Introduction. Currently, a borderline skin condition between psoriasis and atopic dermatitis (AD) in children is under consideration, and its clinical essence and morphological criteria are being formulated.

Aim. To comprehensively evaluate the microscopic parameters and morphoimmunological characteristics of skin inflammatory infiltrates in children with the undetermined clinical picture (UCP) of dermatitis, in comparison with skin changes in typical psoriasis and AD in children and adults.

Materials and methods. A comparative morphological and immunohistochemical study of skin biopsy specimens from children and adults with psoriasis and AD was conducted. The expression of IL-4 and TNF-α was assessed, and the Ki-67 proliferative activity index in the epithelium was determined. The data obtained were compared with the results of the study of biopsy specimens of inflammatory skin lesions from children with the UCP dermatitis, as well as with biopsy specimens of healthy children’s skin.

Results. The morphology of skin lesions in children with the UCP dermatitis shares more common features with those of psoriasis. Immunohistochemically, the highest absolute values of IL-4 and TNF-α cytokine expression by cells of the inflammatory infiltrate were observed in skin lesions of adults, both in psoriasis and in AD. In children, the absolute values of these cytokines’ expression show less variability, but are higher in psoriasis than in AD. The level of cytokine expression in the skin lesions from children with the UCP dermatitis was closest to that observed in skin lesions from children with AD. The Ki-67 proliferative activity index in the epithelium of skin lesions in classical forms of the disease showed maximum values in psoriasis and minimum values in AD, in both children and adults, whereas in the group of children with the UCP dermatitis, the values of the Ki-67 index were close to those in normal epidermis.

Conclusion. In children with the UCP dermatitis requiring differential diagnosis between psoriasis and AD, not only microscopically skin changes diff er from the typical picture of psoriasis and AD, but there also features of microscopic skin changes, which, in combination with the distinctive expression of IL-4 and TNF-α by cells of the infiltrate, indicate particular immunoreactivity in these patients that underlies the differences in the clinical features and requires further study. 

In recent decades, medical rehabilitation has increasingly focused on neurocentered approaches aimed at motor and cognitive recovery through the activation of neuroplasticity mechanisms. In this context, neuromotor exercises, which combine complex motor activity with high cognitive and sensorimotor involvement, are particularly important. The traditional Chinese mind-body movement practices such as Tai Chi and Qigong are increasingly regarded as promising forms of this type of exercises. This article presents an overview of current concepts regarding the neurophysiological mechanisms of neuromotor exercises and the characteristics of Eastern movement practices. Tai Chi and Qigong are characterized by precise motor control, conscious regulation of movement and breathing, and pronounced cognitive-motor integration. Based on N.A. Bernstein’s movement theory, a conceptual model of step-by-step neuromotor activation is proposed, reflecting the process of multilevel formation and recovery of voluntary movement. An algorithm for adaptation of Chinese mind-body practice-based exercises is suggested, providing a structured and individualized approach to their application, taking into account the functional status of the Tai Chi practitioner. The presented methodological principles highlight the potential of integration the approaches into modern medical rehabilitation programs and provide the basis for further clinical and applied research.

Introduction. Ischemic stroke (IS) in young adults, or premature stroke, is becoming increasingly significant due to its rising incidence and the high proportion of patients with unspecified etiology (UE). Obesity, a currently widespread pathology and a key risk factor for cardiovascular diseases, may exacerbate the course of IS

Aim. The assessment of neurological deficit, severity, and the degree of disability in the hyperacute and acute phases of IS of UE, i.e. cryptogenic stroke, in young patients based on the presence or absence of obesity.

Materials and methods. The prospective study included two groups of patients with cryptogenic IS, aged 18–50 years: the main group of 34 patients with obesity (body mass index (BMI) >30,0 kg/m2 ) and the comparison group of 32 patients without obesity (BMI 18,5–24,9 kg/m2 ). Clinical, anthropometric, and demographic parameters were assessed. Functional status was evaluated using the modified Rankin Scale (mRS), and neurological deficit – using the National Institutes of Health Stroke Scale (NIHSS).

Results. The analysis of neurological symptoms in the hyperacute phase of stroke revealed no statistically significant differences between the groups, except for seizure syndrome at the onset, which was observed only in obese patients (11,76%, p = 0,045). The severity of the disease (assessed by the NIHSS) was significantly higher in the obesity group both at admission (7,26 ± 1,62 vs. 5,68 ± 3,89; p = 0,04) and on day 21 ± 5 (2,71 ± 2,1 vs. 1,81 ± 1,35; p = 0,043). However, the early functional outcomes (assessed by the mRS) by day 21 ± 5 showed no significant differences between the groups (1,91 ± 1,4 vs. 1,47 ± 1,2; p = 0,2).

