The article describes a clinical case of acute otitis media in an 8-year-old child complicated by mastoiditis, antibodies to SARS-CoV-2 and IgG coronovirus were detected in the child's blood. The data available today indicate that children make up up to 10% in the structure of infected SARS-CoV-2 and up to 2% in the structure of patients with diagnosed clinical cases of COVID-19. In the Russian Federation, children account for 6-7% of the registered cases of COVID-19. At the beginning of the pandemic, it was revealed that children have a lighter course of the disease and complications and unfavorable outcomes are much less common. However, in the following months, clinicians began to note a multiple increase in the frequency of hospitalization of children for COVID-19. The described case shows the rapid development of acute mastoiditis with the destruction of the outer plate of the temporal bone in a child, as a complication of acute otitis media, after a new coronavirus infection. The article presents information on the relevance of epidemiology, clinical picture, diagnosis and treatment of acute otitis media complicated by mastoiditis in children. It should be emphasized that in order to achieve the most effective tactics of introducing patients, close cooperation of doctors of narrow specialties with pediatricians is necessary, mass testing of the child population, further research to obtain reliable data on the impact of a new coronavirus infection on the child's body. Currently, there is insufficient data in the available literature on the effect of COVID-19 on ENT organs in children. In this regard, further studies on ENT diseases in this category of patients are needed on the background of or after a COVID-19 infection.

The vagus nerve is the main component of the autonomic nervous system. According to polyvagal theory, this nerve is considered as two structurally and functionally separate branches, ventral and dorsal. The dorsal branch is found in most vertebrates. It is associated with primary survival strategies in conditions of severe stress, forcing to «play dead in order to survive». The ventral branch is characteristic of mammals and has an inhibitory effect on the sympathetic pathways to the heart and thus promotes calm and prosocial behavior. This branch ensures the functioning of the esophagus, bronchi, larynx and pharynx. We studied the functional state of the ventral branch, considering that it is the one innervating the soft palate muscle and the muscles of the uvula. As a working hypothesis, we assumed that the dysfunctional state of the above muscles is found in functional disadaptation of the ventral branch of the vagus nerve and in the regulatory reflex mechanisms of the nervous system, i.e. in «neurological disorganization». Neurological disorganization was detected in a fifth of those examined. In this group, dysfunctional condition of the uvula and the soft palate was significantly more common than in normal neurological organization. Therefore, we recommend to use the detection of a tilt of the uvula and unilateral sagging of the soft palate at rest and during exercise as a reliable visual indicator for the diagnosis of neurological disorganization. In conditions of normal neurological organization, the most sensitive diagnostic indicator of functional disadaptation of the ventral branch of the vagus nerve is unilateral sagging of the soft palate when makingg the sound «a-a-a». We recommend to use the results obtained to diagnose neurological disorganization and functional disadaptation of the ventral branch of the vagus nerve.

Pneumonia is an acute infectious and inflammatory lung disease of predominantly bacterial etiology, characterized by respiratory failure, toxic and respiratory disorders, local physical symptoms, and infiltrative changes on the roentgenogram. The incidence of community-acquired pneumonia increases in October-December, reaching a maximum in January-April, correlating with the seasonal increase in the level of acute respiratory viral infections. The similarity of the symptoms of the onset of pneumonia with the manifestations of acute respiratory viral infections can lead to its untimely diagnosis and, as a consequence, to a delayed start of treatment. Therefore, during the period of seasonal morbidity with respiratory infections, the alertness of pediatricians in relation to community-acquired pneumonia should increase. Antibiotic therapy has a decisive influence on the prognosis of pneumonia, therefore, with a reliable diagnosis or in a patient in serious condition with a probable diagnosis, it should be started immediately. The choice of antibiotic in each case of community-acquired pneumonia is carried out individually, taking into account the natural activity of the drugs in relation to the alleged pathogen and their possible acquired resistance, the severity and course of the disease, the patient's contraindications to the use of certain antibiotics. The article provides information on the diagnostic criteria for community-acquired pneumonia. The issues of antibacterial treatment of typical non-severe pneumonia in children of different age groups with amoxicillin with clavulanic acid are considered and its effectiveness is shown. The results of the study allow us to conclude that the oral use of one course of protected aminopenicillin is effective in the treatment of typical community-acquired non-severe pneumonia in children of different ages, as evidenced by the elimination of the main clinical manifestations of the disease in a short time.

