The main reason for the severe and difficult to correct course of asthma is the remodeling of the respiratory tract. The purpose of the review is to summarize the main pathogenetic mechanisms of airway remodeling in asthma and to present the diagnostic capabilities of various methods. Results. The main patterns of development and progression of morphofunctional restructuring of the respiratory tract in asthma are presented. The involvement of immune cells and the role of angiogenesis in the remodeling of the respiratory tract are shown. Instrumental and laboratory diagnostic methods are considered. The diagnosis of airway remodeling faces a number of difficulties. Currently, there are no available non-invasive methods for assessing airway remodeling with high sensitivity and specificity. The lack of informative biomarkers available for airway remodeling limits clinical studies of this process. Understanding the pathogenetic mechanisms, timely diagnosis and treatment of airway remodeling is a promising strategy for preventing the onset and progression of asthma. Conclusion. The pathogenetic mechanisms and modern diagnostic methods of airway remodeling in asthma described and systematized in the review are intended to help in the search for new therapeutic targets for the prediction and treatment of the disease.

ENT-diseases are widespread. Combined pathology is often encountered in clinical practice. Late diagnosis of ENT- pathology combined with other diseases, as well as the complexity of using a systemic approach to solving the problems of managing patients with comorbid pathology in Otorhinolaryngology lead to a decrease in the quality of life of patients, the emergence of polypharmacy and adverse reactions during therapy, a decrease in healthy life expectancy and a significant economic burden. The aim of our study was to substantiate the need to use a systemic approach to solving the problems of comorbid pathology and early diagnosis of ENT-diseases and another pathology. The study used content analysis, analytical methods and the use of our own clinical experience. Results and discussion. The study demonstrated the importance of developing clinical guidelines, standards, procedures for the provision of medical care in the activities of doctors and preventing risks associated with the provision of medical care. The problems of the effectiveness of interaction between specialists of various profiles, the use of an interdisciplinary approach in practice, issues of comorbidity, early diagnosis and rational use of drugs in the presence of concomitant pathology, the possibility of improving regulatory documents and other important aspects of Otorhinolaryngology are considered. In the course of the study, some problems of organizing medical care for patients with comorbid pathology in ENT-diseases were formulated, ways to solve some of them were proposed based on our own experience, data of world literature, as well as regulatory documentation. Conclusion. The solution of issues related to the use of an interdisciplinary approach, multidisciplinary interaction, consideration of comorbidity problems, ensuring early diagnosis and prevention of ENT-diseases, as well as other pathology, play an important role in practical Healthcare. The development of regulatory and legal documentation for the treatment of ear, throat and nose pathology to regulate the practical activities of specialists working in outpatient clinics and hospitals in combination with an individual approach to the diagnosis and treatment of combined pathology in otolaryngology and other areas of clinical medicine can be valuable in terms of preventing risks associated with the provision of medical care and improving the quality of the organization of medical care.

Recent advances in the treatment of arterial hypertension (AH) have been obvious, but the complication rate of the disease remains at a high level. The latter is influenced by many factors, including low adherence to antihypertensive therapy and difficult environmental conditions that contribute to increased anxiety and a tendency to depression. At the same time, blood pressure is influenced by the activity of cortical processes in the central nervous system and parts of the ANS, the condition of which is not always taken into account. Aim. Based on the results of clinical and laboratory studies, to establish the most effective option of antihypertensive therapy in patients with hypertension with different levels of anxiety and depression. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2010 to 2021, patients with stage II HD, grade 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years old) were divided by type of higher nervous activity into equal groups with a predominance in the central nervous system of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of renin-angiotensin-aldosterone system) processes with high and low anxiety. Reactive and personal anxiety, quality of life were determined using the “Well-being, activity, mood” method (WAM test), the coefficient of oxygen utilization by tissues, the degree of dyscirculatory encephalopathy was determined using a valid technique, the speed of a simple sensorimotor reaction, as well as the level of complications of hypertension. Some groups of high- and low-anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and parts of the autonomic nervous system took a personalized version of antihypertensive therapy. The latter included correction of sympathicotonia in individuals with a predominance of excitatory processes and blockade of mineralocorticoid receptors in individuals with a predominance of inhibitory processes. Results and discussion. In contrast to empirical therapy, against the background of personalized antihypertensive therapy, the values of personal (reactive) anxiety, a tendency to depression, quality of life (according to WAM), as well as the value of the oxygen utilization coefficient by tissues were the same as in healthy individuals with the corresponding activity of the central nervous system and the balance of the autonomic nervous system. The rate of arterial hypertension complications due to acute cerebral blood flow disorders in the groups of patients taking the personalized antihypertensive therapy option was significantly lower than in the groups taking the empirical treatment option. Conclusion. The expediency of randomized clinical trials of this approach has been revealed.

