Introduction. Xa factor inhibitors are a significant treatment option for patients with atrial fibrillation, as they assist in reducing the risk of stroke. However, there has not been enough research into the levels of X-factor in these patients.

Aim. To assess the impact of blood clotting factor X on the risk of adverse drug events (ADEs) in patients receiving apixaban or rivaroxaban treatment.

Materials and methods. The study involved 102 patients with atrial fibrillation who were administered Xa inhibitors: 56 received rivaroxaban and 46 received apixaban. Adverse drug reactions were documented, which were noted in the patient's medical records during drug administration. The concentration of the X factor was measured using photocolorimetry with reagents designed to determine the concentration of the factor X — AssaySense Human Factor X (FX) Chromogenic Activity Assay Kit (AssayPro, USA).

Results. In patients receiving apixaban therapy, the X factor concentration was lower in 32.6% of cases and in 43.5% of patients, it was higher than the reference value. In contrast, in patients receiving rivaroxaban therapy, these indicators were lower in 26.8% of cases and higher in 51.8% of patients. Overall, according to the medical records, there were 37 adverse reactions in 29 patients, including 23 (41.1%) ADEs in 19 patients (33.9%) receiving rivaroxaban and 14 (30,4%) ADEs in 10 patients (21.7%) taking apixaban. The level of X factor was statistically significantly associated with the risk of stroke, with an AUC ROC of 0.720 and p-value of 0.05, and with minor bleeding, with an AUC ROC of 0.735 and p-value 0.003. An increase in the X factor level above 12.6 pg/mL increased the risk of stroke by 9.4-fold (95% CI: 1.9-74.3, p = 0.034), while a decrease below 10.5 pg/mL increased the risk of bleeding by 3.2-fold (95% CI: 1.2-8.7, p = 0.021).

Conclusion. The level of the X factor in individuals with atrial fibrillation exhibits a wide range of variability. Deviations from the reference values, either below or above, can significantly impact the risk of experiencing minor bleeding or suffering a stroke, respectively.

Introduction. Type 2 diabetes (T2D) increases the risk of developing cardiovascular diseases, which leads to a high mortality in this category of patients. Issues regarding the prevention of the onset and progression of coronary heart disease (CHD) and chronic heart failure (CHF) in patients with T2D and/or metabolic syndrome (MS) are still not fully understood. The use of metabolic drugs with cardioprotective effects, in particular Mildronate®, is one of the possibilities to improve the effectiveness of combination treatment of CHD and CHF.

Aim. To study the effect of Mildronate® on the quality of life (QoL) of patients with CHD and CHF, suffering from T2D and/or MS.

Materials and methods. A total of 2.084 patients with co-occurring two (or more) disorders: obesity, type 2 diabetes, angina pectoris, CHT, and CHF were included in the INDICOR observational study conducted in real-life clinical practice settings. Group 1 received therapy with disease-modifying agents prescribed due to CHD and T2D; Group 2 received Mildronate® at a dose of 1000 mg per day in addition to the same therapy. The studied lab test results were assessed at baseline and 42 days of therapy.

Results. A 42-day course of therapy in patients receiving Mildronate® at a dose of 1000 mg per day in addition to disease-modifying therapy (DMT) contributed to a percentage increase in the number of patients with CHD, FC (functional class) I angina pectoris (Δ,% + 63%, p < 0.001 ) as compared to the control group with no significant changes (Δ,% + 7%, p > 0.5). A significant increase in the number of patients with FC I CHF was recorded in Group 2 (from 23.5 to 42.1%, Δ,% + 79%) as compared to Group 1, where no significant changes were detected (22.7 to 23.7%, Δ,% + 4%). The QoL in patients with CHF based on data collected using the Minnesota Questionnaire and QoL in patients with CHD based on data collected using the Seattle Questionnaire significantly improved in the groups that received Mildronate® in addition to DMT, as compared with the group of patients who were only on DMT.

Conclusion. Results from the Seattle and Minnesota questionnaires showed that the use of Mildronate® as part of combination therapy in patients with CHD and CHF, suffering from T2D and/or MS, contributed to a significant reduction in the frequency of angina attacks and lowering angina FC, CHF FC, and also enhanced the quality of life in this category of patients.

Chronic hypertension (CH) complicates the course of pregnancy in 1-2% of cases, and it is increasingly common. Compared with normotensive women, women with CH have a high risk of maternal and perinatal complications. Antihypertensive treatment of CH halves the risk of severe hypertension but does not reduce the incidence of preeclampsia or serious maternal complications, which may be due to the small number of observations in the studies conducted. In addition, the treatment of CH does not affect the mortality or morbidity of the fetus and/or newborn, regardless of the start date of antihypertensive therapy. Traditionally used antihypertensive drugs have been proven not to be teratogenic, while there may be an increase in the frequency of congenital malformations associated primarily with uncontrolled chronic hypertension. Although prescribing approved antihypertensive agents for all women during pregnancy are effective in lowering blood pressure in the most cases, it remains unclear whether there is an optimal drug for monotherapy and which combinations of antihypertensive drugs are best used. An alternative approach is to individualize treatment using maternal characteristics and blood pressure characteristics, in addition to blood pressure levels (for example, blood pressure variability), which also have prognostic value. This review examines current data on the treatment of pregnant women with CH from the perspective of current national and international recommendations. Discussion of the existing unresolved issues can serve as a basis for a personalized approach in the management and treatment of pregnant women with CH.

