Introduction. In the structure of the global burden of diseases, back pain ranks first in the world in the list of causes of disability. Neck pain is one of the most common diseases of the musculoskeletal system. An integral part of the strategy for the treatment of acute neck pain is the use of original nonsteroidal anti-inflammatory drugs (NSAIDs) with high proven effectiveness.

Objective. To conduct a comparative analysis of the therapeutic efficacy of the original drug meloxicam (Movalis) and its generic (Amelotex) in the treatment of patients with acute nonspecific musculoskeletal pain of cervical localization.

Materials and methods. The article provides an assessment of the therapeutic effectiveness of the original drug meloxicam (Movalis) and its generic (Amelotex) in the treatment of patients with acute neck pain. Comparative analysis of the results of treatment of 108 patients hospitalized in the Branch of the MC JSC “Admiralteyskie Verfi” aged 18 to 60 years (58 men and 50 women) with a diagnosis of acute dorsalgia of cervical localization (M54.2 according to ICD-10). The average age of patients is 42.5 ± 11.1 years.

Results. As a result of the clinical and neurological study and statistical processing of the data obtained, it was found that the use of Movalis in the treatment of patients with acute neck pain was more effective compared to the use of generic (Amelotex). In  the  Movalis group, the  level of  pain  intensity and the  index of  disability after treatment was significantly lower than in the Amelotex group at an equivalent dose of 15 mg per day (p < 0.01). The analgesic effect in the group of patients receiving Movalis was longer. There was a significant decrease in sleep disorders associated with pain syndrome in the group (Movalis) compared with patients of the second group (Amelotex). Conclusions. The absence of therapeutic bioequivalence between Movalis and Amelotex revealed in our study determines the relevance of the choice of drugs for the complex therapy of patients of this profile. A multimodal approach to the strategy of treating neck pain, individually patient-oriented, including the use of effective and safe medicines, physical exercises, manual therapy, is optimal.>< 0.01). The analgesic effect in the group of patients receiving Movalis was longer. There was a significant decrease in sleep disorders associated with pain syndrome in the group (Movalis) compared with patients of the second group (Amelotex).

Conclusions. The absence of therapeutic bioequivalence between Movalis and Amelotex revealed in our study determines the relevance of the choice of drugs for the complex therapy of patients of this profile. A multimodal approach to the strategy of treating neck pain, individually patient-oriented, including the use of effective and safe medicines, physical exercises, manual therapy, is optimal.

Vertigo is a fairly common complaint with which patients present to physicians of various profiles, and especially to general practitioners, neurologists, and otorhinolaryngologists. Vertigo is a condition where a person has the illusion of movement or of surrounding objects moving when they are not. Vertigo is a symptom of a wide range of diseases, both benign and life-threatening. Vertigo can have a variety of causes, and the suggested treatment should depend on the cause. Due to the multifactorial etiology of medical care, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, vestibular migraine, and cerebrovascular diseases. Patients with other disorders, such as depression and hyperventilation syndrome, may present with complaints of nonrotary vertigo. Differential diagnosis of vertigo can be made using easy-to-perform tests during physical examination, including assessment of nystagmus, Dix-Hallpike maneuver, and blood pressure measurements with head-up tilt table tests. Treatment of patients with complaints of vertigo includes drug and non-drug therapy, depending on the established nosological form. However, due to the multifactorial etiology, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The dimensionhydrinate/cinnarizine combination is one of the drugs for the symptomatic treatment of vertigo of various origins in adults.

Introduction. Modern studies indicate the therapeutic effect of vitamin D (VD) in chronic pain conditions, but there is no data on the use of VD in chronic tension type headache (CTTH) treatment.

Objective: comparative evaluation of the effectiveness of various options for preventive treatment of CTTH: the use of colecalciferol, standard therapy of the disease and a combination of these methods.

Materials and methods. 125 women with CTTH and hypovitaminosis D were treated in the study. The frequency, duration and intensity of headache (HF, HD and HI, respectively), HIT index, frequency of analgesics taking, pericranial muscle dysfunction were evaluated. The VD level was measured by the concentration of 25-hydroxyvitamin D [25(OH)D]. The patients received differentiated therapy for 16 weeks: group 1 – colecalciferol, group 2 – amitriptyline, group 3 – a combination of these medicines. Results. In group 1, HF, HD, HIT-index and the frequency of analgesics taking decreased, all p ≤ 0.001. In groups 2 and 3, the values of all CTTH-parameters decreased, all p < 0.05. HF, HIT-index and the frequency of analgesics taking in group 3 decreased more than in group 2, all p >< 0.017. In women who had VD deficiency before treatment, the decrease in HF from the initial one was 36% in group 1, 55% in group 2, and 74% in group 3. In patients who had VD deficiency before treatment, the effectiveness of therapy in group 3 was higher than in group 2: 74% vs. 55%, respectively, p >< 0.001.

