Erysipelas is one of the first places on the prevalence of infectious disease after acute respiratory and intestinal infections, viral hepatitis. Currently, in most cases erysipelas is caused by beta-hemolytic group A Streptococcus bacterium, but in some cases could be due to co-infection with Staphylococcus aureus. The pathogenesis of erysipelas is characterized by impaired tissue immunity, cellular and humoral immunity deficiency, hypersensivity to hemolytic streptococci group A (Lansfeld). Chronic recurrent erysipelas refers to endogenous infection caused by intradermal and intra-macrophage maintaining L-forms of Streptococcus, and biological damage caused by excess production of cytokines by T-lymphocytes and mononuclear cells. The disease is characterized by increased cases with primary and severe hemorrhagic forms (over 60%), a tendency to develop recurrent erysipelas (30 to 40%), slow regenerative process in the focus of inflammation, the multiplicity of the differential diagnosis. Risk factors of the erysipelas are the disruption of the skin barrier, fungal skin infections, emotional stress, body hypothermia or overheating. Women suffer from erysipelas more often than men. Adults over age 40 years and older are more likely to develop erysipelas in more than 60% of cases. Erysipelas is characterized by seasonality- rise in the incidence observed in spring and autumn than other streptococcal infections. Depending on the lack of treatment efficacy in resolving symptoms of erysipelas, impaired prevention of disease recurrence, recommended treatment by scientists involves antibiotics with immunomodulation therapy and laser therapy.

 

The presented review concerns discussion about current insights into treatment of peripartum cardiomyopathy. The definition of peripartum cardiomyopathy and general issues about diagnosis and pathogenesis of the disorder are provided at the head of the review. Particularly, the role of the system «prolactin — cathepsin D — prolactin 16 kDa» in cardiomyopathy development is disclosed. The general approaches to management of the patients are highlighted. The review provides detailed data about indications, adverse effects and derived clinical experience concerning the main pharmacological drugs which had been used in peripartum cardiomyopathy treatment given their possible unfavorable influence on fetus maturation and maternal lactation. The detailed description is provided on diuretics including loop, thiazide and potassium-sparing drugs. It was noted relative safety and efficiency of nitrates and hydralazine in conditions of limited choice from vasodilator group and, particularly, angiotensinconverting-enzyme inhibitors and angiotensin-II receptor blockers which are contraindicated in pregnancy. A special attention is paid to the group of inotropic drugs: levosimendan, milrinone, and cardiac glycosides. The role of β-blockers and ivabradine is disclosed in heart failure treatment of peripartum cardiomyopathy. Anticoagulants were presented in details given that these drugs are justified in severe cardiac chambers dilation, decrease in ejection fraction, and in presence of intracardiac thrombosis. The place of antiarrhythmic drugs administrating in various cardiac rhythm disorders is discussed in the review. The data is given with account of potential influence on fetus in antenatal peripartum cardiomyopathy in which lidocaine and sotalol are the most preferable drugs; adenosine, quinidine, and flecainide are useful with caution, but amiodarone and dronedarone are absolutely contraindicated. Taking into account proposed pathogenic mechanisms of this cardiomyopathy, the information about pharmacological drugs directed to correction of possible links of development mechanism of this pathology is introduced. On the basis of analyzed data authors discuss relevance, indications and side effects of immunosuppressive therapy, immunoglobulin, pentoxifylline, and prolactin secretion inhibitors — bromocriptine and cabergoline. The experience of cardiac transplantation is specified in patients with refractory peripartum cardiomyopathy, and issues of delivery are highlighted in women suffering from this disease.

 

 

 

