Background. Genital papillomavirus infection is widespread in the population, initiating the development of precancer and genital cancer. The vast majority (83.0%) of human papillomavirus-related cancer cases worldwide are cervical cancer. The review article presents a modern approach to the management of patients after excisional treatment for cervical precancer. Recurrence of cervical precancer after surgical treatment occurs in 8.1-14.4% of cases, which increases the risk of developing cervical cancer. Despite the high effectiveness of local surgical treatment of patients with cervical precancer, an increased risk of late diagnosis of cervical cancer has been proven in comparison with the risk in the general population. Data are presented on factors that increase the potential risk of recurrence of cervical precancer: age of women over 50 years; follow-up results confirming the presence of high-risk human papillomavirus and high viral load, as well as HPV co-infection and abnormal cytology; positive resection margin resulting from excisional treatment of cervical intraepithelial neoplasia. Human papillomavirus persistence is considered one of the leading predictors of relapse of CIN2+, regardless of the type of excision treatment. The combination of persistent high-risk human papillomavirus and a positive sectional margin significantly increases the risk of persistent/recurrent CIN2+. The importance of a positive endocervical margin as a predictor of relapse is emphasized. A negative co-test (cytological examination in combination with an human papillomavirus test) after conization in the dynamics of observation contributes to a favorable prognosis. It was found that in patients with a negative human papillomavirus test and a negative result of a cytological study, the development of cervical precancer was observed in only 0.2% of cases over the next 42 months after conization, which was lower than the incidence of cervical precancer among patients participating in a population-based cervical cancer study screening. Foreign authors include preventive vaccination against human papillomavirus as anti-relapse measures with a bivalent vaccine (against types 16 and 18) or a quadrivalent vaccine (against types 6, 11, 16 and 18), which reduces the risk of relapse of CIN2+ associated with human papillomavirus 16 and human papillomavirus 18, compared with unvaccinated people. The issues of post-excision vaccination based on the results of a number of meta-analyses are discussed. Despite the positive effects of human papillomavirus vaccination, it has not been determined whether post-treatment human papillomavirus vaccination should be recommended for all women undergoing excisional treatment for intraepithelial neoplasia. The assessment of the effectiveness of the preventive vaccine for patients with an initially positive test for human papillomavirus types 16 and 18 requires clarification. It is recognized that the development of this promising area requires continued research to clarify the time of administration of the vaccine dose relative to excision.
Conclusion. Аn integrated approach, including detection of cervical human papillomavirus infection after excisional treatment of intraepithelial neoplasia and subsequent active surveillance, avoids relapses and progression of cervical precancer. Post-excision vaccination against human papillomavirus is recognized as a promising approach for secondary prevention of cervical precancer.

Background. Inflammatory diseases of the pelvic organs occupy first place in the structure of gynecological diseases; the debut of inflammatory diseases in women occurs in most cases at a young age, increasing the risk of reproductive dysfunction, decreased fertility and decreased quality of life. The main symptoms of pelvic inflammatory diseases include periodic lower abdominal pain, increasing at the beginning or end of menstruation (often the intensity of pain does not correspond to changes in the reproductive organs); itching in the perineum; changes in libido, anorgasmia, vaginismus, dyspareunia; bleeding (mucous-purulent, mucous); urinary frequency and defecation disorders (a consequence of rectal dysfunction). Currently, the clinical picture of inflammatory diseases is characterized by a subacute onset, "erased" symptoms, varying severity of the course, which complicates their timely diagnosis and therapy. At the same time, there are discrepancies in the severity of the clinical course and the severity of the inflammatory process in organs and tissues. Late diagnosis and inadequate treatment of inflammatory diseases of the female genital organs significantly increases the frequency of adverse outcomes and the risk of reproductive losses among women.
Conclusion. The problem of therapy of inflammatory diseases of the pelvic organs requires a comprehensive approach. An important component of treatment is antibacterial therapy. Taking into account modern standards of antibacterial therapy for inflammatory diseases of the pelvic organs, the following drugs deserve great attention: doxycycline and azithromycin in a dispersible form, which have improved pharmacokinetic properties, high efficiency and compliance.

