Vol 12 (2023): MATERIALS OF THE XIX INTERNATIONAL BURDENKOVO SCIENTIFIC CONFERENCE APRIL 20-22, 2023

Resume. Since the appearance of the new coronavirus infection COVID-19, the question of the impact of the transmitted infection on the human body has become relevant. It is known that NCI is characterized by changes in the functioning of the hemostasis system with the development of adverse thromboembolic complications. Even more relevant is the question of the effect of the NCI on the course of pregnancy, childbirth and the postpartum period. The purpose of the study: to evaluate the features of the course of the postpartum period in women in labor who underwent NCI during pregnancy. Materials and methods. A retrospective analysis of the birth histories of patients who underwent NCI during pregnancy and delivered in the Clinic of Obstetrics and Gynecology of the Military Medical Academy named after S.M. Kirov in the period 2021-2022 was carried out. A total of 30 patients were included in the study, 15 of whom underwent NCI during pregnancy - the main group. The control group included patients with no indication of a transferred NCI.

The results of the study:

Total blood loss in the main group was 378.53±57.92 ml, in the control group 264.60±95 ml (p=0.04). According to ultrasound data immediately after delivery, the uterine body dimensions in the main group of maternity women were 152.00±24.00 mm, 88.00± 11.00 mm, 110.00±15.00 mm in the main group, in the control group - 107.50±33.00 mm(p=0.03), 75.00±18.00 mm(p=0.04), 97.00±19.00 mm(p=0.02). The width of the uterine cavity in the mothers of the main group was 31.00 ± 1.22 mm, in the control group - 8 ± 2.85 mm (p ≤0.5). At the same time, 72 hours after delivery, no statistically significant differences were found between the parameters of pelvic ultrasound in patients of both study groups.

Conclusion:

Thus, it was found that in maternity women who underwent NCI during pregnancy in mild form, there is a statistically significant increase in the size of the body and the uterine cavity, as well as increased total blood loss, regardless of the parity of labor. At the same time, 72 hours after delivery, there were no changes detected immediately after delivery. Since there were no postpartum hemorrhages in these cases, it can be argued that the prophylactic administration of oxytocin solution is sufficient to compensate for the detected changes.

Relevance. The new coronavirus infection (NKI) significantly exacerbates pregnancy pathologies. Pregnant women with iron deficiency anemia (LDA) are more often admitted to infectious diseases hospitals with NKI (especially in the III trimester, when the inflammation processes are maximally activated). Purpose. To establish how often LDA becomes a predictor of NKI, how it affects the course of pregnancy, childbirth and the postpartum period. Materials and methods. To fulfill the purpose of the study, 133 maternity histories with laboratory-confirmed NKI were analyzed - the main group. The comparison group included 60 pregnant women with HDA only during pregnancy, without NKIs. Results. Studies have shown that pregnant women of the main group had HDD before pregnancy: in most cases, mild rather than severe. The course of pregnancy in women with BIA in 100% of cases complicated NKI in the III trimester: 90% - mild, 10% - moderate. In the comparison group, in 100% of the case in the III trimester of pregnancy, pregnant women were diagnosed with anemia: mild - 90%, moderate - 10%. Anemia in this group was always mild. Delivery of pregnant women with NKI and BIA in 11% of cases occurred during pregnancy from 30 to 36 weeks. There was no preterm birth in the comparison group. Caesarean delivery as a method of delivery was significantly more common in the comparison group. Pregnant women with NKIs gave birth through the natural birth route (62%) with fewer complications than women with pregnant anemia. In the main group, 134 newborns were born: 94% without asphyxia, 6% in asphyxia and 2% stillbirth. In the comparison group, all children (61 newborns) were born alive, full-term, the early neonatal period proceeded without complications. Conclusion. GDA also creates conditions for the formation of an immunodeficiency state, which increases the risk of infection with NKI. Pregnancy anemia, which occurred in the III trimester, corrected with iron drugs, did not affect the immune system of women and did not lead in any case to infection with SARS-CoV-2 strains.

Despite the efforts that the country is making, maternal mortality in Kyrgyzstan remains at a high level, about 38.1 cases per 100,000 live births. Realizing that that confidential enquiry into maternal deaths (CEMD) is the international gold standard for a detailed investigation of the deaths of women, Kyrgyzstan has been implementing this methodology at the national level since 2010.

Aim is to study the influence of medical and non-medical risk factors on the maternal mortality rate in the Kyrgyz Republic.

Methods. To identify medical and non-medical causes of maternal mortality, factors of poor-quality treatment, as well as social and family problems that could affect the tragic outcome, the study group included all cases of deaths of women during pregnancy, childbirth and within 42 days of the postpartum period from direct and indirect causes. In addition, cases of deaths of women from causes unrelated to pregnancy were considered, which were classified as "Absence of an obstetric cause (accidents)", and the category "The main cause was not established", when information was insufficient to establish the cause of death of a woman.

Results. The CRMS method was used to analyze 148 cases of deaths of women during pregnancy, childbirth and the postpartum period in the Kyrgyz Republic in 2014-2015. The average age of the deceased women was 32.5 years and ranged from 17 to 48 years.

The increase in the frequency of operative delivery is observed all over the world, including in the Kyrgyz Republic.

Conclusion. Thus, the most vulnerable were women who did not have a permanent job over the age of 35, who were about to give birth for the first time. Caesarean section is a very high risk factor for maternal mortality in the Kyrgyz Republic, when the likelihood of obstetric bleeding and sepsis in the postpartum period increases.

The relevance: Gestational anemia is one of the most common problems that complicate the course of pregnancy and childbirth. Due to the high prevalence and the huge number of caused complications, anemia during pregnancy is one of the most pressing problems of modern obstetrics. Despite the increased attention of scientists to this condition, there is no tendency to decrease the frequency of occurrence at the moment.

Objective: to study the features of somatic and obstetric-gynecological anamnesis in patients with anemia during gestation.

Research methods: in the period from 01.12.2020 to 20.02.2021, the analysis of exchange cards, birth histories, and newborn histories was carried out in 57 patients delivered on the basis of the 2nd building of the VOKB№1 maternity hospital. We performed a statistical assessment of complications of somatic and obstetric-gynecological anamnesis, the course of pregnancy and childbirth, an anthropometric assessment and the incidence of complications in newborns. The main group consisted of 37 patients with gestational anemia, the control group consisted of 20 patients (without gestational anemia).

Results of the study: Patients with hemoglobin levels below 110 g/l in 89,3% had a complicated somatic history, which is 2 times higher than in the control group. Infertility, erosion, cervical dysplasia, STDs, abortions, and miscarriages were much more frequently diagnosed in the anamnesis. In the process of analyzing the course of pregnancy, placental abnormalities of varying severity, signs of intrauterine fetal hypoxia were most often diagnosed. Complications of childbirth in the main group were diagnosed 30% more often than in the control group.

Conclusion (заключение): The obtained results indicate the need for special vigilance to individuals with gestational anemia; early diagnostics and treatment of anemic conditions will significantly reduce obstetric and neonatal complications.

Despite the relatively low prevalence, complications associated with Venous thromboembolism (VTE) lead, with a high degree of probability, to maternal mortality. Many deaths in women can be prevented by thromboprophylaxis in risk groups. However, the issues of identifying risk factors for the development of VTE during pregnancy, childbirth and the postpartum period continue to be debatable.

Aims. To study the risk factors for maternal mortality in pulmonary embolism (PE).

Material and methods. A retrospective analysis of primary medical documentation of 8 cases of maternal death from pulmonary embolism in the Kyrgyz Republic for 2014-2015 and 2018-2019 was carried out. To determine the relationship between risk factors for PE, a relative risk (RR) was calculated. The timing of the study was dictated by the fact that the analysis was conducted before the COVID-19 pandemic in the country.

Results. Pregnant women over 35 years of age are 7 times more likely to have PE than younger women. The risk of death after childbirth due to PE is significantly higher than the risk of death during pregnancy. In addition to the above, the parity of childbirth was also a significant risk factor for VTE. The relative risk of 3 in the group of women with obesity allows us to attribute the excess weight factor to the risk group for the development of PE. The risk of dying from PE after operative delivery was higher than after vaginal delivery, which allows us to consider caesarean section as a significant risk factor for VTE.

Conclusion: Failure to identify risk factors for VTE during pregnancy, childbirth and the postpartum period is a high-risk factor for maternal morbidity and mortality due to thrombosis, because prevention of VTE development is not carried out or delayed.

Relevance. Currently, the most common method of delivery is caesarean section. The reasons for the increase in the frequency of caesarean section (CS) are an increase in the incidence of pregnant women, a complicated course of pregnancy, a deviation in the course of labor, and also an antenatally diagnosed pathology of the fetus. Over the past 30 years, the processes of adaptation of newborns born by CS have been actively studied by scientists around the world. In this regard, it is interesting to analyze the issue of changes in the adaptive reactions of newborns born surgically. 
The purpose of the study: to analyze and review foreign and Russian-language literature on Relevance. Currently, the most common method of delivery is caesarean section. The reasons for the increase in surgical intervention for cesarean section (CS) are an increase in the incidence of pregnant women, a complicated course of pregnancy, a deviation in the course of childbirth, as well as antenatally diagnosed fetal pathology. Over the past 30 years, operative methods of delivery, and key factors influencing the processes of adaptation of newborns, have been actively studied. In this regard, it is interesting to analyze the issue of changes in adaptive reactions in such newborns. [1]
The purpose of the study: to analyze and review foreign and Russian-language literature on the topic of adaptation of newborns born surgically.
Materials and methods: We analyzed scientific publications on the topic of the impact of the CS on the adaptation of newborns, followed by combining information from various sources.
Results. As a result of the study, complications were considered, which in the vast majority of cases develop in children after cesarean section. Adaptation to environmental factors in these newborns is less favorable and can be manifested by: respiratory disorders, non-rhythmic movements of the chest during breathing, disorders of the cardiovascular activity, a high frequency of dysbiosis of any localization, the development of purulent-inflammatory pathologies, dental status disorders. Such functional disorders on the part of various body systems in the neonatal period indicate the need to single out children in a special risk group.
Conclusion. At this stage, it has been established that the choice of operative delivery has a diverse impact on the processes of adaptation of newborns. It is necessary to continue studying this problem in the future. Properly approach the choice of caesarean section, assess all the risks and long-term consequences. In this regard, performing a caesarean section at the request of a woman without a medical indication is unacceptable.

Relevance. The development of medical digital technologies is proceeding in a number of areas: prevention, determination of diagnostic parameters, monitoring the course and effectiveness of treatment, consulting support and patient support. Mobile healthcare (mHealth) is a new direction in the IT field, focused on both the doctor and the patient. Digitalization, the transition to electronic document management, the development of telemedicine are the key tasks of the national project "Healthcare".
Purpose of the study. Develop a mobile application that allows you to evaluate the nature of the menstrual cycle both as part of the dynamic monitoring of the attached population, and in the case of the selection of HRT.
Materials and methods: object-oriented programming in the integrated Java IDE environment, current clinical protocols of the Russian Society of Obstetricians and Gynecologists (ROAG)
Results: a mobile application "AMK-Stop" was developed, which allows a woman to independently assess the nature of menstruation, and the attending obstetrician-gynecologist to dynamically monitor the patient's health status.
Conclusion: the introduction of mobile applications in the work of the outpatient service, in particular the antenatal clinic, will significantly improve the availability and quality of medical care, significantly reduce the financial costs of medical institutions for unreasonable calls. The predominant use of software components that do not require access to the Internet allows the population of remote areas to receive reliable and up-to-date information about their health that complies with all current clinical recommendations.

Relevance.

The annual increase in the number of cases of cervical cancer (CC) shows the urgent need to activate diagnostic and preventive measures among women of different age groups. The morphogenesis of CC has not been fully studied, the ideas about the oncomorphogenesis of CC are based on the assumption of the sequence of changes in the squamous epithelium from dysplasia to cancer.

Research objective

To study the clinical and morphological features of dysplasia and CC in women in different age groups.

Materials and methods

Surgical and biopsy material, conclusions of pathologists in patients with dysplasia and CC according to the data of the Voronezh Regional Pathology Bureau for the period 2017-2022. The analysis of the annual occurrence, age groups, categories of disease stages, the structure of the final diagnoses and localization of the malignant process, as well as the area and depth of the lesion was carried out.

Results

The incidence of dysplastic changes (LSIL and HSIL) in the cervix had similar dynamics, most often observed in the age group of 30-39 years. CC in the vast majority of cases (97.2%) was represented by squamous cell carcinoma. The most frequent occurrence of CC was in the age group of 40-49 years, while maintaining a high occurrence in older age groups.

Conclusion

СС is represented by squamous cell carcinoma in 97.2% of cases. Among the dysplastic changes, HSIL (CIN2 and CIN3) significantly prevailed over LSIL (CIN1). The area of the lesion, the depth of invasion in СС in different age groups has no clinical and morphological regularity, which indicates the nonlinearity of cancer development in СС.

Uterine fibrοids are οne οf the mοst cοmmοn gynecοlοgical diseases, it is a benign neοplasm cοnsisting οf cells οf the smοοth muscles οf the uterus. It is fοund in a significant percentage οf wοmen, this is 25-30% οf the age grοup frοm 35 years, causing a significant deteriοratiοn in the quality οf life, reprοductive functiοn and is manifested by the fοllοwing clinical signs: the οccurrence οf frequent pulling pains with lοcalizatiοn in the lοwer abdοmen and lumbar regiοn, dysfunctiοnal bleeding οf the uterus, οvaries, changes and dysfunctiοn οf neighbοring οrgans (fοr example, dysuric disοrders οr chrοnic cοnstipatiοn). Risk factοrs fοr the οccurrence οf the disease include: chrοnic anοvulatοry cycle, οverweight and οbesity, frequent curettage and abοrtiοns, hereditary predispοsitiοn. In wοmen in the age range frοm 36 tο 45 years, in mοst cases, an interstitial-subserοus fοrm οf uterine fibrοids is detected. This fοrm manifests itself in the fοrm οf uterine bleeding, cοntributes tο the develοpment οf infertility, the οccurrence οf hyperplasia οf the endοmetrial layer and small-cystic οvarian changes, and it is alsο pοssible tο develοp diseases οf the mammary glands, which are directly related tο dishοrmοnal disοrders in a wοman's bοdy. 

The prοcess οf treating uterine fibrοids is carried οut by prescribing the drug "Mifepristοne", which, accοrding tο the classificatiοn, is included in the grοup οf synthetic sterοid agents with anti-prοgestοgenic activity, that is, it perfοrms a blοck at the stage οf expοsure tο hοrmοne receptοrs. At the same time, the fοllοwing results were οbtained: in mοst patients οf reprοductive age, a benign tumοr decreases by 50% already when chοοsing an initial dοse οf 25 mg / day. 

Introduction. The World Health Organization (WHO) is concerned about the growing trend of obesity among the female population of reproductive age. Regarding pregnancy, obesity is a prognostically unfavorable risk factor for the development of preeclampsia, gestational diabetes mellitus with fetal macrosomia.
Goal. To conduct a comparative analysis of anthropometric data, eating behavior and motor activity of pregnant women with obesity.
Materials and methods. analysis of 148 individual cards of pregnant women and women in labor who were registered on an outpatient basis in the women's consultation of the BUZ IN "VGKP No. 1" in the period from 2020 to 2022. 2 comparison groups were formed: the main group – women with abdominal obesity diagnosed before pregnancy (n=114), the cotntrol group – with normal BMI (n=34). When registering, studies were conducted: BMI (height, weight), anthropometry (waist and hip circumference), DEBQ eating behavior assessment questionnaire, IPAQ motor activity questionnaire.
Results. the average age of women in the main group was 28.9±0.6 years, in the control group – 23.4± 1.2 years. A detailed analysis of the distribution of the incidence of obesity among pregnant women shows that a high percentage of cases (54%) occur in the age range of 20-29 years, and the smallest – up to 20 and over 40 years. Burdened heredity for violation of fat and carbohydrate metabolism was more often registered in the study group (86% of cases), against 15% of the control group. The average BMI in pregnant women of the main group was 38.9± 2.3 kg/m2, in the control group – 23.4± 0.5 kg/m2. A comparative analysis of anthropometric indicators shows that in the study group the coefficient of OT/O was 0.95±0.014, in the control group – 0.81±0.034. Body weight gain during pregnancy was statistically higher in the study group - 6.5 [2.8;10.2], while in the control group – 5.1 [3.3;6.8]. Conducting a questionnaire aimed at assessing eating behavior and physical activity demonstrates the predominance of indicators of eating disorders (irrational, irregular, excessive), low physical activity in the observation group, while in the control group 96% adherents of an active lifestyle and a rational and balanced diet.
Conclusions. The high incidence of eating disorders, motor regime, fat and carbohydrate metabolism among pregnant women leave the problem of obesity relevant and attracting close attention from the medical community. Lifestyle modification at the stage of pre–pregnancy preparation is a vector for reducing obstetric complications during pregnancy and childbirth.

RELEVANCE. The pathogenetic role of extracellular DNA in cardiovascular pathology, in particular hypertension, is not well understood, but its determination is widely used as a promising nonspecific marker of cytolytic processes in predicting the development of complications and mortality in trauma, bronchopulmonary diseases, and lung cancer.

TARGET. The aim of the work was to study the content of free-circulating DNA (scDNA) in the blood plasma of patients with hypertension as a possible biomarker of this pathology.

MATERIALS AND METHODS. The study involved 40 people, of which 20 are conditionally healthy and 20 patients with GB. Detection of ssDNA was carried out using the "diaGene kit for DNA isolation from blood plasma." The resulting DNA samples were used for chromatographic and spectrophotometric analysis.

RESULTS. In the course of the study, it was found that in patients with HD, the content of ss-DNA in the blood is significantly higher than in apparently healthy people. When conducting spectrophotometric analysis, an increase in optical density was also revealed in isolated samples from patients with GB compared with practically healthy individuals.

CONCLUSION. Based on the above, this indicator can presumably be a diagnostically and prognostically significant biomarker of hypertension.

Relevance

Rheumatoid arthritis (RA) is a widespread polyetiological connective tissue disease that occurs in people of almost all age categories and leads to early disability due to damage to peripheral joints and internal organ systems. The search for drugs that reduce the severity of the disease is currently an urgent problem.

Purpose of the study

 Measurement of superoxide dismutase (SOD) enzyme activity in rat tissues in model RA and under the influence of mitochondria-targeted antioxidant (AO) SkQ1.

Materials and methods

 The study groups are represented by male laboratory rats. SOD activity was measured spectrophotometrically.

