Antineutrophil cytoplasmic antibodies associated vasculitis (ANCA-AV) is a systemic necrotizing granulomatous vasculitis affecting mainly small-caliber vessels. ANCA-AV occupy a special place among systemic vasculitis, which is characterized by a highly active life-threatening course of the disease, requiring rapid differential diagnosis and aggressive immunosuppressive therapy. The ANCA-AV group consists of 3 nosologies: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. The “calling card” of ANCA-AV is the lesion of the upper respiratory tract, especially the ENT organs (70–100 % of patients). The nasal cavity and paranasal sinuses are the most common areas of lesion in the head and neck (85–100 %), whereas ear damage occurs in about 35% (range, 19–61 %) of cases. Lesion of the ENT organs is typical for the debut of ANCA-AV, which makes early diagnosis difficult, since diseases of the upper respiratory tract are extremely common in all age groups. Diagnosis verification occurs mainly at the stage of generalized involvement of many organs and systems, causing severe course with the development of pulmonary-cardiac and renal insufficiency, which lead to the death of the patient. The main ENT manifestations of ANCA-AV can be grouped into several groups: sinonasal, otological, tracheobronchial, oral cavity lesions and others. Pseudotumors are often found in ANCA-AV. They are characterized by the appearance of parapharyngeal, parotid, submandibular, paratracheal volumetric formations. As a rule, the appearance of tumor-like formations is observed at an early stage of the disease and is associated with the presence of antibodies to proteinase 3, systemic manifestations of vasculitis. Pseudotumor in the ENT region may be accompanied by secondary neuropathies of cranial nerves, destruction of bone tissue, which requires histological verification of the disease.

Aim. To identify significant indicators of cognitive dysfunction based on discriminant analysis and to assess the influence of the course, nature and localization of ischemic stroke on the cognitive status of the patient.

Materials and methods. We examined 290 patients diagnosed with ischemic stroke in the carotid artery area. Depending on presence of cognitive dysfunction according to the Montreal Cognitive Assessment Scale (MoSA) patients were divided into 2 groups: 240 patients with cognitive decline (≤25 point by MoCA) and 50 patients without it. In order to verify the markers, anamnestic characteristics were assessed, cognitive-functional indicators (according to the scales of the National Institutes of Health, MoCA, Bartel, Rankin, IQCODE questionnaire, additional scales to assess praxis, semantic aphasia, perception and executive function), data of neuroimaging studies. For statistical analysis machine learning algorithms and Python with its libraries (Pandas and SciPy) were implied.

Results. The main neuropsychological indicators for patients with early post-stroke cognitive impairment were decline in the areas of perception, executive function, memory and semantic information processing, affective disturbances and physical fatigue. Relevant indicators identified during estimation of the instrumental and clinical examination results were severity of IS, left frontal and right parietal localisations of ischemia focus, presence of cortical atrophy and leukoaraiosis.

Conclusion. Based on multi-factor analysis of clinical and paraclinical parameters using machine learning algorithms, the main markers of cognitive decline of early post-stroke impairments were identified. This will allow us to optimise the choice of neurocognitive rehabilitation strategies and to personalise the approach in the further management of the stroke patient.

Aim. To describe a clinical case of transthyretin amyloidosis, the first manifestation of which was an episode of acute heart failure.

Materials and methods. Patient V., 58 years old, was taken to the intensive care unit for patients with myocardial infarction V.P. Demikhov State Clinical Hospital with a preliminary diagnosis: acute coronary syndrome without ST segment elevation, pulmonary edema. It is known from the anamnesis that the patient was disturbed for 3 months by a pronounced dry cough, hoarseness of voice, weakness with minor physical exertion.

Results. The complexity of the diagnosis of postmortem diagnosis of systemic amyloidosis was explained by the absence of any clinical manifestations that made it possible to suspect a deadly disease before hospitalization for pulmonary edema. This clinical case demonstrates the rapid development of symptoms of systemic amyloidosis. From the moment of the first symptoms (persistent dry cough, hoarseness of voice) to death as a result of heart failure, about 3 months have passed. The addition of peripheral polyneuropathy to the clinical picture made it possible to suspect a systemic disease.

