Rehabilitation is a strategic direction in medicine aimed at reducing or eliminating the consequences of diseases and injuries. A current challenge in rehabilitation science is developing approaches to address functional limitations in patients with stage 5 chronic kidney disease on dialysis (CKD 5D). In dialysis patients, the rehabilitation process reveals several factors that limit daily functioning, activity, and autonomy, thereby reducing the quality of life for this patient group. To ensure effective restoration of a patient’s activity and participation in renal replacement therapy, it is essential to correctly define rehabilitation goals. The optimal structuring and formulation of these goals are of fundamental importance for the effectiveness of medical rehabilitation. The main rehabilitation targets, which serve as the basis for goal selection, include lack of functional resources in the cardiorespiratory system; mobility impairments; impaired postural balance and motor control; biomechanical and orthopedic disorders of the musculoskeletal system; emotional status; adherence to rehabilitation.

This systematic review aimed to evaluate long-term outcomes after CABG in patients with FH and to identify major determinants of prognosis. A systematic literature search was performed in PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library following PRISMA guidelines. Among 139 identified records, 17 studies met inclusion criteria and provided data on surgical revascularization in heterozygous and homozygous FH. Historical cohorts (Takahashi, Kawasuji and colleagues) demonstrated that the use of internal thoracic artery grafts combined with aggressive lipid lowering—including LDL apheresis—provides 10–18-year survival rates of 80–90%, with most late adverse events related to vein-graft atherosclerosis. Contemporary registries (Béliard, Iyen, HELLAS-FH) indicate that failure to achieve LDL-C targets substantially increases residual cardiovascular risk, while diabetes and socioeconomic deprivation further worsen outcomes. Modern CABG cohorts (Deconinck et al.) show that FH is associated with more than a twofold increase in MACE risk when preoperative lipid control is suboptimal. Long-term CABG outcomes in FH can be favorable when arterial conduits are used and strict LDL-C targets are achieved. Prognosis is driven not only by coronary anatomy but also by the quality of secondary prevention, accessibility of lipid-lowering therapy, and comorbid conditions. Further research is needed in the contemporary era of PCSK9 inhibitors and lipoprotein apheresis.

Arterial hypertension is one of the most common diseases, the frequency of which increases with age. Elderly patients are the most vulnerable part of the population and are at risk of complications and deaths, especially in the presence of geriatric syndromes. Somatic diseases, including arterial hypertension, have their own characteristics, aggravate the course of senile asthenia, increase the risk of dependence on assistance, and worsen the prognosis. The article presents the features of clinical manifestations of arterial hypertension in elderly people with senile asthenia. Features of the choice of therapy and combination of the main antihypertensive drugs, starting blood pressure levels for drug therapy, as well as target blood pressure levels in various age groups.

The article investigates the interrelation between climatic factors, eating habits, and nutritional status in people aged 45–65 years old, as well as its significance for cognitive health. The influence of temperature, seasonality, precipitation, and solar radiation on food accessibility, formation of food preferences, and consumption of nutrients are analyzed. Specific adaptations to climatic conditions and their effect on the risk of nutrient deficiency related to cognitive disorders are discussed. Strategies for diet correction aimed at maintaining proper nutrition and cognitive health under varying climatic conditions are proposed. This review is based on a systematic search of the literature in the following databases: PubMed, eLibrary.ru, Google Scholar, and the Cochrane Library.

Objective: to carry out the analysis of the prevalence of the main risk factors for the development of chronic noncommunicable diseases within the framework of conducting medical examinations (on the example of a medical organization in Stavropol).

Materials and methods: the cohort study was conducted at the clinical base of the Department of Polyclinic Therapy of the Stavropol State Medical University. During the period from January to June 2025, 1,576 people aged 35–74 underwent medical examinations. Of these, 43.7% (689) were men, and 56.3% (887) were women; 51.7% were of working age. During the first stage of the preventive medical examination, participants completed questionnaires and underwent anthropometric measurements, blood pressure assessment, and laboratory and instrumental examinations.

Results: 21.3% of those who underwent medical examinations were considered healthy (group 1), 36.4% had risk factors for chronic noncommunicable diseases (group 2), and 42.3% had diseases (groups 3A and 3B).

Conclusion: conducting medical examinations among the adult population allows for the detection of chronic non-communicable diseases, risk factors for their development, timely establishment of dispensary supervision, and implementation of preventive measures aimed at strengthening health, increasing active longevity, and prolonging a person’s ability to work.

