Objective — to study the frequency and characteristics of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular diseases hospitalized in the emergency departments of cardiology. Materials and methods. Examined 190 patients hospitalized in the emergency cardiology departments of the State Healthcare Institution Regional Clinical Hospital of Saratov from January to March 2020. The study was continuous, a questionnaire was conducted for all patients hospitalized during the specified period. The study involved 103 (54%) men and 87 women, the average age of the patients was 62.05 ± 11.11 years. The reason for hospitalization in most patients was acute coronary pathology — 116 (61%) patients, 34 (18%) patients — decompensated heart failure, 21 (11%) patients — various rhythm disturbances; in 15 (8%) patients — hypertensive crisis against the background of uncontrolled arterial hypertension, in 4 (2%) patients — pulmonary embolism. Results. During the last month, 92 (48%) patients took NSAIDs for various reasons: 42 men (46%) and 50 women (54%). The average age of patients taking NSAIDs is higher than that of patients who did not take NSAIDs (63.98 ± 11.62 years and 60.20 ± 10.27 years, respectively, p = 0.018). Among patients forced to take NSAIDs over the past month, joint pain — 43 (47%) patients, headache — 40 (43%) patients, back pain — 30 (33%) were indicated as the main cause or one of the reasons sick. In 15 (16%) patients, the reason for taking NSAIDs was toothache, in 14 (15%) patients — chest pain, musculoskeletal pain — in 11 patients (12%). Several reasons for taking NSAIDs were indicated by 40 (43%) patients, the majority — a combination of joint pain and back pain. Conclusion. Almost half of patients admitted to emergency cardiology departments had taken NSAIDs in the previous month. Most patients have to take NSAIDs often, regularly, for a long time. More than a third of the examined patients used various methods of drug administration, including unreasonably frequent and prolonged parenteral use or the simultaneous use of various methods of administration of various drugs.

Purpose. To investigate the body composition in patients over 90 years old (long-livers) with coronary artery disease (CAD), and analyzed the relationships between the fat and lean tissues, as well as bone mineral density. Material and Methods. A cross-sectional study of 200 patients over 90 years old (140 men and 160 women, mean age 92,4±2,3 года) who were hospitalized with a diagnosis of CAD was conducted. The body composition was analyzed by dual-energy X-ray absorptiometry (DXA). Results. Overweight or obesity were diagnosed in 139 (69.5%) patients. The musculoskeletal index remained within normal values in 145 (72.5%) patients and was below normal in 55 (27.5%) patients. Decrease of total BMD (T-score) below -2.5SD was detected in 81 (40,5%), and normal total T-score — in 60 (30.0%) patients. The smallest values of BMD were found in the ribs, the largest — in the spine and in lower extremities. A positive correlation was registered between body mass index and bone mineral density in all areas of the skeleton (p <0.0001). A significant positive correlation was found between BMD and the fat mass in all parts of the body, especially significant between BMD of the ribs and the trunk adipose tissue (r = 0.85; p <0.0001). A positive correlation has been established between the lean mass and BMD; the most significant between the BMD and the lean mass in the upper extremities (r = 0.69; p <0.0001). A negative correlation was found between the fat and lean mass; the most significant between lean and adipose tissue in the lower extremities (r = -0.46; p <0.0001). Conclusion. The study results indicate some features of body composition in long-livers. The proportion of overweight patients with normal indices of BMD and lean mass was relatively high. Significant relationships between the bone, adipose and lean tissues were confirmed.

In the presented clinical review, we evaluated the possibilities of drug and non-drug strategies for eliminating and preventing pathophysiological changes in the respiratory system of post-COVID-19 patients. We offer up-to-date rehabilitation algorithms based on the assessment of the severity of clinical manifestations of COVID-19, the possibilities of rehabilitation techniques and the patient’s personal compliance with their implementation.

