Adipose tissue has morphological heterogeneity. Currently, five types of fat cells are known: white, beige, brown, yellow and pink adipocytes. In the future, we will consider white, beige and brown adipocytes. The main pathological role in the development of obesity and a number of other metabolic diseases is played by white adipose tissue. The function of energy storage in white adipocytes is well known. However, in pathological conditions, the mass of white fat can increase significantly, amounting to more than 70% of the total body weight. In addition, white adipocytes are prone to inflammation and pathological production of biologically active substances - adipokines. Many adipokines negatively affect musculoskeletal and bone tissues, exacerbate systemic chronic inflammation and the severity of polymorbid pathology. At the same time, brown adipose tissue, due to its pronounced ability to heat production (thermogenesis), has protective properties. Activation of brown adipose tissue and stimulation of the transformation of white adipocytes into brown ones (the so-called “browning”) with the help of physical activity, medications and dietary supplements seems promising. These methods can be successfully used to combat overweight and obesity. In addition, modern advances in genetics and transplantology allow us to hope for the future use of brown adipocyte transplantation in patients who suffer from severe obesity. Research on the interrelationships of adipose tissue, muscles, cardiovascular, nervous, endocrine and other body systems continue. Undoubtedly, there are many interesting scientific discoveries to be made in medical science.

Objective: To study the condition of the upper gastrointestinal mucosa, frequency of gastrointestinal bleeding, risk factors according to the “REGATA” scale (2021), and assess the effectiveness of endoscopic hemostasis methods in patients with atherosclerosis. Materials and Methods: We studied 118 patients (main group - MG) with atherosclerosis of the visceral branches of the abdominal aorta and 120 patients (control group - CG) without atherosclerosis of these branches but with coronary artery atherosclerosis. Diagnosis of erosive changes in the upper GI tract and verification of the source of gastrointestinal bleeding were confirmed by endoscopic examination. The severity of ulcer bleeding was assessed using a modified Forrest classification. The “REGATA” scale was used to assess the risk of gastrointestinal bleeding. Results: The MG patients showed a high frequency of gastric erosions (75.4%) against a background of diffuse (48.3%) or focal (45.9%) atrophy of the gastric mucosa. Gastric ulcers were diagnosed in 27.1% and duodenal ulcers in 12.7% of OG patients. The high risk of gastrointestinal bleeding according to the “REGATA” scale was observed in 77.1% of MG patients, which was significantly higher than in CG (64.2%) (p<0.05). Ulcer bleeding was identified in 16.1% of MG patients and 4.2% of CG patients. Combined endoscopic hemostasis was performed in all cases of gastrointestinal bleeding. Recurrent bleeding occurred in two cases. Conclusion: Patients with coronary artery disease and atherosclerosis of visceral branches of the abdominal aorta who receive long-term antiplatelet therapy are at high risk of gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) is the main method for diagnosing erosive-ulcerative lesions and identifying the source of bleeding. Endoscopic hemostasis effectively stops bleeding in the majority of cases.

Currently, metabolic syndrome (MS) is interpreted as a symptom complex of disorders of carbohydrate and lipid metabolism and arterial hypertension. Impaired carbohydrate metabolism or insulin resistance with a decrease in the sensitivity of peripheral tissues to insulin provokes the accumulation of visceral fat, which in turn initiates systemic inflammation. Obesity is clearly associated with cardiovascular pathology with progression of risk and development of diabetes mellitus. Aim is to identify the relationship between traditional markers of inflammation and interleukins -8, -10 with the degree of obesity in patients with MS. Materials and methods: the study included 160 male patients with MS and hypertension. Depending on the degree of obesity, patients were divided into 5 groups: the number of subjects in group 1 (n=36), in group 2 (n=76), in group 3 (n=39), in group 4 (n=6) and in group 5 (n=3). All patients with hypertension of 1-3 degrees, with the target blood pressure level achieved. The age of the subjects was 31-65 years. All patients underwent: collection of complaints and medical history, assessment of body mass index (BMI); determination of lipid spectrum, blood glucose. Microalbuminuria and glomerular filtration rate were determined. Interleukins 8, 10 were determined using the ELISA method. Instrumental studies were performed: ABPM, echocardiography. Results: when assessing traditional risk factors, the following was revealed: a direct relationship between the degree of obesity and BMI (r=0.94; p=0.001), with TG levels (r=0.34; p=0.001), with blood glucose levels (r=0 .24; p=0.004), inverse with MAU (r= -0.92; p=0.003) and direct with SBP level (r=0.35; p=0.0007). Inflammation indicators CRP and ESR were correlated with IL-10 levels, which is associated with activation of anti-inflammatory activity (r=0.83; p=0.01; r=0.78; p=0.02, respectively). Heredity and smoking also determined their contribution to the initiation of inflammation - direct relationships were identified with CRP and fibrinogen levels (r=0.30; p=0.04; r=0.36; p=0.01). Correlation analysis of echocardiography data showed that correlations between LVMI and age were identified (r=0.494; p=0.0001); duration of hypertension (r=0.504; p=0.0001); with blood glucose level (r=0.242; p=0.047).

