This article shows the importance of post-registration (post-marketing) monitoring of the use of drugs. The periods of the formation of the pharmacovigilance system at the regional level and the complication of tasks at the stages of development of the regional pharmacovigilance system are considered, the frequency and control of adverse reactions associated with the use of drugs in the Novgorod region are studied. Insufficient activity of specialists is a significant problem, therefore, a significant role should be assigned to systematic, explanatory work to form a correct understanding of the tasks to be solved to overcome the negative consequences of drug use and create a modern regional pharmacovigilance system, strengthen the role of clinical pharmacology and pharmacy. It is necessary to continue work on more complete involvement of specialists in the collection of information on adverse reactions to drugs.

The article considers the issues of assessing the safety level of pharmacotherapy of chronic diseases of the mental group in Pskov region. It was found that the most expensive are antipsychotic drugs required for the treatment of epilepsy and schizophrenia. A frequency analysis of the incidence of side effects when taking psychotropic drugs was carried out and their systematization was carried out into two groups: type A predictable reactions and type B unpredictable side effects, while it was found that side effects are most often encountered with the use of anticonvulsants. The study used materials from the database of the Regional Center for Monitoring the Safety of Medicines of the State Public Healthcare Institution of Pskov Region "Department of Pharmacy" containing information on drug intolerance of psychiatric patients for 2017…2019. When processing the data, methods of descriptive statistics, system grouping, aggregation, and generalization of information, as well as methods of pharmacoeconomic, pharmacoepidemiological and frequency analysis were used. In 2017…2019 in Pskov region, schizophrenia and epilepsy were the significantly predominant diseases among patients with mental disorders, while in patients taking anti-schizoid drugs, side effects were relatively rare, and taking antiepileptic drugs was often accompanied by the presence of side reactions. Among the main psychotropic drugs used for the pharmacoprophylaxis of schizophrenia and epilepsy, Quetiapine, Risperidone and Topiramate were relatively safe.

To assess the chronic pain (CP) prevalence among the long-livers, as well as both prevalence and spectrum of contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for systemic non-invasive use. The study included 1101 patients aged 90+ years old (median — 92 years) who applied for medical aid. Contraindications to analgesics were identified according to the effective versions of product labellings. CP was diagnosed in 51% of women and 52% of men. In the study population we found 1225 contraindications (mean: 2.18±0.056 per patient). The number of contraindications was significantly higher in men (2.51±0.056) compared to women (2.05±0.063, р<0.001). The contraindications to both analgesic classes were also more common in men compared to women (22.3% versus 12.5%, р<0.01). The most commonly seen contraindications corresponded to cardiovascular pathology (75% of patients). The general prevalence of contraindications to NSAIDs among the long-livers with CP was rather high (91-93%). On the contrary, the contraindications to opioids were 5-6 times less common (14-24% of patients, р<0.001). The prevalence of CP among the long-livers is 52%. The high prevalence of the contraindications to NSAIDs allows to use these drugs only in approximately 10% of patients. The contraindications to opioids were significantly less commonly seen. Up to 22.3% of long-livers with CP have contraindications to both NSAIDs and opioids and need alternative approaches to pain-relieving therapy.

Prenatal exposure to gangleron and, to a lesser extent, metamizil leads to significant violations of the motivational component of sexual function in sexually mature offspring of males, expressed in low values of manifestation of primary sexual activity, and an increase in approach latency and sexual dysfunction after acquiring sexual experience. Among the causes of sexual dysfunction in offspring, one can note a change in the hormonal background in male rats, in the form of a significant decrease in the level of the main androgen testosterone, as well as damage to the dopaminergic systems of the brain, manifested in a decrease in the level of dopamine. 

