This explains why 52% of those infected with SARS-COV-2 had hyperglycemia. The level of glucose increase in metabolic  disorders in obese patients can be much higher. Hyperglycemia leads to a  number of complications, including osmotic imbalance of fluid and electrolytes, hyperosmolar non-ketonemic coma, worsening skeletal muscle catabolism, impaired wound healing, altered coagulation, and increased  susceptibility to infections [4]. In addition, hyperglycemia impairs the body's immune function. All of this worsens the clinical outcome of COVID-19. Notably, proper blood glucose control reduces mortality in critically ill  patients, highlighting the importance of blood glucose control.

Conclusion.  The relationship between obesity as a factor complicating the course of  SARS-COV-2 infection has been shown. This mainly concerns the  development of a cytokine storm due to the release of IL-1, IL-6, IL-10 by  adipose tissue, as well as TNF-α. It should be noted that obesity affects the occurrence of concomitant metabolic diseases in patients, such as type 2  diabetes mellitus, coronary heart disease, atherosclerosis, etc., leading to acute myocardial infarction, increased thrombus formation and many other serious conditions. In addition, it is difficult for obese patients to provide specialized medical care when connecting to a ventilator, preventing pressure ulcers and attaching a secondary infection. 

 Currently, inflammatory bowel diseases (IBD), in nonspecific ulcerative colitis (NUC) and Crohn's disease (CD), are an extremely urgent problem. The incidence of both ulcerative colitis and Crohn's disease worldwide is increasing every year, and mainly among the working-age population, which makes inflammatory bowel disease (IBD) a socially significant disease. The clinical picture of IBD is diverse, which often makes it difficult to timely diagnose and prescribe adequate therapy and inevitably negatively affects the prognosis of diseases. Here are some of the characteristics of the NUC and CD. The histogram results of numerous studies indicate the following: in Crohn's disease (CD), the thickness of the intestinal wall is often significantly increased. In the mucous membrane, slit-like ulcerative defects are detected, in the bottom of which there are signs of inflammation in the form of infiltration of the bottom of the ulcers by leukocytes, lymphocytes, histiocytes. As for colitis, based on these clinical cases, it can be concluded that children and adolescents are  characterized by a total lesion of the colon and the appearance of segmental forms. In adult patients, distal colitis, the so-called proctosigmoiditis, prevails.  On examination, the mucous membrane was edematous, vividly hyperemic,  edematous, with superficial erosions. 

 Relevance. The variety of options for combining injuries and disorders occurring in the body with a combined injury, the need for rapid decision-making on treatment require rapid diagnosis of the entire volume of injuries and determining the severity of the injury, but there is still no single protocol for examining such victims.

The aim of the work was to present a modern CT study protocol for patients with concomitant trauma.

Materials and methods. The results of computed tomography of 30 patients with severe concomitant trauma were analyzed. All the victims were  admitted in the first hours after the injury. Men were 30 (67 %), women – 10  (33 %), the average age was 41.3 ± 7.6 (22–79) years. Traditional multiphase full-body MSCT was performed in 20 patients, in 10 patients a special  protocol was used for the study of the "whole body" by the method of  divided bolus.

The results of the study. Craniocerebral injuries were detected in 15 (50 %), spinal injuries – in 7 (23.3 %). Simultaneous injuries to the chest and abdomen were detected in 19 (63.3 %) of the victims. When subjectively evaluated, the quality of the images obtained using the full-body MSCT  protocol with bolus separation and the standard multiphase protocol for the diagnosis of traumatic injuries was equivalent. The average radiation load per patient with traditional multiphase full-body MSCT is 66 % higher than  with the split-bolus protocol.

Conclusions. Full-body MSCT using a split bolus is a modern technique that fully meets the diagnostic conditions for severe combined trauma and, with a decrease in the radiation dose, allows you to determine all possible injuries in the victim in a single study. 

 The article is devoted to the treatment of patients with hiatal hernia. The aim of the study was to develop a method for diagnosing the failure of the  fundoplication cuff in patients with recurrent hernia of the foodwater orifice of  the diaphragm after Nissen fundoplication. The study included 42 patients. The  first group consisted of 16 people with recurrent hiatal hernia. The second  group consisted of 26 people without recurrence of hiatal hernia. When comparing groups of patients, a simple and objective sign of the failure of the fundoplication cuff after Nissen surgery is described. 

