Chronic diseases (CD) represent a significant healthcare challenge, affecting the quality of life for millions of people worldwide. Persistent pain, physical limitations, and the need for regular medical intervention can lead to anxiety, depression, and stress among patients. In this context, psychotherapy may become an important component of comprehensive treatment aimed at both the physical and psycho-emotional well-being of the patient. Objective. The aim of this study is to analyze the role of psychotherapy in supporting patients with chronic diseases, as well as to explore effective stress coping strategies. The research focuses on understanding how psychological support can enhance the quality of life for patients, reduce stress levels, and improve treatment outcomes. Material and methods. This study examines various psychotherapeutic approaches: cognitive-behavioral therapy, acceptance and commitment therapy, relaxation techniques, and meditation. The analysis is based on a review of current research and practices in the field of psychotherapy and chronic diseases. Results. The study confirms the effectiveness of cognitive-behavioral therapy and acceptance and commitment therapy in reducing pain, anxiety, and depression levels among patients. Relaxation methods and meditation—specifically progressive muscle relaxation and mindfulness meditation—have shown significance in stress management and improving emotional states. Conclusion. Working with patients suffering from chronic diseases should be comprehensive, encompassing all aspects of psychological and psychotherapeutic support. Acceptance of illness, deep psychological analysis, and urgent support during crisis periods contributes to improving the psycho-emotional state of patients. A holistic approach ensures more complete and effective treatment, enhancing psychological well-being and overall quality of life for patients.

Parkinson’s disease (PD) affects men and women differently, creating unique challenges and approaches in its treatment. Men are twice as likely to develop PD as women, but women experience higher mortality rates and faster disease progression. Moreover, motor and non-motor symptoms, response to treatment, and risk factors differ between men and women. These differences support the hypothesis that the disease’s pathogenesis may involve different mechanisms in male and female patients, or the same mechanisms manifesting differently. This review summarizes current knowledge on gender differences in the clinical manifestations of PD, risk factors, treatment response, and the disease’s pathophysiological mechanisms. Understanding how the pathology differently affects men and women can aid in the development of individualized interventions and innovative programs to meet the varied needs of patients of both sexes, thereby improving the quality of care.

Objective of the Study. To assess the comparative impact of COVID-19 on the course of acute myocardial infarction (AMI) in Tomsk from 2019 to 2022. Material and methods. This study utilized data from the information-analytical database of the epidemiological program “Acute Myocardial Infarction Registry” (AMIR). During the analyzed period (2019–2022), 3,617 cases of AMI were registered, including 147 (4.1%) episodes where the disease occurred against a background of verified and confirmed COVID-19. All identified cases occurred while the patient was in a non-profile hospital (in respiratory hospitals specifically opened for treating individuals with confirmed or suspected COVID-19). For comparative analysis, all registered patients with AMI were divided into two groups: the first group included 147 patients with confirmed COVID-19 (COV+) and the second group included 3,617 individuals without COVID-19 (COV−). Results. In terms of gender, the differences between the analyzed groups were not significant. In the first group, individuals over 60 years old predominated — 94.2%, while in the second group, such patients accounted for 73.7% (p < 0.001). Atypical manifestations of AMI were recorded in 58.5% (first group) and 24.8% (second group) of cases respectively (p < 0.001). Among the atypical manifestations of the disease in patients of the first group, the asthmatic variant predominated — more than 70% (73.5%) of cases. Patients in the first group predominantly had exertional angina, diabetes mellitus, and hypertension. Despite all patients in the first group being in nonprofi le hospitals (respiratory hospitals) at the time of AMI onset, 78.6% were transferred to the angiography unit of specialized departments, where they underwent coronary ventriculography (CVG) and stenting of coronary arteries. They were then returned to the non-profile hospital for further treatment. Regarding CVG data, no signifi cant differences between the analyzed groups were found. The most common cause of death among patients in both groups was acute left ventricular failure (ALVF), which was significantly more common in patients of the first group. Since the number of analyzed cases of AMI combined with COVID-19 was small, the degree of impact of the new coronavirus infection on the epidemiology of AMI was also found to be insignificant. However, it should be noted that the mortality rate in the group of AMI patients against a background of COVID-19 was very high, averaging 86.9%. Conclusions. 1. Currently, the impact of COVID-19 on morbidity and mortality from acute myocardial infarction among the population of Tomsk has proven to be insignificant. 2. Nevertheless, it is essential to acknowledge the negative influence of COVID-19 on mortality and the immediate course of acute coronary pathology, affecting both age-related and clinical-anamnestic characteristics. 3. The combination of acute myocardial infarction with COVID-19 is often accompanied by necrotic damage to large areas of myocardium and is characterized by very high mortality.

