This article updates the continuing high prevalence of lipid metabolism disorders and their connection with the development of cardiovascular pathology associated with atherosclerosis. Attention is focused on the existing lack of adherence to the correction of dyslipidemia, both on the part of patients and medical workers, as well as the problem of failure to achieve target levels of low-density lipoprotein cholesterol with standard statin treatment. The evolution of modern therapy for lipid metabolism disorders is shown and the feasibility of early initiation of combination treatment in patients with very high and high cardiovascular risk in the presence of severe dyslipidemia is substantiated, and possible treatment strategies existing in current recommendations are outlined. In the presented work, using the example of an outpatient 54 years old after undergoing stenting of the coronary arteries, who has a very high cardiovascular risk (established diagnoses of coronary heart disease, post-infarction cardiosclerosis, hypertension) with failure to achieve the target level of low-density lipoprotein cholesterol of less than 1.4 mmol/l The therapeutic effectiveness of a double combination – an inhibitor of cholesterol absorption in the intestine – ezetimibe at a dose of 10 mg with a statin at the maximum tolerated dosage was demonstrated. It has been shown that the proposed combined lipid-lowering treatment is clinically and laboratory safe. Arguments in favor of starting combination treatment in this clinical case include not only the failure to achieve the target value of low-density lipoprotein cholesterol on high-intensity statin monotherapy as part of secondary prevention and possible familial hypercholesterolemia, but also a hereditary history of cardiovascular pathology, early onset of cardiovascular diseases in patient.

The treatment of atherosclerotic cardiovascular diseases (ASCVD) is actual worldwide and in Russia as the main reason of morbidity, mortality, invalidation of the working population and national economic damage. The main reasons of developing and progressing of CVD are hypercholesterolemia and dyslipidemia (DLP). DLP, as the main factor of the occurrence and progression of atherosclerosis, represent the most relevant modifiable factor of ASCVD. According to the epidemiological study of ESSE-RF, every second adult in Russia has DLP, every fifth – elevated total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, which makes the problem of complex individual lipid-lowering therapy actual. A proportional reduction of risk of ASCVD depends on the absolute reduction in blood levels of LDL-C. Statins remain the main group of drugs that significantly reduce LDL-C level. Rosuvastatin, which has the peak inhibitory activity against HMG-CoA reductase, used in daily doses of 10–40 mg, exhibits high lipid-lowering efficiency already at the initial daily dose, increasing with the rising dose. The combination of a statin with ezetimibe is recommended to achieve target LDL-C level, allows to reduce the dose of statin while maintaining excellent LDL-C lowering efficiency with good safety profile. Fixed combination of statin/ezetimibe in patients at very high ASCVD risk has been shown to be more effective than the same free combination, and reducing of taken pills increases adherence to treatment. The fixed combination of rosuvastatin/ezetimibe, presented on the Russian pharmacological market with Rosulip Plus, can be considered as the drug of choice in patients with DLP of high and very high cardiovascular risk, both from clinical and economic point of view.

The treatment strategy for arterial hypertension is aimed at controlling blood pressure levels, as well as preventing serious cardiovascular complications and affecting the prognosis of the disease. Therefore, pharmacotherapy of arterial hypertension is given great importance as a guide to the treatment of patients in real practice. The new 2023 European Society Guidelines for the diagnosis and treatment of hypertension were developed after a thorough analysis of studies in the field of arterial hypertension, and were not limited to RCTs only, but also included realistic studies (observational, cohort, administrative databases). The 2023 Guidelines support the proven value of five major classes of antihypertensive drugs: thiazide/thiazide-like diuretics, ACEIs, ARBs, calcium antagonists, and β-blockers. New data from meta-analyses support the greater clinical relevance of RAS blockers, calcium channel blockers, and thiazide/thiazide-like diuretics in preventing hypertension-related outcomes, leading to their preferred use in the pharmacotherapy of arterial hypertension, including various combinations of drugs. A new trend in the pharmacotherapy of arterial hypertension has been the inclusion of β-blockers among the main antihypertensive drugs, including their preferred use for a number of clinical conditions. New classes of drugs, such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, are cited as having BP-lowering effects and with strong evidence of reduced cardiovascular and renal outcomes in patients with type 2 diabetes and, in the case of SGLT2 inhibitors, in non-diabetic patients. The 2023 Guidelines significantly updated information on available combination strategies for the treatment of arterial hypertension, and added data on the effectiveness of fixed combinations, including quadropills and polypills. 

A lung surfactant is a complex mixture of lipids and proteins necessary to maintain proper lung function. Drug changes play an important role in chronic lung diseases such as chronic obstructive pulmonary disease, bronchial asthma and idiopathic pulmonary fibrosis. The purpose of this article is to substantiate the use of exogenous surfactant in various respiratory diseases, based on the analysis of publications in domestic and international medical journals, as well as their own experience of application in real clinical practice. This review primarily discusses the contribution of pulmonary surfactants to maintaining homeostasis of the respiratory system; optimal delivery routes; differences between natural and synthetic surfactant; diseases associated with impaired surfactant production, such as idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pulmonary alveolar proteinosis, cystic fibrosis. Special attention is paid to the immunological properties of specific proteins of surfactants A and D, their effect on protection against respiratory viral infection. Data on the direct effect of exogenous surfactant on pulmonary function, an increase in post-bronchodilation FEV1 and FVC are presented. Special attention is paid to the use of surfactant in the new coronavirus infection COVID-19. Pharmacological and therapeutic strategies to improve pulmonary surfactant dysfunction can prevent alveolar collapse, reduce the proinflammatory response, and limit viral infection. Currently, the use of surfactant preparations for the treatment of various respiratory diseases is being studied in several clinical trials, which will significantly revise the understanding of the therapeutic possibilities of an exogenous surfactant and expand its application areas.

Introduction. Pneumonia is a group of acute infectious (mainly bacterial) diseases of various etiology, pathogenesis, and morphological characteristics characterized by focal lesions of the respiratory tract of the lungs with the obligatory presence of intraalveolar exudation. Currently, a wide range of not only pharmacological, but also physiotherapeutic methods of treatment is available. Vibroacoustic therapy is also used to facilitate the discharge of bronchopulmonary secretions.

Aim. To evaluate the effectiveness of vibroacoustic pulmonary therapy using the BARK VibroLUNG device (manufactured by BARK Technology, Kazakhstan) in patients with COVID-19.

Materials and methods. 70 patients with PCR-confirmed positive COVID-19 infection were included in the study. The patients were divided into 2 groups, which statistically did not differ from each other. Group 1 (n = 35) underwent vibroacoustic pulmonary therapy (VALT) in combination with basic treatment. Group 2 (n = 35) received only basic treatment. VALT was performed for 7 days, 2 sessions per day for 20 minutes.

Results. Against the background of complex therapy in combination with the course of VALT, patients in the study group showed a statistically significant decrease in the duration of hospitalization to 19 (12–29) days, as opposed to 27 (24–34) days (p = 0.003) in the control group. When comparing the changes in the indicators of the surviving patients of the study group, a positive dynamics of the main indicators against the background of VALT was obtained: ∆VAS -2 (-3; -1), р = 0.000; ∆SpO2– 6 (2; 7), р = 0.002; ∆PaO2–13 (2; 19), р= 0.001 in comparison with the dynamics of similar indicators of the control group.

