Vladimir Anatolyevich Parfenov

Functional dizziness (FD) is one of the most common causes of chronic dizziness. Objective: a comparative assessment of the efficacy and safety of Vespireit® (buspirone), 15 mg prolonged-release tablets, versus Arlevert® tablets (cinnarizine 20 mg + dimenhydrinate 40 mg) in the treatment of patients with FD. Material and methods. The clinical trial (CT) included 160 patients with FD and scores on the Dizziness Handicap Inventory (DHI) ≥31 points and the Mean Vertigo Score (MVS) ≥1.5 points, who were randomized into two groups. Patients in group 1 (n=80) received Vespireit at a dose of 15 mg (1 tablet) once daily for 28 days. Patients in group 2 (n=80) received Arlevert 1 tablet 3 times daily for 28 days. Treatment was administered against a background of vestibular gymnastics exercises. The primary efficacy endpoint (PEE) was the change in mean MVS score at visit 1-3 (day 28±1) compared with baseline (visit 1-1, day 1). Secondary efficacy endpoints (SEEs) included assessment compared with baseline (visit 1-1, day 1): 1) change in mean MVS score by visit 1-2 (day 7±1); 2) change in the proportion of patients with a ≥50% reduction in mean DHI score by visit 1-3; 3) change in mean score on the numerical rating scale (NRS) by visits 1-2 (day 7±1) and 1–3 (day 28±1); 4) assessment by patient and physician of clinical improvement in proportions of patients and mean scores on the Clinical Global Impression Scale-Improvement Scale (CGI-I) by visits 1-2 (day 7±1) and 1-3 (day 28±1). In case of recurrence (exacerbation of dizziness symptoms), a second course of treatment with the study drugs and a similar assessment using the scales were performed. At the end-of-study visit (day 365±7 from visit 1-1), the proportion of patients with recurrence and the duration of the remission period were assessed. Safety criteria included assessment of adverse events (AEs), clinically significant deviations in vital signs, laboratory parameters, and electrocardiography (ECG) parameters. Results. Assessment of the PEE revealed no significant differences between the groups (p=0.0814); the lower limit of the 95% confidence interval (-0.07 points) did not exceed the non-inferiority margin (-0.3), thus demonstrating non-inferior efficacy of Vespireit compared with Arlevert. Assessment of most SEEs showed a statistically significant advantage of therapy in group 1 compared with group 2: reduction in mean MVS score by visit 1-2 (p=0.0427); proportion of responders with ≥50% reduction in mean DHI score by visit 1-3 (p=0.0433); reduction in mean NRS score by visits 1-2 (p=0.0230) and 1-3 (p=0.12244); proportion of responders with marked improvement (1 point) and considerable improvement (2 points) on CGI-I by visits 1-2 and 1-3 (patient assessment p=0.0453 and p=0.0481, p=0.0101 and p=0.8584; physician assessment p=0.0725 and p=0.0321, p=0.0169 and p=0.8622). A similar anti-relapse effect was established in groups 1 and 2 [proportion of patients without recurrence in group 1 – 94.87% (n=74), in group 2 – 93.67% (n=74; p=1.0000); duration of remission in group 1 – 359.14±38.08 days, in group 2 – 361.33±15.77 days (p=0.1798)]. A total of 84 AEs were recorded in 35 (21.88%) patients: 52 AEs in 18 (22.5%) patients in group 1 and 32 AEs in 17 (21.25%) in group 2. No significant difference was found between the groups in the number of patients with AEs (p=0.8483). During the CT, no serious adverse events (SAEs), fatal SAEs, or AEs leading to discontinuation of therapy were recorded. No clinically significant deviations from normal were observed in the assessment of vital and laboratory parameters or ECG parameters. Conclusion. Assessment of the PEE demonstrated non-inferior efficacy, and for a number of SEEs, superiority of therapy with Vespireit over therapy with Arlevert was established in reducing manifestations of FD. The drugs demonstrated a comparably high level of anti-relapse effect and a favorable safety profile.