In recent decades, obesity has been a pressing medical and social problem for all countries, including the Russian Federation. Obesity is an independent risk factor for the development of many chronic diseases, including reproductive and metabolic disorders. The article presents data on the prevalence of obesity among women. The effect of adipose tissue on reproductive function is shown - on ovarian function, on the endometrium, as well as on the activity of the hypothalamic-pituitary-ovarian system. The relationship between obesity and polycystic ovary syndrome, infertility, and metabolic menopausal syndrome is discussed. The mechanisms of the impact of obesity on the pathogenesis of reproductive disorders in women are considered.

The purpose of this study was to substantiate the possibility of successful management tactics for a patient diagnosed with grade 1 obesity (BMI, body mass index 33 kg/m²). Impaired glucose tolerance. Dyslipidemia. Polycystic ovary syndrome. The patient complained of irregular menstruation, with delays of 30-60-90 days, and progressive weight gain. The patient was prescribed treatment. Daily aerobic physical and moderate strength training, nutrition with a calorie content of 1400 kcal per day. In order to regulate the menstrual cycle and prevent endometrial hyperplastic processes, the patient was prescribed didrogesterone 10 mg 2 times a day from the 14th to the 25th day of the cycle. In order to correct body weight, a drug was prescribed, which is a combination of sibutramine + microcrystalline cellulose. The patient also received metformin at a dosage of 1000 mg. The treatment was carried out for 6 months. The dynamics of the indicators was studied after 3 and 6 months of therapy and was as follows. The patient’s menstrual cycle returned to normal, after 3 months the weight decreased to 77 kg, after 6 months to 65 kg. The body mass index after 3 months was 30 kg/m², after 6 months it was 25 kg/m² (normal). Waist circumference was 85 cm after 3 months, 75 cm after 6 months. In addition, normalization of lipid and carbohydrate metabolism was noted. An integrated approach to therapy, with the inclusion of didrogesterone and a drug in the treatment regimen, which is a combination of sibutramine + microcrystalline cellulose, as well as metformin, made it possible to achieve body weight correction, normalization of metabolic parameters and also contributed to the normalization of the menstrual cycle, ovarian and endometrial conditions, which is especially important in a patient, in particular subsequently planning a pregnancy. The choice of these components of complex therapy was determined by the peculiarities of their pharmacodynamics, as well as the peculiarities of the effect on the body of an obese patient, consisting in a positive effect on various structures and functions of the body, while not exacerbating existing metabolic disorders. This clinical case illustrates the need for an integrated approach to the treatment of patients with obesity and menstrual disorders, the positive experience of such treatment can be used to manage other patients in similar clinical situations.

