The article discusses the causes and mechanisms of cognitive disorders in patients who have recovered from COVID-19. A review of scientific publications in recent years has shown that the impairment of central nervous system function is one of the key features of coronavirus infection. Post-COVID neurological syndrome is observed in most patients. The authors have summarized data on the penetration of viruses into brain structures and studied the leading mechanisms of nervous system damage associated with viral infection. Promising directions for the prevention and treatment of neurocognitive disorders associated with past coronavirus infection are proposed.

According  to the latest  statistical  data,  22% of patients  with emergency  abdominal  surgical  pathology  are  admitted  to medical institutions with signs of peritonitis. Despite modern methods of treatment and diagnosis, the mortality rate for this pathology remains at the same level and is approximately 18–29%, and in advanced forms can reach 75–90%. Recent studies show that in an unfavorable outcome of this pathological process, a leading role is given to a progressive increase in intraabdominal pressure (IAP). The relationship between the degree of endogenous intoxication and IAP values makes it possible to quickly assess the severity of the patient’s condition and the state of central hemodynamics without additional laboratory and instrumental studies. The aim of the study was to evaluate the indicators of systemic endogenous intoxication and intraabdominal  pressure and their relationship  in patients  with peritonitis in the pre- and postoperative  period. Material and methods. This work is based on a retrospective analysis of 74 patients operated on at the clinical bases of the Department of Hospital Surgery of the Moscow State Medical University named after A.I. Evdokimov for peritonitis from January to October 2022. The main causes of acute peritonitis were perforated ulcer of the stomach or duodenum, acute intestinal obstruction, thrombosis  of  mesenteric  vessels,  acute  pancreonecrosis,  complicated  colon  cancer.  The  average  age  of  patients  was 49 ± 2.5 years (34-75 years), 47 women, 27 men. The severity of peritonitis was assessed based on the degree of endotoxemia according to clinical and laboratory data. To monitor intra-abdominal  hypertension, IAP was measured. IAP measurement was performed on the operating table before surgery and in the early postoperative period. At the same time, compartment syndrome of the first degree was found in 51 (68%) patients, the second degree in 14 (19%) patients, and the third-fourth degree in 9 (13%) patients. For a comprehensive assessment of the patient’s condition and the effectiveness of the measures taken, the central hemodynamics was assessed and its relationship with the indicators of intra-abdominal pressure was evaluated. Comparative  analysis of central hemodynamics  manometry showed that with an increase in compartment  syndrome, there is a clear decrease in the performance of cardiac activity indicators, requiring urgent correction. The relationship between indicators of intra-abdominal  pressure and the duration of preoperative preparation was also evaluated. Conclusions. The relationship between the degree of endogenous intoxication and the degree of intra-abdominal pressure has been proven. With an increase in IAP values, the values of endogenous intoxication increase, which subsequently leads to the development of multiple organ failure. Even with the first degree of endogenous intoxication, a decrease in myocardial contractile ability is noted, which leads to the development of cardiovascular failure depending on the severity of the pathological process. The diagnosis of increased IAP syndrome has great practical value for detecting pathology and timely comprehensive treatment in the pre- and postoperative period.

The implementation  of Holter monitoring  (HMECG)  and quality of life questionnaires  in clinical practice allows  for the assessment of the risk of developing dangerous heart rhythm disorders and the most important parameters related to the daily activities of patients with breast cancer. The aim of the study was to evaluate the physical and psychological health, taking into account the variability of heart rate in patients with breast cancer complicated by metastatic lymph node involvement. Material and methods. The study used data from questionnaires  completed by 115 breast cancer patients with metastatic lymph node involvement  who were receiving treatment at the Republican  Oncological  Hospital, divided into two groups: a main group of 45 patients with metastatic breast cancer and lymph node involvement, and a control group of 70 patients without lymph node involvement. The average age of the patients was between 30 and 60 years old. Complaints associated with heart rhythm disorders were considered as criteria for indicating HMECG. Quality of life questionnaires were performed using official versions of EORTC QLQ-C30 and QLQ-C30/BR23 questionnaires. Results. According to the results of statistical analysis, it was found that the effective refractory period of the atria (ERP PR) in the main group during atrial fibrillation (AF) was shorter than in the control group (p = 0.001). It was also found that in addition to shortening the ERP PR, an important factor in diagnosing breast cancer is an increase in the recovery time of the sinus node function and its corrected equivalent (CVVFSU) at relatively low average values of daily, nocturnal, and diurnal heart rate frequencies. Worsening overall condition or general fatigue are some of the most common symptoms encountered in breast cancer patients, which should be considered as important parameters significantly affecting the quality of life of patients burdened with metastatic regional lymph node involvement.

