Introduction. Based on the peculiarities of the formation of the child's immune system, pediatricians are particularly concerned about infants, who have a tendency to generalization of infectious processes (viral and bacterial) and are characterized by physiological deficiency of immunoglobulin A, frequent diseases of the respiratory and intestinal tract, and the development of dysbiosis of mucous membranes. The organization of proper adapted nutrition of children is of great importance for their growth and development. It is not only about pathology, but also various functional disorders of the gastrointestinal tract, which can arise and a healthy baby as a result of improper nutrition or introduction of complementary foods. For infants of the first months of life, the gold standard of nutrition is breast milk of the mother, and if breastfeeding is impossible – an adapted milk formula. Early introduction of complementary foods is inappropriate, as the body of an infant under 4-6 months is not yet ready to accept other foods. However, in conditions of deficiency of breast milk or in its absence, it is necessary to choose its substitute. In this situation, infant adapted formulae based on natural goat's milk are recommended.

Objective. The article presents the peculiarities of the immune system of young children and critical periods of its development. It shows the relationship between the development of diseases, immune system and the possibility of correction with the help of proper nutrition and complementary feeding.

Background. Lactose is the main carbohydrate in breast milk, dairy products and is important for human physiology. Lactase deficiency is a term that is used to describe pathological conditions caused by a decrease in lactase levels (hypolactasia) or a complete absence of the enzyme (alactasia).

Results. Symptoms of lactase deficiency appear after eating foods containing lactose. Patients are concerned about flatulence, colic, diarrhea, vomiting and constipation are possible. Primary, secondary transient and constitutional lactase deficiency are distinguished. In young children, secondary lactase deficiency is most common in the gastrointestinal form of the cow's milk proteins allergy and secondary lactase deficiency due to intestinal infections. Dietary therapy and the enzyme lactase are used in the treatment of lactase deficiency. An individual approach is required when choosing a therapeutic diet. Lactose-free, low-lactose, fermented milk and the "comfort" formulas can be used in lactase deficiency without cow's milk proteins allergy in children on mixed and artificial feeding. For cow's milk proteins allergy and secondary lactase deficiency, fully hydrolyzed and amino acid a lactose-free formulasare used. One to two months after lactase activity has been restored, a child with cow's milk proteins allergy can be cautiously introduced to a high protein hydrolyzed formula containing lactose. The administration of lactose-free and low-lactose formulas containing cow's milk protein to children with cow's milk proteins allergy and secondary lactase deficiency is erroneous.

Background. Breast milk is the best choice for feeding an infant in the first few years of life. Breast milk allows for the transmission of signals from mother to infant within a tightly coupled mother-breast milk-infant system. Notably, the changes that occur in each component of this triad influence the infant's developmental trajectory. In addition to providing essential nutrients, breast milk contains many biologically active components, macro- and micronutrients that promote healthy growth and development, enable the formation of a healthy microbiota, and stimulate the development of the infant's immune system. However, in today's reality, women do not always manage to keep exclusively breastfeeding. Often there is a question about the right choice of milk formula for mixed or artificial feeding of the baby. Since ancient times, goat's milk has attracted the attention of parents as an alternative food for children. It is known that in Europe of XVIII-XIX centuries goat's milk was used to feed babies left in hospitals for foundlings, and the German writer Kanrad A. Zweirlian published a book called "Goat as the best and most effective nurse", where he told about the fact that a child left without a mother was fed with goat's milk. Today goat's milk is called a super milk food with unique therapeutic, nutritional, immunological and biological properties. It is a source of vitamins, proteins, and antioxidants and can be used to create artificial formula as an alternative to breast milk. From the nutritional point of view, goat's milk differs markedly from the milk of other dairy animals, having a greater buffering capacity.

Objective. Currently, there are many studies comparing the possibility of using milk from different animal species (cow, goat, buffalo, donkey, camel, etc.). The article presents the peculiarities of goat milk composition, emphasizing on milk oligosaccharides, which determine part of its unique properties, as well as similarity with breast milk.

Objective. The aim of the study: analysis of the structure of neurological disorders in children with linear scleroderma of the head.

Methods. Clinical and neurological observation, MRI, EEG, examination of genetic thrombophilia markers.

