Acute disorders of cerebral circulation are one of the leading problems of modern clinical medicine, due to their significant spread in the human population and the extremely negative impact exerted on the patient’s body. Currently available data allow us to talk about the multi-vector nature of the pathogenesis of ischemic brain damage. Within the framework of the cascade of developing pathochemical and pathophysiological processes, an essential role in the formation of ischemic stroke belongs to the inflammatory reaction occurring through the immune system’s response to cerebral tissue ischemia. One of the places of its implementation is the vessel wall located in the ischemic zone, where monocytes and neutrophils are attracted with the help of cell adhesion proteins. Complement activation plays a significant role, carried out mainly due to the C3 component or during the initialization of the mannose pathway. Activation of microglia and astrocytes plays a huge role directly in the focus of ischemia. It should be noted that in the process of activation, both microglia and astrocytes are able to acquire a pro-inflammatory or anti-inflammatory phenotype. The prevalence of the pro-inflammatory variant contributes to prolonged damage to brain tissue, while the predominance of the anti-inflammatory phenotype has a protective effect. An important role is played by a violation of the function of the blood-brain barrier, which provides an additional influx of leukocytes to the site of ischemia. In addition, individual subpopulations of T-lymphocytes penetrating through the damaged barrier also play a significant role in the organization and dynamics of the immuno-inflammatory response. The action of Th1 and Th2 cells, gamma-delta T lymphocytes, natural killer cells, as well as regulatory T lymphocytes has been most studied. The role of B-lymphocytes in the formation of a stroke focus is considered.

Chronic cerebrovascular insufficiency (CCI) is an independent disease with complex etiopathogenetic mechanisms and a polymorphic clinical picture. The complex hierarchy of pathogenetic mechanisms and clinical manifestations forces the doctor to choose a strategy for drug therapy, taking into account the multifunctional effect on all pathogenetic mechanisms. With regard to chronic cerebrovascular insufficiency, there are still no unambiguous standards, mainly the use of preventive strategies (antihypertensive drugs, antiplatelet agents, anticoagulants, statins) is recommended. At the same time, a combination of pathological factors leads to a violation of the integrity of the homeostasis system and mitochondrial and endothelial dysfunction, atrophy of the cerebral cortex, neurodegeneration, and proliferation of glial cells. Violations of metabolic, protein-synthetic processes in the vascular wall and neurons underlie subsequent morphological damage, which is the foundation for the development or manifestation of a particular symptom. Therefore, only preventive or symptomatic therapy separately from each other is unlikely to have the expected effect. Due to the fact that there are no unified diagnostic criteria, a unified pathogenetic paradigm, there are no standards in the treatment of CNMC, neuropeptides have been actively studied in recent years. They are capable of selective binding to endogenous proteins and can form structural conformations in response to various stimuli in the biological environment, which allows for various therapeutic applications of peptide assemblies. The drugs have pronounced neurotrophic, mediator, effector and anti-inflammatory properties, are highly effective, can be used in small doses, and have no side reactions. A promising drug in this group is a polypeptide from the brain of porcine embryos6 which has a good evidence base for efficacy and safety in patients with cerebrovascular diseases. . To increase the effectiveness of therapy, it is advisable to combine neurope-tides with antioxidants and antihypoxants, choline precursor drugs.

Introduction. Intravenous thrombolysis (IT) is the primary method of reperfusion therapy for ischemic stroke. Over the past couple of years, there has been a global trend towards the predominant use of the bolus forms of thrombolytic drugs that is caused by necessity to increase the reperfusion therapy rate to achieve its best outcomes.

Aim. To evaluate the efficacy and safety of the use of non-immunogenic staphylokinase for IT in ischemic stroke in real-world clinical practice of the regional vascular center.

Materials and methods. The clinical outcomes of the cohort of 50 patients who underwent IT with non-immunogenic staphylokinase were analysed.

Results. The age of the patients ranged from 46 to 94 years and averaged 71.8 ± 10.0 years; 22% of patients were over 80 years of age. The NIHSS score at admission varied from 3 to 23 scores and averaged 11 (8-14) scores. 36% of patients had large artery occlusions. 14% of patients received a step-wise reperfusion therapy. The median door-to-needle time was 23 (18-26) minutes. 52% of patients didn’t develop any infarction area during control neuroimaging. 62% of patients required no further rehabilitation. Hospital mortality was 12%. 18% of patients developed hemorrhagic conversion mainly in the form of hemorrhagic infarction. 1 patient had a symptomatic hemorrhagic conversion. Major bleeding and angioedema were not observed.

