Any variant of acute leukemia is characterized by a severe course of the disease, a high incidence of complications and mortality. For a long time, there was an opinion that when verifying hemoblastoses during pregnancy, its termination is required. Currently, studies and experience accumulated have shown that in most cases, a complete treatment of hemoblastosis can be carried out during pregnancy without the risk for developing any complications for both a mother and a fetus. The entire range of diagnostic studies is also carried out fully. The safety of pregnant women performing such diagnostically significant procedures as bone marrow puncture biopsy has been repeatedly confirmed. In most cases, a lumbar puncture with a study of the cerebrospinal fluid is also feasible to rule out leukemic lesions of the central nervous system. The choice of treatment tactics is carried out by a doctor depending on the type of hemoblastosis and its stage. The main methods of treatment include multicomponent chemotherapy, supportive treatment, replacement transfusion therapy, extracorporeal methods. In the first trimester, there is a high probability of an unfavorable outcome of pregnancy for both the mother and the fetus. But currently, polychemotherapy schemes have been developed that can be used in this period of pregnancy. The delivery period in patients with acute leukemia is determined individually. The resumption of special therapy is recommended not earlier than 3-4 weeks after birth in order to minimize the risk of developing infectious and hemorrhagic complications in the postpartum period. If it is necessary to continue chemotherapy in the postpartum period, lactation should be suppressed in the patient, since most drugs penetrate into mother's milk. The specific chemotherapy carried out does not exclude the possibility of developing various pathological conditions that can be regarded as complications of cytostatic therapy, because these conditions can also occur during a healthy pregnancy as a result of spontaneous mutations and the development of congenital anomalies in the fetus. In the 2ndand 3d trimesters, polychemotherapy is used with the drugs that are not able to overcome the hematoplacental barrier. Thus, the management of pregnancy in patients with acute leukemia is a difficult task, which is addressed by the joint efforts of hematologists and obstetricians and gynecologists.

The aim was to evaluate the efficacy of intestinal automicroflora medications use in complex therapy in patients with psoriasis vulgaris. The study involved 80 patients with advanced psoriasis vulgaris (mean age 40.5 ± 6.6 years) and 40 dermatologically healthy individuals. The presence and severity of the main intestinal symptoms were determined using the GSRS questionnaire, the quality of life was assessed according to the results of the DLQI dermatological questionnaire, and the severity of psoriasis was determined using the PASI index. The main group of patients with psoriasis vulgaris was divided into two groups depending on the treatment: group I received standard therapy for psoriasis, group II – combined treatment, including standard therapy, correction of microelement status and intestinal automicroflora medications. The results of the study are presented as M ± SD. Statistical data processing, reliability of results at p < 0.05. Results: the average value of the PASI index in patients of the main group was 48.88 ± 9.27 points, according to the DLQI questionnaire – 19.48 ± 6.25 points. According to the GSRS questionnaire, a high prevalence and severity of the main intestinal syndromes in the group of patients with psoriasis vulgaris was established, statistically significant of them – pain, dyspepsia and constipation (p < 0.05). After complex treatment, including standard therapy for the psoriasis vulgaris treatment, correction of the microelement status and oral administration of intestinal automicroflora preparations, there was significant decrease in the prevalence and severity of the main gastroenterological syndromes, a decrease in the PASI index (9.55 ± 4.00 points) and improvement quality of life DLQI (8.40 ± 5.24 points), in comparison with the group of patients receiving standard therapy, where the PASI index after treatment was 47.42 ± 11.22 points, the dermatological index of quality of life DLQI was 15.87 ± 3.84 points. The use of automicroflora preparations is highly effective and can be used in the treatment of not only gastroenterological diseases, but also in the complex therapy of psoriasis vulgaris.

