The article presents modern views on the role of the anti-ischemic agent, ranolazine, in the treatment of a wide range of patients with angina pectoris. It also provides data on a percentage increase in the number of patients with chronic coronary artery disease who need improved anti-ischemic therapy. The need to use alternative agents for the treatment of angina, which is highlighted in the article, is determined by a percentage increase in the number of elderly and senile patients with angina, as such patients often have concomitant diseases that limit the use of haemodynamic anti-ischemic agents. The authors consider various pathophysiological links in the development of myocardial ischemia, which may become the background for choosing a specific anti-ischemic agent. Amongst others, the article provides evidence data on the effectiveness of the usage of ranolazine in patients with angina pectoris and myocardial ischemia, but in the absence of coronary artery obstruction. The mechanisms of action of ranolazine, which determine both its anti-ischemic and pleiotropic effects, are discussed in detail. Special effects of ranolazine that may be beneficial for patients with coronary artery disease and clinically significant diastolic dysfunction are observed. This effect consisted of a positive effect of ranolazine on the left ventricular diastolic function. Data on the cost-effectiveness of the usage of ranolazine in the treatment of angina pectoris are provided. The antiarrhythmic action of ranolazine is considered separately. The article discusses the tolerability of ranolazine and its possible side effects. The all-round good tolerability and high safety of ranolazine in a wide range of patients with coronary artery disease are emphasized.

Hypertrophic cardiomyopathy (HCM) is a genetically determined disease associated with the presence of mutations in the genes encoding the synthesis of myocardial contractile proteins. The presence of obstruction in the LVL is a powerful predictor of adverse outcomes and serves as an indication for surgical treatment. One of the frequent “masks” that patients with HCMP come with is “acute coronary syndrome” or “heart defect”. Patient O., 43 years old, maintained a good tolerance to physical exertion for a long time. Has 2 children. Pregnancies proceeded without pathology from the cardiovascular system. Mild arterial hypertension was registered after the second birth. In August 2017, the patient was hospitalized with a diagnosis of ACS, diagnostic coronary angiography was performed: the coronary arteries are not changed. During auscultation, systolic noise was heard over the precardial region. Previously, noises were detected. On an echocardiogram, an obstructive variant of HCMP with a gradient of 150 mmHg was diagnosed. Given the high gradient of LVL obstruction, the patient underwent selective alcohol ablation. After alcohol ablation, there was a high gradient in VTLJ – 96 mmHg. Cardialgia and shortness of breath persisted. No cardiac arrhythmias were recorded. In August 2019, the patient underwent an extended myoectomy with good effect. At control examinations a year after myoectomy: the pressure gradient on the AoC is 13 mmHg, VTLJ is 11 mmHg. This example illustrates the need to include HCMP in the circle of differential diagnosis when examining a young patient with chest pain, especially in combination with heart murmurs. Echocardiography with Doppler examination is a simple and affordable diagnostic method. The alcohol septal ablation performed was ineffective, and the extended myoectomy had a good hemodynamic and clinical effect and may be the method of choice of therapy in these patients. The peculiarity of this case is the manifestation of the disease at the age of 43, during two pregnancies without clinical manifestations of pathology of the cardiovascular system.

The study of various pathological conditions associated with COVID-19 remains an urgent task. In occupational medicine, COVID-19 is considered as a new biological factor that can occur not only in the environment, but also in production conditions. Medical workers are at an increased risk of infection with the SARS-CoV-2 virus when performing their professional duties, while a new coronavirus infection can be considered as an occupational disease. The presence of severe complications of a new coronavirus infection leading to disability gives relevance to the analysis of the features of occupational diseases of medical workers in order to improve their diagnosis, improve prevention, treatment and rehabilitation. The most important manifestation of a new coronavirus infection is a lesion of the cardiovascular system, one of the possible variants of which may be the development of myocarditis. In the Samara region in 2021–2022, 10 cases of chronic occupational diseases associated with a new coronavirus infection that caused permanent disability were identified to medical workers. Of these, viral myocarditis was diagnosed in four cases and inflammatory dilated cardiomyopathy in one case. The presented clinical case reflects one of the possible serious complications of coronavirus infection – myocarditis, which led to the development of cardiac arrhythmias. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease with the professional activity of a medical worker. The need for a multidisciplinary approach to the diagnosis of manifestations, treatment of COVID-19 and its complications, with the mandatory participation of a cardiologist, improvement of the examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of infection with SARS-CoV-2 medical workers is emphasized.

Currently, the number of percutaneous coronary interventions (PCI) performed in acute and chronic forms of coronary heart disease continues to grow: every year their number reaches at least 5,000,000 worldwide, and more than 200,000 of them in Russia. The main causes of postoperative mortality are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium from ischemia/reperfusion under conditions of balloon expansion and stenting of the affected coronary arteries. The review presents experimental and clinical literature data on the successful use of levocarnitine for cardioprotection in patients with various forms of coronary heart disease and patients with chronic heart failure, both with intravenous administration and as part of a cardioplegic solution during heart surgery. The intracoronary route of administration of levocarnitine solution during PCI in high-risk patients (elderly and senile patients, with multivessel lesions of the coronary bed, difficulties in conducting the intervention) is substantiated. The description of two clinical cases of the use of the technique in elderly patients with acute forms of coronary heart disease with multivessel lesion is given. The postoperative period proceeded without complications with smooth dynamics of biomarkers (troponin I, total creatinephosphokinase, MB-fraction of creatinephosphokinase, lactate dehydrogenase), ischemic ECG shifts were little pronounced. The expected results of the application of the technique are a reduction in intraoperative and postoperative complications of ischemia/ reperfusion and an increase in the effectiveness of the clinical results of PCI in high-risk patients.

Introduction. Next to neurodegenerative disorders, cardiovascular diseases are now the most common cause of cognitive impairment. The combination of factors such as older age and chronic heart failure is a corner-stone of a greater risk for developing vascular cognitive impairment.

Aim. To study the relationship between the parameters of the left ventricular ejection fraction and the concentration of NT-proBNP with the results of neuropsychological testing in patients with chronic heart failure in old age.

Materials and methods. The study included 200 elderly patients with CHF II–III FC. The neuropsychological examination included tests: tracking, Schulte tables, verbal associations, the Montreal Cognitive Function Assessment Scale (МоСА test). Laboratory tests included determination of the concentration of NT-proBNP in serum.

Results. During neuropsychological testing, reduced indicators were obtained: during the MOS test in patients with left ventricular ejection fraction (LVEF) values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 7230 [3325; 8830] pg/ml; in the Schulte test, an increase in execution time was noted in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2900 [700; 7500] pg/ml; in the tracking test – an increase in time in part A in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 5385 [2125; 8675] pg/ml and part B in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 6947 [3325; 9310] pg/ml, in the verbal association test – in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2090 [608; 7126] pg/ml. Correlation analysis showed the presence of a significant relationship between LVEF indicators, the concentration of NT-proBNP and the results of neuropsychological testing (p < 0.001), while, according to the Rea&Parker classification, the connection was assessed as relatively strong and medium strength.

Conclusion. The cognitive impairments identified in this study in elderly patients with chronic heart failure were characterized by a decrease in concentration, memory, executive functions and the overall integrative index of cognitive functions. These disorders were significantly associated with a decrease in the left ventricular ejection fraction and a high concentration of NT-proBNP.

Introduction. The increase in the number of requests for medical help for pain in dorsopathy determines the relevance of this problem. Among all the conditions included in the Health Expenditure Survey, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CТD), which are the most common in developed countries and are characterized by a variety of clinical forms. There is a need to develop safe and effective complexes for the medical rehabilitation of patients with СТD. The complex method of СТD treating with the obligatory use of drug and non-drug methods of treatment prescribed together or sequentially in one complex, in our opinion, is the most optimal.

Aim. To conduct a comparative evaluation of the therapeutic efficacy of restorative treatment methods in patients with cervicothoracic dorsopathy.

Materials and methods. Patients with cervicothoracic dorsopathy (n = 220), stratified into 2 comparable groups, were studied, to whom the original (n = 155) and standard (n = 65) methods of restorative treatment were applied. The original method of treatment assumed a combined therapeutic effect with the use of drug therapy and a rehabilitation complex of physiotherapeutic and psychotherapeutic sessions. Statistical analysis included a comparative assessment of the intensity of the pain syndrome, static-dynamic and reflex disorders before and after the therapy.

