Background. To date, congenital malformations occupy a leading position in the structure of morbidity and mortality of children in the neonatal period. Among newborns, the frequency of detection of congenital malformations is 2-3%, however, by the first year of a child's life, this indicator reaches 5%. At the same time, malformations can be found both in monovariant and in various combinations. One of the rare sets of congenital malformations of scientific interest is the VACTERL association (ICD-10: Q87.2), first mentioned and described by L. Quan and D. Smith back in 1972. This abbreviation is not accidental, it reflects defects that tend to occur simultaneously in one newborn: «V» – defects in the development of the spine, «A» – absence of the anus, «C» – heart defects, «T» – tracheoesophageal fistula, «E» – esophageal atresia, «R» – anomalies kidneys, «L» – limb abnormalities. In addition to these anomalies, a child may have other congenital malformations of various organs and body systems, which significantly expands the range of diagnostic search. To date, despite the achievements of science, the etiology and pathogenesis of this disease have not been reliably established. Many scientists have been actively studying the genetic markers of the VACTERL association for several decades, they have identified seven probable genes. At the same time, it is known that predisposing factors play a significant role in the development of the disease, such as assisted reproductive technologies, obesity and diabetes mellitus of the mother, lack of folic acid intake and smoking during pregnancy.

Results. Some of the congenital malformations can be detected antenatally, during ultrasound screening. However, most of the key defects that make it possible to establish a diagnosis are detected after the birth of a child. The defects included in the VACTERL association, as a rule, do not threaten the life of a newborn child and are amenable to successful correction. This article reflects the course of VACTERL association in a newborn baby.

Background. Neuroinfections are one of the global medical and social problems of pediatrics, due to the high incidence of neurological complications that affect the further development of the child.

Objective. To establish the clinical significance of the concentration of circulating immune complexes (CIC) and C3a, C4, C1inh components of the blood complement system in viral meningitis (VM) in children.

Materials and methods. The study was conducted in 115 patients with CM of various etiologies (enteroviral – 40, arbovirus – 39, mumps – 36) children aged 2 to 14 years. Of these, in 78 (68%) CM proceeded in a moderate form. The etiology of meningitis was determined by PCR-reaction and/or ELISA of cerebrospinal fluid (CSF) and/or blood. As the main target laboratory parameters, the concentration of complement components: C1inh, C4, C3a in blood plasma was determined by ELISA using the kits of reagents «ELISA-Clinh», «ELISA-C4», «ELISA-C3a». The determination of CEC in blood serum was carried out in the immunoprecipitation reaction using 3% and 4% concentrations of polyethylene glycol (PEG) – 6000.

Results. The acute period of severe forms of CM is characterized by an increase in the total amount of CIC up to 14.7 ± 1.2 U/ml, C3a up to 348.7 ± 65.4, C4 up to 319.9 ± 56.4, C1inh up to 405.2 ± 52 .9 μg/ml. With moderate CM, the total CEC pool was 7.3 ± 0.45 IU/ml (p < 0.05), and there were no statistically significant differences in terms of complement fractions. In the period of convalescence of severe forms of CM, the total amount of CIC decreased to 8.1 ± 0.8 U/ml, C3a to 319.3, C4 up to 289.6, C1inh up to 354.6 μg/ml. In moderate CM, CIC decreased to 5.1 ± 0.56 U/ml, C3a increased to 302.5 ± 96.8, C1inh to 434.4 ± 76.5 μg/ml, and C4 decreased to 272.3 ± 42.1 μg/ml compared with the acute period (p > 0.5), remaining higher than the control group, regardless of the severity of the disease. In patients with a protracted course of CM, the C1inh index was 478.2 ± 84.9 μg/ml, C3a was 229.7 ± 44.6 ng/ml, which is 5 and 1.1 times higher, and C4 was 231.5 ± 28.9 μg/ml, 1.1 times lower than in the control group. The concentration of the C1inh fraction of the complement system – 478.2 ± 84.9 μg/ml and CIC – 2.7 ± 0.5 U/ml had a direct correlation with the protracted course of CM (r = 0.685; p = 0.0456)

Conclusion. According to the results of the study, an increase in the concentration of CEC and fractions of the complement system C3a, C4, C1inh in the blood was established, depending on the severity, period, course of the disease, indicating their participation in the development and maintenance of the inflammatory process in patients with CM. There was no normalization of the CIC and complement system parameters during the period of convalescence, and their imbalance during this period may indicate ongoing changes in the tissues of the focus of the inflammatory process and the effectiveness of the therapy.

