Background. Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting, according to 2024 data, approximately 19.7% of pregnancies worldwide. GDM is not merely a transient condition but a marker of a lifelong high cardiometabolic risk for the woman. It is associated with the subsequent development of prediabetes, type 2 diabetes mellitus (T2DM), metabolic syndrome, and cardiovascular diseases. The high recurrence rate of GDM in subsequent pregnancies (up to 84%) and the progressive increase in T2DM risk over time underscore the critical importance of establishing an effective system for secondary prevention, starting from the early postpartum period. However, current clinical practice is often limited to a single examination 4-12 weeks after delivery, which is insufficient for the long-term management of the patient's health.

Objective. Using a clinical case example, to demonstrate the significance of long-term postpartum follow-up and the necessity of an active preventive strategy, including pharmacological intervention, in women with a history of GDM to prevent the development of carbohydrate metabolism disorders and cardiometabolic complications.

Materials and methods. This paper provides a detailed description of a clinical case of the 33 years old patient with GDM diagnosed at 26-27 weeks of gestation. Standard clinical and laboratory methods were used for pregnancy management and postpartum follow-up: a 75-g oral glucose tolerance test (OGTT), measurement of glycated hemoglobin (HbA1c) levels, self-monitoring of blood glucose, urinalysis with assessment of ketonuria, and fetal ultrasonography. During the postpartum period, an OGTT was used to assess carbohydrate metabolism.

Results. During pregnancy, despite diet therapy, the patient exhibited unstable glycemia with episodes of hyperglycemia and ketonuria, which necessitated the initiation of insulin therapy at 32-33 weeks. The pregnancy concluded with a term delivery without complications. An examination 14 months postpartum, following a 13% weight gain from baseline, revealed impaired glucose tolerance (fasting plasma glucose 5.9 mmol/L, 2-hour post-load plasma glucose 8.5 mmol/L). The patient was prescribed a extended-release formulation of metformin at a dose of 500 mg/day in addition to lifestyle modification recommendations.

Conclusion. The presented clinical case clearly illustrates that GDM is a predictor of early prediabetes development, even in the absence of abnormalities in the first weeks postpartum. The modern approach to managing patients with a history of GDM should evolve from episodic screening to a system of lifelong dynamic monitoring aimed at the early detection and correction of cardiometabolic risk factors. Lifestyle modification is the cornerstone of prevention; however, it may not be sufficient. The use of metformin in women with prediabetes and a history of GDM is a pathogenetically justified, effective, and safe strategy that not only reduces the risk of T2DM but also has a favorable impact on the lipid profile and cardiovascular health. The active integration of pharmacological prevention into clinical practice is essential for altering the long-term health trajectory of women.

Background. D. Hypoparathyroidism is a disorder caused by decreased secretion of parathyroid hormone and is characterized by hypocalcemia and hyperphosphatemia. Currently, up to 75-80% of hypoparathyroidism cases are postoperative. Transient hypoparathyroidism after thyroidectomy develops in 19-38% of patients, whereas permanent disease occurs in 1-7%. Russian clinical guidelines (2021) report comparable figures. Historically, clinical observations of tetany after thyroid surgery were first described by Ernest Gley in 1891, which contributed to the recognition of the parathyroid glands as an independent endocrine structure [1]. Hypocalcemia may cause a wide spectrum of neurological disturbances, including paresthesia, muscle cramps, tetany, seizures, cognitive impairment, QT interval prolongation, and transient focal neurological symptoms. The clinical presentation may closely resemble acute stroke, leading to inappropriate triage and delayed pathogenetic treatment. According to Goyal A. et al. (Frontiers in Neurology, 2021), up to 12% of episodes of severe hypocalcemia are misinterpreted as stroke.

Objective. To present a clinical case of chronic postoperative hypoparathyroidism manifesting as an acute focal neurological deficit initially suspected to be an acute cerebrovascular event, and to emphasize the diagnostic value of assessing calcium–phosphate metabolism and parathyroid hormone levels after thyroid surgery.

Materials and methods. We report a clinical case of a 28-year-old woman with Graves’ disease who underwent staged surgical treatment of the thyroid gland (hemithyroidectomy followed by total thyroidectomy), complicated by chronic hypoparathyroidism. A retrospective analysis of clinical manifestations, laboratory parameters (PTH, total and ionized calcium, serum phosphate, and 25(OH) vitamin D), and instrumental investigations was performed, including neuroimaging to exclude acute stroke. The patient’s clinical course and response to acute and maintenance therapy were evaluated.

