Introdiction. The article  highlights  the  importance of optimizing  the  treatment of chronic heart  failure  (CHF) in patients with comorbid cardiopulmonary pathology, namely ischemic heart  disease  (CHD) in combination with chronic obstructive pulmonary disease (COPD). The results of our own research on the evaluation of the clinical efficacy of trimetazidine inclusion in the complex therapy of comorbid pathology  are presented.

Objective. To study the clinical efficacy of trimetazidine as part of the complex therapy  of patients with ischemic heart  failure in combination with COPD.

Materials  and  methods.  60  patients with  CHF II-III FC, left  ventricular  ejection  fraction  (LVEF) <45% were  studied  against the background  of postinfarction cardiosclerosis and COPD of 2–3  degrees of airflow restriction. The patients were divided into 2 groups:  1st  (30 patients)  took trimetazidine; 2nd  (30 patients)  received  therapy  without  the  addition  of trimetazidine. The dynamics of: clinical condition  with the use of SHOCK, FC CHF, test with 6-min. walking, quality of life (MLHFQ, SGRQ), indicators of 24-bifunctional monitoring, TTE, spirometry, platelet aggregation and blood viscosity.

Results and conclusion. The use of trimetazidine as part of therapy led to an improvement in the clinical course of the disease, significantly increased exercise  tolerance. The number  and duration  of ischemia  episodes decreased by 34 and 39% (p < 0.05). The number of angina attacks per week and the need for nitroglycerin  decreased by 65% and 42% (p < 0.05), respectively. There was an improvement in intracardiac  and  peripheral hemodynamics.  Thus, LV LV increased by 21%, pulmonary  artery pressure decreased by 18%, the indicators  of LVD, platelet aggregation and blood rheology improved. There was a more positive dynamics of lipid peroxidation and antioxidant system indicators  compared  to the control group.

This review summaries  the main present-day knowledge  on the pathogenesis of cognitive impairement in patients with cardiovascular and cerebrovascular diseases,  combining  both the development of severe  forms such as dementia, and early non-dementia forms of cognitive  impairment.  Risk factors, including  iatrogenic  ones, and the  mechanisms of development of various forms of cognitive impairment in patients with vascular pathologies are discussed  in detail. The definition of human cognitive functions and the modern classification  of cognitive impairment used in real clinical practice are given.  The clinical aspects  of cognitive impairment  in the  therapeutic practice  with a focus on the  review of a wide range  of specific complaints,  reflecting  the  likelihood  of cognitive impairment and non-cognitive symptoms are considered in detail, taking into account the current national  clinical guidelines of professional communities. Possible iatrogenic  factors that worsen the state  of cognitive functions, including an assessment of the anticholinergic drug load on the patient  are discussed  in detail, and a strategy for identifying and solving this issue as part of a therapeutic approach is provided. An algorithmic approach to the identification of non-dementia cognitive impairment in patients with cerebrovascular pathology  is presented by therapeutic specialists  working in the  primary outpatient healthcare sector. The laboratory and instrumental examination options for patients to identify reversible forms of cognitive impairment are considered in detail. The prospective of choosing preventive  non-drug and drug approaches, as well as the therapeutic strategy options for the use  of drugs  that  improve  the  central  nervous  system  functioning  during  management of patients with  cerebrovascular diseases, depending on the type of cognitive impairment in the general  practitioner practice are assessed.

Acute cerebrovascular accident  (ACV) is an important medical and social problem, which is associated with high morbidity, mortality and frequent  disability. The current  system  for providing  specialized  medical  care to patients with stroke  has shown  its effectiveness, as evidenced by a decrease in hospital  mortality  and  an increase  in the  number  of patients returning  to work. However, the incidence  of stroke remains  high, which is also associated with the COVID-19 pandemic. Every third patient  with COVID-19 had neurological symptoms, and a pathomorphological study of the  brain of the  deceased showed  signs of hypoxic encephalopathy in every fifth. Due to the fact that with COVID-19 there  is a high probability of developing ischemic stroke (IS), it is necessary  to promptly identify and correct  the  following  factors  that  contribute to the  occurrence  of stroke  with COVID-19: cardiovascular  diseases, diabetes mellitus, arterial  hypertension, atherosclerosis. Direct exposure  to the virus results  in systemic inflammatory  hyperactivity  with a prothrombotic state  secondary  to protein  C and S deficiency. An important problem  is both the  prevention of the  first and recurrent  stroke, regardless of the  etiology. The basis of secondary  prevention is the  correction of risk factors, as well as the development of an individual program  with antihypertensive, lipid-lowering  therapy. The leading line of secondary  prevention of IS is antiplatelet therapy, which reduces  the risk of developing acute  vascular episodes by 25%. For the purpose  of secondary  prevention of ischemic stroke, acetylsalicylic  acid, dipyridamole, clopidogrel  are used. In the discussed clinical observation, a patient  developed repeated episodes of transient ischemic attack against  the background  of a stenosing  process  in the  common  carotid  artery, hypertension, and a previous  coronavirus  infection. Given that  the  greatest risk of recurrent  stroke is associated with atherosclerosis, which can be complicated by thrombus  formation, chimes and acetylsalicylic acid were chosen for secondary prevention. Follow-up observation showed  the correctness of the chosen tactics.

Introduction. COVID-19 increases the risk of ischemic stroke (IS), but the impact of COVID-19 on the recovery period of IS remains poorly understood.

The aim of the study – to identify patterns and features of the course and manifestations of the early and late stages of the recovery period after ischemic stroke associated with COVID-19.

Materials and methods. The combined retro-prospective study included 81 patients. Patients were divided into three groups: 1) development of stroke followed by outcome in ischemic stroke (IS) associated with COVID-19 (n = 21); 2) COVID-19 infection without stroke (n = 40); 3) development of stroke without COVID-19 (n = 20). All subjects were interviewed by telephone within 12 months from the date of discharge from the hospital. In patients with stroke, the severity of stroke (NIHSS scale), functional status (Rankine scale), and daily activity level (Bartel scale) were studied. All subjects were interviewed by telephone within 12 months from the moment of discharge from the hospital, the following were assessed: complaints, general condition of patients, the patient’s level of activity and ability to self-care, emotional status and the presence of anxiety and depressive disorders. The following were retrospectively assessed: stroke severity, functional status, volume of lung lesions according to MSCT, the presence of cardiovascular diseases, indicators of general and biochemical blood tests, changes in blood levels of cytokines IL-6, IL-8, IL-10, TNF-α.

Results. The highest mortality at the post-hospital stage (only 67 and 47% of the total number of deaths) was in patients who had an ischemic stroke associated with COVID-19; half of them were registered in the first 3 months; by the end of the 6th month, this figure was 79%. Deaths in patients with IS due to COVID-19 occur 6 months earlier than in the group of patients with stroke without COVID-19. The leading causes of fatal outcomes in patients with IS due to COVID-19 in the first 3 months were acute myocardial infarction and repeated strokes. A high frequency of unfavorable rehabilitation prognoses and deaths both in the acute period of the disease and at the post-hospital stage was observed in patients with high comorbidity with forms of pathology of the circulatory system.

Conclusion. Patients who have had an ischemic stroke associated with COVID-19, in the first 3 months of the post-hospital period, are at an increased risk of developing thrombotic complications and death and require special attention of outpatient doctors in this period after discharge from the hospital.

Musculoskeletal back pain (MSBP) is one of the  most  common  reasons  for seeking  medical  care. A socioeconomic burden  of MSBP is significant, as it leads  to reduced  working capacity of the adult  population.  It is important to consider  that  the MSBP chronicity develops  under the impact of “yellow flags”, i. e. factors that contribute to the central  pain sensitization (pathophysiologically) and pain chronicification  (clinically). The most common factor of pain chronicity is anxiety that underlies  the development  of pain  catastrophization, maladaptive escape  (“pain”)  behaviour,  and  anxiety  disorders.  Anxiety symptoms  can  be expressed not only in the emotional,  but also in the somatic, cognitive and behavioural sphere. Timely detection and management  of anxiety  in patients with  chronic MSBP improves  the  effectiveness of pain  syndrome  treatment. The chronic MSBP treatment requires  a multidisciplinary  approach,  which comprises  kinesiotherapy, cognitive  behavioural therapy, and optimal pharmacotherapy. Evidence-based drugs include  non-steroidal anti-inflammatory drugs, such as dexketoprofen, which can be prescribed  for the treatment of chronic MSBP with a short course and at an average  therapeutic dose. The efficacy and safety of dexketoprofen in the  treatment of pain syndromes, data  from clinical studies  and a systematic  review are discussed. The authors  present their own experience in managing  a patient  with chronic nonspecific MSBP and anxiety. The “yellow flags” that led to the MSBP chronicity in the patient  are provided. The effective  multidisciplinary  approach  to the treatment of a patient with chronic MSBP and anxiety disorder is demonstrated.

