Introduction. Acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) have worse prognosis than those without diabetes. Risk of adverse outcome in this cohort remains high despite the introduction of new methods of invasive treatment of ACS. The use of all-inclusive cardiac rehabilitation (CR) programs allows improving prognosis in patients with ACS and T2DM.
Aim. The aim of the study was to evaluate impact of two- or three-stage CR on long-term prognosis in patients with ACS and T2DM.
Methods. The study included 251 ACS patients hospitalized in the department of cardiology, of which 120 patients with T2DM. Management of ACS was carried out in accordance with the clinical recommendations of the European Society of Cardiology (2015, 2017). All patients underwent standard laboratory and instrumental examination. We analyzed prognostic parameters (myocardial revascularization, myocardial infarction and mortality) during 12 months of follow-up in diabetic and non-diabetic patients with ACS who underwent two or a three-stage CR. Additionally, the achievement of the combined endpoint, which include at least one of the ACE, was analyzed.
Results. Long-term prognosis in ACS patients who underwent three-stage CR in diabetic and non-diabetic groups did not differ significantly. However, the frequency of repeated myocardial revascularization was higher in patients with T2DM in comparison with non-diabetic patients inside the two-stage CR subgroup.
Conclusion. Three-stage CR should be recommended in diabetic patients with ACS to improve long-term prognosis.

Introduction. Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, with heart rhythm disorders accounting for a significant proportion of them. Atrial fibrillation (AF) is an arrhythmia that poses a risk of thromboembolic complications and is difficult to treat with ongoing preventive anticoagulant therapy.
Aim of the study. To analyze the prescription of anticoagulant therapy to patients with AF on the regional level.
Methods and results. The study included 72 patients with the nonvalvular form of AF (from 41 to 82 years old) of the Department of Rhythm and Conductivity Abnormalities of the State Budgetary Institution of the Republic of Mordovia RCH № 4 for 2019. Three groups were singled out depending on the AF form: the first one – patients with the constant form (n = 22), the second one (n = 24) – with the persistent form, the third one (n = 24) – with the paroxysmal form. The risk of thromboembolic complications was assessed using the CHA2DS2-VASc scale and hemorrhagic complications using the HAS-BLED scale. All patients had a high risk of thromboembolism (index above 2 points), which reflects multiple risk factors and indicates the need for oral anticoagulants (OAC). According to HAS-BLED scale calculations, the risk of haemorrhagic complications was low in most patients (2 or less points) – there was no significant increase in the risk of bleeding, but careful monitoring is required. Analysis of the results revealed that only 54% of patients took OAC, despite the fact that all patients were shown anticoagulant therapy. When analyzing the cases of patients who did not take anticoagulants, it was found that 23% of patients, despite the doctor’s recommendations, refused to take the drugs, 47% of patients justified the inability to control IHR and 30% were unable to purchase expensive new OAC.
Conclusion. Despite the recommendations for the management of patients with atrial fibrillation, only 54% were prescribed oral anticoagulants.

Introduction: the majority of patients with cardiovascular diseases in real medical practice are characterized by a combination of two or more diseases and conditions, that is, comorbidity. This places additional demands on the observation and treatment of this category of patients.
Objective: to assess risk factors, the structure of comorbid conditions and the severity of psychoemotional disorders in patients with myocardial infarction with various forms of atrial fibrillation.
Materials and methods: 138 patients (63 men, 75 women) who were hospitalized in the cardiology department of the City Clinical Hospital No. 7 GBUZ with a diagnosis of myocardial infarction with atrial fibrillation were examined. Depending on the form of atrial fibrillation, the patients were divided into 2 groups: the 1^st consisted of 83 (60,1%) patients with a paroxysmal form, the 2^nd group – 55 (39,9%) with a constant form. The examination was carried out in the first three days of hospitalization of patients.
Results: in patients with myocardial infarction with a paroxysmal form of atrial fibrillation, the structure of risk factors is dominated by an average degree of nicotine addiction, dangerous alcohol consumption, high salt intake and excess body weight, and with a constant form of atrial fibrillation, a mostly weak and high degree of nicotine addiction, harmful alcohol consumption and obesity.
Conclusion: in patients with myocardial infarction with a paroxysmal form of atrial fibrillation, the predominant risk factors are: dangerous alcohol consumption, high salt intake and overweight combined with depressive disorders in the form of subclinical and clinical depression, and with a constant form of atrial fibrillation, a high degree of nicotinic dependence and mild anxiety disorders: subclinically and clinically severe anxiety, which must be taken into account when carrying out preventive, rehabilitation measures and the solution of expert issues.

