Acute heart failure (AHF) and acute decompensation of chronic heart failure (ADHF) are urgent health problems. The main tasks of the managing the patients with these conditions include the achieving of optimal and stable resolution of edema and dyspnea, the tissue perfusion improving, the severity of clinical symptoms reducing, the exercise tolerance increasing, the progression of heart failure preventing, the preventing of the target organs dysfunction, complications, decompensations and hospitalizations, the increasing of survival and improving the quality of life. The algorithm for diagnosis, clinical patient profiles recognition, pharmacological (including diuretics, vasodilators, inotropes, vasopressors, anticoagulants, etc.) and non-pharmacological (including oxygen therapy, non-invasive and invasive ventilation, etc.) approaches to the management of AHF and ADHF are presented in accordance with contemporary guidelines.

The review is devoted to the discussion of modern concepts of the role of renal dysfunction in the development of chronic myocardial dysfunction in the context of cardio-renal syndrome (RVC) type 4. At the beginning of the review, the definition of cattle is given, general questions of pathogenesis and diagnosis of the disease are addressed. It is indicated that in patients with the initial stage of CKD, cardiovascular disorders are already registered which in the late stages of development of renal dysfunction are the leading causes of death and the true severity of the disease in patients with renal dysfunction is associated with an increased risk of cardiovascular events, rather than an achievement terminal renal failure and requiring renal replacement therapy. The progression of renal pathology leads to damage to the heart through various mechanisms and factors, both traditional and non-traditional, some of which, at the culmination of the renal continuum, are the result of the dialysis procedure itself in patients with terminal renal dysfunction. Mechanisms for the development of congestive heart failure in type 4 cattle include pressure overload (arterial hypertension) and volume (anemia, edematous syndrome), which increase in proportion to the decrease in renal function. Increase in blood pressure, changes in intracardial hemodynamics, deterioration of arterial compliance contribute to the acceleration of cardiovascular events. The role of laboratory predictors of renal dysfunction in the progression of cardiovascular disorders is discussed. The general approaches of echocardiographic visualization of the heart cavities and its importance in the diagnosis of cardiovascular diseases are discussed. Special attention is paid to the development of pulmonary arterial hypertension, changes in the left and right ventricle of the myocardium with renal dysfunction.

Statins are one of the most common lipid-lowering drugs in clinical practice. The purpose of this review was to systemize the most frequent statin adverse effects, including mechanisms, diagnosis, treatment and prevention. The frequency of statin-associated muscle symptoms is significantly higher in registries and observational studies than in randomized controlled trials. Diagnosis of muscle symptoms is difficult because it is subjective. The serum creatine kinase is often normal or slightly elevated. Association between statin use and the risk of new cases of diabetes mellitus was demonstrated in numerous studies. The drug interaction of statins, high dosage and concomitant diseases can lead to a persistent and clinically significant increase of hepatic enzymes. Basic glycemic tests, hepatic enzymes and serum creatine kinase have been necessary done before statin administration to identify patients with high risk of intolerance. The risk of hemorrhagic strokes after statin therapy is ambiguous due to randomized controlled trials. It is suggested that statins can inhibit cancerogenesis by inducing apoptosis or reducing cell growth, angiogenesis, and invasion. However, the results of preclinical and clinical studies are conflicting. The majority of the studies are observational or of retrospective nature. It is necessary to provide a larger prospective randomized placebo-controlled trials with a long follow-up. Any doctor should know the potential negative consequences of statins taking into account their expansion. Understanding the pharmacokinetics of statins is important for the safety of patients. Dosages, metabolism and risk factors of drug interactions should be considered to minimize statin adverse effects.

Introduction. A number of paraproteinemic polyneuropathy is directly linked to the monoclonal gammapathy of undetermined significance (MGUS). One of the first manifestations of MGUS in addition to the secretion of monoclonal immunoglobulin, and long before the manifestation of malignancy is polyneuropathy.

Materials and Methods. Were examined in 16 patients with polyneuropathy associated with MGUS in age from 53 to 78 years. Patients underwent a course of infusion therapy with human immunoglobulin in the dose of 0.4 g/kg for 5 days.

Results. After treatment revealed a reduction of the manifestations of the sensory component of the neuropathy, neuropathic pain and sensitive ataxia that was confirmed by electromyographic data of stabilography, and a rating on a scale Lovett, the scale of neuropathy disability score, the questionnaire «Pain detect». The motor component of polyneuropathy had more persistent symptoms.

