Historically the consultative polyclinic of the M.E. Nikolaev National Center of Medicine is the only specialized outpatient medical institution for children from the districts of the republic. Due to the fact that mobile medical teams have been established in the Sakha Republic (Yakutia) since 2022 to provide medical care to the population in remote and hard-to-reach settlements, the study of the pathology structure of children according to the data of referral to the main specialized medical institution is becoming very relevant.

Materials and methods. A retrospective analysis of the morbidity of the child population was carried out based on the data of referral to the consultative polyclinic of the Pediatric Center, M.E. Nikolaev National Center of Medicine. 10340 medical records were analyzed.

The results of the study: Out of 10,304 patients, 58 % were children from the districts of the republic. Of the districts, residents from nearby districts (Khangalassky, Ust-Aldansky, Namsky) most often apply. Older children mostly come to the consultation (62 %). Nervous diseases rank first in the morbidity structure (40 %), followed by cardiovascular diseases (18 %) and gastrointestinal diseases (10 %).

Conclusions: The results of the analysis showed that the most sought-after advisory medical care for children in the fields of neurology, cardiology, and gastroenterology. These specialists must necessarily be included in mobile medical teams, since this profile is populationally significant.

The strategic goal of the healthcare and social assistance system in the Russian Federation is increasing of human life expectancy. In this aspect, the importance of timely diagnosis and correction of conditions that occur in older people, one of which is sarcopenia, increases. The article presents an analysis of the current scientific literature on sarcopenia, methods of its diagnosis, treatment and prevention.

Sarcopenia is characterized by a decrease of muscle tissue and strength as a result of the natural aging process of the body or in conditions of pathology. Primary sarcopenia is distinguished, which is mainly based on hormonal disorders (changes in the secretion of somatotropic hormone and cortisol), as well as a decrease in vitamin D levels. Primary sarcopenia has a more unfavorable prognosis and is more difficult to correct. Secondary sarcopenia occurs with physical inactivity, insufficient protein intake, as well as with oncopathology, intestinal diseases, cardiovascular and endocrine diseases. In this case, there is a comorbidity of pathology and a codependency of the pathogenetic mechanisms of the development of the atrophic process in the muscle tissue.

Sarcopenia is not a rare syndrome that occurs in the practical work of specialists of various profiles. However, due to the low awareness of doctors and alertness, it is extremely rare to distinguish it as a separate syndrome. The article provides evaluation scales for the diagnosis of sarcopenia, including in quantitative terms. Insufficient diagnosis of sarcopenia in practice leads to mismanagement and insufficient drug correction of such patients. And this, in turn, prognostically worsens the course of both the underlying disease and comorbid pathology.

The medical and social aspect of this condition is of particular importance. Due to the significant prevalence and association with adverse outcomes, patients with sarcopenia require dispensary supervision, timely palliative status, and medical support for a long time.

The information provided is of interest to doctors of various specialties, nursing staff, social workers, and relatives of patients. Information about sarcopenic syndrome is constantly updated with new data and research in the fields of immunology, pathophysiology, clinical medicine, pharmacology and nutrition.

Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder primarily associated with dopamine deficiency in the central nervous system, accompanied by the development of both motor and non-motor symptoms. Neuropsychiatric symptoms, as a subset of non-motor manifestations, play a major role in disease burden and reduced quality of life in patients. One of the leading symptoms in this category is anxiety, which develops not only as a psychological reaction to the disease but is mainly caused by neurotransmitter dysfunctions (dopaminergic, noradrenergic, serotonergic, and GABAergic dysfunctions in the striatum, limbic system, and thalamus). It is also suggested that anxiety in PD may be associated with genetic factors.

Objective: To examine the predictive role of clinical manifestations and genetic biomarkers (Val66Met mutation in the BDNF gene and Ser9Gly mutation in the DRD3 gene) in the development of anxiety in Parkinson’s disease.

The study included 130 patients with Parkinson’s disease, who were divided into two groups based on the presence of anxiety. The first group consisted of 33 PD patients with anxiety, with a median age of 67.0 [60.0; 71.5] years. The second group included 97 patients without anxiety, with a median age of 67.0 [61.0; 72.5] years. Standardized scales were used to assess motor and non-motor symptoms. Frequencies were used to describe nominal data. Pearson’s χ² test was applied to compare two or more independent groups of nominal data. Quantitative data were presented as medians with interquartile ranges, and the Mann–Whitney U test was used for comparisons. Differences were considered statistically significant at p ≤ 0.05.

