Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed either locally (topical forms) at the first stage, or orally at the second stage, if the effect of local pain relief when using NSAIDs has not been achieved. The combined use of different forms with the same NSAID molecule will enhance and prolong the anti-inflammatory and analgesic effect, reduce the dosage of the oral drug, and thereby reduce the risks of adverse events (AE). Nimesulide is a representative of the sulfonanilide class among NSAIDs, refers to drugs that inhibit mainly the enzyme cyclooxygenan-2 (COX-2), and has no effect on COX-1. Selective COX-2 inhibitors are significantly less likely to cause the development of NSAID-gastropathies. Nimesulide is characterized by a low range of relative risks (RR) compared to other commonly prescribed NSAIDs: <2 for rofecoxib, celecoxib, nimesulide; from 2 to < 5 for naproxen, ibuprofen, diclofenac, etoricoxib, meloxicam; and ≥ 5 for ketoprofen, piroxicam, ketorolac. The anti-inflammatory and analgesic effect of nimesulide is achieved by inhibiting the release of tumor necrosis factor alpha (TNF-alpha), histamine, inhibiting the formation of reactive oxygen species, releasing matrix metalloproteases (MMPs), and inhibiting chondrocyte apoptosis. The clinical effectiveness of the analgesic effect of nimesulide has been proven in pain syndrome in patients with osteoarthritis (OA), lower back pain (LBP), gouty arthritis. The anti-inflammatory effect of nimesulide is manifested in the suppression of pro-inflammatory cytokines. Nimesulide has a low level of AE from the gastrointestinal tract (GIT), therefore it can be recommended for elderly patients.

One of the most common reasons for seeking medical help from doctors of various specialties is a disturbance of balance function, described by patients as dizziness. Despite the apparent simplicity and unambiguity of the complaint, it turns out that under this term patients mean completely different conditions: instability, unsteadiness when walking, swaying, nausea, pre-fainting condition, “fog in the head”, impaired coordination, etc. Often, the patient not only finds it difficult to independently describe his feelings, but also simultaneously lists several descriptors. It is not always possible to specify the patient’s desires, which complicates the diagnosis of dizziness and the establishment of the etiological factor. In connection with the above, an algorithm is currently used in the diagnosis of dizziness, which includes an assessment of the vestibular syndrome by the nature of the course (acute, episodic, chronic), identification of provoking factors (triggers), concomitant symptoms, supplemented by a physical examination, and, if necessary, paraclinical methods. In the treatment of dizziness, priority is given to its rapid and effective relief. For this purpose, drugs are used – vestibular suppressants. Given the high prevalence of comorbid conditions requiring the simultaneous use of several drugs, combination drugs have an advantage. A combination of cinnarizine and dimenhydrinate has demonstrated high efficiency and safety as a symptomatic therapy for dizziness of various origins. The combination of drug therapy with vestibular rehabilitation methods allows achieving better results and longer remission even in chronic cases of dizziness.

The incidence of anxiety disorders in patients with temporal lobe epilepsy (TLE) is higher than in the general population. Studies on anxiety disorders and their correction in patients with temporal lobe epilepsy are not so numerous, and their results are somewhat contradictory. A drug for the correction of anxiety disorders prescribed to patients with epilepsy should have a high efficiency, favourable tolerability profile and minimal side effects. Many studies have shown that gamma-aminobutyric acid (GABA) plays a key role in the regulation of neuronal excitability. Decreased inhibitory GABAergic transmission in the central nervous system is crucial for the development of anxiety. Enhancement of the inhibitory action of GABA leads to a decrease in neuronal hyperactivity, allowing the symptoms of anxiety to be reduced. Benzodiazepines are among the most effective drugs for the treatment of anxiety disorders. Enhancement of the inhibitory action of GABA leads to sedative, anxiolytic and myorelaxant effects. Long-term use of benzodiazepines may lead to tolerance requiring dose adjustment, increases the risk of potential dependence, marked sedation and cognitive impairment are observed. In this regard, it seems relevant to use drugs that target the GABA receptor, but with a smaller spectrum of undesirable effects. Etifoxin, a non-benzodiazepine drug of the benzoxazine family, has anxiolytic action due to a dual mechanism of action on GABA-receptors, so that GABA-ergic transmission is improved. Two clinical observations of mesial temporal sclerosis (hippocampal sclerosis) with the development of anxiety disorders are presented. In addition to antiepileptic therapy, the patients were prescribed etifoxine (Strezam) 50 mg 1 capsule 3 times a day. At the repeated examination after 21 days the general well-being of the patients improved, regression of emotional tension and anxiety disorders was noted. Given the high efficiency of etifoxin in the correction of anxiety disorders and its favorable tolerability profile, as well as additional effects such as anticonvulsant, neuroplastic, neurotrophic and neuroprotective effects, its use should be recommended in the complex treatment of patients with temporal lobe epilepsy.

Introduction. Primary headaches (PH), including tension-type headache (TTH), have a strong negative impact on the quality of life and academic success of children. Posture disorders, particularly upper crossed syndrome (UCS), play an important role in the development and chronicization of TTH.

Aim. To study the influence of UCS on the clinical picture of TTH in children and the effectiveness of non-pharmacological methods of correction.

