Secondary prevention of cardiovascular disease with aspirin is a very important issue. Аcetylsalicylic acid ensures the prevention of premature death, inhibition of progression and the achievement of partial regression of coronary atherosclerosis, prevention of clinical complications and exacerbations of the disease, reduction of the number of cases and the duration of hospitalization. The most promising direction of modern cardiology is considered to be the prevention of cardiovascular diseases (CVD) and their complications (CVD). This is due to two factors: an increase in the life expectancy of the world’s population as a whole and the persistent leadership of coronary heart disease and brain stroke as the leading causes of death, and disability. The pathogenetic aspects of the administration of acetylsalicylic acid are discussed. The most common dosage form of low-dose (ld) preparations of acetylsalicylic acid (ASA) for preventive use is an intestinal-soluble tablet — 80.6% in the structure of ldASK preparations. Low-dose ASK preparations are mainly presented (84.4%) in the form of monopreparations containing only ASA as the active substance, most often at a dose of 100 mg. However, the side effects of aspirin limit drug intake. This is also due to the high frequency of comorbid diseases such as bronchial asthma and stomach ulcer. The article discusses the issue of prescribing acetylsalicylic acid and the possibility of treating patients with concomitant bronchial asthma, gastric ulcer and obesity. The prevalence of gastroduodenal lesions was significantly lower with intestinal-coated ASA than with buffered acetylsalicylic acid. It was demonstrated that endoscopic lesions of the gastroduodenal mucosa were significantly less likely when using intestinal-coated ASA (100 mg / day) than when using conventional аcetylsalicylic acid, and the assessment of the lesion when using intestinalcoated ASA was similar to the assessment of placebo without аcetylsalicylic acid. In addition, the issue of the possibility of including аcetylsalicylic acid in the treatment regimen for COVID 19 is being discussed. 

Difficulties in the differential diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and acute myopericarditis during the novel coronavirus infection (COVID-19) pandemic appear to be a relevant and interesting issue.

We present a clinical case of a 55-year-old female patient with an atypical presentation of NSTEMI. Initially, the disease resembles an acute viral infection. It was known that the patient came in contact with COVID-19 infection. Taking into account that the patient had dull left chest pain unrelated to physical activities, low-grade fever, elevated levels of troponin T and acute phase reactants, absence of  wall motion abnormalities, the  patient was assessed as having acute viral myopericarditis. Contrastenhanced cardiac magnetic resonance imaging (MRI) showed signs of myocardial infarction. Coronary angiography confirmed myocardial infarction and the patient underwent percutaneous coronary intervention (PCI). In the article we discuss the value of electrocardiography (ECG), echocardiography and MRI in the NSTEMI diagnosis, and also additional difficulties in the COVID-19 pandemic era. Due to high probability of myopericarditis the patient received non-steroidal anti-inflammatory drugs instead of optimal medical therapy and early PCI. Our clinical case demonstrates that despite of COVID-19 pandemic significant elevation of troponin level requires adherence to the acute myocardial infarction algorithm. 

Cardiovascular diseases (CVD) are the leading cause of death among adults worldwide, including in the Russian Federation. At the same time, the leading position in the structure of causes of death from CVD is occupied by coronary heart disease (CHD) (16% of the total number of deaths in the world per year). The new clinical guidelines of the Ministry of Health of the Russian Federation for the management of patients with stable coronary heart disease in 2020 identify two main goals of conservative therapy – the elimination of symptoms of the disease and the prevention of cardiovascular complications (CVD). In this connection, when choosing antianginal therapy in patients with stable angina, it is necessary to consider the possibility of using combinations of both first-line and second-line drugs in order to really improve the effectiveness of treatment and achieve the goals set. It is advisable and justified to use more widely 2-line drugs, in particular trimetazidine, at any stage of therapy to enhance the antianginal effectiveness of b-blockers, calcium antagonists and prolonged-acting nitrates, especially in patients with hemodynamic features (arterial hypotension, rhythm and conduction disorders), which is demonstrated in the given clinical example. The effective addition of tremetazidine to the arsenal of traditional antianginal drugs is legislated in practice and is reflected in the new clinical recommendations of the Ministry of Health of the Russian Federation in 2020. The accumulated experience of using trimetazidine allows a pathogenetically sound approach to the treatment of stable CHD, restoring the balance between the need and delivery of oxygen to the heart muscle, and the safety profile expands the possibilities of use in patients with comorbid pathology. 

Hereditary angioedema belongs to the group of rare, orphan, genetically determined defects that represent a significant medical and social problem due to the pronounced impact on the quality of life and potential mortality, as well as the emerging difficulties associated with timely diagnosis and the appointment of adequate treatment. The article presents data on the modern classification of hereditary angioedema, clinical manifestations of the disease, approaches to diagnosis verification and treatment principles. Therapy of hereditary angioedema is determined by the need for effective relief of acute attacks of the disease, prevention of edema before medical interventions, and, if indicated, long-term prophylaxis. The article discusses a differentiated approach to the treatment of hereditary angioedema, characterizes various options for therapeutic interventions. In a clinical case, the history of several generations of a family with manifestations of hereditary angioedema is described. A modern approach to the diagnosis of the disease based on detailed history, clinical symptoms, and laboratory research results has been demonstrated. The analysis of the effectiveness of treatment was carried out and the high efficiency of pathogenetic therapy of hereditary angioedema with human C1-esterase inhibitor was shown. 

Stroke is an acute disturbance of the blood supply to the brain, characterized by the sudden onset of focal neurological symptoms, which persists for more than 24 hours or leads to the death of the patient in a shorter period of time due to cerebrovascular pathology. In the world and in Russia, stroke remains one of the leading causes of death and disability. At the same time, ischemic stroke (IS) is more common – about 80% of cases. Many classes of drugs, such as oral contraceptives, nonsteroidal anti-inflammatory drugs, and various psychoactive substances, can contribute to the development of drug-induced IS (DI IS). Data upon the frequency of DI IS is limited. In part, this reflects the problem of identifying and confirming the causal relationship between drug prescription and the development of IS. DI IS risk factors include: abuse of caffeine and alcohol, older age, smoking, drug addiction, high doses of drugs containing provoking agents, the simultaneous use of several drugs, the presence of comorbid diseases. Adverse drug reactions develop due to the following pathophysiological mechanisms: cerebral embolism, vasoconstriction of cerebral arteries, vasculitis of the central nervous system, orthostatic hypotension. The management of a patient with a DI IS does not differ significantly from the management of a patient with IS of a different etiology and includes thrombolysis or mechanical thromboextraction (in the absence of contraindications), as well as rational methods of secondary prevention. It is necessary to completely cancel or reduce the dose of the drug, the use of which led to the development of a stroke. DI IS prevention measures include the choice of drugs with the lowest risk of its occurrence and the use of modern scales for assessing the risk of this phenomenon.

Introduction. In  addition to acute manifestations, coronavirus infection is characterized by long-lasting symptoms: asthenia, somatic vegetative manifestations, sleep disorders and psychoemotional background, the  question of  therapeutic correction of which is especially relevant.

The aim of the study was to study the mental, somatoform and cognitive aspects of anxiety disorders after coronavirus infection during treatment with tofizopam (Grandaxin®) at 150 mg / day.

Materials and methods. The study involved patients who had a new coronavirus infection, who 4 weeks after the end of treatment for the underlying disease had complaints that suggest the presence of an anxiety disorder. The Hamilton scale was used to assess the level of anxiety. The patients were examined before the start of treatment, after 2, 4 and 6 weeks of therapy.

Results. Prior to the start of therapy, all patients had an overall high level of anxiety: the average HAM-A score was 31.72 ± 2.24  points. At the  end of  Grandaxin® therapy, all patients showed a  decrease in  the  level of  anxiety: the  average score for HAM-A was 12.68 ± 2.04 points (p < 0.001). At the end of the course of therapy, patients noted an increase in mental performance, improved memory and attention, that is, a decrease in the severity of cognitive disorders associated with anxiety was> distinct – the average score on the “cognitive disorders” subscale decreased three times – from 1.6 ± 0.12 to 0.5 ± 0.09 (p˂0.001).

Conclusions. Disorders of the psychoemotional background (more often in the form of increased personal anxiety), sleep disorders, autonomic disorders, asthenic syndrome significantly affect the quality of life of patients who have suffered a new coronavirus infection. A comprehensive approach is needed in the clinical diagnosis of the long-term consequences of a new coronavirus infection and their subsequent correction with drug therapy. 

Low back pain (LBP) is one of the most common reasons to see a physician. In 90–95% of cases, LBP is nonspecific (musculoskeletal). Timely diagnosis of acute nonspecific LBP and its effective treatment are of practical importance, have a favorable effect on the prognosis of recovery and significantly reduce the risk of chronic pain. The diagnosis of acute nonspecific LBP is established on the basis of complaints, clinical picture, data of somatic and neurological examination, absence of “red flags” (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy or lumbar stenosis). Drug and non-drug methods are used in the treatment of acute nonspecific LBP. In acute nonspecific LBP, great importance is attached to informing the patient about the causes of pain and a favorable prognosis, the need to stay active, avoid staying in bed and wearing corsets. As pharmacotherapy, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is effective. Nimesulide, an NSAID that is used to treat various pain syndromes, is effective and safe in the treatment of acute nonspecific LBP. In addition to NSAIDs, muscle relaxants and B vitamins may be prescribed. Therapeutic exercises are not prescribed during the acute period of back pain. Therapeutic exercises are effective in preventing exacerbations of LBP. We present our own clinical example of managing a patient with acute nonspecific LBP. Complex treatment based on international and Russian recommendations allowed to help her relatively quickly and effectively. The achieved positive effect was maintained for 3 months of follow-up of the patient.

