[ Main ]  [ Contacts ]  [ E-mail ]


Contents 2021-4


  1. The state of physical development of children with autism spectrum disorders, depending on adherence to diet therapy
  2.  I.A. Bavykina    4

  3. Epidemiological characteristics of the spread of the new coronavirus infection COVID-19 among students in the academic year 2020-2021
  4. S.A. Saiganov, A.V. Liubimova, A.V. Meltser, Z.V. Lopatin, O.Y. Kuznetsova, O.V. Kovaleva, T.M. Chirkina           10

  5. Hygienic problems of the organization of extracurricular activities of pupils
  6. A.V. Suvorova, I. Sh. Iakubova, L.V. Alikbaeva, N.V. Erastova, T.Yu. Pilkova          20

  7. Clinical and laboratory features of COVID-19 in occupational groups at risk of infection
  8. T.A. Platonova, A.A. Golubkova, M.S. Sklyar, S.S. Smirnova, E.A. Karbovnichaya, A.D. Nikitskaya              27

  9. Аge-related changes in carbohydrate metabolism in healthy youth and mature men under the north conditions
  10.  I.V. Averyanova    36


  1. Pathological manifestations of the complications of COVID-19 coronavirus infection in children
  2.  I.V. Sidorova, A.S. Simakhodsky, I.A. Leonova, D.G. Penkov                         41

  3. Evaluation of effect of dynamic interlaminar fixation on sagittal balance in patients with degenerative spondylolistesis
  4. K.A. Nadulich, V.V. Khominets, E.B. Nagorny, D.V. Averkiev, A.A. Strelba   49

  5. Risk factors for postoperative complications of immediate reconstructive plastic surgery in patients with breast cancer
  6. M.A Monogarova, E.M. Bit-Sava, M.G. Kurbanova, A.O. Damenia               59

  7. Dynamics of microvesicle formation in blood in patients with COVID -19 at different stages of the disease
  8. O.V. Sirotkina, A.I. Ermakov, Yu.I. Zhilenkova, E.A. Zolotova, D.A. Kudlay, T.V. Vavilova, L.B. Gaykovaya      68

  9. Treatment of patients with fractures of long tubular bones in severe combined trauma
  10. A.A. Khromov, E.K. Gumanenko, S.A. Linnik, V.M. Haydarov, A.G. Kravzov, I.O. Kucheev        75

  11. Сoommunity-acquired pneumonia in children: analysis of clinical features, therapeutic approaches
  12. Z.V. Nesterenko, V.P. Novikova, A.V. Polunina, L.A. Kropotina, Yu.V. Peshekhonova,P.V. Vorontsov       85

  13. The experience of clinical and morphological analysis of fatal cases of coronavirus infection of the "first wave" (spring-autumn 2020)
  14. R.V. Deev, Z.P. Asaulenko, A.M. Emelin, S.A. Vinnichuk, A.V. Abdrakhmanov, E.I. Shidlovskaya, F.T. Kaboev, G.B. Pavlinov, A.Yu. Anisenkova, S.V. Mosenko, E.D. Studenikina                          90

  15. Fixation stability evaluationin intramedullary nailing for proximal tibial fractures: an experimental study
  16. A.A. Semenistyy, E.A. Litvina, A.G. Fedotova, M.V. Kulikov                       100




I. A. Bavykina
Voronezh State Medical University named after N. N. Burdenko, Russia, 394036, Voronezh, Studencheskaya street,10

