2022, volume 18

Objective: by analyzing the results of the activities of medical organizations participating in the compulsory medical insurance system of St. Petersburg, to identify trends in the provision of medical care using in vitro fertilization (IVF) techniques within the framework of the program of state guarantees of free medical care to citizens. Material and methods. The structural component of medical organizations providing medical care using IVF techniques in St. Petersburg over the past 9 years (2013-2021), as well as the volume of medical care provided by them in dynamics over the past 5 years (2016-2020), has been studied. Results. Using the example of St. Petersburg, it was found that the increase in the number of IVF cycles carried out during the implementation of the state guarantee program over the past five years amounted to 42.7%. At the same time, uneven opportunities in carrying out this procedure for residents of different regions are noted. The growth noted in St. Petersburg medical organizations occurred due to the outstripping growth of such services provided to nonresident patients: in 2019, their growth rate compared to the level of 2016 was only 21.3% for residents of St. Petersburg and 129.1% for nonresident patients. The leading role in the growth of indicators is played by medical organizations of non-state forms of ownership, in which 66.3% of all IVF cycles are currently carried out for residents of St. Petersburg and 78.0% for nonresident patients. Conclusion. The significant role of large federal centers identified by the example of St. Petersburg in providing significant amounts of medical care using IVF to nonresident patients should be taken into account when developing regional health development programs in order to prevent restrictions on the availability of medical services for residents of St. Petersburg.

Objective: our study aimed to determine the prevalence and grade of malnutrition in patients hospitalized for various indications and to examine its relationship with comorbidities and socio-demographic factors. Material and methods. This study enrolled children aged 1 month to 15 years with a median (Q25; Q75) age of 1.8 (1.27-3.47) who were hospitalized in our hospital with various diagnoses between 1 January 2019 and 31 December 2019. Our study included 498 patients, 286 (57.4%) of which were male and 212 (42.6%) were female. Results. Forty (19.7%) patients with a median (Q25; Q75) age of 2.25 (1.27-3.48) years had a weight z-score of less than -2SD. According to the Waterlow classification, 47.2% (n=235) of the patients had malnutrition. There were significant differences between the groups regarding socioeconomic level and C-reactive protein (CRP) level. Conclusion. Malnutrition is associated with low socio-economic status. It plays an important role in hospitalizations for different reasons.

Using the example of Arnold — Chiari syndrome type II, the difficulties arising in the early diagnosis of this congenital pathology and further tactics of newborn management and surgical correction of the defect are demonstrated. In the presented clinical case, during prenatal ultrasound diagnostics, it was possible to identify a severe malformation of the central nervous system — Chiari malformation — at an early stage. The parents' refusal to terminate the pregnancy and its prolongation ended with delivery by caesarean section. In the postnatal period, the diagnosis of congenital Arnold — Chiari syndrome type II was confirmed, symptomatic treatment was performed and the child was referred for neurosurgical correction, which is the only method to avoid death and severe disability. It should be noted that the forecast for a full and high-quality life remains very dubious due to the high probability of a child's disability.

Objective; to discuss the current views on the risk factors and diagnostic methods of visceral obesity in the aspect of prevention of cardiovascular complications. The review is done using the PRISMA method. Mainly publications from five electronic databases (Scopus, PubMed, Web of Science, Google Scholar and e-Library) from 1980 to 2021 were analyzed using the following keywords and their combinations: "visceral obesity", "risk factors", "diagnosis", "body mass index", "waist circumference", "ectopic adipose tissue", and "cardiovascular complications". In addition, the review includes selected archival publications of principal scientific significance. As a result, the review includes 37 most significant publications for the disclosure of the above-mentioned topic. The combined use of such parameters as body mass index, waist circumference and fasting triglyceride level has been shown to be reasonable in the diagnosis of visceral obesity. In addition, radiological and ultrasound techniques of visceral obesity assessment are being introduced into clinical practice.

Objective: to assess the annual dynamics of clinical, laboratory and echocardiographic characteristics of patients with heart failure with mildly reduced ejection fraction after elective percutaneous coronary intervention. Material and methods. The study involved 101 patients (16 women and 85 men) with signs of chronic heart failure and ejection fraction 40-49%. The examination included scoring on the clinical condition assessment scale, six-minute walk test, determination of N-terminal prohormone of brain natriuretic peptide (NT-proBNP, pg/ml), transthoracic echocardiogra-phy. Mean age is 59±9 years. The distribution by functional classes of heart failure was as follows: I — 1%, II —63.4%, ill — 33.7%, IV — 2%. Results. After 12 months the number of points on the clinical condition assessment scale decreased from 3 (2; 4) to 1 (0; 1) points (p<0.001) mainly due to a decrease in dyspnea. The increase in distance in the six-minute walk test over 12 months was 85 (57; 115) meters (p<0.001). Mean NT-proBNP level in the group decreased from 370 (295; 459) to 264 (193; 343) pg/ml (p <0.001). Over the year, mean increase in the ejection fraction was 7±5% (p<0.001). Conclusion. Elective percutaneous coronary intervention has a positive effect on the annual dynamics of clinical, laboratory and echocardiographic parameters of patients with heart failure with mildly reduced ejection fraction.

