Anticoagulants play an important role in reducing complications and mortality associated with thromboembolic disease. For some time, vitamin K antagonists (VKAs) have been the main drugs used for long-term oral anticoagulant therapy, but because of the significant limitations of VKAs over the past decade, pharmacological research has led to the development of new direct actingoral anticoagulants (DOACs). Direct-acting oral anticoagulants have a rapid onset of action with peak levels within 2–4 hours and a half-life of about 12 hours, which is much shorter than that of vitamin K antagonists, a more predictable anticoagulant effect, no need for dose selection, routine laboratory monitoring of pharmacodynamic effects, and a lower frequency of clinically significant drug-drug interactions compared with warfarin. But anticoagulants can still cause serious adverse drug reactions (ADRs) in the form of hemorrhagic complications in hospitalized patients, as confirmed in studies. Currently, clinical-pharmacological technologies of personalized medicine such as pharmacogenetic and pharmacokinetic studies are considered as promising approaches to improve the safety of modern pharmacotherapy, allowing the prediction and prevention of various ADRs. In addition, there are emerging studies showing the importance of genetic features of patients in relation to the metabolism of oral anticoagulants, as well as described clinical situations where different gene polymorphisms, could be responsible for changes in the pharmacokinetics of DOACs. This article reviews clinical cases in which pharmacogenetic testing and therapeutic drug monitoring are used to optimize the clinical efficacy and maximum safety of anticoagulant therapy with apixaban and rivaroxaban.

Arterial hypertension (AH) is one of the most common problems in the elderly and one of the most important cardiovascular risk factors. AH in the elderly has features with a high incidence of ISAH and is characterized by a high level of SBP and a low level of DBP, which creates certain problems for the safety of treatment. The need for antihypertensive therapy in elderly patients has received convincing evidence of the effectiveness of reducing mortality and cardiovascular complications. The purpose of this scientific review was to raise awareness of the problem of treating hypertension in elderly patients, including those with low DBP. The results of studies and meta-analyzes evaluating the efficacy and safety of standard and intensive SBP reduction in elderly patients, as well as the results of the effect of antihypertensive therapy on DBP levels, especially at baseline low DBP (<70 mmHg), are presented. The studies identified the main groups of antihypertensive drugs that provide an effective and safe reduction in blood pressure in elderly patients, have a cardioprotective effect and do not adversely affect comorbidities. These include: diuretics of the thiazide-like group, calcium channel blockers, as well as additional indications and concomitant conditions – ACE inhibitors and antigotensin II receptor blockers. Several meta-analyses have shown the  benefit of  intensively lowering SBP < 120 mmHg before the standard target level SBP < 140 mmHg. in elderly patients as a lower risk of fatal and non-fatal cardiovascular events and overall mortality. Thus, the impact of intensive SBP reduction was beneficial in preventing 1 case of MACE (NNT = 38) and in preventing 1 case of total mortality (NNT = 85); while the rate of harm in the form of arterial hypotension was significantly high (NNH = 778). With regard to the effect on the level of DBP in elderly patients with hypertension or ISAH, an inverse relationship between DBP and adverse coronary events was revealed and a J-curve was described, confirmed in a number of studies (INVEST, ARIC, SPRINT). Moreover, with an initially low DBP (<70 mmHg), a significant increase in the frequency of outcomes and the relative risk of outcomes was noted. It is not easy to decide on antihypertensive therapy in such situations. The evidence base of studies suggests the benefit of lowering SBP for the prevention of cardiovascular events in elderly patients, but with caution and individual approach. It is important to take into account individual patient characteristics such as cognition, autonomy, and frailty/frailty when setting target BP.

Introduction. The systemic psoriatic process affects not only the skin, but also other organ systems, including the cardiovascular system. Immunopathological inflammation that occurs in the skin and articular tissues is a central link in the pathology of the cardiovascular system in psoriasis.

Objective. Identify diseases of the cardiovascular system and factors of their development in patients with psoriasis and to assess their severity depending on the severity of dermatosis.

Materials and methods. The study included 406 patients with psoriasis aged 18 to 74 years, who were divided into three subgroups depending on the severity of the course. Assessment of the state of the cardiovascular system was carried out using the following methods: uestionnaire, clinical, physical, laboratory and statistical. The comparison group consisted of 200 people.

Results. In 53.9% of patients, psoriasis occurred against the background of cardiovascular comorbidity. More than 90% of patients with moderate to severe psoriasis have more than three risk factors for CCC diseases. Patients are more susceptible to the development of hypertension, hypercholesterolemia, obesity, abdominal obesity, stress and smoking. The higher the cardiovascular risk, the more severe psoriasis is.

Conclusions. The presence of unmodified and modifiable risk factors for the development of cardiovascular diseases is aggravating for the course of psoriasis, which means that the risk of undesirable fatal events is higher. Patients with psoriasis need additional preventive measures aimed at preventing the development of cardiovascular pathology.

Introduction. The severity of the psoriatic process is associated with the involvement of the scalp, genitals, fold zones and nails in the process. The selection of effective therapy for psoriasis of difficult localizations is an urgent task of modern dermatology.

Aim. To evaluate the effectiveness of treatment of moderate psoriasis and nail psoriasis with an IL-17A inhibitor in combination with a combined betamethasone dipropionate + salicylic acid ointment.

Material and methods. A 12-week prospective study included data from 60 patients who were under observation at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology in 2020-2021. Group 1 included 30 patients who received only the biological drug IL-17 inhibitor. Group 2 included 30 patients who received an IL-17 inhibitor in combination with topical therapy with an ointment of 0.05% betamethasone dipropionate and 3% salicylic acid (Rederm). The ointment was applied twice a day in two courses of 3 weeks with a break of 6 weeks between courses. When comparing indicators between groups, Student’s t-test was used for normal samples and the Mann- Whitney test for non- Gaussian samples.

Results. When comparing PASI and NAPSI in patients of group 2 who received an IL-17 inhibitor in combination with external therapy with an ointment of 0.05% betamethasone dipropionate and 3% salicylic acid 2 times a day for two courses of 3 weeks with a break of 6 weeks between courses, the index values statistically significantly decreased after 12 weeks of therapy (p = 0.003) compared to group 1 (p = 0.015).

Conclusions. The study showed that patients who received an IL-17 inhibitor in combination with a combined betamethasone dipropionate + salicycylic acid ointment achieved a significantly greater effect compared to patients who received only biologics. In addition, the combination with Rederm ointment has shown greater efficacy in the treatment of psoriatic onychodystrophy, which is difficult to treat even with biologics.

Radiology methods were believed to be used to assess only structural changes in the brain. Therefore, for a long time, their use in psychiatry was seen ineffective. However, the subsequent development and emergence of new visualization techniques led to the appearance of previously inaccessible opportunities. In modern psychiatric practice magnetic resonance imaging (MRI), taskbased functional MRI (fMRI) and resting state fMRI are methods of the greatest interest. Both structural and functional changes of brain can be assessed with these techniques. Using MRI with high spatial resolution, it’s possible to assess changes in the gray matter of the brain, including its regional volume, cortical thickness, shape of the convolutions and subcortical structures. With the use of fMRI it became possible to evaluate neural activity and neural circuits of the brain. In task-based fMRI patient complete certain tasks, which leads to an increase in blood supply and oxygenation of activated parts of the brain. Resting MRI, on the other hand, evaluates spontaneous fluctuations in the brain activity. Although the diagnosis of mental illness is not based on MRI alone, imaging techniques can facilitate the process. MR-signs such as hypo- or hyperactivation of brain areas, an increase or decrease in the volume of brain zones can be observed. The text describes examples of MR-characteristics of attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, schizophrenia, and MR-features of cognitive impairment in multiple sclerosis.

Introduction. The high prevalence and increase in cases of seeking medical help for pain in dorsopathies determines the relevance of this problem. Among all the conditions included in the study of health care costs, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CTD), which are most common in developed countries and are characterized by a variety of clinical forms. In our opinion, a comprehensive method of treating CTD with the mandatory use of non-drug methods of therapy is the most optimal.

