The aim of the study was to assess the treatment results in patients with anterior STEMI using primary PCI in different patient age groups, including those at late hospitalization, taking into account the initial mortality risk (MR). The study included 804 patients with anterior STEMI, aged 28 to 91 years, who were admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017: 583 of them had the primary PCI performed either within the first 12 hours from the disease onset (311 patients) or at late hospitalization: after 12–72 hours (272 patients); and 221 patients treated without PCI. The distribution of patients by age: under 65 years old, 65–75 years old, and over 75 years old was 340, 139, and 104 in the PCI group, and 126, 47, and 48 in the group without PCI, respectively. In 26 death cases after PCI and in 39 of died without interventions, the state of the coronary bed, the affected area, and the immediate cause of death were determined. We have found that in the absence of reperfusion therapy (RT) in STEMI, the initially high baseline MR assessed by TIMI Risk Score corresponds to high mortality. It affects people of predominantly elderly and, especially, senile age, who more often have a proximal lesion of the main coronary arteries, which causes an extensive area of infarction with the development of fatal complications. The use of primary PCIs, including those at late hospitalization, prevents the progression of acute heart failure, the formation of LV aneurysms, and reduces the deaths rate. In different periods of time, the mortality rate with the use of primary PCI, including the delayed ones, fluctuates; it can rise with a significantly increasing number of the hospitalized at senile age. An increase in mortality is associated with complications, including those arising during procedures in severe multivessel coronary artery disease, which is more common in this patient population. Achieving angiographic success even in the absence of ECG signs of reperfusion can significantly reduce mortality in all age groups. High MR is an optimal indication for using delayed procedures. An urgent use of primary PCIs, including those at late hospitalization, allows the optimization of the STEMI treatment, and the achievement of the maximum reduction in mortality.

Coronary artery disease (CAD) remains the leading cause of death, and its prevalence is projected to increase in the near future. Dyslipidemia is one of the most important risk factors for CAD, and special attention is currently being paid to improving approaches to its correction. In the new revision of the Russian Guidelines for the Management of Patients with dyslipidemia (2020), priorities are given to high-intensity statin therapy: new more strict target levels of low-density lipoprotein cholesterol (LDL–C) are introduced. Experts also emphasize the important role of the cholesterol fraction of non-high-density lipoproteins (non-HDL–C), primarily triglycerides, and introduce their target levels. The concept of residual risk, which remains despite effective statin therapy and achievement of the target level of LDL–C, is closely related to non-HDL–C. Here, hypertriglyceridemia is of crucial importance, contributing to an increased risk of coronary heart disease and cardiovascular mortality. Therefore, combined lipid-lowering therapy in the form of a combination of high-intensity statin and fenofibrate is an effective approach to significantly improve the prognosis and reduce the residual risk. According to research data, rosuvastatin provides a reduction in LDL–C by ≥ 50 %, has a wide range of pleiotropic effects in combination with an optimal safety profile. Fenofibrate allows you to effectively reduce the level of triglycerides and implements additional protective effects on the cardiovascular system. The logical continuation of the principle of combined lipid-lowering therapy was the appearance of a fixed combination (FC) of rosuvastatin and fenofibrate, which already has its own evidence base of studies indicating a complex and complementary effect on the disturbed blood lipid spectrum, a good safety profile of therapy, and the form of ‘single-pill’ significantly increases patients adherence to treatment. It can be expected that the widespread use of rosuvastatin and fenofibrate in clinical practice will effectively reduce the residual cardiovascular risk and thus provide an improved prognosis for patients.

The authors analyzed, classified and outlined the experience of working with patients who had suffered from COVID-19 disease to varying degrees of severity. Evaluated the possibilities of modern echocardiography in the diagnosis of complications of this infection from the heart, proposed the algorithm of ultrasound heart research in this category of patients. This year, the Recommendations of the European Association of Cardiology on the diagnosis and treatment of cardiovascular diseases in patients with coronavirus infection were published. These recommendations clearly describe the risk groups of complications of this pathology because COVID affects not the lungs but also the heart. The most vulnerable were patients with chronic diseases such as diabetes, blood diseases, chronic renal failure, cancer pathology, COPD. It is in these categories of patients that complications of infection from the lungs and heart were most common.

Coronary angiography is still the ‘gold standard’ in assessing the severity of stenotic lesions of the coronary arteries in the catheter laboratory. However, it is often difficult to identify the hemodynamic significance of one or another coronary artery stenosis, which is especially difficult in the case of borderline lesions with a coronary artery stenosis of 40–70 % according to angiography. It is important to note that the results of performed PCI are still largely assessed only on the basis of control angiographic data. This is due to the fact that the largest difference between angiography and FFR is in the intermediate range, and in general there is much less variation between angiography and fractional blood flow reserve (FFR) in the severe and mild lesions. However, the results of studies evaluating FFR after PCI showed a wide range of FFR values after satisfactory results of stenting according to angiography data. This additionally confirms the thesis that only one angiography is limited in determining the ischemic boundaries after PCI, and the level of FFR values after PCI is directly related to the results in the long-term period. Percutaneous coronary interventions under the control of FFR allows the operator to improve the results of endovascular treatment of coronary lesions in patients with coronary heart disease. The use of FFR in a catheter laboratory contributes to an increase in the clinical and economic efficiency of procedures, which is achieved due to the fact that the determination of FFR before PCI can significantly reduce the number of stents implanted during PCI, as well as to avoid unnecessary PCI stages in the treatment of patients with lesions of the LMCA. In addition, FFR allows to timely optimize the results of suboptimal PCI, as well as to reduce the frequency of main adverse cardiovascular events in the long-term period.

