Aim. In this paper, we aim to analyse our own clinical observation of a patient with CLIPPERS syndrome on the basis of available literature data.
Materials and methods. The medical record of a patient treated at the Neurology Unit of the S.V. Ochapovsky Regional Clinical Hospital No. 1 (Kradnodarsy Krai) was investigated, along with available national and foreign literary sources.
Results. The patient was diagnosed with autoimmune brainstem encephalitis (CLIPPERS syndrome) on the basis of the diagnostic CLIPPERS syndrome criteria modified and adapted by W. Tobin and co-authors in 2017. Among them are: 1) subacute development of symptoms for the pons and cerebellum lesions along with other signs of CNS damage (onset is characterised by diplopia and ataxia); 2) good response to glucocorticosteroid (GCS) therapy; 3) lack of involvement of the peripheral nervous system; 4) enhanced MRI lesions homogeneously accumulating contrast agents without a mass effect; 5) a significant decrease in the accumulation of contrast material during GCS therapy; 6) absence of myelin loss.
Conclusion. Considering that the GCS therapy produces a rapid and significant effect, it is important to focus on early detection and treatment of this disease through the development of more accurate markers and evaluation criteria for its diagnosis.

Aim. To evaluate the results of complete functional endovascular myocardial revascularisation which is performed early after stenting the culprit artery (within 90 days) with third-generation sirolimus-eluting stents in patients treated for acute coronary syndrome (ACS) with ST-segment elevation and multivessel disease.
Materials and methods. We analysed the results of a 2-year follow-up treatment period of patients suffering from ACS with ST-segment elevation and multivessel disease who had undergone urgent stenting of culprit artery. Within 90 days after stenting, a complete functional endovascular myocardial revascularisation was performed using third-generation sirolimus-eluting stents. The efficacy and safety of the procedure was evaluated according to the non-inferiority criteria in comparison with the literature data on myocardial revascularisation by coronary artery bypass surgery.
Results. In the course of follow-up treatment, 1 lethal myocardial infarction (after 18 months from complete revascularisation) and 2 non-lethal myocardial infarctions were registered. The symptoms of angina returned in 7 patients, 6 of whom had undergone unplanned re-revascularisation within 6 to 12 months following complete revascularisation. The MACCE rate was 0.143 [95% confidence interval: 0.0770; 0.2497].
Conclusion. In patients having ACS with ST-segment elevation and multivessel disease, endovascular myocardial revascularisation performed early after stenting the culprit artery is equivalent to coronary artery bypass surgery in terms of cardiovascular mortality rates, as well as incidence of non-fatal cardiovascular events. However, such an approach underperforms compared to coronary artery bypass surgery in terms of a composite endpoint of MACCE and the number of required re-interventions.

Aim. To demonstrate that the end volumes are indicative of the severity of the left ventricle pathological condition not only under preserved, but also under reduced ejection fraction.
Material and methods. 32 patients with dilated cardiomyopathy and severe heart failure, as well as with complete monitor and computer and echocardiographic control were examined.
Results. The sensitivity of the ejection fraction and end volumes to the severity of heart failure (stroke index from 15.3 to 57.2, average 29.5±1.6; ejection fraction from 16.5 to 48.0, average 27.4±127; heart rate from 52 tо 113, average 81.8±2.4) was established. It is shown that the percentage change (sensitivity) of the ejection fraction (55%) is much lower than that of the end diastolic volume index (190%) and that of the end systolic volume index (438%) to the severity of heart failure.
Conclusion. Indices of end-diastolic and end-systolic volumes of critical patients with dilated cardiomyopathy are more sensitive to the severity of heart failure than the ejection fraction. It is advisable to use end volumes as indicators of heart failure. An adequate quantitative assessment of the severity of heart failure should include the heart rate (duration of the cardiac cycle T).

