Proton pump inhibitors are a diverse class of drugs with unique acid suppression properties. The aim of the work was to present the therapeutic benefits of rabeprazole and pantoprazole in clinical practice. Numerous studies have demonstrated the high effectiveness of proton pump inhibitors and the relative safety of taking these drugs. However, it is necessary to increase the awareness of doctors and pharmacists regarding the possibility of complications during treatment with proton pump inhibitors in a polymorbid patient. The choice of proton pump inhibitors should be based on the clinical situation, concomitant pathology and therapy, the presence of risk factors in the patient, the speed and stability of the effect of the drug. Rabeprazole is converted from prodrug to drug faster than other drugs, and thus creates a greater gradient of prodrug concentration on the membrane secretory tubules. The pharmacodynamics of rabeprazole does not depend on gene polymorphism; in this regard, there is no need for dose adjustment in fast metabolizers. In addition, a distinctive feature of rabeprazole is the ability to more stimulate the production of mucin, thereby providing an additional cytoprotective effect.

A feature of the metabolism of pantoprazole is that in addition to binding to cysteine 813, there is an additional connection with cysteine 822, which ensures the restoration of acid secretion only the synthesis of a new protein and, as a result, the longest lasting effect of the drug. High pH selectivity characterizes the low probability of inhibition of proton pumps in tissues with a less acidic pH, i.e. determines the specificity of action only in the parietal cells of the stomach and the greatest safety of long-term use in patients with comorbid pathology. Among all proton pump inhibitors, pantoprazole and rabeprazole have the lowest affinity for the cytochrome P450 system and lower inhibitory activity against CYP2C19, demonstrating a minimal risk of drug interactions. 

The article presents modern data on disorders of the gastrointestinal tract in patients with coronavirus infection COVID-19. Along with pulmonary pathology, symptoms such as diarrhea, decreased appetite, and nausea are common. Moreover, gastrointestinal symptoms may precede the onset of respiratory symptoms and precede the development of severe pulmonary pathology. The article analyzes previously published authors’ own data on the effectiveness of dietary correction of disorders in gastrointestinal diseases by using the appointment of specialized dietetic foods with anti-inflammatory, analgesic, antioxidant, and other activities.

The authors note that along with a strict diet for diseases of the gastrointestinal tract with the exception of acute, fatty, fried, restriction of extractive substances, adherence to a sparing diet in order to reduce the negative symptoms described above during coronavirus infection, specialized dietary therapeutic and preventive nutrition is recommended.

The necessity and prospects of using specialized dietary products of domestic production in the diet of patients with coronavirus infection during illness in order to prevent complications and increase treatment efficiency, as well as during convalescence for the rehabilitation of patients, are substantiated. 

The prevalence of abdominal gas – related symptoms in general population is 10–30%. All the causes of bloating can be divided into the following categories: abnormality of gastric accommodation or evacuation, aerophagia, carbohydrates malabsorption and intestinal bacterial overgrowth, excessive consumption of foods rich in fructose, oligo-, di-, monosaccharides, visceral hypersensitivity, abnormalities in peristaltic activity and abdominal muscles tone with irregular gas distribution. To clarify the origin of symptoms, it is important to assess the symptoms severity, localization of the abdominal distention, their relationship to food intake and the bowel function (the presence of constipation testifies the delay of bowel movements), concomitant pathology. Abdominal ultrasound and CT help to detect other causes of abdominal distention such as excessive fat development, tumors and cysts. Radioopaque markers study helps to evaluate the rate of colonic transit while hydrogen breath tests – to diagnose disaccharide intolerance and intestinal bacterial overgrowth. In some cases it is reasonable to exclude celiac disease, hypothyroidism, electrolyte disorders. In the treatment of bloating the correct nutrition and physical activity are of special importance. Complete exclusion of FODMAPs is not recommended. Alpha-galactosidase, anti-foamy agents, peppermint oil preparations, prokinetics, laxatives and probiotics, intestinal antiseptics and non-absorbable antibiotics and agents reducing the severity of visceral hypersensitivity can the used. A natural approach to reduce visceral hypersensitivity is to increase the intestinal short-chain fatty acids using prebiotics, psyllium and butyrate-containing food supplements. Butyrate supports colonocyte nutrition and differentiation, provides anti-inflammatory activity and modulates the functions of neurons and microglia. 

