In the june issue of European Journal of Heart Failure the guidelines, devoted to a problem of the acute heart failure (AHF), which are developed by leading experts of the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine, were published. The aim of this recommendations is to disclose the current approaches of pre-hospital and early hospital management of acute heart failure. In this overview we present basic statements of this document. 

Prosopalgia is the subtype of chronic facial pain. It is not associated with any local pathologic process. Pain syndrome manifests in connection with emotional stress and is comorbid to heterogenic mental disorders. The most effective treatment strategies include different psychotropic drugs and psychotherapy. Taking into consideration important medical and social aspects of this subtype of facial pain complex treatment strategy is necessary with he participation of psychiatrist. 

In this paper, the author once again takes advantage of the method of system analysis in the study of the deep essence of CHD. Destroy the old views on the basic foundations of this disease. In a completely different form of energy brought heart and structure of a single heartbeat. Redefined the significance of systole and diastole. All this information yet, we believe, significantly complicate the understanding of the etiology and pathogenesis of coronary artery disease. But steady progress in the study of this disease continues. 

The comparative valuation of efficiency of the different reperfusion therapy methods was carried out in the patients with myocardial infarction using clinico-economical indices. Tree methods of reperfusion therapy — fibrinolytic therapy and angioplasty, only angioplasty and alone fibrinolytic therapy — were compared by the hospital mortality, the duration of hospitalization, the length of treatment in the resuscitation and intensive care unit, the costs of treatment and the lost years of potential life due to premature mortality. It was found that treatment of the patients with myocardial infarction using fibrinolytic agents and angioplasty together is more effective than treatment using only angioplasty or alone fibrinolytic therapy. 

In the present article the results of research of frequency and character of malignant new growths of somatic and reproductive organs at 2813 blood relatives of 239 the patients having undifferentiated forms of a dysplasia of connecting tissue (UDCT) are stated. For comparison the similar analysis at 1467 blood relatives of 126 patients without UDCT signs is carried out. It is shown that a combination of carriage of prothrombogenic DNA- polymorphisms at women with UDCT and the burdened thrombotic family anamnesis have high correlation interrelation with existence of malignant new growths at blood relatives of patients. 

Aim: To study endothelial function and renal function in patients with arterial hypertension (AH) combined with diabetes mellitus (DM) type 2. Materials and methods. The study included 120 patients with arterial hypertension stage II-III in age from 40 to 65 years: 60 diabetic hypertensive patients (study group) and 60 non-diabetic hypertensive patients (control group). We studied endothelial and renal function. Results. We carried out a parallel analysis of the plasma parameters and organs (urine) component of endothelium in relation to the assessment of renal function. We found a statistically significant increase in the concentration of endothelin 1 (ET-1) in serum and decrease of nitric oxide metabolites (NO) in the urine of hypertensive patients with type 2 diabetes compared with those without type 2 diabetes (1,81 ± 0,07 vs 1,54 ± 0,07 pg / ml and 654,7 ± 45,9 vs 792,1 ± 39,4 M, respectively). In assessing renal function had higher values of proteinuria (PU), albuminuria (AU), as well as reduced glomerular filtration rate (GFR) in the intervention group compared with the control (775,2 ± 40,2 vs 476,5 ± 32, 9 mg / g, 323,3 ± 9,7 vs 190,6 ± 13,1 mg / g 59,2 ± 1,2 vs 74,6 ± 1,8 ml / min / 1.73 m2, respectively, p <0.05). There were significant correlation between endothelial and renal function. Conclusion. The study shows that while the comparable values of SBP office and DBP office the severity of endothelial dysfunction was significantly higher among patients with hypertension combined with type 2 diabetes compared to patients with hypertensive patients without type 2 diabetes. The results of evaluation of the urinary and plasma components of endothelial function in parallel with the analysis of renal function lets to assume that the forecast of hypertensive patients with type 2 diabetes determines not only from the initial value of BP, as the state of the target organ (endothelium, kidney). 

Background. The P-wave signal-averaged electrocardiogram (SAECG) abnormalities is noninvasive marker of atrial conduction delay and predictor of paroxysmal atrial fibrillation (AF). Aldosterone antagonists used as upstream AF therapy may be effective in prevention of AF episodes, but their impact on the P-wave SAECG has not been studied. Purpose. The study aims to investigate the effect of aldosterone antagonists on the P-wave SAECG in patients with paroxysmal AF. Material and methods. The study included 58 patients with coronary heart disease and compensated chronic heart failure with preserved left ventricular systolic function (ejection fraction ≥ 45%) who had a history of paroxysmal AF and sinus rhythm at baseline. All patients received ACE inhibitors, β-blockers, statins, antithrombotic and antiarrhythmic drugs and were randomly assigned to either standart therapy only (control group, 30 patients) or aldosterone antagonist spironolactone 25 mg (spironolactone group, 28 patients) added to standart treatment. The SAECG was obtained at sinus rhythm at the baseline and after 6 months treatment. The atrial late potentials (ALP) were defined as total filtered P-wave duration of ≥125 ms and a root-mean-squared voltage of the terminal 20 ms of ≤3.5 μV. The AF recurrence rate during 6 months was measured. Results. At the baseline ALP were found in 25 (83%) patients of the control group and in 24 (86%) patients of the spironolactone group (р=0.977). After 6 months treatment the ALP rate was significantly decreased in the spironolactone group (57%, χ2=4.27, р=0.03 compared to the baseline) but remained high in control (80%, χ2=0.00; р=1.0). During 6 months AF recurrences were documented in 5 (18%) participants of the spironolactone group and in 14 (47%) patients of the control one (χ2=4.23; р=0.04). Additional spironolactone intake was associated with 28.8% (95% CI 4.6–48.7) reduction in the AF recurrence. Conclusions. Application spironolactone for 6 months additionaly to standard therapy for patients with paroxysmal AF leads to improving P-wave SAECG, reduction of ALP and AF recurrence. 

