Introduction. The high rate of sudden cardiac death in patients with severe SARS-CoV-2 pneumonia is an urgent problem. Aim. To evaluate the role of acute respiratory distress syndrome in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

Materials and methods. The case-control cohort study included patients (n = 83, mean age 72 ± 19 years) with acute myocardial infarction on the background of SARS-CoV-2-pneumonia and comorbid pathology. Group I (n = 56) – with acute respiratory distress syndrome and without percutaneous coronary intervention (deceased), group II (n = 17) – without acute respiratory distress syndrome and percutaneous coronary intervention (survivors), group III (n = 10) – with acute respiratory distress syndrome and percutaneous coronary intervention (deceased). All patients underwent a comprehensive laboratory examination, electrocardiography, transthoracic echocardiography, computed tomography of the chest, measurement of saturation and oxygenation index. Emergency coronary angiography was performed in 28 patients, followed by thrombectomy and stent insertion into an infarct-related artery. There were a total of 67 deceased patients (11 of them patients with percutaneous coronary intervention). The deceased patients underwent a pathological and morphological examination of the heart.

Results. All deceased patients (n = 66) had acute respiratory distress syndrome and accounted for 79,5% of the total number. The majority had acute non-ST segment elevation myocardial infarction and multivessel lesion, while the surviving patients had acute ST elevation myocardial infarction and single-vessel lesion. The surviving patients who underwent successful percutaneous coronary intervention (thrombextraction followed by stent insertion into an infarct–related artery) had lower markers of inflammation and hypercoagulation. The PaO2/Fi02 level is below 234 mmHg. It proved to be a reliable predictor of an unfavorable outcome. Conclusions. Moderate to severe acute respiratory distress syndrome plays an important role in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

This article discusses the issues in optimizing the treatment of a wide range of patients with cardiovascular-renal-metabolic syndrome (CVRMS), which largely determines the increased risk of cardiovascular disease (CVD) complications in patients with the excess of pathological adipose tissue. Approaches to lowering blood triglyceride levels in clinical practice are considered. The results of the data analysis for subjects of the randomized clinical trials (RCTs) demonstrating the efficacy of fibrate/statin co-administration in the subgroups of patients with metabolic syndrome and type 2 diabetes mellitusare are discussed. The article presents recently obtained data on the results of long-term follow-up of patients in the RCTs evaluating the efficacy of fenofibrate vs placebo, which indicate an improvement in the long-term prognosis after the completion of the RCTs in patients who were initially allocated to the fibrate group. The current approaches to the treatment of patients with hypertriglyceridemia, as one of the important components of CVRMS, are reviewed. The role of fenofibrate and drugs that belong to the class of w-3 polyunsaturated fatty acids in the treatment of hypertriglyceridemia is discussed. The article presents current evidence on the pleiotropic effects of fenofibrate, which may determine the positive effect of its use on vascular wall stiffness. The results of large observational studies revealing association between fenofibrate use and decreased risk of chronic kidney disease progression in patients with type 2 diabetes mellitus are discussed. The data supporting a metabolic memory after discontinuation of fenofibrate use which is manifested as the long-term preservation of positive therapeutic effects on kidney function are provided.

Today, cardiovascular diseases continue to be one of the most pressing medical issues worldwide. Spontaneous coronary artery dissection is a fairly rare cause of acute coronary syndrome that is not associated with atherosclerotic plaque. The relevance of studying this condition is associated with high mortality in the acute period: about 50% of patients die suddenly without receiving medical attention. Clinical precursors of repeated spontaneous coronary artery dissection have not been identified. The clinical observation describes the case of 33-year-old patient who was admitted to the Republican Clinical Multidisciplinary Center for High Medical Technologies in Nalchik for diagnostic coronary angiography. Previously, the patient was observed by a vascular surgeon with a diagnosis of obliterating endarteritis of the lower extremities, as well as with echocardiography, a previous myocardial infarction was detected. At the time of the examination, there were no angina attacks or heart failure symptoms. Coronary angiography revealed extensive dissection of various segments of the anterior descending artery, the diagonal branch, the circumflex artery, and the obtuse edge branch. Taking into account the clinical and anamnestic data and the results of angiography, it was decided to refrain from coronary artery angioplasty and coronary artery bypass grafting. Drug therapy with angiotensin-converting enzyme inhibitors, β-blockers and acetylsalicylic acid was prescribed, since revascularization is indicated for high-risk patients.

β-blockers are a valuable class of antihypertensive drugs, which is confirmed in modern guidelines for the treatment of hypertension. However, β-blockers are not a homogeneous class and differ in their pharmacological and clinical profile. Nebivolol is a representative of the third generation of β-blockers with the highest selectivity, additional vasodilatory and pleiotropic effects, neutral metabolic effects and good tolerability, and has proven its advantages over other β-blockers. The additional vasodilatory effect of nebivolol is mediated by NO-releasing activity with an increase in the bioavailability of NO, which is involved not only in the antihypertensive activity, but also provides important vascular protective effects. Studies demonstrate its effect on oxidative stress, endothelial dysfunction and arterial stiffness, as well as a decrease in central aortic pressure and reflected wave in patients with hypertension. Nebivolol reduces ultrastructural changes in the myocardium and coronary bed, reducing interstitial fibrosis and improving diastolic relaxation of the myocardium. Meta-analyses of clinical trials have noted the high antihypertensive efficacy of nebivolol compared to other β-blockers and other classes of antihypertensive drugs, as evidenced by a lower frequency of discontinuation and switching to other drugs. In large-scale studies of real-world clinical practice on large cohorts of patients with hypertension, nebivolol showed favorable long-term efficacy in terms of impact on cardiovascular outcomes compared to other β-blockers (atenolol, metoprolol). Thus, nebivolol has special pharmacological properties, providing additional vasodilator, antioxidant and anti-ischemic effects, which is of particular interest to certain groups of patients, in whom its good tolerability profile can also improve treatment adherence.

Management of patients with cognitive impairment (CI) is one of the topical problems of modern medicine and is carried out mainly in outpatient practice. Alzheimer’s disease (AD) and cerebrovascular disease (CVD)-induced CI and their combination represent the most common cause of cognitive decline in the elderly. The diagnosis of CVD is based on the results of neuropsychological examination, the presence of neuroimaging signs of CVD and/or AD, and the absence of evidence for other causes of CVD. During a neuropsychological examination of CI caused by cerebral microangiopathy, disorders of executive functions are usually detected: slow mental activity, decreased concentration; in AD, decreased memory for current events (amnestic type of CI). Many patients with AD are observed for a long time with a misdiagnosis of chronic cerebral ischemia or dyscirculatory encephalopathy. In recent years, biological markers of the disease have been used for accurate diagnosis of AD in our country. AD is characterized by a decrease in the concentration of beta-amyloid (low level of Αβ₄₂, an increase in the ratio of Aβ₄₀/Aβ₄₂) and an increase in the levels of total and phosphorylated tau protein in the cerebrospinal fluid. Correction of vascular risk factors, regular physical and mental activity, cognitive training, identification and effective treatment of comorbidities, including emotional and sleep disorders, are of leading importance for prevention of development and progression of CVD. At the stage of pronounced CI (dementia), central acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and glutamate receptor blocker memantine are effective for cognitive function improvement. The issues of efficacy and safety of citicoline use in CI of different severity are discussed.

