Background. "Quality of life" includes 12 parameters reflecting socio-economic conditions and cultural and moral aspects of human life. The state of health is an integral component of the quality of life. Without health, social functioning becomes impossible. The study of the quality of life reflects a more complete picture of the disease, and also shows the effectiveness of therapeutic and restorative measures in patients. Of particular relevance is the assessment of the quality of life of patients with respiratory pathology, given its leading position among the child population for many years.

Objective. The presence of connective tissue dysplasia in children with diseases of the lower respiratory tract, it contributes to the development of severe and complicated forms of the disease, as well as disability of patients. In this regard, the study of the quality of life of patients in this category is necessary.

Materials and methods. During the study of the quality of life of 237 children with bronchopulmonary diseases in the age range from 2 to 18 years, a detailed examination was conducted, including a questionnaire, anamnesis collection, physical examination, laboratory (hemogram; determination of the level of type I collagen C-terminal telopeptide), functional (electrocardiography, computer flowmetry). In the presence of indications, patients underwent an X-ray examination of the chest organs, an examination by a neurologist, a medical geneticist, an orthopedist. The presence of DST was established when at least 6 clinical and instrumental markers of connective tissue disorders were detected in the patient, involvement of at least 2 body systems, an increase in the level of type I collagen C-terminal telopeptide.

Conclusion. Connective tissue dysplasia negatively affects the quality of life of patients with bronchopulmonary pathology, reducing the level of psychosocial functioning of children with bronchial asthma and acute bronchitis and limiting physical functioning in patients with community-acquired pneumonia, which is due to a more severe course and prolonged persistence of symptoms of the disease.

Background. In patients with frequent exacerbations of chronic obstructive pulmonary disease occurring against the background of hypertension, there is a high level of personal neuroticism, the presence of signs characteristic of a depressive response in the emotional state and behavior, as well as a decrease in the need for communication and significant changes in the emotional state. Objective. To reveal psychosomatic features of the course of arterial hypertension in chronic obstructive pulmonary disease with frequent exacerbations.

Materials and methods. The observational analytical cohort study included 183 patients with AH and chronic obstructive pulmonary disease aged 45-60 years, from Novosibirsk City Clinical Hospital No. 2, which were divided into 2 groups I – arterial hypertension and chronic obstructive pulmonary disease without frequent exacerbations and II – Hypertension with frequent exacerbations of chronic obstructive pulmonary disease (more than 2 times a year. Data from home and "office" blood pressure monitoring and psychodiagnostic tools were evaluated. Anxiety and depression status was assessed using validated diagnostic methods: the Hospital Anxiety and Depression Scale and the Hamilton Rating Scale for Depression.In addition to the formalized automated evaluation of the above criteria, an expert evaluation of psychological testing data was carried out. Computer analysis of the results of this study was carried out using the SAS, USA statistical software package using standard variational algorithms. statistics. When analyzing intergroup differences in indicators measured on an interval scale, the values of Student's t-test were calculated using the corresponding formulas.

Results. The presence of a statistically significant frequency of anxiety-depressive syndrome was revealed in persons with frequent exacerbations of chronic obstructive pulmonary disease in arterial hypertension, so, according to the results of the Hospital Anxiety and Depression Scale "Mixed anxiety and depressive disorder", it was noted in 68%, significantly (p < 0.05) more often in compared with patients with hypertension and chronic obstructive pulmonary disease without frequent exacerbations. Of these, 72% of patients had an anxiety syndrome and 32% – a depressive syndrome, p < 0.001 and p = 0.001, respectively. It was found that in persons with frequent exacerbations of chronic obstructive pulmonary disease and anxiety-depressive syndrome, uncontrolled hypertension was detected significantly more often than in those examined without TDS (p < 0.0001). It has been proven that persons with signs of TDS had higher levels of SBP (p < 0.003) compared to persons without TDS (p = 0.001). To clarify the nature of depressive disorders, the Hamilton Rating Scale for Depression was used, according to which depressive disorders of 77% were found in most patients of the 2nd group (p = 0.003). An expert evaluation of psychological testing data showed that subclinical depression was observed in 24%, clinically significant depression was observed in 46%, and major depression in 8% of hypertensive patients with frequent exacerbations of chronic obstructive pulmonary disease.