Introduction. One of the most popular alternative therapies for autism is a gluten-free diet, but dietary restrictions could lead to the changes in the nutritional status of patients.
Aim of the study was to assess the state of physical development of children with autism, depending on their adherence to diet therapy.
Materials and methods. Anthropometric data were determined in 138 children with autism spectrum disorders aged 3- 15 years. Patients were divided into 2 groups depending on their adherence to the use of a gluten-free diet. The first group included 30 patients (average age 6.8±3.0 years), who have been following the diet for a long time (at least 6 months). The second group included 108 patients with autism, who consumethe gluten-containing products (average age 6.2±2.6 years). The Z-score of length, body weight and BMI for age was calculated using the WHO AnthroPlus program.
Results. In children with autism, there is no significant difference between the growth indicators for age, depending on the use of diet therapy due to the evaluation of the ANTHRO Plus program. Average physical development is 80% and 74% of children, respectively. Children who do not follow a gluten-free diet are 2 times less likely, than patients who adhere to diet therapy, to be diagnosed with excess body weight (23.3% vs 11.1%), but obesity is 3 times more common (3.3% vs 14.8%). The average Z-score values are significantly lower in patients using diet therapy, and the spread of values is also lower in patients excluding gluten.
Conclusion. While prescribing diet therapy for children with autism, it is necessary to use an individual approach in order to avoid additional psychological stress and possible nutritional changes.
Keywords: gluten-free diet, nutritional status, autism, z-score.


S.A. Saiganov, A.V. Liubimova, A.V. Meltser, Z.V. Lopatin,
O.Y. Kuznetsova, O.V. Kovaleva, T.M. Chirkina
North-Western State Medical University named after I.I. Mechnikov, Russia, 195015, Saint-Petersburg, Kirochnaya street, 41
Introduction: Ensuring the epidemiological safety in full-time education is one of the priority tasks.
Aim of the study was to identify the epidemiological characteristic of the spread of a new coronavirus infection among students in the academic year 2020-2021.
Materials and methods. Active epidemiological surveillance was implemented. In order to identify risk factors for infection development, it was conducted the survey of 5328 students and questionnaire for 239 students, who have tested positive for COVID-19 and for 504 individuals being in contact with the infected ones.
Results. The cumulative incidence of new coronavirus infection was 10.83 (95% CI 10.08-11.61) per 100 students: 11.42 per 100 students (95% CI 10.55-12.34) and 8.63 per 100 residents (95% CI 7.27-10.21) (p=0.004). The intensity and dynamics of the epidemic process is due to the levels of morbidity among the population and students working in medical organizations, the degree of compliance with preventive measures. The probable place of infection transmission for 42.6% of infected students: 16.3% had contact at work in healthcare facilities; 13.3% - at the University; 7.3% had household transmission; 2.9% had dormitory transmission. The risk of infection at the University was 1.31 per 100 persons contacted with infected with COVID-19. Among risk factors were work in the  COVID-lefts [RR=2.77 (95% CI 2.49-3.06; p<<0.01)] and work in other healthcare facilities[RR=2.22 (95% CI 1.99-2.47; p<<0.01) in comparison with  non-working students; blood group II RR=1.82 (95% CI 1.31-2.14; p=0.006)], male gender [RR=1.73 (95% CI 1.12-2.62; p=0.02)], daily use of a fixed-route taxi [RR=1.71 (95% CI 1.12-2.58; p=0.05)], use of suburban electric train [RR=2.11 (95% CI 1.11-3.96; p=0.05)]. Living in a dormitory compared to a city apartment reduced the risk of disease RR=0.54 (95% CI 0.39-0.75; p=0.01) as well as the regular attendance of the swimming pool [RR=0.02 (95% CI 0.12-0.41; p<<0.01)].
Conclusion. The implementation of the developed measures allowed to avoid the epidemic spread of a new coronavirus infection among the students and to conduct the full-time educational process.
Keywords: new coronavirus infection, preventive measures, educational process, medical organization, risk factors, epidemiological surveillance, student, resident.