Results. Severe hypocalcemia resulted in acute focal neurological symptoms, prompting emergency hospitalization with suspected stroke. Brain MRI revealed no ischemic lesions. Positive Chvostek and Trousseau signs, together with the rapid regression of neurological deficits after intravenous calcium gluconate administration, supported a metabolic origin of the presentation. Initiation of active vitamin D analogues (alfacalcidol) in combination with oral calcium supplementation led to clinical stabilization and prevention of recurrent episodes. This case highlights the need for routine postoperative monitoring of serum calcium and parathyroid hormone levels after thyroidectomy and for including hypocalcemia in the differential diagnosis of acute neurological conditions to avoid diagnostic errors and ensure timely pathogenetic treatment.

Background. Gestational diabetes mellitus is a common metabolic complication of pregnancy characterized by impaired glucose tolerance first detected during gestation. Gestational diabetes mellitus affects a substantial proportion of pregnant women worldwide and is associated with an increased risk of adverse maternal and neonatal outcomes. Vitamin D, a secosteroid hormone traditionally known for its role in calcium and phosphorus homeostasis and skeletal health, has attracted growing attention due to its potential involvement in glucose metabolism and insulin regulation. Despite accumulating evidence linking vitamin D status with gestational diabetes mellitus, study results remain inconsistent, particularly regarding the clinical relevance of vitamin D metabolites beyond total 25(OH)D and the dynamic changes in vitamin D metabolism throughout pregnancy. This highlights the need for comprehensive metabolic profiling to better understand how alterations in the vitamin D metabolome during pregnancy are related to calcium-phosphorus balance and the development of gestational diabetes mellitus.

Objective. To investigate the features of vitamin D metabolism and calcium-phosphorus homeostasis in pregnant women and their association with gestational diabetes mellitus.

Materials and methods. A single-center, observational, prospective, comparative study was conducted. Women with gestational diabetes mellitus (n = 35) underwent longitudinal assessment in the second and third trimesters, including evaluation of multiple components of the vitamin D metabolome using high-performance liquid chromatography coupled with tandem mass spectrometry. For comparison, a control group of conditionally healthy pregnant women (n = 37), matched for age, was formed (p = 0.501).

Results. In the second and third trimesters of pregnancy, women with gestational diabetes mellitus showed biochemical parameters of calcium-phosphorus metabolism that remained within the reference range and did not differ significantly from the control group. Concentrations of 25(OH)D₃ and other vitamin D metabolites in women with gestational diabetes mellitus were largely comparable to controls, with a statistically significant reduction observed only for 24,25(OH)₂D₃ in the second trimester. No differences were found in the ratios of vitamin D metabolites reflecting the activity of key metabolic enzymes. During pregnancy, women with gestational diabetes mellitus demonstrated a decrease in albumin levels with stable albumin-corrected calcium, as well as a trend toward increased concentrations of 3-epi-25(OH)D3 and 24,25(OH)2D3 by the third trimester.

Conclusion. Pregnant women with gestational diabetes mellitus exhibit lower serum 25(OH)D₃ concentrations in the second trimester and reduced levels of the metabolites 1,25(OH)₂D₃ and 24,25(OH)₂D₃ in the third trimester compared with the control group. Ratios between vitamin D metabolites reflecting the activity of key enzymes involved in vitamin D metabolism remain stable, indicating preserved enzymatic regulation. The observed differences are most likely attributable to baseline vitamin D status rather than to disturbances in enzymatic metabolism. Thus, the results of the present study, together with an analysis of current clinical guidelines, support the rationale for continuous vitamin D supplementation from the first trimester of pregnancy until delivery. These findings highlight the importance of early (preconception) assessment of 25(OH)D₃ status and timely correction of its levels to optimize the metabolic profile and reduce the risk of gestational diabetes mellitus during pregnancy.

Background. Polydipsia-polyuria syndrome is characterized by abnormally increased fluid intake by the patient, which often mimics the manifestations of central diabetes insipidus (syn. – antidiuretic hormone deficiency). However, the differences between these two conditions are fundamental, as treatment approaches differ significantly: true central diabetes insipidus requires replacement therapy with an antidiuretic hormone analog, desmopressin, whereas polydipsia-polyuria syndrome is often associated with primary polydipsia and requires a different treatment approach. Correct diagnostic tactics play a key role, as misdiagnosis and inappropriate treatment can lead to serious complications such as water intoxication (severe hyponatremia). Early detection of central diabetes insipidus allows for timely initiation of appropriate treatment, preventing the development of dehydration, and minimizing the negative impact of the disease on the patient's daily life.

