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Background. Benign recurrent intrahepatic cholestasis is a rare inherited disorder characterized by recurrent episodes of severe hyperbilirubinemia and pruritus that resolve spontaneously. However, attacks of cholestasis may persist for several months and in some cases be associated with frequent recurrences, which may be grounds for liver transplantation.Objective. To present a clinical case of debut benign recurrent intrahepatic cholestasis following acute hepatitis A.Results. A 30-year-old patient was admitted at the Liver Transplantation Center of Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy for a prolonged episode of intrahepatic cholestasis with severe coagulopathy after acute hepatitis A. Total bilirubin was elevated up to 835 µmol/L and INR was 3.6. The manifestations of vitamin K-associated coagulopathy were controlled after the first dose of parenteral menadione sodium bisulfite. Glucocorticosteroids, ursodeoxycholic acid and plasmapheresis turned ineffective in the treatment of hyperbilirubinemia. Due to long-persisting cholestasis resistant to conservative therapy, the patient was considered for inclusion to the liver transplant waiting list. However, spontaneous resolution of the cholestatic episode was achieved at 5 months after the onset of manifestations. Benign recurrent intrahepatic cholestasis type 2 was diagnosed on the basis of the specific clinical signs, laboratory blood tests and genetic testing.Conclusion. The present Case Report shows a long-lasting episode of cholestasis with severe coagulopathy in acute hepatitis A in a patient with benign recurrent intrahepatic cholestasis with subsequent spontaneous resolution of the clinical symptoms at 5 months after their manifestation onset. Therefore, the differential diagnosis of benign recurrent intrahepatic cholestasis should be considered prior to liver transplantation in patients with intrahepatic cholestasis.

Introduction. Impaired liver transplant function in the long term often leads to graft loss and the recipient death. There are many causes for the development of a late liver allograft dysfunction and different types of its clinical presentation, but there is no generally accepted definition. This hinders its timely diagnosis, analysis of its prevalence, and also makes it difficult to compare the performance of transplantation programs.Objective. To determine the clinical and prognostic value of late liver allograft dysfunction.Material and methods. The study included 103 cases of cadaveric liver transplantation from donors diagnosed with brain death to 100 recipients, of whom 36% were men, aged 48 years old (40;56) (18–68) at the time of transplant, having MELD score 17 (14;21) (7–41). The follow-up period was 52 months (20;77) (8–180). The cases where the graft loss occurred earlier than 3 months were excluded.The late liver allograft dysfunction was defined as a dysfunction of the transplanted liver, which was manifested by at least one of three following signs and occurred at more than 3 months after transplantation: 1) increased aspartate aminotransferase, alanine aminotransferase and/or gamma glutamyl transferase, alkaline phosphatase, bilirubin; 2) impaired synthetic function (increased international normalized ratio, decreased antithrombin III, cholinesterase); 3) liver cirrhosis complications (signs of portal hypertension, ascites, encephalopathy). The following limits were chosen as a diagnostic threshold for laboratory parameter abnormalities: more than 2 upper limits of normal for total bilirubin, more than 1.5 upper limits of normal for the levels of alanine or aspartic aminotransferases, more than 1.5 upper limits of normal for gamma-glutamyltransferase or alkaline phosphatase, more than 1.6 of normal for international normalized ratio.Results. Late liver allograft dysfunction was diagnosed at least once in 64% of recipients. Through the postoperative course, the proportion of patients with late dysfunction varied from 22% to 40%. The etiology of late liver allograft dysfunction was viral (38%), unknown (25%), biliary (19%), immune (17%), and vascular (1%). Late liver allograft dysfunction was reversible in 75% of cases, persistent in 17%, progressive in 8% of cases. Progressive late liver allograft dysfunction led to a graft loss in all cases observed.Recipients with late liver allograft dysfunction were found to have had a 33% higher incidence of early allograft dysfunction (OR 4.7, 95% CI [1.8–12.3]); the incidence of biliary dysfunction was 3.1 times higher with distant choledochojejunostomy (OR 3.9, 95% CI [1.1–13.9]); in patients with autoimmune and cholestatic disease, the incidence of immune dysfunction was 4.8 times higher (OR 5.8, 95% CI [1.7–20.3]).Conclusion. The progressive nature of late liver allograft dysfunction negatively affects the results of transplantation and therefore should be considered as an indication for retransplantation. Reversible and persistent variants of late liver allograft dysfunction have favorable) prognosis. If the etiology of late dysfunction is not established, the regular surveillance with monitoring for fibrosis and repeated attempts to clarify the diagnosis should be continued.

Drug-induced hypersensitivity syndrome (DIHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially fatal systemic reaction characterized by multiorgan damage involving the liver, hematopoietic system and skin, and heterogeneous manifestations of fever, rash, lymphadenopathy and eosinophilia with unpredictable course.We describe a 41-year-old female patient who developed DRESS syndrome after taking sulfasalazine prescribed for non-radiographic axial spondyloarthritis. Treatment with intravenous and then oral glucocorticoids was effective. A review of the literature on this topic is presented.

Coronary artery disease is a widespread cause of death and disability in the population. Angioplasty of the coronary arteries is one of the most common methods of eliminating the cause of ischemia – stenosis of the coronary arteries. As a result of stent installation, a change in the angle of vascular bifurcation occurs usually, as well as a redistribution of volumetric blood flow in the coronary artery system. Considering the high variability of the branching angioarchitecture of these arteries, as well as the structure of their environment, the problem of predicting the specific redistribution of blood flow in these arteries remains unsolved; the main ways of its implementation are computational and experimental hemodynamics. Material and methods. This paper uses an experimental approach to explore the effect of stent placement in a model of coronary artery stenosis, and also provides an analysis of the current level of awareness of the scientific community on this issue. Results and discussion. The experiment showed that the throughput of the model increases by 14 % compared to the model with stenosis, and the redistribution of flows in the model depends not on diameters but on the anatomy of a particular vascular network. The data of the performed mathematical modeling are generally consistent with the results of the experiment before stent installation, when the coronary tree consists of several load-bearing branches, but have quantitative differences for the distal branches of the coronary artery model in the presence of an installed stent. Conclusions. The results of the work can be used to accumulate an experimental data array on the restructuring of blood flow during angioplasty, and can also be used to verify the numerical hemodynamics of the coronary arteries during the virtual installation of a stent in them to resolve stenosis.

Вступ. У військовослужбовців вірусні гепатити залишаються актуальними і в сучасних умовах, особливо при надзвичайних ситуаціях як природного характеру, так і під час війн, миротворчих місій. Мета. З урахуванням збільшення кількості хворих на вірусні гепатити серед військовослужбовців, проаналізувати епідеміологічні, клініко-лабораторні особливості у хворих військовослужбовців на гострі вірусні гепатити. Матеріали та методи. Було обстежено 33 хворих із гострим вірусним гепатитом С та 17 хворих із вірусним гепатитом В, які лікувались у клініці інфекційних захворювань НВМКЦ «ГВКГ» в період 2022-2023 рр. Результати. Встановлено, що у військовослужбовців вірусні гепатити розвивались після мобілізації в період через 3 доби до 1895 днів. У більшості хворих інфікування гострим вірусним гепатитом С відбувалось при наданні медичної допомоги на етапах медичної евакуації. В той же час, при гострому вірусному гепатиті В шлях інфікування в більшості випадків був невідомий. Після мінно-вибухової травми, вогнепальних поранень гострий вірусний гепатит В розвивався в період від 20 до 90 діб, а гострий вірусний гепатит С - в період від 45 до 240 діб. У хворих з гострим гепатитом С більше спостерігалось легких форм, а при вірусному гепатиті В – більше середньотяжких та тяжких форм. У хворих із гострим гепатитом С більше спостерігалось безжовтяничних форм, а при вірусному гепатиті В – більше жовтяничних. Рівень загального білірубіну при жовтяничній формі ГВГС був нижче, ніж при ГВГВ. Після госпіталізації через 7-10 днів спостерігається наростання рівня білірубіну як при ГВГС, так і ГВГВ, в той же час при ГВГВ було більше коливань. На початку госпіталізації рівень АлАТ, АсАТ були вище при ГВГВ в порівнянні із ГВГС. При всіх видах ГВГ із 7-10 доби відбувалось зниження рівня АлАТ, але при ГВГВ зниження відбувалось більш поступово. Висновки. Після мінно-вибухової травми, вогнепальних поранень в більш короткий термін у хворих розвивався вірусний гепатит В, а в більш тривалий термін - вірусний гепатит С. У деяких військовослужбовців інфікування могло відбутись ще до мобілізації. Спостереження за пораненими та обстеження на вірусні гепатити повинно здійснюватись не менше 2-х років після поранення. З урахуванням того, що гострий гепатит С може мати легкий перебіг та безжовтяничну форму, необхідно в термін спостереження активно проводити обстеження поранених на маркери вірусних гепатитів в термін після 30 діб і пізніше. У більшості хворих інфікування на вірусний гепатит С відбувалось при наданні медичної допомоги на етапах медичної евакуації, тому необхідно покращувати профілактичні заходи стосовно профілактики гепатитів на етапах евакуації. При вірусному гепатиті В шлях інфікування в більшості випадків був невідомий. Військовослужбовцям і тим, хто планує призватись до лав Збройних сил, необхідно завчасно проводити вакцинацію проти керованих інфекцій, в тому числі і проти вірусного гепатиту В.

