The article analyzes the current tendencies in the diagnosis and treatment of transient ischaemic attacks (TIA). The prevalence of TIA in the population has not been established due to the uncertainty of the diagnostic criteria. The authors discuss the problem of a qualitative diagnosis of TIA in detail. Based on the current clinical recommendations, modern and promising methods of treatment are discussed. The authors pay special attention to the assessment of the risk of bleeding during aggressive antithrombotic therapy.

Arterial hypertension (AH) remains one of the most common diseases and a leading risk factor for cardiovascular diseases (CVD) in the 21st century. It determines the importance of a search for new factors provoking an increase in blood pressure. This review focuses on studies of preclinical predictors of hypertension. Orthostatic circulatory disorders with clinical signs of cardiovascular deconditioning are risk factors for the development of hypertension and CVD, accompanied by a more rapid increase in vascular stiff ness. Such abnormalities, even minor ones without clinical manifestations, increase the risk of hypertension development in the young population. The review deals with orthostatic changes in hemodynamics and features of neurohormonal change. It has been shown that adaptive processes counteracting an increase in hydrostatic pressure contribute to a significant transient increase in vascular stiff ness. The evolution of orthostatic hemodynamic disorders from preclinical to clinical forms accelerates the process of vascular wall remodeling, leading to a spontaneous increase in its rigidity — one of the significant risk factors for hypertension and CVD. To identify preclinical predictors, a new protocol of passive orthostatic test (POT) was developed. It was standardized not by the tilt angle, but by the height of the hydrostatic column. Further research is needed to evaluate the prognostic capabilities of predictors, to reveal the pathogenetic connection of orthostatic disorders with the development of hypertension, and to remodeling the vascular wall, which causes an increase in its rigidity. It is also required to search for ways to correct preclinical orthostatic disorders in healthy young population for early prevention of hypertension.

The differential diagnostic of prostate cancer is the actual task of modern medicine. The existing methods lack accuracy and specificity. It’s the reason of hyper- or hypo-diagnostic of this disease. We developed and tested the new logistic regression model for diagnostic of prostate cancer in men of various age. The model includes age, the volume of prostate, concentration of prostate specific antigen (PCA), 2-pro-PCA in the blood, the presence of the concretion revealed during digital rectal investigation of prostate and hypoechogenic area in transrectal ultrasound investigation. The model was tested in 114 patients. It has shown the higher accuracy and specificity of the new regression model in comparison to other methods of differential diagnostic of prostate cancer.

Due to the difficult working conditions, the lack of effective treatment methods, and the high mortality rate, the work of doctors with a new coronavirus infection significantly affects their mental and emotional state.

Objective. To study the features of the psychoemotional state of doctors, providing medical care in the context of a pandemic of a new coronavirus infection in Smolensk.

Material and methods. A questionnaire was developed to study the psychoemotional state of health professionals. 110 doctors working with COVID-19 patients were interviewed at the bases of the Smolensk Regional Emergency Hospital, the Clinical Emergency Hospital, and the Clinical Hospital No. 1 in Smolensk. The results of the responses were statistically analyzed and revised.

Results. There was an increased level of anxiety (average score 8.427) and depression (average score 7.518). 26.4% of the respondents were found to have a gross sleep disorder. 76.4% of doctors indicated a deterioration in their condition since starting work with COVID-19 patients. For the majority of medical professionals, the main factors that help to maintain normal psychoemotional state are the support of relatives and colleagues (93.6%) and the provision of PPE (74.5%).

Conclusions. According to the results of the study, increased anxiety, depression and deterioration of the general condition of doctors working in «red zones» were found. An extremely low organization and availability of psychological support for doctors struggling with a new coronavirus infection was revealed.

The dominant position among the reasons of working-age population’s health deterioration belongs to diseases of the peripheral nervous system (PNS), the peak prevalence of which occurs at the age of 35–40. PNS diseases are diagnosed in about 76.0% of industrial workers, and account for more than half of all occupational diseases. They are the main cause of incapacitation and long-term disability. Publications on disability due to PNS diseases are isolated.

The aim of the work. Clinical and functional characteristics of PNS disorders that cause disability in the working-age population.

Material and methods. Among 91 496 first recognized as disabled in the Republic of Bashkortostan in 2014–2018, all disabled people of working age were selected due to PNS diseases, in which the main independent diagnosis was radiculopathy, polyneuropathy, neuropathy and vibratory disease with indication to lumbar-sacral radiculopathy with polyneuropathy of the upper extremities. 107 people were identified to constitute a closed cohort for a comprehensive study of the clinical-functional state and patterns of disability formation in them. The clinical-functional characteristic is given on the basis of the results of studies set forth in the directional medical documents and the assessment by an expert neurologist of the Main Bureau of Medical and Social Expertise. Statistical analysis was performed in Microsoft Excel.

