Objective: to evaluate the efficacy of the combination of 150 mg thixagevimab and 150 mg cilgavimab in prevention of coronavirus infection (COVID-19), as well as the incidence of acute respiratory viral infections in comorbid patients during of 6 months’ study.
Methods and materials: the 6-month prospective observational study of patients with a high risk of COVID-19 was performed, the start of the study was in June 2022. The study included 74 patients divided into 2 groups of 37 people. Patients of the 1^st group received the intramuscular injection of 150 mg of thixagevimab and 150 mg of cilgevimab at the time of inclusion in the study with the aim of prophylaxis of COVID-19. The remaining 37 patients were assigned to the control group; they did not receive this prophylaxis. The groups were similar in age, comorbid diseases and vaccination against COVID-19 and influenza. The frequency and severity of COVID-19 and acute respiratory viral infections in groups were recorded. Statistical processing was carried out in the Statistica 10 program using the χ² test, differences were considered statistically significant at p<0.05.
Results: During 6 months of follow-up, 1 case of COVID-19 was registered in the 1^st group and 8 cases in the 2^nd group, accounting for 2.7% and 21.6%, respectively (p=0.013, χ²=6.2), all cases of the disease were confirmed by positive PCR tests for SARS-CoV-2 and manifested clinically. In the 1^st group a new coronavirus infection was developed in a patient vaccinated against SARS-CoV-2 2 months after the administration of a combination of thixagevimab 150 mg and cilgavimab 150 mg, it proceeded in a mild form. In the 2nd group, cases of COVID-19 were mild in 5 patients and moderate in 3, while 6 of 8 patients were vaccinated against COVID-19. During the 6-month period acute respiratory viral infections had 13 patients of the group 1 (35.1%) and 22 patients (59.4%) of group 2, p=0.037.
Conclusion: Application of the combination of 150 mg thixagevimab and 150 mg cilgavimab reduced the incidence of COVID-19 and acute respiratory viral infections in high-risk patients during 6 months of follow-up. 

The aim of the study was to study the prospects of histaminergic and imidozolinergic drugs for thetreatment of acute period of traumatic brain injury.
Material and methods. The study was performed on 182 mongrel mice with a body weight of 20-26 g who had suffered a traumatic brain contact injury (TBI). TBI was applied using the modified Allen method under nembutal anesthesia. The skull and brain bones were damaged symmetrically on both sides. To determine the anti-ischemic activity of drugs, a decapitation model of complete cerebral ischemia (gasping) was used. The antihypoxic activity of substances was determined by the duration of the reserve time in mice under conditions of normobaric, progressive hypoxia with hypercapnia, Changes in the functioning of compensatory mechanisms of the brain were studied by determining the rate of production of active avoidance reactions. The drugs were administered intravenously for 6 or 9 days of the acute period in the following dosages: betaserk 16 and 24 mg / kg, moxonidine 0.2 and 0.4 mg / kg, diphenhydramine 50 mg/ kg. The reliability of the differences (control-experience) was assessed according to the Student's criterion (t) and the Mann–Whitney criterion (U).
Results. Unlike diphenhydramine, an antagonist of H1-histamine receptors, betaserk, an antagonist of H3-histamine receptors, and moxonidine, an agonist of I1-imidazoline receptors have a favorable anti-ischemic effect in the acute period of traumatic brain injury. Against the background of the administration of drugs, starting from 2 days after TBI, a favorable therapeutic effect was found when prescribing betaserk at a dose of 16 and 24 mg / kg. The drug increases the duration of gasping by 42%-73% (P < 0.05). The effect of moxonidine was less significant (29-34%) (P<0.05), and diphenhydramine showed no pronounced protective effect. The administration of drugs for 9 days showed that moxonidine increases the resistance of injured mice to hypoxic stress by 18.4% (P< 0.05), betaserk – by 13.9%, and diphenhydramine reduces it by 13%. Betaserk additionally activates the production of simple adaptive responses In animals, there was a 51% decrease in the number of samples spent on the production of URAI, and a 16% reduction in training time (P<0.05). On the contrary, moxonidine slows down the process of developing a simple adaptive response.
Сonclusion. The study obtained evidence of neuroprotective properties of histaminergic and imidozolinergic drugs.

