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Diseases arising from exposure to industrial aerosols remain an urgent problem and occupy a leading position among all occupational diseases. Scientists present clinical observations demonstrating the development of pneumoconiosis with a relatively short work experience in contact with fibrogenic dust slightly exceeding the maximum permissible concentrations. The rapidly progressing course is characterized by the development of the disease by the type of complicated pneumoconiosis with the formation of nodular fibrosis or an increase in profusion (severity) by more than one subcategory for five years. As a rule, it develops after ten or less years of work experience in contact with high concentrations of quartz dust. Researchers have considered the features of the occurrence and course of silicosis in persons in contact with industrial aerosols with a high mass fraction of silicon dioxide in production conditions.We have analyzed the situations demonstrating the development of pneumoconiosis with a professional experience of less than five years in persons who come into contact with industrial aerosol in low excess of the maximum permissible concentration of quartz dust, but with a very high mass fraction of silicon dioxide. An important condition in the prevention of pneumoconiosis should be mandatory periodic medical examinations with digital radiography of the lungs in two projections. The authors recommend performing computed tomography (CT) of the chest to persons working in contact with fibrogenic dust with a frequency of once every five years due to the fact that CT has a higher sensitivity and specificity for detecting reticular and focal seals in the lungs, as well as initial changes in the pleura. Ethics. The study was conducted in compliance with ethical principles and with the voluntary informed consent of the participants.

The new SARS-CoV-2 coronavirus and the COVID-19 disease caused by it in medical workers can be considered as an occupational disease if the infection occurred while they were performing their official duties. Along with damage to the respiratory system, SARS-CoV-2 can lead to hematological disorders, disorders of the nervous system, the development of autoimmune and rheumatic diseases. The presented clinical case describes possible serious multisystem pathological manifestations associated with a new coronavirus infection - pulmonary fibrosis, polyneuropathy. We have described the reinvention of SARS-CoV-2 with subsequent hematological disorders, complications from the musculoskeletal system in the form of aseptic osteonecrosis of the femoral heads. The scientists have presented the principles and results of the medical examination conducted in order to establish a causal relationship of the disease with the professional activity of a medical worker. We emphasize the need for a multidisciplinary approach to the diagnosis of manifestations, treatment of COVID-19 and its complications with the mandatory participation of a neurologist and rheumatologist.

In the Republic of Tatarstan (RT), as in the Russian Federation (RF), tuberculosis is the leading nosological form in the structure of occupational diseases (OD) from the effects of biological factors. Although tuberculosis, as a disease, is most common among medical workers (MW) of anti-tuberculosis institutions (80%), the remaining 20% of MW with diagnosed occupational tuberculosis are employees of the Bureau of Forensic Medical Service, neuropsychiatric institutions, and the Federal Penitentiary Service. The study aims to analyze the results of a sample with the tuberculosis recombinant allergen (TRA) "Diaskintest" in employees of the Bureau of Forensic Medical Service (FMS) for screening tuberculosis infection at periodic medical examination. Scientists conducted the study of the employees of the FMS Bureau by staging an intradermal sample with the drug "Diaskintest" (DST) in the conditions of a general medical network in the city of Kazan based on the State Autonomous Health Institution "City Polyclinic No. 18". The first stage of the study was the analysis of the results of tuberculin diagnostics using DST under the clinical recommendations "Latent tuberculosis infection (LTI) in children". The second stage of the study, prospectively, using a continuous method, taking into account contraindications to all employees responding to the TRA, conducted a comprehensive examination using computed tomography of the chest organs (CT CO) to exclude the tuberculosis process. We examined 64 employees of the Republican Bureau of the Forensic Medical Service of the Ministry of Health, Republic of Tatarstan, for tuberculosis infection with a breakdown of the TRA. The number of positive samples was 40 (62.5%), a negative result had 24 employees. In addition, the researchers conducted X-ray computed tomography of the chest organs. As a result, we diagnosed active tuberculosis in 4 employees, tuberculosis of questionable activity in 5, metatuberculous changes in 11 people, latent tuberculosis infection (without focal changes according to CT CO) in 14 people. We recommend using a skin test with the allergen tuberculosis recombinant DST at a periodic medical examination for the timely diagnosis of tuberculosis in the staff of the forensic medical examination.

