Atrial cardiomyopathy is a concept reflecting a special pathophysiological condition of the atria underlying various diseases. The accumulation of data indicating that atrial remodeling precedes the development of atrial fibrillation, ischemic stroke, and heart failure has allowed the scientific community to begin rethinking the pathophysiological role of the atria in the formation of cardiovascular diseases. The article discusses the main mechanisms of atrial cardiomyopathy development and their relationship to atrial morphology and function. An analysis of recent publications suggests the clinical significance of atrial cardiomyopathy, new possibilities for using imaging technologies and electrophysiological examination of the atria to assess the prognosis in patients. The search for ways to influence atrial cardiomyopathy may significantly improve outcomes in patients with atrial tachyarrhythmias and heart failure.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies to complexes of platelet factor 4 (PF4) and heparin. HIT is a potentially life-threatening clinical condition that should be suspected in patients with thrombosis with thrombocytopenia after 4 days of heparin treatment. In case of an established diagnosis of HIT, it is necessary to stop heparin treatment. The ‘‘4 T’s’’ criteria of HIT has been recommended to be used in patients with clinical suspicion of HIT. The diagnosis of HIT requires verification using special laboratory tests to confirm the diagnosis. ELISA and functional blood tests with platelet activity assessment in patient on heparin treatment allow verifying the diagnosis of HIT. Our experience in implementing ELISA for the diagnosis of HIT has shown the high cost of this analysis with a relatively low incidence of HIT in a single hospital. Therefore, it is necessary to create a regional laboratory hub, which is necessary on the scale of a large city. Non-heparin anticoagulants that inhibit thrombin formation, including direct oral anticoagulants (DOACs) are cornerstones of treatment of thrombotic complications of HIT. Warfarin should not be used until the platelet count has recovered. A literature review was conducted in the medical resources e-Library, Pubmed, Web of Science, Scopus dedicated to diagnosis, treatment and prevention using keywords

Cardiovascular diseases (CVD) remain one of the leading causes of morbidity and mortality worldwide, with their prevalence continuing to rise due to population aging. Despite compelling evidence supporting the effectiveness of physical exercise in reducing CVD risk, the molecular mechanisms underlying these protective effects remain insufficiently understood. In recent years, an increasing number of studies have highlighted the key role of epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNA expression, in regulating cardiovascular health. Physical activity serves as a potent epigenetic modulator, inducing long-lasting changes in gene expression and activating signaling pathways associated with cardiovascular function. This mini-review presents current data on the impact of physical exercise on long non-coding RNA expression and their role in the pathogenesis and prevention of CVD. Recent studies confirm that epigenetic modifications induced by physical activity hold significant therapeutic potential for the prevention and treatment of CVD.

Objectives. To study the clinical and diagnostic role of supplemented five-stage stress echocardiography (SE) with physical exercise in patients with known and suspected coronary artery disease (CAD) compared to traditional SE; to analyze the management tactics for patients with suspected CAD depending on the stress test results in combination with clinical data; to assess the contribution of additional SE parameters to the short-term prognosis.

Material and methods. A total of 253 patients (62 (53; 68), 130 (51.4%) men) with known and suspected CAD without a history of MI underwent ABCDE-SE in a single-center study for clinical indications (chest pain, dyspnea, ischemic changes on ECG). The median follow-up period was 198 (118; 324) days. The contribution of additional SE parameters to the diagnosis of significant coronary artery disease and prediction of rehospitalizations (combined endpoint) was studied, and management tactics were analyzed depending on the results of extended SE.

Results. A positive test for the traditional criterion — induced ischemia — was detected in 22 (8.7%) patients; among the additional criteria of ischemia, a decrease in contractile reserve (CR) was most often detected (n = 161; 63.6%). During the observation period, the combined endpoint was registered in 32 (12.7%) patients. In addition to induced ischemia, patients with significant coronary artery disease had lower left ventricular (LV) myocardial efficiency (p = 0.045), LV force under load (p < 0.001), LV SR (p < 0.001), higher SE score (p < 0.001) and more frequent SR decrease (p = 0.005). Most often, coronary angiography was prescribed after a positive step A (72.7%), with a score of 4 (60%); these patients also most often required revascularization (46.7%). The threshold values of the end point predictors were established: SE score > 1.5 (p < 0.001); LV peak GLS < 16.55% (p = 0.016); SR < 1.7 (p = 0.033); chronotropic reserve < 1.79 (p = 0.010). In multivariate analysis, outcome predictors were the nature of chest pain (OR 5.1; p = 0.007), LVEF at peak load (OR 0.82; p = 0.012), SR value (OR 16.0; p = 0.007) and the sum of SE points (OR 18.0; p = 0.006).