The article is devoted to the choice of nutritional support in children with cystic fibrosis. Timely early diagnosis of cystic fibrosis, replacement therapy with microspherical pancreatic enzymes and adequate nutritional support prevent the development of protein-energy malnutrition. A wide range of specialized food products on the market allows you to choose the optimal correction method. The main requirements for the nutritional components introduced into the child’s diet are high calorie content, ease of absorption, anti-inflammatory and immunomodulating effect on the mucous membrane of the gastrointestinal tract. The results of the use of specialized nutrition for cystic fibrosis at the stage of recovery of children with protein-energy deficiency are presented. In the State Novosibirsk Regional Clinical Hospital (Novosibirsk), as part of complex therapy in children of the first year of life suffering from cystic fibrosis, a specialized product of children’s dietary food was used. On the basis of the children’s pulmonology department of the clinic, 8 children with this pathology were treated with the use of a therapeutic mixture during the recovery period from 12 to 180 days. It was shown that during the use of the therapeutic mixture, patients achieved good results, all children had a good appetite and stable weight gain. 

The article provides an overview of the reports of the satellite symposium «Recommendations for the treatment of patients with frequent combination of gastrointestinal symptoms», which took place within the framework of the 116th International Session of the National School of Gastroenterology and Hepatology of the Russian Gastroenterological Association. The speakers discussed the approaches to the management of patients with a typical, frequent combination of gastrointestinal symptoms using specific examples from their clinical practice. Special emphasis in the reports was made on the role of microbiota in maintaining and strengthening the physical and mental health of a person, the negative consequences of dysbiotic changes in the gastrointestinal tract and the use of pro- and prebiotics to correct these changes. 

Despite all the polyetiological nature of liver damage, the similarity of the main links of pathogenesis allows us to use a fairly close pathogenetic therapy, one of the components of which can be hepatoprotective agents. Despite a large number of scientific studies and many years of clinical experience in the use of hepatoprotective agents, the boundaries of this pharmacological group use are still not clearly defined due to the fact that many of the clinical studies did not meet the modern principles of evidence-based medicine.

The results of studying the chemical structure, pharmacodynamics and pharmacokinetics, the practical use of hepatoprotective agents do not give unambiguous answers to many questions regarding the indications for their use, the choice of a specific drug, regimens and duration of treatment.

To a large extent, this also applies to the combined use of hepatoprotective agents, the validity and feasibility of which is not always obvious. Questions about how rational the combination of hepatoprotectors can be, whether it gives any clinical benefit, and whether such tactics are a step toward unjustified polypharmacy, remain without a clear answer.

The clinical and experimental studies verviews conducted over the past decades has allowed us to identify several combinations that have the most pronounced effect on the morphological changes in the liver, or mutually potentiate one of the pharmacological effects. 

The article describes the clinical manifestations of secondary xanthomatosis in a 46-year-old patient with primary biliary cirrhosis who was consulted by a dermatovenerologist. The diagnosis was confirmed by pathomorphological studies of the of skin biopsies.

Xanthomatosis is a systemic disease that develops with lipid metabolism disorders (primary and secondary hyperlipoproteinemia) and is characterized by local or generalized deposition in lipid tissues with the formation of xanthomas — nodules of a white or yellowish tint. Disorders of lipid metabolism are an essential component of the pathogenesis of primary biliary cirrhosis, when serum cholesterol accumulation is observed during obstruction or hypoplasia of the biliary tract. Along with the formation of flat xanthomas, patients may experience jaundice, hyperpigmentation, and itching of the skin. Flat xanthomas are clinically manifested in the form of clearly delimited plaques of yellow-orange or flesh tones, measuring up to 3–5 cm or more, slightly rising above the skin, with a smooth or wrinkled surface. Typical localization is the skin of the trunk, hips, buttocks, face, neck, folds of the palms and fingers.

The presented clinical observation indicates that the appearance of flat xanthomas in the patient was the first sign of metabolic disorders, and a sharp deterioration of the skin process was a consequence of the progression of the pathology of the hepatobiliary system.

The importance of clinical alertness of doctors in relation to concomitant diseases occurring with disorders of lipid metabolism is emphasized. 

The aim of this work was identification of markers of of hyperammonemia (HA) available in routine practice, and assessment of the effectiveness of ornithine in treatment of HA and its clinical manifestations in patients with NAFLD at the pre-cirrhotic stage.

Outpatients with NAFLD with hepatic steatosis were assessed for liver tests, fibrosis on the FIB-4 scale, hepatogenic weakness on the visual analogue scale, and the blood ammonia level, correlations between these indicators are determined. After a 4-week course of ornithine 15 g/day orally, the dynamic of ammonia and hepatogenic weakness was assessed in some patients.

41 patients were included, mean age 46 ± 10 years. The mean hepatogenic weakness was 5.36 ± 1.38 points with a score of 5 points or higher in 70% of patients. The average blood ammonia level was 108 ± 53.3 μmol/l. HA with an ammonia level > 60 μmol/l was observed in 36 patients (87.8%). Correlation analysis revealed a significant direct relationship between the level of ammonia and GGTP (ρ = 0.418, p = 0.017), as well as between ammonia and hepatogenic weakness (ρ = 0.358, p = 0.047). Ornithine therapy in 17 patients was accompanied by a significant decrease in ammonemia (from 141.5 ± 54.9 to 98.5 ± 47.2 μmol/l, p = 0.0001) and hepatogenic weakness (from 5.64 ± 1.39 to 4, 14 ± 1.70 points, p = 0.014).

