Objective. To assess the significance of the influence of arterial hypertension (AH) and coronary artery disease (CAD) on the course and outcome of the novel coronavirus infection in patients of different age groups.

Materials and methods: The study included 808 patients with COVID‑19, 452 men and 356 women, hospitalized in the intensive care unit of the infectious diseases department of the N.V. Sklifosovsky Research Institute for Emergency Medicine during the period from 01.10 to 21.12.2020. Patients were divided into groups according to age: young (18–45 years, n=121), middle-aged (46–60 years, n=268), elderly (61–75 years, n=314), and senile (over 75 years, n=105). In all patients, stage II and III AH, CAD with angina pectoris, previous and acute myocardial infarction were taken into account; indicators of clinical and laboratory studies, electrocardiography, echocardiography, and computed tomography (CT) of the chest organs were evaluated considering the degree of lung involvement. In 110 deceased patients, the severity of lung involvement and the immediate cause of death were assessed.

Results. Of the total number of hospitalized patients, those of young, middle-aged, elderly, and senile age accounted for 15 %, 33%, 39%, and 13%, respectively. Among patients under 45 years of age, 68% had no concomitant pathology, 24% had stage II AH and 5% stage III AH, and only isolated patients had chronic and acute forms of CAD. In the age group of 45–60 years, the number of patients without cardiovascular diseases (CVD) decreased to 41%, those with stage II and III AH increased to 33% and 17%, and those with chronic and acute forms of CAD accounted for 6% and 3%. In the age group of 60–75 years, patients without CVD accounted for only 16%, those with stage II and III AH 43% and 17%, and those with chronic and acute forms of CAD17% and 7%, respectively. Finally, among people older than 75 years, only isolated patients had no concomitant pathology; those with stage II and III AH accounted for 40% and 19%, and the number of individuals with acute and chronic forms of CAD increased significantly to 23% and 16%, respectively. Analysis of the influence of the age factor on mortality revealed a statistically significant relationship: in the age groups under 45, 46–60, 61–75, and over 75 years the rates were 3.3%, 9.3%, 15.0%, and 32.4%, respectively. The mortality rate demonstrated an exponential increase with increasing age, which may be associated with a relatively uniform distribution of patients with AH across all age groups, while patients with CAD were predominantly represented among elderly and senile individuals.

Conclusion. Age is one of the key factors determining the mortality rate in COVID‑19; however, its determining role is indirect. The extent of lung involvement and the severity of concomitant AH and CAD exert a direct influence on the course and outcome of coronavirus infection. With increasing patient age, not only is there an increase in the frequency of subtotal lung involvement, but also an accumulation of severe stages and forms of AH and CAD complicated by circulatory failure. The risk of a fatal outcome, increasing exponentially with each decade of life, is determined by the stage of AH, the form of CAD, and the degree of severity of heart failure.

Relevance. In the field of geriatrics, atrial fibrillation and senile asthenia syndrom stand out as two important medical and social difficulties. The interaction of these conditions has a profound negative impact on the prospects of recovery, contributes to an increase in the number of complications and makes the process of treating patients more complex and complex.

The aim of the study was to compare the components of asthenia in patients with atrial fibrillation depending on age group.

Materials and methods. This observational study included 267 patients with AF, divided into two groups: Group 1 (n=120, aged ≥75 years) and Group 2 (n=147, aged 60–74 years). All patients underwent a comprehensive geriatric assessment using validated questionnaires and instruments: the «Age is not a hindrance» questionnaire (assessment of attitudes toward aging), the MoCA test (assessment of cognitive function), the Geriatric Depression Scale (GDS‑15), the Barthel Index (assessment of activities of daily living), the Insomnia Severity Index (ISI), and handgrip dynamometry (assessment of muscle strength). Statistical analysis was performed using StatTech v. 4.11.1 (developer – StatTech LLC, Russia).