Results. This review presents a modern algorithm for the differential diagnosis of polydipsia-polyuria syndrome. This involves initial confirmation of hypotonic polyuria and exclusion of common causes of nephrogenic diabetes insipidus. Subsequently, functional tests aimed at ruling out primary polydipsia (patients healthy in terms of ADH secretion) are performed, including fluid deprivation and hypertonic saline. A desmopressin test is indicated only after reliable confirmation of the diagnosis of diabetes insipidus. The various proposed variants of the above-described tests, including those modifying antidiuretic hormone release with arginine and assessing the concentration of this hormone (indirectly as copeptin) in the blood, have various limitations in implementation and interpretation and are associated with an element of overdiagnosis of central diabetes insipidus, which, from a clinical perspective, predisposes patients to the development of water intoxication when prescribed desmopressin treatment.

Conclusion. Replacement therapy using desmopressin, an antidiuretic hormone analogue, is a key element in the treatment of central insufficiency and, in most cases, allows for achieving an optimal quality of life.

Background. Innovations have been recently proposed in the treatment of type 2 diabetes. Metformin is recommended as a first-line drug now as before; but indications for the use of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are expanding. Review articles do not always mention that the hypoglycemic effect of glucagon-like peptide 1 receptor agonists is associated with the stimulation of the endocrine function of beta cells, which may be depleted over time.

Objective. Unbiased comparison of the effectiveness and possible side effects of drugs used in the treatment of type 2 diabetes mellitus with overweight.

Materials and methods. Review of Russian and international literature using the databases elibrary.ru, PubMed and Google Scholar, as well as library catalogs.

Results. A brief overview of recent publications on sugar-lowering drugs that can be used in type 2 diabetes with overweight patients is presented. The effect of drugs on body weight and beta cell function, as well as relative cost of the treatment is discussed. Special attention is paid to the following groups of medicines. Glucagon-like peptide 1 receptor agonists stimulate the secretion of insulin, lowering appetite and the gastrointestinal motility, thus promoting weight loss. The relatively high cost of glucagon-like peptide 1 receptor agonists and subcutaneous administration are pointed out. Oral semaglutide is the only glucagon-like peptide 1 receptor agonist preparation used for the oral intake. Sodium-glucose cotransporter 2 inhibitors reduce renal glucose reabsorption, excrete glucose in the urine, lower blood pressure, and promote weight loss. Glycemic control is thus maintained in the long term. Weight loss can also be expected from intestinal alpha-glucosidase inhibitors (acarbose), which inhibit the digestion and absorption of complex carbohydrates in the intestine. The hypoglycemic effect of the drugs of last two groups (as well as metformin) is not associated with the stimulation beta cells, which can be depleted by prolonged stimulation. Combination therapy using sugar-lowering and anorexigenic drugs is discussed.

Conclusion. Complications of diabetes mellitus are caused not only by hyperglycemia, but also by dyslipidemia, hypertension, physical inactivity, smoking and other factors, which requires an individual approach to drug therapy and lifestyle modification.

Results. This literature review describes the authors' data related to the use of inositols in perimenopausal women. During this period of life, women experience hormonal fluctuations and menopausal symptoms, leading to changes in the cardiovascular system and the risk of cardiac and metabolic disorders (atherosclerosis, increased visceral fat formation, critical blood lipid levels, chronic arterial hypertension, and insulin resistance). The researchers demonstrated reliable results supporting the use of inositol for metabolic syndrome in perimenopausal women, suggesting the use of inositols for associated conditions. Secondary messengers of insulin signaling (myoinositol, D-chiroinositol) and α-lipoic acid moderate the various effects of insulin, which is important during perimenopause. Studies have shown reductions in the HOMA index, glucose, insulin, triglycerides, low-density lipoprotein, and body mass index when taking dietary supplements containing the above-mentioned components, which restores ovulation and menstrual rhythm in women of reproductive age. The positive effects of myoinositol and D-chiroinositol, which help reduce the risk of cardiovascular disease, diabetes, and non-alcoholic fatty liver disease, have also been demonstrated in the perimenopausal period. The ratio of myoinositol to D-chiroinositol, 40:1, is physiological, as demonstrated by pharmacokinetic studies. Diferton is recommended as a dietary supplement and an additional source of inositol (B₈), alpha-lipoic acid, folic acid, vitamin D₃, and manganese for women not only with polycystic ovary syndrome in their reproductive years but also with impaired insulin sensitivity (primarily metabolic syndrome) in the perimenopausal period.

