The objective of the study – identify early preclinical signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis.
Material and methods. We examined 142 people with verified rheumatic diseases. All patients were divided into 2 groups. The first group consisted of patients with rheumatoid arthritis – 95 people. The second group – patients with ankylosing spondylitis – 47 people. The control group included 70 practically healthy individuals. In addition to standard diagnostic tests, all patients underwent tissue dopplerography of the heart using the GE Vivid E9 ultrasound device using the two-dimensional deformation technique (speckle tracking) to assess the deformation and rate of myocardial deformation, as well as determining the level of matrix metalloproteinase-9 in the blood serum.
Results. Among patients with rheumatoid arthritis, diastolic dysfunction of both the left ventricle and both ventricles was more common than in the control group. The same pattern was observed in the group with ankylosing spondylitis. The calculation of the relative risk showed that the presence of rheumatoid arthritis in 4,42 times increases the risk of diastolic dysfunction of the left ventricle in comparison with practically healthy people (CI 1,6–12,2). In individuals with rheumatoid arthritis also results in a deterioration of systolic function of both ventricles. The level of matrix metalloproteinase metalloproteinase-9 was highest and most often increased in patients with ankylosing spondylitis. Among patients with rheumatoid arthritis, the average level of metalloproteinase-9 was low, but the incidence was higher than in the control group. The obtained results indicate that in these rheumatic diseases there is a marked degradation of the extracellular matrix components.
Conclusion. Patients with rheumatoid arthritis and ankylosing spondylitis are characterized by a deterioration in the diastolic function of the left ventricle or both ventricles simultaneously, which is accompanied by an increase in the level of metalloproteinase-9.

Objective: to assess how cerebral stroke (CS) in patient’s history affectы length life of patients with stable coronary heart disease (СHD), included in the СHD PROGNOSIS registry.
Materials and methods. We analyzed the data of patients from CHD PROGNOSIS registry who underwent coronary angiography and confirmed CHD diagnosis (n = 541, including 432 men and 109 women) during the reference hospitalization in the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia from 01 / 01 / 2004 to 31 / 12 / 2007. The average age of men and women was 57.5 ± 0.4 and 60.9 ± 0.9 years, respectively. During reference hospitalization, we took into account CS / transient ischemic attack in anamnesis (retrospective part) and frequency of reaching endpoints (general and cardiovascular mortality, myocardial infarction and CS after 4 and 7 years of follow-up (prospective part). In case of 4-year observation, therapy response was 89 %, in case of 7-year observation – 93 %.
Results. Twenty (3.7 %) patients had CS or transient ischemic attack in anamnesis at reference hospitalization, 284 (52.5 %) patients suffered myocardial infarction (p < 0.001). There were revealed differences in patients with coronary artery disease, which cannot be detected in the anamnesis by age, sex, presence of comorbid burden, arterial hypertension and diabetes mellitus, non-cardiological diseases, smoking frequency. The relative risk of death from all causes at 4- and 7-year follow-up was 3.3 and 2.4 times higher, respectively (p < 0.05). Patients with CS in anamnesis demonstrated 25 and 45 % overall mortality in 4 and 7 years, their cardiovascular mortality was 25 and 35 %, respectively. Patients without CS in medical history demonstrated 9 and 18 % overall mortality after 4 and 7 years of follow-up, cardiovascular mortality was 8 and 12 %, respectively (intergroup differences are statistically significant at p < 0.05–0.01).
Conclusion. It was noted that patients with CHD and CS in anamnesis were older, percent of women among them was higher, they more often suffered from grade II–III hypertension and diabetes mellitus, had more comorbidities, but smoked less often. CS in anamnesis significantly worsened the medium-term and long-term life prognosis for patients with CHD, increasing overall and cardiovascular mortality.

