Aim. To assess the prevalence of frailty and describe clinical features of frail patients with stable coronary artery disease (CAD). Methods. 387 patients admitted to the hospital for elective primary coronary artery bypass grafting (CABG) were recruited in the study. Clinical data, demographic data, and the results of the instrumental examinations were collected for each subject. The primary screening of prefrailty and frailty in patients before the surgery was performed using the ’Age is not a hindrance’ questionnaire. The results were processed using the IBM SPSS Statistics 26.0.0 software package. A value of p ≤ 0.050 was considered statistically significant. Results. Frailty was found in 19% of patients with coronary artery disease and multivessel coronary artery disease before open myocardial revascularization, while 58% of patients had prefrailty. The presence of frailty and prefrailty was associated with older and advanced age (p = 0.003), female sex (p = 0.001), type 2 diabetes mellitus (p = 0.006), as well as with comorbidities, including cerebral atherosclerosis (p = 0.020), and heart rhythm disturbances (p = 0.050). Conclusion. The results obtained in this study are consistent with other studies reporting higher levels of comorbidities among frail patients.

In real clinical practice, the problem of polymorbidity and, in particular, its cardiometabolic phenotype, is now widespread. One of the its variants is a combination of arterial hypertension with diabetes mellitus, overweight, cognitive impairment, and peripheral atherosclerotic arterial disease. The clinical significance of such polymorbidity portrait, on the one hand, lies in its frequent occurrence, and, on the other hand, in the cardiovascular risk amplification in the settings of simultaneous coexistence of diseases initially characterized by an extremely unfavorable prognosis for the patient. The article presents a clinical case of a patient with a such polymorbidity variant and considers the nicergoline potential in the complex correction of mutually associated comorbidities. The nicergoline ability to improve cognitive functioning, to have a beneficial effect on peripheral circulation, which is reflected in an increase in the distance of painless walking, and also to realize some antihypertensive effect has been demonstrated. No less important is the fact that the high therapeutic efficacy of nicergoline was combined with an optimal safety profile, which consists in good tolerability of therapy and the absence of adverse drug reactions.

Demographic changes, the increasing frequency of comorbidity make us pay close attention to the prescribed therapy and control of drug to drug interactions. The use of polymodal drugs with pleiotropic effects that affect the key points of development of comorbid pathology may be promising.

Cognitive impairment (CI) are the main clinical symptom of hypertension-mediated brain damage and are present at the earliest stages of the disease. Classification of CI and clinical approach for patients with hypertension and CI are presented. A case report of a typical patient with hypertension and mild CI and their treatment is described. Evidence based management of CI with citicoline is discussed.

Atrial fibrillation (AF) is the most common type of arrhythmias in clinical practice. It has been proven that the presence of AF increases the risk of stroke by five times relative to the population of people without AF. One of the important issues in the management of patients with atrial fibrillation is the management of the risk of thromboembolic complications, namely the optimal selection of anticoagulant therapy. Most oral anticoagulants (dabigatran, apixaban, rivaroxaban) are the most effective and safest drug in patients with nonvalvular AF compared to warfarin. However, even with the use of new oral anticoagulants, there is a proven risk of bleeding, which ranges from minor to life-threatening. Currently, there are approved non-specific strategies for reversing and replenishing clotting factors associated with the use of oral anticoagulants, with certain indications in a patient with severe or life-threatening bleeding, emergency surgery, or before thrombolytic therapy. Over the past few years, specific oral anticoagulants antagonists have been actively studied. Of the specific oral anticoagulants antagonists, only idarucizumab has been approved in Russia (registration of the drug in Russia since September 2018), which makes it safer to use dabigatran in real clinical practice. The article presents clinical cases illustrating the effectiveness of the use of a specific antagonist dabigatran etexilate (idarucizumab) in patients with nonvalvular atrial fibrillation. Clinical examples illustrate the difficulties of managing patients with atrial fibrillation and hemorrhagic complications while taking oral anticoagulants.

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19. The ongoing COVID-19 pandemic poses a major challenge to health systems around the world. There is still little information on how infection affects liver function and the significance of pre-existing liver disease as a risk factor for infection and severe COVID-19. In addition, some drugs used to treat the new coronavirus infection are hepatotoxic. In this article, we analyze data on the impact of COVID-19 on liver function, as well as on the course and outcome of COVID-19 in patients with liver disease, including hepatocellular carcinoma, or those on immunosuppressive therapy after liver transplantation.

