№1, 2022, volume 18

Objective: to conduct a comprehensive analysis of citizens appeals and complaints to medical organizations (hereinafter — MO) of the Russian subject. Material and methods. Based on the reporting data, an analysis of the with citizens' appeals work in the Chelyabinsk Region MO for the period 2015-2019 was carried out. Results. An increase in the number of referrals in the study period (from 8397 to 15271) was revealed, where issues of quality (30.7%) and accessibility (29.1 %) of medical care prevail in the thematic structure. At the same time, there is a decrease in appeals recognized as justified (from 8.6 to 4.6%) and an increase in appeals considered without determining the topic (from 19.8 to 30.2%). For the third level MO, a correlation (r=0.99, p=0.011) between the number of complaints considered by the medical commission and recognized as substantiated was determined. Conclusions. 1. The citizens' appeals dynamics is characterized by a pronounced growth with a thematic predominance of complaints about the quality and accessibility of medical care. 2. The third level MO medical commission work with citizens' appeals to contributes to increasing the objectivity of their consideration. 3. A significant number of requests classified as "others" at the stage of consideration requires additional tools for their detail. 4. The increase in complaints may be due to both objective reasons and subjective evaluation of patients in the context of increasing information availability, which requires further investigation.

Objective: to present up-to-date scientific information concerning the pathophysiological and clinical features of diabetic encephalopathy (DE) in children with type 1 diabetes mellitus (DM). A total of 44 publications were analyzed, obtained from the Cochrane Library, PubMed, eLibrary.ru and Medscape using the following search queries: "diabetes mellitus in children and adolescents", "diabetic encephalopathy", "pathophysiology of diabetic encephalopathy in childhood" and "clinical manifestations of diabetic encephalopathy in childhood". The analyzed literature was published in the year range of 2008 to 2021. This work provides a general overview and describes the etiology, pathophysiology and clinical manifestations of DE in children and adolescents in the setting of type 1 DM. It comes to a conclusion that an understanding of the mechanisms of development of this complication, coupled with timely diagnosis, will help minimize the progression of central nervous system damage in this category of patients.

Objective: to demonstrate successful experience in the diagnosis and treatment of fibrosarcoma of rare localization (in the axillary region). Timely surgical treatment by a complex surgical team with the involvement of specialists of various specialties, in the form of decompression of the brachial plexus and radical excision of a malignant neoplasm, made it possible to improve the patient's quality of life, prevent complete loss of functions of the left arm, and also prevent tumor metastasis.

Objective: to analyze the features of clinical course of lower extremity varicose vein disease and acute thrombophlebitis of varicose veins for the patients with undifferentiated connective tissue dysplasia after crossectomy. Material and methods. The prospective clinical cohort study covered 132 female patients with varicose disease who underwent crossectomy. 67 patients with dysplasia were included into the main group; patients without dysplasia were included into the control group. Examination of patients and ultrasound scanning of lower extremity veins were made in 3, 6, 12, 36 months. The Cox regression analysis was used to assess the influence of dysplasia on the risk of developing thrombophlebitis of varicose veins. Results. The progress of clinical manifestations of varicose disease after crossec- tomy was found for 57 (85.1 %) female patients with dysplasia and for 14 (21.5%) female patients without dysplasia (p=0.002), which needed making phlebectomy The recurrence of thrombophlebitis of varicose veins was found for 22 (32.8%) female patients with dysplasia and for 5 (7.7%) female patients without dysplasia (p=0.002). The indication of Cox-model Exp(S), which characterizes the predicted change of risks for dysplasia, was 4,216 (95% С11.595-11.147). Conclusion. The clinical course of varicose disease for patients with undifferentiated connective tissue dysplasia is characterized by the progression of clinical manifestations of chronic venous insufficiency of extremity. Undifferentiated connective tissue dysplasia increases the risk of developing the recurrence of thrombophlebitis of varicose veins after crossectomy by more than 4.2 times.

Objective: to describe a malignant synovial sarcoma of rare localization. Synovial sarcoma is a soft tissue tumor originating from connective tissue, mainly from the synovial membrane of the joints. However, there are also rare localizations. This clinical case demonstrates the need for a more detailed diagnosis of neoplasms and demonstrates the need for early initiation of surgical and conservative treatment.

