Aim. To study clinical manifestations of urinary tract infections in pregnant women with type 1 diabetes mellitus (DM).

Materials and methods. Pregnant women with urinary tract infections (UTIs) were examined: 110 with type 1 diabetes mellitus (main group) and 133 without diabetes mellitus (comparison group). The diagnosis of UTI was based on the clinical picture (for manifestation forms) and confirmed by a dual culture method using both the classical approach and DipStreak tests. The determination of the sensitivity of the isolated microorganisms to antibacterial drugs was carried out by the disk diffusion test on Mueller-Hinton agar using paper disks. Instrumental research included ultrasound of the kidneys, urinary tract and fetoplacental complex.

Results. In the main group, UTIs were pyelonephritis, asymptomatic bacteriuria (AB) and low AB (10²–10⁴ CFU/ml) was detected in 38, 69 and 31 patients, respectively. In the comparison group, pyelonephritis, AB and low AB was detected in 41, 63 and 29 patients, respectively. In the main group, the classic course of pyelonephritis was observed in 44.7%, low-symptomatic — in 26.3%, “according to the type of carbohydrate metabolism decompensation” — in 21%, and the obstetric variant — in 7.9% of patients. In the comparison group, the classic version of pyelonephritis was in 70.7%, low-symptomatic — in 24.4%, asymptomatic — in 4.9%. Bilateral pyelonephritis in pregnant women with type 1 diabetes mellitus prevailed over unilateral: 65.8 vs 34.2%. During AB, in patients with type 1 diabetes mellitus, hyperglycemia was observed in 23.1% (n = 16), the threat of pregnancy termination in 53.6% (n = 37), and moderate preeclampsia in 17.4% (n = 12). In patients with low AB, glycemia above the target values was recorded in 16.1% (n = 5), the threat of pregnancy termination in 38.7% (n = 12), and moderate preeclampsia in 12.9% (n = 4).

Conclusion. Based on the specifics of the clinical manifestations of UTIs in pregnant women with type 1 diabetes mellitus, the following types of pyelonephritis can be distinguished: classic, low-symptom, “decompensation of carbohydrate metabolism” and obstetric. The classical course of pyelonephritis in pregnant women with type 1 diabetes mellitus is statistically significantly less common (p <0.05) as compared with pregnant women without diabetes mellitus. The features of AB in pregnant women with type 1 diabetes mellitus are the development of hyperglycemia and obstetric complications.

Aim. Analysis of operative delivery outcomes in pregnant women with abnormal invasive placenta depending on the endovascular treatment for intraoperative haemostasis.

Materials and methods. A retrospective study of operative delivery outcomes was performed in 178 patients with placental invasion using ultrasonography (US) data obtained at the Perinatal Centre of the Regional Clinic Hospital No. 2, Ministry of Health of Krasnodar Krai, in the years 2012–2018. In 2012–2014, delivery was managed without endovascular haemostasis (n = 44), and from May 2014 to December 2018 – with prophylactic balloon catheterization of common iliac arteries (n = 134). Upon intraoperative diagnosis of placental invasion, temporary balloon occlusion (TBO, n = 115) and/or uterine artery embolization (UAE, n = 33) were performed. Efficiency of endovascular methods for intraoperative haemostasis was assessed by comparing the degree of placental invasion, amount of blood loss and transfusion, frequency of hysterectomies (HE), duration of surgery, length of stay in intensive care units (ICU) and outcomes for the foetus.

Results. Adoption of endovascular methods for intraoperative haemostasis allowed the blood loss (p = 0.02), haemotransfusion (p = 0.012) and HE frequency (p <0.001) to be significantly reduced. In the absence of clinical and histological manifestations of placental invasion, no difference in blood loss was detected between the groups. The amount of blood loss increased with the degree of invasion. Surgery duration in patients with TBO was signifi cantly longer (p = 0.04). No difference was detected between the groups with respect to the ICU length of stay and outcomes for the foetus.

Conclusions. Establishment of endovascular haemostasis at the planned delivery of pregnant women with abnormal invasive placenta allows the blood loss and HE frequency to be reduced. Further improvement of US diagnostics of placental invasions is essential in pre-selection of patients for X-ray surgical care.

Aim. To analyse the current state of the medical services market in Nur-Sultan (Kazakhstan) in terms of providing medical care to foreign patients.

Materials and methods. The dynamics of medical tourism in Nur-Sultan was identified using the method of retrospective analysis. The main clinics providing medical tourism services in the capital city of Kazakhstan were characterised in terms of their advantages over competitor centres.

