The article provides an overview of the recent literature on the state of hemocoagulation in the viral disease COVID-19 caused by SARS-CoV-2. The issues of its pathogenesis are considered and assumptions are made about the possible benefits of patients from the use of medications that affect the platelet units.

The present article considers the prevalence of gastroesophageal reflux disease (GERD) in pregnancy; etiological and pathophysiological factors predisposing to its development in this group, features of the clinical picture and diagnosis, modern approaches to the treatment of such patients.

Heterogeneity of immuno-inflammatory diseases pathogenesis has been revealed with high concentration of immunoglobulin E in some nosological forms, which requires further study.

Aim. To analyze literature data, to present retrospective analysis and personal observations of patients with high concentration of IgE in the blood.

Material and methods. In 7 patients with autoinflammatory diseases and 130 rheumatic patients, examined earlier, the analysis of IgE concentration has been carried out by radio-immune method or by immune-enzyme analysis.

Results. Clinical observations of patients with derated immunoglobulin E syndrome are represented. The possibilities of genetic analysis and the connection of the derated IgE syndrome with vascular dysfunctions in rheumatic diseases are discussed.

Conclusion. When making diagnosis is complicated in patients with inflammatory syndrome of unclear etiology and high IgE concentration in the blood, it is necessary to keep in mind the autoinflammatory genesis of this process. Further study of the role of the derated immunoglobulin E syndrome in pathogenesis is required.

Echocardiography is an important method for non-invasive evaluation of the structural and functional indicators of the cardiovascular system, which is valuable in early detection of the cardiovascular pathology, especially in older people, because, the prevalence of the most cardiovascular diseases significantly increases with age.

Material and methods. 1189 civil aviation pilots aged 54–68 years who underwent routine in-patient examination at the Central Clinical Hospital of Civil Aviation on a regular basis were examined with further medical assessment at the Central Medical Flight Expert Commission of Civil Aviation of the Russian Federation in 2009–2010. The average age was 56.75 ± 0.07. Transthoracic echocardiography was performed in 1170 flight personnel (98.4%) for evaluation of the structural and functional indicators of the cardiovascular system.

Results. Echocardiography abnormalities were detected in 95.7% of pilots of the senior age group, 14.1% of these changes were in mixt form. Signs of atherosclerosis of the thoracic aorta were most common — 94% of cases. Left ventricle diastolic dysfunction of type I was noted in 60.3% of pilots. Structural and/or functional changes of the heart valves were noted in 18.2% of the subjects, most of them were localized in the aortic valves: 16% of cases. Dilation of the heart chambers were detected in 4.8% of the examined. LVH was found in 1% of pilots of the senior age group, and signs of LV concentric remodeling — in 60.7% of individuals. The decrease in LV myocardial contractility was detected only in one pilot with EF 53%. Small heart abnormalities were identified only in 0.6% of cases.

Conclusions. Echocardiography abnormalities are quite common in pilots of the senior age group, however, «gross» echocardiographic changes are much less common than in the population, which is natural, because these individuals undergo initial medical screening and subsequent follow-up. The use of this method for screening in civil aviation pilots of senior age groups is reasonable, because the prevalence of cardiovascular disease in this group is increasing.

Arterial rigidity plays a significant role in the occurrence of cardiovascular pathology in hemodialysis patients (HD). At the same time, its contribution to the development of specific intradialysis cardiovascular complications remains poorly understood.

The aim of the study is to clarify the prognostic value of arterial rigidity parameters in the development of intradialysis hypertension (IDH) in software-based HD patients.

Material and methods. The prospective study included 45 software-based HD patients. The IDG criterion was an increase in systolic blood pressure >10 mmHg after the HD procedure in more than 4 out of 6 sessions in the period preceding the daily blood pressure monitoring (DBPM). Arterial rigidity was assessed by means of the device using the Vasotens-24 bp lab software package (Peter Telegin, Nizhny Novgorod, Russia). Demographic data of patients and objective examination data, laboratory indicators, dialysis experience, concomitant cardiovascular diseases, and drug therapy were also recorded. The analysis of the obtained data was performed using the IBM SPSS Statistics 26.

