Background. Diabetic foot syndrome is a socially significant late complication of diabetes mellitus. Neuropathic ulcerative defect in diabetic foot syndrome develops on the background of pronounced decrease or absence of peripheral sensitivity, but with preserved main blood flow. Violation or absence of sensitivity leads to the development of foot deformities due to demyelination of motor fibers, as well as the inability to respond to damage due to damage to the sensory component of the peripheral nerve fiber. Autonomic neuropathy makes its significant contribution to the development and aggravation of the process, which is the cause of the development of skin dryness, making it vulnerable to infection. The first successful implementation of a multidisciplinary approach with differentiated treatment of ulcer defects depending on the state of the main blood flow was published in Great Britain in 1986: according to the presented results, healing of neuropathic ulcer defects was achieved in 86% of cases, and ischemic ones in 72%. Currently, significant progress has been made in the study of diabetic foot syndrome. Specific interventions have been outlined to reduce the number of high amputations. The introduction of an interdisciplinary approach to the management of this category of patients has led to a decrease in the number of high lower limb amputations. Factors delaying the healing of chronic wounds in diabetic foot syndrome have been identified.

Results. The publication reflects epidemiologic aspects of the problem, including data on prevalence and lethality. The historical stages of formation of the strategy of complex treatment of patients with this pathology are presented. The questions of pathogenesis of various forms of diabetic foot syndrome are outlined, modern principles of differentiated treatment measures depending on the form of the lesion are given. Types of unloading of the limb involved in the pathological process, indications for the prescription of antimicrobial drugs and the basics of local treatment are discussed.

Objective. The article discusses one of the most common neurological complications of type 2 diabetes mellitus – diabetic polyneuropathy, which is present in every third patient with type 2 diabetes mellitus and is the most common cause of non-traumatic amputation of the lower extremities in most high-income countries.

Results. The available modern data on the pathogenesis, the latest methods of diagnosis and prognosis of diabetic polyneuropathy are summarized. The stages of the symptoms of diabetic polyneuropathy are explained based on modern concepts of the initial lesion of unmyelinated fibers and the further involvement of thicker and well-protected myelinated fibers in the pathological process. Special attention is paid to the indicators available for determination in routine clinical practice and well-known to clinicians: homocysteine, leptin, routine cardiovascular markers, albumin/creatinine ratio, etc. Along with them, progressive biochemical and molecular genetic markers of diabetic polyneuropathy are mentioned, which have the greatest chance of entering clinical work in the near future, such as endocan, the study of the MAPK14 gene. The risk factors for the development of diabetic polyneuropathy in the course of drug and non-drug treatment of type 2 diabetes mellitus and ways to correct them are discussed. Among such factors is a possible deficiency of cyanocobalamin while taking biguanides, thiamine and pyridoxine on the background of restrictive diets. The necessity of their additional subsidies for diabetic polyneuropathy is substantiated. The article presents a modern strategy for pathogenetically based therapy of diabetic polyneuropathy, its place in clinical practice and the expected benefits of its use, not only in the context of replenishing the pool of B vitamins, but also the use of alpha-lipoic acid with antioxidant activity. The trend of recent years is the study of predictors of response to alpha-lipoic acid treatment. Attention is paid to the peculiarities of the pathomorphosis of diabetic polyneuropathy in the context of the new reality created by the COVID-19 pandemic.

Background. Barakat syndrome (HDR syndrome, Hypoparathyroidism, Deafness, Renal dysplasia syndrome, OMIM 146255) is a hereditary disease characterized by hypoparathyroidism, hearing loss and renal disease. The syndrome was first described by the American doctor A. J. Barakat in 1977: two siblings aged 5 and 8 years had steroidresistant nephropathy, hearing loss and hypoparathyroidism. Barakat syndrome is an rare disease: just over 190 cases have been described worldwide. In addition to the three main components, a number of other manifestations of the disease have also been described in patients with Barakat syndrome: disruption of the endocrine and reproductive systems, pathology of the nervous system, congenital heart defects and facial skull malformations, and retinitis pigmentosa. Results. This article presents a clinical case of Barakat syndrome in a 15-year-old boy. The patient was diagnosed with hypoparathyroidism and sensorineural hearing loss. The first signs of hypoparathyroidism appeared at the age of 4.5 years as a seizure syndrome, but at that time the patient was diagnosed with epilepsy, and hypoparathyroidism was diagnosed only at the age of 13 years. Epilepsy was subsequently ruled out. Hearing loss was also diagnosed at age 12. At the time of the last examination, there was no evidence of renal disease or other possible manifestations of the syndrome. The diagnosis was confirmed by genetic tast: previously undescribed probably pathogenic variant of nucleotide sequence HG38, chr10:8058622C>T, c.559C>T, p.Gln187Ter in exon 3 of the GATA3 gene was found.

Conclusion. The purpose of this article is to inform pediatricians about a rare disease to improve the diagnosis of the syndrome. Also, the description of this clinical case will help to supplement the knowledge on peculiarities of the course of Barakat syndrome.