Background. This article provides contemporary data on the epidemiology, pathogenesis, classification and treatment of asthenic syndrome. The pathogenesis of asthenic syndrome and the physiological substrate of asthenic symptom complex are analyzed in detail: persistent feeling of fatigue, malaise, loss of energy, lack of resources for work and any activity, muscle weakness, sleep disorders, hyperesthesia, affective disorders, etc. The central nature of asthenic manifestations is emphasized, which is often unrelated to the nature and severity of somatic disorder – the provocateur of asthenic syndrome.

Objective. The modern concept of the pathogenetic mechanism of asthenia development is considered, which is confirmed by neuroimaging data, the phenomenon of central hypothalamic sensitization and its clinical significance, influence on the course of asthenic disorder are analyzed. An integrated classification of asthenic disorders, convenient for use in real clinical practice, is given, possible ways of coding asthenia according to the current classification of diseases of the 10th revision are listed, separately for asthenic disorders associated with COVID-19.

Results. The necessity of differential diagnosis of asthenia and chronic fatigue syndrome (myalgic encephalomyelitis) with the introduction of revised diagnostic criteria of the latter is indicated. Examples of the clinical significance of asthenic syndrome are given, some diseases accompanied by the development of asthenization in patients are listed, including rare clinical situations are described. The vector of treatment of asthenia with the use of non-drug methods and drug therapy is indicated. The current data on pathogenetically justified drug treatment are selected, the results of modern research are presented.

Conclusion. Attention is focused on the mechanism of action and clinical data on the use of a nootropic drug with a dopaminergic effect, its antiasthenic activity, and safety.

Objective. A review of modern Russian and foreign, mainly English-language, literature on autism spectrum disorders and their prevalence in the world was carried out. Publications no older than 5 years, published in specialized medical journals and manuals, were taken into account. An updated concept of autism in early childhood and adolescence was described. Eligible observational study designs for our review included observational descriptive and analytical case-control studies and cohort studies.

Objective. Currently, every hundredth inhabitant of the planet suffers from autism and there is a steady increase in this problem according to the World Health Organization. The review provides comparative data across countries, highlighting countries with the highest/lowest rates of autism. In addition, a report on monitoring autism spectrum disorders in the Russian Federation was presented, which revealed the dynamics of an increase in numbers compared to 2021 by 17%, the increase amounted to 6,771 people and the main percentage of the country’s demographic development, in relation to natural population growth, falls on its remote regions. parts where, unfortunately, there are no specialists in this area.

Conclusion. Despite the fact that a lot of experience has been accumulated in the foreign practice of inclusive education of children with special educational needs, and many publications are devoted to this problem, this potential cannot be used in a modern Russian school without adapting and taking into account the characteristics of the domestic educational system. In addition, at present, inclusive education of children with autism spectrum disorders is a hotly debated scientific and practical problem and has both supporters and opponents. Also, there is still not a sufficient number of scientific studies that would evaluate the effectiveness and success of inclusive education for children with autism spectrum disorders. Thus, the evolution of views on the nature of autism in domestic and foreign child psychiatry concludes to be of endogenous origin. It should be noted that in the deontological aspect, such an approach may have its advantages, but in therapy and prognosis it is not without its disadvantages.

Background. Dorsalgia is recognized as one of the global health problems. The pathogenetic basis of nonspecific back pain is the involvement of the muscular-ligamentous complex, intervertebral disc, facet joint and neural structures in the pathological degenerative process. The starting point for these processes can be considered changes that occur in chondrocytes, leading to the destruction of cartilage and a slowdown in its repair. This process is accompanied by degradation of the extracellular matrix with loss of glycosa minoglycans. Understanding the pathogenetic component of vertebrogenic pain dictates the need for an integrated approach in the treatment of this group of patients.

Objective. To evaluate the effectiveness of complex therapy for pain caused by degenerative-dystrophic changes in the spine.

Materials and methods. 30 patients with radiological signs of spondylosis and spondyloarthrosis of stage 2-3 took part in the study. All patients received complex therapy with non-steroidal anti-inflammatory drugs and an injection course of chondroprotector. The results were assessed using questionnaires and scales: VAS pain assessment and health assessment, EUROQOL-5D quality of life questionnaire, Oswestry questionnaire.