Conclusion. This clinical case proves the relevance and importance of timely diagnosis of amyloidosis, as well as the need to raise awareness of doctors of various specialties about this disease.

Aim. To present a clinical case of osteomalacia associated with fibroblast growth factor-23-secreting tumor under the mask of ankylosing spondylitis (AS).

Materials and methods. Clinical observation of a 31-year-old patient with long-time diagnosis of AS is presented. Underestimation of back pain cause at the initial stage of diseaseled to an erroneous diagnosis of AS. A thorough assessment of the anamnesis, additional examination using modern imaging methods in combination with laboratory analysis (low blood phosphorus level, hyperphosphaturia, normal value of C-reactive protein, erythrocyte sedimentation rate, negative HLA-B27), made it possible to establish the correct diagnosis of “mesenchymal phosphaturic tumor of the left foot (surgical intervention dated 11.26.2020), secondary hypophosphatemic tumor-induced osteomalacia complicated by multiple bone fractures”, to carry out timely treatment with full recovery.

Results. The literature data on epidemiology, pathogenetic mechanisms, clinical manifestations and management approaches of tumor induced phosphopenic osteomalacia are presented. An algorithm for examining patients with suspected of this disease is described, taking into account the expression of somatostatin transmembrane receptors on the surface of a mesenchymal phosphaturic tumor.

Conclusion. One of the rarest causes of specific back pain is osteomalacia, which can be caused by various diseases, for example, a tumor secreting FGF23 The complexity of the diagnosis lies in the non-specificity of clinical manifestations – generalized myalgia and myopathy, ossalgia, pathological fractures, etc. Timely diagnosis and radical treatment makes it possible to achieve stable remission with complete leveling of symptoms, therefore surgical excision of the tumor is the “gold” standard of therapy.

Back pain is a common reason for seeking primary care from older and younger people. Early spinal imaging by a therapist is indicated to eliminate potentially dangerous causes of pain. Independent magnetic resonance imaging or computed tomography examination at the patient’s initiative in the absence of “red flags” back pain in most cases does not come close to identifying the obvious cause of pain syndrome, and it creates the preconditions for the formation of an exaggerated picture of the disease in the patient himself, driving him into the “trap” of chronic pain. Attention of the polyclinic doctor to the clinical symptoms detailed in the article, following the standard algorithms of diagnosis will allow timely suspicion of “red flags” back pain, avoid hyperdiagnosis of the cause, and minimize the risk of its chronization. The algorithm for treatment of acute and chronic episodes of pain should include informing the patient about the favorable outcome in the vast majority of cases, optimizing the physical activity of the patient, the use of complex drug therapy, the basis of which are nonsteroidal anti-inflammatory drugs (predominantly selective), muscle relaxants and other pathogenetically based medicines.

The presented materials of the Expert Council (Moscow, March 29, 2024) are devoted to modern approaches to modifying the risk of tobacco smoking in patients with oncological diseases of the head and neck organs, as well as choosing the optimal scientifically based strategy for quitting smoking or a way to minimize exposure to tobacco smoke for patients who are not motivated to give up from smoking.

Smoking cessation is the main focus of cancer prevention. Quitting smoking benefits even after a cancer diagnosis regardless of location and stage of the disease. Treatment plans should include smoking cessation recommendations combining motivational strategies and behavioral therapy, pharmacotherapy based on evidence-based medicine with follow-up and re-treatment as needed. The physician can inform patients not motivated to quit smoking at the moment about the strategy of risk modification by switching to alternative nicotine delivery sources (ANDS as the general name for category of smokeless products) that exclude burning tobacco. In the future, patients who quit smoking traditional cigarettes, but use only ANDS, should be maintained constant smoking cessation and encouraged to abandon alternative sources of nicotine delivery.

Given the proven effectiveness of introducing smoking cessation recommendations into practice, it is proposed to develop, on the basis of scientifically based methods and international experience, an algorithm for consulting on smoking cessation assistance and include it in clinical recommendations for the head and neck cancer in section “Prevention and dispensary monitoring, medical indications and contraindications to the use of prevention methods”.