The aim of the study was a comparative assessment of the treatment efficacy in patients with anterior myocardial infarction with ST segment elevation (STEMI) in two periods: 2003–2007 and 2008–2017 with different endovascular service organization. For 5 years of the first period, the percutaneous coronary interventions (PCIs) were performed in the ERS Unit of the Urgent Cardiology Department. A total of 446 patients were hospitalized; a thrombolytic therapy (TLT) was undertaken in 177 patients, PCI was performed in 155, including primary PCI, life-saving PCI, and PCI after successful TLT in 72, 44, and 39 patients, respectively. Due to daytime working schedule of ERS, PCI was performed within the first 12 hours of STEMI onset in 54 patients, within 12–72 hours in 101 patients selected with regard to an initially high risk of death (RD) according to TIMI. In the 2nd period from 2008 to 2017, the patients’ age was 28–95 years old. Over those 10 years, PCIs were performed in a multi-disciplinary ERS Department working around the clock; 1,052 patients were hospitalized, TLT was undertaken in 177, PCIs were performed in 760, including primary PCI, life-saving PCI, and PCI after successful TLT in 583, 110, and 67 patients, respectively. The PCI ratio in the first 12 and 12–72 hours was 394 to 366. There was no patient selection with regard to the initial high RD. There were 291 and 292 patients without PCI in periods I and II, respectively. A 5-year total and cardio-vascular (CV) post-discharge mortality was assessed in 97 patients treated in period I and in 192 patients treated in period II, and in 128 patients without PCI. The initial RD in patients with anterior STEMI in periods I and II was scored 4.8 or 11.5% and 5.1 or 13%, respectively; in periods I and II the in-hospital mortality was 1.3% and 3.9% after PCI, 7.9% and 13.7% of patients without PCI; 5.6% and 6.7% of patients with and without PCI. In patients with PCI a 5-year post-discharge mortality increased by 13.0% and 16.7%, including the CV mortality that increased by 5.2% and 13.0%; and a 5-year post-discharge mortality in those without PCI increased by 33.6% and 28.9%, respectively. During the first 5 years of the day-time ERS working schedule, the number of PCI, mainly with an initially high RD, increased from 19% to 45%; that was accompanied by a mortality decrease from 12.6% to 3.9%. Over the following 10 years, the number of PCI increased from 57% to 88%; the increased number of unresolved complications during procedures was reflected by more frequent death cases, especially in elderly people; that was accompanied by the mortality increase to 7.1% in the first 7 years, and to 8.6%, 18.6% and 6.9% in the following 3 years due to increased number of hospitalized elderly patients, respectively. Based on the comparative assessment of the presented data, the cause for the differences between the results of PCI performed in the first and second periods lies in a differently organized ERS. Being established as integrated with a cardiology unit, ERS provides a high professional level of service, practical skills and individual patient approach necessary for the successful use of various types of PCI, including delayed PCI, PCIs at late admission, which is typical for STEMI patients of older age with a severe coronary artery disease.

The literature review provides data from studies on the clinical characteristics and features of the course of arterial hypertension in patients with chronic glomerulonephritis. The information on the clinical, instrumental and morphological variants of the malignant and therapy-resistant course of hypertension, possible mechanisms of the formation of the drug resistance syndrome are presented. The role of 24-hour blood pressure monitoring methods for elimination of resistance and its prevention was evaluated.

The literature review provides scientific data on the main mechanisms of the development and progression of arterial hypertension in patients with glomerulonephritis, including genetically determined ones. The mechanisms of vascular kidney damage during the formation of hypertension with hyperuricemia and obesity have been specified. Morphological data are discussed according to which not only vascular damage to arterial structures, but also hyperplasia of intact glomeruli and changes in tubulointerstitium are involved in the formation of hypertension syndrome.

Objective. According to the results of a complex analysis of gender-anamnestic, clinical, biochemical and instrumental parameters using the cluster analysis method to identify phenotypes of chronic heart failure (CHF) in the examined patients.

Materials and methods. It was examined 345 patients with CHF with different left ventricular ejection fraction and 60 somatically healthy volunteers. For the study, groups of indicators were formed that most widely characterize the pathogenesis of CHF: gender-anamnestic and clinical, instrumental (echocardiographic study, study of the functional state of the vascular endothelium and skin microcirculation, calculation of the volume fraction of interstitial collagen), biochemical parameters of the functional state of the vascular endothelium, collagen balance, inflammation and oxidative stress.

