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Relevance. Pentanedioic acid imidazolyl ethanamide (PAIE) has been used clinically as an antiviral agent for a long time, however, there is no information in the available literature concerning the dependence of PAIE pharmacokinetics on isoenzymes polymorphism of the cytochrome P450 system (CYP), as well as on the variability of pharmacokinetic parameters in humans. The aim of the study is to determine the main pharmacokinetic parameters of PAIE in healthy volunteers and to assess the contribution of polymorphism of CYP P450 isoenzymes to the variability of pharmacokinetic parameters.Material and methods. The study included 12 healthy volunteers (5 men and 7 women) of the Caucasian race, who took In[1]gavirin® at a dose of 180 mg (2 capsules of 90 mg) on an empty stomach during two dosing periods, separated by a 7-day washout period. Determination of PAIE concentration in blood plasma and urine samples was carried out by high-performance liquid chromatography–mass spectrometry. Polymorphism of CYP genes was analyzed using the polymerase chain re[1]action method in order to analyze the pharmacogenetic features of PAIE metabolism in volunteers during the study.Results. After oral administration, PAIE quickly reached the systemic circulation: the maximum concentration of 578.88±145.21 ng/ml was observed after about 2 hours. Pharmacokinetic parameters of PAIE did not show high intraindividual variability and did not depend on polymorphism of isoenzymes CYP1A1, CYP2C9, and CYP2D6. Within 48 hours after the administration of the studied drug, about half of the taken dose of PAIE was excreted in the urine unchanged, which indicates a significant contribution of the kidneys to the elimination of PAIE. The only adverse event registered in 1 volunteer was a clinically insignificant decrease in the level of leukocytes, which did not require medical intervention and was resolved without consequences.Conclusion. PAIE is characterized by predictable pharmacokinetics, low intraindividual variability of pharmacokinetic parameters, and a favorable safety profile.

Netakimab (NTK) is a humanized monoclonal antibody targeting interleukin-17A.Objective. The main objective of BCD-085-5/ASTERA study was to prove superiority of NTK over placebo and assess its’ safety in patients with active AS.Subjects and methods. BCD-085-5/ASTERA was a double-blind, multicenter, randomized, placebo-controlled, phase III study, which included 228 adult patients with active AS, persisting despite active treatment with NSAIDs. AS was considered active at BASDAI score ≥ 4.0. Patients were blindly randomized (1:1) to receive subcutaneous injections of NTK (120 mg) or placebo at weeks 0, 1, 2 and then every other week up to week 14. Starting from week 16 all patients from NTK group and patients from placebo group not achieving ASAS20 were switched to open label 120 mg NTK s/c once every two weeks. The total duration of treatment with NTK was 3 years.Results. Higher proportion of patients had ASAS40 response at week 16 (primary endpoint) in NTK arm compared to placebo (40,4 vs 2,6%, р Conclusion. Subcutaneous NTK at 120 mg dose demonstrated superior efficacy vs placebo, with fast onset of response and favorable safety profile when used in patients with ankylosing spondylitis.

The paper presents the results of a double-blind (BCD-085-3/AILAS) phase II clinical trial of the original interleukin 17A (IL17A) inhibitor BCD-085 prescribed at different doses to patients with active ankylosing spondylitis (AS) and those of an extended (BCD-085-3ext/AILAS-II) trial characterizing the efficacy and safety of this drug when used for a year. The objective of the AILAS study is to determine the therapeutically effective and safe dose of BCD-085 in the treatment of active AS. The efficacy, safety, and immunogenicity of BCD-085 during its annual use were additionally evaluated in the extended trial. Subjects and methods . The investigation enrolled 89 patients diagnosed as having active (BASDAI scores >4.0; mean spinal pain scores >4.0) AS that met the 1984 New York classification criteria. After the end of the screening period, the patients were randomized at a ratio of 1:1:1:1 in one of four groups that received 40; 80 or 120 mg of BCD-085 subcutaneously or placebo on day 1 of weeks 0, 1, 2 and then once every two weeks up to week 12. The primary end point was the number of patients who achieved an ASAS20 response at week 16. The investigation evaluated the safety of the drug, by calculating the total incidence of adverse events (AEs) and serious AEs (SAEs) and the number of cases of premature therapy termination because of AEs. Results and discussion . An ASAS20 response at week 16 was achieved in 72.7% of patients receiving 40 mg of BCD-085, in 81.8% of those receiving 80 mg, in 90.9% of those receiving 120 mg, and in 42.9% of cases in the placebo group (p=0.004). The superiority of BCD-085 over placebo was proven for 80- and 120-mg doses. The fastest and most pronounced effect was observed in patients treated with 120 mg of BCD-085. In the extended study, an ASAS20 response at week 52 was recorded in 86.4% of patients. One or more AEs during the first 16 weeks of therapy were reported in 11 (50.0%) patients of the 40-mg group; in 6 (27.3%) of the 80 mg group; in 4 (18.2%) of the 120 mg group and in 7 (31.8%) of the placebo group (p=0.183). The frequency and spectrum of AEs did not significantly differ in patients who received placebo and BCD-085 in different doses. No SAE was recorded. Conclusion. Phase II study yielded data demonstrating the high efficacy and good tolerance of BCD-085 in the treatment of active AS. The best effect and optimal tolerance were demonstrated for a dose of 120 mg.

