Pharmateca

Background. During the end of the coronavirus pandemic, an increase in the frequency of acute respiratory viral infections (ARVI)-related hospitalizations of children and changes in the seasonality parameters of certain nosological forms were observed throughout the world.

Objective. Presentation of the epidemiological characteristics of ARVI in children hospitalized in a repurposed children’s hospital in the autumn-winter season of 2022–2023.

Methods. All children hospitalized with signs of acute respiratory tract infections during the repurposing of departments of the St. Vladimir Children’s City Clinical Hospital were subjected to rapid tests for COVID-19, influenza types A and B, and nasal and oropharyngeal swabs were taken for real-time polymerase chain reaction for SARS-CoV-2 and the spectrum of ARVI pathogens. When indicated, as part of differential diagnosis, detection of DNA of Human herpes virus 6, Epstein-Barr Virus (EBV) and Bordetella pertussis, and bacteriological studies were performed. The survey results were assessed retrospectively.

Results. During the conversion period, 2,105 patients were hospitalized. COVID-19 was diagnosed in 32 (1.5%). The diagnosis of influenza was established in 603 (28.6%) children. Respiratory syncytial virus infection (RSVI) was confirmed in 139 (6.6%) cases. Rhinovirus RNA was detected in 54 (2.6%) children. The detection rate of other identifiable respiratory viruses did not exceed 1.5%. 48.4% of disease cases remained etiologically undeciphered.

Conclusion. Influenza virus and respiratory syncytial virus were the most common pathogens detected in the study group of hospitalized patients. The data confirmed an earlier rise and an earlier winter peak for influenza in the 2022-2023 season, as well as a longer period of influenza prevalence. The traditional spring peak of RSVI incidence has also been shifted to the autumn-winter period. The mass of children sick with ARVI in the last pandemic autumn-winter season was associated with an increase in the number of hospitalization. The epidemiological characteristics of the last pandemic season are explained by the consequences of the COVID-19 pandemic, which had an impact on interviral interactions and the state of immunity of children with increased susceptibility to respiratory viruses after a long period of quarantine measures.

Fecal biomarkers (FBM) reflect the severity of inflammation of the intestinal mucosa to a greater extent compared with similar blood serum markers. Serum markers can change for many reasons, but local inflammation in the intestine does not always correspond to the systemic inflammatory response detected in the blood. To date, many FBMs have been identified, but only a few have been thoroughly studied in children. This article examines in more detail the following promising markers: calprotectin, S100A12, M2-pyruvate kinase, osteoprotegerin, myeloperoxidases, HMGB 1, matrix metalloproteinases, and the currently recommended fecal calprotectin. At the moment, there is no single universal marker that would have high sensitivity, specificity and prognostic ability in both Crohn’s disease (CD) and ulcerative colitis (UC).

Background. Inflammatory bowel diseases (IBDs) are a pressing problem in gastroenterology around the world due to a recurrent course, a pronounced decrease in quality of life, disabling complications and the difficulties of individual selection of therapy.

Objective. Clinical assessment of the course and treatment of IBD in a cohort of patients who were followed-up to the City IBD Center in Elizavetinskaya Hospital, St. Petersburg.

Methods. A cross-sectional sample study that included demographic and clinical data of 516 patients with IBD who visited a City IBD Center in 2020–2023 was conducted. This sample of patients was compared with a cohort of 1078 patients with IBD who received treatment in 42 clinics and 6 hospitals in St. Petersburg in 2018–2020.

Results. Systematic differences between the cohort of patients who received treatment in the City IBD Center and the cohort of patients with this pathology who received drug treatment in medical institutions in the city healthcare system were identified. In the City IBD Center, patients with complicated, moderate and severe course of the disease were mainly followed-up. In the structure of extraintestinal manifestations, peripheral arthropathy and damage to the mucous membranes were in the lead, and in the structure of identified complications – anemia and protein-energy deficiency. Distinctive features of drug therapy prescribed for the management of patients at the IBD Center were the widespread use of genetically engineered biological therapy, as well as the active use of immunosuppressants in the treatment of Crohn’s disease, which is fully consistent with current clinical recommendations. Conclusion. In the City IBD Centers within the framework of the St. Petersburg City Healthcare System, the most clinically difficult patients with ulcerative colitis and Crohn’s disease are followed-up and receive the necessary treatment. The importance of City IBD Centers in providing specialized gastroenterological care to patients of this category in St. Petersburg will increase in the coming years.

