Background. Constipation, or constipation, is a polyetiological pathological condition characterized by prolongation of the intervals between acts of defecation and changes in the shape and consistency of fecal matter. The incidence of this pathology is very high all over the world, mainly depending on the nature of nutrition, hypodynamia, standard of living and availability of medical care in different regions of the world. Special attention is paid to the problem of constipation in pregnant women, as it is not only a matter of quality of life, constipation can affect the course of pregnancy and even contribute to its termination. Constipation is one of the most frequent pathologies of the gastrointestinal tract and can occur in 11-62% of pregnant women. The article presents factors predisposing to the development of constipation in each trimester, explains its mechanisms, describes possible complications of chronic constipation in expectant mothers and the negative impact on the course of pregnancy and in the postpartum period.

Results. Approaches to the diagnosis of constipation according to modern classifications, including the "Rome criteria for constipation" 2016, are shown. Special attention is paid to the prevention of constipation in pregnant women. The importance and expediency of a comprehensive approach to the prevention and treatment of constipation in expectant mothers, namely, changing the nature and diet, the level of physical activity in the absence of contraindications and adequate choice of drugs approved for use during pregnancy. A comparative analysis of the use of the most common drugs (lactulose and psyllium) by two groups of pregnant patients is given, the mechanisms of action and effectiveness of psyllium in the treatment of constipation, as well as some other positive properties of psyllium and its tolerance by pregnant women are noted. Clinical examples of effective therapy of constipation in expectant mothers with the use of a medicinal preparation containing plantain ovata (Plantago ovata Forssk.) seed coatings are described.

Background. Atrial fibrillation, the most common persistent cardiac arrhythmia, is a common cause of strokes, heart failure, dementia, worsens the quality of life, increases mortality and has a significant impact on the health economy. The obesity pandemic leads to a serious increase in cardiovascular risks. Obesity is closely associated with the development of atrial fibrillation, as it is associated with diseases and conditions leading to structural and functional remodeling of the heart, as well as hypertrophy and dysfunction of epicardial adipose tissue. Epicardial fat is unique in its anatomy, extremely high secretory and metabolic activity, unobstructed proximity to the myocardium and the ability to interact with it due to the general blood flow. Under physiological conditions, epicardial adipose tissue performs a cardioprotective function. Obesity causes hypertrophy and hypoxia of adipocytes. Under these conditions, adipocytes lose their protective properties, epicardial fat mainly produces proinflammatory and profibrotic adipokines, infiltrates the myocardium, which contributes to the development of atrial fibrillation. Studies show that the thickness and volume of epicardial adipose tissue are directly correlated with the risk of atrial fibrillation, the severity of its course, and the recurrence of paroxysms after catheter ablation. Many potential mechanisms of arrhythmia induction in obesity have been discovered. Research is needed to further clarify these mechanisms and identify ways to prevent them. Taking into account the peculiarities of the structure and functions of epicardial adipose tissue, it is of interest as a promising therapeutic target.

Conclusion. This article represents an overview of the most significant scientific works devoted to the problem of epicardial obesity and its relationship with atrial fibrillation, systematizes modern ideas about the potential proarrhythmogenic effect of epicardial adipose tissue, therapeutic possibilities and future prospects.

Background. Venous trophic ulcers are a typical manifestation of decompensation of chronic venous insufficiency of the lower extremities. The causes of venous trophic ulcers are chronic vein diseases such as varicose veins of the lower limbs, pelvis, post-thrombotic disease of the lower limbs, angiodysplasias (phlebodysplasias), phlebopathies. The launch in the body of these diseases can be due to many factors: genetic, advanced age, obesity, hypodynamia, use of contraceptives, deep vein thrombosis, severe trauma to the lower extremities and so on. All these diseases and factors lead to the development of chronic venous insufficiency, accompanied by prolonged venous stasis of blood. With the progression of chronic venous disease, the appearance of trophic ulcer is a consequence of decompensation of chronic venous insufficiency. Collagen dressings have proved to be a convenient and effective wound covering capable of accelerating healing time, reducing the level of local inflammation in the wound, reducing the size of the postoperative scar. Collagen wound coverings are biodegradable porous preparations, the main component of which is collagen, usually obtained from bovine dermis. The mechanism of collagen action in wound healing is due to its stimulating effect on the proliferation of fibroblasts and their synthesis of endogenous connective tissue proteins, its ability to absorb wound secretion and turn into a soft gel on the wound surface, which is an optimal environment for reproduction and migration of wound cells.