Chronic shoulder pain (CSP) is an urgent problem, mainly due to the high prevalence of this pathology among the population. Until recently, there were no unified approaches to the management of patients with CSP. Currently, such recommendations have been developed by a group of experts, which includes doctors of various specialties. Based on these recommendations, the article presents approaches to diagnosing the causes of CSP, which are quite diverse. The most common causes of pain in the region are syndrome of compression of tendons of muscles rotating the shoulder (SCTMR), calcifying tendinitis (CT), adhesive capsulitis (AС), osteoarthritis of the shoulder joint (OA SJ), osteoarthritis of the acromioclavicular joint (OA ACJ). The article presents the main clinical manifestations of SCTMR, СТ, AС, OA PJ, OA ACJ, describes the necessary laboratory and instrumental research methods necessary to diagnose the specific cause of, as well as to exclude other diseases associated with shoulder pain. Treatment of CSP should be comprehensive and begin only after determining the cause of pain and functional disorders in this area. The first-line drugs are nonsteroidal anti-inflammatory drugs prescribed taking into account the patient’s concomitant diseases. If they are ineffective, local injection therapy (glucocorticosteroids, hyaluronic acid, autologous platelet-rich plasma) should be connected to therapy. In case of OA PJ, OA ACJ, it is advisable to include symptomatic slow-acting antiarthritis drugs in complex therapy. All patients are shown various methods of physiotherapy and rehabilitation. If conservative therapy is ineffective, surgical treatment should be considered.

Dizziness is a common symptom that can stem from a range of pathophysiological mechanisms and occurs in many diseases. While dizziness is usually due to benign causes, it can sometimes signal serious, life-threatening illnesses. Focusing on the time course enables symptoms to be categorized into acute vestibular syndrome, episodic vestibular syndrome and chronic vestibular syndrome. Cerebrovascular pathology can be a cause of vestibular dizziness. In this case, transient isolated dizziness is one of the most common precursors of a transient ischemic attack in the vertebrobasilar basin. Ischemic stroke is considered as the most common cause of central acute vestibular syndrome. Strokes manifested by vestibular symptoms frequently occur due to damage to the brainstem or cerebellum, but can also be observed due to damage to the cerebral hemispheres. Cerebral small vessel disease is a significant factor in the development of dizziness in the elderly. Discriminating vascular causes in patients with acute vertigo is challenging, especially when associated neurological symptoms are not evident. In recent years, several bedside diagnostic techniques have been developed to effectively differentiate between peripheral and central vertigo. Diagnostic criteria for vascular vertigo were established and published by the International Barany Society for the classification of vascular vertigo into several types: definite acute prolonged vascular dizziness, probable acute prolonged vascular dizziness, transient and acute dizziness in evolution, as well as probable acute dizziness in evolution and probable transient dizziness. For the treatment of dizziness, pharmacological, physiotherapeutic, psychotherapeutic/behavioural and, less frequently, surgical approaches may be considered. Combination of different methods is often used. The choice of therapy depends on the pathophysiology and etiology of dizziness.

Dementia remains one of the leading causes of global mortality and disability. Current evidence suggests that 40% of dementia cases could potentially be prevented or delayed by addressing modifiable risk factors, including arterial hypertension (AH). This review examines the pathophysiological relationship between AH and cognitive impairment (CI), along with practical approaches to patient management. Extensive epidemiological studies have established AH as a significant independent risk factor for CI, with cognitive deficits detected in 73.7% of hypertensive patients. The risk of CI increases by 7–16% with every 10 mm Hg elevation in systolic blood pressure (SBP), while severe dementia risk escalates 4.8 – fold when SBP exceeds 160 mmHg. The underlying mechanisms involve cerebral microangiopathy, white matter lesions, and neurodegenerative processes, which become particularly pronounced in cases of chronic uncontrolled hypertension. The cognitive impact of antihypertensive therapy remain controversial: while blood pressure control demonstrates neuroprotective potential, aggressive antihypertensive treatment in elderly patients may compromise cerebral perfusion. In this context, the combined neuroprotective agent containing a combination of extract from the leaves of Ginkgo biloba (EGb) and nicotinoyl gamma-aminobutyric acid (nicotinoyl GABA) – integrating vasoactive, neuroprotective and metabolic properties – emerges as a promising therapeutic option for AH patients with cognitive concerns. Clinical trial and observational data confirm that this unique combination of nicotinoyl GABA and EGb not only enhances cognitive performance but also alleviates anxiety and improves sleep quality. The drug demonstrates excellent compatibility with standard antihypertensive regimens, requires no dose adjustments for concomitant cardiovascular medications and shows efficacy across diverse age groups. Incorporating the complex drug containing nicotinoyl GABA and EGb into comprehensive AH management protocols may offer dual benefits: ameliorating existing cognitive deficits and potentially slowing their progression.

Physicians’ awareness of autoimmune encephalitis as a cause of subacute psychiatric symptoms has increased over the past decade, proportional to the growing number of published reviews and clinical cases on the topic. This trend is driven by improved diagnostic methods, including the detection of specific antibodies in serum and cerebrospinal fluid, as well as a better understanding of the diverse clinical presentations. Classically, anti-NMDA receptor encephalitis (anti-NMDAR AE) is perceived by clinicians as part of a paraneoplastic syndrome in young women with ovarian teratomas. However, the production of pathological antibodies can also occur in men, a factor that must be considered during differential diagnosis, particularly in cases of psychotic disorders, cognitive impairment, or seizures. In this article, we describe a clinical case of a male patient with relatively early-diagnosed anti-NMDAR AE, highlighting the importance of prompt immunological testing and early treatment initiation to improve outcomes. Early diagnosis helps minimize neurological complications and enhances patients’ quality of life.

Introduction. Insomnia and syndrome of obstructive sleep apnea (SOAS) are the two most important sleep disorders, which increase the risk of development and progression of myocardial infarction (MI), but are very poorly diagnosed in clinical practice. Aim. To determine the frequency, structure of major sleep disorders and their relationship with the course of MI.

Materials and methods. The study included 34 people with MI at the inpatient stage of rehabilitation, who were examined in accordance with clinical recommendations, a detailed survey and questionnaire on the Pittsburgh scale modified by Ya.I. Levin were performed to detect insomnia, a STOP-BANG scale was used to assess the risk of SOAS.

Results. 22 men (64.7%) and 12 women (35.3%) with MI were examined. The age median was 63.5 (LQ = 56; UQ = 69) years. Initially, complaints of sleep disturbances were registered in 16 (47%) people; based on the results of a detailed questioning, 27 (79.4%) respondents already noted symptoms of insomnia. The frequency of insomnia with obvious and borderline sleep disorders determined due to Levin’s form amounted to 67.7%. Insomnia was significantly more common in women than in men. Medium and high risk of SOAS was identified in 58.8% and 23.5% of individuals, accordingly. Sleep duration was positively correlated with Simpson ejection fraction (r = 0.41) and hemoglobin concentration (r = 0.38). A relationship was identified between the values on the STOP BANG scale and body mass index (r = 0.37), waist circumference (r = 0.44), and leukocyte level (r = -0.36). Scores determined by the STOP BANG scale were higher in the group of patients with MI without ST elevation (Zadj. = -2.1; p = 0.037).

Conclusions. Insomnia and a high risk of SOAS in patients with MI are more common than in the population and affect the course of MI, so it is important to promptly identify and correct these conditions.

Imtroduction. Personalized combination treatment including cognitive behavioural therapy (CBT) is a promising approach for managing chronic migraine (CM) and comorbid depressive syndrome.

Aim. To evaluate the effectiveness of adding CBT to personalized combination treatment for patients with CM and comorbid depressive syndrome.

