Objective of the Paper: The purpose of the article is to familiarize doctors with the principles of periodic accreditation, its features, as well as to answer the most frequently asked questions in this area.

Key Points. The article describes who and how conducts periodic accreditation of medical specialists, what is necessary for its passage, how to submit documents and what to do if the doctor does not agree with the result of accreditation.

Conclusion. The key to successful periodic accreditation is the timely improvement of qualifications, compliance with the requirements of the professional standard in their specialty and careful compliance with all the rules for submitting documents, which can be found on the official website of federal accreditation centers.

Objective of the Review: to determine the criteria for the effectiveness and quality of modern educational programs, the choice of advanced training programs by medical professionals within the framework of personal and professional growth in the formation of an individual educational trajectory.

Key Points. Additional professional training programs ensure the updating of professional standards in the context of changing goals, content, technologies, regulatory support of professional activity in a particular field, and also take into account the qualification requirements specified in the qualification reference books for the relevant positions and specialties. Educational programs must meet strict    requirements: be relevant, modern, practice-oriented, methodically and scientifically sound.

Conclusion. The formation of the educational trajectory of a medical specialist and the choice of advanced training programs should be based on the quality criteria of both individual educational programs and the educational process as a whole: compliance with the federal state educational standard in the specialty, professional standard in the specialty/position, clinical recommendations and their evidence base. The quality of training of a medical specialist increases many times when the content of the educational program is supported by a specialized interdisciplinary educational event. Training and advanced training of medical workers should be carried out in medical educational organizations with qualified teaching staff, full-fledged logistical and methodological support, as well as their own bases of practical (clinical) training.

Objective of the Review: To describe the aims and objectives of the Cochrane Russia Center.

Key points. Decision-making processes in health care are complex and include various components, involving multiple factors and actors at different levels. In such circumstances, the sources and availability of information are of particular importance. One of the goals of the Cochrane Collaboration, in particular the Cochrane Russia Center, which is based in the Russian Medical Academy of Continuing Professional Education (RMANPO), is to disseminate quality information on health issues. In response to the challenges faced by healthcare systems during the COVID-19 pandemic, the Global Commission on Evidence was established. Its work resulted in developing the Evidence Commission Report. This report providing a number of recommendations for all participants in decision-making at different levels, was translated into Russian by the staff of Cochrane Russia based in RMANPO. In addition, to increase the availability of quality information for both physicians and patients, Cochrane Russia translates summaries of Cochrane systematic reviews and training materials into Russian, develops and publishes information materials.

 Conclusion. Supporting clinical decision making by physicians is the main goal of Cochrane Russia's activities at RMANPO. Cochrane Russia is a link and source of quality evidence-based information for all Russian-speaking audiences.

Study Objective: To study the clinical symptoms and prevalence of hepatic fibrosis in patients with chronic virus hepatitis C (CVHC), genotype 1, or Opisthorchis felineus invasion.

Study Design: Cross-sectional comparative study of random groups of inpatient or outpatient patients.

Material and Methods. We examined 297 patients with CVHC, genotype 1, and 214 patients with chronic opisthorchiasis. CVHC was diagnosed in accordance with the guidelines of the European Association for the Study of the Liver. Opisthorchiasis was diagnosed when eggs or mature parasites were found in duodenal content and/or faeces of the patient. Hepatic fibrosis was assessed with shear wave elastography using the METAVIR scale. Study Results. We have found differences in clinical symptoms: prevailing cytolytic syndrome (82.8% vs 9.8%; p < 0.001), hepatomegaly (20.9% vs 10.3%; p = 0.002), and stage F3-F4 hepatic fibrosis (METAVIR) (20.5% vs 8.4%; p < 0.001) in patients with CVHC and higher prevalence of cholestatic syndrome (14.5% vs 0.3%; p < 0.001), chronic cholecystitis (18.2% vs 8.8%; р = 0.002), gallstones (4.7% vs 0.7%; р = 0.008) in patients with opisthorchiasis.

Conclusion. Highly significant is frequently diagnosed F2, F3 and F4 hepatic fibrosis (METAVIR) in patients with opisthorchiasis (20.5%). These evidences point out that O. felineus invasion is a hepatic pre-cancer condition. Taking into account the high prevalence of O. felineus invasion in some regions of Siberia, the available data show that opisthorchiasis is a relevant medical and social issue which must be addressed.

Objective of the Review: To describe the mechanisms and clinical significance of hepatic fibrogenesis in iron overload in patients with hereditary hemochromatosis and chronic hepatic conditions.

Key Points. Iron overload is toxic and can facilitate hepatic fibrogenesis. Hepatic fibrogenesis is an unfavourable natural event both of hereditary hemochromatosis and chronic hepatic conditions, since it can cause hepatic cirrhosis and hepatocellular carcinoma.