The aim of the study was to study the features of the management tactics of a patient with menopausal metabolic syndrome. We examined the results of the examination and treatment of patient M, 55 years old, diagnosed with grade 1 obesity (BMI 30 kg/m2). Impaired glucose tolerance. Dyslipidemia. Menopausal syndrome. Arterial hypertension 1 st degree. The patient was recommended moderate physical activity, with calorie restriction up to 1400 kcal, and a hypocholesterolemic diet. A drug was prescribed, which is a combination of estradiol 1.0 mg with drosperinone 2.0 mg, HMG-CoA reductase inhibitor 5 mg per day, orlistat with an improved safety profile 120 mg 3 times a day after meals, metformin 1000 mg. The complex treatment was carried out for 6 months with a follow-up examination after 6 months. The patient’s hot flashes stopped, sleep returned to normal, night sweats and headache did not bother her. After 6 months, the weight decreased to the initial body weight. The body mass index after 6 months was 25 kg/m2, which is the norm. The waist circumference after 6 months was 74 cm. Blood pressure stably corresponded to 120/70 mm Hg. Taking antihypertensive drugs was not required. Total cholesterol after 6 months was 4.8 mmol/l. The patient was recommended to continue treatment with subsequent examination annually. Thus, menopausal metabolic syndrome can be considered as one of the variants of the manifestation of menopausal syndrome, which requires an integrated approach to diagnosis and therapy. Individually selected menopausal hormone therapy, being an effective means of relieving the manifestations of menopausal syndrome, also contributes to a positive effect on the components of the metabolic syndrome in this age period. This clinical case demonstrates the need for an individual integrated approach to the management of patients of this age period, with the inclusion of MGT drug, which most effectively has a therapeutic effect due to its pharmacological characteristics.

Currently, there is a global trend of steadily increasing obesity rates. Obesity is a component of metabolic syndrome and is a risk factor for the development of a number of diseases, such as type 2 diabetes mellitus and cardiovascular pathologies. Obesity also leads to hypogonadism in men. In turn, the decrease in androgen levels leads to changes in body composition, reducing the amount of muscle tissue and increasing the content of adipose tissue, thus closing the vicious circle of obesity and hypogonadism. In young men, hypogonadism leads to erectile dysfunction, which can result in infertility. Pathogenetic mechanisms causing the development of hypogonadism in obese men include increased aromatization of testosterone to estradiol in adipose tissue, decreased production of gonadotropin-releasing hormone by the hypothalamus and gonadotropins by the adenohypophysis due to leptin resistance, decreased production of sex steroid-binding globulin and activation of the secretion of proinflammatory cytokines. The functional nature of male hypogonadism associated with obesity suggests the potential reversibility of this condition when treating obesity as the cause of its development. Several studies have shown that calorie reduction, drug therapy for obesity, and bariatric surgery help improve androgen levels in men. And the use of testosterone replacement therapy has a positive effect not only on sexual function in men, but also leads to a decrease in adipose tissue.

Sarcopenic obesity is a complex condition characterized by a combination of obesity and sarcopenia. This pathology has a significant impact on the health and quality of life of the elderly and old people, increasing the risk of chronic diseases and impairing physical functions. Nutritional status plays a key role in maintaining the health and functional ability of older people, influencing the development of sarcopenia and obesity. Understanding the relationship between sarcopenic obesity and nutritional status is critical for developing prevention and treatment strategies. Our scientific article covers the various mechanisms of development of sarcopenic obesity and the influence of nutritional status on sarcopenic obesity, and also examines the role of various nutrients and dietary supplements in the management of this condition. Our scientific article highlights the need for a comprehensive approach to the treatment and prevention of sarcopenic obesity among elderly and elderly patients to improve overall health and quality of life.

Due to the growing number of elderly and senile people in the world population, there is an increase in the prevalence of neurodegenerative diseases. Alzheimer’s, Parkinson’s, multiple sclerosis, amyotrophic lateral sclerosis are the most common nosologies in this group, which are based on neuronal damage and subsequent death of the corresponding parts of the brain and spinal cord. These patients are characterized by a growing deficit in daily activities, a decrease in the productivity of cognitive functions, followed by the need for constant and long-term care, which is associated with huge economic and social costs to society. At the same time, there are no effective programs for the prevention and treatment of these diseases. In the review of the literature, the authors analyzed the works devoted to neurodegenerative diseases, the role of nutrition, epigenetics as factors in the prevention and slowing down the progression of neurodegeneration processes.

