The aim of this publication is to demonstrate the efficacy of tirzepatide in a patient with obesity and obesity-associated comorbidities in a real-world clinical setting. A case report of a 36-year-old patient with obesity, arterial hypertension, impaired glucose tolerance, dyslipidemia, hyperuricemia, and metabolic dysfunction-associated steatotic liver disease is presented. At baseline, body weight was 126 kg, body mass index was 38 kg/m2, and waist circumference was 117 cm. The patient was recommended lifestyle modification and treatment with tirzepatide, with gradual dose escalation to 12.5 mg once weekly. After 15 months of therapy, body weight decreased to 91 kg (-27.8%), body mass index to 27.8 kg/m2, and waist circumference to 94 cm. Body composition analysis demonstrated a reduction in adipose tissue mass with preservation of skeletal muscle mass. Normalization of blood levels of glucose, lipids, uric acid, and blood pressure parameters was achieved during treatment. Echocardiography demonstrated a reduction in epicardial adipose tissue thickness. No clinically significant adverse events were observed throughout the treatment period. Tirzepatide may provide clinically meaningful benefits in the treatment of obesity in patients with cardiometabolic disorders. Its use is associated with substantial weight loss, improvement in glycemic control, lipid profile, and uric acid levels, as well as lower cardiovascular risk. Of particular interest is the reduction in adipose tissue mass while preserving skeletal muscle mass. Tirzepatide has shown multifaceted metabolic effects, along with manageable adverse profiles, which makes it a promising therapeutic agent for addressing obesity and associated comorbidities.

This article examines the characteristics of musculoskeletal (nociceptive) pain in patients with joint hypermobility syndrome and connective tissue dysplasia. Structural collagen deficiency in joint hypermobility syndrome leads to excessive mobility of spinal motion segments and peripheral joints, creating conditions for chronic microtrauma leading to the development of aseptic inflammation. This clinical case presents the course of lower back pain in a patient with joint hypermobility syndrome. A distinctive feature of the disease was the consistent development of functional blocks of the pelvic and lumbar spine joints, arising from dynamic and static overloads. Pathobiomechanical changes included muscle syndromes, represented by myotonic and myofascial pain syndromes. This case also requires differential diagnosis with neuropathic and inflammatory pain. The patient’s low compliance contributed to the disease’s protracted course. Treatment was administered according to a musculoskeletal pain protocol and included NSAIDs, a muscle relaxant, and a high-dose combination of B vitamins. Pathobiomechanical disturbances were corrected using various manual therapy techniques. Diagnosis and treatment of nociceptive pain syndrome in patients with joint hypermobility syndrome and connective tissue dysplasia require a personalized approach, taking into account comorbidity. Treatment effectiveness directly depends on the combination of pharmacotherapy and non-pharmacological treatments.

Introduction. Participants in both activities are exposed to extreme stressors, causing changes in the bioelectrical activity of the brain and cardiovascular system.

Aim. To analyze EEG, NT-proBNP, and secondary stress indicators in participants in each activity.

Results. The level of psychological stress according to the PSM-25 scale in the groups was low (<100 points), signs of autonomic dysfunction according to A.M. Vein were observed in 18.2% of the test group vs 31.3% of the control group, p = 0.350. The EEG in the test group revealed a lower average alpha rhythm frequency (9.7 (9.3–10.4) vs 10.8 (9.8–11.1) Hz, p = 0.014), an increase in interhemispheric asymmetry (11.0 (6.0–19.0) vs 5.0 (3.0–14.0)%, p = 0.041) and higher theta rhythm frequency index (12.0 (9.0–14.0) vs 8.0 (6.0–13.0)%, p = 0.047) compared to the control group. The dynamics of EEG parameters in the hyperventilation test in the test group showed a decrease in the frequency indices of alpha and theta rhythms, an increase in the maximum amplitudes of theta and delta waves, p = 0.014–0.010; in the control group – an increase in the maximum amplitude of theta waves, p = 0.033. The NT-proBNP level was 44.95 (4.7–103.95) pg/ml in the test and 144.9 (36.75–178.5) pg/ml in the control groups, p = 0.059. The alpha rhythm frequency in the groups was associated with the stress level according to the PSM-25 scale (r = 0.392) and NT-proBNP (r = 0.444), its amplitude was associated with the stress level, subjective manifestations of autonomic dysfunction and NT-proBNP (r = -0.420–(-0.394)), p < 0.05.

Conclusions. Objective markers of stress include a decrease in the frequency and symmetry of the alpha rhythm, an increase in theta and delta activity, and NT-proBNP. The hyperventilation test is most significant for detecting stress-induced EEG changes.

Introduction. Symptomatic hemorrhagic transformation (sHT) is associated with poor outcome in ischemic stroke (IS). The search for predictors of sHT for personalized forecasting of this complication is a relevant task.

Aim. To evaluate the prognostic significance of serum concentrations of soluble CD163 (sCD163) and interleukin-38 (IL-38) for assessing the risk of sHT development.

Materials and methods. A prospective cohort study was conducted, which included 86 patients with IS in the carotid territory who received reperfusion therapy (RT). Patients were divided into groups with developed sHT (n = 23) and without sHT (n = 63). Measurement of serum levels of sCD163 and IL-38 prior to RT in patients with IS was performed using enzymelinked immunosorbent assay.

Results. The sCD163 level on admission was significantly higher in the sHT group (549,6 [483,6; 668,7] ng/mL) compared to the non-sHT group (297,3 [235,9; 349,9] ng/mL, p < 0,001). No intergroup differences in IL-38 levels were found. Independent predictors of sHT were identified: sCD163 level (OR 1,010, 95% CI 1,004–1,016, p < 0,001), male sex (OR 5,873, 95% CI 1,261–38,243, p = 0,036), severity of neurological deficit on the NIHSS (National Institutes of Health Stroke Scale) on admission (OR 1,177, 95% CI 1,006–1,439, p = 0,049), and presence of type 2 diabetes mellitus (T2DM) (OR 5,751, 95% CI 1,107–37,296, p = 0,046). A model for assessing the risk of sHT development was created, demonstrating high prognostic value (AUC = 0,96).

Conclusion. Elevated serum concentration of sCD163 is an independent predictor of sHT development after RT. Integrating sCD163 level with clinical parameters (NIHSS score, male sex, T2DM) allows for the creation of a highly accurate model for sHT risk stratification, which may contribute to optimizing patient selection for RT and planning the intensity of their monitoring.

Introduction. Chronic rhinosinusitis without nasal polyps remains one of the most common and clinically significant disorders in otorhinolaryngology, substantially impairing patients’ quality of life and often following a recurrent course. Despite standard treatment, including saline irrigation, topical corticosteroids, and antibacterial agents, symptoms persist in a proportion of patients, necessitating the search for additional effective therapeutic options. One of the promising approaches is phage therapy, which is capable of targeting bacterial pathogens and biofilms while preserving the commensal microbiota.

Aim. To evaluate the efficacy and safety of a complex bacteriophage preparation as part of combination therapy for chronic rhinosinusitis without nasal polyps.

Materials and methods. This prospective study, conducted between 2021 and 2025, included 96 patients with chronic rhinosinusitis without nasal polyps. The main group comprised 66 patients who received standard therapy in combination with a topical bacteriophage preparation, whereas the comparison group included 30 patients treated with standard therapy alone. Treatment efficacy was assessed on the basis of clinical complaints, visual analogue scale scores, SNOT-22 questionnaire results, endoscopic findings, and cytological and microbiological examination data.

Results. The main group demonstrated more pronounced clinical improvement than the comparison group across most of the assessed parameters. Patients receiving phage therapy more frequently showed normalization of the local microbiocenosis, observed in 41 of 66 patients versus 25 of 30 patients in the comparison group. They also exhibited a more marked improvement in subjective symptoms.

Conclusion. The inclusion of phage therapy in the treatment regimen was associated with a more pronounced regression of symptoms, improved quality-of-life indices, and a higher rate of microbiocenosis normalization compared with standard therapy alone. These findings support the clinical feasibility of using topical bacteriophages in patients with chronic rhinosinusitis without nasal polyps.

Introduction. Acute tonsillopharyngitis (ATP) is one of the most common upper respiratory tract diseases in pediatric practice.

Аim. To evaluate the effectiveness of topical therapy for ATP in children using ambazone monotherapy, as well as a combination of ambazone and benzydamine.

Materials and methods. The study was conducted in 29 children (mean age 10.2 ± 4.4 years) who consulted an otolaryngologist for ATP. Patients were randomized into two groups: Group 1 (16 children, mean age 9.9 ± 4.8 years) received monotherapy with ambazone lozenges; Group 2 (13 children, mean age 10.5 ± 4.1 years) additionally received benzydamine. Treatment effectiveness was assessed based on the intensity of sore throat and additional complaints using a 10-point visual analogue scale and confirmed by pharyngoscopy data using a 3-point scale on days 2, 3, and 5 of treatment.

