Myocardial infarction is a condition in which a number of hemodynamic, inflammatory and metabolic disorders occur. After myocardial infarction, many patients have a poor prognosis. In this regard, there is an urgent need for a quantitative blood test biomarker that would effectively assess the state and reserve of the heart muscle, as well as the prognosis in the early post-infarction period. Recent studies have paid great attention to the role of adiponectin in the prognosis of adverse cardiovascular events in the post-infarction period. Many studies have focused on the role of adiponectin in cardiovascular disease, but its role in the post-infarction period is controversial. The aim of the study was to study the gender characteristics of the adiponectin level in the early post-infarction period (30-40 days), in patients who underwent coronary stenting, as well as to determine the relationship of this biomarker with epicardial fat thickness and coronary artery stenosis of the 4^th degree. The study included 93 patients (55 men and 38 women) with a first-time myocardial infarction who underwent coronary revascularization. The patients were randomized into groups. Patients of the first group (37 men and 18 women) did not receive therapy for the prevention of cardiovascular diseases before the first myocardial infarction. Patients of the second group (18 men and 20 women) received therapy for the prevention of cardiovascular diseases. Therapy aimed at the prevention of cardiovascular diseases (arterial hypertension, stable angina pectoris) included regular intake of beta-blockers, angiotensin-converting enzyme inhibitors, statins and antiplatelet agents. The study revealed: stenosis of the 4^th degree of the 1st coronary vessel is significantly more common in men who do not receive therapy for the prevention of cardiovascular diseases before the first myocardial infarction; stenosis of the 4^th degree of the 2^nd coronary vessels was significantly more common in men receiving therapy for the prevention of cardiovascular diseases before the first myocardial infarction; high levels of adiponectin in the early post-infarction period are associated with multivessel damage to the coronary arteries, regardless of the received therapy for the prevention of cardiovascular diseases before the first myocardial infarction.

The article analyzes the possibility of the influence of telemedicine on the levels of systolic blood pressure in patients with type 2 diabetes mellitus in combination with arterial hypertension. The study involved 224 patients who were initially divided into 2 groups: group 1 (patients who refused to undergo structured training; n = 54) and group 2 (patients who underwent structured training; n = 170). Subsequently, the patients of group 2 were divided into two subgroups: group 2a, consisting of 109 patients who underwent structured training, but did not use feedback from the doctor every 2 weeks, carried out in the form of telemedicine; group 2b, consisting of 61 patients who underwent structured training and made contacts with a doctor every 2 weeks. In order to increase the effectiveness of training, family members of the patient living with him often also participated in the process. In some cases, group training was used (no more than 3 people in 1 group, taking into account age, psychological and intellectual compatibility). As a result of the study, it was found that in all three groups, the systolic blood pressure levels at the end of the study were lower than the baseline levels, and in all cases, the differences between the initial and final levels of this indicator were statistically significant. However, with the initial levels of systolic blood pressure not statistically significantly different from each other, the most optimal result was obtained in group 2b – 133.3 mm Hg. (95% CI 131.46; 135.14) and 2a – 133.7 mm Hg. (95% CI 132.25; 135.15). In group 2b, a more gradual decrease in systolic blood pressure was noted than in group 2a. In addition, there were also statistically significant differences in the incidence of systolic blood pressure < 130 mm Hg. at the end of the study between groups 1 and 2a (p < 0.0001) and the difference between the frequency of occurrence of systolic blood pressure < 130 mm Hg. at the end of the study between groups 1 and 2b (p < 0.001). According to the results obtained, it can be argued that structured learning made it possible to achieve a more effective reduction in the level of systolic blood pressure compared to unstructured, "sketchy" learning. The feedback system "patient-doctor" using telemedicine technologies, used to manage arterial hypertension in type 2 diabetes mellitus, made it possible to achieve a smoother decrease in systolic blood pressure levels, while maintaining the effectiveness of therapy.