Conclusions. The results have shown the effectiveness of vibroacoustic therapy in the treatment of patients with coronavirus pneumonia. This method can optimize healthcare costs for the treatment of COVID-19, as there is a significant decrease of duration of hospitalization.

Introduction. Systemic glucocorticoids have been successfully used in the treatment of patients with moderate to severe COVID-19. However, the best clinical efficacy dosage regimen and duration of glucocorticoid usage is remained unclear.

Aim. To evaluate the results of using different regimens of systemic glucocorticoid therapy in the treatment of patients with moderate and severe COVID-19.

Materials and methods. The results of a retrospective study of medical papers of 200 patients who had moderate to severe COVID-19 in the period from May 2020 to December 2021 are presented. The inclusion criterion was the use different regimens of doses and durations systemic glucocorticoid therapy in these patients without the use blockers of Janus kinases. and genetically engineered biological drugs. Clinical effectiveness was assessed by the severity and sufficiency of the anti-inflammatory effect, the frequency and nature of side effects of this therapy.

Results. The regimen of glucocorticoids at a dose equivalent to 6 mg/day of dexamethasone for 7 days demonstrated the greatest clinical effectiveness: it significantly reduced C-reactive protein, hematological inflammatory indices,% lung tissue damage, minimally affecting carbohydrate metabolism and hemostasis. Glucocorticoid therapy equivalent to 20 mg/day of dexamethasone for more than 7 days and pulse-therapy for 3 days demonstrated significantly lower clinical effectiveness.

Conclusions. In patients with moderate to severe COVID-19, it is reasonable to use a dose of glucocorticoid equivalent to 6 mg/day of dexamethasone for 7 to 10 days, or equivalent to 20 mg/day for no more than 7 days. The use of pulse therapy and the use of glucocorticoids at a dose equivalent to ≥ 20 mg/day of dexamethasone for a duration of 7 days are not recommended. To assess the dynamics of inflammation and monitor the effectiveness of glucorticoid therapy, in addition to routine markers of inflammation, it is recommended to use hematological inflammatory indices.

Alpha lipoic acid (ALA) is an essential cofactor for mitochondrial enzymes, a powerful antioxidant, and an important component of many metabolic processes. Most research on ALA has focused specifically on its antioxidant properties. A number of conditions – aging, atherosclerosis, liver cirrhosis, diabetes mellitus, various types of polyneuropathy, psoriasis and others can significantly reduce the level of ALA in the body. The article analyzes modern literature (107 sources, including 17 systematic reviews and meta-analyses). Traditionally, ALA is used in complex therapy of patients suffering from diabetic and alcoholic polyneuropathy. However, the analysis of studies conducted around the world is not limited to these two nosological forms. The use of ALA as adjuvant therapy for a number of conditions and diseases is justified, as confirmed by clinical studies, systematic reviews and meta-analyses. All studies assessed not only the effectiveness of ALC, but also its safety and the incidence of adverse events and showed that ALC has a high safety profile. ALA has not only a pronounced antioxidant effect, but also the ability to chelate toxic metals, increase intracellular glutathione levels, reduce blood glucose levels, overcome insulin resistance, participate in mitochondrial metabolism, stimulate the production of cAMP, normalize the lipid profile, reduce the level of inflammatory markers, etc. Based on Because of the positive effect of using ALC in the treatment of various symptoms and nosologies, the list of indications requires revision, expansion and addition.

Obesity is a vivid example of one of the most common chronic non-infectious multifactorial diseases in today’s world. Not only the conventional elements of an “unhealthy lifestyle” such as hypodynamia and overeating, but also external socio-economic and psychosocial factors play an important role in the development of this disease. This review summarizes the main pathogenetic components that combine the development of both metabolic and vascular, including cerebrovascular, complications of obesity. The authors present the current classification of obesity adopted by domestic endocrinologists, which includes an assessment of the risk of obesity-associated complications. The mechanisms of pathological effects of insulin resistance, which morphological substrate is visceral obesity, are considered in detail. Its key role in the initiation and progression of diabetes mellitus, cardiovascular and cerebrovascular diseases has been shown. The mechanisms involved in the development of cognitive impairment in patients with obesity, insulin resistance and diabetes mellitus are described. Due to the urgency of the problem raised, the prospective of choosing a therapeutic and preventive approach to the management of such patients are assessed. With regard to this category of patients, the use of fonturacetam was discussed. Fonturacetam has been shown to have the proven clinical effects that not only improve the cognitive and emotional status in patients with cerebrovascular pathology, but also have a direct effect on the potential root cause of the development and progression of vascular and metabolic disorders, i.e. on the obesity. Fonturacetam that has an anorexigenic effect can also be prescribed as a weight corrector in addition to the diet therapy. Thus, the use of fonturacetam can become a promising trend in the treatment and prevention of today’s most common diseases.

Introduction. Stroke is a major cause of morbidity and mortality in various populations. Sleep disturbances are common in patients who have suffered an acute cerebral circulatory disorder, complicating the recovery of motor functions, worsening the emotional state and being associated with poorer health and quality of life in general.

Aim. To investigate the impact of sleep disturbance on the emotional state of stroke patients.

Materials and methods. The study included 100 people who were divided into two groups. 50 patients who had suffered an acute cerebral circulatory disorder and who suffered from insomnia formed the main group, which was divided into 2 subgroups. MG₁ – main subgroup 1 (26 people), who received a course of short-term (5 sessions) cognitive-behavioural therapy for insomnia in combination with the drug Valocordin-Doxylamine 25 mg as part of complex therapy. – MG₂ main subgroup 2 (24 people), who received only standard treatment of the main disease. Patients in the comparison group who underwent acute cerebral circulatory disorder without concomitant insomnia (CG, 50 people) also received only standard treatment for the primary condition. In addition to clinical examination, the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Questionnaire (PSQI) and the Insomnia Severity Scale (ISI) were used to assess patients.

Results. Initially, the main group had a statistically significant higher level of depression (clinically expressed depression) than the comparison group (subclinically expressed depression) (U = 54.6; p = 0.012). As a result of treatment in main subgroup 1, where insomnia was corrected, there was not only an improvement in sleep (median PSQI score before treatment 8 (6; 10) and after treatment 5 (5; 6), p = 0.022), but also a reduction in depression (HADS-D score before treatment 12 (10; 14) and after treatment 12 (10; 14)): 12 (10; 14) and post-treatment – 5 (4; 6), p = 0.022) and anxiety (HADS-A pre-treatment: 9 (7; 10) and post-treatment – 5 (4; 6), p = 0.013). In the main subgroup 2, where insomnia was not corrected, there was no improvement in sleep (PSQI before treatment 8 (6; 11) and after treatment 8 (7; 10), p = 0.433), depression (HADS-D before treatment: 9 (8; 11) and after treatment – 8 (6; 9), p = 0.171) and anxiety (HADS-A before treatment: 9 (6; 10) and after treatment – 8 (6; 9), p = 0.064) were less pronounced than in the main subgroup 1 and the comparison group (HADS-D: H (2, N = 100) = 25.73829, p = 0.016; HADS-A: H (2, N = 100) = 28.42621, p = 0.004).

