Microbial (nummular) eczema is a common chronic inflammatory skin disease, the pathogenesis of which is closely linked to impaired innate immunity and colonization by Staphylococcus aureus. Despite significant advances in the understanding of dermatoses, the role of specific effector molecules, particularly cathelicidin LL-37, in the transition from an acute to a chronic process remains insufficiently studied, and existing therapeutic approaches do not always achieve sustained remission. Aim of the review: to conduct a comprehensive analysis of the molecular and cellular mechanisms of involvement of the antimicrobial peptide cathelicidin LL-37 in the development and chronicity of microbial eczema, and to evaluate potential therapeutic strategies aimed at modulating its activity. Materials and methods: the review presents a systematic analysis of data from the scientific literature for the period 2010–2025, selected from the databases PubMed, Scopus, Web of Science, CyberLeninka, and eLibrary. Combinations of key words were used: “cathelicidin LL-37”, “hCAP-18”, “antimicrobial peptides”, “microbial eczema”, “nummular dermatitis”, “Staphylococcus aureus”, “eczema pathogenesis”, “skin innate immunity”. Results. It has been established that cathelicidin LL-37 functions as a key molecular hub integrating epidermal barrier dysfunction, bacterial colonization, and chronic immune inflammation in microbial eczema. Its role is characterized by profound duality. On the one hand, the intact peptide has direct bactericidal activity against S. aureus, promotes wound healing, and supports skin homeostasis. On the other hand, under the conditions of microbial eczema, its pathological transformation occurs: proteolytic cleavage by bacterial and intrinsic skin proteases leads to the generation of pro-inflammatory fragments (KS-30, RK-31), which, through the activation of Toll-like receptors (TLR2/4) and the purinergic receptor P2X7, induce the production of interleukin-1β, interleukin-6, interferon-gamma, and potent neutrophil chemotaxis. This creates a self-sustaining vicious cycle of inflammation. An additional pathogenetic factor is an imbalance in the antimicrobial peptide system, in particular, a relative deficiency of dermcidin and β-defensins. Conclusion. The pathogenesis of microbial eczema significantly depends on the dysregulation of cathelicidin LL-37, which transforms from a protective factor into a trigger of chronic inflammation. This shifts the treatment paradigm from empirical antibiotic therapy and corticosteroids to targeted approaches. The most promising strategies appear to be those aimed at inhibiting specific staphylococcal proteases, blocking pro-inflammatory receptors (TLR, P2X7), using stable LL-37 analogs, and correcting the overall balance of antimicrobial peptides. The development and implementation of such methods could improve the efficacy of managing resistant and recurrent forms of the disease.

The article describes the mechanisms of renal dysfunction in children with constitutional exogenous obesity. The condition of obese patients should be considered under the prism of chronic inflammation of non-infectious origin, caused by dysregulation in the leptin-adiponectin system and accompanied by excessive production of inflammatory mediators, with the development of kidney dysfunction – increased microalbuminuria and proteinuria, decreased glomerular filtration rate and increased creatinine levels.

Epstein-Barr virus, which infects more than 95 % of the world's population, poses a significant threat to the health of children, being a trigger for a wide range of pathologies - from infectious mononucleosis to cancer and autoimmune diseases. This review analyzes modern epidemiological trends that demonstrate a pronounced socioeconomic dependence of the dynamics of seroconversion, which is manifested by the phenomenon of “delayed infection” in developed countries, associated with an increased risk of manifest forms. The molecular mechanisms of Epstein-Barr virus persistence and pathogenesis are covered in detail, including immune evasion strategies and manipulation of host cell signaling pathways (NF-κB, JAK/STAT, PI3K/Akt/mTOR), as well as the role of genetic predisposition in determining the outcome of infection. Particular attention is paid to modern and promising approaches to diagnostics and therapy: quantitative determination of viral load, immunophenotyping, the use of monoclonal antibodies (rituximab, brentuximab vedotin), adoptive transfer of virus-specific T-lymphocytes and inhibitors of signaling kinases (Syk, BTK, JAK, mTOR). The need to develop preventive vaccines based on modern platforms (mRNA, nanoparticles) is emphasized. An integrative personalized approach to patient care is substantiated, combining virological, immunological and genetic monitoring for risk stratification and selection of the optimal intervention strategy.

