One of the common diseases that is increasingly associated with chronic pain is obesity. The association between pain and obesity is multifactorial and includes both changes in central pain perception and the potential development of systemic inflammatory mechanisms. Our purpose was to study the clinical characteristics of chronic pain syndrome in overweight and obese patients and compare it with the level of inflammatory markers. The study included 112 patients – 37 men and 75 women aged 18 to 65 years (mean age 40 [32; 49] years) with chronic pain syndrome – musculoskeletal pain of various localization, primary headaches. Participants were divided into three groups based on body mass index. The research methods included a general clinical assessment of the characteristics of the pain syndrome – the duration and number of exacerbations in the current year, the intensity of pain using a numerical pain rating scale (NPRS), the number of descriptors, laboratory examination at the time of exacerbation – ESR, C-reactive protein, IL-6, fibrinogen. Statistical analysis was carried out using the StatTech v. 2.6.1. Patients with obesity experience longer, more intense and more frequent exacerbations of chronic pain ((p = 0.010, p = 0.004, p = 0.004), more often pain affects the limbs (p = 0.018 for localization in the upper limbs and p = 0.002 for the lower, respectively). We found the correlation of pain intensity with ESR (ρ= 0.337, p < 0.001) and fibrinogen (ρ= 0.224, p < 0.037), statistically significant differences between the level of C-reactive protein and the number of exacerbations per year (p < 0.001) were revealed. The obesity negatively affects the course of chronic pain, provoking more frequent, intense, prolonged episodes, affecting the upper and lower extremities. Due to the dependence of the level of inflammatory markers on the body mass index and the identified relationship with the intensity of pain, it can be assumed that gradual weight gain may exacerbate the course of chronic pain syndrome. The specificity of the relationship between inflammatory markers and pain severity shown in the study suggests that the relationship between obesity and chronic pain is not direct but is likely mediated by various factors.

The paper presents two clinical cases demonstrating modern approaches and possibilities of personification of the therapeutic tactics of surgical rehabilitation of patients with defect-pseudoarthrosis of long bones. Both patients had a complex comorbid status and had previously been operated on repeatedly without success. The aim is to demonstrate the personification of the approach to the compensation of defects of long bones, taking into account the previous stages of treatment and concomitant pathology. A comprehensive study of the materials of outpatient and inpatient patient records, the results of clinical, instrumental and laboratory research methods was carried out, the proposed operational manuals are described in detail. The polyprophilic composition of the medical team of rehabilitation participants, a balanced and balanced tactical and technological approach in the aspect of "risks/possible result" in each of the above observations allowed us to calculate and achieve a good anatomical and functional outcome. Evaluating the tactics and stages of osteosynthesis in this case, we note that before the occurrence of complications against the background of COVID-19 in the form of a recurrence of pseudoarthrosis, the therapeutic measures taken were fairly standard, since the use of osteosynthesis capabilities in such situations is almost routine. However, the resulting failure required the development of personalized tactics for a new stage of treatment. The authors hope that the chosen extraordinary tactics and technology will bring long-awaited success in treatment, the first evidence of which can be considered the beginning of osteogenesis in the area of the junction of fragments after 2.5 months of surgery. The main factors of success are the personification of the approach, based on taking into account both local characteristics and the existing comorbid, as well as social aspects, a reasonable choice of the sequence and scope of surgical techniques and means of fixation, a team approach involving plastic surgeons, rehabilitologists and specialists of other interested profiles. In some cases, in the presence of serious risks and threats, the desire to achieve the maximum possible recovery should be deliberately sacrificed in favor of a certain clinical compromise that functionally suits the patient.

