Weight loss and lifestyle changes can reverse the pathophysiological processes underlying type 2 diabetes, including achieving remission of the disease. A search and analysis of 9109 literature sources from the Scopus, Web of Science, PubMed/ MedLine, The CochraneLibrary databases was carried out for the keywords «diabetes remission», «diabetes reversal», «bariatric surgery», «very low-calorie diet», «low carbohydrate diet». The review presents and critically evaluates the current possibilities of achieving remission of type 2 diabetes mellitus with the help of bariatric surgery, medications, very low-calorie and lowcarbohydrate diets, and exercise.

COVID-19 infection is associated with many different systemic complications. Among these, cardiovascular system complications are particularly important as these are associated with significant mortality. There are many different subgroups of cardiovascular complications, with arrhythmias being one of them. Arrhythmias are especially important as there are a substantial percentage of patients who have arrhythmia after a COVID-19 infection, and these patients are seen with an increased mortality rate. Arrhythmias in COVID-19 patients are associated with inflammation, electrolyte abnormalities, hypoxia, myocardial ischemia, cytokines, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review of PubMed/MedLine articled presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult COVID-19 populations.

The search for new antitumor and antimetastatic therapy targets is a priority task for interdisciplinary research in medical chemistry, experimental pharmacology and pathological physiology. One of the promising scopes of research in this direction is to study the possibility of modifying the polymerization process of tubulin, the main structural component of the microtubules in the cellular cytoskeleton. Various options for influencing microtubules can be used to repurpose already known and develop new antitumor drugs.

Objective: assessment of cognitive impairment (CI) in «fragile» patients with arterial hypertension (AH) and chronic heart failure (CHF).

Materials and methods: the study involved 168 patients with hypertension and senile asthenia syndrome (SSA) over the age of 80 years. Taking into account the presence of CHF, all patients were ranked into two groups: group 1 – patients with hypertension, CSA and CHF (n=84), group 2 – patients with hypertension, CSA without CHF (n=84). Cognitive functions (CF) were assessed by neuropsychological testing using the MMSE short scale, which determines the patient’s mental status.

Results: anemia (p=0.033), AF (p=0.003) and type 2 diabetes (p=0.042) were more common in group 1 patients, and higher BMI (p<0.001) in group 2. CI was recorded in 95.2% of patients (50.6% non-dementic CI, 48.8% mild dementia, and 0.6% moderate). In patients with CAS, AH and CHF, mild dementia was more often detected (p=0.005), and in patients without CHF, non-dementic CI was more often detected (p=0.000). In addition, in the 1st group of patients, a decrease in concentration of attention (p=0.036), and spatial and visual memory (p=0.048) was more often recorded in comparison with patients without CHF. Women of the 1st group, in comparison with men, more often had a mild degree of dementia (p=0.050). In men, there was a clear trend towards a more frequent occurrence of non-dementic CI (p=0.068). In addition, in the same group, 2.3% of women had moderate dementia, and 7.5% of men had no CI at all. Among patients with SSA and AH, but without CHF, there were no gender differences in the incidence of cognitive impairment.

Conclusions: the obtained results of the study indicate the adverse effect of CHF on cognitive functions in senile patients with AH and CAS. Timely and optimal treatment of not only hypertension, but also CHF will reduce the risk of development and severity of cognitive impairment in such patients.

Objective: to study the level of fibrosing factor in patients with coronary heart disease and chronic kidney disease.

Materials and methods: the study included 115 patients, mean age was 67.56 ± 12.42 years (63 men and 52 women) with ischemic heart disease (CAD), stable angina (tension), functional class 1–3, chronic kidney disease (CKD) C1-C4. The level of serum fibroblast growth factor 23 (FGF 23) was assessed using a multimatrix enzyme immunoassay for the quantitative determination of FGF 23 (Biomedica FGF 23).

Results: in patients with CAD and CKD, the level of serum FGF23 progressively increases as the stage of CKD worsens and can be regarded as an early marker of CKD progression in patients with CAD. When studying the correlation between the level of serum FGF 23 and clinical and laboratory data, it was found that there is a correlation between FGF 23 and age, creatinine, urea, glomerular filtration rate.

Conclusion: in patients with CAD and CKD, it is advisable to use the determination of the level of fibrosis factors to identify patients with a high risk of cardiovascular complications.

Objective: estimate the clinical status, a metabolic profile and carried-out cardiotropic, hypoglycemic therapy at outpatients with diabetes 2 types in real clinical practice.

