Vol 24, No 3 (2025)

Objective. To evaluate the etiopathogenetic and morphological features of different types of sepsis of viral etiology. Methodology. The conceptual, process, situational, logical and systematic analysis of full-text versions of literary sources devoted to sepsis of viral etiology was used. Results. Sepsis caused by viruses is an existing but constantly underestimated type of sepsis. This sepsis can be caused by various viruses, but more often they are influenza viruses, herpes simplex, enteroviruses, parechoviruses, coronaviruses and dengue virus. Based on the data presented, it can be assumed that the majority of extremely severe forms of viral infections with dysfunction of internal organs are sepsis. It is most likely that sepsis is usually triggered by a single microorganism, but then new pathogens usually join it, both from the outside and by reactivating dormant infections. Therefore, it may be worthwhile initially to consider sepsis, which is already present in the patient, as a kind of disease of mixed infectious etiology. The full range of microorganisms that cause sepsis is extremely difficult to identify and take into account in real clinical practice, especially in dynamics. But it is based on this that the diagnosis and treatment of sepsis should be approached. Perhaps this "polypathogenic" approach will reduce mortality in sepsis. Early diagnosis of sepsis is also very important. Unfortunately, there are still no simple and unambiguous clinical criteria, laboratory signs and morphological changes, that would uniquely identify a patient with sepsis. Conclusions. In sepsis, along with the "direct" fight against infection, it is equally important to restore the normal functioning of the immune system, as well as to stop the "self-destruction" of the body. This can be facilitated by the proposed concept of the "presepsis" stage for early diagnosis of sepsis. It may be worth considering the feasibility of including the "presepsis" stage in the classification of sepsis, significantly detailing its clinical, laboratory and morphological parameters, taking into account their sensitivity and specificity. The essence of this stage is not only that it begins with a syndrome of systemic inflammatory response of the body of infectious origin, but also that such a "response" of the body is steadily progressing, triggering a syndrome of compensatory anti-inflammatory response, usually against the background of the patient's body characteristics, often already having prerequisites for immunosuppression already at the very beginning of sepsis development. Assessment and correction of the patient's immune status in dynamics should play an important role both in the early diagnosis and in the treatment of sepsis, along with other areas. It is likely that understanding these problems, as well as a detailed study of the mechanisms of pathomorphogenesis of viral sepsis, will make it possible to find molecular targets, and then create drugs that directly affect viruses and mechanisms that allow the immune system to destroy them.

Objective. The aim was to assess efficiency of Kisspeptin -10 during transportation through a GEB after intranasal administration. Methods. The study used 45 outbred mice. The first group of experimental animals was not exposed to any effect - an intact group. In the second, third and fourth group, animals received kisspeptin-10 intranasally in doses of 0.1, 1 and 10 μg, respectively. In the fifth, sixth and seventh group, experimental animals received kisspeptin-10 in doses of 1, 10, 100 μg intra-abdominal in the amount of 0.2 ml, respectively. In the eighth group, animals received a physiological solution of intranasally 20 μl, the ninth group of animals received a physiological solution intra -abdominal 0.2 ml. The behavior of animals was studied using the tests “Open Field”, “Raised Cross Labyrinth” and “Sexual Motivation”. Results. In the present study stable and dose-dependent effects of kisspeptin-10 on the behavior of rats after intranasal administration were obtained. Intranasal kisspeptin-10 caused a significant increase in sexual motivation, an increase in horizontal and vertical motor activity, a decrease in stress, and an increase in exploratory activity in sexually mature male rats. The greatest changes in behavior were caused by a dosage of 10 μg and the central effect of kisspeptin-10 on the brain after intranasal administration in comparison with groups of animals after intraperitoneal administration. While the indicators after intraperitoneal administration of kisspeptin-10 caused virtually no changes in behavior at doses of 1 and 10 μg. Increasing the dosage to 100 μg intraperitoneally showed a significant change in behavior, but not as strong as after intranasal administration of the substance in an amount of 10 μg. Conclusions. To significantly change behavior, intranasal administration required concentrations 10 times lower than intraperitoneal administration. Based on the apparent effects of kisspeptin-10 after intranasal administration in each test, it can be assumed that kisspeptin-10 penetrated into the brain, bypassing the BBB and exerting a central effect. The data confirm the potential and significance of this method of delivering the substance to the central nervous system.