Results. The original and standard methods used in the course of the study statistically significantly (p < 0.05) reduced the intensity of the pain syndrome and reduced the frequency of reflex disorders. At the same time, the use of the original method of therapy was more effective (p < 0.05) in reducing the severity of the pain syndrome and reducing the frequency of reflex disorders in subgroups of patients, both with uncomplicated and complicated forms of cervicothoracic dorsopathy. The use of a standard method of therapeutic effect significantly reduced the frequency of manifestation of static-dynamic disorders in the group with uncomplicated forms of dorsopathy, while in patients with complicated forms of cervicothoracic dorsopathy, no therapeutic effect was achieved.

Conclusions. The original method of therapy has confirmed its effectiveness, which indicates the need and justification for the use of combined restorative treatment of patients with cervicothoracic dorsopathy.

Introduction. Asthenia manifestation treatment is an urgent problem due to its high frequency in outpatients.

Аim. To evaluate in a controlled randomized clinical trial the efficacy and tolerability of the course use of a combination of pyridoxine and glutamic acid in patients with asthenic complaints.

Materials and methods. 50 outpatients with main asthenia manifestations were included in the study if they complied inclusion criteria and signed the informed consent. After randomization, in group 1 a combined supplement with 2.5 mg of pyridoxin and 100 mg of glutamic acid (Metabovit® Life Energy, MNPK “BIOTIKI”) was added to therapy 1 tablet a day sublingually, in group 2 patients received basic therapy for chronic diseases only. The duration of observation was 21 days. Before and after the end of the study all patients underwent neuropsychological examination, which included the questionnaires: Multidimensional Fatigue Inventory (MFI-20), a Reader stress test (adopted by O.Kopina), a questionnaire on the level of life exhaustion (The Maastricht Questionnaire), a “Schulte tables” test with working efficiency evaluation.

Results. In the group of patients receiving Metabovit® Life Energy 1 tablet a day, in comparison with the control group (p < 0.001) the overall score on the MFI-20 self-questionnaire decreased and amounted to 29 [26; 30]; Δ MFI-20 was equal to -22 [-27; -16]; the results reached normative values for most participants; improved time the performance of the “Schulte tables” test decreased by more than 9 seconds; stress levels decreased by almost 30% in men and 20% in women; the indicator of life exhaustion decreased by 60%. In patients in the control group, no significant changes in the studied indicators were detected by the end of the follow-up.

Conclusion. In the group of patients who received the biologically active food supplement Metabovit® Life Energy, there was a significant positive dynamics and regression of most of the symptoms of asthenia, in comparison with the control group.

Dorsalgia − nonspecific back pain is the leader in the number of requests for medical help. Nonspecific musculoskeletal pain accounts for up to 80–90% of all pain syndromes. Back pain can be provoked by professional static-dynamic overloads, violations of the statics of the musculoskeletal system, exposure to cold and/or vibration, overweight, hereditary factors, etc. In outpatient practice, doctors often have to deal with various forms and clinical manifestations of dorsalgia. The leading role in the diagnosis is given to the physical examination of the patient. With the active collection of complaints and anamnesis, the doctor has the opportunity to identify the leading problem that prompted the patient to seek medical help, clarify the localization of the process, the time of occurrence and the sequence of symptoms, which allows you to fully imagine the picture of the disease and differentiate between simultaneously occurring nosologies. The identification of the affected structure, which is the root cause of musculoskeletal pain, does not affect the appointment of basic drug therapy, but it is absolutely necessary when conducting local injection therapy, as well as a number of non-drug treatment methods. Among the pharmacological drugs used to treat musculoskeletal pain, the priority remains for NSAIDs, the choice of which, first of all, is dictated by its safety. The favorable safety profile of Nimesil® (nimesulide) has been confirmed by numerous domestic and foreign studies. Nimesulide is registered in 50 countries for the treatment of pain syndromes, and is also used as an antipyretic and anti-inflammatory drug. According to the results of a study in the Russian Federation, Nimesil® (nimesulide) turned out to be the most frequently prescribed drug, which is due to its high effectiveness and ability to accumulate in therapeutic concentration in the focus of inflammation. In addition to pharmacotherapy, the treatment regimen for musculoskeletal pain should include, on a parity basis, non-drug treatment methods that allow correction of pathobiomechanical changes. If ignored, in many cases, drug anesthesia does not lead to the desired effect, which can contribute to the chronization of pain. The described clinical case illustrates the simultaneous course of two variants of dorsalgia in the patient, different in localization, clinical manifestations, severity and duration of the course.

Stroke that includes both ischemic and hemorrhagic events is a major cause of death worldwide. It is currently the most common cause of disability. The risk of recurrence is the highest among cases where a recent stroke or transient ischemic attack was left untreated. In about 30% of these cases, a recurrent stroke leads to the worsening neurological symptoms or even death. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a top priority. Primary prevention of ischemic stroke includes lifestyle modification and diets, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation therapy in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery in symptomatic patients. Up to 90% of all strokes are preventable, and attributable to major modifiable risk factors. Optimal stroke prevention requires a harmonious, integrated approach to educating about stroke risk and healthy lifestyle, simple screening and management of patients for a history and presence of modifiable and treatable causal risk factors, and improving social and environmental factors. Intake of antiplatelet agents according to the subtype improves the prognosis of patients after an ischemic stroke or transient ischemic attack. Current data on stroke recurrence and mortality are important to examine trends, risk factors, and treatment effects.

Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is a rare or underdiagnosed autosomal-recessive mitochondrial disease that sometimes mimics progressive multiple sclerosis (MS). Difficulties in diagnosing LBSL are due to the possibility of the onset of the disease in adulthood, and the nonspecific clinical picture in the form of slowly progressive neurological symptoms (pyramidal, cerebellar, sensory and cognitive impairments) without the involvement of other organs and systems characteristic of mitochondrial pathology. However, a notable feature of LBSL is its pathognomonic magnetic resonance imaging of the white matter of the brain and spinal cord, which allows a reliable diagnosis when certain criteria are met. Currently, there are no drugs registered for the specific treatment of LBSL, however, correct diagnosis is necessary to complete the epidemiological data, and to prevent the prescription of drugs with side effects that worsen the quality of life of patients. The number of clinical publications about LBSL is small, both in Russian and foreign publications, and therefore each identified case is of great interest. The article presents a brief review of the literature and a case report of a patient with the adult-onset LBSL, who received disease modifying therapy of multiple sclerosis for a long time. The patient’s main problems were progressive lower paraparesis and ataxia. To make clinicians more aware, we have reviewed the difficulties in differential diagnosis between LBSL and MS, we provided detailed medical history, neurological status, and magnetic resonance imaging findings.

According to the Federal State Statistics Service, about 1.3 million patients with primary glaucoma, one of the leading causes of blindness worldwide, the second-most common after cataract1, are registered in Russia. A reasonable solution to the problem of glaucoma, the role and quality of modern generics from the evidence-based standpoint were discussed by participants of the symposium held within the framework of the 22^nd Congress of the Russian Glaucoma Society. The event was moderated by Andrey Brezhnev, Associate Professor of the Department of Ophthalmology, Kursk State Medical University, Head of the Organizational and Methodological Department, Kursk Ophthalmological Clinical Hospital – Regional Publicly Funded Health Facility.

Introduction. The clinical picture of generalized anxiety disorder is characterized by diffuse anxiety, muscle tension and multiple symptoms of hyperactivity of the sympathetic part of the autonomic nervous system. As an alpha-adrenoblocker, proroxan can reduce the hyperactivity of the autonomic nervous system, thereby reducing the severity of anxiety and its somatic symptoms.

Aim. To evaluate the efficacy of proroxan in the correction of autonomic disorders in patients with generalized anxiety disorder compared to placebo.

Materials and methods. 100 people participated in the study: 50 – in the study group received the SSRI escitalopram, 50 – in the control group received SSRI + placebo. The diagnosis of generalized anxiety disorder was made on the basis of ICD-10 criteria. Psychometric assessment using the Montgomery-Asberg scale was performed (only at the screening visit). Weekly psychometric evaluation was performed using the Hamilton anxiety scale, the SCL-90-R scale to assess somatic manifestations of anxiety, and general clinical impression scales (CGI-S disease severity and CGI-I general improvement).

Results. In the course of the study, statistically significant decrease in the mean value of CGI-S scale was observed in both groups, however, more pronounced in the proroxan group (p > 0.05); in the CGI-I scale, more pronounced improvement was observed in the first week of treatment in the proroxan group (p > 0.05). The HAM-A scale also showed a more significant reduction in anxiety in the proroxan group than in the placebo group (p > 0.05). The SCL-90-R SOM scale showed a decrease in the mean value in both groups, more pronounced in the proroxan group, which confirms the effect of the drug on autonomic symptoms of anxiety (p > 0.05).

