In 2016, experts from the Society Critical Care Medicine and the European Society Intensive Care Medicine proposed a new terminology and definitions of sepsis ‒ «The Third International Consensus on the Definition of Sepsis and Septic Shock (Sepsis-3)». Based on the new concept, sepsis should be considered as a life-threatening acute organ dysfunction resulting from dysregulation of the response of a macroorganism to infection, which is manifested by damage to its own tissues and organs. In this case, the diagnostic criteria for sepsis are suspected or documented infection in combination with acute organ dysfunction, the development of which is concluded by the SOFA index by 2 points or more from the baseline value. In the context of a new concept of sepsis for assessing organ dysfunction in pediatric patients, including newborns, the age-adapted pSOFA (pediatric SOFA) scale was proposed. Purpose of the study: to evaluate the diagnostic possibilities of using the pSOFA rating scale in sepsis in newborns. To achieve this goal, the patients of the intensive care unit and intensive care unit for newborns were examined. Study design ‒ prospective, observational, single-center study. Inclusion criteria ‒ newborns with a presumptive or established clinical diagnosis of «sepsis» in combination with progressive organ dysfunction. A total of 18 newborns with neonatal sepsis were under observation. The gestational age of the patients was 30,7 ± 4,5 weeks, the body weight at birth was 1310 ± 678 g. Early neonatal sepsis was recorded in 11,1% of cases, late neonatal ‒ in 88,9%. Of the leading foci of infection in patients, the following were most often recorded: pneumonia (77,7%), necrotizing enterocolitis (66,1%) and meningoencephalitis (22,2%). A statistically significant difference in the pSOFA diagnostic score was determined in patients with sepsis upon admission to the ICU and in the dynamics of the disease with an increase in organ dysfunction (two-stage measurement). There was an increase in the total score of the diagnostic assessment on the pSOFA scale with an increase in organ dysfunction in patients with sepsis in comparison with the total score on admission (p < 0,05). These data indicate that an increase in organ dysfunction in newborns with suspected or documented infection by 2 points or more than the baseline (baseline) value on the pSOFA scale makes it possible to diagnose sepsis. The mean value of the total score with the increase in organ dysfunction on the pSOFA scale did not differ statistically in surviving patients with sepsis and in those who died. For the diagnosis of sepsis in newborns, it is advisable to use the pSOFA scale.

In the absence of effective treatment for COVID- 19, various drugs were empirically used. Contradictory literature data, from adherents to complete denial of the use of vitamins D and C in COVID-19, prompted us to analyze the literature data and express our opinion on this issue. In our country and abroad, many medical centers include vitamins D and C in the therapy of a new coronavirus infection. Almost all organs and systems of our body have receptors for vitamin D. This fact indicates the active participation of vitamin D in protecting against infection, allergies, and prolonging human life. People with vitamin D deficiency are more likely to have respiratory infections, anemia, muscle hypotension, and bone fragility. The use of vitamin D in coronavirus infection is effective with daily intake of physiological doses of vitamin D. Compensation for vitamin D deficiency is important for the activation of interferon-dependent antiviral immunity, and for the prevention of «cytokine storm», normalization of the coagulation system, and for the reduction of chronic inflammation in the presence of concomitant chronic pathologies in the patient. Even the transition from a severe deficiency of vitamin D (25(OH)D < 20 ng/ml) to a moderate deficiency of 25(OH)D (a metabolite of vitamin D, which is used to judge its supply of the body) in the range of 20-30 ng/ml, in Reduces the risk of admission of a patient with pneumonia to the intensive care unit by 3 times and the risk of transfer to mechanical ventilation by 11 times. The use of vitamin C in coronavirus infection is effective by compensating for its existing deficiency and by interacting with other vitamins. An effective way to maintain the level of vitamins D and C in the population is to fortify these vitamins and other nutrients in foods of mass consumption, as well as to take vitamins in other forms. Multivitamins produced in Western countries are mainly designed for people living in these territories, taking into account the common method of fortifying food. For our country, the norms of consumption of vitamins have been substantiated, confirmed by massive studies of the population of different regions.