At the Expert Council meeting on June 26, 2026, the issues of diagnosis and treatment of vestibular vertigo in the elderly were discussed. It was noted that the causes of peripheral vestibular vertigo in the elderly are most often benign paroxysmal positional vertigo, Meniere's disease, bilateral vestibulopathy, and presbyvestibulopathy. The most common causes of central dizziness are transient ischemic attacks, strokes, and migraine-associated dizziness. These common causes of dizziness are often undiagnosed; many elderly patients have an erroneous diagnosis of chronic cerebral ischemia, vertebrobasilar insufficiency, or cervical osteochondrosis and do not receive effective treatment. The management of elderly patients is based on the identification and effective treatment of the causes of vertigo, the use of vestibular rehabilitation, the correction of sensory deficits, and the identification and effective treatment of concomitant diseases. When selecting drug therapy, strict prevention of polypharmacy and adherence to safety criteria with minimization of the use of drugs that increase the risk of falls and cognitive impairment are of key importance. As a pharmacological potentiation of central adaptation, the use of betahistine dihydrochloride (for example, Betaserc Long 48 mg, a dosage form for once-daily administration) is justified. The development of specialty-specific clinical recommendations and standards for the management of elderly patients with vertigo and balance disorders is of great importance, which will reduce the risks of falls and improve the functional activity of patients.

Managing patients with acute low back pain is a pressing issue in modern medicine. A review of the literature in the electronic databases PubMed/MEDLINE, eLIBRARY.RU, Cochrane Library, Google Scholar for the period from 2016 to 2026 is presented. During the patient’s examination, it is necessary to exclude specific causes of pain, vertebrogenic radiculopathy, and central lumbar stenosis. If nonspecific (musculoskeletal) pain is diagnosed, which accounts for the majority of all low back pain-related consultations, the patient should be informed of the benign prognosis of the disease, the high probability of a rapid recovery, and the advisability of maintaining daily activities. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for acute nonspecific low back pain; they provide relatively rapid pain relief and improve the patient’s functional status. The use of a muscle relaxant can enhance the effect and reduce the duration of NSAID use, which is often associated with adverse effects. The efficacy and safety of the muscle relaxant thiocolchicoside (Tiplito), which has a long-standing positive clinical experience, for the treatment of acute back pain is discussed. Several placebo-controlled, randomized clinical trials have demonstrated the efficacy and good tolerability of thiocolchicoside for acute low back pain. Thiocolchicoside (Tiplito) is recommended for acute low back pain as intramuscular injections (4 mg 2 times a day) or oral tablets (capsules of 8 mg 2 times a day). The combination of thiocolchicoside with NSAIDs enhances analgesic efficacy, improves patients’ functional status, and reduces the duration of NSAID use. Common errors in the management of patients with acute low back pain and optimization of drug and non-drug therapy in clinical practice are discussed.

High-dispersion nanocomposite materials based on cerium(III) orthophosphate stabilized with different forms of cellulose (methylcellulose (MC), carboxymethylcellulose (CMC) and sodium carboxymethylcellulose (CMCNa)) with the addition of citric acid were synthesized by chemical precipitation. Experimental samples modified with metronidazole were obtained. A comprehensive analysis of their phase composition, morphology, and physicochemical characteristics was performed using X-ray diffraction, transmission electron microscopy and IR spectroscopy. According to the results of physicochemical studies all synthesized nanocomposites contained nanocrystals with a bimodal size distribution (width 3–6 nm, length 15–200 nm), depending on the matrix composition, and diffraction peaks characteristic of CePO₄. IR spectroscopy suggested a mechanism for the formation of chemical bonds: cellulose polymer chains are retained on the CePO₄ surface mainly through a branched network of weak hydrogen bonds, while the carboxylate groups of citric acid form coordination bonds with Ce³⁺. A positive effect of citric acid on limiting the linear dimensions of CePO₄ crystallites in the presence of a cellulose matrix was established.