Conclusion. The analysis of 50 consecutive cases of IT in ischemic stroke using non-immunogenic staphylokinase indicates the high efficiency and safety of this method of reperfusion therapy.

Introduction. Cognitive impairment significantly reduces the quality of life. This occurs already in the early stages of the disease. At present, the effect of non-drug treatment on mild cognitive impairment and the quality of life of patients has not been sufficiently studied.

Aim. To evaluate the effect of a combination of non-drug treatments on the quality of life of patients with non-demented vascular cognitive impairment.

Materials and methods. 60 patients with moderate cognitive impairment of vascular etiology were included in an open randomized trial. Patients of the first group (n = 30, mean age 63.7 ± 8.8) received a combination of non-drug methods (cognitive training, physical activity, meal planning) for one month. Patients of the second group (n = 30, mean age 64.2 ± 10.7) were informed about the advisability of a healthy diet and maintenance of mental and physical activity. Neuropsychological testing was carried out at the stage of inclusion, immediately after the course of treatment, after 6 months and one year after the start of the study.

Results. Patients of the first group showed a statistically significant improvement in the quality of life (p < 0.05) one month after the start of the study. After 6 months and after a year, there were no significant differences with the first visit. When comparing the indicators of the second group with the initial visit, a decrease in the quality of life was noted throughout the follow- up (p < 0.05). The differences were statistically significant when comparing the two groups with each other at the time of the second visit, but at the third and fourth visits they lost statistical significance.

Conclusion. The results obtained indicate that the use of a complex of non-drug methods of treatment for moderate vascular cognitive impairment improves the quality of life of patients.

Pre-dementia cognitive impairments are a significant part of a cognitive impairment range, considered the most perspective in terms of conversion into dementia prevention. At the same time pre-dementia cognitive impairment treatment presents certain difficulties in connection with the absence of precise medicinal strategies with the high evidence level. According to current clinical recommendations, the priority in cognitive pre-dementia treatment lies in the correction of modifiable risk factors of cognitive impairment progression and non-drug therapy methods. Nevertheless, there is a great need in receiving the proofs of pathogenetically justified use of drugs with a potentially effective mechanism of action. Universal and early pathogenetical mechanism of many diseases of central nervous system, leading to the development of cognitive impairments, including Alzheimer’s disease, is Ca2+ dyshomeostasis. In this connection, the use of drugs, regulating Ca2+ metabolism in neurons in treatment of patients with pre-dementia cognitive impairments, especially high brain penetrance drugs, is potentially well-grounded. The article gives the data review of modern researches, studying the efficiency and safety of nimodipin a selective Ca+ channel blocker of the 2 class. The article provides examples of the use of nimodipin in treatment and prevention of pre-dementia syndroms of various genesis: Alzheimer’s disease, chronic brain hypoperfusion damage, post-radiation and postoperative cognitive dysfunction, etc. The article presents experimental data about nimodipin use in the prevention of postoperative delirium in elderly people and in the treatment of non-cognitive neurological disorders. Justification of the perspectives of the application area extension and directions for the further research of nimodipin are as well given in the article.

Introduction. Allergic syndromes occur in 85.7% of COVID-19 survivors, according to recent statistics. However, there is no clear understanding of the pathogenesis of post-COVID pain syndrome and no therapy algorithms have been developed.

Aim. To study the efficacy and safety of Alflutop (the bioactive concentrate from small sea fish (BCSSF)) in COVID-19 survivors with pain syndromes in the lower back (lumbosacral dorsopathy (LSD)) and osteoarthritis (OA)), who were previously treated with other chondroitin sulphate (CS) drugs.

