Background. Morbidity and mortality from cardiovascular diseases in Russia is high. Arterial hypertension is the main risk factor for cardiovascular diseases and mortality. At the same time, mortality is also caused by coronary heart disease. It is important that the course of cardiovascular diseases depends on early diagnosis and the immediate appointment of adequate therapy.

Materials and methods. In this study, 124 physicians were surveyed. In the first part, antihypertensive therapy was studied, the results of a survey of 104 respondents were used. In the second part, we studied the therapy prescribed in the first year to patients after acute coronary syndrome, using responses received from 20 physicians.

Results. Most of the respondents had the specialization of a general practitioner and had sufficient clinical experience (over 20 years). However, a large number of patients received irrational combinations of drugs. Therefore, many patients with arterial hypertension did not reach the target blood pressure levels within the recommended 3 months. Also, respondents often prescribed a combination of acetylsalicylic acid and clopidogrel to patients during the first year after acute coronary syndrome as a double antiplatelet therapy with the proven effectiveness of using ticagrelor. When prescribing statins, most of the surveyed physicians preferred atorvastatin if there was information about the greater effectiveness of rosuvastatin. 35% of respondents prescribe trimetazidine to more than half of patients during the first year after acute coronary syndrome.

Background. The results of numerous studies have demonstrated a strong relationship between cardiovascular mortality and cardiac biomarker levels. However, a significant number of these studies were devoted to assessing the prediction of cardiovascular events during the acute period of COVID-19. Therefore, the search for markers for predicting the unfavorable course of chronic heart failure in patients with type 2 diabetes mellitus (SD2) and CKD who have undergone COVID-19 is relevant.

Objective. Purpose of the study was to prediction of the unfavorable course of chronic heart failure in comorbid patients who have undergone COVID-19.

Materials and methods. The study included 181 patients with verified cardiovascular pathology and chronic heart failure with preserved ejection fraction of NYHA functional class 1-3, suffering from type 2 DM and CKD, which were divided into two groups: group 1 included 135 patients who had suffered COVID-19 not earlier than 3-6 months ago, in group 2 (n = 46) COVID there was no history of-19. The duration of the study was 18 months. Quality of life was determined using the Kansas and Minnesota Questionnaire, ECHOCG hemodynamics, glomerular filtration rate, cardiac dysfunction biomarkers NT-proBNP and sST2.

Results. The results of the study showed that the reduced clinical and functional status of patients who had recovered from COVID-19 was confirmed by the results of TSC (p = 0.0004) and the total SJC score (p < 0.001). Low indicators of the physical component of health affected the summary assessment of quality of life in patients undergoing COVID-19 according to the results of the KCCQ questionnaires (55.81 points versus 62.86 points in the comparison group, p < 0.001) and MLHFQ (43.0 points versus 38.0 points in the comparison group, p = 0.002). In the first group, more significant adverse changes in the indicators of remodeling of the left heart and hemodynamic disorders were identified, which corresponded to significantly higher concentrations of markers of myocardial dysfunction. Using multivariate logistic regression analysis, a basic statistical model 1 was built to predict the probability of HF decompensation and cardiovascular death (CVD) in patients with chronic heart failure, diabetes mellitus type II and chronic kidney disease who underwent COVID-19. According to the obtained results, the most significant parameters for assessing the probability of CCT of Model 1 were the number of points on the clinical assessment scale, stroke volume, left ventricular mass index, NT-proBNP concentration. This model, sensitivity and specificity of which was 85.6%, 79.2% respectively, had a fairly high prognostic potential (AUC – 0.856; 95% CI: 0.717-0.994; p < 0.001). The inclusion of sST2 in the original model resulted in an increase in the area under the ROC curve (AUC – 0.91; 95% CI: 0,812-0,992; р < 0,001). Thus compared to the baseline model including NT-proBNP concentration, the addition of sST2 increases the predictive power of the model with respect to the risk of CCT in patients with CHFsEF with diabetes mellitus and chronic kidney desease who have had COVID-19. The results of the calculations confirm the high quality of the model with a sensitivity of 93.3%, specificity of 78.9% and accuracy of 86.1%. Comorbid patients with chronic heart failure who underwent COVID-19 have more severe clinical manifestations, structural and functional disorders of the heart and kidneys, higher concentrations of biomarkers of cardiac dysfunction NT-proBNP and sST2. Soluble ST2 outperforms NT-proBNP in predictive properties and is a priority for assessing the risk of heart failure decompensation and mortality in patients with comorbid pathology who underwent COVID-19.

