Evaluation of the net clinical benefit of anticoagulant therapy is an important tool that helps compare thromboembolic and hemorrhagic risks. The net clinical benefit of direct oral anticoagulants (DOACs) exceeds that of warfarin and demonstrates their significant advantage in various patient categories. The dosing schedule of DOACs (once or twice daily) influences peak plasma drug concentrations and continuity of their action, which is particularly important if a patient misses or takes an extra dose incidentally. Twice daily dosing of DOACs may be safer due to less variability in drug concentrations and, according to some data, has a more favorable net clinical benefit profile determined by both thrombotic and hemorrhagic risks. Different DOACs have their own pharmacokinetic properties and interand intra-individual variability in plasma concentrations. It should be considered that the degree of factor Xa inhibition is not only influenced by the administration schedule, dosage, and characteristics of the drug, but also by the phenotypic characteristics of the patients. Further studies exploring the personalized approach to anticoagulant therapy appear promising. Patient adherence to DOACs is determined by multiple factors and, according to current data, varies between medications for once-daily (QD) vs. twice-daily (BID) dosing, which suggests more of a role of the molecule itself and its associated tolerability and side effects. Apixaban has demonstrated the greatest clinical benefit for patients with atrial fibrillation, both in randomized controlled trials and in real-world clinical practice, due to the greatest reduction in the risk of major hemorrhagic complications.

Introduction. The use of factor analysis in the study of metabolic syndrome (MS) makes it possible to assess the independent effect of each factor and their synergistic effect on the likelihood of developing the disease.

Aim. To assess the risk of developing MS in young indigenous and non-indigenous individuals with long-term residence in areas considered to be the Far North.

Materials and methods. A case-control study was conducted among 863 young people aged 18–44 years. The study involved 283 men and 580 women, as well as non-indigenous people (583 people) and indigenous people (small peoples of the Far North – Khanty) (280 people) by ethnicity. A one-factor and multifactorial logistic regression analyses of the relationship between factors and the chance of MS in young people in the general sample, by age and ethnicity, were carried out.

Results. In all the analyzed groups, the chance of having a MS was significantly associated with an increase in the TyG index and non-high-density lipoprotein cholesterol (non-HDL-C) levels. With an increase in the TyG index by one conventional unit, the chance of MS in the non-indigenous group increased 22-fold, which is 4.7 times higher than in the indigenous group, and with an increase of 1 mmol/L, the non-HDL-C level was 3.4 mmol/L 3-fold higher than in the indigenous group.

Conclusion. The TyG index was significantly associated with the odds of having MS, more so than the HOMA-IR index. A significant association was observed with an increase in non-HDL-C levels, predominantly in men (21.4-fold, p < 0.001) and in non-natives (18.7-fold, p < 0.001).

This article discusses the issue of personalized approach for anticoagulants choice according to the atrial fibrillation burden (AFB), primarily in patients with subclinical atrial fibrillation (SCAF), i.e., atrial fibrillation (AF), which is identified using various cardiac implanted or wearable devices, but not on the electrocardiogram. There is some epidemiological evidence that the issue of AF as one of major risk factors for stroke and/or systemic embolism (SE) is becoming more prominent. Various interpretations of the term “AFB” are considered, and the data regarding its clinical significance are presented in detail. Current approaches to the prescription of direct oral anticoagulants (DOACs) in patients with SCAF according to the estimated risk of stroke/SE, and the known history of stroke or transient ischemic attack (TIA) are discussed. The results of the data analysis for subjects of the randomized clinical trial (RCT) evaluating the efficacy of DOAC use in patients with SCAF are considered. The data on the prognostic role of AFB in patients with AF including those with heart failure and reduced left ventricular ejection fraction are presented. The authors address the issue of DOAC choice in patients with SCAF, as well as the significance of once-daily DOACs in this situation. The cost-effectiveness of DOAC use for stroke and/or TIA prevention in patients with SCAF, which largely depends on the cost of therapy, is discussed.

Cerebrovascular disease (CVD) and its chronic forms are among the most common pathologies in neurological and general medical practice. The high frequency of comorbid conditions and diseases, particularly hypertension, diabetes, lipid metabolism disorders, metabolic syndrome, and others, which contribute to the development of chronic cerebral ischemia (CCI), increases the risk of stroke and dementia – threatening, disabling complications, making chronic cerebral ischemia a pressing medical and social problem. Despite the variety of subjective symptoms of CI, cognitive impairment is considered an early and reliable manifestation of the disease. In clinical practice, one disease often masks another, misdiagnosis, and sometimes overdiagnosis contribute to the loss of valuable time and the chronicity of the disease. Timely diagnosis and adequate pathogenetic therapy aimed at improving cerebral microcirculation, optimizing neuronal metabolism, and providing neuroprotection reduce the risk of developing major complications of cerebrovascular diseases and improve the quality of life of both patients and their families. Treatment for patients with CCI includes correcting stroke risk factors, normalizing blood pressure, lowering blood cholesterol levels, and administering antithrombotic and cognitive-promoting medications. According to research data, dipyridamole, which has antiplatelet, vasotropic, antioxidant, and anti-inflammatory effects, has been used successfully in CCI. With dipyridamole use, patients with CCI experience a regression in the severity of neuropsychiatric disorders and an improvement in overall well-being, as confirmed by the presented clinical case. Non-pharmacological methods for maintaining and improving cognitive function are also of great importance.

