The paper presents a retrospective analysis of the medical histories and pathoanatomic protocols of all deceased HIV-infected patients (n = 209) who received specialized medical care in the Novgorod Regional Infectious Diseases Hospital. The study was conducted for 14 years, from the moment the specialized department for HIV-infected patients was established until 2018. There is an increase in the number of HIV-infected patients in need of specialized inpatient care in the region. The reasons are the following: an insufficiently high proportion of patients registered at the dispensary with diagnosed HIV infection (79%); a high proportion (18,7%) of newly diagnosed patients; extremely low coverage (11,9%) of antiretroviral therapy, its late initiation and poor adherence. Against the background of the progression of HIV infection and the development of comorbid conditions, the mortality rate of HIV-infected patients in the hospital is increasing. Of the comorbid conditions, the following predominate: tuberculosis (20,1%), pneumocystis pneumonia (19,6%), cirrhosis of the liver (14,8%), sepsis (11,5%), cerebral toxoplasmosis (7,18%), cytomegalovirus infection (4,31%) and cerebral cryptococcosis (1,44%). Moreover, most of the listed diseases have specific prevention, which was not carried out in the cases of the patients due to late detection of HIV infection, untimely seeking medical care, and low adherence to dispensary registration and antiretroviral therapy.

The objective of this work which is the study of the immunopathogenesis of chronic hepatitis C (CHC) in patients with an unfavorable comorbid background is currently a topical area of research in connection with the search for the best tactics for managing and treating patients. The study involved 700 patients with CHC, observed in the period from 2013 to 2019 in Botkin hospital (St. Petersburg). Immunological features were studied in 79 patients with CHC. The concentrations of cytokines/chemokines: TNFα, IFNg, CCL20/MIP-3α, CXCL9/MIG, CXCL10/IP-10, CXCL11/ITAC in blood plasma were determined by multiplex analysis. In 61 patients, subpopulations of lymphocytes were determined: T-helpers, cytotoxic T-lymphocytes, B-lymphocytes, NK-cells, NKT-cells, and the expression of chemokine receptors CCR6 and CXCR3 on these cells by flow cytometry. The patients were divided into two groups with and without comorbidity, as well as non-infectious pathologies within the comorbidity group. Comorbidity was present in 63% of patients with CHC, among whom multimorbidity was found in 79.4%. The most frequent comorbidities were the following: diseases of the gastrointestinal tract and pancreas — 49% of cases; diseases of the circulatory system — 15.4%; and pathology of the endocrine system and metabolism — 13.9%. In the group of patients with comorbidity, the concentrations of the chemokines CXCL9/MIG and CCL20/MIP3-α were determined, which were 2 and 1.6 times higher than those in the group without comorbidity (p = 0.017). The suppression of the cells of the cytotoxic component of the immune system was more pronounced in the group of patients with aggravated comorbid background. Thus, the content of Th CCR6+, CTL, CTL CCR6+, NK CCR6+, NK CXCR3+, NKT CCR6+ and NK CXCR3+ in patients with comorbidities were 1.6; 2; 1.6; 1.8; 1.6; 2.7 and 1.7 times less than in the group without them. As a result of the study, more than half of the patients with CHC revealed the presence of various comorbid backgrounds. The cytokine profile showed high concentrations of CCL20/MIP-3α and CXCL9/MIG chemokines in the group of patients with comorbidity in comparison with patients without it, and the predominance of the CCL20/MIP-3α chemokine concentration in patients with endocrine pathology, including type 1 and type 2 diabetes. Also, a more pronounced suppression of the innate and adaptive cellular component of immunity with cytotoxic activity was revealed in patients with comorbidity.

COVID-19 is gradually moving into the stage of prolonged diseases, which is designated as post-COVID-19 syndrome. The clinical picture of these negative phenomena is quite diverse, covers dysfunctions of many organs and systems and is characterized by polymorphism of secondary and delayed diseases, complications, syndromes, and symptoms. The pathogenesis of their development is not clear enough; probably, they are based on the consequences of the acute phase of inflammation, systemic prolonged metabolic and structural disorders, including the studied genetic disorders. As the pandemic subsides, the number of people with clinical consequences of the disease increases, which become dominant and require the expansion of rehabilitation measures.

The COVID-19 was studied in 17 patients with various forms of hematological malingnancies and in 19 employees of the institute. Diagnostics of the infection were performed using real-time PCR. The dynamics of the level of IgG antibodies was also studied in this contingent. It has been shown that a higher antibody titer and their longer preservation are observed in patients after a severe form of COVID-19 (with pneumonia). Different dynamics of changes in the level of antibodies and a high drop frequency indicate the need for vaccination and compliance with strict preventive measures.

