Cough is a reflex, protective and adaptive reaction of the body aimed at removing foreign sub-stances and/or pathologically altered tracheobronchial secretions from the respiratory tract. Cough is one of the most important components of pulmonary clearance, which is activated when natural mechanisms fail. It can have both a positive value (clearing the airways) and a negative value (it tires the patient, disrupts sleep, nutrition, and can lead to various complica-tions). Therefore, the treatment of cough using pharmacological and nonmedicinal methods can reduce it in the case of excessive severity and improve pulmonary clearance. The basis of cough pharmacotherapy is mucoactive drugs, which form four pharmacological groups: expectorants, mucolytics, mucokinetics, mucoregulators. In addition, in some cases, drugs can be used to suppress the cough reflex in the central or peripheral link. All of them provide symptomatic cough relief and reduce the duration of symptoms. The choice of medicines for the treatment of cough is determined by their pharmacodynamics and features of influence on the nature of bronchial secretions. 

Neurological, otolaryngological, audio and neurophysiological (trigeminal and acoustic evoked potentials) examinations of 100 patients with complaints about noise in the ears or in the head were performed. The main group of patients consisted of 100 patients with complaints of tinnitus or in the head (69 women and 31 men; average age – 48.1 ± 9.3 years). The exclusion criteria were diseases of the outer and middle ear, organic pathology of the nervous system (tumors, postponed ischemic and hemorrhagic strokes, consequences of severe traumatic brain injury), mental disorders, objective tinnitus, and dysfunction of the auditory tube. The control group consisted of 20 healthy volunteers matched by sex and age with the main group of subjects (9 men and 11 women; average age – 46.8 ± 10.2 years). In 45% of cases found sensorineural hearing loss. These patients have a longer duration of illness (more than 12 months), compared to patients without impaired hearing (55% – up to 3 months). The latter observed high personal and reactive anxiety in their nose and throat pathology. The results of the study showed involvement of the auditory analyzer and trigeminal system in the pathogenesis of tinnitus, depending on the duration of the disease. 

The prevalence of somatic diseases in patients with pneumonia caused by SARS-CoV-2 viruses was assessed, the most common somatic diseases in patients, depending on gender and age groups were identified. 110 patients with viral pneumonia caused by SARSCoV-2 were included in the study. The presence of risk factors for the severe course of the disease, somatic pathology, epidemiological history, changes according to computed tomography and scores on the Charlson comorbidity scale were evaluated. The average age of patients with coronavirus infection caused by COVID-19 with an unfavorable outcome was 75 ± 1,3 years. The most common comorbid combined pathology in this group of patients is postinfarction cardiosclerosis, ischemic cardiomyopathy, and chronic cerebral ischemia. Of the risk factors for severe coronavirus infection, essential arterial hypertension is most common 93.6% (103 patients), age over 65 years old 81.8% (90 patients), diabetes mellitus 66.3% of cases (73 patients) and chronic heart failure 46.3% of cases (51 patients). In this group of patients, the average comorbidity index was 8.9 ± 0.3. Severe lethal disease is most often recorded in people of an older age group with diseases of the cardiovascular system, cerebrovascular pathology and malignant neoplasms. Even patients of young and older age groups had risk factors for poor prognosis. According to the study, the most unfavorable symptoms (fever above 38 оС, shortness of breath and weakness) occur first, 6 days before hospitalization, while the rest appear more often 3-5 days before hospitalization. Patients who have such risk factors as age over 65 years, arterial hypertension and heart failure in combination with symptoms such as fever above 38 оС, shortness of breath and weakness require immediate hospitalization, regardless of the level of hypoxemia and changes according to computer tomography, for further observation and treatment due to the high probability of death. 

The review is devoted to the analysis of the effectiveness of the use of bacterial lysate OM-85 in the complex therapy of acute respiratory tract infections (ARTI) in children. We analyzed 10 controlled clinical trials, including 7 randomized ones (of which 2 were double-blind, placebo-controlled), which included a total of about 800 patients under the age of 15 years, as well as one observational study, which included 587 children under 12 years of age. In all studies, it was found that the use of bacterial lysate OM-85 in children with ARTI leads to a significantly faster improvement. Also, in some studies, it was shown that the use of this immunostimulant reduces the need for antibiotic therapy and has a pronounced stimulating effect on the immune response: it increases the level of immunoglobulins and interferons, as well as other components of the anti-infective response. Thus, a review of the available scientific publications shows the high efficiency of bacterial lysate OM-85 in the treatment of respiratory infections in children, which makes it possible to recommend the inclusion of this immunostimulant in the complex therapy of ARTI in pediatric practice. At the same time, further clinical studies and generalization of their results in a systematic manner are needed in order to form final conclusions about the therapeutic efficacy of OM-85 bacterial lysate and recommendations for its use. 

