Introduction. The number of  patients with chronic heart failure  (CHF) and chronic obstructive pulmonary disease  (COPD) is increasing every year. In both CHF and COPD, secondary mitochondrial dysfunction is observed. In this regard, the attention of researchers is attracted by drugs that have their therapeutic effects at the level of mitochondria, one of which is meldonium. Meldonium has proven itself in the treatment of various diseases, however, the evaluation of the clinical efficacy of meldonium has not yet been carried out in comorbid patients with CHF and COPD.

Aim. To study the  effects of  meldonium as part of  basic therapy on the  clinical condition, the  main functional parameters of the heart and lungs, and the quality of life in patients with CHF and COPD.

Materials and methods. The randomized open study included 60 patients with CHF II A stage, II–III FC (clinical recommendations of the RSC, OSSN 2020) and COPD I–III degree of airflow limitation (GOLD 2021 classification) in remission (age 45–70 years). The patients were divided into 2 groups: the 1st group – the main group (n = 30) with CHF and COPD took meldonium at a dosage of 1000 mg/day in addition to the basic therapy, the 2nd group – the control group (n = 30) was only on basic therapy for CHF and COPD. The observation period is 12 weeks.

Results. In patients with CHF and COPD, in the dynamics of therapy with the inclusion of meldonium, as a result, the severity of clinical symptoms decreased, improvement was revealed in the main structural and functional parameters of the heart, external respiration function, and quality of life.

Conclusions: a significant beneficial effect of combination therapy with the inclusion of meldonium on the clinical and functional parameters of the heart and lungs, indicators of quality of life in patients with CHF and COPD has been established, which makes it possible to recommend the use of meldonium as part of combination therapy in comorbid patients. 

Introduction. Asthenia is an urgent problem during the pandemic of new coronavirus infection (COVID-19) because of its high frequency regardless of the severity of the disease.

The purpose of this subanalysis of data from the multicenter controlled randomized clinical trial TONUS was to evaluate the efficacy and safety of meldonium therapy for аsthenia in COVID-19 survivors.

Materials and methods. A total of 880 patients with asthenia who underwent COVID-19 within the last 6 months were included in the analysis. The efficacy of asthenia therapy was assessed by the MFI-20 scale, Schulte tables, and the General Clinical Impression (CGI) scale. All patients were previously randomized in two parallel branches of the TONUS study, including patients without concomitant disease in TONUS-1 (who received meldonium 500 mg/day for 14 days in the main group) and patients with cardiovascular or cerebrovascular disease in TONUS-2, who received meldonium at a dose of 1000 mg/day for 42 days in the main group. In both arms of the study, the drugs in the comparison groups were multivitamin complexes.

Results. For the TONUS-1 groups.In the group of patients receiving meldonium compared with the control group (p < 0.001): total MFI-20 score decreased and was 31 (25; 40); MFI-20 –35 (–46; 23); performance value –5 (–11; –2) seconds; proportion of patients with significant improvement (by CGI-I) by the end of follow-up was 92.8%. For TONUS-2 groups.In the group of patients receiving meldonium compared with the control group (p < 0.001): total MFI-20 score decreased to 35 (27; 44); MFI-20 –34 (–46; –21), performance value –5 (–11; –2), proportion of patients with significant improvement (by CGI-I) by end of follow-up – 90.8%.

Conclusion. Significant positive dynamics and regression of asthenia were noted in the groups of patients receiving meldonium in comparison with the control groups. 

With the ongoing pandemic of the SARS-CoV-2 virus and the emergence of its new genovariants, along with the relevance of  addressing the issue of vaccination of the population, the importance of non-specific prophylaxis, which is designed to reduce the viral load on the body and slow down the rate of virus spread, is increasing. The currently available research and experience in the use of antiseptic drugs or their combinations with the antimicrobial peptide lysozyme can be used for this purpose.Currently available research and experience in the use of antiseptic drugs or their combinations with the antimicrobial peptide lysozyme can be used for this purpose. Under conditions of lysozyme deficiency unhindered accumulation of non-hydrolyzed substrate, which is a constant source of autoantigens, is accompanied by immunity, metabolic and tissue homeostasis disorders. Analysis of a comparative study of different groups of antiseptics showed high virulicidal efficacy of cetylpyridinium chlorideCetylpyridinium chloride has an electrostatic effect on viral membrane lipids, causing their aggregation and dissolution, which leads to disruption of the integrity of the virus membrane, its interaction with mucosal epithelial cells and penetration into target cells, having a direct virulicide effect on SARS-CoV-2. An important factor of innate mucosal immunity is lysozyme, it has antiviral, antibacterial, antifungal and anti-inflammatory effects, normalizes microbiocenosis, restores immune system activity, increases mucosal barrier function. The combination of cetylpyridinium chloride and lysozyme hydrochloride has a dual antiviral effect, reducing the viral load on the body and enhancing the ability to control the spread of SARS-CoV-2 both from patients in the prodromal period of the disease or with its clinical manifestations, and from asymptomatic carriers with confirmed COVID-19 infection status. 

Comorbidity is an important problem of modern medicine, the study of which is a priority for public health. According to  the literature, the prevalence of comorbidity reaches a third of the population in some countries, while there is a tendency for an increase in the number of such patients in all age groups. In the context of the COVID-19 pandemic, the presence of   comorbidity in patients is a significant risk factor affecting the course and prognosis of a new coronavirus infection; at the same time, it is comorbid patients who belong to the most vulnerable group. The review presents data indicating a significant impact of comorbid pathologies on an increase in the number of complications and mortality; the most common combinations of diseases in patients with a new coronavirus infection were analyzed. There is an increase in the prevalence of comorbidity in all age groups, which dictates the need to develop an integrated interdisciplinary approach for such patients. The vast majority of clinical guidelines for the  treatment of comorbidities in COVID-19 are mainly focused on individual diseases, which limits the use of these algorithms in comorbid patients. Due to the high risk of contracting a viral infection, as  well as the frequent development of   complications and mortality in comorbid patients, preventive measures should be  focused simultaneously on two tasks: measures aimed at preventing infection with COVID-19 and compensating for  comorbid pathology. In the case of SARS-CoV-2 infection, careful monitoring of such patients, most often in a hospital setting, is necessary in order to prevent complications and adverse outcomes. 