Results. Patients in Group 1 (≥75 years) compared with Group 2 (60–74 years) demonstrated a more negative perception of aging (6.0 [6.0–7.0] points vs. 5.0 [5.0–6.0]), severe cognitive impairment (MoCA: 19.0 [18.0–21.0] points vs. 23.0 [21.0–25.0]), signs of clinical depression (GDS‑15: 9.0 [7.0–9.0] points vs. 6.0 [5.0–7.5]), significant limitation of daily activities (Barthel: 75.0 [60.0–90.0] points vs. 95.0 [95.0–100.0]), severe insomnia (ISI: 21.0 [16.0–22.0] points vs. 8.0 [8.0–15.0]) and decreased muscle strength (24.0 [20.0–31.0] kg versus 30.0 [27.0–39.5] kg).

Conclusion. Unlike elderly patients, patients with atrial fibrillation in old age (≥75 years) experience severe polymorphic asthenia, affecting the psyche, thinking, emotions, daily functions, and physical condition.

Modern international guidelines for cardiopulmonary resuscitation (CPR) increasingly emphasize an individualized, physiologically oriented approach to managing patients after cardiac arrest. The updated protocols for advanced life support in children by the European Resuscitation Council (ERC PALS, 2025) confirm the key role of high-quality CPR as the basis for a successful outcome. It emphasizes the importance of maintaining an optimal frequency and depth of chest compressions, minimizing interruptions, and preventing hyperventilation. At the same time, attention is shifting to achieving target physiological parameters, primarily diastolic pressure (≥25 mmHg in infants and ≥30 mmHg in children over one year of age) and end-tidal carbon dioxide concentration (ETCO2) as markers of CPR effectiveness. A number of innovations concern the timing and sequence of adrenaline administration, the priority of rapid defibrillation in shock rhythms, and the management of the post-resuscitation period, where the main focus has been on actively preventing hyperthermia (maintaining a temperature of ≤37.5 °C) and maintaining blood pressure above the 10th percentile for age. The new data highlights the need for a multifactorial neurological prediction that does not rely on a single isolated test. Thus, the new guidelines from the American Heart Association and the American Academy of Pediatrics (AHA/AAP) aim to improve the effectiveness of CPR, personalize post-resuscitation care, and enhance long- term neurological outcomes in pediatric patients.

In 2025, the European Resuscitation Council (ERC) released updated Adult Advanced Life Support (ALS) guidelines, marking a paradigm shift from rigid algorithms to a dynamic “Physiologically-focused CPR” concept. Simultaneously, American Heart Association/American College of Cardiology (AHA/ ACC) guidelines have been updated, allowing for a comparative analysis of key directions in global resuscitation science. Key European updates include a move towards maintaining target physiological parameters (EtCO2, blood pressure) during CPR, refined timing of adrenaline administration for shockable rhythms, a recommendation to use the maximum available energy for defibrillation, and a post-resuscitation care shift from targeted hypothermia management (TTM 32-34°C) to active fever prevention (≤37.5°C) [3]. The American guidelines, in turn, place significant emphasis on CPR quality, minimizing interruptions, more precise determination of when to terminate resuscitation, and the abandonment of outdated procedures [2]. This review details these innovations in a comparative manner, integrating them into a structured clinical context for practitioners.

Background. Currently, continuous glucose monitoring (CGM) systems are widely used in the outpatient management of patients with diabetes mellitus (DM). However, their use for inpatient monitoring is not yet standard. The feasibility of using CGM-derived data during hospital care remains an open question and requires further research. Special attention should be paid to studying the effectiveness of CGM on the manifestations of cardiovascular comorbidity in patients with diabetes mellitus, which is as common a cause of hospitalization as diabetes itself.

Aim. To conduct a comparative analysis of glycemic parameters obtained by flash glucose monitoring versus standard glycemic profile assessment using a glucometer in patients with diabetes mellitus and high cardiovascular comorbidity during inpatient treatment.

Materials and methods. A prospective study included 60 patients with DM who had not achieved glycemic targets and presented with exacerbation of cardiovascular comorbid diseases. Patients in the observation group received a flash glucose monitoring (FGM) system, while patients in the control group underwent 4–5 daily glucose measurements (glycemic profile using a laboratory analyzer). The assessment included glucose levels, time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability (GV). Comorbidity level was assessed using the CIRS scale. All patients were classified as having high cardiovascular risk.

