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

As is known, the new coronavirus infection (NCI) COVID-19 is accompanied by coagulopathy, for the treatment of which heparins are widely used that can cause heparin-induced thrombocytopenia type 2 (HIT), complicated by paradoxical thrombosis. A considerable number of cases of sudden thrombosis after vaccination with Pfizer, Moderna, and Oxford–AstraZeneca vaccines was also described, caused by vaccine-induced “spontaneous HIT syndrome”. An analysis of the medical histories of hospitalized COVID-19 patients (a total of 3,455), showed an 8-fold increase in the frequency of severe thrombocytopenia (<100 × 109/l), compared with patients of the pre-Covid period, and approximately 25% of them can be attributed to the manifestation of HIT. The use of the original Rule of express HIT-diagnostics in the pre-Covid period (“100–5–100”) and the original Algorithm for HIT-treatment (includes the transition to the use of Fondaparinux and succinate-containing drugs), as shown by an earlier our study, made it possible to reduce the frequency of severe thrombotic complications and significantly improve the results of treatment in non-infectious patients. These Rule and Algorithm have been applied in patients with NCI since 2021. The use of these principles partly explains the 3-times decrease of in-hospital mortality in 2021, compared with 2020 (from 18.0% to 6.7%), that coincides with an increase in the use of Fondaparinux and succinate-containing preparations in hospital. Thus, the application of the described Rule and Algorithm in the treatment of patients with NCI COVID-19 increases the effectiveness of treatment and reduces hospital mortality.

Introduction. The traditional method of cardiac rehabilitation (CR) recommends continuing physical training at home, but many patients do not follow these instructions and the effectiveness of the rehabilitation program decreases. Thanks to the use of telemedicine technologies, the doctor can remotely monitor the patient’s condition, ensuring the safety and effectiveness of training. Aim. To test the method of organizing telemedicine support for CR of patients who have suffered a myocardial infarction.

Materials and methods. During the study, 27 patients underwent CR with telemedicine support, and 26 patients underwent traditional CR. To assess the effectiveness of using telemedicine technologies in CR, the results of the six-minute walk test under the control of an electrocardiogram were assessed using the Accordix telemedicine system (Neurosoft LLC, Ivanovo) before and after the rehabilitation program.

Results. After the end of the CR, in the group of patients with telemedicine support, during the six-minute walk test, reliable indicators of an increase in the distance covered were revealed compared to the results of patients in the control group (72 [52; 99.5] m vs. 45 [0.75; 51] m, p < 0.05), restoration of tolerance to physical activity (the ratio of the distance covered to the expected 15 [11.5; 18.5]% vs. 3 [-1.75; 8.75]%, p < 0.05), as well as an increase in the time the pulse stays in the training corridor (15% vs. 0.04%, p < 0.05). Also, in patients in the telemedicine CR group, the number of workouts was significantly higher (14.5 [12.5; 17] vs. 8.5 [4.5; 11.5], p < 0.05).

Conclusion. The presented method of conducting CR using telemedicine technologies has shown greater efficiency compared to the traditional approach. Changes recorded using ECG are analyzed by the telemedicine system, ensuring control and safety of physical activity. The use of telemedicine technologies allows the patient to reduce the fear of repeated myocardial infarction and increase adherence to CR.

In patients suffering from recurrent syncope and after excluding other possible causes, it is recommended to conduct a longterm passive orthostatic test (tilt test) to document vasovagal disorders. The cardioinhibitory variant is confirmed if fainting occurs when there is a pause on the electrocardiogram. The article contains two clinical examples of the development of syncope with prolonged orthostasis. Patients reported a history of episodes of syncopal states. A long-term passive orthostatic test is a diagnostic method that allows differential diagnosis of syncopal conditions in patients. At the stage of diagnostic examination, both patients underwent computed tomography of the head, echocardiography, daily monitoring of ECG and blood pressure, electroencephalography. All indicators of laboratory and instrumental diagnostic methods in patients were within the normal range. In order to further verify the diagnosis, a long-term passive orthostatic test (tilt test) was prescribed in the department of functional diagnostics of the medical diagnostic center. In both cases, the samples were conducted according to the Westminster Protocol. As a result, syncopal conditions were induced with the development of neuroreflective syncope of the cardioinhibitory type with asystole (1 clinical case) and the development of a cardioinhibitory variant of syncope without asystole (2 clinical case), which were accompanied by convulsive syndrome. Thus, tilt test is used to create prolonged passive stress, which allows to identify the presence of autonomous factors that cause neuroreflective fainting in patients. The demonstrated clinical examples show variants of the development of a cardioinhibitory type of syncope during a tilt test. A positive result is determined by the appearance of clinical signs of presyncope or the development of syncope caused by a decrease in blood pressure and / or heart rate. This technique is indicated in patients with a high probability of a positive tilt test result.

Introduction. Due to the negative trend of growth of cardiovascular and endocrine diseases among young people, the need to study the genes involved in the development of metabolic disorders is becoming urgent.

Aim. To study the prevalence of variants of genes CSK, MTHFR, ACE, ADRA2B, TCF7L2 and their association with metabolic syndrome in indigenous and non-indigenous men and women living in the Khanty-Mansiysk autonomous okrug – Yugra. Materials and methods. The study involved 863 people living in the city of Surgut and in the Surgut district of the KhantyMansiysk autonomous okrug – Yugra aged 18 to 44 years. The indigenous population (280 people) is represented by 76 men and 204 women, the non–indigenous population (583 people) is represented by 207 men and 376 women. The DNA of genes CSK, ACE, ADRA2B, MTHFR and TCF7L2 was isolated by polymerase chain reaction.

Results. It was found that among indigenous (khanty) and non-indigenous men and women there are some differences in the prevalence of alleles and genotypes of gene variants in comparison with the international GnomAD database (v.3.1), which is associated with the peculiarities of ethnic composition and environment. The association of the rs1799752 variant of the gene ACE with metabolic syndrome was found in non-indigenous people: in women with the genotype ID (p = 0.027), in men with the genotype DD (p = 0.019).

Conclusion. Thus, there were no statistically significant differences between indigenous and non-indigenous residents in the frequency of alleles and genotypes of variants rs1378942 of the gene CSK, rs1801133 of the gene MTHFR, rs1799752 of the gene ACE, rs28365031 of the gene ADRA2B and rs7903146 of the gene TCF7L2. In the group of non-indigenous residents, the presence of metabolic syndrome is more often associated with the carrier variant rs1799752 of the gene ACE. The research results can be used to develop individual approaches to treatment and prevention that take into account the genetic characteristics of each person.

