Immunoglobulin A nephropathy is the most common immune glomerulopathy in the world. Significant evolution of views on the pathogenesis and treatment of the disease is especially noticeable in recent years due to the emergence of new data on the pathogenesis. It has been proven that immunoglobulin A nephropathy develops as a result of changes in the immune response of the mucous membranes, primarily the nasopharynx (tonsillitis) and gastrointestinal tract. The Russian population of patients is distinguished by its high prevalence, more significant clinical and morphological manifestations and rates of progression, higher proteinuria and prevalence of arterial hypertension and lower renal survival than in Asian and European populations. Immunoglobulin A nephropathy is one of the causes of terminal renal failure and the need for renal replacement therapy using dialysis and kidney transplantation, which requires a more active approach to therapy. The basis for managing patients with immunoglobulin A nephropathy, in accordance with clinical guidelines, is supportive therapy, including lifestyle changes, dietary correction, and drug therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors and sodium-glucose cotransporter type 2 (SGLT2) inhibitors. Treatment methods that reduce glomerular inflammation include immunomodulatory and anti-inflammatory therapy. This lecture presents modern views on pathogenesis, diagnostics, and treatment (including tonsillectomy, fish oil, and various immunosuppressive therapy methods) based on clinical research results.

Introduction. Malignant neoplasms occupy a leading place among the causes of death in the population. Despite the fact that antitumor treatment can significantly prolong the life of cancer patients, it continues to have a toxic effect on organs and systems. Patients with non-Hodgkin’s lymphoma of the indolent type receiving anthracycline-containing therapy regimens, which are the leading treatment regimens due to their availability from the pharmacological and financial side in the Russian Federation, are no exception. The purpose of the study. To identify clinical, laboratory and instrumental indicators, assessed after 3 months of treatment, determining the risk of developing cardiovascular toxicity against the background of 6-month antitumor immunochemotherapy according to the R-CHOP scheme in patients with indolent type of non-Hodgkin’s lymphomas. Materials and methods. An observational case-control study was conducted on the bases of medical institutions in Samara for patients diagnosed with B-cell follicular lymphoma, who were shown to undergo 6 courses of immunochemotherapy in the R-CHOP mode. The patients were divided into two groups: the main group n=21 (16 (76.2 %) men, average age 55.2(9.8) years) with verified cardiovascular toxicity and the control group n=51 (21 (41.2 %) men, average age 53.7(13.6) years) without her. During treatment, the targets were evaluated in two stages: at the start and after three courses of therapy. Results. At the start of the study, patients with verified cardiovascular toxicity had higher values of BMI, CDR, CDR, CDR, volume of the left and right atria, and distal diameter of the excretory tract compared with the control group (p < 0.05). Also, in patients with cardiovascular toxicity, the QTc significantly prolonged during treatment from 360 (245.0; 411.0) to 412 (279.0; 450.0) msec., p=0.032; the concentration of NTproBNP increased from 77 (67.0; 109.0) to 110 (75.0; 222.0) mg/ml, p=0.032; and the value of GLS LV decreased from -21.1 (19.7; 22.4) to -17.7 (15.1; 21.0)%, p=0.004. Conclusion. The expansion of diagnostic protocols within the framework of cardiovascular toxicity among patients with B-cell follicular lymphoma allows timely optimization of management tactics for patients with oncohematological profile.

Aim. To study the characteristics of the neuropsychiatric phenotype of postCOVID syndrome in COVID-19 convalescents. Materials and methods. A sample of 270 COVID-19 convalescents (mean age — 53.2±13.2, (n=130, 48.1 % men)): 62 (23.0 %) without postCOVID syndrome and 208 (77.0 %) with postCOVID syndrome. In the subgroup with postCOVID syndrome, 134 (64.4 %) convalescents had a neuropsychiatric phenotype. The study took into account medical history data, assessed the neuropsychiatric status on the following scales: Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI-20), Symptom Checklist-90-Revised (SCL-90), 36-Item Short-Form Health Survey (SF-36), all patients were consulted by a neurologist, a somnologist and a therapist. Results. The structure of the neuropsychiatric phenotype: insomnia (n=74, 55.2 %), severe asthenia (MFI-20 scale, n=55, 41.0 %), anxiety and depression (HADS scale, n=37, 27.6 %, n=32, 23.9 %, respectively), anosmia/dysosmia (n=13.9.7 %), ageusia/dysgeusia (n=6, 4.5 %). According to the SF-36 questionnaire, in the group of people with a neuropsychiatric phenotype, a marked decrease in indicators was detected in all subscales. According to the SCL-90-R questionnaire, the group with the neuropsychiatric phenotype showed a marked increase in all subscales. The following features were noted in women with a neuropsychiatric phenotype: indicators were lower on the scales: physical functioning by 1.1 times (p=0.017), role-playing functioning due to physical condition by 1.6 times (p=0.031) (SF-36 scale), indicators of obsessive-compulsive disorder by 1.7 times higher (p=0.028), depression 1.5 times (p=0.005), anxiety 2 times (p=0.017) (SCL-90 scale), according to the results of the HADS scale assessment, the incidence of depression in women with the neuropsychiatric phenotype of postCOVID syndrome is 3 times higher (p=0.043) compared with men, having the same phenotype. Conclusion. The neuropsychiatric phenotype of postCOVID syndrome is characterized by the presence of insomnia, severe asthenia, anxiety, depressive disorders, anosmia/dysosmia, and ageusia/dysgeusia. Individuals with a neuropsychiatric phenotype have reduced indicators of quality of life and the level of psychological well-being of the individual in all subscales, according to the SF-36 and SCL-90-R questionnaires. The incidence of neuropsychiatric phenotype, as well as the severity of psychopathological symptoms, is higher in the group of women.

