Introduction. Studies indicate high risks of secondary diseases and adverse events not related to HIV in patients with immunological inefficiency of antiretroviral therapy (ART). The effect of comorbidity on the increase of CD4+ is detected.

The aim of the study is assessing the effect of comorbidity on CD4+ growth and the probability of developing immunological inefficiency of ART.

Materials and methods. A retrospective study was conducted that included HIV-infected patients with CD4+ at the beginning of treatment <200 cells/µl. Two groups were formed: the main group — patients with immunological inefficiency of ART (281 people); the control group — patients with sufficient immunological response on ART (188 people). Results. The probability of developing immunological inefficiency in patients with tuberculosis was 1.7 times higher (odds ratio (OR) — 1.7; 95 % confidence interval (CI) — 1.0–2.9); in patients with HCV-infection — 1.8 times higher (OR — 1.8; 95 % CI — 2.6–1.2). The probability of cardiovascular disease in the main group was 2 times higher (OR — 2.3; 95 % CI — 1.0–5.4).

Discussion. Tuberculosis, HCV-infection and cardiovascular diseases frequently registered in the structure comorbidity in the main group of patients.

Conclusion. According to the results of this study, HIV-infected patients with HCV and tuberculosis co-infection have a higher chance of developing immunological inefficiency of ART.

Introduction. Prioritization of measures to contain the COVID-19 pandemic has led to a decrease in the coverage and intensity of TB control activities.

The aim of study to assess the indicators of detection, diagnosis and treatment of tuberculosis during the COVID-19 pandemic in the Republic of North Ossetia-Alania and compare them with those at the all-Russian level.

Materials and methods. A preliminary collection of statistical information in Russian and several foreign sources closest to the topic was carried out on the PubMed, ResearchGate, ScienceDirect, CyberLeninka and eLibrary platforms. An analysis of the epidemiology of tuberculosis in North Ossetia for 2020–2021 was performed. according to annual reporting forms and reports from epidemiological monitoring systems for tuberculosis.

Results. The detection rate of tuberculosis has decreased during the pandemic. The indicator in North Ossetia was higher than the national level. Clinical and diagnostic indicators for tuberculosis in the republic in 2020 were lower compared to those for 2021 for the study of sputum, decay phase, and bacterial excretion. The proportion of successful tuberculosis chemotherapy in the republic was higher than in a number of regions of the Russia.

Discussion. There was a decrease in registered and, obviously, accumulation of latent cases of tuberculosis during the COVID 19 2020 pandemic due to a drop in preventive coverage of the population in the Russia. A worsening of the clinical structure of tuberculosis in 2021 in Republic of North Ossetia and an increase in the proportion of patients with destruction of lung tissue and the fibrous-cavernous type of disease in the Russia are revealed, possibly due to untimely detection of tuberculosis.

Conclusion. Low activity of primary health care organizations regarding tuberculosis was revealed. Restrictions to prevent the spread of the SARS-CoV-2 pathogen contributed to a decrease in the coverage and intensity of anti-tuberculosis measures. The COVID-19 pandemic clearly affected the rates of primary diagnosis of tuberculosis in 2020, and in 2021 a significant increase was noted.

Introduction. The incidence of enterovirus meningitis in Ekaterinburg has long exceeded the average in Russia. As a result of sanitary, anti-epidemic and restrictive measures related to the COVID-19 pandemic, there was a decrease in morbidity, which led to a reduction in the circulation of non-polio enteroviruses and created risks after lifting of restrictions.

The purpose of the study is to conduct a comparative analysis of non-polio enteroviruses isolated in Ekaterinburg from patients with enterovirus before and after the COVID-19 pandemic.

Materials and methods. Genotyping positive samples by sequencing VP1 gene (cerebrospinal fluid, nasopharyngeal, faeces) from patients with aseptic meningitis was performed using the BLAST service. Multiple alignment and phylogenetic analysis were performed using the MEGA software.

Results. In 2022, after lifting restrictive measures, the incidence of enteroviruses in Ekaterinburg increased 10 times compared to the previous year (3,390 per 100 thousand inhabitants), but remained 6.5 times lower than the long-term average (22,035 per 100 thousand population). 7 types of non-polio enteroviruses were detected: 2 species A (Coxsackievirus A4, Enterovirus A71) and 5 species B (Coxsackievirus A9 and B2, Echovirus 6, 7, 9). Coxsackievirus A9 dominated, followed by Echovirus 6.

