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Objective: To create a new taxonomy of schizophrenia spectrum disorders (SSD) based on the comparability of the design of SSD and borderline states., Material and Methods: The total sample consists of 205 patients with an established diagnosis of SSD (F21; F25; F22 according to ICD-10) collected from studies of the department of borderline mental pathology and psychosomatic disorders of the Federal State Budgetary Institution Mental Health Research Center and the Department of Psychiatry and Psychosomatics of Moscow State Medical University in the period 2014 to 2024. Clinical, psychometric, statistical methods were used., Results: A new two-level model of schizotypal personality disorder (STPD) has been developed: the first level is psychopathic-like disorders of the «Ferschroben» type; the second level are psychopathological disorders (positive, negative, etc.), appearing under their «mask», constituting a «tracing paper» of manifestations of schizophrenia «in miniature». The two-level psychopathological model of STPD is a complex clinical phenotype, including independent but overlapping phenotypic formations: psychopathic-like - the «Ferschroben» type; and basic - schizophreniform disorders., Conclusion: The clinical classification of schizophrenia spectrum disorders has been developed; pseudoneuroses and stress-induced disorders of the endogenous circle are considered in the aspect of the dynamics of STPD.

Climate change and formation of regional weather features increase both direct (immediate effects of extremal temperature and other weather and climatic anomalies) and indirect (environmental deterioration, etc.) consequences of global climate change. The development of investigations of medical weather assessment, medical and meteorological forecasting system, the use of treatment and preventive measures give the opportunity to prepare for weather biotropic conditions and reduce weather-conditioned exacerbations., Objective: To assess the clinical effectiveness of non-drug comprehensive methods, including balneotherapy and physiotherapy, in patients with somatic diseases, complicated by increased meteosensitivity, depending on the features of weather conditions in the Moscow region., Material and Methods: The study included 120 patients diagnosed with «osteoarthrosis/osteoarthritis» with predominant hip and knee joint damage. The majority of patients had comorbidities, namely hypertensive disease (67.2%), ischemic heart disease (32.8%), chronic obstructive pulmonary disease and bronchial asthma (10.8%), grade II-III obesity (10%) and compensated diabetes mellitus (9.2%). The severity and main symptoms of the meteopathic reactions' manifestation were assessed by questionnaires consisting of three blocks, HAM, SF-36 tests and psychological stress scale. Medical and meteorological assessment of weather conditions in Moscow included analysis of the main weather-forming factors for 4 main synoptic observations in 10-minute mode for current and predictive 2 days, as well as daily characteristics of solar activity. Treatment methods included alternating magnetic field (AMF) procedures, general sodium chloride baths, massage and rehabilitation exercises (RE) (1st group); AMF, «dry» carbon dioxide baths, applications with brine on the affected joints and RE (2nd group); AMF, «dry» radon baths, applications with brine and RE (3rd group)., Results: The conducted studies have revealed the trigger role of most biotropic combinations of weather-forming factors that provoke exacerbation in patients with joint diseases. Sodium chloride, «dry» carbon dioxide and radon baths combined with AMF, applications with brine on the affected joints and RE are pathogenetically justified and contribute to increase of adaptive potential, functional reserves of the body and provide significantly high ( p< 0.05) meteocorrective action., Conclusion: The obtained results can be used for rehabilitation of patients with joint diseases complicated by increased meteosensitivity.

Objective: To evaluate the effect of discontinuation or prolongation of DMT on the activity of the disease during pregnancy and in the postpartum period in patients with aggressive MS from the Moscow region., Material and Methods: The study included female patients with an aggressive course of MS receiving DMT at the time of pregnancy. The patients were followed-up for the period 2016 to February 2024., Results: There were 17 cases of pregnancy during natalizumab (NZ) therapy; discontinuation of therapy in the first trimester of pregnancy provoked a resumption of disease activity in half of the patients. There were no exacerbations in patients whose therapy was prolonged until the 34th week of pregnancy. In 5 patients receiving fingolimod (FGL), therapy was discontinued upon the establishment of pregnancy, which caused the resumption of disease activity in three out of 5 cases. In 3 patients receiving anti-B-cell therapy, pregnancy occurred within a few months after the next infusion, there were no exacerbations during pregnancy., Conclusion: The cancellation of NS therapy in the early stages of pregnancy in most cases leads to the resumption of disease activity during pregnancy. Exacerbations in the postpartum period also correlated with early discontinuation of therapy and with a long period before the restart of infusions. Prolongation of infusions to 30-34 weeks of pregnancy contributed to stabilization of the condition throughout the perinatal period. Discontinuation of FGL therapy at the onset of pregnancy increased the risk of repeated relapses of the disease, up to the development of inflammatory immune restoration syndrome during pregnancy and contributed to the increase in disability in the postpartum period.

Objective: To analyze the contribution of alcohol and drug intoxication to fatal occupational injuries and sudden death at the workplace in Moscow., Material and Methods: A number of death cases of various organizations' employees equal 357 in Moscow in 2023 were investigated. The mean age of the deceased was 48.29±13.9 years, 92.4% of them were men., Results: Ethanol in blood has been determined in 15% of the deceased. Narcotic drugs and psychotropic medications have been found in 6.7% of cases. Signs of chronic intoxication have been established in 16.5% of the deceased. Chronic intoxication accompanied or aggravated the course of 70% of cardiomyopathies. The proportion of deceased in an accident at an industry or construction site equal 23.9%, as well as 1 / 2 of the deceased in an accident on the street and in a residential building were impaired by alcohol., Conclusion: The study of the contribution of alcohol and drug consumption to occupational mortality will allow to plan measures for reducing the mortality of working-age population.