Conclusion. In non-invasive diagnostics of significant coronary lesions and prediction of the nearest adverse cardiovascular events in patients with known and suspected coronary artery disease, along with the traditional criterion — the appearance of zones of local LV contractility and the associated decrease in LVEF, LV GLS, and an increase in INLS, additional informative criteria were identified among the parameters of the five-stage SE.

The aim of the study: to evaluate the state of the oxidative potential and antioxidant defense system in patients with psoriatic arthritis (PsA) associated with metabolic syndrome (MS).

Material and methods. The study included 278 PsA patients (130 men, 148 women, average age 55.8 ± 6.95 years), of whom 208 had signs of MS, 70 did not. The control group consisted of 45 practically healthy individuals. Enzyme immunoassay was used to determine the total oxidative capacity of blood serum (TOC), total serum antioxidant activity (TAC), blood levels of oxidized LDL (LDL-ox), and superoxide dismutase (SOD).

Results. In patients with PsA and MS, the value of TOC and the level of LDL-ox were 1.3 times higher than in patients without MS, and 1.3 and 2.7 times higher (respectively) than in healthy individuals (p < 0.001). In patients with MS, the blood TAC value and SOD level were significantly lower (1.7 and 2.3 times, respectively) than in patients without MS, and 2.7–3.9 times lower (respectively) relative to its value in the control group (p < 0.001).

Conclusion. In patients with PsA and MS, higher TOC and LDL-ox values were found compared with patients without MS and healthy individuals, along with lower TAC and SOD values.

Objectives. To compare the body composition of sarcopenic and non-sarcopenic femals. To evaluate the role of bioimpedance analysis and phase angle determination in the diagnosis of sarcopenia.

Material and methods. The cross-sectional study included 90 women aged 61 to 83 years. Group 1 enrolled 56 women without sarcopenia, group 2 consisted of 34 sarcopenic persons. Standardized collection of complaints and medical history, anthropometry, dynamometry, Short Physical Performance Battery, including the Chair rising test, tandem, Timed-Up-and-Go, walking speed, bioimpedance analysis of body composition.

Results. Waist circumference, the age is higher in group 2, p < 0.050. Body composition did not differ in both groups, p > 0.050. A potentially high level of physical performance was detected only in group 1, a low level of nutritional status only in group 2, p = 0.011, χ² = 10.965. A moderate feedback relationship was found between fat mass, fat-free, active cell masses, total and extracellular fluid, and basal metabolism with the relative strength of both hands. There is little correlation between the results of other functional tests and body composition.

Conclusions. Age is an unmodified factor in the development of sarcopenia. The presence of abdominal type of obesity increases the risk of sarcopenia. The determination of muscle strength by the dynamometry method has a pronounced diagnostic significance. Determination of the phase angle using bioimpedance analysis plays an important role in confirming the diagnosis of sarcopenia. A low level of phase angle is an important marker and predictor of the severity of sarcopenia.

One of the key factors in the pathogenesis of eosinophilic esophagitis is the disruption of the epithelial barrier integrity, leading to deep penetration of environmental allergens into the esophageal mucosa. The causes of dilated intercellular spaces in eosinophilic esophagitis are recognized as inflammatory processes induced by type T2cytokines (IL-4, 5, 13), as well as a genetically determined impairment in the synthesis of tight junction proteins. At the same time, the contribution of pathological gastroesophageal refluxes to mucosal damage and increased permeability of the esophagus cannot be ruled out. Given the high prevalence of gastroesophageal reflux disease in the population, this may play an important role in the pathogenetic processes occurring in the esophageal wall of patients with eosinophilic esophagitis. Aim. To study the parameters of 24-hour pH-impedance monitoring in patients with eosinophilic esophagitis in order to assess the role of gastroesophageal refluxes in the pathogenesis of eosinophilic esophagitis and to determine treatment strategies for patients with eosinophilic esophagitis. Material and methods. 24-hour esophageal pH-impedance monitoring was performed on 57 patients aged 18 to 52 years with a previously confirmed diagnosis of "eosinophilic esophagitis," who provided signed voluntary informed consent. The study results were evaluated in comparison with pH-impedance monitoring data from patients with gastroesophageal reflux disease (60 individuals) and healthy volunteers (23 individuals). Results. Pathological gastroesophageal refluxes (primarily acidic) likely play a significant role in the pathogenesis of eosinophilic esophagitis, as they were detected in this study in 21.1% of patients with eosinophilic esophagitis. Routine pH-impedance monitoring is not indicated for eosinophilic esophagitis but may be used as an additional diagnostic method in patients when determining therapeutic strategy (prescribing antisecretory therapy or topical corticosteroids). Assessment of basal nocturnal impedance may be an important additional marker of inflammatory process activity in patients with EoE.

