Vol 79, No 1 (2024)

Sarcoidosis is a disease of unknown etiology characterized by the formation of epithelioid cell granulomas in several organs or tissues without caseous necrosis (fibrinoid necrosis may occur). With sarcoidosis, almost all organs and tissues can be affected, which determines the interdisciplinary nature of the problem. Skin sarcoidosis is one of the most common manifestations of systemic sarcoidosis. At the same time, the role of dermatologists in the diagnosis of sarcoidosis is exceptionally large, since skin lesions are often the key to the discovery of systemic sarcoidosis, which allows internists to purposefully and timely diagnose and treat lesions of internal organs. Skin rashes in patients with sarcoidosis may occur secondarily against the background of specific lesions of the lungs, intrathoracic nodes and other internal organs, however, skin sarcoidosis may also develop primarily. All forms of skin sarcoidosis may be the only manifestation of the disease, and it is impossible to distinguish clinically and histologically between skin changes in systemic sarcoidosis and skin lesions alone. Treatment of skin sarcoidosis often presents great difficulties and includes, depending on the prevalence and activity of the process, local (corticosteroids, tacrolimus) and systemic therapy (immunomodulators, immunosuppressors, TNF inhibitors).

Syphilis is a socially significant disease, and the relevance of monitoring its incidence rates remains constant. The spread and level of syphilis morbidity in the Russian Federation is strongly influenced by migration processes. Over the last 7 years the migration flow in the country has increased by 17.5% and the number of migrant workers, them has increased 3 times. It is contingent of people, that being a “vulnerable group”, and most off all exposed to risky sexual behavior and STI infection. In 2021 and 2022 there was a significant increase in the incidence of syphilis in the Russian Federation, compared to 2020 — by 69.7%. The increase in the incidence of syphilis is largely due to the growth of this indicator among foreign citizens (from 2801 cases in 2020 to 12 748 cases in 2022). The proportion of registered cases of syphilis among foreign citizens in 2022 was 45.9% of all detected cases, while 80% of syphilis patients were citizens of one of 3 countries — Kyrgyz Republic (30%), Republic of Uzbekistan (27%), Republic of Tajikistan (23%). In the structure of clinical forms of syphilis detected in foreign citizens 98% are hidden and unspecified forms of the disease, only 13% of migrants with syphilis were treated and 87% have no information about the fact of treatment. Thus, latent forms of the disease and low percentage of treated foreign citizens with diagnosed syphilis have a negative impact on the epidemiological situation of syphilis incidence. These facts testify to the formation of risks of epidemiological danger of syphilis among foreigners entering the territory of the country, which poses a direct threat to biological security of the Russian Federation and requires the development of a set of measures to prevent the spread of the disease.

Background. The COVID-19 pandemic once again confirmed the correctness of the theory of Academician V.D. Belyakov, according to which the basis for the development of the epidemic process is a phase change in the heterogeneity of the biological properties of the interacting populations of the pathogen and humans. In accordance with the theory of self-regulation of parasitic systems, changes are associated not only with genetic variability, but also with other polydeterminant characteristics of the pathogen: when new genovariants appeared, SARS-CoV-2 became less pathogenic for humans, but more contagious. This circumstance is important not only for theoretical, but also for practical epidemiology, as it makes it possible to predict the direction of development of the epidemic situation.

Aims — to evaluate the manifestations of the epidemic process of the new coronavirus infection COVID-19 through the prism of the theory of self-regulation of parasitic systems.

Methods. An epidemiological retrospective analysis of the incidence of COVID-19 was carried out, including the study of absolute and intensive incidence rates per 100,000 population, the dynamics of changes in the properties of the coronavirus population, and the identification of SARS-CoV-2 genovariants for the period from 03.2020 to 04.2023. To analyze SARS-CoV-2 genovariants at various stages of the pandemic, we used sequencing data presented on the SARS-CoV-2 genome information aggregation platform Virus Genome Aggregator of Russia (VGARus) — more than 248 thousand genetic sequences.

Results. During the pandemic, there have been seven ups and downs in the incidence of COVID-19. During the period of circulation in the human population and adaptation to a new host, a significant amount of data has accumulated on the evolutionary changes in the SARS-CoV-2 genome, taking into account the trends in the acquisition of new epidemiological properties.