Results. The most significant reduction in pain intensity by day 2 of the study was observed in group 2 – up to 4.1 ± 1.7 points (p_{within- group} < 0.001, p_intergroup = 0.026). By the end of the study, 68.8% of children in group 1 and 69.2% of children in group 2 did not report pain in the oropharynx. Of the additional complaints reported by children, the most significant reduction in complaints intensity of difficulty swallowing, foreign body sensation in the throat by day 2 of the study was observed in group 2 – up to 4.9 ± 0.3 points, and up to 4.8 ± 1.8 points (p_within-group < 0.001, p_intergroup = 0.001, 0.045, respectively). For tickling sensation in the throat, the downward trend was more pronounced in group 2, although not reaching statistical significance – 4.3 ± 1.1 points (p_within-group < 0.001, p_intergroup = 0.081). At the end of the observation, hyperemia and edema of the oropharyngeal mucosa were least pronounced in Group 2 of the study (p_{within- group} < 0.001, p_intergroup = 0.500 and 0.370, respectively).

Conclusion. Our study demonstrated compelling results in terms of expanding the clinical use of the combination of ambazone and benzydamine in pediatric patients with ATP.

Acute respiratory infections (ARIs) is a significant pathology in the current landscape of infectious diseases. Interferons, one of which is interferon alpha-2b nasal drop formulation, play a special role in the treatment and prevention of ARIs in children and adults. This article presents case reports of the use of interferon alpha-2b in pediatrics. The same infection within a singlehousehold outbreak developed differently in different people: from mild rhinitis in a 6-month-old child to complicated croup in a 4-year-old child with a history of allergies. Prescription of interferon alpha-2b nasal drops to all contacts (including the infant recently exposed to the virus and healthy adults) is justified. It boosts local immunity, breaks the chain of infection, and prevents a recurrence of the disease if a person continues to be in contact with the infection source. None of the household members who received interferon alpha-2b nasal drops as a prophylactic agent became ill, despite close contact with the convalescent person. These case reports illustrate the variability of the ARI course in children of different ages within a singlehousehold outbreak and the effectiveness of post-exposure prophylaxis with interferon alpha-2b to prevent transmission of infectious agents among exposed persons.

Swallowing disorders are frequent and cause increased mortality due to aspiration induced pneumonia, malnutrition and deterioration of quality of life. The demographic trend of development of society indicates a continuous increase of dysphagia in the future. Dysphagia occurs at any age, however, its prevalence increases with age. The causes of dysphagia in pediatrics and adolescence differ from those in middle age and senoirs. The main causes of oropharyngeal dysphagia include neurodegenerative and neurological diseases, tumors of the head and neck and the consequences of their treatment. Otorhinolaryngologists are often the first contact person patients turn to with problems of choking and coughing while eating. Diagnosis of swallowing is comlex, especially in cases of silent aspiration, when food enterst the lower respiratory tract without a cough reflex. Currenty, there is no common approach or algorithm for diagnosing oropharyngeal dysphagia. Questionnaires in many languages facilitate by collection of anamnesis and specific symptoms of dysphagia. Screening dysphagia tests allow rapid and cost-effective detection of dysphagia and determinate the necessity for further instrumental diagnostics. The gold standart of diagnostic for oropharyngeal dysphagia are the fiber-endoscopic evaluation of swallowing (FEES) and videofluoroscopy. Each of theese methods has its own advantages and limitations. Interdisciplinary collaboration with other specialists plays an important role not only in diagnosing of dysphagia, but also in planing of treatment, ensuring adequate nitrition and improving the quality of life of patients. The article reflects the main aspects of the physiology of the act of swallowing and modern diagnostic approach for the oropharyngeal dysphagia. The search for publication war carried out using the electronic databases of Google Scholar, PubMeb, eLIBRARY.RU, international and domestic journals.

Introduction. Tuberculosis is among the most dangerous infectious diseases. Its high social significance is due to the severity of its clinical manifestations and the risk of developing multidrug resistance.

Aim. To evaluate the effect of a skin test with a recombinant tuberculosis allergen in young individuals not at risk for developing tuberculosis on the results of tests that determine the secretion of interferon-gamma by blood cells in response to Mycobacterium tuberculosis antigens.

Materials and methods. Design: a prospective, open-label study involving a cohort of healthy adults of both sexes (aged 18 to 30 years) not belonging to risk groups for tuberculosis development, without clinical symptoms of the disease, who underwent a preventive examination for tuberculosis within the prescribed time frame. The study included 30 volunteers: 24 women and 6 men; the median age was 26.0 years (Q1 – 23.9 years; Q3 – 28.0 years). All participants underwent Diaskintest® (JSC Generium, Russia), TB-Feron IGRA (RU No. RZN 2021/14954, SD Biosensor, Inc., Republic of Korea), and TigraTest® TB (RU No. RZN 2024/22462, JSC Generium, Russia). The study included five visits to the center. At each visit, the presence of complaints was recorded, as well as adverse events, if they occurred during the observation period.

Results and discussion. The Diaskintest showed no reaction to the administered antigens (recombinant proteins CFP10, ESAT6) in all patients throughout the entire observation period (day of administration, days 3, 10, and 30). Positive and borderline results of laboratory tests after a skin test with ATP (Diaskintest) are not statistically significant, which allows us to conclude that there is no booster effect in the form of false-positive reactions of laboratory tests to the introduction of ATP.

Conclusion. The obtained results indicate that there is no need to establish a diagnostically significant time interval between skin screening and subsequent laboratory analysis of the specific immune response.

Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have dramatically improved outcomes in people with cystic fibrosis (CF), but their use is associated with a class-specific risk of neuropsychiatric adverse events (AEs), including anxiety, depression, suicidal ideation, and sleep disturbance. We report the case of a 45-year-old woman with a rare CFTR genotype (N1303K/G461E) who had been successfully treated with ivacaftor (since 2016) and subsequently elexacaftor/tezacaftor/ivacaftor (ETI, since 2020) without any psychiatric AEs. After switching to the newer combination vanzacaftor/tezacaftor/deutivacaftor (VTD), she developed an acute severe anxiety-panic state on day 10 of therapy, characterized by intense fear of death, confusion, and recurrent panic attacks. Anxiety severity was assessed using the Hamilton Anxiety Rating Scale (HAM-A): baseline score 4, peak score 42 (severe range; psychic subscale 25/28, somatic subscale 17/28). Following VTD discontinuation and initiation of psychotropic therapy (escitalopram, alimemazine, hydroxyzine), the HAM-A score decreased to 13 within one week. Resumption of previously well-tolerated ETI did not provoke recurrence of symptoms. Causality was assessed as “probable” using the Naranjo Adverse Drug Reaction Probability Scale (score 7). This observation is consistent with a recently reported post-marketing case series describing similar VTD-associated AEs that fully resolved after switching back to ETI. The case highlights that prior good tolerance of CFTR modulators does not preclude the risk of neuropsychiatric AEs when switching to a new agent within the same class, and supports the value of standardized psychometric monitoring (HAM-A, Naranjo scale) with any modulator switch.

Introduction. Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation. In cystic fibrosis (CF), FeNO levels are typically reduced despite persistent chronic airway inflammation; however, its diagnostic and clinical value remains uncertain.

Aim. To evaluate FeNO levels in patients with CF, determine their diagnostic utility, and assess associations with clinical and functional characteristics of the disease.

Materials and methods. A cross-sectional comparative study included 102 adults with confirmed CF and 82 healthy controls. All participants underwent FeNO measurement and comprehensive pulmonary function testing. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance, while k-means clustering and principal component analysis (PCA) were used to explore multidimensional data structure.

Results. Patients with CF demonstrated significantly lower FeNO levels than healthy controls (8.4 ± 7.4 vs 16.9 ± 9.0 ppb; p < 0.001). ROC analysis showed good diagnostic performance of FeNO for distinguishing CF patients from healthy individuals (AUC = 0.82; 95% CI 0.76–0.88). The optimal cutoff value was 10 ppb, providing 75% sensitivity and 77% specificity. Cluster analysis and PCA confirmed clear separation between CF and control groups. Weak but significant correlations were observed between FeNO and age, body mass index, and heart rate, whereas no significant associations were found between FeNO and pulmonary function parameters.

Conclusion. FeNO is a useful non-invasive biomarker for differentiating patients with CF from healthy individuals. However, it does not reflect the severity of airway obstruction or overall disease severity and should therefore be interpreted in conjunction with other clinical and functional parameters.

The prevalence of chronic obstructive pulmonary disease (COPD) in women is significantly underestimated by both physicians and patients. This leads to underdiagnosis and delayed treatment. Currently, COPD prevalence rates are comparable among males and females. However, the growth rate and mortality from this disease are higher among women than among men. There are a number of characteristics of COPD in women: earlier age of onset, shorter smoking history with greater lung susceptibility to tobacco, and the presence of other risk factors, such as biofuel smoke inhalation and occupational exposure. Gender-specific disease progression also includes a lower body mass index (BMI) and more severe bronchial obstruction in women compared to men. It is important to note that gender-specific sensitivity to inhaled pharmacotherapy is currently under debate. Current treatment approaches do not differ between men and women. The mainstay of COPD therapy in patients with severe symptoms is a combination of long-acting anticholinergic drugs (LAMAs) and long-acting beta-agonists (LABAs). The fixed-dose combination of indacaterol/glycopyrronium bromide 110/50 mcg (IND/GLY) has proven effective in both reducing symptoms and preventing COPD exacerbations, while maintaining a high safety profile. The clinical observation, presented in article, demonstrates the specific clinical course of COPD and the effectiveness of IND/GLY therapy in women.

