In early February, the Art of Seeing the Truth scientific and educational forum was held in  Moscow. It was aimed to dispel the myths around the domestic drug Kagocel®. The event planner is one of the leading Russian pharmaceutical manufacturers Binnopharm Group LLC. Well-known Russian academicians and professors – leading clinical pharmacologists, pediatricians, internists, infectious disease specialists and pulmonologists spoke to the forum participants. 

The risk of venous thromboembolic complications among pregnant women and puerperas is higher than in the general population, which is due to traditional risk factors, as well as physiological and anatomical changes that occur during pregnancy. Symptoms and signs of venous thromboembolic complications during pregnancy are often nonspecific and may coincide with the consequences of changes, including dyspnea, limb edema, and tachycardia. D-dimer levels may be elevated during ongoing pregnancy, limiting its use as a laboratory marker. Identification of the source of thromboembolism in the veins of the lower extremities can be difficult due to the proximal localization of thrombosis in pregnant women, the rare detection of thrombi in this area is associated with incompressibility of the veins due to their intrapelvic location, as well as with altered blood flow mechanics. The main method of treatment is the use of low molecular weight heparins, however, in case of massive thromboembolism, leading to hemodynamic instability and a  high risk of  mortality, thrombolytic therapy is indicated. Thrombolytic therapy is associated with an increased risk of hemorrhagic complications. The use of warfarin and direct oral anticoagulants during pregnancy is contraindicated due to the possibility of penetration of drugs through the placental barrier. The article presents a clinical case of successful thrombolysis in a patient with pulmonary embolism in late pregnancy. The chosen tactics of management corresponded to the clinical guidelines and made it possible to successfully treat pulmonary embolism without complications for the mother and fetus. Drugs were used that do not penetrate the placental barrier and do not have teratogenic effects.

Introduction. Early diagnosis of FH is generally low. This leads to the early formation of atherosclerotic cardiovascular diseases (ACVD) and increases the risk of cardiovascular complications in young and middle-aged people.
Aim. Identification of HeFH patients using the Dutch Lipid Clinic Network Criteria based on the analysis of electronic databases of two observational registries.
Materials and methods. 3,895  persons were selected from 10,606  participants in  the Duplex and Laboratory registries based on the presence of TC and LDL-C indicators registered in the databases and the criterion of age up to 60 years. Dutch Lipid Clinic Network Criteria (DCLN) were used as criteria for HeFH: “definite” in the presence of >8 points, “probable” in the presence of 6–8 points, “possible” FH in the presence of 3–5 points. The “definite” and “probable” groups were combined into “potential” FH group.
Results. LDL-C levels ≥5 mmol/l and ≥6.5 mmol/l were detected in 8.7% and 0.7% of study participants, respectively. Among them, only 2 patients with DLCN criterion >8 points were identified. Potential FH was found in 13 patients. When recalculated per 100,000, the average prevalence of potential FH was 334/100,000 people (0.33%).
Conclusions. Opportunistic screening is an affordable and effective tool in the hands of clinicians to optimize the detection of FH patients. It is advisable to use DCLN criteria, which are optimal as FH criteria. A well-proven method for analyzing electronic databases based on the  study of  electronic medical records, the  use of  a “potential” FH model and automated integration of the obtained data can significantly facilitate the task. Studies on larger cohorts of patients are needed to improve the detection of FH among young people.

Introduction. Pulmonary embolism (PE) is one of the leading causes of death even in hospitalized patients. The standard treatment results are disappointing. Since 2004, we have tested a new method for the treatment of hemodynamically insignificant PE (own patent RU2224525C1) by using unfractionated heparin (UFH) in ultrasound inhalations with a nebulizer, since 2014 – in combination with apixaban. Aim. To improve the treatment of PE. Materials and methods. The hospital mortality rate of 713 patients of the cardiac intensive care unit with hemodynamically insignificant PE  (from January 1, 2002  to December 31, 2017) was studied. Since 2004, patients have received ultrasound UFH (5000 units twice a day). Since 2014, nebulased UFH has been supplemented with the use of apixaban (10 mg twice a day for 7 days and 5 mg twice a day thereafter). Results and discussion. There is a distinct tendency to the PE hospital mortality decrease, coinciding with the nebulased UFH use (illustrated by a diagram). Neither the systemic bleeding nor the heparin-induced thrombocytopenia were observed. Clinical cases show first reduction of  perfusion disorders are seeing scintigraphicaly in  7  days. Unlike LMWH UFH is recommended in severe kidney damage and obesity, thus ultrasound technique has advantages in such patients. Conclusions. Nebulased UFH is an available, simple, safe and effective in treatmtnt of hemodynamically insignificant PE, especially with the use of apixaban. A real improvement in lung perfusion takes 1 week, as shown scintigraphically.

Introduction. The high morbidity and mortality from heart disease determines the relevance of improving the methods of treatment and rehabilitation for this pathology. However, many issues of long-term complex use of balneohydrotherapy and preformed physical factors in this disease have not been studied enough.
Aim. To study the possibilities of long-term complex use of general fresh baths and amplipulse therapy in the rehabilitation treatment of patients with coronary heart disease with stable angina. functional class II.
Materials and methods. A prospective single-center controlled randomized study was carried out. 107 people were under observation: male patients with CHD with stable angina pectoris FC II, disease duration from 5 to 10 years. The study participants were divided into three age-matched groups (mean age 50 ± 2 years): 1) were prescribed fresh baths and amplipulse therapy (effect on the heart area) according to the generally accepted method, while physical factors were prescribed every other day, and the duration of treatment was 1 month; 2) were prescribed fresh baths and amplipulse therapy according to the same method for  a  duration of  treatment of  3  months; 3) control  – fresh baths and therapeutic exercises were prescribed for  1  month. Rehabilitation was carried out against the background of drug therapy. The evaluation of the results was carried out by functional methods: 24-hour Holter ECG monitoring, spiroergometry, exercise test.
Results. Analysis of the results of the exercise test (bicycle ergometry, spiroergometry) showed that long-term complex use of fresh baths and amplipulse therapy in CHD patients provided a more pronounced training effect and an increase in the coronary heart reserve than a monthly course of fresh baths and amplipulse therapy or fresh baths and therapeutic exercises. The training effect of long-term complex use of fresh baths and amplipulse therapy leads to an increase in the level of physical performance, coronary reserve of the heart, a decrease in myocardial ischemia and an average number of ventricular (1-3 class according to B. Lown) and supraventricular arrhythmias (extrasystoles) per day. 24-hour Holter ECG monitoring confirms these data.
Conclusion. Long-term complex use of fresh baths and amplipulse therapy allows to increase the efficiency of rehabilitation treatment in CHD patients.

