№2, 2021, volume 17

The purpose of the study is to identify existing organizational problems and determine possible perspectives for the development of the palliative care system in the Russian Federation. 10 fundamental current regulatory legal acts the implementation of palliative care in the Russian Federation have been analyzed during the period from 2011 till 2020. The systematization of pathological conditions in which patients need the provision of palliative medical care was carried out, the procedure for the actions of medical workers during its provision was concretized. A regulatory framework has been formed for the systematic expansion of the volume of palliative care in outpatient settings, including at home. The problem of training specialists in palliative care was identified, as well as the problem of accessibility of primary care for the population due to the limited list of medical indications. The main development prospects are the expansion of indications for primary care, the preparation of residency programs for palliative care physicians, the synchronization of regulations, the priority development of regional infrastructure, and the expansion of interaction with non-medical organizations.

The article presents an overview of the data on the study of the effectiveness of modern endoscopic methods of surgical treatment of benign prostatic hyperplasia. The positive and negative aspects of each method are characterized. The review is based on the analysis of databases: PubMed, eLibrary, Cohrane Library, UpToDate, MEDLINE, Embase from 1991-2020 in the number of 40 sources.

Differential diagnosis of volume formations of the brain with a ring-shaped type of contrast enhancement is extremely difficult. This is due to the fact that this type of contrast is observed in: cysts, abscesses, metastases, demyelinating diseases, post-infectious, post-vaccination vasculitis, vasculopathies, hematomas, brain infarction. In this article, the features of the diagnosis and approach to the treatment of a patient with a volume formation of the brain with a ring-shaped type of contrast enhancement.

The aim of the study was to analyze in-hospital mortality and long-term survival of elderly patients who underwent open heart surgery and meet the criterion of "frailty". Material and Methods. The study included 266 "frail" patients over 75 years old (F-index <5). 155 operations of coronary artery bypass grafting (CABG), 47 operations of aortic valve replacement (AVR), 64 operations of CABG in combination with AVR were performed. They were divided in groups depending on type of surgery. Postoperative complications, early and long-term outcomes were compared. Results. In-hospital mortality in general group was 5.3%, in CABG+AVR group — 9.4%, in CABG group — 3.9%, in AVR group — 4,2%. There was no significant difference in in-hospital mortality between groups (p>0.05). Long-term survival in general group was: 1-year survival — 98.3%, 3-year survival — 94.6%, 5-year survival — 82.1 %. Type of surgery has no significant impact on outcome (p>0.05). Conclusion. Early and long-term results of CABG, AVR, and combination of CABG with AVR in the group of elderly patients who meet the criterion of "frailty" are characterized by low mortality and low incidence of non-fatal complications. The type of cardiac surgery and old age do not significantly affect the outcome of surgical treatment.

Treatment of victims with widespread deep burns is a serious problem in modern medicine. First of all, this is due to the high mortality rate in such patients from complications of burn disease, which develop due to the presence of extensive wound surfaces. This article demonstrates a case of successful treatment of a teenager with a flame burn on an area of 65% of the body surface of 2-3 degrees. On the example of clinical observation, the possibility of using active surgical tactics of treatment and cell cultures of autologous fibroblasts in the treatment of a patient with a critical area of burn lesions was demonstrated, which made it possible to successfully restore the lost skin in conditions of a shortage of donor resources, stop the complications of burn disease, and also activate the patient.

Aim is to compare the effectiveness of using different molecular genetic methods in the diagnosis of tuberculosis and the determination of drug sensitivity to rifampin (Rif). Material and Methods. A retrospective analysis of the results of a study of sputum samples obtained from 1992 patients with pulmonary tuberculosis treated in the Saratov Regional Clinical ТВ Dispensary was carried out from 2014 till 2018. The following methods were used: real-time polymerase chain reaction (PCR Real Time), biological microchips, automated Xpert® MTB/Rif technology. Statistical processing of the research results was carried out using the Bayes formula based on the tables of mutual contingency of the "four-field table" and the x2 test. When determining the significance of differences in relative values, a critical significance level of 0.05 was taken. Results. A higher diagnostic sensitivity of the Real Time PCR methods (73.9%) and biological microarrays (70.3%) was established compared to the Xpert® MTB/Rif method (34.2%) (p<0,001) in the etiological diagnosis of tuberculosis. The sensitivity of the methods depended on the massiveness of bacterial excretion and clinical form of tuberculosis. Conclusion: In accordance to lower diagnostic sensitivity of the Xpert MTB/Rif method in verifying the diagnosis of tuberculosis in determination of drug resistance to Rif using the Xpert MTB/Rif method, rather high operational characteristics were found out (sensitivity — 89.7%, specificity — 89.1 % and efficiency — 89.4%) comparable with the method of biological microarrays (93.9%, 71.8%, 82.9%) (p=0.127, p<0.001, p=0.139) respectively.

The objective of the research is to present the findings of both intravital and postmortal morphological examinations revealing some features of thanatogenesis in patients with acute injury of cervical spine affected by permanent ankylosing spondylitis.

An overview of the literature data for the last 40 years (from 1984 to 2020) is presented, dedicated to the study of possibilities of using the isokinetic dynamometry method in the diagnosis and rehabilitation of patients with motor disorders in various diseases and pathological conditions (31 sources). To search for information, the Internet resources eLibrary and PubMed and scientific literature of the library of the Stavropol State Medical University were used. The article highlights the possibilities of the isokinetic dynamometry method for an objective assessment of the functional state of skeletal muscles in health and disease. The characteristics of rehabilitation measures using isokinetic dynamometry devices in patients with pathology of the knee and hip joints are given. Information on the effectiveness, safety and application possibilities of this technique in various fields of medicine is presented. Based on the review, it was concluded that it is rational to use the isokinetic dynamometry method in the complex of diagnostic and rehabilitation treatment for patients with compression radiculopathy.

The review presents an analysis of the literature on indications and contraindications for cochlear implantation (Cl) under general anesthesia, as well as under local anesthesia; special emphasis is placed on identifying the advantages and disadvantages of conducting Cl under local anesthesia. To search for articles, we used the PubMed database, eLibrary, as well as the archives of the journals: «European Archives of Otorhinolaryngology», «Canadian Medical Association Journal», «Otology and Neurotology Journal», «Singapore Dental Journal», «Journal of Applied Gerontology», «Journal of Communication Disorders», «The Hearing Journal», «Cochlear Implants International Journal». The literature review used 43 literature sources; articles were published during the period from 1954 to 2020.