The review examines the key aspects of the pathogenesis of alopecia in endocrine system pathology. The role of hormones, growth factors, cytokines and other biologically active substances has been demonstrated. Alopecia is a frequent symptom that can be the result of not only gerontological, but also endocrinological problems. Therefore, time-consuming differential diagnosis is often necessary. Diagnosis is more effective if a team of specialists is involved: endocrinologist, gynecologist, andrologist, dermatologist / trichologist, and others.

This article focuses on the distant blood pressure monitoring for patients with arterial hypertension. As numerous studies show, even slightly elevated blood pressure significantly raises the risk of cardiovascular complications. And, vice versa, a 5 mmHg decrease in blood pressure reduces the lethality risk. Therefore, it is not enough to prescribe the right medication but also it is of paramount importance to monitor patients’ compliance with the treatment. Clinical observation of patients with arterial hypertension is an effective tool for the prevention of cardiovascular complications. However, to date, the coverage of follow-up and the achievement of blood pressure targets in patients with arterial hypertension is one of the most problematic aspects. Distance monitoring of blood pressure opens more opportunities for the doctor’s involvement, timely assessment and adjustment of the medication. The results of domestic and foreign research show high efficacy of the distance blood pressure monitoring. Positive results regarding the achievement of target blood pressure after 3 months are shown when using the technology of blood pressure monitoring and distance counseling of patients with arterial hypertension. In particular, the article considers the technology of mobile health care (mHealth), which is a more flexible platform for a patient’s continuous self-care.

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).

Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.

Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).

Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.

Purpose. To establish the relationship of serum adiponectin and leptin with clinical data, serological parameters, disease activity, results of ultrasound examination of the musculoskeletal system and X-ray damage of joints in rheumatoid arthritis patients.

Materials and methods. The article presents a comparative characteristic of adipokine levels among 64 women diagnosed with rheumatoid arthritis (group I) and 30 healthy women (group II). The dependence of adipokine levels on clinical, laboratory, ultrasound and radiological changes was revealed in patients with rheumatoid arthritis.

Results. The concentration adiponectin level was significantly higher in rheumatoid arthritis patients compared to the control group (p <0.0001) and had significant correlations with radiological changes in the joints (r=0.40; p <0.001) and the intake duration of methotrexate (r=0.4; p <0.001) and glucocorticosteroids (r=0.3; p <0.05). The level of leptin in the blood serum of women with rheumatoid arthritis and healthy individuals was approximately the same. However, there were positive correlations between the level of leptin and of the tender joint count (r=0.5; p <0.0001), the levels of C-reactive protein (r=0.3; p <0.05) and interleukin-17 (r=0.3; p <0.05), the index Disease Activity Score 28 (r=0.4; p <0.001) and increased blood flow during Doppler imaging (r=0.4; p <0.001).

Conclusion. Thus, patients with rheumatoid arthritis have a significant increase in the level of adiponectin compared to the health group, which is associated with pronounced destructive changes in the joints and the intake duration of methotrexate and glucocorticosteroids. However, a positive relationship between the indicators of disease activity and the presence of a Doppler signal is observed only in leptin.

Aim. To study heart rate variability (HRV) in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) in relation to: blood oxygen saturation level, parameters of respiratory function (RPF), Nt – proBNP concentration in blood plasma.

Materials and methods. We examined 128 outpatients of both sexes. The patients’ age ranged from 45 to 70 years. Group 1 – main (60 patients) with CHF of ischemic genesis of NYHA functional class II – III and GOLD COPD of I – III degree of airflow restriction (GOLD 2019 classification) in the stage of stable remission, group 2 – control group (63 patients), with isolated CHF. All patients with CHF, who were included in the study, had myocardial infarction (AMI) from 1 to 5 years ago. There were no statistically significant differences in the severity of CHF between groups 1 and 2.

Results. In patients with CHF and COPD, in contrast to patients with isolated CHF, a significant prevalence of the frequency of occurrence of the hypersympathicotonic type of autonomic regulation was revealed. Significantly lower indicators of heart rate variability were in the group of patients with concomitant COPD in comparison with patients with isolated CHF. Statistically significant correlations were revealed between HRV parameters and RPF, parameters of blood oxygen saturation level, NT-proBNP concentration in blood. Multivariate regression analysis showed a significant dependence of HRV parameters on the parameters of HRV and the concentration of NT-proBNP in the blood in the group of patients with CHF and COPD.

Aim: to study parameters of arterial stiffness and subclinical atherosclerosis in patients with axial spondyloarthritis (axSpA) without clinically manifest cardiovascular pathology depending on the presence of anemia.