A change in the nutritional status both towards a lack of mass and towards an excess is a factor in the unfavorable course and outcomes of acute infectious diseases. Protein-energy deficiency affects the immune response, altering the body's defense processes. Several studies have shown that the relationship between infection and malnutrition is bi-directional. Obesity also impairs the immune response. An important aspect of the development of nutritional status disorders in patients with acute infectious diseases is the combined lesion of the respiratory and gastrointestinal tract organs. We carried out a study of body composition by bioimpedansometry in 12 children in the febrile period of acute respiratory infection of bacterial etiology (hospitalized with community-acquired pneumonia), as well as in 16 clinically healthy children from 4 to 11 years old. Body fat mass, active cell mass and child's weight were assessed. In conventionally healthy children, ACM and иody fat mass corresponded to the norm. In children with pneumonia, upon admission to the hospital, a decrease in active cell mass was observed in more than 80% of cases, active cell mass by the time of discharge was normal in half of the examined patients. Clinical examples of changes in the nutritional status established on the basis of bioimpedansomerism in children hospitalized with community-acquired pneumonia are described. Thus, for the first time, we conducted a pilot study of body composition in children with acute respiratory diseases of bacterial etiology, which demonstrated the greatest severity of changes in protein metabolism. On the basis of this, a correction of protein deficiency has been proposed by adding a dry product of preventive dietary food for children 1-10 years old to the children's diet.

Cytomegalovirus infection is an infectious disease caused by the highly common herpes virus type 5, characterized by polytropic lesions of organs and systems, complex immunological reactions on the part of the macroorganism, with the formation of a long, often lifelong persistence of the virus in the body. Currently, there is an increase in the incidence of cytomegalovirus infection in all countries of the world. According to epidemiological data, most people become infected with cytomegalovirus during their lives. Thus, in Europe and the United States, 40-60% of the adult population is seropositive for cytomegalovirus; in developing countries, the prevalence of cytomegalovirus infection is even higher – 80% of children and almost the entire adult population. Among pregnant women, specific antibodies to cytomegalovirus are determined from 40% in developed to 100% in developing countries. The frequency of intrauterine transmission of cytomegalovirus ranges from 0,2-2,2%, averaging 1% in the population. The variety of clinical forms, from a subclinical course to the development of severe life-threatening forms in special, immunocompromised groups of patients, makes cytomegalovirus infection a complex and urgent problem of modern medicine. One of the main «target organs» for cytomegalovirus is the hepatobiliary system. A small number of observations, limited data on the pathogenesis of the development of liver damage in cytomegalovirus infection in children, as well as the lack of uniform regulatory documents for the diagnosis and treatment of these conditions in pediatric practice served as the basis for writing this article. The paper provides relevant data on the pathogenesis, clinical picture, diagnosis, as well as approaches to the treatment of cytomegalovirus hepatitis in children.

In some cases, with acute respiratory infection of viral etiology, children may develop bacterial complications (acute purulent otitis media, acute bacterial sinusitis), which determines the need to prescribe antibiotics as etiotropic drugs. In addition, the mandatory need for the appointment of antibiotics for streptococcal tonsillitis/pharyngitis has been established. However, the analysis of the frequency of antibiotic use in children with acute respiratory infection indicates that the use of antibiotics still often remains unreasonable and stereotyped and is not limited to the indicated nosological forms, which leads to a significant acceleration in the development of antibiotic resistance of pathogens. Given the rapid and widespread formation of bacterial resistance to antibiotics, their rational use is one of the most urgent problems of modern healthcare. At the same time, one of the effective tools for introducing the principles of rational antibiotic therapy into domestic medical practice will be the mandatory use of clinical guidelines approved by the Ministry of Health of the Russian Federation from January 1, 2022.The article presents the principles of antibacterial therapy for such infectious and inflammatory diseases of the upper respiratory tract as acute streptococcal tonsillitis and acute streptococcal pharyngitis, as well as acute sinusitis, acute purulent otitis media and acute otitis media in children. The need for antibiotic therapy in acute tonsillitis/pharyngitis of streptococcal etiology is due to the high risk of complications in the acute period of the disease (peritonsillar and retropharyngeal abscess, purulent cervical lymphadenitis), as well as such streptococcal-associated diseases in the future, such as rheumatism and glomerulonephritis. The introduction into practice of the main provisions of the presented clinical recommendations will make it possible to promptly make an adequate decision on the need to prescribe antibiotic therapy and on the choice of a rational starting etiotropic therapy for these nosological forms of acute upper respiratory tract infections.

