The article discusses the issues of anticoagulant therapy in pulmonary thromboembolism. It clearly highlights the main advantages and the preferred use of direct selective oral anticoagulants represented by the thrombin inhibitor dabigatran and the factor Xa inhibitor group including apixaban, edoxaban and rivaroxaban. This article provides a thorough introduction of apixaban with an evidence base allowing to consider it a priority anticoagulant, which may be reasonably administered to the majority of patients with pulmonary thromboembolism from the first hours of the disease to many years of secondary prevention.

Thrombocytopenia in blood count may be a reflex of haemostatic problems of different origin – from autoimmune disease to iatrogenic nature. Sometimes, thrombocytopenia may be revealed in patient with coronary heart disease before PCI procedure as well as some hours or days later. Dual antithrombotic therapy and thrombocytopenia have the same main side effect – bleeding. Etiology of disease and details of medical decision before percutаneous coronary intervention (PCI) in CHD patients are discussed.

A total of 137 male patients with stable ischemic heart disease (SIHD), average age 62.3 ± 7.46 years, were divided into 3 groups depending on the initial measurements of blood pressure (BP) and heart rate (HR). Group 1 included patients with elevated blood pressure and/or heart rate (44.5% of patients); Group 2 included patients with normal blood pressure and/or heart rate (38.7%); Group 3 included patients with lowered blood pressure and/or heart rate (16.8%). Patients of Group 1 received beta-adrenergic blockers (BABs) or non-dihydropyridine calcium channel blockers (NDCCBs), in some cases ivabradine-containing BABs (Raenom®, Gedeon Richter) at doses required to achieve target blood pressure and heart rate. The patients of Group 2 received a limited range of drugs above listed due to their blood pressure and heart rate measurements, and the patients of Group 3 did not receive any due to the low levels of such measurements. Effectiveness of the therapy in patients of Group I was the highest. The use of trimetazidine MB (Predizin MB®, Gedeon Richter) has significantly improved the results of treatment in patients of Groups 2 and 3. Trimetazidine MB added to the therapy in patients of Group 1 improved the effectiveness of treatment. Prolongation of trimetazidine MB therapy contributed to improvement of its anti-ischemic effect. Thus, BABs, NDCCBs and ivabradine entered into the foreground, as an optimal medical therapy (OMT) in patients with elevated blood pressure and heart rate measurements. Trimetazidine MB, and ivabradine in some cases prevail in patients with normal and low blood pressure and/or heart rate. It should be stated that patients with various hemodynamic variants of SIHDa require a differentiated approach to the choice of OMT.

Today, cardiovascular diseases (CVDs) are the main cause of death in all countries of the world, which is largely due to the low adherence of patients with CVDs to treatment. According to the RECVASA register, the average adherence of patients of one of the polyclinics in the city of Ryazan to treatment (n = 1,165) in 2012 was 62.4%, adherence to beta-adrenergic blocking agent (BABs) was 70.8%, to angiotensin-converting enzyme inhibitors (ACEs) – 62.2%, to angiotensin II (ARB) receptor blockers – 57.1%, to statins – 46.8%, and to antiplate agents – 70.0%. The average adherence to treatment in survivors of the same group (n = 918) in 4 years in 2016 was significantly lower (p<0.001) and amounted to 47.8%. Patient adherence to BABs, ACEs also became statistically significantly lower (p<0.0001), at 43.8% and 50.0%, respectively; adherence to ARB was statistically insignificantly lower by 3.6% compared to the original level. The highest level of adherence to the use of antiplatelet agents was 63.9%, although it was significantly lower compared to the initial data (p = 0.0037), and the initially low adherence to the use of statins for 4 years has statistically significantly decreased (p<0.0001) and amounted to only 28.2%. The data obtained determine one of the possible ways to increase adherence to statins a fixed combination of them with other drugs affecting the prognosis, such as antiplatelet drugs.

