Background. Recent studies and guidelines recognize non-alcoholic fatty liver disease (NAFLD) as an interdisciplinary problem at the intersection of gastroenterology, cardiology and endocrinology. The increased interest in NAFLD in recent years, as the most common chronic disease, identifies this pathology as a participant in the development and progression of cardiovascular diseases and type 2 diabetes mellitus. The studies carried out consistently reveal the complex mechanisms of mutual influence of vascular pathology and NAFLD, as well as carbohydrate and fat metabolism disorders.
Objective. The review article examines the pathogenetic pathways of the influence of NAFLD on the development and progression of cardiovascular diseases depending on risk factors and comorbidity. A clear association of NAFLD with obesity, metabolic syndrome and type 2 diabetes, as well as with cardiovascular diseases has been shown, which emphasizes the interdependence of these comorbid conditions.
Results. Analysis of the course of NAFLD identifies several pathogenetic mechanisms – shocks (shocks), closely associated with metabolic disorders that affect the development of a wide range of pathologies, cardiovascular and endocrine. The negative impact of NAFLD on the development, course and prognosis of chronic kidney disease, malignant neoplasms of a number of localizations, as well as cirrhosis and liver cancer has also been shown. However, there is evidence that control and pathogenetically based therapy of NAFLD with correction of metabolic and concomitant vascular disorders can positively affect the course of both the disease itself and comorbid conditions. The role of ursodeoxycholic acid (UDCA) drugs in the treatment of NAFLD and the impact of this therapy on the course of associated diseases and conditions are discussed. The presence of pleiotropic effects of UDCA was noted, primarily on hepatocytes with the implementation of antioxidant, cytoprotective and antifibrotic effects, as well as metabolic effects: hypolipidemic effect, reduction in the level of total cholesterol and low-density lipoproteins, and a positive effect of UDCA on glycemic parameters.
Conclusion. The complex interdependent mechanisms of the development of NAFLD, vascular and endocrine pathologies require further study and clarification, including the development of new and evaluation of existing approaches to the management of patients with similar conditions and diseases, which include the use of ursodeoxycholic acid.

Background. Today in the structure of viral hepatitis viral hepatitis A takes the lead position, the course of typical forms is usually favorable. Over the last few years, however, the frequency of viral hepatitis A has become higher, with increased morbidity in non-endemic areas of the Russian Federation, also with reactivation of chronic herpesvirus infections in re-convalescents of the new coronavirus infection Covid19. The research by the russian scienctists Volynets G. V., Potapov A. S., Pakhomovskaya N. L. in 2011 allowed to diagnose chronic herpesvirus hepatitis in 19.26% of children (18) during the examination of 107 children with chronic diffuse liver diseases. The etiology of liver damage in 39% of cases (7 children) was represented by monoherpesvirus infection: Ebstein – Barr virus infection or human herpes virus type 6. The other cases of chronic herpesvirus hepatitis were due to mixtforms of herpetic pathogens: Ebstein – Barr virus infection and human herpes virus type 6, or herpes simplex virus type 1-2 with human herpes virus type 6. In mixtforms of herpetic hepatitis there was a moderately severe course due to syndromes of cytolysis and cholestasis, but with rapid positive dynamics as a result of anti-herpetic therapy.
Objective. To investigate the course of viral hepatitis A in an 8-year-old child with reactivation of herpetic mixt-infection (VEB, CMV, HPV-1, type 2, HHV-6).
Materials and methods. The patient had a severe course of viral hepatitis A due to cytolysis syndromes (ALT increased to 76 norms), cholestasis and hepatoprivine syndrome (PTI decreased to 48.6%), associated with activation of persistent herpesvirus infection.
Results. There was a rapid positive dynamics of the patient's condition (within 4-5 days) according to laboratory and clinical data on the basis of anti-herpetic therapy (acyclovir) and interferon alfa-2b therapy. In this clinical case during the onset of viral hepatitis A there was reactivation of persistent mixtherpetic infection, and the latter was the trigger for the development of severe form of the underlying disease process.
Conclusion. In case of infection with a hepatotropic pathogen (hepatitis A virus) it is recommended to examine for comorbid chronic herpesvirus infection if there are indications, for example, belonging to the group of “frequently ill children”.

Background. The first scientific description of inflammatory bowel disease refers to the pathologoanatomic work of Samuel Wilkes. This sectional research is related to a real detective story, which had a great public response in Victorian England. The story focuses on the death of Isabella Banks, which happened with the occurrence of fast-flowing intestinal disease. The young woman had been suffering for several weeks and died mysteriously. During the investigation of the case, there was a supposition that there was poisoning, which could have been committed by the husband of the dead, a doctor Thomas Smethurst. The initial data of the investigation, based on authorities in the field of toxicology, confirmed this supposition, and at the first court hearings the doctor was found guilty. According to the results of the investigation, the doctor poisoned his wife with arsenic. Thomas Smethurst was given a death sentence. However, further investigation led to fundamental changes: the toxicological examination turned out to be misleading. The pathology report stated that in the large intestine, "the mucous membrane was ulcerated from edge to edge". There were ulcers of all sizes, most often the size of a "sixpence coin" and "mostly isolated, although some fused together”. In the blind intestine "there was inflammation of the most acute and intense character ... beneath it the exposed muscular membrane was visible... Another striking phenomenon on the inner surface of the intestine, besides desquamation and ulceration, was the effusion of blood, which was observed everywhere, but especially in the blind intestine". The doctor was acquitted, and the death of Isabella Banks was regarded as the manifestation of the disease.
Conclusion. Subsequently, this disease was related to inflammatory bowel diseases; for a long time it was regarded as the first description of ulcerative colitis, however, recently, a lot of experts have considered it as the first description of Crohn's disease. The real cause of Isabella Banks' death is still unclear, although the authors of the article suggest the possibility of the development of toxic megacolon.

