Despite a significant number of publications devoted to the care of patients with chronic heart failure (CHF), a practicing doctor is not always easy to navigate in the use of medicines and indications for high-tech methods of treatment in these patients. The largest evidence base is currently accumulated in patients with CHF with a reduced left ventricular ejection fraction (CHFrEF), which is characterized by a significant decreasing in the quality of life, decreased/lost ability to work, disability of patients and high mortality. This article details all the essential medicines used for therapy of CHFrEF, the sequence and practical aspects of their prescribing in accordance with contemporary guidelines. The issue of treating patients with CHF refractory to standard therapy, including with the help of a new class of drugs from the group of angiotensin receptor neprilysin inhibitor, cardiac resynchronization therapy, implantation of cardioverter-defibrillators and application of devices for mechanical circulatory support and heart transplantation is considered. The publication is illustrated by tables, figures, diagrams, which makes it accessible for understanding and memorizing. 

Osteoporosis is a systemic skeletal disease is characterized by low bone mass and microarchitectural deterioration of bone tissues, leading to bone fragility and low-energy The incidence of osteoporosis has risen because the life expectancy of the population has been increasing . Osteoporosis is an extremely common disease: osteoporosis affects more than 200million people worldwide and causes more than 8.9 million fractures. In Russia, among people aged 50 years and older, osteoporosis is diagnosed in 34% of women and 27% of men. The social significance of osteoporosis is determined by its consequences — fractures of the bones of the peripheral skeleton and vertebral fractures, leading to high material costs and causing a high level of disability and mortality. The normal physiological process of bone remodeling involves a balance between bone resorption and bone formation. In osteoporosis, this process becomes unbalanced, resulting in gradual losses of bone mass and density due to enhanced bone resorption and/or inadequate bone formation. Several signaling pathways underlying primary osteoporosis have been identified, such as the osteoprotegerin/ receptor activator of nuclear factor kappa-B (RANK)/RANK ligand(RANKL), bone morphogenetic proteins, canonical wnt-signaling pathway. In addition, genetic disorders are involved in the development of the pathogenesis of osteoporosis. To identify osteoporosis, WHO recommends the use of dualenergy X-ray absorptive densitometry, which allows you to study the quantitative characteristics of bone tissue. Currently, there are various methods for evaluation of the quality of bone (microarchitectonics, the ability of bone tissue to be resistant to fracture), but these methods have limitations such as high cost and limited availability for their widespread using. The study of markers of bone remodeling in norm and in pathology helps to assess the quality of bone tissue indirectly, gives prospects in the selection of targeted therapy and improvement of early diagnosis of osteoporosis. 

Objective. To estimate a possibility of use of zinc and its fractions as the indicator reflecting a condition of antioxidant system at sick HOBL and persons from risk groups. Materials and methods. Patients with COPD, smokers and non-smoking healthy people have participated in a research. Everything participated in a research has carried out spirometry with definition of an indicator of FEV1 and the subsequent calculation of FEV1 % of due. Taking into account importance of the occupied role when forming COPD of an oxidative stress have been determined the level of activity of the main enzyme of antitoskidantny protection — superoxide dismutases; level of zinc and its fractions as main component of enzyme and also albumine as main tranporter of metabolic active zinc. The indicator “a share of the related fraction of zinc” for definition of changes in fractions of zinc is entered. Results of the study. It is defined that at the smoking patients with the minimum malfunction of external breath of change of indicators are similar to that at patients with COPD. Statistically significant differences in the level of the studied indicators at non-smoking patients are also revealed. With use of the correlation analysis of Spirmen reliable high correlation communications between FEV1 % from due and activity level superoxide dismutases and also between activity level superoxide dismutases and the general level of zinc and also zinc connected are defined that confirms a hypothesis of a possibility of use of level of zinc and its fractions as the indicator reflecting a condition of antioxidant system at the smoking persons at screening researches. 