Dizziness is one of the most common reasons for seeking medical attention from specialists in various fields. However, despite its apparent clarity, patients describe a wide range of sensations under this term: from loss of balance and uncertainty when moving to swaying, lightheadedness, pre-syncope, “heaviness in the head”, and coordination problems. Patients often struggle to clearly articulate their complaints and offer several different definitions of their condition. Specifying complaints can be difficult, which complicates diagnosis and determining the cause of dizziness. Therefore, modern practice uses a diagnostic algorithm that includes assessing the nature of vestibular syndrome (acute, intermittent, or persistent), identifying triggering factors, analyzing associated symptoms, performing a physical examination, and, if necessary, additional diagnostic methods. A clinical case study of a patient with multiple sclerosis who initially presented with complaints of dizziness illustrates the complexity of diagnosing this condition. In the treatment of dizziness, the primary goal is rapid and effective symptom relief. Given the frequent presence of comorbidities requiring the simultaneous use of multiple medications, combination medications are preferred. One such drug is the fixed-dose combination of dimenhydrinate 40 mg and cinnarizine 20 mg (Arlevert). Low doses of dimenhydrinate and cinnarizine enhance each other’s effects when used together, with minimal adverse effects. Due to the different mechanisms and locations of action of the components (peripheral action of cinnarizine and central action of dimenhydrinate), Arlevert is the only anti-dizzy medication with synergistic action in both peripheral and central areas.

Introduction. Exploring the role of B-group vitamin deficiencies in patients with cardiometabolic disorders is important today.

Aim. To study changes in biomarkers for cardiometabolic risk in patients with B-group vitamin deficiencies with underlying insulin resistance and carbohydrate metabolism disorders.

Materials and methods. Seventy patients with abdominal obesity combined with prediabetes or type 2 diabetes were included, 35 of whom received Neuromultivit, 1 tablet twice a day, and 35 patients with abdominal obesity combined with prediabetes or type 2 diabetes who only received a backbone therapy. The observation period was 12 weeks. All patients underwent a preand post-observation examinations, including blood chemistry tests (C-reactive protein, lipid profile, glucose, HbA1C, insulin, homocysteine, B1, B6, and B12 vitamins) and neuropsychological testing such as MoCA test, Schulte Table test, and the Clinical Global Impression (CGI) -based assessment.

Results. During Neuromultivit therapy, improvements were noted in the following parameters: a 0.6 [0.4; 0.9] ng/ml increase in vitamin B1 level (p < 0.001), a 4.6 [3.7; 7.7] ng/m increase in vitamin B6 level (p < 0.001), B12 level by + 256 [202; 474] pg/ml (p < 0.001); homocysteine level decreased by -2.2 [-2.5; -1.6] μmol/l (p < 0.001), glucose level by 0.17 [-0.23; -0.12] mmol/l (p < 0.001); HbA1c level by -0.04 [-0.05; -0.04] % (p = 0.002), insulin level by -0.5 [-0.8; -0.3] μIU/ml (p < 0.001), waist circumference (WC) decreased by -4 [-6; -3] cm (p < 0.001), the MoCA test result improved by +1 [1; 2] score (p < 0.001), the Schulte Table tests showed boosting in speed by -2.1 [-2.3; -1.5] sec, p < 0.001), CGI-I-based assessment demonstrated “significant improvement” in a greater number of patients (p < 0.001). In the control group, no significant positive changes were observed in any of the parameters studied.

Conclusions. Neuromultivit therapy resulted in significant replenishment of B-group vitamin deficiencies, improvement of cardiometabolic parameters and cognitive functioning as compared to the control group.

The state of the gut microbiota largely determines the course of pathological processes in the human body. Currently, there is no doubt about the role of dysbiosis in the development and progression of many disorders, including intestinal infections, IBS, IBD, SIBO, diverticular disease, celiac disease, cancer, food intolerance, allergies, liver and pancreatic diseases, obesity, diabetes, metabolic syndrome, hematological, cardiological, genitourinary, rheumatological, neurological and neuropsychiatric. The development of tools that correct the imbalance of the gut microbiota is one of the most promising areas of the modern science. Methods for diagnosing disorders of the gut microbiota are also being improved. The importance and expediency of including agents that modulate the state of the gut microbiota in the complex therapy of many diseases is confirmed by numerous foreign and domestic studies. The evolution of probiotic products has progressed from single-strain formulations containing one type of microorganism to modern multi-strain synbiotic complexes that combine probiotics and prebiotics. The first generations of probiotics were primarily aimed at replenishing beneficial bacteria, whereas contemporary biocomplexes exert multi-level effects – they regulate the composition and activity of the gut microbiocenosis, promote the synthesis of necessary bacterial metabolites, improve intestinal barrier function, and modulate the immune response. This review article is devoted to evaluating the effectiveness of synbiotic biocomplexes Normoflorin L, B, and Д in the correction of gut microbiocenosis disorders in antibacterial therapy, functional bowel diseases, inflammatory bowel diseases, chronic pancreatitis, celiac disease, metabolic disorders and obesity, diseases of the ENT organs, dermatological and gynecological diseases.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. The complexity of its pathogenesis determines the urgency of finding effective therapeutic strategies. 