Introduction. The professional activity of medical workers (MW) is in close contact with daily contact with various factors of the production environment: physical, chemical, biological, and labor processes. Until 2020, tuberculosis and viral hepatitis prevailed in the structure of occupational diseases (OD) of the medical workers in the Russian Federation. According to the State report "On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2020," the first ranking the second place in the structure of occupational diseases, depending on the impact of harmful production factor took the illnesses associated with the action of biological factors - 20,19%, while the main reason for the growth in the incidence of healthcare workers in coronavirus infection COVID-19 (further COVID-19). The study aims were to identify problematic aspects in the establishment of the COVID-19 work from MW. Materials and methods. We have given descriptions of clinical cases, as well as a retrospective analysis of issues of OD according to the patient registers of the following medical institutions: the Center of Occupational Pathology of Sechenov University, the Republican Center of Occupational Pathology of the Ministry of Health, Republic of Tatarstan, the Regional Center of Occupational Pathology of the Samara Region. Results. In 2020, COVID-19 was the most common OD with fatal outcomes and complications in healthcare workers. Today, difficulties in determining the connection of COVID-19 with the profession arise when assessing the epidemiological history, the consequences after a coronavirus infection, and the formulation of the diagnosis. Conclusions. For a qualitative examination of the connection of COVID-19 with the profession, it is necessary to develop a list of clinical conditions with the definition of the timing of complications.

The organization of work of workers of various professions associated with intense and quite often intense interpersonal communication is an object of increasingly active attention. This applies to medical professionals. Medical workers experience psycho-emotional overload, which can lead to diseases, a decrease in the quality of life. The COVID-19 pandemic has particularly acute the problem of professional burnout syndrome among medical workers. The article discusses the role of quality of life indicators in assessing the syndrome of professional burnout in different categories of workers. Professional burnout syndrome is a significant and relevant medical and social problem, and aspects related to the quality of life can considerably impact the risk of developing professional burnout syndrome.

Introduction. Occupational asthma is a complex and heterogeneous disease. Development of personalized treatment and prevention tactics becomes feasible due to phenotyping, which means identifying of markers to combine cases of occupational asthma with similar manifestations (clinical, instrumental, laboratory) and prognosis to phenotypes. The study aims to determination and comparative analysis of spirographic and immunological parameters for different phenotypes of occupational asthma. Materials and methods. In this study, we included 170 patients with different phenotypes of occupational asthma and 50 participants in control group. The spirographic examination was performed using computer spirograph with determination of the following parameters: forced vital capacity (FVC), forced expiratory volume during the first second (FEV1), Tiffeneau-Pinelli index (FEV1/FVC), peak expiratory flow (PEF), maximal expiratory flow at 75%, 50%, 25% of the forced vital capacity (MEF75%VC, MEF50%VC, MEF25%VC). Quantification of the immunoglobulins IgA, IgM, and IgG in human serum was conducted by Mancini method; levels of IgE, C-reactive protein and fibronectin were determined using a solid-phase enzyme immunoassay. Fibrinogen concentration in plasma was measured by an automatic coagulometer. Haptoglobin concentration in serum was determined by spectrophotometry. Results. According to spirometry and laboratory results obtained, there is a strong evidence, that the phenotype "occupational asthma - occupational chronic obstructive pulmonary disease" has the lowest values in pulmonary function tests and the most significant changes in immunoglobulins, fibronectin and acute phase proteins levels among other studied phenotypes of occupational asthma. Conclusions. Dynamic determination of spirometric, immunological parameters, fibronectin and proteins of the acute phase of inflammation in workers at risk for the formation of occupational bronchial asthma may be recommended to be carried out once every 6 months, followed by the isolation of disease phenotypes. This will optimize diagnostics, therapeutic and preventive tactics, as well as predict the course of this pathology.