The purpose of the study is to evaluate the histological features of the placenta in women with pregnancy complicated by preterm premature rupture of membranes (pPROM) and their relationship with the duration of the interval between membrane rapture and delivery, the level of expression of antimicrobial peptides (β-2-defensins) and other factors of pregnancy and labour. Methods. We examined 56 women of the main group, whose pregnancy was complicated by pPROM at 23-36 weeks of pregnancy and 20 pregnant women of the control group with intact fetal membranes, who subsequently gave birth to full-term babies. The study included anamnesis, study of the course of pregnancy, labour and postpartum period, clinical and laboratory parameters of the mother, including the level of expression of antimicrobial peptides (ß-2-defensins) in the blood serum, functional status of the newborn, histological examination of the placenta. In the histological examination of the placenta, signs of infection and inflammation, placental insufficiency, the presence of compensatory and adaptive reactions were determined. Results. The course of pregnancy, complicated by pPROM, caused a high incidence of perinatal losses. No significant relationship between the condition of newborns and the duration of the interval between membrane rapture and delivery was found; the indicators generally corresponded to the estimates characteristic of premature infants and correlated with the gestational age of the child. Analysis of the localization of infectious and inflammatory changes in the placentas of women with pPROM showed a high incidence of membranous lesions, as evidenced by the detection of signs of purulent necrotic membranitis in more than half of the observations (57.1%), especially with an increase in the duration of the interval between membrane rapture and delivery (more than 70% of cases). Conclusions. It was found that the morphological examination of placentas in women with pregnancy complicated by pPROM in most cases (85.7%) revealed signs of placental insufficiency, of which in a quarter of cases (25.0%) the insufficiency had an acute course, which was closely associated with perinatal mortality. The frequency of lesions of various elements and structures of the placenta, membranes and umbilical cord of infectious and inflammatory nature significantly depended on the duration of the interval between membrane rapture and delivery. The average level of expression of ß-2-defensins in the blood of pregnant women with pPROM was reduced by 1.4 times compared to healthy pregnant women and inversely correlated with both the acute course of placental insufficiency and funiculitis and combined damage to several elements and structures of the placenta.

The aim was to study the prevalence of sustained arterial hypotension in high cardiovascular risk patients with II–III stage essential hypertension and associated factors. Materials and methods. Patients with II–II stage essential hypertension and sinus rhythm (n = 179, mean age 61 (95 % CI: 59.6‒62.5) years, 57.0 % were males) underwent ambulatory blood pressure monitoring (ABPM). Arterial hypotension episodes were evaluated according to the blood pressure (BP) office measurement (

Summary: Evaluation of the effectiveness of antibacterial therapy at different stages of necrotic pancreatitis (NP) is the most important area of ​​scientific and practical research on the course of necrotic pancreatitis and the development of sepsis. The work is based on the results of a comprehensive examination and treatment of 54 patients with necrotic pancreatitis in the intensive care unit of city Hospital № 3, Zaporizhia in 2017-2019 pp. Objective: Optimize the use of antibacterial therapy in the complex treatment of infected forms of NP depending on the microbial spectrum of infection, the course of the disease and the development of sepsis. Material and methods of research. The study included 54 patients with infected forms of NP who were treated in the Department of Anesthesiology and Intensive Care of the 3rd City Hospital. Research results and their discussion. Thus, the analysis of antibiotic sensitivity showed that high activity against pathogens, based on the perception of the main pathogens characteristic of infected forms of NP, is observed in meropenem, taigecycline and tobramycin. When studying the species composition of microorganisms, it was found that the NP is dominated by gram-negative flora: Pseudomonas aeruginosa - 26.5%, Acinetobacter spp. - 21.2%, family Enterobacteriaceae: Klebsiella pneumoniae - 10.2% and Escherichia coli - 15.6%. Resistant strains of Ps were found in 22% of patients. Aeruginosa. The use of detoxification therapy with the inclusion of extracorporeal detoxification methods (discrete plasmapheresis) in combination with two-component antibacterial therapy (meropenem + linezolid) led to a positive trend in the course of the disease. Conclusions. Analyzing the course of the disease in patients with infected NP and its complications on the basis of constant monitoring of bacterial flora with optimal antibacterial therapy, prevention of nosocomial infection and modern strategy of surgical interventions, especially minimally invasive, noted a positive trend in the course of sepsis and sepsis.

Introduction. Antihistamines are the most commonly prescribed class of medications for the treatment of allergic rhinitis (AR). However, they are also widely used in the treatment of inflammatory diseases of the ENT organs. One such drug is levocytirizine, (R) an enantiomer of cetirizine, which is a selective antagonist of peripheral histamine H1-receptors. This article analyzes the properties of levocytirizine in terms of safety and efficacy in allergic rhinitis.Aim of the study is to assess the efficacy of levocetirizine in patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) versus placebo, and safety for patients with allergic rhinitis.Materials and methods. In this, double-blind, placebo-controlled study, 52 patients with year-round allergic rhinitis and 28 patients with seasonal allergic rhinitis were randomized to receive levocetirizine 5 mg/day once or placebo. Mean overall measures of five symptoms (nasal congestion, nasal itching, itchy eyes, rhinorrhea, and sneezing) were compared between treatment groups at 1, 2, and 4 weeks. All individual symptom scores were also examined.Results. Levocetirizine showed a significant improvement in the condition of patients with CAR and SAR over the entire treatment period compared to placebo. Assessment of individual symptoms showed statistically significant differences in favor of levocetirizine. Conclusion. Levocetirizine is an effective, safe, and well-tolerated drug for the treatment of allergic rhinitis.

Introduction. Liver transplantation restores patients' physical and social life, and its quality. The prevalence of low physical activity in liver recipients is unknown as well as the impact of late liver allograft dysfunction on it. Liver transplantation enhances patient's return to the usual physical and social activity and improves the quality of life. However, the prevalence of low physical activity among liver recipients and the impact of the late allograft dysfunction on it, which is a risk factor for obesity and cardiovascular diseases, require studying.The aim of the study was to identify whether the late liver allograft dysfunction influences the physical activity of recipients.Material and methods. The study included 87 liver recipients. We measured anthropometric parameters, physical performance (SPPB, LFI, 6-min walk test), mean step count per day. Late liver allograft dysfunction was determined if elevated transaminases and/or cholestatic enzymes or hepatic failure have been diagnosed later than 3 months posttransplant. Activity trackers were provided to assess physical activity.Results. Median age was 54 years [45;61], 33% were men. The median follow-up period was 36 months [16;64]. The median of the average steps count was 5.9 [4.1;8.7] thousand per day. 60.5% of recipients were sedentary and low active, 24.4% were somewhat active, 15.1% were active. In cases of liver allograft dysfunction, the mean step count was significantly lower than in patients with normal liver function: 4.1 thousand [2.6;5.3] versus 6.8 thousand [4.2;9.4], p=0.003, despite no differences in the physical activity test results.Conclusion. In case of a late liver allograft dysfunction, the physical activity can decrease; 60.5% of liver recipients, in the absence of pathological restriction of movement, have a sedentary and low active lifestyle. Activity trackers may allow identifying patients who need additional check-up or physical training.

The aim. To develop a treatment algorithm with the aim of improving the treatment results of diffuse pigmented villonodular synovitis of the knee. To study and analyze the results of surgical treatment of diffuse pigmented villonodular synovitis of the knee. Materials and methods. The study was based on the results of treatment of 48 patients with pathohistologically verified diagnosis of diffuse pigmented villonodular synovitis (tenosynovial giant cell tumor) of the knee undergoing treatment at the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2010 to 2019. Results. The best functional results can be achieved in patients with diffuse pigmented villonodular synovitis of the knee in stage I of the disease. Using the method of mathematical statistics to evaluate the results obtained, we see that scores obtained through the Lysholm Scoring Scale were statistically significantly different in stages before a surgery (P = 0.000782), 3 months (P = 0.00005) and 6 months after the surgery (P = 0.04); but over time, these differences diminished and became actually insignificant 12 months after the surgery (P = 0.89). Conclusions. Applying our therapeutic algorithm for the treatment of patients with diffuse pigmented villonodular synovitis of the knee, the outcome of the Lysholm score was excellent in 22 % of patients, good – in 45 %, satisfactory – in 21 % and poor – in 12 % of patients.