Materials and methods. A total of 190 patients with CM and depressive syndrome (59 men and 131 women) were enrolled in the study. The mean age of patients was 35.8 ± 7.6 years. All patients underwent clinical interviews, neurological examination and testing. Patients were randomized into two groups: Group 1 received combination treatment, including pharmacological management of migraine, lifestyle recommendations, detoxification therapy (in the presence of drug-induced headache), therapeutic gymnastics (in the presence of musculoskeletal pain in other locations), sleep hygiene (in the presence of insomnia) and CBT, Group 2 received the same treatment, but without CBT. All patients had their clinical and psychological parameters assessed before treatment and at 3^rd, 6^th, 12^th and 18^th  months of observation.

Results. At Month 3 of treatment, Groups 1 and 2 showed statistically significant (p < 0.05) improvements: decreased frequency of headache (HF), analgesics use, migraine impact on daily activities, as well as reduced anxiety and depression. At Month 3 of treatment, in Group 1 the clinical effect (CE) for CM (a ≥50% reduction in HA frequency) was achieved in 74% of patients and depression symptoms regressed in 54% of patients; in Group 2, the CE for CM was observed in 41% of patients, and the absence of depression symptoms was noted in 31% of patients. The parameters were significantly better in Group 1 than in Group 2. From Month 6 to Month 18 of observation, Group 1 showed continuous improvement in parameters, while Group 2 experienced a reversal of positive changes they had previously achieved.

Conclusion. CBT increases the effectiveness of personalized combination treatment in patients with CM and comorbid depressive syndrome over the shortand long-term horizon.

Introduction. The prevalence of chronic obstructive pulmonary disease (COPD) in confirmed COVID-19 cases is relatively low, but severe COVID-19 is a significant burden for patients with COPD.

Aim. To study the effect of COPD on the dynamics of clinical manifestations of severe COVID-19.

Materials and methods. A retrospective single-center longitudinal study included 154 patients hospitalized for COVID-19 (103 patients with COPD and 51 patients without COPD and a smoking history). The presence of COVID-19 was confirmed by laboratory tests and/or clinical and radiological examination. Patients with COPD had a documented diagnosis of chronic obstructive pulmonary disease. The dynamics of clinical and laboratory-instrumental parameters were assessed in the first seven days of observation.

Results. In the studied patients, COPD in most cases was represented by the bronchitis phenotype, proceeded with frequent exacerbations and had pronounced clinical manifestations before COVID-19. Analysis of the dynamics of clinical manifestations of COVID-19 demonstrated that blood oxygen saturation, the volume of lung damage according to chest CT and the level of CRP statistically significantly differed depending on the presence/absence of COPD. The intensity of positive changes in clinical laboratory parameters and CT images was statistically significantly higher in the COVID group without COPD. Analysis of the dynamics of the severity of COVID-associated lung damage showed that in the COVID + COPD group of patients there were no statistically significant changes, and in the group of patients with COVID without COPD, there was a statistically significant positive dynamics of a decrease in the severity of lung damage. After 7 days of observation, in the COVID + COPD group of patients, there were more patients with severity grade III and fewer with severity grade II compared to COVID patients without COPD. Conclusions. Analysis of the dynamics of clinical manifestations of COVID-19 showed that patients with COPD have longer-term persistence of hypoxemia, inflammatory activity and lung damage.

The article presents clinical cases that focus on administration of ketoprofen as a throat wash and flurbiprofen as lozenges in a child with acute viral tonsillopharyngitis and two adult patients with peritonsillar abscesses. The drugs have been shown to provide a rapid and strong analgesic effect. Patients reported a significant reduction in pain within 10–20 minutes after administration of the drugs. It was emphasized that the combined use of a throat wash and lozenges produced a faster effect as compared to the single-drug therapy. The patient with a peritonsillar abscess who received a combination of two drugs demonstrated a complete relief of sore throat a day earlier than a patient who only received lozenges as pain relief therapy. No adverse reactions to the drugs were observed in patients. The presented cases are accompanied by a literature review, which provides information on the epidemiology, causes and mechanisms, as well as methods for treating a sore throat. Otolaryngologists most often see patients with nociceptive pain caused by an infectious and inflammatory factor in their practice. A wide range of drugs from various groups (antiseptics, antibiotics, local anesthetics, etc.) are used to relieve pain, but only a group of non-steroidal anti-inflammatory drugs has a pathogenetic effect.

Introduction. Recurrence of dacryocystitis after dacryocystorhinostomy (DCR) via external, transcanalicular or endonasal approaches is most often associated with the occurrence of pathological processes in the area of the DCR ostium. Dynamic assessment of its condition is a key issue in postoperative period patient management.

Aim. To develop a simple and convenient scale for assessing the DCR ostium condition for clinical use.

Materials and methods. In the course of a prospective study, a dynamic observation of 54 patients (60 cases) was carried out after endoscopic endonasal DCR. The assessment was carried out using FICI scale by 4 parameters: fluorescein endoscopic dye test (FEDT), condition of the internal common opening (ICO), cicatricial processes in the DCR ostium, presence of pathological processes in the ICO area (synechiae, granulomas, membranes). Such parameters as the severity of pathological changes in the DCR ostium margins and the presence of a lacrimal implant were also taken into account. Observation was carried out at 2, 4, 8 and 12 weeks after DCR. Results. During the obtained data analysis the parameters that have the greatest impact on the anatomical and functional results of DCR were determined. A scoring system for assessing DCR ostium parameters was developed. With its help it is possible not only to standardize the approach to patient care after DCR, but also to timely assess the need for corrective surgical intervention in the postoperative period.

Conclusion. A scale for assessing the state of the DCR ostium is proposed, which can be used to objectively assess the state of the DCR ostium and evaluate the need for repeated surgical intervention in order to improve the patency of the LD. This allows for a standardized approach to patient management in the postoperative period. The scoring system is easy to remember and allows for a short assessment of the state of the DS, which makes it convenient for use in everyday clinical practice.

Acute respiratory infections represent a serious medical and social problem, particularly among children under five years of age, leading to significant morbidity and mortality. Infections of the upper and lower respiratory tracts are caused by a wide range of pathogens, with viral agents playing a predominant role. Clinical practice demonstrates frequent cases of bacterial-viral co-infections in the respiratory tract, associated with a worsening of the disease course and an increased risk of complications. The COVID-19 pandemic has made substantial adjustments to the epidemiology of respiratory viruses, altering the usual dynamics of their spread and seasonality. In the current circumstances, the selection of an effective antiviral and/or immunomodulatory agent with a broad spectrum of action has become particularly relevant. The complexity of preventing and treating acute respiratory infections is due to the diversity of viral agents, numbering over two hundred serotypes capable of causing respiratory diseases. In this regard, significant practical interest lies in interferon inducers, which can stimulate the body’s nonspecific immune response. In this review, the authors analyse contemporary data from domestic and foreign literature, and also present their own experience regarding the clinical efficacy of the antiviral and immunomodulatory drug in the treatment and prevention of acute respiratory infections in children. Drag has demonstrated high clinical efficacy and a favourable safety profile in a number of clinical studies. The extensive evidence base obtained during these studies has allowed for the recommendation of the drug for widespread use in the treatment and prevention of acute respiratory viral infections and influenza in children aged three years and older. In the context of a changing epidemiological situation, further scientific research aimed at an in-depth study of the mechanisms of its action and expansion of indications for its use will allow more effective use of the therapeutic potential of this drug in respiratory diseases of various etiologies.

Introduction. Irritable bowel syndrome (IBS) is one of the most pressing problems in gastroenterology, approaches to its treatment are rapidly changing.

Aim. To study the efficacy of mebeverine and psyllium therapy in IBS patients with predominant constipation (IBS-C).

