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A clinical case of a patient with chronic musculoskeletal neck pain (CNP) in combination with tension headache (TH) and increased anxiety is described. The combination of these conditions is common in neurological practice. The disorders mentioned are pathogenetically related and mutually reinforce each other. In this respect, a unified comprehensive approach is required for the successful treatment of patients of this category, which is demonstrated using a clinical case from our own practice. The factors for the development and chronicity of CNP, TH are shown: misconceptions about the disease, catastrophizing the pain, increased anxiety, stress, a sedentary lifestyle, prolonged time spent at the computer, long static postures. Before contacting the Clinic for Nervous Diseases of Sechenov University (СNВ), no effect of the therapy was observed, as the factors for the development and chronicity of the pain were not assessed and not corrected, pharmacotherapy (painkillers, group B vitamins) was used in combination with ineffective non-drug treatment methods (massage, physiotherapy). An educational programme for the patient about the causes of the disease and its prognosis was not implemented, and the patient was not suggested to undergo a course of therapeutic exercise or cognitive behavioural therapy (CBT), the patient was not given any recommendations on ergonomics and physical activity during the day. In the СNB, the patient was offered a comprehensive treatment approach that included educational talks, CBT, kinesiotherapy, taping and Nimesil (nimesulide) administration. CBT is a proven effective psychological method for the treatment of CNP and TH that aims to develop accurate, realistic beliefs about the disease and adaptive behaviour in a patient, as well as skills to overcome pain and increased anxiety. In the treatment of chronic NP, it is recommended to combine CBT with kinesiotherapy, a scientifically proven effective non-pharmacological treatment method. Kinesiotherapy includes therapeutic exercises, education on correct posture and recommendations on ergonomics and lifestyle. Nimesil (nimesulide), a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has proven efficacy and safety in the treatment of musculoskeletal pain, was chosen as pharmacotherapy. It is important to mention that nimesulide was prescribed to the patient from the first days of treatment simultaneously with the start of kinesiotherapy and CBT. Against the background of pharmacotherapy, the patient experienced rapid pain relief, which contributed to adherence to recommendations to increase physical activity, ergonomics and therapeutic exercise, as well as CBT. The complex treatment helped the patient relatively quickly and effectively. After 10 days of treatment, he reported a 50 % reduction in pain and an increase in functional activity. After 2 months, the pain had completely subsided and daily activity and quality of life increased. Six months of follow-up showed the sustainability of therapeutic results achieved.

Treatment of patients with chronic non-specific back pain (CNBP) is an important issue not only in medicine, but also in modern society as a whole, as it is associated with significant socio-economic burden.The lecture presents the most common anatomical sources of CNBP, the causes of CNBP and issues of differential diagnosis. Much attention is paid to the basic principles of therapy for CNBP: drug therapy, kinesiotherapy and psychological methods. Clinical observations are presented that demonstrate the effectiveness of a multimodal integrated approach to the treatment of CNBP based on the use of cognitive behavioral therapy, educational programs and kinesiotherapy and self-monitoring test tasks.

Most hospitalized patients require the use of medications as part of the treatment process. The process of medication use and management includes medical prescription, verification of medical prescriptions, preparation of the dosage form of the drug, dispensing and administering medicines to the patient, as well as monitoring and registering effects, including adverse drug reactions. As practical experience worldwide illustrates, these stages often require constant optimization and are often susceptible to a variety of medication errors. As a result, the implementation of an appropriate centralized, personalized system for the medication use and management in hospitals is essential to ensure a safe, effective and rational approach to pharmacotherapy, both for each individual patient and for the health care system as a whole. [ABSTRACT FROM AUTHOR]

Chronic musculoskeletal pain (CMSP) is one of the most common pathological conditions that limits patients' physical activity and reduces their quality of life. The analgesic and anti-inflammatory effects of non-steroidal anti-inflammatory drugs (NSAIDs) make them the basis of pharmacotherapy for patients with chronic conditions affecting various parts of the musculoskeletal system. The main target of NSAIDs, cyclooxygenase (COX), exists in the form of two main isoforms, COX-1 and COX-2, the inhibition of each of which leads to a cascade of reactions at the cellular and tissue level that can cause both targeted pharmacological effects and side effects. The diversity of the chemical structures of NSAIDs leads to differences in their pharmacodynamic and pharmacokinetic parameters and correspondingly to differences in their efficacy and safety profile. Selective COX-2 inhibitors, coxibs, have shown an increased risk of cardiovascular side effects, which has led to significant restrictions on their use. Cardiotoxicity is not as pronounced with the non-selective COX inhibitors, but the range of their side effects is extremely wide. These side effects are dose-dependent and are characteristic, first of all, of systemic NSAIDs.The combination of systemic and topical NSAIDs makes it possible to reduce the dose of the former and improve the safety profile of anti-inflammatory therapy. Among the non-selective COX inhibitors with a satisfactory safety profile and high anti-inflammatory activity, the group of oxicams and especially tenoxicam should be emphasised, which are characterised by a maximum duration of action, which is an advantage in the treatment of patients with CMSP. This review addresses the issues of rational selection of NSAIDs based on comparative data on pharmacodynamics, pharmacokinetics and clinical trial results.

Background. Type 2 diabetes mellitus (DM) remains the most common type of DM and is associat-ed with disabling complications, reduced quality of life and reduced life expectancy. Satisfactory control of carbohydrate metabolism remains the key way to manage them. Aim. To perform a retrospective analysis of carbohydrate metabolism (in terms of glycated hemoglobin – HbA1c), the prevalence of complications, and features of hypoglycemic and concomitant therapy in patients with type 2 DM. Materials and methods. The analysis of sex and age characteristics, achieved level of HbA1c, diabetes complications, sugar-reducing and concomitant therapy according to the data of outpatient records of the patients who are on dispensary registration with an endocrinologist in the Endocrinology Department of the Consultative and Diagnostic Polyclinic of the Tomsk Regional Clinical Hospital in Tomsk was carried out. Results. 546 outpatient medical records of patients with type 2 DM were analysed, among which there were 39.6% men (n=216) with a history of type 2 DM 8.0 years [3.0; 13.0] , median age 64.0 years [54.5; 71.0] and 60.4% women (n=330), history of type 2 DM 10.0 years [5.0; 15.0], median age 70.0 years [63.0; 75.0]. The achieved HbA1c level in men was 7.6% [6.3; 9.0] and in women 7.4% [6.4; 9.1]. 19.4% of men and 13.6% of women had an aggravated history of type 2 DM. According to the history, 6.5% of men (n=14) and 3% of women (n=10) with type 2 DM had a history of stroke, and myocardial infarction 12% (n=26) and 1.5% (n=5), respectively. Among the analysed outpatient records of type 2 DM patients, 18.5% of men (n=40) and 12.4% of women (n=41) were found to have diabetic nephropathy. Diabetic retinopathy was reported in 9.3% (n=20) of men and 4.2% (n=14) of women. Diabetic macroangiopathies were detected in 29.6% (n=64) of males and 9.7% (n=32) of females. Among other chronic complications of DM, diabetic neuroosteoarthropathy was recorded in 1% (n=2) of males and 3% (n=10) of females, diabetic polyneuropathy in 25% (n=54) and 21.5% (n=71), respectively. Diabetic foot was diagnosed in 1.9% (n=4) of men and 1.8% (n=6) of women. Among comorbid pathology, obesity was diagnosed in 45.4% (n=88) of men and 69.1% (n=228) of women, dyslipidaemia in 10.2% (n=22) and 10.6% (n=35) respectively, hypertension in 39.8% (n=86) and 32.6% (n=108) of cases. The diagnosis of non-alcoholic fatty liver disease was verified in 3.7% of men (n=7) and 1.8% of women (n=6), chronic heart failure in 7.4% of men (n=16) and 2.4% of women (n=8) registered for type 2 DM. According to the analysed outpatient records, 4.1% (n=23) of patients received diet therapy, 48.3% (n=263) received monotherapy and 47.6% (n=260) received combination therapy for type 2 DM. Metformin was the most commonly used monotherapy for type 2 DM 36.1% (n=197), followed by insulin 6.9% (n=38), sulfonylurea derivatives – 2.7% (n=15). Combination of metformin and dipeptidyl peptidase-4 inhibitors (13.9%) was the most commonly used combination therapy. Conclusion. Analysis of the current situation in the diabetology service will help to identify weaknesses and strengths, which is necessary to optimise existing therapeutic approaches in accordance with current clinical recommendations.