It was found that patients with early stages of NAFLD have a high prevalence of HA. The degree of hepatogenic weakness and the level of GGTP reflect the severity and can be used as markers of this disorder. Ornithine can effectively reduce the level of ammonia and improve clinical symptoms in patients with NAFLD. 

Lifestyle modification, which includes the following: a healthy diet and physical activity, along with weight reduction, remains the first line of treatment for non-alcoholic fatty liver disease (NAFLD). However, due to the poor adherence to this type of treatment, especially for long-term weight loss diets, some of which may have harmful effects on the liver, there is significant interest in identifying therapeutic agents for the treatment and/or prevention of NAFLD progression. Due to potential adverse effects of conventional medical therapies, the focus has been directed to studying complementary therapies that are both natural and safe, such as herbal medicine and functional foods as dry materials or their extracts.

Those patients who fail to achieve goals with classical therapy are potential candidates for herbal nutraceuticals.

However, it should be borne in mind that nutraceuticals are sold in the form of mixtures of various compounds, so their appointment is not always easy for the doctor. It is also necessary to assess the cost, long-term effects and potential risk of drug interactions for patients. When using purified phytochemicals, the above problems are greatly simplified compared to plant extracts. Although several clinical trials are currently underway to evaluate the therapeutic effect of nutraceuticals and plant products, it is anticipated that scientists will pay more attention to assessing the efficacy of herbal therapeutic agents in the future by conducting larger randomized clinical trials and carefully evaluating their results. 

Liver fibrosis is a dynamic process of deposition in the liver of connective tissue in various forms of chronic pathology of this organ. Currently, a liver biopsy remains the gold standard for diagnosing fibrosis, but this procedure is associated with the risk of bleeding, intrahepatic hematomas, and infectious complications. The works of various authors show that the measurement of liver density using transient elastography allows you to diagnose the stage of fibrosis in chronic liver diseases. The aim of this study was to obtain optimal transient elastography for differentiating the degree of liver fibrosis F1, F2, F3, F4 according to METAVIR in children. The study included 135 patients from the National Medical Research Center for Children’s Health, who underwent transient elastography measurements of liver density from 2012 to 2018 and liver biopsy ≤ 12 months before elastography. The results obtained were analyzed using ROC analysis. Cohorts — 39% of boys and 61% of girls, average age 10.2 ± 4.7 years. The results showed that liver densities of 5.8 kPa and 7.8 kPa correspond to liver fibrosis F1 and F2 according to METAVIR, respectively, and 9.4 kPa and 12.7 kPa for diagnosis the degree of fibrosis F3 and F4 in children, respectively. Transient elastography is an accurate, non-invasive method for diagnosing fibrosis in children with chronic liver disease. 

In the structure of morbidity, among rheumatic diseases in children, juvenile scleroderma takes the third place in frequency after juvenile idiopathic arthritis and systemic lupus erythematosus. Timely diagnosis of juvenile scleroderma presents certain difficulties, since the traditional criteria for making a diagnosis of scleroderma are applicable to adult patients. Unlike adult patients, in the initial period of the disease, lesions of the internal organs are less likely to occur, and joint damage occurs with equal frequency. According to recent studies, the most common neurological manifestations in juvenile scleroderma with localization of lesions on the head and neck are epileptic seizures, headaches, local neurological deficits, psychoemotional and cognitive impairments. In the course of this study, 51 children with scleroderma with localization of lesions on the head and neck at the age of 3 to 17 years were examined. In most patients (80%), the first symptom of the disease was a characteristic skin lesion in the form of a purple spot, followed by linear tissue induction, less often the disease began with the appearance of an alopecia on the scalp or in the eyebrow area. Scleroderma with lesions on the head and neck is the most severe form of all localized types of scleroderma and can be equated in its severity with its generalized forms. The palette of polysystemic disorders in this form requires a multidisciplinary approach in examination and therapy. The list of mandatory examination methods for scleroderma of the face and neck should include brain MRI, EEG and psychological examination. 

The relationship between body mass index (BMI), visceral adipose tissue, and TG, glucose, and HDL-C was estimated. A total of 150 patients were examined.

