Purpose of the study. To evaluate the efficacy and safety of using a metabiotic preparation, which includes biologically active metabolites of the culture fluid of the probiotic bacterium Bacillus subtilis (B. subtilis) and fructooligosaccharides, for the correction of gastrointestinal symptoms in patients with post-COVID syndrome.

Materials and methods of the study. The study included 40 outpatients with post-COVID syndrome aged 18 to 60 years (mean age 38.25–8.70 years), who, after undergoing COVID-19, were disturbed by gastrointestinal complaints and asthenia. Patients were randomized into 2 groups. Group 1 (n = 20) consisted of patients who received metabiotic capsules in the regimen of 1 capsule 2 times a day for 28 days; group 2 (n = 20) – patients who did not receive additional support. The observation period was 28 days. The severity of gastroenterological symptoms was assessed using the GSRS (Gastrointestinal Symptom Rating Scale) quality of life questionnaire, and asthenia was assessed using the Asthenic Condition Scale (ASS) by L.D. Malkova. Patients of group 1 (n = 10) additionally underwent a study of feces to quantify the composition of the microbiota of the colon by real-time polymerase chain reaction (PCR), test Kolonoflor-16.

Research results. According to the results of assessing the quality of life in patients with post-COVID syndrome using the GSRS questionnaire, the main gastrointestinal complaints included: diarrhea, abdominal pain and dyspepsia; the severity in points was 14.1 points, 7.9 points, and 15.2 points, respectively, which corresponded to moderate manifestations of symptoms. Against the background of taking a metabiotic in patients of group 1, there was a statistically significant decrease in gastrointestinal complaints on the scale of the total measurement of symptoms (p < 0.0001), on the scales of abdominal pain syndrome (p < 0.0170), dyspeptic syndrome (p < 0.0001) and diarrheal syndrome (p < 0.0001). In patients of group 2 on the 28th day of the study, there was no significant change in symptoms. When assessing asthenia after taking metabotics, patients of the 1st group showed positive dynamics, the severity of asthenia before treatment was 51.5 ± 7.9 points, after treatment – 43.3 ± 5.9 points (p < 0.0500), in patients of group 2 there was no significant decrease in asthenic state indicators when assessed at the beginning and at the end of the observation period. On the 28th day, in patients of group 1 the representation of Lactobacillus spp. statistically significantly increased, normalization in the spectrum of Escherichia coli representation was noted, and the representation of UPM decreased. In the examined group, attention is drawn to the complete absence of Akkermansia muciniphila DNA in the feces of patients with post-COVID syndrome and the restoration of the representation of this bacterium after taking a metabiotic in 60 % of patients.

Conclusions. In patients with post-COVID syndrome, the structure of gastrointestinal complaints is dominated by manifestations of abdominal pain, dyspeptic and diarrheal syndromes, and there are phenomena of colon dysbacteriosis, expressed in a decrease in the representation of obligate microflora and an increase in TMR. The use of metabolic tyranny in patients with post-COVID syndrome for 28 days in a regimen of 1 capsule 2 times a day is effective and safe.

Liver cirrhosis is a disease gastroenterologists and therapists face daily, and not only in the hospital when it comes to treating complications, but also at outpatient appointments, when the disease is in the compensation stage. At the same time, in the age group of 20–40 years, mortality from liver cirrhosis (LC) exceeds that from coronary heart disease. Despite modern advances in intensive care and transplantation, the mortality rate in the development of liver failure remains high [1]. For example, in 2015, there were 1.3 million deaths from liver cirrhosis, of which 348,000 were caused by alcohol, 326,000 by hepatitis C, and 371,000 by hepatitis B [2]. The classic manifestations of cirrhosis leave no doubt in the diagnosis, however, a detailed history taking, active identification of risk factors at the stage of the latent course of liver cirrhosis can prevent many severe complications of this disease and reduce the number of hospitalizations.

Gilbert’s syndrome is an autosomal recessive inherited disorder of bilirubin glucuronidation characterized by unconjugated hyperbilirubinaemia in the absence of hepatocellular injury or hemolysis. Gilbert’s syndrome is characterized by mutations to the UGT1A1 gene which encodes the enzyme uridine disphosphate glucuronоsyltransferase which is required for the conjugation and subsequent excretion of bilirubin. Most Gilbert’s syndrome patients experience recurrent and short-term episodes of yellowing of the skin and sclera of eyes caused by bilirubin accumulation in the blood. Approximately 30 % of patients with Gilbert's syndrome do not experience any symptoms, but are detected by blood tests that show elevated levels of unconjugated bilirubin. In addition to traditional methods, genetic analysis of the UGT1A1 gene allows us to confirm the diagnosis of Gilbert's syndrome. The article presents modern concepts of the pathogenesis, diagnosis, differential diagnosis and treatment of Gilbert's syndrome. It is of interest to gastroenterologists, internists and general practitioners who treat such patients.