Materials and methods. The study group included 50 patients with persistent pain in the lower back according to VAS scale (6.6 ± 1.5 scores) without chronic diseases, pain lasted for more than 1 month. The average age was 55.7 ± 3.5 years, 30 men and 20 women, who had mild or moderate COVID-19 in the period of 40 to 90 days before the study. Some patients had been previously diagnosed with LSD before they contracted COVID-19 and had exacerbations 1-2 times a year. Most of the patients also suffered from large-joint OA. Of all patients, 10 were primary patients (before COVID-19 was diagnosed) and received therapy with non-steroidal anti-inflammatory drugs and CS prior to enrolment in the study. The clinical examination provided to all patients included recording of complaints, medical history, a standard examination of the neurological status at visit 1, 2 (day 14–15), 3 (completion of therapy, 30 days after initiation of therapy) and 4 (2 months after visit 1). The pain was assessed according to VAS, and depression symptoms were measured according to the Hospital Anxiety and Depression Scale. At visit 3, the patients were assessed according to the Clinical Global Impression scale. The standard laboratory test results were analysed.

Results. After administration of BCSSF, a pronounced relief of pain and high anxiety was observed in all patients by Day 14. 80% of patients had no pain syndrome without changes in laboratory test results by visit 4. The majority of patients evaluated their condition as good according to the Clinical Global Impression scale.

Conclusions. Early administration of BCSSF is topical in the therapy of post-COVID allergic syndromes.

Introduction. It is now recognized that stress plays an important role in the occurrence and exacerbation of chronic pain syndromes. Stress has a modulatory effect on the structures of the nervous system depending on the nature, duration and intensity of the stressor which is reflected in the clinical characteristics of pain.

Aim. To study the features of the clinical characteristics of chronic localized pain syndromes depending on the presence of psychosocial stressors at the onset of pain.

Materials and methods. The study included 118 patients with chronic localized pain syndromes 38 men (32.2%) and 80 women (67.8%) aged 19 to 66 years (mean age 41 ± 11 years). Depending on the presence of premorbid psychosocial stressors at the onset of pain patients were divided into two groups group I (main), group II (control). The research methods included a general clinical assessment of the pain syndrome characteristics, an assessment of the emotional state, psychosocial indicators and quality of life using special scales and tests. Statistical analysis was carried out using the StatTech v. 2.6.1.

Results. Patients of group I experience more than 4-6 episodes of exacerbations per year, the duration of pain is from 8 to 28 days, affecting an average of 4 (3; 6) localizations, using more descriptors (p < 0.001, p = 0.013, p = 0.014, p=0.017, p=0.002 resp.), more likely to suffer from headaches and cervicalgia (p = 0.004 and p < 0.001 resp.), use on average 4 (2; 5) drug group for pain relief (p = 0.004). Among patients with premorbid psychosocial stressors the proportion of women is 6.5 times higher (p < 0.001). A significantly greater number of patients with sleep disorders and anxiety were identified in group I (p < 0.001, p = 0.009 respectively), the total score in assessing fatigue was 24 (19; 39) points which corresponds to moderate fatigue (p = 0.009). The average stress score on the Holmes-Rahe scale was 80 (53; 102) (p < 0.001), the main stressful events are work-related problems. Direct statistically significant relationships between the level of stress and the characteristics of the pain syndrome were established the number of pain localizations, the intensity of pain, the number of descriptors (p < 0.001, p < 0.001, p < 0.001). The life quality index was 2 (2; 4) scores according to the EQ-5D-3L questionnaire which indicates   a decrease in the quality of life (p < 0.001) in group I. It was noted that the chances of stress onset of pain in an active lifestyle are 3.4 times lower (p = 0.012).

Conclusion. Premorbid psychosocial stressors are markers of the severity of chronic pain and affective distress. At the same time premorbid psychosocial stressors can be considered a modifiable factor. If it is assessed and recognized in time, the development of chronic pain and associated affective distress can be eliminated and potentially prevented.

Headache is a common symptom of both the acute and post-COVID-19 periods which often persists for a long time. Headache is the leading symptom among all the neurological manifestations of COVID-19, and it also can be a severe deconditioning disorder in about one fifth of patients. A new type of headache may occur or an existing primary cephalal gia pattern may worsen in a patient with COVID-19. During the acute period of infection, cephalgia in most patients can be considered as a headache associated with acute viral infections. However, other forms such as a cough headache, exertional headache, etc. are often considered. In these cases, cephalgic manifestations correlate with other COVID-19 symptoms. The long-term persistent headaches, as one of the most frequent and persistent symptoms of the post-COVID syndrome, often occur according to the type of tension headaches and migraines and are significantly more often detect ed in people with a prior history of cephalalgia. The diversity of headache phenotypes in COVID-19 requires the involve ment of universal strategies for their management. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most widely investigated and commonly used to relieve pain in clinical practice, as well as fever and other symptoms of infection. The long-term experience with the use of NSAIDs in clinical practice, the availability of clinical data and the results of special studies reveal the possibility of their usage in patients with COVID-19 and complaints of headaches. However, a thorough analysis of current records of their use in patients with COVID-19 is required for the effective and safe use of NSAIDs in this category of patients.