Materials and methods. A total of 113 children aged 14–17 years were examined. Frequent or chronic TTH with the presence of UCS was diagnosed in 70 children (main group), 43 children with infrequent TTH or without headache without TTH were included in the control group. Examination included history taking, neurological examination, posture assessment with laser leveler and mechanoalgometry. Treatment included kinesiotaping and training of correct motor stereotype.

Results. Patients with UCS showed significantly greater forward head tilt angle, asymmetry of the shoulder girdle, decreased pain threshold of pericranial muscles, increased frequency and intensity of headache compared to controls (p < 0.001). Three months after treatment, there was a statistically significant decrease in head tilt angle, asymmetry of the shoulder girdle, increase in pain threshold and decrease in headache intensity and frequency (p < 0.001) to the level of the control group.

Conclusions. UCS is a significant factor in the development and chronicization of TTH in children. Non-medicamentous correction with kinesiotaping and training in correct motor stereotypes are effective in restoring normal posture and reducing clinical manifestations of TTH.

Recent research increasingly addresses the safety issues of psychopharmacotherapy, particularly in connection with the need for long-term medication use in the treatment of mental disorders. In this context, the Global Trigger Tool (GTT) method serves as an effective instrument for monitoring adverse events, however, its application in psychiatry requires adaptation considering the specifics of this medical field and the organizational features of psychiatric care in Russia. This systematic review includes an analysis of 7 key studies conducted in Sweden, Norway, Singapore, the USA, and Russia, identified in PubMed, Google Scholar, and Elibrary databases (up to March 2025). The included articles describe both the application of the original methodology in psychiatry and attempts to modify it for this medical domain. Of particular interest are studies that attempted to adapt the GTT to the legal and cultural characteristics of national healthcare systems. All included studies demonstrated the value of this methodology for monitoring the safety of pharmacotherapy in psychiatric practice. Based on the obtained results and considering international experience, while taking into account the specifics of Russian psychiatric practice, the authors developed a specialized trigger panel during a dialogue conference. This panel enables the creation of a unified system for monitoring psychopharmacotherapy safety, which is especially relevant for Russian medical institutions. The implementation of this methodology can not only standardize the safety monitoring process but also significantly enhance the safety level of pharmacotherapy in the treatment of mental disorders in the Russian Federation.

Introduction. Cochlear implantation (CI) is the most effective way of rehabilitation for children with profound hearing loss. Choosing the settings of the CI processor is an important task, because the child’s speech intelligibility and understanding depend on the parameters of processor stimulation, and, consequently, the subsequent auditory-speech development and integration of the child into society.

Aim. To evaluate auditory and speech development in a group of children aged from 3 to 14 years using different CI systems: Medel, Advanced Bionics, Cochlear, Nurotron, Oticon and Neurelec by using the MUSS Scale (Meaningful Use of Speech Scale) and the method of speech audiometry in a free field sound.

Materials and methods. The study includes 82 children with CI. The children received complaints, medical history, examination of ENT organs, consultation with a surdo teacher, setting of the CI processor, assessment of speech intelligibility by using speech audiometry in a free field (n = 82) during the process of setting the CI processor and after setting. In a group of 56 children (n = 56) of preschool age from 5 to 7 years, parents answered the questions by using the MUSS Scale (Meaningful Use of Speech Scale).

Results. According to speech audiometry data, the intelligibility of monosyllabic words in the free field was 70.85 ± 1.44%, and of multisyllabic words – 74.51 ± 1.60%. The results of speech intelligibility after setting the CI processor significantly improved and amounted to: monosyllabic words – 76.95 ± 1.31% (p < 0.01), and multisyllabic words – 83.78 ± 1.43% (p < 0.001).

Conclusion. The Scale of Meaningful Speech Use (MUSS) is a simple tool for assessing the development of speech in cochlear implanted preschool children. Speech audiometry in a free field can be used to assess the level of speech intelligibility and to determine the parameters of speech processor stimulation.

Introduction. Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD). Fibrotic HP is associated with disease progression, impaired lung function, and poor clinical outcomes.

Aim. Identify factors that increase the risk of progression of pulmonary fibrosis in patients with HP.

Materials and methods. We conducted a retrospective multicenter observational study analyzing data from a fibrosing ILD registry (n = 1355). The study included 292 patients with chronic HP confirmed by multidisciplinary discussion. We evaluated clinical, functional, and laboratory parameters, including 6-minute walk test results and echocardiography findings at baseline and 12-month follow-up. Risk factors for progression were identified through correlation and regression analyses. ROC curve analysis and Kaplan-Meier survival analysis were performed to assess the prognostic significance of various parameters.

Results. Among 292 chronic HP patients, fibrosis prevalence was 91.8% with 14.5% mortality. Patients were stratified into progressive fibrosis (n = 92, 30.3%) and non-progressive (n = 200, 69.7%) groups. Regression analysis identified significant predictors of progression: male sex (OR 1.68, 95% CI 1.02–2.76, p = 0,041), smoking (OR 1.1, 95% CI 1.0–1.1, p = 0,002), Charlson Comorbidity Index (OR 1,48, 95% CI 1.03–2.12, p = 0.036), GAP score (OR 1.57, 95% CI 1.1–2.3, p = 0,015), and DLco % predicted (OR 0.93, 95% CI 0.89–0.97, p = 0.001). ROC analysis revealed DLco <50% predicted (p = 0.0001), GAP score ≥4 (p = 0.03), and Charlson Index ≥3 (p = 0.04) as significant progression factors.