Objective: to evaluate the effectiveness of surgery in children with secondary proximal hip deformity and acetabular dysplasia. Material and methods. The study included 60 children (65 joints) of 9-16 years old (the average age was 12.5 years old). We divided all patients into two age groups: group 1 — children aged 9 to 12 years old (35 joints), group 2 — children aged 13 to 16 years old (30 joints). We used various surgical tactics; the choice depended on the examination methods and results. Long-term results were followed up to 7 years after the intervention. We assessed the treatment outcomes using Tschauner-Hempel equations and McKay scale. Results. Group 1 featured excellent outcomes in 48.6% of cases, good outcome in 42.8%, satisfactory outcome in 8.6% of cases. Group 2 featured two unsatisfactory outcomes, excellent outcomes in 36.6%, good outcomes in 32.3% and satisfactory outcomes in 24.5% of cases. Conclusion. According to the long-term results of radiometric and functional indicators, surgical correction of residual deformations in hip dysplasia in children and adolescents is a highly effective tool for preventing the development of early coxarthrosis. In order to obtain good and satisfactory treatment outcomes, surgery tactics should rely on a thorough analysis of the anatomical-functional state of the hip joint, taking into account the age of the patient. More optimal for surgical prevention of early hip osteoarthritis is 9 to 12 years of age.

The review presents data on the stages of wound healing and extracted tooth socket in acute and chronic inflammatory processes, cytokine system effect on inflammation character. Objective: to present pathogenic role of cytokine imbalance in extracted tooth socket alveolitis development. Data analysis was carried out on the following Internet resources: eLibrary, Cyberleninka, disserCat, PubMed, ResearchGate, data base of Journal «Medical Immunology» (48 references from 2000 until 2021 years). Based on the analysis, it was concluded that the pathophysiological mechanisms of alveolitis development, based on cellular and molecular-biochemical reactions, haven't been studied enough, the data on this issue are fragmentary and contradictory, there are no laboratory criteria for early detection of disease, warning of initial stage of development of an inflammatory complication and allowing to create its preventive pathogenetic treatment.

Objective: develop a dental prevention program for preschool children. Material and methods. 270 children were examined, including 3-year-olds — 120, 6-year-olds — 150. Groups: I (control) — 60 children of three years and 75 six years, a set of preventive measures included professional oral hygiene and training in individual oral hygiene; Group II — 60 children of three and 75 six years old, including professional oral hygiene, training in individual oral hygiene, brushing their teeth with pastes, with a fluoride content of 1000 ppm and applying Belak-F fluorolac (VladMiVa) to their teeth. At the beginning of the study and after 12 months, the intensity of caries kp(z)+KPU (z), kp(p)+KPU (p), hygiene index was determined. Results. The intensity of caries in three-year-old children, according to the kp (z) index in group II, decreased by 0.24, and in the kp (p) index— by 0.3. The intensity of caries in six-year-old children, according to the index kp (z) in group II, decreased by 0.25, and in the index kp (p) — by 0.4. The hygienic index for Fedorov — Volod-kina was reduced in group II by 0.74 in both three- and six-year-olds. Conclusion. On the basis of the results of a study of the hygienic state of the oral cavity in three and six-year-old children, a program forthe prevention of dental diseases has been developed to reduce the prevalence and intensity of caries in children and its complications.

Objective: to analyze the technologies of endothelial keratoplasty (EK), evaluate the advantages and disadvantages of each method, including Pre-Descemet's endothelial keratoplasty (PDEK) in the treatment of such corneal diseases. The literature review analyzes published data on modern methods of EK. PubMed database was used to search for articles. A total of 50 literature sources that were published between 1956 and 2020 were cited. Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) are popular treatment methods for patients with corneal endothelial pathology, but have a number of drawbacks, such as: low visual acuity due to induced ametropia (DSAEK), donor age limitation and difficulty in manipulating the isolated Descemet's membrane (DMEK). Given the above disadvantages of DSAEK and DMEK methods, the search for alternative surgical techniques is relevant. One of the most recent methods of tissue transplantation for patients, allowing to avoid the above mentioned drawbacks, is PD.

Objective: to compare the clinical visual characteristics of two different models of multifocal toric intraocular lenses (IOL). Material and methods. In a retrospective study, 49 eyes with corneal astigmatism > 0.75 dptr were divided into two groups. In group 1 (n=19), patients were implanted with an open haptic multifocal toric IOL Aery Sof IQ PanOptix Toric (Alcon), and in group 2 (n=30) — BB T MFM 611, VSY (Acriva Reviol). Observations were carried out 1,3,6 and 12 months after the operation. The degree of rotation of the IOL, residual spherical refraction and astigmatism, as well as uncorrected visual acuity near and far were evaluated. Results. There were no differences between the two groups in terms of uncorrected visual acuity in the distance (p=0.382), spherical equivalent (p=0.174), degree of astigmatism (p=0.062), degree of rotation (p=0.219) and uncorrected visual acuity near (p=0.712). However, there was a noticeable improvement in visual acuity in the distance (0.3 and 0.1) and near (0.1 and 0.1) compared with preoperative values in groups 1 and 2, respectively. Conclusion. Both lenses have shown comparable high clinical results, which suggests that it is possible to effectively correct astigmatism and provide sufficient uncorrected visual acuity at any distance.