The article presents the definition of comorbid pathology, discusses issues of prevalence, features of management, assessment of the forecast. The characteristic of complications of acute respiratory viral infections, risk groups of complications, the effect of comorbidity on the course of acute respiratory viral infections, the risk of complications and death, signs of disease progression are given, indications for hospitalization are defined. The treatment of ARVI, etiotropic therapy, interferons, interferon inducers are considered. The methods of prevention of influenza and other acute respiratory viral infections are presented: specific and nonspecific prevention.

Modern concepts about features of diabetes mellitus in very elderly patients are described in the article. Special attention to the therapeutic methods of management of very elderly patients with diabetes mellitus has been devoted. The results of diabetes mellitus study in patients with coronary artery disease older than 75 years in comparison with younger patients are presented.

Fragmentation of a QRS complex is an ECG-phenomenon resulting from non-uniform activation of the ventricular myocardium in the background of cicatricial, fibrous changes. This indicator is associated with adverse outcomes (including the development of life-threatening arrhythmias, sudden death) in patients with various cardiovascular pathologies, including ischemic heart disease. Objective. To study the effect of fragmentation of a narrow sinus QRS complex on the frequency of visits to outpatient hospitals, hospitalization in cardiology hospitals, the frequency of implantation of ECS, recurrent heart attacks and deaths in patients with myocardial infarction in history. Assess the prognostic significance of the prevalence and different localization of QRS fragmentation. Material and methods. The study included 137 patients with postinfarction cardiosclerosis and CHF with preserved LV EF, who were hospitalized in the years 2013-2018. The main group (with QRS fragmentation) included 39 patients, the control group (without fragmentation) had 98 ones. The groups were comparable in age and sex. We analyzed the surface ECG in 12 leads using the following fragmentation criteria: notch R (S) or RSR notch in at least two leads corresponding to the same zone of origin with a QRS duration of less than 120 ms. Results. Total mortality (12 [30.8 %] vs 14 [14.3 %]) and the frequency of sudden death (5 [12.8 %] vs 3 [3.1 %]) were significantly higher in the group with QRS fragmentation. In cases with a fatal outcome, the median number of leads with QRS fragmentation was greater (5 vs 2; p < 0.001). With a favorable outcome in 96.3 % of cases, fragmentation was observed in the leads corresponding to only one of the walls of the left ventricle, with a fatal outcome in 25 % of cases (p < 0.001). The presence of fragmentation along the three walls was associated with an unfavorable outcome. In 75.0 % of the dead, fragmentation along the side wall was observed (p < 0.001). The frequency of visits to outpatient hospitals, the frequency of hospitalizations in the main group were significantly higher (p < 0.001). A direct statistically significant association of high closeness between the number of leads with QRS fragmentation and hospitalization rate was detected (r_xy = 0.77; p < 0.001). The risk of recurrent heart attack in the main and control groups was not significantly different. The chances of an ECS-implantation among patients with fragmentation were 20.1 times higher than in the control group (p < 0.001; OR: 20.1; 95 % Cl: 6.2-65.7). Among patients requiring installation of an ECS, fragmentation of the ventricular complex was on average encountered in a larger number of leads (p = 0.049). Fragmentation on the lower wall of the left ventricle was a factor that increased the chances of implanting an ECS by 18.7 times (p = 0.005; OR: 18.7; 95% Cl: 2.1-167.3). Findings. The presence of fragmentation of a narrow sinus QRS complex in two or more ECG leads in patients with post-infarction cardiosclerosis is associated with a significant increase in the frequency of visits to outpatient medical facilities and the frequency of hospitalizations; the frequency of arrhythmic events requiring the implantation of an ECS; an increase in overall mortality and the risk of sudden death, but not associated with a significant risk of recurrent heart attacks. With increase in number of assignments with fragmentation of QRS the frequency of hospitalizations increases. Fragmentation on the bottom wall increases the chances of installing an ECS, and fragmentation on the side wall is a marker of an unfavorable outcome.

The article provides information on various groups of nitropreparations, their pathogenetic effects, the possibility of their application in various clinical situations. The problems arising from the appointment of nitrates and their solutions are considered. The role of nitro drugs in the treatment of angina pectoris is highlighted. Advantages of modern forms of drugs, including Effox® long, are given. The results of clinical studies of the drug.

The high incidence of stable coronary heart disease, the increasing frequency of myocardial infarction, disability and mortality determine the relevance of the search for new risk markers and laboratory criteria for predicting this severe complication. The aim of the study was to develop an information panel for diagnosing the risk of myocardial infarction in patients with stable coronary heart disease, including significant generally accepted and potentially possible new laboratory parameters characterizing various pathogenetic links of coronary atherosclerosis. The study included 168 patients who were divided into 2 groups: Group 1 - with a history of myocardial infarction, Group 2 - without a history of myocardial infarction. In addition to the standard laboratory and instrumental examination, all patients were identified parameters of endothelial dysfunction, oxidative stress and chaperone activity as potential markers of myocardial infarction in patients with stable coronary heart disease. Assessment of the risk of myocardial infarction in patients with stable coronary heart disease was carried out using a logical and mathematical model, which combined the most informative laboratory indicators of oxidative stress, endothelial dysfunction, and chaperone activity, which are important in the occurrence and progression of coronary atherosclerosis, according to the results of preliminary comparative and correlation analysis. The basis for the development of the information panel was the method of decision trees. The study confirmed the relationship between the severity of coronary atherosclerosis and the occurrence of myocardial infarction. Comparative analysis of the selected groups of patients showed a higher level of oxidative stress, serum homocysteine concentrations and lower values of chaperone activity in Group 1. In patients with a history of myocardial infarction, C-reactive protein was significantly higher than in Group 2, indicating a more pronounced inflammatory response in patients with large atherosclerotic lesions. The study suggests the possibility of using mathematical information panels based on decision trees as a system for assessing the risk of acute myocardial infarction in patients with stable coronary heart disease. As a result of the analysis of the obtained model, laboratory biochemical factors of high risk of myocardial infarction were identified. Such factors were chaperone activity, serum homocysteine level, serum C-reactive protein concentration and superoxide dismutase activity.

The widespread worldwide spread of acute respiratory diseases is an urgent problem in health care. Expressed polyetiology of respiratory diseases does not allow to limit the use of specific vaccine preparations and dictates the need to use to combat them a variety of non-specific means that stimulate the natural resistance of the human body. The main pharmacological action of sodium deoxyribonucleate is the stimulation of phagocytic activity of T-helpers and T-killers, increasing the functional activity of neutrophils and monocytes/ macrophages, providing regeneration and repair processes in the epithelial component of antiviral protection of the body. Based on the above, the study of the clinical efficacy of Derinat® in the form of spray in the treatment of acute respiratory viral infections is relevant.

Fifty patients with cervical dorsopathy with the spinal artery syndrome were studied using clinical scales (neurological deficit, psychoemotional disturbances) and laboratory methods (parameters of oxidant stress). The correlations between the oxidant stress and the dynamics of neurological syndromes and psychoemotional disturbances as well as the efficacy and safety of their treatment with antioxidants were determined.

A case of lung damage in systemic lupus erythematosus (SLE) in a 33-year-old woman is described. This case is of clinical interest due to the complexity of diagnosis due to the fact that SLE is a disease with diverse clinical manifestations involving many organs and systems, which often makes it difficult to timely recognize the onset of the disease. SLE still remains a challenge and requires special attention to the patient s history, clinical and laboratory parameters of the patient, as well as specific immunological examinations.