In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be predicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and continue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflammatory cytokines ((IL17A,  IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in  existing conditions. Perhaps, the results of such work will contribute not only to the early detection and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms.

Introduction. Symptomatic peripheral arterial disease (intermittent claudication) is the main cause of disability and loss of mobility in patients and thus has a significant negative impact on their quality of life. Conservative treatment of these patients should be aimed at improving local blood flow, tissue metabolism and blood rheology. Cilostazol is the only drug with a Class I (Evidence A) recommendation for the treatment of intermittent claudication.

Objective. Тo evaluate the clinical efficacy and safety of the use of cilostazol in patients with a combination of obliterating atherosclerosis of the arteries of the lower extremities and diabetes mellitus.

Materials and methods. In 2021–2022, 102 patients were treated. Men – 78, women – 24, the average age was 62 ± 2.8 years. All patients were prescribed basic treatment of atherosclerosis of the arteries against the background of diabetes mellitus. In the first group (n = 52), cilostazol was additionally prescribed 100 mg 2 times a day. In the second group (n = 50), pentoxifylline was additionally prescribed 600 mg 2 times a day. The severity of the pain syndrome, the pain-free walking distance, the maximum walkable distance, the change in the ankle-shoulder index and partial oxygen pressure in the capillary blood of the foot tissues, the presence of negative outcomes were assessed after 1, 3, 6 months of treatment.

Results and discussions. In group 1 patients, a more pronounced decrease in pain syndrome was noted compared to group 2, both in patients with IIA degree and in patients with IIB degree of lower limb ischemia according to Fontaine. The increase in pain-free walking distance and the maximum walking distance in group 1 were more significant than in group 2, starting from the 3rd month of treatment. The ankle-brachial index practically did not change, both in group 1 and in group 2. Negative outcomes of treatment after 6 months in the 1st group – 1.9%, and in the 2nd group – 8%.

Conclusions. If it is impossible to revascularize the limb in patients with obliterating atherosclerosis of the arteries on the background of diabetes mellitus, the inclusion of cilostazol in the treatment regimen shows better final results than the appointment of pentoxifylline. The use of cilostazol significantly improved the quality of life and functional ability of the lower extremities in patients with intermittent claudication.

Introduction. The incidence of stroke is 2.5–3 cases per 1 000 population per year, mortality – 1 case per 1 000 population per year. According to various data, up to 20% of computed tomography (CT) scans performed on the first day do not reveal signs of  an ischemic focus.

Aim of the study. To assess the detectability of acute ischemia foci using CT, depending on the location of the foci, the timing of  neuroimaging, the severity of stroke, and other indicators.

Material and methods. We analyzed 100 cases of acute cerebrovascular accident (ACV) by ischemic type. The timing of the CT scan, glucose level, coagulogram parameters, NIHSS scores at admission, focus localization, the presence of atherosclerosis of the arteries of the head, and atrial fibrillation were taken into account. Patients were divided into two groups depending on the fact of detection of the focus during the primary tomographic examination. Repeated neuroimaging (magnetic resonance imaging) was performed in 54 patients.

Results. In the “CT-negative” group, stem strokes predominated (p = 0.01), patients were younger (р = 0.038), and there were significantly more women than men (р = 0.00006). An increase in glucose over 8 mmol/l, on the contrary, was more often detected in the “CT-positive” group (14 cases in “CT-positive” against 5 cases in “CT-negative” group, p = 0.022). NIHSS scores ≥ 5 were found in 24 patients (47%) in the “CT-positive” group and in 13 patients (26.5%) in the “CT-negative” group (p = 0.034).

Conclusions. Cases of stroke that are not detected on CT scan upon admission to the hospital are more common among women, with stem localization, are associated with low NIHSS scores. High glucose levels at admission is associated with the detection of ischemic foci during the initial CT examination.

Introduction. The use of mathematical modeling methods in clinical practice will make it possible to identify the pathogenetic forms of dorsopathies and thus reasonably use the concept of targeted treatment in the management of patients of this category.

Aim. To evaluate the possibilities of finite element segmental analysis of the cervical spine for personalized treatment and prediction of the course of dorsopathies.

Material and methods. Based on the combined data of computed and magnetic resonance imaging of the patient (female, born in 1951), a model of the C5 – C7 segment was generated, including: vertebrae C5, C6, C7, IVD, anterior and posterior longitudinal ligaments, two pairs of facet joints, spinal cord, nuchal ligament. Computer modeling and finite element method were used to  analyze the stress-strain state of the cervical spine of a patient with degenerative-dystrophic changes in the C2 – C7 segments. In the Abaqus/CAE 6.14 software, finite element analysis of the C5 – C7 stress-strain state was carried out in the state of flexion, rotation and compression. The data obtained during compression were compared with previous experiments in silico and in vitro for the norm.

Results. For each state, stress and displacement diagrams, load-displacement curves, stress profiles in the MPD were obtained. The axial mobility of the segment under compressive load is two times lower compared to the norm under the same boundary conditions and material models. The degree of involvement of the spinal cord in conflicts with the surrounding anatomical structures was studied. When the model was rotated to the right, conflicts were observed between the spinal cord roots and the bone structures of the vertebrae in the foraminal zones, as well as at the level of the C5 – C6 and C6 – C7 discs with the left posterolateral surfaces of the fibrous rings. When the model was turned to the left, conflicts of the spinal cord were observed in all foraminal zones, as well as at the level of the C6 – C7 disc with the left posterolateral surface of the fibrous rings. Based on the data on stresses in the studied segment, further development of dorsopathies and degenerative changes in the cervical spine was predicted.

Conclusions. The use of finite element segmental analysis of the cervical spine creates objective prerequisites for the formation of a combined personalized treatment and prediction of the course of dorsopathies.

