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Modern view on pathogenesis of immunoglobulin (Ig)A-nephropathy and possible relation to intestinal MALT-system activity is presented in the article. Aberrant glycosylation of IgA and increased association of IgA-nephropathy with intestinal diseases or abnormal intestinal permeability are discussed in details. Based on supposed entero-renal pathogenesis of the disease future treatment modalities are considered. Relevant worlds literature is cited.В статье рассмотрены современные представления о патогенезе первичной иммуноглобулин (Ig)A-нефропатии и ее возможной связи с активностью MALT-системы кишечника. Подробно анализируются механизмы дефектного гликозилирования иммуноглобулина A, а также повышенная ассоциация IgA-нефропатии с рядом заболеваний, характеризующихся хроническим воспалением кишечной стенки и/или нарушением кишечной проницаемости. Обсуждаются перспективы лечения IgA-нефропатии с позиций энтероренальной оси патогенеза болезни. Приводятся данные отечественной и зарубежной литературы.

Introduction. Infectious diseases occupy a leading place in the structure of occupational diseases (OD) of health care workers (HCW). If until 2020, the main OD from exposure to a biological factor were tuberculosis and viral hepatitis (VH), then in 2020 the world faced another infectious disease of professional etiology - infection of health workers with a new coronavirus infection (COVID-19). The aim of the study is to identify problematic issues in establishing the connection of an infectious disease with a profession in health care workers. Materials and methods. A retrospective analysis of cases of occupational diseases was applied according to the data of the Department of Rospotrebnadzor for the Republic of Tatarstan (RT) and the register of patients of the Republican Center of Occupational Pathology. Results. Among the health care workers of the Republic of Tatarstan, mainly occupational infectious diseases are diagnosed (88.9%). Tuberculosis is the most common occupational disease among health care workers of the Republic of Tatarstan, accounting for 68.4%, and viral hepatitis accounts for 20.5%. In 2020, the most common OD from biological factors in the health care workers of RT was infection COVID-19. Conclusions. Currently, the most common disease of infectious genesis in health care workers is a new coronavirus infection. For a high-quality examination of the connection of an infectious disease with a profession, the list of documents must include a card of epidemiological examination, which must be filled in by an epidemiologist not after establishing the connection of the disease with the profession, but in parallel with the preparation of a sanitary and hygienic characteristic (SGC) of working conditions.

The pandemic of the novel coronavirus infection has posed additional challenges for endoscopy services. Endoscopy departments face a high risk of spreading airborne respiratory diseases in their daily work. This is especially true for endoscopic departments and offices that perform bronchoscopic examinations. The world scientific community recognizes the highest epidemiological risk of personnel infection during any interventional manipulations and operations related to the respiratory system, including bronchoscopic interventions.

Introduction. Before the entry into force of the Federal law of the Russian Federation of December 28, 2013 No. 426-FZ "On special assessment of working conditions" one of the available and effective elements of occupational risk assessment in the workplace was workplace certification (WPC) for working conditions, which allows to identify harmful and/or dangerous factors of the production environment, assess the risk levels in the workplace and determine the main areas of employee protection from the adverse effects of harmful production factors. The results of a special assessment of working conditions (SAWC) can be used not only to develop and implement measures aimed at improving the working conditions of employees, informing employees about working conditions and the existing risk of damage to their health, but also to establish guarantees and compensation provided for by the Labor code of the Russian Federation (RF) for employees engaged in work with harmful and (or) dangerous working conditions. The aim of the study is to identify problematic issues during the implementation of SAWC at the workplaces of medical workers to prevent possible errors in its further implementation. Materials and methods. We used data obtained from the results of WPC and SAWC of medical workers of various medical organizations of the Republic of Tatarstan (RT). A retrospective analysis of cases of occupational diseases was applied according to the data of the Department of Rospotrebnadzor for the Republic of Tatarstan and the register of patients of the Republican Center of Occupational Pathology. Results. In the RT medical organizations according to the results of SAWC marked decrease in the number of jobs with hazardous working conditions from 92.2% to 78.2% due to the fact that the methodology of the SAWC will not assess the intensity of the work process in all workplaces health workers, and identification and evaluation of biological factors do not always reflect the actual microbiological status of the environment. As a result, working conditions are assessed as acceptable, which deprives medical workers of previously established guarantees and compensation. In addition, during periodic medical examinations (PME), studies on the biological factor are not fully carried out, which makes it difficult to diagnose viral hepatitis, which occupies the second place in the structure of occupational morbidity of medical workers. Conclusions. For high-quality implementation of SAWC in medical organizations, it is necessary to assess the intensity of the labor process of medical workers, taking into account intellectual, sensory, emotional loads, monotony of loads and working hours, and for the correct assessment of the biological factor, it is recommended to introduce an epidemiologist to the commission.

Currently, the proportion of workers exposed to manganese compounds is quite high, but due to increased safety measures and changes in working conditions, the number of new cases of chronic occupational manganese intoxication has decreased significantly. an attempt has been madeAn attempt has been made to highlight the difficulties of differential diagnosis of occupational chronic manganese intoxication and other neurological diseases on the example of clinical cases of examination of persons with extrapyramidal system lesions in the form of early development of Parkinson’s disease. The assessment of complaints, medical history, neurological status, laboratory tests, and instrumental studies to find the probable cause of Parkinsonism was carried out. The interest of the observations lies in the difficulty of interpreting the data obtained and the importance of studying the professional route of patients. Magnetic resonance imaging of the brain, electromyography of the extremities, electroencephalography, echoencephalography, the study of the concentration of metabolites characteristic of Niemann-Pik disease, copper indicators in the blood help in making a correct diagnosis.When examining a contingent of people working in contact with manganese compounds, if they suspect chronic occupational manganese intoxication, it is important consider other diseases that lead to the development of Parkinson’s disease.The authors declare no conflict of interests.