Introduction. The study of myocardial damage in COVID-19 and hemorrhagic fever with renal syndrome (HFRS) is relevant, especially for HFRS-endemic regions.
Aim. Comparative study of clinical and electrocardiographic signs of myocardial damage in HFRS and COVID-19.
Materials and methods. A retrospective comparative analysis of clinical data, ECG and troponin test was performed in patients with HFRS (n = 62) and patients with COVID-19 (n = 30) of moderate and severe forms.
Results. The heart rate (HR) in the group of patients with HFRS is less than in the COVID-19 group (p < 0.05). The average value of systolic blood pressure in both groups refers to normotension, in the group of patients with HFRS is significantly lower than the same indicator in the group of COVID-19 patients. According to the results of an ECG study of patients with COVID-19 (n = 30), sinus rhythm was observed in 30 (100%), sinus tachycardia – in 2 (6.6%), sinus bradycardia – in 6 (20%), while differences in the frequency of sinus bradycardia in comparison with patients with HFRS are statistically significant. AV blockade of the 1st degree is observed in both diseases, in the group of HFRS with a higher frequency, but the differences are unreliable. Prolongation of the QT interval was found in patients in both groups, with coronavirus infection (13.3%) more often than with hantavirus infection (3%), the differences are statistically insignificant. ECG in patients with HFRS with lung damage shows signs of overload of the right atrium, unlike in patients with COVID-19. Troponin was positive in two patients in each group: two patients with HFRS had myocarditis, one patient with COVID-19 had acute coronary syndrome.
Conclusion. Myocardial damage in both hantavirus and new coronavirus infections has common features due to a systemic inflammatory reaction, electrolyte disorders, and significant differences.

Since the early months of the SARS-CoV-2 pandemic, the understanding that severe forms of COVID-19 are associated with systemic inflammation has spurred the medical community to greater efforts to evaluate the effect of numerous anti-inflammatory and immunomodulatory therapies. Corticosteroids have a broad and non-specific anti-inflammatory action; they can interfere with mRNA transcription of inflammatory cytokines, reducing the production of inflammatory mediators. Therefore, the use of glucocorticoids will reduce the complications caused by the cytokine storm. On the other hand, immunosuppression in the respiratory epithelium may delay viral clearance and predispose to secondary infections and clinical deterioration. Therefore, WHO does not currently recommend the routine use of corticosteroids in the treatment of patients with COVID-19. The RECOVERY study showed a reduction in mortality with dexamethasone in patients with COVID-19 hypoxemia, as well as an increase in the number of days without mechanical ventilation among critically ill patients. The REMAP-CAP Committee concluded that among patients with severe COVID-19, treatment with a 7-day course of various hydrocortisone dose versus no hydrocortisone resulted in 93 and 80% chances of eliminating the need for respiratory and cardiac support for 21 days. The results of studies conducted show that there was no statistical difference between steroid use and mortality in patients with COVID-19 in the high dose group, while there was statistical difference in the medium dose group. The less 5 days group showed a strong association between reduced mortality in patients with COVID-19 and steroid use, while there were no statistically significant associations in the 5–7 days group and the more than 7 days group. Inhaled forms of corticosteroids deserve attention given their effectiveness and logical use.

Introduction. The material presents the results of the study of the effectiveness of the drug Ethylmethylhydroxypyridine malate in  patients with long COVID, based on the  dynamics of  clinical manifestations and metabolomic parameters responsible for the level of oxidative stress.
Aim. Evaluation of efficacy and registration of adverse reactions of ethylmethylhydroxypyridine malate administration to decrease oxidative stress level and reduce symptoms of asthenia and cognitive disorders in patients with long COVID.
Materials and methods. 24 patients diagnosed with U09.9 “Condition after COVID-19 unspecified” were included in a non-randomized controlled prospective study, Patients were divided into 2  groups of  12  each. The experimental group received Ethylmethylhydroxypyridine malate tablets chewable 100 mg in a dosage of 400 mg/day. Clinical assessment by scales (mMRC dyspnea scale; 6-minute walk test  (6MWT); MFI-20  subjective asthenia assessment scale; Montreal Cognitive Assessment Scale (MoCA); Barthel Baseline Functional Activity Rating Scale), and determination of metabolomic parameters were performed on days 1 and 14–18 of the study.
Results. Use of the drug ethylmethylhydroxypyridine malate in patients with long COVID, led to a decrease in the level of oxidative stress, and normalization of  mitochondrial function, as well as more pronounced improvements of  the clinical picture. According to the scale of evaluation of asthenia (MFI-20) in the group of patients who received ethylmethylhydroxypyridine malate improvement of 21% was noted, in the control group improvement of 13% was noted. According to cognitive impairment assessment scale (MoCA), the drug group showed 20% improvement, while the control group showed 12,5% improvement.
Conclusion. The drug ethylmethylhydroxypyridine malate tablets chewable 100 mg in a dosage of 400 mg/day demonstrates clinical efficacy characterized by, among other things, a decrease in oxidative stress, as well as clinical safety due to the absence of development of adverse reactions in patients with long COVID.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a structurally diverse group of drugs with a common mechanism of action (reversible inhibition of  cyclooxygenase). They are widely used due to their analgesic, antipyretic and anti-inflammatory properties; available both as prescription and over-the-counter medications; available as individual pharmaceuticals, compound painkillers. The methods of treatment of acute and chronic pain are different. For acute pain, analgesics such as nonsteroidal anti-inflammatory drugs and opiates are commonly used, sometimes in combination with regional anesthesia such as peripheral nerve blockade or peridural local anesthesia. A systematic review and meta-analysis of the efficacy and safety of nimesulide published in the sources MEDLINE/PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure. The efficacy and safety of the use of nimesulide in clinical practice is shown. In particular, in the treatment of acute musculoskeletal pain (dorsopathy of the cervical-thoracic and lumbar region), as well as migraines, due to a  decrease in  the release of  calcitonin- gene related peptide (CGRP) and prostaglandin E2 (PGE2) from the trigeminal ganglia, while other NSAIDs have shown a lack of efficacy. Noncompliance with international guidelines, irrational use of NSAIDs among all groups of drugs is one of the leading causes of hospitalizations associated with side effects, which increases health care costs. The article presents an overview of the safety and efficacy of medicines containing nimesulide, as well as recommendations for patients and prescribers of this drug.

Psycho-emotional disorders, such as anxiety disorders, acute and chronic stress, are significant risk factors for the development and complicated course of both major cardiovascular and other common chronic non-communicable diseases. The psycho-emotional disorders significantly reduce patients’ motivation and adherence to lifestyle changes and drug therapy, significantly worse quality of life, increase the risk of disability and healthcare system expenditures. The topicality of the issues of diagnosis and management of psycho-emotional disorders in the general practitioner’s practice is caused, on the one hand, by high rates of these disorders in patients with cardiovascular and other chronic diseases, deterioration in quality of life and an increase in adverse outcomes, and on the other hand, inadequate awareness of the risks associated with the sphere of psycho-emotional status in patients. The management of psycho-emotional disorders includes both pharmacological and non-pharmacological treatments. Antidepressants that fall into the class of selective serotonin or serotonin and norepinephrine reuptake inhibitors are the first-line drugs used for the treatment of most of the disorders discussed. However, prescription of these drugs requires to take into account a wide range of possible side effects in patients with chronic diseases, including CVDs. Drugs that have fast onsets of sedative and anti-anxiety action, also known as tranquilizers, are more widely used in real-world clinical practice. Tofisopam is the most promising from this group of drugs in therapeutic and cardiological practice. The efficacy and safety of tofisopam have been studied in numerous studies in patients with chronic non-communicable diseases and a wide range of anxiety disorders, including the long-term use of the drug.