This article reviewed the mechanisms of action of probiotics and the possible effects of individual strains on the general wellbeing if they are taken daily.The content and activity of bacteria in food products should be regulated by special guidelines. The balanced nutrition allows us to get healthy strains in a natural way. Daily consumption of certain strains as part of functional food products is promising for the prevention of obesity, type 2 diabetes mellitus, non-alcoholic fatty liver disease, functional intestinal disorders, colon cancer, cardiovascular diseases and depression. The issues of safety of novel probiotic strains newly introduced in clinical practice require careful consideration. Synbiotics can comprise probiotic strains of bacteria (Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04) with tolerance to acid, pepsin and bile salts, as well as the prebiotic inulin and vitamins B1, B2, B6 and B12 contributing to survival of beneficial bacteria. L. acidophilus is a common probiotic that occurs in the natural environment and food products, no cases of antibiotic resistance of this species have been established. Strains Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04 have a high adhesion capacity, strong inhibitory effects on intestinal pathogens, including fungi, anti-inflammatory effects, help to eliminate oxalates. As can be seen from the above, the use of probiotics and synbiotics is one of the most promising preventive fields of medicine.

To this date there have been no studies of subclinical atherosclerosis in the patients with calcium pyrophosphate crystal deposition disease (CPPD); in osteoarthritis (OA) such works are rare.Objective: to assess the prevalence of subclinical atherosclerosis of carotid arteries (CA) in patients with CPPD and OA.Patients and methods. The case-control study included 26 patients with CPPD and OA. The diagnosis of CPPD was based on the criteria of D.J. McCarty, diagnosis of OA was based on national clinical practice guidelines. We recorded data on smoking, blood pressure level. Assessed blood lipid spectrum, serum levels of glucose, creatinine, uric acid, CRP. Obesity was diagnosed in accordance with the WHO recommendations. All patients underwent CA Doppler ultrasonography (DUS). An increase in intima-media thickness (IMT) >0.9 mm was considered a manifestation of subclinical atherosclerosis. The SCORE index was calculated for all patients.Results and discussion. The median serum CRP level was comparable in CPPD and OA. The CRP level >5 mg/L was detected in 8 patients with CPPD and in 3 patients with OA (p=0.09). Initial signs of atherosclerosis were present in 11 (42%) patients with CPPD and in 8 (31%) patients with OA (p=0.39). In CPPD, an increase in IMT was associated with a CRP level of ≥5 mg/L in 19% of cases, and in OA – in 12.5% (p=0.08). An increase in IMT >1.3 mm was not found in patients of both groups.Conclusion. In patients with CPPD and OA, subclinical atherosclerosis is often present according to the CA ultrasound. Early detection of uncomplicated subclinical atherosclerosis in CPPD and OA is necessary for timely initiation of treatment aimed to prevent the progression of atherosclerosis and the development of cardiovascular diseases.

Problem Statement and Purpose. The world economy has always developed and continues to develop cyclically, which affects the economic development of individual countries and their regions. As a result of cyclical economic development, regions are formed that maintain a progressive or stagnant type of economic development, and some of them, especially during periods of economic crisis, develop a regressive type. Thus, depressed regions or their separate territories appear, the study of which aims to identify in time the territorial disparities and polarizations of different types of the social formation of administrative units and to establish the level of their depression. It should be noted that most of the available scientific achievements concern the study of the territory of Ukraine at the regional level, and not at the subregional (raion) level. Therefore, our research allows us to shed more light on the depression of administrative-territorial units of Chernivtsi oblast, which differs from other regions of Ukraine by its natural-geographical, demographic, ethnic contrast, as well as cross-border and border position, which certainly has a significant impact on depression of regions and cities of regional significance.The purpose of this study is to conduct a socio-geographical assessment of the depression of administrative-territorial units of Chernivtsi oblast, which allows us to learn about the current state of the oblast and its raions in terms of depression, as well as identify possible steps to solve this problem.Data & Methods. To study the depression of administrative-territorial units of Chernivtsi oblast, the following main types were chosen: economic, social, and demographic. For each of these blocks, the main indicators of indicators were determined, according to which a socio-geographical assessment of the level of depression in administrative regions and cities of regional significance was conducted.Having established the rating places for each administrative-territorial unit according to the selected indicators, or their relative values, it was possible to establish the average place of each unit and, accordingly, the level of depression for each of the studied blocks. It was also established the common place of administrative units in the region by all indicators and thus identified different, according to the level of depression, regions.Results. With the help of rating research, the typification of administrative-territorial units of the oblast according to the level of economic, social, demographic, and integral depression was carried out. The most depressed were the agricultural raions of the oblast – Khotyn, and Sokyriany. However, it should be noted that Khotyn raion has the same types of depression in all its components, and in Sokyriany raion the worst is the demographic situation, and the best ‒ the economic one. The lowest level of depression is characteristic of Storozhynets raion, which is explained by its favorable geographical location relative to the oblast center, which contributes to economic and social development, as well as polyethnicity, which strengthens the demographic component.

The article is devoted to the treatment of one of the most common diseases - the treatment of rhinosinusitis. According to statistics only 2% of the sinusitis in population are bacterial. At the same time administration of systemic antibiotic therapy reaches 95.5%. The problem of rational prescription of antibacterial drugs, including management of the rhinosinusitis, is very acute, especially considering the constant increase in the number of antibiotic-resistant microorganisms. Currently, the level of patients with prolonged post-viral rhinosinusitis after COVID-19 has increased. Most have a history of one or more courses of systemic antibiotics and, often, without indications. In article are listed indications for systemic and local antibacterial therapy in adults and children, based on national and European clinical guidelines. The data on complications during the use of systemic antibacterial drugs are presented. Authors give information about the advantages of the local use of antibiotics: the absence of general toxic complications, the creation of an optimal concentration directly in the focus of inflammation. The advantages of combining solutions of neomycin and polymyxin B for topical use, such as a pronounced bactericidal effect against gram-positive and gram-negative bacteria (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa), causing the development of infectious processes in the upper respiratory tract, are separately noted. The author describes his own experience of using the original nasal spray Polydex with phenylephrine, containing a fixed combination of neomycin, polymyxin B, dexamethasone sodium metasulfobenzoate and phenylephrine, in the treatment of patients with post-viral rhinosinusitis. As a result of the collection of literature data, as well as based on their own experience, the authors concluded that the use of this nasal spray in outpatient practice will significantly improve the effectiveness of treatment and reduce the frequency of prescribing systemic antibiotics.

Allergic rhinitis (AR) and chronic rhinosinusitis (CR) can be diagnosed as an independent or combined pathology, as well as a possible complication of each other. Allergic rhinitis is a disease characterized by IgE-mediated inflammation of the nasal mucosa and the presence of daily manifestations of more than one hour and at least two of the following symptoms: nasal obstruction, rhinorrhea, sneezing, nasal itching. The frequency of psychosomatic disorders is quite high and ranges in the population. Studying the mechanisms of disease development provides the basis for rational therapy, not just symptom relief. We have considered the use of elimination therapy for CR associated with AR. This type of treatment is available to all categories of patients, including children and pregnant women at any gestational age. On the basis of the Department of Otorhinolaryngology of A. I. Evdokimov Moscow State Medical University in 2019–2020, a clinical study was conducted, which showed that such a combination of isotonic saline solution and antiseptic leads to improvement of patients and accelerates the recovery. In the process of monitoring 36 patients: in 35 of them achieved clinical cure, 1 patient required the appointment of antibiotic therapy due to the development of symptoms of purulent sinusitis. The results indicate a pronounced advantage of treatment in combination with elimination drugs, which was expressed in a reduction of symptoms during the first week of treatment, their complete regression was noted on the 30th day of use of the drug. Thus, chronic rhinosinusitis and allergic rhinitis are an important medical and social problem, and treatment of such patients requires only an integrated approach with obligatory consideration of the pathogenesis of the disease.Allergic rhinitis (AR) and chronic rhinosinusitis (CR) can be diagnosed as an independent or combined pathology, as well as a possible complication of each other. Allergic rhinitis is a disease characterized by IgE-mediated inflammation of the nasal mucosa and the presence of daily manifestations of more than one hour and at least two of the following symptoms: nasal obstruction, rhinorrhea, sneezing, nasal itching. The frequency of psychosomatic disorders is quite high and ranges in the population. Studying the mechanisms of disease development provides the basis for rational therapy, not just symptom relief. We have considered the use of elimination therapy for CR associated with AR. This type of treatment is available to all categories of patients, including children and pregnant women at any gestational age. On the basis of the Department of Otorhinolaryngology of A. I. Evdokimov Moscow State Medical University in 2019–2020, a clinical study was conducted, which showed that such a combination of isotonic saline solution and antiseptic leads to improvement of patients and accelerates the recovery. In the process of monitoring 36 patients: in 35 of them achieved clinical cure, 1 patient required the appointment of antibiotic therapy due to the development of symptoms of purulent sinusitis. The results indicate a pronounced advantage of treatment in combination with elimination drugs, which was expressed in a reduction of symptoms during the first week of treatment, their complete regression was noted on the 30th day of use of the drug. Thus, chronic rhinosinusitis and allergic rhinitis are an important medical and social problem, and treatment of such patients requires only an integrated approach with obligatory consideration of the pathogenesis of the disease.