The objective of this study is to assess the efficacy of transcranial electrostimulation in the management of phantom pain syndrome. Material and methods. This study involved 117 male patients (mean age 36 ± 3.74 years) who experienced phantom pain syndrome following traumatic limb amputation. The participants were assigned to two groups. The control group consisted of patients receiving standard analgesic pharmacotherapy (n = 60). In the transcranial electrical stimulation group (n = 57), patients received the same pharmacotherapy and transcranial electrical stimulation, administered over 20 sessions, comprising two sessions per day – one in the morning (monopolar mode) and another in the evening (bipolar mode) – over a period of 10 days. To evaluate the intensity and characteristics of pain over time, a visual analog scale and clinical questionnaires DN4, PainDETECT, and LANSS were employed. Assessments were conducted on days 1, 10, and 17 of the study. Results and Discussion. The application of transcranial electrical stimulation was associated with a more pronounced and statistically significant reduction in the assessed parameters on the tenth day of the study compared to the control group. In contrast to the comparison group, pain intensity decreased to a complete absence or mild pain (1 to 3 points on the visual analog scale) in most patients. By day 17, the differences between the groups had somewhat smoothed out, but the transcranial electrical stimulation group retained a statistically significantly lower pain intensity on the visual analog scale. Сonclusion. The therapeutic application of transcranial electrostimulation in the management of phantom pain syndrome has been demonstrated to be associated with a marked improvement in the clinical manifestations of phantom pain syndrome. This finding offers a compelling rationale for the continued investigation of the effects of transcranial electrostimulation in this setting.

Mass poisoning with toxic alcohols requires the readiness of toxicological centers to solve serious health problems in a short time due to the high dynamics of the course of the disease, a wide range of neurological complications and variability in outcomes, depending on the degree of organization of emergency medical care at the stages of medical evacuation. A multicenter retrospective study of hospital medical care for acute mass lesions with methanol was conducted in 116 patients who applied to medical centers of toxicological and therapeutic profile in the Volga region and Siberia of the Russian Federation from 2015 to 2023.

The article presents materials of the consensus devoted on malabsorbtion syndrome (MS), published with the support of the United European Gastroenterology Association. In the Consensus are discussed such questions as Definition of SM, its Diagnostic Testing, Supportive Care of such patients.

Mesh prostheses are used for surgical treatment of postoperative ventral hernias, which becomes an additional risk factor for wound complications. Aim: to determine predictors of wound complications in patients with postoperative ventral hernias after implantation of mesh prostheses. Material and methods. A prospective study of 50 patients with postoperative ventral hernias who underwent mesh implantation was conducted. The patients were divided into two groups: the first group consisted of 39 patients (78%) without wound complications, and the second group consisted of 11 patients (22%) who developed wound complications. Preoperative and postoperative predictors of wound complications were assessed in all patients, as well as complete blood count, C-reactive protein, albumin, and ferritin levels before surgery and on the third postoperative day. Results. Preoperative predictors of wound complications, including age, comorbidities, and hernia size, were not statistically significant. Criteria such as operative time greater than 2 hours, drainage for more than 8 days, and daily wound exudation greater than 100 ml were significant. Among inflammation indicators, albumin and ferritin were statistically significant (p = 0,010). In the group with wound complications, albumin decreased to 35,4 ± 1,8 g/L, and ferritin increased to 357,7 ± 50,5 μg/L. Leukocyte, lymphocyte, neutrophil, monocyte, and C-reactive protein counts were not statistically significant. Conclusions. Thus, for the timely diagnosis of wound complications in patients with postoperative ventral hernias, it is possible to study albumin and ferritin as reliable markers of inflammation after alloplastic operations.

