Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.

The aim of the study evaluation of the structural and functional changes of the heart and common carotid arteries (CCA) in patients with AH I–III degree with the definition of significant criteria for their remodeling in patients with the absence and presence of accompanying obesity (OB) of varying degrees.

Materials and methods. 124 patients (86 men and 38 women) aged 27 to 81 years (average age 55.7 ± 1.01 years) were examined. In 19 of them (12 men and 7 women) AH of I degree, in 87 (65 men and 22 women) II degree AH, in 18 (9 men and 9 women) III degree AH was diagnosed. The diagnosis of AH and its degree was verified in accordance with the existing current clinical guidelines (European Society of Hypertension / European Society of Cardiology’s, 2013). Clinical-anamnestical and instrumental examination of patients were carried out with the assessment of their reflection of myocardial remodeling in accordance with the recommendations. Availability and degree of concomitant OB was carried out in accordance with the calculated body mass index and recommended gradations. Echocardiographic examination, ultrasound scanning were used to study the heart and CCA on both sides and reactive hyperemia test used for studying a number of parameters reflecting the remodeling of myocardium and arteries. Laboratory examination included determination of the main parameters of blood plasma lipid profile. The data analysis was carried out with the help of Statistica 12.6 application package.

Results. Patients with AH and concomitant OB have a number of differences in the heart and arteries compared to patients with AH without OB. Heart: increased size and volume, myocardial mass, myocardial mass index, decreased contractility and more frequent detection of diastolic dysfunction of the left ventricle of the heart. Arteries: increase in thickness of the intimamedia complex, decrease in intraadventitial diameter of the right and left common carotid arteries, more frequent detection of endothelial vasomotor function impairment using the right brachial artery as an example. The analysis of the obtained data confirmed the presence of significant remodeling of the cardiovascular system (CVS) in patients with AH, which is dependent on the presence and degree of concomitant OB: a more pronounced progress in remodeling of the heart and arteries was observed in some patients with AH with concomitant OB, partly dependent on the degree of the latter and, apparently, associated with hormonal changes that lead to an acceleration of processes underlying the formation of CVS remodeling.

Conclusion. The combination of AH with OB of different degrees leads to an increase in the frequency of cases of remodeling of the CVS as a whole in comparison with patients with AH without accompanying OB, with changes in the lipid profile of the blood at the accompanying AH OB of different degrees characterized by an increase in its atherogenic fractions, exacerbated with the increase in the degree of OB.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relievers. However, their use often threatens with serious undesirable effects, associated mainly with damage to cardiovascular system (CVS), gastrointestinal tract, kidneys and liver. Contraindications to NSAIDs prescription are clearly regulated, algorithms for their personalized appointment are determined taking into account risk factors for cardiovascular and gastrointestinal adverse events. The severity of NSAIDs side effects is mainly due to the selectivity to cyclooxygenase-2 (COX-2), as well as the physicochemical properties of various drugs. Cardiovascular adverse events differ among various NSAIDs both within commonly used drugs and among COX-2 inhibitors. It is well known that NSAIDs selective for COX-2 are safer in terms of the effect on the gastrointestinal tract than non-selective drugs. A meta-analysis showed that relatively selective COX-2 inhibitors (meloxicam, etodolac) were associated with a comparable risk of developing symptomatic ulcers and ulcers identified by endoscopy, and safety and tolerability profiles of the drugs were similar.
All NSAIDs are associated with cardiovascular toxicity, however, different drugs have significant risk differences. The mechanism of NSAIDs cardiovascular adverse effects is associated with an increase of blood pressure, sodium retention, vasoconstriction, platelet activation, and prothrombotic state. It has been shown that the risk of cardiovascular adverse events when taking COX-2 inhibitors (celecoxib, etoricoxib) significantly increases. According to a study of more than 8 million people, it was found that the risk of myocardial infarction was increased in patients taking ketorolac. Further, highest to lowest risk authors list indomethacin, etoricoxib, rofecoxib (not currently used), diclofenac, a fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen. When taking NSAIDs, the risk of heart failure decompensation increases, and it turned out to be the greatest for ketorolac, etoricoxib, and indomethacin. Meloxicam, aceclofenac, ketoprofen almost did not increase heart failure risk. It should be noted that when using the drugs (except for indomethacin and meloxicam), there is a tendency to increase the total cardiovascular and renal risks with increasing doses. Thus, it is obvious that a very careful approach is required when choosing NSAIDs. If there is an increased risk of gastrointestinal complications associated with NSAIDs, selective NSAIDs are preferred, with both coxibs and traditional selective NSAIDs showing the best safety profile in the studies. To minimize cardiovascular side effects specialists should consider the risk level of cardiovascular complications, as well as results of large clinical studies where particular NSAIDs are compared.

Objective – to evaluate efficacy and safety of “Carmolis” fluid and gel in patients with knee osteoarthritis, as well as the gel efficacy combined with ultraphonophoresis.

