Background. Cogan syndrome is a rare systemic vasculitis with variable arterial involvement. Its true prevalence is unknown. It is characterized by ocular symptoms, hearing loss, vestibular dysfunction. Cogan syndrome can be classified as typical or atypical. Typical syndrome is characterized by a combination of bilateral keratitis with hearing loss and vestibular dysfunction. Atypical syndrome includes other types of eye or hearing damage and cases when the interval separating these symptoms onset exceeds 2 years. Systemic manifestations are more common in atypical Cogan syndrome. There are different theories about the development of the disease. Currently, the most popular autoimmune theory is that Cogan syndrome is based on autoimmune vasculitis of the most vascularized layers of the eye, inner ear and other organs. The search for immune markers in Cogan syndrome led to the discovery of antibodies to antigens of the inner ear, cornea, and antiendothelial antibodies, but their diagnostic value is not great. Immune markers that allow a confident diagnosis have not yet been discovered.

Objective. Report a case of the Cogan syndrome with systemic manifestations in a female patient.

Results. We present the clinical case of Cogan syndrome in a 37-year-old patient. The disease was diagnosed based on the presence of acute conjunctivitis, acute bilateral sensorineural hearing loss, dizziness. These symptoms were preceded by fever, arthralgia, myalgia, diarrhea. Conjunctivitis and audiovestibular symptoms appeared at the same time. Additionally, the patient exhibited systemic manifestations such as polyserositis, pneumonitis, erosive colitis with malabsorption syndrome, abdominal lymphadenopathy, anemia, thrombocytopenia. The notable aspect of the case was a very early diagnosis (a week after the onset of the disease). This factor determined the achievement of a good and rapid response to treatment within the first week. Treatment included glucocorticoids, pulse cyclophosphamide therapy. Within a month, all symptoms were completely resolved.

Conclusion. Early diagnosis and timely treatment of Cogan syndrome makes it possible to completely relieve symptoms of the syndrome and prevent deafness.

Background. The problem of diagnosing secondary kidney lesions associated with rheumatic diseases in children is given special attention in pediatrics. At the same time, early detection of renal lesions in children with rheumatic diseases is still difficult.

Objective. The purpose of the study: the search for criteria for the early diagnosis of secondary nephropathies in children with RH remains relevant at the present stage. The role of identified candidate genes whose mutations are responsible for the development of secondary nephropathies in children is widely discussed in modern literature. It is relevant to assess the relationship of potential associations of mutations and allelic polymorphism of genes with clinical and paraclinical variants of kidney pathology in children with rheumatic diseases. The study of genetic factors of nephropathy formation in children with rheumatic diseases is necessary to identify a group of patients at high risk for the development of secondary nephropathies. The identification of genetic factors in the formation of nephropathy in children with rheumatic diseases will increase the effectiveness of the diagnosis of kidney pathology, since the carriage of significant genes or polymorphic alleles affects the formation and course of the disease, which has high theoretical and practical significance.

Materials and methods. The article presents data from a study of polymorphism of folate cycle genes – methylenetetrahydrofolate reductase (MTHFR) A1298C, C677T, methionine synthase (MTR) A2756G, methionine synthase reductase (MTRR) A66G, endothelin-1 (EDN1 G7244T, EDN1 G7000A rs1800629) and tumor necrosis factor-α (TNF-α G4682A) y 124 patients with rheumatic diseases.

Results. It has been proven that an increase in the frequency of the homozygous CC genotype of the MTHFR A1298C gene, the homozygous GG genotype of the MTRR A66G gene, the homozygous GG genotype of the MTR A2756G gene in children with secondary nephropathies in nodular connective tissue diseases are non-modifiable risk factors and additional criteria for diagnosing secondary kidney damage in children with nodular connective tissue diseases.

Background. The peculiarity of enthesopathies, or periarthropathies, is that, being an area of constant biomechanical stress and influencing adjacent hard and soft tissues, the enthesis forms an inflammatory impulse, leading to the development of inflammation in the synovial membrane adjacent to the enthesis. One of the pathogenetically substantiated steps in the treatment of enthesopathies is the method of periarticular administration of a chondroprotector. This method allows you to influence various parts of the inflammatory process and influence cellular respiration.

