This article presents an analysis of gastrostomy outcomes in patients. A timely and appropriate decision regarding the need for minimally invasive surgical interventions improves the patient’s quality of life and can prevent premature death. Providing enteral nutrition improves the patient’s quality of life, increases their ability to adapt socially, and prolongs their life. In recent years, minimally invasive (endoscopic) gastrostomy techniques have been introduced into clinical practice. For example, percutaneous endoscopic gastrostomy (PEG) is used for feeding palliative patients with dysphagia. 8.7 % of inpatients at the State Budgetary Institution of the Sakha Republic (Yakutia) Hospital No. 2 – Center for Emergency Medical Aid (CEMA) required enteral nutrition (EN). The specifics of EN are largely determined by access to the gastrointestinal tract. A prerequisite in this case is direct contact between the stomach wall and the anterior abdominal wall. The procedure allows for the creation of both temporary and permanent gastric fistulas. A temporary gastrostomy is inserted for a specific period of time, such as to aid recovery after surgery or to overcome a temporary inability to eat orally. When the tube is removed, the stoma closes on its own. A permanent gastrostomy is inserted long-term or permanently. When EN is to be administered to the patient for less than four weeks, conservative methods (tube feeding) are used. If it is to be administered for more than four weeks, minimally invasive surgery is performed. The CEMA Endoscopy Department began installing gastrostomies in 2022. A total of 11 endoscopic gastrostomies were placed in 2022, 35 – in 2023, and 16 – in 2024.

The article is devoted to the study of clinical and laboratory aspects of the new coronavirus infection COVID-19, combined with myocardial infarction. Materials and methods. A retrospective analysis of inpatient records of patients with COVID-19 and myocardial infarction hospitalized in 2022–2023 in the cardiac resuscitation and intensive care department of the State Budgetary Healthcare Institution of the Republic of Mordovia “Republican Clinical Hospital No. 4” in Saransk was carried out. General clinical indicators (biochemical, coagulogram), instrumental research data (electrocardiogram, coronarogram, echocardiography, computed tomography) were studied, statistical analysis was performed. Objective: To study the clinical picture and results of laboratory and instrumental studies in patients with a new coronavirus infection combined with myocardial infarction. Research results and conclusion. We found that myocardial infarction developed more often in the older age group (75 %) and in half of the cases had anterior-septal-apical-lateral localization, occurring with the same frequency both simultaneously with the onset of COVID-19 and 1–2 weeks after the disease and in the absence of COVID-19 symptoms (laboratory-confirmed cases). Myocardial infarction was most often manifested by burning/pressing pain behind the sternum, shortness of breath, sudden onset of lower limb edema, and a feeling of shortness of breath. With the development of myocardial infarction, complications developed: postinfarction aneurysm, pulmonary edema, cardiogenic shock, as well as various rhythm disturbances: paroxysmal atrial fibrillation, complete right bundle branch block, ventricular fibrillation, first degree atrioventricular block, paroxysmal supraventricular tachycardia, and supraventricular extrasystole. It was important to establish multimorbidity in patients with myocardial infarction – a combination of cardiovascular diseases with diabetes and obesity. The Charlson comorbidity index (as a method for assessing the risk of death in the presence of comorbid pathology) in men reached maximum (7 points) at the age of 70–79 years, in women – in the group of 80–89 years (9 points). The laboratory studies revealed an increased level of D-dimer, ferritin, myoglobin, C-reactive protein, troponin, and lactate dehydrogenase, which confirmed the presence of hypercoagulation and acute myocardial injury.