Background. In modern dermatologist practice, cases of combined dermatological pathology are increasingly encountered, which complicates the differential diagnostic search, leads to a delay in the start of treatment and disease progression. The study of combined dermatoses from the point of view of etiological and pathophysiological mechanisms of occurrence, their mutual influence on each other, diagnostic markers and the impact of complex therapy on each disease is of particular importance for further prognosis in patients with chronic dermatoses.
Objective. The article presents two clinical observations of patients with combined dermatological pathology: systemic lupus erythematosus and psoriasis.
Materials and methods. The difficulties of making a final clinical diagnosis are demonstrated. The importance of a thorough differential diagnostic search, close attention to patients with long-existing rashes, and interdisciplinary interaction of specialists is reflected.
Results. Increased awareness among both dermatologists and allied physicians will promote clinical vigilance, which will improve the quality of life in this group of patients.
Conclusion. Identification of comorbid pathology in the early stages of the development of chronic diseases will contribute to improving the quality of life and the likelihood of a favorable outcome even at the outpatient stage of medical care. Early identification of indicators of the systemic nature of the process and timely initiation of therapy will improve the quality of medical care for patients with multimorbid pathology. In this regard, this article presents our own clinical observations.

Background. Pityriasis amiantacea is a reaction of the skin to various inflammatory diseases (seborrheic dermatitis, psoriasis, atopic dermatitis, chronic lichen simplex and others) that manifests by thick gray-yellow scaly crusts surrounding the hair. Сrusts are often attached to hair quite firmly and an effort to remove them leads to hair pulling, that in combination with the inflammatory process and secondary infection can sometimes lead to the formation of secondary traumatic cicatricial alopecia or non-scarring alopecia with subsequent hair growth.
Objective. The aim is to study and analyze modern scientific data regarding the clinical features and treatment of pityriasis amiantacea, and demonstrate our own clinical observation.
Materials and methods. The article discusses current information about pityriasis amiantacea, a rare condition that can be a manifestation of various inflammatory diseases of the scalp. The article discusses in detail the clinical manifestations and variants of the process, and gives a description of the features of primary conditions that can lead to its development. The authors presented their own clinical case of a case of pityriasis amiantacea in a 21-year-old man, which developed as a complication of seborrheic dermatitis and accompanied by alopecia.
Conclusion. There is no single approach to the treatment of pityriasis amiantacea; the choice of therapy depends on the underlying disease. Determining the primary disease that caused the development of pityriasis amiantacea is a difficult diagnostic task, since regardless of the etiology, the manifestations of pityriasis amiantacea on the scalp are almost the same. The persistence of the process and the lack of generally accepted approaches to therapy require further research. It seems especially significant due to the fact that long-term existence and the absence of treatment, it can lead to the formation of secondary traumatic cicatricial alopecia.

Background. Psoriasis is classified as a systemic immune-mediated inflammatory skin disease, with a frequency of 2-3%. Taking vitamins for psoriasis accelerates the healing processes, normalizes metabolism, relieves the symptoms of the disease, improves the condition of the skin, hair and nails.
Objective. The role of vitamin D in the pathogenesis of various skin diseases has been shown, and vitamin D deficiency was more often observed in patients with atopic dermatitis and psoriasis, which suggests an important role of vitamin D in the pathogenesis of these common skin diseases. Low levels of 25-hydroxyvitamin D (the transport form of vitamin D, which characterizes vitamin D availability) are found in numerous dermatological diseases, including psoriasis. The interaction between intestinal bacteria and the immune system occurs at several levels and vitamin D is an important mediator in this dynamic.
Conclusion. To prevent and successfully treat immuno-mediated inflammatory skin diseases, including psoriasis, it is necessary to ensure the physiological needs of the body in vitamins A, E, D, C, B1, B6, B9, B12, PP. Vitamin and mineral complexes used in the form of drinks not only normalize the vitamin status of the body, but also contribute to the normalization of the microbiota intestinal tract, which affects the health of the skin. In severe skin lesions – psoriasis, the topical vitamin D preparation calcipotriol is successfully used.

