Pulmonary tuberculosis has a lot of clinical manifestations, and it complicates the diagnosis of tuberculosis in the general clinical practice. We studied the clinical manifestations of tuberculosis detected in the pulmonary department and compared them with the significancy of diagnostic methods.Material and methods. People with a verified diagnosis of lung tuberculosis (n = 109) were examined using the GeneXpert MTB/RIF method if Ziehl Nielsen bacterioscopy has negative results or if there was no effect of treatment for two weeks.Results. All patients had complaints of both intoxication and bronchitis as with pneumonia on admission. Infiltrative tuberculosis (57.1 %; n = 68), disseminated tuberculosis (16.8 %; n = 20) were most often diagnosed. We looked for correlations between dyspnea and the prevalence of the process (p = 0.24), dyspnea with temperature (p = 0.24), the presence of pain in the chest (p = 0.405), the results of immunodiagnostics and sputum examination (p = 0.133). We found out that there are no such correlations in tuberculosis. The term for diagnosing tuberculosis was 7.97 ± 3.9 days in the presence of cough with sputum and 9.04 ± 4.3 days in the case of dry cough. The term for diagnosing tuberculosis was 12.31 ± 4.9 days in patients without cough. Mycobacterium tuberculosis was detected using GeneXpert MTB/RIF molecular genetic methods with nonproductive cough in 84.5 % (60 people out of 71), while in the first days of hospitalization in 46.6 % of patients (28 people out of 60, p < 0.001).Conclusion. It was found that the period of hospitalization is little related to the characteristics of patients and depends on organizational measures to identify mycobacterium tuberculosis. It is recommended to immediately apply the GeneXpert MTB/RIF method to patients with mild tuberculosis.

Background. The development and improvement of reconstructive breast surgery provides medical, psychological and social rehabilitation of cancer patients, allowing them to achieve the best cosmetic and functional results. The trend towards the return of prepectoral reconstruction is associated not only with the improvement of mastectomy techniques, but also with implant coating and the emergence of highly cohesive silicone gel filling of implants. The use of polyurethane-coated endoprostheses in prepectoral reconstruction provides more reliable fixation to the surrounding tissues and allows reconstruction of the mammary glands without additional covering of the endoprosthesis.Objective: to improve the results of surgical treatment when performing a one-stage reconstruction by pre-rectal placement of polyurethanecoated implants in breast cancer. Materials and methods. In the period from April 2017 to September 2020 at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of P.A. Herzen Moscow Oncology Research Institute performed 340 prepectoral breast reconstructions (direct-toimplant) using polyurethane-coated implants in breast cancer patients. A group of patients was analyzed (n = 208).Results. We noted the following complications: prolonged seroma (more than 30 days) in 39 (18.6 %) patients, red breast syndrome in 31 (14.8 %) patients, capsular contracture III–IV degree by J.L. Baker in 43 (20.57 %) patients, protrusion/extrusion of the endoprosthesis in 23 (11 %) patients, suture divergence in 8 (3.8 %) patients, necrosis in 8 (3.8 %) patients, infectious complications in 14 (6.7 %) patients, ripping in 10 (4.8 %) patients. Also, 2 (0.95 %) patients had a violation of the integrity of the endoprosthesis, and 2 (0.95 %) patients had rotation of the endoprosthesis. Conclusions. Prepectoral breast reconstruction can be used as an alternative to subpectoral reconstruction in primary operable forms of breast cancer with sufficient thickness of integumentary tissues.