SARS-CoV-2 is a novel coronavirus that has been identified as the cause of the 2019 coronavirus infection (COVID-19), which originated at Wuhan city of PRC in late 2019 and widespread worldwide. As the number of patients recovering from COVID-19 continue to grow, it’s very important to understand what health issues they may keep experiencing. COVID-19 is now recognized as an infectious disease that can cause multiple organ diseases of various localization. It is against this background that a new term was introduced: post-acute post-COVID-19 syndrome characterized by several persistent symptoms inherent in the acute phase of the disease, as well as the occurrence of delayed and (or) long-term complications beyond 4 weeks from the onset of the disease. The work reflected in this article revealed a portrait of a patient with post-COVID-19 syndrome, the most common complications of this period, as well as the mechanisms of their development and the resulting metabolic, cellular, tissue disorders leading to the tissue and organ dysfunctions. A comprehensive biochemical and immunological screening was carried out using the example of three clinical cases to identify the most significant disorders in these patients and to correlate with their clinical status over time. In point of fact, such patients were diagnosed with vascular dysfunction factors (development of endothelial dysfunction), metabolic dysfunction factors (metabolic acidosis, mitochondrial dysfunction, carbohydrate metabolism disorder, insulin resistance, altered branched-chain and aromatic amino acid metabolism), neurological disorder factors (neurotoxicity of the resulting metabolites), immunological disorder factors (decreased efficiency of detoxification systems, secondary immunodeficiency, risk of secondary bacterial infection). 

Inhaled short-acting bronchodilators (beta-agonists and M-anticholinergics) have been used for a long time in patients with bronchoobstructive diseases, the main representatives of which are chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Given the fact that most patients with COPD and BA are treated with long-acting bronchodilators, the question arises about the place of short-acting drugs in modern treatment algorithms for bronchoobstructive pathology. The data on how many patients take short-acting beta-agonists and M- anticholinergics in real-life clinical practice, and how appropriate it is to use these drugs on top of prolonged drugs are provided. The Russian part of the international POPE-study analyzed the characteristics of outpatients with COPD. It was found that the vast majority of patients have short-acting bronchodilators as part of their therapy, and more than 50% of patients receive a combination of SABA and SAAC, and in most cases this is represented by a combination of fenoterol + ipratropium. Taking into account that the majority of patients with COPD and asthma receive prolonged bronchodilators, important from a practical point of view is the question of the effectiveness of short-acting drugs on the background of prolonged ones. The article discusses these aspects of therapy and provides evidence that the use of SABA and SAAC provides an opportunity to achieve additional bronchodilatation when used against the background of prolonged bronchodilators. Thus, symptomatic use of SABA and SAAC on demand in bronchoobstructive pathology have sufficient justification even in the presence of a combination of prolonged bronchodilators in patient therapy. At the same time, it is necessary to take into account the increased probability of side effects with such drug regimen. The article also discusses the issues of different types of inhalation devices for short-acting bronchodilators (nebulizers and metered-dose aerosol inhalers), provides data on their comparative effectiveness and safety. 

Allergic rhinitis remains one of the most relevant problems of modern otorhinolaryngology. The widespread prevalence, late diagnosis, underestimation of the possible risks of disease progression, the development of complications (including asthma) prompts the development and improvement of new treatment options for allergic rhinitis. Allergic rhinitis is a heterogeneous disease that presents with various clinical phenotypes, and therefore the severity of nasal symptoms can vary from mild malaise to severe disease.. Today, pharmacotherapy remains the most frequently used treatment tactic for patients with allergic rhinitis. While prescribing therapy the doctor develops an individual treatment plan based on the principles of personalized medicine, considering: the dominant symptoms, anamnesis data on previous therapy and the effect of treatment, the type of inflammation (Th2-type, mixed inflammation), concomitant diseases (conjunctivitis, asthma, etc.) etc.) and patient preferences. The tissue effects of the histamine mediator lead to the development of symptoms during the course of the disease, which determines the wide-spread use of antihistamines in the treatment of rhinitis. Antihistamines of the second generation are devoid of sedative effects, have a long-lasting effect and a good safety profile. One of the modern II generation antihistamines is bilastine. The research results proved the high antihistaminic activity of bilastine 20 mg in vitro and in vivo, the absence of cardiac and sedative side effects on the central nervous system, the ability to eliminate the nasal and ocular symptoms of disease and improve the quality of life of patients with allergic rhinitis. Thus, bilastine fully complies with current EAACI / WAO ARIA requirements for drugs used to treat AR. The paper presents a clinical case of a patient with chronic persistent allergic rhinitis, household sensitization with a slight uncontrolled course. The oral antihistamine bilastine was added to intranasal glucocorticosteroids, which help to relieve symptoms of the disease, stabilize the condition and prepare the patient for subsequent allergen-specific immunotherapy. 

Introduction. The problem of the development of acute post-traumatic otitis media has not lost its relevance. Long-term preservation of the defect of the tympanic membrane contributes to the development of chronic inflammation in the middle ear and a deterioration in the quality of life of patients.

Objective. To study the effect of blood plasma enriched with platelet growth factors on the regeneration of the tympanic membrane tissues in patients with acute post-traumatic perforation.

Materials and methods. Patients with acute post-traumatic perforation of  the  tympanic membrane were divided into the main (24 people) and control (19 people) groups. Patients of the main group in the area of perforation of the tympanic membrane were injected once by application with a clot of autoplasma, enriched with platelet growth factors. The control group patients underwent dynamic observation of the processes of natural regeneration of the tympanic membrane tissues. On the 5, 10 and 15th days, the tissue regeneration of the tympanic membranes was assessed subjectively (patient complaints, audiometry) and objectively (otoscopy with the calculation of the dynamics of the relative perforation area, otoacoustic emission).

Results. A single application of blood plasma enriched with platelet growth factors to the perforation area was significantly more often accompanied by closure of  the  tympanic membrane perforation (p ≤ 0.01) and a  decrease in  the  average relative area of the tympanic membrane perforation on days 10 and 15 of the study (p ≤ 0.01). The dynamics of the average relative area of the tympanic membrane perforation reflected a high rate of closure of the tympanic membrane defect in the main group. Better healing of the tympanic membrane in patients of the main group was accompanied by an improvement in the auditory function of the affected ear. The quality of hearing was, on average, significantly better in the patients of the main group than in the patients of the control group, both on the 10th and 15th days of observation (p ≤ 0.01).

Conclusion. Clinical use of blood plasma enriched with platelet growth factors has a beneficial effect on the rate, intensity of closure of the tympanic membrane perforation and hearing. 

Introduction. Chronic rhinitis occurs more often in patients; it’s symptoms deteriorate their quality of life, affect sleeping, daily activity, and sometimes cause complications. The treatment depends on the clinical symptoms. In case of inefficiency of conservative therapy, surgery is indicated. Choosing an exact surgical instrument is still controversial.

Objective. The aim of our study is to compare using semiconductor laser (wavelength 1.56 mkm) and radiofrequency (4 MHz) in patients with chronic rhinitis.

Materials and methods. 60 patients with chronic drug-induced rhinitis aged 19–80 years were recruited and divided into two equal groups. All patients underwent surgical procedures: semiconductor laser (IRE-Polus) and radiofrequency (Ellman Surgitron) inferior nasal turbinate reduction. To assess and compare the healing process in two groups we used endoscopy and active anterior rhinomanometry. All patients filled out the SNOT-20 questionnaire. For the mucociliary clearance evaluation saccharin test was used. We observed patients during 12 months.

Conclusion. Both, laser and radiofrequency, techniques are effective in patients with chronic rhinitis. In laser group shorter healing period was observed, what leads to rehabilitation shortening and life quality improvement. 

Currently, rhinitis accompanied by nasal obstruction is one of the most common diseases in children and adolescents. Regardless of the cause of its occurrence - an infectious or non-infectious (allergic) process, each time there is a vascular (vasomotor) reaction. In children of preschool and primary school age, the most common is infectious rhinitis, which develops with viral and bacterial infections. The group of non-allergic rhinitis, which develops more often in adolescents, is united by the term idiopathic (vasomotor) rhinitis.

Purpose of the study. Evaluation of the effectiveness of the use of a complex preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in the treatment of vasomotor rhinitis in children.

Materials and methods. The study included 40 patients of childhood and adolescence, of both sexes (23 girls and 17 boys) aged 6 to 14 years with an established diagnosis of vasomotor (idiopathic) rhinitis, without concomitant pathology, not registered with specialists, without constant admission The study drug was used to lubricate the mucous membrane of the nasal cavity or put turundas with ointment for 3-5 minutes 2-3 times a day. The course of treatment was 7-10 days. The effectiveness of treatment was assessed by the dynamics of clinical data and the severity of the subjective symptoms of the disease.

Results. A comparisons of these scores for re-assessing the status of patients relative to the timing of the study drug use showed a uniform positive trend in terms of the clinical picture and subjective complaints of patients.