Objective. To analyze and summarize literature sources and patent information in the field of development of liquid oral hygiene products and their role in increasing the effectiveness of prevention. Methods. Analysis and synthesis of scientific and patent literature was carried out using the information retrieval system in the field of medicine PubMed, ScholarGoogle, electronic library database eLibrary, electronic library systems IPR SMART (IPR BOOKS), electronic medical library on the BookUp platform, foreign electronic resources of publishing houses Springer Nature and Elsevier. Results. The review found that existing liquid oral hygiene products are designed to rinse, cleanse and freshen the mouth, enhance the natural protective system of saliva, maintain a healthy balance of microflora in the mouth, and prevent gum swelling and bleeding. Currently, a large number of liquid oral hygiene products and methods for their use have been developed, but the search and testing of new products does not lose its relevance. Conclusion. Despite the fact that liquid oral hygiene products are additional oral hygiene products, they significantly increase the effectiveness of basic products for the prevention and treatment of oral diseases, enhancing their effect, cleaning hard-to-reach interdental spaces, and freshening breath. In addition, they are distinguished by convenience and ease of use.

Objective. To calculate and analyze the neutrophil-lymphocyte index and its dynamics in patients with chronic mucopurulent bronchitis after 12 months of observation. Methods. A total of 92 patients with chronic mucopurulent bronchitis were followed up for 12 months. After 12 months, bronchiectasis was detected on OHC CT in 29 patients. NLI, which is the ratio of neutrophils to lymphocytes in the general blood count, was determined twice - at the beginning and at the end of follow-up. Results. At the end of the study, patients with bronchiectasis had higher NLI values than patients without bronchiectasis formation. Among the patients with CSHD who did not have bronchiectasis formation during the observation period: in 39 patients the NLI decreased, in 4 patients it increased and in 20 patients - did not change. Among patients with CSHD in whom bronchiectasis formation occurred during the observation period: 0 - NLI decreased, in 27 patients NLI increased and in 2 patients NLI did not change - NLI increased and in 2 people - NLI did not change. Conclusion. NLI is one of the promising predictors of bronchiectasis development in patients with CSHD. The absence of its decrease during dynamic observation allows predicting the formation of this complication.

Objective. to evaluate the effect of computer electroacupuncture and siping on the state of the autonomic nervous system in patients with allergic bronchial asthma in the acute stage. Methods. The study included 60 patients with bronchial asthma with a predominant allergic component (in the acute stage). Patients were randomized into groups I, II and III (20 people in each group). All patients received standard drug treatment. Patients in group I additionally received a course of siping; in group II, patients received a course of computer electroacupuncture; patients in group III received only standard drug treatment. The study design involved three-fold determination of the Kerdo autonomic index. Results. The first siping procedure led to an increase in the proportion of patients with normotension, and five siping procedures were accompanied by a further increase in the proportion of patients with normotension. In group II, after the first session of computer electroacupuncture, the proportion of patients with normotension also increased statistically significantly; after 5 sessions of computer electroacupuncture, the proportion of patients with normotension was the highest among other observation groups. In group III, no significant changes in the proportion of patients with normotension were registered during the study. The greatest decrease in the module of the Kerdo index values was registered in patients with initial sympathicotonia or parasympathicotonia in groups I and II. Conclusion. The inclusion of sipping nutrition or computer electroacupuncture in the complex treatment of exacerbation of allergic bronchial asthma leads to a more significant effect on the Kerdo index, compared with isolated standard pharmacotherapy.

Objective. To study was to evaluate the clinical picture in patients with severe ICA stenosis (˃ 60%) and phlebohypertension before and at different times after CEAE. Methods. Thirty patients (21 men and 9 women) aged 55 to 69 years with severe atherosclerotic lesions of the ICA ˃ 60% were examined. All patients had confirmed phlebohypertension according to the method of M.V. Shumilina. All underwent eversion CEAE. A collection of complaints with an assessment of the severity of symptoms using a visual analogue scale was conducted before surgery, on days 10-14 after CEAE, and after 6 and 12 months. Results. The data showed no relationship between dizziness and tinnitus and the timing of the postoperative period. Weakness and headache statistically significantly appeared more often on days 10-14 after surgery. There was a significant increase in the intensity of complaints on days 10-14 after surgery and then with a return to the initial level: dizziness, tinnitus (p˃0.05), or a statistically significant decrease in severity: weakness and headache (p˂0.01). Conclusions. Given the nonspecificity of complaints in patients with severe ICA stenosis and phlebohypertension, we consider it appropriate to perform ultrasound dopplerography of the brachiocephalic pool vessels with an assessment of the venous outflow tract and measurement of venous pressure before surgery and at the recommended times after.

