A special group of iatrogenic complications are associated with various diagnostic manipulations — from a physical examination of the patient to angiographic studies, diagnostic laparoscopy or  thoracoscopy. The article presents data on the frequency and nature  of diagnostic iatrogenic in clinical practice. The range of diagnostic  iatrogenesis in terms of its manifestations, severity and prognosis is  wide enough — from skin irritation with gel during ultrasound to  dissection of the coronary artery during coronary angiography. The  article presents examples of iatrogenic diagnostic procedures,  starting with the clinical examination process (collection of  complaints and anamnesis, physical examination), and ending with  complex invasive examinations. Yatrogenia, which occur with the use of preparations containing contrast (in particular iodine-containing  drugs), which are widely used in clinical practice (CT with contrasting, angiography, etc.) with a diagnostic purpose, are considered in detail. The article describes the risk factors, knowledge of which and awareness of their presence in the patient are  mandatory before the introduction of drugs containing contrast. The  review of complications arising during endoscopic examinations was  carried out. The author reminds that iatrogenic events in endoscopic procedures can be manifested not only by complications  from the organ under examination (esophagus, stomach, intestines), but also depend on the patient’s condition, his preparation for the procedure, and the specialist’s possession of endoscopic technique. In conclusion, the author gives a clinical observation in which the  risk factor of the iatrogenic event was the presence of an anomaly in the liver and pancreas duct systems in the patient. The author of the article encourages colleagues to pay more attention to the process of making a decision to conduct a diagnostic study, always to evaluate  the benefit / risk ratio in terms of the real usefulness of the  diagnostic study for the patient and the risk of complication development.

Since the moment when the obstructive nature of sleep apnea was first revealed, many new in-formation on this disease have been obtained. Now obstructive sleep apnea (OSA) recognized as an  independent predictor of the development of impaired glucose  tolerance (insulin resistance, fasting hyperglycaemia), type 2  diabetes mellitus (DM2), resistant arterial hypertension, cardio- vascular death. The problem of identifying and treating patients with OSA is still actual. In real clinical practice, there is a need for an integrated approach to the diagnosis and therapy of comorbid OSA patients with metabolic impairment and cardiovascular  diseases.

The aim of this review is to assess the clinical and  pathogenesis features of metabolic impaired, carbohydrate metabolism, basic metabolism, eating behavior, body weight fluctuations in patients with ob-structive sleep apnea syndrome. 

Methods. In our work, we used a retrospective analysis of pub-lished clinical research data of domestic and foreign authors  over the past 20 years. The review included studies with adequate  design from the standpoint of «good clinical practice» (GCP) and  evidence-based medicine.

The conclusion. According to modern  interpretation, obstructive sleep apnea is considered as an  independent disease that has its pathogenic mechanisms, clinical  and functional manifestations. There are several main causes of the effect of OSA on the metabolic component and the work of the cardiovascular system. Among them, intermittent hypoxemia,  endothelial dysfunction, fluctuations in intrathoracic pressure,  increased activity of the sympathetic nervous system, disturbance of the structure of sleep are leading. OSA is considered as a disease capable of disabling patients of working age, dramatically changing  the quality of life, leading to early mortality due to cardiovascular  disasters. Timely detection of clinical symptoms of OSA and the  strategy of early administration of CPAP therapy significantly  improve the quality of treatment and prognosis of comorbid patients.

Despite the widespread prevalence of chronic hepatitis all over the world, the impact of these diseases on the pregnancy course and on the childbirth is still insufficiently investigated. Recently, some  studies have been published, discussing the relationship between the state of the placenta and the risk of the mother to child transmission of hepatitis. The aim of this work was to make a comparative  analysis of the features of pregnancy in women with chronic  hepatitis B and C (CHB and CHC, respectively), to evaluate the  relationship between inflammatory changes in the placenta and the  frequency of hepatitis markers detection in cord blood. In this work  we present a retrospective analysis of the birth histories of randomly selected women with chronic hepatitis which gave birth in  the maternity hospital No. 16 in St. Petersburg. In total, 35 pregnant women with CHB and 36 pregnant women with CHC were included in this study. Excluded from the study were women with co-infections,  cirrhosis and severe concomitant diseases. The studied groups had  no significant differences in the age, weight and height, as well as in  the number of pregnancies and childbirths in the anamnesis.  According to the results of our study, there were no significant  differences in the state of newborns from the mothers with CHB and  CHC. According to our data, anemia during pregnancy occurred  significantly more frequently in women with CHB than with CHC. It  has been shown that in both groups, the choriodeciduitis was observed in almost a half of the women. Remarkably, the frequency of premature rupture of membrane in both groups was significantly  higher than the average in the population. In addition, a reliable  relationship between inflammatory changes in the placenta and the  detection of HBsAg in the cord blood was revealed. This relationship  suggests that in women with inflammatory changes in the placenta,  the risk of hepatitis B vertical transmission may be higher.