The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy

Liver fibrosis develops as a result of chronic liver damage of various etiologies, is characterized by excessive synthesis of connective tissue by activated stellate liver cells. The toxic effect of alcohol is one of the most significant and common etiological factors worldwide. Stellate cell activation results from the interaction of multiple molecular fibrogenic pathways triggered by intracellular and extracellular, hepatic and extrahepatic stimuli. Data analysis showed that knowledge about these abnormal pathways and biomolecular processes may further contribute to the improvement of approaches to assessment of disease prognosis and treatment of alcoholic liver disease.

Significant role of getting the required amount of air into the human body belongs to the breathing by the nose. The nasal cavity prepares the air for reciprocity with the lower respiratory tract owing to the complex structure of the mucous membrane. When nasal obstruction occurs, breathing is carried out mainly through the mouth, and there is a violation of the basic functions of the nose, as well as the ingress of unadapted aggressive air to the sensitive alveolar structures of the lungs. This leads first to functional, and then to morphological and structural changes. In addition, difficult nasal breathing leads to impaired aeration of the paranasal cavities, middle ear cavity and hypoxia of all organs of the body. Even short episodes of nasal obstruction affect the quality of life, and prolonged untreated or incorrectly treated acute viral rhinosinusitis can spill over into lingering bacterial diseases of the ENT organs. Decongestants are used to eliminate nasal congestion. Decongestants include a wide range of substances that are used topically or systemically, in the form of monotherapy or in combination with other substances. The most popular drugs in this group are topical decongestants, since they have the most pronounced effect. The main nasal decongestants can be divided into two groups: sympathomimetic amines: primary aliphatic; phenolic and non-phenolic compounds, as well as imidazoline derivatives. Among the modern vasoconstrictor drugs oxymetazoline. Using it strictly according to the instructions within 3–5 days guarantees the absence of the development of local and systemic complications.

Increase in the number of acute and chronic diseases is a global trend. On the one hand, the emergence of new types of viruses, their active mutation, an increase in antibiotic-resistant bacterial strains, a high frequency of immunodeficiency and allergic diseases contribute to this. On the other hand is inadequate treatment of inflammatory diseases of the upper respiratory tract, widespread use of systemic antibiotics without indications. The use of bioregulatory medicines with proven efficacy in the complex treatment can reduce the drug load on the body, reduce the bacterial complications and side effects. Traumeel®S joins the physiological course of inflammation and activates pro-resolving mediators, contributes to its faster completion and tissue repair. The efficacy and safety of Traumeel®S has been confirmed in many randomized clinical trials. The drug has proven its value in almost any inflammatory pathology of the upper respiratory tract and ear. The drug Lymphomyosot®, a multicomponent agent with lymphatic drainage action, has proven itself perfectly in the complex therapy of chronic tonsillitis. In November 2019, the Council of Experts of the National Medical Association of Otorhinolaryngologists on the problems of pathology of the lympharyngeal ring was held. It is recommended to use the multicomponent bioregulatory preparation Traumeel®S to correct the inflammatory process, which has shown in studies a modulating effect on inflammatory mediators without suppressing COX-2 (prostaglandins). With exacerbation of chronic tonsillitis and lymphadenitis of nonspecific etiology, it is possible to use the multicomponent preparation Lymphomyosot®, which helps to improve the drainage and detoxification function of the lymphatic system.

This article overviews and systemizes published data on the ways of implementing different methods of biofeedback, robotic devices, and brain-computer interfaces (BCI) for rehabilitation of children with cerebral palsy (CP).Aim. To survey implementation practices and clinical outcomes of rehabilitation technologies and possible neurophysiological mechanisms underlying their efficacy in patients with CP. We searched PubMed, Web of Science and eLIBRARY.ru databases for relevant publications using specified keywords.Results. The analysis of relevant literature has shown that robotic technologies and BCIs with biofeedback based on electroencephalography and electromyography parameters are rapidly developing and implemented for the rehabilitation of children with CP. The first evidence of effectiveness for such methods and approaches has been found. However, there is a lack of fully developed conventional standards for the use of such rehabilitation methods and protocols in children. Control groups comprising of children with CP are often absent in such studies. In many cases, the variations of neurophysiological and neurochemical parameters before and after a course of rehabilitation are not evaluated. Having such data would help clarify physiological mechanisms underlying effective rehabilitation of motor functions and then design more adequate rehabilitation procedures and medication protocols.

Introduction. Constipation is a derangement of the motor, secretory and/or evacuation function of the colon. The same symptoms are recorded in at least 20% of the population in the developed countries – as those occurring sporadically or for a long period.Basic content. The secretory function of the colon significantly affects stool consistency and its free movement. The secretion increases by 8–10 times in the presence of local mechanical irritation. Intestinal mucus is produced by colonic goblet cells. The frequency, time of defecation and stool consistency is in large part determined by the motor function of the colon. The relation of various types of contraction varies depending on the main function – propulsion or mixing. Rhythmic phasic contractions in the colon generate a pendular movement with slow propulsion of the contents and absorption of water. The tonic contractions enhance the mixing effect of weak rhythmic contractions. The propulsive contractions are specifically attributed to the lower gastrointestinal tract and occur spontaneously. They occur quite regularly, from 2 to 10 times a day, and ensure the propulsion of intestinal contents over great distances in the colon. When reaching the sphincter area, such wave causes its relaxation by mechanisms of descending inhibition. The dietary regime and adequate intake of carbohydrates with various chain lengths, including dietary fiber, as well as flavonoids and other components that modify peristaltic activity and secretion, play an important role in the regulation of intestinal secretion and peristalsis. The drugs enhancing intestinal secretion and peristalsis, such as bisacodyl and sodium picosulfate, are also used to treat constipation. These substances hydrolyse into bis-(p-hydroxyphenyl)-pyridyl-2-methane in the intestine, which, upon contact with the receptors in colonic mucosa, stimulates propulsive activity and increases intestinal secretion. The selective action of sodium picosulfate is confined to the colon.Conclusion. Pharmacological and non-pharmacological treatments for constipation are aimed at maintaining and enhancing the natural propulsive contractions of the colon and intestinal secretion.

Aim.Analysis of the effectiveness of the MSCs aministration as the second- or third-line therapy of acute GVHD (aGVHD) resistant to glucocorticosteroid treatment. Materials and methods.The study included 35 patients who received MSCs obtained from the bone marrow of healthy donors as a treatment of steroid-resistant aGVHD. The clinical parameters of patients, MSCs cultural characteristics, the MSC expression profile for various genes including those involved in immunomodulation, expression of cells surface markers, the source of MSCs, as well as the frequency and number of MSC administrations were analyzed. Results.Response to therapy was achieved in 74% of cases, a complete response was reached in 13 (37%) patients, partial response/clinical improvement was demonstrated in 13 (37%). This treatment was ineffective in 9 patients. The prediction of a group of patients with good response to MSC therapy turned to be impossible. The differences between the effective and ineffective for the GVHD treatment MSCs samples were found. The effective ones were characterized with a decreased total MSCs production and an increase in the main histocompatibility complex and PDL-1 antigens expression. Conclusion.These data allow to select optimal samples for aGVHD treatment that can improve clinical results. aGVHD treatment with MSCs has shown efficacy comparable to other treatment approaches. Given the low percentage of complications and the absence of significant adverse effects, MSC therapy seems to be one of the optimal approaches to the treatment of resistant forms of GVHD.

The purpose of the study is to substantiate the personalized selection of substitution therapy medications with the consideration of the pathogenesis of dry eye syndrome development in each patient. In order to achieve the set goal, we conducted a content-analysis of the information fromnomenclature on active ingredient as well as on the mechanisms ofaction of substitution therapy medications provided in the prescribing information and labeling of the medications. After that, we performed a pathogenetic ranging of substitution therapy medications depending on the way they influence a certain aspect of disorder of the tear film renewal process in dry eye syndrome. The information received in the course of the conducted research makes it possible for an ophthalmologist – basing on information on the disorder in the quantitative and qualitative correlation between the tear film layers received with the help of modern diagnostic tools to prescribe targeted dry eye syndrome treatment taking into account the necessary point of application of the substitution therapy medications, considering their composition and action mechanism of the active ingredients which they contain.

Recent statistics have shown increased rates of morbidity and mortality from Clostridium difficile infection worldwide. This problem is mainly typical for surgical patients and is associated with an antibiotic therapy and a prolonged hospital stay. Recipients of solid organs are at a high risk of developing severe forms of C. difficile infection due to immunosupression. Existing recommendations for the treatment of C. difficile infection are based on the severity of the disease and do not consider patients after liver transplantation. The aim of this work is to determine an actual tactics for the diagnosis and treatment of C. difficile in organ recipients in clinical practice.