Objective: To identify the association between cerebrovascular diseases (CVD) and multiple sclerosis (MS) among patients over 50 years old in two independent populations of Moscow and Tyumen., Material and Methods: The study included 94 patients with MS in combination with CVD (main group) and 90 age-and sex-matched patients with MS without a vascular history (comparison group). An analysis of parameters such as disease duration, EDSS at different time points, disease progression index, duration of first remission in each population separately and in both populations together was carried out., Results: The presence of CVD in patients with MS was associated with the presence of other diseases that are associated with an increased risk of developing cerebrovascular pathology. In the main group, there was a statistically significant decrease in the duration of the first remission and an increase in the disease progression index. In addition, other diseases and syndromes were identified in the main group that, in combination with CVD in patients with MS, could lead to a worsening of the course of MS. These included arterial hypertension, diabetes mellitus, obesity, dyslipidemia, chronic venous insufficiency, and regular use of proton pump inhibitors., Conclusion: Comorbid vascular pathology can affect the severity of MS from the very beginning of the disease. It can lead to a shorter duration of the first remission and a higher disease progression index, increasing the degree of disability. The combination of autoimmune-inflammatory, demyelinating, and vascular processes can worsen the prognosis for MS.

Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.

Objective: To evaluate the incidence of laryngeal papillomatosis (LP) and LP recurrence in adults and to determine the risk factors for the development of LP recurrence in adults in Moscow. To solve the tasks set, a survey of patients carried out, including the collection of complaints and anamnesis, a standard examination of the ENT organs, an assessment of the condition of the larynx, and a histological examination., Material and Methods: We conducted a retrospective analysis of the case histories of 299 patients with LP observed and treated at the Sverzhevsky Research and Clinical Institute of Otorhinolaryngology in the period 2010-2020., Results: On average, over the entire study period, the prevalence of PG was 17.80%. It was found that out of 299 patients, 69.6% ( n =208) had a relapse of LP. Papilloma of the larynx were more often localized in the glottis. 275 (92%) patients had a widespread form of LP. LP recurrences were significantly more common in women and in patients with an existing cicatricle process in the larynx. The relapse rate was higher in non-smokers (73.5% vs 47.8%; p <0.001). Although the recurrence rate was higher in patients with non-voice occupations (70.6% vs. 52.9%), there was no statistically significant association between relapses and the vocal professions ( p =0.125)., Conclusion: As a result of the study, a number of risk factors for laryngeal papillomatosis recurrent have been identified, and their study should be continued.

Objective: To analyze the work of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents, operating on the basis of the Morozov Children's City Clinical Hospital of the Moscow Health Department for the period 2018-2021 and to assess the peculiarities of organizing the provision of specialized care to children and adolescents with acute cerebrovascular accident (ACA)., Material and Methods: Annual reports of the Center for the period 2018-2021; included children and adolescents aged 1 month to 17 years 11 months 29 days, with new onset ischemic stroke (IS) and hemorrhagic stroke (HS), cerebral venous thrombosis (sinus thrombosis), confirmed clinically and radiologically., Results: Statistical data on stroke and organization of care for children with this pathology in Moscow are presented. The incidence of IS in Moscow for the period 2018-2021 ranged from 1.6 to 2.5 per 100.000 children, HI - from 2.35 to 3.3 per 100.000, sinus thrombosis from 0.5 to 1.38 per 100.000. When assessing the main etiological factors of stroke in The Center for International Pediatric Stroke Research categories, we noted a prevalence of chronic head and neck diseases (20-37%) and chronic systemic conditions (conditions or diseases with known changes in coagulation or vascular structure, including connective tissue dysplasia, genetic, hematological, inflammatory or diseases of the immune system) (15-20%). In addition, data on reperfusion therapy carried out at the Center are presented. From 2018 (first thrombolysis was performed) to 2021, 7.3-14.7% of all patients with IS underwent thrombolysis., Conclusion: The experience of functioning of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents has shown that the creation of such centers in the regions of the Russian Federation is relevant, but requires taking into account the characteristics of the pediatric population when organizing their work.

Objective: Describe the structure of pathogenic germline variants and clinical and anatomical features in colorectal cancer patients in Moscow., Material and Methods: The whole genome sequencing results of patients with suspected hereditary cancer syndrome were evaluated. All identified genetic variants were validated using Sanger sequencing., Results: The study included 238 patients with colorectal cancer, 41/238 (17.2%) patients have pathogenic germline variants associated with hereditary cancer syndromes or increased cancer risk. Lynch syndrome accounts for 8% of all colorectal cancer cases (19/238), and familial adenomatous polyposis - 1.7% (4/238). 5 new genetic variants were described for the first time in a Russian colorectal cancer patients: MLH1 c.1921dup (p.Leu641fs), APC c.2929C>T (p.Gln977Ter), PMS2 c.327del (p.Ala110LeufsTer2), MSH2 c.1857dup (p. Val620CysfsTer24), ATM c.895G>T (p.Glu299Ter). In 197 of 238 patients, no significant variants were identified or variants with an uncertain clinical underlying cause were identified., Conclusion: According to the results of the study, an earlier manifestation of a malignant neoplasm and a more frequent occurrence of high-grade carcinomas in the presence of pathogenic germline mutations were noted compared to the group of patients without clinically significant varianrs, while in the group with identified mutations, the frequency of regional and distant metastasis was not increased.

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

The Aim of the Study: Was to compare the prevalence and structure of sudden death from cardiovascular diseases (CVD) in the structure of nonviolent death in Moscow Region as a representative of the large region and St. Petersburg as a city of federal importance. Frequency and structure of this parameter, as well as its dynamics were analyzed. The comparison of obtained results with data of Federal State Statistics Service was done. Nonparametric analysis of the initial data has been conducted. Clustering and visualization, based on the following parameters of initial sample, have been done: «death rate from CVD in the structure of nonviolent death», «morbidity rate», «incomes» and «unemployment rate». Correlation dependences between death rate from CVD according to the Form №42 and mentioned parameters of medical and social state of the subject have been determined. Dependences between sudden death rate from CDV and a number of medical and social parameters have been established.

