The human immunodeficiency virus (HIV) is a globally spreading virus that represents one of the most serious social and health problems. The epidemic situation of HIV (human immunodeficiency virus) infection in the world and, in particular, in the Russian Federation remains tense. In HIV-positive patients, specific lesions of the skin and mucous membranes are often noted. Skin processes in HIV-positive patients are usually atypical, have a torpid course, may occur in unusual age groups and are extremely difficult to respond to standard treatment. Lesions of the skin and mucous membranes in HIV-infected can be divided into several groups: allergic reactions, infectious, paraneoplastic processes and dermatoses with unknown pathogenesis. In the modern literature, the issue of the group of «dermatoses with an unclear pathogenesis» against the background of HIV infection, in particular about prurigo, is insufficiently illuminated. In the described clinical case, an HIV-positive patient with a rare manifestation of nodular prurigo is presented. The history of the issue, etiology, clinical manifestations, and treatment methods are covered. The presented case illustrates the manifestation of prurigo against the background of systemic causes (HIV infection) and initiation of highly active antiretroviral therapy without a previous atopic history. Contrary to the literature data, the CD4+ count in a patient with prurigo was more than 200 cells/μL, although pruritus is known to be a dermatoses with a low CD4+ cell count. The role of the immunodeficiency state in the pathogenesis of prurigo remains unclear. Perhaps, in this case, the development of dermatosis is provoked by a direct viral effect or the toxic effect of antiretroviral drugs. An interesting fact is the rapid positive response of the skin process to traditional therapy.

Psoriasis is one of the most common chronic dermatoses. About 125 million patients with this disease are registered in the world, and the frequency of occurrence in the structure of dermatological diseases is about 40%. Despite the fact that in most cases psoriasis does not pose a threat to life, but, nevertheless, it is the direct cause of the appearance of very serious pathological problems, social maladjustment. Recently, an increasing number of researchers speak of psoriasis not as an isolated skin disease, but as a systemic 8psoriatic disease9 with dominant skin manifestations. The 8systemic nature9 of the disease is manifested in the frequent involvement in the process of not only the skin, but also other systems and organs, in particular, the musculoskeletal system in the arthropathic form of psoriasis (psoriatic arthritis). The prevalence of psoriatic arthritis in patients with psoriasis ranges from 7 to 47%, and in 15% of patients arthritis develops before skin lesions, with ordinary psoriasis, arthritis occurs in 6-7% of cases, and with already identified psoriatic arthropathy in 73,2%, pustular or exudative psoriasis, as well as psoriatic erythroderma. The article presents the results of the use of methotrexate in the form of subcutaneous injections in clinical practice in the treatment of patients with moderate and severe psoriasis, in comparison with a similar scheme of using intramuscular injections of methotrexate. The course of methotrexate therapy has been shown to be highly effective in the treatment of psoriasis and psoriatic arthritis. The data on higher safety, a more significant positive effect on the quality of life, better toler ability and longer remission of the process achieved in a group of patients receiving subcutaneous injections of methotrexate are presented.

The article covers information about keratodermia, a heterogeneous group of conditions characterized by abnormal thickening of the skin of the palms and soles. Traditionally, acquired and hereditary forms are distinguished. In clinical practice, the most common hyperkeratosis of the palms and soles, as one of the manifestations of psoriasis, eczema, dermatomycosis and many other diseases. Mechanical and toxic factors (including taking medications), intake of toxic substances with food that lead to changes in the intestinal mucosa can also lead to the development of hyperkeratosis of the palms and soles, modern fashion and beauty requirements can contribute to the development of multiple vitamin deficiencies. Much less common are hereditary forms of keratoderma, which are independent diseases. Early onset, the presence of a positive family history suggest a genetic nature. The distinctive features of hereditary forms are the nature of inheritance, the degree of damage to the epidermis, the presence/absence of the spread of foci beyond the skin of the palms and soles, and concomitant pathology. The development of hereditary forms is based on mutations of various genes encoding proteins (for example, keratin, desmosomes, loricrin, cathepsin C, gap junction proteins), which are involved in the process of keratinization. Hereditary palmoplantar keratoderma has a large genetic and phenotypic heterogeneity, as a result of which making an accurate diagnosis based on clinical manifestations alone, when it is not possible to perform molecular genetic research, is a very difficult task. Thanks to the next-generation sequencing, significant progress has been made in deciphering the genetic basis of keratoderms. This review examines the pathogenetic, clinical, and diagnostic features of diffuse forms of keratoderma, and options for symptomatic therapy, taking into account the torpidity and resistance of the pathological process.