Anxiety and stress-related disorders are characterized by high prevalence, comorbidity and resistance to existing treatments in a significant proportion of patients. Treatment for anxiety spectrum disorders includes an educational program, psychotherapy and the use of medication. The most effective forms of psychotherapy are cognitive behavioural therapy and various relaxation techniques; in recent years, psychological methods have often been used not only in face-to-face sessions but also online. First-line treatments for anxiety spectrum disorders include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In some cases, patients with anxiety spectrum disorders do not respond to SSRIs and SNRIs, and many patients discontinue their medication due to adverse effects; therefore, the search for new drugs remains a priority. This article summarises the findings of the Expert Council meeting (April 2026) dedicated to maritupirdine (Aviandr®), a multi-target antagonist of serotonin, a ₂ -adrenergic and H ₁ -histamine receptors. Based on preclinical and clinical data, including studies on generalized anxiety disorder and post-COVID-19 adjustment disorder, the drug's anxiolytic, antidepressant and pro-cognitive effects, favourable safety profile and absence of withdrawal syndrome have been confirmed. A pro-cognitive effect of the drug has been observed, consistent with data on the blockade of 5-HT6 and 5-HT7 receptors. Experts conclude that the restrictions on the use of maritupirdine in patients with organic brain disorders and epilepsy are not sufficiently justified. Further research into maritupirdine in organic mental disorders, including cognitive impairment and dementia, is required. The use of maritupirdine is appropriate for adjustment disorders of various aetiologies. Maritupirdine's favourable tolerability and safety profile is a significant advantage in the treatment of patients with anxiety disorders and those with stress-related disorders.

Background/Objectives: Diabetic peripheral neuropathy (DPN) is a common and disabling complication of diabetes. B vitamins play essential roles in neuronal metabolism, but evidence on their therapeutic efficacy remains inconsistent. The review and meta-analysis aimed to evaluate the effects of vitamin B supplementation on clinical and neurophysiological outcomes in DPN. Methods: We searched PubMed, Cochrane Database, and ClinicalTrials.gov, supplemented by reference screening of relevant systematic reviews. Randomized controlled trials (RCTs) comparing vitamin B (any form, dose, route) versus placebo or standard care in adults with DPN were included. Primary outcomes were pain intensity, neuropathy scores, and nerve conduction parameters. Risk of bias was assessed using RoB 2. Random-effects meta-analyses were performed where appropriate. Results: Thirteen RCTs (834 participants) were included. Vitamin B supplementation significantly improved Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ: MD −1.44, 95% CI −2.48 to −0.39) and Examination (MNSIE: MD −0.39, 95% CI −0.66 to −0.12). However, the improvement in MNSIE did not reach the established minimal clinically important difference (MCID) of 0.5 points. Pain intensity on numeric/visual analogue scales showed no significant effect (MD −0.44, 95% CI −1.77 to 0.89; high heterogeneity, I² = 84.5%), but disease-specific pain scales favoured vitamin B (MD −3.06, 95% CI −5.61 to −0.51). Sural nerve conduction velocity (MD 2.10 m/s, 95% CI 0.35 to 3.86) and amplitude (MD 0.88 µV, 95% CI 0.08 to 1.67) improved significantly. Peroneal and tibial nerve parameters showed no consistent benefit; tibial velocity favoured control (MD −1.23 m/s, 95% CI −2.37 to −0.09). Combination B-vitamin regimens appeared more effective than monotherapy. Formal subgroup analysis did not demonstrate a statistically significant difference between monotherapy and combination therapy for MNSIE, MNSIQ, or sural nerve NCV (interaction p > 0.05) but demonstrated one for peroneal nerve NCV (interaction p = 0.039), although a numerical trend towards greater benefit with combination regimens was observed. Risk of bias was low in six studies, some concerns in five, and high in two. Conclusions: Vitamin B supplementation may improve certain clinical neuropathy scores and sural nerve function in DPN, but effects on pain and motor nerve parameters are inconsistent. Combination therapy (multiple B vitamins) seems more promising than single agents. However, substantial heterogeneity and risk of bias preclude firm recommendations for routine use. Well-designed RCTs stratified by baseline vitamin status are needed.

