The problem of long COVID-19 (COronaVIrus Disease 2019) has been highly relevant for the healthcare system in the last three years. The persistence of respiratory symptoms, radiological and functional changes in COVID-19 patients brings new challenges to the entire medical community. The aim of the study is to explore long-term clinical and functional changes in patients with severe COVID-19-associated lung injury, including assessment of functional and radiological abnormalities of the respiratory system, as well as persistent clinical symptoms a year after the acute phase of the disease. Methods. The study included 45 patients who were examined 3, 6 and 12 months after COVID-19 with severe lung damage (more than 50% according to chest CT in the acute phase of the disease). Patients underwent multispiral computed tomography of the chest organs, a comprehensive study of respiratory function (spirography, body plethysmography and diffusion test); the clinical symptoms were assessed. Results. Chest CT scans showed gradual regression of pathological changes during the follow-up. However, radiographic changes of varying severity persisted after 12 months of follow-up in 51% of patients. A year later, restrictive disorders persisted in 20% of patients and the diffusion capacity of the lungs was reduced in 69% of patients. At the same time, a statistically significant difference in the DL_СО level was observed between 3, 6 and 12 months. The severity of dyspnea decreased 1 year after hospitalization in 48% of patients. Conclusion. The obtained results demonstrate a gradual regression of both radiological and functional pathological changes during the 1st year. However, CT changes and deviations of the respiratory function persist in some patients, mainly in the form of a decrease in DL_СО, which necessitates further monitoring of this group of patients.

Background Cardiovascular disease (CVD) such as ischemic heart disease impacts the people quality of life and has the highest mortality rate in the globe. This returns to the poor diagnostic and therapeutic strategies including the early prevention methods. Aims To assess the changes in the single channel electrocardiography (SCECG) in rest and on exercise test in patients with vs without ischemic heart disease confirmed by stress computed tomography myocardial perfusion (CTP) imaging. Objectives Ischemic heart disease patients frequently have preventable risk factors and causes that lead to the disease appearance. However, the lack of the proper diagnostic and prevention tools remains a global challenge in or era despite the current scientific advances. Material and methods A cohort, prospective, single center observational study included 38 participants from Moscow. The participants aged ≥ 40 years and given a written consent to participate in the study. The participants subdivided into two groups according to the presence or absence of the myocardial perfusion defect on the CTP with vasodilatation stress-test. Both groups (group 1 with myocardial perfusion defect (n=19), group 2 without myocardial perfusion defect (n=19)) passed general primary consultation by cardiologist, anthropometric measurements, recording 3-minutes single channel electrocardiography (ECG) in rest before and just after exercise test, blood pressure and pulse rate using automatic tonometer, echocardiography, cardio-ankle vascular index, performing ergometry, immediately repeating the single channel ECG, then performing CTP. LASSO regression with nested cross-validation was used to find association between Cardio-Qvark parameters and the existence of the perfusion defect. Statistical processing was carried out using the R programming language v4.2 and Python v.3.10 [^R]. Results The study results showed that the single channel ECG have significantly higher diagnostic accuracy in compare to bicycle ergometry. The specificity 63.2 % [95 % confidence interval (CI); 0.391; 0.833], sensitivity 73.7 % [95 % CI; 0.533; 0.929], and accuracy of the diagnostic method using exhaled breath analysis, area under the curve (AUC) 68.4 % [95 % CI; 0.527; 0.817]. Conclusion Single channel ECG (Cardio-Qvark) has the potential to improve the diagnostic accuracy of the bicycle ergometry. Other Further investigations required to uncover the hidden capabilities of Cardio-Qvark in the diagnosis of ischemic heart disease.

Sarcoid-like reactions associated with the immunotherapy are rare adverse events. The first case of a sarcoid-like reaction related to the use of checkpoint inhibitors was described in 2008 in a patient with melanoma receiving ipilimumab therapy. The gastrointestinal tract is most frequently affected, with less frequent involvement of mediastinal lymph nodes and the lungs, and very rarely the thyroid gland. These changes present significant diagnostic challenges, as it is impossible to differentiate a sarcoid reaction from the progression of the underlying oncological disease without morphological verification. Moreover, a sarcoid reaction can develop in parallel with the progression of the primary disease, further complicating the diagnosis. In the presented case, a patient with progressive melanoma developed mediastinal lymphadenopathy and lung involvement with severe respiratory symptoms 10 months after initiating immunotherapy. To confirm the diagnosis, transbronchial lymph node biopsy and cryobiopsy of lung tissue were performed. Histological examination revealed epithelioid cell granulomas, confirming the diagnosis of a sarcoid-like reaction and enabling the initiation of pathogenetic therapy with methylprednisolone. However, in our case, there were two relapses of sarcoidosis 6 months and a year after discontinuation of immune therapy against the background of discontinuation of steroid treatment, which may indicate the initial induction of sarcoidosis by immune therapy with further chronization of the process. Thus, given the increasing role of immunotherapy in oncology, knowledge about the potential development of various immunopathological reactions is important for determining treatment strategies. This clinical case highlights the importance of raising awareness among clinicians about the possibility of such complications during immunotherapy.

