Cognitive impairment (CI) usually is the earliest and most prevalent manifestation of cerebral vascular disease. Post stroke CI may have different clinical presentation depending on location of vascular lesion, so appropriate temporal association of CI onset with the event of stroke is of most important diagnostic value. Non-stroke (subcortical) variant of cerebral vascular disease usually is associated with small vessel disease. CI in subcortical variant is characterized with attention and executive functions deficit, frequently in combination with emotional disorders, postural instability and gait disturbances of frontal origin. Presence of vascular CI means essential need of thorough vascular risk factor (arterial hypertension, dyslipidemia, diabetes etc.) control. Vasotropic agents are prescribed with pathogenic purposes. The article presents clinical experience of nicergoline treatment of patients with vascular CI of different severity.

Aim. To present a clinical case of TAFRO syndrome – a recently described subtype of idiopathic multicentric Castleman disease of unknown etiology, characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis of the bone marrow and / or renal dysfunction, organomegaly associated with an increase in serum IL-6 secretion.

Materials and methods. Herein, we report a young patient diagnosed with TAFRO combined with C3 nephropathy. The patient was treated with glucocorticoids (methylprednisolone), colchicine, sarilumab, rivaroxaban, and symptomatic treatment.

Results. Key aspects of diagnosis, treatment and course of the syndrome were discussed. The possibility of the combined course of two rare pathologies – a subtype of idiopathic multicentric Castleman disease and C3 nephropathy is still unclear.

Conclusion. The diagnosis of TAFRO syndrome can be considered after the exclusion of a number of infectious, paraneoplastic, systemic connective tissue diseases, POEMS syndrome, liver cirrhosis against the background of autoimmune hepatitis, autoimmune thrombocytopenic purpura, as well as hemolytic-uremic syndrome. Kidney damage in this category of patients, in most of the described clinical cases, is morphologically represented by thrombotic microangiopathy or mesangioproliferative glomerulonephritis. C3 nephropathy in that clinical case seems to be concomitant. Glucocorticoids in high and ultrahigh doses, cyclosporine, IL-6 type inhibitors, as well as anti-CD20 antibodies are used as therapy.

Objective. To describe the clinical case of a young patient with chronic thromboembolic pulmonary hypertension (CTEPH) with heart myxoma and thrombophilia of mixed origin, who underwent surgical treatment.

Materials and methods. Patient Z., 24 years old, was admitted to the cardiology department with cough with sputum production that occurs during physical activity, including streaks of blood, shortness of breath with slight physical exertion, legs and feets edema, weakness and dizziness. The examination was carried out: electrocardiography; multislice computed tomography pulmonary angiography; echocardiography (EchoCG); transesophageal EchoCG; magnetic resonance imaging of the heart with contrast; screening for coagulopathy.

Results. Based on clinical data, medical history, laboratory, instrumental diagnostic, we have put the diagnosis: Myxoma of the right atrium. Patent foramen ovale. Thrombophilia of mixed origin: hereditary – heterozygous mutation of the prothrombin gene (factor 2), acquired – hyperhomocysteinemia. Postthrombotic deep vein disease of the left lower limb. Recurrent pulmonary embolism (last relapse dated October 19, 2022). CTEPH functional class III (World Health Organization), moderate risk. Congestive heart failure with reduced right ventricular ejection fraction, functional class III (by the New York Heart Association). Relative tricuspid valve regurgitation grade 3. The patient underwent surgery: thromboendarterectomy from the right pulmonary artery under conditions of circulatory arrest and deep hypothermia, removal of a right atrium myxoma under conditions of artificial circulation and blood cold cardioplegia: tricuspid valve plasty according to De Vega. After surgery patient’s condition was significantly improved.

Conclusion. The features of diagnosis and treatment of a patient suffering from CTEPH and cardiac myxoma are outlined. Surgery: Pulmonary thrombectomy and cardiac myxoma removal may improve the patient’s condition with CTEPH and left atrial myxoma.

Aim. To evaluate the effectiveness of combination therapy for low back pain (LBP) associated with spinal osteoarthritis (OA) using the Symptomatic Slow Acting Drugs for OsteoArthritis (SYSADOA) group drug Ambene® Bio.

Materials and methods. The study included 30 patients with LBP aged 40 to 65 years. Various scales and questionnaires were used to assess the patients’ condition. All patients received Ambene® Bio 2.0 ml intramuscularly every other day for a total course of 10 injections. Some patients with severe pain continued to receive previously prescribed non-steroidal anti-inflammatory drugs (NSAIDs). After completing the course of treatment with Ambene® Bio, the overall effect of the therapy, changes in individual need for NSAIDs and the presence of adverse events were assessed.