Back pain ranks first among all non-communicable diseases in terms of the number of years of life lost due to poor health. At the same time, the choice of tactics for the treatment of dorsopathies presents certain difficulties, in particular, the choice of a nonsteroidal anti-inflammatory drug (NSAID), which depends on a number of factors. NSAIDs are effectively used in the treatment of musculoskeletal pain, but they have side effects, which determines the individual characteristics of their use. The article presents an overview of scientific data published in the sources MEDLINE, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Clinical Trials.gov, services for the exchange of research information on the clinical practice of NSAID use. The general characteristics and side effects of NSAIDs in clinical practice are analyzed in order to choose an effective and safe trajectory of their use in the treatment of dorsopathies. In the acute period of dorsopathy, the therapeutic effect should be aimed primarily at reducing pain. At the same time, the use of NSAIDs is necessary and justified, should include a detailed assessment of side effects, duration of use, alternative trajectories of drug and non-drug treatment. Numerous side effects of NSAIDs from the gastrointestinal tract, liver, cardiovascular system, allergic reactions, congenital anomalies in the fetus when using NSAIDs during pregnancy and other undesirable consequences, make it necessary to take the maximum possible measures to minimize adverse reactions and long-term undesirable consequences for the patient. Combined therapeutic effects, including, along with the use of NSAIDs, physiotherapy, physical therapy, massage, reflexotherapy, optimization of motor activity, optimization of posture under static loads, the use of cognitive behavioral therapy methods, is optimal from the standpoint of risk stratification and the expected clinical effect in patients with dorsopathy.

A multidisciplinary  approach  including  drug and non-drug  methods is recommended for the  treatment of chronic low back pain (CLBP). Kinesiotherapy, psychological  methods, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been  shown to be highly effective  for CLBP. All of the listed  methods contribute to significant  relief and relief of pain, increase  the patient’s social and physical activity, and improve the emotional state. Psychological  methods help patients cope with catastrophizing pain, increase  daily activities, and  reduce  the  likelihood  of disease  recurrence.  Results  from clinical studies  and  systematic reviews demonstrate the effectiveness of psychological  techniques such as cognitive  behavioral  therapy  (CBT) and mindfulness  therapy  (mindfulness)  in the  treatment of CLBP. Cognitive Functional  Therapy (CFT) is a promising  new psychological method  that was created  on the basis of CPT. Clinical studies  have been conducted confirming the efficacy of CFT in CLBP. CFT is aimed at regular therapeutic exercises, normalization of motor activity with avoidance  of excessive  physical and static exertion, avoidance  of sedentary lifestyle  and normalization of sleep, which is often  disturbed  in chronic back pain. In practice, patients with CLBP often  have low adherence to increased physical activity during the day, to therapeutic exercises. In most cases, this is due to the fact that in the first days of increased physical activity there  is an increase  in pain. Patients mistakenly fear further  progression of pain and disease. Prescribing  NSAIDs usually results  in pain reduction  as early as the first days of administration, so patients with chronic musculoskeletal pain have an increased desire  to engage in physical activity and therapeutic exercises. The choice of a particular NSAID medication is made individually, taking into account the co-morbidities and the risk of possible  side effects. We discuss the use of nimesulide in CLBP.

Diabetes mellitus is one of the most common chronic diseases, the incidence of which is steadily increasing. Approximately 1 in 11 adults in the world today has diabetes. Diabetic polyneuropathy is a common complication of diabetes mellitus and leads to a decrease in the quality and life expectancy of patients, increases the risk of disability. The pain form of diabetic polyneuropathy has a particularly negative effect on the quality of life. It includes both acute (Ellenberg’s neuropathy and acute insulin-induced neuropathy) and chronic forms. The article discusses modern ideas about the pathogenesis of pain diabetic polyneuropathy, as well as risk factors, clinical symptoms and diagnostic methods (electroneuromyography, quantitative sensory testing, sudomotor function, skin biopsy, confocal biopsy of the cornea) of the disease. In most patients, the pain form of diabetic polyneuropathy is accompanied by autonomic disorders. Treatment of painful diabetic polyneuropathy is a difficult task, including the correction of risk factors (glycemia level, patient lifestyle), as well as pathogenetic and symptomatic therapy. As symptomatic therapy, adjuvant analgesics are used, namely drugs from the group of anticonvulsants (gabapentin, pregabalin) and antidepressants (duloxetine). The use of alpha-lipoic acid is the basis of pathogenetic therapy. As a universal antioxidant, alpha-lipoic acid is an absolutely safe drug with a proven effect in the treatment of painful diabetic polyneuropathy and can be recommended for use in clinical practice.

Introduction. Dizziness and headache are among the most frequent complaints in neurological practice, which significantly reduce the quality of life of patients, so the development of effective methods of managing patients with persistent postural perceptual vertigo (PPPD) and migraine is an urgent task.

Objective. To study and optimize typical management practices of patients with PPPD and migraine.

Materials and methods. Twenty-two patients aged 39.3 ± 10.2 years with PPPD and migraine according to the diagnostic criteria of the Classification of Vestibular Disorders of the Barany Society were examined. During the study we used Hospital Anxiety and Depression scale, Beck Depression Inventory, State-Trait Anxiety Inventory, clinical otoneurological examination, otoneurological questionnaire, Dizziness Handicap Inventory, videonystagmography. After the diagnosis was made, the patients were prescribed a complex treatment. To relieve an acute attack of vertigo, dimenhydrinate was prescribed, as well as the combined drug cinnarizine 20 mg + dimenhydrinate 40 mg Arlevert, which in a number of studies showed high efficacy and good tolerability. One month later, the patients were examined in the dynamics.

Results. Patients with PPPD had migraine without aura (54%), migraine with aura (14%), and vestibular migraine (32%). The level of anxiety was significantly higher in the group of patients with PPPD and vestibular migraine. There was moderate severity of dizziness in all groups of patients, after one month against the background of ongoing therapy severity of dizziness significantly decreased in all groups. Diagnoses “PPPD” and “vestibular migraine” were not set beforehand in any of the examined patients.

Conclusions. The study showed a low level of diagnosis of PPPD and vestibular migraine. Management of patients with PPPD and migraine requires a complex approach.

Anxiety disorders are often found in the practice of doctors of all specialties and cause difficulties in making a diagnosis, which is associated with a variety of clinical manifestations. Traditionally, anxiety disorders are considered within the framework of neuroses and include conditions such as adjustment disorders, generalized anxiety disorder, and a number of somatoform disorders. The article gives a distinction between the concepts of “anxiety” and “anxiety disorders”. It should be noted that anxiety disorders cannot be considered in isolation from the concept of “stress”. Chronic stressful situations exacerbate or contribute to the development of somatic pathology, including neurological. The somatic manifestations of anxiety disorders are diverse and affect all organs and systems: cardialgia, tachycardia, heart rhythm disturbances, hyperventilation syndrome, abdominalgia, irritable bowel syndrome, neurodermatitis, etc. It is important to timely and correctly diagnose generalized anxiety disorder, which occurs both in isolation (borderline psychiatry) and in patients with various somatic pathologies and its main manifestation is generalized, persistent anxiety, not caused and not limited by any external circumstances, accompanied by autonomic, motor manifestations. Diagnostic criteria for generalized anxiety disorder are also presented in the article.

To identify and objectify symptoms of anxiety in practice, it is advisable to use special questionnaires: the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale, the Spielberger-Khanin Situational and Personal Anxiety Scale. The article presents a clinical case of a patient with anxiety disorder. The clinical picture and tactics of managing the patient are analyzed. The addition of etifoxine to therapy made it possible to stop the clinical manifestations of anxiety disorder in a short time.

In the modern world, stress occupies a leading place among significant problems for humanity, being an etiological factor of about 80% of diseases. Social, physical and psychological factors can act as stressors that influence and determine the non-specific response of the body. In most cases, the nonspecific stress-induced reaction of the body is manifested by the picture of psychovegetative syndrome, an important component of which is the activation of the sympathetic nervous system. In a prolonged stress situation, psychovegetative syndrome can be a manifestation of stress-induced anxiety. Anxiety is detected in more than 25% of patients with a general somatic profile. Stress-induced reactions and anxiety can subsequently contribute to the development of psychogenic somatic pathology, including the cardiovascular pathology. Acute or chronic stress situation increases the risks of developing arterial hypertension, coronary heart disease, heart rhythm disorders. In the presence of background cardiac pathology, stress-induced reactions contribute to the deterioration of its course and reduce the effectiveness of treatment. The above indicates the need for a comprehensive assessment of the condition of patients with a general somatic profile. The active use in practical medicine of psychometric and psychodiagnostic scales for anxiety and depression is shown to assess the mental status of patients. When detecting stress-induced reactions or comorbid psychopathology, inclusion of psychotropic drugs, including antipsychotics (alimemazine), is indicated in the complex therapy. Timely administration of alimemazine in patients with a general somatic profile stops psychovegetative manifestations, has positive somatotropic effects due to the multimodal mechanism of action of the drug. In this clinical case, the use of alimemazine in a patient with hypertension, rhythm disorders and comorbid anxiety is presented.