Conclusions. The inclusion in the complex therapy of pediatric patients with idiopathic (vasomotor) rhinitis of the drug Fleming’s Ointment, or monotherapy with this agent, contributes to a  rapid and pronounced weakening of  the  clinical manifestations of the disease, allowing you to quickly achieve positive treatment results in the form of relief of nasal obstruction, rhinorrhea, edema of the mucous membrane of the cavity nose, sneezing. There is a positive trend in the state of the mucous membrane itself. 

The review examines the role of mometasone furoate (NSMF) intranasal spray (Nasonex) in the treatment of allergic rhinitis (AR). There is a wide prevalence of AR both among children and adults, its adverse effect on the quality of life of patients. It is emphasized that the main means of therapy for moderate and severe course in accordance with international and Russian recommendations for the diagnosis and treatment of AR are intranasal glucocorticosteroids (INGKS). The pharmacological features of the MF molecule that underlie its efficacy and safety, including the affinity, lipophilicity and viscosity of the drug, as well as low systemic bioavailability, are discussed in detail. The therapeutic effects of NSMF in the treatment of seasonal and perennial AR, its effect on nasal symptoms are discussed in detail. The beneficial effect of NSMF therapy on nasal congestion is emphasized separately. The beneficial effect of NSMF treatment on other clinical manifestations of AR, including ocular symptoms, effects on sleep, and olfactory function, has been noted. The safety issues of NSMF use are discussed in detail, including systemic effects, such as effects on adrenal function, eye, and growth retardation in children, and local adverse effects on the nasal mucosa; there is a high profile of local and systemic safety of long-term use of NSMF in the treatment of AR in both adults and children. 

The current impact of disease on society and the health care system is increasingly driven by disability rather than premature mortality. In otorhinolaryngology, there are many diseases that have a high prevalence and cause significant health losses: hearing loss, chronic tonsillitis and pharyngitis, and more. Nasal obstruction is a common symptom in clinical practice. Given the high prevalence of nasal congestion, a significant decline in quality of life, and a significant socio-economic burden in society, this symptom is often key in the treatment of patients with rhinological diseases and a significant factor in assessing the medical need for  effective treatment options for  this condition. The  resolution of  the  Council of  experts of  the  National Medical Association of Otorhinolaryngologists on problems of nasal obstruction (April 17, 2021, Sochi) states that «it is necessary to conduct a medical and statistical study of public health losses associated with diseases that cause nasal obstruction, using methods for assessing the global burden of the disease and risk factors for the development of nasal obstruction». As you know, the World Health Organization measures the global burden of disease in the number of years of life lost as a result of disability. This indicator combines years of life lost due to premature mortality and years of life lost due to health conditions that do not meet the criteria for full health. The assessment of the disease burden in our country is used quite actively, most often for diseases that lead to death. The assessment of the disease burden indicator for diseases accompanied by nasal obstruction in our country has not been carried out, although the problem of treating nasal obstruction is of high relevance. The aim of the study is to discuss issues related to the study of public health losses due to diseases that cause nasal obstruction, using methods for assessing the global burden of the disease. The article provides an overview of the causes of nasal obstruction, information about its prevalence in various diseases, and discusses the calculation of the burden of nasal obstruction and possible approaches to calculating the global burden of disease, taking into account current methodological problems in this area. 

Introduction. A comorbid patient with the chronic obstructive pulmonary disease (COPD) in combination with cardiovascular diseases (CHD) has a poor prognosis due to the early progression of the pulmonary hypertension (PH). The study surveyed an opportunity of the PH detection using an active PH verification strategy in outpatients with COPD and stable angina pectoris.

Goal. To evaluate the frequency of РH in patients with mild and moderate COPD in combination with CHD and the possibility of using the echocardiographic criterion «right atrial area» to prove РH.

Materials and methods. The study included 52 outpatient patients with an average age of 62.8 ± 8.14 years. A comprehensive assessment of the Borg dyspnea scale, echocardiography, pulse oximetry at rest and after the 6-minute walk test (6MWT) were carried out. Two groups of patients were compared depending on the development of РH after T6MX.

Results and discussion. It was shown that in patients with COPD (GOLD I-II) and angina pectoris, PH was initially detected in 3.3% of cases, and after the 6MWT in 63.3% of patients. In this group, after T6MX, an increase in pulmonary artery pressure was determined from 18.5 ± 10.6 mmHg to 41.2 ± 12.5 mmHg (p < 0.05). After physical activity with increased pressure in the pulmonary artery, there was a significant increase in the area of the right atrium. Only 1/3 of patients with PH had hypoxemia after the 6MWT.

Conclusions. The T6M test makes it possible to detect РH in more than half of patients with COPD (GOLD I-II) and CHD in an outpatient setting. An enlargement in the area of the right atrium according to echocardiography, along with the other indicators of morphological and functional changes in the right heart, can be an additional diagnostic criterion for PH in comorbid patients with COPD and cardiovascular diseases. 

One of the most likely and serious complications of the novel coronavirus infection (COVID-19) is pneumofibrosis, which can negatively affect the duration and quality of life of patients who have suffered from this disease. The appearance of fibrotic changes in COVID-19 is due to a number of pathological processes that occur in the lungs after the pathogen, the SARS- CoV-2 virus, enters there. First of all, an inflammatory response is triggered, which is mediated by macrophages and granulocytes, due to which the synthesis of pro-inflammatory cytokines, incl. IL-1, TNF, which are potent inducers of hyaluronic acid synthetase. There is a  decrease in  the  content of  fibrinolysis activators in  the  pulmonary endothelium, which contributes to the  accumulation of fibrin in the vessels of the lungs. Fibrin can escape into the interstitial space and cause the formation of sclerosing alveolitis. The increasing defeat of pneumocytes favors the release of fibrin into the lumen of the alveoli, which causes the formation of hyaline membranes. The regulation of the fibrotic process involves immunocompetent cells, primarily CD4 + T-lymphocytes, which are capable of producing cytokines, chemokines and growth factors, and these, in turn, stimulate the proliferation and differentiation of  fibroblasts, as well as their production of  collagen. The  more severe forms of  infectious process can lead to the greater risk of developing fibrotic changes. Risk factors are a large area of lung damage, the use of artificial pulmonary ventilation, ARDS, fibrosis in anamnesis. An additional role in the pathomorphogenesis of pneumofibrosis is played by smoking, external inhalation effects (inhalation of organic and inorganic dust), gastroesophageal reflux, type II diabetes mellitus, genetic factors (familial idiopathic pulmonary fibrosis). The pathogenetic features of COVID-19 require administration of anti-fibrotic treatment. Bovhyaluronidazum azoximerum, a drug that is a conjugate of the proteolytic enzyme hyaluronidase, is considered as an antifibrotic agent. The treatment regimens with this drug recommended in the period of convalescence for patients who have undergone COVID-19 are given. 

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19.

Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease.

Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: the main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators.

Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group.

Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease. 

Introduction. Respiratory diseases have always been a serious threat to public health, but in 2020 the situation deteriorated significantly due to the rapid development of the coronavirus infection COVID-19. Due to the lack of available means of ethiotropic therapy and the still insufficient coverage of the general population with vaccination, disinfectants, as well as topical preparations that prevent the penetration of the virus into the body, play an important role in preventing the spread of infection.

Aim of the study. This work is devoted to the study of the virucidal activity of the medicine Mestamidin-nos against respiratory viruses, namely influenza A and B viruses, parainfluenza, respiratory syncytial, adenovirus and seasonal coronavirus.

Materials and methods. This study was carried out by the suspension method according to MU 3.5.2431-08 “Study and assessment of the virucidal activity of disinfectants”.

Results. It was shown that for all studied viruses the use of the compound for 60 minutes led to a complete (up to 0 lgTID50) or sufficient (4 lgTID50) decrease in the viral titer. In the case of a study of a compound with a protein load (imitating strong organic pollution), the effectiveness of the compound was significantly reduced against influenza A viruses, one of the strains of influenza B virus, adenovirus and seasonal coronavirus.

Conclusion. Based on the results of the study, it can be concluded that the effective inhibition of pathogens of influenza and acute respiratory infections using the compound MesaMidin®-nos in the absence of strong organic pollution. 

Respiratory diseases remain a common group of diseases in the practice of general physicians and pulmonologists. Currently, there are various treatment protocols for patients with respiratory diseases, where one of the pharmacological groups is mucolytic drugs. They affect the physical and chemical properties of sputum by splitting complex mucins, which leads to its liquefaction. Indications for use of drugs of this group are clinical conditions, in which there is a cough with thick, viscous, difficult to detach sputum. The article discusses the possibility of treating several respiratory diseases with mucolytic therapy, provides a comparative characteristic of drugs of this pharmacological group. The clinical and pharmacological effects of erdosteine are discussed in detail: mucolytic, antioxidant, anti-inflammatory, immunomodulatory. These properties of the drug are extremely important in clinical practice conditions, because in addition to the mucolytic properties themselves, the patient has many adverse processes due to inflammation. All this is associated with additional damaging factors regarding the tissues and may also indicate an increased risk of complications. Thus, the multipurpose effects of the mucolytic erdosteine in various respiratory tract diseases are presented. In addition to acute respiratory viral diseases, the clinical experience of using erdosteine in chronic obstructive pulmonary disease is discussed in detail. The most important indicator to assess the effectiveness of drugs used in this disease is the reduction in the number of exacerbations per year and the severity of the course of the exacerbation. The conclusions, which are given according to the results of a number of studies, determine significant advantages in the use of erdosteine as mucolytic therapy. 

