Background. Current concepts define gastroesophageal reflux disease as a chronic, recurrent condition, characterised by impaired upper gastrointestinal motility, gastroesophageal junction dysfunction, and pathological gastroesophageal reflux. This contributes to the development of clinical manifestations, as well as inflammatory, dystrophic, erosive, ulcerative, and metaplastic changes of the distal esophageal mucosa due to exposure to aggressive refluxate components. Clinical manifestations associated with gastroesophageal reflux disease can be subdivided into esophageal (heartburn, acid regurgitation) and extraesophageal. Extraesophageal manifestations of gastroesophageal reflux disease represent one of the most complex clinical challenges. The high prevalence of gastroesophageal reflux disease in the population, due to its multifactorial nature, its clinical variability, and absence of a universally accepted diagnostic gold standard often increase the time to diagnosis and the initiation of rational therapy. Managing patients with extraesophageal manifestations is particularly challenging, as their lack of specificity often contributes to misdiagnosis as other conditions unrelated to pathological reflux. Due to its tight anatomical and physiological relationship, among the wide spectrum of extraesophageal manifestations of gastroesophageal reflux disease, otorhinolaryngological and dental ones are the most frequently reported. A multidisciplinary approach, based on the collaboration between a gastroenterologist, otolaryngologist, and dentist, is essential in the management of these patients and improves diagnostic and treatment management.

Conclusion. This article summarizes and systematizes data on the mechanisms, clinical manifestations, and the capabilities of modern diagnosis of otorhinolaryngologic and dental manifestations of gastroesophageal reflux disease.

Background. Diabetes mellitus is one of the most common diseases worldwide, and non-alcoholic fatty liver disease is recognized as the most common chronic liver disease worldwide. According to current clinical guidelines, non-alcoholic (metabolic dysfunction-associated) steatotic liver disease is a chronic liver condition characterised by macrovesicular steatosis involving at least 5% of hepatocytes. In 75% of cases, non-alcoholic fatty liver disease occurs in the presence of obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, or impaired glucose tolerance. A consistent "bidirectional association" of pathophysiological, epidemiological, and clinical characteristics has been demonstrated between non-alcoholic fatty liver disease and type 2 diabetes. The comorbidity of type 2 diabetes mellitus and non-alcoholic steatotic liver disease doubles the risk of cardiovascular diseases, confers a 2-2.5-fold increased risk of cirrhosis and hepatocellular carcinoma, as well as a 22-fold excess risk of liver-related mortality, compared with the general population. Insulin resistance is a leading factor in the development of non-alcoholic fatty liver disease. Evidence has accumulated indicating that intestinal microflora, bile acid metabolism, and autophagy contribute to the pathogenesis of non-alcoholic fatty liver disease. Clinical manifestations of non-alcoholic fatty liver disease are often absent or mild. In real-world clinical practice, patients present to physicians with complaints related to comorbid conditions associated with non-alcoholic fatty liver disease. Modern approaches to non-alcoholic fatty liver disease treatment are aimed at preventing liver disease progression, regressing steatosis, steatohepatitis, and fibrosis, and reducing cardiometabolic risk factors. It is known that there is a close relationship between non-alcoholic fatty liver disease and carbohydrate metabolism disorders, based on common etiopathogenetic factors.

Conclusion. A multifaceted approach to managing patients with non-alcoholic fatty liver disease and type 2 diabetes, using ursodeoxycholic acid, can be recommended for all forms of non-alcoholic fatty liver disease. At the same time, weight management, physical activity, and dietary changes are effective measures not only for preventing the development of non-alcoholic fatty liver disease but also for reducing the risk of developing and progressing cardiometabolic disorders.

Background. Diarrheal syndrome remains one of the most common reasons for seeking medical care and a significant cause of morbidity in both children and adults. The cornerstone of treatment includes rehydration therapy and correction of fluid and electrolyte imbalances; however, probiotics are widely used as adjunctive agents in comprehensive management. Conventional probiotic microorganisms, such as representatives of the genera Lactobacillus and Bifidobacterium, may be susceptible to gastric acidity, bile acids, and digestive enzymes, which can limit their survival and, consequently, their potential clinical efficacy following oral administration.

Results. In this context, spore-forming probiotics are of particular interest due to their increased resistance to the aggressive conditions of the gastrointestinal tract. Spores of bacteria from the genus Bacillus are capable of surviving passage through the stomach and subsequently germinating in the intestine, thereby enabling a more predictable delivery of active cells to the site of action. Among sporeforming probiotics, Bacillus clausii is the most extensively studied. Experimental data indicate its antimicrobial, immunomodulatory, and anti-inflammatory properties, as well as its ability to inhibit the effects of toxins produced by certain intestinal pathogens and to modulate gut microbiota composition. Clinical evidence, including randomized controlled trials, observational studies, and metaanalyses, suggests the potential efficacy of B. clausii as adjunctive therapy in acute diarrhea in both children and adults, in reducing the risk of antibiotic-associated diarrhea, and in decreasing adverse events during Helicobacter pylori (Н. pylori) eradication therapy. Several studies have reported a reduction in the duration and severity of diarrhea; however, the level of evidence for some indications remains limited and requires further clarification. The safety profile of B. clausii-containing preparations is generally considered favorable. In most clinical studies, adverse events were rare, predominantly mild, and did not necessitate treatment discontinuation. Isolated cases of invasive infections associated with probiotic use, including B. clausii, have been reported, primarily in patients with risk factors such as immunocompromised status, prematurity, or the presence of intravascular catheters. According to systematic reviews, the proportion of B. clausii-related invasive complications is low, and the overall risk of bacteremia and/or sepsis associated with its use appears to be low and comparable to or lower than that observed with several other probiotic microorganisms.

