Objective: to assess the perioperative outcomes of discontinuing antiplatelet agents for patients who have undergone surgery for lung neoplasm with coronary stents. Materials and methods: from January 2015 to June 2024, 12,738 patients underwent myocardial revascularization using percutaneous coronary angioplasty (PCI) at the State Budgetary Healthcare Institution «Research Institute - Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky» (RI-RCH No. 1), Krasnodar. The average age of patients was 64.1 ± 12.4 years (minimum 28, maximum 90 years). All patients were divided into two groups: Group C — coronary artery disease and concomitant diagnosis of lung tumor (94 patients); Group D — coronary artery disease without concomitant lung tumor, selected using a random number generator due to the large number of the initial cohort (150 patients). Results: all patients stopped taking antiplatelet drugs more than 5 days before lung surgery, and 67 cases stopped taking the drugs within 2 weeks. In 20 cases, the duration of treatment exceeded 2 weeks, since the surgical plan was superimposed on preoperative outpatient bronchoscopy or puncture biopsy, and the patients did not take the drug again. The overall incidence of in-hospital cardiovascular complications was 17.02%. One patient developed low-risk pulmonary embolism on the second postoperative day, two patients developed symptoms of congestive heart failure and their condition improved after treatment with diuretics and vasodilators, 10 cases of new-onset atrial fibrillation were recorded, and three patients developed hypotension requiring inotropic support in the first 5 postoperative days. Conclusions: for patients with lung neoplasms with coronary stents who required surgery, it was safe to stop oral antiplatelet drugs before lung surgery, and no serious adverse cardiovascular events or death occurred in the perioperative period.

Objective: to evaluate the effectiveness of the sand therapy method for correcting increased anxiety in patients living in inpatient social service institutions. Materials and methods: a cross-sectional prospective study involved 116 patients with coronary heart disease, stable angina, functional class 1–4, living in the Rostov boarding house No. 2 for elderly and disabled people. The average age of patients was 72,38 ± 9,15 years (56 men and 60 women). Patients were randomized into two groups: group 1 — experimental (receiving sand therapy) — 58 patients, and group 2 — control (receiving standard therapy, support and care) — 58 patients. Anxiety levels were assessed using the Hamilton Anxiety Scale and the Geriatric Anxiety Questionnaire, and adherence levels were assessed using the Morisky-Greene Compliance Scale. Statistically significant were the differences in data and correlations between them at p<0,05. Results: the conducted study assessing the effectiveness of the sand therapy method for correcting increased anxiety and influencing the level of adherence in patients living in inpatient social service institutions showed that the use of this method for 2 months statistically significantly reduces the level of anxiety in patients with coronary heart disease (p<0,05). Patients with coronary heart disease who are not adherent to therapy have statistically significantly higher levels of anxiety (p<0,05). A statistically significant negative correlation was established between the level of anxiety and adherence to therapy in patients with coronary heart disease living in inpatient social service institutions (p<0,05). Conclusion: the use of the sand therapy method can help improve the psychoemotional state and adaptation to new living conditions. The inclusion of sand therapy in a set of psychocorrectional measures for patients with coronary heart disease, carried out in inpatient social service institutions, can help improve the psychoemotional state and adaptation to new living conditions.

Objective: to study the cytokine profile in patients with coronary calcification of varying severity, without clinical manifestations of coronary artery disease. Materials and methods: the study included 68 male patients matched for age, including 25 people with coronary atherocalcinosis — corresponding to the moderate-risk group (group 1), 23 people with coronary atherocalcinosis — corresponding to the high-risk group (group 2) and 20 respondents of the control group, without clinical manifestations of coronary artery disease, for whom the coronary index was calculated using the Agatston method. Exclusion criteria were: diabetes mellitus, oncopathology, connective tissue diseases, chronic viral infections. Coronary calcium (CC) assessment and Agatston index calculation were performed using Smart Score software for coronary calcium calculation. Serum cytokine levels (IL-4, IL-6, IL-10, IL-17, FNO-α and IFN-γ) were measured using enzyme-linked immunosorbent assay (ELISA) with Cytokine test systems from Cytokin LLC, St. Petersburg, Russia. Statistical analysis of the study results was performed using Statistica 12.0 (StatSoft, USA). Results: elevated proinflammatory cytokine values were detected in both coronary calcification groups. Assessment of proinflammatory to antiinflammatory cytokine ratio indices reflects polarization of the cytokine profile in patients with coronary calcification via the proinflammatory pathway and prevalence of anti-inflammatory reserve in patients with less severe coronary artery calcification. Conclusion: a comprehensive assessment of the cytokine profile in patients with varying degrees of coronary calcification without clinical manifestations of coronary artery disease is demonstrated, showing the predominance of the proinflammatory response in both groups while maintaining suppressive immunoregulatory effects in patients with less pronounced coronary calcification. The data obtained are not unambiguous due to the peculiarities of the pleiotropic effect of cytokines, which requires a comparison of the results with quantitative and functional indicators of immunocompetent cells responsible for their synthesis.

