Early accurate detection of skin cancer is a growing global problem of health’s services throughout the world. Malignant skin formation can be suspected by using an anamnesis, visual inspection of the skin, and diffrent types of investigations in primary care settings. The dermatoscopic examination is necessary for exclusion or confirmation skin cancer, which is performed by a dermatovenerologist. The patient is referred futher to an oncologist in case the cancer cannot be excluded. Well-organized identification of patients with suspected skin cancer is accociated with favorable prognosis. However, in order to reduce the rates of high neglect for malignant skin tumors and optimize the routing of patients after visiting a primary care phisician, it is worth to pay attention to the following points: annual medical check-up examinations, especially among people of age is over than 40 years; a complete physical examination, including thorough history and full body skin examination by general practition as part of a clinical examination in a primary care settings; the use of mandatory dermoscopic examination by a dermatovenerologist for early diagnosis of skin cancer, and, if possible, dynamic skin mapping with artificial intelligence analysis; increasing the professional and communicative skills, especially needed in managing newly diagnosed skin cancer, since psychosocial factors influence the patient’s attitude towards his/her own health; maintaining continuity between general practitioners and dermatovenerologists to improve the quality of medical care; creation of “Healthy Skin” schools in clinics to increase the medical literacy of the population concerning the education regarding the danger of skin cancer, training in skin self-examination skills; using e-health technologies as an additional source of information.

Aim. To assess clinical characteristics and medication adherence in patients with heart failure (HF) with different left ventricle ejection fractions (LVEF).Material and methods. The study involved 65 outpatients aged ≥60 years with a verified diagnosis of HF. A standard physical examination, laboratory and echocardiographic studies were performed. Adherence to treatment was assessed using the National Society of Evidence-B ased Pharmacotherapy Adherence Scale. A patient was considered to have complete adherence with a score of 0, incomplete adherence — ≥1.Results. Preserved LVEF (≥50%) was present in 33 (50,8%) patients (mean age, 76,2±6,6 years). Mildly reduced and reduced LVEF (<50%) was recorded in 32 (49,2%) patients aged 69,8±7,7 years. Regardless of the LVEF, all patients (100%) had two or more chronic diseases, while 45,5% of patients with LVEF ≥50% and 53,1% of patients with LVEF <50% took six or more medications. Most patients took beta-blockers (78,8% in the group with LVEF ≥50%; 87,5% in the group with LVEF <50%), while in isolated cases — angiotensin receptor- neprilysin inhibitors (3% of patients with preserved LVEF; 6,3% — with reduced and moderately reduced LVEF). At the same time, no patient with HF took quadruple therapy. Full adherence to treatment was found in 87,5% of patients in the group with LVEF <50% and in 57,6% in the group with LVEF ≥50%, p=0,007. As the leading reason for noncomplete adherence to treatment, most patients (61,1%) indicated forgetfulness.Conclusion. Complete adherence rate in outpatients with HF with preserved EF is lower than in patients with reduced and mildly reduced EF. Regardless of LVEF, patients with HF require measures to improve medication adherence

The article discusses the adaptation of European Federation of Internal Medicine clinical guidelines for the management of patients with acute heart failure (AHF). An algorithm has been proposed for the differential diagnostic examination of patients with AHF and acute shortness of breath, signs of congestion, hypoxemia, including the determination of natriuretic peptides (NUPs) and/or cardiac troponin, assessment of the congestion severity using echocardiography, as well as the potential of chest radiography and lung ultrasound in certain clinical situations. Special attention is paid to methods for assessing and treating signs of fluid congestion, which have the most accurate prognostic value in patients hospitalized due to AHF. Assessment of the prognosis and the need for hospitalization of AHF patients in the intensive care unit are highlighted. Treatment strategies for patients with hypotension and low cardiac output are discussed. The latest guidelines for the treatment of patients with AHF, taking into account concomitant diseases, are presented. Indications for hospital discharge of patients with AHF, optimization of the further treatment plan, effective strategies for reducing the risk of rehospitalization and mortality, both at the hospital discharge and outpatient stage, are discussed.

