Vol 27, No 2 (2026): Опубликован 29.06.2026

Objective. To evaluate the analgesic activity and gastotoxicity of four new alphacyanothioacetamide derivatives (AS-143, AS-144, f02-145, TD-0331) after chronic administration compared with reference NSAIDs (indomethacin, nimesulide, ibuprofen) and metamizole sodium. Materials and Methods. The study was performed on 90 outbred white male rats. Analgesic activity was assessed using the hot plate test (52 °C) by measuring the latency of the first behavioral reaction. Gastotoxicity was evaluated after 14-day administration by macroscopic examination of the gastric mucosa, ulceration index, and organometry. Results. All new compounds showed analgesic activity exceeding that of metamizole sodium. In animals receiving the alpha-cyanothioacetamide derivatives, no behavioral abnormalities or changes in appetite were observed. Macroscopic examination revealed no inflammation, edema, hyperemia, or erosive-ulcerative defects of the stomach; the ulceration index was zero, and organometric parameters did not differ from the intact control. In contrast, the indomethacin group demonstrated severe gastotoxicity: refusal of food, hypodynamia, 100% mortality on days 5–7, marked hyperemia, edema, multiple ulcers, and an increase in stomach size. Nimesulide and ibuprofen produced only isolated signs of toxicity (depressed activity, dull fur, hyperemia) with no fatalities. Conclusions. The new alpha-cyanothioacetamide derivatives, especially AS-144 and TD-0331, combine high analgesic potential with a favorable gastrointestinal safety profile, justifying further preclinical investigation.

The university learning process is associated with psychoemotional stress, especially during the exam period. The increase in anxiety among students, especially medical students, creates prerequisites for the uncontrolled use of certain medications. Propranolol, a non-selective beta-adrenoblocker that reduces the activation of the amygdala and relieves somatic manifestations of anxiety, often becomes the drug of choice among students to combat such conditions. Admission is carried out without a doctor's appointment, despite prescription medication and serious side effects. In the course of the work, data on the uncontrolled use of propranolol by medical university students abroad and in Russia were analyzed and systematized.

Introduction. Idiopathic nephrotic syndrome (INS) is the most common primary glomerular disease in children, characterized by variability in the course and response to steroid therapy. Early prediction of the clinical course (steroid-sensitive infrequently relapsing / frequently relapsing / steroiddependent / steroid-resistant variants) allows optimization therapy and reduction of complication rates. In recent years, artificial intelligence (AI) methods have been actively introduced into medicine, including nephrology. Their use helps to establish diagnostic and prognostic criteria for various diseases. Methods. A retrospective analysis of medical records and a prospective follow-up of children with INS hospitalized in the nephrology department and pediatric department №1 of the Voronezh Regional Children's Clinical Hospital №1 for the period 2018–2022 were conducted. The follow-up period was from12 months to 60 months. A total of 105 patients were included in the study; they were divided into 2 groups: group 1 (more favorable course) – steroid-sensitive infrequently relapsing NS (68 patients, 64.8%); group 2 (less favorable course - 37 patients, 35.2%) – including frequently relapsing SSNS (5 children), steroid-dependent NS (23 children), and steroid-resistant NS (9 children). Eleven clinical and laboratory features from the first hospitalization were choosen. A logistic regression model with L1regularization (LASSO) was trained using 5-fold stratified cross-validation. To optimize sensitivity or specificity, a classification threshold of 0.4 was chosen, defining the boundary for a more or less favorable course of INS. Results. Early prognostic markers of the INS course were identified. The more favorable variant (infrequently relapsing SSNS) was characterized by: presence of edema (coefficient +2.308; odds of a more favorable course increase 10 fold in the presence of edema); cholesterol level above 6.2 mmol/L (coefficient +1.388; an increase by one standard deviation (3.7 mmol/L) from the median increases the odds 4 fold); albumin level above 24.0 g/L (coefficient +0.773; an increase by 12.6 g/L from the median increases the odds 2.2 fold); ESR above 5.0 mm/h (coefficient +0.578; an increase by 19.5 mm/h from the median increases the odds 1.78 fold); BMI above 19.0 kg/m² (coefficient +0.411; an increase by 4.4 kg/m² from the median increases the odds 1.5 fold). For the less favorable course (frequently relapsing, steroid-dependent, steroid-resistant variant), the following were significant: proteinuria in a random urine sample above the median (1.5 g/L) (coefficient –2.235; an increase by 3.4 g/L from the median reduces the odds of a more favorable course 9 fold); thrombocytosis (platelet count above the median of 345×10⁹/L) (coefficient –1.673; an increase by 89×10⁹/L from the median reduces the odds of a more favorable course 5.3 fold); age at onset above the median (7.3 years) (coefficient –0.534; an increase by 4.8 years from the median reduces the odds 1.7 fold); male sex (coefficient –0.397; odds of a more favorable course are 1.5 fold lower than in females); presence of hematuria (coefficient –0.857; odds decrease 2.4 fold). The final model on cross validation showed: AUC ROC = 0.697 (95% CI 0.589– 0.801), accuracy 65.7% (69 out of 105), sensitivity for the more favorable course 67.6%, specificity for the less favorable course 62.2%, F1 measure = 0.719. Conclusion. The developed logistic regression model with L1 regularization (LASSO) based on 11 clinical and laboratory features of patients during the first hospitalization demonstrates satisfactory predictive ability (AUC ROC = 0.697) in determining the course of INS in children. After prospective external validation on larger cohorts, the model can be used for early risk stratification of patients: this will allow timely prescription of steroid sparing therapy for children with a less favorable course (frequently relapsing, steroid dependent, steroid resistant variants) and avoidance of excessive immunosuppression in patients with an obviously favorable (infrequently relapsing) variant. For implementation into clinical practice, it is advisable to create a convenient software tool (risk calculator) based on the presented coefficients.

