Objective: to assess and compare outcomes in patients with ST-segment elevation acute coronary syndrome (STEACS) during 28 months of follow-up in relation to reperfusion therapy policy.

Materials and methods. The investigation was based on the hospital registry of patients with acute coronary syndrome. This investigation enrolled 259 patients with STEACS hospitalized through the emergency medical care channel from January 1, 2012 to January 1, 2013. The safety and efficiency of a pharmacoinvasive (PI) approach (n = 60) and primary percutaneous coronary intervention (PCI) (n = 91) were comparatively analyzed after 28 months of follow-up.

Results. The choice of a reperfusion therapy option (primary PCI or PI approach) failed to affect survival in the patients during 28 months of follow-up. The prediction of cardiovascular mortality and morbidity did not differ in both groups in the study period.

Conclusion. The application of the PI approach to treating patients with STEACS was comparable in its efficiency and impact on long-term outcome as compared to primary PCI in real Russian practice conditions.

Objective: to to study and reveal the diagnostic signs of lipodermatosclerosis (LDS) as one of the types of panniculitis (PN).

Materials and methods. A total of 550 patients were examined; LDS with its duration of 18.97 ± 7.4 months was verified in 53 (9.6 %) patients (3 men and 50 women; whose age was 18–80 years), including 32 overweight ones. All the patients underwent comprehensive clinical examination and laboratory and instrumental studies involving biochemical and immunological parameters, as well as chest computed tomography and Doppler ultrasound (DUS) of the lower limb vascular bed. While characterizing the skin lesion, the extent, skin color, number and intensity of pain were assessed using the visual analogue scale (VAS) in the affected areas. Chronic venous insufficiency (CVI) was evaluated in accordance with the international classification and the classification developed by V.S. Savel’ev et al. The skin and hypodermic tissue were biopsied from an area of the highest lesion and further pathomorphologically examined.

Results. Thirty-seven (70 %) of the 53 patients with LDS were noted to have predominantly inflammation of the subcutaneous adipose layer of the leg (88.6 %) on its medial surface (54.7 %) with the development of the glass symptom (79.2 %) (p = 0.005). Main types of the disease course (acute, subacute, and chronic) were identified, which differed in clinical symptoms. ROC analysis indicated that the VAS sensitivity (86 %) and specificity (58 %) in the patients with LDS corresponded to a separation point of 40 mm. In 46 % of the cases, skin lesion was associated with polyarthralgias (n = 15) or myalgias (n = 12) in the presence of insignificant inflammatory activity. Twenty-eight patients (including 19 with chronic LDS) had CVI with a duration of 10.2 ± 1.3 years, which was verified by DUS of the lower limb vessels (p < 0.05). All the patients took venous tonics, nonsteroidal anti-inflammatory drugs, aminocholines, and antioxidants for 3 months. A therapeutic effect was observed in 68 % of the cases. A therapeutic effect was absent in 23 % of the patients and worse health was seen in 9 %, which needed glucocorticoid therapy to be added.

Conclusion. LDS is a clinical type of lobular PN, which requires an extensive diagnostic search. The factors contributing to the development of LDS are female sex, middle age, overweight, anamnestic predisposition, and CVI of the lower extremities. Asymmetric indurations with their characteristic color on the medial surface of the leg with the development of subcutaneous adipose layer dystrophy (the glass symptom) are a diagnostic sign of LDS.

Objective. To assess the quality of life and mood disorders of patients with myasthenia gravis.

Materials and methods. A comprehensive clinical and neuropsychological testing of 34 patients, accounting for 43.6 % of all patients with myasthenia living in the Leningrad region. To assess the severity of the international rating scale used by the severity of myasthenia gravis (MGFA). For the diagnosis of affective disorders, anxiety scale and Spielberger–Khanin depression scale, CES-D were used, quality of life was assessed by the SF-36 scale. The study included patients with stable clinical picture at least for the last 2 months. Comparison was made in population as well as within the studied group, divided into several groups depending on the severity and duration of the disease.

Results. The quality of life of patients with myasthenia gravis in terms of physical health significantly lower (p = 0.04) than in the general population and directly depends on the severity of the disease. Depressive disorders are typical for patients with a long (more than 3 years) history of the disease, including the level of depression scale CES-D averaged 28.1 balls, which was significantly (p = 0.03) higher than for the patients in the early stages of the disease. In assessing affective disorders with anxiety scale Spielberger–Khanin was expressed by the average value on the scale of situational anxiety – 31.8 ± 8.3 points, and on the scale of personal anxiety 31.5 ± 8.1 points, indicating moderate anxiety disorder. We have not found a statistically significant relationship of affective disorders with disease severity and bulbar syndrome.