The article describes the clinical case reports of patients with respiratory tuberculosis who were hospitalized at the Regional Clinical Antituberculosis Center in Kursk. One of them was in the pediatric department for patients with tuberculosis of respiratory organs and the other in the 1st department for patients with multidrug-resistant tuberculosis. As pathogenetic therapy in the complex treatment of pulmonary tuberculosis, in the intensive phase of anti-tuberculosis chemotherapy, we added inhalation therapy with surfactant (medicinal product surfactant-BL lyophilisate for emulsion preparation, 75 mg, manufactured by Biosurf LLC, Russia) according to the instructions to the drug. Treatment of pulmonary tuberculosis is performed by multiple inhalations of surfactant-BL as part of complex therapy against the background of fully deployed antituberculosis drugs (ATD), i.e. when the patient empirically or based on data on drug sensitivity of the pathogen is selected 4-6 ATD that are well tolerated by the patient in the prescribed dose and combination. It should be noted that an adult patient during the intensive phase of anti-tuberculosis chemotherapy had COVID-19. Against the background of inhalation therapy with surfactant, it was possible to stabilize the clinical and radiological condition of the patients, and to improve their condition. Clinically it was expressed in reduction of coughing, increase of tolerance to physical exertion. For example, according to spirometry data on the admission of an adult patient and in dynamics, the vital capacity index (VCI) increased from an extremely sharp decrease (31.25%) to 75%, which corresponded to a very mild decrease. At the moment the patient from the children’s ward is completing a course of antituberculosis therapy with small residual changes in the lungs, and the adult patient was operated on at the Russian Ministry of Health at the Federal State Budgetary Institution “National Research Center of Pulmonary Medicine” for installation of a bronchial valve. Based on the above, we can conclude about the successful, pathogenetically sound use of surfactant-BL in patients with respiratory tuberculosis in both children and adults.

Introduction. In the complex therapy of acute bacterial sinusitis, drugs that have antibacterial, anti-inflammatory, mucolytic effects are widely used. The article discusses the effectiveness of the use of a phytopreparation containing standardized myrtol, limonene, cineol and alpha – pinene in the treatment of acute sinusitis in patients who have undergone SARS-CoV-2.

Aim. To increase the effectiveness of conservative therapy of acute bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2) using a complex phytopreparation.

Materials and methods. A simple randomized controlled clinical research study involved 83 patients suffering from acute bacterial sinusitis after a coronavirus infection. Potential, safety and recovery time were evaluated in two groups: a group of patients (n = 41) taking standardized Myrtol limonel, cineol and alpha – pinene (a phytotherapeutic drug), compared with a group (n = 42) taking an antibacterial drug. The severity of clinical manifestations was assessed according to the VAS scale, cognitive functions and memory were carried out using standard psychological tests and an assessment of the quality of life according to SNOT-22.

Results and discussion. The use of Respero Myrtol forte, containing standardized Myrtol limonel, cineol and alpha-pinene, in the complex therapy of bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2) has significantly improved clinical symptoms, cognitive functions and the quality of life. Good drug tolerance, high potential and safety, recovery and improvement of the quality of life at an early date were noted.

Conclusions. In the treatment of patients with bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2), Respiro Myrtol forte has shown high antibacterial, anti-inflammatory and mucolytic effects, good bioavailability, tolerance and safety.

Introduction. Respiratory viruses are the overwhelming etiological agents of acute bronchitis in adults. However, the routine management of such patients often includes the prescription of antibiotics. The primary treatment for acute bronchitis is the administration of mucoactive agents to liquefy and improve sputum flow.

The aim is to investigate the efficacy and safety of 7% hypertonic solution in patients with acute bronchitis.

Materials and methods. A total of 50 patients were enrolled, of whom 25 participants received Ingasalin® forte (7% hypertonic solution) and 25 patients formed a second control group in which participants received other drugs as mucoactive therapy (routine clinical practice).

Results. Severity of productive cough in Group 1 patients equaled 2,24 ± 0,4 points, in Group 2 – 2,4 ± 0,5 points. On the 4th day there was a significant reduction in the severity of both daytime and nighttime cough in the vast majority of patients. At the same time, severity of daytime cough on the 4th day of treatment in Group 1 was equal to 1,36 ± 0,5, and in Group 2 – to 1,7 ± 0,5. During the same period, the number of AB patients with a significant reduction in cough severity in group 1 was 16 (64%), while in group 2–8 (32%).

Conclusion. Thus, the use of 7% hypertonic solution was accompanied by a good effect in the form of a pronounced cough regression in patients with AB.

Seven of the country’s leading  experts  in the field of therapeutic and surgical hepatology answer  questions on this issue: how relevant  is thrombocytopenia in patients with CLD for clinical practice, what  is the  average  proportion  of patients who need correction  of thrombocytopenia before scheduled and emergency  surgical/invasive interventions and how is thrombocytopenia correction  performed. All experts  are unanimous in the opinion that thrombocytopenia is most common at the stage  of cirrhosis. Further, the experts  discussed  the issues of the total number of patients with CLD, the proportion  of patients with thrombocytopenia at all, the proportion  of patients with thrombocytopenia in need of surgical interventions, the experts were asked to provide schemes  for correcting  thrombocytopenia, which they use in their  clinical practice. The focus of the  experts’ attention was on the discussion of patients who have a platelet level of less than 50 000/µl and need scheduled surgical interventions / invasive procedures. All experts  unanimously stratify these  interventions according to the risk of hemorrhagic complications:  high – more than  1.5%, low – less than  1.5%. The most common and available  method  for the correction  of thrombocytopenia at present is platelet transfusion. Details of all this information, as well as statistical data, can be found in this article.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases. To a large extent, the development of this disease is associated with metabolic syndrome. There is a pathogenetic association of NAFLD with obesity, type 2 diabetes mellitus (DM2), cardiovascular diseases and chronic kidney disease. Numerous studies demonstrate that an increase in the incidence of NAFLD occurs in parallel with an increase in the prevalence of obesity and DM 2. A number of scientific studies in the field of medicine have made it possible to identify the main pathogenetic mechanisms of the development of the disease, as well as the possibility of using various pharmacological drugs to correct these conditions. Currently, the possibility of using in the future a group of drugs that have a single mechanism for controlling the development of hepatic steatosis, and further progression with the formation of inflammation, cirrhosis and, in some cases, hepatocellular carcinoma, is being considered. Of particular interest is a class of drugs intended for the treatment of type 2 diabetes and obesity – glucagon-like peptide-1 receptor agonists (arGLP-1). A search was made of clinical studies, meta-analyses, literature reviews in databases and registries of medical publications over a period of 10 years. Changes in anthropometric indications, changes in non-invasive markers of liver steatosis, inflammation and fibrosis, as well as histological data on the background of the use of drugs of the arGLP-1 class were studied. It has been demonstrated that the study drug class may have a significant potential for impact on NAFLD. However, further studies with sufficient duration and histological evaluation are needed to fully evaluate the effectiveness of arGLP-1 in the treatment of NAFLD.

Introduction. The effective and safe management of dyslipidemia is an important step in the treatment of non-alcoholic fatty liver disease (NAFLD).

Aim. To evaluate the experience of the use of dioscorea drug in the treatment of patients with NAFLD and dyslipidemia.

Materials and methods. The effectiveness of a six-month course of dioscorea monotherapy of dyslipidemia was evaluated in 30 patients diagnosed with NAFLD. The observation period was 24 weeks and included 3 visits: before treatment, at week 12 and 24 of the therapy. Changes in complaints, values of lipidograms and biochemical blood tests, liver elastometry were assessed over time, quality of life was measured by SF-36 questionnaire.

Results. A decrease in the frequency of the initially recorded symptoms such as weakness, fatigue, pain or feeling of heaviness in the epigastric region and upper abdomen, flatulence, anorexia, nausea/heartburn was observed by week 12. No flatulence and nausea were recorded by week 24, the frequency of the remaining symptoms did not exceed 3-20%. During a six-month course of treatment, the reduction ratio for total cholesterol was 16%, LDL – 27%, triglycerides and atherogenic coefficient – 38% each, HDL level increased by 25%. The decrease in the levels of ALT, AST, gamma-glutamyl transpeptidase, alkaline phosphatase to the reference values was recorded by week 12, which was maintained until visit 3. According to elastometry findings, a decrease in liver stiffness (from 5.5 ± 4.2 to 4.3 ± 1.2 kPa; p < 0.01) and an increase in the percentage of patients corresponding to the METAVIR F0 score (from 43 to 77%, p = 0.01) was reported by visit 3. The therapy resulted in increase of SF-36 total score: physical well-being improved from 46.3 ± 9.1 to 50.3 ± 7.2 scores (p < 0.001); psychological well-being from 40.6 ± 9.2 to 48 ± 6.9 scores (p < 0.001).