Галитоз является важной медико-социальной проблемой, встречается примерно у 25% населения в мире, часто становится одним из основных клинических признаков хронических воспалительных заболеваний ротоглотки и возникает в результате образования летучих соединений серы в процессе жизнедеятельности ряда микроорганизмов полости рта и ротоглотки. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить эффективность и безопасность пробиотического штамма Streptococcus salivarius K12 в составе продукта БактоБЛИС при хронических воспалительных заболеваниях ротоглотки, сопровождающихся галитозом. МАТЕРИАЛ И МЕТОДЫ Под наблюдением находились 45 пациентов с катаральным хроническим фарингитом; подтвержденный гастроэозофагеальный рефлюкс зарегистрирован у 33 человек в общей группе. После микробиологического исследования всем пациентам назначен пробиотический штамм S. salivarius K12 в количестве 1×10⁹ КОЕ в форме таблеток для рассасывания, по 1 таблетке на ночь в течение 14 дней. Об эффективности действия пробиотика выносили суждение на основании данных врачебного осмотра и субъективной оценки пациентом выраженности клинических симптомов по 10-балльной визуально-аналоговой шкале (ВАШ) перед началом приема, на 5-й и 7-й день приема пробиотика. РЕЗУЛЬТАТЫ При микробиологическом исследовании у всех пациентов выявлены Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus agalactiae, Streptococcus viridans в пределах 10³—10⁵ КОЕ. В процессе приема пробиотика отмечен положительный клинический эффект по всем трем анализируемым признакам заболевания (выраженность боли при глотании, чувство першения (инородного тела) в глотке, галитоз) у всех пациентов со статистически значимой разницей между 1-м и 7-м днем, а также 7-м и 14-м днем наблюдения. Выраженность боли при глотании уменьшилась с 5,69±0,39 балла до 2,69±0,34 балла на 7-й день и до 0,08±0,05 балла на 14-й день лечения; чувство першения (инородного тела) в ротоглотке — с 6,88±0,23 балла до 3,54±0,29 балла на 7-й день и до 0,69±0,12 балла на 14-й день лечения; галитоз — с 6,16±0,31 балла до 2,47±0,44 балла на 7-й день и до 0,68±0,29 балла на 14-й день лечения. ЗАКЛЮЧЕНИЕ Подтверждена хорошая эффективность местного применения продукта, содержащего пробиотик Streptococcus salivarius К12, при хронических воспалительных заболеваниях ротоглотки разного генеза. Отмечен клинически значимый регресс основных признаков патологического процесса в виде неприятного запаха изо рта, боли при глотании и чувства инородного тела в ротоглотке.

The main objective of treatment of acute respiratory diseases of the upper respiratory tract (URT) is to reduce symptoms severity, prevent the development of complications, and improve the quality of life of sick children. Objective of the research: to analyze the actual tactics of diagnosis and treatment of patients with acute nasopharyngitis (AN) in children according to the data of the clinics of the Administrative Department of the President of the Russian Federation. Materials and methods: a retrospective analysis of 499 outpatient case histories of patients (mean age 8,0±2,5 years) who were on outpatient treatment with a diagnosis of AN for the period from March 2018 to April 2019 was performed. Inclusion criteria: the patient's visit within 1–3 days from the onset of the disease, observation period – at least 7 days, compliance by patients and/or their parents/legal representatives with medical recommendations based on informed consent. Results were processed using the standard package of statistical programs IBM SPSS Statistics 23.0. Results: bacteriological examination of nasal cavity and oropharynx microflora was performed in 27 (5,4%) children with AN, the results mainly showed Staphylococcus aureus. Systemic antibiotics, most often (96,5%) pill form of protected penicillins, were taken by 28 (5,6%) children. Homeopathic medicines were prescribed in 11% of cases (55 children), antihistamines – in 36,8% (194), intranasal glucocorticosteroids (GCS) – in 39,5% (197), immunotropic drugs – in 12,4 % (62). In most AN topical drugs were recommended for sanitizing the oropharynx and nasal cavity (in 89% and 86%, respectively). Rinsing with antiseptic solutions was prescribed in 43,3% of all cases (216 children), half of them (50,5% – 109 children) – miramistin, less often (21,6% – 108 children) – phytopreparations. Decongestants were prescribed to AN patients in 70,7% (353 children) of cases, topical preparations for the nasal cavity containing antiseptics or antibiotics – in 32,3% (161 children). Conclusion: in the system of children's outpatient service of the Presidential Administration of the Russian Federation in the majority of cases, topical drugs were prescribed for AN treatment. Bacteriological study of nasopharyngeal microbiome in AN is not informative and was carried out in 5,4% of cases to exclude bacterial pathogens. The use of intranasal corticosteroids (39,5%), immunotropic drugs (12,4%), antihistamines (36,8%) and homeopathic (11%) drugs should be considered unreasonable.