Rheumatoid arthritis is a frequent and one of the most severe immuno-inflammatory diseases in humans, which determines the great medical and socio-economic importance of this pathology. One of the priority problems of modern cardiac rheumatology is an increased risk of cardiovascular complications in rheumatoid arthritis.
In patients with rheumatoid arthritis, traditional cardiovascular risk factors for cardiovascular diseases (metabolic syndrome, obesity, dyslipidemia, arterial hypertension, insulin resistance, diabetes mellitus, smoking and hypodynamia) and a genetic predisposition are expressed. Their specific features also have a certain effect: the “lipid paradox” and the “obesity paradox”.
However, chronic inflammation as a key factor in the development of progression of atherosclerosis and endothelial dysfunction plays a leading role in morbidity and mortality from cardiovascular diseases in rheumatoid arthritis.
This review discusses the effect of chronic inflammation and its mediators on traditional cardiovascular risk factors and its independent significance in the development of CVD. Drug therapy (non-steroidal anti-inflammatory drugs, glucocorticosteroids, basic anti-inflammatory drugs, genetically engineered biological drugs) of the underlying disease also has a definite effect on cardiovascular risk factors in patients with rheumatoid arthritis.
A review of studies on this problem suggests a positive effect of pharmacological intervention in rheumatoid arthritis on cardiovascular risk factors, their reduction to a level comparable to the populations of patients not suffering from rheumatoid arthritis. The interaction of rheumatologists, cardiologists and first-contact doctors (therapist and general practitioner) in studying the mechanisms of the development of atherosclerosis in patients with rheumatoid arthritis will allow in real clinical practice to develop adequate methods for the timely diagnosis and prevention of cardiovascular diseases in patients with rheumatoid arthritis.

One of the main reasons for seeking medical help is myofascial syndrome (MFS), which is manifested by local inflammation with elements of degenerative changes in the affected tissue, pain and muscle spasm due to dysfunctional disorders in the nociceptive system and a decrease in the quality of life. This review discusses etiopathogenesis in detail, taking into account the factors predisposing to the development of MFS, which are divided into anatomical, ergonomic, medical and psychosocial, and also provides diagnostic criteria for pain MFS, including 5 large and 3 small criteria necessary for diagnosis. The second part of the review examines the indications, efficacy, safety, and benefits of topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs), which have a moderate effect on pain, but have a much better safety profile due to reduced systemic absorption. The use of topical drugs allows you to create an effective concentration of the drug directly in the lesion and avoid undesirable systemic effects. Experts strongly recommend prescribing primarily topical, rather than oral, NSAIDs to patients aged 65 years and older who have concomitant cardiovascular and renal pathology, as well as diseases of the gastrointestinal tract. In more detail, the review examines topical forms of diclofenac, which differ in the maximum degree of transdermal penetration compared to other NSAIDs and the effect of slow release of the active substance into the surrounding tissues.

The increase in the diabetes mellitus (DM) prevalence and incidence has taken on the features of the epidemic. Particularly often, DM occurs in the elderly and senile patients, while at least half of the cases of diabetes in this population remain undiagnosed. DM contributes to the deterioration of the quality of life, causes formation of dependence and progression of various geriatric syndromes leading to increased mortality. Elderly age is an independent risk factor for diabetic neuropathy. The main clinical forms of which are represented by chronic sensorimotor and autonomic impairments, complicated by impaired cardiovascular, gastrointestinal and urogenital functions, as well as chronic neuropathic pain syndrome. Progression of diabetic neuropathy aggravates walking and balance disorders, increases the risk of falls and loss of mobility, and significantly increases the risk of adverse diabetes outcomes. The article discusses in detail risk factors, pathogenesis, differential diagnosis and the possibilities of clinical and non-clinical evaluation of patients with suspected diabetic neuropathy. Possibilities for pain assessment in elderly people with communicative disorders or concomitant cognitive impairment are demonstrated. The article presents an algorithm for management of diabetic neuropathy in elderly ones, ways for optimization of risk and benefit balance, as well as the possibility of etiopathogenetic and symptomatic treatment of pain, autonomic disorders and prevention of late complications of diabetes with use of alpha-lipouc acid, taking into account key characteristics of discussed population.

Nonspecific (musculoskeletal) pain is the most common cause of low back pain (LBP). Chronic nonspecific LBP is a particular problem, as it significantly reduces the quality of life and functional activity of the patient. The diagnosis of chronic non-specific LBP is made after exclusion of a specific cause of pain, discogenic radiculopathy and lumbar stenosis. Unfortunately, patients with chronic non-specific LBP are often misdiagnosed, pain chronization factors (“yellow flags”) are ignored and ineffective treatment is prescribed. Clinical observation of a patient with chronic non-specific LBP, who was initially wrongly diagnosed with spinal osteochondrosis and the treatment was ineffective, is presented. A personalized, multidisciplinary approach to treatment allowed the patient to cope with back pain and to return to his previous daily activities. The patient’s treatment plan included non-drug methods of treatment (educational conversation, physical activity, mindfulness, cognitive-behavioural therapy) and rational pharmacotherapy (non-steroidal anti-inflammatory drug, NSAID). Clinical observation showed the efficacy and good tolerability of NSAID - dexketoprofen (in the form of Dexalgin and Dexalgin 25), which was administered in a stepwise scheme for 5 days. According to modern recommendations, NSAIDs are first-line drugs in chronic non-specific LBP. The results of clinical studies on efficacy and safety in back pain of such NSAIDs as dexketoprofen and nimesulide are presented. In case of prolonged exacerbation the possibility of dexketoprofen prescription with subsequent transition to nimesulide is discussed.

