The new coronavirus infection, which has become a pandemic, is greatly increasing interest in the search for new pharmacological drugs with antiviral and anti-infl ammatory properties. Colchicine, which has been used in medicine for centuries and has been mainly known as arthrifuge, has come to be unexpectedly considered as a drug aff ecting the cumulative endpoint in outpatients, including death and hospitalization requirement in a recent large, well-planned, randomized controlled trial. The article provides data on the pharmacodynamics of the drug, which consists in blockade of infl ammasome activation in patients with COVID-19, and an eff ective impact on the mechanisms of “cytokine storm” — a predictor of acute respiratory distress syndrome and sepsis as a major cause of multi-organ lesions and death. The information that its spectrum of anti-infl ammatory activity may explain the vasoprotective eff ects in patients with coronary heart disease (CHD) who underwent acute infarction in the COLCOT study, is particularly attractive from the point of view of the perspectives for the oral colchicine application in COVID-19. High tolerability of the drug, the absence of severe adverse reactions, simple dosing regimen, low cost of colchicine, the absence of signifi cant drug interactions are additional advantages. The authors of this article believe that this information is suffi cient for planning a study of the eff ectiveness of colchicine as an element of complex therapy in hospitalized patients with COVID-19 in combination with acute coronary syndrome, including the need for percutaneous coronary intervention. Early anti-infl ammatory therapy in patients with COVID-19 is still not recommended, despi te th e fact t h at there comes an understanding of its necessity. And in this situation, colchicine has the potential to challenge.

This work is an attempt to analyze the data on the mechanisms of cardio- and nephroprotection of drugs of the SGLT2 inhibitor group (Sodium / glucose cotransporter 2). The data of recent studies are shown to indicate the eff ect of drugs of this group on the indices of central hemodynamics, on the volume of circulating plasma in particular, which can reduce the risk of progression and decompensation of chronic heart failure (CHF). The ability of empaglifl ozin to reduce pulsatility, a marker of increased vascular wall stiff ness, has been demonstrated. Also, SGLT2 inhibitors improve the energy supply of the myocardium and kidney tissue by increasing the concentration of ketone bodies in the blood, which are a more effi cient energy substrate than glucose and fatty acids. A direct pleiotropic eff ect on the myocardium, improvement of diastolic myocardial dysfunction is also not excluded. It is known that SGLT2 inhibitors also reduce cortical hypoxia, decrease intraglomerular hypertension and increase glomerular fi ltration rate, lessen incidence of nephropathy, its severity and rate of progression. Some studies have revealed antioxidant, anti-infl ammatory, antifi brotic eff ect of type 2 sodium glucose cotransporter inhibitors. The use of this group of drugs also leads to a decrease in body weight. This eff ect is more pronounced in combination with other drugs intended for the treatment of obesity. All this makes SGLT2 inhibitors a promising group of drugs that have a large number of pathogenetic points of application in relation to cardiorenal syndrome.

Analysis of clinical effi cacy and safety of alteplase and recombinant prourokinase in 82 patients with pulmonary embolism (PE) of high and intermediate high risk of death during the hospital observation period, whо were divided into two groups depending on the thrombolytic applied: the 1st group — recombinant prourokinase (40 people), the 2nd group — alteplase (42 people). The results of treatment, indicators of eff ectiveness and safety of thrombolytic therapy with alteplase and recombinant prourokinase were analyzed. The eff ectiveness and safety of thrombolytic therapy, evaluated clinically and instrumentally, did not diff er in the use of the drugs studied. However, at the time of development of PE from 5 to 14 days from the onset of the disease, for thrombolysis, it is preferable to use recombinant prourokinase, as it leads to a more signifi cant reduction in the volume of thrombotic masses than with the use of alteplase.

Severe aortic stenosis (AS) is characterized not only by degenerative changes in the aortic valve but also by extravalvular cardiac damage. Recently, a new staging classifi cation of AS has been proposed based on the extent of cardiac damage, as well as its modifi ed variants with the addition of a measure of global longitudinal strain of the left ventricular (GLS LV), as an earlier predictor of preclinical LV systolic dysfunction.
Aim. To evaluate the signifi cance of GLS LV in the staging classifi cation of AS based on the extent of cardiac damage according to a multidisciplinary hospital.
Мaterials and methods. 66 patients with severe AS with available GLS LV by speckle tracking echocardiography were selected and analyzed retrospectively.
Results. Patients were categorized according to cardiac damage on ECHO: stage 0 was determined in 2 (3%) patients; stage 1 — 10 (15%), stage 2 — 41 (62%), stage 3 — 13 (20%). The use of staging classifi cation of AS with addition of GLS LV quintiles led to patient reclassifi cation. Thus, stage 4 included patients from stage 2 and stage 3 cardiac damage.
Conclusions. In patients with severe AS, the adding the GLS LV to the routine ECHO can help to more accurately determine the stages of AS and make the right decision on the management tactics of such patients.