Metabolic syndrome is currently the leading cause of the development of cardiovascular pathology.This is associated with an increase in the prevalence of overweight and obesity, which leads to a significant increase in related metabolic diseases. The production activities of workers in many railway professions, primarily locomotive crew workers, are characterized by high psychoemotional stress, which is an important risk factor for the development of metabolic syndrome. Objective: to establish an association between the prevalence of metabolic syndrome Materials and methods: 220 men have been included into the research, workers of railway transportation with arterial hypertension. All the men have been divided into two groups according to their profession. The first group consisted of 114 workers of locomotive brigades (engine drivers and their Assistants). 106 workers of a railway transportation of other specialties have been included in II group. General clinical part of the study included: collection of complaints, medical history, work experience and duration of the disease, examination, anthropometric data with determination of body mass index, waist circumference. Laboratory tests included assessment of biochemical parameters (total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG), glucose, fasting blood sugar and 2 hours after meals). Results: The frequency of metabolic syndrome is 37% and 35%, respectively, in the first and second groups. Significant differences were found in the prevalence of abdominal obesity: among workers of locomotive crews, abdominal obesity was significantly more common by 14% than among engineers (office workers) (χ² = 8.42; p = 0.004). Among men of working age, workers in stressful professions (machinists and their Assistants) more often have a combination of three components of MS: hypertension with AO and an increase in the concentration of LDL-C >3 mmol/l. The following clusters of metabolic syndrome are more often observed in office workers (engineers): hypertension with AO and hypertriglyceridemia and hypertension with AO and hyperglycemia. Conclusions: The received results specify in necessity of carrying out of primary preventive maintenance arterial hypertension among workers of locomotive brigades.

Metabolic syndrome (MS) is a group of metabolic disorders with a number of factors that increase cardiovascular risk. Arterial hypertension is one of the components associated with the development of metabolic syndrome, in addition to disorders of carbohydrate metabolism, dyslipidemia and abdominal obesity. Currently, a causal relationship between OSA and MS has been determined, represented by the fact that intermittent hypoxia occurs in OSA, as well as fragmentation of sleep. The transferred coronavirus infection is clearly associated with an increase in the parameters of the lipidogram, as well as the value of the average SAD and DAD per day, the number of complications from the cardiovascular system in patients with hypertension. The aim was to study the characteristics of the level of catestatin and proinflammatory cytokines in patients with metabolic syndrome in combination with arterial hypertension, obstructive sleep apnea syndrome in patients who underwent COVID-19. Materials and methods: The study included 88 male patients with MS and hypertension. Depending on the presence or absence of a history of coronavirus infection, patients were divided into 2 groups: the number of subjects in group 1 (n= 51), in the second group (n=37). All patients with grade 1-3 hypertension, with the achieved target blood pressure level. The age of the subjects was 30-70 years. All patients underwent: collection of complaints and anamnesis, assessment of body mass index (BMI); determination of the lipid spectrum, blood glucose, glomerular filtration rate. The ELISA method determined catestatin, interleukins 1, 6, and tumor necrosis factor alpha. Instrumental studies were carried out: cardiorespiratory monitoring. Results: when assessing traditional risk factors, it was revealed: a direct relationship between the level of IL-6 and the stage of hypertension (r=0.90; p=0.0355), as well as the relationship between BMI and episodes of anpoe for more than 40 seconds (r=0.89; p=0.0107). Intra-group correlation analysis of the data revealed a direct statistically significant relationship between IAG and degree of AH (r=0.86; p=0.0184)