Conclusion. Stroke in young obese patients is characterized by a more severe course, likely due to the influence of dysfunctional adipose tissue, which contributes to development of systemic inflammation and metabolic disorders.

Introduction. Non-communicable diseases, the leading cause of death worldwide, are particularly prevalent in Tajikistan. Cardiovascular diseases are one of the most pressing medical and social issues of our time, due to their significant and growing prevalence, as well as their progressive “rejuvenation”.

Aim . To study the adherence among patients with arterial hypertension (AH) and coronary artery disease (CAD) to pharmacotherapy in the Republic of Tajikistan (RT) and to assess their perceptions of the role of physicians and pharmacists in drug prescription and maintenance of treatment, considering socio-demographic factors, to justify the implementation of adapted pharmaceutical care programs for patients with chronic cardiovascular diseases.

Materials and methods . A cross-sectional descriptive-analytical study was conducted by surveying 1087 residents of the Republic of Tajikistan diagnosed with AH and/or CAD receiving pharmacological treatment. The inventory included questions about the healthcare professional’s priority in prescribing medications, the regularity of medication intake, adherence to multiple drug therapy, and the respondents’ socio-demographic characteristics. Statistical analysis of the results was performed using descriptive and inferential statistics.

Results. The majority of respondents (82,6%) believe that medications should be prescribed only by physicians, 9,7% – pharmacists, 3,6% – self-prescribed or based on the recommendation, 4,1% found it difficult to answer. Perceptions of the healthcare professional who prescribes therapy and the level of medication adherence significantly depend on gender, age, education, income and occupational status (p < 0,001 for all factors). Men, compared to women, take all the drugs prescribed more regularly (52,4% and 37,2%, respectively). The compliance rate increases with age (73,1% of respondents in the group over 61 years old), education level (67,5% among those with an academic degree) and income level. In the case of polypharmacy, only 38,4% of respondents strictly follow doctor’s recommendations; 47,4% try to comply with all prescriptions, but this is not always possible; 6,8% more often purchase only one drug to lower blood pressure. Poor treatment adherence is observed among retirees, low-income and middle-aged individuals.

Conclusion. Nowadays, it seems appropriate to introduce collaborative/supplementary prescribing models (a pharmacist provides assistance, adaptation and monitoring of therapy in accordance with the doctor’s prescriptions), adapted to the national context of the RT, which can help increase adherence to the pharmacotherapy in patients with AH and CAD, improve clinical outcomes and optimize the use of resources of the RT healthcare system. 

Introduction. Implementing import substitution policies for vital antiepileptic drugs (AEDs) requires a cautious approach due to the potential risks of changes in therapeutic effects and safety profiles. There is a lack of structured data on the professional opinions of doctors who directly select therapies.

Aim. Comparative analysis of neurologists’ assessment of the effectiveness and safety of brand-name and generic AEDs for the formation of evidence-based approaches to import substitution in clinical practice.

Materials and methods . A study was conducted using the method of expert assessment. Fifty-eight neurologists, selected according to their level of competence (coefficient of competence >0,7), anonymously evaluated using a 5-point scale the effectiveness and safety of 51 trade names of AEDs, grouped by generic names. Average-weighted scores considering the competence of the experts, the coefficient of variation (v) to evaluate the consistency of opinions, and Kendall’s coeffi cient of concordance (W) were calculated.

Results. The experts demonstrated high consistency of opinions (W = 0,9 for effectiveness, W = 0,7 for safety). An integrated analysis, including the calculation of an weighted average score for the effectiveness and safety of AEDs, revealed the experts’ preference for foreign medicinal products (MP). The largest gap in integral estimates was recorded for generic lamotrigine: domestic Lamictal (7,56 points) and foreign Sazar (8,70 points) (diff erence in integral indices ∆S = –1,14). The smallest gap was shown by domestic Convalis (gabapentin) and Levetinol (levetiracetam) and foreign Neurontin (gabapentin) and Keppra (levetiracetam) with ∆S = –0,11 in both cases. The smallest range of opinions was noted in the assessment of the effectiveness and safety of domestic MP under the trade names Mirodep and Levetinol.

Conclusion. The results of the experts’ assessment allow for the segmentation of AEDs by substitutability in clinical practice. Domestic MP are inferior to foreign ones in terms of effectiveness and safety, but domestic MP with the greatest import substitution potential were identified. The data obtained provide a basis to develop targeted strategies aimed at optimization of the treatment process and formulary policy, considering both bioequivalence and clinical practice.

Introduction. Surgical treatment of pelvic organ prolapse (POP) is traditionally assessed according to anatomical criteria. However, functional outcomes such as sexual dysfunction and pain significantly reduce the quality of life of patients.