Improving the quality of care for patients with the new coronavirus infection COVID-19 is possible only on the basis of a multidisciplinary approach. Evaluation of nutritional status and, if necessary, its correction are an important component of comprehensive treatment and rehabilitation programs for such patients. A significant number of patients with COVID-19 are elderly and senile people who already have signs of nutritional deficiency. Eating disorders and accompanying sarcopenia are risk factors for the adverse course of COVID-19. The progression of sarcopenia in COVID-19 is explained by the occurrence of viral myositis, myopathy provoked by cytokines, and immobilization. Decreased muscle mass is associated with poor disease prognosis and reduced quality of life. Correction of nutritional disorders in patients with COVID-19 should be carried out at all stages of treatment. The importance of the problem of nutritional support is reflected in many publications devoted to the treatment of patients with COVID-19. It should be noted that the European Society for Clinical Nutrition and Metabolism (ESPEN) promptly issued recommendations on nutritional support for patients with new coronavirus infection, which once again emphasizes the urgency of the problem. This was a logical continuation of the recommendations for correcting the nutritional status of patients undergoing treatment in the intensive care unit. Similar clinical guidelines have been developed in the UK, Brazil and a number of other countries. The use of drugs for oral supplementary nutrition in most cases allows to meet the needs of patients for the necessary nutrients, to reduce the severity of sarcopenia and to increase the effectiveness of rehabilitation measures.

The most frequent forms of lower respiratory tract infections in practice of the doctor are the acute bronchitis and communityacquired pneumonia. The doctor should make the decision on tactics of maintaining such patients taking into account a clinical picture and results of inspection. Community-acquired pneumonia is a common and potentially life-threatening respiratory disease. The severity of the problem is that during periods of influenza epidemics or other respiratory viral infections, when Streptococcus pneumoniae is activated, there is an increase in the incidence of community-acquired pneumonia. However, recent years have shown that the etiology of pneumonia has expanded significantly, and among the causes of community-acquired pneumonia, in addition to bacteria, pneumotropic viruses began to occupy an important place (new coronavirus SARS-CoV-2, MERS, influenza A viruses, including pandemic H1N1, avian influenza, bocaviruses, metapneumoviruses, etc.). The association of bacteria and viruses makes the disease worse. In the world, 5-8 people per 1,000 adults suffer from pneumonia annually, in Europe – 2-15. In Russia, cases of community-acquired pneumonia in adults exceed 1,5 million per year. In 2020, Russia registered a significant increase in the incidence of community-acquired pneumonia – 3,6 times (1856,18 per 100 thousand population), including viral pneumonia – 109 times (783,08 per 100 thousand population) due to the spread of the new coronavirus SARS-CoV-2. Approaches to diagnostics and medicamentous therapy of bronchitis and communityacquired pneumonia are considered. Clinical performance of the treatment including intake of amoxicillin is estimated, results allow to recommend amoxicillin for use in out-patient practice.

The purpose of this work was a retrospective analysis of the incidence of toxocars in the population of the Astrakhan region for 2012-2019. 48 epidemiological maps of persons infected with toxocars were analyzed. The clinical diagnosis of «Toxocarosis» was confirmed by clinical examination data, patient complaints, collected epidemiological history, and data from the enzyme immunoassay method using test systems to detect antibodies to toxocar class G antigens. Cases of toxocarosis were observed in persons aged 3 to 75 years, of which children accounted for 18,8% (n = 9). An epidemiological history was collected, as a result of which it was found that most of the infected – 91,7% (n = 44) did not follow the rules of personal hygiene (this category of patients had such bad habits as: eating dirty unwashed fruits and vegetables – 89,6% (n = 43), unwashed dirty hands before eating – 16,7% (n = 8), contact with non – dehelminthized animals – 58,4% (n = 28): dogs – 43,8% (n = 21), including domestic – 90,5% (n = 19), cats – 14,6% (n = 7), including domestic-85,7% (n = 6). The tendency to geophagy (the habit of eating the soil) was observed in 68,8% (n = 33) of the infected. And the habit of biting the nails on the hands and feet (onychophagia) was observed in 18,8% (n = 9) of children. After the final diagnosis, all patients underwent a course of chemotherapy with albandazole. Thus, the high infection rates of people who lived in the Leninsky and Trusovsky districts of Astrakhan are associated with the fact that these areas are densely populated with a large number of private sector, in which there are domestic animals (cats and dogs). Presumably, one of the main causes of human infection with toxocars was not following the rules of personal hygiene, eating poorly washed fruits and vegetables, contact with animals and geophagy. The presence of a titer of antibodies to toxocar antigens above a dilution of 1: 800 indicates the presence of the disease ZVisceral toxocarosis\ in the examined person.

