Due to the high prevalence of diabetes the annual increase of the number of patients with diabetic nephropathy is evidenced. The progressive course of this sequellae and a high percentage of end-stage kidney disease requires a clear approach of early diagnosis, the development of methods of prevention and early treatment from the perspective of evidence-based medicine. This review provides recommendations on glucose-lowering treatment, monitoring of blood pressure and proteinuria, hyperlipidemia. Defi ned individual targets of the correction of hyperglycaemia, depending on the level of albuminuria excretion and the severity of the patient. Indicated the possibilities of applications of certain antidiabetic drugs, depending on the level of glomerular fi ltration rate. Drugs of the fi rst and second line are marked for the selection of antihypertensive treatment. Showed the possible ways to reduce the level of albuminuria. Presented recommendations for the management of patients, depending on the stage of nephropathy.

Iron defi ciency is one of comorbidity in patients with obesity, which allows you to select a particular phenotype (“iron defi ciency”) obesity. There is strong evidence of the pathogenetic link between iron defi ciency and the presence of systemic infl ammation associated with obesity. Data on the frequency and pathogenic form of anemia ( iron defi ciency or anemia of chronic disease ), obesity are not unique. Further research of iron status in obese patients is needed to decide on the feasibility and methods of correction of disorders of iron metabolism , in particular in the preparation of patients for bariatric surgery.

The prognostic scores for cardiovascular diseases are discussed in this article. The scores have advantages and limitations for using in clinical practice. Author has developed the program CardioExpert for mobile devices including the most essential scores for cardiovascular diseases.

Aim. Complex research of the functional condition of the small intestine in different stages of cholelithiasis.

Materials and methods. 47 patients with different stages of cholelithiasis were examined. There were 29 patients with the first (prestone) stage and 18 — with the second (stone) stage of cholelithiasis. In an assessment of the functional condition of the small intestine were used clinical data and results of the load tests by sugars. Cavitary digestion was studied by load test with polysaccharide (soluble starch), membrane digestion — with disaccharide (sucrose), absorption — with monosaccharide (glucose). Glucose level in blood was determined on an empty stomach, then after oral reception of 50g of glucose, sucrose or starch in 30, 60 and 120 minutes.

Results. Researchers showed that in the most of patients with cholelithiasis there were disturbances in clinical and functional condition of the small intestine. In an assessment of the cavitary digestion the level of glycemia was authentically lowered by 43% in prestone stage and by 66% in stone stage of cholelithiasis in comparison with control. In an assessment of membrane digestion in patients with the stone stage of cholelithiasis the level of glycemia was lowered in comparison with group of control and with the prestone stage by 30% and 19% respectively.

Conclusion. In prestone stage of cholelithiasis there were decrease of the cavitary digestion primary, and in stone stage of cholelithiasis — all stages of hydrolysis-resorptive process in the small intestine were disturbed.

The goal of the research was to value the cost-effectiveness and the efficacy of reperfusion therapy in myocardial infarction including one — year prospective examenation.

Methods. The immediate and long-term results of reperfusion therapy in myocardial infarction with ST-elevated (MISTE) were analyzed. The immediate results of reperfusion therapy were estimated in 349 patients with MISTE by the hospital mortality, the duration of hospitalization, the length of treatment in the resuscitation and intensive care unit. The long-term results were estimated in 137 MISTE patients by the frequency of emergency call-outs and the frequency of hospital admissions for ischemic heart disease (IHD) within the post-infarction period. The costs of hospital treatment, reperfusion therapy, emergency call-outs and out-patient treatment were calculated using the rates of compulsory medical insurance fund. The lost years of potential life and open amount of Domestic Product due to premature mortality were also calculated.

Results. The hospital mortality was 2.9 times less in the patients with MISTE who received reperfusion therapy, than in the patients who did not. Reperfusion therapy was attended with reduction of the duration of hospitalization and the length of treatment in the resuscitation and intensive care unit. Economic benefit as a result of the increase of labor potential due to hospital mortality reducing with reperfusion therapy in MI was higher than financial expenditure of reperfusion therapy. The frequency of hospital admissions for IHD within the post-infarction period per one patient was less in the patients with MI who received reperfusion therapy than in patients who did not. There were not significant differences between two groups of patients — with and without reperfusion therapy — in view of the frequency of emergency call-outs for IHD. There was little percentage of patients treated by the therapist and the cardiologist in out-patient departments in both groups of the patients throughout the year after MI.

Conclusion. Reperfusion therapy is effective and profitable in the patients with MISTE. However the low quality of periodic health examination within the post-infarction period probably impairs the long-term results of fibrinolytic therapy and angioplasty and raises the risk of investment to reperfusion therapy in the patients with MI.

Objective: to Study the potential development of links between the formation of neurotic disorders personality and high salt intake (S) with food in patients with arterial hypertension (AH).

Materials and methods: the study involved 229 patients with essential hypertension. We determined the threshold of taste sensitivity to salt (TTS), the daily excretion of sodium ions in urine, was assessed psychological status of the patients, the type of attitude to the disease (LOBI), the severity of depression (Beck questionnaire).

Results. It turned out that people consume AH TTS is much more than a healthy person. Patients consuming an increased amount of S, the disease develops earlier and runs a more aggressive accompanied by the emergence of a large number of neurotic complaints and cardiovascular nature. Their psychological status is dominated by anxiety and tension. Almost half of these patients have depression. Harmonious type of attitude to the disease occurs in them only in 1/3 of the cases, whereas a dominant role is played by neurotic and anxious types.