A.V. Suvorova, I.Sh. Iakubova, L.A. Alikbaeva, N.V. Erastova, T.Yu. Pilkova
North-Western State Medical University named after I.I. Mechnikov, Russia, 195015, Saint-Petersburg, Kirochnayastreet, 41
Introduction. The participation of schoolchildren in extracurricular activities increases the study load and its share in the structure of the daily time budget, which could resulted in the  overwork of the body of children and adolescents and in the formation of chronic diseases, due to this the research on the hygienic assessment of the organization of students ' extracurricular activities and the development of activities preventing overwork in children and adolescents are relevant.
Aim of the study was to present the hygienic assessment of the organization of extracurricular activities of secondary school students of Saint-Petersburg and to offer recommendations for its improvement.
Materials and methods. The research was carried out on the basis of 5 secondary schools of Saint-Petersburg. Under the supervision were 2099 students of the primary (1-4 classes) and 2058 students of basic (5-9 classes) level education. The organization of extracurricular activities was assessed by the number of areas of programs being implemented, the number of classes per day/ week, and the duration of classes. In total, 110 classroom schedule and extracurricular activities of students from 1 to 9 classes were analyzed. The daily regime of students of 5-9 classes (269 students) was studied using the questionnaire.
Results and conclusions. Violations of the sanitary and epidemiological requirements for the educational institutions were established: exceeding the maximum permissible volume of a weekly teaching load; scheduling training sessions without taking into account the daily and weekly dynamics of the students’ mental performance; inconsistency in class room schedules and extracurricular activities; lack of an optimal break between classrooms and extracurricular activities. In addition, the organization of extracurricular activities is carried out without taking into account the age parameters of the daily regime of children and adolescents. Based on the study results, the administration of educational institutions and parents were offered to optimize the individual route of mastering the educational program by the child, to plan extracurricular activities taking into account: the interests of children, health status and daily regime, the material and technical base of the general educational organization, the schedule of compulsory teaching load.
Key words: students, extracurricular activities, educational process, educational institutions, daily regime.


T.A. Platonova1, A.A. Golubkova2, M.S. Sklyar1, S.S. Smirnova3,4,
E.A. Karbovnichaya1, A.D. Nikitskaya5
1 Limited liability Company "European medical left «UMMC-Health», 113 Sheinkmana str., Yekaterinburg, 620144, Russia
2 Federal budgetary institution of science "Central research Institute of epidemiology" of the Federal service for supervision of consumer protection and human well-being, 3А Novogireevskaya str., Moscow, 111123, Russia
3 Ekaterinburg Research Institute of Viral Infections, Federal Budgetary Research Institution «State Research left of Virology and Biotechnology «Vector», Federal Service for Surveillance on Consumer Rights Protection and Human Well-being, 23 Letnyaya str., Yekaterinburg, 620030, Russia
4 Federal state budgetary educational institution of higher education "Ural state medical University" of the Ministry of health of the Russian Federation, 3 Repin str., Yekaterinburg, 620028, Russia
5 State Budgetary Institution of Health Care of the City of Moscow " City Clinical Hospital No. 1 named after N. I. Pirogov of the Department of Health of the City of Moscow», 8 Leninsky prospect, 117049, Moscow, Russia

Introduction. Medical workers are one of the main risk groups for infection with a new coronavirus infection (COVID-19), in this regard, research on the assessment of clinical manifestations and prognosis of the disease in this professional group is of particular relevance.
The aim of the study is to characterize the clinical manifestations of COVID-19 in medical workers and to determine the laboratory criteria that are most significant for the prognosis of the development of severe clinical forms of the disease in its early stages.
Materials and methods. To analyze the frequency of occurrence of clinical manifestations of COVID-19 in employees of medical organizations, an online questionnaire developed by the authors was used, which was filled out by 366 employees who were ill in 2020. Laboratory tests were carried out for some of the employees: a general clinical blood test, an assessment of biochemical parameters and determination of cytokine levels.
Results and discussion. In the majority of employees (281 or 76.8%), the disease occurred in the form of an acute respiratory infection of mild or moderate severity, in 85 (23.2%) - in the form of interstitial pneumonia. Of the clinical symptoms of the disease, the most frequent were fever, weakness, difficulty in nasal breathing and serous-mucous discharge from the nose, anosmia, myalgia, arthralgia, headache, cough, a feeling of "tightness" in the chest, shortness of breath, dysgeusia, sore throat, pain in the eyeball area, dizziness and dyspeptic manifestations in the form of diarrhea, nausea or vomiting.
In patients with severe clinical forms of COVID-19, there were more pronounced changes in the level of white blood cells, an accelerated rate of erythrocyte sedimentation, an increase in the activity of liver enzymes, an increase in the level of C-reactive protein and pro-inflammatory cytokines against the background of an increase in the activity of the C9 component of the complement system.
Conclusion. Data were obtained on the main clinical manifestations of coronavirus infection in medical workers, their severity in various forms of the disease, and laboratory markers associated with the most severe variants of COVID-19 were determined.
Keywords: coronavirus infection, COVID-19, medical workers, clinical manifestations, interstitial pneumonia, acute respiratory infection, laboratory parameters, discriminant analysis, prognostic criteria.