Despite its name, ferritin is not exclusively a biomarker of iron homeostasis. For example, ferritin is a biomarker of inflammation accompanying pathological changes in various tissues and organs. Therefore, to assess the state of iron homeostasis, the ferritin level can only be used in combination with other blood test indicators (hemoglobin, transferrin, iron, hepcidin, etc.). The results of systematization of an array of 34,266 publications on ferritin using topological data analysis methods showed that, depending on the pathology, ferritin levels in the blood serum can change by 4 orders of magnitude: from 10-20 ng / ml for iron deficiency anemia to 100,000 ng / ml in some cases of hemophagocytic lymphohistiocytosis. Each pathology is characterized by specific ranges of diagnostic values of ferritin levels. In particular, in the model of multiple organ pathology (liver, kidney, brain and myocardial damage with iron overload), ferritin levels increased by +53±12 ng/ml (up to 254 ng/ml, P<0.0001) with a threshold value for hyperferritinemia of only 229 ng/ml. At the same time, for leukemia, blood transfusions, COVID-19 and other viral infections, the threshold values of ferritin are 500-1000 ng/ml, and for macrophage activation syndrome, hemophagocytic lymphohistiocytosis and blood clotting disorders - 1000-6000 ng/ml. Standardized human placenta hydrolysate can eliminate hyperferritinemia, inhibit the development of hemosiderosis of various tissues and counteract the development of multiple organ pathology.

Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are two global public health problems that affect almost 30% and up to ~10-15%, respectively, of the general adult population in many parts of the world. It is quite obvious that NAFLD is a “multisystem disease” associated not only with impaired liver function and the development of hepatocellular carcinoma, but also with an increasing risk of developing cardiovascular diseases (the main cause of death in such patients), chronic kidney disease (CKD). However, the mechanisms underlying this association remain largely unknown. The aim of this review is to report on the epidemiology and pathophysiology of the relationship between NAFLD and CKD and to describe the different methods of kidney function assessment in patients with NAFLD as well as to discuss the potential for promising pharmacotherapy with simultaneous benefit for the outcomes of both diseases.

The main components of the metabolic syndrome - obesity, insulin resistance and carbohydrate metabolism disorders, dyslipidemia, arterial hypertension - are comorbid, having a single pathogenetic mechanism for the formation of conditions. The prevalence of oral diseases exceeds the combined incidence of the five major non-communicable diseases. The article presents data on the relationship between oral diseases and the main components of metabolic syndrome. The relationship between adipose tissue dysfunction, chronic inflammation, oxidative stress, insulin resistance, atherogenesis, and the role of pathogenic microorganisms in the mechanisms of pathogenesis of oral diseases and metabolic syndrome are discussed. The most common clinical manifestations in the oral cavity in metabolic syndrome are described. Attention is paid to the positive mutual influence of therapy for the components of metabolic syndrome and oral diseases on the course of these diseases. The article notes that oral health screening should be part of the treatment for metabolic syndrome or any of its components.

The liver is an important organ of metabolism and detoxification and, therefore, requires a large amount of energy, which is mainly produced by mitochondria. Mitochondrial oxidative stress, which occurs when enzymatic and non-enzymatic antioxidants are overloaded with reactive oxygen species (ROS) formed during various pathological processes. This leads to hepatocellular dysfunction and, eventually, liver fibrosis. This review is devoted to modern concepts of the pathophysiological foundations of mitochondrial oxidative stress and its effect on the development of chronic liver diseases of various etiologies.

It has been shown that in patients with GERD and functional dyspepsia, the use of proton pump inhibitors leads to a decrease in heartburn and pain behind the sternum. However, symptoms such as regurgitation, belching, feeling of early satiety and heaviness after eating were stopped ineffectively. The inclusion in the treatment complex of the prokinetic domperidone at a dose of 10 mg 3 times a day contributed to a more effective regression of symptoms of impaired motility of the esophagus and stomach.

The aim of the review is to analyse the Guidelines in the updated version of the ESPEN-ESPGHAN-ECFS 2024 Guidelines on infant, child and adult nutrition in cystic fibrosis (CF). The previous version of the Guideline was published in 2016. An expert working group of physicians, dietitians, and patient community representatives updated the nutritional recommendations, including methods for nutritional assessment and management at all ages. Chapters on pregnancy, liver disease, CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics have been expanded. There are new chapters on nutrition in the use of highly effective CFTR modulator (targeted) therapies and nutrition after organ transplantation. The main point is the change in the concept of nutrition in the era of targeted therapy from a hypercaloric high-fat diet for all patients to ‘healthy eating’ as the main recommendation. The ESPEN-ESPGHAN-ECFS 2024 Guidelines on nutrition in CF contain a number of important provisions that will be useful to paediatricians and general practitioners, pulmonologists, gastroenterologists and dietitians specialising in CF. Significant differences in the clinical and epidemiological situation in the Russian Federation should be taken into account when diagnosing disturbances of nutritional status and determining the tactics of nutritional support for patients with CF.