Materials and methods. A total of 177 patients with IBS-C were examined. The patients were divided into 4 groups: Group A – 42 patients received psyllium 30 g per day for 8 weeks; Group B – 48 patients received Mebeverine 400 mg per day for 4 weeks; Group C – 49 patients were treated with Mebeverine 400 mg per day for 8 weeks; Group D – 38 patients received Mebeverine 400 mg per day and psyllium 30 g per day for 8 weeks. IBS was diagnosed based on Rome IV criteria. Patients were examined with clinical data recorded every 2 weeks for 8 weeks.

Results. According to the IBS-SSS scale, in group C the total score decreased during therapy from 259 to 49 points, in group D – from 240 to 33 points (in both groups p = 0.001; р_C/D = 0,36). The study of the dynamics of stool frequency and form over 8 weeks demonstrated the significant effectiveness of psyllium. The frequency of stool increased in group A from 1.6 to 4.8 times per week (p = 0.01), in group D – from 1.5 to 5.5 times per week (p = 0.03). In patients of groups B and C, such obvious positive changes in the frequency and form of stool were not recorded.

Conclusion. The combination of mebeverine and psyllium in patients with IBS-C, used for 8 weeks, showed good results and made it possible to relieve both the manifestations of pain syndrome and improve intestinal motility indicators.

Veronika P. Gomonova, Karina L. Raikhelson, Victor A. Kashchenko, Aleksandr V. Lodygin, Vadim E. Karev Published in: Meditsinskiy Sovet. 2025;19(8):50–59. (In Russ.) https://doi.org/10.21518/ms2025-218.

Typing errors

These errors do not affect the conclusions of the article. The article has been corrected online.

Aim. To evaluate the efficacy of a tear substitute composed of the combination of trehalose and sodium hyaluronate (Gylan® Extra) in the treatment of iatrogenic dry eye syndrome caused by the long-term use of antiglaucoma drops.

Materials and methods. A total of 35 patients (70 eyes) with glaucoma of different stages and compensated intraocular pressure while using topical antiglaucoma drugs containing benzalkonium chloride (BC) as a preservative were examined. The duration of treatment ranged from 3 months to 14 years. In addition to the hypotensive medication regimen, all patients were prescribed a tear substitute. The patients underwent medical examinations before the prescription of tear replacement therapy, as well as 1 and 6 months after initiation of therapy. The treatment efficacy was evaluated using biomicroscopy, functional tests (Norn, Schirmer’s and Jones tests), and laser confocal microscopy.

Results and discussion. Among patients receiving the hypotensive therapy combined with tear replacement therapy containing trehalose and sodium hyaluronate, 89% showed an improvement in their corneal epithelium condition, a reliable increase in average precorneal tear film breakup time (TBUT): at 1 month – more than 1.5 times, at 6 months – 2 times (p < 0.001). The indicators of total and basic tear secretion increased by 3.4% and 16.6% (p = 0.039) and by 7.8% and 18.3% (p = 0.068), respectively.

Conclusion. The results of the study show the efficacy and appropriateness of prescribing a tear substitute containing trehalose and sodium hyaluronate to treat iatrogenic dry eye syndrome that developed during the long-term use of local hypotensive drugs containing the preservative BC.

Anatoly Yu. Popov, Tatiana P. Baitman, Anton D. Simonov, Pavel V. Markov, David S. Gorin, Alexander A. Gritskevich, Evgeny V. Kondrayev, Dmitry V. Kalinin, Nikolay V. Zhukov

Published in: Meditsinskiy Sovet. 2025;19(10):56–64. (In Russ.) https://doi.org/10.21518/ms2025-297.

Typing errors. Typos have been corrected – the author Vladislav A. Makarov has been added, who was directly involved in collecting and processing the material. Information about the author was missed at the stage of submitting the article to the editors. These errors do not affect the conclusions of the article. The article has been corrected online.

The original article can be found at https://doi.org/10.21518/ms2025-297.

The increasing prevalence of diabetes mellitus (DM) and the emergence of a large number of new hypoglycemic drugs put the question to the assessing the effectiveness of treatment of these patients. Also, a significant role should be given to the probabilistic forecast of both the immediate course of diabetes mellitus itself and the development of complications (mainly cardiovascular diseases), which are the leading cause of mortality and disability in patients. Although the use of such cardiac drugs as statins and angiotensin-converting enzyme inhibitors significantly improves the prognosis of persons with diabetes, achieving target indicators of carbohydrate metabolism, such as glycemia levels and glycated hemoglobin (HbA1c) remains a cornerstone of managing patients with diabetes. This is all the more important since, in modern conditions, an increasing number of patients (especially with type 2 diabetes) are coming under the supervision of a general practitioner. The role of the endocrinologist is limited to establishing a primary diagnosis and, if necessary, adjusting treatment. Determining the level of glycemia and its fluctuations depending on various conditions remains the main method of monitoring the condition of patients and the effectiveness of treatment. The main focus is on self-monitoring of blood glucose levels (SMBG), since assessing the glycated hemoglobin content in real practice does not allow to make quick decisions on changing treatment due to the specifics of this technique. Self-monitoring of glycemia by the patient has become possible due to the appearance of modern glucometers, which allow not only to determine the glucose content in capillary blood, but also to synchronize the obtained results with both the patient’s smartphone and cloud storage, promptly inform the patient about critical fluctuations in glycemia and store test results for a long time. After conducting an appropriate patient education program, self-monitoring of capillary blood glucose levels by using the latest generation of glucometers can be considered optimal for proper glycemic control in patients with diabetes mellitus in outpatient settings and non-critical conditions in inpatients.

Diabetes mellitus (DM) type 2 is characterized by a high level of comorbidity. Frequent concomitant pathologies in individuals with DM type 2 are cardiovascular diseases, as well as diseases of the digestive system (chronic pancreatitis, liver steatosis, chronic gastritis), pathology of the urinary and respiratory systems, concomitant endocrine diseases, disorders of the musculoskeletal system, pathology of the nervous system, sleep apnea. Important tasks in the treatment of patients with DM type 2 are also to reduce the risk of complications, preserve the function of β-cells, increase life expectancy and maintain its quality. Given the comorbidity of patients with DM type 2 and, as a result, the use of a large number of drugs, it is necessary that hypoglycemic therapy is safe, well tolerated, does not have a negative effect on other diseases and does not interact with other drugs. Sitagliptin has demonstrated protective properties in terms of preserving β-cell function and has also proven its safety when used in elderly people, patients with cardiovascular diseases and moderate hepatic and renal impairment. In addition, there is evidence that sitagliptin has a potential cardioprotective effect, which has been shown in animal studies. Thus, sitagliptin can be prescribed to a fairly wide range of patients. Currently, only one sitagliptin drug is registered in Russia, which is completely identical to the original one – this is the drug Xelevia. The drug is available in a dose of 100 mg and is taken once a day, regardless of food intake. This dosing regimen is convenient and increases patient compliance.