Conclusion. Patients with fibrotic HP demonstrate high rates of pulmonary fibrosis progression. The main progression predictors include male sex, smoking, higher Charlson Comorbidity Index, DLco < 50% predicted, and GAP score ≥ 4.

Nowadays, there is a steady increase in the prevalence of chronic atrophic gastritis (CAG). The CAG etiology is complex and associated with many factors, which can act synergistically. Despite significant advances in the understanding of CAG, no specific treatment strategies for this disease have been developed. It drives scientists around the world to attach special attention to studying its pathophysiology and developing effective approaches to diagnosis and treatment in terms of cancer prevention. Today active work is underway to find new diagnostic biomarkers for early detection of atrophy, including the use of proteomic and metabolomic analysis. Due to the complexities of the pathogenesis of atrophic changes of gastric mucosa and the difficulties in treating this disease, it is necessary to consider personalized approaches to the treatment of such patients. The main objectives of the CAG therapy are to relieve dyspeptic symptoms, if any, and to prevent the risks of developing gastric cancer. The latest consensus documents contain recommendations on lifestyle modification, timely diagnosis and subsequent eradication of H. pylori infection, as well as the use of cytoprotective drugs to reduce the mucosal damage progression in CAG. Rebamipide neutralizes lipid peroxidation, increases mucosal blood flow and accelerates epithelial barrier restitution, which allows to recommend this drug for the treatment of CAG. Rebamipide can potentially prevent CAG by improving the mucous membrane state in chronic gastritis of any etiology, for which reason the cyclic and continuous therapy with rebamipide is currently considered as an effective strategy for the treatment of CAG and the prevention of gastric cancer.

The research and publications of the last decade have radically changed traditional medical concepts and our understanding of the possible interrelationship/comorbidity of organs and body systems. A lot of research is devoted to studying the relationship between the gut microbiome and various diseases. Inflammatory bowel disease (IBD) and Parkinson’s disease (PD) are chronic inflammatory diseases that are increasingly affecting millions of people worldwide, posing a major public health challenge. We searched the Pubmed and Scopus information databases for articles published before 04/01/2025 that examined the relationship between IBD and PD. Epidemiological studies and meta-analyses demonstrate the relationship between inflammatory bowel disease and Parkinson’s disease. Possible mechanisms of this relationship include changes in the intestinal microbiota, interaction along the gut-brain axis, and common molecular genetic mechanisms, the most interesting example being LRRK2 (leucine-rich repeat kinase 2), which was initially identified as a causative gene in Parkinson’s disease, and then its involvement in the pathogenesis of inflammatory bowel diseases was established. The presented review suggests the need for further prospective studies to clarify the relationship between inflammatory bowel diseases and Parkinson’s disease. The review highlights the importance of interdisciplinary approaches in understanding the systemic consequences of changes in the gut microbiota in inflammatory bowel diseases and their potential impact on brain health. The modulation of the gut microbiome, taking into account their possible impact on Parkinson’s disease, has a promising potential for improving prevention and treatment through innovative therapeutic strategies, especially in comorbid patients.

The actual concept of type 2 diabetes mellitus (T2DM) treatment includes optimizing the management of metabolic health, primarily glycemia and body weight, as well as preventing the development of cardiovascular diseases (CVD), chronic kidney disease (CKD), and metabolically associated fatty liver disease (MAFLD). Reduction of fat mass contributes to stable compensation of carbohydrate and lipid metabolism, control of blood pressure and reduction of cardiovascular risk, CKD and MAFLD. Glucagonlike peptide-1 (GLP-1Ap) receptor agonists are a highly effective class of drugs for the treatment of patients with T2DM, both by increasing the effectiveness and safety of glycemic control, and by having additional positive effects on the cardiovascular system and body weight. Studies have revealed numerous positive pleiotropic effects of semaglutide, which allows for better management of type 2 diabetes. For the first time in 2019 The Russian clinical guidelines and Algorithms for specialized medical care for patients with diabetes mellitus included information on the proven priority treatment of T2DM with CVD of atherosclerotic origin with GLP-1Ar class drugs. The development of a domestically reproduced drug, Semavik®, has made it possible to increase the availability of semaglutide preparations in the Russian Federation and expand the possibilities of pathogenetically based therapy providing cardiometabolic and other pleiotropic benefits in patients with T2DM. This clinical example presents the results of the efficacy and safety of the Russian semaglutide Semavik® in a patient suffering from long–term uncompensated T2DM, morbid obesity and receiving insulin therapy. Against the background of the addition of domestic GLP-1Ar to therapy, significant positive dynamics of glycemia and other metabolic parameters, weight loss, and improvement in objective examination indicators were achieved. The appointment of a domestic semaglutide made it possible to de-intensify insulin therapy in the form of its cancellation. The use of domestic semaglutide shows and proves its effectiveness not only in achieving the target values of blood glucose levels, but also in reducing body weight and normalizing the lipid profile.