Background. Diseases of the cardiovascular system occupy a leading place in the structure of mortality. The number of patients with circulatory system pathology is increasing every year. Among the most significant diseases are arterial hypertension, coronary heart disease, rhythm and conduction disorders, the complication of which is chronic heart failure. The number of patients with this diagnosis in the world is about 64 million people. The increase in morbidity is associated with an increase in life expectancy of people, an increase in associated pathologies and risk factors for cardiovascular diseases, and a decrease in mortality after myocardial infarction. The presence of comorbid pathology aggravates the course in such patients. Cardiovascular disease is often accompanied by pathologies such as overweight or obesity, hyperlipidemia, apnea, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and others.

Conclusion. The analysis of Russian and foreign literature sources on the studied problem was carried out, which showed that among the comorbid conditions that aggravate the occurrence and course of heart failure, diabetes mellitus and hyperuricemia have recently occupied a separate place. Many studies have noted the presence of pathogenetic mechanisms in the formation of chronic heart failure in patients with diabetes mellitus. These include oxidative stress, endothelial dysfunction, inflammation, etc., which lead to fibrosis and remodeling of the heart. Uric acid is a component of pathophysiological, hemodynamic and inflammatory processes. Its elevated levels are noted in patients with chronic heart failure, which is confirmed by many studies on this topic. However, the effect of hyperuricemia on this disease is not fully known at present. All this interprets the need for further study, search for methods of early diagnosis and reduction of the effect of hyperuricemia and diabetes mellitus on the occurrence and course of chronic heart failure.

Background. A frequent complication during operations on the thyroid gland is damage to the lower or upper laryngeal nerves, followed by the development of laryngeal paresis, with changes in breathing, phonation and impaired swallowing. In general, the incidence of postoperative complications varies considerably: different authors indicate a range from 0.2% to 15%, with an increase in persistent innervation disorders in repeated interventions (1-5%) compared with primary thyroid surgery (15-30%). If non-persistent paralyses are eliminated within 1-3 months after surgery, persistent disorders are a serious problem that requires a complex therapeutic approach and may cause disability of patients in certain professions.

Objective. The purpose of the article is to summarize and systematize the available literature data on therapeutic interventions for postoperative laryngeal paresis, to determine the most effective modern treatment methods; also consider preventive measures and ways to optimize early diagnosis of this complication of thyroid surgery.

Results. An analysis of conservative approaches to the treatment of laryngeal paresis (psychotherapy, physiotherapy, phonopedia, drug treatment) was carried out. Surgical methods for treating laryngeal paresis are considered, methods of prevention and ways to optimize early diagnosis of postoperative laryngeal paresis are presented.

Conclusion. Despite the active implementation of intraoperative monitoring and other preventive measures, complications are still possible during thyroid surgery. Comparative studies with large cohorts of patients assessing the superiority of one method over another are rare, and the results of small comparative studies are inconsistent. It is likely that a combined approach should be considered in the treatment of postoperative laryngeal paresis, taking into account possible regional health care facilities and patient preferences.

Background. In the modern world, non-alcoholic fatty liver disease is a serious health problem in all countries. This disease is becoming more common. Large-scale studies and generalized data analyses have revealed that non-alcoholic fatty liver disease may be associated with an increased risk of cardiovascular diseases and their complications.

Objective. To review current publications and articles on the impact of non-alcoholic fatty liver disease on the development and course of cardiovascular diseases.

Materials and methods. As part of the study, materials from Russian and foreign sources devoted to this topic were studied and analyzed.

The literature was searched in databases such as PubMed, RSCI and eLibrary.

Results. Non-alcoholic fatty liver disease and chronic heart failure with preserved ejection fraction are systemic diseases. Every year the number of scientific papers increases, which indicate a close relationship between non-alcoholic fatty liver disease and chronic heart failure with preserved ejection fraction, an independent correlation has been established between the presence of non-alcoholic fatty liver disease and an increase in the risk of occurrence and progression of chronic heart failure with preserved ejection fraction in the long term. In the Russian and foreign literature, there is evidence of a link between elevated insulin levels, overweight, the role of oxidative stress, impaired fat metabolism and damage to the inner lining of blood vessels. An increase in the amount of free fatty acids in the body can provoke the accumulation of lipids in the heart muscle, which can further cause problems with the functioning of the left ventricle. It is worth noting that changes in myocardial metabolism are associated with impaired energy processes in the cells of the heart muscle, a decrease in adenosine triphosphate levels, oxygen starvation of tissues and impaired electrical activity.

Conclusions. Oxidative stress, chronic inflammation, insulin immunity, endothelial dysfunction and adipocytokine disorders are the main factors that can increase the risk of chronic heart failure in non-alcoholic fatty liver disease. Taking into account all of the above, non-alcoholic fatty liver disease can be considered an additional risk factor for chronic heart failure.

Background. The combination of acute coronary syndrome with diabetes mellitus is characterized by an extremely high risk of complicated course of the disease and worsening prognosis.

