There is have presented case report of clinical course of the disease, rehabilitation and prevention of post COVID-19 condition in a 56-year-old doctor who has undergone severe COVID-19, community-acquired bilateral polysegmental interstitial pneumonia with a volume of pulmonary tissue damage of 75%, with the development of multiple complications in the acute period of the disease and during the period of ongoing symptomatic COVID-19. There are listed typical problems that arise in such patients, the possibilities of rehabilitation measures to restore health and prevent the development of post COVID-19 condition.

During the pandemic that began in 2020, the role of the doctor has increased. The profession of a doctor can be attributed to the stressful for the personality of the doctor, and especially during the pandemic, when you have to work in particularly stressful conditions and with a greater load. The purpose of the study was to study the personality characteristics and burnout syndrome of health workers in the process of carrying out professional activities during the COVID-19 pandemic. The study involved health care workers working with COVID-19 patients and health care workers working with regular patients. As a result, data were obtained on the severity of emotional burnout in health workers of both samples. The results of the relationship between personal characteristics and symptoms of burnout syndrome in health workers were also presented.

The brief review deals with the specific value of B vitamins for the nervous system, the mechanisms of transport and metabolic functions of cobalamin, pathogenetic theories related to vitamin B₁₂ deficiency such as canonical biochemical theory and the theory of dysregulation of cytokines and growth factors; the hyperhomocysteinemic component of cerebral small vessel disease as one of the most common types of degenerative disorders of the central nervous system has been mentioned; the types of disorders associated with cobalamin deficiency that underlie its neurological manifestations have been described.

The relevance of research on molecular hydrogen in the world has increased significantly, since it turned out to be an extremely unique reagent, since it has the ability to act at the cellular level. Hydrogen is able to cross the blood-brain barrier, penetrate into mitochondria and other areas of cells, where it exhibits antioxidant, anti-apoptotic, anti-inflammatory and cytoprotective properties. The aim of the scientific review is to theoretically substantiate the current state of the use of molecular hydrogen and hydrogen water in environmentally friendly and sports medicine. For this, evidence has been provided regarding the effect of consumption of molecular hydrogen and hydrogen water on changes in physiological and biochemical parameters, taking into account the oxidative stress caused by exercise. In addition, this review highlights possible future directions in this area of research.

The importance of relieving paroxysms of fibrillation and atrial flutter is determined by a huge number of patients suffering from this pathology and its recurrent course.

Objective: To create an algorithm for the treatment of patients with atrial fibrillation and atrial flutter by comparing the efficacy and safety of drug-induced rhythm conversion with amiodarone, propafenone, procainamide, niferidil and electropulse therapy.

Material and methods. Heart rate conversion was performed in 299 patients. Amiodarone was used as a drug for therapy in 93 patients, propafenone in 34, procainamide in 52, and niferidil in 50. 70 patients underwent electropulse therapy. A comparative analysis was carried out to establish the effectiveness and safety of heart rate conversion by these methods.

Results. The effectiveness of conversion rhythm in atrial fibrillation with the help of electropulse therapy, propafenone, niferidil, procainamide and amiadarone has been established, which is 90,3%, 82,4%, 77,4%, 72,5% and 70.5%, respectively. It was also found that the use of electro-pulse therapy and niferidil, in which sinus rhythm recovery occurs in 94.4% and 78.9%, respectively, against 58.3% and 26.7% of patients receiving procainamide and amiodarone, respectively, is most appropriate for the relief of atrial flutter. Often, when using niferidil, ventricular extrasystole and prolongation of the QT interval during electrography developed in comparison with patients of other groups. Ventricular tachycardia, including the "pirouette" type, sinoatrial blockade, AV blockade of various degrees, were also slightly more often registered in these patients.

Conclusions. In order to stop atrial fibrillation, there are no differences between medications, and it is better to perform rhythm conversion with atrial flutter with niferidil or electro-pulse therapy.

