Background. Chronic hepatitis C is currently an urgent problem worldwide. According to the World Health Organization, there are currently more than 50 million people living with chronic hepatitis C virus infection, with approximately 1 million new cases of hepatitis C virus infection reported each year. In Russia, according to the State Report "On the State of Sanitary and Epidemiological Well-being of the Population in the Russian Federation in 2023", there has been an increase in the number of registered cases of chronic hepatitis C virus infection since 2021, despite the previous long-term trend toward a decrease in the incidence of chronic hepatitis C. For a patient with chronic hepatitis C, the prognosis is determined primarily by the stage of liver fibrosis. Despite the new possibilities of antiviral therapy, mortality from cirrhosis of the liver and hepatocellular carcinoma remains at a high level, due to both medical and socio-economic factors. The probability of hepatocellular carcinoma formation persists even after hepatitis C virus eradication.

Materials and methods. The article describes a clinical case of liver cirrhosis and hepatocellular carcinoma in the outcome of chronic hepatitis C virus infection. The main errors in the management of a patient with chronic hepatitis C virus infection were analyzed, and risk factors for late diagnosis of the oncological process were identified, which caused the fatal outcome. The pathoanatomic conclusion is presented. This clinical observation draws the attention of doctors of various specialties to the need for caution in the examination and treatment of patients with chronic hepatitis C virus infection regarding the development of hepatocellular carcinoma.

Conclusions. The clinical case demonstrates the importance of dynamic follow-up of patients with chronic hepatitis C virus infection to identify risk factors for liver cirrhosis and hepatocellular carcinoma (stage F-2 and higher, co-infection with other hepatotropic viruses, alcohol consumption, male gender and some genetic factors), as well as for the timely appointment of antiviral treatment. Only such an approach can provide a favorable prognosis for patients at the stage of liver cirrhosis and reduce the risks of transformation into primary liver cancer with subsequent death.

Background. In recent years, researchers pay close attention to studying the composition of the gut microbiota and its effect on the course of autoimmune diseases.

Objectives. To study the quantitative and qualitative characteristics of gut microbiota of young women suffering from autoimmune thyroiditis, as well as to evaluate the effectiveness of metaprebiotic administration for patients with autoimmune thyroiditis and intestinal dysbiosis.

Materials and methods. In this study, we examined fecal microbiota samples and surveyed 25 women with autoimmune thyroiditis aged 18-43 years receiving levothyroxine sodium replacement therapy and 10 healthy women for clinical manifestations of intestinal dysbiosis. After determining the composition of gut microbiota by gas chromatography-mass spectrometry, 10 women with autoimmune thyroiditis and clinical symptoms of dysbiosis were treated with metaprebiotic at a dose of 500 mg 2 capsules 3 times a day for 14 days with repeated examination of gut microbiota and a questionnaire.

Results. When comparing two groups of patients with autoimmune thyroiditis with complaints of intestinal dysbiosis and the control group, differences were obtained in the form of an increase in the following representatives: Streptococcus mutans (anaerobic), Clostridium perfringens, Lactobacillus spp., Peptostreptococcus anaerobius 18 623 (p < 0,005). After a course of meta-prebiotic treatment, there was a decrease in representatives of Streptococcus mutans (anaerobic) and Clostridium perfringens. There was also a decrease of the clinical manifestations of intestinal dysbiosis, such as complaints of constipation, abdominal pain and flatulence. However, some patients continued to complain of dry skin, headaches and general weakness, but these symptoms cannot be convincingly linked to intestinal dysbiosis.

Conclusion. Further determination of the gut microbiota composition and analysis of the data obtained will allow identifying groups of diagnostically significant microorganisms that are associated with autoimmune thyroiditis and their effect on gut microbiota, as well as studying the effect of pre- and probiotics on the course of autoimmune diseases by prescribing probiotic supplements separately or in combination with prebiotics in the future can be considered as one of the key components of autoimmune thyroiditis treatment in combination with hormonal therapy with levothyroxine.

Background. Gallstone disease remains one of the most common pathologies of the hepatobiliary system.

Objective. The purpose of this review is to systematize current data on the pathogenesis of gallstone disease, the role of bile acids and short-chain fatty acids, and gut microbiota in the development of systemic inflammation leading to the formation of cholesterol gallstones.