Introduction. Neurological pathologies are typical not only for adults, but are also widespread in childhood. These are disorders of speech and language functions, autism spectrum disorders, attention deficit hyperactivity disorder, emotional disorders. Also, many cognitive impairments affect patients who have had acute viral diseases, especially the coronavirus infection.

Purpose – to evaluate the effectiveness and safety of a specialized dietary therapeutic food product and dietary preventive nutrition – jelly "Good Memory" and the phytocomplex included in it at various neurological symptoms.

Materials and methods. In a 30-day study with 68 individuals (34 adults and 34 children, ages 1 to 21), the effect of a monthly intake of a phytotherapeutic complex on memory parameters was tudied,attention, intellectual performance of volunteers included in  the study according to Bourbon tests, methodology «Kraepelin score», Eysenck subtests, graphical test and IQ indicators according to the Denver test.

Results. A 30-day intake of a specialized food product jelly «Good memory» contributed to improving the performance of  various types of memory and attention, reducing fatigue, increasing efficiency. The survey showed that the intellectual performance of the comparison group decreased by 59% for all three indicators of mental activity. So, in terms of mathematical abilities, the improvement was 47.1%, for linguistic – 34.7% and for the total indicator – 52.2%. At the same time, the main indicators stabilized intellectual performance.

Conclusion. The results of the study allow us to recommend a specialized nutrition jelly «Good Memory» children over 1 year old  and adults to maintain the integrative functions of the brain and other parts of the mental process, as well as for the prevention and rehabilitation of post-covid cognitive impairment, recovery of mental, intellectual performance. 

Introduction. Biopsy of prostate is a routine urologic procedure. More than 1 million biopsies are performed worldwide annually. The frequency of infectious-inflammatory complications remain high, despite the recommended antibiotic prophylaxis schemes.

Aim. The evaluation of  effectiveness and safety of  combined antimicrobial prophylaxis: Fosfomycin and Fluoroquinolones of 3rd generation.

Materials and methods. 80 patients underwent prostate biopsy in our study and were divided into 2 groups: the first group of 40 patients received routine prophylaxis: Levofloxacin 500 mg 6 hours before the biopsy and 500 mg per day during 4 days after biopsy. The second group of 40 patients, along with standard prophylaxis as in the first group, additionally after biopsy received Fosfomycin 3 gr single-shot.

Results and discussion. In the first group, infectious and inflammatory complications occurred in 8 patients (20%). 12.5% of patients from the first group were hospitalized for paranteral antibiotic therapy. The average length of stay in hospital was 3.4 ± 1.45 days. In all cases, in the first group of patients, E. coli was detected, in 70% of cases fluoroquinolone-resistant strain of the bacterium was received. In the second group of patients now hospitalization was required. One patient out of forty (2.5%) from this group showed signs of urinary tract infection, which was not accompanied by an increase of body temperature, as well as changes in blood and urine tests.

Conclusion. Our results show good effectiveness and safety of fosfomicin for antibiotic prophylaxis for transrectal prostate biopsy. 

Steatohepatitises is an etiologically heterogeneous group of pathological changes in the liver, which are characterized by the inflammatory infiltration of the hepatic parenchyma with underlying fatty degeneration of hepatocytes. Whatever is the etiological cause, the clinical significance of steatohepatitis involves the formation of liver fibrosis and, as a result, an increased risk of developing liver cirrhosis and hepatocellular carcinoma, which are life-threatening conditions. It is common practice to identify the following etiological variants of steatohepatitis: metabolic (55–65% of cases), alcoholic (45–55% of cases) and drug-induced (approximately 5% of cases). The pathogenetic basis of metabolic steatohepatitis lies in the mechanisms of increased lipolysis, excess free fatty acid pool and reduced β-oxidation stemming from obesity and insulin resistance. Pathogenetic factors mediating the development of alcoholic steatohepatitis are the toxic activity of acetaldehyde and increased CYP2E1 activity. Intake of some hepatotoxic drugs increases lipogenesis in  hepatocytes and disrupts the electron transport chain, which leads to the formation of liver steatosis followed by transformation into steatohepatitis. Whatever is the etiological varient, steatohepatitis is asymptomatic in the prevailing majority of cases. However, some patients may present complaints of weakness, discomfort, or indolent pain in the right hypochondrium. A detailed history taking is essential for the establishment of the etiological cause of liver damage. Laboratory tests allow to diagnose steatohepatitis in increased levels of hepatic transaminases, usually not exceeding 2–3 times the normal values. In addition to liver enzymes, increased levels of alkaline phosphatase and GGTP can also be observed in steatohepatitis. Ultrasound imaging is the most accessible instrumental tool in clinical practice to establish the primary diagnosis of hepatic steatosis. Indirect elastometry is an equally informative non-invasive method for diagnosing steatohepatitis, which allows to measure both the degree of steatosis (the function of determining the ultrasonic controlled attenuation parameter (CAP) and liver fibrosis. 

Introduction. Despite the huge number of modern recommendations for the treatment of patients with liver cirrhosis, there is still no clear scheme for prescribing non-selective beta-blockers.

Aim. To evaluate effect of polymorphic markers CYP2D6*3, CYP2D6*4, CYP2D6*10 and CYP2D6*41 carriage on central hemodynamics in patients with liver cirrhosis during propranolol therapy.

