The treatment of patients with a new coronavirus infection (COVID-19) is the cornerstone of practical healthcare. This is due to the widespread and unjustified use of antimicrobial drugs, the use of irrational antiviral therapy schemes. Also, the discussion regarding the use of systemic glucocorticosteroids and monoclonal antibodies continues to this day. In this publication, based on research data and own clinical observations, clinical recommendations for COVID-19 pharmacotherapy are presented.

Postmenopausal osteoporosis is an important interdisciplinary problem of modern medicine. The presented lecture highlights modern approaches to the diagnosis, prognosis and treatment of this pathology. The leading role in the detection of osteoporotic changes is played by radiation diagnostic methods that determine the level of bone mineral density - the equivalent of bone mass. In order to study metabolic disorders of bone tissue, laboratory methods are used that evaluate the activity of bone synthesis and resorption. When predicting osteoporotic fractures, the FRAX model is widely used, which determines the likelihood of fractures in the next 10 years, based on the presence of risk factors. Given the multifactorial nature of the formation of osteoporotic changes, an integrated approach to the treatment of this disease is necessary. According to the recommendations of the European Society of Endocrinology, bisphosphonates should be considered as first-line therapy. Denosumab, romosozumab, teriparatide can be used as second-line drugs. In addition, given the leading role of hypoestrogenism in the development of postmenopausal osteoporosis, the use of menopausal hormone therapy preparations occupies an important place in the prevention and treatment of osteoporotic changes. An important aspect that determines the effectiveness of the treatment of patients with postmenopausal osteoporosis is the need for interaction between doctors of various specialties, including gynecologists, endocrinologists, rheumatologists, traumatologists, doctors of radiation and laboratory diagnostics.

The article presents the review of the modern approaches and issues in management of the patients with primary hypothyroidism. To date globally multiple nonclinical and clinical studies designed to improve the substitutional therapy and quality of life of patients with primary hypothyroidism are performed. The objective of the review is to analyze the global studies for last 5 years and the modern literature concerning the new possibilities and approaches to the primary hypothyroidism treatment. To achieve this objective the systematic search in PubMed dataset with these key words using: "primary hypothyroidism treatment", "levothyroxine side effects", "primary hypothyroidism outcome", "new approaches to hypothyroidism therapy", "new formulations of levothyroxine", "hypothyroidism in elderly" for the period from 2018 to 2023 was performed. Based on this analysis the conclusions that the investigation of different disease course features and discovering of new treatment options are necessary despite the apparent simplicity of substitutional therapy were made.

Aim. To reveal the features of the structural-geometric remodeling of the left chambers of the heart, the diastolic function of the left ventricle and to assess the presence of calcification of the valvular structures of the heart in late postmenopausal women with different levels of vitamin D. Material and methods. The cross-sectional study included 123 postmenopausal women. A standard transthoracic echocardiography was performed with an assessment of morphometric variants of remodeling of the left chambers of the heart and its diastolic function according to the transmitral flow. The significance of differences was assessed using the Mann–Whitney test, χ² Pearson. Differences and correlations were considered significant at p < 0.05. Results. The median concentration of 25(OH)D in the sample was 20.51 ng/ml (15.8÷26.73). Adequate serum concentration of 25(OH)D was observed in 23 (19%) patients (group 1), in 100 (81%) cases vitamin D deficiency was detected (group 2). In group 1 — 7 (31%) patients had normal geometry (NG) of the left ventricle (LV), LV concentric remodeling (CR) was diagnosed in 1 (4%) case, LV concentric hypertrophy (CH) was diagnosed in 3 (13%) cases, and LV eccentric hypertrophy (EH) was detected in 12 (52%) cases. In Group 2, LV NG was diagnosed in 27 (27%) cases, LV CR was detected in 8 (8%) cases, LV CH was detected in 31 (31%) cases, and LV EH was verified in 34 (34%) cases, the differences are insignificant (p = 0.24). Patients of group 2 showed a statistically significant increase in the volume of the right atrium (RA) and thickness of the posterior wall of the left ventricle (TZSLV). In group 1, in 11 (50%) cases, rigid-type diastolic dysfunction (DD) was detected, and in 11 (50%) cases, a pseudo-normal type of DD was detected. In group 2, pseudonormal myocardial DD was detected in 26 (26%) patients, 74 (74%) patients had rigid-type DD, differences between groups were significant (p < 0.001). Calcifications were found in the annulus fibrosus in 16 (70%) cases in group 1 and in 88 (88%) patients in group 2, the differences were significant (p = 0.04). Conclusion. In the study, data were obtained indicating a significant contribution of vitamin D deficiency to changes in the geometry of the left chambers of the heart, diastolic function of the left ventricle, and calcification of valvular structures.