Results. The pathogenesis of cholesterol gallstone formation involves several factors, the most significant of which include genetic predisposition, imbalance between bile components (such as cholesterol, bile acids, and phospholipids), motility disorders of the biliary tract, and systemic inflammation. Bile acids play a key role in stabilizing the physicochemical and colloidal properties of bile. Disruptions in gut microbiota lead to insufficient production of hydrophilic ursodeoxycholic acid and increased absorption of toxic primary bile acids. In contrast, ursodeoxycholic acid exhibits a wide range of pleiotropic effects, including modulation of the bile acid pool, acting as a cytoprotective, immunomodulatory, and choleretic agent. The gallbladder microbiota closely interacts with the gut microbiota. Shortchain fatty acids, produced by gut microbiota, inhibit pathogenic bacteria, stimulate the immune system to mount a specific response, and mitigate inflammatory reactions. They serve as universal "signaling" molecules involved in intra- and intercellular communication. One mechanism involves interaction with nuclear acetyl-CoA, regulating the expression of genes responsible for pro-inflammatory cytokine production. Due to their small size, short-chain fatty acids passively diffuse through cell membranes or are actively transported via sodium-coupled transporters, entering the cytoplasm and even the nucleus of eukaryotic cells. There, they inhibit histone deacetylase activity, regulating acetylation and thus epigenetically dependent gene expression related to cell proliferation, differentiation, epithelial integrity, and immune response.

Conclusion. Short-chain fatty acids and bile acids are key molecules in regulating the "gut-liver-gallbladder" axis, which may be crucial for developing new therapeutic approaches for biliary tract diseases.

Background. Crohn's disease is a chronic recurrent disease of the gastrointestinal tract of unknown etiology, characterized by transmural, segmental, granulomatous inflammation with the development of local and systemic complications. Currently, in some cases, the diagnosis of Crohn's disease remains a difficult task. It often takes several years from the moment the first symptoms appear to the diagnosis is verified. The variety of clinical manifestations makes it difficult to recognize nosology due to the simultaneous involvement of several parts of the gastrointestinal tract in the pathological process: from the oral cavity to the rectum. Isolated lesions of the upper gastrointestinal tract are the most difficult to verify.

Objective. The aim of the work is to analyze a diagnostically complex case of Crohn's disease with isolated lesions of the upper gastrointestinal tract.

Materials and methods. The article describes a clinical case of Crohn's disease with lesions of the upper gastrointestinal tract in a middleaged (55 years old) patient. The features of this case are the low-symptomatic (erased) course of the disease, the absence of pathognomonic gastrointestinal clinical manifestations and characteristic typical endoscopic and histological changes during colonoscopy with examination of the terminal ileum. To establish a clinical diagnosis, the patient underwent a comprehensive examination, including laboratory, endoscopic and X-ray examinations in combination with morphological verification.

Conclusion. Our clinical observation confirms the importance of a comprehensive examination. The leading diagnostic methods for Crohn's disease with isolated lesions of the upper gastrointestinal tract are enterography and esophagogastroduodenoscopy with morphological examination. The patient was diagnosed based on the results of a histological examination, which confirms the need for mandatory morphological diagnosis during esophagogastroduodenoscopy.