Objective. To study the effect of local injection therapy with a metabolic specific stimulator of connective tissue repair on the course of periarthropathies.

Materials and methods. 10 patients (6 women and 4 men aged 54.3 ± 0.4 years) were treated for enthesopathies by injection using a metabolically specific stimulator of connective tissue repair. Eight patients were diagnosed with "unilateral trochanteritis" and instrumentally confirmed, and two patients were diagnosed with "bilateral epicondylitis." Injections were performed periarticularly, 2 ml every 3 days, for a total of 5 injections. To evaluate the results, we used the VAS pain intensity scale, and also compared the range of motion in the hip and elbow joint before and after treatment. There were three control points in total before the start of treatment, at the end of treatment and 14 days after the last administration of the drug.

Conclusion. It has been shown that when the drug is administered locally, the reparative stage and the outcome of inflammation in the tendon part of the muscles begin to predominate. Clinically, this is observed in the form of improved function and elimination of pain.

Background. Peptic ulcer disease is a chronic polyethological disease that occurs with the formation of ulcerative lesions, a tendency to progression and the formation of complications. Among the etiological factors, Helicobacter pylori is the key one. Peptic ulcer disease is a fairly common disease. According to the World Health Organization, in Russia, peptic ulcer disease is diagnosed in 10-15% of the population, which corresponds to the global average. It may differ in different regions: for example, in the USA, peptic ulcer disease is diagnosed in 5-10% of the population, while in India and other Asian countries this figure can reach 20-30%. Peptic ulcer disease is one of the most common causes of disability and disability development. Transcranial electrical stimulation is a medical intervention method in which weak electric currents are used to stimulate certain areas of the brain through the scalp. It is used not only for the treatment of various mental and neurological disorders such as depression, bipolar disorder, Parkinson's disease, migraine, but also in the treatment of internal diseases, as well as in obstetric and gynecological practice. Currently, the scope of transcranial electrical stimulation is expanding. Transcranial electrical stimulation is used in gastroenterology to treat various diseases of the gastrointestinal tract, such as functional dyspepsia, irritable bowel syndrome, chronic constipation, etc. The use of transcranial electrical stimulation as part of the complex treatment of gastrointestinal diseases has beneficial effects: analgesic (effective anesthesia), vegetocorregulating (accelerating the processes of repair of erosive processes), reduces the secretory activity of the stomach. Transcranial electrical stimulation therapy helps to reduce the level of antibodies to Helicobacter pylori, depending on the form, location of the ulcerative defect and age. Thus, with the help of transcranial electrical stimulation it is possible to improve the quality of life of patients. The inclusion of transcranial electrical stimulation therapy in the complex treatment of peptic ulcer disease can significantly accelerate the relief of the main clinical symptoms of this disease for 4-5 days.

Conclusion. Transcranial electrical stimulation is not a standard treatment for peptic ulcer disease. However, in combination with eradication therapy, Transcranial electrical stimulation can improve the effectiveness of treatment and shorten its duration.

Objective. To study the incidence of malignant tumors in liver cirrhosis patients with depending on the stage of liver cirrhosis and main etiological factor, to reveal the influence of hepatocellular carcinoma development on the overall survival of liver cirrhosis patients.

Materials and methods. A prospective observational study was conducted, including 994 patients with liver cirrhosis observed in the Sverdlovsk Regional Hepatological Center in 2015-2020.

Results. Lethal outcomes were recorded in 438 patients (44.0%). Malignant tumors were detected in 125 people (12.6%). The incidence of hepatocellular carcinoma depends both on the stage of liver cirrhosis and on the etiology. The probability of hepatocellular carcinoma in patients with liver cirrhosis Child-Pugh A was 6.3% per year, B – 7.3%, C – 5.9%, in patients with cirrhosis of viral etiology – 8.4%, alcoholic etiology – 4.5%, NAFLD – 3.8%. Additional risk factors that significantly increased the incidence of hepatocellular carcinoma were the level of AFP ≥ 100 IU/ml (p < 0.0001), male gender (p < 0.001), age ≥ 65 years (p = 0.006). Overweight (p = 0.056), diabetes mellitus (p = 0.390), arterial hypertension (p = 0.506) had a statistically insignificant effect. The presence of hepatocellular carcinoma reduced life expectancy in liver cirrhosis patients (p = 0.001). The median OS for Child-Pugh A cirrhosis without hepatocellular carcinoma was not reached, and with hepatocellular carcinoma is 81.7 months (p < 0.0001). With class B cirrhosis, the median OS decreases from 65.7 to 37.4 months (p = 0.02), and with C it does not change: 22.8 and 21.0 months (p = 0.446).