Exocrine pancreatic insufficiency is quite common in clinical practice of doctors of many specialties. Decrease in intraduodenal lipase levels below 5–10% of normal leads to pancreatic steatorrhea, weight loss and a potential decrease in quality of life. These clinical manifestations are more often presented in patients with a primary genesis of exocrine pancreatic insufficiency, while secondary exocrine insufficiency is more often subclinical, which predetermines its early diagnosis. However, many methods for diagnosing exocrine pancreatic insufficiency, which have been developed and used in clinical practice in recent years, have low sensitivity or specificity, or are time-consuming and poorly tolerated by patients. The method for determining the level of coprological elastase is not always reliable, especially in patients with chronic diarrhea, which predetermines its implementation in formalized stool, for example, during therapy. It is important to take into account the fact that with moderate exocrine pancreatic insufficiency, the sensitivity and specificity of assessing the level of fecal elastase can weaken by 30%. However, regardless of the receipt of diagnostic data and the cause of the development of exocrine pancreatic insufficiency, the goal of therapy is to eliminate the processes of maldigestion and malabsorption, reduce the severity of symptoms of indigestion and prevent their negative consequences. At the  same time, it is necessary to include an enzyme preparation in the complex therapy, the choice of which, its dosage and duration of therapy are determined taking into account the individual characteristics of the patient and the severity of exocrine pancreatic insufficiency. In addition, in patients with suspected exocrine pancreatic insufficiency due to clinical manifestations, it is possible to use empirical enzyme replacement therapy. An example of such an approach for patients with secondary exocrine insufficiency is the appointment of the enzyme preparation containing pancreatin.

Currently, lactulose is known to most as a laxative that has a hyperosmotic effect, stimulating intestinal peristalsis. The drug has long established itself as a safe and effective medicine. Lactulose is one of the few drugs that is approved for use in pregnant women and children under 6 months of age with functional constipation. The prebiotic properties of lactulose were discovered in 1957. After research, it was found that it promotes the growth of beneficial bacteria, such as bifidobacteria and lactobacilli. In addition to being used as an effective weak and prebiotic agent, lactulose has been successfully used since 1966 for the treatment of hepatic encephalopathy. The mechanism of action of the drug is that it prevents the absorption of excess ammonia, which is formed in the large intestine, through the hydrolysis of protein and urea by the intestinal microflora. Lactulose, which has a wide range of effects on nitrogen metabolism by the intestinal microflora, affects not only ammonia, but also other bacterial toxins as a result of the studies that have demonstrated the reliable effectiveness of the drug, the world’s leading professional communities have included lactulose in their recommendations as the drug of choice for the treatment of patients with hepatic encephalopathy at any stage of the disease. The article presents current data on the effectiveness and safety of the use of lactulose in various diseases. In addition, attention is paid to such a concept as microbiota. Its functions and influence on the human body are described. 

The purpose of the review is to acquaint general practitioners, therapists, gastroenterologists with the possibilities of diagnosing functional disorders of the gastrointestinal tract associated with constipation, as well as to draw attention to the need for additional examination methods for a comprehensive assessment of functional disorders of the gastrointestinal tract in patients with constipation on pathogenesis.

Functional constipation is an urgent problem today due to its prevalence among different age groups, a negative impact on the quality of life, as well as the variability of the clinical forms of diseases associated with this symptom. The modern diagnostic algorithm for chronic constipation consists of several stages, including the identification of signs of the disease, according to the Rome criteria of the IV revision (2016), the identification of symptoms of “red flags” and laboratory and instrumental research. It should be borne in mind that functional constipation is often based on the pathology of the anorectal zone, which is an important factor in the diagnosis and development of further therapeutic strategies. The article provides an overview of modern and promising methods for diagnosing functional disorders of defecation, taking into account functional disorders of the anorectal zone associated with constipation.

Functional methods such as anorectal manometry, rectal sensory test and balloon expulsion test are the  most studied and obligatory tests for an objective assessment of the sensorimotor function of the anorectal zone. In Russia, these methods are used very little, which requires extensive familiarization of practitioners with the advantages of these techniques. Knowledge and application of the presented examination algorithms will help the clinician to increase the overall diagnostic efficiency and apply the most justified tactics of managing patients with functional pathology of the digestive system associated with constipation. 

In the world, the number of patients with carbohydrate metabolism disorders is steadily growing. Over the past 10 years, the number of patients with diabetes mellitus in the world has more than doubled. Moreover, there is not only an increase in the number of patients with diabetes mellitus, predominantly type 2 diabetes, but also with prediabetes. The term «prediabetes» means impaired glucose tolerance and impaired fasting glycemia. To date, it is obvious that the development of prediabetes lead not only to the higher risk of diabetes mellitus in the future, but also of cardiovascular diseases. Factors that increase the risk of cardiovascular events in patients with prediabetes includeare the following: insulin resistance, accompanied by arterial hypertension and dyslipidemia, and postprandial hyperglycemia. Therefore, it is very important to timely identify patients from the risk group, diagnose and treat carbohydrate metabolism disorders already at the stage of prediabetes. Also it is very important to identify the patients from the risk group, diagnose and treat carbohydrate metabolism disorders at the stage of prediabetes. Treatment of patients with prediabetes implies, first of all, lifestyle modification (moderate hypocaloric nutrition with predominant restriction of fats and simple carbohydrates and regular physical activity of moderate intensity) in order to reduce weight. If lifestyle changes are ineffective, drug therapy may be prescribed. The article discusses the studies conducted to assess the effectiveness of lifestyle modification, as well as various options for antihyperglycemic therapy (metformin, glucagon-like peptide receptor agonists, alpha-glucosidase inhibitors, orlistat) for the treatment of patients with prediabetes. It also provides data on long-term follow-up of patients with prediabetes who received different treatment options. 

The article discusses the pathophysiological mechanisms of the development of vascular aging as a combination of the influence on the  body of  genetic, environmental, regulatory, metabolic and other factors causing biochemical, enzymatic and cellular changes in the arterial vascular bed. The concept of “early vascular aging” and “healthy vascular aging” is defined depending on the ratio of the biological and chronological age of the vessels. The role of diabetes mellitus in increasing vascular stiffness, early vascular aging, as well as the  progression of  atherosclerotic cardiovascular diseases and their complications is considered in detail. Approaches to multifactorial management of vascular age in patients with type 2 diabetes (lifestyle modification with strategy of aggressive treatment of modifiers of atherosclerosis, rejection of bad habits, adherence to dietary recommendations and the use of modern organo- and vasoprotective antidiabetic drugs) are revealed. The mechanism of realization of vasoprotective effects of inhibitors of sodium-glucose transporter-2 (iNGLT-2) is described in detail. The results of completed large random ized trials EMPA-REG Outcome and EMPA-REG BP of the most studied representative of the IGLT-2 group, empagliflozin, are presented. It has been shown that due to their glucose and natriuretic effects, the ability to reduce body weight and blood pressure, improve myocardial metabolism and bioenergetics, decrease the activity of the sympathetic nervous system, as well as positive effects on vascular stiffness, NGLT-2 inhibitors are the drugs of choice in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases. This makes it possible to widely use this group of drugs for managing the vascular age of patients and represents a new opportunity in the prevention of vascular aging in T2DM. 

In recent decades, there has been a significant increase in the incidence and prevalence of diabetes mellitus. Diabetes mellitus is characterized by the development of vascular complications leading to early disability and a decrease in the life expectancy of patients. Aging of the body inevitably leads to the occurrence of age-related diseases, including the cardiovascular system, and increases the risk of death. Metabolic and structural and functional disorders of the cardiovascular system arising in diabetes mellitus have common pathophysiological mechanisms with aging of the body. Chronic hyperglycemia can accelerate the aging process and play a decisive role in the occurrence and prognosis of cardiovascular events in patients with diabetes mellitus. Achieving target glycemic values is an important step towards preventing vascular complications in patients with diabetes mellitus. Improved models of glucometers, equipped with a number of additional functions, allow for structured self-control of glycemia, analyze the data obtained and carry out timely correction of therapy, actively involve patients in the process of diabetes management, which will significantly increase the efficiency of disease management, reduce the risk of complications in patients and improve the quality of life.

In time, prescription of insulin therapy (IT) becomes inevitable for many patients with type 2 diabetes mellitus (DM) to achieve and maintain the target hypoglycemic range.

