Vol 32, No 9 (2025)

This review examines the relationship between iron, vitamin C, intestinal microflora, and the immune system, as well as the rationale for including iron and vitamin C in probiotic complexes. Iron is a key micronutrient involved in respiratory processes, hemoglobin and DNA synthesis, cell cycle regulation, and immune cell function. Iron deficiency is prevalent worldwide and can disrupt both systemic processes and intestinal microbial balance, reducing microbiota diversity and short-chain fatty acid production. Antibiotics used to treat infectious diseases further exacerbate dysbiotic changes by affecting intestinal barrier function and reducing the synthesis of metabolites important for immunity and micronutrient absorption.

Probiotic strains can improve non-heme iron absorption by lowering intestinal pH, stimulating prebiotic fermentation, and influencing the function of transport proteins. Prebiotics such as inulin and galactooligosaccharides also increase mineral bioavailability and support the growth of beneficial microflora. Vitamin C acts as a cofactor, enhancing iron absorption and providing antioxidant protection, while B vitamins influence metabolism and are essential for dysbiotic changes in the microbiota. The combination of iron, vitamin C, and B vitamins with pro- and prebiotic components is characterized by a synergistic effect: it improves the absorption of micronutrients, supports the restoration of microbiota, strengthens barrier mechanisms, and promotes increased immune reactivity. The summarized data emphasize the relevance and effectiveness of this approach for the prevention and correction of deficiency conditions and microbial imbalances.

Herpes simplex viruses (HSV) are extremely common infectious agents characterized by a high degree of contagiousness. Infections caused by HSV types 1 and 2 are often asymptomatic but can cause a range of clinical manifestations, including primary and recurrent vesicular lesions of the oral and labial mucosa, ophthalmological and genital lesions, and viral encephalitis. HSV poses a particular danger to patients in high-risk groups. High susceptibility to herpes infections is typical in newborns due to the physiological immaturity of the immune system, as well as in patients with immunodeficiency conditions of various origins. The immunological response to HSV is a complex process that activates components of both innate and adaptive immunity. Recurrent herpesvirus infections are characterized by an immunological imbalance, characterized by a decrease in the number of CD3+ and CD4+ lymphocytes, a decrease in the immunoregulatory coefficient, and suppression of the functional activity of natural killer cells and antibody-dependent cellular cytotoxicity. Over the course of evolution, HSVs have developed adaptive immunomodulatory mechanisms specifically aimed at evading the T-cell immune response, ensuring lifelong persistence of the pathogen in the host body. In pediatric practice, when clinical markers of immune system deficiency are identified, characterized by recurrent infectious and inflammatory conditions and resistance to conventional treatment methods, the use of pharmacological agents with immunotropic properties is justified. This article discusses the mechanisms of action of inosine pranobex and its efficacy against infections caused by HSV types 1 and 2.

Background: Evaluation of clinical data, psychological profile, and quality of life (QOL) in occupational chronic obstructive pulmonary disease (oCOPD), both with isolated and comorbid course, opens up new possibilities for assessing the development, predicting the course, and personalizing the pharmacotherapy of COPD, as well as for developing individualized strategies for its primary and secondary prevention.

Objective: Determination of the psychological characteristics and QOL in COPD, both isolated and in combination with arterial hypertension (AH).

Material and methods: The study involved 175 patients and 60 controls: Group 1 (control) – 60 healthy volunteers, Group 2 – 35 patients with stage 1 oCOPD (oCOPD I), Group 3 – 50 patients with stage 2 oCOPD, Group 4 – 40 patients with a combination of stage 2 oCOPD and AH, Group 5 – 50 patients with isolated AH. All patients were tested using three methods: the Buss-Durkee Hostility Inventory and the Plutchik-Kellerman-Conte Life Style Index (LSI). Quality of life was also assessed using the SF-36 Health Status Survey. Group data were evaluated using a one-way analysis of variance with between-group comparisons using Dunnett’s test.

Results: For the first time, the characteristics of psychological manifestations and QOL in oCOPD of varying severity, both in isolation and in combination with AH, have been identified.

