The occurrence of paradoxical myocardial deformation, which includes early systolic lengthening and post-systolic shortening, was originally described in the 1970s in experimental animal models and in patients with myocardial ischemia at invasive assessment of the left ventricle (LV). Today, new echocardiographic imaging technology demonstrates that these phenomena are much more common than were initially thought. Quite a lot of studies have been conducred to investigate post-systolic shortening (PSS), but the role of early systolic lengthening (ESL) has become increasingly emphasized in the most recent research articles. In this regard, we have made an attempt to describe most completely and accessibly the clinical potential associated with the mechanisms of occurrence of ESL and the significance of its assessment in various forms of coronary heart disease.

Pheochromocytoma is a rare neuroendocrine tumor that produces catecholamines. Despite the obvious clinical manifestations, there are difficulties in diagnosing it, since the classic symptoms are not always found or may not be obvious. The article presents a clinical case of a patient with pheochromocytoma and a history of hypertension. The pathogenesis and diagnostic features are described, as well as clinical characteristics indicating secondary arterial hypertension. The morphological picture, management tactics of the patient and his condition in the postoperative period are demonstrated.

The article presents an intriguing clinical case of myocarditis in a 36-year-old patient following severe sunburn. The disease developed with a pronounced pain syndrome, a significant increase in high-sensitivity troponin levels, and notable changes in the electrocardiogram (ECG). These factors complicated the differential diagnosis between acute coronary syndrome (myocardial infarction without coronary obstruction) and myocarditis. The rapid regression of clinical symptoms, normalization of myocardial injury biomarkers, atypical ECG dynamics for myocardial infarction, and the absence of coronary artery changes during angiography—alongside magnetic resonance imaging data revealing no areas of ischemic changes but showing inflammatory changes and myocardial edema—contributed to a diagnosis of myocarditis. Dynamic observation two months post-diagnosis indicated no deviations from standard indicators. The article also reviews literature on the mechanisms of myocardial damage associated with sunburn, which differ significantly from those seen in thermal and chemical burns. The authors suggest that severe sunburn is the most likely etiological factor for the observed damage, highlighting the potential for injury not only to the skin but also to internal organs.

Clarification of the presence of diastolic dysfunction, as a possible onset of chronic heart failure (CHF) with preserved LV ejection fraction, is strategic in determining the management tactics and prognosis of patients with HIV infection. It is known that chronic heart failure in HIV-infected people develops in 16–54 % of cases, accompanying the development of multiple pathologies of the myocardium and endothelium [1]. Currently, modern ultrasound equipment, if equipped with a speckle tracking option, provides ample opportunities for diagnosing CHF with preserved ejection fraction, however, this technology is not yet available in all medical institutions, so it is necessary to search for other opportunities for accurate diagnosis of CHF with preserved ejection fraction ejection
The purpose of this work was to substantiate the use of the Tei index as an optimal and accessible indicator for diagnosing diastolic dysfunction and CHF in people with HIV infection. In a large hospital, a group of 240 patients infected with the human immunodeficiency virus (HIV) was studied over a period of four years. The study was of a one-stage, screening, clinical nature. The Tei index is also found in the literature under the name “myocardial performance index” [2]. The clinical significance of determining the Tei index in determining diastolic dysfunction in patients with HIV infection is higher than the ratio E/e’≥13, which makes this indicator recommended for echocardiography in this cohort of patients as an early marker of diastolic dysfunction and CHF.In HIV-infected patients, an increase in the Tei index of more than 0.41 is associated with the development of left ventricular diastolic dysfunction, hypertrophy, increased volume of the left atrium, pulmonary arterial hypertension, anemia and chronic kidney disease. In patients with HIV infection, with an increase in the Tei Index ≥0.41, the likelihood of developing CHF increases 10.6 times, severe CHF with NT-proBNP≥1500 pg/ml increases 8 times, anemia increases 5.75 times, 3.73 times – coronary artery disease, 3.09 times – chronic kidney disease; 2.86 times for ventricular arrhythmias and 2.29 times for pulmonary arterial hypertension.

