Malignant neoplasms are associated with an increased risk of developing acute cerebrovascular accidents. This article provides a review of the literature on hemostatic disorders during oncological processes in patients with ischemic stroke. Cancer-associated stroke can develop for several reasons, including direct effects of the tumor, as well as indirectly through the development of blood coagulation disorders, concomitant infectious diseases, or complications of antitumor therapy. One of the most common pathogenetic mechanisms is cancer-associated coagulopathy. Trousseau syndrome is a variant of paraneoplastic syndrome, characterized by a state of hypercoagulability with the development of thrombosis that precedes the diagnosis of a malignant neoplasm or develops simultaneously with it. Cerebral ischemia in Trousseau’s syndrome is characterized by a multifocal pattern of lesions according to neuroimaging data. To date, there are no clear diagnostic criteria for cancer-associated stroke, which is often one of the first clinical manifestations of the oncological process. According to various studies, laboratory markers of hypercoagulability can serve as predictors of previously undiagnosed malignancy in patients with cryptogenic ischemic stroke. Currently, more and more attempts are being made to develop diagnostic scales based on clinical and neuroimaging characteristics of stroke to identify hidden oncological processes. Another important aspect of the issue remains the lack of evidence-based recommendations for the treatment of ischemic stroke associated with cancer. Given the prevalence of stroke in cancer patients, potentially poor functional prognosss, higher rates of post-stroke mortality and high relapse rates, further research into this issue is required.

Treatment of complicated caries in children and adolescents has a number of features, which is determined by age-related anatomy and the limited functioning time of temporary teeth, as well as the timing of their root resorption. Today, the treatment of pulpitis of preserved temporary (persistent) teeth is of particular clinical interest. Persistent (delayed) teeth are temporary (baby) teeth that are preserved in the dentition after the physiological time of their replacement and are capable of functioning for 10 years or more. In most cases, the presence of retained temporary teeth is due to congenital edentia of permanent teeth, retention or death of their rudiments. There is no data in the literature on the features of the anatomical structure of persistent teeth and recommendations for their endodontic treatment. At the same time, in the treatment of this pathology, the methods of pulpotomy (devital amputation, impregnation method) and pulpectomy (pulp extirpation, vital method) are widely used, followed by obturation of the root canals with resorbable filling materials. Taking into account the above, we conducted a retrospective analysis of 192 orthopantomograms of patients with congenital permanent adentia and the presence of 289 persistent teeth. The anatomical features of the structure of the root canals of persistent teeth have been determined. The results of treatment of 44 preserved temporary teeth with chronic fibrous pulpitis in 27 patients of childhood and adolescence using the method of vital extirpation followed by restoration of the crown parts of the teeth using therapeutic and orthopedic methods are presented. Long-term treatment results up to 60 months were assessed. Meanwhile, the results obtained indicated the absence of signs of root resorption in persistent teeth over a long period of time from the period of their physiological change, as well as the features of the anatomical structure of root canals, similar to that of permanent teeth, and allowing endodontic treatment of preserved teeth using classical for permanent teeth pulpectomy method. The results of clinical observation and X-ray examination in the long term after treatment allow us to conclude that the approach used is highly effective, which reduced the risk of periapical complications and created conditions for the longterm functioning of persistent teeth.

At the end of 2019, an outbreak of a new coronavirus infection, SARS-CoV-2, emerged in the People’s Republic of China with the epicenter in the city of Wuhan, Hubei Province. On February 11, 2020, the World Health Organization determined the official name of the disease caused by the new coronavirus – COVID-19, and on March 11, 2020, announced the beginning of a pandemic caused by the SARS-CoV-2 infection. COVID-19 is a “young disease”, which determines the importance of studying the influence of chronic comorbid pathology on the risk of infection with SARS-CoV-2, the severity of the course and the likelihood of developing an unfavorable outcome of the disease. Accumulated data identify several risk groups for severe COVID-19. First of all, this applies to patients with concomitant chronic pathologies: diabetes, cardiovascular diseases, obesity, and others [5, 15]. Coinfections affecting the respiratory tract pose clinical dilemmas as well as diagnostic and therapeutic challenges. This article presents clinical cases of the course of a combination of COVID-19 infection and pulmonary tuberculosis. The new coronavirus infection was more severe in a female patient with newly diagnosed tuberculosis than in a female patient with a chronic tuberculosis process, which confirms a different influence of the pathological processes on each other.