Introduction. Imbalances in macroand trace elements represent common forms of nutritional deficiency and may affect inflammatory responses, antioxidant defense, and the integrity of the gastrointestinal epithelial barrier. In students during the examination period, chronic stress, irregular dietary patterns, and insufficient sunlight exposure may contribute to the development of subclinical deficiency states.

Aim. To assess the bioelemental status of students during the examination period based on macroand trace element concentrations in blood serum and oral fluid, and to evaluate inter-matrix relationships between corresponding elements.

Materials and methods. Forty-five volunteers were enrolled. Fasting blood serum and oral fluid samples were collected once during the examination period. Concentrations of 35 elements were determined using inductively coupled plasma mass spectrometry (ICP-MS). A three-level within-reference interpretation scale was applied for serum data. Spearman correlation analysis was performed.

Results. For most elements, values clustered within the mid-reference subrange or near the lower reference limit. Selenium deficiency was detected in 37/45 participants (82.2%), with pre-deficiency values in 7/45 (15.6%) and reference-range values in 1/45 (2.2%). Strong positive correlations in serum were observed for Mn–Fe (rS = 0.80), Na–Mg (0.78), Na–K (0.72), and Na–Zn (0.66), with moderate correlations for Mg–P (0.51) and P–Cu (0.49).

Conclusions. A tendency toward reduced concentrations of several macroand trace elements was identified in students during the examination period, with the most pronounced changes observed for selenium. This may reflect the development of an unfavorable nutritional and metabolic background. The limited agreement between oral fluid and blood serum parameters does not support considering oral fluid a reliable surrogate marker of systemic microelement status. The use of a three-level interpretation scale may be helpful for identifying pre-deficiency states.

Fatigue/weakness in chronic liver diseases is a clinically significant symptom that goes beyond subjective discomfort and requires separate clinical assessment. Available data indicate that fatigue/weakness affects quality of life, daily activities, and prognosis, while more pronounced fatigue/weakness at baseline is independently associated with a higher risk of adverse clinical events in patients with liver fibrosis and cirrhosis. The relevance of this problem is determined by the high prevalence of the symptom, its multifactorial nature, its frequent combination with sleep disorders, depressive symptoms, and reduced physical activity, as well as the need for an interdisciplinary approach to the management of such patients in real clinical practice. The present manuscript is a descriptive review. Literature selection was carried out taking into account scientific significance, relevance, and correspondence to the topic of the review. The review included 62 publications for the period 1977–2026, including clinical guidelines, position papers, reviews, meta-analyses, and clinical studies. The authors consider terminological aspects, the clinical significance of fatigue/weakness, as well as approaches to its diagnosis and treatment. The algorithm for assessing and managing patients with fatigue/weakness is considered in detail and may serve as a roadmap for clinical actions for practicing physicians. Particular attention is paid to sleep disorders and depressive disorders in liver diseases, since these conditions may exacerbate fatigue/weakness, affect quality of life, and reduce adherence to treatment. The role of ademethionine is also highlighted, as it occupies a unique position in the treatment of fatigue/weakness in liver diseases owing to its pleiotropic action.

The article addresses an urgent challenge of gastroesophageal reflux disease functional dyspepsia overlap. Studies reported a high prevalence rate of this phenomenon (up to 41% of patients with gastroesophageal reflux disease), which is associated with decreased quality of life and refractoriness against conventional therapy. The pathophysiological mechanisms underlying this overlap involve the unified continuum that includes delayed gastric emptying, impaired fundic accommodation, increased epithelial permeability of the esophageal and duodenal mucosa, visceral hypersensitivity, and duodenal dysbiosis. The overlap should be diagnosed by using an integrative approach that would combine the Lyon Consensus 2.0 (2023) for objectification of reflux and the revised Rome V criteria (2026) for functional dyspepsia. Proton pump inhibitors remain the mainstay of the therapeutic strategy; however, the efficacy of monotherapy is often suboptimal in overlapping disease state. Adding prokinetic agents is a justified treatment for the predominating postprandial distress syndrome, as well as rifaximin for the verified bacterial overgrowth syndrome. Rebamipide (Rebagit) plays a special role in the treatment. Its cytoprotective effect specifically targets a key pathogenetic link of the overlap (increased epithelial permeability), resulting in simultaneous treatment of both the esophageal and gastroduodenal components of symptoms. Rebamipide restores mucosal barrier integrity by increasing the expression of tight junction proteins. It also stimulates the synthesis of mucins and endogenous prostaglandins, and exhibits anti-inflammatory activity, reducing neutrophil migration and inhibiting production of reactive oxygen species. These properties are crucial both for the esophagus, where the impact of refluxate on nerve endings is reduced due to restoration of intercellular contacts, and for the duodenum, where rebamipide reduces barrier dysfunction underlying duodenal hypersensitivity.

Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by the formation of non-caseating epithelioid cell granulomas and multisystem organ damage, which arise from an aberrant primarily Th1/Th17-mediated immune response in genetically predisposed individuals. Among the organs involved in extrathoracic sarcoidosis, the liver ranks first after the lymph nodes. However, the true prevalence of liver involvement is probably underestimated due to the asymptomatic course of the disease. The ante-mortem examinations reveal that hepatic granulomas are detected in 3.6–20% of cases, while autopsy results indicate a detection rate of up to 50–80%. The involvement of Kupffer cells in the aberrant immune response lies at the root of the pathogenesis, leading to the formation of granulomas predominantly at the portal/ periportal location, with intrahepatic cholestasis, progressive fibrosis, and, less commonly, noncirrhotic portal hypertension developing overtime. Clinical presentation can be highly variable, ranging from incidental finding of granulomas on liver biopsy to severe cholestatic liver injury leading eventually to liver cirrhosis. Laboratory test results typically show a cholestatic pattern with elevated alkaline phosphatase and gamma-glutamyl transpeptidase levels and less pronounced transaminases. Diagnostic imaging techniques reveal only nonspecific findings, that’s why histological assessment based on liver biopsy remains the gold standard for hepatic sarcoidosis, with a reported sensitivity of approximately 88%. The diagnosis is ultimately established only after the exclusion of alternative causes of hepatic granulomas. Glucocorticosteroids are typically used as a first-line treatment. Unfortunately, the therapeutic benefits of glucocorticoids are limited by the systemic side effects, and do not always result in regression of histological changes. The use of ursodeoxycholic acid is pathogenetically substantiated due to the pronounced cholangiopathic component of bile duct injury. The findings of the analysis of systematic reviews show that 57.5% patients treated with ursodeoxycholic acid achieved a complete clinical and biochemical response, which is superior to glucocorticosteroid monotherapy (42.8%), with a more favorable safety profile. Further data accumulation in prospective registries and randomized trials will refine the precise role of ursodeoxycholic acid in the treatment of hepatic sarcoidosis.

Gastroesophageal reflux disease (GERD) is characterized by a high prevalence in the population, a chronic, progressive course, and a significant deterioration in patients' quality of life. Typical complaints of GERD include heartburn and acid regurgitation, but some patients may experience upper respiratory, respiratory system, and oral symptoms, as well as sleep physiology disorder. These symptoms and disorders are known collectively as the extraesophageal manifestations of GERD, which are a common reason for seeking medical attention from otolaryngologists, pulmonologists, dentists, and other interdisciplinary specialists. In clinical practice, the most common extraesophageal manifestation of GERD is considered to be laryngopharyngeal reflux, associated with such symptoms as cough, hoarseness/change of voice, repetitive throat clearing, excessive phlegm, pain, or sensation of a lump in the throat. Despite a large number of published papers on this issue, clinicians continue to struggle with choosing the optimal diagnostic approach and a rational treatment strategy when managing patients with LPR and underlying GERD. The article provides an analysis of an update on the mechanisms of development of GERD-associated LPR, diagnostic approaches, and treatment optimization options, including introduction of esophageal protectors in treatment regimens. The authors also presented their own clinical observation, highlighting the need for a multidisciplinary approach and a balanced, comprehensive assessment of clinical data and laboratory and instrumental findings when following up patients with suspected extraesophageal manifestations of GERD.

Obesity is a chronic progressive recurrent disease that develops as a result of exposure to provoking external factors and a genetic predisposition, leading to excessive accumulation of adipose tissue, which worsens overall health. Obesity is a major risk factor for a number of other chronic diseases, including type 2 diabetes mellitus and cardiovascular diseases. According to current clinical data, the diagnosis of obesity should not be based solely on the presence of abnormal or excessive accumulation of adipose tissue. Instead, the diagnosis of obesity should include a thorough analysis of the existing and potential effects of excessive accumulation of adipose tissue on human health. In turn, the approach to obesity therapy should include prevention, elimination or improvement of complications, improvement of mental well-being, physical fitness, as well as general health and quality of life. In recent years, the number of drugs for the treatment of obesity has been steadily increasing, which provides a wider range of drugs with different mechanisms of action combined with lifestyle modification. Numerous studies confirm that new drugs for the treatment of obesity, such as semaglutide and tirzepatide, provide significant and sustained weight loss combined with cardiometabolic benefits and act as first-line drugs for the treatment of patients suffering from obesity and most of its complications. This review considers obesity as a chronic disease, examines approaches to its diagnosis, cardiometabolic consequences, and summarizes new treatment strategies.

Introduction. The combination of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) worsens the patient’s prognosis. Vitamin D deficiency, which is involved not only in the regulation of calcium metabolism but also in immune and anti-inflammatory processes, may accelerate the development of CKD in patients with T2DM.

