Iron deficiency is widespread in patients with cardiovascular disease. In recent years, the correction of iron deficiency in patients with chronic heart failure has been actively studied to improve the prognosis and course of the disease. Currently, there are not many studies on the use of iron preparations in patients with pulmonary hypertension. The aim of our review was to explore the possibility of using parenteral iron preparations in patients with pulmonary arterial hypertension to improve symptoms and prognosis. The final analysis included 5 publications. According to the results of the presented studies, after the use of iron preparations, laboratory data characterizing iron deficiency were normalized in all patients, exercise tolerance increased, and the quality of life improved. At the same time, according to the indicators of instrumental studies, the parameters were without dynamics, catheterization of the right heart also showed no effect on hemodynamic criteria. In all studies, iron preparations were well tolerated, no serious side effects were detected, which confirms the possibility of widespread use of drugs of this group. Timely diagnosis and treatment of anemia and latent iron deficiency in patients with pulmonary hypertension prevent disease progression. However, at present, in real clinical practice, parenteral iron preparations are rarely used in patients with latent iron deficiency, as a result of which active outreach among practitioners is necessary in order to expand the use of this type of treatment.

The review concerns special aspects of valvular heart disease (VHD) in antiphospholipid syndrome (APS). In addition to epidemiological data and classification criteria for APS, information is provided on the prevalence, pathogenetic mechanisms, and pathomorphological features of VHD, which is characterized by verrucous endocarditis (or Libman-Sacks endocarditis), thickening of the leaflets and valve dysfunction. The main pathogenetic events of VHD are caused by the effects of antiphospholipid antibodies, local platelet aggregation, migration of inflammatory cells and deposition of immune complexes. The course of VHD in APS is often complicated by thromboembolic complications, including embolization of the cerebral arteries and coronary arteries. Diagnosis of VHD in APS is based primary on the results of echocardiography, which allows to identify leaflet thickening, verrucous vegetations and assess the function of the valve apparatus. The use of transesophageal echocardiography makes it possible to clarify the features of valvular lesions in case of inconclusive results of transthoracic echocardiography. The issues of management of patients with and VHD are discussed, with an assessment of the results of the use of antiplatelet, anticoagulant, immunosuppressive therapy and surgical correction of severe valvular pathology. Cardiac surgery is associated with an increased risk of postoperative complications due to bleeding or thrombosis, as well as mortality.

Purpose. To evaluate the effectiveness of the course administration of an ozone-oxygen mixture into the periarticular tissues of the knee joint in patients with osteoarthritis who underwent total arthroplasty of one of the joints and to study the effect of this technique on the state of lipid peroxidation and the antioxidant defense system of the body relative to traditional methods of restorative treatment.

Materials and methods. The study included 120 patients with bilateral gonarthrosis after endoprosthetics of one of the knee joints. The average age of the patients was 60 [46; 76] years. Depending on the method of rehabilitation treatment, the patients were divided into 3 equal groups (n=40): the 1st group was prescribed periarticular subcutaneous ozone therapy in combination with therapeutic exercise, the 2nd group — magnetotherapy and electrophoresis on the knee joint area in combination with therapeutic exercise, and 3rd group — only the complex of therapeutic exercise. In all patients, before and after rehabilitation treatment (after 14 days and 3 months), the clinico-functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index scale and the indicators of the intensity of the free radical oxidation processes and the activity of antioxidant protection were studied.

Results. A detailed analysis of the clinico-functional state among patients of group 1 relative to group 2 and 3 revealed the best “long-term” result: a marked decrease in pain (p <0.05, p <0.0001), stiffness (p <0.05, p <0.0001), limitations physical activity (p <0.01, p <0.0001) due to the improvement of the main indicators of the antioxidant protection system against the background of ongoing therapy: catalase (p <0.01) and superoxide dismutase (p <0.01).

Conclusion. The use of periarticular ozone therapy makes it possible to achieve a more stable positive effect in patients after total knee arthroplasty relative to traditional methods of restorative treatment due to its pronounced antioxidant effect aimed at stabilizing the processes of lipid peroxidation.

Aim. To study the place and role of adhesive molecules (E-, L-, P-selectins, intercellular and vascular adhesion molecules of type 1 — ICAM-1, VCAM-1) in development of unfavorable one-year prognosis in young patients with acute coronary syndrome (ACS).

Material and methods. A 12-month prospective follow-up included 95 patients (90 men, 5 women, mean age 41.00 [39.00-43.00] years) with ACS who underwent percutaneous coronary intervention (PCI). The endpoints were evaluated (primary — cardiovascular death, and combined secondary — nonfatal acute myocardial infarction and acute cerebrovascular accident, emergency hospitalization due to cardiovascular causes — unstable angina, arrhythmias, heart failure). Blood concentrations of E-, L-, P-selectins, ICAM-1, VCAM-1 were determined by enzyme immunoassay on the 1st (before PCI) and on the 7th day of hospitalization (after PCI).

Results. During 12 months, 22 (23.16 %) patients had estimated endpoints: death in 2 (2.1 %) patients, nonfatal myocardial infarction in 6 (6.32 %), hospitalization due to unstable angina in 14 (14.73 %). In ACS patients with unfavorable annual prognosis, the levels of leukocytes, P-selectin and ICAM-1 on day 1 (before PCI), L- and P-selectins on day 7 (after PCI) were significantly higher than in patients with favorable annual period. According to multivariate analysis, predictors of unfavorable annual prognosis in young ACS patients were the levels of leukocytes (p=0.020) and ICAM-1 (p=0.010) on day 1 (before PCI) and L-selectin on day 7 after PCI (p=0.040).

