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Aim: To evaluate the prognostic value of pulmonary ventilation disorders in the development of arrhythmia recurrence in patients with chronic obstructive pulmonary disease (COPD) and paroxysmal atrial fibrillation (AF).

Materials and methods: The study included 387 patients with COPD, who were divided into two groups: group 1 consisted of 54 (13.9%) patients with COPD and paroxysmal AF, who had AF paroxysm during hospitalization; group 2 (comparison group) - 333 (86.1%) patients with COPD without arrhythmia.

Results: Significantly more severe bronchial obstruction was found in group 1 patients than in group 2 patients. A one-factor regression analysis revealed that a decrease in forced exhalation volume in 1st second of less than 35% increased the risk of AF recurrence in patients with COPD by 2.49 times (odds ratio 0.401, 95% confidence interval 0.218-0.856; p=0.012). According to the results of bodyplethysmography, patients in group 1 showed a significant decrease in the diffusion capacity of the lungs for carbon monoxide, an increase in aerodynamic and specific bronchial resistance compared with group 2, a decrease in the diffusion capacity of the lungs of less than 8 ml/min/mm. Mercury increased the risk of AF paroxysm in COPD patients by 1.297 times (odds ratio 0.771, 95% confidence interval 0.53-0.92; p=0.013). To assess the risk of arrhythmia recurrence in patients with COPD and paroxysmal AF, we developed a mathematical model (sensitivity - 73.8%, specificity - 70.3%).

Conclusion: Decreased ventilation capacity of the lungs increases the risk of arrhythmia recurrence in patients with COPD and paroxysmal AF.

Aim: To evaluate the safety and effectiveness of various antithrombotic prophylaxis regimens after elective total knee arthroplasty (TKA) and elective total hip arthroplasty (THA).

Materials and methods: Medical history, information about concomitant diseases and previously prescribed drug therapy was recorded in all participants. Subsequently, a prospective observation was performed to record specific antithrombotic drugs and the duration of their use after surgery, patient compliance with the rehabilitation regimen, all cases of thrombosis and bleeding; all patients were contacted by phone 1 and 3 months after surgery.

Results: The study population included 271 males (34.7%) and 511 females (65.3%). 332 (42.5%) patients underwent THA and 450 (57.5%) patients underwent TKA. In the perioperative period, 769 patients (98.3%) received fraxiparine monotherapy as antithrombotic prophylaxis, and 13 (1.7%) patients received fraxiparine in combination with an antiplatelet agent due to previous percutaneous coronary intervention or very high cardiac risk. Within 1 month after surgery, 31 (4.0%) patients did not take any anticoagulants despite the prescriptions, 20 (2.6%) patients used aspirin instead of the prescribed anticoagulants. Other patients received direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban) or warfarin as prescribed; among them 73 (9.3%) patients received concomitant antiplatelet agents. Seven (0.9%) patients used three anticoagulants concomitantly. During the first month after surgery, 9 cases (1.2%) of deep vein thrombosis were recorded (5 patients took no anticoagulants, another 4 participants were not compliant with the rehabilitation regimen). 5 (0.6%) cases of epistaxis, 4 (0.5%) cases of hemorrhoidal bleeding and 2 (0.2%) cases of hematoma in the surgical area were reported. All cases of thrombosis and bleeding were mild and resolved spontaneously. No statistically significant differences in the incidence of adverse events were found between different anticoagulant therapy regimens.

Conclusion: In a cohort of real-world patients undergoing elective TKA or THA, the differences between the effectiveness and safety of various anticoagulant prophylaxis regimens were not statistically significant. The incidence of thrombosis was low, and these complications were mainly reported in non-compliant patients. The incidence of bleeding in patients taking anticoagulants with antiplatelet agents was not elevated, however, the size of this subpopulation is small and does not allow to perform a significant assessment of the safety of this treatment regimen. Based on the findings, it is reasonable to develop additional methods to improve patient compliance in order to reduce the frequency of medication errors and decrease the incidence of possible complications.

Background: Cardiovascular diseases (CVD) and chronic obstructive pulmonary disease (COPD) are the two leading causes of death in the world. Studies show a close mutually aggravating relationship between arterial hypertension (AH) and COPD. Antihypertensive therapy in patients with AH and COPD has a number of features, aiming to reduce the risk of developing cardiovascular complications and mortality from CVD without worsening lung function.

Aim: To analyze the data of patients with AH and COPD included in the national registry to determine the burden of CVD risk factors, concomitant cardiovascular, cerebrovascular diseases and chronic kidney disease, obesity, diabetes mellitus, gout and characteristics of antihypertensive therapy.