Conclusion. Patients with iron overload should be stratified into at-risk groups for early diagnosis of hepatic fibrosis and optimal management

Study Objective: to study the indicators of apoptosis and proliferation in gastric epitheliocytes in indigenous and alien inhabitants of the Republic of Tyva with atrophic and non-atrophic gastritis.

Study Design: cross-sectional comparative study in rural areas of the Republic of Tyva.

Material and methods. Clinical examination and endoscopic examination with biopsy sampling from the mucosa of the antrum and gastric body were carried out in 61 Tuvinian and 65 alien inhabitants in the village of Saryg-Sep of the Republic of Tyva, of which 91 people had non atrophic, and 35 — atrophic gastritis. Helicobacter pylori was determined by two methods: morphological and urease. Morphological diagnosis of gastritis was performed in accordance with the modified Sydney classification (1994). The markers of proliferation (Ki67 and PCNA) and apoptosis (bcl-2 and p53) in gastric epithelial cells were assessed by immunohistochemical method.

Study Results. H. pylori was found in 85.2% (52 of 61) of the examined natives and 81.5% (of 53 of 65) of the visitors (odds ratio — 1.29; 95% confidence interval: 0.51–3.26, p = 0.75). In both populations, in patients with atrophy in the antrum and gastric body, the apoptosis index p53 was significantly higher than in patients without atrophy. Proliferation indicators Ki67 and PCNA in gastric epithelial cells significantly decreased in patients with atrophic gastritis compared to those in patients without atrophy among Caucasoids, but not among Tuvinians.

Conclusion. The obtained results indicate deeper disturbances in the cellular renewal of gastric epitheliocytes in alien inhabitants with atrophic gastritis than in indigenous people with this disease. We suggest that indicators characterizing the proliferation of epitheliocytes in patients with atrophic gastritis may be markers of the risk of developing gastric cancer.

Objective of the Review: To analyse available contemporary references about possible pathological mechanisms of ulcerative colitis (UC).

Key Points. There are data on high prognostic significance of genetic and demographic factors, characteristics of intestinal microbiota in UC development; and the absence of genetic differences in UC morbidity. Results of a number of studies demonstrate favourable impact for UC from some environmental factors, such as smoking, appendectomy and obesity. A significant component of UC and, thus, a useful marker of the disease activity/severity and a potentially attractive pharmacological target for UC management is neutrophils.

Conclusion. Understanding the pathogenic mechanisms and assessment of risk factors allow expanding the comprehensive aid to patients with UC.

Objective of the Review: to analyze the available data on the etiology, pathogenesis, diagnosis and treatment of a new coronavirus infection.

Key points. In 2020, the whole world was engulfed by a pandemic of a new viral disease, which was called the coronavirus disease СOVID-19. We have considered aspects of the etiology, pathogenesis, diagnosis, and treatment of this infection. One of the most difficult issues is the therapy of COVID-19, since the course of the disease exacerbates the development of a cytokine storm.

Conclusion. When choosing a patient's treatment tactics, it is necessary to comprehensively assess possible adverse events, strive to minimize their occurrence.

Study Objective: To conduct a cost analysis of the management of patients with viral pneumonia caused by SARS-CoV-2, and to develop nosological models of patients in order to optimise medical fees.

Study Design: Statistical and economic study.

Material and Methods. We studied 50,539 completed hospitalisations of patients with viral pneumonia caused by SARS-CoV-2 during a period from March 2020 to March 2021 in Municipal Clinical Hospital No. 15 named after O.M. Filatov. Using an expert evaluation, we found out 5 nosological models of patients and calculated mean duration of hospitalisation, confidence intervals (95% CI), and fee parameters using actual costs (cost of one bed-day and completed therapy).

Study Results. We managed to prove the hypothesis, according to which correctness of analysis of actual costs of therapy and precise  prognosis depend on the differentiation of cases of SARS-CoV-2-caused viral pneumonia using nosological models of a patient, nosological forms, and disease severity. We developed nosological models of a patient; identified a range of cost of therapy; and calculated corresponding relative factors.

Conclusion. The cost of management of patients with viral pneumonia caused by SARS-CoV-2 should be analysed and planned dependingon nosological models grouped on the basis of common causation of the disease, presence or absence of complications (pneumonia), presence of comorbidities and surgeries, and condition of patients. The most expensive is the management of patients with COVID-19 and pneumonia and surgery.

Study Objective: To define the predictive value of arterial stiffness parameters in the development of intradialytic hypertension (IDH) in patients undergoing long-term HD.

Study Design: Prospective study.

