Objective: To determine the epidemiological and clinical characteristics of amyotrophic lateral sclerosis (ALS) in Amur Region.
Material and methods: Medical records of 54 ALS patients (23 women, 31 men) hospitalized in the neurological department of Amur Regional Clinical Hospital between 2012 and 2022 were retrospectively analyzed. The annual incidence of ALS ranged from 0.5 to 1.04 cases per 100,000 population. The mean age at disease onset was 59.37±1.33 years.
Results: The most common clinical onset was lumbar, followed by bulbar and cervical; diffuse onset was the rarest. In lumbar-onset ALS, males significantly predominated (70%, n=19 vs. 30%, n=8). Conversely, cervical onset was more frequent in women (64%, n=7) than in men (36%, n=4). No significant sexbased differences were observed in other onset types. Across all onset forms, the segmental-nuclear disease variant was most prevalent. The most common initial symptoms were unilateral leg weakness (39% of cases, n=21) and bulbar symptoms (20.4%, n=11). Unilateral arm weakness occurred in 9.2% (n=5), reflecting the lower frequency of cervical onset. Other initial manifestations were noted in 31.4% of patients (n=17).

Introduction: Working with patients with myasthenia gravis presents challenges due to disease symptoms, life circumstances triggering disease onset or exacerbation, severe exacerbations (including myasthenic crisis), ongoing stressful events, heightened personal anxiety, and the psychological impact of diagnosis itself. Value-Oriented Psychotherapy (VOP) is based on the principle that such difficulties serve as feedback from life, revealing the individual’s internal value distortions.
Objective: To evaluate the potential of VOP in modifying the internal picture of illness and enhancing the efficacy of comprehensive treatment in patients with myasthenia gravis.
Material and methods: A clinical case of a myasthenia patient undergoing VOP consultation was analyzed. Standardized tools were employed, including the TOBOL questionnaire (Typology of Attitude Toward Illness) and hypnotherapeutic techniques. The patient was found to exhibit a mixed ergopathicsensitiv attitude toward illness.
Results: Immediate outcomes of the consultation included improved psychological well-being and a transformed illness perception, enabling the patient to recognize his core life task. Long-term followup revealed a shift to a stable ergopathic attitude without signs of maladaptation. One year later, the patient achieved pharmacological remission and reported positive changes across multiple life domains and sustained psychological improvement. Given the significant role of psychological factors in myasthenia and the promising results of this intervention, further research into the impact of psychotherapeutic approaches on the formation of the internal picture of illness — and consequently on rehabilitation and comprehensive treatment outcomes — is warranted.
Conclusion: The VOP method demonstrated effectiveness in reshaping the patient’s relationship with illness, contributing to improved health status and social adaptation.

Introduction: This article describes the application of a stage-based surgical approach in patients with achalasia cardia treated in the surgical department of the Amur Regional Clinical Hospital. In all cases, the diagnosis was confirmed by esophageal radiography and esophagoscopy.
Material and methods: All patients were women aged 42 to 74 years, with a mean disease duration of 10.3±8.5 years. Disease staging was performed according to B.V. Petrovsky’s classification. A patient with Stage III achalasia underwent video-laparoscopic esophagocardiomyotomy combined with esophagocardiogastroplasty (modified by T.A. Suvorova). For Stage IV achalasia, laparotomy with resection of the abdominal esophagus and circular stapled esophagogastric anastomosis was performed. In a case of Stage IV recurrent achalasia following Heller myotomy, laparotomy and esophagogastric anastomosis were carried out.
Results: Follow-up radiographic (with contrast) and endoscopic examinations in the early and late postoperative periods (6–12 months) demonstrated favorable short- and long-term outcomes.
Conclusion: Surgical strategy for achalasia cardia should be guided by disease stage. Laparoscopic myotomy with esophagocardiogastroplasty is optimal for Stage III. In contrast, esophagogastric anastomosis combined with esophageal resection is preferred for Stage IV and recurrent disease.

