The interest of researchers in melatonin is due to its influence both on the reproductive health of women - successful ovulation, conception, pregnancy and delivery - and fetal health and programming of its diseases after birth. Melatonin, synthesized in the ovary, is involved in the maturation of the egg, protects against damaging effects of free radicals, promotes the development of the yellow body and the formation of progesterone. Normal circadian release of melatonin is involved in the correction of various pathological conditions that arise during pregnancy - sleep disorders, pre-eclampsia, paroxysmal disorders, HELLP syndrome. Throughout the pregnancy, melatonin circadian passes through the placental barrier, affecting the development and synchronization of the suprachiasmal nucleus of the hypothalamus in the fetus. The antioxidant properties of melatonin make it possible to optimize the reproductive physiology of pregnant women, eliminating undesirable oxidation-nitrosation reactions in the cells of the ovaries, uterus and placenta. Deficiency of the pineal and extrapineal circadian secretion of melatonin into reproductive cells, the violation of axonal transmission and the susceptibility of melatonin receptors in the maternal and fetal organs, leads to the development of a wide range of endocrine, immune and vegetative disorders in them. The pro-inflammatory activity of melatonin is caused by the removal of toxic oxygen and nitrogen from cells both by direct absorption and by metabolizing them into non-reactive products, by limiting the production of various pro-inflammatory molecules (prostanoids, leukotrienes, cytokines). The anxiolytic and analgesic effects of melatonin are realized through the action on opioid μ- and β-endorphin receptors. The use of exogenous melatonin in obstetrical practice makes it possible to control labor activity in women, contributing to a favorable delivery. Melatonin is effective in correcting asphyxia in newborns due to suppression of oxidative stress and influence on survival growth. At the same time, the neurophysiological, clinical, ethical, diagnostic and therapeutic aspects of the action of melatonin on a pregnant woman and her fetus are still insufficiently studied. The role of melatonin in obstetrics and gynecology is not clear and far from being resolved. All this makes this problem relevant and promising for study.

Congenital adrenal hyperplasia is one of the most common hereditary diseases. In 90 % of cases, it is due to the enzyme 21-hydroxylase deficiency. The frequency of congenital adrenal hyperplasia - both classical and non-classical forms - is largely due to ethnicity. The greatest prevalence of this pathology is registered in the populations of Iberians, people from the Caucasus and Ashkenazi Jews. According to neonatal screenings, the prevalence of the classical form of the 21-hydroxylase deficiency (both salt-wasting and virilizing) makes 1:28000 in China, 1:15000 in the United States. In Moscow, its prevalence is 1:100000, in Tyumen - 1:10000. The article presents clinical data of the register of children with congenital adrenal hyperplasia in the Sakha Republic (Yakutia). The problem of timely diagnosis of the classical form of congenital adrenal hyperplasia is of particular importance. In this article, we managed to systematize all available Russian and international literature on the topic. In addition, the article includes the data describing the characteristic clinical picture of congenital adrenal hyperplasia according to the data of the Republic’s Register, and the clinical case of a patient with the salt-wasting form of congenital adrenal hyperplasia.

This paper presents a clinical case of soft tissues noma of the face and facial skeleton in an adult female patient, treated at the Department of Surgery Dentistry, N.S. Karpovich Clinical Hospital of Emergency Medical Aid, Krasnoyarsk. The primary surgical treatment of noma resulted in formation of a through defect of the right cheek and pronounced scar contracture of the lower jaw, which requires additional reconstructive surgery. Taking into account that тomф is a very rare disease in the dental surgeon’s practice, they failed to establish the correct diagnosis of the patient correctly. We believe that the reason for such a long period of verification of the diagnosis was the mirror similarity of the clinical picture of the development and course of noma (water cancer) with the development and course of the malignant maxillofacial pathology.

