The immediate impetus for this article is the increasing media coverage of the COVID-19 pandemic, which offers homeschooling with distance learning elements as a replacement for traditional schooling. The conditions of a pandemic are not easy for educational organizations. This is due to the specifics of educational programs in schools, and also to some features of the students' families' socio-economic situations. The parents of many students have few financial means. These students may not have even basic conditions at home to systematically study remotely; for example, they may not have an equipped workplace, a computer, or a tablet connected to the Internet. In the process of distance learning, schoolchildren are much less likely to rely on help and support from their own parents. This is due both to the parents' employment in their own work and to any lack of pedagogical competence they may have to support home-schooling. The coronavirus barrier to learning is proving formidable for many students.

Background:The neuropathic component is present in the mechanism of pain in RA in 36% of cases. The presence of anxiety-depressive disorders and a decrease in the quality of life in patients with RA are shown.Objectives:The study of the clinical features of pain in RA in men and women.Methods:The group consisted of 134 patients with RA (94 women and 40 men), aged 36 to 60 years (average age 48.6 ± 7.1 years) and disease duration from 1 year to 10 years (4.03 ± 1.6 years) hospitalized in the rheumatology department of the Republican Clinical Hospital (Cheboksary). At the time of inclusion in the study, all patients were in the active stage of the disease.An assessment of rheumatological and neurological status was carried out. Pain assessment was performed using: Visual Analog Scale (VAS); Ritchie articular index (RAI). The severity of neuropathic pain was determined using the diagnostic neuropathic pain questionnaire DN4 and PainDetect (sensitivity - 82.9%; specificity - 89.9%). To determine the psycho-emotional deviations used: general health questionnaire (anxiety and depression) - General Health Questionnaire (form GHQ – 28); HADS; Spilberger-Hanin situational and personal anxiety scale. Patient mobility limitations were assessed using the Rivermead mobility index score scale, and quality of life was quantified using the EQ-5D visual analogue scale.To assess the activity of the disease, the level of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and the DAS index - 28-CRP were used. To assess mental and physical functioning, a standardized questionnaire The Short Form-36 was used.To visualize the stage, survey radiographs were used in the direct projection of the metacarpophalangeal and metatarsophalangeal joints, wrist joints, proximal interphalangeal joints of the hands; distal parts of the feet.Results:An analysis of chronic pain syndrome in 36% of patients revealed a neuropathic component of pain (DN4: 5.7 ± 1.1 points, PainDetect: 16.3 ± 4.2).In the group of patients with neuropathic pain (n = 78) aged 55.1 ± 7.9 years, the duration of the disease was 3.4 ± 0.9 years, the more advanced and late clinical stages of the disease, III – IV radiological stages of RA were more common, were present neurological disorders and complaints characteristic of peripheral polyneuropathy. Rivermead mobility index in patients with neuropathic disorders, (n = 78) was 9.1 ± 0.8 points, in the absence of neuropathic disorders (n = 56), 11.2 ± 1.1 points. There were no significant differences in process activity (DAS index - 28 - CRP) and quality of life.According to the questionnaire of situational and personal anxiety, Spilberger-Khanin revealed moderate anxiety and mild - depressive disorders. Quality of life was reduced in all patients with RA.Pain syndrome in patients with neuropathic pain with symptomatic (NSAIDs, GC) and basic cytostatic therapy (methotrexate) showed that, despite the decrease in the severity of the inflammatory process, the positive dynamics was partial (VAS before therapy 6.4 ± 0, 7; VAS in the presence of therapy 4.3 ± 0.5 (p> 0.05); PainDetect = 14.9 ± 4.4; DN4 = 4.3 ± 1.5).In men, statistically significant factors associated with pain were clinical parameters that accounted for 37% and 18% of pain variation (Ritchie articular index (CIR): Fsmc = 4.107, p <0.001; SF-36: Fsmc = 2.107, p <0.001) In women, the main significant factors associated with pain were the subjective feeling of pain and psychological characteristics that accounted for 12% of the pain variation (SF-36: Fsmc = 11.118, p <0.001).Conclusion:A dynamic study of patients with RA in accordance with gender and age will further develop additional criteria for evaluating the effectiveness of complex therapy used to treat chronic pain, and will also increase the overall effectiveness of treatment.Disclosure of Interests:None declared