One of the main methods of treating osteoarthritis is the use of intra-articular injection of sodium hyaluronate, often called by doctors hyaluronic acid. The purpose of the work was to evaluate the convenience of administration and the effectiveness of the hyaluronic acid preparation (Flexotron® Plus) in real clinical practice. This article summarizes the practical experience of a very wide use by doctors in 382 patients of sodium hyaluronate with a molecular weight of 2-2.5 mDa (Flexotron® Plus). The study was observational in nature. Practitioners, in the course of their routine practice, administered a registered hyaluronic acid product called Flexotron® Plus twice with a one-week break; one week after the second injection, participants completed a standardized questionnaire that included questions about convenience, adverse effects, complications, and physicians' opinions about the effectiveness of therapy, its effect on pain and range of motion, and its safety. Also, based on the data of Japanese scientists S. Gotoh, J. Onaya, M. Abe, hyaluronic acid with a weight of 2-2.5 mDa should give the best analgesic effect due to a decrease in the level of bradykinin, we decided to check this conclusion. The average age of patients who received hyaluronic acid was 55.05 ± 11.8 years, of which 159 people (41.6%) were men, and 223 people (58.4%) were women. The vast majority – 82.7% of patients – had knee osteoarthritis. According to doctors, 89.7% of patients after the end of the course of treatment experienced a decrease in symptoms, the number of adverse reactions – namely, unexpressed pain after the introduction of the product into the joint did not exceed 4% and was of a short-term nature. Hyaluronic acid therapy is an effective and safe treatment for osteoarthritis. Flexotron® Plus has demonstrated a favorable safety profile and good results as assessed by practitioners on a large patient sample – 382 people. As the questionnaire data showed, most doctors noted complete or partial relief of pain, which confirmed the conclusions of S. Gotoh, J. Onaya, M. Abe.

Crohn's disease is a chronic multisystem autoimmune disease, prone to relapses, which affects all parts of the gastrointestinal tract, mainly the terminal part of the ileum and the initial part of the colon. Historically, the terms "terminal ileitis", "granulomatous enterocolitis" and "regional enterocolitis" were synonymous with CD in different historical periods. Terminal ileitis was defined as a chronic recurrent disease of the gastrointestinal tract of unclear etiology, characterized by a transmural segmental spread of the inflammatory process with the development of local and systemic complications. The disease is named after the American gastroenterologist Barril Bernard Krohn, who in 1932, together with two colleagues – Leon Ginzburg and Gordon D. Oppenheimer – published the first description of fourteen cases of the disease. The incidence of Crohn's disease has increased 4-6 times over the past 50 years and is 4-6 per 100.000 population, and the prevalence is about 70-75 per 100.000 population. The peak incidence occurs at the age of 15-35 years, and both men and women are equally often ill. The disease is characterized by transmural, segmental, granulomatous inflammation, the development of local and systemic complications, and can also affect the eyes, spine, skin and joints. The role of Mycobacterium paratuberculosis and the measles virus has been discussed at various times in the etiology of the disease. The commonality of the clinic of CD and intestinal tuberculosis, the presence of granulomas also made us think about the tuberculous etiology of Crohn's disease. One of the arguments in favor of the infectious theory was the positive effect of antibiotic therapy. In order for a patient to develop this disease, a genetic predisposition is necessary, manifested by defects in the intestinal immune system. In about 17% of cases, patients have blood relatives suffering from this disease. Crohn's disease and Bekhterev's disease (ankylosing spondylitis) are quite often combined. This article discusses the etiology and pathogenesis of Crohn's disease, the prevalence among the population based on the latest data, the issues of ee diagnosis and therapy. A clinical case of Crohn's disease in a 31-year-old patient at the regional clinical hospital No. 1 in Volgograd is described in detail.

Currently, there has been an increase in cases of inflammatory bowel disease with a late onset in elderly patients, which makes it urgent to study the pathogenesis, clinical features, diagnosis and treatment of inflammatory bowel disease in this age group. Up to 35% of inflammatory bowel disease cases are first diagnosed in patients over 60 years of age. In this category of patients low-manifest forms of inflammatory bowel disease are observed more often than others with a more frequent occurrence of extraintestinal manifestations. Genetics contribute less to the pathogenesis of inflammatory bowel disease and age-related changes (dysbacteriosis, impaired intestinal barrier function, dysregulation of the immune system and regeneration mechanisms) play a more significant role. Ulcerative colitis is more common in older adults. Asymptomatic forms prevail with a relatively stable course. When treating elderly patients the development of geriatric syndromes, multimorbidity, polypharmacy should be taken into account. Particular attention should be paid to the safety of therapy, while maintaining maximum adherence to treatment. Careless prescribing of glucocorticosteroids should be avoided, and if indicated, more often resort to steroid-sparing regimens, especially with the use of 5-aminosalicylic acid preparations, should be used. A prolonged form of mesalazine in the form of microgranules with a semipermeable membrane of ethyl cellulose has a pronounced clinical advantage with a minimal frequency of side effects among this group. When inducing remission in elderly patients with mild to moderate active ulcerative colitis topical glucocorticosteroids may be considered. The advantages of continuing therapy with 5-aminosalicylic acid preparations against the background of the use of genetically engineered biological preparations, thiopurines require further reflection. The risk of surgery in older patients with inflammatory bowel disease is comparable to that of inflammatory bowel disease onset at a young age and does not result in increased surgical morbidity or mortality compared with a younger cohort in the delayed postoperative period.

