Background. Currently, in our country, as well as throughout the world, there is a steady increase in the incidence of cancer, which is explained by several reasons, including the aging of the population, environmental, economic and other factors. According to the Global Cancer Observatory, lung cancer is the most common cancer in the world, accounting for more than 12.4% of the total number of new cancer cases, and it is this variant of malignant tumors that is recognized as the main cause of death from cancer (1.8 million cases, 18.7% of the total number of deaths from cancer in 2022 worldwide). The solution to this serious medical and social problem is seen in increasing the effectiveness of detecting early stages of cancer at an early stage, including at the outpatient stage of medical care. The formation and maintenance of skills of oncological alertness among doctors of almost all specialties can ensure the detection and reduction of the frequency of detection of advanced/late-stage tumors, which means it will help to start specialized treatment earlier. The identification of complaints and symptoms characteristic of oncological diseases using algorithmized approaches and methodological support, followed by consultation of the patient with a pulmonologist or oncologist, are designed to improve the results of treatment.

Results. The article suggests the rules of oncological alertness for their unconditional application at the outpatient stage by therapists and general practitioners, analyzing lung cancer as an example, considering a set of specially designed printed materials that facilitate the implementation of the principles of oncological alertness.

Background. The article describes an example of a combination of previously undetected bullous emphysema and spontaneous pneumothorax. Spontaneous pneumothorax is a pathological condition characterized by an accumulation of air in the pleural cavity, which occurs in the absence of previous trauma or iatrogenic damage. Spontaneous pneumothorax is a rare, but always life-threatening condition faced by doctors of various specialties. This pathological condition in children can be a manifestation or complication of various diseases, but it can also occur in the absence of clinically significant pulmonary pathology.

Results. Based on the analysis of modern literature data, the causes of spontaneous pneumothorax are presented. The issues of etiology, pathogenesis, clinical picture, diagnosis and treatment are covered in detail. The article discusses important aspects of the theories of the occurrence of pulmonary bullous emphysema, etiology and pathogenesis, and the clinical picture of this disease. The clinical observation of bullous emphysema and spontaneous pneumothorax in a patient suffering from bronchial asthma, methods of diagnosis and treatment are described. The patient was admitted to the clinic with a suspected foreign body of the tracheobronchial tree. There is also a history of concomitant bronchial asthma of moderate severity, the father has bullous emphysema of the lungs. An X-ray and functional examination of the chest organs was performed. A comprehensive and differentiated approach to the choice of therapeutic tactics for this disease is determined by videothoracoscopy. Taking into account the patient's condition and the results of the examination, emergency surgery was required, followed by video thoracoscopy, lung resection and pleurectomy. The described clinical case is very rare, as it demonstrates a combination of hereditary bullous emphysema and spontaneous pneumothorax, as a result of which radical intervention was required. The article demonstrates the need for close attention to patients with a family history of degenerative lung diseases. For the treatment of spontaneous pneumothorax on the background of bullous emphysema, modern thoracoscopic methods with mandatory recurrence prevention (pleurodesis, lung resection, pleurectomy) should be used. The prognosis of this disease is always serious and largely depends on the timely provision of qualified medical care.

Background. The number of patients with bilateral was destructive pulmonary tuberculosis. In Russian Federation, the number of patients with bilateral advanced destructive pulmonary tuberculosis has increased, which is due to an increase in cases of drug-resistant pathogens. Such patients often have low respiratory parameters clinically manifested by dyspnea, which is the main reason for a decrease in exercise tolerance and of deterioration in the quality of life.

Objective. The objective of this study is to assess the dynamics of the degree of dyspnea in patients with bilateral advanced destructive tuberculosis after staged bilateral extrapleural pneumolysis with silicone plombage.

Material and methods. The study included 11 patients with bilateral advanced destructive pulmonary tuberculosis who underwent staged bilateral extrapleural pneumolysis with silicone plombage (main group) and 8 patients who underwent consecutive bilateral lung resections (control group). The mMRC scale and the Borg scale were used to assess dyspnea.

Results. The degree of dyspnea on the mMRC scale in the main group decreased by 0,4 ± 0,1, and in the control group one increased by 0,9 ± 0,5 (p < 0,001). When assessing dyspnea on the Borg scale, a decrease of 0,3 ± 0,5 points was revealed in the main group, an increase of 2,5 ± 0,4 point in the control group (p < 0,001).