Topicality. Adhesive intestinal obstruction is a common disease in abdominal surgery with a significant increase from year to year. During the last 20 years, the frequency of cases of adhesive intestinal obstruction (SCN) has increased by 2 times and has no tendency to decrease. In the UK, small bowel obstruction was an indication for 51% of all emergency laparotomies. Scott et al. reported seven emergency surgeries, accounting for 80% of all hospital admissions, morbidity, mortality, and health care costs in relation to general surgery in the United States. These seven operations included partial colectomy, small bowel resection, cholecystectomy, peptic ulcer surgery, adgeolysis, appendectomy, and laparotomy. Adhesive intestinal obstruction of the small intestine was the most frequent diagnosis in the behavior of four out of seven surgical interventions (partial colectomy, resection of the small intestine, adgeolysis and laparotomy). Postoperative adhesive processes are the main cause of small intestine obstruction, accounting for 60% of cases. Among all cases of intestinal obstruction, acute small intestine is 64.3–80%, while having a severe course and a worse prognosis. This causes a high mortality rate in this pathology. It ranges from 5.1% to 8.4%, occupying a leading place among all urgent diseases.

The purpose of the study was to evaluate various modern methods of diagnosing adhesive intestinal obstruction.

Material and methods. In this study, the method of classical analysis of domestic and foreign literature was applied, based on current data on the diagnosis of adhesive intestinal obstruction.

Results. Historically, there has been a certain algorithm for examining patients arriving with suspected adhesive intestinal obstruction, which includes: complaints, anamnesis of the disease and life, objective status, as well as additional diagnostic methods. Patients with OCD usually present a wide range of complaints, such as nausea, vomiting and periodic abdominal pain. Nausea and vomiting follow the appearance of pain and are an early sign of proximal adhesive OCN. However, clinical symptoms are only partially able to diagnose adhesive intestinal obstruction. Laboratory data are of little significance in the diagnosis of intestinal obstruction, but they help to determine the presence and severity of metabolic disorders, homeostasis disorders, as well as to indicate possible starngulation. For the diagnosis of OCN, OBP survey radiography is routinely used. Computed tomography (CT) has a higher sensitivity and specificity compared to abdominal X-ray examination and is recommended by the Bologna Guidelines. Ultrasound examination (ultrasound) is increasingly used in the diagnosis of OCD. Ultrasound is a relatively simple inexpensive non-invasive imaging method that is devoid of radiation exposure, but depends on the operator's experience. To minimize the effects of ionizing radiation in children and pregnant women, magnetic resonance imaging is an effective alternative to computed tomography for intestinal obstruction.

Conclusion. The problem of adhesive intestinal obstruction remains highly relevant, given the prevalence of the disease and high mortality rates. Currently, new promising methods for diagnosing this disease, including biomarkers and high-tech methods for visualizing the pathological process, such as computed tomography and magnetic resonance imaging, are acquiring high importance. At the same time, one should not forget about the routine research methods – X-ray of the abdominal cavity and classical methods of examining the patient – collecting complaints, anamnesis and determining the objective status.

The main goal of this study was to improve the results of therapy in patients with chronic wounds on the foot in diabetics (I-II degree according to Wagner's classification) using histoequivalent bioplastic material «G-derm».

Materials and methods. The study included 72 patients. The comparison group included 35 patients who underwent standard treatment with hydrocolloid dressings. The main group consisted of 37 patients. For them, in addition to standard treatment, the histoequivalent-bioplastic material «G-derm» was used. The patients' condition was assessed in dynamics on the 1st, 10th, 30th days from the start of treatment.

Results. By the 30th day, the complete epithelialization was registered in 12 (16.7%) patients. The main group included 8 (21.6%) cases, and the control group – 4 (11.4%). The unsatisfactory epithelialization (healing less than a quarter of the initial area) by the 30th day of treatment was in 14 (19.4%) patients: in the main group – in 4 (10.9%) patients, in the comparison group – in 10 (28.5%) of patients. The remaining 25 (67.6%) patients in the main group and 21 (60%) participants in the comparison group had satisfactory epithelialization results by the 30th day of treatment.

