Echocardiography is one of the first-line methods of detection and evaluation of coronary artery disease, which helps clinicians in the diagnostic and prognostic evaluation of this disease. However, visual assessment of abnormal left ventricular myocardial wall motion is not always appropriate in detecting less severe or transient myocardial ischemia and in making an accurate differential diagnosis. Speckle-tracking echocardiography is a widely available non-invasive tool that can easily and quickly provide clarifying information and significantly extend the standard echocardiographic study, as the method allows you to identify subtle myocardial damage and local areas of ischemia that correspond to the pattern of coronary disease, and obtain an objective report in the form of simple visual scheme, very easy to use for differential diagnosis and treatment. Therefore, this method, which is increasingly used in various manifestations of coronary insufficiency and is convenient to use both at rest and with stress echocardiography, has proved efficient results in terms of predicting coronary heart disease, quantitative interpretation of emerging or persistent ischemia, assessment of the clinical course and outcome, and left ventricular remodeling. In this review, we have attempted to reflect the currently available findings that demonstrate the significance of speckle-tracking echocardiography for the evaluation and follow-up of coronary heart disease, including some congenital anomalies of the coronary arteries, and to touch on the main achievements and discoveries in the use of two-dimensional and three-dimensional deformation parameters and their potential application for a wider introduction into clinical practice.

Anemia, as the most common hematological complication of HIV infection, is one of the key indicators of its severity and a predictor of death from its complications. Within 3 years, 240 patients with HIV infection were examined in a multidisciplinary hospital. In the examined group, 160 (66.60 %) people had clinical, instrumental and laboratory signs of CHF. Among them, 94 patients (58.75 %) had anemia of varying severity. The presence of CHF 2.75 times increases the chances of developing anemia in HIV-infected people. The development of anemia is associated with the development of CKD stage 3A and above, an increase in the volume of the left atrium, the development of diastolic dysfunction of the left ventricle and severe CHF with a concentration of NT-proBNP ≥ 1500 pg/ml in blood plasma. In patients with CHF and HIV infection, determining the concentration of NT-proBNP ≥ 170 pg/ml is associated with the development of anemia, which gives this test additional clinical significance. Reduced transferrin less than 200 mg/dl 10.99 times increases the chances of developing severe CHF with NT-proBNP ≥ 1500 pg/ml, which makes it recommended to determine the level of serum transferrin in all patients with HIV infection and CHF in order to predict the development of severe CHF with NT-proBNP ≥ 1500 pg/ml.

Electrocardiographic repolarization abnormalities do not always indicate cardiovascular disease and life-threatening conditions. Therefore, an integrated approach, case follow-up and cooperation of functional medicine practitioners, cardiologists and general practitioners are needed. The spectrum of conditions leading to non-ischemic ST elevation or depression can be associated with both electrolyte disturbances and various extracardiac disorders. Modern electrocardiographic diagnosis and differential approach are necessary to reduce the risk of life-threatening conditions in this patient population.

Purpose. To analyze the levels of C-reactive protein (CRP) and lactoferrin (LF) in patients with myocardial infarction (MI) with chronic obstructive pulmonary disease (COPD) depending on the presence of acute MI complications.
Materials and methods. In total were examined 325 patients with MI: 195 patients with acute MI + COPD and 130 MI patients without COPD and 110 healthy somatic subjects. Complications of acute MI were observed in 84 (43.1 %) MI + COPD patients and in 32 (24.6 %) MI patients without COPD.
Results of the study. The level of inflammatory markers we studied was elevated in all observation groups relative to controls. In MI + COPD patients and in MI patients without COPD the level of highly sensitive CRP was statistically significantly higher in the presence of acute period complications. LF levels did not depend on the presence of complications in any of the observation groups.
Conclusions. Increased inflammatory markers in MI patients without COPD and in MI + COPD groups indicate the significance of the inflammatory component in the pathogenesis of MI. In patients with MI + COPD the severity of systemic inflammation is maximal. CRP is informative as an indicator of inflammatory response in MI. The highest CRP level was observed in patients with complicated MI.

