The purpose of the study was to study the characteristics of the course and prognosis criteria of bacterial pneumonia in patients with chronic lymphocytic leukemia (CLL). It has been established that the incidence of pneumonia increases during tumor progression. The highest incidence was noted in patients in stage C (J. Binet et all., 1981). The risk of pneumonia in CLL is associated with the following factors: severe hypogammaglobulinemia, status 3-4 on the ECOG scale, stage C according to the Binet classification, relapse of CLL. Both nosocomial (NP) 47% (of which early 25%, late 75%) and community-acquired (53%) pneumonia (CP) were diagnosed. NPs in CLL often have hidden (25%) and low-symptomatic variants (32.5%). In most cases, VP is characterized by a typical course of the inflammatory process. In CLL, gramnegative flora (56%), as the causative agent of NP, predominates over gram-positive flora (44%); with CAP, gram-positive flora (74%) predominates over gram-negative flora (26%). Most pneumonia is characterized by a severe and protracted course. The unfavorable prognosis of pneumonia in CLL is due to such predictors as: latent variant of the course, stage C according to the J. Binet classification, 3-4 degree of comorbidity on the CIRS scale for diseases of the cardiovascular and respiratory systems, severity of the condition more than 16 points. on the APACHE II scale, status 3-4 on the ECOG scale, identification of Klebsiella pneumonia as the causative agent, age over 60 years, bilateral localization of pneumonia, association of microorganisms that cause pneumonia, presence of severe thrombocytopenia and hemorrhagic syndrome, severe hypogammaglobulinemia, occurrence of pneumonia in the hospital.

A key aspect of the pathogenesis of many diseases of internal organs is disruption of microcirculation processes. New coronavirus infection (COVID-19) is not an exception: due to the tropicity of SARS-CoV-2 virus to the endothelium, disturbance of peripheral microcirculation plays a significant role in the development of the disease. Photoplethysmography is the optimal method for screening diagnostics of peripheral microcirculatory changes. It is a simple, non-invasive, painless and reliable express method based on the determination of blood volume in the microvascular bed. Purpose : to compare the indicators of peripheral microcirculation according to photoplethysmography in students who have suffered a new coronavirus infection without lung damage, and healthy individuals. The study included 46 students of the Amur State Medical University aged 20 to 30 years. To analyze the state of peripheral microcirculation, a photoplethysmogram was recorded using the AngioScan-01 M diagnostic complex. When performing photoplethysmography, AngioScan programme determined mean values of pulse rate, arterial wall stiffness index, vascular wall age, stress index, arterial blood oxygen saturation, and pulse wave type. It was found that in 62.5 % of patients in the main group, the vascular wall stiffness index exceeded normal values, which indicates the beginning of structural changes in the arterial wall of peripheral vessels; in 54.17 % of the examined patients of the main group, the type of pulse curve A was revealed, which is characteristic of the elderly and the detection of this type in young people indicates an increase in the stiffness of large vessels and is a symptom of peripheral microcirculation disorders. Conducting a contour analysis of a photoplethysmogram in patients with a new coronavirus infection without damage to the lower respiratory tract allows us to identify changes in the peripheral microcirculatory bed, which may increase the risk of developing long-term adverse effects of infection. Photoplethysmography can be used as a screening method for diagnosing peripheral microcirculation disorders in people who have suffered a new coronavirus infection.

For the purpose of ultrasound assessment of the functional state of the diaphragm inpatients with COPD who had suffered from COVID-19, 39 patients with COPD complicated by compensated CHL were examined. Group 1 included 19 patients with COPD who had suffered from COVID-19, group 2 included 20 patients with COPD. The study was conducted 3 months after contracting COVID-19. The results of the study showed the greatest decrease in the height of the diaphragm dome in group 1 (p = 0.001). The excursion of the diaphragm during quiet breathing was increased in both groups; in group 2 the indicator was 12% higher than in group 1. The rate of excursion of the diaphragm during inhalation and exhalation during quiet and forced breathing in both groups was significantly increased compared to the control group. Moreover, in group 1, the rate of exhalation of the diaphragm during exhalation was 49% higher. In both groups, compared with the control group, the thickness of the muscular part of the diaphragm during inhalation and exhalation during quiet breathing was significantly higher, but no differences were observed between the groups. Calculation of the fraction of thickening of the muscular part of the diaphragm allows a more accurate assessment of the contractility of the diaphragm muscle. With quiet breathing, this indicator   was reduced by an average of 23.9% (p = 0.01) in both groups, with forced breathing by 35.8% (p = 0.001) compared to the control group, which indicates the initial development weakness of the respiratory muscles of the diaphragm in patients who have had COVID-19. Thus, studying the functional activity of the diaphragm makes it possible to early detect fatigue and weakness of the diaphragm muscles, which will open up new opportunities for the prevention and diagnosis of the development of respiratory failure, and timely correction of established disorders.