Based on the study of megacystics, the possibility of early (during the first prenatal screening) detection of intrauterine malformations of the urinary system, including in combination with fetal chromosomal pathology, was analyzed. Megacystic is one of the few intrauterine malformations available for diagnosis already in the first trimester of pregnancy and is an anomaly of intrauterine development characterized by an increase in the diameter of the fetal bladder of more than 7-8 mm in the first trimester. The prevalence of megacystic is low, but the clinical significance is great, as it is often a symptom of combined malformations and chromosomal abnormalities of the fetus. Possible variants of the megacystic flow are considered. If a megacystic is detected at any stage of pregnancy, an in-depth study is indicated, including medical and genetic counseling and, if necessary, invasive methods of prenatal diagnosis. The practical part of the study is based on an analysis of the outcomes of 32 pregnancies detected in the Voronezh Region from 2020 to 2025, in which megacystic was detected at the First screening. The authors conclude that megacystis prevails in the structure of MVS as a symptom of complex combined fetal malformations, and in 25% of cases it was combined with chromosomal abnormalities, and therefore prenatal screening in combination with medical and genetic counseling is necessary in all cases of detection of an enlarged bladder to resolve the issue of prolongation of pregnancy.

The comorbidity of gastroesophageal reflux disease (GERD) and hypertensive disease (HD) is associated with oxidative stress (OS) through the activation of pro-inflammatory cytokines, the development of endothelial dysfunction, increased sympathetic tone, and impaired balance of nitric oxide (NO) synthesis. It is relevant to study markers of OS and antioxidant protection (AP). Depression and anxiety disorders exacerbate the course of somatic diseases, and OS plays a significant role in their pathogenesis. Objective. To determine the significance of OS and AP indicators (nitric oxide metabolites (NOM), diene conjugates (DC) and catalase) in patients with GERD in combination with HD, their relationship with the level of anxiety and depression. Materials and methods. 23 patients with GERD and HD (1st group), 22 — with GERD (2nd group) and 31 relatively healthy individuals were examined. NOM in the blood was estimated using the Griss reagent. The level of DC was determined using the method of V.B. Gavrilov and co-authors. Catalase activity was determined by the ability of hydrogen peroxide to form a colored complex with molybdenum salts. All methods included measurements using a Specord 200 spectrophotometer. The Spielberger-Khanin and Beck questionnaires were used to assess the quality of life. Results. NOM levels are significantly higher in the 1st group by 26% (p=0.000001), and in the 2nd group by 32% (p=0.000000) compared to the control. There are no significant differences between the 1st and 2nd groups (p=0.45). The variability of the indicator in the first group is average (CV=12.5%), in the first and control group it is low (CV=6.3% and 1.2%). The levels of DC in the 1st group are higher than in the control by 77% (p=0.000001), in the 2nd — by 65% (p=0.000086). There are no significant differences between the 1st and 2nd groups (p=1.0). The variability of DC indicators in the 1st and 2nd groups is very high (CV=37% and 35%), while it is average in the control group (CV=12%). Catalase activity was significantly lower in the 2nd group than in the 1st group by 43% (p=0.000001) and in the control group by 49% (p=0.022). No significant differences were found in the 1st group compared to the control group. The variability of the indicator was very high in the 1st group, high in the 2nd group, and medium in the control group (CV=55%, 28%, 6%). 11 people had normal catalase values, 8 had elevated values (mostly with very high levels of anxiety), and 4 had lowered values (mostly with depression) in the 1st group Discussion. In patients with GERD + HD and GERD, there was an increase in oxidative and nitrosative stress processes. The ambiguous values of catalase levels in patients with GERD and HD are a result of the wide range of DC. High levels of catalase are observed in anxiety disorders, while low levels are observed in depression.