Materials and methods. The study included 200 patients, who were divided into 2 groups depending on the way of application of “Carmolis” forms. Group 1 included 165 patients with knee osteoarthritis (the main group included 90 patients, the control group – 75 patients), who underwent complex local treatment with 2 “Carmolis” forms. Group 2 included 35 patients (20 people in the main group and 15 in the control one). The main group received phonophoresis with “Carmolis” gel, and the control group received “Carmolis” gel locally on the affected knee joint. Patients’ average age in group 1 was 62,7 ± 8,5 years, the average age in the control group was 61.4 ± 8.7 years, the disease duration was 10.1 ± 4.7 and 9.2 ± 6, 0 years, respectively. In group 2 the average age and disease duration were 60.1 ± 12.8 and 5.7 ± 5.4 years, respectively.

At the initial stage 90 patients of the main group 1 were rubbed “Carmolis” fluid locally in the joint followed by massage. After the fluid absorbed completely, “Carmolis” gel was applied, followed by massage. In the comparison group (75 patients), standard therapy was combined only with “Carmolis” fluid applied on the II knee joint.

Twenty patients of the main group 2 were treated with phonophoresis combined with “Carmolis” gel. Clinical efficacy was assessed by pain dynamics.

Results. Treatment with two “Carmolis” local forms significantly decreased average on moving from 61.8 ± 14.2 to 30.7 ± 14.2 (р <0,001), at rest – from 49 ± 19, 9 to 20.4 ± 8.5 (р <0,001), on palpation – from 38.7 ± 10.4 to 18.4 ± 5.7 (р <0,001). A similar dynamics was also revealed during WOMAC assessment (Western Ontario McMaster Universities OA Index). Before the treatment start the average WOMAC pain level in the main group was 240.5 ± 39.8, after the treatment – 114.8 ± 30.4 (р <0,001). The control group also showed pain decrease, but to a much lesser extent than in the main one. At the end of the treatment course, patients of both groups demonstrated a pronounced decrease of synovitis sings, but there were no differences between the groups. The dose of non-steroidal anti-inflammatory drugs in the main group was reduced in 70 (77.8 %) patients, in the control group – in 50 (66.7 %). The tolerability of both forms was very good and good. No adverse events were registered. Data on the effectiveness and safety of “Carmolis” gel combined with ultraphonophoresis are presented in the article.

Conclusion. According to the results, combined therapy using “Carmolis” liquid and gel significantly reduces joint pain and synovitis severity, increases joints» functional ability and improves patients» general condition, which allows reducing the dose of non-steroidal anti-inflammatory drugs. Both “Carmolis” forms had excellent and good tolerability.

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

Calcific aortic stenosis is a common heart disease and the most common cause of surgical interventions on heart valves in old age. Eliminated course, nonspecific clinical symptoms, and late patients seeking surgical help, lead to high mortality, reaching 50 % over the next 5 years. Despite the frequent occurrence, our knowledge of this type of aortic defect remains incomplete. About 300 years ago A. Bonnet first described defect as a random isolated pathological finding in the corpse of a Parisian tailor. Later, R. Virchow designated ectopic calcification / ossification as the main cause of the development of the disease and put forward the theory of hematogenous drift. In 1904, J. G. Mönckeberg considered calcific aortic stenosis a manifestation of “senile degeneration” of valves and blood vessels. W. S. Roberts retrospectively correlated the classic triad of symptoms with the time of death of patients with aortic stenosis. The progress of cardiac surgery in the middle of the 20^th century made it possible to describe in detail ectopic calcification as an active, progressive, recurrent and potentially modifiable process. In the works of the staff of the Nesterov’s department of facultative therapy demonstrated a high incidence of the disease in the population of the Russia. The main reason for the development of symptoms is a progressive obstruction of the exit tract of the left ventricle of the heart, its uneven hypertrophy, rhythm and conduction disturbances in combination with concomitant arterial hypertension and other comorbidities. A change in the nature of systolic murmur, underestimation of symptoms by doctors and patients themselves, the ambiguity of echocardiography data lead to late diagnosis of the disease and untimely surgical treatment. Disturbances of calcium and bone metabolism significantly reduce the functional status of patients, including due to an adverse effect on cardiac hemodynamics. Modern molecular genetic studies are aimed at finding possible ways to control a systemic inflammatory reaction, suppress lipid peroxidation, inhibit calcification and modify the osteogenic potential of interstitial cells of heart valves.

Back pain is one of the main global health problems with a high level of prevalence and patients’ disability. In most cases, it is associated with degenerative spine damage (degenerative disc disease), dorsopathy, discopathy (M51 and M53 according to the International Classification of Diseases, 10^th revision), affecting all levels of the intervertebral disc (IVD) (cytological, chemical and biochemical) as a whole as well as biological molecules that regulate homeostasis of the disc intercellular substance (growth factors, pro-inflammatory cytokines, enzymes). A key point in IVD dehydration is that catabolic processes predominate over anabolic ones due to changed gene expression in the corresponding biologically active molecules, disc angiogenesis and neoinnervation of the structures of the fibrous ring and pulpous nucleus. The latter is responsible for chronic pain in patients.

