One of the serious problems of modern Health care is a new coronavirus infection — COVID-19, which has been declared a global pandemic by the World Health Organization and has covered more than 190 countries. Despite the measures has been taken to limit contacts between people and isolate patients with suspected coronavirus infection, the number of cases grows exponentially every day. Leading laboratories are working on a vaccine, but according to some optimistic forecasts, it may be available no earlier than 11-12 months. According to published data on attempts using various drug regimens in clinical trials, methodological manuals and clinical guidelines for patient management are constantly being developed and updated depending on the severity of the condition. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is ample evidence of serious side effects.

More serious lung tissue lesions are characteristic of patients of an older age group (over 60 years old) with the presence of concomitant diseases, such as cardiovascular, cerebrovascular, diabetes mellitus and obesity, diseases of the bronchopulmonary system and kidneys, which implies taking basic therapy in a constant mode. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is enough evidence of serious side effects, such as the QT interval prolongation, hepatotoxicity, adverse events from the central nervous system. It is necessary to evaluate the interaction of drugs used to treat infections caused by the COVID-19 virus with drugs used in outpatient practice.

An outbreak of unknown pneumonia, caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), was reported in China at the end of December 2019. On February 11, 2020, the World Health Organization officially named SARS-CoV-2 infection COVID-19 (Coronavirus Disease 2019). The most common clinical manifestation of COVID-19 is pneumonia. However, with the spread of the COVID-19 pandemic and analysis of clinical data, symptoms that are not characteristic of “atypical” pneumonia have been identified in patients. Neurological symptoms, skin and eye damage, etc., are described. The extrapulmonary presence of SARS-CoV-2 was also detected in cholangiocytes. Virus-induced effects, systemic inflammation (“cytokine storm”), hypoxia, hypovolemia, hypotension in shock, drug-induced hepatotoxicity, etc., are considered possible factors of liver damage. In 14-53 % of COVID-19 patients, changes in biochemical parameters, which usually do not require drug therapy, can be recorded. Acute hepatitis is very rare. However, special attention should be given to COVID-19 patients at risk: after liver transplantation; receiving immunosuppressants and antiviral drugs; and in cases of decompensated cirrhosis, acute-on-chronic liver failure, and hepatocellular carcinoma. Constant data sharing and open access to research data, new technologies, and up-to-date guidelines are required.

The review provides up-to-date information on the etiological factors and pathogenic mechanisms of development, morphological changes, clinical and laboratory manifestations of acute glomerulonephritis, as well as therapeutic possibilities for its treatment. The review provides up-to-date information on the etiological factors and pathogenetic mechanisms of development, morphological changes, clinical and laboratory manifestations of acute glomerulonephritis, as well as therapeutic possibilities for its treatment. The epidemiological issues of acute post-streptococcal glomerulonephritis are presented, indicating the characteristics of the effects of nephritogenic strains of Streptococcal infection. The immunopathological reactions of the body in acute glomerulonephritis to the causative agent of the disease and its antigens with the development of an imbalance of subpopulations of T-lymphocytes, the nephritogenic potential of streptococcal proteins, a marker of active proliferation of mesangiocytes, C3 and C4 fractions of complement, and also the renin-angiotensin-aldosterone system are shown. The article emphasizes that the informational content of serological tests in acute glomerulonephritis increases while assessing the C3 and C4 fractions of serum complement. The pathological effects of angiotensin II and aldosterone on the renal tissue with the chronization of acute glomerulonephritis, the development of nephrotic proteinuria and a rapid decrease in renal function are presented. The data of a direct correlation between the severity of histological changes and the clinical manifestations of acute glomerulonephritis, possibly the prognosis, are shown. Presented are modern data on the assessment of the main clinical manifestations of acute glomerulonephritis (urinary syndrome, edema syndrome and arterial hypertension). When discussing the treatment of acute glomerulonephritis, the controversial issues of the use of antibiotic therapy, preventive tonsillectomy are noted. The literature data on the treatment options for edematous syndrome and arterial hypertension using thiazide and loop diuretics, calcium antagonists, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers are presented. The issues of immunosuppressive therapy using glucorticoids, as well as prognostic criteria for acute glomerulonephritis are discussed.

Objective: to assess the characteristics of the course of peptic ulcer in combination with duodenostasis (DS) according to clinical, electrophysiological, and morphological studies.

Materials and methods. The study included 169 patients with duodenal ulcer, of which two groups were formed: the observation group consisted of 107 patients with duodenostasis-associated duodenostasis, the comparison group included 62 patients with duodenal ulcer without concomitant duodenostasis-associated duodenostasis. The control group consisted of 30 practically healthy individuals who did not have complaints from the gastrointestinal tract. The results of clinical, objective studies, and laboratory and instrumental data were used in the verification of YB and duodenostasis-associated duodenostasis. To study the closing function of the gatekeeper, the ratio of intraduodenal pressure to intrahastral pressure was used. To study the acid-forming function of the stomach was used device “Gastroscan-5M”, engine — gastroenterological GEM-01 “Gastroscan-GEM” (“Istok-System”, Fryazino). The mucus-forming function was studied using a Sialo Test (research and production center (RPC) “Eco-Service”, Saint Petersburg).