In opinion the Expert council provides management tactics for patients with hypertriglyceridemia (HTG). It is demonstrated that HTG is a common condition in overweight patients and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, so the level of triglycerides (TG) is recommended to be measured in patients with a high, very high and extremely high risk level. An indication for the appointment of drugs that reduce the concentration of TG is its level of more than 2,3 mmol/L. Statins are the agents of choice to reduce the risk of cardiovascular disease in high-risk patients with hypercholesterolemia and HTG. Fenofibrate is used to correct HTG, and in case of intolerance to it or when the target level of TG is not reached, omega-3 ethers of polyunsaturated fatty acids in a dose of 2-4 g/day are recommended. In patients with HTG with a TG level >5,6 mmol/L, fenofibrate is the agent of choice.

Aim.To study the diagnostic characteristics of the rapid test for qualitative simultaneous determination of cardiac fatty acid-binding protein (FABPs) and cardiac troponin I (cTnI) CARD-INFO 1+1 in patients with acute coronary syndrome (ACS).Material and methods.The study included 168 patients undergoing inpatient treatment after ACS, with typical anginal pain lasting at least 20 minutes occurred in the previous 1-24 hours. In addition to routine diagnostic procedures, on admission, we determined FABPs and cTnI concentrations using the high-quality immunochromatographic rapid test CARD-INFO 1 1 (OOO CARDIO-Plus, Russia).Results.The sensitivity of the CARD-INFO 1+1 rapid test was 88,1%, specificity — 89,8%, diagnostic accuracy — 88,7%. The indicators of the diagnostic effectiveness of CARD-INFO 1+1 test in patients with STE-ACS and NSTE-ACS did not significantly differ (p>0,05). The sensitivity of the rapid test reached a maximum in the period from 3 to 6 hours from the onset of pain. Compared with the determination of cTnI performed on admission to the hospital, a higher sensitivity of the CARD-INFO 1+1 test was revealed in patients with STE-ACS (87,7% vs 75,3%; p=0,044), in the first 1-3 hours after the beginning of clinical manifestations (86,8% vs 60,5%; p=0,041) and in the entire sample as a whole (88,1% vs 77,1%; p=0,033), with comparable specificity (89,8% and 93,2%, respectively; p=0,741).Conclusion.Qualitative immunochromatographic CARD-INFO 1+1 rapid test for the simultaneous determination of the content of FABPs and cTnI I is highly effective in the diagnosis of various forms of ACS. The highest diagnostic characteristics of the test were observed in patients in the early stages of the disease (the first 1-6 hours after the onset of pain). Carrying out the CARD-INFO 1+1 test revealed 12 MI cases more (11%) than the first determination of cTnI. Further studies will clarify the place of this technique in the modern algorithm for the management of patients with ACS and evaluate the possibility of using the rapid test in predicting the course of the disease.

History of heart transplantation in combination with immunosuppressive therapy and acute viral respiratory infection overlay makes the patient difficult to manage. In case of COVID-19, the setting is complicated by unknown pathogenesis, including its effect on blood, coagulation system, and lung tissue. Current case report discusses the 60-year-old patient with a COVID-19 infection occurred in the immediate postoperative period after heart transplantation.

Aim.To evaluate diagnostic properties of qualitative tests for cardiac fraction of the fatty acid binding protein (cFABP) in patients hospitalized with suspected acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) level.Material and methods.Totally, 465 patients included, admitted with ACS within 24 hours from onset. All patients underwent cFABP test with immune chromatographic express tests “CardioFABP” (Novosibirsk, Russia) and/or “CARD-INFO” (Obninsk, Russia), as the levels of serum creatinine with further GFR calculation. Assessment of diagnostic characteristics was done by the values of specificity, sensitivity, and diagnostic correctness, as well as overall positive and negative test results according to GFR.Results.The analysis did not reveal significant difference in the number of positive and negative results of cFABP with the “CARD-INFO” (χ2=6,822, р=0,146), “CardioFABP” 10 ng/mL (χ2=4,968, р=0,291) and “CardioFABP” 15 ng/mL (χ2=8,673, р=0,07) in comparison by GFR. With coupled comparison, in the groups of patients by GFR there were differences in specificity for “CARD-INFO” (Fischer criteria =0,017, р˂0,05) and precision for “CardioFABP” (10 ng/mL) (χ2=5,793, р=0,017) in patients by GFR levels 60-90 and 30-59 mL/min/1,73 m2. For the other parameters of diagnostical efficacy there were no differences by GFR. In severe renal dysfunction (GFR ˂15 mL/min/1,73 m2) results of qualitative cFABP were false positive in 10 cases among 11 (90,9%).Conclusion.In patients hospitalized for suspected ACS, the results and diagnostic characteristics of the express-tests for cFABP “CARD-INFO” and “CardioFABP” depended mildly on GFR level with its values ≥15 mL/min/1,73 m2. Low number of patients with GFR ˂15 mL/min/1,73 m2made not possible to acquire significant data on cFABP in this category of patients, however the data available make it not to apply the test in this category of patients.