When examining a patient with lumbosacral pain (lower back pain), it is necessary to rule out any specific underlying causes. The diagnosis of discogenic lumbosacral radiculopathy (DLR) is based on clinical examination; magnetic resonance imaging (MRI) is useful for ruling out other causes of radiculopathy and assessing the characteristics of a herniated intervertebral disc. There is insufficient justification for early MRI (within the first 4 weeks) unless there are signs of cauda equina syndrome, or epidural glucocorticoid injection or urgent surgical treatment is planned. It is recommended that patients with DLR be informed about the possibility of disc herniation regression and recovery, and the advisability of maintaining physical activity. Non-steroidal anti-inflammatory drugs may be used to relieve pain; if these are ineffective, epidural administration of local anaesthetics and glucocorticoids under X-ray or ultrasound guidance may be considered. During the acute phase, it is advisable to perform therapeutic exercises under specialist supervision and to attend educational sessions on movement ergonomics. For subacute and chronic DLR, therapeutic exercises, manual therapy and psychological therapy are recommended. Consultation with a neurosurgeon regarding a possible microdiscectomy is indicated as a matter of urgency in the presence of cauda equina syndrome, as well as if there is no response to conservative treatment within 4–8 weeks. For preventive purposes, the patient is advised to undertake therapeutic exercises and an educational programme on avoiding excessive physical and static loads.

The growing field of nanobiotechnology could provide an alternative platform for the development of new therapeutic agents. A potential means for achieving these goals are nanoparticles of rare-earth metals, for example, nanoceria. According to the results of numerous in vitro and in vivo studies, not only oxide forms of lanthanides can demonstrate a pharmacological effect. A promising nano-object for biomedical application is cerium phosphate, which exhibits both properties characteristic of cerium dioxide and its own unique properties, due to the diversity of morphology. However, at present, a unified methodological approach has not been formulated that would make it possible to formulate principles for obtaining a compound with specified properties. This review was conducted on using the international databases PubMed, PubChem, Scopus and Google Scholar, and included original studies and reviews. The literature describes the preparation of cerium phosphate nanoparticles by the hydrothermal, chemical precipitation, microwave, and sol–gel methods. It was established that reaction temperature, pH value of the medium, use of organic solvents, ratio of reagents, and precursors have a direct influence on the size, shape, and structure of the obtained nano-object, making it possible to synthesize nanospheres, nanorods, and nanoneedles by regulating these parameters. In addition, the strategy of obtaining nano-objects with specified properties can be implemented by using excipients of predominantly polymer nature. The use of auxiliary substances is capable both of exerting a stabilizing effect and improving adherence to the nanoscale range, and of influencing pharmacological activity. The literature describes the possibility of using cerium phosphate as a redox-active, regenerative, antibacterial, sunscreen, and antitumor agent. However, the insufficient amount of data on the toxicological profile, as well as the results of in vivo studies, remains a significant limitation for the introduction of cerium phosphate into clinical practice. Thus, the purpose of the present review is to identify patterns that make it possible to formulate recommendations for the synthesis of cerium phosphate with specified properties, to assess factors affecting its suitability for use in biomedicine, and to consider its prospects and limitations.

Background: Distinguishing functional dystonia (FD) from idiopathic dystonia (ID) remains a major clinical challenge because both conditions are diagnosed primarily on clinical grounds and may be accompanied by non-motor psychiatric symptoms. Although personality abnormalities have been described in functional neurological disorders, their relevance in the differential diagnosis of dystonia remains insufficiently studied, and comparative data on FD and ID are lacking, particularly in the Russian population. Patients and Methods: A total of 178 patients with idiopathic dystonia (focal and segmental dystonia, ID) and 32 patients with functional dystonia (FD) were observed. A clinical interview by a psychiatrist was conducted; the SCID-II-PD questionnaire and the Five-Factor Personality Questionnaire (5-PFQ) were used to assess PD. Results: Patients with FD more often than patients with ID had such PD as dependent, paranoid, passive–aggressive, borderline, schizoid and schizotypal (p < 0.001), as well as obsessive–compulsive (p < 0.013) and avoidant (p < 0.049) according to SCID-II-PD. In FD, personalities of the eccentric cluster A predominate; patients with FD are characterized in personality terms by significantly greater introversion, detachment, naturalness (irresponsibility, impulsivity, carelessness), emotional restraint and practicality (conservatism, low sensitivity, rigidity) according to 5-PFQ. Conclusions: Patients with FD differ from patients with ID in both categorical and dimensional personality characteristics. The predominance of cluster A personality pathology and the identified pattern of personality-related variables may have potential value as adjunctive markers in the clinical differentiation of FD from ID. Further external validation is required before these findings can be incorporated into diagnostic algorithms.