Materials and methods. The study included 60 patients with liver cirrhosis who received propranolol therapy at a daily dose of 30 mg for 14 days. The efficacy of treatment was assessed by dynamic measurement of heart rate, systolic and diastolic blood pressure, ultrasonography measuring the  linear blood flow velocity of  portal vein. Genotyping of  CYP2D6*3, CYP2D6*4, CYP2D6*10 and CYP2D6*41 was carried out by real-time polymerase chain reaction.

Results and discussion. Positive hemodynamics in the form of a decrease in systolic and diastolic blood pressure, an increase in the average linear blood flow velocity of the portal vein compared with the baseline was observed in 41 patients. SBP and DBP decreased by 8.05 mm Hg (p = 0.006) and 4.51 mm Hg (p = 0.037), respectively. Our regression analysis revealed the presence of  a statistically significant effect of  carriage of  the CYP2D6*4  polymorphic marker on the  therapeutic effect of  propranolol (p < 0.05). No statistically significant effect of polymorphic markers CYP2D6*3, CYP2D6*10 and CYP2D6*41 was found (p > 0.05).

Conclusion. The influence of carriage of the polymorphic marker CYP2D6*4 on the hemodynamic effect of propranolol in patients with liver cirrhosis of the Russian population was determined. In carriers of the homozygous GG genotype for CYP2D6*4, there is a more pronounced positive trend in lowering blood pressure during propranolol therapy, in contrast to patients with a heterozygous GA genotype. Based on the results of the study, the existing algorithm for personalizing the treatment of patients with liver cirrhosis with non-selective β-blockers using CYP2D6 genotyping was modernized. 

Non-alcoholic fatty liver disease, or NAFLD – is a pathology that usually has a metabolic cause and is not caused by excessive alcohol consumption. NAFLD is the most frequent chronic liver disease worldwide and is accompanied by a high financial burden for the patient and the healthcare system. NAFLD is generally considered a “benign disease” with low progression to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Nevertheless, due to the large number of affected patients, the prevalence of cirrhosis of the liver has gradually increased, and in fact it represents the third cause of liver transplantation in the world. Moreover, even if the frequency of HCC in patients with NAFLD is lower than in patients with HCV/HBV cirrhosis, the absolute number of HCC associated with NASH is higher due to the higher number of patients with NAFLD. It is likely that the importance of this disease will continue to grow in the future, when new treatments and prevention programs for hepatitis C and B reduce the size of viral liver infections. Many aspects of the disease have yet to be solved. It is very important to understand the mechanisms underlying the occurrence and development of NAFLD, the features of the clinic and diagnosis, as well as the tactics of management and treatment of patients with non-alcoholic fatty liver disease. It is important for patients to get a complete understanding of NAFLD so that they can play an active role in the treatment of their disease. 

Peptic ulcer disease (PUD) is a chronic polyetiological recurrent disease of gastroduodenal region. In most cases, the pathogenesis of PU is caused by imbalance between the aggressive factors and protective factors of the gastric or duodenal mucosa. Helicobacter pylori (H. pylori) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the major causative factors leading to PUD development. 65% of gastric ulcers and 80% of duodenal ulcers were found to be associated with H. pylori infection. In turn, NSAIDs account for 30% of gastric ulcers and 15% of duodenal ulcers. About 0.1–1% of  all PUs are caused by Zollinger-Ellison syndrome. Abdominal pain is the leading symptom in the clinical findings of patients with exacerbation of PUD. Dyspeptic syndrome (vomiting, nausea, belching, abnormal bowel pattern) is much less common in   patients with PUD. Endoscopic examination of the upper gastrointestinal tract is currently the gold standard test used in   the  diagnosis of PUD and is recommended for all patients suspected of having this disease (unless contraindicated). Antisecretory therapy including proton pump inhibitors is the main approach to the treatment of PUD, as well as the prevention of its complications. Integral to the treatment of patients with H. pylori-associated PU is the eradication therapy of the infection. It is  reasonable to use a cytoprotector rebamipide, which accelerates ulcer healing and improves the resulting scar quality, as part of the pharmacotherapy of PUD. In addition, the use of rebamipide in H. pylori eradication therapy regimens contributes to increased efficiency of elimination of the microorganisms. 

Introduction. Diverticular disease of the colon is one of the most common gastrointestinal diseases. During the last 30–40 years, there has been a “rejuvenation” of the disease. Today, the prevalence of the disease in people under 40 years of age is 5–10%, and therefore the costs of diagnostic testing and treatment are gradually increasing, which makes the disease socially significant.

Aim. To study the clinical features of diverticular disease, the features of diagnosis and treatment, and prophylactic approaches. The specific objectives of the analysis were to study epidemiology; study the role and a necessary minimum set of laboratory diagnostic test methods for the diagnosis of diverticular disease; study the incidence rate of SIBO and its impact on the clinic presentation and treatment; develop an algorithm for the diagnosis, treatment, prevention, and management of patients with diverticular disease.

Materials and methods. A total of 195 patients with different forms of diverticular disease were examined. As diagnostic tests, we used blood tests, stool tests, biochemical tests; inflammatory tests: calprotectin, CRP, fibrinogen, ferritin; ultrasound imaging, irrigoscopy, CT, NMR, colonoscopy (if medically required); clinical manifestations at different stages of the course of diverticular disease. 5-aminosalicylates were used to treat exacerbation with inflammation; alpha-normix and motility regulators were used to treat exacerbation without signs of inflammation.

Results. On the basis of the study results, we suggested an algorithm for the diagnosis, management and treatment of patients with diverticular disease. According to the particulars of the management, it is reasonable to divide all patients with diverticular disease into three groups: 1) patients who underwent acute diverticulitis; 2) patients with uncomplicated diverticular disease; 3) patients with complicated diverticular disease.

Conclusions. The first two groups should be followed up by a gastroenterologist/general practitioner, the third group should be followed up by a surgeon. The patient tested positive for SIBO should receive drugs to eradicate SIBO. The treatment regimens for exacerbation of diverticular disease are proposed. 

