The article presents overview and statistical data on heart failure and cardiovascular diseases in Russia, world research data on various forms of heart failure in accordance with the modern classification, their clinical, anamnestic and prognostic differences, different approaches to the treatment of heart failure , discussion the prospects of this direction in cardiology, including the relevance of medical technology assessment.

The article is devoted to the extremely common problem of modern medicine - sleep disorders. Insomnia in a variety of manifestations faced by doctors of different specialties. This review introduces practitioners to the modern classification and approaches to the diagnosis of insomnia. Both pharmacological and non-pharmacological methods of treatment and criteria for their effectiveness are discussed. Advantages of Donormil in insomnia treatment was demonstrated.

The article presents modern approaches to the management of patients with cognitive impairment of different etiology. The authors presented the algorithms for syndromic (mild, moderate, severe) and nosological differential diagnosis of cognitive disorders, and showed the importance of diagnostic laboratory, instrumental and neuroradiological research methods. They discussed the latest research data on the effectiveness of cognitive training, lifestyle optimization, physical activity, and the prophylactic value of timely treatment of cardiovascular and other diseases. The paper shows the possibilities of modern neuroprotective and symptomatic therapy of cognitive impairment of different etiology, the role of EGB 761 in the treatment of diseases with cognitive impairment.

Musculoskeletal pain (MSP) is one of the major interdisciplinary problems of modern medicine and society. Inflammation is a universal mechanism that plays a crucial role in the development of acute and chronic MSP. Therefore, non-steroidal antiinflammatory drugs (NSAIDs) are the first-line treatment for MSP. The effectiveness of all NSAIDs in reducing pain and inflammation is approximately the same, and the degree of safety is determined by their relationship to COX-1 and COX-2 enzymes. Thanks to pharmacological properties and a balanced profile of efficiency and safety, the successful position of the «golden mean» between cokebins and non-selective NSAIDs is a moderately selective aceklofenac, which makes it appropriate for the vast majority of patients with MSP. Introduction into clinical practice of the drug Aceklagin containing 200 mg of aceсlofenaс in a new drug form with modified two-phase release, opens up new possibilities of MSP therapy. Due to the stable concentration of aceclofenac in the body during the day, Aceklagin improves the efficiency of pain and inflammation treatment in patients with MSP, while maintaining a high level of safety inherent in this molecule.

The article presents the data of modern Russian and foreign studies on the use of non-steroidal anti-inflammatory drugs (NSAID). Various types of pain are discussed. The authors outline the key issues of the choice of drugs from the NSAID group, taking into account efficacy, safety and scope of use.

The problem of achieving control of bronchial asthma (BA), regardless of severity, remains relevant. The use of extra-finely dispersed Beclomethasone/Formoterol FC (EMB FC BDP/FOR) according to the concept of Maintenance and Reliever Therapy (MART) has clinical advantages over traditional basal therapy in combination with symptomatic drugs. In the studies, BA Phenotypes for the use of EMD-FC BDP/FOR: BA in smoking patients, asthma with hyperinflation and asthma in older people and with a disease duration of more than 10 years were established. Clinical cases of treatment of EMD FC BDP/FOR are presented in accordance with the MART concept in older patients with uncontrolled asthma on the background of comorbidities and persistent bronchial obstruction, which have a positive effect and controlled asthma.

 The article describes the etiology, elements of pathogenesis and clinic of the main types of chronic rhinitis. The emphasis is made on such forms as vasomotor and atrophic rhinitis, diagnosis and options for conservative treatment. As a comprehensive treatment of these forms of rhinitis is considered a homeopathy: the use of Thuja oil (Thuja occidentalis) and «Fleming ointments» with the problem of nasal obstruction and rinorea. The results of the study of the effectiveness of Fleming ointment for conservative treatment of vasomotor rhinitis are presented. The experience of the use of Thuja oil in the treatment of patients with symptoms of nasal obstruction and rhinorrhea, with the phenomena of atrophic rhinitis.

