Objective: to study the levels of PA and its relationship with other risk factors among the working population of the Ryazan Region.
Material and methods. The MERIDIAN­RO study was conducted as a prospective cohort with cross­sectional and retrospective study in­ cluded a sample of biochemical, ECG and a survey using a standardized questionnaire. The level of physical activity was assessed by ques­ tionnaire CINDI and then was revised by questionnaire IPAQ. In a study from 2011 it included 1,622 people (in 1220 – a city, 402 – village) aged 25–64 years (mean age – 43,4 ± 11,4 years), of which 42.6 % were male, 53.8 % – female.
Results. The level of low PA in the Ryazan Region, measured by questionnaire IPAQ was 22.9 % (24.3 % in urban and 18.4 % in rural areas, p = 0.014). With multinomial logistic regression were established association between the PA and the low presence of higher education (OR 3.63; 95 % CI 2,26–5,85, p = 0.0001, Wald 28.172), smoking (OR 1.32, 95 % CI 1,01–1,72, p = 0.045, Wald 4,031) and elevated levels of Lp (a) more than 30 mg/dl (OR 1.38, 95 % CI 1,04–1,83, p = 0.024, Wald 5.119). It was also revealed a high demand for advice on improving the PA (74.5 %). Conclusion. The low level of PA in the Ryazan Region, as measured by the IPAQ questionnaire was 22.9 % (24.3 % in urban and 18.4 % in rural areas, p = 0.014), which is lower than Russian average. High demand for advice on improving the FA and created conditions for in­ creasing its level in the region indicate the need to intensify work among the population in this area. 

Objective: to study some vascular wall stiffness parameters in patients with ankylosing spondylitis (AS) without clinically manifest cardio­ vascular diseases.
Subjects and methods. One hundred and six patients with AS and 21 healthy volunteers without cardiovascular diseases who were matched for age, gender, and cardiovascular risk were examined at two centers. Cardiovascular risk and vascular wall stiffness (augmentation index and pulse wave propagation velocity (PWPV)) were assessed by oscillography. 
Results. Vascular wall stiffness was comparable in the patients with AS (at both centers) and in the healthy individuals. PWPV was 7.45 (5.4–8.71) m/sec in the AS patients (n = 106) and 8.53 (6.28–9.5) m/sec in the healthy individuals (n = 21); the aortic augmentation in­ dex was 15.6 (7.9–31.1) and 21.1 (10.2–24) %, respectively; p > 0.05 for all. Correlation analysis revealed associations between aug­ mentation index, age, blood pressure, disease activity (BASDAI) and spine mobility (BASMI) scores. 
Conclusion. The vascular wall stiffness did not differ between AS patients without cardiovascular diseases and cardiovascular risk­matched healthy individuals. Its parameters were related to age, blood pressure, and disease activity (BASDAI) and axial skeleton immobility (BASMI) indices. 

Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings.
Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Forty­nine patients after acute myocardial infarction (AMI) and/or percutaneous coro­ nary interventions (PCI) with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT) according to current clinical guidelines (CG), were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra­ indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared.
Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 %) cases and that was not in 3 (6.1 %) patients in the presence of contraindications, 25 (51.0 %) did not receive DAT in the absence of contraindications and 6 (12.3 %) patients received the therapy in the presence of contraindications.
Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications. 

Objective: to study the specific features of arterial stiffness (AS) in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) as evidenced by 24­hour monitoring.
Subjects and methods. A total of 111 patients with COPD, including 76 with signs of CHF, were examined. The patients with COPD and CHF were divided into 2 groups according to the presence or absence of prior myocardial infarction (MI). A BPLab МнСДП­2 apparatus was used to study 24­hour AS monitoring readings. 
Results. The patients with COPD and CHF were noted to have higher values of AS index (ASI) (during a day, daytime) and pulse wave propa­ gation velocity (during a day, daytime, nighttime) than those with COPD without CHF. There was an association between ASI and major car­ diovascular risk factors (hypertension, age, body mass index). The patients with COPD, CHF, and prior MI, unlike those without the latter, were found to have an increased augmentation index throughout the follow­up (during both daytime and nighttime). In the patients with CHF without prior MI, the diurnal ASI was considerably greater than that in both the COPD patients without CHF and those with CHF and prior MI.
Conclusion. Increased vascular wall stiffness was detected in the patients with COPD and CHF. By taking into account pronounced AS changes not only during daytime and nighttime hours, it is reasonable to perform 24­hour AS monitoring in patients with comorbidities in order to obtain more objective results. 

Myocarditis is an inflammatory disease of the myocardium, which is caused by different factors, such as infectious, immune, chemical, physical, and allergic ones. The main cause of the disease is viral agents. In 1837, the term “myocarditis” was introduced in medical prac­ tice by J.F. Sobernheim who considered the presence of an infectious agent and inflammatory and vascular disorders in the myocardium to be the major signs of the disease. The specific symptoms of myocarditis cannot be identified therefore it is rather hard to determine the prevalence of the disease in the population. However, the association with a definite etiological factor (such as with prior infection and use of some drugs) and the presence of the symptoms of myocardial lesion (chest pain, dyspnea, rhythm and conduction disturbances) may sug­ gest an idea on the possible development of myocarditis. Laboratory studies show an elevation of cardiospecific enzymes and the signs of an inflammatory response. Endomyocardial biopsy (EMB) is the gold standard for the diagnosis of myocarditis to the present day. The diag­ nostic value of the method is limited by technical feasibilities, the skills of medical staff, and the development of possible complications. Gadolinium magnetic resonance imaging that can visualize myocardial inflammatory foci may be used as an alternative to EMB. The de­ veloped criteria are of definite diagnostic value; however, the problems in making diagnosis and differential diagnosis remain unsolved. There are no specific myocarditis treatment methods and regimens. Symptomatic therapy is most commonly used depending on the existing manifestations of myocarditis. The intake of nonsteroidal anti­inflammatory drugs and glucocorticosteroids is now a point open to question. It is necessary to remember about the prevention of infectious myocarditis and the sanitization of existing foci of infection in the body. 