Aim. The aim of the study was to reveal the peculiarities of arterial hypertension, that occurs in male law enforcement officers of working age against the background of obesity, to evaluate the factors associated with obesity that affect hypertension. Materials and methods. The study included men of working age working in the system of internal affairs bodies and hospitalized on a scheduled basis in a cardiological hospital with the main diagnosis — arterial hypertension. All studied patients were divided into two groups, the first group included patients with arterial hypertension in combination with obesity, the second group included hypertension and normal body weight. All patients underwent a general clinical and indepth anthropometric examination. Instrumental examination of patients included echocardiography, 24-hour blood pressure monitoring and pulse oximetry. In addition, all patients had an assessment of the risk of obstructive sleep apnea syndrome and studied psycho-emotional status using standard questionnaires. Results and discussion. A comparative analysis of the two groups showed that significant differences were observed with respect to some anthropometric indicators. In patients with obesity, more pronounced signs of myocardial remodeling were revealed by the results of echocardiography. Also, patients of this group were more likely to develop obstructive sleep apnea syndrome, greater propensity to anxiety, combined with eating disorders, more often in a restrictive type. A comparative analysis of the diurnal blood pressure profile of the two groups showed no significant differences, but obese patients required significantly more intensive antihypertensive therapy to achieve target blood pressure figures. Conclusion. Obesity leads to more pronounced myocardial remodeling in working age men with arterial hypertension. More intensive antihypertensive therapy is required for compensation arterial hypertension in the case of obesity. Patients with obesity tend to develop a syndrome of obstructive sleep apnea and are characterized by a high level of anxiety and eating disorders.

Over the last years the incidence of cardiovascular diseases had increased in Russian Federation. In a period of 2010-2014 y. the number of patients diagnosed hypertension increased by 16,8% (139,5 thousand patients). High prevalence of hypertension leads to different cardiac complications that could be responsible for death. Hypertension is a major risk factor for ischemic heart disease and stroke, increases the risk in 3-4 times, and therefore one of the most important causes of morality. The major cause that required emergency hospitalization in adult population was estimated to be cardiovascular diseases (23,9%), including ischemic heart disease (10,7%), cerebrovascular diseases (6%), and diseases attributable to high blood pressure (3,3%). We studied 1 605 374 (9,6%) emergency ambulance calls to patients with high blood pressure during the period of 6 month (2015 y.) . In 16,1% cases emergency service calls were related to hypertensive crisis and 1,45% of patients needed emergency evacuation. We determined that in 7,2% cases patients with high blood pressure called for emergency service again during 24 hours period. Among this group of patients the percent of hypertensive crisis and evacuation was higher — 19,4% and 4,1% respectively. Also we identified that in 59,5% cases the diagnosis was hypertensive disease. We determined that majority of frequent ambulance callers were elderly persons.

 

Objective: to study the prognosis of patients with first diagnosed atrial fibrillation in patients after cardioembolic stroke. Material and methods. In an open, prospective study “APOLLO” (Anticoagulation in Patients with atrial fibrillation, after cardioembolic stroke) for the period 01.10.2013 — 31.03.2015 after the stage of screening (n=1291) were included 661 patients with atrial fibrillation, after cardioembolic stroke, the average age was 68,0 [62,0; and 74,0] years. The observation period is 12 months. Results. Noted the high level of comorbidity (hypertension was verified in 100% of patients, ischemic heart disease — 61,4% of patients, diabetes in — 52,3%, and chronic kidney disease have to 32.1% of patients). At 154 (23,3%) patients AF was first diagnosed at the time of the development of cardioembolic stroke. Patients with first diagnosed atrial fibrillation were comparable with the whole group in age, indicator of the scale HAS-BLED, the frequency of occurrence of hypertension, but among them were significantly more frequently encountered patients with chronic kidney disease, diabetes, and myocardial infarction. The greatest mortality during the year was observed in the group of patients with first diagnosed atrial fibrillation, where he died — 46 (29.9 per cent) of people that is significantly more than the average across the group of patients with atrial fibrillation, after cardioembolic stroke, and patients with different forms of atrial fibrillation (p<0.001). Deceased patients with first diagnosed atrial fibrillation were significantly older and had a more pronounced degree of neurological deficit by NIHSS scale. Conclusion. The data obtained showed high prevalence and poor prognosis newly diagnosed with atrial fibrillation in patients with cardioembolic stroke. The use of the term “newly diagnosed stroke-associated atrial fibrillation” logically justified, which determines how the time of onset of this arrhythmia and high risk of mortality in patients of this group.