Prediabetes is often detected in young women planning pregnancy. The effectiveness of metformin in normalizing metabolic and hormonal parameters in a woman with prediabetes was assessed. Patient H., 33 years old, with obesity and high blood pressure (BP), is planning pregnancy. Obesity for 6 years, weight gain of 7 kg during the year, menstrual cycle irregularities, BP up to 150/90 mm Hg. Waist circumference (WC) 98 cm, hip circumference (HC) 86, WC/HC 1.1, height 166 cm, weight 84 kg, body mass index (BMI) 30.5 kg/m², BP 140/85 mm Hg, venous plasma glucose 6.2 mmol/l. The patient has hyperinsulinemia, insulin resistance and dyslipidemia. Against the background of a hypocaloric diet and increased physical activity, metformin 1000 mg was prescribed with an assessment of metabolic and hormonal disorders after 6 and 12 months. After 12 months, weight was 69 kg (-15 kg), WC 77 cm (-13 cm), BMI 25 kg/m² (-5.5 kg/m2), HOMA-IR 0.87 (-4.83), BP 110/70 mmHg, TG 0.9 mmol/l (-1.0), LDL-C 1.7 mmol/l (-1.6), HDL-C 1.3 mmol/l (+0.4), venous plasma glucose 4.0 mmol/l, insulin 4.9 μU/ml. Normalization of hormones: LH 5.7, FSH 3.8 IU/l, LH/FSH 1.5, testosterone 1.2 nmol/l. Regular menstrual cycle after 6 months. Metformin 1000 mg per day in a young patient with prediabetes against the background of a hypocaloric diet and increased physical activity effectively reduced body weight, normalized the insulin resistance index, metabolic and hormonal parameters necessary for pregnancy planning.

Subclinical hypothyroidism (SH) is a condition characterized by an elevated level of thyroid-stimulating hormone (TSH) with normal concentrations of free thyroxine. In recent years, its impact on the cardiovascular system has been actively discussed, as even a moderate deficiency of thyroid hormones may contribute to the development of dyslipidemia, arterial hypertension, and atherosclerosis. This article analyzes current data on the pathophysiological mechanisms linking SH to cardiovascular diseases and reviews key aspects of diagnosis and therapy for this condition. It has been shown that SH is associated with alterations in lipid profiles, including increased levels of total cholesterol and low-density lipoproteins, which contribute to the progression of atherosclerosis. SH may also lead to endothelial dysfunction and structural and functional changes in the myocardium, increasing the risk of cardiovascular events. Treatment with levothyroxine (L-T₄) improves lipid profiles and vascular function; however, its effect on cardiovascular outcomes remains a subject of debate. Given the potential cardiovascular risks, patients with SH require an individualized approach to diagnosis and treatment. L-T₄ replacement therapy may be appropriate in cases where TSH levels exceed 10 mIU/L or when cardiovascular risk factors are present. Currently, there are many different L-thyroxine medications available on the pharmaceutical market; however, L-thyroxine Berlin-Chemie has a number of key advantages. One of the important distinctions of this medication is the absence of lactose in its composition, making it an optimal choice for patients with lactose intolerance. This medication combines the absence of lactose, high stability, convenience of storage, and reliable protection against external factors, making it an ideal choice for long-term therapy of hypothyroidism. Further clinical research is needed to determine the optimal management strategy.

Introduction. The proportion of men with rheumatoid arthritis (RA) reaches 25%. Given the previously identified high frequency of decreased testosterone in men with RA, the issue of clinical diagnosis of hypogonadism is relevant.

Aim. To evaluate the effectiveness of the Aging Male Symptoms (AMS) questionnaire for diagnosing hypogonadism among patients with RA.

Materials and methods. A cross-sectional continuous study included 78 men with RA who were undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels. All men completed the AMS questionnaire to screen for clinical signs of testosterone deficiency. A correlation analysis was performed between the AMS scores with the testosterone level and clinical and laboratory parameters of RA. ROC analysis of the sensitivity and specificity of the AMS questionnaire was performed in comparison with laboratory diagnostics of hypogonadism.

Results. Based on the results of the questionnaire, androgen deficiency was suspected in 70.5%. Hypogonadism (decreased testosterone levels < 12.0 nmol/l) was detected in 33.3% of patients. A significant negative correlation was found between the total score of the AMS questionnaire and all three subgroups of questions with the level of total testosterone. A moderate correlation was noted between age and the sexual symptoms of the questionnaire. The DAS28 index, the number of swollen joints and the level of C-reactive protein significantly positively correlated with the total score of the AMS, as well as with its somatic and psychological components. When conducting the ROC analysis, the area under the ROC curve was 0.728 (95% CI 0.604–0.851; p < 0.001). The threshold value for the AMS questionnaire at the cut-off point was 38.5 points. The sensitivity and specificity of the model were 75.0% and 69.2%. The diagnostic accuracy of the questionnaire was 51.3%, the positive predictive value was 39.3%, and the negative predictive value was 81.8%.