Today, cardio- and cerebrovascular diseases pose a severe threat to human health and life quality, leading to reduced working capacity, disability and, often, death. The most common cardiovascular diseases are arterial hypertension, chronic cerebral ischemia and ischemic heart disease. Metabolic disorders that cause oxidative stress growth, vessel wall damage, and injury of body cells and tissues, as well as affect energy formation processes are the key aspects of their formation. Glutathione is a powerful antioxidant that protects cell structures from damage by free radicals, helping to reduce oxidative stress. Eltacin has a corrective effect on these pathological processes, rising the antioxidant protection of the body by increasing the efficiency of glutathione-dependent mechanisms of cell redox regulation. As a result of the complex impact on metabolic processes in the tissue, Eltacin has not only antioxidant, but also neuro- and cytoprotective and vegetotropic effects. The drug has a positive effect on the hemodynamic performance of patients with cardiovascular diseases, which is expressed in blood flow normalization in the heart as well as in the brain. The inclusion of Eltacin in traditional therapy for cardiovascular diseases patients leads to an increase in the antianginal and hypotensive effects. Its use in combined treatment regimens contributes to structural and functional state improvement of the myocardium of the left ventricle, which is a key factor for maintaining normal heart functioning. Increased physical activity tolerance allows patients to lead a more active lifestyle, which has a beneficial effect on their overall condition and life quality. In addition, the vegetotropic effectiveness of Eltacin has been proven. It results in meteoprotective effect, which reduces weather factors influence on the hemodynamics of weather-dependent patients with arterial hypertension and ischemic heart disease. Thus, Eltacin not only improves the condition of patients and increases traditional therapy effectiveness, but also provides additional protection from adverse environmental influence.

Pityriasis versicolor (tinea versicolor) lichen (PVL) is a fungal infection of the stratum corneum of the epidermis caused by the yeast-like fungus Malassezia (Pityrosporum), which is part of the normal microbiome of the skin. Malassezia yeast has a conditionally pathogenic potential, penetrating into the stratum corneum and causing the appearance of multicolored spots on the skin. Malassezia fungi are involved in the pathogenesis of head and neck dermatitis, seborrheic dermatitis and folliculitis. PVL occurs in both tropical and temperate climates and affects both sexes equally. There are no systematic data on the prevalence of this disease in the world, but it is known that in tropical climates, PVL is more common (up to 40% in Brazil) than in temperate zones (<1% in Sweden). In Russia, there are also no general epidemiological data on the prevalence of PVL in the available literature. In the Krasnodar Territory in 2022-2024, among patients who turned to a dermatovenerologist for skin peeling accompanied by itching, 28% were diagnosed with PVL. The disease is considered non-contagious and is treated with topical antifungal drugs. In severe cases, the use of systemic antimycotics is indicated, which reduces the duration of the treatment and prevents relapses of the disease. The review provides data on the pathogenesis and prevalence of the disease, as well as modern approaches to PVL therapy.

The relevance of psoriasis is caused by prevalence of a disease, a long chronic current, frequent, is long the proceeding recurrence. According to modern representations psoriasis - one of the most widespread chronic inflammatory dermatosis with primary damage of skin and probably genetically determined immune disturbances which are implemented under the influence of a number of trigger factors, demonstrating inflammatory process in a derma, are followed by permanent disturbance of proliferation and a morphological differentiation of keratinotsit. Diverse clinical manifestations are characteristic of psoriasis: from the single, plentifully shelled papules or plaques of pinkish-red color to an erythrosis, psoriasis arthritis, generalized or limited pustulous psoriasis. Defeat of a pilar part of the head - the most widespread localization of a dermatosis also meets at 80% of patients with psoriasis, in 25% of cases psoriasis of skin of a pilar part of the head proceeds separately. Fast and effective treatment of psoriasis of a pilar part of the head is of great importance as the worst indicator of the index of quality of life is noted at patients with this problem - 82% of the patients suffering from a dermatosis have constant feeling of discomfort and are stigmatized that serves as the reason of deep social isolation and disadaptation. According to the clinical recommendations of the Russian society of dermatovenerologists about external therapy of psoriasis with manifestations on a pilar part of the head, topical glucocorticosteroids in a combination with salicylic acid in the form of various dosage forms belong to drugs of the first line. In article data of own clinical experience of use of the solution containing betamethasone Dipropionas and salicylic acid are stated (Akriderm of SK solution). The good efficiency of medicine concerning psoriasis on a pilar part of the head, convenience of use of a dosage form in the form of solution, fast approach of clinical result at patients with involvement of head skin is noted.

Introduction. Stroke in young adults is associated with high-level socioeconomic components, and patients face the lifelong effects of the vascular catastrophe. Young patients with cardioembolic stroke make up an important subgroup of ischemic stroke patients globally. A key to optimizing treatment and preventing relapses is identifying the causes and risk factors for ischemic stroke in young adults.

Aim. To assess risk factors and endothelial function status in young men with cardioembolic stroke

Material and methods. A total of 19 patients aged 30-50 years with cardioembolic stroke underwent clinical and instrumental examinations. All patients were admitted to the Yaroslavl Vascular Center before the COVID-19 pandemic. The severity of clinical symptoms and stroke were assessed using the NIHSS scales, Modified Rankin Scale, and Rivermead Mobility Index. The main risk factors for IS including the presence of high- or moderate-risk sources of cardioembolism were reviewed. All patients underwent brain neuroimaging, ultrasound imaging, electrocardiogram, echocardioscopy, and laboratory blood testing. An ultrasound guided tourniquet test was performed to assess the brachial artery endothelial vasomotor function. 

Results. The average age of patients with cardioembolic stroke was 43.2 ± 6.4 years. Mechanical valve prostheses (21.1%) and isolated atrial fibrillation (42.0%) are the most common sources of cardioembolism. Other commonly identified risk factors included hypertension (73.7%), dyslipidemia (42.1%), smoking (52.6%), and prior acute myocardial infarction (42.1%). The ultrasound guided tourniquet test showed normal dilation of the brachial artery in 26.3% patients, insufficient dilatation in 42.1% patients and vasoconstriction in 31.6% patients. Statistically significant associations between the main vascular risk factors, serum markers of endothelial dysfunction and ultrasound guided tourniquet test indices were identified.

Conclusion. This study demonstrated a variety of risk factors for cardioembolic stroke in young men. Lifestyle modification is responsible for the occurrence of traditional risk factors in young adults.