 Purpose of work. To study the sensitivity of pathogens of chronic tonsillitis to the combination of antibiotics amoxicillin + clavulanic acid using Raman spectroscopy.

Materials and methods. The study involved 117 patients (all men) in the period of exacerbation of chronic tonsillitis, who were prescribed amoxicillin  / clavulanic acid for its relief according to the standard scheme.  Determination of the sensitivity of the microflora of the tonsils was carried out using the method of Raman spectroscopy. The principle of the method was to determine the irradiation of microflora in samples under the action of an antibiotic by the presence of products of microbial metabolism in it.

Results. Clinical analysis of the results of the treatment in this group of patients showed that 96 of them (82 %) had a quick clinical effect. In 13 patients (11.1 %), it was necessary to increase the duration of taking the antibiotic by an average of 3-5 days, and in 8 patients, to eliminate the  exacerbation, the appointment of a second antibiotic was required.

Conclusions. The results obtained make it possible to recommend the Raman spectroscopy method for determining the sensitivity of microflora to antibiotics, as highly informative in clinical practice. 

 Аnomalies of internal carotid artery can occur not only in the practice of vascular surgeon, but also in other specialties. This article discusses a clinical case in the practice of an otorhinolaryngologist kinking of the internal carotid artery, which simulated pathology of pharynx. 

 In the course of the study, it was possible to identify the weighted average values of the burden of static-dynamic diseases among the female and male population of young age. A continuous study was carried out in 2020 on the basis of the Main Bureau of Medical and Social Expertise in the Rostov Region. In the course of the work, a database was compiled on the accumulated disability in the Rostov region for people aged 18–45 years (23,248 cases). In the course of the study, five age-sex groups were identified: 1) 18–25 years old, 2) 26–30 years old, 3) 31–35 years old, 4) 36–40 years old, 5) 41–45 years old. The study of indicators of a separate age  group included the calculation of the frequency of accumulated disability,  assessment of the structure of the contingent, taking into account the causes and severity of disability. Statistical processing of the data obtained  was carried out by comparing the average values in the Statistica 10  application program. In the first studied age group, the incidence of accumulated disability is 87.9 cases per 10 thousand of the population, among them 17.7 cases per 10 thousand of the population are people with  disabilities. statodynamic disturbances (20.1%). In the second group, the  frequency of general disability is 70.9 cases per 10 thousand of the population, among them 17.0 cases per 10 thousand of the population are  people with disabilities with staticdynamic disorders (24.0%). In the third  group, the incidence of accumulated disability is 119.1 cases per 10 thousand of the population, among them 31.4 cases per 10 thousand of the population are disabled persons with static-dynamic disorders (26.4%). In the fourth group, the incidence of accumulated disability is 182.0 cases per  10 thousand of the population, among them 54.7 cases per 10 thousand of  the population are people with disabilities with static-dynamic disorders (30.0 %). In the fifth group, the frequency of general disability is 276.2 cases per 10 thousand of the population, among them 82.9 cases per 10 thousand  of the population are people with disabilities with static-dynamic disorders (30.0 %). Thus, the indicator of accumulated disability with statodynamic disorders is higher in the fifth age-sex group of the study (82.9  cases per 10 thousand population); in the structure of the severity of  disability, the third group prevails.  

 Purpose. Study of the influence of psychotherapeutic assistance on the rehabilitation of persons who have undergone limb amputation.

Materials and methods. A study of the psychological characteristics of 48 patients who underwent amputation of the lower extremity was carried out  on the basis of the departments of vascular surgery and traumatology of the Samara Seredavin Regional Clinical Hospital. The control group included 25  people (16 men, 9 women), aged 45 to 70 years. Amputations of the  extremities were performed by him in connection with the developed gangrene due to obliterating vascular diseases. The main group consisted of 23 people (14 men, 9 women) aged 35 to 60 years with a stable and prosperous social status, who received an acute sudden injury that ended in amputation of one or both lower extremities. The examination was carried out on the 3-5th day of the postoperative period, depending on the  patient's condition. For the study, the following psychodiagnostic methods  and techniques were used: 1) clinical conversation; 2) coping test by R. Lazarus, S. Folkman; 3) methodology for diagnosing the type of attitude to  the disease; 4) Hamilton Depression Scale; 5) S. Rosenzweig's test of drawing frustration.