The growing interest in the tandem of osteoporosis and sarcopenia is dictated by a higher level of low-traumatic fractures, disability, and mortality than against the background of individual diseases. Osteoporosis and sarcopenia are associated with aging and are characterized by a simultaneous decrease in bone and muscle mass. Osteoporosis and sarcopenia share common risk factors (genetic, endocrine, dietary and lifestyle conditions) and etiopathogenetic pathways that combine diseases into a single syndrome known as osteosarcopenia. Among the hormonal factors that play a leading role in the development and maintenance of the functional state of bone and muscle tissue, it is necessary to single out estrogens. Currently available research results confirm the protective effect of hormone replacement therapy in relation to osteoporosis. Data on sarcopenia and hormone replacement therapy require further research. Correct understanding and application of therapeutic strategies is essential in order to stop the growing wave of low-traumatic fractures. 

Introduction. The causes for adverse pregnancy outcomes are usually complex and, in some cases, can worsen each other.

Aim. To assess the role and establish the interplay of hormonal and infectious factors in the pathological course of pregnancy in women with threatened spontaneous miscarriage.

Materials and methods. A total 120 pregnant women were enrolled for the observational prospective study, in which they were divided into 4 groups. Group 1 included 32 patients with threatened spontaneous miscarriage and hyperandrogenism (HA), who received glucocorticosteroids (GCS); group 2 included 28 patients with threatened spontaneous miscarriage and HA, who did not receive GCS; group 3 included 30 patients with threatened spontaneous miscarriage without HA; group 4 (control) included 30 women with a physiological course of pregnancy. The following examination methods were used: clinical assessment of the course of pregnancy; measurement of the serum levels of dehydroepiandrosterone sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP) and total testosterone at weeks 5 to 8, 9 to 12, 13 to 18, 19 to 24 and 25 to 32 of gestation; microbiological tests of  vaginal discharge.

Results. The evaluation of androgenic status showed that the levels of the tested hormonal parameters in women with HA significantly exceeded those of the control group, while the changes in 17-OHP and testosterone secretion was comparable to that in women without HA, and DHEA-S level decreased to control values by the third trimester. The use of corticosteroids was associated with significant changes in the values and secretion levels of 17-OHP and DHEA-S, but not testosterone; DHEA-S levels decreased to the values that were significantly lower as compared to all groups in the third trimester of pregnancy.

Conclusions. Vaginal infections play an important role in the genesis of gestational failures. Hyperandrogenism exacerbates the problem of miscarriage, however, the use of corticosteroids does not result in improved hormonal characteristics and clinical pregnancy outcomes, deteriorating the vaginal biocenosis. 

Introduction. Subclinical hypothyroidism occurs in 2–3% of pregnant women and is often associated with pregnancy complications, including preterm birth.

Aim – to study correlations between thyroid dysfunction and pregnancy outcomes.

Materials and methods. 64 clinical cases of managing pregnant women in the Perinatal Center (Tyumen) were analyzed for 2017– 2021: 28 women with thyroid-stimulating hormone (TSH) > 2.5 mU/l, 36 women with TSH ≤ 2.5 mU/l) during the entire period of pregnancy. Quantitative features are described by absolute and relative (percentage) indicators. The probability of outcome depending on the presence of a clinical-amnestic factor was assessed by determining the relative risk (RR) and 95% confidence interval (CI). The level of statistical significance in testing the null hypothesis is p < 0.05.

Results. There were no differences in pregnant women with and without subclinical hypothyroidism when considering such medical and social factors as age, marital status, work, education, nicotine addiction, obesity, kidney disease. An increased risk of preterm delivery was found in patients with a TSH level > 2.5 mU/l: RR 1.41 (0.59–3.37), especially against the background of a positive test for antibodies to thyroperoxidase: RR 1.63 (0.62–4.28). In the absence of treatment, the risk of early delivery, preterm birth, preeclampsia was revealed.

Conclusions. A universal approach to determining the threshold values of TSH for the diagnosis of subclinical hypothyroidism in pregnant women, to the need and tactics of its treatment has not been developed. Diseases of the thyroid gland are endemic for Western Siberia, often associated with iron deficiency anemia, their high frequency in the anamnesis of pregnant women is  noted. Establishing a  correlation between subclinical hypothyroidism, hormonal correction and pregnancy complications requires further research. An obstacle is the lack of proper diagnosis of the TSH level in women who give birth on an emergency basis in early gestational periods. 

The conditions of human development during the stages of early ontogenesis are of great importance for human health throughout the rest of his life. The period of intrauterine development and childhood are vulnerable stages of organism formation, when metabolic processes have the greatest plasticity and can be subject to deformation. Exposure to a number of external factors during this period of time can have a significant impact on the functional activity of genes controlling neurotransmission, immune response, endocrine functions and, thus, program the spectrum of metabolic disorders that can lead later to the formation of chronic diseases: obesity, type 2 diabetes, atherosclerosis and diseases of cardiovascular system. Negative programming influence on the metabolic profile and cardiovascular risk is caused by such factors as maternal obesity, complicated pregnancy and childbirth, prematurity, early separation from the mother, violation of child feeding in the 1st year of life. The risk of early development of cardiovascular disease, metabolic syndrome, obesity and diabetes mellitus is significantly increased in individuals who have experienced traumatic stressors during childhood associated with economic disadvantage of the family, parental divorce, neglect, abuse, parental neglect, sexual violence, death of parents, family members, close friends, bullying in the children's community. An in-depth study of this problem, along with the development and organization of measures for monitoring and prevention, in the long term can reduce the burden of chronic non-infectious diseases, improve quality of life, reduce disability, incapacitation and mortality in the adult population.. 

