Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs) from Pub Med database, as well as domestic literature were used.

Aim — to compare the antihypertensive efficacy, effect on blood glucose, uric acid, index of insulin resistance levels, lipid profile and effect on erectile function of long-term therapy, based on carvedilol and bisoprolol in patients with AH 1−2 deg. and overweight/obesity.

Materials and methods. Type of research: clinical, multicenter, randomized, open, comparative, stepped, in two parallel groups. The study included 105 patients (53 in Carvedilol gr. and 52 in Bisoprolol gr. ). 98 patients completed the 24-week course of treatment of (48 in Carvedilol gr. and 50 in Bisoprolol gr.). Average duration of the study for each patient was 23 weeks. We took into account demographic, clinical
and anamnestic data, physical examination on all visits. ECG, biochemical analysis, questionnaire IIEF (International Index of Erectile
Function) was performed initially and at 12 and 24 weeks of therapy. After randomization, patients began to receive 12.5 mg of carvedilol twice or 5 mg bisoprolol once daily. BAB dose titration was allowed, as well as sequential addition of amlodipine and/or indapamide
to achieve target BP levels.

Results. Both groups of patients were comparable in terms of basic clinical and demographic characteristics of the studied parameters
at baseline. Age of patients ranged from 20 to 78 years. Analysis of the blood pressure dynamics during treatment showed no significant differences in the hypotensive effect of treatment (gr. 1 ΔAP V0‑6 = −29.5 ± 11.3/17.8 ± 8.4 and gr. 2 ΔAP V0‑6 = −30.4 ± 12.8/18.7 ± 8 mm Hg; p < 0.001 for both groups) and the need for the appointment of additional drugs. All patients who completed study reached target blood pressure. In both groups for 6 months of therapy, a statistically significant decrease in weight (−1.76 ± 3.3 — gr. 1 and −1.66 ± 2.5 kg — gr. 2; p < 0.001 for both groups) and BMI (−0.57 ± 1.1 — gr. 1, p = 0.001 and −0.53 ± 0.8 kg/m2 — gr. 2, p < 0.001), WC (−1.8 ± 3.2 — gr. 1, p < 0.01 and −1.4 ± 2.8 kg/m2 — gr. 2, p < 0.05) and thighs (differences between-groups were not significant). In carvedilol g. there was a significant decrease in glucose level (−0.45 ± 1.2 mmol/l; p = 0.01), uric acid (−0.05 ± 0.01 mmol/l; p < 0.001) and LDL
(−0.28 ± 0.9 mmol/l; p < 0.05), as well as the downward trend in HOMA index. In bisoprolol group there was an increase of blood creatinine
level (6.35 ± 22.4 mg/dL; p = 0.05) and there was no dynamic metabolic parameters. GFR in carvedilol gr. didn’t not significantly
changed, and in bisoprolol gr. significantly decreased from 12 to 24 weeks of therapy (−3.8 ± 15.2 ml/min/1.73 m2; pV5‑6 = 0.01). Analysis
of EF showed improvement in EF in carvedilol gr. as compared with baseline and with a level of 12 weeks of therapy (Δ2.4 ± 5.0; p = 0.002
for general and Δ0.67 ± 2.3; p < 0.05 for EF 1−5.15). The group also observed the deterioration of the erectile function in bisoprolol gr. by
the period from 12 to 24 weeks of therapy (−1.8 ± 7.9; p < 0.1 for total and −0.73 ± 2.7; p < 0.05 for EF 1−5.15). There were no differences
in frequency and severity of adverse events between groups.

Conclusions. Though antihypertensive efficacy was equal, carvedilol, in contrast to bisoprolol, had not only beneficial metabolic effects, but in case of chronic administration was able to improve erectile function in patients with hypertension and abdominal obesity.

Aim — cross-sectional study of changes in various segments of the vascular bed in arterial hypertension (AH), defining the role of inducers and inhibitors of angiogenesis in these processes.

Materials and methods. The study included 99 patients with arterial hypertension of I–II degree, average age of 63.2 ± 2.6 years, disease
duration 9.2 ± 7.2 years.

Results. It was found that patients with arterial hypertension have disorders in all segments of vascular bed: endothelial dysfunction (high
vWF), microcirculatory disorders, and increased pulse wave velocity (PWV) of elastic-type vessels. The level of angioginesis factors does
not depend on such parameters as gender, age, body mass index. Smoking and duration of hypertension influence on vascular endothelial
growth factor raise and endostatin levels are higher in patients with family history of cardiovascular diseases. Duration of disease is directly
correlated with microcirculatory disorders and the PWV, correlation between microcirculatory disorders and pulse wave velocity indicate
their common processes.