Conclusion. Future research and a fundamental understanding of the mechanism of action of myoinositol and D-chiro-inositol, particularly in combination with alpha-lipoic acid, manganese, folic acid, and vitamin D, will encourage their use as nutraceutical supplements to support optimal metabolism in the perimenopausal period.

Background. Bacterial vaginosis remains one of the most common vaginal microbiome disorders, affecting from 20% to 30% women of reproductive age worldwide. Despite standard antibiotic guidelines, recurrence rates can reach up to 50% within 12 months posttherapy. This necessitates the search for new therapeutic approaches aimed not only at eliminating pathogens, but also at the restoration of vaginal microbiota physiological balance. Studying the role of short-chain fatty acids including butyric acid (butyrate) and prebiotics such as inulin in maintaining vaginal microenvironment homeostasis is of particular interest. Butyric acid, being a key metabolite of the healthy microbiota, possesses anti-inflammatory properties and promotes the restoration of epithelial barrier function. Inulin, on the other hand, serves as a selective substrate for the growth of beneficial bacteria, including Lactobacillus spp. Recent studies demonstrate the potential benefit of a strategy of bacterial vaginosis comprehensive treatment including butyric acid and inulin combination as an additional component of standard therapy. This synergistic effect leads to speedier recovery of microbiota. Inulin serves as a substrate for the endogenous butyric acid production, colonization resistance is enhanced; the pH-dependent metabolism of lactobacilli is optimised. The combination of inulin and butyric acid has a beneficial effect on the vaginal microbiota.

Objective. This study aimed to evaluate the effectiveness of the combination therapy including butyric acid and inulin for the restoration of the normal vaginal microbiome in female patients with bacterial vaginosis.

Results. The data obtained demonstrate that the inclusion of a combination of butyric acid and inulin in standard treatment for bacterial vaginosis promotes more sustainable recovery of vaginal microbiota. Statistically significant differences in pH levels and lactobacillus count at 6 months support the long-term efficacy of a combined approach. The limitations of the study include the small sample size and open-label design, which could have influenced the subjective assessment of symptoms. To confirm the efficacy of the combination, it is advisable to conduct a double-blind, placebo-controlled study with an extended follow-up period.

Conclusion. The combination of butyric acid and inulin has demonstrated significant potential as adjuvant therapy for bacterial vaginosis. Its application is associated with sustained lactobacilli restoration, vaginal pH normalization and reduction in recurrence rates. Further research is needed to elucidate the complex interactions among butyric acid, gut microbiota, and female reproductive system. These findings may pave the way for new microbiota-based therapeutic approaches to improve the reproductive health and the overall quality of life in women with bacterial vaginosis. A promising approach suggests the optimisation of the treatment duration to prolong the beneficial effects on microbiota.

Background. In the context of increasing antimicrobial resistance, prevention and management of infectious complications in invasive gynecology require a shift away from strategies based predominantly on systemic antibiotic prophylaxis.

Results. This review summarizes the current evidence on the use of povidone-iodine as a broad-spectrum topical antiseptic in obstetric and gynecological practice, with particular emphasis on invasive and minimally invasive procedures. Povidone-iodine is a complex of iodine with polyvinylpyrrolidone that provides controlled release of active iodine and rapid antimicrobial activity. It is effective against Grampositive and Gram-negative bacteria, fungi, viruses (including human papillomavirus), protozoa. Importantly, no microbial resistance to povidone-iodine has been documented despite decades of clinical use. Its mechanism of action involves multi-target oxidative damage to microbial cell membranes, proteins, and nucleic acids, which prevents the development of resistant strains. The article discusses the chemical and biological properties of povidone-iodine, including its pH level close to the physiological one, and its relevance following vaginal procedures involving stabilized hyaluronic acid or poly-L-lactic acid. Special attention is given to safety and tolerability. Evidence indicates that local use in non-pregnant women results in minimal systemic iodine absorption without clinically significant thyroid dysfunction, whereas use during pregnancy should be restricted to strict indications due to potential fetal thyroid effects. Randomized controlled trials and meta-analyses demonstrate that vaginal cleansing with povidone-iodine before cesarean section, hysterectomy, intrauterine device insertion, and other gynecological interventions significantly reduces the incidence of postoperative infections, including endometritis. The use of povidone-iodine allows effective infection prevention without routine systemic antibiotics, which is particularly important in the era of antibiotic resistance. The review concludes that povidone-iodine, including the 7.5% solution, represents a safe and evidencebased component of modern infection control strategies in invasive gynecology.