The paper gives data on the clinical efficiency and safety profile of long-term use of the infliximab (INF) biosimilar BCD-055 versus the reference drug Remicade® (REM) in a population of patients with active ankylosing spondylitis (AS).Subjects and methods. An international multicenter randomized double-blind Phase III clinical trial was conducted in 199 patients who were randomized into two groups in a 2:1 ratio and who received BCD-055 or REM at a dose of 5 mg/kg at 0, 2, and 6 weeks, then every 8 weeks. Efficiency assessment was made at 14, 30 and 54 weeks in patients who received at least one dose of INF [intent-to-treat (ITT)], as well as at 54 weeks in those who completed the study according to the Protocol (PP) (per protocol). The efficiency endpoints were the proportion of patients who had achieved ASAS20/ASAS40 responses; changes in BASDAI, BASMI, BASFI, MASES, and SF-36 scores. Immunogenicity was assessed by the proportion of patients in each group with identified binding and neutralizing antibodies (BAbs and NAbs) against INF. The safety analysis included the overall rate of adverse events (AEs), including those that met the respective criteria for serous AEs (SAEs), and grade 3–4 toxicity, as well as the number of cases of early termination of the study because of AEs and SAEs.Results and discussion. The ITT population included 199 patients and the PP one consisted of 161 people. The groups were not statistically different in the rate of and reasons for patient withdrawal from the study. A comparable number of patients achieved ASAS20/ASAS40 responses at 14, 30, 54 weeks (р ≥ 0.05). At 54 week, the proportion of patients who received BCD-055 and REM therapy and achieved an ASAS20 response was 67.42 and 52.24% in the ITT population (p = 0.053) and 80.91 and 68.63% in the PP population (p = 0.128). The BCD-055 and drug comparison groups achieved an ASAS40 response in 53.03 and 38.81% in the ITT population (p = 0.081) and in 63.64 and 50.98% in the PP one (p = 0.177). The proportion of persons with identified BAbs and NAbs was comparable: 21.26 and 3.15% in the BCD-055 group (p = 0.920) and 20.63 and 6.35% in the group REM (p = 0.443), respectively. It was found that the presence of NAbs did not affect the therapeutic response. Both groups did not differ in the detection rate and profile of AEs and SAEs or in the rate of patient withdrawal due to AEs. Most identified AEs were mild to moderate.Conclusion. The efficacy of the INF biosimilar BCD-055 used long in patients with AS did not significantly differ from that of the original drug REM; the safety profile of both drugs was comparable.

The article is on a clinical case of malignant arterial hypertension in predominant kidney damage in a young man with disease anamnesis lasting 17 years. Recent data on the disorder provided, aspects of its management complexity that do make to regard the problem far from solution.

In the clinical case, an individual approach is demonstrated to management of mechanical aortic valve thrombosis. The specifics of the case is in 12­13 weeks pregnancy of the patient, in aggressive antithrombotic therapy, absence of hemorrhagic complications and complications of the fetus.

The review presents recent studies demonstrating somatic shifts in psychological processes regarded as the risk factors for myocardial infarction: depression, stress, anxiety. Based upon a metaphorical term “a perfect storm”, inflammatory, immunological, neuro-humoral predisposing factors are presented, important for myocardial infarction development, as such shifts themselves, which are the somatic substrate for psychological states mediating myocardial infarction development through behavioral and biological risk factors: “sickness behavior”, “depression illness”. Both directions complete a vicious circle of psychosomatic changes. The emphasis is set on the importance of individual approach to rehabilitation and secondary prevention of myocardial infarction, as, from biopsychosocial point of view, the bottom-up and top-down psychosomatic links are unique for any patient.