In the recent years timely identification and management of cognitive and psychoemotional disorders in patients with the most common chronic non-communicable diseases has acquired special importance. Arterial hypertension (AH) is the most significant factor for the development and progression of cognitive and psychoemotional disorders. The development of AH in young and middle-aged adults is a particularly unfavourable prognostic fact. A search is currently underway for therapeutic neuroprotective strategies that can effectively prevent or reduce the damaging pathophysiological effects of hypertension on the brain. For over almost 30 years of active clinical use of the original ethylmethylhydroxypyridine succinate (EMHPS) the enormous clinical experience and evidence of therapeutic benefits in patients with various types of vascular and metabolic disorders have been accumulated. The principal pharmacological effects of EMHPS are antioxidant, antihypoxic, and membrane-protective, due to which the drug produces nootropic, anxiolytic, vegetative-stabilizing and other clinical effects. The favourable effect of EMHPS on the blood vessel wall, endothelial function and rheological properties has also been confirmed, which presents an important component of the complex therapy of a modern patient with AH. The international multicenter, randomized, double-blind and placebo-controlled study MEMO and its subanalysis showed that EMHPS is significantly effective in improving cognitive functions, anxiety and asthenia levels and patient’s quality of life during the long-term sequential therapy in patients with concomitant hypertension.

Arterial hypertension (AH) is one of the significant problems of modern medicine, as the number of patients with this nosology is increasing catastrophically. The frequency of the combination of AH and anxiety is 38%. New data on the role of anxiety in the pathogenesis of AH will probably allow changing the strategies of long-term therapy and prevention in their comorbidity. It is necessary to more widely implement screening tests, cognitive-behavioral non-drug techniques, teach patients relaxation practices, a healthy lifestyle with limitation or complete exclusion of risk factors such as smoking and alcohol. At the same time, drug strategies should not be underestimated, as other methods begin to work quite slowly, a quick result is often needed, which can increase both adherence to basic therapy of AH and increase the effectiveness of non-drug methods. For patients with AH, a faster anxiolytic pharmacological response is important, without the development of withdrawal syndrome, the absence of competitive antagonism with basic drugs, a minimum number of side effects. Benzodiazepines are traditionally used. Given their side effects, among the first-line drugs, the atypical anxiolytic of the benzodiazepine series Tofisopam should be considered. Tofisopam is as effective as diazepam, has significantly fewer side effects and withdrawal symptoms, it increases patients’ adherence to basic therapy, and improves cognitive functions. The anxiolytic effect of the drug is not accompanied by sedative or muscle relaxant effects. At the same time, being a psychovegetative regulator, Tofisopam eliminates various forms of vegetative disorders.

Introduction. Videolaryngoscopy and videolaryngostroboscopy are the “gold standard” for the diagnosis of laryngeal diseases. During a videolaryngoscopy, an anatomical and functional assessment of the state of the larynx is performed. Videolaryngostroboscopy visualizes the vibratory cycle of the vocal folds in order to provide a more detailed functional assessment. Videostrobokymography allows to perform a qualitative and quantitative analysis of the vibratory cycle.

Aim. To evaluate the indicators of videostrobokymography in functional and organic dysphonia.

Materials and methods. 9 patients were examined. In one case, there was no pathology of the larynx. Among the functional disorders, two cases of hypofunctional and one of hyperfunctional dysphonia are presented. Organic diseases: chronic catarrhal laryngitis, Reinke’s edema, vocal fold nodules, vocal fold polyp, vocal fold injury after phonosurgery. Videolaryngoscopy, videolaryngostroboscopy, and videostrobokymography were performed. The strobokimograms were evaluated qualitatively by the presence of periodic oscillations of the vocal folds, phase and amplitude symmetry, mucous wave, the shape of lateral and medial peaks, and the shape of the gap in the opening phase. For the quantitative analysis, the opening quotient (OQ) was determined, which objectively reflected the duration of the opening phase.

Results. Normally, phase and amplitude symmetry were preserved, the mucous wave was visualized, lateral and medial peaks of vibrations were pronounced, the gap in the opening phase was in the shape of a rhomb, OQ was 0.5. Pathological changes included: a decrease in the amplitude of vibrations, an increase or decrease in the mucous wave, phase and amplitude asymmetry, a change in the shape of lateral and medial peaks, a change in the shape of the gap in the opening phase. The OQ index varied from 0.42 to 1 depending on the duration of the opening phase in various diseases of the larynx.

Conclusions. Videostrobokymography makes it possible to assess the indicators of the vibratory cycle in more detail, conduct a graphical analysis, compare the picture at different levels of the glottis, and obtain objective data. The method can be used in the in-depth diagnosis and evaluation of the results of treatment of diseases of the larynx in addition to videolaryngostroboscopy.

Introduction. The main methods of treatment of patients with chronic polyposis rhinosinusitis are surgical and conservative, despite the significant successes achieved in the treatment of the polyposis process, epidemiologic and clinical studies show that there is no complete control of this disease. Taking into account the pros and cons of the above-mentioned methods of treatment, it seems relevant for the scientific community to further search for new methods that will combine high efficacy and low probability of developing undesirable systemic manifestations. One of such methods is targeted biological therapy with the use of monoclonal antibodies.

Aim. To evaluate the efficacy of monoclonal antibodies in the therapy of patients with polyposis rhinosinusitis.

Materials and methods. The authors studied the outpatient records of 102 patients aged 20 to 87 years, in whose therapy monoclonal antibodies (dupilumab, omalizumab, mepolizumab) were used. All patients participating had concomitant pathology in the form of chronic recurrent polyposis rhinosinusitis with the main disease – bronchial asthma. The subjects were divided into 3 groups, in the treatment of which one of the monoclonal antibody preparations was used.

Results and discussion. Regression of the main symptoms of chronic polyposis rhinosinusitis (loss of sense of smell and taste, pain/pressure in the facial area, reduction of runny nose, mucus flowing down the posterior pharyngeal wall, nasal congestion) was observed in each of the 3 groups against the background of therapy with monoclonal antibodies. The effectiveness of the therapy was evaluated according to the results of endoscopic picture (Lund-Kennedy scale), CT picture (Lund-Mackay scale) and the data of subjective questionnaire SNOT-22.

Conclusion. The studied molecules showed efficacy in the therapy of chronic polyposis rhinosinusitis. However, dupilumab was the most preferable molecule, the use of which allows to achieve more pronounced regression of the main clinical symptomatology, to reduce the degree of recurrence of the polyposis process with the absence of the need for repeated surgical interventions, as well as allows to improve the quality of life of patients.