Conclusion. An analysis of the manifestations of the epidemic process of COVID-19, as a classic aerosol anthroponosis, confirmed the correctness of the theory of Academician V.D. Belyakov, according to which the basis of its development is a phase change in the heterogeneity of the biological properties of the interacting populations of the pathogen and humans, based on negative feedback in the process of self-regulation.

Currently, there is no doubt that the problem of electrical instability of the myocardium in pediatric cardiology is relevant. The determination of various indicators of electrical instability of the myocardium, which are predictors of life-threatening rhythm disorders and sudden cardiac death, presents an underdeveloped task not only for functional diagnostics specialists, but also for pediatricians, neonatologists, pediatric cardiologists and doctors of other specialties. Non-invasive research methods such as electrocardiography (ECG), Holter ECG monitoring (HM ECG), available in almost all pediatric treatment and prevention institutions, are quite informative in terms of detecting electrophysiological heterogeneity of the myocardium as a predictor of sudden cardiac death, which is especially important in children at risk, as well as young athletes. Thus, the determination of indicators of electrical instability of the myocardium is of great interest, it is a promising direction in modern clinical practice, allowing to predict the risk of developing fatal arrhythmias in children and adolescents.

Background. Radiation therapy is an integral part of the treatment of most malignant neoplasms of the pelvic organs, which in 25–30% of cases can cause the development of late radiation complications; in addition, 2–8% of patients have severe complications with an outcome in fistulas of various localization. Also, tumors of this localization are prone to local-regional recurrence, which can be combined with late radiation injuries. One of the most radical, and, often, the only method of treating this extremely severe and prognostically unfavorable pathology is to perform evisceration of the pelvic organs; however, its implementation against the background of radiation damage to normal tissues, leading to a significant decrease in the reparative potential, inevitably leads to a high risk of postoperative complications.

Methods. A retrospective analysis of early postoperative complications on the Clavien–Dindo scale was carried out in 136 patients after pelvic evisceration performed at the A.F. Tsyba MRSC in 2019–2021. All patients in the perioperative period underwent complex conservative therapy, including nutritional support.

Results. Pelvic evisceration was performed due to the progression of the underlying disease in 57% of cases, in 29% — due to the development of severe late radiation injuries with an outcome in the fistula, in 14% — due to a combination of local recurrence of the underlying disease with radiation complications). Complications of grade I on the Clavien–Dindo scale were noted in 50%; II — in 20.5%; III — in 3.6%; grade IV — in 3%. There were no cases of postoperative mortality.

Conclusions. Conducting active preoperative preparation of patients aimed at correcting anemia, dysproteinemia, pain syndrome, etc.; as well as modifying surgical techniques and improving the management tactics of postoperative patients can minimize the risk of postoperative complications in patients after pelvic evisceration.

The ectopic ACTH syndrome (EAS) is a constellation of clinical signs and symptoms caused by chronic excess production of cortisol by the adrenal glands due to stimulation by adrenocorticotropic hormone (ACTH) of extrapituitary origin. EAS is a rare pathology, it accounts for approximately 20% of all cases of ACTH-dependent hypercortisolism and up to 10% of all causes of endogenous autonomic cortisol production, however, it is often associated with severe hypercortisolism and is a life-threatening condition. The sources of ectopic secretion of ACTH are neuroendocrine tumors (NET), which differ in histological type, malignant potential, clinical course, and also have different, often difficult to detect localization. Early identification of ACTH -producing NET reduces the risk of death of the patient both from severe hypercortisolism and the tumor itself. The paper describes the features of the course of EAS, the possibilities of its diagnosis, and presents an algorithm for EAS diagnosis, created on the basis of the latest achievements of Russian and world medicine.

January 5, 2024 marked the 75th anniversary of the birth of Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences Valery Ivanovich Sergienko, a leading Russian specialist in the field of physico-chemical medicine.

January 20, 2024 marked the 75th anniversary of the birth of the largest specialist and outstanding scientist in the field of obstetrics and gynecology, laureate of the Government of the Russian Federation in the field of science and technology, full Knight of the Order of Merit for the Fatherland, Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences Leyla Vladimirovna Adamyan.