Biography of Professor Ignatowski A.I. is an example of outstanding personality in the history of medicine, beginning of XX century. Collecting information about this scientist, we managed to trace his whole life path. In this article we tried to concentrate on the most important events of his bright life and professional activity. Alexander I. Ignatowski (1875-1955) — therapist, doctor of medicine, professor, the first head of the Faculty therapeutic Department of the Imperial University of Warsaw from 1915 to 1920 in Rostov-on-Don, State Councilor, Knight of the Order of St. Anna 2 class. Studies carried out in his laboratories and dedicated to the search for the relationship between cholesterol and fatty foods experimental atherosclerosis did Ignatowski one of the founders of the doctrine of atherosclerosis in the world. This achievement was recognized in the United States as one of the 10 most important discoveries in medicine and is described in the book of the same name. His pioneering work laid a solid foundation for further research in the field of lipidology. In Germany, prof. K.T. Far, in Russia — Anichkov N.N. And Khalatov S.S. were among the first scientists who used the experimental protocols of Ignatowski and successfully reproduced his experiments. Thanks to this extensive work, today we have detailed knowledge of the pathophysiology of atherosclerosis, the causes of its occurrence, the consequences of its development, the methods of diagnosis and treatment, and can calculate the risk of cardiovascular events and influence life expectancy. The rich scientific heritage left after him, still has not lost its relevance, and the hypothesis put forward by him almost 100 years ago, repeatedly confirmed.

Proton pump inhibitors are a widely used in clinical practice, and are taken by millions of patients around the world for a long time. While proton pump inhibitors are well-tolerated class of drugs, the number of publications has been raised about adverse renal effects, specially their association with acute tubulointerstitial nephritis. It is one of the leading causes of acute renal injury and have catastrophic long-term consequences called chronic kidney disease. In this review, we consider epidemiology, pathogenesis, diagnostic criteria (including biopsy and morphological pattern), clinical manifestations and treatment of proton pump inhibitors-induced acute tubulointerstitial nephritis. A subclinical course without classical manifestations of a cell-mediated hypersensitivity reaction (fever, skin rash, eosinophilia, arthralgia) is characteristic of acute tubulointerstitial nephritis. Increased serum creatinine, decreased glomerular filtration rate, electrolyte disorders, pathological changes in urine tests are not highly specific indicators, but allow to suspect the development of acute tubulointerstitial nephritis. The “gold” standard of diagnosis is the intravital morphological examination of the kidney tissue. Timely diagnosis and immediate discontinuation of the potentially causative drug is the mainstay of therapy and the first necessary step in the early management of suspected or biopsy-proven drug-induced acute tubulointerstitial nephritis. The usage of proton pump inhibitors should be performed only on strict indications with optimal duration of treatment and careful monitoring of kidney function. Multiple comorbidities (older age, heart failure, diabetes, cirrhosis, chronic kidney disease, hypovolemia) increase potential nephrotoxicity. Awareness of this iatrogenic complication will improve diagnosis of proton pump inhibitors-induced acute tubulointerstitial nephritis by multidisciplinary specialists and increase the possibility of successful treatment.