Background. Infantile (infantile) hemangiomas are benign vascular tumors found predominantly in the pediatric population. Its presence can lead not only to aesthetic discomfort of the child, but also to gross functional disorders. The etiology of infantile hemangiomas is not fully understood. It is assumed that the development of this neoplasm is based on abnormal proliferation of endothelial cells with disruption of the architectonics of blood vessels due to mutation of genes responsible for the processes of tissue proliferation, or as a consequence of antenotal and/or perinatal hypoxia. Despite the fact that in some cases infantile hemangiomas can resolve spontaneously, the question of their therapy is relevant and is considered in relation to each patient individually. To date, the first line of therapy is the administration of the beta-adrenoblocker propranolol, with marked clinical improvement, but possible development of a number of side effects. Therapy is initiated as early as possible, that is, during the proliferative phase of infantile hemangioma development. The chosen method of treatment should be as effective as possible and should not lead to serious complications and the development of side effects. Since there is no unified approach to the management of such patients in the literature, it is necessary to continue searching for other methods of infantile hemangioma treatment depending on the clinical and morphologic course of the disease.
Conclusion. This article presents a clinical case of infantile hemangioma and the results of topical beta-blocker use as an alternative treatment method to reduce the risk of side effects of the beta-adrenoblocker group of drugs.

Background. In premature infants, when determining the beginning of the introduction of complementary foods, it is necessary to focus on the calendar and corrected age. It is considered possible to begin the introduction of complementary foods in premature infants at 4-6 months of calendar age. Complementary foods should not be offered to premature infants earlier than 3 months of corrected age. The time of formation of psychomotor skills is crucial for the introduction of complementary foods: the child must hold the trunk and head well, the ejection reflex has disappeared, chewing movements have appeared, the baby shows interest in new food. When solving issues related to the introduction of complementary foods in premature infants, it is necessary to use an individual approach. Premature babies often refuse to feed, have a low appetite and are more selective in food. Children need advice from a nutritionist, neurologist, gastroenterologist, speech therapist, psychologist. In children with bronchopulmonary dysplasia, damage to the nervous system, high-calorie nutrition may be required. In premature infants, when solving issues related to the choice of products, the sequence and speed of the introduction of complementary foods, it is necessary to focus on existing recommendations for full-term children. The beginning of the introduction of complementary foods in a premature baby is associated with the risk of excess or malnutrition. The complementary foods are introduced from a spoon before breastfeeding or formula feeding. Feeding is given slowly and gradually. All types of complementary foods are started with mono-component products. Individual order of introduction is possible. Tolerance should always be monitored. Currently, it is recommended to give preference to commercially produced complementary foods for premature infants. Such complementary foods are made from tested, high-quality raw materials and meet the strict hygienic safety requirements for infant nutrition. Commercially prepared complementary foods have a guaranteed composition, the necessary degree of grinding, and are enriched with vitamins and minerals.
Conclusion. Vegetarian complementary foods are dangerous for premature babies due to the development of nutritional deficiencies. After the introduction of complementary foods in premature infants, breastfeeding should be continued.