The article presents modern ideas about the pathogenesis of cognitive disorders in cerebrovascular pathology at the cellular level. Dysfunction of neurovascular units is associated with impaired microcirculation, hypoxia, deficiency of energy resources, development of neuroinflammation, increased nitric oxide synthesis and oxidative stress, glutamate excitotoxicity, intracellular calcium accumulation, endothelial dysfunction, impaired circulation of cerebrovascular fluid, venous outflow from the cranial cavity and utilization of brain metabolic products, including misshaped proteins. The above determines the possibility of the combined development of cerebrovascular and neurodegenerative diseases, primarily Alzheimer’s disease. Currently, mixed (vascularneurodegenerative) brain damage is considered as the  main cause of  cognitive disorders, which is confirmed by the  data of post-mortem studies. Pathogenetic therapy of dementia with cholinesterase inhibitors and memantine does not eliminate the cognitive defect, but only slows down its progression. The impossibility of restoring the premorbid level of daily activity of the patient in the treatment of cognitive impairment at the stage of dementia dictates the need for the use of adjuvant nootropic and neuroprotective agents until the breakdown of the functional reserve, that is, at the stage of moderate cognitive impairment. Nicotinoyl gamma-aminobutyric acid has nootropic, tranquilizing, psychostimulant and antioxidant properties. Studies of the last decade have proven the ability of nicotinoyl gamma-aminobutyric acid to suppress neuroinflammation and apoptosis of  cells of  the central nervous system, increase the  expression of  angiogenic and cytoskeletal proteins, normalize the  permeability of  the blood-brain barrier, which can be used to improve the  function of  neurovascular units and correct vascular-neurodegenerative cognitive impairment. A small number of drug interactions with nicotinoyl gamma-aminobutyric acid allows it to be included in the complex therapy of comorbid patients.

Anxiety disorders are widespread in general medical practice, being the reason for seeking medical help from doctors of various specializations. Certain difficulties in the diagnosis and development of patient management tactics are caused by the variety of clinical manifestations of anxiety disorders. Often they are associated with somatic manifestations. Benzodiazepines, antidepressants, anticonvulsants, antipsychotics, antihistamines, and beta-blockers are traditionally used to treat these conditions. A limitation to their use are adverse events, the risk of which increases in the elderly. Modern pharmacology pays special attention to the safety of drug therapy, which makes the choice of a drug a responsible step. In subclinical anxiety disorder with somatic manifestations in outpatient practice, herbal sedative preparations or preparations based on them are used, which have a favorable safety profile with sufficient effectiveness. The drugs of choice are drugs based on herbal raw materials that have sedative, cardiotonic, moderate hypotensive and antispasmodic effects, which corresponds to the objectives of therapy, including in comorbid and elderly patients. The presence of a variety of pharmaceutical forms allows you to choose the drug, taking into account the individual needs of each individual patient. The currently available data on the clinical efficacy of the herbal components of the preparations, good tolerance and safety, subject to all the rules of administration, allow the use of these drugs in general clinical practice. The possibilities of their application are considered in the given clinical observations.

Introduction. The demonstrative example of  unilateral peripheral vestibulopathy is vestibular neuronitis. This disease of infectious-toxic origin has the involvement of vestibular ganglia neurons or vestibular nerve fibers. The overwhelming moment in topic diagnostics of vestibular impairments is within-patient comparison anamnesis data and vestibulometry results. In cases of vestibular neuronitis exception of central vestibular system pathology is mandatory.
Objective. To attain objectification of disequilibrium in vestibular neuronitis by means of registration and assessment of oculogyric and postural reactions.
Materials and methods. Vestibular passport trials are recommended in the examination of patients with acute vertiginous complaints. Special attention has been given to the revelation of impairments of command eye movements, disturbances of ocular pursuit, spontaneous nystagmus, and catch-up saccades in Halmagyi – Curthoys test. Possible impairments of static and dynamic balance control are assessed in modified Romberg test and Unterberger test. Gaze tests with registration of saccadic and pursuit eye movements, spontaneous and optokinetic nystagmus reactions as well bithermal caloric test are carried out in computerized electrooculography and videooculography. Deviations of body gravity center are analyzed with the help of sensory organization test in computerized dynamic posturography.
Results and discussion. The results of screening and computerized vestibular testing of 24 patients are presented. High diagnostic value of registration and analysis of oculogyric reactions as well as postural control signs is demonstrated in cases of acute vestibular neuronitis and acerbation of its chronic recurrent variant. The key objective symptom, which confirms peripheral level of  vestibular dysfunction, is spontaneous nystagmus registration in  elimination of  gaze fixation. Unsteadiness in  static and dynamic trials confirms the vestibular decompensation extent in acute phase of vestibular ganglia / neurons pathology in cases of vestibular neuronitis. Decompensation signs revelation of this peripheral vestibular dysfunction needs urgent medicine: possible etiotropic and obligate symptomatic therapy as well as spare vestibular rehabilitation exercises.
Conclusion. Combination of oculogyric impairments and disturbances of postural control enables to improve accuracy of diagnostics in decompensated stage of vestibular neuronitis.

Introduction. In recent years, diarrheal syndrome is the most common clinically significant negative effect of the antibiotic therapy (ABT), which constitutes a first-priority medical and social problem. The prescription of any antibiotic for any duration of treatment may cause a potential risk of developing antibiotic-associated diarrhea (AAD). In that regard, there is a need for the systematization of the main pathogenetic aspects of the deveopment of AAD and the rationale for the use of probiotics to prevent its development and treatment.
Aim. To conduct a comparative evaluation of the efficacy, adherence and tolerability of a synbiotic Floriosa containing Bifidobacterium lactis Bl-04, Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, inulin, B vitamins, and an eubiotic Bifiform containing Enterococcus faecium, Bifidobacterium longum for the prevention of the development of AAD during and after the use of ABT in inpatients.
Materials and methods. A total of 60 patients, which was used for the ABT in the hospital settings, were included in the study: the 1^st group (30 patients) received a synbiotic, the 2^nd group (30 patients) received an eubiotic. The efficacy of the preventive administration of drugs was assessed by Day 12 and 28 of the therapy. The methods included the patients’ assessment of the efficacy and satisfaction with treatment, an assay of short-chain fatty acids (SCFAs) in feces via gas-liquid chromatography and a Clostridium difficile Toxin A + B rapid test.
Results. No cases of AAD were detected in both groups. The study drugs were comparable in terms of their efficacy assessment by the doctor and patients. A trend towards a higher assessment of the therapeutic effect and satisfaction with synbiotic therapy was observed. Changes in the absolute and relative content of SCFAs in the patients’ feces from the baseline level were established. More pronounced positive changes in the quantitative and qualitative composition of acids due to the treatment were identified in the patients who received the synbiotic and had more than 3 risk factors.
Conclusions. The synbiotic Floriosa and probiotic Bifiform are effective drugs to prevent AAD. The synbiotic has advantages in terms of the overall assessment of the efficacy of the treatment and patient satisfaction, provides a pronounced protective effect on the intestinal microbiocenosis status during and after the ABT (as evidenced by the changes in SCFAs level in the feces), can be the drug of choice for the prevention of AAD, including AAD associated with C. difficile in individuals with more than 3 risk factors for the development of AAD.

