Purpose. To study long-term results of treatment and quality of life in patients with prostate cancer with clinical stage pT3.Material and methods. The study included 107 patients diagnosed with prostate cancer pT3a-bN0M0 G2-5. These are groups of patients who underwent surgical treatment with adjuvant radiation therapy (67 patients) and without it (40 patients). Such indicators of the quality of life after surgical treatment as urinary incontinence, urethral stricture, nocturia were studied. The localization of extraprostatic tumor spread was assessed as a predictor of survival. A comparison of the studied groups of patients in terms of survival rates using the Kaplan-Meier method with their comparison using a log-rank test was carried out.Results. Overall survival rates were statistically higher in the postoperative radiation therapy group (p = 0.021). Similar resultswere obtained when comparing cancer-specific survival (p = 0.044) and disease-free survival (p = 0.05). Adjuvant radiation therapy worsened the patients' quality of life (p <0.05). The best cancer prognosis is in patients with one risk factor for progression. When comparing subgroups with diffuse extraprostatic tumor spread, as well as with invasion into seminal vesicles, survival rates are higher in the group using radiation therapy (p <0.05). When comparing subgroups with focal extraprostatic tumor spread, no statistical difference was found (p> 0.05).Conclusion. Adjuvant radiation therapy significantly improves overall, cancer-specific survival and disease-free survival rates(p = 0.021, p = 0.044 and p = 0.05, respectively). At the same time, radiation therapy worsened the patients' quality of life. Patients with identified focal extraprostatic tumor spread did not have significant differences when using radiation therapy.

The aim of the work is to identify and analyze the prevalence of recurrent oral apthae in patients with acid-dependent diseases of the gastrointestinal tract (GIT).Material and methods. 125 patients with a history of recurrent aphthae were examined, who were receiving treatment with subsequent dispensary observation by a gastroenterologist for chronic gastritis and / or duodenitis, chronic secondary biliary-dependent pancreatitis with hyperacid gastric secretion. The age of patients at the time of observation was 25-45 years old, 43 (34.4%) were men, 82 (65.6%) were women. All patients underwent a comprehensive clinical examination with an analysis of complaints, anamnesis, examination and verification of recurrent apthae of the oral mucosa in diseases of the gastrointestinal tract with hypersecretion syndrome.Results. In the anamnesis, the presence of recurrent oral aphthae was noted in 67 (53.6%) of the examined patients, at the time of a comprehensive dental examination, aphthae were detected in 58 (46.4%) patients. According to the analysis of medical records, the duration of clinical manifestations of acid-dependent diseases of the gastrointestinal tract averaged 8.8±0.2 years. In chronicsecondary biliary-dependent pancreatitis, aphthae relapses at least twice a year were observed with a frequency 1.1 times higher thanin chronic gastritis and / or duodenitis. In chronic gastritis and / or duodenitis, aphthous lesion was observed at least once a year in24.4% of patients (p <0.01).Conclusion. Depending on the presence of acid-dependent diseases of the gastrointestinal tract, recurrent aphthae at the time of clinical examination were observed in 26% of cases with chronic secondary biliary pancreatitis against the background of hyperacid gastric secretion and in 24% of cases with chronic gastritis and / or duodenitis, most often in females (p = 0.012).

Purpose - to analyze the frequency of adverse drug reactions of various antiepileptic drugs (AEDs) depending on the lesion of a certain organ system in adults and children with epilepsy.Material and methods. Treatment of 428 patients with epilepsy was analyzed.Results and conclusions. Out of 359 adverse drug reactions with the nervous system damage recorded in our study with the use of all antiepileptic drugs, 28.0% of side effects were associated with the gastrointestinal tract (GIT) damage, 21.0% of the hepatobiliary system damage and 20.0% - with metabolic disorders. CNS damage was more common in patients taking carbamazepine (45%) and oxcarbazepine (44%). Adverse drug reactions (ADRs) associated with disorders of the gastrointestinal tract and hepatobiliary system were more common when taking levetiracetam (29.4%), carbamazepine (28.9%) and oxcarbazepine (22.2%). Metabolic disorders were more often detected when taking topiramate (34.8%). Side effects with impaired blood system were often associated with taking levetiracetam (17.6%), valproate (16.3%) and carbamazepine (11.8%). The most frequently caused allergic reactions were lamotrigine (23%) and ethosuximide (33%). This study showed that patients taking AEDs require regular follow-up monitoring (monitoring of blood counts, ultrasound of internal organs, examination by a psychologist and psychotherapist).