Background. The high incidence of virus-induced genital tract infections in women, with a high recurrence rate and associated reproductive problems, prompted a review analysis of studies examining the antiviral and immunomodulatory effects of interferon alpha-2b with antioxidants in combination therapy for patients with genital virus-associated infections to optimize therapy during the preconception phase.

Objective. To evaluate the clinical efficacy of the antiviral immunomodulatory drug, administered as rectal suppositories, in the combination treatment of virus-associated genital tract infections in women based on data from a review analysis of studies.

Materials and methods. A selection of relevant publications on the development, antiviral, and immunomodulatory effects of interferons and interferon alpha-2b with antioxidants in vivo and in vitro was conducted in the scientific citation databases PubMed and Google Scholar. A cumulative analysis of the results of using the antiviral immunomodulatory drug in the combination treatment of patients with genital herpes and diseases associated with the human papillomavirus (HPV) was performed.

Results. A cumulative analysis of the results of using interferon-alpha-2b with antioxidants in the treatment of virus-associated diseases involved 5,900 patients aged 14 to 52 years. The antiviral and immunomodulatory effects and high clinical efficacy of interferon alpha-2b with antioxidants as rectal suppositories in the combination treatment of HPV-associated and herpesvirus diseases of the genital tract were demonstrated, with a reduction in the severity of lesions, a decrease in the recurrence rate, and an increase in the successful pregnancy rate. Conclusion. The obtained results dictate the need to include interferon alpha-2b with antioxidants in the form of rectal suppositories 1,000,000 IU No. 10 in the combination therapy of genital herpesvirus and HPV-associated diseases during the pre-pregnancy stage to prevent virus-associated diseases during gestation and improve reproductive outcomes.

Background. The relevance of the problem of ovarian tumors is difficult to overestimate. The incidence of benign ovarian tumors is 13.3% of all gynecological pathology. Cystadenomas account for 80% of all ovarian neoplasms. Sex cord and stromal tumors are detected in 14.9%, among them granulosa cell tumors – 28.2%, thecomas, fibromas – 6.4%. Ovarian fibromas account for 1-4% of all ovarian neoplasms. According to The Ministry of Health of the Russian Federation's 2024 Clinical Guidelines, ovarian fibromas are classified as benign ovarian neoplasms which include cystic or solid ovarian neoplasms without pathological elements or blood flow, with low malignant potential. Such neoplasms most frequently affect perimenopausal and postmenopausal women, are characterized by slow growth and are predominantly asymptomatic. Despite the large amount of scientific and practical material, many "blank spots" remain to this day, for example, the last word in the study of the etiology and pathogenesis of benign ovarian neoplasms has not been said, at present they remain completely unexplored.

Results. The example of this clinical case reflects the typical manifestations of Meigs syndrome. Ovarian tumors, when reaching significantly larger sizes, have a significant impact on the general condition of patients and can and often are complicated by severe concomitant pathology, posing a threat not only to the health but also to the life of patients and often leading to unfavorable outcomes.

Conclusion. The complexity also lies in conducting differential diagnostics of the disease, therefore, the key role in this case is given to a comprehensive interdisciplinary approach and once again emphasizes the importance of timely preventive work of the doctor.

Background. Echinococcosis affects people of all ages. People from 20 to 50 years old are most vulnerable to this disease. Echinococcosis is most common in livestock regions which demonstrate poor sanitation and low level of economic development. Due to the growth of tourism, recent years have witnessed rising echinococcosis morbidity, even in the regions which have never been endemic for this helminthiasis. Currently, echinococcosis has a global distribution.

Objective. Based on the information obtained during the retrospective analysis, to conduct a study of the epidemiological situation of echinococcosis among children in the Astrakhan region.

Materials and methods. From 2008 to 2023, 141 cases of echinococcosis among humans were registered in the Astrakhan region, including 22 cases (15.6%) in children under 17 years of age.