The article focuses on the negative role of hyperaldosteronism in cardiovascular diseases and the possibility of its control when using a selective mineralocorticoid receptor antagonist – eplerenone. Based on numerous, multicenter clinical studies, the advantage of using eplerenone in the complex therapy of cardiovascular diseases has been shown. Eplerenone is a selective mineralocorticoid receptor blocker with minimal activity against androgen and progesterone receptors. From the modern point of view, eplerenone is considered as an antifibrotic drug with a dual mechanism of action: the drug blocks the K⁺-channels of regulatory T-lymphocytes, reduces the production of growth cells and helps to reduce the proliferation of cardiac fibroblasts; blockade of mineralocorticoid receptors by aldosterone leads to a decrease in the activation of fibroblasts. The antifibrotic effect contributes to the preservation of contractility and electrical stability of the myocardium, slows down the development and progression of chronic heart failure. The article presents data, in the framework of evidence-based medicine, on the high clinical efficacy of eplerenone in patients with arterial hypertension, chronic heart failure with reduced ejection fraction with or without myocardial infarction. The possibilities of prescribing eplerenone for moderately reduced and preserved left ventricular ejection fraction are discussed. The importance of the antifibrotic properties of the drug in the organoprotection of target organs (heart, blood vessels, kidneys) is emphasized. The use of eplerenone provides good tolerability, safety and leads not only to an improvement in the quality of life of severely ill patients, but also in the prognosis. The tactics of choosing a specific eplerenone drug for comorbid patients with chronic heart failure and chronic kidney disease with a glomerular filtration rate of 30 to 60 ml/min, based on instructions for use and availability for the patient, are also considered.

According to WHO, cervical cancer is the fourth most common type of cancer among women in the world, in 2020 the number of new cases of the disease reached 604,000. Among women of reproductive age, cervical cancer is the second most com[1]mon type of cancer and the second cause of cancer death in the world. In the Russian Federation, the incidence of cervical cancer in recent years has been in the second position after uterine body cancer in the structure of genital cancers in the country. The problem of increasing incidence of cervical cancer requires the improvement of cervical screening. The last decade is characterized by the emergence of new highly informative methods for diagnosing precancer and the active introduction of modern approaches into practice in many countries. In the WHO Global Strategy to Accelerate the Elimination of cervical cancer as a public health problem, cervical screening is given priority. Modern cervical screening includes switching to primary human papillomavirus (HPV) screening or a соtesting followed by a triage in case of human papillomavirus detection. An overview and analysis of current data on this problem over the past decade is presented. The issues of evidence of the informativeness of traditional cytological screening, liquid cytology, HPV screening, cotesting, triage strategies of HPV-positive women, human papillomavirus screening interval are discussed. The immunocytochemical method of double staining p16/Ki67 is proposed for triage HPV-positive women, as more informative than cytological for the detection of CIN2⁺/CIN3⁺, an assessment of the risk stratification of precancerous using this method was carried out. Along with the expansion of human papillomavirus vaccination, increasing the level of cervical screening and coverage of the female population will help to reduce the morbidity and mortality associated with cervical cancer.

Endometriosis is a chronic, dyshormonal, immune-dependent disease with a characteristic proliferation of tissue similar in morphological structure to the endometrium and located outside the endometrial mucosa. The goal of investigation was to study the peculiarities of localizations and combinations of endometrioid lesions in recurrent external genital endometriosis. 48 patients with recurrent external genital endometriosis were examined. The average age of the examined was 34.96 ± 1.1 years and ranged from 19 to 50 years. The study of the menstrual function made it confirmed that menarche was observed from 13.8 ± 1.9 years, the duration of the menstrual cycle was within 28.75 ± 0.53 (23-45) days, the duration of menstruation was 5.65 ± 0.17 (3-10) days. The onset of sexual activity in patients was noted from 18.98 ± 0.39 (15-30) years. The duration of endometriosis in patients with recurrent forms of external genital endometriosis was 10.0 ± 1.41 (9-11) years. The recurrence rate averaged 2.02 ± 0.44 (1-4) years. The duration of remission was 6.1 ± 0.84 (1-15) years on average. All patients underwent clinical, functional, endoscopic, immunological and morphological methods of examination. It was found out that recurrent external genital endometriosis in 35.7% of cases is manifested by the relapse of endometrioid ovarian cysts, in 24.6% by the presence of endometrioid infiltrates of the sacro-uterine ligaments, in 10.3% of cases by endometriosis of the pelvic peritoneum, in 7.1% of cases by endometriosis of sacro-uterine ligaments, in 6.3% of the presence of retrocervical endometrioid infiltrate, in 5.6% by ovarian endometriosis, in 4.8% of cases by endometriosis of the vesicouterine fold of the peritoneum. The study of the combination and dissemination of endometrioid lesions in recurrent external genital endometriosis demonstrated the presence of stage II of the pathological process according to the classification by A.I. Ishchenko (1993). At the same time, 27.1% of patients had a combination of endometrioid ovarian cyst and endometrioid infiltrates of the sacro-uterine ligaments, 14.8% endometriosis of the sacro-uterine ligaments, 8.3% of patients had endometriosis of the sacro-uterine ligaments and election of the unilateral ovary.

