The modern world constantly presents us with unusual challenges. One of the new trends should include electronic cigarettes and vapes, which are firmly embedded in the ubiquitous environment of young people, including minors. In recent years, reports of cases of lung lesions associated with their use, as well as outbreaks of this new pathology, have become increasingly frequent. The article structures foreign and Russian data concerning a new pathology associated with the use of vaping. Clinical forms from exposure to electronic cigarettes can be represented by both acute lung injury (acute pneumonitis, acute respiratory distress syndrome) and a fibrous process (organizing pneumonia, respiratory bronchiolitis). The difficulties of diagnosis are caused, on the one hand, by an underestimation of the current epidemiological situation associated with vaping, on the other – by the absence of pathognomonic symptoms characteristic of EVALI. Differential diagnosis should include a wide range of diseases. Significant difficulties in verifying vape-associated lesions may occur during the rise in the incidence of influenza and COVID-19, both of which may manifest similarly or even simultaneously with EVALI. Lung damage associated with the use of vapes is essentially a diagnosis of exclusion. Therapeutic approaches are not standardized and are rather scarce. According to the literature, the basis of treatment is respiratory support, pharmacotherapy does not have a broad evidence base. In the domestic general medical practice, one should pay more attention to the collection of anamnesis, especially in young people with respiratory and gastroenterological manifestations, indicating the fact of using vapes during the survey. The focus of primary care physicians and the subsequent implementation of a publicly available diagnostic algorithm will allow for the diagnosis of EVALI in a shorter time. In the future, we will continue to study this pathology and search for more specific manifestations of it.

The article presents a review of the literature on the impact of chronic inflammatory pathology of the pharynx on the physical and sexual development of children. The general factors that have such an impact, including genetic, hormonal, alimentary, and environmental factors, are identified. Methods for measuring the physical development of children are considered. It is noted that for adequate growth, a child needs good nutrition, a favorable psycho-emotional environment, normal hormonal balance, and the absence of chronic diseases. The pathogenesis of the development of chronic inflammatory pathology of the pharynx, in particular chronic tonsillitis, in the development of which an important role is played by hereditary predisposition, an infectious-allergic process in the tissues of the palatine tonsils, a decrease in the overall reactivity of the body and a weakening of nonspecific defense factors (properdin, complement, lysozyme, bactericidal activity of blood serum) is considered. Currently, about 100 different diseases are known, largely due to their origin to chronic tonsillitis. The absence of a therapeutic effect or a short remission in such diseases is often associated with the fact that doctors do not take into account the pathology of the pharynx as a possible cause that provokes and maintains associated disease states of other organs and body systems. Separately, a review of the literature on chronic inflammation of the pharynx as one of the factors influencing the physical and sexual development of children is presented, in particular, a relationship has been established at the level of the nuclei of the hypothalamus in chronic tonsillitis and obesity. A review of the literature on the treatment of chronic pharyngeal infection is presented. It is noted that in the treatment of chronic tonsillitis, local antibacterial, anti-inflammatory and immunomodulating therapy, as well as organ-preserving methods, are becoming more widespread. In addition, in the treatment of chronic nasopharyngitis, rinsing of the nasal cavity by the Proetz movement method in combination with physiotherapy is successfully used. In the treatment of adenoiditis, local hormonal preparations are increasingly being used.