The aim of the research: assessment of the quality of life of doctors in the Trans-Baikal Territory.
Materials and methods. A sociological study was conducted with the creation of a questionnaire based on the WHOQOL-100 questionnaire, including scales of physical health, psychological state, level of independence, social relations, and the environment. Two groups of respondents took part in the survey. The study group consisted of 475 doctors of various specialties employed in state medical organizations of the Trans-Baikal Territory. The control group included 242 residents of the region working in various fields of activity, who are not medical workers. Statistical processing of the data was carried out using the method of parametric analysis with the calculation of relative values, their errors, Student's criterion was used. The difference was considered statistically significant at p<0,05.
Results. When assessing physical health, it was determined that doctors have more employment at work (47,3±3,2%), additional employment (45,1±3,2%), pay little attention to hobbies, recreation (8,9±1,2%) (p < 0,05), which leads to a decrease in vital activity. According to the psychological health scale, it was found that doctors often experience negative emotions (55,7±3,2%) (p < 0,05). According to the independence scale, the prevalence of a high level of efficiency among doctors was reliably determined (30,8±3,0%), in comparison with the control group (p < 0,05). When assessing social relations, both among doctors and in the control group, a relatively high level of satisfaction with relationships in the team and with close people was noted. According to the environmental scale, there is low satisfaction with the financial situation among doctors (48.9 ± 3.3%), lack of opportunity to fully rest (16,9 ± 2,4%), which negatively affects the state of health and reduces the quality of life.
Conclusion. When assessing the quality of life of doctors of the Trans-Baikal Territory, lower indicators were determined on the scales of physical and psychological health, which is associated with complex physical and intellectual work, responsibility for the health and life of patients. 

Purpose: to investigate the indicators of regional blood circulation according to ultrasound dopplerography of the neck vessels and rheoencephalography with “isolated” dyscirculatory encephalopathy (DE) and in combination with chronic ischemic neuroopticopathy to clarify the possible pathogenetic mechanisms of the comorbid state formation.
Materials and methods of research. 77 patients aged 58 to 72 years were examined, 15 patients were in the control group, 62 patients were diagnosed with stage 2 dyscirculatory encephalopathy. According to the presence/absence of chronic ischemic neuroopticopathy, the latter group was divided into two: the first – with “isolated” DE (n=30), the second – with DE in combination with chronic ischemic neuroopticopathy (n=32). All patients underwent Doppler Ultrasonography of brachiocephalic vessels (DU BCV) and rheoencephalography (REG).
Results. In patients with DE, against the background of atherosclerotic lesions of brachiocephalic arteries of varying severity, the tone of large cerebral arteries increases; a tendency to angiospasm of small arterial vessels is recorded; venous outflow from the cranial cavity is disturbed. The addition of chronic ischemic neuroopticopathy in dyscirculatory encephalopathy is accompanied by changes in the DU BCV and REG: pronounced atherosclerotic lesion of the neck vessels, an increase in the intima-media complex thickness; the formation of stenoses in the bifurcation area from 2 sides; a decrease in the speed of blood flow through the carotid arteries and its branches; a decrease in systolic blood flow in all brain basins; an increase in peripheral vascular resistance reflecting angiospasm of arterioles, more pronounced in VBB; an increase in hypertension of large, medium and small arteries; deterioration of venous outflow from the cranial cavity.
Conclusions. The revealed violations of regional blood circulation according to the DU BCV and REG data in patients with dyscirculatory encephalopathy may be pathogenetic mechanisms of the comorbid pathology formation and accompany the debut and progression of chronic ischemic neuroopticopathy in these patients.