According to BMI, in individuals with various degrees of obesity, there were no significant differences in the number of visceral adipose tissue and in the effect on the level of TG, glucose and HDL-C. An increase in the content of visceral adipose tissue leads to a significant increase in the level of triglycerides, glucose and a decrease in the content of HDL-C. In patients with a visceral adipose tissue content less than 10%, the median TG was 1.13 [0.76; 1.46] mmol / l; glucose 5.52 [4.99; 5.71] mmol / l; HDL-C 1.24 [1.06; 1.42] mmol / l. In patients with a visceral adipose tissue content 11% or more, the median TG was 1.585 [1.12; 2.12] mmol / l; glucose 5.97 [5.46; 6.93] mmol / l; HDL-C 1.02 [0.86; 1.31] mmol / l. All differences are highly significant p < 0.004. The level of visceral adipose tissue 16% or more is combined with an increase in the median of triglycerides and glucose above normal values: more than 1.7 mmol / l and 6.5 mmol / l, respectively.

The degree of obesity does not reflect the severity of metabolic disorders, which play an important role, as factors in the development of cardiovascular diseases. The accumulation of visceral adipose tissue is clearly associated with an increase in the level of TG and glucose and a decrease in the level of HDL-C. Thus, the current classification of obesity by degrees does not take into account the accumulation of visceral adipose tissue, which has the most adverse effect on metabolic disorders and, accordingly, on the risk of CVD. 

The problem of treating the new coronavirus infection COVID-19 in pregnant and lactating women is an urgent problem of world health. According to foreign authors (Mantlo E., Bukreyeva N., Maruyama J., Paessler S., Huang C. Antiviral activities of type I interferons to SARS-CoV-2 infection. Antiviral Res. 2020 Jul; 179: 104811) recombinant interferon α is active against the novel coronavirus in vitro in the cell culture model Vero and SARS-CoV-2 (COVID-19). SARS-CoV-2 (COVID-19) is sensitive to recombinant interferon α-2b, but high serum concentrations (more than 300 IU / ml) are required to achieve a therapeutic effect, which are achieved with systemic administration of more than 3,000,000 IU of recombinant interferon α -2b. The article analyzes the clinical symptoms and the effectiveness of therapy for the new coronavirus infection COVID-19 in pregnant and lactating women in outpatient practice with high doses of interferon α-2b (by the decision of the council of doctors). The authors found that complex therapy with high doses of interferon α-2b infection COVID-19 in pregnant women flows relatively favorably and ends with recovery. In lactating women who do not work because of parental leave, the new coronavirus infection had mild clinical symptoms and was accompanied by the development of pneumonia (MSCT I – II) with uncommon lung involvement. As a basic therapy, as well as pregnant women, they were prescribed high doses of recombinant interferon α-2b and β-lactam antibiotic to prevent aggravation of the condition. This therapy made it possible to avoid complications and stop the symptoms of damage to the bronchial tree. 

The enormous impact of SARS-CoV-2 infection and the insufficiency or lack of established and evidence-based therapeutic measures give rise to fundamental and clinical studies to examine the mechanisms of penetration of the virus into the human body and its subsequent effects on the body. The uniqueness of the pathogenesis of the infection caused by SARS-CoV-2 is primarily due the virus tropism to the receptors angiotensin-converting enzyme type 2 (ACE2), which are on the surface of various cells: pneumocytes, epithelials of the esophagus and intestines, cardiomyocytes, endotheal capillaries, urinary and nervous system, as well as in other organs. It is assumed that the suppression of ACE2, induced by penetration of SARS-CoV-2 into cells, may be particularly harmful for subjects with pre-existing ACE2 deficiency. These considerations provide justification for the study of the role of therapeutic approaches conceptually associated with the activity of the ACE2 receptor. 

The aim of the present work was to study the relationship of psychophysiological parameters with indicators of the attitudes to illness and stress-overcoming behavior in patients with coronary heart disease at the stage of preparation for coronary bypass surgery. A clinical and psychological examination of 64 patients, men aged 44 to 73 years (average age 62.1 ± 5.2), with a diagnosis of stable coronary heart disease and undergoing preparation for coronary artery bypass grafting, was carried out. The psychological status was diagnosed using the questionnaire «Type of attitude to the disease», the test «Strategies for coping-behavior» of Lazarus and psychophysiological indicators using the diagnostic complex «Status PF»: complex visual-motor reaction, level of functional mobility of the nervous processes, volume of attention, distribution of attention using the Bourdon Corrective Test, memory 10 numbers test, memory 10 syllables test, memory 10 words test, figurative memory, brain performance. For statistical analysis, the software Statistica 10.0 was used. According to the results of the correlation analysis, it was found that a high level of adaptive harmonious and ergopathic variant of attitudes to illness and productive coping-strategies are associated with high rates of attention and reaction, and a high rate of productive coping-strategies «taking responsibility» is associated with a high level of memory and attention. High rates of unproductive stress-overcoming strategies «Distancing» and «Flight-avoidance» positively correlate with the number of errors in assessing the performance of the brain. Thus, the «targets» of the psycho-correctional effect can be attention and reaction functions to improve indicators of the attitudes to illness indicators, and memory and attention functions in order to form productive stress-overcoming behavior.