The article presents data on the frequency of risk factors for cardiovascular diseases in adolescents. A statistical analysis was also conducted to determine the correlations between the risk factors when an individual has multiple risk factors. The following risk factors for cardiovascular diseases, already occurring frequently in adolescence, were evaluated: high blood pressure, overweight, elevated cholesterol levels, carbohydrate metabolism disorders, low physical activity, eating disorders, and stress perception. A total of 712 adolescents aged 15 –16 years were examined, including 360 girls and 352 boys, residing in the city of Yakutsk, Sakha Republic (Yakutia). The study revealed that among adolescents, low physical activity showed the highest frequency among the risk factors, followed by others in descending order: restrictive eating behavior, high cholesterol and glucose levels, overweight and obesity, and high stress perception. The differences found were based on gender, with boys being more susceptible to obesity. Correlation analyses using Spearman’s (rs) and Pearson’s (rp) coefficients and Pearson’s chi-square test were used to identify relationships between risk factors for cardiovascular diseases. The analysis showed that high blood pressure is associated with adolescents who have high body mass index. Gender-based analysis showed that girls are more prone to arterial pressure disorders and elevated cholesterol and glucose levels.

Epilepsy is one of the most common diseases of the nervous system in children. According to WHO, more than 50 million people worldwide suffer from epilepsy. It is estimated that the proportion of the general population with its active form (that is, with recurrent seizures and the need for treatment) currently ranges from 4 to 10 per 1,000 people. Globally, 2.4 million people are diagnosed with this disease every year. In Russia, epilepsy affects more than 1 million people. The analysis of statistical data on the prevalence and incidence of epilepsy in children in the Republic of Sakha (Yakutia) was carried out. In Yakutia, the first epidemiological study of epilepsy in the pediatric population was conducted in 1985 by E.A. Krivogornitsyna. As a result of the survey, data were obtained on 322 children who were registered at the dispensary with neurologists and psychiatrists in 32 districts of the republic and the city of Yakutsk. According to the study of the epidemiology of epilepsy in children in 2004 (Baisheva G.M., 2004), the prevalence of epilepsy was 5.2 per 1,000 children of the Republic of Sakha (Yakutia), and the primary incidence was 114 per 100,000 children. Prevalence of epilepsy in children under 14 years of age in 2020 was 5.4 per 1,000 population, the primary incidence was 50 per 100,000 population. On average, from 2010 to 2020, the primary incidence of epilepsy in children is 80 per 100,000 population. The prevalence of epilepsy in adolescents aged 15 – 17 years averaged 10.4 %. The average value of primary morbidity in this group of children was 140 per 100,000 population. The organization of comprehensive medical care will make it possible to form a strategy for the management of epilepsy patients at the municipal and republic levels.

In order to assess the safety and efficacy of intraoperative local thrombolysis followed by reconstruction and plasty of the vessel, we studied the immediate results of treatment of 28 patients with thrombotic occlusions of shunts and arteries of the lower extremities. Recently, the inflammatory theory of atherosclerosis has attracted much attention. The inflammatory process in atherosclerosis is observed from the early development of lesions in the vessel wall to the destabilization and destruction of atherosclerotic plaques. The thinning of the fibrous plug and the expansion of the lipid core in it are considered important factors of destabilization leading to damage to atherosclerosis and thrombotic occlusion. The causes leading to the development of inflammatory processes in atherosclerosis are currently studied extensively, but not exhaustively. The indication for thrombolytic therapy was severe ischemia of the lower extremities with a thrombosis duration of 3 days to 3 months and minor symptoms in the distal arterial bed. Local thrombolysis was performed using Urokinase Medak and Fortelizin, restoration of blood flow was achieved in 25 patients. Early recurrent arterial thrombosis at the site of reconstruction developed in three patients. In the long term, the operated limb was amputated in two patients.

The study showed that local intraoperative thrombolysis together with arterial reconstruction is a fairly safe and effective method for the treatment of thrombotic occlusions of the arteries of the lower extremities, shunts and prostheses at different stages of thrombus formation. This method may be a good option when selective catheter- guided thrombolysis is in doubt due to inadequate distal blood flow on angiography.