Conclusion. Thus, spore-forming probiotics, particularly Bacillus clausii, represent a promising option in the adjunctive management of diarrheal syndrome due to their enhanced survivability, potential clinical efficacy, and favorable safety profile. Nevertheless, further large, well-designed studies are needed to more clearly define their role in clinical practice, including indications, optimal dosing regimens, and safety criteria, especially in vulnerable patient populations.

Background. Despite the availability of effective therapeutic strategies aimed at inducing and maintaining remission in inflammatory bowel disease, a subset of patients continues to experience persistent gastrointestinal symptoms, including recurrent abdominal pain and alterations in stool frequency and/or consistency. These manifestations are often interpreted as resembling symptoms of irritable bowel syndrome (IBS). Given the heterogeneity of potential etiologies underlying gastrointestinal disturbances and the absence of validated diagnostic criteria for this specific patient population, the use of the term "IBS-like symptoms" in the context of inflammatory bowel disease remains controversial. Persistent gastrointestinal complaints, and in some cases systemic manifestations, may be attributable to a broad spectrum of etiological factors. These include small intestinal bacterial overgrowth, bile acid malabsorption, carbohydrate (oligo- and monosaccharide) malabsorption, exocrine pancreatic insufficiency, gluten-related disorders, eosinophilic gastrointestinal diseases, mast cell activation syndrome, as well as conditions not directly involving the gastrointestinal tract, such as endometriosis and postoperative adhesions.

Conclusion. In light of the above, the use of the term "IBS-like symptoms" appears justified only in patients with inflammatory bowel disease who have achieved histological remission and in whom persistent gastrointestinal symptoms are attributable to disorders of the gut-brain axis. The application of this term should be reserved for cases in which alternative causes capable of explaining the clinical manifestations – both gastrointestinal and extraintestinal – have been carefully excluded.

Background. IIron deficiency (nonanemic iron deficiency and iron-deficiency anemia) remains the most common condition in the general clinical practice. Iron deficiency negatively affects the prognosis of the underlying disease and reduces the quality of patient’s life. One of the most common and difficult-to-diagnose cause of iron deficiency in clinical practice is autoimmune gastritis.

Objective. The aim of the study was to determine the incidence of iron deficiency (nonanemic iron deficiency and iron-deficiency anemia) in patients with autoimmune gastritis and to identify the factors contributing to its development.

Material and methods. Sixty-two patients previously diagnosed with autoimmune gastritis were included in a cohort observational study. The mean age of patients was 53.5 ± 12.6 years (from 25 to 79 years). By gender, there were predominantly females – 52 (83.9%), and 10 (16.1%) males. All patients underwent laboratory tests: complete blood count, iron metabolism parameters (ferritin, serum iron), antiparietal cell antibodies, anti-intrinsic factor antibodies, serological biomarkers of gastric atrophy.

Results. According to the patients’ history data and laboratory tests, iron deficiency was determined in 38 (61.3%) patients. At the time of inclusion to the study, iron-deficiency anemia was found in 7 (11.3%), anemia of complex etiology (iron deficiency and vitamin B12 deficiency) – in 2 (3.2%), nonanemic iron deficiency (ferritin < 30 μg/l) – in 8 (12.9%) patients. According to the hemoglobin level anemia grade was mild in the majority of patients – 21 (70.0%), moderate – in 6 (20.0%), severe – in 3 (10.0%) patients. The time period between iron-deficiency anemia detection and diagnosing of autoimmune gastritis ranged from several months to 25 years, with average mean 48.7 months (SD = 67.39). The frequency of iron deficiency among females and males was different –67.3% and 30.0%, respectively (χ² = 4.92, p = 0.027; OR = 4,08 [95% CI 1.103-20.923]). Iron deficiency was more common among women of reproductive age then among menopausal women (80.0% vs 29.6%, χ2 = 13.252, p < 0.001; OR = 9,5 [95% CI 2,637-34,227]). Serological biomarkers of gastric atrophy (pepsinogen I < 30 μg/L, pepsinogen I/pepsinogen II ratio < 3.0) were detected more frequently in patients with iron deficiency than in patients without them (89.5% vs 58.3%, χ² = 8.160, p = 0.005; OR = 6.071 [95% CI 1.628-22.638]). Iron deficiency was detected in all patients with hypothyroidism, while in patients with euthyroidism it was less common (100% vs 36.8%, χ² = 7.287, p = 0.007). Oral iron supplements were noneffective in 60.5% of patients and were associated with adverse events in 23.7% of patients.