Results. In patients with ulcer with concomitant DS, the duration of ulcerative history was longer — 10,2 ± 1.2 years than in patients with ulcer without concomitant DS — 9,6 ± 1.3 years (p = 0,041). Complications were revealed in 33 (30.8%) patients with ulcer with concomitant DS, in 4 (6,4%) patients with ulcer without concomitant DS (χ ² = 20,9, p = 0,017). Patients in the observation group were more likely to have erosive-ulcerative lesions of the mucosa than in the comparison group (86 (81,2%) and 23 (37,8%) patients, respectively (χ ² = 33,4, p <0,001). pressure to intragastric in patients of the observation group was significantly reduced in relation to the control group (p = 0,001). In case of YAB with duodenal ulcer with DS according to Gastroscan-HEM, the Pi / Ps coefficient (stomach) postprandially increased by 3,5 times compared with the control In patients of the observation group, the overall level of sialic acids significantly prevailed over firs in the control group (p <0,001) and the comparison group (p <0,001).

Aim — to study the frequency of peripheral joint damage and the incidence of osteophytes in patients with ankylosing spondylitis.

Materials and methods. 124 patients with ankylosing spondylitis corresponding to the international New York criteria of 1984 were examined; 84 men (67,7%). There are two groups of patients: patients aged under 40 years (n=61, men — 44 (72,1%) and over 40 years (n=63, men — 40 (63,5%). In the first group, the median age was 34 [29;38] years, in men — 34,5 [30;37,5] years, in women — 31 [27;38] year; in the second group — 50 [45;56] years, in men — 51,5 [46;54] year, in women — 48 [44;59] years. The activity of the disease was determined, and the results of radiography of the affected joints were evaluated.

Results. Clinical and instrumental symptoms of arthritis at the time of study or in history had 82 (66,1%) of the 124 patients with ankylosing spondylitis. Among all patients 111 (89,5%) revealed osteophytes in the peripheral joints, of whom 72 (64,9%) patients had signs of arthritis. Patients with ankylosing spondylitis have both osteoresorption and osteoproliferation on the x-ray.

Conclusion. Peripheral arthritis occurred in more than half of patients with ankylosing spondylitis and was associated with higher disease activity. Patients younger than 40 years of age are more likely to have asymmetric arthritis. Most patients had signs of osteoproliferation in the peripheral joints, and the defeat of large joints of the lower extremities prevails. In patients older than 40 years osteophytes are more often detected, more groups of joints are involved in the process, the joints of the hands and feet are affected.

Currently, information about the epidemiology, clinical features, prevention and treatment of coronavirus infection affected by SARS-CoV-2 (COVID-19) is constantly updated and updated. The most common clinical manifestations of COVID-19 are fever, symptoms of intoxication, cough, shortness of breath, fatigue, chest congestion, decreased sense of smell and taste, less often — abdominal pain, vomiting, diarrhea, and others. For the current period, there are data from clinical observations describing skin lesions in the new COVID-19 coronavirus infection. One of the first descriptions of skin manifestations in COVID-19 was published by the Italian dermatologist Recalcati S. (2020), who provided data on possible types of skin lesions as a variant of the manifestation of a new COVID-19 coronavirus infection.

This paper presents the confirmed cases COVID-19 infection with skin lesions, from the practice of specialists of mobile teams of emergency medical care state budgetary institution «Station of emergency medical care to them. A.S. Puchkov» in Moscow, at survey of the patients at disease onset. In the initial period of the disease, when examining patients, various morphological elements were observed: papulo-vesicular, papulo-squamous, erythematous, urticary, and others, their localization was also different. Whether the described changes on the skin are associated with direct exposure to the pathogen COVID-19 or are a manifestation of secondary pathogenetic factors (infectious-allergic, allergic, toxic, etc.) is not currently known. Further accumulation of clinical observations of skin manifestations in this disease is necessary in order to analyze and evaluate their diagnostic and prognostic value.

Takotsubo syndrome is transient left ventricles dysfunction presenting as apical ballooning or midventricular enlargement with basal hyperkinesia of the left ventricle, while hemodynamically significant coronary artery stenosis is not found. There is considerable evidence that sympathetic catecholamine stimulation is central to takotsubo syndrome pathogenesis and causes coronary arteries constrictions, additional cardiotoxic effect and myocardial stress. First report about takotsubo syndrome was published 30 years ago by japanese H. Sato and al and was called ‘stress cardiomyopathy’. However, not only psychoemotional, but also physical stressors lead to the development of tacocubo syndrome, which increases the pathology significance. Clinical manifestations of takotsubo syndrome are indistinguishable from acute coronary syndrome, but the coronary arteries are not affected by angiography, there is a rapid positive echocardiographic dynamic. Postmenopausal women are predominantly affected (up to 90% patients). This case demonstrates the possible developing of takotsubo syndrome in a young man. The patient, 40 years old was hospitalized with typical clinical symptoms of ST segment elevation acute coronary syndrome after psycho-emotional stress, complicated by acute left ventricle insufficiency. The coronary artery angiography didn’t reveal of any damage and stenosis, there was normal level of troponins, significant increase of N-terminal propeptide of natriuretic hormone. According to echocardiography it was revealed that regional wall motion abnormality extended beyond a single epicardial vascular distribution and circular lesion of the apical and mid segments. After 3-th day from onset of disease we didn’t reveal left ventricle hypokinesia motion abnormalities by echocardiography, left ventricle ejection fraction became normal. This clinical case discuss includes the compliance of the disease manifestations with the diagnostic criteria of takotsubo syndrome, adopted by experts of the European Society of Cardiologists in 2018. Analysis of patient’s electrocardiograms allows to reveal early stage difference between takotsubo syndrome and anterior myocardial infarction.

Pulmonary alveolar proteinosis is a rare disease of the lungs due to abnormal surfactant metabolism with accumulation of pathological protein lipid substance in the lumen of alveoli.

Presented case of idiopathic alveolar proteinosis is characterized by minimal clinical manifestations of disease at severe changes in pulmonary tissue at radiological investigation of the chest. Diagnosis of AP has been confirmed by results of pulmonary tissue morphology.