Rheumatology is one of the most rapidly developing medical specialties, which effectively adapts achievements and contributes to the progress of the world fundamental and clinical medical science [1]. Such immuno-inflammatory rheumatic diseases (IVRS) both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are not only the most severe chronic inflammatory human diseases, but also “models” for studying the fundamental mechanisms of pathogenesis and approaches to pharmacotherapy of other diseases associated with the development of autoimmunity and/or auto-inflammation. The relevance of the problem of IVR for modern medicine is determined by their high prevalence in the population, the difficulty of early diagnosis, the rapid development of disability and an unfavorable life prognosis. Deciphering the mechanisms of immunopathogenesis, improving diagnostics, molecular taxonomy, developing approaches to prevention, searching for new “targets” of IVR therapy based on “omix” technologies and artificial intelligence are among the priority areas of biology and medicine of the XXI century.

Cerebral small vessel disease (CSVD) is a heterogeneous disease of the microcirculatory vessel bed, leading to the development of cognitive impairments, lacunar strokes, and intracerebral hemorrhages. The pathogenesis of CSVD is characterized by disturbances in the structure of the intercellular matrix of the vessel wall, resulting in the accumulation of pathological proteins, hyalinosis, necrosis, and increased permeability of the blood-brain barrier. Disease progression is associated with a decrease in the area of the microvascular bed, inflammatory processes, atrophy, and demyelination. The article presents a pathogenetic classification of CSVD, discusses principles of diagnosis and treatment. Special attention is given to promising approaches for managing patients with chronic small artery pathology. Principles for the use of vasodilators from various pharmaceutical groups are proposed and justified, along with discussions on the prospects of using systemic proteolytic enzymes and platelet anti-aggregants.

Community-acquired pneumonia is a relevant issue for the medical service of the Armed Forces of the Russian Federation. The article presents the main points of modern clinical guidelines for managing patients with community-acquired pneumonia. It discusses diagnostic possibilities, prognostic scoring systems, criteria for transferring patients to intensive care units, antibiotic prescribing regimens, etc. These guidelines should be used in the training of military doctors and in the professional activities of healthcare workers at all levels of the medical service.

The aim of the study was to summarize the literature data on various types of systemic vasculitis, their mechanisms of development, diagnostic possibilities, and to describe a clinical case. Systemic vasculitis is a group of diseases with heterogeneous etiology, which involve vessels of different calibers, predominantly small and/or medium, manifesting as multi-organ dysfunction, difficult to treat, and with a poor prognosis. Currently, the following types are distinguished: large vessel vasculitis; medium vessel vasculitis; small vessel vasculitis; variable vessel vasculitis; single-organ vasculitis; vasculitis associated with systemic diseases; vasculitis associated with specific etiology. In the clinic of internal medicine, kidney involvement (glomeruloand tubulopathies, renal insufficiency), skin (ulcerative-necrotic and trophic changes), lungs (interstitial involvement, respiratory insufficiency, recurrent pneumonias), and central nervous system (acute ischemic events, thromboses, polyneuropathies, cognitive disorders, gait disturbances), heart (myocarditis with heart failure) are most commonly encountered. Systemic vasculitis most often manifests in winter and spring periods. Hemorrhagic vasculitis and Kawasaki disease are most commonly seen among children and young adults. In the post-COVID era, systemic vasculitis has been detected more frequently. The study presents the results of personal observation of a patient suffering from infectious-toxic systemic vasculitis.

The article discusses the use of methods for assessing lung respiratory function in patients with chronic obstructive pulmonary disease (COPD) and smokers.

The aim of the study is a comparative evaluation of the informative value of capnometry, spirometry, multiple breath nitrogen washout method, and diffusion test in patients with COPD, as well as an early detection of respiratory function impairment in smokers.

Results. Three groups of patients were examined: 1st — 30 patients with moderately severe COPD, average age 50.6 ± 4.3 years, 2nd — 30 smokers, average age 45.6 ± 2.4 years, 3rd (control group) — 30 practically healthy non-smokers, average age 45.6 ± 2.4 years. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with COPD compared to the control group and smokers at rest, both before and after bronchodilator use. Significant differences between smokers and control groups were detected during forced exhalation. According to spirometry data, the FEV1/FVC ratio in patients with COPD was statistically significantly lower compared to the control group and smokers, both before and after bronchodilator use. Diffusion capacity was significantly lower in patients with COPD and smokers compared to the control group. The lung clearance index was significantly higher in the COPD group compared to the other two groups.

Conclusions. All the mentioned methods were informative in patients with COPD, but capnometry and lung diffusion capacity assessment were sensitive methods in smokers, revealing uneven distribution of ventilation-perfusion ratios in the lungs and impaired gas exchange function.

Surgical treatment of nasal septum deviation or deformity (NSD) is a common method of treatment. The quality of treatment is assessed visually with rhinoscopy, taking into account subjective patient sensations. However, there are still no objective criteria for assessing nasal airflow improvement, which complicates the evaluation of patient breathing after treatment. We used a novel CFD modeling method to create a virtual airflow model and determine flow parameters in the nasal cavity in normal and pathological conditions.

Objective: to compare the aerodynamic characteristics of airflow in patients with NSD and healthy nasal cavities.