Results. A prerequisite for the development of medical tourism in a certain country is the development of the whole country as a tourist destination. The recognition of a country as a safe destination by international tourism rankings contributes to the confidence of medical tourists in the quality of the services provided. The following advantages of Nur-Sultan determining its potential as a medical tourism destination were identified: access to modern medical technologies and new facilities; a large number of medical institutions accredited by the Joint Commission International (JCI); a wide range of medical directions; a convenient geographical location; reasonable costs of medical services; security and political stability; the lack of a language barrier for patients from the Commonwealth of Independent States (CIS).

Conclusions. The capital city of Kazakhstan demonstrates a growing trend in the number of medical tourists. The largest number of tourists is currently from the CIS countries: Uzbekistan, Kyrgyzstan and Russia. It can be considered that, under a proper governmental policy, Kazakhstan’s potential as a medical tourism destination will be realised in the nearest future.

Aim. Analysis of the basic indicators of nursing personnel supply of the population and medical organisations providing outpatient care in the public health sector in the Russian Federation over the course of 2010–2018.

Materials and methods. The study was conducted using data from the Federal Statistical Observation Form No. 30 “Medical Organization Information” for 2010–2018. Descriptive statistics and comparative analysis were used to assess the country-wide 2010–2018 dynamics of the indicators of nursing personnel supply of the population and medical centres providing outpatient care, including supply with full-time and employed positions, full-time staffing, the ratio of part-time employment, the number and shortage of healthcare workers.

Results. For the period 2010–2018, the number of nursing personnel in medical units providing outpatient care increased by 2726 people (an increase of 0.5%), from 542,998 to 545,724. At the same time, the population supply with nursing personnel in outpatient medical units decreased from 38.0 to 37.2 per 10,000 population (a decrease by 2.1%), and staffing of full-time healthcare workers in this category decreased by 6.5%, from 94.2 to 87.7%.

Conclusions. The study demonstrates a remarkable shortage of paramedics in outpatient health care (exceeding 200,000 people per annum) over the entire observation period of 2010–2018.

Aim. Evaluation of the impact of tetrahydropyrido[2,1-b][1,3,5]thiadiazine derivatives on L-DOPA effects in the tail suspension test.

Materials and methods. Some tetrahydropyrido[2,1-b][1,3,5]thiadiazines exhibit a pronounced antidepressant and adaptogenic activity. We selected compounds that demonstrated the most potent antidepressant effect in the Porsolt’s forced swim test. We chose to combine two approaches in the study: estimation of the antidepressant drug impact on levodopa effects and the tail suspension test. Caffeine sodium benzoate, amitriptyline and fluoxetine were chosen as the reference compounds. Studies of the 1,3,5-thiadiazine effects on levodopa activity were undertaken to ground detailed downstream analyses of associated responses in the dopaminergic neurotransmitter system. We measured the rectal temperature in laboratory rats prior to and after tail suspension and the total active time during 5 min in the test.

Results. Administration of levodopa at a dose of 150 mg/kg led to a reduction in rectal temperature and the total time of physical activity in rats in the tail suspension test. The dosage of 500 mg/kg led to a temperature increase of 0.7°C prior to and after the stress and a longer maintenance of physical activity. Rats exhibited exophthalmos and polyuria.

Levodopa at a 150 mg/kg dosage in combination with caffeine sodium benzoate did not cause a significant increase in the body temperature and prolonged physical activity by 69% in the test vs. the control group. Amitriptyline in combination with levodopa at a dose of 150 mg/kg triggered a temperature increase of 1.3°C prior to and 1.85°C after tail suspension, thus leading to a prolonged physical activity. Levodopa at a dose of 150 mg/kg in combination with fluoxetine led to elevation of the body temperature by 0.6°C prior to and 0.55°C after the stress. The total active time exhibited a declining trend.

The substance TD-0348 reveals an antidepressant activity. Physical active time increased by 32% in the test vs. the control group. Temperature elevation by 1.15°C prior to and 1.25°C after the stress suggests activation of the autonomic nervous system. TD-0470 in combination with levodopa (150 mg/kg) led to a rectal temperature elevation by 0.4°C prior to and 0.7°C after tail suspension. Physical activity was prolonged compared to the levodopa-treated group (150 mg/ kg). TD-0479 led to a temperature elevation by 0.85°C prior to and 0.95°C after the stress and caused polyuria. Treatment with TD-0164 did not provide sufficient data to suggest an impact on dopamine metabolism.