The biological features of a subpopulation of T helper cells: Th1, Th2, Th17, Th9, Th22, follicular T lymphocytes are considered. The corresponding transcription factors, signaling pathways involved in the biological effects of CD4+T lymphocytes, and interleukins secreted by them, which influence the development of the immune response, are characterized. The maturation efficiency and differentiation of T-helper cells depend on adhesion molecules and humoral factors. Thl-type are critically important in the development of primary immunodeficiency states, homozygous mutations associated with IFN-γ, IL-12 receptors, and STAT1 signaling proteins. IL-25, IL-33, and thymus stromal lymphopoietin are involved in the biological activation of Th2-type. JAK-3, STAT1-6, T_T-BET, and GATA-3 are involved in the maturation and differentiation of T-lymphocytes. Deviations in the functioning of these molecules lead to changes in the biological effects of Th1-type and Th2-type. Thus, the biological effects of the T-helper subpopulation are of great importance in the implementation of innate and acquired immune responses, and new research in this area is certainly relevant.

Cardiac rehabilitation is an important component of the comprehensive treatment of patients with chronic heart failure. The effectiveness of cardiac rehabilitation largely depends on the correct selection of patients. Aim: to analyze the literature data on the methods of selecting patients with chronic heart failure for cardiac rehabilitation. Materials and methods. The analysis of the literature data on cardiac rehabilitation in chronic heart failure is carried out. Articles were searched in the databases PubMed, ScienceDirect, ProQuest, GoogleScholar, Cochrane, Medline, Scopus from 2015 to 2025 by keywords. Inclusion criteria were: clinical trials, meta-analyses, systematic reviews, randomized controlled trials, and the availability of the full text in the public domain. Exclusion criteria were: abstracts, monographs, textbooks. A total of 150 publications were found. The review included 34 publications from 2017 to 2025 that corresponded to the topic and purpose. Results. The main purpose of the selection is to identify patients who can maximize the benefits of cardiac rehabilitation while minimizing the risks of complications. However, the treatment of patients with chronic heart failure faces a number of difficulties related to the peculiarities of pathology, risks of decompensation and organizational barriers. Also, key problems of the cardiac rehabilitation include: rigidity of exercise protocols, the need to individualize programs taking into account the type of heart dysfunction, drug risks and systemic deficiencies in the organization of staged recovery. Various methods are used to assess the functional state and determine indications for cardiac rehabilitation, including cardiopulmonary exercise testing and the six-minute walking test. Cardiopulmonary exercise testing provides more accurate data on cardiorespiratory endurance and functional reserve, while 6-minute walk test reflects daily physical activity, is suitable for routine monitoring, and is more widely available. In clinical practice, the combined use of both methods is often recommended. Conclusion. Improving outcomes requires the introduction of multidisciplinary teams and the adaptation of international recommendations to Russian realities. Further research should focus on optimizing assessment protocols and developing new methods that combine accuracy and accessibility.

The article provides an overview of current data on the role of immune factors in the pathogenesis of reproductive disorders in hypothalamic-pituitary dysfunction in young women. The mechanisms of interaction between the hypothalamus, adipose tissue and the immune system are considered. It has been shown that obesity accompanying hypothalamic syndrome in 80% of cases induces chronic subclinical inflammation characterized by an imbalance of proinflammatory and anti-inflammatory cytokines, changes in the population composition of B-lymphocytes and macrophages of adipose tissue, hyperleptinemia and leptin resistance. A multilevel negative effect of immune disorders on the reproductive system is described: from suppression of GnRH secretion and impaired pituitary sensitivity to impaired folliculogenesis, decreased endometrial susceptibility and changes in immune tolerance. Special attention is paid to the age aspect – patients aged 18-25 years, in whom the effects of neuroimmunoendocrine disorders are most significant for the realization of reproductive function. A promising direction is the development of approaches to targeted modulation of the inflammatory response in order to restore fertility.

