Results. This analytical review provides a comprehensive assessment of current Russian and international scientific literature focused on the problem of coronary artery disease progression in cancer patients. The literature search was conducted in authoritative domestic and international databases, including PubMed, Scopus, Elsevier, Cochrane Library, Clinical Evidence, Best Evidence, and RSCI, ensuring the representativeness and reliability of the data presented. The relevance of this issue is underscored by a significant increase in the frequency of cardiovascular complications in patients with malignant neoplasms, which is directly linked to both the direct effects of anticancer therapy and the indirect influence of the cancer itself. The review details the key pathogenetic mechanisms contributing to the development and exacerbation of coronary artery disease: Direct cardiotoxicity of anticancer drugs: Particular attention is paid to anthracyclines, which induce oxidative stress and cardiomyocyte apoptosis, leading to myocardial dysfunction. VEGF inhibitors are associated with the development of arterial hypertension and thromboembolic complications, as well as direct damage to the endothelium of coronary arterioles, impairing vasodilatory reserve. HER2-targeted drugs, in turn, can block crucial pathways for cardiomyocyte survival and repair. Systemic effects of the malignant process: Tumor progression is accompanied by chronic systemic inflammation, the release of pro-inflammatory cytokines, and a prothrombotic state, which accelerates atherothrombosis and endothelial dysfunction. Furthermore, the work analyzes epidemiological data on the frequency of coronary artery disease progression and identifies key risk factors in oncology patients, including comorbid conditions (e.g., hypertension, diabetes), cumulative doses of chemotherapeutic agents, the type of targeted therapy received, and the baseline state of the cardiovascular system.
Conclusion. Thus, the conducted analysis confirms that the problem of coronary artery disease progression in cancer patients requires a multidisciplinary approach (onco-cardiology) and the development of strategies for active monitoring, early diagnosis of microvascular dysfunction, and cardioprotection at all stages of anticancer treatment.

Background. Currently, psoriasis is the most common skin disease, its prevalence reaches 5% and this pathology often occurs together with arterial hypertension. Both arterial hypertension and psoriasis contribute to the remodeling of the cardiovascular system. As is known, myocardial remodeling is a substrate for electrical instability of the myocardium.
Objective. The aim of the study was to study the parameters of the signal-averaged electrocardiogram in men with stage 2 arterial hypertension with concomitant vulgar psoriasis in the progressive stage, and to evaluate the parameters of the signal-averaged electrocardiogram against the background of psoriasis therapy. A total of 86 men with stage 2 arterial hypertension with a progressive stage of vulgar psoriasis with a severe and moderate course were examined. Signal-averaged ECG was recorded before psoriasis therapy was prescribed and after 6 months of systemic and topical psoriasis therapy.
Results. A statistically significant moderate positive correlation was found between the severity of psoriasis vulgaris (according to the PASI index) and such an SU-ECG indicator as the duration of the filtered QRS complex (r = 0.32; p = 0.005), a statistically significant weak negative correlation of the PASI index with the root-mean-square amplitude of the last 40 ms of the filtered QRS complex (r = -0.27; p = 0.012). Patients with severe psoriasis had more pronounced changes in cardiac electrophysiology, in the form of more frequent recording of late ventricular potentials χ2 = 4.07; p = 0.044, a longer duration of the filtered QRS complex (p = 0.01). Systemic and topical therapy of concomitant psoriasis in patients with arterial hypertension leads to a decrease in the frequency of recording late ventricular potentials, and in patients who had severe psoriasis before the start of treatment, late potentials were recorded significantly more often after 6 months of therapy (χ2 = 3.88; p = 0.049) than in patients with initially moderate-severe psoriasis.

Background. In recent decades, the prevalence of multiple pregnancies has increased significantly worldwide, including in the CIS countries. This is due to both general demographic and social changes, as well as the active introduction of assisted reproductive technologies, among which in vitro fertilization is of particular importance. An increase in the number of multiple pregnancies inevitably leads to an increase in the frequency of complications, which underlines the importance of developing and improving methods aimed at reducing perinatal risks.
Results. Are view of the literature on the methods, timing, and results of selective reduction of a fetus with hereditary and congenital pathology in multiple pregnancies is presented. The authors' own results of selective reduction of a fetus using potassium chloride are described. Detailed information on the implementation of selective reduction of a fetus with Down syndrome in the second trimester of pregnancy following in vitro fertilization is presented. The tactics of medical and genetic counseling of the family and pregnancy management, the need for a control analysis of the karyotype of the reduced fetus to exclude procedural errors are discussed.
Conclusion. Selective reduction is an effective and clinically proven method to reduce the number of fetuses and thereby reduce the incidence of complications, improve perinatal outcomes and ensure a more favorable course of pregnancy. The correct choice of the timing of the intervention, careful preparation and multi-stage counseling of the patient significantly increase the safety and effectiveness of the method

