The continuous changes in the basic values of modern society are based on transformations in the field of intellectual communication, an avalanche-like increase in the volume of new knowledge, the emergence of new medical technology, and a sharp increase in attention to human rights. These processes exacerbate deontological problems, which are most difficult to manifest when a doctor comes into contact with a dying patient. Purpose of the study. To improve the quality of medical care for a patient in a terminal state. Research results. For most people, death is associated with severe physical and spiritual suffering. The doctor can alleviate this suffering only with a deep understanding of the phenomenon of death, both from scientific and religious positions. The article analyzes the philosophical foundations of medical ethics, knowledge of which is necessary for a doctor when communicating with a dying patient. The modern understanding of death as a natural event necessary to support the development of living nature is given. It is shown that our society has not yet developed the principles of the culture of death. In connection with the development of modern medical technologies, it became necessary to search for new criteria for death. The modern legal and moral interpretation of the human right to death with dignity is considered. The difficulty of communicating information about a fatal diagnosis to a patient is noted: when a bitter truth is possible, and when a “holy” lie is needed. The proposition is put forward that the complexity and contradictory nature of the problem of euthanasia is solved by providing the terminal patient with high-quality palliative care. Conclusion. Despite all the wonderful judgments about the necessity and importance of death in the development of mankind, the tragedy of personal death cannot be removed even by the most optimistic philosophy. However, a doctor, armed with modern knowledge, possessing modern deontological methods, endowed with high moral qualities, can significantly reduce the level of feeling of this tragedy. Death is an important stage in a person's life, the confidence of all living people that their terminal period will be provided with proper care and attention, will greatly improve the quality and the entire period of a person's life.

This article discusses the properties of endogenous and exogenous interferon as the most effective element in the fight against a new coronavirus infection, analyzes the use of various groups of interferons, the time criteria for their use, and resistance to modified strains of coronavirus.

The prevalence of COVID-19 infection and the mortality associated with the disease are steadily progressing [1, 2]. The difficulties in diagnosing and treating COVID-19 in the context of a constant increase in the number of cases cause an urgent need to study and describe this infection, which is important for the medical and scientific community around the world. We performed an observational study of patients with COVID 19 infection, which developed during hospital treatment of another acute or exacerbation of chronic somatic pathology. We analyzed the clinical symptoms, the severity of the course of the new coronavirus infection and viral pneumonia.

The new coronavirus infection (COVID-19) is a life-threatening condition. The features of the treatment of COVID-19 in pregnant women are not sufficiently studied and contradictory, therefore, research in this area is relevant.

Objective. Assess the presence of liver disease in pregnant women with COVID-19 infection during pregnancy and after childbirth, taking into account the treatment.

Methods. A retrospective analysis of medical records of 43 pregnant women aged 19 to 39 years (mean age 29.1 ± 5.4 years) who were hospitalized with laboratory-confirmed COVID-19 infection was performed. The selection was carried out by the method of continuous sampling.

Results. 17 women (39.5%) had an acute respiratory viral disease, 26 people (60.5%) were diagnosed with bilateral polysegmental pneumonia with pulmonary tissue damage from 5 to 25%. In the structure of extragenital pathology, 46.5% of women had anemia and 23.3% of diseases of the hepatobiliary system, including chronic non-calculous cholecystitis (4.7%), biliary dysfunction (7%), chronic viral hepatitis B (2.3%) and chronic viral hepatitis C (9.3%). 6.9% were diagnosed with cholestatic hepatosis of pregnant women before admission to the hospital. An increase in the level of transaminases above the upper normal values was noted in 69.8% of cases, alkaline phosphatase – in 76.7%. In the structure of pregnancy complications in women with COVID-19 infection, fetal hypoxia prevailed in 15 women (34.9%). In second place is premature rupture of amniotic fluid (16.3%) and fetal malnutrition (16.3%).

Conclusions. Pregnant women with diseases of the hepatobiliary system and anemia are most susceptible to new coronavirus infection. They have an increase in the level of transaminases and alkaline phosphatase, which can be caused by liver damage due to the increased tropism of the virus to cholangiocytes and hepatocytes, as well as hepatotoxic drugs. The most common complications of pregnancy in women with a new infection are premature birth, fetal hypoxia, and antenatal death.

The aim of the study was to study the characteristic features of ultrastructural changes in the cellular and extracellular matrix of the adrenal and thyroid glands in chronic hypoxia.

Materials and methods. The study used the thyroid and adrenal glands of healthy adult male white rats weighing 180-200 g. The anatomical, histological, histochemical, electron microscopic and morphometric methods were used.

