Background. Allergic reactions occupy a special place among the variety of nosological forms encountered in the activities of a general practitioner. In the scientific community, more and more new approaches to the classification of immune-mediated hypersensitivity reactions underlying the development of allergic diseases appear. The identification of 9 hypersensitivity reactions allows us to expand the existing understanding of the pathogenesis of allergic diseases and the contribution of each type of reaction to the mechanism of their development, allowing for a personalized approach to therapy. The aim of this work is to increase awareness of general practitioners about the pathogenetic aspects of allergy and approaches to optimizing pharmacotherapy to achieve better clinical results.

Results. The main goals of therapy for allergic diseases are to achieve control over the disease or reduce the severity of its clinical manifestations, reduce the frequency of exacerbations and the risk of complications, and improve the quality of life of patients. The treatment strategy adheres to the stepwise principle – the appointment of the required volume of pathogenetically substantiated pharmacotherapy based on the initial assessment of the severity of the disease, followed by a step down or up, taking into account the therapeutic response (respectively, step-down or step-up therapy). To achieve the treatment goals, drugs of various pharmacological groups are used, both improving the long-term prognosis of the disease and reducing the severity of its clinical symptoms without positive long-term effects. Despite the various clinical manifestations of the most common allergic/atopic diseases that make up the "atopic triad", they have universal pathogenetic mechanisms largely associated with the second type of immune response. The use of anti-inflammatory drugs, of which glucocorticoids continue to occupy a leading place, is a pathogenetically substantiated basic therapy for these diseases, and the use of dosage forms (inhalation, topical and intranasal), providing maximum concentration in the inflammation site with a low level in the systemic bloodstream, additionally increases the effectiveness, minimizing systemic side effects. At the same time, histamine H1-receptor blockers, often used in clinical practice, have limited application in the therapy of allergic diseases and are used in the therapy of allergic rhinitis, as well as in a number of clinical situations with atopic dermatitis.

Conclusion. The article presents a pathogenetic rationale for the treatment of allergic diseases using bronchial asthma and allergic rhinitis as an example, based on modern data on the types of hypersensitivity reactions.

Results. The article describes a clinical observation of a rare hereditary Hallervorden – Spatz disease (pantothenate kinase-associated neurodegeneration or neurodegeneration with iron accumulation in the brain) with an atypical late form in the terminal stage with a debut in the fourth decade of life with a rapidly progressive course and a fatal outcome. The most characteristic signs of the disease in this patient were Parkinsonism syndrome, severe postural instability, pyramidal insufficiency, various types of hyperkinesis, decreased cognitive functions, and depression. When substantiating the diagnosis, we relied on the characteristic clinical picture and typical MRI signs in the form of the tiger's eye symptom (a symmetrical hyperintense zone in the region of the pale globe within a larger hypointense zone). Late cases should be differentiated from such diseases as Parkinson's disease, Lewy body disease, Wilson – Konovalov disease, Fahr disease, Huntington's disease, neuroferritinopathy and others. Due to the current lack of effective treatment methods, the patient received symptomatic treatment, since there is no etiologic and pathogenetic therapy for this disease.

Conclusion. The current standard of care is aimed at symptomatic treatment (dopamine agonists or amantadines, anticholinesterase drugs, benzodiazepines, muscle relaxants, botulinum toxin). Surgical treatment methods such as deep brain stimulation, ablative pallidotomy, thalamotomy are also used. It is necessary to increase the awareness of neurologists about the presence of this rare form of neurodegenerative disease with the clinic of parkinsonism due to the presence of other nosological forms of parkinsonism-plus. Early diagnosis of Hallervorden – Spatz disease will allow symptomatic therapy to be prescribed at early stages, corresponding to the various manifestations of the disease, to improve the quality of life of patients and reduce medical and economic costs.

Background. Intracranial hypertension syndrome often develops in patients with brain malignant neoplasms. In three quarters of patients corticosteroid therapy reduces clinical manifestations of cerebral edema, usually within 48 hours, and is a prerequisite for starting radiation therapy after surgery, especially in patients with brain tumors with a significant mass effect. Intracranial hypertension significantly worsens the palliative patient’s life quality. The use of corticosteroids in this category of patients not only allows provide special treatment and improves the quality of life, but is also necessary for saving life. Currently, there are no clear detailed recommendations and protocols for the use of dexamethasone in this group of patients.

Materials and methods. The article provides an analytical review of foreign and Russian literature in order to inform doctors about existing approaches and recommendations for the use of dexamethasone in patients with malignant brain neoplasms with intracranial hypertension syndrome.

