The first cases of CAVID-19 were first identified in December 20I9, and in March 2020, due to the global spread of the disease, the WHO named it as a pandemic. Vaccination is the main method of preventing infectious diseases. To create collective immunity, at least 60 % of the population needs to bevaccinated. The article provides information about the types of vaccines against COVID-I9, contraindications to their use, side effects after immunization. The official statistics on vaccination against COVID-19 in Russia and in the world are given. The normative legal acts regulating vaccination are presented.

The basis of the normal course of pregnancy is a healthy lifestyle, including nutrition as the main component. It is necessary that the diet of a pregnant woman is balanced and contains the optimal amount of not only macro-, but also micronutrients. Vitamins and minerals obtained from food play an important role in the course of many metabolic processes that ensure the growth and development of fetal tissues, and, prevent intrauterine malformations. They are fundamental to ensuring the normal course and outcome of pregnancy. Additional intake of micronutrients is aimed at ensuring the increased physiological needs of a pregnant woman’s body associated with fetal growth, placenta formation, and restructuring of the mother’s body. In recent years, many myths have arisen about the nutrition of pregnant women, in our article we will discuss the most common.

Adequate interaction between the macroorganism and the microbiota is the basis for proper metabolism and overall human health. Probiotics allow for targeted correction of individual metabolic processes, reducing the risk of developing diseases or increasing the effectiveness of drug therapy. Lactobacillus plantarum demonstrates high efficiency in correcting microbiota disorders, improving metabolism, regulating inflammation and immunity. A continuous search is carried out for new strains of microorganisms that have an immunocorregulating and metabolic effect.

Upper respiratory tract infections (URTI) are a large group of infectious diseases (mainly viral and bacterial), affecting the mucous of the nasal cavity, paranasal sinuses, pharynx and larynx. URTI are very common in inpatient and outpatient clinical practice. In this article, we present a clinical case of Patient N., 20 years old, consulted with upper respiratory tract damage caused by Chlamydia pneumoniae. The patient admitted to clinical diagnostic center on 07.07.2021 with complaints of pain in the left maxillary sinus with irradiation to the left temporal region, difficulty in nasal breathing, pain in the pharynx, aggravated by swallowing, and increased body temperature (37,5 °C). The patient was consulted by an interdisciplinary team (ENT doctor and clinical pharmacologist). After carrying out physical, instrumental and laboratory tests the diagnose Chlamydia pneumoniae - associated URTI was established and, the patient was prescribed doxycycline at a dose of 100 mg 2 two times a day on the 1st day following by 100 once a day for the next 6 days with a positive effect. The doxycycline was choisen because of a more favorable safety and efficacy profile compared to fluoroquinolones and some other antibacterial agents. After 7 days of treatment, the patient recovered completely. Among all doxycycline drugs available on the market of the Russian Federation, Doxycycline Express (JSC Pharmstandard-Leksredstva) stands out due to its high quality, bioequivalence to the original drug and comfortable regime of use due to the dosage form (dispersible tablets), that increases the patient’s compliance and allows it to be used by some special categories of patients (elderly and senile patients, patients with dysphagia, etc.

he liver is one of the organs most often affected by medication (MP) intake. Drug-induced liver damage with cholestasis (LIPCH), on the one hand, rarely leads to death in comparison with the hepatocellular type, but, on the other hand, is more often characterized by a long, in some cases chronic course. This type of liver damage is characterized by an increase in the activity of alkaline phosphatase (ALP) > 2 upper limits of normal (ULN) or the ratio of alanine aminotransferase (ALT) / ALP < 2 in chronic course. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most readily available (including over-the-counter) and widely used drugs in clinical practice and are often the cause of LIPCH. This article summarizes the available data at the time of preparation of the article on the prevalence, mechanisms of development and features of LIPPH while taking NSAIDs. A separate section is highlighted on the features of the management of such patients. In particular, in accordance with both domestic and foreign clinical guidelines for the drug genesis of liver damage, it is recommended to stop taking the inducer drug and prescribe ursodeoxycholic acid (UDCA). The efficacy of UDCA in patients with LIPCH, including those associated with the use of NSAIDs, has been confirmed by the results of a large number of randomized placebo-controlled clinical trials. Among the UDCA preparations on the market of the Russian Federation, one cannot fail to pay attention to Exho® (CJSC «Canonpharma Production»), which is bioequivalent to the reference drug, is produced in compliance with GMP standards on a high-tech production base, which ensures its quality, and an affordable price and a large the choice of dosage forms makes it possible to successfully use this drug, including in special categories of patients, for example, elderly patients and/or those suffering from dysphagia.