Postpartum or postnatal depression (PDD) is a common disorder that has serious negative effects on a woman’s health and increases the risk for a child’s emotional, social, and cognitive development outcomes. There are a few unresolved problems in the PDD pharmacotherapy caused by the lack of evidence about drug safety and effectiveness. This review provides a timely update on the current understanding of approaches to the diagnosis and treatment of patients with PDD as part of recurrent depression and bipolar disorder, the features of pharmacotherapy in the postpartum period depending on the manifestations and course of the disease. In accordance with the current guidelines, the treatment of PDD requires the use of the same standard approaches, as in the treatment of depression not associated with pregnancy and childbirth, while it is recommended to refuse breastfeeding in most cases, which runs somewhat contrary to the literature. Several clinical studies have shown that some psychotropic drugs are safe to use in breastfeeding mothers as they demonstrate low transfer into breast milk and rarely cause adverse events in infants. With this respect, sertraline is regarded as the first choice among antidepressants (AD), and quetiapine and valproate among normotimics, however, the limited amount of data does not allow us to make final conclusions about short-term and long-term risks for children. The article also outlines promising directions in the development of new neurosteroid-based antidepressant drugs for the treatment of PDD. Their mechanism of action is mainly associated with a modulating effect on GABAergic neurotransmission.

In recent years, significant successes have been achieved in the treatment of acute ischemic stroke. Given the trend towards an increase in the proportion of patients undergoing intravenous thrombolysis and / or mechanical thrombectomy, the question justifies: is there place for neuroprotective therapy (NT) in the era of active introduction of reperfusion treatment?
The review discusses the main mechanisms of brain damage in ischemia / reperfusion and the leading neuroprotective strategies studied in clinical trials. Neuroprotective approaches to suppress excitotoxicity, oxidative and nitrosative stress are presented. The clinical efficacy of magnesium sulfate, uric acid, and edaravone is discussed. Non-pharmacological methods of neuroprotection have been characterized, including remote ischemic conditioning, therapeutic hypothermia and neurostimulation. NT in a situation of impossibility of cerebral reperfusion is discussed. The results of randomized clinical trials and meta-analyzes on citicoline (ceraxon) are analyzed. A clinical case is presented illustrating the management of a patient for whom reperfusion therapy was not feasible due to the course of the disease.
In the era of the active development of reperfusion methods for the treatment of ischemic stroke, the goal-setting of NT has changed: it is intended to expand the possibilities of application and increase the effectiveness of intravenous thrombolysis and/or mechanical thrombectome, as well as neutralize their negative reperfusion effects. The main targets for NT remain excitotoxicity, oxidative and nitrosative stress. On the other hand, the real clinical situation associated with the low frequency of reperfusion technology in our country necessitates the use of neuroprotectors effective in this category of patients. In this regard, the administration of ceraxon increases the chances of achieving functional independence. The most effective use of the drug from the first day of the disease at a dose of 2000 mg per day intravenously for at least 4-6 weeks with further long-term oral administration at a dose of 1000 mg per day.

Despite the fact that otorhinolaryngologists are already very busy finding a solution to the problem of chronic tonsillitis, it remains unresolved. The prevalence of chronic tonsillitis does not decrease, but rather increases. Diseases of the tonsils are characteristic primarily of the child and adult working population. Chronic tonsillitis attracts attention not only as an independent disease, but as a cause of frequent local and especially systemic complications, which number more than 100. All these facts speak about the unresolved and urgency of the problem of chronic tonsil disease.
In the diagnosis of neck diseases, one of the most common methods is ultrasound. It has a number of significant advantages over other methods, such as high sensitivity and specificity, the ability to detect minor changes in the organs, non-invasiveness of the study, painlessness, accessibility, and the absence of ionizing radiation.
The aim of the literature review is to identify, analyze, and systematize literature data on the application of the ultrasonic research method in neck organ pathology.
Ultrasound diagnostics in the neck is widely used and is actively studied in acute inflammatory-purulent pathology (paratonsillar abscesses, phlegmon), in the pathology of the larynx and trachea, salivary and thyroid glands, as well as in the metastasis of malignant neoplasms to the lymph nodes.
There are several methods for diagnosing lymph nodes, such as: puncture and excision biopsy, lymphography, scintigraphy, thermography and ultrasound ultrasound. Despite such a variety of diagnostic methods, ultrasound is the method of choice for imaging cervical lymph nodes.
One of the most modern methods in ultrasound diagnostics is elastography. This method is most informative in cases when changes in tissues are small in size and cannot be detected using standard ultrasound modes.