Introduction. Dietary nutrition is one of the most important and physiological therapeutic and preventive approaches for chronic reflux gastritis (CRG), not associated with HP infection.
Aim. To analyze the effectiveness and safety of the use of specialized therapeutic nutrition (produced by LEOVIT) in chronic reflux gastritis (CRG), not associated with HP infection, in the acute phase.
Materials and methods. A comparative randomized study included 40 patients with CRG, not associated with HP infection, in the acute phase. During the one-month course, standard diet therapy was used in the control group (20 patients), and in the patients of the main group (20 patients), diet therapy was carried out using specialized dietary products. The dynamics of clinical manifestations, changes in esophagogastroduodenoscopy (EGDS), blood test parameters, and the severity of dysbiosis were studied. Statistical processing of the research results was carried out with the determination of the significance of the mean values using the Student’s t-test.
Results. It was found that the studied specialized therapeutic nutrition (oatmeal porridge with herbs and flax seed, vegetable soup with herbs and oatmeal, gastric jelly LEOVIT) have pleasant organoleptic properties, do not cause intolerance and allergic manifestations, restore digestion, improve the state of intestinal microflora, improve the quality of life of patients. According to endoscopic studies in the esophagus of patients in the main group, compared with patients in the comparison group, “normal” mucosa was statistically significantly more common (95 vs. 60% of cases) and catarrhal esophagitis was less common (5 vs. 40% of cases). The number of patients with an admixture of bile in the lumen of the stomach in patients of the main group compared with patients of the control group was found significantly less frequently in 20% of cases versus 75% of cases.
Conclusion. The investigated approach to diet therapy with the use of specialized therapeutic nutrition in CRG is completely safe and recommended by the authors for long-term use in patients with this pathology. 

Iron deficiency is one of the leading factors in the global burden of disease, affecting mainly children, premenopausal women and low- and middle-income people. With prolonged iron deficiency, iron deficiency anemia (IDA) develops, which, according to the World Health Organization (WHO), remains the most common type of anemia worldwide. The most common causes of IDA include gastrointestinal bleeding, menstrual blood loss and pregnancy in women. Currently, divalent iron preparations are considered the “gold standard” of IDA therapy. To date, there are preparations of divalent iron with delayed release. The advantage of this form is that such drugs are better tolerated, they have a lower incidence of side effects with comparable bioavailability and efficacy compared to conventional forms. Such drugs include Tardyferon®.In our study, it was noted that against the  background of  taking Tardyferon®, the level of ferritin by the end of the 1^st month of therapy in patients with latent iron deficiency increased from 12.4 ± 0.93 to 27.8  ± 4.1 µg/L (p ≤ 0.05). In patients with IDA, it increased from 9.7 ± 1.3 to 25.4 = 5.1 µg/L. By the end of the 3^rd month of treatment, the ferritin level in patients with latent iron deficiency was 200.1 ± 30.8 (p < 0.05), and in patients with IDA – 246.7 µg/L (p < 0.05). We noted a similar dynamic in the hemoglobin level: in patients with IDA, it increased from 97.4 ± 9.3 g/L to 125.8 ± 10.2 g/l (p < 0.05), and in 21 (75%) of 28 patients it reached normal values (more than 120 g/L) by the end of the 1^st months of therapy.By the 3^rd month of  therapy, all patients with IDA had already reached the  target level, and the  average hemoglobin value in  the group was 142.1 ± 5.6 g/L (p = 0.05).Thus, in patients with IDA, against the background of therapy with Tardyferon®, hemogram indicators normalize, the concentration of hemoglobin and ferritin increases by the end of the 1^st month of therapy.

This survey introduces up-to-date statistic data on women’s reproductive health considering current control methods. It includes literature analysis on the contraceptive vaginal ring (CVR) use. Evidential medicine proves that CVR is a long-standing, safe and effective birth control method. CVR usage definitely wins the battle against oral contraception and prolonged contraception methods. The survey includes current patients’ survey results concerning CVR usability particularly during sex. VR’s effect on vagina microbiota and cervix epithelium is also covered, considering the discussions on cervix cancer increase caused by long-term use of combined hormonal contraceptives. Recently, there has been some positive trend towards the protection of reproductive health. However, we have to admit that there are still many unresolved issues, in particular, unavailability of adequate family planning counselling services and advanced effective birth control methods. The pharmaceutical market is saturated with various birth control methods. A careful analysis of medical history details and test results makes it easy to choose the best possible and safe birth control method with due regard of the patients’ wishes. Bearing in mind the less pronounced systemic effect, ease of use, and a favourable safety profile, the choice of CVR as a birth control method seems to be the best solution for women

Introduction. Preeclampsia (PE) and fetal growth retardation (FGR), the main mechanism of which is the pathology of the placenta, directly affect the structure of both maternal and perinatal morbidity and mortality, which determines the medical and social significance of the study of PE and FGR, especially genetic predictors of the development of these complications of gestation.
Objective. To study the involvement of GWAS polymorphism of significant arterial hypertension candidate genes in the formation of FGR in pregnant women with PE.
Materials and methods. The samples for the study included 83 pregnant women with PE in combination with FGR and 369 women with isolated PE who were included in the control group. All women underwent a molecular genetic study of four polymorphisms: rs932764 PLCE1, rs167479 RGL3, rs633185 ARHGAP42, rs7302981 CERS5, and studied their relationship with the development of FGR in pregnant women with PE. The functional effects of polymorphic markers, which showed significant associations with the  formation of  FGR in  pregnant women with PE, were examined using international bioinformatic projects on functional genomics (HaploReg, GTExportal, PolyPhen-2).
Results and discussion. The AA genotype of the rs9327643 locus of the PLCE1 gene significantly reduces the risk of FGR formation in pregnant women with PE according to the recessive model (OR = 0.37; p = 0.01; p_perm = 0.01). The rs932764 polymorphic variant of the PLCE1 gene is located in the region of regulatory DNA motifs for 2 Hdx and Zic transcription factors, localized in the region of histone protein encoding H3K4me1 enhancers in the brain and associated with the expression of the HDAC1P1 gene in male gonad tissues.
Conclusions. The polymorphic locus rs9327643 of the PLCE1 gene is associated with the risk of developing FGR in pregnant women with PE.

Endometriosis is one of the most common gynecological diseases associated with severe pelvic pain, uterine bleeding, and infertility. Current treatment patterns include endometriosis excision and medical management. Since endometriosis is a  chronic disease with a recurrent clinical course, the crucial role holds a long-term suppressive therapy. It should be characterized by high efficacy, tolerability, a favorable safety profile, as well providing sustained remission and improving the quality of life. The current review summarizes the modern data on conservative management, mechanisms of hormonal therapeutic effects. The national recommendations of Russian and international obstetrics and gynecology societies were analyzed, taking into account the results of systematic reviews, meta-analyses and randomized clinical trials. Combined oral contraceptives and progestogens are considered as first-line hormone therapy. Choosing the proper medication is a controversial issue that requires a comprehensive understanding of its effect on various forms of endometriosis. The review analyzes comparative data on the effectiveness, safety, side effects, impact on the quality of life, the frequency of relapse during various progestogens monotherapy and oral contraceptives, including different dosage regimens. This data allows making an optimal choice of long-term management, with high compliance and efficiency, associated with low recurrence rate.