Conclusion. Treatment with human immunoglobulin is effective in reduction of neuropathic pain and sensory ataxia and in increase of superficial and deep sensation, while the motor component of polyneuropathy had more persistent symptoms. 

The aim. To study the physico-chemical properties of hepatic bile and the state of lipid metabolism before and after cholecystectomy for cholelithiasis.

Material and methods. 210 patients with stage I cholelithiasis (comparison group) and 90 patients who underwent cholecystectomy for stage II and III of the cholelithiasis (observation group) were examined. The groups were balanced by gender and age. In verification of the diagnosis, in addition to general clinical data, the results of ultrasound examination of the biliary system were used. A duodenal sounding was carried out followed by a macroscopic, microscopic examination of the hepatic portion of bile, determination of its physical properties and chemical composition. Lipid blood metabolism was studied with an estimate of the coefficient of atherogenicity.

Results. With ultrasound of the biliary system, signs of biliary sludge were found in 86% of the comparison group patients, in 37% of the patients in the observation group there was an increase in the common bile duct. The study of the chemical composition of the hepatic bile of patients of both groups revealed an increase in cholesterol, total sialic acids and total protein, a decrease in bile acids, phospholipids, cholate-cholesterol and phospholipid-cholesterol coefficients. In the study of physical properties, a thickening of bile and an increase in its viscosity were established. Evaluation of the lipid spectrum of blood revealed that lipid metabolism disorders, which are present in patients with cholecystectomy, are preserved after cholecystectomy.

The conclusion. After cholecystectomy for cholelithiasis, bile is still secreted prone to stone formation, as evidenced by its altered physic-chemical parameters. Рatients after cholecystectomy need to use preventive measures to prevent the formation of lithogenic bile. 

The aim of the article was to study for 12 months the adherence to drug therapy and the incidence of cardiovascular risk factors in Yakutia patients who underwent Q-positive myocardial infarction.

Materials and methods. The analysis included 113 patients from Yakutsk with Q-positive acute myocardial infarction, the average age is 59 [51;64] years old.

Results. The following conclusions are obtained: The majority of patients of Yakut nationality who underwent Q-positive myocardial infarction have a high incidence of cardiovascular risk factors. Among the examined patients of this category after 6 months was received a low adherence to prescription drugs: clopidogrel /ticagrelor (by 9.9%), ACE inhibitors / sartans (by 18%), β-adrenoblockers (by 24.6%), statins (by 46.7%). For the 12th month after a second consultation, there was an increased adherence to taking the statins by 33.3% and beta-blockers by 17.8%. AH is a well-controlled risk factor, in most patients there is an effective reduction in high blood pressure values from the first months. The mean of total cholesterol, cholesnerol — LDL and the frequency of hypercholesterinemia, hypercholesterinemia LDL for 12 months after a recent MI is decreased, but the target values were not achieved due to low adherence to taking statins.

Conclusion. Due to the low adherence to drug therapy and the insufficient correction of risk factors for CVD after MI there was noted repeated hospitalizations for repeated ACS, decompensation of CHF, and fatal cases/outcomes, regardless of ethnicity, which requires intensification of the measures for dispenserization, at the primary level health. 

The need to study how the infusion therapy affects the electrolyte composition of blood is a topical issue nowadays. Such a study will provide the necessary answers and help us to introduce the most effective infusion therapy strategies for patients suffering from severe hemodynamic disorders accompanying toxic shock syndrome (TSS). The study analyzes and summarizes the examination and treatment results of 111 patients suffering from various forms of severe infectious disease complicated by TSS. As a result of the study, it was determined that infusion therapy using a combination of hypertensive and colloidal solutions significantly contributes to the rapid restoration of electrolyte composition and compensates for acidosis. Given these data, a combination of 10% sodium chloride solution with 6% colloidal solution can be considered a preferable solution for initial infusion therapy in patients suffering from TSS.

The patient, who has risk factors but considers himself / herself to be healthy, does not consult a doctor, but is in a suboptimal status. The study of the patient’s health at different levels of physical activity is an important issue of preventive medicine.

Material and methods. 351 people (133 men and 218 women) aged 18 to 75 years after obtaining voluntary informed consent to the study were examined. Patients were divided into 8 groups according to the international physical activity questionnaire (IPAQ). In addition to the classic clinical and laboratory examination, patients were interviewed using questionnaires: suboptimal health status (SHSQ-25), hospital anxiety and depression scale (HADS), stress susceptibility questionnaire (PSS). Statistical processing was carried out by programs Microsoft Excel 2010 and Statistica 10,0.