According to the current guidelines, the addition of basal insulin to glucose-lowering therapy in patients with insufficient control of type 2 diabetes, gradual titration of its dose in accordance with a fasting blood glucose level is an effective and safe method for initiating IT. The properties of modern long-acting insulin analogues are considered. Glargine 300 U/ml is a modern analogue of long-acting insulin that is intended to be used once a day. The glargine molecule forms the basis of the drug. Increasing the concentration of glargine per volume unit and formation of a smaller subcutaneous depot led to a change in the pharmacokinetic properties of the drug. Glargine 300 IU/ml provides a more stable, long-term, predictable action with low glycemic variability as compared with glargine 100 IU/ml, which reduces the risk of hypoglycemia. The sugar-reducing efficacy and safety of insulin glargine 300 U/ml as evidenced by the findings of the international clinical phase III EDITION studies are discussed. Insulin glargine 300 U/ml showed a similar decrease in HbA1c levels compared to insulin glargine 100 U/ml with an improved safety profile (lower risk of developing episodes of confirmed or severe hypoglycemia at all times of the day, including the nighttime) and a less pronounced effect on the body weight of patients with type 2 diabetes. The efficacy and safety of the use of glargine 300 U/ml has been confirmed in type 2 diabetes patients with chronic kidney disease and the elderly. In the BRIGHT study, glargine 300 U/ml showed comparable glycemic control when it is being compared. 

Diabetic polyneuropathy (DPN) is heterogeneous in its clinical course and clinical manifestations. Depending on the primary lesion of large or small nerve fibers, different onset, course and clinical manifestations of polyneuropathy are possible. In patients with diabetes, the incidence of associated lesions of the peripheral nervous system is high. When verifying the diagnosis of DPN, it is necessary to carry out a differential diagnosis with a number of diseases: paraneoplastic neuropathies, metabolic neuropathies, neuropathies in vasculitis, toxic neuropathies, autoimmune neuropathies, inflammatory neuropathies and hereditary neuropathies. Diabetes is not the only cause of polyneuropathy. Up to 50% of all cases of polyneuropathies in diabetes have additional causes. Diagnosis of diabetic polyneuropathy - diagnosis of exclusion. The development of polyneuropathy in patients with a duration of type 1 diabetes less than 5 years, the absence of nephropathy and / or retinopathy, asymmetry in symptoms and signs, the predominance of motor symptoms, beginning with upper limb lesions, rapid progression should justify the doctor for differential diagnostic search. You should also take into account the characteristics of the patient (old age, vegetarianism and alcohol use), medical and toxic effects (taking metformin> 3 years and> 2 g / day; cytostatics, chemotherapy, heavy metals), family history of neuropathy. Therapeutic tactics should be individualized and take into account the polyneuropathy polyetiology. The purpose of this review is to discuss the most common reasons peripheral neuropathy in diabetes mellitus. The differential diagnosis of the diabetic polyneuropathy is the focus of this article. 

Hypothyroidism is one of the most common diseases of the endocrine system. It is more often recorded in older women. This disease is characterized by nonspecific symptoms and a blurred clinical picture. Patients often have many symptoms from various organs and systems. Because of this, hypothyroidism often remains unrecognized, and patients are not prescribed the necessary therapy on time. Doctors of various specialties should pay attention to the symptoms that may manifest as hypothyroidism. This is especially true for elderly patients. As a screening, the definition of thyroid-stimulating hormone (TSH) is used. First of all, attention should be paid to the pathology of the cardiovascular system, the presence of arterial hypertension, often diastolic and poorly controlled, a decrease in stroke volume and heart rate. Also, in hypothyroidism, lipid metabolism disorders, an earlier onset of atherosclerosis, a connection with metabolic syndrome and type 2 diabetes mellitus were noted. Therefore, it is recommended to diagnose hypothyroidism in patients with these diseases. Screening should also be done in the presence of neurological disorders, depressive and anxiety disorders, gastrointestinal diseases, and hematological disorders (anemias). The determination of TSH is included in the examination plan for infertility, and may also be necessary for other disorders of the reproductive system: menstrual irregularities in women and androgen deficiency in men. Treatment of overt hypothyroidism consists in the appointment of replacement therapy with levothyroxine. If subclinical hypothyroidism is detected, the question of treatment is decided individually and depends on the level of TSH, the patient’s age, and the clinical manifestations of the disease.

Introduction. Thyroid hormones play an important role during pregnancy, providing organogenesis, growth and development of the fetus, participate in the formation and development of the brain and its structures, affecting cognitive abilities. Thyroid dysfunction is associated with the pathological course of pregnancy and childbirth, as well as a negative effect on the fetus. Iodine deficiency, which persists throughout Russia, creates the preconditions for the more frequent development of subclinical hypothyroidism and hypothyroxinemia in pregnant women. Therefore, early detection of thyroid dysfunction during gestation in the region of iodine deficiency is relevant.

Aim. To assess the thyroid status in pregnant women in the region of iodine deficiency.

Materials and methods. A single-center, prospective, one-sample study was performed in a population of pregnant women registered from June 2019 to December 2019 to the antenatal clinic in Tyumen.

Results. According to the results of biomedical monitoring of iodine deficiency in the population of pregnant women in Tyumen, iodine supply improved, as evidenced by the median concentration of ioduria 154.4 μg / l, the frequency of endemic goiter was 0.37%. Continuous screening of women in the 1st trimester of pregnancy without thyroid pathology revealed subclinical hypothyroidism in 21.5% of pregnant women, carriage of antibodies to thyroperoxidase was found in 10.5% of women.

Conclusions. Given the persisting problem of iodine deficiency, the widespread occurrence of subclinical hypothyroidism in the population of pregnant women, it is necessary to include the study of thyroid status in the standard of examination of pregnant women when registering in an antenatal clinic for early diagnosis and timely treatment of hypothyroidism. It is also recommended to continue preventive measures aimed at replenishing the iodine deficiency starting from the stage of pregravid preparation. 

Glycemic control represents an integral part of diabetes mellitus (DM) therapy. It is not surprising that diabetes technology is evolving to not only create new routes of insulin administration, but also to improve the measurement of glycemia. A significant number of new glucose monitoring systems have been launched to the market over the past 10 years. Nevertheless, only 30% of patients with type 1 diabetes and very few patients with type 2 diabetes use continuous or flash glucose monitoring. The reason for this is not only the cost and technical difficulties of continuous glucose monitoring, but also its clinical appropriateness. There is indisputable evidence that patients who receive intensified insulin therapy, especially those with type 1 diabetes, need frequent self-monitoring / continuous glucose monitoring. As for patients with type 2 diabetes receiving basal insulin and / or other antihyperglycemic therapy, the data received seem to be contradictory and uncertain. However, most of the recommendations simmer down to the need for self-monitoring of blood glucose levels in patients with type 2 diabetes. The diabetes technology section of the American Diabetes Association guidelines 2021 goes into details about the role of self-monitoring of blood glucose in diabetes management, including the need for continuous patient education on the principles and rules of self-monitoring, interpretation and practical use of the results of self-monitoring, various standards of glucometers, factors affecting the accuracy of the results. 

Introduction. Carrying out studies on the supply of vitamin D in the Russian population is an important task in order to demonstrate the global nature of the problem of vitamin D deficiency.

Objective of  the  study. To conduct a  study of  the  level of  vitamin  D at different age periods and to assess the  relationship of the 25(OH)D supply with the seasons of the year.

Materials and methods. The study included 10707 people, 78.8% (n = 2323) women and 21.2% (n = 2266) men, mean age 49.86 ± 21.925 years (Me 56.00).

Results. Only 17.1% (n = 1833) of the examined had an adequate level of 25(OH)D, 31.4% (n = 3362) people had an insufficient level of 25 (OH) D, 43.7% (n = 4681) of the examined – a deficiency of 25(OH)D and among 7.8% (n = 831) a severe deficiency of 25(OH)D was revealed. An adequate level of 25(OH)D was found only in the group of children under 3 years of age (mean value 40.55 ng/ml). From 4 to 7 years of age, there is a pronounced 2-fold decrease in the concentration of 25(OH)D in all seasons of the year. A consistently low content of 25(OH)D is observed in the period 8-10 years – 20.91 ng / ml, and in the period 11-18 years – 18.30 ng/ml. The lowest average values of 25(OH)D were found at the age of 11-18 years (18.30 ng/ml) and from 19 to 22 years (19.15 ng/ml), as well as in senile (76 years and above) age (19.05 ng/ml). The lowest median concentration of 25(OH)D is recorded in spring (17.70 ng/ml) and winter (18.80 ng/ml), with a slight positive trend in summer (20.40 ng/ml) and autumn (22.00 ng/ml) season.

Conclusions. The optimal level of 25(OH)D was found in every fifth (17.1%) subject, vitamin D deficiency (20.01–30.00 ng/ml) was observed in  every third (3362  people out of  10707  examined, 31.4%), a  moderate calcidiol deficiency is recorded among 4681 people (43.7%), a severe deficiency of 25 (OH) D among the surveyed is 7.8%. 

Sodium-glucose cotransporter-2 inhibitors are the new drugs for the treatment of type 2 diabetes mellitus. Its mechanism of action is to increase the excretion of glucose in the urine due to inhibition of reabsorption in the proximal renal tubules, which leads to a decrease in blood glucose levels. These drugs also have pleiotropic effects including reduce body weight and blood pressure, improve the lipid profile (raising high-density lipoprotein cholesterol and lowering triglyceride levels), and reduce the risk of cardiovascular death and nephroprotection. Ipragliflozin, a new representative of the class of sodium glucose cotransporter-2 inhibitors, registered in Russia, has shown effectiveness in relation to glycemic control, reducing the levels of glycated hemoglobin and fasting plasma glucose both in monotherapy and in combination with other antihyperglycemic drugs. The PRIME-V and ILLUMINATE studies have demonstrated that ipragliflozin helps to reduce insulin resistance, body weight, BMI and waist circumference, total and LDL cholesterol. Positive effects of ipragliflozin on pancreatic β-cell mass and function have been shown in animal studies. Several studies have examined the beneficial effects of ipragliflozin on the course of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Significant reductions in ALT and GGT levels and a decrease in the absolute percentage of liver fat have been shown. Animal studies have confirmed the effect of ipragliflozin on the histological characteristics of NASH. The review presents data on the efficacy of ipragliflozin in relation to the components of the metabolic syndrome in patients with type 2 diabetes mellitus, and also discusses the likely mechanisms of a positive effect of the drug on the course of NASH in type 2 diabetes mellitus. 

