The article provides a review of the topical issues of beta-blockers use in the clinical practice. Attention of practitioners is drawn to the possibility of using these or other beta-blockers in various clinical situations. Some beta-blockers, especially non-selective ones, have negative effects and cannot be used in certain clinical situations (metabolic syndrome, type 2 diabetes mellitus). Modern super-selective beta-blockers do not have these negative effects and can be widely used in clinical practice, including metabolic syndrome and type 2 diabetes. The review focuses on metoprolol tartrate, which has the most extensive evidence base for efficient treatment of various cardiovascular diseases. Another problem related to beta-blockers is their infrequent use or use at inadequate doses. In this connection, a practitioner should prescribe them at the recommended therapeutic doses in various clinical situations, according to the instructions for use of the drug.

This article considers some current issues regarding rehabilitation of patients after a stroke during out-patient stage. It presents the key principles of post-stroke rehabilitation: functional approach, frequency and intensity of the training. The main methods of rehabilitation include exercise therapy, physiotherapy, pharmaceutical therapy, etc. The optimal intensity and duration of the training was determined. The article presents the features of physical rehabilitation of the paretic arm. It shows the effectiveness of complex rehabilitation using physical and pharmaceutical methods in restoring lost functions. The use of Vasobral in the process of rehabilitation of patients after a stroke is discussed.

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus. Management of patients with DPN is a complex medical and socioeconomic problem. The article presents the observational study results of 40 patients with type 2 diabetes mellitus complicated by DPN. Patients of the treatment group received Keltikan® complex in combination with basic therapy for 60 days, patients of the control group received only basic therapy. The treatment resulted in the positive changes observed in both groups, while the group taking Keltikan® complex showed more pronounced changes according to the total neurological symptoms (TSS) scale, the neuropathic dysfunctional score (NDS) scale, the neuropathic symptom score (NSS) scale, and also according to the electroneuromyography results.

The article discusses clinical symptoms, diagnostic criteria and basic principles of managing patients with dementia. It also provides the classification of cognitive disorders by severity degrees and considers the differences between the different degrees of dementia severity. The main features of the pathogenesis of cognitive disorders in dementia, the most important approaches to managing patients with dementia are highlighted. The article presents a detailed review of modern drugs used to correct cognitive and other manifestations of dementia.

Balance and vestibular disorders are often detected in patients who have suffered a stroke. Instability may be caused by various reasons. In some cases, impairment of gait is caused by spastic paresis, in others by proprioceptive sensitivity and cerebellar disorders. Management of patients with balance disorders in the post-stroke period is composed of a detailed assessment of functional capabilities, the risk of falls and the cause of instability, as well as the adjustment of physical rehabilitation and drug therapy. The effective methods of physical rehabilitation include general exercises to strengthen stability and physical endurance, and special simulators with biological feedback. The drug therapy includes basic pharmacotherapy for the secondary prevention of stroke and symptomatic agents that can manage various disorders due to pathogenetic mechanisms of cerebral stroke (botulinum therapy, Vasobral).

Nasal breathing plays an important role in the respiratory function, which ensures that a person consumes appropriate levels of air. Nasal obstruction causes a person to consume air mainly through the mouth, which impairs the numerous functions of the nose. This leads first to functional abnormalities, and then to morphological and structural changes. Topical decongestants that have the strongest and fastest effect are the most popular drugs to manage rapidly nasal obstruction. The main nasal decongestants can be divided into two groups: sympathomimetic amines: primary aliphatic, phenolic and non-phenolic compounds, as well as imidazoline derivatives. Among modern vasoconstrictive drugs, Otrivin® complex showed good results. The drug contains xylometazoline and ipratropium bromide. Application of this drug strictly according to the instructions and for no more than 15 days guarantees the absence of severe local and systemic complications.

Recently, the substantial progress has been made toward understanding the human microbiota as an ecosystem that functions as a separate organ in a macro-organism. More and more data on the microbiome as the aggregate of microorganism genes that reside on or within the human body appear. Deterioration of the environment, changes in food production technologies, widespread use of antibiotics result in serious human microbiota disorders, most often in the form of gut dysbiosis of varying severity. The investigation into the causes and the correct choice of a probiotic containing the identified microorganisms with the indication of genus, species, strain and their quantitative composition is the criterion for the success of dysbiosis therapy. The purpose of this article is to discuss the criteria for rational probiotic therapy and prevention of gut dysbiosis and associated diseases. It should be considered that the treatment of diseases accompanied by dysbiosis should be comprehensive and include the elimination of the cause of the disease, the correction of nutrition, the elimination of pathogenic agents and their toxins in the gastrointestinal tract, as well as the restoration of the microbiota composition and functional activity. Probiotics play an important role in restoring the composition and functional activity of microbiota. According to the current guidelines of the World Gastroenterological Organization (WGO), a certain quantity of bacteria (KOE of microorganisms) that is necessary to achieve a  positive effect is an important criterion for the efficacy of probiotic drugs.