Conclusions. Treatment of hypovitaminosis D in women with CTTH is accompanied by a decrease in HF, the effect of headache on the quality of life of patients and the frequency of taking analgesics. In CTTH and VD deficiency normalization of 25(OH)D level contributes to higher efficiency of standard therapy.

Neck pain is a fairly common complaint when visiting a doctor, its occurrence frequency is 10–21% per year, and neck pain takes the 4^th place among the causes of disability; almost 50% of patients continue to experience unpleasant sensations or repeated pain episodes. The elderly people are the most prone to the neck pain, this is associated with the progressive degenerative changes in the facet joints and intervertebral discs. However, reasons of this symptom can be of different kinds. Cervicalgia diagnosis is directed primarily to eliminate symptomatic pains associated with severe somatic pathology, immune diseases, infections and oncology. Comorbid diseases and risk factors can combine with each other causing the  polyetiologic pain  syndrome. Main steps of the cervicalgia diagnostic algorithm are the following: collection of complaints and anamnesis in detail, physical and neurological examination, and also use of visualization methods. Visualization and electrodiagnostic methods are not always informative for patients with chronic cervicalgia and in the degenerative etiology of the syndrome. MRI and the surgeon consultation must be recommended to patients with deteriorating neurological symptoms or with long-term constant pain. Conservative therapy of cervicalgia implies a combination of non-drug methods (compliance with regime, orthopedic treatment, leaf, physiotherapy, etc.) and pharmacotherapy. The last depends on the presence of a neuropathic component of pain and the duration of pain syndrome. The pain therapy with a nociceptive nature is usually implies a combination of non-steroidal anti-inflammatory remedies, non-opioid analgesics and muscle relaxants. Whereas neuropathic pains first-line preparations are tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, gabapentine. The therapy success depends on the proper individual estimation of the pain factors, pain chronization and possible treatment complications. The therapeutic forecast of the acute nonspecific cervicalgia is usually good, but it becomes less predictable if the pain acquires chronic character.

Introduction. Migraine is one of the most common disabling neurological disorders. Recently developed monoclonal antibodies to calcitonin gene-related peptide (CGRP) or its receptor are the first targeted medication for preventive therapy of both episodic and chronic migraine. They have been thoroughly investigated in clinical trials; however, there is little data from real-world clinical practice available to date. The aim of this study is to assess the efficacy and safety of 6 months of treatment with erenumab in real-world clinical practice and investigate the effect of the drug on the patients’ sensitivity to medicines for migraine headaches relief and patient satisfaction after treatment.

Materials and methods. Our observational cohort prospective study included patients in our Headache Clinic prescribed monoclonal antibodies blocking the  CGRP-receptor  – erenumab. During the  investigation, we evaluated the  previous preventive therapy and its efficacy, the number of days with migraine per month, adverse events occurring during the erenumab treatment, depression and anxiety (HADS), migraine disability (MIDAS), the presence of allodynia (ACS-12) and improved response to acute therapy after treatment. A total of 42 patients participated in the study: 6 men, 36 women, the average age was 43.9 ± 12.2. Of them, 38 patients (90%) had chronic migraine. Thirty-two patients (76%) had previously been prescribed preventive therapy, which proved ineffective, and 10 patients (24%) had not once received any type of migraine prevention.

Results. Among our patients, we identified 11 patients with resistant migraine and one patient with refractory migraine. During the study, two patients dropped out due to adverse events (constipation). Thirty patients continued the administration of erenumab 70 mg for at least six months. The average number of migraine days per month before treatment was 22.8, and after six months of treatment, it dropped to 7.3. Twenty-nine patients (72.5%) also noted that the response to acute headache treatment improved after the therapy.

Conclusion. The results of our study are consistent with the international experience of using erenumab and confirm its effectiveness for migraine preventive therapy, including difficult-to-treat migraine cases. However, further studies with more participants and evaluation of predictors of successful monoclonal antibody therapy are still needed.