Aim. To assess the specifics of psychoemotional state of adult patients with non ST elevation acute coronary syndrome (NSTEACS) in 6 months post hospitalization.Material and methods. Totally, 101 patient included, with non-obstructive lesion of coronary flow. Groups were formed by gender: group 1 — 51 females, group 2 — 50 males. Mean age: women 50,5±4,7 y. o., men 46,7±6,8 y. o. Patients were also selected to subgroups by NSTEACS type: subgroup A — unstable angina (UA), subgroup B — myocardial infarction. Patients were questionned by phone in 6 months after discharge. The questionnaire included key points about health, emotional balance, physical activity and life quality.Results. There are gender differences in life quality constituents between men and women. In questions on general health state 6% of women replied that are not satisfied with their health, in men — 2%; satisfactorily graded their health state 27% of women and 38% of men, good — 47% and 46%, excellent — 20% and 14%, respectively. Pre-morbid physical activity at work was saved in 45% of men and 32% of women; active life style retained 47% of women and 42% of men. Men more often felt hopelessness (43% and 12%; p0,05) and were unsatisfied with their psychological state (31% and 6%; p0,05), however men noted loss of interest to former habits (13% и 22%; р>0,05). The specifics in subtypes of NSTEACS was also noted.Conclusion. Regardless an individuality of the meanings of life quality, experiences, coping, there is gender specifics, as specifics in NSTEACS subtype. The specifics can be included as a part of patient-centered work with post-ACS patients.

The Russian biotechnological company «BIOCAD» has designed a chimeric monoclonal antibody against CD20 (BCD-020, Acellbia®) that is a biosimilar of rituximab (RTM; MabThera®, F. Hoffmann-La Roche Ltd., Switzerland). In recent years, there has been evidence that RTM can be used at lower doses than those given in the standard recommendations and instructions for the use of this drug. This serves as the basis for the BCD-020-4/ALTERRA (ALTErnative Rituximab regimen in Rheumatoid Arthritis) trial, the objective of which was to investigate the efficiency and safety of using Acellbia® (at a dose of 600 mg twice at a 2-week interval) as the first biological agent (BA) for methotrexate (MTX)-resistant active rheumatoid arthritis (RA). The investigation enrolled 159 patients aged 18 to 80 years with active RA. After 24 weeks 65.7 and 29.4% of patients achieved 20% improvement by the American College of Rheumatology (ACR) criteria in the Acellbia® + MTX and placebo (PL) + MTX groups, respectively (p

Aim. To investigate on the clinical, anamnestic and laboratory-instrumental predictors of short term outcomes development in pulmonary thromboembolism (PTE). Material and methods. To the study, 136 patients included with the high and intermediate risk PTE confirmed by multispiral computed tomography. The endpoints were obstructive shock, fatal relapse, fatal outcome, necessity of resuscitation, urgent thrombolysis and hemodynamic support. Follow-up lasted for 30 days. Patients were selected to groups of complicated (n=44) and noncomplicated (n=92) course. Results. The predictors of adverse course of PTE were chronic heart failure of II stage (p=0,02), diabetes type 2 (p=000001), atrial fibrillation (p=0,001), permanent risk factor for PTE (p=0,002), syncope (p=0,02), positive test for the fatty acid binding cardiac protein (cFABP) (p=0,00001), troponin I positive test (p=0,02), heart rate ≥110 bpm (p=0,002), systolic BP ≤100 mmHg (p=0,00001), creatinine clearance ≤70 mL/min (p=0,0008). By the method of logistic regression a combination selected showing most predictive power, that includes heart rate ≥110 bpm, BP ≤100 mmHg, positive cFABP and diabetes. Upon the logistic regression coefficients the prediction score was formulated, named ROCky (Risk of Complications) that includes heart rate ≥110 bpm (1,5 points), BP ≤100 mmHg (2,5 pts), positive cFABP test (2 pts), diabetes type 2 (2,5 pts). The threshold estimated for prediction of combination endpoint ≥2,5 (Se 84%, Sp 75%), obstructive shock ≥3,5 (Se 83%, Sp 83%) and fatal outcome within 30 days ≥4,5 (Se 79%, Sp 82%). Combination of ≥2,5 points by ROCky and presence of echocardiographical signs of the right ventricle dysfunction showed more efficacy than the algorithm of European Society of Cardiology (2014) in the studied population of hemodynamically stable patients, for the obstructive shock, fatal relapse of PTE, fatal outcome and combination endpoint. Conclusion. The ROCky scale has demonstrated high efficacy in prediction of complications among hemodynamically stable patients and can be recommended for further investigation and implementation into clinical practice.