It is appropriate and necessary to examine the functional state of the autonomic nervous system and the quality of life in patients with cholelithiasis using the mathematical analysis of the heart rhythm at the present-day level. Materials and methods: 136 patients (115 women and 21 men) were examined, of which 70 patients after cholecystectomy with cholelithiasis and 66 patients with cholelithiasis. Fractional chromatic minute-type duodenal intubation with an analysis of the biochemical and microscopic composition of the bile was used to assess the biliary system condition. The examination of the autonomic nervous system was carried out by determining the heart rhythm using the cardiointervalography method with further mathematical analysis of the structure and variational pulsometry. Changes in the autonomic status in patients with cholelithiasis before and after cholecystectomy differ in general patterns: adaptive possibilities decrease and sympathetic activity of the autonomic regulation increases. An increase in the lithogenicity of bile, which positively correlates with the level of sympathicotonia, is characteristic for patients with cholelithiasis before and after cholecystectomy. The autonomic regulation in patients with cholelithiasis after cholecystectomy improves, however, the high bile lithogenicity persists.

The diagnostic algorithm of IBS includes a careful analysis of symptoms in accordance with the requirements of the Rome IV criteria consensus, the use of laboratory and instrumental methods. The IBS therapy is primarily aimed at arresting the prevailing clinical symptoms and is regulated by the modern clinical guidelines. Trimebutin demonstrates high efficacy in the management of pain syndrome and motor control in patients with IBS in comparison with placebo.

The review aims to provide a contemporary view of the pathogenesis and treatment of the most common duodenum diseases – duodenal ulcer disease (DUD) and functional dyspepsia (FD). Due to its unique structure and functions, the duodenum that anatomically represents the initial section of the small intestine differentiates itself from others. The prevalence of DUD is declining in many Western countries due to the widespread introduction of effective anti-Helicobacter therapy and a significant decrease in the prevalence of H pylori infection. However, the ideas about the poly-biological nature of DUD persists and additional risk factors continue to be studied. DUD is manifested by pain/burning feeling in the epigastric region, as well as by symptoms such as early satiety, epigastric filling after eating in the absence of obvious organic changes in the digestive system. The diagnosis of FD is based on the Rome IV criteria. The duodenum plays an important role in its pathogenesis (disorders of gastric accommodation, motor and visceral hypersensitivity). Most patients with FD have microscopic signs of inflammation of the mucous membrane of the postbulbar part of the duodenum - an increased amount of intraepithelial lymphocytes, eosinophils, and signs of increased permeability of the mucous membrane. In all likelihood, these changes are provoked by infection and / or nutritional factors, as well as by exposure to hydrochloric acid. Proton pump inhibitors (prokinetics in postprandial distress syndrome) form the basis of treatment of peptic ulcer and epigastric pain syndrome; all patients with DUD and dyspepsia syndrome infected with H. pylori receive antihelicobacter therapy. Rabeprazole that is characterized by a long and powerful effect and minimal interaction with the cytochrome 2C19 system stands out from the proton pump inhibitors. Conclusion: acid aggression plays a very important role in the pathogenesis of duodenal ulcers diseases and FD; proton pump inhibitors form the basis for the treatment of such patients both in the form of monotherapy and as part of eradication regimens.

One of the most frequent clinical and laboratory manifestations and complications of inflammatory bowel diseases (IBD) is anemia. In the presented review the reasons, criteria of diagnostics and therapeutic correction of various variants of anemia in Crohn’s disease are considered.