The article describes the clinical observation of Kaposi sarcoma associated with HIV in a patient with disseminated pulmonary tuberculosis, viral hepatitis B and C. Kaposi sarcoma is a multifocal systemic tumor of endothelial origin with characteristic pathohistological signs associated with the human herpes virus type 8 (HHV-8). There are 4 clinical variants of Kaposi sarcoma: classical, endemic, epidemic, AIDS-associated, and immunosuppressive. The Kaposi sarcoma variant in HIV infection is characterized by rapid progression of the pathological process and multifocal dissemination. Clinical observation. Patient S., 41 years old, was admitted to the Surgut clinical tuberculosis dispensary with complaints of rashes on the skin of the entire body. The first elements of the rash appeared about two months ago. Objectively: the pathological skin process was widespread. Numerous bluish-red spots from 2 to 5 cm in diameter with a smooth surface, lenticular and numular papules, nodes up to 3 cm in diameter of a reddish-brown color with a purple hue, dense elastic consistency were diffusely localized on the skin of the face, trunk, and limbs. The diagnosis of Kaposi sarcoma associated with HIV was made based on clinical and anamnestic data and the results of additional research methods. Specific anti-tuberculosis and antiviral therapies were used in the treatment. Despite the treatment, the patient died as a result of decompensation of the main process. The described observation illustrates the complexity of managing patients with combined infectious pathology. Taking into account immunosuppression, disseminated pulmonary tuberculosis, the appointment of systemic cytotoxic therapy is difficult due to the risk of progression of Mycobacterium infection. The complexity of managing patients with Kaposi's epidemic sarcoma is also due to the high probability of multi-organ lesions and the high potential for dissemination of the process.

The emergence of a new variant of the virus and the epidemic potential manifested by the causative agent of COVID-19 have set health professionals tasks related to the rapid development of diagnostics and prevention of a new infection, as well as tactics for providing medical care to patients. The active spread of coronavirus infection has forced active changes to the system of medical education. The goal is to analyze the epidemiological situation of COVID-19 in the Republic of Mordovia in order to understand the development of the epidemic process and make a forecast, consideration of the restructuring of the educational process in the context of a pandemic. In this article, a retrospective analysis of the epidemiological situation on the incidence of COVID-19 in the Republic of Mordovia is carried out, the effectiveness of the implementation of preventive and anti-epidemic measures is analyzed, data on the dynamics of morbidity, recovery and mortality of patients are presented. The elements of the restructuring of the educational process are studied. The epidemiological ituation was analyzed in comparison with some regions of the Russian Federation, data on vaccination, on the dynamics of the bed fund during the pandemic period were studied. The probability of death from the COVID-19 coronavirus in the Republic of Mordovia is similar to the indicators around the world. It can be assumed that distance learning will take one of the leading positions in the process of studying in higher education. A favorable situation in the Republic of Mordovia with morbidity and mortality from a new coronavirus infection was formed positive to the implementation of a scientifically grounded strategy of proactive response – based on a constant assessment of the scale of the spread of a new coronavirus infection, analysis of trends in the epidemic process, modeling the development of the epidemic situation and ongoing preventive measures. The direct participation of university teachers in medical work, the use of their experience and knowledge in solving practical problems will contribute to improving the quality of medical care and the development of the healthcare system of the Republic of Mordovia not only in the conditions of the COVID-19 pandemic, but also in the future.

Intestinal microbiota is a complex ecosystem of the community of enteric microorganisms and is estimated as an individual metabolic organ. Bifidobacteria and Lactobacilli are the predominant microbes in a colon of healthy infants, they are able to suppress a growth of pathogenic and conditionally pathogenic microorganisms and support a development of immune system. Over the past 10 years, research in the field of molecular biology and genome structure of Bifidobacterium and Lactobacillus has focused on such problems as interaction with the immune system and the prospects for their use in antibiotic-associated diarrhea and diarrhea in pediatric practice, as well as in irritable bowel syndrome and inflammatory bowel disease. In recent years, a number of clinical studies have been carried out on the use of probiotics for the treatment and prevention of diarrhea in children, and several detailed analytical meta-analyzes have been prepared, which give a fairly complete picture of the possibilities of using monocomponent and combined probiotic drugs. Important facts have been obtained in favor of the fact that certain strains of Lactobacilli and Bifidobacteria are immunomodulators and are able to influence immune regulation by affecting the balance between pro-inflammatory and anti-inflammatory cytokines. Another mechanism of action of probiotic drugs is their effect on dopamine and serotonin receptors, due to which a positive effect of probiotics has been established in patients under stress and in depression. The article shows that combined probiotic remedies are characterized by synergic action and have an antibacterial effect and immune modulation. Combined probiotics are characterized by synergic activity and support a development of immune system. Due to these properties they have a clinically proven effect in diarrhea and disbiosis in infants.