A study of the clinical effectiveness of the method of plantar pneumostimulation in the rehabilitation of 82 children with spastic and atonic-astatic forms of infantile cerebral palsy, aged 11 months to 17 years, suffering from symptomatic epilepsy, was carried out. When using the assessment of dynamics using the GMFM-66 and GMFCS scales, positive dynamics in motor status was revealed, which turned out to be significant in the younger age group. The authors believe that the reason for this phenomenon is the application of proprioceptive-corrective action in the case of an incomplete process of neuroontogenesis, which allows the maximum use of the reserves of the child's plastic brain. All children underwent an electroencephalographic study before and after the course of plantar pneumostimulation, and in none of the cases there was no clinical or neurophysiological exacerbation of the epileptic process. A conclusion is made about the effectiveness and epileptological safety of the plantar pneumostimulation technique, which allows us to recommend it for widespread implementation in neurorehabilitation practice. 

Affection of the nervous system in acute leukemia is characterized by polymorphism of clinical symptoms, in which connection patients can seek medical help from doctors of various specializations. Eventually, this may affect the timeliness of diagnosis, treatment, and disease outcomes. The report provides a clinical observation of incomplete neuroleukemia syndrome (absence of pathological abnormalities in the cerebrospinal fluid in the presence of clinical manifestations) in a patient with acute development of lymphoblastic leukemia, which accompanied by a lesion of the facial nerve nucleus. Neuroleukemia is one of the serious complications of acute leukemia. The reason for the development of neuroleukemia is the metastasis of leukemia cells in the arachnoid and pia mater of the brain and spinal cord with the penetration of the medulla along the vessels and the formation of perivascular infiltrates, as a result of which a meningitis clinic develops with changes in the cerebrospinal fluid. The basis for the treatment of neuroleukemia is the intrathecal use of cytostatic drugs (methotrexate dexamethasone, cytarabine); intravenous administration of vincristine, cyclophosphamide, doxorubicin, daunorubicin, etc. The features of the given clinical observation is the development of neuroleukemia as the primary manifestation of acute leukemia, more often this occurs during relapse. In our observation, a patient with acute leukemia had a unilateral lesion of the facial nerve, with clinical symptoms corresponding to damage to the nucleus of the facial nerve and there were no changes in the cerebrospinal fluid, which is possible with the development with incomplete neuroleukemia syndrome of a patient. Upon achieving clinical and laboratory remission in neurological status, the patient retained paralysis of the muscles of the face on the left. The presence in patients of pallor of the skin, hemorrhagic syndrome, lymphadenopathy, hepatosplenomegaly should necessarily alert the doctor and requires the exclusion of malignant diseases of the blood system. 

The article presents two clinical cases illustrating the experience of using ibandronate in patients with different clinical types of postmenopausal osteoporosis, including those undergoing medical rehabilitation procedures. Ibandronic acid is highly effective in reducing of vertebral fracture risk and in increasing spinal bone mineral density and also has a good tolerance, safety profile and a convenient administration regimen. Given the evidence base of clinical trials, ibandronate may be a treatment option for postmenopausal women with uncomplicated osteoporosis and with osteoporotic fractures. In particular, the appointment of the drug is justified in patients undergoing rehabilitation after an osteoporotic fracture and associated surgical treatment. Physical therapy in combination with the prescription of pharmaceuticals affecting the bone remodeling allows achieving better results in the rehabilitation of patients with osteoporotic fractures. 

Thrombosis worsens the course of the disease and increases mortality in children operated on for congenital heart defects. The literature describes in detail the disturbances in the hemostasis system observed after cardiac surgeries performed in conditions of artificial circulation, but there are no indicators that could predict the risk of thrombosis in children. The use of parameters of plasma hemostasis as predictors of thrombosis in the algorithm for diagnosing hemocoagulation disorders in children of the first year of life undergoing surgery for congenital heart defects has been substantiated. This study included 130 children aged 3 days to 11 months 29 days (median age – 5 months), who underwent surgery for congenital heart defects (CHD) using artificial circulation. The patients had thrombosis of various localization: in the vessels of the brain, intracardiac, ischemia of the extremities, etc. The incidence of postoperative thrombosis was 26.9%. All patients were divided into two groups: the first group included children without thrombotic complications (n = 95); in the second – with episodes of thrombosis (n = 35). It was found that the values of von Willebrand factor, plasminogen and D-dimer in the second group significantly exceeded their values in the group of children without thrombosis (p > 0.05). The prognostic significance of these indicators was revealed. Based on the results of the study of this cohort of patients, the concentration of D-dimer, von Willebrand factor activity and plasminogen activity in plasma can be considered as predictors of thrombosis in children with CHD. 

Hemolytic uremic syndrome (HUS) is a major cause of acute kidney injury (AKI) in children and one of the causes of the progression of kidney damage in childhood. Endothelial dysfunction is the central pathogenetic mechanism of kidney damage in this pathology. Early detection of endothelial dysfunction in kidney damage is of great interest, since timely correction can help slow the progression of kidney damage. The presence of a direct correlation between the glomerular filtration rate and biomarkers of endothelial dysfunction in patients with impaired renal function has been proven. Due to damage to the endothelium of the renal glomeruli, glomerular filtration decreases until the formation of AKI. It is promising to identify early and sensitive biomarkers of AKI in children with HUS for the development of new diagnostic approaches, which will optimize the early diagnosis and progression of renal damage in this category of patients. The study of the effect of endothelial dysfunction on the course and outcome of HUS is relevant and requires further research in this direction. 

