This lecture discusses the issues of diagnosis and correction of pathological conditions accompanied by hyperandrogenism in women. The most common causes of a symptom complex caused by an increase in the level of androgens are polycystic ovarian syndrome, congenital dysfunction of the adrenal cortex, endogenous hypercortisolism, androgen-producing tumors. The data presented are based on clinical guidelines approved by the Russian Ministry of Health, consistent with the principles of evidence-based medicine.

The review presents data on the incidence of thromboembolic complications with laparoscopic access in gynecological practice and compares it to the conventional laparoscopic surgery. Methods for the prevention of thrombotic complications, dosages of medications and the duration of their use are discussed. Modern approaches to the treatment of gynecological patients after endoscopic interventions indicate the advisability of using preventive measures to decrease thromboembolic complications.

February 2022 est., there were several validated ischemic heart disease (IND) pretest probability scales presented in the clinical guidelines of various cardiology communities (G.A. Diamond and J.S. Forrester, Duke, ESC 2019 scales). Despite their diversity, they lacked clear quantitative criteria and were based on a subjective assessment of the pain syndrome described by a patient, their gender and age. The purpose of this study was to investigate the possibilities of heart rate variability and ECG dispersion mapping for pre-test assessment of the probability of coronary artery disease. We studied 81 patients (mean age 61.48 ± 13.00 years) with suspected CAD. All patients underwent a five-minute ECG recording with the construction of ECG dispersion mapping and assessment of heart rate variability. Each subject underwent coronary angiography (within 12 months before or after the stress test) to verify the damage to the coronary bed. When analyzing the comparison of the results of coronary angiography and dispersion ECG mapping, 3 groups of patients were formed and studied: group A (coronary artery stenosis more than 50%, n = 18), B (coronary artery stenosis less than 50%, n = 16) and C (without coronary artery disease, n = 21). It was noted that the more pronounced the stenosis of the coronary arteries, the higher the index of microalternations “Myocardium” and T-alternation of the myocardium, and the lower the functional reserve of the myocardium. Considering that a short (thirty second) high-resolution ECG recording is required to perform dispersion ECG mapping, this method can be used as a screening for the selection of patients at high risk of coronary heart disease and exercise testing. We suggest that patients should be referred for exercise testing if two of the three criteria are present: BMI ≥ 22%, Functional reserve ≤ 70%, T-alternation ≥ 18% (AUC ROC is 0.718). The sensitivity and specificity of the presented method can be increased by adding indicators from the analysis of heart rate variability (heart rate, HF, LF) and patient’s age (AUC ROC is 0.929) to the formula.

Monoclonal antibodies IL-6 inhibitors (olokizumab) and IL-6 receptor inhibitors (tocylisumab, levilimab) are most widely used for proactive anti-inflammatory therapy in patients with COVID-19. A decrease in blood oxygen saturation after 12–72 hours of anticytokine therapy has been recently observed in some patients treated with MAB. Unfortunately, little attention is paid to this problem. As a rule, the deterioration of the patient’s condition is attributed to the natural course of the disease. The purpose of the study is to identify predictors of reduced blood oxygen saturation against the administration of IL-6 inhibitors and its receptors in patients with new coronavirus infection (COVID-19). Material and methods. The study included 54 patients with COVID-19 who were treated permanently between 2020 and 2021 and were given IL-6 inhibitors or receptors (tocilizumab, olokizumab or levililmab). The results of clinical examination, laboratory and instrumental research were evaluated. Results and conclusions. Clinical-laboratory parameters reliably correlated with decreased blood oxygen saturation against the administration of IL-6 inhibitors and its receptors are as follows: administration of MAB after 2 days of inpatient treatment (OR = 3.52; 95% CI 1.026–12.073; p = 0.04), the presence of hypertonic disease in combination with ischemic heart disease or obesity (OR = 4.0; 95% CI 1.0–16.925; p = 0.049 and OR = 7.353; 95% CI 1.429–37.848; p = 0.009 respectively), increase in the number of monocytes greater than 0.6 × 109/l (OR = 4.929; 95% CI 1.327–18.307; p = 0.014), the decrease of albumin less than 35.1 g/l (OR = 30.0; 95% CI 1.410–638.186; p = 0.033), glucose of venous blood 5.9 mmol/l and above (OR = 11.556; 95% CI 1.223–109.19; p = 0.018). Based on the data obtained in this study, it is recommended to evaluate the predictors listed above before conducting targeted anti-inflammatory therapy, and, if they are available, to dynamically monitor patients for reduced blood oxygen saturation.