The aim was to evaluate the effect of different types of therapy on kidney tubulointerstitial tissue in patients with ankylosing spondylitis by measuring the urinary excretion level of trefoil factor 3 (TFF-3). Urine samples of 50 patients (male/female = 37/13) aged 18 years and older with a confirmed diagnosis of ankylosing spondylitis and no comorbid pathology were investigated. The median age was 39 [34; 56] years, serum creatinine was 69 [60; 80] mmol/l, glomerular filtration rate was 105 [83; 119] ml/min/1,73 m², albuminuria was 4,8 [2,6; 7,2] mg/g. 52% of patients received non-steroidal antiinflammatory drugs, 12% – disease-modifying anti-rheumatic drug, 36% – biologic medication. The TFF-3 level was measured using enzyme immunoassay. Obtained results were normalised to urinary creatinine concentration. The glomerular filtration rate was calculated using the CKD-EPI (Chronic Kidney Desease Epidemiology Collaboration) equation. The results were compared to a gender and age matched controls. The level of TFF-3 in patients with AS was higher than in the control group, the medians were 52.9 [15,9; 105,7] and 23.3 [1,9; 62,9] ng/mmol respectively (p = 0,02). The TFF-3 excretion during non-steroidal antiinflammatory drugs therapy reliably differed from disease-modifying anti-rheumatic drug, biologic medication and controls: the medians were 88,8 [30,5; 127,4], 8,4 [1,6; 16,1], 33,1 [20,6; 87,1], 23,3 [1,9; 62,9] ng/mmol, respectively (p = 0,01). TFF-3 levels did not correlate with glomerular filtration rate and albuminuria. The risk of tubulointerstitial damage with non-steroidal antiinflammatory drug therapy is higher compared with disease-modifying anti-rheumatic drug and biologic medication. Determining the TFF-3 urinary excretion level may improve diagnosis of renal tubulointerstitial alteration.

In the general structure of kidney pathology, urolithiasis is the second most common after inflammatory diseases. Urolithiasis in the clinic is usually manifested by symptoms caused by a violation of the passage of urine through the urinary tract. The classic manifestation of urolithiasis is renal colic – a sudden attack of severe pain in the lumbar region, caused by impaired outflow of urine from the kidney. Rarely enough, urolithiasis manifests itself as urinary disorders, up to acute urinary retention, which are caused by the migration of calculus into the urethra. This article provides a clinical example of a nonclassical manifestation of urolithiasis in a patient who was admitted primarily with complaints of frequent urination, a feeling of incomplete emptying of the bladder, episodes of hematuria, which, after further examination, led to an inaccurate diagnosis and discharge of the patient for outpatient treatment. After 4 days, the patient developed a clinical picture of acute urinary retention, accompanied by pain and fever. Diagnosed with acute obstructive pyelonephritis, urolithiasis, stone of the membranous urethra, acute urinary retention. On the background of cystostomy drainage, the standard treatment of pyelonephritis was carried out, followed by optical contact lithotripsy of the urethral stone. Thus, it is important to carefully carry out a differential diagnosis in patients with symptoms of the lower urinary tract, to remember their nonspecific nature and about rare cases, which, among other things, may be caused by the migration of calculus into the urethra. Prolonged disturbance of the outflow of urine through the urinary tract can cause the development of an inflammatory process in the kidneys, irreversible loss of their functional ability and even death of the patient. For this reason, it is important to carefully carry out a differential diagnosis in patients with symptoms of the lower urinary tract, to remember their nonspecific nature and rare cases, which, among other things, may be caused by the migration of calculus into the urethra.