Objective: To evaluate the effect of the “treat to target” anti-rheumatic therapy on the course of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA). Materials and methods: The study included 22 patients (17, or 77% female) with CHF with valid diagnosis of RA (ACR/EULAR criteria, 2010), median (Me) age of 60 years, and median disease duration of 7 months. Ten patients (45%) were seropositive for IgM rheumatoid factor and 22 (100%) had antibodies to cyclic citrulline peptide. Their median (1st; 3rd quartiles) DAS28 was 5.6 [4.8; 6.5]. The diagnosis of CHF was confirmed in accordance with the guidelines on the diagnosis and treatment of CHF by the Russian Society of Specialists in Heart Failure (2013). NT-proBNP levels were measured by electrochemiluminescence (Elecsys proBNP II, Roche Diagnostics, Switzerland). All patients were started on subcutaneous methotrexate (MT) with rapid dose titration to 30 mg weekly. If the MT was insufficiently effective, a biological disease-modifying antirheumatic drug (bDMARD) was added to the therapy after 3 months, mainly a TNF-alpha inhibitor. After 18 months, 10 (45%) patients were in remission and had low disease activity, 6 (60%) patients underwent MT therapy in combination with bDMARDs. Results: At baseline, 21 (95%) patients were diagnosed with CHF with preserved ejection fraction and one patient had CHF with reduced ejection fraction. After 18 months there was an improvement of clinical symptoms, echocardiographic parameters (reduction of the left atrium diameter and the left atrium end-systolic volume index, IVRT, E'LV), and diastolic function of the left ventricle (LV). No episodes of acute CHF deterioration were registered. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n=5) and low disease activity (n=2), mainly under the treatment with MT and bDMARDs. In patients with RA and CHF, the NT-proBNP levels decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg/ml (p

In diabetic eyes lesions, the importance of the Platelet-Derived Growth Factor (PDGF-BB), its genes and receptors has been shown. Aim of this study: to determine the association of the rs1800818 PDGFB gene with relapses in the surgical treatment of diabetic maculopathy (DMP). Object and methods: 313 patients with type 2 diabetes and 95 controls. Patients underwent a three-port closed subtotal vitrectomy, which, according to the testimony, was combined with peeling of the inner border membrane, panretinal laser retinal coagulation and cataract phacoemulsification. Blood levels before surgery were determined by PDGF-BB (R&D Systems; USA), rs1800818 – real-time polymerase chain reaction (TaqMan Mutation Detection Assays, Life-Technology, USA). Statistica 10 (StatSoft, Inc., USA) was used for statistical data processing. Results. The blood PDGF-BB content was significantly increased compared to the control. At DMP relapses PDGFBB before the beginning of surgical treatment was significantly higher than without relapses. The PDGFB gene rs1800818 polymorphism is associated with DMP: the minor allele T reduced the risk by 1.5-fold. The association of polymorphism with the severity of diabetic retinopathy and the complexes of surgical interventions were not found. rs1800818 has been associated with the surgical treatment relapses: the relapses risk in carriers of minor C allele has been significantly reduced. C-carriers had a lower PDGF-BB content than T-carriers, which had statistical significance for both patients and controls (p≤0.001) and could explain the protective effect of minor C allele for DMP relapses. Conclusion. The obtained results broaden the understanding of the DMP relapses development factors and substantiate the direction of targeted therapy – reduction of PDGF-BB blood content.

The article considers the need to introduce the post of health ombudsman. Aim. To study national legislation regulating the main directions of health care reform in order to improve the constitutional and legal mechanism for the protection of human rights inUkraine and to promote the proper observance of Ukrainian citizens rights in the field of health care. Methods: dialectical method, system analysis, structural-functional and formal-legal method. Results. The state, guaranteeing social rights of citizens, in particular on health care, thus declares that the state of social security becomes possible only if the mechanisms of legal regulation are applied. It is determined that in many countries, the ombudsman institution has become an integral part of the state power mechanism. This institution is an addition to existing forms of control and supervision of the observance of human and civil rights and freedoms. The introduction of the health ombudsman institution inUkraine would increase the control over the functioning of medical institutions and significantly improve the medical care of the population. Conclusions. The introduction of a specialized ombudsman in the field of health care would facilitate the comprehensive implementation of medical reform inUkraine, effectively responding to detected legislative gaps in its implementation, and promote the proper observance of the rights of Ukrainian citizens in the field of health care.

Abstract The article addresses the problem of providing the right of prisoners to proper medical care. Aim. To study and analyze the key regulatory legal acts regulating the right to medical care of persons deprived of their liberty and to find out the problems that arise in implementing this right. Methods: historical, procedural and institutional analysis, behavioral and synergetic approaches, civil law method. Results. The analysis of a normative and legal basis that regulates issues of right to medical care and its implementation has been conducted. It has been theoretically justified, that successful and dynamic development of both medical low in particular and the State as a whole depends largely on the system of legal protection for human rights quality in the field of health care and to what extent everybody can enjoy the rights given. At the same time, the legal norms in the field of health care must not remain declarations only - standards unaccompanied by creation of a system for their realization, protection and defence. Conclusions. A greater focus needs to be placed on the legal framework improvement and actual use of the legislative provisions relating to the investigation of complaints concerning ill-treatment and violation of human dignity, a failure to provide or inappropriate medical care, inadequate custody of persons deprived of their liberty.

The review discusses thesteps of vitamin B12 metabolism and its role in maintaining of neurological functions. The term "vitamin B12 (cobalamin)" refers to several substances (cobalamins) of a very similar structure. Cobalamin enters the body with animal products. On the peripherу cobalamin circulates only in binding with proteins transcobalamin I and II (complex cobalamin-transcobalamin II is designated as “holotranscobalamin”). Holotranscobalamin is absorbed by different cells, whereas transcobalamin I-binded vitamin B12 - only by liver and kidneys. Two forms of cobalamin were identified as coenzymes of cellular reactions which are methylcobalamin (in cytoplasm) and hydroxyadenosylcobalamin (in mitochondria). The main causes of cobalamin deficiency are related to inadequate intake of animal products, autoimmune gastritis, pancreatic insufficiency, terminal ileum disease, syndrome of intestinal bacterial overgrowth. Relative deficiency may be seen in excessive binding of vitamin B12 to transcobalamin I. Cobalamin deficiency most significantly affects functions of blood, nervous system and inflammatory response. Anemia occurs in 13-15% of cases; macrocytosis is an early sign. The average size of neutrophils and monocytes is the most sensitive marker of megaloblastic hematopoiesis. The demands in vitamin B12 are particularly high in nervous tissue. Hypovitaminosis is accompanied by pathological lesions both in white and gray brain matter. Several types of neurological manifestations are described: subacute combined degeneration of spinal cord (funicular myelinosis), sensomotor polyneuropathy, optic nerve neuropathy, cognitive disorders. The whole range of neuropsychiatric disorders with vitamin B12 deficiency has not been studied well enough. Due to certain diagnostic difficulties they are often regarded as "cryptogenic", "reactive", "vascular» origin. Normal or decreased total plasma cobalamin level could not a reliable marker of vitamin deficiency. In difficult cases the content of holotranscobalamin, methylmalonic acid / homocysteine, and folate in the blood serum should be investigated besides carefully analysis of clinical manifestations.

Надп’ятково-гомілковий суглоб серед суглобів нижньої кінцівки травмується найчастіше. Вважають, що ушкоджуються його зв’язки в 1 людини на 10 000 мешканців на день. Найчастіше виникають ушкодження бічних зв’язок надп’ятково-гомілкового суглоба, що становить близько 95 % усіх його травм, разом з тим, як переломи кісточок виникають приблизно у 15 % випадків. Ушкодження зв’язок дистального міжгомілкового синдесмозу більшості випадків відбувається при переломах кісточок типу В та С (згідно з класифікацією Асоціації остеосинтезу (АО)). Оцінка ступеня ушкодження зв’язок базується на результатах клінічного обстеження, сонографії, рентгенографії, а в деяких випадках – КТ- та МРТ-дослідженнях. Збільшення роздільної здатності апаратів МРТ, удосконалення методики проведення досліджень відновлює інтерес до вивчення незмінених структур суглобів, у тому числі надп’ятково-гомілкового в різних вікових групах. Мета дослідження – продемонструвати можливості високопольної (1,5 тесла) магнітно-резонансної томографії у діагностиці незмінених латеральних колатеральних зв’язок та дистального міжгомілкового синдесмозу в людей молодого віку. Матеріали і методи. У дослідженні взяли участь 12 добровольців молодого віку, з них ‒ 8 чоловіків і 4 жінки. Середній вік обстежуваних становив (19,3±2,16) року. Дослідження проводили на високопольному 1,5 тесловому магнітно-резонансному томографі “Siemens Magnetom Аvanto”. Результати досліджень та їх обговорення. Передню надп’ятково-малогомілкову і задню надп’ятково-малогомілкову зв’язки було виявлено у 100 % досліджень надп’ятково-гомілкового суглоба в аксіальній площині. Задню надп’ятково-малогомілкову зв’язку було ідентифіковано в усіх дослідженнях у фронтальній площині. П’ятково-малогомілкову зв’язку було виявлено в 67 % в аксіальній та 83 % у корональній площинах. Передню і заднью міжгомілкові зв’язки синдесмозу, як правило, було добре видно на двох або більше послідовних аксіальних і фронтальних зображеннях. Міжкісткову зв’язку спостерігали у 75 % випадків і складалася з більше ніж двох пучків волокон. Висновки. Ділянка надпʼятково-гомілкового суглоба – це складний топографо-анатомічний об’єкт. Зображення, отримані при магнітно-резонансній томографії даної ділянки, мають багато особливостей. Вивчення даних МРТ-дослідження зв’язок надпʼятково-гомілкового суглоба в осіб молодого віку, в яких відсутній травматичний анамнез, дозволяє сформувати категорію їх візуальної норми з диференційною метою.