Objective. To identify ‘classical’ and ‘modern’ risk factors (RFs) in young people aged 18–25 years in a student environment and evaluate their impact on arterial wall stiffness using non-invasive examination methods.
Materials and methods. 171 students of a humanitarian university aged 18–25 years old were examined, of which 52.1 % were girls and 47.9 % were boys. An anonymous survey was conducted to identify the main risk factors. The method of volumetric sphygmography and highly sensitive compression oscillometry was used to assess the state of the vascular wall.
Results. Against the background of ‘classic’ risk factors (low physical activity – 61.9 %, essential arterial hypertension [AH] – 29.8 %, aggravated heredity for hypertension – 18.3 %, overweight – 14.0 %, obesity – 8.5 %, cigarette smoking – 3.0 %), ‘modern’ RFs were identified: a combination of hookah and cigarette smoking – 31.0 %, use of electronic cigarettes – 17.0 %, use of energy drinks – 25.3 %. In students with the presence of ‘modern’ PR, the values of pulse wave velocity (PWV) were obtained – 8.4 ± 2.7 m/s, relative to the PWV of students without PR 5.1 ± 0.6 m/s (p = 0.002). It was found that the relative risk of an increase in PWV with the combined use of hookah and cigarettes increases by 52.1 times (95 % CI: 11.2–242.1 at χ2 = 37.987; p = 0.001), with the use of energy drinks by 27.4 times (95 % CI: 6.8–111.0 at χ2 = 29.328; p = 0.001), when using electronic cigarettes by 2.6 times (95 % CI: 1.3–5.2 at χ2 = 6.496; p = 0.011).
Conclusions. Students aged 18–25 years showed a high adherence to modern risk factors (a combination of hookah and cigarette smoking, energy drinks, use of electronic cigarettes) that lead to a violation of the elastic properties of the vascular wall, which indicates endothelial dysfunction.

In the modern world, there is a steady increase in the number of patients with diseases pathogenetically associated with insulin resistance and metabolic syndrome, which represent a springboard for the development of not only cardiovascular, but also other socially significant chronic non-communicable diseases. The study of the pathogenetic interaction of numerous humoral and physical factors in the development and progression of vascular-metabolic disorders is the most relevant area of modern clinical research. Over the past decades, there has been a surge of interest in the scientific literature and a detailed discussion of current trends in the development of diseases and conditions associated with insulin resistance and metabolic syndrome, as well as their associated complications in various fields of medicine. Models of the interaction of neurohumoral, metabolic, vascular and other factors proposed by experts are important for understanding the processes leading to an increase in the prevalence of conditions associated with insulin resistance. Carrying out reciprocal interaction with the developing vascular and metabolic complications of diabetes mellitus and obesity, cellular metabolic disorders should become a new therapeutic target for improving the condition and prognosis of patients. A promising direction in the correction of intracellular metabolic disorders is the use of drugs that block the partial oxidation of free fatty acids in mitochondria (partial fatty and oxidation inhibitors) – p-fox inhibitors, which include the most commonly used in modern clinical practice trimetazidine and meldonium. A wide range of comorbid conditions and various chronic diseases in most patients dictates the need for a detailed study of the mechanisms and features of action, as well as drug-drug interactions of these drugs. There is also a need to discuss the possible risks of side effects that may limit the use of some p-fox inhibitors. This review provides a discussion of these issues in relation to trimetazidine and meldonium, as well as an assessment of various options for their safe clinical use.

The article is devoted to the history of the creation and development of emergency medical care for the population of Moscow. The stages of the activity of the home care centers, the night emergency room at the Ambulance Station and their subsequent organization in the district emergency centers are considered. The main regulatory and legal documentation is indicated, in the development of which the heads of the Station n. a. A. S. Puchkov and A. M. Nechaev took part. The work on the creation of a system of emergency and emergency medical care for adults and children in Moscow, the rules of action of the doctor of the emergency room upon receipt of appeals is shown. The article describes the search for effective ways to solve organizational and material problems in the field of emergency and emergency medical care at different stages of the development of the emergency service. The role of the Moscow Ambulance and Emergency Medical Care Station in the development and implementation of organizational and methodological measures to improve the work of emergency departments in the capital is shown. A description of a major project is given, the purpose of which was the full integration of emergency medical care for adults and children into the structure of the Ambulance and emergency Medical Care Station in Moscow at the present stage, the organization of a Single city dispatch center for emergency and emergency medical care with the formation of a single information space, the previous preparatory work for receiving calls on a single federal number 103 on the base of the Station. During its history, the Moscow emergency medical Service has passed a difficult path. Thanks to the efforts made, the service is now an integral part of the Ambulance n. a. A. S. Puchkov and Emergency Medical Care Station in Moscow.

