Introduction. Cystic fibrosis (CF) is a genetic disease that leads to dysfunction of internal organs and significantly increases the risk of respiratory infections. According to the N. P. Bochkov Medical and Genetic Research Center, 1 out of 9,000 newborns suffers from CF. Chronic disease has a negative impact on mental health and can contribute to the development
of anxiety and depressive disorders, as well as accentuated traits and personality disorders.

   Aim. To summarize the currently available data on mental disorders in patients with CF, as well as to summarize current recommendations regarding the management of patients with this disease.

   Materials and methods. Articles were searched in Google Scholar databases, eLIBRARY.ru, Elsevier, PubMed from 2014 to 2024 by key words in Russian and English in accordance with the purpose of the study.

   Results. It has been established that mental health problems are associated with worse compliance to the treatment, as well as difficulties with self-organization and self-care. Some hypotheses that explain the pathogenesis of mental disorders have been provided. The key characteristics of course and clinical presentation of mental disorders in this group of patients have been described. Some potential recommendations for the treatment are provided, taking into the account the specificities of the metabolism of psychotropic drugs in people with CF. The tactics of management, including the creation of a multidisciplinary team that would consist of a doctor of somatic profile, psychiatrist and a psychologist. A strategy for development of this aspect of medical care for patients with CF has also been proposed.

   Conclusion. Drawing the attention of the scientific community to the problem of mental disorders in patients with CF will allow the introduction of methods for monitoring mental status and early detection of symptoms, and will also entail the creation of multidisciplinary teams, including a psychiatrist and a medical psychologist.

   Metabolically associated steatotic liver disease (MASLD) is becoming a major public health problem, especially among the elderly. The recent change in nomenclature from “nonalcoholic fatty liver disease” to “MASLD” reflects a more accurate understanding of the pathogenesis of the disease, linking it to metabolic disorders such as insulin resistance, obesity, and metabolic syndrome. This new terminology emphasizes the importance of a comprehensive approach to the diagnosis and treatment of the disease, given its close association with metabolic disorders and cardiovascular risk. Current estimates suggest that 24 % of the adult population, i. e. one billion people worldwide, suffer from the disease. Interestingly, the prevalence of fatty liver disease peaks between the ages of 40–50 years in men and 60–69 years in women, and then declines slightly in older age groups (over 70 years). The prevalence of MASLD is increasing worldwide, reflecting the increasing incidence of obesity, type 2 diabetes mellitus, and metabolic syndrome. The elderly are particularly susceptible to MASLD due to age-related metabolic changes, comorbidities. Aging is associated with changes in lipid metabolism, insulin resistance, and increased fat mass, which predispose the elderly to hepatic lipid accumulation and subsequent liver damage. In addition, age-related decline in the liver»s regenerative capacity may exacerbate the progression of hepatic steatosis to advanced stages such as steatohepatitis and hepatic fibrosis. However, MASLD in the elderly remains under-recognized and under-diagnosed, posing challenges for timely intervention and treatment. Prospects for addressing MASLD in the elderly emphasize the importance of comprehensive geriatric assessment, including evaluation of metabolic health and liver function.

   Aim. To search for factors associated with the occurrence of a difficult-to-treat state, reflecting the characteristics of both the patient and his disease, as well as preceding treatment.

   Materials and methods. The analysis includes data of patients with rheumatoid arthritis (RA) from the Moscow Unified Arthritis Registry (MUAR). All included patients received вiological Disease-Modifying Antirheumatic Drugs (bDMARDs) and / or targeted synthetic DMARDs (tsDMARDs). Prior to this, all patients were treated with tsDMARDs. The group of difficult-to-treat patients included persons in whom attempts to treat bDMARDs / tsDMARDs with the first two classes of drugs were not successful, and attempts to use bDMARDs / tsDMARDs were continued. Patients in whom an attempt to treat bDMARDs / tsDMARDs of the first or second class proved effective and treatment with the appropriate drug lasted at least 2 years are not difficult-to-treat. All other cases were excluded from the analysis. The differences between the two groups were studied according to various indicators, including demographic, anthropometric, indicators describing the features of the disease, clinical manifestations of the onset and further course of the disease. From the indicators that demonstrated significant differences between the groups, significant independent predictors of difficult-to-treat
state were identified within the linear-logistic regression model by forward stepwise selection. Data describing preceding treatment were analyzed within the framework of a multifactorial linear logistic model with included selected independent predictors of achieving difficult-to-treat state (resistance to treatment).

   Results. In the study were included 1044 patients, including 112 patients (10.7 %) were classified as difficult-to-treat. As significant independent predictors of treatment resistance, the following were identified: a patient’s message about an increase in body temperature at the onset of the disease of more than 38°C (p < 0.001); a patient’s message about swelling of the hands during the disease (p = 0.033); the presence of rheumatoid nodules (p = 0.022); a relatively short time since the appearance of joint pain till contacting a doctor (p = 0.021). A significant relationship was found between
bDMARD / tsDMARD used as first-line drug and the subsequent categorization of the patient as difficult-to-treat (p = 0.013). In patients receiving tofacitinib or rituximab in the first line of targeted therapy, the risk of subsequent treatment resistance was significantly lower than in patients receiving tumor necrosis factor inhibitors (iFNO): relative risk (RR) 0.017, 95 % confidence interval (CI) 0.04–0.72) and RR 0.47, 95 % CI 0.22–0.98), respectively. The analysis of the second line of targeted therapy revealed a significant advantage of etanercept over some other classes of bDMARDs / tsDMARDs in terms of the risk of subsequent treatment resistance. Thus, RR for other drugs of the iFNO class was 2.48 (95 % CI 1.13–5.44, p = 0.023); for abatacept – 3.15 (95 % CI 1.488–6.68, p = 0.003), and for tocilizumab – 2.57 (95 % CI 1.03–6.40; p = 0.043).

