The 8th National Forum of Heads of Pulmonology Departments and Chief Pulmonologists of Russian Federation
constituent entities promoted by Medical Practice Scientific Medical Society was held in Moscow. 

This scientific review presents an analysis of the literature devoted to the significance of patient non-compliance with treatment for chronic cardiovascular diseases (CVD): arterial hypertension (HTN), chronic heart failure (CHF), atherosclerotic cardiovascular diseases (ASCVD). An analysis of the prevalence rate of patient non-compliance in population and cohort studies, the relationship between non-compliance and disease outcomes was conducted. Of independent significance was a systematic analysis of the role of various factors influencing patient non-compliance with treatment for CVD, with the aspect of non-compliance due to socioeconomic factors, including the cost of drugs. A search for publications was performed in the scientific databases PubMed, MEDLINE, ScienceDirect, E-library using the keywords: non-compliance, treatment adherence, cardiovascular diseases, antihypertensive therapy, CHF treatment, statin treatment, generics of cardiovascular drugs, the cost of drugs published no earlier than 2000 and up to March 2026. More than 120 articles were selected, of which 52 articles were selected for qualitative analysis, and 25 articles for quantitative analysis. It was shown that the incidence of non-compliance in CVD in real-world clinical practice is quite high and has a negative impact on the development of adverse cardiovascular events and impairs quality of life. The review reflected a description of specific factors and barriers to optimal adherence to the treatment regimen in patients with various CVDs; the important role of socioeconomic factors and factors related to the cost of drugs was demonstrated. The study of non-compliance due to the cost of drugs revealed 3 main mechanisms: 1) delay in obtaining a prescription due to the cost of drugs, 2) skipping doses, 3) taking smaller doses of drugs than prescribed in order to extend the period of use (i.e., “period stretching”). One solution to this problem is the wider use of generic drugs, the efficacy and safety of which have been proven in clinical practice.

The non-communicable obesity pandemic is inextricably linked to the development of a specific clinical phenotype: obesityrelated arterial hypertension (AH). Its pathogenesis is complex and driven not only by mechanical compression of the kidneys (the “fatty kidney” concept), but also by hyperactivation of the renin-angiotensin and sympathetic nervous systems, as well as systemic inflammation and pronounced endothelial dysfunction. The widespread clinical integration of incretin mimetics, such as semaglutide and tirzepatide, has radically shifted the paradigm of metabolic therapy. Beyond their pronounced weightreducing efficacy, these agents possess substantial antihypertensive potential mediated by both weight-dependent and direct tissue-level effects, such as enhanced natriuresis and direct vasodilation, which often manifest long before a significant reduction in body mass index. Consequently, the continuation of baseline multicomponent antihypertensive therapy (AHT) in the previous dosages in the context of weight loss induced by these agents transforms into a source of iatrogenic hypotension risk. Patients face a rapidly increasing probability of developing severe hypotension, orthostatic intolerance, reduced organ perfusion, and traumatic falls. Based on a literature review and our own clinical experience, this publication introduces an adapted 5-step algorithm for the safe de-escalation of AHT in patients initiating incretin mimetic therapy. The core of this algorithm is the concept of “reverse guidelines” – a planned, step-by-step deprescribing process conducted in the reverse order of classical treatment initiation protocols. Clear clinical and anthropometric triggers for de-escalation have been defined, alongside a strict hierarchy for antihypertensive drug withdrawal (starting with diuretics and alpha-blockers) and a strategy for stepwise dosage reduction. Practical checklists are proposed to ensure systematic monitoring and patient safety, minimize the medication burden, facilitate the optimization of minimally sufficient therapy, or even achieve full clinical remission of obesity-related AH.

Introduction. A promising approach to neuroprotection in ischemic stroke is the use of drugs that combine nootropic and vasoactive properties, providing a comprehensive effect on the processes of systemic reorganization of neuronal connections and the recovery of impaired motor, speech, and cognitive functions.

Aim. To evaluate the effect of combination therapy including Vinpotropile on the dynamics of cognitive function and neurological impairment in the acute period of lacunar stroke.

Materials and methods. This prospective comparative study included 51 patients with lacunar stroke: 26 patients in the study group and 25 patients in the comparison group. The mean age was 65.4 ± 0.8 years. In addition to standard therapy, patients in the study group received Vinpotropile (5 mg + 400 mg) at a dose of 2 capsules three times daily for 30 days after a lacunar stroke. The comparison group received only standard therapy, including aspirin, statins, and antihypertensive drugs.

Results. At the end of 30-days treatment, cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) were statistically significant higher in the study group (+2.8 ± 0.2) than in the comparison group (+1.9 ± 0.3), p = 0.021. By day 30, the median score on the National Institutes of Health Stroke Scale (NIHSS) in the study group decreased to 2 [1; 3], while in the comparison group it remained 4 [2; 6] (p = 0.002). The proportion of patients with functional independence in daily life (mRS ≤ 2) in the study group increased from 76.9% to 84.6%, while in the comparison group it remained 60.0% (p = 0.032 on day 30).

Conclusion. The study results support the inclusion of Vinpotropile in the standard treatment of patients with early recovery period lacunar stroke. A positive therapeutic effect of Vinpotropile is observed after 30 days of treatment initiation, demonstrating the relatively rapid onset of clinically significant action of this drug.

Introduction. Alcohol withdrawal syndrome (AWS) remains one of the most significant clinical problems in addiction medicine, and the search for additional evidence-based therapeutic approaches remains relevant. One such approach may be the use of enterosorbents.

Aim. To determine the effectiveness of including an enterosorbent in the combination therapy of alcohol withdrawal syndrome.

Materials and methods. The study included 60 patients with alcohol withdrawal syndrome who were randomized into two groups of 30 patients each: a standard therapy group and a standard therapy plus colloidal silicon dioxide group. Treatment efficacy was assessed on days 7 and 14 based on changes in clinical symptoms, evaluated using the HAM-A, MFI-20, OCDS, and BIS-11 scales, and laboratory parameters. The severity of alcohol withdrawal syndrome was assessed daily for 7 days using the CIWA-Ar scale.