Aim. To evaluate the efficacy of combination therapy with lifestyle modification (LM) and ursodeoxycholic acid (UDCA) in patients with NAFLD using transient elastography (TE) with the CAP (controlled attenuation parameter) function, steatosis indices (FLI, ST), and liver fibrosis indices (FIB-4, APRI).

Materials and methods. A total of 142 patients with NAFLD were included in the prospective study. All patients were assessed with fibrosis and steatosis index scores, and TE with the CAP function. Patients were divided into two groups based on the type of treatment for the following 6 months: group I — LM and group II — LM and UDCA. All patients were prescribed a hypocaloric Mediterranean diet and aerobic exercise as part of LM. Repeat comprehensive examination was done after 6 months to assess the efficacy of treatment.

Results. After 6 months of treatment, 111 patients came for a follow-up examination. The LM resulted in improvements in both groups, but the group who received UDCA in addition to LM exhibited statistically more significant improvements. There was a significant decrease in biochemical markers: ALT (median -43.60, p < 0.0001), AST (-17.8, p = 0.0001), GGT (-45.00, p < 0.00013), ALP (-74.91, p < 0.00015), TG (-0.165, p = 0.0085). More significant improvements were also detected in non-invasive scores: APRI (-0.22, p < 0.0001), FIB-4 (-0.17, p = 0.0272), ST (-0.09, p < 0.0001), FLI (-3.90, p = 0.0001). According to CAP (-25.00 dB/m), the TE findings showed a significant reduction in fibrosis (-0.70) and steatosis in the UDCA group.

Conclusions. Adding UDCA to the basic non-drug treatment is associated with a statistically significant improvements in biochemical, elastographic, and calculated liver steatosis and fibrosis scores in patients with NAFLD.

Gastroesophageal reflux disease (GERD) ranges among the most common diseases in therapeutic practice. In addition to the classic complaints, patients often experience extraesophageal symptoms, which can complicate the diagnosis of GERD and require a multidisciplinary approach to the patient management with the assistance of related specialists. These include dental manifestations of GERD, which can be conveniently classified into lesions affecting the soft tissues (vermillion border of the lips, tunica mucosa of mouth, tongue, periodontal tissues) and the dental hard tissues (enamel and dentin) in the oral cavity. Epidemiological data on the prevalence of these or other dental manifestations of GERD are limited and heterogeneous. The article considers a number of pathogenetic factors that explain the cause-and-effect relationship between oral/dental lesions and GERD, including the direct damaging effects of aggressive refluxate molecules, changes in the physicochemical properties of saliva expressed as a decrease in its buffering capacity, reduction in secretion of mucin, growth factors, and antimicrobial peptides, and bruxism. From a practical perspective, it is quite difficult to find a link between GERD and possible dental manifestations due to the heterogeneity and nonspecificity of the latter. If GERD is suspected in patients with oral and/or dental lesions, it is reasonable to use the GERDQ questionnaire, esophagogastroduodenoscopy, and, in some cases, 24or 48-hour pH-impedance measurements and high-resolution manometry. The salivary pepsin and bile acid tests may be used as a potential screening tool to identify a cohort of individuals requiring further examination.

Introduction. To comprehensively assess the quality of life of combat veterans with upper gastrointestinal diseases, it is necessary to focus on key indicators related to physical and mental well-being.

Aim. To conduct a comparative factor analysis of the impact of combat experience on the quality of life of military personnel with upper gastrointestinal tract pathology, using a combination of the SF-36, OQ-45, and GSRS questionnaires, to develop differentiated criteria for assessing the effectiveness of preventive and diagnostic measures in military medicine.

Materials and methods. A single-center, observational, cross-sectional study was conducted. 200 Russian National Guard servicemen with upper gastrointestinal pathologies were surveyed. The study group (combat veterans) consisted of 100 people; the control group (non-combat veterans) consisted of 100. The age range was 21 to 65 years. The survey was conducted using the following questionnaires: SF-36; OQ-45; GSRS. To select the key variables, the weight of each “Factor” was assessed using factor analysis with a factor loading coefficient > 0.7 (p < 0.05).

Results. A new 6-factor model for assessing the quality of life of military personnel was obtained, from which three “latent” factors were identified in group 1: “Distress syndrome”, “Physical condition” and “General health” with a maximum factor weight of 15.73%, 13.36% and 11.36%; in group 2 – two “Everyday role activity” and “Social functioning” with a weight of 19.99% and 11.59%. The first group showed 65.65% contribution of each “Factor” to the variance, the second – 63.77%.

Conclusions. Differences in key factors (“Distress syndrome”, “Physical condition”, “General health”) in combat participants and (“Everyday role activities”, “Social functioning”) in non-participants demonstrate a specific impact of combat stress on quality of life with a total explanatory variance of over 63%, which makes it possible to effectively use new technology to improve the diagnosis, prevention and tactics of combatant management, in particular, to conduct a survey only on key factors instead of the entire array of 3 questionnaire instruments.