The article presents clinical cases of management of patients with low compliance with treatment, suffering from rheumatic diseases and disorders of purine metabolism.

Cases report 1. The first patient with advanced gout, after taking 100 mg of allopurinol, developed undesirable effects: sore throat, change in voice, cough, and therefore treatment was discontinued. After six months without therapy, the condition worsened and, in self-medication, the patient resumed taking allopurinol at a dose of 300 mg per day, which, as expected, resulted in a resumption of the allergic reaction and a serious exacerbation of gouty arthritis. In order to stop continuous relapses of arthritis, it became necessary to prescribe glucocorticoids. After stabilization of the state, constant administration of febucostat with positive clinical and laboratory dynamics was recommended.

Cases report 2. The second patient with rheumatoid arthritis (RA) developed analgesic nephropathy, secondary hyperuricemia, and typical gouty attacks in the background of high activity of the underlying disease, existing kidney pathology and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs). Frequent exacerbations of arthritis prompted the patient to finally see a rheumatologist. The adjusted therapy made it possible to reduce RA activity, reach the recommended level of uric acid, and reduce the drug load on the kidneys with almost complete withdrawal of NSAIDs. Thus, in modern conditions, rheumatologists have in reserve all the necessary means for the pharmacological correction of hyperuricemia, even in difficult clinical cases. Febucostat is the drug of choice for correcting uric acid levels in case of intolerance to allopurinol, as well as in the development of secondary gout against the background of renal failure. In addition, it should be noted that the effectiveness of the treatment of rheumatic diseases largely depends on the patient’s compliance. To increase adherence to therapy, regular patient schools are recommended. 

Osteoporosis represents a great healthcare challenge due to an increased risk of fragility fractures that significantly decreases quality of life, shortens life expectancy, and looms as an onerous burden on both the social environment of patients and society as a whole. Osteoporotic fractures can’t be prevented without early diagnosis of low bone mineral density in people at risk. Unfortunately, the population at risk of osteoporosis is not covered by the periodic health examination program in real practice, and involving doctors of different specialties in the prevention and treatment of this disease is one of the options for addressing the challenge. As the risk of osteoporosis is associated with age and estrogen deficiency in women, the gynecologist can and should assume responsibility for the formation of risk groups, monitoring and timely recommendations on preventive and therapeutic actions. The gynecologist’s possibilities should not be reduced solely to recommendations for correcting lifestyle and prescribing menopausal hormone therapy. Antiresorptive agents of the first-line osteoporosis therapy may also be included in the gynecologist’s drug arsenal. Among them are the most commonly used bisphosphonates that are characterized by a good efficacy and safety profile during the long-term use. However, oral administration of bisphosphonates is associated with low compliance due to adverse reactions and the need for strict observance of the rules for their administration. In contrast, intravenous administration of bisphosphonates improves compliance and allows to ensure the optimal treatment outcome. Ibandronate intended for intravenous bolus administration once every three weeks for 5 years is one of the possibilities of using parenteral bisphosphonate therapy in the practice of gynecology. 

A new SARS-CoV-2-associated coronavirus infection pandemic began in late 2019. The present article is devoted to the analysis of the mechanisms of COVID-19 impact on the course of psoriasis and its consequences. According to the scientific literature, patients with psoriasis are somewhat more likely to be infected with coronavirus infection than the healthy population, but tolerate it in a milder form. At the same time, cases of psoriatic process exacerbation during the active phase of the disease and after COVID-19 have been described. The negative effect of infection on skin disease can be explained by the common genome of the two nosologies, the «cytokine storm» and the prescription of COVID-19 drugs. In addition, both COVID-19 and psoriasis can cause liver dysfunction related to the specific pathogenesis of the diseases as well as the prescribed therapy. The article describes our own experience of monitoring patients with exacerbation of psoriasis against the background of coronavirus infection with pathological changes in liver tests. Inclusion of a fixed combination of glycyrrhizic acid and essential phospholipids in the complex treatment allowed to stop the exacerbation of the psoriatic process more effectively, to reduce the activity of liver enzymes without worsening the clinical conditions associated with COVID-19. Thus, in particular, a clinically significant improvement of the skin condition was recorded. In patient B., alanine aminotransferase activity decreased to 44.4 U/L and aspartate aminotransferase activity to 18.2 U/L. In turn, in patient M. the activity of liver enzymes decreased to 37.8 U/L and 34.7 U/L, respectively. The prescription of this drug can be considered pathogenetically justified, given the effect of glycyrrhizic acid on the production of key cytokines involved in the inflammatory process in psoriasis, coronavirus infection and liver pathology. In addition, the hypothesis of the ability of glycyrrhizic acid to prevent the entry of SARS-CoV-2 into the cell by reducing the expression of angiotensin-converting enzyme 2 is of interest. 

Introduction. The  duration of  the  skin  healing period and the  final result of  cosmetic procedures are influenced not only by the treatment protocol and the type of therapy chosen, but also by skin care in the early post-treatment period.

Aim of study. Тo study the effectiveness and safety of the use of the topical agent “Traumeel® Cosmo gel” in patients in the early post-treatment period after cosmetic procedures, accompanied by traumatization of the skin.

Materials and methods. 20 female patients aged 19 to 49 years, who sought help for the correction of age-related skin changes, acne vulgaris, scarring of the skin and received the procedure of cosmetological therapy, accompanied by damage to the skin. All patients were assigned to group 1 (20 patients). Depending on the method of cosmetological treatment, the external remedy “Traumeel® Cosmo gel” was applied from 2 to 3 times a day at the treated area for 7 ± 2 days.

Results. According to the patients’ assessment of the effectiveness and comfort of the treatment, the use of the “Traumeel® Cosmo gel” in  the  early post-treatment period is an effective and safe method of  regenerative therapy of  the  skin  and has a  high therapeutic effectiveness, which was confirmed by the results of the study.

Conclusions. Based on the results of the evaluation of the effectiveness by the doctor and patients, as well as the evaluation of the monitoring of the dermatological status, the quality of life index, the patient’s subjective assessment of their response to therapy, consider the therapeutic effectiveness to be high, significantly contributing to the improvement of the quality of life. 

Hair loss has always been and remains an urgent challenge in the world today. Although this condition is not life-threatening, it still has a strong impact on the patients’ quality of life. Hairlines are affected by multiple factors including age, family history, smoking, nutrition, etc. Alopecia can take many forms, and the specialist’s objective is to determine the correct cause of the disorder of hair growth cycle by taking a medical history from a patient.

The key role in the pathogenesis of androgenetic alopecia is assigned to changes in hormonal status. Telogen effluvium can be triggered by stress, medication, pregnancy, or other medical conditions. For instance, the high number of patients who have had COVID-19 are now faced with hair loss a few months after recovery.

Despite the variety of underlining causes of hair loss, the principle of therapy is the same – the elimination of the trigger and the selection of drugs to normalize the natural hair growth cycle. In this case, the use of drugs containing proteoglycans that are specific proteins involved in the regulation of the hair growth cycle looks promising. Numerous studies demonstrate the efficacy of such proteoglycans as versican, decorin, and syndecan. They activate hair growth and help prolong the anagen phase. This effect of proteoglycans affords to speak about their good therapeutic and even prophylactic properties applied to the problem of hair loss. 

Introduction. Infertility, i.e. the inability to achieve a clinical pregnancy within 12 months of a regular sexual life without contraception, is a current medical problem and affects up to 15-25% of married couples in Western countries.

Objective. To evaluate the efficacy of prophylactic prescription of antioxidants in preparation for cycles of assisted reproductive technology (ART) depending on the level of anthropogenic chemicals in the patient’s body.

Materials and methods. A randomized clinical trial included 144 patients with infertility who applied for ART. Prior to ART treatment, all patients were determined the level of anthropogenic chemical substances (ACS) in the blood by mass spectrometry. The concentration of the following substances was determined: mercury, cadmium, lead, and bisphenol A. The patients were divided into groups depending on the level of ACS: group 1 consisted of 72 patients with high level of ACS (5 points or more), group 2 consisted of 72 patients with low level of ACS. Antioxidant therapy in the experimental group was performed for 2 months before ART. Coenzyme Q10 300 mg/day orally, eicosapentaenoic acid 300 mg/day orally, and docosahexaenoic acid 200 mg/day orally were used as antioxidant therapy. All patients in the control group did not take antioxidant medications for at least 6 months before entering the ART cycle.

Results. When evaluating the clinical outcomes of ART cycles, a positive effect of antioxidant therapy was noted in both patients with high and low levels of ACS; as a result, the chances of pregnancy were 2.3 times higher in the group of patients who received antioxidant therapy compared to the control group. The number of patients treated was 5 for both the total patient group and the subgroups depending on the level of ACS.

