Obesity poses a particular challenge in the selection of drug therapy, requiring special attention to the dosing of drugs, including antibacterial drugs. Pharmacokinetic and pharmacodynamic parameters in obese patients may differ significantly from those in the general population, which affects the efficacy and safety of antibiotic therapy. The purpose of this review is to analyze current data on antibiotic dosing in obese patients to optimize clinical practice and improve treatment outcomes. The study includes an analysis of current scientific publications, clinical guidelines, and pharmacokinetic data regarding the use of antibiotics in obese patients. Particular attention is paid to changes in distribution volume, clearance, and dose adjustment depending on body mass index and other metabolic changes associated with obesity.

HIV infection is a very common disease, often associated with other pathologies, in particular rheumatological ones, such as spondyloarthritis. The presence of HIV infection can change the course of spondyloarthritis, and imposes certain limitations on their treatment. At the same time, progress in the treatment of HIV infection and spondyloarthritis has led to a change in the natural course of this combination of diseases and the emergence of new promising approaches to the treatment of patients with HIV and SpA. The presented work systematizes international experience in treating this cohort of patients, taking into account current trends.

Introduction. Aortic stenosis (AS) is the third leading cause of death from cardiovascular disease. AS is a multifactorial disease, and dyslipidemia is one of the possible etiopathogenetic mechanisms of its development. Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated total cholesterol and low-density lipoprotein cholesterol levels from birth.
Aim: to analyze the contribution of dyslipidemia and elevated Lp(a) levels to the formation of AS in patients with FH.
Materials and methods: 134 patients with heterozygous FH were examined (mean age 52.9±3.2 years, 85 (63.4%) men), of which 10 (7.46%) patients were diagnosed with AS. FH was diagnosed according to the Dutch Lipid Clinic Network criteria. Lipoprotein(a) (Lp(a)) concentration was measured using the turbometric method.
Results. In patients with FH and AS, higher levels of total cholesterol were detected (11.88±1.83 mmol/l compared with 9.85±1.47 mmol/l without AS, p<0.01); higher levels of LDL cholesterol (9.24±1.2 mmol/l compared with 7.23±1.34 mmol/l without AS, p<0.001). An increase in Lp(a) by 1 unit of measurement (1 g/l) leads to a 10.6-fold increase in the OR for AS (OR = 10.5 [5.0; 21.9] p=0.0017).
Conclusions: Increased levels of total cholesterol and LDL cholesterol, Lp(a) are associated with the development of AS in patients with FH.. The role of extraoral TAS2Rs and mechanisms of its regulation remain uncertain, that requires further research, including the field of respiratory pathology.

Currently, the prevalence of sarcoidosis is rapidly increasing. And there are frequent cases of increased calcium, which in modern clinical realities are not given enough attention. The pathology of calcium metabolism in this disease has a multi-component nature and can not only worsen the patient's condition, but also determine the degree of disease activity. Our article discusses the main links in the pathogenesis of calcium metabolism disorders in sarcoidosis, as well as renal dysfunction that can occur as a result of this pathology. Attention is paid to changes in bone metabolism in patients with sarcoidosis as such (especially against the background of glucocorticoid therapy), and those formed as a result of long-term uncompensated hypercalcemia. An algorithm for examining a patient with hypercalcemia in sarcoidosis is also presented and ways to correct changes in calcium metabolism are outlined.

By now, it is well known that the circadian clock is an evolutionarily preserved mechanism that adapts the physiological processes of the body to circadian cycles. Circadian rhythms of kidney function are an integral part of kidney physiology.
The most well-known general data on the mechanism of the circadian clock, as well as the features of the course of some nephrological diseases in terms of circadian rhythms, are briefly considered.
It has to be stated that there are very few studies on the effect of circadian rhythms on the course of kidney disease, especially clinical studies.