Conclusion. Autoimmune gastritis should be included in the differential diagnosis of iron deficiency of unknown etiology, especially in cases of refractoriness to oral iron supplements. Nonanemic iron deficiency and iron-deficiency anemia in autoimmune gastritis develop primarily due to a decrease in acid production and proteolytic activity of the stomach, and additional factors include female gender, reproductive age, and hypothyroidism.

Background. Celiac disease is a chronic immune-mediated disorder for which a gluten-free diet is the only treatment. Despite its efficacy, patient adherence remains a challenge, and low compliance is associated with the risk of complications. Adherence to a GFD is complicated by social, economic, and psychological factors.

Objective. To assess efficacy of the gluten-free diet in patients with celiac disease and identify the main problems associated with its compliance.

Material and methods. A two-stage study using an online questionnaire was conducted. Out of 117 respondents, 77 patients with celiac disease (mean age 34 ± 10 years) were selected. Patients were divided into age groups. Adherence, clinical effect, as well as psychological and socio-economic factors were assessed. Statistical analysis included descriptive methods and the χ² test.

Results. Strict adherence to a gluten-free diet was observed in 88.3% of patients, reaching 100% in the group over 45 years of age. A clinical effect was noted in 89.6% of patients, most frequently within the first month of therapy. Worsening of well-being was observed in 25% of patients. Deficiency conditions were frequently identified: anemia (41.6%) and nutrient deficiencies (49.4%). Psychological disorders were noted in 71.4% of patients. Significant socio-economic barriers were identified: high cost and low availability of products, limited product range, social isolation, and difficulties in adhering to the diet outside the home. A significant association was found between younger age and dissatisfaction with the product range (p < 0.01).

Conclusion. Despite high adherence to a gluten-free diet, its maintenance is limited by psychological and socioeconomic factors and is associated with a risk of nutritional deficiencies, which necessitates personalized and dynamic follow-up of patients with celiac disease.

Background. Hypoxic hepatitis always develops secondary to life-threatening conditions. Up to 50-90% of cases of hypoxic hepatitis are associated with heart failure (both acute and decompensated chronic) and are considered an indicator of adverse prognosis. The exact pathogenesis of hypoxic hepatitis is still being elucidated, but the key mechanism lies in a critical mismatch between oxygen supply to hepatocytes and their metabolic demands, leading to centrilobular necrosis.

Objective. To summarize current knowledge on hypoxic hepatitis and present the results of a pilot retrospective study evaluating clinical and laboratory characteristics and predictors of adverse outcomes in patients of a therapeutic department.

Materials and methods. A literature review on hypoxic hepatitis was performed along with a retrospective analysis of 4.795 medical records of patients treated in the therapeutic department North-Western State Medical University n.a. I. I. Mechnikov during 2017-2019 and 2022-2024. Nine cases of hypoxic hepatitis were identified. Clinical characteristics and laboratory dynamics of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were analyzed, as well as in-hospital mortality.

Results. The incidence of hypoxic hepatitis in the therapeutic department was 0.19% (9/4795). The median age was 65 years (41-81), and 77.8% of patients were male. Cardiovascular diseases predominated in the comorbidity profile. In-hospital mortality was 22.2% (n = 2). Peak aminotransferase levels did not differ between survivors and non-survivors. However, the absence of AST decline and an increase in total bilirubin by days 3-5 were more frequently observed in patients with fatal outcomes.

Conclusion. The prognosis of hypoxic hepatitis appears to depend not only on the peak of aminotransferase levels but also on their dynamics during treatment. Lack of AST decline by days 3-5 and persistent hyperbilirubinemia were more frequently associated with fatal outcomes in our cohort.

Background. Cutaneous melanoma, originating from epidermal melanocytes, is one of the most aggressive tumors that metastasizes both via lymphatic and hematogenous routes. The tumor is brown or black in color, as melanoma cells continue to synthesize the pigment melanin. However, in some cases, the pigment is not detected in the tumor or is present in small amounts, and the melanoma becomes amelanotic, resembling a hemangioma or papilloma. Economical removal of such a formation is fraught with recurrence and a worsening prognosis. In these cases, cytological examination of a scraping or fine-needle aspirate of the formation can establish the correct diagnosis. However, many oncologists are hesitant to use this method, as they believe that trauma can accelerate tumor growth. At the P. A. Herzen Moscow Research Oncology Institute, cytological examination of melanoma scraping or aspirate has been used since the early 1970s. Practice has shown that minor trauma does not affect the disease prognosis. In 1974, methodological guidelines titled "The Use of the Cytological Method in the Diagnosis of Skin Melanomas" were published. The aforementioned method is also used at the N. N. Petrov National Medical Research Center of Oncology, but no impact on prognosis has been observed. Currently, it is established that two factors influence melanoma prognosis: tumor thickness and the level of dermal invasion. Other factors are insignificant. Fiveyear survival rates are 95% for tumors less than 1 mm thick and 45% for tumors 4 mm or thicker.

Conclusion. Two clinical cases are presented where cytological examination of small amelanotic lesions allowed for the early detection of melanoma. In the first case, the melanoma thickness was 0.7 mm and the invasion level was 3. In the second case, the thickness was 0.68 mm and the invasion level was 2. In the first case, the patient was examined 4 years and 11 months after treatment, and in the second case, 10 months after treatment, with no signs of recurrence detected. The conclusion is drawn about the necessity of applying the cytological diagnostic method in the daily practice of surgeons, dermatologists, and oncologists for the early detection of amelanotic melanoma of the skin.