Drug-induced liver injury are one of the most frequent undesirable effects of drug therapy in tuberculosis patients. Hepatoprotective drugs of various origin and chemical composition are used for the correction and prevention of drug-induced liver injury. Currently, preparations of plant origin (from milk thistle, licorice, soy), animal origin, preparations of bile acids, and some others are isolated. At the same time, there is no consistent understanding of their effectiveness, as well as consistent application algorithms, since a number of drugs have been studied only in experimental or small observational clinical studies. The article presents the mechanisms of action of the main hepatoprotective drugs, provides the evidence base of their effectiveness, and also notes their shortcomings. The most studied hepatoprotective drugs in the treatment of drug-induced liver injury is milk thistle preparation, its effectiveness has been shown not only in the treatment of drug-induced liver injury, but also in their prevention, with simultaneous administration together with tuberculosis chemotherapy, mainly in patients who initially had a high risk of developing drug-induced liver injury. Glycyrrhizic acid (licorice preparation) has shown both high preventive efficacy and pronounced therapeutic effect in LPP caused by anti-tuberculosis drugs. Essential phospholipids (highly purified extract from soybeans), in combination with B vitamins, contribute to an increase in the activity and fluidity of hepatocyte membranes, their recovery, however, they have low bioavailability, ambiguous antioxidant potential and are effective only with the cholestatic nature of the lesion. Ursodeoxycholic acid preparations are highly effective – they reduce the level of hepatocyte apoptosis, prevent toxic effects on hepatocyte membranes and on the epithelium of the bile ducts, have antioxidant and choleretic effects. Ademethionine (a drug containing amino acids and their derivatives) has cytoprotective, antioxidant and anticholestatic effects, also has anti-neurotoxic and antidepressant effects. A combination of ademethionine, succinic acid, inosine and nicotinamide showed a good therapeutic effect, which allows to quickly reduce the severity of clinical symptoms of hepatotoxicity and normalize laboratory parameters. In general, the available data make it possible to effectively prevent and stop toxic liver lesions in the treatment of tuberculosis patients. A variety of hepatoprotective drugs with various pharmacological effects (anti-cytolytic, anti-cholestatic, anti-apoptotic, antioxidant, immunomodulatory) provide an opportunity for a rational choice of a drug in various clinical situations.

Gastrointestinal bezoars are an aggregation of undigested material that can be found in the gastrointestinal tract of humans and some animals. The composition and structure of these formations may be different. The etiology of an intragastric bezoar is multifactorial, including certain risk factors and predisposing factors such as comorbid medical disorders, anatomical abnormalities, and gastric motility disorders that contribute to the development of an intragastric bezoar. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobesoars. The most common type are phytobezoars, which consist of undigested fiber from vegetables or fruits. Phytobezoar is a bezoar, which is most often based on vegetable fiber. The formation of a phytobezoar in the stomach occurs as a result of eating large amounts of pine nuts, wild pears, and grapes. Separately, dispyrosbezoars are described, they are formed from persimmon, the viscous properties of which lead to the sticking of persimmon parts into a dense mass, followed by the formation of a lump. Most often, phytobezoars are formed in patients who had undergone surgery on the stomach. The article considers a clinical case of removal of a giant bezoar of the stomach stump, which was discovered 19 years after subtotal resection of the stomach because of a malignant neoplasm of the stomach T3N0M0 stage III. The size of the removed phytobezoar was 15 × 9 cm, it was dense, not elastic in consistency, oval in shape. Before removal from the cavity of the stomach stump, the bezoar was easily displaced by palpation of the stomach. On the cross section of the formation there were pieces of undigested plant fibers. According to the histological examination, it was found that the foreign body is represented by fibrous structures with large inclusions containing fiber. The described picture most of all corresponds to the vegetable origin of the bezoar. The remote formation of the stomach stump led to the exhaustion of patient, her body weight was 39 kg with a height of 163 cm, body mass index was 15 kg/m², the anemia of III severity was diagnosed. The authors of this article remind clinicians of the possibility of the formation of bezoars in the stomach cavity, especially in individuals who consume large amounts of fibrous plant foods, primarily persimmons and oranges.