Conclusion. The results obtained allow us to recommend the prescription of antioxidant therapy to prepare patients for ART programs. 

Introduction. Vitamin D administration is recommended for women with vitamin D insufficiency, who are planning to undergo assisted reproductive treatment (ART). The action of the active form of vitamin D is mediated through its vitamin D receptor (VDR). The presence of VDR in the cells and tissues of the female reproductive system suggests that vitamin D plays an important role in human reproduction. However, the effect of VDR gene polymorphisms on human reproduction has not been adequately studied.

Aim. To assess the effect of VDR gene polymorphisms on the folliculogenesis, embryogenesis and clinical outcomes of assisted reproduction programs.

Materials and methods. The cross-sectional study included 300 patients without complications during the assisted reproduction cycle. The number of follicles, oocyte-cumulus complexes, mature and immature oocytes, the presence of oocyte dysmorphisms, number of zygotes, fertilization rate, and the number of obtained blastocysts were evaluated. The determination of three polymorphisms of the VDR gene (FokI – rs2228570, BsmI – rs1544410, TaqI – rs731236) was performed by real-time polymerase chain reaction.

Results. The incidence of perivitelline space pathology of oocytes in FokI A/A genotype patients was 5.7%, in A/G genotype patients  – 14.7%, in  G/G genotype patients  – 16.3% (p  =  0.041  when comparing A/A  genotype with A/G + G/G genotypes). Depending on the genotype, the pregnancy rate ranged from 38.5 to 52.8%, but no statistically significant differences were found.

Conclusion. It was shown that the perivitelline space pathology of oocytes in the FokI A/G genotype patients is 2.6 times higher, and in the G/G genotype patients – 2.9 times higher than in the A/A genotype patients. However, there were no differences in pregnancy rate among patients with different genotypes of FokI, BsmI and TaqI gene polymorphisms of VDR. 

Introduction. World statistics indicate an increase in patients, including young people, suffering from dry eye disease (DED). Along with exogenous factors, the development of DED depends on a genetic predisposition. Changes in the expression of genes PTPN22, TRIM21, directly or indirectly affecting the T-cell link of immunity, leads to overproduction of cytokines and, as a consequence, damage to the ocular surface.

This study aimed to design a diagnostic panel of genetic markers to determine the risk for DED of various etiologies development.

Materials and methods. The  study included 154  patients with autoimmune diseases with and without established DED. With a  diagnosis of  rheumatoid arthritis (RA) n  =  79  and primary Sjogren’s syndrome (PSS) n  =  75. The  control group consisted of 100 people without ophthalmic diseases, 31 patients with exogenous DED. In this study, we use melting curve analysis to confirm the results of the association analysis for polymorphic markers in genes.

Results. The prognostic value of the predisposing genotypes of the TRIM21 gene of the markers rs915956 and rs7947461 with the risk of DED in the presence of RA (p ≤ 0.001), the marker rs4144331 at the tendency level (p ≤ 0.1) was determined. The risk of developing DES against the  background of  PSS is associated with the  presence of  the  predisposing genotypes of  the  TRIM21  genes, the rs4144331 marker, and the PTPN22 rs33996649 marker (p ≤ 0.001). The association of polymorphic markers of the TRIM21 rs7947461 gene and the PTPN22 gene of the rs33996649 marker (p ≤ 0.01) with the risk of developing exogenous DED was established.

Conclusions. The predisposing genotypes were identified and the associations of polymorphic markers of the TRIM21, PTPN22 genes were established. A diagnostic panel of genetic markers has been created to predict DED of various etiologies. 

Introduction. Thrombosis (occlusion) of the central retinal vein (RCVO) and its branches is one of the main causes of loss or significant decrease in vision, including in people of working age, while RCVO is the second most common retinal vascular disease after diabetic retinopathy. The incidence rates steadily increase with age, amounting to 0.7% in the 49–60 age group and reaching 4.6% in people over 80 years old. Acute violation of retinal venous blood flow often leads to retinal ischemia, triggering the mechanism of activation of endothelial vascular growth factor (VEGF). In a quarter of patients, occlusions of the retinal veins and its branches initially proceed according to the ischemic type, which is characterized by the formation of extensive non-perfused retinal zones occupying an area of 10 or more areas of the optic nerve head (optic nerve disc) according to fluorescent angiography (FAG). In 34% of such patients, the non-ischemic type of venous occlusion becomes ischemic within 3 years.

Aim. To develop an optimal algorithm for  the  management of  patients with operated neovascular uncompensated glaucoma against the background of occlusion of the central retinal vein.

Materials and methods. Two patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Aflibercept (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed.

Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up.

Conclusion. The use of combined laser technologies and anti-VEGF therapy allows potentiating and prolonging the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma against the background of occlusion of the central retinal vein. 

Introduction. The iris is involved in maintaining the ocular hydrodynamic homeostasis as one of the elements of the anterior chamber angle of the eye. From there, the iris is one of the parts of its drainage area. The anterior chamber angle’s structure can predispose to an increase in intraocular pressure and thereby provoke the development of primary angle-closure glaucoma, a disease accompanied by clogging of the drainage area of the eye and, accordingly, an increase in intraocular pressure.

Objective. To analyse the viscoelastic properties of the iris in primary angle-closure glaucoma and primary open-angle glaucoma.

Materials and methods. The study material was a fragment of the iris obtained through iridectomy in the course of sinus trabeculectomy, which is considered the treatment for glaucoma surgery. A total of 43 samples (43 patients) were obtained and analysed, with 20 samples obtained from patients with primary angle-closure glaucoma (group 1), and 23 samples from patients with primary open-angle glaucoma (group 2). A standard ophthalmological examination, which included visometry, autorefractometry, tonometry, biomicroscopy, and indirect ophthalmoscopy, was carried out. The special examination included static perimetry, gonioscopy, ultrasound biomicroscopy or optical coherence tomography of the anterior chamber angle, optical coherence tomography of the disk of optic nerve.

Results and discussion. The avascular part of the stroma (designated by us as S) is the most rigid part of the iris, according to the study. It is characterized by the greatest efforts of the viscous dynamic resistance to the indenter (0.4–2.0 gf/мм2 × S), as well as the maximum integral tensile strength (up to 4.9 × 10-2 N). The inner (vascular) part of the stroma has the lowest dynamic viscosity, according to this study.

Conclusion. The samples vary enormously both in the biomechanical characteristics and relative thickness of this layer. It was observed that this biomechanically incompetent structure completely collapses and ceases to exist in partial dehydration of the sample. 

As defined in the WHO Bulletin (1999), low back pain (LBP) is pain, muscle tension or stiffness localized in the back between the XII pair of ribs and the lower gluteal folds, with or without irradiation in lower limbs. The LBP syndrome is not a nosological unit, but due to its high prevalence, social and economic importance, it has a separate heading in ICD-10 – (M 54.5). Various structures can be the source of LBP: intervertebral discs, facet and sacroiliac joints, muscles, ligaments, tendons, fascia, spinal cord and its roots, peripheral nerves, etc. Depending on which structure the source of pain is, the nature of the pain can have a nociceptive, neuropathic or mixed character, which affects the tactics of patient management. The variety of clinical manifestations of LBP introduces certain difficulties in the process of making a diagnosis and may entail the appointment of treatment methods that are inadequate for the patient’s condition. In such cases, it is advisable to conduct an additional consultation in order to obtain a second medical opinion. The message is devoted to the analysis of a clinical case of LBP. During the examination of the patient, the nature of the pain, initially regarded as neuropathic, began to be interpreted as nociceptive. In accordance with this, a complex treatment was prescribed, which included pharmacological preparations and methods of non-drug therapy. In order to quickly relieve the pain syndrome, the drug dexketoprofen was used according to a stepwise scheme. Obtaining effective anesthesia within 5 days made it possible to abandon further NSAID intake and to continue follow-up treatment with a preparation of B vitamins, a muscle relaxant and SYSADOA in combination with non-drug methods of treatment. The considered clinical case illustrates both the difficulties arising in the diagnosis of LBP and the possibilities of successful conservative therapy of this disease. 

Introduction. The adaptive overload of the central nervous system, caused by occupational stress, leads to the disruption of complex operational activities in the ambulance station workers and an increasing number of errors in medical decision-making towards the end of the work shift.

Aim. To assess the level and prevalence of changes in the work of the central nervous system (CNS) under the influence of occupational stress.

Materials and methods. The study involved 35 workers (medical and nursing staff) of ambulance station (19 men and 16 women aged 20  to 55  years). Electroencephalogram (EEG) was recorded at rest for  3  minutes, according to international scheme 10-20  in  six leads: F3, F4, T3, T4, P3, P4. The  following rhythmic activity indicators were used: THETA  rhythm (4–8  Hz), ALPHA rhythm (8–12 Hz), BETA rhythm (BETA, 12–25 Hz) and their ratios.

Results and discussion. When analyzing the overall activity, there is a decrease in all the studied parameters. At the same time, THETA, BETA and the total power of all ranges showed significant dynamics. In spatial analysis, the most noticeable decrease in activity in the frontal lobes (F3, F4) is responsible for motor behavior (premotor area of the cortex), executive functions (behavior control, inductive reasoning, planning), short-term and spatial memory, attention (spatial and motor). The decrease in activity in the temporal (T3, T4) and parietal (P3, P4) departments is observed only in some indicators.

