The timely insulin administration can promptly normalize the blood glucose level. Indications for early insulin therapy include severe insulin deficiency often in young patients with low body weight; sarcopenia, cachexia and chronic infections especially in elder patients; early manifestation of microagiopathic complications, insufficient effectiveness of two- or three-component combinations of anti-diabetic drugs, severe symptoms associated with hyperglycemia. Adequate insulin therapy reduces lipo- and glucotoxicity, protects beta cells, other tissues and organs from damage. At the same time, there is an opinion that, in view of adverse effects of exogenous insulin and appearance of new anti-diabetic drugs, the insulin therapy should be started as late as possible. Adverse effects include the risk of hypoglycemia, weight gain and possibly also cardiovascular complications. Combinations of insulin with other hypoglycemic drugs and special features of insulin therapy in elder patients are discussed. There is a tendency for the target glycemic levels to increase with age. Obviously, the approach must be individual, taking into account age, clinical and laboratory data, comorbidities, preferences and possibilities of patients.

This article examines and summarizes studies on the epidemiology, risk of developing diabetes, and the influence on the cardiovascular system of patients with diabetes and different levels of alcohol consumption. High costs for the treatment of alcohol abusers have been demonstrated. The article describes the effect of ethanol on glucose metabolism and the mechanisms that cause hyperglycemia and hypoglycemia, the role of ghrelin and leptin in alcohol-consuming patients with diabetes mellitus. Attention is paid to the issues of hypocoagulation and systemic inflammation in diabetics who use ethanol. The effect of alcohol on patients with type 1 diabetes mellitus is shown separately. The influence of alcohol on the development of atherosclerosis, as well as late complications of diabetes mellitus, such as diabetic angiopathy of the lower extremities, is described. The influence of alcoholic beverage preferences on the risk of developing diabetes mellitus has been demonstrated. Low adherence to self-control in ethanol-consuming patients with diabetes mellitus is emphasized. Drinking small or medium amounts of alcohol has been shown to reduce the incidence of diabetes in most studies, while heavy drinkers are at an increased risk of developing the disease. In people with diabetes, light to moderate alcohol consumption reduces the risk of cardiovascular disease and all-cause mortality. The type of alcoholic drink, gender, and probably body mass index are factors that influence these results.

Type 1 diabetes mellitus (T1D) is a chronic disease with each age period specific features, which should be taken into account for achieving glycemic targets. There are many publications about the transition of patients from pediatric medical system in the adult's service, but most of them still have insufficient evidence based on subjective expert opinion or on clinical centered experience. According to the definition adopted by the Society of Adolescent Medicine, the term «transition» refers to a purposeful, planned and timely transition from a pediatric, family-oriented system of medical care to an «adult», patient-centered system. It is known that incorrect transition can lead to patient's «falling out» of medical supervision system and errors in transition have a negative effect on the overall morbidity and mortality, frequency of severe hypoglycemia and diabetic ketoacidosis in the first year after the transition to the adult's service in young adults with T1D. In addition to the increased risk of acute complications of T1D, many authors associate the transition with an increasing occurrence/ progression of chronic complications of diabetes due to the deterioration of metabolic control. To reduce such risks, the transition of adolescents with T1D to the adult's service should be well-timed, continuous and prepared, and now it's time to develop regional structured transfer programs for preserving health and improving the quality of life for a large number of our patients.

Diabetic peripheral sensorimotor neuropathy is one of the most common complications of diabetes mellitus. Diagnosis of diabetic peripheral neuropathy consists of symptom assessment and clinical neurologic examination using quantitative tests to assess the severity of neurologic disorders. The article discusses modern approaches to the complex treatment of pain form of diabetic peripheral neuropathy, starting with the compensation of carbohydrate metabolism. If, despite the normalization of glycemia, the patient continues to complain of pain or other unpleasant sensations, it is necessary to prescribe pathogenetic or symptomatic agents in order to reduce or completely disappear. The means of local therapy for the treatment of diabetic peripheral neuropathy, the purpose of which is to relieve pain symptoms (antidepressants, anticonvulsants, analgesics, topical agents), as well as pathogenetic therapy, based on the effect on the main pathogenetic components of diabetic peripheral neuropathy (use of drugs α-lipoic (thioctic) acid).

