Surgery is the area of medicine that studies acute and chronic diseases that are treated with surgical intervention. Surgery is one of the most ancient branches of medicine. Trepanning of the skull is the oldest surgical method for which there is evidence. The article presents the main aspects of the organization of surgical care at the outpatient and hospital stages.

Stoma in surgery is an artificial opening that creates a connection between the cavity of any organ (for example, the intestines, trachea) and the environment. This opening is done in the hollow organ when it is obstructed or to exclude the parts lying below the stoma from the work. The ostomy surgery is one of the oldest types of surgical interventions. There is evidence of such operations in antiquity and at a later time. However, postoperative care of such defects was problematic, and often led to the death of the patient, since it was impossible to ensure proper sterility of the surgical wound until the creation of effective antiseptics. People, who have undergone medically indicated surgery, are called ostomy patients. Societies of ostomy patients are created in some cities together with medical specialists from the «School of Ostomy Patients» to exchange experience how they live with it.

This article reflects the questions devoted to the definition of restrictive cardiomyopathy. The paragraphs of the article are devoted to the features of the disease development or its etiology as well. The main classification of the disease, clinical features and pathogenesis are presented. Treatment of restrictive cardiomyopathy is considered as a wide range of diseases united by one pathophysiological mechanism of restrictive diastolic dysfunction due to ventricular wall infiltration with various pathological substances or widespread fibrosis. Restrictive cardiomyopathy was considered thoroughly and comprehensively — not only Russian, but also foreign sources were studied, which makes it possible to address the issue fully.

The aim of the work is to highlight the modern methods of obesity treatment that are used in medicine in different countries. Obesity is a health problem in most developed countries. Concomitant diseases may include disorders of lipid metabolism with increased atherogenic LDL levels, coronary artery disease, hypertension, type 2 diabetes, various diseases of the gastrointestinal tract, etc. Currently, medications along with diet and exercises are used in the treatment of obesity. Centrally acting drugs that reduce food intake by reducing appetite, as well as drugs that reduce the absorption of food components (example: orlistat) are prescribed. Hormonal regulation of accumulation or consumption of fat in depots is quite complicated and has not yet been fully studied. Much attention is paid to the study of the pathogenesis of obesity, in particular the effects of adipose tissue hormones, such as leptin, ghrelin. Leptin is considered a hormone that increases with obesity and signals the brain about the presence of sufficient fat reserves in the body. We have investigated the level of leptin in somatically healthy young people with obesity. Statistical analysis showed that the blood leptin level in the obese group was 42.8 (35.42; 45.06) ng/ml. The normal level of leptin in the blood is up to 5.6 ng/ml.

Exudative otitis media is a non-purulent inflammatory disease of the middle ear, accompanied by dysfunction of the Eustachian tube and the accumulation of fluid in the tympanic cavity. The recognized trigger of this pathology is a drainage and ventilatory dysfunction of the Eustachian tube. There are three main theories of the pathogenesis of this disease, but most often there is a combination of factors. The main clinical manifestations are the accumulation of fluid in the tympanic cavity, the absence of signs of acute inflammation and eardrum defects. The upper respiratory tract is treated and nasal breathing is restored at the first stage of treatment of exudative otitis media. In the treatment of exudative otitis media, both medical and local non-drug methods are used. The use of desensitizing treatment, decongestants, mucolytics and enzyme preparations is a common drug treatment. An indispensable condition of conservative therapy is an assessment of the results of direct treatment after 1 month. Surgical treatment methods include such methods as paracentesis of the eardrum, myringotomy, bypass surgery of the tympanic cavity (tympanostomy), laser interventions. The problem of exudative otitis media remains relevant both in medical and social terms.

The relevance of the trends in the reformation of the psychiatric inpatient service [5, 6] in the city of Moscow is presented on the basis of materials of one of the psychiatry departments of the healthcare facility — Psychiatric Hospital No. 13 of the Moscow Healthcare Department. The activities of one of the psychiatry departments for the studied period of time (2016-2018), changes that occurred during the reformation of the psychiatric service are analyzed. A full-design retrospective study of hospital resources was carried out using the example of one of the psychiatry departments of the Budgetary Healthcare Institution Psychiatric Hospital No. 13 of the Moscow Healthcare Department for the period (2016-2018). It is noted in the article that the ongoing reform of the psychiatric service of the city of Moscow [1, 2] took place at the hospital level. The number of patients with schizophrenia remains at a fairly high level, there is a decrease in the number of hospitalizations due to the work of the new outpatient structures of the outpatient psychiatric facilities — the department for delivering outpatient care in the district, the department for delivering intensive psychiatric care at home, and the emergency psychiatry department [7].

A study was conducted in 2016–2017 on the basis of 7 central district hospitals, 10 district hospitals and 15 rural outpatient clinics of the Republic of Dagestan in order to develop recommendations for improving the organization of work for general practitioners. The work measurement method has been used to study organization of work flow of 35 doctors (15 general practitioners and 20 district therapists) for 865 hours. Under these conditions, physicians in rural general outpatient clinics do not spend enough time on preventive work (for GPs, 18 %, for DPs, 14.1 %). A lot of time is spent on medical documentation (29.7 % for GPs, 32 % for UT) and other activities (10.1 % for GPs, 11.6 % for DPs). General practitioners, compared with district therapists, pay more attention to preventive work and to families on the site. Methodological guidelines have been developed on the basis of the research materials for improving the organization of work for general practitioners.