The aim of this study was to assess the role of orthostatic test in prognosis of arterial hypertension (AH) in young adults.

Materials and methods. 842 young adults 20–29 years old with the level of blood pressure (BP) <140/90 mm Hg were enrolled in a prospective study. Active orthostatic test was performed. Observation period was 5 years. After that 2 groups were assigned according to BP level: group 1 – with AH (BP level >140/90 mm Hg), group 2 – with normal BP level (<140/90 mm Hg).

Results. Physiological type of orthostatic reaction was found in 542 persons (64.4 %), primary hypersympathicotonic type – in 79 (9.4 %), secondary hypersympathicotonic – in 93 (11.1 %), hyposympathicotonic – in 94 (11.2 %), sympathicoasthenic – in 34 (4.0 %). 78 persons were withdrawn from the study for different reasons during observation period. AH was diagnosed in 144 (18.8 %) persons (group 1), normal BP – in 620 (81.2 %) participants (group 2). In group 1 hypersympathicotonic response to orthostatic test was observed in 102 (70.8 %) persons, in group 2 – in 47 (7.6 %) participants (р <0,001). By the results of univariate logistic regression analysis male sex (OR 10.8; 95 % CI 7.6–15.3), body mass index >25 kg/m2 (OR 7.2; 95 % CI 5.7–9.1), smoking (OR 5.6; 95 % CI 4.5–7.0), high normal BP (OR 10.7; 95 % CI 6.9–14.5) and hypersympathicotonic orthostatic response (OR 13.6; 95 % CI 10.0–18.7) were significant risk factors of AH. By the results of multivariate analysis body mass index >25 kg/m2, high normal BP and hypersympathicotonic orthostatic response were independent risk factors.

Conclusion. Hypersympathicotonic orthostatic response with increased body mass index and high normal BP are the risk factors of AH development during next 5 years in young adults. It is reasonable to use orthostatic test in assessing the risk of AH development in young people.

The aim of study was to assess the prevalence and 5-year dynamics of atherosclerosis and endothelial dysfunction in patients with chronic rheumatic heart disease (CRHD).

Materials and methods. 205 patients with CRHD were examined. Endothelial function was assessed by “AngioScan-01”, ultrasound examination of carotid arteries was performed, and some patients underwent coronaronagiography. The comparison group consisted from 57 patients with aortic stenosis (AS).

Results. In both groups endothelial dysfunction was observed in large (–6.77 ± 0.89 ms – in CRHD group, –6.68 ± 0.04 ms – in AS group) and small (1.73 ± 0.05 – in CRHD group, 1.51 ± 0.04 – in AS group) arteries. Within 5 years of observation in patients with CRHD statistically significant decrease was observed in occlusion index in amplitude (1.5 ± 0.037) and in phase shift between the channels before and after occlusion (–3.13 ± 0.94). It is important that during this period there was no significant deterioration in parameters of echocardiography and 6-minute walk test. Atherosclerosis of coronary arteries was revealed in 33.3 % patients with CRHD and in 52.5 % patients with AS. According to the ultrasound of the neck vessels in 188 patients with CRHD, the average thickness of intima/media complex was 0.84 ± 0.01 on the left and 0.84 ± 0.01 on the right; frequency of atherosclerotic plaques in the carotid arteries was 72.3 % on the left and 68.08 % on the right. The thickness of intima/media complex was statistically significantly higher in patients with AS on the left (1.02 ± 0.02) and on the right (1.15 ± 0.07); frequency of atherosclerotic plaques in the carotid arteries was 93.2 % on the left and 90.9 % on the right. Assessment of ultrasound data dynamics of carotid arteries in patients with CRHD revealed statistically significant increasing of intima/media thickness on the left (0.88 ± 0.01) and on the right (0.9 ± 0.01). There were no statistically significant differences for speed parameters.

Conclusions. Endothelial dysfunction takes place in the presence of mitral stenosis or AS, it is more expressed in AS. Also, atherosclerosis of carotid arteries in patients with CRHD and AS is more prevalent than in the population. And the frequency of coronary atherosclerosis in patients with CRHD is insignificant in comparison with patients with AS. Within 5 years of observation both endothelial dysfunction and atherosclerosis of carotid arteries progress in patients with CRHD.