Results. A total of 60 patients with linear scleroderma of the face and head (LSF) were examined: 23 boys (38.33%) and 37 girls (61.67%) aged between 3 and 16 years. The average age of disease onset was 6.64 ± 0.53 years. Neurological disorders were found in half of the patients (n = 32; 51.67%). Among them, disease onset in 26 children (81.3%) was characterized by typical skin changes, while in 8 (25%) it was characterized by neurological signs. Neurological disorders included headaches (in 43.8% of children), epileptic seizures (in 25%), cranial nerve involvement, acute cerebrovascular disorders (9.4%), and tics (9.4%). MRI of the brain revealed changes in 27 out of 32 children with neurological disorders (84%): white matter lesions (63%) and less commonly gliotic changes in the periventricular area (31%). EEG monitoring detected abnormalities in 21 children (65%), but a typical pattern of epileptiform activity was only found in 14 children (24%), including 6 children (10% of cases) with epileptiform activity without clinical seizures. Among the three children with acute cerebrovascular disorders, all were diagnosed with genetic thrombophilia, two had cerebral vascular malformations, and one had antiphospholipid syndrome.

Conclusion. The pathogenesis of strokes in children with LSF involves sclerodermic vasculopathy, cerebral vascular anomalies, and mutations in blood coagulation genes leading to hypercoagulability.

Objective. The review provides an analysis of modern domestic and foreign literature on the role of nutritional support in comorbid patients with asthenia. The problem of dietary deficiency of B vitamins is discussed, including as a result of a decrease in their absorption, which can be considered as an etiological factor in the development of neurological disorders and a wide range of pathological conditions, including immune ones, the aggravation of which is observed in different groups of the population, including the elderly.

Results. The growing number of patients with complaints of asthenic manifestations in the symptom complex of their underlying disease cannot but cause alarm, so the authors of the article provide data from scientific studies confirming the general clinical trend – the use of sufficient amounts of B-complex vitamins has a positive effect on physical, mental and energetic results in comorbid patientspatients. Separately, the review presents an analysis of data on the need to include B vitamins in the diet to correct the somatopsychic manifestations of stress both in the long term (impact on worker productivity, reducing the number of days of disability, reducing the level of morbidity and accidents, etc.) and short-term needs. The need for further research into the neurocognitive and physical benefits of not only B-complex supplementation, but also other micronutrients, is particularly emphasized, with overall supporting evidence for the benefits of nutritional support in healthy and at-risk populations in terms of physical, mental and energy outcomes. A detailed analysis of the data in the article revealed the need to consider modern data from experimental and clinical studies, the pathogenetic mechanisms of the development of asthenic phenomena in patients with comorbid pathology, and possible points of application of nutritional support in their correction.

Background. Postpartum endometritis is an infectious and inflammatory process in the endometrium with possible involvement of the myometrium. The main components of the treatment of the disease are antibiotic therapy and removal of necrotic contents of the cavity of the postpartum uterus. From the point of view of caring for the organ, ultrasonic cavitation looks preferable. To increase its effectiveness, various solutions with antiseptic, immunomodulatory or other properties can be used.

Objective. The purpose of our study was a comparative assessment of the effectiveness of the use of various liquids during ultrasonic cavitation in the treatment of postpartum endometritis.

Materials and methods. 80 patients with mild and moderate severity of the disease were examined and treated. The patients were divided into 4 groups of 20 women: 1) patients of the 1st group received treatment according to the clinical recommendations of the Ministry of Health of the Russian Federation; 2) patients of the 2nd group underwent ultrasound cavitation of the uterine cavity using 0.9% sodium chloride solution; 3) patients of the 3rd group underwent ultrasound cavitation followed by additional irrigation of the uterine cavity 0.25% sodium deoxyribonucleate solution; 4) ultrasound cavitation of the uterine cavity was performed in patients of the 4th group using 0.9% furacilin solution.

Results. On the 7th day of treatment for postpartum endometritis, all patients showed an improvement in well-being and objective indicators. At the same time, incomplete reduction of uterine soreness during palpation by the 7th day in patients of the 1st and 3rd groups led to an increase in bed days in these groups. In patients of group 1, there was a slower dynamics of blood parameters such as leukocyte count, C-reactive protein and erythrocyte sedimentation rate. The degree of reduction of tumor necrosis factor alpha and interleukin-10 was the lowest in group 1 and the highest in group 4. The bed day turned out to be the smallest in group 4 and the largest in group 1.