Objective of the study. The study of changes in some parameters of the lipid peroxidation system - antioxidant protection, lipid spectrum in the course of the long-term therapy with the combined chondroprotective drug ARTRA in patients with knee osteoarthritis (OA) Methods. 24 patients with osteoarthritis of the knee joints with 1-3 X-ray stage of the disease (Kellgren and Lawrence, 1957) at the age of 41.8 ± 6.1 years were included in an open prospective study to evaluate the effects of CCD. The following indicators in serum and erythrocytes were determined: initial products of LPO (diene conjugates (DC), ketodienes and conjugated trienes (KD and CT)) in the heptane and isopropanol phase (the method of I.A. Volchegorsky, et al, 1989); intermediates (thiobarbituric acid test modified by L.I. Andreeva, et al, 1988); catalase activity (the method of M.A. Korolyuk et al., 1988); antioxidant activity of plasma (the method of M. Promyslov, 1990); peroxide erythrocyte resistance (G.A. Yarovaya, 1987). The quantitative determination of serum total cholesterol, low-density, very-low-density, high-density lipoprotein cholesterol, triglycerides was carried out using the ready-made CORMEY standardized sets (Germany). The patients’ condition and laboratory parameters were evaluated before the study, in 12 and 24 weeks after CCD was taken. Changes in the examined indicators were documented after a 24-week course. The inhibition of lipid peroxidation processes in the form of a decrease in the primary products and intermediates in the serum and erythrocytes was established. The study showed an increase in antioxidant protection (increased activity of blood serum catalase and erythrocytes and total antioxidant activity of blood serum). The patients’ tests showed a decrease in the concentration of total cholesterol and cholesterols of low-density lipoproteins. Conclusion. The study demonstrated the positive impact of ARTRA on the LPO-antioxidant protection system and the lipid spectrum in patients with OA following the 24-week administration.

Treatment of diseases of the musculoskeletal system to date remains not only a serious medical, but also socio-economic problem. Chronic diseases of the joints and spine are one of the most common causes of disability in patients. The main clinical manifestations of most diseases of the musculoskeletal system are pain and inflammation, which requires adequate antiinflammatory therapy. The data on various mechanisms of action of non-steroidal anti-inflammatory drug (NSAID) diclofenac (Voltaren), as well as the results of clinical studies and meta-analyses confirming its effectiveness and good tolerability are presented. The data of experimental and clinical studies of the efficacy and safety of local forms of diclofenac-Voltaren Emulgel (diclofenac-diethylamine) –are presented. Provides information about the form of the Voltaren Emulgel 2% for 12 hours. It is shown that a wide range of analgesic and anti-inflammatory effects of diclofenac (Voltaren), and good tolerance can be used as symptomatic therapy in the treatment of diseases of the musculoskeletal system.

The aim of the study was to study the efficacy, safety and immunogenicity of trivalent split influenza vaccine in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic scleroderma (SSD). Material and methods. Ninety three patients were enrolled in the study, including 52 patients with RA, 34 with AS, 7 with SSD, and also 40 persons without rheumatic diseases (RD) (control group). At the time of enrolment, all patients received RD drug therapy. The duration of RD was from 2 months up to 46 years. Vaxigrip vaccine, which included the actual strains of influenza virus for the 2016-2017 or 2017-2018 seasons was administered subcutaneously in the amount of 1 dose (0.5 ml) against the backdrop of continuing RD therapy. The main stages of control were visits at 1-, 3- and 6-month intervals after vaccination. Standard clinical and laboratory tests, a clinical examination of the patient and assessment of disease activity were performed during the visits. Immunogenicity of the vaccine was evaluated at each stage of the control procedure using the commercial ELISA kits manufactured by PPDP LLC (St. Petersburg). Results. No cases of influenza or influenza-like illness were recorded during the entire period of observation. 81% of patients had no post-vaccination reactions in the RD group. Pain, swelling and hyperaemia of the skin with a diameter of up to 2 cm at the injection site were reported in 14% of cases and subfebrility, myalgia, malaise, headache in 5% of cases. The frequency of postvaccinal reactions among patients was not significantly different from that in the control group. There were no cases of exacerbation of RD or the occurrence of any new autoimmune disorders. The parameters of the humoral immune response in patients with RD did not significantly differ from those in the control group. Conclusion. The obtained data testify about good clinical efficacy and tolerability of trivalent split influenza vaccine in patients with RD.