The daily pH monitoring of the esophagus and stomach is the gold standard for diagnosis of gastroesophageal reflux disease. The daily pH monitoring of patients with reflux esophagitis and Hp-induced chronic gastroduodenitis revealed hyperacidity state in the stomach in 93.6 % of the patients. Gastroesophageal reflux (GER) exceeded the normal limit in 16 %. The alkaline reflux, indicating duodenogastric reflux (DGR), was observed in 29 % of the examined patients. With pathological GER, in accordance with the DеМееster criteria, the acidification time of the esophagus with a pH of less than 4.0 exceeds 4.5 % of the total time of pH monitoring, and the amount of acid casts throughout a day reaches 46. In this case, the reflux has a damaging effect on the mucous membrane of the esophagus. In addition, the microbial flora that is not typical of the overlying parts gets there, which can also contribute to the development of infectious and inflammatory processes. Under the generalized esophageal mucosal injury index, DeMeester index was above the normal in 71 % of the patients. 100 % of the patients with erosive esophagitis, Hp-induced chronic gastroduodenitis, reflux esophagitis and duodenal ulcer suffered from hyperacidity of gastric contents. The clinical value of pH monitoring of the upper digestive tract is the best diagnosis of functional disorders in acid-dependent diseases of the gastrointestinal tract, which allows in all cases, especially in combined pathologies, to develop adequate treatment tactics and control the course of treatment.

To prevent and reduce hereditary deafness in the region, it is necessary to analyze the current medical genetic counseling of families with hereditary nonsyndromic deafness in the region and develop the necessary recommendations for further work. The purpose of this study was to develop scientifically sound proposals for the development of regional methods for the prevention, diagnosis and treatment of nonsyndromic deafness / hearing loss, increasing the level of availability and quality of medical care for the population of Yakutia. Materials and methods of research. An analysis of pedigrees in families registered on the basis of the medical and genetic center Republican hospital No. 1-National Center of Medicine with the diagnosis of hereditary congenital deafness was carried out. The material for molecular research for the most common mutation for the Yakut population of c.-23 + 1G>A in the GJB2 gene was samples of genomic DNA of peripheral blood leukocytes from 45 patients with the diagnosis: hereditary sensorineural deafness / hearing loss of degree 2-4. Results and discussion. The number of assortative marriages was 33.3 % in 35 pedigrees. A molecular genetic study was conducted in the families examined for the presence of a mutation c.-23 + 1G>A in the GJB2 gene in patients with congenital hearing loss of the registered medical genetic center. The mutation was detected in 44.4 % of the examined. Conclusions and discussion: recommendations were developed and proposed for the prevention of hereditary deafness in the region.

One of the causes of developingchronic nonspecific lung diseases with emphysema is alpha 1-antitrypsin deficiency, caused by a decrease in the corresponding protein in the serum due to mutations in the SERPINA1 gene [1, 2]. According to the World Health Organization, alpha-1-antitrypsin deficiency (A1AT) is a disease caused by a genetically determined deficiency of this protein. According to the European Pulmonary Foundation, the prevalence of the A1AT deficiency in Europe averages to 1 per 1,800-2,500 newborns, which is about 125 thousand people [3, 4], and in the US, there are about 60-100 thousand patients with this disease [5]. The prevalence of the A1AT deficiency in the Russian Federation is unknown. Clinical manifestations of the A1AT deficiency in adults are sufficiently described [6]. Literary data and clinical cases of the A1AT deficiency in children are few, which served as the basis for the description of the clinical case. The lung tissue damage in a patient with the A1AT deficiency started at the age of 6 years with signs of recurrent bronchial obstruction with the development of chronic deforming bronchitis. Increased awareness of practicioners of various fields will improve the establishment of diagnosis and early detection of this pathology.

