Objective: to detect previously undiagnosed arterial hypertension in patients with chronic obstructive pulmonary disease (COPD) as a risk factor for cardiovascular mortality.

Materials and methods. 43 patients with stage I–II of COPD and the absence of clinical signs of cardiovascular diseases were examined. Spirometry, body plethysmography and diffusing lung capacity (DLCO) were included in the respiratory system assessment. The cardiovascular system was assessed with echocardiography and ambulatory blood pressure monitoring (ABPM).

Results. Despite the absence of obvious signs of cardiovascular lesions (an increase of office blood pressure, intracardiac hemodynamic changes), the following cardiovascular risk factors were identified: age (58.2 ± 2.0 years), male gender, smoking, hypercholesterolemia and dyslipidemia (total cholesterol 5.9 ± 0.9 mmol / l, low density lipoproteins 3.8 ± 0.5 mmol / l, triglycerides 1.8 ± 0.2 mmol / l). Correlation analysis has revealed the relation between several respiratory parameters and the severity of dyspnea and quality of life in patients with COPD, as well as its relation with lipid levels.

Conclusion. The patients with COPD have a large number of risk factors for CVD. According to ABPM data, arterial hypertension was verified in 18 (41.9 %) of 43 patients with COPD at normal level of office blood pressure; moreover, 51.2 % of patients demonstrated low reduction of blood pressure during the night-time that nowadays, is considered to be a predictor of cardiovascular disease and sudden death.

Objective: to determine the incidence of atherosclerotic lesions in the carotid and vertebral arteries of young patients from Doppler ultrasound data and to compare the quantitatively assessed traditional risk factors of coronary heart disease (CHD) with severe extracranial artery atherosclerotic lesion.

Subjects and methods. Doppler ultrasound was carried out evaluating structural changes in the aortic arch branches in 1563 railway transport workers less than 45 years of age. A separate sample consisted of 68 young people with carotid atherosclerotic changes, in whom traditional risk factors for CHD were studied, so were in a control group of individuals without atherosclerotic changes (n = 38).

Results. Among the examinees, carotid atherosclerotic lesion was detected in 112 (7.1 %) cases, the increase in the rate of atherosclerotic plaques in patients aged 35–45 years being 9.08 %; that in the rate of local intima-media thickness in those aged 31–40 years being 5.1 %. Smoking (particularly that along with hypercholesterolemia and a family history of cardiovascular diseases), obesity (along with low activity), and emotional overstrain were defined as important risk factors in the young patients. Moreover, factor analysis has shown that smoking,
hypertension, and early cardiovascular pathology in the next of kin makes the greatest contribution to the development of carotid atherosclerotic lesion.

Conclusion. Among the patients less than 45 years of age, carotid and vertebral artery atherosclerotic changes were found in 112 (7.1 %) cases, which were more pronounced in male patients. Smoking, particularly along with hypercholesterolemia and genetic predisposition to cardiovascular diseases, was a risk factor that had the highest impact on the degree of atherosclerotic lesion in the aortic arch branches of the young patients.

Objective: to study the association of C3256T, G13 513A, G14 846A, and G12 315A mutations in the mitochondrial genome with the presence and degree of coronary and carotid atherosclerotic lesions.

Subjects and methods. The investigation enrolled 193 patients (mean age 54.6 ± 9.5 years), including 154 men, who had undergone coronary angiography. A study group consisted of 130 patients with coronary atherosclerosis. A control group comprised 63 patients without this disease. Genetic analysis consisted of 3 steps: 1) isolation of genomic deoxyribonucleic acid from whole blood leukocytes by phenol-chloroform extraction; 2) amplification of polymorphic sites in the examined mitochondrial deoxyribonucleic acid genes by polymerase chain reaction; 3) pyrosequencing
for the detection of nucleotide sequencing and the determination of the level of heteroplasmy of the examined mutations.

Results. The level of heteroplasmy of G13 513A and C3256T mutations was statistically significantly higher in the patients with coronary atherosclerosis than in those without this condition (p = 0.03 and p = 0.01, respectively) whereas that of G12 315A mutation was significantly higher in the persons without coronary atherosclerosis (p = 0.004). The level of heteroplasmy of G14 846A mutation was greater in people over 45 years of age. No association was found between mutations in the mitochondrial genome and cardiovascular risk factors, such as smoking, hypertension, poor family history, and obesity. There was a direct relationship of hyperlipidemy to C3256T mutation (r = 0.18; р = 0.01) and its inverse relationship to G12 315A mutation (r = –0.2; р = 0.005), There was a positive correlation between G14 846A mutation
and lipoprotein (a) levels. There was also a positive correlation between carotid atherosclerosis with С3256Т (r = 0.49; p = 0.0001)
and G14 846A (r = 0.48; p = 0.0001) mutations. G12 315A mutation showed a negative correlation with carotid atherosclerosis (r = –0.32; p = 0.01). 