Порушення в системі гемостазу мають серйозний вплив на перебіг захворювання і наявність ускладнень у пацієнтів із коморбідним перебігом ішемічної хвороби серця (ІХС) та цукрового діабету (ЦД) 2 типу. Мета дослідження – оцінити та проаналізувати показники фібринолізу в різних групах пацієнтів з ішемічною хворобою серця та супутнім цукровим діабетом 2 типу залежно від стадії компенсації останнього. Матеріали і методи. В ході дослідження фібринолітичної системи обстежено 52 хворих, яких госпіталізовано в кардіологічне та ендокринологічне відділення Київської клінічної лікарні на залізничному транспорті № 2 з клінічними ознаками ІХС. Пацієнтів поділили на три групи: перша – 27 осіб із ІХС у поєднанні з ЦД 2 типу в стадії субкомпенсації, друга – 14 хворих у стадії компенсації та третя 11 пацієнтів у стадії декомпенсації. Результати досліджень та їх обговорення. Проаналізувавши дані, ми виявили знижений рівень плазміногену при субкомпенсації на 15,5 % (р

Introduction. The term «functional disorders of the biliary tract and bile ducts» defines the conditions, which produce typical patterns of biliary pains in the absence of obvious signs of organic lesions of the gallbladder and bile ducts. The materials of the Rome IV consensus present the diagnostic criteria of their main types – functional disorders of the gall bladder and sphincter of Oddi. Vasilenko Clinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology of the University Clinical Hospital No. 2 of Sechenov University carried out a noninterventional observational program to study the experience in using Trimedat® (trimebutine maleate) in the routine outpatient and inpatient practice in the treatment of patients with functional diseases of the biliary tract. Information partners of the program are the Russian Gastroenterological Association (RGA) and the Russian Society for the Study of the Liver (RSSL).Materials and methods. The program included patients of both sexes aged 18 to 65 years with ICD-10 diagnoses «spasm of the sphincter of Oddi» (K 83.4), «postcholecystectomy syndrome» (K 91.5), «other specified diseases of the gallbladder» (K 82.8) , «other specified diseases of the bile ducts» (K 83.8), «disorders of gallbladder and biliary tract in diseases classified elsewhere» (K 87.0), if the clinical picture was consistent with functional biliary disorders according to the Rome IV criteria and in cases when the doctor decided to prescribe Trimedat® therapy. Patients were observed for 28 ± 1 days. The dynamics of biliary pain and discomfort, as well as other symptoms (in particular, nausea, flatulence) were evaluated on the background of the therapy, using the Gastrointestinal Symptom Score Scale, in which the severity of each symptom is estimated by 7 grades (Alekseev N.Yu., 2006) with adding a section to evaluate the biliary disorders. In the presence of criteria for functional disorders of the gallbladder, an ultrasound control of the fraction of its discharge was carried out before and after the therapy.Results. 100 patients (33 (33%) men and 67 (67%) women, the average age 42.2 ± 13.2 years (18–65 years)) were enrolled in the program. In accordance with the Rome IV Consensus, the majority of patients (83 (83%)) had the functional disorders of GB; in 16 (16%) patients with the removed GB, the picture corresponded to the functional disorder of SO, one patient with kept GB was diagnosed with SO dysfunction. The treatment with Trimedate® at a standard dosage resulted in a decrease in the proportion of pain in the epigastric region (in the Scale section evaluating the biliary tract symptoms), the degree of nausea and bloating. Differences between the visits were estimated by the Friedman’s test, p

Background. The article describes the methods of the 6 th year students active teaching in the medical university on the subject Internal diseases. Traditional lecturing used in teaching has the lowest retention rate; the use of games as part of an instruction method may enhance retention and reinforce learning by creating a dynamic educational environment. Aim.This study aims to systematically review the literature on educational business games medical students of the senior courses to identify trends and investigate assessment tools used to measure its learning outcomes. To develop and assess using method of business game own variant of educational tool for the 6th year students in the internal medicine discipline. Methods.Seven databases were used in the search: ERIC, Education Research Complete, Medline, Medline Complete, Academic Search Complete, The Cochrane Library and PubMed in period of 2007-2018. Using key words: business games, students, active teaching method, professional training, medicine. Results and discussion.Business game is a complex interactive technology, which allows based on the analysis of the simulated situation, to develop alternative solutions and projects based on a variety of interaction and cooperation between teachers and students, in conditions of different role interests, intellectual and emotional tension, competition and expert evaluation. The developed business game with 7-10 participants allows students to be involved in an atmosphere as close as possible to real medical practice, to form clinical thinking and increase responsibility before making decisions in various clinical situations, which significantly distinguishes this method of training and knowledge control from traditional ones. Business games cultivate personal qualities, accelerate the process of socialization, imitating situations that are real in future professions, develops the ability to search and work with information, allows you to significantly enhance the students creative abilities, promotes the experience exchange, develops the ability to team building, models the conditions of the professional environment, realizing the activity competence approach in training, allows activating the students cognitive activity, forming practical and professional skills of students. Therefore for the teacher this technology has practical sense because it helps them to carry out a purposeful choice of a corresponding training method or their combination for the decision of specific didactic problems. Conclusion. Gaming makes a positive impact on the teaching/learning process. However, existing assessment methodologies have been not fully captured the learning that may occur in these games. Robust research is needed to address the use of games that have been assessed objectively.

Rationale: Liver transplantation is the only curative treatment for diffuse end-stage liver disease and some liver neoplasms. The amount of these interventions in the Moscow Region is very low.Aim: To analyze the results of the first series of liver transplantations done in the Moscow Regional Research and Clinical Institute (MONIKI), to compare it with those done currently in Russia and worldwide, and to establish the optimal volume and trend of development for this new regional center.Materials and methods: More than 200 patients with liver cirrhosis, polycystosis and alveococcus invasion have been examined from May 2016 to August 2018; 70 of them were eligible for liver transplantation and were put on the waiting list. From October 2016 to July 2018, 29 liver transplantations from deceased donors (including 2 retransplantations) and one living related transplantation of the right lobe have been performed. Among the indications to the transplantation, the leading one was viral (HCV or HBV-related) cirrhosis. Four patients were diagnosed with hepatocellular carcinoma.Results: The waitlist mortality was 19%. Median waiting time was 5.5 [3; 9] (0 to 27) months. Until now, the results were followed till 22 months, with median follow-up of 7 [2; 13] months. The survival rate of the recipients was 96.4%, of the grafts 93.3%. In-patient mortality was 3.6%. Early allograft dysfunction was seen in 33% of cases. Median length of the in-hospital stay was 22 [19; 25] days.Conclusion: The successful implementation of the liver transplant program at its initial stage demonstrates the results that meet current efficacy criteria. Achieved level of organ procurement from deceased donors in the Moscow Region could ensure at least 30 liver transplantations annually, with current facilities and a potential for further growth. An increase in the transplantation number would depend on the improvement of transplantation service facilities in MONIKI and on the stable financial support of the program. Finally, it would promote increased availability of this transplantation technology in the region, lower waitlist mortality and shorter waiting times.

Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. Due to objective reasons, the indicators of perinatal and early neonatal deaths of children in the Russian Federation have been steadily declining over the past decades. Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. However, it is necessary to take into account the risks of operative delivery for both mother and baby. The planned caesarean section does not allow to fully activate the adaptive mechanisms of the baby, which disrupts the cytokine cascade and leads to various immunological disorders, one of which is allergy. The last meta-analysis of 13 trials showed a high risk of developing bronchial asthma in children born by cesarean section. Autoimmune diseases, oncological processes and systemic diseases is clearly in evidence in this group. This article discusses the risks for children born by planned cesarean section in the short and long term and the possibility of prevention according to modern trials.