Conclusions. The obtained results confirm the superiority of combination therapy with escitalopram and proroxan in the treatment of generalized anxiety disorder compared to monotherapy. The advantages of proroxan were the absence of sedative effect and, in general, good tolerability, absence of withdrawal syndrome and control of vegetative manifestations of anxiety.

Acute bronchitis (AB) is an inflammation of the lower respiratory tract of predominantly viral etiology, the leading clinical symptom of which is a cough (usually productive), lasting no more than 2 weeks, in combination with characteristic signs of infection of the lower respiratory tract. OB is one of the most pressing problems of modern pulmonology, which is associated with a high incidence, reaching 30–40% annually. According to the results of epidemiological studies, OB is one of the most common reasons for patients seeking medical care in outpatient practice. In children, the incidence of OB in the Russian Federation averages 75–250 per 1000 per year, which is approximately 100 times higher than the incidence of pneumonia. According to the clinical recommendations of the Ministry of Health of the Russian Federation, in the treatment of OB, in the vast majority of cases, the prescription of antibiotics is unjustified. For patients with OB who have a productive cough, it is recommended to prescribe mucoactive drugs to thin and improve sputum expectoration. Herbal medicine traditionally occupies an important place in the treatment of cough. To date, the most convincing evidence base has been obtained for combination preparations, including extracts of thyme herbs, ivy leaves and primrose roots. One of the most studied and effective herbal medicines for the treatment of acute bronchitis is the drug Bronchipret. The active ingredients of Bronchipret (syrup) are standardized extracts: liquid thyme herb extract and liquid ivy leaf extract; those of Bronchipret TP (film-coated tablets) are dry thyme herb extract and dry primrose root extract. Using this combination allows achieving maximum effectiveness due to a synergistic effect of the active ingredients used.

Severe bronchial asthma (SA) is asthma whose symptoms are not controlled by high doses of inhaled glucocorticosteroids, the main drug in the treatment of asthma. SA is associated with a high economic burden and remains a serious public health problem. Modern advances in understanding the molecular mechanisms underlying respiratory tract inflammation have led to the development of monoclonal antibody therapy. In recent years, the approach to the treatment of patients with SA has undergone significant changes: six biological drugs have shown their effectiveness in phase 3 studies, especially in reducing exacerbations, improving asthma control, quality of life, lung function and the abolition of systemic corticosteroids or at least reducing their daily dose, with some differences between them. Choosing a targeted drug is always a difficult task, involving a thorough assessment of clinical, anamnestic and laboratory parameters. Biologics have different targets of exposure and, therefore, different therapeutic indications should be expected; however, some patients may be shown more than one drug, which makes it difficult to choose. The analysis of markers of eosinophilic inflammation makes it possible to determine the mechanisms of pathogenesis, predict the response to treatment, monitor its effectiveness or disease progression. Other factors that need to be analyzed are the frequency of symptoms, asthma triggers, baseline spirometry, oral corticosteroid intake status, frequency of exacerbations and concomitant diseases. The appointment of targeted therapy without a thorough assessment of clinical, functional and laboratory parameters, as well as the lack of control of these indicators during therapy can lead to insufficient effectiveness of treatment.

Introduction. Acute bronchitis (AB) is a very common disease of viral etiology. In real-life practice, the treatment of AB is associated with widespread irrational antibiotic prescribing, which requires the overall implementation of patient management algorithms comprising the identification of biomarkers of inflammation, including C-reactive protein. Mucoactive therapy remains the mainstay of treatment for patients with AB, however the debate over the most effective treatments continues to this day. The emergence of new original drugs, in particular, Erdosteine, expands efficient therapeutic opportunities for AB.

Aim. To analyse the clinical effectiveness of the use of the mucoactive agent Erdostein (Edomari) vs routine use of mucolytics in AB.

Materials and methods. We reviewed the management of 60 patients with AB, 30 of which received Erdosteine (Group 1), the remaining 30 patients received standard mucoactive therapy (Acetylcysteine, Ambroxol, etc.). The following variables were assessed: the time required for reversal of all symptoms of the disease expressed as a total BSS scale score (Bronchitis Severity Score), the time required for reversal of productive cough that needs the use of mucolytics, the period of temporary disability, and levels of C-reactive protein.

Results and discussion. The average CRP level at disease onset was 18.4 ± 8.2 mg/L. The average WBC count was 7.8 ± 3.5 (×109/l). In AB, the duration of productive cough in the Erdosteine group was 5.7 ± 1.4 days, while in group 2 (real-life practice) the duration of mucolytics therapy was 7.1 ± 1.3 days (p < 0.05). The total BSS scale score in group 1 on day 7 was 3.2 ± 0.9, in group 2 – 3.5 ± 0.9. The reversal of physical signs of AB required 5.3 ± 1.2 days in the Erdosteine group, and 5.7 ± 1.4 days in group 2. The period of temporary disability in group 1 was 8.7 ± 1.2 days, in group 2 – 9.1 ± 1.3 days.

Conclusion. Thus, we collected objective data supporting the possibility of using C-reactive protein test in deciding the issue of antimicrobial therapy prescribing. The CRP level observed (18.4 ± 8.2 mg/l) indicated a viral etiology of AB. The use of original Erdosteine (Edomari) in the treatment of acute bronchitis is estimated as highly effective. The average duration of effective mucolytics therapy in AB is 5–7 days.

Short bowel syndrome (SBS) is a rare disease accompanied by the phenomena of malabsorption (impaired absorption of food) and maldigestion (phenomena of creato-, steato-and amilorrhea), as a result of resection of most of the small intestine (usually with a residual part of the intestine less than 200 cm) from – due to various etiological factors. One of the severe complications of this syndrome is the development of intestinal failure, which can be manifested by the occurrence of water, electrolyte and white matter disturbances, hypovitaminosis, and deficiency of micro-and macronutrients. It is possible to suspect the development of intestinal failure if the patient continues to have repeated diarrhea 2–3 months after surgery and a progressive decrease in body weight by 5% or more of the initial weight within a month. Therefore, an important aspect in the treatment of SBS is the correction of electrolyte disturbances and maintenance of nutritional status. However, the severity of the patient’s condition is often determined not only by the course of the disease itself, but also by the long-term use of parenteral nutrition after surgery. Therefore, an important aspect in the management of patients with SBS is the cessation of parenteral nutrition as early as possible and the transition to a physiological nature of food intake. This can be achieved both by choosing certain surgical treatment techniques and by using drug therapy – an analogue of glucagon-like peptide-2 – Teduglutide, which increases the functional ability of enterocytes to absorb. SBS is a significant social problem due to the high mortality rate in childhood and a significant percentage of disability in people of working age, which makes it highly relevant to discuss the management strategy for this category of patients.

Ulcerative colitis is an autoimmune disease characterized by ulcerative destructive processes in the mucous membrane of the colon. Despite advances in the pharmaceutical industry, its prevalence in the world is increasing every year. The etiology of UC is currently unknown to the end. According to modern concepts, ulcerative colitis is considered as a multifactorial disease, in the pathogenesis of which genetic determinism, disorders of the intestinal microbiota with a decrease in populations of anaerobic bacteria in combination with the trigger action of environmental factors are discussed. With high probability, the leading pathogenetic mechanisms of the disease are associated with the polarization of the Th2-type immune response, which is characterized by the synthesis of IL-4, IL-5, IL-9 and IL-13, which is regulated by STAT-5 and Gata-3. During the development of the disease, Th17, a type of immune response, is also involved in the immunopathological process, but with the participation of transcription factors STAT-3 and ROR-yt and the synthesis of IL-17, IL-2, IL-6, IL-26 and IL-22, as well as chemokine CCL20. Diet and lifestyle are part of the global guidelines for the treatment of patients with ulcerative colitis. Derivatives of 5-aminosalicylic acid are used as basic therapy preparations: combined preparations and preparations of pure 5-aminosalicylic acid. Nevertheless, the administration of systemic glucocorticosteroids is indicated to control the activity of the disease. However, as our practice shows, they are effective, but only at the first attack and subsequent 2-3 relapses of the disease, followed by a high incidence of hormone resistance. To date, there are modern medicines with a different mechanism of action, allowing achieving stable remission and improving the quality of life of patients. Among them, JAK -tofacitinib inhibitors are of particular interest in the treatment of ulcerative colitis. This is the first oral drug capable of inducing and maintaining steroidal remission. The choice of a particular drug is determined by the experience of use, cost and national recommendations.