Drug-drug interactions (DDIs) are a major cause of hospital admissions, accounting for 16.6% of ADRs and about 1% of all hospital admissions. Polypharmacy is on the rise, with a Swedish population-based study of people aged ;;;75 years showing that the prevalence of polypharmacy increased from 27% in 1988 to 54% in 2001 and to 65% in 2006. The aim of the study was to analyze the databases on DDI and to assess the possibility of their use in managing the risks of pharmacotherapy in the Russian Federation and the EAEU. Results. The main DDI databases are characterized. The degree of inconsistency in data on the number of DDI, severity and clinical recommendations was determined. The basic requirements for the completeness of information in databases are formulated. The necessity to harmonize approaches to providing information about DDI, as well as the need to create local databases for medical organizations were revealed. A computer program has been created to minimize the risks of DDI in clinical practice, for expert and scientific purposes. Conclusions. Databases and programs for DDI have different goals, a different set of data on DDI with varying degrees of evidence, differences in assessment of severity, likelihood of occurrence, clinical recommendations for treatment and correction of DDI. The variability of information is due to the lack of a unified system for assessing the severity and likelihood of potential negative consequences of DDI; different purposes for creation; difference in budgets at creation. This situation leads to warning redundancy and physician fatigue from insignificant or unproven DDIs. Based on the identified requirements for local databases, a computer program for modeling rational pharmacotherapy for lower respiratory tract infections was created and received a certificate of state registration.

Objective: a comparative study of the peculiarities of pharmacotherapy of rheumatoid arthritis (RA) in presence and in absence of interstitial lung disease (ILD).Material and methods. The study included 1034 patients with active RA who met the 2010 ACR/EULAR criteria. Patients were divided into two groups: with ILD according to high-resolution computed tomography of the lungs (n=82) and without ILD or other types of chronic obstructive pulmonary diseases, including bronchial asthma (52 patients excluded; n=900). Based on medical documentation, archived medical records and medical history, a “drug card” was created for all stages of pharmacotherapy of patients with active RA. The Cumulative Illness Index Score (CIRS) was used to assess the profile and severity of comorbidities.Results and discussion. The main indicators of RA activity in the patients of the two groups were comparable, but a greater number of comorbidities (p˂0.0001) and a higher value of the CIRS multimorbidity index (p˂0.0001) were found in the group with ILD. The presence of ILD had no influence on the frequency of prescription, the total duration of use and the maximum dose of glucocorticoids (GC) (p˂0.05). The average dose of GC was statistically significantly higher in the group with ILD (p=0.008). These patients were taking disease-modifying antirheumatic drugs (DMARDs): methotrexate (p=0.04), leflunomide (p=0.02) and sulfasalazine (p=0.03), less frequently, but they took hydroxychloroquine significantly more frequently (p=0.02) with a comparable total duration of use of each medication. RA patients with ILD and without ILD received biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in 62.2 and 59.6% of cases, respectively (p˂0.05). At the same time, patients without ILD had experience of taking a greater number of different bDMARDs/tsDMARDs (p=0.03). In the group with ILD, patients more frequently received anti-B-cell therapy (p˂0.0001) and significantly less frequently drugs of other classes: tumour necrosis factor α inhibitors (p˂0.0001) and interleukin 6 inhibitors (p=0.01), T-cell costimulation blocker (p=0.04) and Janus kinase inhibitors (p=0.001). Patients with ILD were statistically significantly older at the start of bDMARD/tsDMARD therapy (p˂0.0001), and the period from the onset of RA to the start of bDMARD/tsDMARD therapy was comparable in both groups (p˂0.05).Conclusion. The observed peculiarities of pharmacotherapy in the group with ILD (frequency of use, choice and dose of GC, DMARDs, biologics and tsDMARDs) are probably related to the presence of ILD on the one hand and to the characteristics of concomitant pathology and older age on the other, as the activity of RA was comparable in our patients with and without ILD.

Aim. To study the features of treatment of patients with various types of coronary artery disease (CAD) and type 2 diabetes (T2D) at various healthcare stages.Material and methods. The comparative clinical study included 412 patients of both sexes with acute and chronic coronary artery disease. Depending on the glycemic status and CAD type, patients were divided into four subgroups: subgroup 1a (n=100, 56,6±0,96 years, male/female 67/33) — with acute CAD and T2D; subgroup 1b (n=106, 58,7±1,01 years, male/female 75/31) — with acute CAD without T2D; subgroup 2a (n=102, 57,9±1,04 years, male/female 72/30) — with chronic CAD and T2D; subgroup 2b (n=104, 60,2±0,9 years, 69/35) — with chronic CAD without T2D. The selection and mean doses of standard and hypoglycemic therapy were analyzed.Results. Initially, 86% and 81% of patients with diabetes in subgroups 1a and 2a adhered to glucose-lowering therapy. Among patients with chronic CAD, more than 1/4 (26,4%) received insulin therapy versus 2% in the group of patients with acute coronary syndrome (ACS) and diabetes. After discharge from hospital, oral hypoglycemic therapy was prescribed to 74% of patients with ACS and 48% of patients with chronic CAD. The prescription of insulin therapy for people with ACS increased 5 times (up to 10% of the total number of patients with ACS and T2D). By the time of hospital admission, 70% and 71,5% of patients with ACS and chronic CAD with diabetes received acetylsalicylic acid as an antiplatelet agent, respectively. During hospitalization, all patients with acute CAD were prescribed dual antiplatelet therapy, as well as triple antiplatelet therapy in the case of atrial fibrillation/flutter. It is noteworthy that in the group of patients with chronic CAD, less than 70% received statins. In patients with chronic CAD and diabetes, this parameter was even lower, amounting to 59,8%. At the outpatient stage, all patients, with the exception of the group with chronic CAD without diabetes, took beta-blockers (up to 65%). In the hospital, the use of beta blockers increased to 95%. During inpatient treatment, angiotensin-converting enzyme inhibitors and sartans were prescribed 1,5-2 times more often than in the prehospital stage.Conclusion. The study indicates insufficient prescription of standard CAD and glucose-lowering therapy. Careful inpatient selection of therapy requires continuity at the outpatient stage.

Bronchial asthma is a widespread disease of the respiratory system and has a significant impact on the quality of life of patients, including elite athletes. The main objectives of the treatment of asthma is to achieve symptom control, prevent exacerbations and prevent the development of complications. The article describes approaches to the management and choice of treatment tactics for patients with asthma who play sports professionally.

