Histopathologic confirmation remains a cornerstone in systemic vasculitis, yet routine practice concentrates on “traditional” targets — kidney, lung, skin, and peripheral nerves — because they frequently harbor diagnostic lesions and, in selected contexts, provide prognostic information. In real-world care, however, conventional biopsies are often contraindicated (due to anticoagulation, frailty, and organ risk), unavailable (no active lesion), or repeatedly non-diagnostic despite a high pre-test probability. Several less commonly used, relatively accessible biopsy sites — particularly rectal submucosa, conjunctiva, and gingiva — can provide actionable histology when standard sites fail or are unsafe. This review synthesizes the evidence base for these uncommon sites across primary systemic vasculitides and secondary vasculitis (with emphasis on rheumatoid vasculitis and lupus-related gastrointestinal vasculitis/enteritis), framing their role as phenotype-driven targets and/or surrogate compartments aligned with expected vessel size and tissue layer. We summarize reported diagnostic yields and safety signals, highlight practical requirements that materially influence “yield” (sampling depth, lesional targeting, serial levels, and appropriate stains), and propose an anatomy- and phenotype-first strategy integrating threatened-organ urgency with procedural risk. Two summary tables contrast uncommon and conventional biopsy sites, emphasizing reported positivity rates, complications, and scenarios in which each site meaningfully shifts diagnostic probability and accelerates treatment decisions.
Aim. To evaluate the diagnostic utility of current electrocardiographic criteria for right ventricular hypertrophy in residents of Saint Petersburg. Patients and Methods. This single-center retrospective case — control study included 212 patients. The main group consisted of 106 patients with echocardiographically confirmed RVH, and the control group consisted of 106 patients without RVH, matched by sex and age. The 30 ECG criteria were analyzed according to the AHA/ACCF/HRS guidelines and the National Guide to Functional Diagnostics. Results. Most criteria showed high specificity (average 90.8%) but low sensitivity (14.6%). The criterion (RI + SIII) — (SI + RIII) < 15 mm demonstrated abnormally high sensitivity (86.8%) with low specificity (19.8%). Statistically significant differences were found for 10 criteria, the highest sensitivity among which was characterized by the T wave inversion in V 1 -V 3 (sensitivity 32.1%, specificity 93.4%) and the combination of SI + QIII (sensitivity 34.9%, specificity 82.1%). Conclusion. Existing ECG criteria are effective for confirming RVH when used independently, but cannot be used for screening due to their low sensitivity. It is advisable to develop algorithms for ECG diagnostics of RVH that take into account the results of evaluating combined criteria and the population characteristics of their use.
Introduction. Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal tract, associated with a decrease in the quality of life and high costs of diagnostic and therapeutic measures. It is known that IBS is more common in women, however, most clinical studies were performed on the male population. Objective: to analyze the clinical and diagnostic features of IBS in female individuals. Methods. The search was conducted in the Pubmed database. Studies of adult patients (≥18 years) with a diagnosis of IBS according to the IV Rome criteria, containing an analysis of symptoms in women and men, were included. Study design: randomized controlled trials, cohort studies, case-control studies, or cross-sectional studies; publication language: English. The quality of the studies was assessed using the NIH Quality Assesment Tool by two independent reviewers with the resolution of disagreements. Results. The review included five studies, with the number of participants ranging from 140 to 5931. Abdominal pain, bloating, and postprandial symptoms are more common in women. Mental health data is heterogeneous: patients with frequent postprandial symptoms have higher levels of anxiety and lower levels of quality of life, while depression levels may be lower in patients with dominant bloating. Conclusion. Patients with predominant bloating or postprandial pain have a higher risk of reduced quality of life and mental health disorders. The mixed findings on depression in bloating may indicate different pathophysiological subtypes of IBS, which require further investigation for possible inclusion in future diagnostic criteria.