A comparative analysis was conducted on 114 patients with stable ischemic heart disease (SIHD) and stenoses of coronary arteries (CA) in the range of less than 60% of the artery diameter (Group 1, 58 patients) and more than 60% (Group 2, 56 patients). It was shown that the angina syndrome does not always depend on the degree of CA stenosis; however, typical chest pain and a higher functional class (FC) were significantly more frequently observed in patients with hemodynamically significant lesions of the CA (Group 2). These patients were characterized by fasting hyperglycemia against the background of excess body weight, eccentric hypertrophy of the myocardium, a significant decrease in glomerular filtration rate, and signs of myocardial ischemia were diagnosed during stress tests, as well as electrical instability of the heart manifested as ventricular extrasystole and short paroxysms of unstable ventricular tachycardia. In contrast, patients in Group 1 exhibited hypertensive remodeling of the myocardium against a background of diastolic dysfunction, with significantly more frequent one-vessel lesions of the CA and predominantly paroxysms of atrial fibrillation recorded. In the second stage, an analysis was conducted on patients with SIHD and coronary artery stenoses in the range of 60–90% based on instantaneous blood flow reserve (iBFR). Subgroup 1 (28 patients) had an iBFR of less than 0.84; Subgroup 2 (28 patients) had an iBFR of more than 0.94. Patients in Subgroup 1 significantly differed from those in Subgroup 2 in terms of diabetes mellitus development, presence of atherogenic dyslipidemia, and a higher FC of angina. The aforementioned characteristics of Subgroup 1 increase the likelihood of low iBFR values with the same baseline pre-test probability of stenosing atherosclerosis of the CA. According to the results of the third stage, it was noted that after one year, the clinical condition of patients in both the endovascular treatment subgroup (Subgroup 1, 12 patients) and the medication therapy subgroup (Subgroup 2, 12 patients) significantly improved. The angina syndrome was significantly less frequently reported in Subgroup 1, and their FC was notably lower. In Group 1 and Subgroup 2, against the background of using dihydropyridine calcium channel antagonists, a significantly more favorable course of the angina syndrome was observed. According to one-year prospective monitoring, no cardiovascular complications were registered.

The study of the issue of impaired bone mineral density (BMD) in people living with human immunodeficiency virus (HIV) who were infected perinatally (from birth) has objective reasons for the development of osteoporosis (OP). However, information about the state of bone tissue in this group is limited and no studies have been conducted in Russia. The role of risk factors and approaches to diagnosis, treatment, and prevention of osteoporosis have not been determined. Objectives. To assess the state of BMD using densitometry in perinatal HIV-infected adults on antiretroviral therapy (ART). Material and methods. This study included patients with perinatal HIV infection (n = 38) (main group) who continue to be followed up in the adult department of a specialized center and patients with sexually acquired HIV infection (n = 36) (comparison group) who have reached adulthood but are not older than 25 years old. Both groups were not concurrently infected with HIV or HBV. Were analyzed the level of CD4+ lymphocytes and the HIV RNA. Hip and spine densitometry was performed to assess bone matrix status using the Z-score taking into account age group of study participants. Results. Patients with perinatal HIV infection had a disease duration similar to their age at the time of the study, while the duration of ART administration was 13 years with a maximum of 21 years and 5 months. BMI in the study group showed that 73.6% of indicators were within normal limits, 5 patients had low body weight and one had grade I obesity, accounting for 2.6% respectively. Currently, three (7.8%) patients had detectable levels of HIV RNA despite irregular ART intake, with no signifi cant diff erences in CD4 lymphocyte counts during analysis of this indicator. At the time of diagnosis, the proportion of patients with immunodefi ciency was 20.9%. However, at the time of the study, this proportion had increased to 23.2%. Hip and spine densitometry, two patients (5.2%) were identifi ed with signs of osteopenia. The cause of this disorder is multifactorial and includes the presence of HIV infection, duration of antiretroviral therapy, and, in one case, the presence of concurrent somatic pathology requiring constant intake of glucocorticosteroids. Conclusion. Patients with perinatal HIV infection are at risk of developing osteoporosis and require regular medical monitoring to detect bone mineral density (BMD) disorders early and treat them promptly.

Currently, with the abundance of scientific information, specialists face questions in interpreting repolarization disturbances for formulating an electrocardiographic diagnosis. The formulations accepted in domestic electrocardiography methodology, such as “focal changes in the myocardium” for coronary blood flow disorders, and “diffuse changes in the myocardium” for nonspecific repolarization disturbances, are not always related to coronary pathology. Furthermore, there is confusion in interpreting ECG signs of ischemia and/or myocardial damage in coronary pathology. The article reviews modern electrocardiographic criteria for diagnosing primary specific, nonspecific, and secondary repolarization disturbances in the myocardium that are most frequently encountered in clinical practice. The relevance of differential diagnosis of the causes of ST segment depression and elevation, T wave inversion on the ECG is due to the high frequency of pathological conditions underlying them, the difficulty of diagnosis, and significant differences in therapeutic tactics and disease prognosis. Modern concepts of the complex electrophysiological processes occurring in the heart under normal conditions, in myocardial hypertrophy, and at various stages of ischemic heart disease are outlined.