With global increases in the aging population, the number of patients with cognitive decline is greatly increasing, which has become a big social problem. The studies conducted previously suggest the possible relationship between oral health and cognitive status. It is well-known, that the oral cavity is an important component not only the maxillofacial region, but also acontributor of general health. In this article, we highlight the relationship among dentoalveolar system and the cognitive functions. Studies using functional magnetic resonance imaging revealed that during mastication there is activation of somatosensory cortical areas, the supplementary motor area, insula, and other areas including the striatum, thalamus and cerebellum. According to the results of the сlinical studies, patients with dementia have demonstrated poor oral hygiene, greater incidence of periodontal diseases and tooth loss. Accumulating evidence suggests that cognitive decline may be associated with masticatory dysfunction. Masticatory dysfunction, as an umbrella term, refers to a debilitating condition in which normal masticatory function is compromised due to structural factors (e.g., tooth loss) or functional factors (e.g., weaker biting force or poorer masticatory performance). The presented data support the hypothesis that there is a possible relationship between mastication, oral health status and cognitive functions, therefore maintenance and adequate restoration of the whole masticatory system are important for the prevention of cognitive decline. This problem requires further clinical interdisciplinary studies, assessing cognitive abilities and oral health.

Permanent childhood hearing loss is crucial for speech development and restricts learning abilities. Universal newborn hearing screening programs are well established to detect congenital hearing loss and address the need of hearing-impaired babies. Progressive or acquired permanent hearing loss can manifest later due to genetic causes, intrauterine or postnatal infections, middle ear diseases and excessive exposure to noise when listening the personal audio devices. The hearing loss prevalence in the population of 9 year-olds three times higher compared with newborns. School hearing screening is a part of hearing across the lifespan conception. The article presents international experience and recommendations for the organization of school hearing screening programs. A school-entry hearing test is mandatory, other grades might be screened also. The basic method is pure tone audiometry at frequencies of 500, 1 000, 2 000, 4 000 Hz at 20 dB. Otoscopy and tympanometry can be performed also, while whisper voice speech test is of low sensitivity. The main hearing screening issue is low follow-up of referrals to ascertain audiological assessment. Modern approaches to the prevention of hearing loss in schoolchildren and management of hearing impairements are described. Planning of hearing screening programs requires sufficient human and logistical resources, monitoring of  results and quality improvement, all stakeholders engagement.

Cholesterol pseudopolyps are the most common variant of gallbladder polyps (GP). Their development is pathogenetically connected with the components of metabolic syndrome, especially with dislipoproteinemia and nonalcoholic fatty liver disease (NAFLD). Lipid metabolism disorder in the form of increased levels of total cholesterol, low-density lipoproteins (LDL), decreased high-density lipoproteins (HDL), as well as steatosis and liver inflammation lead to disorders of enterohepatic circulation (EHC) of bile acids, changes in rheological properties of bile, which, eventually, can lead to uptake of excess bile cholesterol by epithelium of GP in form of micelles. Infiltration of microvilli with bile micelles causes activation of tissue macrophages and triggers subclinical microinflammation of GB wall. When neighboring microvilli, crowded with foamy cells, merge, cholesterol pseudopolyp is formed, which represents a focal form of GB cholesterosis. The main drug that influences the recovery of EHC and physicochemical properties of bile is ursodeoxycholic acid (UDCA). There is also evidence that UDCA can improve parameters of lipid metabolism, liver enzymes, reduce the severity of hepatic steatosis. The use of UDCA in patients with polyposis form of GB cholesterosis has demonstrated positive results against cholesterol polyps. Glycyrrhizic acid (GA), which has anti-inflammatory, antioxidant, antifibrotic, and other beneficial properties, can improve the effectiveness of therapy for GB polyps by acting on the subclinical microinflammation component of the GB wall. In a prospective observational study, the use of fixed combination of UDCA with GA in patients with cholesterol polyps of GB and NAFLD for 3 months resulted in reduction of polyp number and size in more than 50% of patients, which was accompanied by significant improvement of lipid spectrum and liver enzymes parameters. Further studies of UDCA+GA combination in the combination of these pathologies are required.

Introduction. In modern systematic reviews, there is a point of view that CYP2C19 polymorphism affects the results of treatment of peptic ulcer, erosive esophagitis and eradication of Helicobacter pylori.

Оbjective. To evaluate the effect of CYP2C19 polymorphism on the effectiveness of treatment with rabeprazole at a dose of 20 mg once a day in patients with GERD during 2 and 4 weeks of treatment.

Materials and methods. In total, the study included 75 patients with GERD (36 men and 39 women, mean age 41.7 ± 1.5 years). A clinical examination with the completion of standard questionnaires took place during three visits: before the start of treatment, after 2 and after 4 weeks of therapy. Esophagogastroduodenoscopy was performed in all patients before treatment and in patients with esophagitis after 4 weeks of therapy. All patients received rabeprazole at a dose of 20 mg once a day. Genotyping of single nucleotide polymorphisms of CYP2C19 metabolizer genes was carried out by real-time polymerase chain reaction. Ultrarapid, rapid, normal, intermediate and poor CYP2C19 metabolizers have been isolated.

Results. Of the 75 patients examined, 8.0% of patients were ultrarapid metabolizers, 30.7% of people were rapid, 49.3% of individuals were normal, 10.7% of persons were intermediate, and 1.3% of patients were poor CYP2C19 metabolizers. Response after 4 weeks of treatment with rabeprazole 20 mg once daily was 94.4% for NERD and 90.5% for erosive esophagitis. In ultrarapid and rapid metabolizers of CYP2C19, a complete response to rabeprazole therapy was registered in 81.3% of NERD patients and in 84.6% of patients with erosive esophagitis.