This review focuses on the causes, pathogenesis, and potential new treatments for anemia in cancer patients. 61 sources published in Pubmed and other scientific databases have been analysed. Anemia is one of the most common complications in patients with oncological diseases and represents a significant negative prognostic factor affecting quality of life, tolerance of anti-tumor therapy, and overall survival. Its development is driven by multiple pathogenetic mechanisms, including chronic blood loss, metastatic bone involvement, functional iron deficiency due to systemic inflammation, and myelotoxic effects of chemotherapy. Early diagnosis of anemia is particularly important, as its presence may serve as a marker of advanced disease, as seen in colorectal cancer. Traditional correction methods – blood transfusions and erythropoiesis-stimulating agents (ESAs) – have substantial limitations. Transfusions carry risks of immune reactions, infections, and potentially worse prognosis, while ESA use is associated with an increased risk of thromboembolic complications and requires strict adherence to indications. In this context, intravenous iron preparations have gained particular relevance. They are effective in both absolute and functional iron deficiency, enabling hemoglobin level elevation, reducing transfusion requirements, and improving patients’ quality of life. Recent studies confirm the safety and high efficacy of monotherapy with intravenous iron, including third-generation agents such as ferric carboxymaltose. Correcting anemia and iron deficiency plays a pivotal role in comprehensive cancer care, helping to maintain treatment timing and improve therapeutic outcomes.

Sleep-disordered breathing is one of the most common sleep-related disorders. According to basic and clinical research, severe obstructive sleep apnea (OSA) is associated with increased all-cause mortality. Other adverse conditions associated with untreated OSA include cardiovascular disease and its complications, the development of type 2 diabetes, obesity and continued weight gain, cognitive impairment, decreased quality of life, excessive daytime sleepiness, and an increased risk of motor vehicle accidents. Their prevalence tends to increase with age. Tools for accurately diagnosing OSA and treatment options have been developed. Obesity is one of the most significant and independent risk factors for the development of OSA. Weight loss is a key aspect of treating patients with OSA, as it has been shown to improve daytime respiratory failure, pulmonary hypertension, sleep-related breathing parameters, and cardiovascular and metabolic outcomes. This review focuses on the results of the SURMOUNT-OSA trial, which assessed the safety and efficacy of tirzepatide, a drug with incretin activity and the first dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, for the treatment of adults with OSA and obesity. The pathogenic mechanisms of OSA in obesity are discussed based on the latest fundamental research and the mechanisms mediated by tirzepatide. In patients with moderate to severe OSA and obesity, tirzepatide reduced the apneahypopnea index, body weight, hypoxic load, high-sensitivity CRP concentration, and systolic blood pressure, and improved patient-reported sleep-related outcomes.

Early disorders of carbohydrate metabolism, due to their high prevalence, are an urgent clinical problem. Many studies indicate a low awareness of primary care physicians about the criteria for diagnosis and approaches to the treatment of prediabetes. However, it is at the stage of prediabetes that changes in various organs and systems characteristic of hyperglycemia begin to form. Early diagnosis and initiation of therapy will improve the quality of life, prevent complications, delay or prevent the development of diabetes mellitus. The purpose of the review is to provide up–to-date data on the diagnosis and treatment of prediabetes. The criteria for disorders of carbohydrate metabolism were described in the 1970s–80s, but a universal approach to diagnosing prediabetes is still lacking. A number of contentious issues remain: whether this condition is truly a stage in the development of diabetes, which diagnostic method to choose, whether lifestyle modifications are sufficient or if drug therapy should be initiated, and which therapeutic method to select. A total of 37 articles were analyzed, including data from randomized controlled trials (RCTs) and 2024 guidelines. The modern physician’s toolkit includes the possibility of pharmacological prevention of type 2 diabetes mellitus using the drug Subetta. This biological agent is created based on affinity-purified antibodies to the C-terminal fragment of the insulin receptor β-subunit and to endothelial NO-synthase. It has a pleiotropic mechanism of action: it increases cell sensitivity to insulin, thereby providing the drug’s hypoglycemic effect. Further information is needed for physicians about various specialties, the risks of developing various organs and systems at the prediabetic stage, and the introduction of active screening and therapy methods.

Introduction. In patients with type 2 diabetes mellitus (T2DM) and obesity, the incidence of metabolically associated fatty liver disease (MAFLD) varies from 70 to 100%, and cardiovascular diseases are five times more common. Metabolic risk factors (RF) for fatty liver disease associated with T2DM are a dangerous combination, mutually aggravate each other’s course and escalate the number of adverse outcomes.

Aim. To investigate the frequency of metabolic risk factors in fatty liver disease in patients with type 2 diabetes.

Materials and methods. An observational cross-sectional (one-time) study was conducted with a retrospective analysis of inpatient observation cards of patients with type 2 diabetes (n = 179). MAFLD was established in the presence of hepatic steatosis, proven by ultrasound, in a patient with type 2 diabetes in combination with two or more metabolic disorders.