Background. The administration of oral anticoagulants in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) is associated with an increased risk of bleeding. Rivaroxaban is metabolised by several pathways, one of which is catalysed by cytochrome P-450 enzymes. Carrying polymorphic variants of genes encoding proteins of cytochrome P-450 system (CYP3A4, CYP3A5) and its metabolic activity may affect rivaroxaban concentration and, consequently, the risk of bleeding.

Objective: to assess the possible relationship between the presence of polymorphic variants of CYP3A5 (rs776746), CYP3A4 (rs35599367) genes, metabolic activity of CYP3A, Cmin,ss of rivaroxaban and bleeding in patients with non-valvular AF and concomitant CKD stages 3 and 4.

Methods. 122 patients from 52 to 97 years old (median age 82 years) with AF combined with CKD stages 3 and 4 were included in the study. Each patient was subjected to pharmacogenetic and pharmacokinetic study, and further the occurrence of bleeding was evaluated during 16 weeks using a special bleeding questionnaire. All patients were further divided according to genotype into «slow» (n=7), intermediate» (n=98) and «normal metaboliser» (n=17) groups followed by analyses of CYP3A metabolic activity, Cmin,ss of rivaroxaban and presence of bleeding events.

Results. During the follow-up period, 48 patients (39.3%) were found to have haemorrhages. The metabolic activity of CYP3A (6-β-hydroxycortisol/cortisol ratio) was statistically significantly higher in patients with bleeding compared to patients without bleeding: 0.8 [0.6; 1.6] and 0.7 [0.5; 1.6] ng/ml, respectively (p=0.046). CYP3A metabolic activity was paradoxically higher in the «slow metaboliser» group compared to the «intermediate» metaboliser group: 2.14 [1.42; 2.38] and 0.80 [0.53; 1.67] ng/ml, respectively (p=0.022).

Conclusion: the influence of rivaroxaban metabolism on the development of bleeding in patients with AF and CKD requires further study.

Cardiovascular diseases (CVD) are the leading cause of global mortality and the leading cause of disability in the world. The leading modifiable risk factors for CVD - the level of systolic blood pressure (SBP) and low-density lipoprotein (LDL) - are responsible for the development of atherosclerosis and atherosclerotic cardiovascular diseases (ACVD). An important area of the evidence-based movement is a multifactorial approach to managing cardiovascular risk, in particular using fixed-dose combination tablets (polypills) containing antihypertensive drugs and statins, which improve blood pressure control and lipid profiles, and also antiplatelet drugs to prevent further ACVD events. The results of studies and meta-analyses assessing the effect of polypills on CVD risk factors and the main outcomes of cardiovascular morbidity and mortality are presented.

A Cochrane meta-analysis of 13 RCTs that examined the effect of polypills on factors in the primary and secondary prevention patient population, as well as subsequent meta-analyses, confirmed significant reductions in the key modifiable risk factors of SBP and LDL. Subsequently, a comprehensive assessment of the effect of polypills was carried out not only on risk factors, but also on outcomes - cardiovascular morbidity and mortality, including in large RCTs (HOPE-3, PolyIran, TIPS-3) and a number of meta-analyses, including up to 25 RCTs. The results showed a significant reduction in the risk of serious adverse cardiovascular events and mortality in primary or secondary prevention against the background of polypills containing antihypertensive drugs and statins, and more pronounced in primary prevention. There was an increase in adherence to polypill therapy, with no significant difference in the frequency of adverse reactions compared to conventional therapy. Fixed combination therapy is especially important for the treatment of hypertension. Moreover, modern trends are the use of combinations of 3 and 4 antihypertensive drugs in half and quarter dosages (quadropills), which, due to the additive effect, increases blood pressure control.

Background. Atrial fibrillation (AF) is a risk factor for cognitive impairment (CI) and dementia. However, the relationship between various forms of AF and CI remains poorly understood.

Objective. Comparison of the cognitive status of patients with various forms of AF and patients without AF.

Methods. The study included patients with various forms of AF: 70 (38.7%) patients with paroxysmal AF (73 [64.75; 76.5]), 54 (29.8%) with persistent or permanent forms (78.5 [68; 83]) and the control group – 57 (31.5%) patients without AF (75 [68; 81]). All patients underwent a study of cognitive functions using the Montreal Cognitive Assessment Scale (MoCA), Mini-Mental State Examination (MMSE), Verbal Association Test (literal/letter and categorical/animal associations), and 10-word memory test.

