The review presents literature data concerning the rate and clinical features in cases of the gastroesоphageal refl ux disease (GERD) and irritable bowel syndrome (IBS )overlapping. The mean rate of GERD and IBS overlapping is 36–48 .8%, but in individual articles varies from 8–11% to 71–79%. A signifi cant variation in the rate is explained by diff erent approaches to the diagnosis of GERD and IBS in various studies (use of questionnaires, endoscopic examination, esophageal pH-impedancemetry). The high rate of GERD and IBS overlapping is related to the common pathogenetic mechanisms of both diseases (disorders оf gastrointestinal motility, visceral hypersensitivity). The features of the clinical picture and treatment in cases of GERD and IBS overlapping are studied insuffi ciently and require further research.

The review represents the analysis of modern data on the pathogenesis and methods of treatment of atopic dermatitis (AtD). The literature search was carried out using the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, e-library databases. AtD is one of the most common skin diseases, aff ecting about 20% of children and 5% of adults in advanced countries. The disease is multifactorial by its etiology. Among the genetic factors, the main attention is paid to the mutation of the gene encoding the synthesis of fi laggrin-protein involved in the functioning of the skin barrier. The role of cytokines regulating the synthesis of IgE — interleukins (IL) -4, -5, -12, -13, -31 is studied in the genesis of immune disorders in AtD. Steady-state stress accompanying pruritic dermatitis contributes to the development of anxiodepressive сonditions degrades quality of life, and stress-related increase of cortisol level may be essential in impairing the barrier function of the skin. Among the new approaches to the treatment of patients with AtD, the possibilities of using Selank, which represents the group of regulatory peptides and narrow-band phototherapy of the 311 nm range, are discussed.

Cardiovascular diseases still occupy a leading position in the mortality rate in advanced countries and are the main cause of disability. The development of information and telecommunication technologies has led to qualitative changes in various spheres of society, including medicine. The concepts of "digital and e-health care", "telemedicine" have come to be widely used in clinical practice. Integration of "telecardiology" as one of the areas of digital healthcare into the clinic will bring apparent benefi ts to both, medical staff and patients.

The use of information and telecommunication technologies for the implementation of programs for the primary and secondary prevention of cardiovascular diseases, cardiac rehabilitation, monitoring of the cardiovascular system indicators, educational programs is relevant, promising and important.

The aim of this study was to summarize, systematize, and extend analysis of data of two-year clinical use of intracardiac ECG (ECG-CS) in patients with coronary artery disease.

Material and methods. 131 patients with coronary artery disease who underwent a planned coronary stenting were included in a prospective study from 2018 till 2020 . Ischemia was monitored with the use of electrophysiological recording system with the following settings: combining electrodes into fi ve cathode-anode pairs with a frequency range of 30–500 Hz, signal cut-off of 1 cm, and an amplitude of 0.3 mV/cm.

Results. According to the ROC-analysis, the sensitivity of the ECG-СS method in case of ST segment depression was 79.5%, the specifi city was 100%; with ST segment elevation — 83% with a specifi city of 100%, according to data obtained in 88 patients with single-vessel disease of the coronary arteries (CA). Out of 43 patients with coronary artery disease, compromise of the diagonal branch and signifi cant ischemic dynamics (p < 0.05) in the intracardiac lead CS 3–4 after stent placement in the ADA according to ECG-CS was observed in 11 (25.6%) patients, in 9 (20.9%) of which successful provisional stenting was performed, and 2 (4 .6%) patients required implantation of the second stent.

Conclusion. ECG-CS is a promising method for detecting myocardial ischemia in patients with coronary artery disease and allows to optimize intervention in the area of coronary artery bifurcation.

A comparative analysis of the clinical and functional state of patients with arterial hypertension (AH), depending on the presence or absence of arterial sclerotic disease of the arterial bed is represented. 2 groups of 110 and 60 patients respectively were formed. The 1st group included persons with arterial hypertension (AH) and atherosclerotic changes in the arterial bed, the 2nd — with hypertension and without any atherosclerotic changes. It is shown that patients with hypertension and stenotic changes of the vascular bed are characterized by an increase in the levels of diastolic blood pressure and indicators of systolic and diastolic pressure load during the day. They have signs of structural changes in the cardiovascular system, as proved by indicators of arterial stiff ness, myocardium remodeling, circadian rhythms of blood pressure abnormalities, and, in addition, kidney damage in a chronic form of disease, stage 2–3.