Aim. Determination of the relationship between the pathogenetic form of CTD (verification of pain triggers) and a personalized method of treating patients, containing a combination of drug therapy and a rehabilitation complex of physiotherapeutic, psychotherapeutic effects.

Materials and methods. Patients with CTD were included in the study. Neurological status assessment and biomechanical tests were carried out for accurate clinical verification of pathogenetic forms of CTD. Depending on the choice of treatment, respondents were stratified into comparable groups. The main group included patients to whom the original technique was applied, which implied a combination of drug therapy, a complex of rehabilitation physiotherapy and psychotherapeutic effects (n = 155), the control group (n = 65) – respondents who received a standard course of therapy. The statistical analysis included a comparative assessment of the intensity of pain syndrome, static-dynamic and reflex disorders before and after therapy.

Results. Both methods have shown their effectiveness. The original technique more effectively reduced the intensity of pain syndrome, reduced the frequency of reflex disorders (p < 0.05), significantly reduced static-dynamic disorders in all subgroups (p < 0.05), while the standard significantly reduced them only in the subgroup with uncomplicated forms of CTD, without achieving a therapeutic effect in complicated CTD.

Conclusion. The original method of therapy of patients with HCG has confirmed its effectiveness.

Introduction. The study of the spectrum of neurocognitive disorders in patients with arterial hypertension (AH) in order to create an effective therapeutic and rehabilitation strategy is an urgent direction of modern medicine.

Aim. To study neuropsychological characteristics in patients with hypertension in middle and old age.

Materials and methods. 357 middle-aged and elderly patients with hypertension were examined. All patients underwent neuropsychological examination: Montreal Cognitive Function Assessment Scale (MoCA test), Schulte Table Test, Verbal Association Test, Trail Making Test (TMT), Asthenia Self-questionnaire (MFI-20), O. Kopina Reader Adaptation Test, questionnaire on the level of life exhaustion, hospital anxiety scale and depression (HADS).

Results. The analysis of the results of general neuropsychological testing showed a deviation from the reference values in the majority of participants. In the Schulte test, an increase in execution time was noted in 50% of elderly patients and in 21% of middle-aged patients. In the TMT test: an increase in the execution time of part A – in 88% of elderly patients and 58% of middle-aged patients, part B – in 97 and 88% of patients, respectively. The MoCA test demonstrated pronounced cognitive impairment in 16% of middle-aged patients and in 35% of elderly patients. More than 97% of elderly and 88% of middle-aged patients showed a high level of asthenia in the MFI-20 test; life exhaustion was noted in 56 and 45%, and anxiety and depression in more than 50% of elderly and 35% of middle-aged patients, respectively.

Conclusion. In the studied groups of patients with hypertension, there was a decrease in the integral index of cognitive functions, as well as changes in indicators in tests characterizing the state of control functions, attention, speed of thought processes and semantic memory, while more pronounced deviations were noted in the elderly. The described cognitive impairments were combined with a high level of psychoemotional tension, anxiety, depression and asthenia.

Introduction. Migraine is a common disabling condition. Migraine patients require fast-acting drugs with high efficacy. Prior studies have demonstrated that zolmitriptan oral dosage forms (oral tablets) are highly effective in the treatment of migraine attacks.

Aim. To evaluate the efficacy, timing of onset of therapeutic effect and tolerability of zolmitriptan nasal spray (Xsenza®) in the treatment of migraine.

Materials and methods. A total of 39 patients aged 20 to 58 years with migraine were enrolled in a prospective, multicentre, observational study. Patients were included in a group to treat three consecutive migraine attacks with zolmitriptan nasal spray at a dose of 2.5 mg according to their habitual behaviour model that most closely reflects clinical practice. Efficacy endpoint (positive attack treatment outcome) was the generally accepted measure of reduction in cephalalgia intensity and concomitant autonomic symptoms (reduction in pain and autonomic symptoms from severe/moderate to mild/absence severity according to VAS) 2 hours after zolmitriptan inhalation.

Results. The absence or mild intensity of headache was reported in 25% of patients 10 minutes (earliest assessment in that study) and in 28% of patients 30 minutes after administration of the drug. The proportion of patients with positive treatment outcomes in all three consecutive migraine attacks two hours after administration of zolmitriptan nasal spray 2.5 mg was 69.2%, 75% and 75%, respectively. Zolmitriptan nasal spray was well tolerated, while most adverse events were mild in severity and transient in nature.

Conclusions. Zolmitriptan nasal spray (Xsenza®) is highly effective in the treatment of migraine attacks and has a rapid onset of action. The drug combines high efficacy and good tolerability.

A new coronavirus infection is an acute viral disease with a primary lesion of the respiratory tract. Morphological changes in the lungs with a new coronavirus infection are characterized by damage to lymphocytes, endotheliocytes, macrophages, monocytes and diffuse lesions of the alveoli with local hemorrhages and accumulation of fluid and fibrin in their lumen and the development of residual changes in the form of fibrosis. The resulting changes in the target organ can lead to the activation of opportunistic infections, including tuberculosis. The clinical observation of the onset of a tuberculous process in a patient who had a new coronavirus infection with residual changes in the lung tissue in the form of fibrosis. Patient I., 30 years old, was admitted to a tuberculosis hospital for examination and treatment. The result of x-ray examination revealed signs of decay in the sixth segment of the lower lobe of the right lung. A positive sputum microscopy result for acid-fast mycobacteria was also obtained. Molecular genetic study of sputum confirmed the presence of Mycobacterium tuberculosis. From the anamnesis it is known that 5 months ago she suffered a new coronavirus infection, confirmed by a molecular genetic method, with a lesion of the sixth segment of the right lung. At the end of the treatment with COVID-19 were performed computed tomography of the chest organs – residual fibrous changes were noted in the sixth segment of the right lung after pneumonia. This clinical observation showed that the presence of residual fibrotic changes in the lungs after suffering a coronavirus disease in a patient is a risk factor for tuberculosis.

Cough is one of the most common reasons for seeking medical attention. As impaired mucociliary clearance plays an important role in the pathogenesis of both acute and chronic cough, much attention is paid to secretomotor and secretolytic therapy in its treatment. Today, medicines that contain medicinal herbs have taken on a special importance. Medicinal components in the herbal mucolytic medicines have a complex effect, which allows to effectively cope with cough at all stages of diseases accompanied by respiratory symptoms. Plantain leaf, coltsfoot leaf, thermopsis grass, ipecac root, marshmallow root, licorice root, anise fruit, thyme (thyme) grass, ivy leaves, primrose roots are among the most common and frequently used components. Bronchipret is one of these well-known herbal medicines which as a syrup contains liquid extracts of thyme herb and ivy leaves and as Bronchipret TP tablets – dry extracts of thyme herb and primrose root. Due to its components, Bronchipret helps normalize production of bronchial secretions, and has an expectorant, secretolytic, anti-inflammatory and bronchodilator effect. Numerous clinical studies have proven high efficacy and safety of Bronchipret, which makes it possible to recommend it as a drug of choice when children and adults need symptomatic treatment of cough in ARVI with cough.

Introduction. Chronic obstructive pulmonary disease (COPD) is a disease characterized by the persistent restriction of airflow and is a consequence of chronic inflammation of the respiratory tract and lung tissue in response to exposure to inhaled damaging particles or gases. The high prevalence of chronic obstructive pulmonary disease and the high risk of mortality among patients has long been an important problem of the modern healthcare. One of the most severe complications of COPD is chronic respiratory failure. The use of oxygen in patients with chronic hypoxemia should be constant, prolonged and as usually carried out at home; therefore, this form of therapy is called long-term oxygen therapy (LTOT).

Aim. To determine the effect of the use of LTOT on survival in patients with COPD and chronic respiratory failure.

Materials and methods. 324 patients were retrospectively included in the study. They were hospitalized in the period from 2011 to 2017 with a confirmed diagnosis of COPD with FEV1 31,6% predicted used LTOT. Clinical data were obtained from patient medical histories. The control group (patients with COPD who did not receive LTOT) was also compiled based on retrospective data.