Obesity and diabetes mellitus lead to metabolic changes that cause morphological and functional transformations in the cardiovascular system. The pathogenesis of cardiovascular damage in obesity is multifaceted. Cardiovascular complications associated with obesity are caused by processes involving hormones and peptides, when inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin-angiotensin-aldosterone and sympathetic nervous systems are included, leading to the development of heart failure with both preserved ejection fraction and reduced ejection fraction. Initiation of effective, safe and affordable therapeutic interventions may be crucial for managing cardiometabolic health. This review aims to summarize the results of studies confirming the efficacy and safety of drugs with incretin activity – one of the most prescribed drugs from the class of glucagon-like peptide 1 receptor agonists – semaglutide and the first dual agonist of glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptors – tirzepatide. Pathogenesis mechanisms of cardiovascular damage in obesity are considered in detail based on the latest fundamental studies and the mechanisms implemented in the heart and blood vessels by glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide. Emphasis is placed on the capabilities of incretin mimetics, in addition to the hypoglycemic effect, to reduce vascular inflammation, adipose tissue mass and contribute to the improvement of the lipid profile, which demonstrates their metabolism-modifying properties. Incretins can be classified as disease-modifying therapy drugs, since they affect the cardiovascular system, improving the functional state of the endothelium, reducing blood pressure, slowing platelet aggregation, inhibiting cardiomyocyte apoptosis, improving glucose utilization, and exerting a vasodilating effect. This explains the reduction in the risk of cardiovascular complications observed in clinical studies, and in experimental studies, a decrease in the necrosis zone during modeling of myocardial infarction and the use of incretin mimetics.

Introduction. In primary prevention, increasing attention is paid to the influence of behavioral factors on the development of carbohydrate disorders. The ability to assess biomarkers associated with eating disorders will optimize the diagnosis of these disorders.

Aim. To establish the levels of markers-regulators of eating behavior associated with eating disorders in patients with early disorders of carbohydrate metabolism.

Materials and methods. A cross-sectional cohort study was conducted on a sample of patients from Tyumen with prediabetes, 122 people, average age – 46.2 ± 8.2 years. Eating disorder manifestations were assessed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition – DSM-V. Eating behavior patterns according to restrictive, emotiogenic and external types were assessed using the Dutch Eating Behavior Questionnaire (DEBQ). The levels of biomarkers of eating disorders – ghrelin and leptin – were assessed. ROC analysis with calculation of AUC, specificity and sensitivity were used to assess the prognostic significance of the index and determine the threshold score.

Results. According to the results of the ROC analysis with the determination of the cut-off point for ghrelin in relation to the risk of developing CP, the area under the ROC curve was 0.851 ± 0.027 with CI 95%: 0.798–0.905 (p < 0.001). The threshold value of ghrelin at the cut-off point is 45.9 ng/ml, a decrease in the level below the threshold value predicts the development of CP. The sensitivity of the model is 72.6%, the specificity is 78.9%. According to the results of the ROC analysis with the determination of the cut-off point for leptin, the area under the ROC curve was 0.831 ± 0.039 CI 95%: 0.756–0.932 in relation to the risk of developing CP, a model was built with an assessment of the probability of having an eating disorder (p < 0.001). The threshold value of leptin at the cut-off point was 0.69 ng/ml.

Conclusions. Patients with early carbohydrate metabolism disorders are recommended to undergo assessment of eating disorders and pathological patterns in terms of food intake during examination at the stage of primary prevention in order to optimize assessment of the risk of developing type 2 diabetes mellitus and subsequent comprehensive work with behavioral risk factors. Assessment of ghrelin and leptin levels as predictors of eating disorders can be used as paraclinical markers.

Introduction. Despite fairly well-developed approaches to the diagnosis and treatment of gout, the situation with timely detection and adequate treatment of this disease remains far from ideal. First of all, this concerns the level of primary care provision.

Aim. To present a clinical description and evaluate the treatment features of patients with gout in primary health care.

Materials and methods. An open, uncontrolled, non-randomized, one-time study included 125 patients (112 of them men) with gout who sought therapeutic admission to a first-level polyclinic during a calendar year. Clinical and anamnestic, physical, basic biochemical data, risk factors for gout, concomitant pathology, and drug therapy were retrospectively evaluated.

Results. Gout was more common in men (89.6%) than in women (10.4%). Moreover, in every 3^rd man (35.7%), the disease debuted before the age of 40. The diagnosis of gout was officially established on average 4 years after the first symptoms of the disease appeared. In almost every 4^th case (24.0%), gout was diagnosed when not only subcutaneous but also intraosseous topuses were already recorded on radiographs. Only 15 patients (12.0%) had the disease verified due to the detection of sodium monaurate crystals in the synovial fluid. Such diseases and conditions as arterial hypertension (72.8%), disorders of fat (63.2%) and carbohydrate (26.4%) metabolism, kidney damage (48.8%), non-alcoholic fatty liver disease (30.4%) were often diagnosed in patients with gout. Urate-lowering therapy was prescribed only to 89 patients (71.2%) with gout, while the target values of uricemia were achieved only in 33.7% of cases. The effectiveness of achieving target uric acid levels when using febuxostat was about 2 times higher than allopurinol (70.6% versus 29.8%, рχ² = 0.004).

Conclusion. Thus, in real clinical practice, there is a delayed diagnosis of gout, insufficient use of available instrumental research methods, pronounced comorbidity of patients, insufficient coverage of patients with urate-lowering therapy and low effectiveness in achieving the target values of uric acid in the blood.

Introduction. Sex hormones can contribute to the pathogenesis of psoriatic disease due to the potential impact on the cells of innate and acquired immunity.

Aim. To study the clinical features of psoriasis (PsO) and psoriatic arthritis (PsA) in men depending on the testosterone level.

Materials and methods. We included 54 men with PsA according to the CASPAR criteria. All patients underwent a standard rheumatological examination, PsA activity was determined by DAPSA, body mass index (BMI), and total testosterone (TT) level in the blood were assessed. Hypogonadism was considered TT ≤ 12.0 nmol/l. Subsequently, the subjects were divided into subgroups depending on the presence of hypogonadism, an intergroup comparative analysis was conducted, and a correlation analysis was conducted between the testosterone level and the main quantitative indicators.

Results. Testosterone deficiency was detected in 22 of 54 patients (40.7%). Patients with hypogonadism were characterized by comparable PsO activity according to the PASI index, but had higher PsA activity according to DAPSA (44.0 [28.8; 50.3] vs. 28.3 [24.9; 36.5]; p = 0.027), a higher number of painful joints (NPJ) (14.5 [10.25; 23.25] vs. 9.0 [4.25; 12.75]; p = 0.04) and number of swollen joints (NSJ) (7.0 [4.0; 12.0] vs. 4.0 [2.0; 6.0]; p = 0.029) with comparable axial lesion activity assessed by BASDAI (5.66 ± 1.46 vs. 5.31 ± 1.36; p = 0.4). A trend towards a higher proportion of patients with moderate and severe psoriasis activity according to PASI in hypogonadism was revealed (63.6% versus 40.6%; p = 0.097). Significant negative correlations were found between TT and PASI (r = -0.29; p = 0.032), as well as DAPSA (r = -0.37; p = 0.013), NPJ (r = -0.33; p = 0.022) and NSJ (r = -0.37; p = 0.012). In addition, testosterone levels negatively correlated with C-reactive protein (r = -0.28; p = 0.044) and BMI (r = -0.44; p = 0.001).