Relevance. Bronchial asthma is widespread in the world, according to WHO estimates, 235 million people suffer from it. In Russia, according to official figures, 1.3 million cases of bronchial asthma have been reported. Domestic experts reasonably believe that these data are underestimated at least 4 times. Considering that patients with bronchial asthma undergo significant changes in the immune system and are especially difficult to tolerate respiratory and other infectious diseases, determining the effect of vaccination on the clinical course of bronchial asthma is very important. The purpose of the review is to show how vaccinations against pneumococcal infection and influenza affect the condition of patients with bronchial asthma. Conclusion. Features of formation of protective immunity at various schemes of immunization against pneumococcal infection are analyzed. In patients with bronchial asthma, the justification of the vaccination scheme with the advantage of the priority administration of conjugated polysaccharide vaccine with the subsequent introduction of a polysaccharide pneumococcal vaccine after 8 weeks is given. Vaccination against pneumococcal infections has led to the elimination of sputum S. рneumoniae. In vaccination against pneumococcal infection, there was an improvement in the level of disease control, which was confirmed by the ACQ-5 test-a decrease in the indicator from 2 [1,5;1,8;3] points (lack of asthma control) to 0,6 [0;1] points (asthma control) during the year of observation, p < 0,001. Vaccination against influenza in patients with bronchial asthma leads to a decrease in the frequency and duration of exacerbations, there is a decrease in the level of markers of systemic inflammation. Combined vaccination against influenza and pneumococcal infection is not accompanied by a reliable difference in tolerability in comparison with monovaccination only against pneumococcal infection or influenza.

Aim. To study the absorptive function of the rat intestine on the background of prolonged alcohol intoxication. Methods. The study was performed on 24 nonlinear white male rats (12 animals in the control and experimental groups) weighing 220-240 g, which had a daily consumption of 20° ethanol solution (ethyl alcohol) for the duration of 180 days. After 6 months perfusion of the isolated segment of jejunum with a dextrose (glucose) solution 35 mmol/L was performed by in the rats the method A.M. Ugolev. The luminescence-histochemical method was used to examine the content of catecholamines and serotonin in the neuroamine containing structures. Results. In the control rats, the rate of absorption in the first 10 min of perfusion reached a maximum value with a further decrease in the intensity of absorption. The content of serotonin and catecholamines in the absorptive epithelial layer of the jejunal villi was lower than in the muscle membrane. In the experimental rats the content of biogenic amines in the wall of the jejunum increased: the amount of serotonin in the absorptive layer of the villi increased up to 122% and in the muscle membrane - up to 126%. The content of catecholamines also increased up to 154% in the muscle membrane and up to 124% in the epithelial layer in the area of the villi compared with controls. In conditions of chronic alcohol intoxication the rate of absorption of dextrose (glucose) during perfusion in the first 30 minutes was reduced by 33% compared with the control. During the next hour, the intensity of absorption reduced by 45% (55% of control). After 1.5 hours the absorption increased slightly, accounting for 64% of the control value and by the end of the 2nd hour the intensity of the absorption reached 91%. Conclusion. An increase in content of catecholamines and serotonin in the mucous and muscular layers of the intestine in chronic alcohol intake and a decrease in the intensity of the absorption of dextrose (glucose) was established; in the setting if modified combined effects of neurotransmitters on smooth muscle cells an increased motor effect is formed, which is accompanied by rapid evacuation of the intestinal chyme with a reduction in the rate of absorption