Results. In the observation group, target glycemic levels were achieved on day 3 (day 6 in the control group, p<0.01). GV was 39.1±1.9% in the observation group vs 47.6±3.2% in the control group (p<0.01). Hospital stay duration was reduced by 42.85% to 4 days (7 days in the control group, p<0.01). In the hospital setting, the time to achieve glycemic targets did not depend on the comorbidity level. Among patients using FGM, no rehospitalizations due to failure to achieve glycemic control were recorded during the prospective follow-up period; GV remained at 11.6±2.2% (with target range maintained >50% of time in 87% of patients).

Conclusion. Flash glucose monitoring technology during inpatient treatment demonstrated comparable accuracy to laboratory analyzer data and significantly improved long-term prognosis.

Background. Patients with type 2 diabetes mellitus (T2DM) frequently present with atypical or non‑anginal manifestations of coronary artery disease (CAD), complicating clinical risk stratification. Current guidelines propose different approaches to pre‑test probability (PTP) assessment; however, their comparative performance in diabetic populations remains insufficiently explored.

Aim. To compare CAD PTP assessed by the Russian Society of Cardiology (RSC) 2024 and ESC2024 models in patients with T2DM and suspected CAD, and to evaluate their prognostic value.

Materials and methods. A total of 101 patients with T2DM and suspected CAD were included. PTP was assessed using the RSC2024 and ESC2024 models. Clinical presentation, cardiovascular risk factors, and rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI) were analyzed. Prognostic value was assessed using Cox regression, ROC analysis, and Kaplan–Meier survival curves.

Results. Non‑anginal and atypical symptoms predominated; typical angina was present in 17.8 % of patients. Most patients had ≥3 cardiovascular risk factors. PTP estimates differed significantly between the RSC2024 and ESC2024 models (p=0.001), with ESC2024 yielding lower PTP values and shifting patients toward lower‑risk categories. During a median follow‑up of 519 [357–701] days, CAG was performed in 50 patients and PCI in 30 patients. PTP assessed by the RSC2024 model was a significant predictor of revascularization (HR1.042; 95% CI 1.004–1.081; p=0.028). ROC analysis demonstrated limited discriminative ability (AUC0.62; 95% CI 0.47–0.78), with an optimal PTP cut‑off of 14%. Patients with PTP <14% had significantly higher event‑free survival (p<0.001).

Conclusions. In patients with T2DM and suspected CAD, the ESC2024 model yields lower estimated PTP compared with the RSC2024 model. The RSC2024 model demonstrates greater prognostic value for revascularization, supporting an individualized diagnostic approach.

This article is devoted to current approaches to non‑invasive ventilation (NIV) and methods of respiratory rehabilitation in patients with acute respiratory failure (ARF). Data from domestic and international studies over the past 10 years are systematized, covering the physiological basis of NIV, a comparative analysis of interfaces, as well as indications and limitations of the method. Issues of respiratory muscle dysfunction in ARF, methods for its assessment, and possibilities for restoring breathing function using respiratory trainers are considered. The review summarizes research findings demonstrating the potential for integrating NIV and respiratory trainers into the comprehensive management of patients with ARF. The prospects for further investigation of the effectiveness and safety of these approaches in various clinical settings are discussed.

Arterial hypotension and shock of unknown origin are common reasons for intensive care unit admissions and are characterized by significant pharmacoeconomic costs and high mortality. The effectiveness of treatment for patients with shock is determined by the timely and accurate identification of the underlying causes and the implementation of personalized therapy. Differential diagnosis of shock is often possible through the analysis of clinical, laboratory, and non-invasive instrumental data. Echocardiography is now an indispensable tool for urgent and routine assessment of the cardiovascular system, providing rapid information on the anatomy, physiology, and causes of cardiovascular failure. The use of high-quality ultrasonography methods, based solely on 2D visualization, significantly expands diagnostic capabilities. However, accurate diagnosis requires the use of more advanced, semi- quantitative or quantitative ultrasonography methods to identify the underlying mechanisms of shock pathogenesis, allowing the clinician to implement personalized treatment for this patient population.