COVID-19 can occur in the form of an acute respiratory viral infection of a mild course, or in a severe form. Both effective treatments for the acute phase of the disease and the clinical and functional long-term consequences of COVID-19, which include the complexity of symptoms and organ damage referred to as «long-term COVID» or «post-acute COVID-19 syndrome», are attracting interest in the medical community. The term «post-acute COVID-19 syndrome» has been proposed to refer to symptoms and/or abnormalities that are not related to another cause, persist or are present after four weeks of the diagnosis of the disease. One of the key components of the post-acute COVID-19 syndrome, which can lead to serious complications of the clinical course in patients, is considered to be pulmonary fibrosis, which is a pathological outcome of chronic and acute interstitial lung disease. COVID-19 itself is relatively new disease, which makes it difficult to study the course of the pathological process. To analyze the pathogenesis, multiple studies were conducted on patients who had been ill with various forms of COVID-19. After the disease, the body can begin both the normal process of regeneration of lung tissue and its distortion, leading to severe complications and long-term restoration of normal functioning of the whole organism. In pulmonary fibrosis, the number of deaths is much higher, which is why biomarkers of this outcome have been developed in order to reduce the number of deaths from the COVID-19 complication. The review is devoted to the epidemiology, pathogenesis, histopathology of pathological flora in COVID-19, postcovid syndrome and biomarkers that can identify patients with an increased likelihood of developing the disease. The purpose of this review is to describe various pathogenic hypotheses that have been formulated in order to explain the development of pulmonary fibrosis, the study of acute phases associated with biomarkers that could suggest the onset of fibrotic lung lesions.

The combination of dysphagia with speech disorders and other higher mental functions in people with the consequences of a stroke makes them dependent on others. Dehydration and malnutrition are quite common in this category of patients, which requires the use of diet modification techniques. This category of patients are at risk of death due to the development of aspiration pneumonia caused by dysphagia, and the impossibility or lack of communication does not allow them to report their needs for drinking and eating, which leads to a decrease in food intake, activation of catabolic processes, dehydration, and the appearance of «post-stroke fatigue», depression and a decrease in the quality of life. The combination of dysphagia and aphasia in patients in the post-stroke period is a complicating factor in the rehabilitation of swallowing function due to the presence of speech impairment. Without special speech therapy classes, the restoration of impaired speech functions, as well as swallowing, is difficult or impossible. For patients with dysphagia and aphasia, in order to stimulate speech understanding in the process of fulfilling instructions for overcoming dysphagia, on the one hand, and restoring speech, on the other hand, a personalized approach to the selection of communication models is needed. Compliance with the recommendations of a speech therapist can minimize the complications of dysphagia, reduce the severity of speech disorders. The use of thickeners and specialized food products when feeding patients can minimize the complications of dysphagia and increase the rehabilitation potential of patients. The article describes the experience of using personalized communication models for 128 patients with post-stroke aphasia and dysphagia. Taking into account the structure and severity of the speech defect, the correct organization of patient care and the use of communication models during feeding made it possible to transfer patients to oral nutrition. Thus, the use of personalized types of communication models for patients with a combination of aphasia and dysphagia can reduce or completely eliminate swallowing disorders, significantly improve the state of speech, shorten the rehabilitation period and improve the quality of life of patients.

The article is devoted to an urgent medical and social problem - vibration disease, which occupies an important place in the clinic of occupational pathology. Syndromic classification of vibrational disease of the last revision is given. Particular attention is paid to the pharmacotherapy of neuropathic manifestations of the disease. The data of a 4-year clinical study of the effectiveness of a complex preparation, which includes trifosadenine, cocarboxylase, cyanocobalamin and nicotinamide, alpha-lipoic acid preparations in patients with professional vegetative-sensory polyneuropathy of the extremities, with an assessment of the state of motor, sensory and autonomic fibers by the method electromyography. In the study of motor fibers, the following were analyzed: the amplitude of the motor response (M-response), the speed of the impulse. For sensitive fibers, the speed of impulse conduction, distal latency, and amplitude of the sensory response (S-response) were determined. During the study, it was taken into account that the complex preparation, which includes triphosadenine, cocarboxylase, cyanocobalamin and nicotinamide, and lipoic acid affect different links in the etiopathogenesis of distal polyneuropathy, and the therapeutic effect is achieved in various ways. Analysis of the clinical picture of the disease revealed that most patients had sensory and vegetative disorders of the distal parts of the upper and lower extremities, spreading proximally. Practically, all the studied patients suffered from all types of sensitivity: vibration, temperature, pain and tactile. During the study, no side effects were observed, and all patients showed good tolerability of the drugs. The conclusion is made about the clinical efficacy of the complex drug, the possibility of its use as monotherapy, as well as complex therapy (with the use of lipoic acid) for neuropathic pain syndrome associated with peripheral polyneuropathy of occupational origin. The use of a complex preparation, which includes triphosadenine, cocarboxylase, cyanocobalamin and nicotinamide, allows you to reduce the dose of the concomitant drug with an analgesic effect, or cancel it. The drug, especially when used with alpha-lipoic acid preparations, can be recommended as a metabolic agent that improves the trophic function of peripheral nerve axons in patients with vibration disease for the long-term treatment of polyneuropathy of the upper and lower extremities.

