Vol 18, No 12 (2016)

A review of the new European Guidelines on cardiovascular prevention in clinical practice, in which, compared with the previous version more attention is paid to population-based approach, specific interventions and prevention efforts in women, young people and ethnic minorities. The review provides information on the assessment of cardiovascular risk; situations that affect the risk; methods of intervention both at the individual and population level. This emphasizes the role of not only public health, but also the state and public organizations. In the new recommendations, it is assumed that the mortality rate from cardiovascular diseases can be reduced by half due to a rather moderate reduction of risk factors. However, this requires more stringent laws and purposeful policy in respect of food, physical activity and smoking.

The main clinical features of left ventricular (NCMLV) are non-compact myocardial heart failure (HF), arrhythmias and thromboembolic complications. Pronounced trabecular and deep inter-trabecular spaces typical of NC, can cause stagnation of blood flow and blood clots in the left ventricular cavity. This article deals with modern aspects of anticoagulant therapy in patients with NC, and describes a clinical case of a man of 54 years with a diagnosis of NCMLV. The patient was admitted with symptoms of severe heart failure and left ventricular thrombosis of multiple complicated with recurrent embolism in the systemic circulation. In the future, when the reduction of self-therapy, the patient suffered repeated thrombosis of the left ventricle with the development of thromboembolic events after popliteal artery and the left brachial artery. All patients with NCMLV as secondary prevention of thromboembolic complications of chronic administration of anticoagulants is recommended. In this case, should be considered for patients with NCMLV, which are also risk factors for thromboembolic events, such as atrial fibrillation or ventricular systolic dysfunction as a primary prevention of thromboembolism anticoagulant therapy.

In the structures of medical prevention in medical institutions (MPI) in several regions the software testing with the functions of automatic analysis of questionnaires to identify chronic non-communicable diseases (NCD) and risk factors (RF) of their development, and the self-view of the FF, identified by the results of questionnaires and surveys within phase I clinical examination was conducted. Automating these processes has significantly increased the establishment of NCD risk factors. Objective: To evaluate the effectiveness of the automation process of identifying, evaluating and accounting systems' RF and determine the indications for the methods of the II stage of clinical examination in accordance with the requirements of the order, approved by the order of Ministry of Health of Russia from February 3, 2015 №36an. Materials and methods. In the July-September 2015 period as part of the clinical examination of individual groups of the adult population on the basis of departments and medical prevention offices in three regions of the Central Federal District with the use of specially developed software, adapted to the current regulatory and procedural requirements made collection and statistical analysis of data. Analyzed the incidence of risk factors and other pathological conditions that increase the likelihood of developing NCD, as a result of the program and the routine processing of questionnaires and the survey results as part of Phase I clinical examination of the comparative analysis of the data reporting forms №131 (Tab. 4000) formed routinely and software. Results. When comparing the data reporting forms №131, created in hospitals on the basis of routine and interpretation software profiles, comparable results were obtained only in relation to the fact of detection of tobacco smoking - 12.6% for software analysis against 11.3% in the analysis, performed by doctors. Other risk factors and conditions, the diagnostic criteria are listed in Appendix №2 to the conduct of the clinical examination, a multiple often identified with software analysis, questionnaires and results of the survey, carried out under Phase I clinical examination. Programmatically RF malnutrition was established in 79.7% of cases vs 24.7% of cases, certain physicians; low physical activity - 30.8% vs 18.5%; family history in the whole group - in 23.5% vs 4.7%; the risk of harmful alcohol consumption - to 3.1% vs 0.5%; the risk of the use of narcotic and psychotropic substances without a doctor's prescription was detected in 1.0% vs 0.1%; Diagnostic criteria for elevated blood pressure levels have been established in 36.5% vs 13.5%; dyslipidemia - 36% vs 18.1%; hyperglycemia - in 4.2% vs 3.1%; overweight - at 54.8% vs 15.6%, of them 29.5% vs 16,8% established obesity. When calculating the absolute cardiovascular risk, performed by software, high and very high levels of risk found at 5.1 and 1%, respectively, the last check-up. Conclusion: the automation of the processes of identification, assessment and accounting of RF and other pathological conditions improves the quality of the clinical examination, reducing the likelihood of errors and the effect of subjective factors in evaluating the data.

Objective: to determine and compare the features of stress overcoming behavior in young patients with minor heart anomalies (MHA) of varying severity based on their gender. Using techniques E.Heim (building stress overcoming behavior differentiated according to spheres) and test S.Subbotin (stress) were examined in 145 healthy men and women (mean age - 22.16±2.42 years) with syndrome of connective tissue dysplasia of heart assessed by Doppler echocardiography was efficient. All observed individuals were divided into 2 groups: basic (n=83) with minimal manifestations of the syndrome of connective tissue dysplasia of heart and the comparison group (n=62) with MHA moderate severity. It is shown that in individuals with MHA moderate levels of stress resistance and adaptability in cognitive, emotional and behavioral spheres of the stress overcoming behavior significantly lower than for those who have symptoms of MHA was less pronounced irrespective of gender (p<0.05).

