Vol 32, No 1 (2025)

Background. Vitamin D deficiency is widespread throughout the world among people of all ages. In the Russian Federation, the prevalence of vitamin D deficiency among the population exceeds 50%.

Objective. Comparative analysis of awareness among parents of children living in urban and rural areas about the need for vitamin D intake through an absentee survey.

Methods. The study involved 115 parents from Astrakhan (Group I) and 115 from the Astrakhan Region (Group II) with children aged 3 to 10 years.

Results. The study showed that most parents who participated in the survey were highly informed about vitamin D, but at the same time, the level of knowledge about its physiological role in the body was insufficient, which may be a factor contributing to the high incidence of vitamin D deficiency in the child population. Not all children received vitamin D supplements. At the same time, 15.6% (Group I) and 6.1% (Group II) of parents received vitamin D less than the recommended prophylactic dose, or an excessive dose in 4.3 and 1.6% of cases, respectively. Many parents were not focused on year-round intake of vitamin D.

Conclusion. The role of vitamin D in our body is extremely diverse. Vitamin D deficiency serves as a predictor of various abnormalities and pathological conditions. Timely detection and correction of vitamin D deficiency are a necessary condition for the normal functioning of the body. Thus, given that the most trusted source of information for parents is medical personnel, pediatricians need to continue and intensify the dissemination of information about vitamin D among the urban and rural population.

Inflammatory bowel disease (IBD) and celiac disease are autoimmune diseases. For the manifestation of these diseases, an external trigger activating the pathological reaction of the immune system is necessary. Such clinical manifestations as diarrhea or constipation, delayed physical development and recurrent abdominal pain syndrome can occur both in IBD and celiac disease. Patients with celiac disease, especially those who do not show positive dynamics on a gluten-free diet, are examined for the possible presence of IBD, since these two conditions can coexist. At the same time, if pathogenetic therapy for IBD is insufficiently effective (dyspeptic disorders and protein-energy malnutrition persist), celiac disease must also be excluded. This article describes a clinical case of celiac disease in an adolescent with a previously verified diagnosis of ulcerative colitis.

Atrial fibrillation and atrial flutter (AF and Aflu) are one of the most common diseases in the world, and its incidence increases with age. For example, in Russia, according to the EPOCHA study, the prevalence of AF is 2.04%, and reaches a maximum in the age group from 80 to 89 years – 9.6%. Treatment of AF in elderly patients is one of the difficult tasks for a clinician. This is attributable not only to the high risk of bleeding on the one hand, and thromboembolic complications on the other, but also to the characteristics of this population, such as the presence of senile asthenia (SA), cognitive impairment, risk of falls and other geriatric syndromes and age-associated diseases. Given these aspects, when prescribing anticoagulant therapy, preference should be given to the most effective and safe anticoagulant that has been studied in elderly patients. This article reviews the evidence base for the efficacy and safety of rivaroxaban in elderly patients with AF.

Objective. Determination of the cost and clinical and economic efficiency of using the coronary calcium score (CCS) assessment for primary prevention with statin therapy using a decision-making model supplemented with CCS parameters and risk estimates from the SCORE and SCORE2 algorithms.

Methods. We assessed the clinical and economic efficiency of CCS measurement and statin therapy prescription based on a model supplemented with CCS parameters and risk estimates from the SCORE and SCORE2 algorithms. The study included 131 patients without symptomatic diseases caused by atherosclerosis. All patients underwent multispiral computed tomography with CCS assessment. A comparison of two primary prevention strategies was conducted, one of which was based only on the assessment of traditional risk factors (risk strategy), the second - taking into account the CCS.