Results. We found that the response of thyroid and adrenal cells to hypoxia is different. So, since the processes of proliferation in the cells of the thyroid gland occur faster and earlier, all tissues are restored on the 15th day of the experiment in the thyroid gland, and in the adrenal gland are restored only on the 30th day of the experiment. And this can be regarded as a higher degree of sensitivity of the adrenal glands to hypoxia, which is a stronger stress factor than the thyroid gland.

Summary. The structures of the thyroid gland adapt to long-term hypoxia earlier, and responds to this with ultrastructural rearrangement – hyperplasia, hypertrophy and proliferation of thyrocytes.

As a result of mechanical trauma to the eye and damage to the blood-ophthalmic barrier, an inflammatory process occurs and, as a result, oxidative stress is a state of the body that develops against the background of an overproduction of free radicals, with a violation of the effectiveness of antioxidant protection. The aim of the study was to study the dynamics of oxidative stress coefficients for the integral assessment of the antioxidant status of rat liver tissues under oxidative stress induced by mechanical eye trauma. The study was carried out on outbred white sexually mature healthy male rats of six months of age, weighing 220–240 g in the amount of 150 pieces. For the integral assessment of oxidative homeostasis in rats, the coefficients of oxidative stress were used: a coefficient expressing the ratio of catalase activity to SOD activity; antioxidant-prooxidant index (API), which expresses the ratio of catalase activity to MDA concentration; the coefficient of the ratio of the concentration of MDA to the concentration of DC and the local antioxidant index (LAI), which is the ratio of the product of the activities of catalase and SOD to the concentration of MDA. The study found that the antioxidant status of rat liver tissue under oxidative stress caused by mechanical trauma of the eye is most effectively stabilized by standard therapy of mechanical trauma of the eye with the addition of quercetin in the form of injections. 

Objective: To establish a possible relationship between the Giacomini vein and osteoarticular pathology of the lower extremities in chronic venous diseases (CVD).

Materials and methods. In 115 examined patients (out of 321), we identified the Giacomini vein (92 women, 23 men). The average age of men was 44.82 ± 1.62 years; women – 45.36 ± 3.31 years. All patients were divided into 3 groups by anatomical randomization. The first group was without pathology, the second group of patients had only CVD, and the third group included patients with CVD and osteoarticular pathology. The criteria for inclusion in the groups were: the presence of Giacomini vein in patients, chronic venous disease and osteoarticular pathology on one or both lower extremities. Exclusion criteria: age of patients less than 18 years, the presence of CVD C5-C6 according to the CEAP classification, post-traumatic changes in the osteoarticular system, post-thrombotic transformation of the veins of the lower extremities. Using triplex angioscanning, the anatomical features of the structure of the venous system of the lower extremities were assessed. The study of the condition of the foot was carried out using the Friedland method.

Results. Group I with an absolute norm of the venous and osteoarticular systems included 30 people (26 %). The second group consisted of 45 patients (39.22 %) with CVD C0-C4 according to CEAP, and the third group consisted of 40 patients (34.78 %) who, in addition to venous, osteoarticular pathology. Chronic venous diseases in patients of groups II and III were distributed as follows: C0 – 25.6 %; C1 – 16.4 %; C2 – 49.4 %; C3 – 4.3 %; C4 – 4.3 % on the CEAP scale. Among the osteoarticular pathology, the most numerous group consisted of changes in the configuration of the foot, non-traumatic deformities – 32 (27.81 %) cases. To confirm the relationship between venous and osteoarticular pathology, we used the Pearson criterion. We found a significant correlation in the presence of nontraumatic deformities of the foot in the group of patients with CVD (Pearson's criterion 0.749642; p < 0.22). A strong correlation was established between the age of patients and changes in the venous and osteoarticular systems of the lower extremities (Pearson's criterion 0.7677696; p < 0.22), which confirms the relationship between the development of nontraumatic changes in the foot and CVD in patients with Giacomini vein with age.

Conclusion. It was found that the presence of an altered Giacomini vein leads to an aggravation of venous stasis in the lower extremities, which in turn increases the likelihood of developing venous pathology. Chronic diseases of the veins of the lower extremities contribute to dystrophic changes in soft tissues, most pronounced in the distal part of the extremity and, as a consequence, predispose to the development of osteoarticular pathology. 

Aim. The article discusses the results of a study using a patented method of two-layer laparoscopic repair of large and giant hiatal hernias using a biocarbon implant in comparison with other surgical techniques.