The article presents an analysis of information from literary sources devoted to the study of the chronopharmacology of alcoholism. For the treatment of alcoholism, an integrated approach is used, which is determined by the severity of the patient's condition and the individual characteristics of the symptoms. Due to the ability of pharmacological compounds to interfere during rhythmic processes at all levels of the organization of the biosystem, the chronopharmacological effect of drugs may be useful or undesirable. Chronic alcohol intoxication is characterized by a high degree of complications from the cardiovascular, nervous systems, liver and gastrointestinal tract. A reliable means of pathogenetic pharmacotherapy of alcoholism has not yet been developed. At the same time, medications are used mainly for the relief of withdrawal symptoms. One of the first places in the treatment of alcohol withdrawal syndrome, accompanied by anxiety, fear and anxiety, is occupied by depressants. However, the expansion of their use in the Russian Federation for the treatment of alcoholism remains unfounded. Since alcoholism causes extremely diverse mental disorders in their clinical manifestations and severity, a wide range of psychotropic drugs is used for their treatment. For antihypoxic and detoxifying therapy, energy-correcting agents are also used. Alcohol withdrawal syndrome with a predominance of neurosis-like and vegetative-vascular disorders is an indication for the use of drugs from the class of antioxidants. They combine the properties of tranquilizers and nootropics, without having a toxic effect on the heart and protecting the myocardium in hypoxia. However, at the moment there is a lack of information about the effectiveness of their use in alcohol withdrawal.

Pathology of the musculoskeletal system and osteoarthritis, in particular, remain a frequent reason for seeking outpatient care. Among the various joints, the knee joint is considered the most affected - it accounts for up to 25% of all lesions of the musculoskeletal system, which is associated with its supporting function and frequent traumatic injury. The growing popularity of outdoor activities, the development of playing and extreme sports leads to an increase in the frequency of injuries of the knee joint, ligamentous apparatus, as well as intra-articular injuries. It is traumatization that is recognized as one of the leading causes of subsequent osteoarthritis. The article offers brief algorithms for the diagnosis and treatment of osteoarthritis for use at the outpatient stage of medical care. Attention is paid to the use of hyaluronic acid preparations, an analysis of the literature data is carried out, the prospects for the use of such therapy in a complex of therapeutic measures are assessed. Hyaluronic acid is a natural component of synovial fluid that serves as a lubricant for articular surfaces and provides a range of protective and regulatory effects. Hyaluronic acid introduced from the outside takes on the load, replenishing the missing functions of the synovial fluid, which allows us to consider such use as prosthetics of insufficient joint function. Hyaluronic acid preparations are a fast-acting local remedy to improve the function of the affected joint and relieve pain, which is important to keep patients active. These effects are due to the rheological features of hyaluronic acid, which not only improve lubricating properties and sliding in the affected joint, but also protect the articular cartilage from shock loads. The industrially obtained hyaluronic xylote has been successfully used in the treatment of osteoarthritis for more than 30 years.

This study examined the effect of clinical factors and antithrombotic therapy on the blood coagulation system of patients in the perioperative period. The study included 80 patients who underwent elective noncardiac surgery. Laboratory control of hemostasis was carried out using routine tests for studying hemostasis (APTT, INR) and a global test for hemostasis (thrombodynamics test). Usage of the thrombodynamics test in this study was more sensitive compared to routine tests and made it possible to identify clinical factors associated with hypercoagulable states and «decreasing in the effectiveness» of low molecular weight heparins in the postoperative period. These factors are: age over 60 years, chronic ischemic heart disease, a history of coronary artery stenting, prior antithrombotic therapy before surgery. Hypercoagulability was found on the first day after surgery in patients with deep vein thrombosis of the lower extremities compared to other patients. The use of a thrombodynamics test a day before surgery allowed to predict an increase of intraoperative blood loss volume. Perioperative bridge therapy with low molecular weight heparins in high thrombotic risk patients was significantly associated with an increase in packed red blood cells transfusion of almost two times compared with other patients and is associated with an increased risk of hemorrhagic complications. The results of the study showed that thrombodynamics test can potentially be used further with the aim of personalizing patients’ management in the non-cardiac surgery perioperative period. It also helps to predict the occurrence of hemorrhagic and thrombotic complications.