[The problem of formation of new risks of medicinal resistance of patients with tuberculosis in condition of active use of antibiotics by population under COVID-19].

In pandemic conditions, situation of active and uncontrolled use by population of antimicrobial preparations treating COVID-19 occurs. So, new risks of development of medication resistance among patients with various infectious diseases, tuberculosis included, appear. The purpose of the study is to characterize prevalence of antimicrobial preparations use by population in relationship with development of medication resistance in patients with tuberculosis during COVID-19 pandemic. Material and methods. The analysis of sales of antimicrobial medicines was implemented on the basis of published official data from the joint-stock company DSM Group presenting monthly audit of the Russian pharmaceutical market. The determination of primary antibiotic resistance was carried out in 2018-2020 on 3312 patients with tuberculosis. The modified method of proportions on liquid nutrient medium in system with automated accounting of microorganisms growth, the method of absolute concentrations and the method of polymerase chain reaction with real-time detection were applied. The results of the study. It was established that the most demanding antimicrobial medications among population were ceftriaxone, azithromycin, levofloxacin, moxifloxacin, azithromycin. At the same time, the maximum increase in sales in 2020 up to 150% as compared with of 2019 was determined in medications derived from quinolone moxifloxacin, levofloxacin, which began to be used in treatment of coronavirus infection. At the same time, these medications are traditionally used in tuberculosis treatment. But in 2020, alarming trend was established that limits treatment of tuberculosis patients. The primary resistance of mycobacteria was also established in newly diagnosed tuberculosis patients, also for the same antimicrobial medications of quinolone derivatives, and increasing in proportion of patients with primary medication resistance to levofloxacin, moxifloxacin in 2020 as compared to 2018 was 189-480%. At the same time, increasing of resistance to other antibiotics made up to 60.8% on average. Conclusion. The study results imply alarming scenario of medication resistance shifts towards very virulent and highly medication-resistant genotypes. This trend can result in conditions of successful transmission of deadly medication-resistant mutants that can seriously undermine effectiveness of implemented programs of struggle with tuberculosis worldwide.

[The quality of life of adolescents as integral characteristic of pre-nosologic health condition].

The purpose of the study is to establish characteristics of quality of life of adolescents and substantiate it as a reference criterion of pre-nosologic condition of health for mass screening observations of adolescent population. During puberty, in adolescents, mainly in girls, deterioration of quality of life is established. At that, minimal indices of quality of life were registered in adolescents 12 years old, that is probably conditioned by decreasing of level of functioning of central and respiratory systems against the background of vegetative balance disorders in this age group as compared with students of other age groups. The dependence of scales of mental component of quality of life of adolescents is established from following functional indices of central nervous system: stability of nervous reaction (r = 0.4) and level of functional capabilities of formed functional system (r = 0.4-0.5); physical component of quality of life of students from functional level of nervous system (r = 0.4-0.5), from integral indices of autonomic nervous system (r = -0.4-0.5); from indices of functional state of respiratory system (r = 0.4-0.6). The obtained data allows to consider quality of life as a reference diagnostic tool for assessing pre-nosologic health condition in mass screening observations of adolescent population.

[Osteoplastic operations in the anterior part of the mandible for correction of malocclusion]. / Kostno-plasticheskie operatsii v perednem otdele nizhnei chelyusti pri korrektsii anomalii prikusa.

Correction of disorders during transformation into one of the most difficult tasks, both in orthodontics and in maxillofacial (orthognathic) surgery. This article presents two clinical cases of median osteotomy/ostectomy. The stages of operations are described. Surgical technique of transversal correction by osteotomy/ ostectomy is presented. Operation is combined with bilateral retromolar osteotomy. Three dimensional fragments moving helps to change lower jaw shape. Indications for this surgical manipulation: one or two side cross-bite, discrepancies between size of teeth and length of alveolar bone (lower macrognathia, microdentia, extra-teeth, huge diastema), asymmetry of mandible.