Dermatomyositis is a systemic disease, mainly of autoimmune Genesis, which is characterized by lesions of skeletal and smooth muscles, skin and mucous membranes. The multi-organ nature of the pathological process determines the polymorphism of clinical manifestations of the disease. In addition to pathognomonic symptoms for dermatomyositis, in the form of gradually increasing lesions of striated muscles, heliotropic rash, symptoms of Gottron and Keining, the disease is also characterized by a large number of malospecific changes. Often, hyperkeratosis, atrophy, vesicular-bullous and ulcerative rashes, dysphagia and reflux esophagitis, colitis and enteritis, pneumonia, fibrous alveolitis and hypoventilation syndrome, heart lesions become dominant. To date, the disease is considered as an idiopathic immune-mediated pathological process that develops in the presence of a genetic predisposition in response to the action of provoking environmental factors. Among hereditary markers of dermatomyositis, changes in the major histocompatibility complex, as well as in genes encoding cytokines, have been described. Trigger factors can be long-term chronic infections, physical and mental trauma, hyperinsolation, vaccination, and certain medications. Numerous cases of combination of dermatomyositis with oncological pathology and systemic connective tissue diseases are described in the literature. The scarcity and low specificity of the symptoms of the disease can lead to a long diagnostic search, while the involvement in the pathological process of several body systems makes patients turn to doctors of various profiles. Thus, dermatomyositis is an interdisciplinary problem, hence the increased awareness of doctors of related specialties can contribute to clinical alertness. In this regard, we present our own observation of a patient with dermatomyositis, which was accompanied by atypical rashes, polysyndromnostyu, as well as the absence of myositis-specific autoantibodies, which required an expanded laboratory and instrumental diagnosis (including to exclude paraneoplastic polymyositis).

Scabies is one of the most common parasitic dermatoses. A disease caused by the scabies mite Sarcoptes (Acaris) scabiei hominis. The fertilized female parasite lives in passages that she gnaws in the stratum corneum of the epidermis and lays eggs there. After 8 days, larvae emerge from the eggs, which, gnawing through the tire of the course, crawl out. By the 28th day after the introduction of the parasite into the skin, the second generation of sexually mature parasites develops. Scabies is transmitted from person to person, as a result of direct contact, during a joint night's sleep, through linen, bedding. Over the past 10 years in Russia, there has been a decrease in the incidence of scabies from 92.4 thousand cases in 2010 to 22 thousand in 2019. Intensive rates are 64.7 and 15 per 100 thousand of the population, respectively. Scabies has its own characteristics in infancy and childhood, therefore, knowledge of the main symptoms of this pathology is necessary for all doctors of the district service and pediatric and other hospitals. The purpose of the study was to assess the epidemiological situation of scabies and to establish the frequency of occurrence of the main symptoms of the disease in children in the Astrakhan region. Material and methods of research: the sources of information were the official data of Rospotrebnadzor on scabies, for the period from 2013 to 2020, and 120 case histories of patients under the age of 17 who were treated for infectious diseases in the State Budgetary Healthcare Institution of the Astrakhan region "Regional Infectious Clinical Hospital named after A. M. Nichogi". The results of the study: It was found that the epidemic process of the spread of scabies in children in Astrakhan region, in the period from 2013 to 2020, exceeds the average in Russia with a tendency to decrease in 2020 by 1.6 times, compared with 2013, the most significant risk group for the spread of scabies were children aged 7 to 14 years. The main signs that make it possible to establish the presence of scabies were: itching of the skin at night, the presence of scabies, detection of the parasite. The detection of scabies in organized preschool and school-age children, when hospitalized in hospitals, may indicate a formal approach to examination for scabies in institutions visited by a child. The article also describes approaches to the drug treatment of scabies.

In choosing the therapeutic tactics of osteoarthritis, a personalized approach should be used, depending on the prevalence of the pathological process and the presence of background diseases. According to Russian and foreign recommendations, groups of delayedacting drugs that structurally modify cartilage are used as the basic pharmacotherapy of osteoarthritis from the first stages (symptomatic slow-active drug in osteoarthritis – SYSADOA). The aim of this study was to evaluate the efficacy and safety of therapy with an injectable chondroprotector in patients with primary and secondary osteoarthritis of various localizations after a stationary course of basic therapy for rheumatoid arthritis, ankylosing spondylitis, or exacerbation of primary osteoarthritis. The study included 30 patients with rheumatic diseases diagnosed with primary or secondary osteoarthritis against the background of rheumatoid arthritis and ankylosing spondylitis. After a course of basic therapy in the hospital at the outpatient stage, patients received an injectable chondroprotector 1 ml intramuscularly 1 time per day for 20 days according to the instructions for medical use. A comprehensive examination of patients was carried out at the inpatient stage. The severity of the pain syndrome was assessed using a 100 mm visual analogue scale. The degree of pain control was assessed by patients 30 ± 7 days after the start of treatment. Therapy with an injectable chondroprotector in patients with primary and secondary osteoarthritis of various localization makes it possible to achieve a statistically significant decrease in the severity of pain syndrome and improve the functional state of the joints in most patients. The therapy is characterized by a high safety profile and good tolerability. It allows not only to more effectively relieve pain in patients with primary and secondary osteoarthritis, but also to improve the safety of treatment by reducing the risk of adverse events while taking non-steroidal anti-inflammatory drugs, which is especially important given the comorbid profile of most patients with rheumatic joint diseases.