The problem of prevention and treatment of acute respiratory infections of the upper respiratory tract remains extremely at the top. Although viruses are the etiological factor in more than 90% of acute respiratory infections, the fact of the active use of antibiotics in the treatment of patients with this patology, along with the lack of effective antiviral agents can cause increasing concern, since this is assocatied with an increase in bacterial resistance, sensitization and inflammatory diseases and therefore requires the development of completely different alternative methods of treatment. Since the discovery of the human microbiome over the past two decades, not only the microbiota as a participant in the infectious process, but also probiotics as a factor in managing the immune responses of the macroorganism in viral infections have been actively studied. In addition, the antiviral activity of different probiotic strains has been demonstrated in the scientific literature, which explains the interest of the scientific community in the use of probiotics in acute respiratory infections, especially since probiotics have shown not only efficacy, but aalso high safety in patients of different age groups, including infants. Thus, the literature review showed that the currently available data both from clinical studies and experimental work on the use of probiotics in acute respiratory infections indicate the potential of such an innovative strategy not only for the prevention but also for the treatment of the acute period of the disease, which should be the basis for its wider use in real practice.

The autonomous regulation of the composition of breast milk according to the baby’s needs is perhaps the most unique and mysterious mechanism. Under physiological conditions, the first drops of milk are rich in antioxidants that the newborn needs to combat oxygen deprivation. Milk to nourish boys is more nutritious and night milk is rich in melatonin, which can soothe and put the baby to sleep. Unfortunately, the conditions surrounding a pregnant woman and her newborn baby are not always natural. Many external factors are considered in the context of the risk of adverse effects on the health of the mother and the baby. This article discusses the most common factors that distort the microbiota of breast milk: obesity, delivery mode and antibiotic prophylaxis. Caesarean section, which significantly depletes the bacterial diversity of breast milk, is reported to be the most important factor. The associated disruption of  microbial colonisation in  infancy leads to a  high risk of  inflammatory bowel disease  (including Crohn’s disease and ulcerative colitis), diabetes mellitus, rheumatoid arthritis and  celiac disease in  children. However, there is another opinion that attributes all the consequences of caesarean section to the necessary preoperative antibiotic prophylaxis in most countries. Maternal obesity also leads to low microbial diversity and impoverishment of breast milk with members of the Bifidobacterium genus, which in turn leads to reduced immunomodulatory potential of breast milk in these women. Often these three factors constitute a  vicious circle of  problems that interfere with the  natural and proper process of forming a healthy microbiome in the newborn and require individualised and professional paediatric care.

The COVID-19 pandemic has affected the incidence of acute respiratory infections in the modern world. Despite the growing etiological significance of viruses in the structure of infectious diseases, the importance of bacterial pathogens in the development of  respiratory pathology remains. The risk of  unreasonable prescription of  antibacterial drugs increases. The irrational use of antibacterial drugs has affected the spread of microorganisms with high resistance to antibiotics. The article presents current knowledge on the role of the most common pathogens of community-acquired pneumonia in children, data concerning the S. pneumoniae strain with reduced sensitivity and resistance to penicillin, macrolides. Information about isolates of S. Pneumoniae with decreased susceptibility to third-generation parenteral cephalosporins (cefotaxime and ceftriaxone) have appeared. The number of β-lactamase-producing strains of H. influenzae resistant to unprotected aminopenicillins is rising. The main steps of the diagnostic process of community-acquired pneumonia approved in the clinical guidelines for community-acquired pneumonia in children in 2022, which were adopted by the Russian Ministry of Health, are considered. This document sets out clear algorithms for diagnosing and selecting antibacterial therapy in children on an outpatient basis. Algorithms for selecting initial antibacterial therapy in outpatient settings are also proposed. In most cases, S. pneumoniae is a causative agent of community-acquired pneumonia in children, which defines the selection of an initial antibacterial drug. According to the clinical guidelines, oral amoxicillin at a standard dose of 45–55 mg/kg/day given in 2–3 divided doses is such a drug for children aged 3 months and older. Particular attention is paid to amoxicillin in the form of dispersible tablets. 

On clinical models of infectious, somatic, malignant, and other diseases, the ability of immune responses to induce pathological processes due to competition, “pathogenicity”, hypersensitivity, and insufficiency has been shown. We are talking about the competitiveness of antibacterial and antiviral immunity, when the deployment of cellular and humoral immune responses weaken both defense mechanisms, competition of allergy and immune deficiency, which aggravates and modifies it, and antiviral immunity often induces a number of pathological conditions of the body. This is due to the inability of antiviral antibodies to completely inactivate the antireceptor structures of virions, interact with them without changing their function, and even stimulate a viral infection, induce autoimmune reactions. The protective system of interferons, which often cause side reactions, is also faulty. In  the  body, immunopathological reactions develop, manifested by immediate and delayed hypersensitivity, which have alternative properties – protective and damaging and autoimmune reactions, mainly with a negative effect. The mechanisms of the processes are discussed in detail in the review. The “inferiority” of immune reactions, respectively, cellular, humoral, phagocytic links, incomplete consistency of anticancer immunity, virus-induced immunodeficiencies are comprehensively covered. Such “alternativeness” of the considered immune reactions, at the same time, turns out to be a necessary condition for eliminating the emerging disorders of the organism’s reactivity. These include specificity and non-specificity, stimulation and suppression, variability and integration of immune responses. At the same time, immunoregulatory reactions are individual and interrelated, develop regionally and systemically and provide degradation of exogenous and endogenous objects and immune activation. All these aspects are discussed in detail in the review. 

Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2^nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2^nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in  the future, the  patient began to use them independently and uncontrollably. Almost daily use of  corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching. 