Results. No statistically significant between-group differences in total CIWA-Ar scores were found on any individual day of observation. The addition of colloidal silicon dioxide was associated with a reduction in anxiety according to the HAM-A scale as early as day 7, and this effect persisted until day 14. The main group also showed a more pronounced reduction in asthenic symptoms according to the MFI-20 scale. Analysis of the obsessive and compulsive components of pathological alcohol craving assessed by the Obsessive-Compulsive Drinking Scale showed statistically significant between-group differences over the day 1 to day 14 interval. The BIS-11 score decreased in both groups by days 7 and 14 of therapy. In the main group, decreases in gamma-glutamyl transferase levels were observed on days 7 and 14, and total bilirubin levels decreased by day 14.

Conclusions. The inclusion of colloidal silicon dioxide in the combination therapy of alcohol withdrawal syndrome was associated with a more pronounced reduction in anxiety and asthenic symptoms, a decrease in obsessive-compulsive alcohol craving by day 14 of therapy, and a more favorable trend in selected biochemical parameters.

Introduction. Modern research has convincingly demonstrated that psoriatic disease is associated with an increased risk of various neurological disorders. Neuropathic pain, cognitive disorders, and cerebrovascular complications are of particular clinical importance, significantly affecting the prognosis and management of patients. 

Aim. To systematize and critically analyze current data on the spectrum of neurological comorbidities in psoriasis and psoriatic arthritis, with an emphasis on neuropathic pain, cognitive impairment, and cerebrovascular risk.

Materials and methods. An analytical review of 128 publications indexed in PubMed, Scopus, and Web of Science databases for the period 2018–2025 was conducted. Inclusion criteria: original studies, meta-analyses, and systematic reviews containing quantitative data on neurological manifestations in patients with psoriatic disease. The sources were stratified by types of neurological pathology: peripheral neuropathy, neuropathic pain, central sensitization, anxiety-depressive disorders, cognitive deficits, and cerebrovascular events.

Results. The prevalence of neuropathic pain in patients with psoriatic arthritis is 26.6–48.5%, depending on the diagnostic tool used. The relative risk of polyneuropathy in psoriasis was increased 19–fold compared with the control group (RR = 19.00; 95% CI 1.12–322.11). The prevalence of depression and anxiety reaches 20% and 21%, respectively. Cerebrovascular morbidity increased by 22% relative to the general population. The role of the IL-23/Th17 axis in the formation of neuroinflammation and disruption of the integrity of the blood-brain barrier has been revealed. Biological therapy targeting TNF-α, IL-17, and IL-23 demonstrates the potential to reduce neurological comorbidity.

Conclusion. Psoriatic disease is a multisystem disorder with a clinically significant neurological component that requires a multidisciplinary approach to patient management.

Kyphoscoliosis is a syndrome characterized by excessive curvature of the spine in the frontal and sagittal planes, which leads to impaired respiratory mechanics and respiratory failure. Kifoscolioz suffers about 1% of the population, but only in 10% of these cases there are significant clinical symptoms. Causes of chest deformation: idiopathic, congenital, deformations associated with neuromuscular diseases, acquired deformations. In the presence of chest deformation, there is often a serious impairment of lung function, which is likely caused by spinal curvature and compression of the chest cavity organs from the chest. These changes can lead to impaired movements of the diaphragm – the main respiratory muscle, resulting in a decrease in its efficiency. Changes in the position of the chest wall, reduced elasticity, and an unfavorable position of the respiratory muscles often lead to restrictive disorders of pulmonary ventilation. The pathogenesis of respiratory failure in patients with kyphoscoliosis is based on alveolar hypoventilation due to changes in the architecture of the chest and the structure of lung volumes, a decrease in respiratory effort during inspiration, a decrease in minute ventilation and hypoventilation during sleep. The aim of this study is to review the methods for correcting respiratory failure in patients with kyphoscoliosis, including surgical and conservative techniques, with a primary focus on respiratory support using non-invasive ventilation. The main conservative method of treating respiratory failure is respiratory support, namely noninvasive ventilation. This method can improve patient survival, normalize gas exchange, increase the efficiency of the respiratory muscles, improve the quality of sleep and life, and increase exercise tolerance.

Introduction. Bronchial obstruction in asthma, resulting from the contraction of smooth muscle, swelling of the mucous membrane, and hypersecretion of bronchial mucus, may also be partially attributed to impaired lung surfactant function.

Aim. To evaluate the efficacy of inhaled surfactant therapy in patients with severe bronchial asthma (SBA) exacerbation and to identify factors associated with treatment response.
Materials and methods. The study included 42 hospitalized patients aged ≥ 18 years with severe bronchial asthma exacerbation (IV–V), who were divided into study and control groups depending on the treatment received. In addition to standard management of asthma exacerbation, the study group received inhaled surfactant at a dose of 75 mg via nebulizer twice daily for 5 days. Patients were followed up at two stages: during hospitalization for 7 days after randomization, and 6 months after completion of the treatment course.

Results. At baseline, the groups were comparable in most parameters, except that asthma control assessed by the ACQ-5 questionnaire was lower in the main group (2.9 vs. 2.1; p = 0.001). During inhaled surfactant therapy, a significant reduction in ACQ-5 score was observed as early as 3 days, with a further decrease to 1.5 points by day 7, and this level was maintained at 6 months (in the control group at 6 months – 2.4 points; p < 0.001). The need for rescue medication in the main group decreased from 3.6 to 0.6 times per day by day 7 (in the control group – from 3.0 to 2.1 times per day, respectively; p < 0.001). Spirometry parameters (FEV1, MEF25–75%) significantly improved in the surfactant group at day 7, and FEV₁ remained improved at 6 months, whereas in the control group FEV₁ decreased at 6 months. Also 6 months after inhaled surfactant therapy the “group × time” interaction was statistically significant for ACQ-5, rescue medication use, and most lung function parameters (p < 0.05), indicating the superiority of surfactant therapy. Blood leukocyte and eosinophil levels showed no significant intergroup differences. Factors associated with the effectiveness of surfactant therapy were baseline MEF_25% (OR = 0.963; p = 0.048), baseline MEF_50% (OR = 0.948; p = 0.040), and baseline blood leukocyte count (OR = 0.446; p = 0.021). The number of exacerbations over 6 months was significantly lower in the surfactant group, with a median of 0.0 (0.0–1.0), compared with 1.0 (1.0–1.0) in the control group (p = 0.003).