Background. Cystitis is one of the most common urinary tract infections undergoing treatment on an outpatient basis. In Russia, up to 36 million cases of the disease are registered annually. The main causative agent of uncomplicated cystitis, detected in 75% of cases, is E. coli, in the remaining cases, the etiological agents are S. saprophyticus, Klebsiella spp. and a number of enterobacteria, extremely rare – anaerobic microorganisms, chlamydia and ureaplasma. The article discusses predisposing factors and the pathogenesis of acute uncomplicated cystitis.

Results. The aim of treatment of acute uncomplicated cystitis is rapid eradication of the pathogen, leading to clinical and microbiological recovery, as well as prevention of relapses of the disease. Uncomplicated acute cystitis in most cases is treated in outpatient settings. The basis of pharmacotherapy of acute cystitis is antibacterial drugs. The appointment of an antibacterial drug is carried out empirically when the symptoms of the disease are detected, taking into account the alleged etiology of cystitis and the clinical and pharmacological characteristics of the drug, with mandatory consideration of the current state of antibiotic resistance. The optimal choice of the drug and the antibiotic therapy regimen contributes to a faster recovery and a reduction in the risk of chronic disease.

Conclusion. Detailed information about the existing regimens of antibiotic therapy for acute cystitis is presented in the article, as well as the main indications for the appointment of antibacterial drugs. The results of studies on the effectiveness of the drug cefixime in the treatment of acute uncomplicated cystitis, including the cystitis of pregnant women, are analyzed.

Background. Urinary tract infections are a pressing problem of modern medicine due to their widespread prevalence and socio-economic significance. Every year, recurrent urinary tract infections occur in more than 150 million people worldwide, which is second only to acute respiratory infections in incidence. In addition, the problem is not only medical, but also socio-economic in nature, since in most cases recurrent urinary tract infections occur among the working population. This can lead to temporary disability and a large number of outpatient consultations. Recurrent urinary tract infections are one of the main causes of hospital-acquired infections, which leads to serious financial expenses. In addition, the quality of life of such patients is significantly impaired: frequent relapses lead to disruption of the psycho-emotional state, the development of neuroses and psychosomatic pathology.

Results. Currently, antibiotic therapy takes the leading position in the treatment of recurrent urinary tract infections, as clearly indicated by both national and European clinical guidelines. At the same time, it should be noted that the tactics of preventive measures remain not fully developed and require further study and the formation of an evidence base. Due to the development of antibiotic resistance, including due to the irrational use of antibacterial drugs, and frequent adverse reactions, the role of non-antibacterial drugs in maintaining the health of the urinary tract is increasingly discussed in the literature. According to clinical guidelines developed by the European Association of Urology, antimicrobial drugs for prevention of relapses is addressed only in cases where the use of non-antibacterial agents has proven ineffective. Currently, European recommendations for the prevention of recurrent urinary tract infections include non-antibacterial agents such as D-mannose; preparations containing cranberries and/or products of its processing. Russian recommendations indicate the significant role of herbal medicine in the prevention of relapses of cystitis in women. Despite the fact that many non-antibacterial agents are already included in recommendations for the prevention of recurrent urinary tract infections, both European and national, their mechanism of action, dosage regimen, and duration of administration continue to be actively studied.

Conclusion. The currently accumulated clinical experience and research data indicate the great potential of such non-antibacterial agents as D-mannose, cranberry, vitamin D, birch leaf extract, which are part of the dietary supplement and can be used to maintain the health of the urinary tract.