Vitamin D, including all its vitamers, being a food substance, does not belong to drugs, it can specifically cure those diseases that were caused by its deficiency in the diet. Vitamin D may be officially registered as a dietary supplement or medicine. In both cases, it is intended for the prevention of vitamin D deficiency as well as for the treatment of profound deficiency and its consequences. Doses of vitamin D in them are strictly regulated; they are strictly controlled before being imported and placed on the market. In relation to monovitamins and vitamin complexes registered as dietary supplements, especially for children, increased requirements are imposed on the doses of micronutrients, their forms, auxiliary components Due to the high doses of micronutrients they contain, the presence of auxiliary components that are not permitted for use in baby food, many monovitamins and vitamin complexes simply cannot be registered as dietary supplements and, as a result, are registered as medicines. However, this does not mean that they are more effective. Food supplements in  their composition are closer to food products, which confirms the validity of their assignment to the category of specialized products. The effectiveness of vitamin D depends not on the form of state registration, but on the dose, its form and the initial supply of the organism. In order to prevent alimentary deficiency of vitamin D, it is advisable to use dietary supplements, the doses in which are close to the physiological need. 

Atopic dermatitis is a common, chronic, immunoinflammatory disease, the study of the pathogenesis of which has recently stepped forward and served as the impetus for the development of new drugs. For the last 10–15 years, in clinical practice, the choice of therapy for patients with moderate and severe atopic dermatitis, which would provide a stable positive effect and possess a favorable safety profile for patients, including those with comorbidities, has become a rather pressing problem. The main links in the pathogenesis of atopic dermatitis and an approach to the management of adult patients with moderate to severe atopic dermatitis are considered. The role of JAK and the JAK-STAT signaling pathway in the mechanisms of inflammation in atopic dermatitis is discussed. The article presents two clinical cases of successful treatment of patients with moderate to severe atopic dermatitis with the JAK inhibitor baricitinib, who had an insufficient response to standard baseline anti-inflammatory therapy. The first case involved the treatment of a 32-year-old patient, who had been ill since early childhood, followed by a long remission and exacerbation in 2016 when the disease began to have a frequent relapsing character. In the second case, a 45-year-old patient had had frequent relapses since the age of 16. Fast and stable results in both cases were achieved with treatment with baricitinib. The drug showed a favorable safety profile and satisfactory tolerability. 

Introduction. Isotretinoin is the first-choice drug in the treatment of severe forms of acne vulgaris. The combination of systemic retinoids with durant corticosteroids helps to reduce the likelihood of developing “retinoic” dermatitis and exacerbation of acne in the initial stages of isotretinoin therapy.

Purpose of the study. Determination of the effectiveness of the combined use of isotretinoin and a durant corticosteroid in the treatment of severe forms of acne vulgaris.

Materials and methods. Twenty six patients with “severe” or “very severe” grade on the IGA scale were included in this randomised, controlled comparative study. Thirteen patients (group A) were treated with isotretinoin 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and 2 injections of betamethasone dipropionate + betamethasone sodium phosphate at dose 1 ml (2 mg + 5 mg/1 ml) at first month (1 injection per two weeks) and thirteen patients (group B) were treated with combined therapy with isotretinoin at a dose of 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and assessment was based on the IGA scale, counting the number of inflammatory and non-inflammatory elements, indicators DIA (dermatological index of acne) and DLQI and was done at baseline, 1, 4 and 8 months of treatment.

Results. At month 8, compared to group B, group A showed more significant decrease in IGA score and 76% patients achieved “clear” or “almost clear skin” degree (76% vs. 30%). The reduction in the number of inflammatory and non-inflammatory elements showed a marked clinical improvement in group A (89.2% vs 22.3 % for nodules). The decrease in DIA was 88.3% in group A and 71.3% in group B. Exacerbations of acne were recorded in 0% (group A) vs 38.0% (group B) of patients. We also found a relationship between the achievement of a 2-point reduction in the degree on the IGA scale after 8 months and the presence of exacerbations while taking isotretinoin (p = 0.012). Analyzing the DLQI between the two, we were unable to identify statistically significant differences.

Conclusions. Combines use of long acting steroid with isotretinoin provides synergic effect while minimizing the side effect of isotretinoin (decreases the number of exacerbations), demonstrates a visible effect to patients within a month, thereby increasing compliance, improving the quality of life and reducing the risk of scarring. 

Introduction. Atopic dermatitis (AD) is a chronic hereditary recurrent skin disease. Dermatosis is the most common pathology in pregnant women among skin and allergic diseases. According to some reports, exacerbations of dermatosis during gestation worsen the course of pregnancy, childbirth and the postpartum period.

Purpose of the study. Тo study of the features of the course of AD in pregnant women.

Materials and methods. An open, comparative, prospective study was conducted in which 55 pregnant women with a diagnosis of AD in the acute stage took part. The SCORAD index was used to assess the severity. Beck’s Depression and Anxiety Scales were used to identify violations of the psychoemotional status. To assess the impact of the disease on vital activity – the dermatological index of the quality of life. The pruritus-5 D scale was used to analyze pruritus.

Results. Among pregnant women, AD, newly diagnosed during pregnancy, was recorded in  20  (36.4%) women, in  23  (41.8%) – an exacerbation occurred during pregnancy after prolonged remission, in 12 (21.8%) – recorded annual aggravation in the spring and autumn seasons. The role of the hereditary factor was registered in 28 patients (50.9%). Among the pregnant women with AD included in the study, only 5 (9.1%) needed inpatient treatment for exacerbation of the disease, 50 (90.9%) were observed on an outpatient basis. Severe degree was recorded in 7 pregnant patients (12.7%), moderate severity – in 32 (58.2%), mild degree – in 16 (29.1%).

Conclusion. The results of our research can serve as a basis for new directions of research work in terms of studying the etiopathogenetic and clinical aspects of AD in pregnant women. 

