Purpose. To prove that colorectal bradyarrhythmia syndrome is a precursor and predictor of constipation and colorectal cancer.
Materials and methods. Using the non-invasive method of chronoenterography – weekly monitoring of the circadian rhythm of the enteral evacuation function, 2869 people who consider themselves relatively healthy were examined. The test ‘Rhythms and Health’ was used to identify the frequency and acrophase of the rhythm of defecation, as well as to assess the level of quality of life. We compared the occurrence of morning acrophase of the bowel rhythm in individuals with a regular bowel rhythm (at least 7 times a week) and in individuals with irregular (delayed) bowel function (with a stool frequency of 1–2 to 5–6 times a week). Three stages of colorectal bradyarrhythmia syndrome severity were analyzed: mild, moderate, and severe. The main symptoms of colorectal bradyarrhythmia syndrome were identified. The risk of colorectal cancer in patients with constipation was analyzed according to known data.
The results of the study. It is shown that the earliest stages of enteral evacuation function irregularity (mild – 5–6, and moderate – 3 times a week 4 times a week) occur almost 10 times more often than the severe stage (1–2 times a week) of colorectal bradyarrhythmia syndrome in the form of constipation. A regular dependence of the regularity of the defecation rhythm on the position of the acrophase of this rhythm in the daily cycle was established: the regular rhythm of defecation (7 times a week) is associated with the presence of morning acrophase of the stool rhythm, and colorectal bradyarrhythmia (1–6 times a week) is associated with the absence of morning acrophase of the defecation rhythm. A natural relationship between a decrease in the frequency of defecation and a decrease in the level of quality of life was revealed. It is proved that the rarer the frequency of stool, the higher the tendency to take laxatives.
Conclusions. Colorectal bradyarrhythmia syndrome occurs in both young people aged about 20 years and adults, and is almost 10 times more common than constipation. Constipation is a proven risk factor for colorectal cancer, as it increases this risk by 2–4 times. A high level of quality of life is characteristic of individuals with a regular stool rhythm, and colorectal bradyarrhythmia syndrome is characterized by a decrease in the level of quality of life in accordance with the aggravation of the stage of this syndrome.

The pandemic of a new coronavirus infection in recent years has led to more frequent and aggressive prescription of antibiotic therapy, which could not but affect the intestinal microbiota. In addition, the direct effect of coronavirus on enterocytes leads to the development of subclinical inflammation in the intestinal wall, contributing to the disruption of the qualitative and quantitative composition of the normal intestinal microflora. Against this background, the number of patients with antibiotic-associated diarrhea, including diarrhea caused by C. difficile, including severe ones. Moreover, the number of clostridial diarrhea resistant to classical vancomycin therapy has increased, which dictates the need to find new ways to treat patients and methods for further prevention of such conditions.

Two cases of toxic epidermal necrolysis (Lyell's syndrome) are described. The introduction discusses the relevance of this problem. Emphasis is placed on the differential diagnosis of Lyell's syndrome with Stevens-Johnson syndrome, since both syndromes are difficult to distinguish in the debut. As differential diagnostic criteria, it is recommended to take into account the presence of Nikolsky's symptom and the area of involvement in the pathological process of the skin more than 30%. In the manifestation of Lyell's syndrome, the role of genetic predisposition is not excluded. The presented observations indicate that the first clinical symptoms are identical. In both cases, the disease was triggered by medications first used. The common background was viral infection: long-term chronic HCV-infection in combination with herpes zoster and HIV-infection without antiretroviral therapy. Our observations expand our understanding of the likely predisposing factors of Lyell's syndrome, which can include acute and long-term chronic viral infections.

Adhesive disease is a syndrome caused by the presence of adhesions in the abdominal cavity, formed due to various reasons, and characterized by frequent bouts of relative intestinal obstruction.
Purpose. Determine the complex of rehabilitation measures for adhesive disease.
Material and methods. Patients with the following forms were observed: a) with pain syndrome (84.1%); b) with periodically recurring attacks of intestinal obstruction; c) there may also be asymptomatic SB (not found in observations). All patients had the following symptoms as pain, thirst, nausea (sometimes vomiting that does not bring relief), a feeling of heaviness in the abdomen, tachycardia, discomfort, flatulence, arterial hypertension. Ultrasound of the abdominal organs and laparoscopy, MSCT of the abdominal organs and plain radiography of the abdominal cavity and electrogastroenterography were performed to detect violations of the motor function of the gastrointestinal tract.
Results and discussion. The complex of rehabilitation measures included the following rehabilitation. Outside the attack of adhesive disease (an attack of intestinal obstruction) and with adhesive dynamic obstruction, patients were treated conservatively; surgical rehabilitation was prescribed for an attack of adhesive mechanical obstruction. Conservative rehabilitation included exercise therapy, diet, folk remedies, medical correction.

