The interdisciplinary interest of researchers to the use of exogenous melatonin in obstetrics and gynecology is due to its effect both for women’s reproductive health - successful ovulation, conception, preliminary period, and delivery, and for clinic gynecological and extragenital diseases - menopausal syndrome, endometriosis, polycystic ovary syndrome, gestational diabetes mellitus and hypertension, sleep disorders and borderline mental disorders. Synthetic melatonin, possessing adaptogenic, immunomodulatory, anticonvulsant, hypnogenic, hypoglycemic, anabolic, anticholesterol, antioxidant, anxiolytic, antidepressant, cytotoxic, sedative, analgesic, disaggregated, geroprotective effects, is not inferior to the mechanism of action of endogenous hormone, has practical use in a wide range of diseases both abroad and in Russia. However, the use of the hormone during the prolongation of pregnancy is very limited due to ethical, legal, organizational and legal reasons and the interdisciplinary discussion on this issue between experts is gaining new momentum and is far from being solved. Methods of laboratory, instrumental diagnosis of diseases associated with the use of exogenous melatonin have an exploratory basis, potential scientific and practical interest and are only in the making. Despite this, it can be unambiguously argued that the fundamental role of melatonin in the regulation of vital functions in the fields of obstetrics and gynecology is unconditional. It closely overlaps with the national goals and strategic objectives that the Russian health care specialists set for reducing infant and maternal mortality and increasing life expectancy. Thus, the interdisciplinary issues of the use of exogenous melatonin in obstetrics and gynecology require further study and are far from being resolved. All this makes this problem relevant and promising for study.

The Sakha Republic (Yakutia) is considered an unfavorable region of the Russian Federation in terms of the viral hepatitis C prevalence, as well as high incidence of cirrhosis and liver cancer in HCV-infected individuals. The aim of the study was to describe the course of chronic HCV infection in patients from the Sakha Republic (Yakutia) to improve the complex of personalized approaches in the management of this group of patients. The study included 175 case histories of patients with chronic viral hepatitis C, 72 (41.2 %) men and 103 (58.8 %) women, the average age 57.4 ± 2.1 years. The diagnosis of chronic hepatitis C was established basing on anamnestic data, as well as the results of physical, laboratory and instrumental examinations. The dynamics of the incidence of chronic hepatitis C in the period 2008-2018 in the Sakha Republic (Yakutia) was characterized by different intensity of the epidemic process; over the entire period of observation, the overall incidence of chronic hepatitis C was on average higher than the national average. During PCR analysis, HCV RNA was detected in 89.7 % of the patients with CHC, genotype 1c was isolated in 65 %, 3a - in 20 %, and genotype 2 - in 15 %. A high incidence of extrahepatic manifestations of patients with chronic HCV infection was determined (47.1 %).

Today, in most cases, the caesarean section is performed under spinal anesthesia. It has several advantages for cesarean section, but it also has several disadvantages. An important disadvantage is hypotension, which requires the use of vasopressors. The aim of the study was to assess the effect of the hyperosmolar crystalloid solution Reosorbilact on hemodynamics during cesarean section under spinal anesthesia. In the period from February to April 2019, we conducted a study of the efficacy of Reosorbilact in patients with elective caesarean sections under spinal anesthesia, which were two groups of 84 patients each. The composition of infusion therapy was standardized in patients of the both groups. The patients of the control group received an infusion of 1200 ml of isotonic crystalloids, and the patients of the studied group received 1000 ml of isotonic crystalloids and 200 ml of Reosorbilact solution. In addition to monitoring standard parameters, the hemodynamic monitoring included a non-invasive measurement of cardiac output using the esCCO method. In case of hypotension, phenylephrine was administered with dose adjustment according to the effect. The introduction to the infusion program during elective caesarean section under the conditions of spinal anesthesia of the hyperosmolar crystalloid solution Reosorbilact resulted in a significant reduction of the severity of adverse hemodynamic effects. Maintaining a significantly more stable hemodynamics and reducing the need for vasopressors were achieved without an increase in total infusion. The results obtained demonstrate the possibility of maintaining stable hemodynamics against the background of restrictive infusion during caesarean section under spinal anesthesia. The decrease in cardiac output, developing on the background of spinal anesthesia in caesarion section, was significantly less pronounced. In general, Reosorbilact during cesarean section under spinal anesthesia proved to be an effective means of maintaining stable hemodynamics while maintaining a restrictive volume of infusion therapy.