Conclusion. The inclusion of dioscorea drug in the NAFLD therapy allows to achieve a persistent decrease in atherogenic indices of lipidograms, normalization of biochemical markers of the functional state of liver, which clinically determines the regression and relief of the main symptoms of the disease, improving the patients’ quality of life. From the objective point of view, the decrease in liver stiffness was recorded, which is essential for improving prognosis and reducing the risk of NAFLD progression.

Clinical masks or variants  of a course  of biliary pathology  are analyzed  in the  article. The knowledge  of these  masks (course variants) is very important because it expands  our view of pathology, considerably  reduces  process  of diagnostics and narrows range  of nosologies  between which differential  diagnostics should  be carried out. Brief description of the  most frequent  variants – masks, which form biliary pathology, is presented in the article. Among them the following variants are indicated: 1) cutaneous; 2) cardiac; 3) oesophageal; 4) autonomic  dysfunction;  5) pancreatic;  6) dyspeptic; and 7) colitis-like variant. Each variant has a clinical sign that allows it to be classified as biliary pathology. Due to the large number of mask variants, a unified examination programme  and diagnostic  steps, a probable  diagnosis wording is given, allowing the most rational therapy to be chosen. Clinical trial included  120 patients:  10 pregnant women with cholestasis (a small but very important study, as pregnant women are often encountered in therapeutic practice, and they are often subjected to unnecessary investigations, resulting  in lost time, and therapy requires  markedly more effort), 45 with organic pathology  and 65 with problems  of functional  nosologies. The pharmacotherapy included a highly effective artichoke drug, which has a pathogenetic effect on most of the pharmacological targets and has a choleretic and protective  effect. Overall treatment efficacy was 90% with good tolerability  and no side effects.

Introduction. Type 1 diabetes mellitus (DM-1) and its complications pose a serious medical and social problem. Erosive changes in the gastric mucosa are among the most common lesions of the digestive system in diabetes mellitus, and can lead to life-threatening gastrointestinal bleeding and early disability of patients.

Aim. Substantiation of the effectiveness of rebamipid course treatment based on an assessment of the functional state and antioxidant activity of the supraepithelial gastric mucosa in chronic erosive gastritis in patients with DM-1.

Materials and methods. A comprehensive examination of 12 DM-1 patients with erosive gastritis and 11 healthy individuals was carried out, including FGDS with biopsy of the antrum mucosa and stomach body, exclusion of Helicobacter pylori infection, determination of the biochemical composition of structural glycoproteins of mucus and the concentration of degraded glycoproteins, evaluation of the antiradical activity of the supraepithelial mucous layer of the stomach.

Results and discussion. In chronic erosive gastritis in patients with DM-1, a significant predominance of degraded monosaccharides in the supraepithelial mucous layer of the stomach was revealed (6 times higher than in healthy individuals), a decrease in the concentration of polymerized glycoproteins in gastric mucus (21% vs. 80%) and a significant increase in the antiradical activity of mucus. Course  treatment of chronic erosive gastritis in patients with type 1 diabetes with rebamipid at a dose      of 100 mg 3 times a day for 3 weeks contributes to the normalization of the indicators of glycoproteins of native mucus, antiradical activity of the mucosa and complete epithelization of the erosions of the antrum of the stomach.

Conclusions. The use of rebamipid in the treatment of chronic erosive gastritis in patients with type 1 diabetes contributes to reducing the degradation of polymerized glycoproteins of native mucus, normalizing the antiradical activity of the mucosa and complete epithelization of erosions of the antrum of the stomach.

Introdiction. The presence of obesity in a patient or, conversely, malnutrition is accompanied by various metabolic disorders and is the focus of modern medical science and healthcare organizers.

Objective. To reveal the mechanism of action (impact on motility through the intestinal microbiota) of the drug mebeverine in the structure of concomitant therapy for IBS.

Material and methods. The index of nutritional insufficiency was proposed and calculated by us on the basis of the parameters of the alimentary-volemic diagnosis, expressed in points; up to 29 points – a mild degree of nutritional deficiency (the risk of surgery is minimal, the operation is possible after a short-term infusion preparation); 29–30 points – medium degree (the risk is relatively high, the operation is possible only after at least minimal preliminary infusion-alimentation correction); 31–33 – severe degree of nutritional insufficiency (the risk of surgery is high, surgery can only be performed in an emergency after minimal preparation or planned after a long preparation of the patient for surgery until the nutritional status is increased by 1–2 levels; 34–42 – extremely severe (only emergency surgery or palliative after preliminary preparation, raising, if possible, the nutritional status by 1–2 levels).Rehabilitation potential was determined according to generally accepted formulas. Microbiota was also determined by the traditional method. Electrical activity and the nature of motility were determined by it using a mingograph.

Results and discussion. During the examination, it was revealed that the microbiota differs with different HN. At 29–30 points, HH and high RR occur. Rehabilitation potential (RP) has 4 levels of assessment: High rehabilitation potential implies the possibility of achieving a full recovery of health

Conclution. Gut microbiota is a key regulator of metabolic disease. When taking mebeverine, it is advisable. Apparently, to apply a detoxification correction, because it is metabolized in the liver. There is no doubt that it is expedient to further study the state of the microbiota in the modern world with various TIN.

Introduction. Functional dyspepsia (FD) is a multifactorial disease, and the combination of drugs with different mechanisms of action makes it possible to optimally influence various parts of the pathogenesis.

Aim. Prospective observational study TANDEM evaluated the efficacy and tolerability of omeprazole and domperidone fixed combination therapy in the treatment of functional dyspepsia in patients with chronic Helicobacter pylori negative gastritis after 4 weeks course of treatment.

Materials and methods. In accordance with the purpose of the study, a study cohort was formed of 50 patients with symptoms of functional dyspepsia (30 men, 20 women). The mean age was 29.06 (25.88–32.25). Efficacy and tolerability were assessed using the Visual Analog Scale and the Likert scale.

Results. The study was completed by 47 patients. After 4 weeks of treatment, positive dynamics in the form of complete relief of symptoms was noted in all 47 patients; no clinically significant changes in the QT interval were detected.

Conclusion. Evaluation of the efficacy of fixed combination omeprazole and domperidone in the treatment of functional dyspepsia in patients with chronic Hp-negative gastritis demonstrated 100% efficacy of the drug in relieving symptoms 4 weeks after the start of therapy. After 72 hours from the start of the treatment, the effect in the form of complete relief of symptoms was registered in 87.25% of patients. On the 14th day the symptoms were completely relieved in 95.74% of patients. Assessment of tolerability demonstrated a good safety profile of the drug, in particular, the absence of clinically significant changes in the QTс interval.

The number of new cases of diabetes mellitus (DM) and its complications is rapidly increasing and a great amount of cases remains undiagnosed. It demonstrates that improvement of existing methods of treatment can be extremely helpful in present situation. It is known, that one of components of pathogenesis of DM is gut microbiota (GM) and its metabolism. Metabolites of GM include short-chain fatty acids (SCFA), some gases, energy and some low molecular metabolites. From the point of influence on stage of diabetes mellitus SCFA are the most interest. They are not only the main source of energy for colonocytes with antiischemic and protective properties, concerning the gut wall, but they also increase satiety, reduce insulin resistance, improve β-cell function and lead to decrease in body mass. Functions of SCFA are so versatile that they can be mentioned in DM with relative and absolute insulin deficiency as well. Due to its plasticity, GM can change its structure and functions in response to some changes in organism. However, in people with DM these changes are severe and continuous, which makes total amount of microorganisms and their proportion change irreversibly, leading to associated changes in amount of SCFA. Considering the positive effects of SCFA on carbohydrate metabolism, modulation of GM metabolism may occur an efficient addition to antidiabetic therapy. One of the powerful factors, influencing GM, is dietary fiber (DF). They are an energetic substrate for GM, they also maintain pH necessary for GM and regulate food passage in gastrointestinal system. Studying the influence of SCFA on DM and correction of metabolic dysregulation with DF need special attention, as DF and SCFA may become a powerful addition to antidiabetic therapy.

The prevalence of diabetes mellitus (DM) in our country is quite high. Most of them are type 2 diabetes. This pathology is characterized by a rather high disability and mortality. The main cause of deaths in type 2 diabetes are cardiovascular diseases – about 52.0%. An important reason for the development and progression of these complications is the lack of compensation for diabetes, which is currently a serious problem. Thus, according to statistics in Russia, the proportion of compensated patients with type 2 diabetes with a glycated hemoglobin level of less than 7.0% is only slightly more than half of all patients. The reasons for insufficient compensation of the disease may be such factors as the lack of patient education and self-control, as well as the patient’s low adherence to compliance with the rules for taking hypoglycemic drugs. The use of prolonged forms of drugs, as well as combined drugs, increases the adherence of patients to therapy. Among oral medications for the treatment of type 2 diabetes, the most commonly prescribed drugs are metformin and sulfonylurea (SM) derivatives. The joint appointment of these groups of drugs improves glycemic control of patients. There are drugs containing fixed combinations of metformin and SM derivatives. For example, containing 2.5 mg/tab of glibenclamide and 400 mg/tab of metformin, and 2.5 mg/tab of glib-enclamide and 500 mg/tab of metformin and 5 mg/tab of glibenclamide and 500 mg/tab of metformin, as well, containing 2 mg/tab of glimepiride and 500 mg/tab metformin. Such dosages are convenient for patient intake and further titration, also have a low risk of hypoglycemia.

