Background. Juvenile idiopathic arthritis (JIA) is an arthritis of unknown cause, lasting more than 6 weeks, developing in children under the age of 16 years with the exclusion of other joint pathology. The incidence of JIA ranges from 2 to 16 per 100 thousand children under the age of 16. The prevalence of JIA in different countries ranges from 0.05 to 0.6%. On the territory of the Russian Federation, the prevalence of JIA in children under 18 years of age reaches 62.3 per 100 thousand children, the primary incidence is 16.2 per 100 thousand, including adolescents, respectively, 116.4 per 100 thousand. children's population and 28.3 per 100 thousand children's population, children under 14 years of age — 45.8 per 100 thousand children's population and 12.6 per 100 thousand children's population. Girls get sick more often. In the etiology of JIA, a combination of various exogenous and endogenous damaging factors and hypersensitivity of the body to their effects plays a role. Pathogenetically, as a result of the presentation of a foreign antigen to T-lymphocytes, activation and proliferation of T-lymphocytes occur with the production of proinflammatory cytokines (IL-1, IL-6, IL-8, IL-17, tumor necrosis factor α, etc.). Macrophages, activated fibroblasts, synoviocytes are also involved in this process, which causes a cascade of pathological changes with the development of progressive inflammation in the joint cavity and systemic manifestations of the disease, resulting in the transformation of acute immune inflammation (characteristic of the early stage of juvenile arthritis) into chronic with the development of pannus and irreversible destruction of joint structures. Involvement of the B-cell link of the immune system leads to the production of a large number of autoantibodies, stimulation of eosinophils and mast cells, as well as the development of allergic reactions. The main clinical manifestation of JIA is progressive gradual destruction of joints, which is often accompanied by extra-articular manifestations, such as fever, rashes, lymphadenopathy, weight loss, which disrupts the growth and development of the child, negatively affects the quality of life. Juvenile arthritis is one of the most frequent and most disabling childhood rheumatic diseases. Objective. This article presents a clinical case of juvenile idiopathic arthritis in a 15-year-old child.

Results. The data of clinical and paraclinical examination of the patient, medical documentation, scientific literature were analyzed. Modern approaches to the management of pediatric patients with this pathology are presented. The peculiarity of this clinical case is the debut at 5 years old, which is prognostically unfavorable, high laboratory activity of the process, high risk of structural progression of the disease, impossibility of diagnosis according to the international classification of diseases of the tenth revision. The difficulty of the clinical case is the difficulty of achieving stable remission, which is based on the ineffectiveness of therapy with sulfasalazine, sulfasalazine + methotrexate, adalimumab + methotrexate, adalimumab, golimumab.

Conclusion. It turned out to be possible to achieve stable remission only with the help of therapy with secukinumab (cosentix), prescribed by off label, against the background of therapy, which achieved a reduction in pain syndrome, a decrease in the degree of activity of arthritis, a decrease in laboratory markers of inflammation, improvements in the clinical and radiological picture, restoration of the volume of movements in the joints and improvement of the patient's functionality, a significant improvement in well-being and quality patient's life.

Objective. The article summarizes the results of many years of own scientific and practical research on the subject of pharmacopuncture – a peculiar way of stimulating reflexology points (otherwise, acupuncture) with small doses of drugs. The "object" of the work carried out was dorsopathy at the lumbosacral level, the choice of which was explained by obvious reasons – the widest coverage of the population, the protracted course and the severity of the consequences. The aim of the study is to clarify the main mechanisms and therapeutic possibilities of pharmacopuncture with various medicines used in the case of vertebrogenic pathology.