Aim. Life quality is an integral parameter of medical care efficacy. In incomplete revascularization after myocardial infarction the quality of life might change in relevance with the severity of residual lesion. The study is done with an aim to reveal the specifics of patients life quality in such clinical situation. Material and methods. The investigation of 100 patients is done (mean age 63±0,9 y.o.) with acute ST-elevation myocardial infarction and incomplete revascularization, of those 20 underwent delayed surgery (percutaneous or bypass) — group 1; 54 had no further surgery (group 2); and 26 did not have primary revascularization — group 3. Life quality was assessed with the Medical Outcomes SF-36. The test was performed in 12 months after index event. Results. Life quality of group 1 patients changes significantly after revascularization towards improvement of physical and psychological health components. Life quality parameters in the group 1 remain high, about a “full” health. In group 2 and 3 patients there is restriction of social contacts, decrease of communicating due to worse physical and emotional conditions. Conclusion. After delayed revascularization, comparing to its absence or intervention only on infarct-related artery, the parameters of life quality post-MI are significantly better.

The study is one of the priority points of the Russian Scientific Medical Society of Internal Medicine, initiated due to known high average level of LDL cholesterol in Russian population and necessity for its optimized control by better access to treatment. AIM To conduct comparative analysis of efficacy and safety of the rosuvastatin compound akorta and original rosuvastatin crestor. MATERIAL AND METHODS To randomized crossover study (PARITET) 60 patients were included with the diagnosis dyslipidemia. Total duration of treatment phase was 14 weeks - two times by 7 weeks, when the drugs were crossed, separated by 4 weeks washout. Main endpoints were the rate of low density lipoprotein cholesterol (LDL-C) decrease comparing to baseline, and reach of LDL-C guidelines-based target level. RESULTS After the first 7-week treatment the rate of decrease in akorta group was 49.0+/-15.6%, in crestor 52.6+/-17.4% (p=0.606). After the second period, in respective groups prescription of crestor led to LDL-C decrease by 43.4+/-17.9%, akorta - by 47.2+/-16.3% (p=0.724). After the first period of treatment the value of target levels reach did not differ significantly (akorta - 70.0%, crestor - 83.3%; p>0.05). After the second period in the group crestor-akorta the value was significantly better than in akorta-crestor group (60.0% and 83.3%; p

Purpose to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. Materials and methods We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. Results Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. Conclusion We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

The article focuses on the comparative analysis of tactics of the rational complete and incomplete revascularizations in patients with ST elevation myocardial infarction and angina, underwent multivessel stenting and coronary bypass grafting. Patients with diffuse atherosclerotic lesion of coronary arteries are one of the most strenuous kinds of patients. The demand for revascularization of high in this group and, by the data of several authors, is up to 70% among all surgeries. This origins from the changes in demographics (population ageing) as the manifest of ischemic disease in younger age that further presents with the worse morphological substrate. The problem of optimal tactics choice (coronary bypass, endovascular revascularization, conservative strategy) of diffuse coronary atherosclerosis is still of the main topics in discussion and controversy in science.

The article focuses on new data on trimetazidine MB cytoprotection studies. The data provided on novel mechanisms of its effect including systemic action not related to myocardium. The results of epidemiological studies and meta-analysis are provided that confirm safety and efficacy of the medication in ischemic heart disease and chronic heart failure.