Currently, demographic aging of the population continues, and the frequency of various age-associated pathologies is increasing. Sarcopenia and cognitive impairment are often found in patients of older age groups, leading to the development of frailty, decreased quality of life, disability and premature death. There is an association between sarcopenia, frailty and cognitive impairment. Cognitive and physical frailty are interrelated: cognitive problems and dementia are more common in people with frailty, and people with cognitive impairment are more likely to become frail. Both frailty and cognitive decline share common pathogenesis mechanisms. The role of mediators of muscle origin (myokines) in the occurrence of cross-talk between muscles and brain is known. Sufficient physical activity plays an important role in maintaining not only skeletal muscles, but also cognitive functions. On the contrary, physical inactivity is one of the most important risk factors for sarcopenia, frailty and dementia. However, the relationship between sarcopenia and cognitive decline and the underlying mechanisms remain to be addressed. This is the focus of this literature review.

March 11, 2020 The World Health Organization has declared the New Coronavirus Infection 2019 (COVID-19) a pandemic. The risk of complications in the acute period of COVID-19 was obvious almost immediately. However, back in 2020, during the onset and height of the pandemic, health professionals began to think about the possible negative long-term and delayed consequences of COVID-19. Until now, the world is facing the long-term consequences of COVID-19 among survivors, who often have multisystem pathological manifestations. The study of the consequences of COVID-19 continues to be an urgent problem of modern medical science. Currently, increased attention is being paid to sarcopenia, which occurred in patients after COVID-19. On the other hand, sarcopenia is a predictor of adverse outcomes in patients with new coronavirus infection. In 2020, a self-isolation regime (lockdown) was introduced in many countries as an effective anti-epidemic strategy. Unfortunately, the self-isolation regime has led to a decrease in physical activity, especially in elderly and senile people. Therefore, physical inactivity against the background of self-isolation itself was a risk factor for sarcopenia. In addition, during self-isolation, many patients experienced an increase in the caloric content of their diet and the development of obesity. Rehabilitation after COVID-19 necessarily includes measures for the prevention and treatment of sarcopenia. Thus, this literature review is devoted to the study of the relationship between sarcopenia and COVID-19.

Diabetes mellitus (DM) type 2 is one of the components of metabolic syndrome. One of the most common complications of type 2 diabetes is diabetic neuropathy, which results in damage to peripheral and/or autonomic nerve fibers. Disorders of the autonomic nervous system - diabetic autonomic neuropathy (DAN)-can occur in up to 60% of patients. One form of GAN is gastrointestinal autonomic neuropathy (GAN). There is no exact information about its prevalence due to the complexity of diagnosis, but according to some data, symptoms occur in half of patients with diabetes. The main manifestations of GAN are esophageal motility disorders (heartburn, reflux), gastroparesis (nausea, vomiting, feeling of fullness), intestinal motility disorders (diarrhea, constipation), anorectal dysfunction (fecal incontinence). Impaired gastrointestinal motility, in particular gastroparesis, leads to changes in the pharmacokinetics of oral glucose-lowering drugs, which reduces their effectiveness. And in patients receiving insulin therapy, impaired movement of food through the gastrointestinal tract can lead to hypoglycemia. In this regard, identifying and treating manifestations of GAN is an important aspect of managing a patient with type 2 diabetes. Diagnosis of GAN should be aimed at excluding other causes of gastrointestinal disorders and includes, depending on the clinical manifestations, fibrogastroduodenoscopy, barium radiography, colonoscopy, etc. The “gold standard” for diagnosing gastroparesis is considered to be measuring gastric emptying using scintigraphy of digested solids, but due to the high cost and complexity of the procedure, this method is not used in routine practice. The main therapeutic measures in the management of patients with diabetes and GAN are glycemic compensation, compliance with nutritional recommendations, treatment of neuropathy and symptomatic therapy.

