Four clinical cases presented at the International Congress “Cardiothoracic Radiology” (Moscow, April 2026) are described, illustrating the challenges of differential diagnosis of respiratory diseases. Using cases of granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, emphysematous lung changes, and inflammatory myopathy, the importance of integrating clinical, laboratory, and imaging findings within a multidisciplinary approach is demonstrated. Keywords: differential diagnosis, computed tomography, respiratory diseases, vasculitis, interstitial lung disease.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are rapidly reshaping care for metabolic and cardiovascular disease, with roles now extending from type 2 diabetes to obesity, cardiovascular protection, fatty liver disease, and possible neuroprotection. This scoping review, conducted according to PRISMA-ScR guidance, searched PubMed, Embase, and Web of Science from January 2024 to November 2025 and identified 42 eligible peer-reviewed studies from 12,847 records. Across trials, GLP-1RAs lowered HbA1c by roughly 0.5–2.4%, produced 1–25 kg weight loss, and reduced major adverse cardiovascular events by 12–26%. Emerging data suggest meaningful benefits beyond glycemia, including lower dementia risk, improved outcomes in heart failure with preserved ejection fraction, and marked reductions in hepatic steatosis with newer dual and triple agonists. Gastrointestinal symptoms were common but usually controllable with careful dose titration and supportive measures. Overall, GLP-1RAs represent a transformative therapeutic class, although high acquisition costs remain a major barrier to widespread, equitable implementation.
X-linked adrenoleukodystrophy (X-ALD) is a rare genetically determined peroxisomal disorder caused by mutations in the ABCD1 gene, characterized by progressive accumulation of saturated very long-chain fatty acids (VLCFAs, C26:0) in cells. Dietary therapy for this condition, in particular Lorenzo’s oil, has been used for approximately 40 years as part of the comprehensive management of patients with X-ALD. This review summarizes current evidence on the mechanisms of action of Lorenzo’s oil (competitive inhibition of elongases, primarily ELOVL1), its effects on plasma C26:0 levels, clinical efficacy, indications, and limitations. Lorenzo’s oil reduces plasma C26:0 concentrations; however, despite its pronounced biochemical effect, there is no convincing evidence of improvement in neurological outcomes in patients with clinical manifestations. Potential benefits are mainly discussed in asymptomatic individuals. Special attention is given to supportive nutritional strategies in patients with dysphagia, sarcopenia, and cachexia, as well as the role of antioxidants, B vitamins, and polyphenols in mitigating oxidative stress. Literature was retrieved from PubMed/MEDLINE, Scopus, and eLIBRARY.ru as of March 2026, as well as federal clinical guidelines for the diagnosis and treatment of X-linked adrenoleukodystrophy and international consensus documents. A total of more than 97 sources were analyzed, of which 47 were included in the review.
Obesity is a complex multifactorial chronic disease characterized by profound metabolic, endocrine, and behavioral alterations. Emerging evidence indicates that disturbances in taste perception may not only contribute to the development and maintenance of obesity but may also result from obesity-associated physiological changes. Consequently, the relationship between obesity and taste perception is increasingly recognized as bidirectional, involving intricate interactions between peripheral gustatory pathways and central neural mechanisms regulating food intake, reward processing, and energy homeostasis. This narrative review provides a comprehensive overview of current knowledge regarding the association between obesity and taste perception disorders. The physiological basis of taste perception, including the recognition of sweet, salty, sour, bitter, umami, and fat taste modalities, is examined. Particular attention is given to the impact of obesity-related chronic low-grade inflammation, hormonal and metabolic dysregulation, alterations in gut microbiota composition, and gut–brain axis signaling on taste receptor function, taste bud integrity, and sensory processing. In addition, genetic determinants of taste sensitivity and their potential influence on food preferences and eating behavior are discussed. The review also analyzes evidence demonstrating changes in taste perception following weight reduction, bariatric surgery, and treatment with glucagon-like peptide-1 receptor agonists. Accumulating data suggest that obesity-associated impairments in taste sensitivity may promote maladaptive eating behaviors and unfavorable dietary choices, thereby contributing to the persistence of excess body weight. Conversely, inherent variations in taste perception may influence susceptibility to increased energy intake and obesity development. A deeper understanding of the mechanisms linking obesity and taste perception may improve obesity phenotyping and facilitate the development of personalized preventive and therapeutic strategies aimed at optimizing eating behavior and long-term metabolic outcomes.