Material and methods: the study used electronic files of computed tomography scans of the nasal sinuses of 60 patients with NSD and 21 healthy participants. Specific software (3D slicer, Ansys Fluent) was used to obtain airflow parameters; 3D models of the nasal cavity airflow were created, and CFD flow modeling was conducted.

Results: in patients with NSD, flow velocity ranged from 5.17 to 15.63 m/s, in healthy individuals from 1.1 to 2.0 m/s; pressure force on the nasal walls ranged from 2.20 to 10.20 Pa in patients with NSD, in healthy individuals from 0.60 to 1.00 Pa; flow temperature ranged from 26.45 to 36.80 °C in patients with NSD, in healthy individuals from 20.14 to 24.40 °C; flow partial pressure ranged from –120.60 to –0.01 Pa in patients with NSD, in healthy individuals from 2.00 to –4.80 Pa, p < 0.0001. Conclusion: Aerodynamic characteristics of nasal cavity airflow in patients with nasal septum deviation significantly differ from those in healthy individuals. The application of CFD modeling of nasal airflow will assist clinicians in objectively assessing nasal breathing in NSD, as well as surgical treatment outcomes and quality assessment in otorhinolaryngological practice.

During the COVID-19 pandemic, many familiar processes had to be adapted due to various restrictions and high workload on healthcare workers. In particular, to reduce the risk of coronavirus infection, remote patient care technologies have been used more frequently. This study aims to analyze the impact of the COVID-19 pandemic and related restrictions on access to free educational courses on diabetes, disease dynamics, and patient awareness of necessary treatment methods. Changes in patient satisfaction with online learning compared to traditional face-to-face formats were studied, as well as changes in medication adherence with regular education and consultations. The authors described possible reasons for changes in the effectiveness of education and proposed measures to optimize treatment processes and patient information in Russia. The study showed that the COVID-19 pandemic led to a decrease in patient participation in educational programs on diabetes. This could have been due to fear of infection, lack of awareness of such programs, and socio-economic inequality.

Modern data demonstrate a stable growth of metabolic syndrome (MS) among young and middle-aged individuals.

The aim of the study was to assess the prevalence of MS, study its phenotypes, clinical and laboratory-instrumental features among hospitalized young and middle-aged men.

Material and methods. A retrospective analysis of 500 medical histories was conducted. Patients were divided into the following groups: with MS, with incomplete MS (preMS), without MS.

Results. MS was diagnosed in 33%, incomplete MS (preMS) in 11.6%, without MS in 55.4% of patients. The most common phenotypes were MS + chronic kidney disease (CKD) and MS + gastroesophageal reflux disease (GERD). The most common component of MS in patients of all three groups was dyslipidemia (DL). Hyperuricemia (p < 0.001; p1–2 = 0.033; p1–3 < 0.001) and elevated transaminase levels (p < 0.001; p1–3  < 0.001) were more common in men with MS. In addition, individuals with MS more often had: changes in urine sediment according to general urine analysis (GU) (p < 0.001; p1–3 < 0.001), ultrasound signs of liver steatosis (p < 0.001; p1–2 < 0.001; p1–3 < 0.001); concrements and cysts on ultrasound examination of the kidneys (US) (p < 0.001; p1–3 < 0.001); presence of CKD (p < 0.001; p1–2 = 0.003; p1–3 < 0.001), predominantly in early stages (Stages 1 and 2). MS was associated with the risk of developing CKD, oncological diseases, ischemic heart disease (IHD), and GERD.

Conclusion. The obtained data demonstrate a high prevalence of MS (1/3) among young and middle-aged men, as well as an increased frequency of CKD and fatty liver steatosis/steatohepatitis in patients of this group.

Due to the non-specificity of a number of clinical manifestations of Addison’s disease, the diagnosis of primary adrenal insufficiency in general therapeutic profile hospitals causes certain difficulties. The article presents a clinical case of diagnosing primary adrenal insufficiency in combination with autoimmune thyroiditis and hypogonadism as a manifestation of autoimmune polyglandular syndrome. Signs of Addison’s disease included hyperpigmentation of the skin and mucous membranes of the oral cavity, as well as low cortisol levels and an increase in adrenocorticotropic hormone(ACTH) concentration, detected in the blood serum antibodies to thyroperoxidase — a specific marker of autoimmune thyroid gland damage. A positive result of the test for autoantibodies to steroid-producing cells indicated functional ovarian insufficiency.

The clinical case of a neuro-mediated syncope episode in a sports-active adolescent is presented. The differential diagnosis included the following conditions: cardiomyopathy induced by physical factors, sinus node dysfunction, and sinus node weakness syndrome. After conducting necessary laboratory and instrumental investigations (ECG, echocardiography, 24-hour ECG monitoring, and exercise stress test), these conditions were excluded. The patient was discharged to outpatient care with recommendations for non-pharmacological syncope prevention.

The article provides information about the last plague epidemic in history, which occurred in Manchuria in 1910 along the Chinese Eastern Railway. The main focus of this publication is on the biographical data of Russian doctors from anti-plague units.

The article reveals the identity of the senior sister of mercy of the Community of Sisters of Mercy named after M.P. Kaufman, Alexandra Petrovna Filippova, depicted in the photograph of 1915.