Conclusions. The compounds TD-0348, TD-0470 and TD-0479 affect physiological processes in experimental rats in response to treatment with L-DOPA at a dose of 150 mg/kg, which suggests the autonomic nervous system (ANS) activation. TD-0470 exhibits antidepressant properties. Treatment with TD-0164 does not provide sufficient data to evaluate its dopamine-related effects.

This review article is devoted to the fundamental task of pharmacology, i.e. the research and discovery of novel medications that render the maximal therapeutic effect at the minimal side consequences to health. Over recent years, the world has witnessed a growing interest towards natural organic compounds on the basis of humic substances (HS), which are broadly applied in animal husbandry, agriculture and veterinary medicine due to a wide spectrum of biologically active properties. The results of chemical and biological trials demonstrate that HS have a great potential for various fields of medicine.

Numerous studies have demonstrated the cardioprotective, antioxidant, antitumour, antibacterial, antiviral, antifungal, antiallergic, membranotropic, hepatoprotective and anti-inflammatory properties of HS. In addition, these substances exhibit a stimulating effect on metabolism, thus enhancing specific and non-specific organismal resistance. Published evidence suggests no toxicity of HS and no inherent teratogenic, embryotoxic, mutagenic or carcinogenic properties.

Fulvic acid (FA) belongs to humic acids, a family of HS. In the present study, we review its chemical properties and biological activity from the standpoint of traditional medicine. Understanding biological properties of FA and its usage in novel drug design is a perspective avenue of research in contemporary medicine.

Published sources referenced in this review are indexed in Scopus, Web of Science, MedLine, the Cochrane Library, eLIBRARY, PubMed and other relevant databases.

The review addresses the problem of kidney lesions in patients with cardiovascular and oncological diseases. In the context of the current spread of cardiovascular and oncological pathologies, a growing number of patients reveal comorbid and/or polymorbid renal dysfunctions. In confluence with cardiovascular disorders, kidney lesions are manifested in various types of the cardiorenal syndrome. In current knowledge, the heart and kidneys are highly interdependent and interact across several interfaces in a complex feedback system. The kidneys can both play a target role and back-influence cardiac functions and pathology. Evidently, the development of acute kidney lesions and / or chronic renal dysfunctions worsens the prognosis of the primary disease and elevates risks of developing acute cardiovascular disorders. Combined cardiovascular and oncological pathologies are nowadays more common. Numerous patients with malignant neoplasms develop renal pathologies due to tumour infiltration or exposure to tumour metabolites, as well as indirectly through the nephrotoxic effect of antitumour chemotherapy and/or radiation therapy. Many studies show that acute kidney lesions and/or chronic renal disorders contribute independently to the severity of cancer and mortality rate. In recent decades, the level of serum creatinine is used as a marker of acute kidney damage, which although harbours inherent weaknesses of being responsive to a spectrum of renal and extra-renal factors and having a delay of 48–72 h of elevation in the blood after exposure to the trigging factor. In this respect, the development of novel kidney-specific lesion biomarkers continues. Among such candidate agents is the kidney injury molecule KIM-1.

Aim. To demonstrate an interesting clinical case of treating a patient with intradermal melanoma metastases.

Materials and methods. A patient with intradermal melanoma metastases was given a combined treatment including photodynamic therapy (PDT) and immunotherapy (intradermal administration of an immunological preparation into metastatic foci).

Results. A clinical case of a patient with a locoregional recurrence of skin melanoma (SM) of the left lower leg was described. Given the prevalence of the pathological substrate and the presence of concomitant pathologies, two treatment methods were selected – PDT and intradermal administration of interferon into metastatic foci. These methods provided both the local and systemic effect. As a result, the stabilisation of the tumour process was achieved.

Conclusion. Combined treatment of locoregional recurrences of skin melanoma using PDT and intrametastatic injections of immunopreparations can be used as an alternative to surgical intervention in somatically weakened patients with a large area of intradermal metastases, which will allow the tumour process to be stabilised. In cases where the area of locoregional intradermal recurrences in somatically compensated patients does not permit surgical treatment, the proposed technique may be the only possible treatment method.

Aim. Assessment of methods for prolonging gestation after an extra-preterm premature rupture of membranes (PROM) in a patient with abnormal invasive placenta and the efficacy of a multidisciplinary approach for treatment of a combined obstetric pathology in a tertiary perinatal centre.