Results. Against the background of complex treatment, pronounced positive dynamics were noted in the form of regression of pain syndrome on the VAS scale from 69 (56-75) to 10 (0-15), p < 0.001 by the end of therapy. Improving the quality of life of patients according to the Osversti questionnaire (%): moderate impairments (28 ± 10) before therapy, after completion of the course minimal impairments (7 ± 5), p < 0.001. The majority of patients, 60% (n = 18), were not taking non-steroidal anti-inflammatory drugs before inclusion in the study, and already at the start of complex therapy, 28% (n = 5) were able to completely stop taking non-steroidal anti-inflammatory drugs, noting a decrease in pain and an increase in motor activity.

Conclusion. The observational study showed the positive effect of an integrated approach in the treatment of patients with exacerbation of vertebrogenic pain – a combination of non-steroidal anti-inflammatory drugs with the chondroprotector, making it possible to significantly reduce the duration of a course of non-steroidal anti-inflammatory drugs or avoid its prescription in case of moderate pain syndrome.

Background. Anxiety and depressive disorders are very common mental disorders, which are based on a pathological reaction to stress. The gut microbiota is a kind of foundation that provides bidirectional communication within the microbiota-gut-brain axis through neurological, metabolic, hormonal and immunological signaling pathways. Numerous negative environmental influences and stresses lead to the gut microbiota imbalance and its functional activity disorders and also violate the interaction within the microbiota-gut-brain axis. Long-term gut microbiocenosis disorders can cause the development of neuropsychiatric diseases and in future they can become factors of their progression, triggering a cascade of new pathological processes.

Objective. The review article presents modern views and evidence base, indicating the effectiveness of the use of psychobiotics in anxiety and depressive disorders and stress.

Results. Probiotic contains Lactobacillus plantarum DR7, which is a proprietary psychobiotic able to modulate the gut-brain axis contributing to a balanced mental well-being. Its mechanism of action can be synthetised in three main functions: modulation of gut microbiota, regulation of neurotransmitter pathways and reduction of inflammatory molecules. Thanks to its complex, specific mechanism of action that targets the gut-brain axis, probiotic shows relevant, clinically proven benefits to fight back stress and anxiety in patients with Anxiety and depressive disorders.

Conclusion. Gut microbiota is a promising target for therapeutic effects in mental disorders induced by stress. Modern targeted probiotics, psychobiotics, can be administered in order to increase the effectiveness of complex therapy.

Background. The article highlights the key points of the report on the feeding of premature infants at the outpatient stage, presented by the chief researcher of the Laboratory of Nutrition of healthy and sick children of the National Medical Research Center for Children's Health of the Ministry of Health of the Russian Federation, Professor of the Department of Neonatology Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Doctor of Medical Sciences Vera Alekseevna Skvortsova together with Evgeniia L. Pinaeva-Slysh at the Scientific and Practical Conference ″Interdisciplinary aspects of Women's and Children's health″, which took place on September 29 as part of the XXIV All-Russian Scientific and Educational Forum ″Mother and Child″.

Objective. To consider the possibilities of feeding deeply premature babies with very low and extremely low birth weight at the outpatient stage, presenting the most optimal options, which include the long-term use of breast milk fortifiers during breastfeeding, and with artificial – the use of a specialized mixture for premature babies up to 52 weeks of postconceptual age as well as the introduction of complementary foods in order to correct nutritional deficiencies.

Conclusion. Thanks to a specialized formula developed by a domestic manufacturer in collaboration with leading neonatologists of the country for feeding deeply premature infants, which can be used not only in the hospital, but also after discharge, it has become possible to improve the indicators of physical and cognitive development of such children and influence the dynamics of the catching-up growth process.

Objective. The review article is devoted to the problem of chronic recurrent lower urinary tract infections.

Results. An analysis of risk factors for the development of recurrent cystitis was carried out, including the role of disorders of the vaginal microbiome. It has been shown that the causative agent of bacterial vaginosis, Gardnerella vaginalis, when it enters the urinary tract, can act as a trigger during exacerbation of chronic cystitis in women. Anatomical and physiological features of the structure of the female urinary and reproductive systems, the presence of risk factors for possible reinfection, as well as the continuous increase in antibiotic resistance in microorganisms causes difficulties in determining the treatment algorithm and requires an integrated and differentiated approach to antibacterial drugs. Today, it is impossible to consider lower urinary tract infections in women in isolation and not take into account the state of the biocenosis of the vagina and intestines. A number of antibacterial drugs used for the treatment of cystitis can have a negative effect on the quantitative composition of lactobacilli, closing the vicious circle of recurrence of the disease. Among the drugs regulated by clinical protocols for the treatment of cystitis, nitrofurans, in particular nifuratel, are of greatest interest. The original drug has shown high effectiveness in the empirical treatment of cystitis as early as on the third day of use, with better tolerability compared to nitrofurantoin. It is also interesting because it has a spectrum of activity not only against the main uropathogens, but also against the causative agents of vaginal infections including bacterial vaginosis. At the same time, nifuratel does not suppress the growth of normal flora, in particular Lactobacillus spp., which makes it possible to normalize the microflora of adjacent reservoirs of infection, vagina and intestines, thereby preventing relapses of cystitis. In some cases, with concomitant vulvovaginitis, it is possible to use combination treatment with the addition of vaginal forms of the drug for persistent eradication of the pathogen, without the need for a second stage of treatment aimed at restoring the microbiome of the genital tract.