Introduction. Chronic migraine (CM) is a neurological disease which is often comorbid with chronic insomnia (CI). The interdisciplinary approach including the cognitive behavioural therapy (CBT) is recommended for the treatment of patients with CM and comorbid CI.

Aim. To evaluate the effectiveness of the interdisciplinary treatment program including CBT in the treatment of patients with CM and CI. Materials and methods. A total of 54 patients with CM and CI (19 men and 35 women, mean age 34.1 ± 8.5 years), were enrolled in the study. The clinical and psychological characteristics were assessed before and after treatment (at Month 3, 6, 12) using interviewing, testing, headache and sleep diaries. All patients received the interdisciplinary treatment, including pharmacotherapy, discontinuation of pain medications in the presence of drug-induced headache (DIHA), CBT for headache and insomnia.

Results. Three months after treatment, there was a statistically significant decrease in mean scores for headache frequency, pain drugs dosing interval, insomnia severity index, as well as according to the Spielberger Khanin's Reactive and Personal Anxiety Scale, Beck Depression Scale, Impact of Migraine on Daily Activities Scale (p < 0.05). The achieved improvements were maintained at Months 6 and 12 of the follow-up period. At Month 3, 35 (65%) patients achieved a clinical effect in the treatment of CM: the frequency of headache decreased by 50% or more, 41 (76%) patients achieved a clinical effect in the treatment of CI: the insomnia severity index decreased by 8 scores and more. At Month 6, 42 (77.8%) patients had a clinical effect in CM therapy, and 44 (81.5%) patients in CI therapy. The achieved clinical effects have been shown to be maintained by Month 12 of the follow-up period.

Conclusion. The interdisciplinary program including CBT is effective in the treatment of patients with CM and CI over the shortand long-term horizon.

The article deals with the diagnosis of dizziness as one of the most common reasons for contacting the primary care system. The term “vertigo” refers to the illusory sensation of the rotational movement of objects around the patient or the patient himself. Traditionally, the clinic distinguishes “systemic” and “non-systemic” dizziness. However, the use of these two terms “systemic” (rotational) and “non-systemic” (presyncope, imbalance caused by a violation of the neural mechanisms for maintaining balance and balance of the body and postural phobic) dizziness can make it difficult to diagnose the etiological factor due to the ambiguity of the term “non-systemic”. The most severe and painful for the patient is rotational dizziness. Most often, dizziness is caused by pathological changes in the peripheral part of the vestibular system: vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease. Treatment of patients with dizziness involves etiopathogenetic and symptomatic therapy. Important, from a practical point of view, is the relief of rotational dizziness itself, regardless of its etiology. A number of studies have shown the possibility of using the combined drug cinnarizine 20 mg + dimenhydrinate 40 mg in the treatment of peripheral and central vertigo. The effectiveness of therapy for dizziness with the use of a combined drug is due to the fact that one component (cinnarizine) acts mainly on peripheral structures (labyrinth), and the second (dimenhydrinate) – on central (vestibular nuclei and related centers of the brain stem) structures, providing a good vestibulolytic effect . The drug has minimal undesirable effects, which makes it possible to use it in patients of different age groups. In the article, the authors consider the effectiveness  of a fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg for the treatment and prevention of rotational verti go (vertigo) of various etiologies with the analysis of clinical cases.

Insomnia is a common disorder among the general population, which has a chronic course and a heavy burden on patients and the health care system. Epidemiological papers on sleep disorders show that a large number of people complain of sleep disorders. Today, there are several classifications and definitions for sleep disorders, and first of all for insomnia. Insufficient sleep can contribute to the occurrence of rapid fatigue during the daytime, reduced activity, attention and efficiency. Studies have shown that long-term and severe sleep disorders can lead to and/or exacerbate various somatic, neurological and mental diseases. Insomnia can contribute to cognitive impairment. Although both non-pharmacological and pharmacological interventions are available, drugs are more often prescribed due to greater availability. Cognitive behavioural therapy for insomnia is recommended as the first line treatment for adults of any age. Pharmacological intervention may be offered, if cognitive behavioural therapy for insomnia is not enough effective or not available. At the same time, the pharmacotherapy for sleep disorders remains problematic despite a large number of sleeping pills. Sleeping agents that are widely used in medical practice both in terms of their mechanisms of action and final results such as their effect on sleep do not always contribute to the development of natural (or at least close to physiological) sleep. Benzodiazepines, benzodiazepine receptor agonists, antidepressants, antihistamines, antipsychotics, melatonin, and phytotherapeutic medicines can be used to treat insomnia.