Conclusion. The AMS questionnaire can be effective for diagnosing androgen deficiency symptoms in men with RA, but RA activity makes a significant contribution to the score, which increases the threshold value at which the questionnaire shows satisfactory sensitivity and specificity.

Introduction. The rare detection of sarcopenia (SP) in patients with rheumatoid arthritis (RA) is associated with the low informative value of available screening methods and muscle strength assessing, and limited availability of instrumental body composition determination. Therefore, it is necessary to develop affordable screening methods for SP with good sensitivity and specificity.

Aim. To establish the sensitivity and specificity of mid-upper arm circumference (MUAC) and calf circumference (CC) measurements as methods for assessing muscle mass in comparison with data obtained using dual-energy X-ray absorptiometry (DXA) for detection of SP in women with RA.

Materials and methods. 201 women (mean age 59.3 ± 9.0 years) with confirmed RA were examined by a standard clinical examination, as well as measurement of MUAC and CC. Body composition analysis using DXA was done. The sensitivity and specificity of anthropometric indicators for SP screening were determined using ROC-analysis.

Results. The appendicular muscle index (AMI) was determined using DXA. AMI < 5.5 kg/m2 was detected in 37 (18.4%) patients. MUAC and CC had a direct correlation with AMI (r = 0.56 and r = 0.52, respectively, p < 0.001). MUAC ≤ 26.0 cm and CC ≤ 33.8 cm were determined, which had the optimal ratio of sensitivity and specificity for low muscle mass screening (67.6% and 84.2%, respectively, for MUAC; 73.0% and 76.2%, respectively, for CC). The area under the curve (AUC) for the MUAC was 0.822 (95% confidence interval (CI) 0.762–0.873, p < 0.001), and for the CC – 0.789 (95% CI 0.762–0.844, p < 0.001). Simultaneous use of the both indicators had a sensitivity of 62.2% and a specificity of 90.2%.

Conclusions. In patients with RA, MUAC or CC had comparable diagnostic significance and can be used for SP screening. Simultaneous use of two measurements did not improve the diagnostic value. Further evaluation of available screening methods is needed.

Introduction. Genital endometriosis makes the “top three” gynecologic disorders and is of high social significance. According to various authors, from 30 to 50% of patients with endometriosis suffer from infertility. As of today, there are many theories describing the occurrence of endometriosis-associated infertility, however, there is no direct evidence of infertility due to endometriosis.

Aim. To carry out a detailed analysis of the medical-biological and clinical-anamnestic features of patients with genital endometriosis depending on the presence or absence of infertility.

Materials and methods. This study included 395 patients with genital endometriosis (132 women with genital endometriosis and concomitant infertility, 263 – with genital endometriosis without infertility). The diagnosis of genital endometriosis was established based on the results of morphological examination after surgical treatment.

Results. It was found that among women with genital endometriosis and infertility the patients of early reproductive age (from 20 to 35 years old, 56.06%) with body weight deficiency prevailed. This group was characterized by a higher incidence of acute pelvic pain (1.9 times), premenstrual syndrome (1.8 times), constipation (1.3 times), earlier sexual debut (14 to 18 years). A single abortion was more often recorded; an earlier age of artificially performed abortions – from 20 to 30 years, was revealed; sexually transmitted diseases (STDs) were registered more often (2.7 times) than in the group without infertility. Surgical interventions on ovaries in the group of individuals with genital endometriosis and infertility were 3.2 times more frequent, ectopic pregnancies – 4 times more frequent.

Conclusion. The conducted study allowed revealing significant differences in the biomedical and clinical-anamnestic characteristics of patients with genital endometriosis and concomitant infertility and without infertility, which should be taken into account in the clinical management of patients.

Preeclampsia (PE) is a gestational neuroimmunocomplex endotheliosis that develops as a fundamental stereochemical process in which the trigger that activates complement along an abnormal pathway and launches a cytokine cascade are neurospecific proteins of the fetal neocortex in the antenatal period of its development. The most well-known clinical consequences of PE are not only FGR, but also prematurity, as well as a significantly more frequent development of individual pathological conditions of the early neonatal period. The development of parameters in the field of PE prediction is an important and necessary stage in the formation of a risk group and personalization of the pregnancy management strategy, and high reliability of the forecast can help to reduce the frequency of hyperdiagnosis. In this regard, a different concept of the nature and essence of preeclampsia is presented, not only as a hypertensive condition during pregnancy combined with placental insufficiency, but as a general pathological specific neuroimmunocomplex gestational endotheliosis, in which neurospecific proteins of the developing fetal brain during the period of formation, construction, active growth and isolation of the neocortex are considered as an antigen that disrupts the activation of complement proteins and stimulates the release of proinflammatory cytokines. Analysis of numerous studies has shown the high diagnostic potential of various biomarkers and their combination with instrumental and clinical examination methods. This concept of PE allows us to propose a new pathogenetic approach to the management of patients with this pregnancy complication. Considering PE as a gestational immune complex complement-mediated endotheliosis, it is possible to plan further studies on the effectiveness and safety of targeted therapy blocking unrestrained uncontrolled activation of the complement system.

Introduction. Recently, special attention has been paid to the quality of life of women and its changes after myomectomy.

