Background. Breast milk is the best way to feed children in the first year of life, since it performs not only a nutritional function. Hormones, biologically active substances, immune complexes, and living cells of mother's milk have a beneficial effect on the child's body, ensuring the normal course of metabolic processes, maintaining resistance to infections and other adverse external factors. Breast milk helps populate the child's gastrointestinal tract with beneficial microorganisms and prevents the proliferation of pathogenic bacteria. Despite the fact that mother's milk is the preferred way to feed children, this option is not always completely or partially possible, and in this case, children require the introduction of milk formulas as an additional or main diet. Artificial milk formulas, due to understandable production reasons, cannot completely imitate mother's milk. The structure of proteins and the spectrum of oligosaccharides in cow's and goat's milk have slightly different characteristics than similar molecules of breast milk. The original characteristics of vegetable fats, which are used to produce milk formulas, also pose a problem. Some of these technological and biological problems can be solved today, and manufacturers of infant formulas are trying to adapt their composition and functions to breast milk as best as possible.

Conclusion. The article discusses such adaptation methods as the use of goat milk and β-palmitate for the production of formulas intended for artificial feeding. In particular, the effect of β-palmitate on the state of the intestinal microflora, and also, indirectly, on immunity, is considered.

Background. Mononeuropathy of the lower extremities (myelopathy) is a sporadic disease in young children characterized by the development of acute flaccid paralysis syndrome: motor deficiency, changes in muscle tone, tendon reflexes, and electroneuromyography parameters. The provoking factor for the development of the disease may be: vaccinations, injuries, previous infections. The etiological factor of the disease is more often enteroviruses, less often herpesviruses, influenza viruses, etc. The main symptoms of the disease are represented by paresis of individual muscle groups, more often quadriceps, calf, resulting in gait disorders: lameness, knee flexion, foot droop. Monopares is of the peroneal and tibial nerves is predominant. The course of the disease is favorable. Recovery of movements in the affected limb occurs within 4-6 weeks or more. The presence of acute flaccid paralysis syndrome in a patient requires the exclusion of a number of diseases: Guillain – Barre syndrome, encephalitis, myelitis, traumatic and toxic neuropathies, neoplasms of peripheral nerves and spinal cord, etc., and, taking into account the epidemiological situation of the present time, polio.

Results. The article presents literature data and own clinical observation of acute infectious mononeuropathy of the lower extremity, which developed in an early age child against the background of vaccination with live polio oral vaccine of the 1st and 3rd types. The description of the symptoms and course of the disease is presented in the form of an analysis of the clinical situation, for the purpose of medical education and differential diagnosis with polio.

Background. Neurofibromatosis is a group of orphan diseases with a wide spectrum of clinical presentation, which makes the disease difficult to diagnose. Pigmentation manifestations represent an early clinical sign in children with neurofibromatosis type I, but it is necessary to differentiate this clinical sign with Legius syndrome and other neurocutaneous disorders. Over the past several decades, neurofibromatosis type I has increased the risk of neurodevelopmental problems, including decreased intellectual ability, motor delays, attention deficit disorder, increased rates of autism spectrum disorder, and psychiatric disorders.

Objective. To present a clinical case of familial neurofibromatosis type I.

Materials and methods. The medical history, results of clinical and additional examination methods of patients who are pupils of the state government institution of the Astrakhan region Specialized Children's Home "Kapelka" in Astrakhan were studied.

Results. We present our experience of two brothers who carry cutaneous stigmata of neurofibromatosis type I. The older brother was diagnosed at 4 years 3 months, the younger brother 3 years 2 months. In a family of boys, this disease was diagnosed in their mother, who died in 2019 at the age of 25. A CT scan of the patient's brain revealed signs of neurofibromatosis type I with multifocal changes in the parenchyma of the cerebral hemispheres, basal ganglia, brain stem and cerebellum. No damage to other systems or organs was detected. Laboratory tests revealed no abnormalities.

Conclusion. Reports of a familial case of neurofibromatosis type I from clinical practice may be important for the training of young doctors in various medical specialties. The clinical course of this disease is unpredictable and requires multidisciplinary clinical assessment throughout life.