The study aimed to evaluate the effectiveness of pharmacological preconditioning and postconditioning with sublingual adenosine in prevention of reperfusion damage in patients with ST-segment elevation myocardial infarction.

Material and methods. In prospective trial 166 patients with STEMI were randomized to sublingual adenosine prior and after  percutaneous coronary intervention (n=82) or standard therapy  (n=84). Reperfusion arrhythmia, blood level of troponin T and effectiveness of reperfusion was assessed.

Results. According to PCI results angiographic success was achieved in 88.1% patients of adenosine group and 92.7% patients of  standard therapy group (p > 0.05). The reperfusion arrhythmias rate was significantly low in adenosine group (78%) compared to control  (92.9%, p = 0.013). The use of adenosine was associated with  25.4% risk reduction in life-threatening reperfusion arrhythmias  (p<0.01). During 24 h after PCI troponin T level decreased in both  groups more significantly in adenosine (p < 0.05). The use of  adenosine was associated with 8.3% risk reduction in myocardial  reperfusion damage (p < 0.05).

Conclusions. The pharmacological preconditioning and  postconditioning with sublingual adenosine in the perioperative  period of PCI in patients with STEMI is usefull to prevent myocardial reperfusion damage but does not affect the efficiency of reperfusion.

In modern society, chronic obstructive pulmonary disease has been isolated relatively recently in an independent nosological unit and, along with cardiovascular diseases, constitutes the leading group of  socially significant chronic diseases, being one of the most important medical and social problems of pulmonology.

The aim of the study was to determine the possibility of predicting and early diagnosis of coronary heart disease in patients with chronic obstructive pulmonary disease living in the North on the basis of evaluation of morphofunctional parameters of the cardiovascular system.

Materials and methods. During the prospective five-year follow- up, an in-depth instrumental examination of 182 patients with chronic obstructive pulmonary disease was conducted to identify the  five-year dynamics of the morphofunctional parameters of the  cardiorespiratory system at various levels of coronary risk taking into account gender differences. In 66 patients (mean age 64.0 ± 1.1 years) (comparison group), nonfatal coronary events were recorded during follow-up.

The conclusion. 1. In the North, cardiac remodeling in patients with chronic obstructive pulmonary disease includes changes in the right divisions due to persistent obstructive disorders and a decrease in  pulmonary volume, as well as an increase in left chambers, a  decrease in myocardial contractility, and progressive left ventricular  hypertrophy. 2. In the course of prophylaxis in case of outpatient  examination of patients with chronic obstructive pulmonary disease,  it is necessary to determine the criteria for predicting high and very  high coronary risk according to the formula d = 0.000108 (Systematic Corоnary Risk Evaluation × “Northern Experience” × frequency of exacerbations of chronic obstructive pulmonary disease × terminal diastolic size of the left ventricle (mm) × systolic blood pressure in the pulmonary artery (mm)) for women  and d = 0.000078 (Systematic Coronary Risk Evaluation × frequency of exacerbations of chronic obstructive pulmonary disease × diastolic left ventricular size (mm) × reserve expiratory volume (%)) for men. A high and very high risk can be determined at d≥ 27.5 for women;  at d≥ 16.2 for men.

