Purpose. To study the therapeutic equivalence of the generic fixed combination of indapamide with perindopril (Perindopril plus, Severnaya Zvezda, Russia) in relation to the original drug in geriatric patients with hypertension (GB) and chronic heart failure (CHF). Material and methods. A study was conducted in 105 patients with GB and CHF (68.6 % of men with average age 80.3 ± 0.7 years), which evaluated the antihypertensive effect, the ability to correct heart failure, the presence of organ protection, the safety of both drugs. Results and discussion. When using a generic fixed combination, the achievement of the target value of office blood pressure was observed after a month of observation in all cases with stable maintenance by 6 months of the study; significant (p < 0.05) decrease in the level of home monitoring of systolic blood pressure (SBP) / diastolic blood pressure (DBP), after a month of research, by 26.1 % / 28.0 %, 6 months – by 26.8 % / 30.1 %; a significant (p < 0.05) decrease in the average daily SBP / DBP after a month of observation by 28.1 % / 28.6 % (after 6 months by 29.7 % / 29.5 %), the average daily – after a month of observation by 27.2 % / 28.2 % (after 6 months by 28.4 % / 31.7 %), average nightly – after a month of observation by 22.4 % / 24.1 % (after 6 months by 24.3 % / 27.1 %); a reliable (p < 0.05) decrease after a month of monitoring the average daily pulse pressure by 27.9 % (average daily pulse pressure by 25.8 %, average nightly pulse pressure by 20.1 %), after 6 months by 30.4 %, 23.5 %, 20.3 % respectively; a significant (p < 0.05) decrease in the carotid femoral pulse wave propagation velocity after a month by 17.9 %, after 6 months – by 26.8 %; after 6 months of observation, a reliable (p < 0.05) decrease in the final systolic volume of the left ventricle (LV) by 10.6 %, the final diastolic volume of the LV – by 7.5 %, the LV myocardial mass index – by 11.5 %, significant (p < 0.05) increase in LV ejection fraction by 2.9 %; significant (p < 0.05) decrease in FC of CHF by 20.7 % by the end of the study. According to the degree of change in these indicators, a generic fixed combination was comparable to the original drug. No side effects were observed in the comparison groups requiring discontinuation of treatment. Conclusions. The generic fixed combination of indapamide with perindopril (Perindopril plus, Severnaya Zvezda, Russia) has therapeutic equivalence with respect to the original drug.

Currently, for the diagnosis of acute myocardial infarction, there is no absolute biomarker that has the maximum possible specificity and sensitivity. Circulating microRNAs, which not only regulate key functions in a healthy heart, but are also important in the mechanisms of cardiovascular diseases such as myocardial hypertrophy, fibrosis, and apoptosis, have great potential as new early biomarkers for managing patients with acute coronary syndrome. This literature review summarizes the current understanding of the role of microRNAs in the development of atherosclerotic plaques at all stages of atherogenesis, the diagnostic value of small molecules as a biomarker of myocardial infarction and the differential diagnosis of this pathological condition with unstable stenacordia. Despite the great interest in the problem and a significant number of scientific papers, further research is needed. The perspective in the study of microRNAs significantly expands the range of diagnostic capabilities of this method.

Objective. To determine the possible role of the endothelial nitric oxide synthase (eNOS) polymorphism T786C (rs 2070744) in developing of recurrent myocardial infarction (MI) in young and middle-aged patients. Materials and methods. 114 patients with acute MI treated with percutaneous coronary intervention and thrombolysis that were admitted to Clinical cardiologic dispensary (Perm city, Russia) were enrolled into a study. Among them there were 28 patients with recurrent MI. The eNOS T786C polymorphism were determined by real-time PCR. Results. In T786C polymorphism of eNOS, compared with the T/T genotype, it was determined that those with T/C has 2,27 fold (95 % CI: 1.01–5.49), and those with the CC genotype has 2.22 times (95 % CI: 1.30–8.53) (p = 0.034) greater risk of developing recurrent MI. Patients with severe coronary arteries atherosclerosis more frequently had eNOS T786C polymorphism of T/C genotype (OR = 4,67; 95 % CI: 1,38–15,37; p = 0,031). Conclusion. The eNOS T786C variants could be evaluated as recurrent MI risk factor in young and middle-aged patients.