Conclusion. Staged bilateral extrapleural pneumolysis with silicone plombage may be accompanied by decrease in the degree of dyspnea, to a lesser extent than after lung resection and therefore collapse surgery is more preferable in patients with low exercise capacity.

Background. Predicting the success of rehabilitation in patients who have suffered an ischemic stroke (IS) is determined by factors of rehabilitation potential (RP). Assessment of RP is necessary to develop an effective rehabilitation program and predict the degree of restoration of impaired functions.

Objective. The purpose of the study is to evaluate the effectiveness of rehabilitation in patients who have undergone IS.

Materials and methods. A prospective study was carried out on 177 patients who were treated in the neurological department for patients with acute cerebrovascular accident and the neurorehabilitation department of the State Budgetary Healthcare Institution of the Republic of Bashkortostan of the Clinical Emergency Hospital in Ufa. All patients underwent clinical neurological, neuroimaging, laboratory and instrumental studies. The NIHSS, Rankin, Rivermead, Montreal Cognitive Function Scale, Hospital Anxiety and Depression Scale, A. M. questionnaire were used. Wein, T. Ehlers test and A. M. Schubert technique. The assessment of the RP was carried out using the analysis of data from the "Rehabilitation Sheet".

Results. The majority of patients with IS were diagnosed with cognitive, anxiety-depressive disorders, and dysfunction of the autonomic nervous system. During treatment, the number of patients with mild neurological deficits, mild disabilities and an average level of mobility increased significantly. Based on a combination of factors, 74% of patients had medium and high levels of RP. In our study, according to the T. Ehlers test, 82.9% of patients before treatment had a medium to high degree of motivation to succeed. Conclusion. An integrated and individualized approach to the correction of various pathological disorders in patients who have undergone IS, taking into account RP, is the key to the effectiveness of restorative treatment at the stages of rehabilitation.

Background. The incidence of somnambulism is about 7% and has a genetic basis for the disease. In childhood, it mostly runs benignly and independently passes by adulthood. However, under the influence of certain factors, recurrences of sleepwalking episodes (or primary events without a childhood history) can be registered in adulthood, and the risk of harm to the patient or others around him is much higher compared to the pediatric variant of the course of the disease. There are several situations in which it is necessary to treat the disease: first, when somnambulism occurs idiopathically and the inducing factor cannot be identified; second, when episodes of somnambulism lead to life-threatening situations (injuries, bruises, going outdoors, driving a car, etc.). In such a dangerous course of somnambulism, treatment is necessary. It can be based on etiology (in the presence of concomitant diseases or the intake of alcohol and drugs) or on pathogenesis. The latter option includes medication and non-medication methods.

Results. The treatment of somnambulism based on etiopathogenetic mechanisms is reviewed.

Conclusion. It is concluded that treatment can be divided into three blocks: etiologic (if possible to identify the factor provoking episodes of somnambulism, such as alcohol intake, medications, obstructive sleep apnea syndrome or upper airway constriction syndrome and restless legs syndrome); pathogenetic – non-medication (hypnosis, anticipatory awakening, sleep hygiene and normalization of emotional state) and medication (most commonly benzodiazepine receptor agonists clonazepam and diazepam in low doses or antiepileptic drugs such as gabapentin and pregabalin).

Background. Prion diseases or transmissible spongiform encephalopathies are a group of neurodegenerative disorders characterized by rapidly progressive dementia and movement disorders. Prion diseases can be acquired, sporadic, genetic (inherited), and are characterized by the accumulation and aggregation of prions or abnormally coiled proteins. The diseases have a long incubation period (years) but progress rapidly after the manifestation of clinical symptoms. The most common human prion diseases are sporadic in nature. Prion diseases include sporadic Creutzfeldt – Jakob disease, as well as rare cases of sporadic fatal insomnia and variable protease-sensitive prionopathy. The diseases have a long incubation period (years), but progress rapidly after the manifestation of clinical symptoms. Fatal familial insomnia (Insomnia, fatal familial; OMIM: # 600072) is a rare autosomal dominant neurodegenerative disease with high penetrance and associated with mutation in PRNP gene.

