Background. One of the most common early manifestations of allergic pathology in childhood is atopic dermatitis. Having a comprehensive impact on the child’s body, the disease leads to a significant decrease in the quality of his life, as a result of which this nosology represents a serious public health problem. Currently, many researchers consider the gastrointestinal tract as a target organ for atopic dermatitis, since a significant part of all complaints from patients with atopic dermatitis are gastrointestinal. On the other hand, the development of diseases of the gastrointestinal tract, especially in early childhood in the presence of a burdened allergic history in the child’s relatives, increases the likelihood of the formation of atopic dermatitis or acts as a risk factor for the transition of an existing disease to severe or moderate forms, as well as increased frequency of exacerbations.

Objective. The aim is to study and analyze the relationship between the pathogenesis of atopic dermatitis and gastrointestinal diseases in children of different ages.

Materials and methods. The object of the study is 436 outpatient records of patients in the allergy department of the regional children's clinical hospital of the Kursk Region Health Committee. Among the patients, 238 were female and 198 were male, in the age category from 1 month to 16 years. During the research, the following was used: copying data from outpatient records, analysis of scientific literature, statistical data processing was carried out using Excel, Statistika 10 programs. Results. From the data obtained it follows that both the presence of pathological changes in the gastrointestinal tract system is a risk factor for the development of atopic dermatitis or the worsening of its course, and the presence of the development of blood pressure leads to a decrease in the efficiency of the tissues and organs of the gastrointestinal tract, since in both In this case, there is an increase in the allergic load on the body, damaging tissues and organs. In this connection, we can conclude about the relationship between atopic dermatitis and diseases of the gastrointestinal tract.

Conclusion. Due to the presence of comorbidity between atopic dermatitis and gastrointestinal pathology, it is necessary to pay close attention to the diagnosis of gastrointestinal disorders in children with a clinical diagnosis of atopic dermatitis and prevent their development in the early stages.

Background. Cysteine leukotrienes are lipid mediators formed upon activation of the 5-lipoxygenase pathway of arachidonate metabolism. These are universal mediators with a wide spectrum of action, affecting almost all aspects of mammalian biology. In clinical allergy and immunology they are best known for their role in the formation of immune-related diseases of the upper and lower respiratory tract.

Results. A brief history of their discovery and study of the role of leukotriene receptor antagonists (montelukast and its analogs), identification of their therapeutic effect and possible undesirable effects are an important illustration for understanding the inclusion of montelukast in national, international clinical guidelines and consensuses. Montelukast is a cysteinyl-leukotriene receptor 1 antagonist, inhibits the effects of leukotrienes and is widely used for the treatment of asthma and allergic rhinitis; it is included in the clinical guidelines for the treatment of these diseases. The drug interferes with molecular signalling pathways produced by leukotrienes in various cells and tissues of the human body. In recent years, a new therapeutic strategy has been observed – repositioning of existing drugs. The anti-inflammatory effects of montelukast are not limited to the respiratory system, but are more systemic in nature, which has led to the development of clinical studies aimed at the reuse of montelukast for the treatment of various inflammatory conditions, particularly for the treatment of several neurodegenerative diseases. Recent advances in neuroinflammation research have led to the discovery of several novel inflammatory pathways regulating many cerebral pathologies. Through pharmacological and genetic studies, cysteinyl leukotriene receptors have been shown to be involved in the pathogenesis of Alzheimer's disease and other neurodegenerative/neurological diseases such as Parkinson's disease, multiple sclerosis and epilepsy. This updated review will also highlight research into the therapeutic potential of montelukast beyond clinical guidelines for rhinitis and asthma.

Background. Scientific substantiation of effective methods of correction of diseases of the peripheral nervous system and musculoskeletal system is one of the promising areas of development of modern physical and rehabilitation medicine. The most effective methods of treating pathological scars are technologies of combined effects of hardware roller massage with spinal stretching due to the use of the patient's own body weight (autorecline of the spine) and electrostimulation of skeletal muscles causes pronounced synergistic therapeutic effects.

