The paper presents the characteristic features of the modern course of infective endocarditis. Unresolved questions of classification of disease
and drug therapy are discussed. Clearly defined indications for surgical treatment of endocarditis.

The aim – definition of distinguished characteristics of the right-sided infective endocarditis (IE) inintravenous drugs abused with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Materials and methods. The study included 10 patients with right-sided IE in conjunction with HIV/AIDS. All patients were male, age – from 28
to 36 years.

Results. Course of the IE in HIV/AIDS among intravenous drugs abused in general corresponds to features specific to IE in intravenous drug users without HIV infection. Distinctive features of IE in these patients are a large burden of lung disease, its disseminated character, more tissue oxygenation disorders and marked pulmonary hypertension and haematological disorders (lymphopenia, anemia), and late diagnosis of IE.

Conclusion. Features of the current right-sided IE in intravenous drugs abused with HIV/AIDS are distinguished . Difficulties in diagnosis of IE in
HIV infection are due to variety of causes of prolonged fever, which should guide doctors to more frequent use of transthoracic echocardiography during prolonged fever in HIV-infected patients.

The aim – to study the association of the mitral annular calcification (MAC) with traditional risk factors and clinical manifestations of atherosclerosis
in patients aged over 65 years without diabetes.

Materials and methods. The prospective study included 100 patients over 65 years with MAC consistently identified among 910 ambulatory patients after transthoracic Doppler echocardiography in relation to the symptoms of cardiovascular disease. The comparison group consisted of 65 consecutively examined patients aged over 65 with no MAC.

Results. When comparing risk factors in patients with and without MAC, MAC statistically significant differences was found with age (72,4 ± 5,4 and 70,2 ± 4,3 years, respectively; p = 0,006), the incidence of hypertension of moderate and severe degree (99 % and 90.8 % of patients, p = 0.012), levels of total cholesterol – TC (6,91 ± 0,92 and 6,2 ± 0,90 mmol / l, p = 0.0008) and lipoproteinlow density (3,57 ± 0,95 and 2,96 ± 0,96 mmol / l, p = 0.004) in subgroups of patients aged 65 to 70 years. In multivariate analysis remained statistically significant association of MAC only with age (p = 0,025, β = 0,173) and total cholesterol levels (p = 0,040; β = 0,160). Averages of the coefficient of atherogenicity of blood lipids, systolic and diastolic blood pressure, C-reactive protein, body mass index, waist circumference, the frequency of smoking, and risk assessment on a scale of SCORE in groups of patients with and without MAC did not differ significantly. In patients with MAC was higher incidence of myocardial infarction (p = 0.024) and more often than in patients without MAC, diagnosed coronary heart disease (p = 0.029). In the multivariate analysis adjusted for age and total cholesterol level is set significantly associated with the presence and extent of MAC with symptomatic atherosclerotic peripheral arterial disease (p < 0,00001; β = 0,410).

Conclusion. In patients with MAC older than 65 years without diabetes, incidence of cardiovascular disease associated with atherosclerosis,
was significantly higher than in patients without MAC. There was a direct relationship with MAC patient's age and level of total cholesterol. No other risk factors for MAC common with cardiovascular diseases related to atherosclerosis in elderly patients were identified.

The aim – the study of latent relationships between indicators of the thickness of intima-media (CMM) and infectious, immune, inflammatory and metabolic factors in patients with varying degrees of severity of vascular changes in these multivariate methods of statistical analysis.

Materials and methods. Study included 220 patients (mean age – 43,9 ± 0,5 years) who were divided into 3 groups. Group 1 consisted of thepatients with no risk factors of cardiovascular disease (CVD), the 2nd – the presence of the above factors, in third – with atherosclerotic plaques in the carotid artery. Every patient had conducted a comprehensive survey, which included an ultrasound of vessels on the apparatus Aloka 5000 with the measurement of the thickness of KIM, the study of lipid panel, the definition of C-reactive protein and cytokines – tumor necrosis factor-α, interferon-γ, interleukin-1, -8, -4, antibodies to cytomegalovirus immunoglobulin (CMV), herpes simplex virus type 1, C. pneumoniae, H. pylori and β-hemolytic streptococcus group A. The immune system status was assessed by indicators of innate and acquired immunity.