On the contrary, hypertension without atherosclerotic changes of the vascular bed is characterized by higher values of systolic blood pressure, increased variability of systolic and diastolic blood pressure during the day, and, in addition, atherogenic dislipoproteinemia and hyperuricemy within the metabolic syndrome are present. As a clinical sign of atherosclerotic vascular changes in patients with hypertension, more “severe” blood pressure is observed. It requires combined antihypertensive therapy, consisting of 3 or more groups of medications.

Purpose. The study aims to investigate the interrelation between plasma levels of aldosterone and brain natriuretic peptide in heart failure with preserved ejection fraction (HFpEF).

Material and methods. A cross-sectional study included 158 patients with HFpEF. The diagnosis of HFpEF was made in the presence of symptoms and/or signs of heart failure, left ventricular EF 50%, increased NT-proBNP level and structural changes in the heart within echocardiography. The study did not include patients with primary hyperaldosteronism and those who received mineralocorticoid receptors antagonists in the previous 6 weeks. In all patients plasma levels of aldosterone and NT-proBNP were evaluated.

Results. Patients’ mean age was 69.9 ± 6.35 years; most of them were women (64%). According to laboratory results 99 patients (63%) had normal (40–160 pg/ml) aldosterone plasma level (nAld) and 59 patients (37%) had high (160 pg/ml) aldosterone level (hAld). hAld patients were younger and, most likely, had comorbidity. They had higher level of NT-proBNP compared to nAld (median level 480 (356–623) pg/ml versus 224 (165–302) pg/ml, p < 0.001). Body mass index, systolic blood pressure, total cholesterol, low density lipoproteins, creatinine and E/e’ were signifi cantly higher in hAld group, while plasma potassium and glomerular fi ltration rate were lower compared to nAld group (р < 0.05). Plasma aldosterone was strongly and positively correlated with NT-proBNP (r = 0.593, p < 0.001).

Conclusion. In HFpEF plasma aldosterone is closely related to NT-proBNP. The level of NT-proBNP is signifi cantly higher in patietns with hyperaldosteronemia compared to patients with normal aldosterone.

The article represents clinical, instrumental and electrophysiological predictors of postablative atrial fi brillation (AF) occurrence after radiofrequency ablation of cavotricuspid isthmus in 209 patients with typical atrial fl utter. The results of our own experience in the treatment of these patients are analyzed. The technique of the modifi ed intraoperative electrophysiological test of AF induction in patients with typical atrial fl utter is described. The role of this technique in the occurrence of postablative AF is evaluated. A mathematical model for predicting postablative AF at the intraoperative stage of treatment of patients with typical atrial fl utter has been developed.

Aim. To study the eff ect of hepcidin, soluble transferrin receptor (sTfR ), and cytokines on iron metabolism and the development of anemia in rheumatologic patients, to propose a working version of the classifi cation of anemia of chronic diseases (ACD) according to the major nosotropic factor.

Material and methods. 126 patients with rheumatic disease, 34 men (45.8 (36–54.9) years old), 92 women (49.5 (38–60) years old) were examined. Group 1 included 41 patients with ACD. Group 2 included 29 patients with the combination of ACD and IDA and 34 patients with iron defi ciency anemia (IDA). Group 3 included 34 patients with IDA and 29 — with the combination of ACD and IDA. Control group included 22 patients without anemia. Comparative analysis between groups with and without anemia and correlation analysis of hemogram parameters, iron metabolism, C-reactive protein (CRP), hepcidin, sTfR , interleukin-6 (IL-6), IL-1β, IL-10, interferon gamma (INF-γ) and tumor necrosis factor alpha (TNF-α) were performed.

Results. In the ACD group, the concentrations of hepcidin, ferritin, CRP, IL-6 were increased in comparison with other groups. The correlation was revealed between erythrocytes, hemoglobin and IL-6 (r = −0.3 and −0.6), IL-10 (r = −0.4 and −0.4), INF-γ (r = −0.4 and −0.3), TNF-α (r = −0.3 and −0.3), hepcidin (r = −0.5 and −0.7), sTfR (r = −0.5 and −0.7). Dependence was shown between IL-6 and iron (r = –0.6), transferrin saturation index (TSI) (r = −0.5), ferritin (r = −0.5), CRP (r = 0.5), between TNF-α and TIBС (r = −0.6), transferrin (r = −0.6), ferritin (r = −0.7), between IL-1β and TIBC, ferritin, transferrin (r = −0.4). The correlation was noted between hepcidin and IL-6 (r = 0.5), IL-10 (r = 0.4), between sTfR and IL-6 (r = 0.4), IL-10 (r = 0.6), INF-γ (r = 0.4).