Updates of clinical guidelines and publication of new research results entail changes in our approaches to diagnosing diseases and treating patients, as well as revising the criteria for choosing a particular drug to a specific patient. We are based on the fact that when managing patients with hypertension it is immediately necessary to use those classes of drugs and individual molecules that have proven to be highly effective, safe and adherent throughout the entire cardiovascular continuum. It is understood that the drugs should be shown in IHD and CHF. Among the ACE inhibitors, ramipril meets this requirement. Often, the choice falls precisely on ramipril because a convenient intake once a day at any time of the day and regardless of the meal increases the patient’s adherence to therapy. A wide range of indications, such as hypertension, chronic heart failure, post-infarction patients, diabetic and non-diabetic nephropathy, as well as a reduction in the risk of cardiovascular accidents, including in patients undergoing cardiac surgery, are a serious additional argument in favor of a wide range of ramipril. Moreover, ramipril can reduce the risk of developing new cases of diabetes mellitus and end-stage renal failure.

Cardiovascular complications of type 2 diabetes mellitus (T2DM) are now a global health problem, due to their main cause of mortality of these patients. Ischemic heart disease (IHD) among all cardiovascular diseases occupies a leading position. The purpose of the study was comparative assessment of possibilities of coronary reserve correction in patients with stable angina and T2DM by nitrates and activator of potassium channels by nicorandil. The study included 54 patients with stable angina of 2-3 functional classes (FC) and T2DM. The dynamics of frequency of angina attacks, mean FC of angina pectoris, exercise tolerance, vasoregulatory function of endothelium under the influence of therapy with nicorandil, isosorbide dinitrate (ISDN) and isosorbide-5-Mononitrate (I5MN) were analyzed. In patients with IHD and T2DM drug of choice for long-term treatment is nicorandil with greater antianginal and anti-ischemic efficacy compared with traditional nitrates. Nicorandil effectively corrects endothelial dysfunction, without causing the development of tolerance and without reducing its effectiveness while taking hypoglycemic therapy.

Autonomic dysfunction syndrome (ADS) includes the somatic (autonomic) function disorders of various origin and manifestations caused by their neurogenic regulation disorder. When establishing the diagnosis of ADS, the doctor most often implies psychovegetative syndrome (PVS), which is discussed in this article. Despite the fact that the ADS is not an independent nosological unit, most doctors use this term to provide the syndromic description of psychogenic polysystemic autonomic disorders. The ADS is mostly caused by mental disturbances of anxiety or anxiety-depressive nature within the neurotic, stress-related disorders, less often by an endogenous disease. The article describes the features of the ADS clinic picture, and focuses on hyperventilation syndrome. It discusses a clinical case of a patient with ADS (with florid hyperventilation syndrome), who was treated ineffectively with antidepressants. The authors also describe options for treating patients with ADS using a neuroleptic agent ziprasidone.

In the article the actual problem of modern medicine – treatment of patients with allergic rhinitis (AR). Given the prevalence of AR are discussed classification issues, the etiology and pathogenesis of the disease. We consider the two-generation antihistamines in the treatment of patients with AR. Based on the data of several studies demonstrated benefits of antihistamines II generation, particularly levocetirizine.

According to epidemiological studies, bacterial rhinosinusitis is one of the most common pathologies of ENT-organs on an upward trend. Rhinosinusitis significantly reduces the patient’s quality of life and, in the absence of timely treatment, can lead to serious complications. Macrolide antibiotics are effective drugs in the treatment of rhinosinusitis. Roxithromycin (Esparoxy), one of modern macrolides, showed good results. The article provides characteristics of this drug, reflects the high quality of efficacy and safety in the treatment of bacterial rhinosinusitis, with due regard to the experience of the Russian and foreign authors.

Seasonal allergic rhinitis (SAR) remains an important medical and social problem, the importance of which is determined by the steady growth of morbidity, the expansion of the spectrum of pollen sensitisation, the development of complications in the form of otitis, sinusitis, eustachitis, and often low efficiency of standard therapy. One of the reasons for the complication of allergic diseases in general and SAR in particular is the combination of allergy and secondary immune deficiency syndrome (SID). In order to form an understanding of the possibilities of allergen-specific immunotherapy (ASIT) optimization, an analysis of the clinical, immunological and allergic status of patients suffering from SAR with concomitant SID syndrome who received two ASIT courses. All patients (40 people aged 18-60 years) were divided into two groups: those receiving only SIT (20 people) and those receiving gamma-D-glutamyl triptofan (GDGT) immunomodulator treatment (20 people) in addition to standard therapy. The results of the study clearly indicate a sufficiently high therapeutic efficacy of the used approach of combination of preventive immunocorrection and ASIT, which consists in a reliable reduction of morbidity and duration of ARVI episodes, more significant effectiveness of ASIT. The basis of the positive effect of preventive therapy of GDGT is the restoration of functional parameters of the immune system.