Results

 Reactive oxygen species (ROS), the formation of which seems to be characteristic of the pathogenesis of the disease, have a significant effect on the state of the antioxidant system (AOS). It has been established that RA induction is associated with an increase in SOD activity in rat tissues, which may be associated with the activation of the AOS enzymatic link, which has an adaptive character - as a response to increased ROS generation. The introduction of targeted AO SkQ1 at various doses was accompanied by a decrease in SOD activity and their shift towards normal values in all tissues studied. The antioxidant activity of the drug is achieved due to the presence of plastoquinone in the SkQ1 molecule, which is capable of neutralizing ROS, as well as a lipophilic cationic group, which ensures immediate penetration of the compound directly into the mitochondrial matrix.

Conclusion

 The ability of SkQ1 to reduce the severity of oxidative stress (OS) that accompanies the course of RA can lead to a decrease in the load on AOS, which makes the use of the drug in the treatment of RA potentially promising.

Relevance. The study of the influence of different temperatures on the structure of protein molecules is important for understanding the mechanism of changes in protein functions, determining the critical denaturation temperature, finds application in solving a number of practical problems, including in medicine. Thus, thermal denaturation can be used to remove proteins from various biological fluids, for example, blood plasma, which facilitates the processes of isolation and analysis of substances. Precipitation of proteins due to denaturation is used to determine their amount in the biomaterial [1].
Goal. The aim of our work was to study the effect of temperature on the protein structure, structural modifications of the protein globule were judged by the spectral properties and hydrodynamic radius of the native and thermomodified protein molecule.
Materials and methods. Bovine serum albumin (BSA) was selected as a model protein, which was heated in a thermostat for 15 minutes to the appropriate temperature (37, 45, 55 and 60 ° C)
Results. We studied the absorption spectra of solutions of native and thermomodified BSA, determined the contribution of light scattering to the absorption spectra of protein solutions. The hydrodynamic radius of the protein globule was studied by the method of dynamic light scattering.
The change in the protein structure is reflected in the change in the absorption spectrum of this solution. During thermomodification of BSA solutions, the optical density of the studied solutions increases. We calculated the contribution of light scattering to the growth of optical density. It is shown that the parameters characterizing light scattering increase with an increase in the BSA heating temperature.
Using the method of dynamic light scattering, it is shown that the radius of the native BSA globule is 3 nm, with an increase in temperature, the size of protein molecules increases.
Conclusion. With the help of spectral methods, it is possible to determine the denaturation of protein molecules, as well as the reversibility of these processes.

Nutrition is one of the factors that has a significant impact on human health. The state of health of students during their studies decreases. And as you know, during the session it takes a lot of effort to safely close the exams, therefore, many students are in a state of pre-illness. This article presents the results of studies conducted to assess the nutrition of students, as a fundamental factor of health, in different periods of study (before and during the session). The aim of the study was to evaluate the nutrition of students taking into account the intensity of training at a medical university before and during the session. As research materials, a questionnaire method and an individual nutrition diary filled in by students throughout the day were used. The analysis of the results obtained was carried out, recommendations were made in order to adjust nutrition to improve health. As a result of the conducted research, it was revealed that the majority of students do not observe the rules of rational nutrition during the academic semester, and this situation worsens during the exams. The nutrition of students has a number of disadvantages, which include non-compliance with the daily diet, the ratio of proteins, fats, carbohydrates. At the same time, most students understand their mistake when building a diet, but do not take measures to eliminate them.

Relevance: The high incidence of respiratory infections, the lack of availability of etiotropic treatment and means of specific prevention, contributed to the widespread use in medical practice of various groups of antimicrobial drugs, including antiviral and antibacterial.
Objective: The aim of the work was to study the frequency and structure of the use of antimicrobials in respiratory infections before and during the SARS-CoV-2 pandemic among young people aged 18-25.
Materials and methods: A descriptive cross-sectional study was conducted using a questionnaire on a specially designed questionnaire in Google form among the population of Voronezh. Statistical processing of the results was carried out using Microsoft Office Exel 2016 and STATTECH, the results were considered significant at p<0.05.
Results: The study found that with respiratory infections rarely, no more than once a year, more than 70% of young people took antiviral drugs, more than half - antibacterial drugs, significantly more often used antiviral agents. In the pre-pandemic period, antimicrobials were rarely used more often, no more than 1 time per year (p<0.001 compared with the use of 2 or more times per year). The frequency of antimicrobial use during the pandemic has not changed significantly. Changes took place in the structure of prescribing in relation to the use of antiviral drugs, which began to be taken 2 or more times a year 1.5 times more often compared to the pre-pandemic period, respectively, 48.44% versus 35.18%. Antimicrobials were significantly more often prescribed by medical professionals, significantly less often young people used the advice of relatives and acquaintances; 35.29% and 11.86% of respondents independently prescribed antiviral and antibacterial drugs, respectively.
Conclusion: The widespread use of antimicrobials in respiratory infections requires increased attention and monitoring due to the threatening growth of resistance of microorganisms.

Relevance: The human body has its own biological clock. These biological clocks are otherwise called the biorhythms of the body, they have a certain effect on the energy and activity of biological processes in organs and organ systems.

Rhythms can be divided into two types: physiological (rhythms that coincide with natural processes) and biological - they are responsible for simple reactions within the cell and behavioral features.

The most important are circadian rhythms, in which body changes are detected within one day. Thus, the biological clock is responsible for the daily normal functioning of a person. Violations often lead to a decrease in immunity, dysfunction of the endocrine glands, an increased risk of developing cardiovascular pathologies and obesity.

Purpose: to compare the effect of circadian rhythms on well-being, activity and mood among schoolchildren and students studying at a medical university.

Methods: a sociological method using the Horn-Ostberg technique and the SAN test (well-being, activity, mood), as well as statistical processing of the results.

Results: Most of the study participants, despite age periodization, are arrhythmics. The manifestations of circadian rhythm disorders in most of the respondents are manifested in the form of a decline in the level of working capacity (38% of respondents) and fatigue and nervous tension (19% of respondents). The influence of the chronotype on the mood of activity and well-being in primary school students has not been reliably confirmed, and in the case of students of 5-6 courses, the correlation indicators between mood in the morning and evening hours and the corresponding chronotype "lark" or "owl" are already more significant r= 0.74 and r=0.71 at p<0.05. Based on the data obtained, an approach was developed for the prevention of circadian rhythm disorders.

Conclusion: Thus, the majority of study participants are arrhythmics. In 38% of the respondents, circadian rhythm disorders are manifested by a decrease in the level of working capacity. It is noted that an increase in workload, a change in lifestyle and daily routine affects circadian rhythms and prevails in senior students.

Relevance: Aging is a physiological, increasing with age, destructive process that leads to a decrease in the adaptive abilities of the body. Aging is an irreversible process, but it can prolong (or lengthen) for many decades by maintaining active longevity.Objective: To study the main demographic indicators of the population: mortality, fertility, population size and life expectancy.Materials and methods: The analysis was carried out on the basis of data taken from the official website of the Territorial Body of the Federal State Statistics Service for the Voronezh Region.Results: It was revealed that in recent years the birth rate has decreased by 1.4 times (2015-2021), the indicator of life expectancy decreased by 4.1 years, and mortality increased by 1.4 times (2019-2021). There is an increase in the number of elderly people, which contributes to the dominance of the mortality rate over the birth rate.Conclusion: The population of the Voronezh Region is subject to an intensive aging process. To improve the main indicators, the demographic policy "On the approval of the concept of demographic policy of the Voronezh Region for the period up to 2025" was implemented. This policy plans not only to increase the birth rate, but also to improve the quality of life of the entire population. Currently, the project has not brought the desired results, but the work that is being carried out in this direction contributes to the improvement of the main demographic indicators.

Relevance: Cervical cancer (CC) in the global structure of malignant neoplasms in women ranks 4th in terms of morbidity and mortality. According to the World Health Organization, more than half a million women get sick every year and about 300,000 die from cervical cancer. Most often, cancer affects women of childbearing age.
Purpose: Epidemiological analysis of the incidence of cervical cancer in the female population for the period from 2009 to 2021.
To assess the awareness of the population of the Voronezh region (VO) about the etiology and prevalence of cervical cancer through an anonymous survey using a Google form.
Methods: Retrospective epidemiological analysis of cervical cancer incidence over a 13-year period. Statistical processing of anonymous survey data and materials of accounting and reporting forms using the Excel package.
Result: According to the results of a retrospective epidemiological analysis of the incidence of cervical cancer in the population of the Russian Federation and VO, a decrease in incidence rates for the analyzed period was established. On the territory of the Russian Federation until 2019, there was an increase in the incidence rate by an average of 0.45 per 100 thousand population, from 2019 to 2021. there was a decrease in the incidence rate by 12.5%.
On the territory of the VO, the incidence rate of cervical cancer is 25.5% lower than the values of the Russian Federation. From 2009 to 2011 there was a decrease in the incidence to 13.92 per 100 thousand of the population, then until 2016 there was an increase in the incidence and in 2015 the maximum rate was recorded - 20.03 per 100 thousand of the population during the study period, after the incidence decreases by 2021 (13.5 per 100 thousand population).
An anonymous survey was conducted to assess the awareness of the population of the VO about cervical cancer, the causes of occurrence and the degree of prevalence. The survey involved 100 respondents aged 18 to 71, of which the proportion of men was 13%, the proportion of women - 87%. According to the respondents, the human papillomavirus (HPV) is the causal factor in the onset of the disease, and in the structure of malignant neoplasms in women, it ranks second or third. The first cases of the disease, according to 78% of respondents, are registered at the age of 20-30. The average age of detection of CC was 36-40 years, indicated by 38% of the respondents. In the question "can men be a source of HPV infection?" 16.2% answered negatively, 33% of respondents believe that in our country there is a domestic HPV vaccine.
Conclusion: The incidence on the territory of the Russian Federation and VO for the analyzed period tends to decrease.
As a result of an anonymous survey, a good awareness of the population of VO about cervical cancer was established. Shortcomings in the knowledge of respondents about the etiology and vaccination with domestic drugs were revealed.

Relevance: The problem of parenteral viral hepatitis is relevant at the present time. According to the WHO (World Health Organization), 325 million people are living with viral hepatitis B or C. The Global Health Strategy on Viral Hepatitis 2016-2021 set out plans to fight the disease worldwide. Today, the program is focused on the period up to 2030. The goal was to eliminate viral hepatitis, and the global target was to reduce new infections by 90% and deaths from viral hepatitis by 65% ​​by 2030.

Purpose: To analyze the awareness of medical students about risk factors, prevention and transmission routes of parenteral viral hepatitis.

Materials and methods: A questionnaire was developed, which includes 20 questions. The questionnaire consisted of three sections: 1) questions reflecting: information about the respondent (gender, course of study, work, etc.; 2) awareness of the ways of transmission of viral hepatitis B, C; preventive measures; 3) awareness of students in the issues of vaccination. Statistical processing was carried out using the computer program Microsoft Excel.

Results: According to the survey, the ratio of respondents by sex was characterized by the predominance of women 66% over men - 34%. The average age of students is 20.63±0.19 years. Medical students have the opportunity to work in medical organizations, and thus are at risk of contracting blood-borne infections in the event of an emergency. The questionnaire method is applicable for correcting the knowledge gained during training. The validity of these surveys, as well as their significance in the educational policy of the university, is of great importance. The results obtained in the course of the study are necessary for more rational actions in the educational processes of the university and the improvement of educational programs and learning technologies.

Conclusion: An analysis of the respondents' answers showed that the problem posed is significant and relevant in our time. However, some students need to continue working on the formation of knowledge about risk groups, prevention and the need for vaccination.

Relevance. Despite the fact that coronary heart disease, as a separate disease, is quite well studied, there are many less developed problems associated with the combination of coronary artery disease and other nosologies. According to many authors, it has been established that patients with COPD are much more likely to die from cardiovascular pathology than from COPD itself. It was determined that people with COPD have the most severe atherosclerotic lesions of the coronary arteries in comparison with the group without COPD. There are various classifications of COPD, but none of them reflects the relationship between the severity of coronary atherosclerosis and the COPD phenotype. In this regard, the evaluation of coronary lesions in patients with various COPD phenotypes is of increased interest.

Purpose. Determination of the COPD phenotype most susceptible to severe coronary atherosclerosis.

Materials and methods. The study involved 74 people with a diagnosis of chronic obstructive pulmonary disease, which was confirmed and verified by clinical and functional methods and standardized criteria. All patients were confirmed to have coronary atherosclerosis by coronary angiography. The severity of coronary atherosclerosis was assessed by the Gensini index.

Results. The COPD phenotype most susceptible to coronary atherosclerosis was identified according to coronary angiography data.

Conclusion. According to the study, the risk of developing coronary atherosclerosis in this COPD phenotype is the highest, which can be used as a prognostic indicator at the outpatient stage.

Annotation. A clinical case of a patient with Chf (chronic heart failure with a reduced ejection fraction) is presented. The article evaluates the effectiveness of the use of such a drug as dapagliflozin, a type 2 sodium-glucose cotransporter inhibitor aimed at improving the patient's condition and reducing the risk of cardiovascular mortality.

Aim.To evaluate the effectiveness of the drug dapagliflozin in the treatment of chronic heart failure on the example of a clinical case.

Materials and methods. The object of the study is the medical documentation of a patient of the Orenburg city polyclinic.The research method was the analysis of the medical record, evaluation of the results of examination and treatment.

Results. The therapy was carried out in the period from October 2021 to November 2022. It showed positive results. During this period of observation, the symptoms of heart failure did not worsen, the condition remained satisfactory. When performing EchoCG, an improvement in LV contractility was noted in dynamics, which is expressed in a decrease in LV volume and an increase in the ejection fraction from 39% when prescribing therapy to 45%.

Сonclusion. CHF is the "finale" of cardiovascular diseases. If earlier patients with CHF had an unfavorable outcome, now with proper therapy it is possible to improve the life and condition of patients.This clinical example shows that the addition of dapagliflozin to the standard therapy for the treatment of CHF rEF FC II showed a positive effect associated with an improvement in clinical symptoms and quality of life.

Background. Since the beginning of the pandemic, the number of coronavirus infections has reached 662,221,274 and the number of deaths has reached 6,701,780. These figures are largely due to the decompensation of heart failure as a result of the addition of SARS-CoV 2 infection.  Increased levels of cardiac biomarkers during coronavirus infection reflect excess inflammation, viral load, cytokine storm, and an atherothrombotic process that can cause direct or indirect heart damage.

Objective. To study the level of NT-proBNP in patients with chronic heart failure who have had COVID-19.

Materials and methods. The study included patients aged 40 to 70 years diagnosed with CHF of ischemic genesis hospitalized with a positive polymerase chain reaction (PCR) smear for SARS-C infection about V-2 (n = 60). The control group consisted of patients hospitalized with a positive PCR smear for SARS-C infection about V-2, without signs of HF in the anamnesis ( n=20). All patients underwent laboratory methods: general clinical and enzyme immunoassays of blood with determination of NT-proBNP levels.

Results. The average NT-proBNP level in patients with CHF and Covid-19 was significantly higher than its value in patients without a history of CVD.  In patients with source III FC CHF (subgr. 1. 3) the level of the biomarker significantly exceeded its value in patients witho II FC CHF and in patients with I FC CHF (subg.1.1)..  The ratio of the odds of a favorable course of CHF and Covid-19 or the transfer to the ICU of patients with CHF and Covid-19 depending on the level of Nt-proBNP (threshold value of ˃300 pg / ml) was studied.  The resulting OR was 12.27, [95% CI 1.53567; 98.1617]. Consequently, the probability of not getting into the ICU in patients with an NT-proBNP level  below the threshold is 12.27 times lower than in patients with an Nt-proBNP level  of ˃300 pg / ml. Also, the ratio of the chances of a favorable course of CHF and Covid-19 or death depending on the level  of Nt-proBNP was studied.  (threshold value ˃300 pg/ml).  The resulting OR was 2.43 [95% CI 0.564593; 10.5233]. Therefore, the probability of non-occurrence of such a checkpoint as death in patients with an NT-proBNP level  below the threshold is 2.43 times lower than in patients with an Nt-proBNP level  of ˃300 pg / ml.

Conclusion. Threshold values  for cardiac  biomarkera (NT-proBNP) for stratification and isolation of risk groups among patients with Covid-19, CHF and Covid-19  have been determined. In patients with Covid-19 and CHF, a strong association has been found between high levels of the cardiac biomarker (Nt-proBNP) and a negative short-term prognosis (ICU transfer/death).  Thus, in patients with CHF and Covid-19 against the background of hypoxia, systemic subclinical inflammation, damage and apoptosis of cardiomyocytes occur, which as a result leads to structural-functional and electrical remodeling of the ventricles with decompensation of heart failure.

Relevance. The problem of psychosomatic disorders remains one of the urgent problems of modern medicine, in particular, it is relevant in gastroenterology. The appointment of psychotropic drugs is mentioned in the latest clinical recommendations for the treatment of chronic pancreatitis and irritable bowel syndrome, however, medical care for the contingent of patients with these diseases is often insufficient, as evidenced by a large percentage of repeat referrals and short clinical remission.
Objective. Analysis of the severity of anxiety and depression in patients with pathology of the gastrointestinal tract who sought medical help in the BUZ IN VGKP No. 7 for the period from 20.04.22 to 13.05.22.
Methods. Five groups of patients were evaluated according to nosological units (gastric ulcer and/or duodenal ulcer, chronic pancreatitis, gastroesophageal reflux disease, irritable bowel syndrome and a group of patients with multiple pathology of the digestive system). The following questionnaires were used: the Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Tract Symptoms Assessment Scale (GSRS).
Results. Manifestations of the main syndromes of chronic diseases of the digestive system were more pronounced in patients with anxiety and/or depression. Most patients with anxiety and depression were found in the group with multiple pathology of the digestive tract. Patients with chronic pancreatitis had the maximum severity of abdominal pain syndrome, reflux syndrome - patients with gastroesophageal reflux disease, dyspeptic – with multiple pathology of the digestive system, diarrheal syndrome and constipation syndrome – with irritable bowel syndrome.
Conclusion. Anxiety-depressive disorders increase gastrointestinal manifestations of chronic diseases of the digestive tract, and those, in turn, contribute to the increase of anxiety and / or depression, forming a vicious circle, therefore, treatment of such patients should be comprehensive.