Results. The MAFLD phenotype in T2DM includes a high frequency of risk predictors: abdominal obesity and hypertension (100%), obesity (59.2%) and overweight (31.3%); meeting the criteria for MAFLD levels of HDL (94.4%), triglycerides (53.6%) and CRP (68.7%) in the blood plasma. Signs of sexual dimorphism were noted: in men: average age – 51.7%, more often normal (18.9%) and overweight (36.3%); most often AH in stage III (27.6%), complications include diabetic foot syndrome (3.9 times) and significant stenosis of the BCA (3 times). Elderly women (63.7%), were 1.5 times more likely to have obesity and stage III hypertension (13.2%), and suffered strokes more often than men (2.5 times).

Conclusions. The impact of genetic factors and various pathogenetic processes leads to the formation of a pathological pattern with a systemic disturbance of energy balance. To reduce the individual and population risk of vascular complications, it is necessary to control each of the components of MAFLD and achieve their target values.

To objectively assess the condition of patients with osteoarthritis (OA), a number of functional scales and indices have been developed and validated. These allow for a comprehensive assessment of pain, stiffness, and function, as radiographic data correlate poorly with symptoms of the disease. These tools allow for dynamic monitoring and are the standard of evidence-based medicine. The need for a comprehensive approach to assessing treatment effectiveness, going beyond the subjective sensation of pain, is emphasized. A comparison of two clinical cases provides a clear illustration: while in the first case, the physician focused solely on reducing pain intensity according to the visual analog scale, in the second, the use of the WOMAC index (Western Ontario and McMaster Universities Osteoarthritis Index) provided a comprehensive picture, including the dynamics of stiffness and functional limitations. This emphasizes that successful pain relief does not always equate to restoration of the patient’s quality of life and daily activities. The WOMAC index allows for the evaluation of the comprehensive treatment effect and the rationale for further treatment. The presented results of the KOLIBRI study which demonstrated that the innovative Russian drug AMBENE® Bio is not inferior to the reference drug in terms of pain severity, but is statistically significantly superior to the reference drug in terms of restoration of joint function according to the WOMAC index, especially after the second course. This demonstrates its cumulative effect and greater ability to restore daily activities. Therefore, routine use of comprehensive indices (such as WOMAC) is essential for objective OA monitoring. The innovative AMBENE® Bio not only relieves symptoms but also has a proven benefit in improving patients’ functional capacity, enhancing its clinical value in long-term treatment.

This article describes the protective effects of indolecarbinol (IC) and its derivative diindolylmethane (DIM) on the functioning of the cardiovascular, nervous, reproductive, musculoskeletal, and immune systems, as well as the liver. Experimental data indicate that IC and DIM provide organ and tissue protection through their antioxidant, anti-inflammatory, antiapoptotic, immunomodulatory, and xenobiotic properties. To date, most reports of the protective effects of IC and DIM in the treatment of various diseases have been obtained only in preclinical studies; this underscores the urgent need for large-scale clinical trials of these promising phytochemicals. The molecular mechanisms of action of IC and DIM, their pharmacokinetics, and experimental side effects are discussed. Data on the clinical efficacy and safety of an IC-based medicinal product in clinical practice are presented. Further in-depth studies of the efficacy and safety of IC/DIM preparations will significantly expand the arsenal of pharmacological agents for combating socially significant diseases. The studies we analysed have demonstrated that DIM and IC have common and several unique anti-tumour mechanisms, which efficacy depends on the tumour type and/or genotype of the cancer cell line. For example, both compounds influence BC cell cycle progression and inhibit cell growth and migration. In addition, these compounds enhance the expression of detoxifying and antioxidant enzymes by the activation of the Nrf2-dependent pathway and can also influence cell proliferation, apoptosis, migration, invasion, angiogenesis, and immunity. This article examines all the major mechanisms of antitumor action.

Introduction. Late preterm spontaneous births (LPSB) constitute up to 75% of all preterm deliveries. However, current screening algorithms, demonstrate critically low sensitivity for predicting this specific subgroup, leaving most at-risk pregnancies undetected.

Aim. To develop and evaluate a prognostic model for LPSB based on a pathophysiologically grounded grouping of risk factors, incorporating cervical length measurement during second-trimester ultrasound screening.

Materials and methods. A retrospective analysis of 250 pregnant women (125 with LPSB, 125 with term births). Four predictors were assessed: adverse obstetric-gynecological history (AOGH), structural defects of the cervix (SDC), infectious-inflammatory conditions (IIC), and cervical canal length (CCL) measured transvaginally at 180–2066 weeks. The model was constructed using binary logistic regression. Predictive performance was evaluated via ROC analysis, sensitivity, specificity, and Youden’s index.

Results.  Independent predictors of LPSB included: IIC (aOR = 28.284; p < 0.001), SDC (aOR = 3.320; p = 0.016), and CCL (aOR = 0.648 per 1 mm increase; p < 0.001). AOGH lost statistical significance in the multivariate model (p = 0.949). The model achieved an AUC of 0.956; at a cutoff of 0.563, both sensitivity and specificity reached 91.2%.

Conclusions. The proposed model enables highly accurate prediction of LPSB as early as the second trimester, significantly outperforming existing clinical tools. An integrated online calculator facilitates implementation into routine antenatal care, promoting timely preventive interventions and reducing neonatal morbidity risks.

