Relevance. Non-invasive studies allow for effective assessment of cardiovascular health, stress levels, and overall physiological resilience. Heart rate variability, defined as fluctuations in the time intervals between successive heartbeats, allows for the study of autonomic nervous system activity. It reflects the dynamic balance between the sympathetic and parasympathetic branches of the autonomic nervous system, providing information that is a valuable biomarker in various fields, including cardiology, sports science, psychology, and occupational health.

Aim. To analyze the effective use of heart rate variability and summarize the obtained information to better inform physicians.

Materials and methods. A literature review was conducted using well-known databases such as the Russian Science Citation Index and PudMed covering a 10-year period.

Results. Heart rate variability is the variation in the time intervals between successive heartbeats and is a noninvasive indicator of autonomic nervous system activity. It reflects the dynamic balance between the sympathetic and parasympathetic branches of the autonomic nervous system, providing information about cardiovascular health, stress levels, and overall physiological resilience. Heart rate variability has become a valuable biomarker in various fields, including cardiology, sports science, psychology, and occupational health. High heart rate variability is generally associated with good health and adaptability, while low heart rate variability may indicate stress, fatigue, or pathological conditions.

Conclusion: Advances in wearable technologies and data analysis have facilitated real-time heart rate variability monitoring, opening up broader possibilities for clinical and personal healthcare applications. This article reviews the physiological basis of heart rate variability, common measurement methods, clinical significance, and current trends in heart rate variability research and application.

Background. The presence of chronic heart failure in patients undergoing chemotherapy for cancer is a significant aggravating prognostic factor.

Objective: To analyze current literature on the risk of cardiotoxic effects during cancer chemotherapy, recommendations for their prevention in patients with chronic heart failure, and new opportunities to reduce the risk of developing and progressing cardiotoxic effects of chemotherapy.

Materials and Methods. A non-systematic review of domestic and international literature on the topic under study was conducted using a continuous subset of the Medical Literature Analysis and Retrieval System Online, Excerpta Medica Data Base, PubMed, Russian Science Citation Index, and eLibrary databases. The following keywords were used: arterial hypertension, ischemic heart disease, chronic heart failure, antitumor therapy, cardiotoxicity, prevention, and combinations thereof. A total of 105 sources were analyzed, 42 of which were used in the review. The search period spanned 10 years, from 2014 to 2024. The review also included sources with publication dates earlier than 2000 and 2004, as they provide valuable information on this topic.

Results. The risk of cardiovascular complications significantly increases in patients undergoing cancer chemotherapy and those with chronic heart failure. Prevention of complications involves a thorough assessment of the patient's profile, selection of anticancer drug, and dosage. A mandatory condition for the treatment of such patients is monitoring standard heart failure therapy (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins). A new approach to preventing cardiotoxic effects in patients with chronic heart failure during anticancer therapy may be the use of a combination of sacubitril/valsartan and a selective, reversible inhibitor of sodium-glucose cotransporter type 2.

Conclusion. The widespread use of chemotherapy in the treatment of cancer requires a thorough, comprehensive approach to diagnostics to prevent acute cardiovascular events in patients with cardiovascular pathology, particularly heart failure. According to studies, the incidence of cardiotoxic effects remains high, likely due to the insufficient efficacy of existing cardiovascular prophylactic agents during chemotherapy. Of interest are studies examining the outcomes of chronic heart failure in patients receiving sacubitril/valsartan during breast cancer chemotherapy. Evaluating the effects of reversible sodium-glucose cotransporter-2 inhibitors is an important area of ​​research. Further research and the implementation of these findings in clinical practice are needed.

Introduction. Sergei Ivanovich Spasokukotsky occupies a significant and unique place in the history of Soviet surgery. After becoming an academician, he embarked on a challenging, yet rewarding and fruitful career as a zemstvo physician. This experience significantly influenced his research and teaching.

Aim. To study the scientific work of S. I. Spasokukotsky as one of the leaders of Soviet and Russian surgery in the first half of the last century.