Aim. To assess the effect of myomectomy on menstrual function and quality of life in women with uterine fibroids.

Materials and methods. A prospective clinical observational study was carried out at the clinical sites of the Department of Obstetrics and Gynecology with a course of perinatology at the Medical Institute of the RUDN University named after. Patrice Lumumba. Women of reproductive age with uterine fibroids (n = 80) and indications for organ-preserving treatment were selected, their complaints, general and obstetric-gynecological anamnesis, clinical, laboratory and instrumental studies of the patients were analyzed. The UFS-QOL questionnaire developed by the SIR Foundation was used to assess the severity of uterine fibroid symptoms and quality of life. Accumulation, adjustment, systematization of source information and statistical analysis were carried out using the IBM SPSS Statistics v. 23 program (IBM Corporation).

Results. The average age of women with uterine fibroids was 40.36 ± 4.5 (27–49) years. During surgery, one myomatous node was removed in 61 (76.3%) women; in the rest, from 2 to 7 myomas were removed. Localization of removed fibroids according to the classification of The International Federation of Gynecology and Obstetrics 2018 (FIGO): in 3 (3.75%) women it was classified as type 7 according to FIGO – in 1 patient the node was isthmus, in 2 it was intraligamentous. The size of the identified fibroids varied from 0.5 cm to 15 cm (3.78 ± 3.0). 50% of patients with uterine fibroids had heavy menstruation, and 27.5% were  diagnosed with iron deficiency anemia. When assessing the average severity of symptoms of uterine fibroids before and after myomectomy, it was found to decrease from 31.46 ± 20.0 (0–93.75) to 14.91 ± 17.1 (0–84.37) (p < 0.001). The HRQL total quality of life score also increased from 71.14 ± 20.7 (22.41–100) to 82.05 ± 17.6 (30.17–100) (p < 0.001). The number of women after myomectomy with a total HRQL level of more than 75 increased statistically significantly by 27.5% and decreased by 20% in the range of 50–75 (p < 0.05). However, when analyzing the results of the UFS-QOL questionnaires, it was found that in 7 (8.75%) patients the quality of life did not change before and after myomectomy, and in 12 (15%) women, despite a decrease in the severity of symptoms of uterine fibroids after myomectomy, quality of life (HRQL total) became slightly lower (Wilcoxon test 129.5, p = 0.242). 6 (7.5%) women experienced worsening symptoms of uterine fibroids after surgery: 25.52 ± 11.4 (9.38–43.75) before myomectomy and 33.33 ± 13.6 (12.5–50) after (Wilcoxon test 30, p = 0.146).

Conclusions. Myomectomy did not always lead to healthier women and an improvement in their quality of life. Further research in this area is required.

Methylethylpyridinol is a frequently used drug in ophthalmology. Many years of experience of its use in clinical practice and a variety of pharmacological effects have caused its wide introduction in the treatment of a wide range of ophthalmopathologies, as well as in various fields of medicine. It is known that methylethylpyridinol has antioxidant activity, neuroprotective effect, ability to stabilize cell membranes and improve microcirculation. These properties open wide possibilities for its application in therapy of eye diseases, in which oxidative stress and deterioration of blood supply play a key role. The broad spectrum of action of methylethylpyridinol is useful in combination therapy with other drugs, which allows to achieve a synergistic and enhanced therapeutic effect. This, in turn, can be applied for treatment of various diseases, including ophthalmologic pathology of the anterior and posterior segment of the eye, as well as ocular manifestations of systemic diseases. A significant advantage of methylethylpyridinol is the presence of the form of eye drops, which has an equivalent effect in comparison with parabulbar administration of the drug. This determines the unique position of the drug in the form of eye drops in ophthalmopharmacotherapy, because to date, the pharmaceutical market has no alternative agents with such a wide range of pharmacological properties in a convenient and safe dosage form, targeting the structures of the eye. This review discusses the therapeutic properties of methylethylpyridinol and the results of preclinical and clinical studies of this drug, which is important for expanding the prospects of its clinical application and ensuring patient safety.

Introduction. Pityriasis lichenoides (PL) is a group of relatively rare chronic skin diseases, united by some common pathogenetic links, clinical symptoms and pathohistological manifestations. The current state of the problem of PL is associated with significant difficulties not only for diagnosis and treatment, but also for determining all links of pathogenesis, and is also associated with the risk of transformation of PL into skin lymphoma, decreased quality of life and increased mortality in this group of patients. The article discusses literature data on the mechanism of development and provoking factors of PL.

Aim. To analyze the literature on the features of the pathogenesis and clinical picture of PL. 

Materials and methods. A retrospective analysis of Russian and foreign literature sources for the period 2010–2023 was carried out, describing clinical cases of PL, features of the pathohistological picture, and modern ideas about the pathogenesis of this disease. Literature published before 2010 was not used in the analysis.

Results. Many provoking factors for the development of PL have been identified, such as drugs, protein molecules of vaccines, microorganisms, etc., but their role has not been fully studied. The authors of most studies note a certain time interval between the acting trigger factor and the development of PL, as well as similar histopathological manifestations that allow to verify PL, and the clinical effectiveness of various treatment regimens. It is assumed that PL develops as a result of increased expression of certain clones of T-lymphocytes (CD8, CD30), which convert the protein structures of the epidermis into an antigenic target during antigenic cross-stimulation.