Conclusions. Inhaled surfactant therapy in patients with severe bronchial asthma exacerbation leads to a statistically significant improvement in asthma control, reduction in rescue medication use, positive changes in lung function parameters, and a decrease in the frequency of exacerbations within 6 months after treatment. The highest chance of treatment effectiveness is observed in patients with lower baseline MEF_25%, MEF_50% and lower blood leukocyte count.

Introduction. Randomized clinical trials and meta-analyses demonstrate the efficacy of fibrate therapy in ursodeoxycholic acid (UDCA)-resistant patients with primary biliary cirrhosis (PBC). However, there is still limited information on the efficacy and safety of fenofibrate use in routine clinical practice in PBC.

Aim. To evaluate the efficacy and safety of fenofibrate therapy in outpatients with PBC, who have an insufficient response and/ or are intolerant to UDCA.

Materials and methods. A retrospective assessment of treatment response (complete biochemical response, Paris-II, GLOBE scores), adverse events, and disease progression was performed in 63 patients with PBC refractory to UDCA monotherapy, receiving fenofibrate at 145–200 mg daily in combination with UDCA at 13–15 mg/kg/day for at least 6 months (average 21.0 ± 12.8 months). The mean disease duration before diagnosis was 35.4 ± 38.4 months, and the proportion of patients with advanced-stage PBC before therapy was 68.3%.

Results. Paris-II, GLOBE and complete biochemical response rates were 54.0%, 58.7% and 25.4%, respectively, and were negatively associated with the presence of clinically significant portal hypertension (CSPH) (p = 0.0006, p = 0.006, p = 0.001, respectively). The addition of fenofibrate to UDCA reduced the incidence of skin itching from 60.6% to 18.2% (p = 0.0005). The following adverse events (AE) were reported during fenofibrate therapy: myalgia (n = 10); asymptomatic cholecystolithiasis (n = 6); an increase in ALT by 5 or more times from baseline levels, which regressed upon drug discontinuation (n = 2); one patient had a serious AE – bleeding from esophageal varices, probably not related to the medication. A 1.7-fold increase in the incidence of anemia associated with comorbid conditions was noted. Fenofibrate therapy was not associated with a statistically significant increase in the incidence of advanced-stage PBC, clinically significant portal hypertension, or the MELD score in patients with cirrhosis.

Conclusions. The addition of fenofibrate to UDCA in UDCA-refractory PBC increases the response rate and appears to be quite safe.

IIntroduction. The increase in the number of secondary immunodeficiency conditions, driven by population aging, the rise in chronic pathology, and the active use of immunosuppressive therapy for a number of diseases (hematological, oncological, rheumatological, neurological, etc.), dictates the need for timely comprehensive diagnosis and treatment.

Aim. To analyse the experience of using agents with immunotropic activity in various forms of secondary immunodeficiency (SID) in clinical practice.

Materials and methods. A retrospective analysis of medical records of 153 patients seeking medical help with a diagnosis of SID was performed.

Results. An induced form of SID was verified in 98.7% of patients. The most common causes were oncohematological diseases, chronic viral and bacterial infections, and to a lesser extent autoimmune and chronic diseases with metabolic disorders, gastrointestinal lesions, reduced nutritional status, and chronic kidney disease. In 1.3% of patients referred with a diagnosis of SID, the diagnosis of Common Variable Immune Deficiency was established. The leading clinical manifestation of SID was frequent infections refractory to standard therapy regimens. Immunological examination of patients revealed abnormalities predominantly in the phagocytic component of the immune system, which justified the inclusion of drugs affecting the phagocytosis system in the comprehensive treatment. In 53% of patients, the high-molecular-weight immunomodulator azoximer bromide was the drug of choice.

Conclusions. A significant number of patients had an induced form of SID with impairment of the phagocytic component of the immune response. The inclusion of immunotropic drugs targeting the phagocytic immunity, including azoximer bromide, in the comprehensive therapy is justified. This approach contributes to the resolution of SID symptoms and improves the course of the underlying disease.

Introduction. Therapy for iron deficiency conditions that complicate pregnancy, childbirth, and the postpartum period is always considered from the standpoint of the relationship between the safety and effectiveness of the medication, forming the patient’s commitment to long-term treatment.

Aim. To analyze the therapeutic efficacy, clinical tolerance and perinatal outcomes when using a ferrous sulfate medication and Ascorbic acid in the treatment of iron deficiency anemia (IDA) in pregnant women.

Materials and methods. The study included 61 women diagnosed with mild IDA in the first half of pregnancy (main group). The medication for treatment of Iron deficient anemia was used Sorbifer Durules (iron sulfate 100 mg Fe²⁺ and Ascorbic acid 60 mg) 100 mg two times per day, until the normalization of hematological parameters and improvement of the clinical picture, with a transition to 100 mg per day until delivery to prevent IDA. The control group included 43 pregnant women without IDA.

Results. The gestational age included in the observation was 14.9 (3.9) weeks. The positive dynamics were revealed an increase in hemoglobin levels by 6.3 g/l (p < 0.05) after one month of the therapy with further increase in hemoglobin at the end of the third trimester of pregnancy (36.9 ± 1.0 week) by 10.4 g/l (p < 0.05). A decrease in hemoglobin levels to 109.2 ± 6.5 and 114.1 ± 8.4 g/l was noted in patients of the main and control groups after delivery, while maintaining average parameters within the physiological values for the first week of the postpartum period (more than 100 g/l). Adverse events during treatment were recorded in 4.9% of pregnant women; there were no clinical cases requiring cessation of medication.

Conclusion. Clinical data and hematological parameters during therapy with a combination of Ferrous sulfate and Ascorbic acid in an extended-release formula (Sorbifer Durules) in pregnant women demonstrated good tolerance and efficacy in the treatment of iron deficiency anemia.

Introduction. Preeclampsia is a serious complication of pregnancy and one of the main causes of maternal and perinatal morbidity and mortality. It is important to identify women at high risk of developing preeclampsia in the first trimester of pregnancy in order to provide timely therapeutic intervention. At the moment, there is no significant progress in predicting and preventing this complication of pregnancy.

Aim. To predict the occurrence of preeclampsia in pregnant women with comorbidity.