Introduction. Osteoarthritis (OA) is one of the most common diseases of the musculoskeletal system, in the development and progression of which hereditary (genetic) factors play an important role.
Aim. To establish the  role of  polymorphisms of  candidate genes rs1060105  and rs56116847  SBNO1, rs6499244  NFAT5, rs34195470 WWP2, rs143384 GDF5 in the progression of knee OA in the population of the Central Chernozem region of Russia.
Materials and methods. The sample for the study, including 500 patients with knee OA, was divided into two groups: group 1 – patients with stages 3–4 of the disease according to J. Kellgren – J. Lawrence (n = 325), group 2 – patients with stage 2 (n = 175). The study was carried out in a case-control design. Genotyping of DNA samples was performed using the polymerase chain reaction method of TaqMan probes. The study of associations of polymorphic genetic loci with the progression of gonarthrosis was carried out by the method of logistic regression, taking into account the corrections – age, sex, BMI.
Results. The G/G genotype rs34195470 of the WWP2 gene (OR = 0.62, p = 0.029) has a protective role in the progression of the knee OA, the A/G genotype of the same polymorphism is a risk factor for disease progression (OR = 1.65, p = 0.012). Within the framework of the dominant genetic model, significant associations with the progression of gonarthrosis were established for the allele A rs34195470 of the WWP2 gene (OR = 1.61, p = 0.039, p_perm = 0.049) and the allele variant G rs143384 of the GDF 5 gene (OR = 0.59, p = 0.024, p_perm = 0.024).
Conclusion. Genetic risk factors for the development of OA of the knee joint of 3–4 radiographic stages are the allele A and the  hepotype A/G rs34195470  of the  WWP2  gene. The genotype G/G rs34195470  of the  WWP2  gene and the  allele G rs143384 of the GDF5 gene are of protective importance in the progression of the disease in the population of the Central Chernozem Region of the Russian Federation.

Introduction. The urgency of the problem of fetal growth retardation is beyond doubt. To date, it has been established that IUGR complicates 15% of all pregnancies in the world, increasing to 25% with a burdened obstetric and gynecological history and complicated pregnancy. According to a number of studies, it is known that FGR leads at a later age to the development of diseases such as metabolic syndrome, obesity, coronary heart disease, hypertension, and type 2 diabetes.
Objective. To identify clinical and anamnestic risk factors for the development of IUGR and assess early neonatal health outcomes for newborns with various forms of IUGR (early and late).
Materials and methods. The work was based on a retrospective review of maps, including 2000 birth histories of women who gave birth at the Center from 2019 to 2021. We selected 145 birth histories with IUGR, according to the inclusion and exclusion criteria and 66 birth histories with a normal pregnancy. Short-term outcomes of IUGR were analyzed on the basis of data from medical records of newborns, long-term outcomes of IUGR were determined after a subsequent study of 64 cases of children at 12 months old, observed on the territory of the Center’s children’s polyclinic
Results. Significant clinical risk factors for the implementation of IGR should include: maternal BMI, pregnancy-induced hypertension/preeclampsia, gestational diabetes mellitus against the background of normal maternal weight and height, and oligohydramnios. Among infants with IGR, an increase in complications such as respiratory failure, myocardial hypertrophy, circulatory failure and disseminated intravascular coagulation is associated with an increased risk of perinatal mortality and an increase in infant mortality.
Conclusions. IGR has a significant adverse effect on the health of the fetus and newborn and its long-term prognosis. Newborns with growth retardation have higher morbidity and mortality, require longer hospital stays, and consequently require higher hospital costs

Introduction. The article presents the data of a retrospective analysis of the debut and clinical manifestations of the types of maculopapular cutaneous mastocytosis (МPCM) in 96 children, and the frequency of non-regression of skin rashes with age in 33 adults.
Aim. To conduct a retrospective analysis of the onset, clinical manifestations and dynamics of maculopapular cutaneous mastocytosis (MPCM).
Materials and methods. Outpatient records of  96  children and 33  adults, who were treated and monitored at the  Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, were statistically analyzed.
Results. Monomorphic type of MPCM was diagnosed in 28 (29.2%) patients, polymorphic – in 68 (70.8%) patients. In 92.6% of children with a polymorphic type and in 35.7% with a monomorphic type, the rash debuted at the age of two years. The clinical picture of the monomorphic type was dominated by multiple small brown or yellow-brown spots. Rashes in the polymorphic type were spread, represented by brown or reddish-brown spots, papules, plaques ranging in size from several millimeters to several centimeters. The positive phenomenon of Unna-Darier was determined in 82.3% of cases. In patients with polymorphic type, the general population level of tryptase (<11.4 µg/l) was determined significantly more often than in patients with monomorphic type (p < 0.05). Elevated tryptase level was found in 53.6% of children and 69.7% of adults with monomorphic rashes. Pruritus was the most common cutaneous symptom, occurring in 49.0% of children. Bullous eruptions developed only in patients with polymorphic type. The most frequently reported systemic manifestations were gastrointestinal symptoms and headaches.
Conclusions. The obtained results suggest that patients with early onset of the disease with polymorphic and variable lesions show a more favorable outcome. 

Due to their pronounced biological activity, glucocorticosteroids are widely used in various fields of medical practice. The variety of effects of these hormones makes them an important part of the treatment of dermatological patients. This group of drugs has a pronounced positive effect on various links in the pathogenesis of many chronic dermatoses due to anti-inflammatory, vasoconstrictive, immunosuppressive and antiproliferative effects. The creation of combined external preparations containing a glucocorticosteroid in  combination with an antibacterial and/or antifungal component has become a  significant achievement in dermatological practice. Due to the rapid relief of signs of inflammation, as well as additional antibacterial and antifungal effects, these external agents have become especially attractive to patients. Widespread advertising and over-the-counter sale of drugs containing glucocorticosteroids leads to the fact that a significant part of patients seek advice from a dermatologist only after their ineffective use. At the same time, their uncontrolled use can lead to a number of side effects, including both pathological changes in the skin and pronounced negative systemic reactions. This fact significantly changes the clinical picture of the disease, limits the possibilities of early laboratory diagnosis of infection, which often prolongs the time for verification of the diagnosis and complicates therapy. The article presents our own clinical observations of patients with skin mycoses who have been using combined topical preparations containing glucocorticosteroids for a long time. This led to an atypical clinical course of the infection and required additional diagnostics using histological examination. The analysis of clinical observations is intended to focus the attention of primary care physicians on this problem, which can increase patient awareness of the risks of using topical drugs containing glucocorticosteroids.

Atopic dermatitis is a common inflammatory skin disease, which is most frequently occurred in children. The disease is characterized as chronic, but only 20% of children have severe atopic dermatitis, while the other 80% achieve a long-term remission by the age of 8. The article summarizes the main details about atopic dermatitis, including statistical epidemiological data, signs of a severe course of atopic dermatitis, criteria for determining the severity of the disease and the main aspects of a stepwise approach to the therapy. The authors paid special attention to the factors worsening the course of atopic dermatitis: the role of allergens and provoking factors, secondary infection, drug hypersensitivity, concomitant diseases, breach of dermatologist’s prescriptions. Despite the large arsenal of modern therapeutic methods, the therapy of a long, persistent course of atopic dermatitis may not produce a proper effect, and this is the reason why the disease acquires a torpid course. Such clinical cases call for finding new therapeutic methods, in particular the use of Janus kinase inhibitors. In the article, the authors described a clinical case: a 17-year-old patient K. complained of widespread rashes on the skin of the trunk accompanied by intense itching; the patient had been suffering from atopic dermatitis since early childhood, the skin process had a recurrent character with alternating periods of remissions and exacerbations about 2 times a year. The case describes the successful use of Janus kinase inhibitor that was capable to reduce the signaling of many cytokines that contribute to the development of signs and symptoms of the disease, in a patient with severe relapsing atopic dermatitis, who showed insufficient efficacy of therapy with standard methods.