Results. The difference between the group of patients and the control group was statistically confirmed in terms of “seeking social support” (higher  in the control group), “confrontation” and “flight – avoidance” (higher in the group of patients) (p < 0.05). In the control group, depression is absent in 85% of the subjects, in 15% of patients there is a mild depressive  state (p < 0.05). According to S. Rosenzweig's method, the  predominance of extrapunitive reactions was revealed in both groups (E = 59.6 in the main group of patients and 44.1 in the control group) due to  reactions of the ego-protective type (ED = 56.2 in the main group of patients and 46.3 – in the control group).

Conclusion. Patients who underwent surgery for limb amputation and who took a conscious and active part in individual and group psychotherapy by the time of discharge from the hospital showed a decrease in anxiety and  depressive manifestations, a decrease in the manifestations of outward aggression, the construction of optimistic prospects) than in patients who  categorically refuse to receive psychological help and support. The provision  of psychotherapeutic assistance to persons after amputation of limbs should begin in the first days after the operation.

 Purpose. Increasing the importance and effectiveness of nicotine addiction treatment in patients with diabetes mellitus.

Materials and methods. A study of nicotine addiction in patients with type II diabetes mellitus was carried out on the basis of the Department of Endocrinology of the Samara State Medical University Clinics in 2019. The psychological study included 60 men aged 45-60 who are undergoing planned treatment in the endocrinology department for type II diabetes mellitus. Psychological research included: conversation, study of the type of attitude towards illness (TOBOL), study of adherence to treatment (Moriska – Green Compliance Scale). Work with tobacco dependence was carried out according to the WHO recommendations according to the “5 A” principle [14]. Work with patients was carried out in the key of rational, behavioral and gestalt therapy.

Results and discussion. In total, 24 group meetings were held – 12 group meetings in each polyclinic group of 26 people. The results obtained showed a decrease in the number of patients with a low level of physical wellbeing,  psychological well-being, optimism, self-confidence, and readiness to quit  smoking. Along with this, there was an increase in the number of patients with a high level of physical well-being, psychological well-being, optimism), readiness to quit smoking. As for compliance, the overall picture has also improved: there were 39 highly adherent patients among the studied (an increase from 10 % to 75 %), moderately adherent – 13 (a decrease from 73.3 % to 25 %), weakly adherent no (there were 16.7 %).

Conclusions. Psychological support of nicotine-dependent patients with diabetes mellitus must necessarily include educational work with patients, work with increasing the level of self-control of the disease and adherence  to treatment, with a psychoemotional state. It is optimal to include patients with diabetes mellitus in the group psychotherapeutic process in order to provide mutual assistance and receive effective support in the treatment of  tobacco smoking and raise the consciousness of patients in relation to the  prevention of complications of diabetes mellitus, and to the disease itself in general. 

 Relevance. The most important condition for a successful result of dental implantation is high-quality osseointegration of dental implants. In the literature, the issue of the quality of osseointegration is widely covered, which directly depends on the primary stability of dental implants. In the area of bone tissue remodeling, surrounding the installed dental implants, there are permanent processes of bone resorption and its restoration [1, 2].

The aim is to reveal the reactivity of alkaline phosphatase and osteocalcin in the biological fluid (saliva) in patients after dental implants.

Materials and methods. The collection and analysis of clinical material was carried out on the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia. Dental implantation surgery was performed in 184 patients aged 32 to 65 years. The gender ratio was 2:3 (40 men and 60 women). The teeth were lost due to poor oral hygiene and  caries complications.

Results and discussion. At the time of admission of patients to the department of the Department of Prosthetic Dentistry of the Clinics of the Samara State Medical University of the Ministry of Health of Russia, the bulk  of the patients had a low hygienic status. The OHI-S index averaged 2.74 ±  0.33 conventional units. (control – 0.50 ± 0.07 c.u.). In order to reduce the negative influence of microorganisms in the supra- and subgingival dental  deposits, all patients underwent professional oral hygiene, as well as  antimicrobial therapy. At the time of installation of dental implants, the average OHI-S and Müllemann-Cowell index was 0.72 ± 0.06 and 0.57 ± 0.06 conventional units, respectively.

Conclusions. 1. The increase in the titer of alkaline phosphatase and  osteocalcin during dental implantation is not statistically significant. 2. TCRF  in the oral fluid (saliva) exhibits maximum activity by the 14th day, exceeding  the initial three times. This indicator remains at an increased level  in the period up to six months from the beginning of the operation. 3. Revealing the values of the TRKF titer after the operation of dental  implantation is advisable to use as an assessment of the state of trophic  processes occurring in the bone tissue. 

