Neuromyelitis optica spectrum disorder (NMOSD) is an aggregate of inflammatory and autoimmune disorders of the central nervous system characterized by recurrent, disabling clinical course and damages predominantly targeting optic nerves, brain stem and spinal cord. NMOSD is stratified into two types: seropositive for aquaporin-4 antibodies (AQP4-IgG) and seronegative, which is reported in 25 % of cases. This article presents modern conceptualizations of NMOSD and describes authors’ own experience of clinical observation of patients.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired progressive or relapse-remitting immunemediated disease of peripheral nervous system. CIDP has typical and atypical variants. Typical variant includes development of symmetric motor and sensory nerve fibers functions abnormalities. The diagnosis of CIDP reveals on clinical presentation and electrophysiological data. There aren’t any biomarkers of such disease. Cerebrospinal fluid analysis, magnetic resonance tomography of peripheral nerves and nerve biopsy may be additional methods to confirm the diagnosis. Instead of international criteria of CIDP diagnosis and large variety of laboratory and instrumental methods, there are many difficulties to make the appropriate diagnosis. This review discusses current concepts of pathogenesis, clinical diagnostics and laboratory and instrumental methods used for differential diagnosis and confirmation of the diagnosis of CIDP and new areas in CIDP research.

Introduction. Currently, globalization and market economy have led to the necessary improving competitiveness of the universities. The parameters of academic efficiency along with reputation indicators become the main criteria for inclusion in international and domestic rankings and thus affect the financial well-being of the university.

The objective of this study is to compare the indicators of scientific activity of the largest Russian medical universities and the foreign non-English speaking university that conducts training in medicine, according to data obtained from scientometric databases and to determine the prospects for including Russian medical universities into the leading international rankings.

Material and methods. The publication activity of 9 largest Russian medical universities for 5 years was analyzed: the number of articles and the number of citations. For comparison, we used data from a similar number of employees of a foreign university that trains students in medicine, included in international rankings. The sources were the Scopus database, as well as international rankings: Times Higher Education, Academic Ranking of World Universities and QS World University Rankings.

Results. Only two Russian medical universities are mentioned in the bottom lines (1000+) in the THE ranking and none of them fall into the QS WUR ranking. However, while maintaining the current trends of increasing the number of publications in Scopus, in the next 2–3 years there are prospects for inclusion in the THE ranking of «Pavlov First Saint Petersburg State Medical University» and «A. I. Yevdokimov Moscow State University of Medicine and Dentistry».

Conclusion. Based on the analysis of publication activity of the largest medical universities in Russia, it can be noted that it is necessary to develop international scientific cooperation and develop strategies for improving self citation in universities, and also need to work more actively with graduates and their employers.

The analysis of the structure and comparative assessment of injuries and deaths in fires in Moscow and the Russian Federation for 2011-2015 was performed. The number of victims in the fires in Moscow during 5 years – 4.084 persons. The part of deaths is 25 %. The number of deaths per 100 fires on average is 35.1 per year, what is 5 times more than in Russia as a whole. However, since 2011 by 2015 the number of deaths in fires decreased by 7.2 %. Convincing data during 5 years on reducing the risk for a person to die in a fire (R2sm) was not received. The indicator in Moscow fluctuates in the direction of increase, while in the Russian Federation it remains at a high level. The same applies to the risk for a person to get injured in a fire and its dangerous factors (R2tr). For 5 years in Russia the risk indicator has grown, but in Moscow it remained at the same level. Individual risk for a person to die in a fire and its dangerous factors (R3sm), as well as individual risk for a person to get injured in a fire and its dangerous factors (R3tr) in Russia decreased, and in Moscow remained practically at the same level as testifies that during this period of time there were no positive shifts.

Introduction. The problem of diagnostics and treatment of an acute appendicitis, despite of comprehensive study of this issue, remains extremely actual that is caused by a high incidence of appendicitis, considerable number of various complications of this disease in the pre - and postoperative period. 

The objective of this study is to assess the current state and dynamics of indicators on acute surgical pathology of abdominal organs in St. Petersburg, scientific justification of the main trends in the development of surgical science and practice. Material and methods.

Materials on monitoring of acute surgical pathology of abdominal organs in St. Petersburg are presented to one of 7 nosological forms in the article, – an acute appendicitis. Historical-analytical, standard- legal and statistical methods were used.   

Results. A decrease in the proportion of patients with acute appendicitis in the structure of 7 nosological forms of acute surgical pathology of the abdominal organs, united in the concept of «acute abdomen» (by 64.18 %: from 91.93 % in 1953 to 27.75 % in 2016); a decrease in the number of operated patients by 67.9 %; an increase in operational activity to 98.28 % in 2016; an increase in the proportion of patients with hospitalization for less than 24 hours from 58.13 % (1932-1946) to 66.74 % (1953-2016); the rate of late hospitalization (later than 24 hours) remains almost stable for the entire period of observation (more than 60 years), and in recent years has even a slight increase (+8.21%). There is a decrease in postoperative mortality in acute appendicitis in 350 times (from 21.00% in 1910 to 0.06% in 2016).

