Current challenges in the diagnosis of herpesvirus infections require a rethinking of existing approaches and the implementation of innovative solutions. This study provides a comprehensive analysis of the evolution of diagnostic methods, from traditional serological tests to advanced molecular technologies. The main focus is on a critical assessment of the effectiveness of various diagnostic methods based on a systematic review of scientific publications from 2013‒2023 from the PubMed, Scopus, and eLibrary databases. The results of the study indicate significant progress in the field of laboratory diagnostics of herpesviruses. Next-generation multiplex polymerase chain reaction systems demonstrate an optimal combination of high sensitivity (95‒98 %) and analysis speed (up to 2 hours), making them the preferred choice for routine practice. Of particular interest are promising isothermal amplification methods (loop-mediated isothermal amplification and recombinase polymerase amplification), which, despite the need for additional validation, open up new possibilities for rapid diagnostics in resource-limited settings. The revolutionary potential of next-generation sequencing technologies and clustered regularly interspaced short palindromic repeat-based systems, which provide unprecedented accuracy in identifying resistant strains and rare genetic variants, is particularly noteworthy. However, their widespread adoption is currently constrained by economic factors. This paper substantiates the need to develop differentiated diagnostic algorithms that combine accessible screening methods with high-precision technologies for complex cases, as well as to achieve international consensus on standardizing diagnostic protocols. 

The influence of nutritional support on the condition of patients suffering from chronic diffuse liver diseases of toxic- alimentary origin, including alcoholic liver disease, is being examined. The material for analysis consisted of publications by both domestic and foreign authors, which describe modern strategies of nutritional intervention, their significance in correcting protein-energy deficiency, as well as in the prevention and treatment of malnutrition and sarcopenia. The summarized results of the studies demonstrate that properly organized nutritional therapy contributes to the restoration of liver functional reserves, reduces the frequency and severity of complications, including hepatic encephalopathy, and positively affects the prognosis and quality of life of patients. An analysis of the effectiveness of various approaches was conducted – from therapeutic diets and enteral nutrition to parenteral methods – taking into account their advantages, risks, and metabolic consequences. Based on this review, the authors conclude that nutritional support should be considered an essential component of comprehensive treatment for patients with chronic diffuse liver diseases of toxic- alimentary etiology, and the development of unified standards for its administration is an important task for future clinical studies.

Epigenetics, which studies heritable changes in gene expression that do not involve alterations in the deoxyribonucleic acid nucleotide sequence, is one of the key areas of modern biomedical research. This review systematizes fundamental epigenetic mechanisms, including deoxyribonucleic acid methylation, posttranslational histone modifications, and the regulation by non-coding micro-ribonucleic acids, and analyzes their role in the development of pathological processes in socially significant diseases: arterial hypertension, type 2 diabetes mellitus, bronchial asthma, and oncological processes. It has been shown that epigenetic changes induced by environmental factors (stress, nutritional deficiency, exposure to toxins) contribute to the formation of stable pathological phenotypes. In particular, hypermethylation of the promoters of the HSD11B2, AGTR1, and TLR2 genes is associated with the development of arterial hypertension, while hypomethylation of PPARGC1A and TCF7L2 correlates with insulin resistance in type 2 diabetes mellitus. In bronchial asthma, alterations in the methylation of cytokine genes (IL4, IL13) have been identified, while in oncology, global hypomethylation alongside localized hypermethylation of tumor suppressors (p16, BRCA) has been observed.Special attention is given to the potential of epigenetic therapy, including deoxyribonucleic acid methyltransferase inhibitors (azacitidine) and histone deacetylase inhibitors (vorinostat), as well as the prospects of using micro-ribonucleic acids as biomarkers and therapeutic targets. The reversibility of epigenetic modifications is emphasized, opening new possibilities for preventive medicine and personalized treatment.