Background. Treatment and prevention of inflammatory periodontal diseases represent a serious general medical and social problem, which remains relevant due to the significant prevalence of periodontitis among the population, as well as the associated loss of teeth and the negative impact of periodontal foci of infection on the body as a whole. Chronic generalized periodontitis is difficult to treat: it is only possible to achieve periods of remission. Therefore, it is of great theoretical and practical importance to develop further ways to improve methods for treating inflammatory-dystrophic damage of periodontal tissues in chronic generalized periodontitis.Objective. To perform an index estimation of treatment efficacy in patients with moderately severe chronic generalized periodontitis.Methods. An experimental randomized single-arm study was conducted examining 204 patients diagnosed with moderately severe chronic generalized periodontitis. Patient examination and data analysis were carried out at the Dentistry Department of the Stavropol State Medical University and the Department for General Practice Dentistry of the Kuban State Medical University in 2021–2022. The study included patients aged 35 to 65 years diagnosed with moderately severe chronic generalized periodontitis. Patients with somatic diseases in the decompensation stage were not eligible for the study. The patients were randomly divided into three groups (closed-envelope method). Group 1 was treated using conventional methods. As well as conventional therapy, Group 2 was prescribed vitamin D (Aquadetrim® at a dose of 5000 IU once per day while monitoring vitamin D blood level). The third group of patients was prescribed conventional therapy along with the developed pharmacotherapy, which included vitamin D (Aquadetrim® at a dose of 5000 IU once per day), vitamin A (3.44% oil solution of retinol acetate at a dose of 50 000 IU, 15 min after a morning meal), and 2-ethyl-6-methyl-3-hydroxypyridine (Mexidol® at a dose of 125 mg twice a day). In each patient, the treatment efficacy was analyzed in adjacent oral cavity segments (split-mouth design) according to clinical pocket depth, attachment loss, and bleeding on probing. Also, the authors used the X-ray index to assess the condition of osseous structures and the simplified oral hygiene index. The specified indices were estimated prior to treatment and at one and 12 months following treatment. The statistical analysis of study results was performed using Excel Microsoft Office 2016 (Microsoft, USA).Results. The obtained data indicate that the immediate clinical outcomes (after one month) of combination therapy in patients from all three groups were approximately the same. However, the efficacy of treatment measures in the long-term period (12 months) was different, as evidenced by the dynamics of index values. Only in Group 3 patients, the full implementation of pharmacotherapeutic measures as part of the combination therapy of periodontitis ensured a stable therapeutic effect throughout the entire period of observation.Conclusion. The data obtained 12 months following treatment indicate that the additional prescription of the developed pharmacotherapy contributed to prompt inflammation relief in periodontal tissues, providing a stable treatment outcome and long-term remission.

Background. The superficial veins thrombophlebitis (SVT) of lower extremities treatment can include conservative therapy (pharmacotherapy), crossectomy and phlebectomy. Objective: рharmacoeconomic evaluation of pharmacotherapy, crossectomy (in combination with pharmacotherapy) and phlebectomy (in combination with pharmacotherapy) in patients with SVT of lower extremities. Material and methods. Pharmacoeconomic evaluation was carried out using cost-effectiveness analysis (CEA) by calculating the costeffectiveness ratio (CER). The relapse/progression of the disease within 3 months after the end of treatment, the dynamics of pain, psychological, physical, social factors and the visual analog scale (VAS) indicator were used as parameters of clinical effectiveness. To assess the reliability of the obtained results, a deterministic, multivariate sensitivity analysis was performed. Results. Considering part of patients without progression and relapse within 3 months after the end of therapy as an indicator of clinical effectiveness, it was found that median CER for pharmacotherapy (22069,01) was significantly lower than for crossectomy (83353,91) and phlebectomy (95702,96) (p=0,000). Also median CER for crossectomy technique was significantly lower than for phlebectomy (p=0,003). The CER values for the dynamics of pain, psychological, physical, social factors and VAS indicators were significantly lower for pharmacologic treatment than for crossectomy and phlebectomy. There were no statistically significant differences between CER values for crossectomy and phlebectomy. Conclusion. It was established that if there are no medical contraindications, it is economically feasible to carry out pharmacotherapy for SVT of lower extremities, which requires the lowest costs to achieve full recovery. The pharmacoeconomic efficiency of crossectomy and phlebectomy are comparable.

BACKGROUND: A substantial increase in the prevalence of eating disorders has been noticed over the past decades. Priority in the treatment of eating disorders is justifiably given to psychosocial interventions. However, it is also well known that centrally acting drugs can significantly affect appetite and food consumption. AIM: To narratively review the available neurobiological data on the mechanisms of central regulation of eating behavior as a rationale to summarize pharmacological strategies for appetite modulation in eating disorders. METHODS: The authors have carried out a narrative review of scientific papers published from January 2013 to March 2023 in the PubMed and Web of Science electronic databases. Studies were considered eligible if they included data on the neurobiological mechanisms of appetite regulation or the results of clinical trials of centrally acting drugs in eating disorders. Relevant studies were included regardless of their design. Descriptive analysis was used to summarize the obtained data. RESULTS: The review included 51 studies. The available neurobiological and clinical data allowed us to identify the following pharmacological strategies for appetite modulation in eating disorders: serotonergic, catecholaminergic, amino acidergic and peptidergic. However, implementation of these data into clinical practice difficult due to an insufficient number of good-quality studies, which is particularly relevant for adolescents as there is a research gap in this population. CONCLUSION: The progress in neurobiological understanding of the mechanisms of central regulation of appetite opens opportunities for new pharmacotherapeutic approaches aimed at changing the patterns of eating behavior. Obviously, treatment of eating disorders is a much broader problem and cannot be reduced to the correction of eating patterns. Nevertheless, at certain stages of treatment, drug-induced modulation of appetite can play an important role among multi-targeted biological and psychosocial interventions. Translation of neurobiological data into clinical practice requires a large number of clinical studies to confirm the long-term efficacy and safety of pharmacotherapeutic approaches and to develop personalized algorithms for the treatment of various forms of eating disorders in different age groups.

Borderline personality disorder (BPD) is a severe and heterogeneous psychiatric disorder known to begin at a young age, often in adolescence. It is associated with suicidal behaviour and self-harm. Up to 10 per cent of BPD patients die by suicide, so it is very important to find effective methods to alleviate the symptoms of this disorder [1]. A combination of psychotherapy and pharmacotherapy seems reasonable. An obstacle to widespread access to psychotherapy is the relatively high costs associated with the salaries of highly qualified psychotherapists. Another impediment is the long time required for effective psychotherapy and the frequent phenomenon of patients with unstable emotions discontinuing therapy prematurely. On the other hand, pharmacotherapy is necessary during periods of aggravation of the disorder, such as increased emotional lability, dysphoric states associated with aggression, impulsive behaviour and the presence of pseudopsychotic symptoms. This paper is a compilation of available treatments for borderline disorder. In the context of considering effective therapies for BPD, an important aspect is the need to increase the length of therapy and the availability of professional help for patients. In addition, research points to the benefits of combining psychotherapy with pharmacotherapy to more effectively alleviate the symptoms of this heterogeneous disorder. It is noteworthy that the relatively high cost of psychotherapy and the need to decrease.

Systemic sclerosis (SSc) is a multifaceted autoimmune disorder characterized by widespread organ involvement, impacting the skin, lungs, gastrointestinal tract, and blood vessels. Patients often confront a reduced lifespan, primarily attributed to pulmonary complications. Current therapeutic strategies concentrate on organ-specific interventions to mitigate inflammation and alleviate symptoms. Immunosuppressive drugs, vasodilators, and anti-fibrotic agents are commonly employed, but ongoing research explores novel drugs and therapeutic approaches. Autologous stem cell transplantation is considered in rapidly progressing interstitial lung disease, although potential complications must be carefully weighed. Recent studies delve into the intricate pathogenesis of SSc, revealing abnormalities in metabolic pathways and protein regulation. The disease manifests with diverse symptoms affecting various organs, with vascular involvement significantly contributing to morbidity, especially pulmonary arterial hypertension. Complications, including heightened susceptibility to infections, are exacerbated by the disease and its treatments. Ongoing research investigates potential treatments such as GPR68 antagonists, soluble guanylate cyclase activators, and melanocortin 1 receptor agonists, displaying promising results in improving pulmonary function. Multiple clinical trials for various drugs are currently underway. In conclusion, addressing the complexities of systemic sclerosis requires a multidisciplinary approach. Understanding its intricate pathogenesis and developing targeted therapies are pivotal for enhancing patient outcomes and extending survival.

Introduction and purpose Obesity, a pervasive global pandemic intricately linked to various comorbidities, necessitates a comprehensive and nuanced approach. This article delves into the intricate realm of obesity guidelines, underscoring the significance of lifestyle modifications, preventive measures for childhood obesity, population-based strategies, clinical management protocols, and vigilant monitoring. GLP-1 drugs, originally designed for type 2 diabetes management, exhibit multifaceted effects beyond glycemic control. They influence appetite regulation, gastric emptying dynamics, and potentially contribute to cardiovascular health improvements. However, the commendable effects come with a caveat - potential side effects necessitating careful consideration in clinical decision-making. Despite gaining popularity through celebrity endorsements, this article firmly underscores the need to view GLP-1 pharmacotherapy as a recommended intervention rather than a miraculous solution. A brief description of the state of knowledge Integral to the obesity discourse is the imperative to address weight stigma, demanding evidence-based approaches in both clinical and public health domains. The narrative extends into the future landscape of obesity pharmacotherapy, contemplating the potential role of probiotics. Emphasizing the necessity for long-term studies and randomized trials, it positions probiotics as a low-risk alternative with significant potential in mitigating obesity while simultaneously addressing concerns related to antibiotic resistance. Summary The pursuit of a balanced and effective approach to obesity management necessitates a nuanced understanding of medical interventions, consideration of societal perceptions, and exploration of innovative possibilities within the evolving landscape of healthcare.

