Vol 23, No 2 (2024)

Objective. To determine the significance of M-cholinoreactive systems (M-CRS) in the implementation of the infarct-limiting effect of postconditioning with L-lactate (PostL) during myocardial ischemia-reperfusion in young and old rats. Methods. The study was carried out on 141 white male rats. The animals were divided into 8 groups: Controlyoung and Controlold - young/old rats, which underwent 30 minutes of myocardial ischemia followed by 120 minutes of reperfusion; Atropine + Controlyoung and Atropine + Controlold - young/old rats that were intravenous administered atropine at a dose of 2 mg/kg 15 min after myocardial ischemia/reperfusion; PostLyoung and PostLold - young/old rats that modulate PostL 25 min from the start of reperfusion; Atropine + PostLyoung and Atropine + PostLold - young/old rats that were administered atropine at a dose of 2 mg/kg 15 min after myocardial reperfusion and 10 min after this were subjected to PostL. After reperfusion, the heart was removed and the size of the necrosis zone was studied using computer planimetry. Results. The sizes of the necrosis zone in the left ventricular myocardium in animals in the study groups were as follows: Controlyoung was 45 ± 4 %, Controlold - 47 ± 5 %, Atropine + Controlyoung - 47 ± 5 %, Atropine + Controlold - 48 ± 7 %, PostLyoung - 33 ± 3 % ( p < 0,01), PostLold - 35 ± 4 % ( p < 0,01), Atropine + PostLyoung - 41 ± 4 %, Atropine + PostLold - 32 ± 4 % ( p < 0,01). Conclusion. Under conditions of action in animals of atropine (2 mg/kg), the infarction-limiting effect of PostL is preserved in old but not young rats. The data obtained give grounds to say that M-CRS activity is important in the mechanisms of implementation of the infarct-limiting effect of PostL in young, but not in old rats.

Objective. To conduct a separate pharmacoeconomical study of the treatment of cardiac arrhythmias in children and adolescents after a new coronavirus infection by COI analysis Methods. The analysis of medical records of sick children and adolescents who have undergone COVID-19 was carried out. (sinus arrhythmia (n=65), sinus bradycardia (n=20)). Pharmacoeconomical research by the method of COI analysis was carried out at the inpatient and outpatient stages of medical and pharmaceutical care. The study identified "patient models" taking into account age groups, variants of rhythm disturbance and actual clinical practice. Results. When studying the patient's model "Sinus arrhythmia", it was found that the direct medical costs for the cost of laboratory research methods on average amount to 1590.0 rubles, and for the cost of instrumental methods - 5400.0 rubles. When calculating the direct costs of drug therapy for patients of this category, it was found that the price range of medicines varies from 299.0 rubles to 633.0 rubles for pharmacy organizations in Smolensk. When calculating the cost of treatment courses of different duration, it was found that 10, 30 and 60 days of treatment on average costs the health care system or a family with a child with this pathology from 574.8 rubles, 1724.6 and up to 3449.2, respectively. At the stage of inpatient treatment (14 days), direct medical costs are: 804.7 rubles for drug therapy, an average of 1590.0 rubles are spent on laboratory research methods, and 5400.0 rubles for instrumental ones. When calculating the cost of laboratory analysis methods for a model Conclusions. The study found that the direct medical costs per patient - the patient model "Sinus arrhythmia" are: for 14 days - 7794.7, for a course of treatment for 10 days - 7564.8 rubles, for 30 days - 8714.6 rubles and 60 days of treatment - 10439.2 rubles; per patient - the patient model "Sinus bradycardia" They amount to: 28911.5 rubles for 14 days, 28624.8 rubles for a course of treatment for 30 days, 30058.4 rubles for 90 days and 30775.2 rubles for 120 days of treatment.

Objective. Systematize research data on the main local and systemic mechanisms of action of injection-based carboxytherapy and its effects on various pathologies. Methods. Data analysis using domestic and foreign studies of the molecular, cellular and systemic mechanisms of action of carboxytherapy, its effect on the functional activity of organs and systems, and possibility of use in pathogenetic therapy for various pathologies. Results. CO2 affects the blood flow, causing arterial hyperemia, enhances the dissociation of oxyhemoglobin, causes excitation of central and peripheral chemoreceptors, and regulates the breathing process. An increase in CO2 concentration has a positive ino- and chronotropic effect on the myocardium, increases volumetric blood flow, increases the oxygen extraction ratio in tissues and enhances their metabolism. In the endothelium, CO2 administration increases the production of vasodilators and the vascular endothelial growth factor, which contributes to the activation of peripheral circulation and enhancement of oxygenation and lipolysis in tissues. Stimulation of reflexogenic zones during carboxytherapy contributes to the analgesic effect. Conclusions. Administration of CO2 via injection, which allows precise dosing of gas volume and has minimal complication risks, is a promising method of pathogenetic therapy for various pathologies, although it is necessary to develop treatment protocols for specific nosological forms, and the mechanisms of action and effects of carboxytherapy require further research.

