Relevance. Verification of a new coronavirus infection (COVID-19) requires clear algorithms for the diagnosis and treatment of patients, depending on clinical, laboratory and instrumental dates. Timely and informed decisions on optimizing management tactics and prescribing proactive anti-inflammatory therapy before development of a complete symptom complex life threatening conditions are needed in some cases. Aim of the study. To analyze the course and outcomes of a new coronavirus infection, depending on the initial characteristics of the patients and treatment options. Materials and methods. A preliminary analysis of the case histories of 129 people hospitalized in the center for treating patients with a new coronavirus infection at North-Western State Medical University n.a. I.I. Mechnikov was made by random sampling. Among the hospitalized patients there were 67 men (51.9%), the average age was 57.9 16.4 years, 62 women (48.1%), and the average age was 60.2 13.6 years. During hospitalization, all patients underwent standard clinical laboratory and instrumental examination, as well as determination of saturation (SpO2), markers of the cytokine storm (CRP, ferritin, AST, D-dimer, fibrinogen, lymphocytes), compute tomography (CT) of the lungs. The effectiveness and safety of therapy was evaluated by the outcome (recovery, death), as well as by the presence of adverse events in the background of the therapy. Statistical processing of the research results was carried out using the Statistica 12 for Windows application software package, the significance of differences between the two relative values was evaluated using the Student t-test (t 2, p 0.05). Results. Fatal outcomes were significantly more frequently recorded among patients of older age groups and males. The presence of concomitant diseases such as obesity, diabetes mellitus, pathology of the cardiovascular system was accompanied by more frequent fatal outcomes. That allows considering comorbidity as a risk factor for severe course and poor prognosis of COVID-19. However, in general, in the presence of the indicated forms of concomitant diseases, it was not possible to establish significant differences with the outcomes of COVID-19, which may be due to an insufficient amount of patients. Predictors of fatal outcome was low values of saturation, the presence of respiratory failure, a significant amount of lung tissue damage (CT-3-4), as well as high values of CRP, ferritin, AST, D-dimer, neutrophilia, lymphopenia, thrombocytopenia. The use of anticytokine drugs (ACD) in complex therapy can be considered a favorable predictor of outcome, which indicates the advisability of wider use. The materials of the study allow not only a preliminary assessment of the course and effectiveness of complex therapy using anticytokine drugs with COVID-19 in patients with comorbid diseases, but also to develop therapeutic and diagnostic algorithms in patients of this category.

The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods. A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.

Аннотация. Актуальность. В связи с постоянным совершенствованием технической базы по проведению лабораторных исследований повсеместно возрастает и количество лабораторных тестов, как необходимых для пациента, так и второстепенных, что не может не отражаться на финансовых затратах на лабораторное обеспечение медицинской организации. Рост расходов требует поиска различных путей по оптимизации затрат. Учитывая повсеместное внедрение медицинских и лабораторных информационных систем, требуется разработка алгоритмов оптимизации лабораторных назначений и с их помощью. Цель. Показать возможные пути оптимизации расходов на лабораторные исследования, в том числе и с использованием интеграции медицинской информационной системы и лабораторной информационной системы. Результаты. В статье описаны основные возможности по оптимизации расходов на лабораторные исследования в многопрофильном стационаре, особенностью которого является территориальное удаление клинических подразделений и лабораторий. Рассмотрены основные механизмы оптимизации -адекватное соотношение централизации лабораторных исследований и децентрализации (проведение анализов на месте лечения пациента -point of care testing), создание «специализаций» для клинико-диагностических лабораторий в зависимости от профиля клинических подразделений и количества назначаемых анализов по профилю. Показан принцип внедрения в медицинскую информационную систему контроля за назначениями лабораторных исследований. Произведена экономическая оценка результатов интеграции медицинской информационной системы и лабораторной информационной системы. Заключение. Совместное использование всех существующих методов оптимизации расходов на лабораторную службу позволит снизить финансовые затраты на лабораторное обеспечение с сохранением качества медицинской помощи.Ключевые слова: управление лабораторными назначениями; минимальный интервал для повторного назначения теста; оптимизация расходов на лабораторию Для цитирования:

Patients with various forms of coronary artery disease often suffer from other comorbid conditions that affect the quality of life and make it difficult to select the optimal therapy. The most acute problem of comorbidity manifests itself in the need for surgical treatment, especially extensive surgical interventions. The key to successful surgical treatment in this category of patients is the work of a multidisciplinary team of specialists deciding on the operability, stages of surgical interventions, choice of methods revascularization and features of patient management in the postoperative period. The article presents a case of successful surgical treatment of the patient with unstable angina and gastric stump cancer, demonstrating the well-coordinated work of a multidisciplinary team of specialists.

The article presents achievement analysis of diagnostic criteria for assessing the quality of emergency and specialized medical care, in which, 62 patients of a therapeutic profile were admitted to the hospital. The general criteria was approved by the order of the Ministry of Health of the Russian Federation No. 203n of 10.05.2017, in terms of the volume and timeliness of care. Research results of the compliance of the provided EMА with the criteria for assessing its quality are: in the group of general quality assessment criteria — 1 00% and volume assessment criteria — 9 9,0% and timeliness — 9 8,9%. EMА at the admission of patients with a therapeutic profile to the hospital indicates a high level of its achievement.