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The problem of comorbidity becomes especially relevant in the conditions of demographic aging of the population. In recent years the number of studies devoted to diagnostic and treatment features of comorbidities, especially in elderly and senile patients, has increased. In spite of this fact, until now there are no clear recommendations for the management of comorbidities in the therapeutic practice.The article is devoted to the presentation and discussion of a clinical case of a comorbid patient with arterial hypertension. The stages of the performed diagnostic search with verification of the clinical diagnosis and the tactics of the prescribed pharmacotherapy are presented. On the basis of the presented data it is shown that exacerbation of one of the chronic diseases of the patient’s general comorbid background may significantly increase the severity of the general pathology and in its turn will determine the prognosis and influence the treatment tactics. The complexity of this case is that the patient has chronic single kidney disease in the stage of chronic renal failure. In analysing this case, it is also important to note the difficulties in the choice of drug therapy, as this situation poses significant limitations in the use of many drugs. This is a challenge that every clinician faces on a daily basis, regardless of clinical experience and medical knowledge. Only a multilevel approach will enable comprehensive medical and social care to be organised for patients with co-morbidities with chronic diseases, provide follow-up not only during exacerbations but also during remissions, contribute to the prevention of exacerbations and complications, which will consequently improve prognosis and quality of life.

Introduction. The problem of gastric ulcer is of particular socio-economic importance and has a tremendous impact on the quality of life of people. The relevance of our study is due to an increase in the incidence of peptic ulcer in the population, the variability of the clinical picture depending on the age category of patients, and the peculiarities of the treatment of this gastrointestinal pathology.The aim of the study is to study the features of the course of gastric ulcer in different age groups of patients under dispensary supervision in the outpatient department of the State Budgetary Healthcare Institution of the Republic of Moldova “Republican Clinical Hospital No. 5” in the period from 2017 to 2020.Materials and methods. A retrospective analysis of outpatient records of 100 patients of different age groups with gastric ulcer who were under dispensary observation at the outpatient clinic of the Republican Clinical Hospital No. 5 in Saransk in 2017– 2020 was carried out. Statistical analysis of the data obtained was carried out using the Microsoft Office Excel program.Results and discussion. It was found that gastric ulcer is more often observed in middle-aged and elderly patients and is accompanied by blurring of the clinical picture of the disease, in contrast to young people, who have vivid clinical manifestations of this disease. Ulcerative defects in young and middle-aged patients are more often small in size and are located mainly in the area of the stomach angle, and in elderly and senile patients, ulcers are localized mainly in the cardiac region, can be gigantic and often lead to the development of complications (primarily gastrointestinal intestinal bleeding).Conclusions. The blurring of the clinical picture, the absence of pathognomonic symptoms in elderly patients determine the late diagnosis of gastric ulcer, which ultimately leads to a high incidence of complications requiring surgical intervention. In clinical practice, it is necessary to take into account these features of the course of peptic ulcer disease in elderly patients and to prescribe the necessary complex of laboratory and instrumental studies and preventive therapy in a timely manner.

Our study was aimed at assessing a relationship between immune system alterations, hypoxia and inflammation in arterial hypertension (AH) coupled to metabolic disturbances. A total of 117 patients were enrolled into clinical study, having been randomized into groups in accordance with study protocol, aged 30 to 62 years. They sought care in outpatient setting or underwent periodic health examination at the Republican Clinical Hospital №5, Saransk, Mordovia, Russia. A control group contained 25 apparently healthy subjects lacking signs of metabolic syndrome (MS) and elevated arterial pressure. A comparison group contained 47 patients with AH grade I-II featured with damaged target organs, but lacking associated relevant clinical manifestations, as based on the assay data. The main group contained 45 patients receiving antihypertensive therapy with overt AH grade I-II verified upon medical consultation coupled to damaged target organs and MS signs with its randomly combined components, but lacking associated clinical manifestations. The patients from main and comparison groups received antihypertensive therapy in accordance with approved guidelines and clinical recommendations for management of AH patients consisting of one of renin-angiotensin-aldosterone system blockers, diuretic and/or dihydropyridine calcium channel blocker. Cytokine profile, level of hypoxia and non-specific inflammation were measured in blood serum. The data obtained demonstrated that AH patients with/without metabolic syndrome were noted to display cytokine profile shifted towards elevated proand anti-inflammatory immune arm pointing at imbalanced immune regulation. Hypoxic changes were also found in blood serum that was confirmed by elevated level of lactic and pyruvic acid in these groups. Moreover, development of such pathology was coupled to hypoxia which served as a modulator of immune-related and non-specific inflammation. Rise of non-specific low-grade inflammation correlates developing irreversible AH-associated changes in organs, progression of atherosclerosis and accelerated cardio-metabolic continuum. Altogether, such alterations underlie pathogenetic mechanisms of tissue damage emerging upon AH and MS being mutually aggravating factor along with activated renin-angiotensin-aldosterone system.