Conclusion. The described treatment option will provide a personalized approach to each patient, which significantly improves the quality of medical care for patients with chronic recurrent lower urinary tract infections on an outpatient basis.

Background. Cardiovascular diseases associated with dyslipidemia are the leading causes of mortality and disability of the population. The peculiarities of drug therapy of hypercholesterolemia dictate the need to take into account the individual characteristics of patients, among whom persons with comorbid conditions predominate, taking a large number of drugs prescribed by narrow specialists and having a risk of side effects from treatment. Unfavorable comorbidity is a combination of dyslipidemia with chronic constipation and cystitis, especially in patients in the pre and postmenopausal period.

Results. According to recent data, this comorbidity is very unfavorable in terms of increasing the risk of adverse cardiovascular events in patients. Of course, in such patients, in addition to correcting cholesterol indicators, a parallel safe correction of comorbid conditions associated with an increased risk of cardiovascular catastrophes, in particular, constipation, bloating, recurrent cystitis, is also required. As the data of recent literature show, this problem is partially solved by modulating the intestinal microbiota. The article provides an overview of research results and approaches to complex therapy for such patients.

Conclusion. The line of nutraceuticals available on the Russian pharmaceutical market, which are a combination of probiotics and a number of synergistic components with proven effectiveness, allows, due to the modulation of the intestinal microbiota, to successfully and safely relieve patients from conditions accompanied by a high risk of the formation and progression of cardiovascular diseases and can be used as a tool for primary and secondary prevention of cardiovascular catastrophes.

Background. The effectiveness, safety and mechanism of action of biological drugs manufactured on the basis of gradual technology, is an object of growing interest in scientific circles. To date, more than 500 articles have been published in the scientific literature, which are devoted to the results of the study of their pharmacological activity, mechanisms of action, and safety. At the same time, the results of a number of studies, ranging from the mechanism of action and ending with the effectiveness of drugs manufactured using the above mentioned technology (technologically processed antibodies) in vitro, ex vivo and in vivo, have been published in international highly rated journals. Using experimental and clinical approaches generally accepted for modern evidence-based medicine, it was shown that drugs based on technologically processed antibodies are not inferior in effectiveness and safety to modern drugs in the corresponding therapeutic groups and open up new opportunities in the treatment of widespread and some socially significant diseases.

Objective. This article is devoted to the review of the results of preclinical studies of technologically processed antibodies to various targets.

Results. A study of the content of a number of papers covering studies of the effectiveness and mechanism of action for drugs based on technologically processed antibodies to various targets has been conducted.

Conclusion. Publications in highly-rated peer-reviewed scientific journals with high requirements for the quality of research help demonstrate new results on this issue, which is especially important for topics related to the research of technologically processed antibodies.

Background. The visceral adipose tissue has the greatest influence on disorders of the structure and function of the heart. Discrepancies in studies assessing the impact of obesity on the structure and function of the heart are apparently related to the heterogeneity of obesity and the fact that patients with varying degrees of visceral obesity were included and compared in the study. The effect of obesity on the heart in most cases is associated with thickening of the LV myocardial wall due to lipid infiltration and mild cardiomyocyte hypertrophy. In addition to fat infiltration of the intercellular space of the myocardium, with visceral obesity, intracellular accumulation of fatty acids occurs, which combine into triglycerides, which leads to steatosis of the heart. Intracellular accumulation of lipids, which in publications is called myocardial fat, ultimately leads to the death of a cardiomyocyte (lipotoxicity). These changes further lead to diastolic dysfunction with the possible subsequent development of heart failure, regardless of the influence of concomitant diseases such as arterial hypertension, diabetes and coronary heart disease. In a smaller number of cases, the predominance of LV dilation over wall thickening contributes to the development of systolic dysfunction. In the presence of diastolic dysfunction, subclinically pronounced systolic dysfunction may also be present. The presence of concomitant diseases repeatedly accelerates and aggravates the heart damage that occurs in obesity up to the development of dilated cardiopathy and severe heart failure, which should be called fatty cardiopathy. Thanks to a better understanding of the mechanisms of the development of fatty cardiopathy, it became obvious that this is a preventable and potentially reversible process associated with overweight, but more pronounced in people with severe obesity and the presence of concomitant diseases.