Eurasian clinical practice guidelines for dietary management of cardiovascular diseases include actual healthy diet recommendations and modern dietary approaches for prevention and treatment of cardiovascular diseases. Nutritional assessment and interventions based on pathogenesis of atherosclerosis and cardiovascular diseases are presented.Modern nutritional and dietary recommendations for patients with arterial hypertension, coronary heart disease, chronic heart failure, heart rhythm disorders, dyslipidemia and gout are summarized in present recommendations. Particular attention is paid to the dietary management of cardiovascular patients with obesity and/or diabetes mellitus. This guide would be interesting and intended to a wide range of readers, primarily cardiologists, dietitians and nutritionists, general practitioners, endocrinologists, and medical students.

Heart failure (CHF) is a syndrome characterized by a progressive course with varying duration of stability period, frequent episodes of clinical deterioration, despite the therapy. HF deterioration often leads to repitalizations and poor prognosis. A possible reduction in rehospitalization rate and prognosis improvement by early administration of optimal therapy and modernization of non-drug approaches is an urgent area of research. An integrated approach using scales, algorithms and relevant therapy strategies can significantly improve treatment outcomes and quality of life in patients with HF.

The applicability of the left ventricular global function index (LVGFI) and its deriva­tive, determined by echocardiography, to distinguish clinical phenotypes in a cohort of patients with heart failure with preserved ejection fraction (HFpEF) is unknown.Aim. To evaluate the differential diagnostic potential of LVGFI and its derivative when phenotyping outpatients aged ≥60 years with HFpEF.Material and methods. A total of 140 outpatients (men, 43%) aged 73 (67-78) years with functional class II-IV HFpEF were included in the study. The follow-up period was 34 (22-36) months.Results. LVGFI was 22,4 (19,4-24,6)%, while derivative index of LVGFI — 283,9 (248,9-332,2) ml. There were 18 (12,9%) deaths. The threshold value for predicting death for LVGFI was ≤21,4%, for derivative index of LVGFI — ≥303,6 ml. Based on cluster membership and mortality analysis, two following risk groups for death of patients with HFpEF were identified: a relatively low-risk (group 1) and moderate (group 2) risk group (mortality within 34 months ~25%). Group 1 was represented by patients, predominantly male, with class II HFpEF, coronary artery disease (CAD) and prior myocardial infarction (MI), concentric hypertrophy, a significant LV mass increase, a high frequency of bendopnea, lower LVGFI and higher derivative index of LVGFI. Group 2 was represented by patients, predominantly female, with class II HF, a history of CAD and myocardial infarction, concentric hypertrophy and concentric remodeling, a moderate LV mass increase, a relatively low frequency of bendopnea, higher LVGFI and lower derivative index of LVGFI. Based on the data obtained, an algorithm was developed to determine the risk of death in patients with HFpEF.Conclusion. LVGFI and its derivative index can be used in phenotyping patients with HFpEF. The developed algorithm for determining the death risk makes it possible to identify outpatients with HFpEF who need intensified therapy and observation by a general practitioner and cardiologist in order to reduce the risk of an unfavorable prognosis.

Introduction . The data of epidemiological studies indicate maintaining high prevalence of heart failure (HF) and an unfavorable prognosis for such patients, which creates the need to change the treatment approach. A feature of the case presented is the young age of the patient and a significant effect that was achieved with quadruple therapy for HF with reduced ejection fraction (EF) after myocarditis. Short description . A three-year follow-up of a patient with HFrEF was carried out. In 2019, at the age of 21, the patient had acute myocarditis, diagnosed according to magnetic resonance imaging. The outcome was postmyocarditis cardiosclerosis, complicated by HFrEF. She had two episodes of HF decompensation, followed by hospitalizations in a cardiology hospital. During the treatment, a quadruple therapy was initiated (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor), against which a significant improve was noted in the form of decrease in congestion symptoms, natriuretic peptide level from 1956 to 501,4 pg/ml, an increase in LVEF from 33% to 39%. The patient is currently on the waiting list for a donor heart transplant. Conclusion . The case report focuses on the complexity of not only the timely diagnosis of myocarditis, but also the treatment of its consequences. The appointment of quadruple therapy for a patient with HF after myocarditis has improved the patient’s clinical condition before heart transplantation. However, this approach needs to be confirmed in a larger number of patients.

The article discusses the modern approaches to a glycemic control among outpatients with prediabetes. The risk factors for prediabetes, the possibilities of its screening, and the issues of treatment non-adherence are discussed. An attention is paid to the aspects of teaching patients the skills of competent self-monitoring of glycemia, and the use of glucometers integrated with smartphones at home. Modern features and advantages of the glucometer for self-control over the disease are discussed.