Results. The comparison showed that the highest direct costs (10,988,419 rubles) were when using the risk strategy, and when using the strategy based on determining the CCS, they were 9.4% less (9,950,340 rubles). At the same time, the use of statins taking into account the CCS allows saving 2.2 times more funds due to the prevention of myocardial infarction and acute cerebrovascular accident. It is expected to spend 7,385,138 rubles on the treatment of complications in the risk group, and 3,386,761 rubles in the group with an assessment of the CCS. The use of statins using the generally accepted methodology would save 9.5 years without complications, taking into account the CCS – 9.7 years. Accordingly, the cost of 1 year of life without complications when using the risk strategy will be: CER = costs per 1 person for the entire period of treatment / 9.5 = 8,830 rubles, when assessing CCS - 7,831 rubles, and would also allow preserving 7.51 years of quality life, taking into account CCS – 7.54 years. Accordingly, the cost of 1 quality adjusted life year (QALY) when using the risk strategy will be: CUR = costs per 1 person for the entire period of treatment/7.51 = 11,169 rubles, taking into account CCS – 10,074 rubles; therefore, using the strategy taking into account CCS has the lowest cost of 1 QALY and is the most cost-effective. Sensitivity analysis showed that even when using the minimum or maximum cost definition of CCS, the results of the clinical economic analysis are robust, and the cost per 1 year of life without complications and per 1 QALY in patients who initiate statin therapy based on the CCS definition is lower than in patients taking statins based on the risk strategy.

Conclusion. CCS testing can be cost-effective, but only if the cost of the procedure is inexpensive.

Acetylsalicylic acid (ASA) remains one of the most widely used drugs in cardiology due to its antiplatelet properties. However, long-term use of ASA is associated with the risk of side effects, especially from the gastrointestinal tract. The choice of ASA form plays an important role in minimizing side effects. Enteric-coated forms reduce the risk of gastropathy, but often have low bioavailability and insufficient antiplatelet effect, especially in patients with concomitant obesity and diabetes mellitus. Buffered forms demonstrate better tolerability and maintain high bioavailability, which makes them preferable for long-term therapy. Also, as a preventive measure for gastrointestinal complications, it is recommended to prescribe proton pump inhibitors, especially in patients with a high risk of gastrointestinal bleeding.

The emergence of new classes of modern lipid-lowering drugs in recent years and their availability allow doctors to achieve target of low-density lipoprotein (LDL) levels in patients with very high and extreme cardiovascular risk. This is achieved by correctly assessing the initial cardiovascular risk and timely escalation of lipid-lowering therapy. The demonstrated clinical example shows the logic of the doctor in making decisions on intensifying therapy, searching for possible options for achieving the target LDL level and the result of successfully achieving the goal. The discussion section discusses the issues of therapeutic/medical inertia and the factors that can be influenced to overcome it.

Biliary tract diseases are among the most common (10–20% among the adult population in developed countries) and costly diseases of the digestive system in the world. In addition to biliary tract pathology, chronic liver diseases are an important global public health problem. The incidence of gallstones in chronic liver diseases is usually high. The prevalence of biliary tract diseases may be associated with age, gender, etiology and severity of the disease in patients with chronic liver diseases. The authors of this article linked the epidemiology, mechanisms and strategies of early diagnosis and treatment of biliary pathology in patients with chronic liver diseases. There are still questions about at what stage the state of the biliary tract should be assessed and what correction should be carried out to avoid serious complications. Hymecromone is currently positioned only as a selective cholespasmolytic with a choleretic effect in case of dysfunction of the biliary tract, including spasm of the sphincter of Oddi, but without cholekinetic activity, which makes the use of hymecromone safe in cholelithiasis. However, among its pleiotropic effects, an antifibrotic effect in liver diseases is also described. The authors present a pharmacochemical comparative analysis of the original Gimecromone and its generics.

Background. Uncomplicated lower urinary tract infection (ULUTI) is one of the most common infectious and inflammatory diseases and is characterized by a high recurrence rate. It is known that the main source of pathogens is the intestine, where uropathogens exist among a complex microecological community – the intestinal microbiota (IM). To date, there are a limited number of studies on the relationship between ULUTI and IM, and there are no studies of this relationship using the gas chromatography-mass spectrometry (GCMS) method by the microbial marker mass spectrometry (MMMS) technique.

Objective. Assessment of the state of the IM and its impact on the development of the disease in patients with ULUTI.

Methods. An observational case-control study was conducted in the period from 01.08.2021 to 28.02.2023 with the participation of 33 patients with episodes of symptomatic ULUTI (first-time or relapse). The state of the IM was assessed using GCMS by the MSMM method on fecal samples.