Being a consequence of COVID-19, cardiovascular disorders are now at the forefront of the infection’s after-eff ects. Researchers note the involvement of heart muscle, vascular endothelium, cardiac conduction system into the infectious infl ammation even if a person has oligosymptomatic SARS-CoV-2. On the other hand, we still do not have a clear understanding of the genesis of the long-standing persistent hyperthermia, reduced stamina and atypical cardialgia.
Objective. The study demonstrates the high frequency of pericardial eff usion among patients who recovered from COVID-19. The study describes clinical symptoms of the COVID-19-induced pericarditis.
Materials and methods. To compare the frequency of pericardial eff usion (based on TTE data) among a sample of patients who recovered from COVID-19 and in the control group of patients who were examined before the pandemic, the study was conducted in accordance with STROBE design. The main group, studied on a prospective basis, included patients who recovered from COVID-19 1 or 2 months ago. The control group was made up retrospectively from the database of the Functional Diagnostics Department for January–February 2019, matching the main group in terms of gender and age. The groups had no diff erence in terms of high blood pressure, ischemic heart disease, Index of Mass Corporal. Hence, 110 pairs of patients were selected from the two groups, where we analyzed TTE results following the event-control protocol.
Results. The cohort of patients who recovered from COVID-19 consisted of 51 men and 59 women, with the average age of 67 ± 9 years old. 30 patients had moderate and severe forms of COVID-19 and were hospitalized. 80 ones had a mild form of COVID-19 confi rmed with PCR test or COVID-19 antibody testing and were monitored on the outpatient basis. The average time of the study spans 5 ± 1 weeks after the fi rst symptoms onset. The control group comprised 110 patients aged 67 ± 5 years. Signs of pericardial eff usion were recorded as part of TTE in 47 (43%) patients from the main group, with 5 of them (11%) having chronic causes for the eff usion. In the control group, the hydropericardium was detected in 4 (3%) patients. The rate ratio is 19,8 (95 OR 18.2–21.6). The frequency of hydropericardium symptoms did not depend on the age, principal cardiovascular diseases and the severity of COVID-19. Pericardial eff usion of the COVID-19 origin had some diff erence in ultrasound imaging as compared to pericardial eff usion of non-COVID-19 origin. The additional anti-infl ammatory therapy was prescribed for such patients.
Conclusions. The hydropericardium should be viewed as a specifi c manifestation of SARSCoV-2 and taken into account when assessing the post-COVID-19 symptoms. Pericardial eff usion is found after COVID-19 12 times as frequent as in the demographically comparable group without the pandemic. Despite the severity of COVID-19, the high frequency of pericardial eff usion necessitates TTE assessment in dynamics throughout at least 2 months after the infection.

Objective. To prove the role of interrelated autoimmune, hemostatic and infl ammatory mechanisms in the pathogenesis of angleclosure glaucoma on the basis of experimental morphological research. Material and methods. The work was performed on 3 denucleated eyes of patients with terminal “creeping” angle-closure glaucoma (ACG) and 2 eyes with terminal ACG during an intractable acute exacerbation. Sagittal sections through the area of Schlemm’s canal, as well as serial cross sections, were examined by the method of paraffi n sections stained with hematoxylin-eosin (HE). To assess the degree of the infl ammatory response in the eye tissues, the density of infl ammatory cells was calculated within the standard eyepiece micrometer grid at a magnifi cation of × 20.
Results. The formation of peripheral anterior synechiae between the periphery of the iris and the trabecular meshwork in the iridocorneal angle is the main etiological factor in chronic angle closure. Several mechanisms contribute to the formation of anterior synechiae. First of all, in our opinion, it is autoimmune infl ammation. Edema and hyperemia of the ciliary processes pushes the iris anteriad, collagen fi bers of the trabecular meshwork are damaged; delayed endothelialization of the trabecular plate occurs, and the angle of the anterior chamber narrows and closes as a result. The resistance to the outfl ow of intraocular fl uid increases. Ischemia, due to increased intraocular pressure (IOP), causes the formation of new vessels in the iris, where aggregates of blood cells are observed. The walls of the newly formed vessels are defective, which contributes to hemorrhages. Thus, in addition to autoimmune infl ammation, we observe signs of endothelial dysfunction syndrome associated with infl ammatory processes with ACG.
Conclusions. 1. The pathogenesis of chronic angleclosure glaucoma is based on autoimmune processes, as proved by lymphocytoplasmocytic infl ammatory infi ltration with an addition of pigment-containing macrophages and fi broblasts at the junction of the iris with the cornea. 2. The detection of intravascular aggregates is a proof of impaired hemostasis in angle-closure glaucoma. 3. Parietal thrombus formation in the newly formed vessels of the iris, fi brin in the tissues are evidence of chronic endothelial dysfunction in ACG. 4. The capillaries of the ciliary processes surrounded by a fi brin ring indicate an acute vasomotor disorder and the release of plasma containing fi brinogen into the surrounding tissue. This is indirect evidence of emotional and vasomotor instability in patients with this form of glaucoma. 5. Disturbances in the systems of immunity and hemostasis are interrelated processes. 6. Increased iris stiff ness is ACG biomarker and may serve as a further target for therapeutic intervention.