The article presents the results of applying the method of corrective action in case of combined (longitudinal-transverse flat feet and postural asymmetry by electrical stimulation using various pulsed currents to change the functional state of muscles and nerves for therapeutic purposes in combination with a foot massager of the thermotherapeutic personal myostimulating apparatus. The scientific study was organized by the All-Russian public organization "Russian Association for Sports Medicine and Rehabilitation of Patients and Disabled People" on the basis of the Federal State Budgetary Institution Federal Scientific and Clinical Center for Sports Medicine of the Federal Medical and Biological Agency of Russia by a doctor in physical therapy, candidate of medical sciences Karmazin V. V. The purpose of this study was to evaluate the effect of the myostimulating function of the device on the postural stereotype of patients with combined flat feet and revealed, according to baropodometry, asymmetry in the distribution of axial load under the feet.The study involved 10 patients with diagnosed flat feet of varying severity and identified support asymmetry of more than 5% displacement to the right or left. All patients included in the group of subjects underwent procedures on the apparatus. Evaluation of the effectiveness of the electrostimulating effect was made on the basis of the subjects undergoing a course of correction with the electromyostimulation apparatus in the amount of 7-8 procedures with the passage of baropodometry after each procedure. According to the results of the procedures, 70% of the subjects, according to baropodometry, revealed a decrease in pressure in the area of the longitudinal arch of the foot, towards which the initial shift of the general center of pressure under the feet was observed. It was also found that the device really has an effective electromyostimulating effect on the muscles of the foot. The need for further scientific study on the impact of the device (electromyostimulation in combination with hyperthermia) and the creation of scientifically based programs for methods of correcting not only flat feet, but various foot pathologies, including those accompanied by pain syndrome of varying severity (plantar fasciitis, stress fractures of bones) metatarsus, tendonitis, ligamentitis, etc.).

A breakthrough in the treatment of infectious diseases occurred with the advent of the era of antibiotics. Epidemiological studies on intracellular pathogens such as mycoplasmas, chlamydia, campylobacter and legionella in the 20th century served as an incentive for the development and introduction into the clinic of new macrolide antibiotics with improved pharmacokinetic and microbiological parameters. High bioavailability, low dosages and low frequency of administration, a wide spectrum of action on pathogens, good clinical and biological tolerance of new generations of macrolides contributed to the improvement of clinical efficacy in the treatment of many infectious diseases and bacterial complications in surgical practice. To date, there are three generations of representatives of this group, one of them is azithromycin. This antibiotic was obtained by modifying erythromycin by including a nitrogen atom in the lactone ring between the 9th and 10th carbon atoms, while the ring becomes 15-membered. The ability of azithromycin to concentrate in macrophages, affect proteins of the barrier activity of the respiratory tract epithelium, exhibit an antifibrotic effect with the ability to remodel connective tissue, as well as exhibit antiviral activity, antioxidant and immunomodulatory effects, allows positioning this macrolide as a promising anti-inflammatory pharmacological agent with a wide range of applications in various pathological conditions states. In the last decade, progressive clinical and in vitro studies have indicated a growing acceptance of the pharmacological profile of azithromycin as a drug.

In routine practice, neurologists and doctors of related specialties often have to deal with complaints of cognitive impairment in young and middle-aged patients, such as deterioration of memory and performance, decreased concentration, increased distraction, difficulties in learning and acquiring new professional skills. Such complaints in people of working age require special attention, differential diagnosis, identification of the root causes of such complaints. In order to objectify the presence and clarify the nature of the cognitive defect, all patients with cognitive complaints, in addition to assessing the neurological status, need to conduct a neuropsychological study with an assessment of the emotional and behavioral sphere. At the international arena, modifiable factors of cognitive impairment have been identified for people aged 45 to 60 years, among which there is arterial hypertension. Recommendations for maintaining cognitive health are formulated in order to prevent the deepening of cognitive defect. Medicamentous therapy of cognitive disorders of varying severity remains a subject for discussion, the accumulation of evidence continues. A number of experts believe that at the stage of mild and moderate cognitive disorders, it is advisable to influence the glutamatergic, noradrenergic, dopaminergic neurotransmitter systems. The expediency of prescribing a combination of vascular and nootropic active substances, including as part of combined preparations, is indicated. Such medications include the drug, containing an extract of the leaves of ginkgo biloba and nicotinoyl gamma-aminobutyric acid. For each of these components, there is a pathogenetic justification for efficacy in mild and moderate cognitive disorders. The efficacy of the drug in cognitive deficits in patients, including middle-aged, was confirmed in a multicenter randomized open comparative study of the clinical efficacy and safety of the drug in patients with cognitive impairment and chronic cerebral ischemia, which was conducted in 5 clinical centers located in Russia. In patients with vascular cognitive impairment, including middle-aged, an increase in scores on neurocognitive scales was shown against the background of the use of the combined drug, significantly superior to monotherapy with a drug based on ginkgo biloba. The positive dynamics was especially significant in patients with arterial hypertension. The authors of the study concluded that the combined drug is an effective and promising tool for the treatment of cognitive impairment in patients with chronic cerebral ischemia, including the middle age category.