Results. The study included 306 patients with acute coronary syndrome without ST-segment elevation on ECG, who underwent PCI for emergency indications. The patients were divided into 2 groups depending on the presence/absence of concomitant type 2 diabetes mellitus. It was established that the results of observation showed that the presence of diabetes mellitus in patients with acute coronary syndrome significantly affects the pathophysiological features of pathology, on the one hand, and the clinical course, on the other. Clinical signs of myocardial ischemia were significant in the group with diabetes mellitus relative to the group without diabetes mellitus (p < 0.05). The primary use of the PCI stent showed that when using BMS, signs of myocardial ischemia were significantly more common after using BMS compared with CCBMS (p < 0.05). The results of the CAG revealed that stent restenosis occurred more often with BMS compared with CCBMS (p < 0.05) and more often in the presence of diabetes mellitus compared with its absence (p < 0.05). 12 months after the primary event, the levels of endocan, FRT and CRP were higher in patients with diabetes mellitus compared with patients without diabetes mellitus (p < 0.05) and in patients who had BMS compared with patients who had CCBMS both in the group of patients suffering from diabetes mellitus and in the group without diabetes mellitus (p < 0.05). In restenosis, the indicators of endocan, FRT and CRP were higher compared with patients without restenosis, both in the presence of diabetes mellitus and in its absence (p < 0.05). The data of the correlation test revealed that in the absence of diabetes mellitus, the value of the endocan upon admission was positively correlated with the risk of restenosis in both BMS and CCBMS (r = 0.65). In patients with diabetes mellitus, the risks of intra-stent restenosis and the occurrence of hemodynamically significant stenoses of other localization correlated with the levels of glycated hemoglobin upon admission for the primary event (r = 0.63). In the group of patients without diabetes, there was a direct correlation between the risk of developing restenosis and low-density lipoprotein cholesterol levels (r = 0.67).

Conclusion. In patients with acute coronary syndrome without ST segment elevation on an ECG, the presence of type 2 diabetes mellitus progresses the course of the disease and worsens patient outcomes. The use of CCBMS in acute coronary syndrome significantly reduces the frequency of coronary artery restenosis in stents, especially in the presence of diabetes.

Background. COVID-19 is characterised by multimorbidity with involvement of not only respiratory organs, but also cardiovascular, urinary and nervous systems and gastrointestinal tract. Clinical symptoms of the disease are united in the gastrointestinal syndrome, registered in 30-79% of cases. The onset of the disease may be accompanied by diarrhoea in 50% of patients and may be combined with or preceded by nasopharyngeal catarrhal symptoms.

Objective. To evaluate the features of the intestinal microbiota in patients with COVID-19, including those affected by the gastrointestinal tract.

Materials and methods. In 85 patients diagnosed with a new coronavirus infection, the quantitative composition of the intestinal microbiota was assessed by the number of copies of microorganisms detected by PCR using the ENTEROFLOR test system.

Results. A study of the structural composition of the intestinal microbiome has shown that patients with diarrhea have a statistically significant excess of copies of B. longum subsp. infantis, Bif. longum subsp. longum and B. breve against the background of a decrease in Bifidobacterium spp., B. adolescentis, B. bifidum and B. senulatum. Of the representatives of gram-negative commensals, Butyricimonas spp. was active. Among the opportunistic and pathogenic flora, an increase in the number of copies of Enterobateriaceae was noted, mainly in patients with diarrhea. They also more often identified S. aureus strains with mecA and C. dificile with resistance genes cdtA and сdtB. A direct correlation was established between C. dificile and Butyricimonas spp., as well as an inverse correlation between B. catenulatum and C. dificile cdtA and сdtB, and between Bifidobacterium spp. and S. aureus mecA.

Conclusion. There is a decrease in gram-positive microorganisms among the commensals in favor of gram-negative microorganisms. Reduction of B. adolescentis and complete absence of B. bifidum and B. catenulatum in COVID-19 patients with diarrhea indicate the formation of inflammatory processes in the intestine. The transition to aerobic metabolism allows Enterobateriaceae to compete with beneficial obligate anaerobes, with the growth of strains containing resistance genes.

Background. On February 10-12, 2025, the XXI Interdisciplinary Congress with international participation "Vein Readings" was held in Moscow. The congress is devoted to topical issues of neurology and every year successfully brings together leading specialists and scientists from near and far abroad. Created by the students of the legendary academician Alexander Vein (1928-2003), the congress not only fulfills the task of increasing the level of knowledge and professionalism of doctors, but also creates conditions for fruitful discussions and interdisciplinary dialog. Each "Vein Readings" is a large-scale event, causing increased attention of specialists. Participants share their own experience, the latest research, discoveries and developments. There are thematic trainings, symposia, discussions and clinical cases, as well as lectures by experts.

Results. On the first day of the congress Ella Yu. Solovyeva, Doctor of Medical Sciences, Professor, Head of the Department of Neurology, Head of the Research Laboratory of Biomedical Research in Neurology, N. I. Pirogov Russian National Research Medical University (Moscow) gave a lecture "Problems and Opportunities of Neurometabolic Therapy", highlighting approaches to the prescription of neurometabolic drugs in clinical practice.