The growing prevalence of drug-resistant mycobacteria, including non-tuberculous species, highlights the urgent need for novel therapeutic approaches, among which phage therapy represents a promising strategy. However, the efficacy of antimycobacterial agents is critically dependent on cultivation conditions, making the choice of an optimal culture medium and a reliable model strain (Mycobacterium smegmatis mc²155) essential for accurate activity assessment and the development of effective therapeutics. The aim of the study was to conduct a comparative evaluation of the efficacy of culture media for cultivation of the reference strain Mycobacterium smegmatis mc²155 and for maintaining antimycobacterial activity. Materials and methods. The reference strain Mycobacterium smegmatis mc²155 was used in this study. Inoculations were performed on liquid media: Middlebrook 7H9 supplemented with 10% oleic acid–albumin– dextrose–catalase enrichment and Tween 80, Shkolnikova medium, Sauton's medium, and a modified medium with reduced salt content enriched with glucose and yeast extract. A bacteriophage lysate obtained from a compost sample by enrichment culture on M. smegmatis mc²155 was used as a standardized indicator of lytic activity. The phage lysate titer was 3.7∙10⁷ plaque-forming units per milliliter. Antimycobacterial activity was assessed by adding 0.25 mL of bacterial culture of M. smegmatis mc²155 (final concentration 3.7∙10⁸ colony-forming units per milliliter) and 0.25 mL of phage lysate to tubes containing 5 mL of the corresponding medium. Results. In Middlebrook 7H9 and modified broth supplemented with phage lysate, a decrease in optical density was observed as early as 4 hours, progressing by 48 hours (0.009 ± 0.028). Both media demonstrated a heterogeneous response: in 9 out of 10 replicates, optical density decreased to 0.008–0.009, while in one replicate it remained high (0.080–0.107), indicating the survival of a cell subpopulation, potentially attributable to persister formation or transition to pseudolysogeny. By contrast, no significant decrease in optical density was recorded in Shkolnikova and Sauton's media (optical density remained at 0.168–0.237). Statistical analysis confirmed no significant differences between Middlebrook 7H9 and modified broth (p = 0.92), while both media significantly outperformed Shkolnikova and Sauton's media (p < 0.001). Conclusion. The modified broth is not inferior to the commercial Middlebrook 7H9 medium in supporting antimycobacterial activity (p > 0.05) and may serve as a cost-effective alternative for phage research. These findings underscore the need for standardization of culture media in antimycobacterial activity evaluation and open up opportunities for optimizing screening protocols.

Long-term use of neuroleptics and antiparkinsonian drugs in animals leads to the accumulation of autoantibodies in the blood and brain tissue, in particular to ionotropic glutamate receptors that selectively bind N-methyl-D-aspartate. Objective To study the interaction of monoclonal antibodies to N-methyl-D-aspartate receptors with haloperidol and bromocriptine in a pharmacological experiment with isolated lymphocytes of healthy laboratory rats in the rosette formation test with sheep erythrocytes. Materials and Methods Isolated lymphocytes of healthy rats in the rosette formation test with sheep erythrocytes were exposed to the effect (load test) of haloperidol or bromocriptine, as well as a combination of haloperidol or bromocriptine and monoclonal (IgG) antibodies to N-methyl-D-aspartate receptors. The effect of dopamine receptor antibodies alone on rosette formation was also assessed. Results. Monoclonal antibodies to the 2B receptor subunit increased T-lymphocyte counts primarily by increasing the number of high-avidity cells (more than 8 erythrocytes per rosette). The effect of bromocriptine in the rosette formation test was significantly weakened by antibodies to the 2B subunit. Conversely, haloperidol weakened the stimulatory effect of antibodies to the 2B subunit on lymphocytes, reducing the number of high-avidity (more than 8 erythrocytes per rosette) and intermediate-avidity (6–8 erythrocytes per rosette) cells. Conclusion. Thus, monoclonal antibodies to N-methyl-D-aspartate receptors (subunit 2B) can alter the action of dopaminergic agents (antagonists such as haloperidol and agonists such as bromocriptine). These data suggest that autoantibodies to N-methyl-D-aspartate receptors in the whole body can also modify the neuro- and psychotropic effects of these drugs.

