Multiple systemic atrophy (MSA) is a rapidly progressive neurodegenerative disease characterized by the presence of autonomic dysfunction and movement disorders. It occurs in adults in most cases and is manifested by various clinical syndromes with varying degrees of severity, such as parkinsonism, cerebellar dysfunction, autonomic insufficiency, and urogenital and corticospinal dysfunction. Difficulties in diagnosis and treatment are largely due to incomplete understanding of pathogenesis. This review summarizes current literature on etiological, including genetic, risk factors, pathogenesis, clinical presentation, diagnosis, differential diagnosis, and treatment options for MSA.

One of the most important aspects in achieving successful outcomes in cardiac surgery is the evaluation of the risk of bleeding during and after the procedure. Preoperative anemia, intraoperative bleeding, and transfusion therapy contribute to a cumulative risk of adverse events. Given the limitations of traditional coagulation tests, a more comprehensive and patient-centered approach is necessary. Factors affecting the risk of bleeding should be considered from the perspective of both individual patient characteristics and the specific type and extent of the planned surgical intervention. The risk assessment should be informed by individual and familial history, as well as previous episodes of bleeding or other relevant information. The use of bleeding risk scales can play a crucial role in this process, providing valuable insights into the likelihood of bleeding complications. In conclusion, a comprehensive approach that takes into account the unique characteristics of each patient and the specific details of the surgical procedure is essential for minimizing the risk of complications and ensuring successful outcomes.

mRNA therapy, or mRNA-based drugs that have emerged thanks to vaccines against SARS-CoV-2, have successfully passed preclinical tests and are currently at various stages of clinical trials in the treatment of many diseases, including rare metabolic disorders. In the case of rare genetic metabolic diseases, the concept of mRNA therapy can be considered as an alternative to protein replacement therapy, where exogenous mRNA leads to the production of a fully active protein instead of a non-functional one, and also delivers it to the desired cellular compartment, such as mitochondria or the cell membrane. Preclinical studies on animal models of some rare genetic diseases have fully confrmed the validity of this concept. In this mini-review, we examine and discuss the mentioned preclinical studies on efficacy and safety in several animal models. For all the diseases considered, mRNA therapy restored functional protein to therapeutically significant levels in target organs, led to stable and reproducible results after each dose of mRNA, and was well tolerated, as confirmed by functional liver tests evaluated in animal models, including non-human primates. These data convincingly confirm the potential of clinical development of mRNA therapy for the treatment of various rare metabolic disorders.

Due to the high prevalence of cervical cancer, it is necessary to take measures aimed at reducing its frequency through vaccination, screening, detection and treatment of precancerous conditions. The article presents a systematic analysis of scientific data on the use of testing for self-sampling for human papillomavirus as a tool to improve the effectiveness of screening and detection of precancerous diseases of the cervix. It has been shown that the use of such tests, which are based on polymerase chain reaction (PCR), have similar clinical accuracy compared to sampling by a doctor, and thus this option is promising for expanding the coverage of cervical cancer screening. The presence of expected economic efficiency also determines the relevance and prospects for these tests, but further research is needed to assess their implementation in routine practice.

A large number of publications on surgical treatment of acute alcohol-induced pancreatitis (AAP) with peritonitis indicates the importance of the problem and the need for a differentiated approach to treatment. The aim of this study is to determine the optimal treatment policy for acute alcohol-associated pancreatitis with peritonitis. The study included 114 male patients diagnosed with acute alcoholic pancreatitis and peritoneal sepsis, with an average age of 48.6 ± 6.4 years. They were admitted to the surgical departments of clinical hospitals between 2013 and 2023. The diagnosis of AAP was confi med based on clinical, laboratory, and instrumental findings. The classification of acute pancreatitis recommended by the National Clinical Guidelines of the Ministry of Health of the Russian Federation (2015 and 2020) has been applied. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scale has been used to assess the severity and prognosis of the disease, while the Sequential Organ Failure Assessment (SOFA) scale has been used to evaluate organ failure. Based on the results, an algorithm for the treatment of acute alcoholic and alimentary pancreatitis with peritoneal syndrome has been proposed, taking into account the type of pancreatic necrosis, the extent of pancreatic damage, and the nature of fl uid accumulation. For patients with edematous pancreatitis, small-focal sterile pancreatic necrosis, and enzymatic peritonitis, percutaneous ultrasound-guided abdominal and omental drainage is recommended. In severe and moderate acute alcoholic-alimentary pancreatitis, with enzymatic peritonitis (more than 8 points on the APACHE II scale), which is manifested during diagnostic and sanitation laparoscopy by the presence of a hemorrhagic effusion and a large number of plaques of steatonecrosis on the parietal peritoneum and the large omentum, we should use an endovisual method of draining the abdominal cavity and the omentum to minimize anesthesiological and surgical aggression and to form and maintain general cavities, as well as to create good access to the pancreatic area. For patients with large-focal, infected subtotal or total pancreatic necrosis and purulent peritonitis, it is advisable to perform laparotomy, abdominalization of the pancreas, necrectomy, omentobursostomy, and drainage of purulent foci in the abdominal cavity and retroperitoneal tissue.