Introduction. Mastocytosis as a result of mast cell infiltration of the skin and other organs develops at any age. The relevance of this work is determined by the lack of systematic data on the pathomorphological features of the clinical forms and types of cutaneous mastocytosis, defined by the Consensus European-American Mastocytosis Group and the WHO classification in 2016. The variability of dermatological clinical manifestations in children and adults, the difficulties in interpreting laboratory tests create a problem for verifying the diagnosis and further treatment.
The aim. To determine the main pathohistological features of clinical forms and types of cutaneous mastocytosis.
Material and methods. The article includes data from patients who were treated and monitored at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology in 2019–2022.
Results. The literature and own data on the characteristic pathomorphological patterns that are important for the diagnosis of mastocytosis with skin lesions in children and adults are systematized. The pathological substrate of lesions in diffuse cutaneous mastocytosis and mastocytoma was a massive infiltrate of mast cells in the papillary and reticular layers of the dermis. The histological picture in the monomorphic type of maculopapular cutaneous mastocytosis (MPCM) in children was characterized by a relatively lower density of mast cell infiltration of the papillary dermis compared to other clinical forms of mastocytosis. Also, in children, the density of mast cells in the affected skin was significantly higher compared to adults. In addition, in adults with PPCM, the  papillary dermis was less infiltrated with mast cells. This confirms the  opinion that the  monomorphic type of MPCM in children is phenotypically similar to MPCM in adults.
Conclusions. Further prospective follow-up of patients may allow conclusions to be drawn about the prognostic value of pathological examination in mastocytosis in adults and children.

Uveitis is one of the leading causes of blindness worldwide. Uveitis accounts for 10 to 15% of cases of complete vision loss and up to 35% of reversible vision loss. Particularly alarming is the fact that the debut of uveitis is recorded at a young working age. Uveitis includes a heterogeneous group consisting of at least 30 nosologies associated with various etiologies. The prognosis of the disease directly depends on the timely detection of its etiology. The review analyzes widely used methods for diagnosing patients with non-infectious uveitis. Special attention is paid to the advantages of confocal microscopy of the cornea, as the most modern non-invasive method that allows a detailed quantitative assessment of corneal subepithelial nerve plexuses and dendritic cells, the number of which increases during inflammatory processes, as well as a qualitative analysis of corneal precipitates and endothelial cells. Early detection of uveitis, which is an extra-articular manifestation of spondyloarthritis, allows appropriate treatment of severe systemic disease. It is assumed that the use of new approaches in the diagnosis of uveitis will prevent the development of severe complications up to complete loss of vision and improve the quality of life of patients.

Introduction. The article presents an objective assessment of the morphofunctional status of the cornea during the long-term wear of soft contact lenses (SCLs).
Aim. To assess the qualitative and quantitative changes in the cornea microstructure using the laser confocal microscopy during the long-term wear of SCLs, as well as combined tear replacement therapy based on formulations consisting of trehalose and hyaluronic acid.  
Materials and methods. The study included 62 patients (124 eyes) divided into three groups. The first two groups included 32 patients (64 eyes) with different degrees of myopia, using SCLs as an optical correction for 7–15 years (11 years on average): Group 1 included 15 patients (30 eyes) using tear replacement therapy in the form of a drug containing trehalose and hyaluronic acid twice a day for 3 months, Group 2 included 17 patients (34 eyes) who did not receive any tear replacement therapy. The laser corneal confocal microscopy was performed using Heidelberg Retinal Tomograph III followed by digital image processing aided by author software with the focus on the state of nerve fibers and dendritiform macrophages (Langerhans cells).
Results and discussion. The laser corneal confocal microscopy with assessment of the structure of the corneal nerve fibers and Langerhans cells can be used for the dynamic monitoring of the state of the anterior segment of the eye in SCL users. When pathological changes are detected, a patient may be recommended the corneotrophic therapy and (or) switching to another type of contact lenses.
Conclusion. The use of tear replacement medications containing trehalose and hyaluronic acid improves the subjective tolerance of SCLs and also makes it possible to significantly reduce the severity of epitheliopathy in patients, who use SCLs as optical correction for a long time.

Introduction. Insulin therapy is the only treatment for type 1 DM and one of the options for intensifying the treatment for type 2 DM. The production of own insulin biosimilars will increase patients access to the providing drugs and can potentially reduce medical costs on healthcare for government.
Aim. Compare the equivalence of pharmacokinetics (PK) and pharmacodynamics (PD), safety, efficacy, and immunogenicity between insulin biosimilar RinLis®, 100  IU/ml  (LLC GEROPHARM, Russia) to original Humalog®, 100  IU/ml  (Lilly France, France).
Materials and methods. The clinical trial was conducted in  two phases. Phase I  – randomized double-blind, two-arm crossover study of  PK and PD using hyperinsulinemic euglycemic clamp  (HEC) method in  28  healthy volunteers (NCT03604575). During HEC regular blood sampling was performed to assess glucose and insulin concentrations. The glucose infusion rate (GIR) was adjusted based on glycemia measurement. These data were used to calculate the PD parameters: the total area under the GIR-time curve (AUC_GIR) and the maximum GIR over the observation period (GIR_max); PK parameters: the total area under the concentration – time curve (AUC_ins.) and the maximum insulin concentration over the HEC (С_{ins. max}). Phase II – randomized multicenter open-label comparative study in parallel groups with an assessment the frequency of an immune response after 26 weeks of therapy (NCT04023344). The comparability of the studied drugs was considered proven if 90% confidence intervals (CI) for the ratio of geometric means of FC and PD were in the range of 80–125%.
Results. In the course of the study, it was revealed that RinLiz® and Humalog® insulin had comparable PK and PD profiles. The ratio of the geometric mean values of the AUC_GIR and GIR_max were in the range of 80–125% and amounted to 106 [95–118] % and 108 [97–121] %, respectively. The equivalence also was confirmed by the ratio of the geometric mean values of the AUC_ins. and С_{ins. max}, which amounted to 91 [86–97] % and 94 [91–97] %. In the second phase of the study after 26 weeks of therapy the frequency of immune response between two groups did not differ.
Conclusion. The obtained data have demonstrated the bioequivalence and immunogenicity of RinLiz® insulin to the original Humalog® in terms of PK, PD and safety parameters.

Diabetes mellitus, a well-known risk of cardiovascular disease (CVD), in patients with type 2 diabetes mellitus (DM2) Hyperglycemia has been found to be an increased risk of coronary heart disease and mortality. In real clinical practice, physicians are faced with the problem of choice when prescribing new hypoglycemic drugs in patients with type 2 diabetes and high cardiovascular risk. Modern possibilities and approaches to the treatment of DM2 have contributed to the creation of a promising class of hypoglycemic drugs that block renal glucose reabsorption - inhibitors of the sodium-glucose cotransporter type 2 (iSGLT-2). The unique mechanism of SGLT2 inhibition not only improves glycemic control, but also has cardio- and nephroprotective effects in patients with DM2 and at high cardiovascular risk. According to current recommendations, when choosing the tactics of treating patients with DM2 and the presence of risk factors for cardiovascular diseases or confirmed atherosclerotic cardiovascular diseases, preference is given to GLP-1 and/or iSGLT-2 receptor agonists in combination with the first-line drug, metformin. This article presents the main results of the efficacy and safety of ertugliflozin in a number of clinical studies and its beneficial effect not only on glycemic control, but also on cardio- and nephroprotective effects. The article also reflects the key results of an extensive program of randomized clinical trials VERTIS (acronym for eValuation of ERTugliflozinefficacy and Safety; evaluation of the efficacy and safety of ertugliflozin): including patients with type 2 diabetes and established atherosclerotic cardiovascular disease (VERTIS CV), with type 2 diabetes and CKD 3rd stage (VERTIS RENAL), as well as VERTIS MONO, VERTIS MET, VERTIS SITA, VERTIS SU and VERTIS FACTORIAL.