 Relevance. Odontoreparation is fundamental to ensure the functional efficiency, high aesthetics and durability of fixed prostheses. At present, with fixed prosthetics of defects in hard tissues of teeth and dentition, various types of artificial crowns are widely used [1, 2].

Purpose of the study: to determine the angular deviations of the vertical surfaces of molars, prepared by students of the 3rd year. Based on the data  obtained, calculate the average value for the group and identify which surfaces of the stump are most prone to errors during odontopreparation.

Materials and methods. Frasaco® phantom teeth (mandibular molars) were  used as research materials.   Preparation for metal-ceramic crowns was carried  out according to the traditional method by thirteen third-year students of the Samara State Medical University of the Ministry of Health of Russia. In this work, 6° was taken as the optimal angle of convergence of the vertical walls (3° on each of the two opposite surfaces). During the preparation, a fissure bur d = 1.6 mm was used.

Conclusion. The average time spent on preparation is quite long, which indicates an insufficient level of manual skills. The revealed phenomena of wall  divergence also indicate that the preparation skills are insufficient. In addition,  divergence was found mainly on the distal surface, which is explained by more difficult access and limited visibility of the prepared surface. 

 Relevance. In patients suffering from defects in the organs of the maxillofacial region, often the most acute problem is not so much the problem of dysfunction, but rather unsatisfactory aesthetics. The loss of a particular organ of the maxillofacial region leads in many cases to become  the cause of persistent disorders on the part of psychoemotional problems [1–3]. In the modern world, the face is the main "visiting card" of a person,  most attracting attention from the people around him. The presence of one  or another defect in the maxillofacial region forms a number of  psychological problems in the patient, causing a feeling of shame from his  inferior appearance.

Materials and methods. The literature analysis of the applied methods of ectoprosthetics in the maxillofacial region was carried out.

Results and discussion. Comparing the traditional and computer methods of making facial epitheses, one should note a common similarity – the  laboriousness of the process, which requires an excellent understanding of  the anatomy of the maxillofacial region, fluency in computer software.  Having analyzed a large amount of foreign literature, I would like to  emphasize that the success of the performed ectoprosthetics largely depends on a clear and complete visualization of the clinical picture as a whole, without focusing on a specific organ. This is the key condition for creating a harmonious aesthetics of the face and the entire appearance of the patient after the treatment as a whole. The restored harmonious appearance of the patient's face will allow for faster adaptation in society. Currently, it is not possible to unambiguously determine the best method. A decrease in the speed of production and the optional  availability of medical education, according to a number of authors [4, 5, 16, 18,  19], are the motive for the choice and widespread introduction of CAD/CAM technologies, while some scientists [28] doubt their effectiveness. However, it is worth remembering that the result of the treatment is important for the patient, not the method itself, and only this is the result of his final assessment. 

RETRACTED ARTICLE

Relevance. Surgical treatment of neoplasms, various genetic disorders and facial trauma often contribute to a violation of the general aesthetic perception of a person and the development of dysfunctions [1]. The main difficulty of reconstructive treatment in the maxillofacial area is a clear understanding of the anatomical and topographic landmarks and three-dimensional relationships of organs and tissues from each other.

Purpose. Development of an algorithm for the use of various types of extraoral implants for various total facial defects. Materials and methods. The collection and analysis of clinical material was carried out in the Department of Maxillofacial Surgery on the basis of the Samara Regional Clinical Hospital  named after V.I. V.D. Seredavina. From 2015 to the present, we have installed 104 extraoral implants of various designs for the rehabilitation rehabilitation of fifty patients suffering from total facial defects of various lengths.

Conclusions. The analysis of our study showed that the use of extraoral implants of various designs for total facial defects of various lengths, taking into  account individual anatomical and topographic features, the etiology of  the total defect, has demonstrated its clinical effectiveness. 

 06.18.2021 in the Samara regional hospital named after I. V.D. Seredavin hosted a conference "Hightech medical care for patients of the Samara region – new horizons", organized by the Ministry of Health of the Samara region, the Samara regional branch of the Interregional public organization "Society of Transplantology", Medical University "Reaviz". The work is a resolution of the conference presidium.