Objective. To study the clinical, laboratory, endoscopic, and pathomorphological features of eosinophilic esophagitis with surgical complications. Material and methods. 113 patients with a confirmed eosinophilic esophagitis (based on esophagogastroduodenoscopy with esophageal biopsy) underwent a comprehensive examination including assessment of complaints, medical history, comorbidities, and nutritional status. Laboratory blood tests, esophagogastroduodenoscopy with endocytoscopy and esophageal biopsy, and pathomorphological examination of biopsy specimens were performed. Some patients also underwent barium esophagogram. Results. Complications leading to endoscopic and/or surgical interventions were recorded in 27.4% of patients with eosinophilic esophagitis. Complicated forms of eosinophilic esophagitis were characterized by more severe clinical manifestations (dysphagia and food impaction were observed in 96.7% of patients), changes in laboratory tests (blood eosinophilia and elevated IgE level), a high score on the EREхFS scale (more than 6 points), detection of strictures during endoscopic examination, and fibrosis in the subepithelial layer upon histopathological examination. Conclusion. One-third of eosinophilic esophagitis cases are complicated, requiring patients to seek urgent endoscopic and surgical care. Most patients with a complicated course are young men under 30 years of age, suffering from persistent dysphagia and recurrent food impaction episodes. Esophagogastroduodenoscopy in patients with eosinophilic esophagitis reveals characteristic signs of mucosal inflammation – edema, exudate, and longitudinal furrows; in cases of delayed diagnosis, rings and strictures are found in the esophagus. To prevent complications, every patient with unexplained dysphagia (especially with episodes of food impaction) should undergo endoscopic examination of the esophagus with multiple biopsies for timely diagnosis and initiation of anti-inflammatory therapy.

Hageman’s disease is a rare genetic disorder of the hemostasis system characterized by a congenital deficiency of blood coagulation factor XII. The frequency of the disease in the general population is unknown, as it is asymptomatic under normal conditions, but it is considered to be about 1 case per 1 million population. The aim of the work is to present a clinical case of successful surgical treatment of a patient with prostate adenoma, with severe congenital deficiency of plasma coagulation factor XII. The patient underwent a postpartum adenomectomy for benign prostatic hyperplasia. Open access made it possible to successfully remove prostate adenoma despite the presence of severe deficiency of blood coagulation factor XII. To correct coagulopathy and compensate for factor XII deficiency, a transfusion of freshly frozen plasma in a volume of 10 ml/kg body weight (870 ml) was performed on the day of surgery and tranexam 1000 mg was administered intravenously. Preoperative correction of factor XII deficiency in the form of transfusion of freshly frozen plasma allowed during surgery and in the early postoperative period to fully compensate for factor XII deficiency and normalize APTT, which ensured adequate intraoperative hemostasis, surgical blood loss of no more than 200 ml. Immediately after surgery, enoxaparin was prescribed 0.4 ml subcutaneously per day for 7 days to prevent thromboembolic complications. The use of low molecular weight heparin eliminated the threat of postoperative thromboembolic complications. The course of the long-term postoperative period is without any special features.

An aortopulmonary septal defect (APSD) is a rare congenital heart anomaly characterized by an abnormal communication between the ascending aorta and the pulmonary trunk in the presence of two distinct semilunar valves. Among septal defects, APSD is associated with the most rapid and unfavorable progression of pulmonary hypertension and Eisenmenger syndrome; in unoperated cases, mortality reaches up to 40% within the first year of life. We present a clinical case of a 49-year-old patient with congenital APSD complicated by Eisenmenger syndrome, who developed infective endocarditis of the pulmonary valve – an extremely rare combination not previously described in the literature.

One of the results of the elevation of Professor V.F. Yasenetsky-Voino of Turkestan State University and Tashkent surgeon to the priesthood (1921) was the best achievements of 1921–1923 in his scientific activity compared with the results of the previous period. They became possible despite his appointment as a junior priest at the Cathedral of Tashkent, his hasty study of theology, and his weekly (Sunday) sermons to the parishioners, which required Valentin (Voino-Yasenetsky) to pay considerable attention to them. A new historical fact has been established about the selfless refusal of a professor-priest to participate in the XV Congress of Russian Surgeons (Petrograd, 1922) for spiritual reasons, where he was expected to present

four original scientific reports. Despite his thorough preparation for the presentations, he was forced to cancel his research trip just days before the forum was scheduled to open. The reason for the refusal was explained by urgent commitments. One of them was related to the professor-priest’s personal participation in an anti-religious debate in Tashkent, where he made a speech in defense of Orthodoxy. Another obligation was to attend an extraordinary meeting of the clergy and laity in Tashkent, where Valentin Voino-Yasenetsky was expected to be elected as a candidate for ordination as a bishop. At the same time, both the debate and the meeting took place in Tashkent during the Petrograd Congress of Surgeons. The participation of the professor-priest confirmed the superiority of the spiritual aspect over secular duties. This feature later became an integral part of his professional activity. It testified not only to the unity of both aspects in the life and work of St. Luke (Voino-Yasenetsky), but also to the primacy of the spiritual principle.