Objective. Identification of the leading mechanisms of endothelial dysfunction formation in type I diabetes mellitus based on literature analysis. Methods. Based on the analysis of literary data, the main mechanisms of endothelial dysfunction development and its consequences in patients with type I diabetes mellitus were identified. Results. Based on the analysis of literature data, the main mechanisms of endothelial cell damage with impaired production of vasoactive substances and development of vascular complications in type 1 diabetes mellitus were studied. They include increased expression of selectin family adhesion molecules, impaired regulation of vascular tone due to insulin deficiency, damaging effects of oxidative stress, non-enzymatic glycosylation and decreased production of nitric oxide due to prolonged hyperglycemia. These damages leads to disorders of the vasomotor, barrier, angiogenic functions of the endothelium, and a decrease in its thromboresistance. Conclusion. Endothelial dysfunction is a predictor of vascular complications of type I diabetes mellitus. According to modern literary data, is formed both due to prolonged hyperglycemia, which results in the recruitment of endothelial precursor cells into the peripheral circulation, and is the result of oxidative stress, non-enzymatic glycosylation, which must be taken into account in the pathogenetic therapy of diabetic angiopathies.

Objective. A summary of research focused on improving the formulation of infant formulas based on goat's milk. Methods. The search for relevant information was carried out in the Russian-language search system eLibrary and the English-language databases PubMed. BMC, Scopus. Of the selected publications, the most significant domestic and foreign works were used for analysis. Results. The review presents an analysis of key areas for improving formulas for infant formulas based on goat milk. An assessment of potential changes in the quantitative and qualitative content of key components of formulas is made, taking into account age characteristics and dietary needs of the child's body. The possibility of combining milk from different types of farm animals (goats and sheep) in the production of modern lines of basic adapted, dietary-preventive and specialized nutrition for children from birth is considered. Conclusion. Combining milk components from different types of farm animals is another promising way to create more advanced adapted formulas for supplementary feeding or artificial feeding.

Objective. The aim of the study was to assess and analyze current data on modern magnesium fixators, evaluate the advantages of their clinical use, identify risks and problems when used in Orthopedics and Traumatology. Methods. The review was prepared using publication databases elibrary.ru, Google Scholar and PubMed. This literature review is not a systematic analysis. Results. Various implants consisting of bioresorbable materials are widely used to reduce postoperative complications. In modern traumatology and orthopedics, magnesium metal fixators are applied along with classical fixing systems made of polymer and ceramic materials. Conclusion. The analyzed sources describe technical, biochemical and physiological aspects of the use of magnesium fixators in clinical practice.

Objective. To evaluate the efficacy of robotic-assisted TKA using the CUVIS system for combined knee joint deformities. Methods. We present a case of a 68-year-old female with grade IV gonarthrosis (Kellgren-Lawrence classification), 24° varus deformity, and 28° flexion contracture. Robotic-assisted total knee arthroplasty was performed using the CUVIS system. Preoperative planning included CT scanning and 3D modeling for deformity correction. Intraoperatively, the system ensured precise execution of the surgical plan, achieving mechanical axis restoration to 0°±1° with optimal soft tissue balancing. Results. The Cuvis robotic system enabled high-precision correction, restoring the mechanical axis to 0° (error ≤1.5°) and achieving full range of motion (0-0-130°). Six-month follow-up demonstrated significant clinical improvement: VAS pain score 1, Lequesne index 2, KSS 165, and IKDC score 75, indicating excellent functional recovery and patient satisfaction. The system's technical capabilities allow its use both in standard TKA cases and for correcting minor tibial condyle bone defects when augments are clinically justified. Conclusion. The autonomous CUVIS robotic system provided accurate preoperative planning and complete correction of severe combined deformities during knee arthroplasty.