Diagnosis of autoimmune gastritis (AIG) is often challenging because of the absence of typical symptoms. Clinical guidelines are lacking, which results in inadequate treatment and poor cancer screening. This work presents an overview of current management options and aims at raising awareness for this disease. The paper also describes a clinical case of the full-scale course of AIG with all its complications. Autoimmune gastritis is mostly considered as a disease of elderly with vitamin B12 deficiency and pernicious anaemia. Today it is recognized that AIG is found with a similar prevalence in all age groups, with iron deficiency being a frequent symptom. Conventional therapy consists of adequate iron and vitamin B12 supplementation, as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumours requires regular endoscopic follow-up. New treatments aiming to reduce gastric atrophy and cancer risk are currently under development. Thus, treatment of autoimmune gastritis should focus on optimizing supplementation of vitamin and macronutrient deficiencies, symptomatic therapy that improves quality of life, and include cancer prevention measures. Clinical studies should address the possibility to arrest the inflammation process and to prevent progression of AIG. The author of the article suggests that itopride hydrochloride and rebamipide will be used for symptomatic and pathogenetic therapy. The problem facing gastroenterologists today is to develop domestic guidelines for the management and screening endoscopic intervals of patients with AIG.

Introduction. Despite advances in treatment, the problem of chronic viral hepatitis C (CVHC) remains very relevant for Russia. There is a debate about which of the most common genotypes in our country: 1 or 3, has a more aggressive course of CVHC. Patients with CVHC exhibit dysfunction of T-cell immunity, many aspects of which remain unclear.

Aim. To research the subpopulation composition of blood T-helpers in patients with genotypes 1 and 3 of chronic viral hepatitis C (CVHC) depending on the severity of clinical and morphological manifestations.

Materials and methods. Clinical, laboratory examination and determination of liver fibrosis by elastometry using the METAVIR scale were performed in 297 patients with CVHC genotype 1, 231 patients with CVHC genotype 3, and 20 healthy individuals in the control group. The study of the subpopulation composition of T-helpers in the blood by flow cytometry (Navios, Beckman Coulter, USA) with the determination of markers CD3, CD4, CD45R0 and CD62L was carried out in 74 patients with CVHC genotype 1, 70 patients with CVHC genotype 3 and 20 people in the control group.

Results. Naive T-helpers (CD3+CD4+CD45RO-CD62L+), T-helpers of central (CD3+CD4+CD45R0+CD62L+) and effector memory (CD3+CD4+CD45R0+CD62L–) in the blood decreased with an increase in the severity of fibrosis and inflammation activity in the liver in both examined groups. In patients with CVHC genotype 3, the content of TEMRA T-helpers (CD3+CD4+CD45R0-CD62L-) in the blood under these conditions sharply decreased (Kruskal – Wallis test, respectively, p = 0.04 and p = 0.02). In patients with CVHC genotype 1, no such patterns were registered (Kruskal – Wallis test, respectively, p = 0.8 and p = 0.87).

Conclusion. A direct correlation was determined between the deterioration of the indicators of the blood T-helpers subpopulation composition with an increase in the severity of fibrosis and inflammation activity in the liver in patients with chronic hepatitis C, which had some differences in patients with genotypes 1 and 3.

Introduction. In recent years, a high resistance of H. pylori infection to antibiotics has been recorded both worldwide and in the Russian Federation. This was the basis for introducing diets that increase the sensitivity of H. pylori to antibiotics into eradication schemes.

Aim. To evaluate the effect of specialized therapeutic nutrition products LEOVIT GASTRO on the eradication of H. pylori.

Materials and methods. Two study groups were formed: the main group – 22 patients and the control group – 20 patients. The groups were randomized from 42 patients suffering from chronic gastritis associated with H. pylori, by random sampling. To assess the tolerability of treatment, in particular, biochemical blood tests were studied.

Results. Therapeutic nutrition provides a significant eradication effect against the background of antibiotic therapy. In 92% of patients, a complete absence of H. pylori contamination was detected, and in 8% of patients the degree of contamination was very weak, although initially it was pronounced, while in the control group, a complete absence of H. pylori contamination was detected in 80% of patients. Analysis of the use of specialized food products indicates the possibility of their use in diseases of the gastrointestinal tract associated with H. pylori, as they promote epithelization, healing of the mucosa, reduction and elimination of inflammation, pain, and discomfort in the gastrointestinal tract.

Conclusion. Therapeutic dietary nutrition LEOVIT GASTRO is one of the important factors positively influencing the success rate of eradication treatment.

Gastroesophageal reflux disease (GERD) is currently one of the most common nosologies, which affects people of different ages, but mostly able-bodied ones, patients of 40–60 years of age. Without effective or appropriate treatment, people with this disease can expect many complications, including severe ones: bleeding, distal oesophageal stenosis, electrolyte abnormalities associated with cardiac and conduction disorders, and the development of severe anaemia. These factors significantly complicate medical treatment and increase economic costs in the ensuing time. The disease is classified as an acid-dependent disease, although the acid-induced damage is not indicated in the definition and consideration of pathogenesis, as the primary diagnosis of diseases begins with an assessment of the clinical variant of the disease course, which also forms an adequate examination program. We proposed for discussion a new classification of GERD course variants, which will help facilitate diagnosis, find adequate pharmacological targets and increase the effectiveness of treatment. Acid-dependent and acid-independent variants are the main GERD course variants according to the proposed classification. Given this, we examined a group of 60 patients treated with the combination of guaiazulene with dimethicone, which impacts the protection of esophageal mucosa from aggressive reflux, reduces the number of refluxes (duodenoesophageal) and has a local anti-inflammatory effect. The overall effectiveness was 87%, and it halved the treatment time, which confirmed the very concept of the clinical classification of GERD course variants. We hope that the proposed classification of GERD course variants will be favourably accepted by the gastroenterology community, discussed and will serve as an effective tool for the treatment of this severe group of patients.

Studies on the additional properties of metformin continue despite the long period of its use as an antihyperglycemic drug. Metformin is a member of the biguanide class of drugs and is successfully used for many years in type 2 diabetes mellitus patients with normal weight, overweight, and obesity both in monotherapy and in combination with other sugar-lowering drugs. It can be used as a drug for the management of T2DM due to its high sugar-lowering activity, low risk of hypoglycemia when used as monotherapy, neutral effect on weight with its further moderate reduction, good safety profile, and availability for most patients. A decreased peripheral insulin resistance under the influence of metformin leads to increased utilization of glucose in the liver, muscles and adipose tissue, which results in an antihyperglycemic effect and, as a consequence of this, improvement of the disease management, preventing or slowing down the development of late complications of type 2 diabetes mellitus. Metformin has a proven track record as a drug with many positive effects, which was confirmed in numerous studies in patients with various complications of diabetes mellitus and concomitant pathologies. The article presents data on the use of metformin in patients with type 2 diabetes mellitus for the purpose of preventing sarcopenic obesity and managing its symptoms. Metformin presents some features of interest in preventing the development and treatment of non-alcoholic fatty liver disease and polycystic ovary syndrome.

The aim of this literature review is the analysis of the new data on subacute thyroiditis that emerged due to studying of potential effect SARS-CoV-2 has on disease’s manifestation and clinical course. The pandemic affected hundreds of millions of people, and thyroiditis as a consequence of viral infection has become more frequently observed in scientific research and case reports. Many academic works indicate that the virus directly impacts both the thyroid gland and the immune system, and some new pathogenic mechanisms were discovered during the course of the pandemic. Despite the fact that subacute thyroiditis is a self-limiting disease, its possible outcome is a permanent primary hypothyroidism with a need of a lifelong thyroid hormone replacement therapy. It also has a tendency to be relapsing. Certain characteristics has been found which show how modern de Quervain thyroiditis is different from the one several years ago. The scale of the pandemic made it evident for scientific community that there is a need for a rapid design of a vaccine as a specific preventive measure. Millions of people received COVID-19 vaccines and reports about subacute thyroiditis following the vaccination started to emerge, the systemic reviews on the issue were written, all this is also highlighted in this review article. Despite the fact that the World Health Organization declared an end to the pandemic in May 2023, the virus itself is likely to still be circulating in the population and it will continue to be one of the etiological factors behind de Quervain thyroiditis, also, coronaviral evolution did not come to an end.