The main objective in performing staged minimally invasive surgical correction of portal hypertension, as a basis for the prevention and treatment of portal bleeding, is the correct selection of initial and subsequent interventions while adhering to the concept of an individualized approach. Objective. To improve the outcomes of treatment and prevention of portal bleeding in patients with liver cirrhosis. Material and research methods. A comparative controlled study was conducted on the treatment outcomes of 295 patients with cirrhotic portal hypertension between 2006 and 2025. Group 1 (n = 109) underwent staged combined minimally invasive surgical treatment and prevention of portal bleeding. Group 2 (n = 84) consisted of patients who received only endoscopic methods. Group 3 (n = 102) included patients who received only conservative therapy. Research results. The frequency of complications after endoscopic procedures didn’t depend on a history of bleeding and was the same in groups 1 and 2. The correlation between functional class and the development of complications after minimally invasive azygoportal disconnection (n = 65) was not statistically significant (p = 0.491). Inverse correlations were found between the initial sagittal size of the spleen and the baseline levels of thrombocytopenia and leukopenia in patients who received splenic blood flow reduction. After transjugular portosystemic shunting, regression of esophageal and gastric varices was noted in 81.58 % of cases (p < 0.0001). The most common combination was endoscopic band ligation of esophageal varices, azygoportal disconnection surgery, and splenic blood flow reduction (n = 21). The choice of the initial method depended on the presence or risk of bleeding. Group 3 had a much higher mortality (7 times higher) than group 2 (p < 0.0001). In group 1, the mortality rate is 3 times lower than in group 2 (p < 0.0001). Conclusion. The use of minimally invasive surgical correction of portal hypertension, following an individualized approach based on the predominant complication, allows for a reduction in mortality.

Antibiotic resistance is one of the most serious threats to global health in the modern world. In the context of all these events, the growing number of infectious diseases caused by polyresistant strains of microorganisms in neonatology departments is of particular concern. Escherichia coli and Klebsiella pneumoniae belong to the “ESKAPE” group of pathogens. This group is included in the priority list in the fight against their growing resistance, since “ESKAPE” pathogens are most often found as the causative agent of healthcare-associated infections and in neonatal intensive care units. Goal. Assessment of antibiotic resistance of E. coli and K. pneumoniae microorganisms in neonatal intensive care units in Volgograd. Materials and methods. The work was carried out in the clinic of “Family Medicine” in Volgograd. The material for the study was smears from the pharynx, feces, blood, urine of newborns from 4 days to 4 months. Identification of microorganisms and determination of the sensitivity of bacteria to antimicrobial drugs were performed using a bacteriological automatic analyzer. Results. As a result of the study, it was found that K. pneumoniae exhibits absolute resistance (100 %) to most common classes of antibiotics, including beta-lactams (for example, cephalosporins of the first generation, cefepime, ceftriaxone), aminoglycosides (gentamicin, amikacin), fluoroquinolones (ciprofloxacin, levofloxacin) and even some carbapenems (ertapenem). E. coli showed complete resistance (100 %) to a number of important groups of antibiotics, including second-generation cephalosporins (cefazolin, cefuroxime), aminoglycosides (gentamicin, amikacin), fluoroquinolones (ciprofloxacin, levofloxacin) and carbapenems (ertapenem). Conclusion. The vast majority of K. pneumoniae strains are absolutely resistant to a number of broad-spectrum antibiotics, including penicillins, cephalosporins, aminoglycosides, and fluoroquinones. Moreover, despite the relatively lower excretion of E. coli, this microorganism is also characterized by a high level of resistance to key antibiotics.

The relevance of the study is determined by the lack of inexpensive and realistic models of newborn heads in the Russian Federation for testing non-invasive respiratory support equipment and training medical personnel. Most of the manikins available on the market either have insufficient anatomical accuracy and the impossibility of taking measurements, or are extremely expensive. Objective. development and testing of a neonatal head manikin with anatomically accurate upper airway for respiratory equipment testing and medical personnel training. Materials and methods. The study is based on the use of anonymized data from computed tomography of newborns without pathologies, obtained at the State Budgetary Healthcare Institution of the Sverdlovsk Region, the Yekaterinburg Clinical Perinatal Center. Based on the data, a 3D model of the head with realistic airways was created, reproducing the anatomical features. The materials included PLA plastic and two-component silicone. The tests were conducted using the CPAP Infant Flow device and high-precision measuring devices. The study period included the development, production and testing of the model over a period of 12 months. Results. The developed head model demonstrated high accuracy in reproducing airway pressure. Ultra-soft silicone allowed identifying areas of increased pressure on the skin, making the model useful for training personnel. The practical significance consisted in testing and adjusting respiratory equipment, as well as training medical personnel in conditions close to clinical ones. Conclusion. The developed manikin of the newborn head has proven its effectiveness as a tool for testing equipment and training personnel. However, further assessment of the model's durability and its adaptation for work with different types of respiratory systems is required, as well as further implementation of additional electronic measuring modules to expand the functionality.

