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The article presents data on the state of cytokine regulation, indicators of endothelial damage when exposed to industrial vibration (general, local) and in combination with arterial hypertension.To improve the quality of early diagnosis and prevention of vibration disease in an isolated course and its combination with arterial hypertension based on a study of the cytokine profile, biomarkers of endothelial dysfunction in this pathology.A comprehensive survey of 84 patients with isolated vibration disease from the effects of local, general, first, second degree and 61 patients with a combined course of vibration disease from the effects of local, general second degree vibration and arterial hypertension, 30 people in the control group without contact with industrial vibration and found healthy by medical examination. The levels of pro-inflammatory (IL-1, IL-8, TNF-) and anti-inflammatory cytokines (IL-4), biomarkers of endothelial damage (EDN-1, TGF-1, VEGF-A, PDGF-BB, fibronectin, Willebrand factor) were determined using the enzyme immunoassay method.The response of the immune system to the effects of industrial vibration is characterized by a cytokine imbalance an increase in the level of pro-inflammatory cytokines (IL-1, IL-8, TNF-) and a decrease in the level of anti-inflammatory cytokine (IL-4). With a combined course of vibratory disease and arterial hypertension, the cytokine imbalance is characterized by an even more significant increase in serum IL-1, IL-8, TNF- and a decrease in serum IL-4 concentration. Endothelial dysfunction with WB from the action of both local and general vibration in combination with hypertension is characterized by a significant increase in serum EDN-1, TGF-1, VEGF-A, PDGF-BB, fibronectin, Willebrand factor.The study of the cytokine profile, biomarkers of damage to the vascular endothelium in this pathology will allow for the early diagnosis of vascular disorders and to optimize preventive measures for workers in vibration-hazardous industries.Обоснование. В статье представлены данные о состоянии цитокиновой регуляции, показателях эндотелиального повреждения при воздействии промышленной вибрации (локальной ЛВ, общей ОВ) и при наличии коморбидного течения артериальной гипертензии (АГ). Цель. Улучшить качество ранней диагностики и профилактики ВБ при изолированном течении и ее сочетании с АГ на основании изучения цитокинового профиля, биомаркеров эндотелиальной дисфункции при данной патологии. Материалы и методы. Проведено комплексное обследование 84 пациентов с изолированной ВБ, связанной с воздействием ЛВ, ОВ 1, 2-й степени, и 61 пациента с сочетанным течением ВБ, связанной с воздействием ЛВ, ОВ 2-й степени и АГ, 30 человек контрольной группы, не имеющих контакта с промышленной вибрацией и признанных здоровыми по данным медицинского осмотра. Определены уровни провоспалительных (интерлейкина ИЛ-1, ИЛ-8, фактора некроза опухоли ФНО-) и противовоспалительных цитокинов (ИЛ-4), биомаркеров эндотелиального повреждения (эндотелина-1, трансформирующего фактора роста 1, фактора роста эндотелия А, тромбоцитарного фактора роста ВВ, фибронектина, фактора Виллебранда) с помощью иммуноферментного метода. Результаты. Реакция иммунной системы на воздействие производственной вибрации характеризуется цитокиновым дисбалансом повышением уровня провоспалительных цитокинов (ИЛ-1, ИЛ-8, ФНО-) и снижением уровня противовоспалительного цитокина (ИЛ-4). При сочетанном течении ВБ и АГ цитокиновый дисбаланс характеризуется еще более значимым повышением сывороточной концентрации ИЛ-1, ИЛ-8, ФНО- и снижением сывороточной концентрации ИЛ-4. Эндотелиальная дисфункция при ВБ, связанной с воздействием как ЛВ, так и ОВ, при наличии коморбидного течения АГ характеризуется достоверным повышением содержания в сыворотке крови эндотелина-1, трансформирующего фактора роста 1, фактора роста эндотелия А, тромбоцитарного фактора роста ВВ, фибронектина, фактора Виллебранда. Заключение. Изучение цитокинового профиля, биомаркеров повреждения сосудистого эндотелия при данной патологии позволит проводить раннюю диагностику сосудистых нарушений и оптимизировать профилактические мероприятия у работников виброопасных производств.