The aim of this work is to present current scientific data in the field of interpreting repolarization disturbances on resting ECGs in ischemic heart disease and benign conditions.

Acute pericarditis is a common cause of chest pain in young individuals and may be accompanied by pericardial effusion, often of small size. In most cases, the cause is unknown or presumed to be a viral infection. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement and is a frequent cause of pericarditis and pericardial effusion. However, significant pericardial effusion and cardiac tamponade in this condition are rare and even less frequently occur as the first manifestation. The diagnosis of SLE presents a complex clinical challenge and requires a high level of clinical suspicion. The article presents a clinical case of a rare form of SLE that manifested in a young patient as pericardial effusion, which subsequently led to cardiac tamponade.

One of the most common causes of upper gastrointestinal bleeding is ulcers of the stomach and duodenum, accounting for about 50% of all cases. Meanwhile, the frequency of bleeding from varicose veins of the stomach averages around 4% per year. The main factor in the development of gastric varices is portal hypertension. In cases where the etiological factor for splenic vein thrombosis is not identified, even after thorough examination of the patient, the term “idiopathic” thrombosis is used. The prevalence of patients with this pathology can reach up to 50% of all cases. Objective of the study. To improve the effectiveness of diagnosing gastric tumors complicated by bleeding. Case description. Patient A., born in 1968, was urgently admitted for inpatient treatment to the Regional Clinical Hospital No. 2 in Krasnodar on April 30, 2024, with a clinical presentation of gastrointestinal bleeding from a gastric tumor. Results. On March 1, 2024, an esophagogastroduodenoscopy (EGDS) was performed at the outpatient clinic, which revealed an infiltrative-ulcerative formation at the bottom of the stomach; due to technical reasons, a biopsy was not taken. A repeat EGDS was recommended for morphological verification of the tumor. On April 15, 2024, a repeat EGDS was performed at the outpatient clinic with biopsy samples taken from the pathological area, after which the patient reported vomiting with blood streaks and hematochezia. On April 30, 2024, another EGDS was conducted at Regional Clinical Hospital No. 2, which showed contents in the gastric lumen mixed with fresh blood, and in the area of the gastric fundus—an isolated varicose vein protruding into the lumen up to 30 mm, with its mucosa exhibiting isolated “stigmata.” The patient was prepared for surgery. A median laparotomy was performed. Upon revision, enlarged gastric arteries resembling “snake entanglement” were noted. The spleen was enlarged, measuring 7.0 × 24.0 × 21.0 cm. A splenectomy was performed. Conclusions. Addressing the clinical problem of bleeding from gastric varices requires coordinated actions from physicians of various specialties: hepatologists, endoscopists, and surgeons. Continuous improvement of professional knowledge and practical skills among physicians will help save our patients’ lives.

This article analyzes the issues of the formation and development of the medical profession within specific historical contexts of social development, as well as from the perspective of the sociocultural evolution of the medical profession. It reveals the characteristics of the formation of the paternalistic model of domestic medicine, which is exemplifi ed by the phenomenon of “zemstvo medicine,” traces of which can still be seen in contemporary medical practice. Special emphasis is placed on analyzing the typologies of relationships in the “physician-patient” system, exploring both classical and alternative models of such relationships. The processes of transformation of the physician’s role in the context of an information society are characterized, highlighting new demands for professional competence that include basic (theoretical, practical, technical) and universal (individual-personal, social-volitional) competencies. Well-founded and detailed conclusions are drawn regarding the evolution of the medical profession from a paternalistic model to a modern understanding of the physician’s role in the realities of contemporary times, as well as the search for an optimal type of harmonious and eff ective relationships between physicians and patients, colleagues, and management.

Vasily Parmenovich Obraztsov (1851–1920) was an outstanding Russian physician (pathologist, surgeon, and therapist). He graduated from the Imperial Medical and Surgical Academy in St. Petersburg in 1875. For 25 years (from 1893 to 1918), he was a professor at Vladimir University in Kyiv and head of the Department of Special Pathology and Therapy, and from 1903 to 1918, he also served as the director of the university clinic of internal diseases. Professor Obraztsov introduced several methods for examining patients: deep sliding (methodical) palpation of the abdominal organs, direct auscultation of the heart (which allows for the recognition of gallop rhythm and the third heart sound), and direct percussion with one finger on the organs of the chest and abdominal cavity. In 1910, he diagnosed myocardial infarction. He was the chairman of the Kyiv Physical-Medical Society, the Kyiv Society of Physicians, and founded a school of internal diseases.

The article presents historical information and biographical data of military doctors and nurses during the First Wave of emigration and their lives and activities in France, in the Provence-Alpes-Cote d’Azur region. Information is provided on the medical institutions (hospitals and infirmaries) of the ROKK to assist Russian emigrants, the work of shelters and sanatoriums in this region and the work of the Tolstoy Foundation in Europe and the USA.