Materials and methods. A search of available literary sources was conducted in scientific databases from 1928 to September 2025, without restrictions on the level of evidence or publication status. Both foreign and Russian articles were analyzed.

Results. Sergei Ivanovich holds a place of honor in the history of Russian surgery as the founder of an influential surgical school. This school is distinguished by its uniqueness, profound approach, and boldness in addressing both general and specific issues of surgical pathology. A hallmark of the school is fearless research in all areas of surgery, including scientific research and solving complex problems in practical surgery. The work of Sergei Ivanovich and his students always demonstrated an inextricable link between theory and practice. A rich and varied practical experience inspired and enriched the high-quality scientific work of Sergei Ivanovich's school.

Conclusion. The success of Sergei Ivanovich and his students was based on a high level of discipline and organization. He tirelessly and persistently trained his students in this spirit. This is why surgeons who graduated from Sergei Ivanovich's school entered life with extensive practical and scientific training, and in the vast majority of cases, Sergei Ivanovich could rightfully be proud of his students.

Background. Atrial infarction is a common but often undiagnosed disease. The lack of clear and reliable diagnostic criteria, as well as the lack of awareness among doctors are the reasons for this state of affairs. The right diagnosis with detection of an infarct-related atrial artery and restoration of blood flow will prevent complications and improve the prognosis

Aim. To analyze the data of literature on the etiology of atrial infarction, diagnostic possibilities and the role of diagnostic methods, including electrocardiography, transesophageal echocardiography, and coronary angiography.

Results. Atrial infarction occurs due to atherosclerotic lesions of the atrial arteries. It is also described in pulmonary hypertension, atrial embolism, complications of percutaneous coronary interventions or ablation of the left atrium. Atrial infarction can be combined with inferior infarction of the left ventricle and with infarction of the right ventricle, which is associated with the joint blood supply. Isolated atrial infarction is possible, more often the right one. Diagnosis of atrial infarction is difficult. Electrocardiographic criteria for atrial infarction do not have sufficient sensitivity and specificity. Transesophageal echocardiography makes it possible to assess atrial wall akinesia and atrial thrombus. It is important to assess atrial branches with coronary angiography. The most common complications are supraventricular arrhythmias, bradycardia, thromboembolic complications, and atrial rupture with tamponade. The main treatment method is reperfusion therapy.

Conclusion. Diagnosis of atrial infarction is difficult. To make a diagnosis it is important to search for signs of atrial infarction using a comprehensive examination, including coronary angiography.

Relevance. Hypertension and pre-hypertension are increasingly prevalent in India and contribute significantly to cardiovascular morbidity and mortality. Physical inactivity is a major modifiable risk factor influencing blood pressure regulation, particularly among young adults and healthcare populations.

Aim. To assess the prevalence of normotension, pre-hypertension, and hypertension and to evaluate the correlation between blood pressure and physical activity among adults aged 18–60 years at Rajasthan University of Health Sciences, College of Medical Sciences, Jaipur.

Materials and methods.  A cross-sectional observational study was conducted among 700 participants. Blood pressure was measured using a standard mercury sphygmomanometer. Physical activity was assessed using the World Health Organization Global Physical Activity Questionnaire. Participants were categorized into inactive, moderately active, and vigorously active groups. Statistical analysis was performed using SPSS version 16.0.

Results. The prevalence of normotension, pre-hypertension, and hypertension was 65 %, 34.85 %, and 0.02 %, respectively. Nearly half of the participants (46.2 %) were physically inactive. Pre-hypertension was significantly more common among physically inactive individuals. Increased levels of physical activity were associated with lower mean systolic and diastolic blood pressure values.

Conclusion. Physical inactivity is strongly associated with elevated blood pressure. Early lifestyle modification with emphasis on regular physical activity can prevent progression from pre-hypertension to hypertension and reduce future cardiovascular risk.

Background. N-acetyltransferase 2 is an enzyme involved in the detoxification of xenobiotics. The N-acetyltransferase 2 gene is polymorphic and causes variants of the enzyme structure, determining susceptibility to neoplasia, metabolic changes and diseases.