Aim — to estimate endothelium lesion, quantity and thrombocyte aggregation function correlation in viral chronic hepatitis C (CHC) and hepatic cirrhosis (HC).

Materials and methods. 50 CHC patients and 28 HC patients were examined. Using IFA method the total nitric oxide, endothelin‑1, vasculoendothelial growth factor levels, Willebrand factor (vWF) activity were investigated, blood plasma desquamated endotheliocyte (DEC) 
number was calculated with Hladovec method, 1978, thrombocyte aggregation (TA) with ADP, collagen, ristocetine was determined.

Results. DEC and vWF demonstrated correlation in CHC (p = 0.014) and HC (p = 0.000004). In HC patients reliable correlation of all the investigated indices of endothelium lesion with the thrombocyte number and TA was detected, but in CHC patients no correlations were revealed. Thus, significant elevation of TA with ristocetine was noted only in CHC. Decrease in thrombocyte amount among CHC patients and,
especially in HC, and heightened vWF activity could change true TA indices. The corrected TA, whose indices in hepatic diseases significantly
increased, was calculated taking into account the correction factor vWF / thrombocytes that in CHC did not differ from that of healthy patients and in HC was essentially higher.

Conclusion. Endothelium dysfunction markers in CH and HC demonstrate correlation with thrombocyte reduction and TA elevation. Determination
of corrected TA permits to reveal disturbances of thrombocyte hemostasis in the form of elevated aggregation in all CHC and HC patients.

Aim — to estimate informing of different risk factors predisposing to development of carotid atherosclerosis and possibility of its prognostication in patients with rheumatoid arthritis (RA).

Materials and methods. 100 patients with RA were examined. Age of patients was 53.4 ± 10.1 years. Clinical examination included conventional methods of research in rheumatology. Doppler ultrasound was carried of the brachiocephalic vessels.

Results. The degree of severity of atherosclerotic changes in carotid arteries varied among different patients and more occurs in the elderly,
with higher activity and severity of the process. Vascular lesions often are identified using instrumental methods than manifested clinically.

Conclusion. Atherosclerosis of varying severity was observed in 80 % of RA patients. Changes in them do not depend on gender, duration of RA. There were a significant increase of the age, increased activity of the process and the index of severity.

Aim — to study clinical and social characteristics of the patients with rheumatoid arthritis in correlation with adherence to basic antinflammatory drugs treatment.

Materials and methods. The study included 154 patients with definite criteria of rheumatoid arthritis by classification of the American College
of Rheumatology (1987) observed in the rheumatology department of the Republican Clinical Hospital and Municipal Clinical Hospital № 7 (Kazan). All patients underwent clinical, radiological and laboratory tests. All patients completes of social-hygiene questionnaire and a questionnaire Health Assessment Questionnaire.

Results. The majority (n = 101, 65.6%)of the patients with RA, adherent to treatment , had less pain intensity by visual analog scale, less severe radiographic changes, better functional status (p < 0,05). Among adherent patients those with longer history of disease (p < 0.05) dominated. Age, sex, educational level, social status, marital status were not correlated with adherence to basic treatment.

Conclusion. The results showed low adherence to treatment of DMARDs in RA patients (65.6%). Adherence was correlated with disease duration, intensity of their pain, functional status, radiological stage of RA (p < 0.05).

Aim — to compare bone metabolism activity in males with chronic obstructive pulmonary disease (COPD) and postmenopausal females.

Materials and methods. The prospective cohort study was conducted. 33 male patients with COPD over 55 years old and 33 female patients without respiratory diseases over 55 were included. General examination, clinical and biochemical blood analyses, densitometry of lumbar spine and proximal part of left femoral bone, respiratory function, osteocalcin and C-telopeptids blood levels have been performed to the patients.

Results. Male patients with COPD had lower T-score for the femoral neck than postmenopausal female patients without pulmonary disorders,
(–1.05 ± 0.85 SD and –0.36 ± 1.24 SD respectively, р < 0.05). Osteocalcin level in males with COPD was significantly higher and C‑telopeptids level was significantly lower than in postmenopausal females (р < 0.05).

Conclusion. Male patients with COPD have lower T‑score for the femoral neck than postmenopausal females without pulmonary disorders of the same age. Furthermore osteoclasts in COPD patients seem to be more activated than in postmenopausal females, on the contrary osteoblasts activity is significantly depressed. Therefore it is necessary to use another approach of prevention and treatment of osteoporosis in patients with COPD.

Aim — to identify clinical features of streptococcal tonzillofaringitis (TF) using the scale of Centor, provide clinical and laboratory characteristics
of its outcomes to choose optimal antibiotic therapy.