Insomnia is a common and serious health problem associated with a significant and growing health burden. About 10% of the adult population suffers from chronic insomnia, and 20% suffer from it periodically. Insomnia is associated with an increased risk of mental (depression, cognitive impairment), somatic (arterial hypertension, coronary heart disease, arrhythmias, metabolic disorders) and occupational problems. The review examines current data on the effect of insomnia on the course of diseases of the cardiovascular system, showing the negative impact of insomnia on coronary heart disease, arterial hypertension and cardiac arrhythmias. A high prevalence (40-80%) of sleep apnea is observed in patients with cardiovascular disease, including coronary artery disease, atrial fibrillation, heart failure and hypertension, leading to adverse cardiac outcomes. A negative fact is the steady (epidemic) increase in cardiovascular diseases among young people aged 18 to 50 years, due to lifestyle changes and an increase in the level of stress factors. Individuals with insomnia have a significantly increased risk of myocardial infarction, cardiovascular mortality, cardiovascular disease morbidity, and all-cause mortality compared with healthy individuals. The optimal drug for the treatment of insomnia may be doxylamine, especially its most easily titrated form - a solution in drops. The drug has a high level of safety and is highly effective in the treatment of insomnia. A concomitant positive effect of the drug may be a decrease in the intensity of vestibular symptoms.

Recognition of the fact that asthma is a complex, multifactorial disorder has led to a more serious focus on the patient and on those disorders of his condition that contribute to the more or less general clinical severity of the disease. Recognition of the fact that asthma is a complex, multifactorial disorder has led to a more serious focus on the patient and on those disorders of his condition that contribute to the more or less general clinical severity of the disease. So, in the pathogenesis of bronchial asthma, T2 and non-T2 endotypes of asthma are determined. By definition, a disease endotype is a subtype of a disease determined by a unique or distinctive functional or pathophysiological mechanism. One endotype of astma may underlie several phenotypes, since the endotype is the molecular basis of phenotypes. The most common and obvious phenotype of bronchial asthma is allergic or atopic. The discovery of IgE also opened a new era in the understanding of the mechanisms of the formation of allergic diseases, including asthma. It is logical that the first targeted (targeted) drug for patients with severe allergic bronchial asthma was omalizumab (anti-IgE therapy). Clinical studies have demonstrated conclusively that in patients with asthma requiring high-dose inhaled corticosteroids and/or systemic glucocorticosteroids, anti-IgE therapy reduces exacerbation rates, reduces asthma severity, and allows withdrawal or significant lower doses of systemic drugs. Omalizumab reduces eosinophilic infiltration of the submucosal layer of the bronchi, eosinophilia in sputum, which correlates with a decrease in the fraction of exhaled nitric oxide. Omalizumab modifies the severe course of allergic asthma in children and adults, reduces the thickness of the bronchial wall, increases the lumen of the bronchi (special CT studies), which is clinically manifested by an increase in FEV1. The anti-inflammatory effect of omalizumab has also been proven.

According to the Weekly National Bulletin on Influenza and SARS and other epidemiological studies, the incidence of SARS and influenza still holds a leading position among all infectious diseases. And, in addition to fever, the most common complaint and reason for seeking medical help in outpatient practice is cough, both as a symptom of acute respiratory infection (ARI) and as a symptom of complications. Among the complications of ARI, bronchopulmonary diseases such as acute bronchitis, chronic bronchitis, bronchiectasis, etc. are most common. Cough appears from the first days of the disease, pronounced, unproductive at the beginning of the disease, sometimes it can be accompanied by parasternal pain as a result of strong coughing shocks. Bronchial obstruction syndrome may be observed. That is why effective pathophysiological treatment of patients with ARI is the most important task of modern pharmacotherapy. According to research data, combined drugs have the most pronounced mucoactive effect in cough syndrome with ARI. The article considers the mechanism of action of the combined oral drug, which contains such active ingredients as bromhexine hydrochloride, salbutamol sulfate, guaifenesin, the time of onset of action of these substances, transformations, as well as the need for cough therapy in the earliest possible time from the onset of the disease.

Introduction. The study of the influence of environmental toxicants on the incidence of allergic diseases is a significant medical and social problem.

Aim. To study the frequency and characteristics of allergic pathology in patients with multiple chemical sensitivity syndrome (MCH).

Materials and methods. Using the QEESI questionnaire, 468 outpatients undergoing a preventive medical examination were surveyed (232 men, mean age 34.2 ± 9.3 years and 236 women, mean age 42.9 ± 13.8 years). Statistical processing was carried out using the statistical program MedCalc. The relationships and differences in the indicators were considered statistically significant at p < 0.05.

Results. The frequency of MCH was 211 people (45.1%). Allergic diseases were found in the study in 21.0% (102) of patients: allergic rhinitis in 24 (44.4%), asthma in 13 (22.2%), food allergy in 9 (16.6%), atopic dermatitis in 8 (14.8%) patients. Significant differences in the subscale of the effect on life were revealed in patients with bronchial asthma (p = 0.01), food allergies (p = 0.01), atopic dermatitis (p = 0.01). The average scores on all points in patients with MCH and allergic diseases were significantly higher than in the group with isolated MCH syndrome (p = 0.01). Among patients with allergies, the number of women was significantly higher (74.9% vs. 25.1%, p = 0.01), women more often had high scores for each of the three subscales compared with men: 25% vs. 10% (p = 0.001) for chemical intolerance, 29% vs. 10% (p = 0.001) in terms of severity of symptoms and 22% versus 5% (p = 0.001) in terms of impact on life.

Conclusion. 25.6% of patients with HCV had allergic diseases: asthma, allergic rhinitis, food allergies, and atopic dermatitis. Significant differences in the subscale of life effects in patients with bronchial asthma, food allergies and atopic dermatitis were revealed.

Introduction. Drugs from the group of glucagon-like peptide-1 receptor agonists were originally intended to be used to treat patients with type 2 diabetes mellitus. However, with their use, a noticeable weight loss effect was noted, which expanded the list of indications and currently these drugs are prescribed to obese individuals, regardless of the presence of diabetes mellitus. On the Russian market, semavic (semaglutide) has established itself as an effective treatment for obesity.

Aim. To assess the effect of semaglutide on eating behavior in the process of weight loss.

Materials and methods. The literature search was carried out using the PubMed and Google Scholar databases. The selection of publications was carried out according to the principle of open free access, analysis of abstracts and assessment of relevance.

