The article provides a brief description of the disease caused by the SARS‑CoV‑2 coronavirus, and considers the leading measures to counteract the spread of infection. The algorithm of the actions of the medical staff of the clinic in identifying a patient with suspected COVID‑19 is presented.

The clinical example in this article shows the successful experience of using the neuroprotective agent citicoline (Noocyl) in a comorbid patient after an ischemic stroke with motor and cognitive impairment in combination with antihypertensive, hypolipidemic, and antiplatelet therapy. High efficiency and good tolerance of this drug, the ability to improve cognitive and motor processes are shown.

Onychomycosis is a widespread nail disease caused by dermatophytes, yeast and non‑dermatophytes. Risk factors for the development of onychomycosis can be various somatic conditions, for example diabetes, age, lifestyle features. Often onychomycosis occurs in athletes. According to some reports, 60.7 % of football players have this disease. The reason for the increased risk of developing onychomycosis in athletes is wearing unsuitable shoes, the frequent use of synthetic clothing and sweat‑preserving shoes, and injuries to the nail plates. Preference should be given to systemic therapy. Treatment can take up to 18 months, due to the slow regrowth of a healthy nail plate. Of the systemic drugs, itraconazole is widely used. The drug can be prescribed according to the scheme of pulse therapy, and positive dynamics is observed after 2 months of use.

Cardiovascular disease is the leading cause of death worldwide. The current recommendations of the European Society of Cardiology (ESC) – 2019 are based on the results of large multicenter clinical trials that have proven the effectiveness of more stringent approaches to the management of patients with high cardiovascular risk. New regimens of drug therapy, the definition of new target values for blood pressure, blood lipid levels and the correction of hyperglycemia, the prevention of thromboembolic complications, are aimed at reducing the risk of cardiovascular events and mortality from cardiovascular diseases. The article discusses recommendations of the European Society of Cardiology – 2019 on the management of patients with chronic coronary disease, with lipid metabolism disorders, and diabetes mellitus.

The aim of the study was to study the changes in clinical and biochemical parameters in patients with different severity of coronary atherosclerosis, depending on the administration of lipid‑lowering therapy. The study included 354 patients with coronary heart disease. All patients underwent coronary angiography with the calculation of the Gensini index. Patients were determined the level of oxidative modification of proteins, RF‑reactive protein, homocysteine and superoxide dismutase activity depending on the administration of lipid‑lowering therapy (statins). A statistical relationship between the group of patients divided by the Gensini index and statin intake was revealed. In the assessment of clinical and anthropometric indicators, significant differences in BMI, waist circumference, systolic blood pressure level were established. In assessing the lipid profile revealed significant differences between the study groups in the level of total cholesterol and the level of HDL‑cholesterol. Low adherence to lipid‑lowering therapy was noted in patients with hemodynamically significant coronary atherosclerosis. In this regard, it remains necessary to search for residual risk markers, taking into account the importance of non‑lipid risk factors.

Spectral analysis of heart rate variability gives an idea of the role of the autonomic nervous system in the regulation of chronotropic heart function. This method can be used to evaluate the effectiveness of drug therapy. Drug therapy should be carried out taking into account the individual clinical form of atrial fibrillation. Information about the vegetative status of the patient will undoubtedly increase the effectiveness of treatment. In this study, spectral parameters were studied in patients with atrial fibrillation. The effect of sotalol on the spectral parameters of heart rate variability was studied.

Cardiovascular diseases in locomotive drivers are a factor limiting their working activity, as they can potentially increase the risks of accidents and disasters in rail transport. Working conditions of drivers are associated with occupational hazards that have a negative impact on the cardiovascular system. A review of clinical studies examining the risk factors for cardiovascular disease indicates the significant role of psychological stress on the health status of drivers. It was revealed that the negative effects of stress on the cardiovascular system depend on work stress, work schedule, and also on social factors: job satisfaction, salary, quality of rest and sleep. The studies revealed a correlation between the development of cardiac rhythm disturbances of high gradations with psychoemotional stress and sleep apnea in locomotive drivers.

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

Amyloidosis combines diseases that are characterized by extracellular deposition of a specific insoluble fibrillar amyloid protein. The prevalence of amyloidosis is an average of 10 cases per 100 thousand people. The clinic of the disease is polymorphic and depends on the organ with amyloid deposition. The article discusses the clinical case of systemic amyloidosis with damage to the stomach, liver and other organs. The differential diagnosis was carried out with tuberculosis, cancer, cirrhosis. The final diagnosis was made by histological examination of biopsy samples of the liver and stomach. Difficulties in diagnosing primary amyloidosis are due to the attrition and non‑specificity of the clinical picture of the disease. Amyloidosis is diagnosed based on organ biopsy data.

Asthenic syndrome is a non‑specific syndrome that is often found in general medical practice in patients with various somatic pathologies both during an exacerbation of a chronic disease, and after an acute process. The leading symptoms in the clinic of asthenia are pathological weakness and fatigue. According to various researchers, they are found in 15–45 % of people. To date, there is no universally accepted definition and clear classification of this syndrome. The main pathogenetic concepts are the psychosocial, infectious‑immune theory of asthenia. The development of asthenic syndrome in patients with somatic pathology may be associated with the depletion of the functional capabilities of the nervous system due to disturbances in the blood supply to the brain, auto‑toxicity or exposure to exogenous toxic factors in bacterial, viral infections. There is no specific treatment for this condition. This article presents two clinical cases of the development of post‑infection asthenic syndrome in a 47‑year‑old patient against community‑acquired pneumonia and in a 36‑year‑old patient after an acute respiratory‑viral infection of moderate severity. In both cases, drug treatment with Mildronate was carried out with a positive trend in the form of regression of asthenia symptoms, side effects during treatment. Mildronate belongs to the class of cytoprotectors – antihypoxants, activates glycolysis and prevents impaired transport of adenosine triphosphate, providing a sufficient level of energy synthesis, which allows cells to maintain homeostasis and morphological integrity. The immunoadjuvant properties of Mildronate are very important in post‑infectious asthenic syndrome, since a violation of the immune response plays a central role in its pathogenesis. The immunoadjuvant properties of Mildronate have been discovered in a number of studies.