Data from an original study evaluating the efficacy and safety of dexketoprofen in the conservative treatment of pain syndrome in patients are presented. This paper presents three clinical cases of successful conservative treatment of pain in patients. Patients, depending on the therapy they received, were divided into three groups: patient S., 50 years old, (pain in the joints) received Dexketoprofen-SZ at a dose of 25 mg twice a day for 5 days; a patient, 50 years old, (severe pain in the lumbosacral spine) received Dexketoprofen-SZ 25 mg every 8 hours (daily dose not more than 75 mg) for 5 days; the patient, 20 years old, (painful heavy periods) received Dexketoprofen-SZ, depending on the intensity of pain, 25 mg every 8 hours. Conclusions. The drug Dexketoprofen-SZ at a dosage of 25 mg 2–3 times a day has shown high efficacy and good tolerability in various patients in the practice of an outpatient cardiologist.

Data from an original study evaluating the efficacy and safety of doxylamine in the treatment of insomnia in cardiac patients are presented. Materials and methods. Ten patients with sleep disorders were under observation. Doxylamine-SZ was prescribed to 10 patients (seven women and three men aged 40 to 60 years) who consulted a cardiologist with sleep disturbances from 2 to 7 times a week in the last month. Patients received Doxylamine-SZ at a dose of 1/2 tablet 15 mg 30 minutes before bedtime. Six patients noted normalization of sleep after 2–3 days of taking the drug and discontinued the drug, four patients who had insufficient clinical effect, the dose of the drug was increased to a whole 15 mg tablet. After 5 days of therapy, an improvement in the quality of sleep was noted in 80 % of patients. Conclusions. Doxylamine-SZ at a dosage of 15 mg 30 minutes before bedtime can be assessed as a safe and effective hypnotic in a cardiac patient.

Purpose. To study the dynamics of blood pressure (BP) indicators under the influence of exogenously administered melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) with various manifestations of desynchronosis of circadian BP rhythms (arterial hypertension – AH, high normal blood pressure) to determine the scheme of their effective compensation. Material and methods. The study included 101 patients with desynchronosis of circadian rhythms of blood pressure – 52 patients with hypertension, constituting the first and second groups, and 49 individuals with high normal blood pressure, representing the third and fourth groups. Patients of the second and fourth groups received conservative therapy, patients of the first and third groups combined it with melatonin. All patients underwent measurements of office blood pressure, home monitoring of blood pressure (ABPM), electrocardiography, 24-hour blood pressure monitoring (ABPM). Results and discussion. In patients of the first and third groups, compared with the traditional treatment groups, by the end of the observation period, a significantly (p < 0.05) decrease in office systolic blood pressure (SBP) / diastolic blood pressure (DBP) was established: in the first group compared with the second – 1.11 / 1.13 times, in the third group compared to the fourth – 1.43 / 1.58 times; significantly more (p < 0.05) pronounced decrease in SBP / DBP during DMAD – by 1.08 / 1.17 and 1.58 / 1.62 times, respectively, Significantly (p < 0.05) more pronounced decrease in average daily, average daily and average nighttime SBP / DBP during ABPM – by 1.13 / 1.20, 1.11 / 1.20, 1.23 / 1.25 and 1.47 / 1.31, 1.42 / 1.19, 1.54 / 1.41 times, respectively; reliably (p < 0.05) more frequent registration of the dipper rhythm type SBP / DBP – 1.6 / 1.4 and 1.6 / 1.4 times, respectively. In addition, the dynamics of patients in the first and third groups showed a significant (p < 0.05) decrease in the mean daily and mean nighttime SBP / DBP variability (SBP in the first group by 27.3 and 41.3 %, respectively; DBP in the first group by 20.1 and 26.3 %, respectively; SBP in the third group by 13.5 and 25.2 %, respectively; DBP in the third group by 12.2 and 28.2 %, respectively). Conclusions. With various manifestations of desynchronosis of circadian rhythms of blood pressure (AH, high normal blood pressure), the prescription of melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) at a dose of 3 mg per day 30–40 minutes before bedtime for a month against the background of non-drug therapy and antihypertensive drugs led to a significantly more effective decrease in blood pressure at its office measurement, DMAD, ABPM with an improvement in the circadian rhythm of blood pressure and normalization of blood pressure variability.