Results. A total of 35 articles were selected for review: 7 Russian-language articles and 28 foreign sources. Data from the vast majority of publications show that semavik for weight loss is prescribed at a dose of 0.5-2.4 mg per week subcutaneously for a course of up to 68 weeks. In alternative cases, the drug is taken orally. The maximum weight loss was 9,6-17,4% of initial body weight. The most common manifestation of complications was gastrointestinal disorders, but only for a small number of patients did they become a reason to refuse to continue therapy. In trials of the drug, a reduction in the total calorie intake was noted in the absence of external dietary restrictions.

Conclusion. The prescription of semavik is accompanied by increased self-control when eating. Self-control extends not only to food, but also to drinking alcohol. Approximately half of patients indicate an improved quality of life. Activation of metabolism appears to be associated with a decrease in insulin resistance, an increase in insulin concentrations, an effect on the effects of cortisol, and an effect on the hypothalamic-pituitary-adrenal axis.

Upadacitinib a selective Janus kinase inhibitor that belongs to the group of targeted immunosuppressors or selective immu-nosuppressants, has emerged as a new strategy for immune-mediated diseases. Previously, clinical cases and studies on adult patients with inflammatory bowel disease were mostly found in the literature; in paediatric practice, this experience is very limited. Use in children is still off-label due to the lack of randomized trials. In the presented clinical case, this drug was prescribed to a 15-year-old boy for a refractory course of ulcerative colitis that had previously lost response to anti-TNF, therapy with vedolizumab and tofacitinib was also failed. Given the unsuccessful previous treatment experience, a child with refractory ulcerative colitis was prescribed upadacitinib. The drug was prescribed at a dose of 45 mg once a day for 8 weeks, then it was suggested to switch to a maintenance dose of 15 mg once a day. Without systemic glucocorticosteroid use, the patient's complaints, clinical, laboratory, and endoscopic changes persisted, but on upadacitinib therapy the boy was able to discontinue glucocorticosteroid. This example illustrates the positive dynamics according to clinical, laboratory and endoscopic data on the background of selective inhibitor of Janus kinases. A growing number of clinical cases using Janus kinase inhibitors show the need for clinical trials in a pediatric group of patients with refractory inflammatory bowel disease.

This review describes the challenges faced by patients with diabetes in self-monitoring of glycemia and their solutions. An over-view of factors influencing the purchase and selection of a glucometer, the use of mobile applications for diabetes mellitus (DM) control, and adherence to DM self-monitoring is presented. Factors influencing glucometer choice such as accuracy, blood sample volume, and the aspects on which they depend are described. Studies investigating such an option as setting an individual glycemic target range and its advantage in improving carbohydrate metabolism are presented. The factors that determine effectiveness and adherence when using mobile apps for DM control, the function of reminders in mobile apps are considered. The article gives some of the most important features of the Contour®Plus ONE blood glucose measurement system for patients, which consists of the Contour®Plus ONE glucometer, Contour®Plus test strips, Contour^TMDiabetes app, Contour^TMCloud. The nuances of glucometer use and applications that make their combination for self-monitoring of glucose levels as comfortable and effective as possible for the physician and the patient are described. The article identifies psychological factors influencing adherence to glycemic self-control. In addition, the article presents a brief description of the current state of the problem of non-invasive glucometry and lists some developments in recent years. Among the presented recent developments are devices based on electrochemical methods (flexible sensors measuring glucose levels in sweat on the skin surface, in saliva, in tears), as well as devices measuring blood glucose levels in blood vessels using optical, electromagnetic and microwave methods.

Dipeptidyl peptidase type 4 (DPP-4) inhibitors hold leadership positions in the treatment of type 2 diabetes worldwide due to their pathogenetically substantiated mechanism of action, low risk of hypoglycemic states and good tolerability. Today, they represent the largest class of glucose-lowering medicines. Sitagliptin, the first antidiabetic agent from this class, is the best known one and along with that remains the most promising medicine. It can be prescribed either as the initial treatment or later in a combination with other classes of hypoglycemic drugs, including sulfonylurea derivatives. Glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GIP), which blood concentrations increase under the effect of DPP-4 inhibitors, enhance glucose-stimulated insulin secretion through activating the cyclic adenosine monophosphate (cAMP) signaling pathway in pancreatic β-cells, meanwhile cAMP plays a critical role in an increase in β-cell sensitivity to glucose. Sitagliptin is an antidiabetic agent with significant data on cardiovascular safety. The efficacy of the drug is broadly similar to that of sulfonylurea derivatives. At the same time, the low risk of hypoglycemic states and the absence of side effects create certain advantages of using this drug in elderly patients. Active use of the drug in patients with diabetes in Japan is associated with the predominance of secretory disorders in the pathogenesis of the disease and the efficacy of DPP inhibitors in this ethnic group. The pleiotropic properties of the drug continue to be studied. The positive effects of sitagliptin in coronavirus infection may be associated with the anti-inflammatory and immunomodulatory properties of the drug. The potential of the drug in the treatment of immune-mediated conditions, as well as its neuroprotective properties in the prevention and treatment of Alzheimer's disease, are considered.

The goal of modern insulin therapy used in the treatment of diabetes mellitus is to mimic physiologic insulin secretion by pancreatic beta cells. The new ultrafast-acting insulin analog aspart (UFAiAsp) demonstrates a faster onset and shorter duration of action compared to the ultra-short-acting insulin analog aspart (USAIasp), which substantiates the possibility of insulin administration immediately before meals, which helps to improve glycemic control by regulating postprandial glucose levels, improving patients' quality of life. We conducted a literature search for the period from 2012 to 2023 in the electronic databases PubMed, Elibrary.ru, and Cophrane library of scientific information on the efficacy and safety of ultrafast-acting insulin aspart in comparison with USAIasp. With the use of UFAiAsp, a reduced risk of late postprandial hypoglycemia due to increased absorption rate and earlier termination of the sugar-lowering effect was observed. The problem of using ultrafast-acting insulin aspart in our country, which is solved by the admission of biosimilar drugs (biosimilars) to the market, is considered. It was shown that the domestically produced biosimilar UFAiAsp (RinFast® Nick) registered in the Russian Federation is recognized as interchangeable with the original UFAiAsp (Fiasp®) in terms of bio- and therapeutic equivalence, immune safety, good tolerability, and also meets the specification norms when used for continuous subcutaneous infusion in terms of physicochemical parameters. Dosing accuracy and absence of occlusions in the systems over 72 hours with the new biosimilar in pumps have been proven. Consequently, UFAiAsp can be recommended for all patients, including children, who require the prandial component of insulin therapy.