Objective. To analyze evidence-based studies of high methodological quality on the use of technologies for the combined effects of hardware roller massage with spinal autorecline and electrical stimulation of skeletal muscles in patients with various diseases.

Results. The analyzed sources of scientific evidence of the effectiveness of combined exposure technologies were dominated by studies performed on samples of patients with dorsopathy, osteochondrosis of the spine, herniated disc. The considered technologies cause significant clinical effects, manifesting pronounced relief of pain syndrome and remodeling of connective tissue.

Conclusion. Evidence-based scientific databases contain a significant pool of information on high-quality clinical studies of the therapeutic effects of combined exposure to hardware roller massage with spinal autoreclination and electrostimulation of skeletal muscles in patients with vertebroneurological profile.

Background. Valproic acid is widely prescribed as an antiepileptic drug and mood stabilizer. Fatigue, tremor, sedation, hepatotoxicity, weight gain, hair loss and thrombocytopenia have been reported as side effects. Drug-induced thrombocytopenia occurs as the valproic acid dosage exceeds 1000 mg/day, or during concomitant antiplatelet agents administration, as well as in elderly patients. This side effect usually develops within 1-2 weeks after the drug initiation, but symptoms may also occur immediately after taking the drug. Patients present with petechiae, ecchymosis, and purpura, as well as epistaxis, hematuria, gingival bleeding, and hematochezia. Aim of the review. To analyze and systematize the literature data on the causes, mechanism and incidence of thrombocytopenia in response to valproic acid preparations.

Materials and methods. An analysis of 42 domestic and foreign publications on the topic of thrombocytopenia due to valproic acid preparations was carried out.

Results. The incidence of thrombocytopenia due to valproic acid drugs ranges from 5 to 31% in the general sample, up to 54% in elder people. Valproic acid has a direct toxic effect on the bone marrow, which reduces the production of neutrophil and erythroid lineages in the bone marrow through inhibition of erythrocyte differentiation and activation of the myelomonocytic pathway. In addition, valproic acid is incorporated into the platelet membrane due to its structural and chemical similarity to fatty acids in cell membranes. This promotes the production of autoantibodies directed against circulating platelets and leads to increased platelet destruction and thrombocytopenia.

Conclusion. Thrombocytopenia is considered a common side effect of valproic acid drugs but has received less interest in clinical trials despite important therapeutic implications. Further research is needed to address this issue.

Background. The article presents the results of a study to identify cognitive deficits in patients based on the level of coronary calcium with concomitant pathology in the form of hypertension and bronchial asthma. Currently, it is believed that a long-term increase in blood pressure, which does not have proper correction, leads to cognitive impairment. At the same time, bronchial asthma, in the absence of proper therapy, in the case of reduced adherence to treatment and as a result of the occurrence of chronic hypoxia of the brain, the disease affects cognitive functions. It has been repeatedly proven that an increase in the calcium index in combination with concomitant comorbidity worsens brain perfusion, which undoubtedly affects cognitive functions.

Objective. The purpose of this study is to evaluate coronary calcium and cognitive deficits in comorbid patients with arterial hypertension and bronchial asthma. In the course of the work, 83 patients with comorbid conditions of hypertension and BA were examined, tested according to these scales and calculated the calcium index, which allowed us to obtain the following results.

Results. The calcium index (Agaston index) in group I with (AH) 41.2 ± 32.1; in group II with AH and BA 91.0 ± 45.2, in group III conditionally healthy – 7.1 ± 2.1. The Montreal Cognitive Function Assessment Scale (MoSA) and the Short Mental Status Assessment Scale (MMSE) were used to assess the level and presence of initial cognitive impairment. According to the MoHS scale, patients with arterial hypertension scored 27.4 ± 1.7 points. The group of patients with bronchial asthma in combination with arterial hypertension scored an average of 26.5 ± 1.6 points, the control group scored 28.1 ± 1.4 points. According to the MMSE scale: in group I, patients with arterial hypertension received 28.7 ± 0.9 according to the results of the survey; in group II with a combination of arterial hypertension and bronchial asthma – 28.1 ± 1.2 points, in group III conditionally healthy patients – 29.3 ± 0.8 points.