A non-interventional prospective cohort study was conducted on adult patients with cystic fibrosis, who received mucolytic therapy with 7% NaCl solution combined with 0.1% hyaluronic acid (medical product Hyaneb) and 7% NaCl solution for 4 and 8 weeks. Materials and methods: A total of 24 CF patients over 18 years old were enrolled in the study. A comparative analysis of respiratory function, therapy satisfaction, efficacy and safety of treatment was conducted following 4 weeks of therapy in 7% NaCl Solution Group (n = 12) and MP Hyaneb Group (n = 12), and the dynamics of these parameters was assessed against the background of the use of MP Hyaneb for 8 weeks (n = 12). Results: At week 4 of treatment, a significantly smaller number of patients complained of nasal congestion, ears and or accumulation of mucus in the throat and chest, irritation of the throat and unpleasant taste in the MP Hyaneb Group. No significant differences in the onset and increase in the intensity of cough were achieved. No significant differences between the groups in terms of spirometry parameters were identified. Findings: MP Hyaneb showed the best tolerability compared to 7% NaCl solution in adult patients with cystic fibrosis. The use of MP Hyaneb reduces the frequency and severity of irritation of the pharyngeal mucosa, cough and nasal congestion following administration for one month.

Local inflammatory diseases caused by various infections are one of the most common pathologies in medical practice. For example, tonsillopharyngitis. This disease is extremely frequent for a physician’s practice. There is a fair amount of drugs, which supposed to be helpful against tonsillopharyngitis, but different drugs are also not the same in their pharmacological effects. In gynecological practice, frequent diseases are specific and non-specific vulvovaginitis, which have inflammatory and infectious components. For administrating local pharmacotherapy in gynecology against inflammation, a large number of drugs with different mechanisms of action are proposed. In this study, we focused on key pathological mechanisms associated with acute and chronic inflammation, for which these drugs should be exposed by their pharmacokinetic and pharmacodynamic properties. The best combination of these properties is available for benzydamine hydrochloride. Benzydamine hydrochloride has a wide antimicrobic activity against bacteria and Candida spices both albicans and non-albicans strains and allows to influence on etiologic cause of the disease. Also benzydamine hydrochloride associated with «cytokine» mechanism of anti-inflammatory action, which means that he does not affect COX enzymes and it allows to avoid gastrotoxic adverse events. Also, in this work showed and discussed aspects of the interaction of benzydamine with local immune system and justification of useful usage the benzydamine for local therapy of acute and chronic inflammatory processes caused by various infections.

The study is aimed at studying the clinical and functional features of BA in young men of military age. Methods. A total of 346 men aged 16–28 years (mean age 18 ± 1.7) were examined. The examination protocol corresponded to the algorithm “Medical Examination of Young Men and Draftees with Bronchial Asthma” in 2008. All patients underwent a general clinical and specific allergological examination, a functional lung examination assessing the reversibility of bronchial obstruction. Results. The diagnosis of BA was confirmed in 283 patients, and newly diagnosed in 23 (8.1%) patients. The mild BA was identified in 277 (97.9%) young men. The majority of patients - 240 (84.8%) - were in the remission phase of the disease, and 5 (1.8%) of them had a sustained remission. Allergic BA was diagnosed in the absolute majority of the examined - 261 (92.2%) people, and predominantly mild intermittent BA in 209 patients (73.8%). Symptoms of allergic rhinitis were reported by 198 (70%) patients with allergic BA and 85 (30%) patients with mixed asthma. House dust, library dust were the most common allergens. 68.2% of patients had the burdened heredity of BA and/or atopy. Most of the examined (79.9%) showed no significant changes in the respiratory function, however, 172 (60.8%) patients showed positive results of the β2-agonist test. At the time of the examination, 56 (19.8%) patients received antiasthma basic therapy, the other used only bronchodilators. Replacement of short-acting bronchodilator monotherapy for a combination of above bronchodilator and inhaled corticosteroids as an adjuvant therapy for stage 1 or 2 GINA patients ensures the early and regular administration of the baseline drug and eliminates the problem of excessive dependence on fast-acting bronchodilators. Conclusion The allergic phenotype of the disease with a predominance of milder form dominates in adolescents with asthma. Treatment with a fixed combination of beclomethasone salbutamol 250 μg/100 μg (SabaComb®) can increase compliance, improve the efficacy of the therapy and reduce the risk of BA exacerbations.