Relevance. Currently, rheumatic diseases (RD) are the most common pathologies in practical medicine. They are one of the frequent causes of a persistent decrease in working capacity, the development of disability. Because of this, the number of cases of patients visiting a doctor is steadily growing. Therefore, the study of the prevalence of rheumatic diseases is of no small importance in their diagnosis and treatment.
Purpose: to determine and evaluate the prevalence of the main and concomitant nosological forms of rheumatic diseases in patients of different age categories.
Materials and methods: The study involved 408 patients who were treated at the VUZ VO VGKB No. 20 on the basis of the rheumatology department from February 2022 to January 2023. As a result of the work, all patients were divided into two groups by gender: women and men. Then, in each group, based on age, 6 categories are allocated. They calculated the percentage of patients with the same underlying rheumatic disease, and also identified their comorbidities.
Results: The number of women of the total number of patients was 61.76%, men - 38.24%. In 12 women aged 20-30 years (the first age category), rheumatoid arthritis is diagnosed as the main diagnosis, which is accompanied in 2.941% of cases by type 2 diabetes mellitus, hypertension (AH) grade 2, risk 4 and chronic bronchitis. Men of this age were not treated.
Conclusion: When examining rheumatological patients, a doctor of any specialty needs to know that rheumatoid arthritis, systemic scleroderma and SLE are most common among women, rheumatoid arthritis, psoriatic arthritis and primary gout among men. Among comorbidities, the leading place is occupied by hypertension of varying degrees and risk, coronary artery disease, as well as chronic renal failure, chronic pyelonephritis, osteoporosis, bone fractures, and type 2 diabetes mellitus.

Background. Analysis of the results of numerous studies allows us to conclude that an absolute increase in the activity of viral diseases by 5 to 7% is directly related to an increase in the frequency of hospitalizations for heart failure by 24% or more.  Since the beginning of the pandemic, the number of coronavirus infections has reached 662,221,274 and the number of deaths has reached 6,701,780. These figures are largely due to the decompensation of heart failure as a result of the accession of respiratory infections and other intercurrent diseases.  The main systemic effect of Covid-19 is systemic inflammation.  At the same time, the underlying mechanisms are quite diverse and have not yet been sufficiently studied.

Objective. To study the level of systemic inflammation indicators (levels of circulating TNF-α, IL-1β, IL-6) in patients with chronic heart failure who have had COVID-19.

Materials and methods. The study included patients aged 40 to 70 years diagnosed with CHF of ischemic genesis hospitalized with a positive polymerase chain reaction (PCR) smear for SARS-C infection about V-2 (n = 60). The control group consisted of patients hospitalized with a positive PCR smear for SARS-C infection about V-2, without signs of HF in the anamnesis ( n=20). All patients underwent laboratory methods: general clinical and enzyme immunoassays of blood with the determination of the levels of IL-1β, IL-6, TNF-α.

Results. The analysis of cytokine status indicators demonstrated an increase in  the levels of pro-inflammatory cytokines in all the studied subgroups in comparison with their levels in 2021 with a stable course of CHF. At the same time,  there were no significant differences in the content of IL-1β, IL-6, TNF-α in the studied groups.

Concluson. Thus, the course of the new coronavirus infection is accompanied by an aggressive inflammatory reaction with the release of a large number of pro-inflammatory cytokines, which can be considered as potential markers of the prognosis of the course and outcomes of the disease in both patients with CHF and patients without HF.

Relevance. The number of patients with chronic kidney disease stage 5  on program hemodialysis is more than two million people worldwide. This category of patients has disorders of phosphorus-calcium metabolism. The effect of blood flow velocity to maintain optimal levels of calcium (Ca), phosphorus (P) and the ratio of calcium and phosphorus (Ca x P) in serum in patients with PGD has not been studied.
The purpose of the study was to determine the relationship between blood flow velocity and calcium-phosphorus metabolism in patients on program hemodialysis; determination of the number of patients who have reached the target indicative indicators of calcium-phosphorus metabolism according to KDOQI and KDIGO.

Materials and research methods. A retrospective study of 67 medical records was conducted at Ural Medical Center LLC from January to March 2022. The following features were evaluated: demographic data such as age, gender, laboratory parameters (calcium, phosphorus, parathyroid hormone, phosphorus and calcium product) , blood flow velocity (ml/min, CKT). Statistical analysis of the data was carried out using Statistica 13.0. Research results.

A retrospective study of 67 medical records was conducted at Ural Medical Center LLC from January to March 2022. The following features were evaluated: demographic data such as age, gender, laboratory parameters (calcium, phosphorus, parathyroid hormone, phosphorus and calcium product) , blood flow velocity (ml/min, CKT). Statistical analysis of the data was carried out using Statistica 13.0. Research results.

In all groups, the levels of calcium and phosphorus were within the normal range, while the target levels of PTH were not achieved in any group. The maximum calcium level was in group 2 (2.27 ± 0.14 mmol/l), slightly lower in group 1 (2.22 ± 0.14 mmol/l), and the lowest in group 3 (2.19 ± 0.08 mmol/l) (p<0.001). There were no significant differences in the levels of phosphorus and parathormone between the study groups of patients. There was no correlation dependence of CKT with any indicator (p>0.05). Conclusion: Our study showed no correlation between CKT and calcium, phosphorus, and parathyroid hormone.

Relevance. Determining the functional state of military personnel is one of the important areas of military medicine. Many studies cover this problem in sufficient detail, however, it is still relevant to search for methods that will allow you to do this in any conditions, including field conditions. 

Goal. To consider and evaluate the methods of remote study of the functional state of military personnel on the example of cadets studying at the branch of the Military Academy of the RVSN. Peter the Great.Materials and methods. In the course of the work, methods were identified and analyzed that make it possible to study FS remotely using questionnaires, performing functional tests and psychological tests. The subjects for this study were taken from among the cadets of the 3rd faculty of the 3rd year of the branch of the Military Academy of the RVSN. Peter the Great in the number of 16 people. Testing took place between December 20, 2022 and December 25, 2022. Results. The first stage of our work was to create our own questionnaire consisting of 20 questions.   The results showed that among the test group, 50% of people notice any changes in their body, but their number corresponds to the limits of the norm.  The rest of the participants were divided into 2 groups with moderate and mild fatigue with a significant predominance of the latter (37% and 13%). The second stage of the work was the development of precise instructions for self-conducting functional tests, obtaining and analyzing the results from the subjects. The results showed that the excess of normal values (approx. for this age group, the normal values for pulse are 60-80 beats /min, for blood pressure 100-130/70-80 mmHg.) when measuring pulse and blood pressure were not detected. Respiratory samples do not correspond to the reference values in only 3 subjects, which is 18%. An orthostatic test with a heart rate calculation is higher in 1 participant (6%), and a test with a load in 2 (12%).The final stage is the conduct of psychological research. The SAN tests turned out to be very useful for us. During the analysis of the results, it turned out that 2 subjects (12%) had below 4 points in terms of "well-being", 5 (31%) in terms of "activity", 7 (43%) in terms of "mood", the ratio of SAN indicators was violated in 9 (55%) of the study participants.

Conclusions. As a result of the study, material was obtained, the analysis of which shows that the determination of the functional state of military personnel by remote method is possible and quite effective. The methods proposed by us can be used as a screening diagnosis of FS deterioration. Earlier detection of signs of fatigue is the key to successful normalization of the condition of military personnel.

Relevance. A promising direction in agriculture today is the use of chemical plant protection products — highly toxic pesticides and herbicides — to increase yields and protect against pests and weeds. The need to use such means is obvious, but their use leads to the formation of a large amount of waste in the form of plastic containers with chemical residues that pose a threat to human health and the environment. The Russian Union of Agricultural Producers together with the Association of European Businesses has launched a project: "Collection and disposal of used containers from plant protection products", which allows agricultural producers to hand over waste for recycling.
Aim. To study the effect of pesticides and herbicides on the body of workers of enterprises processing containers from chemical plant protection products, as well as the presence and influence of other occupational harmful factors and ways to organize the safety of life and work in the studied conditions.
Materials and methods. The study was conducted on the basis of the official representative of the manufacturers of chemical plant protection products — LLC "Graphite".
Results. Due to the high toxicity of plastic waste from chemical plant protection products, the work of workers at processing enterprises must be properly and safely organized. The study examines all possible harmful factors of production (directly chemical plant protection products, noise and vibration, a special microclimate) at each stage of waste processing (primary flushing of cans, crushing, secondary cleaning and drying of crushed containers, granulation), their impact on the body of workers is studied and the available ways of organizing the safety of life and work are analyzed in every case. The rationality and safety of the organization of labor is confirmed by the analysis of the facts of the workers' treatment in the health center.
Conclusion. The measures applied in the production practice of the enterprise to organize the safety of life and work provide the necessary protection of employees, which reflects the analysis of the facts of contacting the health center at the enterprise.

According to the World Health Organization (2019-2020) more than 6 million people die each year due to injuries. The aim of the study was to analyze injuries sustained during "SVO", to study qualitative changes in the structure of military injuries, to assess the severity of patients on the ISS scale and the characteristics of medical care.The study group included 52 patients of both sexes who are on inpatient treatment in one of the military hospitals. Data on the structure of injuries, age and sex of patients, as well as on the treatment measures taken were obtained by copying from the case histories. Patients were divided into groups according to the localization of lesions and the leading mechanism of injury. The ISS scale was used to assess the severity of the patients' condition.
The results of the study showed that 60% of all injuries are mine-explosive, 29% are shrapnel wounds, and only 11% are bullet wounds.The most common localization of injuries was the limbs - 56%, abdominal and chest injuries accounted for 15% and 21%, and craniocerebral injuries accounted for only 8%.
In this regard, the provision of medical care to victims in the course of hostilities has its own distinctive features. An unreliable healthcare system is usually the first victim of armed conflict. This is due to the lack of knowledge of military field surgery, as well as resources, which together limit both diagnostic and therapeutic options.

Relevance. Terrorism is one of the most serious problems of modern society. Due to the current geopolitical situation in the border areas, the risk of terrorist acts within the Russian Federation, including in the Voronezh region, has increased significantly. One of the main tasks facing the state is to strengthen control over compliance with anti-terrorist measures, which are set out in the Federal Law of March 6, 2006 No. 35-FZ "On Countering Terrorism" [2]. The main element of the system of countering terrorism in any state should be the fight against terrorist ideology, which is achieved through the unity of actions of all bodies and organizations designed to participate in ensuring the security of the state and society from terrorist threats. To fulfill these tasks, a center for the prevention of terrorism and extremism was created within the framework of the federal state budgetary educational institution of higher education "Voronezh State Medical University named after N.N. Burdenko".

Objective. Study and evaluation of the effectiveness of anti-terrorist measures carried out by the Center for the Prevention of Terrorism and Extremism at N.N. Burdenko VSMU.

Materials and methods. In the course of the study, the “Regulations on the Center for the Prevention of Terrorism and Extremism of the Federal State Budgetary Educational Institution of Higher Education “Voronezh State Medical University named after N.N. Burdenko” of the Ministry of Health of the Russian Federation”[3]. students about the problem of terrorism, we developed a questionnaire "Anti-terrorist security" and conducted a survey of students. Respondents were asked to anonymously answer 9 questions. Statistical processing of the results was carried out using Microsoft Excel.

Results. 800 students took part in the anonymous survey. After analyzing the results of the questionnaire, it was concluded that the majority of the students surveyed consider the problem of terrorism relevant and are aware of the danger of terrorist acts in modern society. Under the term terrorist, respondents mean a criminal person who deliberately engages in illegal acts. The majority of students consider themselves safe. All this underlines the effectiveness of the work of the Center for the Prevention of Terrorism and Extremism on the territory of the H.H. Burdenko.

Conclusion. Based on the foregoing, we can conclude that the work of the Center for the Prevention of Terrorism and Extremism is an effective measure to combat terrorist activities. In the future, in order to increase the effectiveness of anti-terrorist measures in the face of a growing threat to national security, it is necessary to continue awareness-raising work among students.

Relevance. Due to the rapid development of technological progress to date, the dynamics of the growth of man-made emergencies, entailing health and material losses, have been maintained and increased. Therefore, an analysis of the frequency of such events should be used as input for risk management..

Purpose. To analyze technogenic emergencies of the last five years in the territory of the Voronezh region in order to find possible ways to influence the frequency of their occurrence, prevent and minimize the number of human casualties, as well as reduce material damage.

Materials and Methods. Data from the accounting documentation for the five-year period (2017-2021) reflecting qualitative and quantitative characteristics were used. The information was processed by analysing changes in indicators from year to year.

Results. In the course of the work it was found that the most significant from the point of view of medical outcomes are road accidents, which predominate in the structure of man-made emergencies both in the number of accidents and in the number of deaths and injuries. In addition to the importance for the health system, accidents in transport are a serious burden on the economy of the region. Accidents account for 80 per cent of anthropogenic disasters, 18 per cent of fires and 2 per cent of other disasters. Incidents such as the collapse of the bridge, the fall of a helicopter, the explosion of domestic gas, the explosion of a bus, came into the latter category.

Conclusion. The study shows the need for further development and improvement of measures to prevent accidents, due to their most significant health consequences.

Relevance. The priority direction of modern extreme medicine in our country is the use and development of air ambulance as one of the components of medical evacuation in various emergency situations. The use of air ambulance significantly contributes to reducing the shoulder of medical evacuation, and, accordingly, to reducing the time for making decisions regarding severe victims in various emergency situations.

Purpose: The Voronezh region, due to the large area of the territory, is in urgent need of solving all these problems.

Materials and methods. This paper reflects an attempt to summarize the main directions and problems in the development of sanitary aviation in our region based on the study of medical and sanitary provision in emergency situations in remote areas of the Central Chernozem region.

Results. Our work is based on an analytical analysis of a number of performance indicators of the Voronezh Region State-owned Healthcare Institution "Voronezh Regional Clinical Center for Disaster Medicine" in recent years. This analysis revealed that during the Covid-19 pandemic, the number of requests for medical assistance to the regional clinical center for disaster medicine increased, and, accordingly, the composition of air ambulance significantly increased. The most in-demand specialists who flew to medical organizations of the Voronezh region for 12 months of 2020 - 2022 were anesthesiologists-resuscitators, who made a total of 4,836 departures and departures.

Conclusion. Thus, the air ambulance plays a leading role in the provision of emergency, including specialized medical care.

Relevance.

   The relevance of the topic is due to the fact that emergency situations of a biological and social nature in Russia have been and remain important health problems. To date, COVID-19 continues to be one of the most pressing health problems since the end of 2019, which is associated with numerous clinical variants of the course of the Target infection.

Target.

   To study and analyze SARS-CoV-2 as a biological emergency.

Materials and methods.

   We conducted an analytical review of the scientific literature on this problem, analysis and selection of the most important information, as well as statistical research methods using data from ROSSTAT, the Ministry of Emergency Situations of Russia and the Operational Headquarters for the new Coronavirus infection.

Keywords: emergency, COVID-19, new coronavirus infection, prevention, anti-epidemic measures.

Results.

   From 2019 to 2022, general respiratory morbidity was recorded in the Voronezh Region. During the period taken, 1 662 888 people fell ill with SARS. Registration of COVID-19 cases in the Voronezh Region has been carried out since 2021. In 2021, the total respiratory morbidity was 480,660 people. The diagnosis of a new coronavirus infection was established in 239,057 people (49.7% of the total respiratory morbidity). The number of COVID-19 cases among children under 14 years of age is 15,457 people (6.5% of the total number of cases). In 2022, the number of SARS amounted to 494,947 people. A new coronavirus infection was registered in 314,487 people (63.5% of the total respiratory morbidity). The number of COVID-19 cases among children under 14 years of age is 32,612 people (6.6% of the total number of cases). For the entire period of registration of cases of COVID-19 infection, 21,836,969 cases were confirmed on the territory of the Russian Federation, of which 394,214 deaths. In 2020, there was a trend towards an increase in the number of deaths. In 2021, the increase in mortality reached the maximum mortality for the entire registration period from 2020-2022. In 2022, there was a significant decrease in the number of adverse infection outcomes.

Conclusion.

The reason for the decrease in the total number of deaths and the increase in mild clinical forms is primarily due to the mass vaccination of the population, which began in January 2021. 89,423,801 people were fully vaccinated, and the collective immunity is 7.4%. In 2021, immunization against a new coronavirus infection is being carried out in the region, 812997 people received double immunization. Against coronavirus infection, 441487 people received a completed course of immunization in January – November 2022.

Relevance. The formation of professional competencies among students at the Department of Disaster Medicine and Life Safety using traditional and innovative technologies contributes to the activation of students' cognitive activity on the issues of medical support for the population in emergency situations, but the role of students' adaptation itself is also important for their professional success. Being a complex and resource-intensive process, the adaptation of students not only determines their academic success, personal self-realization and interpersonal relationships, but also sets the pace of their professional development in practical healthcare.

Purpose. The purpose of this study is to analyze the degree of adaptation of students of the same age category to the educational process and to the educational group.

Materials and methods. The test "Adaptation of students in the university" by T.D. was used as a research method. Dubovitskaya, A.V. Krylova, which makes it possible to study the general level of adaptation of senior students to educational activities and the study group, as well as to analyze the cognitive and socio-communicative components in the behavior of students in emergency situations.

Results. The results of the study showed a high level of adaptability of senior students of VSMU. N.N. Burdenko in relation to both educational activities and the educational team.

Conclusions. The analysis of the degree of adaptation is an integral part of the study of the formation of professional competencies among students at the Department of Disaster Medicine and Life Safety. Such indicators as "adaptation to the training group" and "adaptation to educational activities" characterize in detail the degree of communication and cognitive skills of young people on the verge of entering practical health care, and also determine the readiness to carry out their professional activities in emergency situations.

To date, the pandemic of the new coronavirus infection COVID-19 continues with the involvement of the children's population of the globe, including newborns, in epidemic processes. The aim of the study is to analyze the clinical and laboratory features of COVID-19 in infants. There were 44 newborns with a new coronavirus infection COVID-19 who were admitted to the hospital due to perinatal contact with COVID-19 and from intrafamily foci of infection. The main manifestations of the disease were neonatal maladaptation in 63.6% of patients, moderate rhinopharyngitis in 50% of patients, subfebrile fever in 31.8%. Pneumonia (CT-1,2 lesion area) was diagnosed in all who underwent chest CT. It was not accompanied by clinical symptoms of respiratory failure and decreased saturation. The severity was due to metabolic disorders: prolonged retention of elevated values of blood lactate, CPK, LDH, ASAT. There was no increase in DRR.