The advent of insulin biosimilars has ushered in a new era in the treatment of diabetes mellitus, promising increased accessibility and affordability of this life-saving medication. This comprehensive review explores the evolving landscape of insulin biosimilars, focusing on their therapeutic equivalence, regulatory considerations, and clinical implications. Biosimilars are biological drugs produced using innovative technologies that replicate the structure and action of the reference drug in a very close way and are not inferior in effectiveness and other characteristics to the original, but are more affordable in pricing. Assessing their therapeutic equivalence requires a multifaceted approach including physicochemical and biological characterization, preclinical studies, and performance testing. The introduction of biosimilar drugs into clinical practice is gradually gaining importance for global health, especially in the treatment of oncological, autoimmune, endocrine diseases and, in particular, diabetes. The process of their registration and introduction into patient treatment practice has already been standardized in developed countries, international documents necessary for implementation have been issued, and convincing and clear confirmation of the positive results obtained during preclinical and clinical studies proving the bioequivalence and interchangeability of the biosimilar and the reference drug is required. The clinical implications of insulin biosimilars are of paramount importance, impacting patient outcomes, healthcare costs, and overall diabetes management. This review synthesizes existing evidence on the efficacy, safety, and immunogenicity of insulin biosimilars, providing insights into their potential role in diabetes therapy. Insulin biosimilars represent a promising avenue for expanding access to insulin therapy while addressing the economic burden of diabetes care. This review underscores the importance of continued research, robust regulatory oversight, and informed clinical decision-making to maximize the benefits of insulin biosimilars for patients and healthcare systems worldwide.

The article presents step by step international CARE guidelines (CAse REport), which regulate the structure of the description of a clinical case and include a checklist of 13 points. This form of presentation of the material does not create any difficulties in understanding, does not require a long period of time to prepare a publication for the author, demonstrating a unique personalized experience and informing the medical community about interesting clinical manifestations, diagnostic or therapeutic approaches within a particular nosology, as well as describing rare or newly reported side effects of drugs or features of their prescription. Below as an example presented a clinical observation of a young man with diabetes mellitus of complex origin, which was diagnosed after the initial diagnosis of type 2 diabetes mellitus, which was later supplemented with recurrent pancreatitis, pancreatic cyst development and alcohol abuse with underlying severe hypertriglyceridemia (up to 67 mmol/l). Given the limited choice of glucose-lowering therapy, inability to prescribe metformin, glucagon-like peptide-1 agonists, infeasibility to use dipeptidyl peptidase 4 inhibitors and gliflozins (history of episodes of balanoposthitis), after a detailed discussion with the patient, a decision was made to prescribe a combination insulin drug – biphasic Lispro (RinLis Mix 25, Geropharm, Russia), which, together with fundamental lifestyle changes, strong alcohol avoidance, and regular medical follow-ups, allowed him to achieve glycemic targets and reduce plasma triglyceride levels, which once again supported the versatility of insulin as hypoglycemic agent, easiness to use and comprehensive glycemic control, if pre-mixed ultra-fast-acting insulin analogue and its protaminized analogue are prescribed. The prescription of insulin premix in this case is also justified in terms of clinical guidelines, as the man led a regular lifestyle, had low physical activity, an HbA1c level greater than 1.5% of the target value, as well as fasting and postprandial hyperglycemia.

The incidence of type 2 diabetes mellitus is constantly increasing throughout the world. It is known that type 2 diabetes is associated with the development of atherosclerotic cardiovascular diseases, chronic heart failure, and chronic kidney disease. Modern therapy for type 2 diabetes mellitus requires complex treatment and should be aimed not only at reducing glycemia, but also at managing the risks of cardiovascular and renal complications. The results of large scientific studies ADVANCE, ACCORD and VADT have clearly proven the role of glycemic control in the prevention of microvascular complications of diabetes. A number of studies have established that the parameters of glycemic variability are of independent importance in predicting diabetic retinopathy, nephropathy and cardiovascular complications. Hyperglycemia also plays an important role in the development of macrovascular complications. The modern approach to the management of diabetes as one of the most important methods of preventing micro-and macroangiopathies includes the need for mandatory self-monitoring of blood glucose. Self-monitoring of glycemia should be accurate, simple and convenient, allowing the patient to carry out effective and safe glucose-lowering therapy. One of the main aspects of self-monitoring of blood glucose is the choice of a glucometer. From the doctor’s point of view, the most important criterion for choosing a glucometer is compliance with accuracy standards, and from the patient’s point of view, convenience and ease of use. Thanks to the improvement of technology, the accuracy of blood glucose measurements increases, the procedure for self-monitoring of glycemia is simplified, which leads to increased adherence to treatment and the effectiveness of glucose-lowering therapy. Achieving and maintaining the target glycemic level, preventing micro-and macrovascular complications are impossible without the active full participation of the patient himself in the treatment of diabetes, self-monitoring of blood glucose using an accurate and patient-friendly glucometer, i.e., Contour Plus One.

Thiazolidinediones (TDD) are a group of hypoglycemic drugs used for the treatment of type 2 diabetes mellitus (DM). TDD are synthetic ligands of PPAR-γ-receptors activated by the proliferator peroxisome. When TDD is combined with PPAR-γ-receptors, transcription of genes regulating carbohydrate and lipid metabolism is triggered. TDD has protective properties against pancreatic β-cells, as it reduces glucose and lipotoxicity. These drugs reduce insulin resistance, have a positive effect on fat metabolism. This effect makes it possible to use one of the representatives of the class in the treatment of non-alcoholic fatty liver disease (NAFLD), which is confirmed by clinical recommendations from different countries. Type 2 diabetes and NAFLD are diseases closely related to each other by common pathogenetic patterns. When combined, patients have a high risk of developing non-alcoholic steatohepatitis, cirrhosis of the liver and hepatocellular carcinoma, as well as worsening of the course of diabetes mellitus. For many years, drugs of the thiazolidinedione class remained in the shadows due to the negative experience of using specific representatives – hepatotoxic troglitazone and increasing the risk of cardiovascular complications of rosiglitazone. The representative of the pioglitazone class, which has many proven positive effects on the cardiovascular system, lipid metabolism and the course of NAFLD, remained forgotten. It is necessary to find out whether hepatotoxicity is actually a class-effect of TDD or a particular effect of specific drugs. A literary search for information for the period from 1982 to 2023 was carried out in PubMed electronic databases, Elibrary.ru. This article will consider: the historical development of the TDD class, research in the field of the effects of pioglitazone on the liver.

Hormonal contraception is widely used to prevent unintended pregnancies and is represented by a large number of drugs that allow to personalize the choice of contraceptives for each woman. Combined oral contraceptive (COC) variants include not only drugs that differ in qualitative composition, but also modifications of the dosage regimen. Among the non-trivial regimens are triphasic active ingredient dosing that enables to achieve a reduction in progestogen burden while maintaining contraceptive efficacy. This approach is important in prescribing COCs to women who have previously experienced or may potentially experience adverse reactions to progestogens. Identification of target groups of women predisposed to progestogen-dependent side effects helps to correctly prescribe COCs and improve adherence to the contraceptive method. Thus, changes in bleeding characteristics during the use of hormonal contraceptives may lead to refusal of COCs. With the exception of patients who are prescribed COCs for additional therapeutic purposes to control the menstrual cycle rhythmicity and intensity, women expect that they keep the usual pattern of their cycle and react negatively to any changes or deviations from the reference ranges. Meanwhile, the bleeding profile during the use of hormonal contraceptives can change significantly. Characteristics such as the intensity and predictability of uterine bleeding are important for the assessment of the effect of a contraceptive on uterine bleeding. This analytical review presents groups of young women for whom initial use of triphasic COCs may be the best choice.

Introduction. Vulvovaginal atrophy is a chronic progressive disease that includes physiological and anatomical changes as a result of a decrease in the level of sex hormones. VVA affects approximately 50% of middle-aged and older women and has a detrimental effect on interpersonal relationships, sexual health, and overall quality of life. Dynamic quadripolar radiofrequency (DRF) is a non-invasive procedure that may be a potential treatment for vulvar diseases.

Aim. To study the metabolites of vaginal swabs in postmenopausal women treated with DRF.

Materials and methods. The study included 180 women divided into 3 groups: treatment with DRF; treatment with a combination of DRF and estradiol, and estradiol treatment. In all patients, vaginal swabs were taken before the start of treatment and a month after treatment, and clinical parameters were assessed at 6 time points. Lipids were extracted from the cervico-vaginal fluid by the Folch method followed by liquid chromatography-mass spectrometric analysis. A comparative analysis of the clinical data of each of the groups and lipid profiles after treatment with a zero time point and their changes and a correlation analysis of changes in lipid levels and changes in clinical parameters before treatment and after 1 month was carried out.