The review based on the Professor E.V. Buryukova’s report “From Data to Action: Glycemic Profile Optimization and Prevention of Complications Through Effective Self-Monitoring” considers the diabetes mellitus epidemiological burden, evidence of the need for glycemic control, clinical value of the glycated hemoglobin (HbA1c) rate, pathophysiology of hypoglycemia and glycemic variability, principles of the structured blood glucose self-monitoring in type 1 and 2 diabetes mellitus (including glucocorticoid-induced diabetes), as well as innovative options of the Contour Plus Elite glucose meter with the Contour Diabetes application.
Atrial fibrillation (AF) represents the most prevalent supraventricular tachycardia that is associated with the increase in the rate of cardiovascular complications and mortality. The current patient management paradigm is shifted from the “rate control” strategy to the early proactive “rhythm control”, which is confirmed by large-scale randomized trials and current European and Russian guidelines. The review considers pathophysiological basis of arrhythmogenesis in AF, including electrical, mechanical, structural, and autonomic atrial remodeling levels, as well as the key mechanisms underlying arrhythmia initiation and maintenance (ectopic beat, re-entry, trigger activity/delayed afterdepolarizations). Special attention is paid to the pharmacological rhythm control strategy involving the use of Vaughan-Williams class I and III antiarrhythmic agents: molecular targets, pharmacokinetics, clinical efficacy, and safety profile of propafenone, flecainide, lappaconitine hydrobromide (Allapinin), ethacizine, amiodarone, sotalol, etc. are analyzed, including the drugs available mainly in Russia. It is emphasized that propafenone and flecainide are the globally best studied representatives of the IC class featured prominently in the ESC and ACC/AHA guidelines, while Allapinin and ethacizine are used mainly in Russia and CIS countries and are not included in international guidelines due to the lack of large-scale randomized trials. Based on the current data and guidelines, an algorithmic approach to the anti-relapse therapy selection considering the patient’s phenotype (paroxysmal or persistent AF, structural myocardial abnormality, heart failure, coronary artery disease, left ventricular hypertrophy), atrial remodeling level, conduction system features, comorbidity, and drug interaction is proposed. Principles of antiarrhythmic therapy during the early period after cardioversion and after pulmonary vein isolation as part of the hybrid strategy (invasive + drug treatment) are discussed separately. The review presented is intended for practitioners in cardiology and arrhythmia care and is aimed to make personalization of antiarrhythmic agent selection within the framework of safe and effective rhythm control strategy in AF less complex.
Relevance. Adherence to treatment is a key condition for the control of arterial hypertension (AH). In real-world clinical practice, the frequency of irregular medication intake remains high, necessitating the study of predictors of low compliance to optimize outpatient care. Aim. To comprehensively assess the level of adherence to antihypertensive therapy and identify factors associated with its reduction in outpatients. Materials and methods. Adherence was assessed using the Morisky–Green scale (MMAS-8) in 225 patients with hypertension, stratified by age groups: 18–44 (n=20), 45–59 (n=70), 60–74 (n=97), and 75–89 years (n=38). Descriptive statistics, the χ² test, and binary logistic regression were used to identify predictors of low adherence (<6 points). Results. Satisfactory adherence (≥6 points) was found in 21% (n=47) of patients, of whom 9% (n=20) demonstrated high adherence (8 points). Low adherence was recorded in 79% (n=178) of patients. Univariate analysis showed an association between low adherence and age ≥60 years (p=0.032). According to regression analysis, age ≥75 years remained an independent predictor (OR 3.1; 95% CI 1.2–8.0; p=0.018). Of all patients, 75% experienced difficulties in remembering to take medication (unintentional non-adherence), while 25% intentionally adjusted their therapy. Conclusions. A high prevalence of reduced adherence was found among outpatients with hypertension, with a pronounced age association that was most significant in the elderly. The predominance of unintentional non-adherence highlights the need for implementing reminder technologies and optimizing pharmacotherapy.
