The report presents the main provisions of the new clinical practice guidelines (2016 year) relating to the cardiopulmonary exercise test (CPET), proposed by the European Association for Cardiovascular Prevention and Rehabilitation, as well as the American Heart Association. The basic modes and methods of test are described in the review. The key indicators that are measured in the process of its implementation are reflected in the text. Moreover we demonstrated the physiological significance and changes of test indicators in various diseases. Also we have described the main clinical indications for CPET and its using in patients with shortness of breath, lung disease, sent to surgery, associated with partial resection of the lung, and heart valve disorders.

The differential diagnosis of infectious diseases for general practitioners is always a difficult process. The spectrum of clinical entities when jaundice may develop is unusually wide. First of all doctor must exclude or confirm infectious nature of the jaundice, which is dictated primarily by epidemiological rules. This report contains clinical and epidemiological characteristics of key diseases causing jaundice syndrome. Authors conducted analysis based on the data of the 18th department of the Moscow Infectious Hospital № 1 for the years 2014-2015 and revealed how common infectious diseases causing jaundice syndrome are.

The first message introduces readers with a history issue, the origins of the doctrine of iatrogenesis, the first appearance of the term definitions iatrogenesis. Contains information about famous historical figures who were victims iatrogenesis and about the underlying causes of growth iatrogenesis events and place iatrogenesis in the international classification of diseases.

Arterial hypertension (AH) is one of the most widespread diseases in whole the world. AH in youth is associated with high cardiovascular mortality in middle age.

Objectives: The study objectives were to studied prevalence of AH and risk factors in young adults.

Methods. We studied prevalence of AH and risk factors in 981 young adults aged 20-29 years old (22,3 ± 2,26) in cross-sectional epidemiological study.

Results. Prevalence of AH was 14,2%, it was significantly higher in men (22,2%) then in women (4,5%), p>0,05. There was a high prevalence of AH risk factors: overweight (35,4% in men), smoking (27,8% in men), parental hypertension (57,8%), noncompliance of day regimen (58,8%), high stress level (37,7%). In AH group prevalence of overweight, smoking, high salt consumption, parental hypertension and hypodinamia was significantly higher than in population.

Conclusions. Prevalence of AH was 14,2%, main risk factors of AH were observed in more then quarter of studied persons.

The aim of this study is to measure the level of the endothelin-1 in blood samples and to assess vasoactive function of the endothelial in asthma patients with different phenotypes and to develop the methods of the objective assess of the ongoing treatment. Materials and methods. 119 asthma patients were separated into several phenotypes: patients with atopic asthma (60 pat); patients with ACOS (35 pat); asthma with obesity (24 pat). In all patients endothelium-dependent vasodilation and plasma level of endothelin-1 were assessed. Results. Endothelial dysfunction revealed in all asthma phenotypes. The highest level of the endothelin-1 shown in ACOS patients. In patients which achieved asthma control during three month of the anti-inflammatory therapy showed decreasing of the endothelin-1 level by 1,5 times in comparison with basic level (0,35 ± 0,06 fmol/ml and 0,64 ± 0,15 fmol/ml respectively, р < 0,01). But in patients with persistent symptoms and/or without lung function improvement the level of the endothelin-1 was not decreased significantly. Conclusions. Change of the functional conditions of the endothelial depend on the time and severity and phenotype of the asthma. The endothelin-1 level and the endothelium-dependent vasodilatation assess on the course of the treatment allow to reveal success of this anti- inflammatory therapy.

Aim. To find out the links between the state of system and the risk and severity of impairment of renal function in patients after percutaneous coronary intervention (PCI).

Material and methods. The free radical oxidation system’s response was assessed in patients with different degree of severity of the glomerular filtration impairment. The intensity of lipid peroxidation was evaluated by the concentration of malondialdehyde (MDA) in the red blood cells of patients.

Results. Almost all 59 patients after PCI were observed with various degree of inhibition of renal filtration. The mean value of MDA significantly (p = 0,032) increased from 10,3 ± 1,7 mmol/g to 11,0 ± 1,8 mmol/g. The level of MDA was significantly higher (p <0,001) in the group of patients with more severe inhibition of glomerular filtration.

Conclusion. The results indicate the important role of free radical processes in the pathogenesis of renal function impairment.

Objective. Analysis imbalance aqueous body fluids on the prognosis of cardiovascular events in the late period after an acute coronary syndrome (ACS) and myocardial revascularization based on indicators of renal function.

Materials and methods. The study included 120 patients with ACS, including unstable angina was diagnosed in 68 patients, 52 patients — acute myocardial infarction. All patients underwent myocardial revascularization. To register the presence of albuminuria in the range of 30-300 mg/l, and glomerular filtration rate (GFR). It makes calculations indicators aqueous body fluids — the total volume of water (TVW), the total fluid, intracellular fluid (IF), extracellular fluid. The endpoint of the study was the presence of cardiovascular complications within 6 months after ACS.