Research result. When studying the values of discovering the fact of the differences in some indicators: increase of arterial pressure in 3 and 4 group physical activity, age of women, increasing of body mass in the 2, 3, 5 and 8 groups physical activity that proves the relationship of the presence of risk factors and physical activity level of the patient. Significant differences between the actual values of the mean age and the alarm level in groups with high and low suboptimal status were revealed. Significant differences in suboptimal status were revealed, which reflected the presence of risk factors for chronic noncommunicable diseases in groups with different physical activity (age of women over 45 years old, overweight, monthly use of alcohol, the presence of hypercholesterinemia and high level of depression). Significant differences in groups with high and low indicators of suboptimal status in the presence of risk factors for chronic noncommunicable diseases are revealed: age over 45 years, increased systolic and diastolic blood pressure, high levels of anxiety. Significantly differed in the indicators of suboptimal status of the group of physical activity: 2, 3, 6 and 7.

Conclusion. In groups of patients who consider themselves healthy and do not see a doctor for 3 months or more, the risk factors of chronic non-communicable diseases, more common in groups of patients who are not engaged in physical activity, were identified. Differences in indicators of suboptimal health status in the presence of risk factors of chronic noncommunicable diseases are revealed. The SHSQ-25 questionnaire objectively reflected the main screening indicators of chronic disease risk factors, it is simple to use in primary health care, it is an economical and effective tool for screening subclinical, reversible stages of chronic diseases. 

Primary ciliar dyskinesia is а rare orphan disease known for its multiple and variable symptoms caused by the marked genetic heterogenity beyond. As per the abundant symptoms in pediatric patients, a frequent inflammatory diseases of both upper and lower respiratory tract segments are the key points. A Sieberth-Kartagener Syndrome is a classical form of the primary ciliary dyskinesia covered such symptoms as the reversal placement of internal organs, chronic bronchoectases, nasal cavity hypoplasia and/or sinusitis. According to some foreign research, the age mediana value estimated in Eastern and Western European countries for a “Primary Ciliary Dyskinesia” diagnosis is equal to about 5 years. A lack of early diagnosis is nothing but a direct consequence of the poor level of awareness, so common for a primary health care system. This itself leads to increased rates of patients disability. This report deals with clinical peculiarities, diagnostics and treatment details observed and administered in a primary ciliary dyskinesia (Kartagener Syndrome) patient. Noteworthy, both mother’s tough obstetric-gynecological profile and a harsh course of this particular pregnancy were indeed taken into account. Up until 11 months, this patient was subjected to a non-clinical treatment on numerous respiratory infection occasions. A “Kartagener Syndrome” diagnosis was estimated in our clinic on the basis of laboratory and instrumental tests data. Thus, the latter prove a complete reversal of internal organs placement. Further, this diagnosis was re-confirmed by histomorphological patterns revealed in the nasal epithelial biopsy study. A difficulty to come up with the Kartagener Syndrome diagnosis at the pre-hospital treatment stage is in a focus of this specific case report. Noteworthy, we have succeed with the early diagnosis of Kartagener Syndrome and then with a following efficient therapy conducted in our clinic.

Introduction. Infectious endocarditis (IE) caused by microorganisms Burkholderia cepacia is a very rare and poorly characterized form of endocarditis.

Material and methods. We observed a case of late prosthetic mitral valve IE caused by Burkholderia cepacia in a 34-year-old patient.

Results. A patient with a congenital ventricular septum defect underwent surgery on the heart three times in past, including the resection of mitral valve vegetations due to IE at age 17 and mitral valve replacement plus ventricular septum defect plastic reconstruction at 33 years old. The last was complicated by postoperative purulent sterno-mediastenitis treated by thoracoplasty. 10 months later the fever with chills appeared again, a large vegetation on a mitral valve prosthesis was revealed, and Burkholderia cepacia bacteremia with multidrug resistance to antibiotics was find. After the start of treatment with trimethoprim / sulfamethoxazole, normal temperature was observed, but the course of IE was complicated by thromboembolism with a fatal outcome.

Conclusions. Multidrug resistance of the pathogen to antibiotics, including those empirically prescribed for IE, is the main risk factor for the adverse outcome of IE caused by Burkholderia cepacia. The lack of generally accepted recommendations determining the doses of antibiotics prescribed in accordance with the microorganism sensitivity is the problem still present in Burkholderia cepacia IE treatment.