In the article on the example of a clinical case approaches to enhancing antianginal therapy of coronary artery disease were discussed. Arguments were given for prescribing preparations of the second line of antianginal agents (thymetazidine) in the patient with stable angina with high functional class and concomitant hypotonia after a complicated COVID-19. The main mechanisms of action of trimetazidine and results of clinical studies were discussed.

The 2019 coronavirus infection pandemic (COVID-19) is widespread worldwide and is characterized by severe complications from the respiratory system, kidneys, liver, etc. The article presents an analysis of ACS in patients with COVID-19. It was revealed that in patients with coronavirus infection, acute coronary syndrome is characterized by a large number of complications and a high risk of death. The article presents the results of a study conducted by the authors on the study of acute coronary syndrome in patients who have undergone COVID-19. The study compares two groups of patients with ACS, depending on the presence of COVID-19 in the anamnesis. In the comparison groups, the analysis of the prevalence of risk factors for cardiovascular diseases was carried out: smoking, age, diabetes, obesity, dyslipidemia. The results of biochemical blood analysis and coagulogram were analyzed. It was found that patients with acute coronary syndrome who underwent COVID-19 were less likely to have risk factors for cardiovascular diseases. Patients with acute coronary syndrome who underwent COVID-19 had lower blood glucose, cholesterol, VLDL, triglycerides and higher blood clotting rates. As a result of the study, it was revealed that COVID-19 is an independent risk factor for the development of acute coronary syndrome against the background of multiple coronary vascular lesions.

Objective. To evaluate the relationship between the level of high-sensitive C-reactive protein young and middle-aged people without history of cardiovascular complications.
Methods. Data from 427 patients aged 30-55 years old (median age -41 years old; men -83%), based on the center of diagnosis and rehabilitation of «Gazprom Transgaz Moscow» LLC from November 2018 to February 2020 were analyzed. All the participants conducted a comprehensive examination in accordance with the employee profession and order No. 302 of the Ministry of Health of the Russian Federation. Blood hs-CRP level was determined by an immunoturbodimetric method with latex amplification, with a lower detection limit of 0.1 mg/l.

Results. Hs-CRP in comparison with a normal body weight participants (0.52 [0.32;0.98] mg/l) was significantly higher in overweight persons (1.23 [0.68;2.11] mg/l) and in obese patients (1.84 [1.27;3.11] mg/l), as well as in patients with obesity in comparison with patients with overweight (p=0.0001 in all cases). The hs-CRP level in a group with systolic blood pressure (SBP) 120-129 mm Hg hs-CRP was 0.96 [0.50;1.96] mg/l, in the group with SBP 130-139 mm Hg - 1.52 [0.83;2.77] mg/l, in patients with SBP >140 mm Hg- 1.54 [1.03;2.19] mg/l (p = 0.0002). Similar significant (p=0.0002) relationships are revealed for office diastolic blood pressure (DBP). In patients with a total blood cholesterol >4.9 mmol/l (n=355), the average level of hs-CRP was 1.24 [0.60;2.19] mg/l, and in participant with normal total cholesterol (n=72) - 0.69 mg/l [0.37;1.80] (p = 0.002). Among all the analyzed persons, elevated levels of hs-CRP (> 2 mg/l) were associated with frequent flu (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2-3.7; p=0.02) and an increase in the erythrocytes sedimentation rate (ESR) (OR 3.5, 95 % CI 1.5-8.03; p=0.004). After adjustment for sex, age and confounders hs-CRP >2 mg/l significantly associated with abdominal obesity (OR 2.2, 95 % CI 1.2-4.2; p=0.01) and hypertension (OR 1.9, 95 % CI 1.1-3.3; p=0.02).
Conclusion. In young and middle-aged persons passing PME, hs-CRP is a stable cardiovascular risk marker, associated with overweight, obesity, an increase in the total cholesterol level, office SBP and DBP, ESR, and with history of frequent flu.