Hypoglycemia detection in T2DM patients is an important issue which is usually accomplished with self-monitoring of blood glucose (SMBG). Optimal schedule of testing and diagnostic threshold are important for effective SMBG. Aims of study: To evaluate hypoglycemia frequency by SMBG using structured AccuChek 360 View protocol and glucose monitoring and increase SMBG efficacy in the detection of hypoglycemia. Study design: 16 T2DM patients after initiation of insulin treatment were included. Each patient had 3 days of glucose monitoring together with SMBG 7 times a day after hospital discharge and 3 months later. Results: Hypoglycemia was detected in 38% of monitoring periods; this patients had higher glucose variability and lower average glucose. SMBG detected hypoglycemia in 16% of periods. 6 out of 7 unrecognized hypoglycemias were during night. This 6 cases were characterized by minimal daytime glucose levels by SMBG below 5 mmol/l. ROC-analysis demonstrated minimal glucose level during daytime of 4.8 mmol/l to have 92% sensitivity and 74% specificity for detection of any hypoglycemia by glucose monitoring. Conclusion: Structured Accu-Chek 360 View SMBG can reliably detect daytime hypoglycemia but regular nighttime testing is recommended in all T2DM patients using insulin for detection of nighttime hypoglycemia. Minimal glucose levels below 4.8-5 mmol/l during daytime corresponds with high hypoglycemia risk.

Due to the growing prevalence and progression of type 2 diabetes mellitus (DM), the researchers continue the search for the optimal drug not only to achieve the target level of glycaemic control, but also to reduce body weight and the risk of hypoglycaemic conditions. The new combinations of hypoglycaemic drugs are being developed in order to increase adherence to treatment. The studies showed that the addition of a single injection of a fixed combination of insulin degloudec/liraglutide is effective for glycaemic control and weight loss, generally well tolerated by patients and is preferred in individuals with poorly controlled type 2 diabetes on oral hypoglycaemic agents at adequate doses and/or glucagon-like peptide-1 receptor agonists and/or basal insulin to reduce the risk of hypoglycemia associated with insulin therapy.

The article deals with the modern concepts of the pathogenesis of acne, describes the impact of this pathology on the psychoemotional state of patients and the compliance to therapy. The article considers approaches to the treatment of moderate to severe forms of acne using the systemic retinoid - isotretinoin. It presents the results of our own observations and the prospects for eliminating undesirable phenomena during administration of this retinoid.

Increased exposure of the skin to sunlight has many negative effects: premature skin aging (photoaging), the risk of various skin cancers, the appearance of hyperpigmentation, and exacerbation of certain skin diseases.

Apremilast (AP), a phosphodiesterase-4 inhibitor, is a novel drug for the treatment of psoriasis (Ps) and psoriatic arthritis (PsA). AP therapy affects the decrease in the activity of inflammatory changes due to reducing the level of proinflammatory cytokines. The clinical trials showed positive effects on Ps, for example ESTEEM 1 trial (Efficacy and Safety Trial Evaluating the Effects of apreMilast in psoriasis), in which AP therapy led to a decrease of PASI index in patients with moderate to severe plaque Ps: 75% improvement in PASI was significantly more frequent in patients taking AP at a dose of 30 mg twice daily (33%) than in patients receiving placebo (PL) (5%) (p = 0.0001) in 16 weeks. In the PALACE 1 study, 20% improvement in the ACR criteria (ACR20) was reported significantly more frequently at the 16th week of AP treatment in patients taking AP at 20 and 30 mg twice daily than in patients receiving PL (in 30.4%, 38.1% and 19% of cases, p = 0.0166 and p = 0.0001, respectively). After 52-week AP therapy, ACR20 was achieved in 63.0% of patients taking the drug at a dose of 20 mg twice a day, and in 54.6% of patients receiving 30 mg twice a day. According to the randomized controlled clinical trial (PALACE 1, 2, 3, 4), the most frequent adverse reactions (AR) included diarrhoea, nausea, headache, upper respiratory tract infections and nasopharyngitis. The most ARs were mild and moderate, and the frequency of discontinuation of therapy due to ARs was low. The PALACE studies, which enrolled 1493 patients, showed the efficacy and safety of AP in the treatment of PsA with moderate disease activity.