   Conclusion. The analysis of data from the registry of patients who were in real clinical practice made it possible to identify patients who accurately meet criteria of the European Alliance of Associations for Rheumatology for difficult-to-treat RA and patients who exactly do not meet them. A comparative analysis of the groups revealed predictors of following classifying the patient as difficult-to-treat. Based on the listed signs, high-risk groups of resistance to treatment with bDMARDs / tsDMARDs can be identified. The results obtained give grounds for the preferred use in such patients on the first line of treatment of tofacitinib or, possibly, other JAK kinase inhibitors, and on the second line of etanercept.

   Aim. To describe a clinical case of differential diagnostics of motor phenomena during sleep.

   Materials and methods. Patient B., 37 years old. Visit to a somnologist at the University Clinic. Complaints were mainly made by the patient’s wife, since the patient himself does not remember these episodes. According to the wife, sudden sweeping movements of the arms and legs, incoherent speech are noted during sleep, then the patient gets up, can grab his hands, behaves aggressively, shifts things. These complaints have been noted for more than 10 years, with a gradual worsening of symptoms. A neurologist at the place of residence suggested a possible epileptic nature of these episodes,
but no further examination was carried out.

   Results. From a semiological point of view, motor phenomena during sleep can imitate epileptic seizures, parasomnias, rapid eye movement behavior disorders, and normal sleep motor phenomena such as fragmentary sleep myoclonus, periodic limb movements, bruxism, etc. A differential diagnostic search is provided, a comparative characteristic of motor phenomena during sleep and wakefulness is given, as well as a scale of frontal epilepsy and parasomnia, which can help the doctor in making the correct diagnosis.

   Conclusion. Conducting a comprehensive examination of the patient and clarifying the clinical diagnosis made it possible to choose the correct management tactics, avoid unjustified prescription of antiepileptic drugs, and reduce emotional stress in the family due to the ambiguity of the manifestations of night motor phenomena. The established clinical diagnosis allows monitoring the patient in terms of the possible debut of a neurodegenerative disease.

   Pulmonary Hypertension (PH) is a hemodynamic and pathophysiological condition characterized by an increase in mean pulmonary artery (PA) pressure by at least 20 mm Hg at rest, measured during right heart catheterization. One of the fastest and most accessible screening non-invasive diagnostic methods for assessing the likelihood of this condition is echocardiography, which is performed according to the standard transthoracic echocardiography protocol, focusing on visualizing and describing certain parameters that characterize function of heart right chambers. In patients with PH, structural changes in the heart right chambers can be observed, such as enlargement of the right atrium and right ventricle, changes in their geometric shape, thickening right ventricle wall, dilatation of the main PA and its branches, and the appearance of tricuspid regurgitation. Pulmonary artery pressure can be measured using either the velocity of the tricuspid regurgitant jet or the ratio of the time acceleration of flow in the outflow tract of the right ventricle to the ejection time (mean pressure in the PA), or the velocity of the pulmonary regurgitation jet (end-diastolic pressure in the PA). Classic parameters of the functional state of the right ventricle, as well as additional indicators of the evaluation of the right ventricular function, for example, the ratio of the amplitude of movement of the fibrous ring to systolic pressure in the PA, called the right ventriculoarterial coupling, should be evaluated only in expert centers providing care for patients with PH. Correct and timely diagnosis, clear dynamic monitoring of the patient’s condition play a crucial role in prescribing targeted treatment and predicting the disease course.

   Metabolic syndrome (MS) is a complex of metabolic disorders, including insulin resistance, abdominal obesity, diabetes mellitus, hyperuricemia and arterial hypertension. According to the World Health Organization, the number of people with obesity worldwide is steadily increasing, taking on the characteristics of a “pandemic”. Against this backdrop, diseases pathogenetically linked to MS, such as osteoarthritis (OA), are gaining particular significance. Modern biochemical and molecular-genetic research has provided new data on the etiology and pathogenesis of OA, allowing the identification of phenotypes of the condition. One such phenotype is OA associated with MS, or metabolic OA. The development of this form of the disease is influenced by numerous factors, including hypersecretion of pro-inflammatory adipokines, transformation of synovial macrophages, direct effects of free fatty acids, biomechanical overload of joints, and others. Treatment of metabolic OA, in addition to standard approaches outlined in numerous clinical guidelines, has its own specific features. Particular emphasis is placed on weight reduction through lifestyle modification, strengthening of musculo-tendinous complexes, and concomitant therapy for metabolic disorders. These measures have demonstrated significant therapeutic effects, including pain reduction, decreased inflammation, and slowing of disease progression. One of the modern comprehensive remedies with phytonutritional components is Revocca capsules (“BIOTECHNOS”, Russia). Their composition in daily dosage includes phytosterols (calculated as β-sitosterol) at 100 mg, unsaponifiable compounds from avocado and soybean oils (in a 1:2 ratio) at 300 mg, rosehip extract at 300 mg, resveratrol at 70 mg, and zinc (as zinc citrate) at 12 mg. Given the increasing number of patients with the metabolic phenotype of OA, comprehensive hypolipidemic and anti-inflammatory therapy provided by multi-component drugs is becoming increasingly significant.