Objective – a description of clinical cases of impulsive­compulsive disorders in Parkinson,s disease.
The first clinical case. Patient N., 75 years old, suffering for 15 years from Parkinson,s disease, akinetic­rigid form of the disease, stage 4 by Hyun–Yar. Since 2009, he received levodopa/carbidopa 250/25 mg 5 times/day (daily dose of 1250 mg of levodopa); pramipexole 3.5 mg per day (daily dose 3.5 mg), amantadine sulfate 100 mg 5 times/day (daily dose 500 mg). While taking antiparkinsonian drugs the patient developed behavioral disorders such as dopamine disregulatory syndrome combined with punding, hypersexuality and compulsive shopping accompanied by visual hallucinations. The total equivalent dose of levodopa was 1600 mg per day.
The second clinical case. Patient R., 52 years old, suffers from Parkinson,s disease about 5 years, a mixed form. She complained of slowness of movement, tremor in her left hand, sleep disturbances, poor mood. The clinic was appointed piribedil 50 mg 3 times per day. Despite the fact that the patient took only one of dopaminergic drugs in a therapeutic daily dose, she developed impulsive­compulsive disorder as hyper­ sexuality, compulsive shopping and binge eating. 
Results. In the first clinical case for correction of behavioral disorders in patients with Parkinson,s disease levodopa/carbidopa dose was reduced to 750 mg per day (3/4 Tab. 4 times a day); added to levodopa/benserazide dispersible 100 mg morning and levodopa/benserazide 100 mg before sleep (total dose of levodopa of 950 mg per day). Amantadine sulfate and pramipexole were canceled. It was added to the therapy of atypical neuroleptic clozapine dose 6,25 mg overnight. After 3 months marked improvement, regressed visual hallucina­ tions, improved family relationships, background mood became more stable. The patient continue to sing karaoke, but this hobby has be­ come less intrusive. 
In the second clinical event correction impulsive­compulsive disorders piribedil was replaced with pramipexole 1.5 mg prolonged form one time a day. At the control examination after 3 months behavioral disorders completely regressed.
Conclusion. This article describes two clinical cases of impulsive­compulsive disorders in patients with Parkinson s disease, methods of di­ agnosis and correction capabilities of these disorders. 

Clinical medicine develops towards increasingly more specialization; however, there are diseases faced by physicians of different specialties. The most common cardiac arrhythmia after extrasystoles is atrial fibrillation (AF) that increases the risk of cardiac embolism, primarily ischemic stroke, by several times. Identification of the causes of stroke and systemic embolisms has given rise to the creation of clinical scales to assess the risk of their development. According to current guidelines, the long­term use of oral anticoagulants (for an indefinite time) is the best way to prevent cardiac embolic complications with medications in AF. This approach outperforms both monotherapy with acetyl­-salicylic acid alone and in combination with clopidogrel. The administration of anticoagulants is warranted in patients having risk factors for stroke, no matter what the clinical type of AF (paroxysmal, constant, or persistent).

Until quite recently, oral anticoagulant therapy has implied the use of drugs from a group of vitamin K antagonists (VKAs), among which warfarin is at the forefront; however, the pharmacodynamic and pharmacokinetic features of the drug substantially complicate its practical application. The results of a number of large randomized controlled trials have shown that novel oral anticoagulants (NOACs) may be used along with VKAs in patients with non­valvular AF (i. e. in the absence of mitral stenosis or mechanical cardiac valvular prostheses). As com­ pared with warfarin, NOACs have advantages: a much less interaction with foods and drugs and no need for continuous monitoring using coagulation tests and for drug dose adjustment (although the dose should be corrected in renal dysfunctions). When prescribing therapy with VKAs or NOACs, a risk for hemorrhagic complications should be defined. The patient should be informed of the advantages and disadvantages of each therapy option in order to take into account the real possibilities of safely maintaining the persistent coagulation level and the patients, choices. Prognosis and quality of life may be effectively influenced in an AF patient where physicians of all specialties understand each other well and know general approaches to treating these patents. A general practitioner plays a key role in the coordination of all actions. 

Lack of physical activity (PA) is today one of the most important risk factors for atherosclerosis­related deaths. Its level is falling worldwide. A study in the UK, USA, India, Brazil and China (45 % of the world population) total PA declined in these countries and will continue to fall over the next 15 years. In Russia, the level of the PA population decreased. PA is responsible for 12.2 % of the global burden of myo­ cardial infarction. These more than 40 observational studies demonstrate the complete proofs of the linear relationship between the level of PA and total mortality in younger and older men and women. The minimum threshold PA, which can reduce the risk of all­cause mortal­ ity is at a level of 2.5–5 hours a week. Further increase of the PA (its duration and/or intensity) leads to a further reduction of risks. PA should take most days of the week and have a duration of more than 10 minutes a day. Only then did she summed up. In patients with cardiovascular disease to determine the necessary level of PA is difficult. Therefore, before the training they have to undergo stress testing. The program of training should be determined on the basis of findings and the clinical status. Even brief moderate and/or intense exercise can reduce the risk of death of the patient. If an individual does not reach the target of 150 minutes of moderate PA per week, but has been a regular, his risk of CHD was significantly reduced (14 %, 95 % CI 0.76–0.97). The development of programs to improve the PA of the population can have a significant impact on the overall and cardiovascular mortality.