Recently, the influence of malnutrition on the occurrence and progression of bronchial asthma and obesityhas been increasingly studied. Obesity is a 21st century pandemic. Now, there is evidence of the effect of obesity on the risk of developing bronchial asthma. An increased intake of saturated fat leads to an increase in circulating free fatty acids in the body. This induces pro-inflammatory processes, including in the respiratory tract, which leads to a deterioration in the functioning of the lungs, an aggravation of the course of bronchial asthma, an increase in exacerbations of this disease, an increase in the number of hospitalizations due to the severity of the course of asthma. In addition, scientists have found that a diet low in dietary fiber also contributes to the development of systemic inflammation, thereby worsening the course of bronchial asthma. There is evidence of the effect of vitamin D deficiency on the development, progression and deterioration of control of chronic and autoimmune diseases, which also include bronchial asthma, on the deterioration of the state of lipid metabolism in the subjects. An increase in the level of vitamin D in the body of patients leads to an improvement in certain characteristics of the course and manifestation of these diseases. The use of a Mediterranean diet reduces the likelihood and progression of bronchial asthma, bronchial obstruction, and allergic reactions. Adequate intake of vitamins A, C, E leads to a decrease in inflammatory reactions in the bronchial tree, an improvement in lung function indicators, a decrease in exacerbations of bronchial asthma and the frequency of hospitalizations associated with a deterioration in the control of this pathology. Thus, it is relevant and expedient to carry out scientific and clinical work to determine and in-depth study of the influence of nutrition on the development and course of obesity and bronchial asthma, and to identify the relationship between these diseases.

The problem of the peculiarities of the course of allergic diseases during pregnancy, as well as rational and safe approaches to their treatment, is in the focus of close attention of specialists. The article presents the clinical and pathogenetic characteristics of atopic dermatitis in pregnant women. Attention is paid to the principles of diagnosis of atopic dermatitis during pregnancy. Early diagnosis is especially important when pregnancy occurs, since children born to a family where both parents have atopy have a 75% risk of developing atopic dermatitis. First of all, for the prevention of possible exacerbations of atopic dermatitis in pregnant women, it is necessary to resolve the issue of eliminating trigger factors and exclude contact with allergens, special attention should be paid to a hypoallergenic diet. The issues of the choice of tactics of management and therapy of dermatosis are considered, taking into account clinical studies, assessment of the degree of risk for the pregnant woman and the fetus. The features of the use of emollients, topical glucocorticosteroids, topical antipruritic agents, sedatives and antihistamines as part of the complex therapy of pregnant women with atopic dermatitis are discussed.

The article describes the current view of the topical treatment of allergic rhinitis (AR). Today in the world there is an increase in the incidence of AR, its prevalence in different countries of the world ranges from 4% to 32% of the population, in Russia – 10-24%. Most often, the disease debuts in the first half of life. AR is often associated with bronchial asthma, which is detected in 15-38% of patients with AR. Recently, the attention of researchers has been focused on local AR, which is diagnosed in patients with negative skin and serum tests, when AR is confirmed by provocative tests with significant allergens for the patient with the detection specific IgE in the nasal cavity. When conducting local therapy, nasal sprays are used to eliminate allergens and restore the protective role of epithelial barriers, decongestants are prescribed in a short course, and topical antihistamines are used to relieve allergic inflammation. The main drugs for the treatment of moderate to severe AR are topical glucocorticosteroids: mometasone furoate, azelastine, fluticasone furoate, fluticasone propionate, beclomethasone dipropionate and budesonide. A good effect in the treatment of infectious-allergic rhinitis was obtained with saline solutions.

Polymyositis (PM) and dermatomyositis (DM) are autoimmune diseases of skeletal muscles of unknown etiology, which belong to systemic diseases of the connective tissue and are collectively called «idiopathic inflammatory myopathies». The most severe subtype of polymyositis and dermatomyositis (PM/DM) is antisynthetase syndrome (ACC), associated with the presence of specific immunological markers in the blood serum – antisynthetase antibodies. ACC has clinical features that distinguish it from the PM/DM group as a whole. Interstitial lung disease, the most common extramuscular lesion in PM/DM, is a klyuchevoy prognostic factor in the course of the disease, as well as determining therapeutic tactics and prognosis. Difficulties in the timely diagnosis of DM with ACC are often associated with the fact that the disease can begin with pulmonary symptoms in the absence of obvious signs of myopathy. A clinical case of late diagnosis of this disease is presented.