Results. In the ULUTI group, a decrease in the number of Eubacterium spp. biomarkers (median (Me)=7.18, interquartile range (IQR) [4.24; 11.98] vs. Me=19.56, IQR [7.21; 26.85] ×10⁹ cells/g; p=0.005), Clostridium propionicum (Me=0.26, IQR [0.05; 0.49] vs. Me=0.76, IQR [0.25; 4.14] ×10⁹ cells/g; p=0.007), Propionibacterium jensenii (Me=4.71, IQR [2.06; 7.65] vs. Me=8.18, IQR [3.67; 15.57] ×10⁹ cells/g; p=0.045), and a higher number of Peptostreptococcus anaerobius 18623 (Me=4.31, IQR [2.29; 6.53] vs. Me=2.07, IQR [0.59; 4.53] ×10⁹ cells/g; p=0.031) compared to the group of healthy volunteers (HV) was noted. No significant differences in the number of Bifidobacterium spp. and Lactobacillus spp. markers were found (p>0.05).

It was determined that the most significant factor in the IM structure that has a protective effect in the context of ULUTI is Eubacterium spp. In the logistic regression model, it was found that an increase in the number of Eubacterium spp. was associated with a lower probability of having the disease (OR=0.885, 95% CI [0.817, 0.959]; p=0.003).

According to GCMS data, the level of Eubacterium spp. below 15.16×109 cells/g in fecal microbiota can be considered as a risk factor for the development of ULUTI (OR=15.95, 95% CI [3.60, 70.54]; p<0.001).

Conclusion. The state of the intestinal microbiota can have a significant impact on the risk of developing ULUTI. Further extensive studies to obtain a more complete picture of the relationship between intestinal microbiota and ULUTI and to develop new therapeutic approaches to disease prevention are required.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, affecting up to 30% of the adult population. It is closely associated with metabolic disorders such as obesity, type 2 diabetes mellitus and dyslipidemia, which increase the risk of cardiovascular diseases (CVD). Patients with NAFLD have a 2–3 times higher risk of developing CVD compared to the general population, which emphasizes the need for a comprehensive approach to treatment. One of the promising drugs for the treatment of NAFLD is ursodeoxycholic acid (UDCA), which, due to its cytoprotective, antioxidant, anti-inflammatory and immunomodulatory properties, not only reduces liver steatosis and fibrosis, but also reduces the risk of cardiovascular complications. The effectiveness of UDCA has been confirmed by numerous studies, including in combination therapy with statins. Studies demonstrate improvement in lipid profile and reduction in liver injury with UDCA treatment, making UDCA an important component of therapy for NAFLD and associated dyslipidemia.

Amoxicillin+clavulanic acid is an inhibitor-protected aminopenicillin that has been widely used for over 40 years to treat community-acquired lower respiratory tract infections. The drug is effective against the main pathogens of community-acquired pneumonia (CAP) and exacerbations of chronic obstructive pulmonary disease (COPD), including Streptococcus pneumoniae, Haemophilus influenzae, and others. Despite the growing resistance of some strains, the use of increased doses of amoxicillin with clavulanic acid allows overcoming some types of resistance, providing high efficacy with good tolerability. Amoxicillin+clavulanic acid is a drug of choice for the treatment of respiratory infections, including CAP, exacerbations of COPD and chronic bronchitis, as well as bacterial upper respiratory tract infections.

Chronic obstructive pulmonary disease (COPD) is a heterogenic obstructive disease with a wide range of clinical manifestations, which is the 3rd leading cause of death among patients worldwide. Based on the available therapeutic strategies for COPD patients, mucoactive therapy, including carbocysteine, has received intensive attention from specialists. In this review, we analyzed data from randomized clinical trials (RCTs) that expand our knowledge of the mechanisms of effect of mucoactive carbocysteine therapy on the frequency and characteristics of exacerbation in COPD patients. Carbocysteine, being a powerful mucoregulator, actively influences mucins/ciliary cells, oppose viral/bacterial infections, eliminates reactive oxygen species (antioxidant effect), and has a marked cytoprotective effect. The pleotropic effect of carbocysteine may also include the expression of histone deacetylase-2, which increases receptor sensitivity to systemic and inhaled glucocorticosteroids with evident anti-inflammatory effects. Our review will demonstrate that long-term carbocysteine therapy of COPD patients is well tolerated, has a beneficial safety profile and improves the quality of life of those patients.