Background. Connective tissue dysplasia is a heterogeneous group of conditions that, in turn, can lead to the formation of pathology of various organs, accompanied by violations of their morphology and function, which reduces the quality of life of patients, contributes to the unfavorable course and outcome of diseases occurring against the background of connective tissue dysplasia, and sometimes even disability. Phenotypic manifestations of connective tissue dysplasia are quite diverse. The structural features of connective tissue affect the development and course of pathology of the urinary system. Currently, mutations in collagen genes leading to the development of kidney diseases have been established, and the relationship between the severity of connective tissue dysplasia and the development of abnormalities of the urinary system organs has been proven, antenatal risk factors for the formation of congenital malformations of the urinary system organs against the background of connective tissue dysplasia and children have been identified.

Objective. The purpose of the study was to evaluate the role of connective tissue dysplasia syndrome on the development and course of pathology of the urinary system organs.

Materials and methods: the analysis of 24 sources of scientific literature on the topic under study, connective tissue dysplasia syndrome in nephrology.

Results. The analysis of scientific literature data was carried out. Modern data on the effect of connective tissue dysplasia syndrome on the development and course of pathology of the urinary system organs in children are presented. The features of the course are presented and the degree of influence of connective tissue dysplasia on the pathology of the urinary system is described.

Conclusion. Connective tissue dysplasia syndrome is the basis for the development of pathology of the urinary system in children. Therefore, connective tissue dysplasia requires a targeted search for criteria for identifying patients at risk for kidney damage.

Background. According to epidemiological studies, chronic musculoskeletal pain affects more than 30% of people worldwide, causing a huge personal and social burden. Nonsteroidal anti-inflammatory drugs are widely used to treat musculoskeletal pain. The drug etoricoxib, highly selective for COX-2, is characterized by linear pharmacodynamics, that is, its effect directly depends on the dose, and the wide range of doses registered for use (from 30 to 120 mg per day) makes it possible to effectively suppress both acute and chronic pain with various diseases.

Results. This review provides information on the use of etoricoxib in osteoarthritis, particularly of the knee or hip, including in elderly patients; in the treatment of low back pain, one of the most common causes of decreased productivity worldwide; in the treatment of rheumatoid arthritis and ankylosing spondylitis, as well as gout. It has been shown that the selective COX-2 inhibitor etoricoxib has pronounced anti-inflammatory and analgesic activity and has a number of undeniable advantages not only over non-selective COX-1 and COX-2 inhibitors, but also over selective COX-2 inhibitors, being the most highly selective among them. The drug has the same pharmacokinetic parameters in both young patients and the elderly, which simplifies its administration to patients in older age groups, and, in addition, etoricoxib is rapidly absorbed when taken orally. Important characteristics of etoricoxib include its safety in relation to the gastrointestinal tract. The availability of a range of therapeutic doses of etoricoxib makes it possible to effectively treat acute and chronic pain in various diseases affecting the structures of the musculoskeletal system and perioperative pain.

Background. Influenza and acute respiratory viral infection account for about 90% of all infectious morbidity in the population. Every year in Russia alone, from 27 to 41 million cases of these diseases are registered, and according to WHO, every adult on average gets sick with acute respiratory viral infection 2 to 4 times a year. Acute respiratory viral infection s are an etiologically heterogeneous group of infectious diseases affecting the respiratory tract, characterized by a relatively mild and short course. Today, specific antiviral drugs, including those against influenza, are widely represented on the pharmaceutical market. However, to date, no universal broad-spectrum antiviral agent has been created that can prevent the spread of acute respiratory viral infection. In this regard, the development of new antiviral drugs comes to the fore.

Objective. To evaluate the effectiveness and safety of antiviral drugs (enisamia iodide and umifenovir) in real clinical practice in patients with acute respiratory viral infection, with the exception of SARS-CoV-2.

Materials and methods. As part of the research work, 265 medical records of patients with infections caused by various pathogens of respiratory viral infections, with the exception of SARS-CoV-2. All medical records of patients were divided into 3 groups in accordance with the prescribed etiotropic therapy. The comparison group included patients who were not prescribed antiviral drugs. To study the effectiveness of the compared treatment regimens, we assessed the duration of hospitalization and the duration of the main clinical manifestations of acute respiratory viral infection, as well as the severity of the general infectious intoxication syndrome according to the anamnesis and the dynamics of the disease extracted from medical records.

