This review aims to systematize modern rehabilitation methods after a stroke to identify the most effective approaches based on an analysis of scientific literature. The analysis covers clinical studies and reviews dedicated to various rehabilitation methods, including physiotherapy, functional electrical myostimulation, kinesiotherapy, pharmacological approaches, cognitive therapy, as well as the use of cutting-edge technologies such as virtual reality and robotic systems. Aspects of psychological support and social adaptation are also explored. The review shows that the comprehensive use of various rehabilitation methods, including physical exercises, cognitive stimulation, and the application of new technologies, leads to significant improvement in functional recovery in stroke patients. The application of functional electrical myostimulation, kinesiotherapy, and ultrasound therapy demonstrates particularly promising results in improving motor skills and reducing spasticity. Cognitive rehabilitation contributes to significant improvements in memory and executive functions, while innovative technologies allow for focused and personalized approaches for each patient. The study confirms that integrating multidisciplinary approaches into the rehabilitation program after a stroke significantly enhances patients’ chances of recovery and returns them to a more fulfilling life. Future research should focus on deepening the understanding of the interaction between various methods and technologies, as well as assessing their long-term impact on patients’ quality of life.

The significant social impact of increased morbidity and mortality in women due to hormonal dysfunction has led to the development of recommendations for the prevention and treatment of cardiovascular diseases (CVD) in this patient group (Evidence-based guidelines for cardiovascular disease prevention in women). Based on current literature, the mechanisms of development and clinical course of cardio-metabolic disorders occurring during the climacteric period have been summarized. Recent data indicate that the onset of menopause in women is accompanied by a complex of hormonal, metabolic, and structural-functional changes that contribute to the formation and rapid progression of cardiovascular pathology. The relationship between structural changes in the myocardium and its functional characteristics remains a topic of discussion, as does the influence of genetic factors, the imbalance of the renin-angiotensin-aldosterone system, and the immune system depending on the type of menopause, the presence and severity of postmenopausal hypertension, its duration, and several other factors. The deterioration in quality of life among patients with climacteric disorders leads to a range of not only medical but also socioeconomic problems. An important task is to create a specialized multidisciplinary approach to climacteric issues, which will enable individualized comprehensive treatment tailored to the pathogenic mechanisms of dishormonal cardiomyopathy.

Diabetes and obesity are among the key issues for modern healthcare. Approximately 425 million people worldwide have diabetes, and the number of individuals with overweight or obesity exceeds one-third of the entire human population. This necessitates the search for new therapeutic options for treating these conditions and the improvement of existing treatment regimens. This review discusses both the concepts of “diabetes” and obesity, existing treatment schemes, and a new class of antidiabetic drugs—glucose-dependent insulinotropic peptide receptor agonists and glucagon-like peptide-1, as well as its main representative—tirzepatide. The review presents the history of development, justification of the mechanism of action, and existing clinical studies on tirzepatide, a key representative of this emerging class of drugs. This medication has demonstrated a statistically significant reduction in glycated hemoglobin in patients with diabetes and weight loss in patients with obesity and/ or diabetes compared to several classes of antidiabetic drugs. However, it should be noted that adverse reactions in clinical studies were more frequent in the tirzepatide group, especially at high doses, highlighting the need for an individualized approach when prescribing this medication. Additionally, comparisons were made only with insulin and glucagon-like peptide-1 receptor agonists, indicating the limited clinical significance of these studies. The introduction of tirzepatide into clinical practice may potentially reduce obesity levels and help control the progression of diabetes in many patients, thereby decreasing complications and mortality associated with these conditions.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous and multisystem disease with multiple phenotypes and a progressive increase in morbidity and mortality. This article provides a review of the current data on the identification, characterization, and features of therapy for the most common phenotypes of the disease. A literature review was conducted using medical resources such as PubMed, Google Scholar, and UpToDate, addressing issues related to phenotyping in COPD.

Varicose vein disease of the lower extremities is a common problem today. In various countries, approximately 25–30% of women and 10–15% of men sufferfrom this condition. Surgical methods hold a special place in the treatment of such patients. Currently, despite the development of effective minimally invasive endovenous techniques, doctors still face recurrences of the disease due to insufficiency of radical surgery, as well as the natural progression of varicose vein disease as genetically determined, which necessitates further exploration for solutions to improve treatment outcomes. The article describes the history of the development of surgical methods, including the first mentions of this disease, vessel ligation, phlebectomy, minimally invasive techniques, and others.