The aim. To study the features of the N-acetyltransferase 2 gene polymorphism in blood samples of patients operated on for euthyroid and toxic goiter, and its role in the development of complications of the disease and surgery.

Materials and methods. The study included patients living in the Irkutsk region who, during 2021–2023, underwent thyroidectomy for euthyroid and toxic goiter: 11 patients with diffuse toxic goiter, 12 with multinodular toxic goiter and 18 with multinodular euthyroid goiter. The control group is volunteers without thyroid pathology. Single nucleotide polymorphisms in the structural region of the N-acetyltransferase 2 gene (С282Т (rs1041983), T341C (rs1801280), С481Т (rs1799929), G590A (rs1799930), А803G (rs1208) и G857A (rs1799931)) were studied by the polymerase chain reaction method.

Results. The frequency of detection of the unchanged nucleotide sequence at position C282T is reduced (up to 45 % in diffuse toxic goiter and 50 % in multinodular toxic goiter) (p <0.0005). The frequency of detection of the T341C polymorphism in the homozygous state in multinodular toxic goiter was 33 % and was not detected in diffuse toxic goiter and in the control (p <0.0005). The frequency of neutropenia development against the background of thiamazole intake was 9 % and did not depend on the C282T polymorphism (p>0.95). In diffuse toxic goiter, a moderate negative correlation was noted between C282T and C481T, T341C (p <0.0005). At the same time, in multinodular toxic goiter, a positive relationship was found between C282T and G590A (p <0.0005).  

Conclusion. The study demonstrates the features of the N-acetyltransferase 2 gene polymorphism in blood samples of patients operated on for euthyroid and toxic goiter

Relevance. According to polymorphisms in the N-acetyltransferase 2 gene, two main acetylation types are distinguished: rapid and slow. The frequency of adverse drug reactions varies depending on the rate of metabolism. In particular, the incidence of neuro- and hepatotoxic effects of isoniazid is associated with genotype, with slow acetylators having a higher risk of adverse reactions.

Aim: To design and compare a reagent kit developed by the authors for detecting polymorphisms in the human N-acetyltransferase 2 gene using real-time Polymerase chain reaction, aimed at determining the type of xenobiotic acetylation in humans.

Materials and Methods. Based on Eurasian Patent No. 042541, a laboratory prototype of a medical diagnostic reagent kit was developed. The kit included a real-time Polymerase chain reaction mixture, forward and reverse primers specific to the N-acetyltransferase 2 gene, and probes for detecting the rs1495741 polymorphism labeled with FAM and R6G fluorophores at the 5'-end and BHQ2 RTQ1 quenchers with closed nucleotides. Positive controls were constructed as circular plasmids pJet1.2/blunt containing the N-acetyltransferase 2 gene with rs1495741A and rs1495741G alleles. Using the developed kit, 37 Deoxyribonucleic acid samples obtained from healthy individuals were analyzed and compared with the reference method. Analytical sensitivity, diagnostic sensitivity, diagnostic specificity, precision, and reproducibility were assessed to validate the method.

Results. Validation of the reagent kit for real-time Polymerase chain reaction determination of the xenobiotic acetylation type in humans was performed. The analytical sensitivity of the test, determined by titration of the positive control, was 0.1 ng/µL Deoxyribonucleic acid; diagnostic sensitivity was 0.94, and diagnostic specificity was 1. Other validation parameters met the established acceptability criteria, confirming adequate intra-laboratory precision and inter-laboratory reproducibility.

Conclusion. Compared with the reference method, the proposed approach is less labor-intensive, time-saving, and more cost-effective, while maintaining comparable sensitivity and specificity. Based on the validation results, the laboratory prototype of the real-time Polymerase chain reaction kit for detecting the rs1495741 polymorphic site in the human N-acetyltransferase 2 gene associated with xenobiotic acetylation can be recommended for use in human genetic studies.

Background. The placement of intrauterine contraceptive devices rarely gives rise to complications.  However, a failure to observe the procedure technique, lack of control, untimely diagnosis of possible device migration can create life-threatening conditions, including the long-term period  after the manipulation.

