This study examined the prevalence of hematogenous thrombophilia markers in patients with various types of thrombotic complications, heredity for pathological thrombus formation, and assessed the effectiveness of dabigatran, rivaroxaban, and apixaban for secondary thromboprophylaxis in such patients. The most common thrombotic complications in patients with hematogenous thrombophilia were: lower extremity vein thrombosis and pulmonary embolism. In most cases (77%), there was a combined form of hematogenous thrombophilia, when a combination of two or more thrombogenic risk factors was registered. The most frequently diagnosed mutations were F5 Leiden, MTHFR in combination with hyperhomocysteinemia, PAI-1 in homozygous form, primary antiphospholipid syndrome and prothrombin mutation F2 G20210A, less common were deficiency of antithrombin III, protein C and protein S. Heredity of hematogenous thrombophilia was detected in 70% of patients. For secondary prevention of thrombus formation in hematogenous thrombophilia, dabigatran, rivaroxaban, apixaban are equally effective and safe.

Myasthenia gravis is a multifactorial disease in the development of which both environmental and genetic factors play an important role. Of the environmental factors influencing the development of myasthenia gravis, the literature describes the characteristics of the microelement composition of soils, water, food, air pollution, and previous infections. However, we did not find data on risk factors for developing the disease, including using the case-control method, in the available literature. The purpose of the study is to determine possible factors influencing the development of myasthenia gravis using the example of the population of the Amur region. An epidemiological study was conducted using the case-control method of 52 patient-control pairs matched by age (± 5 years), gender, and nationality. As of January 1, 2019 in the Amur region, 88 patients with a reliable diagnosis of myasthenia gravis were registered according to diagnostic criteria, of which 26 were men (29.5%) and 62 women (70.5%). As a result of the studies, a positive correlation was established between the prevalence and incidence of myasthenia gravis and the amount of pollutant emissions into the atmosphere. We also noted that the prevalence of myasthenia gravis is higher in areas with lower contents of copper, cobalt, zinc, especially their mobile forms, although we did not find a reliable correlation. Among patients with myasthenia gravis, there was a statistically significant predominance of those born in large families. Patients noted the connection between the onset of the disease or the deterioration of their condition with stress, intercurrent infections, pregnancy and childbirth, surgical interventions, the effects of drugs, and physical activity. A higher risk of developing myasthenia gravis is associated with reasons such as a history of acute stressful situations and past and chronic bacterial infections, especially chronic tonsillitis. The presence of acute stressful situations in the anamnesis as a risk factor for the development of myasthenia gravis suggests the inclusion of psychodiagnostic and psychotherapy methods in the complex of examination, treatment and rehabilitation of patients with myasthenia gravis. Taking into account the possible connection with streptococcal infection, we suggest paying special attention to the concomitant pathology of the ENT organs and promptly treating them with otolaryngologists.

The absence of positive dynamics in the morbidity and mortality rates from oncologic diseases in recent decades in the eastern regions of Russia served as a basis for studying the epidemiology of malignant neoplasms of the female reproductive system in a particular territory. Objective to assess the territorial peculiarities of the main morbidity and mortality rates of breast cancer (BC) and ovarian cancer (OC) in the population of the eastern regions of the Russian Federation (2012-2021). The data on morbidity and mortality, reporting forms of statistical records of oncological patients and regulatory documents of higher organizations, information on observations of the dynamics of changes in the numerical values of the indicators of the pathology under study were used in this work. In 2021, 3484 new cases of malignant neoplasms of the breast and 755 patients with ovarian cancer were registered in the Far Eastern Federal District. The maximum number of patients fell on the age group of 45-70 years old. The mean values of statistical incidence rates for breast cancer were 49.52±0,72^О/_ОООО (2018 – 49,61±0,73 ^О/_ОООО) and for ovarian cancer were 11,03±0,14 ^О/_ОООО (2018 – 10,95±0,21 ^О/_ОООО). By the end of the study period, the number of actively detected patients increased in breast cancer to 35,2% (2012 – 18,9%) and RNJ to 15,3% (2012 – 7,5%), as did the contingent accumulation index at the end of the year. During the study period, the number of patients with stages I-II of the tumor process increased (breast cancer +4,7%, cancer +13,2%) with a simultaneous decrease in the number of advanced forms of the disease. Morphologic confirmation of the diagnosis is represented by lower figures (98,3% for breast cancer and 94,5% for cancer) compared to the Russian average. The proportion of patients registered for 5 or more years was higher than in Russia, with mortality rates decreasing in the first year after diagnosis. The average values of statistical mortality rates amounted to 14,33±0.38 ^О/_ОООО (2018 – 14,65±0,41 ^О/_ОООО) for breast cancer and 5,13±0,09 ^О/_ОООО (2018 – 5,14±0,10 ^О/_ОООО) for cancer. The quality of activity of the oncological service of the district was marked by the index of reliability of registration, which in the east of the country practically did not differ from the indicators in the Russian Federation (RMJ – 0,26, RF – 0,25; RYA – 0,42, RF – 0,44). The number of patients with malignant neoplasms remains significant in the eastern regions of the Russian Federation against the background of a decreasing number of residents, which indicates a serious disadvantage in the formation of health of the inhabitants of these territories. The low level of active detection of the disease at early stages of its development did not allow to significantly change the morbidity and mortality rates. Preventive measures aimed at early detection of malignant neoplasms with mandatory work in dispensary groups of patients with background and precancerous diseases remain a priority in improving the oncological situation in the eastern regions of Russia. All this should be accompanied by sufficient provision of modern technologies of diagnostics and treatment with systematic training of qualified personnel for primary health care.