Chronic rhinosinusitis is one of the most common chronic human diseases. One of the markers of activation of immunological processes of interest is the soluble IL-2 receptor (sIL-2R). An increase in the concentration of sIL-2R accompanies many inflammatory diseases, including those involving immunopathological processes. The aim of the study was to study the local production of sIL-2R in elderly and senile people with chronic rhinosinusitis. Material and research methods. Of the patients included in the study (n = 147), 4 groups were formed. The content of sIL-2R in nasal secretions was assessed using an enzyme immunoassay kit (Multiscan Accent; FineTest reagents) according to the instructions. Research results. In general, the data obtained show that sIL-2R production in the nasal secretions of elderly people is significantly higher than in the elderly (Iu 13.2[10.2;13.4] pg/ml vs Me 43[35;46] pg/ml, p = 0.014). An analysis of age-related features in patients with chronic rhinosinusitis indicates that the level of the receptor in mature patients is comparable to that in the elderly and senile, respectively (Me 32.2[28;45.5] pg/ml vs Me 72.9[57.2;79] pg/ml vs Me 79[65;99] pg/ml) and demonstrates an increase in sIL-2R production with age. Conclusion. Senile age compared with the elderly is associated with higher production of sIL-2R in the nasal cavity. The inflammatory process during exacerbation of chronic rhinosinusitis is characterized by an increase in its production, but there is no difference in the indicator between elderly and senile patients. 

Despite the intensive implementation of advanced diagnostic methodologies, training in the traditional skill of cardiac and pulmonary auscultation retains fundamental significance in the preparation of medical specialists, thereby stimulating the development and implementation of innovative digital simulation platforms integrated with neural network technologies to enhance the effectiveness of educational processes in medical training. Objective. To conduct an approbation of the developed digital auscultation simulator in a real academic setting, to evaluate its practical utility and to determine areas for further improvement. Materials and Methods. The simulator uses real audio recordings of normal and pathological respiratory and cardiac sounds, which are systematized according to clinical classifications. Two modes are implemented: a training mode with repeated listening and brief explanations, and a testing mode with multiple-choice questions and automatic scoring. The study included 20 physicians and 109 students in their 4^th to 6^th years, with 38 students undergoing repeated testing one week later. The primary outcome was the total score for recognizing respiratory and cardiac sounds. Non-parametric methods were used at a significance level of  p < 0.05. Results. No significant intergroup differences were found between physicians and students in recognizing either respiratory sounds (p = 0.526) or cardiac sounds (p = 0.822). In the subgroup of students who were retested, no statistically significant dynamics were noted for respiratory sounds, with the median changing from 6[6;7] to 7[5;8.75] with p = 0.729. However, a significant improvement in cardiac sounds was recorded, with the median changing from 2[2;2] to 3[3;4] with p = 0.002, confirming the simulator's effectiveness. Overall, physicians and students were better at recognizing pulmonary sounds than cardiac sounds. Users noted the ease of starting and mastering the simulator. Conclusion. The digital auscultation simulator is suitable for inclusion in the educational process, does not require expensive equipment, and provides short-term improvement in cardiac sound recognition among students, serving as an accessible supplement to traditional training. The study's limitations, including a single institution, a small sample size, and a short re-evaluation interval, necessitate the confirmation of results in larger and more randomized studies; further development is related to expanding the sound library and improving the evaluation algorithms. 

The study of the role of microbiota in various neurodegenerative diseases is expanding, In this case, the microflora of the nose can be involved in the pathological process through the “nose – brain” pathway. Analysis of the nasal microbiota in patients with multiple sclerosis may provide insight into the progression of the disease and develop new approaches to improving the effectiveness of treatment and preventive measures. The purpose of the study. To analyze the microbiota of the nasal cavity depending on the duration of the course of multiple sclerosis and its clinical manifestations. Materials and methods. 96 рatients with multiple sсlerosis and 40 рraсtically healthy individuals in the сomрarison grouр were examined using clinical and bacteriological methods. A comparative study of the nature of the nasal microflora was carried out depending on the duration of the disease, the age of the patients and the level of disability. Statistical processing of the obtained results was carried out by calculating the Pearson agreement criterion χ² using the “Statistica 12.0” program. The results of the study. In patients with multiple sclerosis, a significant change in the qualitative characteristics of the nasal microbiota was found, manifested by a significant increase in the colonization properties of opportunistic microorganisms of the species Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli. Increased representation of more pathogenic microorganisms (coagulase-positive staphylococcus, hemolytic escherichiae) in patients with significant neurological lesions. The conducted studies demonstrate significant changes in the nasal microbiota in patients with a clinically pronounced disease, characterizing the “nose – brain” relationship. Conclusion. The nasal mucosal microbiome in multiple sclerosis has unique characteristics, and the prevalence of opportunistic bacteria correlates with the duration of the disease and the severity of symptoms. The potential benefits of correcting these abnormalities require further study. 