Conclusions. Professional workload during the 24 hour shift has a predominant effect on the activity of the frontal lobes, reducing the ability to control and plan complex (precise) motor functions, visual-spatial attention and planning abilities. These mechanisms are key to the professional work of the personnel of the emergency medical service and determine the number of errors. 

Over 10 million operations are performed each year in Russia. A successful surgical treatment demands assessment and mitigation of perioperative risks, one of which is anemia. Patients with low hemoglobin are at greater risk of developing complications and adverse outcomes. These patients more often stay longer at hospitals, have more in-hospital events and readmissions.

Perioperative anemia may be present before surgery, low hemoglobin levels can result from surgery, and can persist after hospital discharge. Preoperative anemia is associated with inferior surgical outcomes and is also an independent risk factor for perioperative complications (acute kidney injury, infectious, thromboembolic, cardiovascular events) and death. Postoperative anemia impairs recovery and increases the risk of reoperations and readmissions.

Absolute and functional iron deficiency is the most common cause of anemia in the perioperative period. The prescription of iron supplements is indicated in the presence of iron deficiency. If the operation is scheduled to be performed in 6 weeks and longer, the prescription of oral iron forms is recommended. If less than 6 weeks remain before surgery, parenteral iron therapy is prescribed. If hemoglobin levels increase insignificantly during such therapy, high-dose iron supplements are indicated. When it comes to emergency surgery and the anemia is not severe, it is recommended to intravenously administer high-dose iron supplements immediately before surgery. In case of severe anemia, blood transfusion is indicated. According to the patient’s blood management concept, blood transfusion should be minimized, including due to the use of high-dose iron supplements, one of which is ferric carboxymaltose.

The choice of treatment for anemia in the postoperative period depends on its severity, the patient’s comorbidities, the type of surgery and the presence of surgical events. In most cases, early intravenous iron therapy is recommended, giving priority to single administration of high-dose iron supplements. Blood transfusion is indicated to patients who have severe anemia, are actively bleeding, and to patients with a severe anemia after the bleeding has been stopped. Iron therapy continues at the outpatient stage of treatment for a long time until the hemoglobin and ferritin levels are normalized, reflecting the replenishment of iron stores in the depot organs. 

Introduction. Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in the population of older patients. Even though long-term combination therapy helps to cope with the main manifestations of PD. It inevitably leads to the appearance of  such side effects as drowsiness, hallucinations, dyskinesia, and many others.  [12]. Therefore, the  search for  effective antiparkinsonian drugs devoid of the above-mentioned adverse reactions remains an urgent task of modern neuropharmacology.

The explored substances are derivatives of imidazole-4,5-dicarboxylic acid. These compounds belong to a fundamentally new class of N-methyl-D-aspartate ligands (NMDA) that are not channel blockers. Their pharmacological effect is realized due to interaction with the NMDA receptor recognition site, which, along with high efficiency, allows us to assume their higher safety, compared to previously existing channel blockers from the NMDA ligand group.

Objective. Studing of  the  antiparkinsonian activity of  new ligands of  the  glutamate NMDA-receptor complex-1,2-substituted imidazole-4,5-dicarboxylic acids on an experimental model of arecoline hyperkinesis.

Materials and methods. Imidazole-dicarboxylic acid derivatives (IEM2258, IEM2248, IEM2247, and IEM1574) were injected into the lateral ventricles of the mouse brain 10 minutes before arecoline in a volume of 5 µl at doses of 0.1-0.5 µmol, then the latent period, intensity, and duration of tremor were recorded. Amantadine was used as a comparison drug.

Results. Preliminary administration of the studied examined substances led to a significant decrease in the intensity and duration of arecoline tremor. The highest inhibitory activity with respect to the intensity and duration of the experimental tremor was demonstrated with the introduction of the compound IEM-2247 (at a dose of 0.1-0.5 mmol, the duration of the latent period of the tremor was 1.7-2.3 times longer than the control one, respectively, the duration of the tremor decreased by 1.5 - 2.5 times).

Conclusions. The  dose-dependent antiparkinsonian activity of  imidazole-dicarboxylic acid derivatives is shown, indicating the prospects for the development of these substances and the further search for effective and safe antiparkinsonian agents among the compounds of this class. 

Introduction. Blood glucose monitoring is critical in maintaining glycemic control in women with GDM and in reducing adverse maternal and fetal outcomes. One of the tools that can help achieve optimal glycemic control during pregnancy is continuous glucose monitoring, which empowers clinicians to assess the characteristics of daily glycemic variability.

The aim. Compare biweekly glycemic profiles and glycemic variability in pregnant women with GDM and in healthy pregnant women using the FreeStyle Libre flash glycemic monitoring system.

Materials and methods. Analysis of the glycemic profile of 49 pregnant women aged 33.2 ± 6.1 years. The average gestational age of the women included in the study was 12.6 ± 6.4 weeks. Pregnant women were divided into 2 groups: 37 pregnant women with GDM and 12 healthy pregnant women. Each group underwent two-week glucose profile monitoring using the FreeStyle Libre continuous monitoring system. Statistical analysis was carried out using Microsoft Office Excel 2016, STATISTICA 10 programs (developed by StatSoft.Inc), EasyGV, version 9.

Results. The average glycemic level in the groups was 4.724 ± 0.37 mmol/L vs 4.24 ± 0.34 mmol/L, respectively (p˂0.001). Comparative analysis of GV parameters in groups of pregnant women with and without GDM: SD – 0.908 vs 0.7213 (p˂0.05); LI – 1.5 vs 0.8 (p˂0.05); HBGI – 0.503 vs 0.42 (p˂0.05); J-index – 10.343 vs 7.9870 (p˂0.001); MOOD – 0.956 vs 0.7992 (p˂0.05); MAGE  – 2.326  vs 1.8042  (p˂0.05); ADDR  – 2.216  vs 0.4210  (p˂0.05); MAG  – 4.612  vs 2.6163  (p˂0.001), respectively. The CONGA index did not show a statistically significant difference in both groups: 3.95 vs 3.7 (p = 0.5).

Conclusions. Flash-glycemic monitoring can be used to obtain more detailed information about the glycemic profile, especially when it is difficult to assess the degree of GDM compensation. Continuous glucose monitoring can facilitate the optimization of glycemic control and provide a basis for treatment decisions. 

Disсоgenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pains, but has a worse forecast and is more often accompanied by a long disabilities. Most patients with DLSR can effectively be treated under polyclinic conditions, but it is not clear how effective conservative methods of DLSR therapy are used in real outpatient practice. This study was carried out in order to analyze the outpatient maintenance of patients with DLSR, which were surgical treatment (lumbar microdiskectomy) due to the ineffectiveness of conservative therapy.

Materials and methods. 90 patients (33 men, 57 women, average age – 59.78 ± 12) years suffered surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR. The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 6 ± 3 weeks.

Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. Only half of the patients were conducted by therapeutic gymnastics. 94.4% of patients received non-steroidal anti-inflammatory funds, 92.2% – muscle relaxant, 79.8% – a complex of vitamins of group B, and epidural blockade with anesthetics and corticosteroids were not used. Relatively widely used ineffective methods of therapy of the DLSR: paravertebral blockade of analgesics (42.2%), intravenous drip administration of actovegin and/or pentoxyfalline (26.7%), magnetotherapy and/or laser and therapy (36.7%).

Conclusion. In an outpatient practice, patients with DLSR do not receive effective conservative treatment, which may be a reason for the early (after 6 weeks) directions for surgical treatment. Polyclinic doctors are poorly informed about the effective conservative methods of DLSR therapy.

Introduction. Menstrual migraine attacks are considered more intense, prolonged, and resistant to treatment than non-menstrual ones. Currently, effect of preventive therapy on the course of menstrual-associated migraine has not been well studied; there are isolated studies on the beneficial effect of hormonal therapy on these attacks.

The aim of the study was to compare the treatment results in the groups of menstrual-associated and non-menstrual migraine.

Materials and methods. This comparative study included 91 patients aged 18 to 48 years (mean age 33,82 ± 8.4) with migraine and menstrual cycle. Depending on the menstrual association of migraine attacks, the patients were divided into 2 groups: group 1 – 54 patients (mean age 36.07 ± 7.37 years) with menstrual-associated migraine (MAM); group 2 – 37 patients (mean age 30.46 ± 8.81 years) with non-menstrual migraine (NMM).

Results. Patients with MAM had more migraine days per month, more often received therapy associated with medication-overuse headache (MOH), more often had experience with triptans in comparison with NMM patients. After the treatment, the number of days with migraine per month in the MAM group remained more than in the NMM group: 8 or more days per month were noted in 36.4%, while among NMM patients – 10.8%. The transition to the new therapy with monoclonal antibodies to the CGRP receptor / ligand was positively assessed by 42.9% of MAM patients and 8.1% of NMM patients. Increased duration of hormonal therapy was characterized by a decrease in the number of days with migraines per month (cor = -0,28).

Conclusion. In the MAM group, more severe diseases and frequent formation of MOH are observed, as well as a higher resistance to therapy than in NMM. In general, the use of standard therapy regimens for MAM is less effective than for NMM.