The thyroid gland is an important organ of the endocrine system. Its hormones influence all human organs and systems. Among thyroid dysfunctions, the most common variant is primary hypothyroidism. Since during pregnancy the mother's thyroid gland undergoes changes and the need for thyroid hormones increases, the risk of hypothyroidism increases. Particular attention should be paid to women who are carriers of antithyroid antibodies, as they are more likely to have thyroid dysfunction during pregnancy. In this regard, such patients should have their thyroid function examined in each trimester of pregnancy. It is known that hypothyroidism, both manifest and subclinical, has a negative impact on pregnancy outcomes and the subsequent psycho-physical development of the child. With obvious hypothyroidism, the risk of premature birth, arterial hypertension, preeclampsia and other complications increases. Therefore, treatment for hypothyroidism during pregnancy should begin immediately. The basis of treatment for this pathology is the prescription of replacement therapy with L-thyroxine immediately in a full replacement dose. For women who were already taking the drug before pregnancy, the dose of L-thyroxine increases by 20-30% with the onset of gestation. Also during pregnancy, there may be a decrease in thyroid hormones, usually thyroxine (T4w), with normal TSH. This condition is called isolated hypothyroxinemia. Its causes may be insufficient iodine intake, as well as increased levels of thyroxine-binding globulin. Its increase leads to an increase in the concentration of the total fractions of the hormones T4 and T3, but at the same time the true level of T4fr is underestimated. Isolated hypothyroidism does not require treatment if TSH levels are normal.

Introduction. The past COVID-19 pandemic has influenced the course of many diseases including endocrine pathology. However, little is known about the clinical and pathogenetic features of thyroid pathology of the post-COVID-19 period.

Aim. Evaluate the clinical and pathogenetic features of thyropathies diagnosed during the post-COVID-19 period.

Materials and methods. A cross-sectional study included 250 patients with newly diagnosed thyroid diseases. 73 participants denied a history of COVID-19 and 177 suffered from it within the previous 9 months. Thyroid status and thyroid ultrasound examination were assessed. IgG SARS-Cov-2 levels were tested in 40 patients with a history of COVID-19. Fine needle aspiration biopsy was performed in 61 patients including 41 with a history of COVID-19. In the main group, all the samples were additionally investigated by immunocytochemical analysis with SARS-CoV-2 protein antibodies.

Results. Among the patients with COVID-19 history higher levels of fT4 (13.6 [12.4; 15.5] vs 12.8 [11.0; 15.3] pmol/l, p = 0.046) and a lower proportion of patients with euthyroidism (122 (68.9%) vs 59 (80.8%), p = 0.037) were detected. In the main group there were more cytological samples with macrophages accumulations (16 (39.0%) vs 2 (10.0%), p = 0.017), however, immu-nocytochemical study did not reveal any SARS-Cov-2-positive samples. During the post-COVID-19 period, approximately 60% of patients with subclinical thyroid dysfunctions experienced spontaneous normalization. There were correlations between IgG SARS-Cov-2 levels and parameters characterizing the structural and functional state of the thyroid gland.

Conclusion. The most typical clinical feature of post-COVID-19 thyropathies was a smaller proportion of individuals with euthyroidism. Mild thyroid dysfunctions identified during the post-COVID-19 period tended to develop spontaneous normalization in 60% of cases. The immunocytochemical tests indicate the absence of SARS-Cov-2 persistence in the thyroid tissue. COVID-19- associated immunopathological reactions are involved in the pathogenesis of post-COVID-19 thyropathies.

Introduction. Over the years, insulin therapy has remained an important component of the complex treatment of patients with diabetes mellitus. Ultra-rapid insulin lispro is a DNA recombinant analogue of human insulin, which has a pharmacokinetic (PK) profile that is as close as possible to the endogenous insulin secretion profile, which ensures effective control of postprandial glycaemia. The development of the ultra-rapid insulin lispro biosimilar will expand the range and increase the availability of modern and safe insulin analogues for diabetic patients in Russia.

Aim. To compare the PK and pharmacodynamic (PD) profiles of GP40261 (ultra-rapid insulin lispro biosimilar) and the reference Lyumjev® in healthy volunteers.

Materials and methods. This was a double-blind, randomised, comparative, crossover study in healthy volunteers who were administered either the test or reference ultra-rapid insulin lispro formulation as a single dose of 0.3 IU/kg. The hyperinsulinaemic euglycaemic clamp technique was used to evaluate the pharmacokinetics and pharmacodynamics of the study products. In order to assess the biosimilarity of the products, 90% confidence intervals (CIs) were calculated for geometric mean ratios of the primary PK parameters AUCins.0-t and Cins.max. The PD parameters of the study drugs were evaluated based on the glucose infusion rate required to maintain the target glycaemic level during the clamp.

Results. The 90% CIs for the geometric mean ratios of the primary PK parameters for the test and reference products were 89.41-94.55% for AUCins.0-t and 82.74-92.92% for Cins.max, which complies with the established acceptance limits of 80-125% for both parameters. The study products were also found to have comparable PD profiles of their active substances.

Conclusion. This clinical study has demonstrated that GP40261 and the reference ultra-rapid insulin lispro are biosimilar and have a comparable safety profile.

Introduction. The literature data confirm a relationship between keratoconus (KC) and signs of dry eye syndrome (DES). The scleral rigid gas permeable contact lenses widely used in the optical correction of keratoconus are more often used in the treatment of dry eye syndrome to protect the cornea and tear film.

Aim. To evaluate changes in the condition of the cornea and tear film in keratoconus associated with dry eye syndrome during the use of scleral rigid gas permeable contact lenses in combination with/without tear replacement therapy.