A review of the literature selected from russian and foreign electronic medical libraries devoted to the use of a fixed combination of fluticasone furoate with vilanterol triphenatate (FF/VI) in the respiratory tract using a metered-dose powder inhaler in bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is presented. (DPI) Ellipt. The results of studies of each of  the  components devoted to their clinical efficacy and safety, and the  use of  FF / VI in  asthma  and COPD are presented. Comparative randomized clinical trials have shown the advantages of FF / VI over the individual components of this combination and over other drugs. This combination was especially effective in AD. The economic efficiency of the transition of BA patients from everyday therapy to FF/VI has been proved. The data on the ability of the Ellipt DPI to form a clinically significant portion of the respirable fraction of both drugs, as well as data on the intuitive use of the device and adherence to the prescribed therapy are presented. In terms of the development of adverse events, the use of this combination in AD did not differ from placebo. With the use of FF/VI in patients with COPD, an increased incidence of pneumonia was noted, which was also typical for the use of FF alone, but did not accompany treatment with vilanterol. The analysis of the literature data based on well-planned multicenter RCTs with a large number of patients showed that the expansion of the use of a fixed combination of FF/VI in AD and COPD can improve control over these diseases and reduce the costs of practical healthcare, as well as preserve the level of treatment safety in comparison with monotherapy.

Chronic obstructive pulmonary disease (COPD) is one of the most important problems of modern medicine associated with a high mortality rate, high costs of treatment and relief of exacerbations of COPD. The main objectives of COPD treatment are symptom control, reduce the frequency of exacerbations and hospitalizations, and reduced risk of exacerbation in the future. The recommendations of the GOLD initiative propose a treatment approach based on the assessment of exacerbation rates external respiratory function indicators (spirometric classification of GOLD), the severity of symptoms assessed on the CAT test and mMRC. When choosing therapy, the physician must first of all take into account the effectiveness, safety of the drug, adherence to treatment in order to achieve the therapeutic goals of treating patients with COPD. The change in therapeutic approaches in COPD treatment is associated with the accumulation of knowledge in physiology, clinical pharmacology, and the isolation of new clinical phenotypes of COPD. Currently, the main classes of drugs for the treatment of COPD are long-acting beta-agonists (LABA), longacting anticholinergics (LAMA), and inhaled glucocorticosteroids (ICS). The evolution of therapeutic approaches in COPD treatment has led to the creation of new fixed inhalation combinations of the main groups of drugs for COPD treatment. The therapeutic strategies recommended by GOLD and the Russian Federal Guidelines determine the long-term goals of COPD treatment – the impact on the risk of exacerbations in the future. The presented clinical observation of a patient with severe COPD demonstrates the effectiveness of a triple fixed combination vilanterol/umeclidinium/fluticasone furoate 55/22/92 μg as a basic therapy. The  chosen treatment strategy not only reduces the  severity of  the  symptoms of  the  disease, but also reduces the  risk of exacerbations in the future.

Тo date, the possible links of the pathogenesis of this disease have been well studied and described, which predetermine certain approaches to the treatment of various variants of gastroesophageal reflux disease (GERD). Effective drug therapy for GERD includes proton pump inhibitors (PPI). However, PPI monotherapy is not always effective. One approach is to increase the PPI dose. At the same time, combination therapy with the addition of drugs that affect the protective properties of the esophageal mucosa seems to be more rational. It is known that in the development of GERD, the violation of cytoprotection of the esophageal mucosa is one of the key links in pathogenesis. Consequently, the issue of combination therapy of PPIs with drugs that increase the protective properties of the mucous barrier along with acid suppression becomes relevant. An example of such an approach is the  appointment of  rebamipide, the  action of  which is to regulate the  synthesis of  prostaglandins through COX-2  mediated mechanisms, influence on endothelial growth factor, increase the expression of tight intercellular contact proteins in epithelial cells of the mucous membrane, reduce the level of interleukin-8 and free oxygen radicals, directed to protect the mucous membrane of  the  gastrointestinal tract and restore its natural barrier properties. The  effectiveness of  the  combination of  PPI and rebamipide contributes to a greater regression of complaints in patients with GERD and a lower frequency of disease relapses than with PPI monotherapy. This article provides a review of the literature on the features of GERD therapy, primarily with an emphasis on the correction of the cytoprotective properties of the esophageal mucosa, including against the background of the use of nonsteroidal anti-inflammatory drugs (NSAID), and a clinical case analysis with a discussion of rational pharmacological correction.