The aim. Study of changes in trace elements and their relationship with markers of an inflammatory response in a new coronavirus infection.
Methods. On the basis of the Regional Clinical Infectious Diseases Hospital of Perm in 2021-2023. a comprehensive clinical and laboratory examination of 514 patients with a new coronavirus infection was carried out, of which 217 people suffered a severe infectious disease, were hospitalized in the intensive care unit (ICU), 297 patients of moderate severity - in a specialized department. By the method of mechanical selection, 2 groups of 171 people were formed: the first group of 72 people. - ICU patients, the second group of 99 people. - Patients of a specialized department. The average age of patients in group 1 was 57,9 years, in group 2 – 59,2 years. On the 1st and 21st days of hospitalization, all patients underwent laboratory studies of trace elements - iron, zinc, copper, selenium and vitamin D 25 (OH), as well as the absolute number of lymphocytes, IL-6, C-reactive protein, procalcitonin, fibrinogen, ferritin.
Results. The study of trace elements on the 1st day of hospitalization revealed a deficiency of Fe, Zn, Se, as well as vitamin D deficiency in patients of both groups, aggravated in the dynamics of the disease. Stable indicators of Cu were determined in patients with severe and moderate course, changes in the Cu/Zn ratio in ICU patients in dynamics. A correlation was found between the indicators of Zn, Se, vitamin D, the ratio of Cu and Zn with registered complications that led to deaths in groups 1 and 2. The relationship between Zn and inflammatory response markers was revealed: in group 1 - r=0.612, p=0.008, in group 2 - r=0.531 p=0.019, Cu/Zn ratio - r=0.812, p=0.000, 0.015, vitamin D in 1 - r=0.794, p=0.000, in 2 - r=0.682 p=0.009, respectively.
Conclusion. The formation of trace element deficiency has a direct impact on the course of a new coronavirus infection, regardless of the severity of the disease. Low micronutrient levels should be considered as a predictor of COVID-19 severity and poor outcome.

Aim: to study the state of the glutathione system in patients with diffuse liver lesions in combination with chronic herpes infection on the background of a secondary immunodeficiency condition.
Methods. 47 patients with diffuse liver lesions (DLL), combined with chronic herpetic infection (GI) on the background of secondary immunodeficiency (VIDS) were examined. The study excluded patients with the presence of markers of hepatitis C virus (HCV) and HBV in the blood, after examination by enzyme immunoassay (ELISA), as well as patients with alcoholic and autoimmune hepatitis. All patients were prescribed a biochemical blood test. Using the PEF-3 device, the activity of lactate dehydrogenase (LD) and its isoenzyme spectrum was also determined by electrophoresis in agar gel. In all examined patients, the content of reduced glutathione was additionally investigated, based on the fact that glutathione reacts with an excess of aloxane.
Results. The data obtained indicate a significant decrease in the activity of enzymes of the glutathione system in patients with diffuse liver lesions, combined with chronic herpetic infection against the background of VIDS, which consequently becomes unable to fully resist the damaging effect of excessive lipoperoxidation products accumulating in the blood of patients. There was a certain positive dynamics of the studied biochemical parameters after the completion of treatment of the combined pathology of the hepatobiliary system (GBS) and CGI by conventional methods, but there was no complete restoration of the glutathione system to normal.
Conclusions. When using conventional therapy for the treatment of patients with diffuse liver lesions, combined with chronic herpetic infection against the background of VIDS, positive dynamics is observed on the part of biochemical parameters, but the state of the glutathione system is not fully restored and does not reach the norm.

Objective. The aim was to study the frequency of occurrence and characteristics of epileptiform activity in children with autism and alalia without epilepsy.
Materials and methods. We analyzed the results of video EEG monitoring in 30 children with autism spectrum disorders (26 boys and 4 girls) and 19 children with alalia (10 boys and 9 girls) without epilepsy at the age of 3 - 7 years. All children underwent video-electroencephalographic monitoring to determine the nature of changes in bioelectric activity.
Results. Epileptiform activity was registered in 43.3% of children with autism spectrum disorders and in 63.2% of children with alalia. We detected regional epileptiform activity in 30.0% of cases in children with autism spectrum disorders and in 47.3% of alalia patients. Bilateral synchronous, diffuse and generalized activity occurred in 13.8% and 15.8% of cases, respectively.
Conclusion. The data obtained allows to clarify the frequency of occurrence and epileptiform activity characteristics in children without epileptic seizures with autism spectrum disorders and alalia.