Background. Urolithiasis is a chronic multifactorial disease characterized by the formation of renal calculi of various salt compositions. Determination of the composition of salts that form calculi is necessary for adequate treatment and prevention of the transition of the stone formation process to the active stage. However, the possibility of determining stone-forming salts in the early stages of the disease (before stone formation) remains a problem for clinical practice.

Purpose of the study: to prove the possibility of determining stone-forming salts of oxalate-calcium composition by examining urine using the systemic self-organization method (Lithos-system technology) in patients at the early (preclinical) stage of nephrolithiasis, as well as at the early stage of disease recurrence. Material and methods. Method of systemic self-organization of a urine drop (Lithossystem technology), method of X-ray spectral microanalysis.

Results. In urine facies (structured films of dehydrated drops) of 57 patients, the systemic self-organization of urine method revealed an active process of stone formation, as indicated by multiple crystalline formations in the marginal (protein) zone of the facies. Microscopy of these crystalline formations in polarized light showed that they were crystallized structures of the fungus of the genus Candida spp. It is known that the main product of the vital activity of Candida spp. is oxalic acid. Electron probe study (X-ray spectral microanalysis method) showed that the chemical composition of crystalline formations in the protein zone of the facies was represented by calcium oxalate. Thus, the simultaneous presence of crystalline formations and Candida spp. structures in the protein zone of urine facies indicates the formation of oxalate-calcium stones.

Conclusion. The method of systemic self-organization of urine can be used to diagnose the process of stone formation based on calcium oxalate in urolithiasis at all (including preclinical) stages of disease development in clinical diagnostic laboratories.

The article presents a clinical case of a rare iatrogenic complication associated with intramuscular or subcutaneous administration of drugs — drug embolism of soft tissues (Nicolaou syndrome). This complication occurred in a woman in labor on the second day after a cesarean section due to the injection of a non-steroidal anti-inflammatory drug for pain relief in the postoperative period. The clinical picture was characterized by the appearance of pain syndrome and swelling of the anterior surface of the right thigh (in the area of the drug injection). According to the ultrasound examination of the soft tissues of the right thigh, moderate thickening of the skin was visualized in the area of the affected tissue; at a depth of 26 mm from the skin surface in the thickness of the muscle — an area of high echogenicity measuring 48 × 5 mm; however, fluid accumulations, as well as cavity formations in the soft tissues were not detected. Against the background of antibacterial, anticoagulant therapy and drug analgesia, positive dynamics, a decrease in the severity of edema and intensity of pain syndrome were noted.

Behçet's disease (BD) is a chronic, systemic, inflammatory disease of unknown etiology. BD can cause neurological impairments, which are classified into parenchymal, non-parenchymal, and mixed forms. One of the most common neurological symptoms of BB is headache. In most cases, it refers to a primary headache and includes tension headaches and migraines. Cerebral venous thrombosis is the most common secondary cause of headache in BD. Isolated intracranial hypertension is another cause of secondary headaches in patients with Behçet's disease.

The article presents historical information about the creation and activities of Communities of Sisters of Mercy in Crimea, as well as biographical data of doctors and nurses. Information is provided on the medical institutions (hospitals and infirmaries) of the ROCC, organized by the Crimean communities of sisters of Mercy to provide assistance during the First World War.

The main milestones in the formation and development of proctology as an independent discipline in surgery are briefly covered. The merits of outstanding scientists in improving methods of treating proctological diseases for more than 200 years are noted. Little-known facts from the history of surgery for acute hemorrhoids are presented. The evolution of views from the origins to the present day in the treatment of acute hemorrhoids is analyzed. Throughout the 19th century, major scientific articles and monographs were published by both domestic and foreign authors, conferences and congresses were held on diseases of the rectum and anus, with a significant place devoted to the study of acute hemorrhoids, especially its surgical treatment. It is noted that the relevance of the topic has grown over the decades and attracted more and more researchers both in our country and abroad.