Introduction. The assessment of myocardial work (MW) demonstrates undeniable advantages over the left ventricular ejection fraction (LVEF) for assessing the prognosis after myocardial infarction (MI), since it takes into account the level of afterload. The role of myocardial indices in predicting outcomes in patients after the first acute MI is not well understood.

Purpose of the study. Evaluation of parameters of global longitudinal strain (GLS), MW and their predictive ability in patients with first MI and successful percutaneous coronary intervention (PCI).

Methods. A prospective single-center study included 131 patients with a first acute MWZ without a history of heart failure (HF) and successful PCI. LV EF was assessed before PCI and again before discharge from the hospital with MW and GLS parameters. Endpoint: hospitalization with HF. Median follow-up: 1.5 years.

Results. ST elevation MWZ was diagnosed in 26.0% of patients; LV EF less than 50% at discharge was recorded in 64 patients (48.9%). The average periprocedural increase in LV EF was 4% in the general group. Hospitalization with HF during the observation period was registered in 34 (26.0%) patients. It was predicted by global wasted work (GWW) > 161.5 mmHg% and GLS < 13.7% (p = 0.026, AUC = 0.638 and p = 0.024, AUC = 0.628 respectively). GWW < 161.5 mmHg% reduces the risk of hospitalization with HF by 2.65 times (HR = 0.377 with 95% CI: 0.158–0.900; p = 0.028). Event-free survival in patients with GWW values above and below the threshold level differs to the maximum 2 or more years after AMI. At GLS > 13.7% before discharge, the risk of hospitalization with HF within 1.5 years is reduced by 2.34 times (OR = 0.428; 95% CI: 0.182–0.960). Significant predictors of hospitalization with HF are GLS (OR = 0.75; 95% CI: 0.61–0.92; p = 0.006), GCW (OR = 0.85; 95% CI: 0.74–0.99; p = 0.036) and LVEF (OR = 0.88; 95% CI: 0.78–0.99; p = 0.040) included in the developed prognostic model.

Conclusion. In patients with first acute MI, regardless of LV EF, at admission in the absence of clinical signs of HF, a developed prognostic model can be used to calculate the risk of hospitalization with HF within 550 days, including GLS, GCW and LV ΔEF, and the GWW level can also be taken into account.

Aim. To determine the type of endogenous intoxication syndrome in patients with myocardial infarction against the background of chronic obstructive pulmonary disease.

Materials and methods. We examined 130 patients with myocardial infarction (MI), 104 patients with stable chronic obstructive pulmonary disease (COPD), 195 patients with a combination of these diseases, and 110 healthy somatic subjects. All patients were subjected to general clinical and special methods of examination. The latter were aimed at determining markers of endogenous intoxication syndrome and were carried out by direct spectrometry (spectrophotometer Cary 50 Scan UV VS; Varian, Australia) – were determined MМM, immunofluorescence analysis (immunoenzyme reactions’ analyzer Uniplan AIFR‑01; production of Picon Co., Russia) – we determined markers of oxidative stress, flow cytoflowmetry (flow cytofluorimeter Navious; Beckman Coulter, USA) – we determined the level of apoptosis. Analysis of the obtained data was performed using SPSS26.0 program.

Results of the study. Two-stage cluster analysis by the levels of endogenous intoxication syndrome among patients with myocardial infarction, chronic obstructive pulmonary disease and their combination resulted in four clusters: polymarker-retentive, necrotic-inflammatory, hypoxicinflammatory, and cluster with no endogenous intoxication syndrome. By means of discriminant analysis a territorial map was constructed, which allows to refer a patient to this or that cluster at an early stage of treatment.

Conclusion. The selection of four clusters of patients with MI, COPD and MI + COPD will assess the presence and severity of endogenous intoxication syndrome. This will enable timely and adequate medication correction and will contribute to the improvement of patients’ quality of life.

Primary hyperaldosteronism, Cushing’s syndrome, pheochromocytoma, thyroid disease, and hyperparathyroidism can lead to secondary arterial hypertension. A physician in real clinical practice should keep in mind a possible endocrine genesis of the disease, especially in young patients, because the therapy should be aimed not only at the correction of arterial pressure, but also at the treatment of endocrine pathology. 

Today, in the pharmaceutical industry, many manufacturers produce so-called combined drugs containing 2 or 3 or more active ingredients. There are many reviews and studies in the world literature proving that most combinations, in contrast to sequential administration, often have a more pronounced synergistic effect of combined drugs. The use of such therapy increases patient compliance, while at the same time causing positive pharmacokinetic and other effects inherent in the combination, providing the clinician with new opportunities in the treatment of infections. Although the combination of fluoroquinolone and fixed-dose nitroimidazole derivatives is not as widely used in clinical practice, we present a review of Simprazole®, a combination of ciprofloxacin and ornidazole, analyzing the available data on clinical use and possible prospects that new drug.