One of the factors influencing cardiac prognosis is changes in the balance of hormonal and metabolic parameters in the blood, particularly leptin, resistin, and testosterone, which are involved in chronic subclinical inflammation. The potential for using these markers in clinical practice formed the basis for the development of a prognostic model for determining cardiac prognosis after percutaneous coronary interventions with coronary artery stenting in patients with stable coronary artery disease, which was the aim of this study. It was shown that increased leptin and resistin levels, as well as decreased serum testosterone levels in patients with stable coronary artery disease, are associated with an increased risk of adverse cardiovascular outcomes within a year of coronary revascularization. In addition, an assessment was made of the influence of leptin, resistin, and testosterone levels on the outcome within 12 months after myocardial revascularization by constructing a prognostic model that allows assessing the likelihood of developing adverse cardiac events.

Objective: to investigate the association of the single nucleotide polymorphism (SNP) rs2476601 (C1858T) of the *PTPN22* gene with seronegative spondyloarthritis (SpA) in a European-descent population of patients from the Krasnoyarsk region.

Materials and methods: the study included 216 patients of European descent from the Krasnoyarsk Territory diagnosed with SpA according to the Amor criteria for spondyloarthritis. Genotyping of the *PTPN22* gene SNP rs2476601 was performed.

Results: the study confirmed an association between the CT genotype of the *PTPN22* gene SNP rs2476601 and SpA in the European-descent population of the Krasnoyarsk Territory. The CC genotype was statistically significantly more prevalent in the control group and is likely to have a protective effect.

Conclusion: the study showed an association between the CT genotype of the rs2476601 SNP of the PTPN22 gene and CSpA in the European population of the Krasnoyarsk Territory. Further research will improve the understanding of the role of CSpA in the pathogenesis.

Objective: to evaluate the clinical efficacy of a biologically active pectin supplement with trepang extract in patients with NSAID-associated upper gastrointestinal lesions.

Material and methods: a prospective observational study included patients aged 18–75 years with NSAID-associated upper gastrointestinal lesions. We compared two groups of patients: the first group (n=25) received a combination of standard medications and a pectin complex with trepang extract, while the second group (n=25) received standard therapy in accordance with clinical guidelines.

Results: the group of patients receiving the combination therapy showed statistically significant improvements in treatment outcomes.

Conclusion: the use of a pectin complex with trepang extract as an adjunct to standard therapy enhances the effectiveness of treating NSAID-related gastropathies.

Objective: to assess the concentration of extracellular matrix markers MMP-2, MMP-9 and their tissue inhibitors TIMP-1, TIMP-2 in the development of COPD of the high-risk category of exacerbations.

Materials and methods: 148 patients with COPD of the high-risk category of exacerbations were examined, 114 of them were men (77%) and 34 were women (23%), the average age was 64.41 ± 6.72 years. Two study groups were identified: the first group consisted of 75 patients with a predominantly bronchitic phenotype of the disease: 61 men (81%) and 14 women (19%) aged 44 to 72 years (average age 64.0 ± 7.8 years); the second group consisted of 73 patients with a predominantly emphysematous phenotype: 56 men (77%) and 17 women (23%) aged 54 to 72 years (average age 64.4 ± 6.7 years). The concentrations of MMP-9, MMP-2, TIMP-1 and TIMP-2 were assessed in the development of COPD in the high-risk category of exacerbations and compared with the clinical phenotype of the disease by the "sandwich" ELISA method, the indicators of the control group (healthy) were used as the norm.

Results: the development of COPD in the high-risk category of exacerbations is accompanied by an increase in the concentration of MMP-2 and MMP-9 against the background of a pronounced imbalance of the antiprotease system in favor of proproteolytic activity with insufficient production of TIMP-1 and inhibition of TIMP-2 production. In the bronchitic phenotype, an increase in the concentration of MMP-9 from 557 ng/ml to 1356 ng/ml, MMP-2 from 198 ng/ml to 213 ng/ml is detected against the background of insufficient production of TIMP-1 (less than 352.5 ng/ml) and inhibition of production of TIMP-2 (less than 98 ng/ml). The emphysematous phenotype is associated with high elastolytic activity of MMP-9 (1357 ng/ml and higher) and MMP-2 (214 ng/ml and higher) against the background of an increasing deficiency of tissue inhibitors. A high (90%) diagnostic significance of the MMP-2 level for the differentiation of phenotypes was determined. Conclusion: with the development of COPD with frequent exacerbations, pronounced elastolytic activity is noted, which is most pronounced in patients with a predominantly emphysematous phenotype. For the purpose of differential diagnosis of clinical phenotypes in patients with COPD of the high–risk category of exacerbations, it is necessary to use the concentration of MMP-2 with a threshold value of more than 214 ng/ml as a laboratory criterion for a predominantly emphysematous phenotype.

