Type 2 diabetes mellitus is known to increase the risk of the development of heart failure with preserved ejection fraction and worsen its symptoms. To date, no specific treatment has been shown to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction. In this review, the authors summarized the existing evidence on how diabetes mellitus can promote the development and progression of heart failure with preserved ejection fraction. The authors also addressed medications including experimental ones that can potentially be beneficial in patients of this group.

The rate of Cesarean section (CS) continues to rise and researchers have no clear understanding of the underlying drivers and consequences. Robson’s 10-group classification is based on simple obstetric parameters (parity, prior CS, gestational age, onset of labor, fetal presentation, and a number of fetuses), which allowed the authors to make an effective evaluation of indicators that lead to an increase in the frequency of abdominal delivery. In the context of the global increase in the frequency of abdominal delivery, further modification of the scale will allow the specialists not only to assess the frequency of CS but also to assess the levels of perinatal morbidity and mortality in the groups that make the most significant contribution to the level of CS. Global trends in the commercialization of childbirth require global approaches to reduce the level of abdominal delivery in the population.

Today, regular physical activity is considered to be an important part of the treatment for many CVDs. Exercise tests are used to determine exercise tolerance and to assess cardiovascular risk. This review outlines the most common methods for assessing exercise tolerance (cycloergometric test and treadmill tests) that have a high diagnostic and prognostic value and allow the specialists to draw reliable conclusions about the patient’s physical activity. The results of stress tests are of great importance in determining further tactics of patient’s management with cardiovascular pathology. Attention is also paid to the issues of cardiopulmonary stress test, which is the most reliable research method, according to the latest international recommendations. However, it is associated with difficulties in conducting and interpreting the research results. The feasibility and effectiveness of tests with the exclusion of the pulmonary component in cardiac patients have been shown for widespread use. A systematic literature search was carried out in databases Medline, Scopus, Web of Science, and Elibrary.

Objective: to study the main aspects of assistance to children with orphan diseases in the Russian Federation. Materials and methods: the most relevant literature sources were studied that covered a concept of orphan diseases in various countries of the world and in the Russian Federation as well as the tactics and regulation of mechanisms for helping patients with rare diseases. Results: the study showed that not all countries have legislative regulations of assistance to orphan patients. The United States and Western Europe are the most advanced in this regard. They have clear criteria for determining orphan pathology and a number of measures are taken to improve the quality of medical care for patients with rare diseases. These activities are not only aimed at improving the health care system but also encourage pharmaceutical companies to develop and produce medicines as well as contribute to the research in this area. The clinical cases covered in the article provide an idea of rare diseases, the complexity of their diagnosis, the severity of the course, and the drugs that are necessary to help patients. Conclusion: orphan diseases have been the focus of attention by the health system and national legislation in the past decades. Their extremely low prevalence in the human population creates difficulties with the timely diagnosis, provision of qualified medical care, and drug provision.

Objective: to study the role of macroelements in the pathogenesis of bronchial asthma in children. Materials and methods: A total of 131 patients with different degrees of bronchial asthma severity were examined instantaneously. The reference group consisted of 31 children of the respective gender and age groups 1 and 2A. The average age of children was 11.83 ± 3.38 years old. All children in the cohort were given a comprehensive clinical-laboratory examination, peakflowmetry, pulsoxymetry, and spirometry. The study of mineral homeostasis in blood serum was carried out by X-ray fluorescence analysis. Statistical processing of the results was performed using the Statistica 10 and Microsoft Office Excel 2010, calculations were carried out in the program R. Results: It was found that the levels of potassium, phosphorus, and sulfur in children with bronchial asthma were elevated, while the levels of calcium, magnesium, and chlorine were reduced compared to the control group patients. The content of these macronutrients in patients with varying degrees of disease severity did not have significant differences. Conclusions: The data obtained on the changes in macro-element homeostasis indicate the important role of diselementosis in the pathogenesis of BA. It is a significant factor that contributes to the progression of chronic inflammation in bronchial organs that requires correction of therapy in children.

Objective: to conduct a comparative analysis of the structure, number, and antenatal diagnosis of fetal malformations in two clinical groups. Materials and methods: a retrospective comparative analysis of the variations, frequency, and detectability of malformations and developmental abnormalities in newborns born in two groups was conducted for the periods from 2010 to 2012 (the first group) and from 2017 to 2019 (the second group). The study of these materials was conducted on the basis of the maternity department of the city hospital of Rostov-on-Don. Statistical processing of the obtained results was carried out using the programs Statistica 10 and Microsoft Excel 2013. Results: in the second group, the number of children with genital abnormalities increased. The number of children with skin abnormalities increased as well as the number of children with gastrointestinal malformations. There is a decrease in the number of abnormalities in the development of the musculoskeletal system and the circulatory system. The rate of cleavage of the lip and hard palate decreased. However, malformations of the fetus were not detected in all cases, although their detectability increased from 4.41% in 2010 – 2012 to 22.62% in 2017 – 2019, i.e. by 5.13 times. Conclusion. The search for modern, reliable, and non-invasive methods for diagnosing fetal malformations in early pregnancy is an important stage in the study of this issue. It is also important to train high-class ultrasound specialists as well as search for new biochemical markers of congenital genetic disorders.

