Modern medicine has a high demand for new drugs for the prevention and treatment of cytomegalovirus (CMV) infection. This review discusses maribavir — an oral antiviral drug with selective multimodal anti-CMV activity for the treatment of adults and children with post-transplant CMV infection resistant to traditional anti-CMV therapy. Despite numerous clinical trials of maribavir, the results of its effi cacy are ambiguous. Alongside successful studies indicating high effi cacy of the drug under review, there are data from statistically unsuccessful studies.

   The aim of this review is to examine the mechanism of its action on cytomegalovirus infection, viral sensitivity and cross-resistance mechanisms, as well as to summarize the results of clinical trials of the drug.

   The increasing number of patients with diabetes in the structure of comorbid cardiothoracic patients necessitates a more detailed study of the pathophysiological mechanisms of the modifying infl uence of diabetes, taking into account new scientific data. This allows for a more systematic view of processes that were previously the prerogative of specialists.

   Content. A modern perspective on the pathophysiological mechanisms of diabetes on cardiac structures is presented, with a description of the two most signifi cant pathological syndromes — diabetic cardiomyopathy and changes in the morphological structure of the atrioventricular valve leafl ets. The expansion of the endocrinologist’s role in the examination and treatment of cardiothoracic patients is justifi ed.

   Conclusion. A systemic approach to the problem of diabetes in cardiothoracic surgery, incorporating a multidisciplinary approach and active involvement of endocrinologists at all stages of the treatment process, will improve treatment outcomes for cardiothoracic patients and reduce their postoperative recovery times.

   The aim of the review is to draw attention to the multifaceted biological action of medications, especially their infl uence on direct intercellular interactions.

   The data are summarized on the fact that common medications such as dopamine, glutamic acid, melatonin, phenylephrine-containing agents can, depending on the stimulated receptors, both organize and disorganize intercellular connections. The action can be predicted considering information on agonism or antagonism of receptor eff ects on intracellular calcium or cAMP. Information is provided on the possibility of mitigating unwanted eff ects. The data on the prospects of using gangliosides in therapy are summarized.

   Acute pancreatitis remains one of the most dangerous pathologies in the structure of emergency abdominal surgery. This is due to many reasons, including an increase in the frequency of destructive forms of the disease, high mortality, and frequent unfavorable outcomes.

   The aim of this study was to investigate a number of leading components of homeostasis in patients with acute pancreatitis of varying severity.

   A retrospective study was conducted on 50 patients with acute pancreatitis of diff erent severity levels who were hospitalized at the Republican Clinical Hospital named after S.V. Katkovа (Saransk, Russia). The patients were divided into groups: the fi rst group (control, n = 30) consisted of patients with mild acute pancreatitis, and the second group (main, n = 20) consisted of patients with severe acute pancreatitis. The study evaluated the endogenous intoxication syndrome, the activity of lipid peroxidation and phospholipase systems, microcirculation status, liver function, and the activity of the coagulation-lytic blood system. The results showed that in the early stages of acute pancreatitis, several pathological processes were observed: the development of endotoxemia syndrome, activation of lipid peroxidation and phospholipase systems, microcirculation disorders, changes in the coagulation and fibrinolytic links of the hemostasis system, and liver function suppression. The severity of these disorders was associated with the severity of the pathology. In cases of mild severity, the changes in the parameters studied were reversible, while in severe cases they were stable and often
irreversible.

   The presence of toxemia, oxidative stress, dysmicrocirculation, and hemostatic disorders should be considered as risk factors for disease progression and complications.

   Cases of occlusive lesions of the arteries of the lower leg occupy a special place in the treatment of critical lower limb ischemia. In this regard, performing open reconstructive interventions is unpromising. A new era in the treatment of occlusions of the arteries of the lower leg has become endovascular surgery. However, due to extensive occlusive lesions of the arteries of the lower leg, direct endovascular revascularization is often impossible. Currently, vascular surgeons adhere to the angiosome principle, according to which the goal of balloon angioplasty is to restore blood supply to the artery supplying the angiosome with purulent-trophic changes. In the clinical example provided, the universality of the angiosome theory is questioned, and clinical success achieved due to the discovery of collateral blood fl ow is demonstrated. The patient underwent surgery with the use of an original hybrid operation technique with the installation of a port system followed by active therapeutic-diagnostic measures on an outpatient basis for 30 days. As a result of the treatment, epithelialization of the trophic defect and cessation of critical ischemic phenomena were noted.

