Regenerative medicine, based on the use of stem cells (SC), represents one of the most promising areas of modern medicine. Objective: to explore the possibilities of using SC in the restoration of tissues and organs, as well as to analyze current clinical trials in this field. Material and methods. The article examines types of SC such as embryonic, pluripotent, and mesenchymal stem cells, and analyzes current clinical trials regarding their application. Results. The main focus is on the mechanisms of action of SC after transplantation, issues of their long-term safety, mechanisms of differentiation, and integration into the tissues of the body. Conclusion. Despite the progress made, the application of SC is associated with a number of unresolved issues, such as the risk of malignant transformation of cells and the possibility of virus transmission during allogeneic transplantation.

Objective of the Study. To evaluate the possibility of identifying a tendency towards the development of hematopoietic disorders and preliminary assessment of their etiology before establishing anemia based on traditional criteria: in the absence of the main criterion for anemia — decreased concentration of total hemoglobin — identify and compare signs of erythrogenesis pathology in the values of other indicators from the complete blood count. Material and methods. A retrospective observational single-center cross-sectional study of erythropoiesis efficiency indicators based on complete blood count results in a population of neurosurgical patients. The values of reticulocyte hemoglobin, delta hemoglobin, and erythrocyte indices (MCV, MCH) were assessed in the absence of formal signs of anemia. Results. Even before the development of laboratory-confirmed anemia, signs of hematopoietic disorders can be traced in the values of reticulocyte hemoglobin, erythrocyte indices, and total hemoglobin, suggesting some pathology in the maturation of the erythroid lineage. The values of these parameters reveal characteristics of different types of anemia — macrocytic hyperchromic and microcytic hypochromic. Conclusion. Deviations in reticulocyte hemoglobin and delta hemoglobin from reference intervals at physiological hemoglobin levels may have independent diagnostic significance. It is reasonable to consider the possibility of early diagnosis of anemias based on these indicators from the complete blood count, which are currently regarded as secondary relative to changes in total hemoglobin concentration.

COVID-19 infection can be complicated by sudden occlusion of the limb arteries, significantly reducing the patient’s chances of recovery. Although surgical restoration of blood flow remains the preferred treatment for critical limb ischemia, in patients with coronavirus, such intervention is associated with an increased likelihood of recurrent thrombus formation. Objective of the study. To assess the quality of life of patients who underwent endovascular revascularization with catheter-guided selective thrombolysis using tissue plasminogen activator alteplase for acute limb ischemia (ALI) in the acute stage of COVID-19 compared to patients without viral infection. Material and methods. The study included 121 patients with ALI who underwent endovascular revascularization with selective catheter-guided thrombolysis using tissue plasminogen activator alteplase. The study group (n = 71) consisted of patients with COVID-19, while the control group (n = 50) included patients without infection. Quality of life was assessed using the SF-36 questionnaire at discharge and 12 months later. Statistical data processing was performed in the R computing and graphical analysis environment of the Comprehensive R Archive Network (CRAN). Results. In the early postoperative period, patients with COVID-19 showed a significant decrease in quality of life across all scales of the SF-36 questionnaire compared to the control group. The overall physical health component was lower by 21% (p < 0.005), and the overall mental health component was lower by 25% (p < 0.007). Twelve months after the intervention, the quality of life of patients who had COVID-19 significantly improved and approached the indicators of the control group: the overall physical health component was 54.0 compared to 55.2 (p < 0.07), and the overall mental health component was 54.2 compared to 59.5 (p = 0.065). The use of minimally invasive access and local thrombolysis reduced pain sensations, decreased the impact of physical limitations, and improved the viability of patients in the acute stage of COVID-19 according to the SF-36 scales. Conclusion. In the acute stage of COVID-19, the quality of life of patients after endovascular revascularization for ALI is significantly lower compared to the control group without coronavirus infection. However, within 12 months after the intervention, the quality of life of patients who had COVID-19 improves and approaches the indicators of the control group and average population values. This should be taken into account during the follow-up and rehabilitation of this category of patients.