The article presents a modern view on the pathogenesis of psoriasis, considers an approach to management of patients with extensive moderate to severe psoriasis, sets out the key features of treatment with genetically engineered biological drugs of different groups: TNF-alpha, IL-17, IL-23 inhibitors. Literature data on the key features, indications, contraindications, and side effects associated with the use of genetically engineered drugs have also been analysed. The experience of using therapies described in domestic and foreign research publications was examined. Approaches to the treatment of patients with moderate to severe psoriasis combined with concomitant comorbid pathologies were discussed, and the features of treatment with genetically engineered biological drugs of different groups were also evaluated. In addition, the publication contains the results of our own observations obtained in the treatment of patients with extensive psoriasis and concomitant comorbid pathology using such biological drugs as secukinumab (10 patients), netakimab (5 patients), guselcumab (7 patients). The schemes of patient investigation, dosage regimens for each drug are given, their efficacy and tolerability are evaluated, and complications acquired during treatment with each drug are analysed, the speed and stability of the therapeutic effect provided by each of them are evaluated. In connection with the emergence of new data on the pathogenesis and treatment of psoriasis, patients have increasing opportunities to receive timely care, maintain disease remission for a long time and improve the quality of life regardless of the severity and stage of the pathological process, as well as of the history and presence of comorbid conditions. 

Introduction. The article considers an objective assessment of the state of morphofunctional status of cornea in keratoconus after a corneal collagen crosslinking procedure.

Aim. To assess changes in cornea structure after corneal collagen crosslinking in keratoconus. Materials and methods. The study included 24 patients: 30 eyes with KC stage I–III aged 17 to 42 years. The patients were examined before and after the  corneal collagen crosslinking procedure. The postoperative follow-up period was 12  months. The patients underwent anterior segment OCT (AS-OCT) imaging to assess the demarcation line depth. The cornea and cornea nerve fibers were assessed layer-by-layer using сonfocal laser scanning microscopy, followed by the  analysis of  resulting confocal images through the author’s analysis algorithm.

Results and discussion. The epithelialization of the cornea completed on day 3–5 after the procedure. According to OCT findings, the depth of the demarcation line averaged to 260 µm in the center and 140 µm in the periphery. The pronounced edema of the outer stroma was observed during the first-week follow-up, and a decrease in the density and apoptosis of keratocytes was noted during the first month. Over a 3–12-month postoperative follow-up period, the transient lacunar edema regressed and the density of keratocytes was restored to the baseline level. During the first three months, a pronounced disruption of the direction and structure of the cornea nerve fibres is seen.

Conclusion. The crosslinking procedure results in changes in the cornea structure, one of which is appearance of the demarcation line in the stroma, which indicates the depth of penetration of the photochemical corneal collagen crosslinking process. The laser corneal confocal microscopy allows to objectively assess the depth of this effect, while the values obtained in the same follow-up periods are comparable with the findings of OCT imaging. 

Introduction. The risk of infectious complications in patients with diabetic foot syndrome (DFS) is 25.2 to 58%, the risk of hospitalization among the patients with complications of DFI is 56 times, and the risk of amputation is 155 times higher than non-diabetics. Detection of the etiologic agent has a crucial role in effective treatment, prevention of dissemination of the infection, and avoiding amputation.

Aim of the study: to analyze the specific characteristics of the severe diabetic foot infection and antibiotic resistance of the pathogens during the inpatient and outpatient stages of treatment.

Materials and methods. We included 62 type 2 diabetic inpatients (38 male and 24 female, group 1) with severe foot infection in to the study. 102 diabetic foot outpatients (56 male and 46 female, group 2) with postoperative wounds were included after discharged from the hospital. Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.

Results. There were prevalence of multidrug resistant Staphilococcus aureus (MRSA), Enterobacterales and Acinetobacter baumannii both outpatient and inpatient stages of diabetic foot infections treatment. The multidrug resistant pathogens were associated with ineffective empiric antibiotic therapy, delay of wound healing and amputations. The presence of multidrug resistant pathogens should be expected in cases of wound size more than 18 sm², history of diabetic foot amputations, chronic osteomyelitis and time before wound professional care more than 14 weeks.

Conclusion. The multidrug resistant pathogens were the main risk factor of amputations in diabetic foot inpatients with severe infections. At the outpatient stage of treatment multidrug resistant pathogens along with chronic osteomyelitis lead to delay of wound healing and new cases of foot amputations in diabetic patients. 

In this review are discussed the most important questions of diagnostics, surgical treatment and complications in the context of  anaesthesia choice and performance in  children and adolescents with different variants of  vertebral scoliotic deformity. Vertebral scoliotic deformity is a multi-etiological disease and significant clinical problem due to frequency and severity of complications when disease progresses. Surgery is performed in  severe and super severe scoliotic deformity when conservative treatment is not effective. Surgical treatment of severe scoliotic deformity allows to improve physiological function of vertebral column and internal organs’ function, improve quality of life and increase life expectancy. Surgical treatment of severe scoliotic deformity is one of the most complex problem in traumatology and orthopedics which requires multidisciplinary coordination of surgeon, anesthesiologist, narrow specialists and the patient at every step of treatment. The most significant problems in surgical treatment of severe scoliotic deformity are forecasting and blood loss management during the operation and in post-operative care which could reach several circulating blood volumes. The problems of blood loss minimization are discussed: patient’s position on operating table, acute normovolemic haemodilution, managed hypotension, use of  antifibrinolythic medications, blood collection and re-infusion, blood transfusion. Blood loss forecasting is an important instrument to get a proactive information to develop personalized approach to patient’s care with assessment of intraoperative blood loss, risk of hemorrhagic shock and disseminated intravascular coagulation syndrome. 