Conclusion. The data confirm the advisability of screening for the early hepatocellular carcinoma detection in liver cirrhosis patients with class A and B, regardless of underlying etiology.

Background. Functional heartburn is one of the disorders of the gastrointestinal tract that is widespread in modern society. The disease is characterized by refractory symptoms of heartburn, lack of relief of symptoms with optimal use of proton pump inhibitors, which requires differential diagnosis with a number of diseases of the esophagus. Functional heartburn is associated with frequent medical treatment, repeated examinations, and increased insurance costs. At the same time, there is a problem of insufficient awareness of doctors about this disease, the lack of a widely available diagnostic method, which leads to a failure to receive effective treatment and a decrease in the quality of life of patients. The disease is often associated with anxiety and depressive disorders, the growth of which has been noted recently, which requires timely diagnosis and correction of these conditions. Visceral hypersensitivity is a key part of the pathophysiology of functional heartburn, and psychosocial factors influence interactions between the gastrointestinal nervous system and the brain, which determines the severity of symptoms in patients. Doctors are recommended to tell patients in detail about the essence of the diagnosis, directions in possible effective treatment, for better adherence to therapy, the use of antidepressants, cognitive behavioral therapy, hypnotherapy and relaxation methods is recommended. At the moment, the standard for the diagnosis of functional heartburn is pH-impedance measurement, with the primary exception of organic pathology during endoscopic examination of the esophagus with biopsy and histological examination, and the exclusion of esophageal motility disorders during manometry. Non-invasive, affordable and cost-effective diagnostic tools are needed to avoid overdiagnosis of gastroesophageal reflux disease and improper use of proton pump inhibitors, saliva pepsin examination and dental examination are promising.

Objective. The purpose of the review is to summarize the existing research data on the prevalence of functional heartburn, the influence of psychological factors on its course, and current methods of diagnosis and treatment of this pathology. In order to identify studies on the problems of diagnosis and treatment of functional heartburn, a literature search was conducted in the PubMed and eLibrary databases until November 2023, original articles, meta-analyses and relevant reviews were reviewed.

Background. PA new chronomedical approach to the classification of one of the most common syndromes in modern medicine, the constipation syndrome, is presented. According to Robert Hegglin "сonstipation is the absence of defecation for 24 hours". In contrast to the previously accepted "Roman Criteria of Constipation" (Rome IV), 2016, which recommended doctors to focus only on the frequency of defecation less than 3 times a week, a more reasonable chronophysiological approach to the criteria of this syndrome is presented. There are 2 more earliest stages of constipation that have not been diagnosed before. The first stage of constipation (mild) is with a frequency of defecation 5-6 times a week. The second stage of constipation (moderate) is with a frequency of defecation 3-4 times a week. The frequency of defecation, presented in the Roman criteria for constipation (less than three times a week), in the modern classification of constipation is presented as the third (severe) stage – with a frequency of defecation 1-2 times a week.

Conclusions. It has been proven that the therapy of patients suffering from constipation is more effective at diagnosing the first and second stages of this syndrome than at the third stage of constipation. The presence of three stages of constipation is confirmed by a progressive (from stage I to stage III) deterioration in the quality of life, an increasing level of anxiety and depression, and an increase in the intake of laxatives from the first to the third stage of constipation. Examples of effective therapy of patients with constipation with the psyllium are presented.

Background. This article highlights the most important nutritional issues for patients with IgA nephropathy associated with a high titer of celiac antibodies in the blood. The importance of therapeutic nutrition, which is part of the nephroprotective strategy as an integral part of the therapy of nephrological patients, is emphasized. The release of certain clinical practical recommendations of KDOQI (2020) once again emphasized the great importance of non-drug exposure for effective therapy of kidney diseases of various etiologies.