Results. The issues of pathogenesis, manifestations and therapeutic approaches to conservative therapy of venous trophic ulcers are high-lighted, the mechanisms of the therapeutic action of collagen dressings are emphasized. A clinical example of recovery of an outpatient with a trophic ulcer against the background of post-thrombotic disease using the collagen wound healing dressing is given, and the features of dressings using collagen sponges are discussed.

Background. Diseases of the upper gastrointestinal tract and acute coronary syndrome have similar manifestations of pain syndrome, which may contribute to the patient's postponement of seeking medical help with the development of acute coronary events. There is a direct correlation between the risk of acute heart failure and the duration of pain syndrome, the time from its onset until the patient receives antiaggregant therapy. Thus, it is relevant to study the peculiarities of the course of acute coronary events in patients with diseases of the upper gastrointestinal tract in order to optimize the provision of timely medical care.

Objective. The purpose of the research was to evaluate the clinical features of different forms of acute coronary syndrome in people with pathology of the upper gastrointestinal tract.

Materials and methods. The analysis of the characteristics of pain syndrome, as well as other manifestations of acute coronary syndrome, was carried out in 39 patients with diseases of the upper gastrointestinal tract compared with a group of 40 people without concomitant pathology of the gastrointestinal tract. The groups did not differ in gender and age characteristics. A special questionnaire has been developed for this work.

Conclusion. It was found that in the presence of pathology of the upper gastrointestinal tract, acute coronary syndrome was accompanied by asthenic syndrome in 77% of cases (p = 0.02), and in unstable angina, this figure reached 83% (p = 0.003). Significantly more often (67%) manifestations of heart failure were in patients of the main group with unstable angina pectoris (p = 0.025). Acute coronary syndrome in patients with concomitant pathology was accompanied by epigastric pain in 15% of cases (p = 0.03), and acute myocardial infarction – in 19% (p = 0.02). Posterobasal localization of myocardial damage was established only in patients of the main group with acute myocardial infarction in 15% of cases (p = 0.039). All this indicates the need to take an electrocardiogram in leads V7-9 in the presence of epigastric pain in patients with diseases of the upper gastrointestinal tract.

Background. Back pain is one of the most common complaints of patients. There are a large number of causes of pain syndrome. This article emphasizes on the traumatism of athletes and the importance of timely and effective rehabilitation measures that can improve the quality of life. Undoubtedly, the role of exercise in the prevention of musculoskeletal diseases is great. In addition, physical exercise is included in the list of recommendations for their prevention and treatment. But, on the other hand, increased physical activity can have a negative impact on the condition of the joints and spine. A vivid example of this is the prevalence of pain syndrome in various parts of the spine in athletes. Various factors can cause degenerative and dystrophic processes in the spine. First, changes occur in the intervertebral discs – they lose elasticity and elasticity, their shock absorption decreases. Then the changes spread to the rest of the spinal tissues. It is generally believed that age is one of the main factors provoking pathological processes in the spine and musculoskeletal system as a whole. But it is impossible not to mention other reasons, which are no less provoking the development of degenerative-dystrophic changes. One of them is physical exertion that exceeds the body's capabilities. As a result, there are often stretched ligaments or traumatization of muscles. Other causes of pain syndrome in athletes include: spondylolysis – defect of the vertebral arch, spondylolisthesis – displacement of one vertebra in relation to another, spondyloarthrosis – degenerative-dystrophic disease of spinal joints and so on.

Conclusion. The earlier the appropriate treatment is carried out, the lower the probability of chronicization of the pain syndrome and complications of the situation. Treatment of low back pain in athletes is aimed not only at managing the pain syndrome, but also at eliminating the provoking factor, restoring mobility, stability and supportability of the spine through competent and timely rehabilitation measures.

Background. Modern preparations – hyaluronic acid-based synovial fluid prostheses significantly help to improve the results of treatment of deforming osteoarthritis and diseases of periarticular tissues. Cartilage deficiency, degenerative changes in the surrounding soft tissues (tendons of rotator cuff muscles) require specific pathogenetic therapy. Several minimally invasive approaches exist to address these uncommon complications, which mainly consist of intra-articular injections of molecules such as hyaluronic acid. In preclinical and clinical studies, preparations of low molecular weight hyaluronic acids have been found to have, in addition to their mechanical positive properties (viscoinduction), also significant anti-inflammatory and analgesic properties.

Objective. Improving the results of conservative treatment of patients with degenerative-dystrophic diseases of the musculoskeletal system. Materials and methods. The authors present a perfect method of complex conservative treatment using modern trends in local injection therapy, developed to improve the quality of life of patients. 3 clinical examples are considered. The effectiveness of this technique has been proven.