The article presents data on the use of nebulizer therapy for major respiratory diseases: chronic obstructive pulmonary disease (COPD), bronchial asthma. The conditions for using aerosol-producing devices for new COVID-19 coronavirus infection, in the hospital and at home are also given. Historical aspects of the creation and use of devices for nebulizer therapy are considered. A differentiated approach is given when choosing an inhaler depending on the clinical situation, taking into account the need to use devices with a high level of precipitated fine particle fraction of the pharmaceutical aerosol, external minimal losses, with a reduced inhalation time and an economical treatment regime with optimal medication consumption. These advantages are inherent to nebulizers of the company PARI: PARI BOY SX and VELOX®. In patients with COPD, options for using nebulizer therapy in a stable state and in exacerbation are considered. It is emphasized that the inhaled route of administration of drugs provides direct penetration of the drug into the respiratory tract and, thus, contributes to a more effective drug effect. In addition, the inhalation route of administration reduces the potential risk of side effects. In patients with bronchial asthma, priority is given to the appointment of inhaled corticosteroids and β2-agonists in exacerbation. Data on the main types of devices, their advantages and disadvantages are provided. In conclusion, it is concluded that nebulizer therapy is a modern way to deliver the drug to the respiratory tract. In a number of clinical situations, the use of nebulizers is the only way to deliver the drug to a pathological focus. The use of nebulizers significantly expands the treatment options for patients with COPD and BA, reduces the need for hospitalization, and prevents the development of severe exacerbations.

Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airways. Inhaled bronchodilators and corticosteroids are the cornerstone of pharmacological long-term treatment for asthma and COPD. The efficacy of any topical inhaled medication is dependent upon successful distribution of the drug to the site of disease. Targeting small airways inflammation in severe asthma and COPD are critically important as the combined surface area of small airways far exceeds the surface area that large central airways provide. Small airway dysfunction in BA is associated with increased asthma symptoms, worse asthma control and an increased number of exacerbations. Chronic inflammation in COPD causes structural alterations and narrowing of particularly the small airways. The extrafine combination of beclomethasone dipropionate/formoterol (BDP/F) enables drug delivery to both the large and small airways, and allows the clinical benefits to be achieved with a lower corticosteroid dose. The use of extrafine BDP/F is more effective in achievement asthma control and reduce COPD exacerbations. If it is necessary to continue ICS as part of a double or triple COPD therapy extrafine fixed combination of BDP/F can be considered as the drug of choice and optimal replacement of the ICS molecule.

The review article presents current data on functional disorders of the biliary system, taking into account the latest recommendations of experts of the Rome Foundation (Rome Criteria IV, 2016) and the Russian Gastroenterological Association (specialized clinical recommendations, 2018). According to modern concepts, biliary dysfunction is a group of functional disorders of the biliary system caused by motor disorders and increased visceral sensitivity. According to the literature data, the prevalence of functional disorders of GB and OS is 10-15%, and violation of OS function is revealed in 30-40% of patients who underwent cholecystectomy (CE). The presence of biliary pain is an obligatory condition in the diagnosis of functional disorders of GB and OS. Bilirubin and serum transaminases (AST, ALT) levels may increase in biochemical blood analysis in patients with functional OS disorder of biliary type, and pancreatic amylase and lipase in case of functional OS disorder of pancreatic type. Ultrasound examination of abdominal organs is considered to be the priority among instrumental methods. This technique allows to exclude organic lesions of both the GB and visualized ducts, and adjacent organs (GSD, biliary tract, liver and pancreas neoplasms). Magnetic resonance cholangiopancreatography (MRCP) is used as a clarifying method, which allows to visualize the state of biliary ducts throughout. Ultrasonic cholecystography is used to assess the contractile activity of the GB. When duct dilation is detected and/or when liver/pancreatic enzyme levels are elevated in the absence of changes according to MRCP data, it is reasonable to perform an endoscopic ultrasound examination. According to the latest recommendations of the Russian Gastroenterological Association (2018), the foundation of pharmacotherapy for this group of diseases are antispasmodics and ursodeoxycholic acid (UDCA).