Allergic rhinitis is one of the most common human diseases and causes a deterioration of the quality of life. The prevalence of allergic rhinitis in the Russian Federation and in the world has increased significantly. The main pharmacological group in the treatment of allergic rhinitis is the 2nd generation antihistamines with high affinity for H1-receptors. The article presents an overview of the new representative of the abovementioned group of drugs - the drug bilastine (Nixar®).

An important and topical problem of modern otorhinolaryngology is the search for effective and safe medicines for the treatment of bacterial sinusitis, which is one of the most common human diseases, and this problem is becoming more and more acute every year. When prescribing antibacterial therapy for patients with acute and chronic rhinosinusitis, an otorhinolaryngologist should be sure that the drug has a rapid bactericidal effect, the spectrum of its activity includes most of the possible pathogens, and pharmacodynamics of the drug contribute to its accumulation in the focus of the pathological process.

Cough is one of the most common symptoms. Cough not only accompanies the respiratory system diseases, but also occurs in diseases of the cardiovascular system, the digestive system, the upper respiratory tract, etc. This is initiated both by the direct irritation of cough receptors in diseases and stimulation of the cough center. The diagnostic search pattern includes endocrine system diseases, systemic diseases, mediastinal lesions, neurological pathology, etc. Not only laboratory and instrumental examination is important for diagnosis, but also a careful assessment of cough characteristics. The diagnosis of chronic cough and the exclusion of lifethreatening causes demand the most attention. The article presents updated CHEST cough guidelines for diagnostic cough search and management algorithms for establishing the main causes of cough. The main groups of drugs used to relieve cough are considered.

Modern therapy of functional dyspepsia (FD) based on the Rome criteria for revision IV includes the use of drugs that reliably eliminate clinical manifestations of the disease and are well tolerated in their use.

The diagnosis and management of patients with obesity and nonalcoholic fatty liver disease (NAFLD) is now the role and importance of the first contact a doctor (therapist and general practitioner). The article discusses the diagnostic algorithm of obesity, based on the classification AAСE / ACE (2014), and the possibility of ursodeoxycholic acid as part of treatment and prevention recommendations in patients with NAFLD associated with obesity.

The review is devoted to erythema nodosum (UE), which is a typical variant of septal panniculitis without vasculitis and is a  nonspecific immune inflammatory syndrome. Often, UE acts as one of the symptoms of systemic pathology, including rheumatic  diseases (RH), sarcoidosis, Crohn’s disease, ulcerative colitis, cancer, etc., which can cause late diagnosis and, accordingly, the  appointment of adequate therapy. 

The article is devoted to third-generation slow-modifying chondroprotective drug therapy including Alflutop. The evidence-based  medicine showed and substantiated in vitro effect of the drug on the pathogenetic processes in the cartilage tissue, its promotion  of the inflammation regression in the musculoskeletal system. The authors present a series of clinical studies of top osteoarthritis doctors, which showed that Alflutop had an anti-inflammatory, chondroprotective, analgesic effect, and that the administration of  the drug allowed patients to reduce the doses of NSAIDs, and it could be used in patients with comorbid diseases. 

The problem of diagnosis and treatment of allergic rhinitis today is particularly relevant, due to the increasing prevalence of that  disease both in Russia and abroad. The three highlighted directions of the treatment are: immunotherapy, elimination therapy and  drug therapy. The basis of the pharmacotherapy of allergic diseases are medicines, which are directed to the main pathogenetic  mechanisms of allergic inflammation. Among the drugs recommended for the treatment of allergic rhinitis, antihistamines of the  second generation play an important role. 