Material and Methods. The prospective study included 45 patients undergoing long-term HD. An IDH criterion was an increase in systolic blood pressure >10 mm Hg after the HD in more than 4 out of 6 sessions during the period preceding 24-hour blood pressure monitoring (24BPM). Arterial stiffness parameters were assessed using a Vasotens-24 BPLab software package (by Peter Telegin, Russia). We recorded the demographics of patients and physical examination results, lab test results, duration of HD, concomitant cardiovascular diseases, and medications taken. For data analysis we used Statistics 26 application package (IBM SPSS).

Study Results. The mean age of patients was 51 [41; 61] years old; HD duration was 4.5 [1.1; 7.8] years. IDH was recorded in 20 patients; the multivariate correlation analysis showed that IDH was associated with the patients’ age (HR = 3.78; 95% CI 1.29–11.04), with the augmentation index AIx (HR = 7.75; 95% CI 2.65–22.7). Inverse correlation was observed between IDH development and reflection wave   transmission time — RWTT _100–60 (HR = 0.27; 95% CI 0.14–0.53), presence of diabetic nephropathy (HR = 0.34; 95% CI 0.094–1.251), residual diuresis (HR = 0.43; 95% CI 0.21–0.87), and albumin level (HR = 0.12; 95% CI 0.02–0.79). Inclusion of arterial stiffness parameters into the mathematical model increased its predictive ability from AUC = 0.886 to AUC = 0.978.

Conclusion. In this study, AIx ≥ –6.5% and RWTT _100–60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which can be a sign of the leading role of progressive artery stiffness in the development of intradialytic cardiovascular complications.

Objective of the Review: coverage of social and ethical problems of diabetes mellitus.

Key points. Discussion of the bioethics of diabetes mellitus is one of the most important tasks of modern medicine in connection with the progressive increase in the prevalence of the disease and mortality from causes associated with diabetes. Bioethics includes the widest range of socio-economic, moral, ethical and legal problems of modern medicine. The article discusses various aspects that lead to the development of diabetes and have become widespread in the course of civilizational development. Psychological disorders of a diabetic patient and the role of self-stigmatization are discussed. The materials of the global "Agenda for the period up to 2030" developed by the UN General Assembly and the UNESCO program on bioethics, ethics of science and artificial intelligence are presented.

Conclusion. Further study of the actual problem of the bioethics of diabetes mellitus requires joint efforts of the world scientific community.

Objective of the Review: To present the pathophysiological mechanisms of the coronavirus infection in obese patients, and approaches to obesity correction in this group of patients following an overview of large randomized clinical trials of cardiovascular safety from PubMed, Cochrane Library, Google Scholar.

Key Points. Clinical trials have demonstrated that obesity is a significant risk factor of a number of comorbidities, including severe and fatal cases of the novel coronavirus infection. A higher prevalence and severity of the novel coronavirus infection in obese patients is caused by a set of factors, with the most significant factor being an increased cardiovascular risk, including tendency to blood-clotting, reduced respiratory efficiency, impaired immune response, and chronic inflammations. Main groups of medicinal products that can be used to manage lipotoxicity have been listed.

Conclusion. It has been proven that a range of positive effects from new antihyperglycemic agents (glucagon-like peptide-1 receptor agonists and sodium-glucose linked transporter-2 inhibitors), combined with a well-studied efficiency and safety profile, is a new method to manage obesity during the coronavirus pandemic.

Study Objective: To study lymphocyte lysates for the dependence of the activity of xanthine oxidoreductase (XOR) complex: xanthine oxidase (XO) and xanthine dehydrogenase (XDG) — on the presence of extraarticular (systemic) manifestations (EAM) in patients with rheumatoid arthritis (RA).

Study Design: Comparative study.

Material and Methods. The study included 77 patients with verified RA (study group) and 35 apparently healthy subjects (control group). Lymphocytes were isolated using А. Böyum method in Lymphosep with a density gradient of 1.077–1.079 g/mL. Ferment activity was measured with kinetic methods and expressed in nM/min/mL equivalent to 10 7 cells per 1 mL. Study Results. XO reference range is 14.11–31.33 nM/min/mL; that of XDG — 18.62–39.64 nM/min/mL. For RA patients as a whole and  patients with and without EAMs, lymphocytes demonstrated a significant reduction in the activity of both ferments vs controls (р < 0.001); in RA patients with EAMs, the XO and XDG activity was even lower (р < 0.001). Spearman correlation analysis identified the dependence of XO and XDG activity on the presence of EAMs: direct moderate correlations for XO (ρ = 0.6; p < 0.001) and XDG (ρ = 0.499; p = 0.000041). There is a strong direct correlation between XO and XDG activity, the intensity of which was higher where RA was associated with EAMs: (ρ = 0.72; p = 0.025) and (ρ = 0.87, p = 0.004) for RA only with articular involvement and for RA with EAMs, respectively.

