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Background. Currently, in our country, as well as throughout the world, there is a steady increase in the incidence of cancer, which is explained by several reasons, including the aging of the population, environmental, economic and other factors. According to the Global Cancer Observatory, lung cancer is the most common cancer in the world, accounting for more than 12.4% of the total number of new cancer cases, and it is this variant of malignant tumors that is recognized as the main cause of death from cancer (1.8 million cases, 18.7% of the total number of deaths from cancer in 2022 worldwide). The solution to this serious medical and social problem is seen in increasing the effectiveness of detecting early stages of cancer at an early stage, including at the outpatient stage of medical care. The formation and maintenance of skills of oncological alertness among doctors of almost all specialties can ensure the detection and reduction of the frequency of detection of advanced/late-stage tumors, which means it will help to start specialized treatment earlier. The identification of complaints and symptoms characteristic of oncological diseases using algorithmized approaches and methodological support, followed by consultation of the patient with a pulmonologist or oncologist, are designed to improve the results of treatment.Results. The article suggests the rules of oncological alertness for their unconditional application at the outpatient stage by therapists and general practitioners, analyzing lung cancer as an example, considering a set of specially designed printed materials that facilitate the implementation of the principles of oncological alertness.

Background. Atrial fibrillation, the most common persistent cardiac arrhythmia, is a common cause of strokes, heart failure, dementia, worsens the quality of life, increases mortality and has a significant impact on the health economy. The obesity pandemic leads to a serious increase in cardiovascular risks. Obesity is closely associated with the development of atrial fibrillation, as it is associated with diseases and conditions leading to structural and functional remodeling of the heart, as well as hypertrophy and dysfunction of epicardial adipose tissue. Epicardial fat is unique in its anatomy, extremely high secretory and metabolic activity, unobstructed proximity to the myocardium and the ability to interact with it due to the general blood flow. Under physiological conditions, epicardial adipose tissue performs a cardioprotective function. Obesity causes hypertrophy and hypoxia of adipocytes. Under these conditions, adipocytes lose their protective properties, epicardial fat mainly produces proinflammatory and profibrotic adipokines, infiltrates the myocardium, which contributes to the development of atrial fibrillation. Studies show that the thickness and volume of epicardial adipose tissue are directly correlated with the risk of atrial fibrillation, the severity of its course, and the recurrence of paroxysms after catheter ablation. Many potential mechanisms of arrhythmia induction in obesity have been discovered. Research is needed to further clarify these mechanisms and identify ways to prevent them. Taking into account the peculiarities of the structure and functions of epicardial adipose tissue, it is of interest as a promising therapeutic target.Conclusion. This article represents an overview of the most significant scientific works devoted to the problem of epicardial obesity and its relationship with atrial fibrillation, systematizes modern ideas about the potential proarrhythmogenic effect of epicardial adipose tissue, therapeutic possibilities and future prospects.

Background. In the article, a clinical case of managing a comorbid 74-year-old patient with a history ofischemic heart disease, who was hospitalized in a vascular center due to myocardial infarction, with subsequently developed acute kidney injury against the background of chronic kidney disease is presented.Objective. The purpose of describing this clinical case is to demonstrate the importance of assessing and considering the significance and modifiability of risk factors for the development of chronic kidney disease, as well as their timely correction. The clinical example illustrates the connection between impaired kidney function and the progression of cardiovascular pathology.Results. The patient described in the clinical case, despite a long history of hypertension, did not receive ambulatory combined antihypertensive therapy in accordance with actual clinical recommendations, but received a monopreparation from the class of angiotensin-converting enzyme inhibitors without achieving the target blood pressure. In 2012, the patient underwent coronary artery stenting due to unstable angina, after which she received only angiotensin-converting enzyme inhibitors and beta-blockers from the drugs recommended by clinicalguidelines and did not receive antithrombotic and lipid-lowering therapy. The patient was diagnosed with type 2 diabetes mellitus 20 years ago without subsequent control of glucose levels and choice of hypoglycemic therapy. In addition, the patient had modifiable risk factors of cardiovascular diseases and chronic kidney disease: long smoking history, obesity. Upon admission to the hospital, coronary angiography was performed with intravenous administration of iodine-containing contrast medium, according to the results of which stenosis of the right coronary artery was detected, and its stenting was performed with drug-coated stents. During the hospitalization period, there was an increase in the level of creatinine and urea in the blood serum with maximum values of 570.7 μmol/L and 37.1 mmol/L respectively. When these changes were detected, the patient was consulted twice by a nephrologist, and a decision was made to conduct sessions of replacement kidney therapy due to severe azotemia with persistent restoration of kidney function. Upon stabilization of the patient’s condition, she was discharged from the hospital with recommendations to continue the program hemodialysis. However, even upon admission to the hospital, the patient’s creatinine level was 260 μmol/L, which may indicate that chronic kidney disease had been developing for a long time before myocardial infarction and before the administration of X-ray contrast medium during coronary angiography.Conclusion. Thus, due to the management of the patient at the outpatient stage without compliance with clinical recommendations, lack of correction of modifiable risk factors for chronic kidney disease and cardiovascular pathology, it was not possible to prevent acute kidney injury against the background of chronic kidney disease and myocardial infarction due to late diagnosis of chronic kidney disease.