Conclusion. Complex therapy for stroke patients suffering from insomnia, including drug and non-drug methods of insomnia correction, increases the effectiveness of treatment by not only improving the quality of sleep, but also reducing the severity of anxiety and depression.

Aim. To evaluate the relationship of neurospecific proteins with neuroimaging and cognitive impairment in patients with OSA.

Materials and methods. 65 patients were examined. Two groups of patients were distinguished: the main group – with moderate and severe OSA, the control group – without OSA. The subjects underwent anthropometry, polysomnography, magnetic resonance imaging of the brain (MRI GM), assessment of cognitive impairment. Glial fibrillar acidic protein (GFAP), antibodies to the NR2 subunit of NMDA (AT to GRIN2A), and brain-derived neurotrophic factor (BDNF) were studied by enzyme immunoassay.

Results. The majority of patients with apnea were found to have pre-dementia disorders on the MMSE scale, leukoareosis, subcortical gliosis, and subarachnoid space (SP) expansion according to GMRI with a body mass index of more than 38 kg/ m2 and a neck volume of more than 45 cm. The sizes of the bodies of the lateral ventricles and 3th ventricle in patients with apnea were larger than the age hole. GFAP and BDNF levels were significantly higher in patients in the main group. Negative correlations were established between the average level of BDNF content and SP expansion and between BDNF and the body index of the lateral ventricles.

Conclusion. The neuromarker GFAP has shown itself to be a predictor of nervous system damage in patients with OSA. The most representative marker of neuroplasticity in sleep apnea patients is BDNF. Despite the high chances of its increase in patients with OSA, this does not compensate for the chances of pre-dementia cognitive impairment. According to MRI GM in patients with OSA, along with vascular lesions (leukoareosis, subcortical gliosis) atrophic changes are detected.

In this article emotional disturbances developing in the postcovid period, their features and risk factors are reviewed, as well as sleep disorders after coronavirus infection (COVID-19). The nervous system (NS) is one of the SARS-CoV-2 main targets, which is confirmed by hypo-/anosmia, which develops in most patients during the acute period of COVID-19, and in some patients it is the first symptom. Currently, the main direct routes of coronavirus impact on the NS are considered to be hematogenous and neuronal. In addition, there is an immune-mediated effect on the NS due to the cytokine storm. After an acute period of coronavirus infection postcovoid syndrome often develops. Neurological manifestations, in particular emotional disorders, occupy a significant place in its structure. Depression, anxiety, fatigue, as well as sleep disorders bother patients most often. In dynamics, the severity of most symptoms in a certain part of patients decreases, however, according to some studies, postcovid manifestations persist or worsen for a long time. Currently, female gender and psychiatric comorbidity are most often considered risk factors for the development of postcovid emotional disorders. Despite the fact that the pandemic is officially considered over, and the acute period of COVID-19 is currently much easier than in 2020–2021, internists and neurologists are still treated by patients with newly emerged emotional disorders in the postcovid period, which underlines the continuing relevance of this problem. It is worth noting that emotional disorders in the postcovid period can develop in patients of all age groups, reducing their quality of life and workability. Public awareness, early diagnosis and initiation of treatment of these disorders will help to avoid global consequences.

Chronic kidney disease is becoming one of the leading causes of death globally. Anemia, a common complication in chronic kidney disease, not only diminishes patients’ life quality but also increases the risk of heart-related problems. The use of recombinant human erythropoietin has revolutionized the treatment of anemia in chronic kidney disease patients. By reaching the desired levels of hemoglobin with recombinant human erythropoietin, patients experience significant improvements in life quality and a decrease in death rates. Epoetin beta is among the various erythropoiesis stimulating agents available in the market. Research indicates that weekly doses of epoetin beta are as effective as three weekly doses of epoietin alpha for reaching hemoglobin goals in patients undergoing renal replacement therapy. This not only enhances patients’ adherence to the treatment but also cuts down on the time and costs associated with managing renal anemia, thus allowing for a therapy that is more tailored to patient needs. On the one hand, this improves patients’ adherence to the treatment. On the other hand, the time and cost burden in the management of renal anemia is decreased due to reduction in recombinant human erythropoietin prescribing rates, which eventually makes it possible to better tailor therapy to the patients’ needs. The proven efficacy and safety profile of epoetin beta combined with the increased convenience of less frequent dosing, make epoetin beta a safe and effective treatment option that can help more patients with chronic kidney disease to reach their target hemoglobin levels.

Introduction. Mastoiditis is an extracranial complication of acute or chronic purulent otitis media, leading to periostitis or osteitis of the mastoid process, accompanied by obvious symptoms and requiring urgent surgical treatment. Latent mastoiditis is defined as a stage of local inflammation due to acute otitis media, without an obvious clinical picture of progressive destruction of the bone cells of the mastoid process. Recently, there has been a trend towards an increase in indolent forms of mastoiditis. The use of systemic antibiotic therapy for the treatment of acute otitis media complicates timely diagnosis and contributes to the chronicity of inflammation in the structures of the temporal bone. Making a diagnosis of latent mastoiditis requires vigilance from outpatient clinicians and the use of objective imaging methods due to the risk of developing intracranial complications.

Aim. Conduct a review of literature sources to determine diagnostic criteria for the formation of latent mastoiditis in outpatient patients.

Materials and methods. A search was carried out for articles from public databases using the query: “latent mastoiditis”, including data from literary sources whose authors made a significant contribution to the development of otorhinolaryngology. Summary data of the literature review, including both original studies and descriptions of clinical cases, identifying the main causes of the formation of latent mastoiditis and its clinical symptoms.

Results and discussion. Local inflammation of the mastoid process, due to acute otitis media, has a progressive course of chronic sluggish inflammation of the bone structures of the temporal bone. Diagnosis of latent mastoiditis causes difficulties for practical healthcare doctors due to subtle clinical manifestations, and therefore it is necessary to determine the indications for referral to computed tomography.

Conclusion. The medical and social significance of latent mastoiditis is that it has an unfavorable not only functional, but sometimes life prognosis, as it can cause the development of intracranial complications.

This compendium for gastroenterologists and hepatologists contains information about pH-sensitive polymers used in dosage forms for oral administration and delivery of drugs to certain parts of the gastrointestinal tract. There is more information here on pH-insensitive polymers in laxatives, hepatology antivirals and rectal agents. There is also background information on the chemical, spatial structure and properties of pH-sensitive and individual pH-insensitive polymers, the physiological basis for their transformations under certain characteristics of the environment in the lumen of the gastrointestinal tract. These are aspects of their use in targeted drug delivery systems, use as active ingredients or “increasers” of the molecular weight of other active ingredients. The main attention is paid to polymers used in the production of enteric coatings for tablets and granules (pellets). The material is illustrated with examples of drugs registered in the Russian Federation and promising drugs with dosage forms for diffuse application of antibiotics to the gastric mucosa, for targeted delivery of drugs to the duodenum and other parts of the small and large intestines. Chitosan-based hydrogels, a liposomal form of doxycycline, enteric dosage forms with pH-sensitive polymers, more complex delivery systems with two drug release triggers, and dosage forms with thermosensitive polymers have been described. Thus, polymers, which are an essential component of the environment and living conditions of modern humans, entered the pharmacotherapeutic field as active substances or components that increase the the local pharmacodynamic effect, bioavailability or slow down the excretion of drugs. Knowledge of the chemical and structural features of high-molecular compounds, their changes in certain environmental conditions is necessary for making the right decisions in those areas of medicine where drugs with polymers of different properties are used, in particular, in gastroenterology, proctology and hepatology.