The prevalence of mycoplasma infection, including pneumonia, remains a pressing problem throughout the world. The purpose of the study is to study primary respiratory mycoplasmosis with the aim of early verification of this diagnosis and determination of the initiation of therapy. A retrospective study was conducted of 100 case histories of children aged 2 to 18 years who were discharged from the gastroenterology department of the Amur Regional Children’s Clinical Hospital in 2023 with a diagnosis of Pneumonia. The clinical picture, diagnosis and treatment of bacterial community-acquired pneumonia caused by mycoplasma pneumoniae (50 people - group 1) and pneumonia caused by typical pathogens (50 people - comparison group 2) were assessed. To verify the diagnosis of pneumonia, chest radiography was additionally used; to identify the mycoplasma etiology of the disease, positive levels of IgM and/or A were detected. Mycoplasma pneumonia (MP) and community-acquired pneumonia of other etiologies (CAP) are equally more common in children aged 12 to 18 years (p>0.05). Dry rales and fine wheezing occurred with equal frequency in the two groups. In MP, bilateral lung damage is more common (p<0.01), occurring with a dry cough (in 76% of children). Children with CAP, however, were significantly more likely to be diagnosed with stage 1 respiratory failure (RF) (p<0.01). From laboratory data, more than half of the children in group 1 (56%) had monocytosis, and in a third of cases (32%) there was eosinophilia. However, clear and reliable clinical and laboratory criteria for MP were not obtained in our study

Introduction. During the first year of the spread of the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the only available measures to combat it were social distancing, wearing protective masks, early detection and isolation of infected patients and those who had contacted them. Later, since December 2020, vaccines became available as the main tool to combat the pandemic[1]. In the Russian Federation, 4 vaccines against COVID-19 are officially registered: Sputnik V, Sputnik Light, EpiVacCorona and CoviVac. It has been proven that the new coronavirus infection has a negative impact on male fertility, causing secondary hyponadism [2]. Objective. To assess the effect of COVID-19 vaccines on male fertility based on the level of sex hormones and pituitary hormones in the peripheral blood, as well as spermogram parameters, after a full course of vaccination. Materials and methods. The study involved 60 men aged 19 to 38 years. 30 subjects were vaccinated with the two-component vaccine Sputnik V, the remaining 30 subjects were vaccinated with the two-component vaccine EpiVacCorona. Peripheral blood (total testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol) and ejaculate of the subjects were used as study material. Results. Analyzing the level of hormones in the peripheral blood, it was noted that all indicators after the full vaccination cycle were within the reference values. The parameters of LH and FSH in the subjects vaccinated with Sputnik V were significantly lower compared with the initial indicators. The level of testosterone (T) in patients vaccinated with EpiVacCorona was significantly higher compared with the indicator before vaccination (in both cases, p ≤ 0.05). As for the parameters of the spermogram, when comparing the indicators before and after vaccination, patients vaccinated with Sputnik V had a significantly higher parameter: sperm with normal morphology (p ≤ 0.05), in the group vaccinated with EpiVacCorona, the total motility of sperm and the class of «progressively motile» sperm were significantly higher after vaccination (p ≤ 0.05). In both groups, the MAR test score was significantly lower compared to the scores before vaccination (in both cases p ≤0.05). Conclusion. This observation demonstrated that COVID-19 vaccines do not have a negative impact on the male reproductive system. On the contrary, some peripheral blood and spermogram parameters had better results after vaccination. From this study, it can be concluded that the vaccines themselves, unlike the SARS-CoV-2 virus, do not have a pathophysiological effect on testicular tissue. Thus, vaccination is a safe and reliable method of protection, not only from the virus itself, but also from its complications.