Objective. We studied risk factors of severe COVID-19, comorbid and concomitant diseases, structure of mortality in patients during the 6th wave of the pandemic who died in the hospital.Materials and methods. The study included 220 patients with coronavirus pneumonia.Results. The majority of patients with coronavirus pneumonia who died in a hospital had pneumonia (90,0%). At the same time, moderate lung damage prevailed – pneumonia with stage CT-1 (34,5%) and CT-2 (30,5%), less often – severe pneumonia (stage CT – 3-4 (28.4%)). Laboratory verification of the SARS-CoV-2 virus was confirmed in the vast majority of cases (97,5 %). A high frequency of comorbid diseases and underlying pathology was found in deceased patients with viral pneumonia: arterial hypertension (92,7%), cerebrovascular disease (87,3%), coronary artery disease (93,2%), chronic kidney disease (80,5%), peripheral arterial diseases (47,3%), type 2 diabetes mellitus (type 2 diabetes) and atrial fibrillation – in every third patient (36,4% and 34,1%), and one in five is obese (20,0%). Acute respiratory distress syndrome (68,6%) and much less often – stroke (18,2%), acute myocardial infarction (6,4%) and pulmonary embolism (6,8%) were the main causes of death in patients with SARS-CoV-2 pneumonia. In patients with fatal pneumonia caused by SARS-CoV-2, there is a high frequency of comorbid conditions and risk factors leading to a severe course of the disease: hypertension, coronary artery disease, severe chronic heart failure, advanced age (> 75 years), chronic kidney disease stages C3-C5, peripheral arterial diseases, obesity and type 2 diabetes. Among the deceased women with coronavirus pneumonia COVID-19, such cardiovascular risk factors as age > 75 years, type 2 diabetes, CHF stage 2 (A and B), obesity of 2-3 degrees, chronic microcytic anemia prevailed; among the dead men – smoking and chronic obstructive pulmonary disease, atrial fibrillation, severe chronic heart failure.

Ischemic heart disease retains its leadership in the structure of morbidity and mortality both in Russia and worldwide. Because of this, the issues of timely diagnosis of coronary artery disease are very relevant. Invasive coronary angiography remains the "gold standard" for assessing the anatomy of the coronary bed, however, not all obstructive coronary artery stenosis are functionally significant and require revascularization. This determines the need for a preliminary assessment of the coronary bed using non-invasive imaging diagnostic methods, which are an alternative to invasive coronary angiography in patients with stable ischemic heart disease. Numerous studies have confirmed the role of computed tomography angiography of the heart in the differential diagnosis of patients with chest pain. Computed tomographic angiography is preferred in patients with the lowest values of the pre-test probability of coronary heart disease, as it has a very high negative prognostic value. The growing availability of software analysis makes computed tomographic angiography of the heart a universal imaging method capable of determining the anatomical and functional significance of stenotic lesions of the coronary arteries, identifying signs of intra- and pericoronary inflammation, and evaluating non-coronary structures. Functional imaging methods (such as stress echocardiography, PET, SPECT, stress MRI) are preferred in patients with a higher pre-test probability of coronary artery disease, as they are designed to detect ischemia and determine indications for revascularization. Choosing the most informative diagnostic method in each specific situation allows you to reduce the frequency of prescribing, increase the validity and effectiveness of invasive coronary angiography and revascularization, thereby increasing the effectiveness of treatment and improving the prognosis. The purpose of this article is to systematize the modern diagnostic approach to the management of patients with stable coronary heart disease with an emphasis on imaging techniques.

In the structure of morbidity in the Russian Federation, respiratory system diseases are in the lead, among which acute respiratory viral infections and bronchitis are make up the majority, as well the leaders in the number of disability cases. The respiratory tract damage mechanisms in viral infections are diverse and require the use of a wide range of drugs. The pathology of the respiratory system in the vast majority of cases is accompanied by the development of cough as a key syndrome, reflecting the severity of the respiratory system, and the tension of the defense systems. When an infectious agent (usually a viral etiology) enters the respiratory system, several pathways for the formation of a pathological cough are triggered: inflammation products have a trigger effect on bronchial chemoreceptors, increasing the sensitivity of all cough receptors, causing expansion of mucosal microvessels, hypersecretion of glands. A violation of mucociliary clearance becomes inevitable along with changes in the volume and viscosity of sputum, which further aggravates the severity of cough and the patient's condition. The use of mucociliary transport stimulants is justified by their most important theirproperties. Carbocysteine, in addition to long-known effects (mucoregulatory, mucolytic, the ability to improve mucociliary transport), also has anti-inflammatory, immunomodulatory and antioxidant effects, which determines its importance in the acute respiratory viral infections and bronchitis treatment. Carbocisteine is recognized by the Russian Respiratory Society, the Scientific and Practical Council of the Ministry of Health of the Russian Federation, the National Medical Association of Otorhinolaryngologists, the Russian Union of Pediatricians as an effective active ingredient for the treatment of diseases of the upper and lower respiratory tract, which is reflected in the relevant modern recommendations of the Ministry of Health for the treatment of bronchitis in children, chronic bronchitis in adults, chronic obstructive pulmonary disease, acute sinusitis and acute otitis media in children and adults. The use of drugs with new pharmacological characteristics improves patient compliance.