Introduction. Pregestational diabetes mellitus during pregnancy negatively affects the course and outcome of pregnancy, primarily due to the increase in obstetric complications, perinatal morbidity and mortality.

Aim. Assessment of obstetric and perinatal complications and the possibility of predicting adverse perinatal outcomes in women with type 1 and type 2 diabetes mellitus.

Materials and methods. The study included 132 women. The main group consisted of 79 pregnant women, 41 of them with type 1 diabetes mellitus (group 1A) and 38 with type 2 diabetes mellitus (group 1B) and 53 patients – the control group, whose pregnancy was not accompanied by a violation of the mother’s carbohydrate metabolism.

Results. Analysis of the course of pregnancy showed that the complicated course of pregnancy is associated mainly with the presence of placental dysfunction in women with diabetes mellitus, which was detected in 94.9% of cases, in contrast to the control group – 33.3%; p = 0,0001. Polyhydramnios (13.9 ± 1.1%; p = 0.005), diabetic fetopathy (13.9 ± 1.1%; p = 0.005), intrauterine fetal hypoxia requiring maternal assistance was detected in women with diabetes mellitus at 30.4% of cases (p = 0.002). Among the detected cases of cerebral ischemia in newborns born to mothers with type 1 diabetes, 43.5 ± 4.2% of women were prematurely delivered according to indications of fetal distress, and 26.1 ± 3.7% were due to decompensated diabetes in the mother. In women with type 2 diabetes mellitus, delivery according to indications from the fetus among children born with CI – 33.3 ± 3.8 percentage (p = 0.598), cases due to decompensation of the underlying disease and early delivery were not detected (p = 0.001).

Conclusions. Thus, complicated pregnancy and adverse perinatal outcomes, despite recent advances in obstetrics and endocrinology, are typical for pregnant women with type 1 and type 2 diabetes mellitus. The management and observation of such patients should be carried out by a multidisciplinary team of specialists specialized in this problem, from the preconception stage to the time of delivery.

Whole metagenomic sequencing is a new field of genomics and bioinformatics based on the construction of a random nucleotide sequence from the total DNA of a sample followed by deep sequencing. One of the advantages of this method, compared to culture and 16S rRNA sequencing, is the possibility of obtaining a more complete characterization of the biodiversity of the studied sample with the identification of unculturable microorganisms from the kingdoms of bacteria, archaea, viruses, fungi, and protozoa. Despite the high cost and complexity of technical implementation, whole metagenomic sequencing is increasingly used in clinical studies to investigate changes in the uterine and vaginal microbiomes in inflammatory diseases of the female reproductive system organs. The use of whole metagenomic sequencing within the framework of complex diagnostics of chronic endometritis is promising. Compared to traditional diagnostic methods (histologic, hysteroscopic, immunohistochemical and microbiologic studies), this method allows not only to identify potential causative agents of the disease at the species level, but also to determine the genes of drug resistance in microorganisms, which is especially important against the background of widespread strengthening of antibiotic resistance. In addition, some authors point to the relationship of bacterial vaginosis pathogens with the development of chronic endometritis, which should also be taken into account when prescribing antibacterial drugs. In this regard, it is highly relevant to study the biodiversity of uterine and vaginal microbiomes using whole metagenomic sequencing. This will allow not only to avoid such serious complications as premature birth, habitual pregnancy failure, failure of embryo implantation after IVF cycles, infertility, but also to develop adequate tactics of etiotropic therapy of chronic endometritis.

Introduction. Uterine fibroids are ranked second and endometriosis is ranked third in the gynaecological pathology pattern. Uterine fibroids and endometriosis are among the most common diseases of the female genitalia and occur in every 4–5 gynaecological patients.

Aim. To improve a multidisciplinary approach to the choice of surgical organ-preserving treatment strategies in hyperplastic diseases of the uterus using occlusion techniques.

Materials and methods. A cohort prospective comparative study examined a multidisciplinary approach to the choice of surgical organ-preserving treatment strategies in uterine hyperplastic hysteropathies using occlusion techniques.

Results. The study showed that uterine artery embolization is indicated if FIGO 2–5 fibroids’ size is > 4 cm in patients who are not planning pregnancy. The laparoscopic myomectomy with temporary uterine artery occlusion is provided if FIGO 2–6 fibroids’ size is from 6.0 to 8.0 cm, the laparoscopic myomectomy with temporary balloon occlusion of the internal iliac arteries is the procedure of choice if fibroids’ size is from 8.0 to 12.0 cm and they are located in the cervical-isthmus region and in areas of vascular bundles, and vaginal myomectomy with temporary balloon occlusion of the common iliac arteries is performed if FIGO 8 fibroids’ size is > 4 cm and they are located in the cervix. If adenomyosis nodes’ size is from 4.0 to 6.0 cm, they are removed using laparoscopic access with temporary occlusion of the uterine arteries; if adenomyosis nodes’ size is ≥ 6.0 cm, they are removed using laparoscopic access with temporary balloon occlusion of the internal iliac arteries.

Conclusion. The multidisciplinary approach in the treatment of hyperplastic diseases of the uterus is regarded as optimal.

Introduction. The effectiveness of gout treatment is assured by achieving a serum uric acid target level, which is currently accepted by most national clinical guidelines and consensus as < 360 µmol/L. Achievement of therapy goals is ensured by modification of patients’ lifestyle and adequate prescription of urate-reducing therapy and often involves a number of difficulties

Aim. To analyze the frequency of prescription and success of urate-reducing therapy in patients with gout over a five-year observation period in real clinical practice.

Materials and methods. Retrospective evaluation of the management of 104 patients (72 men and 32 women) with gout diagnosed for the first time in 2018, followed up to and including 2023. We analyzed the adequacy of urate-reducing therapy prescription, frequency of arthritis exacerbations, and presence of comorbidities in subgroups achieving or not achieving uric acid target level < 360 µmol/L.

Results. 26 people achieved uric acid target level, with a comparable ratio of men and female in subgroups of achieving or not achieving. The fact of achieving uric acid target level was recorded during the first year of observation and was maintained subsequently. Prescription of urate-reducing therapy was registered in 42% of the group, but in only 41% of them it was adequate. Even with adequate prescription of allopurinol, 1/3 of the patients did not achieve uric acid target level. The prescription of an alternative uricostatic agent, febuxostat, was noted in only 9% of patients.

Conclusions. Achieving total control in gout in real clinical practice noted in 25%, and urate-reducing therapy was prescribed in 42% of patients. Urate-lowering therapy was prescribed adequate in less than 1/2 of patients. Alternative uricostatic to allopurinol febuxostat was prescribed in less than 1/10 of patients. Opportunity achievement of the urate-reducing therapy goal was determined within the first year from diagnosis gout. If the uric acid target level is not reached within a given period of time, it is necessary analyze the reasons for failure and prescribe or intensify urate-reducing therapy.

