Leukemoid reaction (LR) associated with solid tumors has been documented for many decades. LR is often associated with an unfavorable prognosis and aggressive course of the disease. However, the differential diagnosis of LR is of significant difficulty when a patient has several potential etiological factors, each of them individually may cause LR or, on the contrary, lead to a systemic reaction of the body within a single pathogenetic chain.

We present a clinical observation of an elderly patient admitted to the intensive care unit due to the first-time encountered weakness in the right extremities. Clinical and instrumental examination revealed an acute cerebral ischemia with leukocytosis increase up to 60.000 cells/μL with leukocyte formula left shift and subsequent patient decompensation with lethal outcome, despite the intensive treatment.

Autopsy revealed a low-differentiated adenocarcinoma of the pancreatic tail with multiple metastatic lesions in regional lymph nodes and liver, as well as a competing disease — acute infective endocarditis of the aortic valve, which was the cause of sepsis development with septicemia type and thromboembolism both in the great circulation circle with the presence of ischemic cerebral infarction, spleen infarcts, and in the small circle with the development of thromboembolism in the right segmental branches of the pulmonary artery. Given the advanced stage of pancreatic cancer and lack of direct evidence of sepsis at primary diagnosis, paraneoplastic nature of LR is more likely, but infective endocarditis and concomitant pathology also may have contributed to the development of LR.

This article describes two clinical observations of the use of mepolizumab in patients with severe uncontrolled asthma with a mixed granulocytic pattern of inflammation in the bronchi and comorbid pathology. The mixed granulocytic form of severe asthma is characterized by a combination of T2 endotype and non-T2 endotype. The most common mixed granulocytic pattern of severe asthma occurs in comorbid pathology, in particular, when it is combined with chronic obstructive pulmonary disease (COPD) or bronchiectasis.

In the presented observations, both patients had an experience of smoking, a late manifestation of bronchial asthma with the development of centrilobular emphysema and an irreversible decrease in the FEV/FVC ratio as part of the development of COPD. A feature of one of the cases was the presence of cylindrical bronchiectasis in both lungs. The choice of mepolizumab as an additional maintenance agent at GINA stage 5 in both cases was justified by the uncontrolled course of asthma despite the use of a high dose of glucocorticosteroids in combination with other basic drugs and the need for the use of systemic corticosteroids > 50 % of the time per year, a history of recurrent exacerbations in previous 12 months, the presence of persistent blood eosinophilia (>150 cells/μl), as well as a combination of asthma with polypous rhinosinusitis in one of the patients.

Overall, the use of mepolizumab 100 mg subcutaneously every four weeks in addition to regular maximum optimized maintenance therapy was characterized by rapid, signifi cant and sustained effi cacy, which was expressed in early achievement of asthma control within the fi rst 16 weeks of therapy.

A real-world study with clinical and economic assessment of the use of succinate-containing drugs in patients with alcoholic liver disease was conducted. The study was based on data from Buyanov City Clinical Hospital in Moscow and Mirotvortsev Clinical Hospital in Saratov. The period of the study was from 2019 to 2022. The main analyzed factor was the duration of hospitalization and 60 patients with alcoholic liver disease and blood transaminases exceeding two norms and blood ammonia more than one and a half norms were included in the study. Of 60 patients 36 used succinate-containing drugs as part of complex therapy (main group) and 24 did not receive them (control group).

The dynamics of indicators of clinical and instrumental status of patients did not differ in both groups (V=0.35; F=0.87; p=0.614). The modelling by Markov chains was performed. The use of succinate-containing drugs demonstrated 8.3 % reducing of costs per case of alcoholic liver disease cure due to the average reduction of hospitalization by 2.42 days.