Background. Exposure to physical and chemical work-related hazards can lead to an impairment of reproductive function, gynecological diseases and a pregnancy course worsening. Aim to determine methods of prevention and treatment of occupational disorders of the reproductive system in women and men who deals with harmful labour conditions. Outcomes and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. Evaluation of a relationship and its degree between a reproductive system diseases and workplace conditions showed that women working in harmful conditions (class 3.1-3.3) had complications of pregnancy and childbirth disorders which were to a high or medium degree related to their labour conditions. Newborns’ health disorders were assessed as a category of very high degree relationships with the mother’s work. Thus the fact that maternal occupational risks induce a child’s health disorders can be considered as fundamentally proven. This study data showed that occupations of high risk of a reproductive health disorders include female workers who work in conditions of class 3 of the 2nd degree of harm. Conclusions. Obstetrician-gynecologists, occupational physicians who work as part of medical commissions for preliminary and periodic medical examinations as well as obstetrician-gynecologists who deals with women of reproductive age in women’s consultation clinic and reproductive health centers (including those planning childbearing) need to make decisions strictly according to legal and regulatory acts on health protection of employees who work under arduous and harmful labour conditions, and above all to consider on maintenance of their reproductive function.

The article is devoted to the actual problem - dust diseases of the lungs. The peculiarities of occurrence and course of pulmonary lesions that have a significant place in the overall structure of occupational morbidity are considered. Modern approaches to treatment, diagnostics and prevention issues in pneumoconiosis are discussed.

The article analyzes the publications devoted to the problem of professional renal lesions caused by chemical factors. Classification, prevalence, peculiarities of the clinical picture, diagnosis of professional renal lesions caused by chemical factors of the production environment are reviewed. The frequency of professional renal lesions remains underestimated due to low manifestation of symptoms and the influence of environmental factors, which require further investigation of this issue.В статье проведен анализ публикаций, посвященных проблеме профессиональных поражений почек от воздействия химических факторов. Рассмотрены классификация, распространенность, особенности клинической картины, диагностики профессиональных поражений почек от химических факторов производственной среды. Частота профессиональных поражений почек остается недооцененной в связи с их скрытым клиническим течением и влиянием факторов внешней среды, что требует дальнейшего изучения данного вопроса.

Osteoarthritis is a common pathology, which indicates the great medical and social significance of this disease. The article discusses the issues of pathogenesis, risk factors and diagnosis of professional and professionally caused osteoarthritis: the age of onset of the disease, the specifics of work, the localization of joint damage. Differential diagnosis issues are discussed.Остеоартрит является общепопуляционной патологией, что свидетельствует о большой медицинской и социальной значимости этого заболевания. В статье рассматриваются вопросы патогенеза, факторов риска и диагностики профессионального и профессионально обусловленного остеоартрита: возраст начала заболевания, специфика трудовой деятельности, локализация поражения суставов. Обсуждаются вопросы дифференциальной диагностики.

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

Aims - to analyze the historical aspects of the formation of the national normative framework in the field of primary and periodic medical examinations, to discuss the existing problems in the carrying out of primary and periodic medical examinations of workers and also to make suggestions for quality improvement of primary and periodic medical examinations and for introduction of occupational risk assessment into the practice of primary and periodic medical examinations. Conclusion. For quality improvement of primary and periodic medical examinations, for efficiency improvement of primary and secondary prevention of occupational diseases it is considered to be necessary to take the following suggestions: - fuller coverage of working people by periodic medical examinations; - thorough selection of organizations that perform the special assessment of working conditions; - the use of the results of the special assessment of working conditions for improving working conditions and informing workers about working conditions; - implementation of occupational risk assessment into practice of primary and periodic medical examinations; - the use of modern methods of molecular and genetic screening

The right drug at the right dose administered to a patient in time is the goal which all medical specialists aim at when prescribing medicines to patients. Pregnancy is a condition when the principle of personalized pharmacotherapy is especially relevant. Due to the developing fetus and the occurring changes in the maternal organism, the selection of drug therapy during pregnancy is especially difficult for a clinician. This issue is tightly intertwined with clinical pharmacogenetics since the genetic code of a woman that determines the activity of the liver cytochrome, the fetus-placental barrier, and renal clearance contributes to the peculiarities of the drug metabolism during pregnancy. Additional data provides the opportunities to form therapeutic models and to determine the ways of personifying pharmacotherapy in pregnancy. The purpose of this review is to summarize the available data on the pharmacogenetics of antihypertensive drugs used during pregnancy.

Cardiac sarcoidosis is of predictive value, but its diagnostics is difficult in view of the lack of pathognomonic clinical signs and the high frequency of cases with subclinical course. In this article, we present an algorithm of clinical examination and treatment strategy using combined immunosuppressive therapy of cardiac sarcoidosis in a young women whose only symptom was frequent premature ventricular beats. In this clinical case cardiac sarcoidosis was diagnosed practically at the onset of the disease and the use of massive immunosuppressive therapy allowed to reach considerable positive dynamics even before development of irreversible changes both in myocardium and lungs.

Investigation's history and nomenclature's evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world's literature is cited.

