The issue of pericardial effusion concerns a wide range of nosologies. Today, it is particularly relevant in connection with post-COVID complications and new cases of this cardiotropic infection. Managing hydropneumopericardium raises numerous questions: from diagnostic criteria and assessing “significance” to the necessity of therapy and the choice of methods. This lecture compiles all key points regarding the management of effusion in the pericardial cavity, systematizes the approach to diagnosis and treatment, details the most challenging dilemmas that arise when managing such patients, and offers examples and personal insights into decision-making based on the experience of treating nearly a thousand patients.

Infection caused by the human immunodefi ciency virus (HIV) has become a signifi cant issue in practical healthcare worldwide and requires a multidisciplinary approach even at the early stages of the disease. The range of systems and organs involved in the pathological process of HIV infection is extensive, with particular attention in clinical practice given to nervous system damage. The treatment of HIV infection has evolved since the introduction of combination antiretroviral therapy (ART) in the 1990s, providing HIV-infected individuals with approaches that ensure viral replication suppression, prevention of acquired immunodefi ciency syndrome (AIDS) throughout their lives through continuous therapy, and interruption of HIV transmission. However, despite the success of these treatment regimens, the global HIV epidemic persists, prompting comprehensive exploration of potential HIV treatment strategies. Currently, modern antiretroviral drugs are widely implemented, leading to a signifi cant increase in the life expectancy of HIV-infected individuals. With the reduction of HIV-related mortality, HIVassociated neurocognitive disorders (HAND) have gained particular importance, as they can develop even in the context of eff ective therapy. The overall prevalence of this pathology among HIV patients reaches up to 42.6%, while treatment options remain a subject of discussion. This article presents a review of contemporary literature dedicated to nervous system damage in HIV infection and current strategies for antiviral therapy selection.

A century and a half ago, Cesare Lombroso, based on anthropological research on “Homo delinquent” in criminology, anticipated the methodology of phenotyping. The rapid development of post-genomic concepts has contributed to the identification of genes responsible for addictive vulnerability, which also defi ne predisposition to other mental disorders. The study of genome-wide associations (GWAS) allows for the simultaneous consideration of genetic determinants in predicting phenotypic traits, including behavioral criminal manifestations and various forms of dependence on psychoactive substances. Identifying genetically determined comorbid deviant behavior and “pre-dependence” may help to focus special attention on the risks associated with the early stages of behavioral disorders and psychoactive substance use, as well as inform state policy, the penitentiary system, and healthcare resources that will support preventive medical measures and early intervention.

Objective of the Study. To develop a method for distal hybrid reconstruction and postoperative management of patients with complex revascularization of the angiosomal artery of the tibia. Material and methods. The prospective study involved 20 individuals suffering from tandem stenotic-occlusive lesions of the common femoral artery and the arteries of the lower leg. Endovascular revascularization of distal segments was performed using a subintimal approach, which presented significant technical challenges due to the extent of occlusion and pronounced atherocalcinosis of the lower leg arteries in the patients. The first group (n = 10) consisted of patients who underwent distal femoral reconstruction with the installation of a port system for postoperative heparinization of the intervention area for 30 days, as proposed by us. The second group, the control group (n = 10), consisted of patients who underwent the intervention using the classical method. Clinical indicators of effectiveness during the early and late postoperative periods were assessed over 90 days. Results. The degree of intraoperative blood loss (Group 1 — 202.4 ± 20.5 ml, Group 2 — 230.8 ± 26.2 ml, p = 0.15) as well as the duration of the surgical intervention overall (Group 1 — 152.1 ± 10.1 min; Group 2 — 144.8 ± 17.1 min, p = 0.13) were comparable between the groups. Early postoperative complications such as bleeding, hematoma formation, and infiltrates at the site of angioplasty were not observed. A comparable increase in the postoperative ankle-brachial index and distance of pain-free walking was noted. When assessing indicators during the late postoperative period, it is important to note a significantly lower number of adverse events and an earlier onset in Group 1 (p < 0.05). Furthermore, two patients from Group 2 underwent major amputations, which did not occur in the study group with our proposed method of hybrid reconstruction. The frequency of recoil effects was comparable between the groups. The study of the dynamics of ulcerative-trophic defects showed that the number of necrosectomies using the port system did not significantly diff er from the control group, while the healing rate of the ulcerative defect after prophylactic heparinization courses was significantly higher compared to the standard distal hybrid operation method (p < 0.05). Conclusion. In situations involving distal hybrid reconstruction, where technical difficulties in revascularizing the lower leg arteries are objectively determined by the severity of their atherosclerotic lesions and a high likelihood of early recurrence of occlusion, the use of a port system with prophylactic courses of heparinization in the vascular reconstruction area yields good clinical results.