Background. Analysis of the regional specifics of primary childhood disability for the targeted development of preventive measures.
Materials and methods. A systematic analysis of primary childhood disability and its structure in the Astrakhan region for 2018-2022 was carried out. The study was conducted in Astrakhan based on the results of reporting documentation from the main bureau of medical and social examination of the Astrakhan region.
Results. The results of the data analysis showed an increase in the number of disabled children during the study period. Over 5 years, there has been a decrease in the number of children unreasonably referred for medical and social examination (p = 0.041): in 2022 – 88%, in 2021 – 86.5%, in 2020 – 89.9%, in 2019 – 77.8%, in 2018 – 75%. Among the causes of primary disability, mental illness and behavioral disorders predominate. An increase in the number of children diagnosed with this group of diseases over the analyzed period was revealed. In second place in the structure are pathologies of the nervous system, in third place are congenital anomalies, deformations and chromosomal disorders. The intensive rate of primary childhood disability for mental disorders and behavioral disorders is increasing; decreases – for diseases caused by neoplasms, disorders of the genitourinary system and the circulatory system. In 2022, a large proportion of disabled children were identified among children aged 4-7 years, then in descending order – 0-3 years, 8-14 years, 15 years and more.
Conclusion. The analysis will allow us to formulate target directions in the development and implementation of preventive and restorative measures for children with disabilities, as well as the implementation of preventive measures, taking into account regional characteristics.

Objective. The article presented by the authors is devoted to new directions in the pathogenesis of non-alcoholic fatty liver disease. The relevance of this problem is high, since currently non-alcoholic fatty liver disease is the most common chronic liver disease in the world and affects from 25% to 40% of adults in developed countries such as the USA and Russia. Non-alcoholic fatty liver disease is a multidisciplinary problem. The pathogenesis of the pathology under consideration is complicated and includes a large number of different links. Recently, the connection between the gut microbiota and the development of non-alcoholic fatty liver disease has attracted enormous interest. In this review the authors focused in detailed analysis of reserches of this link in the pathogenesis of non-alcoholic fatty liver disease.
Results. Based on the analysis of the literature, a correlation was obtained between the composition of the microbiota in healthy people and patients with non-alcoholic fatty liver disease. A large number of works has demonstrated without any doubt the connection between non-alcoholic fatty liver disease, small intestine bacterial overgrowth, and increased endotoxemia, it supports the hypothesis that patients with non-alcoholic fatty liver disease have weakening of intestinal barrier function and the formation of "leaky gut". Based on literature data, the need to complete non-alcoholic fatty liver disease therapy in order to stabilize the permeability of the intestinal epithelium and to increase the pool of butyrate-producing bacteria with butyrate preparations that can be introduced into the human body exogenously.
Conclusion. Based on the analysis, carried out by the authors, the importance of studying the state of the intestinal microbiota of the body, as one of the most important links in the pathogenesis of non-alcoholic fatty liver disease, is emphasized. During the treatment of nonalcoholic fatty liver disease, along with existing treatment methods, additional pathogenetic therapy is required with drugs that restore normal intestinal flora: prebiotics, synbiotics, probiotics, bacterial metabolites.

Objective. The purpose of the study was to evaluate the effectiveness of a 20-day course of injectable chondroprotector in patients with osteoarthritis in extremity joints and nonspecific lower back pain in clinical practice.
Materials and methods. The study included 78 outpatients, aged 25 to 80 years (27 men and 51 women; mean age 50.0 [45.0; 58.0] years), who sought consultation with a neurologist for exacerbated osteoarthritis in extremity joints and lower back pain. The effectiveness of therapy was evaluated using the visual analog scales (VAS) based on the severity of pain, the patient's self-assessment of health, quality of life and the patient's adherence to therapy. The time of onset of the therapeutic effect and whether the patient needed to take NSAIDs were recorded. The EQ-5D quality of life questionnaire was used to assess the patient's general health and its components: mobility, ability to self-care, activities of daily living, presence of pain and/or discomfort, anxiety and/or depression.
Results. Statistical analysis of the survey results using visual analogue scales showed a decrease in pain intensity from 70.0 [10.0; 90.0] to 12.5 [0.0; 70.0]; health assessment improved from 50.0 [0.0; 90.0] to 90.0 [20.0; 100]; and satisfaction with the therapy increased from 30.0 [0.0; 90.0] to 90.0 [20.0; 100]. Positive dynamics were observed in all EQ-5D questionnaire categories after 20 days of treatment, with statistically significant improvements in health levels from the start to the end of the therapy course (p < 0.05). All 78 patients (100%) completed the entire course therapy. Out of these, 74 patients responded positively to the treatment, while 4 patients reported no changes in their condition.
Conclusion. The therapy has shown effectiveness in treating pain in patients with osteoarthritis of extremity joints and the lumbar spine. During the course of therapy, no deterioration in somatic condition, drug intolerance, or complications from comorbid diseases were observed. The therapeutic effect of a 20-day course was observed in the majority of subjects by the middle of the treatment course. Additionally, the use of injectable chondroprotector allowed for a reduction in the dose of NSAIDs taken.