Materials and methods: A comparative analysis of patients of the hypertension registry (conducted in outpatient clinics) was performed depending on the presence (n=3323) or absence (n=54073) of chronic obstructive pulmonary disease. Statistical analysis of the obtained data were performed using the R 4.3.3 statistical computing environment (R Foundation for Statistical Computing, Vienna, Austria).

Results: The prevalence of COPD in patients with hypertension was 5.8% (3323 cases). The presence of COPD in patients with hypertension, regardless of gender and age, was statistically significantly associated with higher odds of having coronary artery disease [odds ratio (OR) 2.21, 95% confidence interval (CI) 2.06-2.38; p<0.001], a history of myocardial infarction (OR 1.73, 95% CI 1.59-1.87; p<0.001), chronic heart failure (OR 1.95, 95% CI 1.82-2.1; p<0.001), a history of acute cerebrovascular accident (OR 1.25, 95% CI 1.07-1.46; p=0.004), transient ischemic attack (OR 2.9, 95% CI 2.31-3.59; p<0.001), atrial fibrillation (OR 1.68, 95% CI 1.45-1.93; p<0.001). Patients with hypertension and COPD more often received drugs from the group of angiotensin-II receptor antagonists than patients with hypertension without COPD (22.7% vs 17.7%). The prescription of drugs from the group of beta-blockers in patients with hypertension and COPD was lower by 4%. Cardiovascular risk factors, comorbidities such as diabetes mellitus, gout, obstructive sleep apnea in patients with hypertension and COPD are more common.

Conclusion: Patients with COPD and hypertension have a higher incidence of risk factors, CVD and comorbid pathologies. They require closer attention during examination and during the selection of antihypertensive therapy. In patients with hypertension and COPD, angiotensin-converting-enzyme inhibitors and beta-blockers are prescribed less frequently than in patients with hypertension without COPD due to possible side effects and contraindications.

For a long time, the clinical lecture occupied a central place in teaching the course of faculty therapy and shaping the clinical thinking of future doctors. Since the time of Zakharyin and Botkin, the form and content of clinical lectures have undergone significant changes. The focus has gradually shifted from the analysis of the patient to the disease, which partly contradicts the principles of teaching in faculty clinics, laid down at their creation. The article traces these trends based on materials published in various periods of medical science development.

Aim: To systematize data on the prevalence and risk of small intestinal bacterial overgrowth (SIBO) in patients with rosacea.

Materials and methods: The search for studies was conducted in the MEDLINE/PubMed, EMBASE, and the Russian Science Citation Index from January 1, 1985, to April 5, 2025. The inclusion criteria were original clinical studies in English or Russian with detailed descriptive statistics describing the prevalence of SIBO in adults with rosacea. The analysis included an assessment of the SIBO prevalence, calculation of relative risk, and 95% confidence interval (CI) using a random effects model. Heterogeneity was assessed using I²-statistics, and publication bias was examined with funnel plots and Begg-Mazumdar and Egger tests.

Results: The meta-analysis included 6 studies with 801 subjects (581 subjects with rosacea, 220 controls). The overall prevalence of SIBO in patients with rosacea was 35.8% (95% CI 23.626-48.985) compared to 9.391% (95% CI 4.256-16.265) in controls. The risk of developing SIBO in patients with rosacea was 3.501 times higher (relative risk 3.50; 95% CI 1.347-9.100; p=0.012). Treatment with rifaximin (1200 mg/day for 10 days) resulted in significant improvement or remission of rosacea in 57.9% (95% CI 49.5-66.3) of patients, with the highest effectiveness (up to 85.7%) observed in those with successful eradication of SIBO.

Conclusion: The results of a systematic review and meta-analysis confirm the potential association between SIBO and rosacea and demonstrate the effectiveness of rifaximin in treating cutaneous manifestations of rosacea in these patients. It is necessary to consider SIBO diagnosis when assessing patients with rosacea, especially in resistant forms of the disease.

The article is dedicated to the memory of the outstanding Russian internist and scientist, academician of the Russian Academy of Medical Sciences - E.M. Tareev, who had a huge influence on the development of Russian medicine. The life and professional path of the scientist, his most significant scientific achievements in various areas of internal pathology, marked by high state awards and prestigious national prizes, are presented. The basic principles of the scientific school of E.M. Tareev are also presented, including his statements on the importance of maintaining at the present stage a broad general therapeutic approach to solving complex integrated tasks of health care.

Relapsing polychondritis is a systemic disease characterized by inflammation of cartilage and proteoglycan-rich tissues leading to progressive deformity and dysfunction of the involved structures. Ear and nasal chondritis and/or polyarthritis are the most common clinical forms of the disease (80%), but all types of cartilage can potentially be involved. Due to the polymorphic nature of the disease, the diagnosis of relapsing polychondritis often remains unclear due to non-specific symptoms. In this article, we offer a clinical observation of this disease.