Conclusion. The work demonstrates the success of healthcare in the field of emergency surgery, which are due to many factors to improve organizational approaches related to the development of diagnosis and treatment of acute appendicitis, including – description of characteristic symptoms, introduction of laboratory diagnostics, study of atypical and complicated clinical forms, peculiarities of the disease course in children and elderly people, definition of the terms of surgical intervention, introduction into clinical practice and improvement of instrumental methods of diagnostics and endosurgical methods of appendectomy, etc. 

Introduction. The increased attention from the state to the organization of rehabilitation measures, especially among children, requires evaluation and development of measures to improve the effectiveness of all areas of rehabilitation – medical, social and professional rehabilitation. The development of measures increasing efficiency is especially important among children, since children are the main potential of the country. 

The objective of the study was to evaluate the medical and social effectiveness of the rehabilitation measures carried out for children after neuroinfections.

Material and methods. During the study, parents of children after neuroinfections were interviewed, as well as the examination of changes in large motor functions and functional state was carried out by doctors of the Clinic of “Scientific and Research Institution of Children’s Infections”. Medical experts used special evaluation scales in order to objectify the research.

Results. The overwhelming majority of parents (90.4 %) note an improvement in the condition of their children in terms of medical and social adaptation. More than one third of parents (35.9 %) note the improvement of their children’s condition, according to all seven criteria proposed for the answer (formation of independent walking skills, stabilization of emotional-volitional activity, acquisition of new social household skills, ability to sit, decrease of muscle tone,  speech development and improvement of manipulative functions of the hand). According to the expert opinion of the doctors of the Clinic, 78.8 % of children suffered from the disruption of large motor functions, and children of the first level, i.e. the lightest, according to the classification scale for large motor functions (GMFCS), was only 17 %. After four courses of rehabilitation in the Clinic, the proportion of children of the first level increased significantly and amounted to 48.2 %. Improvements in the opinion of medical experts, based on the results of the questioning, were also observed in functional status, in such positions as communication, everyday life skills, socialization and motor skills.

Сonclusion. Thus, the effectiveness of rehabilitation measures for children after neuroinfections has been proved. Moreover, with the increase in the number of rehabilitation courses, the state of children improves both by the medical and social criteria.

The paper suggests the results of retrospective cohort study. We analyzed the results of clinical and laboratory examination of 102 hospitalized adult patients with acute diarrhea (AD) of moderate severity and positive feces test for rotavirus. Specific examination for the detection of various pathogens of AD along with standard cultural, serologic (based on the determination of specific antibodies) and ELISA methods included the study of the patient’s feces by PCR. It was found that the use of a complex of modern methods of specific diagnosis allows in 67.2% of individuals along with markers of rotavirus simultaneously identify markers of other pathogens, including bacterial – 51% of patients. Among the examined persons hospitalized on the 4th day of the disease and later, there are 2 times more patients with concomitant diseases of the gastrointestinal tract and 2.4 times more patients taking antimicrobial drugs at the prehospital stage than among those who admitted for the 1st three days of the disease. The cases in adult patients with concomitant non-infectious pathology of the gastrointestinal tract compared to those without it turned to be significantly rarer simultaneously positive for rotavirus and Campylobacter spp. In the examined patients with colitis syndrome there is an apparent trend of more frequent detection of a positive cultural test for Salmonella spp. In the absence of markers of bacterial enteropathogens in the clinical material in the group of adult patients with only detected rotavirus, colitis syndrome is documented 2 times more often than in patients with a positive combined reaction to rota- and norovirus.

The article reflects the results of empirical research and theoretical understanding of the interaction of mechanisms of psychological adjustment to the disease and the main parameters of quality of life in chronic somatic disease. We examined139 patients suffering from different forms of oncological damage of bones of the musculoskeletal system, who treated in «N. N. Blokhin National Medical Research Centre of Oncology». Such psychodiagnostic methods as «BIG 5», «Ways of coping», «Purpose-in-Life Test», «Questionnaire of relation to disease «TOBOL», «SF-36 Health Status Survey», «Quality of Life Questionnaire» EORTC QLQ-C30 with additional module BM-22 for patients with bone tumor were used; Karnofsky scale and ECOG-WHO scale (from medical records) were used to assess the objective somatic status of patients. Cluster, factor and multifactorial dispersion analysis of data was performed, which showed the influence of the selected «profiles» (clusters) of personality («Neurotic person», «Mature, adapted person», «Person with a high level of self-consciousness and responsibility», «Socially maladjusted personality») on the generalized factors of quality of life («Life activity», «Optimal quality of life in the conditions of disease», as well as the factor «Gastrointestinal problems», reflecting the somatization of psychological problems in the situation of the disease). The results of the study show that the integrated study of the mechanisms of psychological adaptation and characteristics of the quality of life in the conditions of the disease opens up new ways of psychological care and social rehabilitation of cancer patients, as it allows to take into account in each case the influence of «the profile of personality» on individual domains of quality of life.