Diabetes mellitus (DM) is a global medical and social problem, its prevalence is steadily increasing throughout the world. The significance of DM is due to early disability and high mortality, primarily from macro- and microvascular complications of diabetes mellitus. Adequate therapy and its timely intensification in order to achieve an optimal individual level of glycemic control is an important aspect in this regard. Insulin therapy is indicated for all patients with type 1 diabetes mellitus. In type 2 diabetes the appointment of basal insulin is necessary if it is impossible to adequately control glycemia with oral drugs. Treatment of diabetes all over the world and in our country requires significant healthcare costs. The problem of reducing the cost of drug therapy in all countries of the world is currently being solved by the admission to the market of biosimilar drugs (biosimilars). A biosimilar (biosimilar) medicinal product (biosimilar, biosimilar) is a biological product similar in terms of quality, efficacy and safety to a reference biological medicinal product in the same dosage form and having an identical route of administration. Insulin glargine is one of the commonly used drugs in clinical practice and is of interest for reproduction. Biosimilar currently registered. This is a biosimilar of domestic production of insulin glargine with proven bio- and therapeutic equivalence, immune safety, good tolerance, recognized as interchangeable with the original insulin glargine. Indications and contraindications for use can be extrapolated to biosimilar without fear of reducing efficacy and the development of adverse events.

Currently, non-infectious diseases, among which various disorders of the endocrine system play a decisive role, occupy one of the first positions in the structure of morbidity and mortality. Endocrine pathology worsens the course of other diseases and is a significant adverse factor in increasing mortality, including cardiovascular accidents. Thyroid pathology ranks second in the structure of endocrine diseases, and an increase in the incidence and prevalence of thyroid pathology in older age groups has been noted in recent decades. Thyroid hormones reduce the concentration of cholesterol, phospholipids and triglycerides in the plasma, while the amount of free fatty acids may increase. Conversely, decreased secretion of thyroid hormones dramatically increases the plasma concentration of cholesterol and phospholipids, and is almost always the cause of a sharp increase in fat deposition in the liver. In the presence of dyslipidemia and arterial hypertension, primary hypothyroidism can be considered as a risk factor for atherosclerosis and, accordingly, ischemic heart disease, especially in the elderly. In conditions of chronic iodine deficiency, a number of autoimmune factors may play a significant role in goiter development. Patients with endemic goiter reveal enzymatic defects in the synthesis of thyroid hormones, which further stimulates autoimmune aggression and degenerative changes in the thyroid gland, leading to a gradual decrease in the functional activity of the gland – hypothyroidism. Iodine deficiency and autoimmune diseases of the thyroid gland are often components of a continuum of comorbidity, which requires personalization of their treatment, taking into account the risks of mutual influences of various pathologies.

Embryo implantation is a key factor limiting the effectiveness of assisted reproductive technologies, and depends on the quality of the blastocyst and the susceptibility of the endometrium. Various methods of treatment aimed at improving the receptivity of the uterine mucosa, including endometrial scratching, have been proposed. At the same time, the main mechanisms underlying this intervention remain unclear. Moreover, the optimal duration of exposure to the uterine mucosa and the groups of patients in which it can have a positive effect have not been determined. The study aims to investigate the main mechanisms and evaluate the effectiveness of local endometrial damage performed at various times before embryo transfer in the program of assisted reproductive technologies in women with and without a history of implantation failures based on the analysis of scientific literature. Clinical studies, systematic reviews and meta-analyses were studied in PubMed, Embase, Cochrane Library, Web of Science databases, Elsevier, Springer, Wiley publishers, on eLibrary, Research Gate platforms, in open sources of the scientific and educational segment of the Internet. The literature search was conducted by keywords: endometrial scratching, local endometrial damage, implantation failures, endometrial receptivity, assisted reproductive technologies, infertility. The search depth is 20 years. The main mechanisms of the effect of scratching on increasing endometrial receptivity include decidualization, the development of a local inflammatory reaction, as well as improved synchronization between the uterine mucosa and the transferred embryo by preventing premature maturation of the endometrium. Studies that showed a positive effect of local damage to the uterine mucosa were mainly conducted in patients with repeated implantation failures and with intervention in the luteal phase of the cycle preceding stimulation. At the same time, the work performed in a non-selective population of women and non-standardized by exposure time, in most cases, did not reveal the advantages of endometrial scratching. In this regard, additional qualitative randomized controlled trials with a large sample size and a clear identification of groups of patients for whom this intervention may benefit are required.

Laparoscopic transabdominal cerclage is becoming the preferred method of treating patients with repeated cases of preterm birth due to cervical insufficiency. This technique reduces the frequency of miscarriages in the second trimester and is an effective prevention of premature birth. This work analyzes modern techniques of applying serclage through transabdominal access: laparotomic, laparoscopic and robot-assisted using the da Vinci® device. Taking into account the advantages and disadvantages of each of these approaches, in clinical practice, preference should be given to the laparoscopic approach, since it is the safest (in terms of blood loss, risk of miscarriage, thrombosis of the veins of the lower extremities, as well as the cosmetic effect and hospital stay) and effective method of treating cervical insufficiency in repeated miscarriages (the frequency of childbirth in the full-term period after this operation is from 82% to 86%). Transabdominal serclage can be applied prophylactically in patients with repeated miscarriages and cervical insufficiency, transabdominal serclage does not have a negative effect on fertility. A promising operation using the da Vinci® device is inferior to the traditional laparoscopic approach, since it greatly exceeds it both in terms of the duration of the operation and in terms of cost, while having comparable efficiency. The option of highly effective treatment using minimally invasive methods suggests that laparoscopic transabdominal cerclage will become the standard of treatment for refractory isthmic-cervical insufficiency. This review examines the literature regarding the indications and results of laparoscopic cerclage.

Introduction. Endometriosis is characterised by a chronic course and significantly affects the quality of life of young patients. Aim. To study the features of the clinical picture and pain syndrome in adolescent girls with genital endometriosis against the background of 1 year of therapy.

Materials and methods. A prospective longitudinal study included 32 girls (14–17 years old) with a confirmed diagnosis of genital endometriosis. The clinical picture and severity of pain syndrome were assessed against the background of conservative therapy with NSAID (naproxen) to relieve dysmenorrhea and gestagen (dienogest) for 1 year.

Results. The main complaint of girls with endometriosis was pain, which appeared on the day before menstruation or in the middle of the cycle since menarche (64%) or increased in 1–1.5 years after menarche (23%) to very intense pain (8.3 ± 1.6 V scale) of a tensive (44%) or clutching (25%) nature. One third of adolescents reported daily pain (24%), the majority (75%) complained of restricted daily activity and performance, gastrointestinal symptoms (44%) and dysuria (22%). After 1 year of treatment with gestagens and NSAIDs patients had a significant decrease in pain on the days of menstruation (p <0,001), as well as outside menstruation (p <0,001), frequency of restriction of daily activities (p <0,001), weakness, lowered working capacity on menstrual days (p < 0.001), gastrointestinal symptoms (p < 0.001) and urinary disorders (p < 0.001) and the need for mandatory pain medication (p < 0.001).

Conclusion. A significant reduction in pain syndrome and clinical manifestations of dysmenorrhea against the background of an improved quality of life was observed in the adolescent patients during 1 year of conservative endometriosis therapy. No intensification or increase in the frequency of headache attacks or significant changes in BMI were observed in the study group, which is indicative of good tolerance and contributes to treatment adherence in young female patients.

Introduction. About 5 million postpartum infectious complications are recorded annually, and about 75 thousand of them lead to maternal death.

Aim. To create predictive model founded on binary logistic regression which could help to diagnosis postpartum endometritis in women after vaginal delivery, based on analyses of links between anamnesis data, anthropometric indicators and risk of postpartum endometritis in postpartum women in modern mega policy.

Material and methods. We conducted a retrospective cohort study, analysis of the 61 medical histories or the postpartum patient admitted to the gynecological department of a state medical institution in Moscow since 2019 to 2021 year was carried out with “Postpartum endometritis” and analysis of history of 70 birth history of postpartum women after physiological labor in different maternity hospital in Moscow.

Results. Patient with postpartum endometritis statistically significant greater have overweight (р = 0,015), dental caries (р = 0,000), vaginitis (р = 0,000), first pregnancy (p = 0,025) and the next complications of pregnancy: acute respiratory viral infections (ARVI) (p = 0,010), urinary tract infections (p = 0,015), gestational diabetes (p = 0,013), inflammatory diseases of vagina and vulva (p = 0,008). They have statistically significant greater induction of labor (p = 0,000) and greater blood loss (p = 0,001).

Conclusions. Predictive model is statistically significant, has 87,1% specifity and 86,9% sensitivity. It allows to prognose postpartum endometritis after vaginal birth.