Objective: Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death., Material and Methods: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases., Results: The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6 th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system» as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst"., Conclusion: The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.

The presents an analysis of the trend of the postmortem ethanol tests in biological samples obtained from the deceased in Moscow in April-May 2019 and 2020. In total, 7110 reports of forensic chemistry studies were examined; all cases were classified by the age of the deceased, following the modern generational theory to study patterns of alcohol consumption in these age groups and the impact of the COVID-19 pandemic. Stable patterns of alcoholic behavior were revealed in the groups of the deceased. It was shown that, on average, every 3rd representative of Generations «X» and «Y» consumes alcohol shortly before death; the highest average blood ethanol levels were found in representatives of Generations «Y» and «X». The number of positive ethanol test results increased in April-May 2020 among males of the baby boom and Generation «X» compared to the same period in 2019. The patterns identified can be used to further study the contribution of alcohol consumption to mortality.

Objective: To study the features of the formation of gender reassignment`s ideas in schizophrenia spectrum disorders and to differentiate diagnosis of these psychopathological formations with transsexualism., Material and Methods: The study was carried out in the Department of Sexology and Therapy of Sexual Dysfunctions of the Moscow Research Institute of Psychiatry - a branch of the Serbsky National Medical Research Center for Psychiatry and Narcology in the period from October 2018 to May 2020. The study included 100 outpatients referred for gender reassignment. The subjects were divided into two groups. The first group consisted of 58 patients with schizophrenia spectrum disorders (Paranoid schizophrenia, F20.0; Schizotypal disorder, F21; Chronic delusional disorders, F22) with ideas of sex change. The second group included 42 patients with a diagnosis of «Transsexualism» (F64.0). Clinical-psychopathological, pathopsychological and statistical methods were used., Results: Patients with transsexualism are statistically significantly more often adapted in terms of work and family, have experience of life in the desired gender, use hormone therapy and gender-affirmative interventions before undergoing a medical commission on gender reassignment and less often hospitalized in psychiatric hospitals, compared to patients with schizophrenia spectrum disorders ( p <0.05). Patients with schizophrenia are more likely to experience delays and disharmony in psychosexual development. Sex reassignment ideas are more common in schizotypal disorder than in other types of schizophrenia., Conclusion: Ideas of gender reassignment in schizophrenia spectrum disorders, as a rule, are formed on the basis of existing deviations in the early stages of the formation of gender identity. The central place in the psychopathology of schizophrenia spectrum disorders with ideas of gender reassignment is occupied by depersonalization-dysmorphophobic experiences with the following formation of overvalued, delusional or paranoid ideas of sex reassignment.

Objective: To analyze the development of surgical approaches for hepatic echinococcosis., Material and Methods: We have analyzed diagnosis and treatment of 349 patients with liver echinococcosis; 97 patients were treated at the Botkin Clinical Hospital for the period from 2009 to 2019 and 252 patients were treated in surgical hospitals of Moscow city for the period from 2014 to 2019., Results: General and specific postoperative complications, relapses and surgical approaches were assessed. The number of echinococcectomies performed in surgical hospitals of Moscow is 3 times higher compared to the Botkin Hospital. The number of liver resections is comparable in both groups. The number of pericystectomies is more than 2 times higher in the Botkin Hospital. PAIR technique was more common in surgical hospitals of Moscow., Conclusion: Evolution of surgical treatment from open echinococcectomy to anatomical liver resections and subsequent pericystectomy with PAIR technique becomes another round of evolutionary spiral in the development of surgical treatment of liver echinococcosis.

Epistaxis or nosebleeds (NB) are the most common emergency pathology that otorhinolaryngologists have to deal with. Purpose of the work: to study the prevalence of patients with NB in the otorhinolaryngological departments of hospitals in Moscow from 2003 to 2019. The reports of the heads of the ENT departments of the city clinical hospitals in Moscow were studied. Inclusion criteria were hospitals working with an adult contingent of patients. An approximation analysis was carried out and trend indicators of the prevalence of NB were studied., Results: 2003 to 2019 the total number of patients treated in ENT hospitals was 563 189 people, 20 623 (3.7%) patients were treated with NB, of which 52 (0.25%) died. The average age of the deceased was 64.7 years, men are 73.7% more prevalent than women. In 96.2% of patients, epistaxis was a complication of the underlying disease, and in 3.8%, it was regarded as a concomitant condition. In 30.8% of the deceased, NB recurred with the background of malignant lesions of the nose and nasopharynx, in 69.2% - posthemorrhagic anemia aggravated diseases of other organs and systems. Over the past 17 years, there has been a tendency for the growth of treated patients with diseases of ENT organs and patients with nosebleeds by 58.5% and 51.1%, respectively. The studied approximation of the relative prevalence and mortality rates in patients with NB showed that for the period from 2003 to 2019. trend values are practically at the same level with the minimum multidirectional linear dynamics - -0.24% and +0.04%, respectively.

Purpose of the Study: The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics., Material and Methods: The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM., Results: The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%)., Conclusions: The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.

Objective: To study the prevalence of somatic diseases in patients with mental disorders based on the results of medical examination in Moscow mental health clinics in 2018., Material and Methods: A retrospective analysis of the results of the clinical examinations of 6492 outpatients, which accounted for 79.5% of patients who underwent medical examination in this time period., Results: Comorbid somatic diseases were found in 4883 (75%) patients. Hypertension and non-insulin-dependent diabetes mellitus were most frequent with the prevalence higher than in the general population of the Russian Federation. Patients with diagnosed schizophrenia, along with hypertension and diabetes mellitus, have found to be at increased risk of diseases of the endocrine system and metabolic disorders. The incidence of the mentioned diseases is not higher than that reported in literature., Conclusion: The higher prevalence of socially relevant diseases (hypertension, diabetes mellitus) among patients with mental disorders demands the development of strategies for prevention, early detection and treatment of these diseases in psychiatric patients.