Conclusion: Exposure to occupational dust is a stress factor leading to the development of severe psychoemotional disorders in oCOPD, both isolated and in combination with AH. We believe that a comprehensive psychological examination, including consultation with a psychologist and the use of the Buss-Durkee Hostility Inventory and the LSI method, as well as QOL assessment, is essential. A QOL assessment was also conducted using the SF-36 questionnaire as part of a program of in-depth periodic medical examinations for individuals working with chemical and fibrogenic industrial aerosols potentially associated with the development of occupational chronic obstructive pulmonary disease (oCOPD). This assessment was also part of a program for providing medical care to patients with COPD, both isolated and comorbid with AH, at pulmonology centers and occupational pathology centers at the federal and regional levels. This assessment took into account the identified psychological changes, decreased QOL, and the need for timely psychological intervention, including the use of pharmacological agents.

Respiratory syncytial infection (RSVI) is one of the main causes of lower respiratory tract infections in children under 2 years of age. Children born before 35 weeks of gestation, children with bronchopulmonary dysplasia, hemodynamically significant heart defects, and immunodeficiency states are at risk for severe RSVI.

Currently, the most effective and safe method for preventing RSVI is immunization with palivizumab. Palivizumab contains monoclonal IgG1 antibodies against the F protein of the virus, which prevents the virus from attaching to respiratory epithelial cells and prevents severe RSVI. Five injections of palivizumab are required for effective immune protection.

Prophylaxis with palivizumab leads to a significant reduction in the incidence of RSVI after two years of follow-up and reduces the frequency and duration of episodes of bronchial obstruction during one year of follow-up.

The use of alemtuzumab in the treatment of multiple sclerosis may be limited by the development of autoimmune complications and the persistence of disease activity in some patients. In such situations, the strategy of repeated courses of the drug is not always effective due to the possible formation of neutralizing antibodies, and anti-B-cell therapy has limitations associated with concomitant pathology. The literature describes the possibility of sequential use of two drugs from the class of immune reconstitution therapy - alemtuzumab and cladribine tablets, which allows achieving clinical and neuroimaging stabilization without the need for constant treatment. We present a clinical case of a patient with highly active relapsing-remitting multiple sclerosis, who, after two courses of alemtuzumab, remained active and developed autoimmune complications. Sequential therapy with cladribine tablets ensured control of the disease, stabilization of the neurological status and neuroimaging data, as well as the absence of serious infectious complications. This experience confirms the potential effectiveness and safety of the “alemtuzumab → cladribine tablets” strategy, but emphasizes the need for further accumulation of clinical data to assess its place in the therapeutic arsenal.

Background: The development of dementia significantly impairs the quality of life of patients and their families and places a heavy socioeconomic burden on society as a whole. The medical community faces the clear challenge of diagnosing and treating dementia as early as possible.

Objective: Evaluation of the effectiveness of early diagnosis and a comprehensive approach to prescribing pathogenetically based drug and non-drug therapy.

Materials and method: An observational case-control study was conducted by analyzing the outpatient records of 100 patients diagnosed with chronic cerebral ischemia and dementia syndrome. All patients were referred to the city dementia center for consultation from a healthcare facilities in Novosibirsk. They were examined by a neurologist, assessed for daily activities, and underwent extensive neuropsychological testing, including the Mini-Mental State Examination (MMSE), the «clock,» and literal and categorical associations. All patients underwent neuroimaging (MRI).

Results: Based on the results of an in-depth study, the diagnosis was clarified: 78 patients had moderate Alzheimer’s disease (AD) of mixed origin (neurodegenerative and vascular), 12 patients had mild dementia with Lewy bodies (DLB), and 10 patients had vascular dementia (VD): 6 patients with a mild dementia and 4 with a moderate dementia. The main challenges of early diagnosis and late prescription of antidementia medications are highlighted. A review of non-pharmacological methods for dementia treatment is provided.

The number of children requiring palliative care is steadily increasing. Pediatric palliative care is a relatively new field of medicine, bringing together specialists from various fields and volunteers. This article provides an analytical review of current issues and key aspects of the development of pediatric palliative care. Pediatric palliative care aims to improve the quality of life of children with severe, incurable non-oncological and oncological diseases, for whom rehabilitation options are limited or nonexistent. The article presents the main models of palliative care organization. In countries with high levels of economic development, inpatient models (particularly specialized children’s hospice facilities) predominate, characterized by significant resource intensity. In countries with limited financial resources, less expensive but proven effective models have become widespread, among which home palliative care holds a special place. An analysis of the legislative and regulatory framework is conducted. In the Russian Federation (RF), legal regulation of palliative care was implemented in 2011 with the adoption of Federal Law No. 323-FZ «On the Fundamentals of Health Protection of Citizens in the Russian Federation.» In accordance with the provisions of this regulatory act, palliative care was included in the system of types of medical care provided to the population. Further institutional development of the palliative care system occurred in 2012, when Order No. 1183n of the Russian Ministry of Health dated December 20, 2012, «On Approval of the Nomenclature of Positions for Medical and Pharmaceutical Workers» officially introduced the position of «Palliative Care Physician.» The distribution and course of life-threatening childhood diseases, which determine the fundamental differences in palliative care provided to children, are analyzed. A literature search using Scopus, Web of Science, MedLine, PubMed, and E-library databases was conducted.

