Cardiovascular disease (CVD) is one of the most common causes of morbidity and mortality in the world. Data on the prevalence of anxiety and depression among patients with CVD are presented. The main risk factors and pathophysiological mechanisms supporting the formation of comorbid disorders are considered. The relationship between anxiety-depressive states, disorders of autonomic regulation, endocrine disorders, inflammation and pathology of the circulatory system is demonstrated. The results of studies on the problems of diagnosis and treatment of CVD complicated by affective or neurotic disorder are described. Particular attention is focused on the questions of drugs safety and increasing patient compliance. Using domestic studies as an example, the efficacy and safety of using a drug containing affinitypurified technologically processed antibodies in high dilutions to the brain-specific protein S100 in the correction of psychoemotional disorders in patients with CVD pathology were demonstrated. The results of an open clinical study of the use of the drug in young patients with grade I arterial hypertension are presented. 

Assessment of left-ventricular geometry in slightly pronounced variants of connective tissue dysplasia (CTD) was done, in order to define a fine dividing line between unconditioned norm and first signs of pathology. Morphometric parameters of left ventricle in young persons with CTD were analyzed in compliance with modern echocardiographic concepts.

The study is based on data obtained from the examination of 214 patients with CTD from 18 to 29 years old (average age 20 (19; 22) years; 49.5% of men) and 100 healthy peers without signs of CTD (average age 20 (19; 21) years; 51.9% of men).

It is known that the asthenic type of physique with a narrow, conical shape of the chest often with a funnel-shaped or keel-like deformation, scoliosis, hyperkyphosis and hyperlordosis of the thoracic spine, «straight back» syndrome predisposes to changes in the heart and large vessels in accordance with the structural features of the spine , sternum, ribs and diaphragm. At the same time, the heart undergoes dynamics from a truly small (asthenic variant) to a thoracodiaphragmatic pulmonary heart (pseudoconstrictive, pseudodilation and false-stenotic variants), from the state of adaptation to the stage of decompensation.

It is indicated that when solving expert questions in adolescents and young people with CTD, a clinical interpretation of the results of a standard echocardiographic study by cardiologists and general practitioners should be carried out, paying attention not only to the development of the fibrous skeleton and associated valve and subvalvular structures, interstitial tissue disorders symmetries with the development of asymmetric left ventricular hypertrophy, intraventricular and intraatrial developmental abnormalities («extra» chords, etc.), but it is necessary to take into account the constitutional features of patients and the geometric pattern of the left ventricle, which is very important in terms of prognosis. 

In 2015, in order to increase patient commitment to taking life-saving drugs, the state program of the Omsk Region «Development of Health Care in the Omsk Region» was developed and introduced in terms of preferential drug provision with acetylsalicylic acid, clopidogrel, and atorvastatin. Based on the results of the implementation of this event, a clinical expert analysis of the effectiveness of dispensary observation was carried out, the routing of patients between the hospital and the clinic was improved and implemented. Based on the proposed technologies, an improved program was again implemented in 2018, the effectiveness of which in terms of the commitment of doctors to clinical recommendations and patients to follow-up was the subject of this study to scientifically substantiate ways to improve secondary cardiovascular prophylaxis.

Against the background of improved patient routing between hospitals and clinics, modernization of free drug provision and development of unified templates of medical records to prevent errors in the management of patients who have undergone acute coronary syndrome and x-ray endovascular intervention on the coronary artery, increased adherence of doctors to current clinical recommendations, and patients to dispensary monitoring, as ways to improve secondary cardiovascular prevention. 

Pathology of the musculoskeletal system and osteoarthritis, in particular, remain a frequent reason for seeking medical care in the outpatient setting. The article offers brief algorithms for the diagnosis and therapy of osteoarthritis for use at the outpatient stage of medical care.

The authors note that at present, osteoarthritis is not an inevitable manifestation of aging of the body, with which has to be resigned to. Osteoarthritis should be diagnosed early in the development of the disease, namely, at the pre-radiological stage. As a diagnosis of structural changes in the joint (cartilage, synovium and ligaments) and assessment of the effectiveness of therapy, MRI research should be widely used. Osteoarthritis therapy is based on both non-drug methods and medication, while the basic therapy is based on symptomatic delayed-acting drugs for the treatment of osteoarthritis. At the same time, chondroitin sulfate and glucosamine, according to the results of numerous studies, have a moderate or significant effect on pain and functional mobility of joints in osteoarthritis, are safe and are characterized by a minimum of side effects. Qualitative long-term randomized controlled trials have demonstrated the ability of chondroitin sulfate and glucosamine to slow the progression of joint space narrowing in osteoarthritis. The use of a combination of these drugs has also been shown to prevent cartilage loss. 