Objective. The study aims to assess the application of an expert evaluation system in choosing a gel base for the development of a topical gel. This system allows for efficient analysis of various bases and optimization of their selection based on several criteria. Methods. The Analytic Hierarchy Process (AHP) method was applied, which aids in decision-making through a structured evaluation of the problem's elements. Expert opinions were converted into weight coefficients for each alternative, allowing the establishment of priorities based on criteria such as spreadability, covering ability, and viscosity change in gels. Results. The analysis showed that a gel based on hydroxypropyl methylcellulose (HPMC) at a 1.5% concentration demonstrated the best spreadability, ensuring uniform distribution on the skin. A gel based on carbopol at a 1.5% concentration exhibited the highest covering ability, while gels with sodium carboxymethyl cellulose (CMC-Na) at concentrations of 3.5-4.5% showed the greatest viscosity stability. Conclusion. The results indicate that a carbopol gel at a 1.5% concentration and an HPMC gel at a 2% concentration are the best options for developing topical formulations. The use of the expert evaluation system and the AHP method significantly optimized the process of selecting gel bases, ensuring precision and decision-making efficiency.

Objective. The purpose of the experimental study of the content of toxic trace elements in wild-growing medicinal plant raw materials of natural ecotopes of the Voronezh region. Methods. Pharmacopoeial types of herbal raw materials were used as the objects of the study: common burdock ( Arctium lappa L.) roots, dandelion medicinal ( Taraxacum officinale F.H.Wigg) roots, plantain large ( Plantago major L.) leaves, nettle dioecious ( Urtica dioica L.) leaves, heart-shaped linden ( Tilia cordata Mill.) flowers, common tansy ( Tanacetum vulgare L.) flowers, wormwood bitter ( Artemisia absinthium L.) grass, motherwort five-lobed ( Leonurus quinquelobatus Gilib.) grass, common yarrow ( Achillea millefolium L.) grass, bird highlander ( Polygonum aviculare L.) grass. The microelement composition of the samples was studied by mass spectroscopic method after acid-microwave decomposition. Results. Among the determined toxic elements, cadmium is strongly accumulated from soils in a number of types of plant raw materials. Mercury accumulates strongly in nettles of dioecious leaves. The average level of biological absorption was noted for lead, bismuth and barium - mainly in the studied roots and leaves of plants. Conclusion. The results of the study of the microelement composition of the studied types of medicinal plant raw materials can be used in medical and pharmaceutical practice.

Objective. To develop a method for the qualitative determination of the amount of flavonoids in the herb of Astragalus glycyphyllus. Methods. The object of the study was the herb of Astragalus glycyphyllus, harvested in 2023-2024 in the Kursk and Oryol regions. The presence of flavonoids in the studied raw materials was determined using well-known qualitative reactions. For the separation and identification of individual flavonoids, the method of thin-layer chromatography on Sorbfil plates was used. Optimal conditions for the experiment were established empirically: the method of raw material extraction, the choice of chromatographic plates, the solvent system, the sample volume for analysis, standard substances and the developing agent. Results. Using qualitative reactions in extracts from the herb of Astragalus glycyphyllus the presence of flavonoids was established. Optimal conditions for the qualitative analysis of flavonoids in the herb of the studied plant were experimentally determined using thin-layer chromatography: chromatography was performed in an ascending manner, the solvent system was chloroform-alcohol 96%-water (26:16:3), and hyperoside CO and astragalin from Fitopanatseya LLC were used as witness substances. After drying, the chromatogram was treated with a 5% solution of aluminum chloride in ethyl alcohol and examined in UV light. As a result of the experiment, five compounds belonging to flavonoids were detected, including astragalin and hyperoside. The developed technique was validated for: specificity, precision and robustness. Conclusions. A method for the qualitative determination of flavonoids in the herb of Astragalus glycyphyllus has been developed. Optimal conditions for extracting flavonoids from raw materials and performing thin-layer chromatography have been established. The developed method has been validated for specificity, precision, and robustness. The presence of flavonoid compounds in the plant under study indicates the possibility of using the herb of Astragalus glycyphyllus as a source of natural antioxidants.

Objective. primary assessment of the biocidal or biostimulating effect of the infusion of individual components and the infusion of the sedative collection in vitro using the Paramecium caudatum test system with the help of the automated hardware and software complex "BioLat 3.2". Methods. The studies were conducted using the automated hardware and software complex "BioLat 3.2" manufactured by Evropolitest LLC, Russia. The device operates on the principle of converting a video image of a well with test organisms into a digital signal, which is transmitted to a computer via a USB port, using the Parametium caudatum ciliate test system. Results. It was established that the infusion of the sedative collection containing horse chestnut flowers, knotweed herb, St. John's wort herb, blue cornelian herb in a certain ratio is characterized by low toxicity in relation to the cellular in vitro test system and exhibits a biostimulating effect, which is confirmed by a significant reliable increase in the number of ciliates by 44% compared to the average control sample and 2 times compared to the initial indicator of the experimental sample during incubation for 24 hours. Conclusion. The infusion of the collection has a sedative effect, is characterized by low toxicity in relation to the cellular in vitro test system and exhibits a biostimulating effect.

