The article discusses the main aspects of registers use to evaluate the effectiveness and safety of drugs. It is noted that the results of the randomized clinical trials are currently constitute the highest level of evidence in medicine, but they have several limitations. Besides, in many
cases evidence based on the results of the randomized clinical trials (RCTs) is simply missing. In this connection need for observational studies that, despite some limitations often supplement the information obtained in the RCT is discussed. Registers as the way to study the effectiveness and safety of drugs could help overcome some limitations of observational studies. The examples of both Russian and foreign studies held within registers in order to study the effectiveness of drugs in cardiology are provided. The framework for RCTs and registries contribution in studying effectiveness and safety of a drug is proposed.

Objective: to evaluate morphofunctional changes in the cardiovascular system of pregnant women with arterial hypertension (AH) to detect
chronic AH - hypertensive disease.

Subjects and methods. 126 pregnant women with AH (at 28–34 weeks gestation; mean age 26.1 ± 1.7 years) were examined. All the pregnant
women underwent assessment of risk factors for AH, double measurement of office blood pressure, 24-hour blood pressure monitoring, electrocardiography, carotid ultrasonography, a microalbumin urine test, and eyeground examination. The pattern of AH was specified 12 weeks after childbirth.

Results. Chronic AH – hypertensive disease – was diagnosed in 51 % of the examined pregnant women with AH. There was a considerable spread of risk factors for AH in this patient group. 26 % of them were found to have lesions of target organs (heart and/or arterial vessels); the rate of microalbuminuria registration was 41 %.

Conclusion. Among our examined group of pregnant patients with AH, the prevalence of hypertensive disease is 51 %. In the identified patient
group, cardiac and arterial vascular changes that could be considered as target organ lesions were found in almost a third of cases. Pregnant women with AH need to be meticulously examined and followed up by a therapist and a cardiologist in the postpartum period.

Objective: to study the diagnostic value of placental growth factor (PlGF) in patients with coronary heart disease (CHD). 

Subjects and methods. 151 patients (75 men and 76 women; mean age 58.9 ± 12.3 years), including 66 patients with exercise-induced stable angina, 32 with unstable angina, 32 with myocardial infarction, and 21 with no clinical signs of CHD), were followed up. Blood PlGF levels were measured in all the examinees; C-reactive protein (CRP) concentrations were also determined using a high-sensitivity method in the patients with CHD.

Results. In the patients with acute coronary syndrome (ACS), the levels of PlGF were significantly higher than in those with exercise-induced stable angina and in healthy individuals (17.3 ± 11.4 versus 11.2 ± 7.3 and 8.8 ± 6.7 pg/ml; p < 0.001). Estimation of the diagnostic value of the determination of PlGF levels in the diagnosis of ACS in troponin-negative examinees revealed that the area under the ROC curve (AUC) was 0.76. The quality of a diagnostic model using CRP was inferior to that with PlGF (n = 45; AUC for PlGF = 0.79; that for CRP = 0.65).

Conclusion. The elevated level of PlGF may be considered as a diagnostic marker for ACS, including in the absence of the higher levels of cardiac troponins.

Background. The patients with abdominal aortic calcification have a high risk of cardiocerebral events, but the pathways of them have not been reported so far. The goal of our study was to assess the structure and function of myocardium and to determine the morphological features of carotid artery atherosclerosis in patients with abdominal aortic calcification.

Materials and methods. A total of 167 executive patients with peripheral arterial disease were enrolled in study. The study group included 85 patients with abdominal aortic calcification (men – 95.3 %; age median was – 66.6 ± 12). Control group included 82 patients without objective signs of abdominal aortic calcification. Abdominal aortic calcification was detected by CT imaging. All patients have undergone echocardiography and duplex scanning of carotid arteries.

Results. Prevalence and severity of ischemic heart disease and cerebrovascular disease were statistically significant higher in patients with abdominal aortic calcification (91.7, 65.8 % vs. 67, 37.3 % (р < 0.01)). We have found statistically significant differences between groups
in heart structure and function. A high left ventricular wall thickness (р < 0.01), left atrium dilation (р < 0.01) and enhanced of left ventricular mass (р < 0.05), ejection fraction reduction (р < 0.05) and more common diastolic dysfunction (р < 0.05) were determined in
patients with abdominal aortic calcification. An intima-media thickness of the common carotid artery was significantly higher in study group patients (1.38 ± 0.07 mm vs. 1.14 ± 0.06 mm (р < 0.001)).

Conclusion. Our findings suggested that abdominal aortic calcification is main reason of hypertrophy and dilation in the left heart due to enhanced peripheral resistance. Hypertrophy and dilation in the left heart is provided a high risk of cardiovascular events in patients with
abdominal aortic calcification.

Objective: to study trends in the incidence and prevalence of chronic pharyngitis, nasopharyngitis, sinusitis, and rhinitis (CPNSR) in different
age groups in Moscow and the Russian Federation (RF) in the period 1996 to 2009.

