According to domestic and foreign literature, COVID-19 (short for COronaVIrus Disease 2019), previously coronavirus infection 2019-nCoV is a potentially severe acute respiratory infection caused by SARS-CoV-2 coronavirus (2019-nCoV).
It is a dangerous disease that can occur both in the form of an acute respiratory viral infection of a mild course and in a severe form, specifi c complications of which may include viral pneumonia, which entails acute respiratory distress syndrome or respiratory failure with the risk of death
The most common symptoms of the disease include fever, fatigue, and dry cough.
The virus spreads by airborne droplets through inhalation of droplets of the virus sprayed in the air during coughing or sneezing, as well as through the spread of the virus on the surface and then into the eyes, nose or mouth. The disease is caused by a new virus, to which there is no acquired immunity, and susceptibility does not depend on age and gender diff erences.
All this creates a high degree of risk of infection for both medical professionals and patients in visiting medical institutions. The risk of infection is especially high during any interventional manipulations and operations related to the respiratory system and the gastrointestinal tract. Such interventions are primarily endoscopic.
The situation is aggravated by the fact that at the moment there are no Sanitary and epidemiological regulations on prevention of COVID-19. At present, hospitals are guided in their work by the orders and instructions of the Ministry of Health of the Russian Federation and Russian Federal Consumer Rights Protection and Human Health Control Service (Rospotrebnadzor).
The usual anti-epidemic measures require adjustment in the new conditions. First of all to introduce zoning in hospitals, especially in endoscopic departments, to collect an epidemiological history before endoscopy, and audio monitoring in the further management of patience.
It is extremely important to create relevant guidelines on the prevention of coronavirus infection using novel experience and scientifi c information including the existing orders and regulations of the healthcare system.

The aim of the study was to evaluate the timeliness and eff ectiveness of the diagnosis of precancerous diseases and early forms of gastric cancer in primary health care.
Materials and methods. A multicenter retrospective descriptive study was conducted with an analysis of the medical records of 426 patients who were diagnosed with malignant neoplasm of the stomach at the time of going to outpatient facilities. We used data from 125 outpatient facilities in 7 centers for the period from 2009 to 2019.
Results. The average age of patients with a fi rst established diagnosis of malignant neoplasia was 61,7 (95% CI 58.6 ÷ 64.8) years. The prevailing form of malignant neoplastic disease was the option “Adenocarcinoma, intestinal cancer” — 77,7%, diff use type cancer — 12,7%, other histological types — 9,6%. The diagnosis of malignant neoplastic disease at the III and IV stages of the disease was fi rst established in 67,4% of patients. The number of years lived by patients with a diagnosis of gastric gastric cancer was 2,0 years. Over a 10-year follow-up, 75% of patients died. Risk factors for gastric cancer were identifi ed in 41% of respondents. Signs of dyspepsia syndrome were observed in 31,5% of patients, and they appeared on average 4,6 (95% CI 4,4 ÷ 4,8) years before the diagnosis of gastric malignancy. Among people with gastric cancer, dyspepsia symptoms occur every day in every third patient. The features of the manifestations of dyspepsia in the observed patients were: daily manifestations of symptoms (33,3%), symptoms at night — 9,4%, an increase in the intensity of dyspepsia (21,3%), the lack of a clinical response to the therapy (proton pump inhibitors, prokinetics, eradication of Helicobacter pylori infection) in 58% of cases. Anxiety symptoms were recorded 2,4 years before a diagnosis of stomach cancer.

Introduction. The interest in achalasia has signifi cantly increased with the advent of new methods for the diagnosis and treatment of this disease. New methods are introduced several years earlier abroad than in Russia, prospective randomized trials are conducted more often, based on the results of which clinical recommendations are established. Therefore, the authors of this article provide an extensive review of foreign literature devoted to the diagnosis and treatment of achalasia, which refl ects not only current trends, but also those areas to which researchers of past years paid attention.
Results. Traditional and new diagnostic methods (timed barium swallow and high-resolution manometry) are described. The Chicago classifi cation of esophageal motility disorders version 3.0 is given. The whole spectrum of treatment of esophageal achalasia — conservative and surgical methods with analysis of immediate and long-term results, including the comparison of these methods and with the combined use of several techniques in one patient is presented. The complex problem of choosing a treatment method for the end-stage achalasia is considered. For key points in diagnosing and treating the disease, clinical guidelines on achalasia published in 2020 (European Guideline on Achalasia — UEG and ESNM recommendations) are presented.
Conclusion. Esophageal achalasia is a chronic disease, for the treatment of which there is still no consensus. Balloon pneumatic dilation, peroral endoscopic myotomy and laparoscopic Heller myotomy with fundoplication are safe and highly eff ective and can be recommended for the treatment of achalasia. Currently, there is a gradual transition to a less invasive initial treatment of the end-stage achalasia, but large multicenter and randomized clinical trials are necessary to obtain fi nal data on various treatment options.

