Background. The incidence of isthmic-cervical insufficiency in pregnant women is 0.8-1%, especially if there is a history of miscarriage in the second trimester of pregnancy, there is a significant increase in the numbers for the development of this pathology, reaching 20%. The most common surgical method for treating isthmic-cervical insufficiency is considered to be the application of a circular suture to the cervix according to McDonald. Due to its simplicity and effectiveness, the McDonald technique is recommended as a first-line procedure. Results. In some cases, complications arise after applying a suture to the cervix. Most often, complications such as vaginal bleeding, premature rupture of the fetal membranes, the occurrence of infectious processes inside the uterus, suture divergence and other possible complications arise after the procedure. Such problems also include eruption of the amniotic sac, and in some cases its prolapse. The issue of treating such patients remains unresolved, since there are no clear clinical recommendations. The study included 7 cases of pregnant women with isthmic-cervical insufficiency and symptoms indicating "insufficiency" or rupture of the cervical suture after previous surgical correction during pregnancy. A specially developed technique involving double circular suture application for enhanced fixation was used in all patients. Micronized progesterone was mandatory before surgical correction and after suturing was performed until the 34th week of pregnancy, and, given the increased risk of ascending infection, patients were prescribed prophylactic antibiotic therapy. After suture placement, antibiotic therapy was administered until the 34th week due to the risk of ascending infection. A secondary suture was placed in one patient at 17-18 weeks, in three other patients the procedure was performed at 20-21 weeks, and in three more women the suture was placed at 23-24 weeks of pregnancy.

Conclusion. The pregnancy outcomes of these patients were carefully analyzed. In one case, a premature birth occurred at 31-32 weeks of pregnancy, and the newborn survived safely. In the other 6 cases, the pregnancy was extended to full term. All children were born with an Apgar score exceeding 7 points. These results indicate the success of secondary suturing in pregnant women with isthmic-cervical insufficiency.

Background. Gestational diabetes mellitus is becoming an increasingly serious public health problem. Gestational diabetes mellitus significantly increases the risk of future maternal prediabetes as well as serious shortand long-term maternal and neonatal complications, including pre-eclampsia, maternal cardiovascular disease and stillbirth, macrosomia, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia, and obesity in the child. Diet is the first-line treatment for gestational diabetes mellitus, even if it should be combined with physical activity correction and insulin therapy. Each meal should contain slowly digestible carbohydrates, protein, monoand polyunsaturated fats, and dietary fiber. Dietary fibers are components of food that the body cannot fully digest, so this type of carbohydrate is not used for energy purposes. However, they must be included in the human diet. Most people eat less than 20 g of dietary fiber per day, of which 8-10 g usually come from bread and other cereal products, about 2-3 g from potatoes, 5-6 g from vegetables and only 1-2 g from fruits and berries. In order to make up for the deficit of dietary fiber intake, food products are enriched with them. Insoluble dietary fiber added to cereal products – bran bread, bread made from whole grains. Soluble dietary fiber, such as inulin, which stimulates the growth of beneficial intestinal microorganisms, enriched dairy products (yogurt). The preventive and ameliorating effects of dietary fiber in relation to gestational diabetes mellitus are well documented in many studies. For example, it has been shown that women with the highest dietary fiber intake before pregnancy had a lower risk of developing gestational diabetes mellitus.

Results. This review focuses on studies of the use of dietary fiber as an adjunct to dietary recommendations to improve glycemic profiles, and shows the role of viscous soluble fibers, including potential use of psyllium.

Introduction. Gayet – Wernicke syndrome develops as a result of vitamin B1 deficiency, which is most often found in people suffering from alcoholism or malabsorption due to intestinal diseases or bariatric surgeries. During pregnancy, this condition can develop as a result of prolonged uncontrollable vomiting, which disrupts the balance of substances in the body and the absorption of nutrients in the intestine. However, this condition is quite rare, and manifestations in the form of polyneuropathy and the absence of the classical triad can present a certain difficulty in differential diagnosis and timely administration of therapy.

Results. This article presents a clinical case of a pregnant woman at 38 weeks with a clinical picture of Gayet – Wernicke syndrome due to severe vomiting of pregnancy in the first trimester and metabolic disorders in the third.