Conclusion. The results of this study show the effectiveness of using histoequivalent bioplastic material G-derm in local treatment of chronic wounds in patients with neuropathic diabetes in combination with standard therapies.The use of histoequivalent-bioplastic material in patients with diabetes leads to faster regeneration of the wound as well as increases the cases of complete epithelialization.

The article presents an observation of the successful treatment of a patient with a fracture of the surgical neck of the right humerus against the background of osteoporotic lesions of the bone skeleton. This patient was initially underwent osteosynthesis with a titanium T-plate and screws, however, 2 weeks later, the metal structure migrated and the cancellous substance of the humerus head was severely destroyed, which made it difficult to carry out repeated resynthesis. We have proposed and tested a new method of osteosynthesis of fractures of the surgical neck of the shoulder using a titanium plate and a cerclage loop. The presented clinical observation demonstrates the feasibility of performing osteosynthesis according to our proposed method in patients with severe osteoporosis, when other methods of osteosynthesis are ineffective, and endoprosthetics of the humerus head is unavailable due to the burdened somatic status of the patient and the inaccessibility of this operation in small hospitals in the country.

The article presents a clinical case of urgent surgical treatment, laparoscopic removal of the spleen in a comorbid patient in serious condition. Surgical treatment was carried out according to vital indications, a smooth postoperative period. With dynamic observation, a possible consequence of surgery is the occlusion of large vessels of the brachiocephalic tree. A multidisciplinary approach, which also extends to the conditions for providing medical care to a patient in the "red zone", clinical attentiveness and integration of services made it possible to save the life and achieve good rehabilitation for the patient despite the comorbid aggravation of her condition.

Problems of prevention of noncommunicable diseases are relevant for many countries of the world. This is due to the fact that the burden of noncommunicable diseases is growing from year to year, creating new challenges to the health systems of various countries. To address these problems, various programs are being implemented, both defining General prevention strategies across the country, and programs to combat individual risk factors. The article presents an analysis of programs aimed at fighting cancer, implemented in various countries. The essence analysis of the program showed that the main tasks, key priorities and directions of the state program for health development of the Republic of Kazakhstan “Salamatty Kazakhstan” (Healthy Kazakhstan) for 2011–2015 were formed and implemented taking into account the trends of economic, social and demographic development of the country. The usefulness of this complex intersectoral organizational technology for strengthening public health at the national level is shown, and evidence of the effectiveness of the program is provided.

Relevance. For many centuries, infectious complications have been one of the most pressing problems of surgical practice. In modern medicine, a wide range of aseptic and antiseptic methods is presented, which, without harm to the body, can destroy pathogenic microorganisms and prevent the development of purulent complications that significantly aggravate the patient's condition and increase the duration of treatment. However, this was not always the case. In the era of the formation of surgery, interventions in a significant majority of cases ended with the development of purulent and septic complications, which inevitably led to death.

The purpose of this study was to study the main points that play a key role in the history of the formation of modern asepsis and antiseptics.

Material and methods. In the course of the study, an analysis of domestic and foreign literature on the history of the development of aseptics and antiseptics was carried out. When compiling the work, the biographical method of historical research was used. Articles and historical sketches of the period of the described events were also used as materials.

Results. The formation of the principles of asepsis and antisepsis is a long historical process in which many of the greatest minds of mankind have been involved. At the same time, like the development of any scientific worldview, the development of asepsis and antiseptics was based on previous knowledge, as well as on knowledge obtained, mainly empirically. From time immemorial, physicians have already had an idea of the antibacterial properties of a number of compounds. The first mentions of attempts to prevent contamination of wounds and their disinfection date back to the time of Hippocrates. In the Middle Ages, for the purpose of disinfecting wounds, cauterization with a red-hot iron and boiling oil was widely used. From the middle of the 18th century, the first antiseptics entered the practice of surgeons. From the middle of the 19th century, a significant contribution to the development of asepsis and antiseptics was made by the Russian surgeon N.I. Pirogov, and his follower N.V. Sklifosovsky. A breakthrough in the development of asepsis and antiseptics in the late 19th – early 20th centuries was the scientific discovery of the French scientist Louis Pasteur, who proved that the processes of fermentation and decay are caused by microorganisms. This discovery formed the basis of J. Lister's antiseptic method. At the end of the 19th century, E. von Bergmann developed the aseptic method. One of the last significant events in the history of antiseptics was A. Fleming antibiotics.