The patients with PD and anxiety had a longer history of the disease, high levels of depression, frequent presence of non-motor symptoms and a lower quality of life. The motor deficit in the 3rd part of the UPDRS scale in patients with anxiety was 41.0 [31.50; 48.50] points versus 35.0 [21.0; 44.50] points in patients without anxiety (p = 0.047). On the contrary, there were no differences in cognitive status and daytime sleepiness between the two groups of patients. As a result of a molecular genetic study, a statistically significant predominance of TC and CC genotypes of rs6280 polymorphism of the DRD3 gene (c.25G>A p.Gly9Ser) and GA and AA genotypes of rs6265 polymorphism of the BDNF gene was revealed in patients with PD and anxiety.

As a result of this study, it was revealed that the development of anxiety in Parkinson’s disease is influenced by the length of the disease, depression, the number of non-motor symptoms, and motor deficiency. In addition, the patients with anxiety were characterized by a lower quality of life than the patients whose anxiety was not detected. As for the genetic basis, our study indicates the contribution of polymorphic variants of the DRD3 (rs6280) and BDNF (rs6265) genes to the development of anxiety in PD.

Of particular interest to clinicians is information about the accessory roots and canals of the mandibular molars, in particular the distolingual root, called Radix Entomolaris (RE) in the literature. A previous study suggested the influence of the brachycephalic type of skull of the Mongoloids (Buryats) on the incidence of RE. However, we did not find specific studies of such a connection in the available literature. The aim. To study the correlation between the frequency of occurrence of the RE root and the type of skull in different ethnic groups of the population based on cephalometric and cone beam computed tomography (CBCT) data of the skull. Materials and methods. During the initial examination of people who applied to the clinic, an experimental group of 186 people, representatives of the indigenous ethnic group of Transbaikalia, was identified and their CT scans of the skull were studied. A division into cephalometric groups (brachy-, meso-, dolichocephalic) was carried out, the frequency of detection of the RE root in each subgroup was assessed, and correlations between the type of skull and the frequency of occurrence of RE were assessed using the Statistica.10 statistical analysis software package (StatSoft, USA). Results. The analysis showed a very weak positive relationship between the distribution of RE and the type of skull in the studied ethnic group. The frequency of RE detection in Buryat ethnic groups is significantly higher than in Caucasians. A separate distolingual root of the first mandibular molar was detected in 9,7 % of cases (in the control – 0 %; χ²=6,87; p<0,05). There was no correlation between the frequency of RE detection and the type of skull in the experimental group (r=0,12; р>0,05), which allows us to consider the presence of this root in the studied ethnic group as an eumorphic (inherited) anatomical feature. Сonclusion. The frequency of RE detection in individuals of the Buryat ethnic group of Transbaikalia is 9,7 %, which is significantly higher than in Caucasians. The absence of a correlation between the frequency of RE detection and the type of skull allows us to consider the presence of this root in the Buryat ethnic group as an eumorphic (inherited) anatomical feature.

The article defines hemorrhagic fever with renal syndrome (HFRS), provides literature data on the prevalence and features of the clinical course depending on the virulence of hantavirus serotypes. More than 90 % of the total number of HFRS cases reported annually is in the European part and 3 % in the Asian part of Russia. The most active foci of the disease are the regions between the Volga and the Urals (Bashkiria, Tataria, Udmurtia, Samara and Ulyanovsk regions). The annual incidence of HFRS in the Russian Far East averages 2 per 100,000 population and is registered mainly among residents of Primorsky and Khabarovsk Territories, Jewish Autonomous and Amur Regions. The disease is characterized by a cyclical course and a variety of clinical variants from abortive febrile forms to severe forms with massive hemorrhagic syndrome and persistent renal failure. Severe forms are of particular importance in the problem of HFRS, causing possible complications and an unfavorable outcome of the disease. The severity of clinical manifestations of HFRS is associated with the virulence of hantavirus serotypes (Puumala, Hantaan, Seul, Dobrava), the genetic characteristics of the macroorganism, the presence of concomitant chronic renal pathology, environmental problems, the infecting dose, epidemiological features of infection, and other factors. Severe forms of HFRS from the first days of the disease demonstrate the entire symptom complex of multiple organ failure in the form of various combinations of hemodynamic disorders with dysfunctions of the kidneys, liver, heart, lungs, and nervous system. The article presents a clinical case of a patient with the diagnosis: “Hemorrhagic fever with renal syndrome (ELISA: IgM positive to hantavirus (1:6400), IgG positive to hantavirus (1:400)), severe severity. The complication is dilutional hyponatremia with transient CNS damage.” According to the literature, mortality rates in hospitalized patients with severe hyponatremia, with a sodium level of less than 125 mmol/l, are significantly higher than those in patients without hyponatremia (28 % versus 9 %), while the increase in mortality is exponential as the sodium level decreases. As a result, it is important to have a deep understanding of the pathophysiology and ways of influencing dilution hyponatremia syndrome. Proper correction of the developed hyponatremia is crucial for the prognosis and outcome of the disease. Thus, the manifestations of hyponatremia can be diverse, up to cerebral edema and hemodynamic instability of patients.