The objective was to study the prognostic significance of intraoperative parameters of pulmonary artery catheterization (PAC), transesophageal echocardiography (TEE) and transpulmonary thermodilution (TPTD) in relation to the hemodynamic disorders in coronary artery bypass grafting (CABG).
Material and Methods. A prospective observational study involved 67 patients aged 53 [46–64] years who underwent on-pump CABG. Hemodynamic parameters were recorded after the induction of anesthesia (stage I) and at the end of the surgery (stage II). Hemodynamic disorders were considered to be the inotropic index in post-bypass period >5, the duration of inotropic support >12 hours, the intensive care unit (ICU) stay >24 hours, the use of intraaortic balloon pumping (IABP), the ICU mortality, the presence of one or more complications (composite outcome). Logistic regression and ROC analysis were used.
Results. At stage I, the left ventricular stroke work index (LVSWI) cut-off <31.7 gs•m/m2 was associated with ICU stay >24 hours (OR 0.9291, 95 % CI 0.8670–0.9958, AUC 0.716), and LVSWI <32.5 gs•m/m² – with a composite the outcome (OR 0.9550, 95 % CI 0.9133–0.9985, AUC 0.704). The left ventricular area contraction fraction <34.2 % predicted the use of IABP (OR 0.9089, 95 % CI 0.8397–0.9839, AUC 0.889). At the II stage, the LVSWI cut-off <28.8 gs•m/m² was associated with ICU stay >24 hours (OR 0.8805, 95 % CI 0.8226–0.9884, AUC 0.716), cut-off <25.6 gs•m/m² – with the use of IABP (OR 0.8274, 95 % CI 0.7101–0.9641, AUC 0.804), and cut-off <23.0 gs•m/m² – with mortality (OR 0.7486, 95 % CI 0.5951–0.9415, AUC 0.892). The left ventricular ejection fraction <26.1 % was also associated with mortality (OR 0.8901, 95 % CI 0.8164–0.9705, ACC 0.948). The global heart ejection fraction <18 % was associated with a composite outcome (OR 0.9018, 95 % CI 0.8297–0.9802, AUC 0.716). The other predictors cut-off values were practically normal. The remaining indicators provided models of average quality or had no predictive significance.
Conclusion. To assess the risk of possible hemodynamic disorders in on-pump CABG, PAC and TEE are the most informative. In prebypass and in postbypass periods, LVSWI, reduced by 1.5–2.2 times, is associated with the risk of various hemodynamic complications and prolonged ICU stay. Decreased TEE parameters of left ventricular systolic function is associated with myocardial dysfunction and with the risk of mortality. The prognostic significance of the TPTD needs further investigations.

The relevance of complex correction of endothelial dysfunction and arterial stiffness in patients with arterial hypertension and coronary heart disease is associated with their leading role in the development of cardiovascular diseases. Endothelial dysfunction, characterized by a deficiency of vasodilators, such as nitric oxide, and an increase in vasoconstrictor mediators, contributes to atherogenesis and thrombosis. At the same time, an increase in arterial stiffness leads to an increase in systolic pressure and impaired diastolic filling of the myocardium, which aggravates myocardial ischemia and contributes to the progression of heart failure. The introduction of an integrative approach to optimizing endothelial function and reducing arterial stiffness into clinical practice can significantly improve the prognosis and quality of life of patients, reducing the risk of serious cardiovascular events, including myocardial infarction and stroke. Results from randomized clinical trials support the efficacy of such a strategy, demonstrating that normalization of endothelial function and reduction in arterial stiffness are achievable with modern antihypertensive and lipidlowering drugs, including polypills. These drugs improve treatment adherence through simplified dosing regimens and provide effective management of multifactorial risks in patients. In addition, ongoing research and development of new therapeutics and treatments continue to highlight the need for early detection and targeted therapy in this patient population. Such strategies not only address the underlying pathophysiological changes but also aim to prevent long-term complications associated with these cardiovascular risk factors. By focusing on an individualized treatment protocol that includes both pharmacologic interventions and lifestyle changes, healthcare providers can offer a more dynamic and effective treatment plan that meets each patient’s individual needs, thereby optimizing therapeutic outcomes and improving patient compliance.
Background. Cardiovascular diseases are the leading cause of death in Russia, with hypertension, coronary heart disease, and cerebrovascular disease predominating. The prevalence of hypertension is 53.9 %, but disease control remains poor, with less than 30 % of patients achieving target blood pressure levels. Therapy often includes combinations of medications, such as ACE inhibitors and angiotensin receptor blockers, which demonstrate advantages over monotherapy. Approximately 70.7 % of patients require combination therapy to effectively manage their condition.
Objective. Comparison of the effects of fixed combinations of amlodipine, atorvastatin and perindopril (Lipertance® 10/20/10 mg) with a combination of amlodipine, lisinopril and rosuvastatin (Equamer® 5/10/20 mg) on the clinical progression of grade 2 and 3 arterial hypertension and functional class II and III coronary heart disease. Also study the effect on arterial stiffness, endothelial function, ankle-brachial index, vascular age.
Materials and methods. The study included 65 patients with uncontrolled hypertension with systolic blood pressure (BP) ≥160 mmHg and/or diastolic BP ≥90 mmHg in combination with stable angina, taking two antihypertensive drugs at the beginning of the study. Depending on the therapy, the participants were divided into II groups: I – 30 people receiving a fixed combination of Lipertance; II group – 35 people taking a fixed combination of Equamer. All patients also received bisoprolol at a dosage of 5–10 mg and an antiplatelet agent at a dosage of 75–100 mg.
Conclusions. Fixed combinations of Lipertance® and Equamer® drugs were highly effective in controlling blood pressure in patients with hypertension and coronary heart disease, achieving target systolic and diastolic levels in more than 85 % of patients. Both groups showed significant improvements in arterial stiffness and endothelial function, demonstrating their potential to reduce cardiovascular complications. Thus, these combinations can be recommended for routine use in clinical practice to improve prognosis and quality of life in patients.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be a critically important method for supporting patients with acute STsegment elevation coronary syndrome (STEMI) undergoing percutaneous coronary intervention (PCI) in high-risk settings.
Objective: to demonstrate the effectiveness of ECMO in a patient with severe cardiovascular insufficiency against the background of myocardial
ischemia in conditions of ongoing intensive care
Clinical observations: a case of the use of VA-ECMO before PCI in a 63-year-old patient with multiple occlusive stenotic lesions of the coronary bed is described. Due to the high risk of complications during planned PCI and ongoing CPR, it was decided to start VA-ECMO to provide mechanical circulatory support. Balloon angioplasty was performed with stenting of the LCA trunk and permanent residence with 2 stents in conditions of extracorporeal life support. After stenting, an effective sinus rhythm was independently restored. On the 4th day, decannulation and excommunication from ECMO were performed. On the 7th day, the patient was transferred from the ICU to the cardiology department. The patient was discharged on the 18th day.
Conclusion: the use of ECMO contributed to the stabilization of the patient’s vital signs in conditions of acute myocardial ischemia and made it possible to perform effective recanalization against the background of resuscitation measures.