The article presents data on the state of cytokine regulation, indicators of endothelial damage when exposed to industrial vibration (general, local) and in combination with arterial hypertension.To improve the quality of early diagnosis and prevention of vibration disease in an isolated course and its combination with arterial hypertension based on a study of the cytokine profile, biomarkers of endothelial dysfunction in this pathology.A comprehensive survey of 84 patients with isolated vibration disease from the effects of local, general, first, second degree and 61 patients with a combined course of vibration disease from the effects of local, general second degree vibration and arterial hypertension, 30 people in the control group without contact with industrial vibration and found healthy by medical examination. The levels of pro-inflammatory (IL-1, IL-8, TNF-) and anti-inflammatory cytokines (IL-4), biomarkers of endothelial damage (EDN-1, TGF-1, VEGF-A, PDGF-BB, fibronectin, Willebrand factor) were determined using the enzyme immunoassay method.The response of the immune system to the effects of industrial vibration is characterized by a cytokine imbalance an increase in the level of pro-inflammatory cytokines (IL-1, IL-8, TNF-) and a decrease in the level of anti-inflammatory cytokine (IL-4). With a combined course of vibratory disease and arterial hypertension, the cytokine imbalance is characterized by an even more significant increase in serum IL-1, IL-8, TNF- and a decrease in serum IL-4 concentration. Endothelial dysfunction with WB from the action of both local and general vibration in combination with hypertension is characterized by a significant increase in serum EDN-1, TGF-1, VEGF-A, PDGF-BB, fibronectin, Willebrand factor.The study of the cytokine profile, biomarkers of damage to the vascular endothelium in this pathology will allow for the early diagnosis of vascular disorders and to optimize preventive measures for workers in vibration-hazardous industries.Обоснование. В статье представлены данные о состоянии цитокиновой регуляции, показателях эндотелиального повреждения при воздействии промышленной вибрации (локальной ЛВ, общей ОВ) и при наличии коморбидного течения артериальной гипертензии (АГ). Цель. Улучшить качество ранней диагностики и профилактики ВБ при изолированном течении и ее сочетании с АГ на основании изучения цитокинового профиля, биомаркеров эндотелиальной дисфункции при данной патологии. Материалы и методы. Проведено комплексное обследование 84 пациентов с изолированной ВБ, связанной с воздействием ЛВ, ОВ 1, 2-й степени, и 61 пациента с сочетанным течением ВБ, связанной с воздействием ЛВ, ОВ 2-й степени и АГ, 30 человек контрольной группы, не имеющих контакта с промышленной вибрацией и признанных здоровыми по данным медицинского осмотра. Определены уровни провоспалительных (интерлейкина ИЛ-1, ИЛ-8, фактора некроза опухоли ФНО-) и противовоспалительных цитокинов (ИЛ-4), биомаркеров эндотелиального повреждения (эндотелина-1, трансформирующего фактора роста 1, фактора роста эндотелия А, тромбоцитарного фактора роста ВВ, фибронектина, фактора Виллебранда) с помощью иммуноферментного метода. Результаты. Реакция иммунной системы на воздействие производственной вибрации характеризуется цитокиновым дисбалансом повышением уровня провоспалительных цитокинов (ИЛ-1, ИЛ-8, ФНО-) и снижением уровня противовоспалительного цитокина (ИЛ-4). При сочетанном течении ВБ и АГ цитокиновый дисбаланс характеризуется еще более значимым повышением сывороточной концентрации ИЛ-1, ИЛ-8, ФНО- и снижением сывороточной концентрации ИЛ-4. Эндотелиальная дисфункция при ВБ, связанной с воздействием как ЛВ, так и ОВ, при наличии коморбидного течения АГ характеризуется достоверным повышением содержания в сыворотке крови эндотелина-1, трансформирующего фактора роста 1, фактора роста эндотелия А, тромбоцитарного фактора роста ВВ, фибронектина, фактора Виллебранда. Заключение. Изучение цитокинового профиля, биомаркеров повреждения сосудистого эндотелия при данной патологии позволит проводить раннюю диагностику сосудистых нарушений и оптимизировать профилактические мероприятия у работников виброопасных производств.

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.