Chronic heart failure with preserved ejection fraction (HFpEF) is a syndrome characterized by a wide range of comorbidities. Considering the role of iron in cellular activity, iron deficiency (ID) may play a significant role in patients with HFpEF. However, the impact of ID on the quality of life and functional status of these patients has not been well studied, and available data are limited due to the small number of studies with conflicting results. Objective: To assess the contribution of ID to the severity of clinical manifestations of heart failure and its impact on FS and QoL indicators in patients with HFpEF. Material and methods. This study was conducted as part of a prospective, randomized cohort study to investigate the effect of ferric carboxymaltose on the quality of life and clinical presentation of HFpEF in patients with ID. To assess the impact of ID on the clinical course of HFpEF and its impact on quality of life, 73 patients were enrolled based on specific inclusion criteria. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MHFLQ) and the SF-36 questionnaire, while functional status was evaluated through the 6-minute walk test (6MWT). Results. The prevalence of ID among the study group was 61.6%. Iron deficiency anemia (IDA) was reported in only 17.8% of these individuals. Of the 73 participants included in the study, 68.9% were women. The median age of patients was 67 years (range 62–71.3). In the group with IDA, a more severe heart failure functional class III was recorded somewhat more frequently (p = 0.075). Symptoms of heart failure, such as shortness of breath, palpitations, and weakness/fatigue, were more common in patients with IDA compared to those without iron deficiency (p < 0.05, p < 0.001, p = 0.001). The 6MWT values were significantly lower in the group with IDA than in those without (p = 0.024). Analysis of quality of life using the MHFLQ revealed a more significant decrease in quality of life among patients with IDA (p = 0.011). According to the SF-36 questionnaire, we found that in the group of patients with ID, indicators of physical activity, vital activity, and general perception of health were significantly lower compared to the control group (p < 0.001). Additionally, mental health indicators were also significantly lower (p < 0.001). Conclusion. Iron deficiency, with or without anemia, is a common condition among patients with HFpEF, detected in more than half of this cohort. Iron deficiency, regardless of whether it is accompanied by anemia, is linked to a reduction in physical performance and a decline in quality of life related to both the physical and mental components of health.

Anemia of chronic disease (ACD) in patients with human immunodeficiency virus (HIV) is a common complication that reduces quality of life and worsens prognosis. The study of hepcidin and soluble transferrin receptor (sTfR) in the pathogenesis and diagnosis of ACD remains relevant. The aim of the study was to compare the secretion of hepcidin and sTfR in patients with HIV infection who developed ACD, iron deficiency anemia (IDA), and their combination. We assessed their impact on erythrocytes and hemoglobin and determined their diagnostic significance in the differential diagnosis of ACD and IDA. Material and methods. A total of 125 HIV-infected patients were examined, who were divided into ACD, ACD/IDA, IDA, and a control group without anemia based on the criteria of Van Santen and Worwood. Patients in all groups were comparable in age and sex. Results. Comparative analysis showed that in the IDA group, the concentration of hepcidin was minimal and sTfR was maximal. In the ACD group, the concentration of sTfR did not differ from the control group, while the concentration of hepcidin was lower than that in the control group. In the ACD group, a moderate correlation was found between hepcidin, sTfR, erythrocytes, and hemoglobin. Their diagnostic significance for the differential diagnosis of ACD and IDA was found to be low. Conclusion. The study established a minor role for hepcidin and sTfR in the development of ACD in HIV patients and their low diagnostic significance for the differential diagnosis of ACD and IDA, which is significantly lower than that of ferritin. Further research into the pathogenesis of ACD in HIV-infected patients is needed.

The aim of this study is to describe anemia in chronic heart failure (CHF) and to evaluate the effectiveness of oral therapy with sucrosomial iron (SiderAL® Forte) in this group. Material and methods. The study included 56 patients with CHF and anemia. Results. Anemia in CHF corresponds to anemia of chronic disease (ACD) with the development of iron deficiency (ID) in 75% of patients. The use of sucrosomial iron leads to a significant increase in hemoglobin and serum ferritin levels, a decrease in the concentration of N-terminal pro-brain natriuretic peptide, an improvement in exercise tolerance, a reduction in the functional class of CHF, and a decrease in mortality over a 2-year follow-up period. Conclusion. The addition of iron preparations with hepcidin-independent absorption to standard CHF therapy shows a significant positive effect across all criteria and can be recommended for this category of patients in routine clinical practice.