Asthenia and fatigue are the most common syndromes in patients with liver disease, which significantly affects their quality of life. The prevalence of fatigue in chronic liver diseases is from 50% to 85%. While some progress has been made in understanding the processes that can cause fatigue in general, the underlying causes of fatigue associated with liver disease remain not well understood. In particular, many data suggest that fatigue associated with liver disease likely results from changes in neurotransmission in the brain against the background of hyperammonemia. Hyperammonemia is a metabolic state characterized by an increased level of  ammonia, a  nitrogen-containing compound. The  present review describes hyperammonemia, which is likely important in the pathogenesis of fatigue associated with liver disease. Ammonia is a potent neurotoxin, its elevated blood levels can cause neurological signs and symptoms that can be acute or chronic, depending on the  underlying pathology. Hyperammonemia should be recognized early, and immediately treated to prevent the development of life-threatening complications, such as, swelling of the brain and coma. The article gives pathophysiological mechanisms of influence of hyperammonemia on state of psychovegetative status of patients with liver diseases, also lists basic principles of treatment. A significant part of the article is devoted to L-ornithine-L-aspartate, which is effective in asthenia and fatigue to reduce the level of hyperammonemia through a variety of well-studied mechanisms in chronic liver diseases.

Intriduction. The course and outcome of COVID-19 infection in patients with liver and gastrointestinal tract diseases remain poorly understood. The article presents a multicenter non-interventional observational program conducted by the Russian Society for the Study of the Liver.

Aim. To study the relationship between COVID-19 and injuries of gastrointestinal tract and liver, to assess the effect of therapy with UDCA and Rebamipide on the course and outcome of COVID-19 infection. Materials and methods. 460 patients were enrolled in the study, of which 46% were patients with gastrointestinal and liver diseases. Some patients received Rebamipide and UDCA at a dose of 15 mg/kg body weight, followed by assessment of the clinical and laboratory parameters.

Results. In the study group, more severe lung injury and the course of infection were observed. The investigators detected three phenotypes of gastrointestinal tract injury: dyspeptic, diarrheal and painful. The latter was more common in patients with gastrointestinal diseases. Liver injury occurred in 87% of patients with COVID-19 (of which 44% had a history of liver disease). Increased ALT and AST were more often recorded in patients with obesity and diabetes mellitus and correlated with the severity of the infection. An inverse relationship was found between the albumin level and death and transfer to mechanical ventilation. At least 5-day Rebamipide therapy leads to reduction of diarrhea and abdominal pain (p < 0.00001 and p = 0.002), decrease in the levels of systemic inflammatory markers (CRP and ferritin, p<0.00001). The use of UDCA leads to a decrease of the systemic inflammation markers: ferritin and is associated with a significant decrease/normalization of ALT levels (p < 0.00001).

Conclusions. In patients with diseases of the gastrointestinal tract and liver, COVID-19 develops in a more severe form and symptoms of gastrointestinal tract injury may prevail in the clinical picture. The severity of liver injury correlates with the severity of COVID-19 and a poor prognosis. Rebamipide reduces diarrhea and abdominal pain. UDCA prevents or reduces liver injury in COVID-19 infection. Both drugs reduce the level of systemic inflammation markers.

Osteoporosis (OP) has traditionally been seen as a pathology that mainly occurs in postmenopausal women and elderly men, and until recently, the problem of this disease among males has not been given sufficient priority. At the moment, however, OP in men is widely acknowledged to be an important issue of modern health care. Given the etiological and pathogenetic characteristics, two categories of OP have been identified: primary and secondary. In the structure of male OP, the secondary category of OP accounts for up to 40-60 % of all cases. Hypogonadism is one of the common causes of bone loss in men. Initially, males develop a larger bone mass compared to women and, accordingly, greater bone strength. Men over the age of 50 do not undergo rapid bone mass loss, as women do after menopause, and the bone mass decreases more gradually, in a linear manner. With ageing, the trabecular number (Tb.N) in men are relatively maintained with underlying more pronounced thinning of Tb. N associated with decreased osteoblast-forming activity. Although the prevalence of OP among men is significantly lower than among women, the clinical consequences of OP in men are of a great importance. The primary strategy of the anti-osteoporotic therapy is to prevent OP and low-traumatic fractures. According to the current guidelines for the treatment of OP in men, bisphosphonates (BP) are the drugs of choice. Zoledronic acid is a highly effective nitrogen-containing BP, the first drug to be injected once a year. Intravenous injection of zoledronic acid is as effective in reducing the risk of fractures in men as in women.