Aim . To study the prognostic relationship between heart failure (HF) and osteoporosis, as well to search for modern principles and approaches to the management of patients. Material and methods . A search was conducted in the PubMed, RSCI databases from 2012 to 2022 using keywords. The studies were selected according to the PRISMA algorithm. Results . Based on the results, 124 papers were received, and 9 articles were eventually selected. The age of the patients was at least 49 years (mainly elderly patients). The median follow-up ranged from 12 months to 10,5 years. The larger percentage were females. Conclusion . Osteoporosis was associated with the HF risk, and patients with heart failure had a higher risk of accidental fracture due to accelerated bone turnover. The foregoing makes it possible to consider patients with HF as a group of increased risk of osteoporosis and associated fractures, and impaired mineral metabolism as a possible additional cardiovascular risk factor.

Aim. The aim is to evaluate the importance of interuniversity scientific-practical conferences for improving the preparation of medical students for future professional activities in the field of outpatient care. Materials and methods. An online survey was conducted of 19 people who had previously given oral presentations at one of the interuniversity conferences organized within the framework of the Scientific and Educational Medical Cluster of the Central Federal District "East European". The purpose of the survey was to identify the benefits that participants experienced as a result of their report at conferences and to reveal their interest in ambulatory medicine. Results. The most significant benefits were increased motivation to study and deepen knowledge (average score - 9.4), as well as desire for development (9.4 points). The respondents rated the development of public speaking skills and increased interest in scientific activities as 9.2 and 9.3 points, respectively. The least significant benefit of participation in the conference was the development of communication skills (8.7 points). The outpatient focus of interuniversity conferences became the most important factor for students’ participation in conferences (9.5 points). Conclusion. Various methods of scientific and professional training implemented by departments of outpatient therapy of the Faculty of the Russian National Research Medical University named after N.I. Pirogov and Voronezh State Medical University named after N.N. Burdenko give participants the opportunity to choose the most interesting option for taking part in scientific and practical work. The joint work of the departments within the framework of the Scientific and Educational Medical Cluster of the Central Federal District "East European" significantly expands the possibilities of preparing medical students for future professional activities in the outpatient field and increases their interest in scientific work.

Aim    To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage. Material and methods    A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].Results    134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.Conclusion    Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.

Aim. To evaluate the importance of certain aspects of research-to-practice conferences, organized by the Department of General Practice of Pirogov Russian National Research Medical University, as well as its contribution to preparing students for future professional activities within the outpatient healthcare and the impact of these events on the interest of participants and speakers for research work.Material and methods. An anonymous online survey included 37 participants in the discussed conferences regarding the respondents’ motivation to attend conferences, assessment of declared subject coverage, the practical applicability of the knowledge gained and other aspects.Results. The most important motivating factors for conference participation were interest in outpatient healthcare (52,4% for the conference "Internal diseases at the prehospital stage" and 87,5% for the conference "A multimorbid patient — continuity between hospital and clinic"), analysis of interesting cases (66,7% and 75%, respectively) and multidisciplinary focus of activities (47,6% and 68,8%). An important aspect was the coverage of current problems of practical healthcare. The most important results were considered by the majority of participants to be expanding their medical horizons (85,7% and 87,5%) and gaining new knowledge on the declared subject (90,5% and 75%). Almost half of the respondents (52,4% and 56,3%) improved their interest in scientific activities as a result of visiting the conferences.Conclusion. Conducting research-to-practice conferences for students, residents and postgraduates serves as a platform for increasing the knowledge and mastering professional competencies. The results of a survey of conference participants and speakers indicate the relevance of involving students in conferences and the numerous benefits they receive, which are discussed in detail in this article.

To date, the problem of preserving symptoms after recovery from a new coronavirus infection is urgent in the world. This condition is called postcovid syndrome. The clinical picture of postcovid syndrome has multiple manifestations: general, respiratory, cardiovascular, gastrointestinal, skin and other symptoms. At the moment, there are no laboratory criteria for the diagnosis of this condition, but the great role of neutrophils in the development of both acute disease and postcovid syndrome has been proven. The formation of neutrophil extracellular traps (not toz) is one of the pathophysiological mechanisms of the course of a new coronavirus infection. In addition, the effect of the ketosis process on the development of complications in the postcovid period has been proven. The article discusses the history of the term, various clinical manifestations of the postcovid period, as well as the role of innate immunity mechanisms at all stages of the course of a new coronavirus infection.