Conclusion. Based on the results of the study, we obtained high efficacy of Razo^® at a dose of 20 mg 1 time per day for the treatment of GERD in a group of patients with a predominance of rapid and normal metabolizers of CYP2C19.

Taurine is a sulfur-containing amino acid. Taurine is necessary for the conjugation of bile acids, has antioxidant, anti-inflammatory properties, acts as an anti-apoptotic factor; cell membrane stabilizer; regulator of Ca2+ signaling, fluid homeostasis in cells, retinal photoreceptor activity; contributes to osmoregulation and conduction in the nervous and muscular systems; a neurodevelopmental stimulant; and an inhibitory neurotransmitter in the central nervous system. Taurine is not only synthesized from cysteine and methionine, but also comes from food. Taurine intake is 40–400 mg/day. The main food sources are animal products: shellfish, fish, meat. Taurine is part of breast milk and adapted milk formulas for the nutrition of young children. Under stress and some diseases, the endogenous synthesis of taurine is reduced. The risk groups for taurine deficiency include people who follow a vegetarian diet and observe religious fasts. There are a number of products in which taurine is added: specialized food products (SF) and food supplements (FS) contain 60–1200 mg of taurine per serving, energy drinks – 300–400 mg per 100 ml. The clinical effects of taurine in diabetes mellitus, heart failure are manifested when it is included in diet therapy in doses of 1.5–3 g for  2–16 weeks. Even the maximum doses allowed for use as part of SFP and dietary supplements are significantly less than the doses that ensure the achievement of a clinical effect, which does not guarantee the expected result when using SF.

Introduction. According to clinical guidelines, the treatment of patients with ulcerative colitis (UC) is carried out as combination therapy with mesalazine in rectal forms.

The aim was to compare the effectiveness of treatment of moderate severity UC patients receiving mesalazine MMH as monotherapy and mesalazine in combination with mesalazine for rectal use.

Materials and methods. Comparative clinical analysis of the results of treatment of patients with moderate UC receiving mesalazine MMX as monotherapy (1st group, 44 patients) and mesalazine in combination with mesalazine for rectal use (microclysters, suppositories) (2nd group, 40 patients) was performed.

Results and discussion. After 2 weeks of therapy with mesalazine MMX, 95.0% of the 1st group patients responded to therapy with mesalazine MMX and continued treatment with it as monotherapy (without microclysters and suppositories). In Group 2, 97.2% of patients responded to mesalazine therapy and continued treatment with topical forms of mesalazine - microglia and suppositories. After 12 weeks, 87.5% of the 44 patients in Group 1 who responded to mesalazine MMX therapy and 88.9% of the 40 patients in Group 2 who responded to mesalazine therapy achieved clinical remission. After 52 weeks, 82.5% of 44 Group 1 patients and 86.1% of 40 Group 2 patients remained in clinical remission. The Meio index decreased from 7.9 ± 0.13 to 2.4 ± 0.4 points in group 1 and from 8.0 ± 0.17 to 2.3 ± 0.2 in group 2. There was no statistically significant difference in the level o  laboratory indices between the groups after 12 and 52 weeks (p > 0.05).

Conclusion. Our study confirms that continuous regular administration of MMX mesalazine as monotherapy in doses according to the clinical guidelines is comparable in its effectiveness to combined therapy with non prolonged mesalazine and topical forms of mesalazine in patients with UC of moderate severity.

Irritable bowel syndrome is a clinically and socially significant disease. The pathophysiology, the clinical manifestations of this disease and the  prognosis for  the patient are closely related to dysbiotic disorders of  the intestine. This review summarizes the ideas about changes in the intestinal microbiome in patients with irritable bowel syndrome. The pathogenetically substantiated approaches to the correction of dysbiosis that improving treatment outcomes are also considered. The results of the FLORAVIE clinical trial, which were discussed at the Expert Council “Identification of indications for prescribing probiotics in patients with irritable bowel syndrome” on March 18, 2022, are presented. Members of the Expert Council, Russian and international clinical guidelines emphasize the relevance of targeted probiotics administration. It was noticed that only strain specificity allows predicting a positive clinical response and has a certain evidence base. In this regard, the FLORAVIE study, conducted in real clinical practice in patients with predominantly severe forms of irritable bowel syndrome, is clinically relevant. It has been demonstrated that 30-day administration of the B. longum 35624 probiotic has reduced the severity of irritable bowel syndrome and has improved the quality of life in all subgroups of patients, especially in those with the most severe form of the disease. The data presented indicate that the inclusion of probiotic strains with proven mechanism of action in the complex therapy of irritable bowel syndrome can lead to the transformation of the course of the disease and improve the quality of life of patients. The high level of evidence made it possible to introduce the probiotic strain Bifidobacterium longum 35624 into a number of domestic and foreign guidelines.

Introduction. Puncture fine needle aspiration (FNA) is currently the “gold standard” for morphological verification of thyroid nodules, which determines the further tactics of patient management. Currently, there are no strict ultrasound criteria for the gradation of malignant neoplasms of the thyroid gland. However, in the modern world, the search for minimally invasive methods for verifying thyroid nodules continues. Purpose of the study. The study carried out a comparative analysis of the results of a preoperative cytological study using the Bethesda system in 2017 and the results of ultrasound studies using developed by the American College of Radiology the Thyroid image reporting and data system (TIRADS). Materials and methods. Thyroid cancer risk stratification system with histological studies of the operating material after 2 440 surgical interventions for nodular goiter, carried out on the basis of the center of endocrine surgery of the city clinical hospital named after. F.I. Inozemtsev in the period from 2018 to 2019 year. Results. The sensitivity of the TIRADS system for the TIRADS 5 thyroid malignancy risk score was 100%. The TIRADS 2 thyroid malignancy risk score was observed only in Bethesda II cytological category and does not occur in malignant histological findings. Grade TIRADS 3 occurs only in patients with a benign histological result, but is also seen in Bethesda II, Bethesda IV, and Bethesda V cytology categories. Conclusions. Based on the study, it can be concluded that FNA is inappropriate in patients with a TIRADS 2 thyroid cancer risk. If a TIRADS 5 cancer risk is detected, regardless of the results of a cytological study, the patient should be recommended surgical treatment. If the cancer risk level is TIRADS 3 and the size of the nodules is up to 2.5 cm, it is also possible to refrain from FNA.