Introduction. Ovarian cysts are among the most common gynecological problems in modern women and may manifest as menstrual irregularities and pain, leading to infertility or pregnancy loss. To select an adequate treatment regimen, histological and immunohistochemical typing of ovarian cysts with assessment of estrogen receptor (ER) and progesterone receptor (PR) expression is required. Materials and methods. Biopsy specimens and medical records from 144 patients aged 18 to 50 years with ovarian cysts were analyzed. The patients were divided into three age groups: Group 1 (18–30 years), including 37 women; Group 2 (31–40 years), including 78 women; and Group 3 (41–50 years), including 29 women. Clinical history data and histological types of cysts were analyzed, and ER and PR expression was assessed. Results. Histologically, the cysts were represented by mucinous cysts (8.1% in Group 1, 3.8% in Group 2, and 3.4% in Group 3), dermoid cysts (35.1%, 5.1%, and 20.6%, respectively), serous cysts (21.7%, 30.8%, and 27.8%), endometriotic cysts (35.1%, 44.9%, and 31.0%), and corpus luteum cysts (0%, 15.4%, and 17.2%). Corpus luteum cysts showed the highest ER and PR expression, with 29.4% being ER- and PR-negative. Dermoid cysts were the least sensitive to hormonal influences, with 52.2% being ER- and PR-negative. Conclusion. The most common cyst type in women aged 18 to 50 years was the endometriotic type; dermoid cysts were frequently detected in Group 1. The incidence of corpus luteum cysts increased with age. Mucinous cysts were the rarest type and occurred only sporadically regardless of age. Approximately 50% of mucinous, serous, endometriotic, and corpus luteum cysts were ER+/PR+. In contrast, 52.2% of dermoid cysts were ER-/PR-, which may limit the effectiveness of conservative therapy in these patients.
Introduction. Establishing the relationship between the pattern of esophageal mucosal injury in gastroesophageal reflux disease (GERD), cortisol levels, and changes in the plasma amino acid profile is a relevant research objective. Aim. To assess plasma cortisol levels and free amino acid concentrations in patients with GERD. Patients and Methods. A total of 58 patients who underwent esophagogastroduodenoscopy were examined. The patients were divided into the following groups: Group 1 (n = 26), patients with non-erosive GERD (NERD); Group 2 (n = 12), patients with erosive GERD (ERD); and Group 3 (n = 20), controls. Plasma cortisol levels were measured, and the plasma amino acid profile was determined. Results. Plasma cortisol levels in patients with ERD were higher than those in the control group: 192.6 (151.4; 272.3) vs 124.4 (100.1; 150.5) ng/mL. Compared with controls, patients with ERD had increased plasma concentrations of valine, 353.5 (313.5; 408.1) vs 291.5 (254.7; 326.4) μmol/L; leucine, 217.8 (177.5; 253.9) vs 177.3 (154.6; 211.1) μmol/L; glutamic acid, 496.1 (308.4; 623.3) vs 302.1 (256.7; 384.5) μmol/L; arginine, 79.6 (60.7; 88.5) vs 60.2 (48.4; 75.3) μmol/L; cysteine, 0.905 (0.727; 1.196) vs 0.675 (0.533; 0.832) μmol/L; and alanine, 661.1 (493.7; 733.9) vs 514.1 (419.4; 629.9) μmol/L, whereas the glutamine concentration was decreased, 389.3 (299.9; 431.3) vs 543.1 (434.7; 677.9) μmol/L. Conclusion. Erosive esophageal injury was associated with increased plasma cortisol levels. The observed changes in the plasma amino acid profile in patients with GERD suggest activation of energy metabolism and catabolic processes in the esophageal mucosa.
Dilated cardiomyopathy (DCM) is a severe myocardial disease characterized by marked dilation of the left ventricle or both ventricles and progressive heart failure. It is one of the leading indications for heart transplantation worldwide. The etiology of DCM is heterogeneous and includes both genetic predisposition and external factors, among which previous viral myocarditis plays a key role. However, establishing the exact etiology remains challenging, because verification of viral myocardial injury in routine clinical practice is associated with objective difficulties. This article presents two clinical cases of severe DCM in young patients after an acute respiratory viral infection. The development of end-stage heart failure refractory to medical therapy required advanced treatment modalities: heart transplantation was recommended for one patient, whereas the other underwent implantation of a cardiac contractility modulation (CCM) system. In addition, the disease course in the first patient was complicated by thromboembolism of segmental branches of the pulmonary arteries in both lungs. Maintaining a high level of clinical vigilance in patients presenting with nonspecific complaints such as dyspnea, weakness, pain, and chest discomfort after an acute respiratory viral infection is critically important, as early diagnosis and timely initiation of pathogenetic therapy for myocarditis may prevent structural myocardial changes and, consequently, irreversible dilation of the cardiac chambers.