Epidemiological studies indicate that chronic inflammation of the middle ear is one of the most common diseases in the field of otorhinolaryngology and accounts for up to 30% of all patients with diseases of the hearing organ. Among the many factors contributing to the occurrence of inflammatory ear diseases, upper respiratory tract infections, allergic reactions and/ or anatomical features play a special role. An analysis of the literature data showed that properly selected therapy, rational administration of antibacterial drugs, as well as prevention will significantly reduce the frequency of relapses of the disease and prevent the development of hearing loss. This material presents a clinical case, which shows that an important aspect of treatment is an individual approach to each patient, taking into account his age, general health and predisposition to infectious diseases. An integrated approach to the treatment and prevention of recurrent acute otitis media can significantly improve the patient’s quality of life, as well as reduce the burden of the disease on the health care system. The use of topical complex remedies for otitis media helps to reduce the chances of prescribing systemic antibiotics. The use is justified, among other things, in the moderate course of otitis media as part of complex treatment, since in the initial days of the disease such patients have a pronounced pain syndrome, which can be effectively stopped due to the synergistic action of an anesthetic (lidocaine 2%) and a glucocorticosteroid (beclomethasone). Patients note a significant improvement in their condition already in the first days of treatment, good tolerability, absence of unpleasant sensations or allergic reactions during use, while reducing the risks of potentiating the development of antibiotic resistance.

Experimental, clinical, and epidemiological data suggest a strong connection between chronic liver disease and cardiovascular disease (CVD). Oxidative and nitrosative stress is a major pathogenetic mechanism shared between the two groups of diseases, which is the rationale behind the use of antioxidants in patients with comorbidities. This review presents a pharmacological profile and summarizes the evidence for the effectiveness and safety of morpholinium tiazotate, an antioxidant, endotheliumprotective, and antihypoxic agent, in patients with liver diseases, CVD, and combinations thereof. In vitro, morpholinium tiazotate scavenges reactive oxygen and nitrogen species, slows down the use of endogenous antioxidants, inhibits pro-inflammatory macrophage polarization and cell apoptosis. Experimental studies have found this drug to stabilize the nitroxidergic system and improve NO bioavailability to a greater extent than direct NO donors, and increase the effectiveness of energy production in ischemia via stimulating glycolysis and citric acid cycle, sustaining aerobic cellular respiration, and inhibiting fatty acid β-oxidation. The compound’s pleiotropic effects include the decrease in atherogenic serum lipid fraction levels, local and systemic inflammation, maintenance of cell membrane integrity, and desensitization of myocardial β adrenergic receptors to catecholamines. Clinical trials in CVD patients evidence that morpholinium tiazotate improves the electroand echocardiographic parameters, decreases the number and duration of ischemic episodes, frequency of cardiac arrhythmias, need for nitrate use, and physical exercise tolerance. In subjects with liver disease (non-alcoholic fatty liver disease, alcoholic liver disease), the drug reduces the symptoms of asthenia, decreases serum levels of cytolysis and cholestasis biomarkers, fatty liver index, and quantitative cardiovascular risk predictors. Current evidence supports the use of morpholinium tiazotate for the treatment of patients with non-alcoholic fatty liver disease and cardiovascular comorbidities.

The course of Gastroesophageal reflux disease (GERD), which is a widespread disease, is aggravated by a combination with other diseases, including functional pathology of the gastrointestinal tract, for example, functional dyspepsia or irritable bowel syndrome (IBS). This combination affects not only the clinical features of the disease, but also the effectiveness of GERD therapy, when there are cases of incomplete response to proton pump inhibitors (PPIs). And the doctor is faced with the choice of drugs for the complex treatment of GERD. For example, in the case of a combination of GERD and IBS in complex therapy, it is necessary to consider the use of antispasmodics or normokinetics. On the other hand, when prescribing this or that PPI, it is important to remember that these drugs themselves can affect the treatment response in patients with a combination of GERD and IBS, especially with diarrheal or mixed variants, since some patients may have a reaction to additional PPI components that are necessary for improvement bioavailability of the drug. Thus, the presence of sorbitol, mannitol, and lactose can aggravate the course of IBS, increasing the manifestations of diarrhea. The absence of these additives in the pantoprazole drug allows it to be prescribed for the correction of GERD in combination with IBS, regardless of the variant of the latter. This article will present a clinical example of a patient with a combined course of GERD and IBS, the mutually aggravating influence of both diseases not only from the point of view of patho genetic mechanisms, but also the influence of PPI pharmacotherapy, which is especially important in IBS with diarrhea. Approaches to therapy are considered, primarily the prescription of antisecretory therapy using pantoprazole as an example.

The article presents the main aspects of pharmacotherapy of patients with chronic gastrointestinal (GI) diseases. The overall goal of our research was to confirm the current paradigm, under which the remission of diseases is achieved by using pharmacotherapy and maintained with minimum doses of drugs. The achievement of this goal is considered on the example of gastroesophageal reflux disease (GERD). A total of 140 patients were randomly selected and divided into three groups: Group 1 (60 patients with acid-dependent variant (ADV) of the disease) received PPIs at medium therapeutic doses for 8 weeks. It took on average 4 weeks of treatment to relieve clinical symptoms and 8 weeks of treatment to reverse morpho-endoscopic lesions on the esophageal mucosa. During the 36-week follow-up period without maintenance therapy, 5 patients (8.3%) remained in remission, while 55 patients (91.7%) had clinical and morphological exacerbations. Group 2 (60 patients with acid-independent variant (AIV)) received rebamipide (Rebagit) at a daily dose of 300 mg for 8 weeks. It took on average 4 weeks to relieve clinical symptoms and 8 weeks to reverse morpho-endoscopic lesions on the esophageal mucosa. During the 48-week follow-up period without maintenance therapy, 6 patients (10%) remained in remission, while 90% of patients had exacerbations. Without pharmacological support, exacerbation was observed in the majority of patients (91.7%) within 48 weeks. Therefore, the prescription of maintenance therapy was required. In Group 3, 10 patients with ADV received omeprazole at a dose of 10 mg per day for 8 weeks after completing the main therapy course; 10 patients with AIV received rebamipide at a dose of 100 mg per day within the same period. During the long-term (48 weeks) follow-up period, the disease exacerbation was identified only in a third of patients with both ADV and AID GERD, and it only manifested as clinical symptoms of the disease without morpho-endoscopic lesions on the esophageal mucosa. Most patients remained in stable remission.