The postpartum period is a sensitive time when mothers are subjected to increased risks of mental disorders. Aim: to study the structure of anxiety and depressive disorders in women against the background of the early postpartum complications. Material and methods. 150 patients, who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology, Baku, were selected for the study and divided into two groups: the main group - with postpartum complications (n = 100), the comparison group — with physiological postpartum period (n = 50). The average age was 29.9 ± 0.64 and 30.3 ± 0.86 years. All patients underwent a comprehensive examination using anamnestic data and the Hamilton Scale to assess the severity of anxiety (HARS) and depression (HRDS). Results. According to etiology and pathogenesis, the studied pathology is multifactorial. Significant risk factors for the complicated course of puerperia are inflammatory diseases of the pelvic organs. Attention is drawn to the adverse effect on the health of women in the puerperal period, the high frequency of diseases of the upper respiratory tract and kidneys in the anamnesis. Diagnosed postpartum inflammatory complications may serve as a risk factor for the development of anxiety and depressive disorders in the postpartum period. The average indicators in women of the control group are within the normal range. A high level of clinical severity of symptomatic anxiety was observed in the main group (48.0 + 5.00% versus 8.0 + 3.84% in the control group, χ2 = 44.19; p < 0.0001), that is, early postpartum complications are a predictor of severe anxiety. Depression of an average degree was more often recorded with a complicated course of puerperia. Discussion. The presence of a burdened obstetric and gynecological anamnesis and extragenital pathology increases the risk of puerperal complications and the development of severe affective disorders. Changes in the emotional status affecting the anxious and depressive component were more often revealed in postpartum women with complications than in women with a physiological course of the postpartum period. Conclusions. Most of the anxiety-depressive conditions in the main group corresponded to moderate severity in the clinical and psychopathological study. Disorders of mild degree were observed more often in a physiologically proceeding postpartum period. When complications are detected, timely diagnosis and correction of anxiety and depressive disorders are necessary for easily women’s adaptation to the postpartum period.

To present some pathogenesis, diagnostics and treatment of thromboangiitis obliterans (TAO) discussion items in accordance with the contemporary views on the nomenclature, classification, pathogenesis and treatment of rheumatic diseases. Materials and methods. 115 patients with thromboangiitis obliterans under observation in Interregional Consultative Center for the patients with systemic rheumatic diseases were examined. The complex analysis of peripheral circulation was carried out by ultrasonic scintiangiography. The methods of study included: morphological analysis of biopsy, autopsic and operating material by histochemical methods; immunofluorescent method was used for detecting the immune complexes. In 224 patients with systemic vasculitides (SV) serological markers, including the wide spectrum of autoantibodies, C-reactive protein, complement, von Willebrand factor antigen as a marker of defeat of vascular wall were detected. Results. Most diagnostically significant criteria were: age younger than 45 years, male sex, smoking, distal vascular lesions of the extremities and confirmation of thromboangiitis obliterans by musculocutaneous biopsy. The involvement of small- and medium-sized arteries and also thrombophlebitis and phlebemphraxis were typical. Reliable diagnosis could have been considered when scintiangiography data that testified about the contraction or occlusion of distal arteries of extremities, and the results of biopsy were presented. Morphological substratum was a destructive-productive or productive thrombovasculitis of middleand small-sized arteries and veins. Necrotic destructive-infiltrative and destructive-proliferative arteriitis, accompanied by fibrinoid necrosis of the arterial wall and by its infiltration with neutrophils were revealed with the productive. The thromboses were revealed with these arteriitis more frequently, and in the wall of such arteries immune complexes were observed. Ischemic manifestations were connected not only with arterial stenosis, but also with microangiosclerosis. Differential diagnostic signs of atherosclerosis were represented. Involving of small- and middle-sized arteries was typical for thromboangiitis obliterans and large- and middle- sized arteries — for atherosclerosis. The thrombophlebitis and phlebothrombosis were characteristic for TAO. No specific laboratory tests were available to confirm TAO diagnosis. It should be noted the specific diagnostic tests and positive serological markers, characteristic for other SV nosologic forms were absent. Some questions of nosologic specification, pathogenesis and principles of therapy were discussed. It should also be noted that the spectrum of TAO interpretation changed since the beginning of the XXI century. The disease requires multidistsiplinary approach both in diagnostics and refinement of nosologic belonging, pathogenesis and designation of pathogenetic therapy.