Conclusion. The multicomponent genesis of anemia in patients with rheumatologic disease was detected. The signifi cance of disorders in iron metabolism, the eff ect of hepcidin, sTfR and cytokines on the development of anemia was found. A working version of ACD classifi cation (with a predominant iron defi ciency, with violations of the regulatory mechanisms of erythropoiesis, with insuffi cient production of erythropoietin) has been put forward.

Issues of the formation and progression of late complications of diabetes mellitus remain interesting and foreground today, especially in cases of type 2 diabetes mellitus (dm) combined with other endocrine diseases. The pathogenetic relation between the mechanisms leading to blood vessels and nerves damage against the background of diabetes mellitus, and, for example, mechanisms of autoimmune thyroid abnormality (ait), is far from being unambiguous, but the very fact of its existence cannot be denied.

Purpose: to determine the predominant type of comorbidity (trans-syndromal, trans-nosological or chronological) and the level of comorbidity according to the disease rating scale (cirs) in patients with type 2 diabetes and ait, to study the structure of later complications of diabetes mellitus in this group of patients and to assess the contribution of certain factors to increased risk of complications.

Methods. 428 patients were examined in a specialized endocrinology department, and two groups were formed: an observation group — 213 people with diagnosed type 2 diabetes and ait, and a comparison group — 215 people with a diagnosis of type 2 diabetes. These groups were comparable in age, the duration of diabetes, body mass index, correction of the disease. The analysis included clinical and laboratory parameters, the results of hormones level studies (tsh, free t4, insulin, c-peptide) and antibodies (at-tpo), thyroid ultrasonography, calculation of the insulin resistance index (homa) and the comorbidity index (cirs — cumulative illness rating scale) followed by a correlation-regression analysis of statistical data. The state of the peripheral nervous system was evaluated with the use of electromyography in patients of both groups, and the severity of diabetic neuropathy was evaluated with the use of the neuropathy disability score and vas (visual analogue scale) scales. The state of the vascular system was studied according to the data of ultrasound examination of the vessels of the lower extremities, echocardiography, and ophthalmoscopy.

Results. The obtained data made it possible to determine the factors infl uencing the risk of type 2 diabetes complications developement, and to establish that neuropathic complications begin and progress faster in patients with comorbid endocrine pathology, however, there is no such dependence for vascular complications. According to the linear regression equation of the dependence of total complications on the duration of the disease, it was revealed that the development of vascular complications in patients with combined endocrinopathy occurs even more slowly than in patients with diabetes. The contribution of diabetes compensation and identifi ed risk factors to the progression of diabetic complications was less important for patients with endocrinopathies. As for evaluating the contribution of individual parameters, the most signifi cant were the duration of diabetes mellitus, albuminuria, atherosclerosis of the vessels of the lower extremities.

Conclusion. In addition to the known risk factors for the development and progression of vascular complications, in patients with overlapping endocrinopathy, the preservation of residual insulin secretion and renal function (chronic kidney disease, proteinuria) were important. the prevalence of “total” Complications in the group of patients with combined endocrine pathology was lower, however, neuropathic complications in the same group were observed more often,т which indicates the primary eff ect of thyroid dysfunction on the structure of the nervous tissue.

The problem of viral hepatitis C remains highly relevant despite the recent signifi cant advancements in the diagnosis and treatment of this pathology. Chronic hepatitis C is a systemic disease with extrahepatic manifestations. Autoimmune processes leading to cryoglobulinemia can contribute to their development. Basic clinical manifestations include cutaneous vasculitis with palpable purpura, arthralgia-myalgia, neuropathy, and renal complications such as glomerulonephritis. Polyneuropathies develop much earlier than hepatic encephalopathy, which is characteristic of liver damage. A clinical case represented in the article was noted in a patient with a long-term course of viral hepatitis C, manifested with pronounced neurological symptoms and the development of cryoglobulinemic vasculitis. In this case, of all the applied methods of treatment, only adequately conducted antiviral therapy contributed to the stabilization of the clinical manifestations of cryoglobulinemia. The promptness of antiviral therapy is of signifi cant importance, since it is a possibility to prevent the development of severe autoimmune pathology.

The article is devoted to the creation of the prevention of severe course of COVID-19 molecular model from the standpoint of the Titov’s phylogenetic theory of general pathology. The role of the renin-angiotensin and kallikrein-kinin systems in the severe course of COVID-19 is discussed. Using the example of activation of the renin-angiotensin system in non-communicable diseases, the importance of controlling traditional risk factors for the prevention of severe COVID-19 is shown.