The aim of the study was to evaluate the genetic characteristics of the pathological process in patients with biopsy-proven PB.
Materials and methods: Dynamic observation and treatment of patients with morphologically confi rmed diagnosis of Barrett’s esophagus (PB) was performed at the Bank of Russia Multidisciplinary medical center in Moscow in the period from 2014 to 2019.the study included 52 patients. Among them, men — 33 (63.4%) and women –19 (36.5%) aged from 28 to 70 years, the peak incidence was mainly in the age range from 50–71 years. As a result, morphological types of PB epithelium were identifi ed at the time of the study: cardiac — 8(15.3%), small — bowel — 25 (48%), large-bowel without dysplasia-17 (32.6%) and large-bowel with mild dysplasia foci –2 (3.8%).
The expression of the p53, P63, and Ki-67 genes responsible for cell proliferation and diff erentiation was studied using an immunohistochemical method.
Results. As a result of the study, it was found that genetic changes in patients with morphologically confi rmed PB increase from the cardiac type of epithelium in the segment to the detection of dysplasia foci on the background of colonic metaplasia. An exception is tokokishechnaya metaplasia, which may be an indirect sign of the development of highly diff erentiated epithelium in response to gastroesophageal or duodenogastroesophageal refl ux
Summary.
1. Mutation of the p 53 genes responsible for regulating cell transcription and activating apoptosis and the P63 gene responsible for cell diff erentiation occurs in all morphological types of PB, with the number of mutations increasing as metastatic changes progress in accordance with the Correa cascade
2. The combination of p53 and P63 gene mutations in almost equal proportions indicates parallel processes of cell proliferation and diff erentiation disorders.
3. Ki-67 expression increases from the cardiac type of epithelium in the segment to the detection of dysplasia foci on the background of metaplastic epithelium. An exception is tokokishechnaya metaplasia, which may be an indirect sign of the development of highly diff erentiated epithelium in response to gastroesophageal or duodenogastroesophageal refl ux.
Conclusion. Studies have shown that there are a number of genetic features of the pathological process in patients with morphologically confi rmed PB, the combination of which is more reliable and reliable assessment of the risk of neoplastic changes than individual indicators.
To date, it remains relevant to develop a marker panel that is suitable for use in clinical practice, informative for both assessing individual risk and stratifying risk groups, and useful for monitoring the eff ectiveness of treatment.

Purpose of the study. To study the epidemiological pathology of the upper gastrointestinal tract among the population of St. Petersburg for the period 2015 to 2018.
Materials and methods. We calculated and analyzed the incidence, prevalence, dynamics and structure of the pathology of the upper gastrointestinal tract in various age groups. The reporting forms of Federal Statistical Observation № 1 for 2015–2018 were the source of the information.
Results. The gastritis and duodenitis has a high incidence among chronic diseases of the upper gastrointestinal tract. The high incidence is can be seen among adolescents aged 15–17–20.3 per 1000. Peptic ulcer can be seen among people aged 18–55–1.2 per. Nowadays there is a problem of registration and accounting of gastroenterological hernias and gastroesophageal refl ux disease. This issue has to be solved and requires search for resolutions in the face of its prevalence and social signifi cance.

Aim. The aim of the study was to assess glucose metabolism, its perfusion in the cardiomyocytes and the detection of the myocardial dysfunction in patients with fatty liver disease and insulin resistance using the positron emission tomography with fl udeoxyglucose.
Materials and methods. In our study patients with the non-alcoholic fatty liver disease and the insulin resistance were examined. All patients underwent the еchocardiography and the positron emission tomography scans for myocardial dysfunction assessment.
Results and discussion. Echocardiography revealed various types of the left ventricular cardiac remodeling. The positron emission tomography showed a pronounced diffuse uneven distribution of the radiopharmaceutical. In addition, zones of hypometabolism and paradoxical accumulation of glucose were detected. It`s important to note that these indicated zones did not form sectors around a specifi c artery area, possibly refl ecting zones of fatty infi ltration or fi brotic changes in the myocardium. Thus, it was shown that in patients with the non-alcoholic fatty liver disease and insulin resistance the intensity and nature of glucose metabolism in cardiomyocytes were changed, indicating the presence of myocardial metabolic dysfunction.
Conclusion. We believe that in systemic insulin resistance metabolic processes were disturbed not only in the liver cells, but also in the cardiomyocytes, the rate of glucose utilization and its transmembrane transfer into cardiomyocytes were changed. As a result of the metabolic dysfunction, the geometric parameters of the heart are changed and various types of the cardiac remodelling are formed.