The results of a survey conducted among first- and second-year medical students of the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” regarding their preferred methods for studying the discipline “Human Anatomy” demonstrated that the majority favor educational video materials. The aim of this study was to review and analyze available educational video resources in human morphology. Materials and Methods: the study utilized video content developed by the Department of Human Anatomy entitled “Anatomy in Digital”, created using 3D anatomical computer models. As part of the study, nine educational videos were produced, each dedicated to the description of individual bones of the neurocranium and facial skeleton. The videos incorporated dynamic visual elements (animated markers highlighting anatomical structures and their labels, accompanied by synchronized narration). Results: the findings indicate that over the four years since the creation of the “Anatomy in Digital” content, the channel has gained popularity among students, medical residents, and practicing physicians, as evidenced by view statistics, user engagement, and feedback on the published videos. Conclusion. The study confirms the importance of further development of educational video content across all sections of the “Human Anatomy” discipline and its integration into the educational process.

Early diagnosis of gallstones in children presents certain challenges for pediatricians. The purpose of the study. Identification of the clinical features of gallstone disease in children of different ages. Materials and methods. The study involved 71 children diagnosed with gallstone disease conditions between the ages of 0 and 18. The participants were divided into three groups based on their clinical presentation: 38 had an asymptomatic form, 20 had dyspeptic symptoms, and 13 had pain. All participants underwent a series of lab and imaging tests. Tre results of the study. A reliable relationship was found between sex and age and the clinical presentation of gallstone disease. Dyspeptic symptoms were found in both sexes in younger children and were often accompanied by pancreatic abnormalities and Helicobacter pylori infection. Painful symptoms were more common in adolescent girls and were characterized by significant changes in the esophagus, including erosive esophagitis. The asymptomatic form of gallstone disease is common in male adolescents and is associated with irregularities in the shape of the gallbladder. Conclusion. The findings emphasize the significance of considering gender and age when assessing the clinical course of gallstone disease in children, and they confirm the necessity for personalized monitoring and diagnosis.

To date, the value of general blood test parameters has been studied in patients with cancer and COVID-19, somatic pathologies (arterial hypertension, diabetes mellitus) and COVID-19. However, there are gaps in knowledge regarding the value of general blood test parameters in cardiac surgery patients and COVID-19. The aim. To study the significance of general blood test parameters in patients undergoing surgery for coronary heart disease associated with COVID-19. Materials and methods. Two groups of patients were formed, which were clinically, instrumentally and laboratory-comparable at the preoperative stage: Group 1 – patients with coronary heart disease and COVID-19; Group 2 – patients with coronary heart disease without COVID-19. A study of general blood test parameters was performed in all patients using the “Sysmex 2000 XN” hematological analyzer. The results. In patients with coronary heart disease and COVID-19, we did not detect any changes in the complete general blood test characteristic of COVID-19: decreased red blood cells, hemoglobin, platelet and lymphocyte counts; increased white blood cells and neutrophils counts. At the same time, we found an increase in erythrocyte anisocytosis indices and large platelet values before the onset of clinical signs of COVID-19 associated pneumonia. Conclusion. Erythrocyte anisocytosis indices and the number of large platelets can be used as additional criteria for COVID-19 in patients undergoing surgery for coronary heart disease.

Recent studies have shown the important role of combined use of antiarrhythmic agents with non-hormonal therapy in women with paroxysms of atrial fibrillation with vasomotor symptoms after surgical menopause. The purpose of the article is to study humoral and vasomotor disorders in women with paroxysms of atrial fibrillation after surgical menopause and to evaluate the effectiveness of antiarrhythmic and non-hormonal therapy. Materials and methods. The study included 38 healthy women aged 32 to 53 years (Group 1) and 46 women with paroxysms of atrial fibrillation aged 36 to 56 years with severe vasomotor symptoms after surgical menopause (Group 2). The research methods included daily electrocardiogram monitoring, assessment of the concentration of female sex hormones, assessment of the severity of vasomotor symptoms using the Greene scale. Results. It was found that the frequency of atrial fibrillation paroxysms depends on the frequency of hot flashes (β = –0,3387, p = 0,00009), their duration (β = 0,2894, p = 0,00007) and the percentage of severe hot flashes (β = 1,0301, p < 0,001). The duration of atrial fibrillation paroxysms is affected by the duration of hot flashes (β = 0,20347, p=0,0019) and the percentage of severe hot flashes (β = 0,70824, p < 0,001). It was found that the ventricular rate during atrial fibrillation paroxysms depends on the frequency of hot flashes (β = 0,43395, p < 0,001) and the duration of hot flashes (β = 0,65372, p<0,001). Based on the results of ROC-analysis, threshold values for the frequency of hot flashes and the percentage of severe hot flashes are established that cause an increase in the number and duration of atrial fibrillation paroxysms in women with vasomotor symptoms after surgical menopause. Conclusion. A relationship was found between atrial fibrillation in women after surgical menopause and sex hormones and vasomotor symptoms. A high efficiency of a combination of metoprolol with propafenone in combination with non-hormonal therapy is established.