125 suffering from the middle stage of alcohol dependence patientshave been examined using the «Methods for the Study of Social Intelligence» by J. Guildford and M. Sullivan, adapted by E.S. Mikhailova. 82,4% of them have low indicators of the level of certain abilities development in the social intelligencestructure, which can complicate their social adaptation after treatment. In order to improve social adaptation, a training program aimed at developing the weaknesses of social intelligencehas been developed. The developed program based on a model of group psychotherapy in small groups. The main components of the program were the following: development of the ability to foresee the consequences of one's own behavior and the behavior of other people in a certain situation; to understand non-verbal reactions and the meanings of the same type of verbal reactions of a person; and to understand the logic of the situation of interaction with other peopledepending on the characteristics of the situation. The objectives of the training also included the development of the ability to empathy, decrease in the level of alexithymia, an increase in the level of self-regulation and resistance to social factors that contribute to the breakdown of remission, and relapse of alcohol dependence. The training conducted in a group of 8-12 people and divided on10 sessions of 2-2,5 hours each. Evaluation of the effectiveness of the training was made after its realization in three groups, and the comparison group consisted of alcohol-addicted patients who underwent a two-month program of medical and social rehabilitation. The analysis of the developed training effectiveness program results showed that the level of social intelligence development are comparable to the results of a two-month program of inpatient medical and social rehabilitation, and sometimes they were higher. 

At the modern stage in Russia, we can observe the tendency of increase in recording cases of neurosyphilis against the background of reduction of morbidity rate of syphilitic infection in general. Increase of neurosyphilis morbidity reflects the situation of frequency increase of primary forms of syphilis in the end of the 90s – beginning of the 2000s, when our country faced with epidemic of this disease. Most experts assume that treponema pallidum always penetrates in the nervous system, in some cases its presence being transitory, in other cases, we observe asymptomatic persistence, and in some, neurosyphilis manifests. Currently, most often syphilis therapy takes place on outpatient basis with repository forms ((Benzathine benzylpenicillins) which create long (during several days and up to 18-21 days after one-time administration), but low concentration of penicillin in the body. These drugs badly overcome blood-brain barrier, consequently, if syphilitic meningitis is latent and not diagnosed, liquor sanation is not achieved, and potential development of neurosyphilis manifest forms is retained. The authors describe the difficulties of diagnosis of neurosyphilis and a clinical case of ischemic stroke in a young patient with neurosyphilis. Diagnosis of syphilis was confirmed by laboratory studies; liquor tests and clinical data allowed to diagnose meningovascular syphilis. The authors highlight that special attention should be paid to observance of algorithm of clinical-laboratory examination of patients if they have disorders in functions of central and peripheral nervous systems, organs of vision and hearing, regardless of remoteness of supposed infection and supposed seroresistance. As neurosyphilis is interdisciplinary problem, complex clinical-laboratory and clinical-instrumental examination of patients is required, involving medical specialists of different profiles.