Results. The duration of hospitalization of patients receiving antiviral therapy enisamia iodide was significantly less than that of patients receiving umifenovir (p < 0.05) and not receiving antiviral therapy. A significantly longer duration of fever was detected in the group of patients who did not receive antiviral therapy (p < 0.05). The duration of the main syndromes affecting the respiratory tract in patients from the group that did not receive etiotropic treatment was significantly longer (p < 0.05).

Conclusion. The drug enisamia iodide has been shown to have high therapeutic efficacy and a good safety profile. This allows us to consider it as a promising universal antiviral agent for the treatment of patients with influenza and acute respiratory viral infection (with the exception of SARS-CoV-2).

Background. Formations of the adrenal cortex may have mixed secretion and produce aldosterone and cortisol. The number of clinical cases of combined secretion of aldosterone and cortisol (the so-called Conching syndrome) is increasing. Most often, the clinical picture is dominated by signs of primary hyperaldosteronism with the development of arterial hypertension and hypokalemia, and autonomous cortisol secretion does not lead to the formation of clinical signs of Itsenko – Cushing syndrome. When examining patients with adrenal cortex formations, signs that allow us to suspect mixed hormonal secretion of these formations are the absence of suppression of cortisol secretion against the background of a night test with 1 mg of dexamethasone and the size of the adrenal gland formation is more than 2.5 cm. With the combined production of aldosterone and cortisol, there is a feature of the management of such patients due to their tendency to metabolic disorders, which consists in the need for a short period of replacement therapy with glucocorticoids in the postoperative period with a decrease in cortisol levels.

Results. In the described clinical case, the patient revealed bilateral formations of the adrenal cortex with mixed secretion of cortisol and aldosterone. The revealed autonomous cortisol secretion was not accompanied by a clear clinical picture characteristic of the Itsenko – Cushing syndrome. However, due to the fact that cortisol-associated diseases and conditions (arterial hypertension, impaired glucose tolerance, weight gain) showed negative dynamics, a comparative selective blood sampling from the adrenal veins was carried out to determine the functionally dominant side of the lesion, which could subsequently become the object of surgical intervention. Taking into account the decrease in renin levels and the result of the saline sample, the level of aldosterone in the adrenal veins was also investigated. Primary hyperaldosteronism was detected accidentally with a distinct lateralization of aldosterone secretion on the right.

Background. Periodic illness, or familial Mediterranean fever, is a monogenic hereditary disease with an autosomal recessive mode of inheritance, which is characterized by spontaneous recurrent attacks of fever and aseptic inflammation of the serous membranes – polyserositis: peritonitis, pleurisy, synovitis. Its main and most severe complication is systemic amyloidosis, in particular, amyloid nephropathy with progressive chronic renal failure in the absence of treatment. The second complication of periodic illness, is adhesive disease, often with the development of small bowel obstruction and infertility. The disease is most common among representatives of the ancient peoples of the Mediterranean and is more common among Sephardic Jews, Armenians, Arabs, Greeks, Turks, Caucasian peoples.

Results. The article presents modern approaches to the etiopathogenesis, diagnosis and treatment of familial Mediterranean fever (periodic illness), considers the clinical and genetic aspects, and also presents clinical cases from our own observations. Studied the ethnic composition and family history of patients to find out the frequency of family cases of this disease. The group consisted of 26 patients aged 16 to 74 years, including 14 men (54%) and 12 women (46%), who were examined in the gastroenterology department of the Republican Clinical Hospital of the Republic of Dagestan in the period 2011-2021. All patients were admitted to the department in the interictal period with complaints – of recurrent attacks of intense abdominal pain accompanied by febrile fever. When conducting general clinical and laboratory-instrumental research and taking into account the data of the anamnesis, another pathology was excluded and a diagnosis of «periodic illness» was made using the diagnostic criteria of the Tel Hashomer clinic.