Introduction. Amid reports of a growing number of diabetic patients, the antidiabetics market players positioning is highly important for companies and the country’s leadership. The regulatory measures and management decisions depend on the competitive situation in the market.
Aim. Analysis of the changes in the level of dominance on the markets for antidiabetics and blood glucose monitors and meters.
Materials and methods. The distribution of these markets by product groups, as well as by commercial and public procurement segments has been taken into account. The Herfindahl-Hirschman and Linda indices, the adjusted Hall-Tideman index, concentration ratios and the SV matrix (strength/variety) were used as analysis tools, and the calculations were made on the basis of IQVIA data for the period from 2004 to the 3rd quarter of 2022.
Results. The dominance of three foreign companies that fell into the B4 and G quadrants was detected in the insulin and insulin analogues market. The glucose-lowering drugs market is the most competitive, it fell into the RO quadrant more often than other markets, and the dominant group, depending on the segment, included foreign and domestic companies with different frequency. The dominance of both three foreign and one Russian companies in the B4 and G quadrants, as well as a larger number of companies, was identified in the market for other alimentary tract and metabolism products. Several foreign and one Russian company that were identified into the B4 and G quadrants steadily dominated in the markets for blood glucose test strips, glucose monitors and meters and accessories, and lancets. 
Conclusions. The antidiabetics market is highly concentrated in its segments. The results show the historical development of the studied markets, the role of the commercial and public procurement segments in them, and serve as the foundation for studying the impact of environmental events on the Russian antidiabetics market.

Type 2 diabetes mellitus (T2DM) dominates the chronic non-communicable disease pandemics by its exceptionally rapid expansion into communities all over the world. In many countries diabetes is a socially significant disease. According to the data over the past decade, the number of people with T2DM has more than doubled globally. Equally disturbing is the fact that there are more than 250 million people with undiagnosed T2DM and more than 300 million with prediabetes. For 2045, it was estimated by the International Diabetes Federation that 693 million people will have diabetes. T2DM is a disorder of complex nature that urges further dedicated studies and ingenuity in the search for novel therapeutic approaches and on the pathogenetic links of disease. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with T2DM, and diabetes itself confers a substantial independent risk of coronary heart disease, stroke, and death from other vascular causes. The article discusses an urgent challenge of modern healthcare – the role of new class of sugar-lowering drugs (exogenously administered glucagon-like peptide-1 receptor agonists (arGLP-1)) semaglutide in reducing the risk of developing cardiovascular complications. The authors paid attention to the main results of SUSTAIN clinical program and use as initial treatment for patients with T2DM with very high risk indicated in the new European guidelines with a view to get additional advantages in terms of life prognosis. 

Introduction. Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that presents with abdominal pain associated with defecation, a change in stool frequency and a change in the appearance of the stool. The high socio-medical significance of this disorder is determined by high global prevalence, impact on quality of life and significant costs for patients, health care and society. Currently, the intestinal wall status, and the qualitative and quantitative changes in gut microbiota are considered as  one of the factors provoking the disorder. Given the role of microbiota in the development of irritable bowel syndrome, it is advisable to use probiotics as a therapy for IBS. 
Aim. To evaluate the effect of synbiotic Maxilac® on the gut microbiota and clinical signs of IBS.
Materials and methods. A total of 15 (9 women and 6 men, mean age 42,6 ± 3,7 years) patients with diarrhea-predominant IBS (IBS-D) were enrolled in the study. They received Maxilac® at a dose of 1 capsule in the evening with meals for 21 days. Before and after treatment, all patients underwent bacteriological testing of faeces and assessment of clinical signs: stool frequency during the week, abdominal pain measurements using a VAS scale (mm), bloating severity measurements using a VAS scale (mm).
Results and discussion. The study showed positive changes in the intestinal microbiota: a significant growth of bifidobacteria and lactobacilli (CFU), typical E.coli and enterococci. The number of hemolytic E. coli, Staphylococcus aureus and Candida fungi (CFU) was significantly reduced. In the Maxilac® group, the defecation frequency decreased from 31 to 16 times a week (p < 0.05); abdominal pain from 55 to 35 VAS scores (p < 0.05); bloating from 60 to 40 VAS scores (p < 0.05).
Conclusions. The synbiotic Maxilac® is one of the drugs that can be efficiently and safely used as part of combination therapy for IBS.

Revision interventions due to aseptic instability show a marked upward trend, and one of the reasons is an increase in the number of people with osteoporosis in the population. The impaired bone metabolism in these cases persist even after re-endoprosthetics. The  authors aim to draw attention of trauma orthopaedists to the need to treat osteoporosis either before or immediately after the re-endoprosthetic surgery. A clinical case is presented. A 65-year-old patient T., 5 months after surgery, complained of persistent pain in the left hip joint radiating to the left knee joint, which intensified when walking, lameness, inability to move without additional support (two crutches), limited range of motion within the left hip joint that had undergone surgery (endoprosthesis). The patient had a history of femoral neck fracture associated with a low energy fall. The left hip joint re-endoprosthetics was performed due to aseptic instability of the femoral and acetabular components of the prosthetic implant. The diagnosed diseases included secondary osteoporosis, D-deficiency, hypocalcemia, and periprosthetic osteolysis. Given the increased intensity of resorption and the fact that the femoral neck fracture occurred with underlying secondary osteoporosis, it was decided to prescribe antiresorptive therapy with denosumab 60 mg once every 6 months combined with alfacalcidol and calcium supplement. Despite an objective 3-month delay in antiresorptive therapy initiation, the treatment result was achieved in the observed patient. In summary, denosumab 60 mg increases the effectiveness of re-endoprosthetics with underlying osteoporosis by reducing activity of the periprosthetic bone osteolysis.

Introduction. Sulodexide is a polymer, the structure of which includes unbranched polysaccharide chains formed by repeating a particular disaccharide unit. This drug was isolated from the endothelium of the pig, and it appeared on the pharmaceutical market in 1974. Sulodexide contains ≈ 80% heparan sulfate (also known as fast-acting heparin) and 20% dermatan sulfate. This drug is produced from the more sulfated waste heparinoids. During production, heparin is chemically decomposed and transformed into the clinical drug Sulodexide.
Aim. To estimate the possibilities and prospects of using the drug Sulodexid in the treatment of various diseases.
Materials and methods. During this study, we analyzed relevant sources of domestic and foreign literature on the use of the drug Sulodexid in various pathologies. Sources of information included publications from the Russian scientific electronic library integrated with the  Russian Science Citation Index, the  Medline database, Scopus, Science Direct, Cyberleninka.ru, and the  New England Journal of Medicine.
Results and discussion. The pharmacological action of the drug is not limited to anticoagulant action, it also has antiaggregant and angioprotective effects. The drug has found application in various fields of medicine, such as pediatrics, surgery, therapy, endocrinology, neurology and proctology. The possibility of wide application is also promoted by the availability of different forms and methods of administration of this drug: intramuscular, infusion and oral, which allows prescribing the drug both in inpatient and outpatient settings. In contrast to other anticoagulants the drug has the most favorable action, since the risk of bleeding is low.
Conclusion. In spite of a sufficiently wide use of the study drug in clinical practice, inclusion in the national clinical guidelines, other effects of the drug require further studies. It is difficult to make a conclusion about the efficacy of the drug in the treatment of some diseases, but with further studies, there is a chance of including it in the therapy of different pathological conditions. 