The frequency of myocardial infarction with non-obstructive coronary arteries (MINOCA) ranges from 5 to 11.1% in the structure of all myocardial infarctions. Left ventricular myocardial performance index (LV MPI) is the only echocardiographic independent predictor of unfavourable prognosis in patients with acute coronary syndrome. Purpose: to study risk factors for coronary heart disease, laboratory and echocardiographic indicators with the calculation of LV MPI in patients within the acute period of myocardial infarction. Material and methods. The study included 72 patients diagnosed with myocardial  infarction. 40 patients had single-vessel coronary artery disease, 32 patients did not have stenosis > 50% according to coronary angiography. All patients underwent clinical examination, electrocardiography, clinical blood analysis and body chemistries. Echocardiography was performed on the first day of the disease. Results. A statistically significant difference among risk factors is hereditary load; in patients with MINOCA, it is the level of low-density lipoproteins and triglycerides. The glomerular filtration rate by CKD-Epi is lower by 17.6 ml/min (p = 0.0007). The LV ejection fraction, MPI is higher in patients with MINOCA (p = 0.001), in 3 patients (7.5%) who underwent percutaneous coronary intervention, LV MPI was 22.6%. Findings. 1. According to clinical signs, patients with MINOCA had a more severe course of the acute period. 2. Indicators of intracardiac hemodynamics are better in the group of patients with myocardial infarction, including the left ventricular myocardial performance index

New coronavirus infection (COVID-19) hospital mortality rate is high but vary in different countries. The aim of the study: to analyze the mortality in the COVID-hospital for the period from January to December 2021 taking into account the age as well as the causes of deaths and comorbidity of patients who died in January–February 2021. Material and methods. Hospital mortality was evaluated according to the registers in 2021. The case histories of patients who died in January–February 2021 were analyzed retrospectively. Results. 984 pa of patients over 60 years old (14.38%) was higher compared to younger people (3.98%), and increased with age. The most frequent complications in 84 patients who died in January–February were acute respiratory distress syndrome, infectious-toxic shock, acute cerebrovascular accident. 78 (92.85%) of the deceased had 2 or more concomitant diseases. Cardiac pathology, chronic kidney disease and diseases of the endocrine system were the leaders in frequency. Vaccination for the previous 6 months was carried out in 3 (3.57%) patients. Conclusion. Mortality rate in the COVID-hospital in 2021 was 10.49% and was significantly higher among patients over 60 years old. A further increase in age was associated with an increase in mortality. The majority of the patients, 78 out of 84 (92.85%) who died in January–February, had multimorbidity.

The article presents general data on IgG4-associated disease, as well as its classification and universal diagnostic criteria. Attention is focused on the possibility of multi-organ lesions, which complicates diagnosis and treatment. A clinical case of an IgG4-associated disease involving the retroperitoneal space (retroperitoneal fibrosis), lungs (bilateral interstitial pneumonia, diffuse and focal fibroid lung), intestines (chronic colitis) in a middle-aged man is described. Sequential administration of glucocorticoids and monoclonal antibodies made it possible to bring a patient into remission, however, the recurrence of the disease required the resumption of hormone therapy at a reduced dose with a positive effect.

The article presents the contribution of V.Kh. Vasilenko to the development of internal diseases propedeutics, which consists in defining the concepts of “symptom” and “syndrome”, describing the IV tone of the heart, creating a classification of circulatory insufficiency and highlighting its forms and stages, clarifying the features of angina pectoris attacks, improving abdominal palpation, developing clinical aspects of esophageal diseases, peptic ulcer, cholelithiasis.

Тhe article presents the facts concerning the career and creative development of an outstanding Russian therapist, an excellent clinician, a wonderful teacher, a well-known public figure and academician of the USSR Academy of Medical Sciences, Honored Scientist of the RSFSR, laureate of the USSR State Prize, Professor Vladimir Nikitich Vinogradov.

The article highlights the obscure chapters of the Moscow Military Hospital and the Moscow Department of the Medical and Surgical Academy history during the Patriotic War of 1812. Data on doctors and medical students who provided medical care to the wounded and sick in Moscow and temporary military hospitals during evacuation are presented. New archival documents are provided

 Тhe article presents the main results of the military medical service work during the Great Patriotic War.