Background. The prevalence of type 2 diabetes mellitus is high in Russia. This disease usually develops in middle-aged and older people over a period of several months or even years. At the initial stage, clinical symptoms are mild, which is why type 2 diabetes mellitus is diagnosed late. Type 2 diabetes mellitus is often detected for the first time during a preventive or random examination. The management of patients with type 2 diabetes mellitus in outpatient therapeutic practice has a number of specific features: the patient is always polymorbid and, in addition to type 2 diabetes, usually exhibits pathology in a number of organs and systems, which may precede type 2 diabetes, develop as a result of its complications, or be exacerbated by it. Multimorbidity always leads to polypharmacy, especially when patients consult different specialists and treatment approaches are not coordinated, so the polyclinic therapist must be the "coordination center" for working with patients. If type 2 diabetes mellitus is suspected, the physician must confirm the presence of the disease based on clinical and laboratory data, in accordance with the diagnostic criteria for type 2 diabetes mellitus, and prescribe individual treatment, the main goal of which is to compensate for carbohydrate metabolism. The main role in this is played by a balanced diet, optimal physical activity, and timely pharmacotherapy. Preference should be given to drugs that demonstrate a broad therapeutic effect, have sufficient hypoglycemic activity, affect metabolism, and have organoprotective properties. The main drug is metformin, a hypoglycemic agent from the biguanide group. By reducing hyperglycemia, it does not lead to the development of hypoglycemia, increases the sensitivity of peripheral receptors to insulin and glucose utilization by cells, reduces glucose production by the liver, delays its absorption in the intestines, and improves the lipid profile. Pharmacotherapy for type 2 diabetes mellitus should always be comprehensive, therefore, the treatment regimen, especially in cases of multimorbidity, should include drugs with a disease-modifying effect, namely, sodium-dependent glucose transporter type 2 inhibitors – gliflozins, which reduce fasting and postprandial blood glucose concentrations, as well as glycated hemoglobin concentration by reducing glucose reabsorption in the renal tubules, have a beneficial effect on the cardiovascular system and kidneys due to osmotic diuresis, associated hemodynamic action, and metabolic effects. In addition, gliflozins act as geroprotectors, delaying aging and preventing the development of age-related diseases. Metformin and gliflozins combine well, are convenient for use in outpatient therapeutic practice, and promote the formation of stable adherence to drug treatment in patients.

Results. Issues related to the diagnosis, treatment, and management of patients with type 2 diabetes mellitus in outpatient therapeutic practice are considered. Emphasis is placed on the polymorbidity of patients and the associated polypharmacy. Criteria for clinical and laboratory diagnosis are provided, and recommendations for rational nutrition and physical activity for patients are given. The role of key pharmacotherapy drugs is argued: metformin, a hypoglycemic agent from the biguanide group, and gliflozins, inhibitors of the sodiumdependent glucose transporter type 2. The disease-modifying effects of the drugs, the breadth of their therapeutic action, the possibility of combining them, and the convenience of their use in outpatient and polyclinic practice are emphasized. 

Background. The defeat of the respiratory system is one of the leading problems of modern pediatrics, which was once again demonstrated by the pandemic of a new coronavirus infection. In addition to the immediate direct impact of SARS-CoV-2 on public health, the pandemic has affected the circulation of major respiratory pathogens. During the period of active circulation of the new coronavirus infection, the role of seasonal respiratory viruses and atypical pathogens in the nosological structure of diseases in children has significantly decreased. Objective. To study the causes of a significant increase in the incidence of microplasma pneumonia in the postcovid period with a decrease in the circulation of SARS-CoV-2.

Materials and methods. The frequency of hospitalization of children with community-acquired pneumonia (CAP) in the hospital in different years of follow-up was studied: the pre-epidemic period, during the pandemic of a new coronavirus infection and at the stage of transition of SARS-CoV-2 to seasonal respiratory viruses. The etiology of pneumonia was confirmed by bacteriological studies of sputum, blood, PCR analysis for SARS-CoV-2, PCR and ELISA examination for Mycoplasma pneumoniae, Chlamydophila pneumoniae, PCR analysis "Respiratory screen".

Results. Prior to the development of the pandemic of the new coronavirus infection in 2018 and 2019, 1,124 and 1,151 children were hospitalized with VP per year, while the proportion of mycoplasma pneumonia was 13.9% and 5.3%, respectively. The first increase in the incidence of COVID-19 in the Voronezh region occurred in the spring of 2020, while there was no increase in the number of pneumonia. In the 2020 epidemic season, other respiratory viruses and respiratory mycoplasmosis were practically not registered. The peak in the number of hospitalizations of children with lung damage associated with a new coronavirus infection occurred in 2021 (2,689 children with CAP). During this epidemic period, rhinovirus infection continued to circulate, as well as adaptation to the pandemic of other respiratory viruses (bocavirus, respiratory syncytial infections), and influenza and respiratory mycoplasmosis were practically not registered. In 2022, Omicron, the coronavirus strain, dominated the region, while the number of pneumonia decreased slightly (1,570 children). The decrease in SARS-CoV-2 activity in the Voronezh region began in February 2023, and the circulation of respiratory viruses returned to the pre-pandemic period. But since March, there has been an increase in the proportion of mycoplasma infection among hospitalized children, and for six months Mycoplasma pneumoniae has been playing a leading etiological role. It was difficult to explain such a significant increase in mycoplasma pneumonia in the region only by another periodic increase in the incidence of mycoplasmosis. Conclusions. The impact of the pandemic of the new coronavirus infection on the epidemic process of both respiratory viral infections and respiratory mycoplasmosis is obvious. The high incidence of COVID-19 and frequent lung damage in the new coronavirus infection have led to a significant increase in people in the population with a history of pneumonia.