The results of treatment of 123 patients with diabetic foot syndrome were analyzed. According to modern concepts, the leading cause of the development of diabetic foot syndrome and subsequent amputation is diabetic polyneuropathy of the lower extremities. The latter and associated foot deformities, as well as the loss of protective pain sensitivity, lead to spontaneous ulcerative defects in the soft tissues of the foot with their further infection and the development of a purulent-necrotic process. Their dermographic data, anamnesis, clinical manifestations and the course of the disease, the state of compensation of carbohydrate and lipid metabolism were studied. The severity of neuropathy, its clinical manifestations, the presence of ulcerative-necrotic lesions, their origin, the presence of concomitant macroangiopathy of the lower extremities, the condition of the bones of the foot, the presence of manifestations of microangiopathy were determined. A study was also conducted on the effectiveness and tolerability of patients with different doses of alpha-lipoic acid preparations (600, 900 and 1200 mg per day), which was used for the etiotropic treatment of neuropathy. The effect of alpha-lipoic acid on the treatment of diabetic neuropathy in patients suffering from purulent-necrotic forms of diabetic foot syndrome was studied. The high efficiency of the use of this group of drugs, both in standard and in increased doses, has been established. The study demonstrated that parenteral administration of alpha-lipoic acid preparations, both at a dose of 600 mg, and 900 and 1200 mg per day, is equally well tolerated by patients, does not cause significantly significant side effects and allows us to recommend the use of this group of drugs intravenously, followed by the use of 600 mg /day orally in the treatment of patients with diabetic foot syndrome complicated by ulcerative necrotic process. 

One of the most severe common diseases in abdominal surgery requiring emergency surgical intervention is acute colonic obstruction. The focus of purulent inflammation in the abdominal cavity serves as a source of concentration of antimicrobial mechanisms, among which the central role is played by neutrophilic granulocytes and factors cooperating with them. The target was to study the indicators of oxygen metabolism of neutrophilic granulocytes at the stage of the postoperative period in patients with ABO and a marker of increasing endotoxinemia. The article reflects effective approaches to monitoring the course of the postoperative period in 157 patients operated on for acute colonic obstruction. The main group (first) consisted of 97 (61.78%) patients, in the abdominal cavity of which a purulent-inflammatory process was detected. The comparison group (second) included 60 (38.22%) patients with a smooth course of the disease. The control group consisted of 23 conditionally healthy people. Special research methods included the assessment of the state of the microbicidal function of neutrophilic granulocytes using reactive spontaneous (SSLCL) and zymosan-induced luminol-dependent chemiluminescence tests (ILZHL). Specific indicators of humoral AB immunity were recorded by determining the concentration of antibodies to lipopolysaccharide (LPS) antigens of E. coli O14, glycolipid (HLP) of Pseudomonas aeruginosa Re-mutant, Proteus mirabilis. An analysis of the SLCL parameters in all patients upon admission revealed their significant increase, and in the main group it persisted for 7-8 days. A different dynamics of neutrophilic granulocytes biocidal activity was noted in these patients during the study of AB protection. Through a dynamic study of the indicators of oxygen metabolism and specific antiendotoxin immunity of gram-negative intestinal microflora, their direct dependence on the clinical course and the development of pyoinflammatory complications was established. It was noted that 2-3 days after the surgical intervention in patients of the main group, there was a significant decrease in the indicators of HLP, LPS E. coli O14 and Proteus mirabilis, which closely correlated with the lack of reserves of antimicrobial biocidal activity of neutrophilic granulocytes. Delayed stabilization of indicators preceded an unfavorable outcome of the course of the disease. The relationship between the parameters of oxygen metabolism of neutrophilic granulocytes and specific antiendotoxin immunity was established, which reflects the nature of the course of the postoperative period in patients with AIO. Testing of indicators of the biocidal reserve of neutrophilic granulocytes according to the reaction of ILZHL can be used as a screening indication of the prognosis of the course of the postoperative period and the formation of pyoinflammatory complications.