I.V. Averyanova
Scientific Research left “Arktika”, Fareastern Branch of the Russian Academy of Sciences. 685000, Russia, Magadan, Karl Marks avenue, 24

Introduction.  Currently, diseases caused by carbohydrate metabolism disorders are of great interest. For now, data on the status of carbohydrate metabolism and pancreas functional activity is still unavailable for both younger and working-age mature men, who are permanent residents of Magadan region (northeast of Russia).
The aim of the study was to examine the correlation between age and severity of main indicators of carbohydrate metabolism in various age groups (youth, mature men) under the north conditions.
Materials and methods. Fifty-five men of working age and one hundred forty-seven young men (mean ages were 36.8±0.8 and 18.7±0.8 yr, respectively), all Caucasians by origin residing in Russia’s north, participated in the study. Blood serum carbohydrate indicators were measured using the methods of ion-exchange chromatography, enzymatically enhanced chemilum in escence, as well as the hexokinase method.
Results. The study results revealed that within the age range from youth to mature men was observed a significant increase in all examined indicators of carbohydrate metabolism and functional activity of the pancreas. Of all the participants, 10% of younger men and 46% of mature men have high level of glycosylated hemoglobin vs. the standard range. Hyperinsulinemia was observed in 20% of younger men and 36% of mature men with the HOMA-IR index exceeding the standard reference in both age groups (25 and 55%, respectively).
Conclusion: The research findings have shown rather unfavorable pictures through all age groups within the study, both for carbohydrate metabolism and pancreas functionality, which is manifested by an increase in the severity of disorders in the analyzed age groups. This tendency could be considered as evidence of a prediabetes, even in adolescence, with it worsening in the older age group. Thus, these findings could be considered as a risk factor for the development of type 2 diabetes.
Key words: younger men, mature men, the North, carbohydrate metabolism, insulin, insulin resistance, prediabetes.



I.V. Sidorova1, A.S. Simakhodsky1, I.A. Leonova1,2, D.G. Penkov1
1 Pavlov First Saint Petersburg State Medical University, Russia, 197022, Saint-Petersburg, Leo Tolstoy street, 6–8.
2 Almazov National Medical Research Centre, Russia, 197341, Saint-Petersburg, Akkuratova street, 2.
Introduction. Thereis a lot of scientific information on COVID-19 in children and adults, but there is a lack of information about complications and diseases, associated with coronavirus infection. Children have mostly asymptomatic and mild forms of coronavirus infection, but having a greater number of pathologies after the coronavirus infection.
Aim of the study wasto improve the quality of diagnosis and treatment of complications after coronavirus infection in children.
Materials and methods: It were performed the analysis of medical documentation from 
«St. Petersburg Children 's City Multidisciplinary Clinical left of High Medical Technologies» per year. Inclusion criteria: a history of COVID-19 coronavirus infection from 1 to 3 months or positive Ig G to SARS-CoV-2.
Results. The analysis of 26 patients with pathological conditions being associated with a previous coronavirus infection was carried out.
Conclusion. Mostly, patients were treated between first and second month after disease, 77% of male patients. The analysis did not establish a clear correlation between the development and severity of the pathology associated with coronavirus infection and comorbid conditions. The most frequent clinical manifestations were: abdominal pain, fever, skin rash and rash around eye, hepatosplenomegaly, increased C-reactive protein, leukocytosis. As a drug therapy, the appointment of anticoagulants and antiplatelet agents, glucocorticoids and antibiotic therapy were absolutely effective. Children's multisystem inflammatory syndrome was reliably diagnosed in 38% of cases among the pathological conditions associated with the postponed coronavirus infection
Keywords: complications after coronavirus infection, children, multi-system inflammatory syndrome in children, COVID-19