Purpose of the study: The aim of the study was to reveal the prevalence of anxiety syndrome in young men (working age) with arterial hypertension (AH), to compare its frequency depending on the presence and absence of obesity (OB), and also to trace its connection with the parameters of left ventricular myocardial remodeling according to echocardiography and with eating behavior. Materials and methods: The examination included 80 patients with AH hospitalized in connection with the deterioration of the course of the disease, as well as for routine examination. Depending on body mass index, all examined patients were divided into 2 groups: 1- with obesity, 2-control. All examinees were questionnaires with questionnaires to identify personal and situational anxiety, as well as various types of eating disorders. Results and discussion: In the course of the study, it was found that the presence of coolant in patients with AH is associated with the inclusion of pathological mechanisms such as anxiety, which in turn lead to the progression of myocardial pathology, in particular myocardial remodeling. It is significant that the anxiety syndrome in OB is directly associated with the restrictive and external type of eating disorders. Conclusion: timely detection of a high level of anxiety, as well as abnormalities in nutritional behavior with OB by testing patients opens up prospects for optimizing treatment using not only medicamental factors, but also psychocorrecting effects. 

The paper presents an assessment of the effectiveness of the method proposed by the authors for the prevention of iron deficiency anemia in minor pregnant women. In the first stage, 593 histories of childbirth were retrospectively analyzed (group 1 — minors 13-15 years (n = 49), 2 group — minors 16-17 (n = 434), 3rd group — middle reproductive age (n = 110) ). In the second stage, a prospective study of the frequency and structure of anemia of pregnant women was carried out (group 1 — minors aged 13-15 years (n = 17), group 2 — minors 16-17 (n = 127), 3rd group — women of middle reproductive age (n = 110)). At the III stage, minor pregnant women were divided into two groups: in 1 (main) group (n = 144), iron deficiency anemia was prevented according to the method we proposed; in the 2nd group (comparison group) traditional therapy with iron preparations was carried out at the appearance of signs of anemia. The essence of the proposed method is that an minor pregnant woman, without waiting for laboratory signs of anemia, is examined for ferritin in venous blood, and at a value below 35 ng/ml, oral iron preparations are prescribed in conventional preventive doses for a period of 3 months, and if through three months the content of ferritin in the venous blood is again below 35 ng/ml — the intake of iron-containing preparations continues for another 3 months. The use of the proposed method contributed to a significant decrease in the incidence of anemia in minor pregnant women. The proposed method of preventing iron deficiency anemia in minor pregnant women helps to reduce the frequency and severity of anemia in this complex category of patients. 

The aim of the study is to analyze the conditions and organization of work of public health workers of state medical organizations in the Far East of Russia according to a medical and sociological survey. Materials and methods. A questionnaire survey was chosen. There are 835 people took part in the poll. To gather social information, three groups of respondents were selected: 1) senior and middle managers, 2) heads of structural units; 3) doctors, various clinical specialties, included in the reserve of management personnel. The collection of statistical data was conducted in 2015- 2017. Statistical analysis of the data was carried out using the methods of calculating relative values, calculating the average values, and ANOVA. Results. According to the obtained results, all groups of respondents believe that present healthcare industry in Russia is developed satisfactorily. Participants in the survey estimate the current state of resources of public health institutions rather low. According to the survey results, health workers give an unsatisfactory assessment of the technical condition of the buildings of medical organizations, of the provision of doctors and middle medical personnel. Among the proposed motivational factors of labor activity, healthcare workers and give a satisfactory assessment of such factors as: the discipline of work, the amount of work, the safety in the workplace, the stability of the workplace and interpersonal relations with colleagues. Opinion of medical workers does not coincide in the assessment of factors: wages, technical support of the workplace, the volume of document circulation, the opportunity for professional development, self-realization and career growth. Senior and middle managers assess these factors as «satisfactory», doctors give an assessment of «unsatisfactory». Heads of structural subdivisions assess the factors of technical support for the workplace, the size of wages and volume of document circulation is «unsatisfactory», the opportunity for professional development, self-realization and career growth as «satisfactory». Conclusion. Based on the subjective opinion of health workers, the results of the study made it possible to identify a number of economic and organizational aspects of working conditions in public health institutions that require scientific and practical justification in health care and management decisions affecting the development of the industry. 