The aim of the study was to evaluate the optimal diagnosis and treatment of gynecological pathology in women with latent forms of infection of the intestinal microflora of the pelvic organs using gynecological massage and peloidotherapy. Materials and methods: an open experimental prospective uncontrolled longitudinal (multiple) interventional study of 80 patients aged 24 to 39 years with nosological forms was conducted: chronic endometritis, undeveloped pregnancy, unsuccessful attempts at in vitro fertilization. The complaints of patients, physical examination data, indicators of the microflora of the genital tract, the lower parts of the large intestine, and the hemodynamics of the uterine vessels before and after treatment were analyzed. After performing 3 procedures of gynecological massage, before applying the peloid, the material of the genital tract was taken for bacteriological examination, sensitivity to antibacterial drugs. The species and quantitative composition of the microflora of the lower parts of the large intestine and the secreted genital tract are compared. Results. Subfebrility was recorded, imperceptible by patients in 9.0 %, impaired intestinal evacuation function in 89.0 %, episodes of dysuria in 79.0 %, facial pustulosis in 56.0 %. A change in the position of the uterus was detected in 89.0 %, the heaviness of the appendage area in 71.0%. A decrease in Bifidobacter was recorded in 62.5%, Lactobacillus in 82.5 %, Escherichia coli in 66.3 %, Enterococcus faecalis in 40.0%. A statistical relationship was established between a reduced amount of E. coli and E. faecalis in the lower colon and an increase in their number in the genital discharge (p = 0.003 and p < 0.001, respectively). 1 month after the end of treatment, body temperature significantly returned to normal (p < 0.001), according to ultrasound examination, the position of the uterus corresponds to the correct one in 95.0%, appendages of normal structure in 93.0 %; arterial perfusion index improved from 1.550 [1.175; 2,150] to 1.750 [1.500; 2.500] (p < 0.001). Conclusion. Intestinal microflora, which persists in the reproductive organs of the small pelvis at the stage of metabolic rest, complicates microbiological diagnosis and treatment. Gynecological massage and vaginal peloidotherapy increases the detection of the pathogen and the effectiveness of therapy.

Cystic fibrosis is caused by mutations in the cystic fibrosis transmembrane regulator gene and is accompanied by chronic damage to the respiratory and gastrointestinal systems. Triple therapy with elexacaftor, tezacaftor, and ivacaftor significantly improves lung function and nutritional status. However, the high cost of the original drugs limits long-term use, making the use of bioequivalent generics such as Trilexa® relevant. Objective: To evaluate the efficacy and safety of switching from the original triple therapy (Tricafta®) to the generic drug Trilexa® in children with cystic fibrosis in a real-world clinical setting. Materials and methods: Data from 28 children aged 6–18 years (14 boys, 14 girls; median age 13.0 years (11.8–15.0)) with confirmed cystic fibrosis, treated with Trikafta® for 2–36 months and transferred to Trilexa® with a subsequent 180-day observation were analyzed. Body mass index, forced expiratory volume in the first second, forced vital capacity (% of predicted), and sweat chloride concentration were assessed; statistical processing was performed using the Wilcoxon test (p < 0.05). Results: the median body mass index increased from 17.6 to 17.7 kg/m² (p = 0.077), with 75.0 % of patients showing an improvement or stabilization of the indicator. Forced expiratory volume in the first second increased from 93.5 to 95.0 % of the predicted value (p = 0.220), forced vital capacity – from 95.5 to 99.5 % (p = 0.025), the proportion of children with forced vital capacity ≥ 100 % increased from 50.0 to 64.3 %. Sweat chloride concentration remained stable (47.5 and 50.5 mmol/L; p = 0.875); no serious adverse reactions were recorded, all patients continued therapy at the full dose. Conclusion: the switch from Trikafta® to Trilexa® in children with cystic fibrosis does not lead to the loss of the achieved clinical effects, is accompanied by the preservation of nutritional status, stability of external respiratory function and sweat test parameters, and is characterized by a favorable safety profile.

