. Coronavirus infection is a highly contagious disease caused by the SARS-CoV-2 virus. Its targets are any organ systems. Infection begins with the entry of SARS-CoV-2 into target cells. They have type II angiotensin-converting enzyme receptors. SARS-CoV-2 infects target cells with the help of the extracellular domain of ACE-2, as well as the transmembrane protein TMPRSS2. Coronavirus blocks the activity of ACE2, as a natural generator of angiotensin peptides, disrupting the balance of hemovascular control. Under normal conditions, this mission is performed by a complex of ACE/ACE2 enzymes that control the synthesis and physiological activity of angiotensin and kinin peptides in the body. Changes in the ratios of the angiotensin-bradykinin axis and cytokine stress are associated with endothelial dysfunction and multiple vascular disorders. Receptors for angiotensin-converting enzyme-2 are widely expressed in various tissues, including adipose, as well as the pancreas and thyroid glands, pituitary gland, adrenal glands and gonads, which may be the cause of the development of extrapulmonary complications of the new coronavirus infection COVID-19, including complications from side of the endocrine system, especially vulnerable due to the expression of the angiotensin-converting enzyme-2 receptor. COVID 19 primarily affects the respiratory system and also affects other organs and systems, including the endocrine system. Today, it is important to study the effect of COVID-19 on the endocrine part of the pancreas, hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axis. Of greatest interest are questions about possible long-term consequences associated with the function of the reproductive system. The most severe course of COVID-19 is typical for the elderly with endocrinopathies and other chronic diseases. There is speculation that selective sodium-dependent glucose cotransporter type 2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, pioglitazone, and even insulin can induce overexpression of ACE-2 receptors, which can have serious negative consequences for people with diabetes in case of infection with SARS-CoV-2. Clinical features of the course of a new coronavirus infection, probable complications, implemented and tested treatment regimens, pleiotropic and undesirable effects of various drugs, the duration of patient rehabilitation – all this is extremely important for patients with endocrine pathology, including autoimmune genesis.

We present a case report of a 40-year-old Caucasian man who was diagnosed with type 2 diabetes mellitus at the age of 27. In his case, the patient took oral hypoglycemic drugs for 6 months, but then insulin therapy was started because glycemic goals were not achieved. In order to verify the right type of diabetes after 6 years of the onset of disease, the patient was tested on the main immunological and genetic markers of diabetes mellitus. This observation period clearly demonstrated the "typical" course of LADA. The main signs of LADA are – gradual decreasing in the level of C-peptide, starting insulin therapy after 6 months from the onset of diabetes. LADA is associates with positive autoimmune markers (GAD-antibodies) in blood samples. In the case of our patient we saw the "classical" development of LADA. According to modern datas, pathogenesis of different types of diabetes is based on multiple variants of β-cell damage, which can lead to unique course of treatment and manifestation of macroand microvascular complications. It means that different gene combination can cause clinical symptoms of diabetes which can not be classified only on 1 or 2 type of diabetes. The idea of "hybrid" forms of diabetes has long attracted attention, since their pathogenesis may be based on various types of damage to β-cells, which affects the course, prognosis, and clinical tactics. On the one side we see typical LADA signs. On the other case, physicians wanted to see the prognosis of the disease, especially predict the same case of LADA in patient’s family. The patient underwent genetic testing for 9 main genes, mutations in which are responsible for predisposition to obesity and type 2 diabetes. According to the results of this study, the patient had a heterozygous mutation in the genes: TCF7L2, CDKAL1, CDKN2A/2B. The patient revealed a hybrid form of LADA, combining both immunological markers of LADA (positive antibodies to GAD), as well as genetic markers of type 2 diabetes mellitus (mutation in the genes TCF7L2, CDKAL1, CDKN2A/2B). The number of patients with the onset of diabetes mellitus at a young age and the absence of a sign of absolute insulin deficiency are increasing. Genetic, immunological tests can help patients to achieve glycemic goals and prevent macroand microvascular complications

