Objective. Data analysis on modern therapy strategies of chronic heart failure (CHF) and the possibilities of adjuvant therapy with phosphocreatine.
Methods. Analysis and systematization of the positions of the year 2020 Russian Ministry of Health clinical guidelines on CHF and modern local and international literature data.
Results. Currently, for the treatment of CHF, a wide range of drugs are used that can improve the prognosis and reduce mortality in patients, including β-blockers, blockers of the renin-angiotensin-aldosterone system, diuretics, aldosterone antagonists and neprilisin inhibitors. At the same time, based on the peculiarities of the pathogenesis of CHF and the characteristics of the myocardial energy metabolism in heart failure conditions, a promising direction is the use of additional (adjuvant) drugs in this category of patients. Here, a special place is occupied by phosphocreatine, which is essential in maintaining the energy balance of cardiomyocytes and has been widely studied in a large number of studies that have confirmed its ability not only to increase exercise tolerance in patients with CHF, but also to improve heart systolic function and prognosis, improving patient survival.
Conclusion. Based on the reviewed body of evidence, a rational approach in the management of patients with CHF is to add adjuvant phosphocreatine therapy to the standard treatment strategy according to the current clinical guidelines, which provides an additional improvement in prognosis and a decrease in mortality rates in patients.

Chronic kidney disease is one of the most common diseases in general medical practice, due to their secondary damage to the kidneys in arterial hypertension, chronic heart failure, and diabetes mellitus. The coexistence of hypertension and diabetes increases the likelihood of developing chronic kidney failure tenfold. In turn, chronic kidney disease is an important independent risk factor for the development of cardiovascular complications, including fatal ones, due to the direct relationship of the pathogenetic mechanisms of cardiorenal relationships. Approaches to the treatment of chronic kidney disease should be aimed both at preventing the risks of developing renal dysfunction, and at treating existing pathology. The multifactorial nature of the disease and the complex etiopathogenetic relationships determine the need to optimize existing approaches to the treatment of chronic kidney disease in multimorbidity patients with concomitance cardiovascular diseases and diabetes mellitus. This is also due to the fact that, unlike other target organs, compensation for background disease does not always prevent further deterioration of kidney function. According to the recommendations of the main scientific communities, in such cases, it is advisable to start therapy with the most effective angiotensin-converting enzyme inhibitors that combine nephro-and cardioprotective effects and have a dual route of elimination from the body, which is especially important in multimorbidity, the aim to prevent polypharmacy, reduce the risk of drug interactions and, consequently, side effects. This article reviews the literature data indicating the high efficacy and safety of the angiotensin converting enzyme inhibitor fosinopril in patients with chronic kidney disease in combination with cardiovascular diseases and diabetes mellitus.

The incidence of all acute cerebrovascular events in COVID-19 patients ranges between 0.2 and 1.3 %, while ischemic stroke (IS) is more common – 1.1 %, the proportion of hemorrhagic stroke is about 0.2 %. The presence of COVID-19 is associated with 3.58 times increased risk of IS and 5.60 times risk of in-hospital mortality. COVID-19 infection increases the risk of different subtypes of IS, especially cryptogenic stroke, which is characterized by the most severe course. The pathogenesis of stroke in COVID-19 is complex and includes a number of pathophysiological mechanisms: coagulopathy, thromboembolism, vasculitis, direct neuronal damage. The main pathophysiological mechanisms in COVID-19 stroke are yet to be established and need further investigation. Strokes in patients with COVID-19 are often characterized by a more severe course and high mortality. The stroke onset in COVID-19 patients is relatively common in younger age groups and in people without any traditional stroke risk factors. Due to the coagulopathy in COVID-19, the effectiveness of reperfusion therapy (thrombolysis and thromboextraction) is potentially reduced. Thus, early initiation of secondary prevention and active rehabilitation, which includes the drugs with cytoprotective and neuroprotective properties, are needed. When choosing a specific neuroprotective drug, special attention should be paid to the drug’s evidence base confirming its efficacy and safety, especially in stroke, it is equally important that the drug has a multimodal mechanism of action to affect the maximum possible diverse pathophysiological mechanisms of stroke development in patients with COVID-19. Citicoline appears to be a promising drug for stroke patients with COVID-19, since its effectiveness in acute ischemia is due to several mechanisms of action, in addition, the drug has a large evidence base in the treatment of stroke.