K.A. Nadulich, V.V. Khominets, E.B. Nagorny, D.V. Averkiev, A.A. Strelba
S.M. Kirov Military Medical Academy, Russia, 194044, Saint-Petersburg, Akademika Lebedeva Street, 6
Introduction.Treatment of patients with degenerative spondylolisthesis is an urgent problem of orthopedics and neurology.
The aim of the study was to analyze the dynamics of the sagittal balance of the spine in patients with grade I degenerative spondylolisthesis operated using the dynamic interlaminar fixation technique.
Materials and methods. Decompression and dynamic stabilization of the spine with interlaminar implants were performed in 15 patients with grade I degenerative spondylolisthesis of the L4 vertebra. Study inclusion criteria: offset up to 5 mm; translational displacement ≤ 3 mm; segmental kyphosis at the L4 – L5 level ≤ 17 degrees, local scoliosis ≤ 10 degrees, absence of severe osteoporosis (T-score above –2,5), types 2-4 of sagittal balance according to Roussouly. Group I included patients with type 2 (n = 3), group II included patients with types 3 and 4 (n = 12).  All patients underwent spondylography, teleradiography, MRI, measured the displacement of the L4 vertebra while standing and during flexion and extension, assessed the sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), segmental lordosis L4-L5 (SL).
Results. The postoperative ODI and VAS values in both groups improved significantly (р<0,5) and were consistent with good results. The sagittal balance parameters remained unchanged after surgery, which had a positive effect on clinical results.
Conclusion. The use of interlaminar fixation in the treatment of patients with grade I degenerative spondylolisthesis with types 3 and 4 of spine-pelvic relationships according to Roussouly does not worsen the indices of sagittal balance of the spine, but in patients with type 2 it requires further study, despite positive clinical results.
Keywords: degenerative spondylolisthesis; dynamic fixation of the spine; sagittal balance; vertebral-pelvic relationships.


M.A. Monogarova 1, E.M. Bit-Sava 1,2, M.G. Kurbanova 1, A.O. Damenia 1
1 Saint Petersburg clinical research and practice left for specialized types of medical care (oncological)", Russia, 197758, Saint Petersburg, Pesochny settlement, Leningradskaya str., 68A, lit. A
2 Saint Petersburg state pediatric medical University, Russia,, 194100, Saint Petersburg, Litovskaya str., 2
Introduction. Despite the popularity and success of reconstructive plastic surgery, the presence of postoperative complications worsen the treatment results and reduce the quality of life of patients with breast cancer.
The aim of the study was to evaluate the frequency and nature of postoperative complications after immediate reconstructive plastic surgery in patients with breast cancer; to determine their risk factors.
Materials and methods. The analysis of postoperative complications in 200 patients with operable breast cancer aged from 29 to 65 years was performed. Risk factors of postoperative complications depending on the method of surgical treatment are identified.
Results. The following risk factors for the development of postoperative complications in breast cancer patients after immediate reconstructive plastic surgery were determined: remote radiation therapy (54.5 %), body mass index greater than 25 (63.6 %), the presence of diabetes mellitus (81.8 %), smoking (54.5 %), axillary lymph node dissection (100 %) and age > 55 years (81.8 %), the use of a two-light endoprosthesis (36.1 %). Remote radiotherapy is associated with an inflammatory process in a group of patients using expanders/implants. In patients with luminal A subtype older than 65 years, the use of intraoperative radiation therapy during surgery allows avoiding complications of remote radiation therapy. The use of signal lymph node biopsy in comparison with axillary lymph node dissection helps to reduce the risk of developing lymphorrhea and endoprosthesis protrusion during immediate reconstructive plastic surgery.
Conclusion. A preliminary assessment of the risk factors for postoperative complications allows to minimize the frequency of their occurrence and personalize the choice of immediate reconstructive plastic surgery.
Key words: breast, breast cancer, immediate reconstructive plastic surgery, postoperative complications, risk factors, quality of life, subcutaneous / skin-preserving mastectomy.