Цель работы – оценить эффективность эндоваскулярной лазерной коагуляции (ЭВЛК) при варикозном расширении вен нижних конечностей и определить пути оптимизации такого лечения. Материал и методы. Среди 263 больных изолированная ЭВЛК выполнена в 33,8% случаев, с кроссэктомией и химической склеротерапией склеровейном или фибровейном – в 8,0%, со склеротерапией без кроссэктомии – в 58,2%. ЭВЛК осуществляли с помощью аппарата ≪Фотоніка-Ліка-Хірург≫ (Украина). Результаты. Значительное улучшение через месяц после ЭВЛК отмечено в 39,9% случаев, а спустя полгода – в 93,9%, при этом факторами риска более низкой эффективности операции являлись мужской пол и пожилой возраст больных, высокое артериальное давление, сужение бедренных артерий и наличие коморбидного гонартроза, причем в течение первых 4 недель от времени оперативного вмешательства результаты лечения были тесно связаны с изменени- ями исходных поверхностных адсорбционно-реологических вязких свойств венозной крови, тогда как в последующем зависели от состояния эндотелиальной функции сосудов (показате- ли поверхностной вязкости, тромбоксана-А2 и простациклина могут обладать прогностичес- кой значимостью), а наилучший эффект достигался после проведения совместной с ЭВЛК склеротерапии и применения ривароксабана, в течение первых двух недель – низкомолекулярных гепаринов и цикло-3-форта.

The review aims to provide a contemporary view of the pathogenesis and treatment of the most common duodenum diseases – duodenal ulcer disease (DUD) and functional dyspepsia (FD). Due to its unique structure and functions, the duodenum that anatomically represents the initial section of the small intestine differentiates itself from others. The prevalence of DUD is declining in many Western countries due to the widespread introduction of effective anti-Helicobacter therapy and a significant decrease in the prevalence of H pylori infection. However, the ideas about the poly-biological nature of DUD persists and additional risk factors continue to be studied. DUD is manifested by pain/burning feeling in the epigastric region, as well as by symptoms such as early satiety, epigastric filling after eating in the absence of obvious organic changes in the digestive system. The diagnosis of FD is based on the Rome IV criteria. The duodenum plays an important role in its pathogenesis (disorders of gastric accommodation, motor and visceral hypersensitivity). Most patients with FD have microscopic signs of inflammation of the mucous membrane of the postbulbar part of the duodenum - an increased amount of intraepithelial lymphocytes, eosinophils, and signs of increased permeability of the mucous membrane. In all likelihood, these changes are provoked by infection and / or nutritional factors, as well as by exposure to hydrochloric acid. Proton pump inhibitors (prokinetics in postprandial distress syndrome) form the basis of treatment of peptic ulcer and epigastric pain syndrome; all patients with DUD and dyspepsia syndrome infected with H. pylori receive antihelicobacter therapy. Rabeprazole that is characterized by a long and powerful effect and minimal interaction with the cytochrome 2C19 system stands out from the proton pump inhibitors. Conclusion: acid aggression plays a very important role in the pathogenesis of duodenal ulcers diseases and FD; proton pump inhibitors form the basis for the treatment of such patients both in the form of monotherapy and as part of eradication regimens.

Presently, there is solid evidence that breast-feeding is ideal for the nutrition, harmonious physical and psychosocial development of the infants. This postulate is confirmed not only by modern scientific data, but also by the entire history of humanity from ancient times. However, history also shows that at all times there were various factors besides medical ones that prevent the appropriate and widespread breastfeeding of infants. These factors were both religious and social, and even political; they changed from one era to another and from one nation to another, and unfortunately, take place in modern society. They often had a character of prejudice and reflected on the health state of both infants and their mothers. This article presents a historical overview of the factors preventing breastfeeding, which can help the paediatrician understand the current causes of the insufficient prevalence of natural feeding.

Every paediatrician faces the problem of how to diagnose and treat constipation in children in the daily practice. According to the sociological survey of parents and doctors, on average every third child has a delay in evacuating stool. According to the 2016 Rome VI criteria, the diagnosis of functional constipation in children from 0 to 4 years of age is based on diagnostic signs that differ for children older than 4 years old. This article considers the mechanisms of constipation development in children of different age groups, and discusses the influence of microbiota on the development of motor and neurosensory intestinal disorders. The use of probiotics in constipation therapy is still controversial. The article presents recent studies of the efficacy of different probiotic strains in the treatment of constipation in children. So far, only Lactobacillus reuteri (DSM 17938) has a proven effect for the treatment of constipation in using monostam probiotics.

The article presents the results of using Normobact L Synbiotic for the treatment of acute intestinal infections (AII) in children. The study included 60 children aged between 6 months and 6 years with a clinical diagnosis of AII, acute gastroenteritis of viral etiology. The average age of patients enrolled was 2.6 years, with 46.7% (28/60) girls. The treatment of AII was carried out in accordance with the clinical guidelines for the management of acute intestinal infections and included pathogenetic and symptomatic therapy. In addition, the study groupa recieved the biologically active additive (BAA) Normobact L (manufacturer Akrikhin, Russia) containing a probiotic strain Lactodacillus rhamnosus GG. According to the ESPGHAN guidelines, this strain has the largest evidence base of efficacy in the treatment of AII [8]. Synbiotic Normobact L was used at a dose of 1 sachet once daily for 7 days. In the comparison group, the patients received Bifidumbacterin in the amount 15 doses divided into 3 daily intakes for 7 days in addition to pathogenetic and symptomatic therapy. The obtained data analysis showed that diarrheal syndrome ceased earlier in the group of children who received Normobact L. The stool became normal 1.19 days sooner than in the group of children receiving Bifidumbacterin. In general, the period of normalization of stools in Group 1 (Normobact L) was significantly less than in Group 2 (Bifidumbacterin): 3.24 ± 0.4 days and 4.43 ± 0.2 days, respectively. It was also found that the period of normalization of temperature in Group 1 (Normobact L) was significantly less than in Group 2 (Bifidumbacterin): 53.00 ± 1.98 and 78.3 ± 2.44 h respectively. The body temperature in 100% of patients in the group of children receiving Normobact L became normal on Day 5, in the group of children receiving Bifidumbacterin on Day 7.

One of the stages of the pathophysiological study of the state of the prooxidant-antioxidant system under the conditions of modeling different types of rhinitis in rats was carried out. The experiment took 36 rats, with bacterial and chemical rhinitis, with treatment and without it. Indicators of peroxidation of lipids and antioxidant system were determined in serum: thiobarbituric acid (TBA) and diene conjugates (DK), reduced glutathione (RG) and catalase (Cat). The obtained research results confirmed the formation of oxidative stress in experimental groups, both in chemical and bacterial rhinitis, according to DK and TBA data at 168.3%, 216.1% (chemical) and 159.4%, 216.1% (at bacterial) compared to intact animals. Imbirol shows pronounced therapeutic antioxidant properties in comparison with the reference preparation Pinosol. The effectiveness of the new gel "Imbirol" has a more positive dynamics of AOS restoration in blood serum when developing experimental rhinitis and does not differ significantly from the parameters of the reference preparation "Pinosol". In the pathogenesis of chemical and bacterial rhinitis, the violation of the antioxidant-antioxidant system is installed at the system level. Application of powerful universal treatment with gel "Imbirol" in both types of experimental rhinitis contributes to the normalization of the indicators of the system "peroxidation-antioxidant protection". The applying of the gel "Imbirol" in chemical and bacterial rhinitis reliably led to the restoration of the excited AOS parameters at the systemic level by reducing the concentration of TBA and DC and increasing the activity of the enzymes of catalase and RG. The obtained results allow to continue the study of the influence of antioxidants in experimental rhinitis, and mechanisms of restoration of the nasal mucosa under the pharmacological influence of the gel "Imbirol".

Extraskeletal manifestations (ESMs) are commonly observed in ankylosing spondylitis (AS). The available data on the association of ESMs with the inflammatory activity and other clinical parameters of AS are contradictory.Objective: to assess the association of ESMs with the inflammatory activity and other manifestations of AS.Patients and methods. The investigators of the V.A. Nasonova Research Institute of Rheumatology examined a total of 452 patients (363 men and 89 women) diagnosed with AS meeting the New-York criteria (1984). The patients' median age was 31.5 [24; 41] years; median disease onset age, 19.5 [15; 23] years; and disease duration, 11.5 [7; 18] years. HLA B27 was identified in 442 (97.7%) patients. In addition to standard laboratory and instrumental examinations, 172 patients underwent transthoracic echocardiography; Rehberg's test, if indicated; IgA test; histological examination of subcutaneous fat tissue or duodenal mucosa for amyloid; renal ultrasound; colonoscopy; and consultations by an ophthalmologist, a dermatologist, a nephrologist, an urologist, and a gastroenterologist. Uveitis, cardiac involvement (cardiac conduction disturbance, aortic and valvular changes), inflammatory bowel disease (IBD), glomerulonephritis, and psoriasis were considered to be ESMs. The latter were detected in 218 (48%) of the 452 patients; there was uveitis in 140 (30%), cardiac conduction disturbance in 61 (13.4%), psoriasis in 17 (3.7%), IBD in 16 (3.5%), nephritis in 16 (3.5%), and aortic and valvular changes in 71 (41.2%) of the 172 patients. The groups of patients with ESM (n = 218) and without ESM (n=234) were compared with regard to the onset age of AS, the presence of HLA- 27, peripheral arthritis, coxitis, enthesitis, syndesmophytis, fever, anemia, the need for biological agents (BAs) and/or systemic glucocorticoids (GCs), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and erythrocyte sedimentation rate (ESR). Results. The ESM and non-ESM groups were matched for gender, age, duration of AS, and the presence of HLA-В27. No significant differences were found in ESR, BASDAI, and the frequency of coxitis, enthesitis, and syndesmophytis in the spine. The ESM group versus non-ESM group was significantly more frequently observed to have peripheral arthritis in 148 (67.8%) of the 218 patients and in 70 (33.2%) of the 234 patients, respectively (p

Stomach's output part and small intestine, combining with damaging of the urinary tract is a rare systemic lupus eritematosus (SLE) manifestation. The patient is 32 years old, suffering from SLE with damaged join, blood system, secondary antiphospholipid syndrome with pulmonary embolism in the history and formation of high postembolic pulmonary hypertension on therapy with hydroxychloroquine and low doses of corticosteroids, was hospitalized because of persistent nausea, vomiting, loss of more than 10 kg body weight 1.5 months. The research have shown the obstruction's formation of the stomach's output part, small bowel obstruction at several levels, as well as thickening of the bladder wall and the unilateral expansion of the ureter. Against the backdrop of strengthening of immunosuppressive therapy these lesions completely regressed.