Material and metods: the outpatient records of 81 patients of both sexes (average age 63.7 + 1.3 years, men 33 (40.7%) with type 2 diabetes mellitus, who are under dispensary observation in one of the polyclinics of Krasnodar, were analyzed. All patients had some clinical (“experience” of diabetes, body mass index) parameters, blood pressure level, laboratory indicators (fasting glycemia, glycated hemoglobin, total cholesterol, high and low density lipoproteins, triglycerides and medication (antihypertensive, lipid-corrective, antithrombotic, hypoglycemic) therapy evaluated.

Results: among patients with type 2 diabetes mellitus, women predominated, most of the patients had obesity of the 1st degree. In 27.2% there was no documented concomitant cardiac pathology, the rest had arterial hypertension and coronary artery disease. Antihypertensive therapy included from 2 to 5 drugs, including all patients receiving ACE inhibitors or sartans, which in 2/3 of cases were combined with amlodipine and in equal quantities with diuretics and beta-blockers. Only 8.5% of patients reached the target level of blood pressure. Lipid-lowering therapy in more than 90% of patients included statins in inadequately low doses, which led to the failure to achieve the target level of low-density lipoproteins in 95% of patients. Antithrombotic therapy was taken by more than 90% of patients, but in a quarter of them without documented indications. One in four outpatients with type 2 diabetes mellitus is diagnosed with nonvalvular atrial fibrillation. Only 71.4% of patients received direct oral anticoagulants. Among the means of hypoglycemic therapy, oral drugs (metformin, sulfonylurea derivatives) or their combination with insulin prevailed.

Conclusion: in most of the patients examined with type 2 diabetes, the main goals of cardiotropic and hypoglycemic therapy were not achieved. To improve the prognosis and quality of life of such patients, it is necessary to conduct comprehensive adequate treatment based on modern recommendations.

Objective: to study the interconditionality of changes in the fluid shear stress on the endothelium (FSE) of the common carotid artery (CCA) wall which is intact from atherosclerosis with the value of the Cardiac Calcium Score (CCS) among patients with e arterial hypertension (AH).

Materials and methods: the study included 99 patients with AH, 52 of them had atherosclerotic lesions of the brachiocephalic arteries (BCA). The ultrasound investigation of the carotid arteries with the determination of FSE in the intact area of the CCA, multispiral computed tomography of the coronary arteries with the determination of CCS were performed to all patients.

Results: the prevalence of BCA atherosclerotic lesion in the study was 53%. The mean value of FSE for patients with AH and BCA atherosclerosis (group 1) were 660.7 (185.6) c-1, for patients with AH without its (group 2) — 735.8 (149.8) c-1, p = 0.009. The parameters of the lipid spectrum in patients of both groups were comparable. Мedian value of CCS in patients with atherosclerotic lesions of the BCA were statistically significantly higher (15.00 (0.00; 178.00),) compared with patients of the group 2 (0.00 (0.00; 171.00), at p = 0.001. The chances of detecting coronary artery calcification among patients of group 1 are in 2 times higher (OR = 2.25, 95% CI: 1.58-8.33) than among patients of group 2. Low FSE values correlated with male gender (rs = 0.40 (95% CI: 0.22; 0.55) p <0.001) and increasing of CCS (rs = -0.23 (95% CI: -0.41; -0.04) p = 0.022).

Conclusions: the prevalence of atherosclerotic lesions of the BCA among patients with AH without a history of symptomatic diseases associated with atherosclerosis was 53%. In the group of patients with AH and atherosclerotic lesions of the BCA, median values of CCS were significantly higher, and coronary artery lesions were detected significantly more often (OR = 2.25, 95% CI: 1.58-8.33) than among patients with AH and intact BCA. The mean value of FSE for patients with AH and BCA atherosclerosis were statistically significantly lower than for patients with AH without it and amounted to 660.7 (185.6) c-1 and 735.8 (149.8) c-1, respectively, p = 0.009. Low FSE values correlated with male gender and increasing of CCS 

Objective: to study the parameters of the compound body composition in middle-aged people with arterial hypertension (AH) to determine the targets for prevention and treatment.

Materials and methods: 37 men and 58 women with AH aged 45 to 59 years were examined. Questioning, anthropometry with determination of waist circumference (WC), body mass index (BMI), study of compound body composition by bioimpedancemetry, as well as measurement of blood pressure (BP) were carried out.

Results: overweight and obesity were found in 87,3% of middle-aged people with AH. In both sexes, there was a direct correlation of visceral fat (VF) with age, BMI, WC and also with diastolic BP.

Conclusion: detection of hypertension, increased BMI, VF is necessary for diagnosing metabolic imbalance in middle-aged people in order to further conduct non-drug and preventive therapy, as well as reduce the development of possible complications.