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016.

Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan).

Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p<0.05, and comparable levels of salt overtaking (39 vs 34 %) and hypodynamia (35% in both groups). Only 10% of students and 7% of doctors smoked. The expected increase in the prevalence of biological risk factors in accordance with the age was significantly more common in doctors: hypercholesterolemia (63 vs 30 %), hyperglycemia (25 vs 14 %), hypertension (36 vs 5 %), obesity (according to WC – 45 vs 10 %, according to BMI – 19 vs 6 %), p<0.05. The profile of the most common risk factors did not differ among doctors and students: hypercholesterolemia and overweight in both groups took the leading positions. Also in accordance with the age, there were more often complaints of snoring-24% in doctors and 7% in students.

Conclusion. The students had a less favorable profile of behavioral factors in diet compared to doctors, and despite of the expected age differences, a high prevalence of hypercholesterolemia and overweight was revealed. Obviously, it is necessary to strengthen educational work in this area at the stage of training of nurses and doctors to preserve the health of both medical personnel and their patients.

Introduction. This study focuses on the problem of early disability of patients with HIV-infection and treatment adherence and dispensary observation. 

Material and methods. The clinical and anamnestic analysis of 1136 out-patient records and medical records of patients registered at Saint-Petersburg State Budgetary Institution of Healthcare “Center for Prevention and Control of AIDS and Infectious Diseases” and directed at medical and social examination was carried out. In addition, using the test methods we investigated the psychosocial characteristics of 76 patients who applied to the psychologist before the beginning of antiretroviral therapy, and assessed the treatment adherence a year after the start of treatment.

Results. The results of the study indicated the increase in the proportion of patients at advanced stages of the disease, increased detection of HIV in older age groups. Late diagnosis of the disease is the cause of temporary disability and early disability of patients with HIV infection. The dynamics of the number of disabled persons due to HIV infection increasing. Men need more time to decide on dispensary care than women. The majority of patients with are men of working age, identified or sought medical care at the late stages of the disease. Women are more attentive to their health and have more complex treatment adherence than men. The interrelations of psychological and somatic characteristics with the level of adherence to medical recommendations were found. 

Locked-in syndrome (LIS) is a rare neurological disorder, usually appears as a result of the pons cerebellar damage, mostly after the brain stroke. Locked-in syndrome is characterized by the paralysis of skeletal muscles (respiratory, facial, pharyngeal, lingual and muscles of the extremities). Patient is unable to speak and breath, facial expressions and voluntary movements are also impossible. Acromegaly is a disease that can be described by the increase of the growth hormone (GH) and Insulin-like growth factor (IGF-1) and develops in most cases due to the pituitary adenomas. Pituitary adenoma (PA) can be treated by neurosurgical techniques, pharmaceutical and radiation therapy (RT). We present a clinical case of 33-year-old woman with PA-caused acromegaly, that developed muscle weakness, nausea, vomit and respiratory disturbance in a 2 months after the radiation therapy. Subacute comatose state was developed in the patient. MRI of the brain revealed a multi-focal lesion of the media-basal regions on both sides, frontal corpus callosum and brain stem. Differential diagnosis included an acute demyelination (SD, PML), viral encephalitis and vasculitis. Treatment included methylprednisolone pulse therapy and plasmapheresis. The consciousness cleared up, but there was no spontaneous breathing, tetraplegia persisted. Autoimmune and infectious diseases was excluded. The homozygous mutation PAI-1-675 4G/4G was found. In this case, acromegaly induced endothelial dysfunction was the pathogenesis factor of multiple cerebral infarctions and demyelinating lesions, as well as RT and its proven pathological influence on the vascular wall and the fibrinolytic system. The revealed thrombophilia was also a factor of multiple cerebral infarctions. A Potential combination of pathogenic factors in the development of cerebral should be taken into account in predicting complications of RT.

Acute inflammatory demyelinating polyneuropathy Guillain – Barre syndrome (AIDP-GB) – acquired immune mediated disease with acute onset characterized by the development of peripheral tetraparesis due to immune system attack to peripheral nerves and spinal roots. This article describes the case report of AIDP-GB development in the patient with hepatitis C and type 2 diabetes mellitus. The patient was treated with course of plasmapheresis and subsequent course of intravenous immunoglobulin (IVIG) for increasing the effectiveness of therapy. During the therapy, there was a significant improvement in the condition of patient and reduction of neurological deficit, confirmed by neurological examination and electroneuromyography, immediately after treatment and in 6 months. In addition, rehabilitation measures for the patient included physical therapy, including physiotherapy and acupuncture. To sum up, the effective treatment of AIDP-GB includes pathogenic therapy (plasmapheresis, IVIG) and rehabilitation measures to facilitate the recovery of the patient and return to professional practice.