Cardiovascular diseases (CVD) are the leading cause of death worldwide and in Russia. Therefore, the question of safe and rational drug therapy is acute. But, like most drugs, drugs for the treatment of CVD have a number of adverse reactions, in particular, the development of acute pancreatitis. This adverse reactions can be both dose-dependent and depend on the duration of administration of these groups of drugs. The purpose of this review is to analyze the literature data on drugs intended for the treatment of СVD that can lead to the development of drug-induced pancreatitis (LIP), on the mechanisms of development of this pathology against the background of taking specific drugs, diagnosis, treatment and prevention. The development of LIP is associated with the use of diuretics, both loop (furosemide, etacric acid, bumetamide), and thiazide/thiazide-like (chlorothiazide, hydrochlorothiazide and chlorthalidone), antihypertensive drugs of central action (methyldopa), angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, statins, antiarrhythmic drugs (amiodarone, procainamide). Literature data on the development of LIP are presented in most publications with the description of clinical case/series of cases, however, in the case of LIP associated with the use of ACEI and statins, there are also data from cohort, retrospective observational, prospective case-control, randomized controlled trials, and meta-analyses. With timely diagnosis, and the cancellation of drugs that have caused the development of OP, the symptoms of the disease regress until they completely disappear and develop serious consequences.

The review presents current data on the prevalence of chronic glomerulonephritis in different regions of the world according to the data of in vivo studies of histology of renal biopsy specimens. The literature data on the significance of glomerulopathies in the development of chronic kidney disease and risk factors of its progression to the terminal stages are reflected. We analyzed data on the most common types of glomerulonephritis – IgA-nephropathy, lupus nephritis on the ratio of primary and secondary forms of glomerulonephritis, their significance in the development of arterial hypertension and cardiovascular complications of this pathology.

The aim of the work is to study the clinical and psychological manifestations of maladjustment of young female students with idiopathic arterial hypotension (IAH). Two groups, aged 18–35 years, were examined: 200 women with IAH with SBP level of 61–98 mm Hg, DBP – 59 mm Hg and less, and 130 women with normal blood pressure. The groups were compared by the frequency of complaints about health problems and the results of assessing mental performance, fatigue using the E. Kraepelin test. The studies were carried out as part of a preventive medical examination. A comparative analysis of complaints showed that women with IAH limit their physical activity due to a deterioration in subjective well-being – the appearance of shortness of breath, pain and discomfort in the chest and legs, dizziness, poor cold tolerance – chilliness of the hands and feet, episodes of involuntary urinary incontinence. With IAH, complaints of apathy, weakness and fatigue, and difficulty concentrating were more often recorded. Women with IAH under psychoemotional stress made more mistakes, and the proportion of women who made mistakes when performing a test was twice as high as in women with normal blood pressure. Thus, we can conclude that IAH in young women is characterized by more frequent complaints of health problems than in women with normal blood pressure, which is combined with a decrease in daily physical activity and cognitive impairment. IAH in female students can be regarded as a risk factor for psycho-emotional and social maladjustment, which negatively affects the effectiveness of learning in the higher education system.

Purpose. According to the assessment of liver hemodynamics, to determine the criteria for the probability of death in patients with severe concomitant injury and to establish the decisive time range in which these indicators are prognostic.
Material and methods. The analysis of ultrasound (US) indicators in 57 patients with severe concomitant trauma was carried out in order to identify criteria for the probability of death and determine the time range in which these indicators have a prognostic character. All patients were divided into two groups: the first group of 40 surviving patients; the second of 17 dead. For comparison, three values were taken for each ultrasound indicator on the 1st, 3rd, 5th, 7th days from the moment of admission to the hospital. Comparison of the first and second groups of patients by these parameters revealed signs characterizing the violation of liver hemodynamics. The Mann-Whitney test, correlation analysis and stepwise logistic regression were used to study the relationships. Differences were considered statistically significant at a significance level of p < 0.05. Correlation was considered strong when R > 0.5. The best reliable regression model was chosen according to the highest value of the Akaike criterion.
Results. In the first three days after trauma in patients of the first and second groups, the most significant were such ultrasound signs as a decrease in the diameter of the own hepatic artery (OHA), a decrease in the linear blood flow velocity (LBFV) along the SPA to 27–38 cm/s, and a decrease in volumetric blood flow in OHA, an increase in the index of resistance (IR) in OHA of more than 0.7, in combination, indicate liver dysfunction in patients in a state of traumatic shock. From the 5th day in the second group of patients, an increase in LBFV in the OHA (100–135 cm/s), an increase of 0.70–0.84, a decrease in volumetric blood flow less than 270 ml/min indicate violations of liver hemodynamics during the formation of organ dysfunction. On the 5–7th day, due to edema of the liver parenchyma against the background of an increase in the size of the liver and spleen and the formation of portal hypertension, arterialization of blood circulation occurs, which is characterized by a significant increase in LBFV in the OHA, a decrease in LBFV and volumetric blood flow in the portal vein. The third-fifth day after the injury can be considered a turning point – the correlation of most of the indicators with the fact of death and significant differences in the criterion in 9 out of 11 indicators indicate significant differences in all indicators in patients of the first and second groups. At the same time, not only dopplerographic indicators of hepatic blood flow, but also linear indicators of the size of the liver, spleen, signs of portal hypertension characterize the severity of the patient’s condition.
Findings. 1). Carrying out an ultrasound of the liver with the use of Doppler ultrasound allows in the first 3 days from the moment of injury to conclude that there is liver dysfunction against the background of traumatic shock. 2). Statistical analysis of Doppler parameters of liver hemodynamics makes it possible to identify patients with a poor prognosis, severe liver dysfunction in the first 3–5 days from the moment of injury, as well as with developing multiple organ failure. 3). The obtained ultrasound results, indicating liver dysfunction in the early post-traumatic period, are confirmed by autopsy data.