Background. Due to the prevalence of vitamin D insufficient supply of the population and its pleiotropic effect, optimization of vitamin D status is beyond doubt.
Objective. The purpose of the review is to compare the effectiveness of taking different vitamers, doses, regimens and formulations of vitamin D to optimize vitamin status and manifest pleiotropic effects.
Results. An analysis of the literature revealed a general pattern: smaller doses require longer administration to achieve normal blood plasma 25(ОН)D levels. When taken regularly over a period of 3 to 6 months, doses corresponding to physiological needs will provide sufficient blood serum levels of 25(ОН)D. To obtain maximum benefit, a daily, continuous supply of daily vitamin D in doses of 800-1000 IU is preferable to intermittent bolus doses. The effectiveness of vitamin D depends on the form (oil, micellar, liposomes, etc.). After stopping the additional intake, "washing out" occurs, i.e. after 8-12 weeks, return to the original vitamin D supply. To maintain a normal blood serum level of 25(ОН)D and, accordingly, to have a positive effect on metabolic blood parameters, it is sufficient for healthy people to take vitamin D in a dose close to the age-related physiological requirement – 400-1000 IU/day. Persons taking glucocorticoids, suffering from osteoporosis, diabetes mellitus, obesity (especially after bariatric surgery) require higher doses of vitamins from 2000 to 5000 IU/day.
Conclusion. The main parameters influencing the effectiveness of vitamin D are the vitamer used, the dose, duration and regimen of administration, and the form of release. To achieve an adequate supply with vitamin D and the manifestation of pleiotropic effects, patients require higher doses than healthy individuals.

Background. One of the most frequent complaints of patients who have undergone COVID-19 are various purulent-inflammatory diseases of the organs of the oronasopharyngeal region of a recurrent nature, in connection with which it is relevant to investigate the causes of the failure of the protective potential of the upper respiratory tract, mucous membranes of this area. The aim of the study was to study the immunological and microbiological features of the mucous membranes of the oronazopharyngeal region in patients with postcovid syndrome who had suffered a severe form of COVID-19 and had complaints from the organs of the oronazopharyngeal region.
Materials and methods. Patients who suffered a severe form of new coronavirus infection (NCI) from 3 to 6 months ago were examined. Concentrations of local interleukins 1ß, interleukin-10, sIgA, facultative anaerobic microflora of mucous membranes of the oronazopharyngeal region were studied.
Results. The data obtained indicate that patients who have suffered a severe form of new coronavirus infection 3-6 months after discharge from the hospital have complaints of impaired sense of smell, taste, dysphonia, tinnitus. In the study of facultative anaerobic microflora of the nose and pharynx of patients with postcovid syndrome, data on the frequency of detection of strains of Staphylococcus aureus, Klebsiella pneumoniae and yeast-like fungi Candida albicans are noteworthy, regardless of the presence of acute stage diseases at the time of examination, unlike patients with rhinosinusitis or pharyngitis who have not undergone NCI. When assessing the concentration of sIgA in saliva and in the pharyngeal scraping material and local concentrations of IL-1β, it was found that in groups of patients with postcovid syndrome, the level of sIgA and IL-1β, regardless of the presence or absence of acute forms of bacterial infections, did not significantly differ from the norm (p > 0.05). That is, in response to the presence of pathogenic and conditionally pathogenic bacteria and their activation, an increase in the humoral immunity of the mucous membranes and activation of cytokine-mediated mucosal protection reactions were not detected, which is evidence of a local immunodeficiency condition.

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.