Heart failure (HF) remains one of the leading causes of morbidity and mortality among patients with HIV infection. Over the past decades, the phenotypes of HF in this population have shifted substantially: while heart failure with reduced ejection fraction (HFrEF) was historically predominant, heart failure with preserved ejection fraction (HFpEF) has emerged as an increasingly important clinical manifestation. The pathogenesis of these conditions is multifactorial, driven by virus-related mechanisms, chronic inflammation, immune dysregulation, cardiometabolic disturbances, and adverse effects of antiretroviral therapy (ART). HFrEF in HIV-infected individuals is primarily associated with chronic inflammation, monocyte– macrophage activation, accelerated atherosclerosis, ischemic heart disease, and pathological myocardial remodeling. By contrast, HFpEF is linked to systemic metabolic abnormalities such as obesity, insulin resistance, dyslipidemia, gut barrier dysfunction, and adipose tissue dysregulation, ultimately leading to the cardiometabolic HF phenotype. A central role in this process is played by metabolic inflammation and the impact of ART (including integrase inhibitors, nucleoside and non-nucleoside reverse transcriptase inhibitors). Understanding the immune and metabolic mechanisms of HIVassociated HF opens new opportunities for therapeutic development. Promising approaches include immunomodulation, metabolic correction, and the use of statins, SGLT2 inhibitors, and GLP-1 receptor agonists. Future studies focusing on patient stratification and clinical outcomes are essential for optimizing the management of this complex patient group

Non-invasive vagus nerve stimulation (nVNS) is a promising treatment showing positive results for a wide range of diseases and is currently under active investigation. Surface electrodes are used to stimulate the cervical or auricular branch of the vagus nerve. The growing interest in nVNS is driven by its simplicity, accessibility, safety, and good tolerability. However, to date, this method has not been widely adopted in Russia. This review covers the main stimulation parameters for auricular and cervical vagus nerve targets and the clinical evidence supporting nVNS use in managing headache, tinnitus, sleep disorders, and anxiety. We discuss FDA guidance on cervical VNS for headache and the research gaps that need to be filled to advance the evidence for nVNS in various conditions. We emphasize the necessity and prospects for a domestic (Russian) peripheral vagus nerve stimulation device, which would promote wider clinical integration and data collection on outpatient use.

COVID-19 is associated with a high risk of thrombotic complications, which determine the severity and outcome of the disease. Identifying key predictors of adverse outcomes among hemostatic system parameters remains an important task. Aime. To assess the significance of hemostatic system parameters as predictors of adverse outcomes in patients with COVID-19. Materials and methods. A single-center retrospective cohort study was conducted, including 9256 patients with confirmed COVID-19. Depending on the outcome (adverse/favorable), patients were divided into groups. Upon admission, coagulogram parameters (APTT, prothrombin index, thrombin time, fibrinogen, D-dimer, antithrombin III) were assessed using an ACL TOP 750 analyzer. Statistical analysis was performed using the Mann-Whitney U test. For the description of quantitative indicators, the median, the 25th and 75th percentiles were used. Results. Statistically significant differences were recorded in patients with adverse outcome compared to survivors: a significant increase in D-dimer level (median 464.5 [Q25–Q75: 245.0–1120.0] ng/mL vs. 198.0 [110.0–350.0] ng/mL; p<0.0001) and fibrinogen (5.62 [4.70–6.80] g/L vs. 5.03 [4.30–5.90] g/L; p<0.0001), a decrease in antithrombin III activity (81.0 % [73.0–89.0] vs. 99.0 % [90.0– 108.0]; p=0.0001) and prothrombin index (83.0 % [77.0–90.0] vs. 93.0 % [88.0–98.0]; p<0.0001), as well as a prolongation of thrombin time (15.4 s [14.5–16.5] vs. 14.9 s [14.2–15.8]; p=0.0001). The APTT parameter did not differ significantly between the groups (p=0.95). Conclusion. Patients with adverse COVID-19 outcomes exhibited marked hypercoagulation with signs of consumption coagulopathy, characterized by a sharp increase in D-dimer and fibrinogen against a background of decreased antithrombin III and prothrombin index. Monitoring these parameters, especially D-dimer and antithrombin III, has high prognostic value for risk stratification and timely therapy adjustment.

