The prevalence of hypertension is about 40 % according to Russian and world statistics. Approximately 1-2 % of patients with hypertension have high blood pressure throughout their lives, which requires urgent or emergency care. Hypertensive crisis is an acute condition caused by a sudden increase in blood pressure to individually high values, accompanied by clinical symptoms and requiring a controlled reduction to prevent target organ damage. According to the severity of clinical symptoms, hypertensive crisis is divided into uncomplicated and complicated. Typical signs of hypertensive crisis include malignant hypertension, severe hypertension associated with other clinical conditions, a sudden increase in blood pressure due to pheochromocytoma associated with organ damage, severe hypertension during pregnancy or preeclampsia. Hypertensive crisis is associated with various acute conditions, most often stroke (ischemic and hemorrhagic), acute cardiogenic pulmonary edema, acute heart failure, acute coronary syndrome, acute kidney injury, acute aortic dissection and eclampsia. The main goals of the treatment of hypertensive crisis are relief of the crisis, post-crisis stabilization, and prevention of repeated hypertensive crises. In patients with an uncomplicated hypertensive crisis, a decrease in mean blood pressure by 10 % during the first hour and by another 15 % during the next 2-3 hours is recommended. Therapy of complicated hypertensive crisis consists in the mandatory use of intravenous drugs with a predictable and controlled effect. The prognosis in patients with a hypertensive crisis, especially complicated one, is not favorable due to the high risk of short-term and long-term mortality. Patients who have undergone a hypertensive crisis require long-term follow-up.

A brief description and the work field of the doctor and humanist F. P. Haass (Friedrich Joseph Haass), who came to Moscow as a family doctor and gave all his knowledge and medical art to his new homeland, is provided. His path is shown from a family practice to the organization of Moscow healthcare, the chief doctor and hospital builder, the organizer of prison medicine, the great philanthropist and humanist who cared for the poor and destitute. His sequence in the implementation of the idea of the need to organize the provision of ambulance and emergency medical care for the poor who were injured in the streets, frostbite, with fever, bitten by animals, etc, is shown. The work area of the Police Hospital, the characteristics of doctors — the main followers and successors of the work of F. P. Haass, a combination of their medical and scientific activities, contribution to medical science are presented. The history of the creation of the first Pasteur station in Russia to provide emergency care for bites of rabid animals is reflected. The role and merits of S. V. Puchkov in preserving the humanistic traditions of Dr. F. P. Haass in the Aleksandrovskaya (Police) Hospital, his achievements in preserving and perpetuating the memory of F. P. Haass, the opening of the monument to F. P. Haass at Maly Kazenny Lane, a large public activity of S. V. Puchkov in Moscow are shown. The importance of family traditions in the upbringing of dedicated medical service, which were followed by S. V. Puchkov’s eldest son, A. S. Puchkov, is presented. Graduate of the Moscow University, A. S. Puchkov (“doctor with honors”) continued the work of F. P. Haass and his father, proved to be a brilliant organizer and became the creator of the modern emergency care in Moscow that F. P. Haass had dreamed about.

We analyzed more than 30 original articles and reviews to evaluate the current state of the issues of epidemiology, treatment, and prevention of hemorrhagic fever with renal syndrome in the world. A literature search was conducted using the Cochrane Library, PubMed, eLIBRARY databases and official WHO, UR Rospotrebnadzor, Rospotrebnadzor of the Russian Federation, and Center for Disease Control and Prevention data.

Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease characterized by fever, hemodynamic disorders, hemorrhagic syndrome and kidney damage in the form of acute interstitial nephritis with the development of acute kidney injury. It is caused by RNA-containing viruses of the Hantaan genus, belongs to the group of zoonotic infections, and is transmitted through the air.

The Udmurt Republic is one of the regions of the Volga Federal District endemic for HFRS. Annually, from 300 to 2,000 people get sick in the territory of the republic. HFRS affects the most able-bodied part of the population, mainly men aged 20-50. Mortality reaches 20% in certain years of observation. The doctor’s lack of caution regarding HFRS (the initial period of the disease has similar symptoms with acute respiratory diseases) leads to late hospitalization of the patient, often with serious complications that are fatal.