Relevance: In the work of a dental technician, there should always be clarity, uniformity and observance of order, but unfortunately, not always a dental technician can, in the process of work, fulfill these conditions. Non-compliance with cleanliness in the workplace often leads to disruption of the workflow, a decrease in quality and an increase in the production time of prostheses, which often leads to a lack of desire to work and develop in this area.
The purpose of the work: The goal is to improve the work of dental technicians in order to avoid errors.
Materials and methods: To correct this, the 5S system was proposed, which is widely used in many areas of production. It consists of 5 principles: sorting, maintaining order, keeping in order, standardization, improvement. But, of course, nothing can happen without self-control, discipline and teamwork. The most difficult thing in this technique is the development of habits, the observance of cleanliness and order, a person usually needs a lot of time for this.
The results of the study: Thanks to the joint work, the result will be the speed and quality of the manufacture of prostheses, the clarity of all stages.
Conclusion: Most often people have a desire to work in a clean, rationally sorted workplace, since order most often, psychologically, attracts a person and gives a desire to start work

Relevance. In orthopedic dentistry, one of the most urgent problems is the restoration of dentition[1]. One of the ways to treat partial and complete absence of teeth is prosthetics using dental implants.
Goal. To study the features of prosthetics with partial and complete adentia using dental implants. One of the main conditions of dental implantation is the proper planning of this procedure, which is the development of an optimal orthopedic treatment plan[2,3].
Materials and methods. The analysis of scientific articles, journals, books on the topic under study was carried out.
Results. According to the principle of its fixation, all structures of prostheses with support on implants can be divided into 3 groups: fixed (fixation is carried out with cement), conditionally removable (screw attachment) and removable prostheses. In the absence of a single tooth, the best solution would be to manufacture a single crown based on an implant[4]. Conditionally removable prosthetics is carried out in the case when only implants are used as a support for a dental prosthesis.
Conclusion. Thus, the study showed that the main advantage of prosthetics based on implants is the preservation of the alveolar ridge and bone tissue, also the load on the jaw joint is evenly distributed and there is a significant improvement in the aesthetic appearance of the patient. These structures are durable and have a high survival rate[5].

Lyme borreliosis (LB) is an infectious natural focal vector–borne disease. Currently, LB remains one of the most common diseases from the group of tick-borne infections. The disease is characterized by polymorphic clinical manifestations and a tendency to a prolonged recurrent course.
For the first time, data on the disease appeared in 1975 in the USA, in the state of Connecticut, the town of Lyme. The first cases of the disease were called juvenile rheumatoid arthritis. Subsequently, it was noted that the disease develops after a tick bite and proceeds in a combination of arthritis and migrating ring-shaped erythema. LB is a ubiquitous disease, found on all continents except Antarctica.
Considering the wide prevalence of LB in Voronezh and the Voronezh region, the polymorphism of clinical manifestations and the tendency to chronic course, knowledge of the features of the clinic and diagnosis of this disease is especially important. The article presents data on the features of the clinical course of LB in the Voronezh region for 2022. The analysis of laboratory data for this pathology is also carried out.
In the Voronezh region, persons 44 ± 13.5 years of age are most often ill with LB, all patients had only an acute manifest erythemic form of the disease with little intoxication. Epidemiological, clinical data and serological diagnostics play a crucial role in the diagnosis of LB.

Relevance.The clinical picture of opisthorchiasis has no specific manifestations characteristic only of this helminthiasis. Symptoms and syndromes are diverse and depend on many factors, which complicates the diagnosis of this disease.
The purpose is to study and analyze the features of clinical manifestations of invasion.
Materials and methods. Medical records of patients diagnosed with acute opisthorchiasis, clinical and epidemiological data, general clinical studies, parasitological and serological studies, ultrasound of the abdominal cavity.
Results. The clinical manifestations of acute opisthorchiasis were analyzed in detail and the main syndromes of the disease were identified. The most informative diagnostic studies have been established – coproovoscopy and blood ELISA with the determination of immunoglobulins G.
Conclusion. The most striking syndromes of opisthorchiasis in the acute stage are dyspeptic, toxic-allergic and asthenovegetative. For the purpose of parasitological confirmation of opisthorchiasis, microscopic examination of the stool is carried out to identify helminth eggs, and also determined
immunoglobulins G in the study of blood by the IF method, the main factor in the transmission of opisthorchiasis is an insufficiently heat-treated fish product.

Relevance: obesity is a pandemic of our time and has significant health consequences, as it increases the risk of developing dangerous chronic diseases: hypertension, type 2 diabetes mellitus, cholelithiasis, as well as atherosclerosis and its complications. The study of the role of the intestinal microbiota in the pathophysiological mechanisms of obesity, as well as the search for new methods of treatment and prevention of this pathology is an urgent task of modern medicine.
Objective: to determine the role of the intestinal microbiota in the development of obesity and to influence its composition with the help of prebiotics and probiotics in order to reduce human weight.
Methods: This study was conducted using PubMed and Google Scholar databases, using the Medical Subject Headers descriptor, without limiting the publication period (with an emphasis on the most recent works). Studies involving animals and obese adults were included. This review did not include obese children, subjects with genetic disorders or autoimmune diseases.
BMI was measured for the selection of overweight patients, the results were recorded.
Bacteriological examination of feces was carried out on the basis of the Lipetsk City Polyclinic No. 4 – and has the character of an open randomized clinical observation. The object of observation: the work included data on 20 patients aged 20 to 60 years with overweight. The exclusion criteria were: taking antibiotics, laxatives and drugs that stain feces.
After dysbiosis was detected, 17 out of 20 overweight patients were prescribed therapy using pre- and probiotics for 21 days. After the study, a control measurement of BMI was performed.
Results: after therapy, body weight decreased by 2-9 kg in 14 patients, body weight remained the same in 1 patient, body weight increased by 2 and 4 kg in 2 patients, respectively. The subjects noted the disappearance of abdominal discomfort, improvement of stool, decrease in blood pressure.
Conclusion: the effect of the gut microbiome on metabolism, hormonal balance, neurotransmitter and brain function may play an important role in weight management and the treatment of obesity. Moreover, the use of probiotics and prebiotics improves the composition of intestinal bacteria and gives promising results in the prevention and treatment of obesity.

The relevance of the study lies in the fact that hemorrhagic fever with renal syndrome (HFRS) is quite widespread in the Republic of Belarus. Viruses that are the etiological agents of HFRS can serve as a trigger for the development of chronic renal failure (CRF) in more than half (57%) of patients in the Republic of Belarus.
The purpose of the study was to analyze clinical and laboratory data for the relationship with the course of HFRS.
Materials and methods of research: the paper analyzed the case histories of 51 patients who were treated at the Minsk City Clinical Infectious Diseases Hospital for the period from 01/01/2017 to 10/18/2022. The study is retrospective, single center, cohort.
Results of the study: among the analyzed patients, men were more often affected by HFRS (74.5% of the entire group). Mostly, HFRS proceeded with moderate severity, but no effect on the length of stay in the hospital and the relationship with antibody titer (AT) were found. Clinical and laboratory dependences in patients with HFRS were analyzed. It was determined that a higher (1:1024 and above) titer of antibodies is not a reliable predictor of a more severe course of HFRS (U = 233, p = 0.080), which, however, requires an expansion of the sample to obtain statistically significant results and further study of diagnostics and treatment of patients with HFRS.
Conclusion: despite the achievements of modern medicine, HFRS remains difficult in the diagnostic search and treatment of a disease with a rather severe course. At the present stage, the most relevant areas for preventing the occurrence of HFRS cases include improving the efficiency of clinical diagnosis and timely conduct of specific laboratory diagnostics for suspected HFRS and optimization of monitoring of HFRS foci in order to develop approaches to predicting the epidemic situation and timely implementation of preventive measures.

Relevance. Diabetes mellitus is one of the main socially significant diseases. Recently, the number of publications devoted to the problem of the development of anxiety and depressive disorders in patients with diabetes mellitus has been growing in the scientific literature.

Target. Comparison of the quality of life and psycho-emotional status of patients with diabetes mellitus with healthy people.

Materials and methods. A survey was conducted on a group of patients with type 1 and type 2 diabetes mellitus who were hospitalized in the endocrinology department of the Voronezh City Clinical Emergency Hospital No. 10, as well as a group of healthy individuals (students of Voronezh State Medical University named after N.N. Burdenko). The number of examined in each group was 29 people. The quality of life was assessed using the SF-36 questionnaire, and the psychoemotional status was assessed using the Spielberg-Khanin questionnaire (to identify anxiety disorders) and the Beck scale (to identify depressive disorders). Comparison of the results of the survey of the two groups of surveyed was made using the Mann-Whitney test. In patients with diabetes, the relationship between the severity of manifestations of anxiety and depression and the level of glycated hemoglobin and the standard deviation of blood glucose during the day was assessed (using the Spearman correlation coefficient). The relationship between the severity of disorders and gender, age, type of diabetes mellitus was also assessed.

Results. Patients with diabetes on the background of modern treatment have a lower level of anxiety and depressive disorders, as well as a higher level of assessment of their mental health.

Findings. The results of the study indicate a decrease in the level of depressive and anxiety disorders in patients with diabetes mellitus, against the background of control and modern therapy for this disease.

In this paper, the stiffness index and the augmentation index are presented not only as markers of arterial wall damage, but also as diagnostic markers of dinapenia and sarcopenia in women with arterial hypertension.

The relevance of this work: muscle degeneration is one of the most acute problems of concern to mankind, therefore, the preservation of muscle mass and muscle strength through human involutative processes is increasingly being presented to healthcare and social services.

The aim of our study: to show the role of the stiffness index and the augmentation index in the process of arterial wall remodeling and the development of dina/sarcopenia in women with arterial hypertension.

Materials and methods. The object of the study was 118 women with arterial hypertension of stage II. A photoplethysmographic method was used to determine the stiffness index of the augmentation index, a simple test with a six–minute walk was used to determine the walking distance and walking speed, and hand dynamometry was used to determine the compression strength of the hands.

Results. As a result of the study, it was revealed that with increasing age in women with arterial hypertension, the stiffness index and the augmentation index increase. Prolonged mechanical influence of high blood pressure on the vascular wall leads to a change in its stiffness-elastic properties. And an increase in the stiffness index provokes a violation of metabolic processes in tissues, including muscle tissues. This fact is confirmed by a test with six-minute walking and wrist dynamometry, a decrease in walking speed, muscle strength and the development of dynapenia and sarcopenia.

Conclusions. The stiffness index and the augmentation index appear as diagnostic markers of premature aging in cardiovascular lesions of the arterial wall and the development of geriatric syndromes (dinapenia and sarcopenia).

Relevance. Antibacterial drugs are an integral component of the complex therapy of purulent-inflammatory diseases in therapeutic and surgical practice. Rational and reasonable use of antimicrobials in most cases affects the effectiveness of the treatment and often determines the outcome of therapy. The combination of factors such as the severity of the patients' condition, the inability in most cases to immediately isolate the pathogens of infection and determine their sensitivity to antibacterial agents makes it impossible to carry out etiotropic treatment at the initial stage. Errors in choosing the means of starting empirical antimicrobial therapy and dosage regimens increase the length of stay of patients in hospitals, aggravate the course of the disease, increase the risk of severe complications with a fatal outcome, lead to an increase in the cost of treatment, as well as an increase in antibiotic resistance.
Goal. To establish the dominant microorganisms in the BUZ VGKBSMP No. 1, to conduct a comparative assessment of antibiotic resistance indicators in the departments provided in 2020 and 2021 for the treatment of COVID-19 patients (2nd surgical, urological and pulmonological) and in the departments that were not directly involved in the treatment of patients with a new coronavirus infection.
Methods. The results of 2,810 bacteriological blood tests performed in 2019 (1,559 studies) and 2022 (1,251 studies) were retrospectively analyzed. The results were processed by the Statistica v.10.0 program.
Results. In the departments that have been repurposed to provide care to COVID-19 patients, there is a predominance of polyresistant flora (MDR), which has shown an increase in resistance to cephalosporins of the third generation, respiratory fluoroquinolones and aminoglycosides of the third generation, which is a negative trend. There is no similar increase in antibiotic resistance in departments that did not directly help patients with COVID-19.
Conclusion. Thus, the use of antibiotics significantly improves the prognosis of patients with purulent-inflammatory diseases, and on the other hand, negatively affects the life of society as a whole, brings huge social and economic losses associated with preventing the spread of infections caused by resistant microorganisms.

Cardiotoxicity of chemotherapeutic drugs is one of the serious complications of drug treatment of malignant neoplasms, since it can create conditions for the formation of myocardial dysfunction. One of the widely used drugs in oncology with cardiotoxic effect is doxorubicin (synonym - adriablastin). The incidence of various cardiac complications in patients taking doxorubicin reaches 36%.

Relevance. The liver is the largest organ of the abdominal cavity, which occupies most of the right hypochondrium and epigastric region, often enters the left hypochondrium to the left lateral line. Segmental anatomy of the liver is well studied by both surgeons and radiologists. However, few studies are devoted to the superficial variant anatomy of the liver. Knowledge of the normal and variant anatomy of the liver is important both for radiological examination and surgical intervention, and for diagnosis in urgent surgery for blunt abdominal injuries.

Goal. To determine the diagnostic significance of sonography and computed tomography for visualizing the features of the anatomical structure of the liver in children, as well as the features of the ultrasound picture of the elongated left lobe of the liver (saddle liver).

Materials and methods. The data of two clinical cases of structural features of the left lobe of the liver in adolescent girls aged 13 years were studied during a routine ultrasound examination of the abdominal cavity organs at the Children's Doctor Medical Center in Voronezh.

Results. During the planned ultrasound examination of the abdominal organs in the medical center "Detsky Doktor" Voronezh, according to the appointment of a gastroenterologist with a difference of 2 years, two cases of structural features of the left lobe of the liver in adolescent girls of 13 years were revealed. Only in one case, a follow–up examination (CT of the abdominal organs) was carried out and the results were provided – a feature of the structure of the left lobe of the liver was confirmed – an increase in size (a variant of development - a "saber-shaped" liver).

Conclusion. The study of anatomical features of the liver is important for modern practical medicine. Knowledge of the variant anatomy of the left lobe of the liver is important both for ultrasonologists and radiologists, especially when using the FAST protocol for blunt abdominal trauma to search for the presence or absence of hemoperitoneum, and for surgeons when planning and performing surgical interventions on the liver in order to prevent a possible misdiagnosis.

Annotation. Relevance. Trends of recent decades demonstrate an increase in the number of patients with mechanical jaundice syndrome (MJ) The problem of diagnosis and treatment of diseases accompanied by MJ syndrome remains an urgent medical and social problem. The issues of timely and rational therapeutic tactics for MH are still far from being resolved. Goal. The study of the role and place of radiation methods in the therapeutic and diagnostic algorithm and its improvement taking into account possible complications. Methods. The analysis of the results of treatment of 868 patients with MJ who were treated at the bases of the general surgery clinic "DSMU" for the period from 2000 to the present was carried out.The results are statistically processed using the Statistica 6.0 Results program. In 216 cases, cholecystolithiasis was the cause of mechanical jaundice. According to ultrasound data, proximal obstruction was detected in 142 cases, central obstruction in 256 cases, and distal obstruction in 470 cases. Conclusion.Repeated ultrasound at the stage of diagnosis of obstructive diseases of GPDD has low information content. An increase in the number of diagnostic measures leads to an extension of the terms of diagnosis and diagnosis and, accordingly, to an increase in the duration of hospitalization of the patient. Performing MRCG at the early stages of the diagnosis of obstructive diseases leads to a reduction in the duration of inpatient treatment of patients by 3-5 days.

Relevance. Multiple myeloma (MM) is a malignant lymphoproliferative disease, the morphological substrate of which is plasmotic cells secreting monoclonal immunoglobulin [1]. The pathology described above is 13% among hematopoietic tumors, this indicator indicates a high incidence. And, although the clinical picture of multiple myeloma is well known, doctors often face diagnostic difficulties. The key diagnostic method is classical radiography as the main method of morphological visualization of MM manifestations, pathological changes in bones[3]. Goal. To evaluate the significance of X-ray examination of bones in patients with multiple myeloma at various stages of follow-up. Materials and methods. The study was conducted on the basis of the Department of Instrumental Diagnostics of the Burdenko State Medical University. The data of the patient's X-ray examination, as well as morphological and immunohistochemical examination of the biopsy material, computed tomography (CT), positron emission tomography (PET-CT), magnetic resonance imaging of the lumbosacral region (MRI) were studied. Results. The paper presents a clinical case of multiple myeloma in a 54-year-old woman. The observation period is from December 2021 to May 2022. Doctors suspected a pathological fracture, the patient was sent to an oncological dispensary. According to the results of histological and immunohistochemical studies of the biopsy material, the patient was diagnosed with multiple myeloma, unclassifying form, osteodestructive syndrome with soft tissue components. At the time of the beginning of polychemotherapy (PCT) according to the VCD program, on the radiograph of the left humerus, the patient has a 10x4 cm destruction site, as well as areas of discharge in the proximal humerus. The patient underwent 3 courses of PCT, against which she notes an improvement in the form of a decrease in the intensity of pain syndrome and a decrease in the need for analgesics. Positive dynamics is observed on the control radiograph, namely the consolidation of the fracture. Conclusion. Despite the emergence of new methods for the diagnosis of oncological diseases (CT, MRI), X-ray diagnostics, today, remains not only informative, but also the most accessible option, both for primary diagnosis and monitoring of the dynamics of the tumor process, and for monitoring the treatment of patients with multiple myeloma.

Relevance: Nowadays, the theory that the gut microbiome affects not only the physiological, but also the mental state of the host's organism, is increasingly being confirmed.

There have been carried out many clinical trials that suggest a connection between pathological conditions and the composition of the intestinal microbiota.The basis of this connection is neurotransmitters and other substances produced by representatives of the normal or altered intestinal microbiota and capable of influencing the course of the disease.

Such relationship is observed in autism spectrum disorders (ASD), which represent a group of biological disorders associated with metabolic disorders. While monitoring the patients with ASD it was noted that many of them had gastrointestinal (GI) symptoms (abdominal pain, constipation, diarrhea, etc.), correlating with worsening of psychological symptoms of ASD.In such patients, there was an increase in anxiety, irritability, and isolation compared to children without GI disorders, which, apparently, is caused by quantitative and qualitative disturbances in the composition of the intestinal microbiota.

Every year the incidence of autism is increasing, and in this connection there is a need for a more detailed study of the pathogenesis of this disease.                       

Objective: To investigate the relationship between changes in the gut microflora producing short-chain fatty acids (SCFAs) and symptoms of ASD.                 

Materials and methods: A number of sources of native and foreign literature on the basis of the Pubmed and CyberLeninka database were analyzed.         

