Chronic heart failure is common among the population. In addition to the necessary drug treatment of this disease, non-drug approaches to management and rehabilitation of patients are also of great importance. One of the main approaches is physical training which can be divided into several types: high-intensity interval training, moderateintensity aerobic training, and resistance training. A search for literature reviews, systematic reviews and meta-analyses from 2023–2024 was performed in the eLibrary, Google Scholar and PubMed databases using relevant keywords. An analysis of the identified sources was performed, the results of which were also compared with the studies published in 2010–2014. All types of physical training had positive effect on the health of the patients. The advantage of high-intensity interval training and resistance training over moderate-intensity aerobic training in the short and intermediate term was shown, which was later smoothed out, probably due to a decrease in patient adherence to non-pharmacological treatment and kinesiophobia. At the same time, the greatest efficacy of the rehabilitation process and positive impact were achieved by combining different types of training, taking into account cognitive, mental and physiological characteristics of the patient, as well as their social, household, and economic capabilities. Telemedicine technologies and personalized selection of treatment tactics taking into account the stages of treatment and rehabilitation the patient was at, as well as a number of measures such as raising awareness and training the patient, improving their communication and interactions with medical personnel, psychological support and treatment of anxiety and depressive disorders helped to improve compliance.

Aim. To evaluate the effectiveness of the drug “Polypeptide from the brain of pig embryos” in correction of imperative urinary incontinence after cerebral ischemic stroke.
Material and methods. The trial was randomized, controlled, blinded with concealment through envelopes. The trial included 170 patients in the early recovery period after cerebral ischemic stroke who were at the second and third stages of medical rehabilitation. Patients in the main group (n = 89) received the domestic drug “Polypeptide from the brain of pig embryos” 1 ml (0.1 mg) subcutaneously daily for 10 days, while those in the control group (n = 81) received only drugs for secondary prevention of ischemic stroke. The groups were comparable in terms ofsex, age, medical and biological parameters, subtypes of cerebral ischemic stroke, period of ischemic stroke, neurologic deficit, severity of cognitive and emotional disorders, and urological symptoms. Research methods included analysis of complaints and history ofthe patients, clinical somatic and neurologic examinations, evaluation of neuro-urologic symptoms using questionnaires, laboratory diagnostics, ultrasound of the urinary tract, urodynamic examinations, and follow-up for 6 months.
Results. During the examination, pollakiuria was diagnosed in 69 (77.5 %) patients in the main group and 64 (79.0 %) in the control group, episodes of imperative urinary incontinence were diagnosed in 43 (48.3 %) patients in the main group and 38 (46.9 %) in the control group, urinary urgency was diagnosed in 41 (46.1 %) patients in the main group and 37 (45.7 %) in the control group; nocturia was diagnosed in 28 (31.5 %) patients in the main group and 25 (30.9 %) in the control group. The intensity of urinary urgency in points was 3.2 in the main group and 3.1 in the control group; the frequency of daytime pollakiuria was 12 ± 0.8 in the main group and 12 ± 0.7 in the control group; episodes of imperative urinary incontinence were 5 ± 0.6 in the main group and 5 ± 0.5 in the control group; cases of night awakenings/trips/night urination in absorbent underwear were 3 ± 0.9 in the main group and 3 ± 0.7 in the control group. Statistically significant differences were obtained in the main group in the form of a decrease in the number of patients with urinary urgencies, daytime pollakiuria, episodes of imperative urinary incontinence compared to the baseline level (p <0.05).
Conclusion. The use of “Polypeptide from the brain of pig embryos” demonstrated a decrease in the frequency of imperative urges, pollakiuria, imperative urinary incontinence, nocturia and the severity of the imperative urge in patients with ischemic stroke.

Aim. To illustrate a comprehensive approach to management of a patient with long-standing generalized tophaceous gout, taking into account concomitant comorbidities, as well as to analyze the factors influencing adherence to therapy and lifestyle modification.
Material and methods. Patient N., 54 years old, with a 16-year history of gout, multiple tophi, hyperuricemia, stage C2 chronic kidney disease (glomerular filtration rate 69.8 ml/min/1.73 m2), dyslipidemia, grade 1 obesity, and nephrolithiasis. A comprehensive clinical, laboratory, and instrumental diagnostic evaluation was performed, and the nature of joint changes and the comorbidity degree were verified. Specialists prescribed uric acid-lowering therapy with febuxostat (80 mg/day), along with preventing therapy for recurrent gouty arthritis using colchicine (0.5 mg/day), rosuvastatin (10 mg/day), and measures for dietary and weight correction.
Results. Against the background of the ongoing therapy, a sustained clinical and laboratory effect was achieved over four months: serum uric acid levels decreased to 282 µmol/L, no arthritis recurrences were recorded, and positive dynamics in the volume of tophaceous infiltration were observed. The patient demonstrates a high level of compliance, following the treatment regimen and recommendations on diet and physical activity.
Conclusion. Modern management of gout requires a comprehensive approach that includes pharmacotherapy and lifestyle modification. However, in practice, only a few patients achieve target uric acid levels, indicating the need to strengthen prevention, educational programs, and improve adherence to treatment.