Objective: to study procalcitonin (PCT) for evaluating the effectiveness of diagnosing pneumonia and sepsis complicating new coronavirus infection in patients with diabetes mellitus and those without it.

Materials and Methods. A total of 65 patients with new coronavirus infection complicated by pneumonia and sepsis were examined, including 35 patients with type 2 diabetes (53.8%). Among the diabetic patients, 20 (30.8%) had complications (diabetic microangiopathies and macroangiopathies). The age of the patients ranged from 42 to 89 years. PCT levels were determined using an automatic immunochemical electro-chemiluminescent analyzer Cobas e 411 (Hitachi High-Technologies Corporation 24-14, 2020). The reference interval for PCT is 0–0.046 ng/ml.

Results. PCT levels in patients with new coronavirus infection complicated by pneumonia and sepsis combined with diabetes (1.7 ± 1.47 ng/ml) did not differ from those in patients without diabetes (3.1 ± 2.96 ng/ml). However, PCT levels in patients with new coronavirus infection complicated by pneumonia and sepsis combined with diabetes and diabetic microangiopathies were higher than those in patients without diabetic microangiopathies.

Conclusion. PCT levels did not differ between patients with new coronavirus infection complicated by pneumonia and sepsis in combination with diabetes and those without diabetes. Thus, PCT serves as a universal marker of the severity of bacterial infection, regardless of the presence of diabetes.

Among the instrumental methods for diagnosing diseases of the pancreas, computed tomography (CT) of the abdominal organs, radiological examination, and ultrasound examination (US) of the pancreas are highlighted. However, it is necessary to point out the existence of limited studies regarding the indications for the use, availability, and comparison of these imaging methods, as well as their role in the diagnostic process when examining patients with acute postoperative pancreatitis.

Objective of the study. To assess the improvement in diagnostic results of acute postoperative pancreatitis through the use of computed tomography.

Material and methods. The study was conducted at the radiology department of the M.A. Topchubashev Scientific Surgery Center in Baku from 2019 to 2022. The study included 60 patients aged 30 to 70 years. All patients underwent an assessment of the degree of clinical manifestations, their structure, dynamics of laboratory indicators combined with the analysis of data from instrumental examination methods (US, CT) throughout the observation period.

Results. The data obtained indicate that surgical interventions on the pancreas are relatively often accompanied by the occurrence of acute postoperative pancreatitis. Acute postoperative pancreatitis leads to disturbances in the functional state of the gastrointestinal organs, manifested by nausea, recurrent vomiting, as well as severe dull pain and bloating in the epigastric region. The sensitivity and specificity of US as the “gold standard” in the diagnosis of postoperative acute pancreatitis were 91.7% and 86.1% for CT, respectively.

Conclusions. CT was found to be more sensitive than US for diagnosing pathological changes in the pancreatic duct in the examined patients, and it is considered most reasonable to use CT in the early stages of the pathological process to clarify the degree of its spread and to predict the development of more severe complications.

Glutathione peroxidase 1 (GPX1) plays a crucial role in blocking the involvement of oxidative stress in the formation of atherosclerotic plaques. A polymorphic variant rs1050450 is known, which may be associated with enzyme activity and thereby affect the progression of ischemic heart disease (IHD).

Objective. To assess the association of the rs1050450 variant of the GPX1 gene with risk factors for the progression of IHD: carbohydrate metabolism disorders and the concentration of atherogenic lipoprotein fractions.

Material and methods. The study included 168 patients with IHD, of whom 54.8% had a history of myocardial infarction (MI). Diabetes mellitus was identified in 29.8%, and glucose intolerance (GT) in 10.1% of patients. The rs1050450 variant (Pro200Leu, 599C > T) of the GPX1 gene was determined using TaqMan probes.

Results. There were 141 patients with CC homozygotes and 27 patients with CT heterozygotes. TT homozygotes were absent in the sample. Among heterozygotes, the frequency of MI was lower than among CC homozygotes—37% vs. 58.2% (p = 0.043). Heterozygotes had lower levels of total cholesterol and low-density lipoproteins (LDL) compared to homozygotes: 3.8 (3.4; 4.5) vs. 4.3 (3.7; 5.6) mmol/L (p = 0.047) and 1.9 (1.4; 2.3) vs. 2.5 (1.9; 3.3) mmol/L (p = 0.005), respectively. At the same time, the frequency of GT was higher among heterozygotes (22.2% vs. 7.8%, p = 0.023).