Results. After the cluster analysis by the methods of hierarchical classification and k-means, we identified 4 clusters/phenotypes of CHF: fibrous-rigid, fibrous-inflammatory, inflammatory-destructive and dilatation-maladaptive. According to the results of the analysis of variance were identified 27 of the 48 indicators in which the level of statistical significance of intergroup differences (for the Fisher test) was less than 0.05, that is, indicators that make the greatest contribution to the division of patients with CHF into phenotypic groups.

Conclusion. Our analysis with the release of phenotypes indicates that patients with CHF with different phenotypes have clinical and pathogenetic features. The data obtained in the future can be used to determine the prognosis of the disease and the choice of tactics for the management and treatment of patients with CHF depending on the phenotype.

Objective. To create a personalized mathematical model of the development of complications – cardiogenic shock and pulmonary edema in patients with myocardial infarction (MI) with chronic obstructive pulmonary disease (COPD) depending of the homocysteine (HCY) level and the COPD phenotype.

Materials and methods. The study included 88 patients with MI and COPD with various phenotypes: 25 patients with emphysematous phenotype, 22 patients with a mixed phenotype, 20 patients with chronic bronchitis phenotype, 21 patients with eosinophilia and bronchial asthma (BA). As a control group, 50 somatically healthy individuals were examined. Gender anamnestic, clinical, and laboratory – instrumental indicators were studied and analyzed to develop a predictive mathematical model. The level of HCY was determined by enzyme-linked immunosorbent assay in all patients.

Results. It was found that in patients with MI and COPD with different COPD phenotypes, the level of HCY was statistically significantly higher than in the control group. The highest level of HCY was in patients with the chronic bronchitis phenotype and was 45 [14.1; 51.9] mmol/l, which was statistically significantly higher than in patients with the phenotype with eosinophilia and BA, with emphysematous and mixed phenotypes. Predictor factors were selected using the logit regression method from gender-anamnestic, clinical, and laboratory – instrumental indicators to create a mathematical model with the highest prediction accuracy. HCY level and COPD phenotype were predictors of the mathematical model for predicting the development of complications – cardiogenic shock and pulmonary edema in patients with MI and COPD. It was also found that the threshold value of HCY for predicting the development of cardiogenic shock and pulmonary edema in patients with MI and COPD was 0.82 ± 0.51 confidence interval [0.72–0.91] mmol/l (p < 0.001).

Conclusion. The personalized mathematical model initiated for predicting the development of complications-cardiogenic shock and pulmonary edema in patients with MI and COPD, depending of the HCY level and the COPD phenotype, has a high sensitivity (85%) and prognostic significance (92%), which allows us to recommend it for use in clinical practice.

The paper summarizes data on modern approaches to the diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins, including ARDS due to bacterial viral pneumonia. The work is based on the data of modern well-organized studies, analysis of international clinical guidelines with a high degree of evidence, as well as the results of our own long-term experimental studies and clinical observations of the treatment of patients with ARDS of various origins, including viral pneumonia of 2009, 2016, 2020. Scientifically grounded algorithms for prevention, differential diagnosis and personalized therapy of severe acute respiratory failure using innovative medical technologies and a wide range of respiratory and adjuvant treatment methods have been formulated. The authors tried to adapt as much as possible the existing current recommendations for the daily clinical practice of anesthesiologists and resuscitators.

Non-steroidal anti-inflammatory drugs (NSAIDs) are a large and extremely heterogeneous group of drugs that have a single mechanism of action and therapeutic activity. The article lists their main subgroups by chemical structure and selectivity of action, describes the most typical side effects due to the pharmacodynamic characteristics of drugs, explains the reasons for their formation, and describes the cardiovascular complications they cause. Taking into account the lack of the desired safety of classical NSAIDs for cardiological practice, the possibility of optimizing their tolerance with the help of modern generations of cyclooxygenase inhibitors, namely the dextrorotatory S-enantiomer of ketoprofen – dexketoprofen trometamol (Dexketoprofen-SZ, «Severnaya Zvezda», Russia) was considered. The drug is distinguished by high efficiency and low risk of cardiovascular toxicity, which makes it widely used in symptomatic therapy of cardiac patients.

