Study Objective: To study the possibilities of correcting modifiable cardiovascular risk factors (FCR) and patient satisfaction according to the results of a 12-month program of telemedicine cardiorehabilitation (TMCR).
Study Design: Prospective comparative study.
Materials and Methods. The TMCR program was completed by 28 patients (of which 85.7% were men; age — 55.2 ± 10.7 years) with ischemic heart disease and/or arterial hypertension (AH) of the 1st–3rd degree, without cognitive dysfunction and contraindications to rehabilitation. The control group consisted of 30 patients (of which 80% were men; age 64.7 ± 6.9 years) who were under traditional observation. TMCR included office and remote consultations, mobile monitoring, the use of a mobile application and the Patient's Diary. The dynamics of modifiable FCR (physical activity, hypertension, smoking, obesity, dyslipidemia, diabetes mellitus) and satisfaction of patients with TMCR were assessed.
Study Results. After completion of TMCR, there was a decrease in systolic blood pressure (SBP) from 144 ± 15 to 130 ± 16 mm Hg (p = 0.02), diastolic blood pressure (DBP) — from 83.6 ± 11.2 to 73.3 ± 11.3 mm Hg (p = 0.03), total cholesterol level from 5.3 ± 1.3 mmol/l to 4.0 ± 1.0 mmol/l (p = 0.02), low-density lipoprotein cholesterol — from 2, 77 ± 0.9 to 1.9 ± 0.9 mmol/l (p = 0.04), triglycerides — from 1.61 ± 0.28 to 1.33 ± 0.61 mmol/l (p = 0,01) with high patient satisfaction with telemedicine care (20.9 ± 11.2 points).
Conclusion. High user readiness and patient satisfaction with telemedicine care are important factors in the practical implementation of modern CR technologies.

Objective of the Review: To consider the pathogenetic relationship of COVID-19 and chronic heart failure, the concept of “postcovid syndrome”, the peculiarities of management of this group of patients.
Key points. Chronic heart failure is a predictor of an unfavorable outcome in patients with COVID-19. Angiotensin converting enzyme 2 is involved in the penetration of viral particles into the cell. Direct viral damage to cardiomyocytes is not excluded, cardiotoxic effects of antiviral therapy are possible. The consequences of COVID-19 are manifested by arrhythmia, myocarditis and pericarditis, cardiomyopathy. Corticosteroids can lead to decompensation of heart failure. The use of renin-angiotensin-aldosterone system inhibitors and β-blockers is associated with lower mortality.
Conclusion. Chronic heart failure in combination with postcovid syndrome requires carefully developed patient management tactics and rehabilitation measures.

Objective of the Review: Help the doctor in a conversation with the patient to additionally motivate him to follow the recommendations for secondary prevention in the period after myocardial revascularization.
Key points. The article discusses the main risk factors that contribute to the progression of cardiovascular diseases (overweight and obesity, smoking, physical inactivity, depression and anxiety, dyslipidemia, diabetes mellitus, arterial hypertension), as well as various methods of secondary prevention after myocardial revascularization, based on modern data of evidence-based medicine: weight loss, regular physical training, psychopharmacotherapy, high adherence to drug therapy.
Conclusion. Conducting secondary prevention measures is extremely important for patients after myocardial revascularization, since the progression of coronary artery atherosclerosis continues after surgery. Therefore, in the postoperative period, the likelihood of developing cardiovascular events, in particular, early periprocedural myocardial infarction, stent thrombosis, and late restenosis, remains. Optimal drug and non-drug preventive measures improve the quality of life and improve the prognosis in this category of patients.

Objective of the Paper: To demonstrate a clinical case of a severe course of the novel coronavirus infection with the development of cardiovascular complications against the background of concomitant comorbid diseases.
Key points. A case of a novel coronavirus infection is presented with a description of the clinical course and the results of laboratory and instrumental examination. In the clinical picture, in addition to massive damage of the lung tissue, according to computed tomography, firsttime ischemic stroke, atrial fibrillation, and type 2 myocardial infarction were observed, which occurred against the background of obesity, type 2 diabetes mellitus and autoimmune thyroiditis.
Conclusion. The polymorphism of the clinical picture and the various variants of manifestation of a novel coronavirus infection, taking in some cases a polysystemic character, require doctors to diagnose the disease in a timely manner and identify its potential complications at an early stage, developing in the acute period, especially in the older age group.