Results. Among patients with permanent and persistent forms of AF predominated those who scored the minimum number of points (≤24 points) when performing the MMSE: 13 (24.7%) versus 6 (8.4%), P=0.023, and the minimum number of points (10 –17 points) when performing the MoCA: 11 (20.9%) versus 4 (5.6%), P=0.023). They named fewer associations as literal: 9 [6; 11] versus 11 [7.5; 13.0], P=0.008, and categorical: 15 [11.25; 18] versus 17 [13; 21], P=0.046, and performed worse on the 10-word memorization test (immediate recall – 2.5 [0.25; 4.0] versus 3 [2.0; 4.5] words; P=0.043). Patients with permanent and persistent forms of AF compared to the control group (without AF) had worse cognitive function when tested on all neuropsychological tests. Compared to the control group (without AF), patients with paroxysmal AF named a larger number of words in the categorical association test: 17 [13; 21] versus 11 [9.5; 12] words (P=0.001) and fewer in the literal association test: 11 [7.5;13.0] versus 12 [10; 13], P=0.049; performed worse on the 10-word memorization test (immediate recall: 3 [2.0; 4.5] vs. 4 [3; 5] P=0.020.

Conclusion. The results obtained indicated an unfavorable effect of any form of AF on the cognitive functions of patients, with more pronounced CIs observed in patients with permanent and persistent forms of AF compared to both patients with paroxysmal AF and patients without AF.

Background. Despite the significant decline in the prevalence of COVID-19 around the world, the consequences of the pandemic on the health and quality of life of patients according to the data from clinical studies will remain a leading public health issue for a long time.

Objective. Dynamic evaluation and analysis of the N-terminal pro C-type natriuretic peptide (NUPC) and endothelin-1 (ET-1) levels in patients six months after COVID-19 against the background of arterial hypertension (AH), depending on the stratification of cardiovascular risk in AH.

Methods. 45 hypertensive patients with confirmed diagnosis of coronavirus infection COVID-19 (virus identified) who were treated in an infectious diseases hospital were examined. Determination of the NUPC and ET-1 levels in blood serum samples was carried out using the enzyme immunoassay method. Biomarker levels were determined twice – on the first day of admission to the hospital and six months after discharge. Cardiovascular risk in AH was also assessed twice – on the first day of admission to the hospital and six months after discharge.

Results. Analysis of the NUPC and ET-1 levels on hospital admission between patients with moderate risk (risk 2) and high risk (risk 3) did not show statistically significant differences (P=0.487, P=0.821, respectively). Six months after COVID-19, in hypertensive patients with very high risk (risk 4), the levels of both ET-1 and NUPC were statistically significantly higher than in patients with high risk (risk 3) (P=0.012 and P<0.001, respectively). An increase in cardiovascular risk in AH six months after discharge from hospital was observed in 15 (33.3%) patients, and in 30 (66.7%) patients, cardiovascular risk in AH remained the same. In hypertensive patients who experienced an increase in cardiovascular risk six months after discharge from hospital for COVID-19, the levels of both ET-1 and NUPC were statistically significantly higher compared with patients who cardiovascular risk in AH did not change (P=0.01 and P<0.001, respectively).

Conclusion. According to the results of the study, it was found that the highest levels of both ET-1 and NUPC six months after discharge from the hospital were in patients with a very high risk (risk 4) and in patients who had an increase in cardiovascular risk in AH.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The socioeconomic burden of COPD is significant and requires targeted resources to optimize COPD management, including symptom control, exacerbation prevention, and effective treatment of comorbidities. Long-acting inhaled bronchodilators have been the mainstay of pharmacological therapy for COPD for many years at any severity of the disease. Numerous randomized controlled trials (RCTs) indicate early and sustained benefits against the background of therapy with a combination of long-acting inhaled bronchodilators in relation to both clinical and functional indicators and quality of life parameters, the frequency of exacerbations. An integrated research program to evaluate the effectiveness of the combination of long-acting bronchodilators, represented by indacaterol/glycopyrronium (IND/GLY), showed a significant advantage in the effect on the clinical and functional characteristics of COPD compared to monotherapy with indacaterol, glycopyrronium, tiotropium, as well as combinations of tiotropium and formoterol, salmeterol/fluticasone. Thus, clinical trial data demonstrate a higher effectiveness of IND/GLY in relation to lung function, COPD symptoms and a reduction in the frequency of exacerbations. Available evidence suggests that the most common comorbidity in patients with COPD is cardiovascular diseases (CVDs), reflecting a multicomponent and complex pathophysiological cardiorespiratory continuum. In addition, CVDs remain one of the main causes of mortality in patients with COPD. Evaluation of the effect of IND/GLY on cardiac function in patients with COPD showed a significant reduction in the level of pulmonary hyperinflation (PHI), which led to improved cardiac function. A decrease in residual lung volume by 750 ml (p<0.0001) during IND/GLY therapy was accompanied by improved regional ventilation in COPD patients with pulmonary hypertension, a significant improvement in pulmonary microcirculation, and an increase in right and left ventricular end-diastolic volumes (p≤0.0002) and improvement in cardiac output (p=0.0034). The obtained evidence of achievement of the main clinical targets in the treatment of COPD and a safety profile comparable to placebo allows to consider IND/GLY as a drug for optimal initial and maintenance therapy of COPD in the majority of patients with severe symptoms, exacerbations of the disease and cardiovascular comorbidity.