Conclusion. The quality of life of patients with myasthenia generally reduced in comparison with the general population, and depending on the severity and depressive disorders typical for patients with a long history of the disease.

Psoriatic arthritis (PA) is a chronic inflammatory disease of the joints, vertebral column, and entheses from a group of seronegative spondyloarthritides, which is observed in patients with psoriasis. In accordance with the 2013 federal clinical guidelines for the management of patients with PA, published by the Russian Society of Dermatovenereologists and Cosmetologists and the Association of Rheumatologists of Russia, its diagnosis should be based on the CASPAR criteria (ClASsification criteria for Psoriatic ARthritis, 2006). The activity of spondylitis in PA is assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) that is a questionnaire containing 6 questions; a numeric rating scale from 0 (“very good”) to 10 (“very bad”) scores is applied for a response. It is recommended that ultrasound studies and magnetic resonance tomography be used for the early diagnosis of enthesitis in seronegative spondyloarthritides. The Psoriasis Area Severity Index (PASI) that takes into account the area of the lesion, the magnitude of erythema, infiltration, and desquamation in different body areas. The early diagnosis of PA and the timely use of disease-modifying antirheumatic therapy are topical problems, as high-activity inflammation may lead to rapid joint destruction, physical limitations, and disability. When the signs of active PA (the presence of one or more swollen and tender joints, and/or 1 or more dactylitides, and/or more enthesitides and/or inflammatory back pain) are detected, prompt drug therapy is indicated. The clear compliance of the algorithm for making a decision on treatment policy and the timely assessment of the clinical manifestations of the disease improves prognosis, adherence to treatment, and quality of life.

Objective: to describe a case of normocalcemic hyperparathyroidism.

Materials and methods. A female patient aged 51 years sought medical advice for complaints of spinal column and bone pains, periodic dizziness, and hand numbness. The patient underwent clinical and biochemical blood tests, determination of the blood levels of calcium, phosphorus, parathyroid hormone, concentrations of total vitamin D, calciuria, electrocardiography, thyroid ultrasonography, and neck computed tomography.

Results. Based on her complaints, examination evidence, evaluation of the clinical presentations of the disease, and objective and instrumental examination findings, the patient was diagnosed with left parathyroid adenoma and primary hyperparathyroidism; stage II hypertensive disease, grade I, a moderate risk; retinal angiopathy of both eyes; stage I dyscirculatory encephalopathy with liquor and venous dyscirculation and moderate vestibular ataxia; urolithiasis; kidney stones; and spondylosis mainly involving the lumbar spine. The diagnostic determinants for verifying the diagnosis were the results of neck computed tomography, namely: the signs of space-occupying lesion in the projection of the left parathyroid gland; the blood level of parathyroid hormone 118.6 pg/ml (normal value (N) 9.5–75.0 pg/ml); total vitamin D 21.64 nmol/l (N 75–250 nmol/l); and calcium 2.48 mmol/l (N 2.15–2.50 mmol/l). The history of urolithiasis, repeated lithotripsy, as well as spondylosis with lumboischalgia was an absolute indication for surgical treatment.

Conclusion. The practical interest in this case is due to the complexity of diagnosing normocalcemic hyperparathyroidism after vitamin D deficiency. The early stages of primary hyperparathyroidism are asymptomatic and frequently give rise to irreversible renal complications, causing renal failure and, as a consequence, disability. This clinical case demonstrates the importance of routinely determining vitamin D concentrations, which in turn triggers parathyroid adenomas.

A whole variety of mobile technologies may be arbitrarily divided into several groups: prevention of diseases; determination of different diagnostic parameters; monitoring of the disease course and treatment effectiveness; consulting support, and telemedicine. Novel technologies offer much prospect for healthcare services, a possibility of improving the quality and availability of medical care. However, there are some problems and contraindications associated specifically with the inadequate participation of the medical professionals in the elaboration of applications, the low computer literacy of the population, and the high cost of such technologies. Nevertheless, the development of medical mobile concepts covers new areas, including the emergence of more complex programs for analyzing diagnostic information, the involvement of novel types of handheld devices and integration of the applications into the social networks. The paper considers the major possibilities of mobile medicine, problems, and prospects for its development.

It is presented the announcement of key reviews on the use of mobile technologies in medicine (mHealth), published in the scientific literature in 2015. These articles covered various questions of technological compatibility between medical mobile devices, realities and prospects of their use in healthcare to improve the efficiency of interaction between doctor and patient, improving the quality of care, as well as the creation of virtual health centre.