Materials and methods. A total of 30 patients (60 eyes) with bilateral stabilized non-operated keratoconus at different stages associated with dry eye syndrome were examined. The patients were divided into groups: Group 1 included 15 patients (30 eyes), who used 0.9% sodium chloride (saline solution) as a moisturizing solution to fill the lens cup before it was placed in the eye; Group 2 included 15 patients (30 eyes) who used 0.18% sodium hyaluronate as a moisturizing solution. All patients underwent the following examinations: biomicroscopy of the anterior segment of the eye using a vital dye (0.1% fluorescein sodium) and assessment of the degrees of epitheliopathy of the conjunctiva and cornea according to the Oxford grading system, determination of the precorneal tear film break-up time (Norn test), as well as the status of total (Schirmer test) and basic (Jones test) tear production.

Results and discussion. Wearing scleral rigid gas-permeable contact lenses, regardless of the type of solution filled into the lens cup before placing it in the eye, improves significantly the ocular surface condition and increases the results of function tests.

Conclusion. The observed tendency towards a higher capacity to repair corneal tissues during the use of 0.18% sodium hyaluronate preservative-free tear replacement agent in the sublens space is confirmed by corneal confocal microscopy outcomes and indicates the greater efficacy of using a combination with a tear replacement agent.

Conjunctivitis accounts for about a third of all ocular pathology in clinical ophthalmology and is the most common inflammatory lesion of the eyes. This nosology can be both infectious and non-infectious in nature. The protection of the visual organ from exogenous and endogenous antigens is carried out with the help of highly specialized lymphoid tissue associated with the eye, which belongs to the peripheral organs of the immune system. The main task of the lymphoid tissue of the eye surface, which includes the conjunctiva, is to maintain a balance between the inflammatory immune response and tolerance to non-pathogenic factors, preventing the development of a permanent inflammatory reaction. Chronic conjunctivitis develops in patients with increased sensitization to a particular antigen. The article presents various aspects of pathogenesis, clinical picture, modern diagnostic methods, as well as management tactics for patients with chronic conjunctivitis of endogenous etiology, which developed against the background of systemic infectious diseases: shigellosis and chlamydia. The clinical efficacy of a combination of antibacterial drugs using the nonsteroidal anti-inflammatory drug bromfenac has been demonstrated. With a prolonged course of chronic conjunctivitis and the absence of a positive response to local therapy, additional examination is necessary to identify possible endogenous etiological factors.

Vitamins are a group of organic compounds that are required to support life and perform biological functions of a living organism. They participate in humoral regulation, perform enzymatic and catalytic functions, their deficiency can result in the development of serious life-threatening diseases. However, taking too much of some vitamins can also be dangerous for a human. In particular, hypervitaminosis A can lead to the development of toxic keratitis. Hypervitaminosis A can arise after consumption of large doses of retinoids, which are efficiently absorbed and slowly excreted; hypervitaminosis can result from both one-time use of large amounts of vitamin A and long-term use of relatively moderate doses. Chronic overdose of this vitamin may cause skin itching, dermatitis, skin pigmentation disorders, dry oral and conjunctiva mucous membranes, hair loss, increased brittleness of nails, nosebleeds, destruction of bone and cartilage tissue, toxic hepatitis, and coma in severe cases. Doctors often use vitamin A to treat some dermatoses (acne), while the cumulative doses of drugs can be significantly higher than the allowed ones. This article presents a rare clinical case of manifestation of toxic keratitis in a patient receiving vitamin A at doses exceeding therapeutic ones. The patient managed to restore the integrity of the cornea and get rid of keratitis while receiving long-term local instillations of drops, including taurine.

Immuno-inflammatory rheumatic diseases (RD) represent a wide range of genetic and non-genetic clinically heterogeneous inflammatory diseases characterized by a combination of autoinflammatory and autoimmune and autoimmune processes. In most cases, these diseases are accompanied by extra-articular manifestations, the most common of which are inflammatory diseases of the eye o, which can occur within a few years after the diagnosis of the underlying systemic disease, and in some cases, RD may debut with ocular pathology. The article presents clinical examples demonstrating the features of eye damage in some rheumatic diseases, such as spondyloarthritis-associated chronic anterior uveitis (SpA), chronic recurrent scleritis, episcleritis, scleromalacia and acute anterior uveitis in rheumatoid arthritis (RA), granulomatous scleral inflammatory masses with ulceration in granulomatosis with polyangiitis (HPA) (Wegener's granulomatosis), verified in the Federal State Budgetary Research University named after V.A. Nasonova. The described conditions were successfully treated by instillations of glu-cocorticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), parabulbar injections of corticosteroids, as well as the systemic use of NSAIDs. In the case of HPA, systemic therapy with corticosteroids and cytostatics was additionally performed. Knowledge of eye symptoms plays an important role in the diagnosis of systemic immunoinflammatory rheumatic diseases, as well as in prescribing correct and timely therapy with the multidisciplinary approach.

Introduction. Effective treatment of renal anaemia is achieved due to the use of erythropoietin-stimulating agents, which not only increase haemoglobin levels, but also significantly improve the prognosis for cardiovascular diseases in patients on haemodialysis.

Aim. To evaluate the safety and tolerability of Russian recombinant human erythropoietin beta (Epostim®) intended for intravenous administration to maintain stable haemoglobin levels in patients with chronic renal anaemia on programmed haemodialysis.

Materials and methods. A retrospective study included 67 patients with end-stage kidney disease on renal replacement therapy by programmed haemodialysis.

Results and discussion. Haemoglobin levels at the initiation of treatment (1 month) with epoetin beta and at the end of treatment (12 months) were 106.3 ± 9.0 and 107.4 ± 10.2 g/l, respectively, p = 0.03. The average number of patients with haemoglobin level < 110 g/l in the first 12 months during therapy with epoetin alfa was 8.5 ± 1.1. The average number of patients with haemoglobin level < 110 g/L in the following 12 months (during treatment with epoetin beta) was 6.1 ± 0.5, p = 0.04. The average number of patients with increased haemoglobin levels > 130 g/l in patients treated with epoetin alfa and epoetin beta did not differ from each other and amounted to 4.3 ± 0.6 and 5.1 ± 0.9, respectively, p = 0.46. After conversion to epoetin beta, the changes in haemoglobin levels were much smoother (Friedman test, p = 0.29). The frequency of first-year dose modifications (epoetin alfa) was 2.1 ± 0.12 episodes per year, and that of second-year dose modifications (epoetin beta) was 1.7 ± 0.16 episodes per year, p < 0.047. Epostim® showed good tolerability; no adverse effects, including serious ones, were reported.