Community-acquired pneumonia is a leading cause of morbidity and mortality both globally and in Russia. Pneumonia that occurs in a hospital during treatment for another illness is called nosocomial pneumonia, according to the World Health Organization. Hematological parameters play a significant role in the pathogenesis of pneumonia. The purpose of the study: was to to study the values of changes in red blood cell indices and parameters at different stages of treatment of patients with community-acquired and nosocomial pneumonia. Materials and methods. The study included 85 patients admitted to the State Budgetary Healthcare Institution of the Astrakhan Region Aleksandro-Mariinskaya Regional Clinical Hospital. Of these, 67 were admitted to the hospital's internal medicine department with moderate community-acquired pneumonia, and 18 were admitted to the intensive care unit with severe nosocomial pneumonia. We analyzed the following red blood cell parameters (number of erythrocytes, hemoglobin, fetal hemoglobin, hematocrit) and derived erythrocyte indices (mean corpuscular volume, mean corpuscular hemoglobin content, erythrocyte distribution width) from printouts from the “Sysmex XN 2000” hematology analyzer. In addition, fetal hemoglobin concentrations were determined in collected blood hemolysates from all patients with community-acquired and nosocomial pneumonia using the Mancini immunoassay. These parameters were assessed at the peak of the disease and before discharge. Statistical data processing was performed using the “Statistica 12.0” software package from “Statsoft”. Research results. A comparison of medians and interquartile ranges of red blood cell, hemoglobin, hematocrit, erythrocyte indices, and fetal hemoglobin values was conducted in patients with community-acquired and nosocomial pneumonia at the peak of the disease and before discharge. The erythrocyte indices and fetal hemoglobin values characteristic of community-acquired and nosocomial pneumonia were determined. The erythrocyte anisocytosis and fetal hemoglobin values were determined, which serve as the basis for transferring patients with pneumonia to the intensive care unit. Conclusion. Thus, for the first time, a relationship was identified between the erythrocyte distribution width and fetal hemoglobin in both community-acquired and nosocomial pneumonia. While the median of erythrocyte distribution width in nosocomial pneumonia was only 1.2 times higher than the median in community-acquired pneumonia, the median fetal hemoglobin in nosocomial pneumonia was even 1.65 times higher. Thus, an increase in erythrocyte anisocytosis above 15 % and fetal hemoglobin above 4.5 g/L are grounds for transferring patients with pneumonia to the intensive care unit for intensive infusion therapy and respiratory support. The erythrocyte distribution width and fetal hemoglobin indicators are simple and reliable biomarkers for predicting the severity and outcome of community-acquired and nosocomial pneumonia. 

Antibiotics in the treatment of diseases of Antibiotics in the treatment of oral cavity diseases lead to bacterial multidrug resistance, so it is necessary to search for alternative methods of treatment. A promising direction is the use of probiotics with antimicrobial potential. The aim of the study was to evaluate the antimicrobial activity of probiotic strain Streptococcus salivarius M18 against strains of Escherichia coli, Staphylococcus aureus depending on the cultivation medium. Materials and Methods. Growth parameters of Streptococcus salivarius M18 strain were studied in milk growth medium, streptococcal broth, thioglycol medium (Russia) by means of daily cultivation on a daily basis. medium (Russia) by daily measurement of the optical density of the culture liquids at a wavelength of 600 nm. at a wavelength of 600 nm on a spectrophotometer PowerWave X spectrophotometer (USA) every 24 h. The total observation period was 15 days. Daily antimicrobial activity of the culture fluid was evaluated by disc-diffusion method against Staphylococcus aureus, Escherichia coli strains on Mueller-Hinton agar. The concentration of lactic acid in the culture fluid was assessed using the kit ‘Lactic acid ‒ Olvex’ (Russia). Descriptive statistics, Duncan's criterion and correlation coefficient were used for statistical analysis of the results. correlation. Results. It was established that in the medium of milk growth medium strain Streptococcus salivarius M18 has expressed growth parameters and shows high functional activity. activity. The zone of growth retardation of Staphylococcus aureus when using 3-day culture fluid was 7 ± 1 mm. When the cultivation period was lengthened to 7 days, the growth retardation zone of Staphylococcus aureus was 7 ± 1 mm and that of Escherichia coli was 10±1 mm. After 10 days of incubation in milk growth medium, the culture fluid of Streptococcus salivarius strain inhibited the growth of Staphylococcus aureus (11.7 ± 0.5 mm) and Escherichia coli (13.3 ± 1.1 mm). In thioglycol medium and streptococcal broth, the strain exhibited lower growth properties and did not show antimicrobial activity until 15 days. Conclusion. Antimicrobial activity of Streptococcus salivarius M18 strain depends on the composition of nutrient medium. The most pronounced growth parameters and functional activity were observed in the milk growth medium.