Conclusion. Hypogonadism, which is associated with high activity of peripheral arthritis and the presence of metabolic disorders, was detected in one third of men with PsA.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystem manifestations and a variable course. The article presents an observation of the course of SLE for 15 years in a male who was diagnosed with SLE at the age of 37 after a one-year period of severe joint syndrome, which was the reason to initially suggest “rheumatoid arthritis.” A year after the manifestation of the joint syndrome in the patient, the clinical picture of SLE was presented by carditis (paroxysms of nodal tachycardia), immunological (LE-cells, antibodies to native DNA and anticardiolipin), hematological abnormalities (anemia, leukopenia, thrombocytopenia), alopecia, lupus nephritis with nephrotic syndrome and antiphospholipid syndrome (renal vein thrombosis). During the last hospital admission, echocardiographic examination revealed signs of valvular heart disease: thickening of the leaflets of the mitral and aortic valves, which may be due to the lupus process itself and antiphospholipid syndrome. The patient was observed in the clinic for 15 years. During the entire period of the disease, the course was characterized by alternating periods of flares and remissions of the activity of the lupus process (relapsing-remitting variant). The patient was on supportive immunosuppressive therapy (methylprednisolone, cyclophosphamide) all this time. The levels of SLE activity, determined by the SLEDAI-2K index at the time of the patient’s admissions, were assessed as high and very high ones. If in the early years of the disease kidney damage was manifested by nephrotic syndrome, then in the last 5 years lupus nephritis has occurred with isolated urinary syndrome. During the last hospitalization, echocardiographic examination revealed signs of valvular heart disease with leaflet thickening of the mitral and aortic valves with moderate mitral insufficiency. The article analyzes authors’ experience of long-term follow-up of SLE patients with a discussion of the literature data on the clinical features of the disease.

Every year, 7.5 million children are infected, about 23 thousand of which lead to death. One of the forms of extrapulmonary tuberculosis is tuberculosis of the female genital organs, which accounts for 5% of all female pelvic infections, it accompa- nies 10% of cases of pulmonary tuberculosis. Most often manifested as a chronic inflammatory disease of the pelvic organs and infertility, in advanced cases, genital tuberculosis leads to irreversible damage to the female genital tract. Most cases of genital tuberculosis are observed in fertile people aged 20 to 45 years (in 0.5–2.0 adult women per 100 thousand), in child- hood and adolescence it is extremely rare. Infection of girls with tuberculosis in itself does not have a negative effect on the formation and development of their reproductive system, but in some cases, at an early stage of the disease, tuberculosis infec- tion can get there through the blood or lymph. In this regard, each clinical case may be of interest to doctors treating girls with gynecological problems. This article discusses a clinical case of genital tuberculosis in a 14-year-old teenage girl. The clinical course was manifested by pain in the lower abdomen. Ultrasound showed a large formation in the pelvis, ascites, and carci- nomatosis. Genital tuberculosis was suspected after chest CT, which showed signs of tuberculous lung disease. Laparoscopic examination revealed inflammatory lesions of the uterus, fallopian tubes, and both ovaries with complete replacement of the right ovarian tissue with a cyst. Therefore, timely and correct diagnostics, treatment of genital tuberculosis at the subclinical level is the only way to avoid irreversible damage to the pelvic organs.

Introduction. During the menopausal transition, women develop diseases of various body systems, which are often combined with each other. In perimenopause, ovarian function first decreases, and then completely “turns off”. The so-called state of hypergonadotropic hypogonadism develops, which leads to a violation of the secretion of neurohormones, a change in the function of the limbic system, the development of involution and atrophy in both reproductive and non-reproductive organs. Therefore, the problems associated with the period of the menopausal transition require an interdisciplinary approach and knowledge by doctors of narrow specialties of the features of its course.

Aim. To study the structure of extragenital pathology and the frequency of comorbidity in women in the periand postmenopausal period.

Materials and methods. An observational retrospective cross-sectional study using the archival method was conducted, which included 206 women in the preand postmenopausal period. In order to study the effect of the duration of preand postmenopause on the incidence of concomitant diseases, the studied women are presented in 4 groups: group I (n = 35) premenopausal women; age from 39 to 57 years, group II (n = 73) women in postmenopause from 1 to 5 years; age from 39 to 60 years, group III (n = 53) postmenopausal women from 5 to 10 years; age from 45 to 66 years, group IV (n = 45) postmenopausal women over 10 years; age from 51 to 84 years.

Results. The leading positions in the structure of somatic pathology in women in the preand postmenopausal period in all groups were occupied by diseases of the gastrointestinal tract (22.9%, 23.4%, 15.1%, 15.6%), arterial hypertension (17,1%, 13.7%, 13.2%, 31.1%) and osteochondrosis (14.3%, 6.8%, 13.2%, 8.9%), respectively, groups. Also, with the duration of the postmenopausal period, there is a tendency to increase concomitant oncological diseases by a factor of two (13.3% in group IV versus 5.7% in group I).

Conclusions. When carrying out a comparative characteristic of methods for assessing comorbidity, it was revealed that the highest level of reliability in the frequency of comorbid pathology was registered when using the CIRS scale. A significant increase in the median of comorbidity in patients of group IV was revealed in comparison with patients of the first three groups (p < 0.01).

Introduction. The innate immune system plays a leading role in the initiation and progression of external genital endometriosis (EGE) lesions.

Aim. Тo analyze the content of subpopulations of immunocompetent cells and the level of cytokines in peripheral blood (PB) and peritoneal fluid (PF) to identify the most informative indicators as non-invasive markers of EGE and the degree of its prevalence. Materials and methods. Phenotyping of lymphocytes by flow cytometry and assessment of cytokine content by multiplex method (27-plex panel) were performed in women with EGE of I–II degree (n = 20) and III–IV degree of prevalence (n = 28) in the PB before surgery and in the PF intraoperatively. The comparison group included 19 women without EGE.

Results. In the PB of women with EGE, regardless of the degree of prevalence of the process, an increase in the content of leukocytes, neutrophils, NF/LF index and a decrease in the content of lymphocytes, a change in the ratio of classical and intermediate monocytes, a low content of T-reg were found, a direct relationship was found between the content of T-regulatory cell subpopulations in the PB and in the PF. For the diagnosis of EGE of I-II degree of prevalence, the best parameters of significance were obtained for the content of MCP-1, MIP-1β in the PF, and for EGE of III-IV degree of prevalence – IL-6, IL-8. In the EGE I-II subgroup of patients, feedback was found between regulatory NK cells and cytokines, which may reflect an immune imbalance at the systemic level. In the EGE III-IV subgroup of patients, direct medium-strength connections were found between CD200+ cells and a wide range of cytokines, which reflects the chronicity of the inflammatory process.

Conclusions. Prospects for further research into EGE of various degree of prevalence are associated precisely with the formation of panels of non-invasive markers.

Introduction. Infertility is a significant global health problem affecting millions of people of reproductive age. According to the World Health Organization (WHO), approximately 17.5% of the adult population suffers from infertility, which corresponds to about one in six people worldwide. The impact of endometrial bacterial communities on human reproductive function remains a subject of active discussion in the scientific community. Current evidence suggests that the composition of the endometrial microbiota may have both positive and negative effects on fertility, but the mechanisms of these interactions require further investigation.

Aim. To evaluate the features of endometrioid microbiome composition in women with infertility and repeated failed IVF programs and its impact on the outcomes of assisted reproductive technology cycles.

Materials and metods. A pilot prospective single-center non-randomized study including 53 female patients aged from 18 to 42 years with infertility and unsuccessful IVF attempts in anamnesis was conducted. Additionally, endometrial biopsy was performed from the 15th to the 25th day of the menstrual cycle in order to assess the endometrial microbiome by metagenomic analysis (MEMA).

Results. According to the results of endometrial metagenomic sequencing, 19 patients had a predominance of Lactobacillus spp., 23 had other strains, and 11 had dysbiotic disorders. Clinical pregnancy was recorded in 7 (30.4%) of the 23 patients with opportunistic microorganisms and in 8 (72.7%) of the 11 women with dysbiotic disorders after the treatment.

Conclusions. It is summarized that women who do not need treatment are 4.75 times more likely to become pregnant than women who receive therapy (p = 0.021). At the same time, the chances of pregnancy in patients who received antibiotic therapy followed by probiotic therapy were 7.7 times lower compared to patients who did not receive this treatment.