Objective: to study the pathomorphological changes in the vessels of the lungs at dierent times of death in patients with COVID-19. Material and methods: autopsy protocols of 40 deaths from COVID-19 with histological, histochemical examination, and photoregistration. To determine the degree of pulmonary vascular lesions, the authors developed and applied a semi-quantitative assessment scale for the sign based on counting the aected lung vessels in 10 elds of view, expressed as a percentage: no sign – (0%), weak sign + (1-25%), moderate sign ++ (26-50%), expressed sign +++ (51-75%), highly expressed sign ++++ (76-100%). Results: during the rst 14 days of the disease, stasis and swelling of individual endotheliocytes were noted in the vessels of the microvasculature. After 15-21 days of the development of COVID-19, signs of alterations in endothelial cells and microthrombosis were observed in microvessels. After 22-28 days of the disease, the phenomena of repair and hyperplasia of endothelial cells were detected. At dierent times of the development of the disease in the lung tissue, the phenomena of acute respiratory distress syndrome, interstitial pneumonia, and focal pneumobrosis were observed. Conclusions: the authors believe that COVID-19 is associated with a progressive microvascular endotheliopathy in the lungs which is characterized by swelling, alteration, and later, by hyperplasia, and regeneration of endothelial cells in combination with microthrombosis. Destructive changes in the walls of the microvessels of the lungs have supercial character without the destruction of the reticular frame and basal membranes. Endotheliopathy, microthrombus formation of microvessels of the lungs, and interstitial pneumonia create a vicious circle of severe respiratory failure, which must be taken into account in the clinic to correct the treatment of patients with COVID-19.

Objective: to study clinical, anamnestic, and laboratory parameters in children with acute and chronic urticaria. Materials and methods: fifty-five children were examined who were admitted to the pediatric department and day-time inpatient facility of the State Children’s Clinical Hospital No. 17 in Ufa in 2019. Two groups were formed: 44 patients with acute urticaria (Group 1) and 11 patients with chronic urticaria (Group 2). For the correct analysis of the hemogram and immunogram, 2 subgroups of patients with acute urticaria were formed: Group 1a – 13 children under 5 years old and Group 1b – 31 children over 5 years old. Results: acute urticaria was typical for young children (Z cor. = -2.14665; p = 0.031822). In children with acute urticaria under five years of age, there was a correlation (p < 0.05) of age with low serum JgA levels (rs = 0.806380) and the incidence of gastropathology with JgM levels (rs = 0.872872); JgG (rs = 0.763763) and the number of blood leukocytes (rs = 0.692820). In children with acute urticaria over five years of age, a correlation was found between age and concomitant gastropathology (rs = 0.421569). Patients with chronic urticaria are characterized by eosinophilia (Z cor. = -2.96741; p = 0.003003) and a pathogenetically significant increase in the CEC level (Z cor. = 1.98537; p = 0.047104). Conclusion: the revealed differences should be taken into account during the examination and management of children with urticaria.

Objective: to study the functional disorder, joint structural changes with acute phase parameters, and interleukin-1 beta (IL-1β) in patients with hand osteoarthritis (HOA). Materials and methods: the study included 52 women with HOA, the mean age was 63.4 (10.0) years old. The degree of functional impairment was evaluated according to the visual analogue scale (VAS) and the author’s questionnaire. The laboratory study included an assessment of ESR, C-reactive protein (CRP), and IL-1β levels in the blood. The instrumental diagnostic was performed by X-ray, ultrasonography (US), and magnetic resonance imaging (MRI) of the hand joints. Results: no significant data were obtained on the dependence of the severity of structural and functional disorders from ESR, CRP, and IL-1β levels (r<0.5; rs<0.5). Conclusions: there was no correlation between HOA activity and CRP and IL-1β levels but some authors propose to use highly sensitive methods to detect CRP. The application of highly sensitive methods for CRP detection could reveal the association between this indicator and the HOA activity. The absence of dependence between IL-1β level and morpho-functional parameters agrees with the data obtained by other researchers. It is possible that the evaluation of the IL-1β level in dynamics can be useful for assessing the treatment response but this requires further studies.