Background. One of the most common nail diseases is onychomycosis, which is an infectious condition caused by pathogenic fungi. Due to increasing resistance of pathogens to traditional antifungal agents, as well as a number of issues related to systemic antifungal drugs (long duration of therapy, side effects), there is a demand for additional treatment methods, one of which is photodynamic therapy, characterized by a high safety profile and good patient compliance.

Objective. The aim of this study is to evaluate the effectiveness and safety of combined therapy for onychomycosis using photodynamic therapy.

Materials and methods. A prospective comparative study included 48 patients with confirmed clinical and microscopic diagnosis of onychomycosis. In the control group (24 individuals), standard treatment with systemic antifungal drugs was administered. The experimental group (24 individuals) received 8 sessions of photodynamic therapy with chlorin-based photosensitizer in combination with a shortened course of systemic antifungal agents. The efficacy and safety of the therapy were assessed at 3, 6, and 9 months through negativation of microscopic analysis and measurement of the area of visually healthy nail plate.

Results. Both groups of patients showed a positive trend in terms of mycological clearance, however, a comparative analysis revealed a 1,36-fold increase in the rate of early mycological cure already at the 3rd month of observation compared to the control group (р ≤ 0,05). Positive clinical dynamics were observed in both groups at all stages of observation, with the percentage of patients recovered by the 9th month being higher in the experimental group: 96% (23 patients) compared to 87,5% (21 patients) in the control group. Side effects were only recorded in the control group.

Conclusion. Photodynamic therapy presents a therapeutic alternative for the treatment of onychomycosis, allowing for a reduction in the duration and potential side effects associated with systemic antifungal medications, as well as achieving higher cure rates.

Background. Modern therapy of patients with atopic dermatitis involves the long-term use of topical medications that can affect different stages of the disease pathogenesis. Topical glucocorticosteroids allow for a rapid clinical response in case of acute atopic dermatitis, but with prolonged use they have a number of undesirable effects. The introduction of calcineurin inhibitors into practice has made it possible to conduct proactive therapy of atopic dermatitis. Pimecrolimus (1% cream) in the treatment of mild to moderate atopic dermatitis can be used in children in the form of medicinal ultraphonophoresis and with prolonged use does not cause pronounced side effects. The duration of therapy is determined by both the regression of clinical manifestations, as well as the features of the previous course of the disease, and the frequency of relapses.

The purpose of the study. To evaluate the effectiveness of using 1% pimecrolimus cream for medicinal ultraphonophoresis in children with atopic dermatitis.

Materials and methods. The study was conducted on the basis of the day hospital setting of the Clinic of Adaptation Therapy at the Orenburg State Medical University. We observed 10 patients aged 5-8 years suffering from moderate atopic dermatitis in the subacute period who received the drug ultraphonophoresis on the UZT-1.01F device using 1.0% pimecrolimus cream as external therapy. To assess the clinical effectiveness of treatment, the standardized severity index SCORAD was used in the dynamics of therapy before and after 7, 14 and 30 days of treatment.

Results. The ultraphonophoresis method using 1.0% pimecrolimus cream made it possible to reduce the severity of atopic dermatitis by an average of 2.7 times according to the SCORAD index (from 50.5 ± 3.5 to 18.5 ± 2.5 points, respectively), which corresponds to the state of clinical remission of the process in 90% of patients with 10 procedures.

Conclusion. Our own clinical experience shows that medicinal ultraphonophoresis with 1.0% pimecrolimus cream as an additional method of external treatment of atopic dermatitis contributes to the prolongation of remission and long-term control of symptoms of the disease.

Background. Due to the widespread use of targeted therapy drugs with various trade names in the treatment of cystic fibrosis, there is a need for a clinical evaluation of the results of treatment with these drugs and their tolerability and safety within the framework of routine clinical practice.

Objective. The aim of the study was to present the experience of the Republic of Tatarstan in the etiopathogenetic therapy of ivacaftor + tezacaftor + elexacaftor and ivacaftor with a change of trade name within the same international nonproprietary name in pediatric patients diagnosed with cystic fibrosis, to demonstrate the clinical efficacy of this drug and its safety.

Conclusion. During 2025, 80 patients received etiopathogenetic therapy with ivacaftor + tezacaftor + elexacaftor and ivacaftor, including 12 children under 6 years of age, 19 aged 6 to 12 years, and 46 patients aged 12 to 18 years. The average age of patients at the start of therapy was 7.5 years. Patients with the pulmonary-intestinal form of the disease (E 84.8) prevailed – 78.3%, with a predominantly pulmonary form (E 84.0) – 21.7%. Prior to the initiation of targeted therapy and when changing the drug to a triple fixed dose combination, a comprehensive assessment of the functional capabilities of the child's body was carried out within the framework of one international nonproprietary name. Monitoring of the safety and effectiveness of treatment was carried out 14 days after the start of therapy, 1 month after, 3 months after, 6 months after, and 12 months after. Against the background of the three-component targeted therapy, patients showed an improvement in respiratory function (FEV1 and FVC), positive weight and height dynamics. When changing the drug within the same international nonproprietary name , the indicators of the function of external respiration remained at the achieved level. During the 6 months of follow-up, there were no exacerbations of cystic fibrosis that required hospitalization.

