One of the topical issues of modern obstetrics is the search for ways to improve the morphofunctional state of the endometrium. The importance of this problem is determined, first of all, as a reserve possibility to reduce the frequency of premature births and, consequently, perinatal morbidity and mortality. The use of ozone therapy in the complex treatment of chronic endometritis in combination with reduced blood flow in the uterus and ovaries opens up prospects for more effective pre-implantation preparation. Aims were to improve the effectiveness of treatment of chronic endometritis in complex periconceptional preparation in women with miscarriage. This prospective cohort controlled study included patients with confirmed chronic endometritis with a history of miscarriage. In total, 81 patients participated in the study. The study was conducted from January 2004 to August 2006. Patients of the main group received systemic ozone therapy at the stage of rehabilitation in complex treatment, the control group underwent traditional treatment. The effectivenesswas evaluated using clinical and paraclinical examination methods. The patients examined with morphologically confirmed chronic endometritis showed a decrease in blood flow in the uterine and ovarian arteries, which significantly affected the reproductive potential of women. Significant differences were obtained in different approaches to treatment. In the main group, against the background of ozone therapy, there was an improvement in blood flow in the uterus and ovaries, which positively affected the increase in the midline echo, improvement of characteristics of the yellow body; the changes were slightly expressed in the control group. In the main group, in patients who underwent periconceptional preparation, the course of pregnancy and outcomes were significantly better than in the control group, with no adverse effects observed in either group. The use of ozone therapy in patients with chronic endometritis significantly improves the effectiveness of periconceptional preparation. 

Data on new biological markers of adenomyosis are presented. The role of ERM proteins in the development and progression of endometriosis is described. An in-depth study of the structure, mass, localization of ERM proteins and their functional relationship with the signaling pathways Rho, RhoA, Rhoc, RhocK1, leading to increased migration and adhesion of ectopic endometrial cells. It describes which cell adhesion proteins are involved in binding to the moesin protein domain and function as crosslinkers between membrane proteins and the cytoskeleton. Data on the regulation of the function of ERM proteins as crosslinkers are presented. In order to study the functional role of ERM proteins, the phenotypes of mice with the presence and removal of the protein moesin, radixin and ezrin separately were described. Various methods of studying the expression of ERM proteins in ectopic and eutopic endometrial cells are considered. The role of the protein moesin and ezrin in the pathogenesis of adenomyosis and in the progression of the pathological process is described separately. The expression of moesin in ectopic endometrial cells in adenomyosis, leading to the progression of the pathological process, was studied. Markers involved in phosphorylation of the moesin protein and markers that inhibit moesin activity are described, which favorably affects the outcome of the disease. The expression of the ezrin protein in ectopic endometrial cells in the proliferative and secretory phases of the menstrual cycle was studied, its role in the development and progression of adenomyosis was described, as well as markers that activate and inhibit this protein were studied. It describes the forms of cancer diseases in which the expression of ERM system proteins is increased, which contributes to more active metastasis of cancer cells and leads to a worse prognosis of the disease. We have studied which biological markers inhibit the activity of ERM proteins, which helps to reduce cancer cell metastasis. 

Detection of adrenal neoplasms frequency is increasing constantly, their estimated at 1 to10%. Although in each case it is necessary to identify hormonal activity and malignant potential, most of them are represented by hormone inactive and benign adenomas. Approximately a fifth of the adrenal formations after further verification are hormone-active or carcinomas that require surgical treatment. The main goal of imaging studies in adrenal incidentalomas is the timely detection of malignant tumors; to determine the characteristics of neoplasms, computed tomography, magnetic resonance imaging and, if necessary, a number of radioisotope studies are used. The size of the lesion detected on computed tomograms exceeding 4-6 cm, its uneven edge or heterogeneity of the structure, an attenuation coefficient of 10 Hounsfield units or higher with a non-contrast study, washout of the contrast agent after 10 or 15 minutes by less than 40%, calcification and invasion in the surrounding tissues suggest the malignancy of the adrenal gland lesion, the likelihood of this increases with a combination of these signs. The developed visualization methods and laboratory evaluation allow to assess their morphological structure and functionality with high confidence. The principles of monitoring the growth and hormonal activity of adrenal formations had been currently developed, but the aspects of the long-term dynamic monitoring remain poorly understood. 