Background. Patients with chronic kidney disease, including dialysis patients, experience significant physical and mental stress, which ultimately leads to impaired physical and psychosocial health. All this significantly affects the quality of life. Kidney transplantation is the most promising direction in providing medical care to patients with end-stage renal disease, since it provides a significant improvement in the quality of life compared to dialysis therapy. Understanding the specifics of the quality of life of patients who have undergone successful kidney transplantation can provide valuable information for making further therapeutic decisions.

Objective. Analysis of the quality of life of kidney recipients under various regimens of immunosuppressive therapy.

Materials and methods. A survey of 176 kidney recipients was conducted using the SF-36 questionnaire. The respondents were divided into 2 groups. The first group included recipients receiving immunosuppressive therapy at standard doses, the second group included recipients receiving immunosuppressive therapy at reduced doses.

Results. The study showed a significant improvement in the quality of life in kidney transplant recipients 12 months after transplantation. Reducing the dosage of immunosuppressive drugs leads to a significant improvement in the quality of life of patients. This is due to a decrease in the frequency and severity of dose-dependent side effects of immunosuppressive therapy.

Conclusion. Kidney and liver transplantation makes it possible to maintain sufficiently high rates of both the physical and psychological components of the quality of life.

Objective. To clarify the current etiology of acute bronchitis and to evaluate the possibilities of mucoactive therapy of patients using erdosteine in comparison with real clinical practice, to determine the optimal duration of mucolytic prescription.

Materials and methods. A comprehensive study of 60 patients with acute bronchitis, 30 of whom (the first group) received erdosteine, in the second group other mucolytics were used (real clinical practice). The following were evaluated: mean time of cough regression on the background of treatment, duration of mucoactive therapy, terms of relief of all symptoms of acute bronchitis (using BSS scale). Virological and microbiological examination of sputum was performed in 35 patients.

Results. Analysis of the main pathogens of acute bronchitis showed that adenovirus infection was registered in 60% of patients, one case each of bocavirus, parainfluenza 1/3 types and rhinovirus infections (2.9% each) were detected. DNA of Chlamydophila pneumonia and Mycoplasma pneumoniae were detected in 48.8% and 17.1% of cases, respectively. It is important that their detection had no effect on the necessity of antimicrobial therapy in patients with acute bronchitis, which confirms the thesis about inexpediency of routine examination for these microorganisms in outpatient practice, except for cases with personalised indications (prolonged course of bronchitis, etc.). The study also updated important indications for antimicrobial therapy in acute bronchitis.

Erdosteine has been shown to be highly effective in controlling productive cough in acute bronchitis and to provide optimal duration of treatment. Thus, the duration of erdosteine administration was 5.7 ± 1.4 days, whereas in the control group (other mucolytics) the duration of drug administration was 7.1 ± 1.3 days (p < 0.05).

Conclusion. The obtained data expand the knowledge about the etiology of acute bronchitis, pathophysiology of cough in this disease and optimal duration of mucoactive therapy. Appearance of a new mucolytic erdosteine in a doctor's arsenal allows to use it successfully not only in long-term therapy of patients with chronic bronchitis (chronic obstructive pulmonary disease), but also to use it in a whole range of acute situations associated with productive cough (acute bronchitis, pneumonia, exacerbation of bronchiectasis, etc.).

Background. Nonalcoholic fatty liver disease and osteoporosis are two common metabolic diseases. The prevalence of non-alcoholic fatty liver disease in populations is as high as 38%, with a much higher prevalence among obese and/or type 2 diabetics. The global prevalence of osteoporosis is estimated at 19.7%, varying considerably between countries and continents, and statistics show that the region and the level of solar activity do not determine the prevalence of the problem. Like non-alcoholic fatty liver disease, osteoporosis is latent for a long time, without a manifest clinical picture. It is quite logical to ask whether non-alcoholic fatty liver disease is an important component of the pathogenesis of osteoporosis or whether these are two frequently occurring diseases.

Objective. The objective of this literature review was to summarise the experimental and clinical evidence on the potential association between non-alcoholic fatty liver disease and osteoporosis.

