Аt present, it can be noted without exaggeration that COVID-19 is the most serious challenge to the international system of practical health care in its recent history. Extremely high rates of morbidity and mortality dictate the need for a more detailed study of the pathogenetic aspects of the developing infectious disaster. In addition to respiratory distress syndrome, and systemic inflammatory response syndrome, COVID-19 is characterized by polyvalent disorders of the mechanisms of systemic hemostasis, which is reflected in the increase in the number of venous thromboembolic complications in the overall structure of morbidity and mortality. This literature review summarizes information on Covid-associated coagulopathy and its impact on changes in the clinical and epidemiological characteristics of venous thromboembolic complications.

Direct оral Anticoagulants (DOACs) include direct thrombin inhibitor (dabigatran) and factor X inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban). The) are widely used worldwide for the prevention and treatment of venous thrombosis. The popularity of DOACs is explained by convenient and predictable pharmacodynamics, the lack of need for regular monitoring of the therapeutic effect, as well as more predictable food-drug interaction and bioavailability. However, like any other anticoagulants, DOACs are characterized by an increased risk of bleeding, especially gastrointestinal one. The correct approach to the prescription of DOACs and prevention of bleeding during treatment including the intake of anticoagulants can significantly reduce the probability of life-threatening complications. In the case of bleeding, the use of specific and nonspecific DOACs antidotes is indicated. Significant bleeding requires the attending physician to know a clear course of action in accordance with published algorithms to save the patient’s life.

The article presents the main clinical, instrumental, and electrophysiological risk factors of atrial fibrillation (AF) occurence in patients with typical atrial flutter (TAF) who underwent radio frequency catheter ablation (RFA) of the cavotricuspidal isthmus (CTI). The term “post-ablation AF” is defined. The role of such a factor as endocardial provocation test in predicting post-ablation AF in patients with TAF is indicated. Studies evaluating the effectiveness of preventive maintenance of RFA AF in patients undergoing RFA CTI are also represented. Mathematical models for predicting AF in the general population and in patients with TAF are discussed.

The review is devoted to introducing a wide range of internists to the new fixed combination of ramipril and indapamide (Concealar-D24), created by Russian scientists. This is the first original domestic development for the treatment of arterial hypertension, which is successfully produced by the first Russian resident of the special economic zone, the pharmaceutical plant «VERTEX» in St. Petersburg. The advantage of Concealar-D24 is a rational combination of two drugs that have not only antihypertensive and organoprotective effects, but also a large convincing base of research on their impact on the prognosis of life in patients with cardiovascular diseases: arterial hypertension, coronary heart disease, heart failure.

Purpose of the study. To make an informed assessment of comorbidity in patients with lymphoproliferative diseases. To evaluate the effectiveness of comorbidity scales CCI and CIRS-G in patients with lymphoproliferative diseases under treatment. To evaluate the effect of the conducted immunochemotherapy on the general comorbidity in this category of patients.

Material and methods. Two scales were used for calculations: Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). 127 primary patients with lymphoproliferative diseases aged 19 to 95 years old (the average age was 51.4) were examined from January 2018 till October 2019. The distribution of patients was based on the types of diseases: non-Hodgkin’s lymphomas — 59 (46.46%), Hodgkin’s lymphoma — 35 (27.56%), multiple myeloma — 20 (15.77%), chronic lymphocytic leukemia — 7 (5.51%) people, Waldenstrom’s macroglobulinemia — 3 (2.36%); each of the following diseases: hairy cell leukemia, T-cell leukemia of large granular lymphocytes, T-cell prolymphocytic leukemia - 1, amounted to 0.78% each.

Results. Comorbidity was detected in 46 patients who received immunotherapy, chemotherapy, combined chemoradiotherapy, which amounted to 36.22% of the total number of patients. Lesions of the peripheral and central nervous system — 20 (43.48%) patients, were diagnosed most frequently. Immunodefi ciency states — 19 (41.30%) people, came next, and diseases of the cardiovascular system — 12 (26.08%) patients, appeared to be least frequent.

Conclusions. When recalculating comorbidity on the CCI and CIRS-G scales, a significant aggravation of comorbidity after treatment, an increase in moderate and severe comorbidity were noted. According to the effectiveness of the CCI and CIRS-G scales in the treated patients, comorbidity is evaluated only approximately, since the Charlson Comorbidity Index does not include polyneuropathy, immunodeficiency states, thrombosis, ischemic heart disease, cardiac arrhythmias, gastritis, and thromboembolic complications and immunodeficiency states are absent in the CIRS-G scale. It is advisable to develop scales for assessing comorbidity, free from disadvantages mentioned above.

The structural- functional changes of heart chambers (changes in size, volume, shape and function of the heart) are the basis of the cardiac remodeling — an important element of the cardiovascular continuum, which is a key mechanism for the progression of the main cardiovascular diseases. Echocardiography is the main and available method for its assessment.

Material and methods. 1189 civil aviation pilots aged 54–68 who underwent routine in-patient examination at the Central Clinical Hospital of Civil Aviation were examined on a regular basis 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 for evaluation of the structural-functional indicators of the cardiovascular system in 1170 of flight personnel (98.4%).