Involvement of the vulva and vagina in Crohn's disease (CD) is rare and underdiagnosed because many other more likely inflammatory processes in this area are considered. Late diagnosis and ineffectiveness of treatment lead to the development of complications, a decrease in the quality of life of women. A clinical case of a lesion of the vulvovaginal zone in a young patient, regarded as extraintestinal (metastatic) CD, is presented. The presented clinical case shows the effectiveness of treatment with ustekinumab for poorly controlled CD and extraintestinal manifestations of this disease, in particular, the effectiveness of treatment of chronic vulvovaginitis has been demonstrated.

Autonomic neuropathy in patients with diabetes mellitus (DM) is the leading cause of damage to the digestive tract. As a result of chronic hyperglycemia and high glucose variability, the esophagus, stomach, small intestine, and large intestine are most often affected. The most common disorder of the digestive system in diabetes is gastroparesis. Clinical symptoms of gastroparesis have similarities with other functional disorders of digestive tract, which complicates differential diagnosis with other diseases. Quality of life of these patients is worsened because of significant difficulties in managing postprandial glycemia. Since patients with diabetes are quite often affected by cholelithiasis, this review also considers the need for surgical intervention and the subsequent effect of cholecystectomy on the development of gastroparesis in these patients. It is important to remember that after gallbladder removal patients need more careful monitoring of glucose levels. This will allow timely prescription of antidiabetic therapy and reduce the risk of developing gastroparesis in the future. In addition, the effect of coronavirus infection on functional damage of the digestive tract in patients with diabetes is discussed. A special diet is important in the therapy of gastroparesis. Exclusion of hard-to-digest fiber, fatty foods, inclusion of vitamin complexes and normalization of microbiota contribute to slower glucose absorption after meals and better compensation of disease. The main therapeutic value is the timely diagnosis of gastroparesis and normalization of glucose levels.

Introduction. Currently, the problem of biofilm-associated infections is of great importance, since the classical methods of antibiotic therapy for purulent-inflammatory diseases become ineffective due to the high resistance of pathogens. An urgent task is to find ways to suppress adhesion processes or destroy an already formed biofilm using various disinfectants, enzymes, a combination of antibacterial and other drugs.

Materials and methods. The object of the study is the bacteria Klebsiella pneumoniae isolated from wounds and fistulas of patients with chronic osteomyelitis. Biofilms were cultured for two days in the wells of polystyrene plates and on coverslips. In the control series of the experiment, the biofilm-forming ability of K. pneumoniae strains was studied after 48 hours. In the second series, after 24 hours, the emerging biofilm was exposed to a solution of 3 % hydrogen peroxide, in the third series, with a skin antiseptic, and after 48 hours, the intensity of biofilm formation was assessed. For statistical processing of the obtained data, the Gnumeric 1.12.17 spreadsheet program was used.

Results and its discussion. K. pneumoniae strains had a high biofilm-forming ability. The impact of disinfectants on the emerging biofilm led to a decrease in the optical density in the wells of the plates and the intensity of biofilm formation. On cover slips in the second and third series of the experiment, a decrease in the total proportion of microcolonies and individual adherent cells was observed. Disinfectants (hydrogen peroxide and skin antiseptic) had a bacteriostatic effect on biofilms formed by K. pneumoniae strains. In addition, a bactericidal effect of skin antiseptic on planktonic bacterial cells was found.

Conclusions. The data obtained must be taken into account for the selection of effective disinfectants used in the clinic to prevent the emergence of resistant strains of microbes.

The study of the human corpses who died from the coronavirus infection COVID-19 allows to define the exact cause of death, which helps clinicians in choosing a timely and effective treatment to reduce mortality. The study analyzed the current literature with the results of studies of cadaveric material and described our own pathological observations the macro- and microscopic picture that was encountered during autopsies. The description of cases of autopsies of patients who died from COVID-19 is necessary, and certainly important for a comprehensive analysis of this problem and is of high clinical and epidemiological interest.