Impaired kidney function has a negative impact on the course of heart failure in both patients with and without diabetes mellitus. Therefore, the development and study of the effectiveness of methods for the treatment of chronic heart failure, especially in patients with diabetes mellitus and chronic kidney disease, in order to improve the prognosis and reduce the risk of cardiorenal complications, is a priority for modern medicine. Inhibitors of the sodium glucose co-transporter type 2 today have a strong evidence base, not only as hypoglycemic drugs. Representatives from this group demonstrated cardiovascular safety and high efficacy in patients with chronic heart failure, both with reduced (EMPEROR reduced, DAPA-HF studies) and preserved left ventricular ejection fraction (EMPEROR-Preserved, DELIVER studies), regardless of the presence of sugar diabetes. An additional analysis of the conducted studies and specially planned projects showed the nephroprotective properties of the drugs. Long-term use of inhibitors of the sodium glucose co-transporter type 2 reduced the risk of progression of renal failure to the end stage and the severity of albuminuria in patients with chronic kidney disease. The proven cardiorenoprotective effects of gliflozins have expanded the boundaries of their clinical application. However, not all representatives of this group registered in our country can be recommended for patients with chronic heart failure and chronic kidney disease. From the standpoint of evidence-based medicine, dapagliflozin, empagliflozin, and canagliflozin have indications for use in various clinical situations. The article presents the results of randomized clinical trials on the use of sodium-glucose co-transporter type 2 inhibitors in patients with cardiovascular diseases, chronic heart failure, chronic kidney disease with and without type 2 diabetes mellitus. The effect of gliflozins on the course of chronic heart failure and renal outcomes was analyzed. The data of the latest studies CREDENCE, Dapa-CKD, EMPEROR-Preserved, VERTIS CV, STELLA-LONG TERM are covered in more detail. Keywords: chronic heart failure, chronic kidney disease, diabetes mellitus, type 2 sodium-glucose co-transporter inhibitor, empagliflozin, dapagliflozin, kanagliflozin, ertugliflozin, ipragliflozin.

   Coronaviruses are highly contagious and highly tropic to the kidney tissue. A new coronavirus infection can cause a wide range of pathological abnormalities of the kidneys, which is due to the content in the organs of angiotensin converting enzyme type 2 (ACE2), transmembrane serine protease 2 and cathepsin L, which are considered a target for SARS-CoV-2. Clinical manifestations vary from mild forms of acute respiratory viral infection to severe multiple organ lesions. Various clinical forms of kidney damage in COVID-19 are due to numerous pathogenetic mechanisms, such as the direct cytopathic effect of the virus on kidney structures, endothelial dysfunction, cytokine storm, hemodynamic and water metabolism disorders, and damage to the renin-angiotensin-aldosterone system. SARS-CoV-2 interacts with ACE2 receptors located on the endothelium of blood vessels, adversely affecting the microvascular bed. In addition, damage to the renal tissue is caused by the synthesis of pro-inflammatory interleukins, as well as hypovolemia and the accumulation of angiotensin II and bradykinin. Kidney damage in patients with COVID-19 includes such nosological forms as collapsing nephropathy, minimal change disease, membranous glomerulopathy, anti-GBM nephritis, acute tubular necrosis, exacerbation of autoimmune glomerulonephritis, allograft rejection. During clinical observations, scientists from different countries have established a relationship between confirmed COVID-19 and the following laboratory data: hematuria, proteinuria, elevated levels of blood urea nitrogen, serum creatinine, uric acid, D-dimer. Recent studies show that patients with coronavirus often suffer from kidney failure, which is closely associated with higher mortality and morbidity and is an indicator of survival in coronavirus infection. In addition, the presence of such risk factors in a patient as chronic kidney disease, cardiovascular pathology, the presence of immunodeficiency states, the use of nephrotoxic drugs, diabetes mellitus, hypertension, obesity, atherosclerosis, and advanced age complicate the course of infection and worsen the prognosis of the disease. Thus, the pathological effect of coronavirus on the body and on the kidneys, in particular, as well as high mortality among patients with renal pathology, determines the relevance of studying this problem and finding ways to solve it.