Objective. The purpose of this study is to develop a diuretic collection for the treatment and prevention of urolithiasis and to standardize it. Methods. The study used official types of raw materials: Equiseti arvensis herba, Polygoni avicalaris herba, Vaccinii vitis-idaeae folia, Zeae maydis styli cum stigmatis , as well as Solidaginis dahuricae herba , which is promising for introduction into medical practice. The studies on standardization of the collection were conducted in accordance with OFS.1.4.1.0020 "Collections". When selecting the collection components and their ratios, the sum of phenolic compounds was determined using permanganometric titration. Analytical reactions and thin-layer chromatography were used to identify flavonoids and simple phenols. The sum of extractive substances was determined in accordance with OFS.1.5.3.0006. On the devices SF-2000 (Ekonova, Russia) and Leki SS1207 (Mediora OY, Finland) set the amount of flavonoids by differential spectrophotometry, the amount of simple phenols - by direct spectrophotometry after purification on a column. The results are processed statistically validated. Results. For the collection of diuretic (for urolithiasis) proposed components that are sources of flavonoids and simple phenols, with their equal optimal ratio. Established external and diagnostically significant microscopic features. For qualitative analysis, a thin-layer chromatography technique was proposed, where the mobile phase and chromogenic reagent are butanol-acetic acid-water 4:1:2 and 2% aluminum chloride solution (for flavonoids); ethyl acetate-acetone-glacial acetic acid-water 75:45:15:30 and 10% phosphomolybdic acid solution (for simple phenols). The content of extractive substances is regulated at least 25.0%, flavonoids (in terms of rutin) - at least 2.0% and simple phenols (in terms of arbutin) - at least 0.6%. Proposed norms of moisture content, total ash and ash insoluble in hydrochloric acid, impurities. Conclusion. The composition has been developed, the quantitative content of flavonoids and simple phenols has been established, and the diuretic collection has been standardized (for urolithiasis).

Objective. To conduct an analysis of the medical, demographic and social profile of patients with chronic myeloid leukemia (CML) to provide high-quality, safe and effective pharmacotherapy taking into account the individual characteristics of each patient in the Tyumen region. Methods. The study was conducted at the Department of Hematology and Chemotherapy of the Regional Clinical Hospital No. 1. A total of 183 medical records of patients with chronic myeloid leukemia were analyzed. Analytical, statistical, graphical, and mathematical methods were used. Results. The analysis showed that the average patient with CML in the Tyumen region is a woman (55%), of retirement age (60-69 years), is observed in the Tyumen municipal district (69%), takes Imatinib (74%), among concomitant diseases most often there are diseases of the circulatory system (23.7%). The average age of patients was 55 years, the diagnosis of chronic myeloid leukemia was most often established at the age of 47 years. The main preferential categories are: 964 - High-cost nosologies, 81 - Disabled 3 groups, 937 - Citizens suffering from hematological diseases. Conclusion. Based on a detailed analysis of the selected parameters from the medical records of patients with chronic myeloid leukemia, a medical-demographic and social portrait of patients with chronic myeloid leukemia in the Tyumen region was compiled to provide high-quality, safe and effective pharmacotherapy, taking into account the individual characteristics of each patient in the Tyumen region.

Nikolai Konstantinovich Nikiforovsky was born on April 22, 1945, in the village of M. Gorodishche, Novgorod Oblast. A child of the post-war era, he experienced all the hardships and privations endured by Soviet citizens. His father, Konstantin Sergeyevich, a partisan and recipient of the Order of the Red Star, died young. From adolescence, his mother, Nina Ivanovna, raised him. Thanks to the upbringing instilled by his parents, his hard work, his extraordinary love of reading, his natural intelligence, and his tenacity, Nikolai Konstantinovich always excelled in everything he did. He graduated from high school in Khmelnik, Ukrainian SSR, with a gold medal, and was admitted to Smolensk State Medical Institute on his first attempt. He was an excellent student and was deeply involved in community service. For a long time, he headed the institute's Komsomol organization and was an active participant in the construction brigades movement in the Smolensk region. His community service did not hinder the future professor from pursuing excellent studies and research. After graduating with honors from the Smolensk State Medical Institute's Faculty of General Medicine in 1969, he continued his studies in clinical residency and then postgraduate studies in the Department of Obstetrics and Gynecology. He defended his candidate's dissertation in 1975 and his doctoral dissertation in 1991.

