Hodgkin’s lymphoma is more often diagnosed in young patients. One of the late complications of pathogenetic therapy of Hodgkin’s lymphoma is osteopenia/osteoporosis and the increased risk of low-energy fractures. Conducting densitometry in young patients in order to assess the bone tissue condition is advisable, but its clinical assessment remains difficult. At the same time, early diagnosis and prevention of bone mineral density decrease in patients with Hodgkin’s lymphoma who received antitumor therapy are very relevant. The purpose — to study the features of densitometric indicators for the verification of osteopenia / osteoporosis in young patients with Hodgkin’s lymphoma. Material and methods. 63 people were included in the study, 33 of them were patients with Hodgkin’s lymphoma who received pathogenetic therapy, and 30 people the control group — healthy volunteers. Bone mineral density was measured in all patients using the HOLOGIC (Hologic Inc., Bedford) in the lumbar spine (L1–L4) and in the hip area (the total area of the hip and hip neck). Criteria such as minimum bone mineral density, T-criteria and Z-criteria for young patients with Hodgkin’s lymphoma were determined. Results. In the group of patients with Hodgkin’s lymphoma, a decrease in bone mineral density is significantly more often recorded in all measurement areas, as well as the Z-criterion in the lumbar spine. Regretfully, in young patients the T-criterion can only be used given a more intensive mineralization of bone tissue than in older people and the presence of additional risk factors for osteoporosis (PCTs, glucocorticosteroids, decreased androgenic and fertile function). In patients with HL who received pathogenetic therapy, a decrease in the T-criterion to osteopenia is more often observed in the proximal femur. Conclusion. In many cases, modern capabilities for osteoporosis diagnostic allow correcting mineral metabolism in bone tissue and preventing the development of complications in young patients with Hodgkin’s lymphoma.

This review provides a summary of data on the health status of adults with cardiovascular disease during air travel. We describe mental and physical stressors affecting the cardiovascular system and hypobaric hypoxia in the commercial aircraft cabin. Valid algorithms for preliminary assessment of the condition of patients with recent acute and chronic coronary syndromes are proposed.

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting the musculoskeletal system. Neutropenia often develops in RA, the pathogenesis of which is currently insufficiently studied. One of the causes of severe neutropenia may be a hematological disease, namely T-cell large granular lymphocyte leukemia (LGL). A third of patients with RA are also diagnosed with LGL, which is due to a similar pathogenetic mechanism. The clinical picture is very diverse and insufficiently specific, which causes difficulties in making a diagnosis. The purpose of this work was to analyze the features of the management of a patient with rheumatoid arthritis combined with T-cell leukemia from large granular cells. A patient born in 1953 with a long history of RA without special treatment was hospitalized in the hematology department with complaints of severe weakness, manifestations of hemorrhagic syndrome. The general blood test revealed severe anemia, leukopenia with agranulocytosis and thrombocytopenia. The patient underwent additional instrumental examinations. Substitution therapy was performed with a positive effect. In this case, peripheral blood immunophenotyping was not performed and the diagnosis was based on trepanobiopsy. According to the immunohistochemical study, leukemia from large granular T-lymphocytes was diagnosed, and therefore the patient receives treatment according to national clinical guidelines. Diagnosis of T-LGL is an urgent issue due to the frequent combination with RA, which indicates the need for a thorough differential diagnosis of neutropenia in this category of patients.

Over the past decade, methodological and clinical approaches to home blood pressure monitoring (HBPM) have changed. The changes are so significant that they have led to differences between modern and traditional concepts of HBPM. The aim of this review was to briefly describe these differences.

3 ФБУН ФНИИВИ «ВИРОМ» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, Екатеринбург; 4 Медико-биологический университет инноваций и непрерывного образования ФГБУ «Государственный научный центр Российской Федерации -Федеральный медицинский биофизический

To avoid under- or overdiagnosis of hypertension, the clinician needs to have firm confidence in the measurement tool. Recently, numerous automatic cuff-based sphygmomanometers have become this tool. The solution to this problem appears to be a wider introduction of device validation (accuracy check) activities in research structures. This review presents a number of aspects that are relevant to the ongoing work to develop a global universal standard for such validation.