Malignant diseases remain an important problem in medicine, while its solution depends on the effectiveness of detecting the early stages of cancer at the outpatient stage, including the therapeutic link in the provision of medical care. Currently existing approaches to the promotion of the foundations of a healthy lifestyle are mainly aimed only at the prevention of behavioral risk factors: tobacco smoking, unhealthy diet, insufficient physical activity and harmful use of alcohol. At the same time, according to experts, even exposure only to them will prevent at least 40% of cases of the development of malignant ovariances. A 3-tier system of medical care has been organized in Russia. It is the first level of primary health care that should ensure the prophylactic focus of health care: competent clinical examination is able to provide a significant, up to 30%, contribution to reducing the overall mortality of the population, including mortality from malignant neoplasms. The first stage in the diagnosis of oncological disease are therapists, to whom patients come with general complaints (fatigue, low-grade fever, joint pain, dysuria, etc.). The most urgent task in the work of a general practitioner is the timely detection of a tumor disease and referral of a patient for treatment to an oncologist. The article considers the possibilities of screening measures with the participation of therapists, general practitioners, and offers specially developed algorithms for the diagnosis of benign and malignant neoplasms of the prostate gland. The formation of oncological alertness skills in a primary outpatient care physician is necessary for early detection and reduction of the incidence of advanced stages of tumors and earlier initiation of specialized treatment. Identification of symptoms suspicious of malignant neoplasms using algorithmic approaches and subsequent consultation with the patient by a specialist urologist or oncologist should improve treatment outcomes.

Objective of the study is an increasing the detection rate of oncological diseases in the early stages using questionnaires. The study involved 25,467 patients who came to an appointment with a general practitioner/general practitioner for any request. During the study, primary care physicians, regardless of the purpose of the visit, purposefully asked questions regarding the risks of malignant neoplasms. The detection rate of oncological diseases was 60,4% in the first half of 2018 against 56,3% in the same period of 2017. In accordance with specific localizations, the following results were obtained: detection of stomach cancer increased by 3%, colon cancer by 2%, malignant neoplasms of the trachea, bronchi and lungs increased by 6%, and the mammary gland, cervix and prostate increased by 1%, 8%, and 2%, respectively. The presence of a clear stereotype of oncological alertness in the primary care physician may contribute to a decrease in the number of advanced stages of tumors due to the initiation of specialized treatment at earlier stages. In such a situation, the main task of the therapist and general practitioner is to identify suspicious symptoms of malignant neoplasms using an algorithmized approach and refer the patient to a specialized institution.

The prevalence of somatic diseases in patients with pneumonia caused by SARS-CoV-2 viruses was assessed, the most common somatic diseases in patients, depending on gender and age groups were identified. 110 patients with viral pneumonia caused by SARSCoV-2 were included in the study. The presence of risk factors for the severe course of the disease, somatic pathology, epidemiological history, changes according to computed tomography and scores on the Charlson comorbidity scale were evaluated. The average age of patients with coronavirus infection caused by COVID-19 with an unfavorable outcome was 75 ± 1,3 years. The most common comorbid combined pathology in this group of patients is postinfarction cardiosclerosis, ischemic cardiomyopathy, and chronic cerebral ischemia. Of the risk factors for severe coronavirus infection, essential arterial hypertension is most common 93.6% (103 patients), age over 65 years old 81.8% (90 patients), diabetes mellitus 66.3% of cases (73 patients) and chronic heart failure 46.3% of cases (51 patients). In this group of patients, the average comorbidity index was 8.9 ± 0.3. Severe lethal disease is most often recorded in people of an older age group with diseases of the cardiovascular system, cerebrovascular pathology and malignant neoplasms. Even patients of young and older age groups had risk factors for poor prognosis. According to the study, the most unfavorable symptoms (fever above 38 оС, shortness of breath and weakness) occur first, 6 days before hospitalization, while the rest appear more often 3-5 days before hospitalization. Patients who have such risk factors as age over 65 years, arterial hypertension and heart failure in combination with symptoms such as fever above 38 оС, shortness of breath and weakness require immediate hospitalization, regardless of the level of hypoxemia and changes according to computer tomography, for further observation and treatment due to the high probability of death.