Conclusion. The use of epoetin beta (Epostim®) allows to effectively maintain a stable haemoglobin level that was achieved after the use of other erythropoietin agents in the treatment of anaemia associated with end-stage chronic renal failure.

The article is devoted to one of the most common parasitic infections in children - scabies. Diversity of the clinical presentations, tendency to the quick progression of secondary infection of rashes and other serious complications make the clinical diagnosis more difficult to establish. This review summarizes the data from the analysis of available sources devoted to the study of modern clinical and epidemiological features and methods for diagnosing scabies in children. An analysis of epidemiological trends and risk factors leading to a global increase in scabies incidence among children was carried out. The recent years featured a growth of cases of a disease in children under two years of age. The article presents the results of scientific researches devoted to the study of the pathogenesis and morphology of the disease, which explain the development of clinical forms and complications of scabies. The current methods for diagnosing the disease, as well as their integration into the International Alliance for the Control of Scabies (IACS) Criteria are analysed. Dermatoscopy has obvious advantages over traditional microscopy. The method is non-invasive and well tolerated by patients, especially children, and makes it possible to acquire data within a few minutes, which takes much less time than ex vivo microscopic examination. The article presents data from domestic scientists' researches on the non-invasive diagnosis of scabies. Despite the development and implementation of new diagnostic methods, scabies often remains unrecognized, which affects the outcomes of therapy. The increasing numbers of patients suffering from scabies require prompt and interdisciplinary interaction of health professionals, especially in the regions where constant migration of the population and low social standards of living are observed. In parallel with efforts to standardize and improve diagnosis using the current methods, the issue of developing additional scabies diagnostic tests remains pressing. The 2020 IACS criteria can be used as a reference standard for research into new diagnostic tools.

Introduction. The Saratov Oblast is a region that has moderate iodine deficiency. Starting from 2020, iodized salt must be used while cooking meals at educational facilities of Russia. However, only a few studies have been conducted to assess iodine intake of children meals.

Aim. To assess iodine intake with iodized salt used in the preparation of Saratov preschool and primary school meals.

Materials and methods. Iodine intake of children was assessed in several pre-schools and schools. The iodized salt content in typical menus for preschool and school hot breakfasts was modelled using process monitoring sheets. Iodine intake was estimated at 40 pg of iodine per 1 g of iodized salt and its 30% loss during cooking of hot meals. In Model 1, preschool and school meals were to be prepared using iodized salt. In Model 2, additional iodine intake was suggested to be consumed with bakery products for school meals baked using iodized salt.

Results. Iodine intake with iodized salt as part of hot dishes (Model 1) in children aged 1-3 years at preschools was 78.8 ± 17.8 pg/day, in children aged 4-7 years - 113.9 ± 20.9 pg/day. When using bakery products with iodized salt in the menu (Model 2), iodine intake in children aged 1-3 years old increased to 108.9 ± 14.5 pg/day, and in children aged 4-7 years to 152.9 ± 16.8 pg/day, i.e. by 29.1-33.4%. Iodine intake with hot breakfasts among primary schoolchildren was 34.2 ± 7.3 mcg/day.

Discussion. The results of this study are comparable to those of the study conducted in the Tyumen region, which demonstrated that the use of iodized salt in preparing preschool meals fully supplies the iodine needs of preschoolers.

Conclusion. The use of iodized salt to prepare preschool and school meals makes it possible to ensure 87.6-94.9% of the recommended iodine intake for preschoolers, and 28.5% of the recommended iodine intake as part of hot breakfasts for children in grades 1-4. Parents were offered daily menus options to use iodized salt in households, which allowed them to balance the iodine intake of their children.

Introduction. Hidden iron deficiency at the pregravidary stage leads to complications from both the mother and foetus, to decrease in the frequency of live birth in the protocols of assisted reproductive technologies (ART).

Aim. Is to determine the quality and number of oocytes in ART programs in patients with hidden iron deficiency and estimate the pregnancy outcomes.

Materials and methods. We analyzed 808 of protocols in ART. There were 10.6% patients with hidden iron deficiency with ferritin levels below 30-50 pg/l. The age, weight, duration of infertility and its causes were assessed in the 1^st (n = 86) and 2^nd (n = 29) groups. The blood count, ferritin levels and other markers of anemia were studied. Hormone levels, the number and quality of oocytes, and the number of embryos and the outcomes of ART protocols have been assessed.

Results. The impact of ferritin levels in ART programs has been revealed. Hidden iron deficiency is moderately associated with the frequency of pregnancy (R = 0,214). The rate of pregnancy is also affected by anti-müllerian hormone (R = -0,351). Mature oocytes are obtained in 84.9% of women in the 1^st group and 94% - in the 2^nd group. Patients with hidden iron deficiency received 2.19 ± 1.73 embryos and without ferritin deficiency - 3.2 ± 1.44 embryos. The analysis demonstrated the effect of ferritin levels on the quality of oocytes in the ART protocols. In addition to ferritin levels, an important factor are the levels of AMH and number of antrum-containing follicles, which affect the number of mature oocytes.

Conclusion. Timely correction of hidden iron deficiency will help to increase the number of mature oocytes, to increase the quality and quantity of embryos as well as to prevent pregnancy complications. In preparation for ART, together with assessment of ovary reserve, it is necessary to determine the level of ferritin.

Introduction. Ultrasound (US) diagnostics is used in the diagnosis of chronic pelvic pain (CPP). In difficult cases, magnetic resonance imaging (MRI), computed tomography (CT) with contrast enhancement are used. In modern medicine, there is no standard diagnostic algorithm for СРР and requires development.

Aim. To compare the results of ultrasound and MRI for differentiating diagnosis between minor forms of external endometriosis and for studying chronic inflammatory processes in the reproductive tract of women with chronic pelvis pain (CPP).