Pityriasis versicolor (tinea versicolor) lichen (PVL) is a chronic superficial fungal infection of the skin caused by the proliferation of lipophilic yeast (Malassezia species) in the stratum corneum of the epidermis. Multicolored lichen is a disease that is widespread everywhere, but it is more common in those countries where the temperature and humidity are elevated. People of both young and old age are ill, the disease is also registered in children. The main causative agents of the so-called malasseziosis, which includes ringworm, are Malassezia sympodialis, Malassezia globosa, Malassezia furfur, Malassezia restricta. Mushrooms of the genus Malassezia are the only representatives of the kingdom of fungi that are commensals of normal human skin. Malassezia spp. – lipophilic fungus, therefore, the intensity of skin colonization is associated with the function of sebaceous glands, a change in the chemical composition of the fatty mantle. In the population, the incidence statistically depends on: age (peak incidence is at the age of 14–40 years); gender differences (men are 1.5–2 times more likely to get sick); the presence of concomitant diseases of the gastrointestinal tract, endocrine disorders, vegetative diseases, immunodeficiency of various etiologies; geographical latitude (in temperate climates – about 2%, in tropical – up to 40% of the total population); professional activity of patients (in persons engaged in physical labor, sweating profusely); hereditary predisposition. The skin of the chest and back is a favorite place of localization, less often the elements are noted on the skin of the neck, abdomen, lateral surfaces of the trunk, and the outer surface of the shoulders. In addition, rashes can be found on the scalp, but without hair damage, sometimes in the inguinal folds and axillary areas. According to the 2020 Clinical Guidelines of the Russian Federation for the treatment of multicolored lichen, external (topical therapy) is used for limited forms of the disease. The article presents our own clinical observations of the effectiveness of using the Russian-made drug Acrimicol (2% sertaconazole cream).

Mastocytosis is a heterogeneous group of diseases with accumulation of clonal mast cells in tissues. Mastocytosis is characterized by complex pathogenesis, diverse clinical picture and ambiguous prognosis. Complex molecular mechanisms, multiorgan damage and variable clinical course require interdisciplinary approaches to diagnostics and development of treatment strategy for mastocytosis. In patients with symptoms associated with mast cell mediators, strict avoidance of any triggers leading to activation and degranulation of mast cells is of great importance. Treatment of cutaneous mastocytosis in children does not have standard recommendations and should consider the clinical form and type of cutaneous mastocytosis, severity of mediator symptoms, age, concomitant and comorbid diseases. Etiotropic drug therapy for cutaneous mastocytosis has not yet been developed, therefore, in pediatric practice, agents for symptomatic treatment of the disease are used. The article systematizes the data of international experience in the management of children with cutaneous and systemic mediator symptoms of varying severity. The characteristics (mechanism of action, indications) of groups of antimediator drugs most often used in outpatient pediatric practice are given. Emphasis is placed on the need to correct the level of vitamin D in children with mastocytosis. Data on the perioperative management of children with cutaneous mastocytosis are analyzed. Skin care and external therapy are relevant for clinical forms of the disease, accompanied by the formation of weals, bullae and itching. Observation of children should be carried out by specialists-dermatovenerologists and allergists-immunologists, with experience in working with this pathology. Children with cutaneous mastocytosis may require psychological or psychiatric help. Families of patients should be informed about the clinical features, the need for dynamic observation, the relevance of preventive and symptomatic therapy, and the prognosis of the disease. Timely prescribed anti-mediator therapy will prevent the development of severe mediator symptoms, improve the quality of life, and improve the prognosis in children with cutaneous mastocytosis.

The article describes clinical cases of the use of a combined topical glucocorticosteroid (THCS) (Acriderm GK drug) in the form of a cream (in the version: betamethasone + gentamicin + clotrimazole) to update data on its effectiveness in infectious dermatitis of the folds. The patients were prescribed the drug as the main treatment according to the scheme: apply a small amount of cream to the affected areas of the skin, lightly rubbing, 2 times a day.

Results. Patient A., 52 years old, was diagnosed with infectious dermatitis of the large folds of the perineum (intercostal and perineo-scrotal folds) and vitiligo of the intercostal fold. Prior to treatment, erythema with slight swelling of the skin and vitiligo were locally noted. Relief of erythema, swelling, and a decrease in the area of the leukoderma were noted 15 days after the start of treatment. A clinical cure has been established. Patient B., 55 years old, was diagnosed with infectious dermatitis of the transverse fold of the anterior abdominal wall. Prior to treatment, severe hyperemia, weeping, and soreness with slight peeling were locally noted. A clinical cure was established 14 days after the start of treatment.

Conclusion. The high therapeutic efficacy of combined THC in the form of a cream for external use (Acriderm GK) has been shown for various types of infectious dermatitis of the folds, including with primary lesions of the folds, and with existing chronic dermatoses in this area.

Introduction. The article is devoted to the study of certain aspects of the introduction of artificial intelligence technologies into the international and Russian healthcare systems. Based on data from international analytical agencies, information is provided on the growth of the digital healthcare market until 2030. Separate segments of this market in Russia and abroad, in which artificial intelligence technologies are used, are considered.

Aim. To analyze the existing Russian and international experience in the implementation of artificial intelligence technologies in healthcare.

Materials and methods. Analytical methods of information collection and processing were used in the work, a content analysis of regulatory legal acts and official sources of open information on the Internet, patent analysis, and the study and synthesis of research results by Russian and foreign authors were carried out.

Results. The basic conceptualization of the global digital healthcare market is defined based on the analysis of the possibility of using artificial intelligence in different segments. Based on the results of the patent search, the countries with the largest number of registered patent documents in the reviewed groups of the international patent classification were identified.

Conclusion.Based on the conducted research, conclusions are drawn about the growing interest of states, developers, manufacturers and consumers in medical technologies based on artificial intelligence technologies.

Introduction. Preventive medicine in Russia is a priority area, the key task of which is to combat the spread of chronic noncommunicable diseases (CKD). The latter are the cause of the premature death of hundreds of people. In this regard, the issues of developing and implementing early screening of NCDs, combined with advanced digital technologies based on artificial intelligence (AI), in clinical practice, are extremely relevant.

Aim. To develop a medical methodology for remote questionnaire screening (DAS) of CNID in young people.

Materials and methods. The study involved 3.155 people aged 19.6 ± 1.5 years (46.9% were men and 53.1% were women). Preventive medical examination of all participants was carried out using DAS.

Results. A high degree of NCD risk was found in 11.7%, an average in 30.9%, and a low in 57.4% of the subjects. The most frequent complaints were from the endocrine (28.9%), digestive (21.8%), respiratory (21.1%), cardiovascular (20.1%) and oncological alertness (8.1%). In 75.7% of cases, the presence of risk factors (RFS) was determined by two or more pathology profiles. Satisfaction with DAS use among the surveyed was 96.6%, and among medical workers 91.7%.

Conclusions. 1. The use of DAS FR HNIZ increases the compliance of patients to undergo a preventive medical examination.

2. The use of statistical methods confirms the effectiveness of the integrated assessment of health and the effectiveness of the detection of NID according to the main socially significant profiles of pathology.

3. The system identifies the most common NIDF, the degree of their severity, and also identifies people with critical FD who need priority care. This option allows you to optimize patient routing, reducing the one-time burden on the medical institution as a whole and on a specific specialist.

4. Depending on the identified NHS disorders and their severity, a set of recommendations has been developed, which implements a personalized approach.