Pathology of the musculoskeletal system and osteoarthritis, in particular, remain a frequent reason for seeking medical care in the outpatient setting. The article offers brief algorithms for the diagnosis and therapy of osteoarthritis for use at the outpatient stage of medical care.The authors note that at present, osteoarthritis is not an inevitable manifestation of aging of the body, with which has to be resigned to. Osteoarthritis should be diagnosed early in the development of the disease, namely, at the pre-radiological stage. As a diagnosis of structural changes in the joint (cartilage, synovium and ligaments) and assessment of the effectiveness of therapy, MRI research should be widely used. Osteoarthritis therapy is based on both non-drug methods and medication, while the basic therapy is based on symptomatic delayed-acting drugs for the treatment of osteoarthritis. At the same time, chondroitin sulfate and glucosamine, according to the results of numerous studies, have a moderate or significant effect on pain and functional mobility of joints in osteoarthritis, are safe and are characterized by a minimum of side effects. Qualitative long-term randomized controlled trials have demonstrated the ability of chondroitin sulfate and glucosamine to slow the progression of joint space narrowing in osteoarthritis. The use of a combination of these drugs has also been shown to prevent cartilage loss.

The article is an interdisciplinary educational dialogue between an infectious disease doctor and a therapist and aims to raise the awareness of therapists in terms of the diagnosis and treatment of infectious diseases. The topic of this article is the key signs of an infectious pathology occurring with damage to the kidneys and the urinary system as a whole. The most common clinical symptoms of kidney and urinary tract damage occurring in infectious diseases are briefly presented. Particular cases of kidney damage in viral infections: hepatitis and HIV infection are considered. In most cases, the kidneys are involved in the pathological process in infectious pathology, causing a wide range of injuries: from urinary syndrome to end-stage chronic kidney disease. The features of kidney damage in infectious diseases, such as urinary syndrome in the absence of other characteristic syndromes indicating kidney damage; acute kidney damage. It is indicated that kidney damage in acute infectious disease occurring against the background of chronic kidney disease is a trigger for its progressive course. Early detection and adequate therapy of an infectious disease can limit the degree and severity of the pathological process in the kidneys. The management of a patient suspected of having an infectious disease should be carried out with the involvement of an infectious disease doctor.

The purpose of this open, not comparative study was to evaluate the efficacy and safety of pain therapy for diseases of the musculoskeletal system. The study included 30 patients with joint pain of different localization who are hospitalized in the therapeutic department, receiving a fixed combination of diclofenac sodium with B vitamins. The severity of pain was assessed using a visual analogue scale (VAS) for day activity (VAS-am) before taking the drug and 3 hours after, for three days. In patients with gonarthrosis and coxarthrosis, the WOMAC pain index scale (The Western Ontario and McMaster Universities Osteoarthritis Index) was additionally evaluated. A statistically significant clinical efficacy of a fixed combination of diclofenac sodium with B vitamins in patients with pain was revealed, verified by the positive dynamics of VAS and WOMAC indices: after three doses, the severity of pain on the VAS scale decreased by 84% (p ≤ 0.01). According to the WOMAC scale (pain) in patients with gonarthrosis and coxarthrosis, pain for the first indicators decreased by 75% (p ≤ 0.01). The maximum effect is achieved on the first day of taking a fixed combination of diclofenac sodium with B vitamins and lasts for 3 days. Patients did not reveal unwanted adverse reactions. The rapid analgesic effect of the drug and the absence of side effects increases the patient's adherence to the drug.

The modern concept for the treatment of osteoarthritis is based on the complex use of drugs, non-drug methods, medical and social rehabilitation. At the same time, non-pharmacological methods play an important role, given the natural combination of osteoarthritis and serious comorbid diseases, which significantly increase the risk of developing dangerous drug complications. One of the most common non-drug methods that is widely used in inpatient and outpatient treatment of osteoarthritis is magnetic therapy. During the Council of Experts, with the participation of therapists, rheumatologists, rehabilitologists and physiotherapists, the issues of the scientific substantiation of the use of magnetic therapy in clinical practice, the methodology of this method of treatment, the existence of an evidence base for its effectiveness and safety, as well as the advisability of including magnetic therapy in the national recommendations for the treatment of osteoarthritis were discussed.

The processes that vary in nature and underlie the pathogenesis of malignant neoplasms (MNs) and immune-mediated inflammatory rheumatic diseases (RDs) share just the same some common features. Thus, many early-stage neoplasias can mask autoimmune diseases, requiring that physicians of various specialties should comply with the principle of cancer alertness. When specific cancer treatments (immunotherapy, cytostatic therapy, radiotherapy) are performed, there may be certain rheumatic syndromes (arthritis, myalgia, serositis, etc.) that require a differential diagnosis. At the same time, the course of a number of RDs (rheumatoid arthritis, Sjögren's syndrome, and polymyositis) can be accompanied by the development of MNs, which is relevant for real clinical practice and calls for further investigation.The community of etiological factors and a genetic predisposition in the development of RDs and MNs remain to be of no less importance. At the same time, therapists should pay attention to the presence of rheumatic masks in many MNs, which undoubtedly prolongs the time between onset of the first symptoms and correct diagnosis.