Cleft lip and palate is one of the most common congenital pathologies of the face and ranks 3rd in the structure of all congenital malformations. An isolated form of this pathology occurs in 7,6-41,4% of cases; as part of symptomatic complexes of a cleft lip and palate, 21,1-61,2% are described. Cleft lip and palate may be predictors of EEC syndrome. EEC syndrome (ectodermal dysplasia, ectrodactyly, cleft lip and palate) is a rare, autosomal dominant disorder with high penetrance. During the neonatal period, diagnosis can be difficult, since a number of signs (lack of hair, teeth) are the age norm. The detection of a cleft lip and palate in combination with pathology of the distal extremities, especially at the stage of prenatal diagnosis, can provide significant assistance in the early diagnosis of EEC syndrome. Most often, this defect can be established at a period of 16-30 weeks. Despite this, the diagnosis of EEC syndrome is rarely made, the condition is more often described as «multiple malformations». The article presents clinical cases of the diagnosis of EEC syndrome in 2 children from the same family, describes the phenotypic characteristics of patients. It is emphasized that in the presence of multiple malformations of the cleft lip and palate in combination with the pathology of the distal extremities can be predictors of the EEC syndrome. The authors point out the great importance of early diagnosis of EEC syndrome in drawing up a correct treatment plan based on the pathogenesis of the disease. Treatment of individual clinical manifestations included in the EEC syndrome (cleft lip and palate, dermatitis, adentia, xerostomia, atresia of the lacrimal ducts), without combining them into a single nosological form, can be long, expensive and unsuccessful. The detection of pathology in parents who are carriers of the EEC syndrome allows predicting the birth of children with this syndrome. The method of choice is the use of assisted reproductive technologies.

Psoriasis is one of the most common chronic dermatoses. In recent years, there has been an increase in the number of patients with severe, disabling forms of dermatosis, resistant to the therapy. The disease significantly reduces the quality of life, disrupts patients' ability to work, which defines dermatosis as socially significant and entails the need to improve therapeutic approaches. Psoriatic arthritis, or artopathic psoriasis, is a chronic inflammatory disease of the joints, spine and enthesis, which can be observed in patients with psoriasis. The article presents the main current information about the pathogenesis of psoriasis and psoriatic arthritis with an emphasis on the immunopathological aspects of the development of diseases and the rationality for the use of the proinflammatory cytokine inhibitor interleukin-17 in the therapy. Modern advances in understanding the mechanism of development of psoriasis and psoriatic arthritis served as a rationale for the creation of a group of innovative targeted drugs – genetically engineered biological drugs, the mechanism of action of which is to block certain cytokines, both circulating in the systemic circulation and located in the inflamed tissue of psoriatic plaques or joint. In the article brief information about the results of clinical trials of secukinumab is provided; clinical examples highlight experience of effective treatment of patients with psoriasis and psoriatic arthritis. It has been shown that early cessation of the progression of the inflammatory process in psoriasis through biological therapy with secukinumab leads to a decrease in skin symptoms, a decrease in pain and subclinical inflammation in the joints. The high efficacy and safety of the drug allows complete control of the disease and improve the quality of life in patients.

The leading etiological factor of chronic gastritis is Helicobacter pylori infection. Herpesvirus infection can take part in the development and maintenance of the inflammatory process in the gastric mucosa. A special place among herpesviruses is occupied by the Epstein–Barr virus, 95% of the population is infected with it. The aim was to determine the persistence of the Epstein–Barr virus in the gastric mucosa in patients with chronic Helicobacter pylori-induced gastritis with gastric erosions and to determine the effect on the course of the disease, depending on the therapy. 84 patients with chronic Helicobacter pylori-induced gastritis with gastric erosions were under observation. The Epstein–Barr virus was detected in the gastric mucosa in all patients at the initial treatment except for Helicobacter pylori. The duration of the disease was from 1 to 10 years. Depending on the treatment of chronic Helicobacter pylori-induced gastritis with gastric erosions, patients were divided into 2 groups, between them, 1 year after the initial treatment, the frequency of occurrence of Epstein–Barr virus in the gastric mucosa was compared. The detection of Helicobacter pylori was carried out by three methods: respiratoryurease test, cytological examination of smears and the method of polymerase chain reaction of the biopsy. In patients with chronic Helicobacter pylori-induced gastritis with gastric erosions, when detecting a herpesvirus infection in the gastric mucosa, the use of meglumine acridonacetate in four-component eradication therapy can significantly reduce the number of Epstein–Barr viruses. A comparative assessment of the data obtained on the presence of Helicobacter pylori in the gastric mucosa in patients of two observation groups indicates a good level of eradication therapy: in the 1st observation group, eradication was 91,3%, and in the 2nd observation group – 89,5%. Mixed infection (Helicobacter pylori and Epstein–Barr virus) in the gastric mucosa is a factor that complicates the treatment process of patients.

