A. D. Sidorova

Cardiovascular diseases (CVD) and dementia are two leading causes of mortality and disability in the aging population, and their shared metabolic foundation (insulin resistance, chronic inflammation, and vascular dysfunction) opens new opportunities for pharmacological prevention. Modern glucose-lowering drugs, i.e. sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors, gliflozins) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), demonstrate pleiotropic effects that extend far beyond glycemic control. Meta-analyses and large cohort studies in recent years confirm their cardio- and renoprotective efficacy, and also point to their potential in reducing the risk of Alzheimer's disease and vascular dementia. The greatest benefit is expected in patients with concomitant cardiovascular and cerebrovascular disease, though definitive confirmation of neuroprotective effects awaits the completion of large randomized trials. This article presents a clinical pharmacological analysis of current data, discussing the mechanisms of action, clinical efficacy, safety, and strategies for personalized use of SGLT2 inhibitors and GLP-1 RAs in preventing cardiovascular and neurodegenerative complications in patients with type 2 diabetes and metabolic disorders.

This article examines obesity as a chronic metabolic disease with a multifactorial etiology, involving a significant dietary component and epigenetic developmental mechanisms. Particular attention is paid to gender differences regarding pathogenesis, clinical manifestations, and treatment response, as well as the role of chronic inflammation (meta-inflammation) in the development of insulin resistance and metabolic disorders. The impact of various dietary patterns and specific nutrients, such as excess saturated and trans fatty acids, high-glycemic-index foods, advanced glycation end-products, and caffeine, on reproductive function is analyzed. The pathogenetic role of the "Western diet" in the development of ovarian dysfunction, hyperandrogenism, and reduced gamete quality is substantiated. Current data on the pharmacotherapy of obesity during the preconception period are presented, including GLP-1 receptor agonists (semaglutide, liraglutide) and dual GIP/GLP-1 agonists (tirzepatide). The direct and indirect mechanisms of their influence on fertility, safety issues, and discontinuation timelines prior to conception are discussed. The article concludes by emphasizing the need for an interdisciplinary approach and personalized management strategies for patients of reproductive age with obesity.

This article presents a clinical-pharmacological overview of current approaches to treating onychomycosis, the most common fungal nail infection, with a global prevalence of approximately 4–5.5%. It examines the epidemiology, etiological profile (characterized by the predominance of Trichophyton rubrum and an increasing proportion of non-dermatophyte molds), risk factors, and key mechanisms of pathogen resistance, including the spread of Trichophyton indotineae, which exhibits terbinafine resistance rates of up to 70%. Regimens for local (lacquers, solutions, creams) and systemic therapy (terbinafine, itraconazole, fluconazole) are analyzed in detail, along with criteria for drug selection based on clinical form, severity of infection, and comorbidities. Particular attention is paid to treating specific patient groups, such as children, the elderly, and patients with diabetes or immunosuppression, as well as to safety monitoring principles for systemic antifungal therapy. The necessity of a combined approach, including mandatory debridement and footwear disinfection, to achieve lasting cure and prevent recurrence is emphasized.

This article reviews current strategies for the treatment and prevention of onychomycosis, a chronic fungal nail infection, the global prevalence of which reaches 20% or higher in high-risk groups (the elderly, patients with diabetes mellitus, and the immunocompromised). The authors examine the etiological profile (dominated by Trichophyton rubrum), risk factors, and key mechanisms of resistance, including the spread of Trichophyton indotineae. Strategies for topical, systemic, and combination therapies are analyzed in detail, alongside criteria for drug selection based on the clinical form of the disease and the patient's comorbid conditions. Particular attention is paid to essential components of successful prevention and treatment, such as footwear disinfection and non-pharmacological methods like laser therapy, photodynamic therapy, surgical nail plate removal, medical instrument-based pedicures, etc. The importance of a comprehensive, personalized approach and laboratory monitoring of cure status to ensure lasting results and prevent recurrence is emphasized.

This article presents a clinical and pharmacological overview of modern incretin receptor agonists used to treat obesity. It examines the evolution of therapeutic approaches, ranging from moderately effective agents (liraglutide) to highly effective long-acting formulations (semaglutide), as well as dual (tirzepatide, a GIP / GLP-1 agonist) and triple (retatrutide, a GLP-1, GIP, and glucagon agonist) agonists. The mechanisms of action, based on central appetite suppression, delayed gastric emptying, and the activation of multiple metabolic pathways, are analyzed in detail. Issues regarding safety, adverse reactions, and specific aspects of use in patients with comorbidities, such as cardiovascular disease, type 2 diabetes, and obstructive sleep apnea, are discussed. Among pharmacological agents, multi-action incretin agonists, specifically tirzepatide and retatrutide, demonstrate the greatest efficacy in weight loss (reductions of 20.9 % and 24 %, respectively, in patients receiving the maximum dose), with effects approaching those of bariatric surgery. The development of oral formulations (semaglutide, amycretin) and further investigation of combination regimens involving metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors appear to be promising. It is essential to expand the indications for use and incorporate new drugs into national clinical guidelines; this would enable a personalized approach to obesity treatment, taking into account the patient’s comorbidities and individual characteristics.