Conclusion. Since Gayet – Wernicke syndrome is a relatively rare disease, obstetricians-gynecologists, ophthalmologists, therapists and neurologists who observe pregnant women should pay close attention to the appearance of patient complaints about memory impairment, weakness, numbness in the limbs and feelings of weakness in the limbs, and impaired coordination. Of course, such complaints are not uncommon in pregnant women, but we must always remember that there is a possibility that they may be early signs of Gayet – Wernicke syndrome.

Background. Benign proliferative processes of the endometrium are the cause of oncological risk, increased in the postmenopausal period. The clinical significance of endometrial polyps is determined by their prevalence in postmenopause and increased risk of precancerous and malignant lesions of the endometrium. Approaches to the management of patients with postmenopausal endometrial polyps are determined by the presence of symptoms, allowing for observation in asymptomatic cases. Additional studies are required to clarify the choice of active management tactics.

Objective. The aim of the study was to examine the condition of the endometrium in patients with verified postmenopausal endometrial polyps.

Material and methods. A retrospective cohort study was conducted at the gynecological department of the Private Healthcare Institution Clinical Hospital Russian Railways-Medicine of Omsk. The study cohort consisted of 133 women with postmenopausal endometrial polyps (mean age – 59.23 ± 6.34 years), who underwent hysteroresectoscopic polypectomy followed by histological examination of the endometrial polyps and surrounding endometrium.

Results. The duration of postmenopause was 9.47 ± 6.66 years. Endometrial polyps dominated in women in late postmenopause (95% CI 60.4-76.4). Patients with postmenopausal endometrial polyps had an asymptomatic course (95% CI 61.2-77.2), uterine bleeding (95% CI 22.8-38.8), recurrent endometrial polyps (15.8%), concomitant treatment with tamoxifen (3.8%). According to the hysteroscopic examination data, a predominance of single endometrial polyps was established (95% CI 67.7-82.7), the sizes of which varied over a wide range (15.7 ± 9.4 mm). The prevalence of glandular-fibrous endometrial polyps (61.7%) over glandular endometrial polyps (36.8%) was characteristic. Atypical endometrial polyps was detected in two cases (1.5%), one of which had signs of malignancy (0.8%) against the background of uterine bleeding. The surrounding endometrium had signs of atrophy (61.7%) and cystic atrophy (34.6%). In 5 cases (3.8%), pathology of the surrounding endometrium was detected: simple endometrial hyperplasia without atypia, atypical endometrial hyperplasia, and endometrial adenocarcinoma. Signs of malignancy of atypical endometrial polyps and cancer in the surrounding endometrium were detected both in symptomatic (n = 41) and asymptomatic disease (n = 92) (p > 0.05).

Conclusion. In patients with postmenopausal endometrial polyps, the disease occurs against the background of precancer and endometrial cancer localized in the polyp or surrounding endometrium in 3.8% of cases. The frequency of precancer and endometrial cancer against the background of a dominant asymptomatic course in postmenopause is 2.2%, which requires histological verification regardless of the size of the polyp according to the ultrasound examination data and the absence of clinical manifestations, and excludes the possibility of observational tactics. 

Background. Tumor-associated localized scleroderma is observed among patients with localized scleroderma. It is assumed that the development of this condition may be facilitated by both the inflammatory processes in scleroderma and oncological processes in the body. However, cases of localized scleroderma developing following radiation therapy are more frequently reported. Additionally, the onset of the disease has been noted in patients receiving immune checkpoint inhibitors.

Objective. To study the prevalence of localized scleroderma associated with oncology, which will allow detecting and predicting the disease at an early stage.

Materials and methods. A retrospective study of 94 cases (99% women and 1% men) admitted within 3 months of diagnosis of localized scleroderma was conducted. The diagnosis was confirmed histologically. The systemic nature of the disease is excluded by a dermatologist. The age of the patients ranged from 52 to 76 years, with an average age of 66 years. The data were analyzed to identify tumor associations. Results. It was found that 8.5% of cases of localized scleroderma were tumor-associated. Among those examined, breast cancer was the most common (50%). In 25% of cases, localized scleroderma developed following radiation therapy. In 12.5% of cases, the onset of localized scleroderma coincided with the intake of anticancer drugs. The time interval between the clinical onset of localized scleroderma and cancer ranged from 1 month to 5 years, with an average of 2.1 years.

Conclusion. The presence of an oncological association in even a small number of patients indicates potential health risks. Further research is needed to better understand the association between localized scleroderma and oncological diseases, to determine the frequency of tumor associations and their clinical significance.