2 clinical forms of ixodic tick-borne borreliosis are recorded occurring with and without erythema in which difficulties arise in the diagnosis, assessment of the severity and prognosis of the disease.The purpose of the work is to study the clinical features and pathogenetic significance of pro-inflammatory and anti-inflammatory cytokines in the development of erythemal and non-erythemal forms of ixodic tick-borne borreliosis.Results. In contrast to erythema, the syndrome of intoxication and involvement of joints, respiratory organs, cardiovascular and nervous systems in the pathological process are most characteristic for the non-erythema variant of ixodic tick-borne borreliosis. In the compared groups, unidirectional changes in the blood cytokine profile were revealed: reliably high levels of proinflammatory cytokines during the peak period and a significant decrease in their level to normalization during the recovery period, and the peak in the production of antiinflammatory and proinflammatory (IFN-γ) cytokines occurs at the stage of reducing of the disease the manifestations and recovery to normal values by 3-6 months of dispensary observation. The revealed relationships between the values of inflammatory mediators and clinical symptoms indicate the dependence of the nature of the disease course on the intensity of the systemic inflammatory syndrome.Conclusions. The dynamics of cytokine production in ixodic tick-borne borreliosis indicates the early formation of Th1 and gradual Th2 types of immune response. In the non-erythema variant of the disease, the level of the studied cytokines is significantly higher which is manifested by a more severe course of the disease and multiple organ lesions.

Purpose. Determination of clinical and epidemiological features of ixodic tick-borne borreliosis in the Samara region.Material and methods. The data of the FBHI "Hygienic and Epidemiological Center in the Samara Region" for the period 2004-2019 were analyzed on the incidence of tick-borne borreliosis. A retrospective analysis of 155 cases of tick-borne borreliosis in patients with mild and moderate severity of the disease was carried out.Results. Over the past 12 years, in the Samara region, an increase of tick suction has been recorded by 3 times, an increase in borrelia infection of ticks of the genus Ixodes up to 1.8%. Ixodic tick borreliosis was observed both in forest zones and within thecity from May to October. Asthenic-vegetative syndrome, erythema, fever and regional lymphadenitis prevailed in patients with ix-odic tick-borne borreliosis in the region. Erythema-free form of ixodic tick-borne borreliosis in comparison with erythema is characterized by an acute onset of the disease with high fever, intoxication, severe asthenic, dyspeptic and statistically significant frequent myalgic syndromes. An increase of the inflammation level markers (CPK and CRP) revealed in patients of the compared groups, and in the group with an erythema-free form of ixodic tick-borne borreliosis, an increase of the level and marker of tissue damage (LDH) indicate the development of systemic inflammatory syndrome and organ damage.Conclusions. The unfavorable situation in the natural foci of ixodic tick-borne borreliosis on the territory of the region remains,which is confirmed by the annual findings of markers of pathogenic borrelia in ixodid ticks and an increase in the number of people who turn up for tick suction in health care institution (HCI). Clinical and laboratory differences between erythema and nonerythema forms of the disease were revealed.

The article presents the results of a study on the analysis of factors affecting the survival of infants born with very low and extremely low body weight in the Republic of Bashkortostan.Purpose: to analyze the factors affecting the survival of infants born with very low and extremely low birth weight in the Republic of Bashkortostan.Material and methods. The study of the factors influencing the survival /death of a child born with very low and extremely low body weight was carried out on materials provided by the municipal health authorities. The research methods included the study of modern scientific literature on the issues under consideration, conceptual modeling, statistical methods of intelligence analysis, as well as methods of multivariate regression analysis.Results and conclusions. The analysis revealed a number of socio-economic, biological, medical and organizational factors that affect the likelihood of an unfavorable outcome in children born with low and extremely low body weight.