Introduction. Endometriosis is a common pelvic disorder and is frequently associated with infertility. The rAFS/ASRM classification reflects the anatomic extent of disease but has limited ability to predict subsequent pregnancy.

Aim. To develop and substantiate a clinical decision algorithm for infertility management (expectant management, intrauterine insemination, and assisted reproductive technologies [ART]) based on contemporary clinical evidence on the development and prognostic value of the Endometriosis Fertility Index (EFI).

Materials and methods. This work was designed as a methodological paper with elements of an analytical literature review, drawing on original studies and a published systematic review/meta-analysis on EFI. The search strategy covered PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, Google Scholar, and eLIBRARY.ru (through December 2024). Search terms were: (“Endometriosis Fertility Index” OR EFI OR Adamson) AND endometriosis AND (infertility OR subfertility) AND (laparoscopy OR surgery) AND (pregnancy OR non-ART). A total of 312 records were identified; after removal of 54 duplicates, 258 remained; 48 full-text articles were assessed; 27 were excluded (no EFI and/or outcome data, review/case report, insufficient data); 21 studies were included in the qualitative analysis. Quantitative synthesis: one published meta-analysis was used. Results. EFI demonstrates a prognostic gradient: the cumulative pregnancy rate within 36 months increases from ~10% for EFI 0–2 to ~60–70% for EFI 9–10 and outperforms rAFS/ASRM in outcome discrimination (AUC 0.64–0.85; pooled ~0.71). Conclusions. EFI is a practical tool for fertility stratification after surgical treatment of endometriosis; the proposed algorithm supports individualized selection of management strategies. A total of 18 and 23 sources were used to substantiate the Introduction and Discussion, respectively (39 overall).

Introduction. The problem of birth of a fetus of insufficient growth – with fetal growth restriction (FGR) or small for gestational age (SGA) – is relevant all over the world and subject to different pathogenesis pathways. Maternal reproductive experience is considered as a key risk factor for FGR or SGA, nevertheless, leaves questions unanswered.

Aim. Stratify risk groups for FGR or SGA based on reproductive history factors.

Materials and methods. A retro-prospective analytical study carried out. Period – 2016–2021. Adolescent girls and women of reproductive age with completed pregnancies included. A prospective cohort study carried out. Study period – 2018–2023. 611 women with insufficient fetal growth (IFG) were included, divided into two groups: with FGR (n = 435) and with SGA (n = 176).

Results and discussion. In the structure of reproductive losses of patients with IFG, non-progressive pregnancy (NPP) dominates. FGR differs from SGA by: the upcoming first pregnancy (OR = 6.63) or first birth (OR = 3.99); reproductive losses (OR = 1.49 (total), NPP (OR = 2.83), ectopic pregnancy EP (p = 0.01) and spontaneous abortion (SA) (p = 0.007); shorter interval from previous pregnancy (p < 0.001) or birth (p = 0.049) to current pregnancy; higher number of SA (p = 0.006) and artificial abortions (AA) (p = 0.03); shorter period of reproductive losses (p < 0.001); lower number of births (p < 0.001); earlier term of delivery (p < 0.001) and low birth weight (p < 0.001); exclusive association with assisted reproductive technologies (p < 0.001). EP and SA are exclusive markers of FGR, AA are more typical for SGA (OR = 2.13). 44.52% of women with IFG have experience of childbirth, 60.29% of them by cesarean section (CS), most of all among women with FGR (OR = 1.68). Only women with FGR had experience of premature birth (21.84%) and delivery of a low-weight fetus, exclusively in case of prematurity. The hierarchy of the relationship between multifactorial reproductive history and the variant of IFG was confirmed using decision trees (classification and regression).

Conclusion. Patients with IFG have no reproductive experience in 44.19%, and its presence is specific, in 31.42% it is burdened with reproductive losses. FGR differs from SGA in a more burdened reproductive history, which represents it as a marker of reproductive dysfunction. There is a hierarchy of relationships between reproductive history factors and the variant of IFG, which allows forming risk groups at the pregestational stage and early pregnancy, adapting diagnostic and preventive measures to them.

The article presents the clinical case of a 50-year-old patient with stage 2 benign prostatic hyperplasia and acute urinary retention. He had been experiencing lower urinary tract symptoms for almost three years and was undergoing medication without any clinical improvement. The patient underwent embolization of the prostatic arteries using digital imaging technologies for detailed determination of the vascular anatomy of the pelvis and verification of the prostatic arteries. Benign prostatic hyperplasia (BPH) is one of the most common benign urological diseases of a polyetiological nature in men, leading to obstruction of the lower urinary tract. Due to intraand postoperative complications associated with surgical treatment of BPH, such as bleeding, infection, TUR syndrome (a complication of transurethral resection), urinary incontinence, urethral stricture, erectile dysfunction, and retrograde ejaculation, there has been an increased interest in less invasive interventions. Unlike surgical treatment, prostatic artery embolization (PAE) has the advantage of being a minimally invasive procedure with a short hospital stay and early mobilization, and a low risk of serious complications. However, the procedure is technically challenging due to the complex anatomy of the pelvic vessels. To accurately identify the prostatic arteries and minimize the risk of complications, it is optimal to use high-resolution imaging techniques to assess the vascular anatomy in detail and improve the outcome of the procedure.