Results. Non-alcoholic fatty liver disease as a manifestation of metabolic syndrome based on insulin resistance affects bone metabolism, increasing the risk of osteoporosis and its complications. Current literature suggests that non-alcoholic fatty liver disease affects bone metabolism in several ways: through alterations in systemic and local bone marrow immune status, modulating insulin-like growth factor-1 levels, gut microbiota composition, short-chain fatty acid metabolism and intestinal barrier integrity. Some studies have shown that bile acids produced by the liver have a protective effect on bone tissue. Bile acids are able to reprogram pro-inflammatory macrophages into their anti-inflammatory phenotypes, thereby reducing the degree of systemic inflammation. Normalising the interplay between the microbiome, immunity and bone metabolism may open new avenues for the treatment of osteoporosis in the future.

Background. Emotional burnout is a form of professional deformation of personality. Among the main symptoms of the new disease are cynicism, apathy, reduced productivity, difficulties in communication with colleagues and patients, embitterment. Emotional burnout, first of all, is a mechanism of psychological defence in the form of partial or complete exclusion of emotions in response to certain psychotraumatic factors related to the profession. At the same time, isolated, long-lasting uncoordinated actions of the nervous system can lead to stable increase of imbalance in the autonomic nervous system, which is known to consist of two main branches – sympathetic and parasympathetic. The main component of the parasympathetic system is the vagus nerve. To perform this study, we relied on the polyvagal theory of S. Porges. The polyvagal theory of S. Porges considers the vagus nerve as two structurally and functionally separate branches – ventral and dorsal. The autonomic nervous system in emotional burnout reacts to bodily sensations and environmental stimuli by means of three neural circuits: dorsal, ventral and sympathetic.

Results. The correlation between the semantics of the text of V. Boyko's questionnaire "Methodology of diagnostics of the level of emotional burnout" and the way of vegetative nervous system reaction has been established. The possibility of additional interpretation of the questionnaire results suggested by us expands the prospect of its use in clinical practice. It gives an opportunity to take a more differentiated approach to treatment and prevention of emotional burnout by comparing the indicators of dorsal, ventral and sympathetic neural circuits. The obtained data allow to assert that the specific anatomical structure of origin of dysfunctional consequences of emotional burnout is the dorsal branch of the vagus nerve.

Background. Survival rates for endometrial cancer have improved in recent decades, so strategies are needed to avoid or reduce reproductive harm caused by cancer treatment. In medicine today, there are questions that do not always have answers. There are not enough works that would analyze and summarize the features that reflect the nature of the course of pregnancy and childbirth, the possibilities of ante- and intrapartum monitoring and the nature of obstetric care, as fundamental factors in the formation of perinatal indicators. In addition, there is extremely insufficient information about the effect of pregnancy on further risks of relapse, which convinces us of the advisability of further study of this problem. Our study allowed us to show the possibility of safe pregnancy and labour in such patients, to evaluate the peculiarities of the course of pregnancy and labour and the long-term prognosis for the woman's health.

Objective. The purpose of our work was to study the characteristics of the course of pregnancy and childbirth in patients after conservative treatment of atypical hyperplasia and endometrial cancer.

Results. The study included 114 patients with spontaneous and induced pregnancy that occurred after conservative treatment of atypical hyperplasia and initial endometrial cancer. The course of the 1st, 2nd and 3rd trimesters of pregnancy, perinatal outcomes and disease-free survival in patients were analyzed.

Conclusion. Our study made it possible to demonstrate the possibility of a safe course of pregnancy and childbirth in such patients, to evaluate the characteristics of the course of pregnancy and childbirth and long-term prognosis for the woman’s health. These results indicate a low recurrence rate of atypical hyperplasia and endometrial cancer after pregnancy, regardless of pregnancy outcome. It should be emphasised that no pregnancy-associated recurrences were observed.

Background. The II All-Russian Neurocongress with international participation was held in Moscow on 10-12 October 2024. The main scientific directions of the Congress included the following topics: acute and chronic cerebral circulatory disorders, epilepsy and paroxysmal states, infectious diseases of the nervous system, cognitive disorders, hereditary degenerative diseases of the nervous system, traumas of the brain and spinal cord, rehabilitation in diseases of the nervous system, neurology of the elderly, new technologies in the diagnosis and treatment of stroke and many others.

Results. At the satellite symposium of Merz Pharma LLC ‘Organisation of rehabilitation of post-stroke patients with spasticity at the regional level’ held within the framework of the congress, the latest approaches to rehabilitation of stroke patients were discussed.