Mediator substances in the nervous system are divided into two large groups neurotransmitters, which carry out signal transmission at the synapse, and neuromodulators, which regulate signal transmission. Neurotransmitters are divided into amino acids (glycine, glutamate and aspartate) and biogenic amines. Neuromodulators, in turn, are subdivided into four large groups: neuropeptides (endorphin, met-enkephalin, calcitonin, substance P), derivatives of fatty acids (eicosanoids and arachidonic acid), purines and pyrimidines (extracellular ATP, ADP, adenine) and gaseous substances (NO, CO and H2S). Neuromodulators, in comparison with neurotransmitters, do not have an independent physiological effect, but modify their effect, their action has a tonic character. The target of a neuromodulator can be not only the postsynaptic membrane and not only membrane receptors. It acts on different parts of the neuron, and its action can be intracellular. Systems of neurotransmitters and neuromodulators play an important role in the functioning of the nervous system and the body as a whole. The study of their functioning and regulation can serve as a fundamental basis for the study of the brain in normal and experimental pathology, creating a basis for the subsequent extrapolation of the obtained data to humans.

The analysis of the results of treatment of 101 patients with purulent-destructive diseases of the lungs and pleura, depending on the implementation of ozone therapy is carried out. With this in mind, patients were divided into 2 groups. Group I included 50 patients with purulent-destructive diseases of the lungs and pleura, who underwent standard antibiotic therapy and surgical treatment. Surgical treatment included thoracotomy, pleurectomy and, according to indications, lobectomy. Of these, abscesses of the lung lobe were revealed in 19 (38.0%) patients, and pleura empyema in 31 (62.0%). In group II, 51 patients in combination with traditional antibiotic therapy and surgical treatment, additionally carried out local and general (intravenous infusion) ozone therapy. Of these, 16 (31.4%) were diagnosed with lung abscess, and the remaining 35 (68.6%) had pleural empyema. The criteria for analysis were the dynamics of lipid peroxidation (LP) and antioxidant activity (AOA) of blood plasma, as well as medium-weight molecules (MSM), reflecting the state of endogenous intoxication upon admission and its change during treatment. A comparative analysis of the treatment results in the studied groups showed that the use of ozone therapy in group II promotes the mobilization and activation of the body’s defenses, normalization of lipid peroxidation processes and activation of antioxidant protection, which results in an improvement in treatment outcomes, which allows substantiating the etiopathogenetic expediency of its use in this pathology.

The data of medical records of patients who applied for a consultation at the Novgorod clinical specialized center of psychotherapy were analyzed. It is found that in clinical practice, it is difficult to differentiate schizophrenia and obsessive-compulsive disorder in some cases, since the patient may have both ego-syntonic and ego-dystonic thoughts. Clinical symptoms of obsessivecompulsive disorder may be the first signs of schizophrenia, the diagnosis of which becomes clearer over time. Clinical symptoms of obsessive-compulsive disorder were differentiated from those of schizophrenia, taking into account the common genetic loci in affective disorder and schizophrenia. The pathogenetic and pathophysiological mechanisms of the formation of obsessive-compulsive symptoms are discussed. Various therapeutic strategies are analyzed, which take into account the approach with the reduction of emotions due to the circumstances that cause them, or due to the direct influence on emotions. In the first case, psychotherapeutic measures are used, and in the second, pharmacotherapy, which served as the main hypothesis in the formation of a comprehensive method of rehabilitation based on rational pharmacotherapy, acting on a significant emotion.

In order to elucidate changes in the number and morphometric parameters of neurons and neuroglial cells in the mesolimbic dopaminergic system of the brain (MDS), dopamine deficiency in the centers of which is considered to be the main prerequisite for the formation of addictions, 0.1 mg of opiates were administered during preand postnatal exposure to this system. 1% solution of morphine hydrochloride inside the amnion of fetuses of female Wistar rats (n = 5) on the 17th day after fertilization and intraperitoneally to rat pups on the 4th day after birth (n = 5). It was found that the perinatal effect of morphine on MDS in rats causes atrophic changes, swelling and death of some neurons, a decrease in the volume and shrinkage of the remaining unchanged neurons. Damage to neurons, more pronounced during prenatal exposure, is accompanied by an increase in the number of microglia cells and their phagocytic activity. Morphine exposure does not change the number of satellite macrogliocytes and the average distance between them and the bodies of viable neurons.