Objective. To adapt therapeutic nutrition as a component of a nephroprotective strategy for patients with IgA nephropathy associated with a high titer of celiac antibodies in the blood.

Results. Based on convincing data from the world literature, which are consistent with the results of our own research confirming the association of the above conditions (even in the absence of clinical manifestations of enteropathy), the effectiveness of the gluten-free diet in the complex treatment of IgA nephropathy, the therapeutic diet for this category of patients has been adapted according to the necessary chemical composition and energy value.

Conclusion. Nutrition modification is an essential element of the complex therapy of nephrological patients. An individual approach to the selection of dietary therapy, including gluten elimination, will not only reduce the immunological activity of the main glomerular disease, but also, possibly, slow down the rate of progression of chronic kidney disease, delaying the development of terminal renal failure and increasing the reserve capacity of the kidneys.

Background. In the complex treatment of premature infants, nutrition plays an important role, the adequacy of which largely determines their growth and development.

Objective. Assessment of anthropometric parameters and body composition of children with very low and extremely low body weight at birth and at 38-40 weeks of postconceptional age.

Materials and methods. We conducted a cohort ambispective randomized study. It included 70 premature babies (28 girls and 42 boys), born with a body weight of less than 1000 g (group 1, n = 40) and from 1000 to 1500 g (group 2, n = 30). Anthropometric data at birth and at the time of the study were assessed using international growth standards INTERGROWTH–21st. The amount and ratio of fat and lean body mass were determined using air plethysmography.

Results. When assessing the nutritional status of premature infants of both groups at term (38-40 weeks of postconceptual age), a significant decrease in standardized z-scores was found – weight, body length and head circumference for age in group 1, as well as weight and head circumference by age in the 2nd group, more pronounced in the 1st group. Malnutrition (z-score of body weight for age less than 1 SD) was detected in 77.5% of children in group 1 and 23.3% in group 2. Analysis of body composition indicators did not reveal significant differences in the percentage of fat and lean body mass in children of groups 1 and 2, but lean body mass was 440 g less in children with extremely low birth weight. In group 1, statistically significant direct correlations were established between the z-score of body weight and lean body mass, expressed both as a percentage and in kg, as well as a significant inverse correlation with body fat mass as a percentage.

Conclusion. The formation of postnatal growth retardation in a significant proportion of children born weighing less than 1500 g dictates the need for careful dynamic monitoring of their nutritional status for timely correction.

Background. The most common forms of lower respiratory tract infections in a doctor's practice are acute bronchitis and Community-acquired pneumonia. The doctor has to decide on the management tactics of such patients, taking into account the clinical picture and examination results. Community-acquired pneumonia is a common and potentially life-threatening respiratory disease. The severity of the problem is that during periods of influenza epidemics or other respiratory viral infections Streptococcus pneumoniae is also activated, which leads to an increase in the incidence of community-acquired pneumonia. In recent years, the etiology of pneumonia has expanded significantly, and among the causes of community-acquired pneumonia, in addition to bacteria, pneumotropic viruses (new coronavirus SARS-CoV-2, MERS, influenza A viruses, including pandemic H1N1, avian influenza, bocaviruses) began to occupy an important place, metapneumoviruses, etc.). The association of viruses and bacteria aggravates the course of the disease. Approaches to the diagnosis and treatment of bronchitis and community-acquired pneumonia are considered. Therapeutic measures for patients with acute bronchitis include early initiation of therapy. Antibacterial therapy for acute bronchitis is prescribed for proven bacterial origin of the disease, hyperthermia for more than 3 days, severe symptoms of intoxication, etc. The generally accepted method of etiological deciphering of pneumonia is a microbiological examination of sputum, as well as a blood test for bacteremia. The bacterioscopy method occupies an intermediate place; Gram staining of sputum allows the doctor to guide the choice of empirical antibacterial therapy. In recent years, the polymerase chain reaction method and the study of pneumococcal antigen in urine have been used; Polysaccharide C of pneumococcus is determined immunochromatographically. The criterion for the quality of care for patients with pneumonia is the initiation of initial therapy with antibacterial drugs.

Results. The article evaluates the clinical effectiveness of treatment including amoxicillin was assessed; the results allow us to recommend amoxicillin for use in outpatient practice.