Purpose: to investigate the prognostic value of secondary hyperaldosteronism patients with heart failure with preserved ejection fraction. Materials and methods: prospective cohort study included 158 patients with hyperaldosteronism and heart failure with preserved ejection fraction. Baseline blood aldosterone levels were determined in all patients. Hyperaldosteronemia was diagnosed when the plasma aldosterone level was > 160 pg/ml. The primary endpoint was all-cause mortality. Results: at baseline, hyperaldosteronemia was detected in 59 of 158 patients (37.3%). Hyperaldosteronemic patients were younger, had higher functional class and NT-proBNP level, and a higher rate of comorbidity (all Ps <0.05). Over a median follow‐up of 32 (28-38) months, a total of 50 (37.6%) patients died. Cardiovascular death occurred in 32 (20.3%) cases, non-cardiovascular – in 18 (11.4%) cases. A total of 65 (41.1%) patients were hospitalized for HF. High aldosterone levels were associated with a significant (p <0.05) increase in the risk of hospitalization for HF (adjusted odds ratio (OR) 2.14, 95% confidence interval (CI) 1.34-9.68), all-cause death (OR 1.64; 95% CI 1.23-7.65, P = 0.033) and HF death (OR 1.56; 95 % CI 1.14-11.3, P = 0.021). Conclusion: Hyperaldosteronism in patients with heart failure with preserved ejection fraction secondary hyperaldosteronism is an independent predictor of hospitalization for heart failure, all-cause, and cardiovascular mortality. The inclusion of plasma aldosterone level in the existing prognosis models of heart failure with preserved ejection fraction will help improve their predictive value and optimize the management of high-risk patients.

Objective: to evaluate the efficiency of the assessment of physical and sexual development, and blood pressure indicators of school-age children of the ethnic Khanties using standards developed on this cohort in comparison with the use of standards that are not adapted to them. Material and methods: the authors assessed of physical and sexual development, and blood pressure indicators in 423 ethnic Khanty children aged 7 to 17 years using standards developed on a cohort of children of the Khanty, the alien population of the north, and international standards. Results: statistically significant differences in the results of the assessment of anthropometric data, blood pressure, and sexual development were found using standards developed on different cohorts of children. The application of standards for the alien population of the north and international standards distorts the conclusion about the assessment of the health of children of ethnic Khanty and contributes to the underdiagnoses of obesity, excess body weight, and arterial hypertension, overdiagnoses of nanism, and a delay in sexual development. Conclusion: the presence of features of physical and sexual development, and blood pressure of ethnic Khanty children determines the need in the standards developed on this ethnically isolated cohort of children for individual and population assessment of their health.

Highly differentiated thyroid cancer is a common endocrine neoplasm with a favorable prognosis. However, errors in the treatment of this pathology can significantly worsen the patient’s quality of life.

Patient V., 65 years old, underwent an operation for papillary thyroid cancer with an injury to the recurrent laryngeal nerve in 2015. Only 6 months later, RAI therapy was performed with an insufficient dose of RI, and levothyroxine was prescribed at a thyrotoxic dose, which led to the development of AF. Throughout the entire period after surgical treatment, biochemical remission could not be achieved, and in 2019, a control ultrasound scan revealed lymphadenopathy of the anterior cervical lymph nodes and metastases in the lungs.

Objective: to study the causes of pancreatitis. Materials and methods: a clinical case of acute pancreatitis during the treatment of ulcerative colitis with 5-aminosalicylic acid-containing drugs. Methods: clinical, laboratory and instrumental (biochemical blood analysis, standard coprological examination, Ultrasound examination of the abdominal cavity, Esophagogastroduodenoscopy). Results: based on the data of the clinic, laboratory and instrumental studies, a diagnosis was made: drug-induced pancreatitis associated with mesalazine intake. Ulcerative colitis, total form, high degree of activity. Duodenal ulcer disease associated with Helicobacter pylori, unstable remission. Erosive bulbitis. The indicated therapy with polyenzyme drugs, proton pump inhibitors, antispasmodics, and glucocorticosteroids resulted in the resolution of clinical manifestations and the normalization of altered laboratory parameters. Conclusions: the use of 5-aminosalicylic acid preparations for the treatment of ulcerative colitis may be associated with the development of pancreatitis, which must be taken into account in clinical practice.

Mauriac syndrome is a severe complication of type 1 diabetes mellitus, manifested by growth retardation, impaired formation of secondary sexual characteristics, lack of libido, and hepatomegaly. Currently, the presented syndrome is quite rare. This is more related to the emergence of intensive insulin therapy, which keeps the level of daily glycemia within the tolerance of type 1 for diabetes mellitus. The article describes a clinical case of the development of Mauriac syndrome in a 21-year-old patient with decompensated diabetes mellitus and multiple complications. The patient was deprived of proper control over the condition of daily glycemia and full-fledged insulin replacement therapy for a long because of unfavorable social and material conditions in the family, which contributed to the development of chronic insulin insufficiency and complications.