Conclusion. Given the reversibility of heart changes in obesity, it is necessary to detect and combat visceral obesity and concomitant diseases as early as possible.

The combination of heart and kidney diseases caused by chronic heart failure and aggravated by kidney damage, called cardiorenal syndrome, is increasingly recognized as a critical pathological unit, leading to a worsening of the prognosis in patients with chronic heart failure with a preserved left ventricular ejection fraction of the heart. The pathogenesis, prognostic predictors and treatment methods have not yet been sufficiently studied, which makes studies of cattle in patients with chronic heart failure with a preserved left ventricular ejection fraction of the heart extremely relevant. The ultimate goal of research is to reduce the burden of disease through prediction, prevention and effective treatment. This work is aimed at reviewing current research in the field of pathogenesis and methods of diagnosis and treatment of cardiorenal relationships in patients with chronic heart failure with preserved left ventricular ejection fraction. The problem with cardiorenal syndrome in patients with chronic heart failure makes it necessary to develop and implement new approaches to nephroprotection. The initial level of creatinine and urea in plasma, especially its increase during hospitalization, is a marker of deterioration of kidney function. New targeted therapies, such as angiotensin/neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors, offer new opportunities to realize potential benefits in reducing cardiac and renal adverse outcomes. Until recently, there were no specific therapeutic agents for patients with cardiorenal syndrome and chronic heart failure. New targeted therapies open up new opportunities to realize potential benefits in reducing cardiac and renal adverse outcomes in patients with chronic heart failure. Randomized clinical trials aimed at patients with chronic heart failure are continuing in order to identify optimal new treatments that may change their prognosis.

Background. For many years in Russia, the problem of diagnosing natural focal infectious diseases transmitted by ticks, including rickettsiosis, has persisted. The main rickettsial tick-borne pathogen in the Far East, Altai Territory and Western Siberia is Rickettsia sibirica, which causes tick-borne typhus, or tick-borne rickettsiosis. Diseases of Astrakhan spotted fever, caused by Rickettsia conorii subsp.caspiensis, are also detected in Russia and Kazakhstan. The emergence of new rickettsioses, for example, those caused by Rickettsia heilongjiangensis, Rickettsia raoultii, Rickettsia helvetica, Rickettsia aeschlimannii, Rickettsia slovaca, is explained by the diversity and wide distribution of tick species that carry rickettsia, and the evolution of the pathogen.

Results. The article presents data on the epidemiology, pathogenesis and pathomorphology of tick-borne typhus. It has been shown that tick-borne typhus is manifested by a characteristic symptom complex – fever, primary affect at the site of tick suction, regional lymphadenitis, maculopapular profuse polymorphic rash, with possible damage to various organs. In typical cases, the diagnosis of tick-borne typhus can be made clinically and epidemiologically. The course of the disease is often benign, but complications of tick-borne typhus can include serous meningitis, pneumonia, and myocarditis. Antibodies to the antigens of tick-borne rickettsiosis pathogens are formed in the blood no earlier than 7-15 days after the onset of the disease due to the low immunogenicity of rickettsia, therefore verification of the diagnosis using the serological methods of RSK and RNGA is significantly delayed. New diagnostic approaches for CST are based on the use of ELISA and PCR methods. The development of molecular diagnostic methods has facilitated the identification of new rickettsia species. Data are presented on cases of rickettsiosis caused by Rickettsia raoulti in residents of Novosibirsk, diagnosed using the PCR method and registered for the first time in Russia.

Conclusion. Early diagnosis of tick-borne rickettsioses is of great practical importance for timely and adequate antibacterial therapy. The development of new approaches to identify rickettsia through detection of genetic material with the further development of a method based on DNA amplification is promising for early diagnosis of rickettsial diseases, studying the pathogenesis and persistence of rickettsia, as well as ecological and epidemiological analysis.