 

Objective: Obstructive sleep apnea (OSA) is associated with the high prevalence of cardiovascular diseases, and such disease manifestations as obesity, arterial hypertension (AH), violation of carbohydrate metabolism, dyslipidemia and endothelial dysfunction. However, the effects of Continuous Positive Airway Pressure therapy (Continuous Positive Airway Pressure — CPAP therapy) on the normalization of blood pressure in patients with OAS+AH are poorly understood and poorly studied. The aim of the study was to investigate 12-month effects of long-term CPAP-therapy with auto-adaptation to inhalation and exhalation (A-Flex therapy) on blood pressure in patients with OSA+AH. Methods: To the prospective single-center study were included 177 patients with snoring, metabolic disorders, obstructive sleep apnea, and hypertension with the established drug therapy (138 men [78%] and 37 females [21%]), in age interval of 35-75 years (56,4 ± 9,4) which apnea-hypopnea index (AHI) > 5 event/hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (Sp02 mean) by the rules of American Academy of Sleep Medicine (AASM). Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements. Results: After 12 months of A-Flex therapy we found a significant decrease of level of systolic and diastolic blood pressure. The group of CPAP-therapy has decreased daytime SBP on -5.9 mmHg (95% Cl from -3.2 to -7.1; P=0.02) and night SBP on -4.1 mmHg (95% Cl from -6.1 to -2.6; P=0.01). Similar dynamics was observed in variations of DBP. The group of CPAP-therapy decreased daytime DBP on -1.1 mm Hg (95% Cl from -2.2 to -0.5; P=0.02) and nighttime DBP on -5.1 mm Hg (95% Cl from -7.2 to -3.5; P=0.01). In addition, the group of CPAP-therapy have clinical changing of excessive daytime sleepiness, expanding physical activity, normalization of night sleep. Conclusions: The 12-month A-Flex therapy in OSA patients with AH has a significant therapeutic effect of stabilization systolic and diastolic blood pressure. The long-term 12-month A-Flex therapy has to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations and arterial hypertension.

 

Aim: To evaluate clinical significance of determining the level of the brain natriuretic peptide for the diagnosis of heart failure of comorbid patients with coronary heart disease and thyrotoxicosis. Materials and methods: 111 patients aged 45 to 65 years (average age was 58.3 ± 5.6 years) were included in the research. All the patients were divided into 4 groups: the main one consisted of 25 patients with thyrotoxicosis, coronary heart disease (CHD) and II-III functional class (FC) chronic heart failure (CHF); the 1st comparison group consisted of 30 patients with coronary heart disease and II -III FC CHF, but without thyroid dysfunction; the 2nd comparison group consisted of 30 patients with thyrotoxicosis without CHD; the 3rd comparison group consisted of 26 patients with thyrotoxicosis and coronary heart disease, without CHF. The following research methods were used in the work: the clinical state assessment scale (CSAS), the 6-minute walk test (6MWT), echocardiography. The level of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) was determined using laboratory sets for enzyme immunoassay (Biomedica, Austria). Results: The comparative analysis of the CSAS indices did not reveal a significant difference in the severity of the clinical symptoms of CHF for the patients of the primary and the 1st comparison group (7.08 and 6.61, respectively, p> 0.05). At the same time, tolerance to physical activity for the patients of the main group was 1.2 times lower than for the patients of the 1st comparison group (p = 0.01). The contractility of left ventricular myocardium for the patients of the main group was significantly lower, as evidenced by the lowest left ventricular ejection fraction — 40.0 (37.0, 42.0)% (compared to patients of all comparison groups, p <0.001). The level of NT-proBNP was increased in all compared groups, including the patients with thyrotoxicosis without combining with IHD and CHF. The values of this index for patients with IHD and CHF and for patients with IHD and thyrotoxicosis without CHF did not differ significantly. The highest concentration of NT-proBNP was obtained in a group of patients with a combination of thyrotoxicosis, coronary heart disease and CHF (p <0.05). The hyperfunction of the thyroid body (gland), apparently, has a stimulating effect on the secretion of natriuretic peptides as the early marker of CHF. Conclusions: At comorbid patients with a thyrotoxicosis and an ischemic heart disease in the conditions of clinically expressed CHF the highest NT-proBNP level, apparently, is caused by influence on production of a natriuretic peptide both hyperfunction of a thyroid gland, and restructuring and a dilatation of cavities of heart, which dictates the need to revise the threshold values of serological markers for the timely diagnosis of heart failure and optimize the maintenance of this category of patients.