Introduction. Pancreatic resection is a common surgical treatment option for chronic pancreatic diseases. Diabetes mellitus, which develops as a result of surgical interventions on the pancreas, belongs to a specific type – pancreatogenic. To assess the state of carbohydrate metabolism in patients after surgery in the volume of pancreatoduodenal resection (PDR), a retrospective single-stage single-center study was performed.

Aim. Assessment of the state of carbohydrate metabolism in patients after surgery in the volume of PDR.

Materials and methods. In Botkin City Clinical Hospital 70 case histories of patients who underwent PDR were selected. The reason for the PDR was pancreatic head cancer (55 people), chronic pancreatitis (7 people), chronic calculous pancreatitis (8 people). Data on age, gender, date of surgery, glycemia levels before and after surgery, as well as C-peptide, insulin, and HbA1c were analyzed.

Results. Out of 70 people in the initial group, diabetes mellitus was diagnosed before surgery in 8 people or in 11.5% of the entire sample. Indicators of carbohydrate metabolism did not differ significantly from each other. However, the level of C-peptide decreased in all patients, while in the group of patients with malignant tumors of the pancreas, despite the decrease in C-peptide, the level of fasting glycemia also decreased.

Conclusion. If before the operation diabetes mellitus was diagnosed in 11.5% of patients, then after the operation the diagnosis of diabetes mellitus was established in 23.6%. Late detection of diabetes mellitus worsens not only the quality of life of patients, but also the overall prognosis, morbidity, and tolerability of chemotherapy. Obviously, the postoperative monitoring algorithm should include regular monitoring of glycemia, glycated hemoglobin at least once a year with normoglycemia in order to early diagnose carbohydrate metabolism disorders and prescribe therapy.

Introduction. Early relevant is the  early prediction of  the development of  type  2 diabetes  (T2D), which allows to prevent the development of the disease and its complications. For the purpose of screening, scales for assessing the risk of its development based on the results of questionnaires are used, but at the moment there are no questionnaires against employees of law enforcement agencies professionally related to psycho-emotional stress.

Aim. Assessment of the prognostic value of the original mathematical model of the VERADIV to assess the risk of developing T2D in comparison with the FINDRISC questionnaires and a DIARISK regarding the cohort of military personnel.

Materials and methods. 212 subjects from among military personnel under a young and middle -aged contract with a waist of the a  avyinary poles and a  representative control group from among civilians  (60  people) were selected for  prospective cohort research. At the first stage of the study, anthropometric psychophysiological indicators were studied, as well as laboratory data aimed at assessing the state of the endocrine function of the pancreas and the degree of insulin resistance. After 3 years, the state of carbohydrate exchange of subjects with the assessment of factors that influenced the development of new cases of prediabetes and T2D was evaluated. Based on the data obtained, an index of the VERADIV was developed, avaluating the likelihood of risk of developing T2D among military personnel. The most important stage in the work was a comparative assessment of the prognostic value of the model of the FINDRISC verasa and the DIARISK, set forth in this article.

Results and discussion. The mathematical model of predicting the risk of T2D, from the age, from the HOMA-IR index, allows the points of aggressiveness and volitional self -control in 91.9% of cases, correctly predict the absence of the development of T2D after 3 years, and during the same period the probability of manifestation of T2D – in 91.7% of cases. For cohorts of military personnel, the specificity and sensitivity of the FINDRISC questionnaire amounted to 69.5 and 75%, respectively. The specificity and sensitivity of the DIARISK questionnaire amounted to 75%.

Conclusion. The results of the study indicate the importance of taking into account insulin resistance and psycho-emotional stress in assessing the risk of developing T2D among military personnel, which confirmed the high prognostic value of the vendiv scale.

The prognosis for gout is largely determined by its timely diagnosis and the choice of drugs for effective urate-lowering therapy which considers the peculiarity of a particular patient’s disease course: the signs of complications, comorbid pathology, and drug tolerability. The report presents a clinical case of gout, which a 30-year-old man with acute arthritis of the right big toe experienced for the first time. The diagnosis of gout was verified by a rheumatologist only 6 years after the first attack. In addition to gout, the patient was also diagnosed with urolithiasis, obesity, hypertension, prediabetes and dyslipoproteinemia. Initially, allopurinol was prescribed, which at a dose of 300 mg/day ensured the achievement of the target level of uric acid. However, the patient stopped taking the drug and eased the frequent gouty attacks by taking nonsteroidal anti-inflammatory drugs. He turned to the rheumatologist again 2 years later. The level of uric acid in the blood was 744 umol/l, the glomerular filtration rate (GFR) was 55 ml/min. The resumption of allopurinol intake was accompanied by the development of dermatitis. Therefore, instead of allopurinol, febuxostat was prescribed, which at a dose of 120 mg/day ensured the achievement of a normal level of uric acid. At this dose, the patient has been taking the drug for the last 2.5 years. The drug tolerability is good. An improvement in kidney function (GFR – 89 ml/min) and normalization of carbohydrate metabolism were recorded associated with medication intake. Thus, febuxostat for gout is an effective drug for urate-lowering therapy. 

prescription is especially recommended in case of intolerance to allopurinol and kidney damage.