Discussion. Some questions of dexamethasone therapy are analyzed: whom dexamethasone is indicated for, what are the optimal doses of dexamethasone for the patients with intracranial hypertension, how to reduce the dose of dexamethasone, how to prevent and treat its adverse events.

Conclusion. At all stages of medical care doctors should strive to do everything possible to stabilize the disease, prolong life, as well as to improve its quality. All the patients in our practice require an individual approach. However, doctors need basic knowledge that they can use in their work adapting it to a specific clinical situation. Therefore, it is necessary to develop and implement a practical guide for the use of steroids in patients with malignant brain neoplasms both in the process of special treatment and in palliative care. Steroid therapy tactical issues should be included in the training program for palliative care doctors, since they most often supervise this cohort of patients.

Background. In neuroinfections due to bacteremia or viralemia, generalized vasculitis occurs, including cerebral vessels, which causes the development of endothelial dysfunction. This contributes to vascular thrombosis, impaired vascular regulation, and stimulates neuroinflammation by increasing the secretion of proinflammatory cytokines from immune and neuronal cells such as microglia and astrocytes. Microglia activation is thought to play an important role in neuronal cell death through the release of proinflammatory mediators. Interleukins, interferons, tumor necrosis factor alpha, and factors that activate and inhibit macrophage activity play a leading role in the development of the acute phase response.

Objective. Comparison of laboratory parameters of the level of leukocytes in the peripheral blood and biochemical markers of inflammation (CRP, ferritin, IL-6 in the blood serum) and the level of IL-6 in the cerebrospinal fluid in patients with meningitis of various etiologies and patients without inflammatory changes in the central nervous system. The study involved 151 patients hospitalized at the State Budgetary Healthcare Institution of the Novosibirsk region "GIKB No. 1" in 2023-2024 with suspected serous or purulent meningitis. In all patients, laboratory parameters of blood and CSF were assessed, according to the results of which the patients were divided into two groups: patients with neuroinfections of various etiologies with pleocytosis in the cerebrospinal fluid of more than 15 and patients without inflammatory changes in the central nervous system.

Results. The study revealed an increase in varying degrees of IL-6 in the cerebrospinal fluid in patients with neuroinfections, and a direct correlation was established between the level of pleocytosis and IL-6 values in the cerebrospinal fluid. A statistically significant increase in the concentration of IL-6 in the cerebrospinal fluid in the acute stage of purulent and serous meningitis was also revealed, which indicates the direct production of IL-6 by neuroglial cells that perform the function of macrophages in the central nervous system.

Background. Neuritis of the facial nerve is a rare complication of acute purulent otitis media, which, in addition to the symptoms of otitis media, is accompanied by dysfunction of facial muscles, facial asymmetry, ophthalmological disorders, etc. Opinions regarding the pathophysiologic mechanisms of the complication include anatomic variations of the facial nerve, retrograde infection, exposure of the nerve to bacterial and viral toxins, and impaired blood supply to the nerve due to thrombosis or compression of the vessels feeding it. The complication reduces the quality of life by 2-3 months, can have long-term consequences and requires timely diagnosis and treatment in conditions of consolidation of specialists of various profiles. The course and outcomes of the disease depend on the aggressiveness of the infectious agent, timely diagnosis, adequate antibacterial and other therapy, and the state of the patient's immune system.

Objective. Generalization and systematization of current data on pathogenesis, clinical manifestations, diagnostic methods and treatment of facial nerve neuritis of otogenic origin; presentation of a clinical case of facial nerve lesion in an adult patient with acute purulent otitis media.

Results. A comprehensive analysis of the existing theories of the pathophysiology of facial neuritis of otogenic origin; the main conservative and surgical approaches to the treatment of the disease; and the role of non-drug therapy is described. The article also presents a clinical case of facial nerve damage in an adult patient with acute purulent otitis media.

Conclusion. Despite the rarity of the described complication, timely diagnosis and adequate treatment are required to achieve a favorable outcome and prevent chronic neurological consequences. Efforts to improve the quality of treatment of the underlying disease, the development of strategies for interaction between various specialists, combined with strict adherence to the treatment regimen by patients with otitis media can lead to success in the fight against facial nerve neuritis of otogenic genesis.