Conclusion. Ultrasound cavitation of the uterine cavity significantly increases the effectiveness of complex therapy of postpartum endometritis and shortens the duration of treatment of patients, enhances the positive effect of ultrasonic cavitation by using 0.9% furacilin solution in a dilution of 1: 5000 as a cavitation liquid. Irrigation of the uterine cavity with a solution of sodium deoxyribonucleate does not significantly affect the healing process.

Background. Urogenital infections are a leading risk factor for isthmic-cervical insufficiency and preterm labor, and the main role in most cases is played by representatives of opportunistic microflora. The most frequent forms of genital infections are bacterial vaginosis, vulvovaginal candidiasis and urogenital trichomoniasis. Bacterial vaginosis is essentially a manifestation of vaginal dysbiosis, it is not lifethreatening, but it is a risk factor for serious complications among pregnant women, namely, it increases the risk of spontaneous abortion, premature labor, premature rupture of fetal membranes, low birth weight and is a co-factor of persistent genital infections. Given the impact of infectious diseases on the course and outcome of pregnancy, as well as the limited possibilities of therapy during pregnancy, it is important to conduct pregravidarial preparation, including screening of infectious diseases, but over 40% of pregnancies are unplanned, which significantly increases the risks of complications of pregnancy and labor, intrauterine infection of the fetus and newborn.

Conclusion. Infectious and inflammatory diseases are an important problem of modern obstetrics and gynecology, especially of rational antimicrobial therapy in conditions of the widespread pathogens’ resistance. The local application of vaginal suppositories Limenda is effective for vulvovaginal treatment in such cases. Furthermore, systemic antibacterial therapy is necessary, spiramycin is very useful in case jozamicin`s withdrawal from the market by Russian Ministry of Health (No. 25-6/159 dated 03/14/24). Macrolide Doramitcin WM is applicable from the first trimester of pregnancy and allows equivalent replacement of the departed 16-membered macrolide.

Background. Chronic hepatitis C is an urgent health problem in Russia and in the world. The medical and socio-economic significance of this pathology is associated with the steady development and progression of fibrosis and cirrhosis of the liver, as well as hepatocellular cancer. This review article reveals the importance of single-nucleotide gene polymorphisms in the formation of liver cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis C.

Objective. To identify the importance of genetic predictors of the development and progression of fibrosis and cirrhosis of the liver, as well as hepatocellular cancer in patients with chronic hepatitis C, including those who have achieved a stable virological response against the background of antiviral therapy with direct antiviral drugs.

Materials and methods. Current scientific publications of domestic and foreign authors, the results of clinical studies devoted to the study of the clinical significance of various single-nucleotide gene polymorphisms in patients with chronic hepatitis C were used as research material. During the work on the article, an analysis of the literature was carried out, generalization and structuring of the data obtained, including the formation of tables, discussion of the research topic with the formulation of conclusions and outlining the prospects for further study of this topic.

Conclusion. Currently, taking into account the high effectiveness of antiviral therapy for chronic hepatitis C with direct antiviral drugs, the quality of life of a patient who has achieved a stable virological response is determined by the presence of liver fibrosis and the risk of cirrhosis and hepatocellular liver cancer. It is becoming important to find a personalized approach to such patients, which allows us to identify predictors of the formation of undesirable outcomes of chronic hepatitis C. Single nucleotide polymorphisms of genes are a promising direction in the study and application as genetic markers of various pathological conditions and diseases.

Background. Comorbidity as the presence of two or more pathological processes in a patient is one of the most discussed topics in medical forums around the world and in Russia. Meanwhile, the breadth of discussion of this problem carries the risk of losing the true meaning of comorbidity, set out by the ideologist of this problem, A. R. Fainstein, namely: a combination in one patient of two and/or more chronic diseases, pathogenetically interrelated. (with an unconditional understanding of the variety of options for these connections).

Results. This article offers the reader a detailed look at comorbidity in its original/true understanding, based on a deep understanding of the pathogenesis of diseases and pathomorphological analysis of completed cases of comorbidity. Various options for comorbidity (causal, complicated, iatrogenic, specified and unspecified) with pathomorphological confirmation are considered. Pathomorphological illustrations of the analyzed variants are offered – preparations from the clinical and morphological archive of the Department of Therapy, Clinical Pharmacology and Emergency Medical Care of the Moscow State Medical and Dental University (now the Russian University of Medicine). Inseparable from the understanding of comorbidity is an accurate, uniform presentation of diagnoses – clinical and pathomorphological – by doctors of all specialties, to ensure continuity in the provision of medical care and improve the quality of diagnosis and treatment. The article updates the rules for formulating a clinical and pathomorphological diagnosis in a comorbid patient, namely: a clear reflection of the presence of the main disease and comorbid ones (competing, combined and background diseases), complications of the main disease and concomitant diseases. In the finale, algorithmized "comorbidity postulates" are proposed, facilitating the perception and use of the proposed methodological approaches.