Conclusion. Currently, there are no clear pathognomonic symptoms of PL, which makes it possible to classify it as a difficult-to-diagnose dermatoses and opens up broad prospects for further study of immunological and histological changes. Crossreactivity between keratinocyte proteins and protein molecules of various antigens makes it relevant to study not only groups of provoking factors, but also (perhaps to a greater extent) the immunological status of patients with PL. Alertness and appropriate diagnostic search on the part of dermatovenerologists are extremely important for timely prediction and detection of PL in a group of patients with a certain immunological predisposition.

A water-soluble anticoagulant obtained about a century ago from animal tissues, heparin has since been used in the clinic for the prevention and treatment of thrombosis, including after surgical treatment, in cardiovascular and viral diseases. The main anticoagulant effect of heparin is best studied, it is based on a combined mechanism of interaction between an inhibitor of plasma serine proteinases, antithrombin and thrombin or factor Xa. According to its chemical structure, heparin is a heterogeneous, linear, highly sulfated anionic glycosaminoglycan with a wide range of relative molecular weight and charge density; these structural properties allow heparin to selectively interact with several proteins, which ensures its various pharmacological functions. Currently, 250 different proteins are known that bind to heparin and whose biological properties can be regulated by it. With the development of various directions in medicine, various properties of heparin have been revealed, which potentially have therapeutic value in other conditions with an inflammatory component. Heparin has a number of additional pharmacological activities, including antiviral, antitumor, anti-inflammatory, antihypolipidemic and antiangiogenic, which allows to expand the scope of its application. In particular, in dermatology and cosmetology, heparin has proven itself in the treatment of localized infiltrates, edema and subcutaneous hematomas. Various invasive and non-invasive procedures in cosmetology, especially in patients with undifferentiated connective tissue dysplasia, may be accompanied by edema, redness, and hematoma formation. Due to its anticoagulant, regenerative, decongestant, and anti-inflammatory properties, sodium heparin gel can shorten the rehabilitation period.

Introduction. Psoriasis is a chronic immune-mediated skin disease, often accompanied by a large number of concomitant disorders, among which a special place is occupied by cardiovascular diseases. A vast number of scientific publications is devoted to the topic of psoriasis and cardiovascular comorbidities. The risk of cardiovascular dysfunction is 2 times higher in patients with psoriasis than in the population in general, just like the incidence of cardiac pathologies. European clinical guidelines urge to carry out cardiac screening in this group of patients to ensure timely prescription of appropriate therapy.

Aim. To study the effect of antihypertensive therapy on the course of psoriasis in patients with concomitant essential hypertension.

Materials and methods. We analysed medical records of 120 patients with psoriasis. They were divided into 2 groups. The first group had concomitant hypertension and the second group did not. Data from the medical records, physical examinations, consultations with GPs and cardiologists were reviewed.

Results. Our retrospective chart review of 120 patients with psoriasis showed that physicians most often prescribe to patients with essential hypertension (EH) the drugs that can provoke exacerbations of psoriasis. Also, patients with EH had more pronounced clinical manifestations of psoriasis, which could be explained by the impact of the cardiopathology itself and its drug therapy.

Conclusions. Given the features of comorbid disorders in psoriasis, the close collaboration of dermatologists and cardiologists is needed. In patients with psoriasis, routine cardiac screening, lifestyle changes and other measures aimed at reducing the risk of cardiovascular diseases are indicated. In the group of patients with concomitant essential hypertension, antihypertensive drugs with a relatively more favourable safety profile should be prescribed, for example calcium channel blockers, angiotensin II receptor blockers, imidazoline receptor agonists and diuretics.

This article discusses the relevance of the etiopathogenesis, clinic and effective treatment of acne depending on the form and stage of the disease. In accordance with the clinical recommendations of the Ministry of Health of the Russian Federation, acne vulgaris is a chronic inflammatory disease manifested by open or closed comedones and inflammatory skin lesions in the form of papules, pustules, and nodules. It is a multifactorial dermatosis in the pathogenesis of which genetically determined hyperandrogenism and a genetically determined type of sebaceous gland secretion play an important role. The incidence of acne in the population is 85–93%, with a steady increase in incidence in puberty and adulthood. Acne treatment is comprehensive – systemic drugs and mandatory local therapy, taking into account the main pathogenetic mechanisms. To achieve the positive effects of therapy, the article describes combined drugs that have a more pronounced therapeutic effect due to their selective action on follicular hyperkeratosis, the inflammatory process, reproduction and colonization of microorganisms. Azelaic acid preparations, as well as combinations of the antibiotic clindamycin and benzoyl peroxide, have such an effect on the affected skin. The publication examines various clinical cases of somatically healthy patients suffering from moderate acne. According to the doctor’s prescription, patients used combined external preparations strictly in accordance with clinical recommendations. At the end of the course of treatment, patients noted a significant improvement in the condition of the dermis in the form of minimizing the manifestations of acne. Careful study and further knowledge of the facts about the etiology and pathogenesis of acne, a wide range of drugs for external and systemic therapy of the disease, and the availability of a large amount of information make it possible to achieve significant improvements, minimal process alterations, and stable remission in the vast majority of patients.