Results. The 5-year survival rate of patients with COPD treated with LTOT was 54.6 (95% CI 49.3–60.4) % (a total of 324 people, 177 of them died, 138 survived, 9 people were censored), in the control group – 34.7 (95% CI 30.6–39.3) % (482 in total people, 298 of them died, 166 survived, 18 censored) (р < 0.001).

Conclusions. The use of LTOT has a significantly positive effect on the survival of patients with COPD.

The article presents the latest international guidelines on functional gastrointestinal disorders (Rome IV criteria). It is difficult to consider all functional disorders within one paper, and therefore it was decided to address the problem using the example of the most common functional disorder – irritable bowel syndrome (IBS) and a similar IBS-like syndrome (IBS-LS), which is particularly problematic in clinical practice. The case is illustrated by our own findings i.e.  an analysis of 130 patients (80 with IBS and 50 with IBS-LS). The treatment included a specialized probiotic ProbioLog IBS (1 capsule per day) and involved several steps (each step comprises 2 weeks, 6 weeks in total). At the end of each treatment step, the therapy was evaluated followed by correction of the following step. The effectiveness of treatment was 80%; additional correction was required for 10% of patients with persistent pain, which was relieved by adding Meteospasmil to the treatment combination. Administration of digestive enzymes was required for 10% of patients with IBS-PS, which developed due to chronic pancreatitis at the stage of exocrine pancreatic insufficiency. Thus, the therapeutic effect on altered microbiota, one component of the pathological symptom group (IBS and IBS-LS), with a probiotic containing three bacterial strains targeted in IBS (ProbioLog IBS) was effective in 80% of patients, and only 20% needed additional correction of treatment with motility regulators and enzyme drugs.

Introduction. It is often observed that decompensated liver cirrhosis is accompanied by hepatic encephalopathy. The role of violation of the structural and functional properties of albumin in the development of this pathology is currently not defined.

Aim. Was to evaluate the effect of albumin replacement therapy on the clinical manifestations of hepatic encephalopathy and the severity of structural and functional changes in serum albumin.

Materials and methods. The study included 28 adult patients with decompensated cirrhosis and hepatic encephalopathy divided into two comparable groups. In addition to the standard examination, the properties of the albumin molecule were evaluated using the EPR test. The dynamics of indicators was assessed in the groups of standard treatment and standard treatment + albumin. Mathematical processing was carried out in the StatTech v. 3.1.4 (developer Stattech LLC, Russia).

Results and discussion. It was revealed that patients with decompensated liver cirrhosis have serious disturbances in the albumin configuration, which lead to a decrease in its functional activity. The ability to bind, transport and detoxify were impaired in the vast majority of patients. The native conformation of the molecule was abnormal in all patients. Against the background of albumin replacement therapy, these disorders are able to recover to normal values. Along with this, we found that albumin replacement therapy reduced the severity of hepatic encephalopathy to a greater extent than standard treatment.

Conclusion. Violation of the structural and functional albumin properties is associated with the progression of hepatic encephalopathy in patients with liver cirrhosis. Transfusions of highly concentrated human albumin lead to the normalization of the molecule properties and the encephalopathy regression.

Introduction. Despite the high prevalence of functional dyspepsia (FD), the question of effective treatment of this pathology remains open. This underlines the relevance of new approaches in the treatment of FD and the introduction of the drug Dyspevict® (acotiamide), a prokinetic with a new mechanism of action, into clinical practice to alleviate symptoms and improve the quality of life of patients with FD.

Aim. Evaluate the efficacy and safety of the use of acotiamide in patients with FD with postprandial distress syndrome (PDS).

Materials and methods. 389 patients were randomized in a 1:1 ratio into two groups. Patients of the first group took acotiamide, patients of the second group – placebo. Study drugs were taken orally for 4 weeks. The main criterion for the effectiveness of treatment was the “response to therapy”, assessed by patients on a 7-point Likert scale. Secondary efficacy criteria were: complete regression or relief of symptoms of FD with PDS, improvement in the quality of life of patients, which was assessed on the basis of the Nepean short dyspepsia index.

Results and discussion. After 4 weeks, “response to therapy” was observed in 143/193 (74.1%) patients in the acotiamide group compared with 98/189 (51.9%) patients in the placebo group (p < 0.001). Therapy with Acotiamide, in contrast to placebo, showed a complete regression and relief of some symptoms of FD with PDS. Also, after the use of acotiamide, there was an improvement in well-being and quality of life in 172/194 (88.7%) patients compared with 131/189 (69.3%) patients in the placebo group (p < 0.001).

Conclusion. The results of the conducted clinical study allow us to conclude that acotiamide is an effective treatment for FD with PDS in adults. The safety profile of the drug is comparable to placebo.

Worldwide, there is an increasing incidence of type 2 diabetes mellitus (T2DM). Management of patients with T2DM is complex and often requires multiple pharmacological treatments to achieve adequate control of the disease. The long-term diabetes-specific complications have been ameliorated by interventions that decrease chronic glycemia. Most clinical guidelines recommend metformin as the first-line oral hypoglycemic agent. Metformin can be used for monotherapy and combination therapy for T2DM. Initially, metformin monotherapy is often effective, although the effect of glucose control is limited after all, so a second agent is often required in most patients. Unfortunately, the traditional therapeutic drugs for T2DM could not effectively control hyperglycemia, and frequently occurring side effects remain a big problem (weight gain, hypoglycemia). Dipeptidyl peptidase 4 inhibitors are superior to traditional hypoglycemic drugs in terms of efficacy and tolerability. Sitagliptin became the first representative of dipeptidyl peptidase 4 inhibitors. Sitagliptin has been shown to preserve β-cell function and improve 2-h postprandial glucose, fasting plasma glucose and glycated hemoglobin in individuals with T2DM. A systematic review and meta-analysis conducted in 2021 demonstrated that sitagliptin administration with or without metformin might reduce the body weight and body mass index if these drugs are taken for more than 6 months. Sitagliptin add on to metformin achieving better treating effects on weight loss and glucose control without the development of hypoglycemia. This review discusses sitagliptin and its combination with metformin. Velmetia is a fixed combination of these two hypoglycemic drugs with a complementary and safe action profile.

Diabetes mellitus is one of the most common endocrine diseases. Type 2 diabetes mellitus is associated with high cardiovascular morbidity and mortality and is a leading cause of chronic kidney disease and end-stage kidney disease. To date, for the treatment of patients with type 2 diabetes, hypoglycemic drugs are used that affect different parts of the pathogenesis. Metformin is a biguanide that is used in the treatment of type 2 diabetes mellitus; it is effective as monotherapy and in combination with other glucose-lowering medications. In addition to the treatment of diabetes mellitus, metformin is recommended and widely used for the treatment of prediabetes. Metformin is generally well-tolerated with minimal side effects and is affordable. Metformin is very effective in HbA1c lowering associated with some weight loss, but does not increase risk for hypoglycemia. With the use of metformin in monotherapy, the decrease in HbA1c levels is 1–2%. Despite the appearance in practice of a fairly large number of new, effective glucose-lowering drugs, metformin is still the drug of choice in many cases. And most diabetic associations recommend metformin as a first-line drug. Metformin has demonstrated many positive effects in observational studies in patients with CAD, heart failure, and chronic kidney disease. This review presents data on the efficacy and, pleiotropic effects of metformin. Possible adverse events are also discussed, including the risk of low level and deficiency of vitamin B12, gastrointestinal tract adverse events.