Aim of the study: to study the clinicodiagnostic features of polycystic ovarian syndrome (PCOS) against the background of insulin resistance (IR) and hyperandrogenism (HA).
Material and methods. We examined 120 women with PCOS and HA, 76 (63.3%) of the total number had IR. The average age of women was 28.54 ± 0.74 (20–44). In women with HA and PCOS against the background of IR, the levels of follicle-stimulating (hFSH), luteinizing (LH), thyrotropic (TТH) hormones were detected, as well as LH/hFSH ratio, prolactin (PRL), estradiol (E2), estrone (E1), total testosterone (T-total), DHEAS, androstenedione (Adione), cortisol (C), 17 hydroxyprogesterone (17-OPG), free triiodothyronine (T3), free thyroxine (T4), SHBG and Anti- Mullerian Hormone (AMH). The levels of carbohydrate metabolism, including glucose, insulin (on an empty stomach), after glucose loading, were determined as well as the HOMA and CARO indices.
Results. It was found that according to the Ferriman–Gallwey score, hirsutism was within the range of 16.15 ± 0.34 (11–24) points, hormones — 13.17 ± 0.30 (9–20) points in the examined patients. The indiff erent number was 2.93 ± 0.11 (2–4) points. The average weight of patients was 74.1 ± 1.79 (50–134) kg, height 1.62 ± 0.005 (1.52–1.78) m, Index of Mass Corporal was within 28.56 ± 0.66 (19.5–51.4) kg/m². In 81.5% of patients with HA and PCOS, absolute sterility was noted on the background of IR. According to hormones studies, there was a statistically signifi cant increase in LH (14.0 ± 0.87 mIU/ml), LH/hFSH (2.39 ± 0.15), TSH (2.83 ± 0.23 mIU/ml), DHEAS (3.32 ± 0.21 pg / ml), 17-OPG (1.0 ± 0.08 ng/ml), Adione (3.94 ± 0.1 ng/ml), T-total (1, 15 ± 0.006 ng/ml), K (125.39 ± 2.86 ng/ml), AMH (7.84 ± 0.36 ng/ml), E1 (153.36 ± 4.56 ng/ml) and decrease in E2 (65.32 ± 2.38 pg/ml), SHBG (36.1 ± 2.0 nmol/l). The study of carbohydrate metabolism and some anthropometric parameters revealed an increase in OB (100.66 ± 1.76 cm), OB / OT (0.86 ± 0.005), glucose and insulin (on an empty stomach) parameters and after glucose loading and HOMA index with a signifi cant decrease in the SAR index. According to the ultrasound data, patients with HA and PCOS against the background of IR revealed a statistically signifi cant decrease in the length and width of the uterus and an increase in the length, thickness, volume of the endometrium, the number of atresic follicles in both ovaries compared to similar data in practically healthy women (p <0.05).

Dyspepsia syndrome is understood as a complex of symptoms, including epigastric pain and epigastric burning, postprandial fullness and early satiation. In cases when organic diseases cannot be detected in patients as the cause of these symptoms, the term functional dyspepsia (FD) should be used. Rome IV criteria of FD in the absence of “alarm symptoms” consider it possible to make a diagnosis of FD without instrumental examination (fi rst of all, without esophagogastroduodenoscopy). The recommendations of the Russian Gastroenterological Association emphasize that this approach leads to serious diagnostic errors, and therefore the diagnosis of PD should be considered as a diagnosis of exclusion, which can be made only after a comprehensive examination of patients.

The article represents data on the frequency and causes of coronary artery dissection. The types of dissections and approaches to their treatment are given. A case of dissection of the right coronary artery (type F) in a young man after signifi cant physical stress with the development of type 2 myocardial infarction is described. Percutaneous transluminal coronary angioplasty with stenting of the remaining dissection of the proximal segment of the right coronary artery made it possible to prevent the recurrence of the disease.

The article is dedicated to the history of medicine in Russia in the 18–19th centuries. It focuses on the construction of military hospitals on the Vyborg side, the formation of the Nevsky facade of the Vyborg side, and the architects of St. Petersburg.

This historical review is more focused on the analysis of highly relevant, unique method proposed by A. Wölfl er, E. Doyen and C. Roux more than 140 years ago. We also try to present main facts and the chronology of Y-reconstruction of the digestive tube concept’s development. Hereby we present historical retrospective of theoretic concept creation, experimental confi rmation and initial clinical experience of Y-shaped reconstruction of the digestive tube on Roux-en-Y-loop, stages of concept evolution and development from the end of the 19th century and continuing into current times. Scientifi c research of surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery founders, expand 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-enteric and pancreatic anastomosis, and the use in the routine practice of bariatric surgery.

The increasing number of patients with comorbid diseases with polypharmacotherapy requires the search for optimal approaches to the treatment. The article discusses clinical aspects of bilateral connection manifested by an increase in frequency, severity and worsening prognosis of comorbid diseases. Common risk factors and pathophysiological mechanisms of diseases can serve as a basis for the development of optimal treatment of patients with comorbidity.