Objective. Evaluation of the effectiveness of pharmacological neuroprotection and the prospects for its clinical use in ischemic brain lesions. Methods. Collection, systematization and analysis of literature data and the results of our own research on the experimental and clinical study of pharmacological neuroprotection in ischemic brain lesions. Results. The second part of the work presents a detailed analysis of possible approaches to pharmacological neuroprotection, taking into account the main pathogenetic pathways of the ischemic cascade and the physiological mechanisms of neuroprotection. The results of scientific research on primary and secondary pharmacological neuroprotection are discussed. It is noted that it is possible to realize the main goals of pharmacological neuroprotection in two ways: by blocking the pathogenetic links of the ischemic cascade (primarily glutamate excitotoxicity and oxidative stress) and by inducing the processes of neuroplasticity and neurotrophy. At the same time, it is important to make a reasonable choice of drugs to influence the reactions of the ischemic cascade and the physiological mechanisms of adaptation. Promising possibilities of using various pharmacotherapeutic agents for primary and secondary neuroprotection are considered. Conclusion. There are different approaches to pharmacological neuroprotection in ischemic brain lesions. The rational choice of targets (pathogenetic and physiological) and drugs for primary and secondary pharmacological neuroprotection determine its effectiveness, as they consistently increase the resistance of brain cells to ischemia/hypoxia and stimulate reparative-regenerative processes in the central nervous system.

Objective. Study and analyze current data on genetic nature atrial fibrillation (AF) and assess the importance of genetic risk in the diagnosis and determination of prognosis, as well as become familiar with the issues of genotype-based pharmacotherapy for familial AF. Methods. Collection, analysis, and systematization of data on the genetic nature of AF. Results. This review article presents current concepts about genetic predictors of AF, including genes involved in the regulation of cardiac ion channels, transcription factors, and secondary risk factors for AF. Modern therapeutic technologies are described in detail, the choice of treatment tactics and assessment of the effectiveness of interventional interventions and genotype-based antiarrhythmic pharmacotherapy. Conclusions. It has been shown that the familial form of AF is quite common in the general population, makes a serious contribution to mortality and thereby diverts enormous economic resources to solve medical and social problems associated with the provision of specialized medical care. In this context, verification of patients with familial AF will contribute to early diagnosis and prevention of cardiovascular complications associated with AF, as well as the introduction of effective pharmacotherapy and interventional procedures.

Objective. To analyze the medical history of a patient who underwent a new coronavirus infection COVID-19, against which a recurrent form of pulmonary embolism developed, as a result of which a thrombendarterectomy from the pulmonary artery system was performed first, and then a transluminal balloon angioplasty of the pulmonary artery. Methods. Analysis of medical records, medical history, complaints, laboratory and instrumental research methods. Results. A clinical case of a patient who suffered from a new coronavirus infection COVID-19, against which a recurrent form of pulmonary embolism developed, is presented. Subsequently, a thrombendarterectomy was performed from the pulmonary artery system, and then a transluminal balloon angioplasty of the pulmonary arterioles was performed by the National Medical Research Center for Cardiovascular Surgery (FSBI NMIC SSH) named after A.N. Bakulev. This patient suffered a new coronavirus infection at the end of December 2021. He complained of shortness of breath and elevated body temperature to the Yartsevskaya CRH, where he was hospitalized in KB No. 1 with a positive smear for Covid-19. During hospitalization, bilateral destructive pneumonia was detected. Due to the presence of weakly positive dynamics of the condition, as well as a negative smear on Covid-19, the patient was hospitalized in the thoracic department of the Smolensk Regional Medical Center in connection with bilateral destructive pneumonia. After a month of hospitalization, the patient noted a deterioration in his condition when he woke up in the morning and began to feel at rest a feeling of lack of air, pronounced shortness of breath and weakness. The results of the examination revealed CT signs of bilateral massive pulmonary embolism, pneumonia infarction with destruction cavities; ultrasound signs of thrombosis of the superficial femoral vein on the left. Taking into account the ultrasound result, implantation into the infrarenal position of the cava filter was performed. Based on the results of the examination and the course of the disease, surgical treatment for massive PE was recommended. The patient was hospitalized at the Bakulev Federal State Medical University, where the operation was performed: thrombendarterectomy from the pulmonary artery system, the postoperative period was complicated by heart and respiratory failure. Due to the development of recurrent pulmonary embolism. Transluminal balloon angioplasty of the pulmonary artery on the left was performed. Currently, the patient is in a satisfactory condition and continues to be monitored on an outpatient basis by his attending physician. Conclusion. The new coronavirus infection COVID-19 provoked the patient to develop a recurrent form of pulmonary embolism. Based on the results of laboratory and instrumental examination methods, as well as taking into account complaints and the clinical course of the disease, a thrombendarterectomy from the pulmonary artery system was performed. Due to the development of recurrent pulmonary embolism, transluminal balloon angioplasty was prescribed. After the operation, the patient's condition improved, and there were no complications of surgery.