Materials and methods. A retrospective analysis of the exchange cards and birth histories of 158 residents of the Stavropol Territory was conducted. The study was conducted on the basis of the Stavropol Regional Clinical Perinatal Center in Stavropol, Stavropol Territory. Pregnant women (n = 158) were divided into three groups: the first group (n = 58) – pregnant women with overweight or obesity; group 2 (n = 70) – pregnant women with iron deficiency anemia and overweight or obesity; group 3 (n = 60) – pregnant women with iron deficiency anemia and normal body weight.

Results. Pregnant women with obesity and anemia had a higher risk of vulvovaginal candidiasis (χ² = 8.015, p = 0.019), premature birth (χ² = 7.431, p = 0.025) and preeclampsia (χ² = 6.456, p = 0.040). For obese pregnant women, the most significant factors in the prognosis of preeclampsia were: the first pregnancy, the APTT level in the third trimester. For pregnant women with IDA, factors predicting the development of preeclampsia: first pregnancy, smoking, hemoglobin levels in the first trimester. For pregnant women with obesity and IDA, the prognostic criteria for preeclampsia were: the first pregnancy, and the indicator of thrombin time in the third trimester.

Conclusions. The identification of prognostic criteria for individual risk factors for preeclampsia makes it possible to more accurately assess the likelihood of preeclampsia and timely resolve the issue of prevention and initiation of therapy and contribute to the elimination of modifiable risk factors for preeclampsia, such as obesity and anemia.

Uterine fibroids are the most common benign tumors, the emergence and progression of which during pregnancy can increase the frequency of pregnancy and child birth complications. Currently, there is a recorded increase in the number of patients diagnosed with myoma among pregnant women. This is primarily due to the manifestation of the pathology at the younger age, and secondly, it is caused by an increase in the average age of pregnant women, which necessitates the development of methods for the prevention and therapy of this condition during pregnancy. We present a clinical case of a patient who was admitted as an emergency to the St. Petersburg State Health Care Foundation “Mariinsky City Hospital” with complaints of abdominal pain. The preliminary diagnosis of “Acute appendicitis” was ruled out during the examination. Also was identified a serious circulatory disorder in the myoma node (necrotizing fibroid). Patient V., a first-time pregnant, was transferred to the Perinatal Center of the Federal State budgetary Educational Institution of Higher Education “St Petersburg State Pediatric Medical University” of the Ministry of Healthcare of the Russian Federation with the diagnosis: “Pregnancy 28 weeks and 4 days. Uterine fibroid, subserous type. Impaired blood supply to the fibroid node”. Due to intractable pain syndrome and the ultrasound findings (uterine fibroid with signs of impaired blood supply), a laparoscopic conservative myomectomy was performed. The pregnancy was carried to full term, at 40 weeks and 1 day. The birth was vaginal. The performed laparoscopic treatment confirms the effectiveness of surgical intervention when a clinic of fibroid node necrosis develops during pregnancy. Early diagnosis and timely adequate treatment make it possible to achieve successful pregnancy outcomes, including reaching full term.

Introduction. The number of patients with refraction disorders has increased significantly over the past decade, which led to a high rise in keratorefractive laser surgeries. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in ophthalmological practice appears to be a topical issue in patients who have undergone various keratorefractive surgeries.

Aim. To evaluate the clinical and pathogenetic efficacy of nepafenac as part of postoperative therapy in patients after Femto LASIK.

Materials and methods. The study included 120 patients (240 eyes) who have undergone a two-step Femto LASIK laser vision correction due to myopia, myopic, and mixed astigmatism. Patients were divided into two comparable groups: a treatment group, who received nepafenac in addition to standard therapy in the postoperative period, and a control group, who received standard therapy without nonsteroidal anti-inflammatory drugs. All patients underwent cornea optical coherence tomography (OCT) with epithelial and pachymetric mapping, as well as measurements of interleukin-6 and interleukin-8 concentrations in tear fluid using enzyme-linked immunosorbent assay. The laser confocal microscopy scans were performed to evaluate corneal nerves and epithelium.

Results and discussion. In the control group, we observed significantly higher levels of proinflammatory cytokines and incidence of epithelial instability on Day 1 after surgery. In the group of patients receiving Apfecto, interleukin-6 levels were 42% lower, and only 32% of patients displayed a great heterogeneity at the level of epithelial profile. By Days 5–7, uniform epithelial restoration was noted in 88% of patients in the treatment group versus 63% in the control group (p ≤ 0.05). The corneal confocal microscopy showed that corneal epithelium and nerve fiber status was consistent across both groups at all follow-up points.

Conclusions. The introduction of the pro-NSAID nepafenac in the postoperative treatment regimen after Femto LASIK is accompanied by significantly reduced inflammatory activity, as well as more stable and predictable corneal restoration.

Introduction. Refractory blepharitis is a complex disease of the anterior segment of the eye, characterized by prolonged course and persistent symptoms that significantly reduce patients’ quality of life. Conventional treatment methods, including eyelid hygiene, warm compresses, and topical antibiotic therapy, are often insufficiently effective. In recent years, researchers have focused on novel approaches such as probing of meibomian glands (MGP) and the use of intense pulsed light (IPL), as well as their combination.

Aim. To evaluate the efficacy of treating refractory bilateral blepharitis using a combination of meibomian gland probing (MGP) and intense pulsed light (IPL) therapy.

Materials and methods. A total of 200 patients (400 eyes) with a diagnosis of refractory bilateral blepharitis were included in this prospective comparative study and randomized into four groups: combined therapy (MGP + IPL), MGP alone, IPL alone, and a control group. Treatment efficacy was assessed using the SPEED (standard patient evaluation of eye dryness) questionnaire, meibography, non-invasive tear break-up time (NIBUT), meibomian gland expression test, and the Oxford scale for ocular surface staining.

Results and discussion. The most pronounced therapeutic effect was observed in the combined treatment group (MGP + IPL), with significant improvement evident as early as one month after treatment: reduction in symptoms according to the SPEED score, increased NIBUT and tear meniscus height, and decreased meibomian gland atrophy. This positive effect persisted over a 6-month follow-up period. The combination of these two modalities provides a synergistic effect: mechanical restoration of meibomian gland duct patency through probing, together with the anti-inflammatory action of IPL, contributes to stabilization of the tear film and slows the progression of the pathological process.

Conclusion. The combined use of MGP and IPL demonstrates high efficacy in the treatment of refractory blepharitis and surpasses monotherapy. The obtained results confirm the promise of this approach and highlight the need for further research to optimize clinical guidelines.