Today, chronic obstructive pulmonary disease is the fourth global cause of deaths worldwide. A number of studies showed that 11 to 16 million people might suffer from the chronic obstructive pulmonary disease in Russia. The prevalence and high mortality of this disease lead to a significant socio-economic burden. A pharmacoeconomic comparison of two alternative drug technologies in the studied groups grants the reasonable opportunity to transfer patients to the domestic analogues, confirming that efficiency unit costs for using Tiotropium-native and Ipraterol-native are lower than the same costs for using the foreign drugs Spiriva and Berodual.

Today, liver diseases are a serious medical and social issue, as the majority of patients with this pathology are the working age population. Moreover, the liver cancer death rates are increasing every year. We interviewed Valery Mikhailovich Makhov, Dr. of Sci. (Med.), Professor of Faculty Therapy Department No. 1, Academic Adviser of the Gastroenterology Department of Vinogradov Faculty Therapy Clinic, Sechenov First Moscow State Medical University (Sechenov University) about the modern therapeutic possibilities in hepatology.

The problem of irritable bowel syndrome (IBS) remains relevant for practice internist and gastroenterologist, as evidenced by the large number of publications in recent years on this issue, affecting various aspects of the pathogenesis, clinical manifestations, diagnosis and treatment of IBS. The article describes the evolution of diagnostic criteria for IBS as part of an international consensus «Rome criteria». Lack of effect of the treatment of IBS ex juvantibus often not a consequence of an incorrect diagnosis, and due to the presence in the patient’s intestinal disorders microbiocenosis. In this situation, it is expedient to correct the microbial landscape of the intestine with the use of probiotic agents. Efficacy in reducing the symptoms of irritable bowel syndrome has reliably demonstrated specific strains of probiotics, such as Bifidobacterium infantis 35624.

Introduction. The term «functional disorders of the biliary tract and bile ducts» defines the conditions, which produce typical patterns of biliary pains in the absence of obvious signs of organic lesions of the gallbladder and bile ducts. The materials of the Rome IV consensus present the diagnostic criteria of their main types – functional disorders of the gall bladder and sphincter of Oddi. Vasilenko Clinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology of the University Clinical Hospital No. 2 of Sechenov University carried out a noninterventional observational program to study the experience in using Trimedat® (trimebutine maleate) in the routine outpatient and inpatient practice in the treatment of patients with functional diseases of the biliary tract. Information partners of the program are the Russian Gastroenterological Association (RGA) and the Russian Society for the Study of the Liver (RSSL).

Materials and methods. The program included patients of both sexes aged 18 to 65 years with ICD-10 diagnoses «spasm of the sphincter of Oddi» (K 83.4), «postcholecystectomy syndrome» (K 91.5), «other specified diseases of the gallbladder» (K 82.8) , «other specified diseases of the bile ducts» (K 83.8), «disorders of gallbladder and biliary tract in diseases classified elsewhere» (K 87.0), if the clinical picture was consistent with functional biliary disorders according to the Rome IV criteria and in cases when the doctor decided to prescribe Trimedat® therapy. Patients were observed for 28 ± 1 days. The dynamics of biliary pain and discomfort, as well as other symptoms (in particular, nausea, flatulence) were evaluated on the background of the therapy, using the Gastrointestinal Symptom Score Scale, in which the severity of each symptom is estimated by 7 grades (Alekseev N.Yu., 2006) with adding a section to evaluate the biliary disorders. In the presence of criteria for functional disorders of the gallbladder, an ultrasound control of the fraction of its discharge was carried out before and after the therapy.

Results. 100 patients (33 (33%) men and 67 (67%) women, the average age 42.2 ± 13.2 years (18–65 years)) were enrolled in the program. In accordance with the Rome IV Consensus, the majority of patients (83 (83%)) had the functional disorders of GB; in 16 (16%) patients with the removed GB, the picture corresponded to the functional disorder of SO, one patient with kept GB was diagnosed with SO dysfunction. The treatment with Trimedate® at a standard dosage resulted in a decrease in the proportion of pain in the epigastric region (in the Scale section evaluating the biliary tract symptoms), the degree of nausea and bloating. Differences between the visits were estimated by the Friedman’s test, p <0.001. In addition, other sections of the scale also showed a decrease in indicators in scores. 79 patients underwent repeated ultrasound cholecystography at the end of treatment. It showed an increase in the fraction of GB emptying.

