This article emphasizes the relevance of the problem of ischemic heart disease (IHD) among young people, highlighting the need to update and deepen knowledge about diagnostic and treatment methods. The article presents a review of contemporary research on the diagnosis and treatment of IHD in youth, paying special attention to the study of the effectiveness and safety of the latest diagnostic methods, the influence of genetic factors, as well as the significance of pharmacological and non-pharmacological approaches to treatment. Research results confirmed the high effectiveness of multi-slice computed tomography of the coronary arteries and cardiac MRI in diagnosing IHD, particularly for early detection of the disease. Significant genetic markers have been identified that can be used for early diagnosis of IHD, especially in patients with a family history of the disease. The necessity of integrating various diagnostic approaches, considering genetic factors, and focusing on lifestyle in the prevention and treatment strategies for IHD in young individuals is noted. The findings of this review may be useful for specialists in cardiology, public health, and medical education.

Cardiovascular diseases (CVD) represent a global medical, social, and economic issue. Currently, the search and study of new biological markers that can provide early diagnosis of CVD, serve as laboratory tools for assessing the effectiveness of treatment, or be used as prognostic markers and risk stratification criteria are ongoing. Scientists are particularly interested in studying chitinase-3-like protein 1 (CHI3L1, YKL-40) in relation to CVD. The precise role of CHI3L1 in both normal and pathological conditions remains unclear. Existing data suggest that CHI3L1 may regulate cell proliferation, differentiation, programmed cell death, as well as participate in embryonic development, angiogenesis, inflammatory responses, tissue remodeling, and a number of other processes. According to clinical studies conducted, CHI3L1 is a promising molecule with diagnostic and prognostic potential in CVD. The definitive confirmation of the role of CHI3L1 in cardiovascular pathology will be obtained through future research.

Based on the analysis of literature data, the issues of neurological complications after the new coronavirus infection COVID-19 are highlighted. There is little evidence for a direct mechanism for the neuroinvasiveness and neurotoxicity of the SARS-CoV-2 virus. Various mechanisms of coronavirus penetration into the brain are discussed - anterograde and retrograde, neuronal spread, transcriptional and hematogenous pathways. Retrograde/anterograde transport and transsynaptic transfer of the virus have been confi rmed by in vitro studies. Penetration of the virus into the central nervous system is also possible by spreading through peripheral nerves, for example, along the vagus nerve, which innervates the lungs and intestines. There are several possible mechanisms for the spread of SARS-CoV-2 across the blood-brain barrier: circulation of viral particles in the bloodstream, viral transcytosis through endothelial cells of blood vessels and capillaries, infection of leukocytes by viruses and transfer of viruses through the blood-brain barrier. Hypoxia caused by cytokine storm and respiratory distress lead to disruption of brain metabolism and the development of neurological complications.

Aim. Analysis of literature data on the study of early and long-term manifestations of neurological disorders and diseases during a new coronavirus infection, postCovid syndrome (long COVID-19), as well as after vaccination.

Results. Among the large number of nervous system disorders, there are five main types with long-term neurological complications associated with COVID-19: 1) encephalopathy with delirium/psychosis; 2) inflammatory syndromes of the central nervous system; 3) ischemic strokes; 4) peripheral neuropathies, in particular Guillain–Barre syndrome and brachial plexopathies; 5) other disorders of the central nervous system.

There is literature data on the development of destructive thyroiditis in patients with COVID-19, which may increase the risk of thyroid pathology in the post-COVID period. Special attention is paid to autoimmune thyroid diseases, while the impact of COVID-19 on nodular goiter (NG) has been studied little.

The aim of this study was to investigate the sonographic and cytological features of nodular goiter in patients with a recent history of COVID-19. Materials and Methods: A total of 132 patients who sequentially presented to a healthcare facility between October and May 2021-2022, where they were fi rst diagnosed with nodular goiter, were examined. Of these, 36 denied a history of COVID-19 (control group), while 96 had experienced it 2-9 months prior (main group).

Results: According to sonographic data, there were more patients in the main group with microcalcifications (17 (17.8%) vs. 2 (5.6%), p = 0.047), cystic components of nodules (22 (22.9%) vs. 2 (5.6%), p = 0.015), and hypoechoic nodules (23 (23.9%) vs. 4 (11.1%), p = 0.078). In the main group, cytological signs of degenerative changes in thyrocytes combined with macrophage clusters were more frequently observed, which is a nonspecifi c but common manifestation of the consequences of destructive thyroiditis (16 (39.0%) vs. 2 (10.0%), p = 0.017).

Conclusion: Nodular goiter identified in the post-COVID period is characterized by an increased prevalence of microcalcifi cations, a tendency towards reduced echogenicity of nodules, as well as cyst formation against a background of degenerative changes in thyroid tissue. The features of nodular goiter identified in the post-COVID period do not exclude a propensity for oncogenic disorders. 

