The objective of the study was to review the current measures of psychological support in the formation of adherence to the treatment in patients with tuberculosis. When writing the article, a descriptive method was used. The relevance of the study was due to the increasing number of patients with multiple and broad drug resistance, as well as the low level of adherence to the treatment of a large number of patients.

Methods and materials. The article discussed measures of psychological support and psychological follow-up for patients diagnosed with tuberculosis in the territory of the Russian Federation and in the CIS countries. The main attention was paid to the identification of common and specific elements in the structure of adherence to the treatment, such as the personal characteristics of the patient, features of the emotional-volitional sphere, and attentive-mnestic abilities. Examples of measures taken to increase the level of adherence to the treatment of in patients with tuberculosis were given. The possibility of using information about the internal picture of the patient’s illness to correct the level of adherence to the treatment was considered.

Conclusions. To date, methods of psychological support in the formation and psychological correction of the level of adherence to the treatment are not given sufficient attention, and the psychological characteristics of a patient are not taken into account when determining the level of adherence to the treatment. The internal picture of the patient’s disease is not considered as a substrate of adherence to the treatment, information about the relationship between the internal picture of the disease and adherence to the treatment is not enough to form a unified, generalized approach to the realization of diagnostic and corrective measures aimed at increasing the level of adherence to the treatment.

Introduction. Lipid metabolism disorders, caused by both excessive physical and psycho-emotional stress, and physical hypoxia, are important problems in the prevention and treatment of a number of diseases.

The objective was to study the effect of 1,2,4-trioxolanes and betulin in fish oil on lipid and energy metabolism in an experiment on rats under hypoxia and immobilization stress (IS).

Methods and materials. The studies were carried out using 75 male Wistar rats (intact and experimental animals) on a model of hypoxia and immobilization stress for 10 days. The treatment was carried out with the composition of betulin (0.1 %), 1,2,4-trioxolanes (10 %) in fish oil.

Results. Under stress, regardless the type of stress, in groups without treatment, there was a significant disturbance in lipid metabolism, which was reflected in the following indicators: total cholesterol increases by 5–8 %, TG increase by 5 times, HDL increase by 10 %, VLDL and LDL increase by ~ 6 times. It was revealed that the composition of fish oil, botulin and 1,2,4-trioxolanes, previously obtained by ozonation of lipids, had a normalizing effect on the indexes of lipid and energy metabolism under hypoxia and IS in rats.

Conclusions. 1,2,4-trioxolanes with betulin in fish oil may be useful for population groups with physical inactivity (students, office workers, elderly people, disabled people), as well as for athletes with excessive physical activity.

Introduction. Phosphodiesterases (PDEs) are a group of enzymes that hydrolyze the phosphodiester bond in cyclic nucleotides. PDE10A is mainly present in the medium-sized spiny neurons of the striatum. Functionally, PDE10A inhibition imitates the effect of D1-like agonists and D2-like dopamine receptor antagonists, and simultaneously modulating “direct” and “indirect” striato-thalamo-cortical brain pathway. To date, the effects of PDE10A inhibition have been characterized mainly, reproducing the inhibitory motor activity of D2-like dopamine receptor antagonists.

The objective was to evaluate the stimulating motor activity of the effect of PDE10A inhibitors, as well as the possible development of tolerance to these effects when they are re-administered.

Methods and materials. The hypodopaminergic state in male Wistar stock rats was modeled by administration of the VMAT2 inhibitor tetrabenazine (3 mg/kg). The effects of selective inhibitors PDE10A, MP-10 (0.3–5 mg/kg) and RO5545965 (0.1–0.9 mg/kg), on the motor activity of rats were evaluated with single and repeated administration (5 and 10 days).

Results. Switching off PDE10A dose-dependently stimulated the motor activity of rats after administration of tetrabenazine. However, repeated administration of PDE10A inhibitors was accompanied by the development of tolerance to their paradoxical stimulating effect.

Conclusion. The development of tolerance may limit the potential clinical use of PDE10A inhibitors to correct hypodopaminergic symptoms in patients with Parkinson’s disease. It is necessary to study the molecular mechanism of this phenomenon.

Introduction. Non-alcoholic fatty liver disease in most cases is closely associated with diseases such as obesity and type 2 diabetes mellitus, however, this dependence is not observed in a number of patients. In this case, hereditary factors, such as the p.I148M polymorphism of the PNPLA3 gene, play the greatest role in the prognosis of the course of the disease.

The objective of the study was to evaluate the effect of the p.I148M polymorphism of the PNPLA3 gene on the course of NAFLD in subgroups of patients with and without concomitant metabolic pathology.