The obesity prevalence in children has increased dramatically over the past four decades and has epidemic nature. Lifestyle correction in majority of obese children and adolescents leads only to slight success in reducing body weight (that usually restores to initial level). The increasing availability of pharmacotherapeutic agents approved by Food and Drug Administration (FDA) for body weight reduction in children provides physicians with new and effective tools for obesity management. Phentermine/ topiramate is a combination medication (with once-a-day administration, controlled release) that has been recently approved by the FDA for pediatric obesity therapy. Its efficacy is significantly higher compared to orlistat and phentermine (in monotherapy), two other FDA-approved drugs for this age group. The aim of this review is to analyze the literature on the topic of phentermine and topiramate mechanism, as well as these drugs safety and efficacy as monotherapy and in combination in children and adolescents with obesity.

Introduction. This publication represents the materials of the traditional scientific conference of senior students of the Institute of Pharmacy of the Sechenov University and the Faculty of Fundamental Medicine of the Lomonosov Moscow State University under the general motto "Drug. Medicine or... Difficulties in translation", which took place on May 27, 2022. Every year the topic of such a conference is the most pressing medical and social problems related to the effectiveness and safety of medicines. This conference was timed to coincide with the 10th anniversary international congress on diseases of the head and neck organs, which was taking place at that time, and was devoted to the problem of pharmacotherapy of oncological diseases.In Russia, as well as in the world, oncological diseases are widespread and occupy the second place among the causes of death. So, according to statistics, every 40th person in Russia has an oncological disease.Thousands of researchers around the world are striving to understand the etiology of cancer, improve the efficiency of diagnosis and treatment of the disease, ensuring slow but steady progress in solving these problems.Early diagnosis and timely targeted treatment are the key to successful therapy and a favorable outcome.The presentations discussed the main directions in the development of anticancer drugs that provide greater efficacy and safety of treatment, modern approaches to early cancer diagnosis using microRNA as tumor markers. Of great interest was the report on the possibility of predicting the toxicity of drugs even before the stage of chemical synthesis on the basis of computer-aided drug design. Also, attention was paid to the problems of palliative care and rehabilitation of cancer patients, psychological, ethical and legal aspects of this. Discussion and medical assessment of these issues will certainly arouse the interest of a fairly wide audience. The following are only three reports from those that have sounded, giving an idea of the "classical" methods, a new direction in treatment, and the technological implementation of targeted tumor therapy.

Introduction. Brain tumours constitute approximately 1% of all newly diagnosed cancers. Their manifestation typically involves headache, neurological impairment, focal onset seizures and syndromes related to tumour location. Severe headache presents as a prevailing symptom and occurs in over 50% of patients. Brain tumour associated headache exerts significant effect on quality of life in cancer patients. The following article aims to provide a comprehensive overview of most common and promising brain tumour related headache treatment strategies. State of knowledge. Headache in brain tumour patients arises from traction or displacement of intracranial pain-sensitive structures, such as vascular tissue, dura mater or periosteum. This can be caused by tumour’s mass itself, by tumour associated oedema or as a sequela of anti-tumour treatment. Most common therapeutic modalities include tumour surgical resection, cerebral oedema management, radiotherapeutic interventions and administration of analgesic agents. Complete removal of the tumour stands as the most effective approach, often bringing substantial alleviation in majority of cases. Conclusion. Headache affects the majority of individuals afflicted by brain tumours. Not all patients are suitable candidates for the resection of the underlying neoplasm. In such instances, the application of alternative approaches might be beneficial. Ongoing and future investigations may enhance the development of novel treatment strategies, possibly influencing the well-being of cancer patients, especially within palliative care area.

Aim. To create and train a neural network (NN) of a predictive personalized model of pharmacotherapy choice in patients with heart failure with mildly reduced ejection fraction (HFmrEF) of ischemic origin.Material and methods. The study included 170 people with HFmrEF of ischemic origin, who on the background standard pharmacotherapy, received a beta-blocker (BB) or BB+mineralocorticoid receptor antagonist eplerenone (EP): bisoprolol (BIS); BIS+EP; nebivolol (NEB); NEB+EP. Patients underwent echocardiography and were analyzed for serum aldosterone (AL), tumor necrosis factor-α (TNF-α), matrix metalloproteinase 9 (MMP-9). To create the NN model, the following approximate predictive function of parameters was used: age, AL, TNF-α, MMP-9, sphericity index (SI), type of pharmacotherapy. The result of this function is a parameter vector: AL, TNF-α, MMP-9, SI and quality of life (QOL). The designed NN model is implemented in the Matlab software package for solving machine learning and Data Science problems. The NN model is represented as a connected graph and NN function. Dichotomous analysis was used to compare the effect of treatment types in pairs. For intergroup comparison of therapy, the Wilcoxon W test method. The critical significance (p) was considered

A common tool for detecting mild cognitive impairment (MCI) is the Montreal Cognitive Assessment (MoCA). An extension of the standard MoCA testing – MoCA-Memory Index Score (MoCA-MIS; Memory Index, MI) – allows a deeper study of the mechanisms of MCI formation. We consider the drug Prospecta as an effective measure to prevent the progression of MCI.Objective: to study the efficacy and safety of Prospecta in the treatment of MCI in patients with cerebrovascular disease (CVD) in real clinical practice.Material and methods. The observational program PRIORITET included 192 patients of both sexes aged 40 to 74 years inclusive (mean age 63.6±8.8 years) with MCI and CVD, they were prescribed Prospecta, two tablets twice a day during 24 weeks. The presence of MCI was confirmed by testing on the MoCA scale; MI was assessed additionally`. At the end of treatment, the condition of patients was assessed using the Overall Clinical Impression Scale and the safety of the therapy.Results. The change in the mean score on the MoCA scale after 24 weeks of therapy with Prospecta was 5.3 (p26 points), reached 48.9%. Additionally, patients were divided into groups depending on the results of testing on the MoCA scale and MI. During therapy with Prospecta, the number of patients in the MIS

A strategic approach is crucial to the management of patients with osteoarthritis (OA). It should be based on the current understanding of the pathogenesis of OA as an inflammatory disease. A review of current clinical guidelines for the management of patients with OA shows significant differences in the evaluation of pharmacological approach, especially the place of symptomatic slow-acting drugs for osteoarthritis, (SYSADOA) and a certain consensus in relation to non-pharmacological methods (primarily exercise, patient education, body weight control, various physiotherapy methods, orthotics and massage/manual therapy). It should also be taken into account the international “treat to target” recommendations, the main idea of which is careful regular monitoring of the patient’s condition and adaptation of treatment tactics depending on the response to treatment. Based on the analysis of literature data and their own clinical experience, the authors developed an algorithm for the strategy of complex therapy of OA, including the following steps: 1) pain control (2-4 weeks), 2) inflammation control (4-6 weeks); 3) control over cartilage degradation (6 weeks – 12 months). For each stage, a specific combination of systemic pharmacotherapy (non-steroidal anti-inflammatory drugs, SYSADOA), intra-articular administration of glucocorticoids and hyaluronic acid, exercises and magnetotherapy (pulsed electromagnetic field) was proposed. A staged comprehensive strategy for the treatment of patients with OA should help to achieve control over the symptoms, while minimizing the duration of NSAIDs and avoiding polypharmacy, and further achievement of inhibition of structural progression.

