Background. The pandemic of severe acute respiratory syndrome COVID-19 drew the attention of researchers and practitioners worldwide to severe cardiovascular injury incurred by the new SARS-CoV-2 coronavirus.

Objectives. A review and structuring of recent evidence on the pathophysiological mechanisms of SARS-CoV-2 impact on cardiovascular system and its major acute complications, assessment of indirect pandemic effects on treatment and diagnosis in practical cardiology.

Methods. Literature sources were mined in the PubMed database with keywords “COVID-19” and “SARS-CoV-2” and the source type “Clinical Trial”, “Meta-Analysis”, “Review”, “Systematic Review”. The search depth was unrestricted, as the vast majority of publications appeared during the past year.

Results. A screening of over 12,000 sources produced 329 most relevant articles available full-text, with 65 included in the review. A key factor of the SARS-CoV-2 penetration into human cell is protein S facilitating the virus—angiotensin-converting enzyme 2 binding and final fusion. Myocardial damage in COVID-19 can occur due to excessive inflammatory response, the disbalance of myocardial oxygen demand and supply, vasculitis, atherosclerotic plaque rupture, coronary spasm, hypoxic vascular damage and endothelial dysfunction, microthrombi formation. The most critical acute cardiovascular complications of COVID-19, apart from myocarditis, are cardiac arrhythmias, acute coronary syndromes, acute heart failure, thrombosis and embolism. The COVID-19 pandemic exerts an indirect negative influence on medical aid in patients with cardiovascular diseases and complications.

Conclusion. Knowledge of the pathophysiological mechanisms of SARS-CoV-2 impact on cardiovascular system and major types of its acute complications allows targeted research into the scenarios of their prevention and treatment. A rational balance is expected between the infection control and treatment for critical noncommunicable, particularly, cardiovascular diseases.

Background. The use of injectables is becoming ever more popular in aesthetic medicine. However, no clear guidelines are provided for the diagnosis and treatment of their early and late complications.

Objectives. Assessment of ultrasonic diagnosis capacity for facial skin and soft tissue evaluation in post-contouring facial oedema.

Methods. A case-control cohort study of post-procedural oedema was conducted. Two cohorts were selected: women having oedema after facial contouring with hyaluronic acid fillers and those without evident somatic displays. The cohorts differed by the filler’s presence (infiltration surrounding geleomas) or absence (soft tissue infiltration) in the swelling as diagnosed with ultrasound. Subsequent high-resolution ultrasonography (HRUS, B-mode and Doppler imaging).

Results. HRUS was used to examine 67 women with oedema after facial contouring. The patients aged 22 to 65 years had filler injections in soft facial tissues 2 weeks to 3 years prior to the visit. The fillers contained hyaluronic acid in 67 cases. Swelling was acute, with a wavelike recurrent course. According to HRUS, 30 patients had the filler in the oedema projection, 30 — in adjacent zones, 6 had no filler in oedema and 1 had fibrosis-associated oedema. The main HRUS traits of filler-induced oedemas were facial contour distortions and a uniformly amplified echogenicity of surrounding tissues.

Conclusion. Patients with oedema after aesthetic contouring should have an ultrasound examination of facial skin and soft tissues for differential diagnosis, evaluation of the swelling degree and filler presence in soft tissues. Oedema typically develops in 3-4 months after the injection procedure. Hyaluronidase injections in the swelling zone are less effective without ultrasonic control.

Background. Pelvic prolapse is a common reason of gynaecological visits. Predispositions of genital prolapse comprise oestrogen deficiency, vaginal labour, congenital connective tissue dysplasia, etc. Specific approaches and treatments for genital prolapse are priority developments in gynaecological surgery.

Objectives. Assessment of the safety and efficacy of variant techniques for pelvic prolapse surgical correction depending on its type and clinical manifestations.

Methods. A total of 188 women were examined and treated surgically. The patients were divided in three cohorts by type of prolapse. Cohort 1 contained 108 patients with a pronounced defect of pubocervical fascia having mesh implants; cohort 2 — 65 patients without pronounced fascial defect having urethral slings and native-tissue corrections; cohort 3 — 15 prolapse patients having sacrovaginopexy for longer reproductive health.