Klinefelter syndrome is the most common chromosomal abnormality among others and is manifested mainly by hypogonadism, gynecomastia, and infertility. Against the background of KS, oncological diseases can develop, more often nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) due to genetic reparations, as well as osteoporosis as a result of androgen deficiency. This article describes a clinical case of a patient with Klinefelter syndrome and the onset of Hodgkin’s lymphoma (HL) in order to assess the risk of osteopenia/osteoporosis in this patient. A patient with previously diagnosed KS went to the doctor complaining of weakness, fatigue, weight loss, local enlargement of the inguinal lymph nodes. The patient was diagnosed with NLPHL and standard pathogenetic therapy was performed. Taking into account the presence of risk factors for osteoporosis (the presence of Klinefelter syndrome, HL, chemotherapy), the patient underwent two-energy densitometry in the lumbar spine, neck and proximal femur in order to assess the condition of bone tissue. As a result, a decrease in bone mineral density was found in all measurement areas. This clinical case describes a rather rare combination of three significantly different nosologies. Interestingly, two of them, namely HL and Klinefelter syndrome, contribute to the development of the third through various mechanisms. The presence of a decrease in bone density in this patient necessitates prevention. Despite the rare occurrence of such combined pathologies, the issue of timely diagnosis and prevention of complications from the musculoskeletal system in this category of patients remains relevant today

Hodgkin’s lymphoma is more common in the younger patient population. An increase in overall and recurrence-free survival increases the likelihood of developing post-cytostatic complications in the form of a decrease in bone mineral density and associated low-energy fractures. The aim of the work is to evaluate risk factors for bone mineral density decrease in patients with Hodgkin’s lymphoma after standard polychemotherapy and autologous hematopoietic stem cell transplantation. Material and Methods: The study included 118 people, of which 88 people were patients with Hodgkin’s lymphoma and 30 people were the control group. The study group of patients with Hodgkin’s lymphoma was divided into 2 groups: patients who received standard polychemotherapy and patients who received standard polychemotherapy and autologous hematopoietic stem cell transplantation. For all patients, measurements of bone mineral density were performed using the HologicDiscovery QDR scanner (USA) in the lumbar spine (L2–L4) and in the thigh region (total area of t he thigh and femoral neck). The minimum measurements of bone mineral density and T-scores in the hip and femoral neck were selected, and the Z-score was calculated for young patients. Results: According to the results of densitometry in both study groups, there was no decrease in bone mineral density below the age norm. In 13 patients (30 %) who received autologous hematopoietic stem cell transplantation, a decrease in T-score was found, which corresponds to osteopenia and osteoporosis. In the standard PCT group, a decrease in the T-criterion was observed in 6 patients (14 %): to stagnation — in 3 patients (7 %), to osteoporosis — in 3 patients (7 %). All patients with Hodgkin’s lymphoma included in the study received high doses of glucocorticosteroids. There was no correlation between the decrease in BMD, Z-criterion and the risk of low-energy fracture on the stage and variant of the disease. Conclusion: The high incidence of bone density reduction, taking into account a favorable prognosis for the life of patients with Hodgkin’s lymphoma, indicates the need to develop schemes for the prevention of osteoporosis and osteopenia.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to global morbidity and mortality. Some patients fully recover from COVID-19, whereas around 45% subjects suffer from various persistent symptoms (fatigue, cognitive impairment, impaired thermoregulation, skin diseases, etc.) for at least four months after SARS-CoV-2 infection regardless of disease severity. Such persistent post-infection effects are known as long-COVID, post-acute effects of COVID-19, or post-COVID state. SARS-CoV-2 infection is accompanied by damage to the innate immune system. Considering the role of natural killer cells and the activation of the complement system in COVID-19 as well as the regulatory properties related to CD46 and its potential involvement in cell virus entry, we found necessary to study immune system parameters associated with impairment of these innate immune cues on various leukocyte subpopulations in post-COVID patients. We studied 92 immune system parameters, including: pan-leukocyte markers for gated lymphocytes, phenotyping of T cells, T-helper inducers, cytotoxic T-lymphocytes, NK- and TNK-cells, T-regulatory cells/suppressors, B-lymphocytes, including B-memory cells, activated helpers, early activation of lymphocytes, activated T-lymphocytes, and late lymphocyte activation markers. Levels of total IgM, IgG, IgA, specific IgM, IgG to coronavirus COVID-19, C1-inhibitor, C3a, and C5a complement components were measured by enzyme immunoassay using Multiscan FC Thermoscientific enzyme immunoassay analyzer (China) and Vector Best reagent kits (Russia). A complete blood count was conducted to study 25 parameters: leukocyte, erythrocyte, and platelet hematopoietic lineages as well as the quantitative and qualitative composition of hematopoietic lineages. Our study results showed that in some patients, six months after suffering from COVID-19, there was a decrease in the level of NK cells (48%) and CD46+pan-leukocyte marker cells (64.5%). A decrease in NK cell levels was accompanied by increased level of total T- and B-lymphocytes, and altered platelet and erythroid hematopoietic lineages. In patients with reduced CD46 expression on T-lymphocytes, both their total count and NK cell count were significantly reduced. Our data also suggest that CD46 might be potentially involved in development of SARS-CoV-2 infection and the post-COVID state. Thus, in 50–65% of patients who have experienced SARS-CoV-2 infection, damage to the innate immune system persists after six months being accompanied by impaired erythroid and platelet hematopoietic lineages. The data obtained indicate a need for using immunocorrective therapy in such patients.