One in 10 patients with asthma suffers from severe asthma, which is characterized by the presence of several clinical phenotypes. The aim of the study is to identify the clinical phenotypes of patients with difficult-to-control and severe asthma based on cluster analysis. Materials and Methods: A cross-sectional study was conducted, including 200 patients with difficult-to-control asthma. Inclusion criteria: severe and difficult-to-control asthma, all patients received treatment according to the 4th-5th step of the provided guidelines (GINA); age over 18 years. Exclusion criteria: the presence of chronic obstructive pulmonary disease, active infectious diseases, including respiratory infections, oncological diseases, pregnancy. All patients underwent clinical and laboratory tests, and levels of leptin, adiponectin, IL-6, IL-8, IL-4, and TNF-α were measured. To phenotype patients with severe asthma, cluster analysis was performed. Statistical data processing was conducted using SPSS Statistics 20.0 and StatTech v. 4.7.2 (StatTech, Russia). Results: The study included 200 patients with difficult-to-control asthma, with a median age of 53.5 (39.0-59.25) years. As a result of the cluster analysis using the k-means method, 3 clusters were identified. Significant differences were found in BMI, eosinophil count, IgE levels, and leptin (p < 0.001 when comparing the 3 clusters). Differences were also found in the levels of pro-inflammatory cytokines, primarily IL-4 (p=0.003 for the 3 clusters), TNF-α, and IL-8 (p < 0.001 when comparing the 3 clusters). It was established that the development of hypereosinophilia in patients with difficult-to-control asthma may be mediated not only by the IL-4 level (1.326, 95 % CI 1.132-1.554), but also by TNF-α (OR 1.046, 95 % CI 1.022-1.07) and IL-8 (OR 1.054, 95 % CI 1.024-1.085). Conclusion: We identified 3 clusters of patients with difficult-to-control bronchial asthma based on the study of clinical, laboratory, and instrumental data. Each identified cluster is characterized by a specific combination of laboratory markers, which can be taken into account when further treating patients with this asthma phenotype.

Background. The relevance of the problem is determined by the increasing prevalence of renal replacement therapy and associated infectious complications, including infective endocarditis (IE) — a disease with high mortality and poor prognosis. Aim. To study the clinical characteristics, laboratory and instrumental parameters, and outcomes of IE in patients undergoing maintenance hemodialysis (HD). Materials and methods. A total of 371 patients with definite IE (modified DUKE criteria) hospitalized between 2000 and 2024 were examined. Of these, 23 patients received maintenance HD at outpatient dialysis centers in the Saratov region. The control group consisted of 348 patients with IE who did not require renal replacement therapy. Results. The mean age of dialysis patients with IE was 51 [38; 56] years, with a dialysis duration of 13 [2; 58.5] months. The prevalence of IE in the studied cohort was 6.2 % (23 out of 371 patients with IE). Positive blood cultures were obtained in 14 (60.8 %) of patients with IE on maintenance HD, with Staphylococcus aureus isolated in 9 (39 %) and Enterococcus in 5 (21.7 %) cases. Left-sided IE localization was observed in the majority of maintenance HD patients (17 (73.9 %)), similar to the comparison group. Patients with IE on maintenance HD exhibited a significantly higher frequency of acute disease progression, diabetes mellitus, and neurological complications (p < 0.05), along with elevated quantitative levels of systemic inflammation markers, such as C-reactive protein and procalcitonin (p < 0.05). The Charlson comorbidity index was higher, and anemia and thrombocytopenia were more severe in patients with IE on maintenance HD (p < 0.05). Hospital mortality in IE patients on maintenance HD was 52.17 %, compared to 17.8 % in the comparison group (OR 4.228, 95 % CI: 1.784–10.02; p < 0.05). Conclusion. IE in patients on maintenance HD is a healthcare-associ ated infection primarily caused by Staphylococcus aureus. IE in maintenance HD patients is characterized by an acute course, severe inflammatory response, and high mortality. Due to the increased risk of IE in maintenance HD patients related to vascular access use and poor prognosis, strict aseptic measures and echocardiographic evaluation in cases of clinical suspicion of IE (e.g., unexplained fever) are recommended. The management of IE in maintenance HD patients requires specific app roaches to antibiotic therapy, dialysis treatment, and prevention to minimize risk factors, necessitating multidisciplinary collaboration among specialists.

Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease of viral etiology, the main complication of which is severe kidney damage. The disease is characterized by a cyclic course, there are 4 periods (febrile, oliguric, polyuric, recollection). In Russia, the disease occurs almost everywhere, but endemic areas are the Far East, the Urals, and the Volga region. In the pathogenesis of the disease, the greatest significance is the development of vascular endothelial damage, where virus reproduction occurs, leading to increased permeability of the vascular wall with the development of hemorrhagic syndrome, edema. In addition, hemorrhages are promoted by a decrease in coagulation factors, as well as platelets. Cases of mild course of this disease in patients carrying the human leukocyte antigen (HLA)-B27 allele have been described in the literature. The aim of our article is to demonstrate a clinical case of mild course of HFRS in a patient with spondyloarthritis associated with HLA-B27. The patient presented with prolonged subfebrileitis as well as inguinal lymphadenopathy. The disease proceeded without kidney damage, development of hemorrhagic syndrome, which are characteristic manifestations of HFRS. Detected IgG and IgM to hantaviruses (causative agents of HFRS) confirmed the diagnosis. The patient had spondyloarthritis associated with HLA-B27, which, according to the literature, can make the clinical picture less vivid, which is observed in our case. Pathogenetic treatment with glucocorticoids resulted in regression of complaints and improvement of the patient’s condition. This article will be useful for specialists of different profiles, as the clinical picture of HFRS has many nonspecific symptoms that can be considered as manifestations of various diseases.

A clinical case of lymphoid tumor hiding under the «mask» of recurrent polychondritis with high activity of inflammatory process and limited response to treatment is presented. In addition to auricle damage, the disease was accompanied by non-erosive non-deforming arthritis, tenosynovitis of the Achilles tendon with its rupture, episcleritis, nasal chondritis, skin lesions in the form of Sweet neutrophilic dermatosis, ascending aorta dilation, subclinical signs of lung and pericardial damage, and development of macrocytic anemia with normal blood levels of vitamin B12 and folic acid, absence of laboratory manifestations of autoimmunity. Despite the fact that recurrent polychondritis with similar clinical and laboratory signs may be part of the phenotype of recently described adult autoinflammatory syndrome (VEXAS), the determination of its genetic marker gave a negative result.

Spontaneous coronary artery dissection (SСAD) is a rare but potentially dangerous cause of acute coronary syndrome, especially in young women without traditional risk factors for cardiovascular diseases. Etiological factors include fi bromuscular dysplasia, hereditary arteriopathies, systemic infl ammatory diseases, and hormonal changes. Despite the progress in diagnosis, the treatment of DMCA remains a diffi cult task due to the high variability of clinical manifestations and the lack of a single standard of therapy. The case of a young patient hospitalized with a ST-segment elevation myocardial infarction clinic, which occurred against the background of intense physical exertion, is presented. Coronary angiography (CAG) revealed spontaneous dissection of the branches of the left coronary artery. The progression of dissection was noted during CAH, which required repeated stenting and the use of mechanical circulatory support (VA-ECMO, IABC). Despite the treatment, the patient maintained unstable hemodynamics and the progression of multiple organ disfunction, which led to death. Histological examination revealed connective tissue dysplasia cannot be excluded, which could be a predisposing factor for the development of coronary artery dissection. Clinical recommendations suggest conservative management of stable patients, however, revascularization is indicated in the presence of complications such as cardiogenic shock. In this case, the invasive tactics did not affect the prognosis.

The above case demonstrates the complexity of diagnosis and management of patients with SDCA. Further research is needed to develop optimal treatment strategies and identify genetic markers predisposing to the development of this pathology.