Hypoglycemia is not only significantly reduces the quality of life of patients, but also refers to life-threatening conditions. When clinical and laboratory signs of hypoglycemia appear, regardless of the presence or absence of carbohydrate disorders, it is necessary to clarify the etiology of its appearance. One of the causes of spontaneous hypoglycemia, which occurs principally with fasting, is insulinoma – neuroendocrine tumor, deriving from β-cells of islets of Langerhans, that uncontrollably secreting insulin, approximately 5-10% of them are malignant. The classic diagnostic method is prolonged supervised fasting test (up to 72-hour), during which the classic hallmark – the Whipple triad has been confirmed. Currently, there are a lot of imaging modalities, including scintigraphy, positronemission tomography/computed tomography and invasive imaging studies. Even when the tumor has not been located preoperatively, surgical cure should be performed if the diagnosis of insulinoma has been established biochemically. The somatostatin analogs of short and long-acting have been reported to control symptoms of malignant insulinomas. Interferon-Alfa Therapy and chemotherapy are used as pathogenetic therapy. Even when metastases to the liver are found, cytoreductive surgery (radiofrequency ablation, embolization and chemoembolization of the hepatic arteries) may be perfomed. Research use of the peptide receptor-targeted radiotherapy is underwaying. 

According to the annual increase in the number of patients with diabetes worldwide, the number of women of reproductive age with disorders of carbohydrate metabolism (DMC) is increasing also. The increase in the prevalence of DMC in pregnancy is due to a change in diagnostic criteria since 2012 and an increase in the number of patients with obesity, as well as an improvement in the quality of diagnosis. The diagnostic difficulties with DMC are caused by clear clinical signs and low hyperglycemia in gestational diabetes mellitus (GDM) have been detected late. As a screening method for diagnosing possible DMC in pregnant women during pregnancy, an oral glucose-tolerant test is carried out. GDM is a serious medical and social problem. It is one of the most frequent extragenital pathologies of pregnancy, which increases the number of complicated outcomes for both the mother and the fetus, and subsequently negatively affects the development of the newborn. In patients with diabetes mellitus (DM) and prediabetes, complications during of the pre- and post-gravidar periods, as well as abnormalities of fetal growth and development are most frequent. Complications of the fetus from the mother with DMC can be divided into two groups: diabetic embriopathy and diabetic fetopathy. Nowadays, the most obvious point is the prevention of complications of DMC during gestation. Planning and management of pregestational DM in pregnancy control plays a major role in preventing risks, both for the mother and for the fetus, and is the basis for the birth of a healthy baby. The study reports clinical cases of pre-gestational and manifest diabetes in pregnancy. 

Adult type of diabetes mellitus in young people (MODY) is a group of diseases associated with gene mutations leading to pancreatic β-cell dysfunction. There are 14 known variants of MODY, the most studied are MODY 1-5. The article presents a clinical cases of MODY3 which is based on a mutation of the HNF1A gene.We observed 2 families in which young girls of 26 and 25 years old were probands, respectively. Diabetes mellitus (DM) was first diagnosed in them at the age of 16. At the onset of the disease, a patient from 1 family had complaints of a nonspecific nature, glucosuria, hyperglycemia up to 9 mmol/l, HbA1с – 8%. And in a patient from 2 families, hyperglycemia up to 14 mmol/l was detected by chance, there were no complaints. When examined 10 years after the diagnosis of diabetes in both patients, the level of C-peptide was within the reference values, which indicates the preservation of the secretory function of the pancreas. Antibodies in a patient from 1 family were negative, compared with a patient from 2 families (the presence of antibodies to GAD was detected), the level of HbA1с was 7.8% and 5.9%, respectively. Of the concomitant diseases, 2 probands were diagnosed with autoimmune thyroiditis. Diabetic peripheral polyneuropathy was a complication of diabetes in both patients. A burdened family history of carbohydrate metabolism disorders was observed in 2 families and was followed in 3 maternal generations. Based on the age of diagnosis of diabetes, preserved secretion of β-cells of the pancreas, the absence of antibodies, determination of diabetes in relatives in three generations, it was suggested that the patients had HNF1A-MODY. After a molecular genetic study, the diagnosis was confirmed in the observed patient and her mother (family 1) and in a patient from family 2. These clinical cases demonstrate variants of the course of monogenic diabetes. 

