Review is focused on modern treatment of asthma, one of the most prevalent and significant respiratory diseases in the world. Goals of long-term asthma management and different treatment tracks for symptoms control and risk reduction based on international and national recommendations are discussed.

The widespread prevalence of chronic kidney disease (CKD) is due to a variety of modifiable and unmodifiable risk factors. Among the second group, such perinatal risk factors as premature birth, delayed intrauterine development, preeclampsia, and low birth weight are considered the most important.

Within the framework of the hypothesis of fetal programming of adult diseases, the article discusses the prevalence of these complications and possible mechanisms of CKD formation in both mother and child.

Regulation of water-salt metabolism is complex and is determined by many factors. Diuretics have affinity for renal tissue and limit the reabsorption of sodium ions in the nephron and secondarily reduce the reabsorption and secretion of other ions and water.

Classifications of diuretics are given, the mechanisms of their action are considered, and the main indications for use are listed, taking into are indicated, taking into account the newly discovered mechanisms, contraindications and side effects are listed. Attention is focused on the use of drugs of other groups that have a diuretic effect. Gliflozins - blockers of sodium-glucose cotransporter-2 type, are promising drugs for overcoming resistance to diuretics. Vaptans inhibit membrane aquaporin transporter proteins (AQPs), are coupled to vasopressin receptors, and reduce water reabsorption in collecting tubules without affecting natriuresis. Vasopressin receptor blockade accelerates the elimination of fluid from the body and improves the symptoms and signs of CHF with short-term use. The diuretic effect can be caused by lithium by a sharp decrease in AQP-2 in the apical membrane of the collecting tubules. Screening of new diuretics involves further study of pendrin inhibitors as monotherapy and in combination with known diuretics. Screening of new diuretics involves further study of pendrin inhibitors in the form of monotherapy and in combination with known diuretics. Prospects for the development of diuretics are outlined.

In modern practice, both classical diuretics and new drugs with an additional diuretic effect and a number of pleiotropic properties, including cardio- and nephroprotection, are used. The action of classical diuretics is not limited to the diuretic effect. They have been proven to improve the prognosis in patients with chronic heart failure and chronic kidney disease, form the basis for the treatment of ascites in cirrhosis of the liver, facilitate the achievement of target blood pressure values and reduce cardiovascular risks as part of combination therapy, and are effective in glaucoma.

This article is a review of published clinical cases of tophaceous lesions of the musculoskeletal system. Tophaceous lesions of organs and tissues are more common in long-term gout, but sometimes they can be the first manifestation of the disease. The aim is to systematize the data presented in the literature on clinical cases of tophaceous lesions of the musculoskeletal system. Materials and methods: review of literature on the presented clinical cases. Results: tophi may occur in various structures of the musculoskeletal system with the development of non-specific symptoms of varying severity depending on the level and volume of the lesion. Conclusion: tophaceous lesions of the musculoskeletal system should be considered in patients with corresponding complaints and an existing diagnosis of gout or the presence of hyperuricemia.

The article presents an analysis of federal clinical guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis, discusses current problems of diagnosis and treatment of progressive fibrosing pulmonary disease. The authors propose changing the existing medical tactics, this will facilitate early diagnosis and adequate treatment, and therefore improve the prognosis for the life of this category of patients.

Introduction. IgA-nephropathy (IGAN) is the most common glomerulopathy worldwide leading to chronic kidney disease (CKD) progression and end stage renal disease. In the last decade sodium-glucose cotransporter type 2 inhibitors (iSGLT2) including dapagliflozin are considered to be the excellent  option for CKD treatment. However, the efficacy of dapagliflozin in patients with IgAN was analyzed only in few studies which had some serious limitations. We conducted the present study to reveal the effects of the drug in the real clinical practice.

Methods. In this retrospective study we enrolled patients with IGAN (n=30) who were diagnosed and treated in nephrology clinic of Pavlov University during 2022. Inclusion criteria were: primary variant of IgAN, eGFR≥25 ml/min/1.73 m² at the time of the diagnosis, follow-up period ≥6 months (mo) from the time of diagnosis/ dapagliflozin initiation, absence of diabetes mellitus. Patients were divided on 2 groups: on dapagliflozin treatment 10 mg/day (Dapa+, n=19) and without iSGLT2 therapy (Dapa-, n=11). In all patients we evaluated basic clinical and demographic parameters including 24h proteinuria and eGFR at the time of kidney biopsy and at 6, 12, 18 and 24 mo of follow-up. All tissue samples were classified by MEST-C (Oxford classification). Tubular atrophy/ interstitial fibrosis was estimated semiquantitatively as T0, T1 and T2 corresponding to < 25%, 25-50% and >50% of cortex involved, respectively.

Results. Basic clinical and morphological parameters were compared between Dapa+ and Dapa-. Reduction of 24h-proteinuria in Dapa+ was greater than in Dapa- at 12 mo (M (IQR): -1.14 [-2.04;-0.31] vs -0.5 [-1.26;+0.34] g/day, p=0,042), 18 mo (M (IQR): -1.09 [-1.98;-0.4] vs -0.84 [-2.4;+0.73] g/day, p=0,042), and 24 mo (M (IQR): -1.34 [-1.68;-0.86] vs -0.78 [-1.02;+0.32] g/day, p=0,021). There was no difference in eGFR changes between two groups. In patients with T<2 decrease in 24h-proteinuria in Dapa+ was better than in Dapa- at 6 mo (M (IQR): -0.94 [-1.21;-0.58] vs -0.58 [-0.58;-1.13] g/day, p=0,042), 12 mo (M (IQR): -0.77 [-1.14;-0.31] vs -0.5 [-0.5;+0.34] g/day, p=0,042) and 24 mo (M (IQR): -0.86 [-1.34;-0.3] vs -0.32 [-1.02;+0.32], g/day, p=0,042).

Conclusion. Dapagliflozin showed the distinct nephroprotective effect in patients with IgAN including those who had mild-moderate tubulointerstitial fibrosis. This finding supports the idea to initiate the iSGLT2 treatment in early CKD stages aiming to achieve better proteinuria reduction and slow CKD progression.

Brugada syndrome is an inherited channelopathy characterized by specific electrocardiographic (ECG) abnormalities, an increased risk of life-threatening ventricular arrhythmias, and sudden cardiac death. Despite the classical presentation of a stable type 1 ECG pattern, it is known that some patients exhibit transient manifestations, which complicates diagnosis and treatment strategy selection. This article presents a clinical case of transient Brugada syndrome and discusses the diagnostic approach when this pathology is suspected. The study of this phenomenon is highly relevant, as the dynamic variability of ECG findings and the often-subtle clinical presentation hinder timely diagnosis, thereby increasing the risk of sudden, potentially fatal arrhythmias.

This year marks the 50th anniversary of not becoming a leading therapist, pulmonologist, scientist, Honored Scientist of the RSFSR and Uzbek SSR, Professor Panteleimon Konstantinovich Bulatov, whose name is forever inscribed in the history of Soviet medicine. His whole life was devoted to the study of one bronchial asthma, about which he knew everything. A talented doctor, organizer, left behind a scientific school of pulmonologists, which continues to grow, adapting to the challenges of new modern medicine, but keeping faith in the principles of a comprehensive approach to the study of respiratory mechanisms, laid in its foundation.