 Software package application. The average age of patients was 51 [41; 61], dialysis experience was 4.5 [1.1; 7.8]. IDH occurred in 20 dialysis patients and, according to multivariate correlation analysis, was associated with the patient’s age (relative risk (HR) 3.78; 95% confidence interval (CI) 1.29–11.04) and such an indicator of arterial rigidity as the augmentation indexAIx (OR 7.75; 95% CI 2.65–22.7). An inverse correlation was observed between the development of IDH and the time ofpropagation of the reflected wave-RWTT_100-60  (OR 0.27; 95% CI 0.14–0.53), the presence of diabetic nephropathy (OR 0.34; 95% CI 0.094–1.251), residual diuresis (OR 0.43; 95% CI 0.21–0.87) and the level of albumin (OR 0.12; 95% CI 0.02–0.79). At the same time, the inclusion of arterial rigidity parameters in the mathematical model increased its predictive ability from AUC 0.886 to AUC 0.978.

 Conclusion. In this study, values of AIx ≥ -6.5% and RWTT _100-60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which may indicate a leading role of progressive arterial rigidity in the development of intradialysis cardiovascular  complications.

2 Altai Regional Clinical Hospital, 656024, Barnaul, Russia

The aim of this study was to evaluate presepsin to improve diagnosis of severe pneumonia, sepsis in patients on hemodialysis.

Material and methods. 62 patients with severe pneumonia, sepsis, chronic glomerulonephritis and nephropathy aged from 17 to 77 years were examined. Among them were 19 patients who received hemodialysis. These patients have been investigated for the level of the presepsin. Presepsin level was quantified on immunohemilyuministsentny analyzer Pathfast (Mitsubishi Chemical Medience Corporation, Japan) in pg/ml.

Results. Рresepsin at the group of patients with severe pneumonia who received hemodialysis was 6587.9 ± 2011.09 pg/ml (n = 7), рresepsin at the group of patients with pneumogenic sepsis who received hemodialysis was 6931.1 ± 820.46 pg/ml (n = 7). Рresepsin at the group of patients with chronic glomerulonephritis and nephropathy who received hemodialysis was 1693.0 ± 248.24 pg/ml (n = 5). There was no difference between the presepsin level at the groups of patients with severe pneumonia, pneumogenic sepsis who received hemodialysis. The presepsin at the group of patients with severe pneumonia, pneumogenic sepsis who received hemodialysis was above the the level of presepsin at the group of patients with chronic glomerulonephritis and nephropathy who received hemodialysis.

Conclusion. The high level of presepsin is an indication of an active infectious disease and the effect of hemodialysis.

Objective: aortic valve replacement is a «gold standard» in the surgical treatment of aortic stenosis. At the same time, an increasing number of patients require combined surgical interventions in addition to aortic valve replacement. Currently, surgical mortality in isolated aortic stenosis varies between 3–8% in low-risk patients under 70 years old and around 5–11% in elderly patients, rising up to 15% in cases of combined heart surgery. The use of sutureless valves for open implantation requires careful analysis of the immediate and long-term results of their implantation and comparison to the results of standard methods of treatment.

Material and methods. The study was designed as a prospective-retrospective study for evaluation of results of different types of biological prostheses use in case of isolated aortic valve stenosis and together with concomitant cardiac pathology. The study included patients over 65 years old with aortic stenosis, who underwent aortic valve replacement. The patients were divided into two groups. The comparison was carried out by the following criteria: intraoperative data, the number and nature of postoperative complications, survival, freedom from ischemic events and from reoperation, dynamics of transaortic gradient, hemodynamic characteristics for the entire evaluation period (5 years).

Results. In the group of patients with implanted sutureless valves, there was a smaller number of postoperative complications, faster recovery, significantly lower mortality rates, higher freedom from valve-related complications in postoperative period.

Conclusions. The use of sutureless prostheses is justified for the aortic valve replacement and is safer compared to standard valves, in the absence of contraindications. Surgical treatment of patients with aortic stenosis with the use of sutureless valves led to significant clinical improvement in most of them, both in the functional class and in the threshold of tolerance to physical activity. The level of typical valve replacement complications was significantly lower. Simplicity and reproducibility of the procedure, fast learning process can certainly contribute s to wider and more active implementation of this technology in clinical practice.