Adequate nutritional support for a critically ill patient has been and remains one of the main, complex and not fully resolved problems of modern resuscitation, which, unfortunately, often remains without due attention. In everyday practice, in order to adequately correct nutritional deficiency, the resuscitator must, first of all, correctly assess the trophological status of the patient. Currently, there is a large selection of nutrients and different methods for assessing metabolic status. The paper presents a critical analysis of existing methods for assessing the nutritional status and algorithms for the personalized choice of each of them in a specific clinical situation in critically ill patients.

Aim. To study the effect of endogenous bacteriophages on the outcome of infectious and inflammatory diseases in intensive care patients.
Materials and methods. 30 patients with positive hemoculture were examined for the presence of bacteriophages. The detection of endogenous bacteriophages in the blood of patients was made using traditional virological methods. Statistical analysis was performed using the Statistica 10 program.
Results. The bacteriophages were found in the blood of 11 patients, 5 of them were examined in dynamics15 strains of microorganisms were isolated. The mortality rate of patients in the phagopositive group was 18.2 %. 19 patients had no endogenous bacteriophages. In this group, the mortality rate was 68.4 %, that is significantly higher than in patients with endogenous phages. K. pneumonia was are the main causative agent of bacteremia and sepsis (12 strains out of 36).
Conclusions. Fatal outcomes were more often detected in patients whose endogenous bacteriophages were not detected in the blood. The most serious complications with frequent fatal outcomes were observed in patients with bacteremia caused by K. pneumonia.

Purpose. To conduct an analysis and research aimed at improving the safety of patients during anesthesia by optimizing training in clinical residency in the specialty of anesthesiology and resuscitation. Particular attention was paid to the human factor, as one of the causes of errors and complications in anesthesiology and resuscitation.
Material and methods. An additional and more detailed analysis of error factors is carried out using a list of associated error factors. We have developed a special questionnaire for an anonymous survey of clinical residents and anesthesiologists and resuscitators. With its help, we intended to find out what personal qualities an ‘ideal’ anesthesiologist-resuscitator should have.
Results. A more in-depth analysis data showed that the most common cause of errors was a lack of practice, in second place there are personal factors, in third place there is a lack of knowledge, and in at last place there are organizational factors. According to the results of an anonymous survey of clinical residents and anesthesiologists, it was established that ‘knowledge’ and ‘skills (abilities)’ are the main factors in ensuring the safety of patients during anesthesia.
Conclusions. Questioning should be recognized as an objective, simple and not requiring additional financial costs way to assess a number of social qualities and factors. Training and educating them of the necessary personal qualities of anesthesiologists and resuscitators is one of the most important components of ensuring the safety of anesthesia.

VR/AR technologies make it possible not only to facilitate the work of operating surgeons, but also to make the training of young specialists more effective, because the drawings in the textbook do not provide a complete understanding of the structure of the human body.
The purpose of this review is to qualitatively assess the use of VR technologies in medicine, which can be considered from three sides: in teaching students, in the work of doctors, and for the rehabilitation of patients.
Materials and methods. An information search was conducted on the resources of eLibrary, PubMed, CyberLeninka over the past 10 years. The keywords were the terms of augmented and virtual reality, as well as a set of keywords for associated comorbidity.
Conclusions. In minimally invasive operations, MR technologies can improve the accuracy of surgical intervention, which will increase the likelihood of success of the operation. MR technologies are a more promising area in medicine than VR and AR technologies. Mixed reality technologies can be used in student education, preoperative planning, and during the surgical operation itself. The relative speed of creating an MR image makes it faster and more accurate to make a diagnosis, develop a patient treatment regimen, as well as more efficient and simple communication between doctors and patients