Results: It was found that the shift in the intestinal microflora affects the manifestations of ASD through changes in the concentration of SCFAs.                                                                  

Conclusion: A large number of trials of the composition of the microbiota in ASD and changes in the concentration of SCFAs produced by it have proven scientific interest and the perspectiveof further study of this question.Confirmation of the proposed pathogenetic chains can become the basis for the development of a new direction in the pharmacotherapy of ASD, which confirms the relevance of the considered problem.

Relevance. Currently, various stimulators of skin wound regeneration are being actively studied, among which aloe extract is of interest. Literature data show that this compound enhances angiogenesis, however, this effect is little studied in relation to a skin wound.

Purpose: to study the effect of aloe extract on the vessels of the microvasculature during skin wound healing.

Materials and methods. The study was performed on 18 guinea pigs. Animals were modeled with a 20x20 mm wound. After euthanasia, material was taken for histological examination on days 7, 14, and 21. Then, histological sections were made and stained with hematoxylin-eosin. Ten fields of vision were evaluated at a magnification of 400, the total number of vessels and their average area were determined. Statistical data processing was carried out using the Mann-Whitney test at р˂0.05.

Results. It was found that on the 7th day there were no statistically significant differences. On day 14, in the group using aloe extract, the total number of vessels was 7.79% more than in the control group (p˂0.05). There is also a statistically significant increase in the average vascular area in the aloe extract group versus the control group by 91%. On the 21st day of experimental skin wound healing, it was found that the total number of vessels in the microcirculatory bed under the conditions of using aloe extract was 88.24% more than with spontaneous wound healing (р˂0.05). The mean vascular area is also larger in the aloe extract group by 14.29% than in the control group (p˂0.05).

Conclusion. Morphological analysis of the vessels of the skin wound showed that aloe extract has an effect on the processes of angiogenesis, as evidenced by an increased number of blood vessels on all days of the experiment.

Premature birth remains one of the most important and main problems of obstetrics and gynecology. There is a lot of data on the pathogenesis of abortive pregnancy, however, for a more detailed understanding of the pathological process, it is necessary to study local mechanisms at the cellular and tissue level. Of great interest is the participation of M1 and M2 macrophages in inflammatory and immunological processes in the structure of the placenta. The use of the obtained data will prevent the development of the pathological process during pregnancy.
The aim of the work is a morphological, histological, immunohistochemical study of the placental biomaterial in preterm labor.
A comprehensive morphological examination of placentas was carried out, which consisted of: macroscopic description, organometry, overview histology and immunohistochemistry. To study the placenta at various levels of structural organization, the material was fixed in 10% neutral formalin. Sections for immunohistochemical and histochemical staining were made from the studied placental tissue samples. A total of 20 placentas were examined. 20 blocks were made, 3 slices were made from each block: 2 slices of 1 micron and 1 slice of 5 microns. Placentas were divided into two groups: the first included placentas from childbirth with prenatal outpouring of amniotic fluid, the second group included placentas with premature birth, provided the amniotic fluid was preserved. The first group was divided into three subgroups (1a, 1b, 1b) depending on the gestation period. Immunohistochemical method revealed CD-68+ and CD-163+ macrophages, which were identified using rabbit monoclonal antibodies. The stained micro-preparations were studied on a hardware and software complex for biological research based on a direct research microscope ZEISS Axio Imager A2. The information received was processed using ZEN 2.3 software.
As a result of the work, it was revealed that the indicators of CD-163 positive macrophages (M2) are high in all the studied placenta groups. The average total number of 25 visual fields: subgroup 1a - 494.25, subgroup 1b - 318.34, subgroup 1b -402, group 2 -395.5. The indicators of CD-68 positive macrophages (M1) are higher in the groups of pregnant women with prenatal outpouring of amniotic fluid (group 1). The average total number of 25 visual fields: subgroup 1a - 67.5, subgroup 1b – 86, subgroup 1b - 145.67, group 2 – 44.
According to the results of the study, it was concluded that M1 and M2 macrophages are actively involved in immunomorphological processes in the placenta during premature birth.

The morphological features of the skin of rats under burn exposure under conditions of spontaneous healing and as a result of the use of ointment with a new derivative of N-acetyl-6-aminohexanoic acid were studied. The aim of the work is to study the effect of a new derivative of N–acetyl-6-aminohexanoic acid on the reparative processes of rat skin during experimental thermal burn. Material and methods. The object of the study was 50 laboratory nonlinear female rats weighing 140-160 g, of which 45 were simulated thermal burn using a steel stencil. From the first day and throughout the experiment, the animals of the experimental group were corrected for burn healing by applying 2% ointment with N-acetyl-6-aminohexanoic acid–2-ethyl-6-methyl-3-hydroxypyridinium N-acetyl-6-aminohexanoate.
Results. During the experiment, it was found that in the rats of the experimental group, the regeneration of burn wounds took place at an earlier time against the background of a lower level of C-reactive protein, in contrast to the comparison groups. Conclusion. The analysis of the results of experimental studies allowed us to establish the stimulating effect of applying ointment with a new derivative of N-acetyl-6-aminohexanoic acid.

Currently, there are about 8000 hereditary diseases and about 800 of them are accompanied by symptomatic epilepsy. It is very important to diagnose these diseases as early as possible, as this allows you to prescribe adequate specific therapy in a timely manner and avoid severe clinical manifestations. Biotinidase deficiency, which belongs to the group of hereditary metabolic diseases, is a serious violation, because. the lack of this enzyme leads to a deficiency of free biotin, which is involved in key metabolic reactions as a coenzyme of carboxylase. This causes the presence in the clinical picture of both skin manifestations (rashes, alopecia as a result of a metabolic disorder of fatty acids), and neurological symptoms due to local lactic acidosis. The clinical picture usually appears in infancy, less often in puberty. Its severity is determined by the degree of activity of the biotinidase enzyme. With delayed diagnosis, the disease progresses rapidly, which can lead to death. However, a correct diagnosis and the beginning of adequate therapy can not only stop the further development of the disease, but also reverse the clinical picture.

Purpose: to analyze the key points of pathogenesis, the clinical picture of biotinidase deficiency and the effectiveness of pathogenetic therapy with biotin.

Materials and methods. Study and analysis of literature on various aspects of biotinidase deficiency.

Results. Detection in a patient in the first six months of life of seizures resistant to therapy with antiepileptic drugs, various skin changes, alopecia, and psychomotor developmental disorders suggests biotinidase deficiency, a pathology from the NBO group. The intake of free biotin at a dosage of 10–30 mg/day contributes to the involution of all clinical conditions: the disappearance of seizures, the restoration of hairline, and the normalization of acid-base balance. A timely diagnosis and the appointment of pathogenetic therapy determine the severity of the clinic and the outcome of the disease.

Relevance: The topic of the influence of the human microbiota on the course of multiple sclerosis is extremely relevant for the medical community. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that affects numerous human functions, such as movement, vision, sensitivity, emotional state and cognitive functions. Multiple sclerosis is a chronic neurological disease that progresses over time and often leads to severe disability. Despite the fact that for many years research in this area has been aimed at studying the genetic and environmental factors that affect the development of multiple sclerosis, we still do not know much about the other mechanisms that are behind the development of this disease.

Objective: to analyze the state and composition of the human microbiome with a different course of multiple sclerosis and the dependence of the progression of cognitive impairment.

Materials and methods.A comparative analysis of clinical data, general clinical laboratory studies in patients of two groups was carried out: the first – control (healthy people), the second – patients with multiple sclerosis and an increased value of Alistipes and the third group - patients with multiple sclerosis and an increased value of Alistipes and Bacteroides vulgatus.

Results: The analysis of the state and composition of the microbiome of patients with multiple sclerosis was carried out and the ratio of microorganisms and their influence on the progression of cognitive functions was revealed.

Conclusion: It was revealed that in patients with multiple sclerosis, the microorganisms Alistipes and Bacteroides vulgatus are at an increased value than in the control group, which indicates a direct dependence of the progression of cognitive impairment on the composition of the human microbiome.

Relevance. Bladder cancer is one of the most common diseases of oncourology. therefore, it is necessary to raise the level of awareness of doctors on this topic. For several decades, the gold standard of treatment for this pathology has been minimally invasive surgical intervention-transurethral resection (TUR) of the bladder.
The purpose of the study. Based on the analysis of medical histories, to identify the main clinical and morphological parameters that allow predicting the development of recurrence of bladder cancer after its surgical treatment.
Material and methods of research. A retrospective analysis of the case histories of 479 patients with RMP who received surgical treatment in the urological department No. 2 of the "VOKB No. 1" for the period 2020-2022 was carried out. The results of the study were statistically processed using standard methods of variational statistics using the MicrosoftExcel 2019 program. In addition, the study used materials from scientific publications on this topic, reflecting the causes and mechanisms of bladder cancer development.

Results.When analyzing the case histories, certain patterns of the course of the disease were identified, which will be discussed in this article. Some of them: men get sick more often than women, and the average age is 68 years. During cystoscopy, an average of 2 tumors are detected, their most frequent localization is the posterior wall of the bladder. After analyzing histological studies, a conclusion was made about the most frequent cellular structure. This allows you to choose further treatment tactics. In more complex cases, radical cystectomy is used. Special attention should be paid to the fact that almost half of the studied patients had at least one relapse, therefore, these cancer patients need regular screening of the bladder using computed tomography, ultrasound, cystography, cystoscopy with biopsy in order to detect the recurrence of the neoplasm in a timely manner.
Conclusion.The structure of the incidence of RMP in the Voronezh region is dominated by male urban residents, active, able-bodied age, which gives social significance to this disease and puts it in the category of environmentally indicator pathologies characterizing the health status of residents of the Voronezh region

Primary multiple malignant neoplasms (PMNNO) are simultaneously or sequentially independently developed tumors in one patient, the pathogenesis and pathomorphosis of which are different. They develop in one or several organs, independently of each other. According to the time of occurrence, synchronous, which are diagnosed simultaneously or within 1 year, or metachronous, which are diagnosed after a year or more, are distinguished. that when a single localization of a tumor lesion is detected, there is a possibility of the existence of a multiple lesion. Materials and methods. In most cases, two tumor lesions are identified. The possibility of the existence of triple localization occurs in 6–8% of cases. It is rare for a patient to have more than 4 tumors. In the context of an increase in the overall incidence of malignant neoplasms of a single localization, recently there has been an orientation towards an increase in patients with PMNO. The number of newly diagnosed PMNO in patients varies from 5 to 17%. A clinical case was considered, 4 tumor lesions were detected in patient S., she underwent a number of diagnostic measures, due to which it was possible to diagnose malignant neoplasms in the early stages and treatment was carried out simultaneously. To date, the issue of the moment of occurrence of multiple tumor lesions has not been resolved, nor has algorithm for their early diagnosis and, consequently, the question of timely and adequate treatment of patients with such a pathology remains open, which makes the topic relevant.                                                                                     Results. On the example of a clinical case, which is described below, it can be said that a tumor diagnosed at an early stage is easier to treat, which leads to a complete recovery of the patient. The main direction in identifying primary multiplicity, along with the clinic, is the search for associations of human biological markers. Conclusion. The available data will be of significant interest for practical healthcare and for research work, because. PMNOs are an excellent model for studying multifactorial susceptibility to cancer.

Annotation. Rationale: The problem of laryngeal cancer over the past 25-30 years has become more relevant due to an increase in a high percentage of disability, as well as a growing incidence rate (according to the World Health Organization for 2021, 2.5-2.7 cases per year per 100 thousand people ), which is associated by many scientists with the progression of tobacco smoking and alcohol abuse in the world. The average age of patients with verified laryngeal cancer in Russia is 63 years, of which the proportion of men is 98%, about 85% of all deaths from laryngeal cancer correlate precisely with cumulative alcohol consumption, smoking both actively and passively, as well as the presence of occupational hazards, which represents a special social significance of the study of this aspect in the territory of the Voronezh region.
Objective: To study the adherence to smoking and alcohol abuse in patients with laryngeal cancer.
Methods. An analysis was made of 100 case histories of male and female patients with laryngeal cancer in the period from 2020 to 2023. Patients who received surgical treatment in the conditions of the department of head and neck tumors of the BHI Voronezh Regional Clinical Oncological Dispensary were surveyed.
Results. As a result of the research, we have established the gender and age characteristics of laryngeal cancer. The main cohort of patients were men (94 people out of 100). The medical histories of these patients were analyzed, it was found that 85% of them had a smoking experience of more than 20 years, and 15% had passive smoking (cigarettes) in their life history. Along with this, 37% of patients note the intake of alcoholic beverages every week. Data were obtained that 87% of all men smoke, and 33% of all women. In addition, according to the results of the survey, it was found that of all smoking men, after verification of the diagnosis and treatment, 43% continued to smoke, and 0% of women.
Conclusion. The results of the study confirm the relationship between the occurrence of laryngeal cancer and a history of long-term smoking and alcohol consumption, reflect the age and sex characteristics of this nosology, demonstrate a high percentage of patients diagnosed at stages II-III, indicate the need for oncoscreening, the implementation of preventive measures , identifying risk groups for laryngeal cancer, oncological informing patients with an average and high risk of developing this nosology in the period before the onset of the disease, as well as correcting lifestyle after its verification.

According to epidemiological data, it is known that 2-3% of malignant neoplasms in women are vulvar cancer. According to 2018 statistics, the incidence of vulvar cancer in the Russian Federation was 2.6 cases per 100,000 female population.
Goal. To identify the advantages of surgery with reconstruction, to assess the complications that occur in patients in the postoperative period.
Materials and methods. The article analyzes the possibilities of performing surgical treatment of patients with vulvar cancer.. On the example of two groups with this disease, surgical treatment of cancer without reconstruction and with the use of reconstructive surgery using skin-fascial flaps from the posterior and medial surfaces of the thighs and buttock area was considered.
Results. They showed the positive and negative sides of these operations. And it was also found out that the main difference between a surgical operation with reconstruction is a wide excision of the affected area with vulvar anatomical structures and the restoration of the resulting wound with skin-fascial flaps. In addition, an assessment of complications in patients in the postoperative period was given. It was found that patients with reconstructive surgery have much fewer complications, since there is a sufficient volume of tissues, good blood supply, which allows the operation to be performed without stretching the edges, and also makes it possible to achieve the most satisfactory cosmetic result.
Conclusions. Choosing the right method of treatment for malignant neoplasms of the vulva is one of the most important problems in oncology. Thus, reconstructive surgery has a sufficient number of advantages in contrast to operations without reconstructions.

Relevance. The life expectancy of cancer patients depends entirely on full-fledged dispensary observation, where key attention is paid to the early detection of relapses and metastases of the primary malignant focus. Today, the interest of doctors of all specialties in neoplasms of the adrenal glands is growing, especially in patients with a burdened oncological history. However, the data regarding metastatic adrenal cancer in most cases are based on the results of autopsy. This dictates the need to update the results of an intravital study of the histological material of adrenal neoplasms in patients, which will make it possible to develop tactics for the management and subsequent treatment of patients. Materials and methods. The medical documentation of patients with a history of malignant neoplasms was studied, in which, during the planned dispensary observation, ultrasound and then MRI (CT) of the abdominal cavity and retroperitoneal space revealed the presence of tumors of the adrenal glands. Material for pathomorphological examination was obtained by performing a biopsy of the tumor and laparoscopic adrenalectomy. The discussion of the results. Histological examination of the obtained material made it possible to identify benign and malignant (metastatic) lesions.

Relevance. Recently, the number of patients with rectal cancer has been steadily growing, which is one of the “leading” cancer nosologies in terms of mortality structure. The research methods that have become routine (sigmoidoscopy, X-ray and endoscopy) are not always informative in relation to determining the extent of the tumor in relation to the intestinal wall, generalization of the disease, and detection of relapse. The main role in the diagnosis of pathological changes in the rectum is given to modern methods of radiation diagnostics - MRI, CT, PET-CT. Currently, ultrasound of the rectum is becoming increasingly important. Materials and methods. The results of ultrasound examination of patients with rectal cancer during the initial diagnosis and after specialized antitumor treatment in order to detect relapses using the diagnostic options of the Hitachi Arietta V-70 expert-class ultrasound scanner were considered and studied. The discussion of the results. Ultrasound examination allows to visualize pathological changes in tissues and focal formations in the rectum with high accuracy, which makes it possible to determine methodological approaches to surgical and chemoradiation treatment of rectal cancer, monitoring patients with cancer of the specified localization

Relevance: operations like radical mastectomy for breast cancer are always difficult from the point of view of the physical and psychological state of a woman. After the surgical treatment, various complications may develop, for example, post-mastectomy syndrome, concerning both the physical condition of the patient and the state of her psyche, which indicates in favor of mandatory rehabilitation of cancer patients by rehabilitologists and psychologists.
Purpose: analysis of the results of psychological tests before and after rehabilitation, analysis of the results of physical examinations by an oncologist-mammologist before and after rehabilitation.
Materials and methods: to analyze the state of the patients' psyche, such questionnaires and tests as the Eysenck self-assessment test of mental states, the Beck questionnaire and the scale for psychological express diagnosis of depressive disorders were used. A physical examination was also performed by an oncologist-mammologist to identify postoperative complications.

Relevance. Scoliosis is a pathology of the musculoskeletal system, which is a lateral curvature of the spine in the frontal plane. Currently, scoliosis is an important medical and social problem, since the progression of this disease is often accompanied by complications in the form of structural and functional disorders of other organs and systems.

Goal. To assess the prevalence of various forms of congenital and acquired scoliosis and their possible complications from the respiratory, digestive, cardiovascular and genitourinary systems among children and adults.

Materials and methods. Data on the disease of scoliosis of 152 people in the age range from 5 to 34 years were analyzed on the basis of the Center for Prosthetics and Orthotics of the Family Medicine Clinic "Eucalyptus", Voronezh. The main object of our study are 145 patients in the age range from 5 to 34 years old suffering from scoliosis of 2-3 degrees and currently being treated at the Center for Prosthetics and Orthotics of the Family Medicine Clinic "Eucalyptus".

Results. It was found that 78.62% of cases (114 people) out of 145 patients, regardless of gender, accounted for idiopathic scoliosis (mainly the age group of 13-15 years), 10.34% - post-traumatic scoliosis, 2.76% - de novo scoliosis (30 years and older), 4.83% - juvenile scoliosis (4-5 years), 3.45% - congenital scoliosis caused by abnormalities in the development of the spine (spina bifida, spinal hernias, dysplastic scoliosis). In 38 patients (26.21%), scoliosis is accompanied by pronounced disorders from various organs and systems, which account for: 17 (11.72%) – the presence of complications from the respiratory system, 12 (8.28%) – the digestive system, 5 (3.45%) – the genitourinary system, 4 (2.76%) – cardiovascular system. 

