Background. Preterm prelabor rupture of membranes constitutes a pregnancy complication that accompanies preterm labor. Since this complication increases neonatal and maternal morbidity and mortality, it is relevant to conduct studies on the effect that the length of the latency period in preterm prelabor rupture of membranes has on the health status of the mother and child.
Objective. To identify risk factors for preterm prelabor rupture of membranes in order to predict complications in subsequent pregnancies (possibly with the use of artificial intelligence).
Methods. We conducted an observational cohort study examining the medical records of 82 pregnant women aged 18 to 43 years at 25–36 weeks of gestation diagnosed with preterm prelabor rupture of membranes (medical histories of pregnant women, labor records, and medical records of newborns). The study was conducted at the Perinatal Center of the Children’s Regional Clinical Hospital of the Ministry of Health of Krasnodar Krai. The medical records of pregnant women and newborns delivered in 2022–2023 were examined. A total of 1675 labor records were analyzed, of which 82 (4.9%) were selected as consistent with the “diagnosis of preterm prelabor rupture of membranes” (i.e., breaking of waters before 37 weeks). Depending on the length of the latency period, all subjects were divided into three groups: Group 1 (n = 35) with the latency period lasting from 12 to 24 hours; Group 2 (n = 8) with the latency period lasting from 24 to 48 hours; Group 3 (n = 39) with the latency period lasting from 48 hours and more. The study examined the anthropometric data of pregnant women and newborns, reproductive history, the course of current pregnancies, their outcomes, laboratory data, and the health status of newborns according to medical records. The statistical analysis was performed using Statistica 13.3 (Tibco, USA). The generally accepted level of statistical significance p = 0.05 was adopted.
Results. The most significant differences between the groups of patients with preterm prelabor rupture of membranes were observed in the number of smoking fathers, pregnancy duration, and endometrial echo on ultrasound after delivery. Such information provides a means to predict the course of subsequent pregnancies and can identify a group of patients in need of obstetric rehabilitation.
Conclusion. The analysis of somatic and reproductive history and the course of current pregnancies, as well as the assessment of neonatal health, served as the basis for developing a program for patients with a history of preterm prelabor rupture of membranes and in need of obstetric rehabilitation.

Background. In present times, no unified standard for selecting a neoadjuvant chemotherapy regimen for breast cancer exists. Although the efficacy of neoadjuvant chemotherapy has been confirmed by numerous clinical studies, tumor drug resistance develops in some cases, which reduces the expected effect of neoadjuvant chemotherapy. Currently, drug resistance to neoadjuvant chemotherapy is a major cause of treatment failure and one of the most challenging problems in the therapy of metastatic and locally advanced breast cancer. Objectives. To evaluate the efficacy of neoadjuvant chemotherapy in HER2/neu-negative locally advanced breast cancer. Methods. A nonrandomized comparative study involving 187 women with a verified diagnosis of HER2/neu-negative (human epidermal growth factor receptor) primary locally advanced (T3N2, T4N0-3) breast cancer was conducted. From 2020 to 2024, these women (mean age of 53.6 ± 7.8 years) underwent therapy, follow-up, and examination in the Crimean Republican Oncological Clinical Dispensary named after V.M. Efetov, Republic of Crimea. At the first stage of neoadjuvant chemotherapy, all patients received a combination of doxorubicin and cyclophosphamide intravenously once every 21 days within four courses; the effect was evaluated. At the next stage, taking into account the immunohistochemical subtype and prescribed cytostatics, the studied cohort of patients was divided into subgroups. Patients with luminal breast cancer (n = 130) received standard (175 mg/m² once every 21 days within four courses — 96 patients) and dose-intensive (paclitaxel 80 mg/m² once a week, 12 administrations — 34 patients) chemotherapies. Patients with triple-negative breast cancer (n = 57) received standard (paclitaxel 175 mg/m² once every 21 days within four courses — 42 patients) and dose-intensive (paclitaxel 80 mg/m² in combination with carboplatin AUC2 (Area under Curve) once a week, 12 administrations — 15 patients) chemotherapies. The results of neoadjuvant chemotherapy were analyzed by calculating the overall objective response rate and tumor pathologic complete response. Statistical analysis was performed using Microsoft Office Excel 2007 (Microsoft, USA), IBM SPSS Statistics, version 23.0 (IBM, USA), and both parametric and nonparametric statistical methods. To analyze the differences in two independent groups, Pearson’s χ² test or Fisher’s exact test (for comparison of very small samples) were used. Differences were considered statistically significant at p ≤ 0.05. Results. During neoadjuvant chemotherapy of HER2/neu-negative locally advanced luminal breast cancer, weekly administration of taxanes after anthracycline therapy does not statistically significantly increase the overall objective response rate and tumor pathologic complete response. The detection rate of resistant forms of locally advanced breast cancer affected by ongoing taxane therapy (paclitaxel 175 mg/m² once every 21 days) is higher in comparison with anthracycline therapy (p = 0.005). Weekly administration of taxanes in combination with platinum-based drugs after anthracycline therapy in locally advanced triple-negative breast cancer does not significantly increase the overall objective response rate and tumor pathologic complete response. The detection rate of resistant forms of locally advanced breast cancer affected by ongoing taxane therapy (paclitaxel 175 mg/m² once every 21 days within 4 courses) is statistically significantly higher compared to neoadjuvant chemotherapy based on anthracycline cytostatics (p = 0.02). Conclusion. The applied regimens of neoadjuvant chemotherapy are characterized by a high incidence of post-cytotoxic complications in the studied subgroups. In the group of triple-negative breast cancer, the combination of weekly paclitaxel and carboplatin administrations is accompanied by marked asthenization. In this regard, priority at the beginning of treatment should be given to anthracycline antitumor drugs.