Aim . To analyze the quality of sexual life and the prevalence of dyspareunia before and after laparoscopic lateral mesh suspension in reproductive-age patients with apical prolapse of stage 2–3 according to the Pelvic Organ Prolapse Quantification system (POP-Q).

Materials and methods . A cross-sectional study was conducted, involving 50 reproductive-age women with stage 2–3 POP-Q apical prolapse, who underwent laparoscopic mesh suspension according to Dubuisson. Sexual function and the risk of dyspareunia were assessed using the validated PISQ-12, FSFI, and VAS questionnaires. Routine follow-up examinations and POP-Q assessments were performed at 2, 6, and 12 months after surgery. Repeated questionnaire survey to assess changes in sexual function has been carried out at the second and third postoperative visits.

Results. The mean age of the patients was 43,6 ± 2,9 years. The mean PISQ-12 score before surgery was 22 ± 3,6 and FSFI score was 33 ± 4,2; one year after surgery, it was 33 ± 1,4 and 52,2 ± 3,9, respectively. Preoperatively, 14% (n = 7) of women suffered from dyspareunia (VAS score 4 to 5). Postoperatively, 6% (n = 3) of patients experienced de novo dyspareunia. The mean number of monthly sexual intercourses increased from 2 to 7. No cases of apical prolapse recurrence were noted during the follow-up.

Conclusion. Assessment of the quality of sexual life is an important domain of the whole evaluation of the effectiveness of POP treatment. Improved sexual function is associated with the absence of pain, a reduction in the severity of prolapse symptoms, and a slower progression of the pathology, which explains the importance of discussing this issue during preoperative counseling. Certainly, the issue of sexual function and quality of sexual life in POP patients requires a multidisciplinary approach to optimize patient care. 

Introduction . In the context of an increased incidence of knee osteoarthritis, the identification of factors, contributing to the development of this pathology is of particular importance. Meniscal injury, including the injury of their roots, predisposes to the progression of osteoarthritis. In this regard, it is especially important to identify these factors.

Aim . To identify morphological features of the structural elements of the lower limb in the injury of the medial meniscus posterior root.

Materials and methods. The study included 100 patients (mean age: 50,5 years), who were divided into two groups: group A – 50 patients with confirmed signs of meniscal root injury according to the data of magnetic resonance imaging (MRI); group B – 50 patients without significant damage to the cartilage, menisci, or ligaments of the knee joint. Morphometric parameters of the knee joint were evaluated and analyzed based on the MRI data (width and index of the femoral intercondylar notch, posterior slope of the medial tibial condyle, concavity of the articular surface of the medial tibial condyle, curvature and slope of the articular surface of the femoral condyles, height of the tibial intercondylar tubercles).

Results . In patients of group A, a narrower femoral intercondylar notch and an increased posterior slope of the tibial medial condyle were identified (p ≤ 0,05), as well as a tendency toward flattening and enlargement of femoral and tibial condyles compared to the same parameters in group B. When comparing the height of the tibial intercondylar tubercles between the studied groups, no correlation was found. Osteophytes were identified in the intercondylar notch (in 90% of cases), first corresponded to the attachment area of the anterior meniscofemoral ligament of the lateral meniscus (mean height: 2,5 mm), and the second – to the attachment area of the posterior meniscofemoral ligament of the lateral meniscus (mean height: 2,7 mm).

Conclusion. The anatomical features identified (intercondylar notch narrowing, flattening of the articular surface of the tibial medial condyle, and an increased slope of its posterior edge), as well as the significant role of the ratio of the heights of the femoral and tibial medial condyles, are of considerable importance and may be used as an additional diagnostic criterion for detection of medial meniscus posterior root tear.

 Introduction. Human cytomegalovirus (CMV), which is characterized by lifelong latency following primary infection, can reactivate causing severe complications in immunocompromised patients and, in particular, in patients with chronic heart failure (CHF). Understanding how CMV affects the development of CHF is important for practical cardiology. An integrated approach to identifying and evaluating the role of CMV in cardiovascular pathology can significantly increase the effectiveness of treatment and improve outcomes for patients.

Aim . To study the characteristics of the course of CHF depending on CMV carrier status and assess its possible impact on clinical prognosis.

Materials and methods. The study included 151 patients hospitalized for decompensated CHF. The patients were divided into 2 groups: CMV-seronegative (CMV–) (n = 72) and CMV-seropositive (CMV+) (n = 79) subjects. The composite endpoint was defined as hospitalization for decompensated CHF and occurrence of adverse clinical events (cardiovascular death, non-fatal myocardial infarction, acute cerebrovascular accident, or pulmonary embolism) during a 24-month prospective follow-up coming after the hospital discharge. Cytomegalovirus DNA in the blood, as well as the level of proinfl ammatory cytokines (TNF-α and IL-1β) and NT-proBNP were determined.