Results. The prevalence of PNS diseases has been found to be increasing. Three of the newly diagnosed neurological patients have been the carriers of PNS disease. PNS diseases are formed and reach peak in working age. Characterized by a chronic, progressive course, they often cause temporary and persistent disability. On average, there are 0.1 ± 0.028 persons with disabilities per 10 thousand of the able-bodied population due to PNS diseases, the level of which in dynamics for 2014–2018 increased by 1.7 times. Persons with disabilities (69.0%) are mainly represented by men, every second (50.6%) is over 50 years old, with an average age of 48.7 ± 5.7 years. The clinical-functional state is characterized by constant pain, numbness, seizures, restriction of movements in the limbs, sensory disorders, vegetative-vascular disorders.

Conclusion. The quantitative evaluation of the main types of the body functions and main categories of vital activity persistent disorders made it possible to detect that 69.3 ± 4.4% persons with disabilities have persistent moderate abnormalities of functions in the range 40–60% (II degree), another 24.4 ± 3.8 — persistent pronounced abnormalities in the range 70–80% (III degree) and 6.3 ± 6.0% — persistent significant abnormalities in the range 90–100% (IV degree). The severity of impaired functioning of the body is the basis for the level of persistent disability determination.

Aim. To study gender and age aspects of epilepsy in patients with localization-related and generalized forms of epilepsy in the village of Mashtaga, Baku city.

Material and methods. The gender structure of epilepsy in the village study was conducted simultaneously with a cohort pro- and retrospective research of its epidemiology at the United City Hospital (OGB) No. 7 in the village of Mashtaga and at the Department of Neurology of the Educational and Therapeutic Corps of AMU during the period from 2016 till 2019. Psychoemotional state (Ziqmond scale), severity of seizures (NHS3 scale), quality of life (QOLIE-10 questionnaire) were studied. For statistical processing, Fisher LSD and Pearson’s rank correlation coefficient were used at the level of significant results — p < 0.05.

Results and discussion. Among 197 patients with epilepsy, 121 (61.4%) men and 76 (38.6%) women were examined. Most of them were accounted for localization-related epilepsy — 129 people (65.4%). 68 patients (33.5%) suffered from generalized epilepsy. The indigenous (37,505 people) and nonindigenous (8295 people) population were represented mainly by Azerbaijanis. The number of male patients with SPE exceeded the number of females (χ² = 8.515; p = 0.004), (p < 0.05). There were more male patients with HE (41 (60.3%)) than females (27 (39.7%)). The severity of seizures, evaluated with the use of the NHS3 scale, was higher in male patients than in females. The psychoemotional state according to the Ziqmond scale in female patients from non-indigenous inhabitants was lower (9.05 ± 0.30; m = 6, M = 13) than in those of indigenous (8.83 ± 0.21; m = 5, M = 12), (p = 0.046). Assessment of the quality of life of patients with epilepsy according to QOLIE-10, did not reveal any gender diff erence.

Conclusions. A gender-specific approach to the condition of patients with epilepsy will contribute to the improvement of both, clinical and psychoemotional parameters, thereby having a positive effect on the quality of life.

Chronic kidney disease (CKD) is the main cause of end-stage renal failure and is a complication of diabetes mellitus (DM). Oxidative stress plays the key role in its pathogenesis. In this regard, the use of drugs with antioxidant effect in DN therapy seems to be reasonable.

Objective. In the course of this work, the effect of combination melatonin therapy on the biochemical parameters of the pathology development, concentration of pigment epithelial factor (PEDF) and the oxidative status of patients with CKD developing in type II diabetes was assessed.

Material and methods. The study involved 60 people with CKD developing in type II diabetes. The patients were divided into 2 groups; each group included 30 people. The first group of patients underwent basic treatment; the second group of participants was given 2 mg of melatonin in addition to the basic therapy. The control group consisted of 65 apparently healthy individuals with normal indicators of general and biochemical blood tests. In the course of the work, the analysis of biochemical indicators of the pathology development, level of PEDF by enzyme immunoassay, the activity of free radical oxidation by the method of iron-induced biochemiluminescence (BCL) and the concentration of reduced glutathione (GSH) in the study participants was carried out.

Results. The addition of melatonin to basic treatment led to a more signifi cant decrease in the intensity of free radical-induced oxidation and the level of PEDF, as well as an increase in the GSH content and general antioxidant eff ect in patients with CKD. The observed changes were accompanied by shifts in the indicators of proteinuria, hyperglycemia and urea concentration close to the ones detected in healthy volunteers group.

Conclusion. The results obtained were, apparently, due to a more signifi cant decrease in the level of oxidative stress in patients who additionally received melatonin, which is characterized by the presence of antioxidant activity. An improvement in the oxidative status in patients of the second group was linked with the degree of changes in the clinical and biochemical parameters of pathology.