Background. One of the leading causes of childhood disability and mortality at the present stage is hereditary and congenital pathology. It is the problem of early diagnosis of these diseases in children that still has great scientific and practical significance. Approaches to the diagnosis of hereditary and congenital diseases are constantly being improved, and the areas of medical practice of their application are expanding. This is possible thanks to the widespread introduction of molecular genetics – a large and diverse group of molecular genetic methods designed to identify polymorphisms in gene structure. The significance of this diagnostic spectrum for medicine in general, including pediatric practice, is obvious: early detection of the disease and initiation of therapy based on the principles of evidence-based medicine, the use of drugs that are considered safe and effective based on molecular diagnostics; monitoring treatment and determining prognosis.

Results. The article presents a clinical case of hereditary thrombocytopenia in a 6-year-old child with a primary immunodeficiency state. A child from the fifth pathological pregnancy, third surgical birth. The patient has had thrombocytopenia since birth. From two months of life to one year, frequent acute respiratory infections are observed (up to two times a month), from one year of age, recurrent nosebleeds are observed once or twice a month. For the first time, the diagnosis of hereditary thrombocytopenia was suspected at the Children's Regional Clinical Hospital in Belgorod. The patient was sent for further examination, in order to verify the diagnosis, at the end of 2021 to the Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology. Based on the results of a molecular genetic examination, mutations in the ETV6 genes (participated in hematopoiesis by affecting cell proliferation and differentiation) and PTEN (tumor growth suppressor) in the heterozygous state were identified. He was repeatedly hospitalized in the children's regional clinical hospital at his place of residence with the main clinical diagnosis: Primary combined immunodeficiency. Hereditary thrombocytopenia associated with a mutation of the ETV6 gene. To this day, the manifestations of hemorrhagic syndrome and thrombocytopenia in the child persist. The described case is of interest due to the rarity of this pathology, the difficulties associated with its diagnosis, and emphasizes the need for interaction between a team of specialists to achieve the most favorable prognosis for patients suffering from hereditary diseases.

Background. Osteoarthritis is one of the most common chronic diseases of the musculoskeletal system worldwide, being a common cause of chronic pain syndrome and disability. A number of pharmaconutraceuticals include well-known molecules, such as chondroitin sulfate, glucosamine sulfate, undenatured type II collagen, have proven effects on articular cartilage, subchondral bone, synovia. The use of these molecules makes it possible to influence main links in pathogenesis of osteoarthritis, and ultimately can slow down the progression of the disease, improve the quality of life of patients. Promising molecules for the prevention of osteoarthritis and a number of osteoarthritis diseases, along with chondroitin sulfate and glucosamine sulfate, are vitamin D3 and K2. One of the most important functions of vitamin D (25(OH)D) is to maintain the proper level of mineralization of the skeleton. By reducing 25(OH)D concentration in blood serum below optimal values leads to an increased risk of fractures, especially in the elderly. Vitamin K2, being a cofactor of osteocalcin carboxylation, improves bone mineral density and increases their strength. Chondroitin sulfate, glucosamine sulfate, undenatured type II collagen block the activity of proinflammatory cytokines, stimulate the activity of osteoblasts and reduce the excessive activity of osteoclasts. The molecules of chondroitin sulfate, glucosamine sulfate, vitamin D3, and vitamin K2 have proven clinical efficacy and safety against osteoarthritis.

Conclusion. Up to date, the molecules of chondroitin sulfate, glucosamine sulfate, undenatured type II collagen and vitamin D3 can be classified as to Disease Modifying Anti-Osteoarthritis Drug (DMOADs) that have both symptom-modifying and structural-modifying effects. Сhondroitin sulfate, glucosamine sulfate, vitamin D3 and K2 are prescribed for the treatment and prevention of diseases of musculoskeletal system. They can be presented both in the form of medicinal preparations and as part of biologically active food supplements. The use of these components may be warranted in patients with osteoarthritis and comorbidities (e.g., cardiovascular, type 2 diabetes mellitus).