The morphological state of the liver was analyzed in 145 patients with cholestasis of non-neoplastic etiology, who were treated at the Novgorod Regional Clinical Hospital and the Central City Clinical Hospital of Veliky Novgorod. The results of liver biopsy during surgery, as well as puncture liver biopsy 5 days and 3 weeks after decompression operations were studied. There were pronounced structural and functional changes in liver tissue that progressed with increasing duration of occlusion. In cases with prolonged chronic jaundice, after decompression of the bile ducts, sclerotic changes, histiolymphocytic infiltration and proliferating biliary epithelium remain in the portal tracts. The study of puncture and intraoperative biopsies in obstructive jaundice makes it possible to determine the form and severity of cholestasis, which, together with other data, affects the prognosis of the disease and the tactics of surgical treatment. With cholestasis of varying duration, it is necessary to carry out measures as early as possible aimed at correcting violations of liver morphology.

Literature data on the pathogenetic relationship of the components of the metabolic syndrome are presented, and pediatric aspects are highlighted. Data from 20 obese children and 20 healthy children were analyzed. It was found that all the examined children with obesity have basic and / or additional diagnostic criteria for MS, which is a risk factor for early development of diseases of the cardiovascular system. It was shown that the main criteria of MS were revealed statistically more often in obese adolescents: AH, visceral obesity, dyslipidemia, IR. At the same time, the leading link in the pathogenetic interaction of these components can be assumed to be excessive fat deposition by abdominal type.

The morphofunctional state of the kidneys and liver in patients with chronic cholestatic hepatitis has been studied. The patients underwent preoperative complex conservative therapy. In the presence of cholecystolithiasis, 62 patients underwent video-laparoscopic cholecystectomy. Moreover, for medical reasons, selective liver vagotomy, electrocoagulation of the liver with laparoscopic extraperitoneal hepatophrenopexy, while maintaining bilirubinemia at the level of 60–70 µmol/l, lymphovenous anastomosis was indicated in 48 patients. The functional state of the liver was assessed according to the results of biochemical blood tests. To study the functions of the patient, a simple urine test and Reberg—Tareev test were performed. It was revealed that there is a clear relationship between the functional indicators of the bilirubin level. Surgical treatment with preoperative preparation helps to improve the function of the liver and kidneys, but in chronic hepatitis of moderate to high activity it does not fully eliminates the electrolyte imbalance.

The analysis of the results of a morphological study carried out on 10 female dogs weighing 12.7-15.4 kg, depending on the regional ozone therapy after trauma to the visceral peritoneum of the uterine horns. The experimental studies were carried out in compliance with the principles of humane treatment of animals and in accordance with the ‘Rules for conducting studies using experimental animals’ of the Ministry of Health of the Russian Federation. In total, 2 series of experimental studies were carried out. In series I, regional ozone therapy was not performed in 5 animals after surgery and traumatization of the peritoneum of the fallopian tubes in the postoperative period. In series II, 5 animals intraoperatively after traumatizing the fallopian tubes were catheterized to the branch of the middle uterine artery, and in the postoperative period, ozonized saline was infused twice a day at the rate of 1.0 ml per 1 kg of animal weight for 5 days. After 14 days, a repeated laparotomy was performed, the injured uterine horn was excised for morphological examination. The preparations obtained during operations were fixed according to a standard technique, embedded in paraffin, ultrathin sections were prepared, and stained with hematoxylin with eosin and according to Van Gieson. The analysis criteria were changes in the morphological structure in comparison with the control data of the preparations obtained during the first operation. It was found that in series I, compared with indicators in II, where regional ozone therapy was carried out, there was a significant increase in connective tissue elements in the serous and underlying muscle layers (P <0.05), with a significant decrease in muscle fibers (P <0.05). The vascularization indices in series II significantly exceeded the results of the study in series I (P <0.05), where regional ozone therapy was not performed. Thus, carrying out regional ozone therapy in the early postoperative period creates the preconditions for reducing the risk of an increase in the specific gravity of connective tissue elements in the wall of the uterine horns, and, accordingly, reduces the risk of the influence of surgical trauma on the development of destructive morphological changes in them, which may result in reproductive changes associated with them violations. This research reveals the need for further investigation.