The aim is to characterize of some clinical and epidemiological indicators of influenza in the Krasnodar Territory over a fve-year follow-up period (2014–2018).
Materials and methods. The results of the monitoring of 2014-–2018 were used. for the circulation of influenza viruses in the form of selective studies of influenza viruses in biological material using the polymerase chain reaction, virological method on cell culture, as well as the state of anti-influenza immunity in serological reactions. The clinical characteristic of the flu was carried out according to the annual reports of the infectious diseases hospital.
Results. An increase in the incidence of influenza in the Krasnodar Territory in the period under review was established. Monitoring of the circulation of the pathogen shows the presence of serotypes A and B in the region of influenza viruses. Among hospitalized adult patients, young people, women, with a moderate course of the disease predominate. The highest incidence and severity of influenza was observed in 2016, when pandemic A(H1N1)pdm09 virus prevailed. There has been an increase in the complicated course of the flu since 2016, despite the diversity of the dominant species of the virus. The leading position among the complications is pneumonia.
Conclusion Epidemiological monitoring is the basis of anti-epidemic and preventive measures. In connection with the marked tendency to an increase in the incidence and an increase in the complicated course of the flu, its rapid diagnosis in the outpatient setting for early etiotropic treatment is necessary.

Aim. To analyse the psychomotor development of children with different outcomes of perinatal hypoxic brain injury and to assess the effectiveness of nootropic therapy in terms of formation of speech skills and cognitive activity.
Materials and methods. The study included 136 children having suffered from asphyxia during labour and/or intrauterine hypoxia. The analysis of the neurological pathology and psychomotor development in the children was carried out during the first two years of their life. Neurological deficit was formed in 55 (40.4%) children; the remaining children exhibited functional disorders of the nervous system. The evaluation of the children’s psychomotor development was carried out using the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/ CLAMS). The level of motor development in the children with cerebral palsy was determined using the System for Assessing Global Motor Functions.
Results. Functional disorders of the nervous system were manifested in the hyperactivity syndrome, tempo-retarded development and dissociation of speech, cognitive and motor functions. The global nature of hypoxic brain damage in children with neurological deficit determined the predominance of severe disorders in motor functions, cognitive activity and speech development. According to the study, neurological deficit was more often formed in premature babies, but severe impairments in motor functions due to pronounced destructive changes in the brain prevailed in mature babies. The study showed the effectiveness of nootropic drugs in children with functional disorders of the nervous system, as well as in children with neurological deficit without pronounced structural changes in the brain.
Conclusion. An analysis of psychomotor development and assessment of the effectiveness of nootropic therapy in young children with perinatal hypoxic brain damage allows the adequacy of the rehabilitation for correction of the revealed violations to be determined.

Aim. This paper is aimed at identifying risk factors (RFs) and assessing their correlation in men and women with essential hypertension (stage III) under medical treatment.
Materials and methods. Ninety-eight patients (45 men and 53 women) with essential hypertension (stage III) were examined. All of them were divided into two groups by sex. Both groups were studied for risk factors (age, disease duration, body mass index), as well as the following indicators: blood lipids; blood glucose; total bilirubin and its fractions; alanine aminotransferase (ALT); aspartate aminotransferase (AST); blood creatinine with the calculation of glomerular filtration rate (GFR) using MDRD and CKD-EPI equations.
Results. Sex-specific differences in RFs and their correlation in patients with essential hypertension (stage III) are presented. The frequency of comorbid pathology and associated conditions, as well as the amount of medication used by men and women is shown.
Conclusion. Women are diagnosed with essential hypertension 4 years earlier; BMI values correspond to Class 1 obesity; GFR level corresponds to Stage 3 of chronic kidney disease; whereas men have higher levels of direct bilirubin, ALT and blood creatinine. Comorbid pathology is significantly more common in women, with diabetes mellitus being the most commonly detected such a pathology. The risk factor correlation in men and women is different, having a statistically significant multidirectional correlative relationship. All of the considered issues require further systematic study, as well as a rational approach to the prescription of medical therapy and the risk factor correction, taking the patient’s sex into account.