Materials and methods. 716 patients were divided into 3 study groups based on the area of the size of the esophageal hernia defect: group I (314 patients) – with small (less than 5 cm²) and medium (5–10 cm²) hiatal hernias, that is, up to 10 cm², which hernioplasty was performed only by the method of posterior cruraphy; group II (323 patients) – with large hernias 10–20 cm²: subgroup 1 (92 patients) underwent posterior cruraphy, subgroup 2 (231 patients) – alloplasty. Depending on the alloplasty technique, subgroup 2, in turn, was divided: subgroup A (89 people) – hernioplasty with a polypropylene implant and subgroup B (142 people) – hernioplasty with a medical biocarbon construction. Study group III (79 patients) – patients with giant diaphragmatic hernias of more than 20 cm² using alloplasty: subgroup A (29 people) – hernioplasty with a polypropylene implant and subgroup B (50 patients) – alloplasty with a medical biocarbon construction.

Results. When comparing group I with subgroup 1 of group II, the following results were obtained. Statistically significant differences were found in the degrees and types of diaphragmatic hernias. The average age of patients and statistical differences for it were insignificant. When comparing subgroup 1 with subgroup 2 of group II, statistically insignificant differences were found in the degrees and types of hiatal hernias. The difference in the average age of patients was also statistically insignificant. The difference in the average age of patients was also statistically insignificant. When comparing subgroup A with subgroup B of group II, statistically insignificant differences were found among themselves in the degrees and types of hiatal hernias. When comparing subgroup 2 of group II with group III, the difference turned out to be statistically significant in the distribution of patients by types and degrees of diaphragmatic hernias. When comparing subgroup A with subgroup B of group III by degrees and types of hiatal hernias, statistically insignificant differences were revealed.

Conclusion. Posterior cruraphia in small and medium diaphragmatic hernias had significant statistical differences in types and degrees compared to that in large hernias, as well as in the average area of the hernial defect. Posterior cruraphia with hernioplasty in large hiatal hernias did not differ statistically significantly according to any of the criteria. Plastic surgery with a polypropylene implant with alloplasty of a biocarbon implant for large hernias did not differ significantly according to any of the criteria. Hernioplasty for large hiatal hernias, when compared with giant hernias, differed significantly only in the degree and type, as well as in the area of the hernial defect. «Onlay» plastic surgery with a polypropylene implant with alloplasty of biocarbon structures for giant hernias did not differ significantly according to any of the criteria, except for gender distribution, which did not have significant fundamental significance, which made it possible to make a more correct comparison of the results of surgical interventions in these research subgroups.

Relevance. Early detection of severe forms of acute pancreatitis remains an unsolved problem of urgent surgery.

Objective of the study: early detection of prognostically unfavorable forms of the disease based on the constitutional characteristics of the patient.

Materials and methods. A comparative prospective analysis of the clinical course of acute pancreatitis in 270 patients with an assessment of the prognostic significance of clinical, instrumental and anthropological data in the early diagnosis of severe forms of acute pancreatitis was carried out. In 179 patients there was a moderate and severe form of the disease, in 91 patients the disease was mild.

Results and discussion. ROC analysis of the studied criteria showed that clinical and laboratory data on the first day of the disease are not reliable predictors of the risk of death. The somatotype and the amount of adipose tissue in the body (type of nutrition) showed a significant predictive value of AUC (0.768 and 0.655, p < 0.01 and p < 0.05, respectively). At the same time, only the body type AUC (0.658, p < 0.0001) showed statistical reliability as a significant prognostic factor for the progress severity of the patient's condition. The criti cal boundary calculated value of the somatotype is 20 nominal units. The risk group includes persons with a body type close to brachymorphic.

Conclusion. Carrying out somatotyping with the calculation of its numerical values, attributing the patient to a particular type of physique in the group of patients with acute pancreatitis in the early stages from the moment of the disease, is an additional criterion for early prediction of the course of acute pancreatitis and will allow to determine the competent treatment to avoid manifestation of severe form of disease.

Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.

The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus.

 Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.

Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.

Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.

The relevance of the study is due to the increase in the volume of conservative and surgical care for women who need mandatory rehabilitation measures in the postoperative period. Until relatively recently, there were very few rehabilitation facilities in the country where women could recover under the supervision of a nurse. Therefore, rehabilitation could drag on for many months and it was very difficult to fully return to normal life. In the modern world, it has become possible to undergo all the necessary analyzes and conduct treatment using the latest scientific methods on high-precision equipment, and then perform a full course of postoperative regeneration. After all, medical centers have great technological capabilities today and control the healing process as soon as possible. The nature of the measures for the recovery of women depends on the changes in the body, which are due to the individual background at the time of treatment. It is important to understand the dependence of a woman's position at the time of recovery: the duration of taking medications, the presence of psychological trauma, the development of chronic diseases, the frequency of repeated interventions. The aim of the study is a step-by-step volumetric study of the implementation of various measures aimed at the rehabilitation of women after conservative and surgical treatment. Modern approaches require responsibility, high qualifications of medical personnel and the direct participation of the patient himself in this process. Timely start of rehabilitation ensures productive restoration of lost functions. The main principle of success is the use of standardized methods, informing the patient at all stages of treatment, using techniques with minimal consequences and maximum impact, and analyzing the course of the postoperative period. The need for an in-depth study of the features of providing medical care to patients with gynecological diseases, including after surgical interventions, is confirmed. The practical significance of the material lies in the high-quality and effective organization of medical rehabilitation, which is of key importance for the full restoration of the functions of the woman's reproductive system.