Currently, one of the topical topics in obstetrics and gynecology is the problem of ectopic pregnancy, which directly correlates with an increase in the incidence of inflammatory diseases of the pelvic organs. Ectopic pregnancy has both the most common forms (the location of the ovum in various parts of the fallopian tube) and rare variants (ovarian, abdominal and cervical). Until 2017, the diagnosis of progressive cervical pregnancy was a direct indication for volumetric organ-carrying surgery – extirpation of the uterus. Currently, in view of the availability of modern treatment protocols ("Procedure for the provision of medical care in the profile of≫ obstetrics and gynecology", No. 1130н, 2020 and clinical guidelines "Ectopic pregnancy", 2017), obstetricians-gynecologists have the opportunity of conservative treatment this pathology and the preservation of the reproductive health of patients. This article presents three clinical cases of the use of organ-preserving techniques in the treatment of progressive cervical pregnancy, which occurred in the gynecological department of the Volgograd Clinical hospital of emergency medical care No. 7. For the treatment of patients, modern medical and surgical techniques were used: the use of cytostatic drugs, ligation of the uterine arteries, followed by vacuum aspiration of the ovum and control hysteroscopy. The effectiveness of the treatment was assessed using ultrasound imaging methods and laboratory research methods (blood test for hCG). Thus, clinical practice confirms the feasibility and effectiveness of organ-preserving surgical interventions, as well as the use of drug (cytostatic) therapy in patients with a diagnosis of ectopic (including cervical) pregnancy. This modern approach will preserve the reproductive potential of young women, as well as reduce the risks of possible complications in the future.

The goal of study was to study the incidence and the clinical manifestation of the endometrial pathology in premenopausal period. 73 premenopausal women with various endometrial pathology were examined. The average age of the examined was 47.82 ± 0.27 (45-51) years. The age of the menarche was 11.0 ± 0.15 (11-17) years, with the duration of the menstrual cycle 27.24 ± 0.47 (21-45) days and menstruation 5.1 ± 0.14 (3-8) grays. Onset of sexual activity was at age 19.5 ± 0.57 (16-31) years. The number of pregnancies was 5.2 ± 0.02 (1-10), from which 1.72 ± 0.11 (1-4) terminated with vaginal births, 1.57 ± 0.11 (1-4) with medical abortions, and 1.91 ± 0.34 (1-4) with spontaneous abortions. All the patients were conducted clinical, functional, hormonal, endoscopic, morphological methods of examination. The results obtained were subjected to statistical processing using standard computer programs "Statgraph", designed for parametric and non-parametric methods for calculating average values. There was confirmed that 5.5% of patients with various pathology of the endometrium had no clinical symptoms. 44.9% of examined had polymenorrhea, 29% menorrhagia, 21.7% metrorrhagia, 20.3% opsomenorrhea, 17.4% bloody spotting from the vagina, 17.4% of patients had lower abdominal pain and 13% had proyomenorrhea. Among the types of the endometrial pathology in the premenopausal period there was prevalence in the endometrial polyp, in 54.8% of patients (at the same time, a glandular-fibrous polyp of the endometrium was diagnosed in 45.2% of patients). 22.5% of examined had endometrial hyperplasia, 13% endometritis, and 9.6% combination of uterine Myoma and endometrial hyperplasia. The incidence of high grade endometrial cancer was 2.7%. Thus, in women with endometrial pathology, who are in the is a fairly high frequency of menstrual irregularities in combination with uterine pathology, which requires dynamic monitoring to prevent the development of complications and malignant neoplasms.premenopausal period, there  is a fairly high frequency of menstrual irregularities in combination with uterine pathology, which requires dynamic monitoring to prevent the development of complications and malignant neoplasms.