Results. According to cluster analysis, all groups of patients revealed the presence of close relationships with linear thickness KIM, infectious, immune and metabolic markers, and in patients with atherosclerotic plaques in blood vessels links with indicators of inflammation are additionally found. Using factor analysis latent variables exist revealed, consisting of indices and thickness of the CMM, in group 1 – blood lipids, in the 2nd – infectious factors (CMV, C. pneumoniae) and immune parameters. In the 3rd group vascular wall was linked with infectious diseases, immune and inflammatory indices and blood lipids, and systolic and diastolic blood pressure.

Conclusion. The closest relationship with vascular wall of the studied parameters was observed in patients with risk factors of cardiovascular
disease, and in the presence of atherosclerosis. To implement the pathological process in the vessel are important factors of acquired immunity depression, chronic intracellular infections, and possibly associated with it inflammatory process.

Aim – assessment of the influence of inhaled nitric oxide (NO) on the course of pulmonary hypertension (PH) in patients with chronic heart
failure (CHF) III–IV functional class (FC), myocardial infarction (MI).

Materials and methods. Results of comparative non-randomized study that included 45 patients (26 men and 19 women aged 51 to 98 years) with PH III–IV functional class, left ventricular myocardial infarction. In the study, patients underwent physical examination and Doppler echocardiography, and assessed FC LH (carried out with six-minute walking test, to determine the degree of dyspnea by Borg).

Results. Symptoms of CHF and PH regressed in both groups of patients against the background of the therapy. 

Conclusion. It is established that the use of inhaled NO is a safe therapy and helps to reduce mean pulmonary arterial pressure (PAPmean) in patients with PH and CHF III–IV FC, myocardial infarction. The method of inhaled NO is simple and easy to use.

The aim – assessment of the prevalence of seropositivity to Helicobacter pylori infection and laboratory comparative study of the peripheral
blood in patients depending on the course of coronary heart disease (CHD).

Materials and methods. Observation of 100 patients with coronary artery disease and 40 control patients is presented. Investigation indicators
of clinical blood tests, biochemical blood analysis and determination of immunoglobulin antibody titer against Helicobacter pylori.

Results. In patients with coronary artery disease signs of systemic inflammation associated with the development of acute coronary syndrome are marked with increased antibody titers to infection Helicobacter pylori.

Conclusion. A history of coronary artery disease in patients with Helicobacter pylori-associated gastroduodenal pathology should be considered as a factor that increases the likelihood of unstable coronary desease course. Detected in patients with coronary artery disease signs of systemic inflammation with an increase in titer of antibodies to Helicobacter pylori infection associated with development of acute coronary syndrome.

The aim – the identification of hormonal and psychological characteristics of patients with metabolic syndrome (MS), determining the effectiveness
of drug-free weight loss.

Materials and methods. The study included 180 patients with MS (according to the criteria of ATP III), received dietary treatment and thermal bath at the spa. Anthropometric measures, the data of the daily blood pressure monitoring, blood levels of hormones (insulin, leptin), were assessed , following surveys were conducted – the definition of eating disorders (PP) tests SANT (estimate well-being, activity, mood,
anxiety) and LOBI (diagnosis related to types of illness). According to the results of the course non-drug treatment, all patients were divided into 2 groups: group 1 – with a positive effect of therapy (n = 87) and 2nd – no effect (n = 93). The criterion for the division served as the simultaneous presence of four factors: decrease in body weight by 2 kg or more, reduction in waist circumference by 2 cm or more, decreased
levels of triglycerides and blood glucose.

Results. The group of patients therapy who proved to be ineffective, characterized by significantly higher levels of insulin and leptin, a predominance of emotiogenic PP, high self-esteem of his being. In relation to the state of neglect of the disease, its denial, indifference to the fate were prevailing. A correlation of levels of insulin and leptin levels with parameters of arterial pressure, PP, test results SANT.