Adaptation processes in chronic diseases, including arterial hypertension (AH) and chronic heart failure (CHF), depend both on the personality of the patient and on comorbidity. Objective: to study the characteristics of adaptation and mental functioning of patients with hypertension and heart failure with comorbidity (the patient has concomitant diseases). Design and methods. 122 patients (49 women and 73 men, average age 62.9 ± 9.4 years) with hypertension and heart failure were examined. AH was diagnosed and evaluated according to guidelines for the treatment of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology (2013). CHF was diagnosed in accordance with the guidelines for the diagnosis and treatment of chronic heart failure of the Society of Heart Failure Specialists, Russian Cardiology Society (2016). Charlson Comorbidity Index (IC) was used to evaluate comorbidity; comorbidity was regarded as high at IC ≥ 6 points (60 patients). To assess personal characteristics and mental status, a projective methodology was used — Sondi’s test, a Mini-mult questionnaire (shortened version of MMPI). To assess the adaptive psychological mechanisms were used «Life Style Index» and «Copy Test». Cognitive functions and quality of life were evaluated. Results. IC was 5.3 (IQR:4-7) points. The group of patients with hypertension, heart failure and high comorbidity differed in the severity of the depressive-hypochondriacal profile compared with patients with low comorbidity. Similar data were obtained in a projective methodology: in the group with high comorbidity, the most pronounced factor is D− (depression) (1.7 (IQR: 1-2) and 0.9 (IQR: 0-1), points respectively, p = 0.009) and factor P− (paranoid) (1.8 (IQR: 1-2.5) and 1.3 (IQR: 1-2) points respectively, p= 0.01). Relationships have been identified that make it possible to talk about common adaptation processes in patients with AH and CHF depending on comorbidity: in patients with high comorbidity, non-constructive coping strategies («confrontational», «flight-avoidance») correlated with psychological defense mechanisms of the regression type (r=0.41, p=0.003) and replacement (r=0.39, p=0,001). Conclusions. Comorbidity has a negative impact on the cognitive and adaptive capabilities of patients with hypertension and heart failure, contributes to the emergence of depressive-hypochondriacal conditions, accompanied by a decrease in motivation and adherence to treatment, which must be taken into account with an interdisciplinary approach to this category of patients.

Purpose: to study the clinical course and features of violations of the motor-evacuation function of the gastrointestinal tract in chronic duodenal insufficiency. Materials and methods. The study included 40 patients with chronic duodenal insufficiency (CDI): 18 (48.2%) women, 22 (51.8%) men, mean age 37.1 ± 13.8 years. The control group consisted of 30 healthy individuals: 10 (33.3%) women, 20 (66.7%) men, mean age 40.5 ± 13.47 years. In the examination of patients, anamnestic and physical data, the results of biochemical, X-ray and endoscopic studies, intracavitary manometry, and electrogastroenterography were used. Parameters reflecting psycho-emotional state and vegetative status were evaluated. Results. In 19 (46.8%) patients with CDI, the pain syndrome occurred after eating, most often localized in the right hypochondrium in 11 (29.0%) and in the epigastric region in 18 (44.9%) patients. Patients with CDF presented some dyspeptic complaints that were not observed in the control group: 22 (57%) noted belching with bitterness, 31 (77.6%) — a feeling of bitterness in the mouth, 21 (53%) — heartburn, flatulence — 25 (53.3%) and mushy stools 28 (71%). In patients with CDI, compared with the control group, there was a decrease in the content of total protein (62.24 ± 0.17 and 72.3 ± 0.21 g/l, p = 0.0002), triglycerides (0.42 ± 0.0021 and 1.5 ± 0.04 mmol/L, p = 0.022), fat-soluble vitamin B12 (188.0 ± 0.21 and 328.6 ± 18.9 pg/ml, p = 0.0048), 25-OH vitamin D (26.87 ± 0.12 and 64.7 ± 1.25 ng/ml, p = 0.018). With CDI, compared with control, a significant increase in gastrin (29.7 [25.7; 32.5] and 19.2 [18.8; 20.1] pmol/L, p = 0.0004) and cortisol (471, 8 ± 1.09 and 365.3 ± 2.6 nmol/L, p = 0.0001). The insulin level was significantly lower than the values of the control group: (2.89 [2.5; 3.0] and 3.8 [2.2; 4.5] μmol/L, p = 0.006). According to the gastroenteromanitor in the postprandial period, impaired propulsive motility in all parts of the digestive tube was established, which proves a decrease in the rhythm coefficient (K-ritm) of the duodenum, jejunum and ileum on an empty stomach by 1.5 times in both phases of the study (p = 0.000). The ratio of intraduodenal pressure to intragastric pressure in chronic heart failure was 1.26 [1.19; 1.32], which is significantly lower than the values in the control group (1.7 [1.0; 2.4], p = 0.0004) and indicates a violation of the closure function of the gatekeeper. Alarm scale RH. Spielberger (adaptation of Yu.L. Khanin) showed an increase in comparison with the control group in the levels of situational (57 [54; 60] and 47.0 [45; 50] points, p = 0.0021) and personal anxiety (25.1 [22.6; 27.4] and 21.9 [19.5; 23.9] points, p = 0.003) in patients with CDI. Conclusion. In connection with the non-manifest course and the absence of specific symptoms of chronic duodenal insufficiency, in the examination of patients for the diagnosis, it is necessary to use, in addition to clinical data, X-ray, endoscopic, manometric and electrophysiological studies.