Aim. To assess the association between vitamin D deficiency and the presence of CKD and to determine the threshold value of vitamin D levels associated with the presence of CKD in comorbid patients with T2DM.

Materials and methods. Participants: 172 patients with type 2 diabetes mellitus aged 47 to 85 years (mean age 67.36 years). The examination included the collection of complaints, measurement of blood pressure, anthropometry and laboratory diagnostics (blood and urine tests, vitamin D [25(OH)D] levels, GFR). Patients with T2DM were classified according to vitamin D levels (25(OH)D) into four subgroups: normal level (30–60 ng/ml), insufficiency (20–29 ng/ml), deficiency (10–19 ng/ml), pronounced deficiency (less than 10 ng/ml). The diagnosis of CKD was based on the KDIGO criteria.

Results. In patients with T2DM and CKD, vitamin D levels were significantly lower: median 17.0 ng/ml vs. 42.0 ng/ml in patients without CKD (p < 0.001). Vitamin D deficiency maintained an independent inverse association with CKD after adjustment for obesity and duration of T2DM (adjusted odds ratio 0.570; 95% CI: 0.424–0.767; p < 0.001). The optimal threshold value of vitamin D for detecting CKD is 27 ng/ml (sensitivity – 96.3 %, specificity – 84.2 %, AUC – 0.953).

Conclusion. The analysis revealed a pattern: in patients with T2DM, vitamin D deficiency is associated with a higher frequency of CKD detection, which allows this indicator to be considered as an early signal of potential nephrological risk. Its measurement can become part of the standard screening to identify individuals at high risk of CKD.

Iodine deficiency remains a global public health issue worldwide and is recognized as one of the leading preventable causes of intellectual impairment. The entire territory of Russia is classified as a region with chronic iodine deficiency. Despite ongoing regional prevention programs, the absence of a federal law on universal salt iodization means that mild iodine deficiency persists. This deficiency not only increases thyroid pathology but also leads to a decline in the intellectual potential of the population. The aim is to summarize available data on the relationship between iodine intake and intelligence quotient (IQ) levels, with a particular focus on critical periods of development (intrauterine and neonatal periods, early childhood). A search for publications was conducted in PubMed, Medline, Google Scholar, and eLIBRARY.ru databases using the keywords: iodine deficiency, intelligence, brain, neurodevelopment, prevention for the last 10 years. Severe iodine deficiency is associated with profound and irreversible neurodevelopmental disorders (Cretinism). Moderate iodine deficiency leads to measurable cognitive impairment in children, while mild deficiency is associated with impairments in attention, memory, academic performance, and decision-making speed. Group-based and individual prevention of iodine deficiency in at-risk populations ensures adequate iodine status and positively influences intellectual outcomes. Iodine deficiency plays a critical role in the formation of cognitive functions, especially during the early stages of neurodevelopment. Prevention in at-risk groups using pharmacological preparations of potassium iodide containing the physiological dose of iodine required during these periods is essential.

This publication is devoted to a comparative analysis of the hemostasiological effects of different classes of glucose-lowering agents in patients with type 2 diabetes, with a particular focus on the molecular and cellular mechanisms underlying their impact on coagulation status. It has been demonstrated that the influence of glucose-lowering therapy (GLT) on the hemostatic system is determined by a spectrum of specific pleiotropic effects that may not be directly associated with the antihyperglycemic efficacy of the drugs and often occur independently of the degree of glycemic control. The most robust evidence for an antithrombotic effect has been obtained for glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), which achieve a multilevel reduction of prothrombotic potential through direct inhibition of platelet activation, lowering of plasminogen activator inhibitor-1 (PAI-1) levels, and enhancement of fibrinolysis. Metformin exhibits a pronounced antithrombotic potential via mitochondria-dependent suppression of platelet activity and inhibition of the release of pro-inflammatory mitochondrial danger signals, which is accompanied by a reduction in venous and arterial thrombosis without an increase in bleeding risk. Thiazolidinediones also exert favorable effects on hemostasis through PPARγ/ AMP-activated protein kinase–mediated mechanisms, providing profibrinolytic and anti-aggregatory actions. Insulin and most sulfonylurea derivatives do not demonstrate clinically meaningful beneficial hemostasiological effects; the exception is gliclazide, which is distinguished by a more favorable antiplatelet profile within its class. Tirzepatide has proven cardiovascular safety, being non-inferior to dulaglutide with respect to the risk of major adverse cardiovascular events, which allows one to hypothesize a high anticoagulant potential of this agent; however, dedicated trials with primary hemostasiological endpoints are still lacking. The analysis performed supports the rationale for incorporating coagulation status into the personalization of glucose-lowering therapy, particularly in patients at high thrombotic risk.

Diffuse toxic goiter (Graves’ disease) is an organ-specific autoimmune disorder of the thyroid gland, most often causing hyperthyroidism in iodine-rich regions. Its development is caused by the production of thyroid-stimulating antibodies directed against thyroid-stimulating hormone receptors (TSH receptor antibodies). In addition to the classic symptoms of diffuse toxic goiter, patients with this disease may experience hematological manifestations such as anemia, leukopenia, and thrombocytopenia. Hematological abnormalities in Graves’ disease are relatively common, but their clinical significance increases significantly. In most cases, cytopenia is moderate and reversible. This condition may be associated with the direct effects of excess thyroid hormones associated with thyrotoxicosis syndrome, the use of antithyroid drugs, or the presence of comorbidities. In addition to hematological diseases, which are the cause of cytopenia, its presence can be caused by other autoimmune diseases, such as systemic lupus erythematosus, Sjögren’s syndrome, autoimmune gastritis, celiac disease, autoimmune hemolytic anemia, and others. One of the symptoms or diseases of these diseases may be a disruption in the production or an increase in the disorder of formed blood elements. The frequent combination of Graves’ disease with other autoimmune diseases in multiple autoimmune syndrome (MAS) or autoimmune polyglandular syndrome necessitates a differential diagnosis of cytopenia in Graves’ disease. A literature search was conducted in PubMed/MEDLINE, eLIBRARY.ru, Cochrane Library, and Google Scholar for the period from 1980 to 2026. A total of 128 publications were evaluated, of which 41 were included in the review.

The aim of this review is to analyze current data on the role of obesity and adipokines in the pathogenesis of hand osteoarthritis (HOA). A literature search was conducted in PubMed, Scopus, Web of Science, and eLIBRARY.ru, using keywords: hand osteoarthritis, obesity, adipokines, leptin, adiponectin, resistin, visfatin, chemerin. The analysis included original studies, systematic reviews, and meta-analyses focused on the relationship between obesity, adipokines, and HOA. Publications from 2020–2025 were of particular interest. After screening the literature, the review included 60 sources. The analysis of current data showed that obesity is one of the leading risk factors for developing HOA, and its impact is due not only to increased mechanical load but also to metabolic disorders accompanied by chronic low-grade inflammation. Adipokines play a significant role in these processes, being involved in the regulation of inflammatory responses, remodeling of joint tissues, and degradation of the cartilage extracellular matrix. The most convincing data were obtained in relation to leptin, resistin and visfatin, which have mainly pro-inflammatory properties. At the same time, the results of studies on adiponectin remain mixed. Individual adipokines are associated with the severity of pain, functional impairment and, in some studies, with radiological manifestations of the OSA. The data obtained indicate a significant role of metabolic factors and adipokines in the pathogenesis of OACC. Adipokines can be considered as promising biomarkers of the metabolic phenotype of the disease and potential therapeutic targets, however, further prospective studies are needed to determine their clinical significance.

This review includes the past 20 yearsʼ historical data on the mechanisms through which HPV infection influences pregnancy course, as well as the association between HPV infection and miscarriage, preterm birth, fetal growth restriction, preeclampsia, and intrauterine fetal death. Updated evidence for effectiveness of preventive vaccination is discussed. The review was prepared using PubMed, eLIBRARY. RU, and cyberleninka.ru electronic scientific libraries. The review includes articles containing the keywords “pregnancy”, “pregnancy outcomes”, and “human papillomavirus infection” in combination with the following: “human papillomavirus infection”. A total of 104 articles were selected based on these criteria. Studies were selected if they indicated an association between human papillomavirus infection and pregnancy complications, such as preeclampsia, preterm birth, spontaneous abortion, and others. Qualitative analysis assessed the quality of the methodology, the adequacy of the study design for the objectives, and the strength of the findings. Based on these criteria, 48 articles were selected, with 23 articles excluded due to a high risk of bias, low or very low strength of findings, and failure to meet the inclusion criteria. Quantitative analysis accounted for differences between the clinics and countries in which the studies were conducted and assessed the statistical significance of the results. Data synthesis resulted in the selection of 22 articles, with 11 excluded (due to low representativeness and concerns about the reliability of the results). Eight articles were used to support the Introduction section. In total, the final systematic review includes 70 articles containing relevant data from randomized controlled trials.