In recent years, the study of the course and outcomes of pregnancy in the presence of type 2 diabetes mellitus (DM) has attracted more attention from researchers. Type 2 diabetes mellitus most often develops in adults, but in recent years it has often occurred in young women planning a pregnancy. Type 2 DM in the mother is associated with pregnancy complications and an increase in adverse outcomes for both the woman and the newborn. Short-term complications include macrosomia, respiratory distress syndrome, neonatal hypoglycemia, congenital fetal malformations, and in the long term, both the mother and the child have a high risk of metabolic diseases. The results of scientific studies confirm that type 2 diabetes, especially in the context of obesity, is closely associated with pregnancy complications: early and late threatened miscarriage, arterial hypertension, moderate and severe preeclampsia, premature detachment of a normally located placenta, placental insufficiency, diabetic fetopathy and intrauterine fetal death, premature birth and low Apgar score of the newborn. Prevention of the development of adverse outcomes for both mother and child in type 2 diabetes is careful pregnancy planning against the background of normoglycemia and achieving target glucose values throughout pregnancy. Self-monitoring of blood glucose is widely used in diabetes of any type to correct treatment, while an important aspect of self-monitoring of glycemia is the correct choice of a glucometer, which reduces the likelihood of errors. One of the accurate and convenient modern glucometers, used including in pregnant women with diabetes of any type, is Contour®Plus ONE. A clinical case of the course and outcomes of pregnancy in a patient with type 2 diabetes is presented.

Diagnosis and differential diagnosis of hypoglycemia syndrome may present some difficulties for general practitioners. Clinical manifestations of hypoglycemia are weakness, tachycardia, tremor, sweating, impaired consciousness up to coma. Symptoms of hypoglycemic conditions at the beginning of their development are often nonspecific, the severity of their manifestations is lost with frequent recurrence. It is important to note that hypoglycemia is a life-threatening condition requiring treatment. Hypoglycemia can be caused by taking hypoglycemic drugs, exacerbation of chronic adrenal insufficiency, or increased secretion of insulin by a tumor – insulinoma. Iatrogenic hypoglycemia in patients with diabetes mellitus is recognized by patients quite quickly, since patients regularly monitor glycemic levels. Hypoglycemia in adrenal insufficiency usually occurs in the early morning hours. In insulinoma, hypoglycemia may develop at any time of the day, since it is associated with spontaneous or provoked secretion of large amounts of insulin by the tumor. The size of the insulinoma may be small, which complicates confirmation of the diagnosis by visualization. Also, insulinoma may occur as one of the manifestations of the syndrome of multiple endocrine neoplasia – in this case, it is necessary to assess the function of the parathyroid glands and pituitary gland. The article presents a clinical case of multiple recurrent insulinoma in a young patient. This clinical observation is of particular interest, since it presents the process of primary diagnostics of insulinoma, as well as postoperative dynamic observation of the patient, during which a relapse of the neoplasm was detected. As part of the preoperative preparation, therapy with short-acting somatostatin analogues was prescribed, after which repeated surgical treatment was performed.

Metformin, as a unique first-line antidiabetic drug, it may also be effective in the treatment of obesity and related metabolic disorders. In meta-analyses and numerous RCTs in obese persons with and without type 2 diabetes mellitus with metformin, a decrease in weight and fat mass (≈ 3 kg), as well as blood lipids and adiponectin was noted. Mechanisms of metformin action for weight loss, dependent and independent of AMP-activated protein kinase (AMPK): enhancement of mitochondrial biogenesis, reduction of fatty acid uptake, due to suppression of transforming growth factor-β1 (TGF-β1)/Smad3 signaling, modulation of the gut microbiota and regulation of a number of other signals – fructose-1.6-biphosphatase 1 (FBP1), protein phosphatase 2 (PP2A), fibroblast growth factor 21 (FG F21), sirtuin 1 (SIRT1), target of rapamycin (mTOR), etc., reduction of lipogenic gene expression, which leads to decrease in energy intake. However, there is conflicting evidence that metformin has little effect on weight loss, energy intake, and body composition – its effect varies depending on gender, age, duration of treatment, does not necessarily persist after treatment is stopped, does not significantly affect body composition. Metformin worldwide and in the Russian Federation has not yet been included in list of medications for the treatment of obesity. Comprehensive, adequately powered studies with longer treatment durations are needed to further evaluate the efficacy and safety of metformin for weight loss and weight gain control.

Introduction. Metabolic-associated fatty liver disease (MAFLD) is a common disease that has a pathogenesis-based relationship with type 2 diabetes (T2D).

Aim. To determine the levels of TXNIP protein in patients with MAFLD and T2D who were on metformin monotherapy, to compare these levels with the findings of MRI of the liver, and to assess changes in TXNIP protein levels six months after starting treatment with glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors.

Materials and methods. The study included 49 patients (34 female and 15 male) with T2D and MAFLD, aged 55 ± 8 years, who were followed up at the outpatient clinic of Almazov National Medical Research Centre (St. Petersburg) from January 2023 to March 2024. The eligibility criteria included BMI values of 25–40 kg/m² and a glycated hemoglobin level not exceeding 9.5%. Results. The study showed that serum TXNIP protein levels were positively correlated with the severity of MAFLD assessed based on MRI findings. Furthermore, TXNIP levels significantly decreased as a result of therapy with GLP-1RAs and SGLT-2 inhibitors.

Conclusion. These correlation data suggest that the TXNIP level could be used as a promising diagnostic marker in patients with MAFLD and T2D, both at the stage of diagnostic evaluation and when considering the outcomes of ongoing therapy.

Diabetes mellitus poses a significant threat to the health and lives of people worldwide. Consequently, the timely identification of individuals at risk and the prevention of disease development are of utmost importance. Increasing physical activity, reducing body weight, and quitting smoking are effective measures for preventing type 2 diabetes. When lifestyle modifications are insufficient, pharmacological glucose-lowering therapy is prescribed. The endocrinologist’s arsenal is dominated by drugs that have a predominant effect on hyperglycemia. Metformin is the 1st line of therapy for disorders of carbohydrate metabolism. It is known that insulin resistance is the main cause of the development and progression of complications of diabetes mellitus. Correction of insulin resistance looks like a promising drug tactic. However, the choice of a drug for these purposes is currently limited. Currently, new, promising drugs are being developed that can increase tissue sensitivity to insulin. Subetta is an original insulin sensitizer that helps to enhance insulin-dependent glucose metabolism. This is a complex drug that increases the sensitivity of tissues to insulin, and normalizes the function of the vascular endothelium, as well as helps to increase the level of adiponectin. A decrease in glycemic parameters, a reduction of the insulin resistance index (HOMA-index) and weight stabilization has been shown in the clinical studies. All-Russian observational non-interventional study is planned to assess the effectiveness of Subetta in real-world clinical practice for patients with prediabetes or type 2 diabetes (SILA). The study includes data from 2,500 patients approximately over the age of 18. The findings of this programme enable a comprehensive evaluation of the effectiveness of combined glucose-lowering therapy in conjunction with Subetta, based on the dynamic assessment of both clinical and laboratory parameters, as well as quality of life questionnaires.