Background. Sexual disharmony is a significant factor in the destabilization of family relations, having a negative impact on the demographic situation. Disorders of sexual function often have comorbid associations with various somatic and mental illnesses, which determines the need for a comprehensive interdisciplinary approach to their diagnosis. However, doctors of various specialties often underestimate the importance of collecting anamnestic data on a patient's sexual health, which makes it difficult to detect such disorders early. In this regard, it is an urgent task to develop short screening tools that provide prompt diagnosis of sexual dysfunctions.

Materials and methods. The study, conducted at the Department of Sexology at the Moscow Research Institute of Psychiatry, involved 194 men, 90 of whom had diagnosed sexual disorders, and 104 were in the control group. All the subjects were offered both classical and modified versions of the Male Sexual Function Assessment Scale.

Results. Data analysis has demonstrated that the modified version of the Male Sexual Function Assessment Scale questionnaire is a highly reliable tool for detecting sexual dysfunctions in clinical practice and can be used for screening in order to refer patients to specialized specialists in a timely manner. The study confirmed that the shortened version of the scale has a high level of internal consistency (Cronbach α = 0.7629 after standardization), as well as a high diagnostic value, confirmed by ROC analysis (AUC = 0.889), which indicates its high sensitivity and specificity.

Conclusion. The study found that the modified version of the Male Sexual Function Assessment Scale questionnaire demonstrates high reliability and diagnostic significance, which makes it an effective tool for use in clinical practice. The main advantages of the abridged version include: reduction of excessive detail of subjective aspects of sexual function, preservation of key diagnostic parameters, as well as increased usability by doctors of related specialties. This tool can be recommended for screening sexual dysfunctions in medical practice, which will allow timely detection of disorders affecting both the sexual and psychosomatic health of patients and refer them to appropriate specialists.

Background. Parkinson's disease, a chronic progressive disease of the central nervous system, is the second most common neurodegenerative disease. Life expectancy has been steadily increasing in recent decades, therefore, the number of patients with Parkinson's disease will increase sharply in the coming decades both throughout the world and in Russia. Epidemiological data of Parkinson's disease are variable throughout the world and within one country. The results of studies of epidemiological indicators of Parkinson's disease in Russia differ significantly depending on the region where they were conducted, which may be due to the demographic characteristics of populations, migration processes, environmental influences, and differences in the organization of the healthcare system. The purpose of the study is to study the main epidemiological indicators for Parkinson's disease in Krasnodar, as well as the structure of some clinical characteristics.

Results. A retrospective analysis was carried out with subsequent statistical processing of 693 outpatient records of patients with Parkinson's disease for 2021, who were under observation in the office of extrapyramidal disorders of the State Budgetary Healthcare Institution of the SBHI RCH named after Professor S.V. Ochapovsky for the period from 2013 to 2021, included in the database of the unified register of patients with Parkinson's disease in the territory of Krasnodar. The obtained data were processed by the method of variation statistics using a personal computer and statistical programs Statistica 10 and Microsoft Office Excel 2007. Prevalence of Parkinson's disease in Krasnodar is above the national average. The ratio between men and women is not statistically significant. The highest prevalence rate is in the age group from 60 to 80 years. The mixed (akinetic-rigid-tremorous) form, stage 3 of the disease, predominates in the population, moderate rate of progression.

Conclusion. The data obtained can be used to expand the information in a unified database, identify existing problems at the diagnostic and treatment stage, which will improve the quality and life expectancy of patients.

Background. The dynamics of body weight is one of the main criteria for the adequacy of breastfeeding in newborns and infants. In the neonatal period, the loss of body weight (BMI) of a child after birth is assessed. Indicators of BMI greater than 10% of birth weight, as well as the retention of BMI over the age of 10 days of life may indicate a child's malnutrition. The average daily weight gain in children under 3 months of age should be 26-30 g., at the age of 3 to 6 months – 17-18 g. With adequate feeding, infants' urine should be light, transparent, odorless, and urinate at least 5-6 times a day. With insufficient nutrition, children may develop hypoglycemia, jaundice associated with insufficient intake of breast milk, hypernatremia, polycythemia, and dehydration. With the progression of dehydration, there is an increase in plasma osmolarity, total serum protein, an increase in the relative density of urine, and oliguria. It should be remembered that many clinical signs are not specific and may be associated not only with malnutrition, but also with defects in child care and the development of diseases.

Conclusion. Medical professionals must have the professional knowledge and competencies to perform differential diagnosis. A child with signs of malnutrition should be prescribed additional nutrition or supplementation in a timely manner. Mother's expressed milk, donor milk, and children's adapted milk formulas can be used for additional feeding. The introduction of supplementary feeding is necessarily carried out against the background of support and stimulation of lactation in the mother. If there are signs of dehydration, you can give the baby extra water between feedings. In children aged 4 to 6 months with malnutrition, complementary foods may be prescribed, preference is given to industrial baby porridges.