Acute cerebrovascular accident has been and remains one of the leading causes of morbidity, disability and mortality in the world. Brain strokes are not only medical, but also a big socio-economic problem for the state. The most common neurological disorders caused by stroke include impaired cognitive, motor and sensory function. Patients who have suffered a myocardial infarction about 90% can return to their previous jobs as for stroke, the situation is completely different from the survivors, only about 10-20% can continue their previous work in a light mode, and the remaining 70-80% remain disabled with varying degrees of disability. Therefore, treatment and early rehabilitation remains the focus of clinicians' attention. Along with drug therapy, acupuncture increases the therapeutic and rehabilitation potential of patients with ischemic stroke as it improves neurogenesis, angiogenesis, synaptogenesis in the ischemic area. Acupuncture is recommended by the World Health Organization (WHO) as an alternative and complementary strategy for treating stroke and improving the outcome of strokes. The review reveals the mechanisms of therapeutic and restorative effects of acupuncture in ischemic strokes. K

The problem of adherence to treatment of patients with coronary artery disease currently requires an integrated approach, as it is socially significant. Despite a wide range of drugs, adherence to therapy remains low, which leads to an increase in the frequency of hospitalizations and acute coronary events. In this connection, it is necessary to search for new ways to increase the level of compliance in patients with coronary artery disease. The aim was to compare the level of adherence to treatment in patients with an unstable and stable form of angina pectoris. The study of compliance involved 220 patients with a verified diagnosis of coronary artery disease, according to clinical recommendations, in accordance with the principles of the Helsinki Declaration. To assess the level of compliance, the questionnaire R. V. Kadyrov was used. It was found that the main form of coronary heart disease in the examined patient population was an unstable form of angina pectoris, regardless of gender and age. The study of gender characteristics showed that men were significantly more likely to suffer from an unstable form of angina pectoris. The level of general compliance was high in patients of both groups, while social, emotional and behavioral adherence to treatment was significantly lower in patients with unstable angina, regardless of gender and age. There was a direct correlation between overall compliance and disease duration in all patients with coronary artery disease, regardless of gender and age, which can be regarded as a poor prognostic sign for assessing the effectiveness and course of coronary artery disease. Compliance should be assessed not only by the general level of compliance, but also taking into account certain types of adherence to treatment and biological factors. At present, one of the important components is the assessment of behavioral compliance, which, in our opinion, should be supplemented by the cognitive and communicative component of the personality.

The article presents a clinical case of cirrhosis of the liver of class C according to Child – Pugh in the outcome of chronic hepatitis C and with the development of primary liver cancer. It is shown that early diagnosis of primary liver cancer and timely initiation of antiviral therapy with a direct antiviral drug led to compensation for cirrhosis of the liver, despite the COVID-19. The course of the new coronavirus infection was complicated by hepatic cell insufficiency and encephalopathy, which required observation and treatment in the intensive care unit. Intensive therapy was carried out with the restoration of the functional state of the liver. However, the patient developed acute psychosis, and therefore he was transferred to the neurological department. The patient was discharged in a satisfactory condition with compensation for cirrhosis of the liver. Subsequently, ligation of varicose veins of the esophagus was performed, which reduced the risk of bleeding. After compensation for cirrhosis of the liver, therapy with direct antiviral drugs was prescribed. After 4 weeks from the start of antiviral therapy, HCV RNA was not detected. However, after completing the course of treatment with an ultra-sensitive polymerase chain reaction method, the hepatitis C virus was again detected, which required the extension of antiviral therapy off-label by the medical commission for another 8 weeks. Adequate antiviral therapy contributed to the cure of chronic hepatitis C, and transarterial chemoembolization of the tumor allowed to stabilize the process for the waiting stage of liver transplantation. According to the control magnetic resonance imaging, after 6 months, the stabilization of the tumor node in the liver remains, no other tumor nodes were detected. The alpha-fetoprotein level is normal. Given the continuing effect, the second course of transarterial chemoembolization is not shown. Further observation of an infectious disease specialist, oncologist continues, a consultation with a transplant specialist is recommended, control magnetic resonance imaging of abdominal organs with intravenous contrast and alpha-fetoprotein every 3 months.