Objective. The aim of the work was to assess the effectiveness and reveal on this basis the therapeutic mechanisms of the system of course application of methods of local electrical stimulation in dorsopathies.

Materials and methods. A total of 90 patients of both sexes under the age of 65 years with protracted exacerbation of lumbosacral dorsopathy were monitored. The results of the neurological examination were compared with the data of psychological and electrophysiological analysis. In the phase of inpatient treatment, patients were divided into two groups, in which conventional medical and orthopedic treatment was performed. In the 1st group, the comparison group of 30 people, the effect was exhausted, in the 2nd, the main group (60 people), an invasive method of electroacupuncture was additionally used – stimulation of segmental and distant microzones with an electric current by means of acupuncture needles inserted into them. The treatment course consisted of 10 daily procedures. At the end of a month in domestic conditions, the patients independently performed non-invasive transcutaneous electrical stimulation of algic zones – from 7 procedures released every other day. At the same time, in the comparison group, as in 1/2 of the main group, true TENS was performed, while in the other 1/2 – imitation (placebo), using models.

Outcomes. At the end of inpatient treatment, a significant advantage of the main one over the comparison group in terms of the achieved effectiveness was revealed. This was manifested in the clarity of regression of neurological symptoms, including the dynamics of algias, as well as the tendency to normalize the mental and vascular background. However, after six months, only in the 1/2 of the main group where patients used true TENS, greater stability of results was recorded, which was combined with a significantly lower number of exacerbations of dorsopathy.

Conclusion. The advantage, in terms of therapeutic reliability, of successive courses of local electrical stimulation may be explained by the typicality of the trace reaction, which ensures the accumulation of effects. In turn, the work performed contributes to further optimization of treatment and rehabilitation programs for vertebrogenic pathology.

Background. Smoking is a significant risk factor for the development of chronic non-infectious diseases such as malignant tumors, cardiovascular and respiratory diseases. Smoking is also considered one of the most important external risk factors for the development and severity of rheumatoid arthritis. It is associated with rapid disease progression, worsening of rheumatoid arthritis, and decreased treatment effectiveness. It is known that smoking in rheumatoid arthritis s associated with an increased risk of cardiovascular diseases and cardiovascular mortality. It is necessary to develop effective methods of quitting smoking among patients with rheumatoid arthritis. Objective. to develop a smoking cessation program for rheumatoid arthritis and evaluate the impact of this program on the patient's decision to stop smoking.

Materials and methods. The prospective cohort included smoking patients with rheumatoid arthritis in inpatient treatment. The smoking cessation program included individual preventive counseling and a Smoking Cessation School. The duration of follow-up after the intervention was 12 months.

Results. 194 smoking patients with rheumatoid arthritis were included: 123 women and 71 men, with an average age of 58.3 ± 10.2 years. The group consisted of smokers with long experience (average experience of 32.0 ± 12.1 years) and high smoking intensity (average smoking index 22.1 ± 14.6 pack/years). 71% have made repeated unsuccessful attempts to quit smoking. All patients received individual preventive counseling. 38 people visited the Smoking Cessation School. After 12 months, 22 people (11.8%) quit smoking, more often after attending School. Among those who quit smoking, there were fewer patients with high nicotine dependence (p = 0.005) and there were more previous attempts at quitting (p = 0.01). They were more likely to have comorbidity, mainly cardiovascular diseases (p = 0.02), and chronic kidney disease (p = 0.003). The characteristics of rheumatoid arthritis (duration of the disease, disease activity, radiographic progression, extra-articular manifestations), including the intensity of pain, did not affect the patient's decision to quit smoking.

Conclusion. The smoking cessation program in patients with rheumatoid arthritis is effective and should become part of clinical practice.