Results. In accordance with this goal, the material reflected in the article reveals the mechanisms, technique and effectiveness of local stimulation performed by complex medicines. As part of the statement of priority – in 2002, for the first time in the country, our textbook "Pharmacopuncture" was presented with the stamp of the UMO of Russian Universities, and a program of postgraduate training of specialists lasting 144 hours was developed. In the course of their own research on this topic, the addition and even potentiation of the reflex and drug links of the method under consideration was noted. In particular, favorable changes in the status of patients, observed against the background of pharmacopuncture with complex medicines, were accompanied by a significant improvement in the results of psychological testing and electrophysiological examination. In a series of parallel studies, the significant superiority of pharmacopuncture with Alflutop over the compared methods was manifested, in addition to clinical effects, in positive structural-modifying changes in the intervertebral discs. Using the same medication, an original effective scheme of therapeutic effects was proposed, combining the techniques of blockade according to the method of A. V. Vishnevsky and pharmacopuncture. Particular attention should be paid to the noted fact of enhancing the effectiveness of local drug stimulation due to the combined use of modern hardware techniques. As part of the branch from the main topic, the method was applied to vertebro-somatic weights, manifested in the form of male sexual disorders.

Conclusion. As for the overall result of the work performed, the efficacy and therapeutic reliability of pharmacopuncture performed in lumbosacral dorsopathies with drugs of various registers has been generally confirmed. At the same time, the noted differences in the achieved effects associated with the peculiarities of the applied local stimulation techniques open up the possibility of individualizing their purpose.

Background. Non-alcoholic fatty liver disease occupies a leading position among the causes of diffuse liver diseases, both in Russia and in the world, while there is a steady upward trend in the incidence, especially in the cohort of patients with metabolic risk factors. In Russia, over the past 7 years, the number of patients suffering from non-alcoholic fatty liver disease has increased by 10%. However, the prevalence of non-alcoholic fatty liver disease appears to be much higher because the first-line imaging test, ultrasonography, has limited sensitivity. Morphological criteria of the disease is the presence of steatosis in more than 5% of hepatocytes. The disease is associated with disorders of carbohydrate metabolism – insulin resistance and is more of a general term that includes the main forms of the disease: non-alcoholic fatty hepatosis, steatohepatitis, the outcomes of which are fibrosis and cirrhosis.

Objective. To discuss the effects and therapeutic targets of ursodeoxycholic acid drugs in the complex therapy of non-alcoholic fatty liver disease.

Results. The goal of therapeutic measures in non-alcoholic fatty liver disease is to prevent the development of steatosis by acting on modifiable risk factors, and if it is present, prevent the progression of steatosis to non-alcoholic steatohepatitis, liver fibrosis, and reduce the risk of cardiovascular complications. Particular attention is paid to the use of the drug ursodeoxycholic acid.

Conclusion. The experimental and clinical data accumulated to date indicate that ursodeoxycholic acid is a pleiotropic drug, the main effects of which are: a decrease in the severity of insulin resistance and steatosis, lipotoxicity, and normalization of the blood lipid spectrum

Background. Hyperamylasemia is a phenomenon not uncommon in clinical practice, and its immediate cause needs to be identified. Usually, increased blood amylase levels are considered as part of the involvement of the pancreas in the pathological process in pancreatitis, traumatic injuries, pancreatic tumors. However, there is a fairly wide range of so-called extrapancreatichyperamylasemias, including a variety of conditions – pathology of the salivary glands, a wide range of surgical diseases, paraneoplastic manifestations, and a recently described state of macroamylasemia. The diagnostic process in patients with hyperamylasemia has not been fully established and sometimes can be challenging.

Objective. The article presents a clinical case of acute enterocolitis in a young man, accompanied by increased blood amylase levels.

Results. A clinical case of detecting a high blood amylase level in a patient with acute gastroenteritis is presented. Subsequent study led to the diagnosis of acute Salmonella pancreatitis that developed secondary to Salmonella enterocolitis. The article describes the differential diagnosis process to identify the cause of increased blood amylase levels and rule out various causes of extrapancreatic hyperamylasemia. An example of calculation of the amylase-to-creatinine clearance ratio used for the differential diagnosis of macroamylasemia is presented. The discussion presents the literature on the characteristics of pancreatitis manifestations in the context of salmonellosis. This pathology is regarded as rare. According to the literature, which is consistent with the discussed clinical case, pancreatitis in salmonellosis usually has certain characteristics: a mild course without severe pain, manifested mainly by hyperamylasemia and/or hyperlipasemia, often not requiring aggressive treatment. A catamnesis is presented – observation of the patient at two and five months after the initial hospitalization; it showed the disappearance of complaints and the gradual normalization of laboratory results.