Objectives. To analyze a clinical case of vape associated lung injury in a 23-year-old girl to demonstrate clinical manifestations of the disease, diagnostic algorithm of examination and compliance of the obtained results with the diagnostic criteria of EVALI syndrome (e-cigarette, or vaping, product use associated lung injury or lung damage associated with the use of electronic cigarettes or vaping). Methods. Analysis of the clinical course of vape-associated lung injury according to the data of anamnesis, general clinical examination of the patient, results of laboratory, radiological and instrumental methods of investigation. Results. The demonstrated description presents a clinical case of lung lesions on the background of vape smoking in a 23-year-old girl. The diagnosis of EVALI syndrome was made on the basis of full compliance of clinical manifestations, paraclinical and radiologic findings with the diagnostic criteria for vape-associated lung disease proposed by the Center for Disease Control and Prevention, a federal agency of the U.S. Department of Health for use in general medical practice: use of e-cigarettes for 90 days; pulmonary shading on chest radiologic evaluation; exclusion of pulmonary infection, including by active anti-tobacco campaign has significantly influenced public attitudes towards tobacco smoking. Conclusion:This clinical case of vape-associated lung damage is a clear example of the negative impact of vaping on human health.

Objective. To study the prevalence of certain geriatric syndromes (sarcopenia, osteopenia), visceral obesity and their combination in females aged 40 to 74 years in outpatient practice. Methods. 111 women were examined on an outpatient basis, aged 40-59 years (n=43) - group 1, aged 60-74 years (n=68) - group 2 with various comorbid pathologies. Anthropometric data (height, weight, BMI) were studied; we used the F-A-C-S algorithm (EWGSOP 2) to diagnose sarcopenia, with determination of muscle strength (MS) on the TVES-DMER-120 dynamometer, muscle mass (MM), lean body mass, visceral fat level (VF) using bioimpedancemetry (Multiscan BC-Oxi analyzer, Russia). Bone mineral density (BMD) was assessed using ultrasonic densitometry of the calcaneus (FURUNO CM-200 light, Japan) with determination of ultrasound speed (SOS m/s) and T-criterion. Results. The incidence of sarcopenia and osteopenia in women was similar in middle (30.3% and 33.7%) and elderly (58.5% and 56.5%) age in the study sample. Visceral obesity in old age was 2 times more common (82.4%) than on average (41.9%). In middle age, a “risk group” was identified for an unfavorable body composition profile (BCM): a combination of reduced MM (< 30% of BCM) and increased BWL (>9%) - the “sarcopenic obesity” phenotype. In old age, the number of such patients increased, which requires personalized approaches to prevention and treatment. There was no linear relationship between osteopenia and reduced MM values when studying BMD indicators (T-score) in this sample, however, with a decrease in BMI, there was a tendency towards an increase in the incidence of osteopenia in both middle-aged and elderly women. Conclusion. The study of BCM using bioimpedansometry in patients over 40 years of age in an outpatient setting allows us to identify a “high-risk group” for the development of sarcopenic obesity with a decrease in MM and an increase in VF, which requires further in-depth examination and observation of specialists (endocrinologists, geriatricians).