Recent advances in microbiome research have highlighted that age-related physiological changes are closely shaped by shifts in the gut microbial community rather than by the passage of time alone. Aging is frequently accompanied by a decline in microbial diversity and the loss of short-chain fatty acid-producing taxa, changes that weaken the intestinal barrier and contribute to the persistent low-grade inflammation described as inflammaging. These alterations intersect with immune and metabolic pathways linked to immunosenescence, cellular senescence, and mitochondrial function. In contrast, microbial ecosystems enriched with butyrate-producing and polyamine-generating species have been associated with more stable epithelial integrity, improved metabolic flexibility, and balanced immune activity. Emerging findings also indicate that the gut microbiota communicates with peripheral organs through the gut-skin, gut-muscle, and gut-brain axes, influencing tissue-specific aging processes. Evidence from animal models and human studies shows that dietary modulation, probiotics, and other microbiota-directed approaches can partially restore microbial functions relevant to aging, although responses vary considerably across individuals. Interest is also growing in postbiotic strategies, including microbial metabolites and vesicle-based components, which may offer targeted effects without requiring colonization. By integrating these mechanistic and translational insights, this review outlines how the gut microbiota contributes to aging biology and discusses the potential for microbiome-based interventions to support healthspan.
Mitral valve prolapse (MVP) is among the most frequently diagnosed valvular heart diseases, with the majority of patients being asymptomatic. However, MVP may also present with ventricular arrhythmias (VA) or sudden cardiac death (SCD). The arrhythmic form of MVP and the complicated course of this condition are closely associated with mitral annular disjunction (MAD). MAD alters the anatomical integrity of the mitral annulus and is thought to contribute to leaflet degeneration and myocardial fibrosis, creating a substrate for malignant arrhythmias. The most common complications associated with MVP and MAD include progressive mitral valve regurgitation, left ventricular hypertrophy and an increased risk of SCD. Cardiac magnetic resonance (CMR) imaging is the most sensitive modality for detecting MAD and myocardial fibrosis and is thus essential for early diagnosis and risk stratification. This review aims to enhance recognition of MAD, summarize current diagnostic and risk assessment strategies, and provide clinical context through two cases of patients with arrhythmic MVP and MAD.
Introduction. Chronic heart failure (CHF) is one of the leading causes of death worldwide. Although guideline-directed pharmacotherapy can alleviate symptoms, it cannot restore the heart’s pump function. The definitive treatment options are heart transplantation and implantation of a left ventricular assist device (LVAD). Patients and Methods. We analyzed the clinical histories and previous examination findings of 11 patients (10 men) aged 43 to 70 years with a dilated cardiomyopathy (DCM) phenotype. In 8 cases, DCM was secondary to recurrent myocardial infarctions; 6 patients had previously undergone coronary artery stenting and 2 had undergone coronary artery bypass grafting. One patient had alcoholic DCM, one had tachycardia-induced DCM associated with an adrenal tumor, and one woman had postmyocarditic cardiosclerosis resulting in DCM. Results. Seven patients had a left ventricular ejection fraction below 20% (range, 12%–25%). Left ventricular end-diastolic volume ranged from 160 to 440 mL. Most patients had right ventricular systolic dysfunction. The medical history included chronic kidney disease up to stage 3A in 8 patients, diabetes mellitus in 4, anemia in 5, and anticoagulant therapy in 7. Atrial fibrillation and paroxysmal ventricular tachycardia were observed in 4 patients, complete left bundle branch block in 6, and implantable cardioverter-defibrillators in 3. Aortic stenosis was present in 1 patient, left ventricular aneurysm in 4, chronic obstructive pulmonary disease in 3, and liver cirrhosis in 1. Two patients died after LVAD implantation due to multiple organ failure. Conclusion. Patients on the heart transplant waiting list are characterized by a high burden of comorbidity, which substantially limits the time available for waiting for a donor organ. LVAD therapy is an alternative treatment option; however, it is also associated with the risk of postoperative complications and death.
