Objective. Development of an algorithm for predicting the complicated course of acute MI (rhythm disturbances, acute left ventricular failure: pulmonary edema, cardiogenic shock) in patients with COPD.

Materials and methods. 37 patients with acute myocardial infarction on the background of COPD were examined, undergoing inpatient treatment in the conditions of the regional vascular center of the State Budgetary Healthcare Institution of the Alexandro-Mariinsky Regional Clinical Hospital in 2017–2019. Clinical examination included assessment of complaints, life history and illness. The enzyme-linked immunosorbent assay was used to determine: the concentration of the HSP 70 protein using the HSP 70 High Sensitivity EIA Kits (Stressgen, USA), interleukins IL‑1β, IL‑2, IL‑6 with reagent kits of VEKTOR-BEST JSC (St. Novosibirsk, Russia) and neopterin test with the Neopterin ELISA kit (IBL International, Germany). Determination of the content of apoptotic cells from heparinized venous blood was performed using the Annexin-V-FITC / 7AAD reagent kit (Beckman Coulter, USA). Statistical data processing was carried out using the SPSS 26.0 (USA).

Results. When analyzing the frequency of occurrence of the studied laboratory diagnostic signs, significant differences were found for the indices of circulating annexin V mononuclear cells at an early stage of apoptosis and neopterin. Based on the data obtained and the selection of predictors, the probability of complications (rhythm disturbances, acute left ventricular failure) was calculated using the logistic regression equation. Using ROC analysis, a cut-off was determined for the levels of circulating annexin V mononuclear cells at an early stage of apoptosis and neopterin.

Conclusion. Information on the estimated high risk of developing complications of acute myocardial infarction, such as rhythm disturbances and acute left ventricular failure, will help to purposefully select the amount of preventive and therapeutic measures in patients with acute MI associated with COPD to minimize this risk.

The effect of hypotensive drugs overdose on cardiovascular system is poorly studied; it should undergo clinical, experimental pharmacology and toxicology together with cardiology. There is too little information about cardiotoxicity of beta-blockers (β-blockers) and calcium channel blockers (CCB) in existing research literature. Intoxication from these groups of drugs causes similar severe hemodynamic abnormalities and myocardial insufficiency, however pathophysiological mechanisms of these abnormalities are not thoroughly studied. The review highlights how difficult it is to identify toxic level and distinctive features of clinical evidence of intoxication. Methods of diagnosis as well as β-blockers and CCB overdose treatment are discussed.

Hypertensive disorders in pregnant women are a significant factor in the development of complications leading to maternal and perinatal mortality. However, most cases of adverse outcomes are preventable. The choice of drug therapy in this group of patients should be made on the basis of a complete analysis and risk stratification.

Purpose of work. Consideration of modern classification, diagnostic methods and rational antihypertensive therapy of chronic arterial hypertension on the example of a clinical case of a pregnant patient in a therapeutic hospital.

Case description. The presented work describes a case of severe arterial hypertension during the first trimester of pregnancy, poorly amenable to drug correction.

Conclusion. The features of this clinical observation are the problems associated with the selection of antihypertensive therapy for severe arterial hypertension during low gestational age pregnancy, taking into account comorbidities

The clinical presentation of cardioneurosis is heterogeneous and includes anxiety-phobic, cenestalgic, and depressive symptoms. General practitioners, who most often see this category of patients, usually recommend to take «sedatives». Modern antidepressant, i. e. selective serotonin reuptake inhibitor, escitalopram demonstrated high efficiency and good tolerability in patients with cardoneurosis (neurocirculatory dystonia).

Technical progress facilitates to a significant increase in injuries and the severity of traumatic injuries. When providing treatment for patients with polytrauma in a multidisciplinary hospital the leading place is taken by the organization of the work of the hospital’s medical personnel, the development and implementation of standards for the guidelines specialized medical care to victims. The main priority of surgical intervention in polytrauma is to bleeding control, and staged treatment with final surgical correction after stabilization of the victim’s condition in 24–36 hours after the injury. An important role is played by standardized transfusion therapy for preventing the development of the lethal triad. Practice shows that a multidisciplinary approach is the cornerstone of providing specialized medical care for patients with polytrauma.

The development of medical technologies and the emergence of new methods of respiratory support with extensive capabilities to control positive pressure on the inhale and exhale made it possible to implement non-invasive ventilation. The integration of microprocessors in modern respiratory interfaces, on the one hand, and a deeper understanding of the mechanisms of the pathogenesis of respiratory failure, on the other hand, made it possible to improve and implement various methods of non-invasive respiratory support in everyday clinical practice. The experience gained in recent decades with the use of non-invasive ventilation made it possible to widely use this method of respiratory support in a wide variety of clinical situations. However, the selection of patients for mask ventilation, the choice of method and algorithm for its application, prognosis of effectiveness, prevention of negative effects, as before, remain relevant. This dictates the need to continue studying the clinical efficacy of non-invasive ventilation in patients with respiratory failure of various origins. The review presents the possibilities and limitations of the use of non-invasive respiratory support in patients with respiratory failure in the intensive care unit.

Purpose. To assess the effectiveness of sub-narcotic concentrations of xenon in the local treatment of extensive wounds in children with severe injuries.

Material and methods. 14 patients (average age 9.3 ± 4.0 years) with extensive wounds were taken into the trial. 67 dressings in them were done with 30 % xenon and oxygen. Pain intensity was assessed by the numerical rating scale of pain (NRSp) (1–10 points); sedation depth – by Ramsay scale (1–6 points) and BIS index.

Results. Inhalations of 30 % xenon with oxygen during wound dressings reduced the intensity of pain from Me 3.67 (1.2; 6.0) to Me 2.0 (1.0; 3.3) points by NRSp scale (p < 0.05); after sedanalgesia, it increased again to Me 3.0 (1.0; 5.3). Analgesia with 30 % xenon was effective in 55 (82.0 %) dressings; in 8 (11.9 %) patients with trauma, xenon concentration was increased to 50 %, and in 4 (5.9 %) cases 50 % xenon was added with Fentanyl 1–2 mcg/kg. The depth of sedation assessed by the Ramsay scale decreased (p < 0.05) from 6.0 (5.6; 6.0) to 3.1 (2.2; 4.5) points; after sedanalgesia it increased to Me 5.0 (4.5; 5.4) points. At the same time, the mean value of BIS index decreased (p < 0.05) from 97.5 ± 1.5 to 86.5 ± 5.0 U; after dressing, it rapidly increased to 93.0 ± 2.1 U. During dressings, 82 % of children were calm, had contact with a doctor. Afterwards, their sleep was restored, their mood improved.

Conclusion. Sedanalgesia with xenon in sub-narcotic concentrations is an effective technique to relieve pain during treatment of extensive wounds in children.