The aim of the study is to conduct a research of patient encounters concerning tick bites and incidence rates of infections transmitted by ixodid ticks among Moscow population; to estimate data about abundance of ticks infected with human diseases in Moscow region and formulate an approach to non-specific prevention of human diseases, transmitted by ixodid ticks, taking into account the city environment. Materials and methods. We have analyzied quantitative data provided by Federal Service on Surveillance for Consumer rights protection and human well-being (period: 2013-2016) about patient encounters concerning tick bites and incidence rates of infections transmitted by ixodid ticks among Moscow population. We employed standard method of collecting and tracking Ixodid ticks abundance in the parks and parklands of Moscow using “flags” and “trackers” within vegetation. Existence of infectious agents in Ixodid ticks was identified with PCR method in the laboratory of the department of highly infectious diseases FBHI «Moscow Centre of Hygiene and Epidemiology». Results and considerations. Epidemiological situation in Moscow in 20132016 concerning infections transmitted by ixodid ticks remains stressful. According to Federal Service on Surveillance for Consumer rights protection and human well-being, Lyme disease and introduced cases of tick-borne encephalitis were registered in Moscow. In 2016, 61 parks and parklands were listed as a potential life environment for Ixodid ticks. Investigation of the cases about infectioning with Lyme disease agents in Moscow region in 2013-2016 revealed that most of the cases were registered in East and North-West districts of Moscow in «Losiniy Ostrov» and «Serebryaniy Bor» parks. Conclusion. In the megapolis environment the approach to prevent infectious diseases transmitted by ixodid tick should be multifaceted. The greatest value should lie in non-specific prevention aimed on protection against several infectious agents that might be in a tick.

Аim. To investigаte the prevаlence of аnxiety аmong the medicаl students аnd its аssociаtion with risk fаctors for non-communicаble diseаses. Subjects аnd methods. Using epidemiologicаl methods, we surveyed 268 third-yeаr students (boys аnd girls, meаn аge 20.6±3.7 yeаrs) of the medicаl fаculty of the Kаbаrdino-Bаlkаriаn Stаte University nаmed аfter H.M. Berbekov. Screening included a survey to identify lifestyle indicators (basic demographic information, including age, sex, literacy, and highest level of education, tobacco use, alcohol consumption, fruit and vegetable consumption, physical activity); evaluation of physical data (blood pressure, heart rate, weight, height, waist circumference); psychological testing. The statistical analysis of the data was carried out using the program STATISTICA 6.0 (StatSoft Inc, USA). Results. We identified the levels of anxiety and the prevalence of high anxiety among students. The situation in the group of girls was the least favorable, 73.3% of which showed high personal anxiety, and the average levels of personal anxiety were 50.6 ± 7.5 points. We have shown correlations between levels of anxiety and risk factors of non-communicable diseases: tobacco use, alcohol consumption, fruit and vegetable consumption, physical activity. Students with high personal anxiety had а high prevalence of а number of social, behavioral and biological risk factors of non-communicable diseases. In the same group, the prevalence of a number of non-infectious disease risk factors was significant, which causes a greater susceptibility to their development of noncommunicable diseases. Conclusion. The obtained results are the basis for further monitoring of the epidemiological situation and planning for the primary prevention of non-communicable diseases among the student population. 

The aim of the research under consideration is to compare clinic instrumental parameters which characterize left ventrical functional status of the patients who have recently suffered acute coronary syndrom (ACS) and of those who endured it 24 months before within aggravated and nonaggravated ischemia clinic course. Methods and materials. The research involved 150 patients who had suffered ACS. The first group included 112 patients with non-aggravated course, the second group was represented by 38 patients with the agravated one. The methods applied were general, laboratory and instrumental. Re-examination was carried out 24 months after the suffered ACS. The global systolic and diastolic left ventrical function evaluation was perfomed with the help of echocardiograghy. The method of Tissue Doppler Imaging (TDI) was used in order to estimate segmental contractility. Results. Those patients with the aggravated ischemia clinic course are distinguished by more frequently repeated anginal atacks and by a higher functional class of blood circulation insufficiency. Comparison of the echocardiography markers within 24 months period after the suffered ACS revealed left ventrical global systolic disfunction. Considerably more patients with the aggravated clinic course have left ventrical diastolic dysfunction. The segmental contractility analysis with the help of the TDI enabled to reveal the decrease of systolic and early diastolic velocity peaks among the patients with the aggravated IHD course variant. Moreover, a lapse of basal segment longitudinal inferior wall strain value was discovered which is not compensated by the LVanteroseptal mid-segment contractility augmentation. Conclusion. As a result of the comparison of clinical instrumental parameters a global and a segmental LV dysfunctions were discovered among the patients with the aggravated IHD clinic course 24 months after an endured ACS.