The study objective was to analyze the clinical signs of chemotherapy-induced neuropathy (CIPN) in cancer patients and explore pharmacotherapy correction options using vitamin B. Materials and design. During Part 1 lasting from May to September 2017, we screened and then enrolled 219 consecutive patients (mean age of 50.4 ± 6.9 years); 105 (46.7%) of them were women undergoing chemotherapy treatment cycles at Samara Regional Oncological Clinic. Through standard-of-care neurological examination and patient responses we defined the clinical signs of polyneuropathy: its localization, primary symptoms, including sensory impairments and/or pain, and then randomized the patients into two groups: group 1 received vitamin B agents, and group 2 received no vitamin B. The patients were observed for 60 days. Results. The incidence of polyneuropathy in oncology patients receiving chemotherapy turns out to be very high. The phenotype of clinical signs and their severity and localization is probably related to the type of the drug agent used. We have proved the efficacy of the step-down therapy with vitamin B agents used to improve clinical signs of polyneuropathy. 

The work purpose — to describe a clinical case of formation and a current of a chronic thromboembolic pulmonary hypertensia (CTEPH) at the patient of young age. Materials and methods. The patient P., 26 years, arrived with complaints to the dyspnea arising at rest and amplifying at the minimum exercise stress, edemas of the lower extremities. In the anamnesis — a clottage of subclavial and humeral veins on the right, recurrent PTE. Results. During inspection at the patient an echocardiography signs of a pulmonary hypertensia. According to contrast-enhanced multislice computed tomography in dynamics there was a dissolution of thrombs in a lumen of a pulmonary artery. At the patient data for a thrombophilia or a systemic vasculitis aren’t taped. Conclusion. In this clinical case features of a current and maintaining the patient of young age with CTEPH after the postponed PTE are displayed. The young age, idiopathic and recurrent character of a pulmonary embolism were the contributing risk factors of development of CTEPH. 

Introduction. The importance of the HCV-infection is determined by the wide spread, progressive course, the formation of liver cirrhosis (LC) and hepatocellular carcinoma. The mechanisms of the effect of the virus on hepatic cells, the processes of fibrogenesis and fibrolysis, mechanisms of the reverse development of the LC remain unexplored. There is no effective pathogenetic therapy. The aim of the study — determination of the effectiveness and safety of intrahepatic transplantation of mesenchymal stem cells (MSC) in chronic HCV-infection at the stage оf LC. Methods. A patient with HCV-LC who has a secondary hemorrhagic vaculities who underwent autologous MSC transplantation into the liver tissue. The liver biopsy specimens were studied in dynamics by light and electronic microscopy and by immunohistochemistry. Results. The transplantation and posttransplantation period proceeded without complications. After the introduction of MSC the features of the formed micronodular LC remained. In some parts of the samples, the septa looked thin, sometimes perforated, indicating a resorption in this place of fibrous tissue. There was a decrease in the degree of transdifferentiation of stellate cells into myofibroblasts, a decrease in the number of fibroblasts and fibroblasts, there were no immune reactions in the form of deposition of amorphous and fibrous masses of moderate electron density along the sinusoidal capillaries that were significantly expressed in the primary biopsy. These changes were combined with the appearance of hepatocyte heterogeneity in the density of the cytoplasmic matrix, the state and quantity of organelles and inclusions, and the structural improvement of intracellular organelles. Conclusion. Autologous transplantation of mesenchymal bone marrow stem cells reduces the degree of destructive changes in hepatocytes, the severity of fibrosis and contributes to the improvement of the morpho-functional state of the liver, and therefore, it can be recommended as an important component of medical interventions.