The prevalence of hypothyroidism in the population is high. The frequency of manifest hypothyroidism in the world, according to various data, is 0.2–2.0%, subclinical one – up to 10% for women and up to 3% for men, and in the older age group (over 70 years) reaches 14%, with the majority of cases of hypothyroidism accounted for primary hypothyroidism. Thus, a doctor of any specialty in his practice is likely to meet a patient with hypothyroidism: both with the established diagnosis, and face the need for differential diagnosis of various pathological conditions with hypothyroidism. This article presents a classification of hypothyroidism based on etiological aspects, describes the clinical picture of the disease, pays special attention to the so-called «masks» of hypothyroidism, which, in our view, can be useful for a doctor of any specialty, provides available methods for diagnosing this syndrome (special attention is paid to laboratory methods), as well as the goals and principles of treatment, highlights the need to monitor laboratory indicators in dynamics against the background of treatment. In addition, the features of correction of hypothyroidism during pregnancy are given. The article presents the peculiarities of selecting drug doses depending on the patient’s age and comorbidity. The distinctive feature and the purpose of this article, from our point of view, is its potential benefits not only for endocrinologists, but also for other health professionals.

Patients with diabetes mellitus (DM 1.2) are at high risk for changing the epidemiological situation during seasonal diseases (influenza, SARS), which mainly occur in the autumn-winter period. Under the current conditions in connection with the pandemic – СOVID-19, these patients turned out to be the most vulnerable, since the “isolation period” limits the possibility of dynamic observation of the patient by a general practitioner, an ophthalmologist, a specialist in the diabetic foot cabinet, and timely prescribing for preferential sugar-lowering drugs and resolving issues of planned hospitalization in specialized medical institutions. Patients who, for a numerous reasons have already have a low level of compliance with their chronic disease, were un-able to consult with a doctor on the topic of correction of sugar-lowering therapy in a short period of time. Any restriction on doctor’s consultation seriously affects the psycho-emotional state of patients with various types of diabetes, which often leads to an increase in blood glucose levels above the target level (5.5–6.5 mmol/L) and, as a result, leads to the development of acute and the progression of chronic diabetes complications. Modern technology in the form of a mobile diabetes management guide can serve as a helpful tool for patients during the “self-isolation”. In addition to the established communication with the doctor, the instructions will give patient the opportunity to make their own decisions and be involved in the treatment process.
New time dictates the needs introduction of a new medical format consultation “doctor-patient”. The article presents the experience of providing counseling for patients with diabetes in the “mobile health care” format using the Contour Diabetes mobile app for the Contour^™ Plus One meter (Contour Plus One).

The feet have an increased load, they are often injured, especially with diabetes. Because of the violation of innervation, patients do not notice minor injuries: abrasions, bruises, cracks, cuts. Because of the circulatory disorders associated with diabetes, the protective function of tissues decreases, and the smallest injury can lead to the formation of a long-term wound that does not heal, which turns into an ulcer when infected.
Despite advances in the study of the pathogenesis of diabetes and its complications, diabetic foot ulcers are difficult to treat, can recur, and lead to amputations of the lower limbs. The main reason for pathological dryness of the foot skin in diabetes is dysfunction of the sweat glands of the skin of feet due to diabetic neuropathy.
Regular skin care with specially selected products can help restore and improve the barrier function of the skin, as well as increase the moisture level of the stratum corneum. Adequate skin hydration reduces itching and the risk of infection if the skin is damaged. In most patients with diabetes, conventional cosmetics slowly eliminate dry skin of the feet. In addition, traditional remedies contain a large amount of oils and can cause unpleasant sensations, which often causes rejection of their use.
In patients with DM, it is desirable to use drugs that quickly and effectively eliminate dryness and cracks. Treatment of dry skin is indicated as a prevention of diabetic foot syndrome. Taking into account the fact that the skin of patients with diabetes mellitus has a low level of humidity, we recommend daily care using moisturizing or nourishing creams or lotions. Some studies have confirmed that the use of external dry skin care products containing dexpanthenol improves the protective function of the skin, increasing the hydration of the stratum corneum.

The article presents the relevance of the problem of postmenopausal osteoporosis (OP) in modern medicine, due to the social and economic consequences of fractures. The pathogenetic mechanisms of its formation are highlighted, indicating that during postmenopausal women amid estrogen deficiency, there is a violation of bone remodeling processes with increased bone resorption and decreased bone formation. Modern recommendations of the pathogenetic therapy of OP are presented, in which it is noted that the drugs of the first choice are drugs of the bisphosphonate class (BF). The ability of BF to suppress the pathological resorption of bone tissue and stimulate bone formation determines their therapeutic effect in OP. One of the drugs of the BF class is alendronate. In the treatment with alendronate, the processes of resorption by osteoclasts are suppressed and the processes of bone metabolism are restored to the premenopausal level, microarchitectural disturbances and bone loss are prevented. It has been demonstrated that the processes of bone metabolism remain stable during prolonged treatment with alendronate for 10 years, while the accumulation of the drug in the bone does not lead to excessive suppression of bone metabolism, but rather remains at the premenopausal level. The data of international and Russian randomized placebo-controlled trials (RCTs) are presented, which indicate the high effectiveness of alendronate at a dose of 70 mg 1 time / week in the treatment of primary OP in postmenopausal women: it had a positive effect on bone mineral density (BMD), reduced pain and, as a result, reduced the restriction of physical activity of patients. Quite good tolerability of the drug was noted, side effects in the treatment group were comparable to those in the placebo group. An analysis of the action of alenadronate shows that it has an aftereffect within a 12-month period after the end of treatment in relation to the BMD of the spine.