Among the proteins of the human body, collagen accounts for at least 25–45% collagen; it is an essential structural component of skeletal tissues, connective tissue of internal organs (heart, intestines, lungs, liver, kidneys), as well as blood vessels. The variety of types of collagen is due to their role and function. The article presents information about the structure and synthesis of collagen, a high concentration of glycine, proline and hydroxyproline in the alpha chains of the collagen helix. Attention is drawn to the fact that cross-links and orientation of collagen fibers in the direction of the vector of external forces and loads provide protection to tissues and organs. The clinical significance of type II collagen is considered on the example of the cartilaginous tissue of the joints and tendons. It is emphasized that an imbalance in the structure of nutrition, genetic mutations, dysfunction of the endocrine and immune systems, especially in old age, are associated with the occurrence of one of the most common joint diseases – osteoarthritis (ОА). It has been established that the degradation or reduction of type II collagen in the cartilage matrix is accompanied by the progression of this disease. Due to the increasing prevalence of OA, signs of metabolic disorders and post-traumatic joint injuries, there is a growing interest in non-pharmacological and pharmacological interventions for the prevention and treatment of osteoarthritis. In recent years, convincing evidence has emerged of the successful use of drugs (biologically active food supplements) of collagen in osteoarthritis. The article presents the results of experimental and clinical studies, meta-analysis and systematic review, confirming the possibility of using these drugs (products) as part of the complex treatment of OA. The possibility of using compositions based on undenatured (native) collagen type II, with the inclusion of ascorbic acid, vitamin D, methylsulfonylmethane and boswellic acids promotes the synergy of these substances, slows down the rate of cartilage destruction, reduces the manifestation of pain and inflammation in the joints, improves functional joint and spinal conditions, promotes the synthesis of endogenous collagen.

Introduction. The reproductive experience of women 18–44 years of age is quantitatively superior to adolescent girls. The structure of reproductive losses of adolescents, its identity or difference in comparison with women of reproductive age is extremely unexplored.

Aim. To compare the structure of reproductive losses of adolescents and women of reproductive age on the example of the Tyumen region.

Materials and methods. A retro-prospective analytical study carried out. Study period – 2016–2021. Adolescent girls and women of reproductive age with completed pregnancies included.

Results and discussion. In the Tyumen region, the frequency of reproductive losses approaches childbirth (42.83% and 57.17%), mainly represented by medical abortion (59.98%). The proportion of completed pregnancies among adolescent girls (1.14%) is  inferior to women of reproductive age (98.86%). Adolescent girls are characterized by the completion of pregnancy by childbirth (OR = 1.68), a high frequency of medical abortion (OR = 1.71). Reproductive losses up to 12 weeks distinguish completed pregnancies in women of reproductive age (OR = 1.68); unsuccessful abortion attempt, criminal and unspecified types of abortion before 12 weeks and other abnormal products of conception after 12 weeks are their exclusive markers. The pregnancy outcome is associated with age: with adolescents – medical abortion before (OR = 1.71) and after 12 weeks (OR = 2.01); with reproductive age – other abnormal products of conception (OR = 1.64) and ectopic pregnancy (OR = 6.15). Reproductive losses are associated with gestational age before/after 12 weeks: with adolescents – spontaneous abortion after 12 weeks (OR = 2.55); with reproductive age – other types of abortion (OR = 20.37), medical abortion (OR = 1.93), other abnormal products of conception (OR = 1.89) before 12 weeks and spontaneous abortion (OR = 5.42) after 12 weeks.

Conclusion. In the Tyumen region, reproductive losses in frequency compete with childbirth. Augmented the concept of the abortion-contraceptive behavior of modern society based on the association of medical abortion with adolescent girls that we have identified. The structure of reproductive losses is associated with a woman’s age period and gestational age.

Worldwide, urinary tract infections (UTIs) are reported in 150-250 million people per year. Annual direct and indirect costs of UTIs for overall patients are estimated to be from $2.4 billion to $3.5 billion Uropathogenic Escherichia coli is the most common cause of UTIs. These bacteria have the ability to colonize urothelium, persist in epithelial cells, and form quiescent biofilms. This bacterial reservoir may provide a source for bacterial persistence and UTIs recurrence. Besides, recurrent UTIs may be caused by the translocation of other bacteria which originate from the gastrointestinal tract or reinfections due to external sources. Menopause and pregnancy are considered as complicating factors that predispose to UTIs. Oral vaccine OM-89 and D-mannose are specified in the European Urological Association guidelines among non-pharmacological methods for the prevention of recurrent UTIs in postmenopausal women. The rationale to the use of D-mannose in UTI prophylaxis is based on its competitive inhibition of bacterial adherence to urothelial cells due to binding of type 1 fimbriae expressed on the bacteria. Exogenous D-mannose is absorbed, but not metabolized by the human body and it is excreted intact in urine. In vivo and in vitro studies showed the ability of mannose-like molecules to provide a 2-fold reduction of bacterial load in the urinary tract after 4 intravesical instillations. Clinical studies also demonstrated a high efficacy of the six months course of oral mannose in the prevention of UTIs.

Introduction. The prevalence of bacterial vaginosis (BV) in the population ranges from 12 to 80% and depends on the cohort of examined women. Of the total confirmed cases, 37-40% are pregnant women.

Aim. To assess the effectiveness of the treatment of bacterial vaginosis (BV) in pregnant women.