 The article discusses the relationship between autoimmune gastritis and Helicobacter pylori (H. pylori) infection. The prevailing point of view in the literature is that Hpylori infection  can act as a trigger factor, contributing to the development and progression of autoimmune gastritis due to the phenomenon of antigen mimicry. At the same time, there are publications on the protective effect of H. pylori infection in relation to the occurrence of autoimmune gastritis and the absence of a link between these diseases. Recent data indicate that the presence of Hpylori infection in patients with autoimmune gastritis contributes to the progression of atrophic changes of the mucous membrane and an increased risk of gastric cancer, which makes it justified to carry out eradication therapy in such cases, which allows to prevent the progression of the disease and the development of complications.

In obstetric practice, a significant number of patients receive anticoagulant medications for prophylactic purposes. This review presents the types of heparins used and examines clinical situations where prophylactic treatment with heparins is administered, including assisted reproductive technologies, obstetric complications of pregnancy, aspects of delivery, thrombotic complications, and extragenital pathology. The possibilities for improving the outcomes of prophylactic treatment with heparins and preventing arising complications are discussed.

The study of the problem of postoperative cognitive impairment arose from the first moment of anesthesia usage. Over the long history of observations, enough clinical information has been accumulated, however, sometimes it is contradictory and difficult to understand. In most cases, the connection between the fact of surgical intervention with the use of anesthesia and a slowdown in neurocognitive recovery in patients has been confi rmed. There is still an ongoing debate about whether the effects on cognitive abilities can be explained either by the anesthetics themselves or by other factors.

The aim of the work is to use a narrative review to study modern ideas about the effect of anesthesia on the occurrence of cognitive impairment and the further development of cognitive dysfunctions.

Material and methods. To analyze the literature, sources from the international databases Web of Science, Scopus, PubMed, as well as the national library system eLibrary were used.

Results and discussion. The review made it possible to collect the results of long-term clinical observations, as well as experimental studies. Several hypotheses have been put forward about the potential mechanisms triggering the occurrence and development of postoperative cognitive disorders, commonly referred to as postoperative cognitive dysfunction. In particular, special attention was paid to changes in the content of Aß- and Tau-protein substances, increased immunological markers of inflammation, impaired regulation of calcium, and mitochondrial dysfunction. All these mechanisms cannot be considered separately. It represents a complex of interrelated, consistent phenomena. Due to the increasing prevalence of various forms of dementia among the population, there is a need to solve the problem of a deeper study of potential factors affecting postoperative cognitive impairment.

Conclusions. Contemporary researchers are faced with the task of further studying the risk factors of postoperative cognitive impairment, their systematization, development and implementation in clinical practice. New methods of anesthesia in surgical interventions involve the modernization of techniques that reduce the potential risk of cognitive dysfunction.

The article analyzes the results of comprehensive medical rehabilitation for patients with coronary heart disease, using nondrug treatment methods such as shock wave therapy for refractory angina pectoris, bioacoustic correction techniques and air-ozone baths after cardiac surgery.

The significance of the studied problem is determined by the high prevalence of asthenic syndrome, which accompanies numerous somatic and psychosomatic pathologies. It is believed that asthenia is more common among the female population, but this is apparently related to physiological processes occurring in a woman’s body.

Objective of the study: to examine the prevalence of asthenic syndrome among men and women according to age.

Material and methods. The study involved 387 respondents who were required to fill out a questionnaire based on the “Subjective Assessment Scale for Asthenia (MFI20).” The MFI-20 allows for the identification of a range of conditions in respondents: general asthenia, reduced activity, decreased motivation, physical, and mental asthenia with a total score exceeding 12 in each subscale.

Results. In the studied sample, asthenia was identified equally among both women and men. General asthenia was observed in just under half of the respondents, being more common among women (48.8%) than among men (29.1%) (p < 0.01). Reduced activity was noted in approximately one-third of respondents and was equally prevalent among men (14.9 ± 1.8) and women (15.1 ± 2.0), accounting for 29.1% and 32.9%, respectively. A decrease in the motivational sphere was observed in only 14.2% of respondents, with similar rates for both men and women, around 14%. Physical asthenia was identified in one-third of respondents (32.9%), but this condition was significantly more common among women (28.2%) than among men, where it was observed almost twice as infrequently at 16.3%, with average scores on the specified subscale of 14.8 ± 1.9 and 14.7 ± 1.3, respectively (p < 0.05). Mental asthenia was determined in 21.5% of respondents, occurring in 17.4% (14.9 ± 1.8) of surveyed men and 22.6% (15.2 ± 1.7) of women.

Conclusion. The prevalence of asthenia among men and women remains high to this day and requires them to adjust their daily routines, regimes of physical and mental labor, and leisure activities.

Objective: To assess the levels of microRNAs (miRs) and the thickness of epicardial adipose tissue (EAT) in patients with ischemic heart disease (IHD) and borderline coronary artery stenosis (CAS).

Material and methods. The study involved 201 patients with stable IHD of functional class (FC) 1–3, having borderline (50–70%) stenoses of the coronary arteries. The first group consisted of 57 (28.4%) patients with increased EAT thickness, while the second group included 144 (71.6%) patients without increased EAT thickness. The levels of the C-terminal fragment of pro-brain natriuretic peptide (NTproBNP) and miR levels (21m2, 133a, 208, 499a) were evaluated. EAT thickness was determined using echocardiography. All patients underwent coronary angiography.