Chronic bacterial prostatitis reduces the reproductive function of men and worsens the quality of life. Impairment of the immune system in chronic bacterial prostatitis requires immunocorrection and use of additional immunomodulatory therapy. The objective of this multicenter, double-blind, randomized, placebo-controlled clinical trial was to prove the efficacy and safety of the recombinant interferon alpha-2b preparation and highly active antioxidants (vitamins E and C) in complex therapy in patients with chronic bacterial prostatitis. Men aged 18 to 50 years with a diagnosis of chronic bacterial prostatitis of category II or IIIA (N = 140) were randomized into two groups. Patients in the main group (N = 70) received interferon alpha-2b, rectal suppositories 1,000,000 IU (20 days bid), and patients in the comparison group (N = 70) received placebo as described above. All patients received levofloxacin (500 mg/day, 28 days) as antibiotic therapy. The efficacy of treatment was assessed by clinical questionnaires, bacteriological and microscopic analyses, frequency of chronic bacterial prostatitis relapses within 6 months from the start of treatment, and by ultrasound and urodynamic testing. The efficacy was evaluated at the end of additional therapy, at the end of antibiotic therapy and six months after the start of treatment. Clinical symptoms of chronic bacterial prostatitis decreased in both groups within 20 days after the start of treatment. However, interferon alpha-2b therapy reduced the average number of leukocytes in the prostate secretion/third urine specimen by 2.6 (95% CI: 1.6-4.4) times by the end of interferon therapy, by 4.2 (95% CI: 2.4-7.2) times by the end of antibiotic therapy and by 5.4 (95% CI: 3.4-8.3) times by the end of follow-up period compared to placebo (p < 0.001). The proportion of patients with prostate secretion microbiota was 20% lower in interferon alpha-2b compared to Placebo group (p = 0.013). Thus, complex interferon alpha-2b therapy improved chronic bacterial prostatitis resolution by accelerating the elimination of bacteria and reducing inflammatory and proliferative processes in the prostate. Interferon alpha-2b had no safety concerns and was well tolerated by patients.

The aimed of this study was to evaluate the effectiveness of a gluten-free diet in patients with IgA nephropathy (IGAN). The study included 65 patients with morphologically verified IGAN aged from 18 to 63 years who were on inpatient treatment at the Main Military Clinical Hospital named after academical N. N. Burdenko from 2020 to 2022. Immunological markers were used as a screening method for determining gluten metabolism disorders: IgA antibodies to tissue transglutaminase and IgA antibodies to deamidated gliadin peptides in the blood. Depending on the level of antibodies, the patients were divided into two groups: group 1 – patients with antibody levels exceeding the reference values and group 2 – patients whose antibody levels did not exceed the reference values, or there were no antibodies at all. Patients were prescribed nephroprotective therapy according to clinical recommendations, in addition, all in group 1 and group 2 patients with proteinuria levels > 0.5 g/day and/or pre-reference values of antibodies in the blood were additionally prescribed a gluten-free diet for at least 6 months. Against the background of the treatment with the use of gluten-free diet in group 1 patients, a decrease in daily proteinuria was noted in 66.7% of patients and erythrocyturia in 77.8% of patients, there is a tendency to decrease the level of creatinine in the blood serum, which indicates the nephroprotective effect of gluten-free diet. The severity of erythrocyturia against the background of HD also decreased in 76.2% of patients from group 2. The frequency of controlled arterial hypertension increased to 90% in patients of both groups. Thus, the introduction of gluten-free diet into the diet of patients with IGAN is justified, as it expands the possibilities of nephroprotective therapy.

Some populations, such as those with HIV infection, may have an inadequate immune response to the coronavirus disease 2019 (COVID-19) vaccine. For these populations, administration of monoclonal antibodies may provide some additional protection. The aim of the study was to evaluate the incidence and outcomes of COVID-19 in patients with HIV infection while using the drug thixagevimab/ cilgavimab as a pre-exposure prophylaxis for a new coronavirus infection.A retrospective non-randomized study was conducted in patients with HIV infection (n = 182) who were administered thixagevimab 150 mg/cilgavimab 150 mg. The mean age of the patients was 41 years. There were 107 men and 75 women. The duration of HIV infection at the time of the study was 6.5 years. All patients were taking antiretroviral therapy. Side effects in the form of drowsiness and subfebrile fever were observed in 1.6% of patients. There was an increase in the titer of antibodies of the IgG class to SARS-CoV-2 coronavirus up to 422.12 ± 8.48 cU/ml, an increase in the average level of CD4-lymphocytes up to 407.92 ± 16.24 with a median of 450 cells/μl, a decrease in the viral load of RNA HIV up to 85.60 ± 9.50 copies/ml. No cases of novel coronavirus infection were registered among patients who received thixagevimab/cilgavimab during the study period. This study shows that thixagevimab 150 mg/cilgavimab 150 is effective in reducing the risk of SARS-CoV-2 infection and COVID-19 hospitalization in patients with HIV infection. The drug may be offered to those who cannot be vaccinated against COVID-19 to provide additional protection.