Gout is characterised by high comorbidity. Cardiovascular pathology and associated disorders of lipid and carbohydrate metabolism, as well as kidney damage are among the most frequent companions of gout, often significantly worsening the “quality” and limiting the life expectancy of the patient. Experimental and epidemiological data indicate that hyperuricemia, characteristic of gout, can have a pathogenetic influence on the formation of components of the metabolic syndrome. The report presents a clinical case of gout that debuted in a man aged 36 years. The patient had arterial hypertension, widespread atherosclerosis, prediabetes, obesity, dyslipidaemia, and non-alcoholic fatty liver disease. Due to renal damage, the patient with a uric acid level of 713 μmol/l was prescribed febuxostat at a dose of 80 mg/day, which was increased to 120 mg/day after 4 weeks in the absence of achieving the target level of uricemia. One year later, complex therapy including original febuxostat provided improvement of renal functional status and a stable tendency to normalisation of liver function (regression of cytolysis, cholestasis syndromes and improvement of elastogram parameters). Against the background of febuxostat therapy there was a decrease in the severity of insulin resistance (reduction of NOMA index from 4.2 to 2.8) and improvement of carbohydrate metabolism (reduction of fasting glycaemia from 6.7 to 5.9 mmol/l, glycosylated haemoglobin from 6.4 to 5.7%). Probably, febuxostat in the presented clinical case contributed to potentiation of hypolipidemic effects of statins (rosuvastatin), which is consistent with the literature data. The triglyceride level underwent especially expressive dynamics during the follow-up (decrease from 3.07 to 0.93 mmol/l). Recent literature data and the presented clinical observation indicate that febuxostat, along with having a strong urates-lowering potential with a favourable safety profile, is able to exert a pleiotropic positive effect on the metabolic disorders inherent in gout.

Introduction. In the structure of urgent gynecological practice, ovarian torsion ranks fifth, which is usually diagnosed in women of reproductive age. To date, there is no single standard for assessing the viability of the ovary and choosing a conservative or radical operation for patients with ovarian torsion, in this regard, there is a need to search for potential predictors that determine the validity of the choice of the volume of surgical intervention.

Aim. To optimize management tactics for patients with uterine torsion.

Materials and methods. In a retrospective study, an analysis of 55 case histories of patients admitted to a gynecological hospital with a diagnosis of ovarian torsion was carried out. Depending on the organ-preserving and organ-removing surgical treatment, the patients were divided into two groups. The analysis of the studied indicators was carried out using correlation, regression, factor and ROC analysis.

Results. The results of the study demonstrated that only a visual assessment of the state of the ovarian torsion to unjustified organ-removing interventions in 57.1% of patients. Based on correlation, factor, regression and ROC analysis, diagnostically significant predictors determining the volume of surgical intervention were determined.

Conclusions. Based on the retrospective analysis, an algorithm for managing patients with ovarian torsion was developed: at stages A and B according to the clinical classification of ovarian torsion damage, regardless of the studied criteria, organpreserving treatment – detorsion must be performed; at stage C, special attention is paid to D-dimer values: at D-dimer <1450 ng/ml – detorsion, and only at D-dimer >1490 ng/ml – organ-preserving surgery.

Introduction. The continuum and pregnancy outcomes in adolescent girls and women of reproductive age, differences between them are partly predetermined by pregestational factors, in particular body mass characteristics. Today, the key role is assigned to the age at menarche, which indicates the achievement of mature reproductive function.

Aim. To identify and compare the relationship between the age at menarche combined with the pregestational body mass index (BMI) and the adverse reproductive outcome (ARO) variant in women of reproductive age and adolescent girls.

Materials and methods. At total of 967 women with ARO were enrolled in the prospective cohort multicenter study. The patients were divided into cohorts based on their age groups (adolescent girls (n = 182) or women of reproductive age (n = 785)) and the ARO variants. Four groups of women were identified: women with non-developing pregnancy (NDP) (n = 244), women with extrauterine pregnancy (EP) (n = 115), women with spontaneous miscarriage (SM) (n = 299), and women with preterm birth (PB) (n = 309).

Results and discussion. It was found that a later ARO corresponds to a higher BMI: a more probable BMI for SM is over 23, for NDP is 23 and less; for PB is over 25, for SM is 25 and less. No threshold BMI limit distinguishing between EP and NDP was identified. The BMI for adolescent girls is generally significantly lower than the BMI for women of reproductive age; it is significantly higher in EP as compared with women of reproductive age and comparable in SM. A trend towards a higher BMI in SM compared to NDP both in women of reproductive age with BMI over 24 and in adolescent girls with BMI over 20 but with different threshold limits is shown. The threshold BMI limit distinguishing PB from SM in reproductive age is 25 and higher, and in adolescent girls it does not reach 23.

Conclusion. In clinical practice, it is recommended to use navigators for predicting ARO variants based on pregestational BMI and/or age at menarche, taking into account the age group of patients, which are obtained using classification trees.

The problem of the growing elderly population, called the “silver tsunami”, is becoming increasingly important for modern society, including healthcare. Increasing women’s life expectancy makes it a national priority to consider improving women’s quality of life and active healthy longevity. GSM (Genitourinary Menopausal Syndrome), which is primarily a consequence of estrogen deficiency in periand postmenopausal patients and is characterized by changes in the genitourinary organs, is underdiagnosed.

The most common complaints are vaginal dryness, irritation, and dyspareunia. One of the components of GSM is urinary tract infections (UTIs), which tend to recur. Approximately 53% of women aged about 55 years report a relapse within one year. Recurrent UTIs negatively affect the quality of life of patients and are the reason for prescribing repeated courses of antibacterial therapy, which is accompanied by a change in the drug resistance of microorganisms. The pathogenesis of UTIs is associated with ascending infection by uropathogenic microorganisms, most often Escherichia coli, against the background of estrogendeficient changes in the epithelium and impaired microbiocenosis of the urogenital zone. Inadequacy of the urothelium and the lack of lactobacilli capable of direct and indirect inhibition of the growth of pathogenic microorganisms lead to colonization of the urinary tract with uropathogens and recurrence of UTIs. Consequently, the use of a vaginal combination of estriol and lactobacilli in the form of long-term intermittent maintenance treatment in order to maintain effectiveness and prevent relapses becomes pathogenetically justified. This combination contains a minimal effective dose of estriol (0.03 mg) with negligible systemic absorption and has a low level of adverse events, which ensures safety and high patient adherence to therapy. However, further clinical studies of the combination of estriol with lactobacilli in postmenopausal patients with recurrent urinary tract infections are needed to improve the efficacy of therapy.