Discussion. In 2022, Coxsackievirus A9 prevailed as the predominant type in enterovirus, was not epidemiologically significant and was rarely found in the cerebrospinal fluid samples. Echovirus 6, the second most frequently detected, was characteristic of the Ural Federal District. The remaining viruses (Coxsackievirus A4 and B2, Echovirus 7 and 9, Enterovirus A71) were also detected in patients with enterovirus before the COVID-19 pandemic.

Conclusion. After the cancellation of prophylactic measures after the COVID-19 pandemic, the incidence of enteroviruses in Ekaterinburg during 2022 increased due to the restoration of circulation of non-polio enteroviruses.

The aim of the work to determine the features of hemostasis and blood rheology in patients with arterial hypertension (HTN) and multifocal atherosclerosis (MFA).

Materials and methods. The study enrolled male and female patients aged from 40 to 70 years, including 59 patients with controlled stage I–II hypertension and multifocal vascular lesions (Group 1) and 42 patients with controlled stage III hypertension, who have suffered an ischemic stroke and have multifocal vascular lesions (Group 2). A test using the Thrombodynamics analyser system T-2 (GemaKor, LLC, Moscow, Russia) was performed to detect the impairment of hemostasis.

Results. Patients with HTN and MFA have an impaired coagulation hemostasis system (an increase in the initial and stationary clot growth rate and the size of the clot, as well as the presence of spontaneous clots), which leads to a high residual risk of cerebral complications, despite BP lowering to target figures and control of lipid profile.

Discussion. Elevated blood pressure in patients with MFA leads to endothelial dysfunction, which is accompanied by activation of coagulation and fibrinolysis pathways. These changes lead to a violation of microcirculatory hemostasis in the brain, the development and progression of cerebral ischemia, and subsequently the occurrence of stroke, both the first and repeated.

Conclusion. An important result of this study is the first registered change in the coagulation link of hemostasis in patients with HTN and MFA aged from 40 to 70 years, which can be considered an additional criterion for stroke prediction.

Introduction. The prevalence of oral cavity age-related diseases, such as chronic periodontitis (CP) and oral lichen planus (OLP) increases in the elderly and senile age people. The aim of the study was to evaluate changes in the biochemical parameters of mixed saliva in age-related oral diseases and evaluate impact of correction by total protein concentration.

Materials and methods. The study included 86 elderly people from 60 to 74 years. They were divided into following groups: excessive attrition of teeth patients (n = 16); moderate CP patients (n = 22); OLP patients (n = 28); healthy peoples (n = 20). Reagent strips Siemens Multistix 10 SG (USA), analyzer Siemens Clinitek Status+ (USA), chemistry analyzer Mindray BS-240Pro (China) were used. In total, 16 biochemical markers and 4 calculated indices were determined. Saliva results were expressed without any correction, and corrected by total protein concentration.

Results. It was found that OLP patients differed by a higher specific gravity and an increased level of total protein and calcium from the control group. CP patients had a higher level of c-reactive protein in compared to the healthy peoples. There were no differences between groups after correction.

Discussion. The data corresponded to literature sources describing mixed saliva changes in age-related oral diseases. However, correction methods practically were not used in the considered works.

Conclusion. Mixed saliva chemical markers changed in age-related oral diseases. It is necessary to find the optimal correction method because dilution and viscosity can significantly affect mixed saliva research results.

Introduction. Hypertensive disorders during pregnancy, despite many epidemiological studies, scientific developments, and the improvement of laboratory and instrumental techniques for searching for predictors of preeclampsia, are a serious problem of perinatal obstetrics. One of these areas may be an in-depth ophthalmological examination.

The aim of the work is to perform an analysis of ophthalmological disorders and laboratory, clinical parameters in women with hypertensive complications of pregnancy.

Materials and methods. A retrospective analysis of 573 cases of hypertensive pregnancy complications was performed. The age of the patients ranged from 15 to 50 years. All patients received a standard general clinical and obstetric examination, examined by an ophthalmologist. A correlation analysis of some laboratory and clinical signs of arterial hypertension (AH) and preeclampsia (PE), including ophthalmological signs of PE, was carried out. Results: PE was accompanied by retinal angiopathy in 67 % of cases. In 9 cases (1.86 %), peripapillary edema was detected in PE. In the presence of peripapillary edema, earlier delivery dates and a lower Apgar score were observed in the newborn. Macular edema was registered in 3 cases (0.62 %) against the background of gestational diabetes mellitus.