A  special form of  streptococcal infection is streptococcal toxic shock syndrome  (STS), characterized by rapid development of symptoms and high mortality. Patient O., 14 years old, was taken to the infectious diseases department of OGAUZ DBNo. 1 by the SMP team with complaints of shortness of breath, vomiting, loose stools in a state of moderate severity due to intoxication syndrome. Diagnosis upon admission: Acute infectious gastroenteritis of moderate severity. Acute respiratory infections rhinopharyngitis, acute bronchitis, pneumonia  (?), DN1. During examination in  the UAC, anemia, leukocytosis, acceleration of ESR, in the biochemical blood analysis – an increase in CRP, in the coagulogram — increased INR, APTT, RFMC, decreased PTI, in urine tests – protein, erythrocytes, on the X–ray — bilateral pleural effusion, in the tank. sputum culture — Streptoccocus oralis 10/3 KOE/ml, PCR SARS-CoV-2: negative, blood test for antistreptolysin-O (ASL-O): 800 IU/ml (norm up to 200 IU/ml), blood for sterility 19.05.20: no bacterial microflora growth was detected. After receiving laboratory data, the diagnosis was made: Acute glomerulonephritis?, Аcute intestinal infection. Double-sided hydrothorax. Internal combustion engine. Anemia of the 1st degree. The final diagnosis: Acute post-streptococcal glomerulonephritis with a debut in the form of streptococcal toxic shock syndrome, a period of extensive clinical and laboratory changes, with a decrease in the debut of kidney function in the form of acute renal failure, recovery period. Against the background of the treatment (2 courses of antibiotic therapy  (cefotaxime, amoxicillin), infusion therapy, pulse therapy with metipred  (5  pulses), double transfusion of  freshly frozen plasma, prednisone, lasix, veroshpiron, enap, curantil, heparin, and other accompanying therapy), pronounced positive clinical and laboratory dynamics was noted. She was hospitalized for 43 days, of which 9 days were in the intensive care unit (5 days on a ventilator). On the 44th day, the child was discharged in a satisfactory condition with recommendations under the supervision of a pediatrician, a pediatric nephrologist at the place of residence 

Infectious and inflammatory conditions, injuries and malignant neoplasms may raise body temperature, and ischemia may reduce it. Temperature is an important physical and biological quantity and a key human health indicator. It serves as a main indicator in screening of most medical pathologies of both surgical and therapeutic and gynecological profiles. Medical thermovision is a modern diagnostic remote non-invasive informative technique without radiation exposure and contraindications, which is based on the registration of natural thermal radiation emitted by human bodies in the invisible infrared range of the electromagnetic spectrum. As physiological changes precede structural changes observed during classical medical imaging, infrared thermography allows for identification of pathological conditions and neoplasms long before these conditions are confirmed by other diagnostic techniques. Separately, it is necessary to point out that the technique is also an effective way to detect viral diseases. Using medical thermography, the course of the disease may be monitored over time: from screening and diagnosis to follow up of treatment and rehabilitation. The technique is widely used in many fields of medicine and is available for multiple uses. In the article, the current domestic and foreign literature on the use and possibilities of the medical thermography technique in different fields of medicine are analysed. Possibilities and prospects for medical thermovision in the realities of modern medical practice are assessed. 

Obesity and metabolic syndrome are one of the major public health problems in the 21st century due to their prevalence. Nonalcoholic fatty liver disease, dyslipidemia, type 2 diabetes mellitus, arterial hypertension, chronic inflammation and anemia are non-communicable diseases accompanying obesity. With obesity, there is a violation of iron metabolism, iron deficiency, which further contributes to the  development of  metabolic disorders. Iron is the  second most abundant metal on Earth, and its bioavailability is reduced due to the formation of insoluble oxides, while iron deficiency is the most common nutritional disorder. Iron metabolism in the body is associated with the formation of reactive oxygen species involved in lipid peroxidation processes. Iron metabolism in the human body is regulated at all levels; dysregulation of any stage of metabolism can lead to iron deficiency and the development of anemia associated with obesity. This review article summarizes data on molecular and cellular abnormalities in iron metabolism in obesity and metabolic syndrome. The aim of our study was to study, according to the literature, pathophysiological disorders in iron metabolism in the development of obesity and metabolic syndrome. In the future, more research is required to study iron metabolism in obesity with the aim of their preventive and therapeutic effects. The role of oxidative stress in impaired iron metabolism in obesity has not been fully studied, while iron deficiency enhances lipid peroxidation processes in antioxidant deficiency. Under these conditions, oxidative stress can damage cells and destroy red blood cells. The question arises whether the restoration of iron homeostasis in obesity can improve metabolic, inflammatory disorders and reduce the manifestation of oxidative stress, becoming a new innovative approach to the treatment of concomitant metabolic diseases associated with obesity. 

Coronary artery disease (CAD) retains top positions in terms of morbidity and mortality both in our country and many countries of the world. CAD takes many acute and chronic clinical forms and can be observed in patients with various cardiac and extracardiac pathologies. The therapy should be personalized to improve the prognosis for each patient with CAD. The COMPASS trial showed that administration of rivaroxaban at a dose of 2.5 mg twice daily combined with a longterm use of acetylsalicylic acid is reasonable in patients with stable coronary artery disease, a high risk of thrombotic complications and a low risk of bleeding to prevent the development of atherothrombotic cardiovascular events. The clinical benefit of this combination therapy is especially high in patients with diabetes mellitus. Once the percutaneous coronary intervention (PCI) is performed in a patient with CAD and atrial fibrillation (AF), we face the task to minimize the risk of atherothrombotic events, including the possibility of stent thrombosis, and the development of ischemic stroke, given the increased risk of bleeding due to such therapy. The results of PIONEER AF-PCI trial have become the  grounds for recommendation of rivaroxaban 15 mg as part of combination antithrombotic therapy for this group of  patients with AF. An option to add rivaroxaban to therapy may be considered in the presence of sinus rhythm in patients with reduced left ventricular ejection fraction and high thromboembolic risk to reduce the incidence of neurological events, as was shown in the COMMANDER HF trial. So there is a wealth of evidence that rivaroxaban may be used as an important component of the combination therapy of patients with CAD in a variety of clinical situations.