The data accumulated to date suggests that it is extremely rare for a gout patient to have only his or her main disease and no accompanying pathology. One of the frequent situations is a combination with another microcrystal arthritis, a disease of calcium pyrophosphate crystals deposition. In addition, diseases of the kidneys (including chronic renal failure), cardiovascular system, gastrointestinal tract, as well as metabolic disorders directly associated with gout or indirectly related to taking medications necessary to control the disease, not only affect the quality and longevity of life of the patient, but also create difficulties for its curation.
The prescription of drug therapy, both symptomatic and pathogenetic, in such cases involves an assessment of all the associated risks, and the choice of drugs, in addition to efficiency, should be based on their safety profile in relation to comorbid pathology.
This article analyzes the main principles and approaches to the treatment of gout and the disease of calcium pyrophosphate crystals deposition in the presence of concomitant diseases (arterial hypertension, chronic kidney disease, chronic heart failure, obesity, dyslipidemia, etc.) on the example of a 50-year-old patient. The possibilities of combined symptomatic therapy including colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids are shown. The necessity and tactics of choice of preventive prophylactic therapy for arthritis attacks and use of phebuxostat in the presence of contraindications for prescription or ineffectiveness of allopurinol are also discussed.

Due to the increase in life expectancy, the number of elderly and senile people with various chronic diseases is growing. One of the most common diseases of the musculoskeletal system is osteoarthritis. According to existing recommendations among all medications the leading place in the treatment of patients with osteoarthritis is given to symptomatic slowacting drugs (SYSADOA). Data from numerous studies show that these patients are often multimorbid, and this fact significantly restricts the appointment of many medications. In such cases, the use of drugs from the SYSADOA group becomes the basis of therapy due to their safety. Medications of this group include chondroitin sulfate and glucosamine sulfate. They are the main structural components of cartilage and synovial fluid and they are used for the synthesis of glycosaminoglycans, they reduce the degradation of cartilage, and also exhibit analgesic and anti-inflammatory effects. In addition, a number of other pleiotropic effects of these drugs have been shown, including a positive effect on muscles in sarcopenia, on reducing the risk of death from several cancers and complications of diabetes mellitus. In recent years, there has also been evidence of the use of the natural egg membrane preparation (NEM), which contains natural glycosaminoglycans and proteins necessary for maintaining the condition of the cartilage and synovial membrane. Studies have shown its anti-inflammatory effect, reducing the intensity of pain and improving functional indicators in patients with osteoarthritis. There was also a decrease in the production of pro-inflammatory cytokines in osteoarthritis for the plant-derived substance harpagophytum, which has therapeutic potential in the treatment of diseases associated with inflammation and oxidative stress.

Introduction. The article presents the results of the study of preparation for assisted reproductive technology (ART) programs in patients with infertility combined with repeated failures of in vitro fertilization (IVF) programs against the background of chronic endometritis. New information about the pathogenesis of chronic endometritis in patients with failures of IVF programs was obtained in the study. The new integrated approach to treatment includes aspiration of endometrial cavity to remove pathological endometrium, intrauterine administration of highly purified hyaluronic acid sodium salt with carboxymethyl cellulose in the form of a gel (Antiadgezin) to prevent fibrosis in combination with human placenta hydrolyzate (“Laennec”) and two-phase hormone therapy, which significantly (by 34.67%) increases the onset of pregnancy.
Aim of the study is to develop a comprehensive algorithm that includes an effective solution for the examination and subsequent treatment of chronic forms of endometritis, including patients with failed IVF programs and assess its effectiveness.
Materials and methods. A study was carried out on 110 patients with one or two unsuccessful in vitro fertilization programs, diagnosed with chronic endometritis, who underwent a comprehensive diagnostic study and “classical” treatment of chronic endometritis. The comprehensive treatment included endometrial cavity aspiration on day 26–27 of the menstrual cycle, intrauterine administration of highly purified hyaluronic acid sodium salt with gel carboxymethyl cellulose (Antiadgezin) in combination with intravenous application of human placenta hydrolyzate and subsequent two-phase hormone therapy. Used: Evaluation of the status of urogenital tract microbiota using PCR, pelvic ultrasound on days 5–7 and 19–21 of the menstrual cycle + doppler velocimetry of vessels (uterine, arcuate, radial arteries), determination of the hormonal background on the 2nd–3rd day of the menstrual cycle (FSH, LH, AMH, TSH, PRL, T4 free), hysteroscopy for the second phase of the menstrual cycle on the 19th–21st day, as well as a detailed histological examination of the endometrium (pipelle biopsy): Immunohistochemistry, PCR-diagnostics of viruses (adenovirus, Epstein-Barr virus, enterovirus), light-optical examination of pinopods, morphological determination of endometrium development stages in the second phase of menstrual cycle.