We conducted a retrospective analysis of 583 cases of patients aged 75 years and older hospitalised in the Intensive Care Unit No. 2, Regional Vascular Center No. 1, Republic’s Hospital No. 2 - Emergency Medical Center, and diagnosed with ACS (Q-positive MI, Q-negative myocardial infarction, unstable angina pectoris). The results of the study showed that the proportion of people of senile age made 16 % of the number of all hospitalised patients in 2015-2017. No ethnic differences were obtained. ACS in women aged 75 years and older was 2.5 times more common than in men of the same age; however, at the same time, in the age group of patients under 75 years old, ACS was 1.5 times more likely to be found in men than in women, which is consistent with literature data. According to nosological forms, unstable angina and Q-positive MI were more common. Selective coronary angiography (SCAG) was performed in 41.4 % of patients due to the presence of severe comorbidity, as well as the refusal of patients to perform SCAG. 35 % of the analyzed patients had three coronary arteries affected, which required surgical treatment of coronary heart disease (aortocoronary, mammaro-coronary artery bypass grafting). The coronary artery stenting was performed in 60 % of the patients undergoing SCAG. High mortality was revealed in patients with Q-negative myocardial infarction (27.8 %), which indicates the need for early revascularization of coronary vessels. It should be noted that 33 % of senile patients sought medical treatment within 24 hours after the debut of the disease. Late access to medical care in this group of patients is a factor that reduces the chances of performing myocardial reperfusion.

Obesity in children and adolescents is one of the urgent problems of modern health care. The relevance of the problem is due to the steady increase in the number of patients with obesity, involvement of vital organs in the pathological process, progressive course and unfavorable prognosis. Clinical changes of the digestive organs in patients with obesity can vary greatly, characterized by the presence of comorbidity, which further exacerbates the metabolic syndrome. The aim of this study was to assess the clinical picture in children and adolescents with obesity and pathology of the digestive system in the Sakha Republic (Yakutia). The paper analyzes the nature of lesions of the digestive system in 250 overweight and obese children and adolescents aged 6 to 17 years, based on the materials of the Department of Pediatric Endocrinology and Gastroenterology and the Advisory Clinic of the Sakha Republic’s Hospital 1 - National Center of Medicine. The comparison group consisted of 250 children and adolescents aged 6 to 17 years, who had average growth and body weight for their age and sex with digestive pathologies. All children underwent the standard examination, which included anamnesis, clinical examination of organs and systems. In the children with obesity, compared with the children with normal body weight, signs of metabolic syndrome were revealed. Also, according to the clinical data, it was found that in the children with obesity, compared with the control group, the structure of diseases of the digestive system was dominated by liver, biliary tract and pancreas diseases. These clinical symptoms completely coincide with the established clinical diagnoses. By the ethnicity factor, it was found that children of the Mongoloid race were more susceptive to such diseases as inflammatory changes in the esophagus (superficial esophagitis), chronic gastroduodenitis (CGD), liver disease - non-alcoholic fatty liver disease (NAFLD), pancreatic disease (steatosis), hypermotor gall bladder dysfunction, and functional disorders of the intestine.

From the standpoint of the policy of import substitution, financial feasibility, accessibility and ease of use, the search for effective methods and the development of new methods for the manufacture of removable dentures is a relevant task. A method of manufacturing removable laminar dentures using the authors’ double screw compression cuvette is presented. The components of the cuvette are described in detail, the technique of manufacturing removable dentures using this cuvette, the advantages of the proposed methodology for manufacturing removable dentures using the proposed author’s cuvette are highlighted. A new design of the cuvette for manufacturing removable dentures (double screw compression cuvette) was developed. It was established that the monomer content in the denture made using this cuvette was less than in the brass standard cuvettes, and the original sizes of the denture did not change. Replacing traditional brass cuvettes with double screw compression cuvettes will allow reaching a new level of manufacturing removable dentures without either significant financial and labor costs, or purchasing imported technologies.

