Background. The most common method for treating chronic polypous rhinosinusitis is functional endoscopic sinus surgery followed by the use of intranasal corticosteroids in the postoperative period. Considering the recurrent nature of the disease, with only about 50% effectiveness of medical therapy, and the increased risk of complications with multiple surgical interventions, there is a need to explore new treatment methods for chronic polypous rhinosinusitis. An important aspect is restoring the epithelial barrier of the nasal mucosa and reducing inflammatory processes within it to alleviate symptoms. Mesenchymal stem cells, which possess a wide range of immunomodulatory properties, may become a promising new therapeutic option for this condition.

Results. The tolerability of immunotherapy with a biomedical cell product based on mesenchymal stem cells from the olfactory epithelium was good in all patients (n = 27). However, local reactions, such as nasal mucosa edema at the injection site and color change of the nasal mucosa to bluish-pink, without clinical manifestations at the site of suspension administration were observed in 5 patients (36%) in Group 1 and in 2 patients (15%) in Group 2. No systemic reactions (such as fever, changes in heart rate, blood pressure, or immediate allergic responses) were detected. In all patients of both the main and control groups, general, biochemical, and immunological blood parameters remained within normal ranges at all stages; no statistically significant differences or clinically relevant deviations were found. These data suggest that additional cell therapy alongside standard treatment for chronic polypous rhinosinusitis does not exert systemic effects on the body based on complete blood count data (p > 0.05).

Conclusion. Cell therapy with a biomedical cell product based on mesenchymal stem cells from the olfactory epithelium is safe and well tolerated in patients with chronic polypous rhinosinusitis. The local application of mesenchymal stem cells from the olfactory epithelium does not produce systemic effects according to blood tests, biochemical analysis, or immunological studies. Local reactions at the injection site-such as mucosal color change or edema – may occur but without clinical significance.

Background. Bronchial asthma is one of the most common chronic non-infectious inflammatory diseases of the respiratory tract, affecting people of all ages and characterized by respiratory symptoms resulting from variable airflow limitation and bronchial hyperresponsiveness. Severe bronchial asthma is registered in 5-10% of patients. This course of asthma remains uncontrolled, despite adequate therapy, including high doses of inhaled glucocorticosteroids, long-acting B2 agonists, long-acting anticholinergic drugs. This variant of the course of asthma requires either continuous therapy with high doses of inhaled glucocorticosteroids/long-acting B2 agonists/long-acting anticholinergic drugs, and in some cases, the appointment of systemic glucocorticosteroids. Severe bronchial asthma patients have the highest incidence of lack of control and development of exacerbations.

Results. The article presents a clinical case illustrating the possibility of using genetically engineered biological drugs in patients with severe bronchial asthma.

Conclusion. For patients with high T2-inflammation (T2-asthma) severe bronchial asthma (allergic or late eosinophilic) in recent years, biological therapy has become available using genetically engineered biological drugs aimed at suppressing excessive immune signaling pathways associated with T2 cytokines (IL-5 and IL-5R, IL-4/IL-13) or immunoglobulin E (IgE). With the right approach to choosing patient management and a biological drug option, this therapy proves to be highly effective, leading to control of severe bronchial asthma, a decrease in the frequency or complete absence of exacerbations, and a reduction in the dose of systemic glucocorticosteroids.