Results. Taking into account the age group of children, cases of echinococcosis were most often reported in such age periods as 5, 6, 7, 10, 12-16 years. Thus, the greatest number of cases was observed in children of all ages 10 (14,2%), 13 (8,8%), 14 (12,9%), 15 (17,8%) and 16 years old (28.1%). Among all infected children, the largest proportion of cases occurred in people aged 7-17 years – 91.2%, while more than half of all infected (67.8%) were school-age children, and 23.2% were secondary school students. The main complaints of children included heaviness and pain in the right hypochondrium – 41.3%, spasms in the area of the parasite – 32.2%. Some patients complained of apathy and irritability – 4.7% each. The duration of clinical symptoms ranged from several days to one year, with the largest number of cases being a month and several days (37.1% and 26.2%). In the process of verifying the diagnosis, a different number of methods were used, both laboratory and instrumental. The diagnosis was carried out using research methods that included the predominance of ELISA, as well as ultrasound and computed tomography of the abdominal organs.

Conclusion. In the Astrakhan region, echinococcosis is most often reported in school-age children, while there is an increase in the number of cases of this disease. The parasite is mainly localized in the liver and lungs.

Background. One of the most serious negative effects of radiation exposure is the activation of oncogenesis processes. In the F0 generation, the prevalence of malignant neoplasms is high, which is also observed in the F1 generation (children of parents who were exposed to radiation as children), especially in relation to thyroid cancer. Multiple endocrine neoplasia (MEN syndrome) is a group of hereditary autosomal dominant syndromes caused by tumors or hyperplasia of multiple endocrine glands, accompanied by dysplasia of other organs and tissues.

Objective. By this clinical case to demonstrate the features of examination, treatment and tactics of patient management; to discuss the role of radiation factor in the etiopathogenesis of the disease in a child with diagnosed medullary cancer (carcinoma) of the thyroid gland, exposed to the complex action of radiation factor.

Materials and methods. Analysis of medical documentation data, patient's medical history, and clinical and genealogical examination methods. A review of literature sources was conducted using the eLIBRARY.RU and PubMed databases. This review includes literature reviews, scientific articles, and clinical studies.

Results. The article demonstrates the importance of diagnostic search in a child with a newly detected thyroid tumor who lives in a radiation control zone and was born to parents who were exposed to radiation as a result of the Chernobyl accident. The article also highlights the importance of expanding diagnostic search for true diagnosis verification, choosing a rational treatment and monitoring strategy, and determining the significance of the radiation factor in the etiopathogenesis of the disease.

Conclusion. The clinical case presented by us shows the need to assess the risks of radiation-induced diseases in children living in radiationcontaminated areas after the Chernobyl accident, due to the high risk of developing stochastic effects.

Background. The incidence of autoimmune diseases is increasing every year. It should be mentioned that early signs of the pathology often emerge on the oral mucosa. Among dermatological conditions, pemphigus vulgaris is classified as such. This type of the disease starts with oral rashes in 50% of cases. However, erosive and ulcerative lesions of the oral mucosa occur in 70-90% of cases. The etiology of pemphigus vulgaris is unclear. From a pathophysiological perspective, pemphigus manifests with the development of autoantibodies against intercellular substance. Clinical features present as intraepithelial blister formation on the skin and mucous membranes.

Results. Topical and systemic glucocorticosteroids are the first-line therapy. In cases of severe forms and torpid course, the treatment regimen includes immunosuppressive drugs. The localization of eruptions in the oral cavity significantly limits the range of available therapeutic options. Furthermore, due to the anatomical features of the region, there is a high risk of rapid secondary infection.

Conclusion. One of the medications accessible for the treatment of erosive and ulcerative lesions of the oral cavity is a combination of undecylenamidopropyl betaine at a concentration of 0.1% and Polyhexamethylene biguanid (polyhexanide) at a concentration of 0.1%. Polyhexanide is an antiseptic. It has been used in clinical practice for decades. It is colorless, odorless, soluble in water and alcohol and possesses bactericidal and fungicidal properties. Our experience indicates its high efficacy and good tolerability in patients with oral manifestations of pemphigus vulgaris. Clinically significant improvement is observed after two weeks of therapy. The drug is associated with a favorable impact on patients' quality of life, given that painful erosive eruptions substantially impact the ability to consume food and cause severe discomfort.