Skin cancer occupies one of the leading positions in the structure of oncological diseases both in Russia and around the world. In recent years there has been a steady increase in the number of reported cases of diseases malignant neoplasms of the skin. This pathology is one of the socially significant problems. This article discusses the main issues of carcinogenesis of malignant skin neoplasms, their morphology and epidemiology on the example of the Novgorod region. Basal cell carcinoma accounts for the largest number of cases in the overall morbidity structure. This trend is typical both for the Novgorod region and for the whole world. The relevance of this topic is primarily due to the constant increase in the incidence of this pathology and the need for an interdisciplinary approach to solve this problem.

A study was carried out on the change in sperm fertility in 73 men included in the in vitro fertilization program with preliminary indicators of normospermia depending on infection during COVID-19 quarantine. Prior to quarantine, all study participants had a PCR test for COVID-19 negative. When a second study was carried out after quarantine, with negative results of the PCR test, Ig G was detected in 38 of 73, with negative results for IgM to COVID-19. With this in mind, the study participants were divided into 2 groups. Group I included 35 men in whom antibodies to COVID-19 were not detected in the blood during the ELISA (enzyme-linked immunosorbent assay) test. Group II consisted of 38 men in whom Ig G to COVID-19 was detected upon repeated blood tests. Considering that 4 of them had azoospermia after acute respiratory syndrome with COVID-19 complicated by respiratory failure, they were not considered. Comparative analysis of spermogram indices after quarantine showed that in group II, against the background of a general tendency towards negative sperm parameters that determine its fertility, the total number of sperm in the test material (P <0.05) significantly decreased, which, in combination with a significant decrease in progressively motile (P <0.05) and the total number of motile spermatozoa (P <0.05), both in relation to the indicators before quarantine and the results of sperm analysis in group I intact according to COVID-19, Thus, infection with COVID-19 even in an asymptomatic or subclinical study that does not require seeking medical attention, it is a pathogenetically significant factor in reducing male fertility. It is advisable to continue research in this direction. Further study of the issue is still required.

Based on the fundamental principles of the principle of dominance by A.A.Ukhtomsky, the theory of functional systems by P.K. Anokhin, studies on the general adaptive syndrome of G. Selye, taking into account the peculiarities of the reaction of the human body to the effects of psychological stressors, as well as the results of our own studies, methods for assessing endogenous intoxication after psychological interventions, protected by RF patents for inventions, a pathogenetic substantiation of the development of neurotoxicosis after psychological correction of previously experienced stressful situations was carried out. For a modern lifestyle, the priority reaction to the influence of a psychological stressor has become the strategy of ‘fading’, characterized by suppression of emotional arousal and a cognitive assessment of the situation and various possible scenarios of its development, often in a negative context. Against the background of activation of the sympathoadrenal system and suppression of emotional excitement, in conditions of peripheral vasospasm at the organism level, anaerobic catabolism becomes a priority, with the formation of neurotoxins, some of which are deposited in the body. At the same time, in the central nervous system, against the background of continuous exposure to psychological stressors leading to psychological trauma, a stagnant suppressed focus of excitation is formed, which has a negative effect on the behavioral and physiological patterns of response to the stimulus. During the psychological correction of post-traumatic stress disorder, accompanied by an intense emotional reaction, a stagnant focus of excitation is activated, which plays the role of a trigger for the reaction in the “fight-flight” format at the body level. In turn, this leads to activation and release of neurotoxins from the depot, which in the post-correction period are accompanied by phenomena of endogenous intoxication, including neurointoxication. Further research is needed in this direction.