The purpose of the study was to investigate the incidence of in-stent restenosis after the first percutaneous coronary intervention (PCI) in patients with recurrent coronary event and to evaluate the influence of comorbidity factor. The analysis of 1,198 electronic patient histories from the Department of Emergency Cardiology with Anesthesiology-Resuscitation Group (ECA with ARG) of the Republic’s Vascular Center, “Republic’s Hospital No. 2 – Сenter Of Emergency Medical Aid», for the year 2022 was carried out. According to the results of the analysis, 77.5 % of 1,198 patients of the Department were treated for acute coronary syndrome (ACS), out of which 62 % were diagnosed with myocardial infarction. The ACS patients underwent PCI in 78.5 % of cases. Restenosis of the previously implanted stent within 5 years was detected in 2.7 % of patients with ACS. Patients with stent restenosis were predominantly men (84 %) aged 60 – 74 years (76 %). Among the studied 60-74-year-old patients, in 68.4 % of the cases, repeated hospitalizations were related to stent restenosis in one year or more after PCI. Recurrent coronary events in 36 % of patients were manifested as ST-segment elevation myocardial infarction (STEMI); 24 % experienced non-ST-segment elevation myocardial infarction (NSTEMI); and 40 % of the patients with stent restenosis were diagnosed with unstable angina. Drug-eluting stents were used in 84 % of the cases undergoing PCI; 56 % of the patients received PCI with two or more stents. Multivessel coronary artery lesions occurred in 80 % of the patients. All patients with restenosis had arterial hypertension, 20 % were obese (BMI≥30 kg/m2), 16 % had type 2 diabetes mellitus, and 4 % had impaired glucose tolerance. Target cholesterol LDL levels were not achieved in 72 % of the patients. According to transthoracic echocardiography data, 28 % of the patients with stent restenosis had left ventricular ejection fraction less than 40 % according to Simpson. Among the comorbidities, chronic obstructive pulmonary disease was found in every third (32 %) patient; chronic kidney disease was seen in 40 %.

The article considers changes in the legal regulation of medical activities, which entered into force on September 1, 2023. New regulatory legal conditions for the development of medical organizations assume that medical organizations participating in the state guarantee program will have the right to provide paid services. Previously, the current procedure assumed that medical organizations providing services under the compulsory medical insurance could provide paid medical care on different conditions than provided for by the state guarantee program. Therefore, the development of private medicine and the problems facing private medical organizations in modern conditions are relevant and require discussion. The purpose of this work is to consider the regulatory legal conditions for the development of private medical organizations in the Russian Federation at the current stage. The conclusion is that today a lot of work is being carried out by the professional community responsible for approving the procedures for the provision of medical care and clinical recommendations, which should be guided by all medical organizations operating in the domestic market of medical services. The infrastructural provision of medicine should meet the needs of the population, ensure the provision of medical care in the specified volumes by type and form and be effective.

In order to achieve high sports results, a comprehensive study of the athlete’s body is necessary. The morphofunctional study is the most informative and accessible. However, the somatotype-related functional state of the cardiovascular system of athletes remains insufficiently studied. The purpose of the research: To determine the indicators of the cardiovascular system of athletes in response to physical exertion, depending on the somatotype according to Reese-Eysenck. An anthropometric and functional study of the cardiovascular system of 49 athletes of the highest sports skill engaged in freestyle wrestling at the Sakha Republic’s Center for Traditional Sports was conducted. The Reese-Eysenck index was used to determine the somatotype. Functional examination of the cardiovascular system included blood pressure measurement and pulse counting at rest, then 1 and 2 minutes after exercise. The exercise consisted of a full squat with arms outstretched with a frequency of 20 squats in 30 seconds. In order to determine the tolerance of physical activity, the Roufier index was calculated. The adaptive potential of the cardiovascular system is determined using the index of functional changes. Somatotyping by the Reese-Eysenck index among the examined athletes revealed that a significantly large proportion of the examined individuals had an athletic somatotype. In pyknics, significantly large indicators of body weight and the transverse diameter of the chest were recorded. A functional examination of the cardiovascular system with the use of physical activity revealed a significantly greater increase in systolic blood pressure after 1 and 2 minutes and heart rate 1 minute after physical activity in individuals with the pyknic somatotype compared with others. The analysis of the results of the index of functional changes of athletes depending on the somatotype revealed the stress of the cardiovascular system function only in athletes of the pyknic somatotype. The obtained results indicate that the training process should be selected individually, taking into account the somatotype of an athlete, since among pyknics there are people with stress of the cardiovascular system with good results of physical activity tolerance according to the Roufier index.