Background. The problem of body weight deficiency or excess in children of different ages is relevant in the practice of a pediatrician and a pediatric endocrinologist. The preschool period is considered as one of the significant stages of a child's life, associated with the formation and consolidation of stereotypes of eating behavior and physical activity, the great influence of family traditions, behavioral patterns of parents.

Objective. To evaluate the features of the trophological status and the frequency of diagnosis of obesity in preschool children living in the Moscow region.

Materials and methods. A single-stage, single-center, non-randomized study was conducted. The anthropometric indicators (height (cm) and weight (kg)) of 385 preschool children (4-6 years old inclusive) (201 boys (52.2%), 184 girls (47.8%)), obtained on the basis of data from an annual preventive examination, were analyzed by random sampling. The calculation of body mass index (BMI) and standard sigma deviation (SDS) was carried out according to the WHO AnthroPlus program.

Results. Trophic status disorders were detected in 141 (36.6%) children (boys – 76 (37.8%), girls – 65 (35.3%). Malnutrition was registered in 41 children (10.6%), of which boys – 20 (48.8%), girls – 21 (51.2%), while 2 of them (4.9%) (all girls) had severe body weight deficiency (SDS BMI < -3). Overweight was observed in 79 children (20.5%) (boys – 46 (58.2%), girls – 33 (41.8%). Obesity was diagnosed in 21 (5.5%) children (boys – 10 (47.6%), girls – 11 (52.4%): grade I –9 (42.8%) children (boys – 4 (44.4%), girls – 5 (55.6%), grade II – 6 (28.6%) of children, and III and morbid obesity had three children (14.3% each), boys and girls equally.

Conclusion. It was found that more than a third of children aged 4-6 years (36.6%), regardless of gender, had trophic status disorders. Excess body weight was registered in every fourth child and was 2 times more common than its deficiency (20.5% and 10.6%, respectively). In 4.9% of children with signs of malnutrition, body weight deficiency was considered severe (SDS BMI < -3). Obesity was diagnosed in 5.5% of children, while 28.6% of them had high degrees (III, morbid). There were no significant differences in gender. The data obtained on the state of trophological status and the frequency of diagnosis of obesity in preschool children complement the results of the examination of schoolchildren in the Moscow region presented earlier, and confirm the need for regular preventive examinations of organized and unorganized children of younger age groups and timely implementation of a set of therapeutic and preventive measures to prevent the progression of metabolic disorders and the development of complications at an older age.

Background. Duchenne/Becker progressive muscular dystrophy is an X-linked recessive disease caused by mutations in the DMD gene encoding the dystrophin protein. Deletions of exons 45-55 often correspond to the principle of preserving the reading frame, being associated with the Duchenne/Becker muscular dystrophy phenotype.

Objective. To present a clinical case of the presymptomatic diagnosis of progressive Duchenne/Becker muscular dystrophy in an early-age patient with deletion of exons 45-55 of the DMD gene, analyze diagnostic markers and justify a strategy for dynamic follow-up.

Materials and methods. A retrospective analysis of medical documentation with clinical, laboratory and instrumental methods was performed. In order to form a theoretical base, data was searched and systematized from scientific electronic libraries (CyberLeninka, eLibrary, PubMed, Google Academy) on progressive Duchenne/Becker muscular dystrophy (preclinical phase) and deletion of exons 45-55 of the DMD gene. The review includes literature reviews, scientific publications, and the results of clinical trials on the topic.

Conclusion. A clinical case of diagnosis of progressive Duchenne/Becker muscular dystrophy in a 1-year-old male patient with isolated hyperfermentemia (ALT – 120 U/l, AST – 107.1 U/L) and a significant increase in creatine phosphokinase (4817.1 U/L) is described. Conducted: biochemical examination (creatine phosphokinase, lactate dehydrogenase, creatine phosphokinase-MV), instrumental diagnostics, including electrocardiography, ultrasound examination of the heart and abdominal cavity), molecular genetic analysis. The molecular genetic analysis method verified the hemizygous deletion of exons 45-55 of the DMD gene. The diagnosis of progressive Duchenne/Becker muscular dystrophy was established at the preclinical stage, despite the absence of manifest neurological symptoms. The case demonstrates the critical role of determining of creatine phosphokinase as a screening marker and the need for an integrated approach for early diagnosis. The detection of in-frame deletion creates prerequisites for the potential use of exon-skipping therapy.

Background. Treatment of wounds in mine blast trauma and diabetic foot syndrome (DFS) remains a clinical challenge. Mine blast trauma is associated with extensive tissue damage and a high risk of infection. Diabetic foot syndrome leads to ulcerative defects in 20% of diabetic patients, and up to 85% of lower limb amputations result from wound infection against the background of impaired microcirculation. The growing problem of antimicrobial resistance necessitates the use of topical antiseptics that also stimulate regeneration. Combined hydrogel dressings are promising, but their clinical potential requires further clarification.