Background. Patients with impaired carbohydrate metabolism are at risk of developing diabetic fetopathy, premature birth and surgical delivery. Strict follow-up to the relevant clinical guidelines for the diagnosis of carbohydrate metabolism disorders, pregnancy management, the choice of the planned date and method of delivery are aimed at reducing the risk of obstetric and perinatal complications.

Objective. To analyse perinatal outcomes, duration and method of delivery in patients with impaired carbohydrate metabolism over the past 5 years (2018, 2022).

Materials and methods. The birth charts of 885 patients with carbohydrate metabolism disorders who were hospitalised prenatally and delivered in the maternity hospital were analysed.

Results. The number of patients with carbohydrate metabolism disorders increased 2.3 times over the past 5 years, from 13,6% (315/2320) in 2018 to 30,9% (570/1840) in 2022 (RR = 0,58; 95% CI 0,53-0,64; p < 0,001), due to patients with GDM, the number of births increased by 2,5 times in relation to the total number of deliveries, from 11,7% (271/2320) in 2018 to 29,3% (540/1840) in 2022 (RR = 0,55; 95% CI 0,49-0,60; p < 0.001). Structure analysis of gestational complications showed that the incidence of diabetic fetopathy is 2,4 times less often: 7,9% (45/570) in 2022 vs 19,4% in 2018 (61/315) (RR = 1,77; 95% CI 1,46-2,14; р < 0,001), a decrease in moderate preeclampsia by 2,3 times is determined. Reduction in the frequency of perinatal complications allows you to prolong pregnancy to full term. The number of preterm births decreased by 5%, from 6,4% (20/315) in 2018 to 1,4% (8/570) in 2020 (RR = 2.07; 95% CI 1,61-2,67; р < 0,05). The number of planned births increased by 18,6%, from 25,1% (79/315) in 2018 to 43,7% (249/570) in 2022 (RR = 0.57; 95% CI 0,46-0,70; р < 0,001). It reduced the percentage of caesarean sections by a factor of 3,2, from 46,9% (148/315) in 2018 to 14,7% (84/570) in 2022 (RR = 2,49; 95% CI 2,12-2,94; р < 0,001).

Conclusion. Timely diagnosis of carbohydrate metabolism disorders and correctly chosen management tactics are foundation for likelihood vaginal delivery at full term.

Background. In vitro fertilization is a way to treat infertility, but it has a fairly common and dangerous complication – ovarian hyperstimulation syndrome, which can affect the development of pregnancy and its outcome.

Objective. The purpose was to analyze the impact of ovarian hyperstimulation syndrome on the course of pregnancy. The study included 123 women who were hospitalized at the Yu. Ya. Gordeev State Clinical Hospital № 1 in 2021-2022. The patients were divided into three groups: the main (n = 43) – women with ovarian hyperstimulation syndrome and after in vitro fertilization; comparison group (n = 40) – women without ovarian hyperstimulation syndrome and after in vitro fertilization; and the control group (n = 40) – women who got pregnant naturally. The patient was interviewed, the impact of pregnancy on the occurrence and development of ovarian hyperstimulation syndrome, the impact of ovarian hyperstimulation syndrome on the course of pregnancy, and the presence of possible complications during pregnancy were assessed.

Results. In the main group, the number of patients with inflammatory diseases of the reproductive system, polycystic ovaries, with tubalperitoneal and endocrine factors of infertility, primary infertility, with repeated in vitro fertilization and repeated pregnancy is greater than in the comparison group. The main group is dominated by working patients with higher education. Pregnant patients are more likely to have moderate to mild ovarian hyperstimulation syndrome than non-pregnant women. Multiple pregnancy contributes to the occurrence of ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome contributes to the development of threatened miscarriage, spontaneous abortion, false contractions up to 37 weeks of gestation, premature rupture of membranes, preeclampsia, placental insufficiency, and fetal growth retardation syndrome. Ovarian hyperstimulation syndrome increases the likelihood of early reproductive losses, preterm birth, low birth weight babies, and the likelihood of a caesarean section. Ovarian hyperstimulation syndrome more often develops in women with endocrine or tubal-peritoneal factors of infertility, with primary infertility, repeated pregnancy and repeated in vitro fertilization; in working patients with higher education. Pregnancy reduces the likelihood of developing severe and moderate ovarian hyperstimulation syndrome. Multiple pregnancy contributes to the formation of ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome contributes to various complications of pregnancy and increases the likelihood of early reproductive losses, increases the likelihood of preterm birth and low birth weight, and creates an indication for caesarean section.