Obesity is the cause of many diseases, as well as psycho-emotional, social and economic problems. Factors predisposing to the development of metabolic syndrome are genetic predisposition, advanced age, postmenopausal status in women, behavioral factors (a sedentary lifestyle, the predominance of fatty foods in the diet), and low socioeconomic status. Metabolic syndrome is characterized by an increase in the mass of visceral fat, a decrease in the sensitivity of peripheral tissues to insulin and hyperinsulinemia, which cause the development of disorders of carbohydrate, lipid, purine metabolism and arterial hypertension. The presence of metabolic syndrome leads to an increased risk of developing type 2 diabetes and cardiovascular disease. The risk of mortality associated with cardiovascular disease is also higher in those diagnosed with this syndrome. Fiber supplements can be a convenient and cost-effective alternative to increase fiber content in the diet without the need for other major dietary modifications. Psyllium has been extensively researched as it is found in many popular over-the-counter laxatives around the world. Numerous studies point to improved glycemic and HbA_1c control in people with type 1 or type 2 diabetes who consumed more dietary fiber. According to the Управление по надзору за качеством пищевых продуктов и лекарственных средств Food and Drugs Administration of the United States, consumption of 1.78 g of psyllium per serving (4 servings per day) improves lipid levels, reduces cardiovascular risk factors. Studies have not shown any improvement in BP or vascular function in overweight and obese individuals with psyllium fiber supplementation during the 12 weeks of intervention. A 2016 randomized clinical trial showed statistically significant reductions in weight, body mass index, and waist and hip circumference in patients with type 2 diabetes. In the Russian Federation, psyllium is also presented in the form of the drug.

Autoimmune polyendocrine syndromes (APS) are a group of syndromes characterized by autoimmune damage of two or more endocrine glands, leading most often to their hypofunction. Often these syndromes are combined with various organ-specific non-endocrine diseases of an autoimmune nature. Currently, 4 types of APS are distinguished: APS 1, APS 2, APS 3, APS 4. APS 1 is a monogenic autosomal recessive disease based on a violation of the structure of the AIRE gene. The classic signs of APS 1 are: chronic candidiasis of the skin and mucous membranes, primary hypoparathyroidism and autoimmune primary chronic adrenal insufficiency. Moreover, clinical features of APS 1 can include primary hypogonadism, primary hypothyroidism with a history of autoimmune thyroiditis and type 1 diabetes. Among non-endocrine pathology, other autoimmune diseases may occur during patient’s life: alopecia, vitiligo, pernicious anemia, malabsorption syndrome, autoimmune hepatitis, enamel abnormality, ectodermal dysplasia, isolated IgA deficiency, bronchial asthma, glomerulonephritis. APS 2 is a multifactorial pathology caused by mutation of genes and the influence of the environment. Two of the most common clinical options of type 2 APS are identified: Schmidt – chronic primary adrenal insufficiency in combination with chronic autoimmune thyroiditis or Graves disease and Carpenter – chronic adrenal insufficiency syndrome in combination with type 1 diabetes. APS 3 and 4 differ from APS 2 only in combinations of components – endocrine and non-endocrine diseases. They lack chronic primary adrenal insufficiency and chronic primary hypoparathyroidism. In addition, rare genetic pathologies occurring with polyglandular syndrome are known, such as Kearns-Seir syndrome, IPEX syndrome, POEMS syndrome, Tungsten syndrome, etc. Diagnosis of APS is difficult due to the variety of clinical symptoms and the difficulty of differential diagnosis. APS is characterized by the incorporation of new autoimmune components during long period of time, which makes it difficult to diagnose a variant of the syndrome. If the autoimmune damage of an endocrine gland appears, other components of APS should be excluded at the latent stage. Currently, there are no effective methods to block auto-aggression. Therapy of numerous endocrine and non-endocrine dysfunctions in APS consists of the treatment of particular components of the syndrome.