Materials and methods. The epidemic significance of CPNSR in Moscow and the RF was estimated, by analyzing the records available in the annual official statistical sources (Form No. 12).

Results. The incidence of CPNSR in Moscow in the study period remains lower than those in the RF. Its prevalence among the population in the city and in the country as a whole shows a significant increasing trend. Among the adolescents in both Moscow and the RF, the incidence of CPNSR is higher than that in children and constitutes 24.4 and 31.6 versus 3.3 and 21.8 per 10,000 population, respectively. The children
and adolescents in the RF are the highest risk groups in the incidence of CPNSR. In 2009, its prevalence rates in Moscow and the RF were 99.5 and 121.3 per 10,000, respectively; which were well above those in 2007 (81.2 and 117.5 per 10,000, respectively).

Conclusion. The high incidence and prevalence rates for CPNSR remain high in all population strata in Moscow and the RF, which may be associated with decreased diagnostic alertness and inadequate treatment for upper airway diseases.

The paper considers main ideas on the prevalence, course, and therapy of chronic pain syndrome. It describes its manifestations, different course variants, and approaches to treating the diseases accompanied by chronic pain. Different approaches to long-term therapy, which involve combination treatment options, are discussed. Data on the use of nonsteroidal antinflammatory drugs as the most common agents to relieve both acute and chronic pain syndrome are given in detail. The data of numerous trials evaluating both the analgesic and anti-inflammatory effects of nonsteroidal anti-inflammatory drugs are presented.

The paper describes a clinical case of the development of neurogenic stress cardiomyopathy that had the characteristics of Takotsubo cardiomyopathy
in a young female patient in the early periods after fourth ventricle tumor surgery.

Panniculitides are a group of heterogenic inflammatory diseases that involve the subcutaneous fat. Treatment for panniculitides, idiopathic ones in particular, has not been conclusively developed and is generally performed empirically. The paper describes a case successfully treated with glucocorticosteroids in combination with azathioprine for the plaque form of Weber–Christian panniculitis.

Sufficient information indicating the implication of dysfunction of interleukins (IL-6 and IL-1 in particular) in the pathogenesis of amyloidosis in a number of autoinflammatory, rheumatic, and autoimmune diseases, including those in periodic disease (PD), has been recently accumulated. Its genetic defect – pirin mutation – gives rise to an alternative innate immune response (phagocytic cell activation) to secrete IL-1 by macrophages and to activate T-helper cells. This causes imbalance in the synthesis of proinflammatory (IL-6, IL-8, and TNF-α) and anti-inflammatory (IL-4, IL-10, and IL-1 receptor antagonist) cytokines. Moreover, the uncontrolled macrophage (monocyte) secretion of a great deal of IL-6 that together with IL-1 is a mediator of the synthesis of the serum amyloid fibril protein precursor SAA by hepatocytes, neutrophils, and fibroblasts plays one of the key roles in the pathogenesis of PD through amyloidosis. With this, IL-6 stimulates the inflammatory process, by enhancing the release of lysosomal enzymes, reactive oxygen species, and eicosanoids (prostaglandins, leukotrienes, thromboxane) from the polymorphic nuclear leukocytes, macrophages, endotheliocytes, and fibroblasts and by augmenting the chemotaxis of macrophages and neutrophils, and the degranulation of the latter, i.e. through its action on the effector cells of inflammation, and prepares the tissue basis for amyloid deposits in this fashion. Thus, the analysis of literary and own materials gives grounds to suggest that pirin mutation is a trigger of the synthesis of IL-1 and IL-6 in PD and their hypersecretion is an initial link of the synthesis of SAA.

The review presents new data of studying the nonspecific biomarkers belonging to the family of cytokines: cartilage glycoprotein 39 and growth differentiation factor 15 in coronary atherosclerosis.

The given review considers the mechanisms underlying the development and maintenance of atrial fibrillations (AF). It is noted that the processes of atrial fibrosis, ion channel remodeling, inflammation, apoptosis, impaired intercellular interactions, and myocardiocyte hypertrophy may give rise to atrial structural and functional changes in AF. The efficacy of angiotensinonverting enzyme inhibitors and angiotensin receptor antagonists is justified in patients with left ventricular systolic dysfunction.

Cardiovascular diseases are the major cause of disease and death not only in the general population, but also in patients with chronic kidney disease. The growing morbidity and mortality from chronic kidney disease and chronic heart failure conduce to an increase in cases of cardiorenal syndrome. Along with angiotensin-converting enzyme inhibitors, β-adrenoblockers, antianemic drugs, and diuretics, statins are appropriate and recommended by a number of trials for the prevention and treatment of the cardiorenal syndrome. Statins are effective in preventing the cardiorenal syndrome in patients at its high risk, improve quality of life and survival; in predialysis patients with chronic kidney disease, they may be secondary prevention of cardiovascular death.