Methods and materials. The study group included 212 patients with NAFLD who underwent p.I148M genotyping of the PNPLA3 gene. The severity of the disease was assessed in the general group (group P) and in subgroups of patients with the absence and presence of obesity (subgroups O– and O+, respectively) and type 2 diabetes mellitus (subgroups D– and D+). The severity of the disease was assessed by the severity of cytolytic syndrome (ALT level), hepatic steatosis and fibrosis (the value of CAP and liver stiffness according to transient elastometry) within clinical subgroups between carriers of different PNPLA3 genotypes.

Results. Higher ALT levels were found in homozygous carriers of p.I148M compared with the reference genotype (CC/GG) in the subgroups P, D–, D+ and O– (p=0.012; p=0.012; p=0.028 and 0.042, respectively), as well as when comparing the general group of carriers with reference genotype (CC/CG+GG) in subgroups P and D– (p=0.036 and p=0.015). More severe steatosis was found in homozygous carriers compared to the reference genotype (CC/GG) in group P (p=0.017) and subgroup O– (p=0.019). Higher values of liver stiffness were noted in the modified PNPLA3 genotype when comparing the reference (CC/CG) genotype with heterozygotes in group P (p=0.027) and subgroup D– (p=0.006) and when comparing the reference genotype with the general carrier group (CC/CG+GG) in subgroup D– (p=0.009).

Conclusions. The carriage of p.I148M of the PNPLA3 gene in patients without metabolic disorders (obesity, type 2 diabetes mellitus) is associated with the formation of cytolytic syndrome, steatosis and liver fibrosis.

The objective was to evaluate the safety and effectiveness of endoscopic methods for removing cystic formations of the esophagus and mediastinum.

Methods and materials. The study included 17 patients with esophageal and mediastinal cysts. All patients underwent gastroscopy, endoscopic ultrasonography and computed tomography at the diagnostic stage to determine the localization, sizes and topography of the formation.

Results. In all cases, the formations were successfully removed. Submucosal tunnel endoscopic resection (STER) was successfully performed in 14 patients, the average operation time was 126 minutes. In 3 patients, the formations were removed by endoscopic submucosal dissection (ESD), the average operation time was 55 minutes. Two patients in the postoperative period had esophageal diverticulum in the area of previously removed formations.

Conclusion. Submucosal tunnel endoscopic resection is safe and effective in the treatment of cystic formations of the esophagus and mediastinum. Long-term results of STER require further study.

Snoring is a sound phenomenon that is often a symptom of more serious condition – OSAS (obstructive sleep apnea syndrome). All patients with complaints of nocturnal snoring, daytime sleepiness, breathing stops in sleep, in addition to the standard otorhinolaryngological examination at the initial consultation should be diagnosed using validated questionnaires, scales to determine the presence of risk of OSAS, according to the results of which a decision is made to consult a -somnologist with further additional examination.

The objective of this work was to evaluate the clinical manifestations, concomitant pathology, and complications in patients at the initial visit to an otorhinolaryngologist complaining of the presence of the acoustic phenomenon of snoring.

Methods and materials. 304 patients with the diagnosis of rhonchopathy were examined. The inclusion criterion was the presence of the acoustic phenomenon of snoring. All patients underwent computed tomography of the maxillofacial region using contrast technique of the soft palate before radiation diagnosis with the followed morphometry.

Results. Analyzing the results of our sample, we come to a clear understanding that each case is very individual and needs a balanced interdisciplinary approach.

Conclusions. When choosing the treatment method for rhonchopathy, it is necessary to take into account the patient’s somatic status, BMI, the presence of chronic tonsillitis and other concomitant diseases to choose the volume and method of surgical treatment

Introduction. The pandemic of the new coronavirus infection COVID-19 has made significant changes in all spheres of modern human life. Understanding disability in patients post COVID-19 (CoronaVirus Disease - 19) allows to assess the need for physical rehabilitation.

The objective was to determine the relationship between post-COVID syndrome and the development of delayed disability in patients who have been exposed to the COVID-19 as part of the assessment of the need for rehabilitation.

Methods and materials. Using the method of standardized phone interview (14) three and twelve months post COVID-19, 855 patients were surveyed with an assessment of the level of rehabilitation needs at the time before COVID-19 (anamnestically), as well as three and twelve months after the disease, on the rehabilitation routing scale (RRS), mobility on the Rivermead scale and comparison of results with clinical data on the course of COVID-19.

Results. Delayed disability was revealed in patients post COVID-19. The necessity of active examination and rehabilitation measures in patients who do not need proper rehabilitation is shown (RRS – 1).