Results. It is found that the presence and magnitude of albuminuria was significantly increase the risk of the end point of the study. In patients with GFR less than 60 mL/min/1,73m2 studied the risk is higher by 17.1%, compared with patients with a GFR above this limit. Analysis of the distribution of the water body fluids showed a significant increase in the average TVW and IF. Through statistical analysis of survival found an increased risk of cardiovascular complications in the late period after ACS in patients who have an increase IF on the stage of development of coronary catastrophe.

Conclusion. The study demonstrated the predictive value to stratify cardiovascular disease risk, not only the presence of albuminuria, but its level and value of GFR less than 60 mL/min/1,73m2. Redistribution of aqueous body fluids in the form of increased IF is a marker of adverse cardiovascular events in the late period after ACS. These data indicate the need for a comprehensive and integrated analysis of existing pathogenetic changes occurring in ACS, as well as the status of the patients premorbid factor for improving risk stratification of cardiovascular complications in the long term after a cardiovascular accident.

Study Objective. To assess predictors of pneumonia in patients with acute myocardial infarction and acute ischemic stroke. Study Design: A retrospective analysis.

Materials and methods. We reviewed archive data of 140 autopsy reports and medical histories of patients died from cardiovascular events to determine the frequency of pneumonia. The statistical analysis was used to derterman the connection between gender, age, duration of hospitalization, use of mechanical ventilation, central venous catheterization, presence of diabetes and COPD with the rate of pneumonia.

Results and discussion. The study included 140 patients, of whom 84 (60,0%) with stroke in ischemic type 33 (23,6%) with stroke hemorrhagic type, and 23 (16.4%) with acute myocardial infarction. We examined the relationship of pneumonia with age, sex, duration of hospital stay, ventilator use, central venous catheterization, presence of diabetes and COPD. The average age of patients with pneumonia was 77±9 years, and without pneumonia 75±12 years. The average duration of hospitalization of the patients who died with pneumonia, was 13 (7,25; 25) days, and without pneumonia 3 (1; 10, and 25). Pneumonia developed in 39 (72,2%) males and 57 (66,3%) women. COPD was diagnosed in 98 (70%) patients. 19 patients (13,6%) patients have diabetes mellitus of the second type. CV catheterization was performed in 108 (77.1%) of the patient. In 83 (59.3%) patients during hospital treatment were on a artificial ventilation.

Conclusion. The incidence of pneumonia increases depending on the duration of hospitalization, age, use of artificial ventilation. Gender, diabetes and COPD, central venous catheterization are not associated with the risk of pneumonia.

We are presenting the clinical and laboratory case of management of 62 years old patient with combined dermatological tumor-associated diseases: localized form of scleroderma, acquired disseminated form of hypopigmentation (vitiligo). The patient initial visit in a medical dermatological facility was due to the emergence of a consistent following complaints such as the sudden appearance of alterated skin sites in the left breast and some later the occurrence of rushes on the skin on the chest area and on the anterior surface of the abdomen. Upon further examination of the patient have been verified malignant tumor of the left breast, therefore appropriate (complex) treatment have been conducted in a medical institution of oncology service. After 1.5 years after the sectoral mastectomy the patient appealed to the dermatologist again with a complaints to the renewed activity of scleroderma process on the skin of the left breast. On the background of activation of dermatological symptoms the patient have been diagnosed recurrent tumor in the left breast. This clinical case is a multipurpose: first of all, it is demonstrates the importance of the principle of oncological vigilance in multidisciplinary daily medical practice which would improve early diagnosis and, consequently, treatment of the underlying disease; secondly, the present clinical case suggests an unexpected paraneoplastic contour of the diseases which are unpopular in this category previously, but generally frequent in the population.

The article presents a clinical case of nonsecretory multiple myeloma, verified with immunohistochemical staining. It was hard to prove the diagnosis as the patient had extramedullar lesions adding to the bone destructions, the bone marrow was minimally infiltrated with plasma cells, ESR was normal, no monoclonal protein was present in the serum and urine.

The prevalence of Anelloviridae virus is high among population in many countries. The hepatotropic and hepatopathogenic features were confirmed in some genotypes of this family. Two chronic hepatitis B clinical cases associated with Torque teno midi virus (TTMDV, genus Gammatorquevirus) in the absence of other Anelloviruses and hepatotropic viruses (HBV, HCV, GBV -C, CMV) were described by using of molecular-biological, histopathological, immu nohistochemical and electron microscopy methods.