A significant problem in pediatrics is the hemostasisdysfunction, especially its anticoagulant system. The deficiency of fibrinolysis factors and the anticoagulant system increases the risk of thrombosis. Children with chronic diseases, such as cardiovascular, nervous systems, in patients with hereditary genetic diseases with a deficiency of anticoagulant factors (congenital or acquired), may have episodes of thrombotic events. Thrombosis in children with genetically determined thrombophilia often occur in the context of risk factors. In the early neonatal period, the deficiency of anticoagulant factors manifests as the form of fulminant purpura, followed by the development of skin necrosis. The genetic factor plays one of the most importantreason in the thrombophilia development, which leads to a deficiency or defect in blood coagulation factors, platelet receptors, or manifests itself in the form of a hereditary predisposition. The current screening of hemostasis does not properly identify the causes of thrombosis. The development of thrombotic complications in children is a multifactorial pathological condition and requires multidisciplinary approach in diagnostic and therapeutic measures. The problem of correct in time diagnostics has the socially significant nature. Currently, international consensus and national protocols for the treatment and prevention of venous thromboembolism are regularly reviewing. In the study, the system of natural anticoagulants was evaluated in children with various pathologies. The study included 33 patients with confirmed diagnoses, including cardiovascular pathology, syndromes of nervous diseases, undifferentiatedconnective tissue dysplasia, hereditary monogenic syndrome. The results obtained indicate a high frequency of occurrence of polymorphisms in coagulation genes (in a third of children with various diseases in the study), in some children a decrease in the activity of natural anticoagulants (NAC) proteins (S,С) (from 12 to 15%) was determined, which confirms the need for the presented diagnostics to predict the condition and assess hemostasis in children.

The negative consequences of antibiotic therapy include, in particular, antibiotic-associated diarrhea, which has been well studied and described to date. However, studies have shown that the clinical symptoms associated with antibiotic therapy are wider than the development of antibiotic-associated diarrhea alone, and are characterized by the development of a symptom complex defined as an antibiotic-associated syndrome. The aim of this study was to establish the clinical features of the antibiotic-associated syndrome in coronavirus infection caused by the SARS-CoV-2 virus. A prospective clinical observation was carried out using the questionnaire method from 2017 to 2022. In total, 147 parents of patients aged 3 months to 18 years who had acute respiratory viral infections (90 people) and COVID-19 (57 people) were interviewed, of which 120 children received antibiotic therapy. Parents of patients filled out a questionnaire to identify the main clinical manifestations of the antibiotic-associated syndrome. A comparative analysis of the clinical manifestations of the antibiotic-associated syndrome in patients with acute respiratory viral infections showed that diarrhea, gastrointestinal and extraintestinal manifestations within a month after recovery were observed in a larger number of patients in the case of prescribing probiotics after completing a course of antibiotic therapy. Significant differences in the effectiveness of bifidobacteria and lactoprobiotics in the prevention of antibiotic-associated syndrome have not been established, with the exception of a lower incidence of constipation in patients who received probiotics containing Bifidobacterium spp. Clinical manifestations of antibiotic-associated syndrome in patients with COVID-19 were observed in more children than in SARS. In acute respiratory viral infections, including coronavirus infection caused by the SARS-CoV-2 virus, the prescription of antibacterial drugs is pathogenetically unjustified and increases the risk of developing an antibiotic-associated syndrome. If it is necessary to use antibacterial drugs in this category of patients, it is most advisable to prescribe probiotic therapy simultaneously with an antibiotic.