The main diagnostic search is carried out by the general practice service of the outpatient clinic. The materials of the article can help to correctly establish a preliminary diagnosis, taking into account clinical and epidemiological data, as well as to prescribe the necessary amount of laboratory and instrumental tests to clarify the diagnosis.

Objective of the study. To assess the clinical and pathogenetic significance of serum interleukin-6 (IL-6) in patients with chronic kidney disease.

Materials and methods. A cross-sectional study enrolled 288 patients with chronic kidney disease (CKD) aged 16 to 86 years, average age (54.5 ± 14.5) years. The study enrolled 146 (50.7%) women and 142 (49.3%) men. Depending on the value of estimated glomerular filtration rate (eGFR), all the examined patients were divided into two groups: 1st (n = 154) - persons with eGFR > 60 ml/min; 2nd (n = 134) - patients with eGFR < 60 ml/min, i.e. renal failure. CKD was identified when there was evidence of damaged and/or reduced renal function. Glomerular filtration rate was calculated using the Hoek equation based on measurement of serum cystatin C, and severity of CKD was based on eGFR values. All patients had concentration of creatinine, cystatin C and IL-6 in their blood serum studied.

Results. In the 2nd group of patients with eGFR below 60 ml/min, average age [(57.9 ± 14.5) years vs. (51.6 ± 13.9) years; p < 0.05], systolic blood pressure [(142 ± 24) mm Hg vs. (133 ± 22) mm Hg; p < 0.05], cystatin C [1.815 (1.430-3.070) mg/l vs. 0.980 (0.900-1.100) mg/l; p < 0.05)] and IL-6 [2.761 (1.400-6.495) pg/ml vs. 1.754 (0.849-3.226) pg/ml; p < 0.05)] levels in blood serum were significantly higher compared with the 1st group. An inverse correlation was found between serum IL-6 and eGFR level (r = -0.144; p = 0.018).

Conclusion. In patients with chronic kidney disease with an eGFR level below 60 ml/min, an increase in systolic blood pressure and serum IL-6 concentration was observed. In chronic kidney disease, an increase in the content of IL-6 was accompanied by a decrease in glomerular filtration rate and an increase in diastolic blood pressure.

Objective. Evaluation of heart rate variability in patients with rheumatic heart disease.

Material and methods. The study enrolled 230 patients, of whom 156 patients with mitral stenosis (CRHD), 36 patients with mitral valve regurgitation, and 38 patients with acquired aortic stenosis were selected. CHF functional class was determined using a 6-minute walk test according to the standard method; there were no patients with FC IV. HRV values were obtained using the Kardiotekhnika-04-3R (M) cardiorespiratory monitor with an estimation of time domain and frequency domain.

Results. The CRHD patients had lower HRV indicators in the time (SDNN - 126.38 ms, SDANN - 112.07 ms, RMSSD - 32.79 ms) and frequency domain (VLF - 2,098.59 ms²; LF - 865.39 ms², HF - 323.48 ms²) compared with patients with mitral valve regurgitation and aortic stenosis. Evaluation of HRV within patients with CRHD, depending on the presence or absence of combined mitral-aortic stenosis, did not show differences in the general and sympathetic tone of the ANS. In patients with combined mitral-aortic stenosis, only a decrease in parasympathetic tone was revealed: RMSSD - 31.18 ms, HF - 286.36 ms². Stratification of patients according to FC CHF showed an increase in parasympathetic tone: RMSSD was 26.67 ms for FC I and 43.69 ms for FC III; HF was 254.67 ms² for FC I and 541.23 ms² for FC III. The sympathetic and general tone of the ANS was minimal in patients with FC II CHF. A study of the change of indicators over 5 years did not demonstrate a significant increase in the time domain, and the main indicators of the frequency domain decreased significantly: VLF from (1,882.73 ± 119.48) to (1,603.54 ± 99.22) ms²; HF from (334.34 ± 33.13) to (252.87 ± 17.84) ms², LF from (819.48 ± 94.41) to (647.01 ± 42.50) ms². A decrease in the frequency domain was also observed when comparing the HRV results of survived and deceased patients.