Natural food sources of  carotenoids are colored vegetables and fruits, eggs, milk. Total carotenoid intake varies from 1  to 22 mg/day in European countries and from 5 to 16 mg/day in the USA. The average daily intake of lycopene in Europe ranges from 5 to 7 mg/day, in the USA – from 5.7 to 10.5 mg/day. Carotenoids are used in the production of fortified foods, biologically active food supplements, specialized foods for various population groups, as well as natural food colors added directly during the production of a food product or in feed for farm animals. Epidemiological studies have shown that dietary carotenoid intake is inversely associated with obesity, retinopathy, cataracts; cardiovascular disease (CVD), diabetes and some cancers. According to the domestic regulatory framework, the adequate level of daily intake of carotenoids is 15 mg, 5 mg of β-carotene, lycopene and lutein, the upper permissible level of consumption of carotenoids as part of dietary supplements and specialized food products is 30 mg (10 mg each). For zeaxanthin, these values are 1 and 3 mg/day. Daily doses of lycopene used in intervention studies were 15–90  mg, and β-carotene 15–50  mg. lutein  – 4–20  mg; zeaxanthin  – 1–20  mg; mezoxanthin 12  mg, astaxanthin  – 12–16 mg. Duration of admission was 4–12 months (up to 48 months). Taking lycopene at a dose of 10–15 mg for several months led to a decrease in indicators of oxidative stress, markers of bone resorption, taking lutein at a dose of ≥ 10 mg improved visual and cognitive functions. The effective doses of carotenoids correspond to or exceed the permitted allowable level of their consumption as part of dietary supplements and specialized food products.

Chronic non-communicable diseases (CNID) are an important problem for health care worldwide. In this connection, there was a need to develop preventive measures aimed at their early detection and timely correction. Taking into account the available evidence base on the effectiveness of preventive measures to reduce risk factors of CNID, special attention should be paid to people with high risks of their development and patients with an already established diagnosis. To improve the quality of preventive medicine, it is necessary to consistently develop and implement modern technologies aimed at early detection of risk factors at all stages of human life using available tests. To date, remote screening is considered as one of the promising areas of telemedicine technologies, which can be successfully used during medical examinations, medical examinations, etc. We have developed a methodology for telemedicine multidisciplinary remote questionnaire screening of the adult population using a system of analysis of unstructured data for population monitoring of CNID. Our telemedicine program was tested based on the city polyclinic for the first stage of medical examination. Depending on the identified risk factors, it was found that patients with the greatest frequency are concerned about complaints from the endocrine, digestive, respiratory, cardiovascular systems and oncological alertness. The interim results of the study once again show that the transition to new social conditions causes an active destabilization of the physical and psycho-emotional capabilities of the human body, which, under excessive loads, are able to increase the degree of activity of the CNID risk factors.

Introduction. The significant pathogenetic effect of arterial hypertension on the development of cognitive and psycho-emotional disorders, on the one hand, and the lack of algorithms for identifying and managing patients with comorbid neurocognitive disorders in therapeutic practice, on the other hand, determines the relevance of studying this problem.
Aim. To study neuropsychological characteristics of patients with arterial hypertension in therapeutic practice.
Materials and methods. A total of 508 patients with arterial hypertension were enrolled in the study. All study participants underwent the clinical examination and neuropsychological tests: Montreal Cognitive Assessment Scale (MoCA test), Schulte tables, Categorical Verbal Fluency Test, Tracking Test, MFI-20 asthenia self-assessment questionnaire, Reeder's Test, Maastricht Questionnaire, and Hospital Anxiety and Depression Scale (HADS).
Results. The analysis of neuropsychological testing results of patients with hypertension showed that almost all the techniques identified deviations from the  reference ranges in  most of  the study subjects. 85% of  patients had decreased total score of cognitive functions assessed in terms of MoCA test scores, 83% of patients showed increased time in performing tracking test part A and 74% patients showed increased time in performing part B, and there was also a large difference between the  time spent on performing parts B and A  of the  test; 49% of  patients demonstrated decreased speed in  performing the  Schulte test. Th psycho-emotional state test results showed a  high level of  psycho-emotional stress in  80.5%, vital exhaustion in 78% and fatigue in 96% of patients.
Conclusions. In this study, the  neuropsychological testing results of  patients with hypertension showed decreased total scores of cognitive functions and individual parameters of the cognitive spectrum, such as attention focusing, information processing speed, memory, speech function and executive functions combined with a high level of psycho-emotional stress, fatigue and anxiety.

Introduction. The issues of dynamic and functional anatomy of the neck are of considerable practical and theoretical interest. This is due to the peculiarities of the displacement of the musculofascial layers when changing the position of the head in space, the description of which presents significant difficulties. Particular practical importance has therefore the study of dynamic phenomena of this area as well as the analysis of morphological and biomechanical changes leading to the development of somatic dysfunction of the neck.
Aim. Based on the topographic and anatomical studies, as well as with the help of finite element modeling, to study the patterns of displacement of the muscular-fascial layers of the neck when turning the head by 20º and 50º.
Materials and methods. The topographic and anatomical study used the results of 18 MRIs, the analysis of which was carried out using the Vidar Dicom Viewer software. To build a finite element model, data from a CT study of a patient were used, which has not any pathological changes in the organs and musculoskeletal system of the neck. As a result of the subsequent processing of the CT study data, a personalized anthropomorphic finite element model of the neck region was constructed, with the help of which a series of virtual topographic and anatomical studies were performed, repeating in general terms the topographic and anatomical part of the work.
Results. 1. The values of rotational and angular displacement of all fascia of the neck are nonlinear. 2. The fascia of the neck are displaced relative to each other when turning the head due to the difference in the values of angular displacement. 3. The magnitude of the angular displacement of the 2nd fascia of the neck at the level C2-C3, C3-C4 and C4-C5 when turning the head 20º, as well as at the  level C4-C5  when turning the  head 50º exceeds the  value of  the angle of  rotation of  the head relative to the trunk. 4. The direction of rotational and angular displacement for all fasciae at the level C6-C7 corresponds to the direction of rotation of the head, with the exception of the dorsal part of the 4th fascia of the neck, which at this level, together with the esophagus, shifts in the opposite direction relative to the axis of symmetry. 5. Fasciae located at a greater distance from the  center of  the intervertebral disc are characterized by large values of  angular and rotational displacement. 6. The rate of change in the ratio of rotational and angular displacements is higher at the level of the lower segments. 7. The results of measurements of the rotational displacement of the fascial layers of the anthropomorphic finite element model demonstrate a positive correlation with the data of the topographic and anatomical study.
Conclusion. The patterns of displacement of the neck musculofacial layers should be taken into account when modeling somatic dysfunction of the neck, as well as in the process of diagnosis and planning of osteopathic effects.