This study examines the long-term effects of SARS-CoV-2 infection on immune status. Given the prolonged and profound immune dysregulation observed during acute SARS-CoV-2 infection, it remains to be determined whether these changes translate into subsequent immune system dysfunction in recovering individuals. In this sense, the aim of the study was to study the parameters of the immune system in patients who had undergone SARS-CoV-2 infection. 150 patients who underwent SARS-CoV-2 infection were examined according to 96 parameters using flow cytometry. A complete blood count was performed using a Medonic device (Sweden); ELISA method determined the levels of general and specific IgM, IgG, IgA, compliment fragments (JSC Vector-Best, Russia). The activity of the phagocytes was studied according to the generally accepted method. The study found that at least four phenotypes of immune system disorders are detected in patients. The first two phenotypes are related to the impairment of innate immune system factors and are associated with a decrease in the number of CD46+ and NK cells. It has been observed that a decrease in CD46+ persists for a long time in a significant number of recovered patients, highlighted by the impaired expression of this marker in various subpopulations of lymphocytes. The decrease in the level of natural killers was accompanied by a compensatory increase in the number of T lymphocytes, mainly due to T helpers and TNK lymphocytes, and the growth of total memory B cells. Two other identified phenotypes are characterized by damage to acquired immune response factors and are associated with damage to B cells and T cytotoxic cells. The relationship of such disorders with damage to hematopoiesis erythrocyte and platelet sprouts, which contribute to the appearance of hypoxia and possible violation of the blood coagulation system, has been shown. Therefore, the results obtained indicate a long-term pronounced damage to the immune system in postCOVID patients that requires immunocorrection of these disorders.

Analysis of the air accident rates of MQ-1 Predators and MQ-9 Reapers from the Drone Crash Database in the period from 2001 till 2021 (12 countries, 174 accidents total) disclosed major factors, including human, for accidents. The main reason was structural faults and manufacturing defects due to, probably, long time in service. Frequency of accidents due to errors of experienced pilot-operator's varied between 19.4% and 22.9 % and due to errors in the course of skill training, 60–64.7 %. To reduce the accident rate, pilot-operators need to be trained on cutting-edge VR simulators and challenged by atypical stress situations such as multiple causation.

The problem of observation and treatment of patients with tuberculosis against the background of Hodgkin’s lymphoma is relevant today. Currently, few cases of managing patients with a combination of these diseases are presented in the Russian literature. A clinical case of observation and treatment of a patient with Hodgkin’s lymphoma and pulmonary tuberculosis is presented in the article. Due to the immunosuppression and myelotoxic neutropenia against the background of chemotherapy for Hodgkin’s lymphoma, the risk of infectious complications, including tuberculosis infection, increases. Diagnosis can be complicated by the atypical course of the infection, as well as the similarity of pathological processes. The purpose was to analyze the features of the management of patients with Hodgkin’s lymphoma combined with pulmonary tuberculosis. Material and methods. A retrospective analysis of the patient’s medical record was carried out, as well as her observation in a hematological hospital. Results. In the primary diagnosis of Hodgkin’s lymphoma, the following methods were used: X-ray (CT, PET/CT), histological and immunohistochemical studies of the biopsy of the cervical lymph node, trepanobiopsy of the ilium, which allows to exclude the involvement of the bone marrow in the process. After 4 courses of PCT in the «escBEACOPP» mode, restaging was carried out. MSCT revealed an infiltrative lesion, which, unlike the tumor component, did not accumulate contrast. The patient was consulted by a phthisiatrician. The diagnosis of infiltrative tuberculosis was confirmed, and anti-tuberculosis therapy was prescribed. Subsequently, resection of S6 of the right lung was performed. When monitoring the response to the treatment, 6 months after the start of anti-tuberculosis treatment, CT revealed the progression of Hodgkin’s lymphoma. The council made a decision to continue PCT with a change in the scheme to «AVD + BV». After 6 courses of PCT, a complete metabolic response was noted. Conclusion. In order to exclude errors in the differential diagnosis of Hodgkin’s lymphoma and tuberculosis lesions, histological confirmation and control using radiological methods are required. It should be noted that it is very important to treat both diseases simultaneously. If all conditions are met, it is possible to achieve control of the course and achieve positive results in the treatment of both diseases.