PTSD was determined as a stand-alone disorder about 50 years ago, and since then it is considered to be in the focus    of attention of the mental health specialists. It’s main clinical features are the set of symptoms of re-experience of the traumatic event in here and now situation. They are defined to be the core symptoms for PTSD diagnostic. Clinical features and disorder course are the subject of wide prospective cohort studies with the use of the standardized psychometric instruments since the 80-s of the last century. In the new ICD-11 mental disorders classification, stress-associated disorders are defined as stand-alone rubric, the core PTSD symptoms are defined, the complex PTSD is proposed as a new diagnosis for the coding of persistent caused by prolonged psychotraumatic experience personality changes, the life-threatening diagnosis and intensive care unit experience were added to the list of PTSD triggers. The PTSD diagnosis is considered to be a challenging clinical task. The connection between symptoms manifestation and extreme traumatic experience should be established, one should take into consideration the existence of possible usually several weeks before symptoms manifestation latent period. It is useful to implement the recommended diagnostic instrument for the diagnosis verification and symptoms dynamic evaluation. The combination of pharmacotherapy and psychotherapy is recommended for PTSD treatment, individual approach should be used in case-management. In 2022 WFSBP Task Force on Treatment Guidelines for Anxiety, O and Post-Traumatic Stress Disorders have been published, there for the first-time cognitive behavior psychotherapy was determined as highly evidence based PTSD psychotherapeutic method of treatment. In March 2023 ministry of health of the Russian Federation has approved national PTSD clinical guidelines, where recommended medication list  has been proposed taking into account the national clinical experience, in particular it includes a wide range of non-benzodiazepine anxiolytics. The article emphasizes the opportunities of their use and presents a clinical vignette where etifoxine is proposed as treatment of choice.

Anxiety disorders are widespread in the population and in general medical practice and have a pronounced negative impact on the quality of life and functioning of patients. Currently, the prerequisites for the diagnosis and treatment of anxiety disorders outside the psychiatric network are accumulating by therapists, general practitioners and other non-psychiatric doctors. A review of the most significant factors contributing to a wider diagnosis and treatment of anxiety disorders in general medical practice is given. This review presents modern ideas about the pathogenesis of anxiety disorders, substantiates the modern idea of their multifactorial nature, the contribution of genetic and epigenetic, psychological and social factors, outlines the concepts of the neurobiological basis of pathological anxiety based on neuroimaging studies. In the future, information is provided on the general manifestations of anxiety disorders, the main clusters of anxiety, the systematics of anxiety disorders according to ICD-10. Modern ideas about the diagnosis of anxiety disorders using both scales and a clinical approach are given, a detailed review of currently available diagnostic scales validated for clinical practice is presented. The main approaches to conducting a clinical conversation are also presented, recommendations are given for the most successful collection of information about the clinical condition of patients. At the end of the review, information is given on existing approaches to psychopharmacotherapy and psychotherapy of anxiety disorders. Taking into account pharmacological and clinical studies, the place of drugs tofisopam (an atypical allosteric modulator of GABA receptors) and buspirone (a partial agonist of serotonin 1A receptors) in the treatment of anxiety disorders in general medical practice has been argued.