The consequences of a new coronavirus infection have become no less relevant than the symptoms of an acute course of an infectious disease. A variety of physical, cognitive, and neuropsychic symptoms that arose as a result of the transferred COVID-19 form the clinical picture of the post-COVID syndrome, which is manifested by long-term functional limitations that negatively affect the quality of life of patients. Practical experience in the rehabilitation treatment of patients with post-COVID syndrome has shown that the basic condition for successful patient care is a multidisciplinary approach: a set of procedures – dosed and adequately selected physiotherapy exercises, breathing exercises using respiratory simulators, massage, psychotherapy, physiotherapy (including inhalations), electro – and magnetotherapy, vibration therapy, hyperbaric oxygen therapy, reflexology, as well as nutritional support. Nutritional support for patients with post-COVID syndrome is considered as one of the components of complex rehabilitation treatment aimed at correcting the systemic viral inflammatory response and metabolic status in patients with COVID-19. The article analyzes the practical experience of using rehabilitation treatment programs for patients with COVID-19 in outpatient medical organizations with inclusion in the mandatory part of nutritional support based on vitamin and DNA-containing biologically active supplements. The results of the study prove the fact that adequate correction of physical and neuropsychic status in combination with full nutritional support for patients with varying degrees of severity of post-COVID syndrome is an integral part of rehabilitation treatment. Comprehensive rehabilitation treatment of patients with COVID-19, based on the individual selection of not only physical and physiotherapeutic treatment regimens, but also nutritional support, will help to avoid many of the negative consequences of the pathology.

Acute respiratory infections often cause temporary disability. According to the World Health Organization, adults experience acute respiratory infections approximately twice a year. The course of acute respiratory viral infections is often accompanied by the development of complications. The second most common complication of acute respiratory viral infection is acute otitis media. It is believed that by the age of three, acute otitis media is transferred once by at least 71% of children, by 7 years of age – 95%. Currently, the clinical picture of acute otitis media has been studied in detail, which allows us to speak about 5 stages of acute inflammation of the middle ear: the stage of acute eustachitis, the stage of acute catarrhal inflammation, the stage of acute purulent inflammation, the postperforative stage and the reparative stage. In Russia, the causative agents of acute otitis media are more often S. aureus, S. epidermidis, Str. pneumoniae and Haemophilus influenzae, somewhat less often Str. pyogenes, Moraxella catarrhalis, Str. viridans, anaerobes. Treatment for acute otitis media primarily involves adequate sanitation of the nose and paranasal sinuses, the establishment of an outflow from the middle ear. According to indications, taking into account the age of the patient and the epidemiological situation, antimicrobial drugs are prescribed. Taking into account Russian data on antibiotic resistance, the drug of first choice for acute otitis media is amoxicillin, and for recurrent or severe disease, amoxicillin with clavulanic acid. When prescribing antibacterial drugs, especially oral ones, it is necessary to remember such side effects of the antibiotic as dyspeptic reactions (bloating, pain, nausea, diarrhea). The likelihood of developing side effects from the digestive tract is influenced by the rate of absorption of the drug and its residual concentration in the intestine. One way to reduce the side effects of antibacterial drugs on the human body is the use of dispersible tablets. In addition, the use of the antibiotic and the form of dispersible tablets eliminates the possibility of dosing errors. Antibacterial therapy is also carried out for moderate and severe forms of sinusitis, as well as for a mild form of recurrent course.

Neuropathic pain is one of the most common complaints in outpatient clinical practice, and its relevance is associated with the difficulties that arise in the process of diagnosis and rational pharmacotherapy. In accordance with the modern classification, acute pain (lasting up to 90 days) and chronic pain are distinguished. Acute pain is a sensory reaction with subsequent involvement of emotional, motivational, vegetative and other factors that occur when the integrity of the body is violated. Chronic pain is defined as pain that continues beyond the normal healing period. According to experts in the study of pain, it is possible to speak of chronicity if the duration of the existence of pain exceeds 3 months. Understanding the pathophysiological mechanisms underlying the disruption of the processes of generation and conduction of a nociceptive signal in nerve fibers, as well as the response to control the excitability of nociceptive neurons in the structures of the spinal cord and brain in neuropathic pain, provide the key to modern therapy strategies, forming the foundation for an adequate, pathogenetically substantiated drug correction. This impact should be comprehensive and individualized. Due to the fact that neuropathic pain syndrome most often develops in patients with comorbid pathology, as well as in people of the older age group, the use of oral and injectable forms of the above drugs is significantly limited. In conditions of polypharmacy, when patients are forced to take several different drugs at the same time, priority is given to topical drugs in the treatment of this pathological condition. Today, capsaicin drugs show great promise as an effective treatment for neuropathic pain, thereby opening a new chapter in the pharmaceutical industry in the field of pain relief. Topical capsaicin, used as monotherapy or in combination with other analgesics, allows patients with a minimal risk of developing adverse events to significantly reduce the severity of neuropathic pain syndrome and, as a result, improve their quality of life.

