Objective. To investigate the influence of arterial hypertension (AH) and ischemic heart disease (IHD) on the course and outcomes of COVID19, considering their various stages, forms, and target organ involvement.
Materials and мethods. A total of 808 COVID19 patients hospitalized in the Intensive Care Unit (ICU) from October 1 to December 31, 2020, aged between 17 and 97 years, were examined. The first group consisted of 246 patients without comorbidities. The second group included 430 patients with AH: 305 with stage II and 125 with stage III. The third group comprised 132 patients with IHD and AH: 84 with angina pectoris, 24 with postinfarction cardiosclerosis, and 24 with acute myocardial infarction (AMI). Clinical and laboratory parameters were assessed for all patients, along with electrocardiography, echocardiography, Doppler ultrasound of the lower extremity veins, and computed tomography (CT) of the thoracic organs. In 110 deceased patients, the severity of lung involvement, signs of heart failure, and the immediate cause of death were evaluated.
Results. Among COVID19 patients hospitalized in the ICU, the prevalence of AH was 70%, including 16.5% with IHD, and 22% had concomitant diabetes mellitus. The mortality rate among COVID19 patients without cardiovascular diseases (CVD) was 4.5%. Among those with Stage II AH, including those with IHD and angina, the mortality rates were 8.2% and 14.3%, respectively. In patients with stage III AH with renal or cardiac involvement, mortality rates were 24% and 62.5%, respectively.
Conclusion. Risk stratification for mortality, considering the prognostically unfavorable significance of the stages and forms of AH and IHD, as well as concomitant viral infections with respiratory complications, allows for an objective assessment of disease progression and prognosis.

Relevance of the problem. In case of myocardial infarction, the patient needs not only continuous medical supervision and urgent hospitalization, but also the implementation at all stages of therapeutic and diagnostic measures that meet modern standards.
Purpose of the work: to analyze the tactics of managing patients with myocardial infarction at the prehospital stage.
Materials and methods. To solve these problems, an analysis of emergency medical care call cards for patients with myocardial infarction for 2022 was carried out.
Results. When analyzing drug therapy, it was revealed that the frequency of use of nitrates was 88.8%; antiplatelet therapy – 88.2%; narcotic analgesics – 82.3%; anticoagulants – 67.3%; β-blockers – 18.7%; oxygen therapy – 36.3%; antiarrhythmic drugs – 6.4%, fibrinolytic therapy was carried out only in 8.9% of patients.
Conclusions: at the prehospital stage, patients with myocardial infarction received sufficient medical care in accordance with clinical recommendations.

Introduction. Acute cerebrovascular accident (stroke) is one of the primary causes of disability in the Russian Federation and worldwide. Approximately one-quarter of strokes are recurrent, with a higher likelihood of leading to disability and mortality. One method of surgical prevention for recurrent cerebrovascular accidents is carotid endarterectomy (CEA). For symptomatic stenosis of the internal carotid artery, surgical intervention should be performed within 14 days of the onset of acute stroke [1]. Currently, the necessity and safety of performing emergency CEA within the first 24 hours of stroke onset, especially in combination with thrombolytic therapy and/or thrombectomy, remains a debated issue. Clear criteria for selecting patients for surgical intervention have not been established.
Materials and methods. The study included 39 patients with ischemic stroke who were admitted to the KBC named after S.P. Botkin on the first day of their stroke and underwent carotid endarterectomy. All patients underwent neurological status evaluation using the NIHSS (National Institutes of Health Stroke Scale), modified Rankin Scale, modified Rivermead Mobility Index, brain CT, CT angiography, CT perfusion, duplex ultrasound scanning (DUS) of the brachiocephalic arteries, and lipid profile analysis.
Results. Hemorrhagic transformation of the stroke focus was observed in 5 (12.8%) patients; all patients with hemorrhagic transformation underwent reperfusion therapy – thrombolysis and/or thrombectomy. Upon admission, the severity of the stroke according to the NIHSS was 8.2±0.9 points, and at discharge, it was 5.4±0.8 points, p<0.05. The mobility index according to the Rivermead Scale at discharge was 8.6±0.8 points, and the degree of disability according to the Rankin Scale at discharge was 2.7±0.2 points. Among patients who underwent CEA within the first day of ischemic stroke, the mortality rate was 12.8% (n=5). Two clinical cases are presented, demonstrating successful carotid endarterectomy in the first day of stroke in combination with reperfusion therapy.
Conclusion. Carotid endarterectomy within the first day of ischemic stroke may be considered not only as a method for preventing recurrent ischemic stroke but also as a treatment method that reduces the degree of patient disability. Further studies are required to develop a patient selection algorithm for CEA within the first day of acute cerebrovascular accident (CVA) to improve the effectiveness of surgical treatment and minimize postoperative complications.