The interaction between two microorganisms—Candida albicans and Helicobacter pylori—affects the effectiveness of eradication therapy, as well as the combination of treatments aimed at eliminating pathogens in the human body. In some cases, achieving complete elimination of the bacteria can be difficult due to the interaction with Candida. Outpatient clinicians encounter situations where standard eradication regimens fail to completely eliminate H. pylori. Patients coexist with both C. albicans and H. pylori, which can lead to a worsening of the condition and a lack of symptomatic remission. Furthermore, antibiotic resistance can develop.

Contemporary therapy for multiple myeloma is often associated with cardiovascular toxicity, a consequence of the disease's relapsing nature requiring increasingly aggressive, yet toxic, anti-tumor regimens with each subsequent line of treatment. While the advent of novel therapies has significantly improved patient outcomes in recent years, this positive trend does not preclude the occurrence of adverse events. Patients with pre-existing comorbidities and heightened susceptibility to toxic effects are at particular risk. However, clinical evidence demonstrates that this issue extends beyond comorbid patients; even relatively young individuals without significant concurrent pathology can develop various forms of chemotherapy-associated cardiovascular dysfunction. This clinical review presents a detailed analysis of a case involving hemodynamically significant hypotensive-type cardiovascular toxicity in a 52-year-old patient with multiple myeloma, which developed following high-dose chemotherapy supported by autologous stem cell transplantation. The presented case underscores the necessity for heightened clinical vigilance regarding this complication and justifies the importance of rigorous hemodynamic monitoring throughout the treatment course.

The problem of metabolic disorders during the menopausal period is currently quite acute, as this condition increases the risk of developing cardiovascular and oncological diseases among the female working-age population. According to a number of epidemiological studies, about two-thirds of women aged 40 to 59 years have a history of excess body weight, of which 50% have grade I or II obesity. Inositol, a cyclic polyol with six hydroxyl groups, functions as a secondary messenger for a number of hormones, in particular: TSH, LH, FSH, and insulin.

The aim of the study was to compare clinical, instrumental and laboratory parameters in surviving and deceased patients with COPD during 1 year of follow-up and identify risk factors for an unfavorable prognosis. Materials and methods. 100 patients with acute COPD were included (median age: 60.5 years). The statistical significance of differences in clinical and instrumental parameters was assessed, and a correlation analysis was performed. A predictive model of an unfavorable outcome is built on the basis of binary logistic regression. Results. An unfavorable outcome of the disease was noted in 10% of patients. The constructed regression model is statistically significant (p<0.01). Factors influencing a high risk of death within 1 year: melatonin level (OR=0.953; 95% CI: 0.950–0.999; p=0.1101), CAT test values (OR=0.349; 95% CI: 0.101–1.206; p=0.096), mMRC (OR=0.014; 95% CI: 0.0003–0.625; p=0.028), concentration of 8isoprostane (OR=0.983; 95% CI: 0.957–1.010; p=0.231), values of MOC25 (OR=1.211; 95% CI: 0.881– 1.664; p=0.237) and TCX (OR=0.012; 95% CI: 0.964–1.063; p=0.625). A significant negative dynamics of parameters in deceased patients and the relationship between the number of hospitalizations and clinical and instrumental parameters (p<0.001) were revealed. Conclusion. Determination of melatonin and 8-isoprostane concentrations in patients with COPD helps to clarify the prognosis of the disease, substantiates the need for personalized correction of therapy and reduce the risk of an adverse outcome.