Conclusions. The use of Trimedate® in patients with functional disorders of the gall bladder and sphincter of Oddi resulted in the reduction of the severity of the main symptoms - the severity of biliary pain, nausea, bloating. The patients with GB dysfunction showed an increase in the fraction of GB emptying.

The article presents new definitions of functional disorders of the gastrointestinal tract (Roman criteria IV) and irritable bowel syndrome (from the section of functional disorders of the intestine). Modern pathogenetic links of IBS and changes in intestinal flora as one of the main pathogenetic mechanisms are considered. The use of probiotics in the treatment of IBS is considered and the data of effective treatment of 520 patients (IBS-diarrhea: 120 children and 400 adults) with the new multiprobiotic Bac-Set are presented.

Dexlensoprazole MB is the R-enantiomer of lansoprazole and is currently the only proton pump inhibitor with the new Dual Delayed Release delivery technology. The pharmacokinetics of the drug shows two peaks of release in the 12-finger and small intestine; antisecretory effect is shown in doses of 30 mg, 60 mg, and retention of intragastric pH > 4 more than 16.5 hours per day; regardless of the time of administration. Clinical studies have shown that dexlansoprazole MB is highly effective in the healing of erosive esophagitis and symptom control in patients with non-erosive reflux disease; maintains remission with prolonged use. Effective in improving the symptoms of night heartburn associated with GERD, with sleep disturbances. Dexlensoprazole MB has a similar safety profile and side effects with lansoprazole.

 This paper discusses the possibilities and benefits of early combination therapy and the application features of a fixed-dose combination of metformin and alogliptin (Vipdomet®) in the treatment of type 2 diabetes mellitus (DM 2).

Foot skin mycosis is one of the most topical problems in dermatovenerology due to the extreme prevalence of these diseases. Treatment of foot skin mycoses is the most important step in the prevention of onychomycosis. The tactics and a specific sequence of the external therapy depends on the specific clinical form of mycosis: acute inflammatory forms require the prescription of solutions and gels, subacute forms required creams, chronic forms require adhesive agents. Exudative form of the foot skin mycosis with vesiculation is an indication for the combination therapy.

The article presents the results of studying the effect of red clover extract (Feminal®) pulse wave velocity in women with menopausal syndrome periand postmenopause. The results obtained allow us to conclude that therapy with red clover extract is effective for treating moderately severe COP, and has a significant effect on the speed of the pulse wave.

The article presents the results of a comparative randomized study, the purpose of which was to evaluate the effectiveness of the use of aminodihydrophthalasindione sodium (Galavit, LLC SELVIM, Russia) in the treatment of patients undergoing an abortion. Included in the study, 48 women were divided into two groups, 24 patients of the main group in addition to the standard rehabilitation were treated with aminodihydrophthalasindione sodium in the comparison group – 24 patients underwent only standard rehabilitation. In this study, all patients (100%) of the main group who were treated with aminodihydrophthalasindione sodium in addition to the standard therapy marked reduction of the clinical symptoms of the disease and positive dynamics was observed at ultrasound. In the control group, the full clinical effect of treatment was observed only in 10 patients (52.6%). 9 women (47,4%) required repeated therapy. Ultrasound studies in 12 patients (63.2%) showed changes equivalent to endometritis.

According to epidemiological studies, about 30% of residents in Russia receive less than 70% of the daily magnesium intake, while magnesium deficiency manifests much more often in women than in men. The prevalence of magnesium deficiency is 1.3 times higher among the female population. Women are more sensitive to magnesium deficiency and normally have higher deposited concentrations of this element. Objective of the study: evaluate the effectiveness of magnesium in the management of menopausal syndrome symptoms. Materials and methods: 30 female patients, aged 47 to 57 years, with various menopausal syndrome symptoms underwent clinical and laboratory examination. In addition to the general clinical examination, all patients underwent atomic absorption spectroscopy to determine serum Mg2+ ions concentrations. All patients received menopausal hormone therapy in combination with magnesium supplement using Magnesium Diasporal 300. Results and discussions: The severe climacteric symptoms relief and an increase in the serum magnesium levels were recorded against the background of the therapy.