Results. Enlarged size of the heart chambers was minor and moderate without heart failure and was detected in 4.8% of civil aviation pilots of senior age group. Abnormal geometry of left ventricular (LV) was revealed in 61.7% of the examined civil aviation pilots of senior age group: left ventricular hypertrophy (LVH) — in 1% of pilots (concentric LVH — 0.6 % and eccentric LVH — 0.4% cases), concentric remodeling of the LV — in 60.7% pilots. The decrease in LV ejection fraction was observed only in one pilot with EF— 53%. Pilots inapt for flying had enlarged chambers more often than pilots with fitness to fly (9.8% vs 3.35% pilots; p < 0,0001) and LVH (2.9% vs 0.45%; p < 0,001).

Conclusions. Echocardiography is an important method for cardiac chambers evaluation, including determination of type LVH geometry. It can be used in the medical assessment of civil aviation pilots of the senior age group.

Purpose. Study of the structural and functional characteristics of the heart in patients receiving long term hemodialysis (HD) treatment, and the identification of links with bone mineral, lipid disorders and anemia.

Material and methods. A total of 160 patients with chronic kidney disease (CKD) of the 5th dialysis (5D) stage (70 men, 90 women) who were treated in the hemodialysis departments of Izhevsk were examined. The average age of patients is 52.9 ± 2.0 years old (31 to 78 years old). The procedures were performed 3 times a week for 4–4.5 hours. The inclusion criteria were the duration of dialysis therapy for at least one year and the availability of informed consent. The adequacy index Kt / V amounted to1.56 ± 0.2. Echocardiographic examination assessed the structural and functional parameters, calculated Left Ventricular Mass, LVM index, relative thickness index, “inner membrane”, fractional-shortening of the middle fibers. A study of general clinical indicators of mineral-bone disorders, Lipemic index, erythrocytes was carried out.

Results. Violation of left ventricular (LV) geometry was found in 140 (87.5%) patients with 5D CKD stage. Concentric and eccentric hypertrophy prevailed. No significant dependence on patient’s sex was revealed. Patients with eccentric hypertrophy showed high rates of inter-dialysis weight gain (p < 0.05) and ultrafiltration (p < 0.05). In patients with concentric hypertrophy, high indicators of calcium-phosphorus metabolism (p < 0.05), pre-dialysis systolic pressure (p < 0.05) and pulsatility (p < 0.05) were obtained. They also tended to have higher triglyceride indices and more pronounced anemia. The correlation of the structural and functional state of the myocardium with the level of phosphorus, calcium, calcium-phosphorus ratio and pulsatility was established.

Conclusions. In most patients with stage 5D CKD, LV remodeling with the prevalence of concentric and eccentric hypertrophy is observed. No significant gender differences were found. In patients with hypervolemia requiring more intense ultrafiltration during dialysis, eccentric LV hypertrophy was detected. High values of pre-dialysis and pulsatility, as well as levels of calcium and phosphorus, are observed with the concentric remodeling type. Correlations of structural changes in the myocardium with calcium-phosphorus metabolism were revealed. The data obtained may open new ways of influencing the regression of LV hypertrophy and improve the cardiovascular prognosis in patients receiving programmed hemodialysis treatment.

The article provides a review of the literature on the possibilities of using various indices of insulin resistance in type 2 diabetes (T2DM) treatment. The main mechanisms of insulin resistance and its role in the formation of type 2 diabetes mellitus and other metabolic disorders are described. The main indices of insulin resistance, used in real clinical practice nowadays, are considered. Methods of their calculation are given. The effect of metformin and incretin active medications on insulin resistance is described. It was shown that the combination of these medications improves tissue sensitivity to insulin in patients with T2DM. Standard indicators for assessing glycemic control, such as fasting glucose and glycosylated hemoglobin (HbA1c), do not reflect the patient’s lipid metabolism. The use of insulin resistance assessment indices in patients with type 2 diabetes mellitus allows both, exercising glycemic control, and the metabolic disorders, often associated with carbohydrate metabolism disorders, monitoring. Using insulin resistance indices, it is possible to select the optimal treatment regimen for type 2 diabetes mellitus for a particular patient, to predict and evaluate the effectiveness of treatment in dynamics. Simple, generally available laboratory indicators and anthropometric data are used to calculate the indices of insulin resistance, and they are easy to measure. In this regard, the use of insulin resistance indices is possible in routine clinical practice.

The article represents a brief overwiev of current understanding concerning Periodic Disease (Familial Mediterranean fever). There are some recommendations for diagnostics and modern treatment with the use of Colchicine, as a protection from kidney amyloidosis development. Materials are based on the analysis of our own clinical data.

Uveitis is a heterogeneous polyetiological immune-mediated disease. Its common feature is inflammation of the choroid. The total prevalence of uveitis of various etiologies in the population varies from 15 to 38 people per 100 000. The cause of this pathology can be any infectious or somatic diseases (both endo- and exogenous in nature), when the body’s immune system is activated. The prevalence of the most common endogenous uveitis, caused by secondary foci of infection, is about 3% of the total number of diseases of this etiology. Uveitis, caused by Streptococcus bacteria, affects eyes due to dissemination from the foci of infection, being transmitted through the blood and lymph vessels. An important stage in the clinical diagnosis of uveitis is the determination of the etiological factor, which allows using of pathogenetic treatment regimens. The diagnosis is performed based on the totality of signs characterizing the specificity of the inflammatory process. Treatment and diagnosis of inflammation of the choroid are still one of the urgent tasks of modern ophthalmology.

The article contains historical materials for the development of domestic obstetrics, anesthesiology, transfusiology, forensic medicine and pediatrics in the late 19th and early 20th centuries in comparison with world examples. The names of dissertation studies and monographs in the presented directions are presented.