[Combined therapy with elastic bands and splints in patients with masticatory muscles hypertension]. / Sochetannoe lechenie patsientov s gipertonusom zhevatel'nykh myshts s pomoshch'yu elastichnykh lent i kapp.

THE AIM OF THE STUDY: Was to investigate the effectiveness of combined treatment with elastic bands and splints in patients with masticatory muscle hypertension. 103 patients (37 men and 66 women) aged from 21 to 65 years were examined. The diagnosis was made based on clinical and instrumental (electromyography) methods. Pain intensity was determined using a visual-analog scale (VAS). Elimination of masticatory muscle hypertension in patients of the first group (51 people) was carried out using only splints while patients of the second group (52 people) had a combined therapy with elastic bands and splints. In the second group of patients reliable reducing of pain intensity was observed by day 14 from the start of therapy (4.54±0.5 points), while in the first group of patients it was discovered only by day 21 (5.08±0.6 points). Reliable changing of the bioelectrical activity of masticatory muscles in the second group of patients was observed by the beginning of second week from the start of preliminary therapy, while in the first group of patients it was discovered only by the third week. Thus, the proposed method of masticatory muscles hypertension treatment using elastic bands and splints has features, favorably distinguish it from the other methods of the therapy, because it provides sparing functioning condition for masticatory muscles.

[Protocol of cone beam computed tomography analysis for patients with craniomandibular dysfunction]. / Protokol analiza konusno-luchevoi komp'yuternoi tomografii u bol'nykh s kraniomandibulyarnoi disfunktsiei.

The article presents a detailed protocol of cone beam computed tomography (CBCT), which includes not only the classic analysis of dentoalveolar and skeletal disorders, but diagnosis of cranial patterns (craniocervical cephalometric analysis by M. Rocabado, cephalometric diagnosis by Sassouni PLUS), analysis of transverse jaw sizes (Penn analysis) and measuring the volume of the airway for screening of obstructive sleep apnea. The literature review was conducted using the PubMed in the Scopus and Medline electronic databases through April 2020. Combining several methods of interpretation of CBCT in a single protocol will allow doctors to obtain a more complete amount of information to make a complete plan of comprehensive treatment.

[The quality of dental care: characteristics and criteria]. / Kachestvo stomatologicheskoi pomoshchi: kharakteristiki i kriterii.

The paper discusses features and criteria of dental care according to legislative acts in Russian Federation. The study contains detailed assessment of safety, cost/effectiveness ratio and adequate timing as features and adhesion to standards, absence of complications and patients satisfaction as criteria for dental care quality.

[Hygienic estimation of functional reserves and adaptive capabilities of students].

In the article there are presented data on characteristics ofpeculiarities of the functional state of medical 1-6 years students of higher educational institutions. The results were obtained with the aid of variation pulsometry. Students were shown to have typical elevated tone of the sympathetic nervous system, especially for students of the 1, 3, 5 and 6 courses, that is confirmed by the amplitude mode (AMo), characterizing the sympathetic activity of autonomous nervous system (ANS), which is an average of the students 1 year accounted for 38.6 ± 1.89%, for students of the 3 course - 38.5 ± 1.72%, for students of the 5 year (40.9 ± 3.25 %) and the students of 6 course (46.7 ± 2.59%). There was determined the trend to the centralization of the heart rate control, as evidenced by a reduced proportion of high-frequency waves (HF) by 29.2% to 35.2%, exceeding by 3.6 to 14.4 times in waves of the very low frequency (VLF) relative to the average standard values; the high proportion of students from 41% to 52%, with a mismatch of the sympathetic and parasympathetic compartments of the autonomic nervous system in the regulation of biological processes of adaptation. For medical students of higher education institutions there are typical functional reserves reduced from 20.5 % to 97.6% and a decrease in the proportion of students with a satisfactory adaptation by 40.4% from the 1 to the 6th year.