Background. Modern Russia, like many countries around the world, is undergoing a significant transformation of family and reproductive strategies, which is reflected in demographic and sexological trends. A comprehensive study of these interrelated processes requires the integration of demographic analysis methodologies, sociological research, and clinical data, emphasizing the relevance of interdisciplinary approaches in the field of public health. Sexual disharmony in couples, often caused by the presence of sexual dysfunctions in one or both partners, is an important factor in the destabilization of family relations and the aggravation of the demographic crisis. The diagnosis of sexual dysfunctions presents significant difficulties in clinical practice, largely due to their high comorbidity with somatic diseases and mental disorders. This fact is not always fully taken into account by doctors of non-core specialties, which makes it difficult to detect violations in a timely manner and organize early access to specialized care for patients. In this regard, the development and implementation of concise, reliable and valid screening tools for the prompt diagnosis of sexual dysfunctions is an important scientific and practical task.

Materials and methods. The study was conducted on the basis of the Department of Sexology of the Moscow Scientific Research Institute of Psychiatry. It was attended by 122 women of reproductive age. The main method was a questionnaire using two versions of the questionnaire for assessing female sexual function: the classical (full) version and a specially developed modified (abbreviated) version. The aim was a comparative study of the psychometric properties of the modified version.

Results. A modified (shortened) version of the female sexual function questionnaire has demonstrated high effectiveness as a screening tool for sexual dysfunctions in women. The study confirmed its high reliability, as evidenced by the Cronbach's index of internal consistency = 0.8141. The diagnostic accuracy of the abridged questionnaire was assessed as high based on the results of the ROC analysis (Area under the curve, AUC = 0.990), which indicates its ability to differentiate women with and without sexual dysfunctions. The shortened version retains the basic diagnostic capabilities of the full version.

Conclusion. The developed modified version of the female sexual function questionnaire is a convenient tool for practical healthcare. Its abbreviated format simplifies its use in clinical practice, especially by primary care physicians and related specialties (internists, gynecologists, urologists, psychiatrists) who do not have in-depth training in sexology. Focusing on key aspects of sexual function while avoiding excessive detail makes the tool convenient for rapid screening in a time-limited setting. This makes it possible to improve the early detection of sexual dysfunctions, timely refer patients to specialized sexologists for in-depth diagnosis and treatment, and, as a result, contribute to the prevention of family disharmony and improve the quality of life of patients.

Background. Abnormal uterine bleeding is one of the most common reasons for discontinuation of menopausal hormone therapy. However, in a significant number of cases, abnormal uterine bleeding occurs without identifiable organic causes, suggesting the involvement of functional and immunological mechanisms, including alterations in the cytokine profile of the endometrium. Particular attention is given to interleukins IL-2, IL-6, and IL-15, which play a pivotal role in regulating the innate immune response of the endometrial mucosa.

Objective. To assess the levels of interleukins IL-2, IL-6, and IL-15 in the endometrial environment of postmenopausal women receiving menopausal hormone therapy, and to evaluate their potential association with the development of abnormal uterine bleeding.

Materials and methods. A randomized controlled study was conducted involving 106 postmenopausal women. The main group (n = 72) received continuous combined menopausal hormone therapy (estradiol 1 mg + dydrogesterone 5 mg), while the control group (n = 34) did not receive hormone therapy. Levels of IL-2, IL-6, and IL-15 in uterine aspirates were measured using enzyme-linked immunosorbent assay (ELISA) prior to treatment, after 6 months of menopausal hormone therapy, and during episodes of abnormal uterine bleeding.

Results. Levels of IL-2 and IL-6 did not show statistically significant changes either after 6 months of menopausal hormone therapy or in relation to the presence of AUB. In contrast, IL-15 levels increased significantly after 6 months of therapy (p < 0.001) in both women with and without abnormal uterine bleeding. Moreover, IL-15 concentrations were significantly higher in women with abnormal uterine bleeding compared to those without (p = 0.0254).

Conclusion. The findings indicate that IL-15 is a sensitive marker of the endometrial immune response to exogenous hormonal stimulation and may be involved in the pathogenesis of abnormal uterine bleeding during menopausal hormone therapy. Conversely, IL-2 and IL-6 did not demonstrate diagnostically relevant changes, suggesting their limited role in the local inflammatory response. These results highlight the need for further studies involving an expanded panel of immune markers and functional assessment of endometrial immune cell populations.