The disturbance depth of leukocyte and erythrocyte homeostasis is of no small importance in determining the severity of secondary widespread peritonitis in different age groups of children. Materials and methods. A  retrospective  clinical  study  of  85  patients  of  different  ages  with  secondary  widespread  peritonitis  was conducted. Determination of structural changes in leukocytes, neutrophils and erythrocytes was carried out before surgery and 1, 5 and 7 days after surgery. Objective. Development of methods for correcting therapy based on the assessment of leukocytes, neutrophils and erythrocytes structural changes in secondary widespread peritonitis in children of different ages. Research results. The conducted studies have demonstrated significant age  differences  in  the  structural  transformations  of  leukocytes,  neutrophils  and  erythrocytes  in  secondary widespread peritonitis. In younger patients, there was a greater growth in the content of white blood cells and a slower dynamics of their decrease throughout the postoperative period. A comparatively greater decrease in the width of the distribution and the average volume of erythrocytes in younger children indicated a smaller difference between micro- and macrocytes with the erythrocyte microcytosis dominance. The inclusion of a carbapenem group drug (Invanz) in the antibacterial therapy regimen and the prescription of an antihypoxant (Mexidol)  improved  the  treatment  results  for  children  with  secondary  widespread  peritonitis.  Сonclusion. Persistent enlargement in the number of leukocytes and neutrophils in younger age groups patients indicates a comparatively severe course of the infectious process in the abdominal cavity, which causes a more frequent development of postoperative purulent inflammatory complications. A material shift in the erythrocyte pool towards microcytosis at a younger age significantly reduces the functionality of red blood cells and leads to the occurrence of intra-abdominal «hypoxic stress». Correction of the antibacterial therapy regimen with the invanz inclusion and the mexidol administration creates the preconditions for a favorable course of the early postoperative period in children of different ages.

This study aims to investigate the clinical effectiveness and potential risks associated with kidney transplantation from living related donors in patients suffering from end-stage chronic kidney disease (ESKD). The comprehensive examination included an analysis of the condition of 48 related donors, among whom 30 individuals underwent planned nephrectomy for subsequent organ transplantation. Prior to surgery, each donor underwent a thorough health assessment that involved detailed evaluation of the functional activity of the contralateral organ and immunogenetic testing to assess tissue compatibility. A detailed study of the anatomical features of the kidneys revealed that 30 % of those examined had atypical configurations of the renal vascular system characterized by the presence of branching polar arteries and additional arterial or venous structures. Despite increasing the technical complexity of surgical intervention, these deviations do not significantly affect long-term functional outcomes of the transplanted kidney. Kidneys transplanted from related donors exhibit high survival rates, substantially improving recipients’ quality of life and eliminating the need for replacement therapy through hemodialysis. Postoperative complications are rare among recipients and generally have mild courses. Most return to their usual lifestyle after an average rehabilitation period lasting approximately 10–12 days. Therefore, kidney transplantation from a living related donor is a highly effective and safe therapeutic method for ESKD, especially when close relatives with suitable genetic compatibility are available. The obtained data emphasize the necessity of expanded screening of potential donors considering possible individual variations in the vascular structure of parenchymal organs.

Syphilis is an infectious disease caused by pale treponema, transmitted mainly through sexual contact (STDs). The disease is characterized by lesions of the skin, mucous membranes, internal organs, nervous and musculoskeletal systems; in addition, it is characterized by a staged, recurrent and progressive course. Currently, there is an increase in the number of patients with serological resistance, which is characterized by persistent positive non-treponemal tests without a tendency to decrease antibody titers for 12 months after adequate therapy. Serological resistance leads to rapid disability of patients or their death. The aim of this research was to study the factors of seroresistance formation in patients with syphilis who have undergone a full course of specific therapy with various drugs in the Yakutsk Republic’s Dermatovenerological Dispensary. The study covered 57 patients with seroresistance in the period 2002–2024. Thus, the prevalence of seroresistance among patients with syphilis in the Sakha Republic (Yakutia) made 0.5 %. The average age was 41+12.9 years; by gender, women predominated with 57.1 %. As a primary diagnosis in patients with seroresistance, latent early syphilis with 66.7 % predominated. Serological resistance formed on average after 28 months. Primary treatment of patients with syphilis with reserve drugs from the group of the 3rd generation cephalosporins was received by 59.6 % of the patients, and with penicillin drugs – 40.4 %. Almost the same data were obtained in the treatment of the patients with serological resistance, which amounted to 60 % and 40 %, respectively. In the structure of concomitant diseases, viral hepatitis was noted in 7 %, STIs – in 3.5 %, HIV – in 1.8 % of the patients.