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry.Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 – in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards – from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0±1.5 months.Results. The age of post-COVID patients with CVMM was 73.7±9.6 years, without CVD – 49.4±12.4 years (p0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p

Introduction. Varicose veins are a common disease with a chronic course and a high risk of complications and cosmetic defects. Venotonic drugs are widely used in conservative treatment of varicose veins.Aim. To study the comparative efficacy of venotonic drugs for local application in experimental conditions.Materials and Methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied drugs were applied in the course of 14 days from the operation. The assessed parameters were the change of local blood flow velocity in the skin in the dynamics and the degree of vascular permeability. The rate of local blood flow was assessed by Doppler ultrasound. Changes in vascular permeability were studied by the degree of extravasation of Evans blue dye in the Miles test. The results were processed using the methods of variation statistics.Results. The study showed that under the conditions of experimental chronic venous insufficiency, a course of application of all the analyzed drugs resulted in an increase in the rate of local blood flow in the skin and a decrease in the degree of vascular permeability. It was noted that application of the investigated gel based on escin, heparin and essential phospholipids to the skin of animals resulted in reliably (p < 0,05) lower indices of vascular permeability in comparison with the rats which received a course therapy with the heparin-containing gel; combined cosmetic agent as well as the gel based on troxerutin, heparin and dexpanthenol.Discussion. The results obtained testify that application of external dosage forms of combined venotonic drugs promotes the regression of chronic venous insufficiency manifestations. Maximum evident effect was registered while applying the studied drug, that can be related to its complex composition including essential phospholipids, heparin and aescin. It is known that aescin is a phlebotonic with a high degree of percutaneous absorption, the effect of which is significantly potentiated by the phospholipid component.Conclusions. The application of the combined product based on heparin, aescin and essential phospholipids provided an optimum rate of onset of pharmacological effect compared to the other analysed compositions.

Objective: аssessment of orlistat, liraglutide and sibutramine consumption in the Russian Federation as drugs recommended by the Russian clinical guidelines for the pharmacotherapy of obesity.Material and methods. From IQVIA database, the information was selected on retail sales and procurement of the specified drugs at the expense of the federal and regional budgets in the period of 2011–2021. The consumed volumes of each drug were recalculated into the number of defined daily doses (DDDs) for each international nonproprietary name in accordance with the World Health Organization methodology.Results. It was demonstrated that over a 10-year period there was a tendency to reduce the consumption of drugs for the treatment of obesity from 83.03 million DDDs in 2011 to 71.7 million in 2021. Sibutramine consumption dominated throughout the observation period: its share ranged from 76% to 84%. The proportion of people receiving obesity pharmacotherapy in the Russian Federation was about 0.5%. Herewith 58–66% of DDDs sales took place in 3 regions: Moscow, Moscow Region and Saint Petersburg.Conclusion. Low efficacy, high frequency of adverse effects, frequent weight gain after therapy termination, as well as low orientation of doctors to the need for pharmacotherapy are probably the main factors determining the low prevalence of using drugs for the treatment of obesity in Russia.

Background. The expansion of the use of herbal medicine as a component of the complex treatment of diseases has led to the development of scientific and practical interest in the study of the chemical composition of plant materials. The high content of a wide range of biogenic elements in unofficial natural raw materials makes it possible to expand the raw material base of cultivated plant raw materials for medical purposes. Purpose. It consists in determining the content of biogenic elements of different morphological parts (grass and roots with rhizomes) in the plant material of Scutellaria baicalensis Georgi and Scutellaria galericulata L. Materials and methods. The basis for the study was the method of atomic emission spectrophotometry, which makes it possible to study a wide range of chemical elements in plant materials. Grass and rhizomes with roots Scutellaria baicalensis Georgi and Scutellaria galericulata L., cultivated in the Astrakhan region, were selected as the subject of the study. Statistical processing of the study results was performed using the STATISTICA software package. Results. As a result of an experimental study, it was found that the greatest amount of biogenic elements is contained in the roots and rhizomes of Scutellaria baicalensis Georgi and Scutellaria galericulata L. The content of biogenic elements in plant materials significantly exceeds their daily requirement for humans. Conclusion. The study revealed the prospects for further study and introduction into medical practice of raw materials Scutellaria baicalensis Georgi and Scutellaria galericulata L., since this raw material has a high content of macro- and microelements.

Introduction and purpose: While irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common problems in everyday clinical practice, their treatment often remains inefficient. The aim of our work is to present the newest discoveries and research conducted in the topic, while putting special accents on methods available in Poland. We decided to refer to British Society of Gastroenterology guidelines of treatment of IBS and FD as commonly accepted treatment standards in Europe. Description of the state of knowledge: Number of patients suffering from IBS and FD remains high. According to current research, there are some new therapeutical options in IBS: fecal microbiota transplant, spinal catepsin S, olorinab and tenapanor. Methods already being in use in other applications such as vitamin D supplementation, losartan and fecal microbiota transplant are also being investigated. Fecal microbiota transplant seems the most promising one. There are no new treatment options in FD, however there are new research on already used rifaximin and prokinetics, which show their efficacy. Intensive research is being conducted on the use of herbal medicines in treatment of FD. Even though some papers prove the effectiveness of acupuncture we have decided to omit this topic due to its controversial nature. Conclusions: Treatment of IBS and FD remains difficult, there are few advances in that area. Unconventional methods such as herbal medicine and fecal microbiota transplant seem to be gaining in importance.

The worlds older population is growing dramatically. At the same time, ensuring an appropriate high standard of living for the elderly by reducing of morbidity and disability of geriatric patients is one of the main objectives of the modern healthcare system. However, changes associated with body aging necessitate application of novel approaches to the correction of pharmacotherapy and usage of specialized dosage forms. Such medicinal products provide both an appropriate therapeutic effect and facilitate their use. Presented review considers several features of pharmacotherapy of geriatric patients.

The article presents clinical study results of the efficacy and safety of combination therapy with sibutramine and metformin (fixed combination) in comparison with sibutramine therapy with microcrystalline cellulose in patients with alimentary obesity.The aim is to evaluate the efficacy and safety of using the sibutramine+metformin fixed dose combination (Reduxin® Forte) and compare it with the sibutramine + microcrystalline cellulose combination (Reduxin®) in patients with alimentary obesity in the course of the obesity therapy.Materials and methods. Male and female patients (240 people) aged 18 to 65 years inclusive with alimentary obesity, meeting the inclusion criteria and not meeting the non-inclusion criteria, were randomized into 2 groups in a 1:1 ratio. One group (n=120) received sibutramine+ metformin p. o., 1 tablet (850 mg + 10 mg) once per day, the second group (n=120) received sibutramine+ microcrystalline cellulose (MCC) p. o., 1 capsule (10 mg + 158.5 mg) once per day in the morning. On day 30 ± 1, in the absence of a 2 kg weight loss compared to the first visit, the dose was increased in accordance with the medical instruction. The therapy period was 180 days. The randomization list was generated by the factory method of random numbers. The efficacy and safety were assessed by anthropometric, clinical and laboratory parameters and the SF-36 questionnaire. The proportion of patients who achieved a decrease in body weight by more than 5% in 6 months, the magnitude and dynamics of changes in body weight and body mass index, waist and hip measurements, their ratios, changes in lipid profile, blood pressure, as well as the total number of adverse events, their frequency and nature of occurrence were analyzed.Results. The both drugs have demonstrated efficacy in all parameters of the obesity therapy. At the same time, in a comparative analysis, a statistically significant advantage of therapy with sibutramine + metformin was demonstrated in relation to the proportion of patients who had achieved more than 5% weight loss (body weight dynamics). Significant benefits were shown in terms of the magnitude of the change in body mass index (BMI); there was a statistically significant increase in the proportion of the patients who had switched from one category of BMI to another. By the end of the study, the vast majority of patients had no longer met the criteria for the diagnosis of “Obesity”. There was also a statistically significant benefit of sibutramine + metformin in terms of lowering triglycerides and low-density lipoprotein levels. The analysis of the safety parameters of sibutramine + metformin confirms a high safety profile of the drug, a comparative statistical analysis of adverse events in terms of their presence, severity, causal relationship with therapy and outcome have not revealed intergroup differences. Adverse events were transient and did not require discontinuation of therapy.Conclusion. The results of the study showed that therapy with Reduxin® and Reduxin® Forte provides a pronounced decrease in body weight. However, the use of a fixed combination has a more effective positive effect on the lipid profile and patients’ quality of life, which, combined with a high safety profile, proves the possibility and expediency of using Reduxin® Forte for the treatment of obesity and restoring metabolic health, even in patients without additional carbohydrate metabolism disorders.