Aim. To evaluate the effectiveness of pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease (COPD) and obesity.
Materials and methods. The study included two groups of patients. The first group consisted of 44 patients with COPD and obesity (23 men and 21 women; median age — 57.47±0.76 years; average body mass index (BMI) — 34.1±1.24 kg/m2) who were receiving only standard medical treatment for COPD. The second group consisted of 44 patients (22 men, 22 women; median age — 56.07±0.83 years, average BMI — 33.4±1.62 kg/m2) who were undergoing pulmonary rehabilitation along with the standard medical treatment for COPD. Pulmonary rehabilitation programme involved group training of COPD patients including dietary recommendations, graduated exercise, as well as recommendations on smoking cessation. At the initial stage and 12 months after the study, the severity of COPD symptoms was assessed using a visual analogue scale, the frequency of exacerbations and hospitalisations, spirometry parameters, as well as quality of life data obtained via the SF-36 questionnaire.
Results. At 12 months into the study, patients from the second group showed a significant decrease in the number of COPD exacerbations and related hospitalisations; a decrease in the shortness of breath, cough, sputum production; as well as an improvement of the SF-36 questionnaire with respect to a number of points. At the same time, spirometry parameters did not improve significantly.
Conclusion. Inclusion of pulmonary rehabilitation programmes in the standard treatment of patients with COPD and obesity contributes to providing higher effcacy of medical treatment, decreasing the load of main COPD clinical symptoms, as well as to reducing their impact on the patients’ health status and improving life quality.

Aim. To provide a complex microbial-zoological characteristics of the postmortem period.
Materials and methods: Microbiological studies: material for examination was isolated from three species of animals, including domestic pig (Sus scrofa domesticus) weighing 50-100 kg, domestic chickens (burnt and unburnt) (Gallus gallus) weighing 1.5–2 kg and house mice (Mus musculus) weighing 80 g. In addition, human corpses, bone remains and over 1000 microorganism isolates were investigated. Entomological studies: material for examination was isolated from human corpses and their bone remains (17), pigs (10), chickens (32), representatives of the mammalian class (20), 79 objects in total. 32394 insects were investigated. Studies of injuries caused by certain vertebrates: 34 human corpses and their bone remains were examined.
Results. Main trends in the microbial decomposition of dead bodies have been determined, which are of great practical significance for the diagnosis of the remoteness of death during the course of forensic medical examination. General characteristics of the process of corpse decomposition by necrophilous insects are given. The effect of the thermal factor (high temperature) on the microbiological and entomological features of corpse decomposition has been established. Anatomical, topographical and morphological features of injuries caused by some vertebrates have been determined.
Conclusion. Our results prove the existence of a close relationship between the objects of forensic medical examination and the microbial processes that occur during the decomposition of corpses and under the action of insects and scavengers.

Aim. To study the crystallogenic and initiating potential of biological fluids in rats under normal conditions and when modeling a contact thermal injury.
Material and methods. To this end, we used our own model of contact thermal burn. This experiment involved the impact of a hot plate on the back of the animal, with the lesion area amounting to 20% of the body surface (3rd degree burn). This model of thermal injury was reproduced in 30 Wistar rats. 24 hours after the burn experiment, the animals were subjected to blood tests. Subsequently, an evaluation of the blood crystallogenic and initiating properties was performed. The range of basic substances used in teziographic tests was rather conventional and included 0.45, 0.9 and 3% sodium chloride solutions, as well as 0.1 N hydrochloric acid and sodium hydroxide solutions. The results of own and initiated crystallization of biological fluids were evaluated using the authors’ system of semi-quantitative indicators.
Results. It is found that, in comparison with intact animals, micro-preparations of dried blood serum from rats after thermal trauma demonstrate a significant inhibition of both own crystallization and that initiated by various basic substances. This phenomenon is manifested in a significant decrease in the index of structural facies (in a crystalloscopic test), the main teziographic coefficient and the belt coefficient. The pathological nature of the observed shifts in the crystallogenic properties of biological fluids emphasizes a sharp increase in the degree of destruction demonstrated by the crystalline elements of the blood samples of rats in the main group.
Conclusion. The conducted research shows that a model thermal injury in rats is accompanied by significant shifts in the crystallostasis of an animal organism, which are manifested in a significant change in the crystallogenic and initiating properties of the blood serum.