This scientific work is devoted to the topical and applied issue of modern anesthesiology – intensive care – rational anesthesia of laparoscopic liver resections. The transformation of surgical access from «open» to minimally invasive – laparoscopic and robot–assisted – encourages anesthesiologists to search for new methods of prolonged postoperative analgesia. The tendency of modern anesthesiology to limit the use of opioids and the popularization of ultrasound technologies expand the scope of application of myofascial blockades in various fields of surgery. The techniques are safe and effective and can be implemented in various groups of patients, in particular in those who has contraindications to neuroaxial block. Currently, the most commonly used method of anesthetic provision is combined anesthesia –general anesthesia and epidural analgesia. It should be remembered about the features of surgical interventions on the liver and the associated risk of developing massive blood loss syndrome, which increases the frequency of post-operative, primarily hemorrhagic complications, after the use of neuroaxial techniques of prolonged analgesia. The sympatholytic effect of local anesthetics with prolonged epidural infusion is well known, in some cases provoking hemodynamic instability, and, as a result, the need for monitoring the patient in the intensive care unit, as well as increasing the length of hospital stay in general. This circumstance contradicts the trend of modern surgery towards rapid and accelerated recovery after surgery. The above together is economically unprofitable and does not meet the requirements of modern protocols. An in-depth analysis of clinical practice led the authors to the idea of using myofascial blocks (in particular, erector spinae plane block), which have positive qualities of neuroaxial techniques, but are characterized by a better safety profile.

Timely and adequate nutritional support is on a par with etiotropic and pathogenetic therapy in terms of effectiveness, especially in intensive care patients. Critical condition and systemic inflammation of any etiology lead not only to primary and secondary damage to organs and tissues, the development of multiple organ failure, but also trigger a cascade of reactions aimed at mobilizing energy substrates to maintain homeostasis and ensure regeneration. This leads to a rapid depletion of endogenous reserves of macro- and microelements and, without proper replenishment, a syndrome of metabolic dysfunction develops, which, in turn, contributes to the progression of multiple organ failure, the development of purulentseptic and metabolic complications, which increases the time of hospitalization and pharmacoeconomical costs, worsens the results of treatment. In everyday clinical practice, when diagnosing nutritional deficiency or the risk of its development, the clinician must determine not only the nutrition program, but also the format of its implementation. This paper presents a critical analysis of the most common ways of providing nutrition and algorithms for personalized choice of nutritional therapy in patients in intensive care units.