O.V. Sirotkina 1,3,4, A.I. Ermakov 2, Yu.I. Zhilenkova 1, E.A. Zolotova 1,
D.A. Kudlay 5, T.V. Vavilova 1, L.B. Gaykovaya 2
1 Almazov National Medical Research Centre, Russia, 197341, Saint-Petersburg, Akkuratova Street, 2
2 North-Western State Medical University named after I.I,Mechnikov, Russia, 195067, Saint-Petersburg, Kirochnaya Steet, 41
3 Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre «Kurchatov Institute», Russia, 188350, Saint-Petersburg, Gatchina, Orlova Roscha, 1.
4 Pavlov First Saint-Petersburg State Medical University, Russia, 197101, Saint-Petersburg, Leo Tolstoy street, 6/8
5 NRC Institute of Immunology FMBA of Russia, Russia, 115478, Moscow, Kashirskoe road, 24

Introduction. SARS-CoV-2 causes the development of COVID-19, pneumonia and acute respiratory distress syndrome, and also leads to the development of cardiovascular, hematological and thromboembolic complications. The development mechanism of COVID-19 associated coagulopathy is currently not fully defined, but it is believed that it includes the activation of leukocytes, endothelial cells and platelets and as a result of a cytokine storm. Cell activation is accompanied by the formation and release of extracellular microvesicles and exosomes into the bloodstream.
The aim of the study was to analyze the number of extracellular microvesicles / exosomes in blood cells in patients with COVID-19 at different stages of the disease.
Materials and methods. The study included 18 patients with COVID-19, who were examined at admission to the hospital and 29 patients, who recovered from COVID-19 and were examined at discharge from the hospital. The comparison groups included 14 patients without symptoms of acute respiratory viral infections, without a history of cardiovascular and thromboembolic episodes, and 11 patients with an episode of venous thromboembolism (VTE) not earlier than 3 months before being included in the study and taking warfarin as a part of anticoagulant therapy. All patients underwent a clinical blood test, were measured with the level of D-dimer, C-reactive protein and serum ferritin. The number of extracellular microvesicles was evaluated on a flow cytometer using a set of Exo-FACS reagents and fluorescently labeled antibodies to blood cells surface markers.
Results. The number of microvesicles is higher in patients with COVID-19 at the time of hospitalization in the comparison with the control group and it is comparable to patients with VTE. In patients with COVID-19, not only platelets, as in patients with VTE, but also leukocytes, contribute to the formation of extracellular vesicles pool. The level of CD45 + microvesicles in patients with COVID-19 at hospitalization is 10 times higher than in the controls and 30 times higher in patients with VTE and correlates with the number of lymphocytes. By the time of discharge in patients with COVID-19, the level of extracellular microvesicles is significantly reduced and practically does not differ from the control group of healthy individuals.
Conclusion. Microvesicles could be considered as potential markers of the activation of the hemostasis system and the risk of COVID-19 thromboembolic complications, correlating with the inflammatory response and revealing abnormalities at the preclinical level.
Key words: COVID-19, coronavirus infection, extracellular microvesicles, exosomes, hemostatic system, coagulopathy, venous thromboembolism.


A.A. Khromov1, 2, E.K. Gumanenko3, S.A. Linnik 1, V.M. Haidarov1,
A.G. Kravzov2, I.O. Kucheev4
1 North-Western State Medical University named after I.I. Mechnikov. 191015, Russia, Saint-Petersburg, Kirochnaya Street, 41
2 North-Western District Scientific and Clinical left named after L. G. Sokolov, 194291, Russia, Saint-Petersburg, Kultury Avenue,4
3 St. Petersburg State Pediatric Medical University St. Petersburg, 194100, Russia, Saint- Petersburg, Litovskaya Street, 2
4 St Petersburg State Budgetary Institution Of Health hospital For War Veterans, 193079, Russia, Saint-Petersburg, Narodnaya street,21/2