Cells supporting homeostasis in nucleus pulpous, chondrocytes, continuously synthesize and restore proteoglycans and hyaluronic acid in nucleus pulpous, restoring shock-absorbing functions of the vertebral-motor segment. Decreased activity and death of chondrocytes in the avascular disc structure is a serious problem for reparative medicine. In accordance with IVD molecular-cellular mechanisms, numerous approaches to treat degenerative disc disease are being developed, each of which, influencing one of the links in the pathogenesis, has a direct or indirect effect on IVD repair.

The article describes morphology, pathogenesis and genetics of degenerative disc disease, as well as main modern strategies of biological therapy: tissue engineering, biologically active substances locally used in IVD matrix, including PRP therapy (Platelet Rich Plasma therapy), methods of gene (using the viral vector) and cell therapy, as well as experience in the local use of genetically engineered biological products. Most successful studies are a combination of cell and gene therapy with the use of synthesized matrices.

Patients with systemic scleroderma, or systemic sclerosis (SS), have an increased risk of developing malignant neoplasms. Cancer can be diagnosed immediately prior to SS symptoms, at the stage of diagnosis and years after SS diagnosis. The first two cases may indicate scleroderma-like paraneoplastic syndrome. In this case, the main mechanism of paraneoplastic syndrome development is associated with immune system activation by antigens, expressed by tumor cells, which leads to the development of antibodies that cross-react with body tissues, causing damage and secondary regeneration. Thus, cancer induces autoimmunity – mutation-specific T-cell immune response, and pathogenetic mechanisms can be the same for fibrogenesis and oncogenesis.
SS clinical and laboratory characteristics that indicate paraneoplastic etiology include minimum time difference between diagnosing scleroderma and cancer, as well as oncopathology in a patient’s or family cancer history, late disease onset (after 50 years), SS symptoms in a man, sudden onset and rapid progression of clinical symptoms, expressed or atypical SS symptoms (malaise, fever, significant weight loss), asymmetric or absent Raynaud syndrome, antibodies against RNA polymerase III, absence of anticentromeric antibodies and anti-Scl70, deviations in laboratory tests indicating possible oncopathology (anemia, hypercalcemia, hypergammaglobulinemia), no response to SS treatment, disappearance of SS symptoms after anticancer treatment and their appearance when cancer reactivation. On the other hand, patients with scleroderma have an increased risk of all types of cancer, with men at higher risk than women. Continuous autoimmune stimulation, B-cell activation, chronic inflammatory process and fibrosis in SS patients can lead to malignant transformation in certain organ systems, especially in lungs.
The most important risk factor for lung cancer in SS patients is interstitial lung disease, requiring special attention from a physician. In addition to lung cancer, SS patients more likely than the general population suffer from malignant hematologic diseases, esophageal cancer, hepatocellular carcinoma and bladder cancer. Scleroderma-like skin changes are also possible when cytotoxic drugs are used to treat cancer (docetaxel, paclitaxel, bleomycin, etc.), as well as during radiation therapy.

Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention.

The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months.

The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery.

In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.

In recent decades, against the background of incidence rate increasing, infectious endocarditis (IE) remains in the category of diseases with a high mortality and a “difficult diagnosis”. According to different studies, 5.2–14.8 % of IE cases were detected only at autopsy or heart surgery, and 27–42.8 % of IE cases with fatal outcome were not diagnosed before death. In 25–66 % patients infectious endocarditis was diagnosed later than 1 month from the onset of symptoms (including later than 3 months in almost a quarter of patients). Late diagnosis, considered as one of the independent risk factors for an unfavorable prognosis of IE (relative risk 2.1), is most frequent with IE in elderly patients. The generally accepted diagnostic criteria of IE, providing a standardized approach to the diagnosis of IE, rely on laboratory and instrumental evidence of bacteremia and visualization of vegetations and signs of valve destruction, as major clinical diagnostic criteria. However, a diagnosis of IE is not suspected at an outpatient stage in 54–79 % of patients, so the necessary transthoracic echocardiographic examination and bacteriological blood tests are not performed. In 84 % cases of right heart valves IE and 27 % of left heart valves IE extracardiac manifestations of the disease due to cardiogenic emboli, immunocomplex mechanisms, or systemic inflammation were initially regarded as an independent disease and patients were hospitalized with incorrect diagnosis. Most often, such masks are associated with involvement of lungs, nervous system, and kidneys, less often rheumatological, vascular, hematological guise and the onset with myocardial infarction or acute abdominal pain are noted. The lecture analyzes the causes of IE diagnosis errors and describes clinical situations that allow suspecting IE, as well as situations in which IE must be considered with a differential diagnosis. Authors emphasize that timely clinical suspicion, with availability of modern effective heart imaging and bacteriological studies remains essential basis for early IE diagnosis.