Nutritional deficit in patients with viral diseases, including COVID-19, can reduce the efficacy of specific treatment, decrease the survival rate, and increase medical expenses. According to international guidelines, timely correction of nutritional status with supplemental enteral and parenteral nutrition containing omega-3 polyunsaturated fatty acid from fish oil (omega-3 PUFAs: ЕРА and DHA) is able to improve clinical outcomes of specific antiviral treatment. The authors conducted an analytical review to assess the results from the study of clinical use of omega-3 PUFAs for the prevention and treatment of COVID-19 and other viral infections. Supplementation of clinical (enteral and parenteral) nutrition with omega-3 PUFAs allows for symptom reduction, shorter stay in hospital, and quicker recovery of patients infected with SARS-CoV-2 and other viruses. When used in combination with adequate macronutrient support, it can reverse nutritional deficit and improve clinical outcomes.

Introduction. It is the recommendations for treatment of sepsis and septic shock combined with rheumatologists’ recommendations for monoclonal antibodies therapy that guide severe COVID-19 management in ICU. However, those recommendations may not be fully applied to patients with acute respiratory distress-syndrome associated with SARS-CoV-2, as there exists a difference in pathogenesis between sepsis and virus-associated pneumonias. Monoclonal antibodies therapy may contribute to cytokine cascade severity and promote lung injury. Cytokine storm aggravates the course of the disease. At present, there are two groups of methods described in literature for cytokine storm control and therapy: pharmacological and extracorporeal approaches.
Materials and methods. We have performed a retrospective analysis of five COVID-19 patients with acute respiratory syndrome. Cytokine adsorption start criteria were respiratory insufficiency and IL-6 levels greater than 500 pg/ml. Adsorption therapy was initiated within 24 hours of ICU admission and continued for 48–120 hours in hemoperfusion mode on Multifiltrate machine (Fresenius Medical Care). The length of a single session of CytoSorb (Cytosorbents Inc.) therapy was 24 hours.
Results. All patients demonstrated SpO₂/FiO₂ ratio growth and IL-6 concentration decrease by the end of hemoadsorption. We noted lymphocyte count rise as well as IgM и IgG SARS-CoV-2 antibodies titer substantial increase.
Conclusions. Our observations suggest that the early start of hemoadsorption associates with gas-exchange stabilization and hinders respiratory distress progression. Hemoadsorption allows for pro-inflammatory cytokines concentrations decrease and prevents secondary lung injury. According to our data, hemoadsorption is beneficial to form a coronavirus infection specific immune response. Further research is needed for a detailed study of the results we here describe.

The aim of the study. To analyze literature data in order to study the pathophysiological mechanisms of development of peripartum cardiomyopathy.
Research methods and materials. A review of modern Russian and foreign, mainly English-speaking, literature on the pathogenetic mechanisms of IPAH development was carried out. We took into account publications not older than 6 years, published in specialized medical journals and guidelines.
Results. According to the data of modern studies devoted to the peculiarities of the development of peripartum cardiomyopathy, much attention is paid to the risk factors of the disease, in particular the age-related obstetric history, pregnancy with twins or more, and arterial hypertension. In addition, the significance of genetic predisposition, inflammatory syndrome has been proven, and the vasculo-hormonal theory is being studied. Difficult issues of the etiopathogenesis of the disease, including myocarditis, the role of the prolactin-cathepsin-prolactin 16 kDa system, and malnutrition are discussed.
Conclusion. Pathophysiological mechanism of development of peripartum cardiomyopathy. appears as a complex combination of inflammatory changes in the myocardium with the participation of a cardiotoxic subfragment – prolactin 16 kDa, which causes damage and dysfunction of the endothelium under hemodynamic stress against the background of possible genetic changes, which leads to damage to cardiomyocytes and a decrease in myocardial contractility.