Introduction. Methylethylpyridinol (MEPD or Emoxypine) is widely used in practice to treat various eye diseases, exhibiting angioprotective, antiplatelet, antioxidant effects. The molecular mechanisms for the implementation of these and other pharmacological effects of MEPD are not entirely obvious.

Aim. To conduct a chemoreactome analysis of MEPD aimed at identifying the molecular mechanisms of the drug action. Materials and methods. The pharmacological/biological properties of MEPD were assessed using methods for chemoinformatic analysis of molecules developed in the scientific school of RAS academicians Yu.I. Zhuravlev and K.V. The analysis procedure is based on the latest machine learning technologies developed in the theory of topological and metric analysis of feature descriptions in application to chemographs.

Results and discussion. The results of chemoproteomic profiling of MEPD showed anti-inflammatory, antihypoxic, antioxidant, vasoprotective and vasorelaxant effects of the drug. By inhibiting arachidonate-5-lipoxygenase, leukotriene A4 hydrolase, leu kotriene LTB4 and prostanoid receptors, inhibiting the production of superoxide anions and leukotriene, MEPD helps to reduce local inflammation in eye tissues. Evaluations of the vasodynamic and neuroprotective effects of MEPD in vitro, obtained as a result of chemoreactome analysis, indicated neurotrophic, neuroprotective and vasodilatory effects of MEPD. The neurotrophic effect in vitro in cultured sensory neurons and neuroprotective activity, assessed by the protective effect against L-homocysteine, exceeded the activity of control molecules. The analysis demonstrated the vasodilatory activity of MEPD and the reduction of intraocular pressure in vivo.

Conclusions. Based on the results of the chemoreactome analysis, new molecular mechanisms of the anti-inflammatory action of MEPD in eye tissues were proposed, carried out through the inhibition of certain target proteins. The antioxidant properties of MEPD can be associated with both specific interactions with proteome proteins (e.g., activation of antioxidant proteins) and with the direct action of the molecule on reactive oxygen species.

Psoriasis vulgaris (VP) occupies a leading place among all forms of psoriasis. The difficulty of treating the psoriatic process is associated with damage to the skin of the scalp, genitals, fold areas and nail apparatus. Finding an effective treatment for psoriasis in these difficult areas is an urgent task of modern dermatology. To evaluate the effectiveness of treatment of psoriasis vulgaris of the scalp using a solution containing a combination of glucocorticosteroid and salicylic acid. This article presents three clinical cases from the practice of a dermatovenerologist. Patients with vulgar psoriasis, predominantly affecting the scalp, were prescribed an Akriderm SK solution containing 0.05% betamethasone and 2% salicylic acid 2 times a day for 3 weeks in topical monotherapy or in combination with systemic therapy. As a result of the therapy, after 14 days, resolution of psoriatic plaques on the scalp was noted; after 21 days of treatment, residual mild erythema was noted, which subjectively did not bother the patients. The article demonstrates the clinical effectiveness of combination topical therapy using salicylic acid and betamethasone in the form of Akriderm SK solution for the treatment of psoriasis vulgaris of the scalp. The combination of these substances in the form of a solution has shown great effectiveness in the treatment of this localization of psoriasis.

Introduction. Systematization of dermatoscopic signs of monomorphic rashes in mastocytosis has important practical significance.

Aim. To carry out an analysis of dermatoscopic patterns of monomorphic eruption in monomorphic maculopapular cutaneous mastocytosis (mMPCM) and indolent systemic mastocytosis (ISM) and compare the results obtained with pathomorphological signs of mastocytosis.

Materials and methods. The study included 6 children aged 4 to 14 years, 27 adolescents and adult aged 15 to 40 years with a monomorphic type of maculopapular cutaneous mastocytosis (MPCM) and 3 patients (minimum age 18 years, maximum – 54 years) with indolent systemic mastocytosis (ISM), who were under observation at Moscow scientific and practical Center of dermatovenereology and cosmetology from 2022 to 2024. Dermatoscopic examination was performed using polarization and immersion dermatoscopy with 20-fold magnification.

Results. The presence of mild vascular signs (punctate vessels) and the absence of a pigment pseudonetwork were the features of monoMPCM in children. In adolescents and adults, pigment network was detected in 77.8%, more often in men. The vascular erythematous component in adults was more intense than in children and was detected in 74.1% of patients. Yellow-brown structureless areas, brown reticular lines (pigment pseudonetwork) are due to hyperpigmentation of the basal cell layer, while the vascular pattern was the result of dilation of vessels in the papillary dermis. With ISM, a pronounced vascular pattern (intense erythematous background and reticular vascular pattern) and the obligatory presence of pseudonetwork were observed. The pathomorphological picture of ISM differed from MPCM by the presence of perivascular lymphomonocytic infiltrates and an insignificant number of eosinophilic granulocytes.

Conclusion. In this study, age-related dermatoscopic features of monomorphic rashes in mastocytosis were systematized for the first time and compared with the pathomorphological signs of MPCM and ISM.

Introduction. Cardiovascular diseases define the pathological landscape of the 21st century. Personal characteristics of patients with cardiovascular diseases who have undergone stenting and bypass surgery are among the main factors in the success of their rehabilitation or, on the contrary, in determining the deterioration of their health. Regarding prevention of postoperative complications, taking into account the personal characteristics of patients is of primary importance. The study compared groups of patients (based on the level of depression) with various forms of cardiovascular diseases: acute coronary syndrome and chronic ischemic heart disease; types of surgical intervention – stenting or bypass surgery.

Aim. To describe and explain the differences in depression levels in patients with different forms of cardiovascular disease who have undergone stenting and bypass surgery.

Materials and methods. The study included 123 patients of both sexes (34–85 years old). The patients were divided into 3 groups: group 1 – 26/123 (21.1%) patients with HIHD who underwent bypass grafting; group 2 – 45/123 (36.6%) patients with HIHD who underwent stenting; group 3 – 52/123 (42.3%) patients with ACS who underwent stenting. The average age of the patients was 61 years ± 6 years. The severity of depression in patients was assessed using the Zung Self-Rating Depression Scale. ANOVA analysis of variance (p < 0,05) was used to compare the mean values of quantitative data.

Results. In Group 1, according to the Zung Depression Self-Rating Scale, the average depression score was 35.5 points; in Group 2, the average depression score was 39.3 points; in Group 3, the average depression score was 42.1 points. There was a statistically significant difference in the severity of the average depression scores between Groups 1 and 3 according to the Scheffe method (p < 0,05).

Conclusion. Patients with ACS who underwent stenting are characterized by a greater tendency to develop depressive disorder than patients with HIHD who underwent bypass. The obtained result indicates greater anxiety in patients with ACS, most probably, due to the unexpected manifestation of symptoms of the disease and an emergency decision to perform surgery.