BACKGROUND : The problem of metabolic syndrome is considered a demographic catastrophe. According to WHO experts, «by 2025, the prevalence of metabolic syndrome (MS) in the world will amount to more than 300 million people, and in the next 25 years it is expected to increase by 50%.» The pathophysiological mechanisms of MS formation and the role of unhealthy diet on the development of intestinal dysbiosis, mitochondrial insufficiency remain unclear. AIM : To study the effect of unhealthy diet on the state of the intestinal microbiota and the development of metabolicmitochondrial insufficiency in the formation of a multi-organ metabolic syndrome, evaluation of ways of correction. MATERIALS AND METHODS : Clinical picture assessment, anthropometric data (body mass index), laboratory results (glucose, cholesterol and fractions) were carried out in patients with MS, triglycerides, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, lipid peroxidation indicators: malondialdehyde, diene conjugates, schiff bases, hydroperoxides, catalase, superoxide dismutase, succinate dehydrogenase (ASDH), α-glycerophosphate dehydrogenase (α-AGFDH). Hemorheological parameters were evaluated by the apparent viscosity of blood, the yield strength, the aggregation coefficient of erythrocytes and platelets. The microbiota and microbiome of the intestine were evaluated by species, strain composition and the level of metabolites-propionic, butyric, acetic acid, lipopolysaccharides, peptidoglycans. A questionnaire was conducted to study the nature of nutrition. RESULTS : The study included 128 patients with MS and 25 healthy individuals. According to medical outpatient records from anamnesis, questioning of each patient, complaints and clinical picture, 26.2% of patients had type 2 diabetes, 3.74% of men had erectile dysfunction, 7.5% of women had polycystic ovaries, 15.1% had night apnea syndrome, 8.7% hyperuricemic syndrome, 96.5% of patients had metabolic fatty liver steatosis. According to the results of the survey, it was revealed that 99.8% of patients adhered to an unhealthy and unbalanced, high-calorie diet, 46.4% of patients had a low level of physical activity, 48.7% had an average. The revealed disorders of lipid, carbohydrate metabolism, microbiota and intestinal microbiome were associated with increased lipid peroxidation, decreased levels of antioxidant defense enzymes, indicators reflecting mitochondrial function against the background of hemorheological disorders. CONCLUSION : In multi-organ MS, unhealthy diet can be considered as a targeted risk factor triggering pathophysiological mechanisms at the level of the intestinal microbiota, followed by a cascade of metabolic disorders in the form of activation of lipid peroxidation with inhibition of antioxidant defense enzymes, the development of multi-organ mitochondrial insufficiency and the development of latent hemorheological syndrome. The revealed metabolic complex obviously constitutes a multiorgan morphological cluster underlying the development of multi-organ metabolic syndrome. Based on the identified disorders, pathogenetically justified correction of MS should include a balanced diet with mitochondrial protective therapy.

Objective. On the example of a clinical case, the difficulties of timely diagnosis of acute pancreatitis are considered. Main points. Acute pancreatitis is an actual problem of modern medicine due to its wide prevalence and high mortality rates. A clinical observation of a 48-year-old patient with dyspeptic complaints and intestinal manifestations is presented. Conclusion. The presented clinical case illustrates not only the difficulty of timely diagnosis of acute pancreatitis, but also confirms that patients with existing pain, dyspeptic and asthenovegetative syndromes after a viral intestinal infection require special attention and are at risk of developing acute pancreatitis.

We studied the neutrophils and monocytes obtained from 37 patients with various inflammatory diseases such as psoriasis, acute infectious process in the abdominal cavity (acute appendicitis/abscess of the abdominal cavity, and acute cholecystitis), acute pancreatitis, and post-COVID syndrome after mild COVID infection. The number and the morphological structure of neutrophil extracellular traps (NET) as well as the effect of IgG on NET were examined. NET were visualized and counted by fluorescence microscopy with fluorescent dye SYBR Green. All the studied types of inflammation were accompanied by spontaneous formation of NET. After application of IgG, the number of NET doubled, their size increased, and transformation of net-like traps into the cloud forms was observed. The clouds form structure of the network is not capable of capturing pathogens with subsequent retraction, the products of its enzymatic degradation can be the factors of secondary alteration. The study results demonstrate a previously unknown mechanism of infection resistance.