The article presents a brief review of scientific papers on the development of several hypersensitivity reactions in HIV-infected patients. A retrospective analysis of registered cases of HIV-infection combined with allergic diseases was carried out. The data was provided by the Novgorod Centre for the Prevention and Control of AIDS and Infectious Diseases «Helper». Based on the data of laboratory studies, the influence of allergic diseases on the immune status of HIV-infected patients was considered. Special attention was paid to drug hypersensitivity, including those developing from antiretroviral therapy.

The article describes a comparative analysis of changes in the regulation of heart rate among professional athletes in a state of cognitive and physical stress. The purpose of the study is to explore specific differences in wave parameters of heart rate variability both in the state of cognitive dissonance and when performing a dosed physical activity. The research involved two groups of athletes: 32 persons in the first group and 36 volunteer athletes in the second group. The subjects were males (mean age was 21±1.5 years) with a comparable level of physical performance, engaged in cyclic sports. The study was conducted in the afternoon at the same time; 2 hours before that, eating and physical activity were excluded. The duration of the study was about 30 minutes for each subject. The Valenta complex of functional diagnostics was used to register wave parameters of heart rate. The Kraepelin's arithmetic test was used as a cognitive load, and a standard veloergometric test PWC170 was used as a physical one. The Wilcoxon signed-rank test was used to characterize the differences and the Spearman's rank correlation coefficient — to analyze the relationship between the various indicators. The obtained data were processed using the STATISTICA 10 software package. It was shown that cognitive load reduced the proportion of high-frequency waves and increased the activity of low-frequency waves, but the total power of the spectrum was modulated individually. After the load test, the contribution of the low-frequency component of the heart rate variability significantly increased. A decrease in the total power of the spectrum was observed among all subjects of the second group. Thus, specific changes in the wave parameters of heart rate variability were discovered: each of them was comparable to those during cognitive and physical load.

In this work, the ultrastructural analysis of the structure of lymphangions of the thoracic duct of a rat was carried out. During the study, the lymphangions of the thoracic duct of outbred male white rats were studied under standard vivarium conditions. The material for electron microscopy was fixed in a 2.5% solution of glutaraldehyde on 0.1 M phosphate buffer pH of 7.2-7.4 for 2 hours, followed by fixation in a solution of 1% osmium tetraoxide for 1 hour at a temperature of 5°С. It was poured into a mixture of epon-araldite, and serial semi-thin sections with a thickness of 1-2 microns, which were stained with methylene blue 1% solution, were obtained. After identification of the necessary objects, the blocks were sharpened and targeted ultrathin sections were prepared on an LKB-3 ultratome, contrasted in a 2.5% solution of uranyl acetate and a 0.3% solution of Reynolds Led Citrate, and scanned in JEM-100 CX electron microscopes. The conducted research indicates that the thoracic lymphatic duct of a rat has a poly-lymphangion system construction. The functional organization of the muscle cuff and the valve section of lymphangions are determined by the ratio and orientation of smooth muscle cells, the geometry of the laying of collagen and elastic fibers.

The aim of the work was to evaluate the effect of polyphenolic extracts of northern berries (bilberries, cranberries, lingonberries, blueberries) on the level of free radicals in vitro and antioxidant defense processes in vivo. Standard research methods were used. Polyphenolic water-alcohol extracts were obtained from bilberries, cranberries, lingonberries, blueberries collected in the Surgut region of the Khanty-Mansiysk district of the Tyumen oblast of the Russian Federation. The inhibitory, antiradical activity of extracts of Vaccinium berries was established in DPPH and ABTS tests. Antioxidant activity was found in vivo in D-ROM and PAT tests, as well as in the test of oxidative hemolysis of rat erythrocytes after the administration of polyphenol extracts from cranberries, lingonberries, blueberries, and bilberries for 10 days. It is assumed that polyphenolic extracts of northern berries have the potential to influence the oxidative status of the body due to the presence of antiradical properties and the ability to increase the level of antioxidant protection.