In the structure of morbidity in the Russian Federation, respiratory system diseases are in the lead, among which acute respiratory viral infections and bronchitis are make up the majority, as well the leaders in the number of disability cases. The respiratory tract damage mechanisms in viral infections are diverse and require the use of a wide range of drugs. The pathology of the respiratory system in the vast majority of cases is accompanied by the development of cough as a key syndrome, reflecting the severity of the respiratory system, and the tension of the defense systems. When an infectious agent (usually a viral etiology) enters the respiratory system, several pathways for the formation of a pathological cough are triggered: inflammation products have a trigger effect on bronchial chemoreceptors, increasing the sensitivity of all cough receptors, causing expansion of mucosal microvessels, hypersecretion of glands. A violation of mucociliary clearance becomes inevitable along with changes in the volume and viscosity of sputum, which further aggravates the severity of cough and the patient's condition. The use of mucociliary transport stimulants is justified by their most important theirproperties. Carbocysteine, in addition to long-known effects (mucoregulatory, mucolytic, the ability to improve mucociliary transport), also has anti-inflammatory, immunomodulatory and antioxidant effects, which determines its importance in the acute respiratory viral infections and bronchitis treatment. Carbocisteine is recognized by the Russian Respiratory Society, the Scientific and Practical Council of the Ministry of Health of the Russian Federation, the National Medical Association of Otorhinolaryngologists, the Russian Union of Pediatricians as an effective active ingredient for the treatment of diseases of the upper and lower respiratory tract, which is reflected in the relevant modern recommendations of the Ministry of Health for the treatment of bronchitis in children, chronic bronchitis in adults, chronic obstructive pulmonary disease, acute sinusitis and acute otitis media in children and adults. The use of drugs with new pharmacological characteristics improves patient compliance.

The study was conducted to study and analyze the clinical and epidemiological aspects of human echinococcal lesions in the Astrakhan region for 2001-2020. In total, 182 cases of human infection with echinococcus were registered during the analyzed period. The largest number of cases was observed from 2008 to 2016 – 121 (66.5%) cases. Echinococcosis was registered in both men – 70 (38.5%) and women – 112 (61.5%). The age of those infected with echinococcus ranged from 5 to 83 years. Most often – 156 (85.7%) patients aged 17 and older were infected with echinococcosis. The number of children with echinococcosis was 26 (14.3%). Most often, the parasite was localized in its typical places (liver, one or both lungs, liver and lung) – 175 (96.2%) cases. The preliminary diagnosis of "Echinococcosis" was made mainly on the basis of clinical symptoms and complaints of patients – 168 (92.3%). The correct diagnosis – suspicion of echinococcal invasion was made in 157 (86.3%) cases, including echinococcosis of the liver – 129 (82.2%), lung – 11 (7.0%), liver and lung – 7 (4.5%), rare localization (echinococcosis of the heart, kidney and brain, retroperitoneal echinococcosis echinococcosis of the abdominal cavity and bladder, echinococcosis of the subdiaphragmatic space, echinococcosis of the liver, lumbar muscle and brain, echinococcosis of the liver and right shoulder, echinococcosis of the spleen, echinococcosis of the kidney, echinococcosis of both lungs, parasitic cysts of the abdominal cavity) – 1 (0.6%). To confirm the final diagnosis, all patients underwent an immunological blood test (the method of enzyme immunoassay), which showed the presence of antibodies to echinococcal antigens in 160 (87.9%) people. The problem of infection with echinococcus in the Astrakhan region remains tense, as evidenced by the increase in the number of cases of this disease. The location of the parasite is not only the liver and/or one or both lungs, but also other internal organs. The main complaints of patients are pain in the supposed location of the parasitic cyst and severity in the epigastric region. The main methods of diagnosis of echinococcosis are enzyme immunoassay, computed tomography and ultrasound examination. The lack of timely surgical treatment of echinococcosis in the future can lead to a fatal outcome.