The aim was to study the frequency and severity of affective disorders and quality of life in patients with coronary heart disease (CHD): unstable and stable angina of II–III functional class.

Materials and methods. 488 patients with verified CHD were examined to identify and assess anxiety-depressive spectrum disorders by the screening questionnaire of Moscow Research Institute of Psychiatry, Ministry of Health of Russia. 172 patients with CHD from the screening group – 96 (55.81 %) patients with unstable angina and 76 (44.19 %) with stable angina, 136 (79.07 %) men and 36 (20.93 %) women were examined with psychometric tests: Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Modified Seattle Angina Questionnaire (SAQ) was used to study quality of life. Excel and Statistica 6.0 programs were used to assess statistical process of the material.

Results. According to the screening questionnaire, in screening group of patients with CHD (n = 488) the symptoms of anxiety-depressive disorder were present in 398 (81.56 %) patients, in 90 patients (18.44 %) they were absent (p <0.0001). In the group of patients with CHD examined by psychometric tests (n = 172), the symptoms of anxiety-depressive disorder according to the screening questionnaire were revealed in 137 (79.65 %) patients, in 35 (20.35 %) patients they were absent (p <0.0001). The severity of depression symptoms according to BDI scale (17.11 ± 9.38 vs. 12.73 ± 8.1 points; p <0.04) and the symptoms of anxiety-depressive disorder according to the screening questionnaire were noted more often (p <0.0008) in patients with unstable angina compared with stable angina – in 85 (88.54 %) vs. 52 (68.42 %) patients (р <0.0008). In the group of patients with stable angina the level of depression according to BDI scale in patients taking pharmacological treatment was higher in comparison with the patients who underwent myocardial revascularization (14.56 ± 9.0 vs. 10.03 ± 6.13 points; p <0.01). Quality of life parameter according to modified SAQ was statistically significantly decreased in the subgroups of patients with increasing severity of depression symptoms according to BDI scale (10–63 points) compared with the subgroup of patients with no depression (0–9 points).

Conclusion. According to the screening questionnaire, a high incidence of anxiety-depressive disorder was found in patients with CHD. The symptoms of anxiety-depressive disorder and the severity of depression symptoms according to BDI scale were noted more often in the group of patients with unstable angina compared with the group of patients with stable angina. Quality of life parameter according to modified SAQ was statistically significantly reduced with increasing severity of depression symptoms according to BDI scale in subgroup of patients with symptoms of depression compared with the subgroup of patients without depression. According to the results of the study the BDI scale is more sensitive for the diagnosis of depression than the HADS scale.

The aim of study was to describe a clinical case of a hereditary disease with autosomal recessive type of inheritance – familial Mediterranean fever (FMF).

Materials and methods. Patient A., 19 years old, Armenian, was hospitalized in the Department of rheumatology of the clinical hospital with complaints of periodic temperature rises to 39 °C, paroxysmal pain in the abdomen, ankle and hip joints, legs edema. In anamnesis from 8 months of age there were attacks of 1–2 day abdominal pain in combination with febrile fever; from 2 years there were arthralgia of the ankle joints, followed by knee and hip. Attacks of fever and joint syndrome recurred 3–4 times a year, lasted for 2–3 days, and disappeared spontaneously. Treatment with nonsteroidal anti-inflammatory drugs and small doses of prednisone was carried out. The examination in the hospital revealed nephrotic syndrome without impaired renal function, increasing of erythrocyte sedimentation rate (up to 62 mm/h), C-reactive protein (up to 60 mg/dl), leukocytosis (up to 16.7 × 109/L). The immunological examination revealed no abnormalities. Bacteriological and serological studies have ruled out the possibility of infectious diseases. Electrocardiography, echocardiography, ultrasound of abdomen and kidneys, multispiral computed tomography of kidneys and retroperitoneum, magnetic resonance imaging of the sacroiliac joints, nephrobiopsy were performed.

