Multiple sclerosis is an important medical and social problem, as it affects people mainly of young and productive age. The modern development
of pathogenetic therapy makes it possible to effectively control the frequency of exacerbations and the progression of the disease, which leads to an increase
in the life expectancy of the patients. In this regard, a relevant topic today is the rehabilitation of patients with multiple sclerosis. The development of
remote rehabilitation contributes to quality of life improvement and restoration of motor functions, allowing patients to remain socially active and ablebodied members of society. In this literature review, modern methods of remote neurorehabilitation of multiple sclerosis patients are considered, economic
advantages are described. The analysis was based on 34 scientific articles in Russian and English, published in the period from 2013 to 2022. Literary sources
were obtained from available databases: E-Library, PubMed, Cochrane.

Spontaneous coronary artery dissection is one of the non-atherosclerotic causes of acute coronary syndrome and is more common in young and
middle-aged women. This condition is an unresolved clinical problem due to the low prevalence, frequent cases of diagnostic errors and the lack of generally
accepted treatment algorithms. The purpose of this review is to present the data of modern literature on the prevalence, pathogenesis, clinical manifestations,
classification and diagnosis of spontaneous coronary artery dissection. The review was carried out using the search for papers published in the PubMed,
MEDLINE and e-library databases within the period from 2018 to 2022 using the keywords “spontaneous coronary artery dissection”, “coronary artery
intramural hematoma”, “acute coronary syndrome”, “myocardial infarction” and “fibromuscular dysplasia”

Worldwide, the rate of preterm birth is 9.6% of all births. In total, almost 13 million newborns are born per year. Low birth weight of preterm
infants is significantly associated with increased risk of cardiovascular complications in adulthood. Understanding the genesis of the “reversible” type of left
ventricular twist in children born with very low (VLBW), extremely low (ELBW) and low birth (LBW) weight allows us to deepen the existing traditional
knowledge on physiology and pathophysiology of the child’s heart. The reverse type of left ventricle twist not only carries information about growth and
development of the child’s heart, but makes it possible to use the patterns of establishment of the mechanics for diagnosis of latent dysfunction that have been
described for the first time. When preparing the article, Google Scholar, CyberLeninka and eLibrary libraries, specialised databases (PubMed, MedLine) and
the Research Gate website were used

The aim of the research. Comparison of the effectiveness of two proprietary technologies for prevention of postmanipulation pancreatitis (PEP).
Material and methods. The prospective two-centre randomised study included 736 patients with pancreatobiliary pathology treated in 2018-2022, who
underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillosphincterotomy (EPT). There were 226 men (30.7 %), 510
women (69.3 %) aged 18 to 92 years, at the average age of 62.7 ± 7.4 years. The patients were divided into 3 groups: in group 1, standard drug premedication
was supplemented with one postbulbar blockade (PBB) upon completion of papillae manipulation. In group 2, standard premedication was combined with
two PBB (2PBB) lidocaine/novocaine solution 0.5 %-10 ml before and after the intervention. The 3rd one was the comparison group without submucosal
injections. The groups were comparable in gender, age, structure of the diseases and the nature of the intervention. Statistical processing was carried out using
the Statistica 10.1 package (StatSoft, Russia).
Results. The effectiveness of the used methods of prevention of PEP revealed the advantages of 2PBB (absence of severe PEP cases). The advantage of PBB and
2PBB was not only the rapid relief of pain, but also prevention of bleeding after papillotomy. For additional evaluation, we identified a subgroup of 97 patients
who used stenting of the common bile and/or pancreatic ducts for prevention of PEP; the use of stents resulted in a longer period of hyperamylasaemia regression,
regardless of the method of prevention of PEP. The average hospital period for 2PBB was 11.3±1.2 days and was significantly shorter than for the other groups. 
Conclusion. 2PBB is the most effective technique for the prevention of severe PEP in comparison with PBB and standard technologies. 2PBB can be used as
a routine technique for prevention of PEP in all categories of patients