Metabolic disorders associated with chronic kidney disease (CKD) can lead to a decrease in the quality of life of patients on hemodialysis. The aim of this study is to analyze the correlation between quality of life (QOL) in patients receiving treatment with PHD and clinical and laboratory indicators. Material and methods. 251 patients with stage 5 CKD were included in the study. There were 108 men and 143 women. The mean age was 54.4 ± 9.9 years. All participants completed a specific quality of life questionnaire KDQOL-SF. Results. The interviewed patients reported more concern about symptoms such as weakness, dizziness, and muscle pain (U = 765, p < 0.001), which was correlated with albumin levels (R = 0.5, p < 0.01) and calcium-phosphorus product levels (R = –0.48, p < 0.05). They also expressed concern about the inability to travel or follow a special diet (U = 553, p < 0.005), which correlated with heart rate levels (R = –0.51, P < 0.1) and serum potassium levels (R = –0.6, P < 0.1). Additionally, the burden of CKD correlated with triglycerides (R = 0.36, p = 0,01).Work capacity is associated with age (R = –0.54; p < 0.001), eKT/V (R = 0.47; p < 0.01). Indicators of cognitive function correlate with blood pressure (BP) (R = –0.51, p < 0,001) and pulse pressure (P = –0,55, p < 0,01). Sexual functions are associated with BP (R = –0,64, p < 0,05), calcium levels (R = 0,76, p > 0.80), iron (0,42, p = 0,90), transferrin saturation coefficient (0.5, p = 0.91). Sleep quality correlates with calcium-phosphate production (0.3, p > 0.15). The feeling of social support correlates with magnesium (0,3, P > 0,8), calcium (0.2, P > 0,1). Conclusions. Correlations between quality of life, blood pressure, albumin, and calcium phosphate metabolism, iron, were found.

To date, there has been no consensus on the impact of polymorphism of components of the renin-angiotensin-aldosterone system (RAAS) on the course of a new coronavirus infection or a possible role in post-COVID syndrome. The objective is to study the significance of COVID-19 and gene polymorphism encoding components of renin angiotensin system in patients with hypertension. Materials and methods: A clinical examination was conducted on 116 stage 2 hypertensive patients with uncontrolled hypertension. Of these, 96 underwent mild or moderate COVID-19, 51 before 12 weeks and 45 after 12. Results. Patients in the ongoing symptomatic phase of COVID- 19 had higher systolic blood pressure than those with post COVID syndrome (p1-2 = 0.03659, p1-3 ≤ 0,00001).The association of polymorphisms of genes AGT:704T>C, AGT521C>T, AGTR1:1166A>C, AGTR2:1675G>A, CYP1IB2:-344C>T with gender, BMI and COVID-19 transmission has not been identified. In the symptomatic phase of COVID-19, carriage of the TT genotype for the AGT704 gene was less frequent (p=0.005) compared to the control group. Conclusions. The effect of COVID on an increase in blood pressure in stage 2 hypertensive patients was determined. An association between blood pressure instability and BMI after COVID was established. During the symptomatic COVID phase, there was an association between increased blood pressure and the C allele of AGT gene polymorphisms (T704).

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion. An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.

One of the long-term complications of abdominal surgery is endometriosis of the postoperative scar (EPS). The frequency of this condition is 0.03–1.08%. Mechanical implantation of endometrium during primary surgery plays a leading role in the pathogenesis of EPS. Together with clinical manifestations, ultrasound and magnetic resonance imaging are important diagnostic tools for this postoperative complication. Differential diagnosis requires excluding suture granulomas, hematomas, fibroids, hernias, lipomas, seromas, abscesses, and other malignant and benign soft tissue tumors in the area of the scar. This article describes a case of EPS in two women who had undergone cesarean section. Adequate removal of endometrial infiltrates, followed by abdominoplasty, allowed them to avoid recurrence and achieve optimal cosmetic results. Currently, in order to prevent the occurrence of EPS after surgical delivery, it is recommended to change gloves after removing the afterbirth and before restoring the integrity of the anterior abdominal wall, as well as limiting the edges of the wound to the abdominal cavity.

The course of chronic non-infectious diseases is often accompanied by the development of comorbid conditions. In chronic heart failure and chronic kidney disease, special attention is drawn to iron deficiency and anemia. Intravenous iron preparations have become widely used for the prevention and treatment of anemia. Their use contributes to the progression of structural changes in vital organs. However, attempts to implement high-dose intravenous ferrotherapy as a routine strategy for compensating iron deficiency in patients with heart failure, with or without anemia, raise questions related to the search for diagnostic markers of iron deficiency states, goals, and conditions for its use. The article discusses the influences of a combination of opposing factors (inflammation, hypoxia) on the erythron system, its humoral regulators, and iron metabolism based on the author’s own research to justify the choice of strategy and tactics for ferrotherapy in patients with heart failure and chronic kidney disease.

The article presents data on the development and creation of the first air ambulance and the participation of A.F. Lingart, the chief sanitary doctor of the Red Army, in this project.

The factual data on the tragic events of the Civil War, including “red” and “White” terror, are presented. Biographical information about doctors and nurses from White Army military units and Workers’ and Peasants’ Red Army who were killed, captured, or shot during the war is provided.