Background. The pathomorphosis of tuberculosis at the regional level should be studied in order to predict antiepidemic measures during the implementation of state programs.

Objective. Analysis of the functional state and effectiveness of the tuberculosis control service in the context of ongoing COVID-19 to predict the volume and main directions of measures to prevent the spread of tuberculosis among the population of the Kursk region.

Methods. Data on the spread of tuberculosis infection from state statistics reports, periodicals, and authors’ observations over 30 years were analyzed.

Results. The features of the spread of tuberculosis infection among the population of the region and the effectiveness of antiepidemic measures carried out during the twentieth and early twenty-first centuries in various socio-economic conditions were revealed. High efficiency of the developed domestic antiepidemic measures, including in the COVID-19 pandemic, was established.

Conclusions. The developed domestic regimes for preventing the spread of the disease have proven their effectiveness in various conditions and only need to be modified taking into account the achievements of medical science and practice. There is an urgent need to restructure the system of providing tuberculosis care to the population, including the structure of tuberculosis institutions. The most promising option for reorganizing the tuberculosis control service in the context of pandemics is the integration of its functions with the activities of other services for the prevention of socially significant infectious diseases.

Background: COPD is a heterogeneous disease with multiple variant forms. As lung function declines and the disease progresses, the risk of alveolar hypoventilation with subsequent nocturnal hypoxemia increases. It is possible that nocturnal hypoxemia with tissue hypoxia plays a key role in the evolution of comorbid extrapulmonary disease. The aim of the present study was to identify predictors of nocturnal hypoxemia in stable COPD patients.

Materials and methods: A cross-sectional observational study included 106 stable COPD patients managed at a respiratory medical center (RMC) between 2019 and 2024 who completed ambulatory computerized somnography, pulmonary function testing, questionnaire and laboratory screening. Nocturnal hypoxemia (NH) was defined according to a time to saturation under 90% (T90) index >10%. Based on the absence/presence of NH, patients were classified into groups of patients with NH (NH+) and without NH (NH-). Predictors affecting nocturnal hypoxemia were identified using multivariate analysis and logistic regression models.

Results: There was a statistically significant effect of age (OR=1.06; 95% CI: [1.02–1.12]; p=0.011), COPD Assessment Test (CAT) score (OR=1.48; 95% CI: [1.10–2.00]; p=0.009), FEV1 (% predicted) (OR=0.96; 95% CI: [0.93–0.99]; p=0.015), high-density lipoprotein (HDL-C) levels (OR=1.02; 95% CI: [1.00–1.04]; p=0.034) on nocturnal hypoxemia. Multivariate regression analysis detected a statistically significant impact on nocturnal hypoxemia of such predictors as: 1) FEV1<50% (% predicted) (OR=3.46; 95% CI: [1.15–10.46]; p=0.028), increasing the risk of NH in 3.46 times; 2) insulin resistance index (HOMA-IR) >3 (OR=3.20; 95% CI: [1.09–9.35]; p=0.034), increasing the risk of NH in 3.2 times.

Conclusions: Significant predictors of nocturnal hypoxemia in stable COPD patients may be such parameters as: decrease in FEV1<50% and change in HOMA-IR index >3, increasing the risks of nocturnal hypoxemia by 3.46 and 3.2 times, respectively. This tendency should be taken into consideration in therapy of stable COPD patients.