Objective. To provide a clinical case of treatment of a patient with arterial hypertension in combination with tachycardia. Methods. Outpatient follow-up, analysis of therapeutic and diagnostic tactics for the management of a patient with arterial hypertension in combination with tachycardia. The available literature on the effect of tachycardia and hypertension on the prognosis and risk of cardiovascular complications has been analyzed. Results. A clinical case of outpatient management of a patient with arterial hypertension and tachycardia is presented. The effect of antihypertensive therapy on clinical symptoms, blood pressure and pulse parameters is analyzed, and treatment results are described. Conclusion. The correct choice of antihypertensive drugs is an extremely important element of the therapy of patients with hypertension, occurring against the background of tachycardia. An adequate combination of antihypertensive drugs in such patients reduces the risk of mortality from cardiovascular complications. A differentiated approach to the selection of antihypertensive therapy is necessary for patients with arterial hypertension in combination with tachycardia, to improve the prognosis and reduce the risk of cardiovascular complications.

Objective. To identify the features of the main indicators during the ultrasound Doppler examination of the vessels of the brain and neck in children aged 7-11 years who are brought up in social institutions for minors who have suffered chronic hypoxia in the antenatal period of the tactical approach to providing assistance at this stage of development. Methods. The study involved 110 children of primary school age who were brought up in institutions of the social sphere for minors (n=110). The main group included 60 children experiencing chronic intrauterine hypoxia (n=60), the remaining 50 children, without chronic hypoxia in the antenatal period, made up the comparison group (n=50). The ultrasound examination was performed using a SIEMENS Acuson X-300 device. During the examination, standard accesses through the temporal and occipital windows were used. Ultrasound Dopplerography was performed in the supine and supine position, as well as examination of the vessels of the neck on the right and left: common carotid, internal carotid, external carotid and vertebral arteries. The following indicators were determined: linear blood flow rate (LSC, cm/s) and resistance index (RI). The average values were used to quantify the central trends of the analyzed samples. Results. In the main group of children, the values of peak systolic blood flow velocity in the anterior cerebral artery were 99.06±8.78 cm/s, the posterior cerebral artery was 84.31±8.07 cm/s, the vertebral artery was 76.75±6.11 cm/s and the main artery was 88.75±5.51 cm/s, which was significantly higher (p<0.05) than in the comparison group, where in these arteries the peak systolic velocity was determined in the intervals: 93.17±3.19 cm/s, 70.7±4.02 cm/s, 58.33±2.49 cm/s, 83.07±3.25 cm/s, respectively. When comparing the maximum final diastolic and time averaged blood flow rates, the interval values of which in children who have suffered chronic intrauterine hypoxia in the middle cerebral artery are 45.97±1.95 cm/s and 82.8±3.63 cm/s, the posterior cerebral artery is 40.95±2.5 cm/s and 62.63±5.12 cm/s, vertebral artery - 38.64±2.36 cm/s and 57.69±4.17 cm/s, the main artery - 41.17±2.6 cm/s and 64.96±3.68 cm/s, and in children who had no signs of chronic intrauterine hypoxia, in similar vessels: 57.38±4.57 cm/s and 91.52±6.94 cm/s, 32.84±2.03 cm/s and 51.77±2.97 cm/s, 29.01±2.09 cm/s and 43.67±2.06 cm/s, 38.3±1.83 cm/s and 60.69±2.34 cm/s, respectively, significantly higher (p<0.05) blood flow rates in the main group in the posterior cerebral, vertebral and main arteries were revealed, while significantly lower (p<0.050.05) in the middle cerebral artery, rather than in the comparison group. Significantly higher (p<0.05) values of resistance and pulse indices were observed in the main group in the middle and anterior cerebral arteries, and in the comparison group in the posterior cerebral and vertebral arteries, while no significant differences were found in the main artery (p≥0.05). Analysis of the results of ultrasound Doppler examination of the vessels of the neck showed that the children of the main group had significantly lower (p<0.05) values of linear blood flow velocity in the internal carotid artery, with values on the right 76.25±6.02 cm/s and on the left 74.37±5.49 cm/s versus the comparison group with intervals of 87.83±3.21 cm/s and 90.5±3.12 cm/s, simultaneously with significantly higher values (p<0.05) in the vertebral artery, where the values in the main group on the right and left are 67.13±2.34 cm/s and 67.25±3.3 cm/s, and in the comparison group 56.33±1.99 cm/s and 57.53±2.28 cm/s. Conclusion. The revealed features of cerebral hemodynamics during ultrasound Dopplerography of the vessels of the brain and neck in children aged 7-11 years who have suffered chronic intrauterine hypoxia indicate the possible nature of the occurrence of one or another variant of neuropsychiatric symptoms. The presence of chronic hypoxia in the prenatal period affects the processes of blood supply to certain areas of the brain, while these changes do not have a unidirectional character.