Diabetic ketoacidosis (DKA) remains one of the frequent and life-threatening complications of type 1 diabetes mellitus (DM1) in pediatric practice. The aim of the study was to analyze the frequency, algorithms of intensive care and the results of treatment of DKA in children in the intensive care unit (ICU) of the Pediatric Center of the Sakha Republic (Yakutia). Materials and methods of research. The analysis of medical records of 138 children with DM1 complicated by DKA was performed. All patients were admitted to the ICU of the Pediatric Center in the period from 01 January 2021 to 31 December 2024. The age of the patients ranged from 5 to 17 years (11.3±3.6 years), males – 62 (44,9 %), females – 76 (55,1 %) children. The results of the study. In 2021–2024, the number of patients with DKA demonstrated an increasing trend, with 59.4 % of children having the primary manifestation of the disease, and in 40.6 % of cases it was recurrent. Disturbances of consciousness were noted in 35 (25.4 %) patients: deafness was observed in 23 (16.7 %), sopor – in 12 (8.7 %) children. Mild DKA was observed in 64 (46.4 %) patients, moderate – in 31 (22.5 %) and severe – in 43 (31.1 %) patients. Conclusion. Achieving a stable course of the disease and preventing complications of DM1 is possible with the joint management of patients by endocrinologists, child psychologists and social services. Intensive therapy of DKA should be carried out in accordance with approved clinical recommendations while monitoring water-electrolyte balance, acid-base status, and glycemic levels.

Today, congenital collagenopathy is a major problem in dentistry and medicine. At the same time, it manifests itself in various general and local phenotypic characteristics, which have a negative impact on the functional state of the organs and systems of the body. The aim of this study was to increase the effectiveness of the diagnosis of distal occlusion in children and adolescents with various degrees of severity of congenital collagenopathy based on the developed biometric measurements of the jaws. Materials and methods. A clinical and craniometric study of 1,207 children and adolescents with congenital collagenopathy aged 12 to 18 years was conducted. In the course of the study, distal bite was found in 584 schoolchildren. Results. The parameters of morphological deformities in the form of distal bite with various degrees of severity of congenital collagenopathy in children and adolescents was established. With a mild degree of distal bite, the distance along the cutting edges of the central incisors of the upper and lower jaw, according to the maximum and minimum values, varies from 3.02+0.04 to 5.61+0.03 mm, where the average value is 4.31+0.03 mm. With moderate severity, there are changes in indicators, the data of which are 5.91+0.05, 8.78+0.04 and 7.34+0.06 mm, and with severe severity – 9.01+0.24, 18.23+0.19 and 13.62+0.11 mm, respectively. The comparative analysis revealed significant differences in the biometric parameters of distal occlusion in congenital collagenopathy of mild and moderate severity, as well as in moderate and severe severity (p<0.05). Conclusions. The data obtained characterize that there is an established pattern associated with increased numerical values of the distal occlusion depending on the severity of congenital collagenopathy. At the same time, the established features of distal bite in various degrees of severity of congenital collagenopathy in children and adolescents have important theoretical, scientific and practical significance for improving their comprehensive medical and social rehabilitation and prevention. Based on the results of biometric measurements, the distal bite is determined, taking into account the severity of congenital collagenopathy in children and adolescents.