Objective. The paper presents the results of a study of the effect of low-frequency ultrasonic cavitation on the biocenosis of the genital tract of patients with repeated caesarean section.

Results. It has been shown that an increase in the frequency of abdominal delivery has led to difficulties in planning the next pregnancy due to the failure of the uterine scar after a previous cesarean section. One of the main reasons for the formation of an inferior scar on the uterus was and remains a wound infection and postpartum endomyometritis, which develop in 10-20%. The difficulties of medical treatment of endometritis are explained not only by the resistance of microorganisms to drugs, but also by the difficulty of creating and maintaining a therapeutic concentration of these drugs in the focus of inflammation for a long time. Therefore, the search for new non-traditional ways of introducing drugs into the lesion is relevant. The use of ultrasonic cavitation in the postoperative period not only reduces the colonization of the birth canal by conditionally pathogenic and pathogenic flora, but also increases the colonization of the genital tract with lactoflora, which ensures a smooth postoperative period and more favorable conditions for scar repair. All patients before and after treatment underwent a comprehensive qualitative determination of the type of microorganism and a quantitative assessment of all clinically significant infections of the urogenital tract based on the polymerase chain reaction method in real time. The use of ultrasonic cavitation in the postoperative period not only reduces the amount of pathogenic and opportunistic microflora, but also increases the population of the genital tract with lactoflora, which ensures a favorable postoperative period and more favorable conditions for scar repair. The positive effect of ultrasound on the process of wound cleansing is associated with the destruction during cavitation of the cellular elements of the wound discharge and the release of lysosomal enzymes, chemotactic factors, bactericidal cationic proteins, and biogenic stimulants. These factors lead to fragmentation and exfoliation of the necrotic layer, enhance the proteolytic activity of the exudate, increase the number of phagocytic neutrophils, stimulate the phagocytic activity of blood leukocytes and their antibacterial action, which accelerates the regeneration process.

Background. Cow's milk allergy is one of the most common food allergies in children. Gastrointestinal forms of food allergy require special attention from the pediatrician, but they still remain poorly recognized. Mostly, gastrointestinal forms of food allergies occur in children of the first years of life, and often have nonspecific signs – restless behavior, changes in stool patterns or regurgitation, which leads to an erroneous interpretation of clinical symptoms. The diagnosis is complicated by the delayed onset of symptoms due to the non-IgE-mediated type of allergic reaction in most cases, therefore, the lack of information content in the classical approach to diagnosing allergies. The two most common forms of gastrointestinal food allergies encountered in pediatric practice: allergic proctocolitis (FPIAP), characteristic of the first months of life and having the most favorable prognosis, and food protein enterocolitis syndrome (FPIES), often occurring in the second half of the year, against the background of the introduction of complementary foods. They do not require specialized diagnostic methods in a hospital setting. The elimination diet is the main tool for diagnosis and dietary therapy of these allergic conditions.

Objective. To provide a clinical algorithm for outpatient pediatricians on the management of children with non-IgE-mediated gastrointestinal food allergy.

Background. Short-term and long-term toxicities of anticancer treatment are of increasing relevance, especially in children. Adverse events of anticancer treatment can cause mortality, organ toxicity of varying severity, subsequent disability, significant negative impact on psychosocial functioning and quality of life of patients and their families. This warrants the need for research on risk factors of drug-induced toxicity and new therapeutic approaches aimed to minimize the negative effects of anticancer and concomitant therapy, including new targeted drugs and immunotherapy. The development of human genome sequencing technologies and its integration into clinical practice, make possible treatment personification based on personal genetic variations. Pharmacogenomics, as a branch of pharmaceutics and pharmacology, plays a key role in predicting drug-induced toxicity and resistance to anticancer treatment in each patient. The main problem is the limited number of clinical studies in this area, small and heterogeneous cohorts of patients and the relative rarity of malignancies in childhood, that makes difficult to interpret obtained data and determine their clinical significance.