The study of the state of lipid peroxidation processes in patients with acute salpingo-oophoritis, as well as the rationale for the use of antioxidant therapy in the complex treatment of patients with this pathology, was carried out. In a group of 50 patients with acute salpingooophoritis, traditional treatment was performed, including antibacterial agents in accordance with the clinical protocol for the diagnosis and treatment of pelvic inflammatory diseases (2015), anti-inflammatory, detoxification therapy (comparison group). In 50 patients with acute salpingo-oophoritis, similar complex therapy was supplemented by the appointment of drugs with antioxidant properties (main group). When patients were admitted to the hospital and after therapy, the state of lipid peroxidation processes in the blood was assessed by the content of lipid hydroperoxides and malondialdehyde in blood plasma and in red blood cells, as well as the state of the antioxidant blood system. The results of the studies indicate the activation of lipid peroxidation and the destabilization of biological membranes in patients with acute salpingo-oophoritis. It is shown that the use of antioxidant therapy in the complex treatment of patients with acute salpingooophoritis helps to reduce the treatment time in the hospital and improves the long-term results of treatment for patients with this pathology.

The trends in life expectancy that have been observed in recent decades directly affect the activities of an obstetrician-gynecologist due to the fact that women need not only to live a long life, but also to reduce the number of diseases, the development of which is often associated with the onset of the menopausal transition and postmenopause. The task of doctors is to help patients to enter the postmenopausal period as gently as possible, minimizing the manifestations of the climacteric syndrome. Currently, the most effective method of treating early climacteric symptoms is menopausal hormone therapy. The article discusses modern approaches to the conduct of menopausal hormone therapy in the event of menopausal disorders, approaches to the selection of menopausal hormone therapy, taking into account the characteristics of each individual patient. The therapeutic effects and possibilities of menopausal hormone therapy, the problems of its acceptability, as well as the management of postmenopausal patients with uterine bleeding are considered.

To assess the efficacy, safety and tolerability of the products specialized children's dietary nutritional therapy in children with Inherited disorders of amino acid metabolism from birth to three years. 8 children from birth to 2y 11m with verified diagnoses were enrolled in this open-label multicenter prospective non-controlled study. Patients were separated to the groups depending on diagnose and nutritional treatment products. Clinical efficacy of the products was assessed according to the Good Clinical Practice guidelines based on clinical and laboratory tests. All patients taken nutritional treatment products throughout the study. No dyspepsia, allergic reactions, impairment of somatic and neurological status were reported. After the treatment, levels of neurotoxic metabolites in the blood and urine were optimal. Nutritional therapy is highly effective in children with Inherited disorders of amino acid metabolism from birth to three years.

The aim of this study was retrospective and operative analysis of the epidemiological situation dirofilaria man in the Astrakhan region for the period from 1951 to 2019. So, it was analyzed 81 epidemiological map persons infected with dirofilaria and admission of ambulatory patients Helminthological center. In total, during the analyzed period from 1951 to 2019, 81 local cases of human dirofilariae infection were registered in the Astrakhan region. The largest number of cases of dirofilariasis was observed in the late 90s – early 2000s – 63% (n = 51). The largest number of cases of dirofilariasis was registered in 2000 and 2002 – 13.6% (n = 11) and 11.1% (n = 9), respectively. In most cases, incorrect diagnoses were made – 77.8%. All the described cases were local-patients did not go anywhere outside the Astrakhan region. The diagnosis of dirofilariasis was made based on the data of the clinical picture, epidemiological history and data from laboratory blood tests. Thus, the problem of dirofilariasis remains relevant today, as evidenced by new cases of human disease; the main location is the area of the eyelids, orbit and scalp; dirofilariasis was more often observed in women, due to the fact that, unlike men, they are more careful about their appearance; characteristic signs of dirofilariosis are hyperemia, edema, pain at the location of helminth, as well as the migration of the parasite under the skin; in most cases, incorrect diagnoses are made.