The aim of this study was to examine the current state of healthcare-associated infections. A review of current domestic and international literature on this topic was conducted. Understanding the relationships between healthcare institutions and the type of healthcare-associated infection, its etiology, epidemiology, and risk factors enables the identification of more effective ways to prevent and control healthcare-associated infections. Assessing risk factors allows for the optimization of the selection of medical procedures, their exposure, the frequency of laboratory diagnostic tests, and antibacterial therapy regimens, both individually and for groups of patients. Currently, it is necessary to develop and implement new solutions for the control of healthcare-associated infections, which will help reduce the length of hospital stays and the number of in-person outpatient visits. One approach to improving the effectiveness of healthcare-associated infection prevention and treatment is continuous microbiological monitoring aimed at identifying hospital strains of pathogens and assessing their susceptibility to antibacterial drugs. 

Bronchial asthma is one of the most common diseases in children (in the Russian Federation, the prevalence among children and adolescents is about 10 %). In modern management of severe bronchial asthma, a thorough analysis of risk factors that determine the progression of the disease and the formation of a severe course is important, which allows for a personalized approach to prevention and treatment. The article presents a clinical case of an adolescent with severe uncontrolled bronchial asthma, who, despite multiple corrections of basic therapy, continued to have frequent exacerbations and a severe course of the disease. The experience of using biological therapy is shown and the adverse effects associated with it are described. Clinical methods, dynamic assessment of laboratory and instrumental parameters, comparison of the clinical and laboratory course of the disease in dynamics are used. The patient's examination data and an assessment of the effectiveness of mepolizumab and dupilumab in the context of improving the control of bronchial asthma symptoms in this adolescent are presented. A clinical case of a 15-year-old girl shows that uncontrolled severe bronchial asthma with concomitant eosinophilia can be successfully corrected using biological therapy. The data obtained emphasize the importance of differential diagnosis and an individual approach to the choice of biological therapy in patients with severe bronchial asthma, especially in cases of ineffectiveness of standard treatment approaches. 

Despite the widespread use of laparoscopic appendectomy as a routine intervention in pediatric surgery, postoperative infectious complications in some cases become extremely severe. An example is the clinical case of a 15-year-old teenager with a severe postoperative condition after laparoscopic appendectomy performed for gangrenous-perforated appendicitis. Goal. To draw attention to the need for an individualized approach in the treatment of patients with severe complications after abdominal surgery, as well as to the importance of assessing the immune status in children who demonstrate an inadequate response to standard therapy. Materials and methods. Anamnesis data, the results of a comprehensive study of specialized specialists, and data from laboratory and instrumental examination of the patient were used for the analysis. The research methods included physical examination, laboratory tests (hematological, biochemical blood and urine tests), as well as instrumental diagnostic methods such as ultrasound and other necessary techniques to detect postoperative complications. Results. The patient had liver abscesses, diffuse peritonitis, severe polysegmental pneumonia, acute tubulointerstitial nephritis, anemia, and signs of multiple organ failure. Based on a combination of clinical and laboratory data, primary immunodeficiency is suspected. Conclusion. The described clinical case highlights the importance of applying an integrated approach to the treatment of patients with severe postoperative complications. Assessment of the immune status in children with an inadequate response to standard therapy can contribute to the timely diagnosis of primary immunodeficiency and optimization of therapeutic measures. This case demonstrates the need to call for a deeper study and individualization of approaches in the treatment of such patients.