Relevance. As is known, the functioning of the thyroid gland is closely related to the metabolism of iodine and depends on the sufficiency or excess of its intake. Therefore, both endogenous and exogenous factors can affect iodine metabolism and, indirectly, the function of the thyroid gland. Clinical manifestations of disorders, regardless of their genesis, have similar features, and the management of patients requires a fundamentally different approach. In these cases, it is the timely and correct differential diagnosis that determines the patient's future. Aim. To share the experience of a differentiated approach to the diagnosis of diseases and conditions caused by disorders of iodine metabolism in order to establish the cause of these disorders, using the example of a presented clinical case. Materials and methods. The data of a 59-year-old patient who was referred for examination and treatment with manifestations of hyperthyroidism are presented. The data of the conducted research (ultrasound, thyroid-stimulating hormone, free thyroxine) confirmed the disorder of the thyroid function, but an additional study – determination of the density of the thyroid gland using computed tomography (RCT) – was required for the differential diagnosis of the disease genesis. Results. To clarify the cause of the disorder of iodine metabolism (increased consumption or excessive intake of iodine), a study of the density of the thyroid gland was carried out. This method revealed a high density of the thyroid gland, confirming the excessive accumulation of iodine in the organ, which is possible only with an excessive intake of exogenous iodine into the body. Conclusion. Modern methods of diagnosing thyroid dysfunction can be supplemented by RCT in cases where it is necessary to perform differential diagnostics of the genesis of the detected disorders and promptly optimize therapeutic approaches.
Aim. To evaluate the influence of the Arg25Pro polymorphism of the TGFB1 gene on the clinical and laboratory parameters of ankylosing spondylitis (AS) and the formation of CVR in patients with AS. Materials and methods. 176 patients with AS underwent genotyping for the Arg25Pro polymorphism of the SELE gene using allele-specific PCR; statistical analysis was performed using the Kruskal–Wallis test. Results. Genotyping for the Arg25Pro polymorphism of the SELE gene was performed in 176 patients with AS using allele-specific PCR. Statistical analysis was performed using the Kruskal–Wallis test. The Arg/Pro phenotype was associated with higher values of BMI (p=0.012), creatinine (p=0.02), urea (p=0.031), uric acid (p<0.05), and the Arg-glucose variant (p=0.027). Arg/Arg homozygotes had a higher incidence of enthesitis (p=0.043) and eye lesions (p=0.024). Identification of the Arg/Pro genotype was associated with a higher incidence of stage 2 (p=0.05) and stage 2 (p=0.02) arterial hypertension (AH). Pyelonephritis was more often recorded with the Pro/Pro phenotype (p=0.05), gastrointestinal diseases – Arg/Arg (p=0.001). Conclusion. The role of the Arg25Pro SNP of the TGFB1 gene in the development of extra-axial and extra-skeletal manifestations of AS, metabolic effects, and pathology of the kidneys and gastrointestinal tract has been demonstrated.
Background. Chronic kidney disease (CKD) is a significant complication in patients with diabetes mellitus (DM), contributing to increased morbidity and mortality. The purpose of the study was to analyse the prevalence and complications of chronic kidney disease in patients with Type II diabetes mellitus in tertiary hospital. Methods. A prospective observational study was conducted in a tertiary care hospital over six months (January – June 2024). One hundred adult patients with T2DM and CKD, defined according to KDIGO 2012 guidelines, were included. Demographic, clinical, and biochemical data were collected, including serum creatinine, blood urea, and albuminuria. Descriptive and comparative statistical analyses were performed. Results. Among the study population, 58% were male and 42% female, with the majority aged 60–69 years (34%). Elevated serum creatinine (74%) and blood urea (68%) were observed, indicating significant renal impairment. Macroalbuminuria (MAA) was the predominant category of albuminuria, particularly in older patients and non-smokers. The most frequent comorbidities included hyperlipidaemia (84%), anaemia (71%), vision impairment (58%), hypertension (48%), thyroid disorders (44%), acid peptic disease (38%), and urinary tract infections (34%). Lifestyle factors such as smoking and alcohol consumption were significantly correlated with albuminuria categories. Conclusion. The study highlights a high prevalence of CKD and its complications among patients with T2DM, particularly in older males. Regular monitoring of renal function and early detection of albuminuria are critical for preventing progression. Targeted interventions addressing comorbidities and lifestyle factors may improve long-term outcomes in this high-risk population.