Objectives. Evaluation of the relationship of clinical, laboratory and morphological factors with remodeling of small-diameter renal arteries in patients with glomerulonephritis (GN) and arterial hypertension (AH). Materials and methods. The study included 105 patients (average age 37.1±1.2 years) with primary GN and hypertension who had indications for morphological investigation of kidney tissue. All patients underwent a standard examination for kidney disease, a morphological study of kidney tissue with a description of the changes that occur in the presence of glomerulonephritis, corresponding to the individual severity of the pathological process. The presence of signs of a tubulointerstitial component of damage (or tubulointerstitial component — TIC) in the form of tubulointerstitial infl ammation (TIV), fi brosis (TIF) was assessed. Vasometry of the interlobular artery (IA) was performed. The value of the intima-media complex (IMC) was considered to be a sign of IA remodeling. A sign of MA remodeling was considered to be an intima-media complex (IMC) value of more than 30.43 μm. Results. Among clinical and laboratory risk factors, an increase in systolic blood pressure has a statistically signifi cant effect on the likelihood of increasing IMC (χ²-criterion = 5.76, p = 0.016), arterial hypertension stage (χ²-criterion = 9.45, p = 0.002), blood urea level (χ²-criterion = 8.11, p = 0.004), decrease in glomerular fi ltration rate (χ²-criterion = 5.0, p = 0.025), increase in the stage of chronic kidney disease (χ²-criterion = 10.32, p = 0.001). The presence of signs of GN progression, such as an increase in erythrocyte sedimentation rate (ESR) or proteinuria, did not have a statistically significant effect on the risk of IA remodeling (p>0.05). The increase in IA IMC is affected by the presence of hyalinosis of glomerular capillary loops (χ²-criterion = 7.56, p = 0.006), periglomerular hyalinosis (χ²-criterion = 6.96, p = 0.008), sclerosis of the glomerulus (χ²-criterion = 3.9, p = 0.048), increased fibrosis of tubulointerstitium (χ²-criterion = 12.16, p = 0.0005). Conclusion. In GN and AH, remodeling of small-diameter renal vessels occurs due to the influence of AH and its severity, tubulointerstitial changes in the renal tissue. New risk factors for vascular remodeling have been obtained — changes in the glomerulus. At the same time, the inflammatory and autoimmune mechanisms of GN were not associated with changes in the vascular wall. The role of hypertension is decisive in changing the structure of small-diameter kidneys.

Background. Periprocedural myocardial injury (PMI) is an acute complication of percutaneous coronary interventions (PCI) in patients with stable coronary artery disease. Its frequency and relationship with the prognosis of the disease are especially important in elective interventions due to the low risk of ischemic events in this cohort of patients. However, according to the literature, there are significant differences in the criteria for PMI and type 4a myocardial infarction (MI), and, accordingly, their frequency and their prognostic value. Aim. To study the frequency and magnitude of PMI during elective PCI in terms of the level of periprocedural increase in cardiospecific biomarkers, as well as to determine the relationship of PMI with long-term adverse events in patients with chronic coronary artery disease. Materials and methods. A single-center open retrospective cohort study was conducted, which included 435 patients (367/84.4 % men, mean age 58.3±8.6 years) from the elective PCI registry. PMI was diagnosed with an increase in the level of creatine phosphokinase MB fraction (CK-MB) or or cardiac troponin I (cTn I) >1×99 percentile URL (Upper Reference Limit), while the level of increase in biomarkers >1, 2, 3, 4 or >5×99 percentile URL was recorded. An increase in biomarkers >5x99 URL percentile was assessed as a large PMI, and in the presence of clinical and imaging evidence of new loss of viable myocardium, as periprocedural MI type 4a. Depending on the level of periprocedural increase in biomarkers, the relative risk (RR) of developing long-term (within 5 years after index PCI) adverse cardiovascular events, death, as well as clinically significant bleeding and newly diagnosed malignant oncological diseases was calculated. In addition, the correlation between PMI and the above endpoints was summarized using Kaplan-Meier analysis. Results. The frequency of periprocedural PMI diagnosed by increased biomarkers >1×99 percentile URL was 40.2 %, >2×99 percentile URL — 9.7 %, >3×99 percentile URL — 6.7 %, >4×99 percentile URL — 4.8 %, >5×99 percentile URL — 3.5 %, type 4a MI — in 2 patients (0.46 %). An association of “major” PMI (>5x99 percentile URL) with cardiovascular complications within 3 years after elective PCI, including fatal ones, was revealed: for acute myocardial infarction (AMI), RR — 6.516, confidence interval (CI) [2.375-17.881]; for death from cardiovascular causes RR — 6.538, CI [1.695-25.227]. An association of “moderate” PMI (>3, but <5 ×99 URL percentile) with acute ischemic events within 3 years after elective PCI was shown: for AMI, RR was 4.073, CI [1.598 — 10.378]. An association of “minor” AKI (>1, but <5 ×99 URL percentile) with acute ischemic events within 3 years after elective PCI was shown: for AMI, RR was 4.073, CI [1.598 — 10.378]. An association of “minor” AKI (>1, but <3 ×99 URL percentile) with newly diagnosed malignant oncological diseases within 5 years after index PCI was revealed: RR 2.319; CI [1.248- 4.310]. An association of late thrombotic events, such as stent thrombosis (index and re-interventions), stent occlusion (index and non-index) as a reason for re-intervention within 5 years after index PCI, was found with most PMI subgroups. Kaplan-Meier analysis of the dependence of clinically significant bleeding within 5 years after index PCI on the development of “moderate” PMI (p=0.003), as well as the association of non-cardiovascular death within 5 years after index PCI with “minor” PMI (p= 0.007). Conclusion. Registration of periprocedural increase in cardiac biomarkers should be carried out during planned PCI not only for the purpose of diagnosing and predicting acute and late ischemic events, but also for assessing the risk of developing stent occlusion, clinically significant bleeding and prognostically important comorbidities in the long-term (5-year) period in order to identification of groups of patients requiring active monitoring, additional examination and selection of an optimal treatment regimen at the outpatient stage of rehabilitation.