Vitamin D has a large number of biological effects due to the effect on the vitamin D receptor, which is present in most tissues in  the body. The possible role of vitamin D in infections is explained by its effect on the mechanisms of the innate and acquired immune  response. Suppression of the inflammatory response is also an important effect of vitamin D.  Many scientists strongly believe that vitamin D deficiency is among the so-called «seasonal stimulators» of acute respiratory viral  infections (ARVI), the potential for the prophylactic and therapeutic use of vitamin D in the season of ARVI and influenza is of particular interest.  25-hydroxycalciferol-stimulated production of antimicrobial peptides, such as defensin and cathelicidin is the most important fact  proving the possible protective role of vitamin D in influenza and other acute respiratory infections. These endogenous peptides  have a direct action, destroying not only microbial pathogens, but also viruses, including the influenza virus. 

Nowadays application of combined oral contraceptives with folates is considered not only as effective contraception, but also as  treatment of hyperandrogenic dermopathy and prophylaxis of cardiovascular diseases. 

Research objective. To carry out the overview of the published works devoted to assessment of efficiency and safety of the phytodrug  mastodynon, which includes Vitexagnus-castus extract, in treatment of mastalgia caused by a benign dysplasia of mammary glands  and/or a premenstrual syndrome, with the analysis of use of the obtained data in clinical practice of obstetrician-gynecologist. 

Materials and methods. The foreign and domestic articles which are selected in Pubmed, eLIBRARY according to keywords «cyclic  mastalgia», «diffusion benign dysplasia of mammary glands», «premenstrual syndrome», «hyperprolactinemia», «Vitexagnus-castus»,  «mastodynon» are used. The results of the analysed clinical trials demonstrate efficiency of phytodrugs in treatment of mastalgia in  patients with various forms of diffusion mastopathy and premenstrual syndrome.

Conclusion. Mastodynon can be recommended as  effective and safe first-choice drug for treatment of a cyclic mastalgia in patients with a diffusion benign dysplasia of mammary  glands and a premenstrual syndrome. 

Purpose: to assess the strength of the pelvic floor muscles and the effectiveness of prevention measures for pelvic organ prolapse  after childbirth in women with risk factors. 

Material and methods. Included 180 patients. In group I (n = 45) – gynecological pessarium was used after childbirth; in group II  (n = 45) – pelvic floor muscle training (Kegel exercises) was used; in group III (n = 45) – no treatment was received. In group IV (control,  n = 45) women without risk factors for prolapse to control functional parameters. Used: vaginal palpation assessment scale of Oxford. 

Results. The increase in the strength of the pelvic floor muscles in group II was more effective than in other groups and in 22.2%  of patients reached 5 points (very strong contractions) compared with 6,6% – in groups I and IV (p<0,05). A significant increase in  the strength of the pelvic floor muscle contraction was not observed in group III. The overall effectiveness of the treatment was  95,6%. Among those who did not receive treatment, the muscles remained weak in 22,2% (p = 0,03). 

Transsexualism is a distress caused by a discrepancy between a person’s gender identity and sex assigned at birth. Theme of  transsexualism has a strong resonance in society today. This phenomenon is significant both for the law system and for the health  care system of the state. There is no statistics information on transgender people in Russian Federation. The author’s goal was to  draw a socio-demographic portrait of patients with an established diagnosis of transsexualism. The following conclusions were  made: the number of MtF and FtM patients searching for medical care is equal; age of the transition is 26.6 years; age of selfidentification in the opposite gender is 10.2 years; most MtF take HRT on their own initative; transsexual persons are distinguished  by a high level of education, large variety of professional activities, a low percentage of registered marriages, and comparable to the  general population onset of sexual life. 

The article presents the data on the state of endothelial function in the normally and in various diseases and conditions. The basic  functions of endothelium in modulation of vascular tone, atrombogenicity and thrombogenicity of the vascular wall, regulation of  vascular wall adhesion, regulation of vascular growth are described. The main causes leading to the formation of endothelial  dysfunction and the mechanisms underlying it are highlighted. Numerous studies on the evaluation of endothelial function in  various diseases are presented. The basic methods of drug and non-drug correction of endothelial dysfunction are presented. 