The origin of one of the main hindrances of successful pharmacotherapy is the hidden gap between the mental horizon of the doctors on one side and the deep-rooted motivation of patients on the other side. Both sides are not aware of the personal and social background of this gap. A questionnaire based on main principles of Positive and Transcultural Psychotherapy is introduced as a guideline to discover this gap and thus to open up a way for new solutions. Sometimes pharmacotherapy is preferred by patients who are not aware of a hidden conflict in their lives as origin of their suffering. Using this questionnaire works with this preference and widens the horizon of the patients, which is restricted by the hidden conflict. Thus, this conflict can be discovered to find a new way for a better solution

Insomnia is the most common form of sleep disturbance in childhood. Sleep disorders and a decrease in its duration and quality lead to the development of cognitive disorders, change emotional and behavioral functions of the developing organism, and negatively affect medical and psychological aspects that require medical correction. The article provides an overview of current literature data on pharmacological approaches to insomnia therapy in childhood. The general principles of treatment and the use of various pharmacological groups of drugs are discussed. It is shown that pharmacotherapy of childhood insomnia should be carried out based on knowledge about the age characteristics of patients, efficacy, safety, analysis of pharmacodynamic and pharmacokinetic parameters of the drugs used. Drug therapy should be combined with cognitive behavioral techniques, including adherence to sleep patterns and hygiene.

Introduction: Worldwide, cannabis is the most widely used illegal psychoactive substance and the third most common drug, after alcohol and tobacco. Cannabis use disorder (CUD) affects approximately 10% of the 193 million cannabis users worldwide. In recent years, cannabinoids have become more and more popular. The CUD is becoming a growing social and health problem. The search for effective forms of pharmacotherapy is still ongoing, and an effective combination of psychotherapy and pharmacotherapy may be crucial for the future of CUD treatment. Material and method: The article was based on a review and analysis of publications and discoveries in recent years, which were available in the PubMed and Google Scholar database. Results: 82 study participants attempted abstinence from cannabis use. In the final primary endpoint analysis, both 400 mg of CBD and 800 mg of CBD were more effective than placebo in reducing cannabis use. 50 people who were addicted to cannabis treated with gabapentin showed a significant reduction in cannabis use and cannabis withdrawal compared to placebo. Moreover, 70 men addicted to cannabis were randomized and those, who used FAAH inhibitors reported fewer cannabis withdrawal symptoms, less cannabis use and lower THC urine levels than placebo users. Conclusions: Gabapentin has been proven to show a reduction in CUD. The use of CBD, FAAH inhibitors and psychotherapy MET/CBT/CM also appear to be effective. In addition, the use of the principles of People-First Language, avoiding slang and idioms, using medical and curing vocabulary, respects the addicted person, and also positively influences the chances of abstinence.

Introduction: Alzheimer's disease is a degenerative disease of the brain, caused by the deposition of beta-amyloid and tau protein. It is characterized by progressive memory and behavior disorders which, over time, completely prevent the patient from functioning properly in everyday life, performing work and disrupting social contacts. Communication problems arise and patients forget more and more words. Unfortunately, we are not able to completely stop the progression of this disease, but we can only delay its development. To delay the progression of the disease, pharmacotherapy includes acetylcholinesterase inhibitors and NMDA receptor antagonists. Matherials and methods: This article, based on a PubMed review of available research, examines the impact of rivastigmine, donepezil, memantine and psychotherapy on delaying disease progression. Results: A number of studies have investigated the effect of 6-12 milligrams of rivastigmine, 10 milligrams of donepezil and 20 milligrams of memantine on patients' ability to communicate. The results were checked using the MMSE, ADAS or SIB scales and interviews conducted regularly by clinicians. In addition, patients were subjected to various forms of psychotherapy, including reminiscence therapy and cognitive therapy. All groups experienced significantly less deterioration in their functional stage of disease compared to the placebo groups. Conclusions: The best results in the treatment of Alzheimer's disease can be obtained by combining pharmacological therapy with non-pharmacological effects. Thanks to this form of treatment, the progression of the disease is delayed, and patients retain their communication abilities for longer.

Microcirculation dysfunction plays a significant role in the development of post-COVID syndrome caused by SARS-CoV-2. However, there have been no studies on changes in microcirculation parameters during pharmacotherapy in patients with post-COVID syndrome. To date, there are no consensus recommendations for the treatment of post-COVID syndrome in the Russian Federation.The aim of the study was to analyse the pattern of clinical manifestations of post-COVID syndrome and bulbar conjunctival angioscopy (BCA) results in a young patient undergoing treatment after mild COVID-19.Materials and methods: analysis of the clinical case of a patient who was followed up at the Therapeutic Ophthalmology Centre between February and September 2021. BCA was performed in a patient with post-COVID syndrome to compare quantitative and qualitative microcirculation parameters before and after the treatment.Results: the paper summarises clinical observation data on a 23-year-old female patient with post-COVID syndrome with mainly neuropsychiatric manifestations and a microcirculation dysfunction as determined by BCA. The patient received pharmacotherapy with meldonium, ethylmethylhydroxypyridine succinate, and meglumine sodium succinate.Conclusions: the prescribed pharmacotherapy led to a significant improvement in the patient’s condition (regression in neuropsychiatric symptoms) with simultaneous improvement of morphological and functional parameters assessed by BCA, which indicates an improvement in microcirculation processes and supports their role in post-COVID syndrome development. The obtained data suggest that the clinical picture of post-COVID syndrome is directly related to the severity of microcirculation dysfunction in various organs and tissues, and that BCA can be used for diagnosis and assessment of the syndrome’s severity, as well as for assessment of the treatment’s efficacy and safety.

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p

Aim. Based on the data from the register of patients with COVID-19 and community-acquired pneumonia (CAP), analyze the duration of the prehospital period, cardiovascular comorbidity and the quality of prehospital pharmacotherapy of concomitant cardiovascular diseases (CVD).Material and methods. Patients were included to the study which admitted to the FSBI "NMHC named after N.I. Pirogov" of the Ministry of Health of the Russian Federation with a suspected or confirmed diagnosis of COVID-19 and/or CAP. The data for prehospital therapy, information from medical histories and a patients’survey in the hospital or by telephone contact 1-2 weeks after discharge were study. The duration of the prehospital stage was determined from the date of the appearance of clinical symptoms of coronavirus infection to the date of hospitalization.Results. The average age of the patients (n=1130; 579 [51.2%] men and 551 [48.8%] women) was 57.5±12.8 years. The prehospital stage was 7 (5,0; 10,0) days and did not differ significantly in patients with the presence and absence of CVD, but was significantly less in the deceased than in the surviving patients, as well as in those who required artificial lung ventilation (ALV). 583 (51.6%) patients had at least one CVD. Cardiovascular comorbidity was registered in 222 (42.7%) patients with hypertension, 210 (95.5%) patients with coronary heart disease (CHD), 104 (91.2%) patients with atrial fibrillation (AF). The inclusion of non-cardiac chronic diseases in the analysis led to an increase in the total proportion of patients with concomitant diseases to 65.8%. Approximately a quarter of hypertensive patients did not receive antihypertensive therapy, a low proportion of patients receiving antiplatelet agents and statins for CHD was revealed – 53% and 31.8%, respectively, anticoagulants for AF – 50.9%.Conclusion. The period from the onset of symptoms to hospitalization was significantly shorter in the deceased than in the surviving patients, as well as in those who required ALV. The proportion of people with a history of at least one CVD was about half of the entire cohort of patients. In patients with CVD before COVID-19 disease, a low frequencies of prescribing antihypertensive drugs, statins, antiplatelet agents and anticoagulants (in patients with AF) were recorded at the prehospital stage.

Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology.(ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC.

Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p

Summary. Mental disorders are clinically heterogeneous chronic diseases resulting from complex interactions between genotype variants and environmental factors. Epigenetic processes, such as DNA methylation and post-translational histone modification, determine the interpretation by the body at the cellular and tissue levels of various environmental factors. Given that epigenetic modifications are environmentally sensitive, stable and reversible, epigenetic research in psychiatry may be a promising approach to better understanding and treating mental illness. This review discusses the clinical opportunities and challenges posed by epigenetic research in psychiatry. Using individual examples, the main conclusions are drawn that confirm the role of adverse life events, alone or in combination with genetic risk, in the epigenetic programming of neuropsychiatric systems. Further epigenetic studies show encouraging results in the use of methylation changes as diagnostic markers of disease manifestations and provide predictive tools for assessing progression and response to treatment. The potential for the use of targeted epigenetic pharmacotherapy, combined with psychosocial methods, in the context of the personalized medicine of the future in psychiatry is discussed next. It concludes with a discussion of methodological limitations that can make it difficult to interpret epigenetic data in psychiatry. They mainly arise due to the heterogeneity of individuals, both at the level of the whole organism and at the level of tissues, and require new strategies to better assess the biological significance of epigenetic data and their translational use in psychiatry. Overall, we believe that epigenetics can provide new insights and a more comprehensive understanding of the etiology and pathogenesis of mental illness, and should ultimately improve the nosology, treatment and prevention of mental disorders.

Objective. To review and summarize literature data in studies of safety of the drug products used for the pathogenetic treatment of COVID-19. Materials and Methods. As the first stage of monitoring the drug’s safety, which are used in the treatment of COVID-19 in Russia, a systematic review of studies of the drug’s safety profiles was carried out: mefloquine, hydroxychloroquine, azithromycin, lopinavir/ritonavir, favipiravir, tocilizumab, olokizumab, baricitinib in the international databases Medline, PubMed, ClinicalTrials.gov and Cochrane Library for the period 2019–2021. Results. The review included 51 articles that met the selection criteria. Based on the results of the review, it can be concluded that the safety profile (frequency, severity and severity) of most drugs repurposed for COVID-19 corresponds to those for the registered indications. At the same time, according to world experience, there is an increase in the number of reports of adverse drug reactions of hydroxychloroquine and azithromycin, which is provoked by the active use of these drugs for combination therapy. Conclusions. According to the literature, a high incidence of adverse events was noted in hydroxychloroquine, chloroquine and azithromycin. Subsequent analysis and comparison of the safety profiles of hydroxychloroquine, chloroquine and azithromycin with data from the national automated information system (AIS) database of Roszdravnadzor is a necessary component of effective and safe pharmacotherapy for COVID-19.

The article considers the features of pharmacotherapy of patients with chronic infectious diseases and co-morbidities in conditions of polypharmacy, the principles of drug metabolism, variants of adverse effects and drug-drug interactions, the possibilities of effective drug combinations. The purpose is to substantiate the possibility and emphasize the relevance of the additional search of the creation of the most optimal combinations of drugs for long-term and massive pharmacotherapy, that could be due to a beneficial drug-drug interaction, optimization of the regimen, route of drug administration and multitarget of the therapeutic effect, reduce the pharmacological load while maintaining the effectiveness of the treatment, increase patient adherence to drug therapy.

Allergic rhinitis remains one of the most relevant problems of modern otorhinolaryngology. The widespread prevalence, late diagnosis, underestimation of the possible risks of disease progression, the development of complications (including asthma) prompts the development and improvement of new treatment options for allergic rhinitis. Allergic rhinitis is a heterogeneous disease that presents with various clinical phenotypes, and therefore the severity of nasal symptoms can vary from mild malaise to severe disease.. Today, pharmacotherapy remains the most frequently used treatment tactic for patients with allergic rhinitis. While prescribing therapy the doctor develops an individual treatment plan based on the principles of personalized medicine, considering: the dominant symptoms, anamnesis data on previous therapy and the effect of treatment, the type of inflammation (Th2-type, mixed inflammation), concomitant diseases (conjunctivitis, asthma, etc.) etc.) and patient preferences. The tissue effects of the histamine mediator lead to the development of symptoms during the course of the disease, which determines the wide-spread use of antihistamines in the treatment of rhinitis. Antihistamines of the second generation are devoid of sedative effects, have a long-lasting effect and a good safety profile. One of the modern II generation antihistamines is bilastine. The research results proved the high antihistaminic activity of bilastine 20 mg in vitro and in vivo, the absence of cardiac and sedative side effects on the central nervous system, the ability to eliminate the nasal and ocular symptoms of disease and improve the quality of life of patients with allergic rhinitis. Thus, bilastine fully complies with current EAACI / WAO ARIA requirements for drugs used to treat AR. The paper presents a clinical case of a patient with chronic persistent allergic rhinitis, household sensitization with a slight uncontrolled course. The oral antihistamine bilastine was added to intranasal glucocorticosteroids, which help to relieve symptoms of the disease, stabilize the condition and prepare the patient for subsequent allergen-specific immunotherapy.

The review examines the role of mometasone furoate (NSMF) intranasal spray (Nasonex) in the treatment of allergic rhinitis (AR). There is a wide prevalence of AR both among children and adults, its adverse effect on the quality of life of patients. It is emphasized that the main means of therapy for moderate and severe course in accordance with international and Russian recommendations for the diagnosis and treatment of AR are intranasal glucocorticosteroids (INGKS). The pharmacological features of the MF molecule that underlie its efficacy and safety, including the affinity, lipophilicity and viscosity of the drug, as well as low systemic bioavailability, are discussed in detail. The therapeutic effects of NSMF in the treatment of seasonal and perennial AR, its effect on nasal symptoms are discussed in detail. The beneficial effect of NSMF therapy on nasal congestion is emphasized separately. The beneficial effect of NSMF treatment on other clinical manifestations of AR, including ocular symptoms, effects on sleep, and olfactory function, has been noted. The safety issues of NSMF use are discussed in detail, including systemic effects, such as effects on adrenal function, eye, and growth retardation in children, and local adverse effects on the nasal mucosa; there is a high profile of local and systemic safety of long-term use of NSMF in the treatment of AR in both adults and children.

The pandemic of the novel coronavirus infection 2019 (COVID-19) has changed many aspects of our lives and initiated numerous studies aimed at finding the factors that determine different courses of this infectious disease. The studies aimed at finding predictors of the severe course of this novel coronavirus infection, as well as the factors that determine the efficacy and safety of this disease pharmacotherapy, are acquiring special social significance.The aim of this work is to find and summarize information on genetic predictors of severe COVID-19, as well as pharmacogenetic aspects that determine the variability of the therapeutic response to the drugs recommended for COVID-19 treatment.Materials and methods. The article provides a review of scientific results on the research of gene polymorphism that determine a body’s response to the introduction of SARS-CoV-2 infection and the effects of pharmacotherapy for this disease, obtained from open and available sources within the period of 2019 – March 2021. The search was conducted in the following electronic databases: PubMed, Cochrane Library, ClinicalTrials.gov; Elibrary, Scopus. The main search inquiries were: “predictors + severe course + COVID-19”, “genetic variations + COVID-19”, “pharmacogenetics + COVID-19”, “gene polymorphism + SARS-CoV-2”, “pharmacotherapy + gene polymorphism + COVID-19” in both Russian and English.Results and conclusion. The exploratory research detailing the mechanisms of infecting with SARS-CoV-2, the variability of the disease severity and the individual characteristics of therapeutic responses to the drugs used, are being actively carried out by scientists all over the world. However, most of their scientific projects are diverse, and the possible predictors of a severe course of COVID-19 found in them, have not been confirmed or investigated in subsequent studies. A generalization of the individual studies results of the genetic predictors concerning COVID-19 severity and effectiveness of its pharmacotherapy, can become the basis for further search and increase the reliability of the data obtained in order to develop a strategy for preventing the spread of COVID-19 infection, to identify potential targets of the treatment, and develop the protocols for optimizing this disease pharmacotherapy.