Conclusion. Among patients with IHD, carriers of the CT genotype of the rs1050450 variant showed a lower frequency of MI but a higher incidence of carbohydrate metabolism disorders. Heterozygotes had lower levels of atherogenic LDL and total cholesterol.

Objective of the study: to investigate the correlation between inflammation activity, infectious components, platelet function, dyslipidemia, and the development of subclinical atherosclerosis in patients with systemic lupus erythematosus (SLE) and ischemic heart disease.

Materials and methods. The study involved the measurement of C-reactive protein (CRP), interleukin 6, IgG antibodies to Chlamydia pneumonia, antibodies to toll-like receptors (TLR2), platelet factor 4 (PF4), platelet aggregation parameters, lipid profile, concentration of antibodies to oxidized low-density lipoproteins (oxLDL), and the thickness of the intima-media complex (IMT) of the common carotid arteries.

Results. The study included 50 women with SLE and 31 with myocardial infarction (MI), with a control group of 21 healthy women. Patients with SLE showed a significant increase in IMT of the common carotid artery (1.00 [0.80–1.10] > 0.80 [0.70–0.90], p = 0.01) and bifurcation of the carotid artery (1.10 [1.00–1.20] > 0.80 [0.70–1.10], p = 0.01) compared to the control group. Similarly, patients with MI had significantly different IMT values for both the common carotid artery (0.90 [0.80–1.10] > 0.80 [0.70–0.90], p = 0.01) and bifurcation (1.20 [1.10–1.40] > 0.80 [0.70–1.10], p = 0.01) compared to controls. There was pronounced activation of inflammation in SLE patients, evidenced by increased levels of CRP (3.67 [2.17–5.92] > 0.74 [0.30–1.26], p = 0.01), interleukin 6 (1.72 [1.39–2.68] > 0.60 [0.22–0.75], p = 0.01), and ESR (21.0 [18.0–26.0] > 10.0 [7.0–14.0], p = 0.01). These markers were also elevated in MI patients compared to controls: CRP (3.36 [1.44–5.90] > 0.74 [0.30–1.26], p = 0.01), interleukin 6 (1.1 [0.69–1.82] > 0.60 [0.22–0.75], p = 0.01), and ESR (19.0 [10.0–28.0] > 10.0 [7.0–14.0], p = 0.01). A significant activation of platelets was noted, with a marked increase in PF4 levels in SLE patients (21.5 [19.80–23.28] > 18.30 [13.88–20.46], p = 0.01) and MI patients (20.76 [19.00–23.50] > 18.30 [13.88–20.46], p = 0.01). SLE patients exhibited pronounced dyslipidemia, characterized by elevated levels of oxLDL antibodies (3.16 [1.45–4.60] > 1.39 [1.26–2,04], p = 0,01). In contrast, MI patients showed significant differences only in low-density lipoproteins (1.05 [0.88–1.21] < 1.32 [1.24–1.37], p = 0,01). The concentration of IgG antibodies to Chlamydia pneumonia in SLE patients (0,062 [0,035-0,124] > 0,0415 [0,022-0,071], p = 0,11) and TLR2 levels showed no significant diferences from controls (635,71 [357,14 –978,5] > 451,54 [352,05–775,0], p = 0,39). In MI patients, TLR2 levels did not differ from controls (448,98 [308,67–964,14] < 451,54 [352,05–775,0], p = 0,854). However, IgG antibodies to Chlamydia pneumonia were significantly higher in MI patients (0,067 [0,05–0,11] > 0,0415 [0,022–0,071], p = 0,026) compared to controls.

Conclusion. In addition to traditional risk factors for cardiovascular diseases, both SLE patients and those with myocardial infarction exhibit common mechanisms of autoinflammation as a form of ischemic heart disease. The inflammatory component was more pronounced in the SLE group, particularly reflected in significantly elevated concentrations of IL-6 and CRP levels. The role of the infectious component requires further investigation.

Uninodular thrombosis of external hemorrhoidal nodes (UTHN) was identified in 81.4% of all forms of thrombosis.

Objective. To develop treatment algorithms for patients with UTHN.

Material and methods. An analysis of data from 362 outpatient patients with UTHN showed that 81.5% sought help from a proctologist more than 3 days after the onset of thrombosis. In 81.3% of cases, anal pain was absent or mild/moderate in nature. First-degree UTHN (UTHN-1) was found in 91.7% of patients, while second-degree UTHN (UTHN-2) was present in 8.3%. In 305 (84.3%) patients, UTHN was visualized on unchanged anoderm. Constipation was noted in 14.4% of patients. The characteristics of inflammation in patients with UTHN-2 included: 1 — necrosis size up to 5 mm; 2 — slight discharge of pus or blood.