Background: The prevalence of T2DM is steadily increasing not only among the elderly, but also at a young age. T2DM is preceded by a long period of significant metabolic changes with the development of insulin resistance and в-cell dysfunction. To reduce the prevalence of complications, treatment is needed which affects several pathophysiological mechanisms underlying the disease. Monotherapy with metformin at the onset of T2DM is often insufficient. The VERIFY study demonstrated the advantage of early administration of a combination of vildagliptin and metformin in relation to the glycemic durability compared to the sequential intensification of metformin with vildagliptin in patients with type 2 diabetes., Aims: To assess the current situation in terms of the incidence of T2DM complications and the structure of the prescribing glucose lowering drugs based on the data from the Diabetes Register (DR) of the Moscow Region. To demonstrate the advantages of early combination therapy in patients with newly diagnosed T2DM using clinical cases., Materials and Methods: The data from the DR of the Moscow region, which is part of the National Diabetes Register of the Russian Federation, were used for the analysis. The data of 6,096 patients with T2DM who died in 2019 were evaluated for building the structure of the causes of death of patients with T2DM. The pattern of glucose-lowering therapy was analyzed based on data of 226,327 patients with T2DM (for 2020), as well as separately of 14,379 patients with newly diagnosed T2DM in 2019. Clinical cases are described based on the data of two patients with T2DM, available in the DR database and outpatient records., Results: In patients with young onset T2DM (&lt;40 years), the prevalence of severe complications is higher than in the general population of patients with T2DM: blindness is in 5.9 times, end-stage chronic renal failure in 2.9 times, lower limb amputations in 6.4 times more. When prescribing glucose lowering drugs, monotherapy is prevalent, mostly metformin. In double combination, metformin is used in 96.22% of cases. In the structure of glucose lowering drugs, with newly diagnosed T2DM, combination therapy is used less frequently than in patients with T2DM in general. Of the drugs of the IDP-4 group, vildagliptin is most often prescribed - 46.25% (including of a fixed combination with metformin - 12.22%). Clinical cases reflect a rapid clinical outcome: a decrease in HbA1c to the target in 6 months, the absence of hypoglycemia or other side effects, and positive weight dynamics., Conclusions: A fairly large propotion of patients with T2DM are on monotherapy with glucouse lowering drugs. Early prescription of the combination of metformin plus vildagliptin provides a longer maintenance of glycemic control without increasing the risk of hypoglycemia and weight gain for patients with newly diagnosed T2DM.

Objective: To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality., Material and Methods: The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment., Results: Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up., Conclusion: Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.

The aim of work is to study dynamics of frequency of alcohol intoxications incidence revealed at forensic examination of corpses in Moscow. Frequency of intoxications incidence was determined as index making a share part of cases where ethyl alcohol was found in blood of corpses, comparing to total number of forensic autopsies. For every calendar year of the five-year period from 2014 till 2018 the comparative analysis of frequency of incidence of alcohol intoxications at concrete types of death was carried out. We defined the trend and the rate of changes of alcohol intoxications frequency. During the period from 2014 to 2017 we discovered the strong tendency to reduction of number of alcohol intoxications at violent death. In 2018 the rate of reduction decreased.

Objective: The article presents an analysis of pre-hospital diagnosis of stroke in children., Material and Methods: Pediatric Stroke Center of Morozov Children's City Clinical Hospital (Center) for the period from October 2018 to December 2019, 502 cases of hospitalization of children by the First aid Station to the Center with directing diagnoses of ischemic stroke (IS), haemorrhagic stroke (HS), transient ischemic attack (TIA), vertebrobasilar syndrome (VBS) were analysed., Results and Conclusion: TIA was the most prevalent diagnosis made by the First aid station, with the lowest rate of confirmation after further examination in the hospital (7.8%). The higher rates of confirmation were observed for VBS (31.5%), IS (11.2%) and HI (9.1%). The so-called «masks of stroke» were diagnosed in 84.3% cases of hospitalizations that was in line with earlier studies, which reported 50 to 93%. Based on the data on the frequency of symptoms, their combinations and specificity, a screening scale for pre-hospital diagnosis of stroke in children was suggested.

Objective: To elucidate the prevalence of hepatitis B and C viral infection among the people who died in Moscow in 2015-2017, by studying the primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the total number of all deaths., Material and Methods: The 2015-2017 primary medical documentations from 8 therapeutic-and-preventive establishments with morbid anatomy units in the administrative districts and from 2 infectious diseases hospitals of the Moscow Healthcare Department were studied. The sample of those who died was 11.8-12.1% of the total number of all-cause deaths in Moscow during these years and was representative at a 0.95 confidence probability and a ±5% confidence interval. The Bernoulli theorem and the Laplace function for the 95% confidence probability were used to extrapolate the obtained data to the number of all those who died in these years., Results: The mortality rates associated with acute viral hepatitis B and C were 0.04-0.07 and 0-0.008, respectively, per 100,000 population, which corresponds to the official statistical data. The mortality rates for chronic viral hepatitis and liver cirrhosis in their outcomes, including hepatocellular carcinomas in their presence, exceeded the official statistical data by many times, accounting for 0.5-1.6 and 10.4-12.1 persons with viral hepatitis B and C, respectively, per 100,000 population and rose by 22.5% over 3 years. The rates obtained for hepatitis B virus were 1.7-5.6 lower, and those for hepatitis C virus were, on the contrary, 1.3-1.5 times higher than average in the European Union countries. There was a manifold (7.4-24-fold) prevalence of hepatitis C virus in the etiology of chronic liver damage. The mortality from liver cirrhosis of alcoholic and unknown etiology was 14.4-19.5 persons per 100,000 population and declined by 21% over 3 years. The percentage of deaths caused by acute viral hepatitis was 0.5% per 100,000 population in Moscow in 2017; that caused by chronic viral hepatitis, including liver cirrhosis in the outcome and hepatocellular carcinoma, which had developed in their presence, was 46.3%; and that of liver cirrhosis of alcoholic and unspecified etiology was 48.7% of the total number of all liver lesions., Conclusion: The study of primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the number of all deaths, makes it possible to objectively estimate the burden of mortality from hepatitis B and C viral infection.