Introduction. Specific perinatal pathologies in extremely preterm infants include bronchopulmonary dysplasia, retinopathy of prematurity and periventricular leukomalacia, which can subsequently lead to disability. It is necessary to identify new prognostic markers for the development of these pathologies for a personalized approach to the management of such patients.

Aim. To analyze early perinatal outcomes in extremely preterm infants with perinatal lesions of the central nervous system and to establish new predictors of their development.

Materials and methods. An analysis of the frequency of formation of specific perinatal pathology (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL)) was conducted in 66 extremely preterm newborns at the time of discharge from the hospital; Their condition was assessed at birth and during the neonatal period, including an assessment of physical development. Neuromodulin (growth-associated protein 43 (GAP-43)) was measured in the serum on the first day of life.

Results and discussion. Most infants (98.5%) were born in a state of asphyxia and required resuscitation. In the neonatal period, cerebral ischemia and congenital pneumonia were diagnosed in 100% of children. Intraventricular hemorrhage occurred in 27.3% of those examined, anemia in 60.6%, and neonatal jaundice in 48.5% of infants. Infants with BPD and ROP had lower growth rates, more often required invasive mechanical ventilation or longer-term CPAP with elevated oxygen concentrations, and also had longer stays in the intensive care unit. The level of growth protein GAP-43 in the groups of children with BPD and ROP was statistically significantly lower than in children without these outcomes (p = 0.035).

Conclusion. The frequency of specific perinatal pathology in extremely preterm infants by the end of the neonatal period was established: BPD – 15.2%, ROP – 21.2%, PVL – 6.1%. The concentration of GAP-43 was determined for early prediction of the development of these pathologies.

The article discusses the causes of occurrence and the clinical features of chronic dermatoses complicated by mycotic infections, which occur in patients with comorbid backgrounds. It presents data from domestic and international literature on the epidemiology and characteristics of the course of combined dermatoses. Recent scientific studies indicate obesity and metabolic syndrome as aggravating factors in the progression of psoriasis, allergodermatoses, and mycoses. The accompanying somatic problems worsen the course of skin diseases, contribute to their chronicity, hinder effective diagnosis and treatment, reduce patients’ quality of life, and may lead to an unfavorable prognosis. At the same time, a patient with metabolic syndrome may simultaneously present several skin conditions, each influencing the course of the others, which exacerbates the clinical picture and increases the severity of the disease. Warm, moist environments and friction in skin folds promote colonization of eruptions in psoriasis and allergodermatoses by bacteria, fungi, or pathogenic yeasts, leading to eczematization with exudation and erosion formation, often resistant to therapy. Particular emphasis is placed on the diagnosis and treatment of this group of patients, as fold lesions pose difficulties, especially against the background of comorbidities. Effective treatment requires a comprehensive assessment of clinical manifestations and the presence of accompanying diseases to prescribe combination therapies, as well as preventive measures to reduce the risk of secondary infections. The article also includes our clinical observations of patients with a comorbid background (obesity, diabetes mellitus) suffering from chronic dermatoses complicated by mycotic infections. It is demonstrated that the use of Akriderm GK cream (0.05% clotrimazole + 0.1% gentamicin + 1% betamethasone) and Acrimicole cream (2% sertaconazole cream) achieves a positive effect in treating dermatitis complicated by fungal infections in the context of comorbidities.

This article presents current data on the etiopathogenesis of athlete’s foot, the clinical characteristics of the disease, and focuses on the persistence of fungal infections in the modern world. Most often, athlete’s foot is caused by dermatophytes, primarily of the genus Trichophyton. In recent years, the biology of Trichophyton rubrum and Epidermophyton flocсosum has been enriched by the development and application of new molecular genetic methods: in particular, the genomes of dermatophytes have been sequenced and compared. The cellular and biochemical characteristics of human infection with T. rubrum, T. interdigitale, and E. floccosum play an important role in understanding the differences in the incidence of athlete’s foot due to various fungal species. This article describes in detail the process of fungal invasion of human skin and identifies the mechanisms by which fungal colonization and the inflammatory response with characteristic clinical manifestations. The main mechanisms of resistance of fungal infections of the feet are indicated. We describe cases of athlete’s foot in various clinical presentations, including those associated with nail lesions. Much attention is paid to the specifics of external therapy using sertaconazole cream, considering its multifaceted activity, and the need for combination therapy with systemic antifungal agents, in cases of skin lesions with pronounced inflammatory phenomena, or external ones, in the form of varnish, in case of combined lesions of the foot skin and nails (if less than 1/3 of the nail plate is affected). This article presents cases demonstrating the high effectiveness of the therapeutic measures taken, the elimination of clinical symptoms, and etiological cure. There are also identified issues of individual prevention, which is an integral part of preventing the development of chronic recurrent fungal infection.

Introduction. Dental rehabilitation is a complex of therapeutic and diagnostic measures aimed at restoring the functions of the maxillofacial region after injuries, diseases or surgical intervention.