Conclusion. The case-control study gave proof to the association between the level of heteroplasmy of С3256T, G13 513A, G14 846A, and G12 315A mutations in the mitochondrial genome and coronary and carotid atherosclerosis. Measurement of the heteroplasmy of С3256T, G13 513A and G14 846A mutations in the mitochondrial gene may be proposed as potential genetic markers to improve the diagnosis of a preposition to coronary and carotid atherosclerosis.

Objective: to compare clinical manifestations, course, mental status in duodenal ulcer (DU) patients with a history of perforated ulcer and its uncomplicated course.

Subjects and methods. One hundred and thirteen patents with DU were examined. Group 1 included 61 patients with uncomplicated DU
and Group 2 comprised 52 patients with a history of perforated ulcer. A comparison group consisted of 20 patients who had undergone laparotomy. Physical and mental status examinations, esophagogastroduodenoscopy (EGDS), and 24-hour pH-metry were performed.

Results. Classical pain syndrome was observed in 75 % of the patients with uncomplicated DU. Prior to perforation, the pain and dyspeptic syndromes were distinguished only by a significantly lower degree in Group 2; following perforation, the pain syndrome was recorded more frequently, it was more extensive, meal-unrelated, and similar to that in the patients who had undergone laparotomy and had diminished appetite (36.5 %). EGDS showed that the complicated course was accompanied by the significantly higher incidence of erosive esophagitis (21.2 %), gastritis (51.9 %), duodenitis (25.0 %), multiple ulcers (28.8 %), and larger ulcers. 24-hour pH-metry indicated that the level of hyperacidity in Group 2 was higher and the circadian intragastric pH variations were less marked than those in uncomplicated DU. The patients with a history of perforated ulcer showed a high rate of anxiety and depressive changes. 

Conclusion. In complicated DU, marked monotonic hyperacidity causes common erosive-ulcerative lesions in the gastroduodenal area in relatively mild pain syndrome, late referrals, and long-term ulcer healing. After perforation followed by wound closure, the pain and dyspeptic syndromes become more pronounced, which is associated with anxiety and depressive changes in the mental status, as well as with early referrals and less healing time.

As gestation progresses, all hemostatic components show changes aimed at compensating for the expenditures associated with fetal development. Activation of the hemostatic system during pregnancy creates a premorbid background for thrombotic and hemorrhagic complications. Hemostasiological examination is one of the compulsory dispensary management stages for pregnant women. An algorithm for the diagnosis of pregnancy-associated disorders in the hemostatic system is to solve the following problems: to identify the causes of hemocoagulation disorders, to determine the risk of thrombotic and hemorrhagic disorders, to prevent obstetric complications, and to monitor antithrombotic therapy. Hemostatic monitoring in pregnant women is based on rating and special methods and includes 3 stages: early, extended, and differential.
The need for extended hemostatic examination is first determined and the direction of a search for a defective component is concretized in relation of the changes found. Interpretation of laboratory test values in terms of a female medical history and gestational age underlies the timely diagnosis, adequate treatment policy, and effective prevention of gestational complications.

Objective: to evaluate the comparative efficacy and tolerability of avocado / soybean unsaponifiables (ASU) and their combination with intra-articular hyaluronic acid in patients with knee and hip osteoarthrosis (OA).

Subjects and methods. A randomized observational non-interventional non-placebo controlled trial was conducted. It included 18 patients who were randomized to 2 groups with 9 in each. One patient group took only ASU along with nonsteroidal anti-nflammatory drugs (NSAIDs); the other received ASU in combination with intra-articular hyaluronic acid. Their treatment was performed for 6 months, followed by a 6-month follow-up. The results were assessed by the WOMAC index. Account was taken of the opinions of a patient and his / her physician on therapeutic effectiveness, as well as altered needs for NSAIDs during treatment and after the follow-up.

Results. There was a gradual reduction in joint pain, stiffness, and dysfunction (as shown by the visual analog scale) in both groups just one month posttherapy. This trend remained for 3 months. After 6 months of therapy, there were slight increases in the values of joint pain, stiffness, and dysfunction in the combined therapy group whereas the values continued to decrease in the monotherapy group. Six months after termination of treatment, the examined values doubled in the ASU monotherapy group and remained at posttreatment visit levels in the combined therapy group. Just the same, six months after termination of 6-month therapy, both groups displayed the significantly lower values of pain, stiffness, and dysfunction than those prior to treatment. ASU used both alone and in combination with hyaluronic acid was noted to be well tolerated. The considerable reduction in the needs for NSAIDs in both groups and, in a number of cases, the possibility of reducing their intake proved the efficiency of ASU used alone and in combination with hyaluronic acid. The important result of this trial was the good tolerability of both test drugs.