Objective: assessment of physical health by the centile method of adolescents aged 13-15 years living in the Altai Territory.Material and methods. The study included 676 adolescents aged 13-15 years living in the Altai Territory. The main anthropometric parameters (body length, body weight, chest and head circumference) were measured, and the waist, hip, shoulder and pelvic circumferences were additionally determined. The work used standard anthropometric devices: height meter, electronic scales, measuring tape, thick compasses. Further assessment of physical health was carried out by the centile method.Results and conclusions. Centile tables of height, weight, girth and latitudinal dimensions of adolescents were compiled. These parameters were compared with similar ones obtained in 2008 in the Altai Territory, as well as in other regions. When comparing, it turned out that modern adolescents of the Altai Territory are much larger their peers of 2008, but also their peers living in remote regions (Andijan, Tver). Thus, to assess the physical development of adolescents in each region, individual centile tables are required, which should be updated more often.

Purpose: to assess the adherence to treatment in elderly patients with nonvalvular atrial fibrillation who were prescribed anticoagulant therapy.Material and methods. During the study, 279 patients with atrial fibrillation of nonvalvular etiology were observed. Dependingon the type of anticoagulant taken, the patients were divided into 2 groups: the first group included 224 (80,3%) people who took warfarin, the second group - 55 (19,7%) people, who were prescribed a new oral anticoagulant - rivaroxaban.Results and discussion. By the end of the observation period, only 12% of patients in the first group and 32.7% of the secondgroup complied with the doctor's prescription. The vast majority of patients refused warfarin therapy due to the inability to control the international normalized ratio (INR). In the case of the appointment of rivaroxaban, the reason for the refusal to take was the high cost of the drug.Conclusions. Effective prevention of thromboembolic complications in atrial fibrillation requires the development of appropriate measures to improve patients’ adherence to treatment.

This article presents the results of our own study of the main clinical signs characteristic of hereditary ovarian cancer (НОС).Material and methods. The selection of patients for the study was carried out by means of a questionnaire in order to identify persons with suspected hereditary nature of the disease. A standard diagnostic panel of DNA, widespread in Russia, intended for the diagnosis of ovarian and breast cancer, was used as an HOC diagnosis. Additionally, targeted sequencing of a new generation wascarried out in patients with negative PCR (polymerase chain reaction) results.Results and discussion. The most significant clinical signs of HOC were: the age of manifestation, the presence of a burdened family and personal cancer history. HOC is significantly more common (p = 0.028) in middle-aged people. The average age of onset of the tumor process was 52.95±11.28 years. HOC is characterized by a burdened family history, and having relatives of the 1st degree of relationship with an oncological history is significantly more in the group of patients with identified germline disorders than in the group without them (p = 0.00033). Malignant neoplasms in relatives by blood in the main group, on average, developed 9 years earlier than in the comparison group (U = 86.5, P = 0.004). The histological subtype specifically attributed to HOC is serous low-grade, endometrioid and undifferentiated carcinomas, but not mucinous ovarian carcinoma, which is more peculiar to ovarian cancer of a non-hereditary nature of the disease.Conclusion. HOC is characterized by an earlier age of onset of the tumor process, a burden of family and personal history.

The recurrence rate of ovarian cancer is up to 90%, which is associated with the asymptomatic course of the disease and the advanced stage of the tumor process at the time of diagnosis and the start of special treatment. Ovarian cancer (OC) in its course is recurrent. Hereditary ovarian cancer (HOC) is characterized by a more favorable course, which is mainly associated with a high response rate to platinum-containing drugs used to treat ovarian cancer (OC). It is with HOC that platinum-sensitive relapse is more common. For HOC, recurrence of the tumor process is characteristic in terms of 6 months or more after adjuvant treatment.Material and methods. For 5 years (from 2016 to 2021), a study of 123 patients with a clinical picture of HOC was carried out. The features of the clinical picture of HOC, indicators of overall and relapsefree survival were studied. The patients were divided into two groups according to the identified germline abnormalities in DNA (deoxyribonucleic acid) nucleotide sequences. To identify germline disorders, a standard diagnostic panel of DNA diagnostics of oncological diseases and new generation sequencing (NGS) were used.Results. The number of patients who did not undergo cytoreductive surgery in the group without germinal disorders was higher than in the main group (p = 0.044). In the comparison group, resistance to platinum drugs developed significantly more often (p = 0.007).When comparing the overall survival rate of women in the main group and the comparison group, no statistically significant dif-ferences were found (p = 0.69). Disease-free survival in patients with germline disorders was significantly higher than in patients without germline disorders (p = 0.004).. The highest rates of relapse-free survival were in patients with germline disorders in the BRCA1 gene. Disease-free survival rates were lower in patients with germline disorders in the BRCA2 gene and in the ATM and RAD50 genes.Conclusion. The absence of germline DNA abnormalities correlates with a more unfavorable prognosis of the course of the disease.