The article covers features and difficulties of osteoarthritis therapy in comorbid patients, modern approaches to the therapy of recurrent chronic pain in this group of patients. The results of efficiency and safety study of parenteral administration of chondroitinsulfate in comorbid patients with severe concomitant pathology under outpatient conditions were presented.

The results of a clinical comparative study show a statistically significant decrease in the level of NT-proBNP in the blood of patients with decompensated CHF on the background of receiving metabolic adjustment meldonium in comparison with the control group, which leads to improved forecast and reduced likelihood of death, also associated with a decrease in the severity of CHF, reducing the risk of re-hospitalization for decompensated CHF and improving the quality of life of patients.

This article discusses the problems of adequate therapy for dys-lipidemia in patients with high and very high cardiovascular risk in clinical practice. Updated Russian and European guidelines for the treatment of dyslipidemia pick out five categories of cardiovascular risk and clarify goals of prevention and treatment of atherosclerosis. The data of most significant clinical studies on rosuvastatin, highlighting its high lipid-lowering efficacy, the effect on the progression of atherosclerosis and the prognosis in patients with cardiovascular disease, are presented.

Primary care physician is a key figure performing first contact with the most patients. Timelines for polyclinics office visits demand rapid diagnostics and making a diagnosis “at doorside” using strict algorithms of diagnostics of the most prevalent socially impactful disorders.

The article focuses on the one of crucial topics in modern healthcare — cerebrovascular diseases. Main pathogenetic ways are considered for vascular complications of the brain, with highlighted energy deficiency as main part of pathogenesis. Taking an evidence data, we evaluate efficacy of mexidol (LLC “Farmasoft”, Russia), an antioxidant for combination therapy of vascular injury of the brain that has been proven as one of the best in clinical practice.

Aim. Proposal for discussion of the new concept of National Clinical Guidelines on obesity.Material and methods. Based on the analysis of the main current documents and guidelines on obesity (EASO guidelines (2008, 2014), NICE Guidelines (2012, 2014), AHA/ACC/TOS Guidelines (2013), AACE Advanced Framework (2014), ASBP Algorithm (2014), The Endocrine Society Guidelines Pharmacologic Management of Obesity (2015), Physical Activity Guidelines for Americans (2008), ACC/AHA Lifestyle Guidelines (2013), Dietary Guidelines for Americans (2015) we developed new concept of the Guidelines on Prevention, Diagnostics and Management of Obesity.Results. A new local, original and solid, but also harmonized with current international guidelines, concept for further elaboration of interdisciplinary clinical guidelines on obesity.Conclusion. The main positions are proposed for discussion of the future National guidelines on obesity.

Aim. To study effect of fluoxetine on sleep architecture in patients with metabolic syndrome and obstructive sleep apnea syndrome.Material and methods. 98 patients with obstructive sleep apnea syndrome and metabolic syndrome (aged 54.3±8.7 y.o.) were included into the study. All patients received fluoxetine 20 mg once daily during 6 months. Influence of fluoxetine on sleep architecture was evaluated with special questionnaire and by polysomnography, including electroencephalogram, electrooculogram, mentalis electromyogram and pulseoxymetry.Results. Decrease in wake time after sleep onset (Δ33%; р

To compare antihypertensive effectiveness and changes of lipid and carbohydrate metabolism profiles, erectile function and life quality in patients with arterial hypertension (AH) while being treated by generic valsartan (Tantordio) comparing to the original. Material and methods. Totally we included 60 patients with AH, mean age 54,6±3,1. Patients were randomized into 2 groups: I (n=30) were assigned for generic valsartan (Tantordio) and II (n=30) were taking original drug. In 4 weeks patients from the group I were switched to the original drug, and patients from II group — to generic. At baseline, in 4 and 8 weeks of drug intake patients underwent blood pressure (BP) assessment and heart rate (HR) measurement, laboratory tests for lipid profile and fasting plasma glucose, life quality questionnaires and erectile function assessment in men. Results. Tolerability of the drugs studied in both groups was good enough. Antihypertensive effect of generic valsartan (Tantordio) and the original was comparable. We noted a decrease of systolic BP (SBP) in patients from the Igroup by 25% and of diastolic BP (DBP) by 20%, and in patients from II group SBP decrease by 25% and DBP — by 20%. Dynamics of BP in men and women did not differ significantly. In both groups we found significant HR decrease. Also in both groups we found significant HR decrease. There were comparable to the original valsartan positive metabolic effects of generic valsartan. While taking generic valsartan there was comparable to the original drug decrease of levels of total cholesterol, LDL cholesterol and triglycerides. An increase of HDL cholesterol was found only in the II group from 1,6±0,5 mmol/L to 1,7±0,5 mmol/L. In both groups we found comparable and significant decrease of fasting plasma glucose inside normal ranges. In women this value did not change, but in men there was a decrease from 5,7±0,5 mmol/L to 5,4±0,4 mmol/L. In all groups we found significant increase of erectile function parameters in men, comparable in both groups increase of life quality parameters without relevant differences by gender. Conclusion. The results of the study have confirmed antihypertensive effectiveness and metabolic benefits of valsartan. Generic valsartan (Tantordio) showed clinical equivalence to the original drug.