Despite the progress in treatment approaches, infective endocarditis remains a severe life-threatening disease with high mortality rate. Growing antibiotic resistance, as well as the ability of microorganisms to form biofilms, complicate the treatment of this disease. The available guidelines emphasize the need for early initiation of empirical antibiotic therapy immediately after blood sampling for bacteria culture test, followed by correction depending on the sensitivity of microorganisms. Combinations of intravenous broad-spectrum bactericidal antibiotics effective against bacteria in biofilms are used. The issue of switching from intravenous forms of antibiotics to outpatient oral therapy is actively discussed in literature. The key problems in treatment of infective endocarditis at the present stage are the tolerance of microorganisms capable of forming biofilms to ongoing treatment and the growth of antibiotic resistance. Improved microbiological diagnostics, introduction of new therapeutic strategies, and compliance with clinical guidelines are necessary to improve outcomes of infective endocarditis. Individual characteristics of the patient, characteristics of the pathogen, and possible risk factors should be taken into account. The combined effect of antibacterial drugs, both “traditional” and “new”, as well as the use of drugs that do not belong to the antibacterial group, may significantly increase survival and reduce the number of complications in patients with infective endocarditis.

Vestibular migraine (VM) is a common but underdiagnosed form of migraine. The incidence of VM according to various population studies is about 3 %. Like other forms of migraines, VM is more common in women, especially of periand postmenopausal age. Apart from headaches and dizziness being the most frequent complaints to neurologists, according to the latest statistical data VM is also the most common cause of episodic vertigo. Currently, there aren’t any instrumental diagnostic methods that could confirm presence or absence of vestibular migraine. Diagnosis of this disease is based on results of clinical examination and anamnesis of the patient. Diagnostic criteria, jointly developed by the International Headache Society and the Barany Society, make it possible to diagnose probable or definitive vestibular migraine based exclusively on clinical and anamnestic data. Therapy of VM is based on the same principles as other migraines: relief of attacks and preventive therapy aimed at reducing the severity and frequency of the attacks. However, there are not enough studies on the effectiveness of classical antimigraine therapy in vestibular migraine, and currently in the medical community there are no generally accepted guidelines on treatment of this disease. Despite this, due to the accumulated experience of previous years, possibilities of vestibular migraine therapy are quite extensive and can be effectively applied in routine clinical practice of a neurologist.

Aim. To identify sensorineural hearing loss and ear noise in patients with chronic cerebral ischemia on an outpatient basis, and to evaluate the experience of using combined neurotropic therapy in this category of patients.
Material and methods. The study included 50 patients with chronic cerebral ischemia (CIG), with hearing impairments of varying degrees, ear noise, vestibular, cerebro-asthenic syndrome, and who had an outpatient appointment with a neurologist. All patients underwent a scale assessment of VAS – a visually analog scale of ear noise, VAS-G – a visually analog scale of dizziness, THI – a subjective scale for assessing the severity of ear noise, MFI-20 – a scale of severity of asthenia. All patients in the study group were treated with сellex on the background of complex therapy in the form of two courses of therapy with an interval of 20 days. Before the start of treatment, after the end of the first and second courses of treatment, testing was carried out according to appropriate scales and questionnaires, as well as otoneurological and audiological examinations.
Results. In the study group of patients, a varying degree of sensorineural hearing loss was detected, as well as a high comorbid background, with most patients experiencing subjective noise of varying intensity, as well as moderately pronounced vestibular syndrome and cerebral asthenic syndrome. After the complex treatment, there was a statistically significant subjective improvement in hearing and speech intelligibility, as well as a statistically significant decrease in indicators on the scales of subjective assessment of noise and dizziness, a decrease in general, physical and mental asthenia. The most statistically significant difference in positive changes was noted after a second course of therapy.
In conclusion, the positive results of this study can be considered a decrease in the severity and severity of symptoms of sensorineural hearing loss, which achieved statistically significant improvement after the second course of therapy, a decrease in the manifestations of ear noise, a decrease in asthenia, a decrease in the feeling of dizziness and instability against the background of neurotropic therapy with сellex. In this situation, preference should be given to drugs with a multimodal mechanism of action, potentially affecting various levels of disorders in vascular pathology of the brain, including the auditory analyzer, as well as contributing to the processes of neuroplasticity of the brain.