The study of post-COVID syndrome (PCS) is relevant. The aim of the review is to study and summarize data on the features of PCS from the literature over the past 3 years. Manifestations of PCS have many variants, different duration and severity. Patients with PCS suffer from fatigue, mood swings and persistent respiratory symptoms, cognitive and psycho-emotional disturbances. Frequent neuropsychiatric manifestations of PCS are speech disorders, headache, dysgeusia, hypo- or anosmia. Severe PCS can provoke the development of acute cerebrovascular accident, Guillain-Barré syndrome, encephalitis or encephalopathy. The researchers found that the symptoms of PCS can range from persistent cough, dyspnea and postural orthostatic tachycardia to renal failure, myocarditis, and pulmonary fibrosis. The persistence of manifestations of PCS can be different. Often, PCS is completely stopped, but in some patients it has persistent manifestations. The researchers found that tachycardia and cardialgia disappeared in 8 months after suffering COVID-19. Fatigue and dyspnea persisted up to 1 year after experiencing COVID-19. The number of chronic somatic pathologies is associated with the incidence of increased fatigue and dyspnea after suffering from COVID-19. Thus, it was found that the manifestations of PCS have a multisystem character and long-term persistence. Most often there are feelings of fatigue, a decrease in tolerance to physical activity, cognitive and psycho-emotional disorders after suffering from COVID-19.

Menstrual disorders occupy the main place among gynecological diseases in girls of reproductive age. A low concentration of progesterone in the second phase of the cycle is one of the most common functional pathologies leading to impaired reproductive function. The purpose of the literature review: to study data on the features of preconception preparation and the course of pregnancy in women with progesterone deficiency. Insufficient hormonal support is accompanied by pathological secretory transformation of the endometrium, which prevents the formation of an «implantation window». When pregnancy occurs, there is a high risk of its complications: spontaneous miscarriage, placental disorders and preeclampsia. This category of women needs preconception preparation with timely diagnosis of luteal phase insufficiency (LPI) and additional dosing of gestagens in a cyclic mode.

In childhood, numerous pathological conditions may be involved in arrhythmogenesis, including hemodynamic disorders resulting from the persistence of fetal communications, neurohumoral In children, arrhythmias are often revealed incidentally. In order to study cardiac arrhythmias (СA) and conduction disorders in children during a preventive medical examination at the Children’s Polyclinic № 2, Blagoveshchensk, a survey of parents and an electrocardiography (ECG) study of 46 children aged 5-7 years was made. According to the results of the survey, the children were divided into four groups: Group I - 10 persons (21.7 %) whose parents answered positively only to family history questions; Group II - 7 persons (15.2 %) whose parents responded positively only to questions about the child’s personal history; Group III - 15 persons (32.7 %) with a burdened family and personal history and Group IV - 14 persons (30.4 %) with no positive answers in the questionnaire. We have identified the following risk factors for the development of СА: aggravated heredity for cardiovascular diseases, death of relatives from heart disease, cases of sudden death in the family of relatives under 50 years of age, syncope in children, and a new coronavirus infection. According to the results of ECG, only in children with positive answers in the questionnaires (groups I, II, and III) there were such СА and conduction disorders as persistent ectopic atrial rhythm, extrasystole, second-degree sinoatrial block, and first-degree atrioventricular block (10 %, 28.6 % and 46.7 % accordingly). With an increase in positive answers in the questionnaire, the number of СА and conduction disorders increases (R=0.46). The QT interval is one of the most important ECG evaluation parameters. In our study, the values of the median of QTc interval in the examined children were within normal limits, but significantly differed from each other (p = 0.04): 418.5 ms (404; 434) in group I, 425 ms (382; 440) in group II, 437 ms (424; 453) in group III and 426.5 ms (404; 430) in group IV. All children with prolonged QTc were referred for a consultation with a pediatric cardiologist.