Results. The article presents clinical case of 15-year-old patient with severe mental development disorder, motor excitability, hyperactivity of sympathetic nervous system and insomnia. The previously described variant in PRNP gene (D178N) was detected by whole exome sequencing. Validation of the mutation in the proband and segregation analysis were carried out: mutation c.532G>A, Asp178Asn in PRNP gene was identified in the proband and his 50-year-old father, who had no signs of prion disease. at the time of the study. Additionally, adenine in the 358th position was found in a homozygous state, which is responsible for the frequent M129M polymorphism in Sanger sequencing of PRNP gene in the proband and his father.

Conclusion. The description of the clinical case of fatal familial insomnia in Russia presented by the authors clearly shows the likely difficulties that doctors may face when examining such patients. The diagnosis (clinical, genetic using massively parallel sequencing methods) remains important in relation to medical genetic counseling and family planning, since methods of pathogenetic therapy for hereditary prion diseases have not currently been developed.

Objective. The purpose was to study and describe the clinical and epidemiological situation of measles in children of the Astrakhan region in 2018-2022.

Materials and methods. From 2018 to 2022, 259 cases of measles were registered in the Astrakhan region, of which the child population amounted to 71.8% (186 people). Measles cases have been reported in children of all ages. The clinical diagnosis was made based on the data of the clinical picture of the disease, complaints, epidemiological history and laboratory data (detection of specific IgM class antibodies by enzyme immunoassay (ELISA).

Results. All children who were diagnosed with measles were conditionally divided into three age groups: the first age group (children aged from 1 month to 1 year), the second age group (ages 1-7 years) and the third age group (7-17 years). Considering the presence of complaints, according to age groups, it can be noted that laryngitis was noted in children of the first age group. The presence of pharyngitis was noted by 61.6% (45 people). Also, children of this group had a runny nose – 80.2% (59 people), conjunctivitis – 67.1%, candidiasis – 93.2% (68 people). In rare cases, stomatitis was detected in children of group 1 – 19.2% (14 people). In children of the second age group, complaints of fever, laryngitis and pharyngeal hyperemia were noted in all cases. Pharyngitis was noted by 69.5% (66 people), and the presence of a runny nose and conjunctivitis – 77.9% (74 people) and 74.7% (71 people), respectively. In rare cases, stomatitis and candidiasis were observed in children – 35.8% (34 people) and 28.4% (27 people), respectively. In children of the third group, as well as in the previous groups, fever and pharyngeal hyperemia were noted in all cases. But unlike children of the first and second groups, the most frequent complaints of children in this group were conjunctivitis, runny nose and laryngitis – 83.3% (15 people), 61.1% (11 people) and 55.6% (10 people), respectively. In rare cases, pharyngitis and stomatitis were noted in children – 38.9% each (7 people each) and candidiasis – 16.7% (3 people). After the final diagnosis was established, all patients were treated with medication.

Conclusion. In recent years, the number of measles cases among children has been noticeably decreasing, as evidenced by the above data. Measles cases were more often reported in children of the first age group – 39.2% (73 people) and the second age group – 51.1% (95 people). The largest number of measles cases was recorded in children living in the urban district – 73.7% (137 people). The main complaints of patients with measles were the presence of fever, pharyngeal hyperemia and laryngitis.

Introduction. The article discusses a new trend in dermatological and cosmetological practice – the use of plant-derived exosomes. Exosomes are microscopic extracellular vesicles that can transfer bioactive molecules between cells. The article describes in detail the characteristics of plant exosomes, as well as their potential applications in clinical practice of a dermatovenerologist, cosmetologist.

Objective. The aim of the study was to investigate the therapeutic efficacy of Melissa officinalis exosome-based composition in correcting age-related skin changes (visible wrinkles and skin texture).

Materials and methods. 30 patients with type II photoaging according to Glogau (the average age was about 41.2 years) and skin phototype III or IV according to Fitzpatrick were under observation. The patients were divided into two groups: the main group (n = 15) received local therapy preparation based on M. оfficinalis exosomes using a mesoroller; the control group (n = 15), where the patients underwent only с therapy without adding exosomes. The course consisted of 3 procedures with an interval of 14-20 days. To assess clinical effectiveness, a three-dimensional analysis of the skin surface was performed and statistical analysis.