Objective: to evaluate total testosterone level in type 2 diabetes mellitus (DM) males with different degrees of compensation of carbohydrate metabolism. Material and methods. The continuous screening cross-sectional non-interventional study included 100 males at the age of 45 [43; 48] years primarily diagnosed with type 2 DM. The study lasted from February 2021 till May 2021. The level of glycated hemoglobin (HbA1c) and total blood testosterone were determined. Group comparison was performed with Mann —Whitney U-test, Kruskal—Wallis test and Fisher criterion. The differences were considered statistically significant atp<0.05. Results. When comparing patients with different levels of HbA1c, it was found that in patients with HbAlcfrom less than 6.5 to 9.9%, both total testosterone levels and the prevalence of its deficiency did not differ statistically significantly. At HbA1 с greater than 12%, the prevalence of testosterone deficiency increased statistically significantly (p<0.001) and testosterone levels decreased (p<0.001). Comparison of groups of patients with HbA1c levels from less than 6.5 to 9.9% and from 10 to 11.9% did not reveal statistically significant differences in the prevalence of deficiency and testosterone levels. However, there was a tendency to worse indicators in the latter group, especially since patients with HbA1c levels from less than 6.5 to 9.9% were older. Conclusion. Total testosterone level in type 2 DM patients are associated with compensation of carbohydrate metabolism. The negative impact on testosterone production was detected in patients with HbA1c level higher than 10%.

Currently, in the intensive care of coagulopathy, as a clinical manifestation of massive obstetric bleeding, plasma and recombinant concentrates of factors of the blood coagulation system are used with good effect, which include, respectively, the concentrate of the prothrombin complex "Prothromplex 600" and the recombinant factor (rFVIIa) "Coagil-VII". When regulating the interaction of drugs, the simultaneous administration of the prothrombin complex concentrate and rFVIIa is not recommended, due to the lack of knowledge of the interaction of these categories of drugs (as well as with antifibrinolytics), while in the instructions for the use of the prothrombin complex concentrate there are no direct indications of the undesirability of using it with rFVIIa. The cases cited by the authors of the sequential use of prothrombin complex concentrate and rFVIIa confirm the presence of clear indications for their use, as well as the possibility of consistent use in compliance with the requirements of dynamic laboratory monitoring in women with massive obstetric bleeding caused by an abnormal location of the placenta and amniotic fluid embolism.

Objective: analysis of trends in the development of neurosurgery for hemorrhagic stroke (HS) at the present stage. Research was carried out using the databases Web of Science, Scopus, PubMed, CyberLeninka, eLibrary by searching/analyzing sources published within 3 years, as well as individual publications older than 5 years (range from 2014 to 2022). The analysis of 50 literary sources was carried out. Neurosurgical approaches to the treatment of HS and current approaches to the study of pathological mechanisms, predictors and risk factors are considered. It is established that much attention is paid to the comparative study of the outcomes of classical and minimally invasive methods of pathology treatment. An increase in the proportion of the latter leads to a decrease in the mortality rate in HS. Arterial hypertension is an unambiguous risk factor in the development of pathology. Much research have been devoted to potential predictors of HS outcomes (prealbumin level, hyperuricemia, lymphocyte/neutrophil ratio). Special attention is paid to the mechanisms of formation of programmed cell deaths in the postoperative period. The list of molecular-cellular predictors optimal for risk stratification in HS has not been formed. It is necessary to search for therapeutic targets through an in-depth study of the mechanisms of development/remission of pathology at the molecular and cellular level.

Objective: to demonstrate the features of diagnosis and successful experience of surgical treatment of chronic subdural cerebral hematoma in a patient who underwent COVID-19. The choice of surgical treatment methods for patients with chronic subdural cerebral hematoma formed due to a violation of the blood coagulation system after COVID-19 and/or prolonged use of anticoagulants is very difficult due to possible complications. In the presented clinical case, the method of closed external drainage was chosen, which contributed to reducing the risk of complications and shortened the recovery period of the patient who underwent COVID-19 in the postoperative period.

Objective: using the example of clinical observation to describe the features of a new method of surgical treatment of aneurysms at the mouth of the posterior inferior cerebellar artery (PICA), in the area of the anterior and lateral medullary segments. Despite a wide range of traditional surgical and minidomes, there is no consensus on the choice of a particular access for cerebral aneurysms. Suggested indications and contraindications for aneurysm treatment methods vary from author to author. The extended retrosigmoid retrocondylar access we use is safe and effective and can be a good alternative in microsurgery of PICA aneurysms in the acute period of hemorrhage. In this clinical example we demonstrate a new surgical approach to the treatment of aneurysms in the PICA orifice based on the experience formed in the clinic with a significant volume of patients (more than 200 annually) operated on in the first 48 hours after hemorrhage, which can be used in practice and allows achieving the fastest early patient activation and reducing the period of medical and social rehabilitation.