The complexity of therapy of lipid metabolism disorders is not only in comorbidity and polypragmasia, but also in predicting a genetically determined response to the treatment. The aim of our work was to  study the pharmacogenetics features of pharmacotherapy of patients with non-alcoholic fatty liver disease, with various forms of IHD, and  patients taking statins. We investigated 4 study groups: I — 60  patients with 2 type of diabetes and non-alcoholic fatty liver disease  (APOE polymorphism); II — 187 patients with IHD (eNOS, AGTR2,  CYP2D6 polymorphisms); III — 111 people with AH and CHF  (polymorphisms: AGT: 704 (Met235Thr), AGT:521 (Thr174Met),  AGTR1: 1166, AGTR2: 1675, CYP11B2: -344, GNB3: 825, ADD1:  1378 (Gly460Trp), NOS3: -786); IV — 62 patients taking  atorvastatin (SLCO1B1*5 polymorphism). Patients with E2, E4 alleles of the APOE gene, taking essential phospholipids, improved  parameters of total cholesterol, HDL, LDL, CA, AP; patients with E3 alleles had a positive dynamics of cholesterol, HDL, TG, LDL, VLDL, CA, urea. Patients having “slow” allelic variants of the gene CYP2D6*10, CYP2D6*4 had received metoprolol, had greater  decrease in heart rate: 1.6 times for CYP2D6*10, 1.7 — for  CYP2D6*4. Earlier debut of IHD is noted in patients with TT variants  of the eNOS gene comparing the patients with GG and GT variants.  Dosages of perindopril depend on AGTR2 gene polymorphisms. The  prevalence of polymorphisms AGTR2: 1675, CYP11B2: -344, NOS3: -786, AGT: 704, GNB3: 825 increases with the increase in the stage of CHF. The parameters of intracardiac hemodynamics in patients  with CHF are associated with AGT: 704, NOS3:-786, GNB3: 825,  ADD1: 1378, AGT: 521 polymorphisms. Allele C of the SLCO1B1*5  gene is associated with an additional risk of statin-induced  myopathy. So the treatment of diseases associated with  atherosclerosis, needs using of a personalized approach for more  effective and safe therapy.

The aim of the study was to study the role of gastrin in disturbing the motor-evacuator function of the gallbladder and the biochemical properties of bile in cholelithiasis.

Material and methods. 230 patients with pathology of the biliary system were examined. In verification of the diagnosis, in addition to general clinical data, the results of ultrasound investigation of the  hepatobiliary system were used. Cholecystometry and dynamic hepatobiliary scintigraphy were used to study the functional state of  the gallbladder. In various variants of the motor-ejaculatory function  of the gallbladder, a study was made of the biochemical properties of bile (cholesterol, bile acids, cholate-cholesterol coefficient) obtained  as a result of multifraction duodenal sounding. The level of the  gastrointestinal hormone gastrin in the peripheral blood was  determined by the enzyme immunoassay.

Results. With ultrasound, 78% of the patients in the US are diagnosed with signs of biliary sludge. In 75.4% of cases with microscopy of the same species, crystals of cholesterol and  calcium bilirubin were detected. The study of the biochemical  composition revealed an increase in cholesterol, a decrease in bile  acids and a cholate-cholesterol coefficient in portions B and C of bile. Disturbances of motorevacuation function of the gallbladder, which are one of the pathogenetic factors of cholelithiasis, were detected in 72% of the patients examined. In patients, the level of gastrin was  reduced, and to a greater extent — with gallbladder hypomotorism.  The significant role of gastrin in changing the functional state of the  gallbladder and, therefore, in the formation of lithogenic bile is  established by the method of correlation analysis. The conclusion.  Investigations of the parameters of the motor function of the HP and the biochemical properties of bile on the one hand and the level of the gastrointestinal hormone gastrin on the other have shown the important role of hypogastrinemia in the formation of lithogenic bile by suppressing the emptying of the HP.

The aim of the study was to study the influence of adherence to treatment on myocardial dysfunction in elderly and senile patients with ischemic heart disease (IHD) and chronic heart failure (CHF).

Material and methods. The study included 86 patients with ischemic heart disease (CHD) of older age groups admitted to  hospital treatment because of the progression of CHF: 21 patients — 65 to 74 years, 65 patients — 75 to 89 years. A standard clinical  study, echocardiography with global longitudinal strain assessment (GLS), and a Morisky-Green test were performed.

Results. It is established that in the group of persons of senile age  there is a lower adherence to treatment and more pronounced  structural and functional changes in the myocardium. The following  correlations were revealed: total score of the Morisky-Green test  with the left ventricular end-diastolic volume (r = -0.33, p <0.05), with the E/e’ (r = -0.37, p <0.05), with GLS (r = 0.53).

Conclusion. The findings indicate a lower adherence of the senile patients on treatment of IHD and CHF in comparison with the  elderly. Low adherence to therapy, as well as postinfarction  cardiosclerosis, can apparently be considered as one of the factors contributing to the progression of myocardial dysfunction.