The article presents the study results of 48 adolescents in order to study the characteristics of headaches (HA) in adolescents with autonomic dysfunction (AD) and factors that cause the occurrence of HA. The patients were divided into 2 groups: group 1 (n=26) – patients with VD who complained of frequent headaches for 3-6 months; group 2 (n=22) – patients with AD who did not complain of headaches. In order to objectively assess the state of the vegetative state, the indicators of cardiointervalography (CIG) were analyzed. In the course of the study, it was found that in adolescents of the 1st group, HA was of a chronic, non-progressive nature. 54.5 % of adolescents had a vascular type, 36 % had a psychogenic type, and 45.5 % had a cervicogenic type of HA. When CIG was performed at rest, no significant differences were found in the compared groups in terms of average indicators characterizing autonomic tone (AT). The value of SI1 at rest is in the range of eutonia values (31-90 arb. units), which is typical for a satisfactory adaptation of the body of a teenager, while SI1 in group 1 tends to vagotonia, which can contribute to a decrease in the adaptive capabilities of the body. According to the CIG data, a significant difference in the variation range index (DX) was revealed in the ortho position. In the first group, DX is significantly lower, and as a result, autonomic reactivity in this group against the background of vagotonic tone corresponds to the values of asympathicotonic. With the help of factor analysis, we identified the factors that cause the occurrence of HA in adolescents with AD: the lower the DX indicator (factor load -0.76) and, accordingly, the lower the index load at rest (SI1). Thus, adolescents with autonomic dysfunction often develop cephalalgia against the background of the parasympathetic type of autonomic regulation.

Unfavorable trends persist in the health of the younger generation, which requires the close attention of the whole society. Specialists in the field of preventive medicine, pediatricians actively not only study the basic patterns and regional features of the formation of the health of the younger generation, but also develop comprehensive disease prevention programs, measures to protect the health of children and adolescents. Regular study and evaluation of the physical development of children and adolescents is a necessary link in the health monitoring system of the younger generation. Indicators of physical development of the child population are informative and accessible for measurement, evaluation and interpretation of the criterion of health; allow timely formation of risk groups for differentiated preventive and therapeutic measures in children’s groups. Teenagers belong to the group in which most often there is a violation of sanitary and hygienic well–being, due to the influence of external factors, academic load, and poor adaptation in the team. Therefore, grade 9 students were selected for the study, whose average age was 15.6 ± 0.2 years. During the study, a complete analysis of the physical development of adolescents was carried out, using individual and generalizing assessment methods. During the study, violations of physical development were revealed in 16.6 % of students, 83.4 % had no deviations. With a comprehensive assessment of sanitary and hygienic well–being in the team, this indicator turned out to be quite high, which indicates the correct preventive measures in a general education institution and a favorable psychological situation in the classroom. And this is the key to good physical development, the absence of somatic pathology and good academic performance.

The high comorbidity of COPD and CVD is explained by the presence of similar risk factors and pathophysiological mechanisms of the development of these diseases. Two-thirds of COPD patients die within 5 years after the onset of circulatory decompensation. The aim of the study was to evaluate the efficacy of ARNI in patients with COPD in combination with CHF with low and moderately low left ventricular ejection fraction (LVEF). 24 patients with COPD in combination with CHF on the background of complex therapy were prescribed «Uperio», the starting dose was 50 mg 2 times a day, followed by titration of the dose to the optimal one (200 mg 2 times a day). The comparison group consisted of 18 COPD patients and was comparable in terms of sex, age, degree of PH, stage of CHF and FC, LV EF. These patients in complex treatment received an angiotensin-converting enzyme inhibitor (ACE inhibitor) - perindopril 5-10 mg/day instead of ARNI. As a result of ARNI treatment, patients had a significant increase in LV EF and RV FAC, which indicates an improvement in the contractility of the right and left ventricles. The six-minute walk exercise test increased (p<0.05), i.e. the functional class of CHF decreased from III to II. After 1 month of ARNI treatment, there was a decrease in NT-proBMP levels (p<0.01), an increase in GFR (p<0.05), and a decrease in SPPA (p<0.01). Indicators of the function of external respiration improved significantly. In the comparison group, only TSHQ and NT-proBMP significantly improved (p<0.05). After 6 months of observation in the group of patients receiving ARNI, rehospitalization was noted in 8.3 % of patients, in the comparison group - in 22.2 %. Thus, ARNI compared to ACE inhibitors showed better results in the treatment of COPD patients with CHF, since sacubitril and valsartan enhance the effectiveness of CHF therapy. ARNI does not cause an increase or appearance of cough, which is observed when taking ACE inhibitors.