Obesity is a global public health problem in the twenty-first century. The most adverse it’s effects are associated with visceral type, with accumulation of epicardial fat, showing high metabolic activity, dysfunction and important role in the development of lipotoxic cardiomyopathy linked with significant morphological and functional myocardial changes, accompanying by high risk of heart rhythm disorders. The aim of the study: to identify structure (frequency and character) of cardiac arrhythmias in men of employable age with visceral obesity, to establish the relationship of arrhythmias with features of the blood lipid spectrum of these patients. Material and methods. 98 men with abdominal obesity and 46 overweight patients were examined. The control group consisted of 40 healthy patients with normal body weight. All the patients were undergone ECG monitoring, echocardiography and analysis of serum lipid levels. Results. The presence of obesity is statistically significantly associated with the risk of supraventricular couplets, frequent ventricular extrasystoles, sinus arrhythmia and atrial fibrillation. The increase in the severity of obesity was accompanied by a tendency to a greater frequency of arrhythmias: in obesity of I degree, the frequency of atrial fibrillation was 12.3%, II–III degree — 21.2%, p = 0.25; frequent ventricular extrasystoles with similar degrees of obesity — 13.8% and 21.1%, respectively. Atrial fibrillation was significantly more often detected against the background of lipid disorders, mainly with a decrease in HDLP. Conclusion. The main type of heart rhythm disturbance in patients with obesity are supraventricular arrhythmias, mainly atrial fibrillation, the frequency of which increases in proportion to the increase in the patient's body weight. Abdominal obesity leads to an increase in ventricular ectopic activity. Dyslipidemia is the one of risk factors for arrhythmias in these patients.

Aim. To assess the structure of cardiovascular pathology in patients with new coronavirus infection (NCI), to identify factors of poor prognosis in these individuals. Material and methods. The study was conducted on the basis of the COVID-19 infectious diseases hospital of the City Hospital No. 33 of Nizhny Novgorod. The study included 284 patients after applying inclusion and exclusion criteria. All subjects were divided into groups: the main group (n = 207) — patients with NCI and cardiovascular diseases (CVD), as well as comorbid diseases, the comparison group (n = 24) with NCI and CVD, the control group (n = 53) with NCI without any comorbid diseases. Demographic indicators, BMI, laboratory parameters, comorbidity and therapy were analyzed. Results. During the study, it was revealed that the most severe course of COVID-19 is characteristic of the main group, and only among them there were fatal outcomes (25% of cases). Analyzing the prevalence of CVD, it turned out that arterial hypertension was the most common in the main group and in the comparison group, coronary heart disease and heart failure were registered somewhat less frequently. The development of acute cardiovascular accidents occurred only in the main group. A mathematical model was developed to determine the risk of death in patients with NCI who are in the hospital. This model is statistically significant (p < 0.001). Conclusion. The older age of patients, the development of acute myocardial infarction, first identified atrial fibrillation and a decrease in saturation contributed to an increased risk of mortality in patients with NCI and CVD. Among drug therapy, the administration of favipiravir, tocilizumab and statins had a beneficial effect on the outcome of diseases.

Rationale. During the COVID-19 pandemic, there was a sharp increase in the incidence of community-acquired pneumonia (CAP) in Russia and the Republic of Karelia (RK). Given the high significance of the problem, it is necessary to clarify the causes of the current epidemiological situation. The purpose of the work: to assess the incidence of CAP, not associated with COVID-19, in the adult population of the Republic of Karelia aged 18 years older in 2011–2019 in the administrative-territorial divisions of the republic, a comparison of its existing and projected levels in 2020–2021. Material and method. A retrospective observational epidemiological study was conducted based on the analysis of statistical data of the Republican Medical Information and Analytical Center of the Ministry of Health of the RK on the incidence of CAP, not associated with COVID-19, in the population aged 18 years and older in 2011–2021. Relative values, indicators of the dynamic series are used. To differentiate the administrative-territorial divisions of the RK by incidence in 2011–2019 the method of k-means cluster analysis was applied. To build a forecast for the incidence of CAP, not associated with COVID-19, for 2020–2021 used additive regression model for time series. Results. Among the districts, 3 clusters were identified for the incidence of non-coronavirus CAP in 2011–2019 with the worst epidemiological situation in Olonetsky. The actual incidence exceeded the predicted one in 2020 in 11 and in 2021 in 9 territories of the region, which confirms the impact of the pandemic on the incidence. Conclusion. There are territories in the republic with a “traditionally” high incidence of CAP, and the COVID-19 pandemic has made a significant contribution to its increase.