Background. Currently, in plastic surgery, contouring and injectable cosmetology, plant extracts and drugs are widely used, the effect of which is aimed at stimulating healing by activating fibrillogenesis and the epithelization process. At the same time, synchronization of these processes is not taken into account, which may cause the development of scar complications due to excessive collagenogenesis. The authors of the article suggest using low-molecular chitosan as a biologically active component affecting all reparative regeneration links in plastic surgery and contour plastic.

Objective. To conduct a comparative morphological assessment of the effect of hydrophilic gel with low molecular weight chitosan and gel containing a composition of extracts of medicinal plants on the aseptic wound process in the acute phase of inflammation (1 day after injury) and regenerative-plastic healing processes (7 days after injury).

Materials and methods. Studies performed on 30 male ICR mice. The aseptic wound was simulated under ether anesthesia by cutting out a full-layer subcutaneous skin area of no more than 50 mm2. A gel containing 2% hydroxypropyl cellulose (gelling agent) and 0.1% low molecular weight chitosan (20 kDa) was then applied daily to the wounds of the test group animals and to the control group gel containing a composition of extracts of medicinal plants animals. Morphological assessment of the acute phase of the wound process in animals of the experimental and control groups was carried out one day after the wound simulation, and morphological assessment of the regenerativeplastic processes in animals of the experimental and control groups was carried out 7 days after the wound simulation.

Results. Comparative morphological studies showed that the gel with low molecular weight chitosan has a pronounced anti-inflammatory effect in the acute phase of the wound process and is superior in anti-inflammatory effect to gel containing a composition of extracts of medicinal plants. It was also found that a gel with low molecular weight chitosan has almost the same effect as gel containing a composition of extracts of medicinal plants on the dynamics of the change in the area of the aseptic wound. However, when using a gel with low molecular weight chitosan, a full-fledged process of reparative regeneration in the skin wound with the participation of tissue macrophages is observed, there is no neutrophil infiltration, which indicates a complete relief of the inflammatory process. The number of fibroblasts, collagen and reticulin fibers is synchronized with the activation of the wound healing process and in fact completely removes the risk of developing fibrous scar complications after skin injury.

Conclusion. Gel with low molecular weight chitosan can be a very promising agent for the treatment of aseptic wounds, in injectable cosmetology, contouring and plastic surgery to relieve edema, relieve pain, relieve acute inflammation and prevent scar complications by activating physiological mechanisms of reparative regeneration due to the activation of tissue macrophages.

Background. The term "Multiple Endocrine Neoplasias" (MEN) refers to a group of inherited autosomal dominant syndromes caused by tumors or hyperplasia of several endocrine glands. Traditionally, two types of this pathology are distinguished: MEN-1 and MEN-2. The latter is further divided into three variants: hereditary medullary thyroid cancer; MEN-2A – Sipple syndrome; and MEN-2B – Gorlin syndrome. MEN-2B is based on a mutation in the RET gene, located on the 10th chromosome. Mutation of this gene is usually accompanied by uncontrolled cell proliferation, primarily in the cell lines of medullary thyroid cancer and pheochromocytoma. The primary manifestation of MEN-2B is medullary thyroid cancer, with pheochromocytoma developing in half of the patients. Gorlin syndrome has several features that distinguish it from other MEN syndromes. Thus, it is the rarest of the neoplasias. It has the most serious prognosis – most untreated patients die before the age of 30. This pathology also has distinct external manifestations allowing for clinical suspicion. Patients exhibit characteristic skull shape changes, spinal deformities, and neuromas of the tongue, oropharynx, and eyelids. In two-thirds of patients, pathology of the large intestine develops – megacolon or Hirschsprung's syndrome. A number of patients have eye pathology, with one of the most frequent manifestations being dry eye syndrome.

Results. This article presents a case of Gorlin syndrome diagnosed in an 18-year-old young man. Unusual external manifestations were the reason for his hospitalization for further diagnostics. Analysis of visual symptoms combined with identified nodular changes in the thyroid gland suggested MEN-2B syndrome, which was subsequently confirmed by additional investigative methods. The patient was found to have a significant increase in the level of calcitonin in the blood; a fine-needle biopsy of the thyroid nodule yielded cytological data suspicious for thyroid cancer; a computer tomography scan of the abdomen revealed signs of megacolon. The patient's parents showed no phenotypic signs of multiple endocrine neoplasia syndrome, which suggested that the pathology in this patient arose as a result of a mutation.