In cases of chronic non-specific neck and low back pain (CNLBP), where emotional disorders are identified, the involvement of a psychiatrist in patient management is considered. However, the effectiveness of this approach in patients with CNLBP and a confirmed anxiety or depressive disorder (F41, F33, F32) remains insufficiently studied.    Objective: To conduct a comparative evaluation of the efficacy of a comprehensive approach (involving a psychiatrist, an educational programme incorporating elements of cognitive behavioural therapy (CBT), and personalised therapeutic exercise) versus a standard approach in the treatment of chronic non-specific low back pain (CNLBP) in patients diagnosed with an anxiety or depressive disorder (F41, F33, F32) by a psychiatrist.    Material and methods.  The study included 55 patients with CNLBP and anxiety (F41) or depressive disorder (F33, F32), who were randomized into two groups. The first group (comprehensive therapy – CT) consisted of patients (n=27) who received a comprehensive (multimodal) approach, including the involvement of a psychiatrist in patient management, 6 sessions of an individualized educational programme incorporating elements of CBT delivered by a certified specialist in chronic pain and emotional disorders, 4–5 individual sessions of therapeutic exercise (TE) with the development of a personalized exercise regimen, and recommendations on workplace ergonomics. The standard therapy (ST) group comprised patients (n = 28) who were treated using a standard therapy protocol (optimisation of drug therapy, a one-off educational programme to improve physical activity, and standard kinesiotherapy). The study protocol involved 6 months of therapy and fol-low-up with efficacy assessments at three time points – 1, 3 and 6 months after the start of treatment. A numerical rating scale (NRS) was used to assess pain intensity; the Spielberger test, which assesses state (ST) and trait (TT) anxiety, and the Beck Depression Inventory were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess quality of life, taking into account the division of this questionnaire into summary scales for physical (PCS-12) and mental health (MCS-12). To determine the impact of neck pain (NP), the Neck Disability Index (NDI) was used; to assess the impact of low back pain (LBP) on daily activities, the Oswestry Low Back Pain Disability Questionnaire was used.    Results.  Against the background of treatment, a more significant decrease in pain intensity according to the NRS was noted in the CT group than in the ST group – respectively, for NP to 1.46 ± 0.75 and 2.92 ± 1.0 after 3 months (p < 0.001) and to 0.69 ± 0.72 and 3.0 ± 1.41 after 6 months (p < 0.001), for LBP 2.04 ± 0.86 and 3.29 ± 1.31 after 3 months (p < 0.001), and to 1.04 ± 0.91 and 3.29 ± 1.48 after 6 months (p < 0.001), a decrease in functional impairment according to the Oswestry questionnaire to 15.57 ± 3.55 and 27.62 ± 3.27 after 3 months (p < 0.001) and up to 10.22 ± 2.54 and 29.67 ± 4.24 after 6 months (p < 0.001), a decrease in functional impairment according to the NDI to 12.54 ± 4.36 and 23.38 ± 4.5 after 3 months (p < 0.001) and up to 8.08 ± 2.81 and 25.23 ± 4.95 after 6 months (p < 0.001), an improvement in the quality of life according to PCS to 46.04 ± 4.31 and 43.21 ± 4.04 after 3 months (p < 0.05) and up to 50.07 ± 3.27 and 43.57 ± 3.17 after 6 months (p < 0.001), an improvement in the quality of life according to MCS to 47.3 ± 4.31 and 44.57 ± 3.13 after 3 months (p < 0.05) and up to 50.56 ± 2.86 and 44.75 ± 2.63 after 6 months (p < 0.001). During therapy, no significant differences were found between the CT and ST groups according to the Beck Depression Inventory, ST and TT, in both groups an improvement in the indicators was observed over time, however, when comparing the survey indicators after 3 and 6 months, the CT group showed a statistically significant improvement according to the Beck Depression Inventory (p = 0.04), while in the ST group no further changes were noted (p = 0.14).    Conclusion. A comprehensive multidisciplinary approach (involving a psychiatrist) to the treatment of patients with chronic non-specific low back pain (CNLBP) and mental health disorders (anxiety and depressive disorders) leads to a more significant reduction in pain and an improvement in functional activity. Prescribed drug therapy for mental disorders improved the improvement in pain, functional activity and quality of life in the long term.