Results. There was a statistically significant reduction in the severity of VVA symptoms one month after treatment in all groups. The most pronounced effect of the therapy was observed in groups with the use of DRF with the preservation of the effect up to 12 months. In the first and second groups, a statistically significant difference was found in the levels of 2 lipids, in the third – in 4. In the first group, a correlation was found with lipids related with pain and lubrication, in the second – with vaginal pH, in the third – with the index of vaginal health, orgasm, satisfaction and pain.

Conclusions. VVA therapy by DRF and local hormonal treatment triggers an inflammatory cascade in tissues. The use of the strategy of treatment with physical methods of influence has a mechanism of influence similar to the local application of estrogen in VVA. DRF therapy leads to the normalization of the vaginal microbiota and can compete with the use of estrogen in this therapeutic effect.

Introduction. The management of pregnant women in the conditions of the spread of a new coronavirus infection has become a priority task for doctors of all specialties, since it is with this pathology that an increase in the frequency of unfavorable gestation outcomes is currently associated.

The aim of the study: to study obstetric and perinatal outcomes after a new coronavirus infection in the I and II trimesters of pregnancy.

Objective. To study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.

Materials and methods. A comparative study of the birth histories of women after coronavirus infection in 2021 was carried out. Group 1 (n = 26) consisted of patients with COVID-19 infection in the first trimester, group 2 (n = 30) – in the second trimester. The 3rd group is represented by relatively healthy women (n = 35). Statistical analysis was performed using the Statistica 7.0, SPSS 17 packages, as well as the statistical functions of MS Excel 2013.

Results and discussion. The course of pregnancy after COVID-19 infection suffered in the first and second trimesters is associated with an increased risk of placental insufficiency (26.9 and 30%, respectively), the development of sympthoms of threatening termination (61.5 and 46.7%), anemia (38.5 and 43.3%), gestational hypertension (15.4 and 16.7%), bacterial vaginosis (19.2 and 20.0%), premature rupture of fetal membranes (34.6 and 16.7%), with the prevalence of urgent labor, but an increase in premature (13.3%) and operative labor (36.7%) with the manifestation of the disease in the second trimester. Newborns of mothers with COVID-19 infection are more often born in a state of asphyxia (65.4 and 53.3%). The structure of perinatal pathology is dominated by cerebral ischemia (42.3 and 40%), perinatal hypoxic damage to the central nervous system (19.2 and 23.3%), neonatal jaundice (11.5 and 23.3%), intrauterine pneumonia (15.4 and 10.0%), congenital malformations (7.7 and 30.0%; p1-2 = 0.04).

Conclusion. The results of the study once again have confirmed the need for further study of the problem in order to find measures to reduce obstetric and perinatal complications in women after COVID-19 infection.

The most effective method of treating infertility is in vitro fertilization, the key element of which is ovarian stimulation. Ovarian response in IVF protocols has varying variability among patients. The ovarian response depends on many factors, but none of these factors has sufficient prognostic ability, and therefore the question of the individual ovarian response during stimulation in IVF programs still remains open, and the association of the ovarian response with polymorphisms of certain genes is being actively studied. The most effective IVF programs are observed among patients of young reproductive age. A decrease in the effectiveness of IVF programs and the appearance of complications is observed in patients of advanced reproductive age. Several types of ovarian response have been identified: poor (it is possible to obtain 3 oocytes), normal (from 4 to 15 oocytes), suboptimal response (less than 7 oocytes) and hyperergic response (more than 15 oocytes). Also, there is a group of patients of various age groups with a paradoxical ovarian response to stimulation. The response of oocytes to hormones can be regulated depending on the expression of receptor genes. FSH receptor (FSHR) polymorphism may explain interindividual variability in ovarian response to stimulation. Genetic screening is determined once and does not depend on endogenous and exogenous factors, while allowing you to adjust the dose of gonadotropins in ovarian stimulation protocols. This review presents current data on the polymorphism of the main genes that regulate the ovarian response in stimulating superovulation in in vitro fertilization programs.

Oftentimes, women with RA experience remission during pregnancy. The beneficial effect of pregnancy on the RA course is associated with a specific hormonal status, including high levels of estriol and progesterone that have known anti-inflammatory effects. After childbirth, decreased endogenous production of steroids can trigger the onset or exacerbation of RA.

Objective. Studying of the characteristics of the gynecological status and concomitant extragenital diseases in postmenopausal women with rheumatoid arthritis (RA) depending on the presence of obesity.

Materials and methods. 394 postmenopausal women with RA (diagnosed according to ACR/EULAR 2010 criteria) were included. By decision of the medical commission, all patients were approved for therapy with genetically engineered biological drugs and/or JAK kinase inhibitors. Before inclusion in the study, all patients had a detailed medical history, an allergic history, registered comorbidities, and a physical and laboratory-instrumental examination. Depending on the BMI values, the study participants were divided into groups. Group A included 103 obese patients of any severity (BMI ≥ 30 kg/m²). Group B included 291 women with BMI <30 kg/m². Patients with an inflammatory process were found to have groups of inflammation by age and duration of RA (p > 0.05).

Results. In patients of group A, more often than in patients of group B, comorbidities were detected: hypertension (p < 0.0001), coronary heart disease (p = 0.03), history of “vascular accidents” (p = 0.0009), especially acute cerebrovascular accident (p = 0.004), type 2 diabetes mellitus (p = 0.0005), which manifest themselves over the age of 45, that is, during the perimenopause. When correcting the gynecological history data, he draws attention to the fact that group A patients are more likely to operate surgically and on the pelvic organs: more had the uterus removed (p = 0.002) or ovarian resection was performed (p < 0.0001), and the frequency of surgical menopause in group A was higher than in group B (p = 0.0009). The debut of RA on average chronologically coincided with the onset of menopause (p = 0.01). At the same time, in the average age of the onset of menopause, it is rare (p > 0.05). The number of women who had a history of pregnancy, childbirth, miscarriages and abortions in the groups were repeated (p > 0.05). But in group A, the average number of pregnancies (p = 0.003) and abortions (p = 0.004) per woman was higher than in group B.

Conclusion. The results of the study revealed the identification of clinical manifestations of inflammation and the severity of rheumatoid arthritis, depending on the presence of concomitant obesity in postmenopausal women, as well as a rarer occurrence of osteoporosis in women with RA and concomitant obesity.

Introduction. During pregnancy, the body’s need for most micronutrients increases, and therefore timely detection and adequate correction of deficient conditions are justified, starting from the stage of pre-gravidar preparation.

Objective. The purpose of the study is to present literature data on the role of magnesium in homeostasis and own experience of the effectiveness of the use of magnesium preparation.

Materials and methods. A review of the literature for 2021–2023 in the databases was conducted in the databases PubMed (the National Library of Medicine), The Cochrane Library, as well as in scientific citation databases (Scopus, Web of Science) The experience of own application of the preparation containing magnesium lactate dihydrate (470 mg) is also presented + pyridoxine hydrochloride (5 mg).

Result and discussion. The intake of magnesium into the human body with food is insufficient. Exogenous magnesium replenishment is clinically justified in isolated or associated with other conditions of established deficiency, primarily with intense emotional and physical exertion, sleep deprivation, as well as with emotional lability, palpitations, muscle fasciculations, with magnesium elimination due to iatrogenic exposure or increased demand, for example, gestational-conditioned. Regular use of Magne B6® has demonstrated its effectiveness in the treatment of symptoms of psychological daily stress (fatigue, irritability, deterioration of sleep quality) in women planning pregnancy.

Conclusions. The results obtained appear to be important in terms of reducing the risks of clinical progression of somatic symptoms and potential gestational complications, as well as improving the quality of life of childbearing age women who are actively planning to implement their reproductive function.

Introduction. In case of nonspecific connective tissue disorder (NCTD), the most significant in terms of prognosis for life is arrhythmic syndrome. Therefore, it remains important to introduce modern diagnostic methods into practice to prevent fatal events in childhood and young people.

Aim. To study the features of arrhythmic syndrome in children with NCTD in relation to the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and structural changes in the heart.

Materials and methods. A total of 45 children aged 10–17 years with arrhythmic syndrome due to NCTD and 20 children with normal heart rhythm and isolated presentations of NCTD (control group) were enrolled in the study. NSDT phenotypic markers, NT-proBNP levels, electrocardiogram (ECG) monitoring findings and speckle-tracking echocardiography data were studied.