Results. This article presents current literature data on clinically significant drug-gene associations and their therapeutic value on the safety and efficacy of anticancer therapy in pediatric patients, their diagnostic, therapeutic and prognostic value, as well as the opportunities of genome-guided managing treatment protocols, including option of rescue therapy.

Background. In available foreign publications, there is evidence of a high incidence of mortality in the development of septic conditions in children in case of deficiency of factors in the natural anticoagulant system. It is known that deficiency of factors in the anticoagulant system can be congenital and acquired. Congenital deficiency is quite rare, and acquired deficiency can be observed against the background of inflammatory reactions in chronic, infectious diseases, oncopathology. Of particular concern is the lack of proper attention to patients of children's age category, the clinical picture of thrombosis in which may be erased. At the same time, it is in children that timely diagnosis and prevention, as well as identifying the presence of a risk of such events, can play a key role in preventing disability. Severe complications of physiological anticoagulant deficiency are thrombotic events and skin necrosis. The presented clinical case describes an episode of acquired protein S deficiency in a child.

Objective. To analyse a diagnostically complex clinical case from real medical practice in order to draw attention to the problem of acquired physiological anticoagulant deficiency against the background of bacterial complications after viral infection in children.

Materials and methods. The article describes a clinical case of acquired deficiency of the anti-clotting system factor complicated by the development of DIC, skin necrosis and venous thrombosis of the lower limbs after a viral infection in a young child. The peculiarity of this case is the debut of the disease with skin lesions of the extremities against the background of the development of disorders in the platelet and plasma links of haemostasis with a developing deficiency of components of the plasma link of haemostasis. To establish the diagnosis, the patient underwent an in-depth study of the haemostasis system to clarify the deficiency of factors of the natural anticoagulant system (protein C, protein S, antithrombin III).

Conclusion. This clinical observation shows the importance of careful history taking and the necessity of timely examination of the patient when bacterial complications develop after a viral infection. The clinical case also demonstrates the importance of multidisciplinary approach and continuity between doctors of different specialities in the diagnosis of severe disorders of coagulation and anti-coagulation systems, which contributes to adequate assessment of the detected disorders, prediction of the risk of possible complications (haemorrhagic and thrombotic syndromes), and preservation of patients' quality of life.

Background. The state of health of children in modern society is changing under the influence of various factors and processes. To a large extent, this applies to children born through in vitro fertilization. This method of reproductive technology is considered the most effective and is evaluated by the effectiveness of childbirth. However, the most important aspect – the state of health of newborns after in vitro fertilization, remains unexplored.

Objective. Purpose of the study was to identify the most significant pathological conditions in children with multiple and singleton pregnancies after in vitro fertilization.

Materials and methods. The results of a clinical and laboratory study of children born in the Astrakhan region through in vitro fertilization for the period from 2016 to 2021, as well as follow-up data of children conceived through in vitro fertilization for 3 years, were studied. Methods of clinical (including somatometry), laboratory and statistical analysis were used.

Results.116 children born through in vitro fertilization were examined, their somatometric parameters, Apgar score, morbidity and laboratory parameters were studied. It has been found that multiple pregnancies In vitro fertilization is a high risk factor for miscarriage and the occurrence of neonatal diseases such as preretinopathy and perinatal lesions of the nervous system. In addition, edematous syndrome, pyelonephritis, gestational diabetes and obesity in the anamnesis of mothers who decide to use the in vitro fertilization method for conception, with a high degree of probability predetermines miscarriage or the detection of perinatal lesions of the nervous system, anemia, preretinopathy in newborns.

Objective. The purpose of the study was to perform a retrospective analysis of the age-related morbidity of the children's population of the Astrakhan region for 2018-2022 in order to increase the effectiveness of preventive measures.