Despite significant advances in the management of myocardial infarction, including in elderly patients, rare and diagnostically challenging clinical situations still occur. We report a clinical case of ST-segment elevation myocardial infarction (STEMI) in a 76-year-old man caused by thoracic aortic dissection. The patient was admitted to the emergency department with a preliminary diagnosis of ST-segment elevation acute coronary syndrome. Due to the typical clinical presentation and electrocardiographic findings, the patient was immediately transferred to the catheterization laboratory for emergency coronary angiography and possible culprit artery stenting without prior echocardiography. Coronary angiography revealed intimal dissection with occlusion of the left main coronary artery. During an intraoperative consultation involving a cardiologist, an endovascular specialist, and a cardiac surgeon, emergency stenting of the left main coronary artery was performed. The procedure was uneventful. Control angiographic images demonstrated restoration of the left main coronary artery lumen with TIMI 3 blood flow. However, despite successful revascularization, the patient continued to experience persistent chest pain. Additional imaging studies, including echocardiography and CT angiography of the aorta, revealed thoracic aortic dissection extending into the left main coronary artery, which caused myocardial infarction. The patient was stabilized and subsequently underwent surgical aortic replacement one month later. He was discharged in satisfactory condition for further outpatient follow-up.
This article presents a clinical case of a 56-year-old female patient with severe uncontrolled persistent asthma of mixed phenotype, characterized by poor disease control despite optimized background therapy and biologic treatment. The patient had a long history of asthma with progressive respiratory symptoms, frequent exacerbations, dependence on systemic corticosteroids, and development of mild respiratory failure (grade I). Particular attention is given to the use of omalizumab, an anti-IgE monoclonal antibody, administered according to the patient’s total IgE level and body weight. Although initial improvement in clinical symptoms and asthma control questionnaire scores was observed, the therapeutic response was not sustained, and disease control subsequently deteriorated. The report summarizes objective findings, including pulmonary function test results, laboratory markers of allergic and eosinophilic inflammation, bronchoscopy findings, sputum cytology, and chest computed tomography demonstrating chronic airway inflammation and progressive fibrotic remodeling of lung tissue. This case highlights the heterogeneity of severe asthma and illustrates the limitations of anti-IgE therapy in patients with mixed inflammatory phenotypes or non-IgE-mediated mechanisms of disease. The findings emphasize the importance of individualized treatment strategies, continuous monitoring, and consideration of alternative biologic therapies in patients with severe uncontrolled asthma.
Borreliosis (or Lyme disease) is an infectious disease that develops after being bitten by ixodes ticks, which are carriers of Borrelia burgdorferi spirochaetes, and affects several body systems, including the skin, joints, heart, and nervous system. Neurological manifestations of the disease, known as neuroborreliosis, can include meningitis, cranial nerve damage, and peripheral neuropathy. A poorly studied and complex problem is the effect of chronic Borrelia burgdorferi infection on the function of the gastrointestinal tract, which can manifest in the form of gastroparesis, motor disorders, and visceral hypersensitivity. The most difficult to diagnose is the simultaneous lesion of the gastrointestinal tract as a result of borreliosis and irritable bowel syndrome. Irritable bowel syndrome is considered a multifactorial disease based on disorders of the gut-brain axis, dysregulation of the enteric nervous system, and increased visceral sensitivity. Damage to these systems in borreliosis, especially under neuroborreliosis, can induce or modulate similar processes, leading to functional symptoms characteristic of irritable bowel syndrome. The article presents a long-term clinical observation of the comorbidity of these two diseases, the difficulties of diagnosis and treatment, as well as a call for discussion and research of this problem due to the fact that the effectiveness of the management of the described patient cannot be considered satisfactory.