Background. Cystic fibrosis is a hereditary monogenic disease inherited in an autosomal recessive pattern, caused by a mutation in the cystic fibrosis transmembrane regulator (CFTR) gene and characterized by multisystem involvement of exocrine glands, with particularly severe res- piratory disorders. Until recently, the treatment of cystic fibrosis was mainly symptomatic. A revolutionary breakthrough in the treatment of the disease is associated with the emergence of pathogenetic therapy with CFTR modulators, which eliminate the disturbances in the functioning of the CFTR chloride channel that underlie the disease. The article provides a detailed review of the classification of CFTR mutations and the corresponding classes of modulator drugs: potentiators (ivakaftor, detivakaftor), correctors (elexacaftor, tezacaftor, lumacaftor, vanzacaftor). Particular attention is paid to the highly effective triple combination of elexacaftor/tezacaftor/ivacaftor, which has become the gold standard for the treatment of cystic fibrosis. It is emphasized that early initiation of modulator therapy can prevent the development of severe manifestations of the disease. The epidemiological indicators of cystic fibrosis in Russia are considered separately, where there is a lag in the proportion of adult patients and the availability of targeted therapy compared to Western Europe and North America. As a solution to the problem of the availability of expensive drugs, data on generic triple therapy drugs are presented. The results of Russian studies demonstrating the bioequivalence, comparable efficacy, and safety of generic targeted drugs for the treatment of cystic fibrosis compared to the original drugs are presented.

Conclusion. CFTR modulators offer a personalized approach to the treatment of cystic fibrosis. The widespread use of both original and generic CFTR modulator drugs is a key factor in improving the effectiveness and accessibility of pathogenetic therapy, which will improve the survival and quality of life of patients with cystic fibrosis.

Background. Sore throat is one of the most common complaints when patients visit a medical facility. There are many possible causes of sore throat: herpangina, infectious mononucleosis, candidal stomatitis, lacunar and follicular tonsillitis, diphtheria, paratonsillar abscess, and a number of other diseases. However, doctors most often encounter tonsillopharyngitis, usually of viral, less often of bacterial etiology. The effectiveness of working with a patient directly depends on the professionalism of the doctor: the breadth of their clinical thinking, their ability to ask the patient questions, conduct a physical examination, and perform instrumental examinations. In the latter case, a correctly performed pharyngoscopy is extremely important, as it allows you to identify the characteristic signs of the disease and conduct a differential diagnosis. The main issues determining the doctor's treatment strategy are the appropriateness of prescribing antibacterial drugs and the choice of symptomatic treatment. Given that the disease is most often viral in origin, antibiotics should not be used in the first days of treatment until the causes of the disease have been clarified. Antibiotics are only justified in cases of verified bacterial infection, namely group A β-hemolytic streptococcus (GABHS). The optimal choice for acute GABHS infection is amoxicillin, and for recurrent infection, amoxicillin/clavulanate. Adequate symptomatic therapy can resolve the problem of sore throat regardless of its etiology. Nonsteroidal anti-inflammatory drugs and analgesics/antipyretics are usually prescribed: systemic and topical. Systemic drugs effectively relieve fever and significantly reduce the severity of sore throat. However, topical drugs are more effective. One of the most effective active ingredients in this group is flurbiprofen, which is available in the form of lozenges. The drug is a derivative of propionic acid, and its mechanism of action is associated with the inhibition of cyclooxygenase and the suppression of the synthesis of pro-inflammatory prostaglandins, which cause the development of the disease. Flurbiprofen has the mildest effect on the affected mucous membrane of the pharynx and is able to suppress the inflammatory process caused by both viruses and bacteria. It quickly penetrates tissues, including deep layers, and has a pronounced analgesic and anti-inflammatory effect on the mucous membrane of the oral cavity and pharynx.

Conclusion. Issues related to the diagnosis and treatment of patients with sore throat in outpatient therapeutic practice are considered. The most common causes of sore throat, physical, laboratory, and instrumental diagnostics are discussed. Criteria for prescribing antibiotic therapy for infectious etiology of the disease are outlined. Emphasis is placed on symptomatic treatment and the use of topical preparations. The effectiveness of flurbiprofen in rapidly relieving pain and reducing inflammation is demonstrated.

Objective. To evaluate the impact of different approaches to smoking status correction within the framework of secondary prevention of chronic obstructive pulmonary disease (COPD) on the severity of systemic inflammation, endothelial dysfunction, and peripheral circulation, as well as on the reduction of dyspnea severity, improvement of quality of life, and increase in blood oxygen saturation levels.