Conclusion. Comparative analysis has shown the presence of correlations between signs of hypertensive complications of pregnancy and changes in the organ of vision. The expansion of ophthalmological research may provide new markers-indicators for the differential diagnosis of hypertensive complications of pregnancy, assessment of the severity of the condition, dynamic monitoring and choice of management tactics for patients with hypertensive complications of pregnancy.

Introduction. The issue of choosing the optimal anesthesia that is least dangerous to the patient’s life is still the main concern of the workers in the anesthesia and intensive care department, including techniques, medications, plans, and instructions followed in order to choose the best anesthesia. It can also be said that spinal anesthesia is the best and most standard anesthesia for those who repair hernia.

The aim of the study — learn about obtaining and verifying hemodynamic stability in patients undergoing hernia repair under anesthesia.

Materials and methods. An accurate and recent study of patients attending Al-Hussein Medical City and Al-Hassan Hospital in the city of Karbala. We included 100 patients who underwent a herniotomy, were divided into two groups on the types of general and spinal anesthesia. Fifty patients received general anesthesia and 50 patients received spinal anesthesia. Data related to the patient’s age, weight, change in blood pressure and pulse rate were analyzed. The study analyzed patients aged 20–90, dividing them into two groups: general anesthesia (GA) and spinal anesthesia (SA), for careful follow-up before, during, and after operations.

Results. We show that it is also more stable in SA which is about 56 % in comparison to GA which is about 40 % but increased blood pressure is more in GA which was 32 % and 24 % in SA, but decreased blood pressure is also more in GA which was 28 % and in SA was 20 %. In this study, as shown, there is more stability in heart rate, which is 56 % in SA but in GA it is 32 % and the increase in heart rate was 34 % in SA but was 60 % in GA. The decreased heart rate was 10 % in SA and about 8 % in GA and the effect of SA is more stable.

Conclusions. We found spinal anesthesia was more than general anesthesia in stability of blood pressure and heart rate and minimum or normal.

Introduction. Stomach cancer is a serious problem of modern medicine and is one of the most common malignant diseases in the world, being in fourth place among the causes of death from cancer. Most patients seek medical help in the late stages of the disease and, as a result, mortality during the first year after diagnosis is about 50 %.

Description. A case of clinical observation of a patient with diagnosed ring-cell carcinoma of the stomach is presented. In the course of the description, key aspects that require attention in determining risk factors, examination tactics and management of a patient with suspected malignant gastric disease are highlighted.

Conclusions. Detection of the disease in the early stages allows not only to significantly increase the patient’s chances of a complete cure, but also to carry out therapy using the most gentle methods. The differential diagnosis of peptic ulcer disease and infiltrative gastric cancer is particularly difficult. Comprehensive clinical, laboratory and instrumental examination of patients contributes to the early establishment of a correct diagnosis and, as a result, timely surgical treatment.

Introduction. Septic myocarditis is a rare disease (from 10 to 22 cases per 100 000 people). The cause of death is usually acute heart failure, hemodynamically significant cardiac arrhythmias, or thromboembolism. Patients in critical condition suffering from infectious myocarditis require massive cardiotonic support to maintain the necessary cardiac output with reduced myocardial contractile function, which leads to an increase in the need for cardiomyocytes for oxygen and aggravates their damage. Veno-arterial extracorporeal membrane oxygenation (ECMO) allows partial or complete replacement of cardiac function and reduces the dose of inotropic drugs, improve oxygen delivery and thereby contribute to the rapid restoration of cardiac function.

The purpose of this publication is to demonstrate in a clinical case the successful experience of ECMO in the treatment of a patient with septic myocarditis in the early postpartum period.

Materials and methods. A 28-year-old patient, data from medical records at the previous stages of treatment and at the Sverdlovsk Regional Clinical Hospital No. 1.

Results. On the third day of treatment, the patient’s condition worsened due to the progression of cardiovascular and respiratory failure. A veno-arterial ECMO procedure was initiated, which lasted 6 days.

Discussion. Positive dynamics in the patient’s condition were observed during six days of ECMO (normalization of echocardiography parameters, levels of cardiac enzymes and natriuretic peptide).

Conclusion. Veno-arterial ECMO as a temporary method of mechanical support of the left ventricle and prosthetic pulmonary function can be successfully used until their recovery in patients with septic myocarditis in the postpartum period.

Introduction. Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type it is a rare variant of skin lymphoma that has an aggressive course and a high risk of extracutaneous manifestations.

The purpose of this work is to familiarize a wide range of specialists with the clinical manifestations of a rare disease — primary cutaneous diffuse large B-cell lymphoma.