Conclusion: With the development of COPD with frequent exacerbations, pronounced elastolytic activity is noted, which is most pronounced in patients with a predominantly emphysematous phenotype. For the purpose of differential diagnosis of clinical phenotypes in patients with COPD of the high–risk category of exacerbations, it is necessary to use the concentration of MMP-2 with a threshold value of more than 214 ng/ml as a laboratory criterion for a predominantly emphysematous phenotype.

Objective: to study the content of MMP-9 and MCP-1 in patients with exacerbation of bronchial asthma combined with type 2 diabetes mellitus and exacerbation of bronchial asthma without of comorbid DM.

Materials and methods: 70 patients with moderate exacerbations of bronchial asthma (BA), including 36 patients with BA combined with type 2 diabetes mellitus (T2DM) (group I) and 34 patients with BA exacerbations without DM (group II), aged 38.8±2.7 years were observed. All patients had their serum and exhaled air condensate (EAC) concentrations of matrix metalloproteinase-9 (MMP-9) and monocyte chemotactic protein (MCP)-1 measured by enzyme-linked immunosorbent assay, as well as their monocyte phagocytic activity measured by the spontaneous test with nitroblue tetrazolium (NBT- test), phagocytic index (PI), and phagocytic number (PN).

Results: in patients of Group I, the concentrations of MMP-9 and MCP-1 in the blood serum exceeded those in Group II and the control group, as well as those in the ACE. The detected correlations between the studied indicators, between each indicator and the FEV₁ and HbA₁C levels, indicated their close relationship with each other in the exacerbation of BA combined with T2DM, and the negative impact of type 2 DM on the indicators. The results of the NBT-test in patients of groups I and II did not differ significantly, but were 1.5 times (p<0,05) higher than the control values and positively correlated with the value of MCP-1 in both groups of patients with BA. The phagocytic capacity of monocytes, despite the increased synthetic activity in patients of group I, was reduced. Thus, the РI in patients of Group I was 1.7 times (p<0,001) lower than in the control group, and similar in patients of Group II. The number of phagocytic cells in patients of Group I was 1.6 times (p<0.05) lower than in Group II, but significantly higher than in the control group.

Conclusions: patients with exacerbation of BA and BA combined with T2DM have a high concentration of MMP-9 and MCP-1 in the blood serum and EAC. The MMP-9 indicator in patients with BA combined with T2DM was noted to be the highest in EAC compared to the blood serum in these patients and compared to the concentration in the blood serum by 1.2 times (p<0.05). In patients with the association of BA and T2DM, a functional imbalance of phagocytic cells was revealed with a decrease in the number of cells capable of phagocytosis, along with an increase in the number of absorbed particles in phagocytic monocytes and increased production of MCP-1. The identified correlations between the values of the studied factors, bronchial patency, and HbA1c in patients with BA combined with T2DM may confirm their involvement in destructive and fibrotic processes in the TB.

Objective: To analyze various clinical manifestations of post-COVID syndrome, with a focus on muscle and joint lesions, identified in the population of the North Caucasus Federal District following COVID-19.

Materials and methods: a cohort study was conducted on the clinical base of the Department of Polyclinic Therapy of the Stavropol State Medical University and among residents of the North Caucasus Federal District: Stavropol Territory, the Karachay-Cherkess Republic, the Kabardino-Balkarian Republic, the Republic of North Ossetia-Alania, and the Republic of Ingushetia. More than 1,500 people were surveyed, but only 864 questionnaires with complete responses from those with confirmed COVID-19 were included in the statistical analysis.

Results: An analysis of the development of post-COVID joint syndrome showed that joint and muscle pain was experienced by 43.4% of the surveyed residents of the North Caucasus Federal District, with the highest percentage in the age groups of under 25, 26-35, and over 66 years.

Conclusion: The conducted study demonstrates the need to examine patients with newly developed symptoms of musculoskeletal disorders and justifies the development of combined methods for treating post-COVID joint syndrome.

Objective: to evaluate indicators reflecting the quality of life of patients with stable coronary artery disease in dynamics before and after coronary stenting, depending on the presence of symptoms of depression, and to compare the informative value of the Seattle questionnaire and SF-36 to identify changes in QOL associated with depression.

Materials and methods: in 85 patients with stable IHD, angina pectoris of 2-3 functional classes, QOL was assessed using two questionnaires: SF-36 (The Short Form – 36v2^® Health Survey, Optum) and the Seattle Angina Questionnaire (SAQ). QOL was assessed before PCI, after 3, 6 and 12 months. Depression symptoms were screened using the HADS and CES-D questionnaires.