   Cystitis is not only a frequent and repeatedly relapsing disease, but also a socially significant disease that significantly worsens the patient's quality of life. In practical work, we quite often met patients with such pronounced dysuric phenomena and hematuria that a sick leave certificate was required for the course of treatment. The article analyzes the results of treatment of 96 patients diagnosed with chronic cystitis with concomitant diagnoses of papillomavirus infection (human papillomavirus) and urogenital herpes (herpes simplex virus) types 1 and 2.

   The aim of the work was to evaluate the effectiveness of complex therapy for acute or chronic cystitis.

   40 patients suffering from chronic cystitis on the background of herpetic viral infection and 50 patients with chronic cystitis on the background of human papillomavirus infection were treated. The prescription of drugs for the treatment of a chronic inflammatory process in the bladder was carried out in accordance with the Russian clinical guidelines of 2016. Patients received antibacterial therapy with Furamag 50, and alternative drugs Ciprofloxacin 500 and Levofloxacin 500 were used. When a herpes viral infection was detected, we used the antiviral drug Acyclovir 200 In case of detection of papillomavirus infection, Isoprinosine 500 was prescribed. In the treatment of patients in both groups, the immunomodulator Tubosan 200 mg was used. As a result of the therapy, the patients achieved remission of chronic cystitis or its complete cure, confirmed by clinical and laboratory data. At the end of treatment, a decrease or complete absence of the viral load of human papillomavirus and herpes simplex virus was also observed. No significant side effects were noted during treatment. Thus, Tubosan can be used as an immunotropic agent in the complex therapy of acute and chronic cystitis to improve the outcome of treatment.

   The increase in the number of cases of COVID-19 poses new challenges for Russian medical science to develop new drugs to combat this infection. After all, we are talking not only about the disease itself, but also about its consequences for the entire in the human body. Honored Inventor of the Russian Federation Andrey Budnevsky, Doctor of Medical Sciences, Professor, Head of the Department of Faculty Therapy of the Federal State Budgetary Educational Institution named after N. N. Burdenko, told us about the importance of the timely start of treatment, about new regimens for treating COVID-19 and about drugs developed by Russian scientists.

   The paper is dedicated to calcipenic states in pediatric patients and contemporary considerations on the approaches to its prevention and treatment. Some basic definitions and terms related to the problem of calcipenic conditions are included. Main functions of Ca in human organism are regarded, the mechanisms for Ca regulation are mentioned as well along with some most important manifestations of this macronutrient’s deficiency, pertaining to endocrine, cardiovascular and central nervous systems (including cognitive decline) plus Ca-associated symptoms from bone tissue and skin. A number of hormones functioning as main regulators for this extremely important macroelement’s metabolism in human organism are alluded (parathyroid hormone, calcitonin, secosteroid calcitriol, thyroliberine, thyroxine, triiodothyronine, somatotropic hormone and insulin). The most important causes for calcipenia in pediatric patients of various age groups are described. The similarities between etiological factors for calcipenia formation and bone fragility states (osteopathies) such as osteoporosis and osteomalacia are described. The approaches to correction (via prevention and treatment) of calcipenic states using available Ca sources are considered. Special emphasis is placed on the potential role and benefits of domestic (Russian-manufactured) biologically active dietary supplement – liquid Calcium, which includes a combination of Ca lactate / phosphate, vitamin D3 (cholecalciferol) and vitamin K1 (phytomenadione / phylloquinone). In conclusion, the predictive role of Ca deficiency for cardiovascular and neurological complications in patients with COVID-19 infection is noted. Data of Russian and foreign researchers involved in the problem of Ca deficiency in various clinical situations is quoted.