Hereditary angioedema with normal C1‑inhibitor (HAE-nC1INH) remains a diagnostic challenge due to normal complement parameters and clinical similarity to histamine-mediated angioedema, frequently leading to misdiagnosis and delayed initiation of appropriate therapy. The aim of this report was to demonstrate diagnostic reasoning in a clinically suspected case of HAE-nC1INH. We present a clinical case of a 25‑year-old woman with recurrent, non-urticarial edema involving the face and extremities, resistant to antihistamines and systemic corticosteroids. Clinical presentation, family history, and laboratory findings were analyzed, including complement C4 level, C1‑inhibitor activity, thyroid hormone levels, and serum 25‑hydroxyvitamin D. The patient exhibited normal C4 levels and borderline C1‑inhibitor activity in combination with a typical clinical phenotype and positive family history, supporting a probable diagnosis of HAE-nC1INH. A pronounced vitamin D deficiency was also identified. An allergic mechanism of angioedema was considered unlikely. This case underscores the importance of heightened clinical awareness in patients with recurrent angioedema of unclear origin. Early recognition of HAE-nC1INH facilitates timely initiation of targeted therapy and prevents prolonged ineffective treatment.
Introduction. Chagas disease is an infectious vector — borne disease caused by the protozoa Trypanosoma cruzi. The main manifestation of the chronic course of Chagas disease is myocarditis, which leads to chamber dilation, congestive heart failure, and cardiac rhythm and conduction disorders. Diagnosis of latent and chronic stages due to low levels of parasitemia is mainly serological. Aim. To study the nature of cardiac arrhythmias and conduction disorders in patients with Chagas myocarditis. Materials and methods. Resting ECG data from 13 patients with chronic Chagas disease aged 28 to 56 years with Chagas myocarditis were analyzed. The etiological factor was confirmed by solid-phase and recombinant ELISA, exceeding the upper limit of the norm by 2–5 times. Myocarditis was diagnosed by a decrease in the left ventricular ejection fraction below 40% and dilation of the chambers. Results. 8 patients had a stable sinus rhythm, 3 had a permanent form of atrial fibrillation (AF), one had an intermittent form of AF, and 1 patient had a lower atrial rhythm. All 13 people had bradysystole — min heart rate 32 in 1 min, max 46 in 1 min (cf. 41.4 ± 4.3 in 1 min). One patient had a blockage of the antero-superior branch of the left bundle of His, three had a complete right bundle branch block, and one had a combination of antero-superior hemi-block and complete right bundle branch block. 5 patients had a complete grade 3 AV block, two of whom had Frederick’s syndrome. Conclusion. The nature of cardiac arrhythmias in Chagas disease corresponds to those in myocarditis and other etiologies, however, the severity of the registered changes allows us to regard this as a severe course, which is much less common in viral myocarditis. All the examined patients have bradysystolic AF and sinus bradycardia, some of them require constant electrocardiostimulation.
Coronary artery disease remains one of the most significant diseases in modern medicine, and the methods of revascularization are currently the main ones in its treatment. The efficacy of the revascularization mostly depends on the quality and completeness of cardiac rehabilitation measures, which should be applied to almost all patients. The present review informs about topical issues of early cardiological rehabilitation of patients with acute coronary syndrome or those who have undergone coronary bypass surgery. Special attention is paid to the problem of physical activity stress tests at the earliest stages of the cardiac rehabilitation. It is demonstrated that the stress tests performing can be safe and highly informative if the requirements for patient selection and safety measures during the tests are carefully observed. The role and significance of the combined use of physical training methods and magnetic and laser therapy in cardiac rehabilitation, as well as personalized cardiac rehabilitation regimens, are also revealed. Personalized cardiac rehabilitation programs significantly increase the efficacy of the revascularization, improve the prognosis of patients and their quality of life.
Pulmonary arterial hypertension (PAH) is a serious complication that can occur in patients with connective tissue diseases, such as ankylosing spondylitis (AS). This review discusses the cases of PAH in patients with AS, and the issues related to the pathogenesis of pulmonary dysfunction in this condition. The pathogenesis of PAH in AS involves several factors, including systemic inflammation, endothelial dysfunction, oxidative stress, and an imbalance of vasodilators and vasoconstrictors. However, the literature on this topic is limited, with only a few studies available on July 2025. Of the published studies, three were case reports and two were observational studies, with a total of 104 patients. PAH was more commonly found in middle-aged men who had a long history of AS. The most common clinical symptoms included shortness of breath during exercise, leg swelling, and palpitations. Risk factors for PAH in these patients include age, duration of AS, smoking history, severe functional impairments, and evidence of endothelial dysfunction. The authors emphasize the importance of early cardiological screening for patients with prolonged and severe AS, and call for studies to assess the effectiveness of specific PAH treatment in this group of patients.