The new coronavirus infection COVID-19 is a systemic disease associated with the involvement in the pathological process not only of the lungs with the development of respiratory failure, but also of cells of the gastrointestinal tract, which causes dysbiosis of the intestinal microbiota, thereby contributing to the development of interstitial inflammation in the intestinal wall. The purpose of our research was to evaluate the effectiveness of the use of the gelatin tannate in intestinal lesions in patients with a new coronavirus infection COVID-19. The study included 58 patients diagnosed with a new coronavirus infection COVID-19 aged 35 to 70 years, hospitalized in the infectious hospital of the State Autonomous Healthcare Institution of the Sverdlovsk region "City Clinical Hospital No. 40" of Yekaterinburg. The patients were divided into 2 groups: the main group (n = 26) of people who received gelatin tannate in the complex therapy, the second group (control, n = 32) who did not receive the cytomucoprotector Adiarin in the complex therapy. The study included the patients with COVID-19 infection with gastrointestinal manifestations confirmed by the results of the analysis of a smear from the nasopharynx and oropharynx for SARS-CoV-2 coronavirus by polymerase chain reaction. The exclusion criteria from the study were age over 70 years, concomitant pathology: diseases of the musculoskeletal system, chronic kidney disease, pregnancy, infection caused by the human immunodeficiency virus, oncohematological and lymphoproliferative diseases. Against the background of taking of gelatin tannate, the following phenomena were observed in the main group in comparison with the control group: a decrease in the duration of febrile syndrome by 1.2 times, diarrheal syndrome by 2.5 times, dyspeptic syndrome by 1.8 times; correlation between the frequency and duration of diarrheal syndrome and the severity of interstitial inflammation in the intestinal wall (r = 0.7, p < 0.01); immunomodulatory effect on the T-cell link of immunity. No side effects were observed.

The article presents an overview of current trends in the approach to the treatment of patients with short bowel syndrome, including examples of children's patients registered in the palliative care service for children of the Tyumen region. Short bowel syndrome is an extremely rare nosological unit in the practice of a clinician and, as a rule, patients with such a diagnosis need to organize a multidisciplinary approach to treatment, since it requires the involvement of specialists of various profiles, such as: pediatrician, surgeon, gastroenterologist, resuscitator, clinical nutrition specialist / nutritionist, psychologist, procedural nurse, as well as parents/legal representatives. The most common manifestations of the disease are symptoms of malabsorption: dumping syndrome, progressive loss of body weight, deficiency of macro- and micronutrients, stunting of growth and development of all organs and systems, other manifestations of dyspepsia and abdominal pain. Attention is drawn to the fact that the number and intensity of symptoms varies significantly among patients, which may depend on a number of factors (the level and volume of resection, residual length, functional safety of the residual segment, the presence of a stoma / stoma, or a restored intestinal tube, concomitant diseases and possible malformations). The traditional tactics of treating such patients include the need for lifelong parenteral nutrition or, as a forced measure, intestinal transplantation. Rehabilitation measures in children with short bowel syndrome should take into account the requirements of correction of impaired absorption and restoration of normal trophic status; relief of diarrhea, prevention and treatment of dysbiosis; control and correction of general digestive disorders, as well as comorbid conditions. The main alertness in the tactics of managing patients with short bowel syndrome is caused by the need for long-term constant parenteral nutrition, which entails a number of life-threatening risks, such as: catheter-associated conditions (sepsis and thrombosis, which, in addition to aggressive treatment, requires periodic replacement of the central venous access and threatens its complete loss), cholestasis with the outcome of cirrhosis, atrophy of the residual intestinal mucosa, impaired metabolism of D-lactate (with the risk of D-lactate acidosis and oxalates (with the formation of oxalate kidney stones), and also, especially in the absence of resection of the bauginia flap in the outcome, the appearance of excessive bacterial growth syndrome, accompanied by the danger of translocation of intestinal flora into its own plastic and subsequent intestinal-associated sepsis). After analyzing publications and evaluating the experience of working with children with short bowel syndrome in the Tyumen region, we found that the analogue of glucagon-like peptide 2 – teduglutide – makes it possible to reduce the volume of parenteral nutrition, infusion time, and also achieve a complete transition to enteral autonomy. The method of treatment with teduglutide is the most promising for patients of this category, as it reduces the risks associated with parenteral nutrition and improves the prognosis of later life.