Results. The cumulative assessment of the regression of clinical manifestations of visible skin folds (wrinkles) and skin texture (pores) showed the advantages of procedures using M. оfficinalis exosomes. With microneedling without the use of exosomes, the reduction in the depth index was 79.64%, and with the addition of M. оfficinalis exosomes – 53.35%. When assessing skin texture (pores), the reduction in the index was 73.25% without adding exosomes, and with addition – the decrease was 54.58%.

Conclusion. A correlation has been revealed between the use of exosomal therapy based on M. officinalis and external age-related changes accompanying the aging process.

Background. Currently, in the treatment of atopic dermatitis universally recognized phototherapy narrowband ultraviolet B (narrow-wave UVB therapy) with a maximum emission at a wavelength of 311 nm, the effectiveness of which has been confirmed by numerous studies. Phototherapy occupies the second line of therapy after unsuccessful treatment with emollients and topical glucocorticosteroids, it can be used both in mono and combined therapy. In addition, there is steroidophobia among patients, often the dermatologist is approached by patients who refuse not only systemic therapy, but also topical application of glucocorticosteroids, but readily agree to physical therapy, paying attention to the overall safety of phototherapy UVB-311 nm.

Results. The article presents the results of clinical studies of the effectiveness of narrow-band phototherapy UVB-311 nm in patients with atopic dermatitis in the form of monotherapy in combination with emollients. UVB-311 nm phototherapy is an effective method for treatment many skin diseases, however, there are still no clear recommendations on the use of the method depending on the severity and duration of the process. The authors, based on their own observations, concluded that monotherapy with narrow-band phototherapy UVB-311 nm is highly effective in patients with atopic dermatitis with a SCORAD index of no more than 40 points; in more severe cases, it is impossible to achieve a positive therapeutic effect with monotherapy. The authors demonstrated clinical cases from their own practice of using narrow-band phototherapy UVB-311 in patients with atopic dermatitis as monotherapy.

Background. When bile is oversaturated with cholesterol, the dynamic equilibrium between proand antinucleating factors is disturbed, which leads to precipitation of cholesterol crystals and their aggregation into microlites. Excess cholesterol is deposited in the gallbladder wall, where it strengthens the sarcolemmal membrane of smooth muscle cells and disrupts signal transmission. Slow emptying of gallbladder and bile stagnation occur, which increases its precipitation and formation of wall and then cavity biliary sludge. Bile acid preparations, in particular ursodeoxycholic acid, have litholytic action and are basic in treatment of biliary sludge.

Objective. To evaluate and compare the quality of life of patients with biliary sludge taking drugs containing ursodeoxycholic acid. Materials and methods. The dynamics of clinical symptoms (biliary pain, dyspepsia, bitter taste in the mouth) and quality of life of 84 patients with biliary sludge receiving conservative therapy with various ursodeoxycholic acid preparations for three months were evaluated using the SF-36 Quality of Life questionnaire and the Biliary Symptom Severity Questionnaire.

Results. After 3 months in patients with biliary sludge taking different ursodeoxycholic acid preparations, the indices of physical functioning, general condition, vital activity and mental health were studied, as well as the effectiveness of pain syndrome relief were compared by the indices of pain syndrome severity reduction and rapidity of pain relief when taking preparations containing ursodeoxycholic acid. Conclusion. Quality of life of patients with biliary sludge on the background of ursodeoxycholic acid preparations significantly improves. At the same time, relief of biliary symptoms leads to improvement of both physical and mental health indicators.

Background. The main therapy for phenylketonuria is a specialised diet with restriction of natural protein, respectively phenylalanine with the prescription of specialised therapeutic foods based on amino acids without phenylalanine. Diet therapy is prescribed as soon as hyperphenylalaninaemia is detected. It is very important to continue treatment for life, and it is equally important that patients maintain ongoing adherence to treatment. However, this therapy significantly limits the consumption of natural foods and requires the use of amino acid mixtures, so the vast majority of patients in adolescence and adulthood have difficulty following the diet, giving up specialised foods and switching to a normal diet. This situation leads to the gradual development of prolonged metabolic decompensation, and intoxication with high concentrations of phenylalanine and its derivatives. This is especially dangerous for women of fertile age diagnosed with classical phenylketonuria who are planning pregnancy or are pregnant. A hypophenylalanine diet with control of blood phenylalanine levels is the basic principle of prevention of maternal phenylketonuria syndrome. However, often the caloric, fat, and carbohydrate requirements of the diet cannot be compensated by prescribing one specialised therapeutic food or compensated by natural foods. The use of a regimen of two specialised therapeutic foods for the treatment of patients with phenylketonuria during pregnancy can prevent a metabolic catastrophe and protect the foetus from teratogenic effects.