One of the most dangerous complications of pregnancy is preeclampsia. For effective prevention of preeclampsia, it is necessary to understand its mechanisms of development clearly. The analysis of modern patterns of preeclampsia cause and development are reviewed in this article. There are also the evidences of more effective strategies of prevention preeclampsia in our review, which have proven themselves most of all. The generalized endothelial mother’s disfunction is in the base of preeclampsia pathogenesis and caused by placental factors, genetical susceptibility and the lack of arterial invasion in trophoblast’s cell hereupon it increases the oxidative stress and inflammatory process, leading to complications of mother and fetus. More accurate understanding of preeclampsia mechanisms allows us to correct the adverse of lifestyle of patients and highlight those who are in the group of PE risk and need the prophylaxis to be prescribed. Nowadays, acetylsalicylic acid is a commonly accepted therapeutic medication and reliably effective (optimal dose from 75 to 162 mg). It is prescribed as the prevention from 11th to 14th week.

Among the diseases of urgent pathology, the leading place belongs to acute pancreatitis, which is inferior to such nosologies as acute appendicitis and acute cholecystitis. Moreover, the lion’s share is occupied by light forms, which make up 85%. The aim of the work is to demonstrate a clinical case of recurrent abdominal syndrome occurring under the mask of acute pancreatitis in a patient with oncopathology identified using a diagnostic algorithm used in outpatient practice. Material and methods. Patient F., 60 years old, repeatedly sought medical help in a network of polyclinics and hospitals providing emergency specialized medical care with recurrent abdominal syndrome. Results and discussion. Against the background of conservative treatment, the patient had a short-term positive dynamics characteristic of a mild form of acute pancreatitis. After taking the patient to the dispensary and conducting an in-depth diagnostic examination according to the algorithm developed by our group of researchers, cancer of the stomach stump T2N0M0 was detected. Conclusion. Patients with recurrent abdominal pain syndrome need dispensary observation on an outpatient basis to identify other pathology occurring under the guise of acute pancreatitis and to conduct adequate treatment.

The COVID-19 pandemic caused by the SARS-CoV-2 coronavirus has shown a wide range of manifestations, including cardiovascular. A clinical description of left ventricular aneurysm rupture in a 33-year-old patient after infection with SARS-CoV-2 is presented.

Publications regarding cardiac arrhythmias associated with the new coronavirus infection (COVID-19) focus primarily on the high prevalence and symptoms of this complication. We have not found any studies on the specific treatment of arrhythmias associated with SARS-CoV2, since a standard therapeutic approach is probably implied. This observation describes a series of cases of various cardiac arrhythmias that occurred against the background of acute COVID-19 and were treated with anti-inflammatory, but not antiarrhythmic drugs. The cases are united by the occurrence of acute SARS-CoV-2 infection, the connection of relapses with inflammation symptoms, as well as the effectiveness of therapy with the main classes of anti-inflammatory drugs. A narrative review of the literature provides the rationale for the inflammatory theory of arrhythmias and sets the stage for discussion about how to integrate differentially anti-inflammatory drugs into the treatment regimen of such patients.

The information about the participation of Russian officers and military doctors in the Chaka War of 1932–1935 between Paraguay and Bolivia is presented. The biographical information of military doctors who emigrated from Russia after the Civil War is given. Their merit was the creation of the medical service of the army, which ensured the victory of Paraguay in the war.

The article is dedicated to the 100^th anniversary of the birth of Professor V.P. Baskakov, Head of the Department of Obstetrics and Gynecology of the Military Medical Academy named after S.M. Kirov. The article presents a brief biography of Professor V.P. Baskakov and the memoirs of his students and colleagues.