Background. In the modern world, professional sports are becoming increasingly popular. In St. Petersburg alone, there are 412 masters of sports, and throughout Russia this number is 6,847 people. Among women's sports, one of the most common types is rhythmic gymnastics. The training of gymnasts is characterized by a special approach: daily training for 5-8 hours, low-calorie diet with restriction of carbohydrate and fat components, high requirements for appearance, for example, for successful performances high height, pathological thinness and long limbs are necessary. Because of psychological pressure and pathological weight control, girls and their parents are under chronic stress, mentors convince children to lose weight all the time. Many gymnasts live with eating disorders and low self-esteem, and these problems accompany them into adulthood.

The features of puberty and the state of the reproductive system in adolescent girls professionally engaged in rhythmic gymnastics were studied.

Results. A survey of 100 gymnasts aged 12-25 was conducted at sports schools for children and youth. The questionnaire review was carried out using a Google form, which contained 50 questions about the specifics of nutrition and physical activity, health status, and the onset of menarche. It has been found that professional rhythmic gymnasts are characterized by delayed sexual development and skeletal maturation, menstrual cycle disorders such as polymenorrhea or oligomenorrhea, as well as primary and secondary amenorrhea, luteal phase insufficiency, anovulation, dysmenorrhea, abnormal uterine bleeding, and in rare cases, juvenile bleeding. In adulthood, gymnasts may face pregnancy complications.

Conclusion. Professional rhythmic gymnasts are characterized by delayed sexual development and skeletal maturation, menstrual cycle disorders such as polymenorrhea or oligomenorrhea, as well as primary and secondary amenorrhea, luteal phase insufficiency, anovulation, dysmenorrhea, abnormal uterine bleeding and, in rare cases, juvenile bleeding. And in adulthood, gymnasts may face pregnancy complications. The occurrence of these deviations is associated with a pronounced energy deficit during puberty in girls, which is caused by excessive sports loads and improper nutrition, namely low calorie intake that does not cover energy costs, as well as restrictions on carbohydrate and especially fat components.

Background. Women who have hypertensive disorders during pregnancy are confirmed to be at increased risk of developing subsequent hypertension and cardiovascular disease. Since hypertensive disorders increase the risk of maternal and perinatal morbidity and mortality, timely and correct diagnosis, as well as the choice of an adequate management plan for such patients is essential to prevent severe complications.

Objective. To analyze maternal and perinatal outcomes in women with hypertensive disorders in order to optimize the management of pregnant women with these complications.

Materials and methods. A retrospective comparative study was conducted based on medical records from 2021 to 2023. Maternal and perinatal pregnancy outcomes were studied in 124 women with hypertensive disorders. Patients were divided into 2 groups: Group 1 – 64 pregnant women with chronic arterial hypertension, Group 2 – 60 pregnant women with gestational arterial hypertension.

Results. The findings suggest that the presence of chronic arterial hypertension and gestational arterial hypertension contributes to an increased incidence of adverse maternal and neonatal outcomes. Our results also confirm the least controlled arterial hypertension in pregnant women with gestational arterial hypertension, which requires prescription of two- or three-component antihypertensive therapy during pregnancy, labor and delivery and postpartum period. Perhaps, achieving the target blood pressure level on the background of antihypertensive therapy and its timely adjustment reduces the incidence of serious complications and undesirable outcomes of pregnancy for mother and fetus. Effective treatment of hypertensive disorders in pregnant women is indicated by the joint stay of mother and newborn in satisfactory condition after delivery.

Conclusion. The data obtained indicate the need to optimize the tactics of management of women with hypertensive disorders and represent a reserve for reducing the incidence of adverse maternal and neonatal outcomes of pregnancy. Achievement of target blood pressure level on the background of antihypertensive therapy and its timely correction reduces the incidence of serious complications and adverse maternal and fetal outcomes of pregnancy.

Currently, many medical professionals are misunderstanding how to properly use biologically active supplements when treating patients. The myth that biologically active supplements cannot be prescribed under any circumstances is quite widespread in the medical community since BADS are not medicinal products and are not included in clinical recommendations. Some medical workers are even convinced that prescribing biologically active supplements could result in criminal liability. Ivan Olegovich Pecherey, a doctor of medical sciences, associate professor, lawyer, and expert in the quality of medical care, told the journalists of "Lechaschi Vrach" about the legal aspects of using biologically active supplements in doctors' real clinical practice.