Patients with a combination of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are a special cohort that requires combination bronchodilator therapy in combination with glucocorticosteroid drugs. Patients with this pathology have difficulty achieving control of asthma and stabilization of COPD; they experience decreased lung function and frequent exacerbations requiring hospitalization, which leads to a decrease in quality of life. The possibilities for treating chronic obstructive diseases of the respiratory system have expanded significantly in recent years, primarily due to the emergence of new combination drugs. The International Guide for Global Initiative for Chronic Obstructive Lung Disease (2023) recommends starting treatment with triple inhalation therapy, including long-acting β2-agonists, long-acting anticholinergics, and inhaled glucocorticosteroids. This article presents data from studies of the clinical efficacy and safety of a fixed triple combination of beclomethasone dipropionate, glycopyrronium bromide and formoterol fumarate, available in the form of an extra-fine aerosol, which made it possible to optimize inhalation therapy in patients with a combination of BA and COPD.

Background. In the context of the COVID-19 pandemic, nurses turned out to be the most vulnerable category of medical workers in terms of the level of professional stress, professional burnout, level of anxiety, coping strategies implemented and the quality of life of nurses specialized in the “red zone” of multidisciplinary hospitals (MDHs), as well as outpatient clinics (OCs) during the new coronavirus infection COVID-19 pandemic.

Methods. The study was carried out at the Department of Occupational Diseases and Clinical Pharmacology named after the Honored Scientist of the Russian Federation, Professor V.V. Kosarev, Samara State Medical University, and the regional center of occupational pathology of the Samara City Hospital № 5. The following groups of nurses were examined: the first group consisted of nurses working in the “red zone” (n=29); the second group consisted of nurses working in MDHs (n=29), the third group consisted of nurses working in outpatient clinics (n=31), the fourth, control group (CG), included workers in engineering, technical and economic specialties not related to activity profile with work in medical organizations (n=190). The assessment of professional burnout syndrome was carried out using the “Maslach Burnout Inventory” for assessing professional burnout, developed by American psychologists S. Maslach, S.E. Jackson adapted by N.E. Vodopyanova, E.S. Starchenkova, as well as the V.V. Boyko questionnaire. The study used the Integrative Anxiety Test (IAT) to study the development of psycho-emotional disorders among general practitioners during the new coronavirus pandemic. The assessment of coping strategies among therapists during the pandemic of the new coronavirus infection COVID-19 was carried out according to the method developed by R. Lazarus and S. Folkman in 1988, adapted by E.V. Kuftyak. Quality of life was determined using the SF-36 questionnaire. Processing of the obtained data was carried out using the Statistica statistical package, StatSoft (USA).

Results. It has been established that the work of medical workers during the COVID-19 pandemic was associated with the impact of a number of specific risk factors associated with the provision of medical care to infected patients, as well as with significant changes in work regarding aspects related to organization and safety, which contributed to an increase in level of professional stress, professional burnout, decreased quality of life.

Conclusion. The work of nurses in a COVID hospital, when compared with nurses working in the MDHs and nurses working in outpatient clinics, was associated with an increase in the level of professional stress, the level of professional burnout, the level of anxiety, an increase in the level of use of coping strategies, and a decrease in the quality of life. It is necessary to continue research into the emotional state of nurses in order to carry out timely preventive treatment to preserve the health of this category of medical workers.