Background. Obesity is a multifactorial disease caused both by internal and external factors. Adolescents are more vulnerable to external risk factors and are more likely to be obese. The incidence of obesity is growing worldwide. Patients having obesity due to excessive calorie consumption are now considered to be a heterogeneity group in terms of eating behavior, emotional status and sleep quality. The obesity clinical pattern in males is quite distinctive. Thus, it was reasonable to expand our knowledge of obesity heterogeneity in terms of sex hormone levels in adolescent boys.

Objective. The study was aimed to examine the heterogeneity of gonadal axis hormones in adolescent boys with obesity using cluster analysis.

Materials and methods. The study involved 84 adolescents aged 14-17 years: 57 with obesity (code E66.0, ICD-10) and 27 practically healthy individuals. The anthropometrics included weight and height measurement and body mass index evaluation. Kisspeptin, testosterone, luteinizing (LH) and follicle-stimulating (FSH) hormones levels were determined. The k-means cluster analysis was used utilizing the Hartigan-Wong algorithm.

Results. four clusters of observations were identified. The first cluster can be described as intact central stimulation with impaired peripherical effect. The second one was the reflection of the normal hormonal status showing median level of kisspeptin, physiological levels of LH and FSH and high level of testosterone. The third cluster showed central hyperstimulation pattern followed by lower levels of testosterone. The fourth cluster had no signs of both stimulation and effect. The majority of clinically healthy children belonged to the second, "normal" cluster. Assigning patients to any cluster compared to the second one was a significant predictor of hormones levels abnormality.

Conclusion. Kisspeptin, testosterone, LH and FSH levels showed heterogeneity and were associated both with BMI deviation and age.

Objective. To study and analyze the epidemiological situation of the incidence of helminth-protozoal infestations in children under the age of 1 year of life for the period from 2012 to 2021.

Materials and methods. During the analyzed period, 27674 cases of parasitic infestations in children under the age of 17 were registered in the Astrakhan region.

Results. According to nosological forms, parasitic invasions were represented by two representatives of helminthiasis (ascariids and pinworms) and two representatives of protozoa (giardia and amoeba). Helminthiasis mainly prevailed – 72.7% (112 cases), including ascariasis – 1.8% (2 cases) and 98.2% (110 cases) – enterobiosis. Clinical manifestations of giardiasis in children were noted in the form of loose stools up to 3-4 times a day – 100% (39 people), vomiting after meals – 69.2% (27 people), fever up to 37.3 °C – 23.1% (9 people), pain in the epigastric region (when touching with a hand) – 89.7% (35 people), and allergic skin rashes – 15.4% (6 people). Amoebiasis in children under the age of 1 year proceeded in the form of complaints of loose stools (according to parents) – 100% (3 people), soreness during defecation and decreased appetite – 66.7% (2 people). Also, such children had stool with mucus – 33.3% (1 person). Ascariasis in children occurred in the form of complaints of stool disorder (alternation of constipation with diarrhea), nausea, pain in the umbilical region – 66.7% (2 people), as well as allergic skin manifestations in the form of urticaria – 33.3% (1 child). In addition, one child's parents noted a stool with mucus. Enterobiosis was clinically manifested in the form of complaints of itching and scratching in the perianal region – 100% (110 people), decreased appetite – 80.9% (89 people) and vomiting – 15.5% (17 people).

Conclusion. The main causative agents of helminth-protozoal invasions in children under the age of 1 year were giardiasis, amoebiasis, ascariasis and enterobiosis. The so-called "leading" place among all parasitic infestations of children of this age group belongs to enterobiosis – 71.4%. Geographically, the incidence of parasitic infestations is higher in Astrakhan than in rural areas of the Astrakhan region.

Background. Medication support of cataract surgery is an integral part of it. The standard regimen of local therapy includes an antibiotic, a glucocorticosteroid, and a nonsteroidal anti-inflammatory drug. Each of the many nonsteroidal anti-inflammatory drugs has unique pharmacological properties, which determines the relevance of information on the choice of a drug from this group in the drug support of cataract surgery.