Pain is often accompanied by sleep disorders, which manifest themselves in insufficient duration or quality of sleep. The relationship between pain and sleep is bidirectional: pain can disrupt sleep, and poor sleep in turn reduces the pain threshold and increases spontaneous pain. Like chronic pain, sleep disorders are a serious public health problem that affects overall health. A recent meta-analysis found a high prevalence of sleep disturbances in people with chronic pain, including insomnia (72%), obstructive sleep apnea (32%), and restless legs syndrome (32%). There is evidence that short or disrupted sleep can cause hyperalgesia (i.e., increased sensitivity to painful stimuli) and the development or exacerbation of spontaneous pain attacks (eg, muscle pain, headache). Current understanding of the neurobiological mechanisms of pain involves the opioid, monoaminergic, orexinergic, immune, melatonin, endocannabinoid, hypothalamic-pituitary-adrenal, and adenosine signaling systems, some of which are reviewed in this article. The clinical implications of the bidirectional relationship between sleep and pain should be considered in pain management. A large-scale study demonstrated that short-term improvement in insomnia symptoms predicted both long-term improvement in sleep and reduction in pain, regardless of the treatment method – pharmacological or non-pharmacological, which supports the hypothesis that improved sleep can lead to more effective pain relief and should serve as a basis for the development of new drugs and, possibly, behavioral treatments that could help manage or relieve pain, potentially affecting the common mechanisms regulating sleep and pain.

Background. There have been no new publications on the alsphobia since 2012, but awareness of amyotrophic lateral sclerosis among people with anxiety disorders has increased, as has the incidence of phobic disorders.

Methods. 233 patients with alsphobia were examined in neurological and psychiatric clinics with an assessment of the dynamics at different times using the Hamilton Depression Rating Scale. Neurological and endocrinological diagnoses as causes of «benign fasciculation syndrome» were established by excluding various causes using the methods of collecting anamnesis and follow-up, magnetic resonance imaging, needle and stimulation myography, analysis of creatine phosphokinase levels, genetic analysis for DAT1 gene mutations, and others.

Results. In total, there were 49 patients (22.4%) with a history of other phobias, 35 (16.0%) with panic attacks, 14 (6.9%) with a patient with ALS in the family, 11 (5.2%) doctors, and 11 (5.2%) iatrogenic cases. Thirty-nine (16.7%) patients were diagnosed with neurological diseases, and ten (4.3%) with endocrinological diseases. In total, there were 159 (68.2%) patients who received a psychiatric consultation, and 74 (32.3%) patients who did not. A total of 212 patients were assessed using the HAM-D scale before treatment and 151 after treatment. The sensitivity and specificity of such symptoms of alsphobia as video recording of twitching, twitching in the feet, interpretive delusions and agitation were 55–79% (p<0.001–0.0005). All these symptoms significantly correlated with each other with correlation coefficients from 0.2 to 0.6. The correlation between the duration and the HAM-D score was not significant (p=0.069). According to the ANOVA, the severity of phobia with assessment using Hamilton score, did not differ significantly (p=0.281). The severity of phobia according Hamilton score did not differ significantly depending on the presence of ALS in the family (p=0.594), iatrogenia (p=0.683), or health care workers (p=0.917). In situational anxiety disorders, the percentage of recovered patients was significantly higher than in endogenous diseases (χ2=23.3, p<0.001). The time dynamics in terms of recovery was significant (p<0.0005), but the differences between neurological, mental, and endocrine disorders, both in general (p=0.567) and in dynamics (p=0.436), were insignificant. Mutations in the DAT1 gene were detected in 15 of 20 examined patients. Prescription of therapy with an antidepressant and/or an atypical neuroleptic, thymoleptic did not significantly change the probability of recovery (p=0.172). According to the results of follow-up, one patient developed ALS, and one patient developed spinal amyotrophy (clinical examples are presented).

Conclusion. The judgement of a psychiatrist whether a patient has situation-mediated or endogenous anxiety disorder plays a key role. The prognosis for recovery is more favorable in patients with situational disorders. High sensitivity, specificity, and correlation of specific symptoms of alsphobia are shown. Management of patients with «benign fasciculation syndrome» within the framework of alsphobia should be carried out using a multidisciplinary approach (neurologist, functional diagnostics physician, psychiatrist, endocrinologist).

Background. Atopic dermatitis (AD) is one of the most common reasons for seeking primary health care for children. Being an immune-mediated dermatosis with a complex mechanism of genetic and environmental interaction, it currently has only a palliative nature of therapy.

Objective. Determination of the degree of influence of the compliance level in patients with atopy on the possibility of managing AM.