The purpose of the review is to analyze the literature data on the relationship between intestinal microbiocenosis disorders and skin diseases, as well as the effect of diet on the skin condition and features of the course of certain dermatological diseases. When analyzing the literature data, a close relationship between violations of intestinal microbiocenosis and the state of the intestinal barrier with skin diseases was confirmed. Western diet, low in fiber, vitamin D, high in fat, excess of gluten and simple carbohydrates, improving microbiome composition and intestinal permeability. In conditions of disturbed microbial balance and changes in the barrier functions of the intestine, the penetration of immunogenic molecules into the systemic circulation, including food antigens, bacterial toxins and pathogens, which can accumulate in the skin, disrupt the epidermal barrier, leading to chronic perception, increases. The task in the treatment of dermatological diseases is to eliminate increased intestinal permeability. There are several ways to restore the function of the intestinal barrier: 1) reducing or eliminating the intake of antigens, especially at a young age (for example, gluten-free diet); 2) changes in the composition of the microbiota (pre-, pros-, and antibiotics); 3) modification of proteins, intestinal barrier and other regulatory proteins (cytoprotectors); 4) elimination of inflammation leading to immune reactions. 

The purpose of this open, not comparative study was to evaluate the efficacy and safety of pain therapy for diseases of the musculoskeletal system. The study included 30 patients with joint pain of different localization who are hospitalized in the therapeutic department, receiving a fixed combination of diclofenac sodium with B vitamins. The severity of pain was assessed using a visual analogue scale (VAS) for day activity (VAS-am) before taking the drug and 3 hours after, for three days. In patients with gonarthrosis and coxarthrosis, the WOMAC pain index scale (The Western Ontario and McMaster Universities Osteoarthritis Index) was additionally evaluated. A statistically significant clinical efficacy of a fixed combination of diclofenac sodium with B vitamins in patients with pain was revealed, verified by the positive dynamics of VAS and WOMAC indices: after three doses, the severity of pain on the VAS scale decreased by 84% (p ≤ 0.01). According to the WOMAC scale (pain) in patients with gonarthrosis and coxarthrosis, pain for the first indicators decreased by 75% (p ≤ 0.01). The maximum effect is achieved on the first day of taking a fixed combination of diclofenac sodium with B vitamins and lasts for 3 days. Patients did not reveal unwanted adverse reactions. The rapid analgesic effect of the drug and the absence of side effects increases the patient's adherence to the drug. 

There are varieties of combination of diseases in the practice of dermatologist. Comorbidity exacerbates the course of the primary disease. Concomitant diseases have common etiopathogenic mechanisms. Currently, there is a widespread increase in the number of patients infected with the human immunodeficiency virus (HIV). «Disguise» of HIV infection — this is one of the urgent problems of modern medicine. Almost every HIV-positive patient has concomitant diseases. Patients with HIV infection have a high incidence of skin lesions, prone to extensive spread and severe relapse. This requires a correct, modern diagnosis, a multidisciplinary approach, which improves the quality of medical care and avoids the complications of drug therapy and diagnostic errors. The clinical case presented in the article has a practical interest in the case of comorbidity interplay. An analysis of a clinical case indicates the clinical and prognostic significance of comorbidity. The clinical course of the recurrent form of herpes zoster indicated the presence of «immunocompetence» in the patient. Upon further consideration of the development of the skin pathological process, the virusinduced genesis of the development of multiforme exudative erythema is clearly traced. Thus, it was shown that the presence of polymorbidity requires an integrated patient-oriented approach in determining the management tactics of this patient population, which will allow you to choose a priority treatment strategy and have a significant impact on the prognosis of diseases and life. 

The article analyzes the results of the clinical application of the plant phytocomplex which contains extracts of medicinal plants (centaury herbs, lovage roots, rosemary herb and lingonberry leaves), which promotes the normalization of urinary tract function and reduces dysuric disorders, as well as pain syndrome in cystitis and pyelonephritis. At the University Clinic of Urology, Russian National Research Medical University named after N. I. Pirogov in the period from November 2019 to March 2020, a prospective, single-center, randomized study was conducted, which included 60 patients with a diagnosis of acute pyelonephritis. Patients were divided equally into 2 groups: treatment group (n = 30) receiving complex therapy, including empirical antibiotic therapy and a herbal complex for 1 month, and a control group (n = 30) not receiving specific phytotherapy. After 1 month of continuous administration of the drug, the frequency of re-hospitalizations and episodes of hyperthermia was less in the study group. A decrease in the titer of the pathogen and the growth rate of pathogenic microflora, according to urine culture, was observed in treatment group. The specific phytotherapy in the composition of complex therapy allows you to effectively cope with the inflammatory process, as well as reduce the frequency of recurrence of urinary tract infections.