Несмотря на большое число краткосрочных исследований, в настоящее время данных об отдаленных последствиях новой коронавирусной инфекции (COVID-19) недостаточно. Длительно сохраняющиеся респираторные симптомы, рентгенологические и функциональные изменения у лиц, перенесших COVID-19, обосновывают необходимость проведения лонгитюдных исследований с целью лучшего понимания процессов и сроков восстановления организма переболевших. ЦЕЛЬ ИССЛЕДОВАНИЯ Изучение клинико-функциональных изменений организма через год после острой фазы COVID-19 у пациентов, перенесших заболевание в тяжелой и крайне тяжелой форме, ассоциированной с поражением легких, с оценкой функциональных и рентгенологических отклонений системы дыхания, а также параметров физической выносливости и качества жизни. МАТЕРИАЛ И МЕТОДЫ В исследование включено 65 пациентов, которым проводили обследование через 3, 6 и 12 мес после острой фазы COVID-19, протекавшей с тяжелым и крайне тяжелым поражением легких. Пациентам выполняли мультиспиральную компьютерную томографию (МСКТ) легких, комплексное исследование функции дыхания (спирография, бодиплетизмография и диффузионный тест), 6-минутный шаговый тест с количественной оценкой одышки как при нагрузке, так и в повседневной жизни, а также оценивали качестве жизни с помощью опросника EuroQol EQ-5D-5L. РЕЗУЛЬТАТЫ За время наблюдения, по данным МСКТ легких, отмечен постепенный регресс патологических изменений, однако рентгенологические изменения разной степени тяжести сохранялись и через 12 мес. у 63% пациентов. Наиболее значимыми рентгенологическими патологическими признаками спустя год наблюдения были «матовое стекло» и ретикулярные изменения. Через 12 мес. рестриктивные нарушения сохранялись у 20% пациентов, а диффузионная способность легких оказалась сниженной у 51% пациентов. Через 3 мес значительная часть пациентов (94%) испытывали физические ограничения и тревожно-депрессивные расстройства (68%), которые существенно снижали качество жизни. Спустя 12 мес небольшое ограничение физической активности встречалось у 46% пациентов, а доля тревожно-депрессивных расстройств снизилась более чем в 2 раза (29%). ЗАКЛЮЧЕНИЕ Пациенты, перенесшие тяжелую форму COVID-19 в острую фазу заболевания, имеют стойкие нарушения диффузионной способности легких и рентгенологические изменения, сохраняющиеся на протяжении года. Со временем физический и психологический статус восстанавливался, но через 12 мес у ¹/₂ пациентов сохранялись небольшое ограничение физической активности и затруднения в повседневной деятельности, а ¹/₃ пациентов продолжали испытывать умеренную тревогу и депрессию.

Objective. To identify gender differences using a new clinical probability model for chronic coronary syndrome (CCS) based on risk factor-weighted clinical likelihood (RF-CL) and traditional Diamond-Forrester CAD pre-test probability model (PTP DF model). Material and methods. The registry study included 144 men (mean age 64.7±10.2 years) and 93 women (mean age 67.3±9.4 years) who were examined for suspected CCS. Diagnosis of CAD was carried out in accordance with current (2024) Russian guidelines «Stable coronary artery disease» [6]. Additionally, we calculated clinical probability of obstructive CAD using the RF-CL model. Results. Clinical likelihood of CCS based on new RF-CL model was higher in men (17% vs. 7%; p<0.001). Men were more often assigned to the group with moderate likelihood of CCS according to RF-CL than women (64% vs. 13%; p<0.001). However, women prevailed in group with low and very low likelihood (p<0.001). Comparative analysis of clinical manifestations of CCS between men and women revealed no significant differences in prevalence of typical angina (25% vs. 20%, p=0.41), atypical angina (21% vs. 29%, p=0.15), non-cardiac chest pain (33% vs. 25%, p=0.19) and dyspnea (42% vs. 29%, p=0.15). After stress testing, 37 positive results and 74 negative results were obtained in men. In the group with positive results, men were significantly more likely to have moderate probability according to the RF-CL model (86% vs. 53%, p0.05). According to clinical data and stress testing, 45 (31%) men and 7 (7%) women were referred for invasive coronary angiography (ICA). When comparing the probabilities of obstructive CAD based on RF-CL and PTP DF model with ICA data, we obtained no significant differences between new and traditional models (p>0.05). Conclusion. In our cohort of patients, the RF-CL clinical probability model did not demonstrate any advantages over traditional DF model of coronary artery disease in men and women.

Sarcoidosis is a systemic granulomatous disease with an unclear etiology. Various organs and systems may be involved in the granulomatous inflammatory process in sarcoidosis, but the lungs and lymph nodes of the mediastinum are the most common targets. Sarcoidosis and monoclonal gammopathy of undetermined significance (MGUS) is a rare combination, with limited data about it in the scientific literature. Only 10 cases of such combinations have been recorded. The possible link between malignant neoplasms and sarcoidosis has been the subject of discussion for several decades. The data obtained in the conducted studies are contradictory. To date, there is no convincing evidence confirming the relationship of sarcoidosis with malignant tumors. The aim of the work is to present a rare clinical case of long-term follow-up of a patient with generalized sarcoidosis and MGUS, who developed malignant epithelioid cell mesothelioma of the peritoneum 11 years after the diagnosis of sarcoidosis. Conclusion. The given case illustrates the variety of clinical manifestations of sarcoidosis, emphasizes the importance of a multidisciplinary approach in the diagnosis and treatment of rare forms of the course of this disease, and also focuses on the need for regular monitoring of the patient’s condition, cancer screening, and timely morphological verification.