Hyperbaric oxygenation (HBO) is a method based on breathing pure oxygen under high pressure, which makes it possible to eliminate any forms of oxygen debt by delivering oxygen to organs and tissues by dissolving it in the body’s liquid media. The list of indications for HBO is constantly expanding, and a number of studies prove the effectiveness of its use in the treatment of various kinds of therapeutic pathologies. Within the framework of this article, the author analyzes the features of the use of HBO in the treatment of a number of diseases.

Isolated systolic hypertension in the young (ISHY) is more common among men, or among obese people, or among athletes and active population groups, which determines its heterogeneity. The close interlacement of neurohumoral and metabolic factors forms a stable background for hypertension. In some cases, ISHY is associated with uneven increase of arterial stiffening with age. However, the absent «interlacement» of factors in the presence of increased stroke volume and hyperkinetic circulation is potentially dangerous in terms of hemodynamic transition and the formation of blood pressure trajectories, leading in the future to established hypertension and cardiovascular complications. The review systematizes the recent literature data on risk factors and pathogenesis of ISHY.

Aims. To evaluate the impact of body weight dynamics on the clinical course of atrial fibrillation in obese patients.Materials and methods. The study included 101 primary obese patients with paroxysmal or persistent atrial fibrillation. Study design: a retrospective, single-center, comparative study. Retrospectively аccording to the he body weight dynamics, patients were divided into 3 groups: those who increased their body weight by >3 % (Group 1, n=40), maintained their initial body weight by ±2.9 % (Group 2, n=29), and reduced their initial body weight by >3 % (Group 3, n=32). Follow-up examinations by a doctor were carried out at least once every 6 months for minimum 36 months. Change in AF type was determined by disease patterns and 7-day Holter monitoring results. The groups were comparable in gender (p=0,9267), age (p=0,3841), height (p=0,8900), and disease form (Paroxysmal atrial fibrillation /Persistent atrial fibrillation) (p=0,8826), the severity of symptoms on the European Heart Rhythm Association score of atrial fibrillations (p=0,8687) and systolic blood pressure at the beginning of the study (p=0,4500).Results. At the final control examination, the body weight of patients in Group 1 increased by an average of 11,4 [9,3; 13,1] kg (р <0,001*), while weight loss in Group 3 averaged -6,2 [-8,4; -5,3] kg (p <0,001*). The decrease in body weight of Group 2 patients was insignificant (p=0,5377) and amounted to -0,1 [-2,0; 1,3] kg. The progression of the disease from paroxysmal to persistent form was observed among 15 (37 %) patients in Group 1, 9 (31 %) patients — in Group 2, 2 (6 %) patients — in Group 3 (p=0,0079*). The regression of arrhythmia from persistent to paroxysmal form was not registered in group 1 (0 %), in group 2, the reverse development of the disease was noted in 1 patient (3 %) and in group 3 — in 6 patients (19 %) (p=0,0053*). There were no free from AF patients in Group 1 at the final follow-up, while 2 (7 %) patients were free from AF in Group 2 and 7 (22 %) — in Group 3 (р=0,0047*). In patients undergoing ablation, procedural success was determined after a 3-month blind period. The need for interventional procedures to restore the sinus rhythm and their multiplicity when comparing the groups did not differ significantly. However, in a pairwise comparison, the difference between groups 1 and 3 of participants was statistically significant (p=0,0079* and p=0,0374*, respectively). Conclusion. This study demonstrates the relationships between the dynamics of body weight and the clinical course of atrial fibrillation. The progression of obesity leads to the progression of the disease. Weight-loss management reverses the type and natural progression of AF, improves the prognosis and the course of disease, regardless of other significant risk factors, increases the anti-arrhythmic therapy effect and the effect of interventional treatment.

The pathophysiological characteristics of isolated systolic hypertension in the young (ISHY) differ from those in the elderly, which is important for the choice of diagnostic and therapeutic strategies. Although there is no consensus among experts about ISHY, it has recently become obvious that this is a heterogeneous state, and, possibly, not spurious. The strategies for ISHY treatment described in the modern literature are discussed in this review.

