Atherosclerosis is a complex multifocal arterial disease involving interactions of multiple genetic and environmental factors. Atherosclerosis is the main cause of death and disability in developed countries, while in developing countries the incidence of this pathology is growing rapidly. Advances in techniques of molecular genetics have revealed that genetic polymorphisms significantly influence susceptibility to atherosclerotic vascular diseases. A large number of candidate genes, genetic polymorphisms and susceptibility loci associated with atherosclerotic diseases have been identified in recent years and their number is rapidly increasing. In recent years, there is significant interest in identifying additional factors of genetic risk for atherosclerosis. In recent years, a large number of genetic studies have been carried out to prove the genetic effect on the atherosclerotic process. Rapid progress in the sequencing of the human genome and molecular genetic methods have helped in the definition of susceptibility loci and associated candidate genes with atherosclerosis and concomitant diseases. The association of a large number of susceptibility genes with atherosclerosis reflects the enormous complexity of the disease. Multiple factors, including endothelial dysfunction, lipid metabolism defects, inflammation and immune responses, oxidative stress, cell proliferation, tissue remodeling and hemostatic defects are involved in the pathogenesis of atherosclerosis. In this review we focus and discuss on some of the major candidate genes and genetic polymorphisms associated with human atherosclerotic vascular diseases.

This article analyzes the literature data concerning the origin and progression of cerebrovascular and cardiac diseases in renal dysfunction. Cardiovascular diseases and chronic kidney disease have common “traditional” risk factors, while the population growth in patients with renal impairment is currently mainly due to secondary renal damage in socially important diseases such as obesity, hypertension, atherosclerosis, type 2 diabetes, ischemic heart disease and chronic heart failure. The presented data of scientific researches testify to the direct correlation correlation between the decrease of the renal function and the increased risk of cardioand cerebrovascular diseases and death, irrespective of other risk factors. Obesity and associated biological substrates are independent risk factors for persistent impairment of kidney function and an increase in the body mass index causes direct damage to the kidneys, due to the disrupted synthesis of fat cytokines by various cytokines with nephrotoxic action, and also mediated — by inducing the development of diabetes mellitus 2 type and arterial hypertension, which are the most frequent risk factors for chronic kidney disease and cardiovascular diseases. The presented data on the role of endothelial dysfunction in impaired renal function, which contributes to the formation of atherosclerosis, and the increase in the severity of the atherosclerotic process contributes to an increase in the sever ity of renal failure. Literature data on the value of the heart rate are also presented. The increase in the heart rate can lead to atherosclerotic densification of the arteries, which is associated with an increase in the rate of spread of the pulse wave with a violation of the mechanisms of autoregulation of the blood flow in the brain and kidneys.

The article provides an overview of current Russian and foreign literature devoted to the problem of pathogenesis, and of the treatment and prevention of antibiotic-associated diarrhea. Antibiotic-associated diarrhea is one of the most relevant aspects of modern drug therapy in due to the frequent prescription of antibacterial agents. Antibiotic-associated diarrhea (according to WHO) is defined as the presence of three or more episodes of an unformed stool for two or more consecutive days that occurred during or after the end of antibiotic therapy. The risk of developing this disorder is highest when using aminopenicillins, as well as their combinations with clavulanic acid, cephalosporins, clindamycin. Despite the presence of a common etiologic factor — the intake of antibacterial agents, the immediate causes and mechanisms of antibiotic-associated diarrhea development in patients may be different. The article describes the main issues of the etiology and pathogenesis of this pathology, the risk factors for the development of antibiotic-associated diarrhea are named, that allows to predict this complication in certain categories of patients. Тhe virulence factors of Clostridium difficile, Klebsiella oxytoca, Candida spp. and the clinical manifestations associated with their effects are highlighted. The clinical variants of this disease are described: 1) pseudomembranous colitis; 2) segmental hemorrhagic colitis; 3) “mild illness”. Contemporary literature data on the possibilities of prevention, as well as effective methods of treatment of antibiotic-associated diarrhea, are presented. For the treatment and prevention of all clinical forms of antibiotic-associated diarrhea, most authors suggest the use of drugs that make up the deficiency of normal intestinal microbiota — probiotics and prebiotics. The problem of the benefits of adjuvant therapy with probiotics during the course of antibiotics for the prevention of antibiotic-associated diarrhea remains controversial, the effectiveness and safety of the use of various probiotic cultures for this purpose is being studied. The information presented in this review is intended to target physicians to the rational use of antibacterial agents, and to early diagnosis of their most frequent side effect, antibiotic-associated diarrhea.