Results. All patients sought medical care due to exacerbation of chronic LBP. X-ray examination of the lumbosacral spine revealed degenerative-dystrophic changes in the vertebral-motor segments of the lumbar spine in all patients and in some patients – in the sacroiliac joints. The treatment showed positive dynamics in 27 (90 %) patients in the form of pain reduction not only in the lower back but also in peripheral joints. Of the 13 patients initially receiving NSAIDs, 7 (53.8 %) reduced the daily dose of the drug, and 3 (23.1 %) were able to stop taking NSAIDs. In 3 (23.1 %) cases, the initial NSAID dosage remained unchanged. Monotherapy with Ambene® Bio was received by 17 (56.7 %) patients. All patients expressed satisfaction with the treatment, of which 18 (60 %) rated the result as “excellent”, 7 (23.4 %) as “good” and 5 (16.6 %) as “satisfactory”.

Conclusion. In all patients, therapy with Ambene® Bio, both in mono mode and in in combination with NSAIDs, had a positive effect, which was expressed in the reduction of the intensity of LBP on visual analog scale, improvement of peripheral joint function. In 7 (23.3 %) patients pain reduction was observed after the second injection of the drug (“the effect of the first dose”). In other cases the pain regressed later, but also within the course of treatment. All patients showed high adherence to therapy, which was explained by the rapid onset of the effect. The results of the study allow us to recommend Ambene® Bio for the treatment of LBP associated with spinal OA and within generalized OA, including patients with comorbid conditions.

Aim. To determine prognostic markers of methotrexate (MT) toxicity in rheumatoid arthritis (RA).

Materials and methods. The study included 294 patients with RA who were prescribed MT at a dose of 10 to 25 mg per week for the first time as basic anti-inflammatory therapy (BPVT). The following adverse events (AEs) were recorded: hepatotoxicity, toxicity from the gastrointestinal tract, blood system. Qualitative parameters were considered as possible predictors of MT intolerance: gender, obesity, smoking, systemic manifestations, as well as rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), intake of glucocorticosteroids (GCS), form of administration of MT; and quantitative: age of RA onset, baseline disease activity according to DAS28 (Disease Activity Score 28) and HAQ (Health Assessment Questionnaire), MT dose. Statistical processing was performed by one-factor methods using Pearson’s χ2 test with Yates correction, Fisher’s exact two-tailed test, Mann–Whitney U-test, and Student’s t-test. Multivariate analysis was carried out by binary logistic regression.

Results. In a univariate analysis, significant results were obtained for hepatotoxicity: a direct correlation with the use of corticosteroids at the onset (odds ratio (OR) 2.0; 95 % confidence interval (CI) 1.1–3.8, p = 0.03), inversely correlated with MT tablet intake (OR 0.5, 95 % CI 0.2–0.95, p = 0.03). According to the results of multivariate analysis, hepatotoxicity was recorded more often when taking GCS in the debut 2.01 times (95 % CI 1.02–3.96, p = 0.043), and in the presence of ACCP – 3.16 times (95 % CI 1.06–9.45, p = 0.039); and less frequently when taking tableted MT by 2.62 times (95 % CI 0.17–0.84, p = 0.017). Gastrointestinal toxicity tends to be associated with a younger age of RA onset (p = 0.06) and greater RA HAQ activity at onset (p = 0.07).

Conclusions. Hepatotoxicity is more expected in patients seropositive for ACCP and GCS treatment in the onset of RA, but is less common when taking MT tablets. AEs from the gastrointestinal tract are associated with a younger age of onset of the disease and a greater degree of activity according to the HAQ index.

Aim. To determine the factors that contribute to the prediction of the volume of pulmonary lesion in patients with systemic scleroderma (SSc).

Materials and methods. The analysis included patients with SSc observed in the Registry of Myositis, systemic sclerosis and mixed connective tissue disease (REMISSIS), who underwent high-resolution computed tomography (HRCT) of the lungs. For the immunological characteristic, all patients were tested for anti-topoisomerase (anti-Scl-70), and anti-centromeric (anti-CENP-B) antibodies, and anticentromere antibodies (anti-Pm-Scl).

Results. The study included 79 patients with SSc. There was 94.9 % women. Average age – 64.4 ± 11.5 years. Signs of interstitial lung disease (ILD), according to HRCT were detected in 50 patients. The largest extent of lung injury was noted in patients with SSc sine scleroderma (32.7 ± 29.3 %), a smaller extent in patients with diffuse form SSc (16.9 ± 17.1 %) and the lowest in patients with limited SSc (8.5 ± 14.2 %). In addition to the type of disease, the extent of lung injury in patients with SSc-ILD was statistically significantly higher in patients with arthralgia, dyspnea and the presence of antibodies to topoisomerase I and combined autoantibodies. Also, a statistically significant feedback was established with all indicators of the test with a 6-minute walk and forced vital capacity and a direct relationship with indicators of pulmonary artery systolic pressure. When evaluating the correlation between the extent of lung injury and the degree of dyspnea according to Borg, it was found that in patients who assessed dyspnea less than 3 points, the extent of lung injury was less than 25 %. Due to the high degree of correlation, a regression formula was created for the dependence of the extent of lung injury on the distance in the test with a 6-minute walk: extent of lung injury = (52.7–0.1) × distance 6MWT. A multivariate model was also obtained for predicting the extent of lung injury in SSc, in which the patient’s immunotype, distance in the 6-minute walk test, saturation after the 6-minute walk test, and the presence of dyspnea became the most effective.