Gastrointestinal bleeding (GIB) is a significant and frequently encountered clinical problem in pediatric practice. One rare etiologic factor is Abernethy malformation, in which lower gastrointestinal bleeding has been reported as the primary presenting symptom in 8.1 % of cases. Abernethy malformation is an extremely rare congenital anomaly of the portal venous system, characterized by diverse clinical manifestations that may be difficult to recognize in early childhood. The aim of this report is to describe the clinical case of an 8-yearold boy with Abernethy malformation and to inform clinicians about the diagnostic strategies and management considerations for this condition. A retrospective review of medical records was performed for a patient treated at the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan (DRKB MZRT) and the Russian Children’s Clinical Hospital, a branch of the Pirogov Russian National Research Medical University (RDKB, RNIMU). The child had been followed by a pediatric surgeon since the age of three for complaints of hematochezia. Local therapy with methyluracil suppositories was initiated following the diagnosis of an anal fissure. During preoperative evaluation for elective adenoidectomy, laboratory testing revealed thrombocytopenia (platelet counts ranging from 57–103 × 10⁹/L). The patient was admitted to the Department of Hematology and Immunology at DRKB for further evaluation. Subsequent diagnostic investigations resulted in the diagnosis of small intestinal angiodysplasia (ileal angioectasias) complicated by gastrointestinal bleeding; moderate anemia secondary to chronic blood loss; and secondary (consumptive) thrombocytopenia. The patient was then referred to the RDKB (RNIMU) for advanced diagnostic workup. The following studies were performed: duplex ultrasonography of the portal venous system, contrast-enhanced abdominal computed tomography, and direct portal venography. Portal venography demonstrated a markedly dilated inferior mesenteric vein (up to 12 mm) draining via a tortuous portosystemic communication into the right internal iliac vein. At the federal center, the patient was diagnosed with Abernethy malformation, Type II. Laparoscopic ligation of the congenital portocaval shunt was performed in the Department of Pediatric Surgery at DRKB. Given the anticipated hemodynamic changes within the portal venous system postoperatively, anticoagulant therapy was administered. The child was discharged in stable condition and continues to receive follow-up care with hematology and vascular surgery specialists at the RDKB in Moscow. This case highlights the importance of recognizing Abernethy malformation as a rare cause of gastrointestinal bleeding in children and underscores key considerations in its clinical presentation, diagnostic evaluation, and surgical management. The report aims to increase awareness among pediatric surgeons, radiologists, and pediatricians regarding this uncommon but clinically significant anomaly.

Congenital malformations are a common pathology. They can be the main causes of morbidity, mortality in infants and disability in old age. The purpose of the review: to expand the understanding of the frequency, structure, causes, diagnostics of children with congenital malformations of the gastrointestinal tract. To search for scientific articles, the Google system, websites: E-library and PubMed were used. By keywords, 2478 publications were found in the E-library database, 764 publications in the PubMed database over the past 5 years, 41 of them are described. Data on the organogenesis of the digestive system and information on what defects are formed from various parts of the primary intestine are provided. This article discusses esophageal atresia, hypertrophic pyloric stenosis, Meckel’s diverticulum, Hirschsprung’s disease, Ladd’s syndrome, anal atresia, and biliary atresia. The frequency of their occurrence is presented; the most common defect is atresia. The formation of the sections of the gastrointestinal tract is described in relation to the anatomical relationship and blood supply, the presentation is carried out sequentially in relation to the embryonic source. The pathogenesis, features of clinical manifestations, various methods of modern diagnostics and specialized medical care are briefly described. The main method of treatment at present is minimally invasive surgery. Video-assisted operations are used, such as peroral submucous pyloromyotomy for hypertrophic pylorostenosis or transanal endorectal reduction for Hirschsprung’s disease. The expansion of the range of use of robotic technology for treatment is discussed. The issue of using transplantation of pluripotent stem cells for the treatment of Hirschsprung’s disease is debatable.

