Primary vasculitis of the central nervous system (PACNS) is a rare form of unknown cause vasculitis that affects the vessels of the brain, spinal cord and meninges without systemic damage. It was found that the average age of the onset of the disease was 50 years. Clinical manifestations depend on the caliber of the affected vessels. The most common initial symptoms are headache and vascular cognitive impairment associated with small vessel involvement. The development of stroke and focal symptoms is interrelated with vascular cognitive impairment and manifests as the lesion of the middle/large cerebral arteries. PACNS is difficult to diagnose, since symptoms of vasculitis outside the central nervous system are rare, serologic markers of inflammation are normal. The analysis of cerebrospinal fluid is usually abnormal due to a moderate nonspecific increase in the level of total protein or the number of leukocytes. Deviations from the norm (cerebral infarction, sometimes tumor-like lesions) are detected according to the data of magnetic resonance imaging of the brain in 97 % of patients with PACNS. Angiography has low sensitivity and low specificity, since it allows to verify vasculitis of only middle and large cerebral arteries, revealing segmental narrowing. To detect inflammation of the blood vessels, as well as to exclude other diseases, it is necessary to perform a biopsy of the substance and the soft membranes of the brain.

The combination of chronic coronary heart disease and type 2 diabetes mellitus in a patient has high medical importance, because relevance of the problem increases every year. Modern requirements for the provision of high-quality medical care to patients with combined pathology require attentive assessment: we can’t deny the pathophysiological relationship of both diseases. Serious changes that occurred in the treatment tactics in relation to such patients require close attention of the medical community. Modern approaches of the therapy of this group of patients include treatment directions that improve the cardiovascular prognosis (lifestyle changes, anti-platelet therapy, antihypertensive therapy, statins and nonstatin lipid-lowering agents, which are indicated for patients who are difficult to tolerate statin treatment, glucose-lowering drugs), as well as careful management of stable angina syndrome (using of antianginal drugs, assessing the possibilities of revascularization). The therapeutic tactics of the new revision offers promising perspective regimens for taking antiplatelet therapy, lipid-lowering drugs. The new line of glucose-lowering drugs has high cardioprotective properties, reduces the intensity of vascular lesions (vasoprotection), and has renoprotective properties. The strategy of choosing glucose-lowering drugs has also undergone some changes: at the moment it is designated as «differentiated», which implies choosing a drug with the highest organoprotective properties. Achievement of target HbA1C levels in the range of 7.0-8.0 % is associated with the lowest patient mortality rate. In addition, to patients with type 2 diabetes mellitus, especially group with coronary heart disease, advised to minimize episodes of hypoglycemic conditions. Aim of this statement is to discuss in detail progressive approaches in the treatment of patients with chronic coronary heart disease and type 2 diabetes mellitus.

Introduction: With increasing global concerns about the prevalence of COVID-19, chest imaging findings are essential for effective diseases diagnosis and treatment. There is a need to distinguish between imaging features of COVID-19 pmeumonia and other viral pneumonia like Influenza.For this purpose, a study was performed on a comparison of chest CT findings between COVID-19 pneumonia and Influenza pneumonia. Methods: Fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swab for Influenza and fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swabfor COVID-19 from March to May 2020 were enrolled in the study. In the patient’s checklist, information such as demographic characteristics (age, sex), laboratory findings including (CRP, ESR, WBC), and clinical signs (fever, cough, fatigue, dyspnea) were also recorded. Results: Gastrointestinal symptoms, anorexia, high CRP, ground-glass opacityare more common in patients with COVID-19 pneumonia than in patients with influenza pneumonia and this difference was statistically significant (P <0.05). But, fever is more common in influenza patients than in Covid-19 patients and this difference is statistically significant (P=0.029). The location of CT scan findings in COVID-19 patients was dominant in peripheral (54 %), while the location of CT scan findings in patients with Influenza was dominant in central (32 %), which is statistically significant (P <0.05). Conclusion: According to the results of the study, lung CTscan findings along with some clinical and laboratory findings can help differentiate COVID-19 pneumonia from influenza pneumonia, which is very important in faster diagnosis and timely treatment of both diseases.