The article analyzes the literature data and considers modern drugs of mucoactive therapy used for cough. The points of application and mechanism of action of the main groups of mucoactive drugs – expectorants, mucokinetics, mucoregulators and mucolytics are described. A parallel was drawn between the pharmacological effects of these groups of drugs and the pathogenetic mechanisms of inflammatory processes of the bronchial tree and increased bronchial secretion. It is shown that the most frequently used combinations are fixed expectorants with various active substances, expectorants and mucokinetics, as well as expectorants, mucokinetics and bronchodilators. The most frequent fixed combinations of expectorants are presented, as well as the composition of the main used mucoactive drugs. The use of rational combinations of mucoactive drugs in the management of cough can increase the effectiveness of pharmacotherapy, reduce the number of drugs used and the risk of side effects, and increase patient adherence to treatment. 

Pressure sores are a common affliction for patients in intensive care units, neurology, and rehabilitation after critical conditions, including trauma, acute cerebrovascular accidents and abdominal surgery. Despite the fact that a sufficient number of wound dressings have been created around the world to prevent and promote healing of wounds resulting from pressure on soft tissues, the features of nutritional status and clinical nutrition are rarely discussed. Chronic wounds (pressure sores and trophic ulcers) significantly reduce the quality of life of patients and place a heavy burden on the health care system. In the pathogenesis of the development of pressure sores, both external factors (chronic compression of the tissue covering the bone protrusion, friction or displacement of the body, exposure to moisture, immobility) and internal factors are involved – arterial hypertension, diabetes mellitus, age, malnutrition, etc. Malnutrition is a common factor the risk of developing chronically non-healing wounds in different groups of patients. Individuals with chronic wounds, including pressure sores, have been shown to perform worse on the Nutrition Screening Initiative and Norton than comparable patients without pressure sores, and populations at risk of developing chronic wounds are also at high risk of malnutrition. A high-protein, energy-rich, ready-to-use enteral tube feeding nutritional product has been specially developed for these cases. It is a complete enteral nutritional supplement with an innovative nutrient composition for patients with chronic wounds, including pressure sores, or at increased risk of developing them. It is fortified with many nutrients that play an important role in wound healing (arginine, vitamins A, C and E, other antioxidants, and zinc). The enteral tube feeding nutritional product also contains micronutrients that are often lacking in many patients with an increased risk of pressure sores and long-term non-healing wounds, for example, patients in hospital and in particular in intensive care units (including those with coronavirus infection), or the elderly. 

The COVID-19 pandemic has caused a global health crisis and is still causing enormous economic damage. The amount of infected people has already exceeded 48 million, and more than 1 million deaths have been registered. A steady increase of new cases of COVID-19 is currently observed on the territory of the Russian Federation. The new coronavirus infection caused by SARS-CoV-2 virus has some clinical and immunopathogenetic features. SARS-CoV-2 is a single-stranded RNA-containing virus that belongs to the family Coronaviridae, the genus Betacoronavirus. COVID-19 can be asymptomatic, the most common clinical manifestation is viral pneumonia, the development of acute respiratory distress syndrome is noted in less than 5% of cases. The entrance gate of the pathogen is the epithelium of the upper respiratory tract and epithelial cells of the gastrointestinal tract. When the virus enters the human respiratory tract, there is a suppression of the activity of mucocillar clearance and the death of epithelial cells, which allows the virus to enter the peripheral blood, followed by damage to target organs (lungs, digestive tract, heart, kidneys). An important pathogenetic value in SARS-CoV-2 infection, especially in severe disease, is an excessive response of the immune system with a massive release of cytokines, which causes acute respiratory distress syndrome. Research has shown that SARS-CoV-2 can be more sensitive to type I interferons (IFN-I) than other types of coronaviruses. IFN-I deficiency plays a key role in the pathogenesis of SARS-CoV-2 and delayed signaling of IFN-I is associated with sustained virus replication and serious complications, as shown in several studies. The use of drugs in this group for the treatment and prevention of COVID-19 is an urgent issue to study. The use of recombinant interferon-α-2b for the prevention of acute viral infections has been successful in multiple studies. This study was conducted to determine the preventive effectiveness of interferon α-2b with an antioxidant complex in health care workers who have direct contact with those infected with the SARS-CoV-2 virus. We observed 109 medical workers who had contact with COVID-19 patients during a month. For prophylactic purposes, 75 medical workers took interferon-α-2b with an antioxidant complex (vitamins E and C) for prophylactic purposes in various regimens for 10 days, and in the comparison group was 34 medical workers without preventive treatment. Only 5.3% of medical workers who received preventive therapy with interferon α-2b were infected with the SARS-CoV-2 virus after 20 days, while 32.4% of medical workers in the comparison group were infected with the covid-19 coronavirus. The data obtained indicate a high preventive activity of Viferon against a new coronavirus infection. 