Conclusion. In patients with MS psychological and behavioral pattern that has adverse effects on weight loss and associated with the levels of leptin and insulin are diagnosed. Taking into account of these characteristics will increase the effectiveness of therapy.

Aim – to study how anthracyclines influence on cardiovascular system in patients with lymphomas and whether angiotensin-converting enzyme inhibitor Perindopril is cardioprotective in these patients.

Subjects and methods. 26 patients with Hodgkin’s disease and non-Hodgkin’s lymphomas were followed before and after treatment with
doxorubicin. 12 of these patients with arterial hypertension received angiotensin-converting enzyme inhibitor Рerindopril, 10 mg/d, during
treatment with doxorubicin. Cardiological evaluation was performed before and the next day after chemotherapy. Average dose of Doxorubicin was 34,99 ± 13,23 mg/m2.

Results. In patients receiving anthracyclines deceleration time DT increased significantly, a significant reduction in heart rate (HR), cardiac
output (CO) and cardiac index (CI) were observed also (рDT = 0,037, pHR = 0,048, рСО = 0,007, рCI = 0,007). In patients simultaneously
treated with Perindopril these parameters were not statistically different (рDT = 0,92, pHR = 0,22, рCO = 0,35, рCI = 0,39).

Conclusion. Administration of anthracyclines (average dose of Doxorubicin 34,99 ± 13,23 mg/m2) leads to DT of the left ventricle and
reduction in HR, CJ and CI. Simultaneous treatment with Perindopril in patients receiving anthracyclines preserves DF and prevents heart hemodynamics abnormalities.

Aim – to evaluate macro-and microrheology hemorheological characteristics parameters in patients with COPD, and their dependence on the severity of COPD.

Materials and methods. The study included 107 people, 80 patients with chronic obstructive pulmonary disease I, II, III, IV degree and 27 persons as a control group. Rheological examination included determination of the viscosity of whole blood and erythrocyte suspensions with a hematocrit (HT) 40 % in plasma and nonggregating environment, the plasma viscosity. Measuring the effectiveness of oxygen delivery to tissues produced by the formula: TO2 = Ht/η, where η — viscosity of blood. The degree of erythrocyte aggregation was evaluated by microscopy with video recording of diluted blood, and computer image analysis. Indices of rigidity of the red blood cells were calculated, indicators of internal viscosity of red blood cell content and efficiency of transport of oxygen to the tissues.

Results. In patients with COPD were identified expressed disturbances of macro-and microrheology of blood parameters were identified. Blood viscosity at all shear stresses were increased by 23–27% compared with the control group, plasma viscosity – 21.5 % (p < 0.001). Indicators of hemoglobin and hematocrit (by 9.7 % and 8.8 % respectively, p < 0,001) were Significantly higher in patients with COPD. The viscosity of erythrocyte suspension to a standard hematocrit of 40 % in saline and in autologous plasma at different shear stresses were increased by 19,5–25,3 % (p < 0,001) and 22–24 % (p < 0,001), respectively. Revealed significant changes in properties of the blood stream, which in turn led to a marked reduction in oxygen-function of the blood in 27.5 % (p < 0.001).

Conclusions. In patients with COPD, there are marked disturbances of macro-and microrheology of blood parameters, the viscosity of whole blood and plasma increases greatly, red blood cell deformability is reduced, and changing of the properties of the blood stream leads to decrease in its oxygenfunction. However, with increasing severity of COPD, there is no corresponding worsening of blood rheology.

The aim – assessing the relationship of markers of endothelial dysfunction and fibrosis (AF) in patients with chronic viral hepatitis and liver cirrhosis (LC).

