Ischemic stroke is one of the leading causes of death and permanent disability. The mortality rate in the acute period of ischemic stroke remains high – from 8% to 20%, depending on the severity of acute cerebral circulatory disorders. Monitoring blood pressure in the acute period of stroke is an important tool for improving the outcomes of the disease. The author of the article questions the expediency of maintaining high blood pressure values in the acute period of ischemic stroke. New perfusion methods of brain research do not support the established ideas about the usefulness of high blood pressure in the first hours and days of ischemic stroke. The article discusses the mechanisms of violations of intracerebral hemodynamics and the influence of blood pressure on them. At least three mechanisms of the negative impact of severe arterial hypertension (AH) on the clinical situation in the acute period of stroke can be distinguished. First and foremost: high blood pressure (BP) does not at least improve cerebral perfusion, but at the very least worsens it not only in the area of damage, but also in areas of the brain remote from the site of ischemia. Second: excessive blood pressure increases the likelihood of hemorrhagic transformation of the ischemic focus and all variants of intracranial hemorrhage. Third: AH increases the load on the myocardium, which leads to a decrease in the minute volume of blood and, ultimately, a decrease in the volumetric rate of cerebral blood flow. The author gives his well-founded opinion on the optimal parameters of blood pressure in patients with ischemic stroke. 

Trends in the incidence of older persons were identified. The general and primary incidence is analysis, risk factors and distribution on health groups persons are more senior than 60 years, following the results of medical examination in Omsk region. Data on primary incidence at persons are compared is more senior than working-age. Information sources: form of statistical № 131 «Data on medical examination of certain groups of the population», form of federal statistical observation № 12 «Data on number of the diseases registered at the patients living in the area of service of the medical organization». Sharp growth on the general incidence of persons is noted is more senior than 60 years, from 2013 to 2015; and stabilization of this indicator in 2015-2018. The quantity of primary diseases to decrease of 2015 by 2018. The prevalence of risk factors – is rather stable throughout the studied period. At distribution of the examined contingents of senior citizens on groups of health during 2013-2018 decrease in a share of I and II group due to increase in a share of the third is noted. The change in indicators of general and primary incidence over the analyzed period of time reflects the improvement of quality diagnostics in the region, the reduction of the impact of risk factors identified during medical examination through preventive measures. Data from the older age group indicate the need for more detailed planning of preventive measures and mandatory evaluation of long-term results. 

In 1865, in his lecture «Phlegmasia Alba Dolens», a great French clinician Armand Trousseau noted a connection between idiopathic venous thrombosis and malignant diseases. Several years later, he noted the appearance of thrombophlebitis of his own left hand, followed by the manifestation of stomach cancer, from which he died. The syndrome in which migratory thrombophlebitis precedes the clinical manifestation of malignant neoplasms of the internal organs, was subsequently named in memory of Trusso. The article presents a clinical case of Trousseau's syndrome in a patient in whom the diagnostic search revealed pancreatic cancer. The patient was initially admitted to the cardiology department with a preliminary diagnosis of acute coronary syndrome. The diagnostic search revealed thrombotic manifestations (pulmonary embolism, deep vein thrombophlebitis of both lower extremities), as well as changes in the liver with increased levels of liver enzymes. Trousseau's syndrome was suspected: a cancer search was performed and revealed signs of pancreatic cancer (changes in the pancreas reveled by the ultrasound and abdominal CT; an ultrahigh level of the CA 19-9 tumor marker) with liver metastases. The diagnosis was not histologically confirmed due to the risk of bleeding during anticoagulant therapy. Unfortunately, the patient died from repeated massive pulmonary embolism. Autopsy confirmed the diagnosis of pancreatic cancer with multiple liver metastases and revealed signs of pulmonary artery thrombosis and deep vein thrombosis of the lower extremities. The awareness of Trousseau's syndrome can guide physicians to search for cancer in patients with «idiopathic» thrombophlebitis. 