Object: to identify factors that limit the effectiveness of pharmacotherapy of hypertension (HT) with comorbid coronary artery disease (CAD) in elderly obese patients by determining laboratory and spectroscopy features related to inflammation. Material and methods: 60 patients (68.2 ± 5.9 y.o.) were observed and treated in Internal Medicine Department of University Clinic of Odessa National Medical University. Patients were divided into 2 groups. The 1st group included patients (n = 30) with body mass index (BMI) ≤25 kg/m2, HT and co-morbid CAD; the 2nd group (n = 30) - patients with BMI≥30 kg/m2, HT and with co-morbid CAD. For each patient’s group antihypertensive combination of Lisinopril and Bisoprolol was prescribed. The Laser correlation spectroscopy (LCS) was a special method for investigation. Results: before pharmacotherapy (PT) in both groups according to LCS 11-150 nm particles are prevailing. But in obese patients 75th percentile of 31-70 nm particles exceeds that one in non-obese group (56.7% vs 30.5%). During PT systolic blood pressure (SBP) value normalized in the patients of 1st group (without obesity), while in the obese patients (2nd group) SBP remained above target level. Creatinine level increased in patients of 1st group (without obesity) by 16.5 μmol / L (p 2 (P Conclusions: 1. In elderly hypertensive patients with concomitant CAD, obesity is a factor limiting the effectiveness of complex antihypertensive therapy. 2. An increase of proportion of allergic-directed and appearance of autoimmune-directed homeostatic shifts in serum according to LCS are associated with a decrease of antihypertensive therapy efficacy in elderly hypertensive patients with CAD and obesity. 3. In hypertensive non-obese patients with CAD under the influence of complex antihypertensive therapy deteriorating of renal function is observed while in obesity renal function is not changed. 4. Homeostatic changes revealed in the second group by LCS values probably reflect manifestation of low grade inflammatory process caused by excessive activity of adipose tissue.

The purpose of this study is to conduct a medical and statistical analysis of disability indicators for the period 2009-2019 in the territory of the Republic of Tatarstan (RT) and to substantiate the main directions for improving rehabilitation measures.Material and methods. The object of the study was the medico-statistical indicators of «Main Bureau of Medical and Social Assessment in the Republic of Tatarstan (Tatarstan)» of the Ministry of Labor of Russia for 20092019. The study was conducted using a retrospective design. On the basis of the obtained indicators, the absolute and relative values of indicators per capita were calculated. Also, the calculation of the intensive and extensive indicators was carried out. Time series were constructed and trends were evaluated using Mann-Kendall test.Results and discussion. According to the results of the study, a reliable trend was revealed to increase the share of first-time disabled persons of the first group by 2.6 times in 2009-2019, which is consistent with similar indicators for the Russian Federation. Analysis of the structure of the causes of primary disability for 10 years showed that one of the main causes, along with cancer, was diseases of the cardiovascular system. It was revealed that during the study period, the indicator of the level of primary disability among citizens with circulatory system diseases (CSD) decreased by 2.5 times, but the share of disabled people of the first group in 2019, significantly increased compared to 2009 - by 3.7 times. It was found that the main causes of primary disability in the adult population with CSD in the Republic of Tatarstan were coronary heart disease and cerebrovascular diseases. On the basis of the obtained data, the necessity of improving the measures of state control over the implementation of rehabilitation programs, in particular medical rehabilitation, by expanding the functionality of the «Federal Register of Disabled People» is justified.Conclusion. Given that the most important element of secondary prevention in persons recognized as disabled is pharmacotherapy, improving the tools for its rationality and quality is one of the priorities for improving the system of rehabilitation of persons suffering from CSD.

Objectives. The main purpose of the article was to create literature review regarding the phenomenon of occurrence and the preventing measures of perverted and/or inefficient drug treatment. Material and methods. A number of scientific and didactic-scientific publications have been studied, which provide information regarding the moment that contribute to the irrationality of drug prescription and a large number of complications of the drug treatment and it’ s inefficiency. International publications via online platforms such as Google Scholar and PubMed have been used. The keywords used for the search were: self-medication, counterfeit, drug interactions, side effects. Results. There have been found 31 publications that reveal information on rationally tactics of drug use and the opportunities to prevent the side effects and complications related to medication administration, with the increasing of efficacy and pharmacotherapeutic harmlessness in surgical field. Conclusions. The prevention of ineffective drug treatment should be based on several important recommendations, including non-prescription of the drug in the absence of evident indications and not to abuse drug applications for Over-the-Counter (OTC) drugs on their own. It is very important to identify other drugs, phytotherapeutic medicines and food supplements, including those used in self-medication, which the patient has already administered, in order to avoid the simultaneous prescription of several drugs, whose interaction is unavoidable. All patients, especially the elderly ones, should be informed on the correct selection and administration of medicines, following the instructions and warning them of the counterfeit drugs that may appear in the distribution system, and inform them about the side effects caused by the administration of these drugs.

Background. Current guidelines describe in detail the approaches to the management of patients with resistant hypertension, however, in real clinical settings the number of non-rational and ineffective combinations of antihypertensive drugs used remains high.Aim. To analyze the distribution of different combinations of antihypertensive drugs for the treatment of resistant hypertension and to estimate the proportion of non-rational combinations.Methods. The retrospective analysis includes 117 outpatients with resistant hypertension. Resistant hypertension was defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes. Exclusion criteria was secondary hypertension. We defined rational combination as the standard combination (renin-angiotensin system [RAS] blocker + calcium-channel blocker [CCB] + diuretic) plus one of the group of reserve drugs (mineralocorticoid receptors antagonist [MRA], beta-blocker, alpha-blocker, agonist of imidazoline receptors [AIR]). Non-rational were considered combinations in which reserve drugs were used before the appointment of a triple combination of first-line drugs. Moreover, in a subgroup of non-rational therapy, situations were identified where such a combination was justified.Results. The proportion of rational combinations was 58.9%, reasonably non-rational - 15.5%, unreasonably non-rational - 25.6%. Unreasonably non-rational combinations are distributed as follows: non-appointment of CCB - 12%, non-appointment of RAS-blockers - 8%, non-appointment of diuretics - 6%, use of RAS-blockers for hyperkalemia - 6%, administration of MRA without non-potassium-sparing diuretics - 5%, double blockade of RAS - 3%, other combinations - 7%. In addition to first-line drugs, beta-blockers (93.2%), loop diuretics (22.2%), AIR (21.4) were the most prescribable, while the proportion of MRA is only 15.4% of the entire sample.Limitation: some patient's characteristics could be missed in case histories and some of the combinations could be falsely recognized as malpractice since the analysis was conducted retrospectively.Conclusion. The proportion of the non-rational combinations for the treatment of resistant hypertension is high. Among the drugs of the reserve, the frequent use of beta-blockers and moxonidine and the inadequate administration of spironolactone are noteworthy. The problem of treatment strategy choice remains relevant in real clinical practice.

Chronic heart failure (CHF) occurs in 4.3-28% of patients with diabetes mellitus and is most often associated with the presence of coronary heart disease, arterial hypertension and the direct adverse effects of insulin-resistance, hyperinsulinemia and hyperglycemia on the myocardium. Diabetes mellitus occurs in 12-47% of patients with CHF and can develop within several years after a diagnosis of HF in 22% of patients due to insulin-resistance of failure tissues. The presence of diabetes mellitus leads to a greater severity of clinical symptoms and hospitalization rate, worsening of quality of life and prognosis in CHF. A decreased left ventricular ejection fraction is an independent predictor of the poor prognosis in the patients with diabetes mellitus. The algorithm of the treatment of CHF in the patients with and without diabetes mellitus is not fundamentally different, but it requires taking into account the metabolic effects of the prescribed drugs. Angiotensin receptor-neprilysin inhibitor are increasingly used in clinical practice and are gradually replacing angiotensin-converting enzyme inhibitors and sartans in CHF both without diabetes mellitus and in its presence. Recently, the effectiveness of type 2 sodium glucose cotransporter inhibitors has been proven in patients with CHF with and without diabetes mellitus. This review is devoted to the relationship of diabetes mellitus and CHF, as well as the approaches to the management of such comorbid patients.