Diabetes mellitus (DM) is an important medical and social problem throughout the world due to its high prevalence. At the same time, the majority of patients have type 2 diabetes. The onset of the disease is gradual, with a prolonged asymptomatic preclinical stage. Therefore, it is necessary to conduct screening among patients at risk. Therapy for type 2 diabetes is carried out with oral hypoglycemic drugs. If it is impossible with their help to achieve adequate glycemic control, it is possible to add basal insulin to therapy, and if the own insulin secretion is depleted, an intensive insulin therapy regimen must be prescribed. Insulin preparations differ in the source of receipt, as well as in the duration of action: background, or basal (insulin of medium duration, long-term or ultra-long-acting) and prandial, or food (ultrashort and short insulin). Currently, along with original insulin preparations, their analogues, or biosimilars (biosimilars), appear on the pharmaceutical market. Biosimilar (biosimilar) is a biological product similar in quality, efficacy and safety parameters to a reference biological medicinal product in the same dosage form and having an identical route of administration. Biosimilars are used all over the world, and this applies not only to insulin preparations, but also to other biological preparations. Proof of bioequivalence is a long-term process that ensures comparability and the absence of clinically significant differences between the study and the reference drug, and includes preclinical and clinical studies. The task of studies of biosimilars of insulin is to confirm the comparability with a reference, previously well-studied biological product. The efficacy and safety of domestically produced biosimilars has been studied in a number of clinical studies, during which the bioequivalence of the drugs was shown. These drugs are of high quality and safe, and their pharmacological characteristics, immunogenicity and effectiveness do not differ from the original drugs.

Glycemic self-monitoring is essential in  the  treatment of  diabetes mellitus. Compliance with the  recommendations for  selfmonitoring of glycemia is an important condition for the prevention of diabetes complications. The article provides a review of the problems associated with blood glucose self-monitoring faced by diabetic patients and doctors. These include low frequency of blood glucose self-monitoring, technical errors in glucose measurements, errors in keeping a diary and errors in using measurement data to diabetes control. The blood glucose monitoring system, which includes the glucometer, test strips, application, сloud for data storage can be used for blood glucose self-monitoring in patients with diabetes mellitus. The article discusses the features and advantages of the blood glucose monitoring system. The advantages of the glucometer are the no сoding technology and the following options: аpplication of additional amount of blood to the test strip; adding meal marks, testing as the measurement results compare with targets and informing about it; storage a large number of measurement results. In addition to the standard blood glucose measurement, the glucose meter and the application offer many features to improve blood glucose self-monitoring that can help to improve diabetes management: automatic transferring measurement results to smartphone or tablet; saving notes in logbook; display of glucose trends and testing as they compare with targets; offering quick and valuable tips for critical high/low glucose values.

In the clinical practice of an endocrinologist, verification of the type of diabetes mellitus (DM) in young people is of high clinical significance, since the prescription of treatment depends on this: from the correction of carbohydrate metabolism by a balanced diet to the prescription of oral hypoglycemic drugs and insulin therapy. In rare forms of diabetes mellitus, which include «latent autoimmune diabetes in adults» (LADA), it is not always possible to make a correct diagnosis. This form of diabetes mellitus occupies an intermediate position between type 1 diabetes mellitus and type 2 diabetes mellitus (DM 1 and DM 2) and is often not detected. In this regard, the study of the LADA flow is of great practical importance. Verification of the LADA diagnosis is based on three clinical criteria: adult onset of diabetes; the presence of circulating islet autoantibodies, which distinguishes LADA from T2DM; the absence of an absolute need for insulin when making a diagnosis, which distinguishes LADA from the classic type 1 diabetes mellitus. The main treatment tactics for patients with LADA should be aimed at preserving their own insulin secretion. This requires the timely appointment of insulin therapy. The question of the possibility of using drugs of peripheral action – biguanides and glitazones, which do not cause depletion of β-cells, is discussed, but their effectiveness has not yet been established. The appointment of any secretogens, including sulfonylurea preparations, is contraindicated Quite often, LADA is difficult to diagnose, and the wrong treatment tactics are prescribed. At the moment, there is little data on the effectiveness of different classes of drugs, which leads to further detailed study of this type of diabetes. Currently, there are no special algorithms for LADA treatment

Introduction. The article is devoted to the study of the mechanism of occurrence of postcovid syndrome, a new laboratory method for its diagnosis and issues of drug and non-drug rehabilitation of patients who have suffered COVID-19.

The purpose of this work was to study the possibilities of using the method of monochrome analysis of nanoparticles for instrumental and laboratory diagnostics of postcovid syndrome and to substantiate the use of complex therapeutic approaches to the treatment of patients.

Materials and methods. The biomaterial (saliva) of 250 patients who underwent COVID-19 in mild, moderate and severe forms, with a slight predominance of males, in the age range from 18 to 75 years, who were in the Center of Eastern and European Medicine (Moscow) on rehabilitation treatment in the period from June 2020 to September 2021, was studied by the method of monochrome analysis of nanoparticles. According to the results of the work carried out, it was found that the most typical saliva spectrum of patients diagnosed with “postcovid syndrome” was multimodal (three or more peaks) with the greatest contribution (45%) to light scattering on agglomerates of  nanoparticles with a  diameter of  more than 1000  nm, with detectable nanoparticles of the middle sub-range of the spectrum from 119 to 122 nm with a 15% contribution to light scattering and an increased contribution to light scattering up to 41% on small nanoparticles with a diameter of 22 nm.