Over the past few decades, the prevalence of diabetes in developed and developing countries has increased dramatically, making diabetes a key health priority worldwide. It can be assumed that an increase in the life expectancy of patients with diabetes significantly affects the prevalence of diabetes, maintaining the trend of its increase. Patients with type 2 diabetes mellitus (DM2) are at higher risk for cardiovascular disease and its adverse outcomes compared to the general population. The pathophysiological relationship between hyperglycemia and cardiovascular disease is beyond doubt. Glycemic control per se remains essential for the successful management of diabetes, prevention of chronic complications of the disease and death. Diabetes control involves, first of all, the achievement of target indicators of carbohydrate metabolism. The use of glycated hemoglobin (Hb_A1c), despite known sensitivity limitations, has become the standard for assessing glycemic control in diabetic patients. Early achievement of the target HbA1c level reduces the risk of diabetic complications, increases the likelihood of long-term sustainable disease control. Numerous clinical studies have demonstrated that higher Hb_A1c and greater Hb_A1c variability are manageable risk factors for adverse cardiovascular events. Optimal hypoglycemic therapy for diabetes in order to reduce cardiovascular risks should ensure the achievement of the target level of glycemic control as soon as possible (the first 3 months of therapy), maintaining the target level of glycemia with the lowest possible Hb_A1c variability in subsequent years and therapy should be safe. Timely intensification of therapy, including the use of insulin, can prevent the negative consequences of prolonged hyperglycemia. Glar-100 has a high efficacy and safety in comparison with other insulin preparations at the initiation and intensification of DM2 therapy. RingGlar® and Lantus® are equivalent drugs.

ANO “Children’s Camp FOX CAMP (Lager’ Lisonok)” has been operating in Russia since 2019. Changes of observations in the Moscow region, Sochi, Kaliningrad region, Sochi, Gelendzhik, Chelyabinsk region, Altai. In the period from 2019 to 2022, 796 children and adolescents with type 1 diabetes mellitus (DM1) visited the shifts and active tours of the ANO “Children’s Camp FOKS CAMP (Lager’ Lisonok)”. The priority of children’s recreation is a focus on increased activity: marathons at various distances, football matches, basketball, alpine skiing and long hikes in the mountains, rafting. It is known that activity in patients with type 1 diabetes increases sharply by the level of blood increase, by a decrease in this indicator. In order, to prevent the development of hypoglycemia during heavy exercise, it is very important to quickly determine blood glucose using a glucometer and take the necessary measures to stop it. Thus, the presence of sufficient shifts is necessary to quickly and accurately carry out self-monitoring, sometimes in various and difficult conditions (on mountain trails, on a suspension bridge, when rafting on a mountain river, on the beach). This article presents the development of events on elevated blood levels in children and adolescents with DM1 in the conditions of the marathon, running at various distances in the conditions of the summer shift in the Moscow region of the children’s health camp ANO “Children’s Camp FOX CAMP (Lager’ Lisonok)”.

The article justifies the need for a large arsenal of drugs to treat perennial rheumatoid arthritis. The authors present randomized controlled trial data showing high efficacy of tofacitinib at different doses as monotherapy, or in combination with methotrexate, or other conventional synthetic disease-modifying anti-inflammatory drugs in suppressing the activity and progression of the disease in various groups of patients, both non-responders to methotrexate, and non-responders to tumour necrosis factor-alpha inhibitors. Extension-phase data of randomized clinical trials demonstrated sustained efficacy of tofacitinib for up to 9.5 years. The authors presented the real-world evidence confirming high efficiency of the drug and noted the rapidity of onset of the effect and its high analgesic activity. The safety issues of tofacitinib with an emphasis on the cardiovascular safety of the drug, taking into account updates to the latest 2022 EULAR Recommendations on the need to consider risk factors for the development of cardiovascular adverse events when planning therapy with Janus kinase inhibitors are discussed. It is reported that slightly increased risk of such adverse events during use of tofacitinib, as compared with inhibitors of tumour necrosis factor alpha, was observed in elderly patients who have at least one risk factor for the development of cardiovascular events. Tofacitinib safety data were obtained from meta-analyses, systematic reviews, national registries, open observational studies, as well as outcomes of the use of the drug in real clinical practice. The launch of a domestic generic of the original drug was noted in the Russian Federation.

In the article, the authors discuss the therapy of OA as one of the common diseases of the musculoskeletal system, which leads to disability of people of working age. Focusing on modern concepts of pathogenesis, the article draws attention to pain and the mechanisms of its formation in OA. The recommendations of the world’s leading communities (EULAR, ARC OARSI) and the conclusions of the consensus resolution of experts of the Russian Federation on the diagnosis and treatment of osteoarthritis 2022 are also given. The article draws attention to some aspects of pain therapy. The data of studies and meta-analyses demonstrating the effectiveness of NSAIDs in pain associated with OA are presented. Among the variety of NSAIDs, the article provides data on the efficacy and safety of nimesulide, as well as its additional properties such as inhibition of cancer cell proliferation, neuroprotective and gastroprotective effects. The conclusions of the consensus meetings of 2005, the purpose of which was to provide a continuous and up-to-date assessment of the clinical profile and safety profile of nimesulide, and 2014, the purpose of which was to familiarize with the current state of pathophysiology and treatment of acute pain with a special focus on nimesulide, are presented. The article also provides data on the safety and efficacy of nimesulide in the treatment of OA in comparison with drugs such as diclofenac, naproxen and ibuprofen. One of the little-studied aspects of pain therapy is the patient’s preference. The article presents data from studies of the effectiveness of various forms of NSAIDs and patient preferences in therapy. The authors of the article conclude that the most acceptable from the point of view of efficacy, safety, the rate of onset of the effect, as well as the preferences of patients is nimesulide in the form of granules for the preparation of a solution.

Introduction. Osteoarthritis (OA) is a chronic progressive disease of the joints, accompanied with pain, which limits the mobility of patients. Functional limitations, chronic pain syndrome worsen the quality of life (QoL) in OA of the joints of the lower extremities. QoL significantly depends on the effectiveness and methods of pain treatment, correction of functional disorders.

Aim. Evaluation of the dynamics of QoL in patients with gonarthrosis treated with a high-tech synovial fluid prosthesis – sodium hyaluronate, domestic production.

Materials and methods. The study group consisted of 50 patients who received intra-articular (IA) injections of domestically produced sodium hyaluronate (OOO Ingal, Russia). Comparison group – 30 patients treated with 2 ml of symptomatic drugs of delayed action (SYSADOA) (bioactive concentrate of small marine fish) administrated IA No. 5. Control group – 100 patients treated with a 1 ml of SYSADOA drugs administrated intramuscularly (IM) No. 20. Study program: 12 months, 6 visits with prospective monitoring of the quality of life of patients according to SF-36 compared with baseline data.

Results. At the time of inclusion, patients had a similar level of physical and mental health components, which did not differ statistically significantly (p = 0.369 and p = 0.089). The study group demonstrated the best dynamics of the physical and mental components of health. The therapy was effective in all groups: most patients showed a statistically significant decrease in pain syndrome, an increase in QoL. The groups differed significantly in the speed of achieving the effect of pain relief, the severity of pain reduction and the duration of the effect of treatment.

Conclusions. The spectrum of side effects of non-steroidal anti-inflammatory drugs (NSAIDs) does not allow their use for pain relief indefinitely. SYSADOAs become less effective in the progression of OA than in the early stages of the disease. The positive clinical effect of intra-articular injection of sodium hyaluronate solutions occurs faster and lasts longer than when using SYSADOA.

Introduction. Cervical canal polyps are a common disease in gynecological practice. In the vast majority of cases, cervical polyps are a benign disease, but signs of dysplasia and malignancy can be observed in 0.1–10% of cases. The doctor faces the task of getting rid of the polyp and preventing its recurrence, which is not an easy task, since the etiology and pathogenesis of the development of this disease are not completely clear. There is an opinion about the connection of the occurrence of cervical polyps with inflammation and changes in the microbiota of the female genital organs, hormonal imbalance or a combination of these factors.

Objective. To study the microbiota of the vagina and cervical canal, as well as the hormonal background in women with cervical polyps and to determine whether the appointment of Neo-Penotran Forte is appropriate and effective.

Materials and methods. 84 women of reproductive age (44 – with polyps, 40 – healthy) had a study of the specific and quantitative composition of the microflora of the vagina and cervix and the study of hormonal status with the determination of the level of sex hormones. To correct the identified violations, miconazole + metronidazole was treated.

