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Aim. To assess the effect of rifaximin and a multi-strain probiotic on the intestinal microbiome and the indicators of cardiovascular risk in patients with coronary heart disease (CHD).Materials and methods. A study conducted during the 2016–2019 period included 120 people over 50 years old divided into 3 groups. Group 1 comprised patients with coronary heart disease receiving standard treatment. Group 2 comprised patients with coronary heart disease receiving additionally a probiotic (Bifidobacterium bifidum no less than 1x109 CFU; Bifidobacterium longum no less than 1x109 CFU; Bifidobacterium infantis no less than 1x109 CFU; Lactobacillus rhamnosus no less than 1x109 CFU) within 28 days. Group 3 comprised CHD patients receiving rifaximin for 7 days followed by addition of the multi-strain probiotic under test for 21 days. Group 4 consisted of healthy individuals, comparable in age and sex with the examined CHD patients. In group 4, blood and stool tests were performed once to provide a comparison with group 1. TMAO concentration was determined using liquid chromatography–mass spectrometry. To study the composition of fecal microflora, 16S sequencing was used followed by a graphical representation of the results. The results were analysed using the IBM SPSS 22.0 statistical data processing software.Results. An additional administration of the probiotic (Bifidobacterium bifidum no less than 1x109 CFU; Bifidobacterium longum no less than 1x109 CFU; Bifidobacterium infantis no less than 1x109 CFU; Lactobacillus rhamnosus no less than 1x109 CFU) is found to have no effect on the lipid profile and the platelet aggregation rate. Rifaximin therapy reduced the amount of total cholesterol, low density lipoproteins (LDL), very low density (VLDL) lipoproteins and triglycerides (p <0.05), although not affecting the level of high density lipoproteins (HDL). TMAO showed a statistically insignificant (p>0.05) downward trend in all groups. The composition of the fecal microbiota, at the end of administration of the probiotic, showed an increase in the proportion of bacteria of the Streptococcaceae, Lactobacillaceae, Enterobacteriaceae families and a decrease in the Ruminococcaceae family (p>0.05). After rifaximin therapy, a decrease in the proportion of bacteria of the Clostridiaceae (p <0.05) and Peptostreptococcaceae (p <0.05) families, a decrease in Enterobacteriaceae (p > 0.05) family and a decrease in the Clostridium and Escherichia/Shigella (p > 0.05) genera was observed. The use of the probiotic after a course of treatment with rifaximin did not have a significant effect on the composition of the microflora. In general, the high variability of fecal microbiota between different patients (significantly superior to intergroup differences) does not allow us to draw unambiguous conclusions.Conclusions. The use of a multi-strain probiotic as an additional therapy in patients with coronary heart disease within 28 days did not have a significant effect on lipid metabolism, TMAO level and the composition of fecal microflora. The consecutive use of rifaximin and the probiotic had a beneficial effect on such factors as lipid metabolism (decrease in the level of total cholesterol, LDL, VLDL, triglycerides), but did not affect the concentration of TMAO and the composition of the intestinal microflora in patients with coronary heart disease.

The review collected the latest literature data on urticaria - one of the most frequent skin diseases in children, accompanied by the appearance of blisters. It is notorious that histamine-liberation lies in the basis of the disease pathogenesis, regardless of the cause provoking an exacerbation. Precisely this explains the unified principle of therapy for all variants of urticaria -the administration of non-sedating antihistamines in the first line. Urticaria is classified for acute and chronic based on the duration of the course (up to 6 weeks or more). Experts do not recommend that physicians carry out any special diagnostic measures in the acute form of the disease, paying the utmost attention to the administration of effective treatment. the review describes the causes of disease exacerbation, the pathogenesis and the clinic of urticaria. Attention is paid to various options for managing patients with urticaria, published in the latest expert recommendations in Europe, America and Russia.

Aim. To study the composition of the intestinal microbiota in patients with chronic heart failure (CHF), as well as a relationship between the features of the CHF clinical course and changes in the microbial composition of the colon.Materials and methods. The study included 60 heart failure patients with systolic dysfunction diagnosed according to the results of echocardiographic examination. The control group consisted of 20 patients comparable to the main group by gender, age and underlying diseases in the absence of CHF. In all patients, the severity of CHF symptoms was assessed using a clinical assessment scale. The levels of the N-terminal fragment of the cerebral natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) were determined. Echocardiographic examination and, if indicated, Holter ECG monitoring were performed. The intestinal microbiota in stool samples was studied by sequencing the 16S gene of ribosomal RNA (rRNA).Results. In comparison with the control group, CHF patients showed a decrease in the relative content of Tenericutes (p = 0.02, Mann—Whitney test) and an increase in the proportion of Euryarchaeota (p = 0.02) and Firmicutes (p = 0.03). At the family level, an increase in the proportion of Methanobacteriaceae (p = 0.03) and a decrease in the proportion of Pseudomonadaceae (p = 0.01) and Moraxellaceae (p = 0.01) were noted. No dependence of the intestinal microflora composition on the functional class of heart failure was observed. However, a correlation was revealed between the relative number of certain bacterial families and the severity of impaired contractile function, the level of the inflammatory marker and the biochemical marker of heart failure.Conclusions. The obtained data indicate differences in the intestinal microbiota composition in patients with and without heart failure. A correlation between the number of some bacterial families and various laboratory and instrumental indicators assessed in heart failure patients was revealed. Further research into the effect of intestinal microbiota on the course of heart failure appears to be promising for improving treatment methods.