Limitations of the study. The study has regional (Samara region) and professional (in terms of detailing working conditions in the comparison groups studied) limitations.

Background. The use of a test with the tubercular recombinant allergen (TRA) expands the possibilities of detecting tuberculosis. This applies to both individual population groups (children, patients with comorbid somatic pathology, immunodeficiency) and individual areas of residence (rural areas), where laboratory and instrumental diagnostic capabilities are limited.

Objective. Evaluation of the role of immunodiagnostics and the results of the TRA test (tubercular recombinant allergen) in identifying tuberculosis infection in children living in rural areas.

Methods. The study included 13,285 children aged 8 to 17 years living in the Omsk district of the Omsk region. Median age Me (25%; 75%) 14 (8.0; 17.0) years. All children underwent an annual TRA test and the results were assessed after 72 hours.

Results. During 2023, TRA tests were administered to 100% of the assigned school-age child population. Of these, 56 children (0.4%) showed a positive reaction to TRA (Diaskintest), in 14 children the TRA test was questionable (hyperemia). Of the patients with a positive test, 49 (0.5%) were children from 8 to 14 years old and 7 (0.2%) were from 15 to 17 years old. The majority had a normergic reaction. Patients with a positive TRA test underwent additional examination. In 62.0% of such patients, no changes were detected according to chest MSCT. In 19 (38.0%) of the examined patients, the following changes were revealed by chest MSCT: dense foci in the lung tissue, calcifications in the bronchopulmonary and paratracheal lymph nodes (calcification sizes from 1.5 to 9.1 mm). Next, all 56 children with a positive reaction to Diaskintest were offered preventive chemotherapy, of which 50 patients (89.3%) received treatment, 6 children (10.7%) did not receive treatment (parental refusal). According to the results of a survey at the end of 2023, no cases of tuberculosis were identified among school-age children.

In conditions of limited diagnostic capabilities of rural healthcare, immunodiagnosis is a mandatory component of annual preventive examination of the child population for tuberculosis, with the subsequent formation of risk groups of individuals with a positive reaction to TRA for additional examination and courses of preventive chemotherapy.

Background. Timely diagnosis of the transition from relapsing-remitting multiple sclerosis (MS) to secondary progressive multiple sclerosis (SPMS) is extremely difficult due to the lack of clear criteria characterizing this period of the disease. The choice of therapeutic strategies in this case is a difficult task, and is associated by additional difficulties in the treatment of patients with low treatment adherence.

Description of a clinical case. A clinical case illustrating the difficulty in determining the type of MS is presented for consideration. The questions had to be resolved: remitting or secondary progressive course of the disease and, if SPMS, then with or without exacerbations? A patient who had suffered from MS for 18 years showed an increase in neurological symptoms over 1.5 years by 1 point on the EDSS scale, and an increase in the number of lesions in an MRI study. However, there were certain difficulties in interpreting these changes: they occurred as a result of exacerbation or progression of the disease. A comprehensive assessment of the data, based on current clinical guidelines and modern ideas about the management of MS patients, made it possible to select the optimal treatment strategy for MS patients with low treatment adherence.

Conclusion. A thorough analysis of the available clinical and radiological data of patients with MS, an attentive, trusting relationship between the attending physician and the patient, and the involvement of the patient and his relatives in discussing the choice of therapy are an important component in the practice of a neurologist. Wide therapeutic options and the emergence of innovative drugs contribute to a patient-centered approach to the treatment of MS.

Background. Studies of the effectiveness and safety of anti-CGRP therapy in routine clinical practice (Real World Studies), where patients with different forms of migraine, varying sensitivity to anti-migraine therapy, as well as concomitant and comorbid diseases are encountered, provide important information for neurologists.

Objective. Evaluation of the effectiveness, safety, and patterns of use of erenumab in the routine practice of a specialized headache center in the Russian Federation.

Methods. The open retrospective study included 126 patients followed-up at the University Headache Clinic (Moscow). The mean age of the patients was 40.3±9–10 years (19–67), women predominated (F – 111, M – 15).