Objective. The purpose of this study is to form an up-to-date understanding of nonsteroidal anti-inflammatory drugs in the drug support of the perioperative period of cataract surgery. The study was conducted in the format of a narrative review. The variety of topical nonsteroidal anti-inflammatory drugs used in ophthalmology is represented by diclofenac, ketorolac, bromfenac, indomethacin, and nepafenac. Differences in the chemical structure of the drugs determine the features of their pharmacodynamics and pharmacokinetics. A significant amount of evidence has accumulated in the literature in the form of results of randomized studies with a control group and experimental works indicating positive anti-inflammatory properties of nonsteroidal anti-inflammatory drugs used in the perioperative period of cataract surgery.

Conclusion. The presented studies demonstrate that nepafenac exhibits significant pharmacodynamic properties for penetration into the anterior chamber of the eye, and also has an anti-inflammatory effect in the posterior segment of the eye against the background of local application, which determines the unique therapeutic potential of Apfecto. Apfecto is a cost-effective generic nepafenac produced with international quality standards.

Background. The last century is characterized by an increase in the number of elderly population worldwide, and according to the World Health Organization, the number of elderly population has increased dramatically over the last century, and by 2030 people aged 60 years and older will account for one sixth of the world's inhabitants. Aging as a biological process leads to a gradual decline in the physical capabilities of the human body and an increased likelihood of developing various diseases. Older people are characterized by the appearance of a number of complex clinical conditions called geriatric complexes. Along with the development of chronic diseases, these include immune aging, due to which elderly people are at high risk of developing infectious diseases, often with an aggravated course and unfavorable prognosis. The process of immunosenescence causes a high risk of infectious diseases in the elderly, often with an aggravated course and unfavorable prognosis. Chronic stimulation of the immune system associated with persistence of some viruses (herpesviruses) in the body, age-related changes in the gut microbiota, cellular aging as a response to damage and stress, as well as the accumulation of "aging" cells in many tissues, especially in adipose tissue cells, lead to the formation of immunosenescence characterized by an unbalanced increase in the blood concentration of proinflammatory cytokines and a decrease in the level of anti-inflammatory mediators. Immunosenescence entails age-related changes in immunity: a decrease in the number of T-lymphocytes, changes in the functional activity of B-lymphocytes, impaired production of specific protective antibodies, slower synthesis of complement proteins and decreased macrophage activity. Aging of the immune system causes high susceptibility and severe course of acute respiratory infections in older people.

Conclusion. The peculiarities of the immune system of elderly patients dictate therapeutic strategies based on modulation of the immune response of the organism. Taking into account the deficiency of the interferon system in people over 60 years of age, the administration of interferon α-2b preparations, including high doses, is justified in the complex therapy of acute respiratory viral infections.

Background. Pulmonary embolism is an acute potentially fatal condition caused by blockage of the pulmonary artery by a venous thrombus, especially dangerous in massive form. Every year, up to 300 000 cases of pulmonary embolism are registered in a number of countries with a mortality rate of up to 30%. Hereditary thrombophilia, a condition associated with a genetically determined tendency to thrombosis, is of particular importance in the pathogenesis of PE.

Results. In the presented clinical case, the use of the non-immunogenic recombinant staphylokinase contributed to rapid thrombus lysis and stabilization of the patient with massive pulmonary embolism. Thrombolytic therapy made it possible to restore the patency of the pulmonary arteries, preventing the development of complications and ensuring a favorable outcome. Clinical indicators have demonstrated positive dynamics, which confirms the effectiveness of the drug in the treatment of massive pulmonary embolism in patients with a genetic predisposition to thrombosis.

Conclusion. The use of the non-immunogenic recombinant staphylokinase has shown high efficacy in the treatment of massive pulmonary embolism, contributing to the improvement of hemodynamics and stabilization of the patient's condition. Nevertheless, patients with hereditary thrombophilia require a comprehensive approach, including anticoagulant therapy to prevent recurrence of thrombosis. The clinical case highlights the importance of an individualized approach to the treatment and monitoring of patients at high risk of thrombosis to improve the quality and safety of therapy.

Background. Autoimmune inflammation in the gastric mucosa and Helicobacter pylori (H. pylori) infection are the main etiologic factors of chronic gastritis. Diagnostics of H. pylori bacteria is regulated by clinical guidelines for the management of patients with gastritis and duodenitis, while verification of autoimmune inflammation in the gastric mucosa is often delayed. An additional difficulty in the diagnosis of аutoimmune inflammation in the gastric mucosa is the combination with H. pylori, due to the shift of the clinician attention only to this etiologic factor without searching for other possible causes of chronic gastritis. Taking this into account, the development of a system for supporting medical decision support system to improve the verification of autoimmune inflammation in the gastric mucosa in individuals with different status of H. pylori infection is of particular relevance.