Results. During the examination, a wide differential diagnosis with infectious and rheumatic diseases was carried out. Taking into account the polysyndromicity of clinical manifestations, systemic lupus erythematosus was suggested. An induction course of immunosuppressive therapy was conducted, that was ineffective. The diagnosis of systemic lupus erythematosus was doubtful and to clarify the nature of kidney morphological changes nephrobiopsy was performed that revealed the presence of kidneys AA-amyloidosis. Given these data in conjunction with clinical manifestations, the patient»s nationality, FMF was diagnosed and colchicine 2 mg/day was appointed. It was possible to stop the clinical symptoms of inflammation in FMF, but the nephrotic syndrome due to amyloidosis persists.

Conclusion. The presented observation demonstrates the complexity of FMF diagnosis that verified 18 years after the appearance of the first disease symptoms. The diagnosis was helped by the presence of disease clinical manifestations and kidneys morphological study that revealed the development of a serious complication of periodic disease – AA-amyloidosis. Treatment with colchicine allowed to stop the symptoms of periodic disease.

The study objective is to demonstrate the difficulty of differential diagnosis in pulmonary-renal syndrome using a clinical case as an example.

Materials and methods. Male patient A., 68 years old, retired, was hospitalized at the N.I. Pirogov City Clinical Hospital № 1 in December of 2017 with complaints of inefficient cough, fever of 39 °С, weakness, apnea, weight loss up 10 kg in 3 months. Examination revealed skin and mucosa paleness, calf edema, heart beat of 102 bpm, normal rhythm, arterial pressure 130/80 mm Hg, respiratory rate 22 breaths per min. Auscultation revealed harsh respiration in the lungs, weakened in the lower parts, fine moist rales. Anemia (hemoglobin – 53 g/l, erythrocytes – 1.85 × 1012/l, serum iron – 3.1 µmol/l), elevated urea up to 41.4 mmol/l, creatinine up to 843.1 µmol/l (glomerular filtration rate – 6 ml/min/1.73 m2), leukocytes up to 12.5 × 109/l, С-reactive protein up to 124.96 mg/l were diagnosed. Clinical urine analysis showed proteinuria 0.47 g/l. Computed tomography of the chest revealed pronounced infiltrative changes in tissues of both lungs, more on the right, alveolitis, bronchiolitis in the middle lobe on the right, 5th segment on the left. Lymphadenopathy mediastinal was diagnosed. After examination (multiple bacteriological blood, sputum tests, interferon-gamma release assay, echocardiography, bronchoalveolar lavage, sterna puncture, esophagogastroduodenoscopy, colonoscopy, etc.), oncological pathology, tuberculosis of the lungs, sepsis, infections endocarditis and other infectious pathologies were excluded. Antibacterial courses prescribed earlier were ineffective. Immunological blood test revealed high titers (1:1280) of antineutrophil cytoplasmic antibodies (ANCA) with perinuclear fluorescence type (myeloperoxidase specificity), negative antibodies to glomerular basal membrane which allowed to diagnose ANCA-associated vasculitis.

Results. Considering the data of clinical, lab, and instrumental examination, the patient was diagnosed with microscopic polyangiitis, ANCA-associated, affecting the lungs (disseminated interstitial lung disease with bronchiolitis) and kidneys (rapidly progressive glomerulonephritis), intrathoracic lymphadenopathy, activity grade III (BVAS index – 23 points). Grade II respiratory failure. Chronic kidney disease 5D (glomerular filtration rate – 6 ml/min/1.73 m2). Grade II arterial hypertension, risk 4. Grade II pulmonary hypertension. Chronic heart failure 2А, functional class IV. Mixed anemia (iron-deficient, chronic disease), severe. Disseminated polyposis of the colon (hyperplastic type). At the hospital, antibacterial drugs (cefoperazone sulbactam), antifungal (fluticasone) were administered, anemia was corrected (iron-containing drugs and erythropoietin, hemotransfusion), hemodialysis. Cyclophosphane 400 mg was administered intravenously, a week later – 800 mg. Methylprednisolone (60 mg/day), co-trimoxazole (480 mg 3 times a week) were prescribed. A pronounced improvement was observed due to the therapy: body temperature normalization, decreased apnea, cough, weakness, increased appetite. The patient was discharged with recommendation for continuation of cytostatic therapy per the regimen and prescription for programmed hemodialysis at the place of residence.

Conclusion. This clinical case demonstrates a necessity of considering ANCA-associated vasculitis during differential diagnosis of pulmonary-renal syndrome. Timely diagnosis and active cytostatic therapy play a principal role in treatment and promote deceleration of disease progression and improve prognosis.

