It is well known that by analyzing data from real clinical practice, it is possible to study current issues in the health and social care systems, generalize the personal experiences of patients, and consider the impact of medical technologies on various drug outcomes, from clinical to socio-economic.

The purpose of the work is to study the features of professional development among internists and surgeons of general and specialized fields. Research materials and methods. The research was carried out within the framework of a comprehensive topic of the Department of Occupational Diseases and Clinical Pharmacology named after Professor V.V. Kosarev, Honored Scientist of the Russian Federation, Samara State Medical University, «Problems of polymorbidity, diagnosis, prognosis and prevention of occupational and production-related diseases in workers with isolated combined effects of factors of the industrial environment and the labor process» (registration number 124053000016-4), registration date 30.05.2024). Patient consent. Each participant in the study gave informed voluntary written consent to participate in the study and publish personal medical information in an impersonal form. The study included: group 1 — gastroenterologists (n=52 people); group 2 — cardiologists (n=58 people); group 3 — oncologists of therapeutic (TP) profile (n=48 people); group 4 — doctors of general surgery (HR) (n=71 people); group 5 — surgeons of the cardiovascular profile (n=30 people); group 6 — oncologists of the surgical (XP) profile (n=65 people); control group 7 — workers of engineering, technical and economic profiles, not related to the profile of activity-people with jobs in medical organizations (healthy) (n=75 people). The assessment of the level of professional burnout among medical workers was carried out using the MBI methodology developed by K. Maslach, S. Jackson, and adapted by N. E. Vodopyanova. The statistical analysis was performed using the R Studio programming language and environment (R v.4.4.1, RStudio 2024.09.1+394). Descriptive statistics for continuous data were calculated as the mean, 95% confidence intervals; for nonparametric data, the median, 25% and 75% quartiles, and the interquartile range. Although the data did not correspond to a normal distribution, the groups were larger than 30 observations, which, according to the central limit theorem, allows us to use the mean and 95% confidence intervals to describe the variables. The x2 criterion was used to compare the percentages. When evaluating differences in nonparametric data groups, the Mann- Whitney criteria were used for two comparison groups, and the Kraskel-Wallis criteria for more than 2 groups. Results. The professional activity of doctors of the TR and XP profile is associated with the effects of chronic occupational stress, leading to the development of professional burnout. Limitations of the study. The study has regional (Samara region) and professional (in terms of the detailed working conditions in the comparison groups studied) limitations. Conclusion. Thus, the data obtained indicate the need to use specialized rehabilitation measures for physicians using relaxation techniques, art therapy, as well as professional adaptation programs when identifying risk factors for increasing the level of occupational burnout among medical workers providing medical care in hospitals of therapeutic, general surgical, and specialized profiles.; physiotherapy methods, such as electrosleep and reflexotherapy, if possible, sanatorium-resort treatment in sanatoriums, local health resorts, etc. with visits to psychotherapy rooms, as well as psychopharmacological drugs.

Introduction. Obstructive sleep apnea (OSA) and metabolic syndrome (MS) are independent risk factors for cardiovascular diseases, including heart rhythm disturbances. Hypersympathicotonia against the background of apnea often provokes tachysystolic arrhythmias, much less often atrioventricular conduction disturbances. The incidence of bradycardia at night in patients with a combination of OSA and MS has not been studied. Aim of the study. To study the incidence of nocturnal bradycardia in patients with a combination of obstructive sleep apnea and metabolic syndrome. Materials and methods. A retrospective analysis of 288 medical records of patients hospitalized in a therapeutic clinic who underwent cardiorespiratory monitoring given the clinical suspicion of OSA was performed. MS was established according to the criteria of the International Diabetes Federation (IDF, 2005). The presence of nocturnal bradycardia was verified by recording an average heart rate (HR) at night of less than 60 beats per minute. Results. According to the retrospective analysis, MS was detected in 264/288 (91,7%) patients, and OSA was diagnosed in 176/288 (61,1%) patients. The incidence of a combination of sleep-disordered breathing and MS in the study cohort was 52,8% (152/288). The study groups were comparable in terms of the range of drugs they took that affected HR and did not receive respiratory therapy at the time of cardiorespiratory monitoring. Therefore, these factors could not affect the incidence of bradycardia in the study cohort. Among patients with OSA combined with MS, nocturnal bradycardia occurred in 41,4% of patients, while among patients with sleep-disordered breathing without MS, the incidence of nocturnal bradycardia was 19,2%, and in patients with MS without OSA — 29,5%. It was found that in patients with MS and OSA, bradycardia at night occurred more often than in patients with MS without OSA (p=0,046), and more often than in patients with sleep-disordered breathing without MS (p=0,032). The probability of nocturnal bradycardia in patients with a combination of MS and OSA is 3 times higher than in patients with OSA without MS (χ2=4,642, OR=2,97, 95% CI 1,06–8,31, p=0,032). At the same time, the frequency of bradycardia in patients with MS without OSA and in patients with sleep-disordered breathing without MS did not differ (p=0,293). Conclusion. The incidence of nocturnal bradycardia in patients with a combination of obstructive sleep apnea and metabolic syndrome is higher than in patients with sleep-disordered breathing without metabolic syndrome, and higher than in patients with metabolic syndrome without sleep apnea. Early prevention and timely treatment of such comorbid conditions as obesity and obstructive sleep apnea will reduce the risk of developing nocturnal rhythm and conduction disorders in patients.