Background. One of the topical issues in medicine is the interrelation between skin pathology and endocrine-metabolic disorders, which, in addition to damage to internal target organs, can lead to morphofunctional changes in skin. Pretibial myxedema (PTM) is most often observed in patients with Graves disease and is a pathology accompanied by mucinous changes in skin, mainly in the area of the anterior surface of shins.

Results. We present our own clinical observation of a case of development of pretibial myxedema of the lower extremities in a man in combination with eczema and onychodystrophy associated with prior thyroidectomy. Among the features of the combined pathology, it is necessary to note: appearance of rashes after thyroidectomy due to thyrotoxicosis and subsequent irregular intake of replacement therapy by the patient; unilateral appearance of mucinous plaques on the anterior surface of the shin in the beginning; overlay of symptoms of eczema on the posteromedial surface of the other shin; signs of onychodystrophy of non-mycotic genesis and edema of the toes; resistance of the eczematous process to the treatment provided. For differential diagnostics, a skin biopsy was performed, which showed the presence of histological signs of mucinosis and an eczematous process, which constitute the spectrum of comorbidity the patient has. Taking into account the important role of the hormonal state in development of these diseases, it shall be assumed that there are similar pathogenetic mechanisms of development of these dermatoses in the patient. Furthermore, local vascular changes and occurrence of lymphostasis in the lower extremities in case of pretibial myxedema could apparently also lead to development of an eczematous process similar to varicose eczema, which was also an important factor contributing to the development of combined dermatoses.

Conclusion. Understanding causes and common factors of formation of multimorbid skin diseases with endocrine pathology is critically important for a dermatologist, because it makes it possible to timely diagnose and prevent the development of permanent skin pathology leading to decrease in the quality of life.

Background. Mycosis Fungoides is a primary epidermotropic T-cell lymphoma of the skin, characterized by the proliferation of small and medium-sized T-lymphocytes with cerebriform nuclei. Despite modern achievements in laboratory diagnostics and immunochemotherapy of hemoblastoses, Mycosis Fungoides remains an urgent problem for doctors of various profiles. At the onset of the disease, difficulties often arise in clinical and morphological diagnosis, and in the later stages of the disease, active monitoring and individual selection of the optimal treatment method are required. The indication for allogeneic bone marrow transplantation in patients with Mycosis Fungoides is under the age of 60 years in the absence of effect from other types of therapy, as well as early progression into the later stages of the disease. Thanks to the application of a multidisciplinary approach to the management of a patient with Mycosis Fungoides, it has become possible to implement the most effective method of treating this disease.

Results. The authors describe a case of diagnosis and successful co-treatment of a 46-year-old patient with Mycosis Fungoides who consulted a dermatovenerologist at the Ural Research Institute of Dermatovenereology and Immunopathology clinic with complaints of abdominal rashes accompanied by painful sensations and periodic itching. The diagnosis was verified by pathomorphological and immunohistochemical studies of the skin biopsy. In the Department of Hematology, Chemotherapy and Bone marrow Transplantation of the Sverdlovsk Regional Clinical Hospital No 1, the patient underwent 6 courses of combined polychemotherapy, and partial remission was achieved. Taking into account the onset of the disease at a young age, the aggressive course and the late stage of the disease, the consultation decided to perform an allogeneic hematopoietic stem cell transplant for the patient. In the post-transplant period, simultaneously with standard systemic immunosuppressive therapy with cyclosporine A and mycophenolate mofetil, topical glucocorticosteroids and a dermatocosmetic agent with anti-inflammatory, antipruritic and regenerating effects were prescribed to the patient as external agents. The presented clinical case introduces dermatovenerologists and hematologists to the experience of successful bone marrow allotransplantation in a patient with Mycosis Fungoides. Currently, the patient is under the supervision of a hematologist and a dermatovenerologist.