Objective: to identify the association of polymorphic allelic variant rs692243 of the PRKAG3 gene with the development of WPW syndrome. Materials and methods: the study included 200 patients with WPW syndrome. To conduct the case–control study, a control group of 200 volunteers of comparable age and gender was selected, whose observation and health status were assessed during the WHO international projects «MONICA» and «HAPPIE». Comprehensive examination of patients included clinical, laboratory and instrumental studies. Diagnostic instrumental studies: electrocardiography (ECG), Holter ECG monitoring (XM-ECG), echocardiography (EchoCG), All patients of the main and control groups underwent a molecular genetic study. The phenol-chloroform DNA extraction technique was used in our patients. PCR-RDF analysis (polymerase chain reaction-restriction fragment length polymorphism) is a standard genotyping method for the study of the PRKAG3 gene. Statistical data processing was carried out using the Excel application software package, Statistica for Windows 10.0, IBM SPSS 20. The statistical significance in the analysis of the frequencies of alleles and genotypes of the PRKAG3 gene between the main and control groups was verified using the criterion χ2. The indicator of the relative risk of WPW syndrome for certain alleles and genotypes was identified as the odds ratio (OR). To carry out a one-factor logistic regression analysis, a step-by-step inclusion of indicators was carried out, which showed significant differences at the level of 0.1. Results: significant differences in the frequencies of genotypes and alleles for rs692243 of the PRKAG3 gene were found when comparing patients with WPW syndrome with those in the control group. The revealed frequency of the CC rs692243 genotype of the PRKAG3 gene in the main group of subjects was 8% (16 people), in the group of healthy volunteers -2% (4 people) (p <0.0001). The identified frequencies of the C rs692243 allele of the PRKAG3 gene also differed statistically significantly among individuals in the main and control groups. The predominance of carriers of the rare C allele among the patients of the main group was revealed -4% (17 people) compared to the control group, -2% (5 people), (p <0.001). Carriers of the C allele had a 1.605–fold higher risk of developing WPW syndrome compared with healthy volunteers (95% confidence interval 1.475-1.771; p <0.001) compared with carriers of the G allele. Conclusion: the revealed associations of the single nucleotide variant rs629243 of the PRKAG3 gene with the development of WPW syndrome prove the risky influence of the CC genotype and the C allele on the development of this pathology.

Objective: comprehensive assessment of the clinical characteristics and microbiocenosis of the pharynx and palatine tonsils in patients with chronic compensated tonsillitis (CCT) in combination with chronic pharyngitis (CP). Materials and methods: the study included 238 patients of both sexes with CCT and CP, who were divided into 3 groups: group I (n=79) — patients with signs of inflammation mainly in the tonsils; group II (n=97) — patients with manifestations of inflammation mainly in the mucous membrane of the pharynx; group III (n=62) — persons with clinical signs of exacerbation of CCT and CP equally. The study included: clinical examination, bacteriological analysis with isolation, identification and counting of the number of microorganisms in the microbial focus. Statistical processing of the obtained data was carried out on a personal computer using the Statistica 10.0. Differences were considered statistically significant at p<0.05. Results: the occurrence of resident microorganisms was lower in group III (p<0.05); coagulase-positive Staphylococcus spp. were more often recorded in groups II and III of patients, while in group III significantly more often than in group II (p<0.05); fungi of the genus Candida were detected more often in groups II and III than in group I (p<0.05). In all groups, movement of the transient β-hemolytic Streptococcus spp. was observed. in permanent types: their concentration of 106 or more was observed in the examined patients in all three groups, amounting to 77.7%, 80.4% and 91.7%, respectively. In all study groups, from 20.9% to 46.7% of the studied microbiocenoses were associations of 3-4 components, and monocultures were statistically significantly more common in group I. In 57.14% and 52.3% of cases, respectively, multiple resistance to antibacterial and antifungal drugs was recorded. Conclusions: the qualitative and quantitative composition of microbiocenoses of the pharynx and palatine tonsils in patients with CT with CP differs depending on the clinical manifestation of this comorbidity. Microorganisms growing in the pharynx and tonsils of patients with CCT and CP are characterized by high resistance, often multiple, to antimicrobial drugs. The results obtained during this study confirm the need to search for and introduce into medical practice new antibacterial drugs for effective pharmacotherapy combination of CT with CP.