Material and methods. 102 patients with axSpA (mean age – 37.7±9.8 years, axSpA duration – 13.5±8.7 years, 66 (64.7%) men) were included. The BASDAI index and C-reactive protein (CRP)-based ASDAS score were measured, the hemogram, the erythrocyte sedimentation rate (ESR), and the level of CRP were studied. Parameters of arterial stiffness were studied by oscillography and photoplethysmography, intima-media thickness (IMT) was evaluated by B-mode ultrasound according to standard protocols.

Results. During analysis of pulse wave properties, no statistically significant differences in parameters of vascular wall stiffness were found in axSpA patients with and without anemia. Aortic pulse wave velocity (PWVao) in patients with anemia was 7.4±1.5 m/sec, aortic augmentation index (Aix-ao) was 19.1±13.7%, stiffness index (SI) was 8.2±1.7 m/sec; in patients without anemia – 7.4±1.4 m/sec, 17.3±10.6% and 8.8±2.0 m/sec, respectively (p >0.05 for all). IMT in patients with anemia was 0.70±0.13 cm, in patients without anemia – 0.73±0.16 cm (p >0.05). Correlation analysis was performed and significant correlations were noted between Aix-ao, PWVao, SI, IMT and age (r=0.488, r=0.516, r=0.289, r=0.461, respectively, p <0.05); Aix-ao, PWVao and the BASDAI index (r=0.243, r=0.253, respectively, p <0.05). Significant correlations between PWVao and Aix-ao (r=0.442, p <0.001), SI (r=0.273, p=0.011) and IMT (r=0.236, p=0.034) were found.

Conclusion. The present study did not confirm the negative effect of anemia on vascular wall stiffness parameters and IMT in patients with axSpA. We consider that potential protective effect of anemia, due to well-known pathophysiological patterns — a decrease in blood viscosity and the induction of nitric oxide synthesis, plays an important role. Further studies are required to assess relationship between hemoglobin levels and markers of endothelial dysfunction in patients with axSpA.

Bronchial obstructive syndrome is a violation of bronchial patency of functional or organic origin, which is manifested by shortness of breath, suffocation attacks, cough, tachycardia. The most common cause of bronchial obstructive syndrome is chronic obstructive pulmonary disease and bronchial asthma. In some cases, the cause of bronchial obstruction is tumors or tumor metastases to the lungs. The article describes a clinical case of bronchial obstructive syndrome, showing that all patients with bronchial asthma, in the absence of an effect from the prescribed adequate basic therapy, with no control over the disease, should be well examined for an alternative diagnosis. In our case, a thorough examination of the patient allowed the allergist to diagnose central lung cancer with metastases to the lymph nodes of the mediastinum. A feature of the case is the primary resistance to tyrosine kinase inhibitors, revealed during a genetic study, which determined the scheme of further polychemotherapy. This clinical case proves the need for differential diagnosis, with a comprehensive approach and the use of various examination methods.

Infective endocarditis of the native mitral valve with multiple cardioembolic cerebral infarctions and myocardial infarctions against the background of a severe new coronavirus infection caused an unfavorable outcome in a young woman. The reasons for this were both the late diagnosis of IE (untimely performance of transthoracic echocardiography) and the synergy of the pathogenetic mechanisms of two serious diseases, which was most clearly manifested in the development of hemorheological disorders, damage to the myocardium, lungs and brain.

The diagnosis and treatment of systemic amyloidosis remains a significant clinical problem for physicians of various specialties. Infectious complications and sepsis account for up to 8% of deaths in amyloidosis patients. This clinical case describes the development of an initially asymptomatic monoclonal gammopathy of unclear significance into systemic AL-amyloidosis, which was complicated by the formation of a renal carbuncle after the first cycles of chemotherapy. There was a significant discrepancy between the severity of the patient’s overall clinical state and changes in laboratory parameters. There were no objective factors for the ascending spread of urinary tract infection or hematogenous dissemination from other foci, so a primary bacteremia was assumed.

The most common anomaly of the aortic arch and its branches is the aberrant right subclavian artery – arteria lusoria. Usually, it produces dysphagia or dyspnea and chronic coughing.

Our purpose is to underline that it is necessary to exclude the anomalies of the branches of the thoracic aorta, including arteria lusoria, in the patients with cardialgia of unknown origin.

Clinical case. An 18-year-old female patient without a previously diagnosed chronic pathology was admitted to a hospital with chest pain after emotional stress for about an hour. The ECG revealed a sinus rhythm with a heart rate of 50 per minute, the normal direction of the electrical axis of the heart, the incomplete right bundle branch block, the negative T wave in the lead III. After excluding ischemic heart disease, acute coronary syndrome, pulmonary embolism, contrast-enhanced chest computed tomography revealed an aortic arch anomaly – a. lusoria.

Conclusion. A. lusoria may manifest by cardiac pain. In patients with chest pain of unknown origin, it is advisable to include anomalies of the aorta and its branches, including the presence of the lusoria artery, in the range of differential diagnostics.