Objective: to establish the features of cytokine production in patients of reproductive age with external genital endometriosis at various stages of the disease.

Materials and methods: the study included 52 patients with external genital endometriosis (EGE). Group I consisted of 31 patients with stages I–II of EGE, group II — 21 patients with stages III–IV of the disease, control group — 20 women without endometriosis. Serum samples were obtained before anesthesia, and peritoneal fluid (PF) samples were obtained during endoscopic examination of patients. Determination of the content of cytokines in blood serum and peritoneal fluid was carried out by enzyme immunoassay using a multifunctional counter for enzyme immunoassays with Victor software (Finland). TNF-α, IL-10 — using reagents from BenderMed Systems (Austria). IL-13, IL-18 using reagents from Cloud-CloneCorp (USA) according to the manufacturer’s recommendations. Application software packages (Megastat and Statistica 10.0) were used to create a database and conduct statistical research. To determine statistical differences between groups, the Mann-Whitney test was used for independent groups and the Wilcoxon test for dependent groups. P values less than 0.05 were considered statistically significant. Data are presented as median and quartiles.

Results: at stages I–II of EGE, an increase in the level of TNF-α, IL-18 was detected in the blood serum and peritoneal fluid, which can stimulate proliferation, invasion of endometrial cells and neovascularization; stage III–IV of the disease was characterized by an increase in the level of TNF-α, IL-10, IL-13 in the peritoneal fluid, which promotes disease progression by evading ectopic endometrial cells from immune control.

Conclusion: the identified features of the production of pro- and anti-inflammatory cytokines at the systemic and local level at various stages of EGE confirm their importance in the development of the disease. Further research is needed to understand the mechanisms underlying the progression of NGE and to develop methods for early diagnosis.

Objective: to characterize a group of patients with fixed drug erythema (FDE) caused by fluconazole to determine the sensitivity and specificity of the local provocative application test (LPAT) and to evaluate cross-allergenic reactivity with other antifungal drugs of the azole group.

Materials and methods: a prospective study was conducted in the period from 2012 to 2022. 347 patients with delayed drug hypersensitivity (DDH) were consulted, FDE could be suspected in 86 patients (24.8%), of which 23 patients were caused by fluconazole (26.8%). We included patients with suspected fluconazole FDE (n=23). LPAT with fluconazole was performed in 12 patients, drug provocation test (DPT) with ketoconazole – 17, DPT with itraconazole – 15, DPT with fluconazole – 1.

Results: the ratio of men and women was 1:6.3, the average age was 30.39±10.23 years. In 1 patient, the diagnosis of FDE caused by fluconazole was withdrawn. Number of reactions: 1 – in 2 patients (9.1%), more than one reaction – in 20 (90.9%). 4 patients (18.2%) had atopy. Sensitivity of LPAT for diagnosing DDH in FDE caused by fluconazole was 41.7%, specificity – 100%, false-negative rate – 58.3%, positive predictive value – 100%. DPT with ketoconazole, itraconazole was negative in 100% of cases.

Conclusions: the results obtained allow us to conclude that FDE caused by fluconazole in the vast majority of cases developed in women aged 19 to 30 years. Since patients with FDE caused by fluconazole tolerate ketoconazole and itraconazole well, it is highly likely that they can switch from fluconazole to one of these drugs. LPAT should be used for diagnosing FDE caused by fluconazole, since it was absolutely safe for the patient and allowed avoiding DPT in 42% of patients. Importantly that the timely and correct diagnosis in more than 90% of cases, it was possible to prevent the development of a repeated reaction to fluconazole.

Objective: comparative characteristics of the subpopulation composition of B- lymphocytes and the cytokine spectrum of peripheral blood in infectious and non-infectious manifestations of CVID.

Materials and methods: the results of observation of 10 people diagnosed with CVID have been presented. Six patients the clinical manifestation had an infectious phenotype of the disease of synopulmonary localization. Four patients were diagnosed with Crohn's disease, hemolytic anemia, and autoimmune hepatitis. The level of cytokines IL-4, IL-10, IL-17, TNF-α, IFN-γ in blood serum was determined by the ELISA, the phenotypic characteristic of B cells of peripheral blood cells was carried out by flow cytofluorimetry.