While studying COVID-19 cases among children, one of the most important areas is the study of the multisystem inflammatory syndrome in children. This study aims to analyze the biochemical parameters of blood serum in children from 0 to 3 years old, that is, belonging to the age group atypical for the development of a clinically manifest multisystem inflammatory syndrome. It has been revealed that more than a half of the subjects have abnormalities in the biochemical parameters of blood serum corresponding to laboratory markers of the multisystem inflammatory syndrome in children, which indicates the possibility of the development of subclinical forms of this syndrome, associated in time with COVID-19, in children of different age groups. The results of the study substantiate the need for further investigation of biochemical parameters in children of different ages and for finding a solution to the issue of dynamic monitoring of children with identified abnormalities, taking into account the possibility of long-term impact of SARSCoV-2 on the organs and systems of a child's body.

The structural and functional changes in the liver among 120 patients with non-neoplastic cholestasis treated in the regional and central city clinics of Veliky Novgorod from 2017 to 2019 have been studied. According to the duration of cholestasis, two groups of patients were identified: the first one was 75 people with 10–14 days of cholestasis and the second one was 45 people with 3–6 weeks of cholestasis; the groups are comparable in gender and age. Primary and repeat liver biopsies have been studied before and after decompression. The digital data have been processed by the methods of variation statistics according to the Fisher-Student's. In patients of the first group, centrilobular bilirubinostasis and accumulation of bile acids in hepatocytes, stellate reticuloendotheliocytes, bile vessels and ducts were observed. Hepatocytes underwent degeneration and necrotic changes (functional cell mass was 12.356 ± 0.928). In patients of the second group with prolonged cholestasis, cholestatic processes, hepatocyte necrosis increased (functional cell mass was 6.517 ± 1.012), and false bile ducts were formed. Periportal fibrosis, incomplete septal cirrhosis, and later secondary biliary cirrhosis developed. With repeated biopsies in the first group, after decompression, there was a decrease in bilirubinostasis, the general structure of the hepatic lobule was moderately restored. In the second group of long-term cholestasis, sclerotic changes, fibrotic processes, histiolymphocytic infiltration, and proliferating biliary epithelium remained in the portal tracts. Thus, monitoring the state of liver tissue during primary and repeated biopsies provides an objective control of changes in liver histology before and after decompression and allows determining the effectiveness of the treatment, which is of paramount importance for the prognosis of the disease and the choice of tactics for conservative and prompt treatment.

A full examination of a dental patient is necessary for accurate diagnosis and the right tactics for treating the disease, but it has certain difficulties. Diseases of oral tissues are diverse in etiology, range, nature of the problems that arise. Some oral diseases have identical preliminary symptoms. These causes create diagnostic problems. Diagnosis of oral tissue diseases is based mainly on the patient’s medical history (disease course, type of symptoms, modulating factors, and accompanying symptoms) and a systematic clinical examination. The problem of a complete and comprehensive diagnosis of patients with pathological conditions of the oral cavity is still very relevant. It is necessary to create clear algorithms for examining patients with pathological changes in the tissues of the oral cavity to find a clear approach to diagnosis and treatment. Often, non-compliance with the protocols for examining a dental patient causes difficulties for practitioners in differentiating certain conditions of the oral cavity that have similar symptoms and clinical manifestations. Early detection of altered epithelium of the mucous membranes of the oral cavity can help in the timely diagnosis of malignancy processes and the necessary medical intervention. Changes in the structure, composition, and shape of oral tissue cells are one of the signs of cancer development, which can be detected at the intracellular level using pathomorphological examination with high-resolution electron microscopy. When determining the severity of pathological changes in the tissues of the studied biopsy specimens, hematoxylin-eosin staining procedures were carried out to more accurately analyze the structure of the cell elements of lymphocytes, cell mitosis; and the state and reaction of the connective tissue vessels were also assessed. On the example of biopsy specimens with severe hyperkeratosis and acanthosis, with the formation of large layers of keratin, the destruction of desmosomal connections of spinous layer cells with visible intracellular vacuolar dystrophy, as well as eosinophilic paranuclear and perinuclear densities was observed, which helped to differentiate pemphigus vulgaris. Cytological changes, including dyskeratosis, parakeratosis, hyperkeratosis, increased granulocyte count, karyorrhexis, pycnosis, together with an increase in the total number of lymphatic cells, were detected using immunocytochemical analysis of the biopsy specimens, which helped to differentiate the development of dense lesion of plasmacytoma in bone tissue.