Conclusions: Patients with hypertension high consumption of S represent a distinct group of patients in whom an increased intake of salt simulates the course of their illness and promotes the development of certain psychological characteristics.

Processes of hydrolysis and absorbtion in small intestine were assessed with 60 of patients using amoxicillin/ clavulanate for treatment of out-hospital pneumonia. It is established that when carrying out an antibiotikoterapiya band digestion and absorption at the kept parietal digestion is broken. Further analysis of the factors presented will allow to work out practical recommendations on prevention of side effects of antibiotics usage in small intestine.

A randomized study of the state of stiffness parameters arteries wall (CAVI — cardio-ankle vascular index), AI (augmentation index) PEP (duration of the voltage of the left ventricle) using «VaSera-1000» («Fukuda Denshi», Japan) in primary hypertension patients (80) not treated with systemic antihypertensive therapy. The effect of long-term (3 months) was be marketed. Losartan combined with Mexicor 300mg/day or mildronate 1000 mg/day for the specified parameters. It sets the initial reduction the properties of the arterial wall in patients with hypertension, in contrast to healthy individuals. Mexicor or mildronat accompanied by improvement east-cal properties of the arterial wall, reducing CAVI and AI in 3 months on 9.4% and 8.9%, 14.9% and 15.4%, respectively. In the control group-term change CAVI and AI no. Mexicor led to a more pronounced increase in PEP, than mildronate, respectively, on 23.7% and 18.9%. Losartan monotherapy results in a less pronounced decrease in the stiffness of the vessel wall.

The risk of coronary heart disease increases significantly with an increase in blood cholesterol and low density lipoprotein (LDL). We know that is not always standard therapy fails to achieve target numbers of blood lipids in patients with coronary artery disease. We examined 100 patients with coronary heart disease (CHD): stable angina II-III functional — study group (60 patients) and control group (40 patients). The studies we have obtained evidence that the combination of plasmapheresis, ultraviolet blood irradiation and statins to reduce total cholesterol in patients IIFK 2,7% IIIFK 23,3%, LDL cholesterol in patients IIFK 30,4%, IIIFK 37,3% (r<0,05). Following the combination therapy achieved level of hyperlipidemia can be maintained with lower doses of statins.

In this article the authors examine the chronic obstructive pulmonary disease (COPD) from the standpoint of comorbidity — in close connection with other common diseases of modern social comorbid patient. This article presents the known and suspected, confirmed and studied basic mechanisms of the pathogenesis of COPD and a number of systemic diseases. Typical pathological process, which the authors explain the stages of formation of comorbidity is a chronic systemic inflammation. On the pages of this paper reviewed the most famous today inflammatory markers and a causal connection with the increase of their concentration and worsening destabilization of these disease entities and clinical conditions such as coronary heart disease, hypertension, diabetes, obesity, atrial fibrillation, stroke, osteoporosis and malignant neoplasm.

Gastroesophageal reflux disease is the most common disease of the esophagus, through the development of which is impaired motor function of the upper gastrointestinal system, allowing the disease to be quite be classified as psychosomatic, especially in the early stages of development, when no apparent organic complications that affect the structure of tissues. A significant percentage of mental disorders is observed in patients even before the development of somatic complaints. Patients in number of 105 people are examined. The first group — experienced (71 patient) received complex treatment, which includes the basic pathogenetic, symptomatic, and psychotropic treatment in the form of anxiolytics and antidepressants. The choice of drug was based on the results of psychological testing. The second group — the comparison group (34 patients) received only conventional treatment, without psychiatric support. Analysis was conducted of the astheno-vegetative syndrome, psychological characteristics of patients in relation to their disease, indicators of anxiety level and severity of depression. Patients with not erosive reflux disease have a frequency of detection of a depression and uneasiness was more than twice higher, than at patients with erosive reflux disease. After carrying out psychotropic treatment these indicators were practically made even. Prescription of psychotropic therapy in the form of antidepressants and anxiolytics has allowed to minimize the timing regression of clinical and psychosomatic manifestations of disease.

We have examined 184 working-aged police officer men who have been suffering from arterial hypertension (AH). It was found that obesity in this group of patients significantly increases frequency of atrial fibrillation. Moreover, it was established that there is a direct relationship between arrhythmia and degree of obesity. The main risk factors of atrial fibrillation in men with obesity are AH II-III stage, left ventricular and left atrium dilatation, low level of high density lipoproteins in serum, abnormal daily profile of blood pressure (non-dipper type). We have not revealed the presence of the association between atrial fibrillation, age and ischemic heart disease in obese patients.

The article presents a case report of hematoma after a mosquito bite in the lower part of the lateral periorbital area in a patient receiving warfarin.

Differential diagnosis of acute myocardial infarction is still raised many questions, despite advances in modern medicine. This clinical situation demonstrates the complexity and ambiguity of diagnosis infarcted debut of Guillain-Barre syndrome.

This year the medical community of the Don marks 85th anniversary since the founding of the Rostov Regional Scientific Medical Society of Physicians. At the root of a society were outstanding clinicians, who left a bright trace in the history of Don Medicine — Professors Zavadsky I.V. , Kastanayan E.M. and others.

The merits of the Rostov Regional Scientific Medical Society of Physicians are hard to overestimate, and today one of our most important tasks is to ensure the continuous education of doctors in the region.