Conclusion. Understanding the reasons for increased blood amylase levels in patients with salmonellosis can help in the diagnosis of an uncommon manifestation of Salmonella pancreatitis.

Background. Dietary modification (DM) is at the heart of the treatment of obesity and related disorders. Young age is the period when preventive interventions are most effective and modification of behavioral factors will prevent the development of pathology. In recent years, in Russia and other developed countries, there has been a steady increase in the number of people with metabolic disorders. Discussion of the problem of eating behavior is extremely important both for the health of an individual and for the healthcare system as a whole. Studying types of eating behavior, understanding the motivational factors that determine eating behavior, eating patterns and food preferences, helps explain why there is a craving for certain food choices and how to modify this behavior.

Objective. The aim of the study is to study the characteristics of eating behavior in young patients.

Material and methods. The study is open, one-moment, transverse. The study included 147 patients who were university students, average age 23.4 ± 3.3 years (18-44 years), 48 (32.65%) men, 99 (67.35%) women with a BMI of 24.96 kg/m 2 (SD = 10.57). The study used two questionnaires to assess the characteristics of DM: The Dutch Eating Questionnaire and The Roman Questionnaire for Neuroorthorexia.

Results. In young people, 45.58 percent of the cases showed DM in the Dutch questionnaire and 40.82 percent showed signs of nervous orthorexia in the Rome questionnaire. According to the Dutch questionnaire, the external type of DM was more often defined (61.22%), less often – restrictive (36.73%; n = 54) and emotional (45.58%; n = 34) types (p < 0.01 for both cases). Mix multiple types according to The Dutch Questionnaire were reported DM in 49.66% of patients. Neuroorthorexia was always combined with a restrictive type of DM. Positive direct correlation DM expression with BMI was recorded only in the external type of DM (rs = 0.41; p < 0.05).

Objective. To propose a patient-oriented approach to the management of a patient with irritable bowel syndrome based on the identified phenotypes of the disease.

Materials and methods. Based on a comprehensive analysis of the interaction of genetic and epigenetic factors, the characteristics of the phenotypes of irritable bowel syndrome have been identified and presented. For each phenotype, individualized treatment regimens for the disease have been developed and tested. To evaluate the effectiveness of the proposed patient-oriented approaches, an open cohort, prospective, randomized study in parallel groups was conducted.

Results. With post-infectious irritable bowel syndrome, patients are recommended to prescribe a strain of Lactobacillus paracasei CNCMI1572, as well as correction of eating habits with restriction of salt and products containing lactose. With the phenotype of irritable bowel syndrome with overweight and obesity, patients were offered the restriction of foods with a high glycemic index, the additional appointment of ademetionine, as well as a synbiotic containing inulin, strains of Bifidobacteriumlactis Bl-04, Lactobacillusacidophilus La-14, Lactobacillusrhamnosus Lr-32 and B vitamins In the comorbid phenotype, it is advisable to prescribe the cytoprotector rebamipide. Additionally, a correction of the diet is necessary with the exclusion of trigger foods. With the essential phenotype, patients are recommended to take the probiotic strain Bifidobacterium longum 35624. The use of the proposed patient-oriented strategies in addition to standard therapy made it possible to achieve more effective relief of clinical manifestations and reduce the severity of irritable bowel syndrome, improve mental well-being, and reduce the frequency of relapses of the disease.

Conclusion. The proposed patient-oriented approaches to the management of a patient with irritable bowel syndrome based on the identified disease phenotypes can be considered as one of the possible ways to improve the effectiveness of disease therapy.

Background. Numerous studies on the investigation of genetic risk factors for ischemic stroke development prove the multifactorial nature of the pathology, when several genes are simultaneously involved in its development, which have a determinative effect on various links of its pathogenesis. Revelation of the genetic predispositions for stroke development is an important factor in its primary and secondary prevention, especially in young and middle-aged people hereditary tainted.

Objective. To develop comprehensive clinical and genetic criteria for various pathogenetic variants of ischemic stroke (IS) to control the preventive measures for primary and secondary disorders of cerebral circulation.