Conclusions. Thanks to the work of great scientists and doctors, there are many life-threatening postoperative complications that claimed the lives of many people, if they did not remain in the past, then their incidence and intensity of manifestations have noticeably decreased, and asepsis and antiseptics have become an integral component of surgical practice.

Background. The pathologies of the salivary glands are very diverse. Salivary stone disease occupies a special place among diseases of the salivary glands of a non-neoplastic nature. The incidence of salivary stone disease is extremely extensive and accounts for up to 85% of all pathologies of the salivary glands.

Objective. Improvement of minimally invasive methods of treatment of salivary stone disease, which does not lead to excision of the gland.

Material and methods. On the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia, in the period from 2010 to 2020, a clinical group was formed, consisting of 193 patients with salivary stone disease of various localization. The age of the patients ranged from 16 to 84 years. All patients were therapeutically examined at the preoperative stage, voluntary informed consent was signed. Shockwave sialotripsy was performed in 95 patients of the main group (in 64 patients the calculus was located in the submandibular salivary gland, in 31 patients – in the parotid salivary gland). For lithotripsy, we used a lithotripter apparatus "Edap" (France) and "Wolf" (Germany).

Results. The analysis of the results obtained as a result of the study made it possible to draw a conclusion about reasonably better results of removal of calculi in the ducts of the salivary glands using the lithotripter "Swiss LithoClast® Master" (Switzerland). At the first visit and the therapeutic effect of the lithotripter, all patients suffering from bouts of salivary colic showed complete cessation.

Conclusion. Thus our study, which was devoted to the study of the results of various methods of treating patients with salivary stone disease showed that sialolithotripsy using special narrowly targeted devices for crushing and subsequent excretion of salivary calculi allows to achieve the best results at present.

Relevance. According to a number of authors, it is known that full adaptation to complete removable dentures occurs within 3 months [3–5, 9]. The main criterion for patients getting used to removable dentures is the synchronization of the work of the masticatory muscles and, as a consequence, the normalization of the chewing function. The aim of the study was to evaluate the bioelectrical activity of the masticatory muscles in patients using the CSPP.

Materials and methods. In patients of the control (n = 23) and main (n = 63) groups, electromyographic examination was performed using the electroneuromyographic system "Synapsis" (Neurotechnology, Russia). Registration of the bioelectric activity of the chewing muscles was carried out directly on the day of applying the prostheses, after 1 and 3 months, respectively.

Results and discussion. The electromyographic indices of the masticatory muscles in the patients of the control group decreased within one month after the treatment and amounted to 231 ± 18.2 μV for the right and 229 ± 16.1 μV for the left proper chewing muscles. The values were also reduced for the right and left temporal muscles – 228 ± 15.2 μV and 225 ± 24.1 μV (p < 0.05). It should be noted that the electromyographic parameters in patients of the main group were comparable to the lower limit of the norm and amounted to 269 ± 16.5 μV and 256 ± 20.4 μV, respectively, after one month of treatment.

Conclusions. In the treatment of dysfunction of the temporomandibular joint with the use of thermoplastic prostheses, an increase in the biopotentials of the masticatory muscles is observed. In the orthopedic treatment of patients with terminal dentition defects using thermoplastic prostheses, the electromyographic parameters of the masticatory muscles are most close to normal after 3 months of using these prostheses.

The work is devoted to topical issues of the use of mechanical bypass of the left ventricle, in particular, the prognostic criteria of right ventricular function, which are key in the outcome of the disease. Retrospective studies of individual institutions were analyzed; patients who received pulsating LVAD were included. Various indicators and scales are presented, and different models of predictors of the development of right ventricular failure are compared. Thus, the development and implementation of reliable predictors of the development of right ventricular failure before implantation of left ventricular assistive devices is an urgent problem of modern transplantology and functional diagnostics.