The combination of heart failure and renal failure is called cardiorenal syndrome. It is a stage of the cardiorenal continuum and, possibly, a small link of the cardiorenal-cerebral-metabolic axis. Despite the fact that the phrase “cardiorenal syndrome” and its five types have become a part of the medical lexicon, many aspects of this problem are still not clear. Cardiorenal syndrome can be diagnosed in 32-90.3% of patients with heart failure. Cardiorenal syndrome type 1 or 2 develops in most cases of heart failure: cardiorenal syndrome presents with the development ofchronic kidney disease in patients with chronic heart failure and acute kidney injury in patients with acute heart failure. Impaired renal function has an unfavorable prognostic value. It leads to an increase in the mortality of patients with heart failure. It is necessary to timely diagnose the presence of cardiorenal syndrome and take into account its presence when managing patients with heart failure. Further researches are needed on ways toprevent the development and prevent the progression of kidney damage in patients with heart failure, to which the efforts of the multidisciplinary team should be directed. The first part of this review examines the currently definition, classification, pathogenesis, epidemiology and prognosis of cardiorenal syndrome in patients with heart failure.

The article presents a literature review on the problem of spontaneous dissection of the coronary artery (SCAD) — tearing of its wall, not associated with atherosclerosis, trauma or iatrogenic effects leading to blood penetration between vessel layers of the artery. The consequence of this dissection is obstruction of the coronary artery due to the formation of intramural hematoma or intima damage, and myocardial ischemia with development of acute coronary syndrome, myocardial infarction or sudden cardiac death. Information on the epidemiology, pathophysiology andetiology of the disease is presented here. It was highlighted a role of arteriopathies, inflammatory diseases, pregnancy and female sex hormones, genetic causes as well as initiating and stress factors in its development. The clinic picture and diagnosis of the disease is described. It was emphasized that in addition to clinical manifestations, the traditional electrocardiogram and coronary angiography remain the standard for diagnostics of the dissection. In the treatment of SCAD, percutaneous coronary intervention with stenting of the affected artery is used, coronary artery bypass surgery and medications with regard to preference of conservative drug therapy. A special attention is paid to the features of diagnostic and therapeutic measures in pregnant and breast-feeding patients. The article also presents a clinical case of development of large-focal myocardial infarction complicated by cardiogenic shock in a young woman without risk factors for coronary heart disease in the postpartum period caused by SCAD. Diagnosis of the disease was accompanied by certain difficulties. An urgent percutaneous coronary intervention with stenting of the infarct-related coronary artery allowed rapidlyimproving and stabilizing the patient’s condition.

The work discusses modern issues of etiopathogenesis, treatment of chronic pharyngitis. The results of the application of a modern method for the diagnosis of mass spectrometry of microbial markers (MSMM), which allows to detect the microorganisms in a biofilm, in a “sleeping state” under the protection of mucin are presented. With the help of this express method, it is possible to conduct a determination of the content in a smear from the pharynx 57 biomarkers of microorganisms at the same time 2 hours after delivery to the laboratory. It was found that 100% of the examined patients with a recurring course of HF (n = 62) increased the total content of microorganisms, which indicates the need for antibacterial therapy; 87% of patients have elevated levels of endotoxin, which is a sign of general intoxication; 71% of patients have reduced plasmalogene content and these patients may be at increased risk for lipid metabolic disturbances; in 100% of the examined patients with frequent exacerbations of CP in the pharynx the nasopharyngeal microflora (coccal) is determined, as well as new etiopathogenetically significant microorganisms (not detected by PCR and cultures), among which there are 7 transient microorganisms (normally in the orifice their level = 0), 11 resident (6- found in the throat in the norm in the minimum level and 5 in the high content). Also, with the help of MSMM, a significant or moderate increase in the content of herpes, cytomegalovirus was detected in the majority (75%) of patients, which indicates the important role of the viruses of the herpes group in the etiopathogenesis in the recurrent course of CP; level of Candida spp. elevated in half of patients; the content of normal microflora is increased in 71% of patients, which indicates the preservation of local resistance in patients with chronic HF, examined by the authors. Thus, the use of MSMM for chronic fever allows to identify new etiopathogenetic microorganisms, on this basis to prescribe a more effective therapy. Thus? it is possible to carry out personified, more effective treatment.