Chronic atrophic gastritis is the most common cause of death from cancer and ranks second among other cancer-related causes of death worldwide. The presented review article analyzes new pathogenetically justified methods of therapy for chronic atrophic gastritis based on experimental and clinical studies presented in the modern literature, including the analysis of randomized clinical trials, systematic reviews and meta-analyses. Based on the analysis, the prospects for the use of new methods of phytotherapy in chronic atrophic gastritis are outlined.

Functional dyspepsia is a widespread disease with many symptoms that reduce the patient's quality of life. The effectiveness of prokinetics, including in combination with proton pump inhibitors, has a high level of scientific evidence in the treatment of functional dyspepsia. The effectiveness of itopride hydrochloride is determined by a dual mechanism of action: antagonism to D 2-dopamine receptors and inhibition of acetylcholinesterase. The drug exceeds of metoclopramide and domperidone in safety in relation to cardiac and neurological disorders. Itopride hydrochloride is not expected to have pharmacokinetic interactions with other drugs metabolized by the CYP3A4 system. In addition to functional dyspepsia, itopride hydrochloride is indicated in the treatment of chronic gastritis, gastrointestinal symptoms associated with gastric dysmotility or delayed gastric emptying, such as bloating, rapid satiety, a feeling of fullness in the stomach after eating, pain or discomfort in the epigastric region, loss of appetite, heartburn, nausea and vomiting. The pharmacoeconomic analysis shows an advantage of Itopride-SZ in comparing of the direct cost of it with the original and several generic drugs. In this way, it allows recommend Itopride-SZ as an affordable drug for various cohorts of patients.

Introduction. In recent years, there has been a clear trend in the use of high-tech treatment methods known in medicine in the provision of palliative care to improve the quality of life of patients with amyotrophic lateral sclerosis and spinal muscular atrophy.
Target. To evaluate the effectiveness of minimally invasive treatment technologies used in the City Geriatric Medical and Social Centre (St. Petersburg, Russia) to restore full enteral nutrition in incurable patients in the provision of palliative care.
Materials and methods. An observational retrospective cohort study based on archival case histories of patients with amyotrophic lateral sclerosis and spinal muscular atrophy admitted to the Respiratory Support Centre at the City Geriatric Medical and Social Centre (St. Petersburg, Russia) was conducted in 2018–2021.
Results and discussion. The most commonly used method of restoring natural enteral nutrition in patients with amyotrophic lateral sclerosis and spinal muscular atrophy was percutaneous endoscopic gastrostomy performed according to the PULL (pullthrough) method according to Gauderer–Ponsky (pulling on itself), and in patients with severe malnutrition, percutaneous endoscopic gastrostomy according to PUSH technique using introducers. Also in demand was the endoscopic replacement of the gastrostomy tube with a gastrostomy bolus tube. Performing percutaneous endoscopic gastrostomy in difficult clinical conditions (patient position, oropharyngeal paresis, stiffness and contractures in the cervical and upper thoracic spine, impaired mental status) required highly qualified personnel capable of providing full-fledged surgical, anesthesiology and endoscopic care. The nature of postoperative complications made it possible in all cases to achieve their elimination in the early postoperative periods without lethal outcomes.
Conclusions. The evolution of methods and methods of providing palliative care corresponds to the general trend in the development of medicine and strives for high-tech, highly informative methods of treatment. With the use of modern methods of specialized treatment, the number of failures in clinical practice is reduced and the professional competence of specialists in the palliative care department is increased. Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis and spinal muscular atrophy, diagnosis of possible early or late complications require the participation of a qualified surgeon, endoscopist and anesthesiologist, as well as the use of the entire range of diagnostic methods possible in a multidisciplinary hospital. The transition to high-tech methods of providing palliative care using modern instrumental techniques requires both legislative and timely budgetary support.

Relevance. Currently, one of the most common risk factors for young students is eating disorders, manifested by high rates of overweight and obesity among adolescents.
The purpose of the study. To study the nature of nutrition and the features of the component composition of the body of medical college students.
Materials and methods. The observation group consisted of students of the 1st and 3rd courses of the medical college. Measured: height, body weight, fat-free body weight (BZHMT), fat mass (fat) and its proportion (% fat), active cell mass (ACM) and its proportion (%), the amount and distribution of fluid in the body, metabolic parameters.
Results and discussion. Violations of the regularity of food intake, the absence of a number of biologically valuable foods in the daily diet of most students, more often in senior students, more often in girls, were revealed. Students' meals are associated with frequent visits to public catering places. During the period of study, the number of overweight and obese students increases. The results showed an increase in LM, a more pronounced increase in the per cent of LM of the body in young men, a decrease in the proportion of BZHM and AKM in the component composition of the body. The results of the correlation analysis confirmed that the increase in MT and BMI is more due to an increase in adipose tissue in young men. It was found that the BMI in boys is mainly due to the fat component, in girls to the fat and muscle components. They argue the need to develop preventive measures to rationalize the nutrition of students, including on the basis of an educational organization of secondary vocational education and correction of students' motor activity.