Genetic markers of obesity play a crucial role in understanding the pathogenesis of this multifactorial disease, which is one of the major public health problems of the 21st century. In the past decade, numerous genetic variants associated with obesity have been identified thanks to the development of genome-wide association studies. Among the most studied genes are FTO, MC4R, TMEM18, NEGR1, and BDNF. Polymorphisms in these genes are associated with various aspects of appetite regulation, metabolism, and fat tissue accumulation. Objective of this study is to investigate the role of genetic and epigenetic factors in the development of obesity and their integration with environmental factors to develop personalized strategies for the prevention and treatment of this condition. Material and methods. The study utilized data from genome-wide association studies (GWAS), epigenetic analyses (DNA methylation and histone modifications), as well as an analysis of external factors (nutrition, physical activity, and others). This comprehensive approach allows for the integration of these data to gain a deeper understanding of the molecular mechanisms underlying obesity. Results. The findings confirmed the significance of genetic markers such as FTO, MC4R, TMEM18, NEGR1, and BDNF in regulating appetite, metabolism, and fat tissue accumulation. Epigenetic changes, including DNA methylation and histone modifications, also had a significant impact on the development of obesity. It was found that external factors such as diet and physical activity could induce epigenetic changes that promote fat tissue accumulation. Conclusion. The integration of data from genome-wide association studies, epigenetic research, and the analysis of external factors represents a promising direction for developing personalized strategies for the prevention and treatment of obesity. This comprehensive approach will enhance our understanding of the molecular mechanisms underlying obesity and create more effective and targeted therapeutic methods that consider individual genetic and epigenetic characteristics of patients.

The development of extrapulmonary complications of COVID-19, specifically spontaneous hemorrhages in soft tissues, is associated with higher expression of angiotensin-converting enzyme type 2 in the gastrointestinal tract compared to the respiratory tract. Currently, a triggering mechanism in the development of hemorrhages cannot be ruled out, which may be induced by heparin-induced coagulopathy and critical conditions accompanied by the production of pro-inflammatory factors in the bloodstream. Since the onset of COVID-19, there has been an increase in the frequency of spontaneous hemorrhages in soft tissues, and this complication is linked to the possible direct impact of the SARS-CoV-2 virus on compromised endothelium. Objective. Based on a comprehensive clinical, laboratory, and instrumental examination, including pathomorphological and immunohistological analysis, to determine optimal approaches for the diagnosis and treatment of patients with spontaneous hematomas in soft tissues due to COVID-19. Material and methods. The study involved 39 patients with spontaneous hemorrhages in soft tissues of various anatomical locations. Results. The development of spontaneous hematomas in soft tissues in patients with COVID-19 is a serious complication, often with an unfavorable prognosis, requiring a personalized treatment strategy. The therapeutic approach was based on choosing a strategy ranging from non-invasive to minimally invasive techniques. Immunohistological analysis was conducted using monoclonal antibodies against CD31, CD34, CD68 receptors, and factor vWF, revealing alterations in the endothelial monolayer that contribute to the occurrence of hemorrhagic events. Conclusion. It can be suggested that the increased frequency of spontaneous hematomas in soft tissues among COVID-19 patients may be associated with the direct cytopathic effect of the SARS-CoV-2 virus on endothelial cells (destruction of the vascular wall due to degradation of the endothelial layer). Minimally invasive procedures are the most preferred methods for stopping bleeding from feeding vessels in patients with COVID-19.