The present article deals with the problems pertaining to the forensic medical diagnostics of the HIV-associated pathological conditions taking into consideration the materials available from the Moscow City Centre for AIDS Prophylaxis and Control with special reference to the number and structure of the diagnosed HIV-associated diseases. We undertook the analysis of co-morbid HIV/AIDS causes of violent and sudden deaths documented at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2013 till 2016. The study revealed the tendency toward a rise in the number of deaths from the HIV-associated infections including tuberculosis, pneumonias, chronic immunodeficiency conditions refractory to the treatment, and from malignant neoplasms. A peculiar feature of the aforementioned period was the increased age of the deceased subjects. In the cases of violent deaths, the HIV-associated conditions were diagnosed as the concomitant diseases, with the markedly predominant ones being acute drug and alcohol intoxication, injures, and attempts at suicide. The available results of the studies give evidence of the necessity and importance of the cooperative work of the specialists for the further improvement of forensic medical diagnostics and monitoring of HIV-associated conditions.

Aim: To analyze the clinical and social outcomes of organic mental disorders (OMD), diagnosed in children and teens; establish the factors that are relevant for the formation of the clinical picture of OMD in different sexes; the circumstances that determine the dynamics of remote OMD and the level of social adaptation of patients in adulthood., Material and Methods: Four hundred and ninety-eight children with organic mental disorders were followed-up in one of neuropsychiatric outpatient clinics of Moscow, until they reached 23-25 years of age. The total duration of observation was from 7.5 to 22 years (M±σ: 17.3±3.5 years). Clinical-psychopathological and follow-up methods were used. To assess social functioning of patients, a form for recording social skills of adolescents and a questionnaire for assessment of social functioning and quality of life were used., Results and Conclusion: In 82% of patients, OMD reduced by the time of adulthood. Disorders with severe intellectual impairment, paroxysmal disorders, psychopathic syndrome, mixed forms of the disease were the causes of a lifelong disability in 3.6% of cases.

Unlabelled: Over the past 15 years the number of children with inflammatory eye diseases has increased by five-six times. Data analysis of Moscow children's health clinics in 2014 showed that for 40,000 outpatients a viral infection was observed in 49,000 cases, whereas some children suffered from the viral infection twice or thrice. 344 children (0.7 percent) had the viral infection accompanied by keratoconjunctivitis. According to 2015 data, viral infection was observed in 37,957 children, including 325 outpatients (0.8 percent) with keratoconjunctivitis., Aim: To analyze clinical features and treatment options of ocular surface viral diseases in children., Material and Methods: We observed 140 children aged 2 to 13 years with ocular surface viral diseases., Results: Despite the presence of corneal disorders, in 95 percent of children changes were reversible - in 1.5 months corneal opacity was not observed. Yet five percent of children, despite the intensive treatment, had bacterial complications, causing decrease in visual acuity., Conclusion: In case of viral infections, ophthalmologists, pediatricians and general practitioners should all be aware of ocular manifestations of these diseases. Even if adequate therapy for ocular surface viral disorders is appointed, in five percent of cases complications are possible, causing decline in visual function. Changes in vision can be a result of general disease manifestation, and only timely and proper treatment will help to relieve the symptoms of inflammation and prevent complications.The results of our observations revealed that the addition of Ophtalmoferon medication to the complex therapy of ocular surface diseases in children showed a high therapeutic efficacy and a good safety profile. This medication, in contrast to other antiviral agents, is available in the form of ready-to-use eye drops, significantly enhancing medication compliance in outpatients.

Aim: to estimate the effect of decompressive stented drainage of biliary anastomosis on incidence of biliary complications., Material and Methods: 294 patients aged from 5 months to 61 years (mean 13.8±0.81) were enrolled. They underwent liver fragments transplantation in the Department of Liver Transplantation of Petrovsky Russian Research Center of Surgery for the period from March 1997 to January 2016. Decompressive stented drainage tubes were used in 28 (9.5%) patients. Reconstruction without drainage was applied in 266 (90.5%) cases. In the group of biliobiliary reconstruction drainage was used in 18 out of 89 cases (20.2%), in the group of biliodigestive reconstruction - in 10 out of 202 cases (4.9%). Incidence of specific biliary complications was assessed., Results: There was significant direct correlation of stented drainage of biliodigestive anastomosis with various biliary complications including bile leakage (r= -0,1253; p=0.06), obturation of anastomosis (r=0.045; p=0.501), stricture of anastomosis (r= -0.0665; p=0.320), other strictures of intrahepatic bile ducts (r= -0.0291; p=0.664), hepatolithiasis (r=0.0857; p=0.199). However significant direct correation was observed between stented drainage and incidence of intrahepatic bile ducts strictures (r=0.2117; p=0.046) and anastomosis obturation (r=0.2330; p=0.028) in case of biliobiliary reconstruction. Significant correation with other biliary complications was absent (p>0.05)., Conclusion: Unconstrained stented drainage during primary biliary reconstruction is associated with increased incidence of biliary complications and should not be indicated routinely. Clear need for drainage should be determined in further investigations.