   In the structure of parasitic dermatoses, pediculosis is a common disease caused by various types of lice (head, pubic, dress) as a result of direct contact, through personal belongings, when using someone else's underwear, etc. and represents an epidemiological danger in terms of the spread of typhus and recurrent typhus. The purpose of the study. To assess the epidemiological situation of head pediculosis and to establish the frequency of occurrence of the main symptoms of the disease in children in the Astrakhan region (AO). Material and methods of research: the sources of information were the official data of Rospotrebnadzor JSC on pediculosis, for the period from 2013 to 2020 and 162 case histories of patients treated for infectious diseases in the State Medical Institution of JSC «Regional Infectious Clinical Hospital named after A.M. Nichogi» Astrakhan. Extensive (%) and intensive indicators per 100 thousand children under the age of 17 were used to establish the dynamics of the incidence of pediculosis. The results of the study: It was found that the epidemic process of the spread of pediculosis in children in AO, in the period from 2013 to 2020, exceeds the average in Russia with a tendency to decrease only in 2020. The most significant risk group for the spread of pediculosis were children aged 7 to 14 years. The main signs that make it possible to establish the presence of head pediculosis were: itching of the scalp, the presence of nits, detection of lice. Other signs of infectability with pediculosis (wet erosions, serous hemorrhagic crusts, papular urticaria, etc.) occurred with varying frequency, depending on the age of the child, and were of secondary importance, since they can occur with a number of other diseases (atopic dermatitis, seborrheic eczema, psoriasis, etc.). The detection of head pediculosis in organized preschool and school-age children, during hospitalization in hospitals, may indicate a formal approach to examination for pediculosis in preschool and educational institutions attended by a child.

   The paper is dedicated to non-ketotic hyperglycinemia and contemporary considerations on this metabolic disorder. Nonketotic hyperglycinemia is a rare, genetically heterogeneous disease (fermentopathy) caused by mutations that lead to disturbances in the metabolism of glycine and the accumulation of large amounts of the latter in organs, tissues and body fluids, which is accompanied by numerous disorders of the functions of the central nervous system and leads to severe developmental delay. The etiopathogenesis of nonketotic hyperglycinemia depends on the deficiency of one or another protein – P, T, H and L. These proteins are involved in the breakdown of glycine in the central nervous system, liver and kidneys, and with nonketotic hyperglycinemia there is a significant decrease in the activity of the glycine-cleaving system with metabolic disorders and utilization of glycine. The resulting accumulation of glycine in the body is manifested by the inhibitory effect of this amino acid on the structures of the spinal cord and brain stem, which simultaneously leads to excitation of cerebral neurons and damage to the central nervous system with the corresponding clinical manifestations of the disease. The article touches upon the epidemiological and genetic aspects of nonketotic hyperglycinemia, variants and subvariants of the disease with a description of the leading clinical symptoms of nonketotic hyperglycinemia. The possibilities of therapeutic approaches to non-ketotic hyperglycinemia are particularly examined. The basic principles and available methods for non-ketotic hyperglycinemia diagnostics are described along with proper differential diagnosis. Some of the listed methods of treatment for non-ketotic hyperglycinemia (exchange blood transfusions, folate, strychnine) are of purely historical interest, while the use of reductors of blood plasma glycine content (sodium benzoate) and NMDA-receptor site antagonists (dextromethorphan, ketamine) have practical significance. Some peculiarities of antiepileptic drugs’ use in non-ketotic hyperglycinemia, and main alternative therapy methods for epilepsy (ketogenic diet, vagus nerve stimulation) in this group of patients are covered. To conclude the article, some considerations on the prognosis for different clinical variants of non-ketotic hyperglycinemia in pediatric patients are provided.