Conclusion. Post-COVID syndrome may be a predictor of the development of delayed disability in patients post COVID-19. The use of RRS in patients post COVID-19 is a reliable method necessary in the process of determining further routing after the disease.

Introduction. The relevance of the problem is determined – an increase in the number of patients who underwent splenectomy, in the absence of currently developed methodological (clinical) recommendations on admission to training and competitive events.

The objective was to develop criteria for admission to training and competitive events, to determine the frequency and volume of medical examinations for this category of persons.

Methods and materials. The analysis of the sources of domestic and foreign authors on the management of patients after splenectomy was carried out. We collected the detailed life history, disease history, sports history, information about family history for the development of diseases of the cardiovascular system, gastrointestinal tract, hematopoietic organs, analysis of the hospital discharge summary, data evaluation from laboratory and instrumental studies (particularly, ultrasound examination of the abdominal organs), ECG with exercise, exercise tests (Martinet-Kushelevsky) in two athletes who underwent splenectomy due to various reasons (blunt abdominal trauma, the spleen rupture in athlete A. N., 14 years old, microspherocytic hemolytic Minkowski-Choffard anemia complicated by sepsis in athlete N. V., 12 years old). The functional fitness indicators taking into account the sports training stage, the results of medical and pedagogical observations during the training process before and after surgery were assessed.

Results. In the clinical blood analysis of athlete A. N., there was a slight leukocytosis (leukocytes- 10.94∙10⁹/l), thrombocytosis (platelets – 669∙10⁹/l), no changes in erythron, erythrocytes- 5.46∙10¹²/l, hemoglobin – 136 g/l, hematocrit – 42.3 %, neutrophils – 4.53∙10⁹/l, lymphocytes – 5.33∙10⁹l. Leukocyte formula by microscopy was without significant pathological changes. The diagnosis was confirmed as: “Reactive thrombocytosis. Condition after splenectomy”. According to the results of IME, there were no absolute contraindications to training and competitive football activities. The athlete received a medical certificate of admission to training and competitive events. In the clinical blood analysis of athlete N.V., there was: erythrocytes – 5.44∙10¹²/l, hemoglobin – 163 g/l, hematocrit – 44.4 %, leukocytes – 12.2∙10⁹/l, neutrophils – 3.8∙10⁹/l, lymphocytes – 6.4∙10⁹/l, platelets – 515∙10⁹/l. He was taken to the regular medical check-up of a hematologist with the diagnosis: “Hereditary spherocytosis, hemolysis compensation. Condition after splenectomy”. Due to the absence of absolute contraindications for training and competitive football events, the athlete was issued the medical certificate on admission to training and competitive events.

Conclusion. A splenectomy history is not an absolute contraindication to sports. The management of an athlete after splenectomy requires an individual approach, taking into account age, sport and stage of sports training, the presence of chronic diseases and/or changes in physical, instrumental and laboratory studies.

Epileptic encephalopathy (EE) is a group of genetic monogenic diseases with leading feature of intractable epilepsy with onset at an early age and the development of neurocognitive deficit. Thanks to the development of molecular genetic diagnostic methods, more than 90 hereditary forms of EE have been identified, more of which have been discovered over the past decade. EE can be associated with impaired molecular function of neuron transporters (voltage-dependent and ligand-dependent transporters), metabolic disorders, and chromosomal diseases. Among monogenic EE, a group of diseases is distinguished, in which brain damage and the development of epilepsy are caused by hereditary disorders of mitochondrial functions. Given the wide variety of forms of mitochondrial dysfunctions, the absence of specific manifestations, different age of manifestation, the diagnosis of this group of diseases is not a routine process and requires DNA test (whole-exome/genome sequencing, gene panels). With the creation of new drugs that correct mitochondrial disorders, in-time diagnosis of mitochondrial dysfunctions, identification of a genetic disorder contributes to the in-time manage of pathogenetic treatment, the choice of an antiepileptic drug, which can reduce the risk of mortality and the degree of patient disability. We describe the case of early neonatal epilepsy in the structure of hereditary deficiency of coenzyme Q10. However, unfortunately, the late started specifical energotropic therapy and the severe course of the disease led to an early death. Hereditary defects in coenzyme Q are rare genetic disorders. In this regard, for the specialists leading the patient, the discovery of this particular defect was most likely an “unexpected” finding. Considering the complexity and duration of the whole exome study, the severity of the phenotype and the delay in energotropic therapy, the course of the disease in the child turned out to be extremely unfavorable. The presentation of the clinical case, in our opinion, will be important for practitioners who rarely encounter this type of pathology.