Objective. To analyze prophylaxis of of postpartum haemorrhage in low-risk groups with natural delivery in a hospital of the 2nd and 3rd level of obstetric care. Methods. 203 cases of history of low-risk women delivered in 2024 at the 3rd (n = 118) and 2nd (n = 85) levels of obstetric care. Indicators were a drug for the prevention of bleeding, its dosage and method of administration, the volume of blood loss, a drop in hemoglobin after childbirth compared to pregnancy. Results. In 203 patients in the third period of labor was used: carbetocin - in 8 (3.9%), intravenous oxytocin 5 U - in 100 (49.3%), intramuscular oxytocin 10 U - in 95 (46.8%). Postpartum haemorrhage - 1.5%. The high efficacy of intramuscular oxytocin use was noted: no haemorrhage was recorded, the volume of blood loss and a decrease in hemoglobin after childbirth within acceptable values. Intravenous oxytocin administration was accompanied by a decrease in the volume of blood loss compared to intramuscular administration only in patients at level 3, but this was not confirmed by objective data: a decrease in hemoglobin of more than 20 g/l was recorded 2 times more often than with intramuscular administration (p<0.05). At the 2 level, the efficacy of the intramuscular and intravenous route of administration is the same (p>0.05). It was noted that the decrease in hemoglobin compared to antenatal in both hospitals was directly proportional to the volume of blood loss taken into account, but at the 3 level its volume is often underestimated. Conclusions. Prevention of postpartum haemorrhage in low-risk groups is carried out for all mothers. Oxytocin effectively prevents postpartum bleeding in low-risk patients. In a level 2 hospital, preference is given to technically simpler intramuscular injections of oxytocin; at level 3, intravenous administration is more often used. Objective control of hemoglobin demonstrates insufficiently objective accounting of blood loss at level 3.

Objective. To analyze the influence of thyroid hormones on the manifestation of hypertensive disorders during pregnancy in women with euthyroidism. Methods. Prospective cohort study including 459 observations. 39 pregnant women with hypertensive disorders: gestational arterial hypertension (n=25) and preeclampsia (n=14). Control group - 420 women with normal blood pressure. The analysis of the relationship of gestational hypertensive disorders with the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) adjusted for body mass index (BMI) and gestational weight gain (GWG) was performed. Results. Compared with the control, the average FT4 values were lower in pregnant women with hypertensive disorders: 10.7±1.7 pmol/l versus 9.9±1.4 pmol/l (p=0.01). The average FT3 level, on the contrary, was higher in the hypertensive disorders group - 5.0±1.1 pmol/l (p=0.046). The level of FT4, FT3, pregravid BMI, and GWG were statistically significant for predicting the development of hypertensive disorders during pregnancy. The model with the following output parameters was obtained: R2N=0.142, AIC=247.3, χ2=29.6, df=454, p<0.001. Statistically significant predictors of hypertensive disorders development were FT4 (OR 0.713, 95% CI: 0.55-0.924, p=0.011), FT3 (OR 1.534, 95% CI: 1.09-2.157, p=0.014) adjusted for GWG and BMI. With FT4 increase by 1 pmol/l, the chance of hypertensive disorders development during pregnancy decreased by 1.4 times, with free T3 increase by 1 pmol/l, it increased by 1.5 times. Conclusion. Free T4 and free T3 levels adjusted for pregravid BMI and GWG statistically significantly affect the development of hypertensive disorders during pregnancy. The probability of hypertensive disorders development increases with FT3 growth and decreases with FT4 increase. No association was found between TSH levels and hypertensive disorders during pregnancy.

In this article provided description of a rare patology in obstetric and gynecological practice: spontaneous heterotopic pregnancy, in which case uterine and tubal pregnancies were developing at the same time. This is an urgent condition which is dangerous both for a woman and a fetus developing in the uterus. Heterotopic pregnancy has difficulties in diagnosis, at that transvaginal ultrasound has a leading value in it (in diagnosis). Also this condition requires emergency surgical care. However surgical intervention in early gestation, when the uterine pregnancy is prolonged, is a risk factor for complicated course of pregnancy. In this article described the features of diagnosis of heterotopic pregnancy, management tactics for such a patient with a desired uterine pregnancy and its outcome.