   The management of newborns and infants suffering from skin diseases requires precise decisions and prompt actions from the doctor, the effectiveness of which largely depends on correct and timely diagnosis. Despite the fact that doctors of various specialties are involved in the treatment of children with skin pathologies, it is not always possible to achieve positive results in terms of reducing the level of the disease and increasing the effectiveness of treatment and preventive care. The number of diagnostic errors is especially high. Raising the level of professional nosological diagnostics is a prerequisite for the development of medical care. The etiology and pathogenesis of skin diseases are extremely diverse and in many cases remain unclear. Localized purulent infections of the skin of infants, as a rule, have a staphylococcal and streptococcal etiology. Differential diagnosis of such a pathology is carried out between scalded skin syndrome, Ritter's exfoliative dermatitis, congenital epidermolysis bullosa, Leiner's desquamative erythroderma, and other blistering dermatoses. Staphylococcal scalded skin syndrome is a disease caused by the action of toxins and characterized by the development of erythema and widespread detachment of the surface layers of the epidermis. Ritter's exfoliative dermatitis is a septic variant of the course of epidemic pemphigus in newborns. The etiological factor is most often Staphylococcus 2nd phage group. Epidermolysis bullosa congenita belongs to the group of orphan non-infectious hereditary skin diseases. Leiner-Mousso desquamative erythroderma is a severe disease that affects exclusively children in the first three months of life. In the development of the disease, the sensitizing effect of pyococcal and yeast infections is important against the background of severe metabolic disorders. The article describes a clinical case of staphylococcal scalded skin syndrome in a patient in the neonatal period. The dynamically changing examination data and the results of additional examinations in dynamics are presented and discussed. The diagnostic search and difficulties in making an accurate diagnosis of skin diseases in newborns, which practitioners face, are shown in detail.

   Lysosomal acid lipase deficiency is a rare hereditary fermentopathy. Cholesterol ester accumulation disease – one of the two forms of lysosomal acid lipase deficiency – is a hereditary autosomal recessive lysosomal accumulation disease caused by mutations in the gene responsible for lysosomal acid lipase, as a result of which the activity of this enzyme is significantly reduced. As a result of a decrease or complete absence of lysosomal acid lipase activity, cholesterol esters and triglycerides are not hydrolyzed and accumulate in the lysosomes of the body's cells, including macrophages, endothelial cells, hepatocytes. The main clinical manifestation of lysosomal acid lipase deficiency is progressive liver damage with the development of hepatomegaly, increased levels of transaminases and/or microvesicular or mixed steatosis, due to the accumulation of cholesterol esters and triglycerides. Lysosomal acid lipase deficiency is a life-threatening genetic disease associated with an increased risk of premature death. The frequency of lysosomal acid lipase deficiency is 1:40 000-1:300 000. Studies on the frequency of occurrence of lysosomal acid lipase deficiency in Russia have not been conducted; the expected frequency is 1:100,000. This article presents a clinical case of lysosomal acid lipase deficiency – a disease of accumulation of cholesterol esters, hereditary deficiency of glucose-6-phosphate dehydrogenase in a 10-year-old child. The data of clinical and paraclinical examination of the patient, medical documentation, scientific literature were analyzed. Modern approaches to the management of pediatric patients with this pathology are presented. The peculiarity of this clinical case is a combination of three fermentopathies (deficiency of glucose-6-phosphate dehydrogenase activity of erythrocytes, deficiency of lysosomal acid lipase, decrease in functional activity of UDP – glucasyltransferase protein). The difficulty of differential diagnosis at the onset of the disease was the predominance of nonspecific symptoms of the disease: fever to febrile digits, vomiting, diarrhea – against the background of drug therapy, jaundice of the skin and sclera, dark urine color, hepatosplenomegaly. The prognosis for the disease of accumulation of cholesterol esters depends on the age of the manifestation of the disease and the severity of clinical manifestations. Timely diagnosis and appointment of pathogenetic therapy in the early stages of the disease determines a favorable prognosis and improves the quality of life of children with the disease of accumulation of cholesterol esters, preventing the development of cirrhosis of the liver.