Permanent vascular access is the key to hemodialysis. Therefore, its adequate and long-term functioning remains important. On the basis of the Department of Vascular Surgery of the State Budgetary Healthcare Institution of Bashkortostan Republic State Clinical Hospital No. 21 of Ufa, experience in the formation of native arteriovenous fistulas and methods of correcting complications arising has been accumulated.Material and methods. A cross-sectional study of patients with vascular access for programmed hemodialysis hospitalized in the vascular department of the State Clinical Hospital No. 21 of Ufa in 2016-2020 was carried out.Results. The main causes of terminal kidney failure are diabetes mellitus 22.3% and chronic glomerulonephritis 19.3%. For preven-tive formation of vascular access, 17% of patients were hospitalized before the start of renal replacement therapy. Only 17% of patients were admitted for preventive vascular access preparation prior to hemodialysis The most common complication in vascular access surgery was fistula thrombosis (87.4%). The survival rate of vascular access at the beginning of its use in hemodialysis was 75%.Conclusions. To improve the quality of life of patients undergoing programmed hemodialysis, a functioning vascular access is necessary. In the management of a patient with terminal renal failure, a multidisciplinary approach is required, which includes early detection of the disease, preventive formation of an arteriovenous fistula, patient education and prevention of complications.

The aim of the study was to investigate structural changes in the red and the white pulp of the rat spleen under immobilization stress when introducing bacterial lipopolysaccharide.Material and methods. The experiment was performed on 60 white rats of the Wistar line. The first control group received physiological saline, the second one received lipopolysaccharide. In the experimental group of rats, the immobilization stress was 24 hours duration. The first experimental group was administered physiological saline solution, the second experimental group was administered 100 μg/kg dose of lipopolysaccharide Pyrogenal («Medgamal», Russia). The material sampling was peformed after 3 hours, on the 3rd day and the 8th day of the experiment. Paraffin sections of 4-5 microns thickness were made from the spleen fragments fixed in 10% solution of neutral formalin, then they were stained with hematoxylin and eosin. The areas of the organ's longitudinal section, the white and the red pulp, the width of the lymph nodes reactive center of the white pulp, the width of the nodules, mantle and marginal zones as well as the width of the periarterial lymphoid muff were measured (40-50 measurements for each animal).Results. It was found that on the 3rd day after the stress, morphological signs of the white pulp activity reduction were detected via the decrease in the white pulp area (by 39.7%), as well as a general decrease of the spleen section area by 4.3%. On the 8th day, there were recovery processes in the spleen, but there was no complete restoration of the spleen structure - the white pulp area was11.55% less than the control group values, and the red pulp area was 6.7% less than the control group values. When lipopolysaccha-ride was administered under stress, there were no signs of the white and the red spleen pulp activity inhibition; the morphological parameters of the spleen did not differ from the control values.