The aim of the study was to evaluate the effect of omega-3 polyunsaturated fatty acids on the main metabolic rates of the arachydonic acid cycle in patients with acute myocardial infarction in the context of traditional complex therapy. Materials and methods of research. We conducted an open, randomized study of two groups of patients (n=59) with acute myocardial infarction (MI), which did not undergo angioplastic and thrombolysis: in the main group (n=26) traditional complex therapy (including double antiaggregant therapy) from the first day supplemented with Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] 1g. per day. In the control group (n=33) only complex therapy was performed. The main components of the arachydonic acid cycle — thromboxane B2 (TxB2) and prostaglandin I2 (PgI2), as well as their analogues, thromboxane B3 (TxB3) and prostaglandin I3 (PgI3), resulting from the replacement of arachidonic acid by omega-3 PUFAs, were evaluated for all patients on the 1st, 7th, 14th days after the onset of MI in the blood plasma. Results of the study. On day 14, an increase in the level of prostaglandin I3 in the Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] group was observed in 10 times, the level of thromboxane B3 was increased in 15.9 times, in the absence of significant differences between the groups in the thromboxane B2 and prostaglandin I2 level. A decrease in the ratios of PgI2 / PgI3 and TxB2 / TxB3 in the main group also was noted. Conclusion. Given the lower functional activity of thromboxane B3 and the decrease in the ratio of TxB2 / TxB3, against the background of Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] therapy, one can judge the presence of an independent antiaggregant effect of omega-3-polyunsaturated fatty acids as a result of their use in patients with MI.

Objective: study of the efficacy of tiotyprid hydrochloride in the complex therapy of patients with gastric ulcer and duodenal ulcer with concomitant chronic duodenal insufficiency. Materials and methods. Verification of ulcer disease was performed clinically and by fibrogastroduodenoscopic researches. In determination of chronic duodenal insufficiency there were used data of contrast duodenography and cavitary manometry. We have studied motor performance of the stomach and gastroduodenal ulcer with a help of peripheral electrogastrograph ЭГГ-4М. The protective properties of gastric mucus were determined by using the Sialo Test reagent kit. Gastrin, cortisol, insulin in the blood serum were studied with a help of method ELISA. Results of the study. We have carry out complex examination of 104 patients with ulcer disease which were divided into 2 groups. The 1st group consisting of 52 patients with gastric ulcer with concomitant HDN was given in the complex therapy prokinetic taupoide hydrochloride in dose of 50 mg 3 times a day for 2 weeks. The 2st group in the number of 52 patients with gastric ulcer with concomitant HDN received only standard anti-ulcer therapy. With a comparative evaluation of the effectiveness of therapy in patients 1 gr. established, in addition to the positive dynamics of clinical symptoms, a distinct improvement in the motor activity of stomach and duodenum, the restoration of the gatekeeper’s closure function, and the enhancement of protective and protective properties of gastric mucus. The scarring of ulcer was revealed in 97,4 ± 1,8% of patients of 1 group, in 87,1 ± 0,41% cases in the stage of mature “white rumen” (S2). In patients 2 group the scarring of the ulcer occurred in 92.1 ± 3.1% of cases, but in 41 ± 4.3% of cases, ulceration was substandard, that is, in the “red scar” stage (S1). Conclusion. The using of prokinete ticopride hydrochloride in the complex treatment of gastric ulcer with concomitant HDN is pathogenetically substantiated and clinically effective.