Introduction. Mycosis of the scalp (Tinea capitis) is one of the most common infections localized on the scalp and occurs mainly in children. The frequency of purulent inflammatory type (Kerion celsii) is about 15% of all cases of of scalp mycosis. The causative agents are zoophilic dermatophyte fungi that cause skin mycoses in cattle, donkeys, dogs, goats, sheep and horses. Zoonotic infection Trichophyton verrucosum is reported ubiquitously, more frequently in Asia and the Middle East. Human infection occurs in rural areas where close contact with animals is more likely. The urgency of the problem is associated with the increasing number of cases of severe scalp mycosis caused by T. verrucosum.

Aim. Analyse clinical and laboratory features of T. verrucosum infection.

Results. The article describes two cases of mycosis of the scalp caused by T. verrucosum. Both patients received complex treatment in the inpatient department of the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology. Effective treatment was delayed due to incorrect clinical and laboratory diagnosis of the disease. After hospitalization in the pediatric dermatovenereology department, both patients quickly responded to treatment with oral antifungals. No growth of T. verrucosum culture was obtained during laboratory diagnostics of pathological material. Direct microscopy revealed an ectothrix-like arrangement of spores.

Conclusions. Due to active migration and the popularity of tourism, dermatovenerologists in their daily practice must be prepared for an increase in infectious diseases. A properly collected anamnesis allowed specialists to establish the correct diagnosis of scalp mycosis caused by a zoophilic dermatophyte. In the given clinical examples, when the bacteriological method did not give a result, direct microscopy allowed to confirm the clinical diagnosis, identify the etiologic agent (T. verrucosum) and optimize the tactics of systemic and topical therapy.

The glycocalyx is a special ultra-fine structure of glycosaminoand proteoglycans, 0.2–5 μm thick, covering the endothelium. Maintenance of the mechanisms of synthesis and secretion of the signaling molecule NO, this regulator of vascular tone, mitochondrial respiration, neurotransmission and immunity, occurs through the reconstruction of the glycocalyx. Sulodexide is a combination of natural glycosaminoglycans – heparan sulfate and dermatan sulfate, which are part of the glycocalyx. The antithrombotic effect of sulodexide, realized through the suppression of platelet adhesion and aggregation, mild anticoagulant and profibrinolytic effects, is well known. In addition to the prevention of thrombus formation, the use of sulodexide is one of the important areas of endothelial dysfunction therapy through the restoration of glycocalyx and NO biosynthesis. Evidence shows that the use of sulodexide is promising for the treatment of both arterial and venous thrombotic disorders in patients with type 2 diabetes mellitus (T2DM), arterial hypertension (AH), coronavirus infection COVID-19, after surgery, with thrombophilia, etc. A meta-analysis of study data demonstrates a reduced risk of death from cardiovascular causes with the use of sulodexide. As part of the personalized prescription of sulodexide, the results of endothelial dysfunction diagnostics should be taken into account. If the patient has a risk of thrombotic events, anticoagulants and antiplatelet agents should be used in accordance with clinical guidelines. Sulodexide has antithrombotic properties and is characterized by a low level of bleeding; it should be used when it is impossible to use anticoagulants with a high risk of bleeding, as well as if the patient has hypertension, type 2 diabetes, chronic venous diseases, and diseases of the arteries of the lower extremities.

According to WHO Report 2024, malaria is still a global health challenge, especially in Africa, Asia and South America. In the opinion of the authors, errors made in adequate assessment of clinical and laboratory indicators of P. falciparum malaria (tropical malaria) in a patient are the major reasons that can lead to a lethal disease outcome. The aim of our research was to describe the clinical and laboratory indicators of severe tropical malaria with a severe and complicated course of disease in a female patient, taking into account the analysis of data from modern scientific and medical literature, and our own experience. An abstract of the case history of patient M., 56 years old, is presented. The patient underwent medical treatment in an infectious disease hospital under the primary diagnosis of Plasmodium falciparum malaria with cerebral complications and acute renal failure, severe course of illness. She fell ill on Day 7 after her journey to Tanzania (Zanzibar Island). The disease developed in a severe, complicated form with acute renal failure, sepsis, severe anemia, bilateral polysegmental pneumonia, and nosebleeds. The parasitemia level reached 1,428,000 per microliter of blood. The treatment regimen of malaria included Coartem. Due to ongoing intensive therapy, positive changes were achieved. A stable absence of parasitemia was observed, however a peripheral edema and a high level of azotemia persisted. The patient continued to undergo treatment in the Department of Nephrology, where a significant clinical outcome in the form of decreased azotemia levels was achieved. The woman was discharged home in a satisfactory condition. The clinical case example fully reflects modern clinical and laboratory criteria for severe, complicated tropical malaria, and demonstrates rapid development of serious complications as a result of late admission to hospital. It represents a practical interest not only for infectious disease experts, but also for therapists, nephrologists, neurologists, resuscitationists and physicians of other specialties.