Mortality from diseases of the circulatory system is a challenge for the modern health care. Arterial hypertension (AH) mostly contributes to development of cardiovascular complications. It often proceeds against the background of metabolic disorders. Pathogenesis of hypertension is currently being considered a multifactorial disease. Pathogenesis of hypertension certainly has distinct features in presence of metabolic disorders,. Therefore, it is relevant to summarize current literature on the role of immunological disorders, endothelial dysfunction and hemostatic disorders in AH genesis during metabolic syndrome (MS). Most authors agree with existence of several mechanisms that determine relationships between AH and insulin resistance. Development of hypertension in MS patients with is a consequence of immunometabolic processes. Abdominal obesity is an important component of MS. It is associated with chronic inflammation of visceral adipose tissue, its excessive infiltration by immune cells, and increased production of adipokines and cytokines (TNFα, IL-6) with hypertension. AH is associated with a significant increase in T cells, that mediate endothelial dysfunction (ED) and provide a link between hypertension and subsequent atherosclerosis. T lymphocytes trigger a cascade of reactions. IL-17 is the end product of these events It is involved not only in increasing blood pressure, but also contributes to the development of vascular wall stiffness in АН patients. Thus, the relationship between several types of immune cells leads to inflammatory reactions, including those of vascular wall, initiating endothelial dysfunction. Chronic non-specific inflammation in MS, supported by the cytokine system, is a triggering mechanism for ED progression. Excessive production of endothelin-1 and inhibition of nitric oxide production are the classic markers of ED. Immune damage leads to imbalance in the production of vasoconstrictor and vasodilating substances, proliferative and antiproliferative factors in endothelium. It was shown that ED is an integral aspect of the insulin resistance syndrome in pathogenesis of arterial hypertension associated with metabolic disorders, and contributes to its worsening, increased vascular reactivity and further AH development. According to modern studies, it has been shown that excessive synthesis of pro-inflammatory cytokines introduces disturbances in the system of vascular hemostasis. When studying the effects of metabolic disorders upon hemostatic system, we may conclude that activation of fibrinolytic and plasma chains occurs in the same way for both men and women, with small gender characteristics of individual components. The rheological properties of the blood are also changed with developing MS. Systematization of the available literature data on the issue under study can serve as a basis for determining prognostic criteria of hypertension progression and risk of thrombotic complications.

Goal. To identify key links in the pathogenesis of toxic myocardiopathy in conditions of endogenous intoxication in peritonitis. Materials and methods. Experimental studies were carried out on dogs (n = 24). The model of purulent fecal peritonitis. We studied the run-time content of toxic products in blood plasma, the lipid composition, the intensity of lipid peroxidation, the activity of phospholipase A2 and superoxide dismutase, and hypoxia of myocardial tissue. We evaluated loss of water and proteins, electrogenesis of the myocardium cells and changes in the ECG parameters. We also performed histological examination of the myocardial tissue. Results. Experimental studies in dogs showed that the development of endotoxicosis of peritoneal origin is accompanied by significant metabolic disorders and cardiac malfunction leading to the development of myocardiopathy. The most important role in the development and progression of myocardial damage in endotoxicosis is played by biomembrane damage and disruption of associated processes. The main processes are quantitative and qualitative modifications of phospholipids in cardiac cell membranes. Conclusion. The obtained data demonstrate the key role of the interrelation between dyslipidemia in the investigated cellular structures and intensification of lipid peroxidation, an increase in phospholipase A 2 activity, and hypoxia; which confirms the significance of these processes in destabilization of the phospholipid matrix of biomembranes.