The objectives of physical rehabilitation are restoration of the activity of the cardiovascular system, prevention of recurrent myocardial infarction and other complications, adaptation of the patient’s body, with a previous myocardial infarction, to the usual daily stress. In our study, we carried out medical rehabilitation (MR) to patients with myocardial infarction using the methods of therapeutic physical activity through terrenkur, scandinavian walking, mechanotherapy.

Purpose. To assess the accuracy of blood pressure measurement by oscillometric and auscultatory methods using the complex for daily monitoring of ECG and blood pressure «Medicom-Combi» in accordance with the criteria outlined in the Universal Standard AAMI/SH/ISO (ISO 81060-2:
2018) for children and adults.
Materials and methods. The study involved 90 patients (average age -33.8 ± 26.7 years) of the cardiological profile of the City Clinical Hospital No. 13 DZM, Children’s City Clinical Hospital No. 9 named after G. N. Speransky, as well as medical personnel, of which 85 were included in the analysis. For each participant, 3 pairs of valid measurements were obtained (reference-test, 255 pairs of measurements in total). Reference measurements were carried out by two experts, independently of each other, using the auscultatory method. Test measurements were read from the complex by a third expert.
Results. According to validation criterion 1, the mean ± standard deviation of differences between test and reference measurements was 0.1 ± 6.0/1.7 ± 5.8 mm Hg for SBP/DBP by the oscillometric method and 0.0 ± 6.5/1.3 ± 6.6 mm Hg for SBP/DBP by the auscultatory method. According to validation criterion 2, the standard deviation of the average difference between the BP values of the same patient according to the results of test and reference measurements did not exceed 6.95/6.73 for SBP/DBP by the oscillometric method and 6.95/6.82 mm Hg for SBP/DBP by the auscultatory method.
Conclusion. The complex for daily monitoring of ECG and blood pressure «Medicom-Combi» meets the requirements of the Universal Standard AAMI/ESH/ISO in terms of measurement accuracy for devices intended for use among children and adults when assessing blood pressure by oscillometric and auscultatory methods. 

Purpose. To assess the accuracy of blood pressure (BP) measurement by the complex for daily monitoring of ECG and blood pressure «MedicomCombi» in comparison with a mercury sphygmomanometer in pediatric patients.
Materials and methods. The recruitment of study participants was carried out in accordance with the criteria outlined in the international protocol BHS-93 for the pediatric population. During the tests, repeated sequential measurements of blood pressure were carried out by experts (using mercury sphygmomanometers) and the tested complex (by oscillometric and auscultatory methods).
Results. The mean SBP, determined by the oscillometric method, was 116.0 ± 13.6 mm Hg, DBP - 69.0 ± 11.8 mm Hg. The mean SBP according to the auscultatory method was 116.0 ± 14.6 mm Hg, DBP - 70.4 ± 11.9 mm Hg. In 66% of cases for SBP and in 62% of cases for DBP, the difference between expert and test measurements by the oscillometric method did not exceed 5 mm Hg. In 100% of cases for SBP and in 96% of cases for DBP, the differences were within 10 mm Hg. The average differences between the experts and the tested complex were - 0.2 ± 5.7 mm Hg for SBP and 1.6 ± 6.1 for DBP. In 68 % of cases for SBP and in 65 % of cases for DBP, the difference between expert and test measurements by the auscultatory method was no more than 5 mm Hg. In 100% of cases for SBP and in 95% of cases for DBP, the differences did not exceed 10 mm Hg. The average differences between the experts and the tested complex were - 0.3 ± 4.7 mm Hg for SBP and 0.1 ± 5.7 for DBP.
Conclusion. The complex for daily monitoring of ECG and blood pressure «Medicom-Combi» has demonstrated compliance with the accuracy requirements specified in the BHS 1993 protocol (class «А/А»), and can be recommended for measuring blood pressure by oscillometric and auscultatory methods in pediatric practice.