The role in the body and the biological significance of the pineal hormone melatonin is discussed. Data are presented on the effect on biological rhythms in humans and animals, as well as on the sleep in general. In diurnal humans and animals, melatonin acts on the suprachiasmatic nuclei of the hypothalamus to dampen the wake-stimulating signal of the internal clock, thereby promoting sleep. Data are presented on the clinical use of melatonin in sleep disorders: Circadian Rhythm Sleep-Wake Disorders (jet lag syndrome, delayed sleep phase syndrome, irregular cycle), parasomnias (Rapid-Eye Movements Sleep Behavior Disorder) and insomnia. A significant effect of melatonin preparations with a high level of evidence was confirmed in Circadian Rhythm Sleep-Wake Disorders, less pronounced in Parasomnias. The effects of melatonin, used as a drug for jet lag, have the greatest degree of evidence. The melatonin preparation is recommended to be taken both before the flight and at the new place of stay in accordance with the time of its evening secretion in this time zone. In delayed sleep phase syndrome, the onset of melatonin secretion is delayed, reflecting a general lag in the body’s internal clock. Taking melatonin preparations leads to a shift in the sleep-wake cycle to an earlier time. In REM sleep behavior disorder, melatonin preparations to reduce excessive motor activity are preferred over benzodiazepines, since this disorder manifests itself in people of older age groups, and an undesirable effect on cognitive functions should be avoided. In chronic insomnia, the effect of melatonin significantly exceeds the placebo effect and is most pronounced in people of older age groups.

The article presents the modern definition of osteoarthritis (OA) not as a degenerative cartilage injury, but as a disease in which abnormal adaptive regenerative processes are activated, including pro-inflammatory pathways of the immune system, based on the clarification of the pathogenesis of the disease. An approach to the separation of various OA phenotypes is described. Various approaches to the tactics of pharmacological treatment of the disease are presented. The possibilities of the glycosaminoglycan-peptide complex to influence the state of chondrocytes and cartilage tissue in various experimental models of induced OA are described. And in the last experimental study, a positive effect of the drug on the clinical manifestations of 2 models of induced OA was demonstrated, a decrease in the concentration of CRP, interleukin 1β was recorded with  an increase in the concentration of anti-inflammatory cytokines (interleukins 4 and 10), a significant decrease in the number of leukocytes in the synovial fluid, as well as a decrease in pathological changes in cartilage during histological examination, which it indicates that the drug exerts its effect directly in the tissues of the joint. Clinical studies have confirmed the analgesic and anti-inflammatory activity of the glycosaminoglycan-peptide complex in OA, although not all conducted in the twentieth century, the positive effect on joint pain and joint function was significantly better than placebo. The absence in these years of regulated criteria for inclusion in studies of the effectiveness of pharmacological drugs in OA, the introduction of new methods for assessing pain, function served as a prerequisite for conducting studies of the effectiveness and tolerability of the glycosaminoglycan-peptide complex at the present stage. Multicenter observational studies, which included massive groups of patients with OA of various localization, confirmed the presence of analgesic and anti-inflammatory activity in the drug, manifested during the 1st course of injections, showed that repeated courses of drug administration are necessary to achieve a more pronounced and stable effect. Data on an increase in the effect of combination therapy with diacerein and on the possibility of achieving an effect in patients with previous insufficient efficacy of other slow-acting symptomatic drugs are presented.

Introduction. The development of osteoporosis (OP) increases healthcare costs and often leads to disability of patients. In this regard, the search for ways to improve the effectiveness of OP treatment is very relevant. Today, there is a wide range of drugs for the effective correction of bone metabolism. However, low patient compliance in real clinical practice significantly reduces the effectiveness of therapy.

Aim. To study the effect of patient compliance on the effectiveness of Zoledronic acid and Denosumab in OP in real clinical practice.

Materials and methods. Study design: a retrospective analysis of outpatient records of 300 patients with OP, who were prescribed Zoledronic acid or Denosumab in 2019, with a prospective analysis of adherence to therapy for 3 years.

Results. It was revealed that 12% of patients did not start pathogenetic therapy for OP (control group). 88% (264 patients) started pathogenetic therapy: of these, 22.33% (67 patients) preferred therapy with Denosumab; 65.67% (197 patients) – Zoledronic acid. After 1 year, therapy with Denosumab 19.4%, Zoledronic acid – 19.29% was discontinued. More than 1 month late with the next injection of the drug: Denosumab – 25.37%, Zoledronic acid – 16.24% of patients. Only 55.22% who received Denosumab and 64.47% who received Zoledronic acid fully complied with the recommendations. Most often, a violation of the schedule of drug administration was observed in patients over 75 years of age, alone, with impaired cognitive status. Discontinuation of therapy with Denosumab or violation of the schedule of its administration led to an increase in the level of bone resorption (C-telopeptide type I collagen (CTX-1)). During therapy with Zoledronic acid, there was no increase in CTX-1. In addition, the cost of course treatment with Zoledronic acid is 2–3 times less than with Denosumab.