This article presents the results of our own research: comprehensive clinical and laboratory examinations, including data from the daily Holter monitoring of the electrocardiogram (DMEKG) in 169 patients with chronic glomerulonephritis at the predialysis stage of the disease. According to the DMEKG, 60.3% of the persons examined by us had episodes of supraventricular group extrasystoles, and ventricular group extrasystoles in 28.9%. In addition, 11.2% of patients had atrial ventricular blockade (incomplete / partial), 8.8% had atrial fibrillation and painless ischemia in an amount of from 1 to 3 episodes per day in 14.7%. Depending on the average heart rate (HR) according to the DMEKG, patients with chronic glomerulonephritis were divided into two subgroups. Subgroup “A” included 38 patients with heart rate less than or equal to 70 beats / min, in subgroup “B” — 131 patients with a heart rate of more than 70 beats / min. With equal values of uric acid, total cholesterol cholesterol, HDL cholesterolcholesterol, TG, plasma creatinine and blood fibrinogen in subgroup “B” there was a statistically significant increase in LDL cholesterol concentration(3.58 (2.74; 5.54) mmol / l vs. 2, 82 (2.30; 3.86) mmol / l; p <0.05) and a decrease in the calculated GFR (70.4 (48.8; 96.3) ml / min vs. 85.7 (31.5; 103,1) ml / min; p <0.05) compared with subgroup “A”. In the subgroup “B” a tendency was observed to increase the degree of daily excretion of protein with urine. The data obtained confirm the fact that the conduct of the DMEKG with the analysis of heart rate is of significant clinical importance for the diagnosis of cardiovascular disorders and the p revention of cardiovascular complications in chronic glomerulonephritis at the predialysis stage of the disease.

Background: obstructive sleep apnea (OSA) is associated with high prevalence of arterial hypertension (AH), obesity, violation of carbohydrate metabolism and dyslipidemia. However, the effects of CPAP therapy to improve epicardial fat thickness of the OSA patient with AH the are poorly understood and poorly studied.

Study objective: the aim of the study was to investigate 12-month effects of CPAP therapy with auto-adaptation to inhalation and exhalation of the OSA patient with AH and metabolic disorders (A-Flex therapy) on epicardial fat thickness (EFT).

Methods: to the prospective single-center study were included 310 patients with OSA and AH (273 male, 45,3 ± 10,4 yr.) with apnea-hypopnea index (AHI) >5 events /hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (SpO 2 ) by the rules of American Academy of Sleep Medicine (AASM). The calculation of the epicardial fat thickness (EFT), the size and volume of the heart cavities, left ventricular mass index (LVMI) were performed by two-dimensional echocardiography. Endothelial functionof blood vessels determined by finger test was measured according to peripheral arterial tone (PAT). The reactive hyperemia index (RHI) and augmentation index (AI) was calculated. Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements.

Results: after 3 months of A-Flex therapy we found a significant decrease of HOMA-IR -1,09 (95% Cl from -1,74 to -0,96; P=0,021), decrease AI -10.8% (95% Cl from -13,70 to -4.6; P=0,001), decrease EFT -1,26 mm (95% Cl from -2,2 to -0,95; P=0,001) in mild OSA patients. After 6 months of A-Flex therapy we found a significant decrease of HOMAIR -2,81 (95% Cl from -3,74 to -1,46; P=0,001), decrease AI -15.6 % (95% Cl from -17,23 to -11,75; P=0,001), decrease EFT -2,15mm (95% Cl from -3,2 to -1,5; P=0,001) in moderate OSA patients. After 12 months of A-Flex therapy we found a significant decrease of HOMA-IR -4,22 (95% Cl from -5,36 to -2,35; P=0,001), decrease AI -21,05 % (95% Cl from -26,5 to -17,4; P=0,001), decrease EFT -4,0 mm (95% Cl from-5,8 to -2,7; P=0,001) in severe OSA patients.

Conclusions: The 12-month A-Flex therapy in moderate and severe OSA patients with AH has a significant therapeutic effect of stabilization systolic and diastolic blood pressure, level of blood lipids and epicardial fat thickness, level of endothelial dysfunction. The 12-month A-Flex therapy has to able to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations.

The goal is to evaluate the influence of meloxicam on the level of blood pressure among patients suffering from hypertension, as well as among patients without diseases of the cardiovascular system, in relation to its pro-hypertensive effect.

Materials and methods. The retrospective research involved 60 patients who regularly taked meloxicam in a dose of 7.5 mg / day. There were patients who didn’t have a cardiovascular pathology in the first group. The second group consisted of patients with hypertension, taking antihypertensive drugs. Retrospectively, the level of blood pressure, measured by the Korotkov’s method, was analyzed by medical histories, before and after 3 months of taking meloxicam in both groups. The total cardiovascular risk was calculated on a SCORE scale.