Urethritis is among the most common urological diseases in men. In the Russian Federation, approximately 350,000 cases of non-gonococcal urethritis are reported each year, which accounts for up to 65% of all inflammatory diseases of the genitourinary (GU) system. In recent years, the global medical community has faced a serious challenge of significantly increased spreading of antibiotic resistance among these microorganisms. The mechanisms acquired by intracellular pathogens to counteract the effect of antibiotics is of particular concern. This phenomenon significantly limits the effectiveness of standard empirical treatment regimens and urges healthcare professionals to discover and clinically implement alternative antibacterial approaches. This review summarizes data on current approaches to antibacterial therapy for urethritis. The authors used peer-reviewed sources from PubMed/MEDLINE, eLIBRARY.RU, Cochrane Library, and Google Scholar, as well as national and international clinical guidelines and recommendations. In total, 79 sources (review articles and original studies among the number) were included. As the results are heterogeneous, the authors used descriptive (narrative) synthesis in the review. A clinical case included as an authors' own observation from real-world clinical practice demonstrates the potential of current antibacterial therapy in a patient with a mixed infection and concomitant organic pathology resulted from gonococcal urethritis. Josamycin maintains activity with the growth of macrolide resistance. The drug has minimal side effects and is approved for use in pregnant women and children. For this reason, Josamycin is considered an effective and safe alternative in urogenital infections, particularly in the presence of multidrug-resistant bacteria. In the context of the above-mentioned issues, Josamycin retains its position as one of the few macrolide antibiotics demonstrating high activity against key urogenital pathogens, such as Mycoplasma genitalium, Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis.

This publication is dedicated to the rationale and implementation in clinical practice of a management strategy for obesity, considered as a chronic, multifactorial, and relapsing disease. The main objective of the article is to propose to the medical community the concept of the “relay approach”, which is designed to replace the traditional opposition of conservative and surgical treatment methods with the principle of their synergistic and sequential application. The authors analyze the biological mechanisms of metabolic adaptation and neurohormonal weight defense, explaining the inevitability of relapses with short-term interventions and dictating the need for continuous patient management. The article details scenarios for the use of “second-generation” incretin mimetics. Clear criteria are proposed for initiating therapy with the GLP-1 RA semaglutide, and the tactic of timely treatment escalation – transitioning to the more effective dual GIP/GLP-1 receptor agonist tirzepatide upon reaching a plateau or a suboptimal response – is justified. A new paradigm is taken into account: the integration of pharmacotherapy with bariatric surgery. The article reveals the role of pharmacotherapy as a “bridge therapy” to reduce surgical risks in patients with severe obesity and as a “reverse relay” tool for the treatment of postoperative weight regain. Separate sections are devoted to optimizing patient conditions in specific clinical situations, including preconception and orthopedic preparation, as well as achieving remission of obstructive sleep apnea syndrome. A differentiated approach is formulated for type 2 diabetes mellitus: a “dual-target strategy” is articulated, taking into account not only weight-reducing efficacy but also economic cost-effectiveness and the organ-protective properties of the medications. This article represents a comprehensive guide aimed at forming multidisciplinary teams to ensure long-term control over the patient’s metabolic health and achieve sustained remission of associated complications.

The novel coronavirus pandemic that ravaged the world has passed, but challenges remain. The long-term consequences of COVID-19 are remain poorly understood. The term “post-COVID syndrome” currently has a temporal component, a clinical and laboratory component, some biomolecular markers have been identified, risk factors for the development of this complication after a coronavirus infection have been determined, and the genetic component of post-COVID syndrome is being clarified. However, regarding post-COVID syndrome in patients with type 2 diabetes, the data are conflicting. Data on the prevalence of post-COVID disorders vary widely, even within a single country. On average, in Europe, the frequency of PCOS in patients with type 2 diabetes is 66.8%, with the maximum frequency being at the age of 50 years. New biomarkers of post-COVID syndrome in patients with type 2 diabetes are emerging, and prognostic criteria for its development in this category of patients are being developed. It was shown that the telomere length was significantly shorter in patients with type 2 diabetes mellitus and post-COVID syndrome than in individuals without post-COVID disorders. High levels of podocyte-specific proteins and neutrophil elastase can serve as criteria for this syndrome. We assessed the significance of some leukocyte indices in the diagnosis and monitoring of the consequences of a new coronavirus infection in patients with type 2 diabetes. However, many unanswered questions remain, in particular, whether there is a genetic predisposition to the development of chronic COVID-19 in patients with diabetes. We previously conducted an analytical review of the presence of PCS in patients with type 2 diabetes. The purpose of this publication was to summarize new data in the literature on the main points outlined previously and to present our own results.

Diabetes mellitus is one of the most common chronic diseases and is associated with a high risk of macrovascular and microvascular complication. Effective glycemic control is a key factor in preventing complications and improving disease prognosis. Poor glycemic control increases the risk of developing late complications of diabetes mellitus, raising the need for effective blood glucose monitoring. It should be borne in mind that glycated hemoglobin (HbA1c) level is measured retrospectively, usually no more frequently than once every 3 to 4 months, which doesn’t provide an opportunity to assess blood glucose fluctuations and readily respond to them. It is self-monitoring of glycemia using individual blood glucose meters that enables routine monitoring and timely therapeutic adjustments. Regular self-monitoring of blood glucose plays an important role in achieving target glycemic levels. Modern blood glucose self-monitoring systems provide high measurement accuracy according to international standards and include additional features aimed at improving usability and interpretation by patients. These features include color indicators of the target glycemic range, synchronization with mobile applications, and technologies allowing reapplication of a blood sample to the test strip if the initial volume is insufficient. This article discusses current approaches to blood glucose self-monitoring in patients with diabetes, clinical significance of measurement accuracy, and the potential of modern technologies to improve patient adherence. The use of advanced blood glucose monitoring systems characterized by accurate measurements and user-friendly features can increase the disease control efficacy, enhance patient adherence to therapy, and reduce the risk of hypoglycemic events. Clinical cases illustrating the practical value of the Contour® Plus Elite self-monitoring system (Ascensia Diabetes Care) in patients of different ages and with comorbidities are presented.