The theoretical substantiation of the pathogenetic significance of psychological stress on the increase in body weight and alimentary obesity in the modern lifestyle was carried out. The methodology for substantiating the concept under consideration was based on the principle of dominant by A.A. Ukhtomsky, the theory of functional systems by P.K. Anokhin, concepts on the general adaptation syndrome of H. Selye and the metabolic syndrome of G.M. Reaven, the peculiarities of the energy supply of the central nervous system under conditions of acute chronic psychological stress. Acute psychological stress increases functional activity of the central nervous system. Consumption of glucose and oxygen increases accordingly. The deficiency of endogenous glucose is replenished in the daytime due to the intake of food rich in carbohydrates, which is regulated by the reciprocal alternation of excitationinhibition of the ventromedial and ventrolateral nuclei of the hypothalamus, which determines the eating habits. After evening meal, during sleep, the energy and plasticity of the central nervous system is restored. At the same time, after replenishing the deficiency of carbohydrates by glycogen catabolism in the liver, lipid synthesis increases. Lipids enter the bloodstream and are deposited in adipocytes. Against the background of anticipation under the permanent influence of psychological stress, the accumulation of energy carriers, lipids, is initiated, which leads to weight gain, and then alimentary obesity. Thus, psychological stress is a trigger for the activation of the functional activity of the central nervous system, which first leads to a change in the body’s metabolism, and then, due to anticipation, initiates the accumulation of lipids deposited in adipocytes. In turn, this first leads to weight gain, and then the development of alimentary obesity.

The rapid dissemination of SARS-CoV-2 has resulted in over 54 million infections and about 1,3 million deaths. SARS-CoV-2 can damage the kidneys, heart, intestines, lungs and other organs. The question of the effect of SARS-CoV-2 on the mucous membrane of the appendix in children remains open. The aim of the study was to assess the molecular genetic profile of cytological processes in the tissue of the appendix in the children with COVID-19. Fragments of the appendix of the children with confirmed COVID-19 (n = 24) were studied by real-time polymerase chain reaction to determine the expression of SARS-CoV-2 RNA and genes encoding protein complexes: ACE-2 and Furin. In patients affected by COVID-19, the presence of coronavirus genetic material in the appendix was recorded. Increased expression of ACE-2 and Furin was found in the tissue, what determines favorable conditions for coronavirus defeat. Based on the results of RT-PCR for SARS-CoV-2 and the expression of ACE-2 and Furin, we can talk about the viral load in the appendix in children.

The paper gives a brief literature review of the development of allergic reactions associated with HIV infection. Main statistic data of HIV and allergic diseases in the Russian Federation was reviewed. Information on the development of allergic diseases in HIVinfected patients based on clinical and laboratory data is presented. Special attention in the study of allergies in HIV-infected patients is paid to drug hypersensitivity since allergic reactions to certain drugs may complicate the selection of antiretroviral therapy and treatment of comorbidity. Drug hypersensitivity is considered for each class of drugs used for antiretroviral therapy in HIV-infected patients. Certain examples of antiretroviral drugs that often develop allergic reactions are given.

Professionally important psychological and psychophysiological qualities (PIQ) of an osteopathic doctor are identified according to expert assessments provided by lecturers of the V.L.Andrianov Institute of Osteopathic Medicine (IOM). With the help of Multipsychometre, a hardware and software system for psychodiagnostics, psychophysiological testing of 35 students majoring in osteopathy was carried out, which allowed one to assess skills and qualities of an individual that matched psychophysiological profile of this specialty. The results of factor analysis (main components) enabled us to determine the significance of psychological and psychophysiological qualities that are necessary for successful training of osteopaths.

The research examines the participation of such personal characteristics as aggression and readiness for risk in the system genesis of the conflict-induced behavior of subjects. Relationships between the indicators of heart rate variability (HRV) and the personal characteristics of athletes when performing the standard exercise test PWC₁₇₀ were showed. During analysis of heart rate and personal characteristics of athletes, correlations between degree of readiness for risk and index of aggression with indicators of total power of HRV spectrum and value of maximum oxygen consumption were revealed. The work also shows that the objective result of activity is ambiguously correlated with aggression and readiness for risk. The effectiveness of the subject's current sports activity depends not only on the level of his physical working capacity, but also on his personal characteristics.