Osteoporosis constitutes one of the major public health problems in Russia and all over the world; this pathology has showed a tendency toward growth in recent decades. In Russia, osteoporosis was detected in 30.5-33.1% of women aged 50 years and older who underwent densitometry examination, and the incidence of proximal femur fracture for persons over the age of 50 years averages to 105.9 per 100 000. Objective of the study: evaluation of the efficacy of osteo activ in the prevention and treatment of postmenopausal osteoporosis. Materials and methods of the study: 58 postmenopausal patients were examined. In addition to general clinical examination, the concentration of total and ionized Ca, as well as vitamin D in blood plasma were determined in all patients. All examined patients were divided into two groups according to the “case-control” principle: the first group (the main group) included 35 patients who were prescribed osteo activ for the purpose of treating and preventing postmenopausal osteoporosis; the second group (the comparison group) included 23 patients, whose diet was corrected in accordance with the daily requirement of calcium and vitamin D. Results of the study: The study showed a significant increase in the calcium and vitamin D concentration in the blood plasma and a decrease in pain syndrome against the background of the therapy in patients of the main group.

Combined oral contraceptives (COCs) are a highly effective method for preventing unintended pregnancy, but unfortunately, the resource of their contraceptive and therapeutic potential is not used enough, and global unintended pregnancies account for about 40%. The reasons for the lack of proper distribution of COCs are insufficient awareness of the beneficial properties of contraception, along with exaggerated fears of the adverse effects of hormone intake both among women and among doctors. This problem can only be overcome by providing adequate information to health professionals regarding the accumulated data and bringing this information to potential users. The review examines the risks of possible complications, as well as the preventive and therapeutic benefits of some COCs. The COC group is represented by preparations, which properties may differ significantly due to the different dose of the estrogen component and the qualitative characteristics of the progestins. Despite the launch of new combination drugs, COCs deserve high attention. Their efficacy and safety is confirmed by the long practical administration.

There is a need to improve the status of vitamin D. Vitamin D not only affects the processes of formation of the musculoskeletal system, but also actively participates in many extra-osseous effects of cholecalciferol. Modern publications point to a number of positive effects of vitamin D for people of all ages. The modern vitamin D3 preparation Detrimax is recommended as an active food additive (tablet form containing 1000 IU of vitamin D3 (cholecalciferol)) and corresponds to the most frequent daily requirement for vitamin D3. Prophylaxis of vitamin D deficiency should be a priority in health policy.

Inflammatory diseases of the female genitals are an actual problem of obstetrics and gynaecology, as there is no tendency towards decline in the prevalence of these diseases despite improvements in treatment methods. An inadequate assessment of the severity of the infection process and an incorrectly chosen therapy scheme leads to the recurring chronic course.

Vitamin D and women’s reproductive health (literature review). Literature search the relationship between vitamin D and fertility in women рerformed in Pubmed. The vitamin D receptor (VDR) and vitamin D metabolizing enzymes are found in reproductive tissues of women. Moreover, we present evidence that vitamin D is involved in female reproduction including IVF outcome and polycystic ovary syndrome (PCOS). In PCOS women, low 25-hydroxyvitamin D (25(OH)D) levels are associated with obesity, metabolic, and endocrine disturbances and vitamin D supplementation might improve menstrual frequency and metabolic disturbances in those women. Moreover, vitamin D might influence steroidogenesis of sex hormones (estradiol and progesterone) in healthy women and high 25(OH)D levels might be associated with endometriosis.

Purpose of the study. Evaluate the efficiency of permanent post-dilution online hemodiafiltration therapy in combination with the prescription of keto analogues of amino acid at a dose of 0,2 g/kg of ideal body weight/day to correct protein-energy malnutrition in hemodialysis patients with adequate intake of essential nutrients. Patients and methods. A total of 645 patients with terminal renal failure received programmed hemodialysis, of which there were 300 men and 345 women aged 58,8 ± 6,9 years. All patients received treatment with programmed GD for 6,9 ± 2,1 years. All patients underwent a comprehensive assessment of nutritional status. The level of leptin and interleukin-6 serum was determined. Patients with signs of protein-energy malnutritian (PEM) were divided into three groups, depending on the method of PEM correction. Results. The study showed the efficiency of postdilution online hemodiafiltration therapy on an ongoing basis in combination with keto-analogues of amino acids at a dose of 0,2 g/kg of ideal body weight/day for correction of PEM in hemodialysis patients. Conclusion. The post-dilution online hemodiafiltration therapy combined with keto-analogues of amino acid at a dose of 0.2 g /kg of ideal body weight/day can be considered one of the pathogenetically grounded methods for correcting PEM in patients receiving programmed hemodialysis with adequate intake of essential nutrients.

The paper presents a brief review of the primary and recurrent disability of persons under the age of 18 in the Voronezh Region in comparison with data on the Central Federal District and the Russian Federation. The article draws attention to the urgency of the comprehensive approach to diagnostics and development of measures of multilevel prevention and medical and social rehabilitation of patients and disabled persons with this pathology. It highlights the great importance of rehabilitation and habilitation for the formation or recovery of their social and professional status.