The objective: to study the relationship between the blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and hemodynamic parameters after on-pump ischemic heart disease (IHD) surgeries, and to evaluate the  biomarker association with myocardial dysfunction manifestations. Material and methods. The study involved 38 patients aged 55,0±1,5 years with IHD who underwent coronary arteries bypass grafting (CABG). NT-proBNP blood level, pulmonary artery  catheterization (PAC) data, and transpesophageal echocardiography (TEE) data were studied within the first hour of admission to the intensive care unit (ICU). Correlation analysis, logistic regression with calculation of odds ratio (OR) and 95% confidence interval  (95% CI) and ROC analysis with calculation of area under ROC curve (AUC) were used. Results. In 52.6% of patients, NT-proBNP blood level was normal (179.75 [112.65–237.5] pg/ml), and in 47.4% of patients the biomarker level was increased (615.25 [425.7–1158.0] pg/ml). NT-proBNP blood level was not correlated with PAC data and moderately correlated with TEE parameters. NT-proBNP >366 pg/mL were associated with left ventricular (LV) end-systolic area index (LVESAI) >9 cm^{2 /m2} (OR1.0032, 95% CI 1.0009–1.0054, p = 0.006, AUC0.847), NTproBNP >440 pg/mL were associated with LV area contraction fraction (LVACF) <40% (OR1.0021, 95% CI 1.0001–1.0042, p = 0.036, AUC0.750) and with LV end-diastolic area index (LVEDAI) >15 cm² /m² (OR1.0029, 95% CI 1.0002–1.0055, p = 0.032, AUC0.865). NT-proBNP <272 pg/mL identified patients without postoperative inotropic support (OR0.9973, 95% CI 0.9947–0.9999, p=0.041, AUC0.737), and NT-proBNP >385 pg/mL was a predictor of ICU length of stay >24 hours (OR1.0029, 95% CI 1.0008–1.0050, p = 0.008, AUC0.731). NT-proBNP >505 pg/mL was associated with a vasoactive-inotropic index >10 (OR1.0026, 95% CI 1.0006–1.0046, p = 0.010, AUC0.769), and NT-proBNP >701 pg/mL was a predictor of the refractory heart failure (HF) (OR1.0066, 95% CI 1.0012–1.0120, p = 0.017, AUC0.976). Conclusion. On admission to the ICU, the median NT-proBNP content in patients who underwent on-pump CABG was within the normal range and amounted to 305.0 [176.2–604.5] pg/ml. Biomarker at this stage of treatment moderately correlated with preoperative echocardiographic indices of LV systolic function. In the early period after admission of patients to the ICU, NT-proBNP levels within 366–448 pg/ml are associated with signs of myocardial dysfunction, including LVESAI >9 cm²/m², LVEDAI >15 cm²/m², LVACF <40% and ICU length of stay >24 h. NT-proBNP in the range of 505–701 pg/ml were associated with severe postoperative HF clinical sings.

Introduction. Arterial wall stiffness is an indicator that depends not only on age and blood pressure, but also on the activity of the inflammatory process, the rigidity of the muscular layer of arterioles, the presence of heart and kidney failure, type II diabetes mellitus, as well as genetic predisposition.
The aim of the study was to evaluate arterial stiffness by the traditional method of oscillometric registration of pulse wave velocities in the aorta, brachial artery and their augmentation indices, to determine the clinical and prognostic significance of its increase in patients infected with the human immunodeficiency virus.
Materials and methods. In order to determine the relationship of arterial stiffness indices with clinical, laboratory and instrumental data in patients infected with the human immunodeficiency virus (HIV), 240 patients were examined. After examination using noninvasive arteriographic oscillometry by the Tensiomed Arteriograph 24 medical device, the patients were divided into two groups, depending on the presence and absence of signs of brachial artery stiffness. Increased arterial stiffness was determined when the pulse wave velocity on the brachial artery increased by more than 10 m/s and the brachial artery augmentation index increased by more than 10%. Rigidity was assessed by the indicator of total peripheral vascular resistance.
Results. HIV-infected patients in 12.7% of cases have signs of increased arterial stiffness. Increased arterial stiffness was more common in smoking patients and less common in alcohol drinkers. Left atrial dilation and signs of pulmonary heart failure were more often detected in the group with increased arterial stiffness. The chances of an increase in the volume of the left atrium against the background of increased arterial stiffness increase 2.7 times. In patients with increased arterial stiffness, a lower serum iron content, increased activity of matrix metalloproteinase1, as well as an increase in the rate of erythrocyte sedimentation were noted.
Conclusion. In patients with HIV infection, it is advisable to assess the stiffness of the arterial wall using an oscillometric method in order to predict the development of left atrial dilation.

Postoperative pain syndrome, which is experienced by up to 75% of operated patients, is a significant factor in the long-term recovery of the patient and the development of complications. To solve this problem, modern surgical care adheres to the concept of accelerated recovery of patients, while anesthetic care is focused on the use of a multimodal approach to analgesia. In the formation of this approach, which meets the criteria of efficiency and safety, anesthesiology has gone through an evolutionary path associated with the emergence of drugs (both general and local anesthetics), new methods of anesthesia, improvement of equipment for monitoring the patient’s condition and the active introduction of ultrasound technologies into the practice of an anesthesiologists. Laparoscopic technologies are common in surgical interventions and, due to their high information content, low trauma and the possibility of rapid recovery of patients, are currently used in almost all areas of surgery, including for emergency nosologies. In conditions of limited time resources and, in some cases, the absence of a personalized examination during urgent interventions, as well as when surgical tactics are reduced to diagnostic laparoscopic intervention, it is advisable to study in more detail the types of anesthetic aids from the point of view of the possibility and safety of their use. In particular, one of the modern methods is interfascial blockades as part of a multimodal approach to anesthetic support of urgent laparoscopic interventions.

The main idea of the work is to integrate OpenIGTLink protocol into the stereotactic medical phantom system for data transfer between all components of the developed architecture. At the same time, the article shows the result of the time spent on the transfer of transactions between the components of the created hardware-software complex and presents its functionality.