Clinical and laboratory parameters in young patients hospitalized in an infectious hospital with a diagnosis of COVID-19 were evaluated. The study included 89 patients with a diagnosis of «covid-19 Coronavirus infection» aged 18 to 44 years, the average age was 35,8 ± 1,6 years (59 (66,3%) men and 30 (33,7%) women). The clinical picture of the disease in most patients was characterized by the presence of bilateral viral pneumonia in 97% of cases. Concomitant diseases occurred in 32 patients (36%), most often in the group from 35 to 40 years, while the share of cardiovascular diseases and obesity was 51%. Mild severity was registered in 3 (3,4%) patients, average-in 86 (96,6%) patients. Men compared to women were more likely to have symptoms of intoxication (50,6% vs. 28,2%) and shortness of breath (28,2% vs. 10,1%), dry cough, dysgeusia and loss of appetite. In 73% of patients, respiratory failure (DN) was registered to varying degrees, and a quarter (26%) had no signs of DN. According to CT data, at the time of hospitalization, lung tissue damage of varying degrees was observed in 88% of patients. In dynamics, most patients showed a decrease in the degree of lung damage, but in 30% of cases there was no regression of lung damage at the end of the hospitalization period. COVID-19 in young patients is highly likely to develop complications in the form of pneumonia, the course of which is benign. The lack of regression of viral pneumonia more than one third of patients require follow-up all survivors and monitoring the laboratory parameters in dynamics for the identification and evaluation of consequences coronavirus infection and the need for further in-depth study of clinical and immunological characteristics of the course COVID-19 in different age groups.

Anemic syndrome is very widespread among the population. Among the pathogenetic variants, anemia of chronic diseases ranks second among various pathogenetic processes, such as prolonged inflammatory processes. This type of anemia occurs in 27% of cases among other anemias, but it should be noted that the incidence of this anemia in some chronic diseases can reach 100%. The article provides basic information about the leading links in the pathogenesis and treatment of anemia of chronic diseases. The pathogenesis is based on a violation of iron metabolism: the exchange of hepcidin, ferroportin, factors that stimulate the production of hepcidin, inflammatory cytokines. To diagnose this type of anemia, it is necessary to carefully collect anamnesis and search for a long-term chronic illness, assess the state of iron metabolism and the level of transferrin, and it is also necessary to differentiate this type of anemia from iron deficiency. The difference between anemia of chronic disease and iron deficiency is that the latter is characterized by an absolute lack of iron, and it is inaccessible to young erythroid precursors. A significant factor is the determination of the type of iron deficiency after the diagnosis of anemia of chronic disease. The basis of the therapeutic approach to the treatment of anemia of chronic disease is the treatment of the underlying disease. In the case when this is not possible, it is necessary to compensate for the anemia by other methods. Modern medicine offers 4 rational approaches to the treatment of anemia of chronic disease: replacement therapy with blood components; ferrotherapy; the use of erythropoiesis stimulants; targeted cytokine therapy.

The article discusses issues related to the peculiarities of the course of influenza against the background of neurological diseases: influenza in epilepsy and other conditions characterized by increased convulsive readiness, influenza in some pathologies of the peripheral nervous system, influenza in neuromuscular diseases and multiple sclerosis, influenza and cerebral vascular pathology. In a number of patients with diseases of the nervous system, contact with influenza virus and infectious process are accompanied by an increased risk of the disease exacerbation, worsening the prognosis, need for hospitalization, and poor outcomes. The expediency and priority of influenza vaccine prophylaxis in persons with specific nosologies that are within the competence of a neurologist are discussed. In many cases, in neurological patients, vaccination is recognized as an effective measure to prevent the severe course of influenza and complicationы emergence. Doctors need in-depth knowledge of the indications and limitations of influenza vaccination in patients with nervous system disorders.

In February 2021, an online press conference entitled «Nutritional care in COVID-19» was held. It presented the results of a prospective, open-label, comparative observational study evaluating the effect of specialty food mix on the ability of COVID-19 patients to recover. The study was conducted under the auspices of the National Association for Clinical Nutrition and Metabolism at 5 centers in Moscow, St. Petersburg, Yekaterinburg and Omsk. According to its results, nutritional support should be added to the standard methods of patient management: about 60-70% of patients with COVID-19 need specialized nutrition.