Materials and methods. An interesting clinical case is presented and the medical history of a patient with B-cell lymphoma from the skin is analyzed.

Results. A differential diagnosis of the disease was made. Based on the study of histological material, the final clinical diagnosis was established and further treatment tactics were determined.

Discussion. The patient had spots and plaques on the lower extremities, the sole visible signs of the disease. These symptoms may suggest a positive prognosis and a gradual progression. Diagnostic measures should include gathering medical history, assessing the local condition, and carrying out an excision biopsy early in the examination process for an accurate and prompt diagnosis

Conclusion. Due to the rarity of this subtype of lymphoma and the limited number of domestic publications on the topic, a more detailed study and description of individual clinical cases can lead to a better understanding of the characteristics of the symptoms and the processes of pathological changes in cells, tissues, and organs. This could potentially lead to the development of more efficient methods for early diagnosis and timely treatment of the condition.

Introduction. One of the problems of domestic phthisiology is the low effectiveness of treatment, which, along with anti-tuberculosis chemotherapy, uses pathogenetic methods, including physiotherapy procedures. The use of several physical factors in the treatment of pulmonary tuberculosis shows great therapeutic effectiveness. However, there are not enough works highlighting the combined effects of physical factors in tuberculosis of the respiratory system, applied in successive courses, taking into account the phase of a specific process and the mechanisms of therapeutic effects of physical methods.

The purpose of the study — is to demonstrate the effectiveness of consistent application of physiotherapy methods in the treatment of patients with pulmonary tuberculosis.

Materials and methods. The materials of the study were the medical records of the inpatient and the results of a comprehensive examination.

Results and discussion. The presented clinical example demonstrates the effectiveness of consistent application of physiotherapy procedures in the complex treatment of a patient with infiltrative pulmonary tuberculosis. After 1 month from the start of treatment, accelerated positive clinical dynamics was noted, cessation of bacterial excretion, partial resorption of infiltrative changes in the lungs, by 2 months — closure of the decay cavities, after 4 months the patient was discharged with minimal radiological changes to continue treatment on an outpatient basis.

Conclusion. Consistent application of physical factors can be one of the effective methods of improving the effectiveness of treatment of pulmonary tuberculosis, as demonstrated by the presented clinical examples. Further research is needed to substantiate the effectiveness of the proposed methodology.

Currently, according to the World Health Organization, the targets for the effectiveness of treatment of patients with pulmonary tuberculosis do not achieve their goals. In this regard, it is urgent to search for optimal integrated approaches in the treatment of patients with pulmonary tuberculosis.

The aim of the work is to demonstrate the high effectiveness of the use of methods of collapse therapy and CBB in the complex treatment of a patient with a widespread tuberculosis process.

Materials and methods. The analysis of the patient’s medical documentation was carried out, the data of the anamnesis of the disease, the analysis of the X-ray archive, the data of clinical, laboratory and instrumental examinations were studied.

Results. Multidrug resistance (MDR) of Mycobacterium tuberculosis (MBT) was established on the 1st day of hospitalization. Comprehensive treatment was carried out in full: chemotherapy according to the MDR-tuberculosis regimen, pneumoperitoneum for 8 months, CBB for 6 months.

Discussion. The presented clinical example demonstrates that against the background of a significant decrease in immunity due to the severe course of viral pneumonia, previously undetected pulmonary tuberculosis has taken a progressive course. Due to the use of complex treatment in a patient with a widespread tuberculosis process, clinical improvement was achieved, the closure of massive decay cavities in lung tissue and resorption of focal infiltrative changes was radiologically achieved.

Conclusion. A clinical example demonstrates the high effectiveness and safety of the use of collapse therapy methods in the complex treatment.

Background. Alström syndrome is a rare autosomal recessive disease characterized by multiple organ dysfunction. The prevalence in the population is less than one person per 1 million. Genomic mutation analysis study identified 109 new mutations increasing the number of known mutations of the ALMS1 protein to 239 which highlights the allelic heterogeneity of this disease and its phenotypic diversity.

The aim of the work. Increasing awareness among medical professionals regarding Alström syndrome.

Materials and methods. The analysis of the medical record of an outpatient patient, data from paraclinical research methods of the child of patient P., born in 2013, who was examined at the Children’s Regional Clinical Hospital (CRCH; Krasnodar).