The purpose of the review is to present an analysis of the literature data on the etiopathogenesis and therapy of liver diseases while Covid-19. Liver damage is common in patients with COVID-19, which can be caused by the direct cytopathic effect of the virus, an uncontrolled immune response, sepsis, or drug damage to the liver. Given the presence of ACE2 receptors in the liver, the liver is a potential target for SARS-CoV-2. Moreover, COVID-19 may exacerbate underlying chronic liver disease, leading to hepatic decompensation, acute liver failure, associated with higher mortality. Doctors should carefully assess the initial state of the liver, pay attention to changes in the course of underlying liver disease, and during treatment should intensify monitoring and evaluation of liver function in patients with severe disease. The physician should establish the causes of liver damage in combination with the pathophysiological changes caused by COVID-19 and based on active treatment of the underlying disease, prescribe treatment to protect the liver to reduce the degree of liver damage. Additional data are currently required to clarify the nature and extent of liver damage, and to determine approaches to therapy in patients with COVID-19. 

Every person who is actively involved in sports has at least once encountered problems from the gastrointestinal tract during competition or training. The physical condition of the athlete is one of the key factors in achieving the set goals and somatic disorders can interfere with the desired results. Three groups of reasons for the development of gastrointestinal symptoms in athletes were identified: physiological, mechanical, and associated with nutrition. Timely identification and correction of violations during physical activity provides an increase in the quality of life of athletes and maintenance of high results. The rapid increase in the number of people actively involved in sports has led to the fact that the function of medical supervision and giving recommendations on rational nutrition while playing sports becomes the responsibility of the work of primary care physicians. The study of the effect of physical activity on organs and systems becomes very important. The review article presents data on the etiology and mechanisms of the formation of gastrointestinal symptoms in athletes during training and considers recommendations for preventing their occurrence. 

Gastritis is a reaction of the mucous membrane (MM) of the stomach to damage and is characterized by the formation of inflammatory, dystrophic and dysregenerative changes in the MM of the stomach, as well as atrophy of epithelial cells with replacement of normal glands with fibrous tissue. The progression of chronic gastritis (CG) is accompanied by the development of MM atrophy, dysplasia and becomes a significant factor in the formation of gastric malignant neoplasms. The article presents the modern etiological classification of CG, approaches to the diagnosis of CG, assessing the stage of gastritis on a scale of progressive increase in the likelihood of developing stomach cancer, presents the histological characteristics, and also substantiates etiopathogenetic approaches to the treatment of various forms of CG, including methods for optimizing the eradication therapy of H. pylori infection. which can be used to increase the effectiveness of not only standard triple therapy, but also other anti-Helicobacter treatment regimens. The use of proton pump inhibitors in the treatment of gastritis is considered. 

To date, IgG4-associated pancreatitis – type 1 autoimmune pancreatitis is a fairly rare disease of the pancreas, which causes great difficulties in the choice of therapeutic and diagnostic tactics for both surgeons and gastroenterologists. The disease is poorly understood and rarely discussed in routine clinical practice. Although, perhaps, in fact, the number of such patients is significantly greater. The prevailing etiological variant of the development of autoimmune pancreatitis remains the theory of lymphocyte activation under the influence of IgG4, which is normally one of the smallest immunoglobulins of class G, exhibiting both pro-inflammatory and anti-inflammatory activity. The inflammatory process caused by activated IgG4-positive leukocytes is characterized by the development of a diffuse or local process due to pronounced infiltration by lymphocytes and plasma cells, followed by their activation into fibroblasts and the formation of focal fibrosis. In the presented clinical case, we tried to describe all the difficulties faced by the patient, his family and friends, his attending physicians. A disease that developed over the years and led to a traumatic operation, the diagnosis – the setting of which required many years of diagnostic search, a treatment that allowed to save life and improve its quality, but due to delay, it turned out to be insufficient to fully rehabilitate the patient. 

The article is devoted to various aspects of nutritional support for children with cystic fibrosis. The basic principles of nutrition of such patients are considered. The article presents the results of a retrospective observational clinical study of the use of a specialized product for therapeutic nutrition, in which the effect of the use of a specialized food product on physical development, the course of the disease and the quality of life of children with cystic fibrosis was studied. The patients included in the study had a diagnosis of cystic fibrosis, documented according to the 2014 European Consensus. The age of the children included in the study ranged from 2 to 17 years. The analysis of indicators of physical development, data on the history of development and diseases of children: the frequency of exacerbations of chronic bronchopulmonary process during the study period, the need for intensive therapy, the presence of complications. The level of physical development in patients was assessed by the body mass index (BMI). Children who received additional food for a long time as part of the daily diet had the best indicators of physical development, which was expressed in high BMI values. Statistically significant indicators were obtained when comparing the group of children who received food regularly for three years, and the control group. The lower frequency of exacerbations requiring hospitalizations also indirectly indicates the advantage of patients in the study groups over the control. 