Objectives – to identify the clinical and epidemiological features of enterovirus infection in the adult population in the Oryol region, to track the seasonality of the disease, distribution in different age groups, and to assess the main clinical forms, symptoms, and complications.
Objects and methods of research. The object of investigation was 24 medical histories of patients who gave informed consent, with a confirmed diagnosis of “enterovirus infection”, the 2 nd infectious diseases Department of Department of Oryol region “City hospital. S.P. Botkin”.
Results. For the period from 2009 to 2019 was gospitalizirovany 24 patients with laboratory-confirmed diagnosis “enterovirus infection”. The most patients with this diagnosis were in 2017 – 33,5 %, the least – in 2012 – 4,1 %. In 2013 and 2019, there were no patients. Women were sick more often than men – 55 % of the total number of subjects. After analyzing statistical data, it was found that young people (aged 20–29 years) were sick more often – 58,3 %. There is a summer-autumn seasonality: 45,8 % and 54,2 %, respectively. 37,5 % of the subjects were in contact with infectious SARS patients. 37,5 % also left the Oryol region the day before.
Most often, enterovirus exanthema was observed in patients – 58,3 %.. The onset of the disease in 100 % of cases was acute. All patients had fever, most often subfebrile – 54,2 %. The studied patients complained of body aches – 100 %, headaches of various localization and intensity – 96 %, sore throat – 12,5 %, vesicular-papular rash on the skin of the trunk, limbs, and head – 58,3 %, and enanthema on the oropharyngeal mucosa – 12,5 %. In 100 % of cases, the diagnosis was confirmed by a positive polymerase chain reaction response to the presence of enterovirus RNA.
Conclusion. The study revealed that over the past 10 years, enterovirus infection in the Oryol region has a consistently low level. It is more common in young people. The disease is characterized by summer and autumn seasonality. In this area, the more common form is enterovirus exanthema.

The aim of the investigation was to describe a clinical case of the development of interstitial lung lesions in a 57-year-old man with a large left atrial myxoma, which had a reverse development after myxomectomy.

Materials and methods. Patient V., 57 years old, was hospitalized in the therapeutic department of the City Clinical Hospital No. 1 named after N. I. Pirogov in connection with bilateral polysegmental pneumonia. A month before hospitalization, he underwent an outpatient examination for progressive dyspnea. Myxoma of the heart was diagnosed. Due to the progression of respiratory failure and the appearance of fever, he was hospitalized. Amidst the multistage antibiotic therapy, there was a torpid course of lung pathology with syndromes of bilateral dissemination and “ground glass”, bilateral lymphadenopathy of the mediastinum, high pulmonary hypertension, and systemic inflammatory reaction syndrome. Thromboembolism of the branches of the pulmonary artery, tuberculosis, sepsis, infective endocarditis, neoplastic processes of pulmonary and other localization were excluded.

Results. The clinical picture corresponded to interstitial lung lesions within the framework of paraneoplastic syndrome in heart myxoma. It was decided to urgently carry out myxomectomy.

Conclusion. The clinical case demonstrates the development of a rare variant of paraneoplastic syndrome in left atrial myxoma, which was suspected during the patient’s treatment for bilateral polysegmental pneumonia. The progression of the pulmonary lesion was explained by active interstitial inflammation and was supported by the immunological activity of the heart tumor.

The performed myxomectomy, despite the persisting syndrome of systemic inflammatory reaction and infiltration of the lung tissue, led in 2 weeks to complete resolution of interstitial lung lesions and pulmonary hypertension, which confirmed the causal relationship between myxoma of the heart and involvement in the pathological process of the lungs.

In the development of renocardial relationships in chronic kidney disease, an important role is given to the activation of the renin-angiotensin-aldosterone system (RAAS), as the main component of the progression and development of cardiovascular complications..The presented review is devoted to the analysis of modern scientific data on the effect of high RAAS activity in chronic kidney disease on the course and prognosis of cardiovascular complications, as well as the protective capabilities of angiotensin-converting enzyme inhibitors, in particular perindopril. The results of scientific research on the role of the RAAS in the progression of chronic kidney disease are summarized. Data on chronic kidney disease as a risk factor for cardiovascular and cerebral complications are presented. Attention is focused on the possibilities of prolonging the pre-dialysis period of chronic kidney disease when using angiotensin-converting enzyme inhibitors. The role of perindopril as a lipophilic angiotensin-converting enzyme inhibitor with a high affinity for tissue RAAS was emphasized in reducing cardiovascular and cerebral risk in chronic kidney disease.