The article describes a clinical case of the occurrence of complex disorders of the heart rhythm and conductivity in a patient of 45 years with decompensated hypothyroidism. The literature data on specific cardiomyopathy appearing in patients with hypothyroidism (“hypothyroid heart”), metabolic, hemodynamic changes against the background of hypothyroidism and possible violations of heart rhythm and conductivity are given. In the described clinical case the patient’s medical history is given, who has been observed in an endocrinologist for hypothyroidism for the last 3 years. 6 months before this hospitalization patient stopped taking levothyroxine on her own initiative. She noticed deterioration in the last 3 months: the clinic of hypothyroidism appeared and began to grow, a frequent extrasystole appeared. At an objective survey — a symptomatology of the expressed hypothyroidism. A comprehensive examination of the patient was performed, which revealed atrioventricular blockade of the 1st degree, frequent ventricular extrasystole, prolongation of the QT interval on the ECG, late ventricular potentials against the background of low concentrations of sodium and potassium in the blood. During the first 24 hours of hospitalization, there was a clinical death. A clear positive dynamics was traced against the background of therapy aimed at the correction of electrolyte disorders, as well as hormone replacement therapy with levothyroxine.

In connection with the polymorphism of clinical manifestations of dermatomyositis, patients in the onset of the disease can apply to doctors of any specialty. However, the statement of this diagnosis causes considerable difficulties for practical doctors who do not work in the field of rheumatology. To a large extent this is due to the fact that inflammation of the muscle tissue can have not only an autoimmune origin, but also be observed with a variety of infections and intoxications. Diagnosis of dermatomyositis is associated with the need to eliminate tumor processes in the body, accompanying it in 20% of cases. The article presents a clinical case of subacute dermatomyositis, which occurred in a man 49 years after massive insolation against the background of photosensitization with fluoroquinolones in the treatment of prostatitis. After detecting a significant increase in the level of serum “muscle” enzymes and electromyographic signs of inflammatory myopathy, a patient with characteristic progressive symmetrical muscle weakness of the proximal limb and skin changes was diagnosed with primary idiopathic dermatomyositis with the activity of III degree. Diagnostic search required the exclusion of infectious and neoplastic diseases. Timely formulation of the diagnosis made it possible in time to prescribe immunosuppressive therapy with glucocorticosteroids, achieving a decrease in the activity of the disease and improving the prognosis.

Primary mesothelioma of the pericardium is a rare heart tumor with a difficult diagnosis, revealed in vivo in less than a quarter of cases. The disease occurs at any age, more common in men and variably exhibits a broad spectrum of non-specific symptoms of congestive heart failure, constrictive pericarditis, pericardial effusion or cardiac tamponade. Patients are usually observed with peripheral edema, ascites, dyspnea, cough, chest pain and atrial fibrillation. Such symptoms, in the absence of cancer alertness, are erroneously attributed by doctors to more common cardiovascular diseases. As a result, primary mesothelioma is detected in 75-90% of cases only at necropsy. The article describes a case of detection at autopsy of primary pericardial mesothelioma sarcomatous type with invasion into the myocardium in a patient of 74 years old. The patient also suffered from concomitant coronary artery disease with a long history of chronic heart failure and recurrent pulmonary embolism, associated with deep vein thrombosis at the final stage of the disease. An objective study revealed signs of chronic heart failure. The laboratory data included mild iron deficiency anemia, insignificant leukocytosis and leukocyturia, as well as signs of moderate chronic kidney disease. Instrumental results corresponded to long-term course of hypertension, signs of congestive heart failure in the presence of atrial fibrillation, atherosclerosis of lower limbs arteries in patient with abdominal obesity. Thus, there were no clinical signs of pericardial damage in a standard examination of the patient. The article describes the complexity of the disease diagnosis, variable clinical picture, as well as the diagnostic value of various instrumental methods from the perspective of evidence-based medicine. It is noted that clinical alertness is still the most important factor in the lifetime diagnosis of pericardial mesothelioma. Disease should be considered in patients with recurrent pericardial effusion, constrictive pericarditis, pericardial mass or thickening of pericardium leaflets. For reliable diagnosis of a tumor, modern imaging studies and histological examination are required.