ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants) is a group of autoimmune diseases caused by adjuvants that have the ability to induce immune responses. The syndrome includes five immune-mediated conditions that are associated with prior exposure to various trigger factors, such as siliconosis, macrophage myofasciitis syndrome, Persian Gulf syndrome, sick building syndrome, and post-vaccination autoimmune events. The development of ASIA syndrome is associated with an individual genetic predisposition and occurs as a result of the combined effect of exogenous and endogenous factors that trigger an autoimmune response. In this case, the reaction of the immune system can be unpredictable. The article presents the diagnostic criteria for the syndrome, as well as its clinical, laboratory and morphological manifestations. The spectrum of clinical manifestations of the autoimmune/inflammatory syndrome induced by adjuvants is extensive and affects almost all systems of the human body. At the same time, its characteristic feature is the regression of clinical, laboratory and morphological manifestations after removal of the adjuvant. There is no doubt that ASIA syndrome has clarified the role of adjuvants in the development of autoimmune processes. This should be taken into account when creating safe vaccines, silicone implants, fillers and other medical devices with minimal side effects. In addition, medical professionals should raise patients’ awareness of the side effects of using certain cosmetic procedures and the use of silicone implants, for which it is necessary to include a description of the etiology, pathogenesis, diagnosis and treatment of ASIA syndrome in teaching aids for students, residents and doctors of various specialties as a separate nosological unit.

The review article describes the involvement of epigenetic factors in type 1 diabetes mellitus (T1DM) etiopathogenesis. The disease is characterized by changes in expression of microRNAs that affect the transcription of genes involved in autoimmune reactions, destruction of beta cells and insulin production. However, the cause of the observed epigenetic changes is still unclear. In evolution, the sources of microRNA genes are transposable elements, which occupy up to 45 % of the entire human DNA sequence and are drivers of epigenetic regulation in ontogenesis. They are sources of transcription factor sequences and binding sites for them. Features of the genome distribution of transposable elements can cause changes in the number of 5’VNTR (variable number of tandem repeats) — repeats of insulin promoter region and HERV insertions into HLA genes, which affects their expression. Therefore, I assume that the cause of the development of type 1 diabetes mellitus may be an imbalance in transcription activation of transposons, which contributes to changes in the expression of specific microRNAs and protein-coding genes, and also contributes to autoimmune response development. Triggers for this may be individual features of genome distribution of transposons, viral infections and stress. An analysis of the scientific literature confirms my proposed mechanisms for T1DM development, since the global role of retroelements in hormonal regulation, the sensitivity of transposable elements to exogenous viral infections and stress, and HERV-W expression of the majority of patients with T1DM with activation of the autoimmune response have been proven. Analysis of the MDTE DB (miRNAs derived from transposable elements database) database showed the transposon origin of 12 T1DM-associated microRNAs (miR-192, miR-224, miR-31, miR-320c, miR-326, miR-340, miR-342, miR-44661, miR-548c, miR-652, miR-95), the use of which can become the basis for targeted therapy for T1DM.

Postcovid syndrome includes many conditions and symptoms, both those that arose directly during the acute period of infection and the appearance of new ones. The purpose of the systematic review is to determine the criteria for the severity of postcovid syndrome. Materials and methods. The following keywords were used to search for literary sources: “postcovid syndrome”, “severity of postcovid syndrome”, “severity of postcovid syndrome” and “symptoms of postcovid syndrome” in Russian and English. We used the search engines “eLibrary.RU — Scientific Electronic Library” and PubMed.gov. Articles were included that presented a study of patients with laboratory-confirmed coronavirus infection at least a month after recovery from COVID-19 with residual clinical signs and/or biochemical changes. The analysis included only publications from the last 3 years (2020– 2023). Results. A total of 2,913 publications were found by two search engines. After removing duplicates, literature reviews, clinical studies of medicines, studies conducted on animals, studies unsatisfactory for time after acute COVID-19, and studies performed on persons under the age of 18, 69 articles were selected for analysis that meet the criteria for inclusion in the analysis. Conclusion. An analysis of the literature of the last 3 years has allowed us to determine that the presence and severity of postcovid syndrome can probably be determined by the presence in a patient of at least one of the signs presented in the review that developed during or after a laboratory-verified COVID-19 infection and persisted for more than 4 weeks from the onset of the disease and that cannot be explained by other reasons.

Hypertension and type 2 diabetes mellitus are often combined and mutually enhance the adverse effect on vascular and renal prognosis. Hypertension is present in about 50 % of patients with type 2 diabetes, and diabetes, in turn, is detected in about 20 % of people with hypertension. The risk of developing hypertension in patients with type 2 diabetes is 2-2.5 times higher than in people without diabetes; the presence of hypertension increases the risk of type 2 diabetes by the same number of times. Hypertension and diabetes mutually burden each other: on the one hand, the presence of hypertension significantly increases the likelihood of developing diabetic macro- and microvascular complications (including diabetic nephropathy and retinopathy); on the other hand, type 2 diabetes, as a classic independent cardiovascular risk factor, increases the risk of complications inherent in hypertension by about 2 times Careful treatment of diabetes with maintenance of target values of glycemia for a long time may be associated with a decrease in the likelihood of developing hypertension by 24 % compared with less adequate control of glycemia. Hypertension in type 2 diabetes may have a number of features that distinguish such patients from the general population of people with hypertension. Such features include a higher proportion of isolated systolic hypertension and resistant hypertension, certain types of circadian rhythm disorders of blood pressure (categories “non-dipper” and “night-peaker”), frequent combination with albuminuria, frequent high salt sensitivity and volume-dependent nature of hypertension, and others.