Objective. To study the copper and zinc content in the severely burned patients’ blood serum and evaluate their capabilities as prognostic criteria for the burn disease outcome.
Materials and methods. 37 patients with a burn area of 50,7±17,2 % of the body surface were examined, 7 of them died. The content of copper, zinc, albumin, globulins and prealbumin in blood serum was assessed within 14 days after receiving thermal injury.
Results. A copper and zinc deficiency was found during the burn shock. In the future, the copper levels normalization and a tendency to the zinc concentration increase with normalization by 14 days after burn injury are noted. The micronutrient deficiency correlation with the albumin, prealbumin and globulins levels was found. The conjugacy between hypocyncemia and hypocupremia with the sepsis presence and the death probability was revealed. A decrease in zinc levels below 4,7 mmol/l leads to a 24-fold increase in the death chances and in copper content below 13 mmol/l – to a 10–fold increase in the chances. The sensitivity and specificity of the zinc concentration threshold value assessment was 71 % and 90 %, respectively, and the copper concentration was 80 % and 75 % respectively.
Conclusion. During the burn shock hypocupremia and hypocyncemia are detected. Further normalization of the copper level and a tendency to zinc concentration normalization were revealed. Zinc and copper concentrations can serve as additional sepsis biomarkers. Threshold values of zinc and copper concentrations in blood serum have been determined which determine the fatal outcome risk of burn disease.

The review is devoted to the problem of postoperative intestinal insufficiency: one of the probable pathophysiological bases of this condition, serotonin deficiency, is considered. The problems of intestinal insufficiency from the point of view of functional and structural disorders of the intestine are considered in detail, the relationship of this condition with the synthesis and metabolism of serotonin is analyzed. Special attention is paid to the accumulated clinical experience in the treatment of intestinal insufficiency through the donation of parenteral serotonin preparations, the advantages and side effects of such therapy, as well as possible complications, are considered in detail. In this regard, emphasis is placed on the most rational and effective approaches to the correction of serotonin deficiency in the treatment of functional intestinal insufficiency of the perioperative period.

Relevance. Healthcare-associated infections (HAIs) are a significant problem in intensive care units. They contribute to increased mortality, lengthen hospital stays and increase treatment-related costs.
The aim of the study was to evaluate the effectiveness of reducing the microbial background and cross-transmission of pathogenic microorganisms associated with the provision of medical care in the intensive care units of surgical hospital with the systemic use of the Alpha‑06A pulsed ultraviolet system with the “Areal” device (Scientific and Production Enterprise «Melitta», Russia).
Materials and methods. The Alfa‑06A air, surface and local areas disinfection system with the “Areal” device was used in the intensive care unit for 2 months – August and September 2024. The “Areal” device directs ultraviolet radiation, generated by the pulsed xenon lamp of the Alfa‑06 installation, into a limited sector. The rest of the room is structurally protected from direct UV radiation. It is allowed to use it in the presence of patients and staff. The use of the installation complemented the standard anti-epidemic measures. At the end of the study period, the results of microbiological studies were retrospectively evaluated and compared with the results of the control period.
Results. A statistically significant (Fisher’s criterion 0.00383, p<0.05) tenfold decrease in the number of positive samples from surfaces during the treatment period in the «Areal» mode was noted. A decrease in bacterial pollution of the environment led to a distinct tendency to reduce cases of contamination of patients with various bacterial flora, and the acquisition by the patients of multidrug-resistant organisms statistically significantly decreased by 100 % (p<0.5). As a result, the use of the Alpha system in the «Areal» mode reduced the cost of expensive antibacterial drugs by 18.9 % in absolute and 7.4 % in relative terms.
Conclusion. The systematic use of Alfa‑06A in conjunction with the “Areal” device in the daily work of the intensive care unit significantly reduces the contamination of surfaces with microorganisms. This is reflected in a decrease in the number of positive samples from various patient loci. The number of cases of persistence of polyresistant problematic bacteria of the ESKAPE group is also decreasing. The improvement of the microbiological background shows a clear economic effect in terms of the cost of expensive antibacterial drugs.