The aim of the research. To determine systemic (blood pressure level) and topical (state of extra- and intracranial arteries) manifestations of vascular
dysfunction in response to nicotine exposure using different means of its delivery in young adults.
Material and methods. The present study included 45 subjects (22 women, 23 men) at a mean age of 25 (23;29) years and a mean smoking history of 7
(4;10) years. The subjects were divided into 3 groups according to the method of nicotine delivery used: 1 – cigarette smoking (n=16, 35.6%); 2 – “IQOS”
(n=10, 22.2%); 3 – vaping (n=19, 42.2%). Before examination and after nicotine use with various devices, all patients had their arterial blood pressure (ABP)
measured on the brachial artery, brachiocephalic arteries at extracranial level and velocity indices in the middle cerebral arteries (MCA) were assessed with
an ultrasound scanner. To assess cerebrovascular reactivity, we used overshoot coefficient, hypoxic and hyperoxic metabolic tests.
Results. There were no differences in the “age” value between all 3 groups of the examined patients, and the reliably lowest smoking history was found in the
3rd group (4 (3;6.5) years). Isolated systolic arterial hypertension was revealed in 11% of the patients in the total group before smoking (Me=142 mm Hg) and
in 49% of the examined patients after smoking - (Me=147,2 mm Hg). Such signs of vascular dysfunction as insufficient vasodilatation and vasoconstriction,
the decrease of overshoot coefficient in the MCA after smoking were revealed in all 3 groups of the examined patients in comparison with the initial indices
without statistical significance of the differences.
Conclusion. Direct correlation between increased ABP, signs of vascular dysfunction in the cerebral arteries and nicotine use irrespective of the method of its
delivery have been found despite a significantly shorter smoking history in vape users.

The aim of the research. To assess the prevalence dynamics and etiological structure of mycoses of the scalp in the Perm region.
Material and methods. The study used statistical data from the Regional Clinical Dermatovenerologic Dispensary in Perm for years 2013, 2016, 2018 and
2021.
Results. It has been found that during the entire study period, mycosis of the scalp occurred mainly in early and preschool age. This pathology was recorded
2.2-2.5 times more often in males. The rise in incidence was observed in August-October. The cause of dermatomycosis of the scalp in patients of Perm and
the Perm region was Microsporum spp., as well Trichophyton spp., Candida spp. and undifferentiated mould fungi. The main pathogen is M.canis, causing
86.2-91.3 % of the cases.
Conclusion. The prevalence and etiological structure of mycosis of the scalp in the Perm region for the period from 2013 to 2021 has been analysed. An
increase in the frequency of scalp mycosis detection since 2016 has been noted. The aetiological structure did not change significantly during the studied
period. Thus, development of new antifungal drugs to affect dermatophytes, including resistant forms, remains relevant.

The aim of the research. To study and compare the nature of coronary vascular bed lesion and microRNA (miRNA) levels-21, -22 -126, -221 in stable coronary artery disease (CAD) patients with borderline coronary artery (CA) stenosis with different clinical phenotypes.
Material and methods. A total of 258 patients with 1-3 class stable angina (51 - 19.8% women and 207 - 80.2% men) with borderline (40-70%) CA stenosis
and presence of arterial hypertension in most cases were included into the comparative descriptive trial with three parallel groups. All patients along with
clinical examination and ultrasound of the heart underwent selective coronary angiography. Determination of miRNA levels was carried using real-time
PCR method. The statistical calculations were carried out through the RStudio program (version 2022.07.2+576, USA) using the R language (version 4.1.3
(2022-03-10), Austria).
Results. Subjects with the CAD phenotype without diabetes mellitus (DM) and obesity (n=115 (44.6%)), CAD phenotype with DM type 2 (n=55 (21.3%)),
and CAD with metabolically unhealthy obesity (MUO) phenotype ([n=88 (34.1%)) prevailed among stable CAD patients with borderline CA stenosis when
conducting random sampling. Coronary vascular bed lesion features is more frequent stenosis of anterior descending artery and circumflex artery, especially
in the distal segments in CAD and DM patients. The right CA lesion frequency was higher in CAD with MUO phenotype together with more pronounced
stenosis of distal segments. The miRNA concentration assessment revealed increased miRNA-221 levels in CAD patients with MUO and increased miRNA-22 and -126 levels in CAD and DM pts. 
Conclusion. In prognostic terms, stable CAD patients with borderline CA stenosis represent a serious contingent due to long hypertension history and expressed cardiometabolic associations. The assessment of miRNA levels in such patients is of great interest and represents a promising direction for further
application in diagnosis and treatment practice