The aim. To report the case of fistulas of bladder and small intestine caused by perforation with intrauterine contraceptive device placed 17 years ago, and to discuss management tactics.

Case presentation. A 39-year-old woman presented with an external purulent fistula after opening an abdominal abscess caused by dislocation of the intrauterine device 17 years after its placement. The intrauterine device produced pressure ulcers to the cervical wall and to the neck of the bladder, then migrated to the pelvis, where fixed the ileum to the bladder wall with the subsequent abscess formation. After opening the abscess, a purulent fistula of the abdominal wall formed. Multispiral computed tomography detected foreign body. It caused perforation of the ileum wall, abscess development, and formation of a tubular intestinal fistula. The contraceptive device was removed, the ileum was resected and the defect in the bladder wall was sutured.

Conclusion. Dislocation of the intrauterine device into the bladder with its chronic inflammation over the period of 13 years resulted in the development of bladder and small intestine fistulas, abdominal abscess, which required surgical intervention with extensible approach. Awareness of patients and doctors about possible complications of this type of contraception allows them to prevent and timely diagnose hazard aftereffects.  

Relevance. There are cases when a rare deformity does not fit into any known algorithm and requires a personalized approach, setting the clinician the non-trivial task of finding a non-standard solution. Such cases include atypical idiopathic deformity of the toes, which is manifested by the varus-hammer-like position of the first, second, third fingers and the claw-like shape of the fourth finger.

Case report. The article presents a clinical case of successful surgical treatment of a patient with an atypical combination of toes deformities, manifested by the varus-hammer-like position of the first, second, third fingers and the claw-like shape of the fourth finger. To correct each type of toe deformity, modern surgical methods were used, including original ones, including corrective osteotomies of the metatarsal bones, phalanges of the fingers, arthrodesis of the joints. The aesthetic and functional result obtained demonstrated the high effectiveness of the treatment.

Conclusion. The use and correct choice of modern surgical techniques makes it possible to achieve good results, even in non-standard clinical cases.

Relevance. This lecture is dedicated to the kidneys, which are vital for our life. Normal kidney function ensures the proper functioning of all organs and systems in the body because kidneys are essential for maintaining homeostasis. The excretory organs detoxify the body's internal environment, maintain acid-base balance, and regulate blood pressure, erythropoiesis, and water and electrolyte balance. Disruption of any aspect of this process underlies the pathogenesis of many different diseases.

Clinical syndromes underlying renal pathology can be divided into minor and major. This lecture will focus on minor renal syndromes, including urinary syndrome and arterial hypertension. These syndromes are of great practical importance because they are among the first to appear in the development of renal pathology and are easily detected by clinical and laboratory methods.

Aim. To review the current view on the etiology and pathogenesis of minor renal syndromes and their significance in general therapeutic practice.

Materials and methods. Domestic and foreign literature sources for the last 15 years were analyzed

Results. The etiology of urinary tract damage is multifactorial. It includes infections, immune mechanisms, toxic, ischemic, and other factors. Renal involvement in the pathological process is often reflected in urine analysis by the presence of protein, casts, various leukocyte populations, erythrocytes, and hemoglobin, as well as changes in the quantitative parameters of diuresis. Clinical manifestations sometimes are absent.

In most cases, these changes are pathogenetically divided into extrarenal (pre- and postrenal) and renal. Determining the level of damage leading to urinary changes is necessary for selecting a proper and specific treatment. For example, proteinuria develops with a wide range of physiological and pathological changes in the body, and its intensity can indirectly indicate the location of the damage. In particular, microalbuminuria is characteristic of cardiovascular diseases and diabetes mellitus, while non-selective massive proteinuria is a sign of severe glomerular damage. Considering the above-mentioned features of renal pathology, a detailed study of sediment and daily urine volume is much important in practical medicine.

Conclusion. Almost all physicians, regardless of specialty, encounter changes in their patients' urine tests. It makes knowledge of normal and abnormal urine test results essential. Timely diagnostic of kidney disease is crucial for the effectiveness of therapy and the prognosis for recovery and patient survival.