Background. The treatment of climacteric syndrome occurring during perimenopause is a pressing issue for the medical community. Currently, treatment of menopausal symptoms is aimed at correcting estrogen deficiency with menopausal hormone therapy. However, there are a number of relative and absolute contraindications for its use. In these situations, it is advisable to consider alternative methods of treating the manifestations of climacteric syndrome.
Objective. To evaluate the possibilities of non-hormonal therapy during the menopausal transition.
Materials and methods. This article describes the clinical case of patient K., who consulted a gynecologist with complaints of menopause, such as hot flashes, night sweats, and irritability, and who had a number of relative contraindications for menopausal hormone therapy. A combination of sulodexide and resveratrol was used as an alternative treatment for menopausal disorders. At the end of treatment, the severity of symptoms and lipid and carbohydrate metabolism indicators were assessed.
Results. After combined therapy, the lipid profile after 3 years showed a 33.42% decrease in low-density lipoprotein cholesterol, very lowdensity lipoprotein cholesterol decreased by 13.75%, triglyceride levels decreased by 12.6%, and total cholesterol decreased by 22.5%. The patient noted that symptoms of night sweats, hot flashes, and irritability became less pronounced, which had a positive effect on her quality of life. The combination of sulodexide and resveratrol has proven effective in relieving menopausal disorders and may be considered for the prevention of cardiometabolic complications in menopause, such as atherosclerosis, hypertension, and thrombotic complications. This aspect requires more in-depth randomized studies.
Conclusion. It is expected that therapy with alternative non-hormonal drugs will not be able to demonstrate an effect completely identical to that of menopausal hormone therapy. However, combination therapy with sulodexide and resveratrol helps prevent the development of cardiometabolic complications: atherosclerosis, arterial hypertension, thrombosis, and thromboembolism. Large-scale randomized studies are needed to evaluate the properties of this combination of drugs.

Background. Periodic disease is an autoinflammatory disorder associated with a mutation in the pyrin gene. Historically, the disease is endemic and affects the Mediterranean region. Its genetic determinism has been proven. In our country, this disease is quite rare and poorly studied. Due to the insufficient study of the etiology, pathogenesis, diagnosis, and treatment of periodic disease, an analysis of new information on this issue is relevant. This disease is not accompanied by an increase in antibody titers or cellular immune response. It is associated with increased production of IL-1β, a pro-inflammatory biologically active substance. The mutation that leads to the development of this disease appeared approximately in the 15th century in the Mediterranean during the plague epidemic. Patients with this mutation were more resistant to the epidemic, therefore, had a better chance of survival and having offspring. Thus, this mutation spread in the Mediterranean and became endemic.
Results. Diagnosis of the disease involves collecting a family history and clinical manifestations of polyserositis, arthritis, myalgia, and fever. Particular attention is paid to laboratory criteria, such as levels of inflammatory markers (CRP, SAA). Treatment involves long-term colchicine or targeted therapy with canakinumab, a drug that blocks IL-1β. This disease has been shown to be congenital and associated with a genetic mutation, making it an autoinflammatory rather than an autoimmune disorder. It has been determined that patients with this disease have increased secretion of interleukins (primarily IL-1β) due to abnormal pyrin inflammasome activity associated with a defect in the pyrin gene. In this case, treatment is conservative. The drug of choice is colchicine, however, increasing attention is being paid to a drug that blocks IL-1β – targeted therapy using monoclonal antibodies.
Conclusion. When we review the current data concerning etiology and pathogenesis of the disease, diagnostic therapeutic aspects are considered.