Results: stable IHD was associated with initially reduced levels of QOL. The presence of depressive symptoms was associated with a decrease in the psycho-emotional component of QOL according to the SAQ and SF-36. In the group of patients with depressive symptoms, there was a positive dynamics of the physical component of QOL after stenting, both according to the SAQ and SF-36. Also with the use of the SAQ and the SF-36 questionnaire, in the group without depressive symptoms, most of the indicators of QOL after PCI remained stable throughout the observation period. There were found statistically significant correlations between the scales of the SAQ and the SF-36 questionnaire reflecting the physical condition.

Conclusion: сorrelation was found between the scores of the disease-specific Seattle Angina Questionnaire and the physical component scores of the generic SF-36 questionnaire, suggesting comparability of these scales for assessing physical status in patients with stable coronary artery disease. In the group of patients with stable CAD and concomitant depressive symptoms, QOL impairment was observed predominantly in the mental health domains. Percutaneous coronary intervention with stenting in patients with depressive symptoms was associated with improvement in the physical component of QOL.

Acromegaly is a severe, chronic neuroendocrine disorder, most commonly occurring in adults, characterized by excess growth hormone (GH) and subsequent elevated insulin-like growth factor-1 (IGF-1) levels. Cardiovascular complications are considered the most common complications in patients with acromegaly, negatively impacting quality of life and prognosis. This article presents a case of aneurysmal aortic dilation with severe aortic regurgitation in a patient with acromegaly. The patient underwent a successful Bentall procedure (aortic and aortic valve replacement), and 6 months after cardiac surgery, transsphenoidal adenomectomy was performed without complications.

The article presents the etiopathogenetic aspects of primary hyperparathyroidism (PHPT) development, caused by genetic mutations and neoplastic processes in the parathyroid glands. A detailed clinical case of a patient with PHPT is described, whose main manifestations were chronic kidney disease (CKD) and the formation of microliths in the pyelocaliceal system, due to hypercalciuria and increased phosphate excretion.

Monoclonal gammopathies are a heterogeneous group of diseases and conditions characterized by the proliferation of a single clone of plasma cells secreting immunoglobulins of homogeneous structure (M-protein). They occur with a frequency of 5-7 cases per 100, 000 population, predominantly in individuals over 50 years of age, especially those older than 70 years. The diagnosis of monoclonal gammopathy of undetermined significance (MGUS) is considered valid when monoclonal IgM paraprotein is detected in the blood at a concentration of less than 30 g/l, lymphoplasmacytic infiltration of the bone marrow is less than 10% of the examined trephine biopsy volume, and there are no signs of target organ damage that could be attributed to a lymphoproliferative disorder. Monoclonal immunoglobulin most often serves as a biomarker of clonal cell proliferation. In addition to plasma cell neoplasms (multiple myeloma, lymphoplasmacytic lymphoma, AL amyloidosis, and others), detection of paraprotein secretion reguires differential diagnosis with other lymphoproliferative disorders, myelodysplastic syndrome, Gaucher disease, systemic connective tissue diseases, liver disorders, sarcoidosis, Sjogren's syndrome, cold agglutinin disease and neurological conditions. B- cells dysfunction may also occur in various infectious and autoimmune diseases, immunodeficiency states, and solid tumors. The availability of serum protein electrophoresis with detection of an "M-gradient" within the compulsory medical insurance at the State Budgetary Institution of the Rostov Region "Consultative and Diagnostic Center "Zdorovye" in Rostov-on-Don" since 2019 has made it possible to assess the prevalence of this laboratory phenomenon and has increased physician awareness of the need for hematology consultation for such patients. The clinical course of MGUS is diverce: long-term benign paraproteinemia (>5 years) with possible transformation into a hematologic malignancy may occur, as well as manifestation of an oncohematological disease (AL amyloidosis), and, rarely, transient paraproteinemia associated with cytomegalovirus hepatitis. The manifestation of monoclonal gammopathies with a wide range of symptoms and syndromes necessitates a comprehensive diagnostic approach and interdisciplinary collaboration among physicians of various specialties.

This article analyzes a clinical observation of a patient with a subacute polyneuropathic syndrome characterized by moderate distal peripheral asymmetric lower paraparesis, calf atrophy, polyneuropathic-type superficial sensitivity disorders in the feet, and deep sensitivity disorders in the feet. During the patient's treatment, a thorough analysis of the patient's complaints and medical history was conducted, and an extensive range of tests was performed, including general clinical, biochemical, cerebrospinal fluid, immunohistochemical, neurophysiological, and magnetic resonance imaging tests. Based on the data obtained, a diagnostic hypothesis was formulated, and a repeated two-fold enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was performed, which was negative at the pre-hospital stage. The positive result allowed for the declaration of the patient's neurological symptoms and the formulation of a final clinical diagnosis.