Materials and methods. The genetic, clinical and laboratory results of the examination of 280 patients with ischemic stroke (IS) have been analyzed. Group I consisted of young age patients, n = 180, aged 22 to 45 years (mean age 33.4 ± 6.57), including 55% of women and 45% of men. 38 young age patients of group I (21,11%) experienced recurrent ischemic stroke. Group II included elderly patients with ischemic stroke (n = 50), aged 52 to 100 years (mean age 73.4 ± 8.24 years), including 70% of women and 30% of men. Group III, the control one, consisted of apparently healthy young age individuals (n = 50), aged 20 to 43 years (mean age 31.5 ± 5.82 years), including 45% of women and 55% of men. Venous blood tests were once performed in all the subjects to reveal genetic polymorphisms of the hemostasis system, the immune response, the endothelial function, and the lipid metabolism. Results. Significant factors of the probability of ischemic stroke development due to polymorphism of genes controlling hyperhomocysteinemia have been revealed: methylenetetrahydrofolate reductase MTHFR (A1298C) (р = 0,012),methionine synthase MTR (A2756G) (р = 0,014), methylenetetrahydrofolate reductase MTHFR (C677T) (р = 0,024); arterial hypertension: angiotensin receptor IIAGTR1 (A1166C) (р = 0,097), G-protein beta 3 GNB3 (C 825T) (р = 0,108); immune response: interleukin-6 (G-174 C) (р = 0,007); aspirin resistance: platelet receptor fibrinogen GP III a (HPA1-1 a/1 b) р = 0,0883; plasminogen activator inhibitor PAI-1 (5G/4G) (р = 0,106). A higher coefficient of ischemic stroke development (1.79 = 0.07), depending on genetic polymorphism, has been revealed in young people than in elderly patients and healthy donors. It has been established that the presence of mutations in the genes controlling hyperhomocysteinemia, the immune response, and the blood clotting system is of important pathogenetic importance in predicting the risk of ischemic stroke at a young age. The data obtained indicate the expediency of including genetic research in the standard of ischemic stroke diagnosis in young people, which will allow us to optimize diagnostic methods and develop the measures to prevent recurrent cases of the pathology.

Conclusion. The study of the contribution of risk factors to the probability of ischemic stroke development has led us to the development of the methodology for primary and secondary prevention of cerebral infarction, which currently is a topical task, the solution of which lies both in the fields of medical genetics and clinical neurology

Background. Despite the fact that in most cases the appearance of pressure ulcers can be prevented, this problem continues to be relevant, affecting up to 30 million patients in the general population. Pressure ulcers are a serious medical, social and economic problem, having a significant impact not only on the general well-being of the patient, but also on the quality of his life on the physical, emotional and psychological levels. At the same time, this disease requires serious financial costs for the treatment of one patient. Pressure ulcer (lat. decubitus) is a local damage to the skin and underlying tissues, which can be caused by prolonged exposure to continuous pressure on the tissues. The most significant risk factors for the formation of pressure ulcers include old age, cognitive impairment, limited motor activity of patients, as well as comorbid conditions, such as urinary and fecal incontinence, edema, microcirculation disorders, hypoalbuminemia, malnutrition and lack of proper care. The syndrome of prolonged compression with the subsequent development of microcirculatory disorders plays a key role in the development of pressure ulcers. Pressure ulcers are formed in places of greatest compression, where there is practically no subcutaneous fat in the area of bone or cartilaginous protrusions. Usually pressure ulcers occur on the surface of the skin above the sacrum and coccyx, the spinous processes of the spine, the calcaneus, the areas of the elbow and knee joints, the acromial process and the spine of the scapula. High-quality and regular patient care, which can be carried out both at home and in a hospital, is the best prevention of the development of pressure ulcers. In addition to care, an important role is played by medical supervision, which allows you to stop both the further progression of pressure ulcers and the development of complications.

Results. Approaches of the prevention and treatment of pressure ulcers are considered, a clinical case is given.