The aim of the research. To assess the impact of past and ongoing gynaecological diseases and sexually transmitted infections on the clinical course of chronic
recurrent cystitis in women, including those with squamous cell metaplasia of the urinary bladder in the age aspect.
Material and methods. In a group of 93 patients with chronic cystitis, urological and gynaecological medical history was studied and cystoscopy was performed. The relationship between chronic cystitis and pathology of the female reproductive system including sexually transmitted infections (STIs) has been
studied.
Results. In the general group, exacerbations of cystitis after coitus were detected in 18.2% of the cases. The most common postcoital cystitis occurred in the
younger age group (21-35 years) and amounted to 38.2%. A greater frequency of postcoital cystitis was found in women who had an STI (29.3% of cases)
than in women without a history of STI (11.1% of cases). Pain syndrome in chronic cystitis with the presence of bladder metaplasia was more common than
without metaplasia. In women with metaplasia – in 79%, and in women without metaplasia – in 38.9% of the cases. The effect of gynaecological pathology
and medical history of STIs on the incidence of squamous cell metaplasia of the bladder has not been revealed.
Conclusion. STIs can be considered a risk factor for postcoital cystitis in women. At the same time, the most vulnerable category of women are young women

The aim of the research. The aim of this research was to study the effect of combined photodynamic and antioxidant therapy on the life quality of patients
with vulvar kraurosis.
Material and methods. Patients with vulvar kraurosis were divided into 3 groups. Participants of the first group underwent combined photodynamic and
antioxidant therapy with administration of ethylmethylhydroxypyridine succinate. Participants of the second group received photodynamic therapy (PDT)
only. Patients of the third group underwent a course of low-level laser therapy (LLLT) on the perineal area. All the participants of the study answered the
questions of SF-36 questionnaire before, immediately after and in 1, 6 and 12 months after treatment.
Results. It has been found that patients with vulvar kraurosis have a low level of life quality, therewith, the method of treatment can affect the life quality
of patients with vulvar kraurosis. Immediately after treatment and/or a month later, patients, who had undergone LLLT, scored higher on most Physical
Health and Mental Health scales than patients, who had received combined photodynamic and antioxidant therapy or PDT. However, in 6-12 months after
treatment, participants, who had undergone combined therapy or PDT, demonstrated higher scores on all scales of the SF-36 questionnaire than patients
from the LLLT group. In comparison with participants, who had only undergone PDT, women, who had received combined photodynamic and antioxidant
therapy, rated their life quality higher on the following scales: Physical Functioning; General Health; Vitality; Social Functioning and Mental Health.
Conclusion. Combined photodynamic and antioxidant therapy demonstrates expressed, persistent and long-term positive effect on the life quality of patients with vulvar kraurosis and has advantages over LLLT and PDT.

The aim of the research. To determine the role of procalcitonin in the diagnosis and prognosis of patients with pneumonia against the background of the
new coronavirus infection.
Material and methods. The study included 41 patients with community-acquired pneumonia and confirmed new coronavirus infection COVID-19. All
patients underwent clinical and instrumental examination, as well as procalcitonin level analysis using the “BioTest Procalcitonin Test PCT” testing system.
Results. High procalcitonin levels of ≥0.5 ng/ml were determined in 20% of patients with COVID-associated community-acquired pneumonia. A high level
of procalcitonin was directly associated with a number of clinical, laboratory and instrumental parameters: hydrothorax (χ2=6.964, p=0.008), extensive lung
damage (>60%) CT results (r=0.371, p=0.017), neutrophilia ≥5.5x109/l (r=0.344, p=0.028), creatinine (r=0.320, p=0.042), CPK (r=0.478, p=0.002). According to the results of multivariate regression analysis, it has been determined that a high value of procalcitonin increases the risk of extensive lung damage
(≥60% on CT) by 4 times (p=0.023), the risk of increased creatinine (≥119 µmol/l) - by 3 times (p=0.041) and an increase in the duration of hospitalisation
(≥24 days) by 5 times (p=0.046).
Conclusion. The data confirm the need to determine the level of procalcitonin in the blood at the time of hospitalisation in patients with COVID-associated
pneumonia in order to prescribe a more effective treatment. A semi-quantitative rapid test makes it possible to do it quickly at a minimal cost.