The relationship between the cardiac pathology associated with connective tissue dysplasia in children and that of their parents require new approaches to their diagnosis and prevention. The purpose of research is the improving preclinical diagnosis of complications of pregnancy in women with the congenital heart disease and connective tissue dysplasia based on a comprehensive evaluation of the clinical and metabolic parameters and development of measures for the prevention of desadaptation of newborn children. Materials and methods. According to the changes in the major markers of collagen of the extracellular matrix of connective tissue: a free, peptidnosvyazanny and beloksvyazanny hydroxyproline in the serum of 50 pregnant women, patients with congenital heart disease with the presence of phenotypic signs of connective tissue dysplasia, and without them, during the gestational period can monitor the metabolism of this protein. Results of the study. The gestational age of 16 weeks the concentration fractions of hydroxyproline in pregnant women with congenital heart disease is different from the concentration of healthy pregnant women, with fluctuations from 1,62 to 5,6 mg/l. At 28–30 weeks of gestation in female patients in the presence of connective tissue dysplasia a level of peptidnosvyazanny hydroxyproline increases by 1,2 times, which is characterized by initial signs of disturbances in the mother-placenta-fetus, but in 35–40 weeks the concentration of free hydroxyproline increases, ratio free / peptidnosvyazanny hydroxyproline reduces, which may be a poor prognostic sign for the fetus and newborn. A similar trend is observed changes in collagen markers in newborns diagnosed with the congenital atrial septal defect, which also the indicates slowing metabolism of collagen and reduction in the speed of biological recycling of this protein. Conclusions. The biochemical markers may be used as additional criteria for preclinical diagnosis of cardiac pathology of the fetus and newborn, assessment and prediction of their current prevention measures, and dysplasia of the connective tissue can be seen as the constitutional basis for congenital heart disease in women and their newborn children. 

The paper presents the results of a study of the functional state of the hepatobiliary system and rehabilitation capacities in patients with diabetes mellitus type 2. Most patients were laced absorption (9 patients (50%) — Tmax=14,989±1,477 minutes), excretory (9 patients (50%) — T1/2=61,644±10,761 min.) the hepatocyte function and motor function of the gallbladder (8 patients (44,4%) — Tmax=51,775±11,294 min.). Violations of the absorptive and excretory functions of the liver depended on the duration of diabetes, glycemic level, the status of fat metabolism and body weight. Rehabilitation capacity of the organism was high 55,6% of patients and was dependent on the state of absorption of liver function, age, diabetes mellitus, and compensation of carbohydrate and fat metabolism. 

The publication is dedicated to the analysis of clinical and cost effectiveness of the combination of drugs for the symptomatic treatment of acute respiratory viral infections. The presented results demonstrate a higher clinical and economic feasibility of treatment of acute respiratory viral infections using the drug Inflyunet® compared with alternative treatment. The use of combined drugs assosiated with less adverse effects than the use of “set” monocomponent preparations for the treatment of acute respiratory viral infections and it is economically more cost-effective for the patient. 

Infective endocarditis (IE) is a rare complication (0,34–1,33%) of liver cirrhosis (LC). Diagnosis of IE remains a challenge for clinicians. The patient with IE was diagnosed on the basis of 1 large (positive seeding cultures) and 3 small (rheumatic heart disease, fever, vasculitis) criteria by Duke. The peculiarity of the case was the identification of atypical pathogen IE — Bifidobacterium.

Ulcerative colitis is one of the most challenging problems in the modern gastroenterology. The diffuse inflammation in colon is the basis of the disease. It is clinically characterized by intestinal bleedings, loose stools with admixture of pus and blood, abdominal pains, tenesmus and constipations. However, extraintestinal manifestations can prevail at the beginning of disease. This manifestation causes difficulties in the diagnosis of ulcerative colitis at the early stages. It can take several months or even years after the first symptoms began. The article presents a case of nonspecific ulcerative colitis in 56-years old woman, who suffered from extraintestinal manifestations of disease for a long time. Within 3 months the patient complained of a low-grade fever, ulcers in the mouth, painful abscessed multiple defects of the neck skin and scalp, pain in the left ear and purulent nasal discharge, which are not pathognomonic for this disease. The patient was examined by general practitioners and specialized doctors. There were no doubts in the diagnosis of «pyoderma, abrasions, acute sinusitis». However, the prescribed treatment had no effect. Blood in the stool and its frequency of 6–8 times per day appeared only 3 month later. Based on this a sigmoidoscopy with biopsy was performed. Ulcerative colitis in the acute phase was diagnosed. Changes on the skin and mucous membranes were regarded as extraintestinal manifestations of ulcerative colitis. Pathogenetic therapy was appointed. The patient’s condition improved significantly. This case underlines the need to improve general practitioner’s and specialized doctor’s knowledge in the diagnosis of this disease. 

Ответ на задачу 7, опубликованную в Томе 5, No 3(23)-2015 г. 

The description of a rare combination syndrome Churg-Strauss syndrome (CSS) with autoimmune thrombocytopenia. The disease is characterized by slow progression and refractory to standard types of immunosuppressive therapy. The first positive results are used prolonged courses of immunosuppressive of dipeptide thymodepressin