Background. Acute pancreatitis remains a global health problem associated with high mortality and significant financial costs. Although up to 80% of cases are mild, the remainder may progress to severe conditions requiring active treatment, the effectiveness of which depends largely on the accuracy of early risk assessment. Conducted studies have revealed no reliable method predicting an adverse outcome of acute pancreatitis, taking into account its pathogenesis, and being equally effective for all etiologic forms. This emphasizes the need for further research to improve prognostic methods.
Objectives. To determine the prognostic value of tools (scales and criteria) for assessing the risk of adverse outcomes of acute pancreatitis with different etiologies.
Methods. A retrospective observational study was conducted on the basis of the Regional Clinical Hospital No. 2, Krasnodar Krai in the period from 01.01.2023 to 01.11.2023. 541 patients were evaluated according to the inclusion criteria. 512 patients aged 18 years and above were included in the study. Patients were divided into groups according to etiologic factors. The statistical significance of the available methods for predicting adverse outcomes (quick Sepsis-related Organ Failure Assessment (qSOFA), Bedside Index of Severity in Acute Pancreatitis (BISAP), Systemic Inflammatory Response Syndrome (SIRS) criteria, the level of C-reactive protein in the blood) for the total cohort and in groups divided by etiology was assessed by using ROC analysis and comparing their prognostic value. Statistical data processing was performed using MedCalc v22.020 (MedCalc Software Ltd., Belgium) and Microsoft Office Excel 2016 (Microsoft Corporation, USA) software packages.
Results. In 309 (60.3%) of 512 cases, the etiologic structure was dominated by alcohol and alimentary factors. Biliary pancreatitis was observed in 176 cases (34.4%) and traumatic pancreatitis was observed in 27 cases (5.3%). In 35.2% of patients, acute pancreatitis occurred in severe form. The overall mortality in the studied cohort amounted to 10.5% (54 patients). At the same time, mortality was different in groups divided by etiology: 15.3% in the group of patients with biliary pancreatitis (the highest mortality among all groups); 8.1% in the group of patients with alcoholic-alimentary pancreatitis; 7.4% in the group of patients with traumatic pancreatitis. When analyzing patients’ survival in subgroups, a statistically significant difference in the share of fatal cases was observed. In the follow-up period, the risk of mortality in patients with biliary pancreatitis was 2.3 times higher than in patients with alcoholic-alimentary pancreatitis and 4.3 times higher than in patients with traumatic acute pancreatitis. The analysis of the cohort revealed the SIRS criteria (AUC 0.831) to be the most effective in predicting adverse outcomes. However, when analyzing subgroups, other data were obtained. For the alcohol-alimentary etiology of acute pancreatitis, the qSOFA scale showed the greatest prognostic value (AUC 0.874, confidence interval of 95% 0.831–0.909; p < 0.001). For biliary pancreatitis, the SIRS criteria provided a more accurate prognosis (AUC 0.857, confidence interval of 95% 0.796–0.905; p < 0.001). For traumatic pancreatitis, only the SIRS criteria produced valuable prognostic results (AUC 0.700, confidence interval of 95% 0.494–0.860; p = 0.014). At the same time, BISAP, qSOFA, and the level of C-reactive protein showed no prognostic value.