Results. Two complications were observed: 1000-mL blood loss requiring internal iliac arteries ligation and haemotransfusion; 300-mL blood loss with pelvic haematoma opening and drainage. Postoperative period without peculiarities in all cohorts. Two patients developed vaginal mucosal erosion up to 1 cm in one month. One-year clinical monitoring in all cohorts showed an improvement in functional and anatomical outcomes.

Conclusion. Genital prolapse requires a personalised approach, which contributes to patient compliance and reduces postoperative complications and recurrences. Mesh implants improve surgical outcomes in patients with severe defects of pubocervical fascia, and urethral slings are effective in urinary incontinence.

Background. Cochlear implantation is currently the most effective method for oral-aural rehabilitation in children with severe sensorineural hearing loss and deafness. Nevertheless, some controversies remain on timing of surgery and use of mono- and bilateral implants.

Objectives. Assessment of the long-term results of oral-aural rehabilitation in children with mono- and bilateral cochlear implants depending on timing of the surgical intervention.

Methods. The following oral-aural rehabilitation phases were scored in children with mono-and bilateral cochlear implants: “Language stage of speech perception and production” and “Understanding of coherent speech and complex text”. A retrospective assay used data on 98 patients following long-term oral-aural rehabilitation after cochlear surgery. Command ofmain language components and oral speech was assessed in detail against 12 skill learning criteria by psychoneurologists and teachers of the deaf. Statistical analyses were carried out with MS Office Excel 2010.

Results. The “Language stage of speech perception and production” phase long-term scoring in children with bilateral cochlear implants demonstrated the skills of developing auditory memory, active (expressive) vocabulary, dialogic speech and voice control to account for an over 50% improvement in the cohort having had surgery under 3 years of age. In patients with monolateral implants, the additional distinctive skills were aural-visual and aural speech perception and command of coherent speech (over 60% difference vs. the cohort with surgery under 7 years of age). The “Understanding of coherent speech and complex text” phase scoring against three criteria was used to conclude on rehabilitation efficacy after cochlear implantation, approve early surgery and provide further counsel for social adaptation in cochlear implant patients.

Conclusion. A comprehensive post-cochlear implant rehabilitation scoring against a number of key criteria provides a more consistent view of oral-aural skill learning. A detailed evaluation of the basic communication tools like command of the main language components and oral speech affirmed the feasibility of bilateral cochlear implantation in children under 3 years of age. The results were used to advance social adaptation in cochlear implant patients.

Background. Navigation is an essential component of visualisation systems and the quality of space in the concept of a lean healthcare organisation. The major goal of a navigation system is to ensure comfort of the patient by optimising his quick orientation and self-routing through the building or the surrounding area of medical facilities. An effective navigation in terms of informative visualisation solutions provides a clear and understandable navigation content at a right time, place and to a necessary extent along the entire route of the visitor.

Objectives. Assessment of the extent, structure and quality of information conveyed by a healthcare institution’s navigation system from a lean production perspective.

Methods. The assay included 73 primary medical institutions from 11 subjects of the Russian Federation to scrutinise all internal and external navigational elements available on-site.

Results. The navigation systems’ content well satisfied the lean principles across all studied medical organisations, with no statistically significant differences country-wide. A routine correction of navigation systems is currently not realised by the absolute majority of organisations (84%, 61/73). The absence of informational noise was the highest-scoring criterion with various navigation panels (60%, 44/73), and facility detailing — the lowest-scoring one (44%, 32/73).

Conclusion. A substantive content is a full competent of navigation systems and should be considered in legal guidelines for improving their design code and brand books at the regional and federal levels. Improvement of navigation systems by content will significantly reduce the main and additional wastes of lean manufacturing incurred by both the patient and medical personnel. Medical organisations with active navigation systems require effective measures for their regular monitoring and content evaluation with control for errors, obsolete or irrelevant data.

Background. Cancer care involves a multidisciplinary approach to diagnosis and treatment of patients. A complex interaction of actors in the deployment of oncology services dictates usage of modern management technologies for improving the quality and efficiency of patient care through processes optimisation.

Objectives. Provision of recommendations for patient routing based on research into the oncology service inter-level information exchange, integration of the process approach and electronic services. The lack of a unified information space with a regional oncology service has been explained. Measures are proposed for the patient routing optimisation as part of establishing a unified digital oncology service circuit.