Conclusion. Treatment of pressure ulcers is a complex and time-consuming task that requires significant economic and human resources, an integrated interdisciplinary approach. The basic principle of the treatment of pressure ulcers is the adequacy of the selected treatment, based on the stage of the pressure ulcer process. In this regard, it remains relevant not only to search for new, effective methods of treating this pathology, but also to optimize the work of middle and junior care staff, as well as the active introduction of an integrated, interdisciplinary approach in the prevention and treatment of pressure ulcers.

Background. In Russia, the number of people suffering from acute respiratory viral infection and influenza annually reaches more than 30 million people, and the annual total economic damage from acute respiratory viral infection is estimated at 40 billion rubles, accounting for about 80% of the damage from all infectious diseases and reaching up to 90% and more in the structure of infectious diseases. On average, an adult suffers from 2 to 4 colds during the year, a child gets sick from 6 to 9 times. A patient with acute respiratory viral infection and influenza needs effective outpatient treatment, since acute respiratory viral disease and influenza are accompanied by disability and are associated with a high probability of developing complications, including life-threatening ones. Of scientific and practical interest is the development of approaches to the treatment and prevention of acute respiratory viral infections in adults, which can be widely used on an outpatient basis. Objective. The purpose of the study was to evaluate the efficacy and safety of the use of interferon alpha-2b (rectal suppositories) for the treatment of acute respiratory viral infections and influenza in patients who sought medical help at the primary care stage.

Materials and methods. A comparative, prospective, open study was conducted involving 60 patients with acute respiratory viral disease. Group 1 (n = 30) received interferon alpha-2b (rectal suppositories) 3 000 000 IU twice a day the treatment of the disease. In group 2 (n = 30) therapy was carried out in accordance with the recommendations for acute respiratory viral disease in adults of the Ministry of Health of the Russian Federation in 2022. Results. In group 1, there was a reduction in the period of fever (1.5 days shorter, relief of all symptoms was observed in an average of 7 days (in the comparison group for 9.5 days), the duration of days of disability was also 3 days less than in comparison group.

Conclusion. the use of interferon alpha-2b (rectal suppositories) as part of the complex therapy of acute respiratory viral infections and influenza can reduce the treatment time, both in terms of accelerating the regression of symptoms and reducing the period of disability, which will improve the quality of life, reduce the likelihood of complications, reduce economic losses of the patient and society

Background. Crohn's disease (CD) in childhood and adolescence most often proceeds in severe forms and is often accompanied by complications that significantly impair social adaptation and quality of life not only because of the disease but also as a consequence of surgical interventions. Objective. The report describes a clinical case of a patient 13 years old with Crohn's disease of the small and large intestine diagnosed for the first time at the Department of Gastroenterology, Moscow State Medical and Preventive Dispensary Hospital. Results. Initiation of genetically engineered biological therapy (GЕBT) with the first-line drug Infliximab was indicated. On day 16 of the infusions, echo signs of occlusive thrombosis of the left internal jugular vein were detected. Despite heparin therapy, occlusive thrombosis of the left internal jugular vein and pulmonary embolism (РЕ) developed and the child was transferred to the intensive care unit (ICU) for vital signs. After 7 days in the ICU, the patient was transferred to the gastroenterological department and subsequently discharged home with improvement. Three weeks later, he was hospitalized again for a third infusion of GЕBT and 8 weeks later for a fourth dose of Infliximab. The patient completed the course of treatment with positive dynamics and marked clinical and endoscopic improvements. He was discharged to the outpatient phase of treatment in satisfactory condition with the final diagnosis: "Crohn's disease of the small and large intestine, marked activity, (PCDAI 85) debut. Esophageal candidiasis. Nonspecific reactive hepatitis." The article is of interest for doctors of practical health care in terms of medical education on the problem of inflammatory bowel diseases.