The article presents basic information about cutaneous leiomyoma – a rare benign tumor of the skin from smooth muscles. The most common leiomyomas of the skin from the muscles that raise the hair, which are inherited in an autosomal dominant manner, manifest mainly in adulthood and occur in men 2 times more often than in women. The clinical picture is characterized by nodules of a hemispherical shape, densely elastic consistency, flesh-colored, pink and red in color with a brownish or bluish tinge, ranging in size from 0.1 mm to 2 cm in diameter, with a smooth and shiny surface, which are located asymmetrically, isolated or grouped on the scalp, lateral surfaces of the neck, trunk and lower extremities. It is known that the most common complaint in patients is pain of varying severity in the area of the nodules. Pain of varying severity in the area of nodules is the most common complaint in patients and can occur spontaneously or be provoked by any mechanical irritation of the skin, cold, as well as emotional stress. This pain syndrome in patients has been well studied and described in clinical practice, at the same time, there are no indications in the specialized dermatovenerological literature of the occurrence of pain in patients during sleep.The case of the diagnostics of cutaneous leiomyoma of the muscles lifting hair is presented in a 66-year-old patient who consulted a dermatovenerologist at the clinic of the Ural Research Institute of Dermatovenereology and Immunopathology. The diagnosis was verified by a pathomorphological study of a skin biopsy. A detailed study of the patient's anamnesis and complaints revealed episodes of unbearable pain in the projection of rashes that occur during emotionally colored dreams. A new clinical syndrome of the disease is described – myalgia in the rem sleep, which can be explained by the predominance of the sympathetic nervous system and the activation of physiological functions of the body during dreams.

The COVID-19 pandemic has turned the lives of all people in society upside down, changing almost all aspects of everyday life, and therefore the discussion of the problem of CO-infection with HIV and COVID-19 in this clinical case is necessary and extremely relevant for doctors. The interaction of HIV and SARS-CoV-2, pathogenetic features, clinical manifestations of co-infection remain a relevant topic for modern research and observations. It should be noted that these two viruses have a significant impact on the human immune system, and this fact is promising for the development of clinical guidelines for the provision of medical care to HIV-infected patients with COVID-19. This article presents a clinical case of severe pneumonia in HIV/COVID-19 co-infection that demonstrates the difficulty in treating such patients. An HIV-infected patient of stage 4B who has refused ART, as well as vaccination against a new coronavirus infection, becomes ill with COVID-19. Against the background of the protracted course of COVID-19, there was a progression of HIV infection with the development of severe bilateralpneumocystis pneumonia and Kaposi's sarcoma. Low adherence to self-control in a patient with HIV infection was emphasized. The use of inadequate ART regimens and, subsequently, the rejection of it, the lack of advisory support regarding adherence to therapy, lead tosuccessful attempts to achieve virological control over HIV infection, as well as to prevent the progression of severe respiratory failure. The effect on the accession of pneumocystis pneumonia with the development of such a complication as acute respiratory distress syndrome has been demonstrated. It was established that coronavirus infection in this case could play the role of a trigger in the development of pneumocystis pneumonia in an immunosuppressive patient with HIV infection.The issues of modern methods of laboratory examination and treatment of infections of the lower respiratory tract are discussed – the most common recurrent infections, including HIV/AIDS, threatening the patient's life.