The article discusses the issues of adherence to therapy in general and adherence to therapy in patients with osteoarthritis. The importance of adherence to the drug regimen in patients with chronic diseases determines not only the success of the prescribed therapy, but also the economic costs of treatment. Among the factors determining the success of adherence, some authors single out the personality of the doctor, the characteristics of the patient’s behavior and the course of his disease. Also, a significant role in the continuation of taking medications is the fear of patients of possible side effects. Among patients with osteoarthritis, according to research data, there was a low adherence to both lifestyle modification (following recommendations for non-drug treatment) and taking medications. When studying a number of social aspects of adherence to therapy in patients with OA, a high influence of the environment was found. According to research data, the factors influencing low adherence to therapy in patients with OA are age, severity of pain, and trust in the doctor. High comorbidity also makes a big contribution to the adherence to therapy in patients with OA, which increases the number of medications taken by patients. To reduce the risk of abandoning therapy with symptom-modifying delayed-action drugs for the treatment of OA and increase adherence, especially in comorbid patients, a personalized approach and discussion (with emphasis on the effectiveness and safety of prescribed drugs) with the patient is necessary. Choosing to prescribe injectable forms of drugs from the group of symptom-modifying delayed-action drugs will increase adherence to therapy due to the peculiarities of the course of their use.

After infection of the new coronavirus infection (NCI) COVID-19 of the patients, the development of long-term consequences can not be excluded and it is correlated not only with severe forms of the disease NCI COVID-19, but also with moderate and mild forms of th is pathology. Patients with rheumatic diseases that suffered from new coronavirus infection (NCI) COVID-19 are often encountered in doctors’ outpatient and inpatient practice. NCI can lead to an exacerbation of an existing rheumatic disease and can also be a trigger factor for autoimmune changes and the debut of a rheumatic disease. Th is article presents a clinical case of granulomatos is with polyangiitis (Wegener’s) of a patient after suffering from NCI COVID-19. The diversity of th is pathology makes its timely diagnostics quite a difficult task, oncological and septic processes, tuberculos is and rheumatological disease were excluded for a long time. Th   is   article reviews a long period of observation of the patient – the use of various diagnostic methods to verify the diagnosis, consultations with various specialists for differential diagnosis, and repeated changes in treatment due to periodic deterioration of the patient’s condition. Th is clinical case is a reminder to doctors, that it is extremely important to fully examine the patient and analyze the dynamics of symptoms during the therapy in details, that can highly increase the chances of earlier diagnos is of such diseases. In addition, a significant factor of improving the quality of provided medical care is the continuous education of each attending physician in order to develop interdisciplinary competencies.

Differential diagnosis of hereditary diseases is challenging due to similar clinical manifestations, diversity of nosologies, wide clinical variability and genetic heterogeneity, severity, rare frequency and complex molecular etiology. In some of them, connective tissue as a whole is involved in the pathological process, affecting almost all organs and systems of the human body, and in particular bone tissue, disrupting its remodeling and microarchitecture. The defect can occur at any of the stages of remodeling: during the initiation process, during bone resorption, osteoblast differentiation, osteoid mineralization, etc. Violation of the microarchitecture of bone tissue is accompanied by the development of low-traumatic fractures and deformities, early osteoarthritis, the formation of contractures and chronic pain syndrome. Genetic studies of patients have expanded knowledge about  the molecular signaling pathways that coordinate bone development and metabolism, the nature of disease inheritance, clinical features, and specific bone biomarkers. This article provides an overview of key cellular mechanisms, features of diagnosis and treatment of hereditary human diseases that affect the condition of bone tissue and skeleton: osteogenesis imperfecta, EhlersDanlos syndrome, Marfan syndrome, juvenile osteoporosis, hypophosphatasia, osteopetrosis, progressive diaphyseal dysplasia, mucopolysaccharidoses, achondroplasia, multiple hereditary exostoses. Doctors of different specialties can encounter these diseases, and making a correct diagnosis will make it possible to determine the correct algorithm for patient management and begin timely treatment, the ability to prevent the development of severe complications, improve the quality of life of patients, restore maximum working capacity and reduce the percentage of disability.

Interferon-gamma (IFN-γ) is the only representative of the type II interferon family regulating Th1 and Th2 immune responses. The discovery of IFN-γ is associated with the name of E. Frederick Wheelock. The expression of the IFNG gene provides a pleiotropic effect for IFN-γ, the main immune directions of this cytokine are antiviral, antibacterial and antiprotozoal. Unfortunately, in publications devoted to the relationship between the severity of inflammatory dermatoses (psoriasis, seborrheic dermatitis, atopic dermatitis) and levels of interferon gamma production, there is no consensus on the direct unity of these events. Although in most cases with acute viral diseases, an increase in interferon production is noted at the initial stages, but in some acute respiratory viral infections, its increase is not recorded (COVID-19, etc.), in cases of chronic viral diseases caused by retroviral infections – human immunodeficiency virus, human type 1 T-lymphotropic virus and endogenous human retroviruses as a result of prolonged exposure to IFN-γ on tissues, their damage may be noted, as well as a change in the functional state of CD4⁺ T cells. In cases of diseases caused by the herpes simplex virus 2, IFN-γ also has a complex effect on the intercellular relationships of infected and uninfected keratinocytes, as well as on the processes of apoptosis in Langerhans cells migrating to the dermis, which causes a violation of CD4⁺ and CD8⁺ involvement in the focus+ T-lymphocytes. In autoimmune diseases, IFN-γ can have a multidirectional effect. In particular, in patients with multiple sclerosis, IFN-γ regulates the processes of neuroinflammation and, depending on the concentration, can either reduce the number of CD11b+ myeloid cells of the central nervous system and reduce the infiltration of inflamed cells and normalize the processes of demyelination, or with an increase in IFN-γ production lead to reverse effects. At the same time, an enhancement of IFN-γ for transcription factors of differentially expressed genes in the case of systemic lupus erythematosus in patients has been proven.

Smooth skin mycoses are common all over the world and occur in 20-30% of the population. Currently, with climate change, the distribution areas of pathogenic fungi are changing, which is observed all over the world. In this paper, the analysis of changes in the epidemiological regions of the spread of mycoses of the feet and hands, microsporia, trichophytia and onychomycosis in Russia is carried out. The most disadvantaged federal districts have been identified. The incidence of mycoses of the feet and hands, as well as onychomycosis, is increased in the Northwestern, Central, Ural and Far Eastern districts. At the same time, infections in the Far Eastern District are localized mainly in the Khabarovsk Territory, but not in the Yamalo-Nenets District. Microsporia is common in the Volga and North Caucasian districts. The incidence of trichophytia is increased in the Siberian, Far Eastern and, especially, in the North Caucasus (10 times higher than the national average) districts. In recent years, the incidence of microsporia has significantly decreased in the Southern and Far Eastern districts. At the moment, the Southern District is the most prosperous in terms of epidemiology of all types of superficial skin mycoses. In the North Caucasian district, it is necessary to find out the cause of highly increased trichophytia. First of all, this may be due to aquaphilic pathogens. The article provides recommendations for the treatment and prevention of mycoses of smooth skin. The main drug in the treatment of superficial skin mycoses is sertaconazole. The hydrophobic nature of the drug makes it possible to obtain effective topical products based on it (creams, gels, shampoos, candles). Several sertaconazole-based drugs have been developed in Russia, for example, Acrimicol cream, recommended for the treatment and prevention of mycoses of smooth skin and multicolored lichen.