Background. Dandy – Walker syndrome (Dandy – Walker syndrome) is a combined malformation of the brain, the identification of which may be an indication for expanding the diagnostic search in order to detect other malformations or chromosomal pathologies. It is characterized by dysgenesis of the cerebellar vermis, cystic enlargement of the fourth ventricle and an enlarged posterior cranial fossa, as a result of which the sinuses of the meninges and the cerebellum are shifted. The frequency of occurrence ranges from 1:5000 to 1:25000. Agenesia or hypoplasia of the cerebellar vermis in combination with other malformations of the brain are diagnosed already with screening ultrasound scanning of the fetus, however, the diagnosis of Dandy – Walker syndrome is made only after birth based on the manifestations of this syndrome during neuroimaging and genetic studies. In addition to the above changes in the cerebellum, Dandy – Walker syndrome is associated with hydrocephalus, agenesis of the corpus callosum, and other malformations of the central nervous system. The mechanism of development of hydrocephalus in Dandy – Walker syndrome is due to the blockage of normal spinal blood flow, resulting in defects in the holes of Magendie and Luschka. It is characterized by a wide clinical polymorphism. Basically, the first clinical symptoms are diagnosed already in the neonatal period.

Objective. The article presents the course of Dandy – Walker syndrome in a child with trisomy 18 (Edwards syndrome).

Conclusion. The unfavorable course of this syndrome is most often associated with the presence of concomitant pathology. The severity of clinical manifestations depends on the variant of the syndrome and the rate of progression of disorders. It is often diagnosed in children with chromosomal abnormalities, which complicates the period of early neonatal adaptation, requires the organization of special care and surgical correction of existing malformations. The presence of an infectious process in children with Dandy – Walker syndrome and chromosomal abnormalities can lead to multiple organ failure and deterioration of the child's condition.

Objective. The article presents a description of a clinical case of autodestructive dermatosis of the facial skin, resolved by foci of cicatricial changes in the skin. The diagnosis of a psychodermatological disorder was confirmed by a psychiatrist and a dermatologist, based on clinical and anamnestic data, and a histological examination.

Results. The initial referral to a dermatovenereologist, discrepancy between the anamnesis and the clinical picture of the disease, atypical dynamics of the skin process, the location of skin lesions in localizations accessible to the patient's hands, an unusual, unnatural configuration of the rash elements, and a predominantly linear nature, served as the basis for suspicions of the presence of skin self-damage. The patient was informed about the suspicion of an autodestructive skin disease and a doubt in the diagnosis was recorded, a denial of the fact of self-damage of the skin. If the patient was in doubt about the diagnosis, a histological examination of the skin biopsy was performed with confirmation of autodestruction and referral for a consultation with a psychiatrist. The psychiatrist diagnosed a generalized anxiety disorder requiring long-term use of escitalopram. At the same time, symptomatic dermatological treatment was prescribed. Due to the patient's disregard for the psychiatrist's prescriptions, there was a progression of the manifestations of the psychopathological process (aggravation of anxiety, anxiety, fatigue, irritability, perfectionism) and an increase in the size of self-harm foci.

Conclusion. The effectiveness of therapy is determined by the patient's readiness to accept a psychiatric diagnosis and long-term use of medications that normalize the psycho-emotional state and, consequently, lead to the prevention of dermatological self-harm and remission of psychogenic symptoms. It is necessary to create the patient's motivation for recovery with joint dispensary observation of a psychiatrist and a dermatologist.

Background. Antibody-Dependent Enhancement is an alternative route for virus entry into the target cells. In this process, cross-reactive antiviral antibodies improve the access of the virus to cells through interaction with specific receptors (complement receptors and Fc receptor on the cell surface), which leads to worsening of the infection. This phenomenon has been widely studied in dengue fever, however, at present its contribution to the pathogenesis of other viral infections remains poorly understood.

Results. It has been shown that the development of Antibody-Dependent Enhancement in dengue fever occurs with a secondary infection, in the case of infection with a different serotype of the virus from the primary infection. Antibodies produced during a primary infection are not able to completely neutralize another serotype of the virus, but instead bind to the virus and Fc receptors on cells, which contributes to increased penetration of the virus into these cells, increased replication and the development of a "cytokine storm" leading to increased capillary leakage and the development of hemorrhagic form of dengue fever. It has been noted that the development of Antibody-Dependent Enhancement in coronavirus infections in animals seriously aggravates the course of the disease, however, the contribution of this syndrome to the COVID-19 clinic manifestations is poorly understood, while the constant change in the dominant virus genetic variant creates prerequisites for re-infection. Numerous studies of the Antibody-Dependent Enhancement made it possible to describe the possible mechanisms of its occurrence and to determine the necessary conditions for its development.