Materials and Methods. A comparative analysis was conducted to assess the impact of different approaches to smoking status correction – complete smoking cessation, switching to alternative nicotine delivery systems, and continued use of conventional cigarettes – within the framework of secondary prevention of chronic obstructive pulmonary disease (COPD), on the concentration of tumor necrosis factor alpha (TNF-α), platelet-derived growth factor AA (PDGF-AA), and the severity of impairments in linear and volumetric microcirculatory blood flow. The study involved 140 COPD patients who were followed dynamically over a 12-month period. Group 1 included 56 patients (mean age 51.65 ± 5.88 years; 63.4% male, 36.6% female) who continued smoking traditional cigarettes throughout the observation period. Group 2 comprised 44 patients (mean age 67.28 ± 7.99 years; 65.4% male, 34.6% female) who completely quit smoking. Group 3 included 40 patients (mean age 63.28 ± 7.19 years; 61.4% male, 38.6% female) who transitioned to the use of electronic heated tobacco systems as an intermediate step in smoking cessation, as part of a harm reduction strategy within secondary prevention. The concentrations of TNF-α and PDGF-AA were measured using enzyme-linked immunosorbent assay (ELISA), while peripheral blood flow was assessed by computerized Doppler ultrasound with a standard transcutaneous sensor.

Results. The present study yielded results indicating that, alongside a reduction in dyspnea severity, improved quality of life, and increased blood oxygen saturation, smoking cessation of conventional cigarettes and switching to electronic heated tobacco systems are associated with a statistically significant change in the concentration of platelet-derived growth factor AA (PDGF-AA) in Group 2, from 325.85 ± 119.7 ng/mL at baseline to 180.41 ± 49.4 ng/mL at the end of the observation period, and in Group 3, from 407.18 ± 123.09 ng/mL to 282.36 ± 33.19 ng/mL, respectively. A similar pattern was observed in the analysis of tumor necrosis factor alpha (TNF-α) concentrations: in Group 2, the baseline value was 14.75 ± 4.52 pg/mL, decreasing to 6.35 ± 2.97 pg/mL after one year; in Group 3, it was 18.59 ± 6.98 pg/mL at baseline and 12.41 ± 4.57 pg/mL after 12 months. In both cases, the differences were statistically significant. Furthermore, a statistically significant positive dynamic was identified in the linear and volumetric velocity parameters of peripheral blood flow in Groups 2 and 3, indicating correction of NO-dependent vasodilation impairments of the microcirculatory bed and endothelial dysfunction against the background of smoking cessation and switching to alternative nicotine delivery sources within the framework of secondary prevention of COPD.

Conclusion. The application of a personalized approach to smoking status correction in patients with COPD, utilizing the harm reduction concept, contributes to the reduction of systemic inflammation severity, endothelial dysfunction, and peripheral circulation impairments, thereby supporting effective secondary prevention of the disease.

Background. Chronic obstructive pulmonary disease remains a significant public health problem. Exacerbations of сhronic obstructive pulmonary disease, often caused by bacterial colonization, are the main cause of progression and mortality. The dynamics of bacterial ecology during exacerbations and its role in pathogenesis have not been sufficiently studied.

Objectiva. Analysis of modern scientific research and publications on the role of the lung microbiome in the pathogenesis of chronic obstructive pulmonary disease and the possibility of correcting dysbiosis in order to improve the prognosis of patients with сhronic obstructive pulmonary disease during exacerbations.

Material and Methods. The analysis of Russian and foreign publications for the period 2010–2025 from the databases PubMed, Google Scholar, RSCI and eLibrary was carried out using the keywords: Chronic obstructive pulmonary disease, microbiota, exacerbation of COPD, antibiotic resistance.