Objective. To evaluate the effect of a combined antiseptic hydrogel dressing on the wound healing process in patients with mine blast trauma and diabetic foot syndrome.

Materials and methods. A prospective single center study was conducted at the Odintsovo Regional Hospital (2022-2025). We analyzed 200 medical records divided into four groups of 50 patients each: main groups ( diabetic foot syndrome and mine blast trauma treated with the hydrogel hydrogel containing collagen hydrolysate, sodium alginate and antiseptics) and control groups (standard therapy). We assessed wound size dynamics, pH, leukocyte count, C reactive protein, microbiology, length of hospital stay, and number of surgical debridements. Statistical analysis used Student's t test, Mann – Whitney U test, and Pearson correlation.

Results. The use of the hydrogel resulted in significant clinical benefits. In the diabetic foot syndrome group, wound pH shifted from 5.05 to 5.90 (p < 0.001); a pH increase > 0.5 by day 10 predicted a favorable outcome with 85% specificity. In the mine blast trauma group, C reactive protein decreased from 109.5 to 50.2 mg/L (p < 0.001). In the diabetic foot syndrome group, hospital stay was reduced by 4.6 days (18.2 vs 22.7; p < 0.001), and the number of surgical debridements decreased from 2.1 to 0.8. In the mine blast trauma group, the rate of autodermoplasty increased from 32% to 72%. The hydrogel was effective against E. coli, K. pneumoniae, E. faecalis, and P. aeruginosa. No adverse events related to the hydrogel were recorded.

Conclusion. The hydrogel containing collagen hydrolysate, sodium alginate and antiseptic exhibits combined antimicrobial, anti inflammatory, and regenerative effects. Its use in diabetic foot syndrome patients significantly reduces hospital stay and the number of surgical interventions. Wound pH dynamics (an increase > 0.5 by day 10) can serve as a prognostic criterion for favorable healing.

Background. Polycystic ovary syndrome, insulin resistance, and metabolic disorders are among the most common causes for reduced fertility in reproductive-aged women. Impaired insulin signaling leads to secondary hyperinsulinemia and hyperandrogenism, which contribute to anovulation, irregular menstrual cycles, and reduced fertility. Inositols have recently received considerable attention as physiological insulin sensitizers capable of restoring metabolic and endocrine homeostasis without the use of hormone therapy.

Objective. Present study aimed to substantiate the efficacy and safety of the use of the dietary supplement RitmoZhinel®, which contains myo-inositol and D-chiro-inositol in a physiological ratio of 40:1, as well as alpha-lipoic and folic acids, vitamins D₃, B₅, B₆, C, E, chromium, and manganese.

Results. The analysis of clinical studies and literature data has demonstrated that inositols enhance tissue sensitivity to insulin, reduce androgen levels, restores ovulation and menstrual function. Meta-analyses demonstrate a statistically significant reduction in the HOMAIR index, decreased testosterone levels, and increased ovulation frequency compared with the placebo group. Additional components of the agent provide antioxidant protection, maintain hormonal equilibrium, and potentiate the metabolic effects of inositols.

Conclusion. The body of evidence confirms the pathogenetically substantiated efficacy of a compound as a non-hormonal agent in supporting reproductive health in women with polycystic ovary syndrome and insulin resistance. Its favorable safety profile and good tolerability highlight the potential of this agent as a promising avenue for nutritional support of women’s metabolic and endocrine health.

Background. Sexual dysfunctions in men of fertile age are multifactorial in nature, which requires a systematic approach to diagnosis. The lack of standardized algorithms leads to hypo- and overdiagnosis of both psychogenic and organic forms.

Objective. To present a structured step-by-step algorithm for the diagnosis of sexual disorders in men, integrating the assessment of sexual constitution, psychometric scales (HADS, IPDE), sexual formula (SFM) and instrumental methods, as well as to prove the diagnostic necessity of each of these tools in a clinical sample.

Materials and methods. The study included 100 men aged 18-50 years (average age 35.4 ± 8.2 years) with complaints of sexual dysfunction. The developed algorithm has been consistently applied to all of them. Regardless of the algorithm, the final diagnosis was determined by an expert panel of four specialists (psychiatrist, urologist, endocrinologist, neurologist). ROC analysis was performed, sensitivity, specificity, predictive value, Cohen's agreement coefficient, Pearson correlation, and criterion χ2 were calculated.

Results. The overall accuracy of the algorithm was 90% (κ = 0.86; p < 0.001). Sensitivity in detecting organic pathology was 88.6%, specificity was 91.1%. ROC analysis of HADS (AUC = 0.92) confirmed the high predictive power of the anxiety scale. A strong correlation of a weak sexual constitution with endocrine disorders was revealed (r = 0.78; p < 0.001). The presence of personality disorders (IPDE) was significantly more often associated with a psychogenic etiology (p < 0.001). The structuring of complaints by SFM allowed us to correctly determine the diagnostic search vector in 94% of cases.

Conclusion. The proposed algorithm has high diagnostic accuracy. Each of the instruments used (SFM, sexual constitution, HADS, IPDE) makes an independent and significant contribution to differential diagnosis, which justifies their mandatory use in clinical practice in men aged 18-50 years.