Objective of the Review: Analysis of the 2022 American College of Gastroenterology clinical guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD).
Key points. Empiric proton pump inhibitors (PPIs), symptom analysis, esophagogastroduodenoscopy, pH-impedancemetry, and highresolution manometry are important in the diagnosis of GERD. The main therapies for typical GERD syndromes are dietary modification, weight loss, and PPIs. In patients with non-erosive reflux disease, once a response to treatment has been achieved, PPIs may be discontinued or switched to on-demand PPI therapy. In patients with stage C and D esophagitis, long-term maintenance treatment with a PPI is appropriate.
Conclusion. The recommendations of the American College of Gastroenterology contain a number of important provisions that will be useful to practitioners. However, the clinical and epidemiological situation in Russia is very different from that in Western countries, and this must be taken into account when determining the tactics of managing patients with GERD.

Objective of the Review: To analyze current data on the diagnosis and treatment of refractory gastroesophageal reflux disease (GERD).
Key points. Refractory GERD is diagnosed when there is insufficient response to proton pump inhibitors (PPIs) twice daily for 8 weeks with the presence of pathological gastroesophageal reflux. Possible mechanisms underlying PPI-refractory symptoms characteristic of GERD include persistence of pathological reflux, esophageal hypersensitivity to reflux, association of symptoms with other diseases, and functional nature of symptoms. To diagnose refractory GERD, a thorough analysis of symptoms, esophagogastroscopy with morphological examination, pH-impedancemetry and esophageal manometry are performed. Treatment includes dietary and lifestyle modifications to reduce body weight in obese patients, optimization of PPI prescribing, use of other drugs, and, if indicated, surgery.
Conclusion. Diagnosing the reasons for the decrease in the effectiveness of PPIs in patients with GERD is a complex process that requires the use of modern endoscopic methods with the performance of a morphological study of the esophagus, pH-impedance testing and highresolution manometry to determine the nature of reflux, the relationship of reflux with symptoms of GERD and the differential diagnosis of various GERD syndromes. The choice of therapy for patients with refractory GERD is determined by the results of the examination and the final diagnosis.

Objective of the Paper: To present a clinical observation of a spontaneous rupture of the esophagus (Boerhaave's syndrome).
Key points. A feature of this observation was the patient's admission to the clinic in a disturbance of consciousness, which did not allow to identify the classic triad of signs of this pathological condition and make a diagnosis during the patient's life. The patient had no history of diseases of the esophagus, it is not known whether she abused alcohol. Fibrogastroduodenoscopy did not show reliable signs of rupture of the esophagus. The absence of clear clinical symptoms and a detailed history led to the fact that fluoroscopy of the esophagus with its contrasting barium suspension, which provides the most informative evidence of Boerhaave's syndrome, was not prescribed.
Conclusion. The authors urge physicians to include Boerhaave's syndromein the differential diagnosis in patients who are admitted with a dominant clinic of impaired consciousness in the absence of obvious laboratory instrumental changes.

Objective of the Paper: To analyze the development and course of gastric MALT-lymphoma in a patient with chronic gastritis associated with Helicobacter pylori.
Key points. Regression of gastric MALT-lymphoma, diagnosed in a 68-year-old patient at stage IE2, was achieved by a combination of 6 courses of immunochemotherapy according to the R-B protocol (rituximab and bendamustine) and H. pylori eradication.
Conclusion. Clinical observation demonstrates the etiological relationship between gastric MALT-lymphoma and the H. pylori infection in the upper digestive tract, as well as the positive effect of immunochemotherapy and persistent eradication therapy, which contributed to the regression of gastric MALT-lymphoma itself and affected intra-abdominal lymph nodes.