The aim of this study was to assess the place of combined calcium and vitamin D preparations in the structure of treatment of postmenopausal women with osteoporosis complicated by low-energy fracture, and adherence to them in real clinical practice. A total of 196 postmenopausal women (mean age 65.8 ± 9.1 years) who had undergone low-energy fractures of various localizations were questioned. The structure of anti-osteoporotic therapy and adherence to treatment were assessed within 3 months after the fracture. 61%, 62%, 58% and 42% of women received anti-osteoporotic therapy at 4 months, 1, 2 and 3 years after the fracture, respectively. Among them, only calcium and vitamin D preparations were treated by 46%, 38%, 34% and 19% of the respondents, respectively. 49% of respondents who did not receive treatment for osteoporosis indicated the absence of recommendations from their doctor as the reason. Adherents to calcium and vitamin D supplementation for 1, 2 and 3 years after fracture were 44%, 30% and 17% of patients, respectively. The most adherent to treatment were those consulted at a specialized osteoporosis center. The results of the study indicate that after a fracture occurred to women, calcium and vitamin D preparations were prescribed significantly more often than pathogenetic anti-osteoporotic drugs. With an increase in the period after the fracture occurred, a decrease in adherence to calcium and vitamin D intake was noted, which demonstrates the need for a more active explanation to patients of the advisability of long-term anti-osteoporotic treatment, including calcium and vitamin D intake.

Thanks to the successful development of modern medical technologies, the emergence of new knowledge, new instruments and implants, the improvement of surgical techniques, anesthetic support, it became possible to perform surgical correction of spinal deformities in a group of patients suffering from neuromuscular scoliosis, with a lower intraoperative risk, faster recovery and fewer complications. Orthopedic and surgical treatment of paralytic deformities of the spine is carried out using dorsal and ventral techniques by means of correction and polysegmental fixation of the spinal column. As a result of the interventions in this group of patients, the balance of the trunk is improved, the progression of deformity of the spine and chest is prevented, and self-care of patients is improved.

Clinical and epidemiological features of acute intestinal infections (AKI) caused by opportunistic enterobacteria (UPE) in young children, depending on the etiological factor were established. The information sources were the data of Rospotrebnadzor Administration in the Astrakhan oblast (AO), medical documentation (720 case histories) of patients under the age of 1 year treated in GBUZ «Regional clinical infectious hospital named. A. M. Nichogi» Astrakhan from January 2000 through December 2020. AKI caused by UPE in children in AO is 74%, including 60% in children under 1 year of age, of the total number of patients with AKI of specified bacterial etiology. Regardless of the etiological factor, AKI caused by UPE occurred in the form of monoinfection (83%), moderate severity (62%). Symptoms of intoxication had a direct correlation (r = 0,52 to 0,76; p < 0.001) with the severity of diarrheal syndrome and dehydration. With a decrease in the age of the child, the duration of relief of these symptoms increased (r = -0,72; p < 0,001).

The article analyzes the rationale for the use and the results of the use of detoxification nutritional support in patients with COVID-19 viral infection. Data from a number of publications indicate that when infected with COVID-19, hemotoxic and metabolic effects occur, similar to those that occur with the accumulation of heavy metals. Intoxication of the body in coronavirus pathology is accompanied by violations of oxidative processes and overproduction, mainly of cytokines («cytokine storm»), which is largely due to a deficit in the consumption and accumulation of micronutrients and biologically active substances in the body with pronounced antioxidant, antiinflammatory, hepatoprotective and other activities ... The results of previous studies to assess the detoxification activity of the dietary food product suggested that this product may be effective in cases of intoxication caused by viral infections, in particular COVID-19 coronavirus. Thus, the use of jelly in a group of workers working in hazardous working conditions led to an increase in urinary excretion of nickel, copper and cobalt, an improvement in oxidative stress indicators: a decrease in malondialdehyde to 4,3 ± 0,06 μmol/l, increase in catalase activity from 417,2 ± 20,6 to 564,2 ± 20,1 μkat/L, superoxide dismutase from 13,7 ± 0,1 up to 15,3 ± 0,08 a.u., ceruloplasmin from 287,4 ± 6,1 to 331,2 ± 8,5 mg/ml. The obtained data, as well as knowledge about the peculiarities of the pathogenesis and course of COVID-19 infection, made it possible to include jelly in the maintenance therapy of patients with this disease. A survey of 283 people who have had a coronavirus infection showed the presence of symptoms of severe intoxication. Nutritional support for a month with detoxification jelly contributed to a significant reduction in symptoms of intoxication: weakness and fatigue, temperature fluctuations, fears, anxiety, suspiciousness, etc. disappeared. The authors recommend longer (at least 3-6 months) nutritional support by specialized detoxification food products for the full recovery of the body and further prevention of the development of post Сovid complications.