Introduction. Traditionally, erysipelas has been associated with streptococcal infection. Taking into account the possibility of carriage of the pathogen on the mucous membranes of the upper respiratory tract, we assumed that in patients with erysipelas of various localization, β-hemolytic streptococcus of group A would be detected.
Objective: Determine the effectiveness of immunochromatographic test for detecting β-hemolytic streptococcus group A in patients with erysipelas.
Materials and methods: The study included 52 patients with various forms of erysipelas. The diagnosis of «Erysipelas» was established clinically. Patients were examined using routine clinical and laboratory methods. To identify the β-hemolytic streptococcus group A antigen, a smear was taken from the mucous membrane of the back wall of the pharynx and tonsils in all patients at the hospital, and a sandwich-membrane immunochromatographic test was used. In order to identify the pathogen from the source of inflammation, in the case of complicated forms of erysipelas, bacteriological method was used.
Results: Immunochromatographic smear test revealed the presence of β-hemolytic streptococcus group A in 3 out of 52 patients (7%). Bacteriological examination of the contents of the wound, conducted by 16 patients (31%), did not reveal β-hemolytic streptococcus group A in any of the patients. One of these patients (with a fatal outcome) had a positive result of an immunochromatographic test (2%). In the wound discharge, 8 patients detected bacteria of the family Staphylococcaceae, including in combination with Enterococcus faecalis, Klebsiella mobilis, Proteus Mirabilis and Pseudomonas aeruginosa. In one case, Acinetobacter baumanii from the Moraxellaceae family was isolated.
Conclusion: We have not established the effectiveness of the immunochromatographic test for determining β-hemolytic streptococcus group A in the emergency department of a surgical hospital in patients with erysipelas. This is probably due to the frequent use of antibacterial drugs in the prehospital phase. It is impossible to exclude the leading role of other etiological factors in the development of inflammation of soft tissues, clinically similar to streptococcal infection.

Multiple micronutrient deficiency (simultaneous insufficient supply of the organism with several vitamins at once (vitamin D, B group), as well as calcium, magnesium, zinc and iodine, and not an isolated deficiency of any one micronutrient is characteristic of a significant part of the Russian population throughout the year, regardless of places of residence. The growing need of the organism at different periods of life (puberty, pregnancy, breastfeeding, aging), various diseases, drug therapy, the period of convalescence, stress, the use of various diets, enrichment of the diet with polyunsaturated fatty acids and dietary fiber, religious observance, adverse environmental factors further increase the risk of multiple micronutrient deficiencies. Micronutrients (vitamins and essential minerals) are closely interconnected into complex metabolic networks, which provide maintaining homeostasis and health. Deficiency of each of the essential micronutrients is a risk factor for the development of a particular disease, and simultaneous multiple micronutrient deficiency creates a “causality network” of not just one, but several diseases at once. Conversely, an adequate or optimal sufficiency of the body with all micronutrients, respectively, creates a “network of conditions ensuring the prevention of the disease”, due to the full implementation of all processes dependent on them in the body. This means that replenishing inadequate food intake of scarce micronutrients is an important way to maintain health and longevity. Given the variety of vitamin-mineral supplements, it is important to choose the right supplement. The maximum effectiveness to maintain the body’s vitamin and mineral status at the optimum level will be ensured by the intake of not individual micronutrients, but vitamin and mineral supplements containing a complete set of vitamins in doses close to the physiological needs of the body and basic minerals (calcium, magnesium, zinc and iodine), the deficit of which is characteristic for the Russian population.

Today, in many countries of the world, there is a steady increase in public spending related to health. One of the promising options for optimizing these costs is the widespread use of telemedicine as a method of remote medical care. It is known that the main contribution to the health of an individual and the population as a whole is made by lifestyle. Effective screening, timely detection of risk factors and diseases at the early stages of their development, medical examinations, universal opening of health centers, prevention offices, health schools – all these measures are aimed at increasing the duration and quality of life of the nation. Despite the availability and relatively low cost of well-known programs for remote screening, it is impossible not to mention their significant disadvantages: the lack of final analytical documents, the coverage of one or more systems, the need for a face-to-face visit to the doctor to calculate risks and determine further patient management tactics. The article proposes a methodology for telemedicine screening of adult health in outpatient settings using a system for analyzing unstructured data for population monitoring of chronic non-communicable diseases. The development is based on risk calculation using the method of “decision rules” as a means of description used in the theory of fuzzy sets. The result of the method developed by the authors is a variant of telemedicine questionnaire screening, which allows determining health risks by specific profiles, forming a final conclusion with recommendations for a healthy lifestyle, further examination, treatment and prevention of chronic diseases. The development can be used in public and private medical institutions. Of particular interest is the possibility of integrating software into medical practice in the current conditions of the pandemic, as well as in the state projects “Lean polyclinic”, “Arctic doctor” and “Zemsky doctor”.