Goal. Explore a comprehensive approach in monitoring and drug monotherapy with the evaluation of its effectiveness and safety of the following antiarrhythmic drugs (AAD): IC class - propafenone, III class - sotalol and class IV - verapamil, compared with the control group without the AAD, for the prevention of recurrence of atrial fibrillation (AF) and atrial tachyarrhythmias in the postoperative catheter isolation of the mouths of the pulmonary veins (PV). Material and methods. PRMF study (Prevention of recurrence of atrial tachyarrhythmias in the postoperative catheter wellhead isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation) is a prospective, comparative, open, randomized with a control group. Included in the study of men and women aged 25 years and over who suffer from symptomatic paroxysmal AF without structural heart disease. 243 patients (after invasive treatment to achieve electrical isolation mouth LP, confirmed during the operation) were randomized by envelope into 4 groups and control group. No significant differences in baseline characteristics: age, sex, duration of AF, the basic or comorbidities, echocardiography parameters and concomitant therapy, there were no between-group. Patients were 365 days. Results. The following results were obtained in the PRMF study: in group 1 (verapamil) effectiveness after 1st surgery was 65.5% (n=40) in group 2 (propafenone) - 70.96% (n=44) in group 3 (sotalol) - 65% (n=39) and control group (no AAD) - 65% (n= 39), respectively. During 3 months of follow up in all groups was carried out by an average 11.52±10.905 cardioversions medication (n=243), an average of 0.839±1.44 electrical cardioversion and the average number of hospitalizations for 3 months follow-up was 0.654±0.74 cases. Conclusion. Antiarrhythmic therapy in the postoperative period of radiofrequency ablation (RFA), the mouth of the LP does not affect the outcome of invasive therapy and repeated surgical intervention. 22% of patients have clinical efficacy. From AAD study significantly influenced the clinical course of early postoperative period of RFA mouth LP - only propafenone, reducing the average number of electrical cardioversion, pharmacological cardioversions and the number of hospitalizations associated with recurrent arrhythmias. Sotalol significantly reduced the mean number of hospitalizations, without lowering medication and electrical cardioversion in the early postoperative period of invasive treatment of AF.

Designed is innovative approach for speech recovery in patients with aphasia. This approach is based on the current view on the course of disease and specific factors influencing rehabilitation of speech. Our methods have been tested in the clinic neurology for 10 years. The developed methods have enabled to improve rehabilitation efficiency of patients with aphasias.

The article discusses the pathogenetic relationship of neurological complications of the most common vascular diseases, as well as an assessment of the possibility of an early screening of the data and state drug prevention. Discussed in detail are the protective and therapeutic mechanism of action meldonium applied for this category of patients.

Respiratory failure is a frequent and relevant complication of many diseases of the respiratory system and the cardiovascular and nervous systems. Acute and chronic respiratory failure is one of the adverse factors, and usually indicates the limit of the forecast for life. The ability to recognize early signs of respiratory insufficiency allows preventive treatment of respiratory disorders. For the correct choice of treatment, it is important to know the basic mechanisms of respiratory nedostatochnosti.V article understands detailed pathogenesis of carbon dioxide metabolic disorders. A brief review of diagnostic methods hypercapnia and hypocapnia.

A review of literature on topical issues in the treatment of inflammatory bowel diseases, such as Crohn's disease. It is based on the results of randomized studies conducted in the last 10 years. Considered terms such as “escape effect” and its causes, the transition from one anticytokine drug to another with the ineffectiveness of the first and the presence of the answer to it.

Diabetic neuropathy (DPN) is the most common complication of diabetes mellitus (DM) and the most common form of all peripheral neuropathies in the world. All patients with diabetes, regardless of the presence or absence of specific complaints, it is necessary to carry out an annual screening for DPN. There are the typical and atypical DPN. The reference method for the study of nerve conduction is electroneuromyography, which helps to establish the cash flow in the early stages. With a view to the diagnosis of atypical lesion unmyelinated with DPN and weakly myelinated nerve fibers of small caliber used quantitative sensory testing temperature/pain sensitivity, skin biopsy study of thin fibers of corneal confocal microscopy. The pathogenetic treatment of DPN include α-lipoic acid, B vitamins (thiamine, cyanocobalamin, pyridoxine), gemoderivat; tricyclic antidepressants, serotonin reuptake inhibitors and noradrenaline or α-2-β-ligands: to alleviate neuropathic pain by use of adjuvant analgesics can be recommended. Vitamins B1, B6 and B12 constitute a group of so-called neurotropic vitamins to ensure the normal structure and function of nerve cells, preventing them from damage in diabetes. For the treatment of DPN used with good effect Neyromultivit which comprises a combination of essential vitamins in therapeutic dosages, namely 100 mg of thiamine hydrochloride (vitamin B1), pyridoxine hydrochloride 200 mg (vitamin B6) and 200 mg of cyanocobalamin (vitamin B12). When using Neyromultivita there is a restoration of sensitivity of different types of nerve fibers, as well as a decrease in symptoms.

Under panniculita the heterogeneous group of inflammatory diseases characterized by lesions of subcutaneous fat is understood. The variety of their forms and course options requires a careful examination of the patient for the purpose of verification of the diagnosis. The article presents a diagnostic algorithm, setting out the principles of differential diagnosis and treatment approaches to panniculita in modern rheumatology practice.

Новые данные обширной исследовательской программы и результаты исследований реальной клинической практики из разных стран вновь подтвердили высокую эффективность и благоприятный профиль безопасности ривароксабана (Ксарелто®) компании Bayer