Introduction. MASLD is currently a significant public health problem, affecting more than 30% of the world's population, and is associated with premature mortality from many causes. Insulin resistance (IR) is one of the leading pathogenetic links in MASLD. According to various authors, there is a direct relationship between the occurrence of lobular inflammation, ballooning degeneration and the level of IR in MASLD in individuals with type 2 diabetes mellitus (DM2), which is due to the inducing effect of IR on unflammation. In patients with MASLD without DM2, the effect of IR on the inflammatory process in the liver still unclear.
The aim of the study was to assess the relationship between the degree of IR and indicators of the necrotic-inflammatory process in patients with MASLD without DM2.
Materials and methods. A total of 110 patients with MASBP were examined: 68 men (61.8%) and 42 women (38.2%), aged 50.5±10.8 years. Traditional liver tests and cytokines TNF-α, IL-1β, IL-6 and IL-8, and cytokeratin fragments-18 (CK-18) were determined. The HOMA-IR index was calculated using the formula (fasting glucose, mmol/l) x (fasting insulin, μIU/ ml)/22.5.
Results. Insulin resistance according to HOMA-IR ≥2.6 was detected in 55 (50.0%) patients and was not detected in 55 (50.0%) patients. When comparing laboratory parameters in MASLD with normal and elevated HOMA-IR, significantly higher levels of FCK-18, ALT, AST, IL-1β and IL-6 were detected in patients with IR. The same pattern was observed for carbohydrate and lipid metabolism parameters. HOMA-IR demonstrated reliable correlations with FCK-18, AST, and the number of lymphocytes and monocytes of peripheral blood.
Conclusion. In 50.0% of patients with MASLD, prior to the development of overt clinical type 2 diabetes mellitus, there was a high level of HOMA-IR, confirming insulin resistance. Its presence was accompanied by a significant increase in biomarkers of hepatocellular death and inflammation, which predicted a more severe course of MASLD.

Paget's disease of bone (osteitis deformans) is a skeletal disease in which foci of destruction of the bone structure occur in one or more bones, followed by its excessive and inadequate replacement. A clinical case is presented with a rare variant of this disease in the form of involvement of the scapula in the pathological process.

Transient loss of consciousness is frequently encountered in the practice of physicians of various specialties. These conditions can be caused by multiple factors that can be divided into two major groups: traumatic and non-traumatic. Non-trauma-related loss of consciousness includes epileptic seizures and syncopal states. Among the latter, it is important to identify cardiogenic syncope as the most significant and common. They can be associated with various structural cardiac pathologies, as well as rhythm and conduction disorders. However, when encountering cardiogenic syncope in a patient with a previously established diagnosis of epilepsy, the physician may face a challenging diagnostic situation. The previous diagnosis typically initially leads to the assumption of another epileptic seizure. The article systematizes and analyzes data from domestic and foreign literature on the differential diagnosis of cardiogenic syncope and epileptic seizures. A clinical observation of a patient with a history of epilepsy and transient loss of consciousness due to paroxysmal atrial fibrillation is presented. Knowledge of the clinical manifestation features of these conditions can help specialists in making the correct diagnosis, as well as prescribing necessary therapy and preventing complications of atrial fibrillation.

Transient loss of consciousness is frequently encountered in the practice of physicians of various specialties. These conditions caThe study addresses the optimization of mechanical ventilation (MV) parameters in neuroresuscitation patients with respiratory failure. Individualized adjustments of tidal volume (VT), respiratory rate, oxygen concentration (FiO₂), and positive end-expiratory pressure (PEEP) improved oxygenation and minimized lung injury risks.

Key outcomes include enhanced gas exchange, prevention of alveolar collapse with PEEP, and effective oxygenation with minimal FiO₂. The research emphasizes the importance of personalized MV settings and advanced monitoring to improve treatment outcomes in critically ill patients.

Vadim Ivanovich Mazurov is an outstanding Russian clinician, therapist, and rheumatologist. He is a recognized scientific authority who has made a major contribution to the development of science and training of scientific and pedagogical personnel, becoming a Teacher for many doctors. He is widely known in Russia and abroad as a clinical scientist who made a huge contribution to the development of domestic therapy and rheumatology. He is the initiator of annual conferences of rheumatologists of the North-West in St. Petersburg, as well as the chairman and co-chairman of the organizing committees of a number of major therapeutic and rheumatology congresses. Vadim Ivanovich Mazurov is a man of broad soul and great charm, who has authority among the medical community of St. Petersburg and Russia.