Currently, due to the increase in life expectancy in the human population, the relevance of the problem of sarcopenia and chronic somatic pathology, including chronic heart failure (CHF), is increasing. At the same time, there are no clear recommendations for managing patients with a combination of CHF and sarcopenia. In addition, the impact of sarcopenia in combination with CHF on kidney filtration function remains poorly understood. The aim of the study was to evaluate the dynamics of muscle mass and strength, kidney filtration function in patients with sarcopenia and CHF in a longitudinal study involving 53 male patients with a mean age of 75.2 ± 7.3 years. The first (main) group (n = 24) consisted of patients with CHF and sarcopenia, while the second comparison group (n = 29) included patients with CHF without sarcopenia. The results showed that patients in the main group had a more pronounced decrease in muscle mass and strength over time, glomerular filtration rate (GFR), calculated using CKD-EPI formulas, based on cystatin C (CKD-EPI_CysC) and cystatin-creatinine (CKD-EPI_CysC+Cr) levels. In the comparison group, a more significant decrease in GFR, calculated using creatinine, was observed. It is emphasized that for more accurate determination of GFR in patients with CHF and accompanying sarcopenia, it is advisable to use the CKD-EPI_CysC formula. Future controlled randomized studies will determine the possibility of including this recommendation in appropriate protocols for managing elderly patients.

Research  objective.  Evaluation  of the influence  of 6-month  antihypertensive  therapy  with  drugs  of different  classes on hemodynamic parameters of the circulatory system in patients with comorbid hypertension and rheumatoid arthritis. Materials and methods. Patients who met age criteria (58.6 ± 6.4 years), duration of hypertension (11.2 ± 1.6 years), onset (aged 45–64 years), and duration (7.2 ± 2.1 years) of rheumatoid arthritis were divided into groups: Group I (136 men, 141 women) — 277 patients  with stage II hypertension;  Group II (28 men, 114 women)  — 142 patients  with stage II  hypertension  and rheumatoid arthritis (in clinical-laboratory remission); Group III (20 men, 92 women) — 112 patients with stage II hypertension and rheumatoid arthritis (in clinical-laboratory  exacerbation). Antihypertensive  monotherapy was prescribed by polyclinic doctors: nebivolol, lisinopril, losartan, amlodipine, indapamide, and a combination of lisinopril and indapamide. Observation was carried out for 6 months. Results. The influence of antihypertensive therapy (6 months) on hemodynamic parameters of the circulatory system in patients of groups I and II was presented by positive dynamics of morphometric and speed parameters, while in group III patients the indicators were less significant and more distant. Conclusion.  The presence of rheumatoid arthritis introduces additional changes in the dynamics of hemodynamic effects of prescribed antihypertensive therapy and is determined by the degree of disease activity and adequacy of basic anti-inflammatory therapy.

There are many variants of acute external hemorrhoids (AEH), with varying degrees of its development. The purpose of the study is to study the features of diagnosis and treatment of outpatient patients with AEH in the form of ovoid (AEH–FO). Material and methods. A solid sample, a retrospective sequential study of the data of 97 outpatient patients with AEH–FO. AEH–FO of the first degree (AEH–FO 1) was detected in 57,7% of patients, the node was more often elastic, blue in color, AEH–FO of the second degree (AEH–FO 2) in 42,3% of patients, wound necrosis on the node, the discharge of blood from it. In 32,7% of patients treated on average after 4 days, the average pain on the visual pain scale (VPS) was 6 points. Conservative treatment was carried out in all patients with AEH–FO with the appointment  of MOFF (90% diosmin and 10% hesparin flavides. When bleeding from the node, tranexam, psyllium, lactulose, macrogol were prescribed for constipation. Analgesia was performed depending on the intensity of the pain. Only 3,1% of patients were operated on before 2018. Conclusions. The treatment of patients with AEH–FO was effective. In the average treatment period of 14 days, all patients recovered and were able to work.