Results. The disease debuted with an acute respiratory infection at the age of 4 months, the primary clinical manifestations were acute respiratory failure, and therefore, the child was hospitalized at CRCH. The results of additional research methods revealed dilated cardiomyopathy with reduced global contractility of the left ventricle. For further disease diagnosis and treatment correction, the child was referred to the National Medical Research Center for Children’s Health (NMRCCH), where he was observed for several years by a multidisciplinary team of specialists. Based on results of molecular genetic studies (pathogenic homozygous mutation in the ALMS1 gene), the child was diagnosed with Alström syndrome at the age of 8 years.

Discussion. This report illustrates difficulty diagnosis and lack of specific treatment.

Conclusion. This clinical case demonstrates a wide range of phenotypic features of the rare hereditary Alström syndrome.

Introduction. One of the main predictors of aging is sleep disturbance, the study of the role of which in the development of the accelerated aging process is recognized as an urgent problem for the medical community.

The aim of the work is to analyze modern data on age-related aspects of sleep status and describe known markers of early aging associated with somnological disorders.

Materials and methods. The search and selection of literary sources was carried out in the databases PubMed, eLibrary, CyberLeninka, Google Scholar. Search depth — 17 years, from 2007 to 2024. The total number of publications included in the review was 80.

Results and discussion. Aging refers to a general pathological process that affects all human physiological systems. Differences between the terms biological and chronobiological age are established. The role of somnological disorders in the accelerated aging process has been determined. It has been established that as age increases, changes in the electrophysiological pattern of sleep are observed. It was found that changes in biological markers of aging are positively correlated with sleep disturbance. The importance of neuroimaging methods in determining the accelerated rate of aging in people with sleep disorders is shown.

Conclusion. Sleep disturbance is defined as a significant indicator of accelerated aging of the body. Further research into changes in the structure and quality of sleep may change the understanding of the pathogenetic mechanisms of aging and contribute to the development of new diagnostic and therapeutic strategies in the field of anti-aging medicine.

Introduction. According to statistics, the average life expectancy of the female population is steadily increasing and more than ⅓ of a woman’s life is in the period of periand postmenopause. Many women approach the period of perimenopause with existing diseases of the endocrine system, most often associated with the thyroid gland. Such a high prevalence of this pathology occurs due to natural iodine deficiency in almost the entire territory of the Russia. Therefore, the relationship between the symptoms of menopause and endocrine diseases is very relevant.

The purpose of the work is to analyze the data presented in the modern literature on the influence of thyroid status on the features of the course of perimenopause.

Materials and methods. This review is based on data from domestic and foreign studies obtained as a result of a selective search in the electronic databases PubMed and eLibrary from 2016 to 2023.

Results and discussion. The period of perimenopause is accompanied by an increase in the incidence of thyroid diseases. The analysis of the literature data showed the influence of thyroid status on the features of the course of perimenopause and the conditions accompanying it (impaired cognitive functions, changes in bone metabolism, the frequency of abnormal uterine bleeding, the risk of cardiovascular diseases).

Conclusion. Given the relationship of thyroid status with the peculiarities of the course of perimenopause, it is necessary to consider the possibility of complex therapy of thyroid diseases and correction of symptoms of menopausal syndrome.

Introduction. Despite the use of modern principles of treatment of severe preeclampsia, mortality rates for mother and newborn in the development of life-threatening complication of preeclampsia, such as HELLP syndrome, remains high. The introduction of accurate models of early diagnosis and prediction of the probability of manifestation and severity of the HELLP syndrome into everyday medical practice will improve the safety of delivery of pregnant women with severe preeclampsia.

The aim of the study is to determine the current state of the issue and systematize current data on methods of predicting the probability of HELLP syndrome manifestation.

Materials and methods. An analytical review of the literature. A qualitative analysis of clinical trials and reviews on prediction of HELLP syndrome was conducted using the following data sources: PubMed and Google Scholar. The search was carried out in Russian and English, using the keywords “predictors”, or “prediction”, and “HELLP syndrome”. The date of the last search query is 22 March 2024.

Results. Anamnestic data and initial characteristics of patients with HELLP syndrome were analyzed.

Discussion. The analytical review included publications devoted to the study of the influence of predictive capabilities of potential biochemical markers, clinical and anamnestic signs and instrumental examination data on the probability of HELLP syndrome development.

Conclusion. Adequate prediction of the manifestation of HELLP syndrome is possible on the basis of a comprehensive analysis of all identified factors, allowing the identification of effective prognostic models to improve maternal and fetal outcomes in pregnant women with severe preeclampsia.