The human respiratory system is daily exposed to various biotic and abiotic factors, and, first of all, there is damage to the cellular elements of the mucous membrane. Prolonged irritating effects are accompanied by inhibition of regenerative processes and subsequent morphofunctional restructuring of the structural components of the lungs. The aim of the study was to research the morphometric parameters of the structural components of the lungs of white laboratory rats at different periods of chronic simulated hypoxia combined with inhalation of natural gas from the Astrakhan field, at a concentration of 3 mg/m3. The study covered 94 white mongrel sexually mature male rats who were in conditions of chronic hypoxia combined with natural gas inhalation for 120 days. The animals were placed in a special seed chamber produced by the Erisman Institute with a volume of 200 liters with a variable composition of the air-gas mixture, and with a decrease in the oxygen concentration in the inhaled air to 17.5 %, natural gas from the Astrakhan field was supplied through a special nozzle. The animals were kept in experimental conditions lasting four hours a day for five days a week. For the manufacture of histological preparations, animals were anesthetized with sodium ethaminal (40 mg/kg weight). Lung tissue samples were fixed in a 10 % solution of buffered formalin. The preparations were stained with hematoxylineosin and Van Gison. The analysis and visualization of the obtained glass preparations was carried out using a ZeissAxioScopeA1 light microscope (Germany) and a LeicaAperioCS2 digital scanner of micropreparations with specialized software. It was determined that the initial significant changes were already formed by 60 days of experimental exposure. In one group of drugs, thickening of the interalveolar septa associated with the processes of edema formation and infiltration by cellular elements were noted, another group of drugs showed emphysemalike changes with stretched and partially torn alveoli. By day 90 of the experiment, a decrease in the airiness of the lung tissue was determined on all preparations, manifested by thickening of the interalveolar septa and a decrease in the diameter of the alveoli. By day 120, the changes identified in the early stages were progressively increasing: there were areas completely devoid of alveoli, other fields of vision showed alveoli with torn walls. On the part of the bronchi, the following pattern was determined: an increased thickness of the walls of the bronchi, mainly due to the mucous and adventitial membranes, followed by deformation of the bronchi of medium and small caliber and the formation of peribronchial infiltrates. The morphometric analysis confirmed that chronic hypoxia combined with natural gas inhalation causes significant changes in the structural components of the lungs.

Today cardiovascular diseases and oncopathology are leading causes in the structure of mortality worldwide. The complexity of diagnostics of haemocoagulation complications in this comorbid pathology remains an urgent problem at present. The aim of our study was to investigate the mechanisms of thrombotic readiness state formation using the thrombodynamics test on the example of patients with cardiovascular diseases (CHD, arterial hypertension) and aggravated oncoanamnesis depending on the activity of oncoprocess. The study was conducted in 100 patients aged 37 – 86 years: 60 patients with active oncoprocess (group 1) and 40 patients with oncoprocess in remission (group 2). Clinical, anamnestic and laboratory data were studied using a statistical analysis. The main attention was paid to the thrombodynamics test indicators (both velocity and structural). It was found that the most informative indicators of the haemostasis system state estimation in patients with cardiovascular pathology and aggravated oncoanamnesis depending on the oncoprocess activity are thrombodynamic indices both velocity and structural. Almost half of cardiological patients with an aggravated oncoanamnesis had a state of thrombotic readiness irrespective of the activity of the oncological process. These indices were higher in active oncopathology than in oncopathology in remission. At the same time no differences in the data of standard coagulogram in both groups could be revealed. Application of thrombodynamics test in cardiological patients with oncoanamnesis allows to reveal the states of thrombotic readiness and to establish the degree of influence of oncoprocess activity on the formation of this state, which demonstrates fundamentally new aspects of diagnostics of procoagulant states in patients of this profile.