Results: the proportion of memory B cells in the healthy donors is 30% of all B-lymphocytes, on infectious manifestation of CVID – 12%, with autoimmune – 14%. The number of switched memory B-lymphocytes relative to the total pool of B-2 cells in infectious manifestation is greater (2.3%) than in autoimmune ones (1.4%). In patients with infectious manifestations the content of IFN-γ and TNF-α was increased inrelation to healthy donors of the comparison group, there were no differences in the serum amount of IL-17, with autoimmune manifestations, the content of all these cytokines was increased, IFN-γ and TNF-α being to a greater extent.

Conclusion: impaired formation of memory B-lymphocytes and cytokine dysregulation of immune processes are detected regardless of the variant of clinical manifestation of CVID. The nature and degree of changes differ depending on the clinical phenotype of the disease.

Objective: to study the clinical and immunological parameters of patients with COVID-19 in moderate form with varying degrees of lung tissue damage.

Materials and methods: 80 patients hospitalized with a diagnosis of «COVID-19, moderate form; complication: bilateral polysegmental interstitial pneumonia» were examined. The difference in laboratory parameters (general clinical, biochemical and immunological) was evaluated depending on the degree of lung damage (up to 25 and up to 50%). Comparison group: 20 healthy volunteers.

Results: the differences between patients with different lung lesion areas consisted in higher levels of prognosis severity markers – CRP, LDH. In the immune status in the CT group 2, there was a decrease in CD3⁺ lymphocytes and their helper subpopulation, dysimmunoglobulinemia and a higher IL-6 content.

Conclusions: CT examination is of great importance for monitoring the progression of the disease. The smaller area of lung lesion reflects a lighter course of the disease, which does not exclude the need for dispensary observation and rehabilitation after discharge.

Objective: comparative characteristics of indicators of psycho-emotional and immune statuses of first-year students in various conditions of the educational process.

Materials and methods: 2^nd groups of first-year students of Rostov State Medical University from the medical and preventive faculty (18 people) and the military training center (17 people) were examined. They were all comparable in age (19 ±1 and 19±2 years), gender (all men), physical condition (corresponded to the I-st health group). The immune status was assessed at the Research Institute of Clinical Immunology using standard methodological approaches. Psychological testing was carried out using the Spielberger-Khanin scale, A. Beck's depression diagnostic methodology, and K. Rogers and R. Diamond questionnaire.

Results: the differences in the immune response system between the compared groups were revealed only in relation to the parameters characterizing innate immunity. In relation to Medical and Preventive Faculty students, the functional capabilities of natural killers in Military Training Centre students are reduced and the expression of one of the most indicative pattern-recognizing receptors by monocytes is diminished. The analysis of the obtained data of the psychological questionnaire showed that the students of the Military Training Centredemonstrate a lower degree of situational and personal anxiety with a lower degree of adaptation in comparison with the first-year students of the Medical and Preventive Faculty.

Conclusion: the immune system indicators responsible for the processes of primary immune response are reduced in military medical students comparing with medical students, which in its turn forms possible prerequisites for the development of clinical manifestations of immune dysfunction. The period of psychological adaptation to the educational process in a medical university is less successful for first-year students of the Military Training Centre. It is necessary to develop measures aimed at increasing the sense of responsibility, psychoemotional and immune adaptation resources.

GATA2 deficiency is a rare disease belonging to the group of phagocyte birth defects, which is clinically manifested by four syndromes: MonoMac syndrome (myedysplasia and immunodeficiency associated with the development of infections caused by Mycobacterium avium complex); monocyte, dendritic cell, B- and NK-lymphocyte deficiency syndrome; Emberger syndrome, including primary lymphedema with myelodysplasia and sensorineural hearing loss, as well as familial myelodysplastic syndrome and acute myeloid leukemia. The disease is inherited by autosomal dominant type, but in most cases, mutations ofthe germ line of the GATA2 gene occur de novo. The first manifestations of the disease occur in early adulthood, the course of GATA2 deficiency is variable and may differ in individuals in the same family with similar genetic variants. The article presents a clinical case of manifestation of GATA2 deficiency at the age of seven years in the form of development of generalized verrucosis, lymphostasis of the lower limb, generalized tuberculosis with involvement of the abdominal cavity, small pelvis, and chest organs. The examination revealed deficiency of monocytes, B- and NK-lymphocytes, myelodysplastic syndrome with multilineage dysplasia. We present a detailed description of the clinical picture and peculiarities of the course of the primary immunodeficiency state, the results of the examination and treatment.