Results. The average EAT thickness in the first group was 6.00 [5.00; 6.50] mm, while in the second group it was 3.00 [2.30; 4.00] mm (p < 0.001). Patients in the first group developed arterial hypertension (p < 0.001), IHD (p < 0.001) in general, and myocardial infarction (p = 0.003) at a younger age. There were no significant differences between the groups regarding the prevalence of obesity, type 2 diabetes, angina FC, or the frequency of use of all four main groups of anti-ischemic drugs. A higher level of miR-208 (p = 0.001) and a greater frequency of increased NTproBNP levels (p = 0.002) were found in patients with increased EAT thickness.

Conclusion. An elevated level of miR-208, a high frequency of increased NTproBNP, and a younger age at which cardiovascular diseases develop in patients with stable IHD and borderline CAS associated with increased EAT thickness may indicate a poorer prognosis, as they reflect the activity of cardiac remodeling.

Objective of the study: To improve the outcomes of hybrid reconstructions in patients with multifocal atherosclerotic lesions of the lower limb vessels.

Material and methods. The study involved 87 individuals who underwent hybrid reconstructions of the lower limb arteries. All hybrid interventions began with open reconstruction of the femoral arteries. Patients were divided into three groups based on the technique used for transitioning between stages of the intervention and performing endovascular revascularization: in the first group, the introducer was placed proximally through a partially sutured patch and distally via puncture of the sutured patch; in the second group, the endovascular stage of the operation was performed by introducing the introducer into one of the branches of the common femoral artery; in the third group, a bifurcated synthetic patch was used for synchronous positioning of the introducers both proximally and distally. Intraoperatively and in the early postoperative period, blood loss, presence and causes of complications, number of reoperations, and length of hospital stay were assessed. Postoperative management included monitoring the functional status of the limb by measuring the ankle-brachial index, ultrasound dopplerography, and laboratory tests at discharge, as well as at 1, 3, and 6 months after surgery. The average follow-up period for patients in the late postoperative period was 6.8 ± 1.1 months.

Results. Technical success was observed in 32 (91.4%) patients in the first group, 20 (90.9%) in the second group, and 29 (96.7%) in the third group. Intraoperatively, two patients in the first group experienced complications that required additional manipulations. In two cases in the second group, arterial wall perforation occurred during introducer rotation. No early intraoperative complications were noted in the third group. In the early postoperative period, four patients in the first group and two patients in the second group developed acute thrombotic complications. No early thrombotic complications were observed in the third group. In the distant postoperative period, primary arterial patency rates were 94.2% in the fi rst group, 95.5% in the second group, and 100% in the third group.

Conclusion. The technique of hybrid reconstruction with simultaneous endovascular revascularization of proximal and distal segments of the arterial basin of the lower limb is effective in both early and distant medium-term postoperative periods.

This clinical case highlights the significance of the problem of iron deficiency anemia (IDA) in patients with bacterial endocarditis (BE) and the necessity for a detailed study of the relationships between these diseases.

Objective: To investigate the correlation between BE and IDA, as well as to clarify the causal relationships between these conditions. Materials and

Methods. The study is based on the examination of a clinical case of a patient with BE and IDA, treated at the Research Institute of Clinical Cardiology No. 1 in Krasnodar, including an analysis of the effectiveness of iron infusion therapies and other treatment methods.

Results. A connection was found between bacteremia caused by Rothia mucilaginosa and the development of IDA. The relationship between trophic immunity and iron deficiency is also discussed.

Conclusions. The study confirms the hypothesis regarding the important role of Rothia mucilaginosa in the development of endocarditis on an aortic prosthesis and in the onset of IDA. Suggestions are made regarding the mechanisms of iron consumption by this microorganism and its influence on the development of iron deficiency states, which requires further research in this area.

This report presents a case of spontaneous rupture in the thinned area of a chronic aneurysm during a type 2 myocardial infarction following SARS-CoV-2 (Severe Acute Respiratory Syndrome-related) infection. A 55-year-old female patient was hospitalized for several hours at a republican cardiology dispensary with a diagnosis of severe SARS-CoV-2 coronavirus infection and type 2 myocardial infarction. Pathological examination of the lungs revealed signs of viral interstitial pneumonia, and in the apex of the heart, in the area of post-infarction cardiosclerosis, there was a through defect measuring 1.5 cm with uneven edges. Microscopic examination showed interstitial edema and muscle fi bers lacking cross-striations, with signs of intracellular edema.

Conclusion: This clinical case demonstrates spontaneous rupture in the thinned area of a chronic aneurysm during a type 2 myocardial infarction (against a background of metabolic disorders) in the context of viral pneumonia due to COVID-19.

The article presents biographical information about military doctors and nurses of the first wave of emigration (after the Civil War), who died in France and were buried at the cemetery of Saint-Genevieve-des-Bois near Paris.