Goal. To study the efficacy and safety of therapy with netakimab (NTK) and the complex drug — betamethasone dipropionate + betamesone phosphate (B) in patients with COVID-19 in outpatient settings.

 Material and methods. A retrospective analysis of the treatment of 12 patients with severe new coronavirus infection who received therapy was performed simultaneously with netakimab (NTK) (the first administration at a dose of 60–120 mg, if indicated-the second administration at a dose of 60 mg) and a combined drug-betamethasone dipropionate + betamesone phosphate (B), at a dose of 2 ml official solution. Treatment was performed at 7th (95% CI [6; 10]) day from the beginning of the disease. Repeated administration of NTK was performed in older patients due to insufficient effect of stopping hyperthermia and/or hypoxemia. A comprehensive examination of patients before and after NTK + B therapy was performed, which included clinical (assessment of the severity and duration of fever, analysis of gas exchange indicators), instrumental (computed tomography of the lungs) and laboratory methods, including determination of ferritin, IL-6.

 Results. Simultaneous use of NTK + B therapy resulted in compensation of hyperthermia and/or SpO₂ > 93% 2.5 (95% CI [1; 3]) days after the first administration, a significant decrease in the level of inflammatory markers, and positive dynamics according to lung CT data. In all cases, increased respiratory support or additional antibiotic therapy, as well as hospitalization, were not required. The search for articles on the topic was carried out in the PubМed database in English and Russian, published in the period from 2001 to 2020.

The aim of the study was to test the screening of the risk of developing cerebrovascular diseases and assess the effectiveness of cytoflavin in patients with a high risk of developing this pathology.

In addition to general clinical screening (determination of glucose and cholesterol levels in the blood, control of blood pressure and pulse, determination of body mass index), assessment of neurological status using an outpatient scale for assessing chronic cerebral ischemia A.I. Fedina and assessment of the level of cognitive functions — using the Mini-KOG test. Using screening, 64 people were examined, the average age of which was 50.5 ± 11.2 years. Surveyed with a high level of risk of developing pathology for the preventive purpose was prescribed Cytoflavin: 2 tablets. 2 times a day, a course of 30 days, with dynamic monitoring of the condition.

Screening for assessing the risk of developing cerebrovascular diseases has shown its effectiveness and allowed us to identify a group of patients at high risk of developing pathology. Patients of this group showed cerebral complaints, signs of asthenoneurotic syndrome and cognitive deficiency. The use of Cytoflavin helped to reduce the manifestations of asthenoneurotic syndrome and improve cognitive functions, had a positive effect on the concentration of attention, memory and thinking. However, the study was pilot in nature and its results can be used in planning further research.

Postinfarction heart aneurysm is one of the most dangerous complications of acute myocardial infarction, determining high mortality rates. Despite the improvement of modern diagnostic methods, as well as the modernization of the system for providing highly specialized medical care to patients with acute coronary syndrome, the issues related to this issue have not lost their relevance. The publications available at this time are few and relate only to specific cases that demonstrate the advantages of a particular type of surgical correction. This clinical observation demonstrates a tactical approach to a patient with acute thrombosed postinfarction aneurysm of the upper left ventricle, when postoperative period was complicated by the development of a massive pulmonary embolism. The obtained results of stage-by-stage surgical treatment clearly show the effectiveness of the active surgical approach in relation to patients with a high premorbid profile.

This article presents a clinical case of pulmonary embolism after splenectomy in a patient who suffered an auto injury. When the spleen is removed, reactive thrombocytosis occurs, which is the main risk factor for thromboembolic complications. It shows the options for the diagnosis of thromboembolism and describes the tactics assignment of antiplatelet drugs. The preventive administration of antiplatelet drugs depending on the severity of thrombocytosis in the postoperative period is discussed.

Represented clinical case demonstrates the possibilities of cardiopulmonary exercise testing in a patient who complained of shortness of breath and chest discomfort during physical exercise. The characteristic feature of this case is a cardiac mixoma revealed after exercise testing.

The article presents the biographical data of military doctors of the Russian Imperial Army who continued to serve Russia after 1917 and participated in subsequent wars of the first half of the 20th century.