Materials and methods. The study included 43 women at 22 to 30 weeks' gestation, divided into two groups: the treatment group consisted of 30 pregnant women diagnosed with BV, the control group comprised 13 pregnant women with normal vaginal microbiocenosis. To determine the antimicrobial activity of vaginal epithelium, samples of vaginal discharge were examined. The treatment was carried out using clindamycin according to the following regimen: 100 mg intravaginally per day at bedtime for 3 days.

Results. The study results showed that the highest activity of antimicrobial peptides (AMP) was found in the group of healthy pregnant women, which accounted for 79.1%. In pregnant women with BV, the level of antimicrobial activity significantly decreased as compared with the group of healthy pregnant women as the severity of the disease increased, amounting to 44.5% in women with mild BV, 36.4% in women with moderate BV and 33.6% in women with severe BV. The level of antimicrobial activity in the group of pregnant women with BV, who received treatment with clindamycin significantly increased by almost two times from the baseline values and amounted to 86.1% in women with mild BV, 78.5% in women with moderate BV and 76.9% in women with severe BV.

Conclusion. The production of endogenous antibiotics, AMP, provides adequate protection against infectious agents. After a  course of therapy with clindamycin 100 mg intravaginally at bedtime for 3 days, the AMP level normalized 2 weeks after treatment.

Currently, cervicitis of nonspecific etiology is one of the urgent problems of modern gynecology due to the extremely high frequency of their occurrence, a tendency to a chronic relapsing course, a negative impact on reproductive health, and the risk of developing a number of complications. The role of violations of vaginal microbiocenosis and local immune status in the development of CNC has been convincingly shown. The replacement of lactobacilli with predominantly anaerobic microorganisms (Ureaplasma, Mycoplasma, Gardnerella vaginalis, Prevotella, Peptostreptococcus spp. and Bacteroides spp.), characteristic of bacterial vaginosis, is extremely often detected in patients with CNC. Of particular importance from the point of view of clarifying the pathophysiological mechanisms of development and the development of new diagnostic and prognostic markers, as well as the personalization of CNC therapy, is the study of the cytokine status. Cervicitis and other inflammatory diseases of the lower genital tract are characterized by an increase in the expression of pro-inflammatory cytokines with simultaneous inhibition of the formation of anti-inflammatory cytokines. Significant multidirectional changes in the balance of pro- and anti-inflammatory cytokines were revealed in active and chronic sluggish cervicitis. It should be noted that, despite the variety of proposed approaches to CNC therapy, this problem is still far from being solved to date. One of the promising directions is the personalization of CNC therapy based on molecular genetic markers (polymorphisms of cytokine genes, Toll-like receptors, genes of the detoxification system). The use of such a personalized approach can significantly increase the effectiveness of CNC treatment and reduce the risk of disease recurrence.

Introduction. The vaginal ecosystem is rich in bacteria, the simplest, fungi as well as viruses that are now introduced by the concept of virome. The lack of knowledge of the role of the virome, especially its impact on reproductive and sexual health, aims to study scientific literature on this issue.

The purpose of this review is to provide up-to-date data on vaginal virome, its relationship with vaginal microbiota and outcomes of pregnancy, and its impact on reproductive and sexual health.

Material and methods. An information search was carried out using Internet resources (PubMed, Web of Science, eLibrary.ru); literature sources for period 2016–2021 were analyzed.

Results. The analysis of the scientific data demonstrated the importance of studying the vaginal virome, its role in the development of gynecological and obstetric pathologies the relationship of vaginal viruses with microbiota and immune system of the host organism. And any imbalance of this relationship can contribute to adverse reproductive outcomes, including the infertility.

Conclusion. The growing interest in the investigation of vaginal virome requires standardization of laboratory protocols and technologies, including the  identification of  RNA viruses. However, there are methodological and analytical restrictions on the vaginal virome research. It is suggested that vaginal virome is the missing link between the bacteria of the female genital tract with protective properties of the mucous membranes and adverse reproductive outcomes. In this regard, future studies that assess vaginal virome in the balance between disease and health are very promising.

Introduction. The COVID-19 pandemic has become a global health problem worldwide. The consequences of the new coronavirus infection continue to be studied. Cardiovascular symptoms and sleep disorders are among the dominant complaints in postCOVID-19 syndrome in women.

Aim. To assess sleep disorders, cardiovascular symptoms, body weight dynamics and their statistical relationships in women with post-COVID-19 syndrome.

Materials and methods. Using a voluntary anonymous questionnaire, we assessed cardiovascular symptoms, body weight dynamics and sleep disorders in 253 women of different age groups who had COVID-19 at least 12 weeks ago. The severity of dyspnea was assessed using the mMRC (Modified Medical Research Council) scale. Resting heart rate was measured. Statistical processing of the obtained data was carried out using the StatPlus 2009 Professional program.

Results and discussion. Among the manifestations of the cardiovascular system in post-COVID-19 syndrome in women of different age groups, palpitations, shortness of breath, and increased blood pressure predominate. There is a statistical pattern in the increased prevalence of rises in blood pressure in post-COVID-19 syndrome among women, depending on age. A variety of sleep disorders occur in all age groups of women, most often in the group of older women. Statistical relationships between sleep disorders and increased blood pressure, severity of dyspnea, palpitations in post-COVID-19 syndrome in women of different age groups were revealed. Severe dyspnea in post-COVID-19 syndrome was frequent noticed in older women. Weight loss in women with post-COVID-19 syndrome is associated with sleep disorders.

Conclusions. Cardiovascular symptoms and sleep disorders in post-COVID-19 syndrome in women of different age groups are closely interrelated. The management of patients in post-COVID-19 syndrome should be carried out taking into account the diversity and interaction of various clinical manifestations. Correction of the identified violations should be comprehensive, based on an interdisciplinary approach of various specialists.