Results. A clinical case is reported of PROM at 22⁺⁶ weeks’ gestation in a patient with two caesarean scars on the uterus and abnormal invasive placenta. In a tertiary perinatal centre, pregnancy was prolonged to 36⁺³ weeks’ term. The period between PROM and delivery was 96 days. A planned caesarean section and metroplasty were performed in the setting of temporary balloon occlusion of common iliac arteries. Blood loss was 75 mL/kg. Placenta increta without chorioamnionitis was confirmed histologically. The patient stayed in the intensive care unit for two days and was discharged home on the 8th day. The newborn was assigned the Apgar score of 6/6. For two days, ventilatory support was rendered in a neonatal intensive care unit. The newborn was diagnosed with congenital pneumonia, the first-degree hypoxic-ischemic damage of the central nervous system and transferred to the second phase of nursing.

Conclusions. A multidisciplinary approach and high technology facilities in the setting of a tertiary perinatal centre allow to reduce perinatal losses and provide high-quality care to patients with an increased risk of massive blood loss with the capacity to manage organ-preserving operative delivery with full rehabilitation in the postoperative period.

Aim. To present the first experience of a successful endovascular recanalisation and stenting of chronic post-thrombotic occlusion of the inferior vena cava and both common iliac veins in Krasnodar Krai.

Methods and materials. A man, 72 years old, was admitted with the complaints of intermittent claudication, pronounced edema of both lower limbs, compaction and hyperpigmentation of the skin of the lower legs. Using ultrasound and computed tomography angiography, chronic post-thrombotic occlusion of the inferior vena cava and common iliac veins was established. The severe course of post-thrombotic syndrome (15 points on the Villalta scale) and the failure of conservative treatment were regarded as indications for performing endovascular surgery. Through puncture accesses in both common femoral veins and in the right internal jugular vein, guides were introduced through the occlusion zone, and balloon angioplasty was performed, followed by stenting of the common iliac veins and the inferior vena cava.

Results. In-hospital and 4-month treatment results were analysed. The postoperative period was uneventful. The patient noted a decrease in the feeling of heaviness and edema in the lower extremities, as well as an increase in walking distance. A follow-up examination was performed following 4 months. The functional status significantly improved. The Villalta score was 4 points (absence or mild post-thrombotic syndrome). Ultrasound examination and computed tomography angiography established the patency of the stents in the inferior vena cava and in the common iliac veins.

Conclusion. Endovascular recanalisation and stenting of the inferior vena cava and common iliac veins is an effective treatment for severe post-thrombotic syndrome.

Aim. To demonstrate difficulties in diagnosing multiple myeloma at the out-patient stage on the example of a clinical case.

Materials and methods. The course of establishing a diagnosis in a 58-year-old patient complaining of pain in the hip joint was analysed on the basis of the patient’s medical records both at the out-patient and in-patient stages.

Results. A case of multiple myeloma occurring under the guise of common degenerative-dystrophic diseases is presented. An oncological diagnosis was suspected due to the patient’s complains of persistent pain, which was poorly relieved by non-steroidal anti-inflammatory pain agents, and progressive changes in the general blood test (acceleration of ESR to 40 mm/h, and then to 50 mm/h; reduction of hemoglobin from 145 g/l to 134 g/l). The diagnostic search started with an ultrasound examination of the abdominal cavity and pelvic organs, which revealed both an extensive formation in the pelvis in the right iliac region and the lymphadenopathy of the inguinal lymph nodes. Subsequently, spiral computed tomography of the abdominal cavity and the pelvis was conducted. In all bones at the study level, multiple spherical solid formations with uneven contours causing destruction of bone tissue were detected, allowing myeloma to be suspected. The patient was referred to the Republican Clinical Oncology Dispensary, where a percutaneous biopsy of the retroperitoneal neoplasm, as well as morphological and immunohistochemical studies, were carried out. As a result, the following diagnosis was established: multiple stage IIIA myeloma, first detected, with damage to the thoracic, lumbosacral spine, ribs, pelvic, and thigh bones. The patient was hospitalised in the Hematology Department of the First Republican Clinical Hospital, where he underwent chemotherapy according to the VCD scheme (bortezomib, dexamethasone, cyclophosphomide), and was discharged with improvement.

Conclusion. The diagnosis of multiple myeloma is a challenging task for a primary care physician due to the diversity of the clinical picture and the lack of clinical suspicion. At the same time, timely diagnosis of the disease at the out-patient stage can significantly increase the effectiveness of treatment and, therefore, improve the prognosis. Thus, more attention should be paid to the differential diagnosis of degenerative diseases of the musculoskeletal system and multiple myeloma.