Methods. The oncology service was effectively remodelled through functional and information engineering of electronic services and the process management integration to establish a horizontal decision flow between facilities and employees on a process level bypassing the supervisor coordination. Statistical approaches were used to analyse the oncological patient population.

Results. The following electronic services have been implemented: specialised patient referral routing, telemedicine and teleradiology. A comprehensive information framework has been created comprising medical, laboratory and radiological information subsystems integrated through regional electronic services of the unified state healthcare information platform. The goals, objectives, general principles, architecture and expected social economic impact on healthcare of Krasnodar Krai have been defined.

Conclusion. Use of electronic services ensures an improved quality of specialised care and effective routing of patients. We perceive prospects of the integrated information platform in the extension and improvement of its subsystems’ functionality and content, sourcing more data providers and the circuit expansion to the federal and regional levels.

Background. Chronic osteomyelitis requires a multidisciplinary approach. The main contributors are physicians of two specialties, orthopaedic trauma and maxillofacial surgeons, depending on the pathology’s localisation. Each specialty often relies on its own research and experience, whereas a cross-disciplinary assessment of same pathology allows a broader perspective of the problem.

Objectives. A comparative survey of orthopaedic trauma and maxillofacial evidence on the aetiology, pathogenesis and treatment of osteomyelitis for effective sharing and leveraging of practices.

Methods. The review generalizes relevant publications on the etiopathogenesis and treatment of osteomyelitis of various location in different patient profiles indexed in the PubMed, Science-Direct and eLIBRARY databases from January 2014 till June 2020. The keyword queries were: osteomyelitis jaws [остеомиелит челюстей], osteomyelitis mandible maxilla, osteomyelitis lower limb [остеомиелит нижних конечностей], osteomyelitis microbiology antibiotic therapy [остеомиелит микрофлора]. We conducted historical and bibliometric analyses of domestic and foreign scientific archives on general and special issues in anatomy, aetiology, pathogenesis and treatment of chronic osteomyelitis of various location.

Results. The working ability and social adaptation are recovered in chronic osteomyelitis patients via a multicomponent process, which includes conservative therapy, surgical treatment and rehabilitation measures.

Conclusion. Main aetiological and pathogenetic traits of chronic osteomyelitis of various location can be used to lay out interdisciplinary tactics in purulent necrotic surgery utilising various materials and methods for function restore.

Background. Rett syndrome is a rare genetic disorder often mimicked by variant other illnesses, which hampers its timely diagnosis. Although knowledge of this pathology has grown remarkably over the past two decades, an appropriate diagnosis is necessary to exclude similar disease phenotypes and select an applicable therapy.

Clinical Case Description. A 3-yo girl was admitted with a loss of earlier motor skills. The girl had neurological monitoring since month 2 of age for a delayed psychomotor development and had courses of neurotropic and reconstructive therapy, ineffective. At 18 months she was diagnosed with infantile cerebral palsy, residual period, atonic-astatic form, grade 3, rehabilitation therapy ineffective. With the disease progression and loss of motor skills, the girl was referred to the Bochkov Research Centre for Medical Genetics for sequence genotyping of the MECP2 gene, which determined a heterozygous single-nucleotide polymorphism c.468C>G (p.D156E) diagnostic of the Rett syndrome. The Rett syndrome has poor prognosis for progressive motor and neurological deficiency and eventual severe mental retardation. Patients with the Rett syndrome can have life expectancy of up to 40—50 years with appropriate care but incur a high risk of sudden death.

Conclusion. The Rett syndrome is a rare disorder manifested by loss of earlier developed motor and speech skills. This report provides a clear case description and illustrates the difficulty of the syndrome timely diagnosis aggravated by a lack of specific paraclinical signatures. Molecular genotyping techniques allow a proper diagnosis and prognosis assessment in this pathology.

Background. Tumours of peripheral nervous system are represented by benign and malignant neoplasms with different clinical and biological traits. Malignant peripheral nerve sheath tumours of paraspinal localisation with the involvement of nerve structures are extremely rare and may occur isolated or comorbid with congenital neurofibromatosis. Current literature contains a few bioptic and selected autopsy clinical reports. Herewith, we present an own sectional observation of a rare malignant peripheral nerve sheath tumour with multiple metastasis supplemented with morphological and immunohistochemical descriptions.