   Aim: to study the dynamics of clinical and echocardiographic parameters in patients with cardiovascular diseases (CVD) at 3, 12, and 26 months after COVID-19 pneumonia.

   Material and methods. The dynamics of clinical and echocardiographic parameters were studied in 130 patients with CVD at 3, 12, and 26 months after COVID-19 pneumonia (57 ± 8 years old, 46.9 % males).

   Results. Between the 1^st and 2^nd visits, body mass index (BMI) increased (30.6 ± 5.1 kg/m² vs. 31.4 ± 5.4 kg/m², p < 0.001), the number of patients with obesity of grades 2 –3 increased (14.6 % vs. 23.1 %, p < 0.001). Early diastolic septal mitral annular velocity decreased from the 2^nd to the 3^rd visit (7.0 [6.0; 8.0] cm/s vs. 6.0 [5.0; 8.0] cm/s, p = 0.023), as did the maximum diastolic lateral tricuspid annular velocity (12.0 [11.0; 14.0] cm/s vs. 8.0 [6.0; 9.0] cm/s, p < 0.001). Between the 2^nd and 3^rd visits, the average global longitudinal strain of the left ventricle increased ( –19.3 ± 2.6 % vs. –19.8 ± 2.2 %, p = 0.034), the frequency of detecting its reduced values decreased (34.9 % vs. 17.4 %, p = 0.003).

   Conclusion. In the long term after COVID-19 pneumonia, patients with CVD show an increase in BMI accompanied by worsening of diastolic ventricular function parameters without signifi cant progression in the frequency and severity of CVD.

   Chronic wounds are a common surgical pathology. Some types of laser radiation allow for eff ective debridement of wounds and stimulation of healing processes. High-intensity erbium laser can comprehensively aff ect tissues in all phases of the wound process, leading to accelerated healing of chronic wounds.

   The aim of the study was to evaluate the eff ectiveness of using high-intensity erbium laser for treating patients with chronic wounds of various origins compared to traditional treatment.

   Material and methods: An analysis of the treatment of 144 patients with chronic wounds was conducted in two groups. In the 1^st group (n = 71), a high-intensity erbium laser and dressings with water-soluble ointments were used. In the 2^nd group (n = 73), standard surgical treatment with similar dressings was performed. Results were evaluated using visual assessment of wound defects, planimetry, bacteriological and cytological studies, assessment of procedure tolerability, and pain intensity before and after treatment.

   Results: рatients in the 1^st group showed signs of healing signifi cantly earlier and more frequently achieved complete epithelialization of wounds. Laser treatment contributed to more effective decontamination of wound defects, and signs of tissue regeneration were more frequently observed in cytological images. Patients tolerated erbium laser treatment better than surgical treatment, although pain intensity after treatment did not differ between groups.

   Conclusion: The study confi rmed the effectiveness of using high-intensity erbium laser for treating chronic wounds. This method can be recommended for use in surgical practice alongside other technical and pharmacological tools.

   Justification. Knowledge of the differences in response to therapy between phenotypes of exacerbations of chronic obstructive pulmonary disease (COPD) is necessary to improve treatment outcomes.

   Objective: to determine the most effective additional pharmacological methods for virus-associated exacerbations of COPD.

   Material and methods. The study included patients hospitalized with exacerbations of COPD with viral (n = 60) and viral-bacterial (n = 60) infections, and a comparison group with exacerbations of COPD with bacterial infection (n = 60). The diagnosis of COPD was based on spirometric criteria, viral infection — according to the results of PCR-RV of sputum for RNA of respiratory viruses. Treatment was carried out in real clinical practice. The groups were comparable in the use of systemic glucocorticoids, short-acting bronchodilators. Dyspnea was assessed using the TDI index (primary endpoint), lung function (spirometry, diffusion capacity for carbon monoxide), exercise tolerance (6-minute walk test), length of hospital stay (secondary endpoints). The сorrelations were determined with the use of Cox proportional hazards model.