The purpose of this study was to investigate the ADO index, and index of comorbidity of Charlson in patients with chronic obstructive pulmonary disease (COPD). Materials and methods: 207 patients with chronic obstructive pulmonary disease (COPD) were observed. The investigated group was made by the patients having the long experience of smoking. Research of function of external breath was studied with multimodular installation of type «Master-Lab/Jaeger». Patients were determined the index ADO and of comorbidity of Charlson. Results: The index ADO increased with stage of COPD, minimum of level ADO was observed in patients with COPD 2 stage 2,23 ± 0,88, in patients with 3 stage COPD ADO was 5,05 ± 1,19, 4 stages of COPD 7,0 ± 1,0. The correlation coefficient between ADO index and and index of comorbidity Charlson was -0,71, p <0,005. The correlation coefficient between ADO and VC was -0,57, p <0,05, between ADO and ERV was -0,63, p <0,05.

The study indicates the main signs of the «athlete’s heart» and distinguishes the physiological manifestations and pathological abnormalities that requires a careful attitude of the doctor. The most common causes of cardiovascular complications in professional sport are demonstrated.

Panic disorder is a widespread socially significant disease, which genetic nature is extremely poorly known. The gene of this neuropeptide (CCK) and its receptors (CCKAR, CCK2R) have being actively studied since the discovery of panicogenic properties of cholecystokinin. The purpose of this work was to estimate the degree of incidence of seven single nucleotide substitutions in the CCK, CCKAR and CCKBR genes in the population of patients diagnosed with panic disorder and a control population consisting of unexamined residents of the Moscow region. A significant increase in the degree of incidence of the T allele of the single nucleotide substitution 109C/T (rs1805000) in the CCKBR gene was identified in the patient population as compared with the controls, prompting suggestions that this substitution is involved in the aetiology of panic disorder. It also demonstrated the association of the combination of alleles -36T CCK, -128T CCKAR (rs11571842 and rs1800908, respectively) with the development of a panic disorder.

The article provides data on 114 patients with stage 2 primary arterial hypertension (AH) according to the WHO classification (2008) and the development of complications associated with hemostasis violations depending on the nationality of patients (Mordva-Moksha, Russians) and polymorphism methyltetrahydrofolate reductase (MTHFR) gene carrier state. Polymorphic genotypes were identified using polymerase chain reaction (PCR) along with traditional clinical and instrumental studies. The analysis of MTHFR gene polymorphic genotypes carriage showed a significant predominance of intermediate genotypes (88% – CT genotype at position 677, 66% – AC genotype at position 1298) regardless of nationality of patients with AH. The carriage of “unfavourable” TT genotypes of MTHFR gene at position 677 prevails in men of the Mordva-Moksha (20%) as compared with the patients of Russian nationality. During a 3-year follow-up, 12% of patients with AH (6.9% of MordvaMoksha and 5.1% of Russian) suffered acute myocardial infarction (MI) or acute cerebrovascular accident (ACVA). Cardiovascular complications (MI/ACVA) developed 1.5 times more often in Mordva patients than in patients with AH of Russian nationality. IM occurred 3 times more often in Mordva-Moksha men than in patients with AH of Russian nationality. The Mordva-Moksha men with AH, who were carriers of the “unfavourable” TT genotypes of MTHFR gene at position 677, developed a complication in the form of MI in 100% cases.

To date, throughout the world, a gold standard for the diagnosis of ectopic pregnancy has been recognized as a study of serum at β-hCG in combination with transvaginal echography. Ectopic pregnancy takes the first place among gynecological diseases in terms of the number of diagnostic errors, especially at an early stage. Purpose of the study. Analyze the defects in the provision of medical care to patients with ectopic pregnancy at an outpatient and outpatient stage and develop an optimized approach for providing primary care to patients with ectopic pregnancy. Material and methods. A retrospective analysis of 194 patients with confirmed ectopic pregnancy according to medical records and a prospective analysis of the quality of care in 332 patients with suspected ectopic pregnancy, taking into account the identified defects according to the optimized approach. Results. Using an optimized approach in the diagnosis of ectopic pregnancy, it is possible to increase the efficiency of diagnosis on the first visit from 27,1% to 76,1%, and significantly improves the quality of primary care.