In contemporary medicine anemia is not just a decrease of hemoglobin level, but risk factor for worse outcome in vascular patients. At the same time anemia usually is not stated in the diagnosis and is not registered in statistic reports. Anemia – is always a complication that is why it always requires diagnostic algorithm to explore the underlying reason. Low hemoglobin level must be always marked by general physician. However in practice this happens just in 25% cases. Due to time deficiency at outpatient visits there is a demand for algorithm to provide GP with. This article concerns such algorithms to investigate the patients with found low hemoglobin level.

Numerous publications on the use of p-blockers in patients with arterial hypertension (AH) and metabolic syndrome (MS) have reported adverse effects of these medications on carbohydrate and lipid metabolism, as well as reduced cerebral perfusion. This review presents the benefits of a third-generation p-blocker — nebivolol (Nebilet®) — in the treatment of MS patients. The authors refer to their own findings that demonstrate effectiveness and safety of nebivolol monotherapy in individuals with AH and MS. Nebivolol treatment resulted in a sustained reduction of systolic and diastolic blood pressure levels and also improved carbohydrate and lipid metabolism parameters, which beneficially differentiates nebivolol from all other known p-blockers. Nebivolol treatment did not demonstrate any negative effects on thyroid hormone levels and reduced aldosterone levels. Nebivolol-induced increase in the endothelial production of nitric oxide resulted in a significant improvement of cerebral perfusion. Moreover, nebivolol treatment a reduction in mean 24-hour QT interval duration, which was increased at baseline. These findings suggest a beneficial effect of nebivolol on myocardial electrophysiology. Nebivolol appears to be a promising medication in the treatment of patients with MS and AH.

Atrial fibrillation (AF) is one of the most pertinent problems in internal medicine, primarily due to its severe thrombotic complications, such as stroke, myocardial infarction, pulmonary artery and thromboembolism, and their medical and economic consequences. This emphasises the importance of the detection of risk factors relevant to prognosis and of the effective and safe long-term preventive treatment with anticoagulants, particularly for ambulatory patients. At the moment, the focus is on the so-called new oral anticoagulants which demonstrate a range of benefits, compared to indirect anticoagulants.

Eating habits formed in early childhood have a significant impact on the future children's health, predispose to certain diseases in adult age, and possibly have a great impact on the quality of life. From this viewpoint, breastfeeding is the best choice. However, for different reasons, a large number of babies in their first weeks and months of life are given infant formula in addition to breast milk or exclusively artificially fed.

Aim. To assess the role of the algorithm-based selection of antihypertensive therapy (AHT) and the continuous medical education in the treatment of arterial hypertension (AH).Material and methods. Based on the autopsy data, we analysed the prevalence of AH and the structure of its complications and comorbidities among 3239 patients of a multidisciplinary Moscow City hospital. We also analysed the practices of preceding ambulatory AHT and conducted the survey on the quality of continuous medical education lectures delivered to internal medicine specialists working at polyclinics.Results. Among patients who died from cardiovascular disease, a high prevalence of AH (96,1%) was combined with prevalent target organ damage (TOD), a strong association between blood pressure (BP) levels and the risk of major cardiovascular events, and a wide range of comorbidities and AH complications. There was a lack of universal AHT schemes and regimens for patients of similar age, gender, and nature and severity of comorbidities.Conclusion. Achievement of target BP levels failed to prevent major cardiovascular events which resulted in fatal outcomes. AHT was administered without adequate consideration of organo-protective and pleiotropic effects of antihypertensive medications. The development of an algorithm which considered age, gender, TOD presence, and previous major cardiovascular events in the selection of AHT had improved the doctors’ understanding of the lecture information.

Aim. To assess effectiveness and safety of pre-hospital medical treatment in patients with acute coronary syndrome and ST segment elevation (ST-ACS) who are undergoing thrombolytic therapy (TLT); to identify TLT complications and the methods for their prediction.Material and methods. In total, the pre-hospital TLT effectiveness was assessed in 237 patients. The comparison group included 274 patients who did not undergo TLT, due to various reasons. The causes of death by Day 7–10 were analysed.Results. The leading cause of death was cardiogenic shock. In addition, in the main group, indirect myocardial rupture was a cause of death more often than in the comparison group (28% vs. 5,3%). Indirect myocardial rupture was associated with haemorrhagic complications of pre-hospital TLT. The proposed method for predicting TLT complications is based on the TIMI scale: 1–4 points suggest TLT safety; 4–5 points correspond to a higher risk of external myocardial rupture (11,6%), which implies the need to perform TLT under control of blood coagulation parameters; and ≥6 points denote the need to avoid pre-hospital TLT and use a mechanic reperfusion strategy.Conclusion. Among ST-ACS patients, mortality levels were 20,9%, which was 2,4 times higher than in the comparison group. In the main group, the morphological data obtained at autopsy demonstrated hemorrhagic myocardial transformation, which was associated with the high risk of indirect myocardial rupture (28,1%). In patients with pre-existing arterial hypertension and with the time from the ST-ACS onset of 2–3 hours, the risk of indirect myocardial rupture should be predicted, based on the TIMI scale. This will facilitate more effective assessment of the systemic TLT complication risk and selection of the optimal reperfusion strategy.