The blood type is determined genetically and can be a marker for assessing the influence of hereditary factors on personality. Research on the effect of AB0 antigens on various character traits, behavior patterns, nutritional strategy, as well as the development of various somatic and mental diseases has been going on for about a hundred years. The purpose of the study: to assess the relationship between blood type and personality traits, temperament type, character and physical activity. Material and methods of research: the personality of 878 medical students was assessed using a temperament and character questionnaire. Based on the results of the survey, data analysis and statistical processing were carried out, a four-field contingency table was compiled and the odds ratio was calculated, the significance of differences was assessed by the χ2 criterion. Research results: a possible correlation of personal qualities, character traits, temperament, learning ability and physical activity with students’ blood group was studied. The most self-confident, energetic, sociable, powerful and independent were the representatives of the first blood group. The owners of the second blood group showed themselves to be calm, balanced, stress-resistant, scrupulous, executive and hardworking, loving harmony and order. Respondents with the third blood group are prone to independence and exactingness, perfectionism and harmony, creativity and flexibility, sympathy and empathy. The most mysterious was the phenotype of the fourth blood group, manifested by greater sensuality, sociability, spirituality, charm, intelligence, and a penchant for mysticism. The best academic performance was demonstrated by more than half of the first-year students with the third blood group, and the holders of the fourth blood group showed the least interest in natural science disciplines. About half of the respondents, regardless of blood type, are physically active to some extent. Conclusion: the results of the work confirm some relationship between a certain blood group and personal characteristics, temperament, learning ability, but most of them do not change significantly.

A clinical observation of a patient with «orphan» hereditary pathology of metabolism is presented. This clinical observation demonstrates the complexity of the diagnosis of the disease associated with the extreme rarity of mucopolysaccharidosis in the population, the polymorphism of the clinical picture. The appearance of enzyme replacement therapy improved the prognosis of the disease with its timely diagnosis.

Abdominal pain in children and adolescents has a variety of causes, a very wide range of clinical manifestations [1]. Two cases of children are presented, the leading complaints of which were abdominal pain in combination with hyperthermic syndrome. Both children were examined and treated in pediatric departments. In the final diagnosis, in the first case - spondylitis of the thoracic spine due to tuberculous lesions of the osteoarticular system (Th6) and in the second case - osteomyelitis of unspecified origin (Th5).These clinical cases demonstrate the need for therapeutic practitioners to have a wide range of knowledge in all related specialties in order to correctly diagnose, treat and route patients.

To evaluate the results of the use of videolaparoscopic technology in the treatment of esophageal achalasia. A clinical observation of a 47-year-old patient with stage IV esophageal achalasia (according to B.V. Petrovsky) is presented. There were complaints of dysphagia, regurgitation of food eaten, weight loss up to 10 kg. Anamnesis - for 9 years, the disease is associated with stress. Contrast fluoroscopy of the esophagus: the esophagus is expanded in the middle and lower thirds up to 7 cm, the distal esophagus is narrowed, S-shaped curved. Evacuation of contrast into the stomach - after 30 minutes. Esophagoscopy: the lumen of the esophagus in the middle and lower third is expanded, the mucosa is moderately hyperemic, hardly passable for the endoscope. The operation was performed: videolaparoscopic myotomy (according to Geller) with gastroplasty according to T.A. Suvorova. Unlike other types of gastroplasty, mobilization in the area of the abdominal esophagus and cardia is gentle and less injurious to the ligamentous apparatus. The anterior wall of the stomach in the form of a triangular fold is fixed with separate sutures to the edges of the defect formed after myotomy, and not only closes the defect, but also acts as a spacer, preventing the formation of restenosis. The displacement of the distal part of the esophagus under the diaphragm forms a more acute angle of His. The above features of the operation reduce the likelihood of reflux esophagitis. Early and late postoperative period is without complications. Dysphagia and regurgitation are absent. Contrast fluoroscopy of the esophagus after 1 year: free flow of contrast from the esophagus to the stomach. Esophagoscopy after 1 year: the esophagus is freely passable for the endoscope throughout its entire length. This clinical observation showed the effectiveness of using modern video-laparoscopic technology in the form of myotomy with gastroplasty according to T.A. Suvorova for stage IV esophageal achalasia, which was confirmed by the results of the early and late postoperative period.