Background. The etiology of acute respiratory viral infections is quite diverse, including influenza virus, respiratory syncytial virus, adenovirus, seasonal coronaviruses, bocavirus, rhino- and metavirus, and parainfluenza virus. The frequency of mixed infections is quite high: according to various sources, viral coinfection accounts for approximately 30%, bacterial coinfection up to 20%, and fungal coinfection up to 8%. The development of coinfections significantly complicates the course of the infection, increasing the risk of death. Severe illness and death are more common with influenza, COVID-19, adenovirus, and respiratory syncytial virus infections. According to current clinical guidelines, treatment of patients with acute respiratory viral infections should be aimed not only at achieving a full and lasting recovery but also at preventing potential complications. Therapeutic tactics for acute respiratory viral infections, as a rule, include etiotropic, pathogenetic and symptomatic treatment; the use of agents with indirect antiviral and immunomodulatory effects may also be recommended.
Results. This review article focuses on the prevention of acute respiratory viral infections, influenza, and COVID-19 in outpatient practice, with a focus on high-risk patients. It examines the mechanisms of complication development in the most vulnerable populations, including pregnant women and the elderly, as well as the characteristics of their immune response. The potential of interferon therapy as a preventive measure is discussed. Particular attention is paid to the use of recombinant interferon alpha-2b in various pharmacological forms, its antiviral and immunomodulatory effects, as well as its clinical efficacy and safety in outpatient practice. The importance of a comprehensive strategy combining vaccination, non-specific protective measures, and the use of interferon-containing drugs for the effective protection and treatment of high-risk patients is emphasized.
Conclusion. The data presented in the article indicate that interferon alfa-2b with antioxidants is appropriate for use in high-risk patients to reduce the incidence and severity of respiratory viral infections, as well as to prevent complications and adverse outcomes.

Background. Slow transit syndrome and functional constipation (lazy bowel syndrome) represent a significant medical and social problem due to their high prevalence, chronicity, and significant reduction in quality of life. In clinical practice, this is a cluster of symptoms associated with impaired intestinal motor function, including infrequent and difficult bowel movements, abdominal bloating, a feeling of heaviness and discomfort, and the need for excessive straining or manual assistance during defecation. The prevalence of functional constipation, including slow-transit syndrome, remains extremely high in the population. According to contemporary epidemiological studies, constipation symptoms are observed in 12-19% of the adult population in economically developed countries, including the USA, the United Kingdom, Germany, and Italy. In the Russian Federation, the prevalence of chronic constipation corresponds to global averages, ranging from 14% to 35% among adults. This issue acquires particular medical and social significance in the elderly population. Among individuals over 60 years of age, the prevalence of constipation reaches 36%, with women affected three times more often than men. This pattern is likely associated with reduced physical activity, polypharmacy, the presence of comorbid neurological and endocrine disorders common in older age, as well as the natural involutional changes of the intestinal neuromuscular apparatus.
Results. This article presents the clinical characteristics of functional constipation and slow intestinal transit based on the Rome IV criteria, describes the necessary diagnostic measures, and highlights the stages of treatment. Particular attention is paid to the risks of long-term drug therapy and strategies for minimizing them.

Background. Patients with chronic obstructive pulmonary disease experience regular exacerbations, often leading to irreversible decline in respiratory function and respiratory failure. These exacerbations are associated with increased mortality, as confirmed by multicenter studies. Bacterial infections are the primary cause of these exacerbations, and the widespread prevalence of chronic obstructive pulmonary disease poses significant clinical and socioeconomic challenges for healthcare professionals. Infectious exacerbations of chronic obstructive pulmonary disease are a serious problem in clinical practice, especially in the context of increasing antibiotic resistance. This study was aimed at evaluating the effectiveness of including immunostimulating therapy with sodium deoxyribonucleate (15 mg/ml; 1 vial intramuscularly daily for 5 days, then five injections at 48-hour intervals; a total course of 15 days, 10 injections) in standard regimens for stopping chronic obstructive pulmonary disease exacerbations (n = 60 patients). The results showed a number of significant positive therapeutic effects: the effectiveness of microbiological sanitation of the respiratory tract significantly increased (19.9%); the effect of antibacterial drugs was potentiated; a pronounced and reliable anti-inflammatory effect (p < 0.001) and a reduction in the bacterial load in the respiratory tract (from 106 CFU/ml to 5.5 × 103 CFU/ml) were noted. A clinically significant improvement in the general condition of patients was observed (oxygen saturation increased to 97% (p = 0.015), regression of leading respiratory symptoms accelerated, and macroscopic characteristics of sputum returned to normal).
Conclusion. Thus, the obtained data convincingly demonstrate the synergistic effect of the immunostimulant (sodium deoxyribonucleate, 15 mg/ml) in the combination therapy of chronic obstructive pulmonary disease. It improves microbiological outcomes and contributes to the stabilization of the disease, which is critical for improving the quality of life of patients and optimizing therapeutic strategies in pulmonology.