A study of the effectiveness and safety of the chondroprotector in patients suffering from lumbosacral dorsopathy. The study included 30 patients aged 40 to 60 years, suffering from lumbosacral dorsopathy with radiculoishemia and not requiring surgical treatment. Analysis of the results showed that chondroprotector is effective in lumbosacral dorsopathy at the prescribed dose: its use reduces the severity of symptoms by more than 50% from the initial level in 83.3% of patients, reduces the intensity of pain in 90%, eliminates the neuropathic component of pain in 73.3%, and significantly improves the quality of life by more than 10 points for each indicator of the SF-36 questionnaire in 76.7%. Chondroprotector showed a high safety profile; all patients demonstrated high compliance and completed the study in according to the plan. Thus, chondroprotector can be recommended in the treatment of lumbosacral dorsopathy with radiculoischemia. 

The high need for expanding the range of dermatocosmetics with moisturizing, nourishing and anti-inflammatory action necessitates the search for new compositions with niacinamide, allantoin without components with proven allergic potential and is consistent with the priority direction of Russian developments in import substitution and creation of our own innovative products. The article summarizes the clinical experience of using a specialized line of cosmetic products (cleansing gel, lotion and balm) to persons with dry and sensitive skin prone to irritation. Dynamic clinical observations demonstrate the feasibility of using cosmeceuticals to restore the barrier function of the skin. The study included persons aged 20 to 40 years with sensitive skin prone to dryness and irritation, who did not use systemic and/or topical medications or cosmetic preparations that could affect the results of the study. The effectiveness of the use of cosmetics was assessed by the dynamics of the clinical indicators of the skin condition (dryness, small-lamellar peeling and signs of skin irritation). 

Lung damage caused by the SARS-CoV-2 virus and the depletion of the immune system is a serious obstacle to recovery patients with COVID-19-associated pneumonia. Stimulating regeneration factors can help repair damaged lung tissue. Prognostically significant indicators of the effectiveness of restorative treatment of patients after the acute stage of COVID-19-associated pneumonia should be based on the criteria for lung tissue regeneration and restoration of the immune system. Patients with COVID-19 should be examined to select a rehabilitation treatment program, taking into account individual indications and to assess the safety of the planned measures. The experience of the practical use of an immunomodulator with a reparative effect of sodium deoxyribonucleate in programs for the rehabilitation treatment of patients with communityacquired pneumonia with confirmed or suspected COVID-19, DN0 or DN1 with CT-1-2 or CT-2-3 (mild, moderate and moderate course), undergoing the stage of rehabilitation treatment in the conditions outpatient medical organizations. The presented rehabilitation treatment programs, tested in outpatient medical institutions, can be fully applied in the conditions of sanatorium-resort rehabilitation of phthisiopulmonary sanatoriums, which will significantly increase the overall quality of medical care not only at the stages of treatment, but also at rehabilitation. 

The article provides an overview of the symposium on the complex therapy of patients with respiratory infections and diseases of the respiratory tract, held on October 29, 2020 with the support of Materia Medica Holding as part of the XXX National Congress on Respiratory Diseases, which was held from October 27 to 30 online with the support of the Russian Respiratory Society and the Ministry of Health of the Russian Federation. The aim of the symposium was to familiarize physicians, general practitioners, pulmonologists and infectious disease specialists with possible ways of managing patients with respiratory diseases caused by respiratory infections, as well as with the results of randomized clinical trials (RCTs) on the management of patients with chronic obstructive pulmonary disease (COPD). The co-chairs of the symposium and keynote speakers were three leading experts in this field – professors A. A. Zaitsev (Moscow), R. F. Khamitov (Kazan) and A. A. Wiesel (Kazan). At the symposium, the results of RCTs were presented, proving the effectiveness of antiviral and immune stimulating drug in influenza and other acute respiratory viral infections, regardless of the timing of the therapy started, its favorable safety profile, as well as the ability to reduce the need for antipyretic drugs and help prevent bacterial complications. Data from another RCT demonstrate the ability of antitussive drug to reduce cough and reduce its severity in COPD, reducing the impact of COPD on patients' lives. 

Despite the COVID-19 pandemic, seasonal infections, in particular the influenza virus, are still in our reality. We have discussed with Dmitry Lioznov, the acting head of Smorodintsev Research Institute of Influenza, how the pandemic has changed the influenza vaccination rates and state-of-the-art in of influenza diagnostic and therapeutic approaches.