Methods. The retrospective cohort longitudinal study included 50 children (main group), who visited the clinic of allergology and immunology in the period from 2012 to 2014 with typical complaints of intestinal dysfunction, manifested by severe intestinal colic (IC), the appearance of pathological inclusions in the stool in the form of mucus, green mucus, in some cases - blood, a decrease in the frequency of bowel movements. The control group included 50 children who visited the clinic of allergology and immunology in the same period with absolutely identical baseline data and complaints. All patients underwent Stool Culture with Bacteria Identification and Antibiotic + Bacteriophage Susceptibility Testing to identify associations of Staphylococcus aureus and Klebsiella pneumoniae, oxytoca, followed by phage decontamination and monitoring the course of AM in dynamics.

Results. The study revealed the presence of excessive growth of Staphylococcus aureus and Klebsiella pneumoniae, oxytoca associations in all children in the study groups. The lg CFU/g levels in the main group were: Staphylococcus aureus – 5.82±1.00 lg CFU/g, Klebsiella pneumoniae – 3.98±0.91 lg CFU/g and Klebsiella oxytoca – 4.46±0.93 lg CFU/g. In the control group: Staphylococcus aureus – 5.78±0.95 lg CFU/g, Klebsiella pneumoniae – 4.12±0.93 lg CFU/g and Klebsiella oxytoca – 4.14±0.92 lg CFU/g. Efficiency monitoring carried out after the end of phage therapy (PT) revealed a significant decrease in the indicators. In the main group: Staphylococcus aureus – up to 2.20±1.19 lg CFU/g, Klebsiella pneumoniae – 1.99±1.19 lg CFU/g, Klebsiella oxytoca – 2.08±1.13 lg CFU/g; in the control group: Staphylococcus aureus – 2.18±1.17 lg CFU/g, Klebsiella pneumoniae – 2.14±1.06 lg CFU/g and Klebsiella oxytoca – 2.22±1.03 lg CFU/g. Initial data of total IgE level at the first control point at 1.6 years: in the main group - 23.92±8.46 IU/ml and 25.72±7.91 IU/ml in the control group. The decrease in the compliance level significantly affected the total IgE level at the second control point of 7 years: 60.28±28.61 IU/ml in the main group versus 103.74±70.19 IU/ml in the control group.

Conclusion. In children with a hereditary predisposition to atopy (based on clinical atopy biomarkers), preventive PT is the main therapeutic component capable of preventing the development of AD trigger reactions. The level of compliance is a determining condition for maintaining the clinical effect obtained from PT.

In recent years, there has been significant interest in the role of adipose tissue in determining the bioavailability of vitamin D, which is attributable to the well-known inverse correlation between obesity and serum 25-hydroxyvitamin D concentrations, described for all age groups, nationalities, places of residence, and independent of gender. Screening studies show that obesity is inferior to low sun exposure as a predictor of vitamin D deficiency severity, while the prevalence of obesity has already reached global pandemic proportions and is observed in about 39% of the world’s adult population. Obesity has been shown to be associated with increased mortality due to its association with comorbidities, including type 2 diabetes mellitus (DM2), arterial hypertension, dyslipidemia, osteoarthritis, and sleep apnea. At the same time, both at the physiological and biochemical levels, the active form of vitamin D has been shown to have many effects that counteract the adverse effects of obesity, which may reduce the risks of tissue damage in obesity and associated metabolic disorders, such as DM2 and cardiovascular diseases. Treatment of obesity, including bariatric surgery, does not always lead to favorable changes in the status and action of vitamin D, which must be taken into account in clinical practice.

Psoriasis is one of the most common skin diseases and occurs in 2-3% of the population; it affects about 125 million people worldwide. Several decades ago, it was considered an exclusively skin disease, but today it is considered a chronic multifactorial, multisystem, immune-mediated inflammatory disease with a complex pathogenetic mechanism caused by chronic activation of adaptive and innate immune responses due to excessive proliferation of keratinocytes with the development of latent multiorgan cellular destruction and dysfunction.

Periodontal diseases are among the most common human diseases and the first cause of tooth loss in adults. At the beginning of the 21st century, the concept of «periodontal medicine» was formed, considering the relationship between periodontal pathology and systemic diseases. Currently, more than 50 systemic inflammatory diseases and concomitant diseases are associated with periodontal pathology.