Results. A high risk of death (relative risk (RR) = 8,57; 95% confidence interval (CI) = 1,98–37,1; p = 0,004) and achieving the composite endpoint (RR = 3,17; 95% CI = 1,78–5,64; p < 0,001) in CMV-seropositive patients during the 24-month follow-up were found. Levels of TNF-α, IL-1β, and NT-proBNP demonstrated a lower risk of death and achieving the composite endpoint in CMV-seropositive subjects compared to CMV-seronegative patients. Significantly higher levels of TNF-α and IL-1β (p < 0,05) were recorded in CMV-seropositive patients compared to CMV-seronegative patients. Conclusion. CMV carrier status is a risk factor for an unfavorable course of CHF: cardiovascular events, and fatal outcomes during 24 months after hospitalization for decompensated CHF are significantly more frequent in CMVseropositive patients compared to CMV-seronegative subjects. At the same time, seropositive patients have elevated levels of proinflammatory cytokines with underlying CHF decompensation, indicating a possible pathogenetic role of CMV infection in the development of inflammation that contributes to cardiac dysfunction progression. 

This review reflects the current state of the issue of morphofunctional changes in the adrenal glands in pneumonia. The risk of pneumonia, as well as its prognosis and outcome, largely depend on the effectiveness of adaptive processes in the human body. Therefore, it is important to consider the impact of endocrine status on the development and course of pneumonia. According to the literature, it is crucial to further study the specific features of the pneumonia progression, taking into account the morphofunctional state of the adrenal glands as one of the most important components of the neuroendocrine system. The use of modern methodological approaches based on the capabilities of modern scientific morphological studies using immunohistochemical and electron microscopic methods will make this possible. 

Early detection of tumors is a significant priority in modern medical practice. Advances in diagnostics and treatment of cancer patients have led to an increase in the proportion of younger patients and in life expectancy after treatment. In addition to other side effects, chemotherapy has a negative impact on the reproductive system, which is especially relevant for women of childbearing age. Furthermore, the recent trend toward later motherhood makes the issue of fertility relevant for a wider range of cancer patients. Understanding the risks helps health professionals choose the optimal treatment strategy for young oncohematologic female patients and increases the chances of their fertility preservation. Also, the study of mechanisms by which chemotherapy affects reproductive function allows for the development and implementation of methods that can reduce the gonadotoxic effect of anticancer therapy without compromising its effectiveness. 

Introduction. Undifferentiated connective tissue dysplasias include hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) (frequency ~1:500). Current treatment and diagnostics of these disorders are based on clinical aspects and do not reflect the pathogenetic features of these conditions. New insights into connective tissue disorganization open up new possibilities in search for drug target and diagnostic biomarkers.

Aim . To develop an updated model of the pathogenesis of HSD and hEDS to provide a rationale for the choiсe of potential drug targets and methods of laboratory diagnostics.

Material and methods . PubMed, Scopus, Google Scholar, and eLibrary were searched for peer-reviewed publications of 2012–2025.

Results. Transcriptomic studies revealed no significant differences between HSD and hEDS: expression of 826 genes (DNA repair, cytoskeleton) was downregulated, while expression of 126 genes (proteases, proinflammatory cytokines) was upregulated. The exception is MTHFR polymorphisms; however, different allele frequencies between HSD and hEDS have not been confirmed in cohort studies. In cell cultures, common basic mechanisms were identified, including predominance of myofibroblast differentiation via TGF-β and integrin-dependent pathways. Impaired synthetic activity of myofibroblasts leads to aberrant deposition of types I, III, and V collagen, an decrease in the number of cross-links, and intracellular accumulation of elastin. This causes extracellular matrix (ECM) degradation with formation of fragments of fibronectin (52 kDa) and type I collagen (45 kDa). ECM disruption results in fascial densification and dislocations. Based on these mechanisms, potential drug targets were identified: inhibitors of matrix metalloproteinases (MMPs) (doxycycline), folate cycle correction (5-methyltetrahydrofolate), and TGF-β signaling blockade (celiprolol).

Conclusion . No significant differences in genomic profiles or cellular metabolic activity between HSD and hEDS were found. These conditions represent a common process of connective tissue disorganization. The main pathogenetic mechanism is a vicious circle of myofibroblast activation, ECM disorganization, immune cell activation, and chronic inflammation, which further stimulates myofibroblasts. Pathogenetically justified therapeutic approaches include MMP inhibition, folate cycle correction, and TGF-β blockade. The corresponding molecules (doxycycline, 5-methyltetrahydrofolate, and celiprolol) require clinical validation.