Introduction. Dyshidrotic eczema is a clinical type of chronic eczema, the clinical picture of which is characterized by itchy vesicular or bullous rashes localized on the skin of the palms and/or soles, a tendency to long-term chronic and recurrent course, the development of complications and resistance to therapy. Despite its prevalence and impact on quality of life, treatment of dyshidrotic eczema may be ineffective due to its polyetiology, chronic and recurrent course, and the lack of well-organized randomized controlled studies on the pathogenetic therapy of dyshidrotic eczema.

Aim. Conduct an analysis of available sources devoted to the study of dyshidrotic eczema. Provide a description of clinical cases of dyshidrotic eczema and experience with external therapy.

Results. The proportion of dyshidrotic eczema among other types of eczema varies from 6 to 31.8%. More than 80% of patients note a negative impact of dyshidrotic eczema on the quality of life. Conducted studies demonstrate a variety of factors predisposing to the onset, among which genetic predisposition, atopy and contact allergy are the main ones. Possible triggers include medications, insolation, humidity, and mycotic sensitization. Dyshidrotic eczema is a long-term and recurrent process with a risk of developing infectious complications. Staphylococcus aureus, Corynebacterium, Streptococcus and Micrococcus are detected in dyshidrotic eczema foci, which must be taken into account in combination therapy. The article presents clinical examples of successful treatment of dyshidrotic eczema localized on the skin of the hands with an external preparation containing a combination of 0.05% betamethasone dipropionate, 0.1% gentamicin sulfate and 1% clotrimazole.

Conclusions. Dyshidrotic eczema is a common condition and affects quality of life. Proper diagnosis is essential for effective and efficient treatment. External therapy with the inclusion of a cream (ointment) containing a combination of 0.05% betamethasone dipropionate, 0.1% gentamicin sulfate and 1% clotrimazole gives better results and increases satisfaction with the treatment of patients with dyshidrotic eczema.

Introduction. Flushing is a subjective feeling of warmth that is accompanied by redness of the skin on any part of the body, but mainly on the face, neck and upper trunk. Episodic flushing with other symptoms associated with mast cell mediators can be observed in 30–50% of children with cutaneous mastocytosis (CM).

Aim. To analyze the frequency of flushing in children with various clinical forms of cutaneous mastocytosis. To study serum tryptase levels in children with flushing.

Materials and methods. The study included data from 275 children aged from 6 months to 17 years inclusive, who were undergoing outpatient treatment and observation at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology from March 2022 until January 2024. The concentration of tryptase in the blood was determined by immunofluo-rescence on a three-dimensional porous solid phase (ImmunoCAP technology, Pharmacia Diagnostics AB, Sweden). Polarization and immersion dermatoscopy with 20x magnification were performed.

Results. Flushings were observed in 17.5% of patients out of 275 observed children with CM. The level of tryptase more than 15 µg/l was determined in 20.8% of children with flushing, above 11.0 µg/l – in 37.5%. Tryptase levels were higher than 8.0 µg/L in 22 (45.8%) patients. In 25.0% of patients with flushing, tryptase levels did not exceed 5 µg/L. The severity of the vascular pattern in lesions and apparently healthy skin was characteristic of patients with frequent or prolonged flushing and tryptase levels above 8.0 µg/L.

Conclusion. This study was the first in the Russian Federation to demonstrate the prevalence of flushing in children with various clinical forms of cutaneous mastocytosis. The results showed that the assessment of serum tryptase levels should be performed in all children with flushing, regardless of the clinical form of mastocytosis, including those with isolated and multiple skin mastocytomas. Clinical laboratory and dermatoscopic monitoring are important for the development of individual therapeutic tactics and prevention of mediator reactions and anaphylaxis.

A rare clinical case of a patient with isolated sarcoidosis of the eyes is presented. Sarcoidosis is a polyethological disease, the morphological feature of which is the formation of epithelioid cell granulomas in various organs and tissues, which is accompanied by a violation of their structure and function. Both congenital and adaptive immune systems are involved in the pathogenesis of sarcoidosis, with damage to lymph nodes, lungs, skin, organ of vision, etc. Risk factors for the development of sarcoidosis have not been definitively established. Environmental factors and genetic predisposition play a crucial role in the development of the disease. The above clinical observation demonstrates the polymorphism of the clinical picture of isolated ocular sarcoidosis. In addition to standard ophthalmic examination methods, the genetic method of reverse transcription and quantitative polymerase chain reaction (RT-PCR, English qRT-PCR) was also used to determine the expression profile of signature microRNAs as potential diagnostic markers of sarcoidosis of the organ of vision.An increase in the expression level of hsa-miR-455-3p, hsa-miR-4663, hsamiR68063p, hsa-miR-450b-5p, hsa-miR-6716-3p, hsa-miR-5000-5p, hsa-miR150-5p can be considered as potential diagnostic biomarkers of sarcoid lesion of eye structures. With sarcoidosis, the involvement of the lacrimal gland is possible. In the presented clinical observation, this was indicated by the results of a functional examination, sonographic signs: revealed multiple linear tubular hyperechoic structures and a decrease in blood flow velocity in the ocular and lacrimal arteries, as well as an increase in the expression activity of hsa-miR150-5p (p < 0.05). In order to prevent possible damage to the ocular surface due to the development of lacrimal gland dysfunction, it is advisable to prescribe local tear replacement therapy with hyaluronic acid preparations. Such effective drugs include tear substitutes of the Optinol® line: “Optinol® Express Moisture” and “Optinol® Deep Moisture”.

Introduction. Oxidative stress is a factor in the pathogenesis of postcovid microcirculatory conjunctival disorders. Antioxidant protection preparations are represented by vitamin and mineral complexes and drops that protect cells from free radical oxidation. These include taurine, the active ingredient of which is taurine.

Aim. To evaluate the effectiveness of the effect on the state of the microcirculatory bed of the conjunctiva and the reparative properties of the drug taurine in postcovid syndrome.

Material and methods. The study included 41 patients (82 eyes), in the postcovid period (more than 12 months after the coronavirus infection), divided into 2 groups. The examination consisted of: clinical examination, functional tests (Schirmer test, Norn test, vital dye tests), laser Doppler flowmetry. Treatment: instillation of 0.1% hyaluronic acid, dexpanthenol. Group 1 patients additionally received 4% taurine 3 times a day.

Results and discussion. The effectiveness of therapy was evaluated after 1, 3 and 6 months. The condition of the cornea was monitored weekly for a month. Results: improvement of clinical and functional (decrease in OSDI index, reduction of conjunctival hyperemia, restoration of corneal epithelium) and instrumental indicators (increase in blood flow velocity in vessels of bulbar conjunctiva) in group 1 patients was established after 1 week and 1 month, with preservation of results by 6 months; in patients of group 2 (with less pronounced dynamics) – after 2 weeks and 3 months and moderate suppression of the intensity of the functioning of the regulatory systems of microcirculation by the 6th month of follow-up. Conclusions: due to the cytoprotective and reparative effect on the ocular surface, improvement of the main indicators of microcirculation, the drug can be recommended for use in patients with impaired microcirculation of the conjunctiva and the presence of corneal epitheliopathy in postcovid syndrome.