The aim of the research. To study and evaluate the level of P53 protein in elderly patients with viral pneumonia caused by SARS-COV-2 at discharge in a comparative aspect with elderly without viral pneumonia.
Materials and methods. Two groups of patients were included in the study – the main group (n=49) and the comparison group (n=20). The main group included patients diagnosed with "COVID-19, virus identified" hospitalized in an infectious hospital, the comparison group included elderly people without viral pneumonia. The level of P53 protein was determined using the method of immuno-enzyme analysis in blood serum. The level of P53 protein was analyzed depending on the degree of respiratory failure (DN), the degree of lung damage according to computed tomography (CT) and the amount of comorbid pathology.
Results. According to the results of the analysis, a statistically significant decrease in the level of protein p53 (p<0,001) was revealed in the patients of the main group. The level of p53 protein at admission was 89,4 [79,1 – 118,5] pg/ml versus 26,6 [22,4 – 35,6] pg/ml at discharge. Analysis of the p53 protein level depending on the degree of respiratory DN and the number of comorbid diseases showed the presence of statistically significant differences (p=0,002, p=0,036). In 42,9% (21 people), the value of the p53 protein level in patients of the main group coincided with the interquantile ranges of the comparison group, and in 57,1% (28 people) of the main group of patients, the value of the p53 protein level was higher. The value of the p53 protein level in the main group at discharge was higher than in the comparison group among patients with DN 0 in 47,1%, with DN I in 55,6% and in 100% with DN II. Among patients with CT0 in 33,3%, with CT1 in 48% and in 71,4% with CT2. Among patients with two or less comorbid diseases, 50% and 81,8% of patients with three or more comorbid diseases.
Conclusions. In 57,1% of elderly patients with viral pneumonia caused by SARS-COV-2, upon discharge from the hospital, the level of p53 protein did not reach the values of elderly people without viral pneumonia. The level of p53 protein in elderly patients with viral pneumonia caused by SARS-COV-2 at discharge is higher than in elderly patients without viral pneumonia was recorded in patients with DN II (in 100%), CT2 (71.4%) and in patients with three and more comorbid diseases (in 81,8%). Statistically significant differences in elderly patients with viral pneumonia caused by SARS-COV-2 upon discharge from the hospital were revealed by analyzing the level of p53 protein depending on the degree of DN and the amount of comorbid pathology.

The leading position in the structure of childhood disability is occupied by cerebral palsy (CP) – a complex and multifaceted disease of the nervous system, affecting various spheres of patients' life. The publication considers the modern understanding of cerebral palsy in children. Epidemiology issues are described, examples of national databases of cerebral palsy patients are given. The causes, pathophysiological mechanisms of cerebral palsy development are characterized. Parallels are drawn between anamnestic, genetic factors and clinical forms of cerebral palsy. Attention is paid to predicting the development of cerebral palsy depending on the concentration of various metabolites in the body. Most of the known biologically active substances lack specificity and are not used in routine clinical practice for the diagnosis of cerebral palsy. Criteria for early diagnosis of cerebral palsy are presented in the publication in terms of age, assessment of movements, and functional activity. The problem of timely diagnosis, formulation depending on etiology is highlighted. Different classifications taking into account topography, severity of motor disorders are discussed. The article presents the main clinical features of the disease and international approaches to treatment and rehabilitation measures based on the review of scientific literature sources.

The literature review presents an analysis of publications by Russian and foreign authors on clinical and laboratory indicators characterizing the immune system of patients with varicella, using modern databases – RSCI, PubMed, Scopus. Taking into account the urgency of the problem of infectious disease, insufficient knowledge and the presence of contradictory results of scientific researchers in the field of immunopathogenesis of varicella, the expediency of further study of the designated direction in science has been revealed.