Alcoholic disease is a disease in which a long-term repeated intoxication with ethanol plays a decisive role, provoking the occurrence of morphological and functional changes in the organs and systems of the body. To select a scheme and successive stages of treatment of chronic alcoholism and withdrawal syndrome, it is necessary to understand the pathogenesis of the disease and the principles of action of the drugs used, in order to determine the points of application of therapy, as well as the stages of pharmacotherapy. The paper presents an overview of articles devoted to the problems of chronic alcoholism. A significant amount of the material used was collected by searching for scientific publications and research by foreign and domestic authors. It is noted in the literature that chronic alcoholism is accompanied by damage to almost all vital organs and systems, which leads to complications, and can also cause the development of alcohol withdrawal. Most of the authors, to one degree or another, pay attention to the predominant damage of the cardiovascular system, probably associated with an increased level of catecholamines during regular alcoholization, to which the myocardium reacts first. It is with this phenomenon that the mortality of patients suffering from chronic alcoholism is associated, not only from complications from the cardiovascular system, but also from manifestations of an iatrogenic nature caused by the use of depressants in the treatment of such patients that can cause acute heart failure against the background of myocardial damage by alcohol. The authors associate these complications with the need to use drugs of depressing groups in high doses, as a result of which they begin to show a toxic effect, primarily on the cardiovascular system. According to modern experimental studies, a decrease in the toxic effect of depressants included in the protocols for the treatment of chronic alcoholism was revealed when used in combination with a representative of the class of antioxidants on laboratory animals. In addition, the dependence of the effectiveness of the therapy on the time of day at which medications are taken has been experimentally established, which dictates the need to take into account the chronopharmacology factor when prescribing therapy.

Malignant neoplasms are a significant social, social and medical problem of modern society. Cancer is the leading cause of death in the world, from which about 10 million people died in 2020. In this regard, the identification of the main factors contributing to oncogenesis is the most urgent task of modern clinical medicine. The development of a tumor involves the appearance of atypical cells in the body. Normally, the defense system monitors any attempts to attack our body, including the appearance of cells with genetically alien DNA, and prevents their harmful effects. If for some reason there is a disturbance in the functioning of the immune system, then atypical cells not only do not die, but continue their uncontrolled growth. One factor in suppressing the immune system is emotional stress. Tumor formations of malignant genesis are polyetiological. It has not been finally established which of the factors is of paramount importance, but it has been revealed that various psychosocial processes are triggers. Among them: social status, working conditions, life events (depression, hopelessness, loss of a loved one, etc.). Stress impact on the human body contributes to the disruption of homeostasis processes, leading to the development of pathological reactions in the body. A special role is played by the activation of the neuroendocrine system: the axis of the hypothalamus-pituitary-adrenal glands and the sympathetic nervous system. In addition, it was noted that stress exposure against the background of oncopathology contributes to a decrease in life expectancy by almost two or more times. A detailed study of the relationship between psychosocial factors and environmental factors in the development, progression and mortality from certain types of cancer is important in understanding the main mechanisms of prevention of this pathology. The analysis of the results obtained can be taken into account in the development of personalized measures to prevent the development of cancer in a particular individual.