Results. Analysis of the results of the study showed a statistically significant (p < 0.01) appearance of a peak of 119 nm on the histogram of patients, which was not observed either in the group of practically healthy individuals (control group) or in the group of patients with general somatic pathology (comparison group). Conclusions. An algorithm for non-invasive diagnosis of postcovid syndrome by saliva was developed. Also, special attention was paid during the study to the development of an integrated approach to the rehabilitation of patients who have undergone a new coronavirus infection, including medicinal and non-medicinal methods of treatment. >< 0.01) appearance of a peak of 119 nm on the histogram of patients, which was not observed either in the group of practically healthy individuals (control group) or in the group of patients with general somatic pathology (comparison group).

Conclusions. An algorithm for non-invasive diagnosis of postcovid syndrome by saliva was developed. Also, special attention was paid during the study to the development of an integrated approach to the rehabilitation of patients who have undergone a new coronavirus infection, including medicinal and non-medicinal methods of treatment.

The review presents modern views on the role of probiotics in the treatment and prevention of complications of the novel coronavirus COVID-19 infection. This infection can be complicated, for example, by the development of diarrhea after the use of antibacterial drugs in case of secondary bacterial infection, extrapulmonary viral infections, viremia, and the so-called «cytokine storm». The emphasis has been placed on such potentially beneficial effects of probiotics as а prevention of antibioticassociated diarrhea, prevention of intestinal damage induced directly by viral replication, prevention of leaky gut syndrome and immunomodulation in case of coronavirus COVID-19 infection. It has been shown that the use of probiotics alongside antibiotic therapy significantly reduces the risk of developing antibiotic-associated diarrhea, including such a severe variant as pseudomembranous colitis. The use of a probiotic during a viral respiratory disease reduces the risk of a severe disease course due to the positive modulation of inflammation and direct antiviral effects. Selected data showed the positive effect of probiotics on the tight junction stability of the intestine, which potentially protects against viremia and the penetration of immunogenic molecules into the internal environment of the body. In order to address the challenges adequately, a probiotic should meet certain requirements in terms of product quality, safety, evidence of efficacy, composition and understanding of the strains. The article presents data on the successful use of a multi-strain immuno-probiotic as an example demonstrating the therapeutic potential of modern multi-strain probiotics as a nonspecific immunomodulatory agent for the prevention of acute respiratory diseases.

Over the past several decades, there has been a global aging of the population around the world. The demographic situation in the Russian Federation is no exception, being a natural result of an increase in the life expectancy of the population. In clinical practice, geriatric diseases have been identified and are widely studied, which deserve priority attention due to a sharp decline in the quality of life of elderly patients. Osteoporosis is called a “silent epidemic” among elderly and senile patients. This disease is associated with a high risk of low-traumatic fractures of various localization. The imperfect rehabilitation program after complex fractures and its insufficient funding are forcing clinicians to focus on more cost-effective solutions to this problem  – the  prevention and treatment of  osteoporosis. Osteomodifying agents are widely used by physicians of  various specialties. Bisphosphonates effectively reduce the risk of low-traumatic fractures against the background of an increase in bone mineral density. The  level of  effectiveness of  bisphosphonates depends on the  patient’s adherence to antiresorptive therapy and the degree of compensation for vitamin D and serum calcium. Low adherence to osteoporosis therapy is based on the need for long-term use of bisphosphonates and a different spectrum of adverse events. In the article, using alendronate as an example, the problem of low adherence to antiresorptive therapy will be considered and ways to solve it are presented.

Introduction. The article presents a comparative analysis of the treatment of patients with combined estrogen-dependent pathology of female reproductive system: fibrocystic mastopathy and endometrial hyperplasia without atypia. The experience of treatment with an indole-carbinol-containing drug as monotherapy while using a levonorgestrel-releasing intrauterine system is presented.

Aim. To evaluate the clinical efficacy of indolecarbinol in the treatment of patients with combined estrogen-dependent pathology of the female reproductive system.