The article provides the data on the level and structure of Class IX “Circulatory Ilnesses” morbidity within the dispensary group of CMCH named after Mandryka P.V. A diff erence was noted between the categories of persons under observation and in comparison to morbidity rates according to the data of the Ministry of Health of the Russian Federation.

Urticaria vasculitis is a multisystem disease with cutaneous lesions which resemble urticaria and histologic signs of leukocytoclastic vasculitis. The article highlights the main aspects of etiology, pathogenesis, clinical and histopathological disease manifestations, and also methods of treatment. Difficulties of a diagnostic process are demonstrated by means of an example of our own follow-up of a patient with Urticaria vasculitis having a history of solar urticaria. The main trigger of episodes relapse of urticarial rash in the form of coldinduced urticaria and urticaria resulting from blood pressure, was a stress factor and hemorrhage from the duodenal bulb ulcer. The analysis of clinical data and peculiarities of disease progression was conducted for the purpose of diff erential diagnostic procedure of urticaria and urticaria vasculitis. The patient’s urticaria lasted longer than 24 hours; haemosideric staining was observed in the course of rash resolving, local oedemata resembling Quincke’s edema ailed, general symptoms were present (arthralgia, fever, abdominal pains, neurological disorders, etc.). Low effi ciency of antihistamines was reported. Laboratory examination revealed the increase in the blood sedimentation rate, lowering of the complement component 3, raise of anti-C1q and cryoglobulinemia. The essential component of the diagnostic search was biopsy of the skin which allowed to reveal signs of leukocytoclastic vasculitis. On the basis of the clinical evidence (fixed urticarial eruption), laboratory data (hypocomplementemia), histological examination of skin (leukocytoclastic vasculitis) and multisystemic pathology found (of joints, heart, GIT, nervous system), the patient has been diagnosed with a hypocomplementary urticaria vasculitis. Moreover, the article includes recommendations on sampling of pathological material due to primary importance of skin biopsy results in diagnostics of the urticarial vasculitis. Medical professionals no matter of their speciality, should know peculiarities of Urticaria vasculitis progression to reduce the likelihood of its error diagnosis as recurrent urticaria or other immunological disease.

Оphthalmic manifestations of diabetes mellitus include changes in the circulation of aqueous humor, increase or decrease in the level of intraocular tension, abnormal permeability of the blood-aqueous barrier, and anomalies of the retinal vessels. A balanced approach to the choice of treatment tactics is a basis for treatment of Primary Open Angle Glaucoma. The criterion for the effectiveness of glaucoma surgery is sustained normalization of intraocular tension and preservation of visual functions. Surgical treatment of glaucoma in patients with severe somatic pathology is accompanied by a high risk of postoperative complications: hyphema, ciliochoroidal detachment, hemophthalmos, repeated increase in intraocular tension, etc. Diabetes mellitus as a systemic disease causes widespread vascular autonomic and endothelial dysfunction. The reasons for the decrease in the hypotensive effect of glaucoma surgery in such patients is excessive cicatrization of the newly created fluid outflow tracts with the formation of adhesions between the conjunctiva and the sclera, the scleral flap and underlying tissues. It leads to a repeated increase in intraocular tension in the late postoperative period. Therefore, the choice of tactics for the management and treatment of patients with glaucoma and with severe comorbidity requires an individual and measured approach.

The term «hypertensic crisis» is used to describe a condition that develops over time, and the outcomes depend on both, timing and completeness of medical care and the initial clinical status of the patient. The term «uncontrollable arterial hypertension» in ESC and RSC recommendations (2018–2020) cannot replace the concept of “uncomplicated HC” completely . It is advisable to adhere to the recommendations of the Russian Medical Society for Arterial Hypertension (RMSAH) developed in 2019, in which the division into complicated and uncomplicated HC still remains. In clinical practice, three variants of a signifi cant increase in blood pressure in patients with arterial hypertension should be distinguished: an isolated increase in blood pressure, uncomplicated and complicated HC. It is necessary to stratify patients with uncomplicated HC according to the degree of risk of cardiovascular complications development in order to determine the indications for their hospitalization. The rapid relief of a significant increase in blood pressure should lead to a safe level of patient’s pressure, taking into account the risk of hypotension and hypoperfusion of vital organs and systems.

Target of this historical review is focused on analysis of highly relevant, unique method proposed by A. Wölfler, E. Doyen and C. Roux more than 140 years ago, also we try to present main facts and chronology of development of concept Y-reconstruction of digestive tube. Hereby we present historical retrospective of theoretic concept creation, experimental verification and initial clinical experience of Y-shaped reconstruction of digestive tube on Roux-en-Y-loop, stages of concept evolution and development till the end of XIX age till our days. The founders’ scientific research onducted in surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery, has expanded application of Roux-en-Y-reconstruction from distal resection of the stomach and gastroenterostomy to gastrectomy, repeated operations on the upper part of the digestive tube, the formation of biliary-digestive and pancreatic anastomoses, as well as the use in the routine practice of bariatric surgery.