Objective: to investigate single nucleotide polymorphisms in IFNγ gene variant rs2430561 and in NKG2D gene variant rs2617160 as potential risk factors for mother-to-child viral transmission among HIV/HCV-coinfected women.

Materials and methods: 65 mother-child pairs were examined, divided into 4 groups depending on the child's infection (HIV/ HCV infected, HIV or HCV infected, not infected). Methods: multiplex polymerase chain reaction (PCR), PCR for determining the viral load of HIV and HCV, flow cytometry for immunological studies, statistical analysis.

Results: the single nucleotide polymorphism in IFNγ gene variant rs2430561 had no prognostic value when determined in the mothers. When recording the TT and AT genotypes of a single nucleotide polymorphism in this gene in a child, it was combined with the probability of the child's infection with HIV/HCV, HIV or HCV, depending on the magnitude of the viral load of HIV and HCV in the mother's blood in different trimesters of pregnancy. The presence of the AA and AT genotypes of the NKG2D gene variant rs2617160 in the mothers had a prognostic value as contributing tothe child infection with HIV/HCV or HIV alone. It was noted that the mechanisms of perinatal viral transmission included a certain level of decline in the absolute number of CD4+ lymphocytes in the woman blood in the second and third trimesters of pregnancy.

Conclusions: the presence of AA and AT genotypes of the NKG2D gene variant rs2617160 in woman co-infected with HIV/HCV makes it possible to predict the risk of child infection not only during pregnancy, but also at the planning stage.

Objective: to study the characteristics of the functioning of the IFN system, the presence of autoantibodies to INFα in patients suffering from atypical chronic active herpesvirus infections (ACA-HVI) in comparison with patients with a typical course of chronic herpesvirus infections (CHVI).

Materials and methods: under our supervision were 485 patients of both sexes aged 23 to 70 years, suffering from chronic herpes virus infections, of which 335 patients suffered from AHA-HVI and 150 people suffered from CHVI. The comparison group was 250 conditionally healthy individuals (CG). The complex of the study included methods for detecting herpesviruses: serodiagnostics, PCR-RT. The IFN system (spontaneous and induced production, serum concentration) was tested by ELISA. The study was approved by the ethics board and informed consent was obtained from all patients.

Results: the incidence of various mono-mixed herpesvirus infections in patients with ACA-HVI (mono – 26,6% and mixed – 73.4%) and CHVI (mono – 23.1% and mixed – 76.9%) was determined, with EBV dominance in patients of both groups. Serum IFNα deficiency was detected in 100% of cases in both groups, and IFNα in 67% in ACA-HVI and 57% in CHVI. At the same time, significant differences were found between the ACA-HVI and HGVI groups in the level of IFNα reduction: 10 and 5 times, respectively, and for IFNγ – 2.0 and 2.6 times, respectively. The induced IFNα production decreased by 89.1% in ACA-HVI and 47.2% in CHVI. A decrease in induced IFNγ production is characteristic of 50% of patients in both groups. At the same time, the level of induced production of IFN α in patients with ACA-HVI was 9 times lower than in the control group and 4.75 times lower than in the group of patients with CHVI. And the level of induced IFNγ production was 2 times lower compared to CHVI and the control group.

Conclusions: when assessing the state of the IFN system in patients with various chronic herpes virus infections, significant differences were revealed. Thus, the most pronounced manifestations of interferonopathy, consisting in a significant decrease in serum IFNα and IFNγ and defects in induced IFN production of both types, are observed statistically significantly more often in the group of patients with an atypical course of the disease than in the group of patients with a typical course of CHVI. The most pronounced disorders in the IFN system and the lack of recovery of IFNα and IFNγ levels in the interrelational period cause atypicity of the course and active viral replication in patients with ACA-HVI.

Objective: to evaluate the epidemiological and immunological efficacy of tularemia vaccination in the Donbass region from 1991 to the present.

Materials and methods: data on the incidence of tularemia, immunization coverage of the population, results of intradermal tests with tularin, agglutination reaction and indirect hemagglutination reaction with tularemia antigen were analyzed.