Introduction . At present, despite scientific and technical progress and the introduction of modern safe technologies in production related to dust formation and dust emission, an increased risk of developing dust pathology of the lungs is noted in the machine-building and mining industries. Chronic lung diseases, including occupational diseases, are one of the most urgent problems of modern respiratory medicine and cause a decrease in the quality of life, working capacity and increased mortality of the working population. The features of the course of dusty lung diseases at the early stages of the pathological process are insufficiently studied, and functional and biological markers — criteria for individual prognosis of the patient’s condition-have not been identified. The aim of the study is to assess the immunological profile, growth factors, early diagnosis and prognosis of current forms of occupational lung diseases. Materials and methods . To assess the cytokine profile of dust lung diseases (varying degrees of severity of chronic dust bronchitis, silicosis and pneumoconiosis from exposure to welding aerosols), 161 people were examined in the main groups: 1 group–35 people who had long-term industrial contact with industrial fibrogenic aerosols, who did not show clinical and radiological signs of lung damage (contact); 2 group–39 people with chronic dust bronchitis; Group 3–56 patients with silicosis (mainly interstitial form, x-ray characteristics of the process corresponded to categories from s1 to u2); group 4–31 patients with pneumoconiosis from exposure to highly dispersed welding aerosols (mainly nodular form, x-ray characteristics of the process corresponded to categories P1, P2, q1, q2). The 5 (control) group included 60 people-donors of the Samara Regional Clinical Blood Transfusion Station, as well as employees of industrial enterprises and institutions who did not have contact with industrial fibrogenic aerosols (healthy). Serum levels of immunoglobulins A, M, and G were determined by radial Manchini immunodiffusion. Evaluation of total immunoglobulin e (IgE), immunoglobulins A, M, G (Ig A, M, G), cytokines: interleukins 1α, 1β, 4, 8 (IL–1α, IL–1β, IL–4, IL–8), interferon γ (ifny), tumor necrosis factor α (TNFa), fibroblast growth factor (FGF2), vascular endothelial growth factor (VEGF) in blood serum it was carried out by the method of solid-phase Enzyme immunoassay. in the machine-building and mining industries. Chronic lung diseases, including occupational diseases, are one of the most urgent problems of modern respiratory medicine and cause a decrease in the quality of life, working capacity and increased mortality of the working population. The features of the course of dusty lung diseases at the early stages of the pathological process are insufficiently studied, and functional and biological markers — criteria for individual prognosis of the patient’s condition-have not been identified. The aim of the study is to assess the immunological profile, growth factors, early diagnosis and prognosis of current forms of occupational lung diseases. Materials and methods. To assess the cytokine profile of dust lung diseases (varying degrees of severity of chronic dust bronchitis, silicosis and pneumoconiosis from exposure to welding aerosols), 161 people were examined in the main groups: 1 group–35 people who had long-term industrial contact with industrial fibrogenic aerosols, who did not show clinical and radiological signs of lung damage (contact); 2 group–39 people with chronic dust bronchitis; Group 3–56 patients with silicosis (mainly interstitial form, x-ray characteristics of the process corresponded to categories from s1 to u2); group 4–31 patients with pneumoconiosis from exposure to highly dispersed welding aerosols (mainly nodular form, x-ray characteristics of the process corresponded to categories P1, P2, q1, q2). The 5 (control) group included 60 people-donors of the Samara Regional Clinical Blood Transfusion Station, as well as employees of industrial enterprises and institutions who did not have contact with industrial fibrogenic aerosols (healthy). Serum levels of immunoglobulins A, M, and G were determined by radial Manchini immunodiffusion. Evaluation of total immunoglobulin e (IgE), immunoglobulins A, M, G (Ig A, M, G), cytokines: interleukins 1α, 1β, 4, 8 (IL–1α, IL–1β, IL–4, IL–8), interferon γ (ifny), tumor necrosis factor α (TNFa), fibroblast growth factor (FGF2), vascular endothelial growth factor (VEGF) in blood serum it was carried out by the method of solid-phase Enzyme immunoassay. Results . The features of the flow of dust lung diseases: the peculiarities of the immunological profile, increasing the level of factors allows to characterize the occurrence, course and progression of dust diseases of the lungs. Conclusions . Determining the immunological profile allows not only to improve the quality of early diagnosis, but also to optimize strategies for primary and secondary prevention in this pathology, to predict the course of the disease, and to reduce the number of disabling forms.

Background. Exposure to physical and chemical work-related hazards can lead to an impairment of reproductive function, gynecological diseases and a pregnancy course worsening. Aim to determine methods of prevention and treatment of occupational disorders of the reproductive system in women and men who deals with harmful labour conditions. Outcomes and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. Evaluation of a relationship and its degree between a reproductive system diseases and workplace conditions showed that women working in harmful conditions (class 3.1-3.3) had complications of pregnancy and childbirth disorders which were to a high or medium degree related to their labour conditions. Newborns’ health disorders were assessed as a category of very high degree relationships with the mother’s work. Thus the fact that maternal occupational risks induce a child’s health disorders can be considered as fundamentally proven. This study data showed that occupations of high risk of a reproductive health disorders include female workers who work in conditions of class 3 of the 2nd degree of harm. Conclusions. Obstetrician-gynecologists, occupational physicians who work as part of medical commissions for preliminary and periodic medical examinations as well as obstetrician-gynecologists who deals with women of reproductive age in women’s consultation clinic and reproductive health centers (including those planning childbearing) need to make decisions strictly according to legal and regulatory acts on health protection of employees who work under arduous and harmful labour conditions, and above all to consider on maintenance of their reproductive function.

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.

The article is devoted to the actual problem - dust diseases of the lungs. The peculiarities of occurrence and course of pulmonary lesions that have a significant place in the overall structure of occupational morbidity are considered. Modern approaches to treatment, diagnostics and prevention issues in pneumoconiosis are discussed.

The article analyzes the publications devoted to the problem of professional renal lesions caused by chemical factors. Classification, prevalence, peculiarities of the clinical picture, diagnosis of professional renal lesions caused by chemical factors of the production environment are reviewed. The frequency of professional renal lesions remains underestimated due to low manifestation of symptoms and the influence of environmental factors, which require further investigation of this issue.В статье проведен анализ публикаций, посвященных проблеме профессиональных поражений почек от воздействия химических факторов. Рассмотрены классификация, распространенность, особенности клинической картины, диагностики профессиональных поражений почек от химических факторов производственной среды. Частота профессиональных поражений почек остается недооцененной в связи с их скрытым клиническим течением и влиянием факторов внешней среды, что требует дальнейшего изучения данного вопроса.