Objective. Materials and methods: 82 patients with type 2 diabetes mellitus participated, which were divided into 2 groups: probable sarcopenia and comparison groups. Conducted: questionnaire surveys (Health Status Survey (SF-36)), Sarcopenia quality and life assessment (SarQoL)), strength, assistance with walking, getting up from a chair, climbing stairs and falling — Strength, Assisted walking, getting up from a chair, Climbing stairs and Falls (SARC-F)), assessment of walking speed and physical activity, carpal dynamometry, bioimpedancemetry, analysis of laboratory parameters. Results: the difference between the conducted questionnaires is statistically insignificant. According to bioimpedansometry, obesity of the 1st degree was recorded in the lesions. In the group with presarcopenia, the main decrease in body composition parameters decreases. In addition, in the main group, the rate of intake is reduced, and decompensation of carbohydrate and lipid metabolism occurs. Differences were considered significant at p < 0.05. Conclusion. Dynamometry and bioimpedance can be used for primary screening of sarcopenia in patients with type 2 diabetes. Maintaining the main indicators of glycemia, correction of dyslipidemia, compensation for obesity D and hypocalcemia of obesity in muscle mass and mass.

Objective. To identify the relationship between the serum vitamin B content and the polymorphism of the vitamin B receptor gene with the severity of the course of COVID-19-associated lung damage.