Sarcopenia is an age-related loss of muscle strength, mass, and skeletal muscle function, and is a common disease with serious adverse consequences. Although the pathophysiology of sarcopenia has not been fully studied, there are common mechanisms between sarcopenia and the phenomenon of accelerated aging observed in diabetes mellitus (DM). Hypoglycemic drugs currently used for the treatment of type 2 diabetes (DM2) may have mechanisms of action that are important for the prevention and treatment of sarcopenia in both patients with and without DM2. This literature review summarizes the data of modern clinical and preclinical studies on the possible effect of hypoglycemic drugs on muscle mass, strength and function, treatment and prevention of sarcopenia in DM2 and without it. It was found that studies of this relationship in patients with DM2 dominated. The limited amount of research in patients without DM2 does not allow us to develop tactics for the prevention and therapy of sarcopenia in full. In this regard, it is necessary to continue research in this direction.

Somatic symptoms, under the guise of which mental disorders can be hidden, are a problem for patients, psychiatrists and doctors of other specialties who are faced with this in the first place. Anxiety for one’s health and subjectively experienced bodily sensations force the patient to repeatedly seek medical help, which can aggravate maladjustment and cause significant damage to resources, causing additional stress, closing a vicious circle. Purpose of the study: to analyze the clinical manifestations, problems of diagnosis and treatment of psychopathological disorders using the example of clinical observation of somatoform disorder in a young man with gastroenterological symptoms. Materials and methods: the patient’s diagnosis corresponded to ICD-10 code F45.3 Somatoform dysfunction of the autonomic nervous system. Clinical-anamnestic, clinical-psychopathological, laboratory and instrumental methods were used. This clinical case demonstrates certain difficulties in diagnosing and treating somatoform disorders due to the need to exclude somatic pathology, nonspecific and difficult to differentiate symptoms that are not subjectively realized by the patient, individual selection of therapy and low compliance with it, and the need for psychotherapeutic assistance.

Muscles play an important role in daily activities. In a healthy person, skeletal muscles make up about 40% of the total body weight and contain 50-75% of all body proteins. During aging and/or in the presence of concomitant risk factors, there is a loss of strength, mass and function of skeletal muscles. Sarcopenia is widespread among older people and is associated with an increased risk of adverse outcomes, including falls, decreased functionality, frailty and mortality. Lack of physical activity in old age is an important risk factor for sarcopenia. Therefore, physical activity is the main method of preventing and slowing the progression of age-related sarcopenia. Although physical activity cannot completely suppress the process of sarcopenia and age-related deterioration of muscle function, physical training can delay the onset of sarcopenia and reduce its severity. This literature review provides up-to-date information on the physiological, biochemical, and hormonal effects of exercise. The main types of physical activity that can be used for the prevention and treatment of sarcopenia in geriatric patients, the advantages and disadvantages of various types of physical exercise are considered.

This paper details the impact of inflammatory bowel disease (IBD) on patients’ quality of life. In order to assess patients’ quality of life, a number of specific and general tools have been developed to assess quality of life in patients with IBS. According to the data obtained in a number of clinical studies, IBS significantly reduces the quality of life of patients compared to healthy people. Moreover, the quality of life is directly related to the form and degree of ICD activity. Thus, worse quality of life is associated with Crohn’s disease and active stage of the disease. However, in the remission stage, the quality of life in patients with Crohn’s disease (CD) and ulcerative colitis (UC) do not have statistically significant differences. In addition, diet and lifestyle are of great importance for the QOL of patients with UC. Conservative therapy is an extremely important link that allows to significantly improve the life quality of patients, in which targeting pre-drugs play an important role. The latter significantly improve the QOL of patients with ICD, contributing to the transition of ICD from the active form to remission.