We searched the Pubmed and Scopus information databases for articles published before 01/21/2025 that examined the relationship between psoriasis and periodontitis. The results of epidemiological and clinical studies, their generalizations in systematic reviews and meta-analyses indicate the presence of a bidirectional relationship between psoriasis and periodontitis. The most likely mechanism is associated with systemic immune-mediated inflammation. Non-surgical periodontal treatment is probably effective in the treatment of psoriasis. The data presented in the review indicate the importance of periodontal health and the need for prevention and treatment of periodontal pathology in patients with psoriasis.

Background. Disturbances in the normal course of apoptosis, its stimulation or blocking, underlie a large number of diseases. Of particular interest is the study of apoptosis in trauma victims, apoptosis-mediated mechanisms of adhesion degradation.

Objective. Identification of general patterns and features of apoptotic processes in cerebral gliosis after traumatic brain injury and abdominal adhesions with regulation of apoptotic processes by diltiazem.

Methods. The work used two experimental models of cicatricial adhesive processes: 1) modeling of severe traumatic brain injury (TBI); 2) modeling of the adhesive process in the abdominal cavity. In the sensorimotor cortex of the brain, the numerical density of neurons and glia was determined, their condition was assessed (staining with hematoxylin and eosin, according to Nissl). Immunohistochemical studies were performed using antibodies to bcl-2 and p53. The number of active forms of the nuclear transcription factor NF-kB was determined by enzyme immunoassay.

Results. TBI was accompanied by a decrease in the numerical density of neurons, an increase in the number of dystrophically and necrobiotically altered neurons, with activation of apoptosis processes in them with high expression of proapoptotic proteins p53. At the same time, the number of astrocytes actively synthesizing apoptosis-blocking proteins bcl-2 increased. Inhibition of apoptosis was also detected in the development of adhesions in the abdominal cavity with pronounced expression of the transcription factor NF-kB. Diltiazem reduced excessive anti-apoptotic activity of NF-kB in peritoneal fibroblasts, contributing to the suppression of cicatricial adhesive processes.

Conclusion. TBI leads to stimulation of apoptosis in neurons of the brain with high expression of p53 and blocking of apoptosis in astrocytes actively synthesizing anti-apoptotic bcl-2 proteins, which contributes to the development of gliosis and microglial scars. Inhibition of apoptosis was also revealed in the development of adhesions in the abdominal cavity by the multiple growth of NF-kB in peritoneal fibroblasts. Glia cells after TBI and peritoneal fibroblasts have a similar direction of apoptosis changes, which provides an anti-apoptotic state in the development of cicatricial adhesive processes: gliosis of the brain, adhesions in the abdominal cavity. Diltiazem reduces apoptotic processes in tissues during adhesion formation.

Background. This article presents an evaluation of the effectiveness of advanced training courses for physicians based on a two-stage survey of participants. The courses and surveys covered three topics: bronchial asthma, chronic obstructive pulmonary disease, and antimicrobial therapy. The first stage of the survey was conducted at the beginning of the courses, and the second – upon their completion, which allows to identify the dynamics in the knowledge level of specialists.

Objective. Evaluation of the effectiveness of advanced training courses using a two-stage survey of students, assessment of the dynamics of the results.

Methods. The survey of physicians was conducted at the Kazan State Medical Academy – Branch Campus of RMACPE. The current questionnaires ASSA-III, ASCO-IV and KANT-IV of the corresponding stages of research projects were used.

Results. Significant positive dynamics in the change in the knowledge level of physicians was revealed (on average, the increase was from 44.0 to 54.8% on various topics).

Conclusion. A higher level of knowledge demonstrated by students at the end of advanced training courses indicates the effectiveness of the courses and the need for continuous education programs for medical specialists.

The article is devoted to the main stages of studying the problem of mesenteric circulation disorders, since this pathology has not lost its relevance over the years. In 1921, A. Cokkins, who described acute mesenteric ischemia, stated that the diagnosis of this disease is impossible, the prognosis is hopeless, and treatment is pointless. Much has changed over time, and one can safely discuss such ultimatum and harsh theses. However, mortality in acute mesenteric circulatory disorder remains high for many years and amounts to 65–95%.