Aminobenzoic acid is a biologically active substance widespread in nature, which has a wide range of therapeutic applications as an antiviral, antibacterial, antioxidant, antimutagenic, anticoagulant, fibrinolytic, immunomodulatory, radioprotective agent. As an interferon inducer it has been used for many years in mono- and complex therapy of viral eye lesions: conjunctivitis, keratoconjunctivitis, keratouveitis, including those caused by the herpes virus (Herpes simplex, Herpes zoster), adenoviruses; keratopathies of infectious, post-traumatic and postoperative origin. Taking into account the available information, a new drug has been registered and introduced into clinical practice, the main active ingredient of which is 0.007% aminobenzoic acid – Exinta. However, a number of studies have also shown the effectiveness of аminobenzoic acid in the treatment of neurodegenerative eye diseases by reducing the intensity of oxidative damage by lipid peroxidation products, as well as increasing the activity of transport adenosine triphosphatases in eye tissues. Based on the results obtained, it is recommended to use a 0.007% aminobenzoic acid solution not only for the treatment of viral eye diseases as an interferon inducer, but also in the treatment of uveitis, burns and eye injuries, retinal dystrophies, retinopathy, after ophthalmological operations, inflammatory and dystrophic diseases of the cornea, for keratopathies of various origins, for accommodation disorders, etc. In the given clinical example, 0.007% aminobenzoic acid showed its effectiveness in the lingering course of chronic conjunctivitis in the background of the low effectiveness of other drugs, where with the help of monotherapy it was possible to achieve clinical recovery.

Systemic vascular complications of diabetes mellitus (nephropathy, retinopathy, injuries to the great vessels of the heart, brain, arteries of the lower extremities) have been proven to lead to early disability and premature death of patients. The annual economic costs of T2DM and associated cardiovascular complications account for at least 1% of GDP. According to the principles of therapeutic management of diabetes mellitus, patient education is viewed as an integrated component of the treatment process. It should provide patients with knowledge and skills that contribute to achieving specific therapeutic goals (disease self-management). Self-monitoring of blood glucose training is a priority objective in the treatment of patients with diabetes. It is self-monitoring of glycemia that is the most important criterion for selecting therapy, compared with the glycemia testing in an outpatient clinic or hospital settings. Modern glucometers provide an option for remote monitoring of glycemia and timely delivering of consultations using a mobile application. Thus, Contour Plus One glucometer with the Russian-language application Contour Diabitis records the blood glucose readings following each test. If low or high glycaemic levels are detected, the application will show a notification and offer the patient options for actions. Quick recognizing out-of-range lab results motivates patients and helps them understand why changes in therapy are required. Immediate notifications shown on the smartphone screen improve motivation to act and respond to the situation. The glucometer system with a mobile application allows to promptly manage glycemia, increase patient’s commitment to active disease management, achieve treatment goals using innovative technologies, and therefore actively manage the course of diabetes mellitus.

Тo date, gastroesophageal reflux disease (GERD) is considered as a condition that includes various subgroups: erosive esophagitis, non-erosive reflux disease, Barrett’s esophagus, hypersensitive esophagus and functional heartburn. A common extraesophageal manifestation of GERD is laryngopharyngeal reflux (LFR), in which, in addition to dyspeptic symptoms, patients note hoarseness, cough, tickling and a feeling of a foreign body in the throat. When LFR occurs, the direct effect of gastroduodenal reflux on the mucous membrane of the larynx and pharynx leads to morphological changes, the development of pachyderma and laryngeal granuloma; indirect activation of reflex mechanisms causes the manifestation of esophagobronchial reflux. The diagnosis of LFR includes an analysis of the patient’s life history, registration of complaints using questionnaires (Index of reflux symptoms), assessment of the clinical and functional state of the larynx using a visually analog scale of reflux signs and videolaryngostroboscopy, the use of instrumental methods and laboratory tests. The detected laryngoscopic signs are not always pathognomonic for GERD-associated LFR: extraesophageal manifestations of the disease can also be observed in the absence of the most typical esophageal symptoms, which is a serious diagnostic problem. Due to the fact that not all instrumental diagnostic methods are informative in various cases of reflux-associated diseases, non-invasive methods are more convenient at the outpatient stage of patient examination questioning patients using special scales and questionnaires. The article presents the most informative and rational methods of noninvasive screening of GERD-associated diseases available in the available literature, aimed at identifying the severity of reflux manifestations, the level of patient satisfaction with their condition and the effectiveness of therapy. In order to improve the screening diagnostic process of LFR, it is necessary to develop and implement a reliable and sensitive questionnaire with an interdisciplinary approach.

A growing body of evidence suggests that periodontal pathology, accompanied by oral inflammation and pathological changes in the oral microbiome, induces changes in the gut microbiome (oral-gut axis) and is involved in the pathogenesis of systemic diseases. This review focuses on the published literature, with an emphasis on the last decade, assessing whether periodontal disease, primarily periodontitis, and periodontopathic bacteria are risk factors for the development of rheumatoid arthritis. The review examines the bilateral connections between rheumatoid arthritis and periodontal pathology, and highlights the main links in this connection. Porphyromonas gingivalis and other periodontopathic bacteria may contribute to the development of inflammatory diseases by remodeling the normally benign gut microbiota into a dysbiotic one. Porphyromonas gingivalis expresses endogenous citrullinated proteins and its own unique bacterial enzyme, peptidyl arginine deminase, leading to the formation of cyclic citrullinated peptide autoantibodies and impaired immunotolerance in susceptible patients. to rheumatoid arthritis. Results from clinical studies suggest that people with periodontitis and Porphyromonas gingivalis infection are at risk of developing rheumatoid arthritis, supporting findings from experimental studies. Non-surgical periodontal treatment is likely effective in controlling rheumatoid arthritis by reducing disease activity (primarily DAS28 and ESR). These observations highlight the importance of periodontal health and the need for prevention and early treatment of periodontitis in patients with rheumatoid arthritis.

Introduction. Chemotherapy is currently the mainstay of treatment for patients with cancer, but despite its high efficacy, it has a number of drawbacks. With many interesting studies on chemotherapy-associated encephalopathy, absolutely no attention is paid to insomniac problems, which can also be “red buttons” for triggering cognitive and emotional disorders.

Aim. To identify the features of neurological disorders in the form of dyssomnias and cognitive disorders in patients receiving chemotherapy.

Materials and methods. The work was conducted in the chemotherapy department and was based on the results of the examination of 50 women undergoing chemotherapy courses with a diagnosis of malignant breast neoplasm. The study sample 

Introduction. Chemotherapy is currently the mainstay of treatment for patients with cancer, but despite its high efficacy, it has a number of drawbacks. With many interesting studies on chemotherapy-associated encephalopathy, absolutely no attention is paid to insomniac problems, which can also be “red buttons” for triggering cognitive and emotional disorders.

Aim. To identify the features of neurological disorders in the form of dyssomnias and cognitive disorders in patients receiving chemotherapy.