Introduction. Although the risk of emerging coronavirus infection may seem to have disappeared at first glance, SARS-COV-2 has complex and poorly understood effects on many organ systems, including the nervous system. Disease progression and unfavorable outcome COVID-19 are not only due to lung damage, elderly age, concomitant pathology: hypertension, diabetes mellitus, etc. have a significant impact.

Aim. To study the structure of mortality in a new coronavirus infection COVID-19, caused by delta strain of coronavirus SARS- CoV-2, taking into account the nature of concomitant therapeutic and neurological pathology, the degree of comorbidity, fatal complications, and sex and age characteristics.

Materials and methods. A postmortem analysis of pathological and anatomical conclusions of 209 patients with COVID-19 with comorbid somatic and neurological pathology who received inpatient treatment in covid hospitals of the Republic of Mordovia in 2021 was performed. The severity of the underlying disease, concomitant therapeutic and neurological pathology, and comorbidity were analysed. The coincidence of the final clinical and pathological diagnoses, fatal complications were assessed. The presented data allowed to identify the main factors of unfavourable outcome.

Results and discussion. In unfavourable outcome of the disease, concomitant pathology is represented by hypertension, ischemic heart disease, chronic heart failure, chronic cerebral ischemia. In women, cases of diabetes mellitus and atherosclerosis were more frequent, in men – hypertension and chronic heart failure.

Conclusions. New coronavirus COVID-19 infection associated with delta strain of SARS-COV-2 virus is characterised by severe and extremely severe course in elderly patients with comorbid somatic and neurological pathology.

Introduction. The study of the prevalence of multiple chemical sensitivity (MCS) among young people is a significant medical and social issue. Sensitivity to environmental factors is not only an indicator of functional disorders but also one of the mechanisms negatively affecting health levels, disease development, quality of life, and reduced productivity. Multiple chemical sensitivity (MCS) represents one of the widespread variants of the body’s maladaptation to chemical components in the environment.

Aim. To assess environmental risks to students’ health through a questionnaire.

Materials and methods. Questionnaire survey using QEESI questionnaire of 287 student volunteers 95 males with a mean age of 20.2 ± 1.3 years and 192 females with a mean age of 20.5 ± 1.4 years. Data collection using the developed digital platform “EcoMedic”. Statistical processing was performed using MedCalc statistical programme.

Results. Among all 287 tested individuals, a total of 94 individuals (33.1%) were found to have MHF criteria. In the group of 135 first-year students tested, 39 individuals (28.8%) met the criteria for the diagnosis of MHF. A survey of 152 fourth-year students revealed that 55 (36.1%) met the criteria for the MHF diagnosis. Compared to the group of 1st year students with MHF, 4th year students suffering from MHF had higher intensity of respiratory/mucous membrane symptoms p = 0.0016, cardiac and chest symptoms, p = 0.001, gastrointestinal symptoms p = 0.0001 and cognitive disorders p = 0.0001.

Conclusions. The prevalence of multiple chemical intolerance among students was 33.1%. Worsening MCH symptoms include increased respiratory/mucosal, cardiac/thoracic, gastrointestinal, and cognitive symptoms.

Introduction. Control of edema in obese patients with postmastectomy lymphedema is an important aspect of care for patients undergoing curative treatment for breast cancer. One effective and highly sensitive method for monitoring edema is bioimpedance measurement, which can be a useful tool for assessing tissue and fluid balance in such patients.

Aim. To study the feasibility of using bioimpedance analysis as a method to assess the efficacy of the anti-edema effects of physiotherapeutic treatment methods in patients with secondary lymphedema after mastectomy.

Materials and methods. In this review, a search for sources describing the effectiveness of the bioimpedanceometry method for controlling edema in patients with secondary lymphedema after mastectomy for breast cancer was carried out in several English text databases: PubMed, Scopus, Web of Science, Springer Link, and in the scientific electronic library elibrary.ru.

Results. After mastectomy, approximately 18% of patients undergoing radical treatment for breast cancer experience secondary lymphedema due to impaired lymphatic drainage of the upper extremity on the affected side as a result of lymph node removal. The development of lymphedema of the upper limb is accompanied by a significant decrease in the quality of life of patients and requires constant medical monitoring. Bioimpedansometry allows you to estimate the volume of fluid in the body and determine the presence of edema based on changes in the electrical resistance of tissues. In obese patients with lymphedema following mastectomy, this method may be particularly useful for early detection of subclinical limb lymphedema and evaluation of treatment effectiveness.

Conclusions. Thus, the use of bioimpedance measurements in the practice of oncologists and rehabilitation specialists can significantly facilitate the control of edema in patients with obesity and lymphedema after mastectomy. This method provides objective data on the state of fluid balance and allows the detection of edema in the early stages, which facilitates the earlier start of intensive non-pharmacological interventions to increase the effectiveness of postoperative rehabilitation and improve the quality of life of patients.

Introduction. CYP2D6 is involved in the metabolism of tamsulosin, which is used to treat lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). However, the impact of carrying polymorphic variants of the CYP2D6 gene on the clinical efficacy and safety of tamsulosin therapy is still not well understood.

Aim. To evaluate the impact of CYP2D6 polymorphic variants on steady state concentration of tamsulosin (Css_min), as well as their correlation with the efficacy and safety of therapy in patients with BPH.

Materials and methods. A single-center prospective study included 75 patients who completed all stages of the study. The median age of the patients was 69 years, body mass index was 27.17 ± 4.86 kg/m². 56 patients (74.67%) had comorbidities, which means the presence of at least one chronic disease in addition to the diagnosis of benign prostatic hyperplasia. 26 people (34.67%) were classified as polymorbid patients, i.e. having several comorbidities at once, while 19 patients (25.33%) had no comorbidities except for benign prostatic hyperplasia. Genotyping was performed by real-time polymerase chain reaction. Css_min of tamsulosin was determined by HPLC-MS/MS. Efficacy of therapy was assessed using IPSS score and Qmax. Safety was assessed based on the incidence of adverse reactions.

Results. Carriage of CYP2D6*4 and CYP2D6*10 was found to be associated with statistically significant increases in Cssmin levels. However, the identified pharmacokinetic differences, carriage of CYP2D6 markers was not reflected in the clinical efficacy and safety of tamsulosin.

Conclusion. CYP2D6*4 and CYP2D6*10 may affect the Css_min levels of the tamsulosin, but does not affect the clinical results of treatment.