To identify the relationship between serum vitamin D content and polymorphism of the vitamin D receptor gene with the severity of COVID-19- associated lung damage. Materials and methods. The paper presents the results of an examination of 200 people, after 1 month suffering COVID-associated lung damage in the period from June 1 to October 31, 2020. The patients were divided into groups of 50 people depending on the degree of lung damage based on the results of computed tomography: group 1 (CT-1), median by age was 51.5 [50.5; 54.8]; group 2 (CT-2), median by age 57.0 [53.1; 57.0]; group 3 (CT-3), median by age 52.5 [51.9; 55.0]; group 4 (CT-4), median 55.0 [53.2; 56.4]. The control group included 56 relatively healthy people who did not have coronavirus infection; the median age was 55.0 [51.1; 55.0]. All groups were comparable in age and gender. The concentration of total 25-hydroxyvitamin D (25(OH)D) was studied in blood serum. A molecular genetic study of the vitamin D receptor gene was also carried out: 283 A>G (BsmI) and 2 A>G (FokI). Results. It was revealed that insufficient levels of 25(OH)D in the blood are one of the risk factors for the development of COVID-19 infection, as well as a risk factor for worsening the course of COVID-19-associated lung damage. Analysis of the polymorphism of the vitamin D receptor gene VDR: 283 A>G showed the predominant inheritance of allele A and homozygote A/A in patients with a high level of damage to lung tissue due to COVID-19 infection — KT-3, 4. Study of polymorphism of the vitamin D receptor gene VDR: 2 A>G showed preferential inheritance of homozygote A/A among patients compared to the control group. When studying the concentration of vitamin D in patients with COVID-19-associated lung damage depending on the polymorphism of the vitamin D receptor genes VDR: 283 A>G (BsmI) and VDR: 2 A>G (FokI), no differences were found. Conclusion. Insufficient levels of 25(OH)D in the blood may be one of the factors contributing to the complicated course of coronavirus infection. Analysis of the vitamin D receptor gene polymorphism VDR: 283 A>G showed preferential inheritance of the A allele and homozygote A/A in a more severe category of patients — with more than 50 % damage to the lung tissue (CT-3, 4) against the background of COVID-19 infection. A study of the polymorphism of the vitamin D receptor gene VDR: 2 A>G revealed the most common carriage of the A/A homozygote among patients compared to the control group.

Noise can be one of the factors provoking the premature development of changes in the artery wall associated with age. Aim: to assess the stiffness of the vascular wall and the prevalence of early vascular aging syndrome in men of working age, depending on contact with noise, smoking status and the presence of hypertension. Materials and methods. 148 men worked in noise and 90 men for whom the level of all harmful production factors in the workplace did not exceed the permissible standards were examined. The average age of the examined patients was 41.6 ± 9.9 years, 133 people (55.9 %) were smokers, 43 people (18.1 %) were obese, 47 people (19.7 %) had a complicated heredity, 132 people (55.5 %) had hypercholesterolemia, and 37 people (15.5 %) suffered from arterial hypertension (AH). Each of the patients suffering from hypertension received antihypertensive therapy. There were no significant differences in the structure of antihypertensive therapy in the compared groups of patients. The groups of surveyed were comparable in age, body mass index, prevalence of smoking, obesity and hypertension. All patients underwent volumetric sphygmography according to the standard procedure in the morning on the VaSera 1500N device (FukudaDenshi, Japan), the device automatically determined the cardio-ankle vascular index on the right and left (R/L — CAVI), the estimated age of the arteries. The syndrome of early vascular aging (EVA syndrome) was considered to be a clinical condition associated with an excess of the estimated age of the arteries of the patient’s passport age by 4 years or more (VaSera criteria). Results and discussion. After exclusion of smokers and hypertensive patients from the analysis and correction for age, the vascular wall stiffness index on the right and left in the main group of patients significantly exceeded the indicated indicator in the comparison group. R — CAVI was 7.2 [6.9; 7.9] and 7.05 [6.05; 7.45], respectively, p=0.02; L — CAVI was 7.3 [7.0; 7.9] and 6.85 [6.05; 7.65], respectively, p =0.007. In the group of people working in noise, the estimated age of the arteries significantly exceeded the passport age (p=0.004), whereas in the control group these indicators were comparable (p=0.27). The prevalence of EVA syndrome in the main group of patients was 14 cases (27.5 %), which was 8.6 times higher than the prevalence of EVA syndrome in the comparison group — 1 case (3.2 %); p=0.004. The comparability of the patient groups according to the main cardiovascular risk factors and the exclusion criteria from the study suggested that the identified changes in the state of the vascular wall are associated with the effects of noise on the body of the examined. Conclusion. Noise can be a factor that accelerates vascular aging. It is necessary to monitor the state of the cardiovascular system in persons working in noise.