Background: Elevated serum uric acid levels are known to be a cause of a number of chronic diseases, including atherosclerosis, gout, nephritis, obesity, diabetes, and metabolic syndrome. Psoriasis is a chronic inflammatory disease with systemic manifestations that, according to recent studies, affects not only the skin and musculoskeletal system but is also accompanied by metabolic disorders.

Hyperuricemia is associated with severe psoriasis, the presence of psoriatic arthritis, and an increased risk of cardiovascular complications and gout. Despite increased scientific interest in this topic, the clinical significance of uric acid levels in patients with psoriasis remains unresolved.

Objective: Analytical Review of the scientific literature to identify a correlation between uric acid levels and the severity of psoriasis.

Conclusion: The results of this literature review indicate a relationship between hyperuricemia and psoriasis. This association is not limited to the presence of metabolic syndrome, but is evident in patients with psoriasis even in the absence of concomitant metabolic disorders due to accelerated cell turnover. Although elevated uric acid levels can be considered a potential biomarker of systemic inflammation, which characterizes the severity of psoriasis and associated pathologies, the limited number of large-scale studies hinders a definitive interpretation of the prognostic significance of this indicator. Nevertheless, the data obtained suggest that uric acid levels are not simply a marker, but rather an important pathogenetic factor reflecting the severity and chronicity of psoriasis, amplifying the inflammatory cascade through the activation of purine metabolism by cytokines. Further studies in larger cohorts of patients are needed to confirm these findings and clarify the prognostic role of hyperuricemia in psoriasis severity. Understanding the relationship between hyperuricemia and psoriasis may open new perspectives for the development of comprehensive therapeutic strategies aimed at correcting both skin manifestations and systemic metabolic disorders.

Background. Nail pathologies which manifest with similar clinical signs are a common clinical situation in the practice of a dermatovenerologist. The imperfection of laboratory methods for research on fungal infections, the presence of combined lesions of the nail plates with other skin changes in the patient, as well as the growth of atypical pathogens in the etiological structure of onychomycosis complicate diagnosis.

Description of a clinical case. The article presents a clinical observation of a patient with a long-term course of nail mycosis caused by Trichophyton verrucosum, combined with changes in the skin of the face, scalp and perianal area. Repeated microscopic examinations of scrapings from the nail plates showed the presence of single yeast cells and spores, while external etiotropic therapy did not lead to improvement. PCR diagnostics for fungi gave a positive result (Fungi 32.7), but the pathogen was not identified. Subsequent cultural research gave an increase in colonies of the fungus T. verrucosum.

Conclusion. The clinical case demonstrates the need for a personalized approach to patients with long-term dermatoses and reflects the pathomorphosis in the course of skin diseases, including fungal etiology. To finally diagnose nail mycosis caused by a zooanthropophilic pathogen, our patient needed a combination of several laboratory research methods.

Background: In the context of declining fertility and in order to increase the effectiveness of the in vitro fertilization method when diagnosed with hypoplastic (thin) endometrium, the development of a new method of treating this pathology becomes relevant.

Objective: Development of a new effective method of treating hypoplastic (thin) endometrium without the use of standard treatment methods - hormone therapy and physiotherapy used in preparing patients for in vitro fertilization (IVF), and evaluation of the effectiveness and safety of the proposed innovative method.

Material and methods: The study included 260 patients of reproductive age (from 25 to 48 years) with diagnosed primary or secondary infertility and the presence of “thin endometrium” that was not treatable by other methods and did not respond to hormonal stimulation carried out in cycles three or four months before the start of the study. In the control group, 30 women with a clinically confirmed diagnosis of “infertility 1 or infertility 2, thin endometrium” were examined. The procedure for irrigation of the endometrium with carbon dioxide was carried out three times on the 7th, 9th and 11th days of the menstrual cycle. Statistical data processing was carried out using Statistica 10.0 software packages.