Granulomatosis with polyangiitis (GPA) is a granulomatous necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies. The clinical picture of GPA is characterized by a wide range of manifestations, including nonspecific symptoms, signs of damage to the upper and lower respiratory tract and glomerulonephritis. The article presents the observation of a patient for 12.5 years, who at the beginning of the disease, along with complaints of malaise, weakness, decreased appetite and weight loss, had a hemorrhagic rash, proteinuria, erythrocyturia, decreased glomerular filtration rate and increased creatinine and urea levels. After a positive result for antineutrophil cytoplasmic antibodies and the results of nephrobiopsy with evidences of glomerulonephritis with the development of glomerulosclerosis and fibrosis of the crescents (pauci-immune variant) with a moderately pronounced tubulointerstitial component, the patient was diagnosed with GPA and immunosuppressive therapy was initiated. Almost 8 years after the manifestation of GPA during continuous pathogenetic therapy, the patient complained of swelling of the left eye and its increase in volume, diplopia. Computed tomography of the head revealed a mass of the left orbit. Morphological examination of the excised mass revealed its inflammatory origin as consequence of vasculitis. The special aspect of the presented case is that ocular and orbital pathologies of GPA developed in the patient 8 years after the initial manifestation of the disease against the background of ongoing immunosuppressive therapy in conditions of laboratory remission of GPA.

Introduction. Today, the traditional model of medical care is being supplemented and partially replaced by new forms of its implementation. Thus, technologies based on artificial intelligence take over the functions of diagnosis, treatment, screening and monitoring of chronic diseases.

Aim. To develop a medical methodology for remote questionnaire screening of chronic kidney disease in young people to optimize their diagnosis.

Materials and methods. The study involved 3,155 students aged 19.6 ± 1.5 years, of whom 46.9% were men and 53.1% were women. During the medical examination, all participants used a remote questionnaire screening.

Results. A low degree of risk was detected in 57.4%, an average in 30.9%, and a high in 11.7% of the subjects. The patients with the highest frequency are concerned about complaints from the endocrine (28.9%), digestive (21.8%), respiratory (21.1%), cardiovascular (20.1%) and oncological alertness (8.1%). The presence of FR in two or more pathology profiles was determined in 75.7% of the examined patients. Among the most common FR are nine related to the self-assessment of the emotional and personal sphere. 96.6% of the surveyed and 91.7% of the medical staff are satisfied with the telemedicine system.

Conclusions. 1. The use of remote questionnaire screening of HCNH provided wide coverage and high satisfaction with medical services. 2. The system allocates a contingent of subjects with high, medium and low risk, as well as people with critical disabilities in need of priority assistance. 3. The combination of data from anamnestic remote examination and clinical examination improves the quality of medical decision-making and reduces its subjective component. 4. The use of statistical methods has shown good effectiveness of the integrated assessment of health and satisfactory for the detection of chronic kidney disease. 5. The use of remote questionnaire screening of HRH in young people reduces treatment costs and improves the quality of life of patients.

The speech function is a human-only feature. It provides communication and serves as the main source of new information in the social environment, both in communication and in training, regardless of gender, age groups and the level of training of medical students. When perceiving speech for students studying in a non-native language, good intelligibility is important, which ensures a correct understanding of words, and therefore the completeness of the information received. Speech audiometry in noise using polysyllabic phrases in students studying in a foreign language can reveal an insufficiently complete understanding of a foreign language, as well as diagnose latent auditory disorders that have arisen against the background of diseases of the hearing organ. In Russia, М. Boboshko et al. developed and widely uses the Russian matrix test (RuMatrix) and there are prospects for using the matrix test in speech audiometry of medical students studying in a foreign language to identify the correct perception of addressed speech. However, ideas about the theories of perception and recognition of foreign speech are changing, it is believed that episodic memory and lexical organization of the cerebral cortex are involved in the process. To understand the level of use of not only sensory but also cognitive resources, it is necessary to assess the possibility of adaptation to the speech source in a natural environment (in noise), which is possible only with speech audiometry of sensitized speech using sentences.

Introduction. There is a growing trend towards increasing the use of epidural analgesia during childbirth. Therefore, it is important to explore the delayed and long-term consequences of its application.

Aim. To investigate the association between conditions such as back pain, headache, incontinence (urinary and fecal), postpartum depression, and the use of epidural anaesthesia, as well as any delays in the development of these conditions and their long-term impact.

Materials and methods. Symptomatic analysis of clinical data, including randomized and non-randomized studies, cohort studies, prospective and retrospective analyses, as well as meta-analyses based on the study of the relationship between anesthesia methods used during childbirth and the development of these symptoms. The search was conducted on platforms such as PubMed, Google Scholar, and eLIBRARY.ru for articles that contained information about long-term conditions developing after epidural anesthesia during childbirth. The study did not include descriptions of individual clinical cases, nor did it include studies that reported effects after epidural anesthesia that were not during childbirth.

Results. A number of studies have been analyzed. Despite some contradictory data, an objective review of the information received suggests that manifestations such as back pain, headaches, urinary and fecal incontinence, pelvic floor dysfunction and postpartum depression do not always correlate with the use of epidural anesthesia. These symptoms do not seem to be related to its long-term or delayed effects. While some effects may occur, these can be better classified as short-term. For example, back pain and urinary retention may be experienced. Additionally, there was no statistically significant evidence to suggest that epidural anesthesia reduces the risk of postpartum depression.

Conclusion. Further clinical studies that adhere to rigorous standards of reliability are needed to provide a more comprehensive understanding of this issue.

Most women of reproductive age (about 80%) experience premenstrual symptoms, which indicate the approaching menstruation and are of little clinical significance, since they do not affect the quality of life. However, some women experience severe physical and/or psychological symptoms before menstruation, which, if left untreated, can lead to a reduced quality of life. The exact etiology and pathogenesis of premenstrual syndrome (PMS) remain unclear. Despite the fact that PMS etiology remains unknown, there are some theories and studies supporting them that inappropriate inflammatory response and oxidative stress may be considered as the causes of occurrence of PMS. Symptoms of premenstrual syndrome can be nonspecific and individual for each specific woman, the diagnosis is made only on the basis of symptoms, pathognomonic hormonal disorders do not exist. Rarely, the symptoms are expressed to an extreme degree and disrupt the ability to work and the rhythm of a woman’s life, then premenstrual dysphoric disorder (PMDD) should be assumed, which is often underestimated, and the patient should be recommended to record her symptoms for ≥2 cycles. Usually, the treatment of premenstrual syndrome involves a combination of various methods in order to determine the most effective in each individual case: treatment includes lifestyle changes, micronutrient support, herbal medicine, pharmacotherapy. Drospirenone-containing combined oral contraceptives are first line for PMS and PMDD. Herbal medicines are used as maintenance therapy. Transdermal estradiol and cyclical gestogens in phase 2 of the menstrual cycle can be used as second line hormonal therapy.