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Background: The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented., Aim: The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19., Materials and Methods: On the basis of the newly created infection centers of the Central Clinical Hospital "RZhD-Medicine" and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy., Results: On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower - 122 (55.2%) and 134 (58.8%); p <0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients., Conclusion: The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

Aim: Analysis of the effectiveness of therapy for non-alcoholic fatty liver disease (NAFLD) with severe asthenic syndrome., Materials and Methods: In the period from 2017 to 2019, on the basis of the gastroenterology center of the Vishnevsky 3-rd Central Military Clinical Hospital, 247 patients with NAFLD, including those at the stage of steatohepatitis, and severe asthenic syndrome were examined and treated. The main group included 124 patients, the control group 123 patients. All patients underwent complex laboratory and instrumental diagnostics and neuropsychological research using the subjective asthenia assessment scale (MFI-20). In both groups, domestic drugs were included in the therapy regimen: from the 1st to the 10th day, Heptrong solution 3 ml intramuscularly in the morning; from the 1st to the 60th day UDCA 250 mg orally, 3 capsules at bedtime, Omega-3 forte 1000 mg, 2 capsules in the morning with meals. In group I patients received additionally from the 1st to the 10th day intravenous drip Cytoflavin 10 ml + 0.9% NaCl solution 200 ml; pentoxifylline solution 5 ml + 0.9% NaCl solution 200 ml. Then, from the 11th to the 60th day, Cytoflavin inside, 2 tablets 2 times a day. Pentoxifylline inside 400 mg 1 tablet 3 times a day. All patients underwent neuropsychological examination using the subjective asthenia rating scale (MFI-20)., Results: The effectiveness of treatment in patients of both groups was assessed by clinical, laboratory data and neuropsychological studies. In the main group, a significant reduction in asthenic syndrome was achieved against the background of diagnosed NAFLD compared with the control group., Conclusion: The early inclusion of patients with NAFLD and severe asthenic syndrome in the treatment regimen, in addition to the basic therapy of Cytoflavin, achieved a significantly high therapeutic effect in the form of normalization of the main clinical, laboratory and instrumental parameters, as well as a significant reduction in the manifestations of asthenia.

Aim: To analyze the efficacy of cytoflavin in the complex treatment of sleep disorders in asthenic syndrome., Material and Methods: One hundred patients with sleep disorders and asthenic syndrome of various etiology and severity were studied. The patients were divided into three groups depending on the type of therapy: the first group received intravenous infusions of cytoflavin for 10 days; the second group, in addition to cytoflavin, received per os melatonin (3 mg or 5 mg) at bedtime; the third group in addition to cytoflavin received per os zopiclone (7.5 mg) at bedtime., Results: On the 14th day of the study, a decrease in severity or complete relief of asthenia manifestations (according to the SHAS scale) and, accordingly, improvement or normalization of sleep in 97% of patients was found. At the same time, during polysomnographic study, the data obtained are characteristic for improving the quality of sleep phases mainly in the first and second groups of patients and, to a lesser extent, in the third group., Conclusion: Cytoflavin effectively suppresses the main manifestations of asthenic syndrome, including sleep disorders.

Aim: To evaluate the efficiency of Remaxol monotherapy in patients with nonalcoholic fatty liver disease (NAFLD) at the stage of steatohepatitis (SH)., Materials and Methods: The treatment of 156 patients with NAFLD at the stage of SH was analyzed. A study group included 84 patients who had received intravenous Remaxol, 400 ml, dropwise at a rate of 40-60 drops per minute once daily in the morning for 10 days; a control group of 72 patients had been treated with the conventional scheme., Results: During the treatment, the study group showed a rapider relief of the manifestations of asthenovegetative and dyspeptic syndromes and a reduction in the magnitude of biochemical manifestations of cytolytic and cholestatic syndromes than did the control group., Conclusion: Incorporation of Remaxol into the therapy regimen in patients with NAFLD at the stage of SH enhances the effectiveness of treatment.

The article considers new approaches to diagnosis, treatment and rehabilitation of patients with arterial hypertension (AH) applied to the Ministry of Defence contingent. For the medical service of the Armed Forces the problem is relevant because of the significant labor losses, high level of dismission, morbidity and mortality of this disease. In the assessment of the patients limitation of life should be considered a variant AH, the stage, availability and seventy of the organ damage, severity and reversibility of complications, the incidence and severity of hypertensive crises, the effectiveness of treatment, comorbidity, education, occupation, the presence of contra-types and conditions of military service or labor. Military medical expertise of soldiers with AH uses the classification of degrees of arterial hypertension of 2010 and a three-stage-classification hypertonic disease created by the World Health Organization, 1996.

Coronary artery disease (CAD) remains the leading cause of death in most highly developed countries. According to the WHO, more than 17 million people in the world die of cardiovascular pathology (CVP) annually; of them, more than seven million die of CAD. For the medical service of Russian Federation Armed Forces, CAD and atherosclerosis present an important problem due to their prevalence in military men leading to high levels of morbidity, mortality, labor losses, disability, dismiss rate and disqualification of highly professional officers and generals. Certain factors of military service and extreme factors have been found to increase CAD risk. Until now, the incidence and prevalence of initial forms of CAD in military men of dangerous professions have been studied insufficiently. In order to investigate the prevalence of atherosclerotic cardiosclerosis (ASCS), the effects of risk factors (RF), and prognostication of its development, 267 military men, including 14 men of dangerous professions (pilots, navigators, command post operators), and 153 engineers, technicians and supply officers were examined at Military Hospital No7, Mandryk Military Hospital No 2, and four units of a Space Forces division. The clinico-functional examination revealed ASCS in 53 or 19.8% of the servicemen; its rate increased with age. Only a few cases of ASCS were found in subjects aged less than 30 years; a significant increase in ASCS frequency was noted in 41- to 50-year-old subjects (29.8%); between 51 and 60 years old ASCS was found in 32% of the subjects, which meant only a 2.2% increase vs. the previous age group. Possibly, this could be connected with the fact that at this age initial signs of initial forms of CAD, including ASCS in military men of dangerous professions depended not only on age, conventional RF of CAD, but on occupational hazardous factors as well. Lipid exchange disorder is an important RF for the development and progress of various CVP, CAD in the first place. Timely and correct diagnostics and interpretation of an altered lipid profile as well as assessment of concomitant cardiovascular RF are necessary conditions to organize rational prophylaxis of the most important CVP.