The aim of the study was to analyze the results of shear wave elastography data of iliac and femoral vein thrombi in the acute period of the disease to identify ultrasound parameters that are prognostically significant for posthospital outcomes.
Material and Methods. At the hospitalization stage, 153 patients with iliac and femoral vein thrombosis underwent venous ultrasound with shear wave elastography. Depending on the outcome of the disease 6–12 months after discharge from the hospital, the examined patients were divided into 3 groups: with recanalization, venous retrombosis and death.
Results. In those with the outcome “retrombosis” the thrombus stiffness during inpatient treatment was higher than in the groups with the outcomes “recanalization” and “death”. According to the Accuracy and Gini coefficients for iliac vein thrombosis, the values of maximum and mean Young’s moduli of iliac vein thrombus on the first, third and sixth days of hospitalization, whereas in femoral vein thrombosis – maximum, average and minimum Young’s moduli of femoral vein thrombus on the mentioned days and minimum Young’s modulus of sural vein thrombus on the first day of hospitalization. The variables separating the posthospital outcomes “recanalization” and “death” in iliac vein thrombosis were the maximum Young’s modulus of femoral vein thrombus on the first day of hospitalization and the length of the floating part of the thrombus; in femoral vein thrombosis – the maximum Young’s modulus of the saphenous vein on the first day of hospitalization, the PE mass and the duration of the period from the first symptoms to hospitalization.
Conclusion. The results of shear wave elastography at the hospital stage of management of patients with DVT allow predicting the recurrence of thrombosis in the following year based on the stiffness values of the proximal part of the venous thrombus and lethal outcome based on the stiffness of the thrombus in the inferior vein of the affected limb.

In the mid‑20th century and later, the main bacterial threat in hospitals was gram-positive infections, with staphylococcus aureus (“staphylococcal plague”) playing the leading role. In the last 20 years, there has been an evolution, a change in flora, and now gram-negative infections, especially the triad (A. baumanii, K. pneumoniae, P. aeruginosa) from the ESCAPE group, determine hospital morbidity and mortality due to increasing resistance to carbapenems and cephalosporins and, accordingly, limited choice. In the review concerning the treatment options for A. baumanii in adults and children (especially infants and neonates), antibiotic therapy options are considered.

Medical thermography (MT) is an actively developing technology that covers many areas of medical practice. Unfortunately, the usefulness of this method in such a crucial area as the treatment of wounds and wound infections are almost unknown. Moreover, there is no data on whether the method will be effective in emergency medical setting, where the conditions are far from standards, necessary for its correct implementation. Clinical evaluation in a wide range of pathologies, including soft tissue infections, local and peripheral blood circulation disorders, osteomyelitis after orthopedic trauma indicates, that infrared imaging diagnostic patterns are valid and almost independent of the environmental conditions. By all its qualities, MT could become the important method in rapid wounds and wound infections diagnostics to use in any surgical departments in the hospitals of any level and to be of interest to verify peripheral vascular disorders in patients with combat extremities injury. To clarify the thermosemiotics, including numerical criteria, as well as the environmental boundary conditions, at which medical thermography maintains its diagnostic value, further clinical studies are needed to support the clinical utility of thermography.

The relevance of improving the efficiency of emergency medical care in the context of emergency medical services (EMS) necessitates the implementation of modern solutions. As part of the study, the ambulance cabin was optimized, ergonomic zoning was introduced, equipment placement was standardized, and standard operating procedures (SOPs) were developed.
The purpose of the study. To compare the efficiency of emergency medical care provided in standard and optimized ambulance cabins, assessing the impact of ergonomic and zoning modifications on the time required for procedures, the quality of care, and the working conditions of medical personnel.
Research objectives. An analysis of the impact of ambulance cabin ergonomics on the speed and quality of medical procedures, as well as an examination of the working conditions of medical personnel in the updated cabin to identify the advantages of implementing a systematic approach to space design.
Materials and methods. The study focuses on designing a new ambulance cabin with an emphasis on ergonomics, zoning, and optimal equipment placement to enhance the efficiency of medical procedures. Methods of ergonomic and demographic analysis were applied to evaluate the functionality of cabin zones, alongside statistical data processing using Excel, specialized software packages, and Python.
Results. Test data revealed that the use of the optimized ambulance cabin enhances the efficiency of emergency medical care. The time required for medical procedures in the updated cabin was reduced, improving the response speed of the team. A decrease in personnel fatigue and increased equipment accessibility were noted due to ergonomic zoning. The results also confirmed more comfortable working conditions for the medical team and a reduction in response times compared to the standard cabin.
Conclusion. The results of the study hold significant scientific and practical value for emergency medical service professionals. The data obtained confirm the potential of implementing innovative solutions in ambulance design, enabling recommendations to improve working conditions for medical personnel and enhance the efficiency of emergency medical care delivery.