Objective. To identify diagnostic significant clinical, endoscopic and morphological signs of autoimmune inflammation in the gastric mucosa in patients with different statuses of H. pylori infection, followed by the development of a medical decision support system.

Materials and methods. An open, cohort, cross-sectional study was performed with the 124 subjects with chronic gastritis. Considering the presence of autoimmune inflammation in the gastric mucosa and the status of infection H. pylori, all patients were divided into three groups: the main group consisted of 35 patients with autoimmune inflammation in the gastric mucosa, comparison group 1 – 38 patients with аutoimmune inflammation in the gastric mucosa + H. pylori-associated, comparison group 2 – 51 patients with H. pylori-associated gastritis. To assess the diagnostic significance of the signs for the purpose of diagnosis Autoimmune inflammation in the gastric mucosa was used Bayes' theorem. All study participants were assessed for the presence of gastrointestinal symptoms using the GSRS questionnaire, as well as an analysis of the incidence of manifestations of anemic, sideropenic syndromes, vitamin B₁₂ deficiency, both at the onset of the disease and at the time of inclusion in the study, with an assessment of their diagnostic significance for аutoimmune inflammation in the gastric mucosa. The calculation of the informativeness of the data on the comorbidity of autoimmune inflammation in the gastric mucosa with other autoimmune diseases was performed, including an analysis of previously received therapy for concomitant pathology. The calculation of the diagnostic significance of results of laboratory studies, endoscopic and morphological examination of biopsies of the gastric mucosa was performed.

Results. Diagnostic significant signs of the presence of autoimmune inflammation in the gastric mucosa in patients with different status of H. pylori infection were determined: female gender, manifestations of dyspepsia syndrome (belching of air, as well as acidic or bitter contents, nausea, a feeling of distension, fullness in the epigastric), symptoms of vitamin B₁₂ deficiency, anemic and sideropenic syndromes, the presence of autoimmune thyroiditis, vitiligo, type 1 diabetes mellitus, decreased hemoglobin and mean corpuscular hemoglobin concentration values, decreased iron and vitamin B₁₂, the presence of endoscopic and histological signs of atrophy and intestinal metaplasia of the body of the stomach.

Conclusion. Based on the results of the study, a medical decision support system was developed to detect аutoimmune inflammation in the gastric mucosa in patients with different status of H. pylori infection. A model for assessing the risk of the presence of аutoimmune inflammation in the gastric mucosa has been created in two versions, differing in the volume of the signs used, which can help a practicing physician in identifying patients at risk already during the initial visit.

Background. The gut microbiota plays an important role in maintaining human health. The brain-gut axis is currently being actively studied. During the research, it was noted that the intestinal microbiota demonstrates circadian rhythms that interact with the circadian rhythms of the host. Chronic insomnia, in turn, can disrupt microbial circadian rhythms, thereby affecting the composition and function of the intestinal microbiota. Jet lag syndrome causes a significant increase in body weight and blood glucose levels due to its effect on the composition of the human intestinal microbiome. With the change of day and night, the number of Paraprevotella, Fusobacteria and Fusobacteriales in the intestinal microflora increases. The vagus nerve, interacting with the intestinal nervous system, releases nicotinic cholinergic signals to activate intestinal glial cells, which can secrete S-nitrosoglutathione to increase the expression of tight junctional proteins. 5-hydroxytryptamine (5-HT) is an inhibitory neurotransmitter that is synthesized and distributed by about 90% in enterochromaffin cells. Sleep disorders occur when the level of 5-HT in the brain decreases. Currently, it has been proven that dysbiosis of the intestinal microbiota is associated with the development of neuropsychiatric diseases and has a significant impact on human metabolic health. The gut microbiota plays an important role in the bidirectional connection between the brain, the immune system, and the gut (the brain-gut-immunity axis). On the one hand, the microbiota stimulates innate immunity by activating lymphoid tissues located in the intestinal system; on the other hand, interactions between bacterial fragments and receptors (such as TLR9 and the inflammasome) on the surface of epithelial and immune cells activate specific systemic and local immune responses.

Results. The review article presents current data on the mechanisms by which the intestinal microbiota can influence the mental state and quality of sleep and the circadian rhythm of the host, and the role of regular stress on the composition of the microbiota is noted. Strategies have been outlined to improve sleep quality based on lifestyle adjustments, individual nutrition, prebiotics and "psychobiotics" to counteract dysbiosis, potentially associated with sleep disorders.