The article describes clinical features, differential diagnosis and treatment of chronic calculouse pancreatitis (HCP) with alcoholic liver cirrhosis (LC). Considered etiologic role of chronic alcohol  intoxication in the development of these diseases. There was long- term use of alcoholic beverages at hepatotoxic doses and smoking in anamnesis. Patient was examined before entering in our clinic.  Сhronic heart failure, nephrotic syndrome, paraneoplastic was  excluded as the cause of hydrops. Patient R. was hospitalized in the  gastroenterology department with ascites of unknown etiology. The  severity of the patient’s condition is caused by malabsorption  syndrome and hepatocellular insufficiency leading to the  development of edema-ascitic syndrome and trophological failure. In patient there was low of proteins (total protein — 38 g / l), low of  albumins (14 g / l). In carrying out endoscopy showed signs of portal hypertension: esophageal varices 1 degree, portal gastropathy; In addition, an increase in the size of the papilla of  Vater. To clarify the nature of the defeat of the pancreas held  endosonography, in which multiple calcifications are found in the  pancreas tissue. To resolve biliary hypertension performed stenting of the common bile duct. Drain the pancreatic duct failed due to the presence of calculus in it at the level of the isthmus. Treatment for  our patient should be considered the imposition Ru’s operation. This  observation demonstrates social importance of problems of  combination HCP with a LC, which lead to reduced quality of life,  early disability, reduced life expectancy, as well as to an increase in treatment costs.

We present a description of the clinical case of a patient with an erythematotelangiectatic type of rosacea. Rosacea is a chronic recurrent dermatosis, characterized by skin lesions of the face in the  form of erythema and papulopustular elements, which has  polyethological origin. The disease occurs more frequently in women  aged 30-50 years who have a certain genetic predisposition to  transient reddening of the skin of the face or less often of the neck  and the decollete zone. It is believed that the dermatosis is more  likely to affect the I and II phototypes, but the disease can occur in  any skin phototype. The patient came to the clinic with complaints  about rashes in the chin and nasolabial triangle, flushing of the face,  accompanied by tingling and burning. The patient turned to the clinic with complaints about rashes in the chin and nasolabial triangle,  flushing of the face, accompanied by tingling and burning. She never consulted a dermatologist before. A diagnosis was made: “erythematotelangiectatic type of rosacea” (according to the  classification proposed by the USA National Rosacea Society, stage I  — persistent erythema and telangiectasia). Using the scale of diagnostic evaluation of rosacea, it was evaluated at 12 points.  There are many approaches to the treatment of rosacea. Drug  therapy is divided into systemic, external and complex. Systemic therapy has a number of side effects, so for light and medium-to- severe rosacea, only external therapy is more often prescribed.  Because of the presence of pathologically altered vessels, the low  efficacy of metronidazole, the patient was assigned a course of  phototherapy with intense incoherent pulsating light at standard  parameters. There was a significant improvement after two  procedures, but vessels smaller than 0.4 mm remained intact, so the duration of the first pulse was increased in order to influence small- caliber vessels. Individual selection of parameters (duration of the first impulse and fluence) was made based on the dermatoscopic picture and patient’s phototype, which resulted in a significant  clinical effect and persistent remission. Using the scale of diagnostic  evaluation of rosacea it was evaluated at 1 point after treatment.  This clinical case demonstrates the effectiveness of phototherapy  with intense incoherent pulsating light with individual selection of the duration of the first pulse and energy density in patients with  erythematotelangiectatic rosacea. In IPL-treatment schemes, it is  desirable to select individual parameters for the duration of the first pulse and the energy density, based on the features of the dermatoscopic picture and skin phototype of each individual patient.

Transient global amnesia was established by Fisher et Adams is 1964 for phenomena characterized by the sudden onset of all types memory loss, retrograde amnesia and the inability to form new  memories and to recall the recent past. The incidence of TGA is 5  to10 people per 100,000 worldwide but the real incidence is unknown because the episodes of memory loss are temporary and many patients don’t go to see a doctor at the time of attack. The triggers of TAG are physical activity, sexual  intercourse, pain, Valsalva maneuver etc. In routine clinical practice  TAG is more important for neurologists. But this problem is also  interesting for therapeutists because TAG could be developed in  patients with arterial hypertension, foramen ovale, mitral valve  prolapse and heart blocks. We present a 57-year-old female with  TAG. She was admitted to the hospital due to hypertensive crisis and an impaired ability to retain new information that started after  physical activity. The diagnosis of TAG was based on information  from attacks witnesses, the sudden onset of anterograde amnesia,  normal cognition of the patient and short duration of attack. Also,  the patient had no features of stroke, acute hypertensive encephalopathy, epilepsy and alcohol blackout. TAG is more typical for females over 50 years, all symptoms start after physical activity and resolve within 24 hours. It is characterized by reversibility of all symptoms and good prognosis of 2 years of follow-up.