Aims. To evaluate the impact of body weight dynamics on the clinical course of atrial fibrillation in obese patients. Materials and methods . The study included 101 primary obese patients with paroxysmal or persistent atrial fibrillation. Study design: a retrospective, single-center, comparative study. Retrospectively аccording to the he body weight dynamics, patients were divided into 3 groups: those who increased their body weight by >3 % (Group 1, n=40), maintained their initial body weight by ±2.9 % (Group 2, n=29), and reduced their initial body weight by >3 % (Group 3, n=32). Follow-up examinations by a doctor were carried out at least once every 6 months for minimum 36 months. Change in AF type was determined by disease patterns and 7-day Holter monitoring results. The groups were comparable in gender (p=0,9267), age (p=0,3841), height (p=0,8900), and disease form (Paroxysmal atrial fibrillation /Persistent atrial fibrillation) (p=0,8826), the severity of symptoms on the European Heart Rhythm Association score of atrial fibrillations (p=0,8687) and systolic blood pressure at the beginning of the study (p=0,4500). Results . At the final control examination, the body weight of patients in Group 1 increased by an average of 11,4 [9,3; 13,1] kg (р <0,001*), while weight loss in Group 3 averaged -6,2 [-8,4; -5,3] kg (p <0,001*). The decrease in body weight of Group 2 patients was insignificant (p=0,5377) and amounted to -0,1 [-2,0; 1,3] kg. The progression of the disease from paroxysmal to persistent form was observed among 15 (37 %) patients in Group 1, 9 (31 %) patients — in Group 2, 2 (6 %) patients — in Group 3 (p=0,0079*). The regression of arrhythmia from persistent to paroxysmal form was not registered in group 1 (0 %), in group 2, the reverse development of the disease was noted in 1 patient (3 %) and in group 3 — in 6 patients (19 %) (p=0,0053*). There were no free from AF patients in Group 1 at the final follow-up, while 2 (7 %) patients were free from AF in Group 2 and 7 (22 %) — in Group 3 (р=0,0047*). In patients undergoing ablation, procedural success was determined after a 3-month blind period. The need for interventional procedures to restore the sinus rhythm and their multiplicity when comparing the groups did not differ significantly. However, in a pairwise comparison, the difference between groups 1 and 3 of participants was statistically significant (p=0,0079* and p=0,0374*, respectively).  Conclusion . This study demonstrates the relationships between the dynamics of body weight and the clinical course of atrial fibrillation. The progression of obesity leads to the progression of the disease. Weight-loss management reverses the type and natural progression of AF, improves the prognosis and the course of disease, regardless of other significant risk factors, increases the anti-arrhythmic therapy effect and the effect of interventional treatment.

The review examines the key aspects of the pathogenesis of alopecia in endocrine system pathology. The role of hormones, growth factors, cytokines and other biologically active substances has been demonstrated. Alopecia is a frequent symptom that can be the result of not only gerontological, but also endocrinological problems. Therefore, time-consuming differential diagnosis is often necessary. Diagnosis is more effective if a team of specialists is involved: endocrinologist, gynecologist, andrologist, dermatologist / trichologist, and others.

The authors examined the current conception of flight safety, medical risks management, prevention of accidents due to the human factor, and updated flight safety definition. Health and physiological examinations within the pilot medical certification procedure are, unconditionally, important determinants of flight safety. However, maintenance and realization of key professional qualities confront a number of extra- and intersystem factors that can create some level of risk. Mitigation of these risks and medical risks management should be taken as the basis for preventing aviation accidents caused by the human factor.

Objective. To study the features of changes in hemodynamic parameters in the air traffic controllers at work and the rate of “masked” hypertension. Design and methods . We examined 55 air traffic controllers from Moscow Centre for Automated Air Traffic Management of the Federal State Unitary Enterprise “State Corporation for Air Traffic Management” and 30 information security specialists who formed the comparison group. The groups were comparable by age, work experience (by the specialty), and the level of office blood pressure (BP). We assessed the main cardiovascular risk factors, and blood pressure parameters by 24-hour ambulatory blood pressure monitoring (ABPM). Results. Despite comparable rates of cardiovascular risk factors, the air traffic controllers demonstrate higher BP levels and higher rates of masked hypertension. According to 24-hour ABPM masked hypertension was detected in 40 % air traffic controllers, which is twice higher than in the comparison group. In addition, the air traffic controllers show significant difference in BP levels in working days and daysoff. Conclusions. The high rate of masked hypertension among air traffic controllers might be associated with the peculiarities of professional activity, namely, with the high stress level.