Hypophosphatemia (GF) is defined as a decrease in the level of inorganic phosphorus in the blood serum below 2.5 mg/dl (0.81 mmol/L). One of the reasons for the development of GF can be the use of a number of medications: diuretics, some antibacterial drugs, insulin, antacids, glucose solutions for parenteral administration, antitumor drugs. The true prevalence of drug-induced (DI) HB is unknown, because the phosphate level is not evaluated routinely, but only when GF is suspected. The most common mechanism for the development of DI GF is an increase in the excretion of phosphates by the kidneys. In most cases, DI GF is asymptomatic and regresses after discontinuation of the inducer drug. To compensate for the phosphate deficiency, non-drug methods (diet) and pharmacotherapy are used. Prevention of DI GF involves avoiding the use of drugs, the reception of which is associated with the development of DI GF, especially in patients at risk of developing GF.

Hyponatremia (HN) is a significant disturbance of the water-electrolyte balance in clinical practice. Drugs are one of the leading causes of low sodium level. Antidepressants, antiepileptic, antipsychotic, antineoplastic drugs and opioid analgesics are the most common medications that induce hyponatremia. Special attention should be paid to people with cancer, who often receive several drugs that induce HN. Risk factors for the development of drug-induced (DI) HN when taking most medications are female sex, weight loss, and old age. In persons receiving therapy with the listed drugs, it is necessary to assess the risk factors for a decrease in the sodium level, clinical manifestations from the nervous system, and to determine the sodium level in dynamics. Special care must be taken when treating elderly patients, since they have several risk factors for the development of DI HN. These measures will help prevent the development of HN and its severe and sometimes fatal complications.

The current stage of health protection and social protection of the population poses new challenges for the ITU institutions to improve the quality of expertise, address issues of disability prevention, and there is no doubt that statistical analysis still plays an important role in their implementation. Considering the issues of disability, the dynamics of a social phenomenon that has all the rights to public attention is reflected. Materials on disability and the activities of ITU institutions, when adequately analyzed and used, are an effective tool in the work of government bodies to organize and improve measures to prevent and reduce disability, improve expert and rehabilitation services for the population. The purpose of this article is to present one of the organizational forms of the work of the ITU Bureau for the study of the causes and factors that directly led to disability, the prevention of disability, taking into account the task set by the Ministry of Labor and Social Protection of the Russian Federation to the Federal State Institutions of Medical and Social Expertise.

Among the many reasons for the development of iron deficiency anemia, chronic blood loss from Cameron ulcers, developing with hiatal hernias, is gaining increasing clinical significance. Nevertheless, doctors of various specialties still have limited knowledge about the role of this pathology in the depletion of the iron depot, the specifics of instrumental verification of the diagnosis, and the possibilities of surgical technologies in the complex treatment of patients with this disease. The described case illustrates the long-term course of severe iron deficiency anemia in a patient with hiatal hernia (type III) due to latent blood loss from Cameron ulcers. The use of a therapeutic algorithm, which included complex conservative therapy followed by laparoscopic surgery to eliminate the hiatal hernia, led to a complete recovery of the patient.