Objective: To assess the one-year dynamics of clinical and functional respiratory parameters in patients with chronic obstructive pulmonary disease (COPD) following SARS-CoV-2 infection (COVID-19).
Material and methods: The study included 98 patients with stable COPD who had recovered from COVID-19 (Group 1) and 43 COPD patients without a history of confirmed COVID-19 (Group 2). Assessments were conducted at two timepoints: K1 (3 weeks to 3 months post-COVID-19) and K2 (12 months post-infection). All participants underwent quantitative dyspnea evaluation using the modified Medical Research Council (mMRC) scale and spirometry.
Results: At baseline, Group 1 demonstrated significantly higher mMRC dyspnea scores compared to Group 2 (p<0.01), with a greater proportion of patients experiencing severe dyspnea. By K2, dyspnea intensity in Group 1 had decreased (p<0.05) but remained worse than in Group 2, and the relative risk of severe dyspnea remained elevated. Spirometric data revealed a strong association between FEV1 (forced expiratory volume in 1 second), the severity of acute-phase lung involvement during COVID-19, and mMRC dyspnea severity. At baseline, FEV1 in Group 1 was 8.9% lower than in Group 2 (p>0.05). By K2, a trend toward improved bronchial patency was observed in Group 1, though no statistically significant differences in spirometric parameters were found between the two groups at this timepoint.
Conclusion: In COPD patients, one year after COVID-19 infection, there is a trend toward improvement in bronchial patency. However, the risk of severe dyspnea (as measured by the mMRC scale) remains significantly elevated at the 12-month mark.

Objective: To assess the state of the microcirculatory bed in the bronchial mucosa of patients with severe community-acquired pneumonia (SCAP) and its association with systemic inflammation markers.
Materials and methods: The prospective study included 40 patients with SCAP. The control group consisted of 20 apparently healthy volunteers. Microcirculation in the main bronchial mucosa was evaluated by laser Doppler flowmetry upon admission and on day 14 of therapy. Perfusion (M) and amplitudes of vasomotor oscillations were analyzed. Data are presented as mean±standard deviation (M±SD). Intergroup comparisons were performed using the Mann–Whitney U test; correlations were assessed using Spearman’s rank correlation coefficient. Statistical significance was set at p<0.05.
Results: On admission, SCAP patients exhibited a statistically significant reduction in perfusion to 14.5±2.8 perfusion units (PU), compared to 25.1±3.5 PU in controls (p<0.001). Suppression of the endothelial component of vasomotion amplitude was also observed (p<0.01), indicating endothelial dysfunction. After 14 days of treatment, perfusion increased to 21.3±3.2 PU (p<0.05). An inverse correlation was found between baseline perfusion and C-reactive protein (CRP) concentration (r= -0.58; p<0.05).
Conclusion: SCAP is associated with marked disturbances in bronchial microcirculation that correlate with the intensity of systemic inflammation. Laser Doppler flowmetry is an informative tool for monitoring local hemodynamic impairments and evaluating therapeutic efficacy.

Iron deficiency anemia (IDA) accounts for more than 90% of all microcytic and hypochromic anemias. However, a number of rare anemias may masquerade as IDA, leading to diagnostic pitfalls. This article presents clinical cases in which beta-thalassemia minor was initially misdiagnosed as IDA, along with a concise literature review on microcytic and hypochromic anemias.
Results: In the two reported cases, serum iron metabolism markers were not adequately assessed early in the diagnostic process. This oversight resulted in prolonged, unwarranted iron supplementation and subsequent iron overload—particularly severe in the second case, where serum ferritin reached 2000 μg/L. Only after identifying markedly elevated ferritin levels was a targeted diagnostic workup initiated, ultimately confirming the diagnosis of beta-thalassemia minor.
Conclusion: The diagnosis of IDA must be based not only on complete blood count findings but also on serum iron metabolism parameters (e.g., ferritin, serum iron, transferrin saturation). Failure to do so may obscure rarer underlying causes of microcytic hypochromic anemia. Clinicians should bear in mind that thalassemia can occur even in individuals of Russian ethnicity.