The article explores the role of tumor-associated macrophages in the development, course, and resistance of non-small cell lung cancer, as well as potential drug targets. The place of tumor-associated macrophages in the tumor tissue, the variants of their differentiation, the patterns of their interaction with cancer cells and other components of the tumor microenvironment are described. Local and recruited tumor-associated macrophages interact with tumor cells, stimulating their reproduction, invasion, metastasis; with tumor immunocytes, suppressing their activity, causing the tumor to escape the immune response; and are also involved in processes limiting the effectiveness of antitumor treatment. The features of the prognostic significance of the content, the polarization of macrophages in the tumor, of the receptors and cytokines expressed by them are indicated. Potential therapeutic targets connected with tumor-associated fibroblasts and their activity are listed.

The informational and legal status of pharmaceutical consulting is explored in various studies and is enshrined in several regulatory documents. Informing patients about the use of medicines (drugs) is carried out by medical and pharmaceutical specialists. The lack of time for consulting, the complexity of terminology, possible drug interactions, the occurrence of unwanted side effects lead to misunderstanding and the risk of complications during a patient's disease. Sociological research data reflect a rather high prevalence of self-medication processes among the population in the Russian Federation. Low medical literacy of the population, the desire to self-medicate in difficult cases aggravate the economic inefficiency of the healthcare system. The situation of using plant-based medicines as self-medication means, affordable and useful, in the opinion of consumers, who do not always critically evaluate various information about medicines in the media, is considered. The necessity of increasing the knowledge of pharmaceutical specialists about plant-based medicines for timely and high-quality consulting of consumers of this popular group of products is shown. There are some known gaps in the legislation regarding the provision of patient consulting that need to be adjusted. The possibility of increasing the medical literacy of the population, the safe use of drugs can be realized with the further strengthening and improvement of the algorithms for conducting pharmaceutical consulting by pharmacy specialists, creating conditions for a longer and specialized communication with patients.

The study of indicators of lipid and carbohydrate metabolism in patients taking neuroleptic and psychotropic drugs is currently a very urgent problem. This is explained by an increase in the number of people taking these drugs. The study of the effect of psychotropic therapy on the parameters of lipid metabolism, lipid peroxidation processes, and the state of carbohydrate metabolism at various values of the neuroleptic load is of particular interest. The article describes the impact of typical and atypical psychotropic drugs on lipid and carbohydrate metabolism in patients requiring psychiatric care. Particular attention is paid to the effect of drugs from the group of atypical antipsychotics on metabolic parameters. The article is devoted to elucidating the effect of antipsychotic drugs on weight gain, the development of diabetes, and other metabolic disorders, which often lead to a deterioration in the clinical course of the disease and the state of health of patients. Despite the fact that various changes in metabolism have been studied by many authors, the mechanisms of these changes have not yet been finally established, and the relationship between lipid and carbohydrate metabolism indicators against the background of the use of antipsychotics and neuroleptics has not yet been studied enough.

The aim of this study was to determine the relationship between the indices of autonomic regulation of hemodynamics with the frequency of complications and unfavorable outcomes of acute coronary syndrome in operated patients. A comprehensive examination of 169 patients with ischemic heart disease (IHD) admitted with a diagnosis of acute coronary syndrome (ACS) within the first 2 hours after the development of prolonged ischemic pain syndrome or its equivalent was carried out. Criteria for the inclusion of patients in the study were the following: age from 40 to 75 full years; the presence of a diagnosis of ACS upon admission; coronary angiography within 2 hours. The diagnosis of IHD and its clinical forms were verified on the basis of modern examination methods, which included general clinical data, ECG, B-mode EchoCG, and coronary angiography. For coronary angiography, a Siemens Artis Zee apparatus with a detector size of 30x40 cm was used. The examination was carried out in the period from 1 to 12 hours from the moment of the onset of pain syndrome associated with the genesis of the current ACS. The control group to obtain comparative indices of autonomic regulation included 50 people aged 40 to 70 years, clinically healthy, without a history of cardiovascular disease. The data obtained determine the pronounced heterogeneity of the examined group of patients in relation to the indicators of the state of the autonomic nervous system (ANS). In our study, it was established that the typical characteristics of autonomic regulation are preserved in most patients and on average for the selected subgroups after surgery. Prospective analysis data also indicate the persistence of the negative impact of pronounced violations of this regulatory system on the state of the cardiovascular system and related outcomes. The most unfavorable in relation to all outcomes was the presence of a pronounced parasympathetic reaction. It was realized in a high frequency of development of acute forms of IHD, including against the background (or associated) with life-threatening cardiac arrhythmias.