Background. Providing medical care to a pregnant woman newly diagnosed with syphilis is an interdisciplinary process. The pregnancy outcome and the risk of delivering a child with congenital syphilis depend on clear, coordinated actions between dermatovenereologists and obstetrician-gynecologists. Every case of congenital syphilis represents a critical healthcare incident requiring immediate response, expert case review, identification of deficiencies in medical care at all stages of pregnancy management, and urgent implementation of corrective measures to address the underlying causes.
Results. This article presents a clinical case of late detection (at 38 weeks of gestation) of an infectious form of syphilis in a pregnant woman during obstetric-gynecological care. It examines the errors made by obstetrician-gynecologists that led to the development of congenital syphilis.
Conclusion. Active organizational and methodological efforts targeting obstetrician-gynecologists are essential. These should include establishing regular ongoing seminars on early and proactive detection of syphilis and other STIs, systematic review of all cases involving delayed diagnosis or late initiation of syphilis treatment in pregnant women, and development of up-to-date regulatory guidelines for interdisciplinary collaboration between obstetrician-gynecologists and dermatovenereologists aimed at early syphilis detection in pregnancy and prevention of congenital syphilis.

Background. Elective surgery can be a source of psychological stress for patients, which may worsen nicotine addiction and increase anxiety levels. Smoking in the perioperative period can significantly increase the risk of respiratory complications.
Objective. The aim of this study was to investigate the relationship between nicotine dependency and anxiety levels in perioperative patients, as well as to assess the effects of various tobacco use modification strategies (complete cessation, nicotine replacement therapy, and transition to heating systems) on anxiety dynamics.
Materials and methods. A total of 96 participants were enrolled in the study. They were divided into two groups: those with nicotine dependence and a control group. Anxiety levels were assessed using hospital scales. Three weeks after implementing various smoking cessation methods, group comparisons and dynamic assessments of anxiety were conducted.
Results. A high prevalence of anxiety was found among patients with nicotine addiction (77%), which was significantly higher than in the control group (53%). Gender differences were revealed: 84% of men who smoked had an increased level of anxiety (compared to 61% of non-smokers), while women who smoked had a lower level (32%) than the control group. After 3 weeks of follow-up, the lowest level of anxiety was recorded in the group that used nicotine replacement therapy, followed by those that switched to tobacco heating systems. In patients who quit without aids, anxiety levels were higher, and among those who continued smoking, the level did not change.
Conclusion. The data obtained confirms a close relationship between nicotine addiction and anxiety in patients. For patients who are not ready for immediate complete withdrawal, switching to tobacco heating systems can be considered as a temporary and transitional measure as part of an integrated approach to harm reduction, but it should not be encouraged as a way to encourage tobacco use. Further research is needed to clarify the long-term effects of various strategies and to develop approaches to treating tobacco addiction.

Background. The development and implementation of effective long-term treatment strategies for secondary lymphedema associated with radical treatment for breast cancer remains a pressing issue in medical rehabilitation.

Objective. To study the impact of a comprehensive rehabilitation program on quality of life in patients with secondary lymphedema of the upper extremities, stages I-III, who underwent radical treatment for breast cancer.

Materials and methods. The study was conducted at the clinical site of the Federal State Institution National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation and included 30 patients with lymphedema associated with radical treatment for breast cancer stages I-III, with an average age of 63.40 ± 10.85 years. The rehabilitation program included laser therapy, magnetic therapy, sessions with a clinical psychologist, group therapeutic exercises in the gym, occupational therapy, exercises on cycling equipment, and pneumatic compression procedures (10 sessions per course). The treatment duration was 12 days. A quality of life study was conducted using the LYMQOL ARM questionnaire. Limb circumferences were measured on the hand, lower and middle third of the forearm at symmetrical points on the affected and healthy limbs.

Results. Before treatment, patients with lymphedema associated with radical treatment for breast cancer had a deterioration in the overall quality of life score to 4.63 ± 1.21 points. After the rehabilitation course, a decrease in hand circumference by 3.54% (p < 0,0001), forearm circumference by 2.32% (p < 0,0001), and middle arm circumference by 3.25% (p < 0,0001) was noted. After the rehabilitation course, improvement was noted in all quality of life indicators (LYMQOL ARM): an improvement in the hand function score (p < 0.001); an improvement in the body appearance and perception score (p < 0.001); an improvement in the lymphedema symptoms score (p < 0.001); Emotional state/mood score (p < 0.001). Overall quality of life improved by 37.36% (p < 0,001).

Conclusions. The study of quality-of-life indicators in patients with lymphedema after rehabilitation using the LYMQOL ARM questionnaire in the Russian population confirmed its reliability and sensitivity in patients with lymphedema. Using this instrument to assess the effectiveness of rehabilitation increases the significance of the study, as lymphedema often impacts not only physical functioning but also significantly limits health-related psychosocial well-being in breast cancer survivors.