Background. Acute respiratory viral infections are a pathology that most often occurs in outpatient therapeutic practice (about 40 million cases per year). The term acute respiratory viral infection is a collective concept and denotes a group of diseases of viral etiology with predominant damage to the respiratory tract.The general epidemiological features of acute respiratory viral infections pathogens consist in common transmission: airborne droplets and through contact with contaminated objects. Although the causes of acute respiratory viral infections may be different, they have common epidemiological and clinical features that determine a unified strategy for treatment and prevention. Results. Treatment of acute respiratory viral infections is aimed at reducing the severity of symptoms, preventing progression of the disease, and achieving a complete and lasting recovery. Laboratory etiological diagnosis at the outpatient stage is carried out using molecular genetic methods only for influenza A and B, as well as COVID-19; to identify other pathogens of acute respiratory viral infections, it is advisable only for clinical and epidemiological indications, since the results obtained do not affect further tactics of patient management. A required component of treatment is non-drug therapy, including bed rest, diet and plenty of fluids.Drug treatment of acute respiratory viral infections and influenza includes etiotropic drugs, pathogenetic and symptomatic therapy. Direct and indirect antiviral drugs are used as etiotropic therapy. Neuraminidase inhibitors, like cap-dependent endonuclease inhibitors, are used in the treatment of influenza A and B, and, unfortunately, are not active against other pathogens of acute respiratory viral infections. Due to the lack of drugs with direct antiviral action active against acute respiratory viral infections pathogens, the main etiotropic drugs are drugs of indirect (immunomodulatory) action with a wide antiviral spectrum, which include interferon inducers.

Conclusion. The article presents an analysis of the literature on the topic of optimizing the treatment of acute respiratory viral infections and influenza in an outpatient setting using drugs from the group of interferon inducers. As a result of the analysis, it was concluded that an integrated approach is necessary, including antiviral therapy in the treatment of any forms of acute respiratory viral infections and influenza.

Objective. The purpose of the study is to evaluate the effectiveness of using the "Program for predicting an unfavorable outcome, the development of cardiovascular complications and the effectiveness of rehabilitation measures in patients with chronic obstructive pulmonary disease (CardioRisk)" (Certificate number of state registration RU2023666935, registration date 08.08.2023) to manage the risks of COPD progression at the outpatient stage, taking into account the clinical phenotype and features of the course of the disease.

Materials and methods. The analysis of the effectiveness of the use of the "Program for predicting an unfavorable outcome, the development of cardiovascular complications and the effectiveness of rehabilitation measures in patients with chronic obstructive pulmonary disease (CardioRisk)" in 150 patients with COPD who are observed on an outpatient basis at the place of residence and are registered at the dispensary for the underlying disease. To assess the effectiveness, dynamic monitoring was carried out for 12 months for patients with COPD who have a high and low risk of an unfavorable outcome of the underlying disease as a result of prognosis. The dynamics of clinical manifestations, the number of exacerbations, the tolerance of physical activity and the prognosis of survival by the value of the BODE index were analyzed.

Results. In the dynamic follow-up group of patients with a low risk of an unfavorable outcome of the underlying disease, a statistically significant positive degree of cough severity was noted – by 4.07% (p = 0.007), sputum separation - by 4.72% (p = 0.024). The number of exacerbations in the first group decreased by 16.08% (p = 0.05; p = 0.02), the BODE index – by 9.3% (p = 0.003; p = 0.04), exercise tolerance increased by 3.7% (p = 0.007). In the second group, there was a statistically significant increase in the severity of dyspnea by 11.3% (p = 0.04), cough – by 14.9% (p = 0.022), sputum separation – by 27.55% (p = 0.001). The number of exacerbations significantly increased during the year – by 12.1 and 8.68% (p = 0.031; p = 0.030), respectively, the BODE index increased by 15.19% (p = 0.045), which indicated a deterioration in the prognosis in terms of survival.