Results. Before treatment, the frequency of days with migraine in the study group was 21.1±7.6 days; after 12 weeks, this figure was 10.2±8.3 (p<0.0001). Among patients with episodic migraine (EM), the frequency of days with migraine before therapy was 11.8±3.7, and after 12 weeks – 4.0 ± 3.3 (p < 0.0001). In the chronic migraine (CM) group, the frequency of days with migraine before treatment was 23.8±6.2, and after 12 weeks it was 11.9 ± 8.5 (p < 0.0001). The proportion of patients with ≥50% reduction in days with migraine after 12 weeks of therapy was 68.3% (n=86), with ≥75% reduction – 32.5% (n=41). The proportion of patients with a complete (100%) reduction in migraine days was 5.6% (n=7). In the EM group, the proportion of patients with ≥50% reduction was 86.2% (n=25), with ≥75% reduction – 41.4% (n=12). In the CM group, the proportion of patients with ≥50% reduction was 62.9% (n=61), with ≥75% reduction – 29.9% (n=41). It should be noted that erenumab was well tolerated at a dose of 70 mg once a month: one patient developed a tendency to constipation, and one patient experienced an increase in blood pressure.

Conclusion. Thus, erenumab is an effective and safe drug for the prevention of migraine in everyday practice and can be recommended for patients with various forms of migraine.

Background. The multicomponent pathogenesis of functional asthenia requires the selection of a set of effective rehabilitation technologies, which is possible based on an analysis of the mechanisms of their therapeutic action. It is urgent to search for technologies that determine a favorable prognosis for medical and psychological rehabilitation (MPR) of patients with functional asthenia (FA), determinants of effectiveness.

Objective. Assessment of the determinants of the effectiveness of MPR in patients with FA.

Methods. 24 patients aged 29.3 (21.5–35.0) years with FA (ICD-10 code R53) were examined. The patients were prescribed a set of physical exercises, a course of audiovisual polysensory relaxation, carbon dioxide baths, climatotherapy, therapeutic nutrition and psychotherapy. The total duration of the course was 30 days. To determine the relationship between integral health parameters and individual clinical and functional signs of maladaptation, a correlation analysis was carried out; canonical correlation analysis was used for the selection of the most informative signs; and for the prediction of adaptive potential values, regression analysis with step-by-step selection of the most significant signs (determinants) into the model was applied

Results. A decrease in signs of asthenia, an increase in the oxygen capacity of tissues, adaptation reserves, the level of somatic health and physical performance in patients with FA were revealed. Average correlations between improvements in adaptive potential and physical performance with instrumental and psychophysical indicators have been established. The effectiveness of MPR in patients with FA was 75%. Determinants of effectiveness included indicators characterizing the level of physical health, systolic blood pressure, age, strength index, post-exercise recovery rate, specific value of pulmonary capacity, and oxygen consumption level.

Conclusion. Various components of the pathogenesis of FA determine the choice of different physical treatment methods, and the combination of mechanisms of their therapeutic action determines the high efficiency of the final result of MPR in patients with FA.

Background. Activation of Cutibacterium acnes is one of the key links in the development of acne. Changes in the species composition of bacteria, increased enzymatic and pro-inflammatory activity determine the development of comedones, papules, pustules and other inflammatory elements. Early use of systemic antibiotics contributes to rapid and positive dynamics of the clinical symptoms of the disease, the formation of remission in a larger number of patients and an increase in the number of patients adherent to treatment.

Objective. Justification of the use of systemic antibiotics as initial therapy in patients with moderate acne.

Methods. We followed-up 60 patients (28/46.67% men and 32/53.33% women) with moderate to severe acne aged from 18 to 50 years (mean age 29.28±3.17 years). Patients were randomized into 2 comparison treatment groups. Group I consisted of 30 patients (12 men and 18 women) who received monotherapy using a gel whose active ingredient was a fixed combination of adapalene 1 mg/g and benzoyl peroxide 25 mg/g once a day for 28 weeks. Group II included 30 patients (16 men and 14 women) who were prescribed complex therapy using a fixed combination of adapalene 1 mg/g and benzoyl peroxide 25 mg/g once a day for 28 weeks and dispersible tablets of doxycycline monohydrate 100 mg 2 times a day for the first 4 weeks. All patients were recommended to use specialized cosmetics to care for problem skin throughout the entire course of treatment.

Results. It was found that initial therapy with the inclusion of an antibiotic increased the effectiveness of treatment. After completing the course of therapy, the number of patients with acne remission or excellent improvement in group II was 20 and 17% higher, respectively, than in the group receiving topical monotherapy.

Conclusion. A more rapid reduction in the activity of symptoms of moderate acne with the gradual use of systemic antibiotic therapy and topical treatment helps to increase patient’s adherence to therapy.