Materials and methods. We examined 40 patients with chronic hepatitis C in the phase of reactivation. The second group included 15 patients with viral CP in stage of decompensation. Using the method of ELISA tests was studied evaluating the functional state of endothelium in the blood serum with a level of total nitrogen oxide (OA), endothelin-1 (ET-1), vascular-endothelial growth factor (VEFR). Evaluated the functional activity of Willebrand factor (WF), calculated the number of desquamated endothelial cells (DETS) in blood plasma, determined the level of hyaluronic acid (HA) in serum. Established diagnostic sensitivity (Qh), specificity (DS) and efficiency (DE) of laboratory parameters.

Results. In chronic hepatitis (CH) found an inverse significant relationship of HA and OA, and direct relationship with Civil ET-1, VEFR, WF, indicating the association of fibrosis with the severity of the damage of the endothelium. Patients with CKD also had a direct correlation between HA and ET-1,VEFR, PV. Ratio of aspartate and alanine aminotransferase (AST/ALT) with hCG was associated with OA, ET-1, VEFR, DETS. In patients with CKD significant coefficient de Rytis nteractions with OA, ET-1, VEFR are found. At the point of separating the concentration of SC > 120.0 ng / ml for the diagnosis of CKD has Qh 92 %, FS –76 %, DE – 82 %. In evaluating the operating characteristics of the indicators of endothelial dysfunction capacity of tests to stratify CG and CP were installed, the sensitivity was 73–92 %, specificity – 50–96 %, and efficiency – 69–86 %.

Conclusion. CG and CP demonstrated the relationship of indicators of endothelial dysfunction with markers OP – HA, AST/ALT. The results suggest that indicators of endothelial damage may serve as indirect markers of AF.

The main approaches to diagnosis and treatment of pain in the back of the elderly are presented. The main place is given to varieties of mechanical pain. Clinical features of non-traumatic compression of the vertebrae, approaches to the diagnosis ostheoporosis fractures are described. The problem of the differential diagnosis of infectious, neoplastic, metabolic damage of the spine is discussed. The main therapeutic approaches to the therapy of acute mechanical back pain are identified.

Incidence of cardiovascular events among HIV-infected patients in clinical practice has increased recently. Usually strategy of treatment in such patients differs from the conventional and requires close cooperation with experts in HIV infection. Example of successful treatment of the acute pericardial effusion in patient with stage III HIV (World Health Organizationclassification) is presented in this clinical case.

Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

In the review the data on the incidence of lung cancer in Russia and the world is presented. Effectiveness of different screening methods used to identify patients with lung cancer, the value of different diagnostic methods is discussed. The data on the current drug therapy of non small-cell lung cancer , built on the basis of doublets of cisplatin and carboplatin used in the first line therapy, as well as on the doublets without cisplatin or carboplatin, generally used in the second line therapy and target therapies which are prescribed separately or in combination with chemotherapy. Indicated the efficiency of certain chemotherapy regimens, data on one-year, sometimes two-year survival, median survival, the major toxicity of combinations, doses, drugs and detailed diagrams of their prescription.

The role of P2Y12 receptor blocker clopidogrel after the introduction into clinical practice of new, more powerful and stable operating drugs belonging to this class of antiplatelet agents is discussed. The advantages and disadvantages of each of the currently used antiplatelet drugs that block the receptor P2Y12 are reviewed. On the basis of the analysis concludes that, despite the emergence of new antiplatelet agents clopidogrel, appears to be widely used for a long time in the treatment of patients with acute coronary syndrome and / or after coronary stenting. This is primarily due to the presence of large evidence base, and confirmation of safety of long-term therapy clopidogrel.

Differential diagnostic search in patients with pulmonary hypertension is always difficult clinical problem. This article describes the clinical case of treating patient with high risk primary pulmonary hypertension.

Reperfusion therapy, in particular, thrombolysis in acute myocardial infarction involves development of serious complications. This clinical situation demonstrates the complexity of treatment of patients with hemorrhagic complications after thrombolysis and makes questions on the 
application of antiplatelet agents and anticoagulants in such cases.

Clinical management of aortic wall dissection is defined by the type of stratification and development of associated complications. As an example, clinical case of conservative management of patients with acute aortic dissection is presented