Aim. To collect data on the patient phenotype at the highest risk of developing albuminuria, to assess the prevalence of albuminuria in the identified phenotypes, and to collect data on the characteristics, prescribed therapy, and comorbidities of patients with and without identified albuminuria.

Materials and methods. Data on presence or absence of albuminuria are collected in this register of real clinical practice instantaneously. All patients seeking medical attention are screened for the presence and extent of albuminuria. All data are collected in anonymized form and entered into an electronic case report form. Inclusion criteria: 1) men and women aged 40 years and older at the time of data collection; 2) the possibility to perform an albuminuria test using dipsticks and/or a test for microalbuminuria or urine albumin/creatinine ratio in a spot urine sample. Exclusion criteria: 1) the patient’s reluctance to participate in the registry; 2) diagnosis of CKD made before screening for the registry; 3) diagnosis of diabetes mellitus type 1 or 2 made before screening for the registry; 4) pregnancy; 5) long distance running or very heavy physical activity in the last 24 hours.

Results. At the time of submission of this material, the active phase of patient recruitment for the registry with the specified power has been ongoing. Based on the expected recruitment rate at 45–50 sites, the registry is expected to include data from 12,000–15,000 patients. If fewer than 12,000 patients are recruited and the estimated recruitment rate for the registry is insufficient, the number of study sites or the screening period may be extended.

Conclusion. Despite the established prognostic significance of the data on AU, the test is prescribed in routine practice to individuals at risk of developing CKD or to patients with an established nephrological disorder. A local registry that combines diverse patient populations, namely patients not only from established CKD risk groups but also patients with a dipstick test for AU, is of scientific and practical interest and can be used in the development of national clinical guidelines and educational materials and used in clinical practice.

Many studies have shown that COVID-19 can progress with coagulopathy and multisystem thrombotic pathologies. This article presents the case of a patient who, 9 days after laboratory-confirmed coronavirus pneumonia against the background of anticoagulant therapy, was diagnosed with splenic infarction in combination with acute myocardial infarction during subsequent hospitalization. Prevention of thrombosis with prophylactic doses of low molecular weight heparin in hospitalized patients with COVID-19 may not be sufficient to prevent the development of coagulopathy. Abdominal visceral thromboembolism should be suspected in a COVID-19 positive patient with abdominal pain despite anticoagulant therapy and normal D-dimer levels.

Iliopsoas muscle abscess is a rare surgical pathology that, in the beginning with the main location of the muscles, determines the diagnosis of this disease. A timely diagnosis will determine a favorable prognosis for the patient. The article describes the case of an elderly patient with fever and intoxication syndrome against the background of chronic pain syndrome. The long course of the pain syndrome complicated the diagnostic search and forced diagnosis. The iliopsoas abscess includes a differential range of disorders in patients, detection of fever, pain in the legs, antalgic gait with closure of the thigh muscles, and a positive psoas symptom. Informing doctors about the manifestations of iliopsoas muscle abscess, the importance of diagnosing this life-threatening condition.

Pulmonary hypertension is a complex syndrome for differential diagnosis, which is the outcome of various pathological conditions. With the exclusion of the two most common causes of pulmonary hypertension, such as pathology of the left heart chambers and pulmonary embolism, further search for etiology often becomes problematic. Despite the emergence of a number of international and domestic recommendations, as well as certain successes in drug therapy, the long-term prognosis in patients with pulmonary arterial hypertension remains unfavorable. In the description of this clinical case in a 39-year-old woman suffering from idiopathic pulmonary arterial hypertension, the main complaint of the patient was very non-specific. The woman could not bear the child, all her attempts, lasting more than 19 years, remained unsuccessful. Even in absolutely healthy women, pregnancy is associated with the highest risks and is a powerful “test” of the body, not to mention patients suffering from rare diseases. The patient has a “subacute” course and a fairly rapid progression of the disease with a significant deterioration in the quality of life, which led to the impossibility of carrying a pregnancy. There were also signs that aggravated the prognosis, such as increased dyspnea, loss of consciousness, a significant decrease in working capacity and a high degree of pulmonary hypertension (according to echocardiography, systolic pressure in the pulmonary artery > 128 mm Hg). Due to the ineffectiveness of standard therapy with a selective inhibitor of cycloguanosine monophosphate — specific phosphodiesterase type 5 — sildenafil; the option of specific therapy for pulmonary hypertension was considered, which made it possible to change the situation and bring the patient into a stable state and draw conclusions about the pregnancy.