Aim. To study the effect of intermittent normobaric hypoxia (INH) during local irradiation of the rat liver in therapeutic doses (total focal dose 30 Gy for 10 fractions) on the biochemical parameters of blood serum characterizing liver function.
Materials and methods. Blood sampling in the animals of the control group and in three tested groups was performed prior to the experiment and following the experiment (after 20 days), respectively. The following criteria of hepatocyte toxicity were investigated: the level of the general and direct bilirubin, general cholesterol and triglycerides, high- and low-density lipoproteins, alanine aminotransferase and aspartate aminotransferase activity. Blood tests were performed using a Sapphire-400 (Tokyo Boeki ltd, Japan) automatic clinical analyzer with the standard Cormay (Poland) sets of reactants.
Results. The experiment showed that the local radiation therapy on the liver region led to a growth in the indicators of pigment exchange, total cholesterol, low-density lipoproteins, triglycerides zdfl and transaminase activity. At the same time, the high-density lipoprotein level decreased. In the tested animals, INH application caused an increase in the bilirubin level and a change in lipid exchange indicators of the opposite direction in comparison with the animals receiving radiation therapy. INH did not change the transaminase activity. Liver radiation against the INH background led to less pronounced changes in blood biochemical indicators than in the group of animals having received exclusively radiation therapy. Such changes in blood indicators can be explained by a radioprotective effect of intermittent normobaric hypoxia.
Conclusion. Intermittent normobaric hypoxia has a normalizing effect on the blood biochemical indices when performing local radiation therapy on the liver region.

Aim. In this work, we undertook a study of age/sex-specific mortality rates from circulatory system diseases and certain nosological forms in 2015 and 2018 among outpatients of Research Institute — Ochapovsky Regional Clinical Hospital No. 1 delivering primary healthcare services.
Materials and methods. We studied age/sex-specific mortality rates from circulatory system diseases among adult population using the data from the medical records of deceased outpatients (Form 025/u), extracts from autopsy reports, as well as medical certificates of death for 2015 and 2018. Non-standardised and standardised mortality rates were calculated.
Results. In 2015, all-cause mortality rate by the medical organisation reached 6.2 per 1,000 population, with the total number of deaths from circulatory system diseases amounting to 49.6%. The non-standardised mortality rates from the circulatory system diseases totalled 307.81 per 100,000 population, including the non-standardised mortality rates from cerebrovascular diseases (44.68), ischemic heart disease (129.08) and myocardial infarction (4.96). Standardised mortality rates from circulatory system diseases amounted to 201.96 (men — 70.58, women — 131.38). In 2015, chronic ischemic heart disease (41.94%) ranked first as the cause of mortality among circulatory system diseases followed by diagnoses requiring additional interpretation and examination of primary medical documentation (35.48%), i.e. not clearly defined causes of death; and cerebrovascular diseases (14.52%). In 2018, chronic ischemic heart disease also ranked first (47.54%) followed by cerebrovascular (36.21%) and other diseases (16.39%) (ICD codes I26, I71.1, R00.8).

Conclusion. It is shown that more attention from the cardiological and therapeutic services of primary health care is required in coding death-causing circulatory system diseases.