Objective. Using a clinical example, show the features of the course and diagnosis of a case of neurofibromatosis type I in a child. Methods. The work used clinical and analytical research methods. The article presents a clinical case of a child who is a pupil of the state government institution of the Astrakhan region "Specialized Children's Home "Kapelka" in Astrakhan, with a diagnosis of Q85.0 "neurofibromatosis type I". An analysis of the materials of the medical record of the pupil of the “Kapelka” orphanage, the results of clinical, laboratory, and instrumental examination methods was carried out. Results. Using a clinical example, a diagnostic algorithm for diagnosing neurofibromatosis type 1 was analyzed. In this case, the diagnosis was complicated by the antisocial nature of the family and the lack of monitoring of the child at the place of residence. The importance of physician vigilance regarding a rare orphan disease and timely diagnosis is noted. Conclusion. A competent approach to work and the pediatrician’s awareness of the diagnostic criteria of the disease made it possible to diagnose phakomatosis at an early age, which in turn will definitely contribute to improving the child’s quality of life and the timeliness of specialized medical care for a rare orphan disease.

Objective. To substantiate a program for supporting children aged 4-7 years of different types of psychoconstitution with chronic adenoiditis based on the identified differences in their health indicators and the characteristics of the clinical course of chronic inflammation of the nasopharyngeal tonsil. Methods. The study was carried out on the basis of the children's otorhinolaryngology department of the regional children's hospital in the city of Vladimir. A comprehensive assessment of the health of children with chronic adenoiditis was carried out, divided according to the scale of the direction of mental activity into types of introverts and extroverts. Results. The debut of chronic adenoiditis in introverts was at the age of 3-4 years, the main complaint was snoring with obstructive sleep apnea syndrome, the duration of the disease was about one and a half years, its course was complicated by frequent acute purulent otitis media, the prevalence of vagotonia and the formation of disorders of the dental system. In extroverts, chronic adenoiditis debuted at the age of 4-5 years, with a disease duration of about six months, its main manifestations were postnasal drip with night cough, signs of excessive sympathicotonia, early formation of exudative otitis media, hearing loss and the development of conductive hearing loss. Introverts were characterized by a predominance of microsomia and minimal indicators of the width and depth of the cavities of the skull and chest with maximum length; among the variants of physical development disorders - body mass deficiency. They were characterized by reduced social activity and high rates of fine motor skills and anxiety. In extroverts, the macrosomatic type with excess body weight predominated, had a high level of impulsiveness and aggressiveness, and good gross motor skills. Conclusion. The identified features of health and development indicators, the course of chronic adenoiditis in children 4-7 years of age of different types of psychoconstitution require individualization of their medical and social support, which should be the basis of a dispensary observation plan.

Objective. To study the etiology, pathogenesis, clinical symptoms, diagnosis and treatment of a rare genetic syndrome - Arbaleda-Tham syndrome. Methods. The authors present a clinical case of a 6-year-old child with Arbaleda-Tham syndrome. The analysis of the outpatient (f.112/y) and inpatient patient records, the results of clinical and anamnestic, laboratory and instrumental examination methods was carried out. Foreign literature sources (UpToDate, PubMed, ResearchGate databases) were analyzed, a comparative analysis of clinical and laboratory data, features of detection and diagnosis in previously described clinical cases of this rare pathology with the results obtained during the presented observation was carried out. Results. Arbaleda-Tham syndrome is a rare genetic disease caused by a mutation of the KAT6A gene. Common symptoms include varying degrees of mental retardation, delayed speech development, hypotension, pathology of the cardiovascular system, eyes and gastrointestinal tract. In most cases, variations in the KAT6A gene occur de novo. The article describes a clinical case of a rare genetic disease with a lesion of the KAT6A gene and clinical neurological manifestations. Conclusion. There are about 90 patients with Arbaleda-Tham syndrome all over the world. New diagnostic measures are being developed for better and earlier diagnosis of pathology, and, accordingly, early initiation of treatment.