Coronavirus is an infection that affects not only the human immune and respiratory systems COVID-19 has similar symptoms to that of acute respiratory infections and influenza, with complications of a new coronavirus infection affecting the heart, kidneys and other internal organs Patients with chronic kidney disease (CKD) belong to the group of particularly high risk of COVID-19 infection and high lethality in the development of the disease This is due to the fact that the cause of CKD is the main population diseases (diabetes mellitus, hypertension, obesity, atherosclerosis), as well as old age, which themselves contribute to high morbidity and mortality from COVID-19 Objective To evaluate the frequency of development of renal function disorders and their semiotics in patients with COVID-19, complicated by pneumonia, who were hospitalized in the Moscow multidisciplinary hospital for diagnosis and treatment, as well as their pre-morbid background, the frequency of chronic pathology of the urinary system and disorders of carbohydrate metabolism and diabetes Material and methods The data were analyzed from 206 patients (82 men and 124 women) aged 26 to 97 years (average age 56 8±6 1 years) undergoing treatment in the 3rd department of Clinical Hospital No 15 named after O M Filatov 197 patients were discharged from the hospital, 6 patients died CKD classifications were used from 2006 and 2013 years for division of patients into groups There were 2 groups of patients of different ages: the 1st group - 78 patients (31 men, 47 women) aged 26-60 years (average age 48 6 years);the 2nd group - 128 patients (51 men, 77 women) aged 61-97 years (average age 74 2 years) The kidney ultrasound was performed on a Lojik-400 ultrasound scanner («General Electric», USA) In total, kidney ultrasound was carried out on 26 patients The glomerular filtration rate (GFR) was calculated using the Cockroft-Golt formula, taking into account the level of creatinine concentration in blood serum, age and sex of the patient The concentration of creatinine in the blood serum was determined by the method of O Shyuk with sodium picrate on a spectrophotometer Getpremier (USA) Results GFR was on average 23 7% higher (p0 1, unreliable) The frequency of detection of urinary syndrome by the level of proteinuria, leukocyte, erythrocyte, cylindruria and the sign of bacteriuria in both groups of patients with COVID-19 and pneumonia was high - within 37-44% Results 1 Possible signs of acute renal injury and pathological urinary syndrome were identified in more than 20% of patients 2 The average level of urea concentration in the blood serum in patients with COVID-19 in the age group over 60 years old significantly and reliably exceeded the values in the group of younger patients, which may be a sign of the development of an inflammatory process in the lungs with more pronounced intoxication, including due to more severe impairment of renal function of nitrogen excretion 3 The incidence of stage III-IV CKD in the group of older patients with COVID-19 exceeds this indicator in the group of younger patients by 4 times The most significant reason for the development of stage III-IV CKD, apparently, is arterial hypertension, 2 7 times more often diagnosed in patients over the age of 60 years Коронавирус является инфекцией, которая поражает не только иммунную и дыхательную систему человека COVID-19 имеет схожую симптоматику с ОРВИ и гриппом, при этом осложнения новой коронавирусной инфекции касаются функционирования сердца, почек и других внутренних органов Пациенты с хронической болезнью почек (ХБП) принадлежат к группе особо высокого риска заражения COVID-19 и высокой летальности при развитии заболевания Это связано с тем, что причиной ХБП являются основные популяционные болезни (сахарный диабет, гипертензия, ожирение, атеросклероз), а также пожилой возраст, которые сами способствуют высокой заболеваемости и смертности от COVID-19 Цель исследования Оценить частоту развития нарушений почечной функции и их семиотику у больных COVID-19, осложненным пневмонией, которые были госпитализированы в московский многопрофильный стационар для диагностики и лечения, а также их преморбидный фон, частоту наличия хронической патологии мочевыводящей системы и нарушений углеводного обмена и сахарного диабета Материал и методы Проанализированы данные 206 больных (82 мужчин и 124 женщин) в возрасте от 26 до 97 лет (средний возраст 56,8±6,1 года), проходивших лечение в 3-м отделении ГКБ №15 им О М Филатова Из стационара были выписаны 197 пациентов, 6 больных скончались Для разделения больных на группы использовали классификации ХБП 2006 и 2013 гг Были выделены две группы пациентов разного возраста: 1-я группа - 78 больных (31 мужчина, 47 женщин) в возрасте 26-60 лет (средний возраст 48,6 года);2-я - 128 больных (51 мужчина, 77 женщин) в возрасте 61-97 лет (средний возраст 74,2 года) Ультразвуковое исследование (УЗИ) почек выполняли на ультразвуковом сканере Lojik-400 (GeneralElectric, США) Всего УЗИ почек было проведено у 26 больных Скорость клубочковой фильтрации (СКФ) рассчитывали по формуле Кокрофта-Голта, с учетом уровня концентрации креатинина в сыворотке крови, возраста и пола больного Концентрацию креатинина в сыворотке крови определяли по методике О Шюк с пикратом натрия на спектрофотометре Getpremier (США) Результаты СКФ была в среднем на 23,7% выше (p0,1, недостоверно) Частота выявления мочевого синдрома по уровню протеинурии, лейкоцит-, эритроцит-, цилиндрурии и признаку бактериурии в обеих группах больных COVID-19 и пневмонией была высокой - в пределах 37-44% Выводы 1 Возможные признаки острого почечного повреждения и патологического мочевого синдрома были выявлены более чем у 20% пациентов 2 Средний уровень концентрации мочевины в сыворотке крови у больных COVID-19 в возрастной группе старше 60 лет значительно и достоверно превышал значения в группе более молодых больных, что может быть признаком развития воспалительного процесса в легких с более выраженной интоксикацией, в том числе за счет более тяжелого нарушения почечной функции азотовыведения 3 Частота ХПБ III-IV стадии в группе больных COVID-19 более старшего возраста превышает этот показатель в группе больных более молодых возрастов в 4 раза Наиболее существенной причиной развития ХБП III-IV стадии, видимо, является артериальная гипертензия, в 2,7 раза чаще диагностируемая у пациентов в возрасте старше 60 лет

The paper focuses on cytoprotective and additional effects of mildronate. The emphasis is on the latest original research evidence on mildronate effects in the settings of cardiovascular and cerebral ischemia. The authors also describe the latest laboratory data on the new therapeutic potential of mildronate.