Conclusions. The patients with CRHD had lower values of the ANS tone in comparison with patients with other acquired heart valve disease. The smallest values of the general tone of the ANS and SNS were observed in those studied with CRHD with FC II CHF, and the activity of the PNS was maximum at FC III. After 5 years of follow-up, only the frequency indices of HRV were significantly reduced.

The objective of research is to assess the significance of hemostatic profile in the postoperative period after coronary artery bypass surgery for predicting the one-year functioning of the grafts.

Materials and methods. 46 men, who had coronary artery bypass surgery (CABS) for stable angina, were examined. 23 of them had 2 type diabetes mellitus (DM2), 23 of them did not have diabetes mellitus. All patients underwent fibrinogen, soluble fibrin monomer complex, D-dimer, induced platelet aggregation and lupus anticoagulant blood tests on the 14th day after surgery. The patients had coronary and bypass graft angiography for the assessment of graft patency a year after surgery.

Results. During the postoperative period, there were no statistically significant differences between patients with DM2 and patients without DM2 in the results of the above hemostatic profile tests (p value for the Mann-Whitney test is >0.05). Lupus anticoagulant was detected in 9 patients with DM2 and in 12 patients without DM2 (p value for Fisher’s exact test is 0.554). 10 patients with DM2 and 6 patients without DM2 had graft occlusions a year after surgery; the differences for this sign were not statistically significant (p value for Fisher’s exact test is 0.18). Fibrinogen, soluble fibrin-monomer complex, D-dimer, and induced platelet aggregation tests did not demonstrate prognostic significance in relation to graft occlusions in both groups of patients (p for χ² in the logistic regression model is >0.05). The factors associated with higher risk of graft occlusion in patients with DM2 were high ratio between screening and confirmatory test for the detection of lupus anticoagulant (odds ratio 2.27; 95% -confidence interval 1.119-1.238; p <0.05).

Conclusion. After coronary bypass surgery, the one-year risk of graft thrombosis is higher in patients with DM2 and high positive LA activity.

Objective. To demonstrate the peculiarities of infectious endocarditis course in patients after ascending aorta replacement using a valved conduit based on the personal observations.

Material and methods. Six cases of delayed infectious endocarditis after ascending aorta replacement using a valved conduit are presented.

Results. The pathological process was represented by aortic root abscess, paraprosthetic phlegmon, fistula penetrated into the conduit wall and cardiac chambers. There was no vegetation on the prosthesis therefore the diagnosis was complicated. Period from fever onset to final diagnosis lasted from 1 week to 2.5 months. The first pathologic changes in all cases were detected using transesophageal echocardiography, but this method was not informative in the early stages of the disease.

Conclusion. Infectious endocarditis in patients after ascending aorta replacement using a valved conduit has its own peculiarities. The most frequently, the process leads to the development of aortic root abscess. Diagnosis of infectious endocarditis in such cases is difficult. Infectious endocarditis should be suspected in patients - carriers of valved conduit with unexplained fever and treatment should be started in accordance with the diagnosis. In this case, structural changes visualization to confirm the disease is not necessary.

Systemic lupus erythematosus is a systemic autoimmune disease. Over the past decades, great success has been achieved in its treatment. However, mortality in systemic lupus erythematosus is still high. An adverse outcome may occur because of kidney damage, damage of the nervous system, severe hematological disorders, etc. The factor of unfavorable prognosis is infectious complications.

The article presents a prospective clinical observation of a faytal case of severe course of systemic lupus erythematosus. The patient was treated in the rheumatology department of the State Regional Clinical Hospital in Saratov from 2007 to 2014.