Objective: to conduct pharmacoepidemiological monitoring of self-treatment using antimicrobial drugs and to assess the perceptions of the population of the Republic of Tajikistan about drugs of this group.Material and methods. The study of the content of firstaid kits and a survey of the population of the Republic of Tajikistan about awareness of the use of antimicrobial drugs were carried out.Results. It has been shown that in the Republic of Tajikistan every second antibiotic is used by patients independently, without adoctor's prescription, mainly for fever and cold. There is a very low level of knowledge of the population about antimicrobial drugs, their undesirable effects and rules for the use of drugs of this group. Most of the patients consider it possible to stop taking the drug after they start feeling better. Moreover, more than half of the population is aware of the danger of developing resistance to antimicrobial drugs and the possibility of developing adverse reactions to drugs of this group.Conclusions. The main ways to reduce the irrational and uncontrolled use of antibiotics by the population should be the following: informational and educational work among the population, dissemination of knowledge about the rational use of this group of drugs, as well as strengthening control over compliance with the rules for dispensing drugs in pharmacies of the Republic of Tajikistan.

The article presents a clinical case of diagnosis and treatment of a full form of false male hermaphroditism. The diagnosis was first established in elderly age. The stages of the examination during diagnosis verification are presented in detail. The article discusses the possible reasons for the delay in establishing the correct diagnosis and the start of adequate therapy. That is why surgical treatment to remove the testicles was performed on a patient aged 65 years.

The article describes a clinical case - bleeding from Meckel's diverticulum. Meckel's diverticulum is a congenital malformation of the ileum as a result of a violation of obliteration of the proximal part of the vitelline duct. Ectopic gastric mucosa, capable of producing hydrochloric acid, or pancreatic tissue is often found in the wall of Meckel's diverticulum. The presence of ectopic epithelium of the stomach in Meckel's diverticulum in children is the cause of ulceration of its wall and gastrointestinal bleeding.It is possible to detect an asymptomatic course of a diverticulum only when examining a patient for another disease, most often with laparotomy for acute appendicitis.

Objective. To analyze the features of the influence of the new coronavirus infection COVID-19 on the myocardium based on materials of domestic and foreign literature.Material and methods. A study of the available literature data was carried out and the pathogenetic features of myocardial damage in patients with coronavirus infection caused by SARS-CoV-2, diagnostic methods and possible directions of therapeutic correction of cardiovascular pathology were determined.Conclusion. The clinical course of COVID-19 is characterized not only by the respiratory tract damage, but also by heart and vascular damage, which can be represented by myocarditis, pericarditis, endocarditis, coronariitis and thrombendocarditis. The leading role in the pathogenesis of damage to the cardiovascular system is played by the renin-angiotensin-aldesterone system, endogenous catecholamine adrenergic stress and endothelial damage. Myocardial damage is confirmed by high levels of serum creatinine, N-terminal natriuretic peptide, highly sensitive troponin T, and the progression of diastolic dysfunction. The literature data obtained indicate the need to further study of diagnostic methods and treatment of patients with COVID-19 at the inpatient and outpatient stages of management.

Despite the scientific progress, the causes of uterine fibroids are currently still a matter of debate. According to modern scientists, the main causes of uterine fibroid are age, inflammatory diseases of the genital area, gynecological diseases, imbalance of sex hormones, endocrine disorders, somatic diseases, stress. The role of heredity in the incidence of uterine fibroid is important, which is detected in risk groups using modern high-tech facilities [3,17]. Uterine myoma develops as a result of somatic mutations in the myometrium cells. Cytogenetic analysis of tissues showed in 40-50% of cases the presence of chromosomal abnormalities [2] and dysregulation of the HMGIC and HMGIY genes located in chromosomes 12 and 6, respectively, where chromosomal aberrations are most common. According to the research results of V.E. Radzinsky [24] carriage of the PL-AII allele of the GP IIIa gene excludes the development of uterine fibroid. According to modern concepts, uterine myoma is a benign cell hyperplasia of the muscular and adventitious membranes of the vessels and the adjacent endometrium [25].The most common theories of pathogenesis are G.A. Savitsky’s theory (2003), infectious theory, mesenchymal theory, the theory of progesterone effects, the theory of prolactin and growth hormone effects, the theory of growth factors effect [21,22, 25].The uterine fibroid pathogenesis may be considered from the standpoint of a multifactorial nature which is based on the total effect of genetic and environmental factors. Thus, uterine fibroid is a benign diffuse or focal hyperplasia of the myometrium and is characterized by a variety of factors of pathogenesis and systemic disorders.