Aim. Update the level of knowledge of neurologists and therapists about the features of the clinical pattern of metabolic syndrome (MS) caused by taking valproic acid (VPA).
Materials and methods. The review was conducted on the databases PubMed, Web of Science, Springer, Google Scholar and e-Library.
Results. The risk of developing VPA-induced MS depends on the dose and duration of taking VPA, as well as on genetic predisposition. This ADR significantly worsens the quality of life of patients who receive VPA for a long time. In addition to weight gain and insulin resistance, VPA-induced MS is accompanied by dyslipidemia, arterial hypertension and type 2 diabetes mellitus. Changes in the metabolome in patients receiving VPA for a long time include a set of changes in the level of metabolic biomarkers in biological fluids and various organs and tissues of the body, including peptides, lipids, amino acids, nucleic acids, carbohydrates, biogenic amines, vitamins and minerals. Such changes in the metabolome can not only significantly affect the phenotype of the disease, but also the expected therapeutic response to VPA and significantly affect posttranslational processes, including secondary transcriptome and proteome changes in patients with neurological diseases and mental disorders.
Conclusion. The problem of VPA-induced MS is an important interdisciplinary problem of neurology and therapy, requiring a personalized approach to prognosis and early diagnosis in order to increase the safety of psychopharmacotherapy and improve the quality of life of patients with neurological diseases and mental disorders.

The review presents an analysis of information from literary sources and personal experience, highlighting the probable causes, clinical and laboratory symptoms, diagnostic features, possible combinations of kidney and urinary tract defects in children, both in isolation and in combination with congenital structural and functional disorders of other organs and systems. It has been repeatedly noted that an unfavorable prognosis is largely determined by the degree of complexity of the defect and the presence of an obstructive component. This review is illustrated by several clinical examples of complex anomalies of the urinary system in newborns, infants and young children.

Since the beginning of the COVID-19 pandemic, there have been reports about the peculiarities of the course of a new coronavirus infection in a special group of patients - pregnant women. Physiological, immunological changes in the pregnant woman's body lead to the transformation of innate and adaptive immune responses from an inflammatory phenotype to an anti-inflammatory one, suppressing fetal immune rejection reactions and contributing to the passive transmission of maternal antibodies to the fetus. Currently, there is evidence of possible vertical transmission of a new coronavirus infection from mother to fetus and the impact of SARS-CoV2 on the fetus on the thrombogenic orientation of its hemostasis, with the development of adverse outcomes. Literature review and clinical case of an unfavorable perinatal outcome of a COVID-19 infection during pregnancy with the development of hemostasis disorder in a newborn are presented.

Idiopathic striatopallidodentate calcification (Fahr's disease/syndrome, idiopathic non-atherosclerotic calcification of intracerebral vessels, idiopathic calcification of the walls of cerebral vessels with progressive dementia) is a chronic neurodegenerative disease with an exchange component belonging to the orphan group. This nosology is based on the deposition of calcium and iron salts in the walls of small cerebral arteries, as well as directly in the structures of the central nervous system: in the cerebral hemispheres, basal ganglia, and cerebellum. Given the multiple lesions of various parts of the brain, the clinical picture of this disease is polymorphic and manifests itself with various symptoms (asthenia, coordination and speech disorders, extrapyramidal syndrome), which, together with a rare occurrence, leads to significant difficulties in diagnosis and, as a result, to a later onset. treatment. This article presents literature data and describes a clinical case of Fahr's disease in a young patient. The debut of the disease was accompanied by focal cervical dystonia with further gradual involvement of the axial muscles and muscles of the upper extremities over the next few years.

Cryptococcus is increasingly regarded as a pathogen with a growing number of clinically manifest cases of acquired immunodeficiency syndrome. Usually cryptococcosis is manifested by damage to the lungs, central nervous system or skin. Cases of cryptococcosis with a description of bone marrow lesions are few. A case of generalized cryptococcal lesion in an HIV-infected patient with pronounced splenomegaly and generalized lymphadenopathy is described. The initial diagnosis was established on the basis of microscopy of bone marrow and confirmed by PCR study. The problems of diagnosis of cryptococcosis and differential diagnosis with other infectious lesions of the hematopoietic organs with the detection of pathogens by microscopy of bone marrow are discussed.