Stress-induced cardiomyopathy is a relatively rare paratraumatic event with a distinct and quite specific semiology. In practice, this condition is encountered primarily in vascular centers specializing in providing medical care to individuals with symptoms of acute coronary syndrome. A relatively high incidence of this nosology is observed among postmenopausal women. However, this rule is not absolute. This pathology is described significantly less frequently in men and is represented by individual clinical observations. The living conditions of the civilian population in certain regions of the Belgorod region determine an increasing number of casualties as a result of hostilities. In this context, the description of clinical observations of such a pathological condition of the myocardium in young individuals exposed to mine-blast trauma with concomitant traumatic brain injury seems relevant.
Postmenopausal atrophic vaginitis is a complex of vulvovaginal, urinary, and sexual symptoms associated with estrogen deficiency. Objective. To expand our understanding of the pathogenesis of postmenopausal atrophic vaginitis. Materials and methods. This prospective study included 51 postmenopausal women diagnosed with N95.2 – Postmenopausal atrophic vaginitis – and 30 postmenopausal women with unverified atrophic vaginitis. All women underwent posterior vaginal wall biopsy using a 3-mm punch. The expression of inflammatory markers (CD-56, CD-4) was assessed using immunohistochemistry. Results. The expression of CD56 in the stroma and epithelium of the vaginal wall in the study group was 0.5±0.28 and 0.84±0.58, respectively (compared to 0.06±0.13 and 0.1±0.04 in the control group; p<0.05), while the expression of CD4 in the stroma and epithelium was 4.5±2.80 and 4.0±2.5, respectively (compared to 0.37±0.33 and 0.36±0.28 in the control group; p<0.05). Conclusion. Vaginal CD56 expression in atrophic vaginitis was 8.3-fold higher in the stroma and 8.4-fold higher in the epithelium compared to the morphological control group. Similarly, CD4 expression was 12.1-fold higher in the stroma and 11.1-fold higher in the epithelium, which indicates persistent abnormal inflammation of the vaginal mucosa in atrophic vaginitis.
Iron deficiency anemia is one of the most prevalent global health concerns. Conventional daily oral iron supplementation is frequently associated with side effects that reduce treatment compliance. This review aims to analyze novel approaches to iron deficiency anemia treatment, specifically intermittent (alternate-day) iron administration, and its impact on therapy efficacy and tolerability. Based on the analysis of contemporary research, the pivotal role of the hormone hepcidin, which limits iron absorption during daily intake, is examined. Evidence indicates that an intermittent regimen helps to lower peak hepcidin levels, potentially increasing fractional iron absorption. The review demonstrates that while the intermittent regimen may not show statistically significant superiority in the rate of hemoglobin and ferritin increase compared to daily intake, it reliably reduces the frequency and severity of side effects (such as nausea, metallic taste, and gastrointestinal disturbances). Therefore, the intermittent dosing strategy is preferable for enhancing patient compliance while maintaining comparable clinical efficacy. Further research is required to clarify its impact on other iron metabolism markers.
Neurogenic pulmonary edema (NPE) is a form of non-cardiogenic pulmonary edema that develops as a result of acute central nervous system injury, including in patients with epilepsy. This article presents a clinical case of a 16-year-old adolescent male with NPE that developed following an epileptic seizure. The clinical, laboratory, and instrumental findings are described, along with the challen ges of diagnostic confirmation within a multidisciplinary approach. This case demonstrates the need to include NPE in the differential diagnosis of respiratory disorders in children associated with neurological diseases.