Background. An urgent problem in primary health care is the provision of medical care to patients who received treatment at home (the patronage group). One of the common syndromes aggravates the condition of this group of patients is frailty (senile asthenia). Additional research is needed to identify clinical and functional characteristics in patronage patients associated with the senile asthenia to develop effective prevention and treatment strategies.

Objective. To study the features of the clinical condition and functional status of patronage patients with frailty syndrome.

Materials and methods. The study involved 280 patronage patients – 78 men and 202 women aged from 60 to 100 years (average age 81 years [72; 86]). Depending on the senile asthenia patients were divided into two groups. Research methods included a general clinical examination with measurement of anthropometric parameters and study of medical documentation, a comprehensive geriatric assessment, the "Vozrast ne pomekha" questionnaire, assessment of nutritional status, intensity of chronic pain syndrome, indicators of basic and instrumental activity, indicators of the psychoemotional state and cognitive status. Statistical analysis was carried out using the StatTech v.4.1.2 and SPSS Statistics v.26. Results. In the group of patronage patients senile asthenia syndrome is associated with the presence of cardiovascular pathology – hypertension (p = 0,010), cerebrovascular diseases (p < 0,001), coronary heart disease (p = 0,051), chronic heart failure (p = 0,048), arrhythmia (p = 0,049) and atherosclerosis of the extremities vessels (p = 0,054). The number of multimorbidities in patronage patients is also associated with the frailty and averages 6 [5; 8] pathologies. The presence of senile asthenia syndrome worsens nutritional status indicators (10 [9; 12] points, (p = 0,005), negatively affects functional activity (Barthel scale, mean score 65,00 [45,00; 80,00], Lawton scale, mean score 0,00 [0,00; 2,00], р < 0,001), and the relationship with non-dementia cognitive disorders and dementia is more often determined (28,9% and 60,2% of patients, respectively, p < 0,001). However, there were no differences between pain perception and depression scores depending on the presence of frailty syndrome.

Conclusion. Frailty syndrome among elderly patients receiving treatment at home is associated with pathologies of the cardiovascular system as well as with common geriatric syndromes – malnutrition syndrome, impaired functional activity and cognitive disorders which requires special attention and a preventive approach aimed at reducing the risk of hospitalization and improving quality of life. 

Background. The events of the last two years of a Special Military Operation have obliged doctors of all specialties to re-evaluate the methods of diagnosis, treatment, and anesthesia of patients with the consequences of gunshot wounds. The article presents a clinical case of a severe pain syndrome (piriform muscle syndrome) due to a gunshot wound and its treatment using botulinum therapy. Botulinum toxin type A has a unique analgesic effect, which has expanded the scope of its application in clinical practice.

Objective. The purpose of the study was to evaluate the effectiveness of botulinum toxin type A preparations in severe pain syndrome due to gunshot wounds.

Results. As a result of the treatment with botulinum toxin type A, a pronounced positive dynamics of pain relief was obtained in case of piriform muscle syndrome, which developed as a result of the consequences of a gunshot wound.

Conclusion. Piriform muscle syndrome is a disorder that often manifests as a clinical picture of different pathologies. A late diagnosis or inadequate therapy can lead to the pathological changes in the sciatic nerve. The key to the effectiveness of the method used is the early detection of such disorder. Currently, the range of preparations for the treatment of pain syndrome is quite wide, but only a methodologically proper injection can increase the effectiveness of piriform muscle syndrome treatment and reduce the risk of complications, which is impossible without the use of imaging techniques. Thus, we believe that injections into the area of the piriform muscle under the visualization control should become the method of choice in the treatment of pain of such localization.

The discussion, dedicated to the treatment of luminal HER2-negative breast cancer stages II and III, was attended by doctors from St. Petersburg – Maria Leonidovna Makarkina, M.D., oncologist of the outpatient department of the N. P. Napalkov Cancer Center, and Elizaveta Vladimirovna Artemyeva, oncologist of the inpatient department of antitumor drug therapy No. 1 of the N. P. Napalkov Cancer Center.