Point-of-Care Ultrasound is a complex of diagnostic ultrasound methods with ultrasound guided interventions. The main difference from the classical use of ultrasound is the use of ultrasound by doctors of various specialties (anesthesiologists, intensive care, surgeons, obstetriciansgynecologists, etc.) to answer diagnostic questions that arise from a clinician when working with patients. The article presents the Russian experience of successful implementation of the method of focused ultrasound-assisted examination (manipulation) in the clinical practice of physicians of various specialties on the example of several medical institutions of Buryatia Region.

Introduction. To date, information of the use of high-flow oxygen therapy (HFOT) in patients with tracheostomy cannulas is limited. The use of HFOT in this group of patients at the ventilator weaning may improve outcomes.

Objective. Improving results of treatment of patients with tracheostomy cannulas with hypoxemic ARF of various origin through the use of HFOT at the ventilator weaning after prolonged mechanical ventilation (MV).

Materials and methods. The prospective open cohort study included 50 patients aged 45 (from 37 to 57) years, the duration of invasive mechanical ventilation was 8.68 ± 3.83 days. Patients were randomized into two groups: in group A, weaning from the respirator was performed through a combination of traditional low-flow oxygen therapy (LFO) and assisted modes of MV; in group B – through a combination of HFOT and assisted modes of MV. The groups compared gas exchange rates, the duration of weaning from the respirator, the incidence of complications (pulmonary and extrapulmonary), the duration of treatment, mortality in the ICU and in the hospital. In all patients, the most significant predictors of in-hospital mortality were analyzed.

Results. The use of HFOT in patients in group B revealed significant benefits in terms of the studied parameters in the early and late stages of the study. Mortality in the groups did not differ. The most significant risk factors for in-hospital mortality were cannulation after transfer from the OR (OR = 9,667; 95% CI: 2.414–38,713; p = 0,001).

Conclusions. The use of HFOT in patients with tracheostomy cannulas is more clinically effective than COT. Risk factors assessment in every patient will allow optimal use HFOT.

The experience of management anesthetic support in a streaming outpatient endoscopic center is presented on the example of 16,956 anesthesia. Patients were stratified according to the degree of risk, complications and adverse outcomes. Analyzed preoperative and postoperative logistics. Controversial moments and prospects of anesthetic practice in outpatient intraluminal endoscopic procedures are presented.

Introduction. The present study examined the effect of iliac fascia blockade in patients after primary total hip arthroplasty (TEH).

Purpose. Evaluation of the efficacy and safety of using the iliac fascia blockade in the postoperative period after TEH.

Materials and methods. The study included 60 patients who underwent primary TEH. Patients were randomly divided into two groups: group 1 (n = 30) – patients who underwent a multimodal scheme of postoperative analgesia in the postoperative period; group 2 (n = 30) – patients who, in addition to multimodal analgesia, underwent blockade of the iliac fascia of the thigh under ultrasound navigation after surgery. In the postoperative period, the level of pain syndrome at rest and during movement was recorded using a visual analog scale of the pain level (VAS 1 and VAS 2) after 6–12–24–48 hours. We also recorded the frequency and quantity of prescription of narcotic analgesics and noted the frequency of side effects from their use.

Results. The level of pain syndrome at rest and during movement in the first 24 hours was lower in patients of the 2nd group. After 48 hours, there were no significant differences between the groups in the level of pain. Patients in group 1 were prescribed opioid analgesics more often than patients in group 2. The number of side effects from the use of narcotic analgesics was greater in patients of group 1.

Conclusions. The use of the iliac fascia block is an effective method of perioperative analgesia after hip arthroplasty. This method allows achieving a high level of pain relief and reduces the need for prescription of opioid analgesics.

Introduction. In 2016, M. Forero published data on the successful application of a new method of analgesia for chest pain – blockade of the fascial space of the erector spinae muscle, which was given the name Erector Spinae Planeblock (ESP). With the accumulation of clinical experience in the use of this blockade, it became obvious that the range of indications for its use can be significantly expanded. We propose a technique for using ESP blockade as a component of anesthesia in retroperitoneoscopic adrenalectomy for aldosteroma. 

Research. The authors conducted a systematic literature review in accordance with the principles of the PRISMA Statement. A bibliographic search was carried out in September–November 2021 in the MEDLINE, EMBASE, Cochrane Library databases. The search terms were: ‘ESP – blocks’, ‘postoperative analgesia’, ‘retroperitoneoscopic adrenalectomy’, ‘preoperative preparation before adrenalectomy’.