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.

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

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.

Aims - to analyze the historical aspects of the formation of the national normative framework in the field of primary and periodic medical examinations, to discuss the existing problems in the carrying out of primary and periodic medical examinations of workers and also to make suggestions for quality improvement of primary and periodic medical examinations and for introduction of occupational risk assessment into the practice of primary and periodic medical examinations. Conclusion. For quality improvement of primary and periodic medical examinations, for efficiency improvement of primary and secondary prevention of occupational diseases it is considered to be necessary to take the following suggestions: - fuller coverage of working people by periodic medical examinations; - thorough selection of organizations that perform the special assessment of working conditions; - the use of the results of the special assessment of working conditions for improving working conditions and informing workers about working conditions; - implementation of occupational risk assessment into practice of primary and periodic medical examinations; - the use of modern methods of molecular and genetic screening

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.

Cardiac sarcoidosis is of predictive value, but its diagnostics is difficult in view of the lack of pathognomonic clinical signs and the high frequency of cases with subclinical course. In this article, we present an algorithm of clinical examination and treatment strategy using combined immunosuppressive therapy of cardiac sarcoidosis in a young women whose only symptom was frequent premature ventricular beats. In this clinical case cardiac sarcoidosis was diagnosed practically at the onset of the disease and the use of massive immunosuppressive therapy allowed to reach considerable positive dynamics even before development of irreversible changes both in myocardium and lungs.

THE AIM: to study the frequency of CKD in women suffering from chronic sarcoidosis. PATIENTS AND METHODS : 160 female patients with sarcoidosis without signs of primary renal pathology and severe cardiovascular pathology were divided into 3 groups depending on the activity of the disease: 1 – chronic progressive sarcoidosis, 2 – chronic sarcoidosis in remission 6-12 months, 3 – chronic sarcoidosis in remission more than 14 months. RESULTS: The negative effect of the progression of sarcoidosis on GFR was revealed. The lowest rGFR and the highest albuminuria were observed in the group of patients with progressive sarcoidosis, a reliable correlation was obtained between the progression of pulmonary fibrosis and renal markers of CKD. CONCLUSION: Progression of chronic sarcoidosis leads to a decrease in kidney function and the formation of chronic kidney disease.

Investigation's history and nomenclature's evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world's literature is cited.

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.

Objective: to study the incidence rates of angina, myocardial infarction (MI), stroke, and the frequency of endovascular interventions in patients with systemic vasculitides, and the incidence rate of atherosclerosis according to autopsy data. Subjects and methods. Three hundred and twenty-one patients with systemic vasculitides: Wegener's granulomatosis (n = 138), Takayasu's arteritis (n = 79), polyarteritis nodosum (n = 55), and Churg-Strauss syndrome (n = 49) were examined; 55 autopsies were analyzed in patients with the above diseases. Results. Fifty-one (15.6%) of the 321 patients were diagnosed as having cardiovascular diseases (CVD): angina pectoris (7.1%) and MI (3.1%) and endovascular interventions (0.9%). The risk of cardiovascular events was found to be associated with traditional risk factors, such as male gender and age. Arterial hypertension, hypercholesterolaemia, and increased serum creatinine were more frequently detected in the CVD group that showed no significant differences from the non-CVD group. According to autopsy results, atherosclerosis was identified in the patients with Wegener's granulomatosis (52%), Takayasu's arteritis (50%), polyarteritis nodosum (52.6%), and Churg-Strauss syndrome (57.1%). Conclusion. CVD and atherosclerosis are common in systemic vasculitides, which requires the traditional risk factors of atherosclerosis to be actively corrected.

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.

In a population-base study published in the Annals of Rheumatic Disease , Avina-Zubieta et al 1 showed that there is almost 2.5-fold increase in risk of venous thromboembolism (VTE) in patients with giant cell arteritis (GCA) compared with that in the general population. Higher incidence of VTE is apparently not unique for GCA as a similar increase in risk of deep vein thrombosis (DVT) and pulmonary embolism was recently found in a meta-analysis of studies in patients with different inflammatory rheumatic diseases.2 We detected only two cases of venous thrombosis (orbital and retinal veins) in our series of 76 patients with GCA, though at least two-thirds of them have been followed for 2 years. At the same time, there were 30 cases of …