Background. Over the past decades, the programs for the prediction and prevention of prevailing cardiovascular diseases have been intensively developing. Up-to-date molecular genetic methods provide scientists with new prospects for the diagnosis, prediction of the outcome and optimal treatment of acute cerebral circulation disorders. Hereditary thrombophilia can be considered as a trigger of ischemic stroke, since in some patients, occlusion of the cerebral arteries due to intravascular thrombosis is revealed during the examination. Knowledge on genetic predisposition of the patient to ischemic stroke will allow us to develop the methods of individualized primary and secondary prevention of the pathology.

Objective. The purpose of the study was to develop a prognostic model based on the design equation of the coefficients of the pathological alleles presence in the genes controlling predisposition to IS according to a set of biochemical indicators. Materials and methods. The genetic, clinical and laboratory results of the examination of 280 people have been analyzed. Group I consisted of patients with IS (n = 180) aged 22 to 45 years (mean age 33.4 Ѓ} 6.57, including 38 patients who experienced recurrent ischemic stroke). Group II included patients with IS (n = 50) aged 52 to 100 years (mean age 73.4 Ѓ} 8.24 years). The control group – group III, consisted of apparently healthy individuals (n = 50) aged 20 to 43 years (average age 31.5 Ѓ} 5.82 years). All patients underwent computed tomography of the brain, ultrasound examination of the brachiocephalic arteries, and echocardiography. Pharmacogenetic investigations as well as venous blood tests were once performed in all the subjects to reveal a genetic predisposition to thrombophilia. Multiple regression analysis (ANOVA) has been used to calculate the prediction coefficients for the presence of pathological alleles.

Results. A mathematical model has been developed at the level of the following genes: angiotensin IIAGTR1 receptor (A1166C), G-protein beta 2 GNB2 (C825T) controlling blood pressure, interleukin-6 IL-6 gene (G-174C) controlling immune response, methionine synthase MTR (A2756G) genes, methylenetetrahydrofolate reductase MTHFR (A1298C), methylenetetrahydrofolate reductase MTHFR (C677T), controlling the level of homocysteine, inhibitor of plasminogen activator PAI-1 (5G/4G), controlling the hemostasis system, platelet receptor fibrinogen GP III a (HPA1-1 a/1 b), controlling aspirin resistance. Calculations of the equation are based on the relationship between the alleles of a particular gene and 22 independent variables. The model is designed to predict the possible presence of genetic thrombophilia.

Conclusion. Thus, it is possible to make recommendations based on the results of standard biochemical studies that allow us to assume the presence of mutations in one of the genes and perform an adjusting genetic assessment. The initial examination of patients with BI can play a principal role in the early identification of the factors that prognostically influence the pathology development. The designed programme can be an effective tool in making clinical decisions for the hospitalized BI population.

Acute coronary syndrome is characterized by rapid development of the pathological process and a high probability of life-threatening complications, primarily myocardial infarction and cardiogenic shock. The combination of invasive methods and different schemes of antithrombotic therapy is currently an integral part of the treatment of patients with acute coronary syndrome with ST segment elevation. The achievements in the field of drug therapy and interventional methods contributed to an increase in survival rates among patients with fcute coronary syndrome. However, the use of AT, especially in case of combination of different medications, is associated with a number of complications, primarily bleeding. Treatment of patients with severe bleeding includes de-escalation or withdrawal of antiplatelet drugs and blood transfusion, but such actions are associated with high probability of stent thrombosis. Presented clinical case illustrates the objective complexity of antithrombotic therapy selecting in such patients. We highlight the issues arising during the use of antithrombotic therapy in the patient with fcute coronary syndrome, complicated by gastrointestinal bleeding, early stent thrombosis after AT withdrawal and the development of cardiogenic shock. Particular issues of patient management beyond the scope of existing clinical guidelines are considered. It was noted that the lack of clear clinical guidelines for particular cases of managing patients with acute coronary syndrome with a combination of hemorrhagic and thrombotic complications causes difficulties in choosing tactics. Due to the lack of evidencebased medicine data regarding the treatment of cardiogenic shock, there are still a number of questions related to the choice of optimal tactics for inotropic, vasopressor therapy, as well as other aspects of pathogenetic treatment, which requires further research in this area.