[Evaluation of occupational risk for health of operators of petrochemical production and their physiological and hygienic stipulation].

The modernization of the technological process in the petrochemical industry has reduced the degree of influence of adverse factors of the production environment, but not eliminated the adverse impact of industrial environmental factors on the health ofworkers. Factors failed to meet hygienic standards in the workplace of operators were shown to be are electromagnetic radiation, chemicals (ammonium, nitrogen dioxide), industrial lighting. In addition operators ' work is characterized by high intensity of the labor process. Therewithal the labor of operators is characterized by the high intensity of the working process. For the operators ofpetroleum industry there is typical the risk from the combined exposure of the complex of chemical substances and noise, this risk proves both to be both potentially dangerous and increase in dependence on doses offactors and length of service. The level of individual professional risk in 32% of the operators is high; risk group for the profession is defined as high. In most cases, in operators of both small and long experience there was established the decline in the functional state of the central nervous system, the predominance of sympathetic tone in the regulation of adaptive processes, reduced reactivity of the autonomic nervous system and the more the length of service among operators the more the number of cases with poor adaptation and its breakdown.

Rare form of erdheim-chester disease presenting with isolated central skeletal lesions treated with a combination of alfa-interferon and zoledronic Acid.

Erdheim-Chester disease (ECD) represents a clonal non-Langerhans histiocytosis, which manifests under an extensive variety of clinical symptoms. This creates a challenge for the physician, who is required to recognize and diagnose the disease in the early stages. Despite this considerable challenge, in the last decade there has been a dramatic increase in ECD diagnoses, in most part due to an increasing awareness of this rare disorder. Involvement of the axial skeleton is exclusively uncommon with no official recommendations for the treatment of the bone lesions. Here, we present a case report of a young male patient with isolated lesions of the spine, ribs, and pelvis, who was successfully treated with a combination therapy of alfa-interferon and zoledronic acid.

Myelodysplasia is in the niche: novel concepts and emerging therapies.

Myelodysplastic syndromes (MDSs) represent clonal disorders mainly of the elderly that are characterized by ineffective hematopoiesis and an increased risk of transformation into acute myeloid leukemia. The pathogenesis of MDS is thought to evolve from accumulation and selection of specific genetic or epigenetic events. Emerging evidence indicates that MDS is not solely a hematopoietic disease but rather affects the entire bone marrow microenvironment, including bone metabolism. Many of these cells, in particular mesenchymal stem and progenitor cells (MSPCs) and osteoblasts, express a number of adhesion molecules and secreted factors that regulate blood regeneration throughout life by contributing to hematopoietic stem and progenitor cell (HSPC) maintenance, self-renewal and differentiation. Several endocrine factors, such as erythropoietin, parathyroid hormone and estrogens, as well as deranged iron metabolism modulate these processes. Thus, interactions between MSPC and HSPC contribute to the pathogenesis of MDS and associated pathologies. A detailed understanding of these mechanisms may help to define novel targets for diagnosis and possibly therapy. In this review, we will discuss the scientific rationale of 'osteohematology' as an emerging research field in MDS and outline clinical implications.

[Organization of medical and psycho-educational services for first-grader's under condition of gymnasium education secondary education].

In this paper a model of organization of medical-psychological-pedagogical service for first graders not ready for systematic teaching in secondary education has been suggested. The results of study of the effectiveness of the introduction of medical, psychological and educational services in school are presented. Based on the dynamics of the autonomic balance, and functional reserve of biological adaptation in children at risk--not ready for medical and psycho-physiological criteria for the systematic training the need for such services on the basis of modern educational institutions has been proven in order to prevent deterioration of the health of students.

[Formation of adaptation capacities in the first graders of a gymnasium].

