The article analyzes the current status of the issue of senile asthenia as a key geriatric syndrome. The definition, epidemiology, risk factors, diagnosis and prevention of senile asthenia are considered. The pathogenetic mechanisms of senile asthenia are described, on which the treatment, rehabilitation and prevention of this syndrome are based. The detailed characteristic of risk factors is given, which are divided into categories: physiological, medical diseases / comorbidities, socio-demographic, psychological states, and disability. The main components of a comprehensive geriatric assessment are reflected, including the study of the functional, physical, social and psychological status of the patient. The emphasis is made on using the most convenient and available tools for assessing the health of the elder, describing their advantages and principles of application. The most useful strategies to prevent senile asthenia are considered, which are aimed at improving the quality of life of the aged patients and reducing the frequency of adverse outcomes.

The purpose — to study the features of vaccination, including against COVID-19, in patients with immune-mediated rheumatoid inflammatory diseases (IMRID). Material and methods. A review of the scientific literature about vaccination, including vaccination against COVID-19, in patients with immune-mediated inflammatory rheumatoid diseases. Results. Patients with IMRID are at risk of infectious diseases with a more severe course and outcome. This problem has become more urgent with the emergence of COVID-19 and the need for vaccination against it. Infectious diseases in IMRID patients may have a more severe source, thus, their vaccination is recommended. However, introduction of DMARDs and GEBDs into clinical practice leads to a decrease in the vaccination effectiveness. The specific role of vaccines in the induction of autoimmune diseases has been actively discussed over the past decade. However, apart from some specific vaccine complications, this role has not been established. COVID-19 can also exacerbate IMRID. Therefore, vaccination should be recommended to these patients. The increase in IMRID symptoms after the vaccine introduction did not in all cases reflect a true exacerbation and cannot serve as a basis for refusing to vaccinate. The preserved sensibility to the disease may be explained by the lack of humoral response combined with insufficient T-cell response. Conclusions. Therefore, vaccination is recommended for patients with IMRID. At the same time, vaccination is recommended against the background of low activity or remission of IMRID 6 months after and 4 weeks before the course of B-cell therapy. Immunological complications after vaccination are relatively rare, but they should not be underestimated, in this regard, it is necessary to carefully monitor patients in the post-vaccination period.

The article examines the literature data reflecting the difficulties of diagnosing primary amyloidosis in clinical practice. By the example of a clinical observation, a diagnostic search is described, performed for a patient with primary (AL) amyloidosis. The given clinical example demonstrates the absence of pathognomonic symptoms specific to this nosology at the beginning of the disease, which creates certain difficulties in its timely detection.

During the COVID-19 pandemic it became known that SARS-CoV-2 virus has other targets beside lungs. Recent studies imply that the virus have shown tropism on kidneys, which under the durable kidney disease leads to aggravation of chronic kidney disease (CKD). The article presents a case of progressive CKD in a patient of the Nephrology Department at Republic Clinical Hospital who had two prior cases of COVID-19. Initially he had the 3A stage of CKD with GFR 58 ml/min/1.73 m2, with proteinuria level of A1 stage. After the first COVID-19 infection, his GFR decreased to 40 ml/min/1.73 m2. After the second COVID-19 infection, GFR decreased to 34.2 ml/min/1.73 m2 and proteinuria reached the A3 stage levels. After six months, GFR was 21.5 ml/min/1.73 m2, and proteinuria reached nephrotic levels. The presented case showed progression of CKD due to SARS-CoV-2.