Aim. To evaluate the quantity and structure of bacterial pathogens of wound infections in wound biopsies in patients with combat wounds of the extremities. Materials and methods. The study enrolled 86 patients who had suffered from limb injuries within 4 to 121 days before admission to the hospital. During their hospitalization, microbiological analysis of wound tissues was regularly performed with seeding on nutrient media and identification of microorganisms in accordance with standard methods and procedures. Before microbiological analysis tissue biopsies were homogenized and weighed. Results. According to the results of the cultural analysis of wound tissues, the growth of microorganisms was detected in 79.1% of patients. In the first microbiological analysis Acinetobacter baumannii was most often detected (in 24.4% of the patients). Wound infection with Pseudomonas aeruginosa was observed in 22.1% of cases, Enterococcus faecalis – in 19.8%, Klebsiella pneumoniae – in 10.5%, Escherichia coli – in 5.8%, Enterobacter cloacae – in 5.8%, Staphylococcus aureus – in 7%. In 64.7% of patients one microorganism was detected during the cultural analysis, in 26.5% – two, in 8.8% – three. The most common co-infection was P. aeruginosa and K. pneumoniae (in 5 patients). 28.6% of A. baumannii strains were resistant to all tested antibacterial drugs, 19% were extremely resistant and 19% were multiresistant. 66.7% of K. pneumoniae isolates were resistant to all tested antibacterial drugs and 33.3% were extremely resistant. 52.6% of P. aruginosa strains were extremely resistant and 47.4% were multiresistant. Antibacterial therapy was prescribed for 80.2% of patients for the treatment of infected wounds. The most frequently used antibacterial drugs were cefepime (in 37.2% of patients), amikacin (in 31.4%), cefazolin (in 30.2%), sulbactam (in 27.9%), vancomycin (in 12.8%) and imipenem/cilastatin (in 11.6%). Patients also underwent secondary surgical wound treatments and ointment dressings were used. Negative pressure wound therapy was used in 56 patients. Limb reamputations during hospitalization were performed in 37 patients. During hospital treatment only in 18.6% of patients the same microflora remained in wound tissues; superinfection was registered in the remaining patients in a series of subsequent microbiological analysis. The most frequently observed were E. faecalis (in 11 patients), S. aureus (MRSA or MSSA) (in 8 patients), A. baumannii (in 6 patients) and P. aeruginosa (in 5 patients). In 14 patients no microbial growth was detected in wound biopsies during the last microbiological analysis. Conclusion. The study results indicate a high frequency of combat wounds infection with gram-negative microorganisms at the hospital stage of medical care. A. baumannii and P. aeruginosa were most often detected among bacterial pathogens. Among enterobacteria and A. baumanii resistant strains prevailed, which must be taken into account when prescribing antimicrobial therapy.
Modern science is actively exploring a new field – glycomics, which deals with the study of glycation and glycoxidation processes in the human body. These studies help scientists discover new aspects in understanding the mechanisms of various diseases development. As glycomics evolves, more and more effective methods of treatment and prediction of many diseases are emerging. Particular attention is paid to the study of the interaction between various isoforms of the receptor for advanced glycation end products (RAGE) and their ligands. This is of great importance for understanding the course of respiratory diseases, particularly chronic obstructive pulmonary disease, and for developing new approaches to treating this disease.