Objective: to study clinical and epidemiological features and risk factors in patients with multiple sclerosis (MS) living in Rostov region and Republic of Ingushetia (RI)

Materials and methods: we examined 87 patients with definite multiple sclerosis. We evaluated neurological deficiency and the specificity of MS course. We have also studied serum concentration of vitamin D3 metabolite — 25(ОН)D3 by ELISA method.

Results: the prevalence of NS in RI was 16,9 cases for 100 thousand of the population as of 1.01.2022. Risk fаctors of MS dеvеlopment were cоntаct with pеtrоl, оil prоducts аnd pаints аt аgу оvуr 15 yеаrs оld, cоntаct with аnimаls аt аgе bеfоrе 15 yеаrs оld, a surgicаl intеrvеntiоn, sеvеrе cаriеs аt аgе оvеr 15 yеаrs оld, heаd injury at аny аgе, tоnsillitis, meаslеs, rubеllа оccurrеd аt аgе bеfоrе 7 yеаrs оld аnd hеrpеtic infеctiоn аt аny аgе, thе diffеrеncеs wеrе stаtisticаlly signifiаant. In fеmаlе MS pаtiеnts wе оbsеrvеd highеr pаrаmеtеrs of rеlаpsе frеquеncy аnd MS prоgrеssiоn sрееd, the diffеrеnсеs wеrе stаtisticаlly significаnt. Ассоrding tо thе cоmpаrisоn оf sеrum vitаmin D cоncеntrаtion wе rеvеаlеd a stаtisticаlly rеliаblе dеcrеasе of sеrum vitamin D lеvеl in male MS patients living in RI compared to the control group.

Conclusions: the regions of Republic of Ingushetia belong to the areas with low and medium multiple sclerosis development risk. The external factors of MS development risk confirm the multifactor nature of the disease. The decrease of serum vitamin D concentration is one of the main modifiable MS risk factors.

Dilated cardiomyopathy (HCM) can be caused by a variety of causes. The most common causes of DCM include post viral myocarditis, alcohol abuse, and the use of anabolic steroids. In the given clinical case, the possible causes of DCM were presumably several factors at the same time — acute viral infections, the use of steroids, which led to severe heart failure with a low ejection fraction.

The article is devoted to a clinical case of management of a young woman with an aneurysm and two atrial septal defects after the development of acute myocardial infarction. It conveys aspects of differential diagnosis and long-term management. 

The variative coagulation abnormalities with thrombotic and microvascular complications are distinguishing feature of the severe new coronavirus infection (COVID-19) pathogenesis. Abnormal coagulopathy is directly related to the risk of death in COVID-19 patients. In many patients with COVID-19, hemostasis disorders have been observed, which increase the risk of developing DIC (disseminated intravascular coagulation), thrombotic microangiopathy or antiphospholipid syndrome as a result of the pathogenetic factors combination: inflammatory response, endothelial dysfunction, increased platelet consumption, microvascular thrombosis. The mechanism of coagulopathy associated with COVID is still being found, COVID-associated coagulopathy exemplifies the potentiating multi-factor interactions between the immune system and the coagulation. We’re reporting a fatal case of 51-year-old male with COVID-19, complicated by severe acute respiratory syndrome (SARS) and severe thrombocytopenia, markedly enhanced fibrinolytic activity with skin-hemorrhagic syndrome, thrombotic complication (myocardial infarction), probably related to the DIC. This case demonstrates the need more basic and clinical research is warranted to further our understanding of the role of coagulation disorders mechanism in COVID-19 to prevent severe outcomes and mortality.

Federation Despite the increased interest of the scientific community in diseases associated with atherosclerosis, the widespread use and availability in clinical practice of diagnostic research methods (Doppler ultrasound, CT, MRI), allowing to visualize the vessels of the abdominal cavity, chronic mesenteric ischemia remains an underestimated, undiagnosed and insufficiently studied disease, mainly due to the lack of knowledge and awareness among doctors, which leads to delays in diagnosis and delayed treatment of patients, which significantly increases the risk of death. Currently, new recommendations for clinical, physical, laboratory and instrumental diagnostics of chronic mesenteric ischemia have been developed and are being implemented. These documents should help primary care physicians in early detection of this disease, optimization of treatment and reduction of mortality from this pathology. The lecture highlights the issues of etiology, pathogenesis, classification, clinical course, laboratory and instrumental diagnostics, as well as the possibilities of conservative and surgical treatment of chronic mesenteric ischemia.

The article discusses the concept of “technology” in the educational process, the role of technology in higher medical education; presents the implementation of some educational technologies used in higher medical education, in the process of teaching hospital therapy. In the article, the authors consider the situational task as a kind of “case technology” in teaching hospital therapy.