The aim of the research. To study the clinical and epidemiological features of patients with infections associated with previous hospitalisation (ISPH) in
medical organisations in Tomsk.
Material and methods. A retrospective analysis of 108 ISPH cases in medical organisations of Tomsk dated January 2019 to December 2022 was carried
out. The study included patients over 18 years of age with a diagnosis of pneumonia (n=59) and Surgical Site Infection (SSI) (n=49), with registered previous
hospitalisation within the last 90 days lasting at least 5 days for pneumonia and a prior surgery within the last 90 days for SSI. Clinical forms of ISPH, patient
body mass index, severity of organ dysfunction (qSOFA), mortality risk (CURB-65), length of stay at the medical organisation, time of infection development,
terms of patients seeking medical help, etiological structure of identified pathogens were assessed.
Results. ISPH were more common in patients with normal and excess body mass. In 18 patients, upon admission to a medical organisation, a high risk of an
unfavourable outcome and development of organ dysfunction was determined. Patients with pneumonia stayed in bed longer than those with SSI. There was
an increase in the duration of hospitalisation in patients with obesity compared with patients with normal body weight. Patients with pneumonia required
hospitalisation in the intensive care unit more often as compared to patients with SSI. The median time to develop SSI in patients after surgery was 15.5
[8.0;28.0] days. Pneumonia developed in patients 6.0 [3.0;13.0] days after discharge from the previous hospital.
Conclusion. ISPH are similar in clinical and epidemiological characteristics to classical nosocomial infections that are detected in patients at the time of
current hospitalisation

The aim of the research. The purpose of the study was to investigate the association of alleles (G>A) and genotypes (GG, GA, AA) carriage of SNP rs7314935
of the NOS1 gene with the «AH+TTH» phenotype development in middle-aged adults.
Material and methods. There was open, observational, cross-sectional, case-control study. Study period is October 2020 – July 2022. Study location is Professor
V.F. Voino-Yasenetsky Krasnoyarsk State Medical University (KrasSMU). We included in the study: residents of the Krasnoyarsk (industrial city of the Siberia);
Caucasians; persons of average (from 45 to 65 years) age; compliance with the protocol of the research; have a signed informed consent form to participate in the
study. We exclude from the study: residents of other regions and members of small ethnic Siberian groups; Asians; age up to 45 years and over 65 years; comorbid
somatic diseases (cognitive disorders; acute infectious process; diabetes and chronic kidney disease; chronic heart failure; other primary headaches (except TTH);
secondary headaches); low compliance; refusal to sign the informed consent form for participation in the study. The sample was 91 complex observed participants:
group 1 (hypertensive patients) – 60 patients; group 2 (control) – 31 healthy volunteers. Group 1 was divided into two subgroups: main subgroup – «AH+TTH»
(30 patients) and comparable subgroup – AH without headache (30 patients). Venous blood was taken on an empty stomach for each participant. Genomic
deoxyribonucleic acid (DNA) was isolated from leukocyte suspension according to the standard protocol [23]. The determination of the carriage of polymorphic
allelic variants of rs7314935 of the NOS1 gene was carried out using real-time polymerase chain reaction (RT-PCR), on the apparatus Rotor-Gene 6000 (Australia)
using TaqMan allelic discrimination technology and commercially available fluorescent probes (primers) developed by Applied Biosystems (USA).
Results. There were not statistically significantly differences (p>0,05) between groups 1 and 2 in average age and gender distribution. The main
(AH+TTH) and comparable (AH without headache) subgroups were comparable (p>0,05) by course and lasting of AH anamnesis, and average age of
AH onset. The onset age of AH was slightly higher than the onset age of TTH. There were 4 main triggers for elevation of BP in patients with AH (group
1). Three triggers did not significantly differ (p>0,05) in main subgroup (AH+TTH) and comparable (AH without headache) subgroups: emotional
and physical overload, and also sleep problems (sleep deprivation, lack of sleep, oversleeping). But headache episodes themselves were statistically
significant trigger for elevation of BP in patients of main subgroup (AH+TTH) compared subgroup of hypertensive patients without headache (p=0,002).
Conclusion. Our study was shown that the heterozygous genotype GA of rs7314935 of the NOS1 gene may be new genetic biomarker of «AH+TTH»
phenotype developing in Caucasian hypertensive patients from East Siberia.