Results: since 2012, immunization against tularemia has not been carried out on the territory of the republic. Since 2015, this approach has resulted in the emergence of foci with multiple cases of human tularemia. Cases were registered on the territory of natural foci of Novoazovsky and Yasinovatsky districts. Since 2017, immunization of the population in enzootic territories has been resumed, planning and selection of contingents to be vaccinated was carried out in a differentiated manner. According to epidemic indications, 400 people were vaccinated from among those at risk of contracting tularemia. In 2020– 2022 vaccination was not carried out. In the five months of 2023, 520 people were vaccinated against tularemia, 80 people were revaccinated.

Conclusions: the use of tularemia vaccine in the Donetsk region for 70 years led to the containment of tularemia, demonstrating the epidemiological and immunological effectiveness of specific immunoprophylaxis. The armed conflict and the cessation of vaccination led to an increase in the activity of the epidemic process in natural foci among animals and a significant increase in the incidence of tularemia in humans.

Objective: to study in an experiment on animals pathomorphological changes in the tissues of the uterus, appendages and blood vessels after ligation of the internal iliac and ovarian arteries.

Materials and methods: An experiment was conducted with 6 mature pigs. Group I (n=3) consisted of intact pigs without surgery, group II (n=3) included animals with ligation of the internal iliac and ovarian arteries on both sides. 12 months after the operation, slaughter was performed and the organo-complex of the uterus with appendages and iliac vessels was taken for electron microscopic pathomorphological examination.

Results: comparative results of the study of the uterus, appendages found that the normal structure of the mature uterus was preserved, there were no changes in the structure of the fallopian tubes, tissues and vessels of the ovaries. All changes were found in the area of ligation of the ovarian and internal iliac arteries, although the arteries retained their lumen, but were deformed and surrounded by dense fibrous connective tissue. Conclusion: ligation of the ovarian and internal iliac arteries with absorbable suture material causes only local changes. The sufficiency of collateral blood flow is confirmed by the absence of atrophy of the uterus, fallopian tubes and ovaries, as well as organ deformities.

The article describes cases of diagnosis of an additional spleen in the pelvis and splenosis of the pelvis in women, detected by ultrasound, confirmed by MRI. The relevance of the publication of the presented observations is determined by the rarity of such localization of the spleen and splenosis in the pelvis and the low awareness of obstetricians and gynecologists, most often conducting ultrasound examination of pelvic organs, about this pathology. Cases of an accessory spleen and splenosis in the abdomen are known and written in the literature, while similar findings in the pelvis are, firstly, a rare find, and secondly, ultrasound examination in gynecology is carried out by obstetricians-gynecologists, who rarely meet with surgical pathology, thirdly, the echographic picture requires differential diagnosis with endometrioma, hemangioma, primary and metastatic cancer, and splenosis and accessory spleen should also be differentiated from each other. The article presents two of our own clinical cases of splenosis and accessory spleen with US and MRI data, discusses the reasons for difficulties in diagnosis and key criteria for differential diagnosis, and also includes a review of the literature on this topic. Based on all of the above, it was concluded that should not forget about such a rare but possible diagnosis as pelvic splenosis, and also remember about a possible congenital condition – accessory spleen.

Hypospadias is one of the most common congenital malformations of the male external genitalia and urethra, the main manifestation of which is meatus dystopia. There is a steady increase in the frequency of its occurrence in many countries of the world. Hypospadias have various forms of severity, which significantly affects the patient's management tactics, the volume of surgical treatment and the further prognosis for the boy's life. The article describes a case of early prenatal diagnosis of the coronary form of hypospadias in the fetus at 15 weeks of gestation, followed by postnatal verification of the diagnosis. The possibilities of echography in the early detection of distal forms of hypospadias using an integrated approach in the assessment of external genitalia in a male fetus are shown. This complex of hypospadias markers includes an assessment of the size of the penis, the presence of a curvature of its body, the shape of the head of the penis and the presence of signs of cleavage of the foreskin, which are manifested by its rounding. The ineffectiveness of the long-used «tulip» sign for the early diagnosis of distal forms of hypospadias has been demonstrated. The comparison of the echographic picture of the structure of the genitals in normal and hypospadias at 12 and 15 weeks of pregnancy was carried out.