Cardioembolic ischemic stroke is a pressing issue of vascular neurology. The cardioembolic stroke proportion in the overall stroke structure does not tend to decrease (Bembenek J.P et al, 2015). Studies conducted in European and Asian populations have found that a significant proportion of cardioembolic stroke patients did not receive an anticoagulant therapy for the disease prevention (AndrikopoulosG. et al., 2014; Nakamura A. et al., 2016). Features of clinical characteristics and disease risk factors in the population of Yakutia need an additional research. This study was conducted to investigate cardioembolic ischemic stroke risk factors in the group of patients hospitalized in the Regional Vascular Center (Yakutsk). The study group included 86 patients with acute cardioembolic stroke. It was found that the most common disease risk factor was the atrial fibrillation. In 87.2 % of patients, the disease developed due to the non-valvular atrial fibrillation, in 2.3 % - due to prosthetic heart valves, in 10.5 % - due to a combination of these pathologies. The permanent form of atrial fibrillation was diagnosed in 82.1 %, the persistent form in 11.9 %, the paroxysmal form in 6 %. In 46.5 % of cases, it was a recurrent stroke. Less than in half of the cases (48.8 %), patients received the anticoagulant therapy for primary and secondary stroke prevention. 91,9 % of the patients who received vitamin K antagonists had the subtherapeutic level of hypocoagulation at the stroke onset. It is necessary to optimize the strategy of the cardioembolic stroke prevention, including improved patient’s compliance to anticoagulant therapy and effectively controlling the level of hypocoagulation.

To achieve the appropriate level of accessibility and quality of medical care, the provision of necessary resources (material, financial, personnel, information, etc.) to the municipal formations of the republic are of great importance. In this study, we analyzed the resource availability in the Southern Economic Zone of the republic (Aldan and Neryungri Districts) according to the indicators included in the official statistical reporting: the provision of medical personnel (medical, nursing), round-the-clock hospital beds (per 10,000 population) and outpatient capacity polyclinic institutions (in visits per shift). The choice of the two districts is not random: Neryungri hosts coal mining; Aldan - gold mining; and along with Mirny Dictrict, they are engines of the industrial development in the Sakha Republic (Yakutia).

As a result of this work, a computer database of pregnant women at high risk was created, and a system of dynamic monitoring of these patients was implemented through information exchange between health facilities in the republic. The system of three-stage medical care was introduced into the activities of therapeutic and prophylactic obstetric institutions of the republic. The information obtained on the causes and the structure of complications during pregnancy across districts of the republic allows for rational distribution of the material, technical and human resources of health care in accordance with the identified priorities. In the region with low population density and inaccessible transport links, available modern perinatal technologies can significantly improve the provision of obstetric and gynecological, neonatological care, reduce maternal and perinatal mortality rates.

Currently, the need of taking into account the age and gender characteristics when planning the volume of medical care is only declared. In reality, planning is carried out without taking into account not only the age structure, but also the characteristics of the level and structure of the incidence in a particular area. Another problem with planning is that it is based on the need in certain medical specialties. The purpose of this study was to analyze the age dynamics of the need in outpatient medical care for malignant neoplasms in men. We used the data on the visits of 78,000 male patients within one year to medical organizations providing outpatient medical care regardless of the organizational form and departmental affiliation. The probability of circulation and the frequency of visits and referrals were studied depending on the age in six five-year age groups: 30-35 years, 36-40 years, 41-45 years, 46-50 years, 51-55 years, and 56-60 years. On the basis of intensive indicators of the frequency of visits and referrals, as well as the number of days of outpatient treatment, a demand schedule was drawn up, which was described by one of the mathematical functions that most qualitatively described the process dynamics. The need in outpatient medical care in men with malignant neoplasms, who have the highest growth rate of needs and determine the need for outpatient medical care for malignant tumors, has almost the same age dynamics. It is characterized by two phases: the first - the phase of intensive growth in demand for younger age groups (30-45 years) and the second (age over 45) - the phase of slowing demand growth, but maintaining high levels of demand achieved. A longer first phase is observed in relation to malignant neoplasms of the respiratory and chest organs and urinary tract.