Due to the increasing number of Russian citizen’s visits to the countries of the tropical countries, the number of cases of imported endemic infectious diseases, mostly dengue fever (DF), also had increased. Dengue fever is an acute viral vector-borne disease, accompanied by fever and intoxication, with the possible development of hemorrhagic syndrome and shock, in which survival depends from the time of initiation of intensive therapy. The greatest incidence of DF in Moscow is associated with travelling to tropical countries during the Christmas holidays, which coincides with the seasonal rise in the incidence of influenza and other ARTI’s. However, ambulance medical workers in most cases (except for the cases of calling the ambulance team to the medical organization during the working hours of the laboratory) are not able to carry out and assess even the minimum of hematological parameters. Therefore, when diagnosing and determining the phase of the disease and its severity, the ambulance medical worker can rely only on epidemiological and clinical data. In this regard, a group of authors proposed an algorithm for early diagnosis and treatment of patients with suspected dengue fever at the prehospital stage, taking into account clinical symptoms and standardized tourniquet test.

The Community-acquired Pneumonia (CAP) is an urgent problem of modern medicine owing to its high prevalence, gravity of a current, the increasing resistance of a microflora to antibacterial therapy, a large number of complications and a high lethality. Udmurt republic is one of leaders among the regions of Russian Federation on morbidity by diseases of the respiratory system, include CAP. It is therefore necessary to take analysis and prognosis incidence for the future improving quality administer. Research objective. The analysis of incidence and mortality from diseases of respiratory organs in the Udmurt Republic for 2009-2016. Materials and methods. The retrospective and prospection clinical-epidemiological research of prevalence and primary incidence of diseases of respiratory organs among the adult population of the Udmurt Republic living in 4 cities is conducted (Izhevsk, Sarapul, Glazov, Votkinsk) and 25 rural areas for the 8-summer period (2009-2016). The analysis is carried out on the basis of data of the state statistical registration and reporting documentation of Budgetary institution of health care of the Udmurt Republic «Republican medical information and analysis center of the Ministry of Health of the Udmurt Republic». Results of a research. The prevalence of diseases of respiratory organs in the Udmurt Republic was 49871,39±1,33 on 100 thousand population. The average growth rate was 2,3%, and the average rate o f a gain was — 0,25%. In comparison with data for the same period to the Russian Federation, average growth rate the average rate of a gain — 5,48% was 1,7%, and that demonstrates some decrease in incidence. In the analysis of structure of incidence of diseases of respiratory organs of the population of the Udmurt Republic it is established that she throughout the entire period of observation significantly hasn’t changed. At the same time annually, leading places are taken by pneumonia and the chronic obstructive pulmonary disease (COPD). Estimating the level of primary incidence of diseases of respiratory organs, it is noted that on UR the average growth rate is 105,42%, the average rate of a gain of 5,42%, in comparison across the Russian Federation average growth rate of 87,07%, and the average rate of a gain — 12,93%. Conclusion. Thus, to UR, as well as in general across the Russian Federation steadily high incidence of pneumonia is noted. At the same time the tendency to increase in incidence and this pathology mortality is noted. This circumstance demands further studying of a problem of pneumonia, including improvement of methods of medical correction.

Introduction. Arterial hypertension is one of the most serious problems of the contemporary health care. Within the qualimetric approach and quantification of “lifestyle” capacity. However, research papers dealing with the relationship impact medical care cardiac profile and complete realization of the potential of the lifestyles of patients, it is not enough. The purpose of the research is to explore the potential lifestyle hypertensive patients and its role in ensuring the effectiveness of the treatment.

Materials and methods. The study was conducted on the basis of the medical organizations of the Kostroma region. Research methods: expert, sociological, analytical, statistical. Analysed data on 400 patients a cardiac profile: lifestyle parameters monitoring data of patients using the original automated management factors impact medical care Cardiac profile, data expert evaluation of physician lifestyles of the patient and the patient questionnaire survey, consisting of 8 questions.

Results and discussion. Found that in patients with arterial hypertension has reduced the capacity of lifestyle for all its components, including the low level of medical activity, low level of medical awareness, inadequate recreational activity disregard for the principles of a balanced diet, the prevalence of bad habits. There are significant differences in the potential lifestyle of patients with low and high levels of treatment success, proving the importance of lifestyle modification patients, his healing in the practice of primary care physicians health.