The article discusses fibromyalgia (FM) as a topical interdisciplinary problem. From the point of view of modern medicine, FM is considered a chronic disease characterized by widespread persistent musculoskeletal pain of a non-inflammatory nature, which is accompanied by fatigue, sleep disturbances and cognitive impairments. The authors focused on a review of the literature on the etiology of FM, which is a multifactorial disease — in particular, genetic predisposition and the state of the intestinal microbiota are of great importance in its development. The criteria for clinical diagnosis of FM should be widely used — the diagnosis can be made in primary health care settings based on the assessment of compliance with the criteria of The American College of Rheumatology (ACR, 2016) and subject to normal results of physical examination and laboratory tests, excluding other diseases. The authors draw attention to the importance of an integrated approach (pharmacotherapy, physical rehabilitation, psychotherapy) in the treatment of FM — the point of view of doctors and psychologists is presented. 

The article provides data on the place of methotrexate in accordance with international and national recommendations 2019– 2020 in the management of patients with rheumatoid and psoriatic arthritis. Data on the prevalence of these diseases, the effectiveness and tolerability of methotrexate according to randomized controlled and cohort studies are presented. The advantages of the subcutaneous form of methotrexate in terms of efficacy and tolerability for both rheumatoid and psoriatic arthritis are discussed. Data on the tolerance of the subcutaneous form of methotrexate from various manufacturers are presented.

Analysis of literature data and the results of our own research indicate the need for early prescription of methotrexate in patients with rheumatoid arthritis and patients with peripheral joint lesions in psoriatic arthritis.

Numerous studies confirm the effectiveness of methotrexate in rheumatoid arthritis in relation to the symptoms of the disease, both articular and non-articular, structural damage (slowing down X-ray progression), which is accompanied by an improvement in the patient’s functional abilities. With psoriatic arthritis, methotrexate is able to reduce the activity of arthritis, enthesitis, reduce skin manifestations, and improve the functional state of the patient. Treatment with methotrexate, when the clinical effect is achieved, is accompanied by a decrease in cardiovascular complications in inflammatory lesions of the joints. 

The review articles analyses modern data on etiology, pathogenesis, clinical picture in chronic adrenal insufficiency (CAI) in children and adolescents.

It is indicated that, depending on the level of affection of hypothalamo-pituitary-adrenal axis, primary (peripheral) CAI connected with adrenal pathology, secondary and tertiary (central) CAI are defined. Clinical symptoms of CAI occur in affection of 95% of adrenal cortex tissue. The disease is characterized by latent beginning and slow rise of clinical symptoms. However, in case of congenital adrenal hypoplasia, the disease symptoms may occur soon after the birth.

The syndromes combined with deficit of adrenal cortex hormones were described. Primary CAI is a heterogeneous disease. There are hereditary and acquired forms of the disease. Among acquired forms of primary CAI there are infectious lesions (sepsis, more often, of meningococcal or streptococcal etiology, HIV-infection, influenza, congenital syphilis, tuberculosis), adrenal hemorrhage, their tumorous affection, two-sided adrenalectomy.

The diagnostics methods and treatment strategy were presented. In CAI, life-length replacement therapy with gluco- and/ or mineralocorticoid drugs is conducted, which support critical function, ensuring organism adaptation to stress influence of the environment and keeping of water-salt balance. The dosage of the drugs used in the replacement therapy is selected individually, and adapted depending on the age of the child. It is recommended, to add kitchen salt and ascorbic acid to the patients’ nutrition, and reduce consuming products containing potassium. 

COVID-19 is an acute respiratory tract infection caused by SARS-CoV-2 coronavirus. Genetic sequencing of the virus has shown that it belongs to beta-coronaviruses related to the SARS virus. In most cases, COVID-19 has a mild course without complications, but 14–20% of patients develop a severe course that requires hospitalization and oxygen support.

The effect of oxygenated saline enteral solution (OSES) in complex intensive care on the possibility of correcting gastrointestinal dysfunction and systemic oxygenation in severe community-acquired pneumonia caused by COVID-19 was determined. Our goal is to capture the attention of specialists to the prevention and treatment of intestinal insufficiency syndrome and enterogenic intoxication due to hypoxic damage to the intestine with the probable translocation of microorganisms in patients with severe respiratory failure developed against the background of community-acquired viral pneumonia COVID-19. The article describes the first experience with the use of OSES in complex intensive care in this category of patients.

The results obtained suggest the pathogenetic validity and feasibility of using oxygenated saline enteral solution in the complex intensive care of community-acquired viral pneumonia with COVID-19.

The use of OSES, in the authors’ opinion, is of particular scientific and practical interest in the current epidemiological situation and deserves the attention of various specialists, and also requires further in-depth study of the effectiveness of this method in the combination therapy of COVID-19.