Conclusion. Available tools for assessing the risk of adverse outcomes in patients with acute pancreatitis demonstrate different effectiveness depending on the etiology of acute pancreatitis, which emphasizes the need for large-scale studies to develop universal multifactorial scales and/or biomarkers capable of accurately predicting disease progression.

Background. In recent years, major non-communicable diseases have become the focus of increased attention from domestic and foreign researchers. The problem of the spread of these diseases exacerbated by the COVID-19 pandemic represents a serious medical and social problem to public health. The variety of systemic lesions and various disorders, as well as multisystemic disorders in patients who have undergone COVID-19, requires careful analysis. One of the key preventive measures taken by medical organizations includes conducting a health check-up of the population, including those who have undergone coronavirus infection. This measure provides important information on the spread of non-communicable diseases and makes it possible to assess the extent to which citizens are engaged in the program and committed to a healthy lifestyle.
Objectives. Examine the spread of non-communicable diseases in the population before, during, and after the pandemic.
Methods. A retrospective analytical descriptive study of primary disease and overall incidences of the major non-communicable diseases in the population of the Republic of Bashkortostan was carried out in dynamics for the period from 2013 to 2023 using the state statistics: data on the population number of the Republic of Bashkortostan of the corresponding years; data from the No. 131/o sectoral statistical reporting “Data on the health check-up of certain groups of the adult population”; data contained in the No. 12 forms of federal statistical monitoring “Data on the disease incidence registered in patients living in the service area of the medical organization”. The dynamics of the incidence of chronic non-communicable diseases was assessed using the data on population seeking medical treatment and the results of preventive medical examinations and health check-ups. The main indicators of the study were: the overall incidence per 100,000 population and the primary disease incidence per 100,000 population (both seeking medical treatment); the proportion of the population who underwent a health check-up; the visibility indicator; incidence dynamics; the rate of increase (decrease) in incidence for all classes of diseases and major non-communicable diseases, such as neoplasms, circulatory diseases, respiratory diseases, and endocrine diseases. The results of health check-ups were assessed by detected circulatory diseases per 100,000 population and primary detected circulatory diseases per 100,000 population. In this study, the method of statistical analysis of dynamic series was used. Statistical processing of the results was carried out using Microsoft Office Excel 2021 (Microsoft, USA).
Results. An increase in the number of pathologies of the cardiovascular system detected during health check-ups was observed in the population of the Republic of Bashkortostan from 2013 to 2023. In the early post-COVID-19 period of 2021–2023, the share of first-time detected circulatory diseases increased, and the rate of increase amounted to +197.6%. Based on the statistics, analysis of all cases of non-communicable diseases registered from 2017 to 2022 made it possible to conclude that the overall incidence of the adult population during the studied period increased in all classes of diseases with an increase rate of +20.1%. The primary disease incidence of non-communicable diseases increased, and the rate of increase amounted to +32.6%. In most cases, patients sought medical treatment for respiratory diseases (the rate of increase amounted to +35.5%). The number of first-time detected respiratory diseases increased (the rate of increase amounted to +43.8%). The overall incidence of circulatory diseases increased with the rate of increase of +32.2% and the primary disease incidence increased with the rate of increase of +22.0%. The early post-COVID-19 period saw an increase in the share of the population seeking medical treatment for neoplasms, including primary medical treatment (the rate of increase amounted to +21.2%). An increase in primary medical treatment for endocrine diseases was also determined (the rate of increase amounted to +19.6%).
Conclusion. A new coronavirus infection represents an additional risk factor for major non-communicable diseases in the adult population and encourages their rapid spread. Post-COVID-19 changes can affect the population regardless of the severity of the previous diseases, including those individuals who haven’t been ill before.

Background. One of the key aspects of state policy aims to improve the quality of medical services, and highly qualified medical professionals play a significant role in ensuring this process. In recent years, certain positive changes have been observed in the staffing issues in the health care system. However, the problem of staff shortages in medical organizations remains unsolved, which affects the reduction of efficiency and effectiveness of measures aimed at preserving and improving public health.
Objectives. To describe approaches to adequate staffing in medical organizations and formation of personnel reserves at the regional level.
Methods. A retrospective analytical descriptive study of the data of the state statistical observation form No. 30 “Information about the medical organization” for the period 2019-2024, the data of the “Medical Center for Information and Analysis” in Stavropol Krai, and the data of the Department of the Federal State Statistics Service for the North Caucasian Federal District for 2021–2023 was conducted. In this study, the following parameters were evaluated: availability of qualified medical staff in public institutions of Stavropol Krai; availability of narrow specialists in all specialties; wages and social benefits of medical workers. Accumulation of primary information as well as content visualization based on the obtained results were performed in Microsoft Office Excel spreadsheets (Microsoft, USA); statistical processing was carried out in the SPSS for Windows v. 26.0 software package (IBM, USA).