Conclusion. In lymphocytes of patients with RA, we found some changes in the XOR enzyme profile, the intensity of which depends on the presence of EAMs in the clinical presentation of the disease. Where XO activity is below 10.86 nM/min/mL and/or with XDG activity below 14.31 nM/min/mL, it isassumed that RA patients have EAMs. It is then recommended that the patient undergoes a comprehensive examination for early EAM identification and therapy adjustment.

Study Objective: To identify the structure and prevalence of cardiac involvement in patients with systemic lupus erythematosus (SLE); evaluation of the relationship with the activity, disease duration and antirheumatic therapy.

Study Design: Prospective cross-sectional study.

Material and Methods. The study included 87 patients with SLE (90.8% women), with the median age of 32 [28; 41] years old and disease duration of 6 [1; 10] years; Systemic Lupus Erythematosus Disease Activity Index, modification 2К, was 9 [4; 16] points, Systemic Lupus International Collaborating Clinics Damage Index was 0 [0; 1] points. All patients were examined by a cardiologist, and traditional risk factors (TRF) of cardiovascular diseases were identified. Patients underwent transthoracic echocardiography (ECHO); if indicated, 24-hour ECG and blood pressure monitoring was performed. Serum NT-proBNP concentration was measured with electrochemiluminescence.

Study Results. The most common cardiac complication was valvular insufficiency with various degree of regurgitation, which was diagnosed in 92% patients; endocarditis was recorded in 30%; mitral or tricuspid valve prolapse was observed in 33.3%. Pericardium pathologies were diagnosed in 44.8% patients, and adhesive pericarditis prevailed (61.5%). Myocarditis was observed in 4.6%, ischemic heart disease (IHD) — in 5.7%, cardiac failure (CF) — in 11.5%, rhythm and cardiac conduction disturbances — in 18.4% and 2.3%, respectively, myocardial  infarction (MI) — in 2.3%. Dislipidemy and arterial hypertension (AH) were recorded in 50.6% and 46% patients. 31% demonstrated high  NT-proBNP levels (> 125.0 pg/mL); median NT-proBNP concentration was 91.8 [27.1–331.2] pg/mL.  Patients were divided into two groups: group 1 did not take any glucocorticoids (GC), immunosuppressants and genetically engineered  biologic drugs; group 2 had various combinations of these products. Patients in both groups were of similar age and sex; they did not have any  differences in the prevalence of valvular insufficiency (86.7% and 97.6%), endocarditis (26.2% and 33.3%), pericarditis (42.9% and 46.7%),  rhythm disturbance (19% and 17,8%), and impaired cardiac conduction (2.4% and 2.2%), IHD (2.4% and 8.9%), CF (7% and 15.5%). MI and myocarditis were diagnosed only in group 1 (4.4% and 9.5%, respectively); however, these differences were not statistically significant. AH was  observed more frequently in group 2 than in group 1 (62.2% and 28.6%, р < 0.01); other TRFs did not demonstrate any differences; however,  total cholesterol concentration and body mass index in group 2 were higher than in group 1: 5.7 and 4.5 mmol/L (р < 0.05); 22.66 and  22.10 kg/m² (р < 0.01). NT-proBNP concentration in untreated patients was higher than in group 2 (150.7 and 32.6 pg/mL, respectively,  р < 0.01), exceeding the normal values.

Conclusion. Despite the juvenile age of patients, the therapy (mostly GC) and longer disease duration are associated with higher incidence of TRF (AH, hypercholesterolemia, overweight), while myocarditis and high NT-proBNP concentration are typical of untreated patients with highly active SLE. SLE patients should be followed up by a cardiologist; symptom-free CF markers should be identified as this condition is life-threatening, especially in patients with extremely active disease; TRFs should be monitored; and minimal GC doses should be used during remission/low-activity disease.

Objective of the Review: To discuss the specific properties of Nimesulide and its use in COVID-19.

Key Points. A significant advantage of Nimesulide is a very rapid analgesic effect, due to rapid and meal-independent absorption in the gastrointestinal tract, almost complete binding to blood albumin, equally rapid achievement of the maximum concentration both in synovial fluid and blood. Now we have some data on the promising use of Nimesulide for COVID-19 management.

Conclusion. An idea that Nimesulide should be among the medicinal products undergoing assessment for the use for COVID-19 management, seems rather rational. Although it is not clear whether such studies will be conducted and what their outcome will be, selection of Nimesulide as one of the primary drugs for pain management and inflammation therapy both by medical professionals and patients is not by chance; it is completely informed and justified.