The nature of nutrition from the moment of conception to the age of 24 months (the first 1000 days of life) is crucial for the development of the central nervous system and vision of the child. Therefore, formula-fed children need to receive nutrition that is not only rich in macro- and microelements, but also compensate for the possible deficiency of essential nutrients contained in breast milk. Although most infant formula contains all the necessary nutrients, this may not be enough for proper brain and vision development. Deficiency of long-chain polyunsaturated fatty acids and lutein, if it occurs during a period when there is a high need for certain nutrients necessary for the development of the central nervous system, can reduce the intensity of development of brain structures, the visual analyzer and affect the cognitive development of the child. Therefore, both nutrients are included in the regulatory documents as mandatory components of infant milk formula. Due to the limited bioavailability of long-chain polyunsaturated fatty acids and lutein from cow's milk, goat's milk-based formulas are a proven effective infant nutrition from birth that solves the problem of limited bioavailability of key essential nutrients.

Influenza is a highly contagious viral infection and poses a serious burden, especially for children under 5 years of age due to an increased risk of severe illness and hospitalization. Influenza-related infant mortality during the pre-Covid period was reported annually. The highest mortality rate was regularly recorded among young children and especially children under the age of 6 months. Influenza vaccination in young children has been proven to be safe and effective. Influenza vaccination of young children not only protects this vulnerable age group, but is also an important way to reduce the transmission of influenza to others at risk, as well as reduce the use of healthcare services, including the use of antibiotics. Immunization against influenza in the current epidemiological conditions is especially relevant, since during the ongoing COVID-19 pandemic, it is impossible to predict the intensity and timing of the upcoming influenza seasonal rise. To prevent influenza in children, any licensed influenza vaccine that meets the indications is used, however, in modern conditions, the priority in influenza prevention is the use of quadrivalent vaccines that ensure the development of the most stable immune response against key strains of influenza viruses. Quadrivalent influenza vaccines include two influenza B strains of the Yamagata and Victoria B lines in addition to influenza A strains (H1N1 and H3N2). Studies have shown that immunization with the quadrivalent vaccine, including in young children, is well tolerated and effectively protects against any circulating and antigenically matched strains of influenza viruses. Russian-made quadrivalent inactivated full-cycle influenza vaccine for the prevention of seasonal influenza is the first quadrivaccine in the Russian Federation approved for use in influenza immunization of children from 6 months of age and pregnant women. The vaccine complies with all World Health Organization recommendations on the composition and amount of hemagglutinin of an influenza virus strain – it contains 15 μg of influenza virus hemagglutinin of each strain (А(N1N1), A(N3N2), B line Yamagata, B line Victoria); does not contain immunomodulators, adjuvants and preservatives; meets the immunogenicity criteria for inactivated influenza vaccines adopted in the European Union and the Russian Federation.

Hereditary connective tissue diseases are widespread in the world. There are doctors of various specialities: pediatricians, surgeons, as well as doctors of narrow specialties: cardiologists, ophthalmologists and others, which deal with syndromes, included in this group of diseases. Currently, verification of the nosological form of hereditary connective tissue diseases remains difficult, due to a large variety of mutations, as well as pronounced clinical polymorphism of phenotypic manifestations of diseases. The report presents a clinical case of a patient with polygenic connective tissue disorder: a combination of autosomal dominant Ehlers – Danlos and Loeys – Dietz syndromes. In the modern literature, we have not found a description of the combination of these two syndromes in one individual. When assessing clinical symptoms, it was found that there was no necessary and sufficient complex of phenotypic manifestations of Ehlers – Danlos syndrome, vascular type. In the presence of ophthalmological symptoms (increasing ophthalmia – buftalm), vascular changes and funnelshaped deformity of the chest, there were no data for pronounced hypermobility of the joints, high skin extensibility, changes in the internal hollow organs. This dictated the need for further verification of the diagnosis – a full-exome scan was performed with the detection of a mutation in the heterozygous state in the TGFBR2 gene of chromosome 3 (exon 5), which leads to the appearance of Loeys – Dietz syndrome type 2 with pronounced tortuosity of arterial vessels, including cerebral, the presence of aneurysmal outgrowth, with the formation of kyphosis, with gradual expansion and weakening of the dura mater. However, the child did not have such frequently observed symptoms as congenital heart defects and aortic aneurysms, facial anomalies. The presence of two syndromes with an autosomal dominant type of inheritance in one patient at the same time can probably have an additive effect and change phenotypic signs. The article shows the need for medical and genetic counseling of the family and long-term multidisciplinary supervision of the child.