Materials and methods. A total of 183 patients of reproductive age with CPP were included in the examination, of which 95 had CCP associated with external endometriosis, and 88 - with chronic inflammatory diseases of the uterus and appendages not in the acute stage. Prior to initiating therapy, all patients underwent ultrasound and MRI examinations. Statistical analysis of the results was performed using Statistica 10 (StatSoft Inc., USA) and MedCalc (version 15.2) software.

Results and discussion. Ultrasound confirmed the presence of endometriosis in 29 (30.52%) women of the main group and in 38 (3.18%) patients of the comparison group. MRI was effective in the main group in 54 examined women (56.84%), in the comparison group - in 41 patients (46.59%). The remaining 12 patients of the main group (12.64%) and 9 women from the comparison group (10.23%) were diagnosed based on laparoscopy performed before the women were included in the study.

Conclusions. If early stages of external endometriosis are suspected in patients with СРР, MRI is justified. Differential diagnosis of small forms of external endometriosis and fibrosis associated with inflammation in MRI is difficult. Additional laboratory tests are required for accurate differential diagnosis.

Despite the close attention of gynecologists, coloproctologists and urologists, the diagnosis and complex treatment of pelvic organ prolapse and associated anatomical and functional disorders remains a relevant and not fully resolved problem, requiring a multidisciplinary approach to its solution. The purpose of this literature review is to analyze and systematize current literature data on modern methods of diagnosis, conservative and surgical treatment used to correct pelvic organ prolapse. This article is intended for specialists who diagnose and correct diseases of the pelvic floor and perianal area. The most relevant and common gynecological, coloproctological and urological problems of pelvic organ prolapse, including rectocele and urinary incontinence, are discussed. Methods of diagnosis and conservative treatment, various options for surgical correction and tactical approaches to their selection, including the use of 3D technologies, are presented. Modern positions on the method of strengthening the pelvic floor using mesh implants installed through the vagina (MESH technology) are discussed. Particular attention is paid to the points of interaction between related specialists specializing in the treatment of various pelvic floor systems, and the need for their joint participation in the treatment and diagnostic process to exchange experience and improve the quality of medical care. Only a comprehensive multidisciplinary approach can improve the results of surgical treatment of pelvic organ prolapse, reduce the risk of intraoperative complications, long-term unfavorable results and the frequency of disease relapses. The introduction of preoperative personalized 3D modeling, planning and surgical navigation makes it possible to develop optimal tactics for surgical intervention and its implementation taking into account individual topographical features. This will help reduce intraoperative trauma and complications and creates a practical basis for conducting operations within the frame-work of Fast Track technologies.

Introduction. Patients' awareness of dyslipidemia levels and adherence to statin therapy are important for the primary and secondary prevention of acute coronary syndrome.

Aim. To study the awareness of patients with acute coronary syndrome about their total cholesterol blood levels, severity of dyslipidemia, and features of statin therapy.

Materials and methods. The study included 304 patients with acute coronary syndrome. Clinical and demographic data, patients' awareness of total cholesterol blood levels, frequency of statin intake, adherence to therapy, low-density lipoprotein cholesterol blood levels were evaluated. Statistical analysis was performed in IBM SPSS Statistica 23.0.

Results. Total cholesterol blood levels were known to 128 patients with acute coronary syndrome out of 304 (42%); awareness was higher among patients with a history of myocardial infarction (68%) compared to those hospitalized for acute coronary syndrome for the first time (31%) (p < 0.05). Low-density lipoprotein cholesterol levels £ 1.4 mmol/L were present in 286 (94%) patients. Statins were taken by 96 (32%) patients; 20% of patient hospitalized for the first time for acute coronary syndrome were taking statins, compared to 59% with a recurrent event (p < 0.05). Patients aged 75 years and older were taking statins in 56% of cases, patients younger than 75 years - in 24.4% (p < 0.05). 68% of patients previously taking statins were adherent to therapy, but 92% of them did not achieve the target low-density lipoprotein cholesterol levels.

Conclusion. Awareness of total cholesterol blood levels was 42% among patients with acute coronary syndrome, with higher awareness among patients with a recurrent event compared to those hospitalized for the first time. Statins were taken by one-third of patients with acute coronary syndrome, more often in patients with a recurrent event compared to those hospitalized for the first time; adherence to therapy was 68% among patients taking statins. Even in statin-adherent patients with acute coronary syndrome, there was insufficient low-density lipoprotein cholesterol levels reduction according to current guidelines. The results confirm the need for further development and implementation of educational programs for patients at all stages of medical care.

At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. There are two hypotheses regarding the possibility of chronic periodontal infection to contribute to the development of systemic inflammation: 1) changes in the microbiocenosis of the oral cavity and periodontal inflammation lead to an increase in bacterial translocation into the systemic bloodstream, causing the circulation of inflammatory mediators and immune complexes to other organs and systems of the body; 2) changes in the microbiocenosis of the oral cavity can lead to disturbances and changes in the intestinal microbiome due to oral intake of periodontopathic organisms. The relationship between periodontal diseases and respiratory diseases has been less studied. We searched the Pubmed and Scopus databases for articles published up to January 31, 2024, that addressed this relationship. The proximity and continuity of the oral cavity and respiratory tract allows the oral microbiome to be a major determinant of the pulmonary microbiome. It is possible to distinguish 2 main ways of translocation of periodontal bacteria into the lungs - aerogenic and aspiration. The data presented in the review suggest a probable bidirectional relationship between periodontal diseases and hospital-acquired pneumonia, the new coronavirus infection COVID-19, and COPD. The relationship between periodontal pathology and BA can be considered possible, but in a number of studies this relationship has not been confirmed, which requires further study. The connection between periodontal diseases and community-acquired pneumonia has practically not been studied, but it is possible, taking into account the direct interaction of the oral microbiota and the microbiota along the mouth-lung axis, and indirectly along the mouth-intestinal-lung axis. Non-surgical periodontal treatment is likely effective in the treatment and prevention of respiratory diseases. The data presented in the review indicate the importance of periodontal health and the need for the prevention and treatment of periodontitis pathology in pulmonary patients.