Objective: To investigate the influence of polymorphic variants in folate metabolism–related genes on the risk of pregnancy complications in women with bronchial asthma (BA).
Materials and methods: A molecular genetic study was conducted in 52 pregnant women with BA, followed from initial prenatal registration through delivery. DNA samples were analyzed using polymerase chain reaction (PCR) to identify polymorphisms in the following genes: MTHFR (677C>T, 1298A>C), MTR (2756A>G), and MTRR (66A>G). Statistical analysis was performed using Statistica 12.0 and Microsoft Excel.
Results: The presence of homozygous and heterozygous variants of these polymorphisms was associated with an increased risk of pregnancy complications, including preeclampsia, threatened miscarriage, preterm delivery, intrauterine hypoxia, and chronic placental insufficiency. The MTHFR 677TT and 677CT genotypes, along with the MTRR 66G allele, showed the strongest association with endothelial dysfunction and related obstetric complications. In women with BA and these risk genotypes, the likelihood of complications was 1.66–1.75 times higher than in those without such genotypes (p<0.05). Mutant alleles were also linked to adverse perinatal outcomes: reduced birth weight and length, and an elevated risk of central nervous system injury in newborns. The impact of polymorphisms varied by asthma severity: in mild BA, risks of hypoxia and preeclampsia were elevated; in moderate BA, risks of anemia and intrauterine hypoxia predominated.
Conclusion: Early identification of genetic risk factors during pregnancy enables accurate prediction of disease trajectory, timely implementation of preventive strategies, and improved perinatal outcomes in women with bronchial asthma.

This article presents a clinical case of primary hyperparathyroidism in a 52-year-old female patient. In addition to classic clinical manifestations — hyperparathyroid osteodystrophy, nephrolithiasis, peptic ulcer disease, and multiple parathyroid adenomas — laboratory findings confirmed the diagnosis: elevated parathyroid hormone levels, increased total and ionized serum calcium, and decreased serum phosphate. Early diagnosis of hyperparathyroidism is often impeded by comorbid symptoms. Following comprehensive diagnostics, personalized treatment was initiated: parathyroidectomy followed by replacement therapy.

This article presents up-to-date information on the epidemiology, pathogenesis, diagnosis, and intensive care management of myasthenia gravis, along with a clinical case of a female patient with myasthenia gravis coexisting with endemic goiter. Particular emphasis is placed on the therapeutic roles of plasmapheresis, intravenous immunoglobulin, and corticosteroids in the treatment of acute myasthenic exacerbations.

Chronic heart failure (CHF) remains one of the leading causes of morbidity and mortality worldwide. Despite significant advances in pharmacological therapy, a substantial proportion of CHF patients continue to experience disease progression and remain at high risk of sudden cardiac death (SCD). Implantable cardiac devices play a central role in the comprehensive management of CHF, offering both prevention of life-threatening arrhythmias and improvement of the heart’s pump function. Among these, implantable cardioverter-defibrillators and cardiac contractility modulation (CCM) devices are of particular importance, as they target distinct pathophysiological mechanisms of heart failure.
This article presents a clinical case of a CHF patient with reduced left ventricular ejection fraction. As the first step, the patient underwent implantation of a subcutaneous implantable cardioverterdefibrillator (S-ICD). The postoperative period was uncomplicated. In the second stage, a CCM device was implanted, followed by S-ICD reprogramming to prevent oversensing of the CCM signal by the defibrillator (cross-talk testing). No interference or malfunction was observed between the two simultaneously functioning devices following the interventions.
Conclusion: The combination of a subcutaneous cardioverter-defibrillator and a CCM device represents a promising therapeutic strategy for patients with CHF. This clinical case demonstrates the feasibility of concurrent use of S-ICD and CCM devices for the prevention of sudden cardiac death episodes and improvement of quality of life.