Heart injury is one of the extrahepatic manifestations of chronic hepatitis C (CHC). The paper gives Russian and foreign authors' data on a relationship between CHC and myocardial injury. It discusses different pathogenetic components (the direct effect of the virus, immunological components), through which hepatitis C virus can induce myocarditis and cardiomyopathies in patients with CHC.Поражение сердца - одно из внепеченочных проявлений хронического гепатита С (ХГС). Представлены данные отечественных и зарубежных авторов о взаимосвязи ХГС и поражения миокарда. Обсуждаются различные патогенетические звенья (прямое воздействие вируса, иммунологические), через которые вирус гепатита С может индуцировать развитие миокардита и кардиомиопатий у больных ХГС.

The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immunosuppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

The paper describes clinical cases in 2 patients (brothers) with giant cell arteritis. It analyzes the genetic and epigenetic aspects of the disease. The data available in the Russian and foreign literature are given.Представлены клинические наблюдения 2 больных (родные братья) с гигантоклеточным артериитом. Анализируются генетические и эпигенетические аспекты заболевания. Приводятся данные отечественной и зарубежной литературы.

The paper gives Russian and foreign authors' data on a relationship between occupational factors and cardiovascular diseases. It considers the impact of psychosocial stress on the risk of hypertension, coronary heart disease, and cardiovascular events in representatives of different professional groups.Представлены данные отечественных и зарубежных авторов о взаимосвязи профессиональных факторов и сердечно-сосудистых заболеваний. Рассматривается влияние психосоциального стресса на риск развития артериальной гипертонии, ишемической болезни сердца, сердечно-сосудистых осложнений у представителей различных профессиональных групп.

Objective: to study the incidence rates of angina, myocardial infarction (MI), stroke, and the frequency of endovascular interventions in patients with systemic vasculitides, and the incidence rate of atherosclerosis according to autopsy data. Subjects and methods. Three hundred and twenty-one patients with systemic vasculitides: Wegener's granulomatosis (n = 138), Takayasu's arteritis (n = 79), polyarteritis nodosum (n = 55), and Churg-Strauss syndrome (n = 49) were examined; 55 autopsies were analyzed in patients with the above diseases. Results. Fifty-one (15.6%) of the 321 patients were diagnosed as having cardiovascular diseases (CVD): angina pectoris (7.1%) and MI (3.1%) and endovascular interventions (0.9%). The risk of cardiovascular events was found to be associated with traditional risk factors, such as male gender and age. Arterial hypertension, hypercholesterolaemia, and increased serum creatinine were more frequently detected in the CVD group that showed no significant differences from the non-CVD group. According to autopsy results, atherosclerosis was identified in the patients with Wegener's granulomatosis (52%), Takayasu's arteritis (50%), polyarteritis nodosum (52.6%), and Churg-Strauss syndrome (57.1%). Conclusion. CVD and atherosclerosis are common in systemic vasculitides, which requires the traditional risk factors of atherosclerosis to be actively corrected.

Infective endocarditis (IE) may be accompanied by the production of a broad spectrum of autoantibodies, including antineutrophil cytoplasmic antibodies (ANCA). ANCA detection creates difficulties in the differential diagnosis of IE, especially in relation to kidney injury, the determination of the mechanism of which is important for choosing a treatment policy and estimating a prognosis. The paper describes a clinical case of a 57-year-old man who was found to have higher proteinase-3 (PR-3) ANCA titers along with the symptoms of anemia, purpura, and kidney injury during his hospitalization; echocardiography revealed vegetation on the aortic valve. IE was diagnosed; 2-week antibiotic therapy was ineffective; there was progressive aortic insufficiency necessitating aortic valve replacement. In the postoperative period, there was progression of renal failure and higher PR-3 ANCA titers, which made it possible to regard kidney injury as a manifestation of ANCA-associated glomerulonephritis. Intensive immunosuppressive therapy with intravenous and oral prednisolone was initiated, which showed positive effects in reducing proteinuria, erythrocyturia, serum creatinine levels, and simultaneously PR-3 ANCA titers. The paper gives the data available in the literature on the frequency of an association of IE with ANCA, the clinical features, diagnostic criteria, and treatment approaches. It discusses the mechanisms of ANCA formation in patients with IE.

In a population-base study published in the Annals of Rheumatic Disease , Avina-Zubieta et al 1 showed that there is almost 2.5-fold increase in risk of venous thromboembolism (VTE) in patients with giant cell arteritis (GCA) compared with that in the general population. Higher incidence of VTE is apparently not unique for GCA as a similar increase in risk of deep vein thrombosis (DVT) and pulmonary embolism was recently found in a meta-analysis of studies in patients with different inflammatory rheumatic diseases.2 We detected only two cases of venous thrombosis (orbital and retinal veins) in our series of 76 patients with GCA, though at least two-thirds of them have been followed for 2 years. At the same time, there were 30 cases of …