Results. An example is given of a combination of specialised therapeutic foods that provide both an increased protein equivalent content and a supplementation of macroand micronutrient demands.

Background. Cerebrovascular disorders are a real tragedy on a global scale. The number of cases of acute cerebral circulatory disorders of this type reaches 400-450 thousand per year. Of particular concern is the increase in the prevalence of ischemic strokes in young ablebodied people. In this regard, primary prevention, comprehensive diagnosis, timely and effective treatment of stroke is the most important medical and social problem. Gadgets like smart watch are becoming increasingly available and can record various types of medical data. This is a unique opportunity to monitor the health of out-patients for a long period of time.

Objective. To test the possibility of implementing primary and secondary prevention programmes using a portable smart gadget in a cohort of patients with cryptogenic stroke and in people who have not suffered a stroke but have risk factors for cerebrovascular disorders.

Results. A programme has been developed to register and store the data on the presence of risk factors for vascular catastrophes in patients and methods of individualized prevention. The key parameters are the data of patients' risk factors recorded in relation to the presence of each clinical symptom with the entry of information into the database according to 'many things to the one' principle. It can be used to accumulate and analyze the data on the presence of risk factors for cerebrovascular disorders, the choice of individualized prevention, and patients' management tactics.

Conclusion. The use of new technologies can lead to the improvement of programmes for the prevention of cerebrovascular disorders. The latest portable smart gadgets are able to continuously monitor various vital parameters, which can radically transform the interaction between a doctor and a patient and contribute to the implementation of individually designed preventive programmes.

Objective. The purpose of the study – to study the features of mycoplasma infection in adolescents and adults in the Novosibirsk region in the epidemic season of acute respiratory infections 2023-2024.

Material and methods. А PCR study of nasopharyngeal mucus was conducted to identify M. pneumoniae DNA in 1306 patients aged 15 to 83 years who were admitted to the State Medical Institution of the National Academy of Medical Sciences GIKB 1 with a diagnosis of "ARVI" or "community-acquired pneumonia". Along with this, patients underwent PCR diagnostics of other respiratory infections: influenza, new coronavirus infection, adenovirus, boca and metapneumovirus infections, respiratory syncytial, parainfluenza, etc. Mycoplasma infection was verified in 58 people (4.4%), while in 10 cases (17.2%) a mixed infection was detected: in 1 (1.7%) case of mycoplasma infection with infectious mononucleosis, in 3 (5.2%) – with influenza A, in 1 (1.7%) – with influenza B, and in 4 (6.9%) – with a new coronavirus infection, in 1 (1.7%) – with staphylococcal sepsis. A retrospective analysis of 48 case histories of patients with verified mycoplasma infection was carried out. Patients with mixed infection were excluded from the study.

Results. Adolescents (41.7%) and young people (52.1%) prevailed among the patients (the average age was 25 ± 10.2 years). In the majority of hospitalized patients, the disease occurred in the form of pneumonia – 81.3%, including bilateral polysegmental – 10.4%, less often in the form of bronchitis – 16.6%. Respiratory mycoplasmosis in combination with serous meningitis of unspecified etiology was detected in 1 patient (2.1%). Fever was noted in 93.8%, sore throat – in 60.4%, almost all had a dry paroxysmal cough, turning into a wet one by the third to seventh days of the disease. The duration of the cough, on average, was 14.2 ± 5.0 days. In most patients, pneumonia developed from day 7 to 10 of the disease (43.8%), with an interstitial type of inflammation, rarely accompanied by a bright auscultative picture (33.3%). Pneumonia was mild and was accompanied by respiratory failure of the 1 and 2 st degree in only 3 cases. Mycoplasma infection in most patients was not accompanied by marked changes in the overall blood count. An increase in C reactive protein was characteristic – in 97.9%, including more than 10 times in 60.4% of cases. The ineffectiveness of the applied antibacterial therapy at the outpatient stage, which caused the hospital treatment, is due to the resistance of the pathogen to beta-lactams.