Materials and methods. The authors studied the responses to the treatment of patients with fibrocystic mastopathy and simple endometrial hyperplasia (n = 65) with the indole-carbinol-containing drug at a dose of 400 mg once daily for 12 months. All patients were divided into two groups: Group I (n = 32) – women who refused hormone therapy (indole-carbinol monotherapy); Group II (n = 33) – the use of indole-carbinol while using the levonorgestrel-releasing intrauterine system. Diagnostic methods: clinical and laboratory examination, ultrasound examination of mammary glands and pelvic organs, mammography, nipple discharge cytology at baseline and 6 and 12 months after the start of therapy. Before study group assignment to treatment, all patients underwent hysteroscopy with endometrial biopsy and histological examination. Descriptive statistics were used to evaluate the data: p-values below 0.05 were considered statistically significant.

Results and discussion. The presented experience in treating women with combined pathology of the female reproductive system (fibrocystic mastopathy and endometrial hyperplasia without atypia) with the indole-carbinol-containing drug showed high clinical efficacy in mastopathy (relief of mastodynia (83.0 ± 1.6%), improvement of the ultrasound view of BI-RADS (66.1 ± 1.4%), reductions in mammographic density (66.1 ± 2.1%, p < 0.05)), high tolerability and satisfactory compliance. This drug combined with hormone therapy is recommended for the treatment of endometrial hyperplasia.

Сonclusion. The use of indole-carbinol in the treatment of benign hyperplastic processes in mammary glands and endometrial hyperplasia is pathogenetically substantiated and shows high clinical efficacy

Woman’s nature is unique. Taking into account some historical milestones, it can be noted that the role of women in society has undergone large-scale changes. The woman took a confident position in society. Its main function remains unchanged and it consists in procreation and procreation. A woman’s activity is consistent with the work of her reproductive system (RS). The gradual decrease, and then the cessation of the work of the ovaries, contributes to the life order and health of the fair sex. Menopause is a natural stage in a woman’s life, which corresponds to the peak of social self-realization. However, in some cases, hormonal changes characteristic of this period can serve as a favorable background for the formation of a number of pathological changes. The growing estrogen deficiency is becoming a pathogenetic impetus for the development of a wide range of climacteric disorders. Vasomotor symptoms and hyperhidrosis are the most frequent companions of women during the perimenopausal transition and early postmenopause. Maintaining optimal activity and the full quality of life of patients should be the goal of correcting the negative manifestations of estrogen deficiency and the complications associated with it. Compensating for estrogen deficiency with menopausal hormone therapy (HRT) is the benchmark for menopausal problems. However, there are a number of patients who have contraindications to prescribing HRT or who refuse to receive it for some reason. For this category of patients, alternative methods of diet correction. Combinations of plant extracts with vitamins and minerals have been successfully used in clinical practice for a long time. The article will provide information on the most studied phytoestrogens contained in soy.

Introduction. Loss of pregnancy remains an extremely acute public health problem today. Live birth accounts for only 30% of gestational outcomes, all other pregnancies that occur end in reproductive losses: 30% – implantation, 30% – postimplantation, 10% – spontaneous miscarriages. In conditions of declining birth rates, reducing reproductive losses is the most important element of the state’s demographic policy.

Аim. Тo assess the reproductive health of women of fertile age in the Tyumen region, registered in antenatal clinics and other medical institutions in connection with pregnancy, as well as the risks associated with an increase in the frequency of diseases endemic for the West Siberian region.

Materials and methods. The study used data from federal statistical observation. Statistical analysis of the data was carried out using the statistical program Statistica (version 13.0). Quantitative features are described by absolute and relative (percent) indicators. The difference is considered significant at p < 0.05. Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. ><  0.05.

Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p < 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. ><  000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p < 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control.

Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate.

The article provides information about the features of the structure, development and differentiated approach to the appointment of dexapanthenol preparations used for the prevention and complex treatment of skin diseases in children of wounded age. Regular use of leave-on cosmetic products including body creams and lotions is very high among children aged 0–4 years. However, in most cases, recommendations for the use of topical baby skin care medicinal products and/or cosmetic products are based not on scientific evidence, but on common sense, expert opinions, advertising, personal preferences of parents, pharmacists, dermatologists and/or pediatricians. For example, adsorbing properties of baby powders are insufficient, and after absorbing moisture, they actually turn to “urine compresses” that aggravate the epidermis injury. After swelling, the starch-containing powders represent an excellent growth media for pathogenic and opportunistic microflora. It is noted that only proper skin care for young children allows you to preserve its integrity and functional state. Special attention is paid to the preparations of the Bepanten® series in the form of cream and ointment, which meet all the criteria for topical products, and can be used for the prevention and treatment of skin diseases in young children, effectively protecting the skin from irritants, promoting its healing and recovery, having an anti-inflammatory effect, increasing its elasticity, elasticity and are recommended for use as a means of basic care. Their effectiveness has been repeatedly confirmed in the numerous domestic and foreign randomized controlled studies in new-born populations at different gestational ages, which provided the scientific justification for their common use in the ‘real-life’ practice of pediatricians, dermatologists and allergists.