Results. Until recently, it was believed that the lungs of healthy people were sterile, so bacterial colonization of the lower respiratory tract was considered only in the context of lung diseases. This belief was based on studies using standard culture methods. However, it has been estimated that more than 70% of the bacterial species on the body surface cannot be cultured using standard methods. The development of culture-independent methods of microbiological analysis has facilitated the identification of uncultivable microbes in the human body and has convincingly demonstrated that the flora inhabiting the bronchopulmonary system is more diverse than previously thought. Studies have shown that the lung microbiome differs between healthy and сhronic obstructive pulmonary disease patients. In patients with сhronic obstructive pulmonary disease, there is a decrease in the diversity of the microbiome and the predominance of commensal bacteria. During the period of exacerbations, low microbial diversity is observed. The use of antibiotics during exacerbations additionally changes the composition of the respiratory microbiota.

Conclusion. The use of antibiotics in сhronic obstructive pulmonary disease exacerbations leads to lower respiratory tract dysbiosis and the development of antibiotic resistance. Analysis of the composition of sputum microorganisms makes it possible to develop individual therapy, and correction of the microbiota of the respiratory tract can improve the results of treatment of acute сhronic obstructive pulmonary disease.

Background. Alveolar echinococcosis (alveococcosis) is one of the most dangerous helminth infections. Alveococcosis is a rare parasitic disease caused by the larval stage of the helminth Alveococcus multilocularis. The main hosts of alveococcus are carnivorous animals (foxes, arctic foxes, cats, dogs), intermediate hosts are rodents and humans as biological dead ends. The source of infection for humans is the main hosts, which excrete alveococcus eggs into the environment with their feces. Infection occurs when alveococcus eggs are ingested during hunting, skinning and cutting up carcasses of killed animals, or eating forest berries and fruits contaminated with alveococcus eggs. In Russia, the highest number of cases of alveococcosis has been recorded in the Altai Krai, the Republic of Bashkortostan, the Novosibirsk and Kemerovo regions, and Moscow. Urban and rural residents are equally susceptible to the disease. Alveococcosis is characterized by infiltrative growth of parasitic tissues with damage to various organs and metastasis. Due to its prolonged chronic and sometimes asymptomatic course, alveococcosis can lead to severe organ and systemic disorders, disability, and often death. It is important to diagnose alveococcosis at an early stage of the disease, which allows for timely treatment and improves the prognosis. The difficulty in diagnosing alveococcosis lies in its prolonged asymptomatic course and the presence of «masks» of other diseases. The method and effectiveness of alveococcosis treatment depend on many factors: the size of the tumor, the presence of metastases, and the condition of the affected organs and systems. If possible, total surgical removal of the alveolar cyst is performed. Given the possibility of metastasis to distant organs, chemotherapy for alveolar hydatid disease is not a radical but a desirable treatment method.

Results. A clinical case of alveococcosis in a young man is presented. The uniqueness of the case lies in the involvement of the lungs without primary liver involvement.

Background. Currently, there is a gradual increase in the number of cases of dysphonia. In individuals whose professional activities involve significant vocal strain, such as teachers, singers, etc., dysphonia may occur 1.4 times more frequently than in the general population. Dysphonia can cause depression, social isolation and decreased quality of life. In professionals, it leads to absence from work and decreased efficiency.

Results. A total of 169 patients were included and divided into two groups. The main group received complex pharmaco-neurological treatment, and the control group received only conservative therapy. All patients underwent instrumental examination before and after treatment: ENT examination using videoendolaryngostroboscopy, ultrasound with elastography, and an assessment of the severity of dysphonia symptoms using the GRBAS scale and the Voice Handicap Index-10 (VHI-10). Complex pharmaco-neurological treatment of patients with functional dysphonia caused by cervical spine pathology showed effectiveness. In the main group, the sonority of the voice improved, hoarseness, the feeling of a «lump» in the throat and pain in the neck disappeared. There was no significant improvement in the control group.