Aim. To analyse the effect of supramolecular gels on the healing of experimental wounds using the approaches of problem-critical analysis.
Materials. 29 Russian and foreign publications indexed in RSCI (E-library, “Advanced Search” mode), Scopus (“Article title, abstracts, keywords”), Web of Science (basic mode), PubMed (basic search mode), Cochrane (“Article title, abstracts, keywords” mode) databases were analysed.
Results. Generalization of literature data published on the application of supramolecular gels under analysis for wound regeneration and repair was carried out.
Conclusion. Damage to the skin and deeper tissues is an urgent medical problem, which leads to a constant search for means to stimulate the regeneration of wounds. Supramolecular gels are promising compounds, which can be different in terms of chemical composition. These compounds can form and break down under the influence of various chemical and physical factors. Important properties of supramolecular gels involve the ability to perform the transport function for the delivery of biologically active substances to the tissues, as well as their antibacterial effect and wound-healing properties.

According to literature data, both the direct action of (B2 *, L, 2A) viral proteins and the inflammatory response of the body are distinguished among the Encephalomyocarditis virus (EMCV) virulence factors. Depending on the EMCV strain and the type of the infected animal, the severity and nature of the disease is shown to be characterized by specific clinical manifestations. Differences in the pathogenetic mechanisms of tissue lesions depending on the magnitude of the virus infectious dose are established, e.g., in the development of EMCV-induced diabetes. The EMCV action was studied in vivo on such experimental animals as pigs, rodents and monkeys. The range of affected animals is extremely wide, with the infection being common almost everywhere. Thus, numerous works describe a fairly high immunological stratum among people, as well as disease outbreaks among the population. It is concluded that EMCV is dangerous not only for zoos and primatological centres, but also has a clear zoonotic potential.

Aim. To show the variety and severity of the clinical symptoms of a rare hereditary disease — Вardet — Biedle syndrome — in a14-year-old girl.
Materials and methods. We carried out a retrospective analysis of anamnestic data, the course of the disease, laboratory and instrumental data, as well as the therapy of a 14-year-old patient with Вardet-Вiedlе syndrome.
Results. A 14-year-old patient with hereditary Вardet — Вiedlе syndrome (polydactyly, mental retardation, progressive obesity, pigment retinopathy) was found to have a congenital abnormality of kidney development — hypoplasia and dysplasia of the only right kidney complicated by chronic secondary pyelonephritis with the development of chronic kidney disease. Urine tests revealed leukocyturia, bacteriuria and proteinuria. The echo-signs of diffuse changes in the parenchyma of the right kidney were found during the ultrasound kidney examination. The left kidney was not determined. The conclusion of dynamic renal scintigraphy: the image of the left kidney is not reliably visualized (a sharp decrease in the function or absence of the kidney), the preserved filtration function and a moderate decrease in the excretory function of the right kidney. Intoxication syndrome, leukocyturia, bacteriuria and proteinuria were relieved against the background of antibacterial (Ceftriaxone) and symptomatic therapy.
Conclusion. We have described a clinical case of the Вardet — Вiedlе syndrome with congenital kidney malformation (impaired function), but with the normal structure of the internal reproductive organs and sexual development. In the future, due to the development of chronic kidney disease, the patient should receive specialized nephrological care, as well as be observed by endocrinologist due to a high risk of developing type 2 diabetes mellitus.

Aim. To present a clinical case of pregnancy and childbirth in a woman with a kidney transplant with a favourable outcome for the mother and the fetus.
Materials and methods. We studied all medical documents — the pregnancy record, observations and delivery record — of a woman with a transplanted kidney.
Clinical case. The article describes the clinical observation of a pregnant woman, who is intended for continuous immunosuppressive therapy after the operation on cadaveric kidney allotransplantation.
Conclusion. Pregnancy management in patients with a transplanted kidney should be carried out under the supervision of an obstetrician-gynecologist, nephrologist and urologist, as well as under the permanent clinical and laboratory monitoring of all indicators of the mother’s body (blood and urine tests, blood pressure control) and the fetus (ultrasound, Doppler). This category of patients belongs to a high-risk group in terms of complications for the mother and fetus.