Objectives. To evaluate the clinical, laboratory, and long-term outcomes of patients with acute myocardial infarction (MI) and ST elevation on the electrocardiogram (STEMI), which occurred during or after COVID-19 infection. Material and methods. A prospective cohort study included 60 participants, matched by age, gender, and the Charlson Comorbidity Index. The participants were divided into three groups of 20: the study group, which included patients with STEMI and COVID-19; a comparison group of patients with STEMI but without COVID-19; and a third comparison group consisting of patients with COVID-19 but without STEMI. During hospitalization, the clinical presentation of STEMI and COVID-19 was analyzed, as well as laboratory, instrumental data, and anamnesis. Additionally, a genetic study was conducted to examine polymorphisms in the SERPINE1, ITGB3, and ITGA2 genes. Residual platelet activity was assessed, and long-term follow-up was conducted after hospital discharge. Results. Patients with identified COVID-19, regardless of STEMI, more frequently exhibited symptoms of this infectious disease. Patients with STEMI, regardless of the presence of COVID-19, had significantly more chest pain and elevated troponin I levels upon admission to the hospital. The groups of patients with STEMI did not diff er in key angiographic characteristics and technical aspects of performing percutaneous coronary intervention; however, in the COVID-19 group, the “symptom-balloon” time was significantly longer — 590 (340 ÷ 870) minutes compared to 305 (179 ÷ 390) minutes in the group without COVID-19, p < 0.001. Platelet aggregation with ADP, adrenaline, and collagen was higher in patients with COVID-19, including those in the STEMI group, compared to the STEMI group without COVID-19, p < 0.001. Patients with STEMI and COVID-19 required a longer hospital stay — 11 (9.5 ÷ 16.5) days compared to 9.5 (7 ÷ 13.5) days in the COVID-19 group without STEMI and 7 (7 ÷ 8) days in patients with STEMI without COVID-19, p < 0.001. No adverse cardiovascular events were observed in the long term in patients without COVID-19, whereas in the STEMI and COVID-19 group, there were 5 fatalities recorded and 4 in the group with COVID-19 without STEMI, as well as 4 cases of non-fatal myocardial infarction in the STEMI and COVID-19 group and 1 case in the group with COVID-19 without STEMI, p = 0.032. Conclusions. The mixed clinical picture of the infectious disease caused by COVID-19 and myocardial infarction may influence an increase in the time from symptom onset to reperfusion therapy, overall hospitalization duration, and worse long-term outcomes such as non-fatal myocardial infarctions and death.

Recurrent Pericarditis (RP) is a significant medical issue despite advancements in modern cardiology. The management of patients with this condition is associated with several challenges due to the variety of clinical manifestations, difficulties in differential diagnosis, lack of standardized treatment protocols, and a high likelihood of recurrences. Furthermore, there is insufficient data in the literature regarding the prevalence, structure, and characteristics of RP in the Russian population, which complicates the development of unified clinical protocols and recommendations. This article presents the rationale and description of the multicenter non-interventional registry of real clinical practice, RUDRA, whose primary objective is to study RP in the Russian population. The main focus is on analyzing the frequency, characteristics of the course, and outcomes of RP, including its idiopathic form. Patient data registration will be conducted in two parts—retrospective and prospective—allowing for a comprehensive analysis and the realization of all set objectives. The registry will investigate key aspects of etiology, diagnosis, treatment, and dynamic monitoring of patients with various forms of RP. The establishment and maintenance of the RUDRA registry may provide new and expanded opportunities for systematizing knowledge about RP, contributing to improved quality of medical care for patients suffering from this condition.

The article presents data on the fate of military doctors and nurses during the first wave of emigration and their activities in the territory of the Kingdom of Serbs, Croats, and Slovenes. Information is provided about medical institutions (hospitals and infirmaries) of the Russian Red Cross Society aimed at assisting Russian emigrants, as well as the work of shelters and sanatoriums.

The evolution of treatment approaches for hemorrhoid thrombosis and acute bleeding hemorrhoids is analyzed from its origins to the present day. Throughout the 19th century, significant scientific articles and monographs were published by both domestic and foreign authors, and conferences and congresses dedicated to diseases of the rectum and anus were held, with considerable attention given to the study of acute hemorrhoids, particularly their surgical treatment. It is noted that the relevance of this topic has grown over the decades, attracting more researchers both in our country and abroad.