Conclusion. During the first 12 months in young ACS patients the most significant factors of unfavorable prognosis are the levels of blood leukocytes and ICAM-1 on day 1 (before PCI), and L-selectin on the 7th day after percutaneous coronary intervention.

Athletes, as well as other general population groups, are at risk of infection with hepatitis viruses.

The aim of the study was to characterise the clinical and virological picture of chronic hepatitis B (CHB) in athletes and to evaluate the efficacy of antiviral therapy.

Materials and Methods. Forty-two elite athletes with CHB were included in the study. The results of clinical and laboratory (including virological) parameters and data of instrumental methods of examination were analysed. The efficacy of antiviral therapy was evaluated by virological, serological, biochemical responses and reduction of liver fibrosis severity.

Results. 35.7 % of athletes periodically reported heaviness in the right hypochondrium, and 19 % experienced mild weakness. Diffuse changes in the liver were detected in two-thirds (66.7 %) of the athletes. Additionally, 19.4 % exhibited liver enlargement and/or splenomegaly, while 29.0 % showed moderate or significant liver fibrosis. Elevated ALT activity was observed in 31.0 % of the athletes. Hepatitis B virus DNA was found in the blood serum of all athletes, with 73.8 % of cases showing a viral load of ≥200 IU/mL. During treatment with nucleos(t) ide analogs, aviremia and normalization of aminotransferase activity were achieved in all cases within 3.0 and 4.5 months, respectively. Stabilization or reduction in the severity of liver fibrosis was observed in 90.9 % of athletes after 24.0 months. Viremia recurrence was noted in 7 out of 17 cases due to drug discontinuation.

Conclusion. The clinical presentation of CHB in athletes is characterized by minimal symptoms. After a relatively short period, antiviral therapy with nucleos(t)ide analogs demonstrated high efficacy in achieving virological and biochemical responses, as well as in reducing the severity of liver fibrosis. Cases of viremia recurrence were associated with discontinuation of the medications.

Primary immunodeficiency is a pathological condition of immune system, expressed in the absence or decrease certain parts of immune system. It was generally believed that primary immunodeficiency is a rare pathology but recent findings indicate the opposite. For that matter all types of specialists (especially family doctors) should be well informed. Primary immunodeficiency manifests with various clinical forms, like infectious, oncological, autoimmune, allergical etc. It should be well-known that primary immunodeficiency often debutes with chronic infections and diarrhea, but other sparks are also possible. As for the diagnostics, “red flags” should be taken into account, in addition to laboratory findings, such as lympho-/neutropenia, decrease in immunoglobulins and other specific tests. The therapy for primary immunodeficiency is based on substantial, vital treatment with immunoglobulins, along with prevention and treatment of comorbidities. The article discusses clinical case of an adult multimorbid patient with primary immunodeficiency, non-hereditary agammaglobulinemia with an emphasis on complexity of stating the final diagnosis in adulthood. The peculiarity of the patient is an absence of family history in immunodeficiency. He suffers from infectious (chronic bronchitis), oncological (basal cell carcinoma) and others (pancreatogenic enteropatia) clinical manifestations. It is observed, how family doctors could approach the treatment of the main pathology considering the intensification of comorbid chronic diseases. Futhermore, such patients should be managed ambulatory with full awareness of the stationary treatment and vice versa.

Tuberculous adrenal insufficiency is a rare cause of primary adrenal insufficiency (PAI), characterized by insufficient production of glucocorticoids, mineralocorticoids, and androgens. Nonspecific symptoms of PAI complicate timely diagnosis and treatment, which often leads to a life-threatening condition, Addisonian crisis. This article presents a clinical observation of a 67-year-old female patient. For 8 months, the patient noted a gradual increase in general weakness, and decreased appetite. When visiting a local clinic in June 2022, she was diagnosed with irritable bowel syndrome. Condition on admission in the medical ward in October 2022 was manifested as severe general weakness, abdominal pain, muscle pain, nausea, vomiting. Given the above symptoms, Addisonian crisis was suspected. Before the results of diagnostic tests were obtained, the patient was given hydrocortisone 100 mg intravenously by jet stream 4 times per day. Based on the test results, the patient was diagnosed with primary adrenal insufficiency caused by a tuberculosis process. The patient was prescribed hormone replacement therapy, she was advised on the principles of independently adjusting the hormone therapy; a consultation with a TB specialist was also recommended to decide on initiating anti-tuberculosis therapy. The patient developed an Addisonian crisis due to a combination of factors: the treatment (the drug interaction), the impact of diagnostic procedures (bronchoscopy) and due to no correction of the prescribed hormone replacement therapy. After the acute condition was relieved, the patient was re-consulted by the endocrinologist who decided to increase the dosage of hormone replacement therapy and continue the treatment with antitubercular agents. This clinical case has demonstrated the specifics of diagnostics and selection of replacement therapy in the treatment of PNI. It has also shown that doctors of various specialties have to be better informed about the algorithm and tactics of managing patients with symptoms of Addisonian crisis.