Results. The data obtained indicated the absence of hormonal disorders in both groups, but the presence of dysbiotic disorders of the vaginal biotope in the group of women with cervical polyps. The frequency of detection of lactobacilli and bifidobacteria in patients with cervical polyps was reduced, and opportunistic microorganisms were isolated with greater frequency, some patients had microorganisms that were absent in healthy women. The microbiota of the vagina of the patients after treatment by miconazole + metronidazole corresponded to the normative values.

Conclusion. According to the study, cervical polyps are a disease associated with dysbiotic disorders of the vaginal biotope andt it is hormone-independent. The drug miconazole + metronidazole has proven its effectiveness and safety.

The review is devoted to the most pressing issues of etiology, classification, diagnosis and treatment of rectovaginal fistulas. The psychosocial impact of a rectovaginal fistula on women’s quality of life cannot be overemphasized. The most common causes of rectovaginal fistula are postoperative and obstetric complications, inflammatory bowel disease, complications of radiation therapy, and neoplasms. A combination of advanced imaging techniques, physical examination, and clinical experience can help determine the location and cause of a fistula. The therapeutic options are varied, but the results are often unsatisfactory. In this regard, the choice of a strategy for the treatment of rectovaginal fistulas should be based on etiology, localization and concomitant pathology. Despite the prevalence and serious consequences of rectovaginal fistulas, there is no generally accepted scientifically based approach to surgical treatment. Collaboration between obstetricians-gynecologists and colorectal surgeons, detailed preoperative assessment, consideration of optimal treatment options and correct surgical technique can achieve a successful outcome in most patients. The aim of the study is to evaluate, on the basis of literature sources, the problem of diagnosis and treatment of patients with rectovaginal fistulas and modern possibilities for improving the results of surgical interventions in this pathology. The methodological basis of the analysis was the study of domestic and foreign literature devoted to this problem. Scientific articles were selected for the period 2016–2021, with the largest randomized controlled trials in this area. The article provides an overview of the main management strategies and technical approaches that are currently effective in eliminating this socially disabling condition.

Introduction. Postponing motherhood correlates with a decrease in natural fertility, the accumulation of aggravated reproductive experience, somatic and other diseases, and, as a result, an increase in the risk of reproductive losses. The present study reflects the significance of intraterritorial differences in the structure and frequency of reproductive losses among female residents of the Tyumen region. Aim. To assess intraterritorial differences in reproductive losses on the example of the Tyumen region.

Materials and methods. An analytical study has been carried out. The study period is 2016–2021. Reproductive losses in various autonomous districts of the Tyumen region were analyzed. Used data from medical records.

Results and discussion. In Tyumen region, 94.33% of reproductive losses occur before 12 weeks of gestation. The proportion of primigravidas in the total number of reproductive losses is 6.78%, HIV-infected – 2.06%. Reproductive losses in the first pregnancy is associated with a gestational age of more than 12 weeks (OR 2.31, 95% CI 2.13–2.49), with HIV infection – less than 12 weeks (OR 3.59, 95% CI 2, 88–4.47). Tyumen region without AO is characterized by a greater association of reproductive losses in pregnancy up to 12 weeks with HIV infection in comparison with the Khanty-Mansiysk Autonomous Okrug – Yugra (KhMAO): OR 1.83, 95% CI 1.67–2.00; and Yamalo-Nenets Autonomous Okrug (YNAO): OR 7.68, 95% CI 6.01–9.81; from 12 to 22 weeks – with HIV infection compared with KhMAO (OR 1.93, 95% CI 1.20–3.09) and YNAO (OR 3.0, 95% CI 1.30–6, 95), with a first pregnancy compared with KhMAO (OR 1.26, 95% CI 1.07–1.48) and YNAO (OR 1.81, 95% CI 1.40–2.35). The greatest contrast was noted between Tyumen region and YNAO. More than 50% of reproductive losses in pregnancy before 12 weeks is due to medical abortion. In Tyumen region without autonomous regions, at more than 12 weeks of gestation, medical abortion competes in frequency with spontaneous abortion. Tyumen region without AO showed high achievements in the total overcoming of criminal abortion.

Conclusion. On the example of Tyumen region, the non-universality of the intra-territorial structure of the Republic of Poland is shown. Artificial reproductive losses dominate over non-artificial ones. Intraterritorial differences in reproductive losses require taking into account, monitoring many risk factors, adapting measures for their prevention, preservation and restoration of reproductive health to them.

Introduction. The development of intrauterine growth restriction (IUGR) begins with fertilization and trophoblast invasion. IUGR is manifested in a decrease in fetal growth rate. However, data on risk factors for fetal growth retardation, their combination with various chronic diseases in a pregnant woman are contradictory.

Objective. To study the features of the course of pregnancy, childbirth, the health status of newborns with IUGR. Materials and methods. The study was a retrospective cohort study. At the first stage, we analyzed 1574 birth histories with a diagnosis of IUGR, placental insufficiency, women with normal pregnancy who gave birth (2016–2021). According to the inclusion and exclusion criteria, 408 women were included in the study. The women were divided into 2 groups. The first group included 202 pregnant women with a diagnosis of IUGR. In the second Group – 206 pregnant women with normal pregnancy, without IUGR, delivered at the time corresponding to the terms in the main group.

Results. We have clarified the risk factors and premorbid conditions involved in the development of IUGR (somatic and gynecological morbidity, pregnancy course). Their analysis is necessary to predict IUGR. The analysis of the timing and method of delivery in the studied groups was carried out. A higher incidence of complications in the early neonatal period was revealed when assessing the health status of newborns with IUGR.

Conclusion. Thus, the study of the mechanisms of IUGR formation in the future will allow the development of modern pathogenetic approaches to prevention and treatment.

Violation of the receptivity of the endometrium in adenomyosis can be supported either by pathological processes in the structure of the endometrium, such as an unexpected increase in vascularization and thickness of the endometrial stroma with a violation of the endometrial environment, or a negative effect on implantation, or a change in the expression of enzymes, cytokines, growth factors, adhesion molecules and various genes, such as hypoxia-induced factor 1α, interleukins (IL-6, IL-8, IL-10, IL-II), IL-8 receptors, CXCR1, CXCR2, matrix metalloproteinases (MMP2 and MMP9), vascular endothelial growth factor, leukemia inhibitory factor (LIF), LIF receptor α, HOXA10 gene, cytochrome P450, aromatase activity, estrogen receptor α, cell adhesion molecules such as integrins, MUC1, pinopods and L-selection. The modern literature data on the receptivity of the endometrium in infertility associated with adenomyosis was analyzed, the etiology and morphofunctional features of the endometrium, its implantation disorders as well as their effects on implantation processes were studied. Infertility is one of the most important and complex medical and social problems in the modern world. Thanks to advances in imaging techniques, there is now increasing evidence that adenomyosis is one of the causes of female infertility. According to studies, adenomyosis was observed in 27% of infertile patients treated with assisted reproductive technologies (ART). Adenomyosis is a disease with an unclear etiology, the pathogenesis of the disease identifies several theories, but there is no single correct one, its connection with infertility in women requires further study and depends on many factors, one of which is the receptivity of the endometrium. Treatment of this disease requires a personalized approach for each patient, to achieve the main goal of overcoming infertility.

Introduction. The novel coronavirus infection (COVID-19) caused the pandemic in 2020 and significant damage to the health of all mankind. Nowadays it’s still unclear how large the influence of COVID-19 and vaccination Sputnik V / Sputnik Light on women’s reproductive health, that’s why this question is topical and requires researches to be answered.

Aim. To find out if there are any changes in frequency of dysmenorrhea and menorrhagia, length of menstrual cycle and menstruation in women which had COVID-19 or were vaccinated Sputnik V / Sputnik Light.

Materials and methods. An uncontrolled (before-after) study was carried out, data collection was made by questionnaire. 344 women took part in this study, all of them were patients of «Family» Clinic. 277 of them had COVID-19 and 236 were vaccinated Sputnik V / Sputnik Light. Processing of received data was made by statistical methods: McNemar’s test and Wilcoxon sighed ranks test.