Results and discussion. Children with arrhythmic syndrome and NCTD had more frequently dolichostenomelia, arachnodactyly, keeled chest deformity of II–III-degree, spinal scoliosis of II–III-degree, joint hypermobility, blue sclera. The structure of the arrhythmic syndrome in children with NCTD is – ventricular and supraventricular extrasystoles, paroxysmal supraventricular tachycardia. Speckle-tracking echocardiography showed a left ventricular strain in anterior basal segment and global longitudinal strain. There was association between a local longitudinal strain in the anterior basal segment and keeled chest deformity of II–III-degree, mitral valve prolapse, longitudinal flatfoot, asthenic shape of the chest, pectus excavatum deformity of II–III degree. There was association between the NT-proBNP level and the diagnostic threshold for NCTD. Patients with arrhythmic syndrome and NCTD had a direct, medium-degree significant correlation between the NT-proBNP level and heart rate, mitral valve prolapse and cardiac arrhythmia such as ventricular extrasystoles.

Conclusion. The results of the study will be implemented in the future in the individual programs for the management of patients with NCTD.

In recent years, there has been growing interest in the use of tear substitutes, based on natural polysaccharides in the treatment of dry eye syndrome, the leader of which is hyaluronic acid (HA). It has sufficient biocompatibility, non-immunogenicity, high viscoelasticity, hydrophilic, mucus-adhesive and good moisturizing properties. At the same time, in order to improve artificial tear preparations, there is a need to improve the mechanical and rheological properties of HA, its hygroscopicity, swelling in an aqueous environment and reducing the rate of biodegradation. One of the ways to solve this problem was the chemical modification of HA, by cross-linking its chains with two or more covalent bonds, with the participation of various polyfunctional molecules: urea, HA-cysteine ethyl ester, polyfunctional diepoxides, glutaraldehyde, carbodiimide, and many others. At the same time, the rigidity of the three-dimensional polymer network increases, increasing its resistance to enzymatic decomposition at the site of burial. Cross-linked HA has a higher viscosity compared to native hyaluronic acid due to the binding of its chains, which determines longer retention on the corneal epithelium and naturally makes it possible to reduce the frequency of drug instillations. Convincing data were obtained on the effectiveness of the resulting cross-linked hydrogel with non-Newtonian properties in vitro – on cultures of corneal epithelial cells and in vivo – on models of mechanical trauma and chemical burns of the cornea, as well as in animals with torpid corneal ulcers. The clinical effectiveness of cross-linked hyaluronic acid in the treatment of patients with dry eye syndrome of varying severity, including those due to Sjögren’s syndrome, has also been established. The higher effectiveness of cross-linked HA compared to native HA preparations has been convincingly proven. Taking into account the available information, an official drug has been developed based on cross-linked 0.2% hyaluronic acid Ocutears® Hydro+ (Santen).

Introduction. Meibomian gland dysfunction (MGD) is considered as the leading cause of the evaporative dry eye syndrome (DES). At the same time the standard methods of DES treatment often allow to achieve only a short-term effect and the search of alternative methods to achieve remission for a longer period is required.

Aim. To evaluate the effectiveness of a combined treatment of DES with MGD using transdermal Intense Pulsed Light (IPL) method combined with preservative-free sodium hyaluronate 0.18% eyedrops.

Materials and methods. The study involved 60 patients (120 eyes) after refractive surgery (femtoLASIK) with DES and MGD aged 20 to 40 years with a follow-up period of 3 months. The patients were divided into two groups: main (30 patients) and control (30 patients). Patients of both groups were administered a preservative-free form of 0.18% sodium hyaluronate four times a day for 3 months. All studied patients underwent standard examination methods, indicators of DES were assessed along with an objective valuation of tear film parameters and the meibomian glands condition by mean of digital biomicroscopy using a MediWorks slit lamp before surgery and 7 days, 1, 2 and 3 months after refractive surgery.

Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups, but in the main group (IPL) positive dynamics of indicators were more pronounced with a cumulative increase of effectiveness after subsequent sessions.

Conclusion. A course of IPL therapy in combination with a course of sodium hyaluronate 0.18% for dry eye syndrome due to MGD reduces the time, allows for longer-term results of therapy and promotes earlier elimination of discomfort.

At the present stage, there is an increase in the prevalence of allergic spectrum diseases. Epidemiological studies and the active introduction of genomic technologies in recent years have made it possible to accumulate data indicating the significant role of bacteria and fungi in the development of sensitization, which is one of the triggering and supporting factors for the course of microbial eczema. Dermatosis has a chronic relapsing course, in the formation of which delayed-type hypersensitivity, free-radical processes, and violations of the epidermal barrier play a significant role. A number of studies have noted the relationship between the development of microbial eczema and genetic factors, neuroendocrine and vegetative-vascular disorders. Features of etiopathogenesis and the recurrent nature of the course of microbial eczema necessitate an integrated approach to the management of patients with this dermatosis. Treatment of the disease includes elimination of the action of bacterial and fungal agents, anti-inflammatory therapy and restoration of the epidermal barrier. To suppress the infection, the appointment of antibacterial and antifungal drugs is indicated. However, their use as monotherapy in patients with eczema can provoke an exacerbation of the allergic process. In this regard, the article describes the current possibilities of using topical glucocorticosteroid drugs in combination with antibiotics and antimycotics. Attention is focused on ways to prevent complications and a staged approach to the management of patients with microbial eczema, the important components of which, after stopping the infectious process, are the suppression of inflammation and the restoration of the epidermal barrier. We present our own observations of patients with microbial eczema treated with preparations containing combinations of glucocorticosteroid with antibiotics and antimycotics, glucocorticosteroid with ceramides.

Introduction. Advances in studying skin ageing processes have proven the importance of high-quality synthesis of type I and III collagen. Protein synthesis is a genetically conditioned process encoded by many genes. Mutations in these genes lead to disorders in this process. The skin ageing genes FLG, AQP3, COL1A1, MMP1, ELN correlate with certain skin morphotypes, and studying the variability of gene transformations opens up new vistas for predicting the development of signs of ageing at any age and, as a result, timely prevention of ageing problems.

Aim. To evaluate the effect of skin ageing correction therapy based on the ageing protein expression and the type I and III collagen production according to genetically conditioned ageing variants.

Materials and methods. Patients in the comparison groups who had the major signs of skin aging received correction therapy according to regimen 1 (SKINOPRO ACTIVE 8 mg/ml every 7 days) and regimen 2 (SKINOPRO FORTE 12 mg/ml every 7 days). Evaluation of the efficacy of therapy with hyaluronic acid, silica and zinc drugs was based on an analysis of the pathomorphological view of biopsy specimens and an immunohistochemical analysis of Ki-67, p53, AP-1, Collagen I, Collagen III, TGF-b, Klotho, calreticulin expression.

Results. The results support the importance of identification of aberrations in genes encoding the skin collagen synthesis to personalize treatment methods for correcting signs of aging in patient with different morphotypes.

Conclusion. The article presents interim results of a comparative analysis of methods for correcting involutional changes in the face and neck skin. The possibility of further clinical studies of pharmacological drugs used to correct the morphofunctional signs of aging of the face and neck skin using the presented test findings is discussed.

Among all forms of psoriasis, vulgar psoriasis (VP) occupies a leading place. The pathogenesis of VP is complex and involves significant participation of various components of the immune system, which manifests itself in the development of not only local, but also systemic inflammation. Also, the course of psoriasis is characterized by disturbances at the level of cellular metabolism, which is reflected in the activation of free radical oxidation and a change in the redox potential. As a consequence, the course of VP is often accompanied by many chronic diseases. The treatment of patients with uncomplicated VP and without articular manifestations is based on the use of local therapy – topical glucocorticosteroids (tGCS), vitamin D analogues, calcineurin inhibitors, keratolytics, as well as targeted phototherapy. At the same time, tGCS monotherapy requires long-term supportive treatment, which is associated with the presence of specific side effects of tGCS. This, in turn, makes it rational to use a combination of local drugs. Considering the variety of approaches to the treatment of VP, it is relevant to study the effectiveness of the use of a combination of various local and systemic drugs of psoriasis therapy. The addition of keratolytics can potentiate the positive effects of tGCS and is especially effective with pronounced peeling. In addition, the use of systemic cytoprotective therapy in the treatment strategy of VP can improve the clinical effect due to the acceleration of degradation of free radical oxydation products and normalization of the redox potential of blood and tissues, which is disrupted in psoriasis. The article shows the clinical effectiveness of the use of combined local therapy based on salicylic acid and tGCS in medicinal forms of ointment and lotion for VP based on clinical examples.