Gonococcal infection is one of the most common sexually transmitted infections. The causative agent is the bacterium Neisseria gonorrhoeae, which in most cases runs asymptomatically, significantly complicating timely diagnosis and treatment. The clinical case presented in the article demonstrates the challenges of early diagnosis of gonococcal infection in the postpartum period, where physiological lochia mask pathological discharge, and the absence of routine screening in the third trimester increases the risk of ascending infection and vertical transmission of the pathogen. On the 3rd day after physiological delivery, a 29-yearold puerperal woman complained of itching, dysuria, and profuse mucopurulent discharge. On the 4th day, fever up to 38.2 °C, subinvolution and uterine tenderness developed. A newly diagnosed gonococcal infection of the lower urogenital tract was confirmed by molecular biological testing. The antibiotic Cefixime Express was prescribed at a single oral dose of 400 mg. The fever normalized within 24 hours, the discharge became scanty and mucous, and all symptoms completely regressed over 3–5 weeks. A follow-up PCR test confirmed the elimination of Neisseria gonorrhoeae. The postpartum period represents a critical window for the activation of latent gonococcal infection, facilitated by lochia, patency of the cervical canal, and birth canal trauma. The key takeaway is the necessity of mandatory STI screening in the third trimester even in the absence of complaints, as well as clinical vigilance in cases of late-onset fever, purulent discharge on days 2–3, and uterine subinvolution. Timely single-dose antibiotic therapy with cephalosporins ensures high efficacy in uncomplicated forms; however, test-of-cure is mandatory to prevent ascending spread of the infection.

Introduction. Chronic blepharitis in patients with type 2 diabetes mellitus (T2DM) is characterized by a persistent course, meibomian gland dysfunction, and a high risk of bacterial colonization of the eyelids. The choice of optimal topical antiseptic therapy requires additional evidence-based data.

Aim. To evaluate the clinical efficacy of picloxydine in the treatment of chronic blepharitis in T2DM.

Materials and methods. An open-label randomized study included 60 patients with chronic blepharitis associated with T2DM. Patients in Group 1 (n = 30) received 0.01% picloxydine instillations, while those in Group 2 (n = 30) received 0.01% benzyldimethyl-myristoylamino-propylammonium instillations four times daily for two weeks. Outcomes were assessed using the SPEED questionnaire, Schirmer’s test, tear film break-up time (Norn test), meibomian gland expressibility (compression test), and microbial culture.

Results. After 14 days, patients receiving picloxydine showed a statistically significant advantage over those receiving benzyldimethyl-myristoylamino-propylammonium: a reduction in SPEED scores (p < 0.0001), an increase in tear film break-up time as measured by the Norn test (p < 0.0001), and an increase in tear production as assessed by Schirmer’s test (p < 0.0001). The compression test also confirmed the superiority of picloxydine (p = 0.0051). Culture analysis demonstrated eradication of opportunistic pathogens in 90% of cases with picloxydine versus 66.7% in the comparison group (p = 0.028). No adverse events were recorded in any patient.

Conclusions. Picloxidine 0.05% shows superior clinical, functional, and microbiological efficacy compared to benzyldimethyl-myristoylamino-propylammonium. Picloxidine can be considered a first-line topical therapy for chronic blepharitis in patients with T2DM.

Introduction. Currently, the issue of wearing soft contact lenses (SCLs) with underlying dry eye syndrome (DES) is becoming increasingly urgent. A certain percentage of patients dropout of SCL wear due to DES symptoms while wearing contact lenses. Therefore, the correct selection and timely initiation of tear replacement therapy are considered extremely important. An eye drop formulation containing sodium hyaluronate and trehalose makes it possible to solve problems of hypoxia, mechanical, and toxic-allergic effects, preventing the development of DES.

Aim. To evaluate the efficacy of a tear substitute composed of the combination of trehalose and sodium hyaluronate in patients with DES while wearing contact lenses.

Materials and methods. The trial enrolled 20 patients (40 eyes) with mild to moderate myopia and signs of DES, aged 18 to 34 years (mean age 26.4 ± 4.1 years), wearing biweekly or monthly silicone hydrogel contact lenses. Examinations were conducted at baseline and after 3-month consecutive use of a preservative-free tear substitute containing sodium hyaluronate (18 mg/L) and trehalose (30 mg/L). The examination methods included non-invasive tear breakup time (NITBUT), tear fluid osmolarity, and completion of the validated OSDI-6 questionnaire.

Results. After 3 months of using a tear substitute containing sodium hyaluronate and trehalose, most patients self-reported a perceptional improvement in their condition, accompanied by objective changes in the tear film. The median NITBUT increased from 4 [2.75; 6.0] to 13 [10.0; 14.25] seconds, which is more than three times higher than the baseline NITBUT.

Conclusion. The course of instillations of Hylan Extra tear substitute formulation demonstrated high efficacy in terms of both objective parameters (tear film stability and osmolarity) and subjective symptom assessment in young DES patients wearing contact lenses.

Introduction. Prior to recent years, treatment of cystic fibrosis (CF) consisted primarily of symptom management. The pathogenetic therapy with CFTR modulators has emerged as a revolutionary method, supplying the capacity to correct the underlying CFTR chloride channel dysfunction.

Aim. To evaluate the efficacy of the generic ivacaftor/tezacaftor/elexacaftor and ivacaftor Trileksa® in a group of patients with pediatric cystic fibrosis, who have been previously treated with branded CFTR modulator Trikafta®, over a 9-month period.

Materials and methods. The Russian Cystic Fibrosis Patient Registry (RCFPR) data were analysed. A total of 156 subjects (82 girls (52.6%) and 74 boys (47.4%) aged 6 to 17 years) with a median age at treatment initiation Me (Q1; Q3) 12 (10; 14) were included in the study. Before starting the generic drug, all children received the brand-name drug. The median duration of treatment with the original drug was 25 (19; 30) months.

Results. The median sweat test value achieved during treatment with the brand-name drug remained at the cutoff level of 64 (56; 81) mmol/L after 9 months of treatment with the generic drug (p1-4 = 0.93). The median FEV1 and FVC (%pred spirometry measurements) remained stable without negative changes overtime (FEV1 p1-4 = 0.40, FVC p1-4 = 0.70). The patients had significant changes in weight and height over the 9-month course of treatment. Adverse reactions to Trilexa therapy were rare, and the incidence was comparable with that observed for the generic drug. A slight increase in total bilirubin within reference ranges from 9.6 (7.4; 15.4) at baseline to 11.9 (8.9; 17.5) after 9 months was reported (p = 0.02) while the frequency of elevated liver function tests decreased from 5.2% to 3.2%. The number of patients with mental disorders increased: no depressive coditions were observed at treatment initiation, but after 9 months they were reported in 3.2% of patients. The percentage of patients with sleep disturbances increased from 1.3 to 3.8%, headaches from 3.8 to 6.4%, and fatigue from 4.7 to 6.4%.

Conclusions. The generic Trileksa is not inferior to the brand-name drug, helps stabilize the achieved clinical and therapeutic outcomes and leads to further improvement in the course of the disease. It is safe, and well tolerated in patients. The long-term efficacy and safety of the drug must be monitored and continuously evaluated while on the market.

Experts resolution assess the role of probiotics in pediatric surgery and address a practical question: should probiotics be prescribed concomitantly with antibiotics? The paper examines how surgical stress, limited enteral feeding, and antibiotic therapy in children disrupt the gut microbiota and increase the risk of antibiotic-associated diarrhea, including Clostridioides difficile, nosocomial diarrhea, and postoperative infections. Based on data from systematic reviews and clinical observations, the authors emphasize the principle of strain specificity: clinically meaningful effects are expected when using strains supported by evidence, primarily Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. Lactis. It is noted that multi-strain combinations may provide a more pronounced reduction in the incidence of infectious complications. The experts propose a practical approach: initiate probiotics from day 1 of antibiotic therapy in the preoperative period and continue for at least 2 weeks after surgery, with duration individualized. The Expert Council considers probiotics a promising component of perioperative support in children, potentially reducing the risk of antibiotic-associated dysbiosis and nosocomial diarrhea, including C. difficile-associated complications (e.g., pseudomembranous colitis), accelerating microbiota recovery after perioperative antibiotic prophylaxis, and lowering the likelihood of inflammatory, infectious, and nosocomial complications, including hospital-acquired intestinal infections. Additional potential benefits include support of local and systemic immune responses, reduced perioperative stress burden, and earlier mobilization, which may contribute to shorter rehabilitation.

Introduction. Total parenteral nutrition (TPN) is an essential component of care for preterm infants; but its prolonged use may increase the risk of infectious complications and mortality. Quantitative estimates of the impact of TPN duration on outcomes in Klebsiella infection; adjusted for confounding factors; remain insufficiently studied.

Aim. To assess the effect of TPN duration (>14 days) on mortality risk in preterm infants with generalized Klebsiella pneumoniae infection and to develop a prognostic model.

Materials and methods. A retrospective cohort study of 91 neonates with confirmed Klebsiella infection; divided into 3groups according to birth weight. TPN duration; complications; and laboratory parameters were assessed. Multivariable logistic regression with ROC analysis was used to identify mortality predictors.

Results. Prolonged TPN (>14 days) was observed in the vast majority of preterm infants (ranging from 66 to 75% across subgroups). Overall mortality among preterm infants was 15.4%; it was highest in the 1000–1500 g group (23.7%). In multivariable analysis; TPN >14 days was an independent predictor of mortality (AOR = 42.6; 95% CI 2.5–729; p = 0.010). The prognostic model showed good discriminatory ability (AUC = 0.84; 95% CI 0.73–0.95); a probability threshold of 30% yielded sensitivity of 86% and specificity of 78%. In patients with the combination of TPN >14 days; CRKP; and stage III NEC; initiation of combination antibiotic therapy later than 48 hours was associated with 100% mortality. Shortening TPN duration to <14 days was associated with a 4.5-fold reduction in mortality (OR = 0.22; 95% CI 0.06–0.77).
Conclusion. TPN duration >14 days is a strong independent modifiable risk factor for mortality in preterm Klebsiella sepsis. Early transition to enteral nutrition and strict control of TPN duration may substantially improve survival in this cohort. The developed prognostic model can be used for risk stratification.

