The article considers the urgent problem of increasing conflict situations in the professional activity of a doctor, namely, conflicts between patients and health workers in the process of providing medical care. The effectiveness of the professional activity of a health worker directly depends on professionally significant qualities, including how well the health worker builds communicative interaction with patients, their immediate social environment, colleagues, and management. The purpose of providing a complete review is to analyze the materials of domestic and foreign studies on conflict management in medical activities. The search for materials on this problem was carried out in the scientific electronic library (SEL) eLIBRARY.RU (https://elibrary.ru/defaultx.asp) and in the Science Direct search system, which includes publications indexed in the Scopus and Web of Science databases. The main objective reasons and subjective factors of conflict occurrence in the conditions of medical care of the population are considered. Based on the results of systematization of the received information, ways of conflict resolution in medical activity are proposed, the necessity of formation of skills of methods of effective partnership interaction with patients and colleagues, competencies of the doctor in the field of psychological and pedagogical activity is shown.

Spinal cord tumors, differing in their histostructure, the nature of growth and the ratio to the diameter of the spinal cord, continue to be a difficult problem, both in terms of choosing the optimal treatment tactics and results. We present the results of surgical treatment of the most common spinal chord neoplasms in 2022, conducted in the Ale xandro-Mariinskaya Regional Clinical Hospita. The purpose of the study – to present the results of surgical treatment of spinal cord and spine tumors with secondary compression of neural structures that differ in histostructure, degree of malignancy and level of lesion. In 2022, 19 patients were operated on by various methods in the Alexandro-Mariinskaya Regional Clinical Hospita. 3 clinical cases with different histostructure and topographic-anatomical level of lesion are presented. Surgical treatment of spinal cord tumors was performed in 19 patients with different histostructure and topo graphic and anatomical lesion levels. Using the example of three clinical cases, the choice of various surgical treatment tactics that are most optimal for maintaining the patient's quality of life is demonstrated. The analysis of the surgical manual, its relationship with the prognostic trend, which affect the overall survival of patients with tumors of the spinal cord and spine. The dependence of a number of factors was revealed: the histological structure, the degree of “aggres siveness” of the oncological process, the possible spread of metastatic foci in the body. This, in turn, is interconnected with modern methods of diagnosis, surgical and adjuvant treatment, neurological and somatic compensation of the patient, which will allow to determine and transfer the aggressiveness of the indicated treatment method. The available modern equipment, accumulated surgical experience and the chosen active tactics for the maximum total removal of the lesion justified themselves, allowing to achieve a good functional result in 18 of the 19 operated patients.

Acute gestational pyelonephritis is a common pathology that often complicates the course of pregnancy. The disease develops against the background of characteristic changes in the urinary system that occur during pregnancy. Inflammatory kidney damage negatively affects the course of pregnancy and is accompanied by numerous of complications. The issues of treatment tactics for acute pyelonephritis have been developed in detail in terms of etiotropic antibacterial therapy, but there is no consensus on the need for drainage of the upper urinary tract. This paper presents our own experience in managing patients with acute gestational pyelonephritis, demonstrating the possibility and necessity of a differentiated approach when deciding on kidney drainage.

Preterm birth, a major cause of neonatal morbidity and mortality worldwide, is increasing in many coun tries, particularly in low- and middle-income countries. The purpose of the study – to analyze the structure and causes of preterm births in Astrakhan Oblast. To realize this goal, we retrospectively analyzed 200 individual charts of pregnant women (form 113-u) and case histories (form 003-u) of patients with PP for the period 2022–2023 delivered at the Re gional Perinatal Center of Astrakhan, which is a level III institution. Statistical analysis was performed using the Statistica 7.0 software package (Developer StatSoft, USA). The research work was conducted in accordance with the Declaration of Helsinki of the All-World Association of Ethical Principles for Scientific Medical Research Involving Human Subjects. In Astrakhan Oblast for the period 2018–2023, against the background of a decrease in the number of women of repro ductive age by 5.75 %, there was a decrease in the total number of births by 20.02 %. Against the background of the overall decrease in the number of births for the period, there is a decrease in the number of premature births by 28.3 %. Currently, according to clinical recommendations, care for women at risk of preterm labor is provided mainly in level III facilities. Thus, the rate of extremely early preterm births in the Regional Perinatal Center of Astrakhan in 2023 was 84.7%, which is 24.7% higher compared to 2018. The presented analysis showed the role of various risk factors for preterm labor, including the timing of pregnancy termination. Preterm birth is a difficult-to-manage condition, where symptomatic treatment improves neonatal outcomes but does not reduce its incidence. Reduction in preterm birth can be achieved by prophylactic progesterone in women with a history of preterm birth, in those patients in whom short cervical length has been identified by routine transvaginal ultrasound, and by personalized preconception care that takes into account history and both environmental and individual risk factors.

Regmatogenic retinal detachment is one of the severe conditions in ophthalmology that, in the absence of timely treatment, leads to disability among the population. The purpose – to analyze the prevalence of regmatogenic retinal detachment in the Astrakhan region over the past five years (2019–2023). Indicators such as morbidity, follow-up, and disability due to this pathology were evaluated. The study analyzed two groups of patients (1,411 individuals): the adult (1,345) and child (66) populations. All patients underwent a standard ophthalmological examination. According to the study, the incidence of regmatogenic retinal detachment in the Astrakhan region significantly exceeded the average for Russia and amounted to 148.4 per 100,000 population. In both groups, the incidence rate in 2020 increased compared to 2019 and remained stable until 2022 inclusive; however, in 2023 it decreased by 15.6 % (adult population) and 33.3 % (child population). Conclusion. Timely treatment of regmatogenic retinal detachment requires a comprehensive approach that includes both prompt care and preventive measures among the population.

A fairly common neoplasm of the temporal bone is a paraganglioma. The incidence of this pathology is 1 : 30,000 of the population, with a predominant prevalence in women. Despite advances in medical technology, the diagnosis and treatment of temporal bone paraganglioma has its own difficulties. This is primarily due to the late treatment of patients to the doctor, an imperfect diagnostic algorithm and the peculiarities of the location and abundant vascularization of this tumor. A clinical case is presented: a patient with a neoplasm of the left middle ear (paraganglioma type C according to Fish), left-sided deafness, neuropathy of the facial nerve (paresis of facial muscles of the III degree on the House-Brackmann scale). It is worth noting the importance and necessity of a multidisciplinary approach, timely decision-making both at the stage of diagnostic examination and during treatment, which will avoid severe complications of this pathology.

The article considers a clinical observation of a patient with type 2 diabetes mellitus after reconstructive angioplasty of the femoral artery on the right, the development of acute bypass thrombosis, wet gangrene and amputation during the new coronavirus infection COVID-19. The use of oxygenated drugs eliminates tissue oxygenation deficiency, and local wound treatment using hardware hydrosurgical treatment and exogenous nitric oxide flows has a beneficial effect on metabolic processes of wound healing, allows suppressing the activity of wound microbiota and preventing death.