The article discusses the results of the use of robotic interventions in complicated diverticular disease. Aim. To evaluate the possibility of using robotic surgery in elective sigmoid resection for patients with chronic inflammatory complications of colon diverticular disease. Materials and methods. From January 2019 to December 2024, 82 elective minimally invasive interventions for colon diverticular disease were performed. 58 patients underwent laparoscopic resection of the affected area and 24 robotic resections. Results. The use of the da Vinci Si robotic system for elective surgical interventions in patients with complicated diverticular disease was comparable to the laparoscopic method in terms of operative time, conversion rate, intraoperative blood loss, postoperative complication rate, and postoperative hospital stay. Conclusion. Robotic surgery can be considered as a variant of the videoendoscopic method and can be used for elective treatment for patients with complicated diverticular disease.

Modern research demonstrates that the immunopathogenesis of leprosy is not limited to the classical Th1/Th2 dichotomy, but involves a much broader spectrum of cellular and molecular interactions. Aim. To systematize current concepts of the complex immunopathogenetic mechanisms of leprosy that extend beyond the classical Th1/Th2 dichotomy and to consider potential immunotherapeutic strategies. Materials and methods. An analysis of contemporary Russian and international scientific publications on the immunology of leprosy was conducted using PubMed, Scopus, and eLibrary databases. Results. The immune response in leprosy is a dynamic network where the balance between effector lymphocyte populations (Th1, Th17) and regulatory cells (Treg, M2 macrophages), as well as the functional state of dendritic cells and innate lymphoid cells, plays a critical role. Mycobacterium leprae possesses a wide array of immune evasion mechanisms, including suppression of antigen presentation, induction of an immunosuppressive microenvironment, and metabolic reprogramming of host cells. Leprosy reactions (type 1 and type 2) result from an acute disruption of this balance and are characterized by cytokine dysregulation. Conclusion. Understanding the expanded immunoregulatory network in leprosy opens prospects for developing adjunctive therapies, such as targeted cytokine therapy, Treg-directed immunomodulation, and interventions that correct macrophage metabolism. These approaches aim to modulate the immune response, which is particularly relevant for the treatment of severe and reactive forms of the disease.

Toxic epidermal necrolysis (Lyell's syndrome) is a life-threatening toxic-allergic reaction with a high mortality rate. The relevance of the problem is due to the risk of developing this reaction to frequently prescribed antibacterial drugs in outpatient practice (in particular, inhibitor-protected penicillins), the complexity of diagnosis, as well as the lack of clinical guidelines approved by the Ministry of Health of the Russian Federation. The purpose of this study was to present a clinical case of toxic epidermal necrolysis associated with the use of amoxicillin+clavulanic acid and to draw attention to the issues of diagnosis and safety of antimicrobial therapy for community-acquired infections at the outpatient stage. Materials and methods. A 76-year-old patient with a history of hypertension, diabetes mellitus, and rectal cancer was prospectively observed for toxic epidermal necrolysis caused by amoxicillin+clavulanic acid, and his primary medical records. Research results. On the third day of taking amoxicillin+clavulanic acid for acute right-sided maxillary sinusitis, the patient developed toxic epidermal necrolysis with a high risk of mortality (≥ 90 % according to the SCORTEN scale). After discontinuation of the medication, hospitalization in a specialized department, and pathogenetic and symptomatic pharmacotherapy for the main and concomitant diseases, the patient showed a stable positive trend and complete regression of the skin lesions by the time of discharge from the hospital. Conclusions. The presented case confirms the need for a thorough collection of a pharmacological history and consultation with a clinical pharmacologist when patients present with any skin lesions associated with the use of medications. The approval of clinical guidelines for toxic epidermal necrolysis is a necessary measure for developing modern treatment and diagnostic strategies for managing patients with this adverse reaction, as well as for updating medical and economic standards for providing healthcare.