Galina V. Shavkuta

Aim . To identify the clinical and demographic profile, disease course, and management of patients with recurrent pericarditis (RP) based on data from the retrospective branch of the RUDRA registry, and to analyze specific patient subgroups. Material and methods . RUDRA (ClinicalTrials.gov: NCT06517966) is an international, multicenter, non-interventional real-world practice registry organized by the Eurasian Association of Internal Medicine, involving 20 centers across 14 regions of the Russian Federation and the Republic of Kazakhstan. The retrospective cohort included men and women aged 18 years and older with a verified diagnosis of RP established within the previous 10 years. Patient enrollment was conducted from September 30, 2024, to July 31, 2025. Statistical data analysis was performed using IBM SPSS Statistics 25. Results. The retrospective branch of the RUDRA registry included 120 patients. Idiopathic recurrent pericarditis (IRP) was verified in 33,3% (n=40), while RP of established etiology was identified in 66,7% (n=80). The median age was 63,0 [50,0;73,0] years; 55,0% were female. Patients with IRP were characterized by a significantly larger volume of pericardial effusion (386 [200;600] vs 200 [100;500] ml; p=0,008), a higher frequency of pericardial strands, clots, and adhesions (40,0% vs 11,4%; p=0,002), as well as higher rates of hospitalization (43,8% vs 9,1%; pConclusion . The retrospective branch of the RUDRA registry has provided the first systematized data on real-world clinical practice in the management of patients with RP in the Russian Federation and the Republic of Kazakhstan. IRP was characterized by a more severe clinical course, a higher social burden, and predominantly medication-induced remission. A significant gap between clinical guidelines and real-world practice was identified, specifically regarding the insufficient use of colchicine in RP of known etiology and the critically low availability of interleukin-1 inhibitors.

Atherosclerosis of extra- and intracranial arteries is the primary pathogenetic substrate for both acute and chronic forms of cerebral ischemia, which remains a leading cause of disability and high mortality on a global scale. This article analyzes data from systematic reviews, meta-analyses, original studies, and professional consensus statements published between 2015 and 2025. The authors examine leading risk factors for the disease and the diagnostic significance of biomarkers. We analyzed age-related, gender, socioeconomic, and racial characteristics, as well as cardiovascular risk in extra- and intracranial arterial atherosclerosis, with specific focus on the pathogenetic features of these lesions. The comparative diagnostic value of imaging techniques for detecting early manifestations of atherosclerosis is described. Priority directions in the prevention and treatment of cerebrovascular disorders are identified, which could significantly reduce morbidity and improve long-term prognosis and quality of life for patients.

Cardiac arrhythmias significantly specify morbidity and mortality, but viral factors are traditionally considered primarily through the lens of acute myocarditis. Meanwhile, persistent herpesvirus infections (Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and herpes simplex virus) can create an arrhythmogenic substrate without overt inflammatory myocardial injury. The review aim was to summarise epidemiological, clinical and genetic data on virus-associated arrhythmias with a focus on herpesviruses, non-myocarditic pathways of arrhythmogenesis and immune-response variability driven by the human leukocyte antigen (HLA) complex. We summarise studies in adults and children demonstrating associations of chronic and reactivated infections with supraventricular and ventricular arrhythmias, atrial fibrillation (AF), conduction disturbances and vascular complications. We discuss the roles of autonomic dysregulation, inflammation, endothelial dysfunction, microvascular ischaemia and genetic variants (HLA and non-HLA) that modify virus-associated cardiac risk and patient risk stratification.

The concept of extraesophageal symptoms secondary to GERD is complex and often controversial, leading to diagnostic and therapeutic challenges. Many researchers consider them to be a manifestation of an independent disease — laryngopharyngeal reflux disease (LPRD). The aim of the work is to provide a review of existing literature regarding the mechanisms, diagnostics and treatment of LPRD. Material and methods. A bibliographic research was conducted in the RSCI, PubMed, ScienceDirect databases. Results. Currently, there is no single diagnostic tool to determine unambiguously the relationship between typical symptoms of laryngopharyngeal reflux and gastroesophageal reflux disease (GERD). Determining the contribution of GERD to their development is based on the results of a comprehensive examination of the patient and his response to anti-reflux therapy. The peculiarities of the pathophysiological mechanisms of LPRD (a high percentage of non-acidic, mixed, as well as liquid and/or gas reflux, low resistance of the pharyngeal and upper respiratory tract mucosa to the damaging effect of refluxate) explain the need for treatment approaches that are different from those used for GERD. Lifestyle modification and anti-reflux diet give more predictable results in the treatment of LPRD than drug therapy. Prospects for increasing the effectiveness of drug treatment of diseases caused by regurgitation of gastric contents (LPRD, GERD) involve their phenotyping, as well as the development of interdisciplinary approach.