Introduction. Rotavirus infection (RVI) remains one of the leading causes of acute intestinal infections in children and is accompanied by pronounced clinical manifestations and the risk of complications. Despite the widespread use of probiotics in the comprehensive treatment of RVI, the comparative efficacy of multi-strain and single-strain probiotic supplements have not been studied in sufficient detail.

Aim. To conduct a comparative evaluation of the efficacy of multi-strain to that of single-strain probiotics as part of comprehensive treatment of rotavirus infection in children.

Materials and methods. We conducted a prospective, two-center, randomized, open-label study of 327 children aged 1–7 years with laboratory-confirmed RVI. The patients were divided into four groups: inpatient ones (C1 — multi-strain probiotic, C2 – Saccharomyces boulardii) and outpatient ones (A1 — multi-strain probiotic, A2 — Saccharomyces boulardii). All patients received standard treatment. The duration of clinical symptoms, changes in stool frequency and consistency, pain severity, and changes in gut microbiota parameters (in inpatient groups) were assessed. Parametric and non-parametric statistical techniques were applied to analyse the data.

Results. The multi-strain probiotic was found to be associated with a more rapid reduction in stool frequency by days 2 of therapy (p < 0.05), as well as with accelerated normalization of stool consistency. The duration of diarrhea in outpatients in the multi-strain probiotic group was significantly shorter than that in the single-strain group (2.5 ± 0.7 versus 3.2 ± 1.2 days; p = 0.042). In the inpatient groups, there was a statistically significant reduction in the duration of fever (p = 0.029), abdominal pain (p = 0.014), and nausea (p = 0.039). The multi-strain probiotic turned out to be more effective in rebuilding damaged gut microbiome. No adverse events were reported.

Conclusions. Multi-strain probiotics as part of comprehensive treatment of rotavirus infections in children showed higher clinical efficacy as compared to the single-strain Saccharomyces boulardii probiotic supplement and provided faster symptom relief and restoration of gut microbiota.

Introduction. The significance and diagnostic value of examination under Wood’s lamp have been widely discussed in recent years within the dermatological community. The use of this device optimizes the clinical diagnosis of superficial fungal infections, in particular scalp mycosis, based on the appearance of characteristic fluorescence at specific wavelengths.

Aim. To analyze the results of examining scalp mycosis lesions in children caused by Microsporum canis under Wood’s lamp and to evaluate the method’s effectiveness for early disease diagnosis.

Materials and methods. A single-center prospective observational study was conducted. The study included data from 43 patients who received outpatient treatment and follow-up at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology between March 2023 and October 2025. All patients were examined using a Wood’s lamp to assess for the presence of characteristic fluorescence indicative of M. canis infection. Mycological examination included microscopic analysis of hair and scale material from the lesions and bacteriological (culture-based) study on Sabouraud agar to identify the causative agent species.

Results. Scalp mycosis was diagnosed across all age groups, with a slight prevalence among children aged 4 to 6 years. Patients reporting contact with domestic animals accounted for 48.8%, while family infection was implicated in 32.6%. The sensitivity of the method was 67.4%. The diagnostic method using Wood’s lamp demonstrated a statistically significant advantage in specificity (100.0%) in patients with an established epidemiological history related to animal infection and a diagnosis confirmed by culture.

Conclusions. The use of Wood’s lamp can enhance the effectiveness of early diagnosis and treatment of scalp mycosis. It has been demonstrated that careful analysis of epidemiological history is important for determining further patient management tactics. Consequently, a detailed analysis of various factors influencing fluorescence has the potential to significantly improve the scalp mycosis diagnostic process and ensure the timely prescription of adequate therapy.

Background. This article summarizes current evidence on the impact of vitiligo on sexual function, quality of life, and interpersonal relationships, taking into account the role of anogenital involvement, anxiety–depressive disorders, distorted body image, and stigmatization. It also presents the results of our own clinical and psychosexual study of patients with vitiligo in the Russian Federation.

Aim. To assess the prevalence and characteristics of sexual dysfunction in patients with vitiligo and its association with clinical features of the disease and psycho-emotional status.

Materials and methods. A systematic literature search was performed in PubMed, EMBASE, Scopus, and the Cochrane Library. In addition, 50 patients with vitiligo (32 women, 18 men) aged 18–55 years were examined. The clinical type and distribution of lesions, sexual function (FSFI in women, IIEF-5 in men), quality of life (DLQI), anxiety and depression (HADS), and interpersonal and marital relationships (author-designed questionnaire) were evaluated.

Results. The literature confirms an increased risk of sexual dysfunction in patients with vitiligo, more pronounced in women, and its close association with anxiety, depression, and low self-esteem. In our cohort, sexual dysfunction was identified in 68.8% of women and 50% of men; anogenital involvement was associated with lower FSFI scores in women, while DLQI scores did not differ significantly between groups. Clinically relevant anxiety and depression were observed in nearly half of the patients and showed a negative correlation with sexual function.

Conclusions. Vitiligo is associated with considerable sexual and psycho-emotional distress, particularly in women and in patients with anogenital involvement. Assessment of sexual function and psychological status should be incorporated into the routine evaluation of patients with vitiligo, and their management requires a multidisciplinary approach.

Introduction. Monopolar microneedling RF therapy involves controlled thermomechanical tissue injury that can initiate a cascade of reparative responses, including early inflammatory signals, dermal cell activation, and subsequent extracellular matrix remodeling.

Aim. To study gene expression and histological changes in the skin before and after monopolar microneedling with Exion.

Materials and methods. Three patients participated in the study. Skin samples obtained from the abdominal area using punch biopsies (4 mm in diameter) were collected for analysis after monopolar microneedle RF lifting (Exion, BTL Industries Ltd., United Kingdom). Patient 1 used an isolated needle with an extended mode. Patient 2 used a non-insulated needle without an extended mode. Patient 3 used an isolated needle without an extended mode. Gene expression analysis was performed using real-time reverse transcription polymerase chain reaction (RT-qPCR).

Results. The most reproducible morphological finding was an increase in the thickness of the viable epidermis in all three patients. This finding suggests that the epidermis is one of the main compartments responsive to RF microneedling. Dermal remodeling was also observed in all three patients. The RT-qPCR data are particularly noteworthy. Increased COL1A1 expression was noted in all three patients, and elevated COL3A1 expression was observed in two of the three.