Modern molecular genetic methods of research, which emerged in the 21st century, completely unfixed all established notions not only about the microcosm, but also about its influence on the life and health of the macroorganism. The identification of intestinal bacteria and particularities of their various strains is increasingly expanding our understanding of the mechanisms of their action on the somatic and mental health of a human being. The various lactobacilli strains have been the most studied probiotic at the present time. The genus Lactobacillus is known to include about 90 species with a wide range of biochemical and physiological properties. Lactobacillus reuteri, which has strains with different mechanisms of action, is one of the unique microorganisms of the family Lactobacillaceae. The range of possibilities for using various Lactobacillus reuteri strains is currently very wide. This article deals with clinical effects associated with the strain-specificity of Lactobacillus reuteri.

The research objective is to study the impact of plastic surgery different methods of acute post-extraction oroantral communications treatment on patients' quality of life in early post-operative period. Materials and methods. The study included 41 patient aged between 18 and 58 years receiving treatment of maxillary sinus perforation, which was caused by tooth extraction. The patients were divided into 3 groups – 14, 12 and 15 persons respectively. Plastic surgery of the oroantral communication in the first group was done in accordance with the methods suggested by the authors using collagen cone and membrane. The same surgery in the second group was done with PRF (Platelet-rich fibrin). In the third (control group), the communication was closed by the vestibular flap following the Rehrmann method. Results of patients' quality of life evaluation after plastic surgery treatment of acute post-extraction oroantral communication show the decrease of its general indicator in early post-operative period in all groups of patients. The general quality of life indicator (well-being indicator) shows a tendency to increase over the first 24 hours after the surgery in both study and control groups. This may mean that a relatively small trauma in a maxillofacial area has a significant influence on patients' perception of their condition and well-being. Absolute numbers of well-being indicator over the first 24 hours after the surgery in the third group were almost 1.5 times higher than those in the groups 1 and2. Ina comparative study of the groups 1 and 3 and then the groups 2 and 3, we observed a significant difference between well-being indicator levels (p < 0.01). The control group demonstrated the return to the pre-operative life quality values on the 7-th day after the surgery. While at the same time, those values in the study groups were equal to the pre-operative ones already on the 4-th day. Conclusions. Operation trauma which was caused by the plastic surgery for closure of acute oroantral communication leads to the decrease of patients' quality of life (oral-related conditions), which correlates with the volume of a surgery and its complexity. The use of less traumatic methods of oroantral communication plastics facilitate the statistically significant decrease of these plastics negative impact on patients' quality of life in early post-operative period and enables the earlier recovery.

Aim. To identify a parameter predicting a collection of at least 2·106 CD34+ hematopoietic stem cells (HSC)/kg body weight per leukapheresis (LA) procedure. Subjects and methods. The investigation included 189 patients with hematological malignancies and 3 HSC donors, who underwent mobilization of stem cells with their subsequent collection by LA. Absolute numbers of peripheral blood leukocytes and CD34+ cells before a LA procedure, as well as a number of CD34+ cells/kg body weight (BW) in the LA product stored on the same day were determined in each patient (donor). Results. There was no correlation between the number of leukocytes and that of stored CD34+ cells/kg BW. There was a close correlation between the count of peripheral blood CD34+ cells prior to LA and that of collected CD34+ cells calculated with reference to kg BW. Conclusion. The optimal absolute blood CD34+ cell count was estimated to 20 per µl, at which a LA procedure makes it possible to collect 2·106 or more CD34+ cells/kg BW.

Aim. To determine the efficiency of maintenance therapy with bortezomib in patients with multiple myeloma (MM) who have achieved complete remission (CR) after autologous hematopoietic stem cell (auto-HSCT), depending on the presence of minimal residual disease (MRD). Subjects and methods. In January 2014 to February 2016, fifty-two MM patients (19 men and 33 women) aged 24 to 66 years (median 54 years), who had achieved CR after auto-HSCT, were randomized to perform maintenance therapy with bortezomib during a year. On day 100 after auto-HSCT, all the patients underwent immunophenotyping of bone marrow plasma cells by 6-color flow cytometry to detect MRD. Relapse-free survival (RFS) was chosen as a criterion for evaluating the efficiency of maintenance therapy. Results. After auto-HSCT, MRD-negative patients had a statistically significantly higher 2-year RFS rate than MRD-positive patients: 52.9% (95% confidence interval (CI), 35.5 to 70.5%) versus 37.2% (95% CI, 25.4 to 49.3%) (p=0.05). The presence of MRD statistically significantly increased the risk of relapse (odds ratio 1.7; 95% CI, 1.2 to 3.4; p=0.05). Two-year cumulative risk of relapse (using the Kaplan-Meier) after auto-HSCT did not statistically significantly differ in MRD-negative patients receiving (n=15) and not receiving (n=10) maintenance therapy with bortezomib (p=0.58). After completion of maintenance treatment, 42% of the MRD-positive patients achieved a negative status. In the MRD-positive patients who had received maintenance therapy, the average time to recurrence was 5 months longer than that in the naïve patients: 17.3 versus 12.3 months. Conclusion. The MRD status determined in MM patients who have achieved CR after auto-HSCT is an important factor for deciding on the use of maintenance therapy.

Objective: to describe a clinical case of neurosyphilis diagnosed in a therapeutic inpatient facility.Materials and methods. Female patient T., 61, was hospitalized in the therapeutic department of a general hospital with referral diagnosis of “Stage II hypertensive heart disease, risk 4. Hypertensive crisis of 03.12.2015” with complaints of general fatigue, episodes of transient memory loss with full recovery, unstable blood pressure level. The patient was examined: She underwent treponemal and nontreponemal serological tests for antibodies against Treponema рallidum, hepatitis, human immunodeficiency virus; electrocardiogram; angiography of carotid and vertebral arteries; magnetic resonance imaging (MRI) of the brain with contrast; serological and microscopic examinations of the cerebrospinal fluid (CSF).Results. The patient»s medical history described episodes of transient global amnesia with full memory recovery, more frequent in the last year; arterial hypertension; chronic urinary tract infection; and chronic cholecystitis with frequent courses of antibacterial therapy (ceftriaxone). Since 1986, a positive serological reaction for syphilis was observed (Wassermann reaction (WR) +++) due to a history of primary syphilis. Considering reliable history of syphilis, positive serum confirmation tests for syphilis (nontreponemal: rapid plasma reagin test 3+; treponemal: passive hemagglutination reaction 4+, antibodies against T. pallidum (total) – present), history of neuropsychological symptoms (transient amnesia) and acute neurological symptoms before hospitalization (transient ischemic attack), brain MRI data (2 lesions of cerebral circulation disorders of ischemic type in the cortical branches of left and right mesencephalic arteries), a diagnosis of neurosyphilis was proposed, and lumbar puncture was performed for confirmation. Inflammatory characteristics of the CSF (cytosis 19/3, neutrophilia up to 12 cells, insignificant lymphocytosis up to 7 cells) and positive confirmation serological reactions (nontreponemal test: serum microprecipitation reaction negative, treponemal test: immunoassay: total antibodies – positivity coefficient (PC) 4.3; immunoglobulin G – PC 2.8) were indications for standard therapy for the “neurosyphilis” diagnosis with subsequent serological control of the CSF and serum.Conclusion. The clinical case demonstrates complexity of neurosyphilis diagnosis due to a lack of pronounced clinical manifestations of the disease and advisability of a multidisciplinary approach to treatment of these patients.

Takayasu’s disease (nonspecific aortoarteritis) affects the absolute majority of 20—40-year-old women; its most common manifestations include aortic arch branch lesions. The specific features of the described case is the male gender of the patient, signs of mesenchymal dysplasia, a concurrence of tuberculosis, pulmonary hemorrhage, and myocarditis at onset, the presence of IgG4, peculiar ocular symptomatology, and its rapid regression after initiation of therapy.