Study Objective: To assess the efficacy and safety of the use of leflunomide (LF) in chronic present and/or refractory sarcoidosis.
Study Design: Retrospective observational non-interventional analysis.
Materials and Methods. We studied the use of LF (20 mg daily) in 15 out of 1470 (1.0%) patients included into the State Sarcoidosis Clinical Database. The group included 11 female and 4 male patients aged 30 to 60 years old. 2 patients had X-ray stage I disease, 11 patients had stage II, 1 patient had stage III, and 1 patient had stage IV. All patients had histologically-proven diagnosis. We assessed the clinical condition of the patients as well as laboratory and functional data. We used SPSS-18 for statistical processing. Study Results. Stable and improved condition on a visual analogue scale was noted in 93.3% of patients. As for the forced vital respiratory capacity, a positive response was 80.0% (improvement in one out of four patient); on the ray pattern, the improvement was 934% (improvement in 66.7% of patients). Good LF tolerability was recorded in 6 patients, 7 patients reported adverse reactions which did not result in treatment discontinuation; and 2 patients discontinued the therapy in 3 months due to sacred fire which was successfully treated with antibiotics (n = 1), nausea, vomiting, and diarrhoea (n = 1).
Conclusion. According to the results, LF can be used as a second or third line of therapy in chronic and/or refractory sarcoidosis.

Objective of the Paper: To demonstrate a rare variant of primary hyperparathyroidism in a patient with mediastinal ectopic parathyroid adenoma and polyossal fibrocystic osteodystrophy using a clinical example.
Key points. Fibrocystic osteodystrophy is a specific manifestation of primary hyperparathyroidism, which in modern conditions belongs to the casuistically rare. Ectopia of the parathyroid gland into the mediastinum also refers to rare variants of the location of this organ. Our patient's attention is drawn to the poor clinical picture with the rapid development of bone changes.
Conclusion. The variety of clinical manifestations of primary hyperparathyroidism, low awareness and alertness of doctors of related specialties in relation to this disease leads to an increase in the time of diagnostic search, the formation of incorrect diagnostic and therapeutic concepts. Determination of plasma calcium level is sufficient, in most cases, to exclude or confirm the diagnosis of primary hyperparathyroidism.

Objective of the Paper: To assess the need for a urodynamic study in a patient with a spinal injury in the early recovery period.
Key points. Patient N, 16 years old, was admitted to the department of medical rehabilitation with an injury of the cervical spine, fracture of the body of C4-C5 vertebrae, compression with displacement into the spinal canal, fracture-dislocation, incomplete rupture of the spinal cord at the level of C4, C5, below are the signs cystic-atrophic changes to the level of C7. According to ultrasound data: polycystic kidney disease. The patient was examined by a neuro-urologist, was assigned to perform complete blood count, urine test, biochemical blood test, ultrasound of the kidneys and bladder before and after emptying, bacteriological urine analysis, complex urodynamic study (CUDS). According to the results of the study, the diagnosis was made: Neurogenic bladder. Detrusor asensory overactivity. Detrusor-sphincter dyssynergia. Ishuriya paradox. Polycystic kidney disease. Autonomous dysreflexia. The patient was prescribed M-anticholinergic and α1-adrenergic blocker, as well as intermittent catheterization 6 times a day. After 2 months, in order to assess urodynamics, a second consultation with a neuro-urologist and a CUDS were carried out. Against the background of the therapy, there is a positive trend, dry gaps have increased.
Conclusion. Correction of a neurogenic bladder in patients with spinal cord injury is an integral part of the rehabilitation process. A multidisciplinary approach with the involvement of a urologist improves the quality of patient rehabilitation.

Objective of the Paper: To demonstrate the possibility of developing late-onset hypoimmunoglobulinemia after a course of immunosuppressive therapy.
Key points. A clinical observation is presented when a selective immunoglobulin A deficiency gradually developed in a patient with Sjögren's disease and MALT-lymphoma, who received rituximab for several years. It was associated with increased frequency of acute respiratory infections. The molecular mechanisms of secondary antibody deficiencies followed by immunisupressive therapy are virtually unknown and are likely to be heterogenous. It is necessary to carry out a differential diagnosis with primary immunodeficiencies.
Conclusion. This clinical observation confirms that when choosing rituximab or other anti-B-cell drugs as basic therapy, one should be aware of the possible development of hypoimmunoglobulinemia both during treatment and in the long-term period. Before starting treatment with rituximab, one must determine the initial levels of serum immunoglobulins to assess the risk of infectious complications and identify primary immunodeficiencies and monitor them even after discontinuation of the drug, particularly in patients with infections.