The problem of respiratory diseases and their therapy options still retains much of its urgency. Respiratory diseases in children are still super common. According to the data on infectious morbidity among children in the Russian Federation for the period 2018–2020, current trends have not changed, and the acute respiratory infections (ARI) are still ranked number one in terms of the frequency of registered diseases. According to the official records, the frequency of ARI in children among infectious diseases is 71,850.02 per 100,000 population, or 71%. Such well-known symptom as cough is one of the most frequent manifestations of respiratory diseases. It causes the greatest discomfort for both the little patients and their parents, the quality of life of the children and those around them worsens, many domestic and foreign authors mention this symptom in their works. And it is this problem that doctors of various specialties most often face. The cough is currently treated with drugs with different effects depending on the characteristics and manifestations of the disease. Systematic reviews and multicenter studies show that prescription of mucoactive drugs to treat cough in children with underlying ARI is substantiated and feasible. The authors substantiated the necessity of using combinations of various drugs aimed to reduce inflammation of the airways, improve mucociliary clearance, thin out and promote sputum discharge and, accordingly, reduce cough. The article briefly discusses the mechanisms of the development of cough in ARI, the action of drug substances included in the combination drugs used to treat cough in children, the possibility of using the combination of muco- and bronchoactive drugs of synthetic and plant origin.

The article considers a clinical case of treatment of one of the variants of myofascial pain syndrome – piriformis syndrome without signs of sciatic nerve neuropathy. The peculiarity of the case is the comorbidity of the opioid syndrome with diabetic sensorimotor polyneuropathy and osteoporosis, which required the appointment of complex therapy. The diagnosis was confirmed by additional research methods: spondylography, MRI of the lumbosacral spine, ultrasound of the piriformis muscle, electroneuromyography. A patient management tactic was chosen based on federal clinical guidelines for the treatment of patients with nonspecific back pain. Treatment included non-medicinal and medicinal methods. In order to relieve pain, dexketoprofen was prescribed 2 ml intramuscularly per 2 ml of 0.5% lidocaine solution – 1 time а day No. 2 – under navigation by ultrasound. Subsequently, the transfer was made to oral administration of 25 mg 3 times а day for 3 days. A step-by-step scheme of prescribing dexketoprofen: its introduction into the piriformis muscle with subsequent transfer to oral administration allowed to significantly reduce the severity of pain after 5 days of treatment. The complex effect on the spasmodic piriformis muscle with the help of a tableted muscle relaxant in combination with postisometric relaxation made it possible to quickly stop the pain syndrome and prevent its chronization. The administration of the preparation of thioctic acid pursued two goals: to improve the metabolism of the spasmodic muscle and restore the energy metabolism of peripheral nerves. As a result of the use of complex, pathogenetically based therapy, a positive effect was achieved.

Cervical intraepithelial neoplasia is widespread among patients of the reproductive period, the peak of the incidence occurs at a young age, often when the reproductive function has not yet been performed. The oncological alertness of the medical community is justified: the incidence of cervical cancer has increased by 24.6% over the past ten years, and in the structure of cancer mortality in the age group of 30–39 years cervical cancer occupies the 1st place accounting for 23%. Тhe same time aggressive management of the disease in patients who have not yet performed their reproductive function is associated with the loss of significant volume of cervical tissues and an increase in the frequency of premature birth. The most acute issue is the tactics of managing cervical neoplasia of the second degree of severity, when there is still hope for the regression of the disease, but at the same time there is a high risk of transition to dysplasia of the third degree of severity and subsequently to invasive cancer. The search for diagnostic markers that allow predicting the probability of regression and, conversely, the unfavorable course of the disease is the most important task solution of which will allow optimizing tactics in controversial clinical cases and avoiding unnecessary surgical aggression, improving the perinatal outcomes of patients undergoing surgical treatment. The search for new economically feasible and diagnostically valuable markers allowing us to predict the course of the disease and determine the amount of necessary surgical treatment continues, but the most significant at this moment is still the determination of the coexpression of p16 and Ki-67 in immunocytochemical studies and p16INK4a in immunohistochemical studies. The diagnostic sensitivity of determining the co-expression of p16INK4a/Ki67 is 98.5%, and the expression of p16INK4a in CIN II indicates that in 81% of cases there is a tendency to a progressive course of the disease.