The purpose of the study was to identify the problems of diagnosis, interdisciplinary interaction and the causes of defects in the treatment of patients with osteoarthritis on an outpatient basis, as well as to assess the efficacy and safety of using the medicine from bioactive concentrate of small marine fish, in routine clinical practice in patients with knee osteoarthritis. The results of an out-patient reception hours with a rheumatologist and case histories of 2312 patients with a referral diagnosis of osteoarthritis of various localization were analyzed. It turned out that 47% of all referrals to a rheumatologist with a referral diagnosis of osteoarthritis can be regarded as unfounded. It was found that 45% of patients, even with an established reliable diagnosis of osteoarthritis, on an out-patient basis, therapy was not prescribed in full and did not comply with the recommendations for the management of this category of patients. After 2 courses (within a year) of treatment with a drug based on a bioactive concentrate of small marine fish, 67% of patients with osteoarthritis of the knee joints were satisfied with the effect of therapy, noting a decrease in pain intensity, an improvement in knee joint function and quality of life. No adverse events were reported in the observation group. Despite the fact that at present the problem of osteoarthritis is well covered, in real clinical practice at the stage of primary care physicians often face difficulties in solving both diagnostic and therapeutic problems. In this regard, there is an urgent need to revise and adapt to the routine outpatient practice of interdisciplinary algorithms for managing patients with osteoarthritis, with the determination of the intervention threshold of a primary care physician and a specialist physician. However, there is a need to develop and introduce into routine clinical practice optimized scales/ questionnaires for dynamic assessment of the quality of life of patients with knee osteoarthritis. The study demonstrates a fairly high efficacy, safety and availability of a drug based on a bioactive concentrate of small marine fish, and treatment with this drug can be widely used in the complex therapy of osteoarthritis of the knee joints.

Dizziness is one of the most frequent causes of appliance to neurologist. The occurrence of dizziness increases in elder groups. The first goal of a neurologist is the differentiation between central and peripherial vertigo. It is necessary for second stage to make detalized differential diagnosis. To realize this purpose doctor should carry out neurovestibular investigation, including HINT test, shaking-test,test Fukuda and mandatory performing of positional tests. The further management includes adequate vertigolytic therapy, treatment of the basic disease and creation of a rehabilitation scheme, which includes both vestibular gymnastics and other non-drug methods (biofeedback, exercises on a stabiloplatform), and drugs that improve vestibular compensation. Peripheral vertigo is much more common than central vertigo and is the most common cause spinning vertigo is a benign paroxysmal positional vertigo. According to various estimates, up to 85% of benign paroxysmal positional vertigo cases have idiopathic origin, frequency of relapse is about 50%. The article presents a clinical case of recurrent benign paroxysmal positional vertigo with multiple canal involvement. A feature of this case is its combination with a vitamin D deficiency. Today, data have been accumulated indicating that vitamin D deficiency and insufficency is not just a comorbid condition often detected in patients with benign paroxysmal positional vertigo, but, most likely, is a factor in the development and recurrence of benign paroxysmal positional vertigo. However, the data are rather contradictory and require further investigation. Identifying and correcting of metabolic factors will optimize therapy.

The annual Congress of ESPEN (The European Society for Clinical Nutrition and Metabolism) was held from September 9 to 14. The Congress was organized by the European Association for Clinical Nutrition and Metabolism. In connection with the COVID-19 pandemic, this main international forum of nutritionists has been held online for the second year. There were traditionally discussed issues related to the role of metabolic processes in the development and course of various diseases, as well as the significance of targeted nutritional support in the complex therapy of the patient at different stages of treatment and rehabilitation. The data of clinical studies presented at the Congress indicate that patients with COVID-19, in comparison with patients with a >non-covid? profile, need more active nutritional therapy, which, in particular, is carried out with the help of specialized products – ready-to-use mixtures for dietary therapeutic and preventive nutrition.