The article presents a comparison of liquid and dry infant formula. The main difference between liquid and dry infant formula is that liquid mixtures are a sterile product, and dry mixtures are a non-sterile product. The sterility of the mixture is important for premature and underweight children, sick infants and children with weakened immunity. The dry mixture can be infected with Enterobacter sakazakii and Salmonella enterica bacteria, which cause diseases in children. In addition to sterility, there are other differences between liquid and dry formulas. Advantages of liquid mixtures: the mixture is ready for use, no water is required for cooking, dilution errors are excluded, saving time and labor. Disadvantages of liquid mixtures: limited assortment, short shelf life, the presence of protein glycation, there are no probiotics in the composition. Advantages of dry mixes: a wide range, the possibility of introducing probiotics, a long shelf life. Disadvantages of dry mixes: the product is not sterile, water is needed, dilution errors are possible, time spent on preparation. There is a gradual increase in demand for liquid ready-made infant formula all over the world. Currently, liquid mixtures for healthy children and premature infants are offered on our market. The domestic manufacturer produces unique liquid therapeutic formulas: comfort, soy and lactose-free mixture.

Congenital epidermolysis bullosa is a group of rare (orphan) diseases characterized by disruption of intercellular connections in the epidermis or epidermal-dermal junction and leading to the formation of blisters on the skin and/or mucous membranes even with minor injury. In addition to the violation of the integrity of the skin and the need to care for it, in patients with congenital epidermolysis bullosa, there is a lesion of the gastrointestinal tract, and therefore, the nutrition of children with congenital epidermolysis bullosa is of particular attention. The presence of multiple non-healing erosions and large transdermal losses of protein, serous fluid, and sometimes blood, as well as increased heat transfer, increase the need for energy and macronutrients in patients with congenital epidermolysis bullosa. Daily energy needs correspond to 115-150% of the age norms of consumption, and even more with pronounced erosion. The protein requirements are 115-200% of the age norm, in liquid – 150-200 ml/kg. Also, patients with congenital epidermolysis bullosa need to replenish ω-3 fatty acids, additional subsidies of microelements (zinc, iron, etc.) and vitamins (D, C, A, B₁₂, B₆, etc.). In case of formula feeding patient with BE it is extremely important to select appropriate formula. The loss of barrier properties by skin and mucous membranes causes an excessive intake of antigens, incl. allergens. Violation of barriers can cause sensitization to cow's milk proteins, with the subsequent development of a clinically significant allergy. In this regard, amino acid formula should be used as baseline nutrition, which ensure the absorption of nutrients under conditions of significant inhibition of the digestive tract's digesting and absorption capacity, and also minimize the antigenic load. Thus, patients with congenital epidermolysis bullosa require constant monitoring and assessment of nutritional status, with the earliest possible initiation of adequate nutritional support. Effective maintenance therapy and nutritional correction can improve the quality of life of patients and compensate for the loss of vital macro- and micronutrients.