Conclusions. The obtained results support the concept of initiating a reparative-remodeling response after monopolar microneedle RF treatment, but require confirmation in larger, methodologically standardized studies.

Introduction. Fungal infections continue to be one of the most common pathologies. Monitoring the prevalence of mycoses is necessary for planning the volume of medical care and optimizing treatment approaches, taking into account regional characteristics.

Aim. To study the epidemiological characteristics of mycoses of various localizations for the period 2020–2024 in the Perm Krai to identify main trends and optimize treatment approaches.

Materials and methods. A retrospective analysis of data from the Territorial Compulsory Medical Insurance Fund of Perm Krai was conducted. Cases of medical care were examined according to ICD-10 codes: B35.0–B35.9 (dermatophytosis), B36.0, B36.8, B36.9 (other superficial mycoses), B37.0–B37.9 (candidiasis). The number of visits in outpatient settings, as well as in day and 24-hour hospital care, was taken into account.

Results. A total of 87,064 cases of mycoses in the analyzed groups were registered during the study period. The prevalence of this group of diseases was 593.7–752.6 per 100,000 population. Dermatophytosis (B35) accounted for 64.1% of the total number, candidiasis (B37) – 15.2%. Other superficial mycoses occurred in 20.7% of cases. The number of dermatophytosis cases increased by 28.8% (from 9,555 to 12,308 visits). In the structure of this group, nail mycosis (B35.1) predominates; its share increased from 58.4% to 63.7%. The most pronounced increase was noted for foot mycosis (B35.3) – 61.1%. Among other superficial mycoses (B36), the increase in the number of cases ranged from 37.6% (B36.9) to 86.2% (B36.8). Candidiasis demonstrated a decrease of 22% mainly due to vulvar and vaginal candidiasis (B37.3). At the same time, a number of nosologies (B37.2, B37.9, B37.0) had a peak in visits in 2022.

Conclusion. The analyzed epidemiological data indicate a 26.7% increase in the prevalence of mycoses from 2020 to 2024. A significant increase in visits related to dermatophytosis is noted. The obtained data can be used for planning preventive and therapeutic measures in the region, optimizing the distribution of outpatient resources, as well as for rational planning of drug provision for the population of Perm and the Perm Krai with antifungal drugs with the appropriate spectrum of action.

Introduction. One of the urgent issues of modern healthcare is the professional burnout of doctors. It has been proven to affect the sustainability of healthcare, the quality and safety of medical care, staff turnover, and economic aspects.

Aim. To summarize international and Russian data on the prevalence, determinants, and consequences of physician burnout, as well as to formulate applied prevention recommendations.

Materials and methods. A narrative review has been prepared with elements of systematization based on searches in PubMed/ Medline, Scopus, Cochrane Library, eLIBRARY.RU, documents of the Ministry of Health of the Russian Federation and relevant organizations. Priority: publications of the last 10 years (emphasis on 5 years), meta-analyses, large cross-sectional studies, national reports, validated burnout measurement tools (MBI and alternatives). Inclusion criteria: studies among doctors of clinical specialties describing prevalence, risk factors, determinants, and interventions. Exclusion criteria: uncensored opinions without data, irrelevant populations, opaque samples.

Results. Physician burnout has a multifactorial nature and significant variability in prevalence, depending on the measurement methodology and the context of the healthcare system. The most persistent determinants include resource overload and scarcity, administrative and digital workload, reduced autonomy, conflict of values, and an insecure organizational culture. The most evidence – based approaches to prevention are organizational and systemic changes, since individual interventions have a moderate effect and do not compensate for structural deficits. The context of reforms and managerial transformations over the past 30 years, the COVID-19 pandemic, staff shortages, and the imbalance between key performance indicators and clinical autonomy are critically important for Russia.

Conclusion. Burnout prevention requires a shift from “individualizing the problem” to managing working conditions and system resources. Combined strategies are promising for the Russian Federation: workload rationing, reducing bureaucracy, supporting primary care and young professionals, developing a team model, confidential psychological assistance programs, and “smart digitalization” as a tool to reduce routine rather than increase it.

Introduction. The article examines the problem of high mortality from chronic noncommunicable diseases (CKD) in the world and in the Russian Federation, where more than 70% of deaths are associated with diseases of the cardiovascular, endocrine, respiratory, digestive systems and oncopathology. It is emphasized that a significant part of these deaths can be prevented by timely identification of risk factors (RFS) and by integrating screening into a continuous preventive continuum.

Aim. Analyze the organization of screening for NCDs from the perspective of continuity of medical care and to develop proposals for improving the prevention system in Russia.

Materials and methods. The paper uses the method of systematic analysis using qualitative and quantitative approaches. Scientific publications (PubMed, eLIBRARY.RU, CyberLeninka.ru, WHO IRIS databases, 2019–2024); regulatory documents of the Ministry of Health of the Russian Federation; data from opinion polls (VTsIOM, Rosstat); international experience (Great Britain, Germany, USA) have been studied; Russian pilot projects to improve the continuity of medical care.

Results. It has been established that a national model of comprehensive screening is being implemented in Russia as part of preventive examinations and medical examinations. Key problems of continuity have been identified, such as: low coverage of the population (28% of Russians have never had a medical examination), communication gaps between levels of care, lack of integrated information systems and limited access to specialized care. Proposals for improvement have been formed, which include: digitalization of patient routes and the creation of a federal screening registry; implementation of the case manager model; integration of prevention into compulsory health insurance with payment based on results; improvement of medical literacy of the population; standardization of clinical routes; development of health and primary care centers.

Conclusion. The implementation of the proposed measures will make it possible to increase the effectiveness of the prevention of NCDS, reduce morbidity and mortality, and achieve the goals of the national project “Long and active Life”.

Introduction. The proportion of international medical students enrolled in Russian-medium medical programmes has been steadily increasing, while many of them continue to experience substantial difficulties in understanding spoken Russian, especially in noise and under high cognitive load. These difficulties directly affect academic performance and clinical communication.

Aim. To identify acoustic, audiological and psycholinguistic factors influencing Russian speech perception in foreign medical students studying in Russian.

Material and methods. The study included 178 students aged 18–30 years (80 from Arab countries, 48 from English-speaking African countries, and 50 from Asian countries) enrolled in medical programs taught in Russian for at least one year and assessing their language proficiency as sufficient for academic purposes. The examination included an ENT examination, pure-tone audiometry, tympanometry, acoustic reflex recording, distortion-product-frequency otoacoustic emissions (DPOAE), and speech audiometry in noise.