   Results. In the groups with virus-associated and viral-bacterial exacerbations, unlike bacterial exacerbations, the following types of treatment were associated with achieving TDI +1 (odds ratio — OR, 95 % confidence interval — CI): fixed triple combination (OR 2.69; 95 % CI 1.48–4.90; p = 0.010 and OR 2.74; 95 % CI 1.29–3.80; p = 0.031), inhalation of 3 % sodium chloride solution (OR 3.64; 95 % CI 1.45–5.42; p = 0.001 and OR 3.23; 95 % CI 2.15–5.43;\ p = 0.042), antiviral drugs (OR 2.91; 95 % CI 1.15–3.62; p = 0.009 and OR 2.76; 95 % CI 1.31–3.90; p = 0.008). As a result of treatment, an increase in DLco/Va, SpO2 after a 6-minute walk, and a decrease in the length of hospital stay were observed.

   Conclusion. Detection of virus-associated infections is a promising marker for determining indications for prescribing long-acting anticholinergic drugs and beta-adrenomimetics, inhaled corticosteroids, inhalations of hypertonic sodium chloride solution, and antiviral drugs for exacerbations of COPD.

   Aim: to evaluate the eff ectiveness and satisfaction of patients with bronchial asthma (BA) using the remote monitoring software product “ASTMATEST”.

   Materials and methods. A specialized website “ASTMATEST” — ww.asthmatest.ru was developed for conducting remote and timely telemonitoring of the health status of patients with verifi ed BA. An open prospective comparative study was conducted at the pediatric department of the City Children’s Clinical Hospital in Ufa from November 2022 till April 2023. The study included 2 groups of patients, similar in age and demographic indicators: the main group consisted of 38 (57.8 %) children whose parents agreed to use the information system of the website “ASTMATEST” in combination with its traditional methods, the control group included 34 (43.2 %) children whose parents refused to use the software product due to various reasons. The effectiveness of remote monitoring was analyzed by comparing the morning and evening peak flow meter readings, symptom control report data. Satisfaction with the work and use of the remote monitoring technology of the website “ASTMATEST” by patients with BA and their parents was assessed through a sociological survey using questionnaires.

   Results. In the main study group, the proportion of patients with severe BA decreased to 18.42 % due to an increase in the proportion of patients with mild (up to 34.21 %) and moderate (47.37 %) severity of BA. In the control group, the proportion of patients with mild BA decreased to 40.74 %, due to an increase in the proportion of patients with moderate (up to 44.44 %) and severe (14.82 %) severity.

   Conclusion. During the survey of patients in the main group using a specially designed questionnaire, it was found that the majority of patients and their parents/legal representatives are willing to continue using the developed software product to assess the level of disease control and adherence to doctor’s recommendations and prescriptions.

   The existing inertia of clinical thinking in establishing a diagnosis, even in the presence of instrumental and valid diagnostic criteria, does not always allow for a reconsideration of the diagnosis given to the patient, especially several years ago. Existing clinical recommendations for certain nosological forms, which currently play a decisive role in diagnostics, treatment, and quality assessment of medical services, may not be fully applicable to all patients with a specifi c disease. As an illustration of the above, a clinical example of a patient diagnosed with “bronchial asthma” about 15 years ago without diagnostic criteria for this condition is provided. Three years ago, on a hospitalization described in the article, a chest computed tomography scan revealed typical signs of diff use pulmonary pneumonia. However, this did not allow for a change in the stereotypical diagnostic view and the correct diagnosis and appropriate treatment, including in a specialized pulmonology department. As a result, the disease progressed with the development of complications in the form of severe respiratory and heart failure. Only a reassessment of clinical symptoms, including inspiratory crackles, chest CT scan (diffuse opacity reduction resembling ground glass), and restrictive abnormalities in external respiration function without obstructive components, allowed for a reevaluation of the diagnosis and the prescription of pathogenetic therapy with glucocorticoids in combination with treatment for respiratory and heart failure, leading to rapid clinical improvement.

   The treatment of gunshot thoracoabdominal injuries is a relevant issue in modern medicine. The high mortality rate, reaching 28.6 %, indicates the need to improve existing diagnostic and treatment approaches in providing medical care to such injured individuals during evacuation stages. The presented clinical case demonstrates the effectiveness of applying a staged approach to providing medical care for thoracoabdominal trauma.

   Data on the first aviation and aeronautical units of the Russian Imperial Army in the First World War are presented. Biographical information about the first air medical offi cers of these military units is given.

   The article presents new information about Pyotr Frantsevich Lesgaft — a pedagogue and mentor, a follower of the traditions of his favorite teachers and professors of the Imperial Medico-Surgical Academy, his contribution to the development of the system of pedagogical upbringing and education of children in Russia.