Introduction. Patients with severe combined injuries, especially polytrauma, represent a special group characterized by high mortality rate, negative immediate and long-term results. Specialized surgical care for these patients is provided by various specialists, where the treatment results mostly depend on the coordinated work and its timeliness. The search for the most optimal algorithm of medical care organization and treatment tactics is still ongoing. Despite the fact that among other life-threatening injuries, fractures of long tubular bones pose less danger to life, they may cause a long-term treatment and disability.
Aim of the study was to improve the treatment results and quality of life of patients with fractures of long tubular bones in severe combined trauma and polytrauma based on new tactics and osteosynthesis.
Materials and methods. In the present study were analyzed tactics and treatment results of 477 patients with severe combined trauma and polytrauma. The control group of patients with traditional treatment tactics included 219 patients. The main group with the new treatment tactics consisted of 258 patients. In the new treatment tactics of patients with fractures of long tubular bones in severe combined trauma and polytrauma, indications for the timing and methods of fixing fractures have changed towards more active surgical tactics based on the inclusion of assessment criteria of condition and injury severity in the treatment algorithm, assessed by modern objective methods.
Results. The immediate treatment outcomes of 274 patients were positive. The long-term, anatomical and functional results of treatment were analyzed in 223 patients. There were no unsatisfactory treatment results. Positive results were achieved in 81.0% of patients, satisfactory – in 19.0% of patients.
Conclusion. Thus, the use of the strategy of early differential trauma care, the use of modern methods of minimally invasive osteosynthesis demonstrated the high effectiveness of the proposed tactics for the treatment of patients with fractures of long tubular bones in severe combined trauma and polytrauma.
Keywords: Injury surgery, polytrauma, minimally invasive osteosynthesis.


Z.V.Nesterenko1, V.P.Novikova1, A.V. Polunina1, L.A.Kropotina 1,
 Yu.V. Peshekhonova1,P.V.Vorontsov 2
1 St. Petersburg State Pediatric Medical University, Russia, 194100, Saint-Petersburg, Litovskaya street, 2.
2 St. Petersburg Medical and Social Institute, Russia, 195271, Saint- Petersburg, Kondratyevsky prospect, 72 letter A.

Introduction. The article presents current views on the features of the occurrence and course of community-acquired pneumonia in children using materials from publications of Russian and foreign scientists, recommendations of the World Health Organization and clinical guidelines of the Russian Federation. The current views on the development of pneumonia in children, on the role of protective mechanisms in the inflammatory process, features of morpho-functional changes in lung tissue in a typical and atypical course of pneumonia, features of the development of infiltration of lung tissue and the appearance of clinical symptoms depending on the causative agent of pneumonia are presented.
Aim of the study was to identify the features of the current course of community-acquired pneumonia in children; to analyze the adequacy of treatment.
Material and Methods. It was performed the analysis of 92 pediatric cases of different age groups with community-acquired pneumonia undergoing observation during a year at the clinic of the St. Petersburg State Pediatric Medical University with an assessment of the therapy effectiveness on an outpatient basis. The reasons for hospitalization of children, the results of laboratory and instrumental examinations, the argumentation of the appointment of antibacterial drugs, methods of their administration were analyzed.
Results: About84.8% of patients were diagnosed with an acute respiratory viral infection on an outpatient basis, 57.6% of them were prescribed antibiotic therapy; due to the ineffectiveness and the identification of pneumonia on the chest X-ray, these children were hospitalized. In 63.1% of patients, pneumonia was caused by atypical pathogens. The degree of adequacy of antibiotic therapy, the choice of groups of antibiotics, the methods of their administration in accordance with the recommendations have been analyzed.
Сonclusion. The performed analysis made it possible to establish the absence of clinical effect in the treatment of acute respiratory viral infections by antibiotics in children. A feature of the current course of pneumonia in children is the increasing etiological role of intracellular pathogens, an atypical course of the disease, resulted in diagnostic errors and inadequate therapy. An unnecessary invasive method of antibacterial drugs administration has been established.
Key words: children, community-acquired pneumonia, atypical pathogens, antibiotic therapy, immune examination.