Introduction. Eczema is a common inflammatory skin disease characterized by pruritus, impaired quality of life, and the need for safe anti-inflammatory therapy.

Aim. To evaluate the safety and efficacy of two cream formulations containing methylprednisolone aceponate in patients with uncomplicated eczema.

Materials and methods. A postmarketing, open-label, comparative, randomized, parallel-group, phase IV study was conducted at three study sites in the Russian Federation. The study population included patients aged 18–70 years with acute or subacute uncomplicated idiopathic eczema affecting no more than 10% of the body surface area. 228 patients were randomised to receive either Komfoderm® K (n = 114) (intervention group) or Advantan® (n = 114) (comparator group). The drugs were applied topically once daily for 2 weeks, with follow-up period of 21 ± 2 days. The primary endpoint was the overall rate of adverse events over 3 weeks. The secondary endpoints included changes in the EASI, the pruritus intensity on VAS (100-mm line), the DLQI, and the sum of 7 eczema symptom scores.

Results. Any adverse event was reported in 4/114 patients (3.5%; 95% CI 1.0–8.7) in the intervention group and 3/114 (2.6%; 95% CI 0.5–7.5) in the comparator group; no statistically significant differences between the groups (p > 0.999). All adverse events were defined as mild, non-serious, and not related to both drugs. By day 14, differences in LS-mean percentage change in EASI score was 2.42% (95% CI -1.17; 6.02), which met the criterion for comparable efficacy. Intergroup differences in EASI, VAS, DLQI, and 7 symptoms scores were not statistically significant.

Conclusions. Both drugs demonstrated a favourable safety profile and comparable clinical efficacy in the 2-week treatment of uncomplicated idiopathic eczema. The patented ceramide-based formulation can be considered as an additional pharmaceutical characteristic of the drug in line with the targets to restore the epidermal barrier.

Introduction. Psoriasis is a common chronic immune-mediated inflammatory skin disease that significantly reduces patients’ quality of life. Modern treatment approaches, especially biologic therapy, demonstrate high efficacy; however, there is substantial interpatient variability in treatment response.

Aim. To develop a prognostic model for assessing the risk of biologic therapy failure in patients with psoriasis.

Materials and methods. The study included 52 patients with moderate-to-severe psoriasis receiving IL-17A inhibitor therapy. A comprehensive analysis of clinical parameters (PASI, BSA) and serum cytokine levels was performed. Treatment efficacy was assessed after 3 months according to a 50% reduction in the PASI score. Results. A therapeutic response was achieved in 75% of patients. The key predictor of treatment efficacy was the IL-17 level: patients with a positive response had significantly higher baseline levels of this cytokine. Based on the obtained data, a mathematical model for predicting the efficacy of biologic therapy was developed (p < 0.001; AUC = 0.820; 95% CI: 0.670–0.969) with a sensitivity of 69.2% and specificity of 82.1%.

Discussion. A significant association was found between baseline IL-17 levels and treatment response. High IL-17 concentrations indicate an active Th17 response and predict a better treatment outcome. The developed model makes it possible to personalize treatment selection and minimize the risk of ineffective therapy.

Conclusions. IL-17 levels are a significant predictor of the efficacy of biologic therapy in psoriasis. The developed prognostic model has high diagnostic value. A personalized approach to therapy selection based on biomarkers can optimize psoriasis treatment. The study results provide a basis for the development of personalized medicine in dermatology.

Introduction. Atopic dermatitis (AD) in children is characterized by a chronic relapsing course, marked pruritus, sleep disturbance, and reduced quality of life. In patients with moderate-to-severe disease, there remains a need for additional anti-inflammatory approaches that improve symptom control and reduce the need for treatment escalation.

Aim. To evaluate the use of the anti-inflammatory drug ammonium glycyrrhizinate (Reglisam, VIFITECH, Russia) in combination therapy and in the prevention of AD exacerbations in children with moderate-to-severe disease.

Materials and methods. An open-label, prospective, observational comparative study was conducted on 60 patients aged 2–17 years with moderate-to-severe AD. The main group included 30 children who received standard therapy combined with Reglisam for 84 days; the comparison group included 30 children who received standard therapy alone. SCORAD index, clinical symptoms, pruritus, sleep disturbance, quality of life assessed by CDLQI, need for additional therapy, and safety were evaluated.

Results. In the main group, a significant reduction in AD activity was observed: by day 84, the SCORAD index was 55% lower than in the comparison group (p < 0.001). By the end of follow-up, mild degree of disease was observed in 90.0% of patients in the main group and in 23.3% of patients in the comparison group. During Reglisam therapy, the extent and severity of skin lesions, inflammatory manifestations, pruritus, and sleep disturbances decreased, and quality of life improved. AD exacerbations occurred less frequently (33% vs 93%), and the need for topical glucocorticosteroids and antihistamines was lower. No adverse events related to Reglisam were reported.

Conclusion. The addition of the anti-inflammatory drug Reglisam to standard therapy for moderate-to-severe AD in children aged 2–17 years may be considered an effective and well-tolerated component of comprehensive treatment and prevention of disease exacerbations.

According to epidemiological data, superficial mycoses may affect approximately 20–25% of the global population. They account for 37–40% of all dermatological diseases, which further underscores the need for discussion and development of preventive strategies both within the specialty and in an interdisciplinary context. The imperative to update approaches to timely prophylaxis and appropriately prescribed antifungal therapy is driven by the rising incidence of complications associated with long-standing dermatophytoses, as well as by recurrent mycotic infections in high-risk populations. The article analyzes 34 publications devoted to the treatment of mycoses of the feet and onychomycosis, posted on the websites of specialized foreign and Russian scientific publications. This article reviews contemporary risk factors for tinea pedis and onychomycosis, including a dynamic lifestyle, self-medication, hereditary predisposition, and comorbid conditions. Preventive measures are examined, the observance of which is critical not only for achieving optimal outcomes of antimycotic treatment but also for preventing disease recurrence. Topical agents are systematically categorized, with their potential utility as adjuncts in combination therapy for mycoses and as prophylactic tools for modifying risk factors for tinea pedis and onychomycosis. The successful management of mycosis depends not only on accurate diagnosis but also on patient adherence to prolonged treatment regimens and preventive measures, as well as on the recognition that relapses are common and are likely to necessitate further therapy. At present, robust evidence is lacking to support a long-term maintenance regimen of topical etiotropic therapy as a strategy for preventing or reducing the frequency of recurrences. Nevertheless, a number of straightforward preventive principles have been identified, which patients may adopt to improve their clinical status, achieve remission, and, over the long term, prevent the recurrence of mycosis.

Introduction. The high variability of the cytokine profile in patients with psoriasis and the risk of adverse events (up to 30% of cases) make it difficult to choose the optimal therapy. In this regard, pharmacogenetics, which studies the effect of single- nucleotide polymorphisms of cytokine genes and their receptors on the effectiveness of treatment, is a promising area.

Aim. To evaluate the association of polymorphisms of genes IL-1B (rs16944), IL-2 (rs2069762), IL-4 (rs2243250), IL-6 (rs1800795), IL-10 (rs1800896, rs1800872), IL-12B (rs3212227), IL-15RA (rs2296135), IL-17A (rs2275913), IL-17F (rs612242), IL-23R (rs11209026), TNF (rs1800629) with dynamics of PASI and BSA indices in patients with moderate and severe psoriasis on the background of three therapy regimens: mometasone furoate, methotrexate and IL-17A inhibitor.

Materials and methods. The study included 155 patients (aged over 18 years, duration of the disease from 6 months to 3 years), randomized into 3 groups according to the treatment regimen. The clinical outcome was assessed after 3 months by reducing the PASI index by 50% or more (PASI 50) and the BSA index. Statistical processing was performed in the StatTech v. 4.11.2 program.

Results. The evaluation of the rs2296135 polymorphism of the IL15RA gene in group 1 (THCs) revealed a statistically significant association with the dynamics of both PASI and BSA (p = 0.02). Carriers of the T/T genotype showed the greatest decrease in PASI (19.89 ± 5.77), while homozygotes with C/C had practically no decrease (-0.004 ± 2.23). No significant associations were found in groups 2 and 3, although in group 2 there was a tendency for T/T carriers to be more effective. The remaining polymorphisms showed no significant associations.

Conclusion. The rs2296135 (IL15RA) polymorphism, the T/T genotype, is associated with higher efficacy of topical mometasone furoate therapy in patients with psoriasis, whereas the C/C genotype is associated with treatment resistance.