Introduction. In the context of a pandemic, it is necessary to quickly and accurately stratify patients into groups based on  the severity of their condition and prognostic risk. For these purposes, some available biomarkers, such as proadrenomedullin, can be used. Objective. To determine the prognostic value of regional mean proadrenomedullin (pro-ADM) in comparison with routine clinical and laboratory parameters in patients with a new coronavirus infection COVID-19. Materials and methods. The study included 140 patients who were hospitalized with a diagnosis of community-acquired pneumonia on the background of COVID-19. The level of pro-ADM was determined on the first and third days of hospitalization by ELISA. In accordance with the outcome of the disease, patients were divided into two groups: those discharged with recovery or improvement (n = 110, 78, 6%) and those who died during their stay in the hospital (n = 30, 21, 4%). Results. Pro-ADM had the highest prognostic value as a predictor of adverse outcome on day 1 AUC ROC 0.72 95% CI (0.57–0.84) sensitivity 79.2%, specificity 62.9% and on day 3 AUC ROC 0.98 95% CI (0.86–1.0) sensitivity 100%, specificity 95.6%. ROC analysis results for C-reactive protein AUC ROC 0.55 95% CI (0.41–0.77), sensitivity 73.3%, specificity 45.6%; procalcitonin AUC ROC 0.62 95% CI (0.49–0.73), sensitivity 80%, specificity 48.2%. The relative risk of a poor outcome for a proADM level > 500 pmol/L is 2.3 95% CI (1.23–4.32), and for a proADM level > 700 it is 8.5 95% CI (4.83–14.94) p < 0.001. Conclusions. Compared to C-reactive protein and procalcitonin, regional mean proadrenomedullin has the highest predictive value as a predictor of death in patients with COVID-19.

Introduction. The availability of an objective assessment of the microcirculatory bed is possible when examining the vessels of the conjunctiva. This is especially true in individuals who have had COVID-19 and have diseases associated with endothelial dysfunction.

Aim. To study the microcirculation in the conjunctiva after a new coronavirus infection caused by the SARS-CoV-2 virus.

Materials and methods. 83 patients with a history of coronavirus infection were examined. Patients were divided into 2 groups depending on the presence or absence of comorbidities. Group 1 patients (n = 42) with post-COVID changes in the conjunctiva (severe  injection of  the eyeball, chemosis, microhemorrhagia, folliculosis of  the tarsal and bulbar conjunctiva, the  presence of  a  nodular formation  (conflicts), slight edema of  the corneal epithelium) and a  history of  concomitant diseases: arterial hypertension, diabetes, coronary heart disease, atherosclerosis. Group 2 patients (n = 41) with no history of concomitant diseases and similar post-COVID changes in  the conjunctiva. The control group consisted of  healthy volunteers without a  history of coronavirus infection (n = 30). All subjects underwent laser Doppler flowmetry of the bulbar conjunctiva 3, 6, 12 months after the coronavirus infection.

Results and discussion. In comparison with the control group of persons after 3 months, microcirculatory disorders were detected in both groups (group 1 – subcompensated, group 2 – decompensated). In group 1, after 6 months and 12 months, violations persisted in  the subcompensation stage, which were accompanied by an increase in  the intensity of  the functioning of  the regulatory systems of the microcirculation: the M index corresponded to normal values, and the values of σ and Kv were above the norm. After 6 months in group 2, compensation of microcirculatory disorders was noted (indicators M, σ, Kv were normal), which persisted even by 12 months of observation.

Conclusion. The data obtained indicate that in patients with concomitant endothelial dysfunction, the processes of restoration of the microvasculature are slowed down.

The coronavirus infection (COVID-2019) caused by SARS-CoV-2 continues to be studied, the virus mutates, new strains differing from the previous ones by rapid spread appear. Due to the difficult epidemiological situation around the world, the long-term course of the pandemic, doctors of various disciplines are increasingly facing its consequences. 25% of patients have various types of alopecia following infection. Suppression of some growth factors due to the collapse of the immune privilege, local and systemic inflammation, oxidative stress, tissue hypoxia, microvascular insufficiency manifested by persistent capillary spasm influence hair loss. The article presents data from the analysis, out-patient medical records of patients aged 19 to 60 years who sought advice from the Ekaterininskaya clinic network with complaints of hair loss and past history of confirmed coronavirus infection. Due to the variety of trigger factors and multifaceted pathogenetic mechanisms of influence on the hair follicle in coronavirus infection, it is more appropriate to use drugs with a complex mechanism of action for the treatment. The patients received a complex drug for the treatment of alopecia, 1 tablet three times a day for 2 months, and a peptide lotion for cutaneous use with active ingredients, which activate cellular metabolism in hair follicles, encourage the hair follicles to switch to the active growth phase. A positive result during treatment was achieved in 92% of patients. Good tolerability, absence of side effects allow us to administer the drugs we use in a range of therapeutic measures in patients with diffuse hair thinning following coronavirus infection, both in monotherapy and in combination with other drugs.

