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BACKGROUND: About 70% of TB dispensary patients have chronic somatic diseases which not only prevent effective treatment of TB but also take progressive course themselves. AIMS: To timely detect and treat acute and chronic somatic disease combined with TB. MATERIALS AND METHODS: since 2020 the algorithm of patient complex investigation by specialists of therapeutic profile was developed in the Tuberculosis Dispensary No. 5, among them the general practitioner was the coordinator of the patients medical route. This became especially relevant during the COVID-19 pandemic. RESULTS: In accordance with the developed algorithms of diagnostic search the patient was comprehensively examined. There were no signs of tuberculosis were in him, however the general practitioner involving to specialists team could diagnose signs of complex cardiac arrhythmia the probable cause which was a new coronavirus infection that he had had six weeks before. CONCLUSIONS: The organization of a new form of medical service for phthisiatric patients allowed general practitioner to reveal serious cardiac pathology directly at the TB dispensary, to refer the patient for consultation to the cardiologist-arrhythmologist, to follow the patient and perform recommended cardiologic treatment simultaneously with measures or medical supervision over persons contacting with tuberculosis.

Aim. To study the indicators of industrial injuries and occupational morbidity in the Russian Federation and the effectiveness of measures for the professional rehabilitation of injured workers in the context of the implementation of state programs aimed at enhancing the labor force and employment. Methods. The analysis of statistical indicators on the number of workers, insured and injured at work from 2007 to 2018 and the results of measures for victim rehabilitation between 2014 and 2019, using data from Rosstat, reporting form No. 7 social security and open data of the social insurance fund. Descriptive statistics were used in the analysis. Results. The level of employment of disabled people planned by the Government of the Russian Federation by 2020 at the level of 40% in relation to people who are injured at work has not been achieved. At the same time, about 80% of the injured person had mild and moderate dysfunctions, about 50% were of working age. Against this background, employment at the level of 0.2 to 6.6% per year indicates the insufficient effectiveness of vocational rehabilitation. In most EU countries, where the return to work rate for work-injured people exceeds 90%, the employer and the insurer jointly participate in the professional rehabilitation of the injured, applying and financing all the necessary organizational and rehabilitation measures. In the Russian Federation, measures for occupational adaptation, maintenance of employment and the creation of special jobs are not subject to reimbursement from insurance funds, only educational events are financed. An employer who has caused harm to the health of work-injured is not economically interested in restoring his professional status. The authors encouraged to amend the regulations of the Russian Federation to ensure financing of the entire range of measures for vocational rehabilitation and the economic interest of employers in restoring the occupational status of work-injured people. Conclusion. Despite the favorable decreasing trend of industrial injuries and occupational morbidity at the enterprises of the Russian Federation over the past 12 years, the number of industrial injuries with permanent disability remains high, and the effectiveness of their vocational rehabilitation is low, which requires an expansion of the list of measures for vocational rehabilitation financed from the social insurance fund and ensuring the economic interest of employers in restoring the professional status of work-injured people.

The case of asymptomatic 3rd stage myxomatous degeneration of the mitral valve in a 42-year old male patient is presented. The patient was referred to Tuberculosis dispensary No. 5 for investigation of pathological findings revealed by fluorography during the coronavirus pandemic period. The patient was examined by TB specialists and the general practitioner in accordance with new interdisciplinary diagnostic algorithms primary involving the GP. As а result of the detailed investigation the patient was found to have previously undiagnosed consequences of pneumonia caused by COVID-19 and 3rd stage myxomatous degeneration of the mitral valve.

Aim. To assess the practice in applying Temporary criteria of determination of extent of loss of professional working capacity currently in force in various constituent entities of the Russian Federation and to substantiate the main directions for their improvement. Methods. The analysis of expert decisions to establish the degree of occupational disability, adopted in the period from 2015 to 2017, was carried out in 77 subjects of the Russian Federation for two nosological forms: (1) consequences of lower limb injuries (T93) and (2) bilateral sensorineural hearing loss (H83.3). A comparative analysis of expert decisions made using current and proposed by the authors criteria in 2 constituent entities of the Russian Federation in 2018 was carried out. For data analysis, we used descriptive statistics methods. Results. Taking into account a high variability in expert decisions making in the constituent entities of the Russian Federation for similar cases (coefficient of variation 21.6%), the authors conclude that it is necessary to change approaches to the methodology for assessing the type of professional activity (qualifications, quality and volume of work, ability to perform it). Using the authors propose criteria based on the concept of reasonable accommodation allowed us to significantly reduce the variability of the decisions made in the pilot regions, the coefficient of variation decreased from 21.25 to 7.43%. Conclusion. High variability of decisions made during the examination of the degree of occupational disability is associated with the imperfection of the methods and criteria for assessing the victim's professional activities; the use of the criteria proposed by the authors allows for a higher reproducibility of the results of the examinations.

The new coronavirus infection has put a number of urgent tasks for the professional community on the effectiveness and timeliness of which not only the life and health of patients depends, but the health and quality of life of the medical workers themselves, especially in the case of infection with COVID-19 in the line of duty. The high incidence of acute occupational diseases caused by COVID-19 among medical workers requires appropriate correction of the mechanisms and procedures for linking the disease with the profession, medical and social expertise, rehabilitation and insurance coverage. In the article, the authors analyzed both the existing ones and those that came into force during the development of the pandemic, regulatory documents and methodological recommendations regulating the connection between the disease of a new coronavirus infection and the profession, methodological approaches to medical and social examination and rehabilitation in case of medical workers becoming ill with a new coronavirus infection and its consequences. Reasonable algorithms for the actions of medical workers are presented, starting from the moment of detecting an occupational disease until the moment of examination at the bureau of medical and social expertise in the event of a persistent loss of professional working capacity.

The new coronavirus infection COVID-19 has posed a number of serious challenges not only for the Russian state, but also for the medical community. At the same time, doctors who are at the forefront of the fight against the pandemic can be safely attributed to the most affected professional group in all respects. The medical community had to not only promptly respond to new challenges, but also resolve issues related to the protection, health restoration and social protection of its own members. Specialists working in the social sphere also found themselves in an equally difficult situation. Measures taken at the state level to organize insurance, social protection and support for medical and social workers allowed us to maintain the human potential of the medical and social sphere. One of the most important links in the process of providing victims as a result of contact with coronavirus infection in the line of duty is a medical and social examination, on the decisions of which not only the possibility of receiving the types of state social assistance due, but also the volume and quality of the rehabilitation measures carried out depends largely. In the article, the authors consider the methodological foundations of medical and social expertise in coronavirus infection and the principles of determining the degree of disability and the appointment of rehabilitation measures, an overview of the main state social protection measures in relation to medical and social workers is given.