The objective of the present study was to evaluate the influence of the medico-social factors on the development of nasal cavity and paranasal sinuses diseases and satisfaction of the patients with the quality of the provided specialized medical assistance. The approaches to the treatment of such patient at the pre-hospital and hospital levels are discussed.

Aim: to determine the indications and to evaluate early and long-term outcomes of total pancreatectomy for pancreatic cancer., Material and Methods: Treatment of 29 patients who underwent one- and two-stage pancreatectomy for different malignancies was analyzed., Results: Median of surgery duration and intraoperative blood loss was 280 min and 2200 ml respectively. Postoperative complications were observed in 9 (31%) patients. There were 2 (6.9%) deaths. 1- and 3-year overall actual survival was 61% and 16% respectively in case of ductal adenocarcinoma. Median was 18 months. Patients after surgery for primary multiple lesion (cancer of pancreatic body-tail and major duodenal papilla), pancreatic metastases of renal cancer, mucinous cystadenoma and neuroendocrine cancer are still alive. Follow-up periods are 4, 49, 49 and 65 months respectively., Conclusion: Total pancreatectomy is difficult intervention followed by severe metabolic disorders. However it can improve long-term survival with acceptable incidence of postoperative complications and quality of life if clear indications for surgery are present.

Aim: To analyze the characteristics of suicidal behavior, which was the reason of urgent admission to the psychiatric hospital, in adolescents., Material and Methods: Clinical and psychopathological analysis was performed for 143 adolescents, 55 boys and 88 girls, aged 15-17 years, admitted to a Moscow psychiatric hospital due to suicidal behavior., Results and Conclusion: Among all hospitalized on medical emergencies suicidal behavior was identified in 42%, repeated suicidal attempts were in 27% of boys and in 47% of girls. Mental disorders on admission and in the past history were found in 75%; 25% of the patients received psychiatric examination and treatment. Personality disorders and adaptation disorders were most prevalent; schizophrenia spectrum disorders made up 13%. Common features of suicidal behavior in adolescents were: the use of low fatal methods, mild expression of antivital feelings, short duration of pre-suicidal stage, suddenness of commitment of suicidal actions, an additional stressful event (conflict situation) for the development of suicidal behavior. Significant differences in the methods of realization of suicidal intentions, preferable character of suicidal behavior (blackmailing/demonstrative in girls, brutal and compulsive in boys) and typology of psychopathological symptoms were established.

Aim: To analyze long-term surgical results in patients with aortic valve disease and concomitant mitral regurgitation (MR) depending on volume of valve surgery., Material and Methods: It was studied 5-year results in 71 patients with aortic valve disease and different degree of mitral regurgitation. Patients were divided into 3 groups. Control group included 40 patients after aortic valve replacement (AVR) and no mitral insufficiency. The 2nd group consisted of 16 patients after AVR and concomitant mitral regurgitation degree 2-3. The 3rd group - 15 patients after aortic and mitral valve replacement. Mortality in long-term postoperative period, quality of life, incidence of complications and echocardiography data were analyzed., Results: There was no significant improvement of mitral regurgitation after AVR. It was showed that persistent MR decreases remote survival and quality of life as well as deteriorates echocardiography data. Herewith these data in the 3rd group did not differ from the control group., Conclusion: Double-valve replacement may be advisable in patients with aortic valve disease and concomitant moderate MR because persistent MR deteriorates long-term, Results: However prolonged time of cardiopulmonary bypass, aortic cross-clamping, greater blood loss require comprehensive approach to advanced cardiac surgery.

Aim: To optimize a system of medical care, introduction of treatment and diagnostic guidelines, including secondary stroke prevention and rehabilitation measures, by implementation of pediatric stroke registry., Material and Methods: Fifty-seven patients, aged from 1 year to 17 years 11 months, included into the Moscow city registry of pediatric stroke were examined. Forty-two patients suffered ischemic stroke and 15 hemorrhagic stroke., Results and Conclusion: The diagnostic search for the causes of pediatric stroke is difficult due to the wide variety of etiologic factors and high frequency of their combinations. This confirms the necessity of multidisciplinary approach to the management of children and adolescents in the acute phase of stroke in a multiprofile hospital with the following specialized ambulatory care.

Approximately a quarter of the world's population at some point in life is at risk of developing shingles (Herpes Zoster). In 10-20% of cases the first branch of the trigeminal nerve gets involved (Herpes Zoster Ophthalmicus, HZO). Ophthalmic complications of HZO are able to cause a significant reduction in visual function., Aim: To study and summarize clinical features of HZO (including the rate of complications and their nature) and to determine the relationship between clinical and laboratory data from these patients., Material and Methods: The study included 133 patients with ophthalmic and neurological complications of HZO (group 1 (n=28) - retrospective analysis of outpatient records for the period 1995-2005; group 2 (n=95) - a prospective study for the period 2005-2015), who received a course of conservative treatment in either the Botkin City Hospital, branch № 1, or in the ophthalmic department of the Moscow herpes centre (Gerpeticheskiy Tsentr Ltd.). Laboratory tests were performed only in patients from group 2 and included: examination of biological fluids for six types of herpes viruses by polymerase chain reaction, examination of tears and urine for DNA of Chlamydia, Mycoplasma, and Ureaplasma, and serological blood testing for markers of herpes virus infection. Patients from group 1 were prescribed topical antiviral, antibacterial, and anti-inflammatory therapy, in rare cases - acyclovir per os. In group 2, the treatment included systemic antiviral medications and immune correction therapy. Anti-inflammatory therapy consisted of local and systemic non-steroidal agents (NSAIDs)., Results: The most common ophthalmic complications of HZO in both groups were stromal keratitis and keratoiridocyclitis, neurological - III and VI cranial nerves palsies. The duration of the disease in the first group ranged from 2 months to 3 years; in the second group, patients were divided into two subgroups: subgroup A with the disease duration of no more than one month (n=81) and subgroup B with the disease duration from 1.5 to 9 months (n=14). Varicella-zoster virus (VZV) DNA was present in tears and/or other biological fluids of patients from group 2 in more than 70% of cases (n=67). Particularly, in 27.4% of cases the virus was isolated in two fluids and in 7.4% of cases - in three fluids. The duration of virus production in tears and other biological fluids (saliva, blood, and urine) ranged from 10 days to 4 months., Conclusion: Topical non-steroidal anti-inflammatory drugs and systemic etiological treatment in case of intraocular inflammation in HZO patients may reduce the risk of severe consequences of VZV reactivation and help avoid recurrences later in life.