The purpose of the review: presentation of modern data on the pathogenesis of abnormal uterine bleeding (AMC) without anatomical substrate (ovulatory, endometrial, coagulopathic) and the effectiveness of their treatment with medication.

Basic provisions. Information on the pathogenesis of AMC not associated with structural abnormalities of the uterus is presented. It was shown that non-hormonal drugs have similar efficacy. Among the hormonal agents, levonorgestrel-containing intrauterine system (IUD-LNG) and estrogen-progestogen preparations (combined oral contraceptives, COCs) favorably differ. COCs recover an acute episode of AMC in 66.8% of cases (according to some data – in 88%), which is higher in comparison with non-hormonal drugs; in chronic cases – reduce blood loss by 88% (after 6 months of therapy), and are not inferior in effectiveness to intrauterine devices with levonorgestrel (83% after 3 months of therapy).

The conclusion. Thus, non-hormonal drugs have similar efficacy in arresting AMC without an anatomical substrate, but are inferior to COCs. In case of chronic AMC, the first-line drugs are IUD-LNG and COC containing E2B / NNG, which contribute to the normalization of the menstrual cycle and the volume of menstrual blood loss with proven efficacy.

Cervical endometriosis is a common disease in young women, which is characterized by the appearance of tissue on the vaginal part of the cervix, similar in structure to the endometrium and undergoing cyclic changes in accordance with the menstrual cycle, and is a form of external genital endometriosis. The article presents the pathogenetic mechanisms of this disease development in terms of possibility of exposure to them during pathogenetic therapy.

The study aims to assess the effectiveness of prostatic biopeptides in the comprehensive treatment of prospermia in men with chronic bacterial prostatitis. Microscopic and bacteriological examination of the prostate gland secretion was performed in order to confirm the presence of the disease. The findings of spermograms were interpreted according to the reference values of the ejaculate parameters recommended by WHO in 2010. All patients were divided into 2 groups depending on the therapy. The patients in both groups received the standard 4-week nonsurgical therapy (antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs). After completing the course of standard therapy, patients of Group 1 (31 people) received a standard amount of antioxidants for the following 4 weeks to correct prospermia. In addition to antioxidants, the patients of Group 2 (37 people) were assigned to rectal administration of prostate extract suppositories, one suppository once a day. It has been established that the long-term drug therapy is required for the correction of prospermia in patients with chronic bacterial prostatitis. The standard nonsurgical therapy consisting of antibiotics, β-blockers and nonsteroidal anti-inflammatory drugs does not lead to a significant improvement in the key ejaculate parameters. The use of prostatic biopeptides improves the qualitative and quantitative characteristics of sperm motility, which is a valuable result of therapy for patients with chronic bacterial prostatitis, who make reproductive life plans.

Lower urinary tract infections are currently an actual clinical and social problem due to the high prevalence, the need for an interdisciplinary approach to diagnosis and treatment, the severity of the combination of disorders of urination and dyspareunia, which leads to the rejection of sexual life, violations of childbearing function. Timely and adequate diagnosis of urinary disorders in women with the identification of risk factors, concomitant diseases, pathogens allow to select a rational, primarily necessary antibacterial therapy that contributes not only to the patient’s getting rid of symptoms of the disease, but also prevents the transition of the disease into a chronic form.

Based on the results of modern clinical and experimental studies, the review article discusses issues of pharmacotherapeutic feasibility, pathogenetic validity and safety of the first and most studied phosphodiesterase type 5 inhibitor – sildenafil – in general clinical practice according to «non-classical» (non-erectogenic) indications in the framework of an interdisciplinary approach modern medicine. As it is known, at present, phosphodiesterase type 5 inhibitors are both the «first line» therapy for treating erectile dysfunction (as monotherapy), as well as an effective option for monotherapy or combined pharmacotherapy of lower urinary tract symptoms on the background of benign prostatic hyperplasia in men with erectile dysfunction. However, given the universality and fundamentality of the mechanisms of their pharmacological action (first of all, the effect on the metabolism of one of the key vasomodulators of the vascular bed, nitric oxide NO), the list of potential and promising indications for prescribing these drugs is constantly expanding due to the presence of various «non-classical» (non-erectogenic) effects, which makes them very attractive for wider application not only in urological practice, but also in other medical specialties. The article describes in more detail and purposefully the accumulated to date scientific and practical data on the effectiveness of the use and potential mechanisms of action of sildenafil in cardiology, endocrinology, neurology, nephrology, obstetrics and gynecology, andrological reproductology and oncology, and also presents the results of studies confirming its safety in the treatment of relevant specialized diseases.