Background. A case of clinical observation of a 32-year-old patient with pseudoxanthoma elasticus (PXE) in the skin folds is presented. A rare genetically determined dermatosis is characterized by progressive calcification and fragmentation of elastic fibers in various tissues, including the skin (especially in the folds), eyes (angioid streaks and retinal defects) and the cardiovascular system (arterial hypertension, gastrointestinal bleeding and vascular damage).

Description of a clinical case. The clinical picture on the skin developed in childhood. Gradually, typical yellowish papules appeared, with a symmetrical location in the neck and armpits; due to asymptomatic nature, the patient did not notice their presence until adolescence. The pathological process progresses, typical papules appear in the groin areas, the elements are grouped, and the elasticity of the skin decreases. The diagnosis was made based on the clinical picture and histological description of a neck skin biopsy. Consultation with an ophthalmologist is recommended. Angioid streaks on the fundus are not specific for PXE, but often provide significant assistance in identifying the disease: they can precede skin changes or be isolated lesions.

Conclusion. Clinical observation of this case is of interest to practicing dermatologists and cosmetologists.

Background. According to the literature, the final decision for the selection of clinical centers is made on the basis of subjective assessments – personal judgment and assumptions of the working team, which, as a rule, is associated to the lack of objective criteria for assessing a clinical center. The clinical site is responsible for both patient recruitment, in accordance with all protocol criteria and regulatory requirements, and for completing the patient recruitment agreed upon during the patient search phase providing successful achievement of targeted patient recruitment. One of the important conditions for successful patient recruitment is the high-quality selection of clinical centers at the feasibility stage, which requires objective tools to select clinical centers that will recruit patients in accordance with all protocol requirements and achieve the target goals of the clinical trial.

Objective. Searching for objective criteria for evaluating clinical centers providing targeted recruitment of patients.

Methods. Data obtained from 70 clinical centers located in 59 cities of Russia, Belarus and Ukraine (RUB region) generated in 4 clinical studies involving 622 patients were retrospectively analyzed. All 4 studies were successful in patient recruitment. The following values were calculated using the descriptive statistics method: mean, error of mean, standard deviation and coefficient of variation.

Results. Objective criteria for the selection of clinical centers (parameters and indicators) that make it possible to predict the upcoming enrollment of patients in the clinical center have been identified. Based on the grouping of parameters and indicators, 4 types of clinical centers were identified: type 1 – silent, type 2 – low-recruiting, type 3 – medium-recruiting and type 4 – high-recruiting, statistically significantly different in objective parameters of primary response time in days: 31.19±5 .27, 21.43±3.26, 23.64±4.04, 12.7±0.79, respectively, and according to objective indicators “Ratio of Primary Response Time in days/Estimated Patient Enrollment”: 4.56±1, 03, 2.42±0.43, 1.94±0.3, 1.345±0.099, respectively.

Conclusion. For the first time, objective criteria (parameters and indicators) for the selection of clinical centers have been proposed, allowing an objective assessment of the upcoming recruitment at the selected site. For the first time, types of clinical centers have been proposed based on selected objective criteria.

Lower urinary tract infections are one of the most common reasons why women seek medical help, in particular from general practitioners/therapists. The guideline addresses the main issues of etiology, pathogenesis, diagnosis and treatment of acute cystitis and asymptomatic bacteriuria. Conditions that require referral of the patient to a specialized specialist for treatment are listed separately.

In 1972 Ya.V. Bokhman identified and substantiated the existence of two types of endometrial cancer (EC), which differ in pathogenesis, tumor histological type, clinical course and prognosis. Various molecular changes characteristic of each type were later discovered. In recent years, four molecular subgroups of EC have been identified and characterized: with ultramutated POLE (POLE mut4); with hypermutated microsatellite instability (MSI); with low copy number and low mutational load, and subgroup with high copy number and frequent TP53 mutations. Several large randomized studies have confirmed the prognostic significance of these molecular subgroups. The research results influenced the creation of a new WHO histological classification in 2020 and a new FIGO classification for staging EC in 2023. The review provides molecular classification of EC, new FIGO 2023 classification, new classification of risk groups for EC, ESGO/ESTRO/ESP ESGO/ ESTRO/ESP 2021 recommendations on the diagnosis and treatment of EC. The use of these new classifications and recommendations in oncological practice will provide personalizing the treatment of patients with EC.