Drug-induced liver injury (DILI) is a fairly frequent adverse drug reaction, which accounts for about half (40–50 %) of cases of acute liver damage. The cholestatic variant of DILI is characterized by an increase in the activity of alkaline phosphatase (ALP) above the two upper limits of the norm (ULN) or the ratio of alanine aminotransferase (ALT) / ALP ≤ 2 in chronic course. A common cause of the cholestatic variant of DILI is a use of drugs for the treatment of infectious diseases, such as beta-lactam antibiotics, Aminoglycosides, Amphenicol, Lincosamides, macrolides, fluoroquinolones, antituberculosis drugs, etc. This problem has acquired particular urgency during the COVID-19 pandemic. The widespread use of azithromycin, hydroxychloroquine, interferons, lopinavir, and other drugs for the treatment of COVID-19 also contributed to an increase in the incidence of DILI. In accordance with clinical guidelines in case of suspicion of a drug-induced liver damage, one should stop use of suspected drug and, if necessary, prescribe hepatoprotectors, for example, ursodeoxycholic acid (UDCA). The effectiveness of the use of UDCA in patients with DILI, including those caused by the intake of antibacterial drugs, has been confirmed by randomized placebo-controlled clinical trials. The effectiveness of UDCA -drug Ursosan^® has been confirmed in real life clinical practice. This drug can be used for long-term (up to several months), or lifelong treatment with hepatotoxic drugs like antituberculosis and antirheumatic drugs. The daily dose of Ursosan^® is 12–15 mg/kg, if necessary – 20 mg / kg (with a weight of a patient about 75–100 kg, daily dose will be equal to two tablets of Ursosan Forte^®, 500 mg).

Background. Chronic systemic inflammation plays a key role in the development of cardiovascular disease. However, the causal relationship between inflammation and arterial hypertension (AH) is not fully determined.
Objective. To assess the levels of high-sensitivity С-reactive protein (hs-CRP) in young and middle-aged individuals and their association with АН.
Materials and methods. The study involved 427 patients aged 30 to 55 years (41 [35; 48] years) undergoing a periodic medical examination on the basis of Gazprom Transgaz Moscow’s Centre for Diagnostics and Rehabilitation from November 2018 to February 2020. 169 patients were evaluated in dynamics after a year. Patients with acute inflammatory disease or chronic exacerbation, taking hypolipidemic, anti-inflammatory, hormone replacement therapy were excluded from the study. The hs-CRP level was determined by an immunoturbodimetric method with latex gain, with a lower detection limit of 0.1 mg/l. Statistical processing of the results was carried out in Statistica 10 program. Differences were considered statistically significant at p < 0.05.
Results. Among young and middle-aged individuals increase in the level of hs-CRP ≥ 2 mg/l was found in 26.9 % of participants of the research. Protein concentrations were most significantly associated with body mass index (r = 0.53; p < 0.05) and systolic blood pressure (r = 0.28; p < 0.05). Persons with hs-CRP ≥ 2 mg/l had a frequency of identification of AH above, then at persons with normal levels of a marker (65.2 against 40.1 %; р = 0.000004). There was a statistically significant association between an increase in the level of hs-CRP and hypertension (OR = 2.8; 95 % CI: 1.8–4.4; p = 0.000004).
Conclusions. The findings indicate that elevated hs-CRP levels are associated with AH in young and middle-aged individuals, and also suggest that chronic systemic inflammation is an independent contributor to the development of AH.

One of the reasons for the development of hemolytic anemia (HA) can be drugs, including some antibacterial, non-steroidal anti-inflammatory, antitumor and antihypertensive drugs. It was found that the most common drug-induced hemolytic anemia (DIHA) develops against the background of taking antibacterial drugs. The true prevalence of DIHA is not known and is approximately one case per 1.0–1.2 million patients. The mechanisms of the occurrence of DIHA are divided into immune and metabolic (non-immune). The first mechanism is associated with the formation of haptens, the second option – with the formation of immune complexes, the third option is mediated by the formation of true autoantibodies to red blood cells, the fourth option of the immune mechanism of the occurrence of DIHA is non-immunological protein absorption on the membranes of red blood cells. The risk factors for the development of DIHA are not fully established. The most common hereditary risk factor for DIHA is glucose-6-phosphate dehydrogenase deficiency. The main method of diagnosing DIHA is a direct antiglobulin test (direct Coombs’ test). The temporal relationship between the use of the inducer drug and the development of HA symptoms is important. The treatment strategy of DIHA is determined by the severity of the disease. In all cases, treatment should be initiated with the identification and withdrawal of the drug that initiated the occurrence of HA. With the development of severe HA, hemodialysis may be required. Prevention of DIHA involves avoiding the use of drugs associated with a high risk of its development.