Aim: To analyze the results of laparo- and thoracoscopy in patients with thoracic and abdominal trauma in conditions of emergency hospital., Material and Methods: For the period 2006-2013 we performed 56 laparoscopic and 15 thoracoscopic interventions in 67 patients with trauma. There were 80.6% of men and 19.4% of women aged 35±1.7 years. Abdominal, thoracic and thoraco-abdominal injuries were observed in 51 (76.1%), 14 (20.9%) and 2 (3%) patients. Abdominal or thoracic trauma alone was diagnosed in 41 (61.2%) cases and combined injury - in 26 (38.8%) patients. 37 (66%) interventions were performed laparoscopically. Conversion to laparotomy was observed in 19 (34%) cases. Mean volume of hemoperitoneum was 458 ml (range 100-1100 ml). In 11 (73.3%) patients thoracoscopic surgery was performed and conversion of access was applied in 4 (26.7%) cases., Results: No injuries of internal organs were observed in 19.6% and 13.3% of patients using laparo- and thoracoscopy respectively. So inadvisable open surgery was prevented although formal indications for laparo- and thoracotomy were present. In 25% and 20% of abdominal and thoracic damages respectively we avoided relatively unjustified laparo- or thoracotomy because of injuries were cured endoscopically. No one missed injury was observed. Postoperative complications were diagnosed in 5.6% of cases. Mortality rate was 15.6% in case of severe combined trauma. Mean hospital stay was 23.2 days (range 3-105)., Conclusion: Endoscopic techniques are perspective in treatment of thoracic and abdominal trauma. It allows to avoid inadvisable laparo- and thoracotomy in some cases and to improve results of treatment.

The objective of the present study was the retrospective analysis of the cases of rapid diagnostics of the HIV status of the corpses referred to the pathologo-anatomical departments of Moscow. The standard statistical methods were used for this purpose. The structure of H IV infections is described in terms of age and sex of the affected subjects as well as stages of the disease. It was shown that cooperation of forensic medical services with AIDS control and prevention centres is of primary importance for the substantiation of the diagnosis, improvement of the quality of the relevant statistical information about the causes of death, enhancement of the objective value of epldemiological data on the occurrence of HIV infection and HIV-associated diseases in the city of Moscow.

Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.

The objective of the present study was to elucidate the causes of late detection of malignant neoplasms of ENT and oral cavity and low survival of the patents with these tumours in Moscow. The secondary objective was to elaborate the organizational measures for reducing the level of negligence and mortality from these malignancies among the city population. It was shown that the main cause behind the negligence is the late application of the patients for the medical assistance. Next in importance are asymptomatic clinical course of the disease in the absence of the pathognomonic and early signs of malignant neoplasms, a combination of several pathologies, imperfection of medical knowledge, and the poor resolving power of the modern methods. It is emphasized that the lack of vigilance against cancer among the practicing health providers is one of the main causes of medical errors. A few ways to address the problem of negligence with respect to malignant neoplasms of ENT and oral cavity in Moscow are proposed.

Disability due to the loss of hearing is one of the main challenges to public health services and social protection of the population. The results of analysis performed by the author indicate the necessity of the comprehensive approach to the solution of disability problems for all social groups of the population. Special attention should be paid to the subpopulation of the able-bodied subjects with hearing disorders who need special medical and social rehabilitative measures to be developed and applied.

Objective: To identify people at high risk of endogenous psychosis in patients of juvenile age with nonpsychotic mental disorders., Material and Methods: Authors examine 49 patients of juvenile age with symptoms of nonpsychotic mental disorders (ICD-10 diagnoses of mood disorder, personality disorder or schizotypal disorder)., Results: In all cases, symptoms related to signs of the premorbid stage of endogenous psychosis (schizophrenia and schizoaffective psychosis) were identified. After psychopharmacological treatment, an incomplete (<30%) reduction of psychopathological disorders recorded at admission was found in 24.5% of patients. Based on the response of patients to treatment, family history (having a first-degree relative with psychosis) and the diagnosis of mental disorder, it was singled out "high-risk" (20.4% patients) and "ultra-high risk" (18.4%) states for psychosis., Conclusion: In light of these findings, the necessity of a longitude prospective study of these patients and pharmacological interventions in outpatient conditions is discussed.

The results of the diagnosis and treatment of 117 patients with cervicothoracic injuries were analyzed. Different complications were observed in 51 (43.6%) cases. The main reasons contributing to the development of complications included late diagnosis of lesions of trachea and esophagus, acute blood loss, inadequate hemostasis during surgery.

Objective: Until now the problem of the typical age of schizophrenia onset has been actively discussing in the world literature. Though there are more and more publications, which mention the growth in the number of cases with late-onset and very-late-onset of the disease, a conviction that schizophrenia is the illness of teenagers or young people is still exists. Author aimed to determine a preferable age of the onset of schizophrenia., Material and Methods: Data obtained in multi-year epidemiological research in Mental Health Research Center (Moscow) were analized. The total number of patients with schizophrenia and spectrum disorders was 5486. A subgroup of the patients with the diagnosis that met the current diagnostic criteria of schizophrenia included 1108 people. The study was based on clinical-epidemiological and statistical methods., Results: Most of patients had early onset schizophrenia (16-20 years old maximum). However, it mostly depended on demographic factors, because more than half of patients were young or middle aged at the moment of the examination. The examination of the group aged over 60 years and those who conditionally belonged to this generation (if 100% would have lived to that age) showed that the maximum number of patients had onset between 30-40 years old., Conclusion: This research demonstrates the essential predominance of cases with onset of the disease in adolescent and young age that may be rather related with demographic characteristics than pathogenetic mechanisms of schizophrenia. The latter determine predominantly middle age of disease onset (30-40 years). Cases both with early and late onset of the disease are not rare and are random deviations from the mean valuation.