This article discusses the issues of studying the dynamics of changes in serotonin in biological fluids as a marker in various neuro-orthopedic diseases in patients of different ages. For this, an analysis of clinical practice has been carried out. It is concluded that changes in serotonin levels can be considered as an indicator of pain sensations and control of ongoing therapy in neuro-orthopedic pathologies. The need for a further indepth study of the existing practice of assessing changes in the level of serotonin in biological fluids during conservative treatment and after surgery in various cases of neuro-orthopedic diseases in patients of different ages is indicated.

The clinical significance of heart rate variability (HRV) was assessed at the end of the last century, despite the fact that HRV studies have been conducted since the mid-19th century. In recent years, HRV has been increasingly used for non-invasive monitoring of the autonomic nervous system. However, the interpretation of HRV features is still not fully understood and widely discussed. It is known that HRV fluctuations are created by various regulatory systems of the body, which have different natural frequencies. The estimated HRV parameters are SDNN and RMSSD indicators – standard deviations of a number of RR-intervals and a number of first differences of RR-intervals, respectively. The purpose of the article was to calculate the power decrease with aging in different frequency ranges, analyze the errors of spectral estimates, and compare the spectral estimates of RSA with the values of RMSSD indicators. Simultaneous ECG and respiration records from the Fantasia Physio Bank database were used as initial data. For reference estimates, the powers in the range of respiration rate found from the records of respiration measurements are taken. It is shown that with age the power of the HF range decreases most rapidly, and the VLF range decreases most slowly. HF oscillation amplitudes are compared with RMSSD values. It is proposed to consider the RMSSD indicator as an assessment of the speed parameter of the regulatory system. Spectral methods are used to estimate the power of individual frequency ranges. For non-invasive monitoring of the autonomic nervous system, spectral estimates of the power of the LF and HF ranges are used. With aging, stress, and various diseases, the activity of regulatory systems decreases, but it remains unclear in which regulatory systems and to what extent violations occur.

This article is devoted to the analysis of the clinical case which includes the clinical manifestations and treatment of multiple choledocholithiasis and locally advanced kidney cancer. A staged surgery was performed. Retrograde papillosphincterotomy with cholechocholitholite extraction was done at the first stage. The second stage includes laparotomy, removal of the tumor of the right kidney / adrenal gland as a single block, cholecystectomy after preliminary angiography and embolization of the vessels feeding the tumor. The presented successful observation demonstrates one of the modern approaches in the treatment of patients with comorbid pathology.

Introduction. Physical training is the most important element of the combat readiness of the troops, its goals and objectives are defined by the Manual on Physical Training in the Armed Forces of the Russian Federation. The solution of these tasks should contribute to the formation of military personnel's readiness to endure extreme physical and mental stress during the preparation and conduct of combat operations. Comprehensive provision of physical training in the troops requires the hard work of various services, including the medical service.

The purpose of the study. Identify problematic issues of medical support for physical training and sports events in the Armed Forces of the Russian Federation and identify ways to solve them.

Materials and methods. The article uses the materials of the work of medical and nursing teams in the medical provision of physical training of units of the Southern Military District from 2016 to 2019. Additionally, the data of an in-depth medical examination of the personnel of some units of the district subordination for 2018 were used.

Results and discussion. When analyzing the work of visiting medical and nursing teams during the medical support of passing the standards for physical training, a number of problematic issues were identified. First, there are always military personnel who regularly do not engage in physical training and during the delivery of standards make excessive efforts and work at the limit of their capabilities. Secondly, some exercises are very dangerous, either in terms of injuries or the likelihood of developing complications from the cardiovascular system. All this applies to the medical support of the competition. As an example, the championship of the Armed Forces of the Russian Federation in fire and rescue sports, held from 3 to 6 September 2019 in Rostov-on-Don on the territory of the garrison fire brigade, is given. The program of the competition included passing the obstacle course, climbing the training tower, extinguishing the fire, etc., all very traumatic. Therefore, for the medical support of these competitions, a medical and nursing team of the resuscitation profile was allocated on a reanimobile with specialized stowage, respiratory and oxygen equipment.

Conclusion. It is necessary to strictly monitor the correctness of the definition of the group of physical training and the gradual increase in physical activity in order to avoid complications and further progression of diseases or even deaths in military personnel. It is impossible to approach formally the conduct of an in-depth medical examination of military personnel.