Conclusion. The results of the study show the effectiveness of complex pharmaco-neurological treatment in the main group of patients with functional dysphonia. These patients experienced: improved sonority of the voice, no hoarseness, no feeling of a «lump» in the throat, no pain in the cervical spine.

Background. The respiratory system is the main target of SARS-CoV-2 infection. In a series of studies among patients with a history of chronic obstructive pulmonary disease, severe complications during COVID-19 were observed more often than in patients with bronchial asthma and patients without bronchial obstructive pathology. There is a need to find new methods of pulmonary rehabilitation to prevent the deterioration and exacerbation of chronic bronchial obstructive pathology in patients with long-term respiratory outcomes of COVID-19. One such promising method of pulmonary rehabilitation is hyperbaric oxygenation – the therapeutic use of gas mixtures with increased partial pressure of medical oxygen. The article discusses the application of hyperbaric oxygen therapy in pulmonary rehabilitation for patients with chronic obstructive bronchial diseases, such as bronchial asthma and chronic obstructive pulmonary disease, as well as those who have recovered from COVID-19 associated with pneumonia, at least three months prior to inclusion in the study.

Materials and methods. The main group consisted of 23 patients who underwent a 10-day course of hyperbaric oxygen therapy, while the comparison group included 20 patients who did not receive hyperbaric oxygen therapy. The average scores of the dyspnea index on the mMRS scale, laboratory markers of inflammation (complete blood count, C-reactive protein, ferritin), spirometric parameters, DLco, and CT patterns were measured at the beginning of the study and three months later.

Results. The patients in the main group demonstrated a statistically significant improvement in exercise tolerance (the average mMRS score decreased from 2.4 ± 0.6 to 1.8 ± 0.4 points, p = 0.002), as well as a reduction in laboratory markers of inflammation (the average C-reactive protein levels decreased from 6.9 ± 3.9 to 4.3 ± 2.5 mg/ml and ferritin from 436 ± 22 to 427 ± 17 ng/ml, p < 0.001). The average FEV1 value in the main group increased from 84.17 ± 5 to 91.11 ± 5% of the predicted values (p < 0.001). No similar changes were observed in the comparison group. Chest CT scans showed that in the main group, reticular changes almost halved, and signs of organizing pneumonia disappeared three months after hyperbaric oxygen therapy. Statistically significant differences were noted in the overall lung involvement on CT in both groups (in the main group – from 29.7 ± 19.2 to 2.7 ± 1.8%, p < 0.001; in the comparison group – from 27.4 ± 20.8% to 21.5 ± 9.5%, p < 0.001).

Conclusion. Thus, the hyperbaric oxygen therapy method proved to be effective in treating the long-term respiratory consequences of COVID-19. Patients showed improved exercise tolerance, reduced manifestations of bronchial obstruction, and a decrease in systemicinflammatory response three months after hyperbaric oxygen therapy, while lung changes on CT resolved more rapidly.

Background. Currently, domestic neurorehabilitation is going through the stage of introducing an occupational therapist into wide clinical practice. Occupational therapy is a relatively new focus and therefore there are challenges associated with educating and retraining occupational therapists. Initially, occupational therapy involves helping patients regain lost skills for everyday activities, and subsequently promotes social and occupational integration. The goals of the intervention are determined by the patient together with the occupational therapist, who assesses the likelihood of achieving the goals and helps the patient accomplish the tasks set. Occupational therapy training involves helping the patient set and achieve goals, identify potential obstacles, and identify factors that contribute to self-efficacy. Stroke currently remains one of the main causes of mortality, long-term disability and disability of the population, restrictions on daily activity, and, as a result, the need for outside care. The dynamics of the restoration of neurological disorders does not always correlate with the restoration of lost functions of self-care and independence in everyday life. This determines the importance of the occupational therapist working with patients after a stroke. The author presented a brief review highlighting the relevance of the problem, the main part of the article is devoted to ergotherapy methods in the structure of the neurorehabilitation department abroad and in our country.