The aim of study is to reflect the possibilities and effectiveness of teriparatide for the treatment of postoperative hypoparathyroidism associated with severe systemic osteoporosis, based on the data of the clinical case.

Materials and methods. Patient N., aged 69, having a history of resection of 2/3 of the stomach according by Bilrot-2, urolithiasis, hypertension; since 2011 has been repeatedly hospitalized in National Medical Research Centre of Endocrinology, Ministry of Health of Russia, for secondary hyperparathyroidism and severe systemic osteoporosis. In 2016 thyroidectomy was performed in connection with papillary thyroid cancer and removal of left parathyroid gland adenoma, after which the patient developed postoperative hypoparathyroidism with severe uncontrolled hypocalcemia. As a replacement therapy, a synthetic analogue of parathyroid hormone, teriparatide, was used. For this work we used epicrisis of 2011–2016, as well as the results of the patient’s examination performed during the inpatient treatment in the Endocrinology Department of City Clinical Hospital № 4 (Ivanovo) from 2016 to 2018.

Results. As a result of treatment with teriparatide in this patient, according to the results of a three-year follow-up, there is a positive clinical effect in the form of absence of convulsive syndrome, normalization of total and ionized calcium levels, absence of new compression fractures of vertebral bodies. Since the recovery of parathyroid gland function after surgery has not occurred, the use of this drug to the patient is recommended for the life term.

Conclusion. The study describes a clinical case involving teriparatide as a therapy for postoperative hypoparathyroidism in combination with severe systemic osteoporosis and impaired calcium absorption in an elderly patient. The clinical effect of this type of treatment over a period of 3 years was proved in the form of normalization of phosphorus-calcium metabolism and the processes of bone remodeling in the absence of any side effects.

The aim of study was to describe a clinical case of central neurocytoma formation and course.

Materials and methods. Patient C., 33 years old, admitted to the neurosurgical department of Regional Clinical Hospital with complaints of headache and sleep disturbance that troubled her for 2 months. No chronic diseases were detected. During the stay in the hospital, the patient was carried out a number of examinations: assessment of laboratory parameters in dynamics, magnetic resonance imaging of the brain, examination by specialists (neurologist, neuroophthalmologist).

Results. Magnetic resonance imaging of the brain revealed a solid volume cystic formation of the left frontal lobe. Bone plastic trepanation and microsurgical removal of the intracerebral cystic tumor in the left frontal area were performed. Revealed neuroradiological and histological characteristics allowed differentiation of neurocytoma from other histological variants. According to magnetic resonance imaging no tumor growth was observed 5 months after surgery. A course of radiation therapy was conducted.

Conclusion. This clinical case presented the peculiarities of the course, diagnosis, surgery and immunohistochemical analysis of patient with central neurocytoma.

The article considers the key points of the new 2018 guidelines of the European Society of Cardiology and European Society of Hypertension on management and treatment of patients with arterial hypertension (AH). The guidelines widen the possibilities for ambulatory monitoring of blood pressure (BP) and at-home measurement of BP in diagnosis of AH, especially for detection of hidden (“masked”) hypertension and white-coat hypertension. New target ranges for BP depending on age and concomitant pathology are established. For most patients, BP <140 mm Hg (primary target) is accepted, for patients under 65 years if therapy is well-tolerated BP <130 mm Hg should be achieved. Selection of treatment for elderly patients shouldn’t be based on chronological age but on biological age taking into account evaluation of senile asthenia, self-maintenance and therapy tolerability. For starting selection of drugs for AH, in most patients two-component therapy (one pill drug) is preferable. The latest guidelines contain simplified algorithms for management of patients with AH. It is shown that in most patients, a preference should be made for combinations of renin-angiotensin-aldosterone system blocker (inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers) with a slow calcium channels blocker and/or thiazide/thiazide-like diuretic. Beta-blockers should be prescribed only for specific clinical cases. Special emphasis is made on evaluation of patient’s treatment adherence as the main reason for insufficient BP control, as well as on increased role of nurses and pharmacists in education, monitoring, and support of patients with AH being an important part of general strategy of BP control.