Conclusion. The incidence of acquired scoliosis significantly exceeds the proportion of congenital scoliosis, and most of the cases are patients with idiopathic scoliosis, regardless of gender. Of particular interest is the problem of the occurrence of de novo scoliosis, characteristic of adults aged 30 and older, since there are no generally accepted criteria for diagnosis, classification and treatment principles. For timely diagnosis and treatment of complications of scoliosis, patients under the age of 18 need consultations with: an orthopedic traumatologist, a pediatrician, a neurologist, a dentist, a gynecologist, a physical therapy doctor, a physiotherapist.

Relevance. More than 600 million cases of a new coronavirus infection with a mortality rate of about 1% have been registered in the world so far. People with comorbidities, including diabetes mellitus, are more susceptible to the adverse course of COVID-19. Numerous studies confirm that post-COVID syndrome is more likely to form in the presence of diabetes mellitus.
Objective of the study. To reveal characteristic features of course and diagnostics of new coronavirus infection against the background of concomitant diabetes mellitus taking into consideration pathophysiological ways of mutual influence of these pathologies.
Materials and Methods. Questions of course and diagnostics of new coronavirus infection on a background of diabetes mellitus have been studied; main pathogenesis pathways in this comorbid condition have been analyzed, the factors influencing negatively on the patient's state against the background of the disease development have been revealed. To confirm or refute the hypotheses, data of 154 patients who were treated at the "COVID-8" department of the VCCEH No.10 during the period from October 2020 till March 2021 were collected and analyzed. The data were statistically processed using Microsoft Excel 10.0 and StatSoft STATISTICA 12.0 software packages.
Results of the study. Compared with the CORONADO data, obesity was much less common in the present study. Of the comorbidities, hypertension, CHD, and coronary artery disease were identified to the greatest extent. Differences with baseline data were also observed for the main complaints. Patients with diabetes mellitus type 2 are characterized by more severe form of the disease according to many indicators. However, there was no statistical significance in the differences in CT and some laboratory indexes.
Conclusion. Understanding the pathophysiological mechanisms of the mutual influence of DM and a new coronavirus infection on the body will serve as a tool for choosing an appropriate drug therapy and help to achieve better treatment results.

Revelance. Obesity today is the leading problem among the population, so the most relevant is to find out the causes and assess the risks of developing this pathology in students. As a result of urbanization, sedentary lifestyle has become not only a peculiar habit for modern society, but also the main reason for the development of this pathology. In 2020, with the emergence of the new Covid-19 virus, the level of physical inactivity increased, which provoked an increase in body weight in the majority of the population, resulting in the development of obesity.

Objective. The aim of the study is to analyze the level of obesity among the students of the Burdenko State Medical University and to assess the risks of its development.

Methods of the study. The study was conducted with the help of an electronic version of the questionnaire created on the Google platform. It was sent out via social networks. 190 students of N.N. Burdenko State Medical University aged 17 to 25 took part in the survey.

Results. The results obtained in the study were evaluated according to the following criteria: assessment of body mass index (BMI); presence of concomitant diseases in students and their relatives; factors predisposing to the development of obesity; presence of relatives suffering from obesity.

Conclusion. On the basis of the obtained results the relationship of alimentary, hereditary factors, sedentary lifestyle of students with the development of obesity in young generation was revealed. The simultaneous presence of three factors in the future will have a negative impact on health, and as a consequence will lead to the development of cardiovascular system diseases, which are among the leading causes of mortality in people. Therefore, in this group of people, it is important to regularly monitor their body weight and to take measures to reduce it if their BMI level is exceeded.

Relevance. The relevance of the topic is determined by its content and the high standard of ethical requirements imposed on the work of medical personnel in recent years.

Purpose: to study the views of 1st and 6th year students of N.N. Burdenko VSMU on ethics in medical activity.

Methods: questionnaire, analysis, survey, generalization method.

The article discusses the importance of medical ethics in medical activity, ethical principles, deontology as a component of ethics. The profession of a doctor both in ancient times and now is one of the humane ones, which determines the essence, meaning, attitude and views of society towards medical workers. Every person in his life has never turned to doctors for help, thereby entrusting health to a representative of medicine. When visiting a medical institution, everyone has the right to hope for respectful treatment, decent, honest communication, and an ambulance if necessary. Professional medical ethics helps a medical professional to choose the most correct, respectful, morally acceptable line of behavior in a variety of situations during work. This determines the interest in considering this issue. The concept of medical ethics and deontology is proposed, the problems of medical ethics are highlighted. The discoverers of these directions, the basic principles, the importance of studying this issue from the point of view of medicine are considered. The results of the study are proposed, which identifies the most important aspects in medical ethics and views on the medical activities of students of the 1st and 6th courses of N.N. Burdenko VSMU.

Results: most students of N.N. Burdenko VSMU consider ethics to be an important part of professional skills, noting that professional ethics can and should be studied.

Conclusion. In conclusion, I would like to note that the topic of medical ethics has been of interest to students of our university since the first day of training. Professional ethics is perceived as an important trait that needs and can be learned. The results of the study showed that selfishness is perceived by all respondents as a negative professional trait, and mercy and truthfulness in the work of a doctor are important criteria that support the image of the profession.

Relevance. The topic is borderline at the junction of two sciences - political (elitology) and historical. The study of A.V. Kolchak's diverse activities is an integral part, firstly, of elitology, which studies the formation, activity and collapse of the Russian elite, and also of historical science, because these activities took place in the early twentieth century and culminated in the global changes in the country.
Research Objective. To examine and analyze the dynamics of development, trends, and identify the factors that influenced the formation.
Materials and methods. The following methods have been applied: a logical method, a comparative method, a descriptive method and a comparative method.
Results. The correlation of historical processes with the formation of Admiral Kolchak as a figure that influenced the development of some events in the national history is revealed.
Conclusion. It is impossible to give an unequivocal estimation of his life path and activity. In recent decades, active attempts have been made to rehabilitate the heroes of the White movement, including A.V. Kolchak. The public perceives him from two positions: either as a Siberian executioner, creator of concentration camps for Red Army soldiers, dictator and monarchist, or as a "polar idealist". Thus, because of such a sharp discrepancy in the assessment of active participants in the White movement (not only with regard to Kolchak), Russian society is split into two camps.

Relevance. In the modern world, in the era of transformation and globalization, the problem of value education of the younger generation is becoming especially urgent. Art, as a form of social consciousness and part of the spiritual culture of society, is able to form a value worldview of an individual.
Goal. The study of the influence of art in general and various genres of art on the formation of the value worldview of the individual.
Materials and methods. Comparative and comparative analysis, generalization of theoretical material are used. The author relies on a historical and philosophical approach and psychological research in studying the problem of the influence of art on the moral education of the individual.
Results. The problem of the influence of art on the formation of personality has interested a person since antiquity. Plato and Aristotle are among the first thinkers to emphasize the influence of art on the formation of human value orientations. In the Renaissance, art becomes one of the tools for the formation of an ideal universal personality. Later, German philosophers drew attention to the reflexive function of art, the possibility of revealing the spiritual potential (I. Kant) and the cognitive function of art (G. Hegel). Russian philosophers L. N. paid special attention to the role of art. Tolstoy, I. A. Ilyin, N. A. Berdyaev, who believed that art elevates the individual and promotes moral renewal. From the point of view of modern scientific research, it has been noted that art can have a positive effect on a person's emotional state, improve mental activity and concentration, as well as reduce the level of the stress hormone. Thus, art gives a person harmony and tranquility, without which it is impossible to form a full-fledged personality.
Various genres of art have specific ways of influencing a person. For example, literature contributes to the formation of correct ideals, enriches a person's life experience and develops empathy; music educates emotional intelligence, helping to better understand one's own feelings and the feelings of others, enriches emotional and sensory experience; painting develops attentiveness, prudence, patience in the search for truth and extraordinary creative thinking.

Conclusions. Art is the strongest tool for educating a person's value worldview, developing spiritual qualities of a person, moral foundations and ideals. It not only educates, but humanizes, forms a person as a full-fledged personality.

The purpose of the article. The article is devoted to the study of existing stereotypes associated with medical activities. Prejudice has a big impact on teenagers who plan to become doctors but are hesitant because of the standards imposed by society. Based on the analysis of the results of a sociological survey of medical students of different courses, it was established which of the stereotypes influenced their future career guidance. The relevance of the designated topic is associated with the problems of early career guidance. The data obtained during the study can be used in work with future medical school applicants.
The target. Identify the main stereotypes and show their failure. This is necessary so that every student can, without doubting himself, choose the specialty that he dreams of.
Materials and methods. Sociological survey on the platform "Google-form". Methods were used: analysis of the received information, work with statistical data, retrospective. A total of 120 respondents were interviewed.
The results. According to the survey, a list of stereotypes about doctors of special professions was revealed: dentists, therapists, pathologists and psychiatrists. In addition, in the course of the study, it was possible to find out what qualities are the standard, according to the respondents, for a doctor. These include: compassion - 63%, reliability - 81%, mindfulness - 92%, sociability - 76% and decisiveness - 74%.
the conclusion. As it turned out, at the heart of any society there are stereotypes caused by false judgments. Their occurrence was influenced by the ambivalent opinions of people about doctors, which are not supported by personal experience and are based only on rumors. It is important to take into account this factor in the course of career guidance work with future applicants and respond to it in a timely manner

Relevance. In this paper we consider the process of formation of the Liturgical Synodal Commission as a body responsible for editing liturgical texts prepared by the Diocesan Liturgical Commissions of the Russian Orthodox Church, as well as for the compilation of new Liturgical texts. This study has not been conducted before, which gives huge opportunities for study. In a short period of time, the Liturgical Synodal Commission has prepared and left a huge number of Liturgical texts that are currently approved or are at the stage of approval by the Holy Synod of the Russian Orthodox Church. Approved texts are widely used in parishes.
The purpose of this work is to study the history of the creation of the Liturgical Synodal Commission, its Liturgical heritage and contribution to the historical veneration of saints of past centuries and especially the New Martyrs and Confessors of the Russian Church of the XX century, which is very difficult to overestimate.
Research methods: The principle of historicism, a critical approach to the study of sources, structural analysis, comparison, generalization. description.
The result of the work performed is a detailed historical analysis of the creation of the Liturgical Synodal Commission, its Liturgical heritage and contribution to the historical veneration of saints of past centuries and especially the New Martyrs and Confessors of the Russian Church of the XX century.
Conclusion: in the course of the study, it can be said with certainty that the Liturgical Synodal Commission has justified and justifies the hopes that the Church has placed on it.

Relevance: Celiac disease is a hereditary disease with diverse clinical forms, which makes it difficult for a practical doctor to suspect it. Diagnosis of celiac disease is constantly improving, the latest recommendations of the European Society of Pediatric Gastroenterology ( ESPGHAN ) came out in 2020.

Purpose: To analyze the use of modern recommendations for clinical and laboratory diagnosis of celiac disease in practical healthcare.

Materials and methods: An analysis was made of the case histories of 17 children who were diagnosed with celiac disease for the first time in 2021, of which 10 were boys and 7 were girls. 6 years old - 3 people, 7-11 years old - 7 people, 12-16 years old - 4 people. The use of serological, genetic, morphological markers was analyzed.

Results : Celiac disease was suspected in 12 patients due to their belonging to risk groups. The symptoms were dominated by a lack of body weight and abdominal pain (11 people), that is, nonspecific gastroenterological manifestations. Specific symptoms - Dühring's dermatitis herpetiformis - in 1 person, diarrheal syndrome, steatorrhea, defects in tooth enamel were observed only in 4 children. According to the results of a laboratory blood test, anemia was detected in 2 people, and 6 more had a latent iron deficiency. Densitometry performed in 5 patients revealed a decrease in bone mineral density in 1 patient. Among serological tests, the determination of antibodies to tissue transglutaminase  IgA , G (13 people) was most frequently used. Also, in 3 people, antibodies to deamidated gliadin peptides and to endomysium were determined, in 6 people - to gliadin  IgA ,  G . In 13 out of 17 children, a morphological study of biopsy specimens was used, classification according to the Marsh / Oberhuber system  was used in 8 cases. Genetic markers were determined in 6 children, they were not found in 1, DQ 2 type was detected in 3 , DQ 8 in 1, both types were found in 1. 

Conclusion: The latest 2020 ESPGHAN guidelines for diagnosing celiac disease are underused, with a significant advantage of reducing the invasiveness of diagnosis. It is necessary to increase the awareness of physicians about risk groups, clinical forms and the consistent use of serological tests.

RELEVANCE. Due to the growing flow of false and controversial information, the growing distrust of vaccination, it is difficult for parents to make a choice “for” or “against” vaccinations for their children, so it is important to establish the main reasons for temporary or categorical refusals of vaccination by parents [1].
TARGET. To analyze the main reasons for parents' refusal to vaccinate children aged 0 to 5 years.
MATERIALS AND METHODS. The study was conducted on the basis of the BUZ VO "VGKP № 1" of the children's polyclinic No. 2. The object was 70 outpatient cards of children from birth to 5 years and a survey of their parents/legal representatives. Statistical, descriptive research methods, questioning, analysis were used.
RESULTS.
According to the gender structure, there are 41 boys (58.6%), girls - 29 (41.4%). By age from 0-1 years old - 10 (14.29%) children, 1-3 years old - 25 (35.71%), 3-5 years old - 35 (50%). Physical development (PD) in patients at the time of the study: 54 (77.14%) had an average harmonic PD, 9 (12.86%) - above average, 7 (10%) - below average. 46 (65.7%) families have the first child, 24 (34.3%) have older children, where 13 (54.4%) are vaccinated, and 11 (45.6%) are partially vaccinated or not vaccinated at all. 62 (88.57%) parents were vaccinated in childhood, 8 (11.43%) were not. 64 (91.43%) parents learned about professional vaccinations from health workers, 6 (8.57%) - from other sources. When assessing the reasons for the refusal of parents from professional vaccinations, the children were divided into 2 groups: 1st - 24 children (34.3%) - not vaccinated, 2nd - 46 children (65.7%) - partially vaccinated. In the 1st group, 10 parents (41.7%) refused to vaccinate their children due to fear of complications, 5 (20.8%) - had an opinion about the uselessness of vaccination, 8 (33.3%) - considered the composition of the vaccine doubtful, 1 - refusal on religious grounds. In the 2nd group, 24 (52.17%) parents partially refused vaccination due to fear of complications, 10 (21.74%) - due to the presence of post-vaccination complications, 7 (15.22%) - were not satisfied with the composition of the vaccines , 5 (10.87%) experienced the ineffectiveness of the previous vaccination (for example, against influenza).
CONCLUSION. Vaccination at the present stage remains an important tool in the fight against infectious diseases. Health workers need to conduct activities to raise awareness of parents about preventive vaccinations. Each case of refusal to vaccinate must be justified from the standpoint of a doctor. The joint work of medical professionals with parents, considering the reason for the refusal, will minimize unreasonable refusal of vaccination and prevent many infectious diseases.

Relevance: Primary immunodeficiency (PID) is a severe genetically determined disorder in the
immune system. Among the main manifestations are severe bacterial, fungal and viral infections
with damage to many organs and onset in the first 2-3 years of life, which can lead to death. The
main method of therapy is the timely transplantation of hematopoietic stem cells (HSCT) with an
efficiency of up to 80%. However, this is possible only in case of early diagnosis.
Purpose: To collect an anamnestic data, to evaluate clinical, laboratory and instrumental results
to confirm the diagnosis of PID.
Methods: A study of the medical documentation of a child aged 1 year 2 months, who was
repeatedly hospitalized in inpatient medical institutions in Voronezh, was conducted. Attention
was paid to the pregnancy and childbirth peculiarities in the mother, the morbidity of the child,
clinical symptoms, the results of laboratory and instrumental tests, including the parameters of
the immunological status.
Results: The patient showed signs of PID according to WHO, and therefore an additional
immunological examination was carried out. The development of sepsis with the release of
atypical infectious agents and meningoencephalitis, multiple organ lesions, and the lack of
sufficient effect from combination therapy suggested TKIN, which was confirmed by the KREC
and TREC results. The onset of severe disease after the age of 1 year can be explained by the
absence of BCG vaccination. The main method of treatment is HSCT. It is currently impossible
to resolve the issue of HSCT in our patient, since there is an ongoing serious bacterial-viral-
fungal infection that requires long-term antimicrobial, antifungal and anti-tuberculosis therapy.
The prognosis for the patient is doubtful due to the high risk of recurrence of the infectious
process.

Relevance. Gastroesophageal reflux (GER) is a retrograde throwing of stomach contents (hydrochloric acid, digestive enzymes and sometimes bile) into the esophagus, which leads to the appearance of symptoms. The scale of the problem dictates both social and economic negative effects for the society of developed countries. This determines the relevance of studying gastroesophageal reflux disease in children.
Objective: to study clinical and instrumental manifestations of gastroesophageal reflux disease in children.
Materials and methods of research. The study was conducted on the basis of the "Healthy Child" medical center in Voronezh in the period from September to December 2022. During the examination, all children were examined by a gastroenterologist and ultrasound of the stomach with a water-siphon test. During the inspection , the following: clarification of complaints, collection of anamnesis, general examination and special status.
The results of the study. Prolonged regurgitation up to a year is an important factor in the formation of GER. For all the examined children, GERD was not the only disease from the gastrointestinal tract, but was most often combined with gastritis (gastroduodenitis) and constipation, and among other concomitant diseases, obesity plays an important role. Among the clinical manifestations, in most cases there were complaints of extraesophageal manifestations, while the younger the child, the more often these complaints occurred. The data of ultrasound examination of the stomach in all cases were compared with anamnestic factors and clinical examination, which makes it possible to use this method of diagnosis of the disease everywhere.
Conclusions. Gastroesophageal reflux disease occurs in almost any age group, and most often the onset of the disease occurs at the age of up to 6 years, from which it can be concluded that at the present stage there is a "rejuvenation of the disease". Due to various clinical manifestations, gastroesophageal reflux disease can occur "under the masks of various diseases", which makes it difficult to make a timely diagnosis and delay rational therapy. which requires a cautious attitude regarding this disease not only pediatricians and gastroenterologists, but also doctors of other specialties.