Conclusion. The effectiveness of using the "Program for predicting an unfavorable outcome, the development of cardiovascular complications and the effectiveness of rehabilitation measures in patients with chronic obstructive pulmonary disease (CardioRisk)" (Certificate number of state registration RU2023666935, registration date 08.08.2023) to manage the risks of COPD progression at the outpatient stage, taking into account the clinical phenotype and features of the course of the disease. The program solves the problem of optimizing the dispensary observation of patients with COPD in the provision of primary medical care, allows for a comprehensive assessment of the individual total risk of an unfavorable outcome of the underlying disease. The data obtained should be taken into account for the formation of a personal rehabilitation program for patients with mandatory lifestyle modification (quitting smoking and using alternative methods to combat smoking).

Background. Nonalcoholic fatty liver disease is by far the most common chronic liver disease worldwide with a global prevalence of 32.4%. Currently, there is an active search for new therapeutic options for the management of patients with nonalcoholic fatty liver disease. At the same time, there is a process of rethinking the effect of known drugs, in particular ursodeoxycholic acid, from the perspective of new points of therapeutic application, including the metabolic effects of this drug. Ursodeoxycholic acid is a naturally occurring hydrophilic non-cytotoxic bile acid that is present normally in bile, occupying 3-5% of the bile acid pool. Ursodeoxycholic acid is currently a drug with multiple therapeutic effects, which is actively used in the treatment of one non-alcoholic fatty liver disease. The article focuses on the effect of ursodeoxycholic acid on lipid, carbohydrate metabolism, and insulin resistance in patients with nonalcoholic fatty liver disease. Special attention is paid to the effect of ursodeoxycholic acid on the state of the intestinal microbiota and the maintenance of the integrity of the intestinal barrier as a factor in the progression of metabolic disorders in non-alcoholic fatty liver disease.

Results. The data of modern literature convincingly show that the most researched, available in clinical practice and reasonable approach to the treatment of nonalcoholic fatty liver disease is the use of ursodeoxycholic acid. The evidence-based advantages of the original ursodeoxycholic acid drug in the correction of metabolic disorders in patients with non-alcoholic fatty liver disease have been noted.

Background. COVID-19 is a viral infectious disease that has infected more than 40 million people. The relevance of studying various mechanisms of immunological protection in the acute and post-acute periods of this disease is beyond doubt.

Objective. The aim of the work was to assess the state of the indicators of blood cells, phagocytic activity and ATP in white blood cells, depending on the period of coronavirus infection caused by the SARS-CoV-19 virus.

Materials and methods. There were 70 patients (41 women and 29 men) in the acute period of covid and 54 patients (38 women and 26 men) in the post-acute period aged from 18 to 68 years. The patients were examined in the acute period of the disease (upon admission to the hospital), in the period of early convalescence (before discharge from the hospital), in the post-acute period 30-35 days after discharge from the hospital and 90-95 days after discharge. In all patients, the number of leukocytes, lymphocytes and neutrophils in peripheral blood was calculated in absolute numbers and percentages of t, the concentration of ATP and phagocytic parameters were estimated.

Results. Changes in the composition of the leukocyte formula in the dynamics of the infectious viral process were detected depending on the severity of COVID-19. The long-lasting proinflammatory nature of pathological changes in the body against and after COVID-19 leads to depletion of the energy potential of innate immunity cells, what follows from the concentration of ATP and significantly reduced phagocytic parameters in acute and post-acute periods in patients regardless of the severity of the coronavirus infection. In the long-term period (90-95 days after discharge), normalization of some phagocytic parameters was not detected in the group of patients who had a severe form of COVID-19, which may be the cause of various bacterial and fungal pathologies and which should be taken into account in the selection of methods for preventing the development of complications.

Background. Influenza represents a serious socio-economic problem, despite the fact that in the last 3 years the reported incidence has occurred in the form of local outbreaks. This was due to the predominant diagnosis of a new coronavirus infection associated with SARS-CoV-2 and the paradigm for monoinfection in one patient. Nevertheless, real clinical practice and wide possibilities for laboratory diagnostics have shown the acceptability of several infectious agents in one person at the same time. Starting from the end of 2022, the incidence of influenza began to grow in the structure of infectious pathology. At the same time, cases of co-infection with influenza and the new coronavirus infection COVID-19 began to be recorded.