Results: After the patients underwent three irrigations of the endometrium with carbon dioxide, there was a clear trend towards an increase in the thickness of the endometrium. This indicates the potential of the method in increasing the number of successful embryo implantations during the IVF procedure.

Conclusion: Our own clinical observations accumulated confirm the high efficiency of using carbon dioxide (CO2) for irrigation of the uterine cavity with thin endometrium, which contributes to a significant increase in the endometrium thickness in the preparatory period before the IVF procedure.

Gliomas are a group of central nervous system (CNS) tumors originating from glial cells. Despite significant efforts in the field of oncology, gliomas, especially high-grade gliomas, remain one of the most complex and aggressive forms of malignancy. Low-grade diffuse gliomas have a relatively favorable prognosis, while high-grade gliomas, especially glioblastomas, are characterized by an extremely unfavorable course. The overall survival (OS) of patients with glioblastoma ranges from 14 to 20 months, and the 5-year survival rate is only 6%. In patients with newly diagnosed glioblastoma, the 6-month progression-free survival (PFS) is approximately 54%, while in relapsed patients, the 6-month PFS is 30–40%, and the 6-month OS is 57%. For newly diagnosed diffuse glial tumors WHO G3–4, the 1-year PFS is approximately 80%, and the median OS is approximately 25 months. These indicators emphasize the need to search for new treatment approaches. This article presents the main current strategies and approaches to the treatment of diffuse glial CNS tumors. A meta-analysis of the efficacy of the combination of bevacizumab and irinotecan was conducted.

This study examines the economic aspects of hepatocellular carcinoma (HCC) diagnosis and treatment in Russia and abroad. HCC is the most common primary liver cancer, requiring significant financial expenditures for diagnosis and treatment. The increasing incidence of HCC leads to an increased need for diagnosis and treatment. The aim of this study is to characterize the economic aspects of HCC diagnosis and treatment in Russia and abroad. To achieve this goal, scientific publications on the economic aspects of HCC diagnosis and treatment indexed in the eLibrary, Cyberleninka, PubMed, and Google Scholar electronic libraries, as well as clinical guidelines from the Russian Ministry of Health and the European Association for the Study of the Liver were reviewed. This article examines the economic aspects of various methods for diagnosing and treating HCC in Russia and abroad, including the cost of procedures, the availability of surgical and medical treatment, and the burden on the healthcare system. Particular attention is paid to the cost-effectiveness of preventive measures, such as hepatitis B vaccination and hepatitis C screening. A detailed analysis of the potential economic impact of the disease, the specifics of healthcare financing, and factors influencing the choice of diagnostic and therapeutic measures is provided. As the burden of HCC increases worldwide, concerted efforts to understand the comparative effectiveness of surveillance and treatment strategies are needed, and more comparative studies among patients with cirrhosis and all stages of HCC are required. Although survival remains the most important outcome, quality of life, costs, and ultimately value must be assessed in parallel when considering the clinical utility of interventions. Further research to identify ways to reduce this disparity is needed.

Background: Neoadjuvant therapy (NAT) is currently the gold standard for the treatment of early HER2-positive breast cancer (BC). However, only patients who achieve a complete pathological response (pCR) benefit from overall survival and progression-free survival (OS and PFS). The question of which patients should begin treatment with neoadjuvant therapy (NAT) and which should be treated initially with surgery remains a matter of debate.

Objective: Determination of the role of tumor p53 expression in achieving pCR after NAT in patients with early HER2-positive breast cancer by review prepared histological biopsy specimens for p53 expression determination, followed by a logistic regression analysis of the resulting database to calculate the relationship between achieving complete pathological response and the presence of p53 expression.

Materials and methods: A retrospective analysis of the medical records of 50 patients who received combination or comprehensive treatment for early (cT1-3N0-2M0) HER2-positive breast cancer in the General Oncology Department, S.P. Botkin Moscow Multidisciplinary Research and Clinical Center of the Moscow Healthcare Department, over a 4-year period from 2021 to 2024. All patients were assessed for p53 protein expression in preoperative biopsy specimens using immunohistochemistry assay. The presence or absence of p53 protein expression was analyzed and correlated with the achievement of pCR.

Results: The presence of p53 protein expression significantly increases the likelihood of achieving a complete pathological response (pCR=1). OR=9.33 indicates that patients with p53 expression have a 9-fold higher chance of pCR than patients without it. The result is statistically significant (p=0.0024), confirming the role of p53 protein expression as a strong predictor of response to NAT.