Introduction. The term “cryoglobulinemia” is currently used to identify immunoglobulins in vitro in the blood serum that precipitate at temperatures below 37 °C; in vivo they form immune complexes that can be deposited in small vessels and activate the complement system with the development of leukocytoclastic vasculitis. Cryoglobulinemia may develop in various lymphoproliferative, autoimmune and infectious diseases.
Aim of study. To develop the technique of plasma proteins cryofraction (selective plasmapheresis with the use of heparin as a stimulant of fibronectin opsonic activity and purified autoplasma to compensate for the removed volume), to evaluate the effectiveness and tolerability of the developed technique in the treatment of patients with cryoglobulinemia.
Materials and methods. 159 patients were treated (120 women and 39 men aged 21 to 83 years).
Research results. Heparinocryofraction technique is a highly effective method of extracorporeal blood purification, which allows to selectively remove from the patients’ plasma such pathological components as cryoglobulins (up to 100% of the initial content), adhesive proteins (up to 84% of the initial content), fibronectin and immune complexes (up to 7% of the initial content). It is possible to reduce significantly and reliably the level of cryoglobulins, circulating immune complexes, non-specific markers of inflammation, daily proteinuria, as well as to normalize the initially reduced concentration of complement components and hemoglobin in the blood of patients with cryoglobulinemia before and after the procedure of cryofractionation. Purified by the proposed method autoplasma is a solution of albumin and normal immunoglobulins, which allows to use it for plasma substitution during a course of cryofractionation procedures, on average 7 procedures with an interval of 1–2 days.
Conclusion. The technique of cryofractionation using heparin and purified autoplasma can and should be widely used in the complex treatment of patients with cryoglobulinemia. Carrying out 6–-7 sessions of plasma cryofractionation allows to remove cryoglobulins from plasma effectively and selectively. Application of purified autoplasma allows to avoid using of blood preparations in plasmapheresis. The proposed method allows to significantly improve the efficiency and tolerance of medication therapy and increase the duration of disease remission.

Sports injuries of the musculoskeletal system of different localization represent actual problems of modern traumatology and rehabilitation. Despite the large number of proposed methods of therapy, the question of the management of injuries in athletes remains open. The main goal is to identify effective and safe approach to drug and non-pharmacological treatment and rehabilitation of athletes, allowing them to restore damaged structures and functional capabilities of the body to the initial level in a short time, as well as reduce the risk of relapse and repeated injury of athletes of any age.
This review of clinical cases demonstrates a modern approach to this problem based on recent breakthroughs in the inflammation resolution. Particular attention is paid to the role of complex bioregulatory medicines Traumeel S and Zeel T in the management of sport injuries. Four clinical cases of patients of different ages and sexes are presented for consideration, two of them had knee injury, one patient presented with acromioclavicular joint injury, and the last one was suffering from achilles tendon rupture. The treatment algorithms based on the complex bioregulatory medicines Traumeel S and Zeel T in different forms (injectables, ointment and tablet) are actively used in multidisciplinary clinic. In these settings patients can receive the necessary therapy according to clinical experience of other colleagues that was published in scientific articles.
Abovementioned clinical cases demonstrate that complex bioregulatory medicines and various physiotherapeutic methods may be considered as an effective treatment option in sport injuries.

Fibrosis and cirrhosis are traditionally diagnosed by making a biopsy. However, in recent decades, scientists around the world have shown that the accepted “gold standard of diagnosis” – morphological assessment of biopsy – has a number of limitations. The search for non-invasive techniques to diagnose fibrosis has led to the development of many scales using laboratory indices. Non-invasive diagnostic techniques are safer for the patient than liver biopsy. In addition, they can be repeated in a dynamic to assess the condition of the liver over time. Most currently available non-invasive diagnostic techniques are considerably cheaper than the accepted “gold standard”. Their practical use is increasing every year, and in a number of countries the frequency of liver biopsies in viral hepatitis B and C is steadily decreasing due to the development of serum and imaging diagnostic systems. Recent studies show that the assessment of the degree of fibrosis by non-invasive methods is as accurate as a morphological study. In recent years, a number of serum markers have been considered as non-invasive diagnostics of the stages of liver fibrosis, among which the largest number of studies are devoted to hyaluronic acid, type IV collagen, and their combination with various common laboratory tests. The latest non-invasive techniques will make a significant paradigm shift in the evaluation of liver fibrosis in the near future. In this review we have analyzed widely used as well as experimental laboratory techniques used in the diagnosis of liver fibrosis.