Tuberculosis of the genitourinary system has not lost its relevance. During the years of the pandemic of a new coronavirus infection, the number of newly diagnosed cases of tuberculosis of all localizations has decreased, but their structure has become more severe and mortality has increased. There is a wide variation in the statistics of urogenital tuberculosis (UGT) in the literature. The true incidence of scrotal tuberculosis is not known; at the end of the last century, it was believed that it was 7% of all cases of tuberculosis. It is believed that the share of isolated tuberculosis of the genital organs of men accounts for no more than 30% of all localizations of UGT, and most often tuberculosis develops in the epididymis. The spread of M.  tuberculosis to the organs of  the scrotum, as a rule, occurs by the hematogenous route from the primary focus in the lungs or kidney. However, the infection can also spread retrogradely from the prostate and seminal vesicles to the epididymis and  testicles. Tuberculosis of the testis and its epididymis is often complicated by infertility and the formation of fistulas. This disease has no pathognomonic symptoms. Differential diagnosis is carried out between tuberculous epididymo-orchitis, testicular tumor, testicular torsion, bacterial epididymo-orchitis. Ultrasound examination is of great diagnostic value in tuberculosis of the scrotal organs. The ultrasound picture in tuberculosis of the testis and its epididymis is divided into 4 types: diffuse enlargement, heterogeneous hypoechogenicity; diffuse increase, uniform hypoechogenicity; nodular enlargement, heterogeneous hypoechogenicity; miliary dissemination. The world literature does not describe an example of tuberculosis of  the scrotal organs, when the disease would be diagnosed during the  patient’s initial visit to the doctor. As a result of late diagnosis or low suspicion for TB, up to 70% of patients undergo unnecessary surgery, although TB orchiepididymitis can be treated medically. The lecture also analyzed a number of clinical observations.

Introduction. In recent years, data have been accumulated regarding possible associations between cognitive impairment and atrial fibrillation. The results of retrospective and prospective studies confirm that anticoagulant therapy in patients with AF can reduce the risk of cognitive impairment and dementia.

Objective. To study the individual characteristics of elderly and senile patients with atrial fibrillation, influencing the choice of anticoagulant therapy, with a view to its subsequent optimization.

Materials and methods. The study included 159 patients with atrial fibrillation of non-valvular genesis aged over 60 years. 4 groups of patients were formed. The largest number of patients received rivaroxaban and warfarin (36.4% and 34.6%, respectively). 26 (16.3%) patients were treated with dabigatran, 20 (12.6%) patients with apixaban. The risk of thromboembolic complications was assessed on the CHA2DS2-VASc scale. The HAS-BLED scale was used to assess the risk of bleeding. A pharmacogenetic study (carriage of polymorphic alleles of the CYP2C9 and VCORC1 genes) was conducted in 138 patients. Cognitive impairment was assessed by a Mini-Cog test and a battery of frontal tests.

Results. Taking oral anticoagulants reduces the risk of stroke and dementia in patients; the presence of cognitive impairment, in  turn, significantly reduces the patient’s adherence to therapy and reduces the effectiveness of therapy. Patients’ adherence to therapy was significantly lower by 10–20% in patients with cognitive impairment according to the Mini-Cog test and a battery of frontal tests. In the absence of pronounced cognitive impairment (higher adherence to treatment) and availability and willingness to control INR, warfarin remains the drug of choice in patients with renal insufficiency.

Conclusions. A number of problems with the use of oral anticoagulants in elderly patients with atrial fibrillation have been identified. The ease of use of new oral anticoagulants, the absence of the need to select doses and monitor therapy is an important factor when choosing a drug.

Introduction. The immune function of the palatine tonsils is associated with a constant proliferation of lymphocytes, therefore, the indicators of proliferation, apoptosis and anti-apoptotic activity in the palatine tonsils are quite informative for assessing their functional state and contribution to adaptive immunity. Chronic inflammation in the palatine tonsils affects their functional state. Understanding the immunocompetence of the palatine tonsils at different stages of the course of chronic tonsillitis allows the optimal tactics of treating this disease, including timely tonsillectomy.

Objective. Based on the results of research and literature sources, to find a comparative characteristic of the contribution of palatine tonsils to adequate immunity, ways to assess their proliferative and anti-apoptotic activity.

Materials and methods. The study included 158 patients with various forms of chronic tonsillitis and 8 patients without signs of chronic tonsillitis, who were divided into 4 study groups, in accordance with the clinical classification of chronic tonsillitis according to B.S. Preobrazhensky and V.T. Palchun. The tissue samples of the palatine tonsils obtained from patients were examined immunohistochemically in an automatic mode using markers of Ki67 proliferation and Bcl2 antiapoptosis.

Results. When conducting an immunohistochemical study with markers of  proliferation and anti-apoptosis, an increase in the proliferative and anti-apoptotic activity of lymphoid tissue cells in chronic tonsillitis of a simple form was revealed, and a significant decrease in these indicators in chronic tonsillitis of toxic-allergic forms of I and II stage.

Conclusions. Data were obtained on the planned tonsillectomy in chronic tonsillitis of the toxic-allergic form of II degree, as well as in case of ineffectiveness of conservative therapy of tonsillitis of toxic-allergic form of I degree.

Vascular tumors often localized in the region of head and neck. Intraosseous hemangiomas localized mainly in the vertebrae and in the skull bones, but they are rarely found in the temporal bone. More often, intratemporal hemangiomas are localized in the internal auditory canal or in the area of the geniculate ganglion and Scarpas ganglion, due to the abundant blood supply of these areas. In other areas of the temporal bone, hemangioma is extremely rare. The symptoms depend on the localization and  size of the tumor. The main clinical manifestations of the disease: facial nerve palsy, hemifacial spasm, cochleovestibular symptoms. The data of computed tomography (CT) and magnetic resonance imaging (MRI) are non-specific. Angiography is recommended to identify the anatomical features of the vessels like aberrant internal carotid artery, high jugular bulb), the blood supply of the tumor and the possibility of embolization, which significantly reduces the risk of bleeding and damage to important anatomical structures of the temporal bone during surgery. Differential diagnosis is carried out with many diseases of the temporal bone: cholesteatoma, glomus tumor, shwannoma of the VII and VIII cranial nerves, Langerhans cell histiocytosis, rhabdomyosarcoma, etc. Surgical treatment is the method of choice and allows to completely resect the tumor. The article presents a  clinical case of intratemporal hemangioma in a patient with a long term symptom of hearing loss.