Influenza is an acute highly contagious respiratory infection, caused mainly by influenza A, B and C viruses. Influenza is of particular importance among other infectious diseases, due to the high virulence of the pathogen, widespread distribution, and the ability to spread pandemic. However, at the present stage, serious changes are registered in the epidemic process of influenza. The leading in these processes undoubtedly belongs to the ongoing COVID-19 pandemic, as well as to other events directly related to this pandemic. This article highlights the current epidemiological characteristics of influenza infection during the COVID-19 pandemic, and considers the likely reasons for the development of such changes. Mass immunization against influenza, introduced according to WHO recommendations, has demonstrated convincing results: the use of influenza vaccines has reduced the risk of morbidity in healthy populations by 70-90%. Moreover, vaccination of the elderly reduces the number of serious illnesses and complications by 60% and deaths by 80%. This method of fighting influenza is also a priority in Russia.

From 17 to 20 February 2021, the XVII interdisciplinary conference with international participation «Wein's Readings» was held online in Moscow. On February 18, as part of this event, with the support of Materia Medica, a symposium entitled «Therapy as an art: how to cope with patient anxiety» was held with a simultaneous master class on art therapy. The information and physical environment around us causes a significant increase in the incidence of adjustment disorders and a massive increase in the level of anxiety among the population, which became especially noticeable during the COVID-19 pandemic. Anxiety disorders are currently found in 8 out of 10 patients seeking medical attention. Scientific research shows that art and culture is a powerful therapeutic agent that can reduce anxiety and other clinical manifestations of disease. Art therapy is starting to become part of the treatment standard. At the master class, a methodology was presented that includes the latest achievements of nanopharmacology and art therapy for managing anxiety – the most common syndrome in the clinical practice of a doctor of any specialty today.

The problem of nutritional deficiency in patients with neurological diseases, discussed at the Council of Experts within the framework of Wayne Readings in 2021, is considered. The lack of necessary substances in the diet of patients with neurological, oncological, endocrinological and other profiles contributes to the development of complications, and primarily infectious: pneumonia, bedsores, etc. It has been shown that nutritional support is an effective method of recovery in the complex therapy of diseases in patients of all ages. The article provides modern international recommendations for the introduction of nutritional support and the results of studies to assess the use of sipping nutrition.

The aim of the study was to assess the efficacy and tolerability of slow-acting injectable agent for the treatment of osteoarthritis in the treatment of osteoarthritis of large and small joints. The study group consisted of 49 patients (87,8% women, 12,2% men, whose median age – 63,4 [52,3; 75,2] years, the duration of the disease – 5,86 [3,07; 11.4] years, body mass index – 30,06 [23,1; 41,4] kg/m²): 14,6% – with damage to small joints of the hands (group 1), 62,5% with damage to large joints, who received the drug only intramuscularly (group 2) and 22,9% with lesions of large joints, who received the drug intra-articularly and intramuscularly (group 3). During the year, 2 courses of injections were carried out with an interval of 6 months. 3 months follow-up period was held. The results of treatment were assessed by the dynamics of the VAS of pain, AUSCAN and WOMAC indices, patient and doctor satisfaction on a 5-point scale, and the need for non-steroidal anti-inflammatory drugs (NSAIDs). After 1 course of treatment, there was a statistically significant decrease in pain according to VAS in all groups by 45,4-57,7%, in the AUSCAN index – by 49,3%, in the WOMAC index in group 2 – by 44,9%, in group 3 – by 53,2%. About 1/3 of patients refused to take NSAIDs. By the beginning of the 2nd course, these indicators increased, but not to the initial level. After the 2nd course of therapy, further improvement was noted pain according to VAS – by 20,2-30,8%, AUSCAN index – by 28,4%, WOMAC index in group 2 – by 20,5%, in group 3 – by 22 ,9%. After 3 months of follow-up there was a decrease in comparison with the initial indicators: pain according to VAS – by 60,8-64,8%, AUSCAN index – by 34,3%, WOMAC in group 2 – by 51,3%, in group 3 – by 35,4%. The dynamics of joint stiffness was most pronounced. Half of the patients stopped taking NSAIDs. Adverse reactions (dermatitis at the injection site and synovitis after i/a administration of the drug) were detected in 2 patients.