Objective: To study the interrelationships of MCP-1 levels in the blood of patients with dyslipidemia and stage 5 chronic kidney disease on hemodiafiltration (HDF) with metabolic and hemodynamic parameters, as well as the risk of cardiovascular complications. Materials and methods: a single-stage, cohort study with a retrospective analysis of cardiovascular complications. The study included 103 patients with an average age of 61.9 ± 12.9 years. Cardiovascular complications were recorded, which at the time of the examination had already developed during the period of dialysis treatment. Lipidogram parameters, including lipoprotein(a) and oxidized lipoproteins, were determined in all patients. Metabolic parameters, signs of vascular calcification, vascular stiffness, and nutritional status were also determined. Results: the average value of MCP-1 in the studied cohort of patients was 54.3 ± 13.6 pg/ml and ranged from 31 to 79 pg/ml. In patients with HDF, an increase in the concentration of MCP-1 occurred unidirectionally with an increase in the levels of LP(a) and LDL, which play an important role in the process of atherogenesis. There was also a unidirectional increase in MCP-1 levels in the blood as the severity of uremic calcification of the valves and aortic wall, hyperuricemia, and signs of vascular inflammation (CRP) increased. An increase in MCP-1 levels was accompanied by a high probability of detecting vascular calcification and calcification of the heart valves, peripheral atherosclerosis, coronary lesions, cerebral stroke (MI) and a combined MI + MI + CHF point. Conclusion: MCP-1 has a negative effect on the risk of cardiovascular events, both as an independent effect and as a combined effect with parameters of lipid metabolism and hemodynamic factors. The latter was the motivation for the development of the original LDL-C + LP(a) scale + MCP-1, which allows you to assess the risk of developing cardiovascular complications.

Objective: to study the taxonomic composition of the colonic fungal microbiota in patients with UC and to develop a model for predicting the effectiveness of therapy based on the presence of fungal microorganisms. Materials and methods: 128 patients with UC — 86 patients in the phase of UC relapse and 42 patients in the phase of remission — were included in the study. The patients were ranked into groups depending on the clinic phase, activity and severity of the disease. The patients' coprofiltrate was examined by NGS sequencing of 18S ribosomal RNA to determine the taxonomic composition of the fungal microbiota of the colon. Results: the mycobiotic landscape of the colon of patients with UC was characterised by the presence of both classical representatives of fungal flora — Candida, Malassezia, Saccharomyces, Penicillium, and unicellular protozoa — Blastocystis, in particular species of Blastocystis_hominis and Dientamoeba_fragilis — colonisers of the intestinal microbiome with pathogenic properties and associated with inflammatory bowel disorder. Based on the data on the percentage of detected fungal genera, a model for the efficacy of conservative therapy of UC was developed. Conclusion: the fungal profile of the colonic microbiota in patients with UC can be considered as a potential diagnostic tool, and the model of remission prediction based on microorganism representation can be considered as a promising method of disease course control.

Objective: study of the structure of comorbid oncological pathology in patients with MS in the Rostov region. Description of the difficulties of differential diagnosis in patients with neoplasms and identification of features of the course of MS in patients with comorbid oncological pathology, first of all, the rate of increase in disability. Materials and methods: the study included 44 patients with significant comorbid oncological pathology (neoplasms of the central and peripheral nervous system, malignant tumors) using patient questionnaires, laboratory and instrumental research methods. Statistical processing of the obtained results was carried out using the Mann-Whitney U test for comparison of independent samples. Results: currently, among the living patients with MS we observed, a combination of oncological pathology with demyelinating disease was identified in 38 women and 6 men aged 35 to 63 years (average age 47.64 +/- 8.25 years). The average age of detection of oncological pathology in the patients with MS we observed was 40.23+/-7.66 years. All 33 patients with malignant neoplasms of various localizations received surgical treatment, followed by chemotherapy (in 10 patients) and/or radiation therapy (in 4 patients); 16 of them, after curing the oncological pathology, resumed first-line DMT therapy. The average annual increase in the EDSS score for each patient with MS in the presence of comorbid oncological pathology and for patients with MS without a concomitant oncological process indicates that the presence of concomitant oncological pathology does not influence the rate of annual increase in the EDSS score of the patients we observe. Conclusions: in accordance with global data, the majority of patients with comorbid cancer pathologies were represented in the age group over 60 years, with the average patient age being 40.2 years. When assessing the dynamics of the EDSS score increase, no significant differences were identified in the clinical course of MS in patients with and without comorbid cancer. Further study of competing oncological pathologies in MS will allow us to develop formal algorithms for patient management and optimize the choice of treatment both in terms of the neoplastic process and in relation to long-term therapy of MS.