The high prevalence of iron deficiency (ID) in women and its important negative impact on the health care system is beyond doubt. The presence of severe problems of a systemic nature requires the development of special state programs to combat ID. The development of such programs is impossible without conducting epidemiological studies in each specific country. The purpose of this work is to determine the frequency and severity of ID in terms of serum ferritin (SF) in primary outpatients, depending on gender and age. The study was conducted in 15 large cities of Russia, in total, 1737 primary patients were included, of which 97 were males and 1640 were females. When studying the parameters of SF in general groups, its values are significantly lower in females, and average 40 ± 99 μg/l, while 61% of this cohort of patients have SF less than 30 μg/l, and 70% live in conditions of SF below target values, which requires the development of preventive programs to combat ID among female patients. Between the ages of 16 and 49, almost all females live in conditions of absolute ID, and it is probably in this group that the above activities should be carried out. On the contrary, as regards male patients, judging by the data obtained, a mandatory determination of SF is required to make a decision on conducting ferrotherapy.

Peutz-Jeghers syndrome is a genetic disorder inherited in an autosomal dominant pattern and characterized by a mutation in the STK11 gene. According to domestic literature, the risk of inheriting this pathology from a parent to a child is 50%. According to WHO data, in 2018, more than 74,000 new cases of colorectal tumors were detected in the Russian Federation, with 5–10% of cases being hereditary syndromes, of which 1% is Peutz-Jeghers syndrome. The frequency of occurrence is approximately 1/29,000–1/120,000.  The aim of the work is to share the experience of diagnosing and treating a patient with Peutz-Jeghers syndrome. Today, we have the ability to timely diagnose pathological changes in the mucous membrane of the small intestine, perform minimally invasive treatment, reducing rehabilitation time due to a decrease in surgical trauma.

Arterial hypertension remains a leading risk factor for cardiovascular disease and mortality. Adequate antihypertensive therapy requires not only the development of new drugs and drug combinations, but also close professional interaction between specialists at all levels of healthcare, with mandatory patient involvement in this process. The aim of this study was to investigate information requests, ways of satisfying them, and interaction in the information field of internists, pharmaceutical workers, and patients in the treatment of arterial hypertension, and to propose ways to improve professional interaction. Material and methods included surveying doctors (n = 99), pharmaceutical workers (n = 220), and patients with arterial hypertension (n = 382), analyzing their medical documentation, organizing joint educational events during the qualification improvement of specialists at different levels of healthcare, and developing a special computer program for the automated workplace of a doctor and pharmacist as a means of improving the level of professional interaction. Results presented the profile of the main information requirements of specialists and patients in the treatment of arterial hypertension and its pharmaceutical support. The need for constant interaction in the triad doctor—pharmacist—patient was substantiated. A concept of an automated workplace for doctors and pharmacists was developed, and its functional computer program was provided. The automated workplace was tested in Yaroslavl pharmacies. Conclusion. Close professional interaction between healthcare specialists with patient involvement is an important aspect of rational pharmacotherapy. Unifi cation of the information environment of medical and pharmacy institutions allows eliminating discrepancies in medical and pharmaceutical consultations and ultimately contributes to clinical success.

The presented clinical case demonstrates the qualified work of medical staff who act not only according to established instructions, but also by vocation. Acute coronary syndrome with ST segment elevation is associated with acute occlusion of the coronary artery and sometimes, despite medical assistance, ends in a fatal outcome. The described clinical case showed the possibility of restoring the functioning of the heart and brain activity, which allowed the patient to be discharged from the hospital in a satisfactory condition. The article also analyzes the patient's condition after discharge: the patient underwent aorto-coronary bypass surgery, plastic surgery of the interventricular septal aneurysm, and mitral valve plastic surgery.

The article presents information about the participation of doctors of the Russian imperial army and navy during the events of the Yihetuan Movement in China in 1900–1901. A brief summary of the course of the battles in Pechelii Bay and Manchuria is presented. Biographical information about the doctors of the army land units and the ships of the Pacific squadron is given.

The article briefly presents the main stages of the development of the Russian military field surgery.