   Antibiotics remain one of the most popular classes of drugs used in modern medicine. The high medical and social significance of infections, their tendency to epidemic spread, places high demands on the effectiveness and safety of antibiotic therapy. Limitations in the development of new antibiotics, the emergence of new infectious outbreaks, and the growing problem of antibiotic resistance make the optimization of dosing regimens and the use of antibacterial drugs relevant. The article considers the possibilities and effectiveness of the use of modern forms of antibiotics with improved pharmacokinetic properties. The opinion that existed in the medical environment for a long time about the greater effectiveness of parenteral forms of antimicrobial drugs has recently been refuted. The innovative technology for creating dispersible tablets proposed at the beginning of the 21st century proved the comparability of both therapeutic concentrations of an antibiotic when using dispersible forms of an antibiotic and parenteral forms of administration, and the clinical effectiveness of their use. The manufacturing technology of dispersible forms consists in the fact that the tablet is formed from a plurality of microspheres consisting of a filler and an active substance, which creates conditions for protecting the microspheres from the influence of the acidic environment of the stomach and ensures the release of the active substance when exposed to bicarbonates in the intestine, i.e. in the zone of maximum antibiotic absorption. All this contributes to a higher bioavailability of the drug compared to tablet forms, and also provides more uniform dosing and, as a result, predictability of pharmacokinetics. This dosage form differs from traditional oral dosage forms in higher bioavailability of active substances, comparable to injectables, as well as a number of advantages that improve compliance. The improved pharmacokinetic profile of these forms of antibiotics is intended to provide higher clinical efficacy and tolerability and help reduce antibiotic resistance.

   The literature review presents current data on the origin and sources of industrial production of vitamin D, and describes the features of metabolism, biological and pharmacological properties of various vitamin D vitamers. Vitamin D vitamers are groups of structurally similar molecules that differ in the presence of certain functional groups and biological activity. The role of micellization in the mechanisms of absorption and assimilation of cholecalciferol is considered in detail; justified pharmaceutical technologies that improve its bioavailability. Depending on the dosage form and time of appearance in the Russian Federation, it is proposed to classify vitamin D drugs in the Russian Federation into three generations. First generation – fish oil preparations; second-generation drugs – vitamin D in an oil solution; the third generation – vitamin D as part of an aqueous solution of micelles. Preparations of the 3rd last generation, at the moment, are the most modern, as they level out the shortcomings of the previous two generations (fish oil and oil solution), and have the main advantage – high bioavailability, regardless of the patient's gastrointestinal diseases and the composition of the accompanying food (due to the content of finished micelles). The indications for the use of vitamin D preparations for the treatment, prevention and maintenance of the target level of vitamin D in children and adults are summarized, depending on the active substance (cholecalciferol, ergocalciferol) and its dosage form (drops, tablets, capsules).

   Influenza retains a special place among human infectious diseases, due to its ubiquitous distribution, annual outbreaks and epidemics. Complicated forms of influenza are one of the main causes of death in the world. Influenza poses a significant risk to the elderly: patients aged 60 years and older make up the majority of hospitalized influenza patients and are more likely to become severely ill. In addition to the severe manifestation of respiratory symptoms and viral pneumonia in elderly patients with influenza, data are presented on the complications of influenza from the respiratory, central nervous and other systems, and the risk of heart attack and stroke. Approaches to vaccination against influenza, including the elderly, are considered. The use of influenza vaccines reduces the risk of hospitalization due to diseases of the cardiovascular and respiratory systems, reduces overall mortality, and these effects are most pronounced in people of older age groups. Influenza vaccination of older adults reduces severe illness and complications by 60 % and deaths by 80 %. Persons over 60 years of age in the Russian Federation are immunized against influenza as part of the National Immunization Schedule. For the elderly (both healthy and at risk), a single annual vaccination is recommended at least 2-3 weeks before the start of the seasonal rise (in most cases from October to May), and can also be carried out during the influenza season. Russia uses inactivated influenza vaccines. To increase the immunogenicity of vaccines while maintaining their low reactogenicity, it is common to add immunoadjuvants to the vaccine composition, which are part of the domestic vaccines. The Russian influenza vaccine that meets all WHO recommendations on the qualitative and quantitative content of influenza virus antigens is trivalent inactivated split influenza vaccine. The current priority is the use of quadrivalent vaccines, which ensure the development of the most stable immunity. In Russia, such a vaccine, which meets all WHO recommendations, is quadrivalent inactivated split influenza vaccine. The article presents the characteristics of influenza vaccines used in the Russian Federation and data on their effectiveness, including in the elderly.