Neuronal ceroid lipofuscinosis is a group of diseases caused by the accumulation of autofluorescent lipid-containing pigments: ceroid and lipofuscin. Pigments form intracellular inclusions that look like curvilinear layered bodies (sometimes resembling fingerprints) in neurons, skeletal muscles, internal organs, and leukocytes. The gene responsible for the development of the disease is localized on chromosome 1 in the 1p32 segment. The type of inheritance is autosomal recessive. Depending on the age of manifestation, type 2 NCL is divided into three forms: congenital, late infantile, and juvenile forms. The classic form of the late infantile form of the neuronal ceroid form is widespread throughout the world, but with the greatest frequency in western Finland. The first symptoms usually appear between the ages of two and four. Manifest symptoms are generalized tonic-clonic seizures, delayed speech development, ataxia. As the disease develops, other types of epileptic seizures join (myoclonic, partial, dialeptic). Following the development of epileptic seizures, intellectual disturbances develop, and there is a loss of previously acquired motor skills. The article describes a clinical case of neuronal ceroid lipofuscinosis type 2, diagnosed in a boy born in 2017, who debuted as an epileptiform syndrome. The dynamics of changes in the clinical manifestations of lipofuscinosis since the onset of manifestations in 2019 is highlighted in detail, studies conducted on the patient in the hospital are reflected, with interpretations of the conclusions, symptomatic treatment regimens are given with indications of the dose regimen for each drug. The main features of the manifestation and progression of type 2 neuronal ceroid lipofuscinosis were considered in the framework of a specific individual case. Based on the data presented in the study, the prognosis for this disease, in the absence of replacement therapy, is unfavorable. That is why it is so important to be able to establish this diagnosis in a timely manner.

The data of therapy and clinical and laboratory monitoring of 42 patients with chronic dermatoses accompanied by pyogenic infection and skin defects, including: 12 patients with atopic dermatitis, 14 patients with eczema, 7 patients with vesicular dermatoses (acantholytic, vulgar pemphigus, During dermatitis), as well as patients with ulcerative pyoderma, are summarized. The age of the patients was from 18 to 74 years; men – 22, women – 20. Simultaneously with standard systemic therapy the сombined drug in the form of a cream was used as the main external remedy. According to bacteriological studies, the etiological factors for the development of secondary pyoderma in most patients were S. aureus and fungi of the genus Candida and/or their combination. High resistance of S. aureus strains to benzylpenicillin (20.0%), oxacillin (14.0%) was recorded; whereas only 1 strain out of 30 (3.3%) was resistant to gentamicin. Monitoring of these groups of patients established regression of EASI indices, the severity index of pyogenic manifestations, the severity index of bullous dermatoses by more than 75.0% from the baseline in the period from 7 to 14 or 21 days of therapy, which corresponded to the clinical remission within the inpatient stage of treatment. The study confirms the high efficiency of the innovative domestic drug cream in the complex therapy of patients with chronic, recurrent dermatoses with secondary infectious complications.