Relevance. Urinary tract infections are among the most common infectiousdiseases encountered in the practice of doctors of various specialties, both at the outpatient and hospital stages. In recent years, there has been an increase in the incidence of acute pyelonephritis. The management of patients with acute complicated pyelonephritis requires further study aimed at optimizing the diagnostic algorithm and treatment methods. Objective. Studying the state of blood circulation in the kidney in patients with purulent pyelonephritis and improving the quality of treatment of these patients by introducing our own developed methodology. Materials and methods. In the Regional clinical hospital (Barnaul city, Russia), in the conditions of the urological department, the author personally examined and operated on 30 patients with purulent pyelonephritis according to his own method with an established diagnosis of purulent pyelonephritis. On the first day, all patients underwent retroperitoneoscopic decapsulation of the kidney on the affected side in combination with regional arterial infusion of alprostadil for 3 days. All patients underwent general clinical examination, multispiral computed tomography (MSCT) of the kidneys with bolus contrast enhancement, duplex scanning of renal vessels, and morphological examination of the material before and after the operation. Results. In all cases, the postoperative period proceeded favorably with a shorter treatment time. On the first day after surgery, patients noted a decrease in the intensity of pain in the area of the affected kidney. When comping the data of MSCT of the kidneys with bolus contrast, obtained in patients before treatment, the disappearance of foci of destruction in the kidney and a pronounced restoration of the previously lost blood flow of the kidney on the side of the lesion in the early stages are determined. Nephrectomy was not performed in any case. Conclusion. Each of the stages of the proposed method for the treatment of acute purulent pyelonephritis is an integral part of the technique as a whole; each stage is necessary to influence its level of the vascular bed and parenchyma in the area of its microabscesses and zones of infection. The method allows to achieve restoration of blood circulation in the kidney with the opening of antibiotics access to the organ parenchyma.

The article describes the experience of clinical testing of the personal telemedicine system (PTS) ‘Obereg’ for remote monitoring of patients with the consequences of severe conditions in leading Russian clinics. It is shown that such patients are at high risk of complications when transferred from the ICU to a normal ward with limited medical supervision and lack of instrumentation. The use of remote monitoring using the personal telemedicine system ‘Obereg’ allows to solve this problem. The results of the use of PTS ‘Obereg’ for the organization of monitoring in the home patronage of patients with limited mobility are presented. It is indicated that such devices should be used in an emergency situation similar to a coronavirus pandemic to monitor patients who are in infectious boxes and on home treatment.

In certain clinical situations, the usual food intake is impossible, insufficient or contraindicated, which causes nutritional deficiency with a deficiency of all macro- and micronutrients, and worsens the prognosis and treatment results. In such cases, parenteral nutrition (PN) is used to compensate for the deficiency of nutrients. Complex parenteral nutrition, along with macronutrients (amino acid solutions, fat emulsions and carbohydrates), includes solutions of vitamins (multivitamins, MVC) and trace elements (trace elements complexes, TEC). The aim of this work was to review the results of studies over the past 30 years on the clinical use of MVC and TEC for injections within the framework of the international ASPEN and ESPEN recommendations for the prevention and treatment of a number of diseases and pathological conditions accompanied by vitamin and trace elements deficiency, including full or partial PN. In accordance with international recommendations based on the results of most randomized clinical trials, the use of MVC and TEC allows preventing and eliminating vitamin and trace elements deficiency during long-term complete and/or partial PN, accelerating the recovery process of patients in critical conditions, and reducing the time spent in the ICU and in the clinic as a whole, to reduce the number of complications and mortality.

We studied coagulation parameters of severely burned patients at early period of disease (1–10 days). All patients had II–III degree burned wound, varied from 22 to 75 % total body surface area (median 40 % [35; 60]). Patients were divided into two groups: survival (35 patients, 1th group) and lethal (19 patients, 2nd group) outcomes. During burned shock (1st‑2nd day) 1th group had normal activated partial thromboplastin time, fibrinogen concentration, protein C activity, whereas in 2nd group these parameters were reliably abnormal. In both groups we noticed significant decay of antitrombin III activity and increase of D-dimer, followed by very low integrity of platelets. We found correlation between morphofunctional platelet rate and blood clotting activity. At 3rd day all patients showed significant increase of fibrinogen concentration without change of other parameters. At 10th day patients with survival outcome normalized antitrombin III activity and had particular recover of platelet integrity, patients with lethal outcomes did not have such effects. Values of D-dimer, antitrombin III and protein C activity reliably differed between the groups throughout the observation period. The decrease of antitrombin III and protein C activity in the first day after the burn is critical. Reducing the activity of antitrombin III less than 75 % is a predictor of adverse outcome.

ECG diagnostics during coronavirus infection (COVID‑19) pandemic is extremely difficult without the use of remote transmission methods. The article proposes remote methods of transmitting information when taking an ECG at home, in the ‘infectious zone’, during remote consultation, when providing an ambulance and for patients at risk using ECG machines and ECG recorders manufactured by Monitor Ltd. (Russia).