[Minimally Invasive Technologies in Surgery of the Chest Wall in Children].

Today, in our country, as well as throughout the world, there is no single approach to the tactics of managing patients with deformations of the anterior chest wall. These patients constitute a large and heterogeneous group. The team acquired great experience in treating children with pectus excavatum and pectus carinatum, as well as a unique experience in the surgical treatment of pediatric thoracic outlet syndrome and sternum clefts. Now in the world there are a lot of surgical methods used for the correction of congenital deformities of the chest wall, however, the majority of them are extremely traumatic for the patient, and the postoperative scar often presents a minor cosmetic problem than the deformation itself. In addition, almost all methods require the use of expensive technologies, the patient's long hospital stay and the use of potent drugs. As for the children with thoracic outlet syndrome and sternum clefts, these patients are extremely difficult in terms of timely diagnosis and surgical care, due to the fact that pediatric surgeons and pediatricians are very little aware of this pathology. The team of authors developed a number of techniques, based on the collaborative work of surgeons, anesthesiology and resuscitation specialists and pediatric services. They resulted in successful surgical correction of these malformations and gave patients the opportunity to lead a normal life.

[Initiation of pharmacotherapy as a risk factor for older patients.]

The article presents the literature and original data on the problems of falls in elderly patients. The connection of the fact of falling with initiation of therapy by a number of drugs known to have a negative impact on the risk of falling is considered. The article presents data on the frequency and structure of falls on the example of patients with cardiovascular diseases older than 75 years, treated in a multidisciplinary hospital. The analysis of the data showed a tendency of prevalence of the fact of falling in 1/3 patients (33,8%) in the first 5 days of hospital stay, which may be associated with high drug burden and the appointment of «new¼ drugs for the patient. The study noted that it was on the first day that the selection of therapy took place and additional drugs were often prescribed, leading to a state of polypragmasia. Analysis of individual groups of drugs was able to reliably confirm the relationship between the appointment of drugs that increase.

Detection of causative agents of tick-borne rickettsioses in Western Siberia, Russia: identification of Rickettsia raoultii and Rickettsia sibirica DNA in clinical samples.

OBJECTIVES: The main causative agent of tick-borne rickettsioses in Siberia is considered to be Rickettsia sibirica; however, only a few cases have been genetically confirmed. Other pathogenic species of Rickettsia have been detected in ixodid ticks in Western Siberia. The aim of this study was to detect the aetiological agents of tick-borne rickettsioses in Western Siberia and compare their clinical manifestations. METHODS: A total of 273 blood and 44 cerebrospinal fluid (CSF) samples from 273 patients hospitalized because of tick-transmitted infection in April-September 2016 were examined for the presence of Rickettsia spp., using nested PCR with subsequent sequencing. RESULTS: DNA of Rickettsia spp. was found in samples from 10 patients. The gltA gene fragment sequence analysis revealed R. sibirica DNA in seven patients (blood samples) and Rickettsia raoultii DNA in three patients (two blood and one CSF sample). Most patients infected with R. sibirica showed typical clinical symptoms, including high-grade fever (38.9-39.5°Ð¡), myalgia, rash, eschar at the site of the tick bite, and elevated levels of serum aminotransferases. In contrast, patients infected with R. raoultii showed nonspecific symptoms with short-term fever (37.2-37.7°Ð¡); one patient had a short episode of meningeal syndrome. CONCLUSIONS: We report the first finding of R. raoultii DNA in clinical samples from Russian patients. The clinical manifestations of this rickettsiosis were nonspecific and differed from those caused by R. sibirica.