NSAIDs are the most commonly used drugs in clinical practice for pain relief in various diseases. To date, considerable scientific material has been accumulated on the pharmacogenetics of NSAIDs and the role of genetic factors that can influence the pharmacokinetics and pharmacodynamics of drugs, changing the efficacy and toxicity profile. The most clinically significant changes in pharmacokinetics in carriers of slow alleles of CYP2C9*3 have been identified for celecoxib and flurbiprofen, which determines the need for testing and lowering of drug doses. Studies were carried out to study the role of polymorphism of the metabolizing enzymes CYP2C9, CYP2C8, UGT in the development of gastrotoxicity and gastrointestinal bleeding during application NSAIDs, as well as diclofenac’s hepatotoxicity. The association of «slow» alleles CYP2C8*3 and CYP2C9*2,*3 with the risk of gastrointestinal bleeding associated with NSAID use, which are substrates of CYP2C9 and CYP2C8, is shown. The effect of variants of alleles PTGS1 (gene COX-1) and PTGS2 (gene COX-2) on pharmacodynamics, efficacy and toxicity of NSAIDs, in particular, the severity of the analgesic effect and cardiotoxicity of the drugs, was studied. In this way, pharmacogenetic predictors of adverse effects that patients can experience, and the need for dose adjustment based on the patient’s genotype, or individualizing the choice of alternative NSAIDs to increase the effectiveness of analgesia, have been determined.

An anonymous sociological survey of 89 doctors and specialists from different cities and regions of the Russian Federation practicing ayurvedic methods was conducted. It is shown that this contingent in sociological terms differs little from «ordinary» colleagues, they have sufficient both general medical and «ayurvedic» experience, and are convinced by personal experience of the effectiveness of Ayurvedic methods.

The supply of the with magnesium and vitamin B2 is essential to maintain the energy metabolism of cells, hormonal balance, endurance, immunity, cardiovascular health of athletes. As a result, by increasing the availability of these micronutrients, it is possible to increase maximum aerobic power, achieve better sports results and stimulate adequate recovery after competition or after intensive training. A promising way to increase the supply of athletes with magnesium and vitamin B2 is the use of aqueous solutions of magnesium citrate in combination with riboflavin.

Today, there is an ambiguous dynamics of state financing of health care. Up to 2017, the Government of the Russian Federation gradually reduced the amount of allocations for health care. For example, in 2017 expenses decreased by 33% compared with 2016. Constantly observed adjustment of budget lists and their differentiated interpretation. Nevertheless, Vladimir Putin, in his message to the Federal Assembly in 2018, announced an increase in health care spending to 4.1% of GDP. Therefore, every year there is a growing need to explore the market for paid medical services. The article discusses the dynamics of paid medical services and the impact on them of various socio-economic factors, focusing on the development of the institute of public-private partnership as one of the tools for solving problems of health financing. The authors propose a series of comprehensive measures at the federal and regional levels that allow them to optimize the interaction of participants in the medical services market.

Objective: definition of indicators of system prooksidanty-antioxidants at active and passive smoking during pregnancy. Material and methods. On the basis of city clinic for women 39 pregnant women on the term of a gestation of 37 weeks are examined. Questioning, rapid test for identification of a kotinin in urine, determination of level of a malon dialdehyde (MDA) and also activities superoxide dismutases (SOD) and catalases is carried out to bloods of surveyed. Patients are divided into 3 groups: I-of 11 smoking pregnant women subject to II-13 to passive smoking at pregnancy, III-control group of 15 women. Results. At patients of I and II groups substantial increase of level MDA in blood serum is noted. Reliable decrease of the activity of SOD of erythrocytes in the I group and insignificant decrease of the activity in II is taped. The indicator of catalase/SOD was statistically higher at active smoking. Conclusion. Active and passive smoking at pregnancy leads to change in prooxidatic and antioxidatic systems.