Th e most common pathologies of the respiratory organs caused by harmful production factors include dust diseases, bronchial asthma, various variants of toxic lesions and hypersensitive pneumonitis. However, there are also more rare diseases, the awareness of doctors about which is insuffi cient. Th ese include, in addition to alveolar proteinosis, rare forms of interstitial pneumonia, including lipoid pneumonia. Lipoid pneumonia is a rare lung disease characterized by the accumulation of lipid substances in the alveoli. Cases of development of lipoid pneumonia as a result of inhalation or aspiration of various substances, including oil products are described. Th e presented clinical observation presents a case of morphologically confi rmed disease development in an employee of the petrochemical laboratory who has been in contact with oil vapors and products of its processing for a long time. Th e main approaches to the treatment of such patients are mentioned. Due to the fact that this pathology is not in the list of occupational diseases approved in the Russian Federation, it was not possible to link the patient’s disease with the profession. Th e article discusses the features of the legal framework in the fi eld of occupational diseases in the Russian Federation and in the world, proposed harmonization of the list of occupational diseases with the list of the international labour organization as one of the main tasks to improve the legal framework in the fi eld of occupational pathology in Russia.

Osteoarthritis is a common pathology, which indicates the great medical and social significance of this disease. The article discusses the issues of pathogenesis, risk factors and diagnosis of professional and professionally caused osteoarthritis: the age of onset of the disease, the specifics of work, the localization of joint damage. Differential diagnosis issues are discussed.Остеоартрит является общепопуляционной патологией, что свидетельствует о большой медицинской и социальной значимости этого заболевания. В статье рассматриваются вопросы патогенеза, факторов риска и диагностики профессионального и профессионально обусловленного остеоартрита: возраст начала заболевания, специфика трудовой деятельности, локализация поражения суставов. Обсуждаются вопросы дифференциальной диагностики.

The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

The right drug at the right dose administered to a patient in time is the goal which all medical specialists aim at when prescribing medicines to patients. Pregnancy is a condition when the principle of personalized pharmacotherapy is especially relevant. Due to the developing fetus and the occurring changes in the maternal organism, the selection of drug therapy during pregnancy is especially difficult for a clinician. This issue is tightly intertwined with clinical pharmacogenetics since the genetic code of a woman that determines the activity of the liver cytochrome, the fetus-placental barrier, and renal clearance contributes to the peculiarities of the drug metabolism during pregnancy. Additional data provides the opportunities to form therapeutic models and to determine the ways of personifying pharmacotherapy in pregnancy. The purpose of this review is to summarize the available data on the pharmacogenetics of antihypertensive drugs used during pregnancy.

Heart injury is one of the extrahepatic manifestations of chronic hepatitis C (CHC). The paper gives Russian and foreign authors' data on a relationship between CHC and myocardial injury. It discusses different pathogenetic components (the direct effect of the virus, immunological components), through which hepatitis C virus can induce myocarditis and cardiomyopathies in patients with CHC.Поражение сердца - одно из внепеченочных проявлений хронического гепатита С (ХГС). Представлены данные отечественных и зарубежных авторов о взаимосвязи ХГС и поражения миокарда. Обсуждаются различные патогенетические звенья (прямое воздействие вируса, иммунологические), через которые вирус гепатита С может индуцировать развитие миокардита и кардиомиопатий у больных ХГС.

The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immunosuppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

The paper describes clinical cases in 2 patients (brothers) with giant cell arteritis. It analyzes the genetic and epigenetic aspects of the disease. The data available in the Russian and foreign literature are given.Представлены клинические наблюдения 2 больных (родные братья) с гигантоклеточным артериитом. Анализируются генетические и эпигенетические аспекты заболевания. Приводятся данные отечественной и зарубежной литературы.

The paper gives Russian and foreign authors' data on a relationship between occupational factors and cardiovascular diseases. It considers the impact of psychosocial stress on the risk of hypertension, coronary heart disease, and cardiovascular events in representatives of different professional groups.Представлены данные отечественных и зарубежных авторов о взаимосвязи профессиональных факторов и сердечно-сосудистых заболеваний. Рассматривается влияние психосоциального стресса на риск развития артериальной гипертонии, ишемической болезни сердца, сердечно-сосудистых осложнений у представителей различных профессиональных групп.

Infective endocarditis (IE) may be accompanied by the production of a broad spectrum of autoantibodies, including antineutrophil cytoplasmic antibodies (ANCA). ANCA detection creates difficulties in the differential diagnosis of IE, especially in relation to kidney injury, the determination of the mechanism of which is important for choosing a treatment policy and estimating a prognosis. The paper describes a clinical case of a 57-year-old man who was found to have higher proteinase-3 (PR-3) ANCA titers along with the symptoms of anemia, purpura, and kidney injury during his hospitalization; echocardiography revealed vegetation on the aortic valve. IE was diagnosed; 2-week antibiotic therapy was ineffective; there was progressive aortic insufficiency necessitating aortic valve replacement. In the postoperative period, there was progression of renal failure and higher PR-3 ANCA titers, which made it possible to regard kidney injury as a manifestation of ANCA-associated glomerulonephritis. Intensive immunosuppressive therapy with intravenous and oral prednisolone was initiated, which showed positive effects in reducing proteinuria, erythrocyturia, serum creatinine levels, and simultaneously PR-3 ANCA titers. The paper gives the data available in the literature on the frequency of an association of IE with ANCA, the clinical features, diagnostic criteria, and treatment approaches. It discusses the mechanisms of ANCA formation in patients with IE.