Objective. This clinical case demonstrates the course of a coronavirus infection complicated by pneumonia in combination with influenza and the addition of three infectious agents Streptococcus pneumoniae, Mycoplasma pneumonia, Candida albicans in a young patient without predictors of a severe course.

Conclusion. Our clinical observation shows the importance of a thorough examination of the patient for such respiratory viral infections as the new coronavirus infection COVID-19, influenza A(H1N1)pdm09, which often develops with lung damage. During the period of rising incidence at the height of the epidemiological season, the doctor’s alertness regarding the development of a bacterial process in the lungs in such patients should remain at a high level. The widespread spread of coronavirus infection COVID-19, the massive number of admissions to infectious diseases and therapeutic hospitals, the presence of a similar X-ray picture of the lungs should alert the doctor regarding the adequate and rational use of antimicrobial and antiviral drugs, excluding the possibility of drug immunosuppression and subsequent activation of one’s own flora that can cause bacterial infections and fungal infection of the patient’s body.

Background. The clinical feature of purulent sinusitis, a common but often underdiagnosed disease, has received considerable attention due to its ability to cause severe neurological complications. Although it is often encountered in otolaryngological practice, it can nevertheless be accompanied by severe neurological consequences.

Results. A comprehensive review of clinical cases, diagnostic techniques, and therapeutic interventions was performed to provide insight into the pathogenesis, progression, and treatment of these complications. Drawing on the intersection of otolaryngology and neurology, the complexities of diagnosing and treating conditions such as meningitis, intracranial abscesses, and cavernous sinus thrombosis secondary to purulent sinusitis are presented. Case histories for five years were reviewed in a retrospective and prospective manner, and cases of neurological complications were carefully identified and analyzed. Diagnostic strategies for accurately diagnosing and assessing the extent of sinusitis and its neurological involvement are reviewed in detail, with an emphasis on the use of advanced imaging techniques such as high-resolution CT and MRI.

Conclusion. Modern research and scientific data on purulent sinusitis provide a complete understanding of the pathology of the disease, diagnostic methods and therapeutic approaches. They emphasize the need for an individualized treatment plan that takes into account the severity of the disease, the patient's overall health, and the potential risks and benefits of various treatment methods. This comprehensive approach, based on the latest scientific evidence, is critical for the effective treatment of purulent sinusitis and its complications.

Background. According to various data, the prevalence of chronic non-communicable diseases among young people tends to increase. This is often due to lifestyle changes, increased stress factors, poor nutrition, low physical activity, bad habits, etc. It is known that the pathological effect of the main risk factors and the formation of diseases begins in adolescence and young age, and therefore, the development of a concept of their prevention is of particular interest for this particular population group. In this regard, early detection and diagnosis of chronic noncommunicable diseases play an important role in preventing their progression, improving the prognosis and quality of life of young patients. Identification of risk factors and determination of their severity at an early stage of the development of diseases allows them to begin their timely correction, which contributes to the prevention of complications. However, low health awareness and lack of medical literacy among this population group is an obstacle to the early detection of chronic noncommunicable diseases in young people. One of the key tools for early detection of chronic noncommunicable diseases in young people is screening aimed at identifying risk factors and primary signs of the disease in people without clinical manifestations. Screening can be carried out using various methods, including questionnaires. The introduction of automated screening diagnostic systems using artificial intelligence is of genuine interest among young people. Moreover, artificial intelligence technologies actively contribute to the creation of conditions for improving the quality of health services.

Results. We have developed and tested a methodology for remote multidisciplinary questionnaire screening of chronic noncommunicable diseases for the first stage of medical examination of young people. The system has allocated a contingent of subjects with high, medium and low risk, and also helps to collect a preliminary medical history for each subject, which helps to improve the quality of medical decision-making and reduces its subjective component, thereby increasing the time for direct examination of the patient. Each subject received personalized medical recommendations on a healthy lifestyle, taking into account the identified risk factors and their severity.

Conclusion. The present development of St. Petersburg programmers and doctors makes it possible to optimize the provision of medical and preventive care to the population and improve the quality of patient examination.