Results. It was determinated that long-term medication of meloxicam led to an increase of blood pressure indicators, both in patients without established diseases of the cardiovascular system, and in patients with the hypertension and an average total cardiovascular risk, who are regularly taking antihypertensive pills to achieve target blood pressure.

The aim. Find out the nature of the changes of the hepatobiliary system in patients with intestinal bacterial overgrowth and study the possible mechanisms of their association.

Materials and methods. 148 patients with intestinal bacterial overgrowth and intestinal dysbiosis were examined. The level of total cholesterol, cholestasis and cytolysis markers was determined in the blood using the analyzer «Labsystems» (Finland). Intestinal bacterial overgrowth syndrome was assessed using a hydrogen breath test with lactulose on the LactophaH2 apparatus of AMA (St. Petersburg). Intestinal dysbiosis was determined by plating feces on nutrient media. Bile acids in bile were determined on the AmazonX mass spectrometer (Bruker Daltonik GmbH, Bremen, Germany). Ultrasound examination of the abdominal cavity performed with the apparatus «SHIMADZU SDN-500» (Japan). Liver elastography was performed using the AIXPLORER apparatus (France).

Results. The syndrome of intestinal bacterial overgrowth in 67% of cases was established in the presence of ileocecal insufficiency, in 33% of cases — with preserved ileocecal function. The combination of intestinal bacterial overgrowth syndrome and intestinal dysbiosis was detected in 81,8% of patients. The majority of the examined patients showed clinical symptoms of damage the hepatobiliary system and intestines, which was confirmed by change laboratory parameters — increase the level of total cholesterol, markers of cholestasis and cytolysis compared with the control group. In the study of bile acids in bile, decrease free (mainlycholic) and increase conjugated (glycodesoxycholic, taurodesoxycholic, glycocholic, taurocholic) bile acids was observed compared with the control group. In general, patients with the syndrome of intestinal bacterial overgrowth revealed the presence of non-calculous cholecystitis — in 11,5% of cases, I stage of cholelithiasis — in 25,7%, II stage of cholelithiasis — in 18,9%, non-alcoholic fatty liver disease on stage steatosis and steatohepatitis — in 43,9% of cases.

Conclusion. Intestinal bacterial overgrowth syndrome is the beginning of bacterial translocation, which is the triggering factor in inflammation of the liver and biliary tract. In turn, diseases of the hepatobiliary system contribute to the development of intestinal dysbiosis by reducing the synthesis of bile acids with antibacterial action, as well as violations of their excretion. Thus, strong association of intestinal bacterial overgrowth syndrome with damage to the hepatobiliary system has been established.

Aim: To estimate the frequency of occurrence malnutrition and efficacy its correction in chronic pancreatitis (CP).

Materials and methods: 148 patients were examined. Group I included 71 people with chronic alcoholic pancreatitis (CAP); group II — 77 patients with chronic obstructive pancreatitis (COP). Trophological status (TS) was investigated by criteria of V.M. Luft. Lymphocytes, pancreatic amylase, lipase, total protein, albumin, urine diastase and faecal elastase-1 were investigated before and after treatment. Two treatment options were used: combination therapy (CT, (Mezym-forte 10500 USP/day and pharmaconutrient Ensure 2 200 ml/day)) and high-dose pancreatic enzyme replacement therapy ((HD PERT), Kreon 120000 USP/day) for 10 weeks. 62 patients received HD PERT: 24 patients with CAP and 38 patients with COP; CT — 86 patients: 47 and 39, respectively.

Results: The prevalence of malnutrition in patients with CP was 92% (n=136). Lymphopenia was determined in 44%, hypoproteinemia-in 11,5%, hypoalbuminemia-in 54%. 12 (8%) patients did not have malnutrition. In the group CAP: mild malnutrion was established in44, moderate — in 20, severe — 2, eutrophia — 6; in the group COP: mild malnutrion — in 33, moderate — in 37, severe — 0, eutrophia — 6. Aftertreatment in the group CAP: malnutrion moderate — in 7, mild — 58, eutrophia — 7, in the COP: malnutrion moderate — 37, mind — 31, eutrophy — 8.

Conclusions: Malnutrition is frequent symptom complex in patients with CP. The severity of malnutrition is more severy in CAP. The most effective treatment malnutrition was CT in patients with CAP. HD PERT is indicated to correct exocrine pancreatic insufficiency.