Background. Severe community-acquired pneumonia remains one of the leading causes of intensive care unit admission and mortality. In a subset of patients, the course is complicated by sepsis and acute respiratory distress syndrome (ARDS). In such cases, adverse outcomes are often determined not only by pathogen eradication and parameters of respiratory support, but also by systemic inflammation, endothelial dysfunction, and injury to the alveolar–capillary barrier with increased vascular permeability.

Objective. To systematize evidence on barrier-stabilizing strategies of adjuvant organoprotective therapy in severe community-acquired pneumonia and pneumonia-associated ARDS, and to critically appraise the potential role of synthetic Leu-enkephalin analogues (dalargin) within this set of interventions.

Materials and methods. A narrative literature review was conducted with a systematized search of the PubMed/MEDLINE, Cochrane Library, eLIBRARY.ru, and Google Scholar databases covering the period from 2020 to 2026. Search terms reflected the clinical context (severe community- acquired pneumonia, acute respiratory distress syndrome), key pathogenetic targets (endothelial dysfunction, glycocalyx degradation, increased vascular permeability), and pharmacological interventions (dalargin, leucine-enkephalin analogues). Clinical guidelines, randomized controlled trials, observational studies, and review articles reporting data on barrier injury and adjuvant therapeutic strategies were considered eligible. A qualitative thematic synthesis was performed. A formal meta-analysis was not undertaken due to substantial heterogeneity of the available data.

Results. Systemic glucocorticoids occupy the most clearly defined place among adjuvant therapies; however, their effects depend on phenotype, disease severity, and the choice of endpoints. For most non-steroidal immunomodulators and interventions targeting coagulation and microcirculation, evidence is characterized by neutral results in mixed populations or signals largely confined to secondary outcomes, without a consistent effect on “hard” clinical endpoints. Dalargin is considered a candidate for barrier-oriented organoprotection based on experimental data and limited clinical signals that require confirmation in well-defined infectious phenotypes. Conclusion. Barrier stabilization represents a promising niche for adjuvant therapy in severe community-acquired pneumonia and ARDS.

Background. Ultrasound is the first-line method in the topical diagnosis of primary hyperparathyroidism (PHPT). However, its diagnostic capabilities in the context of diverse echostructure and variable locations of parathyroid glands (PTG) remain insufficiently studied. Optimization of the diagnostic algorithm requires further development and evaluation.

Objective. To determine the diagnostic and prognostic value of ultrasound in primary hyperparathyroidism, taking into account the diversity of echostructure and location of abnormal parathyroid glands.

Materials and methods. A prospective cohort study was conducted in 294 patients with laboratory-confirmed PHPT. All patients underwent preoperative ultrasound of the neck and upper mediastinum using expert-class equipment. In cases where PTG were not visualized, single- photon emission computed tomography (SPECT) was additionally performed. The diagnosis was confirmed by pathological examination of surgical specimens.

Results. Abnormal PTG were detected by ultrasound in 278 patients (94.6%). The sensitivity of the method was 94.72%, accuracy – 93.20%, positive predictive value – 98.29%, specificity – 16.67% (attributed to the study cohort with an already established diagnosis). The area under the ROC curve (AUC) was 0.760. Comprehensive examination revealed 303 abnormal PTG (solitary in 285 patients, double in 9 patients). False-negative results were primarily associated with ectopic location (retrotracheal, retroesophageal, mediastinal, intrathyroidal) and small adenoma size. False- positive findings were due to misinterpretation of thyroid nodules or lymph nodes as abnormal PTG, especially in the presence of concomitant nodular thyroid pathology (66.7% of patients).

Conclusion. Ultrasound has high sensitivity and positive predictive value, confirming its utility as the first-step method in the topical diagnosis of PHPT. Detailed analysis of ultrasound features (shape, margin, echogenicity, vascular pattern, presence of calcifications and cystic component) revealed no statistically significant correlation with the morphological substrate or clinical variants of the disease. When PTG are not visualized or ectopia is suspected, SPECT should be added to the diagnostic workup.