The health profile of elderly patients with coronary artery disease commonly includes comorbidities, polypharmacy, a high likelihood of side effects in drug interactions, depression, cognitive deficit, which inevitably affects the quality and effectiveness of drug therapy as well as adherence to the prescribed therapy. The risk of poor outcomes is less likely to be adequately assessed in elderly patients with coronary artery disease. They less often receive effective drug therapy to manage the risks. This article discusses the optimal selection of highly effective antianginal medical therapy aimed at preventing recurrent episodes of angina pectoris and improving the quality of life of an elderly patient with coronary artery disease.

Clinical practice and ongoing scientific research in recent years show the importance of the problem of multimorbidity in atrial fibrillation (AF). The prevalence of AF in the general population is 1–2%, while the frequency of its occurrence increases with age – from less than 0.5% at the age of 40–50 to 5–15% at the age of 80. Only 19.6% of patients with AF have no comorbidities, 69.3% of patients have 1 to 3 comorbidities, and 11.1% of patients with AF had 4 and more comorbidities. In patients with AF and with 4 and more comorbidities, the risk of death from all causes is almost seven times higher than in patients without comorbidities. As shown by the post hoc analysis of the ARISTOTLE study, apixaban was equally effective and safe in both patients without concomitant pathology and in muliborbid patients. The efficacy and safety of apixaban has been shown in AF and concomitant arterial hypertension, heart failure, coronary heart disease, including in patients with acute coronary syndrome, diabetes mellitus, chronic kidney disease and chronic obstructive pulmonary disease. The data of scientific research in recent years are reflected in the recommendations of the Ministry of Health of the Russian Federation on AF (2020), which presents a separate section on the management of patients with concomitant diseases. It is emphasized that apixaban has shown its superiority over warfarin and other direct oral anticoagulants in terms of efficacy and safety, both in isolated AF and in patients with concomitant diseases, which makes its choice preferable in the treatment of multimirbidity AF patients.

Recently, more and more attention has been paid to the problem of drug‑induced (DI) atrial fibrillation (AF). It is known that the development of DI AF can be associated with the intake of cardiovascular and anticancer drugs, drugs that affect the central nervous system or respiratory organs. However, there are other drugs that can provoke DI AF, which practitioners are less aware of. This article is a review of the current literature on DI AF associated with the intake of other groups of drugs and individual drugs that are not included in the above groups. Analysis of the available literature has shown that the incidence of DI AF reaches 6.9% when taking zoledronic acid and 1.5% when taking alendronate, although data from different authors regarding the causal relationship between bisphosphonate therapy and the development of AF are ambiguous. The use of high doses of glucocorticosteroids (at a daily dose of ≥ 7.5 mg in terms of prednisolone) is also associated with an increased risk of AF (OR = 6.07; 95% CI: 3.90–9.42). Treatment with non‑steroidal anti‑inflammatory drugs is also associated with a higher risk of developing DI AF compared to those who do not use it – the incidence rate is 1.17 (95% CI: 1.10–1.24) for nonselective and 1.27 (95% CI: 1.20–1.34) for cyclooxygenase‑2 inhibitors. The literature contains a description of clinical cases of DI AF while taking immunosuppressants (azathioprine, methotrexate + etanercept, fingolimod, cyclosporine), drugs that affect the genitourinary system (vardenafil, sildenafil, yohimbine hydrochloride, hexoprenaline), local anesthetics, bupacaero testosterone, stanozolol, testosterone cypionate, nandrolone decanoate extraboline) and nicotine‑containing products (nicotine‑containing chewing gum).

Acute respiratory viral infections (ARVI), including influenza, remain the most common infectious diseases. In the context of COVID‑19 pandemic, there is a need for differential diagnosis of respiratory syndrome. The clinic of ARVI, depending on the pathogen, may have its own characteristics. Influenza and COVID‑19 have common pathways of transmission of the pathogen and similar symptoms, so the optimal differential diagnosis is the use of test systems for both viruses. Against the background of influenza and other acute respiratory infections, complications from various organs and systems can develop. The article discusses in detail the issues of the clinical course of ARVI, differential diagnosis, modern approaches to therapyand prophylactic. Complications of influenza from the cardiovascular system are considered in detail. The data of our own observations on the risk of developing acute coronary syndrome in persons who have undergone COVID‑19 are presented. Prevention of the development of complications of influenza and other acute respiratory infections is the early appointment of antiviral therapy. Numerous studies confirm the effectiveness of interferon inducers in the treatment of influenza and other ARVI. The article presents the results of clinical studies confirming the effectiveness of therapy with the interferon inducer Kagocel. Against the background of its use, a decrease in the severity of clinical manifestations, a reduction in the duration of the disease, and the prevention of complications were noted. In studies, the drug has shown a high level of safety. The article discusses studies on the effectiveness of chemoprophylaxis of influenza and other acute respiratory infections.