The constant increase in the number of patients with cancer pathology determines the expediency of a multidimensional approach to the analysis of epidemiological features of malignant neoplasms in certain territories of the Russian Federation. Purpose: to assess the territorial peculiarities of the main morbidity and mortality rates in malignant neoplasms of the oral cavity in residents of the eastern regions of the Russian Federation (2013-2022). The data on morbidity and mortality, reporting forms of statistical accounting of oncological patients and regulatory documents of higher organizations, information on observations of the dynamics of changes in the numerical values of the indicators of the pathology under study were used in the work. In the eastern regions of Russia in 2022 524 new cases of malignant neoplasms of the oral cavity were registered: of them tongue cancer 164, cancer of the major salivary glands 84 and tumors of other and «unspecified» parts 276. The statistical mean incidence rate (both sexes) per 100 000 population for tongue cancer was 1,57 ± 0,14о/оооо (2020 – 1,54 ± 0,15о/оооо), for cancer of the major salivary glands – 0,71 ± 0,03 о/оооо (2020 – 0,71 ± 0,03о/оооо), and for other and «unspecified» parts of the oral cavity 2,3 ± 0,06о/оооо (2020 – 2,22 ± 0,07о/оооо). The specific weight of the number of patients detected actively – 17,35 ± 1,67% (2013 – 6,16 ± 0,61%) does not give an opportunity to improve the prognosis and quality of life of 65,3% of patients with visual localizations of oral cancer, which belong to stages III-IV of the disease. The number of patients with stages I-II of the tumor process decreased – 34,5% (2020 – 39,5%) with a dynamic increase in the contingent accumulation index – 5,3 (2013 – 3,7). The number of morphologic studies (98,6%) practically did not differ from th  Russian average (98,9%), while the proportion of patients registered for 5 or more years was lower – 51,1% (RF-52,6%). The average value of the statistical indicator of mortality in men amounted to 7,69 ± 0,16 о/оооо (2020 – 7,93 ± 0,13о/оооо) per 100 000 population, which exceeded the same indicator in women – 1,9 ± 0,09о/оооо (2020 – 1,8 ± 0,09о/оооо). Insufficiently active detection of visual localizations of the disease did not allow to significantly change the incidence rates in the studied time period. Improving the quality of preventive measures will enable primary health care to detect early forms of oral cancer with the   formation of «cancer risk» groups for further monitoring of background and precancerous conditions in the population of the region, which will, in turn, reduce mortality rates. Primary health care should be constantly provided with medical personnel with special training in the section «Oncology».

Success in the treatment of malignant neoplasms is due to early diagnosis and an integrated approach to treatment. The identification of immunotherapy as a separate type of complex cancer therapy is beyond doubt. In order to increase the effectiveness of antitumor therapy, aggressive radiation and drug treatment regimens are being developed and applied. This leads to the development of immune disorders, allergic and infectious complications in patients. Side effects of special treatment, in turn, interfere with the optimal treatment of the main treatment, reduce its effectiveness and worsen the patient’s quality of life. The results of the study confirm the effect of Imunofan on immunity in patients with malignant neoplasms of the reproductive system. Immunomodulation, especially in conditions of intense intoxication, can play an important role in supporting the body’s defenses. This opens up new prospects for the development of complex treatment strategies that include Imunofan as an important component.

Eventration of the intestine through a defect in the wall of the vaginal stump after hysterectomy is an extremely rare complication and requires emergency surgical care. A strangulated loop of intestine with necrosis can cause the development of peritonitis, sepsis and death. In recent years, an increase in the number of such complications has been reported after surgery performed using the robotic method and laparoscopic approach compared to vaginal and laparotomy. The purpose of our observation is to present a rare case of long-term complication of laparoscopic hysterectomy in a patient with endometrial cancer, to indicate possible risk factors and a method of correction. In a young non-smoking patient without obvious risk factors, three months after removal of the uterus, an eventration of a loop of the small intestine through the vagina occurred, the trigger of which was sexual intercourse. As a result of early treatment, there were no signs of intestinal necrosis and peritonitis, which made it possible to reduce and eliminate the defect through vaginal access.