Results. The use of local injection therapy using various types of hyaluronic acid as part of the complex conservative treatment of degenerative and dystrophic diseases of the musculoskeletal system significantly improved the effectiveness of treatment, increasing the mechanical, analgesic and anti-inflammatory effect.

Conclusion. The developed scheme of complex conservative therapy of degenerative-dystrophic diseases of the musculoskeletal system using local injection therapy of various forms of hyaluronic acid helps to improve treatment results and improves the quality of life of the patient.

Background. Approximately half of young children with seizures and increased convulsive readiness have postchiasmal visual disturbances. Congenital optic nerve atrophy is considered the most significant cause of blindness and visual impairment in children, especially premature infants. The diagnosis of epilepsy complicates the standard approach to the treatment of children with partial optic nerve atrophy. The choice of medical and physiotherapy treatment is limited. Therefore, we faced the question of the need to select modern gentle effective methods of complex treatment of patients in this group. To date, the methods of treatment of optic atrophy are aimed at improving blood circulation and metabolism of the retina and optic nerve, as well as at creating conditions that promote better conduction of neuronal excitation along the optic nerve fibers. The article describes the use of infrasonic phonophoresis with a complex of water-soluble polypeptide fractions of bovine retina, which has a stimulating effect on photoreceptors and cellular elements of the retina, improves functional interaction of pigment epithelium and outer segments of photoreceptors, glial cells in case of dystrophic changes, accelerates restoration of light sensitivity of the retina. The absence of complications and sufficiently high efficiency with more successful motor rehabilitation, improvement of intellectual abilities allow us to recommend this method of treatment to patients with epilepsy and partial atrophy of the optic nerve.

Conclusion. A non-invasive complex treatment method using infrasound phonophoresis, pneumomassage using peptide bioregulators and amino acids has a significant effect, but does not cause psychological trauma to children, which makes it possible to use the proposed therapy as a method of choice in pediatric patients with descending partial optic nerve atrophy against the background of epilepsy and with a high risk of developing convulsive activity.

Background. The relevance of this study is associated with the wide prevalence of anxiety and depressive disorders, their variability and diversity of comorbidity, including sexual disorders in the form of orgasmic dysfunctions in women and men. The article presents data on the formation of orgasmic dysfunctions in patients with mental disorders, the mutual influence of mental and sexual pathologies, the similarities and differences of orgasmic disorders in men and women, their clinical and therapeutic aspects.

Materials and methods. We examined 122 patients (64 women and 58 men) aged 18 to 45 years who sought sexological help. The main research methods were clinical-psychopathological and clinical-sexological using as additional tools: the Hospital Anxiety and Depression Scale (HADS), the Weitel Scale, which allows to determine hypochondriacal traits, the Asthenic State Scale – SHAS and Visual Analogue Scale to measure the subjective perception of orgasmic intensity – The оrgasmometer – male and female versions. To compare the characteristic clinical and psychopathological features of orgasmic dysfunctions in women and men with anxiety-depressive spectrum disorders, in accordance with the ICD-10 diagnostic criteria, patients were divided into two groups. The first group consists of patients with neurotic, stress-related and somatoform disorders (F4), and the second with affective mood disorders (F3).

Results. During the study, it was possible to identify the main factors that are a possible predisposition of orgasmic disorders (weak type of sexual constitution, accentuation of character, disturbances in the formation of libido in the form of a delay in the platonic and erotic phases, episodes of generalized anxiety or persistent (at least 3 months) decreased mood with anhedonia and asthenia). The first study group (F4) included patients suffering from neurasthenia, dissociative and somatization disorders in women, and patients with neurasthenia, hypochondriacal and somatization disorders in men. The second group (F3) was homogeneous in mental pathology and was represented by dysthymia. In the structure of anxiety-depressive spectrum disorders in these patients, the features of the formation and clinical course of orgasmic dysfunctions, diagnosis using additional tools in the form of specialized scales were considered, and general principles of therapy were proposed.

Conclusion. The presented clinical and psychopathological features of orgasmic dysfunctions make it possible to identify the connection not only with the phenomenon of orgasm, but also with all components of the copulative cycle with affective and other psychopathological symptoms, which allows us to trace the mechanisms of their formation, improve the diagnosis and determination of the prognosis of these disorders, and choose the tactics of treatment and rehabilitation measures , allowing to increase the effectiveness of therapy for orgasmic disorders.