Coronavirus infection caused by the SARS-CoV-2 virus has claimed the lives of 8.4% of the world's population. Despite the officially declared end of the pandemic, the consequences of the disease do not allow us to talk about a complete recovery of patients and raise serious concerns. Post-COVID effects are manifested by more than 200 symptoms and are often associated with vascular damage. We noted an increase in the frequency of severe and critical stenosis of the brachiocephalic arteries (BCA) in patients who had COVID-19. The aim of the study: to analyze the acute and late effects of coronavirus infection on the human cardiovascular system, the mechanisms of their occurrence and their relationship with occlusive-stenotic lesions of the BCA in the post-COVID period. The SARS-Cov-2 virus penetrates target cells (mainly epithelial), binding via the protein S to the angotensin-converting enzyme on their surface. Infection with the virus leads to the development of an excessive and uncontrolled immune response – a cytokine storm, disrupts hemostasis, increasing coagulation activity. As a result, patients in the acute period of the disease develop systemic disorders (DIC-syndrome, acute respiratory distress syndrome, multiple organ failure). From the cardiovascular system, there is an increased risk of thromboembolism, myocardial damage, symptoms of premature aging of blood vessels (increased arterial stiffness, endothelial dysfunction, proinflammatory activity of the endothelium and progression of lipid disorders). In the post-COVID period, there are disturbances in central and local hemodynamics, symptoms of cerebrovascular pathology (cognitive impairment, vestibulo-ataxic disorders, pyramidal insufficiency, increased risk of arterial and venous thromboembolism, stroke and heart attack). COVID-mediated damage to the brachiocephalic arteries is a multifactorial process that includes the direct effect of the virus on the vascular endothelium, the influence of systemic inflammation, impaired hemostasis, and the effects of concomitant diseases. These factors can interact with each other, worsening the condition of patients and increasing the risk of acute vascular complications. The scheme of the development of occlusive-stenotic damage to the brachiocephalic arteries due to coronavirus infection is presented.
In the interdisciplinary relationship between an internist and other specialists, the least studied aspects are their interactions with a dentist. Drug therapy for somatic diseases can impact a patient's dental status, as well as the results and prognosis of dental treatment. Proton pump inhibitors (PPIs) are the most effective medications for the treatment of acid-related diseases. Numerous studies have shown that long-term use of PPIs is associated with the development of osteoporosis and an increased risk of hip, spine, and wrist fractures. Implantology in dentistry involves the placement of artificial roots (implants) in the jawbone, followed by prosthetic restoration. We searched PubMed and Scopus databases up to January 5, 2026, for publications on the impact of PPIs on the results and prognosis of dental treatment. Experimental and clinical studies, reviews, and meta-analyses demonstrate a potential association between PPI use and implant failure and increased failure rates. To improve the effectiveness of dental treatment outcomes and prognosis, dentists need to be aware of the patient's concomitant/comorbid medical conditions and potential side effects of medications that may adversely affect oral organs and tissues.
Myelin oligodendrocyte glycoprotein (MOG-IgG)-associated disease is a rare autoimmune inflammatory demyelinating disease of the central nervous system characterized by MOG antibody-mediated damage to the myelin sheath of neurons in the brain and spinal cord and the formation of various clinical phenotypes: from optic neuritis and transverse myelitis to acute disseminated encephalomyelitis and cortical encephalitis. Although the clinical picture of this disease may seem like neuromyelitis optica spectrum disorder, most experts consider MOG-IgG-associated disease as a separate nosology with a characteristic pathogenesis. This article discusses the history of disease study, the basics of pathophysiology, the main clinical and radiological characteristics of the disease, as well as updated diagnostic criteria and modern treatment prospects. A clinical case of a patient with MOG-IgG-associated disease is presented.
This study explores pathomorphological and histological alterations in the immune organs of neonates following antenatal exposure to maternal SARS-CoV-2 infection. Particular attention is given to structural changes in primary and secondary lymphoid organs, including the thymus, spleen, and peripheral lymph nodes, which play a critical role in early immune competence. The findings suggest that the observed immune remodeling is predominantly driven by indirect mechanisms, namely maternal systemic inflammation and immune activation, rather than by direct transplacental viral transmission. Characteristic pathological features include accidental thymic involution, hypoplasia of the splenic white pulp, and attenuation of germinal center formation within lymph nodes. Collectively, these alterations reflect a state of functional immunological vulnerability in affected neonates, underscoring the need for individualized postnatal immunological monitoring and follow-up strategies.