Objective. The article systematizes the available data on the ergotherapy intervention and its effectiveness for rehabilitation after stroke.

Methods. The search for literary sources was carried out using Russian and foreign databases (elibrary, CyberLeninka, PubMed, Cochrain) by keywords.

Conclusion. Occupational therapy can become an important component of comprehensive rehabilitation aimed at achieving maximum independence and improving the quality of life of people with disabilities. As the results of Russian and foreign studies show, the use of occupational therapy is extremely effective in the rehabilitation of patients: restoring the ability to self-serve and perform household and professional duties. Therefore, the introduction of occupational therapy in the department of neurorehabilitation is an urgent healthcare problem.

Background. The work is devoted to the study of the effectiveness of the use of robotic systems for the treatment of increased muscle tone of the lower extremities in children suffering from cerebral palsy. Cerebral palsy is one of the most common factors leading to disability in children, and is characterized by impaired motor function and spasticity. Recently, robotic simulators have been increasingly used in the rehabilitation of patients with cerebral palsy.

Objective. To evaluate the effectiveness of robotic simulators in the rehabilitation of patients with cerebral palsy suffering from spasticity.

Materials and methods. Analysis, synthesis, generalization of scientific literature on the research problem.

Results. Studies confirm the effectiveness of such treatment, which is manifested in a decrease in the level of spasticity, which indicates a positive effect on muscle tension and mobility of the patient. Various types of robotic trainers are used in modern rehabilitation practice. These include trainers for the upper limbs, which are equipped with manipulators or exoskeletons and are designed to restore the functionality of the arms and shoulder girdle; trainers for the lower limbs to improve walking and maintain balance, including devices that stabilize the legs during walking, as well as systems that help patients learn walking skills; robotic exoskeletons designed to facilitate walking can be used both in hospitals and at home. Different types of exercise equipment have unique functional capabilities and demonstrate varying degrees of effectiveness in the rehabilitation of patients with cerebral palsy.

Conclusion. The increased range of motion indicates an improvement in overall mobility and the ability to perform a wider range of movements. The analysis showed that different types of robotic simulators have unique functions and a level of effectiveness in the rehabilitation of patients with cerebral palsy.

Background. In September 2025, Kazan hosted Russia's largest national congress of cardiologists, with nearly 5.000 participants attending in person and more than 15.000 online. The Russian Cardiology Society, presented a satellite symposium entitled «Three in a boat: men's dreams of woman's heart». The symposium was chaired by one of the country's leading cardiologists, Academician Simon Teimurazovich Matskeplishvili, who spoke about the gender-specific approach to therapy in women patients at high cardiovascular risk. In addition, the symposium was attended by professors Dmitry A. Napalkov, who presented a report on choosing the optimal route to the target blood pressure level, and Igor V. Sergienko with a report on a combined approach to the female heart in real clinical practice.

Conclusion. The satellite symposium «Three in a boat: men's dreams of the a woman's heart» was one of the most memorable events of the Russian National Congress of Cardiologists. Speakers at the symposium discussed the latest clinical guidelines, fundamental research findings, and innovative treatment methods applicable to real-world practice, focusing on approaches, differences, and characteristics of cardiovascular disease treatment in womеn.