Modern concepts about the importance of subclinical inflammation in various age-associated pathology are described in the review. The term “inflammaging” (inflammation due to aging) refers to the special role of inflammation in the aging processes. This type of inflammation is low-grade, controlled, asymptomatic, chronic and systemic. Inflammaging determines the rate of aging and life expectancy. The balance of pro-inflammatory and anti-inflammatory cytokines plays a significant role in aging processes. The increased levels of pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-α in the elderly are associated with different diseases, disability and mortality. Interleukin-6 is a multifunctional cytokine involved in the regulation of acute phase response and other immunological reactions, in the hematopoiesis and in chronic inflammation. This cytokine is important in the pathogenesis of chronic inflammation diseases, as well as different oncological disorders. Interleukin-6 is often called the “cytokine of gerontologists”, since it is one of the main signaling pathways associated with aging and age-related diseases. This cytokine also plays an important role in the pathogenesis of atherosclerosis, coronary artery disease, chronic heart failure and increases the risk of death from cardiovascular diseases and overall mortality. Interleukin-6 is a key proinflammatory cytokine responsible for the “metabolic inflammation”, obesity, insulin resistance and diabetes mellitus. This cytokine has a significant impact on the development of sarcopenia and frailty. The serum levels of interleukin-6 negatively correlate with muscle mass and skeletal muscle function in the elderly, so it is considered as a biomarker of sarcopenia and functional decline. Interleukin-6 may contribute to the development of osteoporosis by stimulating osteoclastogenesis and bone resorption. The modern data indicate the diverse effects of interleukin-6 and confirm the significant role of this cytokine in aging and in different age-associated pathology.

The review of the literature examines the General problems of treatment of chronic heart failure, among which special attention is paid to the problem of adherence. This problem remains one of the most urgent and difficult to solve in medicine, because it directly affects the effectiveness of treatment and the outcome of the disease. The article considers the commitment of both doctors to comply with clinical recommendations and patients to prescribed therapy. Some of the reasons that explain the lack of adherence to treatment (such as gender, age, institution where the patient is observed, and others) are described. It is also described that comorbidity is an aggravating factor in the treatment of chronic heart failure. It is described that comorbidity is an aggravating factor in the treatment of chronic heart failure. The presence of concomitant diseases increases the number of medications taken, which exacerbates the problem of adherence to medication therapy. It is noted that medical registry is the ideal model for studying adherence in clinical practice. The main Russian registers included of patients with chronic heart failure are considered. It is noted that in none of them a full assessment of patients’ adherence to therapy was carried out. In the largest foreign chronic heart failure registers, the assessment of commitment is also given insufficient attention. Separate clinical trials are described, including randomized trials, specifically studying various aspects of the problem of adherence and its impact on the course of the disease. Special attention is paid to the methods of assessing adherence in these studies. It is noted that there is no “gold standard” for its evaluation, and existing methods (such as Chips, determining the concentration of the drug in the blood, counting prescription forms and others) are unacceptable for real clinical practice. This indicates the need and prospects for further work on assessing adherence to therapy in patients with chronic heart failure.

Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs $ 200 billion annually – more than $ 1,500 per employee.
The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.

The presented review concerns aortic regurgitation which occupies a significant place in the structure of valvular heart disease. The detailed anatomic and physiologic description of the aortic valve is provided. The characteristics of sinotubular, ventricular-aortic junctions, and virtual aortic annulus are presented. There are data about prevalence of aortic regurgitation on the basis of results of population studies, indicating the increase in incidence of aortic regurgitation among individuals older 70–74 years. The detailed etiologic structure of this valvular pathology is described with specifying of the most common causes of both aortic disease and aortic cusps alterations. In particular, there are some aortic diseases, resulting in acute aortic regurgitation, including acute aortic dissection and paravalvular regurgitation in incompetence of the prosthetic aortic valve; in chronic one – idiopathic dilation of the aortic root, inherited connective tissue dysplasias (Ehlers–Danlos, Marfan, and Loeys–Dietz syndromes), bicuspid aortic valve, aortitis of various origin, seronegative arthropathies (reactive, psoriatic arthritis, ankylosing spondylitis) etc. Infective endocarditis and traumatic exposure are commonly responsible for development of acute regurgitation due to aortic cusps abnormalities. Chronic aortic regurgitation as a consequence valve defects occurs in rheumatic heart disease, degenerative changes, congenital anomalies, systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), non-specific aortoarteritis, etc. The special attention is paid to pathophysiologic features of acute and chronic aortic regurgitation in the review. Acute aortic regurgitation is characterized by sudden increase in end-diastolic volume and due to the noncompliant left ventricle of normal size, it undergoes abrupt exposure a significant pre-load and after-load which results in decrease of left ventricle systolic function and stroke volume despite on relative preservation of contractile function of myocardium. In contrast to acute aortic regurgitation it is remarkable in its chronic form slow, progressive influence by increased overload of the left ventricle with possibility to adapt driven by its gradual dilation and hypertrophy.