Background. Subungual exostosis is an overgrowth of bone and/or cartilage tissue in the area of the distal phalanx of the finger. The etiopathogenesis of the disease remains incompletely understood. It is believed that many exogenous and endogenous factors participate in the development of subungual exostosis. The epidemiology of the disease also remains incompletely understood with conflicting data on its gender and age characteristics. Most often, toes are affected. Despite the fact that subungual exostosis is a surgical and orthopedic pathology, the disease also has a negative impact on the condition of the nail apparatus and the nail in particular. Nail changes with this pathology are observed in approximately 10% of patients. Affecting the nail apparatus, subungual exostosis can change the shape and consistency (structure) of the nail plate, lead to the development of various onychodystrophies, which can significantly affect the timing of the correct diagnosis and further patient management. This circumstance is also aggravated by the often asymptomatic course of the disease, in which nail pathological changes may be the only clinical sign of damage to the bone/chondral structures. Nail lesions in subungual exostosis can imitate other onychopathies, including infectious diseases, nail tumors, or be the cause of other associated disorders, such as onychocryptosis. However, in most cases, nail changes in this pathology are nonspecific, which creates additional difficulties for clinicians in the framework of routine care. It should be noted that timely diagnosis and rational therapy of subungual exostosis are important in preventing the development of complications such as osteomyelitis and ulceration. This is especially important for patients with vascular and metabolic disorders.

Results. This article presents data on subungual exostosis and variants of nail lesions in this pathology. Particular attention is paid to the issue of differential diagnostics between nail lesions in subungual exostosis and other onychopathies, including various types of onychodystrophies, benign and malignant nail tumors, and other associated disorders. According to the authors, subungual exostosis and associated nail lesions is an important interdisciplinary problem that requires the active participation of both orthopedists and dermatologists. 

Introduction. The most physiological nutrition for a child from the first days of life is breast milk, which contains all the necessary nutrients, a large number of biologically active compounds and protective factors that influence growth, proper development, the formation of the immune system, programs health, protecting against a huge number of diseases. Despite the unique composition, a large number of children in the first year of life do not have the opportunity to receive breast milk in the required volume, and the pediatrician and neonatologist are faced with the task of providing nutrition, taking into account various factors: characteristics of the course of pregnancy, gestational age at the time of birth, degree of maturity, anthropometric indicators, allergy history, method of delivery, etc. The basis of the modern approach to organizing artificial and mixed feeding of children in the first year of life is the use of adapted milk formulas.

Results. The article discusses mixtures with partially hydrolyzed whey protein, provides data on their safety, features of production and composition, and the possibilities of their use for children in the first year of life. Partially hydrolyzed protein is digested and metabolized faster than intact protein not only from cow's milk but also from women's milk, as evidenced by studies in animals, adults and infants. Consumption of partially hydrolyzed proteins results in their faster digestion and absorption, increasing amino acid availability. Partially hydrolyzed protein in the small intestinal phase of digestion requires fewer enzymes, the key ones being enterokinase and trypsin. Absorption of the final products of protein cleavage (diand tripeptides) from partially hydrolyzed protein occurs across the small intestine more rapidly than from whole protein. During the final breakdown of the hydrolysate to amino acids, which takes place in the cytoplasm of enterocytes with their further entry into the systemic bloodstream, oligopeptides do not compete for transport systems with free amino acids, thus ensuring a progressive and gradual process of their absorption.

Results. The seminar featured presentations by Corresponding Member of the Russian Academy of Sciences, Rector of the Smolensk State Medical University, Chief freelance Specialist of the Ministry of Health of Russia on Clinical Microbiology and antimicrobial Resistance

S. Kozlov; Vice Director for Scientific Work of the Scientific Research Institute of Antimicrobial Therapy of Smolensk University, Candidate of Medical Sciences A. V. Dehnich; Associate Professor of the Department Phthisiopulmonology of Kazan State Medical University, Doctor of Medical Sciences I. Yu. Wiesel. Antibiotic resistance is one of the most serious global threats to human health, making it difficult to treat life-threatening infections. According to the forecast of the World Health Organization, the level of antibiotic resistance in the world may increase by 17% by 2050. This problem is extremely acute in cities with millions of inhabitants, which is associated with high population density, active migration processes, the growth of a stratum of unvaccinated people, outbreaks of ornithosis spread by pigeons, whose population is growing uncontrollably in megacities. The global situation of antibiotic resistance has only worsened since the COVID-19 pandemic. Conclusion. The increasing antibiotic resistance inside the population of cities with millions of inhabitants, especially after the COVID-19 pandemic, and the high risk of atypical (intracellular) infections characterized by bilateral damage of the nasopharynx in combination with damage of the lower respiratory tract, therapists should be informed about a rational choice of an effective antibacterial drug from the macrolide group that blocks not one or two, but three domains on the ribosome of the pathogen at once, exerting a triple bactericidal effect (spiramycin). Since this macrolide has avoided widespread use during the COVID-19 pandemic, infectious agents have not yet developed widespread resistance to it.