The stay of young Arab men in the harsh climate of Yakutia creates significant adaptive stress. In these conditions, it is important to study their somatotypological characteristics, which will reveal the risks of maladaptation disorders associated with the somatotype. The aim of the study was to determine the somatotypological characteristics of young Arab men studying in Yakutia. 55 young Arab men (from 17 to 21 years old), students of the NEFU Institute of Medicine, were examined. Body length and weight, chest circumferences, waist and buttocks, shoulder diameters, pelvis, transverse and anterior-posterior chest diameters were measured. The body mass index and the Rohrer index were calculated. Asthenic, normosthenic, and picnic somatotypes were determined by the Reese-Eysenck index. According to the severity of endomorphy, exomorphy, and mesomorphy scores, Heath-Carter somatotypes were established (from the bioimpedance protocol). Fat, musculoskeletal, lean, active cell mass, phase angle and degree of hydration of the body (total water, extracellular and intracellular water) were determined by bioimpedance measurement. The statistical analysis of the obtained data was carried out using the SPSS 22.0 application software package. Nonparametric methods were used. The assessment of intergroup differences was carried out using a nonparametric method using the Mann-Whitney U-test. The predominance of persons with asthenic somatotype according to Reese-Eysenck was revealed. Somatotyping using the Heath-Carter method showed the absence of somatotype variability; all the Arab youths examined were of the mesoectomorphic type. According to the Rohrer index, people with medium and high body density dominated. The young Arab men with asthenic somatotype were characterized by significantly lower parameters of body weight, BMI, chest circumference, waist, buttocks, shoulder diameter, transverse and anterior-posterior chest diameters. An analysis of body component parameters revealed significantly lower absolute and relative values of fat mass and higher relative values of active cellular, musculoskeletal, lean mass and total water in individuals with asthenic somatotype. The predominance of the asthenic somatotype and the presence of a significant proportion of people with medium and high body density among the surveyed Arab youths may indicate that this group belongs to the arid adaptive type. The data obtained contribute to an in-depth understanding of the anatomical and anthropological characteristics of young Arab men studying in Yakutia and create the basis for subsequent scientific research.

The relationship between urinary amino acids and the pathophysiological mechanisms of undifferentiated connective  tissue  dysplasia  (UCTD)  development  in  children  of  different  ages  remains  relevant  for  early diagnosis. The aim of the study was to identify the stages of development of undifferentiated CTD in early schoolage children (7–10 years) and adolescents (11–15 years) by determining the amino acid composition of urine. A comparative study of the urine amino acid profile was conducted in children with undifferentiated connective tissue dysplasia (UCTD) of primary school age (7–10 years) and adolescents (11–16 years) living in the Sakha Republic (Yakutia). In primary school-aged children, as connective tissue (CT) disorders worsened (from grade 1 to grades 2-3 uCTD), elevated levels of not only CT disorder biomarkers such as 5-hydroxyproline and hydroxyproline were detected, but also amino acids such as glycine, proline, as well as serine and threonine, which participate in hydroxylation reactions and the synthesis of extracellular matrix proteins. This may indicate an early disturbance of amino acid metabolism underlying connective tissue disorders. The following groups of amino acids were identified that underwent the greatest changes in children of different ages with uCTD: amino acids associated with collagen metabolism (glycine, proline, hydroxyproline, and 5-hydroxyproline), branched-chain amino acids (valine, leucine, isoleucine), acidic amino acids (aspartate, glutamate), and aromatic amino acids (phenylalanine, tyrosine). The results of the study make a definite contribution to the development of modern ideas about the peculiarities of the formation of adaptive reactions of an organism living in extreme environmental conditions.

The medical and demographic situation in any given territory is always of interest to both government agencies and healthcare authorities. State policy aimed at the socioeconomic development of regions within the Arctic Zone of the Russian Federation (AZRF) has become increasingly important, given the Arctic territory’s growing importance to the country in recent years. For example, the Sakha Republic (Yakutia) is represented within the AZRF by thirteen districts (uluses): Abyisky, Allaikhovsky, Anabarsky, Bulunsky, Verkhnekolymsky, Verkhoyansky, Zhigansky, Momsky, Nizhnekolymsky, Oleneksky, Srednekolymsky, Ust-Yansky, and Eveno-Bytantaysky. This article analyzes the medical and demographic situation (MDS) from 2000 to 2022. An analysis of the medical, demographic, and population situation in the districts of the Arctic zone of the Sakha Republic (Yakutia) for the period from 2000 to 2022 revealed a number of significant aspects. For example, in a number of districts, higher levels of overall and infant mortality were observed compared to the national average, and there was also heterogeneity in natural increase. A comparison of the Arctic zone of the Sakha Republic (Yakutia) with global indicators revealed that, according to the WHO scale, both Yakutia and the Arctic zone are classified as territories with very low levels of infant mortality as of 2022. This is despite the fact that in 2000, they would have been in the group with an average infant mortality rate. The Arctic zone has comparatively low rates of both marriage and divorce among the population. There are trends toward population decline due to the excess of emigration over incoming residents. As a result, it is proposed to focus the attention of local authorities and district-level medical institutions on improving key MDS indicators.