This article describes the clinical observation of the patient who developed multiple new diseases after suffering a new coronavirus infection in 2020. Before COVID-19, she had only been diagnosed with hypertension. The patient experienced a severe case of COVID-19, developing pneumonia (CT2) in 2020 (at age 52), Four months later, diabetes mellitus was newly diagnosed, and three months later bronchial asthma and paroxysmal arrhythmias were diagnosed . Three years later, in 2024, the patient again experienced a new coronavirus infection, after which she noted a significant deterioration in cognitive function, hypertension control, and diabetes. Over the past year, progression of all microand macrovascular complications of diabetes mellitus has been noted – nephropathy (decrease in SCF from 55 to 21 ml per min), retinopathy (non-proliferative retinopathy), significant deterioration of polyneuropathy, progression of atherosclerosis, confirmed by instrumental methods (ultrasound Doppler imaging of the lower extremities, ultrasound Doppler imaging of the cerebral vessels). The data are consistent with severe post-COVID syndrome. The results are compared with global data. Risk factors for the development of post-COVID syndrome are identified. Associations of single-nucleotide polymorphisms of pleotropic genes with the development of severe post-COVID syndrome are found. Personalized therapy is identified.

This article discusses the differential diagnosis of treatment-resistant neck pain. Traditionally, cervicalgia is considered a nonspecific musculoskeletal pain successfully treated with standard treatment (NSAIDs, muscle relaxants) for 2–4 weeks. However, in the two presented clinical cases of middle-aged patients (45 and 48 years old) with subacute, intense pain lasting 1–2 months, standard therapy proved ineffective, necessitating a revision of the diagnostic framework. This description is of interest because it demonstrates a rare cause of secondary cervicalgia–vertebrobasilar dolichoectasia–simulating nonspecific musculoskeletal pain. Key “red flags” for further investigation included: reluctance to treatment, persistent pain, dissociation between pain severity and local muscle tension, and phenotypic features of connective tissue dysplasia (positive Beighton criteria). MR angiography verified compression of the medulla oblongata and pons by a tortuous, dolichoectatic left vertebral artery. As a result, the diagnosis was revised from nonspecific to secondary pain due to neurovascular conflict, and the patient was referred to a neurosurgeon. Therefore, in cases of prolonged neck pain associated with connective tissue dysplasia that is refractory to standard therapy, vascular anomalies must be excluded to promptly adjust the management strategy for this patient population.

Introduction. Screening of healthy volunteers is an essential stage of Phase I clinical trials and bioequivalence studies, ensuring participant safety and the quality of the study population. A high rate of screening failures leads to prolonged recruitment periods, additional costs, and reduced efficiency of clinical trial conduct. However, data on the structure of screening failure causes and associated risk factors remain limited.

Aim. To assess the frequency of screening failures, identify the main causes of screening failure among healthy volunteers, and evaluate the influence of demographic factors on screening outcomes.

Materials and methods. A retrospective analysis of screening data from 1,000 healthy volunteers evaluated for participation in Phase I clinical trials and bioequivalence studies was performed. All participants underwent clinical examination, electrocardiography, laboratory testing of blood and urine, screening for infectious disease markers, and testing for alcohol and illicit drugs. Statistical analysis included descriptive statistics, the χ² test, Student’s t-test, and ROC analysis.

Results. Screening failures were identified in 175 volunteers (17.5%). The main causes of screening failure were abnormalities in biochemical blood parameters (31%), followed by deviations in complete blood count, inability to comply with study protocol requirements, detection of infectious markers, electrocardiographic abnormalities, and blood pressure deviations. The frequency of screening failures was not associated with sex (p = 0.164). Volunteers older than 40 years had a higher risk of screening failure, primarily due to age-related metabolic abnormalities.

Conclusion. Laboratory abnormalities, particularly deviations in biochemical blood parameters, represent the leading cause of screening failures among healthy volunteers. Age is a significant risk factor for screening failure, whereas the effect of sex on the overall screening failure rate was not statistically confirmed. The findings may be used to improve volunteer pre-screening algorithms, enhance recruitment efficiency, and optimize the conduct of early-phase clinical trials and bioequivalence studies.

Artificial intelligence (AI) in dermatovenereology has, in recent years, evolved from an experimental concept into an effective tool for clinical decision support. Modern algorithms demonstrate high diagnostic accuracy in the recognition of skin neoplasms and inflammatory dermatoses, and their use by physicians improves the sensitivity and specificity of diagnosis. AI is actively applied in the analysis of clinical images, teledermatology, confocal microscopy, and histological studies, enabling more objective assessment of skin lesions and monitoring of disease dynamics. AI is of particular importance in the management of patients with allergic dermatoses, where the clinical presentation is often complicated by secondary infection. Clinical decision support systems can detect microsigns of inflammation, assess the risks of bacterial and fungal complications, and recommend preventive therapeutic approaches. This facilitates earlier and more justified use of combination topical therapy. Combination preparations containing glucocorticosteroids, an antibiotic, and an antifungal agent allow simultaneous control of inflammation and the infectious component. The use of such agents as Akriderm GK demonstrates high clinical efficacy and rapid achievement of remission. The integration of AI into clinical practice improves diagnostic accuracy, accelerates therapeutic decision-making, and reduces the risk of complications. At the same time, the key role in decision-making remains with the physician, while AI serves as an adjunct tool that enhances clinical reasoning and improves the quality of medical care.

Introduction. Chronic rhinosinusitis is a heterogeneous inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, the clinical significance of which is determined by the duration of symptoms, the frequency of exacerbations, high-quality treatment, as well as the impact on quality of life. In an industrial metropolis, the analysis of the refractory course of the disease, including the regional aerogenic background, is of additional importance.

Aim. To evaluate the impact of anthropogenic stress on the formation and features of the refractory course of various forms of chronic rhinosinusitis in patients living in a megalopolis with a developed heavy industry.

Materials and methods. A retrospective comparative analysis of 152 patients was performed: 72 patients with chronic rhinosinusitis and 80 patients with polypous rhinosinusitis. In each phenotypic group, refractory and non-refractory course was distinguished and clinical symptoms were evaluated. Statistically significant differences were considered at p < 0.05.

Results. A refractory course was detected in 52 of 152 patients (34.2%). Among patients without nasal polyposis, the refractory variant accounted for 29 out of 72 cases, among patients with polypous rhinosinusitis – 23 out of 80 cases. In both phenotypic groups, the refractory course was accompanied by higher values of SNOT-22 before and after surgery, greater severity of nasal congestion, abnormal discharge, and facial pain according to VAS. At the same time, the severity of CT changes did not differ statistically significantly between the refractory and non-refractory course in either non-polypous or polypous forms.

Conclusion. The refractory nature of chronic rhinosinusitis in megalopolitan residents is more associated with clinical severity, quality of life, impaired mucociliary clearance, and repeated need for antibacterial therapy. The results obtained confirm the need for phenotype-based follow-up of patients after surgical treatment and more accurate consideration of comorbid and regional risk factors.

Introduction. Given the clinical heterogeneity of laryngopharyngeal reflux (LFR) and the absence of universally accepted diagnostic criteria, comprehensive assessment of both subjective symptom dynamics and objective videolaryngostroboscopic (VLSS) findings during therapy is of particular importance.

Aim. To evaluate changes in the clinical and functional status of the larynx in patients with LFR and gastroesophageal reflux disease (GERD) receiving antireflux treatment, based on VLSS findings and the Reflux Finding Score (RFS) and Reflux Symptom Index (RSI) questionnaires.

Materials and methods. A total of 20 patients were examined, including 10 men and 10 women. Assessment was performed at three visits: before treatment, after 4–5 weeks, and after 8–9 weeks. At each visit, the Reflux Symptom Index (RSI) and Reflux Detection Score (RFS) data were assessed. All patients received pharmacological therapy consisting of a proton pump inhibitor at a standard dose for 4-8 weeks, along with lifestyle modification recommendations.

Results. At baseline, the median RSI was 15.5 points and the median RFS was 12.5 points. After 4 weeks, the median RSI decreased to 8.0 points, and after 8 weeks to 4.0 points. The median RFS decreased from 12.5 to 8.5 and 5.5 points after 4 and 8 weeks, respectively. The differences were statistically significant (p < 0.001). A clinically significant decrease in RSI of at least 30% was achieved in 95% of patients, while a clinically significant decrease in RFS was observed in 90%. By the end of follow-up, 85% of patients reached the threshold value of RFS ≤ 7.

Conclusions. Antireflux therapy in patients with LFR and GERD is associated with a marked reduction in subjective symptoms and laryngopharyngeal manifestations of the disease, as assessed by VLSS.

Introduction. Smoking, as one of the significant modifiable risk factors, is being actively studied in the context of asthma.

Aim. To assess the effect of electronic cigarettes and electronic tobacco heating devices on the course and control of bronchial asthma, as well as changes on inflammatory profiles. An important aspect is to assess the profile of the patient using smoking devices in order to optimize the therapy selection and patient management strategies.

Materials and methods. An open-label observational clinical trial including medical history assessment, physical examination, completion of the Asthma Control Questionnaire (ACT) and the Asthma Quality of Life Questionnaire (AQLQ), clinical functional examination, and venous blood sampling for biomarker analysis. The study included patients aged 18–45 years with a confirmed diagnosis of bronchial asthma for at least 12 months.