Medicinal plants have historically proven their value as a source of molecules with therapeutic potential. Paediatrics pose a unique set of risks of medication errors. The toxicity of herbal medicines may be due to intrinsically toxic constituents of the herbal ingredients. Other important mechanisms associated with the toxicity of herbal medicines include allergic reactions and contamination by heavy metals. Currently, in pediatrics, bioregulatory drugs, the main tool for bioregulatory therapy, are increasingly being used. Bioregulatory medicine and herbal medicine can be used as a basic treatment alone or in combination with classical therapy, depending on the patient's ability to self-regulate. Phytotherapy and bioregulatory medicine and drugs created on their basis are used by pediatricians of all specialties in many countries of the world. It should be noted the high compliance of patients with these drugs and, in general, their good compatibility with the generally accepted therapy protocols. 

Official instructions and recommendations for feeding infants often do not keep pace with the emergence of new names and varieties of adapted and special formulas. Breast milk is the optimal product for feeding children in the first months of life; it contains numerous stimulating factors that ensure the development of the immune system, the digestive system, and the formation of a normal biocenosis. Natural feeding promotes the maturation of these systems and forms the most physiological way of further functioning. However, if breast milk is not enough to ensure adequate feeding, or for some reason natural feeding is not possible, the question of introducing supplementary feeding arises. The concept of «supplementary feeding» includes mixtures – breast milk substitutes. In this article, we propose an algorithm that will allow the practicing physician to freely navigate in all the variety of artificial mixtures not only at the moment, but also in the future, when new products appear on the market. By understanding the principles for administering formulas outlined in this article, it will be fairly easy for a pediatrician to extrapolate these principles to future formulas. 

Almost immediately after a pandemic of a new coronavirus infection (COVID-19) was declared by World Health Organization, we began to see papers which described neurological complications more than in 30% of patients. Neurological manifestations are not leading in the clinic of diseases caused by coronaviruses. However, evolvement of the nervous system is possible shown, and respiratory, sensory, motor, autonomic and other disorders of the central and peripheral nervous system. Structure of virion SARS-CoV-2 determine possible affinity for a number of receptors expressed on the neuronal membrane; viral proteins or genetic material were found in the nervous tissue. Also, COVID-19 can worsen the course of already existed neurological diseases, so, this article provides basic recommendations for management of certain groups of patients with nervous diseases, developed by leading foreign and Russian professional communities. Considering earlier epidemics of other coronavirus infections, neurologists are most likely to encounter cognitive and psychoemotional disorders and other pathologies in the follow-up period. Therefore, it is important to choose appropriate management and monitor the development of early and long-term consequences of neurological manifestations and complications of COVID-19. 

The aim of this study was to evaluate the effectiveness of the prevention of new coronavirus infection COVID-19 in familial foci of infection using interferon alpha-2b gel for topical use. A simple prospective comparative study included 89 families (266 people), in connection with the registration of a case of a new coronavirus infection in one of the family members. They were divided into 2 groups: in the 1st group of 27 families (84 people), family members did not use drugs for the prevention of COVID-19 when one of the family members fell ill. Group 2 included 62 families (182 people) – these families underwent drug prevention of COVID-19 with interferon alfa-2b, gel for external and local use 36 IU/g for all family members immediately after the detection of a case of the disease in the family. In the 1st study group of 84 people, the disease was registered in 27 patients (32,1%). Of the mild cases, coronavirus infection developed in 29,6% of patients, in the moderate form – in 70,4% of patients. Out of 57 contact persons, a new coronavirus infection was diagnosed in 46 contact persons (80,7%), 11 people remained healthy (19,3%). In the 2nd group of 182 people, coronavirus infection was registered in 62 patients (34,1%). Of these, in a mild form in 14,5%, in a moderate form in 85,5% of patients. Of the 120 contact persons over the entire observation period, 6 patients (5,0%, р < 0,05). Carrying out drug prophylaxis to contact persons, which consists in the administration of recombinant interferon alpha-2b intranasally, makes it possible to prevent a large number of cases of the disease in familial foci of infection in persons belonging to different age groups.