The paper is focused on hypoxia and cell ischemia as universal pathogenetic mechanisms of disease development, which can be addressed by both etiotropic and pathogenetic therapy. The latter is represented by the so-called metabolic correctors. At present, one of the most widely used metabolic correctors is mildronate. The authors discuss the effectiveness of mildronate in various clinical situations and also present the relevant original findings.

Aim. To investigate the association between periodontal hemodynamic disturbances and systemic endothelial dysfunction (ED); to assess the effectiveness of various toothpastes for periodontal disease prevention in patients with nicotine dependence. Material and methods. In total, 120 young individuals aged 22—28 years were divided into 2 groups, according to the presence or absence of nicotine dependence. All participants underwent ED assessment with the EndoPAT device. Microcirculation (MC) was assessed with the high-frequency Doppler ultrasound system MinimaxDoppler-K. Patients with nicotine dependence were divided into 2 subgroups. Subgroup A was recommended to use the R.O.C.S. toothpaste Anti-Tobacco (WDS Laboratories) twice a day, while Subgroup B participants were recommended to use the toothpaste Colgate Advanced Whitening with polishing micro-crystals (ColgatePalmolive Poland) twice a day. Results. Significant between-group differences were observed for reactive hyperemia index and augmentation index. ED severity was higher in smoking participants. Velocity and volume parameters of periodontal MC were lower in smokers. The use of each specialized toothpaste was associated with improved periodontal MC, decreased prevalence of periodontal pathology-related complaints, reduced periodontal pocket depth, and decreased periodontal index values; however, the Anti-Tobacco toothpaste was more effective. Conclusion. Young smokers demonstrated а more severe ED and disturbed periodontal MC, which manifested in a more advanced periodontal disease.

Aim. To compare the effectiveness of different antihypertensive medications in the management of hypertensive crise (HC) in the early post-surgery period after carotid endarterectomy (CEE). Material and methods. The study included 39 patients (14 women, 25 men; mean age 65,6±6,6 years) hospitalised to the Cardiovascular Surgery Department of a major Moscow City hospital. All patients underwent CEE, with a HC developed in the early post-surgery period. All participants were divided into three groups: in Group I, HC was treated with nimodipine, while Groups II and III received enalaprilat and uradipil, respectively. Results. Intravenous administration of all three medications resulted in an antihypertensive effect. A significant reduction in blood pressure (BP) levels was observed after the administration of nimodipine and uradipil. However, nimodipine caused reflectory tachycardia, which was not observed in patients treated with uradipil. Conclusion. The results obtained are consistent that out of the three studied medications, uradipil appeared the most appropriate for the HC management in the early post-CEE period. It reduced BP levels without causing reflectory tachycardia or clinical hypotension, which confirms clinical effectiveness and safety of uradipil as a medication of choice for the urgent HC management.

The paper gives information on osteoporosis (OP) as a cause of back pain. In OP the latter is stated to be induced by not only osteoporotic fractures, but also other pathological changes associated with bone mineral density loss. Data on the management of back pain due to OP are presented and the efficacies of alendronate and vitamin D3 are noted

Aim. To study the sleep structure and sleep disturbances in obese (O) patients with arterial hypertension (AH). Material and methods. Group I included 62 patients (30 women and 32 men) with chronic cerebrovascular disease (CerVD) and arterial hypertension (AH), aged 53,4±7,4 years. Group II included 42 patients (27 women and 15 men) with increased body mass index (BMI), over 30 kg/m2 (mean BMI 33,5±2,6 kg/m2 ), aged 49,3±7,3 years. In all participants, Stage I-II discirculatory encephalopathy was diagnosed. The control group (CG) included 24 healthy volunteers (14 women and 10 men), aged 49,3±8,2 years. Sleep disturbances were evaluated with the questionnaire on subjective assessment of sleep disturbances, as well as with an objective method of polysomnography. Results. Subjective complaints of sleep disturbances were reported by 87% of AH patients. All elements of sleep structure were disturbed: comparing to the CG, falling-asleep time was significantly increased (31,5±9,8 minutes), as well as the prevalence of within-sleep wakefulness (21,1±7,9%; р