Objective. We aimed to study the parameters of arterial stiffness and its variability during 24-hour monitoring in relation to the clinical and endoscopic activity of ulcerative colitis. Materials and methods. This cross-sectional retrospective study involved 100 patients with ulcerative colitis (mean age 40 [33; 49] years, 38 (38 %) men, disease duration >1 year, without concomitant cardiovascular diseases or metabolic disorders) and 50 healthy control subjects. Arterial stiffness parameters were assessed via 24-hour ambulatory blood pressure monitoring with Vasotens technology. Based on disease activity patients were divided into 3 groups: Group 1 included 30 patients in clinical and endoscopic remission; Group 2 consisted of 22 patients in clinical remission with endoscopic activity; Group 3 included 48 patients with both clinical and endoscopic exacerbation. Statistical analysis was performed using the software package “IBM SPSS Statistics Version 25.0”. Results. Increased arterial stiffness (aortic pulse wave velocity (PWVао) >10 m/s) was detected in 67 (67 %) of ulcerative colitis patients, which was significantly higher than in the control group (OR = 4.74; p<0.001). The most pronounced alterations were observed in the group with clinical-endoscopic exacerbation, which showed increased aortic pulse wave velocity at systolic blood pressure (SBP)=100 mmHg and heart rate (HR)=60 bpm (PWVао 100-60) (p=0.003), augmentation index adjusted for HR=75 bpm (AIx75) (p<0.001), and PWVао variability (p=0.002). In endoscopically active disease without clinical symptoms, AIx75, PWVао100-60, and variability of the rate of increase in blood pressure in the aorta (dP/dt var.) were significantly higher compared to controls. Logistic regression analysis identified age >40 years (p=0.001; 95 % CI: 2.045 to 15.309), disease activity of ulcerative colitis (p=0.025; 95 % CI: 1.151 to 8.200), and a positive family history of cardiovascular disease (p=0.033; 95 % CI: 1.131 to 17.312) as independent predictors of increased arterial stiffness in patients with ulcerative colitis. The prediction model demonstrated good performance: аrea under the ROC curve (AUC) = 0.76 ± 0.051 (95 % CI: 0.66–0.86), sensitivity 0.851, specificity 0.638, and accuracy 0.747 (p <0.001) and can be implemented in practice for the early identification of patients with high cardiovascular risk. Conclusion. Patients with ulcerative colitis exhibit a significant increase in arterial stiffness, which correlates with the degree of inflammatory activity. Endoscopic activity, even in the absence of clinical symptoms, is associated with adverse vascular changes. The developed predictive model, based on three clinical criteria (age >40 years, active ulcerative colitis, and positive family history), could be implemented clinically for the early identification of high cardiovascular risk in this patient population.

Objective. To identify clinical, laboratory and instrumental predictors of 12-month mortality in patients after PE and to develop a prognostic model. Material and methods. This retrospective study included 150 patients discharged after an episode of PE (2021–2024). The diagnosis was confirmed predominantly by CT pulmonary angiography. Demographic, clinical, laboratory and echocardiographic parameters were assessed. The primary endpoint was death within 12 months after PE (excluding in-hospital and early mortality within 30 days). Univariable and multivariable logistic regression were used to identify independent predictors. Model discrimination was evaluated using the AUC, and calibration using the Hosmer–Lemeshow test and a calibration plot; internal validation was performed by bootstrap resampling. Results. During follow-up, 20 patients (13.3 %) died. Three independent predictors of 12-month mortality were included in the multivariable model: hemoglobin level, estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF). The model demonstrated high discriminatory ability (AUC 0.906; 95 % CI 0.852–0.960; p <0.001) and good calibration (χ²=4.009; p=0.856). At the probability threshold p=0.08, sensitivity of the model was 100 % and specificity 69.2 %. The Mezo score showed higher AUC values compared with sPESI, ICOPER, GPS and the Yamaki scores. Conclusion. The Mezo score, based on hemoglobin level, eGFR and LVEF, provides high accuracy in predicting 12-month mortality in patients after PE and, after external validation, may be used for early risk stratification.