Mixed cryoglobulinemia is the most common extrahepatic manifestation of chronic HCV infection. Objective of the study. To investigate the frequency and diagnostic criteria of mixed cryoglobulinemia (MCG) associated with chronic HCV infection. Material and methods. The study included 83 patients with chronic HCV infection, aged 50.5 ± 12.6 years, of which 37 (44.6%) were men. The presence of cryoglobulins (CG) was examined, the cryocrit value was calculated, and rheumatoid factor (RF), complement component C4, and individual parameters of cellular immunity were determined. The frequency of MCG, its manifest forms, and immunological disorders were assessed, as well as the impact of antiviral therapy. Results. MCG was found in 61.4% of patients. Manifest forms of the disease were more frequently observed in the group of patients with a cryocrit of 1% or higher compared to those with a cryocrit of 0.5–0.99% (p < 0.017). In a multifactorial model, at a threshold cryocrit value of 0.5%, the detection of CG correlated with the duration of HCV infection (p = 0.001), and at a cryocrit value of 1%, it also correlated with a decrease in complement component C4 (p < 0.025). A sustained virological response (SVR) 12 weeks after the completion of therapy with direct-acting antiviral agents (DAAs) was achieved in 100% of patients. Despite the elimination of the virus, 29.4% of patients continued to have cryoglobulinemia. In 80% of patients with cryoglobulinemic vasculitis, immunological disorders persisted after the disappearance of CG. Conclusion. MCG develops in more than half of patients with chronic HCV infection and can be diagnosed with cryocrit values exceeding 0.5%. Early initiation of DAA therapy is a key factor in the prevention of MCG. The development of SVR does not exclude the persistence of MCG and immunological disorders in the early period after antiviral therapy, which necessitates mandatory long-term monitoring of these parameters.

Central Military Clinical Hospital named after P.V. Mandryk of the Ministry of Defense of Russia, Moscow, Russia The Wolff–Parkinson–White (WPW) syndrome is a relatively rare arrhythmia compared to atrial fibrillation and atrial flutter; however, after excluding atrial fibrillation and flutter from the statistics, pre-excitation syndromes of the ventricular myocardium account for 25% of supraventricular tachycardias. Due to the characteristic clinical picture on the ECG, which is often sufficient for diagnosing the condition, patients with WPW syndrome are quickly referred to specialized hospitals for further treatment. Currently, catheter ablation is the primary method of treating WPW syndrome. This article presents a clinical case of intraoperative induction of atrial fibrillation with frequent antegrade conduction to the ventricular myocardium via an accessory atrioventricular connection.

The number of patients with multiple diseases is increasing globally, leading to challenges in determining the primary cause of death (PCD). Often, the medical death certificate (MDC) lists nosologically unjustified codes as the PCD. The aim of this study is to investigate the reasons for outpatient medical visits by patients whose PCD after death was recorded as unspecified encephalopathy (G93.4), cerebral cyst (G93.0), and senile degeneration of the brain (G31.1); and to discuss possible reasons for these codes being listed as the PCD. Material and methods. Data from the electronic database of the Main Directorate of the Civil Registry Office of the Moscow Region (USR system of the Civil Registry Office of the Moscow Region) and electronic medical records (EMR) from outpatient clinics (APU) for 2020–2021. In total, 15,741 cases were registered in the MCC with codes G93.4, G93.0 and G31.1 indicated as UCD, of which 11,678 (74.2%) applied to the APU. Results. There were no recorded instances where the sole reason for outpatient visits was codes G93.4, G93.0, and G31.1. Nearly 80% of patients who had one of these three codes listed as PCD after death had visited outpatient clinics more than once. The average number of outpatient visits for any reason was 6.8 ± 8.8. Almost 70% had registered cardiovascular diseases (CVD) (of which 42.9% were cerebrovascular diseases), cancer accounted for 7.2%; diabetes mellitus for 5.3%; and nervous system diseases (NSD) for 8.8%; while 11% were related to COVID-19. The overwhelming majority of deaths coded as PCD G31.1 and G93.4 occurred in individuals aged 75 to 95 years (84% and 77.5%, respectively), while for code G93.0 it was 63.2%. In each subgroup of deceased individuals, women predominated, with an average age (84.6 ± 8.1 years) higher than that of men (78.5 ± 10.8 years). Conclusions. Codes G93.4, G93.0, and G31.1 as PCD are predominantly used in older age groups against a backdrop of repeated outpatient visits and multimorbidity. It is insufficient to simply prohibit their use; a coordinated position among specialists is necessary to select the appropriate PCD (and corresponding code) in cases of non-life-threatening multimorbid pathology in elderly individuals

The article presents biographical information and details about the fate of military doctors and nurses during the first wave of emigration and their activities in Bulgaria. It includes information about medical institutions (hospitals and infirmaries) of the Russian Red Cross Society aimed at providing assistance to Russian emigrants, as well as the work of shelters and sanatoriums.