Clinical Case Description. An autopsy was performed on a 30-yo man’s cadaver. A tumour infiltrate was observed along Th5—Th9 of the spinal column intimately associated with thoracic vertebral bodies. Metastases were detected in the right lung, myocardium, peripancreatic and perirenal adipose tissue. Histological tumour examination revealed heterogeneous solid and rosette-like structures. Tumour immunophenotype: vimentin+, pancytokeratin-, CD45-, S-100+, NSE+, GFAP-, proliferative activity index (Ki-67 = 75-80%). This profile is descriptive of peripheral nerve sheath malignancy of high grade with multiple organic metastases.

Conclusion. The sectional observation presented illustrates the difficulty to in vivo diagnose rare peripheral nerve sheath malignancies due to their infiltrative growth into spinal bone marrow and metastasis to organs (lungs, myocardium, peripancreatic and perirenal adipose tissue).

Background. Mitral valve prolapse has common prevalence of 1% in population. Patients with mitral valve prolapse (MVP) continue to pose a major challenge in practical cardiology for its nonspecific manifestations, usually, palpitations and atypical chest pain. Several studies have demonstrated a high incidence of ventricular arrhythmias in individuals with MVP. MVP was observed in 2.3% of patients with sudden cardiac death. Comparing to the common population with sudden cardiac death, MVP patients belonged to a younger age group and less frequently had concomitant cardiovascular pathology.

Clinical Case Description. Patient T. referred with complaints of transient constricting chest pain at rest and exercise, dyspnoea at exercise. A total duration of ST-T segment displacement episodes was 168 min, with painless episodes prevailing. Spiral computed angiography did not reveal calcinosis, soft coronary atherosclerotic plaques or abnormal arterial origins. Severe ventricular repolarisation abnormalities with sinusoidal T-U waves morphology in MVP are harbingers of sudden cardiac death, despite a normal QT interval duration. The T wave inversion in the lower lead and ventricular extrasystole also comprise the risk factors for sudden cardiac death in patients with MVP.

Conclusion. Mitral valve prolapse caused an ischaemic ST-T segment depression in a young woman indicating a high risk of sudden cardiac death and need for immediate drug therapy. The Russian recommendations on treatment of connective tissue dysplasia and known literature suggest magnesium preparations as a preferred medication. Beta-blockers are effective in increased sympathetic nervous system reactivity or tone. Collagen synthesis stimulators, vitamins C, D, P, group B, preparations of magnesium, calcium, manganese, copper and antihypoxants are also recommended. Treatment with bisoprolol and magnesium orotate eliminated ischaemia and ventricular extrasystoles and improved the patient’s condition.

Background. Lean production technologies in medical institutions are deployed within the national program “Healthcare”. The vocational training of medical personnel in lean technologies have become a timely demand. Educational organisations are achieving this goal via including philosophy, the principles and techniques of lean production in curricula and involving students and residents in project activities.

Objectives. Assessment of driving and restraining forces in the student community with respect to project activities within the “Lean University” concept initiative.

Methods. The study unitised Force Field Analysis and the Kurt Lewin’s 3-stage Model of Change. The sample comprised students of Kuban State Medical University, Ministry of Health of the Russian Federation. An anonymous survey of students from two study cohorts (with and without experience in the “Lean University” activities) revealed the main driving and restraining factors shaping the students’ attitude towards the “Lean University” initiative.

Results. A total of 1508 students were surveyed. The survey revealed the following major driving forces that motivate students’ project activities: the intention to solve a problem that affects students (60%, experienced cohort), the intention to gain new experience, knowledge and skills (40%, inexperienced cohort). The intention to benefit a university was the second motivating in both respondent cohorts (57 and 36%, respectively).

The restraining factors for students to participate are: a lack of free time (over 60 respondents in each cohort), lack of understanding of the project’s matter (over 30% in each cohort), erroneous belief in the infeasibility of remote participation (no or seldom visits to the project’s office) (19% of respondents in inexperienced cohort).

Conclusion. Guidelines have been formulated to encourage the student community to develop practical skills in lean technologies for improving the overall internal processes efficiency at a higher educational institution.