Conclusion. The results of the performed trial provided support for the efficacy of ASU in treating both moderate and severe knee and hip OA. Hyaluronic acid in combination with ASU ensures a longer duration of the achieved effect than that of ASU monotherapy (during 12 months, a minimum of 6 months after termination of treatment) regardless of the severity and duration of OA.

The paper considers an association between spinal pain syndrome and the magnitude of vertebral column changes in osteochondrosis and the specific features and characteristics of pain syndrome. It gives the data that allow the consideration of spinal osteochondrosis as a degenerative and dystrophic process that is concurrent with the compensatory rearrangement of a vertebral motor segment, chiefly a disk, and aimed at adapting the functional capacities of the vertebral column as a whole. The issues of therapy for spinal pain syndrome with a combination of nonsteroidal anti-inflammatory drugs and a vitamin B (B1, B6, and B12) complex are covered.

Low back pain (LBP) is one of the most common pain syndromes caused by musculoarticular pathology. Analgesics, nonsteroidal antiinflammatory drugs (NSAIDs), myorelaxants, and non-drug therapies are used to treat patients with LBP. The sufficient efficiency of this type of therapy is strongly supported by the results of clinical trials; its fundamentals have been embodied in a number of regional and international guidelines for the management of patients with LBP. Alongside the sufficient efficacy of NSAIDs, their use, their long-term use in particular, is associated with a wide range of adverse reactions. The increased efficiency of treatment in patients with LBP is frequently achieved by the application of topical dosage forms. Whether the new Russian drug Nanoplast forte may be used to treat patients with LBP is considered.

The paper describes 2 cases that demonstrate the patterns and specific features of infective endocarditis in the presence of hypertrophic obstructive cardiomyopathy, diagnostic difficulties, comorbidities, as well as error analysis and a disease outcome

It is presented a case of delayed diagnosis brad systole against permanent atrial fibrillation (syndrome Frederick) which became to syncope patient and to the later implanting of pacemaker.

Glucocorticoids (GCs) are first-line drugs to treat systemic lupus erythematosus (SLE) of both high and moderate activities. These are the only agents that are able to provide so prompt anti-inflammatory and immunosuppressant effects in rheumatic diseases. Along with antimalarials and immunosuppressants, GCs are used in the standard classical treatment regimen for SLE; however, despite the high efficacy of these drugs, their related immediate or delayed adverse reactions are one of the major problems in the management of a patient with SLE. Occasionally, they may be severer than the indication itself for their use and may be even fatal. The paper describes the adverse reactions observed in a female patient with SLE during long-term use of a high maintenance GC dose.

The paper describes a clinical case of developing rheumatoid arthritis complicated by osteoporosis in a male. It considers the possible risk
factors of osteoporosis and fractures, including those associated with rheumatoid arthritis, the necessity of assessing the 10-year risk of major osteoporotic fractures and femoral neck ones to timely use not only calcium and vitamin D preparations, but also antiosteoporotic therapy to prevent osteoporosis.

The paper considers a clinical case of early-stage mixed Parkinson’s disease (PD) with significant affective disorders and restless legs syndrome. Once-daily extended-release pramipexole 3 mg significantly improved a patient’s status and led to regression of movement and affective disorders. The paper gives data on the efficacy of dopamine receptor agonists in treating PD and the benefits of their extended-release formulations.

This review discusses actual scientific results on cardiovascular risk factors, such as sex hormones, age at menopause, dyslipidemia, sympathicotony, body weight and obesity, etc., in postmenopausal women. Some aspects of assessment of cardiovascular risk in women, according with guidelines of American Heart Association (2011), were discussed also. Key points of preventive interventions were highlighted

The paper analyzes the cause-and-effect relations of obstructive sleep apnea syndrome (OSAS) and cardiovascular diseases (CVD). In OSAS,
there is activation of the sympathetic nervous system and proinflammatory and procoagulant systems, endothelial dysfunction, and accelerated atherosclerosis in response to intermittent hypoxia and sleep fragmentation, which leads to increased risk for CVD. Continuous positive airway pressure therapy reduces the risk of death in patients with OSAS

New markers for cardiovascular disease (CVD) risk are the subject of an intensive discussion in the scientific literature. The biomarkers (new
lipid parameters, inflammatory markers) and signs of subclinical atherosclerosis are candidates to be included in models to assess the cumulative risk of CVD. The paper considers the basic studies dealing with new markers of CVD risk and their place in current clinical recommendations.