Conclusion. Of particular concern is the phenomenon of a vaccine-associated enhancement of viral infection, which leads to a worsening of the viral infection with the formation of non-protective antibodies in patients after immunization. The introduction of vector vaccines into clinical practice has led to a significant increase in the risk of breakthrough infections and severe forms, which imposes restrictions on the use of these vaccines, and creates increased requirements for their development and testing.

Objective. We studied risk factors of severe COVID-19, comorbid and concomitant diseases, structure of mortality in patients during the 6th wave of the pandemic who died in the hospital.

Materials and methods. The study included 220 patients with coronavirus pneumonia.

Results. The majority of patients with coronavirus pneumonia who died in a hospital had pneumonia (90,0%). At the same time, moderate lung damage prevailed – pneumonia with stage CT-1 (34,5%) and CT-2 (30,5%), less often – severe pneumonia (stage CT – 3-4 (28.4%)). Laboratory verification of the SARS-CoV-2 virus was confirmed in the vast majority of cases (97,5 %). A high frequency of comorbid diseases and underlying pathology was found in deceased patients with viral pneumonia: arterial hypertension (92,7%), cerebrovascular disease (87,3%), coronary artery disease (93,2%), chronic kidney disease (80,5%), peripheral arterial diseases (47,3%), type 2 diabetes mellitus (type 2 diabetes) and atrial fibrillation – in every third patient (36,4% and 34,1%), and one in five is obese (20,0%). Acute respiratory distress syndrome (68,6%) and much less often – stroke (18,2%), acute myocardial infarction (6,4%) and pulmonary embolism (6,8%) were the main causes of death in patients with SARS-CoV-2 pneumonia. In patients with fatal pneumonia caused by SARS-CoV-2, there is a high frequency of comorbid conditions and risk factors leading to a severe course of the disease: hypertension, coronary artery disease, severe chronic heart failure, advanced age (> 75 years), chronic kidney disease stages C3-C5, peripheral arterial diseases, obesity and type 2 diabetes. Among the deceased women with coronavirus pneumonia COVID-19, such cardiovascular risk factors as age > 75 years, type 2 diabetes, CHF stage 2 (A and B), obesity of 2-3 degrees, chronic microcytic anemia prevailed; among the dead men – smoking and chronic obstructive pulmonary disease, atrial fibrillation, severe chronic heart failure.

Background. At present, infection caused by the SARS-CoV-2 virus is one of the most urgent problems of infectious pathology. The total number of cases of a new coronavirus infection in the Russian Federation exceeded 22 million, of which more than 398 thousand cases were fatal.All resources of the healthcare organizations around the world were thrown into the fight against the coronavirus pandemic, which affected the quality of medical care for patients with other diseases. During the pandemic, data have been accumulated on the peculiarities of the course of COVID-19 infection, the clinical manifestations of which are variable: from an asymptomatic course to the development of massive lung damage and acute respiratory distress syndrome. Risk factors for severe COVID-19 are age over 60 years, comorbid background, including immunodeficiency conditions. Oncohematological diseases are associated with the highest risk of death from COVID-19. A particular danger is the development of COVID-19 infection in a time interval of less than 14 days from the course of antitumor therapy. Hodgkin's lymphoma is a localized or disseminated proliferation of cells of the lymphoreticular system, which can affect the lymph nodes, spleen, liver or bone marrow. Due to the progressive insufficiency of cellular and humoral immunity of the underlying pathology, as well as suppressing the immune response of treatment, such patients have a high risk of infection with SARSCoV-2, severe course.

Objective. The present article describes a clinical case of COVID-19 with the development of severe respiratory distress syndrome against the background of a critical lesion of the lung tissue in an immunosuppressive patient.

Results. The dynamics of the patient's condition against the background of respiratory support is described, and laboratory parameters during treatment are given. Despite the high mortality among patients with oncohematology, in connection with the previous immunosuppressive and toxic therapy, the outcome of the disease in this patient was favorable due to the timely detection of SARS-CoV-2, hospitalization in the hospital, as well as the correct tactics of treating the patient.