Today, the dry eye syndrome therapy is based on the techniques aimed at compensating for loss of moisture in the conjunctival cavity (the so-called tear replacement therapy) either by additional moistening of the eye surface, or by maintaining the moisture in the conjunctival cavity. Traditionally, the first step is to moisturise the eye surface, and the artificial tear products is the leader in this area. In recent years, natural mucopolysaccharides are one of the basic components of artificial tears that attract the greatest practical interest, and among them is the hyaluronic acid, or rather its sodium salt, which is almost identical in pharmacological properties to native hyaluronic acid with the respective molecular weight. Hyaluronic acid is characterized by high mucoadhesiveness, which allows the artificial tear solution based on this polymer to bind to mucins on the eye surface and prolong the residence time of the formulation on the ocular surface. The even more significant property of high molecular-weight HyA is the so-called thixotropy: the high molecular-weight HyA has a high viscosity on the open eye, which provides good wettability of the ocular surface. Today, preservative-free solutions based on the hyaluronic acid sodium salt, which are characterized by high thixotropy, hygroscopicity, mucoadhesiveness and good tolerability, are the priority. The high effectiveness of such drugs has been established. They provide deep hydration in the treatment of dry eye syndrome due to Sjögren's syndrome, meibomian blepharitis and perimenopause, as well as dry eye syndrome in children. The latter was developed due to neuroparalytic keratitis, chronic blepharitis, and systematic damage to the ocular surface by eye drops containing preservatives.

The eye is particularly vulnerable to oxidative stress due to its constant exposure to atmospheric oxygen, sunlight, ultraviolet and ionizing radiation, chemicals, pollutants, and microorganisms that may shift the physiological balance towards oxidation. Today, oxidative stress is considered a major pathogenetic feature of a wide spectrum of ocular conditions including diseases of the lens (cataract), anterior chamber (glaucoma), cornea (keratoconus, traumatic injuries, post-operative conditions), eye surface (pterygium, dry eye syndrome), retina (uveitis, retinopathies), and optic nerve (optic neuropathies, glaucoma). Potential strategies for pathogenetic therapy in conditions, associated with oxidative stress, include direct inhibition of lipid peroxidation, induction of Nrf2 transcription factor signaling, repression and sequestration of vascular endothelial growth factor (VEGF), and the use of agents with direct antioxidant effect. Methylethylpyridinol or 3-oxy-6-methyl-2-ethylpyridine hydrochloride, a potent free radical scavenger, is often regarded as a major antioxidant agent for ophthalmological purposes. Methylethylpyridinol is characterized by a possibility of being used in different types of dosage forms. In ophthalmology, it is given by injection, as well as by instillation in the form of eye drops. Methylethylpyridinol can be used for the treatment and prevention of inflammation and burn injuries of the cornea, hemorrhages into the anterior chamber of the eye and into the sclera, thrombosis of the central retinal vein and its branches, diabetic retinopathy and complications in myopia, as well as for the protection of the cornea when exposed to high intensity light and wearing contact lenses. This paper reviews the main features of oxidative stress as the leading pathogenetic factor in ocular diseases, and the possibilities of antioxidant therapy using methylethylpyridinol.

Modern keratorefractive surgery provides high efficiency, safety, predictability, stability of clinical and functional results of correction of various types of ametropia. In the process of preoperative diagnostics, standard and special examination methods are performed to exclude corneal diseases and determine the optimal technology for laser vision correction in each specific case. However, detection of subclinical forms of dystrophies and degenerations of the cornea is not always possible in the course of standard preoperative diagnostics. In this connection, the aim of this work is to present a clinical case of the manifestation of corneal epithelial dystrophy after laser vision correction. The article describes a rare case of clinical manifestation of corneal epithelial dystrophy after excimer laser vision correction, which was compensated by anti-inflammatory and corneoprotective therapy. Diagnostic studies are also separately described, including keratotopographic examination, optical coherence tomography of the anterior segment of the eyes and in vivo confocal microscopy of the cornea, the role of these research methods in the early diagnosis of degenerative processes of the cornea is noted. In vivo laser confocal microscopy is classified as a minimally invasive diagnostic manipulation that allows real-time analysis of all layers of the cornea at a level close to histological. Recently, this method of diagnosing the anterior segment of the eye has found wide application in clinical practice. The management of patients with corneal dystrophies requires increased attention from an ophthalmologist; anti-inflammatory and keratoprotective therapy of the cornea, followed by long-term dynamic monitoring of the eye condition, is topical as a prescribed treatment.

At the present stage, acne is considered as a multifactorial dermatosis, in the formation of which a significant role is played by genetically determined hyperandrogenism and impaired secretion of the sebaceous glands, as well as changes in the skin microbiome. It is known that the risk of occurrence and severity of the disease are significantly influenced by various environmental components, which are commonly called exposure factors. This article provides an analysis of studies on the influence of the most common exposure factors on the pathogenesis and clinical course of acne: diet, skin care, stress, novel coronavirus infection (COVID-19), environmental pollution and climatic conditions. It has been shown that these factors affect the main components of the skin barrier, affect the microbiota and immune reactivity, which subsequently leads to the activation of the leading pathological mechanisms of acne formation. Considering the variety of factors that provoke the disease, emphasis is placed on the need for proper skin care and pathogenetically substantiated therapy in a maintenance regimen with the appointment of topical retinoids and azelaic acid. Due to anti-inflammatory and comedonolytic effects, as well as inhibition of the growth of Cutibacterium acne, these active ingredients provide a complex effect on the main pathogenetic links of the disease. The article presents our own clinical observations of patients with acne, who underwent complex therapy and prevention of exacerbations with the use of Adaklin and Azix-Derm. It was noted that these drugs are effective both in the complex treatment and in the prevention of exacerbations in patients with mild to moderate acne, while the therapy is well tolerated by patients - the resulting adverse events are reversible, easily corrected with moisturizing agents and do not require discontinuation of drugs.

Introduction.  Proper  education of patients and  their  environment is essential in achieving  compensation for type 1 diabetes mellitus  (T1DM).

Aim. Identifying problems  in T1DM management in children and adolescents in daily life and assessing  the needs for educational activities for children and parents.

Materials and methods.  A sociological  survey with the participation of 508 parents  of children and adolescents with T1DM was conducted in February-April 2022 in 7 federal districts of the Russian Federation. The electronic questionnaire contained 80 questions on various areas of disease  management.

Results. Age of children from 3 to 18 years (average 10.7 ± 3.64 g); gender  of children female – 52.2% (265), male – 47.8% (243); T1DM experience – from 1 month  to 15 years (average  3.9 ± 3.2 years). Parents  face problems  of glycemic variability in children (19.5%), difficulties  in adjusting  insulin dosages  (14.4%), catering  in schools/kindergartens (21.0%), preferential provision of insulins  and medical  devices  for self-control of glycemia (17.1%), age characteristics of childhood  and adolescence (14.9%), psychological  problems  (24.4%), indifference  of medical  workers  (10.8%), difficulties  of examination for glycated  hemoglobin (36.3%); low physical activity of children (57.9%), lack of knowledge  and skills of proper monitoring  of glycemia during physical activity (46.6%), inaccessibility  of sports (22.7%). Parents  receive knowledge  in schools of diabetes (37.6%), from endocrinologists  (42.5%), dia chats  in instant  messengers (70.5%), social networks  (59.6%), Internet  resources  (77.2%) are considered an important source  of information.  91.3% of parents  need  constant replenishment of knowledge,  they consider  it important to educate children and form a responsible attitude towards  their health.

Conclusion. The current  continuing  education of patients with T1DM and their environment in the management of the disease in everyday life, the solution  of issues  of timely and full preferential provision of children  and adolescents with T1DM medical devices  for monitoring  glycemia  and  insulin  preparations will contribute to increasing  the  effectiveness of therapy,  reducing the risk of complications and improving their quality of life.

Melkersson – Rosenthal syndrome (SMR) is a disease manifested by a triad of symptoms: swelling of the lips and/or face, paralysis of the facial nerve, scrotal tongue. In clinical practice, the monosymptomatic variant of SMR is more common. The disease can develop at any age, but most cases occur at 25–40 years with a 2-fold predominance of women among patients. In children, SMR is more often observed at the age of 7 to 12 years, and the smallest child is described at the age of 22 months. The causes of the Melkersson – Rosenthal syndrome have not been definitively clarified. There are many hypotheses about the pathogenesis of SMR, the main of which are allergic, angioedema, infectious and genetic, immunological dysfunction. There are various historically established terms: Mischer’s granulomatous cheilitis, orofacial granulomatosis, SMR, which are regularly used as synonyms in the available literature. To date, SMR remains a diagnosis of exclusion, which is accompanied by the establishment of controversial diagnoses in practical healthcare. In most cases, the treatment of SMR is ineffective. Mainly systemic glucocorticosteroids, antibiotics, antihistamines, immunosuppressive drugs are used, upon discontinuation of which the disease often recurs. In this publication, we present two clinical cases of SMR. The interest of the first case lies in the presence of the entire group of clinical symptoms and the achievement of a positive treatment result. The second case is characterized by the achievement of long-term remission as a result of combination therapy with betamethasone, azithromycin and ketotifen. An overview of successful treatment options is also presented.