Introduction. Evaluation of clinical data, functional characteristics and immunopathogenesis of occupational chronic obstructive pulmonary disease (OCPD) in its isolated and comorbid course opens up new possibilities in assessing the development, predicting the course features and a personalized approach to pharmacotherapy of OCPD, as well as in developing an individual strategy for its primary and secondary prevention. The aim of the study was to determine the clinical and functional characteristics and immunological markers of the risk of developing COPD in its isolated course and in combination with arterial hypertension (AH). Materials and methods. The study involved 235 patients: Group 1 (n=60) (control) — healthy volunteers; Group 2 (n=35) — COPD of the first degree of severity; Group 3 (n=50) — COPD of the second degree of severity; Group 4 (n=40) — a combination of COPD of the second degree of severity and (AH); Group 5 (n=50) — isolated course of AH. The function of external respiration was assessed using a computer spirograph «Care Fusion» by MicroLab UK (Great Britain). Determination of the levels of cytokines IL-4, IL-6, IL-8, IL-10, IL-17, MCP-1, FGF 2, TGF-b in the blood serum was carried out by the method of solid-phase enzyme immunoassay using kits and reagents (OOO «Proteinovy Kontur», «Vektor-Best», «Diateks-E», «DIA-plus», «Pharmacia diagnostika»). To study the content of vascular endothelial growth factor (VEGF) in the blood serum, the method of solid-phase enzyme immunoassay of the «sandwich» type was used using a reagent kit from the company «eBioscience». Calculation of the optical density results was performed using a multichannel spectrophotometer «Dynatech MR 5000» (USA), wavelength — 450 nanometers. Spirometry and immunological data of the groups were assessed using one-way analysis of variance with intergroup comparisons using Dunnett's test in the form of mean and standard deviation (M±SD). Results. For the first time, the features of clinical, functional and immunological manifestations of OCPLD of varying severity were established in its isolated course and in combination with arterial hypertension. Study limitations. The study has regional (Samara region) and professional (according to the details of working conditions in the studied comparison groups) limitations. Conclusion. The revealed clinical, functional and immunological features of OCPLD in its isolated course depending on the severity and in combined comorbid course with arterial hypertension can optimize the approach to early diagnosis, prognosis, prevention and pharmacotherapy of OCPLD.

Peripartum cardiomyopathy is a rare but severe myocardial disease characterized by the development of heart failure in the perinatal period in women without previous structural or ischemic heart changes. It usually occurs in the third trimester of pregnancy or in the first months after childbirth and is manifested by symptoms of acute or chronic heart failure, such as shortness of breath, swelling, fatigue and tachycardia. The clinical picture varies from mild symptoms to severe forms with the development of acute heart failure and cardiogenic shock. Diagnosis is based on clinical data, electrocardiographic changes, echocardiography, and exclusion of other causes of cardiac dysfunction. An important aspect is the differential diagnosis with other forms of cardiomyopathy, coronary heart disease, and myocarditis. The diagnosis uses echocardiography to assess the ejection fraction and structural changes of the myocardium, as well as laboratory tests to exclude other causes. The present clinical case describes peripartum cardiomyopathy in a 27-year-old woman who developed an epileptic status after childbirth, which complicated the course of the disease. The analysis of this case makes it possible to emphasize the importance of timely diagnosis and an integrated approach to the treatment of cardiovascular and neurological complications in the perinatal period, as well as to discuss the specifics of managing patients with this pathology.

Transthyretin amyloidosis (ATTR) with predominant cardiac involvement rapidly leads to severe heart failure. The disease is not uncommon in elderly patients and is perceived as part of a comorbid pathology, so it is often diagnosed at late stages. The purpose of this publication is to demonstrate a unique clinical case of hereditary transthyretin amyloidosis with non-invasive verification of the diagnosis, safe and relatively accessible compared to myocardial biopsy. Early diagnosis of amyloid cardiomyopathy allows timely initiation of pathogenetic therapy.

The present work investigates the role of ectopic bitter taste receptors (TAS2R) in the pathogenesis of respiratory diseases. Data are provided on the mechanism of G-protein-mediated signal transduction from taste receptors. Participation of TAS2R in the local protective mechanisms in a ciliated epithelium of the respiratory tract and its activation by «quorum sensing» system molecules and its connection with the components of mucociliary clearance are presented. In addition, TAS2R receptors are also considered to be associated with allergic diseases, in particular – with bronchial asthma.

The article is dedicated to the 150th anniversary of the birth of the outstanding Russian and Soviet physician, scientist and one of the founders of Russian Cardiology, Georgy Fedorovich Lang. The publication presents the biography of Georgy Fedorovich and outlines the main milestones of his life which contributed to the formation of G.F. Lang as an outstanding scientist, an unsurpassed practicing physician and a talented manager. The article also describes the activities of Georgy Fedorovich as the head of the Faculty Therapy Department of the 1-st Leningrad Medical Institute, including the time during the difficult years of devastation for the country after the end of the Civil War, as well as during the period of severe trials that befell the residents of Leningrad during the Great Patriotic War. The scientific achievements of G.F. Lang and his students in the field of cardiology, hematology and endocrinology are described in detail. The enormous contribution made by Georgy Fedorovich Lang to the development of Russian medicine is highly valued.

The article is devoted to the scientific biography of the Honored Scientist of the Russian Federation, Professor Vladislav Vasilyevich Kosarev, founder of the Samara Scientific and Pedagogical School of Occupational Pathologists, head of the Department of Occupational Diseases and Clinical Pharmacology named after the Honored Scientist of the Russian Federation, Professor Kosarev V.V. FSBEI HE SamSMU of the Ministry of Health of the Russian Federation from 1984 to 2015, author of the first monograph in the Russian Federation, Occupational Diseases of Medical Workers.