The aim of the paper is to evaluate the effectiveness of osteopathic treatment of patients with chronic bronchitis (smokers) based on the study of indicators of the functional state of the body. Changes in the health status and quality of life of 24 patients (men and women) aged 35-45 years with a diagnosis of chronic bronchitis were evaluated. Among them, 2 groups of individuals were identified: the control group (n = 12), who received medication (inhaled forms of bronchodilators, mucolytics, antibiotics according to indications), and the treatment group (n = 12), who received osteopathic treatment as an add-on therapy (from 8 to 10 sessions once a week for 2.5-3 months). Changes in indicators of osteopathic status, functional state of the body (subjective state, severity of psychoemotional stress, psychovegetative status, functional state of the respiratory system) and quality of life were evaluated in the course of the study with the help of SF-36 questionnaire. It was shown that at the background of osteopathic correction of somatic dysfunctions, there was a significant improvement in the functional state of the patient’s body.

The study examined the psychological status of children with urinary dysplasia. Play therapy as well as fun physical exercises were used to impact the psychoemotional background of children with chronic health conditions. When children are troubled and struggling to adapt, in the course of the play children can use imagination and escape to another stress-free reality. Based on the data obtained from the study, a positive dynamics of indicators of psychological development was revealed for all the considered test scores in children who received sufficient physical therapy. To solve the problem of forming a positive psycho-emotional outlook, integrated work of various services that provide the rehabilitation process is necessary. Methods for assessing the psychoemotional status in children with urinary system pathology should be more widely used by health care professionals who implement physical therapy programs at the stages of rehabilitation, including evaluating the effectiveness of integrating play in physiotherapy. In conclusion, it seems that play therapy has a beneficial impact on the care of hospitalized children.

The analysis of the results of treatment of 67 patients with acute nonspecific inflammatory diseases of the uterine appendages was carried out. Depending on the complex treatment of this pathology with the use of local and general ozone therapy, 2 groups of patients were formed. All patients considered in this study signed an informed consent and mutual agreement on the confidentiality of personal data and research program. 36 patients of Group I were given standard treatment of acute nonspecific inflammatory diseases of the uterine appendages. Group II (n=31) was given ozone therapy on top of the standard treatment. Ozone therapy included both local and general effects. When conducting local ozone therapy daily, 2 times a day, the genital tract was sanitized by irrigation with ozonated 0.9% sodium chloride solution. To correct local hypoxia and neutralize endotoxicosis, intravenous infusions of 200.0 ml of 0.9% NaCl solution were carried out daily 2 times a day. The analysis criteria were the dynamics of oximetry indicators, nitrogen balance (residual nitrogen (OA), creatinine, urea, uric acid, nitrogen-containing compounds (ACC) and the CASS / OA ratio, reflecting the state of endogenous intoxication upon admission and its change after 3 days against the background of treatment. Comparative analysis of oximetry indices showed that 3 days after the start of treatment, oxygen saturation in patients of Group II increased significantly faster (P <0.05) than in Group I, where ozone therapy was not carried out in the treatment of nonspecific inflammatory diseases of the uterine appendages. In Group II, the indicators of nitrogen balance and the coefficient of endogenous intoxication of CASS / OA normalized, which indicated the high efficiency of ozone therapy in the treatment. At the same time, the positive dynamics in Group II significantly exceeded the indicators in Group I (P <0.05), which testified to the pathogenetic feasibility of including ozone therapy in the complex of measures in the treatment of acute nonspecific inflammatory diseases of the uterine appendages.

A clinical and anthropometric study of 96 men who had suffered cryptorchidism in childhood was conducted. During the examination, attention was paid to physical development, distribution of subcutaneous fat, amount of body hair, genitalia, and body proportions. The type of pubic hair was determined visually. Regression scales were used to assess individual physical development. The study found that most of them have symptoms of hypogonadism: infertility, impotence, sparse body hair, insufficient development of secondary sex characteristics, eunuchoid habitus.