Introduction. An outbreak of novel COVID-19 infection has become a real challenge for the entire human society, and first of all for the healthcare services. The development of new drugs is a complex and lengthy process. At the beginning of the pandemic, it forced an intensive study of well-known drugs for the therapy. Remdesivir was first investigated as a potential treatment for Ebola virus. After beginning of the COVID-19 pandemic, in vitro evaluations demonstrated its activity against SARS-CoV-2. Subsequent clinical studies showed the efficacy of remdesivir in shortening the time to recovery.

Aim. To evaluate the effect of the carriage of polymorphic alleles of the CES1 gene (A > C, rs2244613) on the safety profile of remdesivir therapy.

Materials and methods. A total of 154 patients hospitalized with coronavirus infection were included in the study. All patients received remdesivir as etiotropic therapy in the standard regimen: 200 mg on the first day followed by 100 mg daily for 5-10 days. In the course of observations, clinical and laboratory signs of adverse events were reported. Venous blood samples were collected from each patient for pharmacogenetic studies. Genotyping was performed using the real-time polymerase chain reaction technique. Statistical analysis: вata were analysed by using IBM SPSS Statistics, Version 23.0.

Results. There were no significant associations of carriage of various CES1 variants with the frequency of adverse reactions (bradycardia, nausea, vomiting) and laboratory markers of adverse events (ALT, AST, creatinine levels).

Conclusion. In our study, no association was found between the carriage of CES1 gene polymorphisms and the safety parameters of remdesivir in hospitalized patients with COVID-19. Further research into the possibilities of personalizing COVID-19 therapy through pharmacogenetic testing is needed.

Introduction. Factors affecting the severity of the course of a new coronavirus infection remain unexplored to the end

Aim. To study the factors associated with the transition of COVID-19 from moderate to severe form of the disease in patients undergoing inpatient treatment

Materials and methods. The diagnosis of COVID-19-associated pneumonia was made by a clinician on the basis of PCR test data and an up-to-date chest CT scan. A total of 195 consecutively recruited patients were examined. The average age of the surveyed was 54 (12.1) years.

Results. Significantly more patients with severe coronavirus infection at the time of hospitalization were active tobacco smokers (33 (29.73%) vs 67 (79.6%); p < 0.002) and had a BMI consistent with pre-obesity/obesity (42 (37.84%) vs 44 (52.38%); p = 0.027). In patients with severe COVID-19, a significantly higher content of leukocytes was noted in the complete blood count (6.054 (2.813) vs 7.307 (4.707); p = 0.021). The groups also differed significantly in the content of micro- and macroelements. The imbalance of minerals revealed in our study is published for the first time, because. The study of the content of Al, B, Li, Co, Sr and Si in patients with COVID-19 was not carried out.

Conclusion. The revealed changes in the microelement status require further study to confirm their significance in the development of a severe form of a new coronavirus infection in patients.

Introduction. The role of comorbid conditions in susceptibility to SARS-CoV-2 infection and the severity of associated COVID-19 disease has been an area of ongoing research since the pandemic began.

Objective. To evaluate the impact of elderly asthma on the clinical course and outcomes of severe COVID-19.

Materials and methods. Elderly patients (WHO, 2020) (> 60 years, n = 131) with bronchial asthma (BA) hospitalized for severe COVID-19 were included in the study. The presence of COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a confirmed diagnosis of bronchial asthma (GINA, 2020). Follow-up was performed at the hospital stage and for 90 days after discharge from the hospital.

Results. In the groups of patients with lethal outcome (regardless of the stage) there were statistically significantly higher Charlson index, respiratory rate, CT lung lesion volume, leukocyte, neutrophil and neutrophil to lymphocyte ratios, lower absolute eosinophil count. In the group of patients who died during hospitalization, severe (IV–V) asthma (p = 0.03), steroid use during the previous year (p = 0.02), chronic heart failure (p = 0.009), and the atopic asthma phenotype was less common (p = 0.02). Those who died in the 90-day posthospital period had greater lung lesion volume on CT scan, and diabetes mellitus was more common (p < 0.001). The most significant predictors of mortality were identified.

Conclusion. The common most significant predictors of hospital and 90-day posthospital mortality in older patients with bronchial asthma were comorbidity index and lower eosinophil levels. Hospital mortality is further characterized by a higher neutrophil to lymphocyte ratio and lower total protein; 90-day posthospital mortality by the amount of lung damage on CT scan and the presence of diabetes mellitus.

Introduction. For many years, one of the problems in medicine that attracted the attention of specialists from different areas of medicine was herpes virus infection. There are many reasons for this, including the often persistent nature of the course, a wide variety of clinical manifestations and routes of transmission, and many target organs of this infection. The disease can proceed in different ways, it has both asymptomatic, mild and rather severe course. For otorhinolaryngologists, Epstein-Barr virus (EBV), cytomegalovirus (CMV) and herpes virus 6 (HHV-6) are the most relevant and important in the context of the treated site of the pathological process. Since the end of 2020, humanity has faced a new, previously unexplored viral infection – a new coronavirus infection. And just like the previously studied herpes virus infection, COVID-19 has a large number of clinical manifestations and affects a huge number of organs and organ systems.

Aim. To determine the types of interplay between COVID-19 and herpesviruses (EBV, CMV, HHV-6) in children of different ages with abnormalities of the lymphoid ring of pharynx.

Materials and methods. In the course of the study, a comprehensive examination was carried out and the results of examination of children with pathology of the lymphoid ring of the pharynx who had herpes virus infection and COVID-19 were analyzed.

Results. The results of the study obtained in the course of the work are consistent with the data that the virus carrier. The presence of an infectious agent triggers the production of macrophages and leads to clonal selection of T and B cells. Further, lymphocytes are transformed into lymphoblasts, which are capable of division and their transformation into plasma and B-memory cells occurs. As a result of this process, hypertrophy of the lymphoid tissue occurs and its reactive activity increases. (persistent herpesvirus infection) is one of the important causes of lymphoid proliferation in children. The combination of antigenic load and immaturity of the immune system in children is accompanied by an increase in the activity of lymphoid tissue and its compensatory activity.

Conclusions. Past mild and asymptomatic COVID-19 can contribute to the reactivation of lymphotropic herpesviruses, first of all EBV, in 55-65% of children of preschool and school age.

Introduction. On average, 10% of patients hospitalized due to new coronavirus infection (COVID-19) will be readmitted. To date, the reasons for readmission and the characteristics of these cases are not fully presented.

The aim of the study was to analyze readmissions of COVID-19 patients to identify the causes of readmission, clinical features, examination data and treatment outcomes.

Materials and methods. The study was performed retrospectively by using electronic records of the medical cases of the St. Petersburg City Hospital of St. George. Inclusion criteria: 1) the presence of two or more hospitalizations during 2020–2021; 2) COVID-19 confirmed by polymerase chain reaction within 14 days before or during the first hospitalization, or the detection of changes in the lungs with a high probability associated with COVID-19 during primary computed tomography. One hundred and two people met the specified criteria.

Results. In 85% of cases, the cause of re-admission was symptoms of respiratory infection; in 13% – thrombotic events (pulmonary embolism, acute cerebrovascular accident, deep vein thrombosis of the lower extremities); 12% – severe pain syndrome of various localizations; 11% - infectious and inflammatory processes; 9% – antibiotic-associated diarrhea; 5% – atrial fibrillation and less often other pathologies. Patients with respiratory symptoms had a high degree of respiratory failure, an increase in the volume of affected lung tissue and an increase in the content of various markers of inflammation in the blood when compared with the data of the initial examination. Nine percent of patients died during hospitalization.

Conclusions. The leading cause of repeated inpatient treatment of COVID-19 patients were symptoms of reactivation of the infection with a number of indicators of a greater severity of this “second wave” of the disease. Further studies are required to reduce the risk of repeated inpatient treatment.

Introduction. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, a comprehensive examination is necessary. Herpesvirus infection (HVI) plays an important role in the etiology of hypertrophy of lymphoid formations of the pharynx.

Purpose. To evaluate the results of preoperative diagnosis of chronic lymphoproliferative syndrome in children in early childhood.

Materials and methods. In 96 patients aged 1 to 3 years 11 months with lymphoproliferative syndrome more than 3–6 months, endoscopy, otomicroscopy, impedance, ultrasound examination of abdominal organs, cervical and submandibular lymph nodes, serological and molecular genetic analyses of markers of EBV, CMV, HCV-6 in the blood; PCR in pharyngeal tonsil scrapings were performed.