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

The systemic analysis of forensic medical practice in Moscow during the past 15 years has demonstrated the scientific, practical, and social significance of expertise of peace-time blast injuries resulting from many terrorist attacks with the use of improvised high-capacity explosive devices that caused multiple human victims. The authors emphasize the current lack of objective forensic medical criteria for the reconstruction of the mechanism of injuries in numerous victims of the explosion of a high-capacity blasting device. It dictates the necessity of their development and substantiation of their practical application.

The prospective study of postoperative venous thromboembolism after standard prophylactic measures among high risk patients was performed. The ultrasound lower limb veins investigation registered postoperative venous thrombosis in 32.7% of these patients, the proximal thrombosis was in 9.1%. Half of the cases demonstrated the isolated sural sinus thrombus and the overall sural sinus involvement was 83.3%. 50% of all thromboses were diagnosed within the first week after the operation. 86.1% of all cases were registered within 2 weeks after the surgery. Terms of anticoagulative drugs prescription showed no influence on the thrombosis incidence aiming the researched patients. The study demonstrated the high true incidence of postoperative venous thromboembolism after standard prophylactic measures among high risk patients and the leading role of the sural sinus in its initiation.

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.

The present study was undertaken for the purpose of the comparative analysis of the degree of severity and inflammation-induced changes in palatine tonsils of the patients presenting with non-anginous forms of chronic tonsillitis both on the side of development of paratonsillitis and on the opposite side showing no visually visible signs of the acute inflammatory process. The secondary objective of the study was to compare pain syndrome during abscess-tonsillectomy and tonsillectomy proper, respectively. We analysed the causes behind the reduction of the total number of tonsillectomies for the treatment of chronic tonsillitis available from the accessible literature for the past 10 years. Moreover the analysis of medical records of the patients with chronic tonsillitis and delayed paratonsillar abscess was performed based on the results of the treatment of the patients admitted to the Otorhinolaryngological Department of the City Clinical Hospital No 1 during the period from 2002 and 2011. The severity of clinical manifestations of the inflammatory process was estimated based on the study of palatine tonsil biopsies removed during surgery using the radioautographic technique. The severity of pain syndrome during abscess-tonsillectomy and tonsillectomy proper was evaluated based on the McGill pain questionnaire. The results of the study confirmed apparent tonsillar inflammation in the patients presenting with chronic tonsillitis including its non-anginous forms.

232 cases of septic complications after penetrating thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. 75% of patients were reported to have any medico-social deviations. Among them the distributing was as follows: persons with no fixed abode (100%), women (91%), patients over 50 years (86.2%) and patients after knife thoracic injury (77.4%). Among patients with hemocontact infection the majority were incomers from the near-abroad countries (37%), victims of assault (20%) and patients aged 31-40 years (18.4%).

The objective of the present work was to estimate the incidence and characteristic features of the deaths by drowning in living apartments of Moscow as exemplified by the South-Western administrative district and nearby areas. Because the majority of the known and described morphological signs can not be considered as associated exclusively with drowning, new criteria for the assessment of this condition and the enhancement of reliability of the data obtained need to be developed. The author maintains that this goal could be achieved through a more close cooperation between forensic medical experts and law enforcement officers.

The diagnosis of multiple sclerosis in children and adolescence should be differentiated from a group of rare white matter diseases, with fuzzy diagnostic criteria. Some of these conditions require modern diagnostic techniques and wide knowledge of the doctor. The Moscow Division for treatment of children and adolescents with multiple sclerosis is a specialized advisory structure, which has specialists with experience in the differential diagnosis of multiple sclerosis with pediatric onset. The emphasis on the clinical aspects in differential diagnosis of early onset multiple sclerosis can reduce the time for the diagnosis and help to avoid diagnostic mistakes.

The objective of he present works was to analyse epidemiological parameters characterizing the prevalence of chronic tonsillitis morbidity and specific features of its local and systemic complications (the former included paratonsillar abscess, PA, while the latter acute rheumatic fever, ARF, and acute post-streptococcal glomerulonephritis, APSGN). The data subjected to the analysis comprised information collected by the Statistical Department of the Clinical Infectious Hospital No 1 for the past 10 years about the number of hospitalized patients having the diagnosis of tonsillitis in combination with PA and the data on the number of peritonsillar abscess drainage procedures performed between 2008 and 2010 (Statistical Department of S.P. Botkin City Clinical Hospital), the number of tonsillectomies, the prevalence of ARF and APSGN during the last 10 years (Medical Statistics Bureau of the Moscow Health Department), and the results of monitoring regular medical check-ups of the patients presenting with the above pathologies. The number of the patients hospitalized at the Clinical Infectious Hospital No 1 for the diagnosis of tonsillitis in combination with PA was shown to increase as well as the number of autopsies of the patients with PA performed at S.P. Botkin City Clinical Hospital. Simultaneously, the number of tonsillectomies in the clinics of Moscow Health Department decreased whereas the prevalence of ARF and APSGN and the number of the patients with chronic tonsillitis under dispensary observation for over 2 years increased. It is concluded that otorhinolaryngologists working in outpatient facilities must promptly identify indications for radical surgical sanitation of the pockets of chronic infection by means of bilateral tonsillectomy.