Background. Wound healing is a complex biological process involving a series of well-coordinated events aimed at restoring the integrity and function of the skin. This process is characterized by the coordinated activity of immune system cells. Resident and recruited immune cells in the skin secrete cytokines and growth factors that promote inflammation. They also interact with non-immune cells to remove invading pathogens and debris. Disruption of immune system regulation at any stage of the process can lead to prolongation of the inflammatory phase and the development of a pathological condition such as a chronic wound. A chronic wound is a defect that does not heal within 12 weeks. Such injuries significantly impair the quality of life of patients and are accompanied by significant economic costs for treatment worldwide. Modern antitumor treatment methods, including chemotherapy, radiation therapy, targeted therapy, and immunotherapy, significantly alter immune system function and tissue regeneration processes. In cancer patients, wound healing exhibits a number of peculiarities related to disrupted interactions between innate and adaptive immunity, altered activity of inflammatory mediators, deficiency of cellular repair elements, and disturbances of the skin microbiome. As a result, chronic non-healing wounds develop, the risk of infectious complications increases, and the effectiveness of standard treatment methods decreases. The treatment of both acute and chronic wounds remains one of the pressing issues in modern medicine. The high prevalence of acute/chronic wounds, as well as their significant impact on patients' quality of life and prognosis, necessitate the search for and implementation of effective therapeutic strategies aimed at optimizing reparative processes and reducing the risk of complications.

Results. The article reviews current data on the mechanisms of immunopathogenesis of wound healing in cancer patients, the role of antitumour therapy in its disruption, and the latest potential approaches to preventing and correcting the identified alterations.

Background. The causes of anemia during pregnancy remain multifactorial, and its adverse effects on pregnant women are severe and sometimes fatal. Intrauterine growth restriction, stillbirth, low birth weight, abortions, complicated childbirth, postpartum hemorrhage, and maternal and perinatal mortality are just a few of the complications associated with anemia during pregnancy. In view of this, there is no doubt about the need for preconception preparation and examination of women who are planning a pregnancy, in order to timely detect and treat iron deficiency anemia or latent iron deficiency.

Conclusion. The primary objective of preventing complications of pregnancy associated with iron deficiency anaemia is to diagnose it in a timely manner. The presence of iron deficiency is indicated by symptoms including pale skin and mucous membranes, dizziness, insomnia, drowsiness, nausea, orthostatic collapse, brittle nails, hair loss and brittleness, dry skin, stomatitis, and muscle weakness. Diagnostic confirmation is provided by monitoring the levels of haemoglobin and ferritin during pregnancy and after childbirth. This will assist in determining the most appropriate treatment tactics. This approach, which involves the utilisation of contemporary medications, is poised to yield enhanced pregnancy outcomes on the whole.

Background. Since its introduction, botulinum toxin type A has become an indispensable tool in aesthetic medicine, allowing not only the elimination of expression lines, but also the restoration of symmetry and correction of facial contours through the harmonious redistribution of muscle tone. Given the pace of modern life and patients' desire to maintain daily social activity, there is a growing need to optimize results and increase the duration of botulinum therapy. Among the possible solutions that could affect the effectiveness of neuromodulators, the elimination of local zinc deficiency is of particular interest. Zinc, acting as an indispensable cofactor of the light chain of botulinum toxin type A, not only stabilizes the structure of the toxin, but also dynamically supports its protease activity in presynaptic neurons. A local deficiency of this element can become a «hidden barrier» to achieving optimal aesthetic results. Recent studies reveal the dual role of zinc: in addition to its direct effect on the catalytic domain of BTA, it regulates many other processes that indirectly determine the rate of toxin elimination and the duration of the effect. However, traditional methods of correcting deficiency, such as oral supplementation, show conflicting results, highlighting the need for innovative solutions.

Results. This article systematizes data on the molecular mechanisms of zinc dependence of botulinum toxin type A, factors contributing to tissue deficiency of this trace element, and modern strategies for its correction. Particular attention is paid to clinical markers of hidden zinc deficiency relevant to everyday practice and the prospects for combined approaches combining highly purified botulinum toxin type A preparations with adjuvant zinc delivery methods. The results of the analysis are intended to revise the paradigm of preparing patients for botulinum therapy, making the correction of local zinc deficiency an important step in increasing the effectiveness and prolonging the aesthetic result. For cosmetic doctors, understanding these relationships is key to overcoming resistance, reducing the frequency of repeat procedures, and achieving lasting patient satisfaction-the most important criteria for success in modern aesthetic medicine.