The article presents data on cases of pseudomembranous colitis registered in the region in patients infected with SARS-CoV‑2. A preliminary analysis of 214 cases of pseudomembranous colitis was carried out, of which 99 people died. As an illustration of the significance of the problem, the medical history of a patient with coronavirus infection and pseudomembranous colitis is presented. The article presents a point of view on the reasons for the increase in the number of cases of pseudomembranous colitis during the COVID‑19 pandemic.

The article presents data on the prevalence of gastrointestinal symptoms in patients with COVID‑19, the mechanisms of its development, the impact on the course of the disease and the tactics of drug therapy. It is noted that the persistence of the SARS-CoV‑2 virus in the intestine may be responsible for an increase in the duration of the disease and the development of multi-organ lesions, since the intestine, on the one hand, is the site of penetration and replication of the SARS-CoV‑2 virus, and on the other, is a potential source of virus spread due to increased intestinal permeability against the background of infection and disturbed microbiocenosis. Based on this, it seems pathogenetically justified to use drugs in the complex therapy of patients that contribute to the normalization of intestinal microbiocenosis and intestinal permeability.

Chronic acalculous cholecystitis is the cause of violations of the functional state of the liver in the form of stagnation in the intrahepatic bile ducts and a decrease in the activity of hepatocytes and is considered within the framework of a single pathology of the hepatobiliary tract. Complex therapy with the inclusion of the drug ademetionine, which in addition to the hepatoprotective effect affects the outflow of intrahepatic bile, contributes to the restoration of the detected violations.

The aim. To determine the definition of nutritional extinction and its characteristics in various phases of carcinogenesis, to show the role of nutritional counseling in the selection of personalized metabolic correction programs.

Materials and methods. 107 patients with pancreatic head adenocarcinoma (T3 and T4). In addition to traditional methods, the nutritional status was assessed according to the parameters of the well-known personalized alimentary-volemic diagnosis and the main common metabolic syndromes (inflammatory, hypermetabolism-hypercatabolism, toxic-anemic, anorexia-cachexia).

Results. The phases of nutritional extinction are identified, in accordance with which the original schemes of metabolic correction are developed. The effectiveness of the programs used, calculated according to the degree of well-being, was significantly higher in comparison with standard solutions. The feasibility of using this tactic was confirmed (in addition to traditional tests) by measuring the metabolism in lysosomes (according to the analysis of the level of cathepsin L using ELISA in the blood serum of the considered groups of patients).

Conclusions. 1) When determining the tactics of nutritional treatment of cancer patients, it is advisable to distinguish the phases of nutritional extinction, on the basis of which to carry out a differentiated metabolic correction. 2) The role of nutritional counseling (along with consulting with a surgeon and an anesthesiologist) allows you to clarify the strategy of treatment of patients with oncological pathology, and in some cases, make adjustments to the choice of the nature of the surgical aid.

Inflammatory bowel diseases are an urgent public health problem and are often complicated by the development of anemic syndrome. Significant progress has been made in the treatment of ulcerative colitis and Crohn's disease, but the correction of associated anemia in most cases remains insufficient. This article describes in detail the pathogenetic mechanisms of the formation of anemic syndrome in inflammatory bowel diseases, as well as possible ways to correct this condition.

The aim. To analyze the prevalence of antibiotic-associated diarrhea (AAD) caused by Clostridium difficile in a hospital setting.

Materials and methods. 93 patients with 3 or more episodes of unformed stool (diarrhea) for two consecutive days or more, developed after the use of antibiotics, were monitored. All patients underwent rapid stool analysis for the presence of Clostridium difficile A and B toxins using the X/pert C. diff toxin A/B test.

Results. Toxins A and/or B of Clostridium difficile were detected in 32 patients (34.4 %). The remaining patients (n = 61; 65.6 %) had idiopathic AAD. The most of the patients who were found to have Clostridium difficile toxins in the feces were in the infarction department, cardiology intensive care and trauma departments, i. e. they had severe diseases associated with reduced immunity and inactivity.

Conclusions. The prevalence of AAD caused by Clostridium difficile in hospital settings is high. It is recommended to prescribe drugs for the correction of disorders of the gastrointestinal microflora from the first day of antibiotic therapy, since this will significantly reduce the prevalence of clinical manifestation of diarrhea associated with Clostridium difficile.

Objective. To establish the diagnostic role of ASL-perfusion of the liver in magnetic resonance imaging (MRI) in assessing the risk of portal hypertension in patients with viral hepatitis.

Materials and methods. 109 patients with viral hepatitis were examined, including 69 (63.3 %) men and 40 (36.7 %) women, the average age of patients was 49.0 ± 2.3 years. All subjects (n = 109) underwent abdominal ultrasound with doppler vascular examination and clinical elastography, ASL-perfusion of the liver with MRI with an assessment of the volume of hepatic blood flow (HBF, ml/100 g/min).

Results. The highest diagnostic and prognostic significance of ASL-perfusion for the liver is a targeted study of changes in the right lobe: for the right lobe, AUROC = 0.886 (95 % CI: 0.799–0.889); for the left, AUROC = 0.635 (95 % CI 0.627–0.641). The diagnostic and prognostic significance of ASLperfusion was evaluated in comparison with ultrasound with doppler vascular examination: AUROC = 0.991 (95 % CI: 0.880–0.993); AUROC = 0.801 (95 % CI: 0.776–0.804), respectively. The quantitative and qualitative characteristics of ASL – liver perfusion were evaluated.

Conclusion. When performing ASL-perfusion of the liver, MRI should evaluate quantitative and qualitative criteria. Criteria for the prognosis of portal hypertension according to ASL- perfusion in MRI in patients with viral hepatitis: HBF 131–160 ml/100 g /min, red card – very high risk, HBF = 161–185 ml/100 g/min, red card – high, HBF = 40–130 ml/100 g/min, mixed card – medium; HBF = 131–160 ml/100 g/min, blue card-low risk (r = 0.883).

Obesity is the 21st century pandemic. By 2025 6 % of men and 9 % of women will suffer from morbid obesity. For morbid obesity bariatric surgery is the main treatment option. The presence of pathology of the upper gastrointestinal tract (GERD) determines the choice of surgical intervention. The study involved 68 patients 47.1 ± 10.2 years with morbid obesity. Patients had the following gastroenterological pathologies: erosive esophagitis – 6 (8.8 %), hiatal hernia – 9 (13 %), erosive and ulcerative lesions of the stomach and duodenum – 13 (19 %). Heartburn disturbed 38 (55 %), regurgitation – 17 (25 %), severity and feeling of fullness in the epigastrium – 29 (42 %), pain or burning in the epigastrium – 8 (11 %) patients. Fifty (73.5 %) patients underwent laparoscopic sleeve gastrectomy, 18 (26.5 %) patients – laparoscopic Roux-en-Y gastric bypass. Comprehensive preoperative examination (x-ray of the upper gastrointestinal tract with barium, daily pH impedance measurement, esophageal manometry) and phenotyping of GERD lead to reduction of GERD symptoms in patients with morbid obesity after sleeve gastrectomy.