The article highlights the outcomes of the study on the effect of osteopathic care of pregnant women in post-term pregnancy on the frequency of operative delivery, the state of a newborn in the early neonatal period, and the level of postpartum depression in puerpera. The study involved primiparous pregnant women in the gestation period from 40 weeks and 3 days up to 41 weeks. Women with burdened obstetric anamnesis, chronic diseases in the acute stage, mental illness, alcohol and drug addiction were excluded. The main group received osteopathic treatment; the control group were provided with medical preparation for childbirth. It was determined that, against the osteopathic treatment, in pregnant women, indicators of the cranio-sacral mechanism were improved, a decrease in the dysfunction of three diaphragms before and after childbirth was observed as well as an improved newborn's condition according to the Apgar Score and neurosonography data, and the assessment of preductal SpO2; an improved mental status and a significantly decreased frequency of operative delivery were observed.

Twenty women aged 45–55 years with severe menopausal syndrome were studied during the research this article dedicated to. Osteopathic status indicators, severity of menopausal syndrome, severity of depression and drowsiness, body mass index, waist circumference, concentration of prolactin, follicle-stimulating hormone, thyroid-stimulating hormone, and cortisol in the venous blood were determined. It was found that the most characteristic somatic dysfunctions were intraosseous injuries of the wedge shape of the bone and sacrum, impaired mobility of the thoracic, pelvic, and cranial diaphragms, bone walls of the pelvis, internal organs of the small pelvis, kidneys, and mediastinum. As a result of osteopathic treatment, there was a relief of clinical manifestations of menopausal syndrome, mood enhancement, decreased drowsiness, normalized function of the hypothalamus-pituitary-adrenal axis and metabolic status of the patients and, subsequently, a significantly decreased severity of menopausal syndrome. The effectiveness of traditional allopathic treatment for this condition remained unsatisfactory.

The purpose of the study is to analyze the frequency of early postoperative complications and their dependence on the comorbid status of patients with breast cancer (BC). A retrospective analysis of the medical records of 1938 women with I-IIIB st. BC (mean age – 50.8 years), whose treatment began with the Halsted, Patey, Madden radical mastectomy or radical resection. The entire cohort of patients had early postoperative complications including long-term lymphorrhea (26.1%), wound suppuration (8.9%), suture line disruption (7.2%), plexitis (7.3%), bleeding (1%). There was no statistically significant difference in the frequency of these complications depending on the type of operation. Comorbid conditions were diagnosed in 97.5% of patients. The main ones were the following: cardiovascular diseases (36.2%), metabolic diseases (10.2%), and kidney diseases (6.3%). In a paired comparison of the frequency of cases of wound suppuration and suture line disruption in groups of patients (with any type of operation) with the main comorbid conditions with a control group (without diseases), no statistically significant difference was found (p = 0.111), as well as for plexitis (p=0.414). In the case of small groups of patients with bleeding, it was not possible to use the criterion for comparison. As for the increase in the frequency of long-term lymphorrhea, statistically significant differences related to the type of surgery were obtained for patients with cardiovascular diseases (p=0.0013), metabolic diseases (p = 0.011), and kidney diseases (p = 0.034). Thus, prerehabilitation should include correction of the comorbid status of BC patients, which will significantly reduce the frequency of long-term lymphorrhea, thereby reducing the course of the postoperative period and bringing the start of adjuvant therapy closer.

The article is devoted to the study of the consequences of the impact of the situation associated with the coronavirus epidemic on the mental state of people (especially those suffering from certain mental illnesses), as well as the issues of providing psychological and psychotherapeutic assistance in the context of the coronavirus infection epidemic on the example of the Novgorod Clinical Specialized Psychiatric Center (NKSCP). Based on the analysis of psychotherapeutic assistance to 1300 patients who were admitted to the psychotherapeutic department of the NSCCP in the period from 01.01.2021 to 22.11.2021, specific measures for organizing and providing psychological and psychotherapeutic support of patients are described. The article discusses the experience of the practical work of a psychiatrist, psychotherapist, psychologist with patients in the context of the COVID-19 epidemic in the NSCCP. In particular, we are talking about overcoming the consequences of self-isolation and other restrictions that negatively affect the full-fledged sociopsychological functioning of a person. The role of remote forms of work with patients, such as audio and video consultations, is emphasized. The article contributes to the study of the problem of the socio-psychological consequences of the epidemic and the organization of the system of psychotherapeutic assistance to different segments of the population in the context of the epidemic. The described methods of providing psychological assistance can be useful for practical application in the framework of overcoming the negative consequences of the epidemic.