Introduction. Destruction of malignant tumours with oncolytic viruses is one of the most effective and safe methods of antitumor therapy. To gain access to
tumour cells, the virus must circulate in the bloodstream for a long time, avoiding the action of the immune system. However, when a virus is introduced into the body, it provokes the production of virus-neutralising antibodies that reduce its antitumor effect. The most effective way to protect a virus from antibodies
that neutralise it is to screen it: in particular, using selective DNA aptamers.
The aim of the research. Using experimental methods and theoretical calculations, to develop DNA aptamers suitable for creating an antitumor drug based
on the VV-GMCSF-Lact oncolytic virus, which effectively screen viruses and can protect them from virus-neutralising antibodies.
Material and methods. Modelling of the secondary structures of aptamers was performed using the mFold program for nucleic acid folding, modelling of
the corresponding spatial full-atom structures of aptamers was performed using the SimRNA and VMD programs. Molecular dynamics calculations were
carried out using the GROMACS 2018.8 software package. Cluster analysis of the obtained molecular dynamic trajectories was performed using the VMD
program. Binding of Cy5-modified aptamers to the virus was assessed using flow cytometry on a BD FACSCanto II cytometer (Becton Dickinson, Franklin
Lakes, New Jersey, USA).
Results. Modification of aptamers experimentally obtained using the SELEX technology made it possible to obtain five truncated oligonucleotides NV1t_72,
NV4t_64, NV4t_53, NV14t_41, and NV14t_57, which screen the oncolytic virus VV-GMCSF-Lact, the most effective of which was the NV14t_57 aptamer.
Theoretical calculations have shown that the affinity of aptamers is determined by their three-dimensional structure, which depends on the method of modification.
Conclusion. A highly selective aptamer NV14t_57 has been obtained, which is the most promising candidate for further work on the creation of a drug for
antitumor therapy of oncological diseases based on the VV-GMCSF-Lact oncolytic vaccinia virus

The article presents a rare clinical case of pregnancy and childbirth in a woman with combined malformation of the spine and spinal cord (spina
bifida, spinal hernia, diastematomyelia, syringomyelia, tethered cord syndrome) and concomitant somatic pathology (history of nephrectomy due to mixed
vesicoureteral reflux in the rudimentary left kidney, chronic pyelonephritis of the single kidney). The clinically combined malformation in the patient was
manifested by pain in the spine, progressing with an increase in pregnancy duration, CNS-associated neurological deficit in the form of dysfunctions of pelvic
organs, lower flaccid paraparesis in combination with severe orthopaedic disorders (gait disturbance, limited mobility and deformity of the feet as a result of
bilateral persistent contracture of the ankle joints). Pregnancy management was carried out by an interdisciplinary team of specialists with mandatory assessment of intrauterine development of the foetus and of the course of pregnancy (complex biochemical analysis and ultrasound screening in each trimester of
pregnancy) as well as timely correction of emerging complications. Delivery was performed by elective caesarean section. A viable full-term child was born.
This clinical case justifies the need to develop a single standard for the management of patients with this pathology

Recently, a new term has appeared to describe a viral coinfection of influenza and SARS-CoV-2. Some authors call it flurona, others – flucovid. The
term denotes a disease with symptoms of both influenza and COVID-19, such as fever, cough, fatiguability, headache, dyspnoea and loss of taste or olfaction,
but not rhinorrhoea or sore throat. Multisystem inflammatory syndrome in children (MIS-C) associated with the SARS-CoV-2 virus is a severe pathology.
Multiple organ failure associated with the influenza A (H1N1) virus also progresses with impairment of many organs and systems, combined infection with
SARS-CoV-2 and influenza A (H1N1) viruses. A feature of the described clinical case is the coinfection with SARS-CoV-2 and influenza A (H1N1) viruses,
which is denoted by the terms flurona, or flucovid in modern literature. Clinical manifestations of MIS in this child were: an increase in body temperature
above 38.0°C, multiple organ disorders (cardiological, respiratory, renal, gastrointestinal, neurological), an increase in the concentration of D-dimer, C-reactive protein, thrombocytopenia. Knowledge of the pathology under consideration will allow physicians to timely identify such patients among children with
infectious pathology, establish the adequate tactics of dynamic observation, and in some cases, the prognosis

The article considers diagnosis of a rare disease occurring in 1 in 15,000 newborns: disorder of sex development conforming to the 45XO/46XY
mosaic karyotype revealed in a child aged 9 years during scheduled examination before surgical intervention on hypospadias. The stages of diagnostic search
are presented (including a joint examination in functional analysis of the patient by specialists of diagnostic departments together with the treating physician)
as well as radiological diagnosis results and determination of indications to surgical treatment. The process of surgical treatment and specifics of endoscopic
visualisation have been shown. The features of development of gonads in patients with disorder of sex development has been considered. The importance of
multidisciplinary approach in diagnosis, treatment and consultations for such patients has been shown.