Results. ENT diseases were detected in the majority of students, more frequently in the group from Arab countries, while the absence of ENT pathology was significantly more common among students from Africa and Asia. Hearing impairments (predominantly grade 1 conductive hearing loss, less commonly sensorineural hearing loss) were noted in 27.5–40.0% of the subjects, with no significant between-group differences. Tympanometry data showed that 25% of the subjects had type C (with an average peak pressure of -20 daPa). No DPOAEs were recorded in type C tympanograms, or their amplitude was significantly reduced. Signs of initial cochlear dysfunction were also revealed, which were significantly more frequent in the Asian group.Speech audiometry with desensitized speech recorded a shift in the optimal sound pressure level (SPL) for achieving 100% intelligibility with conductive hearing loss up to 95 dB (without auditory discomfort). Speech audiometry in noise showed a statistically significant decrease in maximum values (100%) in all study groups, both with and without hearing impairments, with more pronounced changes recorded in the Asian group (14.0%) compared to the Arabic group (28.8%; p < 0.05).

Conclusion. Speech-in-noise audiometry reveals deficits in understanding spoken Russian that are not captured by pure-tone audiometry or quiet speech tests and closely correspond to real communicative challenges of international medical students in academic and clinical settings.

Introduction. Early and accurate diagnosis of sepsis in patients in intensive care units is critically important. Therefore, it is important to search for biomarkers with high diagnostic and prognostic significance.

Aim. To assess the significance of presepsin (sCD14-ST) in comparison with procalcitonin (PCT) and C-reactive protein (CRP) in patients with clinical signs of a systemic inflammatory response and suspected sepsis.

Materials and methods. A retrospective analysis of the data of 142 patients admitted to the intensive care unit (ICU) of a multidisciplinary hospital in the period from January to December 2025 was carried out. The diagnosis of sepsis was verified according to Sepsis-3 criteria (SOFA ≥ 2 points in the presence of confirmed or suspected infection). The levels of presepsin, PCT and CRP were determined in blood plasma in the first 24 hours after admission. The diagnostic accuracy of biomarkers was assessed by ROC analysis with the calculation of area under the curve (AUC), sensitivity, specificity, positive and negative likelihood ratios.

Results. Of the 142 patients examined, 98 (69.0%) met the criteria for sepsis, 44 (31.0%) had non-infectious systemic inflammatory response syndrome (SIRS). The median presepsin concentration in the sepsis group was 1,284 pg/ml, which was significantly higher than in the non-infectious CVD group (386 pg/ml, p < 0.001). Presepsin AUC for the differential diagnosis of sepsis and non–communicable CVD was 0.87 (95% CI: 0.81–0.93), PCT – 0.84 (95% CI: 0.77–0.90), CRP – 0.72 (95% CI: 0.64–0.80). The combination of presepsin and PCT increased the AUC to 0.91. With a presepsin threshold value of 582 pg/ml, the sensitivity reached 85.7%, and the specificity was 79.5%.

Conclusion. Presepsin demonstrates high diagnostic accuracy in early detection of sepsis, comparable to or exceeding that of PCT and significantly superior to CRP. The combination of presepsin and PCT optimizes the differential diagnosis of infectious and non-infectious inflammations in ICU patients.

Periodontal diseases are among the most common human ailments. At the beginning of the 21st century, the concept of “periodontal medicine” emerged, examining the relationship between periodontal pathology and other diseases of the body. Today, periodontal pathology is associated with more than 50 different systemic diseases. Alzheimer's disease is the most common form of primary degenerative dementia in late life. By 2050, the number of cases worldwide will reach 140 million. The anatomical proximity of the oral cavity and brain suggests a link between periodontal disease and CNS pathology. The authors searched the Pubmed database for sources published before October 19, 2025, that examined the relationship between periodontal pathology and Alzheimer's disease. A total of 630 publications were identified. In the present study, the authors analyzed 121 publications out of 423 sources published over the past 5 years. The data obtained during the analysis demonstrate a link between Alzheimer's disease and periodontal disease, the presence of epidemiological and genetic parallels, and pathogenetic relationships confirmed by clinical and experimental studies. Porphyromonas gingivalis, through multiple virulence factors, acts as a key pathogen in Alzheimer's disease and periodontitis. The analysis of research conducted by scientists over the past five years suggests the importance of interdisciplinary approaches in understanding the systemic consequences of periodontal disease and its potential impact on brain health. The relationship between periodontal disease and Alzheimer's disease suggests that oral health is an important factor in the prevention and treatment of Alzheimer's disease.

Introduction. Visualization methods remain fundamental in modern diagnosis and treatment planning for pelvic organ prolapse (POP). Artificial intelligence (AI), three-dimensional (3D), and finite element (FEM) modeling are emerging as powerful tools with growing recognition of their results.

Aim. To summarize current data on the use of AI, 3D, and FEM technologies in the diagnosis and treatment of POP. 

Materials and methods. Using the PRISMA ScR checklist presented in the review, based on the scope of application, as a methodological framework, PubMed, Web of Science, Scopus, and the Cochrane Library were searched from January 2020 to December 2025. The review included studies applying AI algorithms to diagnostic imaging modalities (ultrasound, CT, MRI), as well as 3D and FEM. Current evidence was examined to identify measures aimed at achieving best practices.

Results. 4,652 records were retrieved, 988 relevant publications were identified, and 254 full-text articles were retained and screened based on titles and abstracts. Fifty-four articles were then assessed for inclusion criteria, and 32 articles were included in the study. Reasons for excluding 22 articles included irrelevance for visualizing POP, insufficient methodological or diagnostic detail, and publication type. The studies were based on internal datasets with limited model interpretability and a lack of external validation, so clinical implementation and outcome assessment remain understudied.

Conclusions. AI methods improve image analysis, optimize workflows, provide a personalized approach, and increase the effectiveness of POP diagnosis and treatment. FEM technologies are effective in functional computer-aided biomechanical assessment of the pelvic floor. Personalized 3D modeling enables the development of optimal surgical treatment strategies. Future studies should prioritize external validation, methodological rigor, standardization, and implementation in real-world settings to bridge the gap between experimental models and clinical utility.