Aim. To evaluate the effectiveness and safety of zopiclone in apnoea-free sleep disorders among patients with metabolic syndrome (MS). Material and methods. The study included 60 patients with chronic cerebrovascular disease (CerVD) and MS (mean age 53,3±11,2 years). Zopiclone was administered in the dose of 7,5 mg once a day, 30 minutes before going to bed, for 21 days. Therapy effectiveness was evaluated by various subjective and objective sleep assessment methods. Results. After a zopiclone treatment course, all patients reported substantial improvement of sleep quality. These beneficial effects were explained by changing sleep architecture — the duration of sleep phases and stages (%). In particular, Stage 1 of slow sleep phase, the most affected at the pre-treatment level, was significantly reduced by 20 %, while Stage 2 of slow sleep phase increased by 14 % (p

Aim. To study testosterone undecanoate effects on some modifiable cardiovascular risk factors in men with metabolic syndrome (MS).Material and methods. Androgen status screening (anthropometry, total and free testosterone level measurement) was performed in 35-75-year-old men with cardiovascular disease (CVD). In 50 MS patients, a double-blind, randomized, placebo-controlled trial of testosterone undecanoate was performed, focusing on hypogonadism clinics, erectile function (EF), quality of life (QoL), lipid profile (LP), inflammatory markers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6).Results. In men with CVD, clinical and laboratory androgen deficiency was observed in 67,8%, more often in those with visceral obesity. By Week 30 of testosterone treatment, androgen deficiency became less manifested clinically; EF, QoL, and LP also improved. Baseline levels of inflammatory markers pointed to elevated CVD risk. Testosterone undecanoate therapy was associated with significant, 2-fold reduction in CRP concentration, and 1.2-fold decrease in TNF-alpha and IL-6 levels.Conclusion. In men with CVD, hypogonadism was widely prevalent; testosterone level was age-independent in combined pathology. Testosterone level normalization facilitated improvements in LP and QoL. Testosterone undecanoate therapy was safe and well-tolerated.

Aim. To study sleep disturbance role in obesity pathogenesis among co-morbidity-free patients. Material and methods. The study included 66 co-morbidity-free obese patients and 24 healthy volunteers. All participants underwent detailed clinical examination. Psychometrical scales for subjective self-assessment were used: subjective sleep disturbance assessment scale, hospital anxiety and depression scale; vegetative disturbance scale. Somnological function was assessed by polysomnography method. Results. Sleep pathology in obesity was registered in 86% of the patients, including 59% with sleep respiratory disturbances (RD) and typical complaints: poor quality of morning wake-up, morning headache, daytime somnolence. Falling asleep process, sleep continuity, and total sleep length were unchanged, but deep stages of slow-wave sleep (stages 3 and 4) and fast sleep phase (FSP) were deficient. In 27% of the patients, sleep RD were absent, with premature wake-ups as a typical complaint. Objectively, total sleep time reduction, falling asleep and intra-sleep vigilance time increase, sleep structure disturbance, mostly due to frequent wake-ups, decrease of deep stage slow-wave sleep and FSP were observed. No subjective or objective sleep quality disturbances were registered in 14% of the patients. Conclusion. In complex obesity treatment, differential sleep pathology correction is important, including RD management and adequate psycho-pathology therapy.

About 150 million men worldwide suffer from erectile dysfunction (ED). In the next 25 years, this figure could double. High ED prevalence is explained not only by ageing problems, but also by increased prevalence of diseases and taking medications, causing sexual dysfunction. Therefore, ED is not only a factor determining male quality of life, but also one of the principal social parameters of the health care system in general.

The study is devoted to long-term prognosis in women with gestational arterial hypertension (GAH) in anamnesis. A retrospective epidemiological study of GAH clinical importance in women with essential AH was performed. In AH group, more than 50 % women had GAH syndrome in anamnesis. As a rule (45 %), this syndrome included chronic AH (AH before pregnancy or diagnosed before 20 weeks of gestation). Low birthweight in children predicted AH risk in their mothers. Inpatients with AH and GAH syndrome, the clinical course was more severe (higher risk of target organ damage, early cerebrovascular complications, coronary heart disease) than in AH patients without GAH syndrome. In AH/GAH women, genetic factors were less important than in AH women without GAH. More than a half of GAH patients (62,3 % ) received anihypertensive therapy. The latter did not affect significantly obstetric complication risk, labor outcome, and long-term prognosis in women. Only 34 % of GAH patients received an advice to continue the cardiologic follow-up after birthgiving. GAH syndrome should be considered as an independent cardiovascular risk factor. Women with GAH should be in focus of cardiologists' special attention, even if blood pressure level normalized post-partum. Such patients require regular medical examination and active cardiovascular prevention.

Arterial hypertension in pregnancy: mechanisms of formation, prevention and therapeutic approaches.

Efficacy and safety of eprosartan therapy as assessed from the standpoint of evidence-based medicine.

Different nitrate forms in acute coronary syndrome at preclinical using.