Results. The study substantiated the possibility of creating the “Portal for career development of medical staff in Stavropol Krai”, i.e., a specialized electronic platform for the recruitment of medical workers and job search by graduates. Conclusion. The planned sectoral changes, such as the creation of a unified platform for a center of medical staff in the healthcare system of Stavropol Krai, will make it possible to improve the efficiency of management decisions as well as attract young specialists to the industry.

Background. Epidermolysis bullosa represents a group of genetic skin diseases caused by mutations in genes for structural proteins of the epidermis and dermo-epidermal junction. The population incidence of congenital epidermolysis bullosa in Russia amounts 1:50,000– 1:300,000. Improved early diagnosis and treatment of genetic diseases leads to patients reaching reproductive age, which makes it possible for them to make informed choices about pregnancy and childbirth. World literature contains little information on the management of pregnancy and childbirth in epidermolysis bullosa. In this regard, we consider it important to present the clinical experience of pregnancy and delivery of a patient with this disease.
Clinical case description. The clinical experience of managing pregnancy and childbirth in a patient with generalized dystrophic epidermolysis bullosa is presented. The patient performed delivery by cesarean section at term using spinal anesthesia and observing no complications for both mother and newborn. Special precautions were taken during diagnostic and surgical interventions. Given the high probability of bullae formation due to friction and skin shear, a plan was developed to prepare the patient for delivery, measures were taken to prevent trauma to the skin and mucous membranes, and anesthesia method and postoperative care for the patient and the newborn were defined. In order to reduce skin traumatization during all manipulations, sanitary napkins, emollients, non-adhesive silicone tapes and dressings were used. Newborns were provided with special care to prevent possible skin injuries. Although epidermolysis bullosa increases the risk of maternal complications, joint efforts of obstetricians, dermatologists, anesthesiologists, neonatologists, and psychologists manage to minimize complications for both mother and newborn when managing pregnancy and childbirth.
Conclusion. A multidisciplinary approach involving an obstetrician-gynecologist, dermatologist, anesthesiologist, neonatologist, and psychologist improves the outcomes of pregnancy and childbirth management and minimizes risks to both mother and newborn.

Background. The article investigates a lifestyle of the elderly population of the largest industrialized region of Russia and describes the subsystem of activities ensuring health and healthy lifestyle of silver-age citizens in this region. The research project is carried out taking into account the problems of active longevity; the methodology is based on the concepts of subjective well-being and subjective health. Objectives. To describe silver-age citizens in one of the typical industrial Russian regions (Sverdlovsk Oblast) taking into account two socially significant characteristics of their lifestyles: self-perceived health status and self-perceived character and level of social activity; to identify connections between them and other demographic and social indicators. Methods. “Social participation of older people in the Russian regions in the post-pandemic period” project supported by the Russian Science Foundation served as the empirical basis of the study. Data collection methods included a survey of the elderly people aged 60 to 98 years conducted in different municipalities of the Sverdlovsk Oblast from May to September 2023. The sample type is quota sampling structured in accordance with the general population by gender and type of settlement. The sample size is 690 cases. The results of the study showed that self-perceived health status and self-perceived level of social activity are interrelated and interdependent, can be considered as the basis of subjective well-being of an elderly person, and provide an important condition for an active and healthy lifestyle. Their connection with a complex of other demographic (sex, age, and territory) and social (education, employment, family ambiance, preferences for types of social practices and forms of activity, etc.) factors is considered, which makes it possible to describe both these basic characteristics and their social context in a more informative way. Results. The data analysis revealed statistically significant links between the self-perceived health status of elderly residents of the Sverdlovsk Oblast and their social activity in cultural, educational, developmental, sports, and recreational spheres of life. The research data show that self-perceived health status is associated with orientations to prosocial behavior. The stronger the Ural silver-age people’s orientation to helping behavior practices and helping other people, the more positive their self-perceived health status is. Social exclusion is shown to be an important factor determining not only subjective health, but also the quality of life of the elderly people in general. Conclusion. The revealed connection between self-perceived health status and different types of social activity of elderly people will help therapists to carry out more effective prevention of age-related socio-psychological changes in their patients due to complex recommendations that take into account the need for their inclusion in various practices of social interaction to maintain their physical and mental health.