Results. 84 patients were included in the study (82 men and 2 women), with a mean age of 21.99 ± 2.38 years. Of these, 32 patients were non-smokers, while 52 reported using various nicotine and tobacco products. Among the smokers, 30 (57.7%) used two or more types of smoking devices. Passive smoking exposure was reported across all groups, with 69 patients (82.1%) indicating regular exposure to environmental tobacco smoke from their surroundings. Smokers were more frequently exposed to passive smoking. The average age of smoking initiation is 16 years. In both groups, according to ACT data, the lack of asthma control in smokers is 18.1 ± 4.2, non-smokers 16.8 ± 3.4. ACT score distribution curves showed a broader spread among smokers, with a more pronounced secondary peak corresponding to partial asthma control. Correlation analysis of peripheral blood eosinophil levels revealed a narrower distribution among smokers, while non-smokers exhibited a longer right-tail distribution, indicating a higher proportion of individuals with elevated eosinophil counts.

Conclusion. The use of electronic nicotine delivery devices and electronic tobacco heating devices affects the course and control of bronchial asthma. Further research is needed to optimize therapy and management of patients using smoking devices

Introduction. Mass immunodiagnostics using a Recombinant Tuberculosis Allergen (RTA) test is aimed at the early and timely detection of Latent Tuberculosis Infection (LTBI) and tuberculosis.

Aim. To determine the detection rate of LTBI and tuberculosis in children and adolescents using immunodiagnostics, taking into account the risk of developing tuberculosis infection and the results of screening for its detection.

Materials and мethods. A retrospective study of 139 medical records of children aged 1–17 years was conducted between 2023 and 2025 at the Tuberculosis Department of St. Petersburg Children’s Hospital No. 3. Inclusion criteria were positive reactions to the RTA test and/or IGRA test. Exclusion criteria included cases of parental/legal guardian refusal to have the child tested, and infants. A comprehensive screening for tuberculosis infection was conducted, and two groups were identified: Group 1 – 70 children with LTBI, and Group 2 – 69 children with tuberculosis. Results of the RTA test and the Mantoux test were analyzed.

Results. During mass immunodiagnostics, tuberculosis infection was detected in 78.4 ± 3.49% (109/139) of patients: 85.7 ± 4.18% (60/70) in children with LTBI, and 71.0 ± 5.46% (49/69) in those with tuberculosis (p = 0.034). This method revealed 13.7 ± 2.92% (19/139) of children from previously unknown tuberculosis contact with tuberculosis patient. The proportion of patients aged 1–7 years with LTBI detected by immunodiagnostics was 72.2 ± 10.56% (13/18), with tuberculosis 45.5 ± 10.62% (10/22) of cases; in children aged 7–18 years it was higher: 90.4 ± 4.09% (47/52) (p = 0.112) and 83.0 ± 5.80% (39/47) of cases (p = 0.0025), respectively. In children aged 1–7 years with tuberculosis, the RTA test was hyperergic more often in 50.0 ± 10.67% (11/22) of cases than with LTBI in 16.7 ± 8.79% (3/18) of cases (p = 0.021); in children aged 8-17 years, the prevalence was 48.9 ± 4.09% (23/47) and 40.4 ± 6.80% (21/52) (p = 0.397), respectively.

Conclusion. Mass immunodiagnostics in childhood and adolescence is the most significant method of screening for tuberculosis infection.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal bone marrow disorder caused by a mutation in the PIG-A gene and a deficiency of GPI-anchor proteins on the surface of blood cells. The clinical picture is characterized by chronic intravascular hemolysis, cytopenias, and thrombotic complications. Diagnosis of PNH is often difficult due to the polymorphism of symptoms and the lack of pathognomonic features. This article presents a clinical observation of an 87-year-old patient with longstanding refractory anemia that was unresponsive to standard therapy with iron, vitamins B₉ and B₁₂, and blood transfusions. Key laboratory markers that led to the suspicion of PNH included significantly elevated lactate dehydrogenase (LDH), indirect bilirubin, reticulocytosis, a negative direct Coombs test, decreased haptoglobin, and the detection of hemosiderinuria. After excluding myelodysplastic syndrome (MDS) and oncologic pathology, flow cytometry revealed a large PNH clone (86% granulocytes with FLAER/CD24 deficiency, 18% type Ill red blood cells). This clinical case demonstrates the importance of a targeted search for PNH in elderly patients with unexplained hemolysis.

A clinical case of a 54-year-old patient with ischemic stroke (IS) and a permanent form of atrial fibrillation taking dabigatran etexilate 150 mg 2 times a day is presented. The last dose of the drug was 13 hours before hospitalization in the Regional vascular center. 155 minutes after the development of IS symptoms, 5 g of idarucizumab was administered to reverse the anticoagulant effect of dabigatran and intravenous thrombolysis (IVT) was performed. Thrombin time values decreased from 86.6 seconds to 20 seconds immediately after administration of the specific antagonist. After IVT, the National Institutes of Health (NIHSS) score decreased from 5 to 3 points. Brain CT scan 24 hours after vTLT revealed signs of ischemia in both cerebellar hemispheres, brain MRI on the 2nd day of the disease revealed hemorrhagic transformation in the right cerebellar hemisphere and ischemic foci in both cerebellar hemispheres. The patient was discharged on day 19 after regression of hemorrhagic transformation with clinical improvement. The presented observation confirms the safety and efficacy of idarucizumab in neutralizing the effect of dabigatran before thrombolytic therapy in patients with ischemic stroke.

Acromegaly is a rare neuroendocrine disorder caused by autonomous hyperproduction of growth hormone, most commonly due to a pituitary adenoma, which accounts for more than 95% of cases. Magnetic resonance imaging (MRI) is the standard imaging modality for this condition; however, it cannot be performed in some patients, for example due to the presence of MRIincompatible metallic implants, which creates diagnostic challenges in determining indications for surgical treatment. We report the case of a 59-year-old patient with biochemically confirmed acromegaly in whom MRI was contraindicated because of an iron-containing metallic fixation device in the clavicular region placed after a fracture. Contrast-enhanced computed tomography (CT) revealed pituitary enlargement but did not provide sufficient diagnostic accuracy. For lesion localization, positron emission tomography combined with computed tomography (PET/CT) using ¹⁸F-fluorodeoxyglucose (18F-FDG) was performed and demonstrated a focus of increased radiotracer uptake in the sellar region. Based on these findings, the patient underwent transsphenoidal adenomectomy. The diagnosis of somatotropinoma was confirmed by immunohistochemistry, with growth hormone expression detected in 100% of tumor cells. Following surgery, the patient achieved remission of acromegaly. This case suggests that ¹⁸F-FDG PET/CT may serve as an alternative modality for lesion localization in acromegaly when MRI is not feasible or is contraindicated. The diagnostic performance and clinical role of this method require further investigation.

This paper describes a clinical observation of a patient with active systemic lupus erythematosus (SLE) primarily affecting the skin and joints and high immunological activity. Given the insufficient effectiveness of previous therapy, progression of the skin syndrome, and the inability to reduce the glucocorticosteroid (GCS) dose, the patient was initiated on anifrolumab (AFM) at a dose of 300 mg once every 4 weeks. After just 4 weeks, partial regression of the manifestations of acute cutaneous lupus erythematosus (ACLE) was observed: bullous and maculopapular lesions resolved, although facial erythema persisted. Complete resolution of the skin syndrome was noted three months after the start of therapy. By the sixth month of AFM therapy, a significant reduction in antinuclear factor (ANF) and anti-dsDNA antibody titers was observed, as well as low disease activity (SLEDAI-2K score 4 points), which allowed for a reduction in the glucocorticosteroid dose. Health-related quality of life was assessed using the LupusQol questionnaire, which revealed a significant improvement with AFM therapy. No adverse reactions were reported in this patient after the first or subsequent AFM infusions. Thus, by the 6th month after the start of therapy, it was possible to achieve low disease activity on therapy with hydroxychloroquine 400 mg/day, AFM 300 mg intravenously once every 4 weeks. At the same time, the prednisone dose was reduced to 10 mg/day. At the moment, AFM therapy according to the 300 mg IV drip scheme once every 4 weeks continues, the possibility of further reducing the dose of GCS is being considered.

The article provides a rationale for the interdisciplinarity (the impact of gynecological pathologies on the psycho-emotional state of reproductive-age patients) and identifies the main features of the psycho-emotional state of women with genital and extragenital endometriosis. The authors specify characteristic features of personality psychology and explore the role of endometriosis as a serious gynecological pathology affecting patientʼs psycho-emotional status. Endometriosis has been shown to negatively impact interpersonal relationships in patients. Essential characteristics demonstrating the role of pain in changing the patient's mental status are disclosed. In this study, we used databases from the following international information resources: Scopus, Web of Science, PubMed Central, Oxford Handbooks Online, as well as national resources such as eLIBRARY.RU, Znanium. The study involved a search of national and foreign research literature using the following keywords: endometriosis, gynecological pathology, women'ʼs psychoemotional state, pain as a disease phenomenon, depression, and behavioral safety culture. 15 research papers were selected. The complete list of references for the research proposal, including books and monographs, comprised 30 sources, and foreign researchers’ publications. We reviewed and analyzed about 15 research papers during the screening process. In total, 200 patient records were included in the randomized controlled trial (RCT). The authors selected and processed about 20 sources using quantitative analysis. For qualitative analysis, we analyzed and reviewed about 5 papers. About 17 sources were used to substantiate the Introduction and Discussion sections. We excluded about 10 research papers from the sample at the search and selection stage, due to not meeting the inclusion criteria for the research topic or because they were judged to be not relevant to the review. In total, the final systematic literature review included 30 sources, comprising domestic and foreign publications.