R.V. Deev1, Z.P. Asaulenko1, 2, A.M. Emelin1, S.A. Vinnichuk1,
A.V. Abdrakhmanov1, E.I. Shidlovskaya1, F.T. Kaboev1, G.B. Pavlinov2,
 A.Yu. Anisenkova2, S.V. Mosenko2, E.D. Studenikina1
1 North-Western State Medical University named after I.I.  Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41
2 "City Hospital No. 40 of the Kurortny District", Russia, St. Petersburg, Sestroretsk, Borisovast., 9B.
Introduction. The study of pathomorphogenesis and thanatogenesis in a COVID-19 became in the period 2020-2021 new professional challenge for the pathological service. This determined the main direction of diagnostic and research activities during this period.
Aim: clinical and morphological analysis of deaths and to summarize the experience gained from the study of deceased patients who died from severe forms of new coronavirus infection, who were hospitalized in the first wave of the pandemic.
Materials and methods. The study included clinical and morphological data obtained from the study of medical records and cadavers of 100 patients with intravital and (or) postmortem confirmed new coronavirus infection.
Results and discussion. It was found that the largest proportion of the dead belongs to the elderly (60-74 years old) and senile (75-90 years old) age groups - 38% and 43%, respectively; deceased young age - 2.
During hospitalization, half of them had high-grade lung lesions: CT-3 and CT-4 - in 31.1% and 28.5%, respectively. In other cases, lung damage progressed in the hospital. The paper provides data on the average length of hospitalization, comorbidity, averaged indicators of clinical and biochemical blood tests. It was found that the main mechanism of thanatogenesis was pulmonary (79%), associated with an increase in respiratory failure or ARDS; in 19% of the deceased, the cardiac mechanism of death was revealed; in 2% of cases, the cause of death was general intoxication. Pathogistologically, in the lungs of the deceased, signs of various phases of diffuse alveolar damage were revealed, and in patients who had been in hospital for a long time, increasing pulmonary fibrosis and pathological regeneration of the respiratory epithelium were found. The result of immunohistochemical detection of the N-protein of the SARS-Cov-2 virus has been demonstrated.
Conclusion. The study revealed clinical and morphological relationships in patients with severe forms of coronavirus infection, established a thanatological profile
Keywords: new coronavirus infection, COVID-19, death, diffuse alveolar damage.


A.A. Semenistyy1, E.A. Litvina2,3, A.G. Fedotova1, M.V. Kulikov4
1 City Clinical Hospital №13, 115280, Russia,Moscow, Velozavodskaya street,1/1
2 Inozemtsev F.I. City Clinical Hospital, 105187, Russia, Moscow, Fortunatovskaya street,1
3 Russian Medical Academy of Continuous Professional Education, 125993, Russia, Moscow, Barrikadnaya street, 2/1-1
4 Financial University under the Government of the Russia Federation, 125167, Russia, Moscow, Leningradskiy avenue, 49
Introduction: The stable fixation of proximal tibial fractures with intramedullary nailing is a challenging issue.  The length of proximal fragment has a great influence on the stability of the achieved fixation. However, published biomechanical and clinical studies comparing different fixation methods of proximal tibial fractures do not take into account the abovementioned factor. 
The aim of the study was to evaluate how the length of the proximal fragment in tibial fractures affects the stability of fixation with intramedullary nail; to identify the optimal ways to blocking the nail depending on the length of the proximal fragment.
Materials and methods. Different types of proximal intramedullary fixation (different combination of locking and poller screws) were examined in a synthetic composite tibia model with a 1-cm gap simulating a comminuted proximal third tibia fracture with no bony contact. Depending on the length of the proximal fragment, 5 groups were formed: Groups 1-4 - 35mm, 45mm, 60mm and 90mm respectively, Group 5 - 200mm (control group – “reference”).  The 9mm ETN was used for the experiment. Stiffness was measured in eccentric axial loading on Electromechanical Testing Machine LFM-50. An analysis of variance with further Turkey’s test was performed to compare results in different groups.
Results: The study results revealed that more stable fixation could be achieved as the length of proximal fragment increases. In Group 2 was observed a mean increase in fixation stability of 35.87% when compared to Group 1. In Group 3 was observed a mean increase in fixation stability of 23.19% when compared to Group 2. In Group 4 was the most stable fixation, demonstrating an increased stability. The fixation stiffness in Group 4 is only 4.46% less than in the "reference" group.
Conclusion: The results obtained in this experimental study objectively show the general tendency of the influence of various poller/locking screws combinations, as well as the length of the proximal fragment in extra-articular proximal tibial fractures, on the stability of fixation achieved with intramedullary nail.
Keywords: intramedullary nailing, tibia, proximal tibial fracture, poller screw, locking screw, fixation stability, fixation stiffness




(с) 2020 North-Western State Medical University named after I.I.Mechnikov