Грипп и ОРВИ продолжают оставаться основной нозологической формой в структуре всех инфекционных заболеваний. Особенно опасен грипп для беременных. Цель: оценить отношение беременных и медицинских работников к вакцинации против гриппа. Материалы и методы: форма № 5, формы статистического учета №1-грипп раздел 1, информация с официального сайта ФГБУ «НИИ гриппа» Минздрава РФ; информационно-аналитические справки Министерства здравоохранения РФ. Было проанкетировано на различных территориях РФ 1126 беременных на разных сроках беременности и 447 медработников. Статистическая обработка проводилась с использованием программ Microsoft Excel 2010 и IBM SPSS Statistics 20.0. Результаты и обсуждение. Среди опрошенных беременных планировали или уже вакцинировались против гриппа лишь 8% женщин, Наиболее частые причины отказа от вакцинации против гриппа во время беременности: сомнение в безопасности. О внесении в Национальный календарь профилактических прививвок вакцинации против гриппа беременных знали лишь 25% опрошенных. 73% опрошенных медицинских работников не рекомендовали беременным вакцинацию против гриппа, в связи с тем, что считают нежелательным вмешательство в иммунитет беременной, 33% сомневаются в безопасности вакцинации, 13% вообще не знают о возможности вакцинации против гриппа беременных, 6% имеют личный негативный опыт вакцинации против гриппа, а 4% не видят необходимости в вакцинации от гриппа. Заключение: полученные материалы свидетельствуют о необходимости совершенствования обучения медицинских работников по вакцинопрофилактике инфекционных болезней, включая и вакцинацию против гриппа беременных, а также проводить широкую и активную информационно-пропагандистскую работу с населением, привлекая средства массовой информации.

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease metabolically healthy obese (MHO). Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS). Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 1860 years with obesity. Three types of MHO criteria were used: 1) HOMA index (2.7); 2) IDF-criteria of metabolic syndrome, 2005; 3) the BioSHaRE-EU 2013 criteria (obese patients without any symptoms of MS). We conducted a comparative analysis of anthropometry, status of lipid and carbohydrate metabolism, the functional state of the liver. Results. The MHO prevalence was: 34.5% according to HOMA index, according to the definitions of MS 2005 38.6%, in BioSHaRE-EU 9.6%. In groups of MHO and MS dyslipidemia was observed in 27.3 and 49.5% (p0.05), hypertension in 25% and 71.6% (p0.05), steatogepatosis in 47.7% vs 51.3% (p0.05) of observations, respectively. Among comorbidities the gynecological pathology was most prevalent - 50.8 and 61.4% (p0.05), disorders of carbohydrate metabolism differed significantly in frequency- 6.82 and 39.1% of patients (p0.05). Patients with MHO had a shorter duration of the existence of obesity than MS (18.7 vs. 24 years) (p=0.0004) and less likely to have attempted to reduce weight 85.8% and 91.6%. Average BMI, waist circumference, hip circumference, fasting glucose, total cholesterol, insulin basal, basal C-peptide, HOMA index in groups of MHO and MS differed significantly (p0.05). Median ALT was 20 and 23.2 U/l, AST 20 and 23 U/l, triglycerides 1.1 and 1.8 mmol/l, high-density lipoprotein 1.4 and 1.1 mmol/l, respectively. Conclusions. The MHO prevalence was maximal according to the MS definitions from 2005, and minimal with BioSHaRE-EU criteria. The main analyzed indicators differed significantly in groups MHO and MS. Longer obesity existence in the MS group may suggest an instability of MHO phenotype over time.