The defeat of the kidneys during obesity is a complex multifactor process, which is a whole cascade of mechanisms. A special role in this chain is given to leptin a hormone fatty tissue. The role of this hormone as a biomarker damage to the kidneys in obese patients was our scientific interest. A clinical study of 110 patients treated in the outpatient department of the Central Consultative and Diagnostic Polyclinic No. 1 of Tashkent city was conducted, divided into 2 groups: group I (n = 55) – patients with obesity and chronic kidney disease; group II (n = 55) – patients with obesity without chronic kidney disease.The control group included practically healthy volunteers from among patients and hospital staff belonging to that age group who do not have hypertension and abdominal obesity.The paper presents data on the evaluation of the functional state of the kidneys in the analyzed groups, the role of leptin in the progression of renal dysfunction in obese patients is determined. It was noted that in obese patients, there are more pronounced functional changes in the kidneys (microalbuminuria, increased leptin levels, decreased glomerular filtration rate). The study found that in patients with obesity that do not have routine clinical laboratory data for renal damage, microalbuminuria is detected in the 1st obesity group with chronic kidney disease 41,7 ± 1,68 mg/l, and in the control group 15,3 ± 0,85 mg/l. Based on the data obtained, the calculation of the glomerular filtration rate according to the chronic kidney disease EPI 2011 formula. (ml/min/1,73 m2) in obesity patients are preferable, since the detection of kidney lesion is greater in patients requiring a special examination, correction of therapy and dynamic observation.It has been shown that microalbuminuria and leptin are among the early markers of kidney damage in obesity. The levels of leptin, plasma insulin and microalbuminuria are significantly higher in obese patients.In patients with obesity in combination with nephropathy, significant correlations between the level of leptin, microalbuminuria and lipid and carbohydrate metabolism were revealed. Application in the clinical practice of determining the level of carbohydrate, lipid exchange indicators, insulin resistance index and serum leptin is a perspective for diagnosing a renal lesion during obesity.

The article notes the up-to-date problem of adequate chronic pain relief in patients with various diseases, indicates the concept’s weakness of using opioids as the main means for moderate to severe chronic pain control proposed by the WHO in 1986, emphasizes the importance of their use only as an adjunct to rational pathogenetic pain therapy – as a multimodal analgesia component – in both cancer and non-cancer patients. It gives the information on the possibility and features of narcotic analgesics minimal dosages use for moderate pain control. The innovative pharmacological class of drugs with a dual mechanism of action representative, an agonist of μ-opioid receptors and a norepinephrine reuptake inhibitor, tapentadol, is characterized. The mechanism of its action, advantages, efficacy and safety, place and features of its use in clinical practice are analyzed. In the department of palliative care of one of the city clinical hospitals in Nizhny Novgorod, long-acting tapentadol has been used since 2018. Over the past two years, more than 70% of patients suffering from chronic pain syndrome of moderate to severe intensity received it in the hospital. The drug is prescribed to patients with various forms of chronic pain syndrome in malignant neoplasms, for example, of the pancreas, stomach and intestines, involvement of the pleura and soft tissues in the pathological process, with bone pain. The starting dose is usually 50 mg twice a day, then it often rises with an increase in pain to 300-500 mg per day. The drug is used when tramadol is ineffective in a daily dose of 200-300 mg or when it is poorly tolerated by the patient. Of the side effects, in rare cases, there is the appearance of nausea and dizziness, in isolated cases, the appearance of drowsiness and mild cognitive impairment in debilitated patients. As a rule, these side effects disappear after a few days.

The topic of probiotics and their effect on our body is now in great demand, but along with the popularization of the topic, myths are formed that do not have scientific evidence. The rapid growth in scientific publications on the microbiome and probiotics is supported by an increase in the number of health publications in the media. «Living cultures» are becoming an everyday concept – also in the context of fortified foods. But the culture of health prevention with the help of functional (probiotic and fermented milk) products is still being formed on the Russian market, despite the fact that fermented milk products are our national stereotype of nutrition. International scientific organizations and manufacturing companies are joining forces to systematize and broadcast the latest information and knowledge about probiotics and the possibilities of their use for maintaining human health. The International Scientific Association of Probiotics and Prebiotics – ISAPP (The International Scientific Association of Probiotics and Prebiotics) has been conducting a great educational work in the field of probiotics for 20 years. Led by an academic council of international experts with the participation of an industry advisory committee, ISAPP is a leader in scientific transparency in the use and clinical efficacy of biotic substances. Today, there are five scientifically agreed and approved definitions in the world: probiotics, prebiotics, synbiotics, postbiotics and fermented foods. In 2022, ISAPP will provide science-based information on the entire family of «biotic» substances, as well as fermented foods. An Economic Modeling Study demonstrated a positive impact of probiotics on the health care and economic burden of flu-like RTIs. Improved disease outcomes translated into considerable cost savings for both the payer and society.