Background. The prevalence of sarcopenia in the world is 10% in both men and women. In recent years, there has been an increasing accumulation of information about the increased prevalence of sarcopenia in patients with non-alcoholic fatty liver disease. It is known that hypodynamia is accompanied by a decrease in muscle mass and affects the profile of myokine production and its effect on preventing further loss of muscle mass and accumulation of intrahepatic fat. Irisin myokine secretion is induced by physical activity, which seems to explain the negative effect of hypodynamia on hepatic steatosis. There is also an association between physical activity and hepatokine production. In addition, loss of muscle strength and physical inactivity is a risk factor for more progressive loss of muscle mass, fat accumulation and worsening inflammation, leading to a vicious cycle of recurrent hypodynamia and even more severe sarcopenia.
Results. The review article provides data on the effect of various types of physical activity on sarcopenia. Special attention is paid to the swarm of myokines in the pathogenesis of sarcopenia and the modern drug myostatin inhibitor. Aspects of the role of hyperammonemia in the pathogenesis of sarcopenia and its influence on this pathogenetic mechanism are considered. The aspects of nutritional support for patients with sarcopenia are described.

Background. Caesarean section is a method of delivery in which the birth of a child takes place through surgical intervention. In many countries of the world, there is an increase in the number of caesarean section assignments. The attention of the medical community should be focused on strategies to reduce the frequency of caesarean section. Caesarean section does not improve perinatal outcomes in comparison with childbirth through the natural birth canal. During surgical delivery, a woman and a child may have negative consequences from the use of anesthesia, the development of bleeding, injuries and infections. After surgery, you should strive to ensure skin-to-skin contact between mother and child, early breastfeeding is necessary. After caesarean section, more often than after independent childbirth, there is a violation of the formation of lactation. A woman needs support and counseling on breastfeeding issues. The intestinal microbiota in children born by caesarean section differs significantly from the microbiota of children with natural delivery. There is a deficiency and delayed colonization of loci with protective microbiota, bifidobacteria and lactobacilli. Changes in the microbiota in children born by caesarean section play an important role in the occurrence of metabolic and immune disorders. Several studies have concluded that caesarean section is a risk factor for the development of respiratory tract diseases, bronchial asthma, allergic diseases, obesity, overweight and neurological disorders in children.
Conclusion. Further studies and discussions of the clinical characteristics of children born by caesarean section are needed.

Objective. To study and analyze the structure of the incidence of children under the age of 1 with childhood infections using the example of measles, rubella, scarlet fever and chickenpox.
Materials and methods. The structure of infectious and parasitic morbidity in children under the age of 1 year was 7.3% (60,827 cases), of which childhood infections accounted for 1.01% (617 cases).
Results. The nosoareal of childhood infections was represented by four types: whooping cough, scarlet fever, chickenpox and measles. Cases of infection of children with chickenpox were recorded both in urban areas – 47.8% (221 cases), and in the districts of the Astrakhan region – 52.2% (241 cases). The second largest number of cases of childhood infections in children under the age of 1 year is whooping cough, which accounted for 14.4% (89 cases). Cases of whooping cough were observed in children living both in urban areas and in rural areas of the Astrakhan region, prevailing mainly among urban residents – 56.2% (50 cases). Measles ranks third in terms of the incidence of childhood infections among children under the age of 1 year, accounting for 10.4% (64 cases). The number of cases of scarlet fever infection in children was 0.3% (2 people). These cases were recorded in children living in Volodarsky and Privolzhsky districts – 1 person each in 2018 and 2020, respectively. In most cases, young patients had complaints such as fever above 38.0 °C – 85.9% (530 people), exanthema syndrome – 85.6% (528 people). In addition to these complaints, there were such as catarrhal manifestations of the upper respiratory tract – 13.4% (101 people), lesion of the lower respiratory tract – 18.2% (112 people), conjunctivitis – 9.7% (60 people), vomiting – 15.7% (97 people) and regional lymphadenopathy – 13.8% (85 people). In rare cases, complaints of central nervous system damage in the form of encephalitis were noted – 0.5% (3 people) and angina – 0.3% (2 people). After the final diagnosis was established, all sick children were prescribed medication.
Conclusion. The number of cases of infectious diseases in children of the Astrakhan region has remained very tense in recent years. The main so-called childhood infections in children of the first year of life are chickenpox, scarlet fever, measles and whooping cough. The structure of morbidity in children of the first year of life is represented by the prevalence of the child population both in the districts of the Astrakhan region and directly in the urban area. The main complaint of all sick children was an increase in temperature above 38.0 °C; the rest of the complaints were identical to the complaints.