The study objective is to evaluate the effectiveness of different approaches to correction and prevention of arterial hypotension episodes in patients undergoing long-term hemodialysis (HD).

Materials and methods. The study included 35patients undergoing long-term hemodialysis in the dialysis center. In all patients, automatic non-invasive measurement of arterial pressure (AP) was performed using a built-in option of the “artificial kidney” device. Prior to the study, all patients underwent clinical test with evaluation of “dry weight” and bioelectrical impedance analysis. Crossover design was used in the study: at the beginning, hypotensive episodes were corrected in all patients using the standard method (the first 4 hemodialysis procedures); then during the following 4 procedures in addition to standard methods a computer algorithm automatically controlling ultrafiltration rate using an automatic system of pressure control (ASPC) with constant AP monitoring (AP was measured prior to hemodialysis and after it and at least 1 time in the first 5 min of the procedure; from the 4h procedure onwards, intervals were determined by the algorithm automatically) was used. Values of mean AP during hemodialysis procedures for the whole monitoring period were analyzed. The duration of the study was 3 weeks for all patients.

Results. Mean pre-dialysis systolic and diastolic AP in the patients for the standard approach was 124.6 ± 27.7 and 74.5 ± 21.1 mm Hg, post-dialysis AP was 114.4 ± 24.4 and 71.3 ± 16.3 mm Hg, respectively. For ASPC, pre-dialysis and post-dialysis AP was statistically significantly higher than for the standard approach: 133.2 ± 21.3 and 79.3 ± 15.8 mm Hg (p <0.001; p = 0.009), 125.7 ± 23.9 and 75.9 ± 18.3 mm Hg (p <0.001; p <0.001). Detailed analysis of intra-dialysis AP measured during the standard approach showed that it was 110.2 ± 17.3 and 68.3 ± 13.9 mm Hg. Using ASPC, intra-dialysis AP was significantly higher: 124 ± 20.5 and 75.9 ± 14.2 mm Hg (p = 0.03; p = 0.02). Mean AP was also higher: 82.5 ± 13.9 mm Hgfor the standard approach versus 91.5 ± 15.6 mm Hg (p = 0.01) for ASPC. The ultrafiltration rates were slightly higher without ASPC (8.2 ml/kg/hour vs. 7.9 ml/kg/hour). Therefore, it was shown that the use of ASPC in addition to standard methods of hypotension correction is effective and safe. There weren»t any significant differences in «hemodialysis-dose effectiveness» (Kt/V) in both groups; however, in the ASPC group target values of inorganic phosphorus in serum (for a dialysis patient) were reached which is one of the most important parameters of hemodialysis adequacy. Concentration of inorganic phosphorus for the ultrafiltration control algorithm was 1.5 mmol/l, for the standard dialysis program — 1.8 mmol/l which shows benefits of ASPC. This data didn»t reach statistical significance (p = 0.07) which likely can be attributed to a low number of observations.

Conclusion. Intra-dialysis hypotension with high ultrafiltration rates is a frequent and potentially dangerous complication of hemodialysis which negatively affects patients» long-term prognosis mainly due to an increase in cardiovascular morbidity and mortality. A new method for prevention and correction of hypotension using ASPC allows to decrease ultrafiltration rate on time preventing a hypotensive episode, decreasing its rates and improving attainment of AP target values (both pre- and post-dialysis) as well as intra-dialysis variation during dialysis procedure.

Materials and methods. The results of lipid profile cross-sectional study of 2088 Bishkek residents aged 18—65 years who came to “Bonetsky Laboratory” from January to December 2016 were analyzed.

Results. Among 2088examined residents there were 938 (44.9 %) men and 1150 (55.1 %) women; 48.4 % of them had an increased level of total cholesterol (≥5.2 mmol / l). The prevalence of hypercholesterolemia (HC) in women was higher (52.3 %) than in men (43.6 %). With age in both men and women, the increased frequency of HC was found, in men the peak was observed at the age of50—59years (50.3 %), and in women >60 years (61.2 %). HC associated with lipoprotein content (low-density lipoprotein >2.58 mmol/l) was found in 80.0 %, and in women more often than in men (81.6 and 78.1 % respectively). In both male and female, the greatest rise in HC dynamics was observed at the age of30—39years, then a monotonous rise of HCfrequency was observed in women (86.0 %) >60years, and in men the subsequent rise of HC from the age of 30—39 years was not observed. Reduced levels of high density lipoproteins up to 30 years of age were more common in women than in men (46.4 % vs 29.0 %). The peak in the frequency of low level of high density lipoproteins was found at the age of40—49years and was more often in women. Hypertriglyceridemia (>1.7 mmol/l) up to 30 years of age was registered with the same frequency regardless of gender and age (36.0 % in women, 37.0 % in men). Two-factor variance analysis for the lipid profile showed a high statistical significance of gender and age.

Conclusion. The study showed a high prevalence of dyslipidemia among the population of Bishkek city. The presented data justify the necessity of active prophylaxis for primary and secondary prevention of ischemic heart disease among the population.