Conclusion: p53 protein expression is a significant predictor of achieving a complete pathological response (RCB = 0) after effective NAT.

Background: Chronic pruritus is a common symptom in dermatology and is often associated with anxiety and depression. The relationship between pruritus and psychological disorders, particularly in patients with dermatoses, melanocytic skin neoplasms, and cutaneous toxic reactions, is poorly understood. Understanding this relationship is important for improving patient care and quality of life.

Objective: Assessment of the prevalence of anxiety and depression symptoms in patients with dermatoses, melanocytic skin neoplasms, and cutaneous toxic reactions and analysis of their relationship with pruritus.

Methods: A cross-sectional, observational, controlled study was conducted in patients with pruritic and non-pruritic dermatoses and melanocytic skin neoplasms. The frequency of pruritus and its relationship with anxiety and depression were assessed. No medical interventions were performed. The study was conducted from February 2021 to January 2025. The primary endpoint of this study was a comparative assessment of the intensity of itching and the level of anxiety-depressive disorders in patients with various dermatological and oncological skin diseases. Itching intensity was assessed using the NRS (0-10 points), GAD-2 (anxiety), PHQ-2 (depression), and PHQ-4 (anxiety and depression).

Results: The main group included patients with itchy (atopic dermatitis, n=106) and non-itchy (psoriasis, n=101, acne, n=104) dermatoses; benign and malignant melanocytic neoplasms (melaniform nevi, n=105, melanoma, n=88); skin toxic reactions associated with antitumor therapy (STR, n=93); the control group included 216 healthy volunteers. Patients with chronic inflammatory dermatoses more often reported suicidal ideation. According to the intergroup comparison, the mean total GAD-2 anxiety and PHQ-2 depression scores differed significantly (p<0.0001). Screening scores for anxiety were highest in patients with acne and atopic dermatitis. Depression was most common in patients with chronic itchy rashes (atopic dermatitis) and lesions of visible skin areas (acne). A significant positive correlation was shown between the intensity of itching and the total PHQ-4 score. Current approaches to the prevention of dermatological adverse events of antitumor therapy are presented.

Conclusion: The study demonstrated a strong association between pruritus and psychological disorders in dermatology patients. These disorders are associated with high levels of anxiety, depression, and suicidal ideation, highlighting the need for a comprehensive approach to patient treatment. An algorithm for preventive dermatological care, taking into account the nature and severity of rashes, is presented. This algorithm forms the basis for dermatological supportive therapy for patients with skin toxic reactions.

Background: Carbon monoxide (CO) is an integral component of smoke that is harmful to the health of not only smokers but also those around them. Therefore, analyzing carboxyhemoglobin levels in the blood of smokers and nonsmokers can be considered not only as a factor reflecting hypoxia but also as a parameter for assessing potential damage to vital body functions.

Objective: Assessment of carboxyhemoglobin (COHb) levels (% of hemoglobin saturation) in the blood of volunteers who switched to using an electronic tobacco heating system (ETHS) compared to volunteers who continued smoking conventional cigarettes (CC) and who quit smoking (SC) following short-term exposure.

Materials and methods: The study included 60 volunteers (M – 48, F –1 2) aged 21 to 65 years (mean age 32.4 years). Volunteers were randomized into three study groups [ETHS: conventional cigarettes (CC): smoking cessation (CS)] in a 2:1:1 ratio, accounting for equal representation in each group of male and female volunteers who smoked 10-19 or more conventional cigarettes per day (data on the number of conventional cigarettes smoked was obtained during screening based on the results of a questionnaire for the previous 4 weeks of smoking).

Results: The blood carboxyhemoglobin levels in volunteers in the CC group remained virtually unchanged throughout the study period, while in the ETHS groups it was statistically lower than the level at Day 0, starting from the first day (Day 1) of the study; in the SC group, a trend toward decreased carboxyhemoglobin levels was observed throughout the study. However, no differences were found at the Day 3, Day 4, and Day 5 study points compared to Day 0.

Conclusion: The results of the data analysis allow to conclude on the likelihood of harm reduction effects of the study product (ETHS) when used during the study period (5 days) based on the volunteer examination methods used, including a complete blood count, urinalysis, blood chemistry, ECG, spirometry, and the results of an objective examination assessing anthropometric parameters (height, weight, BMI) and vital signs (blood pressure, heart rate, respiratory rate, body temperature), and the absence of reported adverse events/severe adverse events.