Introduction. Polypharmacy and the administration of potentially non-recommended drugs are the causes of adverse drug reactions. The absence of potentially recommended drugs leads to a decrease in the duration and quality of life, an increased risk of complications from various organs and systems.
The purpose of the study. To analyze the structure of prescribed drugs in patients over 65 years of age with atrial fibrillation (AF) and chronic kidney disease (CKD) stages 3 and 4 for the presence of рolypharmacy and compliance of prescriptions with the criteria STOPP/START.
Materials and methods. 125 case histories were analyzed in patients 65 years and older with AF and CKD. Patients were divided into two groups: group 1 – patients with AF and CKD 3a (n = 51; 84.3 % of women; mean age 86.1 ± 6.4 years; mean score on the CHA(2) DS(2)-VASc scale 6.2 ± 1.1 points; mean score on the HAS-BLED scale 3.00 ± 0.68 points); group 2 – patients with AF and CKD 3b and 4 stages (n = 39; 84.6 % of women; mean age 87.9 ± 4.7 years; mean score on the CHA(2) scale; DS(2)-VASc 6.1 ± 1.2 points; the average score on the HAS-BLED scale is 3.10 ± 0.71 points). All 100 % of patients in both groups had a high risk of stroke on the CHA(2) DS(2)-VASc scale (≥ 2 points for men; ≥ 3 points for women), 82.4 % of patients in group 1 and 79.5 % of patients in group 2 had a high risk of bleeding on the HAS-BLED scale (≥ 3 points). According to the prescribing sheets of medical histories, the frequency of polypharmacy was evaluated, as well as the structure of drug prescriptions according to the STOPP/START criteria.
Results. The number of patients who were prescribed ≥5 drugs was 100 % in group 1 and 94.9 % in group 2. The number of patients receiving ≥10 drugs at the same time was 11.8 % and 20.5 % in group 1 and 2, respectively. In 64.7 % of patients from group 1 and in 53.8 % of patients from group 2, potentially non-recommended but prescribed drugs (STOPP) are present in the prescribing lists. At the same time, 96.1 % and 100 % of patients in groups 1 and 2, respectively, were not prescribed drugs that are recommended for elderly patients (START criteria).
Conclusion. Patients with AF and CKD aged 65 years and older are often prescribed potentially non-recommended drugs that significantly reduce the quality of life and increase the risk of adverse drug reactions. These patients were also often not prescribed potentially recommended drugs that are necessary to improve the prognosis, reduce the risk of complications, and reduce the number of hospitalizations. The revealed facts dictate the need to optimize pharmacotherapy in elderly and senile patients with AF and CKD in a hospital setting.

The effect of the comorbid background on the course of the infectious process in chronic HCV infection requires study due to the existence of a risk of progression of liver fibrosis even after the eradication of the virus against the background of concomitant diseases.
Material and methods. The article analyzes the prevalence of various comorbid conditions in 700 patients with chronic HCV infection, who were observed in the hospital of the Botkin in St. Petersburg, an assessment of the mutual influence of the comorbid background and the progression of liver fibrosis in HCV infection was given. To determine the contribution of comorbidity to the course of HCV infection, the odds ratio (OR) parameters were calculated.
Results. HCV-infected individuals have higher prevalence of comorbidity (63 %) and multimorbidity (50 %). In patients with severe fibrosis or cirrhosis, the presence of the comorbidity factor increased to 85 %. In the examined group of patients, diseases of the biliary tract and pancreas prevailed (30.0 %), occult Hepatitis B Infection was revealed in 19.0 %, in 15.4 % – cardiovascular diseases, in 13.7 % – diseases of the upper gastrointestinal tract. Diabetes mellitus was found in 4.6 % of patients, and obesity – in 5.9 %, kidney disease – 3.0 %. The remaining concomitant diseases occurred in less than 2.0 % of the observed patients. It has been established that diseases of the biliary tract and pancreas, gastrointestinal tract, diabetes mellitus, obesity, cardiovascular diseases are risk factors for the development of liver fibrosis in chronic HCV infection.
Conclusions. The data obtained indicate the need for a more personalized approach to monitoring patients and the need to create integrated models of medical care for patients with chronic hepatitis C.