Conclusion. In real clinical practice, zoledronic acid has clinical and pharmacoeconomic advantages, especially in patients with expected low adherence to OP therapy.

Management of patients with primary osteoarthritis (OA) is often a difficult task due to the specifics of the course of the disease, comorbidity, and low compliance of patients to treatment methods, including symptomatic slow acting drugs (SYSADOA). More than half of the surveyed practitioners (62.2%) express doubts about patients’ adherence to SYSADOA treatment. The described clinical observation demonstrates difficulties in the treatment of primary OA in a patient with comorbidity and low compliance. A three-year course therapy of orally administered SYSADOA did not have a significant effect, and new joints were involved in the process. Thus, the patient was offered a shorter course of therapy (10 injections) with a drug from the SYSADOA group. Its active component is a bioactive extractextract from a small sea fish (Ambene® Bio), created using a unique patented technology. There have been studies of the drug and its clinical efficacy described in literature. In the described case, a short course of therapy contributed to an increase in compliance to treatment. A repeated course of 10 injections every other day was carried out after 6 months. At the same time, the patient refused to take non-steroidal anti-inflammatory drugs. Subjective improvement was confirmed by laboratory and instrumental methods.

Introduction. The problem of treatment of osteoarthritis (OA) remains relevant due to the high prevalence of the disease, the insecurity of drugs used by patients in the treatment of pain. The knee joints are most often affected. Chronic pain, impaired joint function significantly reduce the quality of life of patients, lead to the destabilization of concomitant diseases. In the complex therapy of OA, local remedies are widely used.

Objective. To study the effectiveness of ketorolac for external use (KEU)in the complex therapy of osteoarthritis of the knee joints (OAKJ).

Materials and methods. 58 patients with OAKJ of II-III radiological stages were studied. The main group (n = 30) in the complex treatment of the disease used KEU locally for two weeks. In the control group (n = 28), as in the main one, physiotherapy, nonsteroidal antiinflammatory drugs (NSAIDs) were used, KEU was not prescribed.

Results. The values of VAS at rest and when walking after a week of treatment significantly differed from the initial values in the main group of patients (p < 0.01 for VAS when walking, p < 0.05 for VAS at rest). The WOMAC pain index was also significantly lower than its initial values (p < 0.01). Positive dynamics of clinical indicators was also observed in the control group, however, there were no significant differences after a week of therapy for both your VAS at rest and the WOMAC function index. The reliability of the differences with the baseline in the main group was maintained after two weeks of observation, and the value of the WOMAC function index was significantly different (p < 0.01). In the control after two weeks of treatment, the values of the severity of pain according to VAS at rest, the index of WOMAC function did not reach significant differences with the baseline. After a week and two weeks of treatment in the main group, positive results were achieved in 17 (56.3%) and 23 (76.6%) patients, respectively. In the control group, positive therapy results were observed in 13 (46.4%) and 18 (64.2%) patients, respectively, at the control periods of observation.

Сonclusion. The use of KEU is effective and appropriate in the complex therapy of OAKJ.

Acute and chronic stress conditions have an adverse effect on human health at any age and are related to the psychosocial risk factors for chronic non-communicable diseases, increasing the risk of occurrence and development of not only cardiovascular, but also other common diseases such as diabetes mellitus, obesity, broncho-obstructive diseases, ulcerative lesions of gastrointestinal tract, etc. The negative effect of stress on the human health is effectuated both through endogenous pathophysiological changes and through behavioural disorders such as physical inactivity, malnutrition, smoking, alcohol intake, etc. It has also been shown that psychosocial risk factors significantly aggravate the clinical course of existing diseases, significantly reduce adherence to treatment, worsen quality of life, increase the risk of disability and expenditures paid in the healthcare system in patients with chronic non-communicable diseases. Thus, acute and chronic stress have a negative effect on the physical, mental and emotional health, that's why the right choice of both preventive measures and timely management is very important. The combination of non-pharmaceutical effect, including training in stress resistance skills, proper response and emergency self-help in a stressful situation, with the prescription of effective pharmacological therapy can be considered as the optimal strategy. Valocordin® available in the form of drops or tablets represents a combination of low doses of phenobarbital with ethyl bromisovalerianate and plant components, which enhances the positive effects of the combination due to functional.