Relevance: Cystic fibrosis (CF) is an orphan genotypically polymorphic hereditary disease with autosomal recessive transmission. CF is caused by a mutation in the CFTR gene, is characterized by damage to the exocrine glands, and has a chronic severe course with an unfavorable prognosis. This disease is characterized by a progressive chronic course, can lead to early disability and death. This leads to a decrease in all components of the quality of life, namely the physical, emotional, social and role functioning of the child.
Purpose: to assess the quality of life of children with cystic fibrosis in the Voronezh region.
Materials and Methods: Statistical analysis of 3-part questionnaire data using Microsoft Office Excel. Questions of the questionnaire touched upon aspects of the underlying and concomitant diseases, assessment of the quality of physical and moral health, quality of life on the part of children and their parents. The study was conducted at the bases of the "Regional Center for Cystic Fibrosis in Voronezh", BUZ VO "Regional Children's Clinical Hospital No. 2".
Results: we surveyed 24 patients aged 2 to 18 years, the largest number of children in the age group 11-14 years (34%). Children with CF have comorbidities in 66.7% of cases. Up to 60% of children suffer from acute respiratory infections 3-4 times a year, which increases the frequency of taking antiviral and antimicrobial drugs. In this regard, 50% of children are forced to study at home, up to 60% of children cannot study in additional sections. 50% of parents are not satisfied with the health of their children, and only 16.7% note a deterioration in their condition compared to last year. 16.6% of children are not satisfied with family relationships. 25% of children say that their health conditions prevent them from spending time with family and friends. Children with CF have a special attitude towards themselves from their peers in 8% of cases, and from teachers in 45% of cases. 41.6% of parents are satisfied with the availability of medical care. More than 80% of parents say that the quality of life of their child will improve the provision of original drugs.
Conclusion: assessment of the quality of life of children with CF is important in pediatrics. Particular attention should be paid to the problems of socialization and adaptation of children in society. Continuous provision of patients with new drugs will help improve the quality of life of children. We predict an improvement in the quality of life of CF patients due to the introduction of targeted therapy.

The purpose of the study: to create a diagnostic algorithm that would help a doctor of any specialty to suspect and not miss a child with stunting.
Materials and methods: the analysis of publications, manuals and educational literature on this topic was carried out, the most relevant approaches in the diagnosis and treatment of stunting in children were selected.
Results: the analyzed information was structured into a diagnostic algorithm that can be used in practice by a doctor of any specialty.
Conclusion: the chosen topic is multifaceted and broad. Growth retardation can be of various etiologies, so there is a wide variety of approaches to the treatment of stunting in children. Early diagnosis is of great importance for this disease, because hormone replacement therapy is carried out before the closure of growth zones, that is, if a child of puberty turns to the problem of stunting, in this case it will be almost impossible to help. Even if it is the beginning of puberty, there will not be enough time for full-fledged hormone therapy, which will not allow the patient to achieve average growth rates.

Relevance: Asthma in children with allergic rhinitis is more severe with frequent relapses and long duration.

Purpose: To analyze the peculiarity of asthma n children with allergic rhinitis.

Methods: a research was conducted of 132 children suffer from asthma in age from 6 month to 18 year who had observation at Voronezh children pulmonology center. We have analyzed duration of disease, allergic reactions in family members, children’s allergens, asthma peculiarity and efficacy of basic therapy.

Results: We have registered increase of allergic rhinitis in children with asthma. Diagnostic process duration is from 2 months to 14 years. The majority of patients was examined by pediatricians as patients with frequent respiratory infections and has not received correct treatment. Increase level of eosinophils in hemogram and immunoglobulin E is not obligation for confirm the diagnosis. Level of ECP is more important as a diagnostic method of allergy. Asthma in children with allergic rhinitis has important peculiarities such as more frequent relapses and long duration of exacerbations.
Conclusions: Basic therapy according to modern protocols has good efficacy and leads to control of both diseases.

The aim of the research is to examine the state of the parietal microbiome in children with ASD using gas chromatography-mass spectrometry of blood microbial markers, to determine the likely triggers of ASD in children with functional disorders of the gastrointestinal tract. 

Materials and methods. Small intestine microbiome was studied by chromatography-mass spectrometry of a dry blood drop (CMS according to G.A. Osipov). 39 children (1.5 - 10 years old) took part in the research. All children had stable functional gastrointestinal  disorders. The first group (26 children) included children without signs of autism and other psycho-neurological dysfunctions. Children from the second group (13 people) were previously diagnosed with ASD in accordance with CARS scale by a psychiatrist. Statistical data were processed on a PC using the STATISTICA 12 software package. ROC analysis was performed. 

Results. The state of the microbiome in the first group significantly differs from the second group. Children diagnosed with ASD show predominance of Clostridium ramosum, Clostridium perfringens, Eggerthella lenta and Nocardia asteroides. Moreover, the amount of Clostridium ramosum in children diagnosed with ASD as well as suffering from functional disorders of the gastrointestinal tract, in more than 75% of cases exceeds the reference values (2000 10 * 5 cells / gram). The average value of Clostridium ramosum for this group is 3494 10*5 cells/gram. Thus, the study of the parietal microbiota in children with signs of autistic disorders can be used as a method of additional diagnostics. 

Conclusions. One of the most significant differences in microbiome of autistic and neurotypical children with gastrointestinal symptoms is the overgrowth of Clostridium ramosum, which may be used as a factor in the early diagnosis of ASD in children.

Relevance. Myopia is one of the most important problems of modern ophthalmology. This problem is especially relevant for students and schoolchildren, due to the peculiarities of the educational process. Therefore, the control of the progression of myopia and the prevention of myopia are important not only for healthcare in Russia, but throughout the world. Visual impairment at a young age has lifelong consequences, both for the person himself and for his family. This affects the development of a person, his education and skills, requires the care of a family and specialists. Low vision affects both his abilities and social prospects.
Target. Evaluation of the loss of skills and identification of the dependence of the deterioration in the quality of life in students from 20 to 22 years old with various degrees of myopia, with a directed choice of optical correction in a certain age group “Looking into the Future” using the approved IVI-C questionnaire. Evaluation of the optimal options for optical correction for each degree of ametropia.
Materials and methods. A group of 30 students of VSMU was chosen. N.N. Burdenko, out of 11 men and 19 women from 20 to 22 years old. The group included people with different degrees of myopia - weak (50%), medium (33%), high (17%). Among the selected students, a survey was conducted according to the tested IVI-C questionnaire, containing 30 questions of the type “Do you confidently get to the university, do you confidently use public transport?” and others with answer options: Always, Almost always, Sometimes, Almost never, Never, No, for other reasons.
Results. The data obtained during the survey were converted into points. The results were plotted in a chart that showed that the average score that students scored without optical correction was 50 points, and those using optical correction such as glasses and lenses was 85. Also, data analysis showed that the average score when questioning students with a weak degree myopia was 78.5, with an average degree of 63.2 and with a high degree of 57.0.
Conclusion. In the course of the study, the relationship between visual impairment and the quality of life of students without optical correction was confirmed using the approved IVI-C questionnaire. Identified problems can be solved with the help of optical correction, such as wearing eye lenses and glasses, as well as performing refractive surgery. The optimal options for each degree of ametropia were identified and conclusions were drawn that spectacle correction is the optimal and universal method of optical correction for each degree of myopia.

Relevance. In modern society, the fight against the spread of such a socially significant problem as alcoholism has been going on for many years.

Objectives: to study the attitude of young people to alcohol consumption, to study the motivation for alcohol consumption among young people, to identify the degree of prevalence of alcohol consumption among students of the Burdenko VSMU, to analyze the data obtained based on the survey, to provide recommendations for solving the problem of excessive alcohol consumption

Materials and methods.
The object of our research were students of the Burdenko VSMU of the Ministry of Health of the Russian Federation in Voronezh. The method of conducting is a survey using an anonymous questionnaire . The materials for studying this problem were the study of popular science literature, the collection of information via the Internet (ICD-10, medsoftpro).

Results:
Out of 100% of the surveyed students, 80.1% drink alcoholic beverages; respondents prefer alcoholic beverages such as wine, vermouth, champagne (55.7%), beer is in second position (47.1%), they also use light low-alcohol cocktails (41.4%), they will not give up strong alcoholic beverages (37.1%). 76.5% of respondents know about the dangers of alcohol. However, 22.9% believe that the harm of alcohol to the body depends on the amount of alcohol consumed.

Conclusion:
Alcohol is a risk factor for the occurrence of CNID in students of the Burdenko State Medical University of Voronezh.

Annotation. The pandemic of a new coronavirus infection, which began its spread in 2019, the geopolitical conflicts taking place during its time, man-made and spontaneous events, including the special military operation that began in February 2022, are accompanied by serious social upheavals and can significantly affect the risk factors for the spread of STIs. A hypothesis has been put forward: what is the dynamics of the incidence of sexually transmitted infections in 2019-2021 in connection with the social upheavals of recent years and their characteristic features for society? it may differ from their trends traced from 2014 to 2019. Objective: to study the peculiarities of changes in the age and social structure of newly identified cases of bacterial sexual infections in the Kursk region during the coronavirus pandemic. Results. Cases of diagnosis of syphilis and gonorrhea in minors during the period under review were noted only in 2019, when their share in the structure of primary morbidity was 3.3%. The social group for which in 2019 – 2021 the largest number of primary cases of bacterial STIs accounted for, there was an unorganized contingent – not studying and not having an official place of work. Their share has consistently decreased from 51.7% to 46.4%. Conclusion. Changes in the social structure of primary morbidity are more significant and are characterized by an increase in the proportion of workers with a decrease in the proportion of students and the cessation of detection of gonorrhea and syphilis in schools.
Keywords: 78 coronavirus infection, sexually transmitted infections, syphilis, chlamydia.

Relevance: this article touches on one of the important problems of modern youth - low physical activity. A passive lifestyle leads to the development of chronic diseases of the cardiovascular system, musculoskeletal system and other organs and systems.
Purpose: to assess the level of physical activity of students of the Voronezh State Medical University. N.N. Burdenko and, based on the data obtained, to identify possible ways to solve physical inactivity among students.
Materials and Methods: An anonymous survey of medical university students was conducted during 6 months of 2022. The questionnaire in the Yandex-form format consisted of 18 questions and two blocks: general and special. Statistical processing of the obtained data was carried out in Microsoft Excel 2007. Quantitative data are presented as a percentage.
Results: out of 100% of the students surveyed, in their opinion, lead an inactive lifestyle - 48.6%, do not go in for sports - 35.8% of students. The main reasons for not wanting to go in for sports, according to the respondents, are as follows: heavy workload at school and at home (68.5%), I can’t force myself (43.5%), there is no time (41.3%). Students currently assess their physical condition as poor (3.7%), worse than average (15.6%), average (48.6%), fairly good (24.8%) and very good (7.3%). ).
Conclusion: the analysis of the survey conducted led to the following conclusion - many students neglect sports, which can lead to chronic non-communicable diseases. The conducted research and the data obtained can help to study this problem in more detail and understand how to draw the attention of students to their health and to an active lifestyle.

Observance of a healthy lifestyle, and in fact Orthodox, preserves a spiritual person's moral and physical health, prolongs life and creativity, gives a sense of contentment and fullness of life, that is, what we call happiness – joy, fullness and meaningfulness of spiritual life, individual health, absence of chronic diseases, catastrophic disasters, insurmountable suffering and the possibility of realizing creative potential

Relevance. Occupational diseases are registered annually and have a significant impact not only on an individual employee and his family, but also on the population as a whole, which is why this topic deserves close attention. The purpose of the study was to analyze the professional incidence of the population of the Russian Federation and the Voronezh region for 10 years. Materials and methods. The materials for study were state reports, accounting and reporting forms of the Office of Rospotrebnadzor and the Center for Professional Pathologies of the Voronezh Region, data from scientific publications. The study was conducted using a retrospective epidemiological analysis method. Results. During the study, a tendency was established to reduce the level of occupational morbidity in the Russian Federation and in the Voronezh region. Regions and areas with the highest levels of occupational pathology compared to the average long-term indicators in other regions were identified. The structure of occupational diseases was analyzed by gender, work experience, influencing factors and the main causes of occupational disease. Conclusion. It was established that the most significant risk group is men who have more than 20 years of work experience and are subject to the influence of physical factors. An increase in acute occupational diseases in 2020-2021 was noted, due to an increase in the number of sick women, mainly health workers.

Smoking is one of the most important health problems. Smoking is a leading risk factor for the development of non-communicable diseases. NCDs, in turn, cause more than 2/3 of deaths in developing countries. The World Health Organization has been creating and implementing a lot of anti-smoking projects for many years. Many countries promote tobacco control as a key health priority [1]. Unfortunately, smoking tends to spread among the young population. The spread of smoking among medical students deserves special attention. They, as future doctors, should set an example of a healthy lifestyle for others, especially for smoking patients. The aim of the study is to assess the prevalence of smoking among students of the Medical University of VSMU named after N. N. Burdenko. The research method is an anonymous survey. 164 people took part in it. Most of students want to quit a bad habit (56.1%) and this is mainly due to the desire to prevent the consequences (27.8%) and get rid of addiction (27.8%). In the set of questions about the distribution of electronic cigarettes: 77.4% of respondents support the problem of relevance, 42.7% are negative about the distribution of electronic cigarettes. From all of the above, it follows that smoking is not only a risk factor for the development of CNID in students, but also a factor in reducing the effectiveness of preventive work in the future.

Relevance. Currently, in the healthcare system of the Russian Federation, much attention is paid to the issues of reproductive health of the population. A significant area of activity in this area is the fight against the spread of sexually transmitted infections (STIs) and the identification of factors that can form a responsible attitude of society towards this problem.

The purpose of the study is to determine the role of a burdened obstetric and gynecological history in the formation of attitudes towards the problem of sexual infections among the inhabitants of the Chernozem region.

Materials and methods. The results of an anonymous survey of women were used as research materials. The survey participants were 520 women aged 18 years and older who are under the supervision of obstetric and gynecological institutions of the 2-3 levels of the Kursk, Belgorod and Voronezh regions. The resulting summary of data was examined by implementing descriptive statistics methods with calculation of relative values.

Results. Most pregnant women are aware of STIs, but many of them do not have sufficient and reliable knowledge on this issue, as well as their partners. It was also found that not all women are aware of the real threat of STIs during pregnancy and who should be contacted if they are detected. Findings. The results of the study made it possible to draw conclusions about the need for a competent reorganization of educational and medical activities on the part of health and healthcare authorities.

Relevance. The young generation of the DPR is forming a new way of life, adaptation to the external natural environment, in which biologically harmful industrial products are constantly in large or small concentrations. Over the past nine years (2014-2022), two severe stress factors have been added: active military actions (civil war on the territory of Ukraine, ITS, bombing, destruction, fear of losing life), epidemiological situation of coronavirus infection. All this complex of factors has an impact on the health of the young part of the population during the period of puberty - adolescence of 14-17 years. Goal. To study the influence of exogenous factors on the prevalence of respiratory diseases among DNR adolescents. Materials and methods of research. The studies were conducted among the adolescent population (14-17 years old) living in the DPR. Results. The primary morbidity of adolescents with respiratory diseases in the conditions of active hostilities in the Donbass is in the pre-

Relevance. In the 21st century, non-communicable diseases (NCDs) pose a serious threat to human health, as confirmed by the annual worldwide "premature" mortality of about 17 million people in the working-age population. In this regard, the importance of early diagnosis and timely prevention of significant behavioral risks, especially for the younger generation and young people, is increasing.
Purpose. The purpose of the study was to study behavioral risk factors among students of the Medical University of Minsk.
Materials and methods. The work uses the method of anonymous questionnaire using a specially developed questionnaire and subsequent assessment of the functional state of organs and systems, determination of significant behavioral risk factors affecting the prevalence of non-infectious pathologies. Statistical data processing was carried out using the STATISTICA 8.0 computer program.
Results. In the course of analyzing the results of the study, it was found that more than half of the students have a particular pathology, namely disorders of vitamin and mineral metabolism, cardiovascular diseases, diseases of the gastrointestinal tract and diseases associated with disorders of carbohydrate and fat metabolism. Among the cohort examined, 25% of non-smokers and non-drinkers. At the same time, the share of students who smoke and abuse alcohol was 33.3% of students. The correlation analysis between the presence of a combined nature of these risks and the state of health of students did not establish a statistically significant relationship between the factor and outcome characteristics (Chi-square criterion, χ²=0.897, p = 0.344). However, an assessment of the risk of NCDs among exposed and non-exposed BHMU students showed that the risk of health abnormalities in the group exposed to smoking and alcohol is higher than the probability of disease among those not affected by these factors (Re > Rne) 0.67 > 0.55.
Conclusion. Consequently, the combination of behavioral habits (tobacco smoking and alcohol) significantly affects the development of non-infectious pathology in the population. The present study found that if smoking and alcohol consumption are taken as a causal and preventable factor, a reduction in disease risk among risk factor-exposed BHMU students can be expected by 18% in the event that they quit smoking and abuse alcohol.

Relevance. The concept of choice is one of the components of the neurocognitive pool, which undergoes significant disturbances in the schizophrenic process. Concomitant diseases, such as chronic viral hepatitis, certainly affect the neurocognitive profile, exacerbating cognitive disorders, thereby affecting the social adaptation of this group of patients.

The purpose of the study is to study the features of problem-solving behavior in patients with paranoid schizophrenia with concomitant viral hepatitis.

Material and research methods. 64 patients diagnosed with F 20.0 "paranoid schizophrenia" were examined. The experimental-psychological part is represented by a test for problem-solving behavior - the "Tower of London", taking into account the execution time and the number of moves.

Research results. As a result of the study, it was possible to find out that the choice of strategy in solving the problem in the patients from the study group was significantly different from the comparison group. At the beginning of the experiment, 23 (48.9%) patients of the study group were skeptical and suspicious about the testing. During the experiment, in the study group, 34 (72%) patients had an increase in the time for constructing the tactics of task execution, on average it was 10-14 seconds, in the control group this indicator was 6-8 seconds. The average number of "moves" also differed from the control group and was 32-34 moves, while in the control group it was 27-29 moves.

Conclusions. Thus, in the course of the experiment, it was possible to find out that in the study group the main indicators of problem-solving behavior differed significantly from the comparison group, the time spent on building tactics for completing the task and the number of execution errors increased.