Over the past period of the COVID‑19 pandemic, experience has been gained on the ways of spreading the infection, new approaches to treatment have been formed, and preparations for vaccine prevention have been created. Information about COVID‑19 is updated with new data on the features of the clinical course, including rare manifestations of the disease. The clinical symptoms of CAVID‑19 are characterized by a significant variety and are due to the tropism of the SARS‑CoV‑2 virus to various tissues. The article describes a clinical case of COVID‑19. With severe intoxication syndrome, the patient was found to have concomitant acute tonsillitis. The article provides a review of the literature on the clinical symptoms of COVIND‑19 and the mechanisms of their development. The differential diagnosis of viral and bacterial tonsillitis is considered. Efficacy of antibacterial therapy of tonsillitis with cefixime. The clinical case is illustrated with photos.

Rational feeding is one of the most important conditions that ensure adequate maturation of various organs and tissues, optimal parameters of physical, psychomotor, intellectual development, infant resistance to infections and other unfavorable external factors. The ideal food for an infant is mother’s breast milk, because it has a relationship with the tissues of the child and is the ‘gold standard’ for optimal nutrition. The nature of feeding in the first year of life largely determines the state of health of the child, not only in infancy, but also in the subsequent years of his life. Insufficient or improper nutrition of the mother during pregnancy and lactation is a consequence of the production of milk with a low content of vitamins and essential nutrients, which may be one of the reasons for the development of alimentary‑dependent conditions in young children, negatively affect growth indicators, nervous and mental development of a child. The best way to replenish the micronutrient deficiency in the diet of nursing mothers is to take biologically active food supplements in the form of vitamin and mineral complexes.

Progressive increase in the proportion of elderly patients in the population of many countries actualizes the issues of preserving physical and mental health, working capacity and quality of life of retirees. As a part of preventive geriatric rehabilitation, ‘the Active Longevity’ program has been operating in many cities of Russia over the past three years, one of the aspects of the program is the involvement of elderly patients in active life, including an increase in physical activity. This study included 744 patients who attended face‑to‑face physical training sessions. According to the results of the survey, 41% of pensioners noted an increase of daily physical activity, 94% reported an improvement in health and mood, the level of total blood cholesterol decreased. Almost all patients, both with and without clinical and subclinical manifestations of anxiety and depression, reported a good and very good mood immediately after exercise. Increasing physical activity in elderly patients improves the quality of life and prolongs its duration, and is also an effective method of non‑drug treatment of anxiety‑depressive disorders.

Systemic lupus erythematosus (SLE) is one of the most complex rheumatological diseases, occurring with a variety of clinical forms and manifestations. The debuts and variants of the course of SLE can vary significantly, so it is called ‘chameleon disease’ or ‘the great imitator of diseases’. In 2019, a group of experts from the European Anti-Rheumatic League and the American College of Rheumatology developed the latest criteria for the diagnosis of systemic lupus erythematosus. A prerequisite for the diagnosis is a positive antinuclear factor in combination with the seven clinical criteria for SLE (constitutional, hematological, neuropsychiatric, skin‑mucosal, polyserositis, renal) and the three immunological signs (antiphospholipid antibodies, levels of complement and its fractions, SLE‑specific autoantibodies) The article describes a case of systemic lupus erythematosus, diagnosed in a patient who was admitted to the hospital with a directional diagnosis of ‘fever of unknown origin’. The diagnosis of systemic lupus erythematosus was established on the basis of seven clinical criteria and two immunological diagnostic criteria.

A rare case of acute pericarditis in a patient with a previous COVID‑19 infection is analyzed in a clinical follow‑up. The anamnesis of the disease, the clinical picture of the disease, the dynamics of laboratory and instrumental indicators are described. The complexity of identifying the causative agent of the infectious process and the difficulty of selecting etiotropic therapy is demonstrated. The recommendations of the European Society of Cardiology for the diagnosis and treatment of pericardial diseases (ESC2015) were taken into account and applied in practice. The article presents an overview of clinical cases of pericarditis in patients with COVID‑19 according to international publications, the results are compared with the clinical case presented by the authors.