Aim: To evaluate the efficacy of a combination therapy containing chondroitin sulfate (CS), glucosamine (GL), methylsulfonylmethane (MSM), hyaluronic acid (HA), and native/hydrolyzed collagen compared to collagen-free therapy in the initial management of knee osteoarthritis (OA) exacerbations.

Materials and methods: A single-center, prospective, comparative phase IV study included 60 patients with knee OA (Kellgren-Lawrence stages 2-3). Participants were randomized into two groups: Group A (n=30) received CS/GL/MSM/HA, while Group B (n=30) received the same regimen supplemented with collagen. Pain dynamics (VAS, WOMAC), NSAID requirements, and functional outcomes (Timed Up-and-Go test, walking speed, muscle strength) were assessed at weeks 1, 2, 4, and 8.

Results: Group B demonstrated significant superiority: a 76% reduction in WOMAC pain scores (vs. 47% in Group A; p=0.04) and a 74% reduction in VAS scores (vs. 56%; p<0.05). NSAID use at week 8 was 2.6±0.5 days in Group B (vs. 4.3±1.8 in Group A; p=0.04). Functional improvements (12% increase in walking speed, 42% reduction in Timed Up-and-Go test duration) were also more pronounced in Group B (p<0.05).

Conclusion: The combination of CS/GL/MSM/HA with collagen significantly outperforms collagen-free therapy in reducing pain, improving joint function, and decreasing symptomatic treatment needs in patients with knee OA exacerbations. These findings support the inclusion of collagen in OA combination therapy.

Aim: To study the association of uric acid (UA) levels with skeletal muscle mass, strength and physical performance in women with rheumatoid arthritis (RA).

Materials and methods: One hundred thirty women (median age 61 [53; 66] years) with confirmed RA who signed informed consent were examined. A clinical and laboratory examination was performed, including an assessment of muscle strength, physical performance. Dual-energy X-ray absorptiometry according to the "whole body" program was done.

Results: The median UA level was 262.8 [197.4; 310.5] μmol/l, the incidence of hyperuricemia was 9.2%. Positive correlations of UA with the total lean mass index (r=0.32; p<0.001), appendicular lean mass index (r=0.24; p=0.006) were established. These associations were confirmed in multiple linear regression analysis (b*=0.38; p<0.001 and b*=0.29; p<0.001, respectively). There was no association between the level of UA and RA parameters (duration of the disease, glucocorticoid intake, RF and ACCP seropositivity, ESR, CRP and DAS-28 index), as well as with muscle strength. A negative correlation between the level of UA and parameters of physical performance was found.

Conclusion: The frequency of hyperuricemia was 9.2% in women with RA. Multiple regression analysis confirmed an independent association between lean mass and UA level.

Background: Pathogenesis of ankylosing spondylitis (AS) is based on long-term chronic inflammation, which can lead to the development of secondary amyloidosis.

Aim: To analyze the frequency of secondary amyloidosis in a hospital cohort of patients with AS and describe their clinical and laboratory features.

Materials and methods: Four hundred and fifty eight patients with AS were examined. Patients' disease activity and functional status were assessed according to the Russian expert recommendations. Additionally, in all patients, SAA in blood serum was determined using nephelometric method. Patients having high laboratory activity during several years underwent fibrogastroduodenoscopy and biopsy of the duodenum submucosal layer, in the absence of contraindications.

Results: Among 458 patients with AS, the diagnosis of AA amyloidosis was confirmed in 21 (4.5%) cases; the frequency among men was 5.6%, among women - 2.6%. In 15 (3.3%) cases, AA amyloidosis was diagnosed for the first time, and only in 6 (1.3%) patients it was diagnosed before. Patients with AA-amyloidosis had higher disease activity measured by ASDAS-CRP and higher ESR values. Patients with amyloidosis had higher frequency of syndesmophytes and they underwent joint arthroplasty more often compared to the control group. Among the patients with amyloidosis, a significant negative association was revealed between the patients' age of enrollment in the study and the presence of arthritis, the values of BASDAI and ASDAS indices. The following associations were not observed in the control group. We did not find the expected association between SAA and activity scores, these values did not differ between groups.

Conclusion: In a specialized rheumatology department, the frequency of AA-amyloidosis in patients with AS reaches 4.5%. Amyloidosis significantly more often develops in males, in patients with juvenile onset, in the late stage of the disease, in patients with high disease activity. Without a targeted search for secondary amyloidosis in patients with AS, its detection rate in real clinical practice is about 30%.