5. The use of DAS FR HNIZ in young people has shown significant social and economic effectiveness.

Introduction. Palatine tonsils play an important role in protecting the human body from numerous pathogens entering through the upper respiratory and digestive tracts. One of the main components of the protective function of the palatine tonsils is the formation of humoral immunity, which occurs as a result of a B-cell response to foreign antigens with the participation and under the control of follicular T cells. Disorders in the involvement of B and T cells in the immune response in the tonsils may be associated with various pathologies, chronic infections, immunodeficiency or lymphoproliferative diseases.

Aim. To perform a methodical analysis of various subpopulations of B and follicular T cells in tonsils using flow cytometry. To evaluate various components of the local immune response.

Materials and methods. The selection of patients for the study was carried out in the otorhinolaryngological department of the City Clinical Hospital No. 1 named after N. I. Pirogov, Moscow from 2024 to 2025. Fresh tonsils were obtained from patients undergoing tonsillectomy or tonsillotomy. Mononuclear cells (MNCs) isolated from the organs were stained with a mixture of surface markers for Band T-follicular cells, followed by intracellular staining of the transcription factors Bcl6 and FoxP3 for subsequent flow cytometry analysis.

Results and discussion. Based on the obtained data, a strategy was proposed for identifying key B-cell subpopulations (naïve, double-negative B cells, memory B cells, and germinal center (GC) B cells) involved in the humoral immune response in tonsils. Additionally, an approach was developed for analyzing T-follicular cells in tonsils, distinguishing subpopulations of T-follicular helper (Tfh) cells, T-follicular regulatory (Tfr) cells, and CD25++ Tfh cells, which are essential for the control and regulation of B-cell responses.

Conclusions. The developed analysis can be used both in basic research and in clinical practice for the diagnosis and monitoring of immunopathological conditions.

Pain is a complex, distressing sensory and emotional experience directly associated with actual or potential tissue damage. Short-term pain serves a protective signaling function; however, under prolonged action of pathogenic factors and dysfunction of the nociceptive system, acute pain responses can transform into a pathological state. This state is characterized by a persistent pain syndrome lasting beyond normal healing time (usually more than 3–6 months), leading to the development of Chronic Pain Syndrome (CPS) and Chronic Post-Traumatic Pain (CPTP). These phenomena entail complex negative consequences: persistent physiological shifts, significant functional limitations, neurological disorders, and various mental disorders.

Chronic Pain Syndrome has a profoundly negative impact on all aspects of patients’ quality of life. A critically important aspect is its ability to significantly hinder the rehabilitation process. The present article details the clinical phenomena of CPS and CPTP, analyzes their specific impact on the psychoemotional status and, consequently, on patients’ rehabilitation potential. Scientific data is presented demonstrating how various negative factors of the pain syndrome directly impede the implementation of therapeutic measures, reduce treatment adherence, and diminish the effectiveness of rehabilitation programs in patients who have suffered various injuries. The article also describes the influence of attachment style on patients’ individual experience of pain and introduces the hypothesis that rehabilitation of such patients might be possible using psychological techniques aimed at strengthening self-identity of self. The article emphasizes the necessity of a comprehensive treatment approach integrating pain management and psychological intervention.

Introduction. Poly-L-lactic acid (PLA) fillers correct skin volume loss by stimulating fibroblasts to synthesize collagen. Tissues around the PLA injection site accumulate CD68+ macrophages and CD90+ fibroblasts. They also increase the levels of TGF-β1 and tissue inhibitor of metalloproteinase 1 (TIMP1), which promote the deposition of collagen I and III. One of the serious complications after the introduction of poly-L-lactic acid (PLA) fillers is granulomatous inflammation. Genetic testing is of great interest in terms of predicting both the effectiveness of cosmetic procedures and their safety.

Aim. To determine the genetic predisposition to unwanted fibrosis and the likelihood of developing granulomatous inflammation (foreign body reaction) after the introduction of PLA-based products.

Materials and methods. The pilot study involved 54 female patients who underwent vector lifting procedures, a PLA-based drug, and genetic testing. Buccal epithelium served as the material for the molecular genetic study. PCR was performed using a Rotor Gene Q amplifier (Qiagen, Germany).

Results. The study clearly identified patterns of granulomatous inflammation development in patients with IL-4 and IL-13 gene polymorphism. Comparison of the two groups showed that markers rs2243250_IL-4 and rs20541_IL-13 have statistically significant differences (p < 0.05), indicating their potential association with complications. Correlation analysis confirmed the presence of a moderate positive relationship between complications in the form of a delayed granulomatous reaction to the introduction of a PLA-based filler and the rs2243250_IL-4_TT gene (Rm = 0.480, p = 0.020*), which emphasizes its significance in this sample. Univariate analysis showed that the rs2243250_IL-4_TT gene, indicating a high mutation, significantly increases the risk of an unfavorable outcome (OR = 32.008, p = 0.011*).

Conclusions. Findings show that the presence of polymorphism and substitution in two alleles in the rs2243250_IL-4_TT gene variant significantly increases the risk of adverse outcomes.

Diabetes mellitus is characterized by disorders of almost all types of metabolism. In this disease, there are marked changes not only in carbohydrate metabolism, but also in the metabolism of fats, proteins, and micronutrients. Micronutrient deficiency in diabetes mellitus is caused by several main reasons: dietary restrictions, metabolic disorders, and decreased absorption of micronutrients in the gastrointestinal tract. In Russian clinical guidelines and algorithms, the issues of micronutrient deficiency and their correction are covered very modestly. However, vitamins and trace elements play an important role in glucose metabolism, so understanding the effects of vitamin and mineral deficiencies and the potential benefits of taking them is important for the prevention and/or treatment of diabetes mellitus. We conducted a search in the PubMed and Scopus information databases for publications on the study of the level of vitamins A, C, E and zinc in patients with diabetes mellitus and their possible use as adjuvant therapy for the disease, which included sources up to 04/25/2025. The above review indicates a decrease in the levels of antioxidant vitamins (A, E, C) and zinc in patients with diabetes mellitus. The presence of micronutrient deficiency in diabetic patients hinders glycemic control and is one of the factors contributing to the development of complications of the disease and comorbid pathology, primarily cardiovascular diseases. The identification of micronutrient deficiency and its correction will have a positive impact on the prevention and treatment of diabetes mellitus, and contribute to improving the quality of medical care for the population with diabetes.

Dyspnea is a painful sensation of lack of air. It has both subjective and objective manifestations and is well-known in the clinical practices of doctors of many specialties. The most common causes of shortness of breath are respiratory and cardiovascular diseases, neuromuscular disorders, psychosomatic conditions, and metabolic disorders. Acute dyspnea, which lasts up to one month, and chronic shortness of breath, which lasts more than one month, are both characterized by a spectrum of pathological conditions. Chronic dyspnea in older people can be a challenge to diagnose because of age-related changes, the atypical course of diseases, comorbidity, and possible polypharmacy. The presented clinical case describes the experience of treating an elderly patient with a chronic dyspnea that had a complex genesis. During the follow-up the patient gradually developed diseases, each of which manifested as shortness of breath: atrial fibrillation, which subsequently led to chronic heart failure; mixed anemia due to iron, folate, and B12 deficiency; and finally, systemic sclerosis-associated pulmonary hypertension. The search for new reasons of dyspnea has become possible due to a dynamic reassessment of the patient’s condition, which involves analyzing changes in the clinical findings, expanding the range of laboratory and instrumental examinations and involving specialists from diverse disciplines. Modern diagnostic algorithms and a multidisciplinary approach are important tools for managing patients with chronic dyspnea.