Thallium compounds are extremely toxic. Their mechanisms of toxicity are associated with reduced activity of enzymes involved in glucose metabolism and impaired synthesis of high-energy compounds. Symptoms of thallium intoxication appear 3-4 hours after its ingestion in the form of dyspeptic phenomena. Within 2-5 days, symptoms of nervous system damage appear in the form of sensory polyneuropathy with neuropathic pain syndrome. After 2-3 weeks, dermatological complications develop: alopecia, anhidrosis, glossitis. The antidote is potassium hexacyanoferrate.

Clinical case. A 38-year-old woman was admitted to the hospital with subacute sensorimotor polyneuropathy, hepatitis, and alopecia. Laboratory tests showed a slight increase in liver enzyme levels and a tendency towards decreased blood potassium levels. Stimulatory electroneuromyography revealed sensorimotor polyneuropathy of the axonal type. Given the multisystem involvement, a differential diagnosis was conducted between autoimmune diseases and acute intoxication. A blood test for markers of systemic connective tissue diseases was negative. Toxicological analysis of serum and urine revealed a sharp increase in thallium levels. Administration of potassium hexacyanoferrate yielded a positive result. A follow-up examination of the patient one year later showed complete resolution of motor and sensory symptoms and regrowth of hair.

Thallium intoxications are currently extremely rare and present challenges for timely diagnosis. In cases of toxic polyneuropathies, differential diagnosis should include intoxication with other heavy metals (lead, mercury, cadmium) as well as autoimmune processes. Timely administration of the antidote facilitates the elimination of thallium compounds from the body and yields a pronounced positive clinical effect.

The improvement of diagnostic methods and the possibilities of modern medicine lead to a deeper study of autoimmune pathology. In clinical practice, cases of a combined course of two or more immunological diseases have become increasingly common, which is called the term “overlap-syndrome” or “crossroads syndrome”. There is still no data on the specific causes of the overlap-syndrome, among the most likely versions is a combination of genetic changes, including the diversity of human leukocyte antigen (HLA) alleles, with external trigger factors. The features of this syndrome are the difficulties of differential diagnostic search due to the variety of symptoms. Untimely verification of the diagnosis leads to a late appointment of treatment and a less favorable long-term prognosis. In clinical practice, a combination of systemic scleroderma or systemic lupus erythematosus with rheumatoid arthritis is most common. This article provides an example of the overlap-syndrome in a 69–year-old patient with three autoimmune pathologies — systemic scleroderma, CABG, and primary biliary cholangitis with multiple organ damage (lungs, skin, gastrointestinal tract, salivary glands, blood vessels, and nervous system). The patient had a long history of Raynaud’s syndrome, as well as primary biliary cholangitis. Two years before the treatment, the patient was diagnosed with Sjogren’s syndrome, and in 2025, a limited form of systemic scleroderma. Thus, during her lifetime, the patient developed 3 autoimmune pathologies included in the overlap-syndrome. Specialists should pay increased attention to patients with a long history of rheumatological disease in order to detect other autoimmune pathologies in a timely manner and initiate timely treatment to prevent the development of complications.

Timely recognition and treatment of pulmonary arterial hypertension, a dangerous complication of systemic connective tissue diseases, is extremely important, as these patients have a poor prognosis.

In this article, cardiologists present a clinical case of a diagnostic search for the cause of severe pulmonary arterial hypertension of high functional class and pericardial effusion in a 60-year-old female patient with suspected Sjögren’s syndrome. An assessment of the clinical status and autoimmune markers was performed, echocardiography, computed tomography and magnetic resonance imaging, coronary angiography and right heart catheterization, ophthalmological testing, as well as biopsy, ultrasound examination and salivary gland scintigraphy were performed. Subsequently, Raynaud’s syndrome and scleredema, as well as specific immunological disorders, were verified, which made it possible to diagnose a limited form of systemic scleroderma, prescribe immunosuppressive therapy, and establish the secondary nature of Sjögren’s syndrome.

The diagnostic results, supported by the opinions of the supervising doctors, can be discussed by the medical community and are of practical use for cardiologists, who rarely encounter rheumatological diseases in their routine practice.