Materials and methods. The study included 386 patients with HF (183 men and 203 women). Scale Centor, bacteriological and immunological
methods were use to identify levels of antibodies to streptolysin O, polysaccharide A, glucuronic acid, dezoksiribonukleinaze B d.

Results. All patients with HF were divided into groups with suspected viral and streptococcal etiology using Centor scale. By the result of complex bacteriological and immunological diagnosis of 13.5 % of patients with HF in the group with suspected viral etiology were moved into the group with streptococcal etiology. For this group as for group with suspected streptococcal etiology systemic antibiotic therapy was recommended.

Conclusion. To complete the question about use of the antibiotic therapy in patients with TF clinical and laboratory examination should be a complete, including the use of the Centor scale. For patients with diagnosed streptococcal etiology of TF dispensary observation and primary prevention of rheumatic fever are required.

Aim — to investigate the prognostic value of different risk factors associated with stable angina in a contemporary population of patients,
to identify the key prognostic features, to evaluate the risk distribution and to construct a reliable tool for the risk prediction.

Materials and methods. Prospective observational cohort study, conducted between January, 2004 and December, 2007 in Moscow, Russia. 641 patients were included on the basis of planned hospitalization to National Research Center for Preventive Medicine (Moscow) with a clinical diagnosis of coronary heart disease and performance of coronary angiography. 5 years follow‑up period (median time 3.9 years, min. 0.76 years, max. 6.52 years). 551 patients were followed-up by phone interview, among them: 432 men (78%, (age 57.7 ± 0.4), 119 women (age 60.3 ± 0.7), 354 of them attended follow-up visit and were secondary examined. Univariate and multivariate Cox regression model was used to identify independent predictors of events. Variables were selected in a stepwise forward manner. The probability
of survival was calculated using the Kaplan—Meier method, and survival were compared using the long-rank test.

Results. Annual death rate from all cause was 11.38 per 1000 patient-years at risk. The primary endpoint (combined all-cause mortality, nonatal MI, non-fatal stroke/TIA) was registered in 13.61% of cases, with annual rate of 17.34 per 1000 patient-years at risk. Frequency of the secondary endpoint (cardiovascular adverse events, such as CV death, non-fatal MI, non-fatal stroke/TIA, recurrent angina, endovascular revascularization, CABG) was registered in 36% of all followed‑up cases.

Conclusion. This article describes the first results of PROGNOS IBS study — a comprehensive patient registry. Our data demonstrates the risk factors distribution and morbidity/mortality rates in the contemporary population of patients. A score will be developed to estimate risk probability of death and adverse cardiovascular events.

Aim — to assess survival of patients with dilated cardiomyopathy (DCM) in 3‑year follow-up based on clinical history, clinical symptoms, indicators of instrumental methods of examination and tactics of the patients.

Materials and methods. 105 patients with diagnosed cardiomyopathy were included in prospective single-center study. Follow‑up period was 3 years or until achieving primary endpoint. Complaints were collected, general clinical research, 6-minute walk test, electrocardiography in 12‑lead were performed annually. Also scale of evaluation of clinical status in patients with chronic heart failure (CHF) in the modification of V.Y. Mareev and assessment of adherence were used annualy.

Results. The group of patients with DCM was represented primarily by man, severe heart failure (III–IV functional class) was originally diagnosed in almost 80 % of patients. During the 3 years of follow-up progression of heart failure, worsening of hemodynamic indices were identified in survivors. When evaluating recommended therapy with found that it meets the current guidelines of treatment of heart failure,
however, low adherence to treatment of patients was revealed with statistically significant difference between groups of survivors and deceased patients. The annual mortality rate was 20 % and had no significant fluctuations. The main cause of death was heart failure decompensation.

Conclusion. Progression of CHF in patients with DCM was confirmed .The most reliable method of assessing the progressive course of heart failure is 6‑minute walk test. The annual high mortality (20 %) indicates an extremely poor prognosis for this disease. The major causes of death were progression of heart failure and sudden cardiac death.

Treatment of chronic heart failure (CHF) often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

It is believed that the concentration of C‑reactive protein (CRP) significantly increases in acute forms of systemic lupus erythematosus (SLE). A moderate increase of CRP levels in patients with stable disease progression reflects the low‑grade chronic inflammation in the vascular wall and the development of subclinical atherosclerosis. The article presents data showing that increased CRP levels in SLE patients is not statistically related with disease activity and cardiovascular risk as well as the level of interleykin‑6. Patients with lupus nephritis have lower CRP concentration compared to patients without renal disease and CRP concentration depends on proteinuria and hypoalbuminemia.

Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

The article highlights current approaches to diagnosis and treatment of back pain, associated with osteoporosis. An algorithm for management of patients with vertebral compression fracture, complicated by pain, the main approaches to drug treatment of back pain and osteoporosis are described.