Aim. Clinical evaluation of the developed method of restorative treatment and rehabilitation of patients with soft tissue deficiency in the area of a tooth or dental implant, after reconstructive surgery on the oral mucosa.

Materials and methods. The study involved 281 patients undergoing surgical rehabilitation treatment for oral soft tissue deficiency. All patients were divided into three groups: I (n = 90, control), II (n = 86, control by installing a protective mouth guard) and III (n = 105, algorithm). All patients underwent an assessment of the healing time of the donor and recipient sites and the severity of pain using a visual analog scale.

Results. Long-term healing, lasting 10–15 days, was observed in 57–79% of patients in groups I and II. In 87% and 84% of patients in group III, surgical wounds healed within 6–9 days. In 85–95% of patients in groups I and II, severe and unbearable pain was observed on days 1–4 after surgery. On day 8, 99% of patients in these groups still experienced mild to moderate pain. On days 1–5 of observation, 97% of patients in group III reported moderate or mild pain. On day 8 of observation, 72% of patients in group III reported mild pain, while the remaining patients did not report any pain during this period.

Conclusion. The developed method of software-based optimization of treatment and rehabilitation, which includes vestibuloplasty with digital planning and the use of Sulfacrylate bioadhesive, photobiotherapy, electrophoresis with Fermenkol gel, and normobaric hyperoxygen therapy, has demonstrated a reduction in the healing time of the donor and recipient sites, as well as a decrease in the duration and intensity of pain.

Localized scleroderma (LS) is a chronic autoimmune disease of the connective tissue characterized by focal fibrosis of the skin and subcutaneous tissues. The urgency for in-depth study of the etiological factors and pathogenetic mechanisms of development of LS is determined by the need to identify new biomarkers of the disease that will enable the disease to be diagnosed and the pathological process to be predicted at an early stage. Investigating the role of genetic predisposition, environmental factors, and infectious agents in initiating the autoimmune response, as well as exploring molecular mechanisms of activation of fibrosis formation is of particular scientific interest. Current data indicate significant clinical polymorphism of LS, which creates essential diagnostic challenges and requires improvement of classification approaches. This article presents a review of the current literature on the etiology, pathogenesis, and clinical forms of localized scleroderma. It discusses the multifactorial nature of the disease, including genetic predisposition (polymorphisms located in HLA-DRB1*04:04, STAT4, and IRF5), exposure to infectious agents (Borrelia burgdorferi, herpes viruses), and the influence of exogenous factors (mechanical trauma, ionizing radiation, and chemicals). The pathogenetic section provides coverage of three key aspects of LS development: autoimmune inflammation with a predominant Th2 lymphocyte response and hyperproduction of IL-4, IL-6, and IL-13; vascular disorders manifested by endothelial cell apoptosis and microthrombosis; and activation of fibrogenesis through the TGF-β/Smad signalling pathway followed by excessive deposition of type I collagen. The clinical section presents a detailed classification of LS forms and description of their diagnostic criteria: plaque, linear (including “en coup de sabre” variant), bullous, deep, generalized, pansclerotic, and mixed LS. Lichen sclerosus et atrophicus (LS & A) remains a point of contention among dermatologists due to the ambiguity of its classification and pathogenesis. Results of the systematic literature review indicate the existence of three main concepts explaining the pathogenesis of LS: systemic autoimmune disease, localized scleroderma, or bullous dermatosis variant. In recent years, immunohistochemical and molecular genetic studies have been shown to reveal significant heterogeneity in LS, which requires a revision of existing classifications.

This article is dedicated to the risk factors for psoriatic arthritis development in psoriasis patients, as well as current biotherapeutic options for moderate to severe course of psoriasis and psoriatic arthritis in the absence of response to traditional therapy. The etiology and pathogenetic mechanisms of psoriasis and psoriatic arthritis are considered in the analytical part of the article. The disease is widespread and affects up to 11% of the world's population. One of the most common and severe comorbid conditions is psoriatic arthritis (PsA), which develops in one third of patients with psoriasis. PsA is a chronic potentially severe inflammatory disease of the musculoskeletal system characterized by such clinical manifestations as damage to the axial (spondylitis, sacroiliitis) and peripheral joints (arthritis, dactyl), enthesitis, accompanied by psoriatic skin rashes and onychodystrophy. The disease can develop both before and after the manifestation of skin manifestations. PsA is a disease with a progressive course that can lead to disability and the development of irreversible changes, therefore it requires timely diagnosis, taking into account risk factors and preclinical manifestations, the appointment of effective treatment, and an interdisciplinary approach to therapy. Modern drugs used in the treatment of PsA are aimed at reducing inflammation, maintaining control over the disease and should inhibit destructive processes in the joints, improving the quality of life of patients, meeting modern requirements for efficacy and safety, and not pose a heavy financial burden. The article presents two clinical observations of prescribing disease-modifying treatment to patients with psoriasis and a high risk of PsA and its subclinical manifestations. This article presents two clinical case reports on the treatments of long-lasting psoriasis vulgaris in men with a history of failure to respond to glucocorticosteroids (GCS) and cytostatics. They were prescribed systemic biologic drug therapy, which showed the expected results.