Due to the increasing demands on the heads of medical organizations in terms of ensuring the proper quality of medical care, there is a need to pay more and more attention to the leadership qualities of not only the direct head of the institution. It is equally important to form the leader’s competencies among managers at any level: deputy chief medical oficer, head of the medical department, head nurses, and technical service manager.

The majority of strabismus correction surgeries are performed in outpatient conditions. Improving the quality of pain management is essential to avoid undesirable events, especially among children after general anesthesia during strabismus surgery. The use of opioid analgesia during surgery may be accompanied by a higher risk of postoperative nausea and vomiting, as well as longer sedation leading to delayed discharge from hospital. The local 0.4% hydrochloride oxybuprocaine anesthetic has a local pro-active analgesic effect on the operated eye prior to the surgical incision, and later the additional use of drops in the surgical field eliminates the need for further analgesic administration in the perioperative and postoperative period without any subsequent sedation or significant nausea and vomiting episodes that are observed with intravenous fentanyl injection. The results of the study showed that the local application of 0.4% oxybuprocaine is comparable in the effect with intravenous fentanyl injection in achieving the desired optimal effect in the perioperative and postoperative periods and contributes to discharge from hospital in the near future.

Background. Today, a special place in surgical practice is the treatment of patients with spigelian hernias, which can be subcutaneous, interstitial, prepperitoneal, and make up 1% of all external hernias of the abdomen. The difficulty in diagnosing of spigelian hernias can lead to a serious complication – infringement of the hernia, which will require emergency surgical treatment. Therefore, the study of the typical, sexual and variant anatomy of the Spigelian line region is important in improving the diagnosis and treatment of such patients.

The aim. To study the features of typical, sexual and variant anatomy of the Spigelian line region.

Materials and methods. We examined 42 non-fixed corpses of persons of both sexes without signs of pathology of the anterior abdominal wall. Among them were 26 (54.2%) men and 22 (45.8%) women. At autopsy, we performed anatomical dissection of the semilunar line region. We measured the width of the aponeurotic stretch from the end of the transverse abdominal muscle fibers to the lateral edge of the rectus abdominis muscle at level corresponding to d. bicostarum, umbilical ring and d. bispinarum.

Results. We identified four clusters corresponding to the variations in the shape of the semilunar line: tapering down (9.5%), uniform wide (19.0%), tapering up (28.6%) and wide in the middle (42.9%). We found that the semilunar line, tapering up, was significantly more often observed in women (83.3%), uniformly wide – in brachymorphic body type (75.0%), wide in the middle – in mesomorphic body type (66.07%), and the semilunar line, tapering down, was found only in men. Variants of the shape of the semilunar line, tapering up or down, were absent in persons of the brachymorphic body type. Semilunar line, tapering up, was found (without significant differences) in persons of the mesomorphic body type in 41.6%, in the persons of the brachymorphic body type – in 58.4%, and semilunar line, tapering down, was noted in persons with a dolichomorphic body type in 75.0%.

Conclusion. New data may allow to predict the location, type of spigelian hernia, and also improve the diagnosis and treatment of spigelian hernia.

The article presents the results of a dynamic analysis of the satisfaction of patients diagnosed with CAVID‑19 with the quality of medical services provided remotely at the telemedicine centre in Moscow in 2020.

Purpose of research. Conduct a dynamic assessment of patient satisfaction with the quality of remote medical services provided in different time periods.

Material and methods. The results of an anonymous survey of 424 patients on the quality of remote medical services were dynamically evaluated. The first group (138) received medical care from 01.04 to 30.04, the second one (286) – from 01.06 to 30.06 of 2020 after the implementation of measures to improve them. Statistical analysis was performed using IBM SPSS Statistics 20.0.

Results. When analysing the results, a high level of patient satisfaction was revealed, but there was a significant (p < 0.05) difference in the level of satisfaction between the groups. The factors of connection between telemedicine services and patient satisfaction were identified, which served as the basis for organizational measures.

Conclusion. Providing medical services using telemedicine technologies can be considered as one of the most effective ways to provide medical care.