Ventricular tachycardia (VT) is rare in newborns and has a wide range of clinical manifestations from asymptomatic to severe heart failure and cardiac arrest. Treatment of ventricular arrhythmias remains a very difficult task for a doctor today, in each case this issue is solved individually. The purpose of this study is to demonstrate a clinical case of a newborn with VT. A retrospective analysis of the patient’s medical history was performed, which was examined and treated in the Department of Neonatal Pathology. From the sixth day of life, the child’s anxiety was noted, and arrhythmic heart sounds were heard during auscultation. An ECG revealed cardiac arrhythmias in the form of unstable recurrent monomorphic ventricular tachycardia with a frequency of 142-200 beats per minute. An instrumental examination was performed at the children’s multidisciplinary hospital – no organic heart diseases were detected. The patient was prescribed protective antiarrhythmic therapy with propafenone with a positive effect and subsequent dynamic monitoring. No rhythm disturbances were detected during treatment with daily ECG monitoring. The child’s condition in the department remained stable. He was discharged for outpatient treatment with recommendations for dose adjustment according to the child’s weight. During a follow-up examination after 1 month, a sinus rhythm is recorded according to ECG data, no ventricular rhythm disturbances were detected. The above clinical case of VT in a newborn makes it possible to focus the attention of neonatologists, pediatric cardiologists, and pediatricians on the features of the clinic, diagnosis, and treatment of this rare pathology.

The Far East is distinguished by high rates of tick-borne rickettsiosis (TBR), which is dominant among all natural focal infections. It is important to note that the etiological agent of TBR in Khabarovsk Territory is R. heilongjiangensis. In general, in the region in the period 2022–2023, a pronounced upward trend in incidence was revealed (by 55.85 %), amounting to 25.08 per 100 thousand people. A detailed study of individual links in the pathogenesis of TBR caused by a new endemic pathogen remains relevant in the search for associations of significant biomarkers in order to assess the severity and prognosis of the disease. Purpose of the study. Evaluation of the relationship between the level of copper (Cu) and individual elements of the cytokine status in the blood serum of patients with TBR caused by R. heilongjiangensis, to understand the issues of immunity formation, and in particular, the participation of nutrients in this pathophysiological process. The levels of serum Cu and some proinflammatory (IL-2) and anti-inflammatory (IL-4) cytokines were analyzed in patients with moderate CR, taking into account two-time examinations: during hospitalization (at the height of the disease (4-5 days of illness)) and in the early convalescence period (8-10 days from the onset of the disease). It was found that at the height of the disease, a statistically significant increase in the serum Cu level was observed (1.8 times, p<0.000009), which was combined with a significantly pronounced activation of the endogenous mediators studied (IL-2 – 1.7 times, IL-4 – 1.7 times, p<0.05). The correlation analysis revealed a weak unidirectional reliable relationship between the Cu level and the IL-2 cytokine during the peak of the disease (r=0.3132, p<0.05) and a significant multidirectional relationship between the Cu and IL-4 content during the recovery period (r=-0.5709, p=0.0086). The obtained results indicate the induction effect of cytokine status elements during inflammation on the generation of a free Cu pool for the purpose of its mobilization as a direct bactericidal agent, and, therefore, it becomes one of the positions of nutritional immunity in patients with CR caused by R. heilongjiangensis.

Acne is a chronic recurring disease of the hair follicles and sebaceous glands, which affects up to 80 % of the population aged 12 to 25 years, and about 30–40 % of people over 25 years. Pharmacotherapy of the nosology is consistent, involves long-term course use of drugs. Today, a wide range of drugs used in the pharmacotherapy of acne is sold in the Russian Federation. In the context of significant offers of drugs on the pharmaceutical market, it is relevant to study the competitive advantages and trends of its development. The purpose of this study was to study the competitiveness of drugs for the treatment of acne. The analysis of the range of drugs for the treatment of acne was carried out, including 39 trade names (TN) and 31 international nonproprietary names (INN). The parameters of the competitiveness of the analyzed drugs were identified: efficacy, safety, ease of use, cost of the course of treatment and dosage form (DF); a sociological study of 92 consumers suffering from acne was carried out; taking into account the opinion of 10 highly competent pharmaceutical and medical specialists, an expert assessment of the competitiveness of drugs for the treatment of acne was carried out and their comparative characteristics were performed. Statistical processing of the results was carried out using the data analysis package in Microsoft Excel. Based on the results of the study, recommendations were developed for optimizing the assortment policy of pharmacies for drugs for the treatment of acne.