Materials and methods. To study the age-related morbidity, an analysis of medical documentation (case history f. № 003/y) was carried out in 3436 children who sought medical help from the State Medical Institution of State Budgetary Healthcare Institution of the Astrakhan region Children's City Polyclinic No. 4 and the State Budgetary Healthcare Institution of the Astrakhan region Regional Infectious Clinical Hospital named after A. M. Nichogi. Depending on the age, the children were divided into groups: from 8 months to 1 year – group I (n = 288), from 1 to 7 years – group II (n = 1927), from 7 to 17 years – group III (n = 1221).The research work was carried out on the bases of the Federal Budgetary Healthcare Institution Center of Hygiene and Epidemiology in the Astrakhan Region and the Federal State Budgetary Educational Institution of Higher Education Astrakhan State Medical University of the Ministry of Health of the Russian Federation Federation.

Results. During the analyzed period, more than 60% of all cases of influenza related to children (67.1%). These cases were registered in three age groups: from 8 months to 1 year, from 1 year to 7 years and from 7 to 17 years. The reported cases of influenza in children relate to the period from 2018 to 2022. The incidence of children of the first age group was 8.4% (n = 288), the second group – 56.1% (n = 1927), and the third group – 35.5% (n = 1221). The highest incidence was recorded in 2019 and amounted to 34.6% (n = 1098). This year, the incidence was as follows: the first group – 7.7% (85 cases), the second group – 58.7% (n = 644) and the third group – 33.6% (n = 369). The lowest incidence in children was registered in 2022 and amounted to 7.8% (n = 273), where the first group was 16.8% (n = 46), the second group was 39.9% (n = 109), and the third group was 43.3% (n = 118). The majority of cases of influenza were registered in children living in urban areas – 93.6% (n = 3216). At the same time, the first group was 6.6% (n = 211), the second group was 57.3% (n = 1846), and the third group was 36.1% (n = 1159). In rural areas, the third age group with 63.9% (n = 141) cases is the most susceptible to the disease, the second group is 23.5% (n = 51), and the first group is 12.6% (n = 28).

Conclusion. Based on the data, it can be concluded that H3N2(A) influenza was the most common strain of influenza among children in the period from 2018 to 2022. The main symptoms of influenza in children included fever, weakness, fatigue, headache, myalgia or arthralgia. Some children also complained of pain when swallowing, runny nose, cough, vomiting and diarrhea. These data will help to better understand the nature of influenza in children and take appropriate measures to prevent and treat it. Taking care of children's health should be a priority for everyone – parents, medical professionals and government agencies. Only through joint efforts will we be able to reduce the incidence of influenza among children and create a healthier future for our society.

Background. Back pain remains a common and challenging medical problem. Damage to the articular-ligamentous apparatus of the spinal column is a source of both nonspecific and specific causes of pain. The universal treatment for patients with back pain is the prescription of chondroprotectors, the undisputed leader among which is chondroitin sulfate.

Objective. Evaluation of the effectiveness and safety of drug therapy from their group of delayed-acting symptom-modifying drugs in patients with back pain when used for 20 days.

Materials and methods. The study included 30 patients diagnosed with dorsopathy with acute or chronic pain syndrome. Patients received a modern injection chondroprotector consisting of a complex of polypeptides, mucopolysaccharides (chondroitin sulfate), amino acids, sodium, potassium, magnesium, iron, copper, zinc, 2 ml every other day for 20 days according to the instructions for medical use of the drug. Before and after 30 ± 5 days from the start of treatment, a comprehensive examination of patients was carried out with an assessment of the severity of pain on a 100-mm visual analogue scale, a general assessment of the patient’s health status on a visual analogue scale, an assessment of satisfaction with therapy on a visual analogue scale, and the level of anxiety-depressive disorders on hospital HADS scale, sleep disturbances according to the insomnia severity scale. The criterion for analyzing the effectiveness was the degree of pain control assessed by the subjects on a visual analogue scale 30 ± 5 days from the start of treatment (10 days after completion of the course) compared with the initial value.