The number of cases of drug-induced liver injury (DILI) has been increasing since the 1990s. DILIs cause up to 40,000 deaths each year. One of the leaders in the number of DILIs are antineoplastic drugs ms, such as alkylating agents, antimetabolites, targeted drugs, monoclonal antibodies, etc. One of the most effective and safe strategies for the treatment and prevention of DILI is to use hepatoprotective drugs. Currently, on the market of the Russian Federation, is available novel drug Heptrong® (does not have an International Non-proprietary Name), which has anti-inflammatory, antioxidant activity and the ability to stabilize and reduce the permeability of hepatocyte membranes, suppress the activity 5-lipoxygenase, a decrease in the synthesis of leukotriene B4, interleukin-1, interleukin-6, which are pro-inflammatory cytokines. The drug activates the antitoxic function of the liver, improves its protein- and lipid-synthesizing functions. Heptrong® neutralizes the processes of inflammation in the liver, thereby reducing the severity of the clinical manifestations of drug-induced lesions.

Atrio-ventricular (AV) blockages are a serious violation of the heart rhythm. One of the reasons for the development of this pathology may be taking medications. This effect has a significant number of drugs used for the treatment of diseases of the cardiovascular system, central nervous system, general and local anesthetics, antineoplastic drugs, and many others. The main mechanism for the development of drug-induced AV blockades is the inhibition of AV node conduction. The most common risk factors for the development of drug-induced AV blockades are taking two and more drugs that have an inhibitory effect on AV conduction, the initial duration of the PQ interval more than 0.2 second, initial dysfunction of the AV node, increased plasma concentration of a potential inducer drug due to the presence of kidney and/or liver disease, drugdrug interactions, and specific risk factors for individual drugs. Special attention in solving this problem should be paid to both stopping the developed AV conduction disorder – medication or using an electric cardiostimulator, and its prevention. This article systematizes the literature data on drug-induced AV blockades in order to increase the awareness of practitioners and patients about their prevalence, risk factors, approaches to diagnosis, treatment and prevention.

A literature review of the combination of sarcoidosis and the novel COVID-19 infection is presented. In mild forms of sarcoidosis, without a decrease in lung function and without requiring immunosuppressive therapy, no additional risks have been identified in the context of a new COVID-19 pandemic. However, at the stage of diagnosis, one should be careful about changes in CT scans in patients with COVID-19, due to their similarity with other conditions manifested by the picture of ‘frosted glass’, as is the case with sarcoidosis. Immunosuppressive therapy for sarcoidosis should be reduced to the minimum possible, leaving only that which ensures the stability of the condition. The self-isolation regimen and the willingness to seek early medical care should first of all be observed by patients with sarcoidosis with large lung lesions.

Purpose. To assess the contribution of impaired supply of the body with zinc, selenium and copper to the development of cardiovascular complications in patients with Graves’ disease (HD). Methods. The study included 113 women aged 25–60 years with a diagnosis of HD: 54.0 % (n = 61) with moderate thyrotoxicosis, 46.0 % (n = 52) with severe. The duration of the disease is 1–5 years. The control group consisted of 37 women 25–60 years old without thyroid pathology and cardiovascular complications (CVC). All patients were assessed: in the blood – the level of thyroid-stimulating hormone, free thyroxine, the concentration of antibodies to the thyroid-stimulating hormone receptor; in the hair – the concentration of zinc, selenium, copper; results of ultrasound examination of the thyroid gland, echocardiography, 24-hour monitoring of electrocardiography. Results. Selenium deficiency was found in AF in 70.9% of cases (n = 22), zinc in 77.4 % (n = 24), copper in 67.7 % (n = 21) of cases, in CHF, selenium deficiency in 76.9% (n = 40), zinc – 82.7 % (n = 43), copper – 76.9 % (n = 40). In the control group, selenium deficiency was detected in 15.5% (n = 6) (p = 0.01), zinc deficiency – in 27.0% (n = 10) (p = .01), copper deficiency – in 10.8 % (n = 4) (p = 0.01) cases. Using logistic regression, a diagnostic model and a table of CHF risk factors in points were compiled, taking into account the levels of selenium, zinc, copper in the hair. It is advisable to use the table in all patients with HD to determine the degree of risk of CHF; with an average and high risk of developing CHF, it is recommended to include preparations of selenium, zinc, copper in the treatment regimen for HD. Conclusion. The results obtained show that the deficiency of these microelements increases the likelihood of a severe course of HD, the development of CVO, and requires diagnosis and correction.

The pandemic of COVID-19, a disease caused by a novel coronavirus SARS-CoV-2, is associated with significant morbidity and mortality. Recent data showed that patients with chronic obstructive pulmonary disease (COPD) have an increased risk for severity and complicated COVID-19 infection. In coronavirus pandemic, patients with COPD should continue standard maintenance therapy, including bronchodilators and their combination with inhaled glucocorticosteroids, in order to maintain a stable condition and prevent the development of exacerbations that can be provoked by COVID-19. It is important for this group of patients to carefully monitor the condition and follow measures aimed at preventing infection with coronavirus infection due to the increased risk of adverse outcomes.