A duet of non-alcoholic fatty liver disease (NAFLD) / metabolically associated fatty liver disease (MAFLD) and hyperammonemia in patients with metabolic dysfunction is still insufficiently studied, and elevated ammonia levels in this patient population remain an underestimated pathogenetic factor in routine clinical practice. This article presents two clinical observation reports demonstrating the role of hyperammonemia in the clinical picture of NAFLD/MAFLD in female patients of different ages and metabolic status, as well as the efficacy of introduction of L-ornithine-L-aspartate (LOLA) in the combination therapy regimen. Observation report 1: A 65-year-old female patient with MAFLD, metabolic dysfunction (obesity, diabetes), laboratory-confirmed cytolysis, and verified hyperammonemia (ammonia 190 μmol/L). A 12-week LOLA treatment resulted in normalization of ammonia levels (to 56 μmol/L), regression of cytolysis syndromes, and improvement of inflammatory and metabolic parameters. Observation report 2: A 42-year-old female patient with NAFLD/MAFLD, type 2 diabetes, and clinical signs of minimal hepatic encephalopathy (the time to complete the number connection test was 52 seconds). The 3-month treatment with LOLA resulted in improvement of mental status (the time to complete the number connection test was 37 seconds) and normalization of cytolysis and glycemia indicators. Key conclusion: Hyperammonemia is a clinically significant but often underdiagnosed component of NAFLD/MAFLD, and elevated ammonia levels in this patient population remain an underestimated pathogenic factor in routine clinical practice. Its correction with LOLA improves laboratory, cognitive, and functional parameters even without mandatory measurement of ammonia in blood.

The authors present probable eosinophilic myocarditis in a patient with bronchial asthma and seasonal allergic rhinitis, sensitization to pollen allergens. Myocarditis debuted in 3 weeks after viral infection (cardialgia and shortness of breath). ECG revealed violation of repolarization in anterior and high lateral segments of the left ventricle with negative T waves in leads V1—V3 and smoothed T waves in leads V4—V6, I and aVL. In winter, pain syndrome increased after a long journey by bus. ECG revealed deeper negative T waves in leads V1—V3, new deep negative T wave in leads V4—V5. There was high serum IgE (125 IU/ml) and eosinophilia. Intramural accumulation and delayed elimination of contrast agent were revealed on delayed 2D MDE series. MRI verified local myocardial edema as an objective criterion of myocardial damage. This case demonstrates atypical course of eosinophilic myocarditis with unclear symptoms, severe ECG changes and no classic laboratory abnormalities.

Aim. To define the boundaries of professional responsibility of general practitioners (family physicians) and develop algorithms for their interaction with specialist physicians. Material and methods. Fifty individuals meeting the inclusion criteria, representing 13 Russian regions, were recruited as experts. Expert assessment cards for job functions were developed for 14 areas in which general practitioners (family physicians) practice. It included information on 252 different diseases. Results. It was found that general practitioners (family physicians) can independently manage patients in 9,9% of cases, monitor treatment prescribed by a specialist in 35,7% of cases, refer patients for followup care with a specialist in 40,5% of cases, and hospitalize patients in 13,9% of cases. With regard to internal medicine, the predominant job functions are independent patient management (21,6% of all cases) and monitoring of treatment prescribed by a specialist (52,7%). Other areas of professional activity are primarily related to monitoring treatment prescribed by a specialist or preliminary diagnostics. Conclusion. The obtained results should be taken into account when defining the professional competencies of the educational standard for general practice (family medicine) during next revision, improving educational programs. This should also form the basis for interaction algorithms between general practitioners (family doctors) and specialist physicians.

Purpose of the study. This publication considers the development of ventricular tachycardia paroxysm in a patient with chronic gastritis associated with Helicobacter pylori, erosive duodenitis. Materials and Methods. A paroxysm of less than 30 s. duration with the frequency of ventricular contractions maximum 169 per min was registered during ECG Holter monitoring at night. The electrocardiogram at rest, cardiac ultrasound and spiral computed coronary angiography showed no pathology. A probable trigger of ventricular tachycardia in a young patient without organic lesions of the cardiovascular system could be viscerocardial reflexes caused by pathology of the upper gastrointestinal tract. Results. Eradication of Helicobacter pylori and administration of proton pump inhibitors resulted in the elimination of ventricular tachycardia. Conclusion. The case serves to confirm that even chronic gastritis can have a proarrhythmogenic effect and emphasises the need for a comprehensive examination of patients with gastroenterological problems.

This paper rationales a planned study, the purpose of which is to define the boundaries of professional responsibility of general practitioners (family physicians), as well as to develop algorithms for in ter action between general practitioners (family physicians) and specialist physicians based on expert assessments to improve patient routing in primary care. The study has multicenter, cross- sectional de sign. The methodological basis was current regulatory documents governing professional activity and the list of diseases falling within the professional responsibility of general practitioners (family physicians), as well as expert assessments. Fifty specialists from 13 Russian regions will serve as experts as follows: faculty members from Russian universities training general practitioners (family doctors), district general practitioners (family doctors) of the Moscow Department of Health, chief freelance general practitioners (family doctors) of the Central Federal District of the Russian Federation and other federal districts, as well as physicians with at least 10 years of related experience. The study is structured around 14 independent sub-studies, corresponding to the medical specialties within which the general practitioners (family doctors) practice. Expert assessment cards for work functions were specially developed for each sub-study. A total of 252 diseases are planned to be analyzed. The study will in clude four phases, the last of which is scheduled to be completed in October 2026.

This review is based on analysis of information sources on the status and development of primary health care (PHC) globally and in selected countries, as well as international evidence-­based guidelines. The paper assesses the incidence of stroke, as well as its prevention and early diagnosis in young patients. A database of publications, regulatory documents, and online resources was used, using selected keywords and concepts related to PHC management. Priority was given to materials from the last decade related to stroke in young patients. The increasing incidence of stroke in young patients is a concerning public health issue. The mean age of stroke in young people is decreasing (from 18 years), necessitating effective methods for the prevention, detection, and treatment of this disease. The steady increase in ischemic stroke rates, disability-­adjusted life years (DALYs), and disease prevalence requires targeted prevention programs. This will reduce the medical and social burden, reduce the pressure on the healthcare system and improve public health outcomes.