The presence of high disease activity, multiple system disorders — polyarthritis, lupus nephritis, hepatitis, leukopenia, and recurrent necrotizing cutaneous vasculitis required the administration of high doses of immunosuppressive drugs.

The progressive course of the disease, resistance to hormonal therapy, the rapid development of infectious complications made the prognosis for the patient’s life extremely unfavorable. Persistent autoimmune leukopenia was the background condition for the development of complications. We used combined therapy — the oral administration of high doses of glucocorticoids together with intravenous injections (pulse therapy), broad-spectrum antibacterial drugs, intravenous immunoglobulin, drugs that improve tissue trophy and microcirculation. It was possible to decrease the disease activity, and also to restore the functional activity of the patient, to maintain low disease activity for 3 years, to prolong the life of a young patient by 8 years. The adverse combination of high activity of systemic lupus erythematosus with recurrent soft tissue infections caused difficulties for the therapy. Administration of adequate doses of cytostatic and biological agents were impossible due to leukopenia and secondary infection, which led to the death of the patient.

The article reviews the literature on the diagnosis and treatment of primary lymphomas of the central nervous system and describes a case of mental disorder before and after surgery in a patient with lymphoma of the third ventricle. Using an interdisciplinary approach, psychopathological dynamics is analyzed taking into account the structural and functional state of the brain, which allowed to clarify the possible causes of mental disorders and methods of treatment. Acute onset of confusion and headache was associated with disorders of the liquor outflow, due to the localization of the tumor. The reason for the disintegration of consciousness after surgery was brain hypoxia and the instability of connections between cerebral structures associated with it. The peculiarity of the consciousness recovery could be determined by premorbid personal traits.

Relevance. Gilbert’s syndrome (GS) is a disease with an autosomal recessive type of inheritance caused by either impaired expression of the UGT1A1 gene, which encodes the isoform of the uridine-5-diphosphate glucuronosyltransferase (UDP-GTA1), or structural modifications of UDP-GTA1. GS is characterized by unconjugated hyperbilirubinemia; drug metabolism disorders and the development of drug-drug interactions. For diagnosis of GS, molecular biological methods are used to determine single nucleotide polymorphisms (SNP). Data on the prevalence of SNP related to GS in Russia are scarce. Study objective: Detection of genetic variant (TA)5/6/7/8 (rs8175347) in the UGT1A1 gene (Gilbert’s syndrome) by pyrosequencing in outpatient practice.

Material and methods: 200 outpatients were examined. Of whom: men — 107 (53.5 %), women — 93 (46.5 %) aged 15 to 86 years; patients from 30 years and older formed the majority — 175 (87.5 %). Detection of the genetic variant (TA)5/6/7/8 (rs8175347) in the UGT1A1 gene (GS) was carried out by pyrosequencing using the PyroMark AmpliSens® Pyroscreen UGT1A1 genetic analysis system (manufactured by the Federal Budgetary Scientific Institution Central Research Institute of Epidemiology of Rospotrebnadzor, Russia). For comparison, sequencing according to F. Sanger was used.

Results: Normal (TA)6/(TA)6 genotype was found in 71 (35.5 %) patients, (TA)6/(TA)7 genotype was found in 81 (40.5 %) (heterozygous status) and (TA)7/(TA)7 genotype — in 48 (24 %) (homozygous status). Rare (TA)5/(TA)6, (TA)5/(TA)7, (TA)6/(TA)8 and (TA)7/(TA)8 genotypes were not found. The results of the determination of (TA)6/(TA)7 genotypes in the homo- and heterogeneous status by pyrosequencing and Sanger sequencing were the same in all cases. In 30 out of 48 patients, GS was newly diagnosed, and in half of the cases these patients were persons of the older group. None of them showed an increase in bilirubin level.

Conclusion: The incidence of GS in outpatients was 24 %. Pyrosequencing allows us to identify various variants of the (TA)5/6/7/8 polymorphism in the homo- and heterozygous status. AmpliSens® Pyroscreen UGT1A1 kit can be used in clinical practice to diagnose GS and to assess side effects of prescribed drugs.