Right ventricular pathology diagnostics often causes difficulties. The article presents a clinical case of difficulty in verifying a two-chamber right ventricle. A patient with a history of resection of aortic coarctation but uncorrected ventricular septal defect eventually developed high-velocity flows in the right ventricle cavity, diagnosed by transthoracic echocardiography, which were regarded as manifestations of intraventricular obstruction in hypertrophic cardiomyopathy of the right ventricle. During additional examination, discrepancies arose in establishing the final diagnosis. Differential diagnosis was made between hypertrophic cardiomyopathy of the right ventricle, non-compact cardiomyopathy of the right ventricle and a two-chamber right ventricle.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by polysyndromic lesions of various organs and systems. Clinical manifestations of SLE may include lesions of the skin, joints, kidneys, serous membranes, and hematopoiesis system, which significantly complicates the diagnosis and management of patients. This paper presents three clinical cases demonstrating the variety of manifestations and severity of the course of SLE. In the first case, the disease debuted with a massive hydropericardium, which required surgical intervention. In the second case, the patient was observed for a long time with autoimmune nephritis, but later developed pulmonary embolism, which required correction of therapy. The third case was characterized by high activity of the disease with polyserositis, pancytopenia and severe skin manifestations, which required the use of genetically engineered biological therapy (GIBP). In the presented cases, a comprehensive examination of patients was performed, including immunological markers, instrumental diagnostic methods (CT, ECHO-CS, biopsy), as well as a differential diagnosis with hemoblastosis, vasculitis and other systemic diseases. The treatment was based on glucocorticosteroids (GCS), cytostatics (cyclophosphamide) and biological therapy (rituximab), which made it possible to stabilize the condition of patients and reduce the activity of the disease. Thus, the presented clinical cases illustrate the significant variety of clinical manifestations and the complexity of the diagnosis of SLE, which emphasizes the need for a multidisciplinary approach to the management of such patients. Modern therapies, including GIBP, make it possible to control the activity of the disease and improve the prognosis of patients with severe forms of SLE.

A clinical case of the rare kidney disease ALECT-2-amyloidosis, which is the first description of this pathology in the Russian Federation, is presented. The data of patient D., 72 years old, who sought medical help in December 2024 with complaints of severe general weakness, shortness of breath, lack of appetite, and widespread edema are presented. There were signs of nephrotic syndrome. A morphological examination of the kidney biopsy revealed a pattern of amyloidosis with a predominant lesion of the arterial walls, arterioles, and glomeruli. At the same time, the deposits were identified as not belonging to the AA-type and AL-type using immunofluorescence analysis using appropriate antibodies. Proteomic analysis of urine revealed an increase in the level of leukocyte chemotoxic factor 2 (LECT2), which indicates its relation to amyloidogenesis. At the same time, in the cases described in the literature, as a rule, there was no increase in its plasma level, which was also not recorded during a proteomic blood test in our patient. Thus, amyloidosis with kidney damage was caused in the patient by LECT2 and was identified as LECT2-amyloidosis.

Myotonic dystrophy type 2 is an autosomal dominant neuromuscular disease characterised by slowly progressive muscle weakness and difficulty in muscle relaxation after contraction (myotonia). The disease has a significant impact on the psychological well-being, economic status and overall quality of life of patients. Two clinical cases of myotonic dystrophy type 2 are considered. It is noted that myalgia is the main symptom reducing the quality of life.

Hirschsprung's disease (HD) (congenital agangliosis of the colon) was isolated into an independent nosological unit in 1886 by the Copenhagen pediatrician Hirschsprung. This disease is diagnosed in children and adults. To date, the etiology and mechanisms of HD disease development have been revealed, effective methods of diagnosis, surgical treatment and conservative management of patients have been developed. Treatment can significantly improve the prognosis and quality of life of patients. The clinical observation of a patient with HD who underwent surgical treatment 16 years after the disease was detected is presented.

Hemorrhagic syndrome occurs as a result of vascular wall damage, disturbance of the structure, function and number of platelets, coagulation hemostasis disorders. For diagnosis, not only laboratory parameters are important, but also complete information about the patient’s condition, history, comorbidity, heredity, ongoing treatment. The use of standardized tools such as ISTH-SSC BAT scale, bleeding risk scales help in diagnosis and determination of patient management tactics. The causes of hemorrhagic syndrome of hereditary genesis are more often thrombocytopathies, hemophilia, Willebrand’s disease, telangiectasia; acquired - secondary thrombocytopenia and thrombocytopathies, DIC, prothrombin complex factor deficiency, hemorrhagic vasculitis, as well as drugs (antithrombotic, cytostatics, antibiotics and others). The clinician has an important role in diagnosis and treatment, which requires knowledge of modern guidelines, clinical recommendations, instructions, standards and other regulatory documents.

Despite the heterogeneous etiology of myelopathies and the stereotyping of the main clinical manifestations of spinal cord lesions, pathognomonic clinical features, signs of involvement of extraspinal structures, features of the course of the pathological process, differences in the presentation of lesions on sagittal and axial magnetic resonance images and laboratory diagnostic data allow differential diagnosis between both inflammatory and non-inflammatory forms, and within these groups themselves.