Results. Significant positive dynamics were observed among patients with back pain. Initially, the pain was 84 mm; after 30 ± 5 days from the start of treatment, the pain decreased to 23.33 mm (p < 0.05). The patient's overall health assessment on the visual analogue scale increased from 55 to 86.67 mm (p < 0.05). Patients rated their satisfaction with the therapy highly: from 29 to 91.33 mm (p < 0.05). There were no cases of serious adverse events. A decrease in the severity of affective disorders (anxiety-depressive syndrome and insomnia) was recorded during treatment (anxiety by 3.5 times, depression by 1.3 times and insomnia by 2 times) (p < 0.05). Conclusions: drug therapy in patients with back pain can achieve a statistically significant reduction in the severity of pain and improvement in the affective component in most patients. The therapy is characterized by a high safety profile and good tolerability.

Objective. To evaluate the relationship between undifferentiated connective tissue dysplasia and atherosclerosis of the brachiocephalic arteries (BCA) in postmenopausal women.

Materials and methods. A cross-sectional study enrolled 120 women, aged 68 (65 ± 70) years, the duration of menopause: 18 (16 ± 21) years. Ultrasound duplex scanning of the of the brachiocephalic zone arteries extracranial parts has been performed. The normal thickness of the intima-media complex (TIMT) was considered to be < 0.9 mm, an increase in TIMT of more than 1.3 mm was interpreted as the presence of an atherosclerotic plaque (AP). Total cholesterol, high density lipoprotein cholesterol, low density lipoproteins cholesterol, serum triglyceride levels were assessed by the enzymatic colorimetric method. UCTD was verified according to the clinical guidelines the Russian Scientific Medical Society of Therapists. The first group consisted of 27 (22.5%) people with verified undifferentiated connective tissue dysplasia. The second group included 93 (77.5%) women without undifferentiated connective tissue dysplasia. The measure of data averaging is the median (Me), the measure of dispersion is the interquartile range (Q1 ± Q3). Mann – Whitney, χ² – Pearson tests were used. Differences, associations and correlations were considered significant at p < 0.05.

Results. Thickening of IMT was detected in 18 (67%) cases in Group 1 and in 63 (65%) cases in Group 2, the differences were not significant. Atherosclerotic plaques were found in 17 (63%) patients of the Group 1 and 62 (67%) patients of the Group2. Only 23 (19%) study participants has adequate serum vitamin D levels, in 97 (81%) cases, a decrease in the serum level of 25-hydroxyvitamin D ≤ 30 ng/ml was detected. No direct relationship was found between the serum vitamin D level and the brachiocephalic arteries intima-media complex thickness. Vitamin D deficiency was associated with higher LDL cholesterol (p = 0.03) and lower HDL cholesterol (p = 0.03) levels. Patients with UCTD had more frequent pathological tortuosity of the vertebral artery: 8 (30%) in Group 1 versus 9 (9%) in Group 2 (χ² = 5.77, df = 1, p = 0.017). When assessing the linear parameters of blood flow in the brachiocephalic arteries in local samples, significant differences were found only in the right vertebral artery diastolic velocity values. However, in patients with UCTD, which is associated with the use of resistive properties of blood vessels.

Conclusion. In this study, more than half of postmenopausal patients with arterial hypertension atherosclerotic lesion of brachiocephalic arteries has been revealed. In the presence of UCTD criteria, pathological tortuosity of the vertebral arteries was more often detected. A decrease in diastolic velocity against the background of low values of the pulsation index of the vertebral artery in patients with UCTD may be a consequence of the participation of vertebral arteries in extracerebral and intracerebral circulation aimed at preserving regional blood flow of the brain against a background of a more significant decrease in the elastic properties of the arteries.

Background. Within the framework of the Russian National Congress of Cardiology, on its opening day on September 21, 2023, a satellite symposium «Improving the quality of life and improving the prognosis in cardiology: two sides of the same coin» was held under the chairmanship of Doctors of Medical Sciences, Professors Yu. A. Karpov and O. D. Ostroumova.

Objective. To present an overview of the reports made at the symposium by O. D. Ostroumova «"Old" and "new" risk factors for cardiovascular complications in patients with arterial hypertension» and A. O. Nedoshivin «Quality of life of a patient with stable ischemic disease: a surrogate endpoint or the most important goal of treatment?» in order to raise awareness of cardiologists, therapists, general practitioners and geriatricians about modern approaches to drug therapy of patients with arterial hypertension and coronary heart disease, taking into account age, comorbidity, balance of efficacy and safety of drugs, especially in the treatment of elderly patients.