Results and discussion. After COVID-19, there was a statistically significant increase in the length of the menstrual cycle from 28 days (Q1 = 28.0; Q3 = 30.0) to 29 days (Q1 = 27.0; Q3 = 32.0), (p = 0.023) in 30.26% of women. The duration of menstruation after a new coronavirus infection also increased statistically significantly in 20.3% of women (p = 0.031), but the median did not change. In the post-vaccination period, there were no statistically significant changes in both the duration of menstruation and the length of the menstrual cycle (p = 0.793 and p = 0.356, respectively). A statistically significant increase in the frequency of menorrhagia was found from 21.0 to 28.8% after COVID-19 (p < 0.001). There was no statistically significant dynamics in the frequency of dysmenorrhea in the post-COVID period (p = 0.152). After Sputnik V / Sputnik Light vaccination, there was a statistically significant increase in the frequency of menorrhagia from 20.3 to 24.6% (p = 0.013). However, there was no statistically significant dynamics in the frequency of dysmenorrhea in the postoperative period (p = 0.581).

Conclusion. COVID-19 does not affect the frequency of dysmenorrhea, however, after this disease, there is an increase in the duration of the menstrual cycle and menstruation, as well as the frequency of menorrhagia, which may be associated with the use of anticoagulants as COVID-19 therapy. Vaccination Sputnik V / Sputnik Light has an effect only on the frequency of menorrhagia, increasing it. We need further researches to completely evaluate the impact of COVID-19 and vaccination on women’s menstrual function.

Introduction. Dry eye syndrome (DES) is a common cause of blurred vision and discomfort in patients after eye surgery, which has a great impact on the on the patients’ mental state. Evaluation of the presence of DES during the preoperative examination is important not only for obtaining a high postoperative result, but also for the timely administration of therapy in order to improve the patient's quality of life.

Aim. Thus, the aim of this study was to establish the features of the clinical course of dry eye syndrome and to determine the effectiveness of ultra-high viscosity hyaluronic acid therapy in patients with anxiety and depression after cataract and keratorefractive surgery.

Materials and methods. The study involved 100 patients (150 eyes). Preoperative examination included DES diagnostic and psychotesting. DES in all studied subjects was treated with ultra-high viscosity hyaluronic acid 3 times a day for 3 months after surgery in combination with topical combination of glucocorticoids, antibacterial and non-steroidal anti-inflammatory drugs, which were administered within 1 week after surgery. There were no intraoperative complications in all studied cases.

Results. It was found that patients with depressive and/or anxiety symptoms (46% of the subjects) had higher OSDI scores, while there were no differences in clinical and functional tests of dry eye syndrome between the studied groups. There was a significant improvement in the results of OCT meniscometry and Norn's test during therapy with ultra-high viscosity hyaluronic acid. The given clinical examples show the importance of timely diagnosis and treatment of DES.

Conclusions. The study showed the importance of dry eye syndrome evaluation and timely artificial tear therapy prescribing for both to achieve a high postoperative result and to reduce the patients’ subjective discomfort and improve patients’quality of life.

Introduction. The Ahmed glaucoma valve (GV) type drainage implantation is characterized by high efficiency and low complication rate, and is finding an increasing application in clinical practice. Although GV provides better intraocular pressure (IOP) control and higher surgical success rates compared to trabeculectomy, the so-called hypertensive phase (HP), typically defined as an IOP elevation more than 21 mmHg, can occur at the period from one to three months postoperatively, related to the fibrous capsule reservoir formation, which does not have the character of persistent hypertension.

Aim. To analyze the effectiveness of the Dorzolamide-Optic carbonic anhydrase inhibitor and the Latanoprost-Optic prostaglandin analogue as the drugs of choice in clinical conditions at different periods during postoperative follow-up when antihypertensive therapy after GV implantation is needed.

Materials and methods. The study included 80 glaucoma patients who underwent GV implantation in the clinic “Eye Surgery Rascheskov” with a postoperative follow-up period of at least one year. In order to increase the effectiveness of surgical intervention and preserve visual functions, hypotensive therapy was prescribed in studied patients either when IOP exceeded the target pressure, or when there was a tendency to a constant increase between control visits. 180 operated patients with IOP level within the target level during the follow-up period were excluded from the study.

Results. The overall incidence rate of the hypertensive phase (GF) was 44.4%. In all studied patients to compliance with the operation technique and early therapy appointment, Dorzolamide-Optic monotherapy was sufficient to achieve stabilization of visual functions for up to 3 months after surgery. During a follow-up period more than 3 month, 15 patients (18.8%) required additional appointment of Latanoprost-Optic to achieve the target IOP level. After 2 months following the implantation, the antihypertensive therapy was discontinued under the IOP control in 17 patients (21.3%).

Conclusions. Medical management of HP is crucial for preventing further optic nerve damage and preserving visual functions, as reduction of the incidence and severity of HP are known to be associated with higher operative success rates and a better long-term IOP control.

Introduction. The number of patients with urolithiasis (UCD) is increasing annually both among the adult population and among children, and therefore it is necessary to develop an integrated approach to the prevention and treatment of this pathology. Most often, with urolithiasis, oxalate-calcium crystalluria is determined, to reduce the level of which, low-mineralized mineral waters with a minimum sodium content are recommended.

Aim. To study the effect of mineral water “Serebryanyy klyuch” on the course of experimental calcium oxalate nephrolithiasis.

Materials and methods. During the study on laboratory rats, oxalate nephrolithiasis was simulated for 3 weeks by providing a 1% solution of ethylene glycol as a drink, while the rats of the experimental group used mineral water “Serebryanyy klyuch” as a solvent. The results of urine biochemistry (calcium, creatinine, activity of lactate dehydrogenase and γ-glutamyl transferase) and morphological studies (determination of the amount and size of calcium deposits in the kidneys, assessment of the structural and functional state of the nephrothelium) were evaluated.

Results. Calcium-oxalate deposits in the control group of rats were detected in 25% of cases, while large-sized stones were observed in the kidney tubules. In the experimental group, the presence of stone deposits was detected in 1 (11.1%) case, with a clear shift towards smaller deposits. Morphological signs indicating the development of dystrophic changes with the phenomena of nephrosclerosis were much less pronounced in the conditions of consumption of mineral water “Serebryanyy klyuch”.

Conclusion. Thus, the use of mineral water “Serebryanyy klyuch” in the conditions of a three-week experimental oxalate nephrolithiasis was accompanied by characteristic signs of facilitating the course of the pathology and contributed to a decrease in the proportion of large calculi in the kidneys.

Introduction. Iron-deficiency accompanies many diseases, including cardiovascular pathology, so timely diagnosis and correction of this condition is necessary.

Aim. To study the features of the course of stable exertional angina against the background of iron deficiency anemia before and after correction with iron (III) polymaltose hydroxide in patients in primary health care using a computerized patient register.

Materials and methods. 1210 patients with stable exertional angina aged 50–85 years (309 men, 901 women) were included. A special computer program was created for data analysis. In 500 out of 1210 patients, IDA was detected (385 women, 115 men). Mild anemia – 410 patients, moderate – 75, severe – 15. The main group – patients with stable exertional angina and Irondeficiency anemia (the first subgroup – patients treated with iron (III) polymaltose hydroxide and the second subgroup – patients who did not receive the drug iron (III) polymaltose hydroxide due to refusal of treatment or contraindications) and the control group – patients with stable exertional angina without Iron-deficiency anemia. All patients received standard therapy recommended for the treatment of stable exertional angina (the main group additionally received iron (III) polymaltose hydroxide).

Results. In the first subgroup of the main group, after treatment with iron (III) hydroxide polymaltose, there was a statistically significant increase in hemoglobin levels by 11,7%, hematocrit by 5%, erythrocytes by 4%, serum iron by 112,8%, and an improvement in exercise tolerance by 48,7%, episodes of ST segment depression by 30,2%. In the second subgroup and the control group, there were no significant changes in the above parameters.

Conclusion. Iron-deficiency anemia contributes to the severe course of stable exertional angina, which is confirmed by the high frequency of III-IV functional class exertional angina, a decrease in tolerance to exercise stress. Correction of Iron-deficiency anemia reduces the frequency of episodes of transient myocardial ischemia in the main group.