The aim of the research. The aim of this study was to investigate risk factors of arrhythmias, the frequency of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF) and AKI impact on dynamics of electrocardiographic parameters. Materials and methods.103 patients with acute decompensation of chronic heart failure who were survival on 10 hospital day were studied. Twenty-four-hour ECG recordings were performed on 1 and 10 days of hospitalization using automatic algorithm to measure QT and heart rate for analyze the arrhythmogenic factors. AKI was diagnosed according to KDIGO Guidelines (2012). Results. AKI was revealed in 25 (24,3%) patients with ADCHF. At admitted to the hospital the corrected interval QT (QTc) > 440 ms had 42(41%) patients with ADCHF. Stabilization of the state is characterized by shortening of the QTc interval. In men, AKI had impact on the QTc: 475,50±31,72 ms vs. 445,16±29,67 ms without AKI (р=0,02). This effect persists until discharge from hospital. In women, the effect of AKI on the QTc prolongation was not detected. Patients with AKI had more premature ventricular complexes: 622,0 (128,0; 1488,0) premature ventricular complexes vs. 389.0 (42,0; 1237,0) premature ventricular complexes in patients without AKI on admission (p=0,005 ), 501,0 (81,0; 1150,0) premature ventricular complexes in patients with AKI vs. 325,0 (70,0; 1228,0) without AKI (p <0,001) on the 10th day of treatment. In sinus rhythm revealed an increase of the index of variability of QT and pathological significance of heart rate turbulence. The values of heart rate variability, exceeding the “risk-sharing point of death” did not improve on 10 day treatment. Conclusion. At admitted to the hospital QTc prolongation was found in 42 (41%) patients with ADCHF. In men, the presence of AKI was associated with the QTc prolongation. Although there is clinical stabilization in patients with acute decompensated of chronic heart failure on 10 day treatment arrhythmogenic factors are saved.

 

Pneumocephalus is defined as intracranial air. Pneumaticcephaly is associated with several etiological factors, such as head injuries, surgical interventions, infections and neoplasms. On average, the incidence of posttraumatic pneumocephaly fluctuates between 0.5-1% of all skull injuries. Spontaneous pneumocephalus without cerebrospinal fluid leak is very rare. Clinical manifestations of pneumocephaly depend on the location and volume of air in the cranial cavity. The most common and described symptoms are headache, “splashing sound”, rhinorrhea and otorrhea, meningism, dysfunction of cerebrospinal nerves, epileptic seizures, collaptoid states, psychiatric symptoms. In this article we report an effective treatment of spontaneous cerebrospinal fluid leak, complicated by pneumocephaly and meningitis. A 57-year-old patient was admitted to National Scientific and Practical Center of Neurosurgery named after academician N.N. Burdenko in the department of neurotrauma in a serious condition. Medical history: One year ago the patient began to notice the flow of clear fluid from the left nasal passage, which periodically spontaneously ceased, then again recurred. Two months before admission she noticed headaches, fever, nausea, vomiting. Objective data on admission: serious condition, level of consciousness: stunning, drowsiness, lethargy. There is stiff neck. The SCT of the brain shows destructive changes in the posterior wall of the main sinus, with the presence of the exudative component in the left parts of the main sinus, the latticed labyrinth, the posterior parts of the left maxillary sinus. In the ventricular system, basal cisterns, anterior sections of the frontal lobes, the accumulation of air is determined. Under general anesthesia, the operation “Endoscopic endonasal plastic of a complex skull base defect in the region of the sphenoid sinus on the left under the control of the navigation system” was performed. There was subdural injection of 1.0 ml of 5% of Fluorescein sodium. CSF rhinorrhea stopped completely after the surgery with complete resolution of pneumocephalus before discharge.

 

The Vestibular Neuritis is often mistakenly diagnosed pathology manifested by a sudden acute systemic dizziness, nausea, vomiting, unsteadiness when walking and peripheral nystagmus. The Vestibular Neuritis often occurs under the guise of different diseases — migraine, Meniere’s disease, acute disorders of cerebral circulation and others. The vestibular Neuritis is a quite rare pathology, which may cause diagnostic difficulties for physicians of different specialties. As the diagnosis of “vestibular neuritis” is primarily a “diagnosis of exclusion”, it is necessary to know peculiarities of clinical picture, course and differential diagnosis with other similar netalogue. The diagnosis of the disease requires the joint and coordinated work of medical specialists: neurologists, ENT, specialists of functional and laboratory diagnostics and laboratory services. Due to the low awareness of this disease doctors of different specialties often make mistakes in diagnosis and treatment. The article presents a clinical case of development of the vestibular Neuritis under the guise of ischemic stroke in the vertebral-basilar pool as an example of the difficulties of differential diagnosis in clinical practice. On the example of a clinical case the course of the disease and possible complications that can occur during this nosology are considered.