Conclusions and proposals. It is recommended that the monitoring capacity of the lifestyles of patients with arterial hypertension in the context of district clinics.

The study discusses the relationship of thiol concentrations in intercellular fluid with the level of peripheral blood mononuclear cells (MNCs) in convalescents with community-acquired pneumonia (CAP) components MAPK/SAPK and JAK/STAT-signaling pathways, nuclear transcription factor NF-KB. The content and level of phosphorylation of JAK2 protein kinase, signal transducers and transcription activators STAT3, STAT5A, STAT6, NFKB nuclear transcription factor inhibitor (IkBa), stress-activated protein kinases JNK, ERK, the level of the p50 subunit of nuclear transcription factor NF-κB were determined by enzyme immunoassay in MNC. The results of the study indicate that the stage of reconvalescence of CAP is characterized by a lack of antioxidant protection, manifested by a decrease in the concentration of thiol compounds in the supernatant against which there is a decrease in the level of phosphorylation of protein kinase JAK2, factors STAT3, STAT5, STAT6, JNK, which is also associated with an increase in the level of phosphorylation of protein kinase ERK. The analysis showed that the thiol status is characterized by a positive relationship with the activity of STAT5A, JNK, p50. The level of thiols and ERK, as well as STAT3, was characterized by a negative relationship. Thus, the increase in the level of thiols contributes to the increase in the activity of the transcription factor STAT5A and decrease-STAT3 with a corresponding change in cell reactivity with respect to specific cytokines, as well as a specific effect on the differentiation of individual populations of immunocompetent cells.

The aim. To study the changes in the morphological picture of bile depending on the age of the patients and the possibility of using the information obtained in this way in the early diagnosis of gall stone formation.

Material and methods. The study included 396 patients with stage I cholelithiasis, group 1 consisted of 125 patients of mature age (30-44 years), group 2 — 164 patients of middle age (45-59 years), group 3 — 107 elderly patients (60-74 years). The examined groups of patients were balanced by sex. In the verification of the diagnosis, in addition to general clinical data, results of echographic examination of the gallbladder were used. Multifractional duodenal sounding with the subsequent macroscopic, microscopic, morphometric, biochemical and physical investigation of bile is carried out. To study the morphological picture, features of the microstructure of gallbladder bile, the assessment of crystallograms was carried out.

Results. When echographic examination of the gallbladder in all patients was determined signs of biliary sludge. The destabilization of bile is evidenced by an increase in cholesterol, a decrease in bile acids, a cholesterol ratio, an increase in its viscosity and surface tension. A morphometric study of the cystic bile of patients with early gallstone disease showed a decrease in the angle of inclination of liquid crystal lines, as well as the appearance of optically active inclusions, such as branched dendrites with lamellar branches, entangled fiber aggregates, shield-like aggregates and short branched dendrites. With an increase in the tendency of bile to stone formation, the optical activity of microcrystals increases, lamellar druses and branched plateau-like aggregates are determined.

Conclusion The crystal-optic method of studying bile is highly sensitive, but at the same time simple in its execution and can be widely used in the early diagnosis of cholelithiasis. The degree of violation of the microstructure of bile increases with increasing age of patients.

The aim of the research is to assess risk factors of damage of the cardiovascular system in patients with primary osteoarthritis with identified coronary atherosclerosis.

Materials and methods. 52 patients at the mean age 41 [34; 52] were involved in the study. Therewere 37 womenand 15 menamongthem. Planned contrast study of the coronary arteries (on the apparatus ALLURAXperFD20 Philips) were performed to all patients. As a result, hemodynamically insignificant (less than 50%) atherosclerotic stenosis of the heart vessels was verified in this group. In all patients were determined such indicators as: height, weight, waist circumference with the calculation of body mass index by Kettle`s method. The questionnaire was used to assess the presence of risk factors for development of cardiovascular diseases, such as: smoking, family history of cardiovascular diseases, hypodynamia. In addition, all patients had daily monitoring of arterial pressure by the device «Kardiotechnika– 07-AP-3», clinical and biochemical blood tests and the total cardiovascular risk was calculated.