This study discusses the relevance of etiopathogenetic theories of the occurrence and clinical forms of microbial eczema – a chronic recurrent allergic skin disease formed under the influence of exogenous and endogenous causal factors, characterized by the appearance of polymorphic rash, inflammatory reaction, disorders of various systems and organs that contribute to the occurrence or exacerbation of the disease. Various exogenous factors – infectious agents – resident and transit symbionts – bacteria and fungi, viruses, allergizing food products, medicines. Various immunological disorders are described, a modern classification of eczema with the isolation of clinical forms is indicated, a description of the clinical stage-by-stage course of eczema, differences in rashes in acute and chronic eczema and their clinical forms of evolutionary development in various clinical forms of microbial eczema, and the basic principles of topical and general treatment are discussed. The publication considers variant clinical cases of treatment of patients suffering from chronic microbial eczema, somatically healthy or with a comorbid history requiring systemic administration of drugs according to the profile of the disease. Patients used traditional therapy regimens with the inclusion of combined external agents containing a corticosteroid, an antibiotic and an antimycotic, strictly in accordance with clinical recommendations. Upon completion of treatment, patients noted a significant improvement in the form of almost complete relief of erythema, reduction of itching of the skin, elimination of wetness, disappearance of efflorescence characteristic of eczema and secondary manifestations of infiltration, peeling and lichenization of the affected skin.

The article presents the current state of the problem of dirofilariasis. Helminth infection caused by nematodes of the genus Dirofilaria is mainly a disease of carnivores from the canine and feline families. Humans are considered occasional hosts in which Dirofilaria spp., more commonly D. repens, rarely reach sexual maturity. The climatic conditions of the territory are one of the determining factors for the spread of vector-borne diseases. Due to the fact that in recent years there has been a tendency to increase average temperatures everywhere, these changes lead to a shift and expansion of the ranges of many organisms, including pathogens and vectors of various diseases. The clinical picture of human dirofilariasis caused by D. repens most often manifests itself in one of two clinical forms -subcutaneous and ocular, although, according to the literature, there are cases of damage to other localizations. Due to the fact that damage to the organs of vision occurs most often in humans, the clinical case presented by us is relevant. The patient, in our clinical case, permanently lived in one of the districts of the Ryazan region. The landscape and natural complex of this region, taking into account the presence of a large number of wetlands, an abundance of water bodies and suitable climatic conditions, creates a favorable environment for the development of insects of the Culicidae family (mosquitoes of the genera Anopheles, Culex, etc.), which are transmissible carriers of various human and animal diseases, including dirofilariasis. The complex cycle of the parasite, the possibility of migration in the body can lead to multiple organ damage. Scientific publications describe cases of finding dirofilaria in the lungs, heart, and genitourinary system. In this regard, the awareness of doctors and patients about this disease is very relevant, and will reduce the likelihood of prolonging the correct diagnosis and treatment.

Introduction. Frequently and long-term ill children are an urgent problem in pediatrics. It is of interest to take into account the possibility of rehabilitation of frequently and long-term ill children using the natural resources of the region.

Objective. To study the clinical and immunological parameters of children -residents of the Altai Territory, who are often prone to acute respiratory diseases, and the effect on these indicators of herbal tea from the shoots of Pentaphylloides fruticosa, used in complex therapy and rehabilitation of frequently and long-term ill children.

Materials and methods. The study involved 49 children aged 3.5 to 7 years of both sexes, who are in the dispensary group of frequently and long-term ill children. During the study, a retrospective analysis of primary medical documentation was carried out, as well as a comprehensive clinical and laboratory, microbiological and parasitological examination, and determination of the immune status. In a prospective cohort study, the effect of the use of herbal tea from the shoots of Pentaphylloides fruticosa on the clinical and immunological parameters of frequently and long-term ill children was evaluated as part of complex therapy with bacterial lysates and endogenous interferon inducers.

Results. The age-sex structure of frequently and long-term ill children is dominated by children of preschool age (up to 70%), mostly males (53%), who have a burdened anamnesis (31%). Frequent episodes of respiratory diseases are not a consequence of immune deficiency and develop against the background of an associated, persistent viral and bacterial infection that occurs against the background of transient functional instability of the immune system. The quantitative analysis of immunograms showed a significant immunocorrective role of Pentaphylloides fruticosa extraction preparations in comparison with baseline values.

Conclusions. The conducted clinical and immunological study did not reveal any significant clinically significant disorders of the immune system in frequently and long-term ill children -residents of the Altai Territory. At the same time, the use of extractive preparations of Pentaphylloides fruticosa has a significant immunocorrective effect on the parameters of the immune system and can be considered as an important component in the complex rehabilitation of frequently and long-term ill children from the age of 3.5 years.

Introduction. This study presents the results of interstitial exposure of a semiconductor laser with a wavelength of 445 nm to biological tissue samples at different pulsed wave power in a constant mode, with a contact method.

Aim. To study the interstitial effect of a semiconductor laser with a wavelength of 445 nm on experimental tissue samples in a constant mode at different power.

Materials and methods. As an experimental sample, we used biological tissue with a developed vascular structure in the form of pig liver. The source of laser radiation was a semiconductor laser with a wavelength of 445 nm, with a power range from 0.5 to 4 watts. When working with biological tissue samples, we evaluated their external and internal changes after laser exposure. The exposure time during interstitial exposure was 1 mm/sec with a 20 mm immersion depth of the laser fiber into the fabric. The results of the macro and microscopic picture were evaluated using histological examination and morphometry of the zones of destruction and coagulation necrosis, on a transverse section of the tissue.

Results. The results of an experimental study indicate that interstitial laser exposure has a pronounced coagulation effect combined with a cutting effect. The optimal combination of coagulation and cutting effect of exposure, accompanied by visual contractility of the tissue, without excessive carbonation at a power of 3.0 watts.

Conclusion. The use of interstitial exposure of a semiconductor laser with a wavelength of 445 nm on experimental tissue samples in a constant mode at different power showed the predominance of the coagulation effect in combination with the cutting effect with a pronounced reduction in tissue volume. Experiments have shown that the power of 3 W is the optimal power of laser exposure in the interstitial method, in which there is a pronounced reduction in the volume of the studied drug without excessive carbonation.

Anterior uveitis is the dominant clinical extra-articular manifestation of spondyloarthritis associated with the carriage of the human leukocyte antigen allele (HLA-B27), which may precede joint and spinal involvement. In 20–30% of cases, uveitis occurs with frequent relapses – up to 5–6 exacerbations per year, often has a protracted character and is poorly amenable to local anti-inflammatory therapy, which leads to a decrease in vision and a deterioration in the quality of life. Timely and accurate assessment of the severity of intraocular inflammation plays an important role in making a diagnosis and in choosing the right treatment tactics for treating anterior uveitis in patients with HLA-B27-associated spondyloarthritis. The current standard clinical approach to assessing inflammation is the presence and number of inflammatory cells in the anterior chamber aqua humor according to the SUN classification using slit lamp imaging. However, the assessment of SUN is very subjective. Moreover, the individual variability in anterior chamber cell count, which is the main diagnostic criterion for uveitis, can be exacerbated by certain testing conditions, such as the brightness of the slit lamp light bar, light beam size calibration, light source intensity. Advances in optical imaging technology, the application of the latest technologies and the improvement of already known methods offer new opportunities for an objective, accurate and quantitative assessment of inflammation. The article describes the possibilities of studying the cornea and the anterior chamber of the eye using anterior segment optical coherence tomography, confocal microscopy of the cornea and keratotopometry.

Currently, the study of verbal forms of communication of patients with neurotic disorders is of great interest. According to studies, certain specific features of the speech of patients with neuroses have been identified. They affect both quantitative and qualitative characteristics of speech. In particular, the tendency to intensification of speech generation (verbosity), a more complex discursive structure with greater depth and degree of branching, a tendency to use certain lexical units and grammatical constructions were revealed. The detected features correlate with the patient’s cognitive attitudes and the level of his emotional stress. Of additional interest is the assessment of the dynamics of various indicators of speech in the process of psychotherapy. An extremely small number of studies have been devoted to studying the linguistic characteristics of speech in patients with panic disorder. At the same time, it is in this category that the clinical manifestations are most distinct and illustrative, which gives many advantages in the study of various aspects of speech. According to the already available data, patients with panic disorder are characterized by a decrease in control over the semantic side of the utterance in favor of control over the articulation of the spoken text. The correlation of pitch and tone variability depending on the emotional conditions of the story was revealed. Further study of speech features in patients with panic disorder is necessary to improve and expand existing knowledge, potential use in the process of psychotherapeutic treatment.