Psycho-emotional disorders such as depression and anxiety disorders are important modifiable risk factors for the development and complicated course of many common chronic non-communicable diseases. A particular feature of such comorbidity is the significant impact of psycho-emotional disorders on the motivation and adherence of patients to a healthy lifestyle and various therapy options, which increases the risks of complications and, as a consequence of this, the healthcare expenditures. The topicality of the issues of screening and management of psycho-emotional disorders in the general practitioner practice is caused, on the one hand, by high rate of these disorders in patients with chronic non-communicable diseases, deterioration in quality of life and an increase in adverse outcomes, and on the other hand, inadequate awareness of the possibilities to manage the psycho-emotional state of patients with comorbidities. The therapy for psycho-emotional disorders includes both drug and non-drug methods, however, the effectiveness of such therapy in relation to the clinical course and prognosis in patients with different comorbidities is not the same. This review presents the most common comorbidities of psycho-emotional disorders and somatic diseases in therapeutic practice. A buspirone and tofisopam therapy for psycho-emotional disorders in patients with various comorbidities was discussed. The efficacy and safety of tofisopam and buspirone have been studied in numerous studies in patients with chronic diseases and a wide range of anxiety disorders, including a long-term administration.

Coenzyme Q (CoQ) plays a key role in cell bioenergetics; it is not only supplied with food, but also synthesized in the body. Endogenous CoQ synthesis decreases with age, with statin use, with cardiovascular, neurodegenerative, and other diseases. In this regard, specialized food products (SFP) enriched with CoQ are being developed. Aim of the review – compare the CoQ doses allowed for use as part of dietary supplements and SFP with doses that provide a clinical effect. Literature review was carried out using the RSCI, Pubmed databases and Google Scholar, ReserchGate systems for the keywords “ubiquinone”, “coenzyme Q10”. The amount of CoQ contained in SFP is set by domestic regulatory documents based on an adequate daily intake for adults (30 mg) and the upper allowable intake level as part of SFP and dietary supplements – 100 mg/day. Actually used doses of CoQ range from 60 to 500 mg/day. Various ways to increase the bioavailability of CoQ have been described. When patients take CoQ, a U-shaped dose-effect relationship is observed, an effective dose that significantly reduces systolic blood pressure, fasting glucose and insulin levels, the degree of hemoglobin glycation, the HOMA-IR glycemic test is in the range of 100–200 mg / day. An improvement in the antioxidant status and a decrease of pro-inflammatory cytokines concentration in the blood plasma of athletes is provided by CoQ doses of 60–300 mg/day, in patients with type 2 diabetes mellitus and coronary heart disease, doses of 100–150 mg/day. Clinically effective doses of CoQ (100–200 mg/day) when used for at least 12 weeks correspond to or are 1.5–2 times higher than the upper allowable consumption level in the composition of SFP and dietary supplements. The inclusion of CoQ in the dietary therapeutic SFP in an amount that does not reach doses that are effective in a certain pathology does not achieve the expected result. A possible way to solve the problem is to increase the acceptable levels of consumption of CoQ in SFP, as well as increasing the bioavailability of CoQ in the composition of emulsions, liposomes, phytosomes and oleogels.

Introduction. Paresis and paralysis of the larynx are a fairly common complication after thyroid surgery and are found in all clinics (oncology and endocrinology). The frequency of this complication according to the literature ranges from 4 to 35%. The risk of damage to the recurrent nerve increases especially during repeated operations on the thyroid gland. According to the literature, postoperative transient and persistent paresis of the larynx is distinguished.

Aim. To evaluate objective data on the larynx state in the postoperative period, estimate the time required for reversal of laryngeal paresis, and develop a laryngeal function recovery complex for the postoperative period.

Materials and methods. We analyzed data on 628 patients treated at the clinic in the department of head and neck tumors in 2020–2021. The study included 47 patients (7.2%) who met the selected criteria. Among them were 40 women and 7 men. The average age is 51 years (43–60 years). The duration of the disease averaged 62 months (24–102). In 38 patients, papillary cancer was detected, in 1 – medullary, in 8 – follicular tumors of a benign nature.

Results of the study. Early detection of laryngeal paresis occurred in 42 patients. In 52% (24 patients), postoperative hypocalcemia was detected, which was stopped on the background of drug administration. In 3 patients, fold mobility remained on days 1–2 after surgery, and paresis appeared on days 4–5. Speech therapy work includes a phased set of activities: 1) rational psychotherapy; 2) work on the normalization of physiological and phonation respiration; 3) phonopedic exercises; 4) in the presence of dysphagia, work is carried out to restore the function of swallowing.

Conclusions. The development of postoperative paresis of the larynx is possible even if the integrity of the recurrent nerves is preserved; the use of the technique of microsurgical neurolysis can significantly reduce the frequency of paresis of the larynx; with transient paresis, most often mobility is restored after 1-3 months; the use of an integrated approach to the rehabilitation of this category of patients allows to achieve improved functional results; with bilateral persistent paralysis of the larynx, as an alternative to tracheostomy, the chordotomy technique using a CO₂ laser can be used.

Introduction. Cancer of the uterine body (СU) is a malignant hormone-dependent tumor with age-related characteristics, more common in pre- and postmenopausal women (75%). Comorbid pathology in the structure of acquired diseases is polymodal in nature, which makes it difficult to diagnose somatic pathology, choose tactics for diagnostic and therapeutic approaches, and prevent complications.

Aim. To study the structure of extragenital pathology, the frequency and severity of comorbidity among the patients with CU using indices (CIRS, Charlson, Kaplan – Feinstein).

Materials and methods. An observational retrospective cross-sectional study using the archival method was carried out, which included 100 women with verified RTM stages I–III. In order to assess the effect of age on the structure and incidence of comorbid pathology, patients were divided into two groups: group I (n = 39) under the age of 55 years, group II (n = 61) – over 55 years.

Results. In the structure of somatic pathology in patients with endometrial cancer in both groups, diseases of the cardiovascular system (64.1% and 91.8%), endocrine system, metabolic disorders (28.2% and 55.7%), organs digestion (28.2% and 24.6%). At the same time, diseases of the cardiovascular system (p < 0.001), endocrine system and metabolic disorders (p < 0.001) statistically significantly prevailed in patients older than 55 years. The average number of nosological forms of somatic pathology was significantly lower in group I (Me – 2), compared with patients in group II (Me – 3, p < 0.05). When using the M. Charlson scale to analyze the frequency of comorbidity in group II, somatic pathology was diagnosed in 100% of cases, which is significantly higher than in group I, and cases with moderate comorbidity predominated more often (2.7 times, higher in group II compared with I) and pronounced comorbidity (10 times). When analyzing the frequency of comorbidity according to the CIRS scale (Cumulative Illness Rating Scale-Geriatric) and the Kaplan – Feinstein index, no significant differences were found in the studied groups.

Conclusion. Patients in the second group were significantly more likely to have arterial hypertension, coronary heart disease, hyperlipidemia, type 2 diabetes mellitus were significantly more often detected compared to patients in group I. When conducting a comparative characteristic of methods for assessing comorbidity, it was found that the highest level of reliability in the frequency of comorbid pathology was registered when using the M. Charlson scale (p < 0.001).

In the past decades, biofeedback has become a widely adopted non-pharmacological option in the management of a variety of somatic, neurological, and psychiatric conditions. The biofeedback method is based on the associations between one’s vegetative and mental functions; during a session with the device, information about the change in his/her condition over time is “returned” to the patient as accessible audial or visual stimuli. The efficacy of biofeedback treatment may primarily be attributed to improvements in the state of the patients based on establishing an individual model of his/her best psychophysiological state, enabling effective rehabilitation activities at a rate suitable for each patient along with ensuring better awareness of the patient of his/her body functions; such an intervention is stepwise and helps sustain the patient’s motivation for success, thus affecting the pathological condition. This review describes the historical prerequisites for the development of biofeedback techniques and the principal mechanisms of their action; a brief summary of studies looking at the efficacy of this method in various somatic, neurological, and psychiatric conditions is also provided. The presented data clearly indicate that the use of biofeedback results in a decreased medication load in patients suffering from conditions such as arterial hypertension, epilepsy, ADHD, chronic pain, anxiety disorders, autism etc. while there are practically no contraindications for this method, except for acute psychosis, photosensitive epilepsy, and severe cognitive impairment. In this connection, clinical implementation of biofeedback techniques should be intensified in a variety of conditions.