Diseases of the respiratory system (both acute and exacerbations of chronic ones) remain the most frequent non-surgical complications after surgical interventions of various sizes, increasing the duration of the patient»s hospital stay, increasing economic costs and the percentage of deaths. It was shown that respiratory complications developed after abdominal operations increased the risk of 30-day mortality by 10 times. The most common complications include: reintubation, acute respiratory failure, pulmonary edema, atelectasis and pneumonia. The development of respiratory complications is due to the pathology of the respiratory system and respiratory muscles. It is proved that the use of drugs that inhibit neuromuscular conduction in 75 % of cases provokes the development of atelectasis, respiratory muscle dysfunction and reduces respiratory volumes. Respiratory complications are most often caused by hypoxia or hypercapnia. Hypoxia is characterized by a decrease in the partial pressure of oxygen and is well corrected by additional oxygenation. In the first hours after surgery hypoxemia occurs in 50—55 % of cases with a decrease in saturation up to 80 %. Complete normalization of respiratory dysfunction usually occurs 4—6 hours after extubation. Hypercapnia, on the contrary, is characterized by an increase in the partial pressure of oxygen, the phenomena of hyperkalemia and respiratory acidosis. Correction of electrolyte and buffer disturbances is necessary. It is important for the Clinician to remember the need to identify possible risk factors for respiratory complications (modifiable and unmodified) and ways to correct them. Examination of the patient by a therapist before the planned operation, including possible preoperative preparation in the therapeutic departments of a multidisciplinary hospital helps to reduce the frequency of postoperative complications. In this article the authors describe recommendations for evaluation, prevention and diagnosis of respiratory complications in the perioperative period in patients with comorbid pathology.

The aim of the work was to study the clinical case of a rare heart disease — peripartum cardiomyopathy.

Materials and methods. The puerperal, 34 years old, was admitted to the regional cardiologic dispensary from the regional perinatal center after an emergency cesarean section at 37 weeks of gestation with complaints on short of breath, heaviness in the interscapular region, dyspnea at little exertion and rest, cough with light colored phlegm.

Results. Based on anamnesis data (infection at the 22nd week of pregnancy), the clinical picture (symptoms of heart failure from the 36th week of gestation), instrumental research data, a clinical diagnosis was made: Peripartum cardiomyopathy. Echocardiography has become one of the main diagnostic methods that made it possible to verify the diagnosis. Dilatation of the left atrium and left ventricle, reduction of the left ventricular ejection fraction to 40 % and pulmonary hypertension were revealed. The recovery of heart systolic function occurred after 6 months (increasing of the left ventricular ejection fraction up to 58 %).

Conclusion. This clinical case is interesting because this rare for Russia disease developed in the third trimester of pregnancy (according to literary data, it often occurs after childbirth). Because of the unstable patient»s condition, an emergency caesarean section was performed, that saved the life of the mother and child. Restoration of heart systolic function occurred after 6 months.

The aim of study was to describe the clinical case of possible development of cardiac complications in patient after the chemotherapeutical treatment.

Materials and methods. Patient Sh., 63 years old, admitted to N.I. Pirogov City Clinical Hospital № 1 of Moscow Healthcare Department in connection with new onset of anginalprecordialgia. In anamnesis: rectum adenocarcinoma with multiple courses of chemotherapy of first and second lines. The last course of chemotherapy was performed a month before the previous complaints. Previously, coronary anamnesis was not burdened.

Results. During the examination, signs of ischemia on the electrocardiogram, diffuse hypokinesia of the left ventricular myocardium according to echocardiography, subocclusion of the anterior interventricular branch of the left coronary artery were identified. Balloon angioplasty and stenting of the anterior interventricular branch of the left coronary artery were performed with good perfusion effect.

Conclusion. In this clinical case, ischemic complications in patient receiving chemotherapeutical treatment are displayed.

The aim of study was to describe the case of diagnosis of orphan disease — paroxysmal nocturnal hemoglobinuria in clinical practice of the therapist on an outpatient basis.

Materials and methods. The patient Sh., 47 years, due to the gradual increase in the volume of the abdomen, the appearance of swelling of the legs, the increase in shortness of breath, yellowing of the skin, the appearance of rare but abundant nosebleeds appealed to 63polyclinic N. I. Pirogov City Clinical Hospital № 1. The patient was repeatedly hospitalized. During the diagnostic search, additional research methods were carried out: evaluation of laboratory data in dynamics; x-ray of the abdominal cavity; ultrasound examination of the abdominal cavity, kidneys and retroperitoneal space; computed tomography of the abdominal cavity; ultrasound examination of the pelvic organs; liver biopsy followed by microscopic examination of micro-drugs; samples for the diagnosis of autoimmune diseases; immunophenotyping of peripheral blood. The patient was consulted by a surgeon, hematologist.

Results. In the course of difficult verification of such rare pathology, diagnostic and therapeutic concepts changed. The patient underwent symptomatic treatment: drainage of the abdominal cavity with evacuation of more than 14 liters of ascitic fluid; therapy with fresh frozen plasma; plasmapheresis. And only after positive clinical and laboratory dynamics during therapy with Eculizumab, immunophenotypic diagnosis was performed, that showed erythrocytes of type I (normal expression of CD59) — 1.2 %, type III (complete deficiency of CD59) — 49.5 %; monocytes with FLAER/CD14 deficiency — 83.4 %; granulocytes with FLAER/CD24 deficiency — 77.77 %. On the basis of these results, the diagnosis of paroxysmal nocturnal hemoglobinuria was established. Taking into account the severe course of the disease, according to vital indications, the patient continues therapy with Eculizumab at a maintenance dose of1200 mg every 14 (± 2) days.

Conclusion. Timely highly qualified diagnosis, a modern approach in the treatment of this disease, provided a satisfactory outcome of the process in the patient with improved clinical condition and a favorable prognosis for health.