Objective. To study the course of the new coronavirus infection in patients with chronic kidney disease (CKD), to identify cases of acute kidney injury (AKI) in the setting of COVID-19 infection, and to access the impact of renal function on prognosis in these categories of patients during the acute phase and after hospitalization, at 3, 6, and 12 months after recovery. Materials and methods. The ACTIV and ACTIV 2 registries included men and women older than 18 years with a diagnosis of COVID-19 based on a positive PCR test for COVID-19 and a characteristic chest X-ray or computed tomography chest scan. Results. A total of 9364 patients (4404 men, average age59 [48-69]) were included in the analysis. 716 (7.67 %) patients had CKD. 8496 (90,7 %) patients had their glomerular filtration rate (GFR) measured during hospitalization, and the values were distributed as follows: ≥90 ml/min/1.73m² – in 4289 (50,5 %) patients, 89-60 ml/min/1.73m² — in 3150 (37,1 %) patients, 59-45 ml/min/1.73m² — in 613 (7,22 %), 44-30 ml/min/1.73m² — in 253 (2,98 %), 29-15 ml/min/1.73m² — in 110 (1,29 %), <15 ml/min/1.73m² — in 81 (0,95 %) patients. 11.6 % of the subjects (n=1068) developed AKI during hospitalization. This complication was reported more often than cytokine storm (in 7.46 % in 687 patients, р<0,001) or sepsis (in 0.17 % in 16 patients, p=620). CKD increased the risk of death by 3.94-fold in patients with COVID-19 during hospitalization compared with patients without CKD. The mortality of patients with AKI during hospitalization was 3.94 times higher than the mortality of those without AKI. CKD also affected long-term survival after hospitalization: within 3 months of follow-up, the risk of death in patients with CKD increased 4.88-fold, within 6 months — 4.24-fold, after 12 months – 8.36-fold. Conclusion. The prevalence of CKD in COVID-19 patients is similar to that in the general population. AKI developed in 11.6 % of cases with COVID-19 infection and was observed more frequently in patients with overweight and hyperglycemia. CKD and AKI increased the risk of hospital mortality in patients with COVID-19. In the group of patients with CKD, mortality increased in the post-COVID period, 3, 6 and 12 months after. The high mortality rate of patients who had AKI during the coronavirus infection was observed only in the first 3 months of follow-up in the post-COVID period.

Diabetes mellitus (both type 1 and type 2) is considered one of the risk factors for severe COVID-19 and death from this infection. Past infection with COVID-19 leads to deterioration in the control of existing diabetes mellitus, progression of pre-diabetes to diabetes, an increase in the number of new cases of diabetes and an increase in the proportion of glucocorticoid-induced diabetes, which significantly aggravates the course of post-COVID syndrome for this category of patients. Antihyperglycemic drugs may influence the pathogenesis of COVID-19, which may be of relevance for the treatment of patients with type 2 diabetes mellitus and post-COVID syndrome. The review also presents our own data on the effect of various regimens of oral hypoglycemic agents on post-COVID syndrome in people with type 2 diabetes mellitus. The observation showed that the use of dipeptidyl peptidase-4 inhibitors as part of a treatment strategy in patients with type 2 diabetes mellitus with a past COVID-19 infection was associated with a decrease in the duration and severity of post-COVID symptoms.

Aim of the work: to demonstrate the difficulty of verifying the diagnosis of Q fever with negative results of PCR (DNA of Coxiella burnetii) in the blood and to assess the occurrence of serological markers among patients selected for this study based on a combination of clinical and epidemiological data. Materials and methods: plasma/serum samples of 111 patients according to clinical and epidemiological data studied due ELISA and PCR for specific antibodies to Coxiella burnetii and DNA of pathogen. Additionally, in the presence IgG to C. burnetii phase II, IgG / IgA to phase I and the avidity of specific IgG were studied. Results: the specific antibodies to C. burnetii antigens at negative results of PCR detected in 10 cases. The article provides the description of three clinical cases for demonstration of difficulties of coxiellosis diagnosis with analysis of serological profiles, titers and avidity of antibodies. Conclusion: the results of the study indicate that negative results of PCR testing do not exclude C. burnetii infection. For patients who, according to clinical and epidemiological data, Q fever is not excluded, it is advisable to prescribe a complex of laboratory tests to verify the diagnosis, which includes not only studies of the pathogen’s DNA, but also specific antibodies. To clarify the stage of the disease and reduce the risk of developing complications of coxiellosis, it is necessary to monitor the dynamics of antibody titers to C. burnetii in phase I and II phase states differentially.

The article is devoted to the analysis of a clinical case of the severe hypothyroidism. A review of the “clinical masks” of the hypothyroidism is presented. The examination of the polymorbid patients should include the level of thyroid-stimulating hormone and thyroid hormones. The untimely initiation of substitution therapy is associated with a poor prognosis, and the early start of the treatment is a guarantee of saving the life of a patient with severe hypothyroidism.

Microscopic colitis is an inflammatory bowel disease of unknown etiology that presents as chronic watery diarrhea with no endoscopic evidence of the bowel involvement but with the microscopic changes. Diagnosis of microscopic colitis is based on the histological examination of the intestinal biopsy and requires a highly qualified gastroenterologist, endoscopist and histologist. The article presents a clinical case of microscopic colitis in a 42-year-old patient, reflects the main stages of diagnosis and treatment of the patient.