Background. Climacteric syndrome is characterised by a combination of neurovegetative, psycho-emotional, and metabolic disorders, secondary to estrogen deficiency during the perimenopausal transition and postmenopause. Epidemiological studies suggest that up to 80% of peri- and postmenopausal women experience climacteric symptoms, including hot flashes, night sweats, anxiety, depression, sleep disturbances, a decline in libido, and genitourinary syndrome of menopause. Despite the high efficacy of menopausal hormone therapy, its clinical use is limited by contraindications and patient concerns regarding safety. Consequently, there is growing interest in non-hormonal therapies, including phytoestrogens, amino acids, and micronutrients. The most extensively studied components of nonhormonal therapy include phytoestrogens, amino acids, antioxidants and vitamins, providing a more comprehensive intervention targeting the pathogenesis of climacteric disorders. Phytoestrogens (soy and red clover isoflavones) can selectively bind to estrogen receptors β, exerting mild estrogen-like activity and alleviating vasomotor symptoms. The amino acids β-alanine and tryptophan are involved in the modulation of neurotransmition, including the synthesis of serotonin and melatonin, which improves sleep quality, reduce anxiety and the frequency of hot flashes. Antioxidants, particularly resveratrol, possess anti-inflammatory and cardioprotective properties, thereby improving cognitive functions and mitigating the risk of metabolic dysfunction, common in postmenopausal women. Vitamins B, C and E are involved in neurotransmitter synthesis, provide antioxidant protection and maintain optimal functioning of the nervous and cardiovascular systems, which alleviates climacteric symptoms.

Objective. The present study aims to evaluate clinical data supporting the efficacy and safety of a dietary supplement, which contains red clover isoflavones, resveratrol, β-alanine, 5-hydroxytryptophan, and vitamins B, C and E for the treatment of menopausal symptoms.

Conclusion. The body of evidence indicates that non-hormonal complexes derived from phytoestrogens and micronutrients can alleviate vasomotor symptoms, enhance psycho-emotional well-being and improve the quality of life in female patients while maintaining a favorable safety profile.

Background. One of the significant problems of early rehabilitation of acute cerebrovascular accident is the development of hemodynamic disorders caused by changes in flows in the system of basal anastomoses. As a result, actively conducted physical rehabilitation may not only fail to achieve the expected effect, but also lead to the opposite result. A solution to this problem could be a method of dynamic monitoring of the state of cerebral hemoperfusion, which could be used, including in the context of rehabilitation measures, to monitor changes in the patient's condition during the physical load imposed on him. In our study, we examined the possibility of using the clinical electroencephalography method to solve this problem, since the technique is widely used in modern healthcare, does not require significant costs for the study and does not have an adverse effect on the patient.

Objective. The purpose of the presented work is to describe the possibility of studying rhythmic slow-wave phenomena associated with the development of local hemoperfusion disorders that occur with increased physical activity in patients in the early recovery period of ischemic stroke.

Materials and methods. We examined 24 people who had suffered an ischemic stroke (atherothrombotic variant) during the year, who had a Rankin index of 3. The average age of the examined was 57.3 years, Mo – 55, Me – 58, First quartile – 55, third – 61.3. Age range – 38 years. Minimum age – 35 years, maximum – 73 years.

Results. Our study found that during the first 6 months, physical impact on the affected limbs causes significant changes in cerebral hemodynamics, which can lead to the development of hemodynamic steal in adjacent areas of the cerebral cortex, including in the unaffected hemisphere. These data should be taken into account when developing physical rehabilitation programs for patients with stroke, and the EEG method itself can be successfully used for direct monitoring of cerebral hemoperfusion, including in the context of rehabilitation activities.

Background. West Nile virus disease ranks as the most leading natural-focal zoonotic diseases in Russia, predominantly in the south of the country, peaking during the summer and autumn months. The first cases of West Nile fever were reported in the Astrakhan region (isolated cases have been observed since 1967, followed by a widespread occurrence since 1997 (8 cases in 1997 and 95 cases in 1999). Subsequently, the disease has spread to the Volgograd (380 cases – since 1999), Rostov (5 cases since 2000), and Ulyanovsk (a single case in 2006) regions. The past 20 years have witnessed a significant expansion of the infection into new regions, with cases reported in the Saratov, Samara, Lipetsk, and Belgorod regions, including some areas of Siberia. In 2010, West Nile fever was first reported in the Chelyabinsk region, the Republics of Kalmykia and Tatarstan, Krasnodar, and Voronezh regions. The same year, outbreaks of West Nile fever were reported in the Volgograd, Rostov, and Voronezh region. Between 2010 and 2024, a total of 2,728 cases of West Nile fever have been recorded in Russia to date. We present a clinical case of a neuroinvasive form of West Nile fever, a combination of encephalitis and acute flaccid paralysis in a 60-year-old man. Most cases of West Nile fever are asymptomatic or mild, and a small proportion of infected people may develop severe neurological forms that can lead to irreversible consequences and death. The mortality rate in the neuroinvasive form of West Nile fever reaches 20%. Difficulties in the diagnosis of neuroinvasive forms in West Nile fever are associated with the non-specificity of the initial symptoms.