The article examines modern approaches to the nutritional support of athletes as a key factor in optimizing physical performance, accelerating recovery, and maintaining health. It presents current data on the physiological roles of macronutrients: carbohydrates (as the primary energy source and substrate for glycogen resynthesis), proteins (as building material for muscle tissue and regulators of muscle protein synthesis), and fats (as an energy source during prolonged physical exertion). Hydration strategies, principles of «high-quality» weight loss, and the concept of nutritional periodization aligned with the training cycle are discussed. Various groups of dietary supplements and ergogenic aids, including creatine, beta-alanine, caffeine, omega-3 PUFAs, vitamin D, and probiotics, are analyzed in detail, with an evidence-based assessment of their efficacy. Particular attention is paid to nutritional planning for the pre-, intra-, and post-workout stages (the «energy,» «anabolic,» and «adaptive» phases). A conclusion is drawn regarding the need for a personalized and scientifically grounded approach to sports nutrition, taking into account the specifics of the sport, the athlete’s individual characteristics, and the goals of the training process.

Pharmacotherapy in athletes and physically active individuals requires a clinical and pharmaceutical approach, since intense physical exertion affects the pharmacokinetics and pharmacodynamics of drugs, changes in hydration status, fluctuations in renal and hepatic blood flow, dietary factors, and widespread use of dietary supplements. Additional complexity is associated with anti-doping regulations that apply not only to specific substances but also to routes of administration, dosage ranges, and timing of use. The most important practical risks in sports medicine were associated with nonsteroidal anti-inflammatory drugs, multi-ingredient over-the-counter products, sympathomimetics, systemic glucocorticoids, diuretics, central nervous system-active drugs, and selected antibacterial agents. Dietary supplements cannot be considered inherently safe because of variability in composition, insufficient standardization, limited evidence, and the risk of contamination with prohibited substances. The greatest concern from both clinical and anti-doping perspectives is raised by multicomponent pre-workout products, fat burners, testosterone boosters, and products with non-transparent labeling. The importance of evaluating «drug-drug», «drug-supplement », «drug-energy drink», and «drug-sports nutrition» interactions is emphasized.

This article presents a contemporary overview of the epidemiology, clinical features, and pharmacotherapy of hepatitis D virus (HDV) infection, the most aggressive form of chronic viral hepatitis, associated with a high risk of liver cirrhosis and hepatocellular carcinoma. Global epidemiological data are highlighted, indicating an HDV prevalence of 4.5 % to 14.6 % among HBsAg carriers, with an emphasis on endemic regions, including areas within the Russian Federation (the Republic of Tuva, Yakutia, and Dagestan). The mechanisms of viral replication, the pathogenesis of coinfection and superinfection, and differences in the clinical course have been analyzed in detail. Particular attention is paid to the evolution of therapeutic approaches: from ineffective interferon therapy to targeted agents, including the viral entry inhibitor bulevirtide (the first specific drug against HDV), the farnesyltransferase inhibitor lonafarnib, and novel molecules (HH003, nucleic acid polymers) currently undergoing clinical trials. Combination therapy regimens involving pegylated interferon and nucleoside analogs for HBV coinfection are reviewed. The study concludes that improving diagnostics and expanding access to antiviral therapy are essential for improving clinical outcomes.

Global population aging necessitates a shift in the medical focus from treating diseases to prevention and extending the period of active longevity. Aging is a multifactorial process involving the accumulation of molecular damage, with cellular senescence (permanent cell cycle arrest) serving as a key component. Among modifiable factors, nutrition, rational pharmacotherapy, and physical activity are the most significant. From the perspective of nutri-gerontology, an excess of protein and refined carbohydrates during middle age (45–59 years) hyperstimulates IGF-1 and mTOR signaling pathways, thereby accelerating aging and contributing to insulin resistance. Conversely, the activation of «anti-aging» sirtuins (SIRT) is achieved through calorie restriction, protein restriction (particularly animal protein), and intermittent fasting. The Mediterranean diet and the DASH diet are recognized as the most effective dietary patterns. Promising pharmacological approaches include mTOR inhibitors (rapamycin), metformin, and sirtuin activators (resveratrol); however, their routine use requires further research.

Paracetamol remains one of the most sought-after analgesics and antipyretics due to its high safety at therapeutic doses. Its analgesic effect is mainly realized centrally through a metabolite that activates vaniloid receptors, which explains its effectiveness in headache, dental and moderate postoperative pain, but the absence of a clinically significant anti-inflammatory effect. Unlike NSAIDs, paracetamol does not cause gastropathy, does not affect platelet aggregation, and is safe in pregnant, lactating, and aspirin asthma patients. The main risk is hepatotoxicity in overdose (>4 g/day in adults) associated with the accumulation of the NAPQI metabolite. The combination with ibuprofen provides additive analgesia. Use requires caution in patients with liver disease, alcoholism, and concomitant administration of CYP2E1 inducers (rifampicin, isoniazid) or valproic acid.