Results and discussion. The clinical picture in children with chronic lymphoproliferative syndrome of younger age was dominated by complaints of difficulty in nasal breathing, snoring in 42% of children, recurrent otitis in 58%, manifestations of asthenovegetative and intoxication syndromes and frequent acute respiratory viral infections in 70% of patients. A high degree of infection of children of the younger age group was revealed – HCV-6 in 87%, CMV in 63% of children, 46% – EBV. And high activity of the infectious process in 31% of patients for all three GVI, more often for EBV in 27%. A combination of two or three GVI was detected in 83% of patients. During instrumental examination, a high degree of hypertrophy of the nasopharyngeal tonsils (adenoid vegetations of 2–3 degrees – 67% and 3 degrees – 18%, combined with hypertrophy of the palatine tonsils in 27% of cases), an increase in neck lymph nodes of more than 16mm, including lymph node packs in 28% of younger children and reactive hepatosplenomegaly in 17.7% of patients.

Conclusion. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, it is important to assess the severity of lymphoproliferative syndrome according to the clinical picture and instrumental research methods (nasopharyngeal endoscopy, ultrasound examination of neck and abdominal lymph nodes) in combination with laboratory data and characteristics of the stage of activity of the infectious process of herpesvirus etiology.

One of the current trends in otology is the prevention and treatment of chronic purulent otitis media (HCSO). The disease leads to decreased social activity, deterioration in the patients’ quality of life, often causes severe intracranial complications, and reduced perception of sounds at different frequencies with hearing impairment. The social significance of chronic purulent otitis media consists in a violation of working capacity in persons of the most mature age – 25–50 years, in connection with which, the disease causes certain economic damage to the state. In modern otorhinolaryngology, new therapeutic and diagnostic techniques are gradually being introduced, methodological approaches to surgical treatment and medicines for the treatment of HCG are being developed, which causes therapeutic and diagnostic progress, but in this regard has significantly increased the cost of medical care. The purpose of this work is to analyze from an economic, social and clinical point of view the effectiveness of medical care provided to patients with chronic purulent otitis media. The analysis was carried out on the basis of a literature review, collection and processing of material from official studies, published articles in domestic and foreign publications. Despite the significant advances made by modern otorhinolaryngology, the discussion regarding such a sinister disease and its medical and social aspects is still relevant. We can say that the etiological factors, the pathogenesis of HCSO have been studied quite carefully, the basic concepts of treatment have been developed. But there are new information and directions in this matter that need to be investigated. The problem of treating patients with chronic purulent otitis is of urgent importance for otosurgeons. Questions are being discussed about which type of surgical treatment (tympanoplasty) will be optimal, how many stages of intervention are required, what materials should be used. Тhe question of medical, economic and social justification for the disease of chronic purulent otitis media is subject to study. It is in this aspect that this problem is relevant.

Introduction. The concept of staging of cardiometabolic diseases (CMD) in the clustering of metabolic syndrome (MS) components is closely related to insulin resistance (IR), which depends on the status of sex hormones and age. It is assumed that the formation of menopausal MS starts in perimenopause due to changes in the functional state of the pituitary-ovarian axis. However, mechanisms explaining sex differences in IR, especially during the menopausal transition, have not been established.

Aim. To evaluate the relationship of MS markers in a cohort of women aged 35–59 years without carbohydrate metabolism disorders with different functional state of the ovaries, depending on the presence of arterial hypertension (AH) and the influence of age-associated factors.

Materials and methods. In 88 normoglycemic women aged 35–59 years with different functional state of the pituitary-ovarian axis and divided into 2 groups depending on the presence of hypertension, the following were determined: BMI, waist circumference (WC), levels of blood pressure (BP), triglycerides (TG), HDL cholesterol, FSH and estradiol, fasting glucose (FG), TyG index. SPSS (version 13) assessed ME (25–75%); intergroup differences according to the Mann-Whitney test; Correlation analysis according to Spearman and partial correlation were performed to level the effect of age.

Results. The largest range of significant associations, independent of age and in tandem with it, was found only in the group of patients with hypertension: in OT and FG, which increase at FSH levels > 25 mU/l; lipid parameters among themselves and with FG; TyG with FSH and estradiol levels, and TyG with all parameters focusing on OT and HDL cholesterol.

Conclusions. In the process of the formation of menopausal MS in AH, significant relationships of traditional CMD markers with the TyG index, which reflects the presence of IR through the relationship of carbohydrate and lipid metabolism, are partially influenced by FSH and estradiol levels in tandem with age-associated indicators: the duration of AH and postmenopause.

The ubiquity of the global Internet, social networks, online marketplaces, and other types of services has fostered the development of information and communication technologies (ICTs), including in the healthcare industry. One of the successful and promising uses of ICTs is telemedicine, the interest in which increased during the COVID-19 pandemic. The authors developed their own version of telemedicine questionnaire screening of adult health. The created telemedical questionnaire screening system includes a methodology of selection and ranking of questions, which allows determining the degree of existing health risk in specific profiles: cardiology, gastroenterology, pulmonology, endocrinology and oncology. Due to the presence of artificial intelligence, the system developed by us, is able to form a personalized final medical conclusion and recommendations for a healthy lifestyle. The advantages of the program include a personalized approach, no binding to place and time, flexibility of decisive rules adequate to the expert physician’s opinion, proprietary methodology of selection and ranking of clinical symptoms taking into account their degree of expression and validity, formation of a pathology profile rather than a nosological unit, which ultimately increases the information value of screening and covers all major body systems. Convenience and clarity of the results and conclusions contribute to the formation of adherence to a healthy lifestyle, refusal from bad habits, and increase the awareness of the program users in the issues of prevention and diagnostics of non-infectious diseases. The development will make it possible to reduce the time spent on outpatient appointments by 20% when using the program in primary health care facilities.

Introduction. According to official statistics, stroke ranks second in the structure of mortality in Russia after coronary heart disease. Mortality and morbidity rates from this pathology among people of working age have recently increased by more than 30%. It should be clarified that the main cause influencing the development of acute cerebrovascular accident is hemodynamically significant atherosclerosis of the carotid vessels. Moreover, the pathological process itself can progress rapidly, or, on the contrary, remain stable for a long time.

Aim. To assess the features of the development of fatal and non-fatal cases of ischemic stroke and develop an optimal approach to its assessment in patients with peripheral atherosclerosis in the long-term period.

Materials and methods. The study included a group of 519 patients with atherosclerotic lesions of various vascular beds. The average age of the examined patients was 60.0 ± 8.7 years.

All persons underwent standard biochemical studies, a set of instrumental studies, in the presence of clinical manifestations that arouse suspicion of atherosclerotic lesions of the vascular pools, coronary angiography, angiography of the renal vessels, brachiocephalic arteries and arteries of the lower extremities were performed. The second stage of the work included a prospective follow-up of patients for three years with an assessment of the endpoints.

Results. In the course of the statistical analysis, it was revealed that factors such as a history of amputation of the lower limb (p = 0.048), chronic ischemia of the lower extremities (p = 0.016), atherosclerosis of the abdominal aorta (p = 0.024) influenced the risk of developing non-fatal ischemic stroke in examined patients

Conclusions. The complex analysis carried out made it possible to develop an original nomogram for assessing the risk of developing fatal and non-fatal cases of ischemic stroke in the long-term period, which can be used in real clinical practice.

This article presents a clinical case of thrombophilia in a patient with short bowel syndrome. Thrombophilia is characterized by a disorder of the blood clotting system, in which the risk of thrombosis increases. Thrombophilia, local vascular insufficiency, intestinal obstruction with fistula formation requiring intestinal resection play a significant role in the pathogenesis of short bowel syndrome. The patient was admitted with the diagnosis “thrombophilia, resection of the small intestine (residual small intestine 17 cm), ileostoma”. Condition after multiple surgical interventions on the abdominal cavity. Surgeries performed: atypical gastric resection, resection of the greater omentum, jejunostomy, resection of the cardial and antral parts of the stomach, derivation of duodenostomy, esophagostomy, derivation of loop jejunostomy, Braun enteroanastomosis, perforation of the colon, suturing, derivation of colostomy, cholecystectomy, GI reconstruction, Roux esophagoenteroanastomosis, resection of the sigmoid colon, small intestine, bearing intestinal fistulas, removal of double-barrel ileostomy, abdominal cavity drainage, relaparotomy, closure of ileal perforation, retrograde intubation of the small intestine, determination of indications for intestinal transplantation. The following tests were performed: CT-enterography, colonoscopy with subsequent morphological examination, abdominal ultrasound, enterogastroscopy, clinical and biochemical blood tests, PCR, coagulogram, urinalysis, percussion and auscultation of the chest. Morphological examination showed fragments of the wall of the colon – with erosion, fragments of fatty tissue – with immature granulation tissue, fragment of stroma covered with multilayer flat keratinized epithelium with the focus of epithelized slit-like ulcer. Clexane was administered as part of the treatment complex, nutritional support additionally included Micrazyme capsules 25000 units, teduglutide, remabipid. Rebamipid and Teduglutide allowed to stabilize the patient's condition and improve the condition of the perioperative area tissues. In case of ineffectiveness of the therapy used the indications for liver transplantation are determined.