To study the rate of chronic glomerulonephritis progression when added by anemia and cardiovascular disease (CVD).231 patients (133 men and 98 women) with predialysis chronic glomerulonephritis (CGN) were examined. The patients' mean age of was 35.8±11.8 years; the disease duration was 1 to 17 years. The disease onset was the date when urinalysis showed evidence of persistent proteinuria and (or) hematuria. Besides, the time when anemia developed and the clinical and instrumental signs of CVD appeared was taken as the initial reference point; the time when end-stage renal failure was diagnosed was taken to be the endpoint. Red blood cell counts with the inclusion of its indices, hemoglobin concentration, hematocrit values, daily proteinuria values, and glomerular filtration rate were analyzed. The biochemical parameters included the concentrations of electrolytes, creatinine, fibrinogen, iron, cholesterol, total protein and C-reactive protein (CRP). Electrocardiography and echocardiography, bicycle ergometry and 24-hour ECG monitoring were used to detect CVD.The presence of anemia and CVD in patients with predialysis CGN versus those without anemia and CVD was associated with an increase in the concentrations of CRP [36.2 and 12.6%; respectively; (p0.05)], creatinine [123.0 (83.2-217.0) and 86.5 (72.0-128.5) µmol/L; (p0.05)] and a decrease in GFR [65.4 (30.8-95.5) and 92.7 (64.5-122.3) ml/min; (p0.05)]. The 8-year survival of patients with CGN concurrent with CVD was noted to be 58% whereas the renal survival in patients with CGN + CVD + anemia was shorter and the 6-year survival in this case was as high as 52%.Anemia and CVD in patients with CGN serve as additional independent factors for the progression of the underlying disease. The concurrence of CGN, anemia, and CVD substantially reduces the predialysis period.Цель исследования. Изучить скорость прогрессирования хронического гломерулонефрита в условиях присоединения анемии и сердечно-сосудистых заболеваний (ССЗ). Материалы и методы. Обследовали 231 пациента (133 мужчин и 98 женщин) с хроническим гломерулонефритом (ХГН) на додиализной стадии заболевания. Средний возраст больных составил 35,8±11,8 года, продолжительность заболевания - от 1 до 17 лет. За начало болезни принимали дату, когда документально в анализах мочи регистрировались стойкая протеинурия и (или) гематурия. Кроме того, за исходную точку отсчета принимали время развития анемии и появления клинико-инструментальных признаков ССЗ, конечную - время диагностирования терминальной стадии почечной недостаточности. Проанализированы количество эритроцитов с оценкой их индексов, концентрация гемоглобина, значения гематокрита, величина суточной протеинурии, скорость клубочковой фильтрации. Биохимические параметры включали исследование концентраций электролитов, креатинина, фибриногена, железа, холестерина, общего белка и С-реактивного белка (СРБ). Для выявления ССЗ применяли электро- и эхокардиографию, велоэргометрическую пробу и суточное мониторирование электрокардиограммы. Результаты. Наличие анемии и ССЗ у больных на додиализной стадии ХГН по сравнению с лицами без анемии и ССЗ ассоциировалось с увеличением концентрации СРБ (36,2% против 12,6%; р0,05), креатинина - 123,0 (83,2; 217,0) мкмоль/л против 86,5 (72,0; 128,5) мкмоль/л (р0,05) и снижением скорости клубочковой фильтрации - 65,4 (30,8; 95,5) мл/мин против 92,7 (64,5; 122,3) мл/мин (р0,05). Отмечено, что 8-летняя выживаемость больных ХГН в сочетании с ССЗ составляет 58%, тогда как показатель выживаемости почек у лиц с ХГН + ССЗ + анемия еще более сокращается, а 6-летняя выживаемость при этом достигает 52%. Заключение. Анемия и ССЗ у пациентов с ХГН служат дополнительными самостоятельными факторами прогрессирования основного заболевания. Сочетание ХГН с анемией и ССЗ существенно сокращает додиализный период.Резюме Цель исследования. Изучить скорость прогрессирования хронического гломерулонефрита в условиях присоединения анемии и сердечно-сосудистых заболеваний (ССЗ). Материалы и методы. Обследовали 231 пациента (133 мужчин и 98 женщин) с хроническим гломерулонефритом (ХГН) на додиализной стадии заболевания. Средний возраст больных составил 35,8±11,8 года, продолжительность заболевания — от 1 до 17 лет. За начало болезни принимали дату, когда документально в анализах мочи регистрировались стойкая протеинурия и (или) гематурия. Кроме того, за исходную точку отсчета принимали время развития анемии и появления клинико-инструментальных признаков ССЗ, конечную — время диагностирования терминальной стадии почечной недостаточности. Проанализированы количество эритроцитов с оценкой их индексов, концентрация гемоглобина, значения гематокрита, величина суточной протеинурии, скорость клубочковой фильтрации. Биохимические параметры включали исследование концентраций электролитов, креатинина, фибриногена, железа, холестерина, общего белка и С-реактивного белка (СРБ). Для выявления ССЗ применяли электро- и эхокардиографию, велоэргометрическую пробу и суточное мониторирование электрокардиограммы. Результаты. Наличие анемии и ССЗ у больных на додиализной стадии ХГН по сравнению с лицами без анемии и ССЗ ассоциировалось с увеличением концентрации СРБ (36,2% против 12,6%; р0,05), креатинина — 123,0 (83,2; 217,0) мкмоль/л против 86,5 (72,0; 128,5) мкмоль/л (р0,05) и снижением скорости клубочковой фильтрации — 65,4 (30,8; 95,5) мл/мин против 92,7 (64,5; 122,3) мл/мин (р0,05). Отмечено, что 8-летняя выживаемость больных ХГН в сочетании с ССЗ составляет 58%, тогда как показатель выживаемости почек у лиц с ХГН + ССЗ + анемия еще более сокращается, а 6-летняя выживаемость при этом достигает 52%. Заключение. Анемия и ССЗ у пациентов с ХГН служат дополнительными самостоятельными факторами прогрессирования основного заболевания. Сочетание ХГН с анемией и ССЗ существенно сокращает додиализный период.