Results. Each patient had from 1 to 6 risk factors of cardiovascular diseases, the median was [25-th; 75-th percentiles] 3 [2; 5]. In the group of women family history of cardiovascular diseases, hypodynamia and hypertension met more often the in the group of men (р=0,002). Men with higher frequency demonstrated the presence of bad habits (smoking), high levels of triglycerides and low-density lipoproteins (p=0.0001). The correlation analysis revealed that the incidence of hypertension, hypodynamia and dyslipidemia was associated with the duration of osteoarthritis, the intensity of pain according to visual analog scale and the number of affected joints.

Conclusion. The presense of generalized subclinical inflammation in patients with ostheoarthritis together with the classic risk factors of development of cardiovascular diseases, probably mediates the early beginning of atherosclerosis in this category of patients.

Objectives: Maximally quickly identify the exacerbation of the disease and timely strengthen the therapy, for more rapid achievement of remission or low disease activity.

Methods: The authors created an interactive web portal for self-monitoring of RA activity. The patient management model using this method is that a patient conducts a monthly self-evaluation of the disease activity and transmits this information to his treating doctor in a remote manner via the web portal. In case of worsening and in the absence of any dynamics, according to the patient, he was invited to the center, where this information was verified by a doctor. If, in the patient’s opinion, there was an improvement, he did not come to clinic, but continued therapy. Currently, 30 women with RA, age 57 (38; 71), who completed the 6-month treatment period, are included in the study. 20 women included in the control group, average age 60.5(40; 77).

Results: During 6 months, there was a positive dynamic of the course of the disease, the activity of the RA by DAS 28 decreased. Initially, 5 patients (16.7%) had high DAS activity, 24 — moderate (80%), 1low (3.3%). After 6 months of treatment 8 patients (26.7%) had low activity, 22 (73.3%) achieved remission. The mean value of the DAS 28 index at the time of inclusion was 3.99 (2.46; 5.78) and after 6 months of management 2.175 (0.79; 4.31), a statistically significant decrease (Wilcoxon T-test = 5). The DAS 28 index at the time of control group was 4,1 (2.46; 5.78) and after 6 months of management 3,9 (0.79; 4.31), a statistically significant decrease (Wilcoxon T-test = 5). Analysis of clinical and laboratory parameters did not reveal statistically significant deviations.

Conclusions: The 6-month period of patient management via the Internet portal for self-monitoring of rheumatoid arthritis activity proved the possibility of achieving remission and low disease activity in all patients.

The article contains a clinical description of the case of combination of such two opposite states as obesity and malnutrition in a patient with chronic pancreatitis. The patient was hospitalized with exacerbation of chronic pancreatitis and alcohol abuse. The examination revealed exocrine pancreatic insufficiency and mild malnutrition. The patient was prescribed enzyme replacement therapy and additional oral sip feeding with a positive effect. After 10 weeks of exocrine pancreatic insufficiency were stopped, but malnutrition remained and required a longer course of treatment. The relevance of this problem, the main difficulties of diagnosis were presented in the article. All patients need to measure anthropometric parameters, BMI, lymphocytes, total protein, albumin. Using only BMI leads to hypodiagnosis of malnutrition in patients with chronic pancreatitis.

In recent years, the number of patients receiving anticoagulant therapy worldwide is growing rapidly. This is due to the rapidly expanding scope of their application: an increasing number of patients with non-valvular heart disease, including atrial fibrillation, the risk of thromboembolic events, an increase in the number of surgical interventions, especially in cardiac surgery (in the treatment of valvular heart disease, cardiac anomalies, infective endocarditis, staging of heart pacemakers, conducting electric cardioversion), the use of anticoagulants in the treatment of other organs and systems (in neurology, angiosurgery, obstetrics and gynecology). Despite the presence of a large number of anticoagulants in the arsenal of the modern physician, one of the most studied and often prescribed is varfarin. Warfarin is an anticoagulant of the indirect action of the coumarin group, a competitive antagonist of vitamin K. However, along with high availability and efficiency of its use, it has a large number of possible contraindications and features of the reception, such as: many drug-drug and other interactions, the need for careful control of the dosage and the regimen of the drug, strict control of the international normalized ratio throughout therapy. With caution, this drug should be used in patients who abuse alcohol and have cognitive impairment. In this group of patients, in addition to personal awareness of patients, it is necessary to conduct explanatory conversations with relatives / caregivers about all possible side effects and measures for their prevention. Non-observance of precautionary measures at therapy by warfarin can lead to heavy, and in rare instances even lethal consequences, one of which is warfarin-induced coagulopathy. This clinical case presents a case of the development of severe acquired (warfarin-induced) coagulopathy in a patient with cognitive dysfunction.