This research article presents treatment outcomes of 30 newborns for necrotizing enterocolitis (NEC) in the Surgical Ward of the Pediatric Center, Republic’s Hospital No. 1 - National Center of Medicine in the period 2005-2018. A retrospective chart review was conducted, where the reviewed data of gestation course and childbirth, risk factors for the development of this disease were considered: birth deformity, dietary pattern, clinical data, laboratory, instrumental and radiological methods of investigation before the manifestation of necrotizing enterocolitis, timing of diagnosis, types of surgical treatment performed, tactics of antibiotic therapy, studied the results and fate of treatment. We describe the clinical experience and therapeutic tactics for this pathology. The main risk factors of the disease were established, for which statistical data analysis was performed using the online program medcalc.net (“https://www.medcalc.net/”) and “STATISTICA 13.3. EN” (“StatSoft Russia”), where we determined the normal type of distribution of results and conducted tests for the presence of a significant difference in the subgroups: gestational age with a favorable outcome (G1), gestational age with mortality (G2), and birth weight with a favorable outcome (M1) and birth weight with mortality (M2). The analysis of the conformity of the type of distribution of features to the law of normal distribution was carried out using the Shapiro-Wilk W test; Student’s t-test was used to assess the differences between the groups. It was statistically established that there is a direct relationship between gestational age, birth weight and disease outcome. Based on the data obtained, it is possible to predict the further course of the disease and change the protocol for treating patients. This tactic allowed improving the results of treatment of necrotic enterocolitis in newborns and reducing the mortality of this pathology by two times.

The article reviews the environmental status of the Sakha Republic (Yakutia). The data of the Territorial Authority of the Federal State Statistics Service for the Sakha Republic (Yakutia) for 2009-2017 were taken into account: the primary morbidity rates for main classes of diseases, air emissions of pollutants emanating from stationary sources, the number of objects with stationary sources of air pollution, provision of substandard and conditionally benign drinking water; provision of substandard drinking water. The purpose of the study was to identify the dependence of the morbidity of the population in the Sakha Republic (Yakutia) on the environmental status using the correlation analysis. The object of the study was the primary incidence of the population in the Sakha Republic (Yakutia) under the main classes of diseases in 2009-2017. Using the correlation analysis, the probable effect of environmental factors on the primary incidence of the population in the Sakha Republic (Yakutia) by the main classes of diseases was studied. A strong correlation was found between the availability of substandard drinking water and the prevalence of blood and blood-forming organs diseases and individual disorders involving the immune mechanism (r=0.85), endocrine system diseases, eating disorders, metabolic disorders (r=0.71) and diseases respiratory organs (r=0.87) among the population of the Sakha Republic (Yakutia).

A serious ecological and parasitological situation has developed on the territory of Russia, and it requires changes in the strategy and tactic of preventing socially significant diseases. Up to 1.5 million cases of parasitic diseases are recorded annually in Russia. The total number of the infected with parasitosis reaches almost 20 million people. 70% of them are children. The Sakha Republic (Yakutia) is a region with high rates of the incidence of natural focal biohelminths. Diphyllobothriasis is one of the most pressing, socially significant problems in this area. This article provides the analysis of the statistical data on diphyllobothriasis incidence in the Sakha Republic (Yakutia) in 2014-2018. During this period, the incidence rate in the republic varied from 112.2 to 477.18 per 100,000 people, on average. In general, it can be noted that the year 2018 saw another increase in the number of diphyllobothriasis cases in the population. The diphyllobothriasis incidence rates above the republic’s average are is noted in all northern districts, with Zhigansky, Kobyaisky and Olyokminsky Districts being in the top. Those are the districts where the populations eat fish most often. Most patients are adults. The main causes of diphyllobothriasis infection are non-compliance with hygiene rules and violation of sanitary standards when cooking fish at home. Based on the analysis, to reduce the incidence of the population in the Sakha Republic, it is recommended to increase the frequency of preventive and anti-epidemic measures, to strengthen sanitary and epidemiological control of the diphyllobothriasis infection, and to follow individual hygiene rules.

To achieve the appropriate level of accessibility and quality of medical care, the issues of resource endowment (material, financial, personnel, information, etc.) in the municipalities of the republic are of no small importance. In this study, we analyzed the availability of resource by the indicators included in the official statistical reporting: medical personnel sufficiency (doctors, nursing personnel), round-the-clock hospital beds (per 10,000 population) and the capacity of outpatient clinics (in visits per shift). It became obvious that in Verkhnevilyuisky, Verkhoyansky, Tattinsky and Even-Bytantaysky Districts, the situation with the medical personnel sufficiency, round-the-clock hospital beds and outpatient clinics capacity is generally unfavorable, except for the nursing personnel sufficiency. A direct relationship was found between the deteriorated situation with resource endowment and the increase in the indicators of the general and primary morbidity of the population, especially in Verkhoyansky, Tattinsky and Even-Bytantaysky Districts.