The article presents a clinical case of a 10-year-old child who, during the period of clinical and hematological remission of acute lymphoblastic leukemia, was diagnosed with papillary thyroid cancer with metastasis in the lymph node. This clinical case confirms the need for long-term and thorough follow-up of patients with oncological pathology, which will contribute to the timely detection and rational treatment of second malignant tumors.

TWe described а clinical case of diagnosis of nail-patella syndrome in an 11-year-old boy. In the observation, in addition to the classical signs (changes in the osteoarticular and urinary systems), the syndrome was manifested by growth retardation, moderate protein-energy deficiency and signs of connective tissue dysplasia. The diagnosis was confirmed by whole exome sequencing, which made it possible to detect a pathogenic variant in the LMX1B gene in a heterozygous state that had not previously been described in the literature.

Idiopathic (primary) arterial pulmonary hypertension in children is a very serious and urgent problem worldwide. The disease is extremely rare and has a serious prognosis for life due to the threat of sudden cardiac death. A case of diagnosis of the disease in a 3-year-old girl who began receiving therapy with a non-selective endothelin receptor antagonist and requires further careful monitoring is presented.

Тo evaluate the results of resection of the abdominal esophagus with the application of a circular hardware esophagogastroanastomosis in the surgical procedure for severe cardiac achalasia. A clinical observation of 71-year-old patients with stage IV achalasia cardia (according to B.V. Petrovsky) is presented. She was admitted for surgical treatment to the surgical department of the Amur Regional Clinical Hospital. Complaints of dysphagia, regurgitation of food eaten, chest pain, body weight loss of 20 kg. History of the disease for 22 years. Contrast fluoroscopy of the esophagus: the esophagus is sharply dilated in the middle and lower third up to 6 cm, the distal part of the esophagus is narrowed, evacuation of contrast into the stomach after 35 minutes. Esophagoscopy: signs of esophagitis, the cardia is not passable for an endoscope with a diameter of 1 cm. An operation was performed: resection of the abdominal esophagus with circular hardware esophagogastroanastomosis. Smooth early and long-term (after 6 months) postoperative period. There are no signs of dysphagia. Body weight gain over 6 months was 9 kg. With fluoroscopy and endoscopy of the esophagus six months later: the esophagus has shortened in length and changed, after the onset of contrast in the stomach without delay. The esophagus is freely accessible to the endoscope throughout Conclusion. This case led to a positive result of resection of the esophagus with esophagogastroanastomosis as a result of severe achalasia cardia stage IV (according to B.V. Petrovsky)

Peptic ulcer disease is a widespread disease of heterogeneous origin. The contamination of the mucous membrane of Helicobacter pylori is the leading cause of the development of this condition. Upon detection of the microorganism, through various studies, a tendency to a more severe course of this disease was revealed, as well as therapy for HP-associated peptic ulcer disease turns out to be less effective. The reason for this was the incomplete eradication of the pathogen, as well as the resistance of the microorganism to certain groups of antibiotics. That is why the selection of effective therapy for the eradication of Helicobacter pylori in HP-associated peptic ulcer disease remains the most important stage for the patient’s recovery. The drug Pilobact AM solves all the questions raised. The ease of use and successful combination of doses of medicines allows for highly effective and safe action on H.pylori and the mucous membrane of the gastrointestinal tract, thereby showing excellent results in the treatment of peptic ulcer disease.

Respiratory diseases are the most common among adults and children. To date, according to WHO, between 27.3 and 41.2 million people suffer from influenza and other viral infections in the Russian Federation, while in the world – up to 1 billion cases, of which 3 to 5 million are severe. Acute viral respiratory infections’ annual incidence among children is 20-30%. To diagnose acute respiratory viral infections, it is necessary to have at least one of the clinical manifestations characteristic of respiratory diseases. Diagnostic studies conducted on an outpatient basis make it possible to accurately diagnose and prescribe medication. And also provide general recommendations. The need for timely treatment of respiratory diseases is explained by the high frequency of complications that lead to fatal consequences. The article tells about the main support points for general practitioners and pulmonologists who face these diseases.