Materials and methods. The work was conducted in the chemotherapy department and was based on the results of the examination of 50 women undergoing chemotherapy courses with a diagnosis of malignant breast neoplasm. The study sample included women whose history excluded conditions that independently caused various disorders of the sleep process and cognitive impairment. The women ranged in age from 37 to 58 years, had no history of drug or alcohol dependence and no history of traumatic brain injury. All the patients were divided into 3 groups according to the number of chemotherapy courses (group I – up to 10 courses, group II – from 10 to 19 courses, group III – from 20 courses and more).

Results and discussion. A tendency to worsening of insomniac disorders according to ISI was revealed in patients of the second and third groups in comparison with the first group (p > 0.05). The analysis of cognitive disorders severity values according to the MMSE scale similarly did not reveal reliable differences between the groups (p > 0.05), and there was a tendency for MMSE values to decrease with the increase in the number of chemotherapy courses. When calculating the correlation between the results of ISI and MMSE, we obtained an inverse high strength relationship (ρ = -0.8715). In other words, the more pronounced was the patient’s problem with the sleep process, the less she scored on the MMSE scale (more pronounced cognitive impairment).

Conclusions. The results of this study will add to the data available in the scientific literature on the effect of cytostatic drugs on the CNS and provocation of encephalopathy with insomniac and cognitive disorders. The data obtained will be useful for oncologists, neurologists, rehabilitologists and specialists working with oncology patients. 

The issue of optimal management of vitamin D deficiency and insufficiency is very topical. The role of vitamin D in the regulation of not only phosphorus-calcium metabolism, but also the relationship between its deficiency status and the risk of developing various diseases, including autoimmune, metabolic, oncological, cardiovascular, etc., has been well studied. Studies have shown that vitamin D deficiency and insufficiency are detected in 84.3% of examined population aged 18 to 50 years in Russia as a whole. According to the results of studies, the level of consumption of vitamin D foods in our country does not ensure adequate vitamin D intake, and the only effective method for managing its deficiency and maintaining 25(OH)D concentrations at the proper level may be supplemental vitamin D intake in the form of drugs or food additives. Given the importance of maintaining adequate vitamin D levels and high prevalence rates of vitamin D deficiency and insufficiency in people of different ages and genders in various geographical regions of our country, there is a growing interest in options for timely and adequate therapy. Domestic experts have developed various therapeutic options for the management of vitamin D deficiency and insufficiency. A single dose of 300,000 IU of oral cholecalciferol once weekly, which proved to be effective and safe for managing vitamin D deficiency in adults is the best option from the perspective of medication adherence and patient convenience. Presently, the first high-dose drug, a matrix tablet containing 50,000 IU colecalciferol, has been granted a marketing authorization in Russia. The drug is indicated for the treatment of vitamin D deficiency and insufficiency.

Telemedicine technologies based on artificial intelligence are certainly relevant and promising areas of medical development in Russia and the world. Thanks to their active implementation in practical healthcare, medicine has moved to a new level of quality in the provision of electronic medical services. One of the urgent problems of modern healthcare worldwide is the growing number of chronic non-communicable diseases. To date, the economic and social losses associated with their spread have reached significant levels in most countries of the world. In this connection, there is an urgent need to develop measures aimed at early identification of risk factors contributing to the development of chronic non-communicable diseases and their timely correction. In a number of countries, today the use of modern technologies, including those based on artificial intelligence, which guarantee the identification of risk factors and complications of chronic noncommunicable diseases at an early stage, which, in turn, allows to increase the effectiveness of treatment, and ultimately improve the quality of medical care. By using systems capable of processing huge amounts of medical data and providing the doctor with a comprehensive assessment of the available information within a few seconds, it is possible to significantly increase the efficiency of the doctor’s work, while not lengthening the appointment time and even reducing the workload. Telemedicine systems based on intelligent technologies that are being created for practical use must undergo clinical trials and verification of diagnostic accuracy. Systems for determining risk factors for chronic noncommunicable diseases that have been successfully tested are already being used today for preventive medical examinations. 

L-carnitine plays a key role in cell bioenergetics, it belongs to vitamin-like substances, but unlike vitamins, it not only comes from food, but is also synthesized in the body. Endogenous synthesis decreases with age, under certain physiological conditions, taking medications. In this regard, specialized food products (SFP) and food supplements are being developed, containing L-carnitine as one of the functional ingredients. Comparison of doses of L-carnitine approved for use in biologically active food supplements and specialized food products with doses that provide a clinical effect.A review of existing literature on this issue in recent years was carried out using the RSCI, Pubmed databases and in the Google Scholar, ResearchGate systems. The amount of L-carnitine contained in a daily portion of SPP is established by domestic regulatory documents based on an adequate level of daily intake for adults, which is 300 mg and the upper permissible level of daily intake in the composition of SFP and food supplements is 900 mg/day. Reception of L-carnitine 1–2 g per day. within 5–12 weeks led to an increase in its concentration in the blood plasma, and also improved the indicators of the antioxidant status. Long-term intake of L-carnitine in doses of 2–3 g in patients with dyslipidemia, type 2 diabetes (DM2) and cardiovascular diseased (CVD) led to an improvement in the lipid profile of blood plasma, glycemic control, and had an anti-inflammatory effect. The condition for achieving a clinical effect in patients is long-term use and high doses. The intake of physiological doses of L-carnitine is appropriate for individuals from risk groups. Clinically effective doses of L-carnitine, when used for at least 12 weeks, correspond to or are 2 times higher than the upper permissible intake level in the composition of SPP and dietary supplements.

Introduction. The polymorphism of clinical manifestations of chronic polypous rhinosinusitis determines the need for a detailed scientific approach in the study of pathogenetic mechanisms.

Aim. To study the morphological manifestations of disorders of the neuroepithelium of the olfactory zone of the nasal cavity in patients with chronic polypous rhinosinusitis.

Materials and methods. We conducted a prospective analysis of biopsic specimens as well as clinical and functional parameters of 16 patients with chronic polypous rhinosinusitis, who were divided into two groups: treatment group (A) and comparison group (B), aged 25 to 65 years (average age 53 ± 14.3 years). The study subset included 7 men and 9 women. We assessed the main clinical manifestations: radiologic abnormalities in the nasal cavity and paranasal sinuses evaluated according to the Lund-Mackay score, olfactometry and MoCA test in addition to a pathomorphological examination of olfactory neuroepithelium biopsied from the nasal cavity and determination of the chronic inflammation activity index using a histological activity score.

Results. In all patients with chronic polypous rhinosinusitis in the symptom complex, there was a violation of the sense of smell in the variants of hyposmia (50%) and anosmia (50%). The presence of neurocognitive disorders according to the MOS test was detected in 70% of patients. During morphological examination, pathological disorders in the olfactory zone of the nasal cavity were caused by atrophy of nerve fibers and lympho-macrophage infiltration involving mixed glands (variable range – mild/moderate/severe). All the analyzed signs were directly dependent on the duration of the disease and the severity of the lesion.

Discussion. Analysis of radiologic findings according to the Lund-MacKay score combined with the age of the patients and duration of the disease confirms the rationale of conducted study and its topicality.

Conclusion. The revealed pathological changes in the neuroepithelium of the nasal cavity in the olfactory zone were observed only in patients with chronic polypous rhinosinusitis and were directly dependent on the duration of the disease and the form of the inflammatory process.