Objective. To analyze and describe a clinical case of a patient with a neuroinvasive form caused by West Nile virus. Medical education of doctors on the problem of neuroinvasive forms of West Nile fever.

Materials and methods. The analysis of the inpatient patient's medical history was carried out: clinical symptoms, laboratory parameters, instrumental research data, as well as the dynamics of the patient's condition against the background of therapy.

Results. The clinical picture of the neuroinvasive form of West Nile fever, a combination of encephalitis and acute flaccid paralysis, which caused difficulties in diagnosis and timely administration of drug therapy, is described.

Background. Neisseria meningitidis (meningococcus) is a highly fatal disease worldwide, occurring in epidemic and sporadic cases. The virulence of invasive N. meningitidis is determined by several key factors, including surface adhesins (pili), a protective capsule, and endotoxin release (lipid A from lipooligosaccharides). Furthermore, the bacterium has evolved genetic adaptations, including horizontal gene transfer, antigenic variation, and molecular mimicry, which allow it to successfully colonize mucosal surfaces, invade the bloodstream, and evade the immune system. The acquisition of N. meningitidis typically occurs through exposure to respiratory droplets. Meningococcal infection can present in both localized (nasopharyngitis, carriage) and generalized forms (meningitis, meningococcal bloodstream infection, meningoencephalitis, and mixed forms). Atypical presentations also include: arthritis, myocarditis, iridocyclitis, and others. The clinical form of infection is a key determinant of the outcome, the spectrum of potential complications and long-term sequelae, accounting for approximately 20-30% of cases. The epidemiology of N. meningitidis is variable and unpredictable. Early clinical symptoms are nonspecific and can lead to misdiagnosis and, therefore, delayed optimal treatment.

Objective. To analyze clinical and laboratory data to identify the clinical features and markers of adverse events in meningococcal sepsis (meningococcemia).

Materials and methods. We analyzed the records of inpatients under 18 years of age treated for meningococcemia (meningococcal sepsis) at the Minsk City Children's Infectious Diseases Clinical Hospital from 2009 to 2024.

Results. The main clinical manifestations of meningococcal sepsis are febrile fever (98.1-100%) and rash (100%). Meningococcemia most often occurs in combination with nervous system damage and the development of meningitis/meningoencephalitis (53.2-69.3%). The development of Waterhouse-Friderichsen syndrome in meningococcal sepsis increases the risk of death by almost 9 times. Conclusion. Established markers of an unfavorable course of meningococcal sepsis include septic shock and Waterhouse-Friderichsen syndrome.

Background. Currently, the search for pharmacological agents with anti-aging activity is one of the most popular areas in medicine, cosmetology and nutrition. Moreover, the main focus of research is aimed at evaluating the anti-aging activity of natural compounds, in particular polysaccharides, which combine not only a wide range of biological activity, but also high safety due to the absence of side effects typical of most synthetic drugs. Among natural polysaccharides, chitosan is the most promising agent with anti-aging activity.

Objective. To evaluate the anti-aging activity and effectiveness of low molecular weight chitosan (50 kDa).

Materials and methods. The anti-aging effects of low molecular weight chitosan were studied using two in vivo models: 1. The galactose model of accelerated aging in mice. Outbred nonlinear male ICR (CD-1) mice were used for the study. The mice were divided into two groups: experimental and сontrol. Mice from both groups were administered high doses of galactose daily for 4 weeks. Mice from the control group drank regular water, while mice from the experimental group drank a 0.1% aqueous solution of low molecular weight chitosan (50 kDa). Histological changes in the liver, skin, and testes of mice were assessed after 4 weeks. 2. A study of the anti-aging effects of low molecular weight chitosan administered intradermally to intact mice. Outbred nonlinear male ICR mice (CD-1) were used for the study. The mice were divided into two groups: "Experimental" and "Control." Mice from the control group received 5 intradermal injections of 10 μl of saline daily for 5 days, while mice from the experimental group were similarly administered a 0.1% solution of low molecular weight chitosan. Histological changes in the skin were assessed with morphometric analysis after 8 days.

Results. The conducted studies demonstrated that low-molecular-weight chitosan (50 kDa) exhibits pronounced anti-aging activity when administered enterally in a galactose-accelerated aging model and with intradermal injections of a 0.1% aqueous solution. Enteral administration of low-molecular-weight chitosan (50 kDa) to mice compensates for metabolic changes in tissues caused by high doses of galactose. This compensation for the negative impact of hypergalactosemia is observed for all morphometric parameters: dermal thickness, sebaceous gland and Leydig cell volume density, liver destruction, and germ cell epithelium height in the seminiferous tubules. The most likely mechanism for the anti-aging activity of low-molecular-weight chitosan following intradermal injection is related to the activation of natural physiological mechanisms of skin self-renewal, which are largely associated with the activity of tissue macrophages producing a complex of anti-inflammatory cytokines and tissue proteinases, including elastase and collagenases.

Conclusion. Low-molecular-weight chitosan can be considered not only as a pharmacological agent for stimulating regenerative and plastic processes in the skin but also as an effective anti-aging biologically active component for cosmetic compositions. Moreover, such cosmetic compositions can be used not only topically but also by intradermal injection, including administration using mesorollers.