Objective: to analyze the clinical experience of using the CKD progression rate calculator to stratify the prognosis of elderly patients with DM2, belonging to a very high cardiovascular risk group. Material and methods: to determine the systemic coronary risk of elderly patients with DM2, the generally accepted and most relevant SCORE2 and SCORE2-OP algorithms were used to assess the 10-year risk of fatal and nonfatal cardiovascular events. Further more accurate stratification of the risks of CKD was performed using a prognostic Calculator of the rate of progression of CKD in elderly patients with DM2, developed at the Department of Endocrinology of the Samara state medical university. Results: as a clinical example, two 69 and 70-year-old patients were randomly selected from the group of participants used in the development of the mathematical model of the Calculator. According to the SCORE2 and SCORE2-OP algorithms, both patients were assigned to a very high-risk group of cardiovascular diseases, the values of which were 33% for patient XXX; 24% for patient YYY, excluding concomitant DM2 and CKD. To clarify the clinical prognosis, an original Calculator was used, which demonstrated different characteristics of the CKD progression rate in these patients (“low” and “high” with a cut-off value of the GFR reduction index of 3.83 ml/min/1.73 m2 per year), despite the identity of the parameters of the clinical and laboratory status. Conclusions: the use of traditional ASSR risk assessment scales for predicting outcomes in a cohort of elderly with DM2 has significant limitations, since most patients of older age groups fall into a homogeneous group of very high risk without the possibility of further stratification; the use of a Calculator for the rate of progression of CKD allows you to refine the prognosis, optimize the program of follow-up and determine indications for prescribing drugs with proven nephroprotective the effect in elderly patients with DM2.

Telemedicine is the use of telecommunication systems to provide medical care to the population at a distance. It has the potential to improve patient outcomes, access to care, and reduce health care costs. As telemedicine consultation applications continue to evolve, it is important to understand in which clinical situations and settings of care a telemedicine intervention is appropriate and can ensure that patients receive quality care. Objective: to assess the acceptability, effectiveness and safety of using TMC in the provision of specialized endocrinological care to patients. Search strategy: review of the most relevant studies published in the electronic databases Medscape, PubMed, PubMed Central, MEDLINE, Scopus, eLibrary, CyberLeninka. The selection criterion was scientific articles published up to March 2024 inclusive. Search keywords: telemedicine, virtual care, endocrinology, diabetes. Conclusions. The results of currently published studies have shown that telemedicine interventions can have a beneficial effect on the outpatient management of patients with chronic non-communicable diseases, in particular diabetes mellitus, and improve the self-management of glycemic parameters in patients. However, many questions remain unresolved regarding the choice of the optimal strategy for monitoring, treating and providing quality medical care to patients with endocrine pathology. Findings to date indicate significant promise for implementing telemedicine interventions within health care delivery. The advisability of their use in each specific case must be approached individually and solely as another, additional tool for improving the quality and accessibility of medical care.

Curcumin, an active ingredient derived from turmeric root (Curcuma longa), has significant pharmacological properties including anti-inflammatory, antioxidant, antimicrobial, anticancer and analgesic activities. Studies show that curcumin affects the expression of various microRNAs and long non-coding RNAs to regulate cell proliferation and apoptosis in various types of malignant tumours. In addition, curcumin modulates signalling pathways such as PI3K/Akt/mTOR, MAPK/ERK and AMPK, activating autophagy and inhibiting tumour angiogenesis. It also inhibits metastasis and invasion of tumour cells by affecting epithelial-mesenchymal transition and expression of matrix metalloproteinases. Curcumin exhibits antibacterial and antiviral activity by disrupting bacterial cell membranes and inhibiting viral replication. The antioxidant properties of curcumin are due to its ability to neutralise reactive oxygen species and stimulate antioxidant enzymes. Curcumin also promotes wound healing by modulating inflammatory processes and stimulating angiogenesis. The analgesic effect of curcumin is due to its ability to stimulate the release of endogenous opioid peptides and modulate the activity of GABA receptors and ASIC and TRPV ion channels. Curcumin has an effect on lipid and carbohydrate metabolism, which makes it a promising agent for the treatment of dyslipidaemia and insulin resistance. The effect of curcumin on haemostasis is manifested in its ability to inhibit platelet aggregation and blood clotting, which may be useful for the prevention of cardiovascular diseases.