Objective. Family Planning and Reproductive Health are core issue in context of large and diverse population of India's large and diverse population. This research is aimed at studying family structure and reproductive plans among unmarried (eligible) medical students from India, their ideas about premarital sex, contraceptive use. Methods. Using a specially designed questionnaire, an online survey was conducted of Indian students (n=241) of a medical university from India who are studying in Russia, India and other countries. The scenario of possible decisions regarding unplanned pregnancy in terms of the influence of family, cultural and social factors on it is analyzed. Particular emphasis in the study is placed on the issues of sex education in the families of respondents and the possible influence of the parental family on the reproductive plans of young people. Results. Analysis shows results, which correlate with world trends: the model of a family with 1-2 children, delayed reproductive plans, the predominance of material needs over family values, tolerant attitude towards premarital sex and a high willingness to terminate an unwanted pregnancy. Conclusion. The findings highlight the need for holistic approaches aimed at improving the health literacy of young people in matters of reproductive behaviour, timely familiarization with effective reversible contraception.

Objective. Experimentally measure the numerical values of the torque and angle of Azdent brackets. Compare and identify the differences between Roth and MBT prescription brackets from this company. Methods. Experimentally, using an electronic goniometer, the torque and angle of brackets of Roth and MBT prescriptions were measured. The angles were projected on millimeter paper by means of a directional light source. The obtained values were compared with the standard values. Results. Numerical values of the torque and angle for each bracket are obtained. A table has been compiled based on the results of the study to facilitate the comparison of brackets of various prescriptions. For Roth registration: braces for the upper canine have a torc of -2.05°±0.76°, different from the 0° specified in the standard specification. For the MBT prescription: braces for the lower canine have a torc of +0.05°±0.82°, different from the one specified in the standard characteristic of the torc parameters -6°; braces for the lower first and second premolars have an angulation of +2.10°±0.83° and +1.95°±0.79°, respectively, different from the angulation specified in the standard characteristic of the parameters at 0°. The value of the torc for the upper canine in the MBT prescription of the studied braces company is -0.10 ° ± 0.78°, has a significant difference from the norm variant of -6 degrees, which plays a role in the future position of the canines of the upper jaw in the dental arch and should be taken into account by orthodontists when choosing equipment and planning orthodontic treatment. The data are analyzed and recommendations for practical application are given. Conclusion. During the study, it was found out that Azdent's Roth and MBT prescription brackets have similar values of torque and angle to brackets from other manufacturers, with the exception of the lower and upper canines, the first and second premolars of the lower jaw. Thus, orthodontists can use brackets from this company along with brackets from other manufacturers, but they must make a treatment plan in accordance with these features.

Objective. To determine the importance of an integrated approach to the diagnosis and therapy of a non-valvular form of atrial fibrillation developing against the background of a variety of combined pathology. Methods. Collection, systematization and analysis of literature data on the clinical study of the mechanisms of development of atrial fibrillation against the background of a number of comorbid conditions, as well as a review of antiarrhythmic drugs, taking into account their characteristics and limitations for use in conditions of comorbidity. Results. The article presents an analysis of the results of scientific research on the mechanisms of atrial fibrillation in patients with chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, hyperthyroidism, chronic alcohol intoxication or obesity, as well as the main pathogenetic pathways of arrhythmogenesis in these conditions. It was revealed that the key factors in the development of atrial fibrillation are an imbalance in the work of neurohumoral systems (sympathetic and parasympathetic, natriuretic peptide, renin-angiotensin-aldosterone, kinin-kallekrein), persistent aseptic inflammation, oxidative stress, hemodynamic and electrolyte disorders, hypoxia, intoxication and heart remodeling. Conclusion. Management of comorbid patients with atrial fibrillation should be based on strategy of main risks minimization (prevention of cardioembolic stroke, venous thromboembolic complications, coronary events, decompensation of chronic heart failure, acute renal damage, worsening cognitive impairment, adverse events of anticoagulant and antiarrhythmic therapy of atrial fibrillation).