Relevance: The influence of smells on the sphere of feelings and sensations, their ability to serve as a stimulus for the emergence of certain emotions has not been sufficiently studied at the present time. However, olfactory neuroanatomy is closely related to the limbic system of the brain, which is considered the main area of emotions. That is why the use of olfactory stimulation as a method for assessing the emotional background is justified and relevant. Purpose: Development of a new, complex method for studying the emotional sphere using odors, rating scales and testing it on individuals with normal and pathologically altered emotional states - anxiety and depressive disorders. Methods and materials: Analysis of the results of a clinical study obtained using a set of odorants for olfactometry (rapid test 12), the scale of affective odor exposure (AIO), the scale of sensitivity to chemical odors (CSS-SHR), the odor questionnaire in everyday life (OELQ ), the Beck Depression and Anxiety Scale, the correlation of indicators with ten basic emotions according to K. Izard. Results: Sensitivity to specific common odors correlated with symptoms of depression or anxiety. Conclusion: The conducted research shows that the technique is adequate to the set goal and can be used to study both the emotional sphere of healthy subjects and the peculiarities of emotional states in pathology.

Objective: to study emotional barriers in doctor-patient communication, where the patients were first-year students of the medical faculty of the N.N. Burdenko VSMU.

Methods: survey method, analysis method

The article discusses the issues of doctor-patient communication, specifies the principles that a doctor should be guided by in a dialogue with a patient. The concept of communication and a communicative act is proposed, two forms of communication are distinguished: verbal and nonverbal. The approaches to this issue of Russian authors are analyzed in detail. The results of an empirical study are proposed, where the emotional barriers of patients are identified, which are the respondents of the study: students of the medical faculty of the N.N. Burdenko VSMU.

Results. According to the received data on the diagnosis of communicative control (M. Schneider) respondents with low communicative control, who are characterized by spontaneity and openness in communicating with people in the form of excessive straightforwardness and obsession, almost invariably behavior despite the difference in situations, there are 10%. There are 60% of people with average communicative control who are free to communicate, sincerely relate to others, but are limited in their emotional state, measure their behavior with others. There are 30% of people with high communicative control, who take care of themselves and their emotions, who understand how to present themselves in the environment, but who experience certain difficulties during unforeseen interaction.

According to the method "Diagnostics of emotional barriers in interpersonal communication (V. V. Boyko)": there are 40% of people who experience emotional problems in daily communication. There are 20% of people whose emotions "for every day" become some kind of limiter in their relationships with others. There are 40% of people whose emotions do not allow them to create a relationship with others, most likely they are subject to some disorganizing reactions. And there were no people who were insincere in their answers, or who did not know themselves well from the outside, and people around him who were not hindered by emotions from communicating with others.

Conclusions. Thus, psychological or emotional barriers do not contribute to a fruitful communicative act, and understanding their origin and causes helps to reduce the negative impact. Therefore, consideration of a specific scheme for getting out of the psychological barrier situation is necessary. The main thing in this scheme is the observance of the rule of relationships, which forms all further contacts leading to harmony, taking into account the individual psychological characteristics of each individual.

The relevance of the research topic is due to the modern requirements imposed on a university student, to the ways to achieve goals and results in the educational process, and in the future to successfully build a career. The article analyzes separate concepts such as "laziness" and "procrastination". The term "laziness" is considered as a form of procrastination. Their interrelation with each other and the specific features of the concepts being studied. Erroneous opinions related to phenomena in the course of work are reviewed and eliminated. All individual characteristics and their influence on the University student in the educational process are studied: self-esteem, temperament, psychological prerequisites of laziness. Attention is focused on the causes and factors of these phenomena. With the help of an empirical study conducted on first-year respondents of the Pediatric Faculty of Voronezh State Medical University, the results of which allow us to trace and eliminate the relationship of the problem. Also, the data of the survey carried out note the high effectiveness of the methods: the Eysenck questionnaire for the study of temperament and the S.A. Budassi method for determining self-esteem, which allows for a more accurate analysis. Systematic exercises are proposed to combat the described phenomenon in order to increase motivation and efficiency.

In recent years, a lot of research has been concentrated on the study of burnout syndrome. Emotional burnout syndrome is a symptomatic complex of psycho-emotional, motivational-attitude and holistic disorders that occur with prolonged exposure to various adverse professional factors [1].

The main signs of burnout are: severe exhaustion, a feeling of cynicism and detachment from work, a feeling of inefficiency and a reduction in professional achievements [2].

With the impact of severe, debilitating factors, a person can meet not only at work, but also while studying at the university, especially since at the moment a large number of students combine study with work.

At the moment, additional factors that increase the risk of burnout and depression are the coronavirus infection of 2019, quarantine restrictions, as well as socio-economic restrictions.

Another problem is the relationship between burnout syndrome and depression. Recent studies indicate a close relationship between these two phenomena: both emotional burnout can lead to the further development of depression, and depression can be a predictor of emotional burnout [3,4]. In this regard, burnout syndrome as a factor in the development of depressive disorder is of particular socioeconomic importance, since depression occupies one of the leading places in the world among all medical causes of disability and mortality among young people [5].

Relevance. The professional orientation of any person significantly determines his future, the ability to self-actualize, get satisfaction from work and the value of a person of working age for the state. Goal. This determines the purpose of the work – to identify the features of the professional orientation of first-year students of the N.N. Burdenko VSMU. Materials and methods. The study involved first-year students of the pediatric, preventive medicine, dental and Pharmaceutical faculties of the N.N. Burdenko VSMU. The identification of professional orientation was carried out on the basis of a differential diagnostic questionnaire. Results. The results obtained indicate that the professional orientation of first-year students is carried out in accordance with the interests and inclinations of the respondents.This is a significant conclusion, indicating that every employee of the organization should be in his place and do the work for which he has the maximum predisposition. Conclusion. However, the interviewees do not see their professional orientation related to calculations, measurements, presentation and processing of the received data. This contradicts the scientific side of any activity and is a disadvantage of modern school education in Russia.

The relevance of this topic is due to the need to highlight the work of the school of first aid (PP), because this is one of the forms of preventive work of medical staff, which consists in training participants in the main aspects of providing assistance directly at the scene of events. The purpose of this school is to raise public awareness about the basics of first aid, its scope, responsibility and effectiveness criteria.
The main directions of the school of first aid:
1. Formation of students' strong skills and conscious knowledge in first aid
2. Formation of the correct algorithm of actions in providing first aid to victims
3. Formation of students' correct attitude to their health
4. Increasing the interest of the population in the field of first aid training
5. Formation of knowledge about the signs of pathological conditions that require urgent measures.
The role of a nurse in the organization and work of the school of the first pomorsch:
1. Informing the population on the most pressing issues of first aid
2. Development and consolidation of skills performed during first aid
3. Clarification of rights and obligations in the provision of first aid
As a rule, in the event of an accident, eyewitnesses of the incident can provide assistance-ordinary people who have the right to provide it. Basically, such people have minimal training and knowledge in first aid. Nevertheless, eyewitnesses of the incident can perform simple actions and eliminate the immediate danger to the victim.
The purpose of the work is to determine the main activities of a nurse in the first aid school.
Materials and methods. In the course of the study, a questionnaire was conducted during 2022-2023 in the social network VKONTAKTE. 52 people participated in the survey.
The results of this survey show satisfactory results of the analysis of people's basic knowledge about in the field of providing PP. The survey also showed a lack of knowledge in some areas.
Conclusion The purpose of preventive work of nurses is to provide as much practical and theoretical knowledge as possible in the field of first aid, demonstration and development of basic skills, clarification of legal aspects, therefore their role in the school of "First Aid" is very great. Nurses make a great contribution to the development and functioning of such schools, increasing the medical literacy of the population. Basic knowledge about first aid, not only can be useful to the listeners themselves in everyday life (for example, first aid for burns), but also can save the lives of other people

Relevance. Statistics show that myocardial infarction (MI) is most common in people over 50 years of age. This group accounts for more than 40% of cases.Myocardial infarction is a serious and potentially fatal disease caused by necrosis of the heart muscle. The most common cause of necrosis is spasm of the coronary arteries, deterioration of the trophism of the heart, called coronary insufficiency. Myocardial infarction is an indication for hospitalization, and with proper medical care, the patient has every chance of recovery. However, the important prerequisites are timely qualified care, strict adherence to the treatment plan and adequate nursing care.The role of a nurse in caring for a patient with a myocardial infarction is difficult to overestimate, since she fulfills all the doctor's prescriptions. With this pathology, the patient observes strict bed rest, so the average medical staff provides the patient with satisfaction of vital needs.The purpose of the work is to study the main activities of a nurse in myocardial infarction.Materials and methods. The study was conducted by questionnaire, in 2022 on the basis of medical organizations in Voronezh, Voronezh
State Medical University. N.N. Burdenko, as well as through social networks. 50 people took part in the survey.Results. The results of the survey showed that the awareness of the population about myocardial infarction, the role of nursing care is good, but awareness about first aid for it, the peculiarities of diet, physical activity is insufficient.

Relevance. Human papillomavirus (HPV) is one of the most common viruses on the planet. At the moment, there are more than 190 different types. Papillomaviruses of high oncogenic risk are isolated from a huge number of HPV species. 49% of uterine body cancer per 100,000 female population. This type of cancer ranks 3rd among all oncological diseases in women. Timely prevention of the virus will help reduce mortality.

Goal. To study the human papillomavirus, to carry out preventive measures among the population aged 16 to 25 years, to examine patients with HPV in a surgical and gynecological hospital.

Materials and methods. During the research work, statistical data on HPV in the Voronezh region and the incidence of this virus in Russia were used. A survey was conducted among girls aged 16 to 25, which helped to identify what needs to be prepared for a preventive conversation. A visual examination of patients of the outpatient surgery center treated with papillomas and the gynecological department at BSMP No. 10 was carried out.

Result. My research has shown that girls aged 16 to 25 years — 61.5% of those who passed the survey, know their HPV status and undergo annual gynecological examinations. 95% of respondents were not vaccinated against HPV for various reasons. Most of the respondents explain this by fear of vaccination and fear of its consequences, as well as tell that they did not know about the existence of an HPV vaccine. 5% of the respondents were vaccinated.
Examining papillomas, it can be concluded that not all neoplasms of a benign nature need to be surgically removed. Only those papillomas that have changed color, shape, size over time, do not have clear boundaries, etc. are subject to removal. indications.

Conclusion. Work to educate the population about HPV, its transmission methods, diagnosis, treatment and prevention is necessary. This should become an integral part of the work of doctors and nurses, especially in the field of gynecology, urology, surgery, oncology, pediatrics. Most of the surveyed population showed interest in the research topic. It is necessary that as many girls as possible are vaccinated against the human papillomavirus. This will reduce mortality from cancer. It is also important to explain to the population at the appearance of which neoplasms on the skin it is necessary to immediately contact a surgeon.

Relevance. Finishing treatment during dental restoration is one of the important stages in achieving an aesthetic and functional result that satisfies both the doctor and the patient. The aim of the work is to find the most optimal protocol for finishing the restoration, which will meet the highly aesthetic requirements. Material and methods. Modeling of restorations with composite material was carried out on the phantoms, five finishing protocols were carried out on the restorations. A photoprotocol of works was carried out at each stage for the purpose of further evaluation. The results of the study. Each protocol is evaluated in points, according to the results of the score evaluation, a protocol was identified that meets all the requirements of modern finishing: it gave an ideal dry shine, smoothness of the surface and color stability in the optimal time spent. Conclusion. The article is devoted to a close analysis of modern protocols for finishing and polishing seals. According to the results of the score assessment, the optimal protocol for finishing and polishing seals was identified.

One of the criteria for successful dental treatment is the painlessness of the procedure and the psychophysiological comfort of patients.
The purpose of this work is to study the clinical and pharmacological properties of modern carpular anesthetics of the amide series.
Sources and methods. The work was carried out on the basis of the analysis of literature sources: manuals, monographs and statistical data of Russian and foreign specialists in the field of anesthesiology, chemistry and stomatology.
Results and their discussion. In the course of the work, the research was considered dedicated to the study of the effectiveness and biological safety of anesthetic agents of the amide group.
Conclusions. Analysis of domestic and foreign studies statistical data, as well as literature sources have shown that the most optimal and effective carpular anesthetic of the amide series in dental interventions is articaine, which is due to the high rate of onset and strength of anesthesia, sufficient duration, low toxicity and allergenic of this anesthetic.

The number of dental patients with various oral diseases developing against the background of COVID-19 is rapidly increasing, among which are multiple dental caries, periodontal tissue lesions, as well as a variety of diseases of the dental pulp. A history of diabetes mellitus is also known to have a significant impact on the course of oral lesions and diseases. A study was conducted to determine the need for repeated endodontic treatment in patients who had previously undergone COVID-19 and had a history of diabetes mellitus due to complications in the periodontal complex. Radiological follow-up 1 year after the primary endodontic treatment revealed that such patients required repeated endodontic treatment much more frequently (76.2% of cases) compared to patients without confirmed somatic pathology (11.4% of cases). One of the reasons causing complications in the treatment of complicated forms of dental caries can be the lack of treatment complexes capable of completely eliminating the inflammatory process in the root canals. And the history of diabetes mellitus in combination with COVID-19 promotes more rapid spread of the infectious process to periodontal tissues with subsequent pathological changes in them and destruction.

Relevance. Diabetes mellitus is a common pathology of the endocrine system, also the number of patients with coronavirus infection is increasing every year. History of diabetes mellitus in combination with COVID-19 also contributes to more rapid spread of the infectious process to periodontal tissues with subsequent pathological changes in them.

Objective: to determine the treatment rate of patients with a history of coronavirus infection and diabetes mellitus for chronic pulpitis
Materials and Methods. Analysis of data obtained by the study of archived medical records of dental patients, where COVID-19 was indicated in the column "previous diseases" was carried out. A total of 56 dental records of such patients were selected and analyzed. Among them there were distinguished 2 groups of patients: basic (21 patients with diabetes mellitus) and control (35 patients without confirmed somatic pathology).

Results. According to data of X-ray investigation among the patients with diabetes mellitus in the anamnesis (the 1st group) 16 patients (76,2%) required repeated endodontic treatment a year later. Among the patients without confirmed somatic pathology (the 2nd group) according to X-ray investigation 4 patients were found to have periapical changes and require re-treatment of the root canals, that is 11,4%.

Conclusions. The success of treatment of chronic pulpitis after coronavirus infection and in patients with diabetes mellitus depends on the joint management of the patient with an endocrinologist.

Relevance.

Odontopreparation is one of the indispensable stages of treatment in the selection of fixed prostheses, as a result of which the doctor has to remove a large amount of dental hard tissue, thereby overheating the surrounding tissue due to the abundant heat released by the cutting instruments, which may subsequently lead to undesirable complications, such as inadequate dentin dehydration.

Purpose of the report.

To tell our colleagues about how it is possible to avoid the above complications, to reveal all features of a structure of firm tissues of a tooth.

Materials and methods.

We will present types, methods and principles of traditional preparation.

We will tell about innovative technologies in odontopreparation and modern systems of cooling.

Results.

As a result of our report, the current generation of doctors will know all the possible problems of this manipulation, and the most important thing - how and how to circumvent them.

Conclusion.

After reading our article, you'll learn a great deal about how to perform a preparation with minimal risk of complications.

Relevance. Infective endocarditis (IE) is a rare but devastating condition in which the innermost lining of the heart becomes infected. This may include more than one valve, which can lead to severe valvular failure and heart failure. It can also progress to abscess formation, septic embolism, stroke, and organ ischemia [1].
Knowledge, current practice, and inconsistency in pre-procedure antibiotic prophylaxis against infective endocarditis for patients with various cardiac lesions is a prerequisite for the development of infective endocarditis.

Aim. Conduct a literature review of scientific studies studying the incidence of infective endocarditis in order to substantiate the relationship between infective endocarditis and odontogenic infection.
Materials and methods. A systematic review was conducted in the PubMed electronic database with a depth of 5 years from 2018 to 2022.

Results. The aim of the study was to investigate the relationship between infective endocarditis and odontogenic infection. As a result of a systematic review, most studies on the etiology of infective endocarditis indicate Staphylococcus aureus as the main causative agent of IE. In second place in terms of frequency of the pathogen is the group Streptococcus viridans, as a result of which a connection between infective endocarditis and odontogenic infection is assumed, since the incidence of this group of streptococci is characteristic of odontogenic infection.

Findings. The data obtained during the study related to the research topics indicate that a more in-depth and evidence-based study of the type of RCT is needed due to the incompleteness of the available data. Therefore, it is impossible to completely refute the relationship between infective endocarditis and odontogenic infection according to the available data, as well as its absolute confirmation.

Relevance. Crowding of teeth is one of the most common deformities in orthodontic patients. Ankyloglossia (agkilos-curved; glossae-tongue) is a developmental anomaly characterized by the presence of a connective tissue fold (frenulum) formed by the upper aponeurosis of M. Genioglossus, interwoven into the ventral part of the tongue between its tip and the middle third. The prevalence of this anomaly is 1-10% (4-16% in newborns).
Goals. To determine the severity of crowding in patients with ankyloglossia.
Materials and methods. The analysis of the study included 32 patients aged 12-30 years. 15 male and 17 female, planning their treatment in the clinic "City of Smiles" and BUZ IN DKSP No. 2 in the period from January to December 2022.
To determine the severity of crowding of teeth in the lower jaw, the Little method was used.
Clinical determination of the frenulum of the tongue is carried out by the Kotlow method (1999): 4 degrees of freedom of the tongue (12-16 mm - mild ankyloglossia, less than 3 mm - severe ankyloglossia).
Results. During the measurements, it was found that 12.5% of patients have a space deficit of up to 3mm (minority crowding), 35.5% of patients have a space deficit of 3 to 5 mm (moderate crowding), and 52% of patients have a space deficit of over 6 mm (pronounced crowding). In a clinical examination of patients according to the Kotlow classification, it was revealed that 72% of patients have a history of a short frenulum of the tongue (severe ankyloglossia).
Conclusion. In the modern world, such pathology as angiloglossia is becoming more common.
According to the Sepet E study, mild and moderate types of ankyloglossia are not associated with crowding of the mandibular incisors and the type of bite, and the pronounced and severe degree has a direct impact.

Relevance: At this time, the number of people suffering from various defects of the dental system is increasing, one of the reasons is the loss of teeth.
The purpose of the work:
To identify the most important factors influencing the adaptation to full removable prostheses to increase the effectiveness in orthopedic treatment.
Materials and methods of research:
A very large number of synthetic elastomers used for the manufacture of two-layer bases of the prosthesis are now known.
The following research methods were used in this work:
• Sociological survey method
• Clinical examination method.
Research results:
We conducted a survey of three groups and found out which group has the best adaptation to full removable prostheses.
Conclusion:
So, the use of a two-layer basis for prosthetics reduces the adaptation time of patients by minimizing the traumatism of the prosthesis tissues and the uniformity of pressure distribution on the prosthesis.