Objective: To study the interconnections and mutual infl uences of the components of the diffuse endocrine system of the gastrointestinal tract and non-alcoholic fatty liver disease (NAFLD).
Materials and methods: 138 patients with NAFLD and intestinal pathology, 36 patients without intestinal dysfunction were examined. The morphometric indicators of the expression of colonocytes immunopositive to the vascular endothelial growth factor, as well as to leptin, were compared with the clinical and endoscopic features of the colon and liver, and the functional and structural parameters of the liver were evaluated. Correlations of the studied indicators are revealed. A mathematical model is proposed that takes into account, along with the functional characteristics of the liver, structural, immunohistochemical, and morphometric parameters of the colon mucosa, which allow predicting the stage of liver fi brosis.
Results: It was established that NAFLD is characterized by a dysregulation of diff use endocrine system parameters, which makes a certain contribution both to the formation of structural changes in the colon and to the progression of liver fi brosis.

The aim of the research: to study the diagnostic capabilities of non-invasive methods for the diagnosis of hepatic steatosis in patients with NAFLD.
Materials and methods: the study included 240 male patients aged 21 to 54 years (mean age 41,1 ± 8,1 years), 172 of them with non-alcoholic fatty liver disease, 68 without this pathology. All performed measurement of anthropometric parameters, biochemical study of blood serum, ultrasound examination of the hepatobiliary zone, calculation of diagnostic indices of steatosis (FLI and HSI), non-invasive determination of the degree of steatosis on the device FibroScan with function CAP.
Results: the CAP values of the FibroScan apparatus, as well as indicators of predictive steatosis indices signifi cantly (p<0,05) diff ered in the study groups; the quality of diagnostic models, estimated by the AUROC index, in the steatosis indices FLI and HIS was recognized as excellent, in the CAP values of the FibroScan apparatus as very good.

The study aims to evaluate the eff ectiveness of standard and modifi ed settings of the spectral color allocation technology in the diff erential diagnosis of the colon morphological type of epithelial formations.
Materials and methods: video colonoscopy using standard and modifi ed mode of technology. A total of 746 patients were selected for spectral colour selection, of whom 80 were selected. There were 36 men, 44 women. The average age of the patients was 60 ± 9 years. There were 171 epithelial fomations, of which 106 (61.9%) were located in the left side of the large intestine: in the rectum — 33 (31.2%), in sigmoid — 52 (49%), in descending part — 21 (19.8%). In the right parts of the colon there were significant lower number of formations — 65 (38.1%): ascending intestine — 26 (40%), transversely — colon — 32 (49.2%), cecum — 7 (10.8%). Endoscopic studies were performed according to standard method using video colonoscopes from Fujinon, EC-590ZW / L, EC-530WL.
Results: statistically revealed that the probability of determining the correct morphological type of epithelium is formation is 6 times higher when using the modifi ed spectral color technology highlight compared to standard technology settings.
Conclusion: the modifi ed settings of the technology of spectral color highlighting allow much more accurative performance an optical biopsy of epithelial colon formations.

Purpose of the study. Improving the quality of treatment for liver echinococcosis by improving surgical tactics and developing eff ective methods to reduce disease recurrence.
Materials and methods: 371 patients with echinococcosis of the liver, who were admitted to the surgery department of the 2nd clinic of Samarkand State Medical Institute, were examined. Of the 371 patients in 311 (83.8%) patients, the disease was detected for the fi rst time and in 60 (16.2%) patients, echinococcosis was recurrent.
The results of the study: compared with 2005–2008. the incidence of postoperative complications decreased from 13.1 to 4.3%. Complications such as suppuration of the residual cavity (6 times), suppuration of the laparotomy wound (2 times), the formation of bile fi stulas (3 times), and no subphrenic abscesses began to occur much less frequently. The duration of inpatient treatment after surgery decreased by 2 times compared with the control — from 21.2 ± 1.2 to 10.9 ± 0.3 days.
Conclusions: the developed algorithm for choosing the tactics of surgical treatment of liver echinococcosis, taking into account the integrated approach to choosing access, the method of treatment and elimination of the residual cavity, as well as preventive chemotherapy, has improved the quality of care by reducing the frequency of immediate postoperative complications from 12.5% to 4, 3% (p = 0.027 according to the χ2 criterion) and relapse of the disease from 11.9% to 2.6% (p = 0.031 according to the χ2 criterion).

Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment.
Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment.
Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected.
Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

The aim. The aim of our study was to analyze the available data from literature sources concerning the issues of epidemiology, pathology, clinic, diagnosis, and features of surgical treatment of neuroendocrine tumors of the vermiform process.
Materials and methods. We conducted a retrospective analysis of foreign and domestic literature sources that contain upto-date information about the state of the problem of neuroendocrine tumors of the vermiform process
Results. Appendicular neuroendocrine tumors (ANEO) account for up to 16.7% of all neuroendocrine tumors of the gastrointestinal tract. In 54% of cases, ANEO show themselves for the fi rst time with a picture of an acute abdomen that resembles that of acute appendicitis. The main method of treatment is surgical. So far, there are no clinical guidelines that specify clear criteria for performing an appendectomy or right-sided hemicolectomy. Although gastrointestinal neuroendocrine tumors are less sensitive to it, there is evidence of a good response to temozolomide therapy (CAPTEM scheme: temozolomide+capecitabine). Octreotide can also be eff ective, especially in the group of functionally active ANIOS. The 5-year survival rate of patients with ANEO is 94% for tumors up to 1 cm in diameter, 70.5% for tumors larger than 2 cm, and 33.7% for distant metastases at the time of diagnosis.
Conclusion. Treatment of patients with ANEO gives rise to the following confl ict situation: on the one hand, the risk of recurrence of the disease in the long term is quite low, but if it occurs, it signifi cantly worsens the prognosis and, consequently, signifi cantly affects the overall survival. We emphasize the need to further study the biological properties of ANIO, the importance of generalizing all available data, which is possible only with close international contact of scientists around the world.

Barrett’s esophagus (BE) is a condition in which a stratifi ed squamous epithelium of the distal esophagus is replaced with a metaplastic intestinal-type columnar epithelium. BE is a precancerous condition associated with an increased risk of esophageal adenocarcinoma (EA). Current clinical practice guidelines recommend endoscopic surveillance with histological examination of esophageal biopsies for early detection of the EA. Epithelial dysplasia is the only clinically meaningful indicator of the risk for development carcinoma in BE, which is now used in practice. The existing limitations of this approach require new tools for the detection of early neoplastic disorders in BE and additional criteria to assess a risk for their progression. Within the framework of this review, the most signifi cant genetic and molecular indicators that can claim the role of diagnostic or predictive biological markers in BE are considered.

The article presents a clinical case of omentum lymphangioma in a child, which was successfully resected by open laparoscopy. This clinical case indicates the need for caution in relation to tumors of the abdominal cavity, which for a long time can occur against the background of nonspecifi c complaints or asymptomatically, and also shows positive dynamics against the background of the therapy.

A clinical case of a combination of ulcerative colitis with cirrhosis in the outcome of primary sclerosing cholangitis in a twelve-year-old child is presented. The uniqueness of the clinical observation lies in the atypical onset of ulcerative colitis in the form of complaints of weakness and headache, as well as detected anemia of 3 severity. It is important that the child lacked diarrhea, blood in the stool, tenesmus, weight loss, and fever. Of the most characteristic signs of liver damage, only itching of the skin of the lower extremities was noted. As a result, the child was diagnosed with cirrhosis of the liver at the end of the extraintestinal manifestation of ulcerative colitis — primary sclerosing cholangitis.

Obstructive jaundice with duodenal obstruction are often encountered in patients with primary cancer or metastasis to bilipancreatoduodenal zone. Usually palliative surgery involving creation of gastroentero and liver-cholecysteneteroanas-tamosis is used. This palliative surgery carries a high risk of complications and death if performed at the height of jaundice. In this case endoscopic stenting of duodenum or EUS-guided transmural biliary drainage may be preferred method of treatment. At the same time in the majority of patients performing of ERCP in cases of duodenum obstruction is not technically feasible. In this case EUS-guided transmural biliary drainage can be implemented. This clinical case demonstrates endoscopic treatment of a patient with pancreatoduodenal cancer complicated by duodenal obstruction and obstructive jaundice using endosonography and x-ray guided endoscopy.