Objective. Study of the stability of model formulations of transdermal hydrogel with choline alfoscerate by long-term stability tests during storage under natural conditions for 12 months in aluminum tubes with internal lacquer coating from various manufacturers, as well as by the met. Methods. The authors developed the formulations of transdermal gel with choline nootropic alfoscerate and studied their stability by two methods. To study stability by long-term testing, gels of the two compositions were stored in a laboratory refrigerator in aluminum tubes at a temperature of 8-15°C and humidity of 55-65%, as well as in a dark place at room temperature of 20-25°C and humidity of 55-65%. Monitoring of indicators ("Description, Authenticity, Quantity, Single Impurity, Sum of Impurities, and Hydrogen pH") was carried out at certain intervals: immediately after the preparation of the gel (before packaging in tubes), as well as after 3, 6, 9 and 12 months of their storage. To study stability by the method of accelerated tests, gels in aluminum tubes were put into a thermostat at a temperature of 38-42°C and humidity of 70-80% for 9 months (which corresponds to 36 months of storage in terms of natural storage according to the method [1]). Results. When studying the stability of gels by the indicators "Description", "Quantitative determination", "Single impurity", "Sum of impurities", "pH", during all observation periods, insignificant changes in the quality of hydrogel No. 1 were recorded during the study by long-term tests during its storage at a temperature of 20 to 25°C, as well as from 8 to 15°C. Based on the results of accelerated stability tests, it was determined that the gel with choline alfoscerate of composition N1 could potentially have a shelf life of 24 months in a tube produced by Linhardt-Altai LLC. During the study of gel composition No. 2 by the method of long-term tests during 12 months of storage, it was determined that it complied with the standardized indicators when stored in tube No. 2 at a temperature of 8-15°C. Conclusion. According to the results of the studies, the stability results without significant changes in the quality of the drug were shown by a transdermal gel with choline alfoscerate of composition No. 1 (composition: choline alfoscerate, Ultrez10 carbomer, methyl hydroxybenzoate, 1M sodium hydroxide solution, purified water), which was stored at various temperatures in a tube manufactured by Linhardt-Altai LLC in natural conditions for 12 months during all periods of observation. It is promising to continue the study of the stability of gels by means of long-term tests for 24 months.

Objective. To determine the quantitative content of the amount of phenylpropanoids in stevia tincture. Methods. The objects of the study were samples of tinctures from stevia leaves on alcohols of various concentrations - 40%, 70%, 96%. Quantitative determination of the amount of phenylpropanoids was evaluated by direct spectrophotometry in terms of chlorogenic acid. Samples of tinctures based on stevia leaves were obtained by modified maceration, percolation maceration and remaceration. The resulting tinctures are a transparent or opalescent brown-green liquid, the smell is specific, the taste is sweet Results. A study of the amount of phenylpropanoids in stevia tincture was conducted. The presence of phenylpropanoids was confirmed by direct spectrophotometry in a tincture of stevia leaves, the analytical maxima of the studied compounds were determined - 290 and 330 nm. The optimal extractant was determined - 70% alcohol, the optimal method for obtaining tincture was chosen. It was revealed that the content of phenylpropanoids in stevia tinctures varies in the range from 1.71 to 2.95%. Conclusion. Thus, studies have been conducted on the production and standardization of stevia tincture. As a method for quantifying the amount of phenylpropanoids of stevia tincture, we have proposed a method of direct spectrophotometry with the determination of the amount of phenylpropanoids in terms of chlorogenic acid, at an analytical wavelength of 330 nm.

Objective. Compare the content of iron, manganese, copper, zinc, selenium, chromium and cobalt in the raw materials of membranous astragalus, woolly-flowered astragalus, pepper mountaineer, bird mountaineer, buckwheat, horsetail, madder dye and in the thick extracts obtained from them. Methods. The studies were carried out on an atomic absorption spectrometer "Kvant-2A", a mercury-hydride generator "GRG-111", laboratory scales VK-600, using a muffle furnace SNOL 8,2/1100, a water bath LOIP LB-161 (TB-6/W), RSO selena. The methods used are regulated by the following normative documentation GOST 30692-2000; GOST 32343-2013; GOST 31651-2012. Results. In the analyzed samples of raw materials of membranous astragalus, woolly-flowered astragalus, pepper mountaineer, bird mountaineer, buckwheat, horsetail, madder dye and the thick extracts obtained from them, the quantitative content of the following trace elements was calculated: iron, manganese, copper, zinc, selenium, chromium and cobalt. Conclusion. As a result of the conducted research, a comparative quantitative analysis of trace elements in raw materials and thick extracts was carried out, and methods with a high yield of trace elements in extracts were proposed.

On the occasion of Lyudmila Vyacheslavovna Kozlova's 75th anniversary, the article provides a brief overview of her life path and significant contribution as a teacher and scientist to Russian medical education and medical science; as a pediatrician and public figure to the development of the Smolensk Pediatric School and practical healthcare in Russia.