The aim of present work was to assess the role of immunological disorders, hypoxia and lipoperoxidation in development and progression of erosive/ulcerative lesions of duodenum accompanied by chronic cerebrovascular insufficiency. We have studied a cohort of 125 patients with erosive and ulcerative lesions of duodenum associated with chronic disorders of cerebral circulation, aged from 48 to 74 years old. They underwent outpatient treatment and care at the Clinical Hospital No.5 (Saransk) over 2015-2018. A comparison group consisted of 39 patients with chronically impaired cerebral circulation, who did not show signs of erosive/ulcerative lesions of stomach and duodenum over the study period. Patients received conventional anti-ulcer therapies for 14 days. The cytokine profile, indexes of hypoxia, and serum markers of lipid peroxidation were evaluated. The study has shown an increase in the level of pro-and anti-inflammatory cytokines in cases with erosive/ ulcerative duodenal lesions associated with chronic impairment of cerebral circulation throughout the observation period, thus indicating to evolving imbalance of immunoregulatory system. The development of hypoxic changes in the blood plasma was observed, which was confirmed by increased contents of lactic and pyruvic acids, like as the hypoxia coefficient at all the observation terms. The lipid peroxidation processes were also activated in the course of evolving disorder, as judged by increased contents of diene conjugates, triene conjugates and the malonic dialdehyde levels upon admission, as well as on day 7 and 14 of observation, associated with decrease in the antioxidant potential of blood plasma, estimated by the superoxide dismutase index. A trend for a decrease in the indexes of diene conjugates, triene conjugates, malonic dialdehyde and an increased levels of superoxide dismutase was registered as late as after 30 days of observation. Hypoxia and lipid peroxidation may be viewed as predictors of chronic inflammation. Developing imbalance between pro-inflammatory, anti-inflammatory cytokines, and chronic hypoxia are of significant value for pathogenesis of erosive-ulcerative lesions of duodenum, being associated with chronic impairment of cerebral circulation. Under such conditions, oxidative stress is observed, with a shift of equilibrium towards pro-oxidants, along with exhausted potential of antioxidant defense system. In general, these disturbances determine the pathogenetic mechanisms of damage that occur in erosive and ulcerative lesions of duodenum, being associated with chronic cerebrovascular insufficiency, which have a mutually negative influence in the course of disease progression.

The clinical study enrolled 120 patients, who were hospitalized to the Therapeutic Department of Republican Clinical Hospital No. 5 of Saransk. The patients were divided into 2 groups: Group I (n = 60) included patients with metabolic syndrome; Group II (n = 60) included patients with arterial hypertension. The paper presents data on the assessment of the functional state of kidneys in the analysed groups, defines the role of metabolic disorders in the progression of renal dysfunction in patients with metabolic syndrome and arterial hypertension. It is noted that more pronounced functional changes in the kidneys (microalbuminuria, increased cystatin C levels, decreased glomerular filtration rate) are detected in patients with arterial hypertension and metabolic syndrome, as compared with patients without metabolic disorders. Cystatin C and microalbuminuria have been shown to be one of the earliest markers of kidney damage in hypertension, especially in combination with metabolic disorders. Cystatin C and microalbuminuria level is significantly higher in patients with arterial hypertension and metabolic syndrome, as compared with patients with arterial hypertension, who have no metabolic disorders. Significant correlations were found between cystatin C, microalbuminuria levels and lipid and carbohydrate metabolism in patients with arterial hypertension in combination with metabolic disorders.

OBJECTIVE. The authors developed the integral criterion of prediction of endogenous intoxication in acute peritonitis based on evaluation of homeostatic disorders in blood plasma. MATERIAL AND METHODS. The patients (42) with peritonitis of moderate severity aged from 20 to 59 years old were examined. Calculation of prediction index of endogeneous intoxication using the proposed formula was made. RESULTS. Given clinical and laboratory data showed that the severity of peritonitis was caused by endogeneous intoxication, which was associated with intensification of lipid peroxidation process. The proposed index of prediction of endogenous intoxication allowed doctors to perform an accurate and adequate prevention of the possibility of endogeneous intoxication progress in acute pancreatitis. CONCLUSIONS. There was demonstrated the high efficacy of new integral criterion of prediction of endogeneous intoxication in acute peritonitis.

Cardiovascular disease (CVD) is an urgent problem of world and national medicine. The leading place among this pathology belongs to arterial hypertension (AH). The prognosis becomes even more unfavorable when combined with AH metabolic disorders. The number of patients with metabolic syndrome (MS) is projected to exceed 500 million by 2025. In patients with MS, the frequency of sudden death and CVD increases 2-4 times, the risk of coronary heart disease is 3-4 times higher, and the risk of ischemic stroke is 2 times higher. The risk of formation of type 2 diabetes increases 5-9 times. AH is one of the components of MS and is observed in more than half of patients. Target organs in such patients are affected much earlier and their changes are much more pronounced than in patients with hypertension without MS. We set a goal to study the effectiveness of treatment of arterial hypertension in patients with metabolic syndrome who were on inpatient treatment in the therapeutic Department of GBUZ RM «Republican clinical hospital №5» in Saransk in 2017-2018.