Purulent diseases in otorhinolaryngology are of great interest due to their widespread prevalence and the objective difficulties of treatment. One of the most frequently encountered nosological forms is purulent sinusitis. A key element in the complex treatment of bacterial sinusitis is systemic antibiotic therapy aimed at the eradication of pathobionts from the focus of infection. However, the increasing worldwide drug resistance of etiologically significant microorganisms complicates antibacterial chemotherapy of purulent sinusitis and raises questions about its future feasibility. The threat of a change from a resistance era to a post-antibiotic era is very significant, given the acute shortage of new antibiotics and the relatively rapid adaptation of bacterial microorganisms to them. The global community is therefore faced with the challenge of finding other drugs with antimicrobial activity. In recent decades, genetically modified virulent bacteriophages and phagolytes isolated on their basis are becoming increasingly attractive in the fight against purulent infections of various localizations caused by drug-resistant bacteria. This literature review focuses on the potential of phage therapy for acute bacterial sinusitis in an era of globally increasing bacterial strain resistance. The article details the causative agents of community-acquired and hospital-acquired acute sinusitis, the main mechanisms of bacterial antibiotic resistance, the effect of virulent phages on bacteria, and studies on the efficacy of phage therapy in the treatment of acute sinusitis. The facts outlined herein clearly indicate the efficacy of phage therapy, as well as therapeutic perspectives on using bacteriophages in the complex treatment of purulent sinusitis caused by antibiotic-resistant microbiota.

Introduction. Currently, the issues of prescribing anticoagulant therapy to the wounded are poorly studied, the doses of drugs and the timing of its implementation have not been determined.

Aim. To study various modes of anticoagulant therapy for the prevention of venous thrombosis of the lower extremities in the wounded after surgery using the parameters of the plasma hemostasis system and the Thrombodynamics test.

Materials and methods. A prospective study was conducted, which included 90 wounded with mine-explosive/gunshot injury receiving anticoagulant therapy in preventive doses. The studies were carried out on the equipment of the Thrombodynamics recorder (HemaCor, Moscow). The patients were divided into 3 groups: 1 group, which included 30 patients taking rivaroxaban at a dose of 10 mg/day, 2 group of 30 patients receiving enoxaparin sodium at a dose of 40 mg once a day, 3 group consisting of 30 patients receiving enoxaparin sodium 40 mg 2 times a day. In the dynamics of treatment, the parameters of the plasma hemostasis system and the parameters of the Thrombodynamics test were evaluated.

Results. It was revealed that during preventive anticoagulant therapy, there were no significant differences in the standard parameters of the coagulogram, when studying the parameters of the Thrombodynamics test, significant differences were

observed between groups 1 and 3 in values (V/VSt, Vi, Tlag, СS), between group 2 and 3 in parameter (V/VSt, Vi, Tlag, СS), between group 1 and group 2 in the value of D. A statistically significant relationship was found between the Thrombodynamics parameter D and the indicators of TV, prothrombin by Quick, and fibrinogen content.

Conclusion. The Thrombodynamics test can be used as a potential tool for a personalized approach to monitoring the hemostasis system in the wounded.

Diffuse toxic goiter is one of the frequent endocrine pathologies that lead to damage to the cardiovascular system. The prevalence of thyrotoxicosis in people over 65 years of age is 15%. The clinic of thyrotoxicosis among elderly patients is nonspecific and asymptomatic. Asthenic symptoms prevail – increasing muscle weakness, weight loss, neurological symptoms, expressed in lethargy and depression, changes in the gastrointestinal tract, cardiovascular system. Elderly patients often have tachycardia, atrial fibrillation, atrial fibrillation, increasing heart failure, which is associated with age-related changes in the myocardium, concomitant atherosclerosis-associated diseases. Atrial fibrillation in patients with thyrotoxicosis increases the risk of thromboembolic complications. Low-symptomatic manifestations of thyrotoxicosis require a more thorough examination, including laboratory, hormonal and instrumental methods. This article considers a clinical case of an elderly patient with diffuse toxic goiter. The features of the clinical picture with the predominance of disorders from the cardiovascular system -interruptions in the work of the heart, increased shortness of breath, signs of increasing cardiovascular insufficiency are presented. Diagnostic studies, differential diagnostic search, confirming the presence of thyrotoxicosis and cardiovascular insufficiency were conducted. Appropriate treatment has been prescribed. An integrated approach in the treatment of patients with diffuse toxic goiter in combination with ischemic heart disease significantly improves the condition of patients, normalizes the thyrotoxic status, and, consequently, the state of the cardiovascular system against the background of the use of thyrostatics. Also, the wellbeing of patients improves because of correction of cardioprotective therapy, the heart rate is normalized, the signs of chronic heart failure are significantly compensated.

The 2019 outbreak of a novel coronavirus infection in Wuhan City has resulted in a pandemic that has not only brought about global social change, but has also been a challenge for the entire medical community. The accumulation of material on this disease has revealed the multisystemic nature of internal organ damage with the development of new associated conditions, particularly those related to immunopathology and rheumatologic diseases. This review describes the literature on musculoskeletal symptoms during different periods of new-onset coronavirus infection (COVID-19). The paper defines the terms post-COVID syndrome and Long COVID, and describes clinical observations and the most common symptoms in adults and children. Clinical cases of joint syndrome are described in patients who have had a new coronavirus infection and no history of rheumatologic disease. Possible molecular pathogenesis of autoimmunity activation (cellular and humoral immune response as well as direct cytotoxic effect of the virus) both in acute period of coronavirus infection as well as during recuperation is also considered. Literature analysis of peculiarities of course of COVID-19 in patients with rheumatological diseases was carried out, in particular the risk of infection, its severe course and unfavourable outcome. In general, according to the analysis of the literature, musculoskeletal lesions occur more frequently between 3 and 10 weeks after the end of the acute stage of infection, most often manifested by muscle and joint pain, while the incidence of true reactive arthritis associated with COVID-19 is low. The pathogenesis of musculoskeletal damage requires further investigation and patients should be followed up for a longer period of time.

Introduction. When analyzing constantly incoming information, it becomes clear that the growing risk of co-infections with a new coronavirus infection is the main threat of complications leading to death.

Aim. A significant part of the information is the data accumulated by specialists on co-infections with systemic mycoses, which often causes a fatal outcome in coronavirus infection.

Material and methods. In study systematized information about systemic mycoses in case of coronavirus infection, diagnosed according to the data of medical institutions in Vladivostok, specializing in the treatment of patients with a new coronavirus infection in the period from autumn 2020 to spring 2021.The results of a survey of 200 patients with a new coronavirus infection who were diagnosed with ventilator-associated pneumonia were studied.

Results and discussion. Systemic mycoses in patients with COVID-19 do not create a relatively new situation: fungal-bacterial or viral-fungal co-infections were described even during the H1N1 or H7N9 influenza outbreaks. Almost all patients were treated with corticosteroids at high doses causing immunosuppression, which in turn contributed to the development of systemic mycosis. 26% (52 patients) were diagnosed with systemic mycoses, where the leading pathogens were fungi of the genus Aspergillus: A. niger, A terreus, A. fumigatus. The second place (15%, 30 patients) was occupied by representatives of the genus Candida, where C. albicans prevailed. All patients with diagnosed mycoses who were on treatment were prescribed, among other things, antimycotic therapy (voriconazole, fluconazole, caspofungin). However, all patients had a lethal outcome, which was determined by the combination of infection with the SARS-CoV-2 virus, and, ultimately, by the development of systemic mycosis, including the presence of concomitant pathology that determines the development of the infectious process.

Conclusions. In the event of novel coronavirus infection, identification of associations of SARS-CoV-19 virus and other viruses combined with fungi also requires early clinical evaluation.