Results. Conservative treatment is the primary method for managing patients with UTHN. The use of a conservative treatment algorithm allowed for the recovery of 340 (93.9%) patients within a timeframe of 7 to 19 days. Twenty-two (6.1%) patients with UTHN-1 and UTHN-2 underwent surgery after inflammation subsided. In 45 (9.7%) patients, despite refusing surgery, recovery also occurred. Limitations on performing surgeries in outpatient settings include: 1 — the success rate of conservative treatment; 2 — lack of facilities for performing surgeries in outpatient clinics; 3 — frequent refusals by patients for surgery. The period of disability during the postoperative period averaged 12 ± 1 days.

Conclusion. Treatment algorithms for patients with UTHN allow for a balanced use of conservative or surgical treatment methods.

Purpose of the study: to analyze the clinical manifestations of autonomic dysfunction syndrome in patients who have recovered from COVID-19 of varying severity.

Material and methods. An outpatient examination was conducted on 45 patients (26 women, 19 men) who had recovered from COVID-19 within 3 to 6 months prior to the examination. The average age of the patients was 58 years [26; 73]. Inclusion criteria were a confirmed PCR test for COVID-19 from 3 to 6 months after the onset of the disease. Exclusion criteria included severe cerebrovascular or cardiovascular pathology that complicated necessary measurements and severe somatic conditions of the patients. All patients underwent electrocardiographic examination (ECG), an orthostatic test, calculation of the Kerdo autonomic index (KAI), and assessment for signs of autonomic disturbances using A.M. Vein’s questionnaire (1998).

Results and conclusion. During the orthostatic test, a statistically significant decrease in systolic blood pressure (SBP) was observed, more pronounced in patients who had experienced severe (p < 0.05) and moderate (p < 0.01) forms of the new coronavirus infection. Orthostatic hypotension was noted in 76 ± 0.18% of the examined patients. A statistically significant greater increase in heart rate during the orthostatic test was observed in patients who had suffered from severe and moderate forms of the new coronavirus infection (p < 0.05). A statistically significant lower value of the KAI was found in patients who had experienced moderate and severe COVID-19 compared to those with mild forms of the infection (p < 0.01 and p < 0.05, respectively). Signs of autonomic dysfunction were identified in 82 ± 0.15% of the examined patients, with a direct correlation of moderate strength established between the severity of autonomic disorders and the degree of severity of COVID-19 (p < 0.01). The consequences of the new coronavirus infection in the form of autonomic dysfunction persist for an extended period — up to 6 months or longer. The core clinical picture of autonomic disorders in these patients consists of symptoms of peripheral autonomic insufficiency.

The article describes a clinical case of circular apical myocardial infarction of the left ventricle in a young patient without risk factors for coronary artery disease with an identified myocardial bridge of the coronary artery, vaccination with vector vaccine and HIV-positive status without antiretroviral therapy. The clinical picture was characterized by pain syndrome in the form of pressing pains behind the sternum with irradiation to both arms, increased cardiospecific enzymes, typical ECG changes in the form of ST segment elevation and zones of hypokinesis during echocardiography. Coronary angiography revealed a myocardial bridge in the anterior descending artery in the middle segment, narrowing the vessel lumen by 60%, and thrombotic occlusion in the distal segment. A hemodynamically significant myocardial bridge was located in the infarct-dependent artery, which suggested its role in the genesis of myocardial infarction. A blood clot in the cavity of the left ventricle and occlusion of the coronary artery made it possible to talk about hypercoagulation. Possible causes of thrombosis may be vaccination with a vector vaccine, positive HIV status without antiretroviral therapy, and a previous coronavirus infection. The systemic nature of hypercoagulation is indicated by the transient cerebrovascular accident that developed in the patient against the background of myocardial infarction.

The article presents data on the first units of Sisters of Mercy in the Active Army during the Crimean War. Historical documents regarding the beginning of the work of the Sisters of Mercy of the Russian Red Cross Society in the Moscow military hospital are provided. Their work during the Russo-Chinese War of 1900–1901 and the Russo-Japanese War of 1904–1905 is described, focusing on hospital ships (“Tsaritsa,” “Mongolia,” “Kazan,” etc.) and the land front (in Port Arthur, Manchuria).