Primary hyperparathyroidism is a common pathology, but it is fact that doctors of various specialties run against difficulties in diagnosinging. The variety of clinical manifestations causes a long period of diagnosis and, late start of treatment. The main symptoms of this pathology are described taking into account the pathogenesis. The most common laboratory markers of hyperparathyroidism are incrising level of parathyroid hormone and hypercalcemia. Imaging examination methods are used to establish primary hyperparathyroidism. Targeted ultrasound examination of the parathyroid glands should be performed in all patients with suspected calcium metabolism disorders.
This article presents a clinical case of primary hyperparathyroidism with predominant gastrointestinal symptoms. The patient was twice admitted to the hospital with various clinical manifestations of damage to the gastrointestinal tract. Erosive gastritis, terminal ileitis, chronic pancreatitis, and cholelithiasis were identified. A differential diagnosis was made with small intestine lymphoma and Crohn’s disease. In addition, there were General cerebral symptoms in the form of lethargy, rapid exhaustion. Due to severe electrolyte disorders, the patient was observed in the intensive care unit. Due to the development of mechanical jaundice, endoscopic retrograde cholangiopancreatography with papillosphincterotomy was performed. Based on hypercalcemia, elevated parathyroid hormone levels, and visualization of parathyroid gland formation, the diagnosis of primary hyperparathyroidism was established based on ultrasound data. An adenomectomy of the left lower parathyroid gland was performed. in the surgical department. The patient was discharged with positive dynamics in the form of improvement in General health, cessation of pain, regress of vomiting, expansion of motor activity. Betimes diagnosis and treatment of primary hyperparathyroidism, on the example of the described case, leads to complete relief of symptoms and improvement of the quality of life of patients.

The presented article contains the clinical observation of bradycardia development in 64-year-old patient with chronic kidney disease who was in ambulatory treatment at the hemodialysis department. During electrocardiogram recording an arrhythmia was detected as a junctional rhythm. The specific changes on electrocardiogram, presence of risk factors, and data of additional collection of history disease allowed purposing the development of dangerous condition — hyperkalemia. The diagnosis was confirmed after detection of the serum potassium level. This case illustrates the necessity to consider the possibility of hyperkalemia in patients with chronic kidney diseases including those who undergoing hemodialysis treatment. Relevant clinical manifestations and changes on the electrocardiogram require the urgent assessment of the serum potassium level for timely and adequate correction of the electrolyte disorder.

Clinical case of paraneoplastic vasculitis аssociated a brain tumor was presented. Paraneoplastic vasculitis is a rare type of paraneoplastic syndrome. The frequency of detection of paraneoplastic vasculitis in cancer patients is 0.01-5%. In 70% of cases, the manifestation of vasculitis is observed long before the clinical manifestations of the tumor. Most studies report so-called leukocytoclastic vasculitis (allergic) or allergic angiitis. Vasculitis is usually accompanied by slowly progressing tumors such as breast and prostate cancer. It also develops with of stomach cancer, lung cancer, kidney adenocarcinoma, epithelioma, sarcoma, cholangiocarcinoma, other solid tumors, multiple myeloma, non-Hodgkin’s lymphoma. The nosological forms of paraneoplastic vasculitis include called polyarteritis nodosa, hemorrhagic vasculitis, Wegener’s granulomatosis, non-specific aortoarteritis, idiopathic pulmonary hypertension syndrome, thrombovasculitis, allergic hemorrhagic vasculitis, cutaneous vasculitis, systemic necrotizing vasculitis with increased ANCA titer. The patient suffered from paraneoplastic vasculitis with the development of amyloidosis of vascular tissues and arterial hypertension. The progression of the vascular process led to damage of the arteries of the brain and heart, the development of ischemic stroke and hemodynamically significant stenosis of the coronary arteries, the development of acute myocardial infarction complicated by acute heart failure, which caused death. The clinical significance of the case lies in the fact that paraneoplastic vasculitis, which was developed due to a brain astrocytoma with the formation of amyloidosis was firstly described.

The article describes a clinical case of a progressive form of systemic scleroderma in a 39-year-old man. The patient has an acute course and rapid progression of the disease with a significant initial decrease in the forced vital capacity of the lungs, with signs of an unfavorable prognosis, such as a diffuse form, a high skin count (> 14), male sex, and high positivity for antibodies to Scl-70. In connection with the ineffectiveness of standard therapy with glucocorticoids and immunosuppressants at an early stage of the disease, the option of treatment with genetically engineered drugs (rituximab) was considered. As a result of the therapy, a positive trend was noted.

Primary hyperparathyroidism (PGPT) is an endocrine disease characterized by excessive secretion of parathyroid hormone (PTH) in upper — normal or elevated blood calcium levels due to primary parathyroid gland pathology (osch). Primary hyperparathyrosis, depending on the clinical manifestations, can occur in the normocalcemic, mild and manifest form. This article presents a clinical case of the development of the manifest form by the type of visceral disorders. Which appeared in the form of pathology of the gastrointestinal tract. This form of the disease is an indication for surgical treatment and further correction of calcium-phosphorus metabolism.