Hemochromatosis is a hereditary disease that affects many organs and tissues. It is associated with other genetic and autoimmune disorders. The article presents 2 cases of family hemochromatosis (a father and his son), the difficulties of its diagnosis, as well as the interconnections with other diseases. Making a diagnosis is complicated by the fact that the manifestations of the disease are often subtle and nonspecific, especially at its beginning. For example, a patient from the first case report presented with an incoming diagnosis of arterial hypertension. Nobody had found any associations between his son’s autism spectrum disorder and his complicated heredity. One of the problems related to hemochromatosis is that its treatment at the early stages is currently not developed. At the stage of clinical manifestations, the treatment is mostly symptomatic. The chemotherapy is recommended only in severe cases. If this disease is diagnosed, couples planning pregnancy should be consulted by a geneticist.
A decrease and increase in testosterone levels in men before andropause is accompanied by a number of metabolic, functional and organic changes on the part of various systems, primarily the cardiovascular system. Such men are characterized by the development of dyslipidemia and increased cardiovascular risk. Hypogonadism is also associated with obesity, impaired carbohydrate metabolism, and the development of atherosclerosis. Uncontrolled administration of anabolic steroid hormones in the absence of medical indications for this leads to impaired blood rheology, the development of life-threatening cardiac arrhythmias, severe heart failure, and intravascular thrombosis. Two clinical cases are presented: a young man with an arrhythmic variant of cardiomyopathy, which developed as a result of taking anabolic steroids, and a middle-aged man with long-term existing hypogonadism. The clinical manifestations of these conditions, the rate of their development and progression, and the reaction of changes to hormone replacement and non-specific therapy performed in the case of hypogonadism are shown. The peculiarities of both cases are that the patients themselves underestimate the severity of the changes and their condition, and refuse to correct therapy. Despite the obvious and simple treatment of such conditions and the reversibility of most changes, low adherence to therapy significantly increases cardiovascular risk and the risk of sudden death.
Crohn’s disease is a chronic autoimmune disease with an unknown etiology and predominant involvement of the gastrointestinal tract, primarily the small and large intestine. Due to the impact of a huge number of damaging factors, the prevalence of the disease is steadily increasing. The clinical manifestations of Crohn’s disease can be multifaceted, and in many cases can be reduced only to abdominal pain. All that significantly complicate the verification of the disease and obliges the doctor to conduct a thorough differential diagnosis. The presented clinical case indicates defects in its implementation, which was probably due to certain difficulties in collecting anamnesis, the paucity of clinical manifestations, as well as the lack of specificity in the endoscopic and pathomorphological picture. It is worth noting that the diagnosis was also not confirmed by specific laboratory data. As a result, these violations at the diagnostic stage led to incorrect patient management tactics for several years. During the appointment with a gastroenterologist, a correctly performed repeated differential diagnosis made it possible to establish the correct diagnosis and conduct an effective therapy of the disease, as well as to exclude a serious misdiagnosis.
The present review is a critical view of the teachers of the Department of Propaedeutics of Internal Diseases and students on the current problems of teaching clinical disciplines, in particular, the development of practical skills. Objective reasons and subjective factors that limit traditional teaching methods “at the bedside” from the point of view of students and teachers are highlighted. The article provides up-to-date literature data on the possibilities and experience of using artificial intelligence and virtual reality platforms in teaching medical students, residents, and training doctors of various specialties. The positive aspects (the possibility of repeated skill development, a wide range of clinical situations, inclusiveness of training) and negative aspects of using such platforms (lack of contact with a sick person, understanding of impunity for decisions made) are noted. The possibilities of certain educational platforms, their functionality, and an approximate list of practical skills, instrumental and laboratory investigation data used to train students in identifying a particular syndrome or disease are highlighted.