Short bowel syndrome is a pathological symptom complex that occurs after removal (resection) of the small intestine (more than 25% of its length), or when there is a signifi cant violation of its function. The most common cause of short bowel syndrome is adhesions of the small intestine that occur after surgical interventions on the abdominal organs.
A description of the clinical observation of short bowel syndrome with severe manifestations of enteric insufficiency in a 41-year old patient is given. The patient was admitted to the surgical Department of FGBUZ Central clinical of the hospital Russian Academy of Sciences with com-plaints of General weakness, pain, spastic nature in the abdomen without clear localization, pain in the area of operational wound (for 4 months had 4 surgery for adhesive intestinal obstruction), abdominal distention, thirst, dry mouth, semiliquid chair 3–4 times a day, weight loss for the last 7 months before the hospitalization at 22 kg, the body mass index was 17.3 kg/m2. After the last surgical intervention, ileostomy of the ascending colon was applied using the Brooke method in connection with adhesive small bowel obstruction. The functioning segment of the jejunum was anastomosed with the ascending colon and was 22 cm long.
At admission, the state of moderate severity, moderately emaciated, dehydrated. Liquid stool up to 6 times a day, without pathological impurities. MSCT of abdominal organs from 03.05.2018 with contrast: in meso — and hypogastria (mainly on the left), expanded loops of the small intestine (up to a maximum of 37–38 mm) fi lled with liquid content were visualized, the contrast preparation in the above described loops of the small intestine was not visualized. Additionally, non-expanded loops of the small intestine were visualized in the hypogastria and did not contain contrast. Non-functional loops of the small intestine in the meso — and hypogastrium. Liver, biliary system, pancreas, spleen — without features.
On the background of complex therapy, the stabilization of clinical and laboratory indicators was achieved, which allowed to plan surgical treatment-laparotomy, closure of ileostomy, imposition of small intestine anastomosis in the large intestine. A laparotomy was performed with the right pararectal access. Continuous viscero-visceral and of viscero-peritoneal splices were found in the abdominal cavity. With technical difficulties caused by fi brous-calcifi ed splices, it was possible to separate the ascending colon and the part of the jejunum that goes to the anterior abdominal wall to the site of the bred jejunostomy. The intersection of the jejunum stoma was performed in close contact with the anterior abdominal wall. A double-row “end-to-side” anastomosis was formed with the middle third of the ascending colon. When performing laparotomy with left pararectal access under conditions of a pronounced adhesive process, it was possible to isolate a section of the sigmoid colon and a loop of the small intestine that was previously disabled (during the previous operation). Ileosigmoidostomy formed a double row “side to side”. The preserved portion of the small intestine was 85 cm.
In the postoperative period, there were signs of endogenous intoxication. Against the background of intestinal paresis and severe intoxication, there was an increase in the markers of infl amemation and pancytopenia. Complex therapy with parenteral mixtures, prebiotics and antimicrobial drugs stopped the symptoms of intoxication, the activity of infl ammation, and improved laboratory parameters, which allowed us to gradually switch to oral food intake. Semi-formed stool 1–2 times a day. She was discharged on the 10th day after the operation for outpatient treatment under the supervision of a surgeon and gastroenterologist. One-year rehabilitation period with a positive effect, which indicates the uniqueness of this clinical observation.

Background. The fi rst clinical case of autoimmune hepatitis (AIH) was described in 1951, and in the 1970s, several randomized clinical trials proved the eff ectiveness of glucocorticosteroids in the treatment of AIH. Nonetheless, this disease remains a mystery to clinicians due to its rarity and heterogeneity.
Aim. To describe the clinical case of the patient with AIH (SLA/LP antibodies) and discuss its management.
Clinical case. A 22-year-old male with an acute manifestation of autoimmune hepatitis and a delayed, isolated increase of autoantibodies (SLA/LP). The initial diagnosis was made based on hypergammaglobulinemia and the eff ectiveness of glucocorticosteroids. Highly specifi c antibodies were detected only after 3.5 months, and the AIH was confi rmed histologically.
Conclusion. This clinical case emphasizes the need to isolate type 3 AIH due to the more severe course and common relapse after the withdrawal of immunosuppressive therapy.

The World War II was and is unforgettable for the Soviet people because it is the Great victory of the Great people. The president of the Russian federation defi ned the attitude of the West to the victory by the next words: “Countries do not stop trying to distort historical truth about the World War II… Russia will answer the truth to attempts to distort the facts about the World War II”. For our people this war is great tragedy and great feat. On the fi rst day of aggression the Soviet government declared: “Our cause is just. The enemy will be defeated. Victory will be ours.” The strength and courage of military commanders, soldiers and officers, who did, everything to ensure that on the night of May 1 the Red Flag hosted above the Reichtag. According to estimates of marshals of the Soviet Union, the role of the Soviet medical scientists, doctors, middle and junior medical workers is invaluable. It were they who returned to service 73.3% of the wounded and 90.6% of the sick, in absolute numbers that were about 17 million people, and 6.7 million people participated in the Berlin operation. Thus, the last point in the war was put by a Soviet soldier, a Soviet officer, returned to service by the Soviet medicine.