The paper is focused on the importance of Viktor A. Lusov, as well as the department he had been heading for many years, for the Russian cardiology. The biographical information and the data on Professor Lusov’s students and colleagues are presented. The authors emphasise the important role of the clinical school maintained by Viktor A. Lusov — a talented doctor, scientist, leader, and teacher.

Aim. To assess the association between the changes in heart rate variability (HRV) and hemostatic parameters in patients with coronary heart disease (CHD) and chronic heart failure (CHF) as its complication. Material and methods. In total, 65 patients were examined at theO.M.FilatovCityClinicalHospital No. 15. The main group included 51 patients with CHD and CHF (35 men, 16 women; mean age 62Ѓ}6 years). The control group included 14 CHD-free patients with arterial hypertension (7 men, 7 women; mean age 56Ѓ}7 years). The examination included standard methods, plus the assessment of HRV and a wide range of coagulogram parameters. Results. CHD patients with CHF demonstrated the hyperactivation of sympathetic nervous system, which was manifested in increased LF/HF (up to 2,5 U), together with the suppression of parasympathetic activity (SDNNi decrease up to 39,1 ms; p2,0 U), protrombin time was reduced by 10,9%, while hematocrit was increased by 10,2%. In patients with elevated spontaneous platelet aggregation, increased sympathetic tone during nighttime was manifested in the reduction of mean cardiac interval duration (893,1Ѓ}111,5 ms vs. 982,7Ѓ}66,7 ms; p2,0) was associated with a significant reduction (–20%) in ADP-induced platelet aggregation. Conclusion. Chronic pathological sympathetic hyperactivation in patients with CHD and CHF affects hemocoagulation parameters. Increased spontaneous platelet aggregation, reduced protrombin time, and elevated hematocrit, together with catecholamine-induced vasospasm, might increase the risk of thrombotic complications.

Aim. To study the effects of taurine therapy on the occurrence of cardiac arrhythmias and QT interval dispersion (dQT) among patients with postinfarction cardiosclerosis (PICS) and subsequent chronic heart failure (CHF). Material and methods. The study included 40 patients with previous myocardial infarction (MI), left ventricular ejection fraction (LVEF) Results. In PICS patients with CHF, taurine demonstrated beneficial effects on the dynamics of dQT and cardiac arrhythmia occurrence. Conclusion. Taurine could be included in the complex treatment of PICS patients with FC II-III CHF.

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

An investigation was made on 38 patients affected by exertion angina pectoris of the I-III functional classes. The patients survived a Q-associated myocardial infarction not earlier than 1 year ago. The patients were treated according to a 10-session course of laser infrared therapy. The dynamics of several hemorheological indices (such as blood viscosity, the hematocrit of venous blood, fibrinogen, fibronectine, thrombocyte aggregation, antithrombin III, and the activated partial thrombplastin time) was estimated prior to the treatment, 5 - 7 days after the beginning of laser therapy, and 30 days after the beginning of laser therapy treatment. It was found that laser therapy was capable of producing a significant decrease in the blood viscosity, fibrinogen level, and in the aggregation of thrombocytes. Moreover, laser infrared therapy carried out on patients affected by post-infarction cardiosclerosis and by stable exertion stenocardia of the I-III functional classes produced a reliable normalization of hemorheological indices of the blood.

AIM To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach). MATERIALS AND METHODS We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0. RESULTS The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%. CONCLUSION The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.