The article presents a brief analytical review of the European Society of Cardiology consensus statement on the definition and clinical features of heart failure (HF) with a summary of the latest results on the treatment and prevention of exacerbation. The main viewpoints are compared with existing approaches in the Russian Federation. The definition and classification of worsening HF (WHF), as well as its main clinical manifestations, epidemiology, outcomes, pathophysiology, approaches to early detection, patterns of in- and outpatient treatment of WHF are discussed. Attention is paid to the terminology necessary to identify a cohort of patients with HF exacerbation with a previously established diagnosis of HF in order to unify approaches to diagnosis and treatment.

Aim. To evaluate the effectiveness of the student science club (SSC) in a medical university to prepare students for future professional activities. To achieve this aim, the task was to analyze pedagogical methods and their impact on increasing the motivation to participate in the SSC work, the emergence of interest in scientific activities, and the deepening of knowledge in outpatient internal medicine.Material and methods. A survey of 25 SSC participants was conducted. The questionnaire was developed by the curator and graduate of the SSC. Data collection was carried out using an online survey, the form of which was created on the Google Forms basis. The questionnaire contained 14 questions regarding motivation to attend meetings, the benefits of the SSC, evaluation of the effectiveness and efficiency of classes. University graduates working in medical institutions were asked additional questions regarding the practical application of the acquired knowledge and the impact of work in the SSC on their choice of future specialty.Results. The underlying motive for participation in the SSC work was personal scientific enrichment. Also, the majority of respondents noted the effectiveness of the club format, which includes short informative blocks and a vigorous debate. The most important aspects of the effectiveness of the SSC work have the practical significance of the acquired knowledge (average score, 10 out of 10), increased motivation to study (9,2), and improved level of theoretical training (9,1).Conclusion. Identification of the main motivation factors and effectiveness of SSC classes can be useful for chiefs in drawing up a work plan, choosing the optimal meeting format, preparing reports, and organizing scientific work. The greatest attention in the SSC of the Department of Polyclinic Therapy should be given to clinical reviews of patients with complex diagnoses and problems in the selection of therapy, work with real examination results, including ECG, the continuity of the theoretical knowledge gained with their practical application. A significant factor in the SSC success is the development of a structure for classes that increases their effectiveness, and the creation of a favorable psychic atmosphere that helps increase motivation to attend meetings and actively participate in the work.

The problem of rational management of patients with heart failure (HF) remains extremely relevant due to its increasing incidence and poor prognosis. Based on current guidelines, therapy for patients with HF involves systematic and long-term use of many medications, and their effectiveness largely depends on the quality of the patient’s compliance. Pharmacotherapy of older patients with HF is complicated by metabolism and the coexistence of many diseases associated with polypharmacy, which significantly reduces the response to therapy. Insufficient adherence to treatment has been proven to reduce the quality of life of patients. Currently, three HF phenotypes have been identified, depending on the left ventricular ejection fraction. However, the number of studies examining the characteristics of patient adherence in different phenotypes is limited, which requires further research. The article is an analytical review devoted to various aspects of adherence to treatment in patients with HF. The terms and concepts associated with compliance, the history of its research, the main modern approaches to pharmacotherapy of HF for different phenotypes are briefly covered. The results of a number of large clinical studies are presented, including the assessment of adherence in patients with HF and its relationship with prognosis.

Aim. To analyze the specifics of residency training in the specialty 31.08.54 "General practice (Family Medicine)" at the medical university.Material and methods. Theoretical (search and analysis of available full-text articles in the Elibrary database using keywords: residency, general practice, teaching methods, medical university) and verbal-communicative method were used in the form of an online survey of 27 residents using a questionnaire developed in based on Google Forms.Results. During the period from 2018 to the present, 68 residents have been trained in the specialty "General practice (Family Medicine)". The practice-oriented direction of training is important for the majority of residents (77,8%). Theoretical training turned out to be especially interesting and useful for 48,1%, scientific activity — for 7,4% of residents. Among the difficulties, work according to standards (51,9%), working with the patient (14,8%) and interpreting the paraclinical data (11,1%) were noted.Conclusion. The educational process in residency in the specialty "General Practice (Family Medicine)" allows for multifaceted training of future specialists to work in primary healthcare. The department has created conditions for additional development by residents of new skills and abilities for successful work, but our own experience indicates the need for further improvement of the educational process.