The purpose of this medical and social research is to study the knowledge, attitude and participation of the population in the preventive and screening examinations and to analyze the real practice and results of the programе of preventive examinations. For the period from May 2020 to January 2022, the special survey of 461 adults of Moscow residents aged 18-79 years was conducted. The median sample age was 45 years. The number of women in the study sample was 284 (61.6%), men – 177 (38.4%). The survey using a unified and structured questionnaire was conducted through individual and anonymous interviews. Statistical processing of data was carried out by methods of descriptive statistics and one-factor analysis of variance. 33.2% (95% CI 28.8-37.6) of respondents in the study sample did not know or had misconceptions about the purposes of preventive and screening examinations. The majority, 65.5% (95% CI 61.07- 69.9), had limited or insufficient knowledge, with only 1.3% (95% CI 0.25-2.35) of respondents having relatively sufficient knowledge. 40.6% (95% CI 36.03-45.07) of the respondents knew nothing about the scientifically proven measures and methods for cancer prevention and only 19.1% (95% CI 15.44-22.76) had relatively sufficient knowledge. Less than half of the respondents, 43.8% (95% CI 39.18-48.42). Had sufficient motivation and readiness to undergo preventive examinations. Most of the persons who underwent medical examinations received an incomplete set of studies and measures indicated for preventive examination. Most often, questionnaires, measurement of body mass index, analysis of feces for occult blood, examination for the detection of visual and other localizations of oncological diseases and individual preventive counseling are not performed. The majority of respondents either never underwent the preventive examination or received an incomplete set of studies and measures indicated for preventive medical examination. Such inadequate implementation of the preventive survey program for population has a small effect, or even the absence of it. The main reasons for the ineffective introduction of preventive examination are named and approaches to the development and improvement of the preventive examination program. in the health care system are proposed.

Type 2 diabetes is a serious burden on the health of the elderly, affecting approximately 25% of people over 65 years of age. It is expected that this percentage will increase sharply in the next decades due to the increase in life expectancy of the population. Diagnostic criteria for diabetes mellitus in elderly patients do not differ from the general population, there are several features of their management. The elderly population varies greatly in functional and cognitive abilities. These factors, along with an increased risk of hypoglycemia, falls and concomitant diseases, complicate the development of treatment regimens, therefore it is necessary to use a personality-oriented approach, minimizing the risk of excessive or insufficient therapy of diabetes, since the use of antidiabetic drugs in the elderly is associated with significant risk. The prevalence of diabetes mellitus significantly increases after the age of 80 with insufficient physical activity, alcohol consumption, a history of cardiovascular diseases, visceral obesity and hypertension. Cognitive impairment is 2 times more common in elderly people with diabetes. In addition to micro- and macrovascular lesions, a complication of diabetes in the elderly is also sarcopenia, which has a negative impact on the physical and psychosocial health of patients with diabetes and worsens their quality of life. Age-related metabolic changes and emerging kidney pathology predispose elderly people to an increased risk of developing diabetes mellitus and diabetic nephropathy, respectively. Despite the available therapy, a significant number of elderly patients with diabetic nephropathy have progressive renal failure and adverse cardiac outcomes, therefore, research is needed to study methods for early detection of diabetic nephropathy and new therapeutic interventions. Among the elderly with diabetes, individuals with poor glycemic control are at higher risk of cardiovascular events. Elderly patients have greater variability in glycemia and are more prone to arrhythmias, but active glucose control can reduce the risk of severe arrhythmia. Treatment of diabetes in elderly patients with heart failure can be a difficult task, taking into account numerous concomitant diseases, primarily chronic kidney disease. The complexity of treatment regimens, the clinical characteristics of patients and the ability of heart failure therapy to influence glucose metabolism and, conversely, the potential of some antidiabetic agents to modulate its outcomes are problems that need to be solved within the framework of an individual approach. Elderly men suffering from diabetes, for the prevention and treatment of osteoporosis, smoking cessation, glycemic control, regular exercise, active prevention and treatment of complications of osteoporosis, as well as testosterone replacement therapy are necessary. In elderly people, it is necessary to use individual pharmacotherapy with hypoglycemic drugs with a low risk of hypoglycemia and proven safety for the cardiovascular system, avoiding excessive treatment and simplifying therapy regimens. Glycemic targets in the elderly as part of individual treatment may be revised. Intensive treatment of elderly people with diabetes is common, creating an increased risk of adverse events such as hypoglycemia and hospitalization due to medication errors. Those receiving many drugs belong to the older age group, have numerous diseases, including kidney failure and dementia. In such patients, it is permissible to de-intensify therapy or even completely cancel hypoglycemic drugs without significantly worsening their glycemic control.