The paper presents the data of a study of biological and sociopsychological adjustment in the first graders of a gymnasium. It is shown that is less strained regulatory processes due to the enhanced activity of the parasympathetic part of the autonomic nervous system and to reduced impacts of the sympathetic nervous system, as well as increased functional reserves, better biological adjustment, and a larger number of children with normal sociopsychological adjustment during an academic year.

[Use of conditioned reflex therapy in patients with masticatory muscles hypertension].

This work deals with the thoughts on the nature and origin of disorders of masticatory muscles and temporor joint. The authors incline to opinion of their psychosomatic origin. In connection with this point of view the methods of investigations were added by the psychosomatic approach (Eysenk, Spilberger-Hanin, Lichko, Vassermann): so the methods of direct and indirect psychotherapy (behavior therapy and placebo), the same as psychopharmaco-therapy were included in complex rehabilitation. As behaviour therapy method the computer videoautotraining with biological adaptive reverse connection was used. 185 patients (61 men and 124 women) in age of 16-70 (mean age: 34,9+/-1,3 years old) were investigated. Complete recovery or significant improvement of health took place in 97% of patients, insufficient effect - 3% of investigative patients.

[Substantiation of psychosomatic nature of temporomandibular joint disorders complicated by parafunctions of masticatory muscles and their combined treatment].

The nature and origin of disorders of masticatory muscles and temporomandibular joint are discussed. Their psychosomatic origin is suggested. Methods of direct and indirect psychotherapy as well as psychopharmacotherapy were included in complex rehabilitation. Computer videoautotraining with biological adaptive feedback was used. 105 patients (31 men and 74 women) at the age of 16-70 years (mean age 34,9+/-1,3 years) were examined. For the first time dysfunction computer arthrophonography of joint sound was used. Combined therapy of this patients was carried out including: psychological correction (suggestion, placebo-therapy, computer videoautotraining), pharmacotherapy (psychotropic, myorelaxative, analgetic drugs preparations), physiotherapy (electrophoresis, phonotherapy, vibroacustic massage), use of orthopaedic apparatuses. Complete recovery or significant improvement of health was observed in 92% of patients, insufficient effect - in 8%.

[Amino acid metabolic indices in newborn rats]. / Nekotorye pokazateli aminokislotnogo obmena u novorozhdennykh krys.

In simulated tests on rats of the 1st months of life set up for the purpose of educing causes accounting for a highly effective utilization of the milk proteins in the early post-natal perions subject to study were the amino acids metabolism rates. An investigation of the enzymes activity showed that a falling of the milk proteins utilization effectiveness proceeds against the background of an intensive inclusion of the catabolic route of the amino acids metabolism in the liver. The urea content in the urine correlated with a gradual inclusion of the enzymatic liver systems partaking in the urine formation. The amino acids metabolism with a ramified chain in the liver tissue of rats of the first days of life was found to stand low to a still greater degree than this was the case in adult animals. One of the causes responsible for a highly effective utilization of the milk proteins in the perinatal period may be due to an incomplete functioning of the catabolic route of the amino acids metabolism in the liver.

[Effective utilization of milk proteins by rats during the neonatal period]. / Effektivnost' utilizatsii belkov moloka krysami v period novorozhdennosti.

The assimilation of milk proteins in dynamics by rats during the first 23 days of their life was studied. During this time the animals were kept on a natural milk feeding and were denied the maternal one. Data on the amount of consumed protein and on an increase of the protein content in the carcass in 2- and 4-day long intervals served as a basis for determining the degree of effective utilization of protein (U) by rats. It is shown that the degree of the food protein, while remaining at a high level, experienced certain changes. It is possible to distinguish three periods in the change of this value: the first--starting from birth up to 5 days, with U rising from 74,5 up to 92.1 per cent, the second period, the milk diet proper,--up to the 15th day, marked by a high value of U (approximately 93 per cent) and, finally, the third period--transitional to the ration of an adult animals--marked by a drop of U down to 67.8 per cent. The data obtained may be used in considering issues related to features specific for the processes of the protein assimilationin in the early post-natal period.