This article is devoted to the actual problems of psychosomatic medicine. Common myths are discussed, according to which only 7 psychosomatic diseases are known (restrictive interpretation), or alternatively, all human diseases are psychosomatic (expansive interpretation). The article presents a modern classification of psychosomatic disorders, information on predisposition to them, and highlights the main concepts of pathogenesis. Attention is devoted to the main forms of somatoform disorders, organic neuroses, nosogenic disorders, and the problem of hypochondria is illuminated. In this article attention is paid to the need for an integrated approach to the treatment of psychosomatic disorders, including the impact on both mental and somatic components. The requirements for the use of psychopharmacological drugs in psychosomatic medicine are given, emphasis is placed on the principle of «minimum sufficiency», which requires the use of minor doses of safe drugs that can cure the psychosomatic symptoms and are capable to treat the diagnosed mental disorders. The main non-drug methods aimed at correcting psychosomatic disorders are presented. The authors are convinced that in the field of psychosomatics the chances for successful diagnosis and therapy are given by the concept of «counter movement» – the interdisciplinary interaction of psychiatrists and internists, the essence of which is the urgent need for interdisciplinary cooperation of psychiatrists and internists, which increases the chances of successful assistance in such a complex and myth-rich field like psychosomatics.

An analysis of the literature data on the role of the cardiotrophin-1 protein in chronic heart failure was carried out. Articles were selected and analyzed in PubMed, ScienceDirect, ProQuest, GoogleScholar, Cochrane, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus and PEDro databases. The search for articles was carried out using the keywords: «Heart failure», «Biological markers», «Cardiotrophin-1», «Galectin-3», «Myocardium» and their combinations. Inclusion criteria were publication date from 2017 to 2022, clinical studies, meta-analyses and systematic reviews, randomized controlled trials, availability of the full text in the public domain or the abstract. Exclusion criteria: abstracts, monographs, textbooks, publication date before 2017, inconsistency with the research topic. A total of 80 publications were found. The review included 18 publications from 2017 to 2022 that corresponded to the topic and purpose of the study and were significant for revealing the subject of the study. Information is presented on the role of cardiotrophin-1 in chronic heart failure. Cardiotrophin-1 is activated in cardiac fibroblasts and cardiomyocytes in response to mechanical, humoral, metabolic and hypoxic stress. This biomarker is abundantly expressed in cardiac tissue and its overexpression is mainly stimulated by ventricular stretch/pressure, which promotes myocardial hypertrophy. Experimental administration of cardiotrophin-1 leads to fibrosis and myocardial remodeling, which indicates its role as a diagnostic biomarker in these pathologies and chronic heart failure in general.

Objective: to study the indicators of the functional state of the body and working capacity in the dynamics of learning in elementary school children with different school success.

Materials and methods: the study included 573 elementary school students. Group I – 82 students with excellent academic performance Group II – 491 children with good academic performance. The vegetative index of Kerdo (VIC), the Rufier test, the Genchi test, and the adaptive index (AP) were determined by the method of F. Halberg. The mental performance of younger schoolchildren was studied using Schulte tables.

Results: the values of VIC in group I children were 2.5–3.5 times higher. The difference in IR between the groups increased, amounting to 32.88% in the 4^th grade. The Gencha sample was characterized by lower values (by 1–2 seconds) in group I children. The difference in AP in the 1^st grade was 4.73 sec., then in the 4th grade –6.86 sec. The Schulte tables showed higher values of work efficiency, workability and endurance coefficient along with a decrease in speed and strength indicators and physical endurance.

Conclusions: by the end of primary school, the vegetative balance in group I children is between normo- and sympathicotonia. The Gencha test made it possible to establish insufficient resistance of the body to hypoxia. Children of group II demonstrated better adaptive capabilities of the CCC, speed and strength indicators and physical endurance. The data obtained must be taken into account in the pedagogical process with younger schoolchildren and require the development of differentiated recreational activities.

Diseases of the nervous system, accompanied by impaired locomotor reactions, occupy a leading place among the causes of disability. In this regard, the review carried out an analysis of national and foreign scientific data devoted to current views about the neurophysiological mechanisms of plasticity and their leading role in ensuring the recovery of movements in neuromotor disorders. Special attention is given both to the organization of the spinal locomotor center as a common final path in the implementation of motor rehabilitation, and to the management of the locomotor center, taking into account modern ideas about the structure of the locomotor body system. Based on the results of systematic literature data, the authors concluded that neuroplasticity of the spinal locomotor center and supraspinal centers of movement regulation is proven, and indicate the expediency of searching for methods which activating the plasticity of the central nervous system.