The question of the long-term effects of the new coronavirus infection on the cardiovascular system is still open. The condition of the vessels, in particular their stiffness, is an independent prognostic parameter for the development of cardiovascular diseases, their complications and mortality. This study, conducted on men aged 18-40 years with a mild form of new coronavirus infection on day 8-10 of the disease, showed significant negative changes in the intensity of peripheral blood flow, arterial rigidity and saturation compared with the control group. It is important to use portable non-invasive devices for monitoring cardiovascular parameters in order to identify patients at risk of cardiovascular complications and correct their management tactics.

According to Russian epidemiological studies, the prevalence of CHF in the Russian Federation increased from 6.1 to 8.2% over a 20-year observation period. Modern therapy has reduced both the number of rehospitalizations due to CHF decompensation and mortality. In the Russian Federation, the average annual mortality among patients with clinically evident CHF is 12%. Reducing mortality and the number of hospitalizations is the main criterion for the effectiveness of therapeutic measures. Objective of the study: The objective of our study: to evaluate the effectiveness of ARNI in quadruple therapy in patients with CHF with a low left ventricular ejection fraction (CHFrEF). A total of 48 patients with stage 2 CHF with reduced ejection fraction (EF<40%) were examined: group 1 included 28 patients who received ARNI (valsartan+sacubitril, Uperio, Novartis, Switzerland) as part of a four-component combination therapy at a starting dose of 50 mg 2 times a day, group 2 included 20 patients receiving an angiotensin-converting enzyme inhibitor (ACE) – perindopril 5-10 mg/day. Patients were examined upon admission to hospital, after 1 and 6 months of treatment. During treatment, patients in both groups achieved target blood pressure levels. At the same time, the clinical effect in the treatment of patients with CHFrEF with ARNI developed faster, which was accompanied by achieving the target blood pressure level (p<0.01), reducing dyspnea and edema by the end of the first week. As a result of treatment in the 1st group, significant improvement in cardiac function was noted already after 1 month of treatment (p<0.05), after 6 months, further improvement in LVEF and cardiac volumes was observed (p<0.01). In the 2nd group, against the background of treatment, a slight improvement in these parameters was revealed after 1 month (p>0.05), and reliable improvement was noted only after 6 months of treatment (p<0.05). The drug Uperio demonstrated a significant advantage in reducing the NT-proBNP level by the end of the first month of treatment already at the starting dose of the drug (p<0.01). In both groups, improved exercise tolerance was observed. Moreover, after 1 month of treatment in the 1st group, the increase in the six-minute walk test was reliable, and in the 2nd group - only a tendency to its increase. It was found that Uperio, compared with perindopril, reduces the risk of rehospitalization. Thus, when treating patients with CHF with ARNI, the clinical effect develops quickly, is accompanied by good tolerability, improved hemodynamic parameters, which leads to a decrease in the functional class of CHF and an improvement in the prognosis of the disease.

In the realities of modern life, the level of third-party noise pollution is constantly increasing: the location of highways near residential buildings, the use of various home appliances, repair work in close proximity to working people, as well as large teams working in the same space. Acoustic load is one of the most significant environmental factors leading to increased fatigue, physical and mental stress, decreased performance and productivity, as well as significant stress and poor health. Prolonged sound exposure can lead to neurosis, cardiovascular diseases, and hearing loss or impairment. The purpose of the study. To assess the intensity of noise pollution in the dormitory of a medical university and determine its impact on the performance of students. Material and research methods. 150 students living in the dormitory took part in the survey. The noise level was measured using a Testo 815 sound meter in the morning and evening hours on different floors of the dormitory, in corridors and rooms. To assess the performance of students under the influence of irritating factors, in this case, noise pollution in the dormitory, a proof test by A.G. Ivanov-Smolensky. Results and discussion. The results of measuring the noise level in the dormitory showed that even with repair work on the first floors, the level of noise pollution practically does not exceed the permissible values, with the exception of the floor located above the one being repaired. Most students note silence as the most comfortable living environment, but when it changes, they experience mental and physical stress, fatigue, overwork and an increase in the number of conflict situations. Men and women react differently to sound frequency; males were more sensitive to high-frequency noise, and females were more sensitive to low-frequency noise. A functional test showed a significant decrease in the performance of students during noise exposure. Conclusion. The noise level in the hostel does not exceed acceptable standards, however, even the existing noise contributes to a deterioration in well-being and a decrease in performance.

The article presents an analysis of statistical data on malignant neoplasms incidence in pregnant women in the Amur Region, our own clinical cases on tactics of management of pregnant women with oncological diseases. The article summarizes diagnostic and treatment data on patients with pregnancy-associated breast cancer, cervical cancer and ovarian cancer.