Cough is a symptom that often causes patients to seek medical attention. Among the diseases, the main symptom of which is cough, chronic bronchitis (CB) leads. Currently, the generally accepted methods for assessing the etiology of cough are the collection of complaints, medical history and objective examination, and laboratory and instrumental studies. However, a large proportion of the information received about the patient is descriptive and subjective. The study aims to assess the possibility of using spectral analysis of cough sounds for rapid diagnosis of CB. Materials and methods. The main group consisted of patients suffering from mild non-obstructive catarrhal or mucopurulent CB in the acute stage (n = 64: 46.3% - men, 53.7% - women; age - 46.7 (45; 48) years). Comparison groups consisted of patients with moderate persistent asthma, uncontrolled, in the acute stage (n = 21), patients with COPD (chronic obstructive pulmonary disease), moderate exacerbation (n = 22), healthy individuals (n = 20), mild COVID-19 patients with less than 25% lung involvement by chest X-ray computed tomography, with no prior chronic respiratory tract disease (n = 20). The comparison groups were comparable in sex and age to the main group. Each subject recorded cough sounds. Using the fast Fourier transform algorithm, the frequencytime parameters of the sounds of the entire cough episode and for individual phases of the cough sound were estimated: duration (ms) (T, T1, T2, T3), the ratio of low and medium frequency energy (60-600 Hz) to high frequency energy (600-6000 Hz) (Q, Q1, Q2, Q3), the frequency of maximum energy sound (Hz) (Fmax, Fmax1, Fmax2, Fmax3). Study results. When comparing the cough sound of the main group and comparison groups, some features were revealed. The duration of coughing in CB is longer than in comparison groups. Duration of phase 2 cough is less than duration of phase 2 cough in patients with AD, COPD and induced cough of healthy individuals. Cough in patients with CB is dominated by lower frequencies compared to cough in AD and COVID-19, and compared to cough in COPD and induced cough in healthy individuals, highfrequency energy predominates. Analysis of the frequency of the maximum sound energy also revealed significant differences in this indicator of the main group and comparison groups. Based on the identified data, a model for the diagnosis of CB was developed in the form of a regression equation, when solving which the value of the integrated Y index was obtained. In patients with CB, the Y value ranged from 0.51 to one. Conclusion. The spectral characteristics of cough sounds are of differential diagnostic value, the method for assessing them is accurate, quantitative, and can significantly reduce the time for making a diagnosis of CB.

The frequent use of antibiotics for the new coronavirus infection was associated with the lack of effective treatment methods, similar symptoms to pneumonia, and coinfection with bacteria. Fluoroquinolones are a class of synthetic antimicrobial drugs that inhibit DNA synthesis by acting on the enzymes DNA gyrase and topoisomerase IV. Antibiotics of this group reduce the production of proinflammatory cytokines such as IL-1b, IL-6, IL-8 and TNF-α. PC has an immunomodulatory effect on Thelper cells. Some antibiotics in this group can inhibit the replication of the SARS-CoV-2 virus. The aim of the work was to study the immunomodulatory properties of antibiotics from the group of fluoroquinolines in patients with a new coronavirus infection of moderate severity. The study included 65 people hospitalized with a new moderate coronavirus infection. The first group consisted of 50 patients who did not receive antibiotics at the outpatient stage of treatment. The second group included 15 patients who received standard fluoroquinolone antibiotics (levofloxacin, ceftriaxone) on an outpatient basis. The study revealed the immunomodulatory activity of fluoroquinolines in the form of a decrease in the production of interleukin-6, a decrease in the number of monocytes and T-helper cells in peripheral blood.

Extrapulmonary forms of tuberculosis, in particular paranasal sinuses, larynx, eardrum, middle ear, are not a common pathology among all diseases of ENT organs. Taking into account the severity of this pathological process and the complexity of discordance associated with "masking" and blurred symptoms, the relevance of studying the problems is great. The paper presents the results of own clinical observations of ENT organ tuberculosis and summarizes recommendations on the need for increased alertness in the event of implicit signs of this disease, as well as on patient management tactics.