A case of a rare pathology – Takayasu’s disease in a young woman of 35 years is presented. Takayasu’s arteritis (TA), or nonspecific aortoarteritis, belongs to the group of systemic vasculitis with frequent damage to large-diameter vessels. This disease is often found in the literature in the form of synonyms of this pathology – «middle aortic syndrome», «aortic arch syndrome», «pulse absence disease», «Martorell syndrome». CT-angiography is one of the main methods of diagnosing this disease.

Two clinical observations of the diagnosis of bone and solitary plasmacytoma in patients with a non-secreting variant of multiple myeloma are presented. A patient with bone plasmacytoma achieved partial remission of the disease as a result of chemotherapy and was referred to a federal center for autologous stem cell transplantation. The patient with extramedullary plasmacytoma turned out to be resistant to chemotherapy and radiation therapy, and a lethal outcome was stated. A conclusion was made about the worst prognosis of multiple myeloma in the presence of extramedullary lesions.

The problem of detecting and diagnosing cervical pathology in pregnant women is currently an urgent problem, since there is an increase in the incidence of cervical cancer, as well as various precancerous processes affect the course and outcome of pregnancy. The article describes a clinical case of dynamic observation of a woman with cervical deciduosis detected in the second trimester of pregnancy. The presented colposcopic and pathomorphological studies of the cervix at different stages of pregnancy made it possible to conduct a differential diagnosis and exclude the tumor process in a pregnant woman.

A brief literature review is given on a rare disease - Fisher-Evans syndrome (combination of immune hemolytic anemia and immune thrombocytopenic purpura). The clinical observation of this disease from the personal practice of the authors is demonstrated. The disease was diagnosed in a patient with high comorbidity who had undergone lymphogranulomatosis (cured). Initially, the disease debuted with immune thrombocytopenia (ITP), therapy with glucocorticoids and rituximab did not lead to a positive effect. Remission of ITP was achieved only after splenectomy. Thrombocytopenia no longer recurred. But five years later, a severe hemolytic crisis developed. High doses of glucocorticoids managed to stop the hemolytic crisis, but complete remission of immune hemolytic anemia was achieved after rituximab therapy.

The purpose of this publication is a clinical demonstration of a case of ocular ischemic syndrome in cardiovascular pathology. When referring a patient to the clinic for planned surgical treatment of complicated cataract of the right eye, as a result of a complete ophthalmological examination, a case of ocular ischemic syndrome on the paired artificial eye was revealed. The clinical case is of interest to practicing ophthalmologists, neurologists, therapists, increasing the alertness of specialists about the possible occurrence of ocular ischemic syndrome occurring under the guise of other diseases. Patients with concomitant cardiovascular pathology after cataract phacoemulsification surgery with intraocular lens implantation are at risk for the development of hemodynamically significant changes in the main vessels of the brachiocephalic trunk and the organ of vision. Timely diagnosis and therapy can improve visual functions, partially restore visual fields, prevent the development of irreversible changes in the retina and optic nerve.

A clinical case of a child with an orphan disease in which spontaneous, progressive bone resorption occurs is presented. Only about 350 patients with Gorham-Stout syndrome have been described in the world literature. The uniqueness of the case described in the article consists in the early manifestations of the disease.