The aim of this study was to analyse genetic (polymorphism 4a/4b gene NOS3), biochemical (endothelin-1) and functional (endothelial function coefficient) markers of a condition of vascular endothelium in patients (n = 65) with chronic heart failure (CHF) with  mid-range ejection fraction (40–49%), depending of the stage of the disease and identify the presence of associations between the  analyzed markers. Somatically healthy people (n = 65) were examined as a control group. A decrease in the value of the endothelial  function coefficient and an increase in the production of endothelin-1 in all groups of patients compared with somatically healthy  people were revealed. The severity of these changes was greater in groups of patients with more severe stage of the disease. The  analysis of polymorphism 4a/4b gene NOS3 in patients with CHF revealed a statistically significant predominance of the number of  patients with a more severe stage of the disease among of patients with polymorphism 4a/4b. Patients with polymorphism 4a/4b  had a statistically significant lower value of the endothelial function coefficient and a higher level of endothelin-1 compared  patients with polymorphism 4b/4b. Thus, polymorphism 4a/4b is characterized by a deeper lesion of the vascular endothelium in  patients with CHF with mid-range ejection fraction and the development of more severe stages of the disease. The obtained data  can be used in the aspect of personalized medicine. 

The presented work is devoted to the development of new approaches to the individual expert analysis of the obtained values  of laboratory data. A description of the sequence of the stages of mathematical transformations, the creation of a» panel «  neural network, the formation of matrix tables. Referring to their earlier publications, the authors argue that the structural  changes in the «panels» of the ratios of indicators formed by the rows of «reference points», despite the same type of displacement of the absolute parameters of the selected value, could in different observations both coincide and differ significantly,  while demonstrating the selective relationships that are justified in the known literature data. According to the authors, the  proposed algorithm makes it possible to establish hidden links between the dynamics of various laboratory indicators in individual cases, thereby significantly increasing their informativeness. The development and implementation of this method of  analysis, firstly, will allow to identify in the individual laboratory data, at least as «Express» method, States (images) corresponding to different complex pathological changes, including those requiring for its diagnosis of labor-intensive and expensive  research, and secondly-significantly expand the information content of routine laboratory research and without additional labor  and financial costs to be used in any health facilities. 

The clinical study enrolled 120 patients, who were hospitalized to the Therapeutic Department of Republican Clinical Hospital No.  5 of Saransk. The patients were divided into 2 groups: Group I (n = 60) included patients with metabolic syndrome; Group II (n = 60)  included patients with arterial hypertension. The paper presents data on the assessment of the functional state of kidneys in the  analysed groups, defines the role of metabolic disorders in the progression of renal dysfunction in patients with metabolic syndrome  and arterial hypertension. It is noted that more pronounced functional changes in the kidneys (microalbuminuria, increased cystatin  C levels, decreased glomerular filtration rate) are detected in patients with arterial hypertension and metabolic syndrome, as compared with patients without metabolic disorders. Cystatin C and microalbuminuria have been shown to be one of the earliest markers of kidney damage in hypertension, especially in combination with metabolic disorders. Cystatin C and microalbuminuria level is  significantly higher in patients with arterial hypertension and metabolic syndrome, as compared with patients with arterial hypertension, who have no metabolic disorders. Significant correlations were found between cystatin C, microalbuminuria levels and lipid  and carbohydrate metabolism in patients with arterial hypertension in combination with metabolic disorders. 

The concept of risk-adapted therapy is a modern standard of choice for the treatment regimen of Hodgkin’s lymphoma in childhood.  As a rule, patients are distributed depending on the number of factors in the groups of low, intermediate and high risk with a  particular volume of the treatment program. The rational use of chemotherapy and radiation therapy can reduce the risk of gonadal  toxicity. Loss of oocytes in patients receiving Hodgkin’s lymphoma therapy in childhood is usually associated with systemic  chemotherapy and pelvic irradiation. A combination of inhibin B and FSH is proposed as a screening marker to assess the gonadotoxic  effects of chemotherapy, in both girls and boys.