Influenza and acute respiratory viral infections continue to occupy leading positions in the structure of infectious pathology. The high risk categories of the disease include pregnant women who, due to hormonal and physiological changes occurring in the body during the period of carrying a child, are at risk of developing severe/complicated course of respiratory infections, especially in the third trimester of pregnancy. A small number of medications that are effective and allowed to be used in women during gestation make it relevant to develop and implement new schemes for the prevention and treatment of acute respiratory viral infections in pregnant women. To date, one of the promising directions is the use of drugs that have antiviral properties and activate the functioning of the immune system, which would prevent the development of complications and prevent reproductive losses. The results of scientific studies devoted to evaluating the effectiveness and safety of the use of recombinant interferon α-2b with antioxidants for the prevention and treatment of influenza and acute respiratory infections in pregnant women are presented. The preventive use of recombinant interferon α-2b with antioxidants preparations (rectal suppositories or gel for external and topical use) in the form of mono- or combined systemic and topical forms makes it possible to achieve a significant reduction in the incidence of influenza and other acute respiratory infections, including COVID-19, reduce the frequency of pregnancy complications, increase the number of favorable perinatal outcomes and the birth of healthy children. The use of recombinant interferon α-2b drugs as a therapeutic agent in pregnant women in case of respiratory infections can reduce the overall duration of the disease and the period of intoxication, reduce the frequency of severe forms and complications of respiratory infections, significantly reduce the risk of premature birth and the birth of children with low body weight, reduce the frequency of exacerbations of chronic, including extragenital diseases of pregnant women. The conclusion is made about the expediency of including recombinant interferon α-2b with antioxidants drugs in the complex of preventive measures and basic therapy of influenza and acute respiratory infections in pregnant women.

Little is known about the behavior of antibodies associated with anti-phospholipid syndrome in syphilis. To investigate the patterns of antibodies associated with anti-phospholipid syndrome production in syphilitic infection. The serum level of anti-phospholipid antibodies was measured in 394 patients with different forms of syphilis, 85 of which were followed after treatment. The patients included in the study had complete anamnestic data that met all the necessary diagnostic criteria, and underwent all types of clinical and laboratory examinations to establish the diagnosis. To detect anti-bodies the ThromboCombo IgG/IgM ELISA Kit, Anti-Cardiolipin Screen, Anti-Cardiolipin ELISA (IgAGM), Anti-β2-Glycoprotein 1 ELISA (IgAMG) were used. The cut-off values for positive results were determined based on the manufacturer's recommendations. Comparisons of qualitative features were carried out using the chi-squared test (χ²) or Fisher tests, quantitative – t-test or Mann – Whitney U-test, with the level of significance adjusted to identify significantly different pairs in multiple comparisons using the Bonferroni procedure. The paired t-test or the Wilcoxon test was used to compare quantitative traits in related samples. Spearman's rank correlation method was used to assess the relationship. Anti-cardiolipin antibodies occurred with the greatest frequency in patients with secondary syphilis (81%). The frequency of anti-cardiolipin antibodies was significantly higher in primary (49%) and early latent (52%) syphilis compared with late latent syphilis (18%), neurosyphilis (15%) and serofast state (17%). The anti-cardiolipin antibodies level decreased shortly after initiation of treatment in patients with early syphilis, and lasted years at low values without changes in patients with late syphilis. The proportion of patients testing positive for beta-2-glycoprotein I antibodies did not differ significantly in all forms of syphilis (13-21%). No significant antibody response to phosphatidyl serine, phosphatidyl inositol, phosphatidic acid was observed in the patients with syphilis. Anti-cardiolipin antibodies may play a role in the development of complications in early stage syphilis and have utility in early diagnosis of syphilis, diagnosis of reinfection, and differential diagnosis of early and late forms. The screening for syphilis is recommend in subjects with first-episode of raised level of anti-cardiolipin antibodies.

In accordance with modern recommendations, healthy exclusively breastfed children do not need routine administration of additional fluid. The addition of healthy full-term newborns can lead to less active sucking of the baby, a decrease in lactation. Experts believe that additional drinking can be dangerous for children due to the development of diseases associated with the use of low-quality water. However, there are clinical situations where infants may need additional fluid. Supplementation of an infant can be indicated with a large decrease in body weight, conditions and diseases with an increase in body temperature above 38.0 °C, with dehydration, polycythemia, uric acid infarction, the use of radiant heat and phototherapy. Additional liquid injection to an infant may be advisable at elevated air temperature and low humidity in the room. Compliance with the drinking regime is important in infants with intestinal infections, overweight and constipation. In each case, the issue is resolved individually and the weight of the child, the degree of maturity, the compliance of anthropometry with the gestation period, the presence of exicosis and metabolic disorders are taken into account. In all cases, the child is offered boiled water. The keyword is "suggested". If the baby is willing to drink, then it means he needs extra fluid. Additional soldering is carried out from a spoon or syringe. The recommended amount of drinking per day corresponds to the volume of one feeding.